Minutes of the Health Commission Meeting Tuesday, May 7, 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 Edward A. Chow, M.D. at 3:10 p.m. Present:  Commissioner Edward A. Chow, M.D., President Commissioner Roma P. Guy, M.S.W., Vice President Commissioner Arthur M. Jackson - arrived at 3:25 p.m. Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner David J. Sanchez, Ph.D. Commissioner John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF APRIL 16, 2002 Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez, Umekubo) approved the minutes of the April 16, 2002 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Monfredini chaired and Commissioner Umekubo attended the Budget Committee meeting. (3.1) Black Coalition on AIDS HIV Prevention Contract Update This item was continued to May 21, 2002. (3.2) DPH-Bureau of Environmental Health - Request for approval of proposal to increase food facility permit fees. (3.3) AIDS Office - Request for approval of a contract modification with Westside Community Mental Health to decrease funds in the amount of $58,415, for an adjusted contract value of $196,739, to provide women’s HIV prevention services, for the period of July 1, 2000 through June 30, 2002. Commissioners’ Comments Commissioner Monfredini asked if the agency understood why the contract was reduced, and if they were comfortable with the new funding level. Abner Voles from the agency said that they understand the reasons and appreciate the Department’s assistance. Commissioner Monfredini asked if the Commission should receive a status report on this contract. Mr. Tierney replied that the contract renewal would be presented to the Commission prior to June 30, 2002, and the Commission can receive an update at that time. (3.4) PHP-CSAS - Request for approval of a retroactive contract modification with Larkin Street Youth Services, Inc., in the amount of $400,000, for the period of April 1, 2002 through June 30, 2002, to provide prevention and intervention substance abuse services targeting homeless youth aged 12 to 21 years old, for a total contract value of $1,488,577 for the total period of July 1, 1999 through June 30, 2003. (3.5) PHP-CSAS - Request for approval of a retroactive contract modification with Positive Direction Equals Change, Inc., in the amount of $60,000, for the period of April 1, 2002 through March 31, 2003, to provide new substance abuse ancillary services and a new collaborative prevention program with Visitacion Valley Beacon Services, for the period of May 1, 2001 through March 31, 2003, for a total contract amount of $400,000. (3.6) PHP-Maternal and Child Health - Request for approval to accept and expend retro-actively a grant from the California Family Health Council, Inc., through a subcontract with UCSF School of Nursing, in the amount of $69,152.61, for child care consultation services for the period of September 1, 2001 to June 30, 2002, and two sole source contracts with Children’s Council and Wu Yee. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez, Umekubo) approved the consent calendar of the Budget Committee, with Item 3.1 being continued to the May 21, 2002 Budget Committee meeting. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. HIV Reporting In California After more than a year of public comment and policy revisions, the California Department of Health Services last week issued final regulations implementing non-names based HIV reporting in California, effective July 1, 2002. The Department of Public Health actively participated in the State’s regulatory process and worked with San Francisco’s HIV community to offer the Department’s collective experience in tracking HIV by unique identifier through a San Francisco-specific pilot project. Unfortunately, the final regulations do not incorporate all of its recommendations. Nonetheless, the Department will work with the State to implement a successful and accurate system of HIV reporting for California. The Ryan White CARE Act reauthorization of 2000 encourages the move from AIDS cases to HIV cases for purposes of calculating the Title I formula by July 1, 2004. Congressional Testimony in Support of Treatment on Demand On May 14, 2002, Barbara Garcia will be testifying before the United States House Committee on Appropriations. Her testimony, on behalf of Congresswoman Nancy Pelosi, will include a review of San Francisco’s approach to substance abuse policy and program implementation, highlighting the process and preliminary outcomes of recent initiatives. Behavior Health Model of Care for the Department “Improve integration of services for target, vulnerable and at-risk populations who need multiple services” is strategy 1.6 of the Department’s Strategic Plan. Following this direction, Barbara Garcia, has been leading the development of a comprehensive model of care for clients impacted by substance abuse, mental health, and physical health. Based on this work, the Department is embarking on a three-year plan to implement a Behavior Health model of care. Dr. Bob Cabaj has been appointed Behavior Health Director. Dr. Jorge Partida and Jo Ruffin will act as the Deputy Directors of Behavior Health. The planning process for the Behavior Health Plan will ensure that the many stakeholders; providers, consumers and advocates are involved, providing input. DPH believes that this next step of integration will provide a more comprehensive approach to providing essential services to San Franciscans. April - Harm Reduction Month Over three hundred DPH staff, providers and community members participated last month in harm reduction presentations. The events focused on harm reduction and the implications of integrating the Department’s Harm Reduction Policy into practice. Steven Tierney was Honored with a Hero Award On May 2nd Steven Tierney, ED.D., Director of HIV Prevention Services in the AIDS Office, was presented with the 2002 John Lorenzini AIDS Hero Award by the AIDS Candlelight Vigil Committee for his work in HIV Prevention. John Lorenzini chained himself to the door of the old Federal Building to protest the indifferent attitude of Reagan Administration officials toward the growing AIDS health crisis. He was the first person arrested in San Francisco for AIDS-related civil disobedience. He served as the Director of the Persons with AIDS Alliance and fought for more education about HIV/AIDS, including teenage outreach and changing the health community to view AIDS as not just a "gay plague". David Ruch will Receive the Brownie Mary Award David Ruch and another Needle Exchange volunteer will be receiving the Brownie Mary Award on behalf of all the Needle Exchange volunteers. Brownie Mary was a fighter in the AIDS and medical marijuana communities. She helped thousands of people with AIDS and those suffering critical illnesses by baking brownies cooked with medical marijuana. San Francisco Emergency Response Map Members and friends of the San Francisco General Hospital Foundation will be gathering next week to celebrate the release of the city's first San Francisco Emergency Response Map. The map has been produced in three languages and prominently displays all of the City's emergency response facilities--Fire Stations, Police Stations and Hospitals. The reverse side of the map offers highlights of what to do and who to call in a variety of emergencies such as a fire, power outage, poisoning and earthquakes. DPH is deeply grateful to the George Jewett Foundation and Lucy and Fritz Jewett for their generous contribution and leadership in producing this map. Distribution is being handled through a number of venues throughout the City. Any DPH employee who would like a copy of the map can call 206-4478. WEDGE Legacy Celebration The WEDGE Legacy Celebration is May 18th from 6:00 to 9:00 p.m. at the new San Francisco LGBT Community Center who will acknowledge the invaluable contributions of everyone in the extended "WEDGE family"--staff, community educators, teachers, students and especially HIV-positive volunteers. The evening will feature speakers recounting their experiences with WEDGE an awards ceremony honoring individuals who have made significant contributions to the program's success, entertainment and light refreshments. The WEDGE program, recognized nationally as model program, was a unique collaboration between the San Francisco Department of Public Health and the San Francisco Unified School District. WEDGE volunteers working together for 15 years to reach thousands of teens with messages about self-esteem, decision-making and saving lives. For additional information, contact the WEDGE Program at 415-581-2440. SRO Hotel Owners/Operators/Managers Code Compliance Workshop DPH’s Environmental Health, Dr. Johnson Ojo, in conjunction with the Department of Building Inspection, Fire, Police, District Attorney and City Attorney, conducted an informational workshop for SRO owners on April 24th. The workshop provided an opportunity for hotel owners, operators and managers to discuss their concerns and to be provided vital information on how to comply with the SF Municipal Codes and sanitation guidelines. DPH also presented on tuberculosis control, and mental health issues. Nearly 100 owner/operators participated in the workshop. DHS Recognizes LHH for Community Reintegration Program The California Department of Health Services (DHS) Licensing and Certification Program has awarded Laguna Honda Hospital with an honorable mention for its Community Reintegration Program. The DHS Best Practices Program, now in its eighth year, encourages excellence and innovation in long-term care. LHH rehabilitation staff, Lisa Pascual, M.D., and Paul Carlisle, RPT, will present the project at the three Best Practices conferences held throughout the state in July. The project is entitled, "The Role of Data Base Utilization in Achieving Community Reintegration." The LHH team created the Access Data Program because of the growing number of younger patients being referred who need rehabilitation and discharge planning. The Rehabilitation Services Department developed the Community Reintegration Program (CRP) to expedite patients' transitions from the acute hospital to LHH, provide a comprehensive rehabilitation treatment program, and achieve effective and efficient community reintegration. Integral to the success of the CRP was the ability to track the efficiency of referral intake and admissions, to demonstrate objective functional improvement with comprehensive rehabilitation and to document the effectiveness of community reintegration. With the development of a Rehabilitation Services Database, reports can now be generated to assess multiple aspects of the CRP including: San Francisco General Hospital Medical Center Passes Their Survey San Francisco General Hospital Medical Center has successfully completed their Consolidated Accreditation and Licensure Survey (CALS). This year’s survey was conducted from April 22nd to April 26th and involved over 16 surveyors from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Institute for Medical Quality (IMQ) and the State Department of Health Services (DHS). As part of the survey, all areas licensed under SFGHMC were surveyed; including all of the acute services, emergency services, diagnostic services, the Mental Health Rehabilitation Facility, the Hospital-based Primary Care and Specialty Clinics, and Bridge to Wellness. The hospital, Mental Health Rehabilitation Facility (MHRF), and Bridge to Wellness were surveyed and accredited under three different JCAHO manuals. The hospital was surveyed under the Hospital Manual and received a successful preliminary score of 84%. The MHRF was surveyed under the Long Term Care Manual and received a preliminary score of 97%. Bridge to Wellness was surveyed under the Behavioral Manual and received a perfect preliminary score of 100%. Gene Marie O’Connell, Executive Administrator of SFGHMC, credits the success to all of the dedication and hard work of the staff. Over the next months SFGHMC will be waiting for the official scores from JCAHO as well as the final findings from DHS. Commissioners’ Comments Commissioner Monfredini asked if the Behavioral Health roles for Bob Cabaj, Jo Ruffin and Jorge Partida are in addition to their current positions. Dr. Katz said that at some point the Department will not have separate Mental Health and Substance Abuse Divisions-there will be one Behavioral Health Division. However, during implementation, there will be some extra work required to implement this system. Commissioner Chow said that San Francisco’s participation in the non-named based HIV reporting effort was very important. He commented that the change to the Behavioral Health Division is a work in progress, and the concept is appropriate because so many of DPH clients are dually diagnosed. He acknowledged Commissioner Guy for her role as moderator of the Harm Reduction panel discussion. He commended Gene O’Connell and the San Francisco General Hospital for receiving such a fine rating from JCAHO. The surveyors uniformly agreed that the staff at San Francisco General Hospital acted like a family, which they do not often see at large urban institutions. Commissioner Parker is pleased to see that the Department has developed a Behavioral Health Division. This fits in very well with the Strategic Plan goal of prevention. The Department should emphasize STD and HIV/AIDS as part of this model. 5) HIPAA UPDATE - QUARTERLY REPORT Kathleen Murphy, Deputy City Attorney, CHN and Acting Compliance Officer, presented the quarterly HIPAA Update. Since the last update the three task forces have transitioned from determining what needed to be done to actually doing the work. The chairs of the three task forces updated the Commission on the work that has been done since the last Health Commission update. Donna Jacobs, Co-Chair of the Transactions and Code Sets Task Force, said that since the last update, IS vendors were invited to present their plans and timelines for compliance to the task force. Remediation is currently underway for several systems under the Department’s purview, for example Invision and Diamond. Congress delayed the implementation date for the Transaction and Code Set Standards until October 2003. There is no formal approval process, the request just needs to be submitted, which DPH will be doing. The request is due by October 15, 2002. The delay is just for the Transactions and Code Sets requirements, not for other HIPAA requirements. Next Steps Continue working with the various system vendors to plan for and implement required system enhancements and upgrades; begin to work on the request for extension for submission to CMS; begin to develop a strategy with our billing partners for the coordination of testing and implementation of the standard transactions. Cheryl Austin, Privacy Task Force Co-Chair, updated the Commission on the Privacy Task Force. The deadline for compliance with this is April 2003. Since the last update, the Privacy Task Force developed, distributed and collected a HIPAA privacy assessment survey. Analysis of the survey continues and they expect a 70-80% response rate across all DPH divisions. Next steps are to hire a Privacy Officer, analyze survey results, develop recommendations for corrective action, develop needed privacy policies and procedures, patient notification documents and staff education program. By March 2003 the Department will be compliant. Dave Counter, Chair of the Security Task Force, updated the Commission on the work of that task force. The three components of security are confidentiality, integrity and availability. There are four categories of compliance requirements: administrative procedures; physical safeguards; technical security services; and technical security mechanisms. Next Steps Administrative Procedures: continue to monitor regulations; Disaster Plan will continue to be updated and tested; personnel access authorization will be reviewed with the Privacy Officer; and security management procedures will continue to be refined. Physical Safeguards: media and change controls will be monitored; physical access controls will be finalized; workstation procedures will be finalized and budgeted; security awareness training program will be completed. Technical Security Services: network and application access controls will be monitored; internal audits will be finalized with Privacy Officer; individual authentication will be reviewed and budgeted; data authentication will be reviewed and budgeted. Technical Security Mechanisms: network data integrity will be reviewed and budgeted; message authentication will be reviewed and budgeted; external intrusion controls will be fully implemented; encryption requirements will be reviewed and budgeted. Mr. Counter said that much of the technologies that may be required by HIPAA are expensive. One of the things that the regulations my call for is that when sending patient information over the e-mail, that the Department can ensure that that material has not been altered in any way during transmission. Commissioners’ Comments Commissioner Chow asked if staff feels comfortable that they will receive buy in and cooperation from our partners by the end of the year. Mr. Counter said yes, and Ms. Murphy added that there will soon be a full time compliance officer who will have the time to make sure this happens. Commissioner Chow asked that the Joint Conference Committees hear a more specific progress report on the Privacy Task Force in six months, since the privacy regulations are the first regulations that need to be complied with. Ms. Austin said that the survey results would inform them of the areas that need work. Commissioner Jackson asked how we ensure that peoples’ passwords are secure and private. Dave Counter said that the biometric identification is one way to prevent misuse of passwords and authenticate the user. This would be a costly project, approximately $1 million. 6) ANNUAL HOMELESS PROGRAM UPDATE AND CONSIDERATION OF A RESOLUTION Anne Kronenberg, Director of Policy and Planning, presented the Annual Homeless Program update. San Francisco has a unique situation. There are an estimated 10,000 - 14,000 homeless individuals in San Francisco. San Francisco is an attractive destination, but the job market is tight and rents are high. It is also a sanctuary city known for its tolerance. Demographics of SF Homeless 36% increase in homelessness between 2000 and 2002 75% single adults; 25% families 2/3 male-significant veteran population 2/5 suffer from mental illness 1/3 Domestic Violence Victims 14% have HIV/AIDS The Department of Public Health and Department of Human Services are the major providers of homeless services. Problems include: services expansions have not been systematic-they are often in response to available funding; no common data/measurement tools; and uncoordinated efforts. The Continuum of Care is a five-year strategic plan for homeless services. It guides the work of all stakeholders, including city departments. Ms. Kronenberg is the Chair of the Oversight Committee, which is charged with developing the implementation plan for all five years. The priorities in the Continuum of Care are consistent with the DPH Strategic Plan. The Department has a Homeless Coordinating Committee, which represents all DPH homeless services. The committee has had a variety of successes. It completed an inventory of DPH homeless programs, and developed a common, citywide definition of homelessness that was adopted by both the Health Commission and the Board of Supervisors. Ms. Kronenberg then gave an overview of DPH outreach services, which are an integral part of the homeless services. Outreach services have recently gone through reorganization. In Phase I the Mobile Assistance Patrol (MAP) vans established first response teams to go out into the community and attempt to bring people into services. They had previously been used primarily for transportation. Phase II will attempt to increase coordination between the MAP team and the other outreach teams in the Department. Ms. Kronenberg highlighted the Department’s case management services, which exist in each part of the continuum of care and are key to successful client outcomes. The Department has various programs that serve the homeless community, all of which fall into various parts of the continuum of care. (The list of programs is included in the 2002 Annual Homeless Report.) Ms. Kronenberg gave a definition of each part of the continuum. Prevention - Services designed to prevent homelessness or prevent its secondary effects. Includes education, health promotion, testing and screening, adherence support and primary care. Emergency/Front End - Services delivered in an emergency setting and/or on a short term or intermittent basis. Generally delivered for one month or less, and accessed through drop-in centers, shelters, emergency departments and urgent care settings. Transitional Services - Services delivered for a finite period aimed at achieving greater levels of health and/or housing stability. Typically delivered for one to two months, and include detoxification, time-limited residential treatment and transitional housing. Long Term Stabilization Services - Designed to keep newly or marginally housed individuals in stable housing. Not time limited and include outpatient treatment, supportive housing, services linked to permanent housing, rent subsidies, childcare and vocational and employment services. Ms. Kronenberg then used hypothetical individuals to describe how someone would work through DPH homeless services. She then discussed the relationship to the Strategic Plan. The programs and services meet all four goals in a variety of ways. Recommendations/Principles Increased coordination and accountability between city departments Quantifiable outcomes for every stage of the service delivery system Coordinated intake process for the single adult system to ensure individualized, tailored services for clients as well as for program development and evaluation. To enhance interdepartmental coordination and accountability: an annual report should be produced by the Mayor’s Office of Housing DHS and DPH that would go the commissions, the Mayor and the Board of Supervisors; Establishment of coordinated intake All clients work with a case manager on a shelter placement Outreach staff develop standardized assessments and referrals. Dr. Katz said that there is a high percentage of homeless individuals who were foster care children. This presents an opportunity in terms of improving this system, and making sure it is delivering children what they need to become fully functioning adults. This is one area where a lot can be done to prevent homelessness. Public Comment Elizabeth Frantes, the assumption that all homeless people need case management is absurd. It assumes that people cannot handle their own business. Funding case managers does not help the homeless people. Anyone can find himself homeless. Homeless women are constantly under attack and there is no safe place for them to go. Uzuri Greene, used to be homeless and was able to get low-income housing. She was on the list since 1997. Should move some of the homeless families into buildings that are consistently vacant. Need more training programs. And the budget does not make sense-essential programs are being cut. We do not need more outreach, we need more services. The list for Section 8 only opens up every five years. Commissioners’ Comments Commissioner Monfredini asked if the MAP vans have to be called to a location or if they drive the streets looking for people. Barbara Garcia said they do both: they have a 24-hour dispatch center, and also certain geographic areas where they make rounds. An outreach worker is now with the driver, so they can do more effective outreach and engagement with clients. Commissioner Monfredini asked who MAP reports to. Ms. Garcia said it is operated by CATS and funded by CSAS. The program reports to her. Commissioner Parker asked how the number of homeless people is calculated. Ms. Kronenberg responded that prior to 2000 a number of different methods were used to count homeless individuals. In 2000 a homeless census was undertaken and this is the methodology that is now used every year. Commissioner Parker said that even though the City has a large safety net, there continues to be an increase in homeless, as well as problems such as substance abuse. We need to find other ways to treat this people. Ms. Kronenberg said that prevention before homelessness occurs is the ideal answer. The Department is trying to provide wrap-around services-mental health, primary care, substance abuse. But it is a daunting challenge. Commissioner Chow asked Ms. Kronenberg to describe what she discovered on her fact-finding visit to New York. Ms. Kronenberg said that while New York City does not provide any better services, they do have a wealth of resources. The State subsidizes the program in New York City, which is why they are able to provide the quantity of single room occupancy hotels and other living arrangements. Commissioner Monfredini said that one way New York is different is that they are able to track where people are in the system. They also do not give out cash-all services are provided through vouchers. Ms. Kronenberg said they want a coordinated intake and information system in San Francisco so that no matter where someone enters the system, the City would know they are there and the services they are accessing. Commissioner Guy commended that staff for the report, which took years to develop. The Department of Public Health and DHS are true core partners in solving this problem. The housing piece is a crucial but costly item. This problem cannot be solved through coordination alone; we need more housing. The City is headed in the appropriate direction in terms of housing as a health issue, coordinated services, and quantitative data. That is what this report represents. Commissioner Sanchez said the number of homeless veterans has not dropped since the 1980s and 1990s. He asked if services for homeless veterans are better coordinated regionwide, and if the Veteran’s Administration (VA) sits at the table. Ms. Kronenberg said that they work very closely with the organizations that serve veterans, and the Local Board has a seat for veterans, which is currently held by someone from VA administration. Commissioner Sanchez said that it seems the City is providing services that were formerly provided for by the Federal government, who decided they were no longer going to care for people who had traumatic wartime experiences. Commissioner Jackson said that when foster children reach 18 the funding stops and the young person is out and alone. This puts people on the streets, and is a serious problem. Commissioner Jackson also said that the City needs to look at developing day care for sick children. This allows single people to keep working and can prevent them from becoming homeless. Commissioner Chow said that there should be a follow-up report at the Population Health and Prevention Joint Conference Committee on how we can better serve young people aging out of the foster care system and homeless veterans. Action Taken: The Commission adopted Resolution # 5-02, titled: “Recognizing the Need for Increased Interdepartmental Coordination and Accountability in the Homeless Service Delivery System, Including Quantifiable Outcomes, and Supporting the Mayor’s Office of Homelessness in the Development of a Coordinated Intake Process for the Single Adult System.” 7) ANNUAL HOUSING UPDATE Marc H. Trotz, Director of Housing and Urban Health, presented the Annual Housing Update. Housing and Urban Health is a new section is the Community Programs Division. The main goal is to provide community-based housing and innovative healthcare services to homeless and disabled persons. The Department invests in housing to improve the health outcomes of the Department’s target populations, to improve the day-to-day living environment for homeless and disabled people, to provide housing tailored to the needs of clients in the pubic health system, to provide community based exits from the Department’s institutions and to reduce over-utilization of high-end healthcare resources. Mr. Trotz gave some supportive housing statistics based on a study that was done that looked at 250 people one year prior to getting into supportive housing and one year after getting into supportive housing. 58% reduction in emergency room use for the past 12 months 57% reduction in hospital inpatient bed use for the past 12 months Elimination of the use of residential mental health programs for the past 12 months. Mr. Trotz said that a preliminary cost analysis has been done on the Broderick Residential Care Facility. In the one year prior to getting into Broderick, the 22 residents cost the public health system $2.3 million in long-term care or acute hospitalization costs. The projected cost to house and care for the 22 individuals for their first year at Broderick is $1.2 million, which is a $1.1 million savings to the public health system. The supportive housing and medical services provided by Housing and Urban Health further all four of the Department’s Strategic Plan goals. Housing and Urban Health funds four categories of housing. Permanent housing includes direct access to housing, non-profit owned housing and tenant-based subsidies. Transitional housing is intensive on-site programs targeted to specific populations and the length of stay is from 3 to 24 months. Emergency/Stabilization provides stabilization services to medically/behaviorally complex clients while a longer-term placement is identified. The length of stay is usually up to eight weeks. Direct Medical Services are street-based medical services not directly tied to housing programs. They are harm-reduction-based interventions around substance, HIV and AIDS and other medical conditions. Most of the Housing and Urban Health budget is spent on permanent housing. The largest revenue source is the general fund, closely followed by Federal Ryan White/CARE funding. The State provides very little funding-four percent. Mr. Trotz described various HUH housing programs, including the Le Nain Hotel, the Pacific Bay Inn, the Broderick Street Residential Facility, the Star Hotel, the Windsor Hotel, Canon Kip Community House, Derek Silva Community House, Hazel Betsy, Peter Claver, Planetree, Autumn Glow, Rita da Cascia, Rose Hotel, Brandy Moore Transitional Program, De Paul House, Ferguson Place, Restoration House, Safe House and Ark House. DPH took over the AIDS Housing waitlist this year, and this has been successful. This provides San Francisco with a fair and equitable system for managing HIV/AIDS housing slots. The list has over 2000 active clients waiting to be placed. Managing the list in house give us a lot better information about who is waiting and better management of access. Mr. Trotz then discussed some of the direct medical access programs. They provide on-site medical support at housing sites to help stabilize medically complex clients. They also have Action Point Centers, which are drop-in programs for clients with HIV/AIDS . Housing and Urban Health also helps provide medical care at the 13 needle exchange sits. Future Programmatic and Policy Directions Medi-Cal rate for supportive housing, and more State involvement in housing. Centralized access to stabilization beds. The Department funds 300-500 short-term stay beds that are dispersed and into which access is not effectively controlled. So they are not available to hospital discharge planners. Creating new housing settings responsive to our institutions. Public Comment Joyce Miller, community activist, spoke before the Commission to bring awareness for the need for more women and children care facilities, Mothers in Prison, Families in Crisis campaign. She thanked that staff of the Health Department for supporting the rally she has every year. She asked the Commission to remember that there is a need for an increased for treatment facilities for women. Commissioners’ Comments Commissioner Jackson congratulated Mr. Trotz on the extraordinary work he and his staff have done. Commissioner Guy supports the recommendation to have the State allow supportive housing to be covered by Medi-Cal. We need to continually present our case to the Governor. Dr. Katz said that the state funding process does not make sense. They are content to pay for the more expensive skilled nursing facility like Laguna Honda and housed them in a more humane, less restrictive and less expensive way, and the State pays zero. 8) THIRD QUARTER FINANCIAL REPORT Monique Zmuda, DPH Chief Finance Officer, presented the Third Quarter Financial Report. The report covers a nine-month period, but most of the data represents revenue collected and billed and expenses incurred for the first eight months. Based on this data, the Department is projecting a year-end surplus of $30.5 million for FY 2001-02. $10.4 million of this surplus has already been accounted for to give back to the City and County in the current year to meet the Mayor’s general fund reduction plan. The remaining surplus will revert back to the general fund at the end of the year. Ms. Zmuda summarized the projected fiscal year revenues and expenditures by division. San Francisco General has an estimated $7.4 million surplus, all of which is due to increased Medi-Cal revenue, much of which is a result of the increased census. They have received positive rate adjustments from Medi-Cal in the current year. San Francisco General Hospital does continue to run in excess of its budgeted salaries and operating expenses. Laguna Honda Hospital has an $11 million surplus, largely due to the matching program approved by Medicaid whereby local dollars are used to draw down federal dollars. Primary Care is estimating a surplus of $2.5 million. Health at Home has a small surplus, and Jail Health Services anticipates a $2 million deficit. The vast majority is due to salaries that are in excess of the budget. They are not overspending, but rather are underfunded. Public Health is showing a $2.5 million surplus. Mental Health projects a $6.1 million surplus, $3 million of which is a result of increased Short-Doyle Medi-Cal revenues. Substance Abuse projections show a $2.7 surplus. $1.1 million is from prior year revenue, which is a result of favorable cost report adjustments. Expenditures are below budget largely due the intentional delay in starting up new programs. The Mayor’s Office has committed to rolling over $15 million of the surplus for next year’s budget. Ms. Zmuda will return to the Commission in August with the year-end report. She does not expect the financial picture to change significantly by year-end. Commissioners’ Comments Commissioner Parker asked Ms. Zmuda to explain why San Francisco General Hospital is projected to have a $22 million surplus in Other Patient Revenues. Ms. Zmuda said that this is a misaligned revenue source. This account has been realigned for next year to reflect the actual revenues. The discrepancy is a function of the funding mix and the accounting system, and where these dollars are registered when they come in. This year they registered many more under patient payments then under Medi-Cal because patients who are under capitation are no longer considered Medi-Cal, they are considered insured. 9) PUBLIC COMMENTS Patrick Monette-Shaw commented on the HIPAA presentation, specifically the biometric computer mice. He said that if the HIPAA final rules indicate that the biometric technology is required, then no doubt we have to do this. However if not, the money is better spent on more doctors, more nurses, more administrative support, etc. So if it is not required, do not do it. Elizabeth Frantes said that C.H.A.M.P. shut down last Friday. C.H.A.M.P. provided her with important help when she needed it. They were forced to close because somebody complained to the Feds. She asked the Commissioners to write letters to San Francisco’s Congressional representatives. The Federal Government has put a chilling affect on local politicians and the clubs. Protected space on city property is needed. 10) CLOSED SESSION A) Public comments on all matters pertaining to the closed session None. B) Vote on whether to hold a closed session (San Francisco Administrative Code Section 67.11) Action Taken: The Commission voted to hold a closed session. The Commission went into closed session at 5:50 p.m. Present in closed session were the Health Commissioners, Norm Nickens, Mary Louise Fleming, Michael Leon Guerrero and Michele Olson. C) Closed session pursuant to Government Code Section 54956.9 and San Francisco Administrative Code Section 67.10(d) Conference with Legal Counsel - Existing Litigation Proposed settlement of a litigated claim for $70,000, Imogene Jones v. CCSF, Department of Public Health et al, United States District Court Case #CO1-1405 WHA D) Reconvene in Open Session The Commission reconvened in open session at 6:10 p.m. Possible report on action taken in closed session (Government Code Section 54957.1(a)2 and San Francisco Administrative Code Section 67.12(b)(2).) Action Taken: The Commission approved the settlement for $70,000 in the case of Imogene Jones v. CCSF, Department of Public Health et al, United States District Court Case #C01-1405 WHA. 2. Vote to elect whether to disclose any or all discussions held in closed session (San Francisco Administrative Code Section 67.12(a).). Action Taken: The Commission voted not to disclose any discussions held in closed session. 11) CLOSED SESSION This item was continued to the May 21, 2002 Health Commission meeting. A) Public comments on all matters pertaining to the closed session B) Vote on whether to hold a closed session (San Francisco Administrative Code Section 67.11) C) Closed session pursuant to Government Code Section 54956.9 and San Francisco Administrative Code Section 67.10(d) Conference with Legal Counsel - Existing Litigation Proposed settlement of a litigated claim for $18,800, Mariano v. CMHS and SFUSD, Special Education Hearing Office, State Department of Education, Case Nos. SN 02-00356 and SN 02-00632 D) Reconvene in Open Session 1. Possible report on action taken in closed session (Government Code Section 54957.1(a)2 and San Francisco Administrative Code Section 67.12(b)(2).) 2. Vote to elect whether to disclose any or all discussions held in closed session (San Francisco Administrative Code Section 67.12(a).). 12) CLOSED SESSION A) Public comments on all matters pertaining to the closed session None. B) Vote on whether to hold a closed session (San Francisco Administrative Code Section 67.11) Action Taken: The Commission voted to hold a closed session. The Commission went into closed session at 6:10 p.m. Present in closed session were the Health Commissioners, Sai-Ling Chan Sew, Rick Sheinfield and Michele Olson. C) Closed session pursuant to Government Code Section 54956.9 and San Francisco Administrative Code Section 67.10(d) Conference with Legal Counsel - Existing Litigation Proposed settlement of a litigated claim for $7,000, Ozeri v. San Francisco Unified School District (SFUSD), and Department of Public Health (DPH), Community Mental Health Services. Special Education and Hearing Office, State Department of Education, Case No. SN 99-00145, File #021183 D) Reconvene in Open Session The Commission reconvened in open session at 6:20 p.m. 1. Possible report on action taken in closed session (Government Code Section 54957.1(a)2 and San Francisco Administrative Code Section 67.12(b)(2).) Action Taken: The Commission approved the $7,000 settlement in the Ozeri v. San Francisco Unified School District and the Department of Public Health, Community Mental Health Services, Special Education and Hearing Office, State Department of Education, Case No. SN 99-00145, File #021183. 2. Vote to elect whether to disclose any or all discussions held in closed session (San Francisco Administrative Code Section 67.12(a).). Action Taken: The Commission voted not to disclose any discussions held in closed session. 13) ADJOURNMENT The meeting was adjourned at 6:22 p.m. Michele M. Olson, Executive Secretary to the Health Commission