Minutes of the Health Commission Meeting Tuesday, February 21, 2006 at 3:00 p.m. 101 GROVE STREET, ROOM 300 San Francisco, CA 94102 1) CALL TO ORDER President Monfredini called the meeting to order at 3:05 p.m. Present: Commissioner Lee Ann Monfredini, President Commissioner James M. Illig Vice President Commissioner Roma P. Guy, M.S.W. Commissioner Donald E. Tarver, II, M.D. Commissioner John I. Umekubo, M.D. Absent: Commissioner Edward A. Chow, M.D. Commissioner David J. Sanchez, Jr., Ph.D. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF FEBRUARY 7, 2006 Action Taken: The Commission (Guy, Illig, Monfredini, Tarver, Umekubo) approved the minutes of the February 7, 2006 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Monfredini chaired and Commissioner Tarver attended the Budget Committee meeting. Items for Approval (3.1) CHN–LHH – Request for approval to accept and expend retroactively a grant from the Regents of the University of California, in the amount of $75,000, to pilot a new medication management process, for the period of March 1, 2005 to May 31, 2006. (3.2) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive renewal contract with Patricia Sullivan Consulting, in the amount of $333,643, including a 12% contingency, to provide Professional Consulting services to support the HIV Health Services Voucher Program, for the period of November 1, 2005 through February 28, 2006. (3.3) AIDS OFFICE-HIV Prevention – Request for approval of a retroactive renewal contract with Harder & Company, in the amount of $176,179, which includes a 12% contingency, to provide technical support to the HIV Prevention Planning Council and the SFDPH HIV Prevention Section, for the period of January 1, 2006 through December 31, 2006. Items for Discussion and Approval (3.4) AIDS OFFICE-HIV Prevention – Request for approval of a retroactive contract renewal with Better World Advertising, in the amount of $213,920, which includes a 12% contingency, for continuation of the “HIV Stops With Me” prevention education/social marketing campaign, for the period of January 1, 2006 through June 30, 2006. (3.5) PHP-CBHS – Request for approval to accept and expend retroactively funds from the California Department of Mental Health, in the amount of $656,945, for community program planning and system improvement, for the nine-month period of January 6, 2006, to September 30, 2006. Public Comment Jackson Bowman spoke about the HIV Stops with Me Campaign. The campaign uses scare tactics, which is a very destructive way to stop the spread of STDs. Trevor Hoppe spoke about the HIV Stops with Me Campaign. The campaign sends the wrong message and is pos-phobic. He is shocked to see this in San Francisco and is deeply dissatisfied with this campaign. Commissioners’ Comments Commissioner Guy asked how Better World Advertising receives feedback about campaigns and incorporates and/or responds to criticism of particular campaign. Les Pappas, Executive Director of Better World Advertising, said that they have received little criticism about the campaign. Commissioner Guy wants to ensure that there is a process by which the agency is open to criticism. Commissioner Illig said that the AIDS Office and the HIV Prevention Planning Council are forums for feedback and criticism, and he encouraged the speakers to get in touch with these entities. Tracy Packer from the AIDS Office added that the contract before the Commission today moves toward developing a different campaign, and comments such as those given today would help inform the future campaign. Action Taken: The Commission (Guy, Illig, Monfredini, Tarver, Umekubo) approved the Budget Committee Consent Calendar. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., presented the Director’s Report. Laguna Honda Hospital Inspection Continues State and federal inspectors from the California Department of Health Services and Centers for Medicare & Medicaid Services are concluding their current Licensing and Certification Survey at Laguna Honda Hospital with an exit conference expected this afternoon. They began their annual Licensing and Certification survey at LHH on Sunday, February 5th. In addition, the State Fire Marshal arrived at LHH today to begin their annual life safety inspection. Health Access Committee Mayor Newsom’s newly formed Health Access Committee met for the first time last Tuesday, February 21st. Sandra Hernandez, M.D., Director of the San Francisco Foundation and Lloyd Dean, CEO of Catholic Healthcare West serve as co-chairs. Gene O’Connell, Michael Drennan and Dr. Katz are representing the Department. The committee will deliver a report in 100 days outlining implementation steps for the Mayor’s proposed defined benefit program. Community Behavioral Health Services Community Behavioral Health Services has sent out selection notices following the completion of the Substance Abuse Outpatient Treatment RFP, #2005-25. The RFP expands outpatient methadone maintenance in the recognition that it is less costly and more effective than drug free treatment for heroin users. This goal was accomplished by moving $400,000 from outpatient drug free to outpatient methadone maintenance. In addition, the unit of service reimbursement rates and costs per client were standardized and brought up to date. As can be seen below, with the equalization of rates and the expansion of methadone maintenance, the chosen proposals result in increased units of service and increased unduplicated clients. Unduplicated Clients (UDC) Units of Services (UOS) Mean cost per UOS 04/05 4,851 116,612 $80.78 Proposed 06/07 5,018 177,667 $53.82 The RFP required respondents to base treatment methods on current outcome research, include tobacco interventions, and to provide a protocol for coordinating care with mental health and primary care to assure the better outcomes, maximize Medi-Cal and third-party reimbursement, and implement the DPH’s shift to behavioral health. Black History Month Celebration The African American Health Initiative and the Managers of African and African American Descent will hold the Annual Black History Month Celebration at CHN Headquarters, February 23rd, at 5:30 p.m. All are invited to participate and celebrate the contributions of African Americans to America and the ongoing challenge of making human and civil rights a reality for all oppressed people. This year holds significance with the honoring and loss of more of the great leaders of the modern Civil Rights Movement. While we will be mindful of our collective history, we will also look to the passing of the baton to a new generation of "freedom fighters" of all peoples. San Francisco Public Health Foundation Fundraiser The Public Health Foundation is sponsoring an event tomorrow evening at 101 Grove Street to raise money for Project Homeless Connect. Alex Tourk will represent Mayor Newsom and give a brief update on the success of the program. Please join us for the festivities February 22nd at 5:30pm in the foyer of the building. Community Health Network, San Francisco General Hospital, February 2006 Credentials Report 02/06 07/05 to 02/06 New Appointments 11 117     Reinstatements 0 0 Reappointments 62 275    Delinquencies: 0 0    Reappointment Denials: 0 0 Resigned/Retired: 13 85 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Deceased 0 0 Changes in Privileges    Additions 6 38    Voluntary Relinquishments 9 28    Proctorship Completed 13 94    Proctorship Extension 0 6 Current Statistics - as of 02/1/06 Active Staff 466 Courtesy Staff 580 Affiliate Professionals (non-physicians) 193 TOTAL MEMBERS 1,239 Applications In Process 20   Applications Withdrawn Month of February 2006 0 2 (07/05 to 02/06) SFGH Reappointments in Process Mar. 2006 to Jun. 2006 215   Commissioners’ Comments Commissioner Illig asked if the Department has a grievance procedure for agencies that are not successful in the RFP process. Dr. Katz said an agency can grieve that the RFP process was unfair, in that there was some bias towards or against a proposal. Other than that, an agency cannot grieve the outcome of an RFP. If in the RFP process none of the top bidders are felt to be culturally competent, the money will be removed from the RFP and rebid. Commissioner Illig asked if the RFP scores and the reviewers would be made public. Dr. Katz said yes. 5) EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF FEBRUARY Commissioner Illig presented the Employee Recognition Awards for February. Individual  Award Division Nominated By Linda Sims, R.N. SFGH/SFBHC Nursing Tom Hall and Marilynn Mendoza Team Award Division Nominated By SFGH Operating Room, Sterile Processing Department, Financial SFGH Jan Allison Bill Chun Robert Perry Cora Talens 6) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH’S FY 2006-07 BASE BUDGET, AND CONSIDERATION OF A RESOLUTION APPROVING THE BASE BUDGET Gregg Sass, DPH Chief Financial Officer, presented the FY 06-07 base budget for DPH. Mr. Sass said that the Mayor’s Office had been forecasting an $80 million shortfall for FY 06-07 but based on some good news in the Controller’s Six-Month report, the City is now estimating a $35 million shortfall. Mr. Sass recapped the Mayor’s budget instructions, which he presented on January 17th: absorb half the cost of restoring 7.5% employee pickup for DPH employees; submit a list of expenditure savings worth 3% of the Department’s reduced general fund subsidy; and propose one-time expenditures equal to 3% of DPH’s reduced general fund. Mr. Sass gave an overview of the regulatory, inflationary and structural issues, revenue neutral programs and increased revenues that have changed since the January 17th presentation, including reducing the projected cost of the long-term care placement initiative, increasing the DPW work order for SFGH project management and increasing Food and Water Fee revenue. The net result of these changes is ($4,355,000). The Health Department is only proposing a single reduction initiative in order to meet the $7.13 million general fund reduction target. DPH proposes to expand the $5 and $10 prescription co-payment requirement, currently used in the SFGH Outpatient Pharmacy and contracted network