Minutes of the Health Commission Meeting Tuesday, October 4, 2005 at 4:00 p.m. RICHMOND RECREATION CENTER 251 18TH AVENUE San Francisco, CA 94121 1) CALL TO ORDER Commissioner Monfredini called the meeting to order at 4:10 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 Donald E. Tarver, II, M.D. Commissioner David J. Sanchez, Jr., Ph.D. Absent: Commissioner John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF SEPTEMBER 20, 2005 Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Tarver) approved the minutes of the September 20, 2005 Heath Commission meeting, with one correction. The minutes will reflect that the Laguna Honda Hospital Foundation is in suspension, not disbanded. 3) APPROVAL OF THE CONSENT CALENAR OF THE BUDGET COMMITTEE Commissioner Illig chaired and Commissioner Chow and Commissioner Sanchez attended the Budget Committee meeting. (3.1) PHP-Community Health Promotion and Prevention – Request for approval to accept and expend a new grant from Bay Area Community Resources, in the amount of $80,000, to support a four-year pilot project to promote healthy living and prevent and manage chronic health conditions among Russian-speaking newcomers in San Francisco, for the period of October 1, 2005, to June 30, 2009. Commissioners’ Comments Commissioner Illig said Commissioner Tarver is very interested in the outcomes for this project. Ms. Erwin replied that Dr. Lisa Johnson and Dr. Hali Hammer are co-chairs of the initiative, and would be developing specific outcomes around medical indicators, self-efficacy and provider knowledge. Commissioner Chow asked if the materials that are developed by the collaborative would be available to other people beyond the target populations. Ms. Erwin said the intent is to widely distribute the materials. (3.2) AIDS OFFICE-Prevention Services – Request for approval of a retroactive new contract with Instituto Familiar de la Raza, in the amount of $175,840, which includes a 12% contingency, to provide Prevention with Positives services to the San Francisco Latino population, for the period of August 1, 2005 through June 30, 2006. (3.3) AIDS OFFICE-Prevention Services – Request for approval of a retroactive new contract with Instituto Familiar de la Raza, in the amount of $224,000, which includes a 12% contingency, to provide Health Education and Risk Reduction services to the San Francisco Latino population, for the period of August 1, 2005 through June 30, 2006. Commissioners’ Comments Commissioner Illig asked if the agency is considering expanding its board. Estella Garcia, Executive Director, said that there were eight members of the board until July. The board is interviewing for a replacement, and is also considering term limits. Commissioner Sanchez said that this is an opportunity for Instituto Familiar de la Raza to revisit the pathways it has developed over the past 25 years. (3.4) AIDS OFFICE–HIV Health Services – Request for approval of the following four AIDS Outpatient Mental Health contracts supported with FY 2005-2006-2007 Federal Ryan White CARE Title I (CARE I) funds in the amount of $233,276 for the period of November 1, 2005 through February 28, 2006 and $699,830 for the period of March 1, 2006 through February 28, 2007 pending approval of the Federal CARE title I Grant, and City and County General Fund in the amount of $17,367 for the period of November 1, 2005 through June 30, 2006. In addition, a total 12% contingency, in the amount of $59,833 will be applied, as outlined in the table below. Instituto Familiar de la Raza $149,333 New Leaf $229,913 UCSF - AIDS Health Project $451,860 Westside Community Mental Health $179,200 Total $1,010,306 Mr. Loyce presented a summary of the $4 million 2005/2006 general fund allocations. The Mayor allocated $1.557 million that was used for integrated case management, legal/immigration services, complementary therapies and outpatient substance abuse services. The Board of Supervisor’s added $1.55 million for restoration of CARE reductions and for Centers of Excellence awards. $500,000 was used for two COE solicitations, and the remainder was used to restore services affected by the 2005/06 CARE Award reduction. In addition, the Board added $1 million in general fund dollars. $400,000 has been allocated for methamphetamine treatment. The Director of Public Health will determine the allocation of the remaining $600,000. Commissioners’ Comments Commissioner Chow asked how the specific contract allocations were determined and what the scope of work will be for each contract. Ms. Long replied that there were ten applications and five successful bidders. The scope of work exceeded the money that was available, so each contractor’s scope needed to be revised. This process is still underway, which is why there are no units of service yet. Different bidders applied