Minutes of the Special Health Commission Meeting Tuesday, February 8, 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 Roma Guy, MSW, at 3:05 p.m. Present: Commissioner Edward A. Chow, M.D. Commissioner Roma P. Guy, M.S.W. Commissioner Ron Hill Commissioner Harrison Parker, Sr., D.D.S. Commissioner John I. Umekubo, M.D. Absent: Commissioner Lee Ann Monfredini Commissioner David J. Sanchez, Jr., Ph.D. 2) PRESENTATION OF THE PROPOSED DEPARTMENT OF PUBLIC HEALTH BUDGET FOR FY 2000-01 President Roma Guy opened the public hearing by indicating this is a Special Meeting requested by the Commission to hear from the public on the Department’s proposed budget for FY 2000-01. Simultaneously, the Commission had requested the Department to develop an overall Strategic Plan for the future of the Department. The Commission will, at its February 15 meeting, make a decision on the proposed budget. Before hearing public testimony, President Guy announced that Dr. Mitch Katz, Director of Health, was empanelled to be in the Superior Court today but requested his Executive Assistant Anne Kronenberg to present his message on the budget. Ms. Kronenberg read Dr. Katz’s message. Dr. Katz arrived at this meeting at 4:30 p.m. Public Speakers: Mabel Jung, Civil Service Community Mental Health Clinics, opposed cuts in the Civil Service Mental Health programs. Greg Parks, patient at Team II Clinic, received better care at this clinic than in the past ten years; opposed closure of this clinic. Dr. Stan Lipstiz, Civil Service outpatient clinics, described affects on citizens of San Francisco; described a patient. Enola D. Maxwell, Potrero Hill Neighborhood House, opposed closure of Potrero Hill Health Clinic; this is an exceptional clinic that knows people in the community; residents will not tolerate cuts. Eve Milton, Potrero Hill Health Center CAB, suggested proposals for the clinic. Yoshi Milton, Samoan community representative, no cuts at SFGH; need to find a way to save SFGH; people will suffer. Dr. Mark Leary, Deputy Chief SFGH Psychiatry, the proposed budget will displace paying patients to other places; special culturally competent psych units need to be preserved; opposed closure of inpatient psych units; present Laguna Honda Hospital units cannot serve these patients. Olivia Florez, SFGH, opposed closure of inpatient psych unit; SFGH works with psych patients in a special way. Shannon Coughlin, CHRIA, expressed outrage for departments to be told not to ask for new general funds and that Dr. Katz complies; every penny should go to free health care. Nora Roman, RN, Emergency Coalition to Save Public Health, expressed directives to the Department are absurd; budget cuts equal service cuts; acute care is still needed; privatization of pharmacy is inappropriate; re-open satellite pharmacy at SFGH; fund public health fully. Cindy Gyori, Tenderloin Clinic/Bayview Clubhouse, pointed out that contractors' wages are lower then civil services wages. Siddig Tillad, Co-chair HIV Services Planning Council, encouraged the development of reduction protocols and decreases in services; stakeholders need to be realistic and plan ahead. Mickey Shipley, CSAS Treatment on Demand Planning Council, opposed service cuts; described work of the Council; need substance abuse treatment services in the jails, culturally competent services for transgender population; more alcohol services, and dual diagnosis services for Asian/Pacific women. Lynn Kash,, Women's Community Clinic, advocated for this clinic to be included in the Department's budget; saves money by providing prevention services. Louis Altman, Mental Health Association of San Francisco, advocated preventive care (i.e., residential housing). Jeffrey Sherman, Episcopal Community Services, advocated for COLA's for contractors; may have to reduce services if COLA's are not given. Claudia Deyton, described her access to services at Potrero Hill Health Center; keep clinic open; other ways to save money during times of prosperity; clinic is smaller and more manageable. Norma Satten, PECC and LTC Task Force, supports home and community-based long term care and alternatives to institutional care. Estela R. Garcia, Instituto Familiar de la Raza, described the mental health/substance abuse services; quality of care to be upheld for Latinos and underserved. John Borsos, SEIU Local 250, described impact of hiring freeze and budget cuts; agrees with the new programs; this budget is pitting one vital service against another vital service; 18 million is not enough; explore other revenues; ask the private hospitals how they will address revenue problems. Don Bechler, Health Care for All, feels this proposal is out of synch with people in San Francisco; health plan should be better for San Franciscans. James Beck, Haight Ashbury Neighborhood Council, encouraged to lobby the Board of Supervisors to augment budget; supports integrated services, culturally specific services. Jo Anna DeVito-Larson, Mission Neighborhood Health Center, read letter from Gladys Sandlin opposing cuts to the Center, which has played a major role in the primary care network. Richard Heasley, San Francisco Mental Health Contractors' Association, questions why the financial positions of the City (i.e., surplus) is resulting in a negative effect on DPH; need more than the $18 million; wants to be partners with DPH to come up with a better proposal. Marushka France stated that every time she looks at our beautiful City Hall dome, she wonders how many people have died due to lack of services. Bill Klink, Local 3, pointed out the drain on CBO's who contract with DPH; urged a 5% increase in COLA's. Robert Resner, Other Bar, is a patient at Potrero Hill; described difficulty of waiting in the Pharmacy lines and taking a half day for a clinic appointment; budget cuts do not show patients respect. Steve Fields, Progress Foundation, applauds the direction in recognizing changes needed in the system of care; the Mayor's direction is unprecedented and people need to hear it. Treatment on Demand Planning Council Norma Hotaling, SAGE, described need for centers of service for comprehensive care. Ron Perez, Sheriff's Office, advocated for interventions and detox services in the jails and that methadone be available. Frank Johnson advocated for African American focus for substance abuse treatment services. Ann Togia, Samoans Against Substance Abuse, needs funding for substance abuse and mental health services for Samoans. Marc Rosenthal, Multi-Service Center South, stated treatment expansion is still a goal, not a reality. Pat Harrison, Glide Memorial Church, pointed out people are the greatest resources; money can always be found for a passion. Substance Abuse Mental Health Work Groups Jennifer Friedenbach, Coalition on Homelessness, stated people's health is being compromised; no meaningful public input into the budget process; cutting services and playing a shell game; send message to Mayor to fully fund the mental health system and Treatment on Demand. Darren Lewis, Coalition on Homelessness, observes that there are hypocrisy and lies in the City even though all reports promote expansion of services. Rosemary Dady, attorney, promoted increased resources for SSI advocacy which would result in savings for the City. James LaPoint, Coalition on Homelessness, was a former heroin user and was homeless; now has a job; recovery is very fragile; need for a chance and opportunity. Marykate Connor, Caduceus Outreach Services, pointed out there will be service cuts; unconscionable; this is negligence not treatment and negligent advice to the Mayor. Steve Walsh, MD, Northern California Psychiatric Society, advocated to maintain the inpatient culturally competent psych units. Hillary Yancey stated the need to help people in the community. Conny Ford, Local 3, urged the need for contractor COLA's for the workers; say no to Mayor Brown and Dr. Katz; do the right thing. Oscar Lee Williams, Potrero Hill Family Resource Center, supports Potrero Hill Health Center and its outreach to public housing; expressed difficulty in getting appointments at SFGH; questioned the sale of the Center property. Jamie Motley, Y-MAC, advocated for school-based health clinics, which are critical to the youth. Berta Guillen, Y-MAC, advocated for young people and health clinics in the schools. Nick Pasquariello, Potrero Hill Community Advisory Board, advocated for the excellent dental services at Potrero Hill Health Center; dental care is neglected in the budget. Nellene Urrey, LHH Nursing Supervisor, described staffing needs in nursing; frozen positions for LVNs, CNAs and RNs need to be released. Helynna Brooke, Mental Health Board, stated it is unconscionable in a time of prosperity to cut services to severely ill; there's fear that people from out-of-town will come for services. Allen Meyer, SFCCC, on behalf of John Gressman, expressed disappointment at the budget cuts without planning and input from the community and providers; described impact of cuts on three Consortium members. Anne Cassia, homeless youth, do not turn backs on queer youth. Amelia Truman, SFGH Department of Psychiatry, opposes closure of an inpatient