Minutes of the Health Commission Meeting Tuesday, March 16, 2004 at 3:00 p.m. 101 Grove Street, Room #300 San Francisco, CA 94102 1) CALL TO ORDER The meeting was called to order by Commissioner Chow at 3:05 p.m. Present: Commissioner Edward A. Chow, M.D., President Commissioner Lee Ann Monfredini, Vice President Commissioner Roma P. Guy, M.S.W. 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. 2) APPROVAL OF THE MINUTES OF THE MEETING OF MARCH 2, 2004 Action Taken: The Commission approved the minutes of the March 2, 2004 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner David J. Sánchez, Jr., Ph.D. chaired, and Commissioner Guy and Commissioner Penn attended, the Budget Committee meeting. (3.1) CHN-SFGH Radiology – Request for approval of two contract modifications with Medical Contracting Services and The Registry Network, Inc., to increase the contract amount by a total of $600,000, from $900,000 to $1,500,000, to provide intermittent, as-needed, professional services of per diem and traveling radiology technologists with on-call availability seven days a week for San Francisco General Hospital and to extend the period of the contracts by two months from March 1, 2003 through August 31, 2004. Secretary’s Note – the term of the contract will be through June 30, 2004, rather than August 31, 2004. (3.2) PHP-Housing and Urban Health – Request for approval to accept and expend a grant from the U.S. Department of Housing and Urban Development, in the amount of $2,000,000, to provide permanent supportive housing for chronically homeless people with disabilities, for the period of April 1, 2004 through March 31, 2007, and a contract with Mercy Services Corporation, in the amount of $201,464 per year for a total of $604,393, to provide housing and property management services to 88 formerly homeless persons, for the same period. (3.3) AIDS Office-HIV Prevention – Request for approval to accept retroactively and expend a grant from the Regents of the University of California, University AIDS Research Program, in the amount of $106,788, for “Late Night Breakfast Buffet”, for the period of February 1, 2004 to July 31, 2005, and a contract with Public Health Foundation Enterprises in the amount of $57,572 for the same time period. Public Comment Patrick Monette-Shaw (submitted via e-mail) - This contract involves providing refreshments and $30 so-called “incentives” to crystal methamphetamine users, most likely to gay and bisexual men in the Castro district. As this Commission knows, it is widely understood in the national research community that offering incentives skews the data collected. SF DPH conducts far too many so-called “scientific” studies that issue cash, and other forms of incentives, calling into question the validity of data collected in San Francisco. I am hearted to learn from Steven Tierney, DPH’s director of HIV Prevention that the Prevention Planning Council is considering a policy to potentially ban use of incentives. To preserve data integrity, I urge this Commission to issue a Resolution banning the use of incentives for all HIV/AIDS prevention studies; STD prevention outreach; and outreach, needs assessments, and community forums conducted by either the HIV Prevention Planning Council, the Health Services Planning CARE) Council, and DPH. Commissioners’ Comments Commissioner Guy requested an update through the Population Health and Prevention Joint Conference Committee. (3.4) AIDS Office-HIV Prevention – Request for approval of a retroactive contract renewal with Stop AIDS Project, in the amount of $106,225, to provide Positive Force services, for the period of January 1, 2004 through June 30, 2004. (3.5) BHS-Substance Abuse – Request for approval of a retroactive contract renewal with Asian American Recovery Services, in the amount of $4,483,387, to provide fiscal and management oversight services for Community Behavioral Health Services, for the period of July 1, 2003 through June 30, 2004. Action Taken: The Commission approved the Budget Committee Consent Calendar. Item 3.3 was referred to the Population Health and Prevention Joint Conference Committee for a six-month follow-up report. 4) DIRECTOR’S REPORT At approximately 11:30pm on Wednesday, March 3rd, a fire broke out in an empty ward at Laguna Honda Hospital. The ward, 3C, was empty at the time and no one was injured. The positive outcome of this event was due to the quick-thinking and efficient response of LHH staff who moved over 90 residents and evacuated 70 of them out of the building to safety. Once residents were back in their rooms and rested from the event, LHH staff interviewed and examined everyone affected by the fire, checking on their condition, both mentally and physically. I am very pleased with the level of care and concern extended to our patients and am proud of the staff’s excellent response to this emergency. Thanks also to SFGH, which