Minutes of the Health Commission Meeting Tuesday, October 26, 2004 at 3:00 p.m. 101 GROVE STREET San Francisco, CA 94102 1) CALL TO ORDER The meeting was called to order by Commissioner Chow 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 David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. Absent: Commissioner James M. Illig 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF OCTOBER 5, 2004 Action Taken: The Commission approved the minutes of the October 5, 2004 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Sanchez chaired and Commissioner Guy attended the Budget Committee meeting. (3.1) BHS – Request for approval to accept retroactively and expend a grant in the amount of $1,497,910, from the Substance Abuse and Mental Health Services Administration and the Center for Substance Abuse Treatment, to expand treatment capacity for methamphetamine abuse in San Francisco, for the period of September 30, 2004 to September 29, 2007, and subcontracts with Continuum in the amount of $191,799 and with the Regents of the University of California in the amount of $1,046,569, for the same time period. (3.2) PHP-AIDS Office – Request for approval to accept retroactively and expend a grant in the amount of $1,071,520, from the Centers for Disease Control and Prevention, for morbidity and risk behavior surveillance, for the period of September 1, 2004 to May 31, 2008, and a new contract with PHFE Management Solutions, in the amount of $111,778, for the period of September 1, 2004 through May 31, 2005. (3.3) PHP-STD Control Program – Request for approval of a new retroactive contract with PHFE Management Solutions, in the amount of $140,000, to provide fiscal agency services for the STD Prevention and Control Section – Positive Reinforcement Project (PROP), targeting gay and bisexual men and other MSM who report using methamphetamines, for the period of October 1, 2004 through June 30, 2005. (3.4) PHP-AIDS Office – Request for approval of a retroactive contract renewal with South of Market Health Center, in the amount of $128,801, to provide HIV prevention services, targeting defined behavioral risk populations, for the period of July 1, 2004 through June 30, 2005. Commissioners’ Comments Commissioner Guy supports the Filipino Task Force on AIDS (FTFA) as it moves forward through the transition to a new executive director. She is concerned about the agency’s troubles, particularly the delay in completing financial audits. There is a need in the community for the services the agency provides, and she wants to make sure the agency is on the right track. Benny Cruz-Ferma, interim co-executive director of FTFA said a preliminary audit was submitted today, with the final audit to be done in the next two weeks. He does not expect that the audit will contain any surprises. He added that the Board of Directors is beginning the search process for a permanent executive director. Melenie Eleneke, director of the transgender program, added that the firm doing the current audit will do the FY 02/03 and FY 03/04 audits as well. Commissioner Guy asked for an update at the Community Programs and Services Joint Conference Committee in January 2005. Commissioner Sanchez said a lot of agency staff are working free of charge to make the agency work, and this is commendable (3.5) PHP-AIDS Office – Request for approval of three FY 2004/05 contract modifications funded by one-time Federal Office of Minority Health (FOMH) grant funds for a combined one-time total of $184,116 and General Funds totaling $24,571, for a combined total increase of $208,687, for the period of September 30, 2004 through January 31, 2005 with the following agencies: AGENCY Original Contract Amount General Fund Close Out Amount FOMH One Time Amount Total Amount Contract Term: 9/30/03-9/29/04 10/01/04-10/31/04 9/30/04-01/31/05 9/30/03 - 01/31/05 Dolores Street Community Center $65,850 $5,488 $20,120 $91,458 Mission Neighborhood Health Center $70,440 $5,870 $51,503 $127,813 Regents of the University of California, UCSF - Positive Health Practice $158,556 $13,213 $112,493 $284,262 TOTAL: $294,846 $24,571 $184,116 $503,533 (3.6) CHPP-Health Promotion – Request for approval of a retroactive renewal contract with Youth Leadership Institute, in the amount of $60,659, to provide technical assistance and training services for violence and substance abuse programs, for the period of October 1, 2004 through September 30, 2005. (3.7) BHS-Substance Abuse – Request for approval of a retroactive contract renewal with Asian American Recovery Services, in the amount of $5,002,993, to provide fiscal and management oversight services for Community Behavioral Health Services, for the period of July 1, 2004 through June 30, 2005. (3.8) BHS-Substance Abuse – Request for approval of a retroactive contract renewal with Chemical Awareness and Treatment Services Inc. (dba Community Awareness and Treatment Services, Inc.), in the amount of $6,861,429, to provide residential, transportation, drop-in and overnight intervention substance abuse services, for the period of July 1, 2004 through June 30, 2006. Action Taken: The Health Commission (Chow, Guy, Monfredini, Sanchez, Umekubo) approved the Budget Committee Consent Calendar. Commissioner Sanchez abstained from voting on Item 3.1 and Item 3.5. Item 3.4 was referred to the Community Programs and Services Joint Conference Committee meeting for a status report in January 2005. 4) DIRECTOR’S REPORT Mitch Katz, M.D., Director of Health, presented the Director’s Report. Flu Vaccine Update Dr. Katz announced that DPH will receive 11,430 doses of Aventis vaccine from the State Department of Health Services tomorrow. This quantity falls far below the 65,000 doses the Department had originally ordered from Chiron Corporation whose license to manufacture Fluvirin influenza virus vaccine was suspended earlier this month. However, it is possible that additional vaccine will be reallocated to DPH. The Department’s first priority is vaccinating high risk persons who are living in congregate settings (e.g. long-term care institutions such as Laguna Honda Hospital) and their health care workers because congregate settings pose the greatest risk of epidemic spread. Beyond this, the Department is currently determining the supply and need for vaccine among our community partners. To that end the Department sent faxes to over 800 providers on Friday- pediatric and adult - asking for their vaccine status: Did they receive vaccine? Would they be willing to sell vaccine to DPH? Would they be willing to have non-patients in high risk groups referred to them? To date, the Department has received 70 responses. After fulfilling the needs of high-risk persons in congregate settings, DPH will distribute the remaining vaccine according to CDC risk and survey responses. The distribution plan will be posted on the DPH website when it is finalized. EEO/Cultural Competency Director to Retirement Dr. Katz announced that Norm Nickens has accepted a new position as the Executive Administrator to the General Manager of the Retirement System. Norm has been with the Department of Health for ten years, first in the capacity as Assistant Director of the AIDS Office, then Deputy Director of Population Health and Prevention and for the last five years he has done an exemplary job as the Director of the Office of EEO and Cultural Competency. November 15th is Norms last day at DPH. Dr. Katz wished Norm success in his new job. The Department’s loss will be the Retirement’s Systems gain. Hearts and Souls Auction Joan Ryan’s column in Sunday’s Chronicle (available on www.sfgate.com) gave a glowing account of the work performed at San Francisco General Hospital and highlighted the upcoming “Heart & Soul” auction. The article featured a story about the 3-year-old son of San Francisco Giants’ chief operating officer, Larry Baer, whose life was saved by the excellent work of the emergency physicians and staff at SFGH Trauma Center. November’s Heart and Soul auction is expected to raise $1.5 million for the SFGH Hospital Foundation. For more information, visit the website at www.heartsinsf.com. SAN FRANCISCO GENERAL HOSPITAL: OCTOBER Health Commission - Director of Health Report (From 10/04/04(Changed to 10/7/04) MEC and 10/12/04 JCC) 10/04 07/04 to 10/04 New Appointments 31 67   Reinstatements 0 0 Reappointments 46 126   Delinquencies: 0   Reappointment Denials: 0 Resigned/Retired: 18 59 Disciplinary Actions 0 Restriction/Limitation-Privileges 0 0 Deceased 0 0 Changes in Privileges   Additions 14 25   Voluntary Relinquishments 3 17   Proctorship Completed 10 30 Current Statistics - as of 10/1/04 Active Staff 440 Affiliate Professionals (non-physicians) 182 Courtesy Staff 526 TOTAL MEMBERS 1,148 Applications In Process 36 Applications Withdrawn Month of October 2004 2 3 (10/04 to 06/05) SFGH Reappointments in Process Nov. 2004 to Feb. 2005 155 Commissioners’ Comments Commissioner Chow asked if the Department has the ability to separate, on a citywide basis, pediatric physicians from physicians who serve adults. Dr. Katz said that the Department is able to do that. Commissioner Chow reiterated that the DPH website will be the best place to get up-to-date information about the availability of the flu vaccine. Commissioner Chow commended Norm Nickens for his work at DPH and wished him well. Commissioner Umekubo asked if there would be increased resources targeted toward treating the flu, such as increased stocks of Tamiflu. Dr. Katz said he is not aware of an effort to increase Tamiflu, but he will look into this. He has been in communication with San Francisco General Hospital and other hospitals to develop surge capacity for an increased number of flu patients. Dr. Katz said that the nasal spray vaccine is a good alternative for healthy people age 4-49. 5) CONSIDERATION OF A RESOLUTION APPROVING THE RECONFIGURATION OF EMS SERVICES IN THE FIRE DEPARTMENT EMS Chief Glenn Ortiz-Shuldt gave an overview of the reconfiguration proposal. The basic elements of the proposal are: the establishment of 42 ALS engine companies (from the current 21); dynamic deployment of ambulances with higher number of ambulances at peak times; and the use of dedicated paramedics and dedicated EMTs to staff ambulances. The Fire Department is looking forward to a number of benefits as a result of the reconfiguration. In terms of timeline, the Fire Department hopes to post for the new positions in January, test for the positions a few months later, and begin hiring as early as May or June. The Fire Department is working with the EMS Agency to develop the training curriculum. John Brown, M.D., EMS Agency Medical Director, reviewed some of the major changes that would take place with the new configuration, including number of ambulances, lengths of shifts, number paramedics on scene and dispatch systems. Dr. Brown recommends that the quarterly reports for the reconfiguration be provided as part of the EMS quarterly reports at the Community Programs and Services Joint Conference Committee. Public Comment Rich Pekelney, San Francisco Paramedic Association, said the reconfiguration is going to create a much more difficult system, which would make it more difficult to maintain quality. He is concerned that the pay and work experience between EMTs and paramedics will impact quality. The devil is in the detail, and there are no details. Commissioners’ Comments Commissioner Chow asked how long it would to completely roll out the new configuration. Chief Ortiz-Schultd said they are anticipating completion within 16-18 months of the first job posting. Action Taken: The Commission (Chow, Guy, Monfredini, Sanchez, Umekubo) approved Resolution 17-04, “Approving the Reconfiguration of Emergency Medical Services in the San Francisco Fire Department,” (Attachment A). 6) STRATEGIC PLAN UPDATE Anne Kronenberg, Deputy Director of Health and Jim Soos, Senior Health Program Planner, Policy and Planning presented the Strategic Plan. Ms. Kronenberg discussed the goals, guiding principles and strategic planning process. There was little change to the goals. They are: San Franciscans have access to the health services they need Disease and injury are prevented Services, programs and facilities are cost-effective and resources are maximized Partnerships with communities are created and sustained to assess, develop, implement and advocate for health funding, policies, programs and services The mission and vision for DPH remain unchanged. The Department has two roles: population health and clinical care. The Strategic Plan reflects Federal and State regulatory and statutory requirements and is consistent with Health Commission policies and resolutions. The guiding principles are: Clear vision and mission statements Broad view of health Continue public health and health care delivery Use data to drive decisions Ensure that services are comprehensive and integrated Expand primary prevention Emphasize integration: PHP/CHN; DPH with community partners; DPH with other city departments; program contracting to improve efficiency Blend revenues to support integration Develop legislative advocacy strategies Recognize current fiscal realities but not be driven by them Ms. Kronenberg said staff held 18 community meetings and three staff Town Hall meetings. There was an e-mail survey of 623 non-profit and community organizations. Staff worked with the Mayor’s Office, the Board of Supervisors and hundreds of community groups and received input from 433 San Franciscans. Mr. Soos highlighted the changes from the 2000 Strategic Plan: Increased emphasis on cultural competence (Objectives 1.2 & 4.1) Emphasis on patient flow and continuum of care (Objective 1.11) Explicit integration of prevention into program planning department-wide (Objective 2.3) Inclusion of urban planning/land use policy as a public health issue (Objective 2.5) Explicit inclusion of emergency/disaster preparedness responsibilities (Objective 2.6) Inclusion of behavioral health prevention (Objective 2.7) Explicit objective to ensure public health infrastructure (Objective 3.3) Increased emphasis on outcomes-based evaluation (Objective 3.7) Inclusion of business community as public health partner (Objective 4.5) Mr. Soos thanked Alicia Neumann, a former DPH intern, for her work on the strategic plan update. Public Comment Patrick Monette-Shaw - written summary attached* Commissioners’ Comments Commissioner Chow said the Health Commission would consider the resolution approving the Strategic Plan at the next Health Commission meeting. Commissioner Guy commended staff for the document. She is pleased that the plan includes complementary medicine and further develops prevention and integration. The next step is evaluation. Commissioner Chow was particularly pleased with the enhanced strategies around cultural competency. He hopes that with benchmarks there will be an easy way to check in to see how the Department is doing in meeting objectives. Commissioner Umekubo commended staff for the report, and asked if the outcomes would be reported to the Health Commission or through the Joint Conference Committees. Commissioner Chow said that both forums would be utilized. 7) APPROVAL OF SAN FRANCISCO GENERAL HOSPITAL MEDICAL STAFF BYLAWS Valerie Ng, Chief of Staff, San Francisco General Hospital, presented amendments to the San Francisco General Hospital Medical Staff Bylaws for 2004-2005. The Bylaws have been approved by the Meidcal Staff and reviewed by the San Francisco General Hospital Joint Conference Committee. A grid summarizing the changes is attached (Attachment B). Commissioners’ Comments Commissioner Umekubo said the San Francisco General Hospital Joint Conference Committee reviewed the bylaws. The amendments are important in terms of the upcoming JCAHO survey. Action Taken: The Commission (Chow, Guy, Monfredini, Sanchez, Umekubo) approved the amendments to the San Francisco General Hospital Medical Staff Bylaws. 8) PRESENTATION OF PROPOSED FY 2004-2005 MID-YEAR BUDGET REDUCTIONS Mitchell H. Katz, M.D., Director of Health, presented proposed mid-year budget cuts that would be implemented if San Francisco voters do not approve Propositions J and K on November 2, 2004. The City’s budget for the current fiscal year was balanced on the assumptions that an increase in the sales tax (Proposition J) and a gross receipts tax (Proposition K) would be approved. If not, the City will lose $97 million in an 18-month period. The Health Department has been asked to produce a plan that would cut the DPH general fund by $23 million for the 18-month period beginning January 15, 2005. The bulk of the $23 million in cuts are reductions that had been part of the FY 04-05 submission but had been restored by the Board of Supervisors. However, because that list did not equal the target, the Department added a substantial cut to substance abuse services. The list of proposed cuts is as follows: Dr. Katz hopes that no action will be necessary on these cuts. But if Propositions J and K do fail, he will return to the Commission on November 9th for action. Public Comment Anthony Salazar, Friendship House, spoke in support of Friendship House and continued substance abuse services. Barbara Farrell, Treatment on Demand, said that substance abuse makes up less than 10 percent of the DPH budget, but is 29 percent of the cuts. Housing in not health care, and people in housing will not have any outpatient substance abuse services. Veronica Shwindler, Friendship House, said the agency has been very helpful to her on her road to recovery. Raho Ortiz, Development Director for Friendship House, said the CBHS money is 10 percent of their budget, and the cut would greatly impact their ability to provide services. Cedric Akbar, Positive Directions Equals Change, said the pain in the Bayview Community is visible. He urged the Commission not to cut substance abuse. Ed Warshauer, SEIU 790, is opposed to every single cut and supportive of a revenue stream for DPH. Proposition 63 should mitigate some of the potential cuts, and the union is totally opposed to reducing the number of beds at Laguna Honda Hospital. Barbara Rothkrug, Public Health Nurse at Castro Mission Health Center, is opposed to reducing mental health services. She has dialysis patients who are undocumented and will not get services if SFGH dialysis is cut. Eve Meyers, San Francisco Suicide Prevention, said suicide is the end stage of substance abuse and mental illness. Do not cut these services. Patrick Monette-Shaw - written summary attached* Norma Hotaling, SAGE, is disturbed that there is such a huge proposed cut to substance abuse services this early in the year. She would like to see the Department and community come together for a combined planning process. Kent Woo, NICOS, urged the Commission to save the anti-gambling initiative, regardless of whether J and K pass. It is the only project of its kind in the Bay Area and the nation. Please make this program part of the DPH baseline. Jenny Wiley, Friendship House, said treatment is so much cheaper than incarceration, so save treatment. Karen Patterson-Matthew, Bayview Hunters Point Foundation, encouraged decision makers to continue to advocate for people in need. Richard Heasley, Conard House, said that he and others have been working hard to get Propositions J, K and O passed. There is the possibility that the City will have to confront the next phase of dismantling the system of care. People will fall through the cracks. Commissioners’ Comments Commissioner Monfredini thanked Dr. Katz for his hard work and thanked the community for testifying before the commission. Commissioners are very much aware of the good done by DPH’s great contractors and this is painful. Unfortunately the Commission cannot just ignore the possible need for budget reductions. She asked Dr. Katz if the mid-year deficit projections include statewide initiatives that may or may not pass. Dr. Katz replied that the projections to not include any statewide impacts, nor do they include the deficit that is expected for the next fiscal year. Commissioner Guy said it is good that the Commission is beginning the discussion now, and there should be a follow up discussion on the next agenda. There needs to be strategic planning after the election. She added that none of the propositions address the issue that DPH does not have a baseline budget. Commissioner Chow said the situation remains fluid and there will be more information after the election. He thanked the public for its thoughtful testimony. He hopes the anti-gambling initiative could be maintained and that NICOS is part of any strategic planning discussions. Commissioner Sanchez said that rather than a continuum of care we have a continuum of challenges. 9) PUBLIC COMMENT/OTHER BUSINESS Patrick Monette-Shaw - written summary attached* 10) ADJOURNMENT The meeting was adjourned at 5:45 p.m. Michele M. Olson, Executive Secretary to the Health Commission Health Commission meeting minutes are approved by the Commission at the next regularly scheduled Health Commission meeting. Any written summaries of 150 words or less that are provided by persons who spoke at public comment are attached. The written summaries are prepared by members of the public, the opinions and representations are those of the author, and the City does not represent or warrant the correctness of any factual representations and is not responsible for the content. *Written Summaries of Public Testimony Submitted by Members of the Public From Patrick Monette-Shaw for Item 6 - Commissioner Chow noted this Commission will consider a resolution tonight regarding the new DPH Strategic Plan. You can’t consider any Resolution, because it hasn’t been placed on today’s agenda as an action item, required by the Sunshine Ordinance, nor has copies of the resolution been made public and available on the table containing meeting materials. Anne Kronenberg indicated that the Mission and Vision for DPH is unchanged, but then Mr. Soos notes 83 of the objectives were changed or revised. The new Strategic Plan makes no mention of Dr. Katz’s new vision for Laguna Honda Hospital as “a psychosocial rehabilitation center for the urban poor,” which is a huge change in DPH’s mission. Despite a Guiding Principle the Strategic Plan wouldn’t be driven by “fiscal realities,” Goal 1, Objective 11 regarding patient flow fails mentioning the LHH admission policy change has been completely driven by financial pressure over decertified days. From Patrick Monette-Shaw for Item 8 - Dr. Katz just quoted Yogi Bera’s famous line, “It’s deja vu all over again,” referring to the $23 million in cuts DPH should Propositions J, K, and O. Dr. Katz has recommended cutting the same programs cut during the budget battle last summer, but were subsequently restored by the Board of Supervisors. It’s deja vu for me, too, since my recommendation to cut the fat from DPH’s top management last summer was ignored. Eliminating just four of DPH’s 16 managers of IS could prevent cutting the African American Health Initiative ($209,359), and could prevent having to implement a pharmacy co-payment for SFGH outpatients ($279,000). DPH knows the co-payments will be such a burden on these outpatients that they simply won’t be able to afford them, and Dr. Katz is projecting decreased utilization of pharmaceuticals, which could endanger lives. It is time for fresh ideas. Pitting client against client must stop. From Patrick Monette-Shaw for Item 9 - During Agenda Item 6, Ms. Kronenberg noted the Commission sought input from two of the three Joint Conference Committees. Why wasn’t the Laguna Honda JCC consulted? Could it be Dr. Katz’s new vision that LHH’s mission will be a “psychosocial rehabilitation facility for the urban poor” would not have been approved by LHH’s Executive Committee and medical staff? As well, last summer Commissioner Monfredini and I had a conversation about the raid of $25 million from the tobacco settlement money to rebuild LHH. When I noted there was discussion about changing LHH’s decades-old medical model focus to a social-“wellness model,” I suggested this Commission should put a new proposition before the voters to find new bond money for social rehabilitation, Ms. Monfredini indicated such a measure would be unlikely to pass voter approval. LHH’s bond money for a long-term care nursing home should not be diverted to social wellness programs.