Minutes of the Health Commission Meeting Tuesday, January 21, 2003 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 JANUARY 7, 2003 Action Taken: The Commission approved the minutes of the January 7, 2003 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Monfredini chaired, and Commissioner Penn and Commissioner Umekubo attended, the Budget Committee meeting. (3.1) Update on Walden House’s 2002-03 contract. Commissioner Monfredini said that an agency with a history this long should never have gotten into this situation. Mr. Acampora, the Executive Director, agreed and said the agency has been working very hard over the past two years to address the problems that were created by a systems conversion and the tremendous growth of Walden House. Walden House has only been in this situation once in its 34-year history and was able to overcome it, and he feels confident that they can overcome this situation as well. Commissioner Monfredini emphasized that the agency has tremendous challenges and she is concerned that they will not be able to meet these challenges in six months. Debi Lowis, Chief Administrative Officer, said November was not a good month for Walden House in that they did not get money from the State, but December was a better month, and as of Friday they had $900,000 in the bank, which just about meets payroll. They are anticipating getting funds from the State contract in the next two weeks. Commissioner Monfredini emphasized that no one wants to see the agency fail. She asked if there was still a Walden House Foundation. Ms. Lowis said that there never really was a functioning foundation, and that the woman set up her own 501(c)3 without anyone’s knowledge. Commissioner Monfredini said this could not happen, and asked the current status. The foundation has requested dissolution from the Attorney General. The Charles Schwabb grant will be given to the agency. Commissioner Monfredini said the agency needs to submit formal reports to Gregg Sass on the 15th of each month, and asked for another status report when appropriate on discussions with Cal Mortgage. Commissioner Umekubo asked how long Walden House has been without a CFO. Ms. Lowis replied that the former CFO has been on contract, assisting with audits, forecasts, the bond package, and other financial issues, and is committed to staying on with them until a new CFO is hired. They have retained a search firm. They have been without a full-time CFO for 18 months. Commissioner Penn asked why the delay in hiring a permanent CFO. Ms. Lowis replied that the first strategy was other priorities-Y2K compliance conversions, etc. When they got to the point where they were current-approximately four months ago-they focused on the CFO search. Commissioner Penn asked about the $1 million loan from the Board of Directors to the Agency. Ms. Lowis said the original intent of the loan was to provide bridge funding until the Wells Fargo loan went through. At this point the loan was interest free. When the Wells Fargo loan did not happen, the loan was extended and made interest bearing. Commissioner Penn is concerned about the discrepancy between what Mr. Acampora wrote to the Attorney and the information in the financial documents. Commissioner Penn noted that some of the assumptions in the bond forecast/model are not necessarily grounded in reality. Ms. Lowis said that the experts have made these analyses, and they trust their expertise. Commissioner Penn just asked them to take note of caution. He thanked them for the very detailed corrective plan, but would like more specifics in future reports. (3.2) DPH - Request for approval for retroactive revision of selective DPH FY2002-03 patient rates for Community Mental Health Services and Records and Statistics. (3.3) CHN-SFGH Medical Staff Services - Request for approval of a contract renewal with CheckPoint Credentials Management Services, in the amount of $70,000, to provide as-needed, supplementary credential verification services of clinicians who provide patient care at San Francisco General Hospital, Laguna Honda Hospital and the primary care clinics of the Community Health Network, for the period of February 1, 2003 through January 31, 2005. (3.4) CHN-SFGH, HAH AND LHH - Request for approval of three contract renewals with the following firms: On-Call Therapists, Inc., Physical and Occupational Therapist’s Registry, Inc. and Preferred Healthcare Registry, Inc., for a combined total amount of $503,760, to provide intermittent, as-needed rehabilitation (physical, occupational and speech) therapy personnel services for the Community Health Network, for the period of February 1, 2003 through January 31, 2005. (3.5) CHP-Violence Prevention - Request for approval of a contract renewal with San Francisco Study Center, Inc., in the amount of $109,900, to provide fiscal administration of violence prevention community action projects services targeting the Bayview community, for the period of January 1, 2003 through June 30, 2003. (3.6) CHP-Housing and Urban Health - Request for approval of a new contract with Baker Places, Inc., in the amount of $443,649, to provide behavioral health services targeting Direct Access to Housing participants, for the period of January 1, 2003 to September 29, 2003. Commissioner Monfredini asked how outcomes would be measured. Mr. Trotz said that the SAMSHA grant includes money for evaluation. Margot Antonnetty added that the grant has several evaluation components that have been incorporated into the contract. DPH will be doing annual monitoring, plus will be instrumental in putting this program together with the agency. One evaluation component is the number of people who go to treatment, stay through the course of treatment, and go back to the housing site. Staff will report the evaluation results as part of the annual contract renewal. Commissioner Monfredini asked to bring this back through the Community Health Network Joint Conference Committee. (3.7) PHP-CHPP - Request for approval of a retroactive sole source renewal contract with Booker T. Washington Community Services Center, in the amount of $297,000, to provide community action and outreach/education services regarding infant mortality among African Americans, for the period of September 30, 2002 through September 29, 2003. This contract’s retroactive status is due to delays in submitting contract and/or support documents, including the annual Cultural Competency report to DPH, which affected subsequent routine contract development and calendaring. The contractor has not been receiving payments under an interim agreement. Ginger Smyly reported that the agency submitted its Cultural Competency Report last week. Neal Hatten, Interim Executive Director, said he has a six-month contract for interim director but will stay until everything is stabilized. William Lowery, president of the board, said the Board has engaged Compass Point to help with the executive director recruitment process. They have narrowed down to a number of finalists, and should make a selection in the next two weeks. Commissioners’ Comments Commissioner Penn asked if the Board is making progress replacing the two deceased board members. Mr. Lowery replied that one was replaced yesterday and they hope to replace the other soon. Commissioner Penn asked how the contract is being monitored. Ms. Smyly said there is an independent evaluator for the contract, and she will give a six-month update to the Population Health and Prevention Joint Conference Committee. (3.8) PHP-Behavioral Health - Request for approval of a sole source contract modification with Walden House, Inc., to incorporate the Haven Grant in the amount of $183,000, to provide residential services with an array of interventions addressing substance, mental health, housing educational, vocational and medical problems and the Practice Improvement Collaborative research grant in the amount of $55,000 to provide administrative support services, for the period of February 1, 2003 through June 30, 2003. Total amount of the contract for FY 02-03 is $7,886,465. (3.9) PHP-Behavioral Health - Request for approval of three new retroactive contracts for the term of January 1, 2003 through June 30, 2004 with three contractors (listed below) awarded pursuant to Request for Proposal (RFP) 21-2002, to conduct assessments for and provide Therapeutic Behavioral Services to eligible children and youth, birth to twenty-one, and their families who reside in and out of the City and County of San Francisco. For a total combined contracts amount of $2,562,000 for the 18-month period. The contracts are retroactive to January 1, 2003 due to delays in negotiating rates for units of service and the need for contractors to revise budget documents.   Contractor Proposed FY 02-03 Proposed FY 03-04 Total Award Edgewood Children’s Center for Children and Families $604,000 $1,208,000 $1,812,000 Seneca Center $150,000 $300,000 $450,000 Fred Finch Youth Center $100,000 $200,000 $300,000 TOTAL $854,000 $1,708.000 $2,562,000 (3.10) PHP-Behavioral Health - Request for approval of a retroactive contract renewal with the Regents of the University of California, in the amount of $430,776 per year, for a total contract value of $1,723,104, to provide mental health services targeting clients with AIDS/HIV disease or disabling HIV disease who are low-income and uninsured or underinsured, for the four-year period of July 1, 2002 through June 30, 2006. This contract is retroactive due to the need to separate, 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 is currently not receiving payment. Commissioner Sanchez abstained from voting on this item. (3.11) PHP-Behavioral Health - Request for approval of a retroactive contract modification with Mount Saint Joseph-Saint Elizabeth Epiphany Center for Families in Recovery, in the amount of $516,072 for the 2002-03 fiscal year, to provide funding for two new programs, residential treatment services for pregnant/postpartum adult women and overnight partial day services at the Broderick House and one-time additional funding for expansion of the adult intensive outpatient program, for the period of July 1, 2002 through September 29, 2003, for a total contract amount of $852,823. The Commission severed Item 3.1 for separate discussion. Action Taken: The Commission approved Items 3.2 to 3.11 of the Budget Committee Consent Calendar, with Commissioner Sanchez abstaining from voting on 3.10. Commissioners’ Comments on Item 3.1 - Walden House Contract Update Commissioner Monfredini said that Gregg Sass has asked for five things from Walden House: Hire a full-time CFO; refinance debt; closure of the Attorney General investigation; reduce Accounts Receivables from $9 million to $7 million; and have an unqualified audit. The agency did receive an unqualified audit. The Budget Committee requested that the agency submit monthly reports to Mr. Sass, the Health Commission be kept apprised of discussions on debt refinance and another update be given to the Budget Committee in April or May 2003. Commissioner Parker asked if the Board of Directors is aware of these problems. Ms. Garcia said the Board is aware. Commissioner Parker said that when there are problematic contracts before the Budget Committee there should be a Board member present. Commissioner Sanchez echoed this, particularly since it was a former Board member who originally brought some of these allegations forward. The Board members are the people finally accountable. Commissioner Parker requested a written correspondence from the President of the Board within 90 days stating that they are aware of the problems and on top of the situation. Action Taken: The Commission accepted the contract update and directed that monthly reports be submitted to the DPH CFO, a status report be presented to the Budget Committee in April or May 2003, and the Walden House Board of Directors acknowledge in writing their oversight of this situation. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. State Budget Overview On January 10th, Governor Gray Davis presented his outline for bridging a $34.6 billion State spending gap for fiscal years 2002-03 and 2003-04. In addition to the $10.2 billion in mid-year reductions he proposed in December, the Governor’s plan includes $11.8 billion in program reductions, $8 billion in state-local realignment, and $1.7 billion in loans. The proposal that has the most significant impact on local jurisdictions is the elimination of the backfill for vehicle license fees for non-realigned programs, which reduces reimbursement to cities and counties by approximately $1.3 billion this year and $2.9 billion in 2003-04. There are a number of items in the proposed budget that, if passed, would specifically impact revenues at DPH. The two proposals that would have the most significant impact are a proposal to create a new realignment program and proposed changes to Medi-Cal. The total impact of the Governor’s budget on DPH is impossible to calculate. However, if adopted, the Governor’s proposed budget would reduce revenues to DPH by at least $11.4 million per year. This assumes that the proposed realignment program would provide at least $73 million per year for DPH alone to fund the existing cost of the realigned services. Thus, to the extent that Realignment II revenues fall short, the revenue loss to DPH increases. In addition, the Governor’s budget would increase the number of uninsured San Franciscans by 5,900, thus increasing the amount of unreimbursed medical care DPH provides. “Realignment II” The budget proposes significant changes to funding for certain health services through a new “Realignment II” program. Realignment II would dedicate revenues from three new taxes (a $1.10 cigarette tax, $.01 sales tax, and an income tax on high wage earners) to fund the following programs at their current level: 15% Medi-Cal Share of Cost All of Medi-Cal Long Term Care Some mental health services (AB 34/2034 and Children's System of Care) Alcohol and Drug Programs (Drug Medi-Cal, drug court, Prop 36, and "non-Medi-Cal alcohol and other drug services) A new "Healthy Communities" realignment (which includes Adolescent Family Life Program, Black Infant Health Program, Indian Health Program, Local Health Department MCH Program, Expanded Access to Primary Care, Grants-in-Aid for Clinics Program, Rural Health Services Development Program, Seasonal Agricultural and Migratory Workers Program, County Health Managed Care Program, California Health Care for Indigents Program, Rural Health Services Program, Public Health Subvention) Increased county share of various programs currently in realignment, including assumption of 100% of non-federal share of IHSS Court Security The first five of these items directly impact DPH. DPH currently receives approximately $73 million for the portion of these realigned services that it provides and would, therefore, need the realignment formula to yield at least this amount just for DPH. Medi-Cal In addition to the portions of Realignment II that pertain to Medi-Cal, there are a number of other Medi-Cal proposals that will reduce enrollment, reimbursement and the scope of services under the program. Eligibility The following proposals related to Medi-Cal eligibility will result in the loss of Medi-Cal coverage for approximately 5,900 San Franciscans who will then be uninsured: Rescission of the 1931(b) Medi-Cal expansion, which would reduce Medi-Cal eligibility for two parent working families from 100 percent of the federal poverty level (FPL) to 75 percent of FPL, eliminating eligibility for approximately 2,900 San Francisco parents. Reinstating Medi-Cal quarterly status reports, which will reduce the number of Medi-Cal beneficiaries in San Francisco by approximately 3,000. As the City’s primary safety net provider, an increase in the number of uninsured San Franciscans would result in an increase in uncompensated care for DPH. Reimbursement The Governor’s budget proposals also reduce reimbursement for Medi-Cal services. It is estimated that the following proposals would reduce revenues to DPH by approximately $10.9 million per year: Five percent provider rate reduction in addition to the 10 percent rate reduction proposed in December, for a total provider rate reduction of 15 percent. It is estimated that this will result in a loss of $10.5 million per year for DPH. Ten percent rate reduction to mental health managed care, which would result in a loss of approximately $375,000 per year for DPH. Rescission of the Aged and Disabled Expansion Program, which extends Medi-Cal with no share of cost to the aged and disabled with incomes up to 133 percent of FPL. Rescinding the expansion would result in a Medi-Cal share of cost for the aged and disabled with incomes above the SSI/SSP benefit level of approximately $750 per month. However, it is likely that because these beneficiaries are very low income, they will be unable to pay their share of cost and DPH will provide services without this reimbursement. Scope of Services The Governor proposes to eliminate 18 optional Medi-Cal benefits, some of which are provided by DPH. It is estimated that limiting the scope of Medi-Cal eligible services will result in reduced revenues to DPH of approximately $500,000. Next Steps To address current mid-year reductions, the Assembly has proposed raising the vehicle license fees to previous levels and adopting about one-half of the proposed mid-year reductions. At this time, the Legislature has indicated that it will not consider mid-year cuts in Medi-Cal eligibility, provider rates or optional benefits. The Legislature will continue to debate the budget shortfall in the coming months. It is likely that no significant budget action will be taken prior to the Governor’s release of the May Revision of his budget proposal, which will include more accurate figures related to income tax revenues. Also significantly impacting the Legislature’s debates will be the Legislative Analyst’s report that the budget deficit is $3 billion to $8 billion less than the Governor’s estimate. DPH will continue to monitor the State budget debates closely. Party and Play Study The HIV Prevention Planning Council, Research Committee and the HIV Prevention Section will host a community forum at Davies Medical Center February 4th at 6:30 p.m. to present descriptive findings from the Party and Play Study. The Party and Play Study is the first study to assess HIV prevalence and risk behaviors, substance use, and HIV prevention and care service use among a group of men who have sex with men recruited exclusively between the hours of midnight and 4:00 a.m. in San Francisco. In addition to presenting descriptive results, a Community Report with study findings will also be released at the meeting. Occupational and Environmental Health Section Received an Award The Department of Toxic Substances Control has recognized the DPH Occupational and Environmental Health Section for its exemplary work in pollution prevention. The section was awarded the National Pollution Prevention Week Award for 2002 for its Clean & Green program that aims to reduce the use of toxic chemicals in San Francisco Businesses. Virginia St. Jean, an industrial hygienist with the section, deserves special recognition for the development and her leadership of this new program. Harm Reduction Focus Groups The Foster Care Mental Health Program conducted two private provider focus groups to discuss the implications of the harm reduction policy on conducting psychological assessments with dually diagnosed clients. These meetings provided a forum for psychologists to discuss specific issues related to this topic. The forum also acted as a way to introduce and discuss the harm reduction policy as it related to DPH, DHS and the dependency court. African American Health Summit An African American Health Summit will be held on January 31st and February 1st, 2003. The goal is to reduce health disparities in the African American community through education and training. Ginger Smyly, Cynthia Selmar, Norm Nickens, Mildred Crear and Rita Times have been participating in the planning and will be presenting at the Summit. COMMUNITY HEALTH NETWORK SAN FRANCISCO GENERAL HOSPITAL CREDENTIALS REPORT January 2003 Health Commission - Director of Health Report (From 1/13/03 MEC and 1/14/03 JCC) 1/03 7/02 to 12/02 New Appointments 10 161 Reinstatements 1 Reappointments 30 140 Delinquencies 0 0 Reappointment Denials 0 0 Resigned/Retired 8 79 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Changes in Privileges Additions 1 14 Voluntary Relinquishments 2 19 Proctorship Completed 22 86 Current Statistics - as of 1/1/03 Active Staff 420 Affiliate Professionals (non-physicians) 160 Courtesy Staff 492 Referring Staff 44 Total Members 1116 Applications In Process 25 Applications Withdrawn Month of Jan 2003 1 6 (07/02 to 12/02) SFGH Reappointments in Process Feb. 2003 to May 2003 167 Public Comment L.S. Wilson from the Coalition on Homelessness read a statement directing DPH to reinstitute the study of homeless deaths in San Francisco. Commissioners’ Comments Commissioner Monfredini asked if the Party and Play Study forum is open to the public. Dr. Katz said it is. Commissioner Guy said that there has been a financial earthquake, and harm will be done as a result of the State budget cuts. The Health Commission has its frames of reference-Strategic Plan, resolutions, etc.-to guide it through the budget process. Commissioner Chow asked if the DPH budget that the Health Commission will consider will include State budget cuts. Dr. Katz said that the base budget that will be presented does not include any estimates of state budget impacts. But there will be a five percent contingency that may well be the City’s response to state budget cuts. This contingency might be increased. Commissioner Monfredini asked if the Health Commission would deal with the State budget impacts when they arrive, or will that be left to the Mayor and Board of Supervisors. Dr. Katz said the Mayor and Board of Supervisors would make this decision. Commissioner Parker emphasized the importance of a healthy economy to the success of DPH. The criminal justice system, educational systems and other systems need to step up to the plate and not allow everything from housing to drugs to fall on the steps of the Health Department for providing solutions. Commissioner Sanchez said that not only will the State budget impact our programs, but also the Federal budget has not been finalized. DPH really is in a challenging time and it is important to participate in advocating to State legislators and members of Congress. Special Presentation to Jo Ruffin Commissioner Chow gave special recognition to Jo Ruffin, Director of Community Mental Health Services, and presented her with a certificate. The Health Commission thanked Ms. Ruffin for her many years of service, commitment and dedication. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF JANUARY Commissioner Sanchez presented the Employee Recognition Awards for January. Steven Tierney, Ed.D., Director of HIV Prevention Services. Nominated by James Loyce, Jr., Deputy Director of Health and AIDS Programs. Ana Carcamo, Secretary, Environmental Health Section. Nominated by Richard Lee and Ken Sato, Environmental Health Section. SFGHMC Adult Medical Center Nursing Team: Maribel Amodo, R.N., Margo Dextraze-Cordova, R.N., and Amalia Fyles, R.N., M.S. Nominated by Nancy Parker, R.N., Nurse Manager 6) ELECTION OF PRESIDENT AND VICE PRESIDENT OF THE HEALTH COMMISSION FOR 2003 Commissioner Umekubo nominated Commissioner Chow to serve as President of the Health Commission for a second term. Action Taken: The Commission elected Commissioner Chow to serve as President of the Health Commission for 2003. Commissioner Parker nominated Commissioner Guy to serve as Vice President of the Health Commission for a second term. Action Taken: The Commission elected Commissioner Guy to serve as Vice President of the Health Commission for 2003. 7) ADOLESCENT HEALTH REPORT Iman Nazeeri-Simmons, Adolescent Health Coordinator, presented the Adolescent Health Report. The Adolescent Health Plan is meant to be a guide to the Department of Public Health. The plan focuses on a paradigm shift on how the Department should approach adolescent health. The Adolescent Health Plan was built off the work of DPH’s Strategic Plan. Three main goals: Health needs are identified and addressed Health services are integrated and coordinated Health policies and initiatives are promoted Ms. Nazeeri-Simmons presented demographic data on adolescents and young adults in San Francisco, as well as the latest Youth Risk Behavior Survey data. Youth between 10-24 represent 15 percent of San Francisco’s population. This population is more diverse than the rest of the population. 28 percent of San Francisco students attend private schools, and Asian/Pacific Islander, Latino and African American Youth are over-represented within the San Francisco Unified School District. The San Francisco Youth Risk Behavior Survey data demonstrates that San Francisco youth are dealing with compelling issues. Nearly half of high school students have tried smoking cigarettes. Most students (70%) have not had sexual intercourse. In the 12 months prior to the survey, 14 percent had suicidal ideation; 29 percent reported feeling sad or hopeless. For middle school students, 20% reported suicidal ideation and 60% reported feeling sad or hopeless. The Adolescent Health Plan grew from the California Adolescent Health Collaborative strategic plan. The eight recommendations were developed as a result of a collaborative effort with DPH, DCYF DJP and DHS staff, the school district, Youth Commission, and San Francisco youth advocates. Eight Recommendations for Achieving Adolescent Health Integrate youth development principles and practices into youth programs and services Support families and communities to maximize health and well-being Eliminate racial and ethnic health disparities Ensure the health of vulnerable youth populations, including youth in foster care, youth in the criminal justice system, newcomer youth, lesbian/gay/bisexual/transgendered youth, homeless youth and youth with special needs. Integrate school-based health and public health Ensure that environments where youth live, learn and work are healthy Coordinate adolescent health programs and services Ensure access to and utilization of comprehensive health care services The plan includes specific department program strategies for improving youth health. These strategies were developed collaboratively with program directors and staff. The areas of adolescent health that are addressed are: behavioral health (alcohol, tobacco and other drugs, and mental health); environmental health; injury and violence; nutrition and physical activity; oral health; primary care and sexual health. Next Steps Work with sections to achieve program strategies Evaluate adolescent health program strategies Assess where gaps persist and provide strategic action to address gaps Public Comment Victor Damien is a youth advocate and leader for the Children’s System of Care Youth Task Force. He acknowledged the number of youth in the audience who are youth advocates. He stressed the importance of having youth programs in existence, funding youth programs. Tajel Shah, DCYF, read the Youth Commission’s Public Health Committee’s statement, which expresses support for the plan. On behalf of DCYF, Ms. Shah thanked Ms. Nazeeri-Simmons and Barbara Garcia for developing the plan. DCYF intends to use this plan to help prioritize the use of the Children’s Fund over the next three years, and is anxious to begin implementing the ideas set forth in the report. Sharon Dolan, Health Initiatives for Youth, expressed support and gratitude to DPH for developing this plan, which will be helpful to community agencies in planning their future. Grateful that it includes youth development principles and builds upon work that has already been done. Cloteal Norman, Youth Task Force member, read a poem she wrote titled “My Opportunity.” She said that without youth programs, youth would really get into trouble. Jo Ruffin honored her last week and this would not have happened if she were not in a youth program. Commissioners’ Comments Commissioner Monfredini asked for clarification about whether sexual behavioral was sexual intercourse or sexual activity. Ms. Nazeeri-Simmons said that they only asked about sexual intercourse and they do not have any data on other types of sexual activity. Commissioner Umekubo commented that adolescence is a very difficult stage of life. He is concerned with the statistics about the number of youth who are sad and depressed, and systems really need to be put in place, be it through families or community. He is very happy that the youth came to this meeting, and encouraged the youth leaders to bring as many other youth as possible into their mission to accomplish change. Commissioner Parker said the Commission supports that Adolescent Health Plan because youth are the future. He asked if DPH plays a significant role in addressing issues such as poverty, criminal behavior, etc. or are these just taken as fact. Further, does DPH specify the desired outcomes they want to achieve in the next three years? Ms. Nazeeri-Simmons said that each DPH section has its own data that will be used for evaluation purposes. For example the Adolescent Health Office will work with STD to develop goals for reducing the rates of chlamydia in girls. Commissioner Parker would like DPH to work more closely with schools-both public and private-to outreach to and serve youth. Commissioner Penn agrees that a paradigm shift is needed. Children should not be looked at as problems. Adolescence is a period of great opportunity. He was struck by the theme in the report that youth need to be involved in all aspects of programs and services. The health of young people is impacted at so many different levels and youth should be used to educate older people. We need to get an estimate of the number of homeless youth in San Francisco. The rates of chlamydia and gonorrhea in the African American community are staggering, and he asked what role OAH has in addressing this problem. Ms. Nazeeri-Simmons said that she works with the various service providers and will work with these programs to address specific problems. Commissioner Penn emphasized that this needs to be treated like the emergency that it is. Commissioner Chow asked how the Office of Adolescent Health helps prioritize the strategies laid out in the report. Ms. Nazeeri-Simmons said that the different sections are already implementing many of the strategies. Her role is to work with the programs to provide them various types of information and coordinate efforts, because the program staffs are truly the experts, then to point out where the gaps exist. Commissioner Chow is committed to developing and institutionalizing a process for selecting youth members of the Population Health and Prevention Joint Conference Committee. Commissioner Guy said that the Population Health and Prevention Joint Conference Committee will discuss the specific strategies outlined in the report in more detail over the next year. She and Commissioner Parker have long wanted a formal youth voice on the Health Commission, specifically as members of the Population Health and Prevention Joint Conference Committee. She requested an analysis of the costs associated with extending the Healthy Families programs to youth up to age 24. Commissioner Sanchez commended staff for an exceptional report. It is critical to look at the quality of the school sites, that they are safe and healthy. 8) HEALTHCARE ACCOUNTABILITY ORDINANCE UPDATE Anne Kronenberg, Director of Policy and Planning, along with Frances Culp, DPH, and Jean Frasier, Executive Director of the San Francisco Health Plan, presented an update on the Healthcare Accountability Ordinance. The Healthcare Accountability Ordinance mandates that City and County of San Francisco contractors provide health care coverage for their employees. Contractors have three options to meet this mandate: 1) offer health plan benefits at no cost to the covered employees; 2) make payments of $1.50 per employee per hour to DPH; 3) participate in a health benefits program developed by DPH. This presentation is focused on DPH’s analysis of the feasibility and economic viability of creating a purchasing pool to meet the third option. Based on preliminary findings DPH has determined that it is not economically viable to create a local purchasing pool or public health plan. However, the landscape has changed and new legislation, AB 2178, has become effective on the statewide level that expands the opportunity for employers to meet the mandate of HCAO through Option 1. This opportunity is through PacAdvantage, the California small business health insurance pool. PacAdvantage is considered a model for health care pools nationwide. The impact of the new legislation on San Francisco businesses are: more employers can join PacAdvantage and provide coverage for their employees regardless of business size; includes part-time employees working 20 hours or more per week; businesses can now comply with HCAO through a private health plan. To determine the interest in a local purchasing pool, DPH and the Office of Contract Administration conducted a survey of 1,400 contractors. Twenty four percent of the surveys were returned. Of those returned, 62 percent said they were not interested in this option. Reasons why local pool is not economically viable as compared to commercial insurance Administration cost is higher for the small number of HCAO-covered employers Cost of care would either be the same or higher-utilization would be the same or higher and rates paid to providers would be the same as commercial because a small pool will not have leverage Higher administration plus higher cost of care equals a HCAO pool would cost more than existing insurance. Conclusions Employers can now meet the needs of their employees and the requirements of HCAO without creating a local purchasing pool. DPH will continue efforts to find insurance options in San Francisco for hard-to-cover employees, specifically those working 15 to 20 hours per week. Commissioners’ Comments Commissioner Guy supports the direction, and asked how this decision gets communicated to the Board of Supervisors. Further, what are the options for insuring people who work 15-20 hours per week. Ms. Kronenberg said that this would be a challenge, though luckily the number of people working 15-20 hours is not large. The report will be shared with the Board of Supervisors. Commissioner Penn asked if there is an estimate on the number of DPH contractors that would qualify for a local pool. Dr. Katz said that 95 percent of DPH contractors prior to the ordinance offered health insurance to their employees. Commissioner Penn asked if the PacAdvantage program offers similar benefits as other insurance providers. Ms. Frasier said PacAdvantage has three options, and they either exceed or meet the minimum standards developed by the Health Commission. Commissioner Umekubo asked how many employers citywide are not providing healthcare. Ms. Kronenberg said DPH does not have this information but will have a better idea when contracts are renewed. He asked how employers find out about PacAdvantage. Ms. Frasier said PacAdvantage is well known to insurance brokers, which is the primary way they become known to employers. Most small employers use brokers. Ms. Kronenberg said that DPH will work with Office of Contract Administration and PacAdvantage to sent a letter to all contractors in the city. 9) PRESENTATION OF THE SAN FRANCISCO GENERAL HOSPITAL REBUILD/INSTITUTIONAL MASTER PLAN (IMP) STATUS REPORT Anthony Wagner, CEO, Hospital Systems, gave a San Francisco General Hospital Medical Center Rebuild Update (Attachment A). Commissioners’ Comments Commissioner Monfredini supports the direction outlined in the report. She continues to advocate for the opportunity for all the health systems and hospitals in San Francisco to have the ability to do joint planning. Commissioner Penn asked if the issue of land availability has been assessed and addressed. Mr. Wagner said that land is available. UCSF currently does not own enough land for a new hospital, but they are in discussions with one of the landowners. DPH does not own any land in Mission Bay. Dr. Katz added that the existing redevelopment plan for the area would almost certainly need to be amended. Commissioner Penn encouraged the planning process to fully explore with equal priority the various options. Commissioner Penn asked if the reason UCSF has not come to the table sooner is a reflection of their being under a different timetable or the fact that they might not value the relationship with DPH. He wants to make sure that we are not pursing options that UCSF does not fully embrace. Mr. Wagner said that the fact that UCSF is willing to share the cost of the consultant contract to evaluate co-location demonstrates a level of commitment. Commissioner Guy said that this additional planning time allows DPH to do more ambulatory care planning in follow up to the Lewin Report recommendations. 10) PUBLIC COMMENTS None. 11) ADJOURNMENT The meeting was adjourned at 6:45 p.m. Michele M. Olson, Executive Secretary to the Health Commission