Minutes of the Health Commission Meeting Tuesday, November 5, 2002 At 3:00 p.m. Simon Auditorium Laguna Honda Hospital 375 Laguna Honda Blvd. San Francisco, CA 94116 1) CALL TO ORDER The Health Commission meeting was called to order by Commissioner Chow at 3:25 p.m. Present:  Commissioner Edward A. Chow, M.D., President Commissioner Roma P. Guy, M.S.W., Vice President Commissioner Harrison Parker, Sr., D.D.S. Commissioner David J. Sanchez, Ph.D. Commissioner John I. Umekubo, M.D. Absent:  Commissioner Lee Ann Monfredini Commissioner Michael Penn, Ph.D. 2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF OCTOBER 15, 2002 Action Taken: The Commission (Chow, Guy, Parker, Sanchez, Umekubo) approved the October 15, 2002 minutes with two corrections to the Director’s Report. On page 5, “LHH” was changed to “DPH.” 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Umekubo chaired and Commissioner Parker attended the Budget Committee meeting. (3.1) 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 $197,138, to provide specialized gerontological care services for the period of October 1, 2002 through September 30, 2003. This contract is retroactive because the negotiations over services and rates took longer than anticipated. (3.2) CHN-Office of Managed Care - Request for approval to enter, retroactively, into a contract between the Community Health Network of San Francisco and the State of California, Department of Corrections, to provide medical services for the inmates referred for such services from the Correctional Training Facility and California Medical Facility, in the estimated amount of $225,000, for the period of March 1, 2002 to June 30, 2003. (3.3) AIDS Office - Request for approval of a retroactive contract renewal with San Francisco AIDS Foundation, in the amount of $765,621, to provide client advocacy, benefits counseling and emotional support services to persons with HIV/AIDS, for the period of July 1, 2002 through June 30, 2003. This contract is retroactive due to the late award of some General Fund programs following the budget process. An interim agreement was processed to allow payments until the contract was developed. Public Comment Patrick Monette-Shaw (submitted 150-word testimony, read into the record) - Last February 14, DPH submitted its 10% Reduction Proposal to you. Playing brinksmanship, DPH -- in a bald attempt to frighten the horses proposing eliminating critical healthcare services -- submitted several recommendations, citing SF's CARE Council decision several years ago to eliminate emotional support services. Agenda Item 3.3 today proposes a contract for the San Francisco AIDS Foundation to provide PLWHA emotional support. Why is there a double standard permitting City General Funds use for services the CARE Council determined were not a significant priority for use of federal funds? How and when did SF get from not needing, to now needing, emotional support for PLWHA? Does this $765,621 contract use any portion of the $ 739,727 SF’s Supervisors may have backfilled to restore lost CARE money? Was the $739,727 included in the Mayor’s final budget, or is this a diversion of funds made by Supervisor’s without the Mayor’s approval? William Ray (submitted 150-word testimony, submitted and read into the record by Patrick Monette-Shaw) - Initiative #A-01, page 40 of the 10% Reduction Proposal DPH submitted to this Health Commission last February 14 indicated an emotional support contract to SFAF was for only $383,179. How did this contract manage doubling to $769,621in eight months? A decision matrix prepared by the CARE Council shows only Benefits Counseling, not advocacy or emotional support, as a need identified by PLWHA. A Community Forum ranked Benefits Counseling at rank 9 of 31; the LaFrance Associates $175,000 Needs Assessment ranked Benefits at rank 12 of 31. Neither the Forum nor the Assessment identified either client advocacy or emotional support as a category consumers need or want funded; the Assessment states “consumer advocate services [have] the lowest need” (page 12-75). Benefits contracts should go to Positive Resource Center, not passed through to SFAF to take a cut of this money. Why is this Commission contracting for services community members don’t want? (3.4) CHP-Behavioral Health Services - Request for approval of a retroactive contract renewal with Episcopal Community Services, in the amount of $608,782, to provide mental health and substance abuse services targeting homeless individuals, for the period of July 1, 2002 through June 30, 2003. This contract is retroactive due to the need for the contractor to revise contract documents to incorporate COLAs and other allocation changes after finalization of the Department’s FY 2002-03 budget. The contractor has continued to provide services and receive payment under a 6-month interim agreement approved by the Health Commission on April 16, 2002. Commissioners’ Comments Commissioner Umekubo asked if the Episcopal Sanctuary Services program would meet its goals for the current year. Lynn Armstrong, program director, replied that the program is fully staffed this year so they anticipate that they will be able to achieve the contract goals. (3.5) CHP-Behavioral Health Services - Request for approval of a retroactive contract renewal with Calvin Y. Louie, CPA, in the amount of $5,328,200, to provide fiscal intermediary services for the Community Mental Health Services supplemental residential care facilities, for the period of July 1, 2002 through June 30, 2003. This contract is retroactive due to the need for the contractor to revise contract documents to incorporate allocation changes after finalization of the Department’s FY 2002-03 budget. The contractor has continued to provide services and receive payment under a 6-month interim agreement approved by the Health Commission on April 16, 2002. (3.6) CHP-Behavioral Health Services - Request for approval of a retroactive contract renewal with National Council on Alcoholism, in the amount of $213,165 per year, for a total contract amount of $852,660, to provide a 24-hour telephone referral help line and the Youth Aware Life Skills substance abuse prevention program, for the period of July 1, 2002 through June 30, 2006. This contract is retroactive due to the need for the contractor to revise contract documents to incorporate the COLA after finalization of the Department’s FY 2002-03 budgets. The contractor has continued to provide services and receive payment under a 6-month interim agreement approved by the Health Commission on April 16, 2002. Commissioners’ Comments Commissioner Umekubo asked if the independent audit would be submitted on time this year. Arthur Bosse, the agency executive director, said that last year’s audit was submitted on time and he expects this year’s to be on time as well. (3.7) CHP-Behavioral Health Services - Request for approval of a retroactive contract renewal with Japanese Community Youth Council, in the amount of $660,620 per year, for a total contract value of $2,642,480, to provide substance abuse prevention services targeting at-risk Asian youth, for the period of July 1, 2002 through June 30, 2006. This contract is retroactive due to the need for the contractor to revise contract documents to incorporate COLAs and other allocation changes after finalization of the Department’s FY 2002-03 budget. The contractor has continued to provide services and receive payment under a 6-month interim agreement approved by the Health Commission on April 16, 2002. Commissioners’ Comments Commissioner Parker is impressed with the program’s prevention efforts for youth. Commissioner Umekubo asked if the agency would be able to submit its independent audit on time. Executive Director Jon Osaki replied that last year the audit was late because, although the draft was completed on time, the Board of Directors did not meet in December so could not approve it. Since this problem was identified, the Board has agreed to meet in December and will approve this year’s audit next month. (3.8) CHP-Behavioral Health Services - Request for approval of a retroactive contract renewal with Ohlhoff Recovery Programs, in the amount of $366,113, to provide residential and outpatient substance abuse services targeting women and adolescents, for the period of July 1, 2002 through June 30, 2003. This renewal contract is retroactive due to budget revisions made to include funding for a COLA. The contractor has continued to provide services and receive payment under a 6-month interim agreement approved by the Health Commission on April 16, 2002. Commissioners’ Comments Commissioner Parker asked if the Proposition 36 program is similar to the agency’s other programs. Barbara Farrell replied that they started the program last July and it is the same as the others. He asked if the agency must report Proposition 36 clients who do not complete treatment. Jim Stillwell said that clients who have difficulty with the treatment setting are reported back to the Health Department. The Department can case manage the individual and place him in a variety of different programs to try to help him be successful before having to report him to the criminal justice system. Commissioner Umekubo asked about the agency’s difficulty submitting the annual cost report and audit on time. Barbara Farrell said they had a lot of difficulty recruiting a controller. They hired someone who was unsatisfactory and let that person go. They have a new person who meets all the requirements and should be able to submit all reports on time. (3.9) CHP-Behavioral Health Services - Request for approval of a retroactive contract renewal with Potrero Hill Neighborhood House, in the amount of $398,898, to provide intensive outpatient substance abuse services targeting youth/young adults and adult parolees/probationers, for the period of July 1, 2002 through June 30, 2003. This contract is retroactive due to the need for the contractor to revise contract documents to incorporate the COLA after finalization of the Department’s FY 2002-03 budget. The contractor has continued to provide services and receive payment under a 6-month interim agreement approved by the Health Commission on April 16, 2002. Commissioners’ Comments Commissioner Umekubo asked if the agency is meeting its units of service this year. Enola Maxwell, executive director, replied that the agency serves many clients who do not meet DPH’s criteria. Her staff member added that they are achieving their units of service this year. Commissioner Umekubo asked that staff update the Commission on if the agency is meeting its units of service through a report to the Population Health and Prevention Joint Conference Committee (PHP JCC) in January. (3.10) CHP-Behavioral Health Services - Request for approval of a retroactive contract renewal with St. Vincent de Paul Society of San Francisco, in the amount of $1,522,082, to provide substance abuse treatment and substance abuse/mental health shelter services targeting homeless adults, for the period of July 1, 2002 through June 30, 2003. This contract is retroactive due to the need for the contractor to revise contract documents to incorporate COLAs and other allocation changes after finalization of the Department’s FY 2002-03 budget. The contractor has continued to provide services and receive payment under a 6-month interim agreement approved by the Health Commission on April 16, 2002. Commissioners’ Comments Commissioner Parker asked how many clients utilize each site, and why the agency is losing 20.5 fulltime employees and what impact this will have on services. Mr. Stillwell will get the information to Commissioner Parker within 30 days to the PHP JCC. Commissioner Umekubo asked if the annual audit would be submitted on time this year. (3.11) CHP-Behavioral Health Services - Request for approval to accept and expend, retroactively, a targeted capacity expansion grant from SAMHSA/CSAT, in the amount of $1,499,997, to expand the City’s treatment capacity for homeless addicts by enhancing residential treatment and improving service coordination, for the period of September 30, 2002 to September 29, 2005. (3.12) CHP-Behavioral Health Services - Request for approval of a contract modification with Walden House, Inc. to incorporate the Haven Grant, in the amount of $271,620, to provide residential services with an array of interventions addressing substance abuse, mental health, housing, educational, vocational and medical problems, for the period of November 5, 2002 through June 30, 2003. This item was tabled and will be re-agendized at a future meeting. (3.13) CHP-Housing and Urban Health - Request for approval to accept and expend a new “Behavioral Health Treatment for Homeless” grant from the Substance Abuse and Mental Health Services Administration, in the amount of $1,799,243, for the period of September 30, 2002 to September 29, 2005. (3.14) CHP-Health Promotion and Prevention - Request for approval to accept and expend a grant from the US Department of Justice, in the amount of $100,000, for the support of a one-year project to work with youth-led community action teams to address availability and use of substances in Bayview Hunters Point, for the period October 1, 2002 to September 30, 2003. Action Taken: The Commission (Chow, Guy, Parker, Sanchez, Umekubo) approved the Consent Calendar of the Budget Committee with the exception of Item 3.12, which was tabled. In addition, the Commission requested that a status report for Item 3.9 be presented to the PHP JCC in January and a status report on Item 3.10 be presented to the PHP JCC in 30 days. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Nursing Home Quality Data Online To publicize the Nursing Home Quality Initiative, the federal Centers for Medicare & Medicaid Services (CMS) has posted skilled-nursing facility (SNF) quality measure data on the Web at www.medicare.gov/NHCompare/home.asp. Laguna Honda's and San Francisco General’s SNF quality measure data are included in the data published. On November 13th, CMS will run full-page ads in major newspapers across the country. The ads will feature the 50 largest SNFs in each state and their results, which are based on 10 quality measures CMS selected in order to compare SNFs serving Medicare and Medicaid patients nationwide. Response to Syphilis San Francisco, as is true of other American cities with a large population of gay and bisexual men, continues to experience an increase in the number of syphilis cases. During the month of October, 56 early syphilis cases were reported. This is the largest number of cases reported for any one month this year. As of October 31st, a total of 429 early syphilis cases have been reported in the City. As has been the case all year, nearly all of the cases are among gay and bisexual men. Over 60% of the cases continue to be HIV positive and nearly 30% report using amphetamines during sex. DPH is continuing to intensify our effort to reduce the number of new syphilis cases. In particular, three units within the Health Department have volunteered to temporarily detail staff to the STD Program to assist their staff with syphilis case management and follow up of high-risk individuals. The three staff members who have been reassigned, Giuliano Nieri from the AIDS Office, Thomas Hoynes from the TB Control program, and Uzziel Prado from Environmental Health, have all accepted the reassignment with enthusiasm and with a statement of their commitment to assist in helping to reduce the spread of STDs to the residents of San Francisco. This is an example of teamwork and collaboration among the various units in the Health Department and exemplifies everyone's commitment to public health. A meeting will be held on November 6th with several key staff from the STD Division at the Centers for Disease Control and Prevention (CDC) to discuss the allocation of additional federal funds to eliminate syphilis in San Francisco. Currently, an additional $400,000 has been awarded but was then restricted until 2003. There is the possibility that additional monies may be awarded after the meeting. As required by the funder, 30% of all syphilis elimination monies must be awarded to community-based agencies. We will be putting these funds out to bid as soon as we are authorized to do so by the CDC. The remainder of the funds will be used to hire additional staff to perform investigations and community outreach as well as to supplement our advertising and stipend budgets. The STD Program has also recently implemented a new incentive program for syphilis testing. Men who go on our website or the Healthy Penis web site can print a coupon which can be exchanged for a Castro movie pass or a gift certificate to A Different Light Bookstore after getting a syphilis test at City Clinic. This Program is being sponsored by the Internet Sexuality Information Services agency that is one of the community agencies that has been working closely with the STD Program to try to eliminate syphilis in San Francisco. Mayor’s African-American Summit on HIV/AIDS On October 23rd, Mayor Brown held a Regional African American Summit on HIV/AIDS at Treasure Island. The 150 participants represented a variety of government and community-based organizations from San Francisco, San Mateo, and Alameda counties, and the State of Office of AIDS. Conference participants received a status report on HIV/AIDS Statewide, as well as local presentations from San Francisco and Alameda counties. Special breakout sessions were held to address the issues of the following specific populations: men, women, transgender, prison populations, youth and the faith community. Each group was charged with making recommendations for HIV/AIDS health promotion, prevention, and treatment status for year 2010. A regional policy-maker group met on October 31st to review the recommendations and begin the process of planning for implementation. The policy group will meet again on December 17th. Community Action Forum On October 28th and 29th DPH was one of the sponsor's of a Community Action Forum held at the LGBT Community Center. This Forum was designed to create a framework for gay men's health that was broader than disease prevention; including health promotion and community development. The organizers believe that HIV and STD prevention must be carried out in the context of a broader health agenda. Dr. Katz was pleased to speak at this conference alongside researchers and health providers from Sydney, London, Vancouver, The Harlem Director's Group and San Francisco's Caesar Chavez Center for Community Research. A consensus statement and framework for further action will be developed and published by the end of this year. Steven Tierney, Ed.D. Recognized for Outstanding Community Service The Northern California Chapter of the Society For Adolescent Medicine has awarded Steven Tierney, Ed.D., Director of the HIV Prevention, the Northern California Chapter’s Society for Adolescent Medicine Award for outstanding community service on behalf of adolescents. Our congratulations to Steve for this recognition of his important work in with adolescents at risk for HIV. Retreat - Caring for Patients with Chronic Illness in the Safety Net Last Friday, a working retreat titled, “Caring For Patients With Chronic Illness In The Safety Net: Directions For The Future,” was held at the Cathedral Hill Hotel. It was sponsored by a coalition composed of the Community Health Network/Primary Care, the Departments of Medicine and Family and Community Medicine at SFGH, Kaiser Permanente, and the San Francisco Community Clinic Consortium. Health Commission President Ed Chow and Vice President Roma Guy attended. Barbara Garcia and I gave brief remarks. Over 200 people attended to hear national and local experts on Models of Chronic Illness Care and Innovative Approaches to Self-Management and to make recommendations to the Retreat’s Planning Group. The following Saturday, the Planning Group met to set action goals. At this meeting there was agreement among the sponsors to apply for funds, as a coalition, in order to facilitate the adoption and adaptation of the Chronic Care model to our health systems. Congratulations for an excellent working retreat to the Tri-Chairs, Helen Chen, MD, Hali Hammer, MD, and Alex Moy, MD. Grant to Develop Community Based Mental Health Services for Children & Families The Children and Family Mental Health Services section of Community Behavioral Health Services has been awarded $1,000,000 from the Substance Abuse and Mental Heath Services Administration (to develop and implement "systems of care" communities. Systems of care communities are comprehensive, individualized mental health services for children with serious emotional disturbance and their families. This program establishes mental health services for children with emotional and behavioral disorders where they live, rather than in costly out-of-state and out-of-community settings. DPH Staff Elected to the National WIC Association Maria R. LeClair, MPA, RD, Director of Nutrition Services, was elected to represent the Western Region on the Local Agency Committee of the National WIC Association (NWA) for two years. The NWA provides leadership to the WIC community by promoting quality nutrition services; advocating for services for all eligible women, infants, and children; and assuring sound and responsive management of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Commissioners’ Comments Commissioner Chow congratulated Dr. Katz for receiving the first Community Service Award from the American College of Physicians Northern California Chapter. He asked what types of comparative data would be listed on the CMS website. Larry Funk responded that the website includes 12 quality indicators. LHH performance is better than the national and state average on all but two of the indicators. The two are the percentage of residents requiring heavy assistance with feeding and the percentage of residents with behavioral problems. The other information contained on the website are indicators as to how each SNF with Medi-Cal or Medicaid contracts performed on their most recent survey. Mr. Funk’s assessment is that LHH faired quite well, particularly given the population. Commissioner Parker said that it seems like a lot of DPH’s syphilis prevention efforts are counterproductive since the rate is increasing. He added that putting messages on websites with sexual content does not seem to be making any impact. Commissioner Guy congratulated the Children and Family Mental Health Services section for getting the $1 million grant. She echoed Commissioner Parkers comment that with regard to syphilis, the DPH strategies have not been successful. The Health Commission needs to support new programs and approaches, and staff needs to think outside of the box. Dr. Katz agrees. He said that one difficult aspect is that DPH’s campaign may be working-rates might have been higher without our efforts-but we cannot know for sure. But the rates are still increasing. The good news is that the CDC and a number of health departments, including New York, Seattle, London, etc. are working on the program. He will continue to keep the Commission apprised through his Director’s Reports and the PHP JCC. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF NOVEMBER Commissioner Parker presented the employee recognition awards for the month of November. Ellen Apolinario, RN, Nurse Manger. Laguna Honda Hospital, Nursing Unit D5/E6. Nominated by Lucy Fisher, Mary Lousie Fleming and Mivic Horose.  Asian Focus/Chronic Cluster Team Elaine Gecht, MD, Unit Attending; Camay Ko, Activity Therapist; Rita Ng, Medical Social Worker; Stella Yim, RN, Nurse Manager. Laguna Honda Hospital, Nursing and Medical Services. Nominated by Debbie Tam, Gayling Gee, Mary Louise Fleming and Terry Hill, MD.  6) PRESENTATION OF THE LAGUNA HONDA HOSPITAL ANNUAL REPORT Larry Funk, LHH Executive Administrator, began by introducing his executive team. In addition, he recognized two employees-Dorothy White and Ann Prato who both just celebrated 40 years of service to LHH. Mr. Funk also thanked the LHH Volunteers Board of Directors and more than 700 volunteers, and specifically recognized Rosario Lopez and Art Elkins. Mr. Funk also introduced Robert Neil, president of the Clarendon Hall Resident Council and Charles Levinson, another residents. Mr. Funk summarized the Annual Report’s Message from the Executive Administrator. This is Laguna Honda’s 136th year of service to San Francisco. During fiscal year 2001-2002, LHH recorded a banner year in its performance, highlighted by a number of significant contributions to the DPH mission. The hospital maintained an average daily census of 1059. The outpatient service volumes were equally impressive with 13,590 Adult Day Health Care client days, 1,656 Alzheimer’s Day Care client days and 7,463 senior nutrition program meals served. The hospital continued efforts to improved patient flow, increasing admissions from San Francisco General Hospital by two percent compared to last year. LHH has also increased discharges back into the community. The Community Reintegration Program completed its first full year of operation. The hospital also partnered with the Department of Aging and Adult Services to develop an Information Technology System, and instituted a Vocational Rehabilitation program to help residents develop employment skills. The hospital’s financial performance was strong, and revenues exceeded budget by $12 million. Mr. Funk discussed future challenges, including closely analyzing national trends toward increased nurse staffing hour and exploring funding means for increased staffing and relating costs. A related challenge in the requirement for a site-specific, acuity-based reimbursement system for nursing facilities, and the need to like research data to the new reimbursement formula. Another challenge is the management of the Hospital Replacement Project. Dr. Terry Hill presented the demographic information for hospital residents and staff. With regard to the age distribution of male residents, Laguna Honda Hospital is markedly different from other facilities in California. At Laguna Honda, 26% of male residents are under age 55. He also reiterated the hospital’s commitment to improving patient flow and LHH actively participates in a committee that assesses patient flow between SFGH and LHH. 197 patients were discharged home in FY 2001-2002. LHH is enthusiastically participating in the Department of Aging and Adult Services Living With Dignity policy committee and is doing strategy planning for long-term care services within San Francisco. Mary Louise Fleming discussed staff recruitment, education and training. The hospital is facing a workforce shortage-currently there are 30 vacant RN positions-and staff recruitment and retention is critical. Through the academic partnerships formed with San Francisco State University and UCSF, a total of 14 nursing staff received their masters’ degrees this past year. Seven more RNs have been accepted to UCSF’s School of Nursing three-year master of science program in gerontology. The hospital collaborates with academic institutions from all over the country to develop. The hospital has created a national model for a Pain Resource Nurse training program. Mr. Funk concluded the presentation with the four priorities for Fiscal Year 2002-2003. Continue to enhance the performance of the Leadership Team Advance the hospital toward becoming a center of excellence for long-term care rehabilitative and outpatient services Expand efforts to integrate services with community-based providers Proactively manage the beginning of the construction of the Hospital Replacement Project. Commissioners’ Comments Commissioner Chow recognized Cheryl Austin for her work 15 years ago on the Blue Ribbon Committee. Most if not all of the concepts recommended in the report have been implemented. There is one telling statistic. In 1985, 81 residents were discharged back to home. Today over 219 people were discharged. This is a major accomplishment to get people into the most appropriate area of care. With the new hospital, not only will we have an outstanding new building, but an outstanding program to put in it. Commissioner Sanchez said that LHH is a very rare institution that has served the city for 136 years. It is one of the unique models in the nation and has an inclusive community. Commissioner Parker thanked LHH and its staff for its history of providing excellent care to the residents of San Francisco. He has observed that in these changing times, LHH staff has become proactive in addressing changes handsomely. We are facing two basic crises. First, the disproportionate number of young men who are using senior service and facilities. Hopefully we will be able to address the root causes of why these men need long-term care. Second is the disproportionate number of African Americans in the institution. African Americans constitute seven to eight percent of the general population, yet 25% of LHH residents. This indicates that we have a lot of work to do to address health disparities. Commissioner Umekubo thanked staff for their fine work. He has seen a lot of progress at LHH during his four years on the Commission. The challenges never end and we must always strive to go beyond the status quo and focus on quality. Commissioner Guy supports staff and acknowledged the great challenges they face on a daily basis. When the ribbon is cut for the new building, Cheryl Austin should get the scissors. 7) PRESENTATION OF THE LAGUNA HONDA REPLACEMENT PROJECT UPDATE Michael Lane presented an update on the LHH Replacement Project. He first acknowledged Arla Escontrias and Jim Kautz for their work. They are on track to complete design in December. They recently completed review of the 50% construction documents, which were presented to LHH staff. There were no major discrepancies between what was shown and what the staff had expected. The utilities project will begin November 18th and the roadway project will begin in December. The official groundbreaking will be in September 2003. Mr. Lane showed a series of slides showing the floor plan, room configuration, improved accessibility, and other areas. The design allows for rehabilitation space to be expanded in the future, which was one of the staff desires. Over 35 meetings were held with neighborhood associations and community meetings will continue throughout the life of the project. The Community Advisory Group meets quarterly. The project team is also communicating with residents, their families and LHH staff. This is done through the LHH Residents Council, the LHH Family Council, the hospitals Mirror Residents News, town hall meetings and department staff meetings. They are also establishing an operations committee, which will meet weekly to ensure smooth interaction between construction and day-to-day operations. With regard to the budget, after the 50% construction documents were completed they needed to make some minor adjustments to stay on budget. They have been fortunate in that the first two bids came in under estimate. The staff needs to begin planning for the furniture, fixtures and equipment (FF&E). No decision has been made on the laundry but the project received approval to issue the RFP. The building in which the laundry is located needs to be demolished next September. Mr. Lane is a little concerned about the State’s ability to meet the review timelines they had committed to. OSHPD has been impacted by budget cuts. Also, Supervisor Tony Hall has introduced legislation to allow LHH to select contractors on a qualifications basis ration than a low bid basis. There will be a hearing on this legislation in December. Commissioners’ Comments Commissioner Umekubo asked if OSHPD would assign a team dedicated to this project. Mr. Lane said that the project does have a team, but not a dedicated one. But this allows for consistency in who the replacement project communicates with. They have weekly conference calls with the OSHPD team, which also visits the project monthly. OSHPD has been meeting its commitments up to now, but Mr. Lane is concerned about the future. Commissioner Chow said we are lucky to have Mr. Lane as the project manager. Commissioner Parker asked Mr. Lane to explain the significance of the 50% construction documents. Mr. Lane replied that at the point these documents are complete, everything is locked in pretty tightly. From these documents a reasonable budget estimate can be done. Commissioner Parker asked if the contractors are bound to the budget they submitted in their bid. Mr. Lane said that the contractors are locked in for their bid price for the full period of construction. What does arise, however, are change orders during construction. The project team is taking steps with the architect to minimize change orders for unforeseen conditions. But there is still some exposure going into construction. Commissioner Parker asked how long the laundry would be out of operation. Mr. Lane said it depends on the proposals, all of which must include any time need to include specific information about any time needed to contract out the laundry. Commissioner Parker said that, with regard to the FF&E, the Department should advocate that some of the DPH surplus be set aside every year for this purpose. Commissioner Guy thanked Ms. Escontrias because there have been community challenges. She asked how hazardous materials would be handled. Mr. Lane said they have done phase one and phase two site assessments, and are working with both the DPH Environmental Health Division and the Department of Public Works. They are hoping to keep the material on site. Commissioner Guy acknowledged the challenges presented by fund raising for the FF&E. 8) PRESENTATION OF THE FIRST QUARTER REVENUE AND EXPENDITURE REPORT Gregg Sass, DPH Chief Finance Officer, presented the First Quarter Revenue and Expenditure Report (Attachment A). This report presents the first quarterly financial projection of revenues and expenditures for the Department of Public Health for fiscal year 2002-2003. These projections based on revenue collected and billed, and expenses incurred for the first three months of the fiscal year ending September 30,2002. Based on this data, DPH is projecting a year-end surplus of $1.785 million for FY02-03. This amount represents 0.2% of the Department’s total operating budget. Projections include revenue surplus of $4.7 million and overexpenditures of $2.9 million. Commissioner Umekubo left the meeting at 5:25 p.m. Dr. Katz acknowledged the fine work of Gregg Sass. Commissioners’ Comments Commissioner Parker said the message we get from the Mayor’s Office is to make up the deficit in Jail Health Services with savings in another area of DPH. The Department should find out why the Mayor’s Office takes this approach with the jail, but not other areas. 9) PUBLIC COMMENTS Patrick Monette-Shaw (presented at the end of the Budget Committee meeting) - DPH’s current syphilis prevention campaign uses Healthy Penis 2002 and his nemesis, a syphilis sore, making SF the nations’ laughingstock. Life-size adults in these two costumes parade the Castro area, but, sadly, nowhere else in town, as the campaign is only for affluent, multiple college-degreed Castro-clone white men. Why are communities of color - like Bayview/Hunters-Point, the Tenderloin, or Mission District - excluded from this ridiculous prevention campaign? The campaign includes this vacu-formed squishable toy syphilis sore [displaying syphilis toy] replete with a “gay” earring; is there also a companion healthy-penis-with-gay-ear-ring plush toy? What is the unit cost of this “incentive” merchandise; how many were produced? My clinical colleagues think this is a disgusting, belittling use of public health money. Will we next have toy AIDS-related Kaposi sarcoma toys? Breast cancer lumpy toys? When you trivialize a problem, you get trivial results. Don’t expect syphilis rates to drop using this trivial, insulting nonsense. 10) ADJOURNMENT The meeting was adjourned at 5:45 p.m. Michele M. Olson, Executive Secretary to the Health Commission