Minutes of the Health Commission Meeting Tuesday, March 17, 1998 3:00 p.m. 101 Grove Street, Room #300 San Francisco, CA 94102 1) CALL TO ORDER The regular meeting of the Health Commission was called to order by President Lee Ann Monfredini,  at 3:05 p.m. Present: Commissioner Debra A. Barnes Commissioner Edward A. Chow, M.D. Commissioner Roma P. Guy, M.S.W. Commissioner Ron Hill Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner David J. Sanchez, Jr., Ph.D. 1) CALL TO ORDER 2) APPROVAL OF MINUTES OF THE MEETING OF MARCH 3, 1998 Action Taken: The Commission unanimously adopted the minutes of March 3, 1998. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner David J. Sanchez, Jr., Ph.D.) (3.1)PH-CHS-CSAS - Status report on Bay Area Addiction Research and Treatment, Inc.'s compliance to the Health Commission's Policy on Board Composition.  Commissioner Barnes expressed that she was pleased with the progress of the contractor.  (3.2) DPH - Presentation and consideration of the Department-wide Capital Projects for  FY 1998-99 in the amount of $19 million.  (3.3) CHN - SFGH - Consideration of a proposed lease amendment for the General Clinical Research Center (GCRC) at San Francisco General Hospital.  Commissioner Sanchez abstained on this item due to conflict of interest.  (3.4) CHN-LHH - Approval of acceptance of a gift of stocks, valued at $178,000, to Laguna Honda Hospital from the Barbara Wylie Trust.  (3.5) Central Administration - Policy & Planning - Approval of a new contract with The Pacific Health Policy Group, in the amount of $119,695, to provide consultant services for the 1115 Waiver Development Project, for the period of April 1, 1998 through March 31, 1999.  (3.6) PH-CHS-CMHS - Retroactive approval of a new contract with Davis Y. Ja and Associates, Inc. (D.Y. Ja), in the amount of $173,320, for a research project for the period of January 1, 1998 through June 30, 2000. (DPH contracted with D.Y. Ja for services totaling $53,000 during  FY 1996-97).  (3.7) PH-CHS-CSAS - Retroactive emergency contract and sole source approval with Chemical Awareness and Treatment Services, Inc. (CATS), up to the amount of $749,279, to provide overnight shelter and support services to homeless residents of San Francisco for the period of March 1, 1998 through May 31, 1998. (DPH contracted with CATS for services totaling $2,566,823 during FY 1996-97).  This item was deferred to Item #9 on the agenda. Action Taken: The Commission unanimously approved the Consent Calendar of the Budget Committee, except for #3.7, which was deferred to Item #9 on the agenda. Commissioner Sanchez abstained on #3.3. President Monfredini acknowledged today's swearing-in by the Mayor of Commissioner Chow's reappointment to the Commission. ADMINISTRATION W. K. Kellogg Foundation Initiative The W. K. Kellogg Foundation announced that it was launching a major new initiative with the goal to develop improved models for safety net providers. The San Francisco Department of Public Health and the University of California at San Francisco were sent a request for qualification to apply for the initiative. The Foundation anticipates awarding 10 five-year project grants, ranging in value from $2.5 to $5 million. DPH, working in collaboration with the UCSF and the San Francisco Community Clinic Consortium (SFCCC), submitted a proposal in response to the request for qualifications. Dr. Andrew Bindman, head of the San Francisco General Hospital Primary Care Research Group, took the lead on preparing the proposal. DPH and the SFCCC wrote sections of the proposal. We highlighted five areas where we thought San Francisco safety net providers could improve services to vulnerable population groups. The areas were: Improvement in the medical information systems . In particular, given the large investment that DPH has made in its MIS system, for a relatively small additional allocation we could create links between the CHN and the SFCCC. Also by improving our capacity to perform population-based analysis, we can learn more about the cost and outcomes of the care we provide. Focus on primary and preventive care strategies . The Department's proposal highlighted two current projects that are working to increase the use of primary and preventive care: the APPROACH project and the Emergency Department case management program. In our response we said we would look at additional ways that we could improve our application of primary care and case management throughout the CHN and the SFCCC. Community outreach . Here we proposed expanding models of community mobilization and community empowerment to address important health care issues in San Francisco. We cited the example of our work with the Bayview Hunter's Point Task Force and the Bridges Project as two examples of the importance of these community safety net collaborations. Training . Use of the Kellogg Foundation resources would allow providers throughout the CHN and the SFCCC to participate in a broader training mission. Improved Planning . We proposed further planning to make the safety net sites more accessible