Minutes of the Health Commission Meeting July 10, 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 Guy, M.S.W., at 3:06 p.m. Present:  President Roma P. Guy, M.S.W. Vice President Edward A. Chow, M.D. Commissioner Arthur M. Jackson Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner John I. Umekubo, M.D. Absent:  Commissioner David J. Sanchez, Jr., Ph.D. 2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF JUNE 19, 2001 Commissioner Chow requested a change to his comments regarding the Director’s Report, in order to clarify his intention. The word “organization” was replaced with “joint conferences.” Action Taken: The Commission adopted the minutes of June 19, 2001, with Commissioner Chow’s change noted. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Lee Ann Monfredini) Commissioner Monfredini chaired, and Commissioner Jackson attended, the Budget Committee meeting. (3.1) AIDS Office - Request for approval to retroactively accept and expend a performance agreement from Public Health Foundation Enterprises, Inc. (PHFE), in the amount of $69,799, to fund a project for “HIV Strain Diversity and Nonprogressors”, for the period of July 1, 2000 to June 30, 2002. (3.2) AIDS Office - Request for approval to retroactively accept and expend a performance agreement from Public Health Foundation Enterprises, Inc. (PHFE) in the amount of $754,360, to fund a project for “San Francisco HIV Vaccine Clinical Trials”, for the period of June 1, 2001 to May 31, 2002. (3.3) AIDS Office - Request for approval of a contract renewal with Mobilization Against AIDS International (MAAI), in the amount of $271,838, to provide HIV prevention services to youth of color and Latino adults, for the period of July 1, 2001 through June 30, 2002. (DPH contracted with MAAI for services totaling $289,204 during FY 2000-01). Commissioners’ Comments During the Budget Committee, Commissioner Monfredini expressed concern that the data had not been collected correctly. Steven Tierney responded that this contract and all the HIV contracts are currently out to bid and they will be evaluating each bid on the work they do and their administrative operation. (3.4) PHP-Health Promotion - Request for approval of a contract renewal with Men Overcoming Violence (MOVE) in the amount of $90,368, to provide family violence prevention services targeting service providers and community members, for the period of July 1, 2001 through June 30, 2002. (DPH contracted with MOVE for services totaling $79,500 during FY 2000-01). Commissioners’ Comments During the Budget Committee, Commissioner Monfredini expressed concern about the organization’s difficulty submitting material to the Department of Public Health in a timely manner. Alan Silva, the acting director of MOVE, responded that due to the transition in the leadership of the organization, they are still developing their communication structure with the department. Commissioner Jackson and Commissioner Monfredini requested that the department and the organization report to the Budget Committee at a future date when the program has been more fully developed. (3.5) PHP-Housing and Urban Health - Request for approval of a modification to a one-time only sole source contract with Mission Housing Development Corporation (MHDC), the lead agency in a collaborative to conduct a census of families with children living in SRO hotels. The budget has been increased from $70,724 to $98,724 and the contract period has been extended an additional month from April 1, 2001-July 31, 2001 for a new contract period of April 1, 2001 August 31, 2001. (DPH contracted with MHDC for services totaling $70,724 during FY 2000-01). Commissioners’ Comments Commissioner Monfredini and Commissioner Jackson directed staff to provide the committee with a report once the census is complete. (3.6) PHP-Mental Health - Request for approval of a sole source contract renewal with Echo Consulting Services of California, Inc., in the amount of $404,935, to provide maintenance and support services for Community Mental Health Services’ billing software, INSYST, for the period of July 1, 2001 through June 30, 2002. (DPH contracted with Echo for services totaling $341,432 during FY 2000-01). (3.7) PHP-Mental Health - Request for approval of a sole source contract renewal with InfoMC, Inc., in the amount of $284,500, to provide maintenance and support services for the San Francisco Mental Health Plan’s cCURA2 software, for the period of July 1, 2001 through June 30, 2002. (DPH contracted with InfoMC for services totaling $143,500 during FY 2000-01). . (3.8) PHP-Mental Health - Request for approval of a contract renewal with Calvin Y. Louie, CPA (CYL), in the amount of $539,504, to provide fiscal intermediary services for the Community Mental Health Services supplemental residential care facilities, for the period of July 1, 2000 through June 30, 2002, for a total contract value of $8,079,008. (DPH contracted with CYL for services totaling $4,039,504 during FY 2000-01). (3.9) CHN - Request for approval of two (2) contract renewals with the following firms: Asereth Medical Services, Inc. and Rxrelief, for a combined total amount of $1,200,000, to provide as-needed supplemental pharmacy personnel services to the Community Health Network, for the period of July 1, 2001 through June 30, 2002. (DPH contracted with these two firms for $1,150,000 during FY 2000-01). Commissioners’ Comments During the Budget Committee, Commissioner Jackson asked staff to report back to the committee what portion of the total unit cost the Licensed Pharmacist, Registered Technician and Pharmacy receive. (3.10) CHN - Request for approval of a contract renewal with Richmond Area Multi-Services, Inc. (RAMS) in the amount of $1,769,103 per year, for three years for a total contract amount of $5,307,309, to provide culturally competent partial hospitalization and aftercare treatment services targeting the community’s mentally impaired population, for the period of July 1, 2001 through June 30, 2004. (DPH contracted with RAMS for services totaling $4,576,229 during FY 2000-01). 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 Board of Supervisor’s Proposed Budget for FY 01-02 The Finance Committee of the Board of Supervisors completed six days of budget hearings and reviews for the FY 2001-2002 budget on June 28, 2001. The Finance Committee recommended reductions in the amount of $178,695 to the Health Department budget as submitted by the Mayor’s Office. Subsequently, the Finance Committee recommended that $6,806,093 be added back to the Department’s budget to fund Contractor COLA’s and program enhancements. The Board of Supervisors will vote to approve the FY 2001-2002 budget on July 23 and July 30, 2001. The following details the $6.8 Million recommended by the Finance Committee to be added back the Department’s budget for FY 01-02. $2,600,000 University of California 2% COLA and services. $2,345,094 Non-profit contractor COLA’s. $ 369,000 Jail Health Psychiatric Services contract. $ 75,000 Mission Neighborhood Health Center Excelsior Clinic. $ 50,000 Walden House substance abuse services. $ 100,000 Job training for the mentally ill. $ 100,000 Family Links/ Parent Talkline. $ 140,000 Richmond Area Multi-Services. $ 75,000 Shanti Lifelines - breast cancer case management. $ 75,000 New Leaf mental health services. $ 50,000 Hepatitis C Education Services for intravenous drug users. $ 50,000 Healthcare for Women. $ 40,000 Positive Resource Center HIV support services. $ 35,000 Transitions Program. $ 35,000 Dolores Street Community Services $200,000 Ark House - transitional housing for GLBT youth. $367,000 SF AIDS Foundation - housing subsidies. $100,000 Drop-In Clinic for mental health services. POPULATION HEALTH AND PREVENTION African American Health San Francisco Department of Public Health's African American Health Initiative and the African American Coalition for Health Improvement and Empowerment sponsored the First Annual Community-Based Health Conference June 23rd at the Bayview Opera House. On June 29th, the San Francisco African American Health Summit was held. The summit, "Catalysts for Change", was a gathering of elected officials (including Assembly Member Kevin Shelley), public and private business leaders, health plan providers and community leaders, to develop an agenda for strengthening the African American community in San Francisco. Proposition 36: The Substance Abuse and Crime Prevention Act On June 28th, Proposition 36 Advocates, including the Lindesmith Center Drug Policy Foundation, issued 'report cards', grading 11 counties encompassing 75 percent of the state population on the quality of their implementation plans. With an "A" grade, San Francisco ranked the highest (the only county to receive an "A"), followed by San Mateo (A-), Alameda (B), Orange (B), Los Angeles (B-), Fresno (C), Riverside (C), Santa Clara (D+), San Diego (D+) and Sacramento (D). The County of San Bernardino came in last with a failing grade. To view the report card, please refer to http://www.prop36.org/report.tpl. San Francisco's plan is the result of a collaborative planning process that included representatives from the Board of Supervisors, City and County agencies, Probation, Parole, members of the community, the Treatment on Demand Council, advocacy groups, substance abuse treatment providers and the faith community. Community Mental Health Services Receives 2.5 Million Grant for Youth Services The City and County of San Francisco was awarded a Youth Development and Crime Prevention Grant by the State of California (Department of Alcohol and Drug Programs, Department of Mental Health, and the Employment Development Department). San Francisco will receive $834,357 annually for three years. Children's Mental Health Services, part of Community Mental Health, will serve as the lead agent for the grant, which is in collaboration with Community Substance Abuse Services, the Private Industry Council/Workforce Investment Commission and the Juvenile Probation Department. The project will serve youth ages 14-18 who have at least one juvenile probation referral and either a significant alcohol or drug problem or serious emotional disturbance. Communities being targeted include South of Market, Mission, Bayview Hunters Point and Visitation Valley. COMMUNITY HEALTH NETWORK San Francisco General Hospital Credentials Report 07/01 2001 YTD New Appointments 8 36 Reinstatements 0 5 Reappointments 22 242     Delinquencies: 0 0     Reappointment Denials: 0 0 Resigned/Retired: 35 97 Disciplinary Actions 0 0 Restriction/Limitation- Privileges 0 0 Changes in Privileges     Additions 0 13     Voluntary Relinquishments 1  12     Proctorship Completed 71 71 Commissioners’ Comments: Commissioner Parker thanked the Board of Supervisors Finance Committee for the budget add-backs, particularly the COLA increases for UCSF and the non-profit organizations. Commissioner Chow commended the administration for the development of the budget and its work with the Board of Supervisors. Commissioner Guy stated that the budget reflects the Health Commission’s priority to invest in community-based care with such initiatives as the African American initiative, and to collaborate with other agencies such as the Police Department and the Recreation and Parks Department. She noted that community health can be enhanced when all of the stakeholders are brought together. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEES RECOGNITION AWARDS FOR THE MONTH OF JULY On behalf of the Health Commission, Commissioner Parker presented the following awards: Individual Nominee: Joe Goldenson, M.D., EMS Medical Director Team Nominees: Malou Acha, Mila Alcantara and Odessa Fernandez, Contracts Procurement and Accounts Payable. 6) BAYVIEW HUNTERS POINT TASK FORCE UPDATE (Rajiv Bhatia, M.D.) Dr. Mitch Katz provided the Commission with an update on the actions that have been taken since the February 20, 2001 Health Commission hearing at the Milton Myers Recreational Center. Dr. Katz reported that following the meeting, the Department of Public Health convened the leaders of several city departments to bring to bear all of the resources the City has to offer, and identify the short-term and long-term issues that departments can address. Three meetings were held in which department leaders were asked to prioritize and commit new resources that could be deployed swiftly to the community in ways that could improve health. The following departments participated in these meetings and made commitments to concrete actions: MUNI Recreation and Parks Department Public Utilities Commission Port of San Francisco Department of Building Inspection Planning Department Department of the Environment Dr. Katz described the commitments of each of the departments listed above. Further explanation of each department’s commitments can be found in Attachment A. Dr. Katz reported that the Health Department would coordinate a series of meetings for the Bayview around economic issues. He will convene a meeting with the department heads from the Department of Human Services, the Mayor’s Office of Economic Development, the Private Industry Council, the City Treasurer and others. He will also convene a separate set of meetings around the public safety issues in the Bayview with the Police Department, the Probation Department, the District Attorney, the Sheriff and others. These meetings will be geared toward concentrated efforts focussed on action. Tony Wagner reported to the Commission the steps the Department of Public Health is taking to improve and enhance services to the Bayview community. The Department undertook an informal survey of residents to ensure community input in the planning process. Two prominent survey responses were an overwhelming concern with violence and public safety, and the desire to reconstitute the Ujima Project. The Department plans to resurrect the Ujima Project at the Milton Myers Recreation Center. Various DPH services, including WIC outreach, substance abuse outreach and referral, mental health screening and others will also be provided at the recreation center. The Department will also provide an array of services at the housing unit located at One Harbor Road. Dr. Rajiv Bhatia continued the presentation by reporting the specific commitments made to address environmental health concerns. The DPH-Environmental Health Section has: Produced and distributed a guide to environmental health services. Created a MOU with the Department of Building Inspection to coordinate responses to mold complaints. Developed a comprehensive indoor environmental investigation protocol to be used in coordination with the Department of Building Inspection, tenants, tenants’ rights groups, and landlords to evaluate subsidized housing in Hunter’s Point. Agreed to conduct training for subsidized housing residents on asthma and indoor air quality. According the to report, the Department of Public Health also made the following commitments: Develop a clinical presence at Hunter’s Point. Services provided: preventive health, mental health, public health nursing, and WIC. Ensure that the appropriate entities both within DPH and externally are notified to respond to incidents of violence and homicides. Produce consumer friendly guide to citywide environmental health services. Station mobile services in the Bayview. Coordinate sewage back-up responses with the Department of Building Inspection and the Public Utilities Commission. Coordinate response to mold complaints with the Department of Building Inspection. Commissioners’ Comments Commissioner Umekubo asked the other departments to put timelines on their initiatives. He also recommended that the Department establish target benchmarks the Department would like to achieve in a particular timeframe. He stressed that this is an on-going, multi-year endeavor that will need monitoring. Commissioner Parker requested that the department share what it is doing with the Bayview residents. He stated that there needs to be a lifetime commitment to carrying out these projects in Bayview Hunter’s Point. Commissioner Chow stated that as these initiatives