Minutes of the Health Commission Meeting

Tuesday, January 8, 2002
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 Commissioner Roma P. Guy, M.S.W. at 3:05 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 18, 2001

Action Taken: The Commission approved the Health Commission minutes of December 18, 2001.

3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE

Commissioner Jackson chaired, and Commissioner Monfredini attended, the Budget Committee meeting.

(3.1) AIDS Office - Request for approval of a retroactive contract modification with Positive Resource Center, in the amount of $140,000, for a total contract amount of $365,000, to provide staff support and consultation services to the HIV Health Services (CARE) Planning Council, for the period of March 1, 2001 through February 28, 2002.

(3.2) AIDS Office-Prevention - Request for approval to accept and expend retroactively a one-year grant from the Regents of the University of California in the amount of $72,500 for an HIV prevention planning collaborative allocation tool project, for the period of September 30, 2001 to September 29, 2002.

(3.3) CHN-Laguna Honda Hospital - Request for approval of a retroactive sole source contract renewal with the Regents of the University of California, on behalf of the UCSF Department of Physiological Nursing, in the amount of $174,879, to provide specialized gerontological care services, for the period of October 1, 2001 through September 30, 2002.

(3.4) CHN-Office of Managed Care - Request for approval of a retroactive sole source contract renewal with the Regents of the University of California, on behalf of the UCSF Medical Center, in the amount of $1,700,000, to provide tertiary care services, for the period of July 1, 2001 through June 30, 2002.

Action Taken: The Commission approved the Consent Calendar of the Budget Committee, with Commissioner Sanchez abstaining from voting on Items 3.2, 3.3 and 3.4.

4) DIRECTOR’S REPORT
(Mitchell H. Katz, M.D., Director of Health)
(Report on activities and operations of the Department)

Chinatown Public Health Center

The Chinatown Public Health Center received an Appreciation Award from NICOS at their annual meeting in December. NICOS is a coalition of health, mental health and social service agencies serving the Chinese community. The Health Center was recognized for outstanding work enhancing the health and wellness of the San Francisco Chinese community. Two special projects were highlighted: the Chinese Women Cancer Support group and recent issuance of their stories, and the publication of "Healthy and Delicious" low fat Chinese cookbook, which incorporates important nutrition education. Both publications are "first of their kind" and are presented in Chinese and English.

Community Mental Health Staff Departures

Louise Rogers, Planner and Risk Manager for CMHS, is leaving after seven years to become Deputy Director of Operations for San Mateo County Mental Health. Louise was instrumental in a large number of innovations at CMHS, including the successful design and implementation of the Single Point of Responsibility programs.

Fire Updates

The Department of Public Health routinely responds to fires and other incidents that displace residents. Working with the Department of Human Services, Mayor’s OES, and the American Red Cross, the Health Department assures that displaced residents have temporary housing, access to their prescriptions, mental health counseling, and food. DPH staff has been very busy during the last few weeks, responding to three fires and continuing to do follow up services. Special thanks to Charlie Morimoto and Mike Petrie for their response efforts.

227 Turk Street

As reported at the last Commission meeting, a fire occurred December 15th at a 66-unit apartment building on Turk Street. At that time, we believed that residents of the unaffected units would be able to reoccupy by December 23rd. The process took longer than we had anticipated, but residents were back in the building to welcome the New Year. Inhabitants of the 5 severely burned units have been vouchered into hotels, and we are working to find alternative housing.

Update for 449 O’Farrell St. Fire

Fire broke out in a 28-unit apartment building at 449 O’Farrell Street in the early morning hours of December 23rd. Thanks to the work of the City response team, including Charlie Morimoto, and DPH outreach staff, residents of the 20 unaffected apartments were able to reoccupy their units December 29th. DPH is looking to secure long term housing for the seven families still displaced.