pharmacies, to include all clients except those on general assistance and the homeless. Drugs excluded from the new co-payment policy will include insulin, anti-psychotics and antibiotics for acute infections. This initiative is expected to reduce the general fund requirement by $1,363,396. The combined effect of these initiatives, including the proposed reduction initiative, produces a general fund reduction of $7,323,694, which exceeds the Mayor’s budget instruction to absorb half of the $14.26 million employee retirement pick up for DPH employees. Dr. Katz added that staff continues to work on development of a list of additional expenditure reductions to further reduce the Department’s general fund subsidy by 3%, should this become necessary. Public Comment Sue Carlisle, M.D., Associate Dean, SFGH, UCSF School of Medicine, said she and the other medical staff at SFGH are very proud to be partners with DPH in providing high quality, comprehensive and culturally competent health care to San Francisco. She and her colleagues ask that the Health Commission keep this partnership in mind when considering the budget, and correct structural deficits that have resulted from cuts over the past years. Debbi Lerman, San Francisco Human Services Network, thanked the Department for presenting a base budget that has no cuts to the non-profit sector and for including an allocation for the cost of doing business. So far this has been a thoughtful process. Contractors understand that the amount of money set aside in DPH’s budget is not enough to meet the need. The Human Services Network urged the Commission to keep in mind that grant-funded agencies are faced with the same cost of doing business increases as other agencies. Richard Heasley, Conard House, spoke about how important it was that the Health Department did what it did around cost of doing business. He applauded everybody’s efforts. Commissioners’ Comments Commissioner Guy asked what the process would be for the contingency budget cuts. Dr. Katz said if the Department is required to submit a $7 million cut, he anticipates that the reductions would be painful, and predominantly cuts to non-mandated services. He is hoping that the revenue picture will improve so that additional cuts are not required. If cuts were required, these would be presented to the Health Commission. At this point, there is no deadline to produce these cuts. Commissioner Illig thanked Dr. Katz and his management team for asking contractors for information about their cost of doing business, and for adding money to the budget to fund some of these costs. It is important to recognize that San Francisco General Hospital generates a large amount of revenue. He lauded staff for being creative and finding other revenue. He also commended staff for reducing the total number of FTEs that were added to the budget. Commissioner Illig would like to get reports about whether the revenue-neutral budget initiatives were successful. He plans to have the CHN JCC review some of the revenue-neutral proposals as they are implemented. When and if the Health Commission gets the $7 million budget reduction proposal, some of the proposals in the base budget should be put back on the table. Commissioner Tarver commended staff for the additional work that was done on the structural, inflationary, regulatory and revenue issues. He asked about the rationale for excluding certain drugs from the co-pay requirement. Dr. Katz said that the decisions were based on what would most likely result in added costs to the system if prescriptions were not taken. For example someone who does not take her insulin would most likely end up in the emergency room. Commissioner Tarver suggested that voluntary work furloughs be considered as a cost-savings measure. He hopes that the Medicare Part D implementation be closely followed to determine if there is any cost savings resulting from Medicare only patients now having their drugs paid for. Commissioner Umekubo thanked staff for giving the Health Commission a breath of fresh air around the budget. He hopes that the Department monitors whether or not the co-pay results in people not taking their preventive medicines. Commissioner Umekubo asked if the Department encourages combination medications. Dr. Katz said these are used when possible. Dr. Kotabe does a very good job of managing the Department’s formulary. Action Taken: The Commission (Guy, Illig, Monfredini, Tarver, Umekubo) approved Resolution 04-06, “Approving the Submission of the Department of Public Health’s Base Budget for Fiscal Year 2006/07,” (Attachment A). 7) PUBLIC COMMENT/OTHER BUSINESS Bob Douglas, member of the Mental Health Board, asked the Health Commission to improve the quality of food that is given to SFGH patients. He was a patient there last year and the situation is atrocious. 8) ADJOURNMENT The meeting was adjourned at 4:55 p.m. Michele M. Seaton, Executive Secretary to the Health Commission Attachment(s): 1 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 noted 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.