Minutes of the Health Commission Meeting Tuesday, May 20, 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 3:10 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 David J. Sanchez, Ph.D. Commissioner John I. Umekubo, M.D. Absent: Commissioner Michael Penn, Ph.D. 2) APPROVAL OF THE MINUTES OF THE MEETING OF MAY 6, 2003 Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez, Umekubo) approved the minutes of the May 6, 2003 Health Commission meeting. 3) PROPOSED ACTION: APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Monfredini chaired, and Commissioner Umekubo attended, the Budget Committee meeting. Commissioner Penn was absent. (3.1) CHN-Jail Health Services - Request for approval of a retroactive renewal contract with Haight Ashbury Free Clinics, Inc., in the amount of $3,677,861, to provide psychiatric and substance abuse treatment services targeting inmates in the San Francisco County Jail system, for the period of July 1, 2003 through June 30, 2004. Secretary’s Comment Although the title indicates a retroactive renewal contract, the contract is not retroactive. (3.2) CHN - Request for approval of two contract renewals with the following firms: Asereth Medical Services, Inc. and Rxrelief, for a combined total amount of $1,200,000, to provide as-needed supplemental pharmacy personnel services to the Community Health Network, for the period of July 1, 2003 through June 30, 2004. (3.3) CHN-SFGH - Request for approval of a renewal contract with the Regents of the University of California, in the amount of $336,000, to provide orthotics and prosthetics for medically indigent adult clients of the Community Health Network, for the period of July 1, 2003 through June 30, 2004. Commissioner Sanchez abstained from voting on this item. (3.4) PHP-STD Prevention and Control - Request for approval of a retroactive new sole source contract with the Regents of the University of California, in the amount of $98,000, to provide STD screening and counseling services targeting behavioral risk populations at the Magnet Clinic, for the period of April 15, 2003 through December 31, 2003. Commissioners’ Comment The Commission requested a follow-up to the Population Health and Prevention Joint Conference Committee in December 2003. Commissioner Sanchez abstained from voting on this item. (3.5) AIDS Office-HIV Prevention - Request for approval of a retroactive renewal contract with UCSF-Center for AIDS Prevention Studies, in the amount of $150,000, to provide health program planning services targeting gay and bisexual men, for the period of December 1, 2002 through June 30, 2003. Commissioner Sanchez abstained from voting on this item. (3.6) AIDS Office - Request for approval of a new sole source contract with CompassPoint Nonprofit Services, in the amount of $70,000, to provide HIV Non-Name Reporting System technical assistance, for the period of June 1, 2003 through June 30, 2004. (3.7) AIDS Office - Request for approval to accept and expend retroactively a grant from the National Institute of Allergy and Infectious Diseases, in the amount of $85,335, for a study on the effects of highly active antiretroviral therapy on cancer incidence in AIDS cases, for the period of May 1, 2003 to October 31, 2004. (3.8) PHP-Housing and Urban Health - Request for approval of a contract modification with John Stewart Company, in the amount of $181,287, to provide property management services at the Windsor, Le Nain, Camelot and Star hotels targeting formerly homeless clients with special needs, for the period of May 1, 2003 through June 30, 2003, for a contract total of $1,669,620 for the period of July 1, 2002 through June 30, 2003 (3.9) CHPP-Health Promotion - Request for approval of a contract renewal with San Francisco Study Center, Inc., in the amount of $761,441, to provide fiscal sponsor services for the Tobacco Free Project Community Capacity Building Training Center, for the period of July 1, 2003 through June 30, 2004. (3.10) CBHS-Substance Abuse - Request for approval of a contract modification with Jelani, Inc., in the amount of $524,992, for a total contract value of $3,108,421, to provide residential and outpatient substance abuse treatment services targeting women, children and families, for the period of July 1, 2002 through June 30, 2003. Commissioners’ Comment The Commission requested a six-month status report to the Community Health Network Joint Conference Committee. (3.11) CBHS-Substance Abuse - Request for approval of a contract renewal with Jelani, Inc., in the amount of $3,843,458, to provide residential and outpatient substance abuse treatment services targeting women, children and families, for the period of July 1, 2003 through June 30, 2004. The Commission requested a six-month status report to the Community Health Network Joint Conference Committee. (3.12) CBHS-Substance Abuse - Request for approval of a contract renewal with Latino Commission on Alcohol and Drug Abuse, in the amount of $1,254,755 per year for a total four-year contract amount of $5,019,019, to provide residential substance abuse treatment targeting adult Latinos and postpartum Latinas, for the period of July 1, 2003 through June 30, 2007. (3.13) CBHS-Substance Abuse - Request for approval of a contract renewal with Mission Council on Alcohol Abuse for the Spanish Speaking, Inc., in the amount of $948,062 per year for a total contract amount of $3,792,248, for the provision of substance abuse services targeting monolingual and bilingual Spanish speaking individuals and families, for the period of July 1, 2003 through June 30, 2007. (3.14) CBHS-Substance Abuse - Request for approval of a contract renewal with Iris Center, in the amount of $1,093,102, to provide outpatient, prevention and intensive outpatient substance abuse services targeting low-income women, women of color and lesbian/bisexual and transgender women, for the period of July 1, 2003 through June 30, 2004. The Commission requested a six-month status report to the Community Health Network Joint Conference Committee. (3.15) CBHS-Substance Abuse - Request for approval of a contract renewal with Japanese Community Youth Council, in the amount of $739,894 per year for a total contract value of $2,959,576, for the provision of substance abuse prevention services targeting at-risk Asian youth, for the period of July 1, 2003 through June 30, 2007. (3.16) CBHS-Mental Health - Request for approval to accept and expend retroactively a new grant from the California Department of Mental Health, in the amount of $798,888, with extension of 12 months for carry forward funding, to develop model strategies and specific protocols to improve placement and community reintegration for African American long term clients, for the period of June 16, 2003 to June 30, 2004. The Commission requested a status report to the Community Health Network Joint Conference Committee in February 2004. (3.17) CBHS-Mental Health - Request for approval of a new contract with Hyde Street Community Services, Inc., in the amount of $1,752,159, to provide comprehensive mental health outpatient services at the Tenderloin Clinic and wellness and recovery services at the Clubhouse, targeting eligible adults in the Tenderloin area, for the period of July 1, 2003 through June 30, 2004. (3.18) CBHS-Mental Health - Request for approval of a renewal contract with Bay Area Bookkeeping, in the amount of $634,000 per year, for a total contract amount of $2,536,000, to provide check writing services for payment to non-contract providers of the San Francisco Mental Health Plan and Family Mosaic Project, for the period of July 1, 2003 through June 30, 2007. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez, Umekubo) approved the Budget Committee consent calendar. Commissioner Sanchez abstained from voting on Items 3.3, 3.4, and 3.5. It was noted that although the title of Item 3.1 indicated that it is a retroactive renewal contract, it is not retroactive. The Commission asked for the following reports to Joint Conference Committees: Items 3.4, 3.10, 3.11, 3.14, and 3.16. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Budget Update There have been significant developments with the Department's Budget in the past two weeks. Labor negotiations with SEIU 790, 250 and 535 (miscellaneous employees) have resulted in several changes to the the budget. As a result of agreement with SEIU for members to pick up the 7.5 percent employee share of retirement, and agree to certain changes in the nursing contract related to jail health, the City has agreed to: restore the Mental Health Rehabilitation Facility as a locked subacute psychiatric rehabilitation facility for an additional year, abandon the plan to outsource the Laguna Honda laundry and relocate a city-staffed laundry at Oyster Point, and abandon a plan to outsource jail health services and instead make nurse staffing and scheduling changes and other reductions in health and psychiatric services in the Jails for general fund savings of $4.5 million. These revisions are contingent on union ratification of the negotiated settlement. It also assumes that 790 nurses will reopen their contract and provide sufficient concessions to fund the MHRF and Jail Health. In anticipation of ratification, we have made these revisions to our budget. In addition, the Mayor's budget office has requested the Department absorb an additional $3.3 million in reductions to our General Fund. We have met this requirement with a combination of budget reductions and an additional commitment to deliver a surplus in the current year. We have eliminated an additional 3.0 FTE administrative positions for GF savings of $300,000; and will return an additional $3 million in FY02-03 surplus comprised of $1.8M in SB90 revenues and $1.2 million in other revenues and projected expense savings. May Revise On May 14th, the Governor released the May Revision to the 2003-04 budget he proposed in January. Called the May Revise, this budget amends his earlier proposal based upon actual income tax revenues. Because the May Revise relies heavily on borrowing and new taxes rather than substantial spending reductions to bridge the State’s $38 billion shortfall, cuts to health programs are not as significant as we had anticipated. Most of the reduction proposals that the Governor presented in January are still relied upon in the May Revise to help balance the budget. These include: Medi-Cal quarterly status reports; a 15 percent rate reduction in Medi-Cal; elimination of 18 Medi-Cal optional benefits; and rescission of the Medi-Cal expansion program for aged, blind and disabled beneficiaries. The Governor’s budget also includes a scaled-down version of the Realignment II proposal set forth in January and now includes two mental health programs (AB 34/2034 and Children’s System of Care), several social service programs, but no health programs. According to the Legislative Analyst’s Office (LAO), the Governor’s May Revise would leave the budget only precariously balanced for 2003-04, but would leave the state facing substantial operating deficits in the following years. The LAO recommends that the Legislature implement more ongoing reductions for 2003-04 than proposed by the Governor to help mitigate the out year burden. A comprehensive overview of the May Revise will be presented to you at your next meeting. Public Forums on SARS On May 15th, "A Better Chinatown for Tomorrow" organized a community meeting to discuss the impact of SARS on Chinatown businesses. Although San Francisco has had only two suspected cases, one probable case and no confirmed cases of SARS, fear of the virus has impacted our local businesses. Since March, when SARS was first recognized in Asia, fewer people have been visiting, shopping and dining out in Chinatown. Dr. Rajiv Bhatia, Medical Director for Environmental Health and Occupational Health and Safety, and Path Fu, Adult Immunization Coordinator, attended the event to answer questions from the community and to emphasize that Chinatown is a safe place to visit. Also on May 15th, the Centers for Disease Control and Prevention's (CDC) SARS community outreach team visited San Francisco to discuss the impact and stigmatization that SARS has had on the Asian/Pacific Islander (API) community in the Bay Area. Several API community organizations attended the meeting, held at the API Wellness Center in Chinatown, as well as DPH staff . There was considerable interest from both the community and the CDC on the Chinese language information and outreach strategies we have developed in response to SARS, including our "Frequently Asked Questions" fact sheet, the SARS Information Line (554-2905), press conferences and community meetings. The next meeting will be held in Cantonese, Sunday, June 8th in the Sunset District. DOJ Findings Letter on Laguna Honda Hospital The leadership of DPH and Laguna Honda continue to collaborate with the City Attorney's Office in responding to the April 1, 2003 letter from the Department of Justice (DOJ). The letter is the most recent written communique in the DOJ investigation that began in 1997 and focuses on ADA-related issues. We are pleased that the DOJ has recognized the dedication of staff who are genuinely concerned with the well-being of Laguna Honda residents and the City's commitment to further improve the services provided by the Hospital. Laguna Honda staff have also identified areas where we believe our resident care programs can be further improved and are developing plans to do so. There are also many areas where we disagree with the DOJ's factual recitations, analysis, and recommendations. As in the past, we will continue to cooperate with the DOJ in an effort to move toward closing this investigation. We will continue to keep the Commission apprised of our progress on this issue. Earn While You Learn Workshops Community Vocational Enterprises (CVE) and the Mobile Support and Treatment Team Homeless Integrated Services Project (MOST AB 2034) are engaged in a unique and innovative collaboration that provides paid training and vocational development for MOST AB 2034 clients, who are seriously mentally ill and have histories of homelessness. Prior to enrolling in the MOST program, these clients had been treated in acute psychiatric and medical facilities or had arrest histories, but had not linked with community-based mental health programs. Many have little or no employment history. To help ensure that clients can successfully transition from training to employment, CVE has been facilitating interactive workshops for a group of eight MOST AB 2034 clients. More information about CVE can be found at www.cve.org. Advanced Access Community Mental Health Services (CMHS) initiated Advanced Access in November of 2002 with the goal to eliminate delays in accessing CMHS adult outpatient services. As a result of this initiative, delays in intake appointments, initial psychiatrist appointments, and follow-up appointments have been virtually eliminated. The average wait time for intake appointments has been reduced from three weeks to less than 48 hours. In support of Advanced Access, Pharmacy Services developed a new protocol for new and inactive clients to obtain medication on the same day as the intake and the Children's Services section initiated its own advanced access initiative. Additional information about CMHS’s Advanced Access initiative can be found at www.sfadvancedaccess.org <http://www.sfadvancedaccess.org/>. IMD Alternatives for African-American Clients Community Behavioral Health Services (CBHS) has been awarded a grant from the California Department of Mental Health to developi community alternatives to Institutions for Mental Disease (IMDs, i.e., psychiatric locked facilities) for African-American clients. The grant of $399,444 is for each of two years, and will provide the opportunity to develop a model of culturally competent strategies to successfully transition African-American clients from IMDs to community settings and to develop an intensive case management team to work with this target population. A review of data of locked psychiatric long-term care facilities treating San Francisco clients indicates that a disproportionate number of African-American males are placed in these facilities, that they stay longer, they are harder to place in the community and they recidivate faster. We are very pleased at this opportunity to develop approaches to help African-American clients more successfully return to community living. The Dimensions Clinic The Dimensions Clinic, established in 1998 through the collaboration of Castro-Mission Health Center, Special Programs for Youth, Health Initiatives for Youth, and New Leaf, has been named as a recipient of the Lavender Youth Recreation and Information Center (LYRIC) 2003 Champions award. Dimensionsprovides comprehensive, non-judgmental and confidential physical and mental health services exclusively to LGBTQQ youth. The annual Champion Awards event will take place on Wednesday, May 28th from 6pm - 8:30pm at the San Francisco LGBT Center. For tickets or more information, contact Ron Wong and Associates at 415.355.9988 World Asthma Month Updates: The Childhood Asthma Initiative grant, funded by the State DHS and First Five California has focused on children under 5 years old with asthma. Over 200 children and their families have been provided asthma education and home environmental assessment and controls such as dust-mite proof bed and pillow covers. In addition to patient education services, the grant supports media awareness campaigns, a clinical quality improvement project at Excelsior Clinic, and a parent advocacy project promoting asthma policy development for childcare settings. For World Asthma Month, Children’s Environmental Health Promotion arranged an African American focused outreach program on KBLX radio 102.9, a Channel 14 Spanish-language interview program with two experts from the Asthma Task Force, and a Chinese print ad with Sing Tao Daily and the World Journal. The San Francisco Asthma Resource Guide, “You Are Not Alone” is also available in English and Spanish by calling 554-8930. Peg Hickox, RN, MSN Peg Hickox, RN, MSN, Program Director for the OMI Family Center, received a certificate of honor from the San Francisco Board of Supervisors on May 6th, in recognition of outstanding service to people of the City and County of San Francisco. As part of Nurse Week, Ms. Hickox was commended for her commitment to nursing, her service to mental health patients, and for being an inspiration to all. SAN FRANCISCO GENERAL HOSPITAL CREDENTIALS REPORT May 2003 Health Commission - Director of Health Report (From 5/12/03 MEC and 5/13/03 JCC) 5/03 7/02 to 4/03 New Appointments 10 191 Reinstatements 2 1 Reappointments 18 301 Delinquencies 0 0 Reappointment Denials 0 0 Resigned/Retired 11 117 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Changes in Privileges Additions 6 23 Voluntary Relinquishments 8 23 Proctorship Completed 14 137 Current Statistics - as of 5/1/03 Active Staff 419 Affiliate Professionals (non-physicians) 162 Courtesy Staff 494 Total Members 1,077 Applications In Process 34 Applications Withdrawn Month of Jan 2003 3 15(07/02 to 4/03) SFGH Reappointments in Process June. 2003 to Sept. 2003 118 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF MAY Commissioner Roma Guy presented the May Employee Recognition Awards. Individual Awardees Division Nominated by James Alexander, Budget Manager Dept. of Public Health, Central Admin. - Finance Unit Mitch Katz, Director of Health, and Finance Unit Staff Women’s Health Care Team Awardees Division Nominated by Lindy Edward, RN Amy Krehbiel, RN Daena Petersen, Health Worker Dept. of Public Health, Tom Wadell Health Center Marian Pena, Health Center Director 6) PRESENTATION OF THE ANNUAL EMERGENCY MEDICAL SERVICES (EMS) AWARDS President Edward Chow presented the Annual Emergency Medical Services Awards. San Francisco Fire Chief Mario Trevino was present to congratulate the awardees.   EMS Field Provider Award to: Steve Ager, EMT-P Irene Ager, EMT-P   S.F. Fire Department EMS Hospital Provider Award to: Lettie Miller, RN   S.F. General Hospital EMS Community Provider Award to: Maureen Shannahan, RN Mary Allen, RN 7) THIRD QUARTER REVENUE AND EXPENDITURE REPORT Gregg Sass, CFO, presented the third quarter financial projection of revenue and expenditures for the Department of Public Health for fiscal year 2002-03. These projections are based on revenue collected and billed, and expenses incurred for the first nine months of the fiscal year ending March 31, 2003. Projections include revenue surplus of $22.6 million and over expenditures of $9 million. Based on this data, the Department of Public Health is projecting a year-end surplus of $13.6 Million for FY02-03. This amount represents 1.3% of the Department’s total operating budget and 4.7% of the Department’s General Fund. The Mayor instructed Departments to reduce reliance on the General Fund by 3% ($8.7M for DPH). On December 3rd, the Commission approved the Department’s plan to return revenue to the City as part of our plan for avoiding service cuts in this fiscal year. Subsequently, we reported to the Health Commission that we committed to the Mayor’s Budget office an additional surplus of $4M to avoid service cuts, bringing the total promised surplus to $12.7 million dollars. At the current time it appears that we will meet this target. Carry over of surplus has allowed us the Department avoid further service cuts in the next budget year. In addition, Mr. Sass reported an additional surplus of $3.0 million, including $1.8 million in SB 90 - State Mandated Cost, $0.5 million in Children’s System of Care cost savings, and $0.5 million in SFGH PY settlements. This brings the total estimated surplus to $16.6 million. Projected FY 2002-03Year-End Surplus/Deficit Commissioners’ Comments Commissioner Monfredini thanked Mr. Sass for his regular reports and his attention to detail. Commissioner Chow requested clarification of the Mental Health work order with DHS, questioning whether the services were provided. Mr. Sass responded that the services were provided, but were billable to DHS through the CalWORKS work order, thereby reflecting a surplus. Commissioner Umekubo questioned the implications of the additional $3 million in surplus given the cuts the Department has recently had to make. Mr. Sass responded that it does help us with the two percent cut in materials and supplies requested by the Mayor to all Departments. Since the majority of DPH’s materials and supplies are necessary medical supplies, DPH can’t cut into that budget like other departments. Dr. Katz added that this $3 million will not help with cuts that have already been made, but will save the Department from deeper cuts. He noted that this surplus is largely the result of salary savings coming from unfilled positions. 8) RESOLUTION REGARDING YOUTH PARTICIPATION IN THE HEALTH COMMISSION JOINT CONFERENCE COMMITTEES Commissioner Roma Guy presented a resolution regarding youth involvement in the Health Commission via the creation of a Youth Health Advisor appointment to the Population Health and Prevention Joint Conference Committee (PHP JCC). The PHP JCC previously benefited from a youth perspective through the involvement of Rolando Bonilla. When Mr. Bonilla left to attend law school, the PHP JCC members discovered that there was no formal process for appointing another youth member, and have spent recent months discussing what process should be put in place and what the selection criteria should be. Iman Nazeeri-Simmons, the Adolescent Health Coordinator, worked closely with the PHP JCC and the Health Commission Office to create a job description for the position, as well as identify the qualities that the PHP JCC would like to see in appointees. The PHP JCC members think it is important to formalize this process through a Health Commission resolution. This ensures consistent and continuous youth involvement in the PHP JCC, even when there is a change in Health Commission membership or DPH staff. The resolution is fairly specific to the PHP JCC, but it allows for other Joint Conference Committees to appoint youth members if those JCCs deem this type of participation desirable. Ms. Nazeeri-Simmons thanked Commissioners Parker and Guy for their leadership, noting that this change is part of the principles of youth development. This provides an opportunity to develop leadership, participate in civic affairs, and receive mentorship from adults. Commissioners’ Comments Commissioner Parker gave his support to this policy, noting that this is an opportunity to demonstrate respect for the youth of the community and an indication of willingness to make changes on their behalf. Commissioner Monfredini asked who is responsible to develop the criteria to appoint the youth member. Ms. Nazeeri-Simmons responded that it is the responsibility of the Office of Adolescent Health to supervise and develop a job description. Specific criteria include San Francisco residency, age 15 to 24, an understanding of the health needs of San Francisco youth, and a commitment to working with diverse youth populations. Commissioner Monfredini indicated the need for the youth member to understand and respect confidentiality and asked who would be responsible to ensure mentorship. Ms. Nazeeri-Simmons responded that she would be responsible to provide an orientation to all aspects of the role, including the need for confidentiality, and would ensure the mentorship intended. Commissioner Parker expressed concern about the addition of layers of bureaucracy with necessary approvals from the Director of Health and the Health Commission President, and could stifle independent thought and expression. Commissioner Chow responded that this formalizes the role of the Commission to appoint members to the JCC. Commissioner Guy added that this fills the need to create a home for appointee so that person doesn’t get lost in the bureaucracy. She does however share Commissioner Parker’s concern of the need to be cognizant to allow the appointee to develop his/her individual voice. Commissioner Monfredini additionally responded that she would never support the stifling of individual voice, but understands the need for criteria for the position, and believes the approvals are consistent with the Commission process. Commissioner Sanchez added that this formalizes the process to create a unique voice on the JCC. Commissioner Chow added that this makes youth voice official. Commissioner Parker asked about term limits for the position. Commission Guy responded that there are no specific term limits included in the resolution, only an age limit with an upper limit of 24. Commissioner Chow noted that if the process isn’t working, it can always be changed. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez, Umekubo) approved Resolution #11-03 “Supporting Youth Involvement in the San Francisco Health Commission and Establishing a Youth Health Advisor Appointee to the Population Health and Prevention Joint Conference Committee,” (Attachment A). 9) WOMEN’S HEALTH REPORT Anne Kronenberg introduced the report noting the origins of the Office of Women’s Health. She recommended that the Office of Women’s Health be integrated into the PHP like the Office of Adolescent Health, and that reports be done through the PHP JCC with annual updates to the Health Commission, rather than being a direct report to the Health Commission. Ms. Kronenberg also noted how appropriate it is for this report to be given during Women’s Health Month in California. Maria Cora, Women’s Health Coordinator presented the new Women’s Health Plan noting that it is a guide for DPH for San Francisco women (age 19 and up) and young women/girls (ages 10 to 18), covering a four-year time span, 2003 through 2006. Ms. Cora provided an outline of the plan noting the importance of women’s health and well being, and included a profile of San Francisco women, young women, and girls. She noted that women face particular challenges to health including poverty, lack of health insurance, environmental and occupational hazards, social inequity, unhealthy lifestyles, insufficient research data, and a current economic crisis. Ms. Cora described the guiding principles for women’s health and described how the six core recommendations were developed. The recommendations include: Recommendation 1: Promote wellness and provide excellence in health care to women and girls in San Francisco in gender-specific context. Recommendation 2: Reduce mortality and disability rates among women through concerted prevention efforts. Recommendation 3: Reduce mortality, injury, and negative effects on the quality of life due to violence confronted by women, girls, and their families. Recommendation 4: Expand screening and treatment services and collaborate in prevention efforts to reduce cancer among women. Recommendation 5: Eliminate health disparities based on race and ethnicity, disabilities, and sexual orientation. Recommendation 6: Ensure the health of vulnerable populations of women by enhancing access to health services. Next steps for the plan include dissemination, prioritization, and implementation. Progress will be monitored and achievement of recommendations will be evaluated in 2007. Public Comment Carlina Hanson of the Women’s Community Clinic expressed her support for the plan and thanked Maria Cora for her work. She emphasized the unique needs of women in San Francisco, including the diverse population of women. She invited Commissioners to the Open House of the Women’s Community Clinic on May 29, 2003 at 6:30 at 2166 Hayes St. Belle Taylor-McGhee, Executive Director of the Department on the Status of Women recommended that the Commission adopt the plan, and she commended Maria Cora on her work. She noted the small number of girls in San Francisco and their diversity - 79% are girls of color. She recommended the addition of a specific recommendation on cooperation with CBOs and other community groups. Norma Hotaling of SAGE commended the Department for addressing gender specific health needs and Maria Cora for her report. She noted that violence and exploitation impacts women’s abilities to secure careers and to succeed. Commissioners’ Comments Commissioner Guy responded that she appreciates how far this process has come. The ability to articulate and organize the gaps that exist in the knowledge of women’s health is a tremendous step. This work will help frame the discovery of what is the same and what is distinct in health between the genders. She wants to be certain that this work is integrated into the prevention framework. We need to understand the health disparities that exist between the genders, including STDs, unintentional injury, and others. She stated the need to pursue evaluation for this effort. Finally, she requested that the Department look at the Avon grant to determine how broad it can be. Commissioner Monfredini stated her support for the report. She noted that women tend to be the social glue in relationships, which is stressful, and the frequent role of women as caregivers. She noted the number of health problems caused by stress, and indicated the need to address mental health issues. She noted that mental health is as important as physical health. She concluded by asking how the Department is reaching young women and girls through this process. Ms. Cora responded that she is working as part of the San Francisco Continuum of Care, which includes Iman Nazeeri-Simmons’ Office of Adolescent Health. Commissioner Parker stated that in many areas, women are catching up to men in bad health practices, and this needs to be addressed. He noted that without women, there would be no humanity. Commissioner Umekubo noted the importance to advocate for gender-specific research within the Department. He asked how progress will be monitored? Through following disease rates over time? Benchmarking? Ms. Cora responded that monitoring will occur on the macro and micro levels. After four years, what are the effects on disease rates? This will be difficult as frequently there are no gender-specific data. Without data, there will be a need to consider anecdotal evidence. Ms. Cora further explained that they will be working with providers to help them provide gender-specific care and treatment. Commissioner Chow noted that as a report to the Commission there is no action item attached. He requested a way to move this work forward. Ms. Kronenberg suggested a resolution to the Health Commission, which will be prepared for the next Health Commission meeting. Commissioner Chow noted that it is a well-written, excellent report. His only recommendation would be to move tobacco cessation from 2005 to an earlier time, since many of those efforts are already occurring. Ms. Cora agreed with that recommendation. Commissioner Monfredini departed the meeting at 5:31 p.m. 10) EMERGENCY MEDICAL SERVICES (EMS) SECTION ANNUAL REPORT John Brown, M.D., EMS Medical Director presented the 2002 EMS system highlights, which include: EMS System Planning and Development Continued implementation of the Advanced Medical Priority Dispatch System. Development of the aero medical utilization policy. Expanded development of the Advanced Life Support Engines. Improved hospital/EMS System communications Emergency, Disaster, and Terrorism Preparedness Established Department Operations Center for disaster command and control. Developed Department of Public Health Emergency Operations Plan. Improved alerting and communication system. Developed the MCI Level 2 and 3 Policies and Procedures. Community Programs Increased the availability of Public Access Defibrillators. Increased enrollment in the Disaster Registry Program. Dr. Brown also reported on San Francisco’s ambulance call volume, ambulance response (noting that we are already meeting the EMDAC standards for response times for both first ambulance and first ALS), Advanced Life Support units, receiving hospital ambulance volume, ambulance diversion, unusual occurrences, and the Disaster Registry for seniors and disabled persons. Future directions for EMS include: Implement system-wide comprehensive LEMSIS data collection and quality improvement system. Negotiate Ambulance Provider Agreements with EMS providers. Expand the number of ALS engines. Fully implement Advanced Medical Priority Dispatch system and QI program. Continue Trauma Plan implementation, including medical helicopter environmental impact report and preventable death study. Integrate MacMillan Sobering Center into the EMS System. Continue expansion of the Public Access Defibrillator program. Assist EMS training programs to achieve accreditation. Continue to prepare DPH, EMS System, and the City for natural disasters and terrorist incidents. Implement a mass gathering permit process. Commissioners’ Comments Commissioner Chow asked how the goal to put a paramedic on every ambulance is affected by the SFFD budget. Dr. Brown responded that it is not affected by the current budget. There are already paramedics on most engines, and while it may not be 100 percent this coming year, it will probably be about 70 percent. Commissioner Sanchez asked about the effect of federal bioterrorism funding, and whether the Department has an internal group to address this? Dr. Brown responded that there is an internal group within DPH. Currently DPH is receiving about $500,000 of the City’s $2.5 million in federal bioterrorism funds. An additional $10 million is expected in the City. What initially appeared to be seed money is now turning into funding streams. Commissioner Umekubo asked about the differences in ambulance response times between SFFD ambulances and the private companies. Dr. Brown responded that the private companies respond as back up to SFFD when they have ambulances available. The private companies tend to place ambulances in places where there are the most calls - known as “good positioning.” Among SFFD ambulances that mimic that system, there is a better response time. He added that SFFD is required to cover all areas of the City including the Outer Sunset and Outer Richmond where there are fewer resources and longer distances, which tend to bring down the overall average for the SFFD response times. Commissioner Umekubo asked about the systems of communication among hospitals and why there is a varying response time among different systems. Dr. Brown responded that after September 11, there was a concerted effort to make certain that all staff at all facilities could be facile with all systems in case of failure of one system. Staff is more familiar with some systems than others, and there were some technical difficulties with one system, but overall, training is continuing and system glitches are being solved such that response times are improving for all systems. Commissioner Chow asked how we would monitor diversion rates and compare data over time given the changes in the diversion definition. Dr. Brown stated that he shared that concern, but is looking to other ways to capture data. For example, with the opening of the Sobering Center, he would look beyond diversion to see whether there has been a decrease in the number of public inebriates at all hospitals. He added that hospitals are making progress in the inappropriate use of diversion. Dr. Chow raised the concern of community opposition to the helipad, and whether there are ways to decrease commercial use of helicopters over those same communities as a way to gain support for a helipad at SFGH. Ms. Kronenberg noted that while this is outside of the Department’s purview, she and Gene O’Connell have met individually with members of the Board of Supervisors to discuss efforts to mitigate noise from commercial helicopters in those communities. Commissioner Parker asked whether there are criteria for the placement of Public Access Defibrillators and whether sites need to be certified. Dr. Brown responded that there is a need for an “enabling agency” (i.e., sponsor), which needs to meet certain criteria (medical direction, initial and ongoing training requirements). He noted that he has been meeting with MUNI and BART regarding the placement of Public Access Defibrillators on transit vehicles. He added that there are probably an additional 50 or so sites in San Francisco with Public Access Defibrillators that have not registered with EMS. Commissioner Guy asked about the impact of bioterrorism funding and how it is shaping the City’s overall disaster response capacity. Dr. Brown responded that it is building overall capacity in positive ways including an ability to approach disaster planning from an overall systems perspective. He noted the importance of communication system development and the integration of DPH sections, which had previously not worked together, as two examples. On the downside, he noted that there is a federal bias toward certain vendors, which may not meet the City’s needs. 11) PUBLIC COMMENTS There were no public comments. 12) ADJOURNMENT The meeting was adjourned at 6:29 p.m. Jim Soos, Acting Executive Secretary to the Health Commission