Minutes of the Health Commission Meeting Tuesday, December 18, 2001 at 3:00 p.m. 101 Grove Street, Room #300 San Francisco, CA 94102 1) CALL TO ORDER The Health Commission meeting was called to order by President Roma P. Guy, M.S.W., at 3:15 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 David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF DECEMBER 4, 2001 Action Taken: The Commission approved the minutes of the December 4, 2001 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Sanchez chaired, and Commissioner Jackson and Commissioner Monfredini attended, the Budget Committee meeting. (3.1) CHN-SFGH Nursing Operations - Request for approval of new contracts with C.W. Healthcare, Inc. and Medstaff, Inc. and contract modifications with HRN Services, Inc., Nurse Providers, Inc. and United Nursing International, for a combined total of $1,375,000, for supplemental, temporary Per Diem and Traveling nursing personnel services for San Francisco General Hospital, Community Health Network, for the period of September 1, 2001 through August 31, 2002. (3.2) CHN-SFGH & LHH Facilities - Request for approval of thirteen (13) contract modifications with the following firms: Acker & Guerrero Roof Co., Inc., Adolph Schmidt General Contractors, Anderson Carpet & Linoleum Sale Co., Inc., Angotti & Reilly Inc., Ayoob & Peery Plumbing, Baca & Sons Painting, Floortrends Inc., McClure Electric & Co., Robert Poyas, Inc., Sabel Painting Co., Monticelli Painting & Decorating, Sierra Electric Co. and The Shooter Co., to increase the combined contract amount by $2,162,500, from $3,825,000 to $5,987,500, for the provision of intermittent, as-needed facility maintenance services above baseline civil services staffing for the period of July 1, 2000 through June 30, 2002. (3.3) PHP-AIDS Office - Request for approval of a retroactive contract modification with the Regents of the University of California, through UCSF/AIDS Health Project, in the amount of $41,107, for a contract total of $139,196, to provide HIV Counselor Certification services, for the period of January 1, 2001 through December 31, 2001. Commissioner Sanchez abstained from voting on this contract. (3.4) PHP-AIDS Office - Request for approval of contract term extensions with the following seven contractors for HIV prevention services for the period of January 1, 2002 through June 30, 2002, Aguilas, Inc., CompassPoint Nonprofit Services, Haight-Ashbury Free Clinics, Inc., Harder+Company, Iris Center, Stop AIDS Project and Tenderloin AIDS Resource Center. (3.5) PHP-Housing & Urban Health - Request for approval of eighteen FY 2001-2003 Housing and Urban Health Contracts for a combined total of $6,982,960. (3.6) PHP- Promotion - Request for approval of a contract modification with San Francisco Study Center in the amount of $550,000, for a total contract value of $1,258,856, to provide additional fiscal agent services for the Pedestrian Safety Project, for the period of January 1, 2002 through September 30, 2003. (3.7) PHP-Prevention - Request for approval of a retroactive contract renewal with NICOS Chinese Health Coalition in the amount of $75,000 to provide problem gambling prevention services, for the period of July 1, 2001 through June 30, 2002. (3.8) PHP-Mental Health - Request for approval of retroactive contract renewal with Saint Francis Memorial Hospital for the provision of 24-hour acute psychiatric inpatient hospital services in the amount of (1) $50,000 City funds targeting uninsured adults, and (2) $4,300,000 Medi-Cal funds for three hospital providers targeting Medi-Cal adult beneficiaries for the period of July 1, 2001 through June 30, 2002. Items 3.8, 3.9 and 3.10 were discussed together. Commissioners’ Comments Commissioner Sanchez asked why the agencies had low program compliance ratings. Sai-Ling Chan-Sew responded that one of the agencies submitted its declaration of compliance 11 days late. With regard to the St. Mary’s program, client satisfaction is low primarily because these kids are locked up against their will, and do not like it. Linda Wang stated that the Department has modified some timelines because some have been unrealistic. Commissioner Jackson asked what makes the timelines unrealistic. Ms. Wang replied that one factor was that the deadline was during the holidays, when a number of staff was out, and another factor was the form being mailed to the wrong person. Commissioner Jackson emphasized that contractors must get documentation in within the timeframe. Commissioner Monfredini said when contractors get money every year, they should know the deadlines and just comply. (3.9) PHP-Mental Health - Request for approval of retroactive contract renewal with St. Luke's Hospital for the provision of 24-hour acute psychiatric inpatient hospital services in the amount of (1) $50,000 in City funds targeting uninsured adults, and (2) $4,300,000 in Medi-Cal funds for three hospital providers targeting Medi-Cal adult beneficiaries for the period of July 1, 2001 through June 30, 2002. (3.10) PHP-Mental Health - Request for approval of retroactive renewal contract with St. Mary's Medical Center in the amount of (1) $170,000 in City funds for the provision of acute psychiatric inpatient hospital services targeting uninsured adolescents and (2) $4,300,000 in Medi-Cal funds for three hospital providers for the provision of acute psychiatric inpatient hospital services targeting Medi-Cal beneficiaries, for the period of July 1, 2001 through June 30, 2002. (3.11) PHP-Mental Health - Request for approval of retroactive contract modification with Richmond Area Multi-Services, Inc. in the amount of $344,081 for the period of July 1, 2001 through June 30, 2002, to provide children’s mental health services, for a total contract value of $4,213,125, for the period of July 1, 1998 through June 30, 2002. (3.12) PHP-Mental Health - Request for approval of retroactive contract modification with Richmond Area Multi-Services, Inc. in the amount of $532,269 for the period of July 1, 2001 through June 30, 2002, to provide adult mental health services, for a total contract value of $8,341,888, for the period of July 1, 1998 through June 30, 2002. Commissioners’ Comments Commissioner Monfredini asked if the underbilling problem had been corrected. Ms. Chan-Sew responded that the agency has instituted an internal audit to make sure they do not underbill. The executive director, Evelyn Lee, reiterated this. (3.13) PHP-Mental Health - Request for approval of retroactive sole source contract renewal with San Francisco League of Urban Gardeners, acting as fiscal agent for Southeast Neighborhood Jobs Initiative Roundtable, in the amount of $50,000, to provide outreach services targeting African-American residents of the Bayview Hunter's Point, Potrero Hill, and Visitacion Valley neighborhoods, for the period of July 1, 2001 through June 30, 2002. (3.14) PHP-Mental Health - Request for approval of a retroactive sole source contract renewal with West Bay Pilipino Multi-Service Center in the amount of $60,000, to provide mental health services targeting immigrants transitioning to community care, for the period of July 1, 2001 through June 30, 2002. (3.15) PHP-Substance Abuse - Request for approval of a retroactive contract renewal with Asian American Recovery Services in the amount of $5,183,663, to provide substance abuse services targeting for adult men and women of predominantly of Asian/Pacific Islander descent, for the period of July 1, 2001 through June 30, 2002. (3.16) PHP-Substance Abuse - Request for approval of retroactive contract renewal with Youth Leadership Institute (YLI) in the amount of $377,795, to provide substance abuse services targeting teenagers and young adults, for the period of July 1, 2001 through June 30, 2002. (3.17) PHP-Substance Abuse - Request for approval of a retroactive month-to-month contract renewal with Women and Children's Family Services, Inc., in the amount of $1,611,030, to provide residential and outpatient substance abuse services to alcohol/drug addicted women, targeting low income pregnant and postpartum women, their children, their families and/or significant others, for the period of July 1, 2001 through June 30, 2002. Commissioners’ Comments Commissioner Monfredini, expressing frustration that the problems with this agency have not only continued but also gotten worse, asked the Executive Director Mary Daddio and the chair of the board Adriana Gross to respond to the Department’s recommendations. Ms. Gross said the board is recruiting for more board members, and is taking the recommendations seriously. Commissioner Monfredini asked for an update to the CHN Joint Conference Committee on January 29th and for a report to the Budget Committee on February 19th. Commissioner Monfredini asked the Department to start to consider alternative services if in fact the contract is terminated. Commissioner Jackson asked if there have been past instances of fiscal mismanagement. Ms. Daddio responded that there had been one instance, and the person is no longer with the agency. Commissioner Jackson asked for an explanation of the low client satisfaction rating. Ms. Daddio responded that the State has reviewed the client complaints, and found them to be unsubstantiated. Commissioner Jackson said that it might the time for new leadership. Ms. Gross responded that the Board is looking at every avenue to ensure the services remain intact. Commissioner Sanchez emphasized that these are very difficult clients, and if ever we need to maintain the highest standards, it is for this at-risk population. The Board of Directors and the Executive Director might need to revisit the agency’s mission and determine if they are able to provide the highest level of services for all the various programs. Further, as dollars decrease, if there is no documentation that programs are working, the funds are going to go away. At the Health Commission meeting, Commissioner Parker raised the issue of numerous contracts having low program compliance ratings. Monique Zmuda responded that two factors contribute to the program compliance difficulties. First, there are more contract requirements than ever before. Second, DPH is stricter in its monitoring. Commissioner Jackson suggested that at some point the Department consider imposing penalties on agencies that do not submit paperwork on time. Action Taken: The Commission approved the consent calendar of the Budget Committee, with Commissioner Sanchez abstaining on Item 3.3, Commissioner Chow abstaining on Item 3.7. and Commissioner Umekubo abstaining on Item 3.10. 