Minutes of the Health Commission Meeting Tuesday, October 5, 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 3:05 p.m. Present: 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. Commissioner John I. Umekubo, M.D. 2) APPROVAL OF MINUTES OF THE REGULAR MEETING OF SEPTEMBER 21, 1999 Ms. Mori pointed out a correction on page 11. The table for the projected FY 1998-99 year-end surplus/deficit will be replaced with a corrected table. Public Speaker: Gilbert F. Criswell, Cable Channel 53 Public Access Journalist, requested the minutes of September 21, on #3.6 to reflect his reference to a letter from the Human Rights Commission regarding discrimination allegations on New Leaf; a Commission follow-up request on Prop I requirements for the new contract to New Leaf; his official title to indicate Gilbert F. Criswell, Cable Channel 53 Public Access Journalist and member of the Gay Men’s Association of the Thomas Paine Society for Common Sense in Government; and questioned whether the word males means heterosexual or gay males. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) (3.1) Update on progress of Latino Commission Program. Jim Stillwell, CSAS, reported that since this contractor was denied a conditional use permit from the Planning Commission, the program will have less beds than originally planned. It is presently continuing as a transitional program and will resubmit for a conditional use permit. (3.2) CENTRAL ADMINISTRATION – Request to approve a resolution authorizing the Department of Public Health to accept and expend 37 recurring State grants to be awarded to the Department during 1999-2000 fiscal year. Commissioner Sanchez requested a status report on quality assurance of the school bungalow site. (3.3) PHP-Health Promotion – Request to authorize a performance agreement between the Regents of the University of California and the Department of Public Health, enabling the Department to receive up to $66,134 for collaboration on the "Safe Houses: Meanings of Home Modifications as Self Care", for the initial contract period of September 1, 1999 to February 29, 2000. Commissioner Sanchez abstained on this item. (3.4) CHPP-Health Promotion – Request for approval to accept and expend a new grant from the Center for Disease Control and Prevention, in the amount of $272,273, for the Raise African American Infant Survival: Erase Disparity Project (RAISE), with a contract for $85,893 with Booker T. Washington Community Service Center for community participation in the planning and evaluation of the project, for the period of September 30, 1999 to October 1, 2000. (3.5) CHPP-HIV Prevention Services – Request for approval of contract renewal with Instituto Familiar de la Raza, in the amount of $51,092, for the provision of individual risk reduction counseling, multiple session groups, venue-based individual outreach and evaluation services targeting sexually active Latino males of various populations between the ages of 18 to 50, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with Instituto for services totaling $4,526,738 during FY 1998-99). (3.6) CHS-HIV Services – Request for approval of contract modification with Shanti Project in the amount of $77,009, for a total contract of $419,404, for the provision of integrated HIV Health Services targeting HIV infected San Francisco residents who are uninsured, underinsured or have severe needs, for the period of March 1, 1999 through June 30, 2000. (DPH contracted with Shanti for services totaling $1,188,213 during FY 1998-99). (3.7) CHS-AB 75 Project – Request for approval of renewal contract with Lifemark Corporation in the amount of $174,000, for the provision of fiscal intermediary services for the FY 1999-00 CHIP Program, for the period of November 15, 1999 through March 31, 2001. (DPH contracted with Lifemark for services totaling $190,000 during FY 1998-99). (3.8) CHS-CSAS – Request for approval to accept and expend a new grant from the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services, in the amount of $100,000, to study the feasibility of implementing the Physician Prescription of Methadone Program, for the period of September 15, 1999 to September 30, 2000. (3.9) CHS-CSAS – Request for retroactive approval of a multiyear renewal contract with Jelani House, Inc., in the amount of $2,856,320 per year, for a total contract amount of $8,568,960, for the provision of residential and outpatient substance abuse treatment services targeting women and their children, for the period of July 1, 1999 through June 30, 2002. (DPH contracted with Jelani for services totaling $2,358,901 during FY 1998-99). (3.10) CHS-CSAS – Request for retroactive approval of a multiyear renewal contract with Chemical Awareness and Treatment Services, Inc. [dba Community Awareness and Treatment Services, Inc.] (CATS), in the amount of $4,436,341 per year, for a total contract amount of $8,872,682, to provide residential, transportation, drop-in and shelter substance abuse treatment services for the period of July 1, 1999 through June 30, 2001. (DPH contracted with CATS for services totaling $8,090,034 during FY 1998-99). (3.11) CHS-CMHS – Request for approval to accept and expend a new two-year grant from the Department of Health and Human Services, Substance Abuse Mental Health Services Administration, Center for Substance Abuse Prevention in the amount of $96,123 for the "Kinabukasan" Family Strengthening Program for Pilipinos, for the period of October 1999 through September 2000. (3.12) CHS-CMHS – Request for approval of a new contract with Filipino-American Council of San Francisco, Inc., in the amount of $96,123, to provide outreach, prevention and research services targeting Pilipino families, for the period of October 1, 1999 through September 30, 2000. (3.13) CHS–Children Youth and Families – Request for approval of retroactive modification to the three-year contract with Polaris Research and Development, Inc., to add $99,166 for the period of April 16, 1999 through December 31, 1999, for the provision of home visitor services, bringing the second year contract amount to $135,966. The total amount of this three-year contract is $232,516 for the period of January 1, 1998 through December 31, 2000. (DPH contracted with Polaris for services totaling $730,150 during FY 1998-99). (3.14) CHN-Primary Care – Request for approval of retroactive renewal contract with Bayview Hunters Point Foundation (BVHP), in the amount of $150,831 per year, for a total contract amount of $301,662, to provide counseling and social service referral services to families and individuals experiencing stress resulting from the loss of a loved one from an act of violence, for the period of July 1, 1999 through June 30, 2001. (DPH contracted with BVHP for services totaling $7,300,035 during FY 1998-99). Commissioner Parker pointed out a typographical error on #3.9; requested a clarification on #3.10; and commended the contractor on #3.14. Action Taken: The Commission unanimously approved the Consent Calendar of the Budget Committee, with Commissioner Sanchez abstaining on #3.3. 4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) (Provides information on activities and operations of the Department). Mt. Zion Hospital Dr. Katz gave an update on Mt. Zion Hospital. UCSF/Stanford will sponsor a community forum on October 5, 1999 in the Western Addition. Historically, Mt. Zion has served the African American, Jewish, and Russian communities. Dr. Katz has been meeting with community groups to look at creative proposals. Data shows the acute care census at Mt. Zion to be 50. The Commission will be holding a Prop Q hearing on Mt. Zion on Tuesday, November 16, 1999 at 3:30 p.m. at the Board of Supervisors Chambers in City Hall. This hearing will be televised on Channel 54. ADMINISTRATION Federal Year 2000 Budget The Federal Year 2000 Budget has not been adopted. On September 30, 1999, President Clinton signed a three-week continuing resolution. A continuing resolution is a temporary spending measure to keep the federal government operating. It allows for the federal government to continue providing vital services such as Social Security, education, health and national security. It is our understanding that Congress and the Administration have not been able to reach agreement on the various expenditure caps. It has been difficult to adhere to these budget caps and still fund critical programs. The President is concerned that his budget plan, which provided for increase funding for education, savings in Social Security and Medicare, has not been adopted by the majority in Congress. The Department is working closely with the City’s federal lobbyist in tracking the Labor/HHS/HUD appropriation bill that is most significant to us. This bill provides funding for various federal Department of Health and Human Services programs such as Medicare, Medicaid, Ryan White and NIH. We hope that Congress and the Administration will be able to approve appropriation bills before the expiration of the current continuing resolution. The President does have the authority to issue a subsequent continuing resolution if needed. Tobacco Tax Revenues for the CHIP Program As reported earlier to the Health Commission, the Department expected its current year budget for the County Health Indigent Program funded by tobacco tax revenues to be reduced in the State 99-00 budget. In accordance with final State allocations the Department’s current year budget of $8.0 million for the indigent health program revenues will be reduced by $3.1 million to $4.9 million. The Controller will be preparing a supplemental appropriation request to offset reduced tobacco tax revenues with increased General Funds for the Department of Public Health. This adjustment will result in no net impact on the Department’s FY 99-00 expenditure appropriation. Release of Funds Held on Reserve The current year budget contains one-time funding added by the Board of Supervisors during the annual budget hearings in June. Four of these programs added back by the Board are held on reserve pending Board approval to release funds. The Department is now requesting release of funds for two of these programs: 1) $300,000 for mental health residential treatment services; and 2) $245,000 for fire prevention education for occupants of single room occupancy (SRO) hotels. The Finance Committee of the Board approved release of the $300,000 for enhanced mental health services on September 29. The Finance Committee is expected to hold a public hearing on the release of the $245,000 for SRO fire prevention on October 13. The request to release funds for the remaining two programs (children’s mental health and methadone access physician training) will be forwarded to the Board later this year. City Clinic Vandalized Yesterday afternoon members of ACTUP San Francisco entered the STD Surveillance Offices of DPH and verbally harassed staff tearing posters off the wall. The ACTUP group demanded to see Jeff Klausner, M.D., Director of the clinic or Gwen Hammer, M.D. of the CDC. The group left when they learned neither was on site. Staff called DPH Institutional Police and the SFPD. I sent Jimmy Loyce, Deputy Director over to debrief staff and assess the damage. The Department is committed to ensuring staff have a safe working environment. A restraining order is being pursued and security has been increased. King Hotel Fire A fire broke out at the King Hotel, 663 Valencia Street Sunday morning at 11:30. The Red Cross and various city departments including Human Services, Office of Emergency Services, and Public Health were on site shortly after fire fighters had the fire under control. One fatality occurred as a result of the fire, and four people were injured. This 43 unit single occupancy hotel housed close to 70 people, including 11 families, 20 children, 5 couples and 15 single adults. Evacuated tenants were triaged to a temporary Red Cross shelter on Harrison Street. I would like to acknowledge the good work of DPH Mental Health staff, Linda Wang and LaDonnis Elston who were at the shelter to provide support and counseling. In addition Alice Bowles, RN of the CHN volunteered to provide overnight nursing coverage at the shelter. Child crisis was on site to ensure all the children were in stable condition. Ben Gale from Environmental Health conducted a site visit to assess the suitability of the temporary shelter, and Willie Crawford obtained 200 towels from Laguna Honda and delivered them to the shelter. As you may remember, DPH chaired the Board of Supervisors SRO Emergency Response and Coordination Committee last year. The response to this fire highlighted the progress made through the work of the committee. DPH is working in coordination with other City agencies to transition the fire survivors to permanent housing as quickly as possible. Senior Legislative Planner I am pleased to announce that Ms. Colleen Johnson will be joining the Office of Policy and Planning as Senior Legislative Planner. Ms. Johnson currently works for AIDS Project Los Angeles where she is the Manager of Local Government Affairs. Colleen has experience in state legislation, health policy, government relations, grant writing, community planning and managing service programs. Colleen will start on Monday, October 25, 1999 and her telephone number will be 554-2633. Until Colleen starts, please continue to forward State legislative requests to Tangerine . Please join me in welcoming Colleen to the Department and the Office of Policy and Planning. POPULATION HEALTH AND PREVENTION CARE Title I Application I am pleased to report that the HIV Health Services recently submitted the 10th CARE Title I application to the Federal Government. This year’s application requested over $42 million for HIV Health services for San Francisco, San Mateo and Marin Counties. We should hear from HRSA in January 2000 as to our final award for the CARE fiscal year starting in March 2000. My thanks to Laura Thomas for coordinating the application again this year. CDC Male Screening Award Today I was informed that we were awarded $257,053 this year and I believe $257,053 the following year to conduct the male chlamydia screening study evaluating the effectiveness of male screening to reduce the burden of disease in the population and to understand transmission of infection. October Highlights Women’s Health October is a significant month for women's health. It is the "awareness" month for both domestic violence and breast cancer. How are these two major women's health concerns related? Both domestic violence and breast cancer are shrouded in secrecy. Women are the customary target of both diseases. And too often, survivors are blamed for the disease. This month, we will see a lot of attention brought to these important women's health issues. Domestic Violence activities are scheduled throughout the city during the month of October. A calendar of events is attached and is available to the public in the lobby at 101 Grove Street. Activities range from the release October 5th of the national report on Lesbian, Gay, Transgender and Bisexual Domestic Violence presented by CUAV, to A Men's March Against Domestic Violence on October 23rd. Breast cancer quilts are on display at City Hall throughout the month of October. This is a collaborative project between the Department of Public Health's Breast and Cervical Cancer Services and the UCSF/Mt. Zion Art for Recovery Project. The exhibition presented by the Art Commission Gallery, a program of the San Francisco Arts Commission, displays quilts honoring and remembering women from the Western Addition, Chinatown and Bayview Hunters Point. There will be a reception October 13th at 5:30 on the ground floor of City Hall. A number of educational programs offering information about breast and cervical cancer and women's health are scheduled throughout the month. Calendars are attached and available to the public in the lobby at 101 Grove Street. COMMUNITY HEALTH NETWORK 1999 Survey Plans of Correction Accepted The State Licensing & Certification office notified Laguna Honda Hospital September 24th, that its Plans of Correction (POCs) for both the Acute and Skilled Nursing Facility surveys had been accepted. We will distribute copies to the Commission for their information. The Licensing & Certification office also notified LHH that it will conduct a follow-up visit in October to monitor compliance with the approved Plans of Correction. The Hospital Leadership Group is actively preparing for the revisit. The approved SNF POC included placement of additional beds in M7, the acute medical unit, and in L4, the rehab unit. This bed redeployment and relocation of residents is scheduled to begin this month. The Hospital will also transfer residents out of ward F3, which will then be refurbished and utilized as a flex unit to allow sequential upgrade of other wards in the main building. With these resident moves accomplished, the Hospital will then begin reducing census in the open wards from 26 to 25 as agreed with HCFA. The target date for completion of this open ward census reduction is December 1999. We intend to maintain census at 1065 after all these moves and adjustments. The POC also requires that the Hospital meet and confer with HCFA after the November 2nd election to discuss future adjustments to census. The LHH JCC will discuss our approach with HCFA over the next few weeks. LHH Hospice Receives Recognition The Laguna Honda Hospital Hospice received recognition recently from two sources. First, the Hospice unit and beautiful therapeutic garden were featured in a newly published book titled Healing Gardens: Therapeutic Benefits and Design Recommendations. The book features innovative concepts in healthcare and senior living design. Secondly, the LHH Hospice was included in an HBO special program hosted by Linda Ellerbee on Life Afterlife. The program is a 90-minute documentary that explores the question of what survives after life. Our Hospice was one of several across the country selected for inclusion. Many of the Hospice residents and staff were interviewed during the on-site filming. The program premiers tonight on HBO at 7:30 p.m. eastern time. The Leadership Team is very proud of the accomplishments of the Hospice unit staff and the quality of care provided our residents. Employee Recognition Event Reminder I wish to invite Commission members to the Hospital’s annual Employee Recognition Dinner Dance on October 28th beginning at 6:00 p.m. at the Spanish Cultural Center on Alemany Boulevard. This year 285 employees will be honored, including 11 employees who will celebrate their 30-year employment anniversary, and one who will be honored for his 35th anniversary. In addition, the Hospital has invited a number of very special guests who have contributed above and beyond normal levels for Laguna Honda Hospital this year. These guests will also be recognized and honored at the special event. All Commissioners are cordially invited to join in the festivities. President Monfredini acknowledged Mr. Loyce’s quick response to the incident at the STD Clinic. She strongly indicated the disruptive and intimidating behavior is not to be tolerated and supports appropriate legal action against the individuals who were responsible for the incident. Commissioner Parker emphasized the need for a safe workplace; and the incident at the STD Clinic is inappropriate. Public Speaker: Gilbert F.Criswell, the Gay Men’s Association, indicated the STD Clinic incident was a result of the Department’s report on the syphilis outbreak and the delay in releasing the STD Report. 5) PRESENTATION OF CERTIFICATE TO THE DISASTER MEDICAL ASSISTANCE TEAM On behalf of the Commission, President Monfredini presented a Certificate of Appreciation to the Disaster Medical Assistance Team. In the two short years since its inception, the team has developed into a deployment capable disaster response unit of more than 60 individuals from all medical disciplines. All members of this volunteer unit have equipped themselves at their own cost and participated in training, including multiple day deployments to the field sites. The CA-6 Team has provided care to Kosovar refugees at Fort Dix, and has been in standby mode for flooding and hurricane disasters. This is the first such regional, multijurisdictional disaster response unit developed in the Bay area capable of providing emergency medical care to large numbers of patients on short notice. The Health Commission commends the work of all the team members on behalf of the residents of San Francisco, the Bay Area and the entire State of California, and awards this Certificate of Appreciation to the CA-6 Commandeer, Don Cheu, M.D., on behalf of the entire team. 6) MONTHLY UPDATE ON DEPARTMENT OF PUBLIC HEALTH STRATEGIC PLANNING Tangerine Brigham, Director of Policy and Planning, presented an update including the orientation meeting, the committee membership, and the initial strategic planning work plan. For a copy of the 7-page update, call the Commission Office at 554-2666. There will be a Steering Committee, a Finance Sub-Committee, a Population and Program Sub-Committee, and a Departmental Communications Sub-Committee. Staff support for the Committees will be: Name - Committee Richard Hodgson, DPH Policy and Planning Steering Anne Okubo, Central Administration Fiscal Finance Judith Klain, CHN Planning and Marketing Population and Programs The Steering Committee will be co-chaired by Jimmy Loyce, Deputy Director; and Tangerine Brigham, Director of Policy and Planning. The work plan for this strategic planning initiative is divided into two components: one entitled "December 1999 Deliverables and Expectations:, and the other entitled "December 2000 Deliverables and Expectations." Ms. Brigham requested that it delay its presentation on a proposed strategic approach to financing issues for the fiscal year 2000-01 budget. This was originally scheduled for November 1999. However, additional time has been needed to form the Steering Committee and Sub-Committees. As noted previously, the Strategic Planning Orientation Meeting is not scheduled until October 13, 1999. We strongly believe that the Finance Sub-Committee will need additional time before it can make recommendations to the Steering Committee. Therefore, the Department requests that the presentation be delayed until the first meeting in December 1999. The Department will make all attempts to keep to the timeline and detailed work plan. However, the work plan may be modified and updated throughout the planning process as the strategic planning issues are fully explored and deliberated on. The work plans must also be reviewed and agreed upon by the Steering Committee and Sub-Committees. President Monfredini requested updates on November 2nd and December 7th. 7) HEALTHY FAMILIES UPDATE As a follow-up to the Commission’s request for an update on the California’s Healthy Families Program in San Francisco, Ms. Brigham provided background information, a description of program expansions and enhancements, San Francisco-specific data, and a description of the Department’s outreach and education efforts. For a copy of the complete report, call the Commission Office (554-2666). Ms. Brigham stated that there is a need to focus on the African Americans, Latinos, Asians other than Chinese, and adolescents, because the number of enrollees is low in these areas. Questions and Comments from Commissioners: What is San Francisco’s goal for the number of children to be enrolled? Can minors with children apply? There is a low enrollment of Caucasians. Duplication of efforts in the Chinese community is needed in other communities. What are the strategies for ineligible or underinsured children? The Department needs to forge collaborations with schools, new initiatives, and existing grassroots, community groups (i.e., Beacon sites, churches, Mission Vocational Program, Latino Task Force); the Department needs to expand efforts to the specific target populations. The Department needs real data to evaluate and measure success. Healthy Families is an important income to our system; but local data is needed. Another update, along with data, will come to the Commission in March/April 2000. 8) OTHER BUSINESS/PUBLIC COMMENTS Public Speaker: Gilbert F. Criswell, Cable Channel 53 Public Access Journalist, again encouraged the Commission to televise its meetings. Commissioner Guy requested advance written information on Mount Zion in preparation for the Prop Q hearing scheduled for November 16, 1999. The meeting was adjourned at 4:50 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission