Minutes of the Health Commission Meeting Tuesday, November 4, 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 Vice President Guy at 3:10 p.m. Present: 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 John I. Umekubo, M.D. Absent: Commissioner Edward A. Chow, M.D., President Commissioner David J. Sanchez, Ph.D. 2) APPROVAL OF THE MINUTES OF THE MEETING OF OCTOBER 21, 2003 Action Taken: The Commission (Guy, Monfredini, Parker, Penn, Umekubo) approved the minutes of the October 21, 2003 Health Commission meeting. 3) APPROVAL OF THE MINUTES OF THE SPECIAL MEETING OF OCTOBER 21, 2003 Action Taken: The Commission (Guy, Monfredini, Parker, Penn, Umekubo) approved the minutes of the October 21, 2003 Special Health Commission meeting. 4) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Monfredini chaired, and Commissioner Penn and Commissioner Umekubo attended, the Budget Committee meeting. (4.1) AIDS Office-HIV Health Services - Request for approval to accept retroactively and expend a grant from the Department of Health and Human Services, Office of Minority Health, in the amount of $745,125, for HIV care and related services for women and minorities, for the period of September 30, 2003 to September 29, 2004. (4.2) AIDS Office-HIV Health Services - Request for approval to accept retroactively and expend a grant from the Health Resources and Services Administration, in the amount of $150,000, for transgender cultural competency training, for the period of August 1, 2003 to July 31, 2005; and a two-year contract with Ramsell Corporation in the amount of $41,268, for the period of November 1, 2003 to July 31, 2005. (4.3) CHP-Housing & Urban Health - Request for approval to accept retroactively and expend a grant from the Substance Abuse and Mental Health Services Administration, in the amount of $745,125 to expand supportive housing services for homeless people with disabilities, for the period of September 30, 2003 to September 29, 2004, and approval to modify five contracts (Baker Places, Inc., for $281,140; Episcopal Community Services for $20,000; John Stewart Co., for $91,400; Page Street Guest House for $20,000 and Mercy Services Corp., for $165,073) for the same time period. (4.4) CHP-Housing & Urban Health - Request for approval of a contract modification with Ark of Refuge, Inc., in the amount of $335,393, to provide additional transitional housing services targeting Lesbian, Gay, Bisexual, Queer and Questioning young adults, for the period of October 1, 2003 to June 30, 2004, for a total contract value of $636, 208. (4.5) CHN-SPY/YGC - Request for approval of a contract modification with St. Mary Prescription Pharmacy, to increase the contract by $123,750, for a new total of $258,750, to provide as-needed outpatient pharmacy services for the clients of the Community Health Network, Special Programs for Youth/Youth Guidance Center and associated programs, for the period of July 1, 2002 through May 31, 2004. (4.6) CHN-Primary Care - Request for approval of a retroactive renewal contract with Shanti Project, in the amount of $75,750, to provide LifeLines Project services which support women living with breast cancer, for the period of July 1, 2003 through June 30, 2004. (4.7) CHPP-Health Promotion - Request for approval of a retroactive sole source contract renewal with the Regents of the University of California at San Francisco - Family Health Outcomes Project, in the amount of $180,000, to provide evaluation services to the DPH Seven Principles Project, for the period of September 30, 2003 through September 29, 2004. (4.8) CBHS-Mental Health - Request for approval of a retroactive contract renewal with Baker Places, Inc., in the amount of $6,459,963, to provide mental health residential, outpatient, rehabili-tation and intensive day treatment services, for the period of July 1, 2003 through June 30, 2004. (4.9) CBHS-Mental Health - Request for approval of a new retroactive contract with Learning Services of Northern California, in the amount of $60,368, to provide school-based mental health partnership services and childcare consultation services, for the period of July 1, 2003 through June 30, 2004. Action Taken: The Commission (Guy, Monfredini, Parker, Penn, Umekubo) approved the Budget Committee Consent Calendar. 5) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Proposed Public Health Charter Amendment Yesterday the Rules Committee passed Supervisor Daly’s proposed Charter Amendment to the full Board without recommendation. The Board of Supervisor’s is scheduled to hear the proposed Amendment at this afternoon’s meeting. Supervisor Gonzales has already signed on as a co-sponsor. Supervisor Daly will need four additional sponsors today to have the measure qualify for the March 2004 ballot. The Health Commission held a public hearing on the draft Charter Amendment on October 21st and passed a resolution supporting the amendment in concept. Supervisor Daly agreed to most of the recommendations cited in the Commission’s resolution. Based on the discussion of the Health Commission and the testimony given at the hearing DPH staff recommended, clean-up language and additions were made in the following areas: Adding a section on Disease Prevention and Health Promotion: General discussion of the Department’s role in addressing disease prevention and health promotion would highlight the importance of prevention efforts and provide DPH with needed flexibility, especially in addressing chronic conditions such as diabetes and heart disease, as well as those that may currently be unknown. Emergency Medical Services (EMS): Additional language on EMS and the inclusion of EMS in the Charter Amendment would complement existing language on trauma care and ensure that San Francisco’s Charter is consistent with State EMS regulations. Behavioral Health Programs: Changing the language to address measurable outcomes rather than the lengths of waiting lists. This would enable the City to better evaluate the effectiveness of behavioral health interventions. Supervisor Daly wants the Amendment to be in effect before the FY 04-05 budget season. He has stated, however, that should he not secure the votes today that he would continue to pursue this direction in the future. Dr. Katz will keep the Commission informed. Health at Home There was a full-page ad today in the Chronicle sponsored by the Department of Health and Human Services. The ad was entitled: “How does your local home health agency compare?” Health at Home (HAH) was compared with other California-based home health agencies in three areas: patients who get better at bathing; patients who get better at walking; and patients who get better at taking medicines. HAH ranked slightly below the statewide average in the first two categories, and slightly above in the third category. It should be noted that the survey ranked agencies in 50 categories, and only chose to use three of these in the ad. Health at Home believes that the reasons why DPH’s statistics on "Patients who get better at bathing" and "Patients who get better at walking or moving around" are slightly lower than the State average are due to the following reasons: HAH has a higher number of patients who live in a compromised home environment, where access to bathing facilities are limited or inconvenient. Clients living in hotels or apartments, where a common bathroom may be down the hall, where sanitary conditions are often poor, and where, showers and not bathtubs are available, will often lack the ability or the incentive to bathe regularly. Because HAH also sees a high percentage of clients with chronic illnesses, including HIV, oncology and palliative care diagnoses, as well as a number of paraplegics, often improvement in ambulation is not expected. As their disease state progresses, their functioning will also deteriorate. As indicated in benchmark statistics for high-risk characteristics of our patient population, a higher percentage of HAH clients more often use alcohol and drugs, have less economic resources, and have limited support in the home. All factors impact on how effectively they can improve their level of functioning. Smoking Cessation The Tobacco Free Project's Stop Smoking Program, in cooperation with CHN’s Environmental Health and Safety Committee, will offer a free smoking cessation program for SFGH employees from October 27 through November 24 on Monday and Thursday mornings from 11:30 a.m. to 12:30 p.m. Employees interested in registering for the 6-session program should contact Daryl Kent at 206-4314 or Darlene Bahrs at 206-6074. Pedestrian and Traffic Safety Program Awarded Congratulations to the Community Health Promotion and Prevention section for winning the AAA Community Traffic Safety Program Silver Award, recognizing the DPH Pedestrian and Traffic Safety program for “efforts and success in improving local traffic safety.” The award considers the overall efforts that we have supported and carried out in the past three years. The award will be presented at the November Meeting of the Pedestrian Safety Advisory Committee of the Board of Supervisors. The meeting is on November 24th, at 5:30 p.m. at City Hall. 6) DEPARTMENT OF PUBLIC HEALTH ANNUAL REPORT Frances Culp, Office of Policy and Planning, Randy Reiter, Ph.D., Epidemiology and Disease Control, and Jim Soos, Office of Policy and Planning, presented the Department of Public Health Annual Report. This report differs from previous reports in that information that has been historically presented in three different reports-the Annual Report, the Strategic Planning Update and the State of the City Public Health Address-is now consolidated it into one report. Ms. Culp described the clients that DPH serves. The Community Health Network served 118,028 clients, Laguna Honda Hospital cared for 1,707 residents, Housing and Urban Health provided 1,730 beds, Community Mental Health Services served 22, 887 clients, Community Substance Abuse Services served 13,109 clients and the City Clinic had 20,855 patient visits. San Francisco has more Asians and fewer Hispanics than the rest of California. There are more one-person households. Dr. Reiter discussed the factors influencing health. Social determinants include income distribution, poverty, housing, racial disparities, transportation and access to food. Behavioral risk factors include smoking, physical inactivity, diet and alcohol and other drugs. Dr. Reiter presented data on the overall burden of disease in San Francisco. He summarized the leading causes of Disability Adjusted Life Years, which is a function of mortality and morbidity. Overweight and obesity are now considered, along with smoking, the leading cause of preventable death in the U.S. San Francisco is doing better than the State but it is still a large problem. Ms. Culp talked about the Department’s budget and funding sources. The Department has been doing more with less. Public Health needs continue to grow, but funding is becoming less reliable each year. Mr. Soos presented an overview of the Strategic Plan. The Strategic Plan provides a framework for a formal and ongoing process of developing, implementing and evaluating organizational goals. The Strategic Plan is a roadmap for the Department. It is used to plan for program development and reductions and determine budget priorities; certain sections are used to evaluate programs. Divisions are responsible for implementation and the Office of Policy and Planning is responsible for oversight and monitoring. Strategic Plan accomplishments include: Service Expansions such as ISIS, OBOAT and the McMillan Center Healthy Kids and the Health Care Accountability Ordinance SFGH Rebuild and Primary Care Improvements Behavioral Health Integration Prevention Framework On-line Contracting and the Soarian Project Partnerships with City Departments and CBOs Mr. Soos said there have been Strategic Plan challenges. The four strategies that have been the most problematic are the viability of contract agencies, infrastructure of contract agencies, capital funds for school health programs and staff recruitment, retention and training. These difficulties are largely due to lack of funding. The Strategic Plan was conceived as a three- to five-year document, and is now nearly three years old. Mr. Soos said the next step is to evaluate and update the plan. This will include internal process to gather input from Department staff as well as external process to solicit community and contractor feedback. This process will take eight months, with the final report being presented to the Health Commission in June 2004. Ms. Culp highlighted one new DPH program or service expansion for each of the four Strategic Plan goals. Goal 1: San Franciscans have access to the health services they need, while the Department emphasizes services to its target populations Program: LHH’s long term care for immigrants Goal 2: Disease and injury are prevented Program: Pedestrian/Traffic Safety Goal 3: Services, programs and facilities are cost-effective and resources are maximized Program: Streamlining STD testing Goal 4: Partnerships with communities are created and sustained to assess, develop, implement and advocate for health funding, policies programs and services Program: Clean and Green Commissioners’ Comments Commissioner Monfredini asked how the public would be educated about the move to an on-line reporting system. Ms. Culp said that for the first few months the report will be highlighted on the DPH homepage, so it would be easy for people to find. Commissioner Monfredini suggested having using the voicemail system to inform callers; Dr. Katz suggested including a statement about the annual report on all the Department’s public notices. Commissioner Umekubo suggested that previous years’ data are included with the report, so trends are more clearly identified. Commissioner Umekubo asked if the increase in population since 1990 is due to higher birth rates or increased immigration or some other factor. Staff will get him this information. Commissioner Parker asked if the national goal to eliminate racial health disparities is reflected in this report, and if DPH has established a similar, local goal. He also asked how the data can be used in a way that motivates people to change their behavior. Dr. Katz said he would see if staff could take the most compelling findings and turn them into impact messages. Dr. Reiter added that the purpose of the DALYs is to give a common measure of the efficacy and cost-effectiveness of interventions. One of the aims of the future development of the Overview of Health is to develop interventions that help San Franciscans. Dr. Katz said San Francisco does not have separate goals from the National health goals. Certain of our outcomes will differ from the national goals, primarily based on the differences in San Francisco’s population. For example, the CDC’s goal on TB rates does not allow communities with large immigrant populations to factor this into to data computation. There are some cases where it might be beneficial to have local goals to reflect San Francisco’s unique community. These should be approved by the Health Commission and perhaps developed by the PHP JCC. Commissioner Penn applauded staff for linking specific programs to strategies. It makes the plan a living and breathing document. He suggested that the next iteration include suggestions for improvements in the following year. This report can be a vehicle to educate San Francisco about public health challenges, inform the community about programs and services and hold the Department accountable. There should be a specific section about health disparities, both in terms of racial and ethnic disparities and gender disparities. Commissioner Guy said she was initially apprehensive about combining the Annual Report with the Strategic Plan, since an annual report is a look back and a strategic plan in a plan for the future. But the report emphasized next steps, including an evaluation of the Strategic Plan. She suggested that each Joint Conference Committee should have a discussion about the Strategic Plan and make recommendations to the evaluation process. Commissioner Guy cautioned that there are challenges to on-line reading. Most people do not have color printers, cannot download complex documents and other challenges. She appreciates the breakdown of data related to men’s health disparities. 7) SAN FRANCISCO GENERAL HOSPITAL ANNUAL REPORT Gene O’Connell, Executive Administrator, SFGHMC, presented the San Francisco General Hospital Annual Report. She gave a brief overview of patient demographics. Served more than 94,000 clients last year. 53 percent of the patients were male, and 47 percent were female. Nine percent of the patients were homeless sometime during the year. Sue Currin, Chief of Nursing, and Valerie Ng, M.D., Chief of the Medical Staff, described the services at San Francisco General Hospital in terms of an average day at the hospital. Each hour, a service, program, staff person or patient was highlighted. The day began at 1:00 a.m. Sue Carlisle, Interim Associate Dean of UCSF, said that it has been a privilege to serve as interim dean at SFGH this past year, and she has forged a partnership with Ms. O’Connell and the SFGH staff. Ms. O’Connell overviewed the strategic goals for FY 2003-2004 SFGH will focus on retention and recruitment as a means of decreasing vacancy and turnover rates Increase SFGH operational efficiency Maximize revenue through improved documentation and charge capture Develop the facility master plan for the rebuild of SFGH Complete Level 1 Trauma Center verification and designation approval process Conduct an environmental impact study on air medical access Open the Avon Foundation Comprehensive Breast Center Improve organizational effectiveness by transitioning DPH to a single information system supporting the continuum of care Implement changes to place all patients at appropriate level of care within emergency services, acute services, rehabilitation facilities and community treatment Continue to maintain compliance with JCAHO and state licensing requirements and with other state and national quality initiatives Commissioners’ Comments Commissioner Parker applauded staff for the impressive report. Not only are these services provided 24-hours a day, but also 365 days per year. The hospital is fulfilling its commitment as a safety net for the community. Medicine is such an important component of every individual’s life. Also, although the male population is less than the female population, men constitute a larger percentage of SFGH’s clients. Are they coming in with different illnesses than women? Ms. O’Connell said there are no specific male-oriented clinics, but the chronic disease cases are predominantly male. SFGH is working with other hospitals in San Francisco to address African American health disparities in San Francisco. Staff can more consistently identify this through the SFGH JCC in the coming year. Commissioner Penn said it is a pleasure to see the personal side of the hospital. Commissioner Umekubo said the report painted a vivid picture of a day at the hospital. It was a refreshing approach. He asked how the Kaiser model for chronic disease management is progressing. Ms. O’Connell said that some programs, such as the wound care clinic and diabetes program, have been providing this kind of care for a while. But as an institution they are still in the preliminary stage. Commissioner Umekubo applauded SFGH for identifying best practices and incorporating them into their daily activities. Commissioner Monfredini said it is refreshing to hear a CEO say her first goal is her employees and their retention. People feel lucky when they are brought by ambulance to SFGH because they know they will get the best care. Commissioner Guy said this report would be a helpful orientation tool for new commissioners, the Board of Supervisors, funders and others. She thanked all the staff for taking the time to come to the meeting and support the report. SFGH has already met numerous challenges, and there will be more to come. She supported the SFGH JCC examining the reasons why males receive a disproportionate number of services. This is not just the case at SFGH but throughout the safety net. Commissioner Guy reinforced her support of the hospital getting the staff it needs. This is a major challenge. Dr. Katz said that he has a personal connection to SFGH through having done his residency there, being an attending physician, being an administrator, and this year having a personal medical experience there. All of his experiences have been positive. 8) PUBLIC COMMENTS None. 9) ADJOURNMENT The meeting was adjourned at 5:40 p.m. Michele M. Olson, Executive Secretary to the Health Commission