Minutes of the Health Commission Meeting Tuesday, March 21, 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 3:15 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) APPROVAL OF MINUTES OF THE REGULAR MEETING OF MARCH 7, 2000 Action Taken: The Commission unanimously adopted the minutes of the meeting of March 7, 2000. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) (3.1) PHP-CMHS – Request for retroactive approval to accept and expend federal Substance Abuse and Mental Health Services Administration (SAMHSA) funds received by, and passedthrough, Asian American Recovery Services, Inc. (AARS), a community-based agency currently providing substance abuse and mental health services to San Francisco’s Asian community, for Comprehensive Asian Preschool Services. (3.2) PHP-CMHS – Request for approval of a new sole source contract with Support for Families of Children with Disabilities (SFCD), in the amount of $270,000, to provide mental health outreach and counseling services targeting families of children with mental health issues and special needs, for the period of April 1, 2000 through March 31, 2001. (3.3) PHP–HIV Prevention – Request for approval of a two-year contract renewal with Regents UCSF AIDS Health Project (UCSF) in the amount of $455,676 per year for a total of $911,352, to provide HIV counseling, testing, risk reduction and partner counseling and referral services targeting behavioral risk populations, for the period of January 1, 2000 through December 31, 2001. (DPH contracted with UCSF for services totaling $6,442,691 during FY 1998-99). Commissioner Parker asked about outreach to the African American community. The Department will provide a report on statistics and trends for testing and counseling. The Department can also provide an overview of the HIV Prevention Program. (3.4) PHP–HIV Prevention – Request for approval of a two-year contract renewal with Haight Ashbury Free Clinic Inc. (HAFC), in the amount of $81,689 per year for a total of $163,378, to provide HIV counseling, testing, risk reduction and partner notification services targeting behavioral risk populations in San Francisco, for the period of January 1, 2000 through December 31, 2001. (DPH contracted with HAFC for services totaling $13,406,339 during FY 1998-99). Commissioner Parker pointed out more efforts need to be made in the African American community. He would like to follow the trends from year to year. (3.5) PHP–HIV Prevention – Request for approval of contract renewal with CompassPoint Nonprofit Services (formerly Support Center for Nonprofit Management), in the amount of $300,000, ($180,000 for the term of 1/1/2000-12/31/00, and $120,000 for the term of 1/1/01-12/31/01), to provide organizational development and capacity building services for HIV prevention community-based organizations, for the period of January 1, 2000 through December 31, 2001. (DPH contracted with Support Center for services totaling $1,106,985 during FY 1998-99).  A follow-up status report will be calendared for May 2, 2000. (3.6) PHP–HIV Prevention – Request for approval of a two-year contract renewal with Asian Pacific Islander Wellness Center (APIWC), in the amount of $471,653 per year for a total of $943,216, to provide HIV prevention services targeting various Asian and Pacific Islander behavioral risk groups, for the period of January 1, 2000 through December 31, 2001. (DPH contracted with APIWC for services totaling $1,178,221 during FY 1998-99). (3.5) PHP–HIV Prevention – Request for approval of a two-year contract renewal with California AIDS Intervention Training Center (CAITC), in the amount of $142,398 per year for a total of $284,796, to provide HIV prevention services for the period of January 1, 2000 through December 31, 2001. (DPH contracted with CAITC for services totaling $263,217 during FY 1998-99). (3.8) PHP–HIV Prevention – Request for approval of a two-year contract renewal with California AIDS Intervention Training Center (CAITC), in the amount of $138,001 per year for a total of $276,002, to provide HIV prevention/street outreach services targeting various behavioral risk groups, for the period of January 1, 2000 through December 31, 2001. (DPH contracted with CAITC for services totaling $263,217 during FY 1998-99).  A follow up status report will be calendared for May 16, 2000. (3.9) PHP-Special Projects (HIV Seroepidemiology) – Request for approval to accept and expend new funding in the amount of $214,584 from John Snow, Inc., to support personnel for the HIV Postexposure Prophylaxis (PEP) Registry Project, for a period of April 1, 2000 to September 30, 2001; and a sole source contract with UCSF for research assistance in the amount of $188,405 for the same time period. (DPH contracted with UCSF for services totaling $6,442,691 during FY 1998-99). (3.10) PHP-BEHM – Request for approval of new contract with Dillard Environmental Services, in the amount of $200,000 per year for a total of $450,000, to provide hazardous waste management and transportation services, for the period of April 1, 2000 through June 30, 2002. Action Taken: The Commission approved the Consent Calendar of the Budget Committee. 4) FOR DISCUSSION ONLY: DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) (Report on activities and operations of the Department, and may include activities within the Community Health Network and Population Health and Prevention Divisions). ADMINISTRATION Departmental Strategic Planning Update The Department has made a lot of progress with strategic planning since my last Health Commission presentation. The Populations and Program Subcommittee developed priorities for populations the Department should serve in the future. The Subcommittee will finalize its recommendations today and these preliminary recommendations will be presented to the Health Commission at is next monthly update. The Finance Subcommittee met on March 10th to review infrastructure needs and options for financing infrastructure improvements. The meeting focused on the needs at San Francisco General Hospital, the community health centers and contractors within Population Health and Prevention. The Health Commission will receive a presentation on infrastructure needs at today’s meeting. Internal DPH town hall meetings have been scheduled to familiarize staff with the planning initiative and to obtain input on our strategic direction. The meetings start this week and continue through April 7th. Attached is a flyer with the meeting schedule. DPH submitted a grant application to the San Francisco Foundation to fund community engagement for the strategic planning process. The grant will fund outreach efforts to ensure that demographically and geographically diverse community participants are involved in the Department’s strategic planning. Lastly, the Steering Committee co-chairs met with seven of the Department’s community advisory boards to solicit input and suggestions for strategic planning. Three more advisory board meetings are scheduled over the next several weeks, and additional board meetings are being set. CMA Drug Treatment Reform Resolutions I was pleased to participate as an Alternate Delegate for the SF Medical Society on the California Medical Association's House of Delegates. The delegation passed five exciting, progressive drug treatment reform resolutions. As you know, CMA is the largest state medical association in the country. Policy statements from CMA can be used in a number of different venues to effect changes, particularly to persuade governmental agencies and medical institutions to act in accordance with the statements. In summary the resolutions call for: Law enforcement and emergency medical services agencies adopt and publicize policies which encourage the appropriate medical rescue response to illicit drug overdose and which minimize the fear of legal retribution for persons making 911 calls. Controlled trials of take-home naloxone to further evaluate the acceptability of naloxone to heroin users in preventing overdoses. Transplant centers to abrogate policies that automatically exclude patients maintained on methadone from liver transplant recipient waiting lists. County and city jails make appropriate treatment modalities, including methadone maintenance, available to opioid-dependent inmates. Governmental agencies to establish programs of office-based physician prescription or physician order of methadone maintenance. Appointment to Local Board I have asked Anne Kronenberg to act as my surrogate and coordinate the homeless programs we provide throughout the Department. Anne has been very involved with the Single Room Occupancy Fire Disaster response, and sits as my representative on the citywide SRO Task Force. For the past year, she has worked closely with other city departments and community advocates on a number of issues related to homelessness. As you know, both the PH&P and the CHN provide homeless services. It is my belief that Anne, who resides in neither division, will be able look at the services DPH provides with a global perspective. She will pull together a DPH homeless working group with the goal of more efficiently coordinating and delivering services to this vulnerable population. In addition, I asked Anne to be DPH’s representative on the Local Board, replacing Marian Pena whose term expired in February. I am sure you all join me in thanking Marian for the dedication, hard work and deep commitment she brought to the Local Board for the years she served as the DPH representative. POPULATION HEALTH AND PREVENTION Violence in the Workplace Training The Department completed the first phase of its "Preventing Violence in the Workplace Training Program". Over 500 supervisors and managers were trained in this phase durring the last six months. I would like to thank trainers Doreen Dare, John Fazio, Jennifer Dahlstrom, Lucy Fisher, Susan Gearhart, Mabel Jung, Penney Mitchell, Jean Miranda, Kitty Mah, Erica Smentowski, Jeff Lintner, Alex Mackenzie and Linda Wang. Phase two of the Violence Prevention training will target line staff. The training will focus on DPH's policy prohibiting violence in the workplace, employee responsibility to report, and the role of the Management Response Teams in consulting on threats/incidents of violence. Newcomer's Program The Newcomers Health Program of Community Health Promotion and Prevention Branch was selected to conduct a roundtable presentation at the California Conference of Local Directors of Health Education Annual Conference April 13-14. The presentation, entitled "Community Assessments of New Immigrant Populations: A Critical Factor in Program Planning and Community Capacity Building" will focus on the importance of conducting assessments to develop links into a new community, to learn about community issues and to effectively interact with members. Based on experiences of the Newcomers Health Program, results of such assessments can lead to successful development, funding and implementation of community-based preventive health programs. For more information contact Patricia Erwin through e-mail or at 705-8552. Injury Prevention Through a grant from the CDC, the Community Health Promotion and Prevention Branch and the San Francisco Injury Center at UCSF, will sponsor two Injury Prevention events as part of the celebration of Public Health Week, April 3-9. A half-day conference on "Injury Prevention: a Public Health Approach" will be held April 5th, 8:30 am to 12:30 pm, at the Civic Center Conference Room, 455 Golden Gate. The morning Conference is a brief introduction to the principles and practices of injury prevention, for advocates, community activists, agency managers, program staff, and public health professionals. Carolyn Fowler, Ph.D., from Johns Hopkins Center for Injury Research and Policy, the Director of Injury Prevention Programs for Baltimore County, Maryland, will be the Keynote Speaker. Other speakers include Barbara Alberson, MPH, Chief of the State & Local Injury Control Section, and Roger Trent, Ph.D., Chief of the Injury Surveillance and Epidemiology Unit, California Department of Health Services, and Andrew McGuire, Executive Director of the Trauma Foundation. The afternoon program April 5th is "Skills for Community-Based Injury Prevention." This focuses on San Francisco specific issues and programs and will provide professionals and residents the opportunity to work on specific prevention approaches. These will include Finding and Using Data, Creating Safe Communities, Community Capacity Building and Advocating for Change. Pre-registration is required for both morning and afternoon sessions. For a complete conference brochure and application, contact Tomas Marrero at 554-2740. Please join the Community Health Education Section in celebrating Public Health Week at a drop-in Open House April 7th, 1-4pm, 101 Grove Street, room 118. STD Prevention and Control Effective, March 7th the Department began to use the Becton Dickenson Probe-Tek urine test to diagnose chlamydia at City Clinic. All STD screening sites in the City will be using this method of testing by May. The primary advantage to this test is that the DPH Lab can test one specimen for both gonorrhea and chlamydia at the same time for approximately one third less money. The Lab will also be able to process more tests with less risk of contamination than with the previous method. World TB Day Friday is World TB Day and San Francisco is, once again, the West Coast site for World TB Day activities. In observance of World TB Day, the Department's TB Control Program will be hosting a press conference in Chinatown on Friday at 10 a.m. After five years of steady decline in TB cases, San Francisco's 1999 figures show an increase of 13%. We will be kicking off a long term effort directed at reducing the reservoir of potential TB cases by concentrating on individuals with dormant TB infection. TB Control hopes to increase awareness and assure access to TB screening and treatment for any resident who has been in San Francisco less than five years and comes from a country with a high incidence of TB. Dr. Chow will be representing the Health Commission. He will be joined by Dr. Masae Kawamura, Director of TB Control for this Department, Dr. Sarah Royce, Director of the State's TB Control Branch, and Supervisors Mabel Teng, Leland Yee, and Michael Yaki. Dr. Alex Moy, medical director of Chinatown Public Health Center, will be speaking on behalf of the Department. COMMUNITY HEALTH NETWORK Maintain Licensing & Accreditation The annual Title XV Survey of the SFGH Jail Health acute care units, 7D, 7L, 7B and the Institutional Police holding cell took place January 31st. There were minimal findings/deficiencies noted during the survey, which were quickly corrected. Training As we are all aware, there is a shortage of RNs throughout California, particularly in high-tech/specialty areas. In 1998, Perioperative Management recognized this as a major problem for SFGH and began meeting with representatives from other Bay Area hospitals. A training program was developed which included sending selected nurses through the Consortium Education Network O.R. Nursing Training Program. Nurse training for the O.R. is extensive taking 6 months to complete all training objectives. By July, SFGH will have 7 new skilled nurses in Perioperative Nursing. Condolences to the Family of Sandy Porter & the Staff at Potrero Hill Health Center Jessica (Sandy) Porter, HWII/Outreach Worker at Potrero Hill Health Center (PHHC) died unexpectedly March 18th, at the age of 45. Ms. Porter was among the original employees of PHHC when it opened in 1976. She lived across the street from the Health Center, in a SF Housing Authority unit for the past 25 years, and was a trusted link to the Hill’s high-risk target populations. She assisted in recruiting for and staffing the Community Advisory Board at PHHC – a continuously functioning CAB since 1976. Following the tragic shooting death of the Center’s former Director, Dr. Bob Ross, in 1983, Sandy helped maintain the Center’s primary care focus and continuity. Her tireless efforts at organizing community input and support through many budget crises over the years were well known. Ms. Porter is survived by her twelve-year -old son, Sterling. Memorial services place and date will be known later this week. SFGH Credentials Report 3/00 2000 YTD New Appointments 11 35   Reinstatements 4 4 Reappointments 43 85   Delinquencies 0 0 Reappointment Denials 0 0 Resigned/Retired 14 20 Disciplinary Actions 0 0 Restriction/Limitations – Privileges 0 0 Changes in Privileges   Additions 0 1   Voluntary Relinquishment 0 0 Commissioner Chow encouraged the Department to publicize the TB treatment protocols Commissioner Umekubo inquired about the timeline for implementation of the physician prescription orders for methadone maintenance. Dr. Katz foresees implementation in the next fiscal year. President Guy requested the Commission to send condolences to the family of Sandy Porter. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR MARCH 2000 On behalf of the Commission, President Guy presented the March Employee Recognition Awards to the following employees: Nominee Division Nominated by: Donna Childers Central Administration, MIS Vicki Zulueta and Monique Zmuda Mary Magocsy Population Health and Prevention John F. Brown EMS Section Louise Murphy, RRA CHN, Health Information Services, Health Information SFGH Services Staff Bonnie Lee-Quon CHN, Health Information Services, Health Information SFGH Services Staff Bobbie Herron accepted the award for Louise Murphy. 6) PRESENTATION OF STATUS OF THE DEPARTMENT OF PUBLIC HEALTH FACILITIES At the request of the Commission, Dr. Katz provided information on the capital requirements for the Department. A copy of the full report is available in the Commission Office. Dr. Katz reported the following: The Department of Health has evaluated the capital needs for its clinical facilities for the next rthree to five years, and has prepared proposals for the consideration by the Health Commission, the Board of Supervisors and the Mayor. The following pages summarize the capital needs for the Department of Public Health’s acute care hospital and clinics. This report excludes capital projects for Laguna Honda Hospital since it will be rebuilt over the next seven years. Also, we have identified capital needs for private non-profit agencies that deliver health services to the Department’s patients and clients. We will work with the City’s departments and bureaus to develop revenue streams thata can assist non-profit agencies in accessing funding to meet their capital needs. Our initial assessment of facilities indicates that the Departments of Health requires capital investments for repair and renovation of our primary care clinics throughout the community. Renovations are required to provide additional examination rooms and other clinical space, to improve patient flow, and to expand dental service areas. In the area of acute care, the Deparatment of Health must comply with the SB 1953 Facilities Seismic Safety Act which requires San Francisco General Hospital to meet a higher standard of seismic performance. This requirement will result in seismic retrofit or replacement of San Francisco General Hospital. The Department also proposes to build a new ambulatory care and research facility on the grounds of the San Francisco General Hospital Campus. This facility will relocate outpatient clinical services and medical research activities (for which the Department collects rental income) that are currently in the seismically compromised masonry buildings to this new facility. Finally, the Department proposes to complete seismic renovation of the masonry buildings at San Francisco General Hospital. These buildings, once renovated, could be used for administrative and other non-clinical uses, as well as for intermediate care, independent living or other supportive services. The report contained four components: A list of capital improvements required for SFGH, the hospital based clinics, and the community based clinics; A summary of the implementation of SB 1953 for SFGH; A summary of the proposed construction of the medical clinic and research facility; and A summary of the need to complete seismic renovation of the masonry buildings at SFGH As the Commission is aware, the Department’s strategic planning process will define the level and scope of services that will be provided over the next several years. These recommendations will be presented to the Health Commission by year ending 2000. The recommendations from the strategic planning process may result in revisions to the capital plan presented in this report. In addition, the Department is in the process of conducting a facility seismic assessment of San Francisco General Hospital. This includes a geotechnical evaluation, detailed structural review and analysis of the frame, and a survey of non-structural systems serving non-ambulatory patients. Results of this assessment will better define the components of the SB 1953 project for the next several years. The Department is also involved in a detailed ADA assessment of all of our facilities. As such, these projections of capital requirements for the Department of Health should be considered preliminary until the results of the strategic planning process and the seismic assessment studies have been completed. Commissioners Comments: These estimated costs do not include inflation factors Complimented Department for report; need to rebuild these buildings Need to look at the U.C. partnership and its effect on the rebuilding of SFGH Need to know how many primary care clinics and what services will be provided in primary care Will look to the Strategic Plan of the Department for direction of primary care Need to consider recommendations from consultants regarding SFGH Discuss these issues at the JCC-SFGH and JCC-CHN before coming to full Commission Serious questions on 101 Grove seismic retrofit Cost factors need to be realistic Different timetables need to be considered Nathan Nayman, Hospital Council, referred to his letter to the Board of Supervisors, reported that all hard costs for hospitals will be submitted to the State, discussed SB 1953 issues, and recommended the Commission to look at temporary waivers for antitrust laws. Commissioner Hill left at 5:00 p.m. 7) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH HOUSING SERVICES UNIT Marc Trotz, Director of Housing Services, presented the activities of the Housing Services Unit. Commissioner Umekubo asked how much would it cost to house the homeless population? The Department estimates at $150,000 per unit for capital costs only, it would cost $1.5 billion to build housing for 10,000 homeless people. Dr. Katz commended Mr. Trotz and his hard working staff for their work with the community. Dr. Katz sees health and housing being so connected and pointed out the Housing Services Unit substantially changing people’s lives. 8) CONSIDERATION OF A RESOLUTION APPROPRIATING PROPOSITION A FUNDS FOR TOBACCO PREVENTION AND CONTROL ACTIVITIES IN 2000-01 FISCAL YEAR (This item was considered after agenda items #5). Ginger Smyly, Deputy Director for Health Promotion and Prevention, presented the proposed FY 2000-2001 plan and budget for tobacco prevention and control to be funded with $1 million annual allocation of tobacco settlement funds, earmarked by Proposition A. Ms. Smyly acknowledged this as a joint effort of the Department, the Tobacco Coalition, the School District, community representatives, Environmental Health, Police Department, and the City Attorney’s Office. A copy of the full report is available in the Commission Office. Ms. Smyly reviewed the targeted populations, the guidelines for use of the funds, and recommendations for the use of funds. She pointed out in the proposed budget there will be less funds going to the City Attorney’s Office and more to Environmental Health Commissioner Umekubo suggested the education materials and information would be helpful to all healthcare providers. He recommended partnering with the S.F. Medical Society. Commissioner Chow recommended going back to remind private practitioners about the available materials. He also suggested using many different newspapers, medical groups, and managed care programs. Commissioner Hill complimented the Department for its work and collaboration with the School District. Action Taken: The Commission adopted Resolution #3-2000, entitled "Appropriating Proposition A Funded for Tobacco Prevention and Control Activities in Fiscal Year 2000-01." Ms. Smyly acknowledged Alyonik Hrushow and her staff. Dr. Katz stated the Department will move this approved resolution to the Board of Supervisors. Public Speakers: Karen Licavoli Farnkopf, American Lung Association of San Francisco/San Mateo, Co- Chair of the Tobacco Coalition, thanked the Commission for its support; commented this is a consensus document with input from the community. Kirk Kleinschmidt, American Heart Association, commented that the enforcement provisions are very important; there is a way to go on the smoking ban in bars. 9) OTHER BUSINESS/PUBLIC COMMENTS None. The meeting was adjourned at 5:45 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission