Minutes of the Health Commission Meeting Tuesday, November 2, 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 3:15 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 John I. Umekubo, M.D. Absent: Commissioner David J. Sanchez, Jr., Ph.D. President Monfredini encouraged everyone to vote today. 2) APPROVAL OF MINUTES OF THE REGULAR MEETING OF OCTOBER 19, 1999 Action Taken: The Commission unanimously adopted the minutes of October 19, 1999. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) (3.1) CHS – HIV Health Services – Update on the Filipino Task Force on AIDS for the provision of HIV prevention services. Dr. Larry Meredith reported on the excellent progress by the contractor in addressing the issues in the monitoring report. (3.2) CHS – Update on the Bayview Hunters Point Foundation for Community Improvement, Inc., for the provision of HIV services and an organization development plan. Barbara Garcia, Director of Population Health and Prevention, gave an update on the agency’s Organizational Development Plan, which is being coordinated with the agency, the Department, and the Support Center for Nonprofit Management. Michelle Dixon, AIDS Office, gave an update on the HIV contract, expressing her concerns on the contractor’s lack of documentation. The next step is to give a 30-day period to come into compliance on the required documentation. President Monfredini commented that the contractor is in serious trouble; and, unfortunately, this is not the first time this contract has had difficulties. She expressed her support for Barbara Garcia and Michelle Dixon’s recommendations to the contractor. Karen Patterson Matthew, Executive Director of Bayview Hunters Point Foundation Board of Directors, reported the progress made to address the monitoring report. She stated that it is unfortunate that what has been identified as a problem with the specific HIV contract is being extended to the total organization. She stated the overall work of the organization is exemplary; and that she is working towards restructuring of services in the organization. Dr. Wayzel Fuller, President of the Bayview Hunters Point Foundation, acknowledged the Board’s fiscal and legal responsibility over the agency. Commissioner Hill indicated the Commission is not critical of the organization as a whole and expressed his gratitude for the work of the organization. Commissioner Umekubo requested a monitoring report in 30 days. Commissioner Hill requested the Bayview Hunters Point Foundation Board of Directors provide a resolution to the Commission in 30 days, indicating full disclosure and knowledge of the proposed Organizational Development Plan, and concerns on the HIV contract.. There was a discussion on Board structure and size. The Commission does not dictate the size of a Board of Directors but suggests the size of the Board be commensurate with the size of the agency’s total budget. (3.3) CHS – HIV Health Services – Request for approval of contract modification with the Support Center for Non-Profit Management for one-time funds, in the amount of $269,279, for a total contract amount of $519,279, to provide HIV CARE Planning Council support and further development of the Reggie system to benefit HIV positive San Francisco residents for the period of March 1, 1999 through February 29, 2000. (DPH contracted with the Support Center for services totaling $1,106,985 during FY 1998-99.) (3.4) CHS - Housing – Request for approval of a new retroactive sole source contract with Lutheran Social Services of Northern California to provide benefits counseling to homeless persons and evaluation services for a demonstration project, in the amount of $67,000, for the period of October 1, 1999 through June 30, 2000. (DPH contracted with Lutheran Social Services for services totaling $1,127,952 during FY 1998-99.) (3.5) EMS Agency – Request for approval to accept and expend retroactively a continuation grant from Department of Health and Human Services in the amount of $200,000, of which $30,000 will be used for new subcontracts with AMR/HUSK and TRW, for the continued development of the Metropolitan Medical Response System for the period of April 1, 1999 through April 30, 2000. (DPH did not contract with AMR/HUSK or TRW during FY 1998-99.) Action Taken: The Commission unanimously approved the Consent Calendar of the Budget Committee, with specific requests for #3.2. 4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) (Provides information on activities and operations of the Department). DIRECTOR’S REPORT ADMINISTRATION Halloween – Millennium Dry Run The City used Halloween as an opportunity to test plans for the upcoming millennium celebration. The City’s Emergency Command Center was activated using the Incident Command System to coordinate and respond to Halloween celebrations. The Police Department acted as the Incident Commanders, setting up a command post at the Eureka Valley Recreation Center for the Castro Street celebration. The crowd was reported to be over 250,000 people. Health Department staff were at the ECC and the Police command post, and the SFGH command post communicating with each other by 800mhz radios. The Health Department staffed the Castro – Mission Health Center as a Field Care Clinic (FCC). The FCC officially opened at 6:00 p.m. remaining open until 3 a.m. Bilingual staff were available on site. The FCC saw 16 patients: of these, 3 were mental health patients, 5 were intoxicated, and 2 were transported to SFGH severely intoxicated. Four teams of foot patrols (consisting of a Rock Medicine volunteer, an EMT, a substance abuse and mental health worker) patrolled the crowds and responded to 9-1-1 calls forwarded by the command post. The foot teams were a huge success. Over 50 patient contacts were recorded, although we believe that there were at least 15 additional contacts. The heavy traffic on the radio made it difficult to call everything in. The foot teams used stair chairs to transport the injured patients through the crowds. The two most serious reported on-site injuries were a broken ankle, and a severed fingertip. DPH learned a lot of valuable lessons for the millennium celebrations about staging, team composition, supplies, difficulties in locating patients (and each other). Several times when the foot teams were co-dispatched with EMS, the foot teams were actually first on scene. For example, a foot team was first on scene to a report of an awning collapse. When they arrived to find that the persons who had fallen had left, they were able to cancel the SFFD response. The Emergency Room at SFGH reported its quietest Halloween in 7 years, we believe this can be directly attributed to our efforts at triage in the field. Many thanks to all those who participated in this real life training drill. It is fortunate that Halloween provided an exciting opportunity to test and refine the field care model we have developed for the millennium weekend. Federal Budget Congress and the President are still unable to come to agreement on the FY 2000 budget. On October 29, the President signed the third continuing resolution, extending the FY 1999 budget through November 5, 1999. Just one day earlier, on October 28, the House passed the final spending bill of the year, the Labor, Health and Human Services (Labor/HHS) budget bill. However, the President has indicated that he will veto this bill. There are a number of issues that still remain a barrier to finalization of the budget. Among these are the environment, education, foreign policy issues, and spending limits imposed by the Balanced Budget Act. Department staff will continue to monitor the federal budget and work with the City’s federal lobbyist to ensure the maximum level of funding for health care programs. Proposition 187 On October 27, Ron Prince, the chairman of the Proposition 187 movement, announced that he will likely pursue a similar initiative for the November 2000 ballot. Proposition 187 would have barred the State from providing public services, such as education and non-emergency health care services, to undocumented residents. Additionally, it would have required various state and local agencies to report persons who are suspected of being undocumented to the California Attorney General and the United States Immigration and Naturalization Service. As you know, the City opposed Proposition 187. The proposed 2000 ballot measure would prevent the Legislature from passing any laws permitting the provision of State or local benefits to undocumented residents. A second proposed ballot initiative would require the Governor to defend initiatives to the U.S. Supreme Court, if necessary, and allow proponents to be co-defendants. As both ballot initiatives would seek to amend the State’s constitution, they would need to be passed by two-thirds of the voters. Additionally, Prince is considering a third ballot initiative that would require public schools to count the number of undocumented residents enrolled. He has not yet, however, decided whether to pursue such an initiative. The Department will monitor these proposed initiatives closely. Should this issue gain momentum, the Department will develop a comprehensive strategy to educate the community, staff and other City Departments on the position adopted by the Board of Supervisors to provide health care services regardless of immigration status. Proposition 10 On October 28, the Secretary of State announced that an initiative to repeal Proposition 10 had qualified for the March 7, 2000 ballot. As the Health Commission is aware, Proposition 10 placed a 50 cents per pack tax on cigarettes and a similar tax on other tobacco products. The money generated by this tax increase funds early childhood development programs and programs that prevent or reduce tobacco, alcohol and other drug use during pregnancy. The official title and summary of the initiative is as follows: Repeal of Additional Tobacco Surtax Enacted by Proposition 10. Initiative Statute Repeals additional $.50 per pack tax on cigarettes and equivalent increase in state tax on tobacco products previously enacted by Proposition 10 at November 3, 1998, election. Provides for elimination of funding for Proposition 10 early childhood development and smoking prevention programs. Prohibits imposition of additional surtaxes on the distribution of cigarettes or tobacco products unless enacted by the state legislature. Provides that all additional tobacco taxes previously collected under Proposition 10 shall be appropriated and expended at which time the California Children and Families First Trust Fund shall terminate. The City, in particular the Department of Children, Youth & Their Families and Department of Public Health staff, will monitor this issue closely and keep the Health Commission apprised of its progress. Departmental Strategic Planning Initiative Last month the Department’s Strategic Planning Steering Committee and its sub-committees met twice to receive an orientation on the strategic planning initiative. The first meeting provided all committee and subcommittee members with an opportunity to review the key strategic issues facing the Department, discuss the planning process and review the goals and objectives of this effort. The second meeting provided all committee members with necessary background information on health trends, health status, health mandates and the Department’s revenues and expenditures. In addition, committee members received a summary report of community advisory council recommendations. The Finance sub-committee will present its proposed strategic approaches to fiscal year 2000-01 financing issues to the Strategic Planning Steering Committee on November 16, 1999. The Department is scheduled to present a proposed resolution to the Health Commission at its December 7, 1999 meeting regarding these financing issues. The Populations and Programs and the Communications sub-committees will hold their first meetings within the next two weeks. The Department’s strategic planning web site is operational and information may be accessed by logging on to www.dph.sf.ca.us/stratplan. COMMUNITY HEALTH NETWORK Laguna Honda Resurvey Inspection Commences On October 26th, a team of six State Licensing & Certification surveyors arrived unannounced at Laguna Honda to commence a monitoring survey to check compliance of the implementation of the Hospital’s approved Plan of Correction. The Survey Team reported that they anticipated being at the Hospital through this week. I will report on the outcome of the resurvey as soon as the results are available. LHH Annual Employee Recognition Dinner On the evening of October 28th, Laguna Honda Hospital celebrated its annual Employee Recognition Dinner honoring employees reaching 5-year milestones in tenure. Over 50 employees received honorable recognition, topped by Walter Ahrens who is celebrating his 35th anniversary at Laguna Honda. Over 280 people attended the awards presentation, banquet dinner, costume party and dance. State Senator Speier, Mayor Brown and City Attorney Renne were recognized by DPH for their efforts to rebuild Laguna Honda. The evening was a spectacular event that added to the fervor of saving Laguna Honda for future generations while honoring the committed staff who serve the residents of the Hospital. Health at Home November is National Home Care Month and DPH will celebrate by honoring the dedicated staff and volunteers of Health at Home, the home health agency of the Community Health Network. Health at Home's staff of RN's, social workers, occupational and physical therapists, home health aides and volunteers make over 17,000 home visits annually to more than 800 patients. I hope the Commission might join us and attend the Open House November 17th from 3-6pm, 45 Onondaga (corner of Alemany Blvd.) POPULATION HEALTH AND PREVENTION Women's Health Services "Time for Healing, Time for Change," the second Bayview Hunters Point Town Hall meeting on Breast Cancer, was attended by approximately 200 people October 27. The Bayview Hunters Point Breast Cancer Quilt was on display and Our Lady of Lourdes Miracles choir sang. The audience heard presentations from a breast cancer survivor, from the spouse of a breast cancer survivor, an acupuncturist, and SFGH Oncologist Judith Luce. This event was a collaborative effort between DPH staff, community based organizations and community residents who came together following the first Bayview Hunters Point town hall meeting. Special recognition goes to Barbara Cicerelli, Woman's Care Navigator with Breast and Cervical Cancer Services for her outstanding leadership in organizing and staffing this event. Violence Prevention The Health Promotion Section of the Community Health Promotion and Prevention was awarded $48,000 from the Department of Health Policy and Management, Harvard School of Public Health, to continue and expand our efforts in piloting the Multi-Agency Active Firearm Surveillance Program. Over the last three years through several State grants and through City general funds the Section has been collecting, analyzing, and reporting firearm injury-related data. Initial analysis of data demonstrated that a multi-agency approach is required for a full appreciation of the nature and scope of firearm-related injuries. Over the past year vital links have been established with the San Francisco Police Department, Medical Examiner's Office, San Francisco General Emergency Department and Trauma Unit, Emergency Medical Services, and University of California San Francisco Injury Center. Developing a single comprehensive clearinghouse of all information pertaining to firearm incidents will clarify the impact of firearm-related injuries occurring in San Francisco. One of the primary goals of the funders at Harvard is to create a national firearm injury surveillance system and San Francisco's success in developing a data collection and analysis program has positioned us for the award of these funds. The San Francisco project will serve as one of six national prototypes that are currently being