psych ward; described diverse cultural units. Reverend Kas Togia, Samoans Against Substance Abuse, promoted funding for substance abuse services in the Samoan community. Kent Woo, NICOS Chinese Health Coalition, requested reinstatement of funds in the base budget for the gambling prevention program; gambling is a public health problem; described the use of last year's funds for this program. Doris Mitchell, Local 250, on behalf of Bryan Uyeno and Gil Pope, described conditions for laundry workers; need for adequate staffing in laundry and housekeeping; there is low morale among the workers. Larry Bean, MHRF, described understaffing issues at the MHRF. Paul A. Hendrickson, Bayview Clubhouse, supports funding for mental health system; need for more staff; love and caring can help the mental health consumers. Dr. Antonia Sacchetti, Mission Neighborhood Health Center, opposes cuts to the Center and to the poor and uninsured; the number of uninsured continues to increase. Taj James, Coleman Advocates for Youth, supports priorities for children; questioned where are the political priorities. Karen Patterson Matthews, Bayview Hunter's Point Foundation, stated there's misperception that BVHP Foundation serves only the Bayview; it serves citywide; cuts are deplorable; opposed cuts to homeless programs and the CIRT program; solicited assistance of the Commission to retain services. Gil Thornally, son of LHH resident, described understaffing in nursing and food service at LHH; medical services funding needs to be increased. Margie Bonilla, LVN at LHH, stated quality of care and licensing are being jeopardized due to lack of staffing and workloads. Phoebe Rosales, LHH Nursing, supports more staffing at LHH for resident care. Dr. Mitch Katz, Director of Health, highlighted the proposed budget. A copy of the budget is available for viewing in the Commission Office. The total proposed budget for FY 2000-01 for the Department of Public Health, including grants, is $841.1 million. This is a $4.4 million increase over the current year budget of $836.7 million. Operating revenues are projected to decrease $10.4 million from $530.9 million in FY 1999-00 to $520.5 million in FY 2000-01. Grant revenues are projected to decrease $3.4 million from $73.2 million in FY 1999-00 to $69.8 million in FY 2000-01. If this budget request were approved, the General Fund allocation from the City and County to the Department of Public Health for FY 2000-01 will increase $18.3 million to $250.9 million from $232.6 million in FY 1999-00. This represents an 8% increase to the current General Fund allocation. This $18.3 million increase in general fund in FY 2000-01 requires that the Department absorb the costs to fund salary increases to civil service staff. Dr. Katz stated that if the Department is given more than the $18 million, he would allocate the added funds to prevention and supportive housing and not to backfill the areas which have already been cut. Commissioners' Comments: Questions raised on the proposed cuts: What is the access from Potrero Hill to SFGH? What will happen to dental services at Potrero? What are productivity levels at the primary care sites? Visits are down at the primary care clinics. What are the LHH staffing issues? How does the Department prioritize programs to be added to the base budget (i.e., grant-funded programs, one-time funded programs, and underserved communities)? The public and stakeholders need to unite and minimize turf. Public voices need to be heard on a consistent basis to create the sense of urgency. It's not possible for the Department and Commission to satisfy all parties all of the time. Expressions of gratitude and compliments were given to the Department staff for their budget work and their direction. Money will always be an issue. The Commission will monitor this new direction of the Department at the Joint Conference Committees. There needs to be problem solving in the area of primary care. Infrastructure and capital improvement issues are important. Dr. Katz's leadership on this new direction was praised. The Department cannot keep a status quo; change needs to move forward. Risks have to be taken. Efficiency, productivity, monitoring, an evaluation need to be integrated into this new direction of the Department. President Guy thanked the public for their participation and comments. She also thanked Dr. Katz and his staff for their dedicated and hard work in developing the budget and new direction for the Department. The meeting was adjourned at 7:30 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission