Minutes of the Health Commission Meeting Tuesday, March 7, 2006 at 3:00 p.m. 101 GROVE STREET, ROOM 300 San Francisco, CA 94102 1) CALL TO ORDER The meeting was called to order by Commissioner Monfredini at 3:10 p.m. Present: Commissioner Lee Ann Monfredini, President – left at 5:00 p.m. Commissioner James M. Illig, Vice President Commissioner Roma P. Guy, M.S.W., Commissioner David J. Sanchez, Jr., Ph.D. Commissioner Donald E. Tarver, II, M.D. Commissioner John I. Umekubo, M.D. – arrived at 3:35 p.m. Absent: Commissioner Edward A. Chow, M.D. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF FEBRUARY 21, 2006 Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Tarver) approved the minutes of the February 21, 2006 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Sanchez chaired and Commissioner Tarver attended the Budget Committee meeting. Commissioner Chow was absent. Items for Approval (3.1) PHP-STD Prevention & Control – Request for approval of a retroactive renewal contract with PHFE Management Solutions, in the amount of $68,152, including a 12% contingency, to provide Fiscal Intermediary Support for the STD Prevention & Control “Positive Reinforcement Opportunity Project, ” for the period of January 1, 2006 through June 30, 2006. (3.2) PHP-STD Prevention & Control – Request for approval of a retroactive renewal contract with PHFE Management Solutions, in the amount of $180,472, including a 12% contingency, to provide Fiscal Intermediary Support for the STD Prevention & Control “Syphilis Prevention Project”, for the period of January 1, 2006 through December 31, 2006. (3.3) AIDS OFFICE-HIV Prevention – Request for approval of a retroactive renewal contract with PHFE Management Solutions, in the amount of $136,316, including a 12% contingency, to provide Fiscal Intermediary Support for the HIV Prevention Section-Post Marketing Surveillance, Condom Availability Program and Street Start Programs, for the period of January 1, 2006 through June 30, 2006. (3.5) CENTRAL ADMIN-Policy & Planning – Request for approval to accept and expend retroactively funds from the Health Resources and Services Administration (HRSA) Hospital Preparedness Program (Year 3 Funding) in the amount of $548,465.74. Items for Discussion and Approval (3.4) AIDS OFFICE-HIV Prevention – Request for approval of a retroactive renewal contract with the AIDS Health Project, in the amount of $81,760, including a 12% contingency, to provide training services to HIV Prevention providers, for the period of January 1, 2006 through July 30, 2006. Commissioners’ Comments Commissioner Tarver asked that future reports include the units of service for the previous contract. Joanna Rinaldi will provide the Commission with the detailed units of service for the last contract. (3.6) AIDS OFFICE-HIV Prevention – Request for approval of a retroactive new contract with the UCSF-Positive Health Program, in the amount of $140,296, including a 12% contingency, to develop and provide HIV Prevention – Skills Building Training Services for Prevention for Positives in a Clinical setting, for the period of September 1, 2005 through June 30, 2006. Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Tarver) approved the Budget Committee Consent Calendar. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., presented the Director’s Report. Plaza Apartments Grand Opening On March 15th Commissioners have received an invitation to the grand opening of the Plaza Apartments, 988 Howard @ 6th, on March 15th, from noon – 1:30. This extraordinary mixed-use development is the latest entry in the Department’s Direct Access to Housing program, providing 106 green and sustainable studio apartments with compressive support services to San Francisco’s neediest and lowest income residents. The building also comes with 2,200square feet of retail and a state of the art performing arts space located on the first and basement levels. The Department’s role has been to design and fund the support service package that will care for the new tenants, most of whom have been chronically homeless or needing placement out of our institutions. Services to the residents will be provided directly by staff from the Department of Public Health and Conard House. Here is a breakdown of the new tenants and where they came from: Returnees/certificate holders 9 Directly from the street 18 Shelters 5 Healthcare and treatment programs 74 Total 106 DPH will also be providing the rent subsidy that enables the project owner to rent to extremely low-income people while being able to maintain a financially feasible project. This project is further proof that people with long histories of homelessness and chronic medical and behavioral health conditions can live in the community with appropriate supports. Commissioner Monfredini has agreed to speak on behalf of the Health Commission during next week’s ceremonies. She will be joined by Mayor Newsom and a number of other leaders from the City and community-based agencies who worked to bring this old hotel on line as one of the premier pieces to the South of Market Redevelopment Project area revitalization efforts. Dr. Katz extended a special thanks to Marc Trotz, Margot Antonetty, Josh Bamberger, MD, Pam Swedlow, Sonia Bailey and John Tambis for the hard work each of them contributed to this project. DSH Advance on Its Way to SFGH Dr. Katz is happy to report that the State Department of Health Services is processing a $31 million payment to SFGH, representing an advance on disproportionate share services (DSH) provided during the six months ended 12/31/06. The Medi-Cal waiver has replaced payments previously made under SB855, SB1255 and GME with a payment system based on Certified Public Expenditures. The plan has not finalized a mechanism for making interim payments to public hospitals. SFGH was one of nine hospitals that submitted a request for an advance for costs incurred through 12/31. Those nine public hospitals will each receive an advance. Healthcare for the Homeless Week March 19-25 is the second annual Healthcare for the Homeless Week, a national event designed to draw attention to the need for appropriate healthcare for individuals who are homeless and an opportunity to recognize those who deliver an array of healthcare services to them. The Department will be observing this occasion with two special presentations. On March 22nd noon-1:30 pm, in Room 220, Barry Zevin, MD, Medical Director of Tom Waddell Health Center, will be presenting a talk entitled, “Bio-Psycho-Social-Spiritual Approaches to Healthcare for the Homeless.” The following day, March 23rd from noon – 1 p.m., the Tom Waddell Community Advisory Board (TWHC CAB) will be presenting a play entitled “The Witness,” in Room 220 produced by the Faithful Fools Street Ministry. The Witness is a one-woman play written and directed by Martha Boesing, an internationally known playwright and acted by Recca Noon, a well-known local actor. Both Ms. Boesing and Ms. Noon will be available for questions after the presentation. Dr. Katz encouraged the Commissioners to attend this unique opportunity. Health and Safety of the Day Laborer and Domestic Worker Community On March 29th the Department of Public Health and the Unidos Community Council will be hosting a community forum: “Respect and Dignity: Working for the Health and Safety of the Day Laborer and Domestic Worker Community,” at the Women’s Building, 3543 18th St. from 6 p.m. – 8 p.m. The event is part of a partnership called Jornaleros Unidos con el Pueblo (Day Laborers United with the Community), or “Unidos.” This research partnership is funded by the National Institute of Environmental Health Sciences and brings together staff from the Department of Public Health, immigrant day laborers and community service organizations. The project’s goal is to improve the health and working conditions for the immigrant day laborer community. Each of the Health Commissioners will be receiving invitations to attend this event. Dr. Katz hopes commissioners can join Rajiv Bhatia, MD and his staff, along with special appearances by day laborers and domestic workers who have recorded their stories on videotape and will be featured during the first half of the program. After the screening, staff will provide an overview of the Unidos project work and its accomplishments and a panel will be looking for proposed solutions to improve the health and safety of the workers. This is truly an exciting blend of public health and community outreach and participation. Dr. Katz looks forward to reporting back to this Commission on the outcome and lively discussion that will follow this important community forum. LHH Residents Celebrate Construction Progress The Laguna Honda Replacement Program is moving ahead and the residents and staff have planned the first of what will be a number of events to celebrate the construction progress of the new facility. The Commissioners, along with staff, residents and LHH volunteers, will have two chances to attend the first celebration this Friday at 1:30 p.m. in the Main Building and at 2:30 in Clarendon Hall. Come and see the newly erected and very impressive steel girders of the Link Building, have some refreshments, be a loud voice among the cheering section and sway to the melodies of a steel drum band. Also, those who would enjoy a bird’s eye view of construction sites can watch the live action at the rebuild site by going to the internet and logging onto Camera #1 & #2 at http://turnerconstruction.oxblue.com/cam1/ or http://turnerconstruction.oxblue.com/cam2/. Commissioners’ Comments Commissioner Illig asked if the DSH money is already included in the DPH budget. Dr. Katz said it is already part of the budget. Commissioner Guy asked when the Commission would receive information about the State’s licensing visit to Laguna Honda Hospital. Dr. Katz said that the State has not released its report, and may not do so for a few months. The State, in its exit conference, focused on two issues. The first is medication errors, which can be addressed through an IT solution. The second issue is patient-to-patient altercations. 70 percent of the people highlighted by the State are diagnosed with advanced Alzheimer’s disease. The Department will be working on better behavioral plans, more activities and more cohorting of people with advanced dementia. 5) UPDATE ON THE CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION WORKPLAN Christina Goette Carpenter, Community Health Promotion and Prevention (CHPP), Libby Albert, Department of Children, Youth and their Families and Patricia Erwin, CHPP, presented an update on the chronic disease prevention workplan. Chronic Disease Prevention Guiding Principles Primary Prevention Interventions addressing individual, community and systems Physical activity focus The workplan includes research, data collection, best practices and grant development; policy development; collarboration, partnership and coordination; training and advocacy; and pilot programs. Examples include the Citywide Chronic Disease Prevention Consortium, the Let’s Be Healthy Fun n Fit Fair and the Childhood Nutrition & Physical Activity Task Force. Ms. Albert talked about Mayor’s Shape Up San Francisco Challenge. The mission is to increase the awareness of and opportunities for increased physical activity and improved nutrition through message and action. Challenge projects: basketball tournament, April 2006; Mayor’s Summit, April 26, 2006; Mayor’s Field Day and Kids Fitness Challenge, May 20, 2006; San Francisco Employees WALK & ROLL, August-September 2006; San Francisco Students and Families WALK & ROLL, October – November 2006. Ms. Erwin described the Let’s Be Healthy! Project, which is a collaborative project of DHP’s Newcomer Health Program, Ocean Park Health Center, Family Health Center and Bay Area Community Resources. The goal is to promote overall well being, change community norms about healthy living and improve self-management of chronic health conditions among San Francisco’s 25,000 Russian-speaking newcomers. The project includes a community education campaign, walking groups, yoga classes, healthy eating and cooking groups and group medical visits, among other activities. The project utilizes Pomoshniks who are recruited and trained to provide community leadership around healthy living. Commissioners’ Comments Commissioner Monfredini said that there are many barriers to physical activity, including fear, violence, lack of public spaces, etc. Adults often do not give children the freedom of movement. She applauded the success around healthy food availability. Commissioner Umekubo is shocked at the statistic that 80 percent of San Francisco children ages 5, 7 and 9 failed to meet physical activity standards. These are children’s most active years. Commissioner Umekubo said there is a misconception that a person must work out at the gym to get healthy when just 30 minutes a day is considered moderate exercise. The Department should get the message out to counteract this misperception. Commissioner Sanchez said San Francisco spearheaded the development of early childhood education programs that emphasized exercise, diet and health. This model should be revisited, based on San Francisco’s student and family composition. Commissioner Sanchez said the infrastructure at the schools does not encourage physical activity. Different communities face different barriers, and the disparate needs must be kept in mind when trying to increase physical activity. Commissioner Guy sees this effort as the beginning of defining what role the Health Department has in citywide physical activity and what the public health benefits of physical activity are. The initiative targeting the Russian community increased sociability and decreased depression, as well as increasing physical activity. She would like the PHP JCC to discuss lessons learned from the Mayor’s Summit to take this to the next step. We have to look at the workplace as a place for people to have physical activities. We have to collaborate with the schools to increase sports opportunities. Commissioner Illig encouraged getting DPH’s contract partners involved in this effort. Commissioner Tarver said that physical activity is not a factor at any of the DPH sites he works at. If the message is not having an impact on DPH sites, this does not bode well for the general community. Commissioner Tarver said people in the Bayview understand and desire fresh, nutritious food but face issues of cost and access. 6) UPDATE ON IMPLEMENTATION OF HEALTH MANAGEMENT ASSOCIATES’ REPORT RECOMMENDATIONS Mitchell H. Katz, M.D., Director of Health, presented an update on Health Management Associate’s (HMA) recommendations. The report highlights the progress that has been made since October in implementing the recommendations of the HMA report. The number one recommendation was to assemble an Integration Steering Committee (ISC). This committee was created in August and has met bi-weekly since that time. The ISC formed subcommittees to address specific issue areas: the Clinical/Operations Subcommittee and the Capital Integration Committee. Rather than creating a Finance Integration Committee, the ISC took on the additional role as the Budget committee for the coming year. Another recommendation was to recruit and hire a Chief Operating Officer. The steering committee wrote a job description and proposed the position to the Mayor’s Office as a new initiative in the FY 06-07 budget proposal. Dr. Katz updated the Commission on the status of HMA’s recommendations in Section 2 of the report. An HMA consultant is functioning in the role of a long-term care health director. With her help, ISC created a job description. The Department was notified by the Mayor’s Budget Office that funding for this position has been identified. The Department has been working with a consultant to identify uniform assessment tools used in other states to determine and prioritize need for nursing facility services. A tool that San Francisco could use without modification has not been identified. The HMA report recommended that all persons with long term care needs should have access to a community-based case manager. Dr. Katz described the work of the targeted case management unit, as well has other intensive case management services, including the African-American IMD Alternatives Program, the creation of three intensive case management positions to facilitate connection of psychiatric clients from the hospital to the community and the conversion of the Bay View Hunter’s Point day treatment program into an intensive case management program. Recognizing the need to coordinate and communicate across the system, DPH has integrated some of its key case management teams across the treatment system and with other city departments. In response to other recommendations, the ISC is looking into the potential of establishing a 20-hour per week clinic at LHH that is a satellite of one of the existing FQHC clinics. It has had discussions with St. Mary’s about the possibility of creating a DPH SNF within their hospital, and is now exploring other placement options. A Medical Services Advisory Committee has been established to provide a voice for physicians and other medical care providers throughout the Department. And Dr. Katz raised the issue of regional planning for SNF services at the July meeting of the Association of Bay Area Health Officials. In conclusion, Dr. Katz said the Department has made significant progress on HMA recommendations, and he believes that progress on these issues has improved DPH. Commissioners’ Comments Commissioner Guy would like to enhance the job description for the long-term care director by adding a component about collaborating with other parts of the long-term care continuum. Commissioner Sanchez said DPH has a history of collaboration and partnership. DPH, with its history of quality care and quality providers, is uniquely qualified to address issues around death and dying, long-term care, and other critical components. Commissioner Tarver said that the Department has responded to the HMA report with a true restructuring. He encouraged the steering committee to consider input from everyone who serves and is served by the system, not just administrators. He is pleased to see providers involved in this effort, and suggested adding an outpatient provider to the group. The committee structure should allow for the discussion of access to outpatient services, given current waiting lists. He and other Commissioners have requested a list of all the beds that DPH owns and has access to, and he looks forward to getting this information. He asked that future updates include progress reports on the long-term care community trust fund, because the Health Commission wants to keep this initiative alive. He supports a “RCF-plus” model, where RCFs have higher levels of staffing to support people who cannot successfully live in board and care homes or an independent setting. Commissioner Umekubo asked if other counties are lobbying for a waiver. Dr. Katz said that San Francisco is the only county with a large number of DP/SNF beds, so other counties are not seeking this. However, there is a movement to provide more alternatives to institutionalization. Commissioner Illig would like to see more outcomes attached to the Integration Steering Committee’s work, such as the placement committee’s goal to decrease the number of patients at SFGH and LHH that are waiting for placements into lower level of care settings by 50%. Commissioner Illig is anxious for DPH to have a database of all the beds that it has access to. He encouraged accessing and connecting the various lists and databases to get a comprehensive look at what is available in the city. He asked what happened to the money that was budgeted for a new SNF at SFGH. Dr. Katz said that it exists within SFGH’s capital budget, but it is being used for other capital projects. Commissioner Illig said it would be very useful to look at the specific range of needs required for people to live in the community and the cost of meeting these needs. Commissioner Illig asked at what point the Department should stop arguing with the bureaucrats around the waiver and get the Legislature involved. Dr. Katz said the bureaucrats are not opposed to this approach. He noted, however, that this does not help with CMS. Commissioner Illig is looking forward to getting regular updates at the CHN JCC. 7) PUBLIC COMMENT/OTHER BUSINESS None. 8) CLOSED SESSION A) Public Comments on All Matters Pertaining to the Closed Session None. B) Vote on Whether to Hold a Closed Session (San Francisco Administrative Code Section 67.11) Action Taken: The Commission (Guy, Illig, Sanchez, Tarver, Umekubo) voted to hold a closed session. The Commission went into closed session at 5:10 p.m. Present in closed session were Commissioner Guy, Commissioner Illig, Commissioner Sanchez, Commissioner Tarver, Commissioner Umekubo, Mitchell H. Katz, M.D., Health Director, John Kanaley, LHH Executive Administrator, Adrianne Tong, Deputy City Attorney and Michele Seaton, Health Commission Executive Secretary. C) Closed Session Pursuant to Government Code Section 54956.9 and San Francisco Administrative Code Section 67.10(d) Action Taken: The Commission (Guy, Illig, Sanchez, Tarver, Umekubo) approved a settlement in the amount of $200,000, M. Harb V. City and County of San Francisco, et al, San Francisco Superior Court No. 437254. D) Reconvene in Open Session The Commission reconvened in open session at 5:35 p.m. Possible Report on Action Taken in Closed Session (Government Code Section 54957.1(a)2 and San Francisco Administrative Code Section 67.12(b)(2).) Vote to Elect Whether to Disclose Any or All Discussions Held in Closed Session. (San Francisco Administrative Code Section 67.12(a).) Action Taken: The Commission (Guy, Illig, Sanchez, Tarver, Umekubo) voted not to disclose any discussions held in closed session. 9) ADJOURNMENT The meeting was adjourned at 5:35 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 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.