Minutes of the Health Commission Meeting Tuesday, December 7, 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 NOVEMBER 2, 1999 Action Taken: The Commission unanimously adopted the minutes of November 16, 1999, with the correction of a typographical error on the name for Dr. William Goodson, President of the S.F. Medical Society. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) (3.1) Update from Bayview Hunters Point Foundation on requests from the Health Commission. Department of Public Health staff, Barbara Garcia and Michelle Dixon, provided updates on the contractor’s organizational development plan and the HIV services contract. Due to the late submission of the response to the monitoring report for the HIV contract, another site visit will be rescheduled. An update on both the organizational development plan and the HIV services contract will be provided in March 2000. Karen Patterson Matthew, Executive Director of Bayview Hunters Point Foundation, reported the organization will be able to make the recommended short-term and long-term changes, as put forward by the Support Center consultants. (3.2) CHN-Office of Managed Care – Request for approval of a new service agreement between the Department of Public Health and Beech Street Corporation, the preferred provider organization (PPO) engaged by the Health Service System for City Plan 1 enrollees commencing November 1, 1999 and automatically renewable each year. (3.3) PHP-CHSS-TB Control – Request for approval of retroactive contract renewal with the Regents of the University of California San Francisco (UCSF) at San Francisco General Hospital (SFGH), in the amount of $227,435, to provide physician and radiologist services at the SFGH Tuberculosis Control Ward, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with UCSF for services totaling $7,888,724 during FY 1998-99). Commissioner Sanchez abstained on this item due to conflict of interest. (3.4) PHP-CHSS-TB Control – Request for approval of sole source contract renewal with the Regents of the University of California San Francisco (UCSF) in the amount of $2,711,327, to provide Model Tuberculosis Prevention and Control Center services to local and national TB health care providers, for the period of December 31, 1999 through March 31, 2001. (DPH contracted with UCSF for services totaling $7,888,724 during FY 1998-99). Commissioner Sanchez abstained on this item due to conflict of interest. (3.5) CHN-Medical Records/Radiology – Request for approval of multi-year contract renewal with Bay Area Medical Transcription (BAMT), in the amount of $250,000, to provide medical transcription services for the Community Health Network, for the period of December 1, 1999 through June 30, 2001. (DPH contracted with BAMT for services totaling $135,000 during FY 1998-99). (3.6) CHN-Medical Records/Radiology – Request for approval of multi-year contract renewal with Mediscript, in the amount of $75,000, to provide medical transcription services for the Community Health Network, for the period of December 1, 1999 through June 30, 2001. (DPH contracted with Mediscript for services totaling $25,000 during FY 1998-99). (3.7) CHN-Medical Records/Radiology – Request for approval of multi-year contract renewal with Transcription Stat (TS), in the amount of $250,000, to provide medical transcription services for the Community Health Network, for the period of December 1, 1999 through June 30, 2001. (DPH contracted with TS for services totaling $145,000 during FY 1998-99). (3.8) PHP-Policy and Planning – Request for approval of retroactive new contract with Northern California Coalition for Immigrant Rights in the amount of $60,000, to provide outreach services to public charge clients, for the period of November 1, 1999 through June 30, 2000. (3.9) PHP-HIV Research – Request for approval to accept and expend funds in a new four year performance agreement from the Public Health Foundation Enterprise, Inc., in the amount of $211,587 (for the first 12 month budget period), to conduct a preventive HIV vaccine phase-three efficacy trial in adults at-risk for HIV infection, for the period of September 30, 1999 to September 30, 2003. (3.10) PHP-CSAS – Request for approval to accept and expend a new grant from the Center for Substance Abuse Treatment (CSAT) Substance Abuse and Mental Health Services (SAMHSA) in the amount of $246,423, to develop a Community-Based Practice Research Collaborative, with a sole source contract in the amount of $25,000 to San Francisco State University, and a sole source contract in the amount of $25,423 to the University of California San Francisco, for the period of October 1, 1999 to September 30, 2000. Commissioner Sanchez abstained on this item due to conflict of interest. (3.11) PHP-CSAS – Request for approval of retroactive contract renewal with Horizons Unlimited, in the amount of $4,342,236 or $1,085,599 per year, to provide day treatment, outpatient and substance abuse prevention services to youth and young adults of the Latino population, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with Horizons for services totaling $1,212,673 during FY 1998-99). Department of Public Health staff Jim Stillwell reported a positive progress by the staff and Board of this agency. Commissioner Hill is recommending this contract be renewed for one year, instead of multiyears. (3.12) PHP-CSAS – Request for approval of retroactive contract renewal with Women and Children’s Family Services, Inc. (WCFS), in the amount of $1,893,470, to provide residential and outpatient substance abuse services to alcohol/drug addicted women, targeting low income pregnant and postpartum women, their children, their families and/or significant others, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with WCFS for services totaling $2,061,586 during FY 1998-99). (3.13) PHP-CMHS – Request for approval of retroactive contract renewal with Saint Francis Memorial Hospital (SFMH), for the provision of 24-hour acute psychiatric inpatient hospital services, in the amount of: 1) $156,498 in City funds targeting uninsured adults; and 2) as part of a network of six hospital providers for $5,000,000 in Medi-Cal funds, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with SFMH for services totaling $196,498 during FY 1998-99). Commissioner Umekubo abstained on this item due to conflict of interest. (3.14) PHP-CMHS – Request for approval of retroactive contract renewal with Saint Mary’s Medical Center (SMMC) for mental health services, in the amount of: 1) $320,000 in City funds targeting uninsured adolescents; and 2) as part of a network of six hospital providers for the provision of inpatient hospital services targeting Medi-Cal adult beneficiaries for $5,000,000 in Medi-Cal funds, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with SMMC for services totaling $2,337,412 during FY 1998-99). Commissioner Umekubo abstained on this item due to conflict of interest. (3.15) PHP-CMHS/CSAS – Request for approval of retroactive contract renewal with Walden House, Inc., in the amount of $6,834,982, to provide residential mental health and substance abuse treatment for the period of July 1, 1999 through June 30, 2000. (DPH contracted with Walden House for services totaling $8,383,220 during FY 1998-99). Commissioner Sanchez requested, for the future, an evaluation of the Treasure Island programs provided by this contractor. (3.16) PHP-CMHS – Request for approval of retroactive contract renewal with Westside Community Mental Health Center, Inc. (WCMHC), in the amount of $5,609,338, to provide mental health services, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with WCMHC for services totaling $13,932,678 during FY 1998-99). Commissioner Umekubo pointed out an error in the reporting on the number of crisis clinic patients served by the contractor. (3.17) PHP-CMHS – Request for approval of retroactive contract renewal with Edgewood Center for Children and Families, in the amount of $1,683,245, to provide mental health services targeting children and adolescents, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with Edgewood for services totaling $1,396,872 during FY 1998-99). (3.18) PHP-CMHS – Request for approval of retroactive contract renewal with Progress Foundation, Inc. (PFI), in the amount of $6,726,476, to provide mental health residential treatment and other mental health services to adults, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with PFI for services totaling $6,166,045 during FY 1998-99). (3.19) PHP-CMHS/CSAS – Request for approval of retroactive sole source contract renewal with San Francisco State University (SFSU), in the amount of $150,703, to provide mental health foster care training and substance abuse counselor training services, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with SFSU for services totaling $179,716 during FY 1998-99). (3.20) PHP-CMHS – Request for approval of retroactive contract modification with Seneca Center to increase the contract by $513,177, for a total contract amount of $1,193,413, to provide mental health residential treatment services targeting seriously emotionally disturbed adolescents, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with Seneca for services totaling $1,415,406 during FY 1998-99). (3.21) PHP-CMHS – Request for approval of retroactive new multi-year contract with Instituto Familiar de la Raza, Inc. (IFR), in the total amount of $4,144,128 or $1,036,032 per year, for the provision of mental health services targeting adolescents and youth, for the period of July 1, 1999 through June 30, 2003. (DPH contracted with IFR for services totaling $4,526,738 during FY 1998-99). (3.22) PHP-CMHS – Request for approval of retroactive contract modification with California Pacific Medical Center (CPMC), as a provider within the San Francisco Mental Health Plan, for the provision of outpatient mental health services for the period of July 1, 1999 through June 30, 2003. (This contract is part of the $3.3 million Mental Health Managed Care outpatient plan). (3.23) PHP-CMHS-MIS – Request for approval of new sole source contract with Echo Consulting Services of California, Inc., in the amount of $224,059, to provide software licensing and maintenance services for INSYST, for the period of November 1, 1999 through June 30, 2000, as a result of a contract assignment from United Behavioral Health to Echo Consulting Services. Commissioner Hill complimented Department of Public Health staff on the progress to decrease the number of retroactive contracts; however, more improvement needs to continue. Commissioner Guy pointed out for #3.12 the need for Board development and an appropriate number of Board members. Commissioner Sanchez stated the need for all contractors to comply with these standards for Boards of Directors. Action Taken: The Commission approved the Consent Calendar of the Budget Committee, with the specific recommendations. Commissioner Guy abstained on #3.10 and #3.19 due to conflict of interest. Commissioner Sanchez abstained on 3.3, #3.4 and #3.10. Commissioner Umekubo abstained on #3.13 and #3.14. On behalf of the Commission, President Monfredini made a special presentation to Ben Gale, who is leaving after 12 years as our Director of Environmental Health to become the Director in Santa Clara County. Mr. Gale managed both the Consumer Protection and Toxics Programs. 4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) (Provides information on activities and operations of the Department). ADMINISTRATION State’s Supreme Court Ruling On Indigent Care In late November, the California Supreme Court ruled that counties must continue to provide essential medical care for residents who cannot afford to pay for those services themselves. As you recall, the case concerned Sacramento County’s decision to reduce or eliminate health care for some low-income residents. Sacramento County had proposed that residents who received General Assistance or those who did not quality for other welfare programs would only be eligible for free emergency medical care. The court declined to define precisely "subsistence medical care" but stated that, at a minimum, a county must provide "medical services necessary for the treatment of acute life-and-limb threatening conditions and emergency medical conditions." The ruling reaffirms the need to maintain a health care safety net for low-income individuals. The ruling also stresses that the Legislature previously eliminated requirements that counties provide the same quality of health care to residents who cannot afford to pay for those services as non-indigent individuals receiving health care services in private facilities. Finally, the Supreme Court indicated that if a county chooses to determine a financial eligibility standard for county health services, it must consider "whether implementation of the standard would leave some residents who are incapacitated by age, disease or accident, and whose condition is not relieved through other means without subsistence medical care." We are pleased that the California Supreme Court reversed the judgement of the Court of Appeals and reaffirmed that counties are the providers of last resort. Federal Budget As the Health Commission may be aware, Congress has approved the federal budget. A significant impact to the Department is the Balanced Budget Refinement Act of 1999 (BBRA). The Balanced Budget Act of 1997 proposed sweeping reductions in critical health care funding for safety net providers such as DPH. While the BBRA primarily focuses on restoring Medicare reductions, there are a number of revisions that affect Medicaid funding. Highlights of the Balanced Budget Refinement Act of 1999 include the following: Permanent extension of the disproportionate share hospital transition rule for California’s public hospitals. As a result, California public hospitals will be able to calculate their hospitals – specific caps at 175% of unreimbursed Medi-Cal and uninsured expenses. This provision was critical to ensure that California maintains its disproportionate share funding. The sunset date for states to spend $500 million for Medi-Cal outreach and enrollment has been removed. The 1996 Welfare Reform Act provided these funds for states to ensure that individuals leaving welfare would retain their Medicaid coverage. These funds were due to sunset at the end of this year. It is our understanding that California has spent between one-third and one-half of its $80 million allocation for this purpose. The phase out of cost-based reimbursement for federally qualified health centers has been extended. The Balanced Budget Act phased out the Medicaid requirement that States pay FQHCs on the basis of cost. The phase out was due to begin in 2000 when States would be required to pay on 95% of reasonable cost, and then by 2004, the requirement would be repealed all together. The 1999 BBRA extends the 95% requirement through 2001-02 and indicates that a study will be conducted to determine an appropriate rate structure for FQHCs after 2004. In addition, the Labor -- HHS Appropriations Act includes $25 million in SID money for the Healthcare Access for the Uninsured Initiative. These funds will help improve the coordination of safety net providers who serve the uninsured, as well as filling in service gaps. This bill also includes $15 million as a grant program to States to develop programs and approaches for expanding health insurance coverage for the uninsured. While we are quite pleased with the adjustments to the Balanced Budget Act. Next year the Department of Public Health in concert with other public hospitals, health advocates and providers will advocate for freezing further Medicaid disproportionate share hospital reductions given that this was not a part of the Balance Budget Refinement Act of 1999. In addition to these budgetary changes, last month the President signed the Work Incentives Improvement Act, which expands access to health care for people with disabilities. This is particularly critical for individuals with disabilities who wish to re-enter the labor force but have difficulty doing so because of preexisting conditions. State Budget The Legislative Analyst Office (LAO) recently released a report providing projections of general funds, revenues and expenditures for the current fiscal year go through 2004-05. The California economic outlook is quite good. It is estimated that this fiscal year 1999-00, the State’s year-end reserve would be over $2.6 billion. This is significantly more the estimated $881 million that was proposed earlier this year for the State’s year-end reserve. The significant revenue will trigger further reductions in vehicle license fees. As the Health Commission is aware, a portion of vehicle license fees is used to fund realigned health, mental health and social services. The Legislative Analyst Office projects that Medi-Cal benefits will increase on average 6% annually – mainly due to increases in rising health care costs. CalWORKs spending is projected to decline in 2000-01. With respect to Medi-Cal and CalWORKs, this year will be the first time that most families and children enrolled in Medi-Cal will not be welfare recipients. The Legislative Analyst Office projects that this trend will continue such that "almost all of the decline in welfare caseload will be offset by an increase in the number of Medi-Cal" families and children who are not on welfare. The Governor’s proposed fiscal year 2000-01 budget will be released around January 10, 2000. State Children and Families Commission Proposition 10 revenues will total approximately $700 million in 1999. Of this, $560 million will be distributed to counties (subtracting the State’s 2% share). San Francisco has received its first Prop 10 payment of $5.6 million, representing amounts due from January 1999 through August 1999 and interest thereon. Hereafter, Prop 10 payments will be made to counties on a monthly basis. On November 5th, the State Commission staff convened a meeting of "large" counties including San Francisco, to create an opportunity for networking between local Commissions and to present the State Commission's media strategy. Though San Francisco is considered a small county in terms of the distribution of Prop 10 funds, we were invited to attend due to San Francisco’s status as a major media center. The State plans to fund pilot or demonstration projects in counties identified among the State’s top ten priority areas. These pilot projects will be funded out of the State’s 2% of the Prop 10 funds and it is anticipated that they will help mitigate some critique from the media regarding the delay in implementing county programs. To date, there has been no expenditure of Prop 10 funds as the only county that has completed its plan is Alameda County and it has only done so very recently. The State has scheduled another meeting for December 17th in San Francisco. This meeting will be a workshop for local commissions to discuss and devise strategies to communicate the mission and programs of Prop 10 locally. Local Children and Families Commission The Early Childhood Interagency Council will be nominating members to a Strategic Planning Advisory Committee that will conduct the bulk of the planning activities with staff. Included in their charge will be the implementation of a civic engagement project. Housed at Starting Points, the civic engagement project will gather community voices, including those most difficult to reach: parents and other caregivers, to ensure that community input remains an integral part of all phases of the planning process. The planning process is scheduled to be completed in the spring of 2000 in order to be compliant with the State Commission’s timeline for accessing funds. For more information, San Francisco’s Children and Families Commission website is www.sfprop10.mocyf.org. The website of the State Commission is www.ccfc.ca.gov. SRO Hotel Fire A two-alarm fire broke out at the Western Hotel, 335 Leavenworth Street late in the evening November 26th displacing residents. The Red Cross responded to the residential hotel fire shortly after midnight with representatives of the Health Department, Office of Emergency Services, Department of Human Services and the Mayor’s Homeless Office also on the scene. This particular hotel had a sprinkler system, so damage to the building was contained to one unit. Due to an electrical outage, smoke and water damage, residents were unable to return to their units. Approximately 40 residents were displaced. A temporary shelter was established at the Recreation Center located at 6th and Folsom, and fire victims were moved to the shelter by MUNI. Residents were able to return to their rooms’ three days after the fire when the damage had been assessed and the power was restored. Y2K Plan Update The Department has issued to the Health Commission its quarterly status report for Y2K Compliance for the period ending November 30, 1999. In this report, we note that staff continues to work with the City’s Y2K Program Management Office to insure coordination of contingency planning and Y2K readiness. In the past quarter, the Department staff participated in several external Y2K efforts. These included participation at a Board of Supervisors’ hearing on the City’s Y2K plans, a planning conference convened by the Mayor’s Office, and a focused training effort with the City’s Office of Emergency Services to review and finalize Y2K related emergency operational planning. As you know, a complete inventory and assessment of all of our MIS, medical and facility equipment and systems was conducted. I am very pleased to report that 100% of our mission critical systems and equipment has been tested as compliant or successfully remediated as of this date. Our supplies and distribution systems have been assessed as compliant, and we have planned for delivery or additional supplies for the millennium events. Finally, we have developed contingency plans and have developed appropriate back up procedures in the event of an emergency resulting from Y2K failures, either within DPH, or elsewhere in the City. In summary, DPH has completed a significant process in order to eliminate or minimize disruption from the Y2K millennium event. Significant technical and professional resources have been allocated to the compliance effort and the Department will continue to consider this area a high priority. Full completion of our Y2K compliance plan indicates that DPH is well prepared to insure continued uninterrupted business operations though the millennium event and beyond. As the millennium approaches the Department will continue to monitor its compliance and enhance its readiness procedures to insure optimal response to this historic event. The Department will schedule a final Y2K project closure update for the Health Commission in the weeks following the millennium event. I am attaching a copy of the quarterly status report for your review. COMMUNITY HEALTH NETWORK State Licensing & Certification Team Returns to LHH On December 6th, a team of State Licensing & Certification Surveyors arrived unannounced at Laguna Honda to conduct a resurvey and verification of a Plan of Correction submitted December 3rd. The survey team announced it would be at Laguna Honda through December 8th. I will advise the Commission of the outcome of the resurvey as soon as the results are available. U.S. Department of Justice Representative Visits LHH A representative of the U.S. Department of Justice is visiting Laguna Honda today as part of its ongoing investigation concerning the civil rights of residents. The Hospital's Leadership Team and legal council from the City Attorney's Office are conferring with the DOJ representative. I will keep the Commission apprised of any new information that may be forthcoming as a result of this week's DOJ visit. POPULATION HEALTH AND PREVENTION Asthma Training Report The Primary Care section of the CHN, the Children’s Environmental Health section of Population Health and Prevention, the American Lung Association, UCSF, SFHP and various pharmaceutical companies teamed up to present a series of trainings entitled "Asthma in the Primary Care Setting". Workshops were held at Ocean Park, SFGH, Maxine Hall and Chinatown Health Centers with over 400 physicians, nurses, respiratory therapists and other health providers attending. The workshops were geared towards primary care providers of asthmatics with the major feature being the review of the National Institute of Health’s latest guidelines and standards of care for asthma treatment. We were fortunate to have Stephen Lazarus, Susan Janson, and Homer Boushey as presenters from UCSF, as well as our internal SFGH experts, Rajeev Venkaya, Kevin Coulter and Karen Smith from Excelsior Clinic. Dental Section We recently surveyed and assembled data on the oral health status of San Francisco’s low-income children, as well as the availability of treatment services for the low-income population. We sent out surveys to all agencies serving the dental needs of this population and received information back from most of these agencies. Most of the screening data was collected by our own DPH staff who regularly screen children in schools in an effort to track community needs and help access these children to needed services. We know that 46 percent of low-income elementary school and 18 percent of low-income preschool children have untreated tooth decay. As a result, we are targeting these age groups for increased prevention efforts. In the future we will perform a quality needs assessment that looks closer at the adult population, where we currently have little information. I am attaching a copy of the report for your review. STD Clinic Effective December 1, 1999, the STD Clinic will begin utilizing GCLCX to diagnose pharyngeal gonorrhea in clients who report more than one receptive oral sex encounter in the past two weeks. A study was done with 202 men seen in the STD Clinic who reported having receptive oral sex to compare the efficacy of GCLCX with GC culture. The results of the study indicated that 10% of these men were positive for GC using the GCLCX test compared to 4% using the GC culture. On November 16th, the STD Program held a community forum for Men who have Sex with Men (MSM) to discuss STDs and their impact on MSM in San Francisco. The forum included a presentation on the epidemiology of STDs and another on proctitis, genital ulcer disease and urethritis. Translators were available for attendees who were hearing impaired. Pedestrian Safety The Community Health Promotion and Prevention Branch has been awarded a Pedestrian Safety Program grant from the State Office of Traffic Safety. The grant will fund data linkage and surveillance efforts, to provide the data needed to design interventions to reduce injury to pedestrians, and community capacity building, to involve residents and agencies in improving pedestrian safety. Adolescent Health in San Francisco I am pleased to provide the Commission with two new reports regarding the health of children and youth. "A Snapshot of Adolescent Health in San Francisco", developed under the auspices of the Adolescent Committee of the DPH Coordinating Council for Children, Youth and Families, provides an overview of key health and socioeconomic indicators for San Francisco's young people. The second report, "The Health and Well-Being of San Francisco's Unified School District Students, K-12", demonstrates the strong interdependence between student health and school performance. Both reports emphasize the largely preventable and treatable nature of the health conditions associated with child and adolescent mortality and morbidity and the need for expanded psychosocial services for our children, youth and families. HERC Grand Opening The Grand Opening of the Bayview Hunters Point Health and Environmental Resource Center took place on November 20, 1999. Over 100 residents and supporters attended and were taken on tours of the facility. The ribbon cutting, by Supervisor Alicia Becerill was witnessed by District Attorney Terence Hallinan and representatives from Congresswomen Nancy Pelosi's office. Supporters shared refreshments and entertainment and received information on breast cancer, asthma, prostate cancer and the environment. Commissioner Chow requested information on how the HERC integrates with the Department. He suggested a quarterly report on this important project. Commissioner Guy requested an evaluation component be included with this project. Commissioner Sanchez commended the Department for the three Department of Public Health reports on Children and Youth. 5) CONSIDERATION OF A RESOLUTION WHETHER CHANGES AT UCSF/MT. ZION MEDICAL CENTER WILL OR WILL NOT HAVE A DETRIMENTAL IMPACT ON THE HEALTH CARE SERVICE OF THE COMMUNITY Observing that no official representatives from UCSF/Stanford Health Care or UCSF/Mount Zion were present to respond to questions, President Monfredini expressed her disappointment and dismay for the perceived disrespect for the Commission and its Prop Q process. She also feels the Commission was not being told the truth at the November 16, 1999 Prop Q hearing, especially when a week later, the UCSF/Mount Zion Emergency Room was closed. Ms. Joyce Newstat, UCSF Community Relations staff, was present but could not respond to questions on behalf of UCSF/Stanford Health Care. President Monfredini thanked Ms. Newstat for her ongoing cooperation and responsiveness to the Commission. President Monfredini had requested multilingual signs be posted; and Ms. Newstat quickly responded. Ms. Newstat expressed a misunderstanding on the attendance of official representatives from UCSF/Stanford Health Care. Public Speakers: Raised negative impact on Russian emigres, cutbacks by UCSF at San Francisco General Hospital, lack of the County’s ability to do anything, and concerns for the Mt. Zion staff and long-standing role of Mt. Zion. Greg Smith, Bay Area Council Frederick Hobson, S.F. Tomorrow and S.F. Health Plan Jacqui Gough, CNA Kevin Reilly, CNA Dr. Reuven Jaffe Commissioner Chow had questions regarding the availability and time frame on the number of critical care beds. He requested responses prior to any decision on the proposed resolution. Commissioner Hill expressed his support for the Prop Q process and requested the representatives to attend the next meeting. Commissioner Parker stated there is lack of respect and courtesy to the Commission. Commissioner Umekubo recommended to continue the proposed resolution to the December 21st meeting. Commissioner Guy encouraged UCSF to divulge information on future cutbacks to services at San Francisco General Hospital. Commissioner Sanchez encouraged the Commission to move forward on the consideration of the resolution. Commissioner Chow stated his disappointment for the perceived disrespect to the public on the public process. Action taken: The Commission continued this item to the December 21st meeting and requested Ms. Newstat to notify Mr. Stempel, Dr. Goodell, and Dr. Goldman to attend this meeting. Action taken: The Commission added an amendment, proposed by Commissioner Guy, "Whereas, additionally, there will be a loss of skilled nursing beds with the closure of the UCSF/Mount Zion Skilled Nursing Facility, thereby decreasing the number of available skilled nursing beds in the City and County of San Francisco; . . ." 6) UPDATE ON MILLENNIUM EVENT PLANNING Department of Public Health staff, Anne Kronenberg and Chris Wachsmuth, provided an overview of the Department’s comprehensive, departmentwide planning process with other City agencies and private health providers to ensure the health and safety of all San Franciscans and visitors during the 4-day millennium celebration. There will be a coordinated health response utilizing technical preparedness, health prevention messages, disaster preparedness and management, augmentation of current direct care services and for the first time ever, the addition of DPH Field Care Clinics at several celebration sites. They reviewed the Department of Public Health Millennium Celebration Response Plan: Millennium Celebrations Mission and Goals Planning Assumptions Venues and Casualty Estimates DPH Millennium Celebration Public Education Prevention Messages Health Services Available Millennium Weekend DPH Millennium Disaster Response Organizational Charts Emergency Operations Center (EOC) DPH Operations Center (DOC) DPH Medical Command Center (MCP) DPH Millennium Direct Services Field Care Clinics SFGH Services Psychiatry Community Urgent Care Institutional Police Ambulance Services Special Programs for Youth President Monfredini requested a follow-up report after the millennium celebration. 7) PRESENTATION OF THE CHILDREN’S SERVICE PLAN FROM THE DEPARTMENT OF CHILDREN, YOUTH AND THEIR FAMILIES Deborah Alvarez-Rodriguez, Director of the Department of Children, Youth and Their Families, provided an overview of the 2000-2002 Children’s Service Plan. She emphasized that this is a 2-year planning cycle and is focusing on outcomes and results. She also encouraged the Commissioners to give her feedback on the plan. Commissioner Chow encouraged the continued collaboration and coordination between DPH and DCYF. Commissioner Guy pointed out the importance of integration of data with community input and perceptions. Commissioner Parker noted the need for balance among boys and girls’ programs. The Commission thanked Ms. Alvarez-Rodriguez for a comprehensive plan. 5:00 P.M. TIME SPECIFIC: 8) PRESENTATION OF SCHOOL-BASED HEALTH SERVICES AND CONSIDERATION OF A RESOLUTION ENDORSING THE PROPOSED PLAN BY THE DEPARTMENT OF CHILDREN, YOUTH AND THEIR FAMILIES, TO PROVIDE SCHOOL-BASED/SCHOOL-LINKED PHYSICAL HEALTH AND MENTAL HEALTH SERVICES IN TWO HIGH SCHOOLS IN THE SAN FRANCISCO UNIFIED SCHOOL DISTRICT Jimmy Loyce, Deputy Director of Health; Deborah Alvarez-Rodriguez, Director of the Department of Children, Youth and Their Families; Sally Chow and Trish Bascom, Administrators from the S.F. Unified School District, presented recommendations for school-based, school-linked services expansion at San Francisco’s high schools. For a copy of this report contact the Commission Office (554-2666). During the FY 1999-2000 budget process, the Board of Supervisors placed $550,000 on reserve (one-time only) in the DCYF budget for school-based health services. The Board of Supervisors asked DCYF to convene a School Health Task Force with representatives from the Department of Public Health, the San Francisco Unified School District and numerous public and private agencies, including private health plans, youth advocates, and health service providers. Commissioners’ Comments: Sustainability is needed Need to include all high schools Programs need to be youth-friendly Youth need to be involved with planning and development Exciting to see the three departments working together Health promotion and prevention need to be included Positive commitment and response from the School District are encouraging This program will succeed and expand The Principals from Galileo and Lincoln High Schools voiced their support for the plan. Action Taken: The Commission unanimously approved Resolution # 27-99, entitled "Endorsing the Proposed Plan by the Department of Children, Youth and Their Families, to Provide School-Based/School-Linked Physical Health and Mental Health Services in Two High Schools in the San Francisco Unified School District" with an amendment by Commissioner Chow changing the words "governing body" to "Policy Steering Committee." 9) OTHER BUSINESS/PUBLIC COMMENTS None. The meeting was adjourned at 6:35 P.M. Sandy Ouye Mori, Executive Secretary to the Health Commission