Minutes of the Health Commission Meeting Tuesday, January 30, 2001 3:00 p.m. at 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 P. Guy, MSW, at 3:10 p.m. Present:   Commissioner Edward A. Chow, M.D.  Commissioner Roma P. Guy, M.S.W. Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF JANUARY 9, 2001 AND THE SPECIAL MEETING OF JANUARY 16, 2001 Action Taken: The Commission adopted the minutes of January 9 and 16, 2001 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner David J. Sanchez, Jr., Ph.D.) (3.1) PHP-AB75 Project – Request for supplemental appropriation in the amount of $1,203,219 in State Emergency Medical Services Appropriation (EMSA) funds to pay for emergency physician services pursuant to Senate Bill 2132, for FY 2001-02. (3.2) PHP-Housing and Urban Health – Request for approval of retroactive contract renewal with Baker Places, Inc., in the amount of $737,839, to provide mental health and substance abuse services targeting formerly homeless tenants of eight SRO hotels, for the period of July 1, 2000 through June 30, 2001.  (DPH contracted with Baker for services totaling $11,110,692 during FY 1999-2000). (3.3) PHP-Housing and Urban Health – Request for approval of a new sole source contract with Self Help for the Elderly, in the amount of $50,000, to assist in the provision of residential care facility housing, for the period of February 1, 2001 through June 30, 2001. (3.4) AIDS Office-HIV Prevention – Request for approval of a contract renewal with Black Coalition on AIDS (BCOA), in the amount of $86,379, to provide HIV prevention services targeting high-risk African American transgender persons, for the period of January 1, 2001 through December 31, 2001.  (DPH contracted with BCOA for services totaling $373,912 during FY 1999-2000). (3.5) PHP-Community Health Promotion and Prevention – Request for approval of a retroactive sole source renewal contract with NICOS Chinese Health Coalition, in the amount of $65,000, to provide problem gambling prevention services in the Chinese community, for the period of July 1, 2000 through June 30, 2001.  (DPH contracted with NICOS for services totaling $50,000 during FY 1999-2000). (3.6) PHP-CMHS/CSAS – Request for approval of a retroactive multiyear contract renewal with the Homeless Prenatal Program (HPP), in the amount of $101,977 per year, for a four-year total contract amount of $407,908, to provide outreach and case management services targeting poor and homeless pregnant women and/or substance-abusing women with children, for the period of July 1, 2000 through June 30, 2004.  (DPH contracted with HPP for services totaling $112,262 during FY 1999-2000). (3.7) PHP-CMHS – Request for approval of a retroactive multiyear contract renewal with Seneca Center for Children and Families, in the amount of $2,052,763 per year, for a four-year total contract amount of $8,211,052, to provide mental health residential services and day treatment services targeting seriously emotionally disturbed adolescents, for the period of July 1, 2000 through June 30, 2004.  (DPH contracted with Seneca for services totaling $1,193,413 during FY 1999-2000). (3.8) PHP-CSAS – Request for approval of a retroactive multiyear contract renewal with Westside Community Mental Health Center (WCMHC), in the amount of $1,916,198 per year, for a four-year total contract amount of $7,664,792, to provide substance abuse services, for the period of July 1, 2000 through June 30, 2004.  (DPH contracted with WCMHC for services totaling $9,784,090 during FY 1999-2000). (3.9) CHN/SFGH, HAH AND LHH – Request for approval of two new contracts with the following firms:  On-Call Therapists, Inc. and Preferred Healthcare Registry, Inc., for a combined total amount of $259,160, to provide intermittent, as-needed rehabilitation therapy personnel services (Physical, Occupational and Speech Therapists) for the Community Health Network, for the period of February 1, 2001 through January 31, 2003. (3.10) CHN/SFGH, HAH AND LHH – Request for approval of a new sole source contract with Physical and Occupational Therapist’s Registry, Inc. (POTR), in the amount of $244,600, to provide intermittent, as-needed rehabilitation therapy personnel services (Physical, Occupational and Speech Therapists) for the Community Health Network, for the period of February 1, 2001 through January 31, 2003.  (DPH contracted with POTR for services totaling $78,000 during FY 1999-2000).  Action Taken: The Commission approved the consent calendar of the Budget Committee. 4) DIRECTOR’S REPORT  (Mitchell H. Katz, M.D., Director of Health) ADMINISTRATION HIV Consensus Meeting, Preliminary Report On January 19th Mayor Brown convened a group of two dozen researchers and AIDS experts to review current studies and data to determine the HIV prevalence and incidence rates for the behavioral risk populations of San Francisco. In a draft report, the group estimates that the rate of new HIV infections among men who have sex with men (MSM), MSM who are also injection drug users (IDU) and Transgender male to female (MTF) is 2.2 percent, up from 1.04 percent in 1997. This translates into 748 new infections projected for this year. The document is currently under public comment period. The IDU/Heterosexual Consensus Meeting is slated to take place next month. Upon the conclusion of this next Meeting, a similar Consensus Document will be produced and undergo the same process before both documents are integrated and officially released. A copy of the draft HIV Consensus Data for MSM, MSM IDU and Transgender MTF will be given to all Commissioner’s and is available to the public at HIVINSITE.UCSF.EDU. Summary of the Governor’s 2001-02 Budget Overview On January 10, 2001, the Governor proposed a $102 billion budget. This represents an increase of $7.5 billion over last year. With a $10.3 billion surplus, the budget assumes $2.3 billion less resources in the upcoming year, and, therefore, proposes to spend the remaining $8 billion primarily on education and energy, but also for tax cuts, and to maintain a budgetary reserve. With the exception of the Healthy Families program, most of the policy-related increases in the non-education portion of the budget are for one-time purposes, such as a $1 billion set aside for the energy initiative, fiscal relief to local governments, new housing, and air and water quality projects. While the Governor continues his commitment to long-term care with modest increases to his Aging with Dignity Initiative, most of the budget augmentations in health care are attributable to caseload increases under current guidelines rather than new policy initiatives. The Governor has allocated $21.6 billion in General Fund (GF) dollars for health and human services for 2001-02. This represents an increase of $1.3 billion over 2000-01 funding levels. However, in 2000-01, health and human service expenditures represented 27.5% of the total GF budget, while in 2001-02, they represent 26.1% -- a decrease of 1.4%. Summary of Major Health-Related Provisions Tobacco Settlement Funds The Governor’s budget proposes using all current and future Tobacco Settlement funds for health care programs. In 2001-02, the State expects to receive $468 million in Tobacco Settlement funds. Setting aside $23 million in reserves, the Governor plans to spend approximately $445 million for the Healthy Families and Medi-Cal programs, the Child Health and Disability Prevention Program (CHDP), breast and prostate cancer treatment, and a youth anti-smoking program. Unfortunately, however, the Governor is using Tobacco Settlement funds to supplant State General Fund. As a result, the State’s General Fund commitment to health services will decrease between 2000-01 and 2001-02. The General Fund commitment to Medi-Cal alone is proposed to decrease by $132 million. Medi-Cal Eligibility There are no policy changes for Medi-Cal eligibility in 2001-02. The approximately $500 million ($215 million GF; $170 million Tobacco Settlement funds; $115 million federal) in budget increases for 2001-02 are attributable to policy changes the Governor made in fiscal year 2000-01, such as: expansion of Medi-Cal for working families, working disabled, and the aged, blind or disabled; continuous eligibility for children; and elimination of quarterly status reports. Reimbursement Pursuant to a legal settlement, the Governor’s budget provides $64.2 million (GF) to increase reimbursement rates for hospital outpatient services by 30% effective July 1, 2001. However, as the Department’s outpatient services are provided under federally qualified health centers (FQHCs), these rate increases will not impact the Department. The Governor’s budget does not include the $350 million lump sum settlement amount for retroactive payments for outpatient services provided between 1992 and 2001. San Francisco will receive only a small portion of that amount since obtained it obtained FQHC status in 1995 and, therefore, does not qualify for settlement funds beyond that date. The budget continues a program to pay Medicare managed care premiums for Medi-Cal eligibles and maintains funding for ancillary medical services for persons in Institutes for Mental Disease. Managed Care The Governor includes $181.4 million ($91 million GF) in his budget to continue funding for the 9.2% rate increase for two-plan model rates effective October 2000. Fraud To continue with the anti-fraud efforts initiated in 2000-01, the Governor includes $1.4 million ($697,000 GF) to make permanent anti-fraud initiatives, such as stringent provider enrollment, expanded field audit activities, increased penalties; and onsite review of laboratories. Healthy Families The largest increase in health care is the $201.5 million ($115.3 million federal funds; $76.1 million Tobacco Settlement; $0.6 million GF) expansion of the Healthy Families program to include parents of children eligible for Healthy Families and Medi-Cal for Children with incomes up to 200 percent of poverty. Healthy Families expenditures proposed for 2001-02 represent a $333 million increase from the 2000-01 budget to serve an 561,000 children, (106,000 more than last year) with incomes up to 250% of poverty. The budget also includes $3.1 million ($631,000 GF) for caseload increases for mental health services. Public Health Subvention The Governor’s budget includes an increase of $1 million (GF), for a total statewide allocation of $3 million, for public health subvention. This will mean a minimal increase, from $24,000 to $27,000, for San Francisco to perform its core public health functions, such as communicable disease control and surveillance and activities. HIV/AIDS The General Fund contributions for HIV/AIDS services are budgeted at the same levels as last year. The $5.1 million increase for the AIDS Drug Assistance Program to maintain caseload and program cost increases are proposed using federal CARE Act Title II funds. Prevention In the area of prevention, the budget includes: $20 million (one-time federal funds) for the Community Challenge Grant Program to reduce teenage and out-of-wedlock pregnancies; $20 million (Tobacco Settlement) for a teen anti-smoking campaign; $4 million (Prop 10) for the Childhood Asthma Initiative; and, $1.1 million for the Lead Poisoning Prevention Program. Proposition 99 As Californians continue to use fewer tobacco products each year, revenues for 2000-01 are estimated to decline $11.9 million below the 2000-01 budget level to $360 million. For 2001-02, revenues are estimated to decline by an additional $5 million to $355 million. The budget releases $11 million in litigation reserves, which partially offsets the $16.9 million decline in revenues estimated between 2000-01 and 2001-02, for the anti-tobacco media campaign. The proposed budget continues $24.8 million for emergency room physician and specialists under the California Healthcare for Indigents Program (CHIP). No further relief is provided, however, to ensure indigent health care services under CHIP. The budget also includes $11 million, an increase of $4.7 million over 2000-01, for increased caseload in the Access for Infants and Mothers (AIM) program, and $11.5 million for increased caseload in the Breast Cancer Early Detection program and a funding shortfall in the Breast Cancer Control Account. $65 million in funding for CHDP is shifted from Proposition 99 to the Tobacco Settlement Fund. Environmental Health Nearly all of the funding allocated to environmental health issues is for State-level programs rather than programs operated at the local level. The budget includes State-level funding for clean beaches, pesticide regulation and radiation control. Behavioral Health Mental Health The Governor’s budget includes $55.6 million to continue, on an ongoing basis, funding for AB 34 programs for the homeless mentally ill. This will ensure continued funding of $2.3 million for the Department for outreach and integrated services for homeless mentally ill. The budget also includes a $21.2 million ($20.2 million GF) increase for caseload growth and provider rate increases for psychiatrists and psychologists in the Mental Health Managed Care program and $12 million (federal funds) to fund Therapeutic Behavioral Services as a Medi-Cal benefit. Alcohol and Drug Programs The Governor included the $120 million (GF) designated in Proposition 36 for substance abuse treatment for non-violent drug possession offenders and also included $20.9 million ($10.2 million GF) for Drug Medi-Cal caseload increases and to fund the relapse prevention program created in 1999-2000. Aging with Dignity The Governor’s budget includes funding to continue components of the Aging with Dignity Initiative he introduced in 2000-01, such as nursing home quality assurance and the Senior Wellness Campaign. The budget also includes $1 million ($508,000 GF) to develop an assisted living waiver, pursuant to AB 499 of 2000, and $1 million ($500,00 GF) for the development of an assessment tool to identify individuals who qualify for long-term care in a community setting. Categorical Health Programs For uninsured or underinsured individuals with incomes below 200 percent of poverty, the budget includes an increase of $10 million (Tobacco Settlement), for a total of $20 million, for prostate cancer treatment, and $20 million for breast cancer treatment. Federal Health Insurance Portability and Accountability Act (HIPAA) In order to facilitate compliance with the privacy regulations of the federal Health Insurance Portability and Accountability Act (HIPAA), the Governor’s budget includes $22.4 million ($3.9 million GF) for the Departments of Health Services, Mental Health, and Alcohol and Drug Programs and the Office of Statewide Health Planning and Development. COMMUNITY HEALTH NETWORK San Francisco General Hospital Bond Proposal Planning Process (SFGHBPP) The SFGHBPP had a successful Kick-off last Wednesday. Gene O’Connell and the CHN staff from SFGH and the CHN Planning Office did an outstanding job in getting this planning process started. The process is being patterned after the very successful LHH bond proposal planning process. As with LHH, City Attorney, Louise Rene and myself are Co-Chairs of the overall planning committee. Three sub-committees have been established: Program – Gene O’Connell, Chair; Finance - Ken Jensen, Chair and Technical – Carlos Villallva, Chair. All committees have broad-based CHN and Community representation. The sub-committees began meeting this week. Recommendations from the planning process are scheduled to go to the Health Commission on March 20th and the Capital Improvement Advisory Committee on March 21st. We will again report on the progress of the planning process at the February CHN Joint Conference. Laguna Honda Hospital Replacement Project (LHHRP) As we move forward in our planning for the LHHRP, we are mindful of the necessity of including ample network representation in addition to the LHH staff. Particularly, now that the City has embarked on a replacement bond planning process for San Francisco General Hospital (SFGH) it is imperative that quality communication occurs between both planning processes. In that regard, Ken Jensen and Larry Funk met with representatives of LHH and SFGH last week to discuss those services that may lend themselves to physical space and operational consolidation on a single site, whether at SFGH, LHH or at an off site location. Some of the areas under discussion include Materials Management, Central Supply, Food Services, and accounting. These reviews will continue over a short period of time until we make a decision regarding the physical placement of these services. Efficient use of time is critical to maintain the financial viability of this project. We will continue to work with the Project Manager, Michael Lane, Larry Funk and the Architects in bringing this project to fruition. We have scheduled an advisory group meeting for February 7, 2001, at 7:00 PM at Laguna Honda Hospital Resident’s Library located on the 3rd floor of the main building. Integration of LTC Pilot Project Task Force with the Department of Aging and Adult Services. On January 19, 2001, the LTC Pilot Project Task Force reviewed issues related to the integration of its activities with the new Department of Aging and Adult Services (DAAS). The intention is to operate planning activities of the LTC Pilot Project Task Force and DAAS as one integrated effort and a. transition plan to integrate all planning activities is now being developed. DAAS will expand the Commission on the Aging into the Commission on Aging and Adult Services. Additional Commission slots will be added: long-term care (2 slots); younger disabled adults (1 slot); veterans affairs (1 slot); and dependent adults (1 slot). Short-Term Stay Program s Beginning at Laguna Honda This month Laguna Honda Hospital will begin implementing the "Short-Term Care Program: Expediting Reentry to the Community." Short-Term Care is a program providing services to individuals who demonstrate potential for discharge within 90 days from time of admission, utilizing rehabilitation interventions and early, aggressive discharge planning. The Short-Term Care Program will be the first of several LHH efforts this year to promote early discharge and independent functioning, and should expedite patient flow through the CHN. Pharmacy Transition Update Complete data for the first two weeks of PBM operation (November 16 – 30, 2000) indicate that a total of 2,711 prescriptions were filled for uninsured CHN patients by 77 community pharmacies located in San Francisco during that period. In December, 93 community pharmacies were utilized to fill 6,695 prescriptions. 31% of the prescriptions filled in the community were filled in independent pharmacies, 48% were filled in a Walgreens Pharmacy, and the remainder was filled in other chain pharmacies. In December 2000, the pharmacy at SFGH experienced a drop in total prescription volume of approximately 29% when compared to the average for the three months preceding PBM implementation. The average weekday prescription volume also declined to 823 (from pre-PBM averages of 1100 – 1150.) However, the volume of prescriptions filled at SFGH for uninsured CHN patients, combined with the volume of prescriptions filled by the PBM pharmacies, remained the same as it was prior to PBM implementation. This finding may be interpreted as an indication that the PBM is continuing to serve uninsured CHN patients. It is anticipated that the SFGH pharmacy will be able to achieve its goal of wait times consistent with the community standard (30-40 minutes) for the majority of patients when the average daily prescription volume is 500 or less. POPULATION HEALTH AND PREVENTION Campaign Nominated for GLADD Media Award, 2001 We have been informed that the "HIV STOPS WITH ME" campaign--sponsored by the Department's HIV Prevention for Positives Project--has been nominated for a prestigious national media award by Gay and Lesbian Advocates and Defenders (GLADD)--a major media watchdog agency. The HIV Stops With Me campaign is an excellent example of the benefits of public-private partnerships for health education and community service. Congratulations to Charles Klein, Project Manager, Mike Shriver (former) Community Advisory Board Chair and our partners at Better World Advertising. More information about this project can be found on the hivstopswithme.org website. African American Health Initiative The Department's African American Health Initiative participated in the first health fair held in conjunction with the Martin Luther King Birthday Celebration at Bill Graham Auditorium. The event was an excellent opportunity to address the health disparities that impact the African American Community. Staff was on hand with outreach and information on breast and cervical cancer, domestic violence, HIV programs and prostrate cancer. The Adult Immunization Program gave out free flu shots. The health component was co-sponsored by Kaiser Permanente and The Glide Foundation. Thanks to Cynthia Selmar for coordinating these efforts. Community Health Promotion and Prevention In observance of Child Passenger Safety Week (Feb 11-17), a free car seat inspection will be held at Gate 5 of the Cow Palace on Sataurday, February 10 from 9 AM to 2 PM. Trained car seat checkers from San Francisco, San Mateo and Santa Clara counties will help families determine the appropriate seat for their children and vehicles, and position the seats correctly. Call (650) 991-8106 for an appointment. Drive-ins will be seen on a first come, first served basis. Housing and Urban Health The Department hosted a Regional Heroin Overdose Working Group on January 22. Representatives from Seattle, Portland, Salt Lake City, New Mexico, Santa Cruz and San Francisco participated. Data, programs, policies and successes were presented. Future collaborations were planned with the goal of reducing deaths due to heroin overdose, the third leading cause of years of lost life in San Francisco. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE AWARDS FOR JANUARY 2001 On behalf of the Commission, Vice President Umekubo presented the awards to the following: Individual Nominees Division Nominated by Stephanie Feldman, Physical Therapist Rehabilitation Department SFGH Vinita S. Levet, PT Evita Mullins, Nurse Manager CHN – Primary Care Michael Drennan, MD Center Director, and staff Joseph Pendon Nursing – SFGH Gene O’Connell, Executive Director, SFGH Note: Stephanie Feldman was unable to attend. 6) ELECTION OF THE PRESIDENT AND VICE PRESIDENT OF THE HEALTH COMMISSION FOR 2001 Commissioner Chow nominated Commissioner Guy for re-election as President of the Commission. Action Taken: The Commission unanimously re-elected Commissioner Guy as President. Commissioner Umekubo nominated Commissioner Chow for Vice President of the Commission. Action Taken: The Commission unanimously re-elected Commissioner Chow as Vice President. President Guy stated the assignments for the Joint Conference Committees will be announced at the February 6, 2001 meeting. President Guy announced that the Mayor has appointed Arthur M. Jackson, who is the President of the Commission on the Aging and a former Health Commissioner, to serve the remaining term of former Health Commissioner Ron Hill.  Commissioner Jackson will attend the February 6, 2001 meeting. 7) PRESENTATION ON OPTIONS FOR ACHIEVING UNIVERSAL HEALTH INSURANCE COVERAGE IN SAN FRANCISCO AND CONSIDERATION OF A RESOLUTION Tangerine Brigham, Director of Policy and Planning, gave an overview of options for achieving universal health care coverage.  The document outlines additional steps that can be pursued to achieve the City and County’s goal of universal health care.  Specifically, this document recommends developing a health insurance program that provides coverage to uninsured children (0-18 years of age) who are:  (1) ineligible for State and Federally-funded health insurance, and (2) have family incomes at or below 300% of the Federal poverty level. Supervisor Mark Leno, Chairman of the Board of Supervisors Finance Committee, indicated his high priority along with his Board colleagues for children’s health care coverage.  He would work with the Commission and the Department on this very important issue. Public Speakers: Deborah Alvarez-Rodriguez, Director of the Department of Children, Youth and Their Families, urged Commission to explore all State and Federal revenues; continue to look at implications for family members; encouraged the Department to work collaboratively with the Mayor and her Department. Melinda Paras, Health Access, stated this is a real opportunity to take a substantial portion of the children’s population and take small incremental steps towards universal health care; already have foundation for outreach; the CHN would be positioned to absorb this population. Jean Fraser, S.F. Health Plan, endorses the plan and incremental approach; submitted written testimony explaining why the S.F. Health Plan is the logical choice for the program. Margaret Brodkin, Coleman Advocates for Children and Youth, supports the planning and outreach; supports coordinated system for universal health along with DCYF and the Proposition 10 Commission; wants to participate in planning. Neil Gendel, Healthy Children Organizing Project, supports concept of coverage for all children, especially 0-5 years; access to culturally appropriate coverage. Dave Fox, retired Deputy City Attorney, supports universal health care for children. Dr. Elissa Song, UCSF Pediatrician, commends the plan; this is first step and should include parents; provide secure source of funding; do not cut existing children’s programs. Suki O’Raghallaigh, aide for Supervisor Gerardo Sandoval, pointed out District 11 has more uninsured children. Commissioner Comments: This plan is an outstanding approach to provide health services to children; go forward in increments; thanked the Department and staff Thanked all speakers; very important protocol; critical to have sustained funding Challenge is how to get the word out and get enrolled effectively in collaboration with other groups Supports going at the 300% poverty level, including vision and dental. Dr. Katz stated the Department will collaborate with all of the appropriate entities. Action Taken: The Commission adopted Resolution #4-01, “Supporting Achievement of Universal Health Care and Expanding Health Care Coverage to Uninsured Children and Youth.” 8) PRESENTATION OF THE PROPOSED DEPARTMENT OF PUBLIC HEALTH BUDGET FOR FY 2001-02 Mr. Matthew Hymel from the Controller’s Office presented graphs on total City revenues, allocation of revenues.  He pointed out the following risk factors in the FY 2001-02 budget: Lower beginning balance Business tax litigation Stagnant health revenues Rising energy costs Monique Zmuda, DPH Chief Financial Officer, presented a Summary of the Proposed Budget for FY 2001-02.  A message from the Health Director for FY 2001-02 Budget was submitted.  A copy of the full Budget is available in the Commission Office. Ms. Zmuda reported the budget reflects the direction of the Department’s new Strategic Plan.  She pointed out the Department is not assured of receiving the requested additional $22 million in General Funds.  Without this, she foresees a need for proposed reductions.  She also pointed out the importance of COLA’s to the contractors and will continue to advocate for this. Ms. Zmuda acknowledged the work of her new staff person James Alexander, Budget Analyst. Public Speakers: Keith Choy, Mayor’s Criminal Justice Council, advocated for $200,000 emergency housing as an above the base budget service. Alan Gelb, M.D., SFGH Medical Staff, indicated the budget process was better this y ear; supports COLA’s for UCSF; be bold and include in budget now. Frederick Hobson, DAAB, submitted budget recommendations from the DAAB/CAAB and a Board of Supervisors’ resolution supporting the DAAB recommendations. Kate Monico-Klein, Forensics AIDS Project, supports above the base funding for emergency housing. Jennifer Friedenbach, Coalition on Homelessness, urged Commission to stand up to Mayor Brown and support the mental health system. Belinda Lyons, Mental Health Association, supports a full-time access advocate position. L. S. Wilson, Coalition on Homelessness, stated the need to integrate job training and mental health treatment in the community. Darren Lewis, Coalition on Homelessness, urged funding of 10 peer counselors to work in the community. Christina Taylor, Community Housing Partnerships, works with Transgender Outreach and peer counseling; described discrimination and need for hormone therapy; supports COLA’s for all positions. Kym Valdez, Swords to Plowshares, supports the People’s Budget, COLA’s for contract agencies; described the CBO’s loss of ability to pay bills. Kate Gudsey; Jail Psych Services, supports increase in funding for jail health; complex patients in the jails; not able to recruit and retain staff. Phil Hopewell, M.D., SFGH/UCSF, described the U.C. contract; not funding the COLA’s will result in service reductions. Don Seaver, M.D., Jail Psych Services, needs excellent clinicians and reasonable salaries. Talmadge King, M.D., Chief of Medical Services, supports the high-utilizer program; can’t go into next year without cuts. Alicia Fernandez, M.D., SFGH Department of Medicine, described high-utilizers of acute services and the conference on this subject; high-utilizer program is case management based. Michael Wise, S.F. Network of Mental Health clients, submitted sample of Voices at Bay newsletter. Nika St. Claire, Contractor’s Association, urged increased funding for staffing and infrastructure; urged 10% COLA’s or forced to reduce services by 10%. Michael Lyon, Emergency Coalition, described need for critical care beds; demanded all service cuts restored. Helynna Brooke, Mental Health Board, supports full COLA’s and full funding for single standard of care for mental health. Mark Siobal, SFGH Respiratory Services, described impact of underfunded COLA’s; will cause decrease in services and will be out of compliance. Eve Meyer, S.F. Suicide Prevention, urged to include COLA’s and described impact on the partnership between the Department and contractors. Ward Gypson, M.D., SFGH, supports trauma enhancement for traumatic brain injuries. Robert MacKersie, M.D., SFGH, supports ER respiratory and support services to trauma services. Sue Carlisle, M.D., SFGH urged to maintain exceptional care at SFGH; increases in COLA’s; committed to working smart. Ernest Ring, M.D., SFGH Radiology, supports COLA’s; described radiology needs; lack of good salaries for staff. Neil Stollman, M.D., SFGH, described prevention through colon cancer screening would have to be cut if COLA’s are not given. Karen Patterson Matthew, BVHP Foundation and Mental Health/Substance Abuse Contractors Association, expressed willingness to support the Strategic Plan but is disappointed on the elimination of support to CBO’s and COLA’s; urged Commission to refuse a budget that eliminates COLA’s for contractors. Darryl Inaba, HAFACI, supports COLA’s for contractors; considers this a priority in the budget; harder to maintain staff. Richard Heasley, S.F. Mental Health Contractors Association, described CBO’s reaching desperation, more difficult to maintain service levels. June Duenas, Family Links to Mental Health, supports children’s mental health to prevent more expenses later in life. Written testimony was submitted by: Laura Ware and Joyce Miller, Local Homeless Board Alan Kaufman, Citywide Case Management Forensic Project S.F. Association of Alcohol and Drug Program Contractors Commissioners’ Comments: Expressed concern of impact on SFGH without COLA’s to the U.C. contract Expressed concern of impact on service delivery without COLA’s to Department contracts Important to include concern for COLA’s in the budget and that service impacts will occur without COLA’s Supports inclusion of the high utilizer program at SFGH; relook at this Acknowledged the continuous message that multitude of safety nets are being threatened Wants one Department approach to COLA’s not to separate out the U.C. contract Indicate in the resolution about the COLA’s and what you would be losing Wants to see revision of resolution to include the concern for COLA’s with consequences on services Complimented staff on work on the budget Dr. Katz pointed out in the absence of COLA’s, there will be service cuts. 9) OTHER BUSINESS/PUBLIC COMMENTS Commissioner Monfredini raised the question of starting Commission meetings earlier when agendas are lengthy. The meeting was adjourned at 7:20 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission