Minutes of the Health Commission Meeting Tuesday, February 17, 2004 at 3:00 p.m. 101 Grove Street, Room #300 San Francisco, CA 94102 1) CALL TO ORDER President Chow called the meeting to order at 3:20 p.m. Present: Commissioner Edward A. Chow, M.D., President Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner Michael Penn, M.D., Ph.D. Commissioner David J. Sanchez, Ph.D. Commissioner John I. Umekubo, M.D. Absent: Commissioner Roma P. Guy, M.S.W., Vice President 2) APPROVAL OF THE MINUTES OF THE MEETING OF FEBRUARY 5, 2004 Action Taken: The Commission (Chow, Monfredini, Parker, Penn, Sanchez, Umekubo) approved the minutes of the February 5, 2004 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) PHP-TB Control - Request for approval of a retroactive sole source contract renewal with the Regents of the University of California, in the amount of $1,491,727, to provide Model Tuberculosis Prevention and Control Center services to local and national TB healthcare providers, professionals and funders, for the period of January 1, 2004 through December 31, 2004. Commissioner Sanchez abstained from voting on this item. (3.2) PHP-Prevention/Primary Care - Request for approval of a retroactive contract modification with the San Francisco Study Center, in the amount of $137,550, for FY 2003-04 only, to provide fiscal agent services for the Yes We Can Urban Asthma Partnership’s pediatric asthma community health services, and to add a contingency amount of $648,285 for a total contract value of $6,050,657 for the period of July 1, 2003 through June 30, 2007. (3.3) PHP-Housing and Urban Health - Request for approval of a new sole source contract with Tenderloin Neighborhood Development Corporation, in the amount of $117,342, to provide housing and support services targeting homeless, extremely low-income elderly with one or more disabilities, for the period of February 1, 2004 through June 30, 2004. Public Comment John Melone, member of the Homeless Senior Task Force, spoke in support of this project. We need to get seniors into housing, not into shelters. The task force is requesting $2 million additional funds in next year’s budget. Mel Beetle, member of the Homeless Senior Task Force, spoke in support of this project. He told the committee that this site will have supportive services, as well as housing. (3.4) CHN-SFGH and Health at Home - Request for approval of a contract renewal with Toyon Associates, Inc., in the amount of $735,931, to provide reimbursement and revenue optimization services to San Francisco General Hospital and Health at Home Agency, for the period of April 1, 2004 through March 31, 2006. (3.5) CHN-Laguna Honda Hospital - Request for approval of a contract renewal with Healthcare Financial Solutions, in the amount of $95,418, to provide reimbursement and revenue optimization services to Laguna Honda Hospital, for the period of April 1, 2004 through March 31, 2006. (3.6) BHS-Substance Abuse - Request for approval of a contract modification with Mt. St. Joseph-St. Elizabeth’s, in the amount of $178,175 for FY 2003-04 only, for a total four-year contract value of $4,457,613, to provide mental health and substance abuse residential and outpatient services for the period of July 1, 2003 through June 30, 2007. Secretary’s note - the correct amount of the contract is $159,085. (3.7) BHS-Mental Health - Request for approval of a contract modification with MedImpact Healthcare Systems, Inc., in the amount of $3,008,620 for a total contract amount of $9,330,779, for the provision of pharmacy benefits management services for indigent mental health consumers, for the period of April 1, 2003 through June 30, 2005. (3.8) BHS-Mental Health - Request for approval to enter into a performance agreement with Managed Health Networks, Inc. and its affiliates to provide comprehensive child crisis services at a capitated rate, with projected revenues of $75,000 per fiscal year for a total contract amount of $100,000, for the period of March 1, 2004 through June 30, 2005. Commissioners’ Comments Commissioner Monfredini requested an update on this contract to the CHN JCC in six months. (3.9) BHS - Request for site approval for relocation of Swords to Plowshares from 1063 Market Street to 1060 Howard Street, first and second floors, and relocation of the Department of Public Health’s Disability Evaluation Assistance Program from 238 Eddy Street to 1060 Howard Street, third floor. (3.10) AIDS Office-HIV Health Services - Request for approval of a contract modification with the Regents of the University of California/UCSF/Women’s Specialty Clinic, to add $50,529 to the original amount of $477,200 for a two-year total