Minutes of the Health Commission Meeting Tuesday, September 19, 2006 at 3:00 p.m. ALEX PITCHER JR. COMMUNITY ROOM SOUTHEAST COMMUNITY FACILITY 1800 Oakdale Avenue San Francisco, CA 94124 1) CALL TO ORDER Commissioner Monfredini called the meeting to order at 3:15 p.m. Present: Lee Ann Monfredini, President James M. Illig, Vice President Edward A. Chow, M.D. Roma P. Guy, M.S.W. David J. Sanchez, Jr., Ph.D. Donald E. Tarver, II, M.D. John I. Umekubo, M.D. Commissioner Monfredini welcomed everyone to the meeting and said the Health Commission was honored to be in the Bayview at the Southeast Community Facility. She acknowledged Dr. Harrison Parker, former Health Commissioner and current member of the Southeast Community Facility Commission, who was in the audience. Commissioner Monfredini said the Health Commission and the Department of Public Health clearly understand that violence in the community impacts the health of the community, and that both the response to violence and violence prevention fall within the purview of the Health Department. The Health Commission welcomes all public testimony. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF SEPTEMBER 12, 2006 Action Taken: The Commission approved the minutes of the September 12, 2006 Health Commission meeting with two corrections. Commissioner Umekubo’s comments on the primary care report should say 20,000 patients, rather than 2,000 patients could be added to the system. The Credentials Report will be revised to include the accurate year-to-date count for proctorships completed. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Sanchez chaired and Commissioner Tarver attended the Budget Committee meeting. The Budget Committee requested that Items 3.1, 3.2 and 3.3 be moved from the Approval section of the agenda to the Discussion and Approval section. Items for Discussion and Approval (3.1) AIDS OFFICE-HIV Prevention – Request for approval of a retroactive renewal contract with PHFE Management Solutions, in the amount of $174,211, which includes a 12% contingency, to provide Fiscal Intermediary Support for the Post Marketing Surveillance, Condom Availability Program and IDU Risk Assessment & Outreach services, for the period of July 1, 2006 through December 31, 2006. (3.2) AIDS OFFICE-HIV Prevention – Request for approval of a retroactive renewal contract with PHFE Management Solutions, in the amount of $96,554, which includes a 12% contingency, to provide Fiscal Intermediary Support for the SFGH HIV Testing Evaluation, Condom Availability Program, and Information Systems Administration for CTL services, for the period of July 1, 2006 through June 30, 2007. Commissioners’ Comments Commissioner Sanchez asked if the fiscal intermediary contracts were put out to bid. Tracey Packer, AIDS Office, said they were put out to bid. Commissioner Sanchez asked this because PHFE Management Solutions is located in City of Industry, and he likes to see local businesses have the chance to bid on services. Commissioner Sanchez asked if demographic data is available. Ms. Packer said they have data for the Condom Availability program, and could provide a larger presentation, perhaps at a Joint Conference Committee, with additional data. Commissioner Sanchez wants to be able to track if the programs are making a difference over time. Commissioner Tarver said he would appreciate more detailed program information in future monitoring reports. (3.3) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive renewal contract with Native American AIDS Project, in the amount of $168,000, which includes a 12% contingency, to provide case management and peer advocacy services to native Americans diagnosed with HIV or AIDS, for the period of July 1, 2006 through December 31, 2007. Commissioners’ Comments Commissioner Tarver asked if this contract could be a four-year contract, rather than a one-year contract. Ms. Long replied that the AIDS Office drafted criteria for multi-year contracts and submitted this to the Finance office for review. Ms. Okubo, Deputy Finance Director, said that the Budget Committee would be discussing the multi-year criteria for all divisions at its next monthly meeting. (3.4) PHP-Housing and Urban Health – Request for approval of a retroactive multi-year renewal contract with Richmond Area Multi Services, in the amount of $5,433,389, which includes a 12% contingency, to provide permanent supportive housing services in a residential care environment at the Broderick Street Adult Residential Program, targeting homeless adults, for the period of July 1, 2006 through June 30, 2010. Commissioners’ Comments Commissioner Tarver applauded the Broderick Street facility. He would like to highlight this program to see how DPH could replicate these services. Ms. Antonetty replied that Housing and Urban Health is in conversation with another agency to help them acquire a 50-60 bed facility that would be a similar model. (3.5) AIDS OFFICE-HIV Prevention – Request for approval of a new contract with Institute for Community Health Outreach, in the amount of $133,560, which includes a 12% contingency, to provide HIV prevention services – Health Education and Risk Reduction Services for Youth – to behavioral risk populations in San Francisco, for the period of August 1, 2006 through December 31, 2007. Commissioners’ Comments Commissioner Tarver would like to see, for the next contract monitoring cycle, more than two contract objectives. This provides the opportunity to fully capture the impact of the agency’s work. Action Taken: The Commission approved the Budget Committee consent calendar. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. MFAC Awarded to Sue Currin, RN Dr. Katz announced that Sue Currin, RN, Chief Nursing Officer for San Francisco General Hospital, has been named as a recipient of this year’s Municipal Fiscal Advisory Committee, (MFAC) 2006 Public Managerial Excellence Award. The MFAC Public Managerial Excellence Awards are dedicated to recognizing outstanding leadership, creativity, and managerial excellence in San Francisco government. Over the last 25 years, more than 100 City employees have been commended for their innovation, imagination and dedication to public service. Sue was nominated for two key issues that she addressed this past year: the high patient census and the national nursing shortage. Ms. Currin developed nursing recruitment and retention strategies that helped to decrease nursing vacancies from 24% to 8 %. She also instituted the CA State AB394—the Nursing to Patient staffing ratios, which allowed for a significant decrease in the use of costly overtime and outside agency nurses, as well as increased consistent quality of care. Also under Ms. Currin’s leadership, the Bed Utilization Committee and discharge rounds increased patient flow, resulting in a 20% decrease in diversion and a decrease in decertified bed days. Other innovations Ms. Currin introduced included implementation of a Patient Discharge Lounge; grant funding for professional nurse management development; a baby-friendly program that has resulted in a 55% increase in breast fed babies; expansion of the Integrated Soft Tissue Infection Clinic; creation of a Medical-Behavioral Unit; implementation of the Clinical Institute Withdrawal Assessment for Alcohol Protocol; development of a business plan in collaboration with Orthopedic Services; and development of a plan to create a short-stay unit for cardiac patients to decompress the Emergency Department. I know the Commissioners join me in extending our sincere congratulations to Ms. Currin for recognition of her outstanding managerial skills and for her deep and personal commitment to the patients at San Francisco General Hospital. She will receive her award on October 24th at the St. Francis Hotel. Elizabeth Gray – New Long-Term Care Director Dr. Katz announced that Liz Gray has accepted the job of Long Term Care Director. The Commission will remember that the 2005 Health Management Associates Report recommended the creation of this new position. Ms. Gray will be responsible for the research, analysis and development of LTC options to strengthen the continuum of care within DPH. She will also supervise the Targeted Case Management program that is responsible for identifying persons at Laguna Honda Hospital or at risk of entering LHH who wish to receive community-based LTC services as an alternative to institutional services. Dr. Katz and the Commission joins welcome Liz to her new role in the Department. New California Department of Public Health Governor Arnold Schwarzenegger has signed SB162 establishing a new California Department of Public Health (CDPH) within the existing Health and Human Services Agency and statutorily transfers some responsibility from the California Department of Health Services (CDHS) to the new CDPH beginning July 1, 2007. At the same time, the Department of Health Services (DHS) is being renamed as the Department of Health Care Services (DHCS). The Governor will appoint a State Public Health Officer, who must be a licensed physician or surgeon, to head the new CDPH as well as two chief deputy directors. It is hoped that the creation of the new California Department of Public Health will result in: Focused leadership in public health and health care financing at the state level; A more effective public health infrastructure in California, resulting in decreased illness, injury and death rates; Protection for California residents in the event of an act of bioterrorism or other major public health emergency; and Increase accountability and improve program effectiveness for the public health and health care purchasing functions of state government. National HRSA Award Congratulations to Michelle Long who was the recipient of the “Hank” Carde award at this year’s HRSA conference in Washington, DC. Michelle was recognized for her dedicated service as the San Francisco EMA grantee and her outstanding leadership in adapting the service system to the needs of a changing epidemic. Michelle has worked in HIV/AIDS since 1991. The award is named after Freeland Henry “Hank” Carde III, a retired US Navy officer and twice awarded bronze star combat veteran of the Vietnam War, who was considered one of Washington D.C.’s most effective AIDS activists. Bronze Key Award Dr. Katz reported that Jim Stillwell, CBHS Designated County Alcohol and Drug Administrator, has been awarded the 2006 Bronze Key Award by the National Council on Alcoholism and other Drug Additions-Bay Area (NCADA-BA). The Bronze Key Award is presented to a member of the community who has made significant contributions to the field of alcoholism. Mr. Stillwell will receive his award on November 30th at the NCADA-BA annual fundraiser and silent auction. Congratulations to Jim for this well-deserved recognition. 6th Street Multi-Service Resource Center Earlier this month, in conjunction with Supervisor Chris Daly’s office, CBHS conducted two community forums to discuss the development of a 6th Street Multi-Service Resource Center. Center services will be targeted to persons frequenting the 6th St. corridor who need resources for housing, mental health and substance abuse services. Over 85 people attended the forums and offered input on the types of services they would like to see at the Center. Commissioners’ Comments Commissioner Monfredini thanked Ms. Gray for accepting the Long-Term Care Director position, and congratulated Sue Currin, Michelle Long and Jim Stillwell for their awards. Commissioner Chow said that for the past several months, Liz Gray has taken exceptional control over the TCM program and has made it much more successful. This bodes well for her new responsibility. Her work is much appreciated. Commissioner Guy appreciates that the report publicly recognizes so many of DPH’s great staff. She thanked Ms. Gray for taking on the challenge of moving the Department forward in long term care. Regarding the new California Department of Public Health, Commissioner Guy is interested in having future discussions about what the local impact will be. Is this a true change or just a bureaucratic change? Commissioner Sanchez appreciates the recognition of our wonderful staff. Commissioner Umekubo thanked the community for welcoming the Commission to the Southeast Community Facility. He congratulated all the DPH employees that were recognized in the Director’s Report. Commissioner Tarver recently attended a Google fundraiser for the Trauma Recovery Center, which is a great example of a public private partnership. Commissioner Tarver thanked Assemblymember Leno for his leadership in having the State provide funding for this critical program. 5) BAYVIEW HEALTH ACTION PLAN Mitchell H. Katz, M.D., Director of Health, presented a report on improving the health of Bayview Hunters Point residents. This report looks at chronic disease and disparities in Bayview Hunters Point and includes recommendations for further action aimed at improving both health outcomes and health access in the neighborhood. Currently in Bayview Hunters Point, DPH funds Southeast Health Center primary care clinic, 25 substance abuse programs, 22 mental health program and nine HIV/AIDS services-providers. Through community-based primary care centers and care provided at San Francisco General Hospital, the Department serves an average of 12,800 patients from Bayview Hunters Point annually, with an average of over 31,900 visits each year. BVHP experiences a disproportionate number of social determinants with adverse effects on health: crime and violence; environmental injustice; limited high-quality employment opportunities; fewer resources for nutritious foods; fewer opportunities for recreation; lack of culturally competent providers; and barriers to access to health care. BVHP’s disproportionate exposure to the negative social determinants results in negative health outcomes and health disparities, including: Lower life expectancy Greater rates of violent injuries Higher rates of hospitalization for chronic diseases including heart disease and asthma High rates of mortality from cancer Higher infant mortality Dr. Katz presented an overview of the health issues in several key areas, including Environmental Health, Behavioral Health, Diet and Physical Activity, HIV/AIDS, Cancer, STDs, Maternal Child Health and Injury Prevention. For each of these areas, Dr. Katz detailed DPH activities to improve outcomes. Dr. Katz then presented recommendations for further work. Recommendations for Further Work General Health Care Increase chronic care models to provide better care for diabetics, asthmatics and other chronic illnesses Increase availability of specialty care Environmental Health Identify key health assets in BVHP to be prioritized in the Bayview Redevelopment Plan Ensure sufficient resources for the Green Business Program to conduct outreach and training Use noise and air monitoring to ensure transportation and land use planning for future development Develop more open space and recreational opportunities in BVHP. Asthma Create asthma information website Fund mold remediation workshops Cluster asthma care days to utilize mobile spirometry and education services. Tobacco Use and Related Issues CCSF should adopt policies that protect residents from second-hand smoke Behavioral Health Fund additional culturally appropriate behavioral health clinicians Fund wraparound services for those not meeting Medi-Cal criteria Extend mental health service hours and create a drop-in clinic Diet and Physical Activity Disincentives to retailers selling unhealthy foods Revitalize the Bayview Farmers market and possibly change location HIV/AIDS Design public image and pride campaign Develop positive social networks to reduce isolation and depression STDs Fund education efforts for medical providers to routinely screen sexually active youth Seek funding to provide increased staffing to conduct STD screening 24 hours a day in jail health programs Dr. Katz concluded his presentation by saying the disparities in BVHP need to be addressed in a comprehensive strategic manner and DPH needs to work with the community to prioritize recommendations for expanded services. Public Comment Jacob Moody, Bayview Hunters Point Foundation, illustrated the need for more coordinated leadership and efforts with two examples of city departments not aware of each others activities. There must be broader conversations that coordinate efforts. Good intentions expressed by others towards Bayview Hunters Point need to be harnessed. There are a number of missed opportunities. There are resources in the community that when seen as assets can change the quality of life of people living in the community. Coordination must happen at the highest level, and solutions must not be imposed on the community. Cathy Davis, Bayview Hunters Point Senior Services, said seniors are missing from the report. There are a lot of aging seniors in the community, and they need to be considered in planning efforts. There are not a lot of programs that are geared toward and allow seniors to stay in the community. Seniors are leaving because facilities and services are not available. Please add the services that allow seniors to age in place to DPH’s scope. Perry Lang, Black Coalition on AIDS, said that BCA provides HIV services to men and women, straight and gay alike. The initial report stated that BCA only provided HIV services to men. We need to engage directors and board members of agencies involved in this work in this dialogue. This is not happening. He also urged the establishment of a Health Support Center. There needs to be a larger conversation with the people who do the work and do the research to develop the recommendations for dealing with chronic health conditions. Jesse Tello said that Bayview needs a lot of help. There needs to be more outreach for these kinds of meetings. He is proud to be in this neighborhood. Many of the problems are caused by people not from this community. The police have cleaned out a lot of the drug dealers, but they still gather on Newhall and Kirkwood. He wants more police surveillance. Sports are needed in the community. The Mayor’s Office and the Recreation and Park Department need to increase sports opportunities. Daisy Anarchy, Sex Workers Organized for Labor, Human and Civil Rights, said her organization fights for the rights of all sex industry workers. They have worked with DPH staff over the years, and have established a good working relationship. However, they have been unsuccessful in attempts to meet with Jeffrey Klausner, and would like assistance in making this happen. The St. James Infirmary and SWOP have been lobbying against legislation that will protect sex workers. It’s totally inappropriate for DPH and Dr. Klausner to be working with St. James Infirmary and SWOP against this legislation. Marilyn Metz, M.D., Arthur H. Coleman Medical Center, informed the Commission and the community that the Arthur H. Coleman Medical Center is working towards developing a non profit that would allow them to expand the types of services they offer. Most of the preventable and chronic diseases that they deal with are lifestyle related, and as such they have found a need for support groups, classes, workshops and other forums where patients can receive health information. One-on-one medical visits are not the place where people can get this kind of information. They have been in discussion with Mark Ghaly at Southeast Health Center about forming a public/private partnership. They have been sponsored by the San Francisco Foundation. Dr. Harrison Parker, Southeast Community Facility Commission and former Health Commissioner, said that over the past five years, San Francisco has lost 25 percent of its African American population, 10 percent of the Latino population and 5 percent of its overall population. What impact has this had on health disparities in Bayview Hunter’s Point. DPH has been increasing the amount of funding targeted toward Bayview Hunter’s Point. What impact has this had on health disparities? The community needs to know what they are getting. When environmental health determinants are reduced, the population’s health will improve. He offered a number of suggestions: create a policy to prorate available community health program funds according to health disparities; create a policy to incrementally increase primary health prevention funds from two percent to 10 percent to reduce the onset of disease and disability; to plan proactively and set goals for health disparity reductions; and, as the San Francisco safety net, to advocate to the Board of Supervisors the right to certify all identifiable health determinants and health disparities in the City and County of San Francisco. Ahimsa Porter Sumchai, M.D., has submitted corrections to the report via e-mail. For example the incidence of homicide in Bayview has not declined. One area where DPH needs to be proactive is in the area of environmental impact reports. There have been a number of large projects that would have large health impacts, and the Health Department has to take a larger role. The Department also has to take a larger role in the area of lead and air quality. Abner Boles, Ph.D., Executive Director, Westside Community Services, said it is imperative that the commission reidentifies violence and violence response as a public health issue. As part of this there needs to be identified recommendations and funds carved out for these programs. It is no longer tolerable and must be made the dynamic public health issue that must be responded to. Javarre Wilson, graduate student in the San Francisco State MPH Program, is disturbed by the disparities that are identified in the report. He is equally disturbed about the violence. He lives in Oakland, where the murder rate has surpassed that of last year. The leaders there say that the only response is more police officers on the streets. He disagrees that there is no effective way to deal with the violence in Bayview Hunters Point. The Health Department should work with other City departments to provide jobs, education, role models and other efforts. The Health Department should be more proactive in working with the residents and leaders in the community. Betty McGee, Executive Director, HERC, said HERC is the expert in pediatric asthma and women’s health. Next year their contract will be put out to bid. They want to be able to continue providing the services they do now. With the funds they get from DPH, HERC was able to go into the homes clean up mold. To date they have done more than 100 homes. Through another grant they are leaving clean air machines in those homes. They would like to expand services to address childhood obesity. They have had requests from childcare facilities to do asthma training. Karen Pierce, director of the HEAP Program, offered to take commissioners on a “toxic tour,” which looks at the condition of the neighborhood from the perspective of public health and environmental justice. Ena Aguirre said there are a number of forums that would be useful in disseminating information about community meetings. She offered to help the Health Commission for future meetings. Commissioners’ Comments Commissioner Monfredini said that each of the commissioners is willing to meet with anyone from the community to learn more about what we can do to increase input in Health Department activities and recommendations. Commissioner Monfredini said she would like the Health Commission to come back to the community in the next year, perhaps at a more convenient meeting time. Commissioner Tarver welcomes the invitation to come back to the community. This is essential because it is the Health Department’s responsibility to address health disparities, and the Department and Commission’s responsibility to be accountable to the community. DPH needs to be reorganized to be more integrated. Many organizations do not work together and could pool resources to be more flexible and coordinated. There needs to be a point person who is solely responsible for tracking health disparities, the Department’s efforts and outcomes. We need to uncover the primary causes of people’s behavioral health issues and primary health issues. The Department needs to reexamine how it connects with people about what their health needs are. Programs need to be targeted toward and welcoming to African Americans in order for them to feel like they are being served. He also commented on the loss of African American administrators within DPH. Recruitment efforts need to focus on this. Housing is a health issue and as housing is improved, health outcomes will improve. We need to think about families, as well as individuals. He views the data outlined in the report as a crisis. DPH can respond to this, but we must continue to hold ourselves accountable to making change. With regard to when to have a follow up Health Commission meeting, he recommends having discussions with community stakeholders regarding the appropriate time, location and outreach efforts. Commissioner Illig said this report is a good beginning for getting a grasp on the services DPH provides in Bayview Hunters Point. Next year, he would like to see a different report. For example, how much money is the Department putting into this neighborhood, and what are we getting for this investment. He noted that the outcomes for the Family Mosaic Project are excellent, and he would like to see this level of detailed outcomes for other intervention programs. He would like the Department to work with community stakeholders to identify, across the health spectrum, the desired outcomes and the problems we should tackle. Next year’s report should have numbers attached to the interventions and identified strategies and outcomes. We also need to identify the impacts of the changing demographics in the community. Commissioner Umekubo said the community is faced with myriad problems. We need to prioritize the problems and try to break the cycle. This requires coordination across city departments and with the community. This is going to take resources. It would be nice if there were the ability to show small accomplishments as we take on this long task. Commissioner Guy heard today that leadership exists to coordinate programs and services to better serve this community. We have to look at what we want to do from a population-based perspective. We need to determine if we are to focus on the geographic neighborhood, which encompasses the changing demographics, or if we are to focus on changing the health status of the African American community in the area. From a policy planning perspective, she wants to see leadership working together to comprehensively and strategically plan for the future. Commissioner Sanchez said the comments conveyed a degree of trust that DPH is really working with the community as partners. He was encouraged by the testimony of the SFSU graduate student. This reminded him of the 60s when people came together concerned about violence, concerned about health, concerned about racism, concerned about housing, concerned about education. Communities change, but issues that impact the quality of life of individuals are constant, and it is good to see youth focused on these issues. Violence as a health issue should be one of our major focuses. We need to continue and reaffirm the dialogue with the community. The trust is here. And we are all partners. There are a lot of resources in the neighborhood, a major one being the Mission Bay campus. We need to work together to see that our young people have the benefit of these resources. Commissioner Chow said the Health Commission is committed to improving the health in this community and reducing disparities. We are getting much more information about the problems, and they are clearly complex. The Department has given us a snapshot with this report. There are 59 programs that provide services to this community. This clearly requires coordination, and we do not know the extent to which this happens. Clearly there is room for improvement. He believes that Dr. Katz’s conclusions encompass the many things that need to be done. Some problems need to be addressed geographically, and some ethnically and culturally. For example, diabetes needs to be addressed in a culturally competent way throughout the city for those populations that are being impacted, for example the African American population. There is no question that the Health Department and Health Commission must work with the community to refine and prioritize recommendations. There should be outcomes for each of the initiatives. Violence is a health issue and is a citywide issue. Given this, what is the Health Department hoping to achieve? Disparities need to be addressed in a comprehensive strategic manner. Commissioner Monfredini committed to the neighborhood that the next time the Health Commission meets in the neighborhood, the Commission will work with neighborhood stakeholders to improve outreach and also will work to bring representatives from other city departments and commissions. 6) PUBLIC COMMENT/OTHER BUSINESS None. 7) 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.