Minutes of the Health Commission Meeting Tuesday, May 16, 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 3:15 p.m. Present: Commissioner Lee Ann Monfredini, President Commissioner James M. Illig, Vice President Commissioner Edward A. Chow, M.D. Commissioner Roma P. Guy, M.S.W. Commissioner Donald E. Tarver, II, M.D. Absent: Commissioner David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. President Monfredini announced that the Health Commission would hold a community meeting in September at the Plaza, located at 6th and Howard Streets. Details of this meeting will be forthcoming. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF MAY 2, 2006 Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Tarver) approved the minutes of the May 2, 2006 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Chow chaired and Commissioner Tarver attended the Budget Committee meeting. Commissioner Sanchez was absent. Items for Approval (3.1) CHN/SFGH-Health Information Services – Request for approval of two contract modifications with the following firms: Mediscript Medical Transcription and Pacific Medical Transcription, to increase the total shared contract amount by $115,000, from $551,177 to $666,177, and extend the term by three months, from June 30, 2006 to September 30, 2006, to provide intermittent, as-needed medical transcription services for San Francisco General Hospital. (3.2) DPH-IS – Request for approval of a contract renewal with Dataway, in the amount of $592,432, which includes a 12% contingency, to provide information technology support services, for the period of July 1, 2006 through June 30, 2007. (3.3) CHP-Disease Control – Request for approval of a retroactive renewal contract with San Francisco Study Center, in the amount of $592,921, which includes a 12% contingency, to provide fiscal intermediary services, for the period of August 31, 2005 through August 30, 2006. Items for Discussion and Approval (3.4) BHS – Request for approval of a contract modification with ZiaLogic, in the amount of $78,400 for FY 2005/06, with an annual contract amount of $70,000 for 05/06 and a total contract amount of $302,400, which includes a 12% contingency, to provide behavioral health integration consultation services, for the period of June 1, 2004 through June 30, 2007. Commissioners’ Comments Commissioner Tarver is eager to see the timeline for the 12-step program of implementation, and asked for an update at a future CHN JCC meeting. Dr. Gleghorn said last two years have focused on educating providers about the new paradigm, and the initial project with Zialogic focused on education around what it means to provide co-occurring services. Now the effort is moving into an implementation phase. Commissioner Tarver noted that many front line providers work part-time and need to be included in trainings and other education efforts. Commissioner Chow noted that it is incorrect to assume that because a contractor does not provide direct services, it does not need to be culturally competent and comply with the Health Department’s requirements. (3.5) CHN-SFGH – Request for approval of a contract renewal with Richmond Area Multi-Services, Inc., in the amount of $8,524,624, with an annual contract amount of $2,131,156, for a total contract amount of $9,547,579, including a 12% contingency, to provide culturally competent partial hospitalization and aftercare treatment services, targeting the community’s mentally impaired population, for the period of July 1, 2006 through June 30, 2010. (3.6) CHN-SFGH – Request for approval of a contract renewal with National Medical Health Card, in the amount of $250,000, to provide third-party administrator services, and $2,300,000 in pass-through prescription dispensing fees to Rite Aid Corporation and AG Pharmacy, targeting CHN indigent clients, and a 12% contingency of $306,000, for the period of July 1, 2006 through June 30, 2007. Commissioners’ Comments Commissioner Tarver said many patients are part of both CHN and CBHS and each system has different rules for which pharmacies they can go to. He asked if there is an opportunity to select a community vendor that has more overlap with CBHS. Commissioner Tarver also noted that the formularies for primary care and CBHS are different. Dr. Kotabe said the two divisions work closely together to try to get the formularies as similar as possible. Ms. Kotabe said that Rite Aid was the only chain that was willing to work with the Department for this program. A year into the program they sent out letters of interest to all pharmacies in San Francisco. Major chains did not come forward. Commissioner Chow said it is hard to imagine that people in Chinatown, who must go to the Rite Aid on Market Street, would be highly satisfied with the service. He encouraged Dr. Kotabe to continue the efforts to expand the 340B program to allow clients to go to more than one pharmacy. He asked Dr. Kotabe to pursue conversations with the public health clinics about possibly generating interest among community pharmacies to participate in the programs. (3.7) CHN-SFGH – Request for approval of a contract renewal with the Regents of the University of California, in the amount of $1,176,000, which includes a 12% contingency, to provide orthotics and prosthetics for medically indigent adult clients of the Community Health Network, for the period of July 1, 2006 through June 30, 2009. (3.8) CHN-Jail Health Services – Request for approval of a contract renewal with Haight Ashbury Free Clinics, in the amount of $3,476,478, which includes a 12% contingency, to provide psychiatric and substance abuse treatment services targeting inmates in the San Francisco County Jail system, for the period of July 1, 2006 through June 30, 2007. Secretary’s Note – This item was continued to the next Health Commission meeting. (3.9) DPH – Request for approval of a resolution authorizing the Department of Public Health, San Francisco General Hospital Medical Center to accept a gift of funds in the amount of $146,041, in support of the Mammography Van Program, which provides mammography services to indigent and under-served women in San Francisco. (3.10) DPH – Request for approval of a resolution authorizing the Department of Public Health to accept a monetary gift of $25,000 from Cellestis, Inc. to increase TB screening capacity at the Public Health Laboratory. Commissioners’ Comments (at the Health Commission meeting) Commissioner Monfredini said that the gift from Avon is wonderful. DPH needs to commit additional personnel and funds for the mammography van and the Avon Comprehensive Breast Center. Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Tarver) approved the Budget Committee Consent Calendar. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Health Director, presented the Director’s Report. Nurse Week Nurse Week was a great success throughout the Department. Nearly 325 staff and guests gathered at the Ritz Carlton for the Dorothy Washington Nursing Scholarship fundraiser. Since the creation of the scholarship fund three years ago, more that $37,000 has been awarded to San Francisco General Hospital staff enrolled in baccalaureate and graduate level education. Last week, guest lecturer Susan Hohenhause, from Duke University’s Office of Patient Safety and Quality, spoke to the staff about "A Practical Approach to Patient Safety," followed by a reception and awards program in the SFGH cafeteria attended by 350 staff. Dr. William Schecter received the Friends of Nursing Award; Karen Boyle, RN received the Daisy Award; Terry Dentoni and Debbie Tam received the O'Connell Society Award; and the Mildred Crear Award was given to Margaret Moran, PHN and Yan Oi Wong, PHN. At Laguna Honda Hospital, the nursing staff selected the theme, “Making A Difference in the Lives of Our Residents,” to illustrate their dedication to those who make the hospital their home. LHH honored its nursing staff with receptions on all three shifts and a Best Practice Award was presented at each reception to the Unit O7 interdisciplinary team and nursing staff. In addition, Lynda Johnson, City College of San Francisco Nursing Program Instructor, gave a lecture for nursing staff focused on the Making A Difference theme. The events were well attended by the LHH nursing staff. West Nile Virus The West Nile Virus (WNV) season is fast approaching. On May 9th, the Communicable Disease Control & Prevention Unit distributed the 2006 "West Nile Virus Health Update” to all San Francisco clinicians. The Health Update provides information about WNV recognition, testing, reporting, procedures, surveillance activities and information resources for San Francisco. The Update and additional West Nile Virus information can be found at www.sfcdcp.org. DPH will be working once again this year with the PUC, Recreation & Parks, Public Works and the Department of Environment in eliminating areas where mosquitoes breed and alerting the public about how to prevent West Nile Virus. Last year, WNV infected 935 Californians and claimed the lives of 19. There were no locally acquired cases of WNV in San Francisco. DPH hopes to continue this tradition during the upcoming WNV season. Balboa Teen Health Center 20th Anniversary The Balboa Teen Health Center is celebrating 20 years of service to San Francisco’s adolescents on May 18th, with a reception, silent auction and program beginning at 5 p.m. at Balboa High School, 1000 Cayuga Avenue. The theme of the celebration is “Lighting the Way to Healthy Futures.” The Center has become increasingly committed to advocating for school-based health services on both a citywide and a statewide level. Working with the School Health Center’s Association and with funding from the Kellogg Foundation, nine state associations and community partners have committed to a five-year project aimed at sustaining and expanding school-based health care. Balboa Teen Health Center is the only comprehensive school-based health center in San Francisco and was the first of its kind to open in northern California in 1986. The center provides routine medical care, mental health and substance abuse counseling, and health education services to all Balboa High School students at no cost to the student or family. Clients are 95% youth of color, 22% are English language learners and 61% qualify for free or reduced lunches. Last year, 70% of Balboa’s student body visited the center for services. Dr. Katz hopes the Commissioners will be able to join representatives from the Department of Public Health, the Unified School District, Bayview Hunter’s Point Foundation, San Francisco Public Health Foundation and many supporters from the community for this wonderful event. Juvenile Justice Pilot Project The Department used the occasion of Mental Health Awareness day on May 8th to focus attention on a new mental health program for youth and their families who have become involved the juvenile justice system. Called the “Multisystemic Therapy (MST) Pilot Project,” the program is an intensive, home-based mental health treatment program that seeks to keep juvenile justice youth with their families. The first group of youth has successfully graduated from this new partnership that the Department manages with the Juvenile Probation Department. A press conference highlighted the success of the program and featured a family who participated in the program. Network of Care.org Launch The Mental Health Association of San Francisco co-sponsored a kick off event today with staff from Community Behavioral Health services for the new www.networkofcare.org website. This latest addition to the growing number of web-based resources is an interactive, single information place where individuals, professionals and anyone concerned about mental health can go to easily access a wide range of information about mental health. The website features a special San Francisco resource directory and is designed to be accessible to everyone, regardless of literacy level, disability or language. Community Health Network, San Francisco General Hospital Credentials Report, May 2006 05/06 07/05 to 05/06 New Appointments 13 146     Reinstatements 0 0 Reappointments 31 449    Delinquencies: 0 0    Reappointment Denials: 0 0 Resigned/Retired: 10 122 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Deceased 0 0 Changes in Privileges    Additions 3 553    Voluntary Relinquishments 2 49    Proctorship Completed 10 125    Proctorship Extension 0 6 Current Statistics – as of 05/1/06   Active Staff 464 Courtesy Staff 568 Affiliate Professionals (non-physicians) 198 TOTAL MEMBERS 1,230 Applications In Process 42   Applications Withdrawn Month of May 2006 0 2 (07/05 to 05/06) SFGH Reappointments in Process June 2006 to Sept 2006 239   Commissioners’ Comments Commissioner Illig asked how the Balboa Teen Clinic is funded. Dr. Katz said it is funded by DPH, though not exclusively. The clinic bills Medi-Cal to the extent that patients are eligible. This is the only school-based clinic in San Francisco that provides comprehensive services. Commissioner Chow noted that 70 percent of the school population has visited the clinic. Commissioner Chow asked where the conversation should take place about establishing similar clinics at other school sites. Dr. Katz said the Commission has adopted a policy to establish more school-based clinics. The challenge is funding, since they would largely be funded through the general fund. Commissioner Guy said that the Health Commission supports wellness centers at school sites, rather than full-fledged clinics. There was testimony at the Richmond Health Commission meeting about the lack of school-based services in the Richmond and as a follow up to that it was discovered that Washington High School made the decision to close its center. Other schools are seeking wellness centers. The PHP JCC continues to discuss this issue. Commissioner Illig said that St. Mary’s discontinued its medical van that went to the Catholic high schools because they found that medical services could not be provided without parental consent. Commissioner Chow wants to continue to pursue how to best serve the youth of the Richmond. 5) PRESENTATION OF THE ANNUAL EMS AWARDS Commissioner Chow presented the Annual EMS Awards. EMS Field Provider Award: Mary Roan, EMT-1, AMR Dispatcher Award: Marla Dukes, ECD Hospital Provider: Peter Emblad, M.D., Kaiser, Presidio F.D. Community Member: Megan Corry, EMT-P, Community College Ray Lim Excellence In EMS Award: James Green, San Francisco Fire Department, EMT-P 6) REPORT ON CHRONIC CONDITIONS OF CALIFORNIANS-SUMMARY OF FINDINGS RELATED TO SAN FRANCISCO Frances Culp, Health Planner, Office of Policy and Planning, presented the findings of a report on the chronic conditions of Californians, as these findings relate to San Francisco. The report was done by the UCLA Center for Health Policy Research and was titled Chronic Conditions of Californians—Findings from the 2003 California Health Interview Survey. The report focuses on chronic diseases that respond well to medical treatment and management, allowing localities to understand the burden of specific medical conditions, including heart disease (HD), hypertension, asthma and diabetes, in their area to inform planning for proper interventions. In addition, the report reviews a variety of characteristics of the individuals with chronic conditions, including race/ethnicity, low-income and Medi-Cal participation. This summary highlights data presented in the report for San Francisco and how local findings relate to the state average. In 2003 in California, 1,763,000 adults reported a diagnosis of HD, with 42,000 of these individuals in San Francisco; 6,012,000 adults reported hypertension, with 144,000 in San Francisco; 1,678,000 adults reported diabetes, with 42,000 in San Francisco; 3,020,446 adults reported asthma, with 69,000 in San Francisco; and 1,326,000 children under 18 reported asthma, with 16,000 in San Francisco. Ms. Culp presented data on race, ethnicity and socioeconomic status for each disease. In general, San Francisco fares better than the State average for residents reporting chronic conditions and access difficulties. A smaller percentage of San Franciscans describe their health as fair or poor—17.2% in San Francisco compared to 20.5% statewide. Of concern, however, are data related to the races and ethnicities in San Francisco reporting chronic conditions more frequently than the State average. This includes 50% of African American adults diagnosed with hypertension, 16% of Latino adults diagnosed with asthma and 10% of Asians reporting a diagnosis of diabetes. DPH has a number of initiatives that aim to alleviate the burden caused by chronic conditions on a local level: SFGH’s 100,000 Lives Campaign; one of the three interventions is to deliver reliable evidence-based care to prevent deaths from heart attacks; Partnering with CBOs to encourage physical activities; Statewide collaboration to improve diabetes care; Chronic Care Learning Collaborative, which included the Ocean Park Clinic, improved care for patients with diabetes by adopting a chronic care model to keep patients healthier and more engaged in managing their disease; Mobile Eye Van; and Asthma Task Force and Pediatric Asthma Clinic Commissioners’ Comments Commissioner Monfredini said that the Health Department has invested in prevention and chronic disease management and hopefully the next survey results reflect these efforts. Commissioner Monfredini asked if early diagnosis could prevent a condition from becoming chronic. Commissioner Chow said that various manifestations of a disease like diabetes could be prevented. And lifestyle is a key component a managing chronic diseases. Commissioner Tarver said prevention could offset a person having a diagnosis or chronic disease progression. Commissioner Illig asked if the California State Interview Survey (CHIS) included HIV in its survey. Ms. Culp said that she is almost certain that the survey included HIV, but it was not part of UCLA’s report that highlighted a few of the diseases. DPH and the State consider HIV a chronic disease. Commissioner Chow confirmed that the survey is all adults, except for the asthma data, and self-reported. He noted that the report shows that in San Francisco, 10.2% of Asian Americans have diabetes. Commissioner Chow is curious that CHIS data shows that San Francisco has less chronic disease than the State in general. It is hard to believe that San Franciscans are healthier, given the city’s aging population. Dr. Katz said that San Francisco has a much better public and private health care system than other counties. In addition, although San Francisco has pockets of extreme poverty, San Franciscan’s median socioeconomic status is quite high, and socio-economic status is related to health outcomes. In addition, San Francisco has a different ethnic composition. Any or all of these factors could contribute to San Francisco’s lower level of chronic disease. Commissioner Guy said that if we were to use these highlights to guide our investments, one key area is asthma. Also, DPH has models in place, for example the chronic care initiative at Ocean Park. We need to dissect the impacts of this model and apply to other clinics or to other diseases. It is also important to look at environmental impacts on chronic diseases. With regard to hypertension, there are a lot of best practices for managing this disease. A lot of our primary prevention could be targeted toward hypertension. The report is a good beginning, and there is a lot more prevention work that could be done. Commissioner Chow said diabetes is becoming a growing problem in the Chinese community, not just in the United States but also in China. Data from Hawaii shows that 12% of Japanese have diabetes. The issue of diabetes in the Asian community is important. Commissioner Tarver noted that there are limitations to any survey. DPH should have statistics about depression and psychosis in its BIS system. He would like to see the top diagnoses in the CBHS clinics, what is changing and how we should target our resources. African American health disparities continue to be despairing in their persistence, and Commissioner Tarver asked what the Department is doing to target this declining population. What health resources are in place in the Western Addition, Bayview Hunters Point, South of Market, and what are the best practices for serving this population? Ms. Culp will follow up on what data is available. Secretary’s Note - Commissioner Illig recognized the participants in the Mental Health Association’s “Training for Advocacy, Skills, Connections” program. As part of the training, individuals attended the Health Commission meeting to observe the Health Commission. 7) CONSIDERATION OF A RESOLUTION REGARDING HRSA/CARE ACT TRANSITIONAL HOUSING POLICY Margot Antonetty, Director of Programs, Housing and Urban Health, presented a resolution opposing Health Resources and Services Administration’s (HRSA) CARE Act transitional housing policy. On March 29th HRSA issued a notices stating that eligibility for short-term and emergency housing assistance using Ryan White CARE Act funds would be limited to 24 months beginning in March 2007. Many CARE Act clients served in transitional housing in San Francisco would be chronically homeless without these services, and their health status would quickly deteriorate resulting in increased health care costs as emergency room visits and hospitalizations increase. This policy would severely impact DPH’s ability to transition clients into permanent housing, and would eliminate the City’s flexibility to extend eligibility for transitions housing in cases or severe need. Ms. Antonetty said that the Department is asking HRSA to develop a length of stay policy that gives EMAs flexibility based on the population being served and system capacity. Commissioners’ Comments Commissioner Guy asked what the average length of stay is for San Francisco CARE Act transitional clients. Ms. Antonetty said there are people in rental subsidies for many years. Ms. Antonetty said that when the system was created, people in transitional housing left because they needed a higher level of care or they died. Now people are living longer but still need supportive housing. Commissioner Guy asked what the consequences would be if the policy is imposed. Ms. Antonetty said that 400-500 people are on CARE funded subsidy. DPH only places 40 people per year on all programs, which indicates that more than 400 people have been on their subsidy for longer than two years. To force people out of subsidies is bad policy. Commissioner Tarver said HRSA’s policy would adversely impact the people who already have subsidies. SSI provides too little money to afford living situations. That said, things have changed and San Francisco should be creative and reform itself before the federal government reforms for us. In addition, with such a large waiting list, perhaps there should be more movement into and out of transitional housing. Employment training, educational opportunities and other programs should be beefed up to help people move off of subsidies and be further rehabilitated. Ms. Antonnetty said that Catholic Charities has a pilot program that incorporates a focus on returning to work. Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Tarver) approved Resolution 10-06, “Opposing the Health Resources and Services Administration Policy that Restricts Transitional Housing Funded Under the Ryan White CARE Act to 24 Months,” (Attachment A). 8) PUBLIC COMMENT/OTHER BUSINESS Laura Lucia Leale, Alliance for Lupus Research, (taken before the Director’s Report), said the organization, founded by Robert Wood Johnson IV, has the mission to find a cure for lupus. They are based in New York but will be having a major grass roots event in San Francisco in November—The Walk for a Cure for Lupus. They are sponsoring a series of free events leading up to the walk. They are largest private funder of lupus research. They have committed $35 million to lupus research and are committed to advocacy to put this on the national radar screen. Michael Wise, Southeast Mission Geriatric Services, said approximately one third of their clients are Spanish speaking and they do not have enough Spanish-speaking staff. They also need a working computer to access client information from the Department’s system. C.W. Johnson said he has just been diagnosed with Type II diabetes. He is finding that only some places take Medi-Cal. There are only three or four places people with Medi-Cal can go for medications. He would like to see Medi-Cal reform to increase access. 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.