Clay and Locust

On Saturday, January 5, Mike Petrie, from the Department’s EMS section, responded with the Fire Department, Mayor’s Office of Emergency Services and the American Red Cross to a 4-alarm fire in three apartment buildings at the corner of Clay and Locust Streets. There were not fatalities or injuries, but 19 adults and 5 children living in 15 apartments were displaced. All of the displaced residents were able to find housing with family and friends.

Commissioners’ Comments

• Commissioner Parker asked if any special or additional preparations have been taken to provide services to the homeless during the winter months. Dr. Katz responded that the Mayor’s Office of Homelessness has opened 550 shelter slots as part of its winter program. Ms. Kronenberg added that over the last week an additional 40 shelter beds were opened.
• Commissioner Umekubo shared that, on Christmas Eve, the house next door to his caught on fire. He was impressed by the response of the San Francisco Fire Department and the Red Cross.
• Commissioner Guy commended Dr. Katz for attending at San Francisco General Hospital during December.
• Commissioner Chow asked what triggers the Health Department’s response to a fire. Ms. Kronenberg replied that the 911 Dispatch Center calls the Health Department for three-alarm fires or greater. However, she has asked that the Department be informed for two-alarm fires as well, or when more than 12 people will potentially be displaced.

5) ADOPTION OF A RESOLUTION COMMENDING THE START OF ENROLLMENT IN THE NEW HEALTHY KIDS PROGRAM AND PROCLAIMING JANUARY 13, 2002 AS “HEALTHY KIDS DAY”

Jean Fraser, Executive Director of the San Francisco Health Plan, presented a proposed resolution that commends the beginning of enrollment in the new Healthy Kids Program. There will be an official launch Thursday, January 10, 2002, and the first of many big enrollment events will occur this weekend.

Commissioners’ Comments

• Commissioner Monfredini asked what happens to the 1,200 children who will not be eligible for any public health insurance program. Ms. Fraser responded that these children are members of families whose income is above 300 percent of the poverty level. The policy decision was made to make a cut off at 300 percent because it is believed that income level is sufficient to purchase private insurance (for a family of four, this is $53,000). The San Francisco Health Plan has developed a list of alternative private insurance providers to refer people to.
• Commissioner Parker clarified that, if the 1,200 children are somehow covered, San Francisco will have 100 percent health insurance coverage for San Francisco children.
• Commissioner Guy said that this program was one of the Health Commission’s top priorities, and was pleased to see that it is now ready to begin enrollment.
• Commissioner Chow said that there will always be some people who elect not to get health insurance. While it is a complicated issue, he understands the 300 percent cut off because there should be an obligation on the part of the family to pay its fare share if it is able so that dollars can truly be directed toward the very needy children. Commissioner Chow commended the City and the Health Plan for achieving such a broad level of coverage.

Action Taken: The Commission unanimously approved Resolution #01-02 titled “Commending the Start of Enrollment in the New Healthy Kids Program Offered Through the San Francisco Health Plan, Encouraging San Francisco Families to Obtain Health Coverage for Their Uninsured Children Regardless of Immigration Status, and Proclaiming January 13, 2002 ‘Health Kids Day’ in the City and County of San Francisco.”

6) FEDERAL LEGISLATIVE UPDATE

• Medicaid County Organized Health Systems (COHS)
• HIV/AIDS Funding
• Hospital Facility Replacement
• Public Health Funding
• Substance Abuse -- Treatment on Demand
• The First Session of the 107th Congress

This session was marked by extraordinary events, including a contested election, the largest tax cut in more than 20 years, dramatic change in control of the Senate, the terrorist attacks of September 11 and economic decline. With new legislative and budget priorities that emerged as a result of September 11, several pieces of business were left unfinished.

Federal Budget

As a result of Congresswoman Nancy Pelosi’s efforts, the 2001-2002 federal budget included two of the Department’s 2001 budget initiatives: $1 million for San Francisco’s Treatment on Demand Initiative; and $650,000 for HIV care and services at San Francisco General Hospital for women and persons of color.

Upper Payment Limit

Bioterrorism

Congress approved a $20 million anti-terrorism package, which includes $865 million for upgrading state and local public health capacity and $135 million to assist hospitals and emergency departments. Legislation specifying how the money will be spent did not pass, so the Secretary of Health and Human Services was charged with developing a distribution plan.

Federal Medical Assistance Percentage (FMAP)

The Federal Medical Assistance Percentage (FMAP) is the portion of Medicaid and the State Children’s Health Insurance Program that is paid by the federal government. California’s FMAP decreased from 51.4 percent in 2002 to 50 percent for 2003, which is estimated to cost California $400 million per year.

Mental Health Parity

The 1996 federal mental health parity law expired September 30, 2001. Congress considered an expansion of the law that would close loopholes in the 1996 law by requiring insurers that provide mental health coverage to offer those benefits at the same level as physical health coverage with respect both to costs (such as deductibles) and to access to services. This effort was not successful.

State Plan Amendments for Laguna Honda

The State Legislature approved three programs that would provide additional Medicaid funding for Laguna Honda Hospital.

• SB 1128 will provide supplemental Medicaid reimbursement to help pay for the debt service on the rebuild of Laguna Honda Hospital.
• One-time funding for distinct part nursing facilities was included in the 2000-01 State budget.
• The Public Distinct Part Nursing Facility Supplemental Reimbursement Program was included in the 2001-02 State budget.

340B Drug Pricing for Inpatient Pharmacies

Through the Public Hospital Pharmacy Coalition and the City’s federal lobbyist, the Department advocated to clarify the current CMS interpretation and of the best price exemption to ensure public inpatient pharmacies were eligible for the same discounts that are given for outpatient drugs. Un-fortunately there was no legislative clarification on this issue, but the Department was able to secure strong support from the San Francisco Congressional delegation to continue to support efforts next year.

Community Based Services

The Department submitted comments on the New Freedom Initiative, President Bush’s initiative to remove barriers to independent living for people with disabilities. The Department proposed various suggestions about how federal agencies could work together to ensure that services were available for persons with disabilities in the least restrictive setting.

Nursing Workforce Shortage Legislation

The House and Senate each passed bills that attempt to address the nursing workforce shortage, but neither has yet to be finalized. The $136 million Senate bill is broader that the House bill, which has no price figures. Both will go to conference committee when Congress reconvenes.

2002 Federal Legislative Priorities

• Medicaid
  • Upper Payment Limit - ensure maintenance of an upper payment limit of 150% for California
  • Disproportionate Share Hospital Program - Eliminate and/or reduce future Balanced Budget Act-imposed reductions.
  • County Organized Health Systems
• Health Care Workforce Shortage - support initiatives that will increase the health care workforce.
• HIV/AIDS Funding - seek additional funding to minimize cuts in service as a result of a loss of $545,000 in Ryan White Title I formula funding in both FY 2002 and FY 2003.
• Substance Abuse, Treatment on Demand - seek to institutionalize funding of $1.3 million for San Francisco’s Substance Abuse Treatment on Demand initiative.
• Community-Based Services
  • Ensure access to appropriate community-based services as an alternative to inpatient care.
  • Pursue a HUD waiver to prioritize subsidized housing for persons leaving institutional care to community.

Commissioners’ Comments

• Commissioner Monfredini asked if the federal “homeland security” money would come directly to public hospitals, and if it will be earmarked for particular activities. Ms. Johnson replied that it will most likely go through the State, who will determine how it can be used. At this time there are no details as to how the money will be spent, and the federal government is seeking input from local and state entities. Dr. Katz added that San Francisco is considered a territory by the CDC, so it might get a separate allocation without having to go through the State. Also, there seems to be a growing consensus that good bioterrorism preparedness is not one particular activity, but rather good general public health-surveillance, communication, infection control, nursing and other functions.
• Commissioner Chow asked if the Department is participating in the various nursing workforce initiatives. Ms. Johnson responded that the Department’s lobbyist and delegation have been involved in the nursing workforce legislation that will be considered in the 2002 session.
• Commissioner Umekubo asked what impact the FMAP decrease will have on the Department. Ms. Zmuda said that this will depend on how much the State will accept this reduction or if they will choose to pass this reduction on to local governments. They will know better when the State budget it released on Thursday.
• Commissioner Guy asked if the Department is specifically pursuing the exemption from the new upper payment limit level. Ms. Johnson said yes, and all of California is united on this approach. Dr. Katz added that he has made calls to Senator Feinstein’s office on this issue because it is so critical to the department’s fiscal ability to provide services.

7) EEO ANNUAL REPORT AND CONSIDERATION OF PROPOSED ADOPTION OF STANDARDS FOR CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES (CLAS) IN HEALTH CARE

Norm Nickens, Director of the Office of Equal Employment Opportunity, Affirmative Action and Cultural Competency, presented the annual EEO report.

EEO

In FY 2000-01, the EEO Office received 58 formal complaints of discrimination or harassment. These numbers do not include all requests for reasonable accommodation under the ADA.

There was a significant increase of complaints filed on the basis of disability, which in part reflects a change in State law that substantially expanded the definition of disability. Mr. Nickens stated that this change has impacted the Department.

Another change that happened in 2001 is that, through court decisions, Proposition 209 has been firmly applied to public sector employment. Thus the annual affirmative action plan that was previously submitted to the Commission on an annual basis will be replaced by a new Equal Employment Opportunity report, the format of which is still under review by the City Attorney’s Office.

Mr. Nickens stated that one of the major challenges is trying to improve the communication and coordination between the Department’s EEO activities, its human resources activities and its workers’ compensation programs. The EEO office is working with other City departments and the City Attorney’s office to develop training programs for all City managers on the interaction between workers’ compensation, ADA and leave policies. The goal is to find a way to simplify the process such that an employee does not have to fight her or his way through three complex system.

Equal Access to Services Ordinance.

Mr. Nickens then gave an update on the Equal Access to Services ordinance, which was adopted by the Board of Supervisors last year. The ordinance specifically requires the provision of translation services to limited English proficient clients, the availability of services and interpretation at the point of public contact and a uniform, departmentwide grievance process. Mr. Nickens said that adequate programs are already in place at San Francisco General Hospital, and the goal is to use these as models for other areas of the Department. The draft implementation plan is due on February 1, 2002. Preliminary first year goals are identification of bilingual clients, bilingual workers and complaints regarding lack of translation services and development and posting of bilingual signage related to request for translation. Mr. Nickens stated that the advocates that brought this to the Board of Supervisors have made it known that they intend to scrutinize two departments: the Police Department and the Department of Public Health.

Employee Assistance Program

The Employee Assistance Program (EAP) was placed under the EEO Office in August 2001. The EAP provides services to employees of all City and County departments, as well as employees of the San Francisco Unified School Districts. EAP offers counseling in a number of areas, including depression, substance abuse, parenting skills, workplace violence and others. This unit has been increasingly called upon to provide organizational development services to other departments as well. The work of this unit was heavily impacted by September 11th and its aftermath. During the three weeks following September 11th, EAP counselors went out to 19 City worksites. Mr. Nickens intends to “re-launch” EAP to the various Departments throughout the City and County so that employees are aware of its resources.

Cultural Competency

Mr. Nickens said that the EEO Office formed an interim Task Force on Cultural Competency to review the Department’s cultural competency standards and suggest changes. Mr. Nickens summarized the recommendations that resulted from this review.

1. Establish an ongoing Cultural Competency Task Force that includes departmental and community representatives. Mr. Nickens hopes to add 5-7 community representatives, and will finalize the list of community individuals on Friday, January 11. He is recruiting individuals with significant experience in developing standards on culturally competent services and/or bilingual services as well as individuals from the disability community and Department contractors. Mr. Nickens will present this list to the Commission through the Population Health and Prevention Joint Conference Committee.
2. Adopt Culturally and Linguistically Accessible Services (CLAS) standards as guidelines.
3. Require cultural competency objectives, where appropriate, in all contracts. Mr. Nickens hopes to have training in place by March and objectives in contracts by July.
4. Develop standardized monitoring tool for the evaluation of cultural competency in the contract monitoring process.
5. Develop a series of training programs based on a train the trainer model for both DPH staff and contractors.
6. Develop web-based resources, including training materials, local resources and model policies and procedures.

Mr. Nickens said that there are advantages and disadvantages to using the CLAS standards that were developed by the Office of Minority Health. Among the disadvantages are that they were developed for large health care institutions as a result of a national process, are weak on disability and silent on sexual orientation. They are strong in responding to the needs of racial and ethnic minority populations. They are being recommended as guidelines because they provide a formal definition of cultural competency, and a uniform working set of standards on cultural and linguistic competency for contractors and Department staff. The guidelines will be adopted as guidance, and adapted to reflect local priorities.

Commissioners’ Comments

• Commissioner Parker asked if the Department is required to have CLAS standards. Mr. Nickens replied that some aspects of the CLAS standards currently exist as part of federal contracting requirements, for example the provision of bilingual services. Commissioner Parker asked for clarification that DPH is adding standards beyond what is required. Mr. Nickens said that many of these standards are going to ultimately become requirements, so the Department is getting ahead of the curve. In addition, the CLAS standards have broad applicability for funding agencies, accreditation agencies, etc. Commissioner Parker asked if resources are available for smaller contractors to help meet these new standards. Mr. Nickens said that the first year goal is to have sample policies on the website, and a possible second year goal is to offer technical assistance to agencies. Commissioner Parker asked if the EAP program is available for the contractors. Mr. Nickens replied that EAP services are available to City and County employees, their family members and significant others.
• Commissioner Umekubo asked if a standard self-assessment tool has been developed. Mr. Nickens replied that the Department has not been overly prescriptive to agencies in terms of what constitutes self-assessment. The self-assessment tool for the Department has not yet been developed. Commissioner Umekubo stated that it is an enormous task to train all DPH staff. Mr. Nickens said that he is hesitant to recommend mandatory training for all staff, but he is currently identifying which key divisions and/or key staff do need mandatory training.
• Commissioner Chow asked if the Department is expecting outcome measures from agencies prior to the completion of training on the new standards. Mr. Nickens acknowledged that this is a challenge, but wants to make the attempt to have some measures in the next contract cycle. Commissioner Chow said that the resolution gives a framework by which San Francisco can lead the country in cultural competency.
• Commissioner Guy asked that the membership list of the Cultural Competency Task Force be forwarded to the Health Commissioners once the community representatives have been appointed. She also asked that an update be presented to the Population Health and Prevention Joint Conference Committee. Mr. Nickens suggested that this be done after March, as some of the training sessions will have been completed and the preliminary draft of compliance with Equal Access to Services Ordinance will have been submitted to the Immigrants Rights Commission.

Action Taken: The Commission unanimously approved Resolution #02-02, “Amending the Department of Public Health’s Policy Directive 24, Contractors’ Compliance with Antidiscrimination Protections and Cultural Competency, and Adopting Guidelines for Culturally and Linguistically Appropriate Services (CLAS) in Health Care.”

Commissioner Sanchez left the meeting at 4:50 p.m.

8) PUBLIC COMMENTS

Michael Lyon, Coalition to Save Public Health, talked about the cost of the PBM contract. His opinion is that there is no way the Department can get better pricing in the contract without 340B pricing. Mr. Lyon submitted an immediate disclosure request for certain information related to the pharmacy.

9) ADJOURNMENT

The meeting was adjourned at 4:55 p.m.

Michele M. Olson, Executive Secretary to the Health Commission