Minutes of the Health Commission Meeting Tuesday, December 3, 2002 At 3:00 p.m. 101 Grove Street, Room #300 San Francisco, CA 94102 1) CALL TO ORDER The meeting was called to order by President Chow at 3:20 p.m. Present:  Commissioner Edward A. Chow, M.D., President Commissioner Roma P. Guy, M.S.W., Vice President Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner Michael Penn, Ph.D. Commissioner David J. Sanchez, Ph.D. Commissioner John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF NOVEMBER 19, 2002 Action Taken: The Commission approved the minutes of the November 19, 2002 Health Commission meeting with one amendment. Commissioner Chow’s comments on Page 7 were amended to read “Commissioner Chow, on behalf of the Commission, acknowledged Matisse Enzer and Alejandro Levins, who donated their time and resources to develop and implement an innovative pager system for the Action Point Project, and presented Certificates of Appreciation to these two individuals.” 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Monfredini chaired, and Commissioner Umekubo and Commissioner Penn attended, the Budget Committee meeting. (3.1) CHN-Primary Care - Request for approval of a retroactive sole source contract renewal with Lyon-Martin Women’s Health Services, in the amount of $96,024, to provide comprehensive primary medical care services to low-income women and transgender residents of San Francisco, for the period of July 1, 2002, through June 30, 2006. This contract is retroactive because of extended contract negotiations. There is no interim agreement currently in place. The Department requested that this contract be modified to a one-year term and an amount of $24,006. Fred Milligan, DPH Program Manager, said that because of the uncertainties in the budget, they felt it was best to have a one-year contract rather than a multi-year contract. Commissioners’ Comments Commissioner Monfredini emphasized to the agency that the reduction in the term of the contract is not a reflection of the Health Commission’s unhappiness with the agency, but rather a result of the reality of the budget. Ms. Williams-Flournoy, executive director, said she understands the realities of the budget cuts. Commissioner Umekubo asked that staff report on how the upcoming audit compares to the previous audit, in terms of addressing previous quality assurance findings. (3.2) CHN-Primary Care - Request for approval of a retroactive sole source renewal contract with Shanti Project, in the amount of $75,750, to provide LifeLines Project services that support women living with breast cancer, for the period of July 1, 2002 through June 30, 2003. This contract is retroactive due to reductions in funding and negotiation of related program reductions. Shanti is currently not receiving payments through an interim agreement. Commissioners’ Comments Commissioner Monfredini asked the status of the search for a permanent executive director. Kevin Burns, Shanti program manager, replied that they have selected a new executive director who will begin on December 16. Commissioner Umekubo commended the agency for its excellent monitoring report. (3.3) PHP-AB75 Project - Request to authorize adoption of the County Description of Proposed Expenditure of California Healthcare for Indigents Program (CHIP) funds for FY 2002-03. (3.4) PHP-Behavioral Health Services - Request for approval of a retroactive contract renewal with Family Service Agency of San Francisco, in the amount of $5,573,291, to provide children’s mental health, adult care management, geriatric, substance abuse and fiscal intermediary services, 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 a COLA after finalization of the Department’s FY 2002-03 budget. The contractor has continued to provide services and receives payment under a six-month interim agreement approved by the Health Commission on April 16, 2002. Public Comment Chuck Collins, Executive Director of the Family Services Agency, expressed his appreciation for the years of partnership with DPH. He is proud of the ratings the agency has received. The agency has been working with staff in preparation from next year’s budget. (3.5) PHP-Behavioral Health Services - Request for approval of a retroactive contract renewal with Homeless Children’s Network, in the amount of $228,285, to provide quality child care services targeting center-based and family child care providers and to provide therapy to homeless children in shelters, for the period of July 1, 2002 through June 30, 2002. This contract is retroactive due to the need for the contractor to revise contract documents to incorporate a COLA after finalization of the Department’s FY 2002-03 budget. The contractor has continued to provide services and receive payment under a six-month interim agreement approved by the Health Commission on April 16, 2002. Commissioners’ Comments Commissioner Monfredini asked if the corrective action plan is being implemented and monitored. Carla Weiss, Ph.D., Executive Director, said the agency is implementing the four-part plan detailed in the Plan of Correction and the results will be reflected in the 2001-2002 monitoring report. (3.6) PHP Behavioral Health Services - Request for approval of a retroactive contract renewal with San Francisco Pretrial Diversion Project, Inc., in the amount of $68,601, to provide substance abuse prevention services targeting adult Superior Court defendants, 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 a COLA 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 six-month interim agreement approved by the Health Commission on April 16, 2002. Commissioners’ Comments Commissioner Penn asked why the agency received a low score for client satisfaction. Mr. Leong said that the problem has been that they do not provide direct services, but referrals. They are working with DPH to develop an appropriate satisfaction survey in the next three months. The Budget Committee wants this survey implemented in the next six months and requested a follow-up report in six months. Commissioner Umekubo asked if the cultural competency plan has been submitted. Mr. Leong said it has not been submitted but will be in the next two weeks. (3.7) PHP-Behavioral Health Services - Request for approval to accept and expend a grant from the Substance Abuse Mental Health Services Administration (SAMHSA), in the amount of $8,873,683, for the support of a six-year project to expand our local children’s system of care, for the period of September 30, 2002 to September 29, 2008. Commissioners’ Comments Commissioner Penn asked about how the UCSF Child Services group was selected to evaluate the program. Esperanza Echavarri replied that they were selected through a review process. (3.8) PHP-CHPP - Request for approval of a retroactive sole source contract renewal with NICOS Chinese Health Coalition, in the amount of $60,600, to provide problem-gambling prevention services in the Chinese community, for the period of July 1, 2002 through June 30, 2003. This contract is retroactive due to the reserve status of funding, which was only recently released by the Controller’s Office in November 2002. NICOS is currently not receiving contract payment through an interim agreement. Commissioners’ Comments Commissioner Umekubo asked if the agency addresses the close connection between compulsive gambling and domestic violence. Mr. Woo said that NICOs works closely with the Cameron House to tackle this issue. Commissioner Penn asked to what the agency contributes it success. Mr. Woo said probably the media campaign. Commissioner Chow abstained from voting on this item. (3.9) DPH-Central Administration - Request for approval of a new contract with P.B. Strategies, in the amount of $85,000, to provide strategic planning and project management services for ongoing primary care capital improvement projects, for the period of December 1, 2002 through June 30, 2003. (3.10) SFGH - Request for approval of a resolution approving the transfer of the Department of Public Health's Institutional Police to the San Francisco Sheriff's Department and Authorizing the Director of Health to enter into a Letter of Management Agreement regarding this transfer. Health Commission Discussion The Health Commission discussed item 3.10 separately. Dr. Chow welcomed Sheriff Hennessey, who said that this has been a long process working through a pilot program. The two departments have a good working relationship and have worked together on many efforts over the year, particularly jail health services. Commissioner Chow said this partnership would lead to an even more professional force than we currently have for and on behalf of the patients. Commissioner Sanchez expressed his excitement at this transition and hopes that this new partnership will provide opportunities for young people to pursue law enforcement careers within the context of the DPH institutions. Commissioner Monfredini said that this issue has been deliberated through the San Francisco General Hospital Joint Conference Committee and she looks forward to its implementation. (3.11) SFGH - Request for approval of an ordinance amending the Administrative Code, authorizing the Department of Public Health to procure and enter into maintenance and repair contracts for the preservation and protection of public health facilities. Commissioners’ Comments - Health Commission Commissioner Monfredini emphasized that she takes very seriously the issue of executive directors attending the Budget Committee meeting when they have contracts before the Commission. She asked the Health Commission to request that the Department fully explain to all contractors that importance of executive directors attending the meetings when their contract is up for approval. Anne Kronenberg said staff would certainly convey this message. Action Taken: The Commission approved Items 3.1 - 3.9 and 3.11 of the Budget Committee Consent Calendar with the amendment to Item 3.1 to change the term of the Lyon Martin contract to one year and an amount of $24,006. Commissioner Chow abstained from voting on Item 3.8. After separate discussion, the Health Commission approved Item 3.10 and adopted Resolution #13-02, “Approving the Transfer of the Institutional Police to the San Francisco Sheriff’s Department and Authorizing the Director of Health to Enter into a Letter of Management Agreement Regarding this Transfer”, (Attachment A). 4) DIRECTOR’S REPORT The Director’s Report was presented after Item 5. 5) PRESENTATION OF THE ANNUAL AIDS UPDATE Dr. Susan Buchbinder introduced artist Rob Anderson, who created the multi-media presentation “Rattlesnake Inside a Moving Car,” which was displayed outside of the Health Commission meeting room. The exhibit presents the personal sound recordings and images of individuals who have been HIV positive for 20 years or more. Commissioner Chow, on behalf of the Health Commission, presented Mr. Anderson with a Certificate of Appreciation. Jimmy Loyce, Deputy Director of Public Health for AIDS Programs, presented the AIDS Office Annual Report. He gave a brief overview of the AIDS Office organization, which includes HIV/AIDS Statistics and Epidemiology, HIV Prevention, HIV Research, HIV Health Services and Prevention Research and Evaluation and HIV Health Services. The AIDS Office has 157 employees and its budget consists of general funds, federal funds and grants, state funds and private foundation grants. Two community planning councils advise the Department and the Mayor: the HIV Prevention Planning Council and HIV Health Services Planning Council. Dr. Susan Schwarcz, co-director of HIV/AIDS Statistics and Epidemiology, presented the epidemiological data. Dr. Schwartz’s section is responsible for gathering the data that is used by others to understand what is happening with the epidemic. They use a variety of data to help understand the magnitude and direction of the epidemic, the backbone of which is AIDS case reporting. This data is augmented with a variety of HIV prevalence and incidence studies, behavioral surveys and other indicators such as STD rates. DPH has just implemented HIV case reporting so future presentations will include this data. AIDS cases peaked in 1992 and have declined since then. Deaths due to AIDS have declined since 1996 due in large part to the availability of effective treatment. Although there is a decline in AIDS cases, there is an ever increasing number of people living with AIDS in San Francisco. San Francisco has had approximately 28,000 people diagnosed with AIDS. Currently approximately 9,000 people are living with AIDS. Dr. Schwarcz discussed the rates of AIDS among men by race. In 1992 whites were disproportionately infected. By 1996 the rates of African American men had caught up with the rates of white men and in 1998 the rates of African American men surpassed that of whites. However, the rates in all ethnicities have declined. For women, throughout the epidemic African Americans have accounted for the majority of infected women. The proportion of the percent of homeless AIDS cases has been increasing. Rates of HIV peaked in 1982 then declined, and in the mid-1990s rates were stable. However, in the late 1990s and continuing to the present, HIV infection rates are increasing in San Francisco. Dr. Schwarcz discussed the estimated rates of HIV seroconversion in San Francisco in 1997 and 2001 for specific risk groups. Rates have increased for MSM and MSM-IDU. Rates in non-MSM IDUs have decreased, in large part due to the very effective needle exchange programs. Rates for heterosexuals are extremely low. Rates in transgendered individuals were very high. Survival for people with AIDS has been improving, but less so for African Americans than for other groups. They have done analysis that demonstrates that there is not a racial difference that cannot be accounted for by treatment. They looked at HAART use by neighborhood, and the neighborhoods that had higher survival had higher HAART use. She recapped prevention and care successes: New AIDS diagnosis and AIDS deaths continue to decline in all racial/ethnic, risk and gender groups No child under 13 diagnosed with AIDS Risk of AIDS due to transfusion now 1 in a million HIV transmission among non-MSM IDU is stable HIV among pregnant women is low and treatment to prevent transmission to infants is high HIV transmission among heterosexuals is rare Dr. Steven Tierney presented the HIV Prevention Section. The types of services they offer include outreach, workshops, social marketing, risk reduction counseling, HIV testing, prevention case management, media development and needle exchange. Behavioral risk populations are used to prioritize and target services to those at the highest risk of HIV infection. Dr. Tierney highlighted the Community Action Forum on Gay Health and three new initiatives to address prevention needs in the young African American MSM community. New Initiatives in HIV Prevention Research Provider capacity assessment for prevention for positives Systems Capacity Assessments by Neighborhood (SCAN) in the Bayview and Tenderloin Needs assessments with Native American Two Spirit communities, heterosexually identified MSM, recently seroconverted men Services Expansion of prevention with gay men who use methamphetamines Condom social marketing HIV prevention for gay men over 45 Innovation in HIV Prevention Web infrastructure development (SFHIVPrevention.org) Evaluating Local Interventions data collection system Michelle Long Dixon presented HIV Health Services. Services include primary medical care, home health care, dental care, housing, substance abuse treatment, mental health care, case management, peer and treatment advocacy, benefits counseling, food, legal assistance, child care and transportation. HIV Health Service priorities are to: Ensure access to care and eliminate disparities in care Assure comprehensive, high quality, culturally competent services Increase integration of services Bring those who know that they are HIV positive but are not into care into care Ms. Long Dixon presented information on quality management initiatives and the development of standards of care. One of the features of this effort has been to include clients in the development process. Future Directions Epidemiological Trends - HIV transmission appears to be increasing among MSM, MSM-IDU and possibly transgendered persons. Increases in HIV transmission are associated with amphetamine use in MSM. Declines in AIDS deaths and increases in new HIV infections results in an increase in the number of persons living with HIV/AIDS. Prevention Challenges - Increased need to shift and focus prevention messages to be effective for higher risk populations. Federal policies regulating prevention messages limit the effectiveness with those populations. Increased data collection requirements from State and Federal government puts focus on evaluation rather than client services. Care Challenges - Service increasing numbers of people living with HIV/AIDS; addressing the complexity of care, including multiple diagnoses, homelessness, Hepatitis C and other medical conditions. Expanding cultural competency and capacity to address needs of emerging populations, including the transgender community. Linking prevention, health services and research to improve services to clients. Resource Challenges - $2.2 million cut in CARE Title I for FY 2002 and a larger cut projected for FY 2003. The Office of Minority Health grant for technical assistance will end in 2003. Commissioners’ Comments Commissioner Penn asked if the Department really understands what is going on in the African American community that leads to higher rates of infection and lower survival rates. Mr. Loyce said that they do not have their hands around this problem, and that there are likely multiple answers. It is partially due to institutional racism. Partially because MSMs in the African American community tend not to consider themselves gay and do not respond to or identify with the messages about HIV prevention. The one thing they can do is continue to interact with the community and ask for messages that resonate. The AIDS Office will be rolling out multiple campaigns based on some focus groups. Commission Penn emphasized that these efforts need to be constantly evaluated to see if they are working, so that we do not continue to miss the core of the problem. Commissioner Parker said that even if we knew the avenues to take to address health disparities in the African American community, we would have to decide if we are willing to spend the majority of the funds to correct this disparities, because that is what it would take. He asked how people access the HAART program and where are these services geographically located. Ms. Long Dixon said that HAART therapy is available at all primary care sites. They have also instituted early intervention programs in the Mission and Bayview Hunters Point to try to increase the access to African Americans and Latinos. Another important element is the outreach workers who help clients adhere to the HAART program. Dr. Schwarcz added that among individuals who are diagnosed with AIDS, the survival of African Americans is worse because their use of HAART is worse. They are doing research now on the reasons for not using HAART therapy and expect to have sufficient data by March. Commissioner Umekubo said that although the rates of infection have decreased, and this is positive, he is concerned that something might change, such as the biology of the disease or the efficacy of the medication that would cause the rates to increase again. And the success could also lead to complacency and funding reductions. Our prevention funding has already been decreased and this presents a huge challenge. Commissioner Monfredini said that the information in the report pertains to San Francisco, that San Francisco’s rates have dramatically decreased because of the work San Francisco has done so it is not surprising that the Ryan White funding has decreased. She is concerned that the fact that heterosexual transmission rates are almost non-existent will lead to complacency. Another concern is that the funding will continue to decrease. Ms. Long Dixon said that the funding for AIDS care throughout the country is not increasing but the number people getting infecting is increases. So instead of being able to continue the level of services, San Francisco’s funding was reallocated. Commissioner Chow asked if there is data that compares San Francisco’s rates to the national rates. Dr. Schwartz said the trends across the nation in AIDS incidence and AIDS deaths are the same as San Francisco’s. The difference is that the epidemic peaked earlier in San Francisco and we began the use of HAART earlier. What is not known is what is happening nationwide with new HIV infections. San Francisco does have these estimates already. Commissioner Chow said there are numerous challenges. It is important that we understand how our primary care clinics operate and how they can be incorporated into the continuum of AIDS services. He would like the Commission to get a progress report both the epidemic and the various initiatives. Commissioner Guy said that there are numerous national issues that are impacting San Francisco, including funding. She asked if the AIDS Office is planning to hold another consensus meeting and if there will be information about race. Dr. Schwartz said that in 2003 they will poll their colleagues to find out what studies they are doing and evaluate the possibility of having a consensus meeting. Also, at the last meeting there was harassment of researchers and we have prevent this from happening again. Commissioner Guy said we have to emphasize the connection between HIV and other STDs and asked how Southeast Health Center is involved in all the initiatives. Patricia Perez Arce replied that the Southeast Health Center has an early intervention program funded by the AIDS Office. The Health Center in conjunction with the community undertook a needs assessment to find out what health programs should be emphasized in the community and AIDS services were one emphasis. Commissioner Guy said she read that said the national government is going to frown upon harm reduction and condom use, and asked if this is true. Mr. Loyce said he learned at a recent meeting with the CDC that the abstinence model is going to receive more funding. He is not sure where the CDC will ultimately go with this but will monitor the issue carefully. He added that the Mayor’s Office called a regional summit on African American HIV Prevention and Health. They are actively pursuing a regional approach to African American AIDS prevention. Commissioner Guy recommended that the Population Health and Prevention JCC look at the timelines for the various initiatives, incorporate this topic into the discussion about men’s health, and report to the Health Commission in six to eight months. Commissioner Sanchez said that the degrees of freedom researchers have has peaked, and he believes we will begin to see limitations. The impacts of the budget reductions, both State and Federal, will have a severe impact on prevention and health services. We will need to revisit our priorities both in the research and clinical communities so that we can sustain critical initiatives and stay the course. He congratulated staff for getting grants in this environment. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report Governor’s Health Care Proposal to CMS Last Wednesday, the Governor announced that his Administration was forwarding to the Centers for Medicare and Medicaid Services (CMS) a package of proposals to strengthen California's health care system, support the State’s critical safety net hospitals, and assist Los Angeles County during its health care crisis. The plan has three key components. The package relies primarily on CMS approval of the pending Selective Provider Contracting Program (SPCP) federal waiver. The SPCP waiver provides funding under the SB 1255 program to disproportionate share hospitals (DSH), such as San Francisco General Hospital, which relies on this program for approximately $19 million in revenue each year. The State reports that if the SPCP waiver is approved as submitted, it will be possible to provide $100 million in additional federal funds to Los Angeles County for each of the three State fiscal years to be covered by the pending SPCP waiver without disadvantaging the rest of the State. The second component of the State’s health care proposal is intended to improve the fiscal stability of safety net providers. This component of the proposal would use county and University of California funds to draw down additional federal funds for Medi-Cal managed care plans at levels more comparable to that of the private sector. This is intended to assist counties with public hospitals and government-operated Medi-Cal managed care programs, but the details have not yet been released. The third component of the proposal is intended to promote cost-effective outpatient care and reduce costly inpatient care. Under this component, any California public hospital system currently receiving DSH funds and meeting certain conditions to reform their health system would continue to receive DSH funding at their current level, even if they decrease their volume of inpatient care. State Budget In late November, Governor Davis announced that he expects that the 2002-03 State budget shortfall will be even more serious than the $21 billion shortfall estimated by the Legislative Analyst. The Governor has called for a special legislative session to address budget shortfalls projected for both the current and upcoming fiscal years. Beginning next Monday, December 9th, the special session will meet to enact $5 billion in current year budget reductions, as well as other budget changes for the current year and the budget year combined. Naloxone for Heroin Users Results are now available from a pilot program funded by the Department to help reduce the number of deaths attributable to heroin overdoses. Between May 2001 and February 2002, participants in the program were trained to identify signs of an overdose and to administer Naloxone, which floods the body with a chemical that blocks the action of opiates on nerve and brain cells and triggers instant heroin withdrawal. More than 20 overdoses were documented during the pilot program period. One participant in the study died, however, the death was a result of a bacterial infection, unrelated to a heroin overdose. Two-thirds of the overdoses were treated with the antidote and the remaining interventions were use of CPR or a telephone call to 911. In addition, a large number of participants went into drug treatment and some documented a significant decrease in the number of injections per day. We will further evaluate the data from the trial program over the course of the next few months. Syphilis Testing Incentive Program The STD Program has recently implemented a new incentive program for syphilis testing. Men who go to the STD Program or the Healthy Penis website can get 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, one of the community agencies that have been working closely with the STD Program to try to eliminate syphilis in San Francisco. LHH Publishes Monthly Quality Newsletter The Laguna Honda Quality Management Department is now publishing a monthly quality assurance newsletter. The newsletter is distributed in hard copy and is posted on the Department’s Website under LagunaNet. The purpose of the newsletter is to further advance the importance of quality improvement while educating the staff on trends and innovations in quality improvement, particularly in long term care. Celebration of National Hospice Month In conjunction with the Proclamations issued by Mayor Brown and President Bush recognizing November as Hospice Month, the Department of Public Health recognizes Laguna Honda Hospital’s Hospice and Palliative Care Service. Since its opening in December 1988, Laguna Honda has successfully combined professional expertise, community volunteerism and administrative leadership to provide outstanding end-of-life care for nearly 1,400 terminally ill San Franciscans and their loved ones. The 25 bed Hospice and Palliative Care Service has upheld the Department’s customer service philosophy and has become a model for patient/family-centered care giving. CHIPPS Program Recognized The Department's Community and Home Injury Prevention Program for Seniors (CHIPPS) was highlighted and recognized as a model program in a recent article on "Preventing Elder Falls". The article, which appears in the November/December 2002 issue of Every Second Counts, the national emergency response magazine, describes growing interest and concern at the Federal and State levels in elder fall prevention. December at SFGH As in past years, Dr. Katz is attending on the medical service at SFGH for the month of December. Dr. Katz takes great pride to practice medicine in a hospital that provides high quality care in a compassionate manner to persons regardless of their income or social situation. Dr. Katz couldn't help but note when he picked up his new service on Sunday, that of the 11 medicine patients, 7 were homeless, 2 were living in supportive housing funded by the Department of Public Health and one was in jail. All but one of the patients were in the hospital because of the direct or indirect consequence of substance use. DPH must continue to develop both preventive and daily treatment options to prevent the devastating consequences of substance use. Commissioners’ Comments Commissioner Parker said he has had the opportunity to visit the hospice ward at Laguna Honda Hospital on many occasions and has always been impressed. He congratulated Laguna Honda for its many years of great service. 6) PRESENTATION OF A PROPOSAL FOR A REVISED FY 2002-03 BUDGET, AND CONSIDERATION OF A RESOLUTION SUPPORTING THE PROPOSED REVISIONS Gregg Sass, DPH Chief Finance Officer, presented the General Fund reduction plan for FY 02-03. In November the Mayor’s Office projected a $170 million shortfall in the City’s budget for the next eighteen months. As part of the FY 03-04 budget instructions, Departments have been asked to submit a plan to reduce general fund by three percent in the current year as one of three steps to balance the FY 02-03 and FY 03-04 budgets. The three steps are: Current Year: Reduce General Fund by 3% in 2002-2003 Budget Year: Absorb cost increases for 2003-2004 within the reduced 3% General Fund Contingency plan: Prioritized 5% General Fund contingency plan for 2003-2004 DPH has developed a plan to reduce general fund by three percent in the current year for a total reduction of $8,662,460. The plan is achieved through increases to revenues as well as reductions to expenditures. No service reductions will be made with these decreased to the General Funds. Details of the reduction plan are listed in Attachment B. Commissioners’ Comments Commissioner Penn said that at a prior Health Commission meeting Dr. Katz said there was a pool of money that could be drawn from to meet the current year budget reduction and asked if these are reflected in the reduction plan. Dr. Katz said that the plan includes a number of one-time dollars, primarily because it would have been difficult for the Commission to decide on on-going cuts without the context of the entire budget. So the really painful decisions will be before the Commission in February. Commissioner Guy acknowledged that the budget deliberations are going to be very tough. The Commission and Department need to be honest so that the people of San Francisco understand the consequences of these budget reductions. The addbacks will present a new challenge. Commissioner Chow said that the addbacks should be considered part of the base budget and deliberated during the budget process in the same context as the rest of the base budget. Public Comment Bryan Uyeno spoke in opposition to contracting out the laundry at Laguna Honda Hospital. Having laundry on site provides an important service. If it is contracted out it will cost the city more than it currently costs. Dominic Chan, SEIU, spoke in opposition to contracting out the laundry at Laguna Honda Hospital. The laundry workers are the working poor. Contracting out means we are having the work done by people who make seven or eight dollars an hour. At Laguna Honda people earn a living wage. The union is happy to work to find other solutions rather than eliminating 70 jobs. The union also believes that this contracting out violates the contract. Action Taken: The Commission approved Resolution #14-02, “Approving a 3% General Fund Reduction to the Department of Public Health’s Budget for FY 2002-03”, (Attachment C). 7) PUBLIC COMMENT Elizabeth Frantes spoke in support of medical marijuana. The criminal suppliers control medical marijuana. There is artificial scarcity. The Department of Public Health should be in control of the supply. We have to grow as much as we can. 8) ADJOURNMENT The meeting was adjourned at 5:55 p.m. Michele M. Olson, Executive Secretary to the Health Commission