for different amounts. A review panel ranked the proposals and made funding recommendations. The AIDS Office looked at the populations that were served by agencies not getting funding through this process to make sure they were covered by other providers. Commissioner Illig requested, on behalf of Commissioner Tarver, that New Leaf provide a copy of its most recent cultural competency report. Commissioner Tarver notes that the demographics provided in the packet indicate that 53 percent of program participants are people of color, yet 80 percent of staff are white. (3.5) AIDS OFFICE-Prevention Services – Request for approval of a retroactive new contract with Aguilas, Inc., in the amount of $272,160, which includes a 12% contingency, to provide Health Education and Risk Reduction services and Prevention with Positives services to the San Francisco Latino population, for the period of August 1, 2005 through June 30, 2006. Commissioners’ Comments Commissioner Illig conveyed Commissioner Tarver’s commendation of the pamphlets that the agency distributed at the Castro Street Fair. (3.6) AIDS OFFICE-Prevention Services – Request for approval of a retroactive contract renewal with Centerforce, Inc., in the amount of $156,800, to provide HIV prevention services for the State's HIV Corrections Initiative, targeting inmates at San Quentin State Prison and Valley State Prison for Women, for the period of July 1, 2005 through June 30, 2007. Commissioners’ Comments Commissioner Illig asked if the inmates served through this program are San Francisco residents. Mr. Tierney said they are. (3.7) AIDS OFFICE–HIV Health Services – Request for approval of the following six Centers of Excellence contracts funded with FY 2005-2006-2007 Federal Ryan White CARE Title I (CARE I) funds in the amount of $2,102,973 for the period of November 1, 2005 through February 28, 2006 and $6,308,918 for the period of March 1, 2006 through February 28, 2007 pending award of the Federal CARE Title I Grant, and City and County General Fund in the amount of $110,000 for the period of November 1, 2005 through June 30, 2006. In addition, a total 12% contingency, in the amount of $609,493 will be applied, to all contracts with the exception of the University of California at San Francisco contracts.   Grand Total Mission Neighborhood Health Center $746,667 Tenderloin AIDS Resource Center $2,578,738 UCSF Chronic Care HIV/AIDS Multi-Disciplinary Program (CCHAMP) $2,606,999 UCSF Family Service Network $835,780 Westside Community Mental Health $2,240,000 Native American Health Center $123,200 Michelle Long, Director of Health Services for the AIDS Office, described the Centers of Excellence (COEs). The goals for the COEs are that individuals living with HIV/AIDS and severe needs, or individuals from special populations, will have better health outcomes and improved quality of life; that they will have seamless access to primary medical care and critical support services; and that people currently not in care will be linked to and maintained in health care. Commissioners’ Comments Commissioner Chow asked how it was determined that there would be seven COEs. Ms. Long replied that CARE dollars provided funding for five COEs. The AIDS Office looked at the coverage provided by these five, and found that Native Americans and the jail population would not be served. So they used general fund dollars to fund these two COEs. Commissioner Chow asked how many agencies are being defunded, and how many patients will be impacted. Ms. Long replied that 12 agencies would be defunded, and not included in a COE. The AIDS Office is planning the transition of patients of defunded programs to one of the COEs. Commissioner Illig understands that the COEs will serve high-need patients. He is concerned that people who are not high-need, but were previously served by an integrated service program, will not receive services under this new model. Ms. Long said the AIDS office held a meeting with contractors, and some agencies indicated additional capacity. In addition, there will still be stand alone programs that will service patients who are not as high need. Commissioner Illig said Commissioner Tarver would like additional information about how the UCSF AIDS Health Project is planning to expand services to people of color. Commissioner Illig said the Westside demographics that were included in the packet indicate that the majority of the program clients are white, and asked how the program could serve more African Americans. Abner Boles, Executive Director of Westside, said that the program in question historically served the Castro, but has been relocated to 6th and Folsom. Other steps are also being taken. The Budget Committee asked that an update on this model be presented through a Joint Conference Committee. The report will specifically cover an update on the Centers of Excellence and what happened to people that were not effectively transitioned. In addition, the Budget Committee invited the HIV Planning Council to present at this Joint Conference Committee meeting. The Budget Committee commended staff for the new report format. (3.8) AIDS OFFICE–HIV Health Services – Request for retroactive approval of the FY 2005-2006 City and County of San Francisco General Fund HIV Health Services contract renewals: $2,553,866 in General Fund and a 12% contingency amount of $299,724 for a combined total of $2,853,590 for the period of July 1, 2005 through June 30, 2006 with the following agencies: AIDS Legal Referral Panel $142,483 Asian Pacific Islander Wellness Center $213,854 Immune Enhancement Project $210,083 Instituto Familiar de la Raza $138,437 Legal Services for Children $100,996 Mission Neighborhood Health Center $151,156 Native American AIDS Project $112,000 Positive Resource Center $136,079 Quan Yin Healing Arts Center $121,013 San Francisco AIDS Foundation $1,107,049 Shanti Project $364,298 UCSF - AIDS Health Project $56,142 Total $2,853,590 (3.9) PHP-STD Prevention & Control – Request for approval of a retroactive new contract with PHFE Management Solutions, in the amount of $235,931, which includes a 12 %, to provide fiscal intermediary services to support HIV prevention services which include; Health Education and Risk Reduction, Prevention with Positives, and Partner Counseling and Referral Services, for the period of July 1, 2005 through December 31, 2006. (3.10) PHP–STD Prevention and Control Services - Request for approval to accept and expend a new three year grant from the Centers for Disease Control in the amount of $80,000, to establish an enhanced STD Surveillance Network, for the period of September 30, 2005 through September 29, 2008 and approval of a new contract with PHFE Management Solutions, for the period of January 1, 2006 to December 31, 2006. (3.11) PHP-Community Programs/AB 75 Project – Request for approval of a contract renewal with AmeriChoice, in the amount of $127,700, to provide fiscal intermediary services for the FY 2005-06 CHIP Hospital and Physician Program, for the period of November 15, 2005 through March 31, 2007. (3.12) CBHS-Community Programs – Request for approval of a retroactive contract renewal with Positive Directions Equals Change, in the amount of $305,500 per year, for a total contract amount of $1,368,640, which includes a 12% contingency, to provide outpatient substance abuse treatment services, for the period of July 1, 2005 through June 30, 2009. (3.13) CHN-SFGH Radiology – Request for approval of a sole source contract renewal with Aureus Radiology, LLC, in the amount of $100,000, to provide as-needed Digital Mammography Radiology screening services in a mobile van setting on behalf of San Francisco General Hospital’s Avon Breast Center, for the period of October 1, 2005 through September 30, 2006. Commissioners’ Comments Commissioner Illig asked if the contractor is complying with the City’s equal benefits ordinance. Galen Leung replied that the Department received a 12B waiver for this contract from the Human Rights Commission with the stipulation that the service is put out to bid next year. Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Tarver) approved the Budget Committee Consent Calendar. 4) DIRECTOR’S REPORT Anne Kronenberg, Acting Director of Health, submitted the Director’s Report for review and comment. SFGH Certification Survey Results San Francisco General Hospital’s annual unannounced licensing and certification survey for long-term care from the Department of Health Services began on September 19th and was successfully completed on Thursday, September 22nd with only three minor deficiencies identified. SFGH has two long-term care facilities on campus: a 30-bed unit located in the Main Hospital on 4A, and a 60-bed unit located at the San Francisco Behavioral Health Center (SFBHC). We are pleased with the outcome of this survey that reflects the excellent care our staff delivers to our long-term patients throughout the Department. Chinatown Public Health Center The staff of Chinatown Public Health Center today kicked off the “San Francisco Chinese 5-a-Day Project” at the Four Seas Restaurant with a press conference and luncheon. This is the first California Nutrition Network project in the state targeting low income Chinese population to promote fruit and vegetable intake and an active lifestyle. Over 20 community partner agencies participated in this project. Today’s event featured Martin Yan, author and star of the TV show Yan Can Cook, along with Assemblyman Leland Yee, Board of Supervisor President Aaron Peskin and a number of other federal, state and local representatives. The Chinese 5-a-Day Project developed a 50-page, bilingual Chinese/English education flipchart-cookbook offering tips on increasing fruit and vegetable intake and physical activity, the dietary guidelines for 2005 and innovative Chinese cooking recipes. Martin Yan assisted in the development of the low fat, nutritious recipes. The Health Commissioners will be receiving a copy of the cookbook. Thanks to Catherine Wong and Grace Lam of the Chinatown Public Health Center for their excellent work on this project. Hurricane Katrina Volunteer San Francisco General Hospital Surgeon Jan Horn, MD, has returned from three weeks service in New Orleans as a member of a Search and Rescue Team under the auspices of FEMA. Dr. Horn and his team were responsible for evacuating patients who were stranded in New Orleans, and, unfortunately, were heavily involved in the recovery of individuals who did not survive Hurricane Katrina. We are proud of Dr. Horn’s contribution to the relief effort, and thankful for his safe return. 10/05 07/05 to 10/05 New Appointments 25 53     Reinstatements 0 0 Reappointments 37 121     Delinquencies: 0     Reappointment Denials: 0 Resigned/Retired: 7 45 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Deceased 0 0 Changes in Privileges     Additions 5 15     Voluntary Relinquishments 6 9     Proctorship Completed 33 8     Proctorship Extension 0 6 Current Statistics - as of 10/1/05 Active Staff 466 Affiliate Professionals (non-physicians) 193 Courtesy Staff 558 TOTAL MEMBERS 1,217 Applications In Process 30 Applications Withdrawn Month of October 2005 1 0 (07/05 to 10/05) SFGH Reappointments in Process Nov. 2005 to Feb. 2006 197 LHH Credentials Year-to-Date Report - 7/1/2005 to 9/20/2005 New Appointments 5     Reinstatements 0     Withdrawal 0 Reappointments 10     Delinquencies: 0     Reappointment Denials: 0 Resigned/Retired 8 Disciplinary Actions 0 Restriction/Limitation of Privileges 0 Changes in Privileges 0     Additions 0     Voluntary Relinquishments 0 5) PRESENTATION OF DPH SERVICES AND DEMOGRAPHICS OF THE RICHMOND DISTRICT Jim Soos, Senior Health Planner, Policy and Planning, presented health data for 94118 and 94121, the two zip codes that encompass the Richmond. There are 83,000 residents in these two zip codes, which is 10 percent of the San Francisco population. Mr. Soos described residents by gender, age, ethnicity and income. The average income is higher than in many parts of the city, but this data is skewed because 94118 includes Presidio Heights and Laurel Heights. One in seven households in the Richmond earns less than $20,000. The Richmond has a high number of pedestrian injuries and death. Between 1995 and 2004 there were 38 severe injuries and nine deaths in the Inner Richmond, and 22 severe injuries and three deaths in the Outer Richmond. Richmond residents do not extensively use DPH services. The percentage of DPH clients is as follows: 4% of inpatient and primary care clients, 3% of aging and long-term care clients, 4% of Community Behavioral Health Services and 2% of AIDS clients. The Department funds a variety of programs that serve Richmond residents. 6) PUBLIC HEARING ON HEALTH NEEDS IN THE RICHMOND DISTRICT Commissioner Monfredini welcomed everyone to the meeting. The Health Commission is pleased to be in the Richmond to learn about community concerns. Carly Leung, Newcomer’s Health Program, said the Newcomer’s Health Program provides health screening and services to newcomers in San Francisco. Many asylees have serious health problems. The Chinese asylee community appreciates the services the program provides, and benefit from it. Commissioner Tarver asked if there are issues around accessing services, since the clinic is located at San Francisco General Hospital. Ms. Leung said this has not been a problem, since SFGH is in a central part of the city. They are in good communication with the people in the program to make sure people make their appointments. Commissioner Guy asked how clients get connected to program. Ms. Leung said they have two primary methods. First, they do home visits and talk to neighbors to see who could benefit from services. Second, they receive a list of people who have applied for asylum status within the United States. Commissioner Sanchez said it is very commendable that staff is able reach these populations. Olga Radom, Newcomer Health Program. Ms. Radom is a health worker and also came to this country as a refugee. In San Francisco, the Russian-speaking newcomer population has grown over the past decade. Russian immigrants have chronic health problems. It is a diverse population. Most clients experience many difficulties before immigrating to the United States. Most lose educational and socio-economic status when they come to the U.S. Many do not understand the U.S. health model. The program provides outreach, health assessment, treatment, interpretation and health education. She said that DPH should be looking at finding the financial support for getting people to the refugee health clinic, for example taxi vouchers. Public transportation can be complex. The Russian community is not an easy community. Sasha Mosalov, Sunset Russian Tobacco Education Program. A new branch of the program is Let’s Be Healthy, which is a new approach that includes chronic disease management, healthy eating, physical activity, including walking groups. One way the Commission could help is to have the doctors give support for the effort, and to offer ideas. Commissioner Monfredini asked if it is difficult to persuade Russian women to get mammograms. Ms. Radom replied that mammograms are part of the newcomer screening, and she has never had anyone decline one. Kyle Shea, GOYAC youth advisory council at Washington High School. He said there are no queer youth programs in the Richmond community. When he came out in 7th grade, he had no clue about where to go. He would get attacked and did not know how to get help. Commissioner Monfredini asked Mr. Loyce to connect with Mr. Shea and talk about what services the AIDS Office has to offer. Commissioner Guy recommended that he work through the Health Commission’s Youth Health Advisors. Commissioner Illig urged him to contact Youth Space, which is looking for outreach opportunities. Bryant Tan, API Wellness Center Youth Program Coordinator, thanked the Commission for supporting their efforts to increase resources for gay youth. The API Wellness Center occasionally comes out to the Richmond. Queer youth services need to be localized in the community. His center is in the Tenderloin, and many API queer youth live in the Richmond and Sunset. The city needs localized queer youth services. Secondly, there is a need for culturally competent information for Asian families. Jason Kwong, API Wellness Center, lives in the Richmond district and asked for additional queer youth services in the Richmond. He told the story of his friend who recently came out to his parents. He really needs resources to help him with this process. Commissioner Tarver said it is critical that people coming out have needed resources. He appreciates that youth are willing to speak about these issues. Sai-Ling Chan-Sew, DPH Community Behavioral Health Services, said that DPH used to fund RAMS to run a drop in program at Washington High School for queer youth. She will look into the feasibility of reinstituting this program. Commissioner Guy said the schools are a natural connection. Milo Santos, the Health Commission’s Youth Health Advisor, will work with staff and report through the PHP JCC. Carolyn Kozen, services coordinator for Asian Youth Prevention Services program at JCYC, talked about behavioral health findings specific to API youth. There is a misperception of Asian’s behavioral health needs because of the model minority stereotype. 71% of youth surveyed reported feeling depressed or suicidal. They would like to work with schools to provide culturally competent mental health services at the schools. They would also like disaggregated data collected for the Asian population. And the community needs more substance abuse services. She submitted a copy of the report recommendations, which are on file in the Health Commission office. Commissioner Chow said the Health Department has programs and contractors that provide the kinds of services we need, and we need to get these services together. Rod Magbual, Japanese Community Youth Center (JCYC), said that aggregating Asian data could mask ethnic-specific problems. It is great that the Commission comes out to the neighborhood level. There is a tremendous need, and communities should get together. He is a health educator at Presidio Middle School. Asian youth are misperceived as a model minority, but they have needs and their families have needs. The perceptions need to be deconstructed. Ms. Chan-Sew said that in response to the March 2004 survey, called the SAAY Report, DPH began a small contract with JCYC to look at how to further the SAAY report recommendations, particularly around depression. Commissioner Sanchez said that funds have been allocated for school-based services at the School District level and we should reinitiate the discussion with the district about school-based services. Commissioner Illig suggested that the Health Commission send a letter to the Youth Commission suggesting that they hold a hearing in the Richmond around these issues. Commissioner Chow asked that the Community Programs and Services Joint Conference Committee get a follow up report from Ms. Chan-Sew about the SAAY report recommendations. Benny Wong, Family Services Agency, said they need more services to educate the Chinese community about mental health problems. FSA provides services to the Chinese community, but there is no funding for education. Mr. Wong submitted a copy of a study of San Francisco Chinese immigrant seniors’ perception of their illnesses, which is on file in the Health Commission office. Kavoos Bassiri, Executive Director of Richmond Areas Multi Services (RAMS), said RAMS was founded in the Richmond District in 1974 because there was no public health clinic in the area. RAMS has 25 programs covering 18 languages. They also have programs throughout the city. The agency has residential programs, vocational programs, children’s services, school-based services, outpatient programs, outreach programs and many others. So they are providing a lot of services, but Mr. Bassiri highlighted three areas of need. The first is additional funding to maintain bilingual and trilingual staff. Lack of funding makes it difficult to recruit and maintain staff. The second is to have flexibility in service delivery, because traditional psychotherapy is not going to work all the time with this population. They want to do outreach and want to work in the schools, but funding support is difficult. Third is to support collaborations and partnerships. They have a partnership with Richmond District Neighborhood Center, but this was cut last year. When effective outreach is done, the Asian community is very interested in treatment and services. Carol Mu, RAMS, said there is no limit to how many patients are served by one provider. This is unrealistic, since staff and money are limited. She has trouble discharging people to private providers because private providers are unwilling to accept Medi-Cal. The primary care clinics are impacted. Judy Lam, Ph.D., director of the Adult Outpatient Services Clinic at RAMS, said the patients she sees need safe housing, employment opportunities and places to go to socialize so that their isolation is minimized. People diagnosed with mental health issues need a place to go socialize. If the Richmond had something like that, patients’ health and overall quality of life would improve. When she loses culturally competent providers to DPH or to Kaiser because they are able to pay more, she has an extremely difficult time hiring replacements. She also advocated for smoking education program and domestic violence programs in the Richmond. Rose Sneed, Fu Yau Project. The Fu Yau Project is a collaboration between RAMS Children’s Department and CCDC. The program provides mental health consultation to child care providers. The program is all over the city, with some of the services in the Richmond. The majority of the children they work with live in low-income households or are homeless. They try to do prevention work with the children in the childcare setting. They work with teachers who are dealing with children who are acting out. Christopher Chow, Executive Director of Richmond Village Beacon Center. The Beacon Center is one of eight throughout San Francisco. It is a unique partnership with DPH, DCYF, the School District and others. They have a variety of programs at Washington High School with various communities, including African Americans, Latinos, queer youth, etc. One of the things he finds in the Richmond is that is it so big that people feel isolated. Washington High School has 2,400 students. Richmond Beacon has access to students and parents that others do not have. On the other hand, people come to his program with the school district issues. The Richmond District has many high need children, youth and families. 45% of Richmond District residents speak a primary language other than English. There is a need for more linguistic capacity in health services delivery. He submitted a copy of his testimony, which is on file with the Health Commission office. Winnie Xie, a resident of the Richmond, said parents she talks to notice several issues that she wants to bring to the Health Commission’s attention. First is more coordination between the schools, the Health Department and Recreation and Park. Second, lots of kids have depression and we need to talk about how to best treat these problems. Commissioner Monfredini thanked everyone for speaking and educating the Commission about the needs and service gaps. She suggested that the Health Commission digest this information and bring specific issues back though the Joint Conference Committees. Commissioner Illig said a lot of what he heard today was about the need for coordination between services that already exist. He also wants the Health Commission to get an update on the impact of the administrative cuts in Primary Care. He also wants to provide bilingual pay premiums for contractor staff. 7) PUBLIC COMMENT/OTHER BUSINESS None. 8) ADJOURNMENT The meeting was adjourned at 6:40 p.m. Michele M. Seaton, 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.