dispatched help to clean up hazardous material on the site, and to Environmental Health, which sent staff to check for toxics and air quality. The source of the fire remains under investigation by the San Francisco Fire Department. The State’s local Licensing & Certification Office and OSHPD both sent surveyors to inspect the site. We do not anticipate that either of these agencies will take a position until the investigation is complete. COMMUNITY HEALTH NETWORK: SAN FRANCISCO GENERAL HOSPITAL CREDENTIALS REPORT March 2004 Health Commission - Director of Health Report (From 03/08/04 MEC and 03/09/04 JCC)   03/04 7/03 to 03/04 New Appointments 18 110 Reinstatements   0 Reappointments 68 270 Delinquencies   0 Reappointment Denials   0 Resigned/Retired 07 110 Disciplinary Actions   0 Restriction/Limitation-Privileges 0 0 Changes in Privileges     Additions 10 88 Voluntary Relinquishments 0 2 Proctorship Completed 12 121 Current Statistics - as of 02/1/04   Active Staff 427 Affiliate Professionals (non-physicians) 171 Courtesy Staff 506 Total Members 1,104 Applications In Process 33   Applications Withdrawn Month of Jan 2003 0 11(07/03 to 03/04 SFGH Reappointments in Process Def 2003 to Mar 2004 176   Commissioners’ Comments Commissioner Penn asked if the sprinklers were off for any other ward. Dr. Katz said the sprinklers were off for most of the rest of the hospital. Dr. Katz reiterated that the new protocol requires that in addition to the sprinklers being checked, the water pressure in the sprinklers be checked as well. Commissioner Parker asked if it would be wise to have different wards on different, independent fire safety systems. Dr. Katz will discuss this with Laguna Honda staff. Commissioner Chow recognized Commissioner Harrison Parker, who is leaving the Commission after eight years of dedicated service. Commissioner Parker helped make prevention a singular item of focus for the Department, and ensured that prevention would be incorporated into the Strategic Plan. Commissioner Umekubo learned a considerable amount about preventive care from Commissioner Parker. He appreciates all his years of service. Commissioner Sanchez said it has been an honor to serve with someone of such distinction. Commissioner Parker’s dignity and his ability to stick to his principles are outstanding. Commissioner Monfredini learned so much about caring and patience from Commissioner Parker, who listened to every word that everyone has said throughout the years. It is a critical lesson in serving the public. She is delighted to host an Italian meal in his honor at her home. Commissioner Guy said Commissioner Parker has learned in his lifetime what the essence of public health is, and how it affects daily life. He leaves a legacy of a focus on prevention. His wry sense of humor helped the Commission get through some difficult times. Commissioner Penn is privileged to have benefited from Commissioner Parker’s leadership. Commissioner Parker said it has been an honor to serve on the Health Commission. One thing he has learned is that the more one gives back to the community, the more one owes. It has been a privilege to work in this Department, which is the finest in the nation. This Commission has been a dream team, and he is proud to have been a part of it. 5) RESOLUTION URGING THE BOARD OF SUPERVISORS TO ASK THE LOCAL CONGRESSIONAL DELEGATION TO LOBBY FOR THE RESTORATION OF RYAN WHITE CARE FUNDS Dan Bernal, Deputy District Director for Congresswoman Pelosi, addressed the Commission and presented a letter from the Congresswoman to Health and Human Services Secretary Tommy Thompson expressing concern about the $4 million reduction in San Francisco’s Ryan White CARE Act funding (on file). Commissioners’ Comments Commissioner Guy asked if a copy of Congresswoman Pelosi’s letter was sent to the media. Mr. Bernal said that it was forwarded to the Chronicle and other media outlets. Commissioner Chow extended the Commission’s thanks to Congresswoman Pelosi for her years of advocacy for HIV and AIDS funding. Public Comment Patrick Monette-Shaw (submitted via e-mail) – The $4 million loss of CARE funds may be a result of past performance in our EMA the media is complicit in keeping from the public, including the failure of San Francisco to spend funds during the year in which Congress appropriated them to be spent (the so-called "rollover" problem), DPH’s failure to issue contracts expeditiously to service providers, DPH’s and our CARE Council’s failure to "quickly" allocate funds, failure to reallocate funds between service categories to spend all funds, failure to complete a revised “severe needs” definition, and possibly the failure of DPH to have met some federal deadlines. Rather than eliminating entire service categories, this Council could have preserved those categories by imposing waiting lists. Judged as “past performance,” their errors contributed to this loss. Non-AIDS programs should not be de-funded to backfill this loss with General Funds. Decision-making behavior rewarded by this resolution will be repeated. Action Taken: The Commission approved Resolution #03-04, “Opposing Reductions in San Francisco’s Ryan White CARE Act Title 1 Award,” with one amendment. In the first Resolved clause, the language was changed from “opposes” to “strongly opposes,” (Attachment A). 