to clients. The Kellogg Foundation required a three week turn-around for response to the request for qualification. I am happy to report that, based on our submission, the Kellogg Foundation has said they would make a formal site visit to San Francisco the first week of April. If, based on the site visit, they are interested in funding us we will bring a formal request to apply for and accept funds to the Health Commission for approval. This initiative is very exciting in that it offers potential financial support for strengthening our safety net providers in San Francisco. PUBLIC HEALTH Contractor Merit Awards In July 1997, the Board of Supervisors appropriated $1 million to the Department of Public Health budget to provide one-time, merit-based incentive grants to DPH contractors. These awards were designed to acknowledge excellence and to provide incentives for continued high performance and compliance with Health Commission and City and County of San Francisco policies.  I am pleased to inform the Commission that the performance-based merit awards were sent out early this month. Performance was measured by the organization's past accomplishments of objectives, client satisfaction, quality and quantity of work performed, timeliness of reports, quality assurance, and staff and board demographics. Public Health Division-wide Meeting The Public Health Division held its first annual staff meeting at Civic Auditorium March 2nd. Offices remained open and programs continued operation with a skeletal staff. Over 600 Public Health staff attended the forum which focused on an overview of the organization of the Public Health Division and an update on the programs within its various branches.  The session opened with a slide show featuring Public Health Division staff accompanied by a Charlie Parker soundtrack. The goal of the two-hour meeting was to foster communication and discussion of public health issues within the Division. The new Public Health Division has also produced a newsletter, News & Views, and has created the Urban Health Seminar series. A dedicated group of staff, led by Jessica Wolin, are to be congratulated for organizing this successful event. 1998 Women Making History I am pleased to announce that Barbara Garcia, Director, Community Substance Abuse Services, and Cynthia Selmar, Director, Southeast Health Center, are recipients of the "1998 Women Making History , Women's Health Award." The reception on March 24 will be held at California Historical Society. COMMUNITY HEALTH NETWORK Black History Month On February 26, Maxine Hall Health Center commemorated Black History Month with an Open House. The event was attended by more than 100 community residents and health center clients. Highlights of the program included: two African American vocalists who live in the community; poetry recitations by two poets who are health center clients; a poetry recitation by a nine year old African American community resident; a quilting display by a health center client; and, a display of handmade ethnic jewelry by another health center client. All who attended were inspired by this celebration of health and art in the African American community. Resignation It is with regret that I announce the resignation of Kate Favetti, Senior Personnel Officer at San Francisco General Hospital. Kate accepted the position of Executive Officer of the Civil Service Commission. She began her new job yesterday, I am sure you join me in wishing her well.  SFGH Trauma Center Pediatric Resuscitation Room Opens The Trauma Center at SFGH is pleased to announce the grand opening of the new Pediatric Trauma Resuscitation Room on March 12, 1998. The new Trauma Room was made possible by a generous gift of the Rhoda Goldman Foundation and becomes the fourth trauma resuscitation room located in the SFGH Emergency Department. The design and development of the room was a collaborative effort involving the SFGH Foundation, Drs. Margaret Knudson and Ron Dieckmann, and ED Chief Nurse John Fazio. An opening celebration was attended by members of the SFGH Foundation, Dr. Douglas Goldman, Trauma Center Physicians and staff, Emergency Department physicians and staff, and an eleven year old former trauma center patient and her mother.  Over 200 children a year who require the specialized care available at a Level 1 Trauma Center are admitted to the SFGH Trauma Service. While the focus of the Pediatric Trauma room is on care and treatment of children with life-threatening injuries, the Center was designed as a multipurpose area. The room is also used to care for adult trauma victims and for children requiring conscious sedation during extended emergency treatments. Metropolitan Medical Strike Team [MMST] SFGH will be hosting the United States Department of Defense biochemical and hazardous materials exposure training for health care workers March 30 to April 2. Ann Stangby, RN, SFGH Base Hospital Coordinator, is directing SFGH's participation in this program and is co-chairing the MMST Hospital Task Force.  This training is part of the nationwide effort to provide specialized training to EMS and acute care hospital personnel in 27 cities throughout the U.S. The course content will include rapid response, decontamination and emergency treatment for victims of weapons of mass destruction. The program is specifically designed as a "train-the-trainers" model. Program participants from SFGH, SFFD EMS, community hospitals within San Francisco, San Francisco International Airport Medical Clinic, and the EMSA will then be expected to return to their home department to provide education and training to colleagues. This training is part of a larger weapons of mass destruction readiness program being funded by a grant awarded to Dr. John Brown, EMSA Medical Director. President Monfredini and Commissioner Barnes indicated their willingness to participate in the site visit from the Kellogg Foundation. February statistics are available in the Commission Office. Jessica Wolin, Senior Health Planner, reported the following: During this week, the Department of Public Health will build upon the National Public Health Week theme of "Healthy People in Healthy Communities." We plan to release two reports: the executive Summary of the "San Francisco Mortality Report", and a brief paper entitled "How Healthy is San Francisco?: The Department of Public Health Gives San Francisco A Checkup.' In the early fall, a synopsis of the Mortality Report was presented to the Health Commission and a review of the final report will be possible in the future. The report will be an analysis of all deaths in San Francisco from 1990 to 1995 broken down by age, sex, race and zip code. In addition, this report links causes of death with their underlying risk factors or determinants. The Mortality Report is the most comprehensive report of the City's health that has ever been undertaken. The Executive Summary will provide the most important information in a format that is easily understood. In addition, the Department will release "How Healthy is San Francisco?: The Department of Public Health Gives San Francisco A Check-Up. In this user-friendly paper, the Department will highlight key statistics and information that indicate the public health status of our city. We will take a broad view as we define "public health status." What determines if we are a healthy community are many factors not traditionally thought of as health indicators, such as social issues, economics and the environment. It is our hope that by drawing together information about the City and County of San Francisco that illustrates our public health status in a manner that is accessible to the public and the media, we can bring attention to the myriad of issues that affect our community's well being. In honor of Public Health Week, the Department will distribute these reports to community members, other organizations, and City Department, to raise awareness about public health. Furthermore, we will do extensive outreach to the media to encourage them to focus on public health issues during the week of April 6, 1998. Commissioner Barnes encouraged a photo opportunity with the Mayor to publicize Public Health Week. Commissioner Guy suggested having an editorial in the S.F. Chronicle or S.F. Examiner. Action Taken: The Commission unanimously adopted Resolution #11-98, "Requesting the Mayor and the Board of Supervisors to Proclaim April 6-12, 1998, Public Health Week, in the City and County of San Francisco," (Attachment A). 6) CONSIDERATION OF A RESOLUTION SUPPORTING THE CONCEPT OF A CITY AND COUNTY OMBUDSPROGRAM TO ADVOCATE FOR HEALTH CARE CONSUMERS Dr. Mitch Katz, Director of Health, reported that the Board of Supervisors, under the leadership of Supervisor Amos Brown, is drafting legislation that would create a countywide ombudsprogram. The program would provide consumer education, outreach, advocacy and direct assistance to Medi-Cal recipients in San Francisco. The Health Department maintains ombudsprograms at San Francisco General Hospital and at Laguna Honda Hospital. This new program would, however, serve all medical recipients, regardless of where they are currently receiving services. The establishment of an ombudsprogram is consistent with the Consumer Bill of Rights and Responsibilities established by the Presidential Advisory Commission on Consumer Protection and Quality in the Health Care Industry. A letter of support for a countywide ombudsprogram was submitted to the Commission by Supervisor Amos Brown. Public Speakers: Frederick Hobson, Consumer Board member, S.F. Health Authority Howard Wallace, Health Care worker, Local 250 Maria Luz Torre, Parent Voices Patricia Bruno, Medi-Cal Community Assistance Project Shirley A. Bierly, President, California Legislative Council for Older Americans Michael Lighty, California Nurses Association Mr. Hobson clarified that this program will start with Medi-Cal recipients and then expand to all consumers. The Commission encouraged the Department to have its staff liaison with this program. Action Taken: The Commission unanimously adopted Resolution #12-98,  "Supporting the Concept of a City and County Ombudsprogram to Advocate for Health Care Consumers," (Attachment B). 7) PRESENTATION AND CONSIDERATION OF A RESOLUTION ENDORSING A RESPONSE TO THE BOARD OF SUPERVISORS HEALTH, FAMILY, AND THE ENVIRONMENT COMMITTEE'S REQUEST TO SUBMIT A PROPOSAL TO ADDRESS ASTHMA, BREAST AND CERVICAL CANCER, AND PROSTATE CANCER IN BAYVIEW HUNTERS POINT Dr. Bob Prentice, Director of Public Health Division, as background information, reported that a town hall meeting organized under the auspices of the Bayview Hunters Point Health and Environmental Assessment Project (BVHP-HEAP) resulted in hearings before the Health Commission and the Board of Supervisors to review findings related to health problems in Bayview Hunters Point. The Health, Family and the Environment Committee of the Board of Supervisors asked the members of BVHP-HEAP and other community groups and individuals to return with specific proposals to address the identified problems of asthma and breast, cervical and prostate cancer, with the understanding that these are only initial programmatic responses that will serve as a foundation to build from over time. The attached budget and narrative are the result of a collaborative community process that reflects hours of discussion and review among community representatives, members of a variety of public and nonprofit organizations and Health Department staff. The process not only brought together groups that had not worked together before, but even encouraged some to set aside historical tensions in order to achieve a higher goal. Dr. Prentice introduced Karen Pierce, the new Project Coordinator of the Bayview Hunters Point Health and Environmental Assessment Project, who presented a proposal (Attachment C), which is a multiyear program that the community feels it needs. Other members of the Project presented. Marie Hoemke, member of the Asthma Task Force, presented the asthma portion of the proposal. Kathy Sommers presented the breast and cervical cancer portion of the proposal. Cynthia Selmar, Director of Southeast Health Center and member of the Project, reported that a detailed workplan is underway. Commissioner Parker, as a provider in the Bayview Hunters Point community and acknowledging the historical neglect in the community, stated that this is an opportunity to welcome this challenge and move forward to address these health issues. Commissioner Parker commended the Board of Supervisors in designating this project as a priority. Public Speakers: Dee Epps-Miller, BVHP Healthy Start Collaborative Gloria Thornton, S.F. Health Plan Ena Aguirre, resident of BVHP Nathan Nayman, Hospital Council Ray Thompkins, BVHP Task Force Francine Carter, resident, BVHP Task Force President Monfredini announced that even though Commissioner Barnes had to leave, Commissioner Barnes is in support of the proposal. President Monfredini thanked everyone who testified. She noted that the Task Force has completed this phase and encouraged the members to step back, look at the larger goal, and look to your professionals. She commended the Task Force for its commitment and hard work to come to this point. Action Taken: The Commission unanimously adopted Resolution #13-98,  "Endorsing a Response to a Request from the Health, Family and the Environment Committee of the Board of Supervisors to Submit a Proposal to Address the Problems of Asthma and Breast, Cervical and Prostate Cancer in the Bayview Hunters Point Community," (Attachment D). Dr. Katz reported that Supervisor Bierman will hold another hearing in April at the Health, Family, and Environment Committee. She is working on a resolution upon recommendations from the Commission. 8)STATUS REPORT ON THE EMERGENCY MEDICAL SERVICES (EMS) RECONFIGURATION PLAN Dr. John Brown, Medical Director for EMS Agency, introduced the second quarterly report (October-December 1997) of the San Francisco Fire Department, EMS Division, with the following: The Fire Department has accomplished several important milestones in the merger process, including the deployment of the paramedic ambulances to fire stations and the electronic linkage of the Fire and EMS Dispatch functions. While response times have not yet decreased, the changes in staffing and deployment strategies occurred late in the quarter and it is too early to see the benefit of these changes. Moreover, call volume has been affected by various factors, including a high hospital diversion rate, which results in longer transport times. I believe we are on tract with the implementation of the Phase II EMS Plan as amended. We anticipate that Local 798 labor negotiations will conclude soon and we will have full implementation of the new ambulance deployment strategy. Rich Shortall, EMP-P, EMS Chief of the Fire Department, and Dr. S. Marshal Isaacs, EMS Medical Director, provided an update on the status of changes in the delivery of emergency medical services. For a copy of the full report, contact the Commission Office (554-2666). The following areas were covered: Station Deployment/Paramedic Captains Combined Communication Center