contract amount of $527,729, to provide primary care, case management and voucher distribution services targeting women with advanced HIV-related illness or complex medical problems that cannot be managed at other San Francisco CARE-funded sites that provide services for women, for the period of March 1, 2002 through February 29, 2004. Commissioner Sanchez abstained from voting on this item. (3.11) AIDS Office-HIV Health Services - Request for approval of a contract modification with the Regents of the University of California/UCSF/Positive Health Practice to add $78,973 to the original amount of $25,714, for a total contract amount of $104,687, to provide program enhancement, outreach worker and psychotherapy services to the Men of Color Program, for the period of March 1, 2003 through February 29, 2004. Commissioner Sanchez abstained from voting on this item. (3.12) AIDS Office-HIV Health Services - Request for approval of a new retroactive contract with Ramsell Corporation, in the amount of $163,545, to provide voucher distribution services to CARE-funded service providers and quality management training and technical assistance to Office of Minority Health-funded service providers, for the period of January 1, 2004 through February 29, 2004. (3.13) AIDS Office-HIV Health Services - Request for approval of a contract modification with Project Open Hand to add $265,641 to the original amount of $1,296,809 for a total contract amount of $1,562,450, to provide delivered meals and Grocery Center services, for the period of March 1, 2003 through February 29, 2004. Action Taken: The Commission (Chow, Monfredini, Parker, Penn, Sanchez, Umekubo) approved the Budget Committee Consent Calendar, with Commissioner Sanchez abstaining from voting on Item 3.1, Item 3.10 and Item 3.11. Item 3.8 was referred to the CHN JCC for a six-month report back. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Staff Volunteers to Assist at City Hall I am pleased to announce that a number of DPH staff responded to a request from the Mayor over the holiday weekend to assist with the overwhelming number of couples waiting in line to obtain marriage licenses at City Hall. As the Commissioners are aware, last week Mayor Newsom directed the Assessor's Office to begin issuing marriage licenses to same sex couples. At times, the line for marriage licenses stretched through two floors of City Hall, out the front door and around three sides of the building. DPH staff helped with crowd control, distributed information, helped process applications, collect fees and, in the words of one of the volunteers, "did whatever needed doing." I am grateful to those who gave up their holiday weekend to lend a hand to this historical event. Annual Survey of Laguna Honda Completed. The State Licensing & Certification team concluded its annual survey of Laguna Honda on Friday, February 6th and provided preliminary findings in an exit conference. The Life Safety Code survey team identified issues related to fire safety and non-conformance to current building codes in some resident care buildings, which are between 80 and 95 years old. The Licensing Team reported no findings of substandard care. Upon receipt of the written results, Laguna Honda staff will submit a Plan of Correction for deficiencies identified in the survey process. I wish to thank Commissioner Monfredini for representing the Commission at the exit conference and the staff for successfully managing the survey process. SFGH Pediatric Asthma Clinic Recognized by the CDC The SFGH Pediatric Asthma Clinic has been selected by the Centers for Disease Control and Prevention (CDC) for national recognition for its work as a leading contributor to the YES WE CAN collaborative, an intervention that encompasses the delivery of optimal medical care, clinical case management, social case management by community health workers, home environmental remediation, and support and education for providers. The YES WE CAN demonstration project is led by a steering committee co-chaired by Dr. David Ofman, medical director for Primary Care, and Professor Mary Beth Love of San Francisco State University with participants from 17 San Francisco organizations. Dr. Shannon Thyne, medical director for the Children’s Health Center, heads up research and evaluation efforts. The CDC’s National Center for Environmental and Respiratory Health conducted a rigorous review of evidence-based interventions; YES WE CAN was only the sixth asthma intervention ever to be selected for national publication. The clinic will be written up in a detailed case study and published as a toolkit to promote lessons learned and nationwide replication of its comprehensive multi-pronged intervention. JCAHO Readiness Kickoff for 2005 Survey On Tuesday, January 27th, the SFGH’s Quality Management department held a kickoff at Management Forum with the theme “Bring It On,” to prepare SFGH for its anticipated Joint Commission on Accreditation of Healthcare Organizations (JCAHO) survey in 2005. Hiro Tokubo, Director of Quality Management, and Lawrence Marsco, Manager for JCAHO Regulatory Affairs and Patient Safety Officer, have been meeting with front-line managers to discuss the impact of revisions to Joint Commission standards and the adoption of a new scoring system that defines elements of performance that determine compliance with each standard. SFGH managers and associate administrators have been designated into teams responsible for each chapter of the Joint Commission standards. Curry Senior Center to Honor Community Partners On February 28th, Curry Senior Services will honor both St. Francis Memorial Hospital and Asian Neighborhood Design at its annual fund raising dinner. This year's "Leap Year Ball" will be held at the Mark Hopkins Hotel. St. Francis Memorial Hospital will receive the Francis J. Curry Award for its generosity towards serving the health care needs of the senior community. Asian Neighborhood Design will be honored with the Joseph J. Mignola, Jr. award for its expertise and support in planning and development of Curry's new facility at 315 Turk St., as well as for its commitment to expanding services to underserved communities throughout the Bay Area. LHH Executive Administrator Elected to AHA Governing Council. I am pleased to announce that LHH Executive Administrator, Larry Funk, has been elected to a three-year term on the American Hospital Association's Governing Council for Long Term Care and Rehabilitation. The Governing Council develops national policy and advocacy priorities for hospitals in the areas of long term care and rehabilitative healthcare services. We are pleased that Mr. Funk will represent DPH in this venue. Sue Carlisle, M.D., Ph.D. Sue Carlisle, M.D., PhD, has been named by the UCSF School of Medicine Dean as the new Associate Dean at SFGH, succeeding Dr. Phil Hopewell. Dr. Carlisle has worked closely with Gene O’Connell and managers at SFGH for the past year as Interim Associate Dean, Chief of Service for Anesthesia at SFGH, and Vice Chair of the Department of Anesthesia and Perioperative Care at UCSF. She received her medical degree from University of Pennsylvania and her PhD in Parasitology and Cell Biology at Tulane University. She has received numerous accolades, including Outstanding Resident and Outstanding Clinical Faculty while at UCSF, and a teaching award from St. Mary’s Residents while practicing at French Hospital. "Hearts in San Francisco" The San Francisco General Hospital Foundation kicked off its “Hearts in San Francisco” campaign on Valentine’s Day. One hundred thirty five-foot heart-shaped structures will be transformed by renowned artists such as Michael Osborne, the designer of the popular 2002 LOVE stamp, and San Francisco Chronicle cartoonist Phil Frank, and displayed throughout the Bay Area during the spring and summer of 2004. A select few will be auctioned off in November with proceeds to benefit programs at San Francisco General Hospital. Designated locations for these structures include Union Square, Yerba Buena Gardens, Telegraph Hill, Stern Grove, the Embarcadero, Twin Peaks, and Golden Gate Bridge’s Vista Point. Volunteers will serve as walking tour guides for visitors. COMMUNITY HEALTH NETWORK SAN FRANCISCO GENERAL HOSPITAL CREDENTIALS REPORT February 2004 Health Commission - Director of Health Report (From 02/09/04 MEC and 02/10/04 JCC) 02/04 7/03 to 02/04 New Appointments 8 102 Reinstatements 0 Reappointments 51 219 Delinquencies 0 Reappointment Denials 0 Resigned/Retired 11 99 Disciplinary Actions 0 Restriction/Limitation-Privileges 0 0 Changes in Privileges Additions 13 75 Voluntary Relinquishments 0 2 Proctorship Completed 15 106 Current Statistics - as of 02/1/04 Active Staff 428 Affiliate Professionals (non-physicians) 170 Courtesy Staff 508 Total Members 1,106 Applications In Process 29 Applications Withdrawn Month of Jan 2003 1 10(07/03 to 02/04 SFGH Reappointments in Process Def 2003 to Mar 2004 199 Commissioners’ Comments Commissioner Monfredini was honored to be at the Laguna Honda Hospital exit interview, and is proud of the hospital staff who is doing great work under difficult situations. Commissioner Chow asked for a budget update. Dr. Katz said he is continuing to work closely with the Mayor’s Office. The Mayor’s Office is committed to the Health Commission holding its two public hearings. He hopes the budget will be ready to be presented in March. 