Minutes of the Health Commission Meeting Tuesday, February 15, 2005 at 3:00 p.m. 101 GROVE STREET, ROOM 300 San Francisco, CA 94102 1) CALL TO ORDER Commissioner Monfredini called the meeting to order at 3:08 p.m. Present: Commissioner Lee Ann Monfredini, President Commissioner Roma P. Guy, M.S.W., Vice President Commissioner Edward A. Chow, M.D. Commissioner James M. Illig Commissioner David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. Commissioner Monfredini announced that Item 7, the presentation of the FY 2005-2006 budget, would not be presented at today’s meeting. Commissioner Monfredini announced the 2005 Health Commission committee assignments: Joint Conference Committee For Community Programs And Services (CPS JCC): David J. Sanchez, Jr., Ph.D., Chair, Roma P. Guy, MSW, Member Joint Conference Committee For Laguna Honda Hospital (LHH JCC): Edward A. Chow, M.D., Chair, James M. Illig, Member Joint Conference Committee For San Francisco General Hospital (SFGH JCC): Lee Ann Monfredini, Chair, John Umekubo, M.D., Member Budget Committee James M. Illig, Chair, Edward A. Chow, M.D., Member, David J. Sanchez, Jr., Ph.D., Member IHSS Public Authority James M. Illig S.F. Health Authority John I. Umekubo, M.D. SFGH Foundation David J. Sanchez, Jr., Ph.D. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF FEBRUARY 1, 2005 Action Taken: The Commission approved the minutes of the February 1, 2005 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Illig chaired, and Commissioner Chow and Commissioner Sanchez attended, the Budget Committee meeting. (3.1) SFGH-Finance Office – Request for approval to submit a resolution to the Board of Supervisors to accept revenues newly estimated to exceed $1,000,000, under a contract with Triage Consulting Group, previously approved by the Health Commission on July 6, 2004. (3.2) AIDS Office-HIV Health Services - Request for approval of the FY 2005-2006 Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 Title I contracts for a combined total of $474,893 for the period of March 1, 2005 through February 28, 2006, for HIV Health Services programs with the Regents of the University of California – San Francisco (UCSF) with the following programs: Department Service Description 12-Month Amt UCSF - AIDS Health Project Mental Health Crisis Services $310,358 UCSF - AIDS Health Project Primary Care $164,535   TOTAL $474,893 Secretary’s Note – For Primary Care services, the agenda should read “UCSF-Pediatrics AIDS Project” rather than “UCSF AIDS Health Project.” Commissioners’ Comments Commissioner Chow asked that the Commission receive monitoring reports and demographic information for these two contracts. Ms. Long Dixon, Director, HIV Health Services, replied that the 2004-2005 monitoring reports would be completed at the end of April, and she will forward the information to the Commissioners through the Joint Conference Committee. Commissioner Illig asked that there be uniformity in the kind of information that is presented with the agenda items, specifically in the areas of contract monitoring and demographics. Commissioner Sanchez abstained from voting on this item. (3.3) AIDS Office-HIV Health Services - Request for approval of the FY 2005-2006 Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 Title I contracts for a combined total of $519,263 for the period of March 1, 2005 through October 31, 2005, for HIV Health Services programs with the Regents of the University of California – San Francisco (UCSF) with the following programs: Department Service Description 8-Month Amt UCSF - AIDS Health Project Mental Health Services $360,145 UCSF - Women’s Specialty Clinic Primary Medical Care $142,451 UCSF - Positive Health Practice Men of Color Program $16,667   TOTAL $519,263 Commissioners’ Comments Commissioner Chow requested a copy of the Centers of Excellence solicitation once it is released. Commissioner Sanchez abstained from voting on this item. (3.4) AIDS Office-Health Services - Request for approval of the FY 2005-2006 Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 Title I and Title II contracts for a combined total of $14,232,623 for the period of March 1, 2005 through February 28, 2006 for Title I funds, and April 1, 2005 through March 31, 2006 for Title II funds for HIV Health Services programs with the following agencies (These agencies listed below in italics will be offered a six-month extension): Agency 12 Month Amount 12% Contingency Amount Total Amount AIDS Community Research Consortium $88,067 $10,568 $98,635 AIDS Emergency Fund $637,553 $76,506 $714,059 Asian Pacific Islander Wellness Center (APIWC) $45,247 $5,430 $50,677 Baker Places, Inc. $126,089 $15,131 $141,220 Baker Places, Inc. (CARE II) $41,074 $4,929 $46,003 Catholic Charities $163,398 $9,608 $183,006 Community Awareness & Treatment Services $199,625 $23,955 $223,580 Community Awareness & Treatment Services $201,951 $24,234 $226,185 Dolores Street Community Center $174,033 $20,884 $194,917 Haight Ashbury Free Clinic $709,776 $85,173 $794,949 Housing & Urban Health Services - Contracts:       Ark of Refuge, Inc. $302,705 $36,325 $339,030 Baker Places, Inc. $1,308,662 $157,040 $1,465,702 Black Coalition on AIDS $360,108 $43,213 $403,321 Catholic Charities $1,078,483 $129,418 $1,207,901 Larkin Street Youth Center $579,134 $69,496 $648,630 Lutheran Social Services $132,080 $15,850 $147,930 San Francisco AIDS Foundation $2,544,315 $305,318 $2,849,633 Tenderloin AIDS Resource Center $171,788 $20,615 $192,403 Walden House, Inc. $72,960 $8,755 $81,715 The Latino Commission $250,000 $30,000 $280,000 Lutheran Social Services $532,056 $63,847 $595,903 Marin Department of Health & Human Services $1,045,981 $125,518 $1,171,499 Positive Resource Center $268,815 $32,258 $301,073 San Francisco Food Bank $92,800 $11,136 $103,936 San Francisco Suicide Prevention $101,794 $12,215 $114,009 San Mateo County AIDS Program $2,226,607 $267,193 $2,493,800 University of Pacific - School of Dentistry $523,215 $62,786 $586,001 Walden House $1,275,755 $153,091 $1,428,846 Westside Community Mental Health $192,522 $23,103 $215,625 TOTAL $13,446,593   $14,232,623 Ms. Long Dixon said that the contract with Haight Ashbury Free Clinic was being removed from the list of requested contract approvals. Commissioners’ Comments Commissioner Chow clarified that the request is for a six-month interim extension, and then when the individual contracts are finalized they would come back to the Health Commission for approval. Ms. Long Dixon said that in the past, contracts have only come back to the Health Commission if an agency received a monitoring report that was not acceptable or commendable. Commissioner Chow asked that these be interim approvals only, and that the contracts come back to the Health Commission for approval. Ms. Long Dixon agreed to do this. Commissioner Illig said that if an agency has submitted a written response to a contract monitoring finding, that this response be included in the packet that is presented to the Budget Committee. (3.5) AIDS Office-HIV Health Services - Request for approval of FY 2005-2006 Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 Title I contracts for a combined total of $12,559,316 for the eight month interim agreement period of March 1, 2005 through October 31, 2005. Agency 12-Month Annualized Amount 8-Month Amount Ark of Refuge $94,081 $62,721 Asian Pacific Islander Wellness Center (APIWC) $20,685 $13,791 Asian Pacific Islander Wellness Center (APIWC) $203,098 $135,399 Community Awareness & Treatment Services $20,143 $13,429 Continuum HIV Day Services $135,556 $90,371 Continuum HIV Day Services $302,833 $201,889 Family Service Agency of San Francisco $188,590 $125,726 Haight Ashbury Free Clinic $415,059 $276,707 Institute for Community Health Outreach $141,051 $94,035 Instituto Familiar de la Raza $227,178 $151,452 Iris Center $144,375 $96,251 Lyon Martin Women’s Health Services $328,912 $219,275 New Leaf $141,691 $94,461 Saint Mary’s Medical Center $580,585 $387,057 San Francisco Community Clinic Consortium $328,253 $218,836 Tenderloin AIDS Resource Center $566,874 $377,916 TOTAL   $12,559,316 Ms. Long Dixon said that the contract with Haight Ashbury Free Clinic was being removed from the list of requested contract approvals. Commissioners’ Comments Commissioner Chow said that it seems that many agencies need assistance in meeting cultural competency requirements, and he Chow would like to understand if agencies face common difficulties. Ms. Long Dixon said that these issues would be discussed in the 2004-2005 monitoring reports. Commissioner Illig is concerned that contractors, who are already facing funding constraints, would be required to set aside money for things like translation, TDD/TDY and other things. He suggested that the Commission take another look at the cultural competency requirements to see what is encouraged and what is mandated. Commissioner Illig and Commissioner Umekubo abstained from voting on this item as it pertains to the contract with St. Mary’s Medical Center. (3.6) PHP-EMSA - Request for approval of a new perpetual software license and software maintenance agreement with FirstWatch Solutions, in the amount of $72,800, to provide access to the FirstWatchTM software application for the Real Time Syndromic Surveillance Information Project, for the period of March 1, 2005 through March 31, 2009, for a total contract value of $72,800. (3.7) BHS-Mental Health - Request for approval of a new contract with Resource Development Associates in the amount of $114,285 to provide consulting services to develop the Mental Health Services Act (Proposition 63) plan, for the period of February 22, 2005 through September 30, 2005. (3.8) BHS-Mental Health - Request for approval of a retroactive contract renewal with the Regents of the University of California, in the amount of $359,022, to provide crisis intervention and stabilization, clinical case management and linkage services, for the period of July 1, 2004 through June 30, 2005. Commissioners’ Comments Commissioner Chow asked what was being done to address the program performance issues. Mitzi Goya, program director, said there was a lot of change in leadership in 2002-2003. The medical director and case managers left, and she was on maternity leave. In May 2003 she did an analysis and was able to turn things around. The program is currently at 84 percent of productivity. Commissioner Sanchez abstained from voting on this item. (3.9) BHS – Request for approval to accept and expend retroactively funds from the University of California, San Francisco (UCSF), in the amount of $276,279, for expansion of the Positive Health Program at San Francisco General Hospital for local and multi-site evaluation activities on the integration of buprenorphine into the Positive Health Program, for the period of September 1, 2004 to August 31, 2009. Commissioners’ Comments Commissioner Chow requested an update on this program and the OBOAT initiative at the Community Programs and Services Joint Conference Committee. (3.10) AIDS Office-HIV Health Services – Request for approval of a new contract with Patricia Sullivan, in the amount of $297,410, to provide consultant services for the purchase and distribution of vouchers to CARE-funded service providers, for the period of certification through February 28, 2005. Jimmy Loyce, Director of the AIDS Office, provided additional background on the proposed contract. The contract was let through an RFP process. The CARE council determined at the end of the year that they wanted this money to be spent on vouchers. DPH staff will purchase and distribute the vouchers. The role of the contractor is to pay the bills for the voucher. She is insured for $1 million and bonded. Public Comment Randy Allgaier, chair, San Francisco HIV Health Services Planning Council, expressed that the Planning Council has prioritized the rollover funds to be spend on vouchers for transportation, food and clothing. It is important to the Planning Council that the money is spent down so that monies are not returned to HRSA, and they appreciate the work the Health Commission does to facilitate this process. Commissioners’ Comments Commissioner Chow asked for clarification about the risk of losing unexpended funds. Mr. Loyce said that the current administration is looking very closely at rollover requests, and Ryan White is under scrutiny across the country. Commissioner Chow asked why the Department does not pay the bills for the vouchers, but instead uses an outside vendor. Mr. Loyce said the process takes too long, and these funds have to be expended very quickly. Commissioner Illig said every year since CARE funding was authorized, HRSA has approved the rollover. Commissioner Illig asked if the 2003 request for solicitation was to distribute vouchers. Ms. Long Dixon said Ms. Sullivan has been certified as a professional consultant. The scope of work is consistent with the work she is being asked to perform. Commissioner Sanchez said that there was a valid processes for both using the funds for vouchers and selecting the individual to facilitate issuing the vouchers. So he supports this direction. Commissioner Illig explained his concerns with this issue. This year there has been a $2.4 million cut to HIV/AIDS services. He disagrees with the Planning Council’s decision to put this money into vouchers instead of direct services. He asked the AIDS Office to report to the Budget Committee the rollover request amount. Mr. Loyce said he would report this to the Health Commission when the FSR is complete. Commissioner Illig wants to improve communication with the Planning Council so that the Council and the Health Commission are on the same page with regard to funding priorities. Commissioner Sanchez appreciates the spirit of inquiry and the sharing of information. This is what makes the Budget Committee productive, improves dialogue with agencies and positively impacts outcomes. Action taken: The Commission approved Item 3.1 through 3.3 and 3.6 through 3.10 of the Budget Committee Consent Calendar. For Item 3.4, the Commission approved six-month contract extensions, with the contracts coming back to the Health Commission for approval of the 12-month renewals. For Item 3.5, the Commission approved eight-month contract extensions, with the contracts coming back to the Health Commission for approval of the 12-month renewals. The contract with Haight Ashbury Free Clinics was removed from Item 3.4 and Item 3.5. Commissioner Sanchez abstained from voting on Item 3.2, Item 3.3, Item 3.8 and Item 3.9. Commissioner Illig abstained from voting on Item 3.5 as it pertains to the contract with St. Mary’s Medical Center. Commissioner Umekubo abstained from voting on Item 3.5 as it pertains to the contract with St. Mary’s Medical Center. Commissioner Chow requested an update on the OBOAT initiative at the CPS JCC. Commissioner Chow and Commissioner Illig requested that the Health Commission have a discussion about cultural competency guidelines. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., presented the Director’s Report. Federal Budget On February 7th, President Bush released his $2.57 trillion fiscal year 2006 budget. The budget proposes a 1.2 percent decrease to discretionary funds in the federal Health and Human Services (HHS) budget, including large reductions for the Centers for Disease Control and Prevention, $60 billion in reductions to Medicaid, and the elimination or significant reduction of a large number of HHS programs. The budget proposal would eliminate 99 programs, make large reductions in funds for 55 and restructure 16 to save a net total of $17.2 billion. The HHS programs to be cut include seven Health Resources and Services Administration programs that fund emergency medical services for children, hospital construction, traumatic brain injury and hearing tests for infants. In addition, the budget proposal would eliminate a $59 million federal anti-obesity campaign that encourages children ages nine to 13 to exercise. The Medicaid reductions are to be accomplished through a number of provisions, such as limits on state claims for federal matching funds, restrictions on transfers of assets by seniors to obtain Medicaid eligibility, and reductions in reimbursements for prescription drugs. Of particular importance to California is the Administration’s proposal to save $15.2 billion from efforts to restrict states’ use of intergovernmental transfers (IGTs) and from proposals to limit payments to public providers to no more than the cost of providing services. Estimates show that the President’s budget would reduce funding for Medi-Cal by $550 million to $18.96 billion. In addition, the Bush administration also announced plans to work with governors to "chart far more sweeping changes" in Medicaid than those included in the budget proposal. Governor Schwarzenegger is meeting with the Bush Administration this week to discuss, among other things, California’s proposed changes to safety net hospital financing. Other states will be watching to see if California is among the first states where these “sweeping” changes are negotiated. SFGH Core Measures Dr. Katz congratulated the staff of San Francisco General Hospital on their good marks for quality patient-care, referring to an article published in the San Francisco Examiner last week that highlighted the use of Core Measures by the Centers for Medicare and Medicaid Services (CMS). Core Measures are sets of clinical performance indicators used by JCAHO and CMS as a measure of quality of care on selected health diagnoses. All hospitals are required to submit data on three core measure sets. SFGH submits data on Pneumonia, Heart Failure and Acute Myocardial Infarction. The first publication of core measure results was available at the end of last year. As noted in the article, SFGH administered ACE Inhibitor 95 percent of the time to patients with heart failure for LVSD (Left Ventricular Systolic Dysfunction). The 95 percent score was within the top 10 percent of all reporting hospitals nationwide. It was also the best of all San Francisco hospitals that reported at least 25 cases of heart failure. The high score was contributed, in part, to the use of preprinted protocols implemented by the Department of Medicine. Mammovan Moves into Service The Mammovan’s inaugural day February 9th at the Native American Health Center was a success. The clinic staff created a women’s health day with culturally competent breast health education, nutrition and HIV counseling, dental screening, diabetes testing, breakfast and lunch, incentives and a raffle. Thirty-two women were screened, including several homeless women. The Mammovan will be going out once or twice weekly on a rotating basis to various neighborhood clinics such as Chinatown Public Health Clinic, Maxine Hall in the Western Addition and Southeast in BVHP. Appointment to Health Service Board On February 9th, 2005, Mayor Gavin Newsom appointed Dr. Katz Commissioner to the Health Service Board. Dr. Katz attended his first meeting last Thursday. He hopes to bring his experience in the Health Department as well as his experience as Board Chair of the San Francisco Health Authority to helping to determine health benefits for City employees, retirees and dependents. Commissioners’ Comments Commissioner Chow asked how the federal budget cuts might impact San Francisco. Dr. Katz said that if the proposals were approved, the result would mean millions of dollars of lost revenue to San Francisco. Of particular concern are the intergovernmental transfers. The City’s budget does not consider possible federal impacts. Commissioner Guy congratulated San Francisco General Hospital for the recognition of its quality service. Commissioner Umekubo congratulated San Francisco General Hospital and applauded the trend toward best practices and protocols. This will translate to better care. Commissioner Chow suggested that the Hospital Council look at more widespread utilization of preprinted protocols. Commissioner Illig added his congratulations to San Francisco General Hospital, and hopes that this could be more widely publicized. Commissioner Monfredini reiterated her thanks to the Avon Foundation for its support of the Mammovan, and thanked Gene O’Connell for her leadership it getting the Mammovan back in operations. 5) CONSIDERATION OF A RESOLUTION ENDORSING THE EMS POLICY ON MEDICAL PLANS FOR MASS GATHERINGS John Brown, M.D., Medical Director, EMS Agency presented an overview on the proposed EMS policy on medical plans for mass gatherings. The purpose of the policy is to provide guidelines for type and amounts of medical coverage at various venues, and allow for flexibility to match venue-specific needs with available resources. This policy should decrease dependence on non-event EMS system. The policy was developed using lessons learned from the “Mellow Millennium” response, medical literature, successful Halloween in the Castro events and the San Diego Model. Plans must address: description of venue; safety of participants and spectators; communication; medical resources and evaluation of ill or injured. Types of resources that may be needed include first aid stations, ambulances, mobile teams and CPR and 911 access. Dr. Brown said there was a public comment period on the proposed policy from January 21 through February 5, 2005, and a public meeting to receive comments on February 1. Comments and responses ranged from concerns that the policy was too demanding to not being comprehensive enough. Most were supportive of the concept. The policy was modified to include suggestions and clarify points as requested. The policy is contingent on the Board of Supervisors changing City ordinances, and the effective date would be announced after the Board takes action. Event after-action reports would be reviewed to see if lessons learned suggest any changes to the process or policy. Dr. Brown said non-EMS stakeholders are welcome to attend Operations Advisory Meetings to discuss the policy. Public Comment Joseph Pred, owner of Mutual Aid Response Services and a commissioner on the Entertainment Commission, spoke in support of the policy, as written and modified through the public comment process. This will improve the quality of care at large events. Commissioners’ Comments Commissioner Monfredini asked what happens with spontaneous events. Dr. Brown said the policy tries to address protester events where a permit is required, even though these permits are issued on short notice, to ensure that organizers consider access to emergency care. If there is no advance warning about mass gatherings, the Fire Department has the ability to respond, and in certain instances, EMS would activate its multi-casualty incident protocol. Commissioner Monfredini said this is an excellent way to anticipate and prevent problems at events. Action Taken: The Commission approved Resolution 03-05, “Endorsement of the Emergency Medical Services and Emergency Operations Section Policy on Medical Plans for Mass Gatherings,” (Attachment A). 6) PRESENTATION OF THE FY 2004-2005 2nd QUARTER FINANCIAL REPORT Gregg Sass, DPH Chief Financial Officer, presented the FY 2004-2005 2nd Quarter Financial Report. This report presents the second quarter financial projections of revenues and expenditures for the Department of Public Health for fiscal year 2004-05. These projections are based on revenue collected and billed, and expenses incurred for the six months of the fiscal year ending December 31, 2004. In making the projections, staff has taken into account the effect of mid-year budget cuts and projected expenditures for salary, benefits, work orders and fringe benefit projections. Projections include a revenue surplus of $12,482,000 and expenditure deficit of $7,818,000, after adjusting for SB855 IGT transfers to reflect SB855 disproportionate share revenues net of related transfers. Based on this data, the Department of Public Health is projecting a year-end surplus of $4,664,000 for FY 2004-05. Department of Public Health Preliminary Financial Results December 31 Projection   REVENUES EXPENDITURES TOTAL   Revised Current Surplus/ Revised Current Surplus/ Surplus/ Division Budget Projection (Deficit) Budget Projection (Deficit) (Deficit) Department of Public Health           SFGH $543,451,000 $532,868,000 $(10,583,000)  $543,451,000 $527,832,000 $15,619,000  $5,036,000 SB855 Adjustment (98,225,000) (75,088,000) 23,137,000 (98,225,000) (75,088,000) (23,137,000)  -  SFGH Adjusted  $445,226,000  $457,780,000 $12,554,000  $445,226,000  $452,744,000 $(7,518,000)  $5,036,000 Laguna Honda 154,265,000 152,739,000 (1,526,000) 154,265,000 154,761,000 (496,000) (2,022,000) Primary Care 42,187,000 44,226,000   2,039,000 42,187,000 42,197,000   (10,000)   2,029,000 Health at Home 7,665,000   7,478,000 (187,000)   7,665,000   7,237,000   428,000   241,000 Jail Health 21,690,000 21,592,000   (98,000) 21,690,000 22,167,000 (477,000) (575,000) Public Health 91,304,000 91,004,000 (300,000) 91,304,000 90,403,000   901,000   601,000 Mental Health 172,175,000 172,175,000    -   172,175,000 173,171,000 (996,000) (996,000) Substance Abuse 65,095,000 65,095,000    -   65,095,000 64,745,000   350,000   350,000 TOTAL DPH  $999,607,000  $1,012,089,000 12,482,000 $999,607,000  $1,007,425,000 $(7,818,000)  $4,664,000 (1) The Revised Budget in the table above includes: Annual Appropriation Ordinance for DPH, carry forwards from  prior year, Inter Governmental Transfer (IGT) for SB855, Transfer In and Project Related expenses. Mr. Sass presented detailed financial information on for the various divisions in the Department. The mid-year budget cuts have the effect of reducing DPH’s spending authority by $3,500,000. DPH is therefore required to return a surplus of $3,500,000 to the General Fund at year-end. The projections indicate that the Department will exceed this requirement by $1,100,000. Mr. Sass said he anticipates the need for a revenue-funded supplemental appropriation to address current-year structural problems. The amount of this supplemental appropriation will be significantly less than what was needed in the prior year, because the Department made a number of structural corrections to the budget this fiscal year. Commissioners’ Comments Commissioner Illig wants to be sure that the Mayor’s Office understands the underlying reasons for the overexpenditures at Laguna Honda Hospital. Laguna Honda has needs that must be addressed in next year’s budget, and he does not want the hospital to be held responsible for problems that are not of their doing. Commissioner Illig clarified that the financial statement does not include grants. Mr. Sass said the statement only includes general fund. Mr. Sass said he would be happy to present a separate grants report. Commissioner Illig suggested that the report be presented to the Budget Committee first, where there can be in-depth discussion. Commissioner Monfredini asked staff to calendar this report at the most appropriate time, after the budget has been adopted, recognizing that staff is currently overwhelmed with budget preparation. Commissioner Guy asked if there is a trend toward an increasing need for out-of-county IMD beds. Dr. Katz said that one of the goals for the restructured MHRF is to be able to bring some out-of-county placements back to San Francisco. Commissioner Chow is interested in how the Proposition 63 funds are incorporated into Mental Health’s budget, and what the true Mental Health base budget is. Dr. Katz said that there are still discussions about the interpretation of Proposition 63’s maintenance of effort requirements. However there is interest in funding a variety of community placements for out-of-county IMD beds with Proposition 63 funds. Commissioner Umekubo asked why there was an unfavorable variance in capitation revenue at SFGH. Mr. Sass replied that there are a lot of factors. The two areas where they had variances were in larger than budgeted out-of-network costs, and the later-than-expected transfer of pharmacy benefit program to SFGH. 7) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH BUDGET FOR FY 2005-06 This presentation was continued to a future Health Commission meeting. 8) PUBLIC COMMENT/OTHER BUSINESS None. 9) ADJOURNMENT The meeting was adjourned at 4:45 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 changes or corrections to these minutes will be reflected in the minutes of the next 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.