move forward, violence and public safety must be addressed, and that it is important to get agencies such as the Sheriff’s Department involved. He would like the Commission to receive follow-up reports for each initiative. Commissioner Chow also asked if this collaboration would be expanded to other communities throughout the city, and if all the diverse communities in the Bayview would be able to participate in the current effort. Dr. Katz responded that they are addressing public safety next, and that the services are geographically focussed, so all will have access. Mr. Wagner added that during the planning stages, it was made clear that this effort would reflect the diversity of the neighborhood. Commissioner Monfredini asked if gang activity has been addressed, as this is a public health issue. She also asked if the department is using models from elsewhere. Cynthia Selmar responded that the Health Department is working with a number of other agencies to address gang issues. The department is looking at best practices. Commissioner Monfredini then expressed concern that those property owners who are told to fix up their properties might abandon the endeavor, and lead to more homelessness. Commissioner Jackson stressed that economic development is a critical issue. He suggested that collaborative efforts be expanded beyond the departments to non-profits such as SF Works. He also conveyed a concern voiced by a number of people at the summit that when the neighborhood improves, it will lose its rich diversity. He said the department must ensure this does not happen. Commissioner Guy stated that the Commission has a new vision to involve stakeholders in the health agenda. She said that when the Health Commission and the Department of Public Health undertook the African American Initiative, it was unclear if it would be successful. But with every stakeholder involved and all the elements in place, it has been successful. She also stated that the Commission needs to direct the next steps, to see quantifiable objectives with benchmarks so that the stakeholders can identify with the progress, and that there should be continued discussion in the joint conferences over the next year. 7) LAGUNA HONDA HOSPITAL REINTEGRATION PROGRAM (Dr. Lisa Pascual, Director of Rehabilitation Services) Dr. Lisa Pascual, Director of Rehabilitation Services at Laguna Honda Hospital, described the new Community Reintegration Program (CRP) developed on the rehabilitation unit and other satellite units at Laguna Honda Hospital. The Community Reintegration Program is a program for individuals who demonstrate the potential for discharge within 90 days of admission, with an emphasis on: Rehabilitation Functional maintenance Discharge planning Community reintegration The rehabilitation staff has developed a database to track referrals, demographics and outcomes, including clinical data based on nationally recognized measures. The database provides a means of identifying how efficiently people get in the hospital, how effectively their function is improved, and how well this function is maintained as an outpatient. The Fiscal Year 2001-2002 budget will allow for the following: Outpatient follow up and case management utilizing a social worker. Addition of Restorative Rehabilitation Aides to enhance functional maintenance activities for patients in the CRP and FMP. Addition of skilled therapists to cover the increased need for skilled therapy for patients in the CRP and on other wards. Commissioners’ Comments Commissioner Chow asked staff to clarify why Laguna Honda accepts patients from other acute rehabilitation facilities such as St. Francis Hospital. Dr. Pascual responded that Laguna Honda has two levels of rehabilitative care: acute-level care and SNF-level care. Dr. Pascual said that often times an individual receives acute-level care at one facility and then is referred to Laguna Honda for SNF-level care. Commissioner Umekubo asked if staff has developed projections for the rehabilitation unit. Mr. Funk responded that staff is currently looking at the data to determine the number of rehabilitation services they will need to provide at the new facility. Commissioner Umekubo then asked if there are adequate community resources available for patients. Dr. Pascual responded that there is a lack of community resources available for cognitively impaired people who need 24-hour care. Commissioner Chow asked if Laguna Honda is expanding its rehabilitation component to meet community need, and if additional resources would be allocated for program improvements. He also asked staff to explain the environmental changes that have taken place that make an acute rehabilitation program useful and marketable at this time. Mr. Funk responded staff is doing extensive planning for the new facility and trying to make these programs in the new facility as user-friendly as possible. Mr. Funk said that over the next few weeks, staff will complete a projection analysis of various types of therapies that will be needed and the space needs for these programs. Commissioner Guy commended Dr. Pascual on her commitment. She stated that is an important issue for the Laguna Honda JCC, and that the JCC should monitor it. 8) PUBLIC COMMENTS None. 9) ADJOURNMENT The Commission adjourned the meeting at 5:35 p.m. Michele M. Olson, Executive Secretary to the Health Commission