Minutes of the Health Commission Meeting April 17, 2001 3:00 p.m. at 101 Grove, 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 3:10 p.m. Present  President Roma P. Guy, M.S.W. Vice President Edward A. Chow, M.D. Commissioner Arthur M. Jackson Commissioner Harrison Parker, Sr., D.D.S. Commissioner David J. Sanchez, Jr., Ph.D. Absent: Commissioner Lee Ann Monfredini Commissioner John. I. Umekubo, M.D. 2) APPROVAL OF MINUTES OF THE REGULAR MEETING OF APRIL 3, 2001. Action Taken: The Commission adopted the minutes of March 20, 2001. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner David J. Sanchez, Jr., Ph.D.) (3.1) PHP - Housing and Urban Health Services - Request for approval of a new contract with John Stewart Company, in the amount of $1,005,375, to provide property management services and related start-up costs for the new Direct Access to Housing Programs at the Star and Camelot Hotels, which will provide 105 supportive housing units, for the period of May 1, 2001 through June 30, 2002. Commissioner Sanchez asked about funding streams in the housing programs (3.2) PHP - Substance Abuse Services - Request for approval of Phase I of the implementation of the Proposition 36 Substance Abuse Crime and Prevention Act, to authorize expenditures of $2.3 million in FY 2000-2001. (3.3) AIDS Office - Request for approval of St. Mary’s portion of the FY 2001-2002 Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 Title I, for the period of March 1, 2001 through February 28, 2002, for Title I programs, in the amount of $1,234,862 consisting of $776,854 for Integrated HIV Health Services and $458,008 for AIDS Dementia Care. Jimmy Loyce, Director of DPH’s AIDS Office, described the more recent visits and meetings in which his office has engaged concerning St. Mary’s AIDS Dementia Unit (ADU), in response to concerns raised by President Guy and other Commissioners Shareen Salem, Executive Director of Inpatient Nursing Services at St. Mary’s, stated that the administration will work with the CNAs, and will conduct training within one month. She also stated that administration will work on communication issues. Public Comment: Allen Fitzpatrick, R.N., St. Mary’s stated that the skilled nursing unit nurses are still concerned about the ADU, but encouraged by recent events. He supports continued funding for St. Mary’s ADU. Marcy Fraser works with HIV community programs. She stated that the rest of the community values the services provided by St. Mary’s ADU. Commissioners’ Comments: Commissioner Sanchez, on behalf of the Budget Committee, stated that the recent Proposition Q hearings provided dialogue concerning site and quality of care issues Commissioner Jackson acknowledged that St. Mary’s CEO had been present throughout the meetings In response to Commissioners’ concerns, Mr. Loyce stated that his office will continue to conduct site visits and monitor the program. 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 2001 State of the City Public Health Address Last week I delivered the State of the City Public Health Address before the Board of Supervisors. All members of the Health Commission have been provided copies of the report. The Department has provided this Address for the last six years to provide the public and our elected officials with information on the health status of the community. My remarks focused on expanding community-based services, prevention, environmental health, communicable diseases, substance abuse and mental health services. I would like to acknowledge the tremendous work done by Frances Culp of the Office of Policy and Planning in working on this report. As the Health Commission is aware, Population Health and Prevention compiled the overview of San Francisco’s health status. The report will be available on the Department’s web site at www.dph.sf.ca.us. Raymond Hotel Fire A fire broke out at 6:15 a.m. Easter morning at the Raymond Hotel, 1011 Howard Street. Red Cross established a temporary shelter at the South of Market Recreation Center at 6th and Folsom. The fire displaced seventy-eight individuals. Three residents suffered minor injuries, no fatalities occurred. The Health Department, Department of Human Services, Mayor’s Office of Homelessness, Animal Care and Control, Recreation and Park were all on hand to strengthen and enhance Red Cross response efforts. Many residents of the Raymond are DPH patients, and have fairly high medical needs. Dr. John Brown responded to the site and was able to provide medications for 34 residents. Barbara Garcia, LaDonnis Elston and the MOST Team all responded and triaged clients. The shelter will remain open until Wednesday when it is hoped that temporary housing will be secured for all those displaced residents. Proposed Race, Ethnicity, Color or National Origin Classification State Initiative University of California Regent Ward Connerly’s American Civil Rights Coalition has sponsored a new initiative entitled “Race, Ethnicity, Color or National Origin Classification.” The initiative would prohibit state and local governments from using race, ethnicity, color or national origin to classify individuals in government operations (including public education, contracting or employment operations). Actions taken to maintain federal funding are exempted, though classification of public health data is not. The initiative is currently in circulation. If the required number of signatures is collected, 670,816 by August 31, 2001, it will appear on the State’s March 2002 ballot. If approved by California voters, the effective date is January 2005. Voter approval of such an initiative could significantly impact the Department’s operations. Currently, the Department collects and reports race, ethnicity and national origin information through its hiring and contracting processes. The Department would be stymied in its ability to collect information on the ownership of contracting businesses, to evaluate a contractor’s cultural competency and to respond to lawsuits alleging racial discrimination. Additionally, the Department collects race, ethnicity and/or national origin to appropriately evaluate the health needs of San Francisco’s diverse communities and to conduct program planning. As currently written, the initiative would severely limit the Department’s ability to analyze and respond to health disparities based on race, ethnicity and/or national origin. As in the past, if this initiative is certified for the March 2002 ballot, then the Health Commission may want to consider adopting a resolution urging the Board of Supervisors to take a position on the initiative. The Department will keep the Health Commission apprised of this proposed initiative. President Bush’s Proposed Fiscal Year 2002 Budget Last week, President Bush released his fiscal year 2002 proposed federal budget. The proposed budget is similar in intent to the President’s budget priorities released in February 2001. The budget is designed to “moderate recent rapid growth in spending while funding national priorities, paying down the debt and providing tax relief.” The debt would be reduced by $2 trillion and taxpayers would get back $1.6 trillion in surplus over the next 10 years through tax relief. The fiscal year 2002 budget for the federal Department of Health and Human Services (DHHS) totals $468.8 billion, an increase of $38.3 billion (8.9%) from the 2001 budget. In the area of health, the President’s highlights are: modernizing Medicare enhancing scientific research expanding access to health care protecting public health increasing access to substance abuse treatment investing in infrastructure and reforms management encouraging organ donations   Modernizing Medicare Immediate Helping Hand: The Immediate Helping Hand proposal will give immediate financial support to States so that they can provide prescription drug coverage to beneficiaries with low incomes or high drug expenses. This will provide coverage for up to 9.5 million beneficiaries. Medicare Reform: The President proposes to devote nearly $156 billion this year and over the next ten years to improve the financial condition of the Medicare program and to modernize the benefits package. Expanding Health Care Access Community Health Centers: The DHHS budget launches a multi-year Presidential initiative by proposing an increase of $124 million for Community Health Centers in FY 2002 and supporting 1,200 new or expanded health center sites over five years. This increase will expand the delivery of services to up to one million additional individuals in FY 2002. National Health Service Corps: The DHHS budget includes $126 million in FY 2002 for the National Health Service Corps (NHSC). The NHSC has placed over 20,000 health care providers. Native American Health Services: The FY 2002 DHHS budget provides $3.0 billion for health care services at the Indian Health Service (IHS), an increase of $151 million (5.3%) over FY 2001. Medicaid and SCHIP: The FY 2002 DHHS budget proposes to stem the growth of Medicaid costs, ensure the fiscally prudent management of the Medicaid and SCHIP programs, improve the way these programs provide health care to the poor and near-poor, and increase State flexibility in using private insurance coverage and coordinating with employment-based insurance. Public Health Grant Flexibility: The FY 2002 DHHS budget proposes to give states greater flexibility to transfer funds among public health grants. The budget also includes the President’s Healthy Communities Innovation Fund initiative that supports grants to health care improvement projects in State and local communities. DHHS could make available approximately $400 million in existing grants for innovations. Increasing Access to Substance Abuse Treatment The FY 2002 budget proposes an increase of $100 million for substance abuse treatment services that will help close the treatment gap. This includes $60 million for the Substance Abuse Block Grant. An additional $40 million will support 80 additional Targeted Capacity Expansion (TCE) grants. Encouraging Organ Donation The FY 2002 budget request includes $20 million, an increase of $5 million, to launch a national campaign to encourage organ donation. Enhancing Scientific Research Enhancing Research at the National Institutes of Health: The FY 2002 budget proposes a total of $23.1 billion for NIH, an increase of $2.75 billion (13.5%) over FY 2001. NIH will expand its focus on four broad research areas - genetic medicine, clinical research, interdisciplinary research, and health disparities. Supporting Research on Healthcare Quality and Outcomes: The FY 2002 budget provides a total program level of $306 million for the Agency for Healthcare Research and Quality (AHRQ), an increase of $36 million (13.5%) over FY 2001. Protecting Public Health Protecting Patient Safety and Reducing Adverse Events: The budget includes an additional $10 million to increase inspections and oversight of clinical trials, train clinical trial inspectors, and allow for follow-up of all complaints concerning clinical trials within 30 days. The Agency for Healthcare Research and Quality will spend $53 million to continue its work on reducing medical errors. Safeguarding the Nation’s Food Supply: To help safeguard the nation’s food supply, the FY 2002 budget includes a total of $124 million, an increase of nearly $15 million, for FDA food safety activities. FDA will expand inspections of food manufacturers, improve coverage and inspection rates at import entry points, and focus on illnesses derived from chemicals and pesticides. In addition, $34 million will be provided to the Centers for Disease Control and Prevention (CDC) for food safety activities. Investing in Infrastructure and Reforms Management Revitalizing Laboratories and Scientific Facilities: The budget includes $150 million for buildings and facilities at CDC. Enhancing Coordination and Reducing Duplication of Operating Systems: The FY 2002 budget invests to streamline financial management and other information technology systems to eliminate unnecessary and duplicate systems. A total of $122.5 million will finance DHHS’s unified financial accounting system and information technology. Redirecting Resources: The FY 2002 budget eliminates $475 million in earmarked projects and $155 million in funding for activities that were funded for the first time in FY 2001. The budget shifts $597 million from programs such as Health Professions and the Community Access Program to higher priority activities. POPULATION HEALTH AND PREVENTION Proposition 36 Effective July 1, 2001 Proposition 36 requires that certain nonviolent drug possession offenders receive drug treatment and supervision in the community, rather than incarceration. As the lead agency for the implementation of the proposition the Department of Public Health (DPH) is facilitating a planning process, inclusive of the community and representatives from both public health and criminal justice. The process is designed to inform the development of a countywide implementation plan. On Wednesday, March 28th, the Proposition 36 Steering Committee, co-chaired by Barbara Garcia and District Attorney Terence Hallinan, met for the second time to review recommendations made by three subcommittees (Criminal Justice, Treatment, and Data, Assessment, Monitoring & Evaluation). The Steering Committee and members of the public provided valuable input for the subcommittees to consider as they develop their final recommendations to be presented at the April 18th Steering Committee meeting. DPH will be taking the recommendations developed through this process to produce an implementation plan, which will be presented to the Health Commission on May 15th. Asthma Task Force Legislation sponsored by Supervisor Maxwell to form a citywide Board of Supervisors’ Asthma Task Force will be heard by the Rules Committee on April 19th at 1pm. This legislation represents the efforts of a citywide group of asthma advocates and service providers and was initiated one year ago by Supervisor Becerril. The Task Force will gather and review existing information on the prevalence, management, and prevention of asthma and will identify legislative actions and citywide strategies to ensure the highest standard for asthma management and prevention services for San Francisco residents. Membership will be balanced among those diagnosed with asthma, community and advocacy organizations, and academic, public and private health care professionals. SFDPH will have a representative on the committee, and the Health Commission will be asked to contribute to the plan’s findings and recommendations to the Board. Children's Environmental Health Promotion Program As an adjunct to World Asthma Day, the YES WE CAN Urban Asthma partnership is slated to launch a new Poster Campaign beginning mid-April through May 3rd. The campaign is designed to raise public awareness of the burden of asthma and promote asthma self -management and clinical "best treatment." 5500 indoor posters in three languages (English, Spanish, and Chinese) will be distributed to more than 900 sites within the City. Next year, the campaign will extend to buses and billboards. The YES WE CAN Urban Asthma partnership is comprised of 11 organizations who advocate for low-income communities on issues of child health and community wellness. The Children's Environmental Health Promotion Unit of DPH was a founding member of this partnership. The Urban Asthma partnership began implementing a medical/social model at SFGH 6M Pediatric Asthma Clinic as a pilot program last year which will serve nearly 700 asthmatic children living in the southeast areas of the City. Children, Youth and Family Services Two abstracts from CYFS were accepted for the upcoming 2001 Maternal and Child Health Conference being held May 30-31 at the Hyatt Regency San Francisco Airport. Janet Shalwitz, MD, will conduct a workshop entitled “Think Globally/Act Locally: Effective Community-Based Planning for Adolescents.”; Patricia. Evans, M.D., MPH, will conduct a workshop entitled “Creating Partnerships for Updating a Foster Care HIV Screening and Testing Protocol.” COMMUNITY HEALTH NETWORK Volunteer Luncheons Volunteers from both Laguna Honda Hospital and San Francisco General Hospital will be honored at upcoming Luncheons on April 24th and April 28th respectively. All members of the Health Commission are cordially invited to attend. SFGH Honors Mrs. Edna Woods The l906 Earthquake anniversary offers us a wonderful opportunity to appreciate what this magnificent City survived 95 years ago. This City and the nation are well aware of the tremendous loss of lives and the destruction of neighborhoods from both the quake and fire. This year SFGH will play a major part in the City's Earthquake Awareness & Preparedness month. On April 10, 2001 Gene O’Connell and staff started by reaching out to a SFGH neighbor and friend who was born the same year of the l906 quake and who has lived practically all of her life across the street from San Francisco General Hospital. (Her first 8 months was in a tent city at Bryant & l6th Streets.) Edna Wood, a third generation San Franciscan, was honored during a special ceremony at SFGH for her enormous spirit and a lifetime supporting her neighbors and community. At the age of 95, Ms. Wood continues her activism with the East Mission Improvement Association and St. Peter's Church. CHN Personnel Updates I am happy to announce that Diane Jones has been selected as the new Coordinator of Community Home Care for Health at Home. Ms. Jones comes to Health at Home with extensive knowledge experience in harm reduction and AIDS/Oncology. For the last 19 years, She has been with San Francisco General Hospital, working in various capacities including as a Charge Nurse the Emergency Department and Nurse Manager for the AID/Oncology unit. In addition to all of her experience at SFGH, she also serves as a trainer/consultant for the Harm Reduction Training Institute. Ms. Jones will work with other members of the Health at Home Management Team to develop and ensure the quality and delivery of Home Health services and to provide clinical coordination for CARE Title I home care contracts and the expansion of other services. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEES RECOGNITION AWARDS FOR THE MONTH OF APRIL Commissioner Parker presented the awards to the following:   Individual Nominees Division Nominated by Michele Friedman, RN, MSc., Head Nurse PHP - Community Mental Health Services Bill McConnell Gemma Deocampo, Business Analyst DPH - Central Administration Information Technology Monique Zmuda, David Counter, Antonia Cardona-Malgieri Team Nominees Division Nominated By Thomas O’Connor, Manager, Systems Group PH&P - Enterprise Information Systems/Engineering Systems Andy Ludlow Christopher Kim, Engineering Group 6) UPDATE ON IMPLEMENTATION OF STRATEGIC PLAN Tangerine Brigham, Director of Policy and Planning, discussed the Departmental strategic planning update before the Commission. Ms. Brigham began by discussing the strategies completed, and those that will be initiated in future fiscal years. She discussed the staff resources, Commission policies, resolutions, and recommendations. Ms. Brigham also highlighted the wide variety of current service integration initiatives. In addition, Ms. Brigham outlined measures taken to ensure continued staff involvement in the strategic planning initiative. She informed the Commission of a series of community town hall meetings, one in each of the City’s supervisorial districts, to communicate the adopted strategic plan to the community, and to gather the community’s input into the process. She stated that DPH staff will provide regular updates to the Commission through the Joint Conference Committees (JCCs). Commissioners’ Comments: Commissioner Parker asked about value of Town Hall participation; Ms. Brigham responded that the meetings provide a “reality check” for DPH planners, and that the community comments are valuable Commissioner Parker asked about increasing the emphasis on prevention activities; President Guy supported Commissioner Parker’s interest in prevention. Ms. Brigham responded that the Department has a multiyear prevention plan Vice-President Chow complimented the Department concerning the grid that it developed to graphically illustrate the strategic plan; Ms. Brigham stated that the Department will add a “status” column with updates on each of the proposals President Guy stressed the strategic plan as a living document, and wants to monitor community involvement The Commission would like to see more specific strategic plan status reports, details, and “do-ables” at the JCCs The Commission requested the Department to provide another report at an October Commission meeting Each Joint Conference Committee (CHN, LHH, SFGH, and PHP) will establish on-going reporting mechanisms for the implementation of the Strategic Plan. On a regular basis, each JCC will discuss their priorities, progress, and other related issues. 7) PRESENTATION OF THE HOMELESS CONTINUUM OF CARE PLAN AND CONSIDERATION OF A RESOLUTION IN SUPPORT OF THE PLAN Anne Kronenberg, DPH’s Director of External Affairs, updated the Commission concerning the Homeless Continuum of Care Plan. The Commission also considered a proposed resolution to approve the plan, and to urge the Board of Supervisors to adopt it. Ms Kronenberg provided an overview of the plan and its highlights. She stated that DPH was well represented providing input at committees. Ms. Kronenberg assured the Commission that the plan was not dealing with just one slice of homelessness, but was taking a larger approach, to streamline and integrate services, and to offer other services on site. During the presentation, Ms. Kronenberg was joined by Rita Semel and Bob Nelson, co-chairs of the Local Homeless Coordinating Board, described the plan as a work in progress, and as a five-year, broad-stroke plan. George Smith, Director of the Mayor’s Office of Homelessness, stated that the plan looks to prevent homelessness. According to Ms. Kronenberg, the Health Commission was the first body to review, and then approve, the updated plan. Commissioners’ Comments: President Guy stated that the planning and engagement had been rigorous and disciplined, and urged other Commissioners to support the proposed resolution Commissioners complimented the document and the dialogue that has taken place Commissioner Jackson asked about points of access for the working poor; Ms. Kronenberg stated that case managed shelters reach out to the working poor Commissioners look forward to hearing again from Ms. Kronenberg later this summer concerning the Plan and community input Action Taken: The Commission considered the proposed resolution. It added the underlined language to the 14th Whereas clause to read: “Whereas, the Department’s emphasis on prevention, early intervention and primary care for the homeless and at-risk populations has the positive consequence of improving health status and reducing emergency room visits . . . .” On the motion to pass the Resolution, as amended, five Commissioners (Guy, Chow, Jackson, Parker, and Sanchez) voted aye, none voted no. The motion passed. 8) PRESENTATION ON LONG-TERM CARE INTEGRATION PILOT PROJECT, AND CONSIDERATION OF A RESOLUTION REVISING THE DEPARTMENT OF PUBLIC HEALTH’S ROLE Anthony Wagner, Executive Administrator of DPH’s Community Health Network, and co-chair of the Long-Term Care Pilot Project Task Force, began his presentation by thanking others who were involved in the planning efforts. These people included: Jennie Chin Hansen, Executive Director, On Lok, and co-chair of the LTC Pilot Project Task Force; Dr. Sandra Nathan, Executive Director, Department of Aging and Adult Services (DAAS); Bill Haskell, Department of Aging and Adult Services; and Tangerine Brigham, Director of Policy and Planning, DPH. Mr. Wagner focused on two issues: 1) Whether the City should continue to participate in the AB 1040 program; and 2) Whether the Task Force Mission can be pursued by the Department of Aging and Adult Services. He outlined the various changes that have occurred since AB 1040 was adopted in 1985. Mr. Wagner then offered several next steps: The Long-Term Care Pilot Project should be disbanded for the purpose of developing a comprehensive plan under AB 1040 The lead agency responsibilities of DPH to develop and implement a long-term care integration project under AB 1040 should be terminated The activities of the Task Force to plan and oversee implementation of improvements in San Francisco’s LTC service delivery system should be transferred to the DAAS Continuum of Care Policy Committee DPH should continue to provide technical assistance on LTC to DAAS, and should participate on the DAAS policy committees that oversee this work A joint meeting of the Health Commission, the Human Services Commission, and the Aging and Adult Services Commission will be held for the Task Force to present: 1) its findings and recommendations regarding participation in the State’s LTC Long-Term Care Pilot Program (AB 1040); and 2) the initial administrative oversight for implementing improvements in San Francisco’s LTC service delivery system In June 2001, the Task Force will proceed to the Board of Supervisors with a final presentation to report on AB 1040 and long term care service delivery of older and disabled adults Ms. Chin Hansen spoke briefly, supporting Mr. Wagner’s statements, and emphasizing the City’s commitment to long term care. On behalf of DAAS, Dr. Nathan accepted the long-term care planning and oversight responsibilities identified for her organization. Action Taken: On the motion to pass the resolution, four Commissioners (Guy, Chow, Parker, and Jackson) voted aye, none voted no. Commissioner Sanchez had left the meeting before the vote. The motion passed. 9) OTHER BUSINESS/PUBLIC COMMENTS None. The meeting was adjourned at 5:35 p.m. Arthur R. Greenberg, Interim Health Commission Secretary to the Health Commission