5) ELECTION OF PRESIDENT AND VICE PRESIDENT OF THE HEALTH COMMISSION FOR 2004 Commissioner Umekubo nominated Commissioner Chow to serve as president of the Health Commission. Action Taken: The Commission (Monfredini, Parker, Penn, Umekubo, Sanchez) elected Commissioner Chow to serve as President of the Health Commission for 2004. Commissioner Chow abstained. Commissioner Penn nominated Commissioner Monfredini to serve as Vice President of the Health Commission. Action Taken: The Commission (Chow, Parker, Penn, Umekubo, Sanchez) elected Commissioner Monfredini to serve as Vice President of the Health Commission for 2004. Commissioner Monfredini abstained. 6) RESOLUTION ACKNOWLEDGING CHILDREN’S DENTAL HEALTH MONTH Action Taken: The Commission (Chow, Monfredini, Parker, Penn, Umekubo, Sanchez) approved Resolution #02-04, “Acknowledging February 2004 as ‘Children’s Dental Health Month’ and Honoring the Agencies and Individuals who Have Made a Difference with Children’s Dental Health in San Francisco”, Attachment A. Commissioner Chow acknowledged the people recognized by the resolution, and each person was presented with a certificate. Dr. Katz acknowledged Dr. Samantha Stephen, Director of DPH Dental Services. Commissioners’ Comments Commissioner Sanchez said this is an important recognition. The individuals provided critical services above the safety net. During the various budget processes, many services will be reviewed, including the UCSF School of Dentistry. When the school was created, establishment of community dental clinics was critical. There has been talk that these will be put on the chopping block. Commissioner Sanchez encouraged the people in the room, who are very committed and very active, to fight against any cutbacks to these services. If there were to be closures to these clinics, the Health Commission could hold a hearing. 7) SECOND QUARTER FINANCIAL REPORT Gregg Sass, DPH Chief Financial Officer, presented the FY 2003-2004 Second Quarter Financial Report. This report presents the second quarterly financial projection of DPH revenues and expenditures for fiscal year 2003-04. Staff is currently projecting a net surplus of $1.842 million. Projections include a revenue surplus of $8.957 million and over expenditures of $7.115 million. Department of Public Health Preliminary Financial Results December 31 Projection Mr. Sass provided the Commission with detail of revenue and expenditure projections for each DPH division. Public Comments Michael Lyon - concerned that the budget is moving forward and there has been no information about potential cuts. He informed the Commission that there is a proposal in Congress that requires hospitals that want to receive funding for services for undocumented people to fingerprint and report these people. Dr. Katz informed the Commission that the Department would not participate in such a program. Shanell Williams, San Francisco Youth Commission, urged the Commission to continue to support the extension of Healthy Kids. When looking at cuts, please consider the impacts on youth. Commissioners’ Comments Commissioner Parker asked if it is typical to backfill positions with overtime. Mr. Sass said that in some instances, the only option available for backfilling is overtime, P103 and registry. It is not fiscally prudent to propose a budget that assumes there will be over expenditures in these areas, to be offset with additional revenues. This year, the department is proposing to address these structural issues. However, to attract permanent personnel, it is likely DPH will need to offer higher pay, because the department is competing for a scarce resource. Commissioner Parker asked if Jail Health Services are entirely general funded. Mr. Sass said yes. Commissioner Umekubo asked how far back the cost report settlements go. Mr. Sass said most go back three years. It is unlikely there will be many more of these in the future. Commissioner Chow asked if the department continues to receive capitation revenue from entities such as SF Health Plan. Mr. Sass said DPH does receive capitation revenue from Medi-Cal, Healthy Families, Healthy Kids and Healthy Workers. 8) PREVENTION STRATEGIC PLAN Ginger Smyly, Director, Community Health Programs and Prevention, presented the Prevention Strategic Plan, 2004 through 2008. The Population Health and Prevention Joint Conference Committee two years ago asked staff to develop a strategic plan. Participants in developing the strategic plan were the Prevention Steering Committee, which developed a Prevention Framework; the Prevention Planning Committee, which guided the Prevention Strategic Plan development process; and the Prevention Workgroup, which identified top social determinants and health outcomes. Guiding Principles for the Strategic Plan were that it be population based, evidence based, address root causes and inequities, build on existing efforts, promote public partnership and evaluate results. Ms. Smyly noted that the strategic plan puts into place a framework and system for prevention planning and identifies broad issue areas that the Department should address. It is not meant to supplant and incorporate section-specific planning. There is a lot of great work already being done in the sections, for example, HIV Prevention Plan, Tobacco Free Project plan and others. DPH Prevention Workgroup recommends the following priority prevention issues: Social Determinants, such as socio-economic status, social connectedness or isolation, institutional racism and transportation systems. Health Outcomes, specifically cardiovascular disease, which is the leading cause of death of every race and cultural group in San Francisco, and depression. The Prevention Strategic Plan’s first strategy is to develop a multi-year prevention plan. The Plan includes the following strategies: Develop a future investment strategy. This strategy would include moving funding to effective, evidence-based prevention efforts and coordinating fund/grant development for strategic health plan priorities. Ensure prevention as core component by having some portion of new programs be prevention oriented, creating ongoing discussion, training about prevention within and among DPH sections and reviewing new programs for prevention relevance and best practices. Strengthen prevention in health care services - interventions should be evidence-based, consistent with expert guidelines and linked to social determinants. Evaluate existing prevention programs by establishing an evaluation workgroup, and having sections evaluate existing programs for effectiveness. Ms. Smyly reviewed the implementation steps for DPH’s prevention branch, for the Prevention Planning Committee and for each of the sections. Ms. Smyly described examples of prevention programs including living wage, pedestrian and traffic safety, chronic disease management and health equity and sustainability. These programs are described in detail in the plan itself. Challenges and Opportunities Poor financial climate for reassigning old dollars Will and orientation of management and field staff Public health workers lack prevention background No revenues in prevention, such as Medi-Cal fee-for-service (despite this, staff has been creative and successful in getting grants) Poor financial climate for new dollars Lack of general fund to leverage new grants Ms. Smyly ended by saying that DPH has a successful track record in creating successful prevention programs. It is fortunate that the Department is surrounded by academic resources and private and public foundations that can assist staff in creating model programs. There is also an increasing availability of data and best practices. Commissioners’ Comments Commissioner Parker is impressed that staff was able to take the prevention framework to the next step. The health professionals are not focused on prevention, but instead are focused on diagnosing and treating. By the time a diagnosis has been made, the damage has been done. It will be incredibly challenging to change this approach. An underlying component of all the social determinants is disrespect. This is a barrier. We have to get people to value their health. Commissioner Umekubo said prevention is a concept that requires a different mindset. The medical profession is so focused on rapidly addressing problems. Insurers also fund treatment, and there is little incentive to provide prevention services. But if DPH takes that lead with prevention, for example with cardiovascular disease, this will have an impact. He encouraged the staff to incorporate private hospitals, the San Francisco Medical Society and other private physicians. Ms. Smyly noted one of the efforts is partnership with Community Clinic Consortium, DPH safety net clinics and Kaiser. Commissioner Umekubo asked if the Commission and its joint conference committees could get periodic reports. Commissioner Chow reiterated that many private practitioners want to work on these issues, and look for opportunities. Commissioner Chow said in the current economic climate, our talent is our biggest resource, because unfortunately we do not have funding. 9) PUBLIC COMMENT None. 10) ADJOURNMENT The meeting was adjourned at 5:00 p.m. Michele M. Olson, Executive Secretary to the Health Commission