Minutes of the Special Health Commission Meeting Tuesday, May 11, 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 James M. Illig 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 MAY 4, 2004 Action Taken: The Commission approved the minutes of the May 4, 2004 Health Commission meeting. 3) PRESENTATION OF FISCAL YEAR 2004-2005 DEPARTMENT OF PUBLIC HEALTH CONTINGENCY BUDGET AND CONSIDERATION OF A RESOLUTION REGARDING THE FY 2004-2005 DPH CONTINGENCY BUDGET Mitchell H. Katz, M.D., presented the proposed fiscal year 2004-2005 Contingency Budget for the Department of Public Health (See attached Powerpoint presentation, Attachment A). Commissioners’ Questions Commissioner Sanchez asked for clarification that inpatient dialysis service would not be eliminated. Dr. Katz replied that inpatient dialysis services will be maintained. Dr. Katz added that when UCSF stopped providing dialysis services, SFGH took over with the hope that it could make it work. In every instance except the $1.6 million in capital costs that would be required to meet JCAHO standards, SFGH could have made it work. Commissioner Illig asked if the community-based providers who will be serving some of the mental health clients from Mission Mental Health and Sunset Mental Health have been selected. Dr. Katz said the Department would go through an RPF process for the agencies. In the case of Mission ACT, the two remaining programs are run by UC. Commissioner Penn asked if there are additional people at Laguna Honda Hospital laundry that need to be reassigned. Dr. Katz said that all the employees have been reassigned to other jobs. Dr. Katz added that the Department would still need laundry workers for tasks such as linen distribution. Commissioner Umekubo asked if there are enough dialysis slots in the community to absorb the SFGH patients. Dr. Katz said that one of the reasons DPH agreed to take on the service was because of the concern that people would end up being treated in the hospital at a higher cost because there was inadequate outpatient capacity. However, now the situation is different, other facilities have completed their renovations and there is now capacity. Public Comment Isabelita Evangelista, please to continue to provide funding for the Potrero Clinic. Doctors and staff are very good. Manuel Vasquez, the closing of Mission Mental Health will mean a reduction in services. The proposal eliminates 11 clinical positions. They embrace integration, but not at the cost of the Mission community. Eric Seely, Senior Psychiatric Social Worker at Mission Mental Health. If cuts need to be made, they should be across-the-board, not just at Mission Mental Health and Sunset Mental Health. It feels like communities are being pitted against each other. Lucy Vargas, Social Worker at Mission Mental Health, pleaded that service continue to be provided in the community. Clients will not leave the community. Tom Waddell clinic is excellent, but it is a different world. Tesde H. Torgia spoke in support of the Mission ACT. Susan Gamboa, Mission ACT. She appreciates that this is a budget emergency, and staff is prepared to go into emergency status by finding a transition space in the community where there is lower rent. But keep the services in the community. Mary Anne Sirring, Mission ACT, please keep these services. Michael Sauter, Health Worker at Mission ACT, said staff has worked to keep people out of the hospital and to become engaged with the clients. Now they are being told that because their clients are stable, they no longer need this level of service. Larry Huerta said the program has helped people. It should stay open. Theresa Archuleta spoke in support of the Potrero Health Center. She is also concerned that the Urgent Care at SFGH has too long of waits, so the people go to the emergency room, which is very costly. Bruce Folsom, Social Worker with Southeast Mission Geriatrics. He works very closely with Mission Mental Health. If this change goes through, many of their elderly clients would have to be transferred to Southeast Mission Geriatrics. Also, the only two City programs serving the geriatric population are being targeted. Jim Salaices said Mission ACT helped him after he tried to commit suicide. Silvia Solorzano, Mission ISC, said the higher ups do not need to give up their pagers and cell phones, they need to visit the clients. Eleanor Dwyer, Mission ACT, said the program’s successes are now being used against them. She submitted a written document (on file). The clients are not ready to step down. She proposes finding affordable facility costs to remain intact. Monica Soto, Social Worker at Mission ACT, read from three of the 21 letters of support that she has for Mission ACT (on file). Victoria Gonzalez, clinician at Mission Mental Health. The clinic has been a light in the community for more than 20 years. The current plan represents the destruction of services under the guise of integration. The Department has spent years developing these services; please save these services. Orlando Tolbert spoke about the cost-savings of Mission ACT. Mission ACT is part of the solution to long-term care. Laurie, spoke in support of the services at Mission ACT. She was very supported at that clinic. When people are in crisis, they cannot even get on the bus. Charles Evans, consumer at Mission Mental Health. The program is very needed in the community-it is the best model and program he has ever seen. Staff