Minutes of the Health Commission Meeting Tuesday, April 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 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 David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. Absent: Commissioner Lee Ann Monfredini On behalf of the Commission, President Guy presented a special Certificate of Appreciation to Paul O’Malley, who has worked for the Department for 27 years, first at the San Francisco City Clinic, and later in the HIV Research Section. He was honored for his years of commitment to better the lives of persons at risk of or living with HIV infection, both through his work and his personal support. Mr. O’Malley thanked his colleagues for a tremendous life experience work in the Department, especially for the last 15 years with his staff. 2) APPROVAL OF MINUTES OF THE REGULAR MEETING OF APRIL 4, 2000 Action Taken: The Commission unanimously adopted the minutes of the meeting of April 4, 2000. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) (3.1) DPH-Administration – Medical Cannabis ID Cards – Certification Fee. (3.2) CHN-SFGH – Request for approval of a six month extension modification to the contract with Paralign Revenue Management, Inc., to enhance Medi-Cal and other third-party reimbursements through an Uncompensated Care Recovery Program at SFGH, for the period of April 1, 1998 through December 31, 2000. (DPH compensation for FY 1998-99 was $855,849). (3.3) PHP-CMHS – Request for approval of a sole source retroactive contract renewal with Alameda County Health Care Service Agency, in the amount of $979,967, to provide access to 24-hour skilled neurobehavioral nursing care and adolescent subacute mental health services, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with Alameda County for services totaling $825,180 during FY 1998-99). (3.4) PHP-HIV Prevention Services – Request for approval of a retroactive contract renewal with Haight Ashbury Free Clinic, (HAFC), in the amount of $105,649 per year, to provide HIV prevention outreach services targeting women for the two year period of January 1, 2000 through December 31, 2000, for a total of $211,298. (DPH contracted with HAFC for services totaling $13,406,339 during FY 1998-99). The Department is recommending a 1-year renewal with continued technical assistance. Darryl Inaba, Pharm. D., Executive Director of HAFC, reported that progress is being made with the technical assistance on organizational development. (3.5) PHP-HIV Prevention Services – Request for approval of a retroactive contract renewal with the Regents of the University of California, through UCSF/AIDS Health Project, in the amount of $178,089, to provide prevention provider training services, for the period of January 1, 2000 through December 31, 2000. (DPH contracted with Regents UCSF for services totaling $11,398,542 during FY 1998-99). Commissioner Sanchez abstained due to conflict of interest. (3.6) PHP-HIV Prevention Services – Request for approval of a retroactive two-year contract renewal with Stop AIDS Project (SAP), in the amount of $510,258, to provide venue-based individual outreach services, for the period of January 1, 2000 through December 31, 2001. (DPH contracted with SAP for services totaling $793,093 during FY 1998-99). (3.7) CHPP-Health Promotion–San Francisco Pedestrian Safety Program – Request for approval to accept and expend a new grant in the amount of $449,929 from the California Office of Traffic Safety for a pilot study of pedestrian injuries and implementation of community driven environmental prevention strategies, for the period of June 1, 2000 through May 31, 2002. Commissioner Sanchez stated that many community groups (i.e., seniors and children) may participate in this program. Commissioner Parker recommended the involvement of motorists for education purposes (i.e., Department of Motor Vehicles). Commissioner Hill also recommended to include Muni drivers. (3.8) CHS-Children, Youth & Families Services – Request for approval to accept and expend a six-month grant in the amount of $201,921 from the California Department of Health Services, to meet the health care needs of children in foster care by increasing public health nursing time, for the period of January 1, 2000 to June 30, 2000. Commissioner Sanchez requested an update come back to the Budget Committee on this grant. Action Taken: The Commission approved the Consent Calendar of the Budget Committee, with Commissioner Sanchez abstaining on #3.5. 4) FOR DISCUSSION ONLY: DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) ADMINISTRATION California’s Revenue Projections Exceptional revenue performance have led the State Legislative Analyst’s Office (LAO) to predict that if upward trends continue at their current pace, State revenues will exceed the Governor’s proposed budget by more than $4 billion, bringing the total estimated surplus to approximately $9 billion. The addition of 42,000 jobs per month since November 1999, a 10.7% increase in taxable sales in the fourth quarter of 1999, a sharp increase in new home construction, and unprecedented increases in the State employment withholding payments all contribute to this increase in revenue. Further, estimated tax payments, which reflect current job and income trends, are more than double the increase anticipated by the Governor’s budget. Increased sales tax revenues between December 1999 and March 2000 indicate strong consumer spending both in the 1999 Christmas shopping season and in the first months of 2000. In late May, after April’s tax receipts have been tabulated, the Governor will release updated revenue and expenditure estimates along with any changes to his budget proposals (the "May Revise"). It is likely that among the Governor’s top priorities will be transportation and education with one-time rather than ongoing projects being the preferred method of funding. While it is a little early for Legislative proposals for the expenditure of the State’s surplus, it is likely that when the Legislature returns from its Spring break next week, budget discussions will be accelerated. Senator Burton has already requested that $300 million be earmarked for mental health programs. Over the last two months, as the Legislature has held budget hearings on health-related issues, the Department has been actively advocating for the health needs of San Franciscans. The Department will continue to monitor the State budget and keep the Commission apprised of important developments. Congratulations on 5-Year Technology Milestone Last week marked the five-year anniversary that DPH went "live" on the Shared Medical Systems Remote Computing Option (RCO), thereby establishing the DPH Enterprise Network. Although initially focused on implementing key information systems required for the transition to Managed Care, the infrastructure was quickly leveraged to support the full range of DPH data communication needs; including CCSF financials, integration of data from many discreet application systems and electronic mail on over 3,000 desktops. This has allowed DPH to be well poised today to fully embrace information technology, use of the Internet, and the sophisticated infrastructure needed to participate in the new world of e-commerce. I wanted to acknowledge this significant milestone, and compliment the DPH MIS staff that made it a success. POPULATION HEALTH AND PREVENTION PHP Administration Barbara Garcia, Director of Population Health and Prevention, was invited to serve on the California Senate's Task Force on Homelessness. The Task Force will look at statewide responses to the issue of homelessness. Barbara's expertise and background will lend a valuable contribution to the Task Force. I am sure you join me in congratulating Barbara on her appointment. Newcomer's Program The Newcomers Health Program of the Community Health Promotion and Prevention Branch, in collaboration with Bay Area Community Resources, a local non-profit agency, was awarded a three-year $375,000 grant from the Tobacco Control Section of the California Department of Health Services. The program funded by this grant will focus its efforts primarily on the Russian-speaking refugee and immigrant community in the Richmond and Sunset districts of San Francisco. The project goal is to increase newcomer’s awareness of the dangers of tobacco on the community. For more information please contact Patricia Erwin at 705-8552. Helios Health Machines Two Helios Health machines were installed in the STD Clinic waiting room. While waiting for an appointment, clients can access a variety of health related information over the Internet. Clients wear earphones to assure confidentially and so they don’t disturb others. STD Screening The STD program is now conducting weekly STD screening at the Folsom Gulch bookstore; a site mentioned by several recently diagnosed early syphilis cases. This is the first time that the STD Program has successfully collaborated with a bookstore on this type of activity. To date, over 20 clients have received STD education and 5 have been tested. Got Treponemes? An eye catching STD postcard using the take off phrase "Got Treponemes" (the bacterial agent that causes syphilis) is being distributed at venues frequented by high-risk clients. A "rainbow colored" flyer was developed for use in venues popular with men who have sex with men as a way of getting them to think about being tested for STDs. Disease Control Investigators who are part of our Syphilis Rapid Response Team developed both of these materials. State Review of Implementation of the San Francisco Mental Health Plan (SFMHP) The latest State Department of Mental Health review of our Medi-Cal specialty mental health services plan was conducted January 11-14, 2000. I am pleased to inform you that the review was very favorable. Only two deficiencies were found. One was minor and had to do with contract language that is easily corrected. The other concerned the 24-hour access line (a problem encountered by most counties). We have already moved to correct the problem. COMMUNITY HEALTH NETWORK HUD Award I am pleased to announce the recent award of $693,750 from the Department of Housing and Urban Development to be used to support the redevelopment of the Laguna Honda Assisted Living/Housing for Seniors. Southeast Health Center Surprise Last Thursday, (4/13), at approximately 9:20 a.m., a young woman from the Bayview Hunters Point community walked into Southeast Health Center and announced that she was in labor. Ten minutes later, Dr. Chris Behrens, assisted by Drs. Shanti Martinez and Elsa Tsutaoka, delivered a six pound, 12 oz. baby girl. The mother and daughter were transported to SFGH by ambulance for follow-up care. This is the first time in Southeast Health Center's 25 years of operation that a baby was born in the facility. I hope the Commission will join me in commending the quick and excellent response of the staff at Southeast Health Center, proving once again that the well-trained, committed DPH staff can and will respond to any public health need. Medical Quality Incentive Plan I am pleased to announce that all CHN (City and County-employed) physicians who participated in the Joint City and County and UAPD Medical Quality Incentive Plan (MQIP) during this past FY l999 - 2000 received the maximum percentage points possible to receive the full 3% bonus incentive pay. Our physician colleagues in Mental Health, the Medical Examiner's office and in dentistry also performed outstanding, all achieving 3% bonus incentive pay. CHN Physician performance ranged from 78.5% to 100% based on total number of awarded points versus total possible points. A performance score equal to or above 75% merited a 3% bonus. The incentive pay is to be distributed in accordance with bonus distribution plan outlined in the MQIP. SFGH Credentials Report 3/00 2000 YTD New Appointments 13 59 Reinstatements 4 4 Reappointments 27 112 Delinquencies 0 0 Reappointment Denials 0 0 Resigned/Retired 11 31 Disciplinary Actions 0 0 Restriction/Limitations – Privileges 0 0 Changes in Privileges Additions 1 …2 Voluntary Relinquishment 0 …0 Public Speaker: Bill Castellanos, Union of American Physicians and Dentists, commended the Department staff and management for their support for the 3% bonus incentive pay. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEES RECOGNITION AWARDS FOR THE MONTH OF APRIL On behalf of the Commission, President Guy presented a team award to the Laguna Honda Hospital Team: Team Division Nominated by Robert Christmas, Laguna Honda Hospital Tony Wagner, Executive Associate Administrator Administrator, CHN Arthur Greenberg, Tony Wagner, Executive Deputy City Attorney Laguna Honda Hospital Administrator, CHN Leslie Holpit, R.N. Laguna Honda Hospital Tony Wagner, Executive Associate Administrator Administrator, CHN Adrianne Tong, Laguna Honda Hospital Tony Wagner, Executive Deputy City Attorney Administrator, CHN Melissa Welch, M.D., Chief Medical Officer Community Health Network Tony Wagner, Executive Administrator, CHN Mr. Christmas acknowledged the CHN leadership of Tony Wagner, CHN Executive Administrator. Note: President Guy, with consensus of the Commission, announced that agenda item #9 will follow agenda item #5. Commissioner Hill left at 3:45 p.m. 6) CONSIDERATION OF A SUPPLEMENTAL APPROPRIATION OF $12.7 MILLION FROM THE TOBACCO SETTLEMENT FUND FOR LAGUNA HONDA HOSPITAL Dr. Katz reported the Department is modifying its request from $12.7 million to $9,243,481 for architectural and engineering costs necessary to begin the Laguna Honda Hospital replacement project. The construction and program management teams would be in next year’s budget process. The source of funds for this supplemental appropriation is from the first payments to the City and County of San Francisco from the State Attorney General from tobacco settlement funds. Funds of $9,243,481 will be used for architectural and engineering work necessary to conduct environmental review processes, to complete planning and programming work, to secure preliminary permits and to complete architectural and engineering analyses. Dr. Katz introduced Michael Lane, who was appointed by Mayor Brown as the Project Manager for the LHH Replacement Project. Mr. Lane reviewed the RFQ process for the Executive Architect, the Construction Management Proposal, the Environmental Impact Report, the hiring of the Project Manager and Administrative Assistant, and setting up his office space. He also reported the formation of a Policy Committee, which will be advisory to him. He introduced Marilyn Thompson, a Project Manager, and informed the Commission that, as requested, he would brief the Commission on the replacement project. Public Speakers: Norma Satten, PECC, encouraged the Department to make more effort for home and community-based services and to plan for the assisted living project simultaneously with the LHH replacement, thanked Planning Director Tangerine Brigham for obtaining funds for the assisted living project. Mitch Jesenich and Karen Sherr, PECC, ILRC, HAT, demonstrated the need to have the scales of justice balanced; need more affordable housing, support services and community-based services for the disabled; important to have balance between finances for institutional care and community-based services. Action Taken: The Commissioners (Guy, Umekubo, Chow, Parker, and Sanchez) approved the supplemental of $9.2 million for the architecture and engineering team. Dr. Katz agrees on the need to build more affordable housing and assisted living facilities in the community. 7) PRESENTATION OF THE 8-MONTH DEPARTMENT OF PUBLIC HEALTH BUDGET REPORT FOR FY 1999-00 Dr. Katz reported on the latest information as of April 17, that the Department will have a $10 million deficit instead of $14.2 million deficit. The Department was informed that an additional $4 million has come in from SB 90 funds. Therefore, the Department will be requesting a $10 million supplemental at the May 2nd Commission meeting. This $10 million is the loss from SB 855 Medi-Cal disproportionate share revenues. Dr. Katz reviewed the 8-month expenditures and revenues for the Department. A copy of the full report is available for review at the Commission Office. Commissioner Chow commended the Department for working diligently to stay within the budget. He feels the public needs to be informed and educated on the facts of the Department of Public Health budget. Public Speaker: Frederick Hobson, S.F. Health Plan Board member, referred to his letters to members of the Board of Supervisors advocating revenue proposals (i.e., modest local income tax, sales tax dedicated for health care, and a luxury tax) to address the loss of federal dollars for public health. President Guy requested Commissioners to voice any concerns over the proposed $10 million supplemental request. Hearing none, this item will be calendared for the May 2nd Commission agenda. 8) UPDATE ON THE HEALTHY FAMILIES PROGRAM Tangerine Brigham, Director of Policy and Planning, provided an update on the California Healthy Families Program, which has been in existence for 22 months and has over 262,400 children enrolled statewide. San Francisco’s enrollment in Healthy Families is 7,313. A copy of the full report is available at the Commission Office. In her update, Ms. Brigham covered background information program expansions and enhancements, legislation, specific data for San Francisco, and outreach and education efforts. Ms. Brigham acknowledged Rachelle Lee with the Planning section, who monitors the outreach contract with Family Services Agency. The Commission thanked Ms. Brigham for the update. 9) UPDATE FROM THE LONG TERM CARE TASK FORCE (AB 1040) Tony Wagner and Jennie Chin Hansen, Co-Chairs of the Task Force; Tangerine Brigham, Director of Policy and Planning; and Bill Haskell, Project Coordinator for the Long Term Care Integration Pilot Project, provided an update on the work of the Task Force. Areas covered were background information, the initial and subsequent planning activities, the operational and budget analysis, the Case Management Study, and policy implications. A copy of the full report is available in the Commission Office. The original goal is to bring the Commission a comprehensive plan by October 17, 2000. However, realistically, the Task Force most likely would bring a progress report on October 17th; with the final recommendations coming at the beginning of 2001. Mr. Wagner acknowledged the perseverance of the Task Force members and the consumer advocates in working towards a long term care plan. Commission Comments and Concerns: Report is informative; encouraged continued dialogue. Encouraging to see attention on long-term care. Important to look at how this will be adequately funded and avoid a deficit situation. What can the Commission expect realistically by October; time should be taken to have consensus. Encouraging to achieve a one-stop shopping for consumers Use of data in the recommendations for the Task Force is a good approach. Increasing expectations from the public. Monies should go to services and less on administration. Incorporate how the Laguna Honda Hospital project fits into the long term care integration project Tough questions need to be asked and addressed. Need to look at the actual feasibility of the different options. President Guy would like to see at the October update the different options and clarification of the feasibility of these options. Public Speakers: Marie Jobling, PECC Executive Director, expressed strong support for the work of the Task Force; promoted community-based problem-solving including labor, community, providers, consumers, and the public to be involved in the process. Norma Satten, PECC Board of Directors, expressed commitment to bring Task Force recommendations to the Commission; need for a more systematic way of serving consumers. President Guy thanked all of the stakeholders involved in this planning for the future of long term care in the City and County of San Francisco. Commissioner Chow left at 5:45 p.m. 10) UPDATE ON THE DEPARTMENT OF PUBLIC HEALTH STRATEGIC PLANNING INITIATIVE Tangerine Brigham, Director of Policy and Planning, presented the Departmental Strategic Planning Update, (Attachment A). Commissioner Parker commended the Department for a good report. He commented that with all of the health needs and limited resources, can all of the stakeholders involved be comfortable with a strategic plan. Dr. Katz expressed that he is pleased with the progress of the strategic planning given the fact that the Department has to take care of day-to-day issues while understanding that long-term planning is important. President Guy encouraged the Department to include in future recommendations the issues that were taken into consideration during the discussions among the stakeholders. Commissioner Sanchez left at 6:15 p.m. 11) OTHER BUSINESS/PUBLIC COMMENTS Public Speakers: April Martin Chartrand, member of S.F. Mental Health Board, thanked Dr. Katz for his response to her letter and described her experiences as a patient at SFGH, Ward 6A, March 17-19, 2000; expressed concerns regarding health and safety and patient rights’ violations; raised system issues for patient care and the physical and emotional impact on patients. President Guy pointed out the importance of integrated care. The meeting was adjourned at 6:40 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission