Minutes of the Health Commission Meeting Tuesday, April 20, 1999, 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 3:04 p.m. Present: Commissioner Edward A. Chow, M.D. Commissioner Roma P. Guy, M.S.W. Commissioner Ron Hill Commissioner Lee Ann MonfrediniCommissioner Harrison Parker, Sr., D.D.S. Absent: Commissioner David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. 2) APPROVAL OF MINUTES OF THE REGULAR MEETING OF APRIL 6, 1999 Action Taken: The Commission unanimously adopted the minutes of April 6, 1999 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) UI: Monique Zmuda, Chief Financial Officer, provided an update on the implementation of the amended Policy #24. She described a transition period and a schedule of trainings. The Department will develop a standardized way of reporting compliance to Policy #24. PHP-HIV Prevention Services – Request for approval of a retroactive renewal contract with the Regents of the University of California San Francisco/Urban Health Study, in the amount of $564,263 to provide community-based HIV-prevention services to injection-drug users, for the period of January 1, 1999 through December 31, 1999. (DPH contracted with UCSF for services totaling $14,314,598 during FY 1997-98). (3.2) PHP-Housing – Request for approval of a new contract with the John Stewart Company, in the amount of $864,994 for the provision of property management services at the Windsor Hotel, for the period of May 1, 1999 through June 30, 2000. (3.3) PHP-CMHS – Request for approval of a modification to the contract with St. Mary Pharmacy Management Services (SMPMS) to increase the contract amount by $1,085,775 (for a new total of $2,926,466) and to extend the contract term by three (3) months to provide community-based pharmacy services for the period of July 1, 1998 through September 30, 1999. (DPH contracted with SMPMS for services totaling $1,673,691 during FY 1997-98). (3.4) PHP-CMHS – Request for approval to authorize Community Mental Health Services to enter into a cooperative program agreement with the Department of Rehabilitation, San Francisco District, including a required match of $160,605, to provide vocational services to metal health clients for the period of July 1, 1999 through June 30, 2000. PHP-CMHS-Family Mosaic – Request for approval of a modification to the contract with Catholic Youth Organization (CYO)-St. Vincent’s School for Boys to make new referrals for the provision of sub-acute residential treatment services for the remainder of FY 1998-99 and to utilize the original contract amount of $91,500. (DPH contracted with CYO for services totaling $84,567 during FY 1997-98). Commissioner Hill expressed that he is pleased with the cultural competency report and looks forward to working with the contractor. Commissioner Parker stated that he is impressed with the documents. He asked the contractor whether the Compliance to Policy #24 was burdensome. Brian Cahill, Executive Director of CYO, stated that this is an opportunity for his agency to serve communities of color and high risk youth. (3.6) PHP-CMHS-Children’s Services – Request for retroactive approval for new mental health children’s services contracts and contract modifications for a combined total of $2,040,000 for the period of April 1, 1999 through June 30, 2000, with the following agencies: Children's Council of San Francisco $190,000 (New Contract) Family Service Agency of San Francisco $300,000 (Modification to FY 1998/99 Contract) Homeless Children’s Network $100,000 (Modification to FY 1998/99 Contract) Instituto Familiar de la Raza, Inc. $350,000 (Modification to FY 1998/99 Contract) Jewish Family and Children's Services $400,000 (Modification to FY 1998/99 Contract) Richmond Area Multi Services / Chinatown Child Development Center $400,000 (Modification to FY 1998/99 Contract) San Francisco Psychoanalytic Institute and Society $100,000 (New Contract) Westside Community Mental Health Center $200,000 (Modification to FY 1998/99 Contract) Commissioner Chow suggested the Department request demographics of the contractor’s Board of Directors as part of implementing the newly amended Policy #24. The Department will present a 3-month progress report to the full Commission. Action Taken: The Commission approved the Consent Calendar of the Budget Committee. 4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) (Provides information on activities and operations of the Department). ADMINISTRATION Marijuana for Compassionate Use As the Commission is aware, I recently attended a meeting convened by Board President Tom Ammiano with Attorney General Bill Lockyer, City Attorney Louise Renne, District Attorney Terence Hallinan. The goal of the meeting was to ensure that medicinal marijuana remains available for persons in San Francisco who need it. Attorney General Lockyer confirmed he would respect local jurisdictions in their handling of implementation of Proposition 215 (the Compassionate Use Act of 1996, or the Medical Marijuana Initiative). Given that this Health Commission, the Board of Supervisors and the Mayor have all been supportive of Proposition 215, we foresee no problems with the ongoing functioning of the existing marijuana clubs in San Francisco. Attorney General Lockyer asked that the Health Department prepare a briefing on the type of research that is needed to assess the efficacy of marijuana for a number of medical conditions. In the past, the National Institute of Health has been extremely reluctant to fund well-designed research that could scientifically demonstrate the efficacy of marijuana for a number of conditions. He promised to advocate for increased federal funding of my research. POPULATION HEALTH AND PREVENTION HRSA AIDS Housing Meeting Last Wednesday Marc Trotz and I traveled to Rockville, Maryland, to meet with Health Resources Services Administration (HRSA) representatives concerning potential changes in HIV CARE funding for housing. Essentially, HRSA distributed draft guidelines on housing policy changes that would have potentially restricted the use of CARE funding for permanent housing. The basis of these draft guidelines was the concern that CARE funding was created to meet the health needs of HIV infected persons. Thus, some narrow readings of the CARE Act might suggest that funding for housing should not come from CARE dollars. The San Francisco Health Department, as well as many other agencies involved in HIV/AIDS services in San Francisco, sent strong opposition to this draft policy. The limited and expensive housing market in San Francisco makes it very difficult for HIV infected persons to gain permanent housing. In the absence of housing it is impossible to provide optimal medical care for individuals. I am happy to report that at our meeting we made significant progress with HRSA. I believe that they understand the unique housing shortage in San Francisco and how it impacts on our ability to deliver care to HIV infected persons. Based on the meeting, I believe that the final draft of HRSA’s AIDS Housing Policy will provide us with sufficient flexibility to use our CARE dollars for housing. The San Francisco Immunization Coalition Today I had the pleasure of attending a luncheon meeting of the San Francisco Immunization Coalition. The luncheon was held in honor of National Infant Immunization Week. The new Chair of the San Francisco Immunization Coalition, Dr. Michelle Pepitone, hosted the luncheon. As the Commission is aware, the Coalition, which is staffed by the Department, sponsors a number of important events all year to highlight the importance of immunization of children. COMMUNITY HEALTH NETWORK Jail Health Services Jail Health Services has received a "Certificate of Accreditation" from California Medical Association (CMA) for the provision of medical care and health services in the jails. The announcement was made at the March 26th CMA meeting in Sacramento. DOJ Monitoring Visit at LHH A representative from the Department of Justice concluded a fourth site visit on April 15th. The purpose of this visit was to monitor the Hospital’s progress in responding to issues identified in the May 6, 1998 Findings Letter. We anticipate hearing the results of the monitoring visit within the next few weeks. I will keep the Commission apprised of the status of this important issue. Sharon Kotabe, Pharm. D. Promoted to Associate Clinical Professor I am pleased to report that UCSF has announced the academic promotion of Sharon Kotabe, Pharm. D., Director of Pharmacy for the CHN, to Associate Clinical Professor in the School of Pharmacy, effective July 1st. We are extremely proud of Dr. Kotabe’s academic advancement and are fortunate, indeed, to have an administrator of her caliber assume responsibility for the CHN pharmacy services. Please join me in congratulating Dr. Kotabe on this significant professional accomplishment. Chinatown Public Health Center CHN's Chinatown Public Health Center will be sponsoring "Exercise for a Healthy Life," a free 4-week exercise, relaxation, nutrition, and goal setting course to assist Chinese speaking persons with chronic diseases. The course will take place at the Chinese Recreation Center on Tuesdays from 2:30 to 4:00 p.m. beginning May 18th through June 8th. For more information, or to register call 705-8500. Fifth Anniversary of the Transgender Clinic The 5th anniversary celebration of the Tom Waddell Transgender Clinic will be celebrated Tuesday, April 27th, from 5:00 to 7:45 p.m. at the Women's Building, 3543 18th Street, 2nd Floor. Annual SFGH Volunteer Luncheon The SFGH Volunteer Recognition Luncheon will be held this Saturday, April 24th at noon. This year’s event will take place at Gabbiano's Restaurant, 1 Ferry Plaza. We would be delighted if Commissioners joined us for the festivities. SFGH Appointments 4/99 YTD New Appointments 17 71 Reappointments 56 174 Delinquencies 0 0 Reappointment Denials 0 0 Resigned/Retired 23 63 Disciplinary Actions 0 0 Restriction/Limitations – Privileges 0 0 Changes in Privileges Additions 6 12 Voluntary Relinquishment 0 1 Current Statistics – as of 4/8/99 Active Staff 359 Affiliate Professionals 133 Courtesy Staff 586 Referring Staff 37 Total Members 1115 Applications in Process 45 Reappointment In Process 20 Reappointment Requested not Received 13 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR APRIL 1999 On behalf of the Commission, President Monfredini presented certificates to the following: Individual                                Nominee Division Nominated by Branzuela, Anna PH & P – Comm Health & Safety Svcs – STD Clinic Christine Geoghegan Brehmer, Jim PH & P – Env Health/MIS Geri Clarabal Jeremy Chevrier Elena Kaledina Paye, Wendy CHN/SFGH- Medical Staff Svcs Department Melissa Welch, M.D. Sylvia Villarreal, M.D. Yee, Ph.D., Tina Tong PH & P/Comm Health Svcs-DMS/Admin. Anita Madrigal Jo Ruffin Team                                    Nominee Division Nominated by Austin, Francine PH & P – Comm Health & Safety Servs. Jackie Tulsky-Peterson, M.D., Beasley, Susan TB Control – TOPS Satellite Clinic (Tuberculosis Outreach & Prev. Serv.) and Alberto Martinez Box, Candy Comia, Virgilio David, Ronald " " " " Davis-Jackson, Sheila " " " " Duong, Kieu " " " " Gallashaw, Woodrow " " " " Gomez, Rafael " " " " Heller, Yise " " " " Hudson, Sandra " " " " Khadgi, Gopal " " " " Marshall, Eileen " " " " Nyhagen, Richard " " " " Sias, Van " " " " Steele, Ronald " " " " Sunga, Mina " " " " Prior to the presentation to Tina Tong Yee, Ph.D., two bath house activists disrupted the meeting with a demand for the issue of reopening of the bath houses be calendared for a Commission meeting. The meeting resumed after the two individuals were escorted out of the Commission hearing room. 6) SPECIAL PRESENTATION TO BOB PRENTICE, Ph.D., DIRECTOR OF POPULATION HEALTH AND PREVENTION On behalf of the Commission and as an activist, Vice President Guy presented Bob Prentice, Ph.D., with a Certificate of Appreciation. She acknowledged his leadership in the Department and in the community in areas of homelessness and public health. She also pointed out his efforts and skills to build collaboration, even in a hostile environment. Dr. Prentice thanked the Commission and emphasized the importance of never losing the spirit of public health. He encouraged the Commission to continue support for the principles of public health. Public Speakers: All speakers expressed support for Dr. Prentice, his reinstatement, a call for a cooling-off period with mediation, and questions to the Commission. Note: Since there was a 4:00 p.m. time specific agenda item, the testimony for this item resumed at 5:45 p.m. Masa Rambo, Tom Waddell Health Center Zoe Clayson, S.F. State University/DPH Partnership Neil Gendel Buffy Bunting Eve Milton, Potrero Hill Health Center Rev. Carl Stuart, Citywide Advisory Board Paul Boden, Coalition on Homelessness Elizabeth Anello, Tom Waddell Health Center Richard Olive, Bayview Hunters Point Health Care Task Force Robert Tobin, private citizen Vickie Legion Michael Blecker, Swords to Plowshares David Novogrodsky, Local 21 Martha Hawthorne, Local 790 Dr. David Ofman, CHN, Primary Care Dr. Barry Zevin, Tom Waddell Health Center Dee Epps-Miller, Healthy Start Martha Ryan, Homeless Prenatal Program Martin Waukazoo, Native American Health Center Laura Ware, Community Housing Partnership Joe Wilson Marykate Connor, Caduceus Outreach Services Josh Brandon, DPH Homeless Deaths Research Susan Mizner 7) 4:00 TIME SPECIFIC: PRESENTATION FROM THE LAGUNA HONDA HOSPITAL PLANNING COMMITTEE, AND CONSIDERATION OF A RESOLUTION REGARDING RECOMMENDATIONS FROM THE PLANNING COMMITTEE The Commission received a report from the Laguna Honda Hospital Replacement Planning Committee, co-chaired by Dr. Mitch Katz and City Attorney Louise Renne. The report provided programmatic and technical field recommendations from the Committee. The financial aspects of replacing Laguna Honda Hospital were presented today. For a copy of the presentation and the full report, contact the Planning Office at 554-2631. The Commission did not take any formal action today but will consider a resolution on May 4, 1999. Dr. Katz, Ms. Renne, and Chief City and County Architect Tony Irons presented the planning process, background information on Laguna Honda, recommendations from the Program, Technical Build, and Finance Sub-Committees. Ms. Renne thanked all of the members of the Planning Committee, sub-committees, and especially Tangerine Brigham, Director of Policy and Planning. Commissioners’ Comments: Concerned about the stability of Medi-Cal reimbursement at Laguna Honda Hospital The use of the $300,000 figure for an average San Francisco home is unrealistic Raises the policy question of whether the City should be in the business of skilled nursing facilities Answers to the public have to be readily available Look at how other Counties address the need for skilled nursing facilities Show the number of people being served by the program enhancements Look at the State’s position on funding of free standing and distinct part skilled nursing facilities The public should be informed of built-in inflation factors for acuity of patients and costs Question of the City’s debt capacity President Monfredini encouraged Commissioners to call staff regarding any questions they may have. 8) UPDATE ON PREPARATIONS FOR THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS (JCAHO) AT SAN FRANCISCO GENERAL HOSPITAL IN MAY Bob Christmas, SFGH Administrator, gave an overview of the Consolidated Accreditation and Licensure Survey (CALS) preparation at SFGH from May 17-21, 1999. Three surveys compose CALS: the Joint Commission on Accreditation of Hospital Organizations (JCAHO), the California Department of Human Services State Licensing Survey, and the Institute of Medical Quality (IMQ ) Survey. Mr. Christmas reviewed the following areas: SFGHMC’s Mission Statement and Organizational Chart Overview of each of the surveys which compose CALS Focus of CALS preparation activities Overview of preparation activities Role and responsibilities of the Governing Body Commissioners Guy and Parker expressed appreciation for the preparations. Commissioner Guy stated her interest on this subject and relies on the Commissioners on the Joint Conference Committee of SFGH. (8A) CONSIDERATION OF APPROVAL OF THE HOSPITAL PLAN FOR THE PROVISION OF PATIENT CARE AND THE ENVIRONMENT OF CARE – EXECUTIVE SUMMARY, MARCH 15, 1999 Gene O’Connell reported the Hospital Plan for the Provision of Patient Care was approved in March at the Joint Conference Committee of SFGH. Action Taken: The Commission unanimously approved the Hospital Plan for Provision of Patient Care. Eric Miller, Director of CHN Facilities Management, presented the annual Environment of Care, which included: Emergency Preparedness Environmental Services Hazardous Materials Life Safety Medical Equipment Safety Security Utility Management Action Taken: The Commission unanimously approved the Environment of Care – Executive Summary, March 15, 1999. 9) CONSIDERATION OF A RESOLUTION RECOGNIZING THAT THE CURRENT HOUSING CRISIS POSES A SERIOUS BARRIER TO THE PROMOTION OF EFFECTIVE PUBLIC HEALTH PRACTICES Dr. Katz presented a resolution which acknowledges a serious housing crisis in San Francisco. The shortage of affordable housing stock, skyrocketing rents and substandard housing conditions create significant barriers to the implementation of effective disease prevention and health promotion activities. The Department of Public Health recognizes that safe, decent and affordable housing is essential to the well being of all San Franciscans. In addition, providing housing is key to preventing the current over-utilization of emergency and acute services. Public Speakers: Supported the Resolution; advocated funding of a housing trust fund, eviction defense, back rent, and move-in costs/subsidy program. Frederick Hobson, Board member, S.F. Health Authority Jennifer Friedenbach Chance Martin, Coalition on Homelessness Josh Brandon, DPH Homeless Death Prevention Project Emanuel Smith, Jr., Thor Tenants’ Union Robert Ingalls, Thor Tenant’s Union Vivian Louie, Community Housing Partnership Jeremy Graham, Tenderloin Housing Clinic Rev. Glenda Hope, S.F. Network Ministries Steve Leoni Rebecca Vilkonian, Homeless Prenatal Program Marykate Connor, Caduceous Outreach Services Robert Haaland, S.F. Tenants’ Union Dr. Barry Zevin, Tom Waddell Clinic David McGuire, Hartland Hotel Carric Depman, Local Homeless Coordinating Board Commissioner Chow recommended an amendment to delete "any and all" from the resolution. Commissioner Guy expressed her support to look into a housing trust fund. Commissioner Parker commented the City is not addressing the housing problem as a whole. Action Taken: The Commission unanimously adopted the amended Resolution #14-99, "Recognizing that the Current Housing Crisis Poses a Serious Barrier to the Promotion of Effective Public Health Practices." 10) CONSIDERATION OF A RESOLUTION IN SUPPORT OF SAN FRANCISCO HEALTH DEPARTMENT ADOPTING A PILOT PROJECT IMPLEMENTING A NO-NAMES BASED HIV REPORTING SYSTEM Dr. Herminia Palacio, Special Policy Advisor to the Director, provided an update on the development of a non-names based HIV case reporting pilot project, in response to changes in the epidemiology of HIV/AIDS. In 1995, the Commission passed Resolution #15-95 opposing State legislation which would require mandatory names reporting of HIV infected persons. In 1997, the Commission reaffirmed this policy. Dr. Palacio gave background information on AIDS surveillance data, the policy significance of HIV case reporting, and current Federal, State and local activities on the debate about the merit of name-based systems versus unique identifier systems. Dr. Palacio described the pilot project as follows: San Francisco Unique Identifier Pilot Project The salient features of the proposed pilot project are that it is a laboratory based system, and that it will be able to test the accuracy and completeness of the surveillance data base. We propose a laboratory-based system because research indicates this method yields a higher level of reporting than do systems which rely exclusively on provider-initiated reports. We propose a rigorous evaluation component because it is critical to document our ability (or inability) to meet CDC performance standards. Two different alpha-numeric codes were selected to facilitate more complete and more accurate data (i.e. data with fewer duplicates) than either code could achieve alone. One of the codes is the Soundex, which is currently used by the San Francisco Department of Health to encrypt names prior to forwarding AIDS surveillance data to the California Department of Health Services. The Soundex relies on the last name. The other code is a modified HRSA Uniform Reporting Number (URN), which encrypts various bits of information such as elements of the first and last names, date of birth, race/ethnicity, and gender. We propose conducting the pilot project at two sites, San Francisco General Hospital and Kaiser Permanente Medical Center. When the laboratory of the participating institution performs a test that yields a result indicative of HIV infection (e.g. positive HIV-antibody test, detectable HIV viral load test, CD4 test), the laboratory personnel will: a) generate the Soundex and URN codes, b) send a report with the test result and patient codes (but no name) to the Department of Public Health, and c) send the test result to the medical provider who had ordered the test as usual, except for the addition of the patient codes and an advisory that the case was reported and that a health official would be calling to the provider about the case. Upon receipt of the report, the DPH surveillance officer would check the case against previously received case reports. For newly reported cases, the surveillance officer would contact the medical provider to gather additional information required by the CDC, such as date of initial diagnosis and HIV risk category, to complete the case report. For the purposes of evaluating the pilot project, participating laboratories will retain a link between the patient name and the surveillance codes. This list will serve as "gold standard" for the evaluation because it represents the true number of individual cases reported during the pilot project. After the data collection phase has ended, the completion rate and the duplication rate of the unique identifier system will be evaluated by sending the DPH unique identifier surveillance data base to the laboratory for comparison against their master list (the master list will not go to DPH). By having the participating laboratory perform the data analysis, the proposed project completely avoids any new disclosure of the patient name, because names do not leave the original medical institution. The medical institutions gain no additional knowledge from the surveillance codes, as the institutions already have access to the patient’s name and medical history. Thus, there is no new threat to patient confidentiality as a result of the pilot project. The laboratory will perform the data analysis and inform DPH of the level of completeness and accuracy in the data base. Dr. Palacio stated that the results of the proposed pilot project can help inform the debates at the State legislature. The implementation of the proposed pilot project would allow the Department to take the next steps towards improving our HIV/AIDS surveillance consistent with Commission policies. Commissioner Chow commented that this is a national issue; and we should be a part of it. President Monfredini expressed support with the assurance of confidentiality. Public Input: Steve Heiling, S.F. Medical Society, submitted written support for the resolution. Action Taken: The Commission unanimously adopted Resolution #15-99, "Supporting the San Francisco Department of Public Health Adoption of a Pilot Project Implementing a Non-Names Based HIV Reporting System." 11) PUBLIC COMMENTS Public Speakers: Lincoln Madison expressed support for agenda item #10 and requested the sex club regulations. Steve Filandrinos does not support the monitoring of sex clubs. Gil Criswell, Spectrum, supports giving medication and treatment along with surveillance procedures. Richard Cornwall supports bath houses to promote safe sex practices and encouraged a public forum about the transmission of diseases. President Monfredini expressed her willingness to meet with any of the speakers for informational purposes. The meeting was adjourned at 8:45 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission