Minutes of the Health Commission Meeting Tuesday, December 6, 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 3:15 p.m. Present: Commissioner Lee Ann Monfredini, President – left at 5:30 p.m. 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 John I. Umekubo, M.D. Absent: Commissioner David J. Sanchez, Jr., Ph.D. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF NOVEMBER 15, 2005 Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Tarver, Umekubo) approved the minutes of the November 15, 2005 Heath Commission meeting, with two corrections. The first paragraph of page 13 was changed to include all of the attendees from CPMC, and the Secretary’s Note for Item 3.18 was changed to June 30, 2006. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Illig chaired and Commissioner Chow attended the Budget Committee meeting. Commissioner Sanchez was absent. (3.1) PHP-Community Behavioral Health Services – Request for approval to accept and expend funds from the SAGE Project, for evaluation of a Center for a Substance Abuse Prevention project focusing on substance abuse, HIV and Hepatitis prevention, in the amount of $205,000, for the period of September 30, 2005 to September 29, 2010. (3.2) PHP-Housing and Urban Health – Request for approval to accept and expend a grant from the Department of Justice, in the amount of $739,982, to expand the Direct Access to Housing program, for the period of July 1, 2005 to June 30, 2006, and approval of a contract with the Tenderloin AIDS Resource Center, in the amount of $505,308, for the same period. (3.3) DPH-Central Administration – Request for approval of a contract modification with P.B. Strategies, LLC, in the amount of $331,087, for a new two-year total of $694,126, which includes a 12% contingency, to provide strategic planning, project management and capital integration services for the Department, for the period of July 1, 2005 through June 30, 2007. Secretary’s Note – the contract modification amount is $192,343, and the two-year contract total is $731,841. (3.4) AIDS Office-HIV Prevention – Request for approval of a retroactive renewal contract with the Harm Reduction Coalition, in the amount of $84,000, which includes a 12% contingency, to provide HIV Prevention skills-building training services to HIV/AIDS service providers, for the period of July 1, 2005 through June 30, 2006. (3.5) AIDS Office-HIV Prevention – Request for approval of a retroactive renewal contract with Better World Advertising, in the amount of $175,840, which includes a 12% contingency, to provide the “HIV Stops With Me” prevention education/social marketing campaign, for the period of October 1, 2005 through December 31, 2005. (3.6) CBHS – Request for approval of a contract renewal with Sunny Hills Children's Garden Family and Children's Services, in the amount of $591,756, to provide mental health services for youth ages 12 through 18, for the period of July 1, 2005 through December 31, 2006. Commissioners’ Comments Commissioner Chow asked why the agency received a score of 2.5 in Program Performance. Ms. Chan-Sew said that the agency inaccurately calculated units of services, and the search for parental or kin participation in family therapy has been challenging. Commissioner Chow asked what will be done with Family Therapy Services. Barry Feinberg, Sunny Hill chief operating officer, said they have put together ambitious outreach and mechanisms to get families involved. (3.7) CBHS – Request for approval of a retroactive contract renewal with the Fred Finch Youth Center, in the amount of $315,257, to provide therapeutic behavioral services and dual diagnosis mental health services for adolescents, for the period of July 1, 2005 through December 31, 2006. Commissioner Chow clarified that the concerns about performance were related to the residential program, and that this year we are not contracting for these services. Ms. Chan-Sew said the residential program would be closed because funding for Level 14 programs is inadequate. Ms. Chan-Sew added that there is a high demand for Level 14. DPH will have to refer to other places, some to Sunny Hill, some to Seneca and elsewhere. Commissioner Illig said that whenever an agency has a needs improvement score, the contract summary needs to include an explanation. (3.8) DPH-Office of Policy and Planning – Request for approval to retroactively accept and expend a two-year contract from California Managed Risk Medical Insurance Board, in the amount of $4,378,351, for the Healthy Kids Project, for the period of July 1, 2005 through June 30, 2007. Commissioners’ Comments Commissioner Illig asked if this revenue goes back into DPH. Mr. Soos said he has been informed by the CFO that that the revenue would come back to DPH and posted as excess revenue, and then be returned to the General Fund. (3.9) CHN-SFGH – Request for approval of two new retroactive contracts with Crdentia Corporation and First Call Nursing Services, Inc., in the amount of $2,700,000, to be shared with previously approved contractors: Agostini Medical Staffing, Arcadia Health Services, Inc., HRN Services, Inc., Medstaff, Inc., Nurse Providers, Inc. and United Nursing International, to provide supplemental, temporary Per diem and Traveling nursing personnel services for San Francisco General Hospital Medical Center, for the period of November 15, 2005 through June 30, 2006. Commissioners’ Comments Commissioner Illig asked if the national firm complies with 12B. Darius Zubrickas from Crdentia said yes. The benefits were already in place for the San Francisco branch, but now the benefits extend to all Credentia employees. (3.10) AIDS Office-HIV Prevention – Request for approval of a retroactive new contract with Tenderloin AIDS Resource Center, in the amount of $135,165, including a 12% contingency, to provide Prevention with Positives Program services in a clinical setting, for the period of August 1, 2005 through June 30, 2006. (3.11) AIDS Office-HIV Health Services – Request for approval of a retroactive new contract with Patricia Sullivan Consulting, in the amount of $149,744, which includes a 12% contingency, to provide professional consultation services to support the Community of Color Community-Based Organizations Capacity-Building Project, for the period of August 1, 2005 through July 31, 2006. Secretary’s Note – this contract was continued to the December 13, 2005 Health Commission meeting. (3.12) AIDS Office-HIV Prevention – Request for approval of a retroactive new contract with Patricia Sullivan Consulting, in the amount of $75,661, which includes a 12% contingency, to provide professional consultation services to support the Transgender Capacity Building – In-Depth Needs Assessment and Clinical Best Practices Development program, for the period of September 30, 2005 through September 29, 2006. Secretary’s Note – this contract was continued to the December 13, 2005 Health Commission meeting. (3.13) CBHS – Request for approval of a retroactive contract renewal with Westside Community Mental Health Center, Inc., in the amount of $1,700,205 per year, for a total contract amount of $3,808,459, which includes a 12% contingency, to provide a Single Point of Responsibility program serving severely mentally ill adults, for the period of July 1, 2005 through June 30, 2007. Secretary’s Note – Commissioner Tarver abstained from voting on this item. Commissioners’ Comments Commissioner Illig asked how the program would be evaluated. Mr. Batonbacal, Director of CBHS Adult Services, said DPH commissioned a five-year study to evaluate this program to look at whether the program resulted in reduced costs to the system. In addition, CBHS has embarked on a program review redesign process where they will take a better look at outcomes and timely performance review reports. Commissioner Illig asked why there is a cost differential between Westside & UCSF. Mr. Batonbacal said the different is approximately $1,500 per patient. Commissioner Illig said the Health Commission would be very interested in the results of the five-year study, perhaps through a joint conference committee. Commissioner Chow asked what Assertive Community Treatment is. Dr. Boles, Westside Executive Director, said it is San Francisco’s attempt to implement a national model to identify clients that are costly to the system and develop an individualized, wrap around treatment plan to keep individuals out of the hospital. This is a very intensive program. Dr. Boles said they are working with DPH to revise outcome objectives to reflect individual client improvements, rather than things such as number of visits. (3.14) CBHS – Request for approval of a retroactive contract renewal with Regents of the University of California, on behalf of the UCSF Clinical Practice Group, in the amount of $2,954,497 per year, for a total contract amount of $6,618,073, which includes a 12% contingency, to provide a Single Point of Responsibility program serving severely mentally ill adults, for the period of July 1, 2005 through June 30, 2007. (3.15) CBHS – Request for approval of a retroactive contract renewal with Conard House, Inc., in the amount of $7,921,514, to provide residential, outpatient, supportive housing and vocational training mental health services, for the period of July 1, 2005 through December 31, 2006. Commissioners’ Comments Commissioner Illig asked if there are plans to expand the board beyond five members. Richard Heasley, Executive Director of Conard House, said that board development has been an ongoing process, and they are always recruiting new board members. They have had a lot of difficulty exceeding five or six. Board members have to spend at least four hours a month on board activities. (3.16) CBHS – Request for approval of retroactive contract renewal with the Edgewood Center for Children and Families, in the amount of $6,157,478 per year, for a total contract value of $6,157,478, to provide mental health services for the period of July 1, 2005 through December 31, 2006. Action Taken: The Health Commission (Chow, Guy, Illig, Monfredini, Tarver, Umekubo) approved the Budget Committee Consent Calendar. Items 3.11 and 3.12 were continued to the December 13, 2005 Health Commission meeting. Commissioner Tarver abstained from voting on Item 3.14. 4) DIRECTOR’S REPORT Anne Kronenberg, Deputy Director of Health, presented the Director’s Report. AMA Hospital Recognition Program Late last month, the American Medical Association recognized San Francisco General Hospital Medical Center for developing exemplary programs to improve communication between health care professionals and patients. SFGHMC is one of eight hospitals nation-wide to receive the honor, and was selected as part of the AMA Ethnical Force Program’s Patient-Centered Communication Initiative. SFGHMC’s patient-centered communication programs span a wide range of endeavors such as enhancing chronic disease care, promoting shared decision-making and coping with illness, developing efficient systems to improve medical interpretation, targeting bi-lingual/bi-cultural concordance in mental health care, and assisting immigrants and refugees in a healthy beginning. The diversity of patients at SFGHMC is reflective of the diversity of San Francisco and effective health care communication is critical to ensure positive health care outcomes for SFGHMC’s patient population. Language barriers, low health literacy levels and cultural difference can all affect the quality of care that patients receive. This latest recognition reflects the high quality standard of care that has become a SFGHMC tradition. End of West Nile Virus Season In the ironic realm of prevention as it relates to public health, you know you’ve done a good job when nothing happens. Dr. Katz is therefore pleased to report that West Nile Virus season has ended and San Francisco had no reported cases of this infection in humans from a local source. Three San Francisco residents became infected with the virus—two contracted the disease from the Sacramento area and one from out of State. Dr. Katz thanks Dr. Rajiv Bhatia and the great staff of the Environmental Health Division as well as the other City departments that worked to coordinate the West Nile Virus Prevention plan including the Department of Public Works, the Recreation & Parks Department, the Public Utilities Commission, the Department of the Environment and the Fire Department. Of course it is possible to have a case post season and of even greater concern is preventing human cases again next year. Marc Trotz to Receive Francis J. Curry Award Dr. Katz reported that Marc Trotz, Director of Housing and Urban Health for DPH, has been named as a recipient of the 2006 Dr. Francis J. Curry Award. Dr. Curry was a creative and innovative Director of Public Health who championed low income, underserved populations in San Francisco. The Curry Award is given each year to an individual or organization that demonstrates Dr. Curry’s values in action. Previous winners have included Rep. Nancy Pelosi, Senator Diane Feinstein and Supervisor Sue Bierman. In naming Marc Trotz this year’s recipient, the Curry Senior Center cited his “vision, approach and stewardship in developing permanent supportive housing for homeless seniors…and his leadership in implementing the Mayor’s Ten Year Plan, the outstanding work he has championed in his role and his commitment to collaboration with community groups, government entities, and service providers.” Marc will receive the award in late March 2006. He shares the award with Dariush Kayhan, Department of Human Services. Dr. Katz congratulated Marc for this prestigious award. US Trade Representative Advisory Committee Mele Lau Smith of the Tobacco Free Project has been invited to be nominated to serve on the advisory committee to the US Trade Representative (USTR). The US is currently negotiating trade agreements with significant implications for altering domestic U.S. laws and policies, as well as those of our trading partners. Public health groups have advocated that there be public health representatives represented on the advisory committee to the USTR to ensure that public health impacts are taken into account in developing U.S. trade policy. Dr. Katz is confident that Ms. Smith will be a strong voice in representing public health interests on this advisory committee. Commissioners’ Comments Commissioner Illig asked who gives the Francis Curry Award. Ms. Kronenberg said the Curry Senior Center gives the award. Commissioner Monfredini asked what the census is at SFGH. Ms. O’Connell said today’s census is 319. Ms. O’Connell acknowledged the efforts of Liz Gray, DPH Director of Placement, for her work in getting people out of SFGH and into community placements. Commissioner Illig asked if the private hospitals took any patients from SFGH. Ms. O’Connell said that UC and CPMC were also full at the same time as SFGH. St. Mary’s has willingly responded to SFGH’s requests. 5) CONSIDERATION OF A RESOLUTION REGARDING ST. LUKE’S/CALIFORNIA PACIFIC MEDICAL CENTER President Monfredini said this is the first time the Health Commission is considering a resolution like the one being considered today, and read the resolution. Commissioners’ Comments Commissioner Monfredini is pleased with the resolution and thanked commissioners for their input. Commissioner Tarver said the resolution captures the essence of the Health Commission’s discussion, and is an affirmation of the Health Commission’s expectations. Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Tarver, Umekubo) amended the resolution to add “outpatient services” to the fifth whereas clause. Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Tarver, Umekubo) approved Resolution #17-05, “Resolution Regarding the Merger of California Pacific Medical Center and St. Luke’s Hospital,” as amended (Attachment A). 6) CHARITY CARE REPORT FOR FISCAL YEAR 2004 Anne Kronenberg, Deputy Director of Health, Director, Office of Policy and Planning and Alicia Neumann, Health Program Planner, presented the FY 2004 Charity Care Report. This is the fourth Charity Care Report Summary pursuant to the Charity Care Ordinance, and was prepared with the participation of the Charity Care Project, which represents the following charity care stakeholders in San Francisco: California Pacific Medical Center, Consumers Union, Health Access, the Hospital Council of Northern and Central California, Kaiser Permanente Medical Center, Operation Access, Saint Francis Memorial Hospital, San Francisco Community Clinic Consortium, the San Francisco Department of Public Health, Service Employees’ International Union (SEIU) Local 250, St. Luke’s Hospital, St. Mary’s Medical Center, and the University of California, San Francisco Medical Center. San Francisco’s Charity Care Ordinance focuses on one type of community benefit, charity care, which is defined as the provision of health care services without expectation of reimbursement to those who cannot afford to pay. The Ordinance includes two requirements for nonprofit hospitals: first, to notify patients of their charity care policies; and second, to report to the Department of Public Health specific information about the charity care that they provide. Ms. Neumann presented the data from the 2004 Charity Care Report, including information about applications/requests for charity care, the number of unduplicated patients who receive charity care, the number and type of services and the cost and expenditures. In general, Fiscal Year 2004 shows increased expenditures and decreased applications, patients and services due to reported improvements in data collection. For Fiscal Years 2001-2004, outpatient is increasing as a percentage of total charity care, while emergency services are decreasing. Ms. Neumann noted that SFGH’s reporting of charity care expenditures now includes the SF Behavioral Health Center. DPH analyzes hospital charity care by location, size and non-profit tax benefits. In general, charity care shows a correlation with only patient location, not hospital size or non-profit benefits. For Fiscal Years 2001-2004, tax benefits are increasing faster than charity care. Findings and Recommendations: Hospitals should continue to pursue creative approaches to increase outpatient charity care, especially for residents of Bayview/Hunters Point, Potrero Hill, Tenderloin, Civic Center and Bernal Heights, Mission. The Department of Public Health and San Francisco’s hospitals should promote the institutional reforms and community benefits reporting recommended by the Public Health Institute in its demonstration project, Advancing the State of the Art in Community Benefit. The Charity Care Project should continue to expand its discussion to increase and improve the provision of charity care to poor, uninsured and underinsured San Franciscans. There are four areas they would like to focus on next year: coordination and consistency in charity care services and reporting; expansion of services through existing facilities and infrastructures; increased physician participation in the provision of charity care; and coordination and consistency in community benefits reporting. Gene O’Connell, SFGH CEO and co-chair of the Hospital Council and Ron Smith, Hospital Council Regional Vice President, gave an update on San Francisco hospitals’ commitment to vulnerable San Franciscans. Every San Francisco hospital has responded to the Health Commission’s recommendation, in its December 7, 2004 resolution, that hospitals increase the provision of outpatient charity care services in high-risk neighborhoods. After that resolution was adopted, all 11 hospital CEOs immediately met with SF Clinic Consortium and city clinic leaders and established monthly meetings. Hospitals met with numerous community groups such as St. Anthony’s Foundation and adult day care centers to determine need. They reviewed current programs to improve and increase funding and hospitals supported 110 programs in the targeted neighborhoods. Mr. Smith updated the Commission on the African American Health Disparity Project, including a $1 million allocation to treat prostate cancer. Mr. Smith noted that every hospital is represented at the Health Commission meeting. Mr. Smith gave examples of hospitals’ projects, including: $500,000 from UCSF for imaging services; $2.4 million from CPMC for specialty physician services for Clinic Consortium clients; more than $2 million from St. Mary’s for clinic and hospital services; more than $1 million from St. Francis for services to Glide Clinic; $1.18 million from Kaiser Permanente in safety-net partnership with Clinic Consortium and DPH to improve chronic care management; more than 4,000 patient visits to St. Luke’s diabetes center; 12,000 services provided by Chinese hospital through the Chinese Community Health Resource center; and VA Medical Center is relocating and expanding its service center for the homeless to a more convenient location on 3rd Street. San Francisco’s Charity Care Ordinance focuses on the specific type of community benefit defined as charity care. Other activities that are considered community benefits include such voluntary and involuntary activities as health promotion and education; financial or in-kind support of public health programs; medical education; research; and the difference between cost and reimbursement for services provided to beneficiaries of public insurance programs, such as Medi-Cal. However, there is no standard definition of these activities, which precludes consistent reporting of community benefit across hospitals. The report includes a summary of hospitals’ community benefits activities, which were presented by hospital representatives: Jeffrey Sterman, Pubic Affairs Director, Kaiser Hospital, introduced Mike Alexander, Kaiser CEO. Mr. Sterman said Kaiser is now taking a look to see what they could do to augment Kaiser’s decline in charity care, which is partially due to ambulances not bringing indigent patients to Kaiser. He distributed a copy of the 2005 community benefit plan (on file in the Health Commission Office). Kaiser has a long-standing partnership with community clinics, and is working with them on various initiatives including chronic disease management. Kaiser is in conversation with the Mayor’s Office, SF Health Plan and DPH to discuss advancing programs. Kieren Flaherty, Director of Local Governmental Relations, UCSF, said that the Health Commission’s direction last year was very helpful in allowing UCSF and other hospitals focus their scarce resources on areas of greatest needs. UCSF is committed to the charity care process and is looking at developing a traditional community benefits program that mirrors what other hospitals do. Mr. Flaherty introduced Susan Moore from UCSF. Barry Lawlor, Director of Community Health, St. Mary’s Medical Center, said different hospitals come with different specialties and abilities, and St. Mary’s has been fortunate to have the Sister Mary Philipa clinic. The zip code data has allowed St. Mary’s to identify patients that could be served by Sister Mary Philipa but were instead going to SFGH. He has worked closely with SFGH over the past year to address this issue. He also discussed the St. Mary’s McAuley adolescent behavioral unit, which is the only inpatient psychiatric program for youth in San Francisco. Abby Yant, St. Francis Memorial Hospital, said a shared accomplishment is the development of the DPH/CHW partnership. The LCR is now available in St. Francis’s emergency room, which has been helpful to patients. St. Francis has worked with DPH to provide other services; one on-going discussion is psychiatric services. St. Francis awarded $100,000 to four community clinics: Glide, St. Anthony’s, Curry Senior Center and South of Market. This contribution was one part of a $500,000 donation from St. Francis to the community. She emphasized the recommendation to work with the Public Health Institute. This is a wonderful initiative. Terry Giovannini, Director of Community Health Programs at CPMC, introduced Jim McCaughey, Vice President of Planning and Business Development, and said that CPMC took the Health Commission’s recommendation to heart last year to look at innovative ways to serve outpatients in areas that have demonstrable need for care. It is CPMC’s role as a non-profit institution to serve the community, and one way they are doing so is through their charity care partnership fund. Many services are offered that represent millions of dollars of efforts but are not counted as charity care. CPMC is committed to increasing access. Jim Hickman, president of St. Luke’s Hospital Foundation, put a personal face on charity care by describing the work of a respiratory therapist at St. Luke’s. He also recognized Carla Rodriguez from St. Luke’s. Dick Hodgson, San Francisco Community Clinic Consortium, thanked Anne Kronenberg for her leadership on the Charity Care Working Group, and for recognizing the full range of community benefits. He also thanked the Hospital Council for spearheading the meeting between hospital CEOs and the Community Clinic Consortium. Together they can make a dent in the problem of the growing uninsured population. Commissioners’ Comments Commissioner Monfredini thanked Ms. Kronenberg for her leadership. In addition, she applauded the commitment of every single hospital to participate in the monthly working group meetings. Commissioner Guy thanked the leadership around this issue, from DPH and all the hospitals. This collaboration has been several years in the making. It is really helpful that the hospitals focused on the clinical aspects of their initiatives. This allows for an evaluation of impact over time. She wants to acknowledge that, with the growing number of people without health insurance, primary care and clinical care efforts would not result in decreased emergency visits. This is a challenge, and the report elucidates this. Commissioner Umekubo is gratified to see all the hospitals come together. If we can identify common problems and pool resources, the impact could be greater. Please keep the dialogue going. Commissioner Illig asked if patients must apply for charity care. Ms. Neumann said that patients must apply. They can apply for charity care after services have been provided. Commissioner Illig said it is important to look at the issue of underinsured, as well as uninsured. Because this demonstrates that hospitals are providing services that are not fully reimbursed but do not meet the definition of charity care. He is also glad to see the data on the direct grants provided by the hospitals. He was surprised to see that St. Luke’s was able to give away $3.5 million while at the same time losing $21 million. Mr. Hickman replied that this was a one-time disbursement of endowment funds. Commissioner Chow is very pleased with the report. A year ago the Public Health Institute convened the conference that the resolution alludes to. This was a process that potentially allowed for a uniform manner of recognizing community services that responded to uninsured and underinsured. He attended that conference and believes that this could be a framework that San Francisco hospitals use to report services. He commends to the Commission that while they may not have process details, pursuing this effort is worthwhile. Commissioner Tarver said that while the VA hospital is not required to report charity care, have they been approached about voluntarily participating. Ms. Kronenberg said they were invited to join the group, but did not participate this past year. She will approach them again. Commissioner Tarver said that medical groups are a key component of the health care delivery system and it would be good if some of their data could be captured. Commissioner Tarver asked how the Department, the working group and the public track the impact that increased efforts have on health outcomes, i.e. reduced rates of prostate cancer. Ms. Kronenberg said the group would think about how to evaluate outcomes at its upcoming meetings. Commissioner Tarver said this collaborative effort has resulted in new services. He encouraged the group to look at all of the monies that are available to geographic areas, including DPH civil service programs, and all these efforts should be collaborative. He also asked the group to consider how to expand notification to patients that charity care is available. He said that CPMC has such a large share of inpatient beds, has large charity care expenditures, but the percentages, compared to licensed beds and tax benefit, is not as large. He will be looking at how CPMC would be expanding that effort. Jim McCaughey, CPMC, said CPMC recognizes that the number of beds does not correlate to charity care because of barriers to accessing these beds. They will be working on reducing these barriers throughout the coming year. Commissioner Tarver noted that the ethnic breakdown of CPMC’s charity care cases is not reflective on the community. This is not surprising, but in the future he would like to see CPMC report on how they reach other ethnicities, including African American and Latino populations. Mr. McCaughey said they would be working on both the application denials and ethnic breakdown. Commissioner Monfredini said that violence has increased over the past years, and is clearly a public health issue. She asked the working group to consider violence prevention, outreach, response and other initiatives as an area to focus on. Mr. Smith said the Hospital Council has discussed this at great length and would like to talk to the Health Commission about this further. Action Taken: The Commission approved Resolution #18-05, “Supporting Recommendations Contained in the Fiscal Year 2004 Charity Care Report,” (Attachment B). 7) ANNUAL ENVIRONMENTAL HEALTH REPORT ON REGULATORY ACTIVITIES Rajiv Bhatia, M.D., Director, Environmental Health Section, presented the annual update on EHS regulatory activities. Environmental Health is responsible for environmental health broadly in San Francisco. They have four major divisions: Environmental Health Regulatory Programs; Children’s Environmental Health; Occupational Health; and the Program on Health Equity and Sustainability. The focus of today’s presentation is on regulatory programs. The programs constitute the largest share of Environmental Health resources and staff, are a mandated county responsibility, involve innovative practices and projects, and require day to day collaboration among Environmental Health, DPH and sister institutions. Dr. Bhatia said that 2005 was a challenging year because there was a reduction in administration of staff at the same time that new programs were added to environmental health. New programs: massage program; retail tobacco program; weights and measures program; agriculture programs; pesticide enforcement program; and Proposition 65 enforcement. Dr. Bhatia introduced members of his staff, each of whom presented regulatory program highlights. Lisa O’Malley – Symbol of Excellence for Food Safety Last Year, the Board of Supervisors established a Symbol of Excellence Program to recognize high standards of food safety. Health Inspectors calculate a score based on violations found through inspection. Food establishments are required to post current inspection report on the premises. Environmental Health will soon begin awarding a Symbol of Excellence to establishments where three consecutive unscheduled inspections result in scores greater than 90. Environmental Health pilot tested a team approach to food safety compliance education in Chinatown this year, which was very successful. Environmental Health anticipates this program may become a model for a citywide compliance education program. Tom Rivard – Evaluating San Francisco’s Emergency Siren system The City is required to have an emergency siren system. Background noise affects effectiveness. Environmental Health is uniquely qualified to evaluate these systems, and it enforces the City’s Noise Control Ordinance through its Noise Program. The Noise Program supports OES and DTIS in evaluating the acoustical coverage and design of the outdoor emergency warning system. Virginia St. Jean – Development of the Green Programs One example of a Green Program is the work that was done around body shops. Body shops regulated by DPH have great potential to reduce toxics. Environmental Health developed best practice guidelines for the industry. It did outreach and training to San Francisco-area businesses, then gave Clean and Green Awards to compliant businesses. There will be evaluation and broader use of guidelines in the region. Helen Zverina – Success in Mosquito Control Environmental Health coordinates and monitors the City’s preparation and response to West Nile Virus. A network of local public agencies has joined with DPH and community stakeholders to develop mosquito prevention efforts. The State awarded Environmental Health with funding for additional mosquito control technicians, equipment and supplies. There were three West Nile cases in 2005. Next year, the Department will be able to test dead birds in-house, thereby avoiding the usual 2-week wait for results from the lab at UC Davis. DPH is developing structural mosquito and rodent control via the Health Code. Karen Cohn and Joe Walseth – Preventing Lead Poisoning through Candy. Some candy products from Mexico contain lead, and results in potentially significant exposure. EHS developed a community outreach strategy based on local survey data to educate the community and generate interest in the community for doing something about the problem. They notified potential retailers about the potential hazards. At Environmental Health’s request, the Board of Supervisors approved a resolution encouraging swifter DPH and federal and state agency actions. Dr. Bhatia – Improved Housing Conditions for Tenants of Residential Hotels SRO health issues include crowding, insufficient bathrooms and kitchens, repeated code violations, noise and tobacco smoke. Every year the violations are corrected, and every year they occur. The voices have been getting louder, and complaints more numerous. The Department has been asked by the SRO Task Force to have a response. He presented the spectrum of DPH’s response, which includes fines and penalties, structural pest exclusion, property owner Health Code training, SRO structural & operational changes, city vector control plan and tenant education and communication. Dr. Bhatia said that Environment Health activities enhance wellness, and allow San Franciscans to have a higher quality of life. The Health Commission could help in this effort by asking the question to other entities in San Francisco: how are your efforts enhancing or detracting from the health of San Franciscans? One potential is to hold joint hearings with the Planning Commission and other commissions to talk about issues that overlap both departments. Commissioners’ Comments Commissioner Guy reiterated that the focus of this report was on the mandated, regulatory programs, which are not often highlighted and recognized. These efforts contribute to our health and wellness. Commissioner Tarver appreciates the staff efforts across a broad swath of responsibility. The food safety efforts are very concrete, as well as the Clean and Green programs. He asked how these efforts are communicated to the media in a positive way. Dr. Bhatia said there is a green program website, a multiple-county listing of green businesses, and periodic media references. Commissioner Tarver commended the SRO efforts and asked if additional legislative, budget or other resources are needed to make SROs safer and cleaner. Commissioner Umekubo asked how the issue of lead in Mexican candy was initially identified. Dr. Bhatia said it is the FDA’s responsibility to ensure that food that is imported is safe. They discovered through testing approximately 10 years ago that Mexican candy is unsafe, and then the State recognized this. But nothing was done except a letter of warning to the industry. So local action was taken. Commissioner Umekubo said there is a similar problem with mercury in fish—different State and Federal standards, extensive lobbying, etc. Commissioner Illig asked if medical marijuana permitting is part of Environmental Health’s responsibility. Dr. Bhatia said that DPH has 18 months to develop regulations, in concert with sister departments and the industry. Then the regulations have to be published. They need to hire a staff person. Once the regulations are approved, they will be accepting applications. Commissioner Illig asked if this activity would be sustained by fees. Dr. Bhatia said they’ve estimated a $3,000 application fee and an annual inspection fee to cover the full costs. Commissioner Illig would like the Health Commission to consider joint meetings with other commissions, such as the Planning Commission. Commissioner Chow supports the idea of joint meetings to discuss areas of common interest. He is concerned but not surprised with the federal government’s inattention to lead in candy. He is also concerned about the conditions in SROs, particularly the cycle of recurring violations. Perhaps DPH should investigate more frequently than once a year. Commissioner Chow has been involved in rodent abatement effort in District 3. This effort required community buy in. The SRO issue also requires cooperative efforts, among different city agencies and the community. He also wants to understand the new requirements around tobacco enforcement, and do we know if the efforts actually result in decreased smoking. Dr. Bhatia said that there is a behavioral survey of youth smoking done nationally, and this provides periodic data. A new element of the enforcement program is to revoke the permit for establishments that are caught selling tobacco to minors. This effort will also give data in the next few years. 8) PUBLIC COMMENT/OTHER BUSINESS Michael Lipson spoke about lead paint in his apartment. He and his wife became aware last March of a program through the Mayor’s Office of Housing for a free lead paint inspection, which they participated in. The inspection in June uncovered lead hazards in their flat. DPH issued an abatement order, with a deadline of July 29th. It has been a struggle, intensified by an uncooperative landlord, to get a safe living environment, and DPH has not provided an adequate response. DPH punted them to DBI, who referred them back to DPH. The lead remediation effort has been inadequate. They brought in their own inspector. His wife and baby have been unable to live in the apartment. His requests have been ignored. He is looking for enforcement of the abatement order. Dr. Katz said DPH has the most expertise around lead. The city’s system for dealing with things like lead is bureaucratic and frustrating. Commissioner Monfredini connected the family with Rajiv Bhatia, who will follow up on the Lipson’s specific case. 9) ADJOURNMENT The meeting was adjourned at 6:35 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.