Medical Direction Quality/Risk Management Training Multicasualty Incidents/Special Events Response Times Additionally, they presented the following addendum: On February 21, 154 paramedics officially became H-1 Fire-Rescue Paramedics and began 24-hour shift assignments at 16 strategic Fire Stations throughout the City. The Department's ability to staff 16 paramedic ambulances 24-hours each day is the first significant step towards the goal of improving ambulance response times and the overall delivery of emergency medical care to San Francisco residents and visitors. We have begun to monitor the number of emergency calls that each ambulance is dispatched to during a given 24-hour period. We specifically review the number of times an ambulance is dispatched during the final 7 hours of the shift. It is our ultimate goal to distribute the EMS workload as evenly as possible given our EMS resources, in order to meet response time standards without creating an unreasonable workload for our EMS providers. Toward this end, the first meeting of a joint Labor/Management Committee to review workload and its potential impact on the quality of care delivered has been held. This committee will meet on a regular basis.  Consistent with the trends noted during the second quarter, we continue to note an increase in requests for emergency medical service. The dispatch center reports an average of 210 ambulance dispatches per day. This is a significant increase over the 160 EMS dispatches that had been historically reported. In addition to factors already discussed, the heaviest rains ever reported in the Bay Area certainly contributed to the increase in EMS call volume. We are currently analyzing response time data for this period in preparation for the next quarterly report. Commissioners' Comments: There needs to be careful analysis of data to determine the cause of the increased EMS call volume. Demographic data of the population is needed. The time of day and specific neighborhoods could be factors. The merger process on the whole has been positive, with the present problems being minor. Personnel issues were the most important and were the biggest hurdles. Staff was encouraged to approach major foundations to do a comprehensive study for quality data. The integration process has been successful. Concern was expressed for Local 790. President Monfredini thanked the Fire Department staff for the quarterly report and will look forward to the next report. 9) PRESENTATION AND DISCUSSION ON THE EMERGENCY SHELTER PROGRAM AND POTENTIAL POLICY IMPLICATIONS Note: This item was presented prior to the Director's Report. (Agenda item #4). Dr. Mitch Katz, Director of Health, gave a report of the 1998 Emergency Shelter Program (Attachment E), with an overview of the potential policy implications raised by the emergency shelters. Dr. Katz raised issues of the impact on warehousing of the homeless, security concerns, public health issues (i.e., TB, lice, scabies, gastrointestinal problems), and the site not being available for long-term use. He emphasized that up to now there has been minimal negative impact from these factors. Dr. Katz reported that after taking into consideration the Commissioners' concerns and after gathering data, the Department will come back to the Commission with a proposed policy regarding the emergency shelter. He emphasized that the emergency shelter should be seen as a first step towards permanent housing. President Monfredini stated the Department would target April 21, 1998 to bring any policy issues to the Commission. Commissioners' Comments: Although the emergency shelter is not a permanent solution, keep the shelter open as long as monies are available. The shelter should be a year-round commitment with a plan to have permanent housing for the future. Homelessness should be looked at by other Departments; not sure this Commission is the body to make the decision on the emergency shelter. Permanent housing, not just warehousing of the homeless, should be developed. Dialogue on the issues is welcomed. Data collection is needed for analysis. Dialogue with the community and staff prior to any decision is needed. Homeless crisis is on-going and is separate from a natural (El Niņo) crisis. There is a need to study the constituency. The emergency shelter is a half solution; and yet, the City cannot wait for permanent housing. (3.7) PH-CHS-CSAS - Retroactive emergency contract and sole source approval with Chemical Awareness and Treatment Services, Inc. (CATS), up to the amount of $749,279, to provide overnight shelter and support services to homeless residents of San Francisco for the period of March 1, 1998 through May 31, 1998. (DPH contracted with CATS for services totaling $2,566,823 during FY 1996-97). Commissioner Guy raised the concern about the impact of this emergency contract on the contractor's existing programs and its Board of Directors. Action Taken:The Commission unanimously approved the emergency contract. None. The meeting was adjourned at 6:00 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission