Minutes of the Health Commission Meeting Tuesday, March 18, 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 Commissioner Chow at 3:05 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. - arrived at 3:15 p.m. Commissioner John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE MEETING OF MARCH 4, 2003 Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Penn, Umekubo) approved the minutes of the March 4, 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) CHN/San Francisco General Hospital - Request for approval of a contract renewal with Pharmaceutical Care Network, in the amount of $2,700,000, for pharmacy benefits management services targeting CHN indigent clients, for the period of April 1, 2003 to June 30, 2003. (3.2) PHP-Behavioral Health Services - Request for approval of a contract renewal with Med-Impact Healthcare Systems, Inc., in the amount of $2,809,848 per year, for a total contract amount of $6,322,158, to provide pharmacy benefits management services targeting indigent consumers of mental health treatment services, for the period of April 1, 2002 through June 30, 2005. (3.3) PHP-Behavioral Health Services - Request for approval of two new retroactive contracts with Mount Saint Joseph-Saint Elizabeth and Fred Finch Youth Center, in the total amount of $1,995,786, to provide day treatment intensive services, medication support and mental health services for youth ages 12 through 19, for the period of February 15, 2003 through June 30, 2005. (3.4) PHP-Behavioral Health Services - Request for approval of a retroactive contract renewal with St. Mary’s Medical Center, for the provision of acute psychiatric inpatient hospital services, in the amount of (1) $170,000 in City funds targeting uninsured adolescents, and (2) $4,000,000 in Medi-Cal funds for four hospital providers targeting Medi-Cal beneficiaries, for the period of July 1, 2002 through June 30, 2003. (3.5) PHP-Behavioral Health Services - Request for approval of a retroactive contract renewal with Mt. Diablo Medical Pavilion for the provision of 24-hour acute psychiatric inpatient hospital services, in the amount of (1) $100,000 in City funds targeting uninsured children and adolescents, and (2) $4,000,000 in Medi-Cal funds for four hospital providers targeting adult Medi-Cal beneficiaries, for the period of July 1, 2002 through June 30, 2003. (3.6) PHP-Behavioral Health Services - Request for approval of a retroactive contract renewal with Saint Francis Memorial Hospital for the provision of 24-hour acute psychiatric inpatient hospital services in the amount of (1) $50,000 in City funds targeting uninsured adults, and (2) $4,000,000 in Medi-Cal funds for four hospital providers targeting adult Medi-Cal beneficiaries, for the period of July 1, 2002 through June 30, 2003. (3.7) PHP-AIDS Office - Request for approval of a retroactive contract renewal with Public Health Foundation Enterprises, Inc., in the amount of $745,649, to provide HIV research services targeting high-risk men, for the period of July, 1, 2002 through June 30, 2003. Commissioners’ Comments Commissioner Penn requested a report to the Population Health and Prevention Joint Conference Committee in order to get an update on the study results. Grant Colfax, Director of HIV Prevention Studies, said they should have results January 2004 and he will work with the Health Commission Office to schedule a report to the JCC. (3.8) PHP-AIDS Office - Request for retroactive approval of a new contract with Centerforce, Inc., in the amount of $112,373, to provide HIV prevention services including an expanded public information campaign and program enhancement services targeting incarcerated and post-release populations at San Quentin State Prison and Central California Women’s Facility, for the period of January 1, 2003 through September 30, 2003. (3.9) PHP-AIDS Office - Request for approval of a retroactive contract renewal with Glide Foundation, in the amount of $572,620, to provide HIV prevention services targeting defined behavioral risk populations, for the period of January 1, 2003 through December 31, 2004. Commissioners’ Comments Commissioner Monfredini requested a six-month update to the Population Health and Prevention Joint Conference Committee to see that the agency’s improvements continue. (3.10) PHP-AIDS Office - Request for approval of a retroactive contract renewal with Mission Neighborhood Health Center, in the amount of $142,702, to provide HIV prevention services targeting defined behavioral risk populations, for the period of January 1, 2003 through December 31, 2003. (3.11) PHP-AIDS Office - Request for approval of a retroactive contract renewal with UCSF/Urban Health Study, in the amount of $545,518, to provide HIV prevention services targeting defined behavioral risk populations, for the period of January 1, 2003 through December 31, 2003. (3.12) PHP-AIDS Office - Request for retroactive approval of a two-year contract renewal with Instituto Familiar de la Raza, in the amount of $380,144 per year, for a total contract amount of $760,288, to provide HIV prevention services targeting Latino behavioral risk populations, for the period of January 1, 2003 through December 31, 2004. (3.13) PHP-AIDS Office - Request for approval of a retroactive contract renewal with St. James Infirmary, in the amount of $96,262, to provide HIV prevention services targeting behavioral risk populations, for the period of January 1, 2003 through December 31, 2003. (3.14) PHP-AIDS Office - Request for approval to retroactively accept and expend a grant from the National Institute on Drug Abuse, in the amount of $830,615, for “Club-Drugs and HIV Risk Behavior in High-Risk Men”, for the period of March 1, 2003 to February 28, 2008. Mr. Colfax stated that the amount of the contract is $830,516, not $830,615 as stated on the agenda. (3.15) PHP-AIDS Office - Request for approval to accept and expend retroactively subcontract funds from the University of California, San Francisco, in the amount of $93,523, for “University Technical Assistance Projects in Support of the Global AIDS Programs” for the period of January 1, 2003 to September 29, 2003. Action Taken: The Commission approved the Budget Committee Consent Calendar, with Commissioner Umekubo abstaining on Items 3.4 and 3.6 and Commissioner Sanchez abstaining on Items 3.11 and 3.15. The Commission asked for the following follow up reports: Item 3.7, Public Health Foundation Enterprises, to provide a follow-up report, at the appropriate time, to the Population Health and Prevention Joint Conference Committee; and Item 3.9, Glide Foundation, to provide a follow-up report to the Population Health and Prevention Joint Conference Committee in six months. In addition, the amount of the contract for Item 3.14should correctly read $830,516. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, submitted the Director’s Report to the Commissioners for their review. In order to begin the budget public hearing, questions about the report were held until after the budget hearing. Severe Acute Respiratory Syndrome In response to reports of increasing number of cases of an atypical pneumonia that the World Health Organization has called "Severe Acute Respiratory Syndrome" or SARS, the Centers for Disease Control and Prevention issued an alert over the weekend to US health authorities, including San Francisco Department of Public Health. SARS appears to have originated in Viet Nam, Hong Kong and parts of China. Symptoms include high fever and difficulty breathing. Because of the loose clinical definition of the syndrome, many possible cases of SARS have been identified in the US, but no confirmed cases have been identified to date in the United States. Yesterday, Dr. Susan Fernyak, Director of Community Health Epidemiology and Disease Control, held a press briefing with local media to report on the Department's response and activities. A special Health Alert is being sent to all San Francisco Emergency Departments and hospital and infection control staff and practicing clinicians. We will make more information available as we learn about this emerging infection. Ryan White Care Act Title I Award The HIV Health Services Section of the AIDS Office received unexpectedly good news last week. The Ryan White CARE Act Title I award for FY 2003 was $33,941,235, an increase of $379,765 or 1.1% over last year's award. The funding is for HIV health services in the San Francisco Eligible Metropolitan Area, consisting of San Francisco, San Mateo, and Marin Counties for the 2003 fiscal year which began March 1st. The grant includes $529,951 for Minority AIDS Initiative programs. San Francisco had anticipated a decrease in funding for this year and had planned to cut some services for people living with HIV/AIDS, but will now be able to continue to support the essential DPH and community-based programs funded through Title I. The increase reflects a highly competitive grant written by Laura Thomas with help from other AIDS Office staff, especially Christopher Gortner, Dean Goodwin, and Suzanne Wang. HIPAA (Health Insurance Portability and Accountability Act) The Federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that by April 14, 2003 the privacy provisions in the Act be implemented and that all personnel who produce, transcribe, store, transmit, or otherwise have access to protected health information receive training in implementing the privacy provisions. Also, as part of the privacy provisions, DPH will issue a standardized Summary and detail Notice of HIPAA Privacy Practices (two documents). These documents must be given to all DPH clients and patients including those seen by contract providers beginning April 14th. A series of trainings on the privacy policy and Notice have been scheduled between March 25 and April 10. The training will be a “Train the Trainer” model. Section managers and contractors are asked to send a representative to the training who can then go back and train their own staff. Training materials will be made available upon request. Registration is not required for attendance. The trainings will be held at 101 Grove Street, Room 300 on the following dates: March 25 Tuesday, 2:30 to 4:00 pm   27 Thursday, 1:30 to 3:00 pm   28 Friday, 10:30 am to noon April 3 Thursday, 3:30 to 5:00 pm   9 Wednesday, 9:30 to 11:00 am   10 Thursday, 2:30 to 4:00 pm Questions regarding the trainings can be directed to Carolyn Lieber at 255-3470 or Michele Friedman at 255-3482. Medication Adherence Pilot CBHS Quality Management has completed a full year evaluation of an Eli Lilly funded medication adherence pilot based at Westside Community Mental Health Clinic. A cohort of twenty-six medication non-compliant clients were enrolled in the pilot beginning in the Fall of 2001. The results thus far are promising. Eighty percent of clients have been retained in the program; the overall mean adherence to medications exceeded 90%; acute service use has declined by 60 to 90%; client functioning has shown distinct improvement and client satisfaction with the program is very high. The pilot has another six months before completion. National Public Health Week Activities DPH will observe National Public Health Week April 7 - 11. The theme this year is “Getting in Shape for the Future; Healthy Eating and Active Living”. Planned activities include two Brown Bag Lunch presentations, one by Laura Brainin-Rodriguez entitled “The Heart of the Matter” discussing what leads to heart disease and the role of nutrition in protecting against or contributing to health disease. The second Brown Bag Lunch, April 11th, will be a presentation by Fernando Ona of the Environmental Health section. He will present concepts of Food Security and Food Systems and the role of Environmental Health in protecting Food Security. Both Brown Bag lunches will be at 101 Grove Street, Room 300 at 12:00 noon. In addition, there will be a participatory demonstration/introduction to the Tai Chi in the Park Program in the Civic Center on Wednesday April 2nd. There will also be a web page featuring a complete list of DPH Public Health Week activities and web links to nutrition and physical activity resources. San Francisco Food System Council The San Francisco Food System Council is hosting a citywide conference on March 31st at The State Building, 455 Golden Gate Ave., San Francisco, from 8:30 am to 3:00 pm. A continental breakfast and lunch will be served. Admission is free of charge. This conference has been organized to share information, promote ideas and give input on policies concerning the local food system. Our agenda will include breakout session and panelist addressing the following topics: Direct Marketing (How to start a CSA and expanding farmers' markets)  Food Policy (SF County Food Policy) Community Food Assessment Workshop (How to do a Food Assessment) Funding Food Projects Catherine Sneed, Executive Director of The Garden Project is the keynote speaker and Supervisor Sophie Maxwell will address the audience regarding her resolution on the multi-disciplinary task force on childhood nutrition. For registration information and a copy of the agenda, please contact Karlene (Nita) Hines, Food Alliance Coordinator at 415-252-3952 or email at karlene.hines@sfdph.org. COMMUNITY HEALTH NETWORK SAN FRANCISCO GENERAL HOSPITAL CREDENTIALS REPORT March 2003 Health Commission - Director of Health Report (From 3/10/03 MEC and 3/13/03 JCC)   3/03 7/02 to 2/03 New Appointments 08 171   Reinstatements 1 Reappointments 42 214   Delinquencies 0 0   Reappointment Denials 0 0 Resigned/Retired 7 98 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Changes in Privileges   Additions 3 20   Voluntary Relinquishments 3 20   Proctorship Completed 15 122 Current Statistics - as of 1/1/03 Active Staff 425 Affiliate Professionals (non-physicians) 157 Courtesy Staff 490 Referring Staff 44 Total Members 1116 Applications In Process 31 Applications Withdrawn Month of Jan 2003 1 12(07/02 to 2/03) SFGH Reappointments in Process Apr. 2003 to Jul. 2003 128 5) PRESENTATION OF THE FY 2003-04 CONTINGENCY BUDGET REDUCTION PROPOSAL Dr. Mitch Katz, Director of Health, gave an overview of the proposed FY 2003-2004 Contingency Plan. DPH is currently being asked by the Mayor to produce a contingency cut of $40 million or 15 percent of its General Fund. This is in addition to the base cut of $18 million dollars that has already been forwarded to the Mayor’s Office. The Department has developed a plan that produces a $16 million General Fund reduction toward the target of $40 million. Staff was unable to avoid reductions to community care and prevention, which are integral to the Strategic Plan. The impact of the cuts is difficult to assess because the unprecedented reductions to the public health system are compounded by similar reductions in the Department of Human Services, Department of Aging and Department of Children Youth and Their Families. The Department will prepare additional contingencies of up to $24 million. Reductions will be taken if there are insufficient revenues in the city or if labor concessions cannot be negotiated. The ten areas identified for reductions are: Consolidate community care primary clinics ($8.6 million and 128.83 FTEs) Reduce Mental Health services - day treatment, mental health residential care and closure of the OMI Family Center ($3 million and 13 FTEs) Eliminate eight Substance Abuse programs ($1.1 million) Reduce Community Health and Prevention - AACHIE and HERC by 50 percent and NICOS by 100 percent ($0.6 million and 2 FTEs) Reduce HIV Prevention ($1 million) Reduce HIV Health Services ($0.3 million) Reduce HIV Administration ($0.6 million and 7.5 FTEs) Reduce Employee Assistance Program ($0.1 million and 2 FTEs) Eliminate DPH administrative positions ($0.4 million and 5 FTEs) Reduce Health at Home Services ($0.4 million and 5.8 FTEs) Public Comment Jane Gainer, program coordinator, AACHIE, is opposed to cuts to the program. Jesse Mejia spoke in support of the Health Realization program. Arthur Payer spoke in opposition to cuts in Chinatown Mental Health. Steven Fields, executive director, Progress Foundation, opposed to cuts in senior residential treatment program. Howard Friedlander, Assistant Director, Progress Foundation, urged the Commission not to cut their program. Karla Thurston spoke in support of the Bayview Clubhouse. Save the services. Betty McGee, HERC, said the proposed cuts disproportionately affect the African American community. Ben Eiland, Haight Ashbury Free Clinic, spoke in support of the Glide substance abuse program. Sharon, Green-Peace, is opposed to cuts in the HERC program. Richard Gee, Drug Abuse Advisory Board is opposed to cuts to advisory board. He submitted written copy of his testimony (on file). Bonita, a patient at Tom Waddell Clinic, opposed to cuts. Marcia Sims, Institute for Community Health Outreach, spoke in opposition to cuts in HERC funding. Karen Ho, NICOS Chinese Health Coalition, asked the Commission to preserve Chinatown Mental Health services, the Chinatown North Beach Public Health Center and the anti-gambling programs. Reiko Fujiwara, spoke against the cuts in service at the Ocean Park Health Center. Peg Hickox, Director of OMI Family Center, is opposed to closing the program, which serves 500 people in an area of the city that does not have many services. Gloria Frush-Frederico, OMI Family Center Urgent Care Team, spoke in support of the OMI Family Center. Dr. Joe Cambi, OMI Family Center, spoke in support of the center. Hal Young spoke in support of the OMI Family Center. These programs need to be where children and families reside. Isa Hershoff-Looper, therapist at OMI Family Center, spoke in support of the center. Please let them continue to provide these critical services. Martha Ryan, Director of the Homeless Prenatal Program, urged the Commission not to make any more cuts in public health. Ask the Mayor to go elsewhere to find his cuts. Carla Roberts, Homeless Prenatal Program, is opposed to the drastic cuts in outpatient treatment slots. Methadone works but different people need different services. Rita Walsh said the reduction of services at Tom Waddell would be disastrous and cost more money in the long run than it will save now. Guadalupe Valenzuela, Homeless Prenatal Program, asked the Commission not to cut health programs. Judy Crawford, Homeless Prenatal Program, spoke against cuts to all public health programs. Falechia Harris, Homeless Prenatal Program, urged Commission to not cut public health programs. Mattie Scott, spoke in support of Maxine Hall Health Center, HERC and AACHIE. This center is the only place people can go in the Western Addition. Dominic Chan, Local 250, said that if these cuts go through, San Francisco would be no different from any other city. The cuts pit communities against each other. Paul Wagner is opposed to cuts in the Bayview Clubhouse. Rita Shimmin, Associate Director at Glide Memorial Church, said the City has to look at different areas for cuts. These budget cuts will result in costs in other areas. Terrence Baxter, Environmental Health worker at HERC, said HERC needs more funds, and should not be cut in half. African Americans disproportionately affected by prostate cancer. Wattie Sanders, volunteer with the HERC program, said many African Americans have cancer but no health plan, and encouraged the Commission not to cut the program. Andrew Hayes, outreach worker at Tom Waddell Health Center, said there needs to be humane specialized outreach on the streets. Rick Bennett said the HERC program is critical to life and death in Bayview Hunters Point. Do not cut HERC. Monette Mabry urged Commission not to cut HERC. Program has helped her with her son, who has asthma. Jonathan Vernick, Baker Places, said that the trend appears to be maintaining institutional programs at the expense of community programs, and this needs to be carefully examined. Kwok Chan, spoke in support of the Chinatown Health Center. Caral Cheung urged the Commission to keep the Chinatown Public Health Center open. Scottie Kenyon spoke in support of the OMI Family Center. Please tell the Mayor to make the cuts someplace else. Jin Kuang spoke in support of the Chinatown Public Health Center, which needs to be open more than two days a week. Yuk Chan said that the public health nurse from Chinatown Public Health Center has taught her to control her diabetes. Without these services she would need to go to the hospital. Gene Wong, volunteer for North of Market Senior Center, spoke against cuts in services for Tenderloin homeless services. Gay Kaplan, spoke on behalf of Gene Wong and Jack Casford, in support of the North of Market Senior Center. The proposed cuts would be devastating for seniors. James Rouskou spoke in support of acupuncture services. Reverend Kay Jorgensen spoke in support of the Tom Waddell Health Center. Caroline Hughes spoke in support of the Tom Waddell Health Center. Mr. Zhou spoke in support of the Chinatown Public Health Center, where he receives treatment and education for his diabetes. Do not cut the services. Kam Leung spoke in support of Chinatown Public Health Center. The location of the health center allows her to work and maintain her health. Edward Garza spoke in support of the Castro Mission Health Center. Marjorie Anne Williams, spoke against the proposed cuts. Evelyn Raglin spoke against cuts in substance abuse services. Keep all of the centers open. Kym Valadez, Swords to Plowshares, said the veterans they serve use the public health programs that are proposed to be cut. Barbara Farrell, Ohlhoff Recovery Program, is opposed to cuts in the contingency plan, which cuts services to the most vulnerable in the community. Eve Meyer, San Francisco Suicide Prevention, who is also speaking for Karen Patterson Matthews of the Bayview Hunters Point Foundation. Ask the Mayor to make decisions that do not lead to people’s suffering, as these cuts will. Ruthie Houston spoke in support of Maxine Hall Health Center. Verlita De Parine spoke in favor of the importance of transgender services at Tom Waddell Clinic. Jim Buckley from the Castro-Mission CAB submitted 150 signatures in favor of keeping health centers open. Pamela Gaddies spoke in favor of maintaining HERC and AACHIE programs, and making sure that programs for African-Americans continue. Kimberly Thornton spoke against making cuts to the nationally recognized transgender services. Agnes Morton, former public health nurse speaking against cuts in prevention, the AACHIE program, and the Ocean Park Health Center. Michael Bartolomie spoke about the benefit he received from the Bayview clubhouse. Roger Kat spoke about the need for more money in our system. Indy Turan spoke against cuts in case management at the Tom Waddell Clinic. Elliot Wagner, Director of Acupuncture Clinic at Tom Waddell Health Center, spoke in support of the acupuncture program. It is the only alternative medicine clinic for homeless people in San Francisco. Mario Robles, spoke against the cuts at Tom Waddell Clinic. Angela Chu spoke against cuts at the Chinatown Public Health Center Henry Sikorski spoke against cuts at the Chinatown Public Health Center. Bill Schwalb, SFUSD substitute teacher, spoke in support of the Castro Mission Health Center. Linda Zaretsky spoke in support of the Bayview Clubhouse. Tell the Mayor to find cuts elsewhere. Leslie Will said that people voted for the MHRF as it is-as a hospital-and not how it is proposed to be-a board and care home. Mark Ellinger spoke against cuts at Tom Waddell Clinic. Do not cut the public health budget. Yuliya Kogan spoke against cuts at the Ocean Park Health Center. It is the only clinic available for Russian speaking San Franciscans. Sasha Mosalov, Sunset Russian Tobacco Education Project, spoke in support of the program and the Ocean Park Health Center. Anatoliy Boubuov spoke in support of the Ocean Park Health Center. Do not cut. Gloria Peterson, Chinatown Public Health Center, asked the Commission not to make these draconian cuts. Rich Liu spoke in support of the Chinatown Public Health Center. Ali Weinhouse, Lincoln High School teacher, said Ocean Park Health Center is the only health center in the Sunset. The access is already very limited. Do not cut back health services. Edward Hatter, Program Coordinator, Potrero Hill Neighborhood House, is opposed to the ZAP cuts. Margie Peterson said health is so important to people and should not be cut. Dr. Meg Schwarzman, SFGH and Potrero Hill Health Center, said it is shortsighted to reduce outpatient services in the clinics. Patients health will be jeopardized. Marie Kempke, speaking on behalf of Linda Civitello-Joy from the American Lung Association, urged the Commission not to cut primary care. She submitted a written copy of her testimony (on file). Tim Winkler stated that the city wasted millions of dollars, and now healthcare is suffering. Monika Ramos spoke against cuts at Tom Waddell Clinic. Norma Hotaling, Executive Director, SAGE, said people are crying and desperate for health services. The infrastructure will not be able to be rebuilt. Julie Kavanagh, Silver Avenue Family Health Center, spoke against the public health cuts. Urged the Health Commission to take the lead and oppose these cuts. Kim Low spoke on behalf of the Tom Waddell Acupuncture Clinic. The cuts will impact communities, families, children and lives. Geri O’Shea-Miller, Health at Home, spoke in oppositions to the cuts, which will result in patients staying at SFGH longer. Louanne Lee, school district nurse, asked the Commission to consider the impact these cuts will have on the community. Richard Whitlock spoke in support of the Tom Waddell Acupuncture Program, which has helped him immensely. Randall Kalal said everyone should be asked to share the burden of the cuts, not just the poor. Debbi Lerman, San Francisco Human Services Network, said cuts will be a devastating blow to the safety net in San Francisco. Non-profit agencies cannot backfill these cuts. Programs, and agencies, will close as a result of the cuts. Melvin Beetle, Board of Directors, Senior Action Network, said the budget cuts will be devastating to seniors. Tell the mayor this is not the way to go. Vickie Johnson, Tenderloin Housing Clinic, said Tom Waddell provides services to the Mission Hotel for residents who cannot get to a clinic. Tom Waddell provides these services to a number of other locations. Do not cut the services. Dee Epps-Miller spoke in support of the HERC and AACHIE programs, which are important community interventions. Also asked the Commission to keep the health centers intact. Finally, public health is public safety. Jane Hannigan spoke in support of the Tom Waddell Health Clinic, which provides astounding services. Carlos Gonzalez spoke against cuts to the Castro Mission Health Center. Please consider all possibilities before making these cuts. Herman Taft, Central City Hospitality House, spoke against all public health cuts. The need for these services has not gone away, so cutting the programs is not going to work. Tell the Mayor to cut somewhere else. Iris Biblowitz, nurse at Tom Waddell Clinic, is opposed to the budget cuts that will lead to a terrible public health crisis. Now is the time when we need a highly functioning public health system. Richard Heasley, Executive Director, Conard House and Mental Health Contractors Association. The cuts are unconscionable and unnecessary. There are other places to make cuts. Find another way. Larry Bevan, South of Market Mental Health and SEIU 250, said the cuts are pennywise and pound foolish. Reject these inhumane cuts and tell the Mayor to raise revenues, not cut services. Martha Hawthorne, nurse at Castro Mission Health Center, said the cuts will destroy the health centers and destroy public health. There is already a two-month wait for new patients. Please vote against the cuts. Michael Lyon is opposed to the cuts. James Moss urged the Commission not to cut services. Barbara Rothkrug, Public Health Nurse, Castro Mission Health Center, urged the Commission to say no to all the cuts; none are acceptable. Day treatment services are critical. Red Jordan Arobateau spoke in support of the Tom Waddell Clinic. The proposed cuts are outrageous and should not be made on the most vulnerable members of society. Take the cuts from the top. Dr. Katie Olson, Southeast Health Center, said it is already difficult for patients to get appointments. The decrease in services would have a terrible effect. Ed Kinchley said the cuts being proposed represent an abandonment of commitment to public health. They need to be rejected. Kim Tavaglione, Local 250, said the health centers are the first line of disease and should not be cut. Maria Porch, Tom Waddell Clinic, spoke in support of the health centers. She also submitted written testimony (on file). Dr. Paul Quick spoke against the budget cuts. It is demeaning for people to have to plead for these services. There are other areas where the cuts could be made. Commissioners’ Comments Commissioner Umekubo asked for a status of the Vehicle License Fee issue. Dr. Katz said that if the Vehicle License Fee were approved the deficit would be reduced from $143 million to $68 million. The deficit is a moving target. Commissioner Umekubo said that primary care is the foundation of health care and to reduce these services would be a huge step backwards. The entire city would suffer. He feels strongly that he cannot support this proposal. Commissioner Monfredini asked what the other departments are sacrificing. Dr. Katz said that all departments’ targets are the same, except for those that have voter-mandated services, such as the Police Department. Recreation and Park has the most developed proposal, after the Health Department. The Fire Department is proposing to close firehouses, but wants a blue ribbon panel to select which fire houses. Commissioner Monfredini said that everything the Health Department has built up would be destroyed by this proposal. Commissioner Parker said he could not support the contingency budget. None of DPH’s programs should be reduced or eliminated. Since the contingency plan would devastate the safety net, the Board of Supervisors and Mayor should declare a state of emergency. Commissioner Sanchez said this would dismantle a world-class health system that has taken 40 years to develop. The Department’s Strategic Plan will be meaningless because we will be unable to implement any programs or provide basic services. This is unacceptable. Commissioner Penn suggested that the Mayor and Board of Supervisors be invited to the next meeting to have a dialogue on the budget. Otherwise the public testimony and commission deliberations are done in a vacuum. He also thinks the Department should look at its salary structure. Commissioner Chow said that the budget information needs to be disseminated widely to the public. He also stated that the Commission does need to clarify the best methodology for communicating the devastating impacts to the Mayor and Board of Supervisors. This proposal is not just detrimental to the health services that have been developed over the past years, but it destroys them. DPH’s priorities were to move toward community-based care, toward integrating behavioral health, and enhancing primary care services. This needs to be expressed to the Board of Supervisors and Mayor. These issues can be addressed through a resolution, which can be developed over the next few weeks. There needs to be a dialogue about all revenue opportunities. The City needs to address this crisis together. Commissioner Guy said that the City cannot survive this budget crisis through cuts only. More revenue is needed. The impacts of these proposals need to be transparent to everyone-employees, the public, the Mayor, Board of Supervisors. Over the past number of years the health system in San Francisco has incrementally improved. This is being threatened by the proposed budget cuts. We need an improved tax base in San Francisco. The community needs to continue to fight for universal health care. 6) PUBLIC COMMENTS Nsoah Chionesu spoke against the elimination of acupuncture services at Bayview Hunters Point Foundation. With regard to all of the other proposed cuts, the public health system is being dismantled, and the country is on its way to becoming like a third world country. What is on the other side of the safety net? Gene Hartman Jr. spoke in support of the Bayview Hunters Point Foundation acupuncture program. Bob Stallworth spoke in support of the Bayview Hunters Point Foundation acupuncture program. The testimony about the contingency budget cuts demonstrated what type of city San Francisco is-it is a community. Soldaini Antonello spoke in support of Bayview Hunters Point Foundation acupuncture program. Do not cut any education or health programs. 7) CONSTITUTIONAL PRIVACY RIGHTS/CONFIDENTIAL MEDICAL INFORMATION A) Public comments on all matters pertaining to the closed session None. B) Vote on whether to hold a closed session to protect individual privacy rights under the State and U.S. Constitution and to maintain confidentiality of protected information under State and Federal law. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Penn, Sanchez) voted to hold a closed session. The Commission went into closed session at 8:15 p.m. Present in closed session were Commissioner Chow, Commissioner Guy, Commissioner Monfredini, Commissioner Parker, Commissioner Penn, Commissioner Sanchez, Dr. Mitch Katz, the appellant, the appellant’s attorney, and Michele Olson. C) Closed session to protect individual privacy rights under the State and U.S. Constitution and to maintain confidentiality of protected information under State and Federal law. FOR ACTION: Consideration of an appeal by a City employee of a denial of the determination for catastrophic illness status pursuant to Section 16.9-29 of the San Francisco Administrative Code D) Reconvene in Open Session The Commission reconvened in open session at 9:00 a.m. 1. Possible report on action taken in closed session (Government Code Section 54957.1(a)5 and San Francisco Administrative Code Section 67.12(b)(4).) Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez) approved the appeal of the denial of determination for catastrophic illness status, allowing appellant Doe six weeks of catastrophic illness status. Commissioner Penn voted no. 2. Vote to elect whether to disclose any or all discussions held in closed session (San Francisco Administrative Code Section 67.12(a).) Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Penn, Sanchez) voted not to disclose discussions held in closed session. 8) ADJOURNMENT The meeting was adjourned at 9:01 p.m. Michele M. Olson, Executive Secretary to the Health Commission