Minutes of the Health Commission Meeting Tuesday, November 14, 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: 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. Absent: John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF OCTOBER 17, 2006 Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Tarver) approved the minutes of the October 17, 2006 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Sanchez chaired and Commissioner Tarver and Commissioner Chow attended the Budget Committee meeting. The Budget Committee requested that the following items be moved from the “Approval” section of the agenda to the “Discussion and Approval” section: 3.1, 3.3, 3.5, 3.7, 3.8, 3.9 and 3.11. Items for Approval (3.2) AIDS Office-HIV Health Services – Request for approval of a retroactive renewal contract with Instituto Familiar de la Raza, in the amount of $850,214, which includes a 12% contingency, to provide Latino case management services for individuals diagnosed with HIV or AIDS, for the period of July 1, 2006 through December 31, 2010 (4.5 years). (3.4) AIDS Office-HIV Health Services – Request for approval of a retroactive renewal contract with UCSF Positive Health Practice, in the amount of $770,000, which includes a 12% contingency, to provide Men of Color Program services, for individuals diagnosed with HIV or AIDS, for the period of July 1, 2006 through December 31, 2008 (2.5 years). (3.6) AIDS Office - HIV/AIDS Statistics & Epidemiology Item – Request for approval of a retroactive renewal contract with PHFE Management Solutions, in the amount of $197,125, which includes a 12% contingency, to provide Fiscal Intermediary Support for the HIV/AIDS Core Surveillance Activities, for the period of September 1, 2006 through December 31, 2007 (16 months). (3.10) BHS – Request for approval of retroactive contract renewal with Rebekah Children's Services, in the amount of $86,520, which includes a 12% contingency, to provide mental health services for children, for the period of July 1, 2006 through December 31, 2007 (1.5 years). (3.12) CHN-Jail Health Services – Approval to accept and expend retroactively a two-year grant from the United States Conference of Mayors, in the amount of $70,000, to develop an HIV prevention intervention in collaboration with women in the San Francisco county jails and students from the San Francisco State University Department of Sociology Center for Research on Gender and Sexuality, for the period of September 1, 2006 to August 31, 2008. (3.13) EMS – Request for approval of a contract modification with EMSystem, LLC, in the amount of $586,188, for a total contract amount of $1,500,653, which includes a 12% contingency, to provide patient/hospital/disaster service worker tracking software, hardware and maintenance services, for the period of April 15, 2005 through November 30, 2008 (3.7 years). Items for Discussion and Approval (3.1) AIDS Office-HIV Health Services – Request for approval of a retroactive renewal contract with Asian Pacific Islander Wellness Center, in the amount of $328,347, which includes a 12% contingency, to provide case management, treatment advocacy, and peer advocacy services for individuals diagnosed with HIV or AIDS, for the period of July 1, 2006 through December 31, 2007 (1.5 years). (3.3) AIDS Office-HIV Health Services – Request for approval of a retroactive renewal contract with Shanti Project, in the amount of $559,335, which includes a 12% contingency, to provide integrated case management, peer advocacy, treatment advocacy and outreach services for individuals diagnosed with HIV or AIDS, for the period of July 1, 2006 through December 31, 2007 (1.5 years). Commissioners’ Comments Commissioner Tarver encouraged the contractors to find methods of increasing participation in client satisfaction surveys. Commissioner Tarver noted that IFR receives additional compensation to address language barriers. While it is true that the other agencies do not face the same language barriers, there are other barriers that need to be overcome, and perhaps the Department should consider allocating additional funds in these areas as well. (3.5) AIDS Office-HIV Health Services – Request for approval of a retroactive renewal contract with Positive Resource Center, in the amount of $626,799, which includes a 12% contingency, to provide HIV Work Re-Entry services for individuals diagnosed with HIV or AIDS, for the period of July 1, 2006 through December 31, 2010 (4.5 years). Commissioners’ Comments Commissioner Tarver encouraged the agency to collaborate with the Department to possibly hold offsite workshops in addition to site-based workshops and counseling. Commissioner Tarver offered to help with linkages between Positive Resource Center and other agencies. Commissioner Chow noted that many of the contracts are retroactive due to delays in general fund allocation, and he asked if there was any break in service due to this delay. Ms. Long said that providers have continued to provide services. Commissioner Chow would like to discuss further with his fellow commissioners and finance staff the alternative of approving contracts without the general fund allocation and modify the contracts later to add general funds. He is aware that this is one of the topics being discussed with the Human Services Network. (3.7) BHS – Request for approval of a retroactive contract modification with Larkin Street Youth Services, in the amount of $906,810, which includes a 12% contingency, to provide Proposition 63 mental health services to transitional-aged youth, for the period of July 1, 2006 through June 30, 2007 (1 year). Commissioners’ Comments Commissioner Tarver asked what new services would be provided under this contract. Sherilyn Adams, Executive Director of Larkin Street Youth Services said there would be a total of 18 new beds, some to serve youth with severe mental health problems and some to serve youth coming out of foster care. They will also be able to expand mental health services to youth at three drop-in centers. Commissioner Chow said the Commission is trying to understand what additional services Proposition 63 will bring to our community. So it is important that when Proposition 63 contracts come forward to the Commission, the documents specify what the new services are—what are we getting that we did not get before. Ms. Adams noted that all services that are provided by this contract are new, because there was not funding for this before. Commissioner Chow said that at the appropriate time the Commission should get an update on the entire Proposition 63 program. (3.8) BHS – Request for approval of contract modification with Positive Resource Center, to increase the amount to $807,500 per year for the period of July 1, 2006 through June 30, 2009, to provide advocacy and training services for disabled, uninsured clients, for a total contract value of $3,133,200, including a 12% contingency, for the period July 1, 2005 through June 30, 2009 (4 years). Commissioners’ Comments Commissioner Tarver asked about the requirement for new SSI recipients to have a representative payee. Jane Gelfand, Positive Resource Center, replied that the clients have a treating source who makes the determination about the need for a client to have a representative payee. They also work closely with Conard House to offer these services to clients. Commissioner Tarver added that it seems that the Department should be moving toward department-wide standards for client satisfaction surveys. (3.9) BHS – Request for approval of a retroactive contract renewal with the Hamilton Family Center, in the amount of $145,930, which includes a 12% contingency, to provide children's mental health services, for the period of July 1, 2006 through December 31, 2007 (1.5 years) Commissioners’ Comments Commissioner Tarver suggested that the consultants work to develop means to access ethnicity information. This is important information to provide culturally informed treatment. Commissioner Chow commended the agency on its outcomes. (3.11) CHPP-Health Promotion – Request for approval of retroactive contract renewal with the International Institute of San Francisco, in the amount of $272,871, which includes a 12% contingency, to provide preventive health services, including outreach, medical interpretation, health education and referrals for documented refugees and other immigrants, for the period of October 1, 2006 through September 30, 2007 (1 year). Commissioners’ Comments Commissioner Tarver asked why the contract is being reduced. Patricia Erwin, Community Health Promotion and Prevention, said that typically there is a general fund augmentation of grant dollars and general fund dollars of approximately $20,000 to $30,000 per year. These funds cannot be added to the contract until they know what is available, but she is assuming that they will be able to augment the contract again next year. Commissioner Tarver urged Ms. Erwin to work with DPH fiscal staff to see if a six-month interim agreement is appropriate for this contract. (3.14) AIDS Office-HIV Health Services – Request for approval of a retroactive renewal contract with Walden House, Inc., in the amount of $1,903,732, which includes a 12% contingency, to provide comprehensive monitored residential detox and residential substance abuse services to individuals who are affected by HIV/AIDS, for the period of March 1, 2006 through August 31, 2007 (1.5 years). Commissioners’ Comments Commissioner Tarver asked for an update on client satisfaction. Peter Fogel, Walden House program manager, said the agency put a new program in place in September and will be starting this survey in November. Commissioner Tarver asked if DPH staff is comfortable with the progress that staff has made on outcome objectives. Ms. Herring said the agency continues to improve. Commissioner Sanchez noted that Mr. Sass and his staff have been working closely over the last number of years with Walden House. He asked Mr. Sass to provide his perspective on the agency. Mr. Sass said he has a good working relationship with Walden House. He is very pleased to hear that the recent audit is going to show a small profit. The process DPH is following is for Barbara Garcia and Anne Okubo to work closely to identify agencies that are experiencing either fiscal or program problems, with the intent to intervene early. Walden House has not been one of the contracts in this situation for some time. (3.15) AIDS Office-HIV Health Services – Request for approval of a retroactive renewal contract with San Francisco AIDS Foundation, in the amount of $5,124,137, which includes a 12% contingency, to provide HIV Services Partnership–Psychosocial Services Collaboration for individuals diagnosed with HIV or AIDS, for the period of July 1, 2006 through December 31, 2010 (4.5 years). (3.16) AIDS Office-HIV Health Services – Request for approval of a retroactive renewal contract with AIDS Emergency Fund - Emergency Financial Assistance Voucher Program, in the amount of $2,627,337, which includes a 12% contingency, to provide emergency assistance grants for housing, utility bills and medical expenses for individuals diagnosed with AIDS or disabling HIV disease, for the period of March 1, 2006 through August 31, 2008 (2.5 years). Commissioners’ Comments Commissioner Tarver said that the number of API participants in this program seems low. Mr. Smith said that 3.1 percent of the clients were API, which is consistent with the percentage of API clients reflected in REGGIE data as using CARE funded services. Commissioner Chow noted that when the monitoring was done, the agency had a $170,000 deficit. Mr. Smith said the agency received a $300,000 bequest shortly after the monitoring visit. (3.17) BHS – Request for approval of a contract renewal with Sunny Hills Services, in the amount of $1,684,107, for a total contract amount of $1,886,200, which includes a 12% contingency, to provide mental health services for youth ages 12 through 18 years, for the period of July 1, 2006 through December 31, 2010 (4.5 years). (3.18) BHS – Request for approval of a retroactive renewal contract with Ohlhoff Recovery Programs, in the amount of $444,236 per year, for a total contract amount of $1,776,943 for four years, which includes a 12% contingency, to provide behavioral health services to women and adolescents, for the period of July 1, 2006 through June 30, 2010 (4 years). Commissioners’ Comments Commissioner Tarver asked if there is a creative way to capture more Medi-Cal revenue for this program. Mr. Stillwell said that as of yet, they have not discovered an easy way to do this, but continually give this thought. (3.19) BHS – Request for approval of retroactive contract renewal with Asian American Recovery Services, in the amount of $9,169,726, which includes a 12% contingency, to provide fiscal intermediary services and management for mental health and substance abuse services, for the period of July 1, 2006 through December 31, 2007 (1.5 years). (3.20) BHS – Request for retroactive approval of contract renewal with Walden House, Inc. in the amount of $9,345,303, which includes a 12% contingency, to provide residential mental health and substance abuse treatment services, for the period of July 1, 2006 through June 30, 2007 (1 year). Commissioners’ Comments Commissioner Tarver asked that the Department evaluate its ability to restructure the way adolescent services are provided, given that DPH does not control the funding for these programs or the client referral. Commissioners’ Comments (at Health Commission meeting) Commissioner Monfredini said that she and Commissioner Sanchez met with DPH staff and representatives of the Human Services Network to discuss contracting issues. This was a positive first step. Commissioner Sanchez said that the Budget Committee has served as an opportunity for dialogue and discussion about both contracts and broad budget issues. One of the issues the Budget Committee has been working with staff on is criteria for multi-year contracts. The Department is proposing to establish criteria that would apply across department divisions. The Budget Committee accepted these criteria. Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Tarver) approved the Budget Committee Consent Calendar. 4) DIRECTOR’S REPORT Anne Kronenberg, Deputy Director of Health, presented the Director’s Report. Ms. Kronenberg introduced Rebekah Varela, who will be acting as the Health Commission Executive Secretary while Ms. Seaton is on maternity leave. Presentation on the San Francisco Health Access Program (SF HAP) At the 134th Annual Meeting of the American Public Health Association on November 7th, 2006, Dr. Katz gave a presentation on the SF HAP as part of the Ellen Parsons Memorial Session: Universal Access: At a Tipping Point. Dr. Katz also spoke on the SF HAP at the 5th Annual Asian & Pacific Islander Community Health Center Conference on November 9th, 2006. At both presentations people from other cities express great interest and enthusiasm for the SF HAP model. Clean & Green Program The DPH's Green Program in the Environmental Health Section has produced a newsletter to encourage businesses in the City to maintain their Clean & Green "Beyond Compliance" award status. The newsletter contains updates on local green resources and rebates; conservation tips for businesses, community relations ideas and more. The newsletter is being distributed to all Clean & Green awarded auto repair shops. Mylan Settlement Funds In the fall of 2005 DPH received a “Notice of Funds Availability and Grants Process” from the California Attorney General. These funds were to be directed towards making prescription drugs for the treatment of anxiety available and affordable to low and moderate-income consumers. The funding was the result of a settlement of an antitrust complaint against Mylan Laboratories, alleging that the company cut off the supply of active ingredients from their competitors. CBHS submitted a proposal to the Mylan Settlement Fund to provide physician training and consultation for primary care providers on the diagnosis and treatment of anxiety disorders and to provide anti-anxiety medication for the increased number of low income, uninsured patients who are likely to receive treatment as a result of the educational endeavor. CBHS has been awarded $377,345 over the next two years for this purpose. Massage Program Update Massage Parlor licensing and enforcement has been in the public domain recently. Dr. Katz wanted to bring the Commissioners up to date on the activities we are doing around this topic. Mayor’s Task Force The Mayor’s Task Force on Massage Code Enforcement is currently conducting biweekly joint inspections of massage establishments until all the approximately 150 licensed establishments are inspected. The Department of Public Health is the lead agency on the Task Force and we are joined by representatives from SFPD, DBI, City Attorney’s Office, City Planning and the Fire Department. Operation Gilded Cage All of the Department of Public Health cases resulting from operation “Gilded Cage” have now been settled. Out of the eleven cases: 2 received a $2,500 fine, which was paid in full with 60 days license suspension held in abeyance for 1 year. 1 establishment received a $1,000 fine, which was paid in full. 2 establishments voluntarily closed and were put out of business. 1 establishment received 90 days suspension, 60 days of which were held in abeyance for 1 year. (30 days already served) 3 establishment permits were permanently revoked and the remaining 2 cases were dismissed. On-going Surveillance The Department of Public Health continues its surveillance inspection of massage establishments. Between July and October 2006, DPH issued 31 citations as a result of our routine and joint code enforcement inspections. The cases were presented at the Director’s Hearing and administrative fines ranging from $100 to $1,000 were levied practitioners and establishment owners. New Grant: Shaken Baby Syndrome Prevention DPH received a $20,000 grant from the Kaiser Permanente Foundation to provide partial funding to create a Shaken Baby Prevention program at all five delivery hospitals in San Francisco. The increasing incidence of infant victims of Shaken Baby Syndrome (SBS) is a tragedy for the child, the family and the community. The momentary loss of control by a caregiver can lead to either the death of a baby or to life-long permanent and severe neurological damage. Infant victims can be left with blindness, profound motor and cognitive retardation, and seizures. This preventable outcome occurs in families of all socioeconomic levels and is typically a consequence of an exasperated caregiver following a period of the baby’s prolonged crying. This grant gives us the potential to affect the lives of the 13,000 babies born in the City every year. These funds are in addition to smaller donations DPH has received from UCSF and others. Additional grant applications are pending with the San Francisco Foundation, Gold Foundation and other agencies in order for us to mount the kind of program we want to develop. This is a very innovative project that brings together what are otherwise very competitive organizations in the city around an important problem facing our children and families. Lawsuit filed against Health Care Security Ordinance On November 8, 2006, the Golden Gate Restaurant Association filed a Complaint for Declatory Relief and Injunction against the City and County of San Francisco in United States District Court - Northern District of California (case number C-06-6997). Golden Gate Restaurant Association (GGRA) is a membership-based, non-profit, trade association representing restaurants and culinary employees in San Francisco. Many of its members would be subject to the provisions of the Health Care Security Ordinance (Ordinance). Plaintiff's filing was anticipated. In June 2006, GGRA announced that it had hired a law firm to research the legality of the draft Ordinance. As Plaintiff, GGRA challenges the Ordinance on the grounds that it conflicts with Employee Retirement Income Security Acts (ERISA) which, among other things, establishes national standards for pension and health plans in private industry. Specifically, Plaintiff's allege that the: Required Health Care Expenditures provision of the Ordinance "conflict directly with" ERISA, Ordinance interferes with uniform federal regulation of employee benefit plans by imposing different and substantive and administrative obligations in San Francisco than are owned by plan sponsors elsewhere in the country, Ordinance creates an alternate local enforcement mechanism in conflict with ERISA and Ordinance causes injury with no adequate legal remedy because it requires multiple GGRA members to comply with regulatory provisions that are inconsistent with and pre-empted by ERISA. GGRA seeks the following relief: Declaration that all portions of the Ordinance imposing requirements, penalties and sanctions regarding the Required Health Care Expenditures are preempted by ERISA; and Permanent injunction prohibiting defendant from implementing or enforcing any Ordinance requirements, penalties and sanctions relating to the Required Health Care Expenditures. Granting this relief would prevent the City and County from implementing the Required Health Care Expenditures provision of the Ordinance. It is important to note that in its complaint, GGRA states its wholehearted support for the San Francisco Health Access Program and "its laudable goals," and does not seek declaratory relief and injunction with respect to this provision of the Ordinance. It is the Department's understanding that the City Attorney's Office is reviewing the complaint and will submit the required response. While this lawsuit has been filed, the Department does not envision discontinuing its work to develop and implement the Health Access Program. High End Users Starting in October 2004, the HOME Team, a mobile team comprised of San Francisco Fire Department EMS staff and clinical staff from the Department of Public Health, began operating 4 days a week providing outreach, stabilization, and placement of EMS High Users. A High End User is an individual who has have been picked up by ambulances four or more times in any one month. An EMS Captain and a DPH clinician ride in an EMS van and direct the outreach efforts by targeting and ranking high users and analyzing their pick-up sites, using data gathered from 911 calls. Additionally, they respond to the requests of EMS field units and citywide hospital ED staff. The team also deploys in areas with a high concentration of street-homeless people, specifically targeting individuals lying on the ground in the Tenderloin, Market Street, SOMA, the area between the Main Library and City Hall, in underground encampments and on freeway on-ramps and off-ramps. The typical High EMS User is in his 40s or 50s, is homeless, struggles with chronic alcoholism-- usually combined with significant mental and physical health impairments--and faces a high mortality rate. The SFFD and DPH partnership is essential in effectively dealing with this very challenging population. While the EMS Captain is able to offer emergency medical and referral services, he is not able to offer the long-term intensive case management and placement services that these patients need for recovery and safety. DPH social workers provide wrap-around services on an on-going basis for psychiatric treatment, medical treatment, case management, benefits advocacy, food, clothing, referrals to residential medical supportive detoxification treatment, substance abuse residential treatment, and/or permanent supportive housing. In addition to improving the quality of life for many of these high users, an analysis of total pickups for FY0405 (2,632) versus FY0506 (1,991) showed a 24% decrease (642) ambulance trips and ED visits. St. Francis benefited from the most decrease (165 fewer visits), then SFGH (138 fewer visits). Attached to the report is a matrix reflecting the EMS High User patterns over the past two years. Crystal Heart Award Dr. Katz congratulated Jim Soos, Assistant Director of Policy & Planning, who was a recent recipient of a 2006 Crystal Heart Award at the San Francisco Health Plan’s 5th Annual Healthy Kids & Young Adults Appreciation Night. In citing Jim’s many accomplishments and commitment to the Young Adults program, the Health Plan noted his role as “an invaluable collaborator, handling every situation