developed in Maine, Maryland, Utah, Atlanta, and Allegheny, PA. 5) UPDATE ON 1998-99 YEAR-END DEPARTMENT OF PUBLIC HEALTH FINANCIAL REPORT Monique Zmuda, Chief Financial Officer, reported the following: Based on preliminary fiscal year-end closing statements, the Department of Public Health is projecting a surplus of $6.4 million for FY 1998-99. This is $5.6 million more than the 0.8 million previously reported to the Health Commission in September, based on 4th quarter projections. This increase in the fiscal year surplus is primarily as a result of: Additional prior year beginning balances at San Francisco General Hospital that were higher than reported on the City’s accounting system; Additional closeouts of unspent capital project funding from prior years; and, Closeout of encumbrances for expenses which were not made during the fiscal year, yielding an additional savings beyond that originally estimated. San Francisco General Hospital $ 285,142 Laguna Honda Hospital (1,216,962) Primary Care (2,783,801) Forensics 223,718 Subtotal CHN (3,491,903) Population Health and Prevention 9,933,152 Total DPH $6,441,249 Ms. Zmuda reported the annual audits of the Department are being done. Results of the audits are expected to be completed by November and will finalize the surplus for the FY 1998-99. 6) FIRST QUARTER REPORT FY 1999-00 REVENUE AND EXPENDITURE REPORT Monique Zmuda, Chief Finance Officer, reported the following: The Department of Public Health is projecting a year-end deficit of $3.9 million for FY 1999-00 based on expenditures and revenues for the first quarter ending September 30, 1999. This amount represents less than half of 1% of the Department’s total operating budget of $923 million. Projections include revenue shortfalls of $2.5 million and over expenditures of $1.4 million. The following table shows projected fiscal year revenues and expenditures by division. Projected FY 1999-00 Year-End Surplus/Deficit Ms. Zmuda reported that the budget will be closely monitored. At Commissioner Chow’s request, updates will go to the Joint Conference Committee of the Community Health Network, looking at primary care, productivity, and revenues and expenditures. She stated that the deficit for the first quarter is manageable. In answer to Commissioner Hill’s question whether a supplemental will be needed, Ms. Zmuda replied no. Commissioner Chow raised the issue of the census at San Francisco General Hospital and the impact of the Mount Zion closure on emergency services. Commissioner Umekubo requested clarification on increased Medi-Cal revenues. Commissioner Guy observed that underestimates on Medi-Cal revenues need to be watched. The trend of more unsponsored patients is not decreasing. 7) PRESENTATION OF A LEGISLATIVE REPORT Tangerine Brigham, Director of Policy and Planning, gave an overview of the 1999 California Legislative Session: Summary of Selected Enacted Legislation (1999) Summary of Selected Failed Legislation (1999) Summary of Selected Pending Legislation (2000) Disposition of 1999 Legislative Priorities Legislative Priorities for 2000 For a copy of the full report, contact the Commission Office (554-2666). Ms. Brigham reported that the Planning staff will work with the State Department of Health Service and the Governor’s Office to help formulate a health agenda. Commissioners’ Comments: Commission should take a more active role in determining legislative priorities Commission is to advocate for health issues Commission needs to be informed and strategic Health advocacy partnerships between the public and private sectors should be encouraged Need to work with the newly-formed State Department of Managed Care Legislative report was thorough and extraordinary Public Speakers: Nathan Nayman, Hospital Council, advocated the framing of health care bills (i.e., access to health, cost of health care, health work force). 8) OTHER BUSINESS/PUBLIC COMMENTS None. 9) CLOSED EXECUTIVE SESSION: A. PUBLIC COMMENT ON ALL MATTERS PERTAINING TO THE CLOSED SESSION. Action Taken: The Commission unanimously voted to hold a closed session. The Commission went into closed session at 4:30 p.m. B. VOTE ON WHETHER TO HOLD A CLOSED SESSION TO CONFER WITH LEGAL COUNSEL. (SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.11(a).) C. CLOSED SESSION PURSUANT TO GOVERNMENT CODE SECTION 54956.9 AND SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.11(b). CONFERENCE WITH LEGAL COUNSEL - EXISTING LITIGATION. 1. DARCEL GRACE V. CCSF, IN THE AMOUNT OF $131,050, U.S. DISTRICT COURT NO. C98-3090 CRB 2. SHARON NORRIS V. CCSF ET AL, IN THE AMOUNT OF $50,000 The Commission came out of closed session at 5:15 p.m. D. RECONVENE IN OPEN SESSION: 1. POSSIBLE REPORT ON ACTION TAKEN IN CLOSED SESSION. (GOVERNMENT CODE SECTION 54957.1(a)(2) AND SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.14(b)(2).) Action Taken: The Commission approved the settlement for Darcel Grace v. CCSF in the amount of $131,050, and the settlement for Sharon Norris v. CCSF in the amount of $50,000. 2. VOTE TO ELECT WHETHER TO DISCLOSE ANY OR ALL DISCUSSIONS HELD IN CLOSED SESSION (SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.14(a).) Action Taken: The Commission voted not to disclose any discussions held in closed session. The meeting was adjourned at 5:20 P.M. Sandy Ouye Mori, Executive Secretary to the Health Commission