6) CONSIDERATION OF APPROVAL OF SAN FRANCISCO GENERAL HOSPITAL REBUILD STEERING COMMITTEE’S RECOMMENDATIONS Dr. Katz said it is the Department’s recommendation to reschedule this presentation to the next regular Health Commission meeting. Staff has learned that they can request a special hearing of the Capital Improvement Advisory Committee up until April 16th. Given this, it is preferable to continue this item to fully focus on the budget presentation at today’s meeting. The Health Commission approved deferring this item to the April 6, 2004 Health Commission meeting. 7) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH BUDGET FOR FY 2004-05 Mitchell H. Katz, M.D., Director of Health, presented the proposed FY 2004-2005 Department of Public Health Budget. He gave a power point presentation (Attachment B). Public Comment Ebony James, spoke in support of Walden House. She lived on the streets of San Francisco with no family, no options. Since she’s been at Walden House, she’s learned that she is somebody. If this resource is taken away, she will have no more choices. Kimberly Wright, spoke in support of Walden House. As a direct result of her addiction she was homeless. Today her life is changing for the better thanks to Walden House. Others should have the same opportunity. Melvin Merrell Kenoly, III, from Walden House. Walden House helped him learn to live again. The parenting class helped him get back with his son. Please take care with any budget cuts. Roni Robertson, N.P. and Susan Abata, M.D., read a letter signed by more than 100 primary care providers representing primary care clinics in the Community Health Network (on file) regarding the Chief of Service position elimination. Curtis Grant, representing Friendship House Association of American Indians. He successfully went through the Friendship House program, and now works helping others overcome their addictions. This program teaches people to be self-sufficient. He asked the Commission to recognize the importance of substance abuse services. Dr. Stan Lipsitz, Team II Clinic. This outpatient mental health clinic specializing services to the gay and lesbian community. He expressed a number of concerns about the proposed integration of this clinic with the OMI Mental Health Clinic. Inevitably clients drop through the cracks when clinics relocate. Also, members of the gay and lesbian community feel safe in the current environment. Greg Parks, Team II Clinic client. Staff of the clinic is always caring, compassionate and dedicated. The Team II Clinic should be used as a role model for other clinics. The clinic has been a lifesaver for him. David Lalley, Director of Southeast Mission Geriatric Clinic, spoke in opposition of the integration of this clinic with the OMI clinic. This clinic serves a very frail and vulnerable population. He is concerned about how they would get to the OMI; interaction with the more active adult population at OMI; and the long-standing unhealthy air issues at the OMI Mental Health Clinic. The consolidation would diminish the quality of geriatric services in San Francisco. Sandra Cook, Team II Clinic. Please do not send this clinic and the clients away again. The last time the clinic was moved, in 1993, they lost a lot of clients. Rochelle Ransom – Since she’s been in Walden House, she has been clean for one year and she is reuniting with her children. Please don’t take this program away. Johnny Dishmon –Walden House gave him his life back. It taught him the skills he did not get when he was young, for example treating people with respect and taking responsibility for his actions. LaJuana Tucker – Walden House taught her how to be a good mother, and helped her reunify with her children. They have a lot of programs for people in need of help. Kate Walker spoke on behalf of the Mental Health Board. When cuts are made to save money, it adds tremendous stress on the professionals and staff who are working with patients. These cuts can turn a Code Yellow into a Code Blue. Diana Nunez – Walden House taught her how to be a better mother and stay off drugs. Brian Greenberg, Administrative Manager of Walden House. He appreciates that the City is in tough economic times. But there are two misunderstandings in the DPH Budget with regard to Walden House. The WHITS program is no longer in an unlicensed facility. These beds are extremely cost-effective. For the $292,000 cut, it is faulty to assume that people will get discharged earlier with utilization management. Jason Williams – Walden House taught him how to be a better parent. He challenged the Commission to think of the children who are out on the streets. Theresa Frye – Walden House has given her the best year of her life this past year. Walden House taught her patience and gave her self-esteem. Vincent Jimenez – thanks to Walden House, he now has custody of his son. Barbara Norris, graduate of Walden House – she has reunited with all of her children. Walden House changed her life, and can change others. Tammy Williams – she has had a depression problem all her life. Thanks to Walden House, she has learned how to deal with everyday situations. She has recently been granted unsupervised visits with her children. Chuck Deutchman, ED of Walden House, said that Walden House clients speak for the program. While Walden House made a strong commitment to Dr. Katz to work with him during this budget, they cannot absorb this magnitude of cuts. While he supports methadone treatment, it does not work for everyone. From their point of view, it is about homelessness. Residential treatment is extremely important for this population. Also, some of the DPH methadone services could be Medi-Cal funded if offered at different locations. Merrill Buice, San Francisco Human Service Network – concerned about lack of clarity in the proposed standardization of indirect costs. Even during good economic times it is difficult for the City to give contractors funds to cover increases in the cost of doing business. The non-profit service providers already subsidize the city’s various requirements with other funds. Curtis James Betteya, spoke on behalf of Friendship House. This program has been very helpful in getting him to deal with his addiction. He hopes to see this program around for many years. Juanice Noneo, spoke on behalf of the Friendship House. Without this program she would not have recognized how lost she was. She asked the Commission to remember that programs like Friendship House help the community. Patrick McAdams – Walden House has helped him with mental and physical health issues. Mental health issues cause substance abuse. Helen Waukazoo, Executive Director of Friendship House Association of Native Americans – for 40 years, the Friendship House has been in the business of healing. She is here to support others that are in the same field, and asked the Commission to oppose the budget cuts. Jenny Wiley, Friendship House Association of Native Americans – substance abuse programs affect homelessness. She and others are here in solidarity against substance abuse cuts to other organizations. She is also concerned about the impact of the standardization of indirect costs. She asked the Commission to send a message to the mayor opposing any cuts. She asked all representatives of Friendship House to stand. David J. Hull, Morrisania West – The program has changed his whole perspective on life. When he was a child, he was taken away from his parents. If Walden House were around then, he would probably have been back with his family. The City should put as much money as possible into Walden House’s parenting programs. Donald Frasier, President of the San Francisco Alcohol and Drug Contractors Association – there needs to be more discussion of the successfulness of methadone. Also, there needs to be a lot more discussion about the indirect costs. Yehile Yiscael, Clinical Coordinator of Morrisania West YORES program. He and others would like to work with the Commission to minimize the cuts and present other alternatives. We need to increase, not decrease, funding for programs. The alternatives to these programs are prison and emergency rooms, which are much less cost effective. This is a national and statewide problem. Francisca Oropesa, Southeast Mission Geriatric Service. They have been in their current location for 20 years. The location is particularly suitable for the older population they serve. The building was just renovated, which was money well spent. Most of the clinic’s clients are Medicare and Medi-Cal eligible. It makes good fiscal sense to maintain the clinic and allow clients to come to a safe environment. Susanna MacKaye, psychiatric social worker for Jail Health Service. She spoke in support of Citywide Forensics. Citywide Forensics is a key component of successful discharge from jail. Kathleen Connelly, speaking on behalf of David Furiello of Citywide Forensics. This program has demonstrated success in the reduction of parole violations, new crimes committed and other benchmarks. These clients are at high risk to re-offend. If the program is eliminated, the Behavioral Health Court will lose its most important provider. Joanne Wile, Citywide Forensic Team – spoke in support of continued funding for the team. This program serves severely mentally ill offenders. The program has had many successful outcomes. She submitted a letter (on file). Jean Miranda, Director of the City’s EAP Program – the EAP serves every department in the city, but is housed in DPH. The EAP program has helped the City avert many crises. Layoffs add to stress of employees, and make EAP services even more necessary. She urged the Commission to reinstate the positions. Greta Harper – she is in recovery at Epiphany House. Today she has hope, not just for herself, but also for her children. Norma Hotaling, SAGE program – thanked Commissioner Parker and Commissioner Guy for all their heartfelt work on the Health Commission. Again, this year, the Commission is faced with hard work to maintain a public health infrastructure that it has taken decades to build. She is very impressed with the work Walden House is doing to rebuild its organization. They deserve the Department’s support, as they are going through a very difficult time. And please keep women’s and children’s services. Beth Bernstein, SAGE program – spoke in opposition to cuts in residential substance abuse treatment programs. She stressed the importance of providing clients with safe housing. The clients need this to maintain meaningful long-term recovery. Lawrence Lurie, M.D. – spoke against the cut for the private provider network. The largest mental health cuts in this budget are made in this area. The PPA is a community-based private-public partnership that is unique in this country. Private practitioners treat public clients for low fees. Costs are much lower than at the public clinics. Finally, the psychiatric patients will not be able to pay the $5 and $10 co-pays. They will leave the system. Barbara Farrell, Executive Director of Ohlhoff Recovery Program. She is horrified that the baseline budget removes women and children’s substance abuse services, and abandons St. Joseph’s as it’s losing its grant. Substance abuse treatment impacts myriad health issues. Melvin Beetle, Vice President of the Senior Housing Task Force, is appalled at the proposed cuts to the senior housing project. DPH was given the money from the Board of Supervisors for this program. The contract is ready to begin on July 1. The annual funds will come from the Board of Supervisors. The Board has already supported the program, so he does not know why this cut is on the table. Bob Prentice – a deficit of this magnitude is structural, and to try to deal with this year-by-year is futile. The feds and the State are dumping the deficit on local governments. San Francisco should look at other counties that have asked voters to approve on-going, local funding streams. It will be hard to rebuild primary care without the Chief of Service position. DPH should not lose people like David Ofman. Eve Meyers, San Francisco Suicide Prevention – in the week to come, when even more cuts will need to be considered. There are cuts that can be made that do not affect people. She urged the Commission to focus on those. Joanna Chestnut – presented a chart that demonstrates the estimate of potential cost savings of the Epiphany House services compared with the cost of incarceration and foster care (on file). Sharon Nelson, Epiphany House, spoke in support of the programs. Michael Lyon, Coalition to Save Public Health, the Department is not going to be able to get people to pay the co-pay. Puneet Sandhu, Committee of Interns and Residents – she urged the commission to consider the residents partners in this budget crisis, and see that the residents can spend as much of their time as possible on patient care. Richard Heasley, Executive Director of Conard House – they were planning to use the $100,000 to cover the increase in insurance premiums. Non-profits do not get COLAs to cover increases. He does not know how he is going to pay for this, except to cut five to six FTEs. He has never seen an indirect cost cap go down. Providers have different rates because they have different costs. He is concerned about how this will be developed, and would like to be involved in the process. Nancy Lewis, co-chair of the NP Working Group, spoke in opposition to reductions in primary care. Gregory Evans, Page Street Guest House – the program has been very successful, and has saved the city money. He is concerned about the proposed bed cuts. Jon Barash, Silver Avenue Family Health Center, spoke in support of the CPC Medical Director Position. This position is so important for a number of reasons. For example, the medical director implemented direct appointments from SFGH to the clinics. This greatly enhanced follow-up visits. This position is the thread in a tapestry, without which the tapestry will shred. Dale Milfay, National Alliance for the Mentally Ill, said creative financing rather than draconian cuts are what is needed. The cuts proposed are penny wise and dollar foolish. Her son, who is mentally ill, could not afford to make the co-payments. All administrators should for three months live on $750 per month, and donate the rest to the general fund. Paul Miller, spoke on behalf of Team II clinic – he has been a patient for ten years, and it is a very good clinic. It is a small clinic, which is why it is effective. Combining it with others will not replace the current services. Karen Patterson Matthew, Executive Director of the Bayview Hunters Point Foundation – appreciates the way the budget was put together, but she and others are bracing for the contingency cuts. She asked that the Commission be very thoughtful about what gets presented to the mayor. She thanked Dr. Parker for all of his work in the community and on the Commission. Patrick Monette-Shaw (submitted via e-mail) - This budget proposes in Initiative K-1 to eliminate the Bayview Multi-purpose Senior Services’ Adult Day Health program to save a paltry $46,000, forcing 125 elderly clients to lose this service. If one or two of them fall at home and fracture their hip, not only may they face a statistic known as premature death, but the costs to treat them at SFGH followed by a rehabilitation hospitalization at LHH could wipe out this meager $46K savings. Initiative K-6, implementing a prescription drug co-payment for outpatients earning 100% of the federal poverty level is unethical. The City’s AIDS community lobbied the California legislature just eight days ago claiming AIDS patients covered by ADAP should not be required to pay co-pays. It is unethical to claim one disease group should not have to pay them, but expect a diabetic patient from the Bayview to have to pay co-pays. This initiative estimates $110,000 decreased use of pharmaceuticals. For those unable to afford the co-pays, their medications will stop, and soon thereafter they may face disease progression, additional morbidities, acute hospitalization at SFGH and possibly rehabilitation hospitalization at LHH. It will not take many such patients to wipe out the proposed savings. Subtracting the $100K from the $285K annualized savings results in only $175K in new revenue. By eliminating just two of DPH’s 16 manager’s of information systems, you could preserve both the pharmaceuticals and the Bayview ADHC program, and still have $25K left over. Commissioners’ Comments Commissioner Guy thanked staff throughout the Department who worked on the budget. Last year DPH was cut to the bone, so the baseline cuts are very difficult. The Commission resolution should clearly state that these cuts would have an impact and how many people will be affected. Commissioner Parker thanked everyone who testified today and gave a face to his or her program. The Department should focus on best practices in six areas: develop a more effective prevention system; develop a waste reduction system; develop a full-employment system; develop a more effective taxation system; develop a universal healthcare system; develop a more effective allocation and reserve-funding system, particularly for the CBOs allocation. There is a dichotomy when people promote prevention, but fund direct services. Commissioner Penn asked if it is feasible to work with DPH contractors to see if there are additional ways to achieve costs savings. Dr. Katz said the program managers try to do this on a regular basis, to make sure we are getting the most services for the money. There are probably other cost-savings ideas, which are identified through discussion and partnership. Dr. Katz added that CBOs have only received a three percent COLA since he became Health Director six years ago. Commissioner Umekubo asked Dr. Katz to explain how the functions of the Chief of Service for Primary Care will be carried out. Dr. Katz said he plans to ask the remaining nine Chiefs of Service to take on various functions of this position. The administrative structure exists under Barbara Garcia. With regard to the co-pay, Commissioner Umekubo asked if the intent is to decrease utilization? If so, this seems unproductive. And did staff consider a lower co-pay? Dr. Katz said it is not the intention to decrease utilization, but he needed acknowledge that research shows that utilization does go down when co-pays are instituted. Commissioner Umekubo said there is chronic underfunding of healthcare, and it is more and more difficult to come up with creative ideas. The success stories related during public testimony underscore the importance of these services. Public Health should be a priority in this city. DPH should not have to take the same hit as other departments. He would like to know what cuts are being made in other departments, such as Police and Fire. He commended administration for cutting so many administrative positions. Commissioner Sanchez said it is so beneficial to have the chance to listen to individuals who have empowered themselves through different programs. It reinforces the purpose of the Public Health Department, and gives new fight to efforts to save the safety net. Indirect costs affect every single one of the contractors, and the City needs to get input and buy-in about the criteria and methodology. Perhaps there should be a pool available to non-profits to access insurance. He would rather see a smaller co-pay, such as $1 and $3. It has taken years to develop the Community Health Network. San Francisco now has a world-class model, and there needs to be one person that is accountable to and provides quality assurance for the overall operations of the primary care clinics. This could be accomplished various ways, such as a three-year rotation, an administrative stipend, or other model. Commissioner Monfredini said that non-profits are accustomed to continuously re-evaluating their budgets and programs. In addition, the Budget Committee has worked hard to identify and eliminate waste in non-profits. She thanked staff for all their work. She said the Commission, Dr. Katz and DPH managers will spend countless hours working on the budget. In addition, community groups will spend hour organizing and testifying against cuts. Yet when the budget gets to the Board, somehow they find the money to restore programs. She apologized for the need to have to go through this every year. Commissioner Chow commended staff for finding so many cuts while minimizing direct service reductions. Although these cuts will have an impact, it is less than it could be. He acknowledged the public for the strength and commitment to come speak to the Health Commission. DPH is closing the baseline budget on our own county workers’ backs. If there is not an administrative structure in DPH’s $1 billion operation, it will not be able to get the most for the money, nor provide the assistance that smaller agencies need. The Commission’s resolution needs to illuminate this fact. He questions whether or not indirect costs should be uniform. Smaller agencies could have very large indirect costs. He is hoping that the process be uniform, not the number. None of our contracts have kept up with the cost of living. One of his smaller concerns is that the Citywide Forensic program is not included in the base. The report to the Commission demonstrated tremendous outcomes, and this program should be picked up somewhere. Finally, if this budget is forwarded to the Mayor’s Office, the Commission should express that the department has done its fair share. Commissioner Guy said it would be worthwhile to have a serious discussion with the Mayor and Board of Supervisors about funding the structural deficit in the jails, and who is responsible for these services. We have to collaborate over the next decade on taking responsibility. The Citywide Forensics Team is a perfect example of how a good program gets lost. The cuts over the last several years have had an impact, even though the Board of Supervisors has restored many of the DPH cuts. For example, SFGH cannot fill its nursing positions. She asked for more information about whether the cuts are having a disproportionate impact on women’s and girl’s services. She would like this information before the budget is forwarded to the Mayor. She said that the Commission needs to acknowledge that more is being required by administrative staff, for example in the area of cultural competency. Administrative cuts will clearly impact staff’s ability to perform. 8) PUBLIC COMMENT Patrick Monette Shaw (submitted via e-mail) - The proposed ‘04-’05 budget thankfully addresses the issue of capping indirect costs to service providers holding DPH contracts; this is long overdue. I urge this Commission to put a salary cap above which contractors will not be allowed to claim indirect costs. An executive director, like Pat Christen at the SF AIDS Foundation, making 200,000 should not be allowed to claim indirect costs above, say, $90,000. Contractors holding multiple contracts should be allowed to claim indirect costs for only one contract. Operational overhead expenses should have a reasonable usual-and-customary cap above which indirect costs would be disallowed. Commissioner Monfredini once advised non-profit contractors to do additional fundraising for COLA raises; this Commission should issue a formal policy prohibiting COLA’s not awarded to City employees, and COLA indirects. I welcome new Commissioner Jim Illig. However, because he is president of the HIV/AIDS Provider Network, as a matter of conflict-of-interest he should recuse himself from voting on Budget Committee consent calendar items. As principal author of the Mayoral transition team report on health and human services, which report noted the rebuild of Laguna Honda Hospital should be reconsidered, Illig should recuse himself from voting on any and all matters before the Commission regarding LHH, again to prevent real or perceived conflict-of-interest. 9) ADJOURNMENT The meeting was adjourned at 7:20 p.m. Michele M. Olson, Executive Secretary to the Health Commission