Minutes of the Health Commission Meeting Tuesday, January 18, 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 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. Absent: Commissioner Edward A. Chow, M.D. 2) APPROVAL OF MINUTES OF THE REGULAR MEETING OF JANUARY 4, 2000 Action Taken: The Commission unanimously adopted the minutes of January 4, 2000. 3) DIRECTOR’S REPORT (Provides information on activities and operations of the Department). (Mitchell H. Katz, M.D., Director of Health) ADMINISTRATION Governor Davis’ State of the State Address On January 5, 2000, Governor Gray Davis delivered his State of the State Address. The primary focus of Governor Davis’ address was education, though he also addressed, to a much lesser extent, health care for the elderly, transportation and public safety. With regard to health care, Governor Davis’ proposals relate largely to health care for the elderly, but also address the elimination of Medi-Cal fraud. The Governor supports community-based alternatives to care in a nursing home. However, recognizing that there will continue to be a need for nursing home care, the Governor also proposed changes to nursing home regulations. Following are the Governor’s health care proposals: $500 tax credit for the elderly or their caregivers for the cost of special assistance provided at home Increased wages for in home support service workers Expanded coverage of out-of-pocket costs for disabled seniors $20 million this year and $500 million over 10 years, funded in partnership with the private sector, to expand adult day care facilities, community centers and full-service residential centers Tightened financial requirements for nursing homes 200 additional nursing home investigators Increased fines for negligence in a nursing home that leads to death of an elderly resident Increased wages for nursing home workers Increased training opportunities for nursing home workers $26.2 million for the elimination of Medi-Cal fraud Ryan White CARE Act The tentative 2000-01 Ryan White CARE Act award for the San Francisco Eligible Metropolitan Area (EMA) is $35,246,477, down $972,000 from last year. This represents a 2.8% decrease. The San Francisco EMA includes Marin, San Francisco and San Mateo counties. Pursuant to the hold harmless clause in the current Ryan White CARE Act formula, San Francisco generally experiences an annual decrease of approximately 1% to 1.5%. San Francisco will experience a greater reduction in the upcoming year due in part to across the board funding cuts in federal Health and Human Services budgets. Additionally, pursuant to the AIDS State of Emergency declared by the Congressional Black Caucus in 1998, a portion of the CARE Act appropriations have been directed to areas where the epidemic is disproportionately represented in persons of color. We are currently working with the Department’s HIV Services staff, and the Ryan White Planning Council to determine how we will manage the reduction. Strategic Planning Initiative Since my last report to the Health Commission, the Department’s strategic planning initiative has focused its work on: adopting guiding principles for the initiative and approving the communications plan. Attached to my report are copies of the guiding principles, a flyer announcing the first series of community meetings and the updated work plan indicating our progress to date. The guiding principles are based on the belief that the Department must take a broad view of health, better utilize health data (qualitative and quantitative), ensure comprehensive and integrated services, and emphasize prevention. The communications plan describes the strategy for assuring that there is broad and diverse input into this effort from staff, consumers and the public-at-large. The first series of community meetings will be held later this month. Both the guiding principles and the communications plan are accessible via the Department’s strategic planning web site (www.dph.sf.ca.us/stratplan). In addition, an electronic mail address has been created (StrategicPlanning@dph.sf.ca.us) to provide the public and staff with an opportunity to provide comments on this effort. Over the next several weeks, the Populations and Program Sub-Committee will be developing its recommendations to the strategic planning questions concerning populations served by the Department. The Finance Sub-Committee will resume its meetings in February 2000 after the Department’s proposed 2000 budget has been approved the Health Commission. The City Attorney’s Office is assisting in our strategic planning effort by reviewing and summarizing the numerous mandates that relate to public health and health care services. I will continue to keep the Health Commission apprised of this effort as it proceeds. Journal Article on Unmet Needs for HIV-Infected Persons The journal Medical Care, last week published a national study showing substantial need and unmet need for supportive services among HIV-infected persons. In the study, two-thirds of the sample needed at least one supportive service: 43% needed benefits advocacy, 33% needed emotional counseling, 19% needed housing, 17% home health care, and 10% needed substance abuse treatment. Among those in need of services, 40% did not have their needs for services met. The specific unmet needs in diminishing order was for benefits advocacy (35%), substance abuse treatment (28%), emotional counseling (25%), home health care (17%), and housing (16%). The Department believes the study underscores the importance of adequate-funding and reauthorization of the Ryan White CARE Act to help jurisdictions such as San Francisco help pay for crucial supportive services.  [related news release] POPULATION HEALTH AND PREVENTION Emergency Medical Services System Report Attached for your review is a detailed report on the Department’s EMS Section including updates on the SFFD - Paramedic merger, hospital diversion, and specific EMS program updates. Of special note is preliminary data on the 1 and 1 pilot project indicating that ambulances staffed with one EMT and one paramedic safely and effectively respond to medical calls as an integrated component of the SF EMS system. The 1999 average percentage of time for all SF Hospitals on Critical Care Diversion was lower than in 1998, but Total Diversion steadily increased. The months of millennium planning paid a dividend and helped San Francisco hospitals prepare for the flu season. All local hospitals, including SFGH invoked their internal response mechanisms to manage the increase in patient demand. The overall impact of the Mt. Zion closure on flu season is unknown at this time, but the EMS Section is doing a review this Spring that will give the Commission a "before and after" closure snapshot. We are pleased to report that the Disaster Registry Program for seniors and persons with disabilities reached several milestones late in 1999. Lock boxes including registrants’ names were delivered to all the SFFD Battalion stations. Children, Youth and Family Program’s New Childcare Health Unit The Children Youth and Family Program is pleased to announce the formation of a new Childcare Health Unit. The program will be staffed by four public health nurses: Marcia Livingston, Johanna Solorzano-Montano, Veronica Thorne-Dixson and Jimmy Yan. The overall objective of the Childcare Health Unit is to improve the health and safety outcomes for San Francisco children in childcare. The commitment of the unit will be to promote quality childcare by advocating and coordinating the linkages between health, safety and childcare. This will be accomplished by providing health and safety consultation services to the childcare community through Childcare Health Consultants in the county public health system. Initially, four designated CalWORKS childcare centers will receive consultation services. By focusing on these centers, the Childcare Health Unit will develop program objectives to increase access to quality health and childcare services for all San Francisco families. Sistah, Sistah Program Receives Grant From Union Bank Union Bank of California, Bayview Branch, has awarded the Sistah, Sistah Program a $10,000 grant to be used in program activities. Sistah, Sistah is a home-visiting program that works with pregnant women and their families to help prevent child abuse and promote the development of healthy infant practices in the home. The program is funded by the State of California through the San Francisco Department of Public Health. Services include: in-home visits by trained staff, weekly parenting classes, job and medical referrals, child development classes, family support services and a group for fathers called Navigator Group. Hepatitis C Forum CSAS and the community-based organization SAGE are sponsoring a forum on Hepatitis C January 31st at Fort Mason. John Tindall, Lac founder and Director of the Yuan Traditional Medicine College will present information about natural health care approaches to treating and managing Hepatitis C. Afrocentric Parenting Conference On February 11, the Black Infant Health Improvement Project will present the Fifth Annual Afrocentric Parenting Conference. The purpose of the Conference is to share practical, theoretical, spiritual insight and enhance knowledge and skills for parenting and the African-American family. The conference will feature Joseph Dullin, the founder and Executive Director of the National African American Parent Involvement Day, a national call to Black parents and educators for more participation in schools. Season for Bacterial Meningitis On January 18th, a Public Health Reminder was sent to hospital ERs and ER physicians reminding them that winter months are the season for bacterial meningitis along with recommendations for work-up and treatment. There have been 5 cases of bacterial meningitis in the past month, a slight increase over winter months in previous years. COMMUNITY HEALTH NETWORK Laguna Honda Hospital Replacement Project Process Begins Request for Qualifications Released Significant strides have been made in initiating the LHH Replacement Project process. The Department of Public Health and the Department of Public Works have issued a Request for Qualifications (RFQ) for the project's Executive Architect. On Tuesday, January 11th, the RFQ was presented to the architectural/engineering professional community in Simon Auditorium at Laguna Honda. Approximately 100 potential applicants were present at this meeting. February 15th is the deadline for responses for the RFQ. During February, a Technical Review Committee will screen the applications to identify those that meet the minimum qualifications. A short list of the best applicants will then be selected for interviews. A selection panel will interview applicants on the short list and select the very best executive architect for the project. Final selection is tentatively scheduled for March 24th. We expect the architect's contract to be consummated within a few weeks thereafter, and the design work to commence this spring. Environmental Impact Report Process Initiated Department staff has filed an application to begin the Environmental Impact Review (EIR) for the project with City Planning. The firm Impact Science Incorporated has been selected by City Planning to perform the initial environmental review. The review will focus on transportation and historic preservation issues along with other required environmental elements. It is expected that the entire EIR process will take approximately one year to complete. HUD Funds Available for Application The Mayor's Office has received notification from the United States Department of Housing and Urban Development that the City may apply for $750,000 in development funds for the LHH Assisted Living Project. These funds are a direct result of advocacy by our State Senator, Dianne Feinstein. Our staff will meet with representatives from the Mayor's Housing Department to develop the application. The housing component will be coordinated under the master plan for the project by the City Architect. Project Management Team Being Planned There have been several meetings with the City Architect and representatives from the Department of Public Health and the Department of Public Works regarding the development of a management team for this project. The scope of the project requires a number of professional disciplines to successfully manage the project. Those departments with direct responsibility for the project will have representatives on the project management team. I will continue to provide the Commission with periodic progress reports on the Replacement Project. Balboa Teen Health Center Grant The Community Health Network’s Balboa Teen Health Center recently received a $370,185 grant from the California Endowment "Communities First" program to fund Phase II of the Center’s Partner Support Program. The Partner Support Program is an innovative program that seeks to improve the self-esteem of at-risk adolescents attending Balboa High School to reduce high rates of teen pregnancy and sexually transmitted diseases and to prepare students for the worlds of work and college. Phase I of the program focused on sexuality issues. Phase II will expand the focus to promote positive decision-making by individuals as they confront a variety of options in their lives that could lead to positive or negative outcomes. It will also seek to increase the number of male students involved in the program. I would like to extend my congratulations to Michael Baxter, Teen Health Center Director, and Jan Murphy, CHN Primary Care Administrator. The documents attached to the Director’s Report are available in the Commission Office, 101 Grove Street, Room #311, (telephone 554-2666). 4) BUDGET COMMITTEE ITEM (Commissioner Ron Hill) CHN-Administration – Request for approval of contract modification with UCSF Stanford Health Care (UCSF SHC), in the amount of $850,000, to provide tertiary care services targeting medically indigent adults for the period of January 1, 2000 through June 30, 2000. The total contract amount will be $3,400,000 for the period July 1, 1998 through June 30, 2000. (DPH contracted with UCSF SHC) for services totaling $1,705,000 during FY 1998-99). Action Taken: The Commission approved the contract modification in the amount of $850,000. 5) ELECTION OF PRESIDENT AND VICE PRESIDENT OF THE HEALTH COMMISSION Commissioner Hill nominated Commissioner Roma Guy for President, with a second by Commissioner Monfredini. Commissioner Parker recommended to close the nominations. Action Taken: The Commission elected Commissioner Roma Guy as the President for the year 2000. Commissioner Sanchez nominated Commissioner Umekubo for Vice President, with a second by Commissioner Hill. Action Taken: The Commission elected Commissioner Umekubo as the Vice President for the year 2000. President Guy announced that she and Commissioner Parker have been reappointed by the Mayor to the Health Commission. Commissioner Guy thanked her colleagues for their support. She acknowledged and thanked Commissioner Monfredini for her leadership role in the passage of Proposition A (Laguna Honda Hospital Bond), the amended Policy #24, and designation of prevention as a high priority for the Commission. Commissioner Monfredini thanked her colleagues for their support during her 2-year presidency. She is proud of her work on the passage of Prop A, the amended Policy #24, and the inception of the monthly Employee Recognition Awards, Vice President Umekubo thanked his colleagues for their support. During his first year on the Commission he has gained much insight into health care in the City and County of San Francisco and looks forward to the challenges and working with the Department and his colleagues. Commissioner Sanchez thanked and complimented Commissioner Monfredini for her leadership. 6) PRESENTATION OF THE 1999 SAN FRANCISCO GENERAL HOSPITAL COMPETENCY REPORT Gene O’Connell, Executive Administrator for San Francisco General Hospital, presented the annual staff competency report. It included: A summary of our employees’ performance appraisal ratings Problem areas identified for employees with poor ratings Education plan to address problem areas and support the employees A copy of this report is available in the Commission Office, 101 Grove Street, Room #311. Commissioner Monfredini complimented staff for an improved report and acknowledged the hard work to produce this report. Ms. O’Connell acknowledged Rod Auyang of Human Resources, and Doreen Dare, R.N., M.S., Director of Training and Education. 7) UPDATE ON EQUAL ACCESS TO MENTAL HEALTH SERVICES Louise Roger5s, Planner for the Mental Health Division, presented a status report on the implementation of the Mental Health Plan and single standard of care policy in FY 1998-99. President Guy thanked Jo Ruffin, Director of Mental Health Services, and her staff, for the report and the important and useful data. She also acknowledged the public for advocating and encouraging the Health Commission to support this mental health policy. 8) PRESENTATION OF THE GOVERNOR’S STATE BUDGET Tangerine Brigham, Director of Policy and Planning, provided this overview of the health related provisions of Governor Davis’ proposed 2000-01 State budget: Governor Davis released his proposed 2000-01 budget on Monday, January 10, 2000. The budget proposes total expenditures of $88.1 billion, $68.8 billion of which is attributed to the State’s General Fund. This represents the largest budget the State of California has ever had. The Governor’s budget message made particular note of capital gains taxes which increased by 28% between 1997 and 1998, by another 22% in 1999, and are budgeted for no increase or modest decline in 1999. Since this is a particularly volatile and unreliable source of revenue, the Governor’s budget, as it did last year, earmarks a substantial portion of the budget for one-time expenditures, such as construction of new State buildings and highways. More than half of the State’s General Fund expenditures (53.5%) is proposed in education. Expenditures for kindergarten through 12th grade are up $28 billion, (6.25%) from last year. Spending on higher education has increased 11%, with an additional $8.8 billion budgeted for 2000-01. The Governor’s budget also includes $7.5 billion for transportation projects across California, including more money for light rail, Caltrain service in the San Jose area and San Francisco Bay ferries. The Governor’s proposed spending on public safety would rise 2.7% to $7.3 billion. The proposed budget, however, offers little new financial help for cities and counties. For health and human services, the Governor has proposed General Fund expenditures of $18.9 billion, up 5% from last year. Many of the proposed increases are maintenance of need and caseload increases rather than program expansions. These programs include Access for Infants and Mothers (AIM), Healthy Families, the Breast Cancer Early Detection Program, the Child Health and Disability Prevention (CHDP) Program, the California Children’s services (CCS) Program, and the Genetically Handicapped Persons Program. The proposal also budgets $3 billion for environmental protection. The health related issues included Medi-Cal, the Aging with Dignity Initiative, public health, behavioral health, Healthy Families, Department of Managed Care, and Tobacco Settlement funds. A copy of the full report is available in the Commission Office, 101 Grove Street, Room #311. Dr. Katz pointed out this State budget is an improvement over previous years. He also stated the State Senate and Assembly are not all sold on the large fraud problem. There are more needs for health care services. President Guy pointed out that State Senate Pro Tem John Burton has mental health and homelessness as high priorities. Ms. Brigham will keep the Commission informed on the health related State budget actions. 9) OTHER BUSINESS/PUBLIC COMMENTS President Guy announced that she will be making and announcing her appointments of Commissioners to the Commission Committees within the next 72 hours. This information will be available in the Commission Office (554-2666). All of the Commission Committees will be open to the public. President Guy is open to changing and evaluating the Committee structure, with input from staff and the public. The meeting was adjourned at 4:45 P.M. Sandy Ouye Mori, Executive Secretary to the Health Commission