Minutes of the Health Commission Meeting Tuesday, January 4, 2000 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. On behalf of the Commission, President Monfredini presented a Certificate of Appreciation to Elizabeth Stoller, MPH, who has been with the Department for 14½ years and will be taking a position with the Institute of Global Health. President Monfredini acknowledged the leadership of AIDS activist Dick Pabich, who recently died. He had been the Mayor’s AIDS Policy Advisor. 2) APPROVAL OF MINUTES OF THE REGULAR MEETING OF DECEMBER 21, 1999 Action Taken: The Commission unanimously adopted the minutes of December 21, 1999. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) (3.1) DPH Administration – Request for approval of proposed ordinance to revise patient rates for home health and trauma services. Trauma services were not included in this revision. (3.2) PHP-CHS-Medical Services (AB 75) – Request for approval to authorize adoption of the County Description of Proposed Expenditure of California Healthcare for Indigents Program (CHIP) funds for fiscal year 1999/00. The Department submitted a FY 1999-00 Description of Proposed Expenditures of CHIP/RHS Funds. (3.3) PHP-HIV Services – Request for approval to extend the terms of 70 CARE-funded HIV health service contracts with the following 49 contractors, for three months, from March 1, 2000 through May 31, 2000: AIDS Emergency Fund; AIDS Legal Referral Panel; American College Traditional Chinese Medicine; Ark of Refuge; Asian and Pacific Islander Wellness Center; Baker Places, Inc.; Bar Association of San Francisco; Bayview Hunters Point Foundation; Black Coalition on AIDS; Catholic Charities; Chemical Awareness and Treatment Services; Community Dental Care, Inc.; Continuum HIV Day Services; Dolores Street Community Services; Family Service Agency of San Francisco; Family Support Services of the Bay Area; Glide Foundation; Haight-Ashbury Free Clinics, Inc.; Immune Enhancement Project; Instituto Familiar de la Raza; Iris Center; Larkin Street Youth Center; Legal Services for Children; Lutheran Social Services; Lyon Martin Women’s Health Services; Maitri AIDS Hospice; Mission Neighborhood Health Center; New Leaf; Project Open Hand; Positive Resource Center; Quan Yin Healing Arts Center; Saint Mary’s Medical Center; San Francisco AIDS Foundation; San Francisco Community Clinic Consortium; San Francisco Food Bank; San Francisco Suicide Prevention; Shanti Project; The Support Center; Tenderloin AIDS Resource Center; UCSF AIDS Education Training Center; UCSF Center on Deafness; UCSF Department of Psychiatry/AIDS Health Project; UCSF Department of Psychiatry/Substance Abuse Services; UCSF Pediatric AIDS Program; UCSF Women’s Specialty Clinic; University of the Pacific School of Dentistry; Urban Indian Health Board; Walden House; Westside Community Mental Health Center. Commissioner Sanchez abstained on the UCSF contracts. Commissioner Umekubo abstained on the St. Mary’s contract. (3.4) PHP-Housing Services – Request for approval of a new contract with Episcopal Community Services in the amount of $67,513, to provide support services to Rose Hotel tenants as delivered by the Health, Housing and Integrated Services Network, for the period of December 1, 1999 through June 30, 2000. Action Taken: The Commission unanimously approved the Consent Calendar of the Budget Committee, with Commissioners Sanchez and Umekubo abstaining on the UCSF and St. Mary’s contracts, respectively. 4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) (Provides information on activities and operations of the Department). ADMINISTRATION Millennium Thank You I want to express my sincere thanks to all DPH staff who helped make the Millennium celebration a well-planned success. Although the evening did not evolve into the rapid-response mode for which we had prepared, the months and weeks of planning down to the essential details served as a good basis for emergency preparedness both within the Department as well as with other City agencies. During the course of the evening, I visited all of the Field Care Clinics and dropped by the Emergency Operations Center. I found the people who worked on New Years Eve to be responsive and energized by the teamwork and the very clear mission to care for those who were in need of assistance. It was an evening that was personally and professionally gratifying. I was proud of our efforts as a Department, gratified by our level of commitment and reassured that the public health of the residents of San Francisco is in good and capable hands. 1999 Homeless Death Report Attached is a copy of the 1999 homeless death report for your review. This report has been compiled annually since 1990. Using data provided by the Medical Examiner, the City counts the number of homeless individuals who die each year to help us identify and fill the gaps in our City’s system of care so that we in turn can prevent future homeless deaths. Unfortunately, the number of homeless deaths has increased again this year. When DPH took over the homeless death review, it had no connection to City programs. Since then the Department has developed a homeless death prevention team to identify and evaluate people who were homeless and at risk to insure that they have case management and access to health care and other City services. As the report indicates, the leading causes of homeless death are related to alcohol and drug abuse. For the last several years, with the support of the Mayor and the Board of Supervisors, the City has been incrementally implementing its Treatment on Demand (TOD) program. This year’s report shows that the proportion of homeless deaths due to substance abuse has decreased indicating the success of this initiative. San Francisco has also increased mental health access for the homeless population with the support of the Mayor and Board of Supervisors. Homelessness has increased on a national level; tracking homeless deaths will help us formulate a thoughtful approach to preventing future deaths in San Francisco. Soft Tissue Infection The Examiner published a story in yesterday's paper that reviewed the problem of soft tissue infection at SFGH. I have reported to the Health Commission informally on this subject on a number of occasions, and take this opportunity to highlight some of the important points on this topic. Soft tissue infections, or abscesses, are frequent consequences of long-term injection drug use. If caught early, abscesses are simple to treat. When left untreated, abscesses often need to be treated in the operating room rather than the outpatient setting and can lead to systemic infections, long-term hospitalizations, amputation and even death. Approximately one of every three injection drug users in San Francisco has an active abscess at any given time. It is the leading diagnosis upon discharge from the SFGH emergency department and the leading diagnosis for admission to the hospital. The Subcommittee on Hospital Management and the joint Soft Tissue Infection Committee have been meeting to address some preemptive programs designed to decrease the number and intensity of soft tissue infections. Two proposals are being discussed. A wrap-around approach to already existing community-based services would provide staffing for medical care and substance use treatment assessment and referral at every DPH-funded needle exchange program. This would be augmented by follow up care and primary care at a CHN clinic thereby reducing the burden of care for STI’s in the hospital and reducing costs to the City overall. The second proposal, in collaboration with the Department of Surgery at San Francisco General Hospital, would create an Outpatient "Wound Center", ideally located on Unit 4C, the current location of the Wound Care Clinic. Patients who present with soft tissue infection could be directed to this multidisciplinary clinic where they would receive specialized medical care, linkage to other services, education and management follow-up. This has the potential to free up the emergency room and decrease surgical care and subsequent admissions. POPULATION HEALTH AND PREVENTION CALWorks Since Welfare Reform began, Population Health and Prevention has been developing behavioral health and domestic violence programs specifically to meet the needs of CalWORKs families. When we began, it was estimated that 40% of CalWORKs recipients were victims of childhood physical or sexual abuse and over 60% were current victims of domestic violence. None-the-less, we were all shocked and saddened to learn that one of the CalWORKs graduates, who was employed by DHS as a Public Service Assistant, was murdered by her ex-husband two weeks ago. The victim left 4 children. CalWORKs Counseling staff from Westside reached out to family members -- including the 10-year-old daughter who witnessed the murder, her schoolmates, teachers, and childcare workers -- to provide crisis intervention and on-going support. With the help of the CalWORKs Domestic Violence counselor from WOMAN, Inc., Westside also provided support to the DHS Employment Specialists to help them deal with their own shock of losing a valued co-worker. Although we were able to provide support to many of those who were traumatized as a result of this sad event, we will intensify our education and outreach efforts with CalWORKs families and DHS staff to try to prevent such tragedies from striking in the future. Community Substance Abuse CSAS has just been awarded 1.3 million dollars from the Substance Abuse and Mental Health Services Administration for the development of a medically assisted detox with Baker Places Inc. This detox will be located in the community but is targeted to provide service to CHN clients from the Emergency Department and Psychiatric Emergency Services. COMMUNITY HEALTH NETWORK Announcements Welcome to Hiroshi Tokubo, the new Director of CHN’s Quality Management program. Mr. Tokubo has experience in academic medical centers at Mt. Sinai Medical Center, both University of California Medical Centers in Irvine and San Francisco and at Brigham and Women’s Hospital. He earned his MBA from City University in New York and his JD from Hastings College of Law in San Francisco. His skills include facilitating inter and multi-disciplinary team projects involving resource utilization and process improvement. Thanks to Allison Moed for serving as Acting Director of Quality Management. Dr. Katz gave an overview of his month-long clinical work at SFGH, giving examples of patient care in the acute care setting. He sees the need to develop alternatives to acute care services and prevention strategies to decrease the costs at the acute care levels. Commissioner Guy encouraged the Department to have an evaluation component to the new grant for a medically assisted detox with Baker Places Inc. Commissioner Chow would like to see an analysis of the homeless population in the quarterly reports on homeless deaths. Commissioner Sanchez acknowledged the high quality of care at SFGH given to an elderly person in the Latino community. Commissioner Parker expressed his concern for the overall health status of San Franciscans and the need to put more emphasis on prevention. 5) SPECIAL PRESENTATION TO KEY LAGUNA HONDA HOSPITAL BOND INITIATIVE VOLUNTEERS The Commission presented the following persons with special recognition certificates for their work on the recently-passed Laguna Honda Hospital Bond Initiative (Proposition A): Lee Ann Monfredini Mitchell H. Katz, M.D. Louise Renne Jean McClatchy Bricker Charles Levinson Robert Neil Laney Whitcanack Tony Irons Tangerine Brigham Larry Funk Anthony G. Wagner Doris Mitchell Sal Rosselli Joan Braconi John Marshall Oletha Hunt, CNA President Monfredini described each persons contribution to the campaign and expressed her personal appreciation to the team. Commissioner Guy thanked President Monfredini for her leadership and acknowledged the overwhelming voters’ support (well over the required 2/3 vote) for this bond measure. Jean McClatchy Bricker, Doris Mitchell, and Oletha Hunt were not present. Sal Rosselli was present but had to leave prior to the presentation. 6) FOLLOW UP REPORT ON THE CITYWIDE MILLENNIUM PLAN Anne Kronenberg, Director of External Affairs, submitted a document detailing the millennium celebration. She also submitted the final version of the DPH Millennium Celebration Response Plan and external materials produced by DPH for the millennium weekend. Ms. Kronenberg reported that the Department of Public Health spent 6 months in a comprehensive, department-wide planning process with other city agencies and private health providers preparing for the New Year’s eve celebrations. The extensive planning process can be credited with the overwhelming success of the weekend celebrations. The Field Care Clinics provided services to over 200 revelers. Had these clinics not been operational, the ambulance providers and emergency departments would likely have been overwhelmed. Commissioner Umekubo thanked Ms. Kronenberg for her work and also acknowledged the leadership of Dr. John Brown and the private hospitals. Commissioner Chow stated this system developed for special events could be a model for other cities. Dr. Katz commented on the positive joint collaboration among all of the City Departments (i.e. Public Health, Fire, Police, Sheriff). Nathan Nayman commented that this planning process success resulted from the private and public sectors setting aside differences and keeping focused on the goal. On behalf of the Commission, President Monfredini thanked the Department and Ms. Kronenberg for an excellent and comprehensive response plan. 7) OTHER BUSINESS/PUBLIC COMMENTS** None. The meeting was adjourned at 4:40 P.M. Sandy Ouye Mori, Executive Secretary to the Health Commission