Minutes of the Health Commission Meeting Tuesday, October 3, 2000 4:00 p.m. Jean Parker Elementary School Cafeteria 840 Broadway San Francisco, CA 94133 1) CALL TO ORDER The regular meeting of the Health Commission was called to order by President Roma P. Guy, MSW, at 4:10 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. Absent: Commissioner David J. Sanchez, Jr., Ph.D. Commissioner Lee Ann Monfredini Commissioner John I. Umekubo, M.D. 2) APPROVAL OF THE REGULAR MEETING OF SEPTEMBER 19, 2000 Action Taken: The Commission adopted the minutes of the meeting of September 19, 2000, with the correction on page 10, present in the Closed Session was Commissioner Parker. Commissioner Sanchez was absent.. 3) APPROVAL OF THE CONSENT CALENDAR OF HE BUDGET COMMITTEE (Commissioner Ron Hill) (3.1) PHP-AB75 Project – Request for approval of a renewal contact with Lifemark Corporation in the amount of $176,000, to provide fiscal intermediary services for the FY 2000-01 California Healthcare for Indigents Program (CHIP), for the period of November 15, 2000 through March 31, 2002. (DPH contracted with Lifemark for services totaling $2,129,089 during FY 1999-2000). (3.2) PHP-CMHS – Request for approval to accept and expend a new grant in the amount of $1,995,576 from the California Department of Mental Health, to implement a program of integrated services for seriously mentally ill and dual/multiply diagnosed adults, for the period of October 1, 2000 to June 30, 2001. (3.3) PHP-HIV Health Services – Request for approval of a contract renewal with California AIDS Intervention Training Center (CAITC), in the amount of $167,664, to provide early intervention services for the period of July 1, 2000 through June 30, 2001. (DPH contracted with CAITC for services totaling $140,453 during FY1999-2000). (3.4) PHP-HIV Prevention – Request for approval of a contract renewal with Glide Foundation, in the amount of $68,794, to provide HIV prevention and education services targeting high-risk behavior populations, for the period of July 1, 2000 through June 30, 2001. (DPH contracted with Glide for services totaling $384,015 during FY 1999-2000). (3.5) PHP-HIV Prevention – Request for approval of a new contract with the Regents of the University of California at San Francisco-AIDS Health Project (UCSF), in the amount of $157,963, to provide STD screening and treatment to anonymous HIV testing populations, for the period of October 1, 2000 through December 31, 2001. (DPH contracted with UCSF for services totaling $11,454,369 during FY 1999-2000). (3.6) PHP-HIV Prevention – Request for approval of a contract renewal with Stop AIDS Project (SAP), in the amount of $151,246 per year for two years, for a total contract amount of $302,492, to provide HIV prevention condom distribution services targeting gay and bisexual men and transgenders, for the period of July 1, 2000 through June 30, 2002. (DPH contracted with SAP for services totaling $851,627 during FY 1999-2000). (3.7) PHP-HIV Prevention – Request for approval of a new contract with Stop AIDS Project (SAP) in the amount of $162,500, to provide innovative web-based HIV prevention interventions, for the period of October 1, 2000 through December 31, 2001. (DPH contracted with SAP for services totaling $851,627 during FY 99-2000). (3.8) PHP-HIV Prevention – Request for approval of a contract renewal with Stop AIDS Project (SAP), in the amount of $507,795 per year for two years, for a total contract amount of $1,015,590, to provide HIV prevention services to gay and bisexual men, transgenders and intravenous drug users, for the period of July 1, 2000 through June 30, 2002. (DPH contracted with SAP for services totaling $851,627 during FY 1999-2000). (3.9) PHP-HIV Prevention – Request for approval of a new contract with Tenderloin AIDS Resource Center (TARC), in the amount of $162,500, to create a community center that will provide innovative HIV prevention services for high risk individuals living in the Tenderloin, for the period of October 1, 2000 through December 31, 2001. (DPH contracted with TARC for services totaling $458,660). (3.10) PHP-HIV Special Projects – Request for approval of a contract renewal with the San Francisco AIDS Foundation (SFAF), in the amount of $244,199, to provide treatment adherence case management services targeting HIV-infected individuals, for the period of July 1, 2000 through June 30, 2001. (DPH contracted with SFAF for services totaling $2,662,268 during FY 1999-2000). (3.11) CHSS-TB Control – Request for approval of a contract modification with the Regents of the University of California at San Francisco (UCSF), providing Model Tuberculosis (TB) Prevention and Control Center services to local and national TB health care providers. This modification will decrease the contract amount by $551,067, for a modified total of $2,160,260, and reduce the contract term by three months for the period of December 31, 1999 through December 31, 2000. (DPH contracted with UCSF for services totaling $11,454,369 during FY 1999-2000). (3.12) CHS-Housing Services – Request for approval of a new retroactive sole source contract with Chinatown Community Development Corporation (CCDC), the lead agency and fiscal agent for the Chinatown SRO Collaborative, in the amount of $250,000 for the period of July 1, 2000 through June 30, 2001. Commissioner Chow acknowledged the experience and credibility of Chinatown Community Development Center and Chinese Progressive Association, two local community organizations for the Chinatown SRO collaborative. Action Taken: The Commission approved the Consent Calendar of the Budget Committee. Note: Translators Edward Koo and Grace Lam provided Cantonese translation throughout the remainder of the Commission meeting. 4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) ADMINISTRATION 2000 State Legislative Session The State Legislature adjourned for the end of its two-year session on August 31, 2000. Over this two-year session, the Office of Policy and Planning tracked 862 health-related bills, 385 of which were active at the end of the Legislative session. The Legislature will begin its 2001-2002 session on January 4, 2001. The Legislature passed 1,454 bills. The Governor signed 1,088 and vetoed 362 bills. The Governor had until September 30, 2000 to take action on the bills presented for his consideration. The Governor’s options were to: (1) sign the bill, (2) veto a bill, or (3) neither sign nor veto a bill before the deadline then it would become law without his signature. The Governor has summarized the 1999-00 legislative session as one in which the State: passed two state budgets that were on time and in balance, brought accountability and higher expectations back to the classroom, instituted a high-school graduation exam and expanded advanced placement courses, adopted the most comprehensive and rigorous teacher training and recruitment program anywhere in the country, opened the doors of higher education to more Californians than ever before with merit scholarships and Cal Grants, through tax relief, we put more prosperity than ever before back in the hands of those who created it - the people of this State, passed the toughest gun safety laws in the nation, beefed up public safety spending, and strengthened our effort to eradicate hate crimes, reformed our HMO's, restored the eight-hour day, workers' protections and the prevailing wage, expanded health care coverage for uninsured children, created a historic new program to ensure that older Californians are "Aging with Dignity," made the largest general fund investment in transportation in California history, established new affordable housing programs, took steps to restore our parks and protect our water supply and tackled most formidable challenge - energy - by acting to reduce prices and increase supply. At this time, the Department is aware that the Governor has signed the following health-related legislation expanding coverage to uninsured children: AB 1015 (Gallegos), which authorizes California to extend Healthy Families coverage to the uninsured parents of children eligible for the program AB 2415 (Migden), provides that California will continue to fund health coverage for uninsured legal immigrant children, subject to annual state budget appropriations. Previous legislation authorizing this coverage specified that it would sunset at the end of the budget year. AB 2900 (Gallegos), which provides a technical adjustment to California’s Medi-Cal program to facilitate Healthy Families coverage of these adults. In the area of non-profit hospitals, the Governor signed AB 2276 (Cedillo) which requires the Office of the Attorney General to prepare a plan to evaluate current charitable care and community benefit standards for not-for-profit hospitals, and submit the plan to the Legislature by March 1, 2001. The Governor also appropriated an addition $1 million to local health departments for communicable disease control and public health surveillance activities in signing SB 269 (Ortiz). This bill would have appropriated $4.9 million for this purpose, but was reduced by the Governor. On November 7, 2000, the Department will provide the Health Commission with its 2000 State Legislative Report. This report will highlight and summarize health-related bills that were enacted and those that were vetoed. We will also give a disposition of the Department’s 2000 legislative priorities, as well as, presenting the Department’s proposed 2001 legislative priorities. POPULATION HEALTH AND PREVENTION STD Prevention and Control On 9/18 and 9/25, the STD Program held its Annual STD Update. In addition to an update on morbidity trends, topics included new urine based lab testing methodology for chlamydia and gonorrhea, partner delivered therapy and syphilis elimination and rapid response. Women's Services I would like to extend congratulations to Barbara Cicerelli of the Office of Women's Health Breast and Cervical Cancer Services (BCCS) staff for her nomination to the Hall of Honor of the Exploratorium "Changing Faces of Women" exhibit. The Hall of Honor is a special part of the exhibit honoring Bay Area individuals who have made significant contributions to improving the health and lives of women in their community. COMMUNITY HEALTH NETWORK Laguna Honda Hospital Licensure and Accreditation The Laguna Honda Hospital annual Licensure and Certification survey concluded with a 15-minute exit conference on September 25, 2000. The ten surveyors from the L&C division of the State Department of Health Services took thirteen days to complete the survey. Although we have not received a final report, by all indications, the survey went extraordinary well Personal Thanks I would like to personally thank Melody Davenport and Chun Lau, two employees working at San Francisco General Hospital, who intervened to stop the attempted theft of a purse from another SFGH employee. I also want to recognize the prompt care and attention extended to all three employees by Violence in the Workplace Management Response Team members Penny Mitchell and Sgt. John Majka. Commissioner Chow pointed out that the Commission would continue to monitor the progress at the State level on the evaluation of current charitable care and community benefits standards for not-for-profit hospitals. Dr. Katz commented that the City and County of San Francisco is further along on this issue, given the recent charity care analysis prepared by DPH. 5) CONSIDERATION OF REVISIONS TO THE SAN FRANCISCO GENERAL HOSPITAL MEDICAL STAFF BYLAWS Dr. Alan Gelb, SFGH Chief of Staff, presented the following revisions to the SFGH Medical Staff Bylaws: SFGH Bylaws, Article II, Section 2.2.A1 Licensure to include Sections 2113 and 2168, Certificate of Registration recommendation change SFGH Bylaws, Article II, Section 2.2 C Board Certification requirement recommendation change SFGH Bylaws, Article II, Section 2.4 Board Certification requirement, waiver of qualification recommendation change SFGH Bylaws, Article IV, Section 4.5 A Proctoring requirement recommendation change SFGH Bylaws, Article IV, Section 4.5 D Proctoring duration recommendation change SFGH Bylaws, Article VI, Section 6.2 A Board Certification requirements for service chiefs recommendation change SFGH Bylaws, Article XII, Section 12.1 Changes to Bylaws language concerning unilaterally amending the Bylaws recommendation change These revisions, which were approved at the July 11, 2000 meeting of the San Francisco General Hospital Medical Executive Committee, do not require Medical Staff approval, but do require Governing Board ratification. Dr. Gelb pointed out in Article II, Section 2.4, August 1, 2000 is a clerical error. The date should be October 3, 2000. Additionally, Dr. Gelb brought attention to a new Section 4.2 Integrative Therapies Subcommittee, which will look at various forms of alternative therapies (i.e. acupuncture), and which is of interest in the Asian community. Commissioner Chow pointed out Article XII, Section 12.1, promotes a process of cooperation between the Medical Staff and Governing Body. Action Taken: The Commission approved the revisions to the SFGH Medical Staff Bylaws (SFGH Medical Staff Credentialing Procedure Manual, SFGH Medical Staff Rules and Regulations, and the SFGH Medical Staff Committee Manual). 6) CONSIDERATION OF A RESOLUTION SUPPORTING DOMESTIC VIOLENCE AWARENESS MONTH, AND ENCOURAGING ALL CITY CAR OWNERS TO PLACE DOMESTIC VIOLENCE BUMPER STICKERS ON BUMPERS Kate Monico-Klein acknowledged October not only as a Domestic Violence Awareness month, but also as Breast Cancer Awareness month. The Department has planned activities throughout October to address the mythologies which surround both domestic violence and breast cancer. Commissioner Chow expressed concern about the use of "mandate" and would prefer "strongly urge." Commissioner Parker likes the idea and intent of the resolution but questions the use of "mandate." Because of the broadness of the issue, Commissioner Guy as a public official would support a mandate. Commissioner Hill expressed his support for the use of "mandate" and would support the resolution as proposed. Commissioner Chow proposed a friendly amendment to replace "mandate" with "strongly urge." Action Taken: The Commissioners (Guy, Chow, Parker) voted to amend the resolution by replacing the word "mandate" with "strongly urge." Commissioner Hill voted no. Action Taken: The Commissioners (Guy, Chow, Hill, Parker) voted to adopt the amended Resolution #13-00, "Recognizing that October is Domestic Violence Awareness Month, and Supporting Placement of "There’s no Excuse for Domestic Violence" Bumper Stickers on all Department of Public Health Vehicles." City Supervisor Alicia Becerril was present at this meeting in Chinatown. She introduced her City Hall staff and commented that she would be happy to carry the Commission’s Resolution on Domestic Violence to the full Board of Supervisors. 7. PRESENTATION ON CHINATOWN COMMUNITY HEALTH AND WELLNESS On behalf of the Commission, Commissioner Chow acknowledged the following persons for their assistance and cooperation in organizing today’s meeting in the Chinatown community: Sandy Mori, Executive Secretary to the Health Commission Kent Woo, NICOS Executive Director Madeline Ritchie, Health Center Director, Chinatown Public Health Wilma Louie, DPH Mental Health Division Edward Koo, translator, Clinical Social Worker, Chinatown/North Beach Mental Health Services Grace Lam, translator, Nutritionist, Chinatown Public Health Center Commissioner Chow presented a special Certificate of Appreciation from the Commission to the NICOS Chinese Health Coalition. Accepting on behalf of NICOS was Dr. Evelyn Lee, President. NICOS Chinese Health Coalition is a public-private-community partnership of more than 35 health and human service organizations and concerned individuals. NICOS’ mission is to enhance the health and wellness of San Francisco’s Chinese community. Since 1985, NICOS has been engaged in research, training, advocacy, resource development, and program implementation for the benefit of this population and the agencies that serve it. The Founding members are: North East Medical Services, Chinese Community Health Care Association (IPA), Chinese Hospital, On Lok Senior Health Services and Self-Help for the Elderly. Public Speakers: Dr. Evelyn Lee, President of NICOS Chinese Health Coalition, presented the summary of findings from the Chinese Community Health Study in the Fall of 1995. Dr. Alex Moy, Medical Director, Chinatown Public Health Center, described the Center’s services: mental health, nutrition, public health nursing, dental, and WIC; the Center has no social worker on its staff; described collaboration with Chinese Hospital and North East Medical Services. Linda Yau, cancer survivor, described her experiences with her cancer and the cancer support group; due to common interest and backgrounds, offers her help to other cancer patients in the Bay Area; cancer support group should be an independent group. Helen Yuen, Director of Nutrition Services, Self-Help for the Elderly, emphasized culturally appropriate services to Cantonese, Mandarin, and Vietnamese-speaking people of all ages; advocated for the maintenance and expansion of nutrition services in Chinatown. Irene Chan, community member, CPHC Advisory Committee, advocated for bilingual, biliterate staff; need for asthma workshops for Chinese-speaking parents; advocated for a social worker and public health nurse positions; has made repeated pleas for the past five years for signage for Chinatown Public Health Center. Note: Dr. Katz announced a sign for the Chinatown Public Health Center will be funded and put up by the end of October. Brenda Yee, interim CEO of Chinese Hospital, submitted a booklet on Chinese Hospital; provided overview of the hospital’s services, including services to the indigent and poor. Angela Sun, Chinatown Community Health Resources Center, gave an overview of services to monolingual Chinese; need for culturally competent services. Helen Kwan, CCDC, promoted pedestrian safety education to children and seniors. Sister Paulette Yeung, Social Worker, St. Mary’s Teahouse Ministries, described the gambling problems in the Chinese community and emphasized treatment, prevention, and public education; works with Cameron House, Asian Perinatal Advocates, and RAMS. Tina Shum, Social Worker, Cameron House, described services for domestic violence, gambling; has trilingual staff. Daniel Ip, Chair of Asian American Mental Health Task Force, stated the monolingual geriatric population is neglected in the area of mental health; advocated for a bilingual position in mental health. Anni Chung, CEO for Self-Help for the Elderly, stated Asians have high tolerance for pain and have historically not asked for help; encouraged the Department to include in its Strategic Plan the high percentage of Asians in each Supervisorial district; promoted the need for parity and equity; requested the Department to set up a Task Force to work with the community; to look at creative ways to address the housing crisis; look at Chinatown Public Health Center and give it adequate and sufficient funding (i.e., replace social worker position); create a special Asian/Pacific Islander initiative to look for resources; and invited Commissioners to take a tour of Chinatown. Kent Woo, Executive Director, NICOS Chinese Health Coalition, reinforced Ms. Chung’s comments. President Guy thanked the speakers, translators, and Commissioner Chow for organizing today’s community meeting. Commissioner Chow encouraged the Department to look at Chinatown Public Health Center as a model for community resources and services to the whole community. As the Department moves into its overall Strategic Plan, it should look at the local data in comparison to national data and focus in on the needs of Asians. Commissioner Parker pointed out there are similar problems in various communities. The City has more and more unmet needs. He believes prevention should be the priority and yet there is a continued push for treatment and little for prevention. There needs to be a change in the mindset in the community and in the health field. There is an overall need for universal health care. President Guy thanked the audience and Commissioners for their participation. 8) OTHER BUSINESS/PUBLIC COMMENTS None. The meeting was adjourned at 6:35 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission