Minutes of the Health Commission Meeting Tuesday, December 21, 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 3:10 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 DECEMBER 7, 1999 Action Taken: The Commission unanimously adopted the minutes of December 7, 1999. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) (3.1) CHN-Laguna Honda Hospital – Request for approval of contract renewal with Regents of the University of California, Department of Physiological Nursing (UCSF), in the amount of $141,725, to provide nursing services to Laguna Honda Hospital residents, for the period of October 1, 1999 through September 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. (3.2) PHP-CMHS – Request for approval of new contract with California Mental Health Directors Association (CMHDA), in the amount of $189,340, to provide mental health services for out-of-county minors under the San Francisco Mental Health Plan for the period of November 1, 1999 through June 30, 2001. (3.3) PHP-CMHS-Pharmacy – Request for approval of new contract with MedImpact Healthcare Systems, Inc. (MIHS), in the amount of $2,488,008 per year, or $6,012,686 total amount, to provide pharmacy benefits management services to a network of community pharmacies, for the period of February 1, 2000 through June 30, 2002. Commissioner Hill requested general information on any new contractor be included in the Commission packet. (3.4) PHP-CSAS – Request for retroactive contract renewal with Addiction Research and Treatment, Inc. (ART), in the amount of $4,422,029, to provide methadone maintenance and related counseling services targeting opiate-addicted persons for the period of July 1, 1999 through June 30, 2000. (DPH contracted with ART for services totaling $3,559,732 during FY 1998-99). The Department reported the performance scales in the monitoring reports will be corrected for the next round of contract reviews. (3.5) PHP-CSAS – Request for approval to accept and expend a new grant from the San Francisco Foundation, in the amount of $60,000, to support a multiple-year community planning process for a strategic plan for the substance abuse treatment-on-demand system, for the period of January 1, 2000 through December 31, 2002. Commissioner Hill acknowledged this important partnership with the S.F. Foundation. Commissioner Sanchez abstained on this item due to conflict of interest. (3.6) PHP-CSAS – Request for approval to accept and expend a new grant from the State of California Department of Alcohol and Drug Programs (DADP), in the amount of $367,942, for the Drug Court Partnership Program, to provide substance abuse assessment and treatment to individuals who are not meeting the conditions of probation, with a sole source contract modification in the amount of $367,942 to Asian American Recovery Services (AARS), for the period of July 1, 1999 through June 30, 2000. (3.7) PHP-CSAS – Request for approval for retroactive contract modifications to 12 contracts with providers of day treatment substance abuse services, to change the method of payment from a unit rate to an actual cost rate for the period of July 1, 1997 through June 30, 1998 (fiscal years 1997/98 and 1998/99), for the following contractors: Asian American Recovery Services, Inc. Horizons Unlimited of San Francisco, Inc. Morrisania West, Inc. Potrero Hill Neighborhood House, Inc. Mt. St. Joseph-St. Elizabeth's Epiphany Center Iris Center Mission Council on Alcohol Abuse for the Spanish Speaking Women and Children's Family Services SAGE Project New Leaf Services for Our Community Henry Ohlhoff House Westside Community Mental Health Center Commissioner Sanchez commended the Department in providing technical assistance to these contractors. Commissioner Hill commended the Department for addressing the program issues. (3.8) PHP-CMHS/CSAS – Request for approval of retroactive contract renewal with Westside Community Mental Health Center, Inc. (WCMHC), in the amount of $1,122,610 per year, or a total amount of $4,490,440, to provide mental health and substance abuse services for CalWorks Program’s Temporary Assistance for Needy Families clients, for the period of July 1, 1999 through June 30, 2003. (DPH contracted with WCMHC for services totaling $13,932,677 during FY 1998-99). (3.9) CHPP-Health Promotion – Request for retroactive approval of contract renewal with Polaris Research and Development, Inc., in the amount of $103,000, to provide Perinatal Outreach and Education services and Black Infant Health Project services, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with Polaris for services totaling $730,150 during FY 1998-99). (3.10) CHPP-HIV Prevention Services – Request for approval of new contract with Stop AIDS Project (SAP), in the amount of $231,754, to provide community level interventions to HIV seropositive men, for the period of December 29, 1999 through December 31, 2000. (DPH contracted with SAP for services totaling $793,093 during FY 1998-99). Public Speaker: Gilbert F. Criswell, Spectrum Newspaper, Cheap TV, Channel 29, opposed the approval of this contract and expressed concerns about the Community Advisory Board membership, the Steering Committee, and the key opinion leaders. Tim Leifield responded to the concerns. (3.11) CHPP-HIV Prevention Services – Request for approval of new contract with UCSF – AIDS Health Project, in the amount of $80,000, to provide training services members and staff of Department of Public Health community councils, for the period of December 29, 1999 through December 31, 2000. (DPH contracted with UCSF for services totaling $7,888,724 during FY 1998-99). (3.12) CHPP-HIV Prevention Services – Request for approval of new contract with Better World Advertising, in the amount of $295,640, to provide social marketing and health communication services to men who may or may not be aware of their HIV+ status and reside in San Francisco, for the period of December 29, 1999 through December 31, 2000. Commissioner Umekubo encouraged the contractor to develop a cultural competency plan. Before the full Commission, public speaker on: #3.10 – Gilbert F. Criswell, Spectrum Newspaper, Cheap TV, Channel 29, AT&T Cable, encouraged the Commission not to fund this contractor. #3.12 - Gilbert F. Criswell, Spectrum Newspaper, Cheap TV, Channel 29, Public Access TV Cable, expressed concerns on the costs for advertising from this contractor and submitted the Spectrum advertising rates. Commissioner Chow requested general information on the new contractor, Better World Advertising. Action taken: The Commission approved the Consent Calendar of the Budget Committee. On behalf of the Commission, President Monfredini made a special presentation to Abbie Yant, who has been with Emergency Medical Services for 14 years, and maintained continuity at the EMS Section during the period of several years transition of Medical Directors. 4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) (Provides information on activities and operations of the Department). ADMINISTRATION Homeless Death Review 1999 The 1999 Preliminary Homeless Death Review was released today. The report indicates that according to Medical Examiner data, 169 homeless deaths were recorded in 1999. Fifteen deaths are still under investigation. This indicates an increase by 12 deaths of those recorded in 1998. I think it is important to note a few things when acknowledging the report findings. When DPH took over the homeless death review, it had no connection to programs. The Department developed a homeless death prevention team to identify and refer the ‘at risk homeless population’ to insure they have access to care. For last several years, beginning FY96-97 the City has increased access to treatment for individuals using and abusing drugs through expansion of existing services and development of new services targeted to this populations. Mental Health services have also been expanded and efforts between outreach teams are now coordinated. In the 1998 Homeless Death Review, heroin was identified as a primary cause of homeless death. A heroin subcommittee of the Treatment on Demand Council (TOD) was formed to look at the issues of overdose prevention. These recommendations are coming forward as TOD initiatives in the FY00-01 budget request. It is important to note that the leading cause of death in the 1999 report is once again attributed to drugs and alcohol. The fact that homeless deaths increased this year means we have to continue outreach and to expand our services so the population is supported. POPULATION HEALTH AND PREVENTION HIV Prevention Funds for Incarcerated Individuals HIV Health Services applied for and received $500,000 in funding with the State Office of AIDS for a collaborative 3 year project for Intervention, Prevention and Continuity of care for incarcerated individuals within correctional settings and the community. The DPH, HIV Prevention Section, the Forensic AIDS Project and Centerforce in Los Angeles are included in this collaboration. Prevention for Positives Project In September, the HIV Prevention Section received a supplemental grant to the previously funded (1998) HIV Prevention for Positives multi-site demonstration project. The Prevention for Positives project is aimed at expanding knowledge of serostatus among communities of color and high risk populations, and is to provide prevention interventions geared toward behavior change among HIV + individuals. The annual supplemental funding of $372,600 (projected for 4 years) will be used to promote HIV testing in 6 neighborhoods in San Francisco. For the first time, CDC has allowed the Department to use these funds to offer HIV, STD, hepatitis A, B, C, and TB screening and testing in addition to HIV testing. Medical treatment will also be available by a nurse practitioner. COMMUNITY HEALTH NETWORK JCAHO Laboratory Survey at SFGH I am pleased and proud to report that the SFGH Clinical Laboratory, Anatomic Pathology and Nuclear Medicine Sections received a preliminary score of 99 out of 100 from their biennial JCAHO survey. The survey took place December 14 -17, during which all three Sections were evaluated on leadership, quality control, proficiency, competency, and performance improvement. Standards were met in all areas of evaluation. The surveyor cited the Clinical Laboratory Point of Care Testing Program as exemplary. Our congratulations and thanks to Donna Borland, Robert Christmas, Mary Clancy, Gayling Gee, Edward Howes, Heinz Lehmann, Valerie Ng, Gene O'Connell and all of their staff for their outstanding performance. Anthony Wagner American Hospital Association Delegate It is my pleasure to announce that Tony Wagner has been certified as a state delegate and member of Regional Policy Board 9 (RPB) of the American Hospital Association's (AHA) House of Delegates for a second term ending December 31, 2003. Region 9 includes Alaska, California, Hawaii, Nevada, Oregon and Washington. The regional policy board meets three times a year to discuss policy issues and alternatives. In addition, Mr. Wagner was elected to the Board of Trustees for the California Healthcare Association, formerly the California Hospital Association. Tony was re-elected to the California Association of Public Hospitals Board of Director's Executive Committee. SFGH Credentials Report 12/99 YTD New Appointments 17 1881     Reinstatements 0 Reappointments 21 3854     Delinquencies 0 0 Reappointment Denials 0 0 Resigned/Retired 08 189 Disciplinary Actions 0 0 Restriction/Limitations – Privileges 0 0 Changes in Privileges     Additions 0 28     Voluntary Relinquishment 0 6 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR DECEMBER 1999 On behalf of the Commission, President Monfredini presented awards to the following employees: Individual Nominee; Division; Nominated By David Rizzolo, Asbestos Program Manager Management; PH&P, Bureau of Environmental Health Management Program; Richard Lee, Manager, Community Toxics Prog. Cheryl Austin, Director Medical Records; Community Health Network, Laguna Honda Hospital, Medical Records; Larry Funk, Director  LHH Ginger Smyly, Deputy Director; PH&P, Community Health Promotion and Prevention; Larry Meredith, Director  CHP&P 6) CONTINUATION OF 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 Dr. Brian Goodell, UCSF/Stanford, apologized for the misunderstanding at the last Commission meeting and had submitted a letter to each of the Commissioners. He presented an update on the Mt. Zion reconfiguration and its impact on Parnassus Heights with the Emergency Department and inpatient care. Commissioners’ Comments: Concern for services to the Russian-speaking community There are still no replacements for the loss of skilled nursing beds at Mt. Zion Reconfiguration transition has caused inconvenience and stress to patients and staff There is a need to prevent other hospitals from closing Decreasing SNF beds overall in San Francisco Role of the Commission is to hold hearings and determine whether the closure of health services will or will not have an adverse effect Public Speakers: closure of Mt. Zion is detrimental Jacqui Gough, CNA Francisco Ugarte, CNA Frederick Hobson, S.F. Tomorrow, S.F. Health Plan Board Nathan Nayman, Hospital Council, expressed the need to work together on funding for private/public hospitals Action Taken: The Commission unanimously adopted Resolution #28-99, "Determining Whether the Elimination or Curtailment of Health Services by the University of California/Mount Zion Medical Center, Will or Will Not Have a Detrimental Impact on the Health Service of the Community". 7) PRESENTATION OF THE WOMEN’S SERVICES ADVISORY COMMITTEE Kate Monico-Klein, Coordinator of the Office of Women’s Services, outlined a proposal to create a Women’s Health Services Advisory Group to advise, propose policy, and advocate on behalf of the health care needs of women and girls. She recommended the following: That the Health Commission support the creation of a Women’s Health Services Committee (WHSC), designed to develop strategic plans on core health care issues to ensure that the interests and needs of women and girls are reflected in Department of Public Health strategic planning. WHSC shall focus upon policy impacts at all levels. Findings and recommendations shall be reported through the Director of Population Health and Prevention to the Health Commission on an annual basis or more often, as needed. WHSC shall report to the Director of Population Health and Prevention, as the designee of the Director of Public Health. WHSC shall meet monthly. The Committee shall be staffed by the Coordinator of Women’s Health Services with assistance from the Planning Division staff of the Department of Public Health and staff support from the Community Health Network. Membership shall be appointed by the Director of Public Health or his designee, the Director of Population Health and Prevention, for two-year terms. The work of the Committee, including its mission, membership and continuation, shall be reviewed every two years. Membership Membership shall be limited to 11 appointments, two of which shall be standing appointments from the Commission on the Status of Women and Women’s Health Leadership. Membership shall be drawn from community women’s health advocates and providers, including representatives reflecting the following women’s health populations and interests: Women’s health Chronic disease Violence prevention Homeless women Incarcerated women Immigrant women Young women Disabled women Older women Women’s Health Leadership (standing appointment) Commission on the Status of Women (standing appointment) Commissioners’ Comments: The membership should be more than 11 (i.e., 13-15) The WHSC would report to the Population Health and Prevention and would meeting monthly This proposed plan would implement the original policy of the Health Commission passed in 1991 An annual report should come to the Commission This is an excellent plan Commissioners encouraged the Department to make this Committee an effective one. 8) PRESENTATION OF THE AFRICAN AMERICAN HEALTH INITIATIVE (AAHI) Cynthia Selmar, LCSW, MPH, Director of the AAHI in the Community Health Promotion and Prevention Division, gave a status report on the AAHI, whose goal is to improve the health status of the African American community in San Francisco through focusing on prevention, health promotion, and community capacity building. For a copy of the full report, contact the Commission Office (554-2666). Ms. Selmar also included an overview of African American Community Health Focused Programs between 1984-1998 and a packet of information on the AAHI. The packet included organizational development information, African-centered principles/supporting policies, the AAHI goals, and a list of accomplishments. Brian Katcher, Pharm.D., Community Health Promotion and Prevention, presented data which points out the disparities in health outcomes between African Americans and other Americans. Ms. Selmar reported the conclusions of the AAHI: Independent of economics, race affects access to care. Independent of economics, race affects the type and quality of health care treatment received. Consequently, to improve the health of African Americans, it is not sufficient merely to remove economic barriers to access. To improve the health of African Americans, health care institutions must be more than affordable. Public Health and Health care institutions must encourage and provide for culturally competent primary prevention and health promotion, in addition to ready access to quality health care. If we are to achieve justice in health care for African American, then every effort must be made to more strategically utilize a public health approach to prevent injuries and illness prior to the need for health care services. A just health care system will focus on eliminating the disparities in health outcomes between African Americans and other Americans. AAHI suggest several policy approaches that can be taken to deal with this issue: Strategically target culturally competent prevention and health promotion services to African Americans at risk of injury, illness and premature death Eliminate racist practices in health care delivery and health care education. Allocate appropriate resources to implement culturally creative prevention programs in non-traditional settings; and Implement policy that demands departmental participation, at every level, in the implementation of the African-American Health Initiative and ensure African-American participation is included in decision-making that impacts the African American community. Coalition Speakers: Ena Acquirre, Executive Committee BVHP/HERC Charles Clary, Facilitator, Prostate Cancer – Men’s Collaborative Kathy Perry, Kaiser Permanente, Public Policy and Advocacy Committee Tosca Lee, I Am Cares Chair, Interfaith Committee Beverly Rashidd, Executive Director, Booker T. Washington Community Service Center, Chair, AACHIE Raymond Tompkins Gladys Sandlin, Latino community activist The speakers emphasized the need to expand the budget for the AAHI; pointed out the health disparities in the African American, Latino and Native American communities; advocated for housing, nutrition and education; and promoted funds should flow with the disease rates. Ms. Selmar highlighted the differences about the AAHI’s approach: The need is overwhelming and is evidenced-based on the Department’s own data, Health promotion and prevention focused which is a theme that can easily be replicated throughout both branches of the Department of Public Health and with all its contract programs Community empowerment-educating and teaching new skills (organizing, planning, asset mapping, grant writing, computer skills and decision making skills), creating employment opportunities, and developing opportunity for political advocacy and action Focused on developing both community responsibility and accountability and departmental responsibility and accountability. A Steering Committee is proposed that will be comprised of both departmental representatives and community representatives. The tasks will include assigning program staff, monitoring and evaluating programs that focus or target African Americans, providing technical assistance, recommend changes in funding patterns, and recommend policy that will ensure departmental/community program responsiveness and accountability Based on the integration of African-centered principles for community survival Finally, the desire is to change the culture of public health by creating and implementing health promotion and prevention programs in non-traditional health settings, (i.e., community businesses and social service organizations, recreation and community centers, faith-based communities, and in other public agencies/departments programs Ms. Selmar recommended how the Commission and Department can help the AAHI: Develop clear and specific policy/mandates that ensures departmental commitment to reduce the burden of health disparities in the African American community. (Federal and State mandates already exist as models). Allocate 1-2 % of the overall departmental budget to ensure availability of appropriate resources to implement and institutionalize the African American Health Initiative. Be open and flexible to contract amendments and the reallocation or targeted or focused resources (change current funding trends) to ensure program responsiveness to community need and program outcomes/accountability. Provide the leadership necessary to engage other Department commissions in supporting the African American Health Initiative by developing an intra-agency commission agreement via the Mayor and Board of Supervisors that acknowledges the need to collectively address the health and social issues impacting the African American community. (Department of Human Services, Department of Children, Youth and Families, Commission on the Aging, Parks and Recreation, Commission of the Environment, Commission on the Status of Women, just to name a few). Commissioner Parker thanked the Department for having the foresight to create the AAHI, and to appoint Ms. Selmar as the Director. Money is not the only support needed; need to work, work, work. Commissioner Hill stated the report is impressive. He inquired whether the Bayview Hunters Point Foundation was involved. Ms. Selmar indicated a line staff person from the agency is involved. Commissioner Guy sees this as another step; next is the budget process. She heard a consensus and unity for support. Commissioner Chow promoted a citywide effort in the African American community, to have a consensus from the community, and work with the CBO’s to adopt the principles. Commissioner Sanchez commended the Department for being a key partner and giving access. Commissioner Umekubo promoted access to care and to educate providers and health care professionals about the AAHI. Ms. Selmar would like to have a clear mandate and funding from the Health Commission. Dr. Katz sees the AAHI as a high priority, given the data available. Commissioners thanked Ms. Selmar and the community representatives for the excellent presentation. President Monfredini left at 6:00 p.m. Commissioner Sanchez left at 6:15 p.m. 9) CONSIDERATION OF A RESOLUTION FOR MEDICAL MARIJUANA IDENTIFICATION CARDS Dr. Herminia Palacio, MPH, Special Policy Advisor to the Director, provided the following background: The State of California passed The Compassionate Use Act of 1996 (Proposition 215) "to ensure that seriously ill Californians have the right to obtain and use marijuana for medical purposes". Following the passage of Proposition 215, the San Francisco Health Commission passed Resolution 4-97, defining the Department’s role in the implementation of the Proposition. In brief, the Department of Public Health supports the implementation of Proposition 215 through the responsible and accountable operation of marijuana distribution centers, and through the education of physicians regarding the potential benefits and risks of medicinal marijuana. To help facilitate communication between physicians and marijuana distribution centers, the Department of Public Health developed a standardized Physician’ Statement Form. While the use of this form is not mandate, it is our experience that forms in current use by marijuana distribution centers are modeled after this form. Drs. Gurley, Aranow, and Katz performed an extensive review of the literature, which served as the basis for the Department of Public Health’s Clinical Guidelines for Recommending Medical Marijuana, and which has been published in medical literature. Nevertheless, as the quality of the research to date has generally been poor, we recognize the need for additional research about the potential health benefits of marijuana. At his request, the Department of Public Health has supplied Attorney General Bill Lockyer with a brief that would assist and inform efforts to secure additional research on the clinical efficacy of marijuana. In addition, there are recent reports on medical marijuana issued by the National Institute of Health, and the Institute of Medicine. These early phases of activity around Proposition 215 were focused largely on education and support of clinicians, to facilitate the safe and responsible implementation of Proposition 2145 in their clinical practices. More recently, users and providers of medical marijuana (cannabis) have identified the need for public activities in a new arena, that of facilitating cooperation with law enforcement, to protect the rights of medical cannabis users and their primary care givers, as defined under Proposition 215. In response to community input and planning, and in consultation with representatives of the Department of Public Health and the City Attorney’s Office, Supervisor Mark Leno has proposed the creation of voluntary identification card system for individuals who qualify as medical cannabis users or primary care givers under California Health and Safety Code 11362.5. The intention of the voluntary identification card system is to provide an additional tool to facilitate the safe and responsible implementation of Proposition 215 under California Health and Safety Code 11362.5, and is, therefore, concordant with prior San Francisco Health Commission policy directives regarding medical marijuana. Dr. Palacio submitted a proposed resolution in support of the development and implementation of a voluntary medical cannabis identification card program. Commissioners’ Comments: This policy sends mixed messages to young people The issues of maintaining integrity and minimizing abuse of the ID cards were raised Supportive of Proposition 215 but due to Federal law, would the Health Commission and Department be putting themselves at risk? The Department should try it but should include monitoring and evaluation components Action Taken: The Commission (Chow, Guy, Parker and Umekubo) adopted Resolution #29-99, "Supporting the Development and Implementation of a Voluntary Medical Cannabis Identification Card Program," with Commissioner Chow’s addition of "monitoring" to the last Resolved. Commissioner Parker opposed the resolution. 10) CONSIDERATION OF A REPORT AND RESOLUTION FROM THE DEPARTMENT OF PUBLIC HEALTH STRATEGIC PLANNING STEERING COMMITTEE ON FINANCING APPROACHES FOR THE FY 2000-2001 BUDGET Monique Zmuda, Chief Financial Officer, reported on the strategic planning for financial strategies. The report includes the work of the Strategic Planning Steering Committee and its Finance Subcomittee. The findings and recommendations will be used to guide the development of the FY 2000-01 DPH budget. Ms. Zmuda reported that the strategic planning process will continue throughout the next calendar year, culminating in a final report to the Health Commission December 2000. This report addressed many of the goals outlined by the Finance Subcommittee. However, the Finance Subcommittee will continue its work in the coming year to address outstanding issues as well as to investigate any new issues that arise during the year. The outstanding issues to be completed or updated in the next year by the Finance Subcommittee include: Capacity of current health care agencies to continue to provide care Health care benchmarks Assessment of potential of increasing revenues and/or reducing operating costs (update) Assessment of options to redeploy or reallocate resources to increase efficiency and integrate services (update) Summary of legislative changes which will impact on health care financing (update) Impact of political changes on financing health care services (update) Revenue maximization strategies Cost reduction potential Grants Alliances with other entities Public Speakers: Gladys Sandlin, Strategic Planning Steering Committee, supports the report Glynn Washington, Human Services Network, advocated for parity of COLA’s between the CBO’ and civil servants Commissioners’ Feedback to the Department: Complimented staff and Steering Committee Department needs to live within its means Department has to be realistic; cannot achieve all of the recommendations; needs to prioritize the recommendations Department did an amazing piece of work in a short time Priorities include capital equipment, long-range plans for infrastructure, seismic upgrade, increase Medi-Cal reimbursement, prevention, African American Health Initiative, and development of community-based alternatives to inpatient and acute care Need to decide what the SFGH census should be, considering the appropriate salary savings and diversion statistics Need for hospital collaboration Need to look at the question of taking from one division to cover another division with a deficit Commissioner Chow recommended to eliminate the second Resolved. Commissioner Hill proposed the following two amendments: WHEREAS, the Health Commission acknowledges that without increased funding the reallocation of existing resources may result in service reductions or the redefinition of the scope of services; and, WHEREAS, the Health Commission expects the Department staff to operate programs within the approved revenues and expenditures for the present and future fiscal year; now, therefore, be it Public Speaker: Nathan Nayman, Hospital Council, stated the value of a hospital is not to be tied to the number of beds. Dr. Katz advocated looking at our health system in different ways and developing alternatives to hospitalization. Action Taken: The Commission unanimously adopted Resolution #30-99, "Endorsing Recommendations of the Strategic Planning Steering Committee and Other Department Committees Setting Priorities for the FY 2000-01 Budget," with Commissioner Hill’s additional amendments. 11) OTHER BUSINESS/PUBLIC COMMENTS None. The meeting was adjourned at 7:15 P.M. Sandy Ouye Mori, Executive Secretary to the Health Commission