4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) (Report on activities and operations of the Department) Fire December 15th at 275 Turk Street A three alarm fire broke out Saturday evening at 10:25 PM at 275 Turk Street. The 66 unit 5 story apartment building housed 159 residents including families, infants and seniors. The group includes Spanish, Tagalog, Cambodian, Bosnian, Arabic, and English speaking families. All residents were evacuated safely. The fire spread to all five floors via the light well, and there was extensive damage to at least 5 apartments and the roof. The building was closed by the Fire Department, and PG&E shut off the gas and electricity, so no one was able to return to an apartment. A Salvation Army hotel across the street immediately invited the building residents into the lobby and dining room, and the staff later housed several of the families in vacant rooms. The South of Market Recreation Center was also opened as a shelter. On Sunday, Charlie Morimoto worked with staff from DHS to assist the families in identifying temporary housing. By Sunday evening all residents of the shelter were housed in motels, and the recreation center was closed. It appears that many of the families will be able to reoccupy their units before Christmas. Charlie will continue to work with the families and case managers from DHS to ensure that the residents needs are met. CSF/DPH Electronic Mail Project As part of a City-wide effort to standardize electronic mail services, the Health Department’s Information Technology team in collaboration with the Department of Telecommunications and Information Systems completed the installation of a new E-Mail system in November. Over 4,000 DPH users were transitioned to Lotus Notes over a period of two weeks making DPH the first and largest City Department to complete the project. The implementation went very smoothly, and IT staff are continuing to assist users throughout the Department with training and support issues as they arise. The new system meets all of the Department’s requirements, including the privacy provisions required for HIPAA. The Department’s IT staff, under the leadership of Dave Counter, are to be congratulated for the successful completion of a very complex and difficult task. SFGH/LHH Data Network Project The Departments’ Information Technology team has begun a major overhaul of data network capabilities at San Francisco General and Laguna Honda Hospitals. Working in conjunction with engineers from Pacific Bell, currently obsolete network equipment will be replaced with state of the art data transport devices over the next four months. This new network will provide the infrastructure needed for the upcoming HIPAA security regulations, and will allow for the ongoing functioning and future expansion of data services at both locations. Diesel Exhaust Ordinance On December 10, 2001, Supervisor Sophie Maxwell introduced new legislation to the Board of Supervisors to limit the amount of diesel exhaust emitted by electrical generators. Diesel exhaust is a known toxic air contaminant and a likely carcinogen. If adopted the ordinance will: ensure that diesel backup generators used in the City and County of San Francisco are registered with the Department of Public Health; require new backup diesel generators to have the best available air emission control technologies; limit the time of operation of diesel backup generators during non-emergency situations. The Department’s Environmental Health Section is designated as the enforcement agency for this proposed law. Diesel backup generators that provide electrical power to certain public and medical facilities would be exempted from the requirements of this ordinance. Tobacco Cessation Services Mini Grants The Tobacco Free Project allocated Master Settlement Funds for tobacco cessation services targeting San Francisco’s special populations and ethnic communities. Seven mini-grants in the amount of $10,000 each were awarded based on a competitive application process. The agencies selected address the following populations: LGBT adults, LGBT youth, Asian pregnant women with smoking family members; Chinese male smokers; pregnant non-Kaiser members; Russian speaking immigrants; and HIV/AIDs patients. The American Lung Association of San Francisco and San Mateo Counties, Asian Perinatal Services, Chinatown Health Center, Prevention Resources, and UCSF Positive Health Program were among the agencies selected for funding. African American Health Initiative Conference On Dec. 12th the African American Health Initiative co-sponsored a forum entitled "African-Americans' Healthcare and Medical Research: Beyond the Legacy of Tuskegee". The Keynote speaker was Dr. Alvin F. Poussaint, M.D., Harvard University. Dr. Patricia Evans was one of the panel discussants. There were approximately 350 in attendance; the program was taped and will be aired at a future date. Cynthia Selmar, Director of the African American Health Initiative will inform the Department of the show dates. Contractor Meeting on FY02-03 Budget On December 6th, Community Programs brought together over 50 people to discuss the impact of a projected $175m city deficit in FY02-03 on the Department and the implications for contractors. In response to the anticipated reduction, the following departmental strategies were discussed: reviewing consolidation of departmental functions prioritizing services based on the strategic plan working towards the integration of physical health, behavioral health, housing and social services focusing or refocusing community services to reduce hospitalizations and accept hospital referrals determining where revenues may be increased to fund expenditure increases reviewing the productivity of civil service programs and determining the impact of reducing positions and/or closing programs reviewing all Contracts for potential program reductions, based on productivity, contract compliance and performance choosing not to backfill expired grants or continue programs funded with one time Board of Supervisors or Mayoral funding. SAN FRANCISCO GENERAL HOSPITAL, DECEMBER 2001 (from 12/10/01 MEC and 12/11 SFGH) 12/01 2001 YTD New Appointments 6 89   Reinstatements 0 6 Reappointments 26 424   Delinquencies: 0 0   Reappointment Denials: 0 0 Resigned/Retired: 6 153 Disciplinary Actions 0 0 Restriction/Limitation- Privileges 0 0 Changes in Privileges   Additions 0 19   Voluntary Relinquishments 2 27   Proctorship Completed 29 185 Current Statistics - as of 12/1/01 Active Staff 370 Affiliate Professionals (non-physicians) 143 Courtesy Staff 486 Referring Staff 43 Total Members 1,042 Applications In Process 100 Applications Withdrawn Month of November 2001 0 SFGH Reappointments in Process Through April 2002 165 Commissioners’ Comments Commissioner Monfredini, referencing the fire at 275 Turk, asked Dr. Katz to provide a summary of the fire prevention efforts. Anne Kronenberg responded that three SRO collaboratives have been formed in the Mission, Chinatown and Tenderloin. One of the primary roles is to work with the Department of Building Inspection and the Fire Department on prevention. This latest fire was in an apartment building, not a SRO, so was not part of the SRO collaborative focus. Ms. Kronenberg said that it is a constant battle to make sure the fire safety tools are in the buildings. Commissioner Sanchez, commenting on recent reports about no heat in some San Francisco classrooms, asked if there is a way for the Health Department to inspect each school for heat, carbon monoxide leakage, ventilation, etc. Dr. Katz responded that he would work with the Commission to identify how the Health Department can help, but the greatest challenge is that many of the facilities are indeed substandard. Commissioner Jackson asked what authority or leverage the Department has over the school district vis-à-vis facility safety. Dr. Katz responded that if there is a health hazard, the Department is able to close down the school, but beyond that, the Department has very little control. 5) ANNUAL AIDS UPDATE Jimmy Loyce, Deputy Director of Public Health for AIDS Programs, presented the Annual AIDS Update. Mr. Loyce emphasized that this report is a result of the efforts of all AIDS Office staff, and acknowledged Dr. Willi McFarland, Dr. Jonathan Fuchs, Dr. Sandra Schwarz, Dr. Steven Tierney, Dr. Doug Sobesta, Brenda Walker, Michelle Long Dixon and Laura Thomas. The AIDS Office was founded in 1984 with a staff of four and now has 157 employees. At the request of Dr. Katz, in 2002 the AIDS Office was reconstituted for two reasons: the Department wanted to speak with one voice on the epidemic; and a unified AIDS Office was needed to provide leadership to the 11-point prevention plan. The AIDS Office budget is more than $78 million, and sources are the General Fund, Federal funds and grants, State funds and private foundation grants. There are two Community Planning Councils-HIV Prevention and HIV Health Services. The HIV Prevention Planning Council provides input on plans and priorities for services and target populations. The HIV Health Services Planning Council prioritizes services and allocates funding by service category. Both are constituted of citizens of San Francisco. Mr. Loyce provided an overview of HIV/AIDS in San Francisco, including estimates of HIV Prevalence and Incidence for 2001, and ethnic and gender breakdown of people living with AIDS in San Francisco. Mr. Loyce then discussed the risk groups, and stated that men who have sex with men (MSM), and MSM injection drug users make up 86 percent of the AIDS cases in San Francisco. AIDS cases peaked in 1992 then started declining. Mr. Loyce then presented a number of maps that showed the geographic distribution of AIDS by population and census tract. Mr. Loyce then discussed the future direction of the epidemic: More new cases among MSM Fewer new cases in IDUs, which is directly related that to the needle exchange program Increasing numbers of HIV positive transgendered individuals Slower progression to AIDS and longer survival with AIDS Increasing proportion of cases in people of color Mr. Loyce presented an overview of the various research efforts that are underway, including studies focussed on prevention for high-risk HIV uninfected, prevention for HIV positives and prevention of disease progression. With regard to HIV Vaccine trials, there have been more than 60 trials to test over 30 vaccines so far. Most vaccines are only in the early stages testing. There are two later stage studies: the VaxGen trials and the NIH sponsored HIV Vaccine Trials Network (HVTN). DPH is one of the HVTN core global sites, and the first planned trial with more than 10,000 volunteers-½ MSM and ½ heterosexuals-will start in 2003. DPH is also one of 61 VaxGen Phase III sites. Mr. Loyce highlighted some of the studies currently underway in the Surveillance and Seroepidemiology Section, including a door-to-door HIV prevalence and incidence survey of men who live in low income neighborhoods, a study to determine factors that contribute to compliance with HAART (Highly Active Antiretroviral Therapy) and trends in causes of death among person with AIDS in the era of HAART. Mr. Loyce then discussed the HIV non-naming reporting system. In 1999, the Health Commission took a strong position opposing the use of names for reporting HIV cases. Surveillance conducted a pilot study that demonstrated that complete and accurate data could be collected without the use of names. The State proposal uses unique identifiers, not names. HIV prevention services include outreach, workshops, social marketing, risk reduction counseling, HIV testing, prevention case management, media development and needle exchange. Behavioral Risk Populations are used to prioritize and target services to those at highest risk of HIV infection. Three tiers were developed: Tier 1 (highest risk)-MSM and transgenders, both male to female and female to male; Tier 2 (high risk)-injection drug users; Tier 3 (lower risk)-non-IDU heterosexuals and women who have sex with women. HIV Health Services include primary medical care, home health care, dental care, housing, substance abuse treatment, mental health care, case management and peer and treatment advocacy. Mr. Loyce described Project Reggie, a centralized computerized client registration database at all agencies receiving CARE Act funding. Consumers and advocates felt strongly that patients be able to register one time, and be know throughout the entire system. Project Reggie allows this to happen. Mr. Loyce discussed key findings from recent CARE evaluations, including: CARE serves those it intends to reach: injecting drugs, poverty, having dependents, unstable housing and low health status are associated with not getting needed services; and barriers include agency factors, emotional issues and lack of information about services. Key Challenges facing the AIDS Office: Resources Decreasing federal funding - cuts to seroepidemiology, surveillance and prevention, and an anticipated cut to CARE Title I. In addition, the federal government may no longer allow appropriated but unexpended dollars to be carried over to the next year. Decreasing state funding - cuts in prevention and testing and counseling Decreasing San Francisco general funds Decreased private resources available for our community partners Programs Increasing access to prevention for at-risk populations with changing demographics Addressing increasing incidence among MSM Expanding cultural competency and capacity to address health and prevention needs of emerging populations, including the transgender community Linking prevention, health services and research to improve services to clients Addressing the needs of the multiply diagnosed and homeless populations Commissioners’ Comments Commissioner Monfredini asked if the workforce re-entry program for people infected with HIV was still in operation. Ms. Long Dixon responded that this program, which is funded through the General Fund, is going well, although its success depends on favorable state and federal legislation that has not yet been approved. Commissioner Umekubo asked the incidence of AIDS due to blood transfusions. Dr. McFarland responded that this has been the biggest prevention success, and the number of cases is negligible. Dr. Katz added that Red Cross statistics indicate that this would happen in one in a million cases. Commissioner Umekubo asked if the use of HAART had any negative medical outcomes, besides drug resistance. Dr. Schwartz responded that, with regard to resistance, while it is true that a number of individuals who are on therapy may at some point become resistant, the AIDS surveillance data shows that there is an overall improvement in survival. Dr. Schwarz said they looked carefully at conditions that could result in death that would have been due to the use of HAART, and found potentially a small increase in pancreatitis but the other conditions that they thought would be associated with the use of HAART were not seen. Commissioner Parker asked if there is a standard prevention message or a variety of different messages. He also asked if the community at large is addressing the need to identify new messages. Dr. Tierney responded that there are a variety of targeted prevention methods and messages, and that both the HIV Prevention Plan and the Department’s 11-point plan emphasize reinvigorating and reinventing the prevention messages. Dr. Tierney added that in the next year they intend to increase the State funding that is spent on prevention for HIV positive people. Commissioner Jackson asked if the Department is successful in monitoring the sex clubs. Dr. Tierney responded that the Coalition for Healthy Sex, a group of sex club owners and Department of Public Health staff, has been reorganized in the past year. In addition, the Department’s STD division is working with the club owners. This on-going relationship ensures that the rules and regulations are posted and that the staff has been educated around risk reduction and prevention messages. Commissioner Jackson asked if the Department has ever considered closing the clubs. Dr. Katz replied that there is nothing in the law to prevent the opening of a sex club. However, if the Department becomes aware of a problem, it sends a written warning. If changes are not made, a second letter is sent saying the club will be closed by the Health Officer. Commissioner Chow asked staff to more fully describe the Early Intervention Program. Ms. Long Dixon responded that the concept is to put programs in the neighborhoods where at-risk people live, and serve them early with therapy before they get AIDS. This program has expanded to the Bayview Hunters Point neighborhood. Commissioner Chow then asked the status and promise of the HIV vaccine trials. Dr. Fuchs stated that the Department has completed the second year of a three-year trial. Interim analysis showed excellent safety. The trial needs to continue through the third year before efficacy can be determined. Commissioner Sanchez commended the AIDS Office. He also said that many agencies that received federal dollars are experiencing the same problem of losing unspent dollars that previously could have been carried over to the next year. Commissioner Guy asked Dr. Schwarz to respond the San Francisco Chronicle article about the increasing resistance to HIV combination drug therapy. Dr. Schwarz responded that this is not surprising, as the HIV virus mutates rapidly. Regardless of that, survival rates are increasing. Dr. Katz added that the treatment decisions are getting more and more complicated, but so far science keeps bringing new therapies even as the old ones become less effective. Commissioner Guy thanked staff for their professionalism in responding to adverse situations, for clearly communicating with the Commission and for developing partnerships in an era of controversy. She asked what lessons have been garnered from the last five years. Dr. Tierney responded that the primary lesson is to stay focused and respond immediately. Dr. McFarland said it was to remain vigilant and quickly catch shifts in the demographics of the epidemic. Mr. Loyce stated that is was to have community-based strategies. Dr. Katz stated that good public health is constantly changing, and that innovation is of vital importance. 6) DEPARTMENT OF PUBLIC HEALTH ANNUAL REPORT Frances Culp, Office of Policy and Planning, presented the Department of Public Health Annual Report. The first part of the presentation focussed on the inside of the department: its workforce, community advisory boards, contractors, patients and budget. The second part of the presentation was organized around the Department’s Strategic Plan Goals and strategies, with Ms. Culp highlighting various Department programs and accomplishments for each goal. Goal 1: San Franciscans Have Access to the Health Services They Need, While the Department Emphasizes Services to its Target Populations. Strategy: Focus population based public health services on the entire community and personal health care services on target populations. The Emergency Medical Services (EMS) Section Disaster Team, which released the Level 1 Multicasualty Incident Policy and focused on health and medical responses to threats of bioterrorism. The Tom Waddell Health Center, which opened a Dental Clinic to serve homeless and HIV positive patients. Strategy: Expand health coverage to the uninsured to improve health status and access to care. Health Care Accountability Ordinance, which will result in health coverage for an estimated 16,050 San Francisco workers. Healthy Kids, which will help cover the estimated 5,000 uninsured children in San Francisco. Strategy: Ensure that the Community Health Network continues its vital role in the delivery of health care. The Trauma Center at San Francisco General Hospital - three trauma nurse practitioners were added to the team. The Mental Health Rehabilitation Facility Strategy: Improve integration of services for target, vulnerable, at-risk populations who need multiple services The Office of Housing and Urban Health - development and opening of the Broderick House. Strategy: Use data and evaluation more routinely and uniformly to guide program planning and priority setting. Community Substance Abuse Services partnership with the Treatment on Demand Planning Council to use qualitative and quantitative data to identify 12 major priorities. The Epidemiology and Evaluation Section of the AIDS Office, which evaluated the HIV Prevention Case Management Program to determine new guidelines and standards. Goal 2: Disease and Injury are Prevented Strategy: Strengthen primary prevention activities of the Department STOP Red Light Running Campaign Back to Sleep Campaign, to educate new parents about Sudden Infant Death Syndrome Strategy: Address social and economic determinants of health Community Mental Health Services creation of a Vocational Liaison Committee to expand employment opportunities. Community Health Education Section release of the RoadMap for Preventing Violence. Goal 3: Services, Programs and Facilities are Cost-Effective and Resources are Maximized Strategy: Continue to adopt a financial strategy that enhances revenue and reduces expenditures by avoiding institutional care Community Mental Health Services increased case management capacity and the ability for case managers to access community services, rather than institutional care. Laguna Honda Hospital and Rehabilitation Center created the Community Reintegration Program. Strategy: Improve recruitment, retention and training of Department staff San Francisco General Hospital created the Nursing Retention and Recruitment Committee, which will identify key retention issues and develop a retention plan to address the nursing workforce shortage. Strategy: Design an e-government strategy and presence for the Department The Management Information Systems Staff undertook a number of projects to improve the Department’s Intranet site, including an online staff directory, legislative tracking system and medical cannabis ID card system and staff training tutorial. Goal 4: Partnerships with Communities are Created and Sustained to Assess, Develop, Implement and Advocate for Health Funding, Policies, Programs and Services Strategy: Increase local, state and federal advocacy for efforts under the direction of the Mayor’s Office The Office of Policy and Planning worked closely with Nancy Pelosi to secure $1.105 million for HIV Services and $1.105 million for Treatment on Demand, and worked to secure an additional $25 million for California’s trauma centers. Strategy: Explore opportunities to partner with other providers and the community on common health issues The Department was the lead agency for the implementation of Proposition 36. Jail Health Services collaborated with Continuum and the AIDS Office to implement the Homebase Project/HOPE Study. Strategy: Continue to expand assessment of community health needs The Bayview Hunters Point Task Force released the Community Survey. HIV Prevention Research Section enrolled 736 high-risk men who have sex with men into Project Explore. Commissioners’ Comments Commissioner Monfredini thanked the staff for the clear and concise report. Commissioner Umekubo stated that it is amazing how effective the Department has been in instituting the changes that have been necessary over the last few years. The lesson to be learned is that this is a changing world, and we always need to think about ways to make things better and more cost effective. This annual report really lays out how the Department has done this. Commissioner Sanchez congratulated Department staff for its commitment and compassion. Commissioner Parker complimented staff for how well they have adhered to the Strategic Plan. This demonstrates that the Department does have a comprehensive plan, and should be supported with additional funding. 7) PUBLIC COMMENTS None. 8) ADJOURNMENT The Health Commission meeting was adjourned at 5:35 p.m. Michele M. Olson, Executive Secretary to the Health Commission