is using peer counselors to help free the staff counselor’s time. Jan Sparks spoke in support of Mission ACT. Without this program he would be going in and out of hospitals. The staff helps clients hold on to their freedom and assure their futures. Donna Martinez, Mission ACT, this program has helped her completely. She is triple diagnosed. They care about one another, and the program needs to stay open. Juanita Valenzuela, spoke in support of the Potrero Hill Neighborhood Clinic. Please keep these services open. Deborah Hughes, San Francisco used to be the city that knew how. The private sector will not serve these patients. Eligibility workers need to be in the clinics. Eileen Auerbach, OT at Mission ACT, said that the research that was used as justification to close ACT distorts the research. The key factor in successful step-down is when the same staff members worked very closely with the client in the same location. She submitted a letter to the Health Commission (on file). Manuel Mena, mental health clinician, said the proposal guts the safety net services to the Latino community. Community-based providers are not safety net providers, so they will not be able to pick up the clients that are losing services. The Department should look for a building with cheaper rent. Evangelist LaVonne V. McIntosh, she stands as an advocate of Maxine Hall Health Center, Mission Mental Health and other health programs. Rosalind deLisser, Nurse Practitioner at Mission Mental Health and Mission ACT. Mission ACT and Mission Mental Health are already on the cutting edge of integration. She was hired to integrate primary care services at these two programs. Dr. Raul Moncayo, Director of Training at Mission Mental Health, the reduction takes the guts, heart and brain out of mental health services for the Mission community. Richard Heasly, Executive Director of Conard House, said he and others were pleased with the Mayor’s decision to not require a $37 million reduction from DPH. The plan is an affirmation of non-profit, community-based services that serve every neighborhood and every language. The Department gets a lot of value from community providers. Jesus Velez, Mission Health Center, over the past six years he has had several relapses, but each time less work because he gets services at Mission Mental Health. If he cannot see his psychologist, who knows what will happen. Larry Burgheimer, community mental health is supposed to be preventive, cuts will have long-term repercussions. Hywel Sims, referenced a letter he submitted (on file) that points out inaccuracies in the Department’s justification for reducing funding to its programs. Vincent Price, on behalf of Mission ACT, if not for this program he would be dead or in an institution. Randall Humphreys said it has taken him 15 years to find Mission Mental Health. Do not close these services. Jonathan Vernick, Executive Director of Baker Places, said he empathizes with changes that happen as a result of budget cuts. This year’s budget cuts come after much deliberation about the budget shortfall, and the proposals make sense by emphasizing integration. Steve Fields, Executive Director of Progress Foundation, said that the safety-net community programs always seemed to bear the brunt of the cuts; this year these front line services are maintained. There is no cut that happens in the health budget that does not cut into blood and bone. He looks forward to the Mayor proposing a revenue bond in November so that some of the priority 2 programs could be restored. Isabel Santos, Sunset Day Treatment Center, there are enough people in the Sunset that need these services. Rhonda Giarretto, Public Health Nurse from Tom Waddell, said DPH already has clinics that do not have the capacity to serve current clients. The proposal has no details. Please involve the people who work day-to-day in these clinics in these decisions. Karen Patterson Matthew, Executive Director for Bayview Hunters Point Foundation, said there needs to be changes, and hope that the decisions are made in a rational manner. Alan “Mickey” Shipley, if you ask clients to go to a new location, they have to start their whole lives over again. Nancy Lewis, FNP at Cole Street Youth Clinic, spoke on behalf of the programs for youth. Please save their clinic director’s job. Michael Baxter has provided tremendous services. Under his leadership, the clinics have made a difference in the lives of so many San Francisco youth. Pam Fischer, President of NAMI San Francisco, said that Sunset Mental Health has the only socialization program in the city. Please save the Mission clinics and Sunset Mental Health. Jane Kiskiras said the proposed cuts are the same as were proposed by Governor Reagan, and you have seen the results of this. Need to find more and better funds, not cut programs. Private businesses should do more to help. George R. Williams, said people are being ripped off by pharmaceutical companies. If the Department keeps throwing money at pharmaceuticals, it will not have money to provide services. The Senior Action Network has 12 bills in the hopper, and will have 1,500 at a rally tomorrow. Terry Wong, spoke in opposition to the closure of Sunset Mental Health. It is a comprehensive agency serving adults and children. One of the unique programs is the Socialization Wellness Recovery Program, which could not be continued if the program is consolidated. Jay Sheffield, Social Worker at Tom