Minutes of the Health Commission Meeting Tuesday, March 2, 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 3:10 p.m. Present: Commissioner Edward A. Chow, M.D., President Commissioner Lee Ann Monfredini, Vice President Commissioner Roma P. Guy, M.S.W. Commissioner Harrison Parker, Sr., D.D.S. Commissioner David J. Sanchez, Ph.D. Commissioner John I. Umekubo, M.D. Absent: Commissioner Michael Penn, M.D., Ph.D. 2) APPROVAL OF THE MINUTES OF THE MEETING OF FEBRUARY 17, 2004 Action Taken: The Commission (Chow, Monfredini, Parker, Penn, Sanchez, Umekubo) approved the minutes of the February 17, 2004 meeting, with one amendment. Commissioner Sanchez’s comment for Item 6, the Children’s Dental Health Month resolution, was expanded to say, “The dental clinic at SFGH serves 15,000 patients a year. If this clinic were to close, it would have a detrimental impact on the hospital and its patients, and would warrant a Proposition Q hearing. Dr. Katz said the Commission could hold a hearing on these cuts. Commissioner Chow said that even if Proposition Q does not specifically apply, there would be opportunity for public hearings.” 3) PRESENTATION AND APPROVAL OF THE BUDGET COMMITTEE CONTRACTS (3.1) CHN-Primary Care - Request for approval to accept retroactively and expend a new grant from the San Francisco Health Plan Access Enhancement Fund, in the amount of $426,085, to increase patient access to care by removing physical, linguistic and/or other barriers to care, for the period of January 1, 2004 to June 30, 2006. Commissioners’ Comments Commissioner Chow asked to staff to describe the Urgent Care expansion. Gene O’Connell, SFGH Executive Administrator, said that the current year’s budget includes the FTEs for the Urgent Care Clinic expansion. This expansion will allow the clinic to be open during the day. Commissioner Parker, regarding asthma education, asked how the clients that will be served by this expansion would be targeted and selected. Ms. Liu said the funds would be used to hire a .2 FTE nurse practitioner to serve more clients at the Southeast Health Center. Ms. Liu will provide the Commission with more information when the planning process is complete. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez, Umekubo) approved this item. (3.2) CHN-SFGH - Request for approval of a resolution for a Proposition J contract for the provision of laundry processing services at San Francisco General Hospital, for the period of April 1, 2004 through September 30, 2004. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez, Umekubo) approved this item. (3.3) CHN-SFGH - Request for approval of a new contract with Turnstone Consulting, in the amount of $344,000, to provide Air Medical Access Project: Phase II environmental analysis consultation services, for the period of March 1, 2004 through December 31, 2005. Commissioners’ Comments Commissioner Umekubo asked when the report would be ready. Ms. Clark from Turnstone Consulting said it depends on what kind of study is required by the Planning Department. A full EIR would take a year to 15 months. A Negative Declaration would be a year or less. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez, Umekubo) approved this item. (3.4) PHP-EMS - Request for approval of a retroactive contract renewal with the Regents of the University of California, in the amount of $1,269,941, to provide clinical quality improvement and risk management services, for the period of July 1, 2003 through June 30, 2006. Commissioner Chow asked for more detail on quality assurance activities that would be performed by the new position. Dr. Brown said the Dispatch Center has many quality improvement functions including monitoring call takers and dispatchers as they are interacting with callers and determining training needs. Further, as EMS transitions to a full civilian staff, dispatchers being asked to serve multiple functions, and work environment needs to be closely monitored and training programs need to be developed. Commissioner Guy asked that the quarterly reports be submitted to and reviewed by the CHN JCC. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Umekubo) approved this item. Commissioner Sanchez abstained from voting on this item. (3.5) PHP-STD Prevention - Request for approval of a contract modification with Better World Advertising to increase the contract amount by $70,000, for a new contract total of $119,999, to provide STD-Syphilis awareness social marketing campaign services, targeting gay and bisexual men, for the period of January 1, 2004 through December 3,1 2004. Commissioners’ Comments Commissioner Guy asked that the Commission receive the results of the evaluation when it is complete. Jacquie Siller said that the campaign has mainly been focused on getting people tested. Prior to the campaign approximately 1,700 gay and bisexual men were tested at City Clinic; at the end of last year this number had risen to 2,800. Commissioner Umekubo noted that the most recent monthly syphilis report showed a decrease, so these efforts are working. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez, Umekubo) approved this item. (3.6) AIDS Office-HIV Prevention - Request for approval of a new retroactive contract with New Leaf: Services for Our Community, in the amount of $75,000, to provide HIV prevention services targeting defined behavioral risk populations, for the period of November 1, 2003 through June 30, 2004. Commissioner Monfredini asked for outcomes to be reported when they are available. Mr. Steven Harlow from New Leaf said that the waiting list has already shown improvement; clients can get into intake in one week. The intake no-show rate was 65 percent a year ago, because people had to wait four weeks. The no-show rate has dropped to 10 percent. Commissioner Guy thanked the agency for its work, and the quick turn around time for starting this service. During these very difficult economic times, it is very important to hear that programs have demonstrated success. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez, Umekubo) approved this item. (3.7) AIDS Office-HIV Prevention - Request for approval of a retroactive contract renewal with South of Market Health Center, in the amount of $78,392, to provide HIV prevention services, targeting defined behavioral risk populations, for the period of January 1, 2004 through December 31, 2004. Commissioner Chow asked if the data entry issue has been addressed, Steven Tierney said yes. Commissioner Guy asked why the decision was made to defer counseling and testing until 2005. Agency staff said the DPH contract manager asked them to take this on as part of this year’s contract. The agency said yes, but was not prepared to do this. They are doing a pilot project now, and plan to bring this activity into the contract next year. Commissioner Sanchez said there needs to be common ethnic categories that are used by all agencies, from the CDC on down. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez, Umekubo) approved this item. (3.8) AIDS Office - Request for approval of the FY 2004-2005 Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 Title I, Title II and General Fund contracts for a combined total of $35,477,794 for the period of March 1, 2004 through February 28, 2005 for Title I funds, April 1, 2004 through March 31, 2005 for Title II funds and July 1, 2004 through June 30, 2005 for General Fund programs with the following agencies: AIDS Community Research Consortium $88,067 AIDS Emergency Fund $637,553 AIDS Legal Referral Panel $263,326 American College of Traditional Chinese Medicine $261,444 Ark of Refuge $94,081 Asian Pacific Islander Wellness Center $494,257 Baker Places $167,164 Catholic Charities $142,403 Community Awareness & Treatment Services, Inc. $569,836 CompassPoint Non-Profit Services, Inc. $44,269 Continuum HIV Day Services $678,219 Dolores Street Community Services $174,033 Family Service Agency of San Francisco $188,590 Family Support Services of the Bay Area $262,493 Glide Foundation $93,500 Haight Ashbury Free Medical Clinics, Inc. $957,470 Harder + Company $76,140 Immune Enhancement Project $211,239 Institute for Community Health Outreach $241,051 Instituto Familiar de la Raza $350,783 Iris Center $144,375 Legal Services for Children $133,213 Lutheran Social Services $532,056 Lyon-Martin Women’s Health Services $328,912 Maitri AIDS Hospice $927,317 Marin County $1,229,743 Mission Neighborhood Health Center $134,961 New Leaf $193,269 Positive Resource Center $268,815 Project Open Hand $1,296,809 Quan Yin Healing Arts Center $120,251 Ramsell Consulting Services $95,979 Saint Mary’s Medical Center. $580,585 San Francisco Community Clinic Consortium $328,253 SFDPH Community Health Network -Forensics Services $323,462 SFDPH Community Health Network -Health at Home $444,755 SFDPH Community Health Network - Primary Care $2,714,436 SFDPH Community Health Network -SFGH $1,690,189 SFDPH Community Health Network-SFGH-Positive Health Practice $280,212 SFDPH Community Health Network-Tom Waddell $156,602 SFDPH PHP Mental Health Services $277,425 SFDPH PHP Public Health Laboratory $61,580 SFDPH PHP STD Services $170,294 SFDPH PHP Substance Abuse Services (Baker post-detox services) $236,107 SFDPH PHP Housing Services:   Ark of Refuge, Inc $266,944     Baker Places $1,743,142     Black Coalition on AIDS $370,108     Catholic Charities $1,356,948     Larkin Street Youth Center $643,403     Lutheran Social Services $140,223     San Francisco AIDS Foundation $2,544,315     Tenderloin AIDS Resource Center $261,284     Walden House $72,960     Subtotal, SFDPH PHP Housing Services $7,399,327 San Francisco Food Bank $92,800 San Francisco Suicide Prevention $101,794 San Mateo County $2,411,008 Shanti Project $1,262,325 Tenderloin AIDS Resource Center $566,874 UCSF/AIDS Health Project $1,102,880 UCSF/Men of Color Program $25,714 UCSF/Pediatric AIDS Program $164,535 UCSF/School of Dentistry $217,144 UCSF/Substance Abuse Services $562,460 UCSF/ Women’s Specialty Clinic $213,675 University of the Pacific-School of Dentistry $523,215 Urban Indian Health Board, Inc. $48,300 Walden House $1,605,462 Westside Community Mental Health Services $192,522 To Be Determined: AIDS Dementia Unit & Quality Management services $322,241 Total: $35,477,794 Michelle Long Dixon, Director of HIV Health Services, told the Commission that the dollar amounts allocated to each contract do not currently reflect the reduction in Ryan White CARE funding the AIDS Office was just informed of. The Notice of Award, which has not yet been received, indicates that San Francisco will receive a 12% reduction, which equates to more that $4 million, for the current fiscal year. Ms. Long Dixon clarified a mistake in the documents. Christopher Cunnie is listed as the Board Chair for Walden House; he is the Executive Vice President. Commissioner Monfredini said she thought the Marin County project had seen a decrease in population. Ms. Long Dixon said Marin serves approximately 800 person with HIV. The allocation is based on the number of people with AIDS; Marin has approximately 360 persons with AIDS. Commissioner Guy asked if there is a defined community process for how the reductions would be made. Ms. Long Dixon said that last year the Planning Council made the decision to make any cuts starting from the bottom of the prioritized list. Ms. Long Dixon said this would mean a challenging transition because a lot of the programs at the bottom provide unique services. Commissioner Guy asked that the PHP JCC get frequent updates on the process. Commissioner Umekubo pointed out that the President of St. Mary’s Medical Center is Ken Steele. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez, Umekubo) approved this item. Commissioner Umekubo and Commissioner Sanchez abstained from voting on the contracts related to St. Mary’s Hospital and UCSF, respectively. 4) DIRECTOR’S REPORT Commissioner Chow announced that Mr. Jim Illig would be appointed to the Health Commission to succeed Commissioner Harrison Parker. It is not yet known when this appointment will be effective. Commissioner Chow welcomed Mr. Illig, and said that the wisdom of Commissioner Parker will be missed. Commissioner Chow announced 2004 Committee Assignments: JOINT CONFERENCE COMMITTEE FOR COMMUNITY HEALTH NETWORK (CHN) Edward A. Chow, M.D., Chair Michael Penn, M.D., Ph.D., Member David J. Sanchez, Jr., Ph.D., Member JOINT CONFERENCE COMMITTEE FOR LAGUNA HONDA HOSPITAL (LHH) John Umekubo, M.D. Chair Harrison Parker, Sr., D.D.S., Member JOINT CONFERENCE COMMITTEE FOR POPULATION HEALTH AND PREVENTION (PH&P) Roma Guy, MSW, Chair Harrison Parker, Sr., D.D.S., Member JOINT CONFERENCE COMMITTEE FOR SAN FRANCISCO GENERAL HOSPITAL (SFGH) Lee Ann Monfredini, Chair John Umekubo, M.D., Member BUDGET COMMITTEE David J. Sanchez, Ph.D., Chair Roma Guy, MSW, Member Michael Penn, M.D., Ph.D., Member IHSS PUBLIC AUTHORITY Harrison Parker, Sr., DDS S.F. HEALTH AUTHORITY John I. Umekubo, M.D. SFGH FOUNDATION David J. Sanchez, Jr., Ph.D. Dr. Katz presented the Director’s Report. Election Day Dr. Katz brought to the Commission’s attention two initiatives on the statewide ballot that will have a significant impact on the City and on the Department. Proposition 57 would authorize California to issue a $15 billion bond to pay off the State's accumulated General Fund deficit through June 30, 2004. Proposition 58 would implement several budget reforms, such as requiring a balanced budget, providing for legislative and gubernatorial action in a fiscal emergency, and establishing a budget reserve. Proposition 57 and Proposition 58 are linked and, thus, both must pass by a simple majority in order to enable the State to issue the bonds described in Proposition 57. If these initiatives fail, the City’s deficit will increase by an estimated $100 million. And, as the largest City department, this will undoubtedly have a significant impact on DPH. Baldwin House Hotel Fire A two-alarm fire occurred early Saturday morning, February 28th at the Baldwin House Hotel located on 6th Street between Mission and Market streets. The fire was reported at 3:23 a.m. in a second floor room of the 180-room hotel. DPH and DHS staff responded to the fire scene to evaluate the medical and social needs of the residents. This is the second fire in the Baldwin Hotel in the last 18 months. Two residents were taken to SFGH and treated for smoke inhalation. Two rooms were directly affected by the fire, and some other rooms were damaged by smoke, water, or broken doors for entry. During the evacuation of the building, an elderly man was discovered dead on the third floor. The death was not related to the fire. Sixteen people were vouchered to local hotels by the Red Cross through Monday night. They will be returning to the Baldwin Hotel today. Because all of the residents had access to their rooms, DPH staff did not have to replace any prescriptions. There was no cause to call in any mental health services as residents affected by the fire were coping well with the situation. Special thanks to Jim Soos for his excellent and timely response. Ryan White CARE Act Award On March 1, the Health Resources Services Administration (HRSA) announced the Ryan White CARE Act Title I awards, which provide funding for HIV care services to the 51 most impacted metropolitan areas in the country. The San Francisco Title I award for federal fiscal year (FY) 2004 is $29,849,780 compared to $33,941,235 awarded in FY 03. This is a reduction of $4,091,455 or 12.1 percent. There will also be a $50,857 reduction in DPH’s Minority AIDS Initiative Award. The AIDS Office has already begun the process of informing the HIV Health Services Planning Council, the HIV Provider Community and other affected DPH sections. They are also assessing the fund balances to determine DPH’s ability to narrow the funding gap. The Department will work closely with the elected officials on the federal, State and local level to address this issue. “Public Health Grand Rounds” features SFDPH Traffic and Pedestrian Safety Program Between March 3rd and March- 5th, the national Public Health Grand Rounds team from the University of North Carolina, Chapel Hill, will be in San Francisco to videotape interviews and neighborhood footage on the Department’s efforts to promote traffic and pedestrian safety. Public Health Grand Rounds, sponsored by the Centers for Disease Control and Prevention (CDC), is an effort to share expertise on dealing with public health problems with health professionals throughout the country and around the world. In Public Health Grand Rounds, the "patient" is defined as the community and the "presenting problem" is defined as a public health issue challenging the community and requiring its informed response. The interviews and local traffic scenes will be used for a Grand Rounds program, "Promoting Safe Travel and the Public's Health," which will be a live satellite broadcast/web cast on March 26, 2004. Educational Cross Cultural Exchange The South of Market Mental Health Center has been asked for a second year to participate in an educational cross-cultural exchange sponsored by Stanford University. On March 22nd, 30 Japanese medical students in their third or fourth year of residency will visit the center in an effort to learn more about cross-cultural issues in health care and to explore differences in medical care between Japan and America in particular. The DPH site was selected to represent a community based mental health clinic serving an inner city population and for its specialty programs serving the Filipino community and homeless mentally ill population. Dr Steven Wozniak, MD and Carey Martin, Nurse Practitioner will be hosting their site visit. Commissioners’ Comments Commissioner Chow asked what steps the Department is planning to take regarding the reduction in Ryan White CARE funding. Dr. Katz said the Department would lobby, but he has little expectation of success. The progressive decrease to first-line cities is part of the legislation and not unanticipated. Commissioner Chow asked what the impact of the Minority AIDS Initiative Award reduction would be. Mr. Loyce said this money goes directly to agencies that serve minorities. The process for implementing the reductions will be linked to the planning priorities set by the Planning Council. He will keep the Commission apprised on this process through the PHP JCC. Commissioner Monfredini said that DPH has been aware that there would be a funding decrease, and she hopes that some preparations have already been made. It will challenge agencies to use resources more efficiently. Commissioner Guy anticipated a reduction, but is shocked by the magnitude. Mr. Loyce said the hold-harmless cities, including San Francisco, anticipated a five to ten percent reduction. Commissioner Umekubo recommended that the Department send a letter to San Francisco’s Congressional delegation expressing the Commission’s disappointment with the funding reduction. Commissioner Sanchez said that, given the state and federal climate, there is going to be a dismantling of services like never before. DPH is going to have to think even more creatively. It is going to take an all out effort, and a dialogue that extends beyond San Francisco. Commissioner Guy encouraged the Commission and the Department to protest the cuts, particularly with Congresswoman Pelosi. Commissioner Chow asked the Department to send a letter now, and the Commission will calendar a resolution opposing this cut at the next Commission meeting. Public Comments  Jim Illig said that this reduction was not anticipated, and there will be a lot of protest. San Francisco had the 3rd highest cut of any EMA in the country. Many EMA’s got additional funding. It is clear that San Francisco was targeted and the Commission, the Department, the provider community has to protest with San Francisco’s delegation against this cut. Fernando Ona presented the Health Commission with the five posters that were selected from the Student Art Contest for Harvesting Health-food, health and the environment. 5) PUBLIC COMMENT None. 6) ADJOURNMENT The meeting adjourned at 4:38 p.m. Michele M. Olson, Executive Secretary to the Health Commission