Waddell Health Center, DEAP assists the most vulnerable people in San Francisco. Since January 2002 have achieved 200 successful SSI applications. The program has saved the City millions of dollars. DeForest Woods, representing 5th Street Agenda and Mental Health Association. In order to help a person with mental illness, you have to get to know him or her. He pleaded with the Commission to think twice about making these cuts. Matsumoto Ichiro Kenneth, spoke in support of Sunset day treatment. The treatment gives him serenity, harmony, peace and so many other blessings. It gave him a chance. It is a very safe place. The older people that are served by this program will probably end up at Laguna Honda. C.W. Johnson, client at the Sunset Mental Health Center, said this is the most integrated service program he has ever seen. Do not take this away. Teresa Friend, Homeless Advocacy Program of the Bar Association, spoke against the elimination of the DEAP program. HAP’s successful partnership with DEAP saves the City millions of dollars per year, plus gives the patients better medical care. The community-based provider only serves people who are currently in treatment. Patricia Perez-Arce, Ph.D., Director of Castro-Mission Health Center, said the base and contingency budget cuts will result in reduced services at the primary care clinics of up to 25 to 30 percent. 39 clinical and staff positions are being eliminated, as well as all health center directors. There are other ways to save money. Jennifer Gunn, RN at the SFGH Dialysis Center, said most of the dialysis patients speak a language other than English. These patients could not receive training and education in their own language at any other facility in San Francisco. None of the current workers will work at the private, for-profit dialysis centers that the Department is proposing will serve these patients. Madeline Burnell, Social Worker at the SFGH Dialysis Unit, said the unit sees homeless, people with mental health and substance abuses, and people who speak a variety of languages. Ligia Jeanette Vasquez Villigran, spoke against closing the dialysis unit. Victor Travis, Health Educator at the Balboa Teen Health Center. The staff is very distressed that their center director, Michael Baxter, has received his pink slip. If the Commission is concerned about the health and welfare of young people, they should hold on to Michael Baxter. Stella Rubenstein, spoke in support of Michael Baxter and read from a letter from the Balboa High School principal and assistant principal (on file). Madeline Ritchie, Center Director at Chinatown Public Health Center, spoke against the proposed primary care cuts. The Commission must recognize that there is an enormous need for mental health and medical services in San Francisco. We need to collectively look for new revenue, and not be pitted against each other. Donald Frazier, Walden House, said it is good that the proposed budget saves direct services, except one. Walden House was targeted for cuts in the baseline budget. He recommends restoring funding for the cuts that were made. Anonymous supporter of Sunset Mental Health. Mentally ill people tend to be isolated because of the stigma of mental illness. He has gone from a socially isolated individual to a tax-paying worker because of Sunset Mental Health. Evelyn Soto, consumer of services at Mission Mental Health, as well as a peer counselor. She is a peer counselor and graduate student because of the care she received at this clinic. The clinic is very easily accessible by BART and busses. She is also concerned that people who get services at primary care clinics will not welcome mental health clients. James Beck, HAFC, it is unacceptable that there is no revenue bonds for critical services, unacceptable that mental health services are being cut, now we are funding the school district out of the general fund. That said the Department must be commended for focusing on administrative cuts, rather than direct services. It is really unprecedented. Dr. Rudy Rodriguez, Medical Director of the Dialysis Unit, is baffled by the proposed closure because nothing has changed since the department decided. If the unit is closed, it will take a long time for the clients to find other chairs. Most dialysis units in San Francisco do not accept emergency MediCal. Approximately 10 percent of clients have emergency MediCal. There are viable options to closure. Angie Gonzalez, works in the Dialysis Unit, said these clients are going to end up in the emergency room and end up costing the city more money. Kathryn Fontcuit, physician assistant at the SFGH Renal Center, said they have met their budgetary goals, passed hospital and DHS inspections, and it is appalling to see that they are now threatened to be closed. Care is not the same at private dialysis providers. Dr. David Pearce, Chief of Nephrology at SFGH, spoke on behalf of the Renal Center. The center serves the most vulnerable patients in San Francisco. The dialysis is and can continue to operate in the black, even considering capital improvement costs. Inez Ascencio, Southeast Child and Family Therapy Center, spoke in opposition to elimination of the senior social workers. The cuts would impact client services. She provides services to clients. In her program specifically, 125 clients would be impact. Juan Pauli, Director of Mission Family Center, said he is disturbed that the cuts are not evenly distributed. Also, too many people in the trenches who are being cut. Cristy Johnston, speaking on behalf of Mauricio Vela, spoke in support of the senior social worker position at Southeast Child and Family Therapy Center. She is one of the only Spanish-speaking social worker who provides direct services. Do not cut her position. Anna Ulbrich, Bernal Heights Neighborhood Center, spoke in support of the senior social worker position at the Southeast Child and Family Therapy Center. The statement that this cut will not impact direct services is false. Estela Garcia, Associate Director, Instituto Familiar de la Raza, said that on the one hand the budget recognizes the importance of community-based providers. But on the other hand, she is concerned with the dismantling of mental health services. There needs to be a process for putting these changes in place. Richard Marquez, Mission Anti-Displacement Coalition, profoundly opposed to this round of cuts, particularly the closure of Mission Mental Health. The people of the Mission district will bear the brunt of these cuts. Leticia Perez, spoke in support of Inez Ascencio, who has worked with her for several years. She is one of the few bilingual staff at this program. Mary Kate Connor, Director of Caduceus Outreach Services, said it is very clear that anyone with psychiatric illness is being disregarded. Over the last 15 years, cuts in the Health Department have been disproportionately targeted toward mental health services. Dr. Paul Quick, Tom Waddell Health Center and DEAP, said that he cannot imagine where they are going to put the clients from Mission Mental Health, and it is not a culturally appropriate location for Spanish speaking clients. With regard to DEAP, this program targets a population that is not currently connected to services. He submitted a letter for public record (on file). Junie, client at Mission Mental Health, please do not take the only services she had. Debbie Lerman, Human Services Network, applauded the Mayor for letting the department submit a budget with less than 15 percent of a contingency cut and that preserves direct services. There needs to be leadership in identifying new revenue. Barbara Farrell, Ohlhoff Recovery Services and chair-elect of the Treatment on Demand Planning Council. Applauded the Department for looking at administrative reductions instead of service cuts. Jeanette Hassberg, said all over the state cuts are targeting people with psychiatric disabilities. The services are so much more important than the buildings they are in. The program helps save the city money. Michael Lyon, Coalition for Public Health, asked how far these cuts are going to go. Patients just above the poverty level are going to pay more for their medication. Health patients are going to be sent to clinics whose infrastructures are already being destroyed. Martha Hawthorne, Public Health Nurse at Castro Mission, said the Health Commission must clearly articulate that this is a budget of despair. She submitted information about the Dimensions Health Services (on file). Jerry Berbiar, member of Coalition for Public Health, said Castro Mission has helped him immensely. The services that helped him are being dismantled, and this is unacceptable. Laurie Hampton spoke against the proposed cutbacks, and submitted her comments for the record (on file). Jennie Woo, Public Health Nurse at Chinatown Public Health Center, the centers will be very chaotic without center directors, and having medical directors do administrative work will reduce the time they can spend providing medical care. Laura Guzman, Mission Resource Center, spoke in opposition to cut to Mission Mental Health. This is a slap in the face to the Mission community. The clients will not go to Tom Waddell. The services are not proximate. Derrie McClure spoke in support of Walden House residential treatment. Larry Geffen spoke in support of funding for residential beds at Walden House. Athena Pierce, speaking in support of Walden House, said the program is losing funding for beds for people trying to become active members of society. If they are denied a bed, they are denied a chance to change. Donald Adams spoke in support of Walden House residential treatment. Without this program, he and others would be back in prison. Treatment is more cost effective than sending people to jail. Roy Steele spoke in support of Walden House residential treatment. Hjalmar Bjorkman spoke in support of Walden House residential treatment. This program gives him the help he so desperately needs. Kevin Rose, representing the owners of 2712 Mission Street. There has been a lot of discussion about the high rent for this lease. The owners are willing to renew an option to purchase a below-market rate. The ownership group is a 20-year resident of the city with ties to the Mission. The owner is not currently making a profit. Ruth Rivera spoke on behalf of Mission Mental Health and Mission ACT. People who live in the Mission will not be able to go to other clinics. Jan Shropshire, PHN at Chinatown Health Center, said the health center is a magical place. The clinical directors provided much-needed leadership. Chinatown Health Center has a history of cost-effective quality services. Why fix something that is not broken. Francisco Da Costa, Director of Environmental Justice Advocacy, said there should be no cuts, but rather increased funding. Eve Meyer, San Francisco Suicide Prevention and President of the Mental Health Contractors Association, which voted this morning to support this budget, even though it is a bitter pill. Andrea Leung, Asian American Mental Health Task Force, spoke in support of continuing services at Sunset Mental Health. She is very concerned about where the clients will receive proper service-the community-based provider is not even known. Otto Duffy, Tom Waddell Advisory Board, said there are policy options available to sidestep these cuts. Mark Bernstein, psychiatrist and Medical Director at Sunset Mental Health, said he first heard of the proposal to close the sight four days ago. It makes no sense to reconfigure this program in a sterile environment miles away, which is already facing staff shortage. It is foolhardy to sell an on-going resource for one-time cost savings. Robert Freeh, client at Mission Mental Health, said he is not ready for change or to go to a different person for services. Do not close this program. Dr. Brandon Vance, Mission Mental Health, said he has seen the strong relationships that staff has developed with the clients. The location is very important. People in the Mission district are unlikely to consistently go to another location for care. Thalia Gravel, Transgender Lifecare Project at the Castro-Mission Health Center. There is only one person who is really truly experienced with the needs of transgendered people, and this person is the Transgender Lifecare Project. Iris Goodwill, Tom Waddell Clinic, said the clinic still accepts patients into primary care even though they do not have the capacity. She finds it unrealistic that the proposed cuts will not affect patient care. There are inaccuracies in the contingency budget Larry Bevan, Local 250 Shop Steward, commended the budget for targeting administrative positions. But one area of concern is the cuts to mental health. There are not enough services currently, so where are these 1,300 people going to go. Barbara Devaney, Bayview Hunters Point Foundation who sees clients at Sunset Mental Health, said without this clinic there would be a loss of community. Ying Zhang-Chiu, Sunset Mental Health, said this is the only mental health service provider in this area that has the language capacity to deal with this population. The clinic is the home and the lifeline for many people. Tina Shereen, Family Practice resident at SFGH, said the clinics are already stretched to capacity. She was unable to get follow-up care for a patient because the clinic was not accepting patients at this time. Cuts to support staff will make an already difficult situation worse. Christine Dehlendorf, Family Practice resident at SFGH, said there is already a shortage of capacity in primary care; her patients cannot get timely follow-up appointments. Cuts to clinicians and support staff will overwhelm and already overwhelmed system. Cynthia Pon, psychiatric social worker at Sunset Mental Health. The savings from the proposed cuts are primarily being directed to community-based alternatives. So the real result is only a displacement of mental health clients. Jane Ma, the proposed budget impacts for civil service programs without any discussion or involvement of program staff. Sunset Mental Health is a unique program that has worked collaboratively with Ocean Park for many years. Pam-Pam Gaddies, Operation Save a Life, said that violence is a health issue, and she invited the commission to visit Sunnydale and Hyde Lisa Leighton, PHN at Silver Avenue Clinic, spoke against the cuts to primary care nurses, including the elimination of the director of nursing for the CHN network. She said the Department is losing revenue due to inadequate billing. Eun Joo Justice, psychiatrist at Sunset Mental Health Center, said that Manhattan has no homeless people because they provide long-term, expensive mental health services. Here, the Mayor wants to reduce the homeless population, yet he is cutting mental health services. Allegra Melillo, Resident and the Family Medicine Clinic at SFGH and doc at Ocean Park Health Center. Sunset Mental Health saves lives, and we really need to look at the long-term effects to the community. Patrick Monette Shaw (submitted via e-mail) - Initiatives DEPT1 and DEPT2 in the Contingency Budget don’t list job classifications for 83.51 FTE positions being eliminated. Ethically, this Commission cannot approve this budget without first knowing which positions will be eliminated. You must table voting on this budget until the public learns which healthcare safety net positions are being eliminated. Health Commissioners have no business recommending in the last paragraph of your draft Resolution to the Board of Supervisors and the Mayor that the Commission supports employees continuing to pay the 7.5% retirement awarded in lieu of a wage increase years ago. You have no business asking me to pay 7.5% for a second year. Instead, ask the 27 San Francisco companies on the Chron 200 list who earned $10.5 billion in net income last year for 7.5%. That would yield $787.5 million, solving this year’s and next year’s purported deficits. Make big business pay its fair share! Written testimony Gary Robinson, Union of American Physicians and Dentists, submitted a letter expressing opposition to the contingency budget (on file). Commissioners’ Comments Commissioner Penn thanked the Department and Mayor’s Office their hard work. The spirit of the reductions is commendable, but the practical execution of the cuts will be damaging. The timing has been so condensed and he feels extremely uncomfortable taking action on this proposal today. The cuts disproportionately affect vulnerable populations, and the draft resolution does not reflect this. Finally, it is very difficult to evaluate the contingency budget without seeing other options. Commissioner Sanchez said the term “budget of despair” accurately describes the proposed budget. One of the main focuses of the Department has been to provide culturally competent services. The Public Health Department has been a leader in some of the best models for health care, including homeless services, wellness centers, and so many others. This is now being dismantled. We need to look at alternatives to closing the Mission mental health clinics. There are no other resources in the Mission. Other health centers are at capacity. He would like to remove the two Mission mental health programs from the contingency budget, and will propose a formal amendment to the resolution. Commissioner Umekubo thanked the public for its testimony. In times of crises, people step up with cost-savings ideas that should be considered. The contingency budget contains good elements and bad. There are close to $10 million in reductions that do not affect services, and this is positive. The Health Commission should try its best to preserve the services that will have an impact on direct services. Commissioner Guy said the staff provided a positive context for evaluating the proposed budget, which is helpful. The budget partially moves the Department in the right direction, but the Health Commission needs to make clear other cuts will have a devastating impact. The Health Commission was not given the time it needs to fully deliberate upon the impact of these cuts. Whether it is the intent or not, the public health sector is really being dismantled. She wants the Health Commission to reflect on the cuts, and the testimony, before taking action. The Health Commission cannot judge the impact of the administrative cuts. It is the Health Commission’s responsibility to ensure that quality assurance is maintained. She asked why the services provided by DEAP are recommended to be provided by a contractor. Dr. Katz replied that it is his assessment that they could get as many clients eligible for SSI for less money. It is a different model. Commissioner Guy is concerned that the Mission mental health clinics are proposed to be closed to save money on rent. How can the integrity of these successful services be maintained? She also heard the same concerns around Sunset Mental Health. Culturally competent services are not easily replaced. Commissioner Illig said his first reaction to the plan was relief because he knows what could have been on the table. Also, Dr. Katz did the right thing by focusing on administrative cuts. Structural changes mean integration, reorganization, and reduction in administrative services. This can be painful and in a perfect world would be done with more time to plan. But the fiscal shortfall necessitated that this be done now. The public testimony clearly conveyed the human costs of these cuts, for both clients and staff. The staff will have the extra burden, as well as staff of community-based organizations, of working with clients to make sure they are not lost during the restructuring and integration. He is concerned that one third of the general fund cuts are in mental health. He clarified that Shanti serves some of the most vulnerable homeless individuals. The Health Commission and the Department need to work with the Board of Supervisors to get revenue packages on the ballot to backfill some of these cuts. Commissioner Monfredini supports the budget, but also supports revisiting the mental health programs in the Mission. She commended Dr. Katz for taking internal cuts first. Commissioner Monfredini trusts that Mr. Sass, the DPH CFO, would re-examine billing system to make sure that the Department is bringing in as much revenue as possible. Commissioner Chow said this was a very difficult budget, and staff and the Mayor’s Office must be commended for reducing the magnitude of cuts that needed to be proposed. Staff took cuts internally first, with the effort to maximize preservation of services. That said there are cuts in services. He has asked that the Primary Care restructure be brought to the Health Commission for more detailed discussion. Action Taken: The Health Commission approved an amendment to add the following language to the resolution: After the 7th whereas, “Whereas, the Commission has heard extensive testimony about the reconfiguration of mental health services within the Mission; and” After the 1st Further Resolved, “Further Resolved, that the reconfiguration of mental health service in the Mission must be studied further prior to the Health Commission recommending its submission to the Mayor; and” (Commissioners Chow, Guy, Monfredini, Penn, Sanchez, Umekubo voted for the amendment; Commissioner Illig voted against the amendment.) Action Taken: The Health Commission unanimously passed Resolution #09-04, “Regarding the Fiscal Year 2004-2005 Contingency Budget, and Urging the Mayor and the Board of Supervisors to Work Together to Minimize Reductions to Health Services,” as amended (Attachment B). 4) PUBLIC COMMENT None. 5) ADJOURNMENT The meeting was adjourned at 8:30 p.m. Michele M. Olson, Executive Secretary to the Health Commission