with a sympathetic ear, a keen analytical mind, and a pragmatic response.” Jim was also singled out as exemplary public servant: “someone who is dedicated to improving life for others.” Community Health Network, San Francisco General Hospital, November 2006 Credentials Report 11/06 07/06 to 11/06 New Appointments 19 97     Reinstatements 0 0 Reappointments 36 178    Delinquencies: 0 0    Reappointment Denials: 0 0 Resigned/Retired: 7 64 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Deceased 0 1 Changes in Privileges    Additions 5 26    Voluntary Relinquishments 2 19    Proctorship Completed 0 35    Proctorship Extension 0 0 Current Statistics – as of 11/1/06     Active Staff 490   Courtesy Staff 569   Affiliate Professionals (non-physicians) 205   TOTAL MEMBERS 1,264   Applications In Process 34   Applications Withdrawn Month of November 2006 0 4 (07/06 to 11/06) SFGH Reappointments in Process Dec. 2006 to Mar. 2007 177   Commissioners’ Comments Commissioner Tarver asked how the Mylan settlement award would be applied. Ms. Garcia said that they would be working with the pharmacy director and primary care clinic directors to arrange the trainings. Its purpose is to try to do integration work with the primary care centers. Commissioner Tarver said to be sure to link the psychiatrists who work with the clinics to this effort. Commissioner Chow asked if the increased referrals of EMS high utilizers to Kaiser and the VA is a reflection of a change of demographics. Ms. Martinez said she cannot speak to whether the increase is a result of Kaiser’s efforts or just a function of a decision by the EMS provider to bring a person to the nearest emergency department. Ms. Martinez will be happy to look into this issue. Commissioner Guy said the data around the massage parlor enforcement is very interesting. She would like a report to through the joint conference committee about the added value of transferring the monitoring of message establishments from the Police Department to the Health Department, particularly around any improvement in health status. Ms. Kronenberg said that Dr. Bhatia would be happy to provide a report. She is pleased that the assumption is that the Health Department is going to proceed with the HAP, whatever the outcome of the lawsuit. It would be unacceptable to move forward with a program that is solely funded with public dollars. Commissioner Illig said that Ms. Martinez presented the EMS High Utilizers project to the CHN JCC, and he was impressed with the outcome of the program, particularly in terms of the success that can be achieved when resources are focused on a target population. Commissioner Chow asked that, as the City Attorney responds to the GGRA lawsuit, the Health Commission be fully apprised of this response. Commissioners welcomed Tangerine Brigham as Deputy Director of Health, Director of HAP. 5) PRESENTATION OF THE DEPARTMENT OF CHILDREN, YOUTH AND THEIR FAMILIES CHILDREN’S SERVICES ALLOCATION PLAN Margaret Brodkin, Director, Department of Children, Youth and Their Families, presented the proposed Children’s Services Allocation Plan for 2007-2010. One of the key provisions of the Children’s Amendment of 2000 is a three-year funding cycle for DCYF. In the first year of the cycle, DCYF is required to complete a Community Needs Assessment, a draft of which was presented to the Health Commission about 18 months ago. This is followed by a Children’s Services Allocation Plan, which establishes funding allocations and outcomes for the overall fund. In the third year, DCYF will issue a RFP for a three-year commitment of funding. The proposed allocation plan was developed through an analysis of the $365 million the city spends on funding, 23 community meetings, eight strategic conversations, two grantee feedback sessions, eight city department discussions and research on best practice. The goals of the program are to:: 1. Celebrate and build on strengths 2. Forge a network of services 3. Serve all neighborhoods/focus on greatest need 4. Promote collaboration and decrease fragmentation Ms. Brodkin summarized the allocation categories and provided examples of strategies for each of the categories. New strategies to meet changing needs include: Early Care and Education – grants to shelters and child care programs, child care subsidies, infant/toddler sustaining grants, workforce investmentss Out of School Time – grants for high quality programs serving 6-13 year olds, teen programming, San Francisco Beacon Initiative, Rec Connect Youth Workforce Development – service learning, Mayor’s Youth Education and Employment Program, New Directions, Jobs for Youth Family Support – SafeStart, comprehensive family support services, Family Action Grants, Family Support Network Wellness Empowerment – Early Childhood Mental Health Consultation Initiative, Afterschool Mental Health Consultation, middle school wellness empowerment, Wellness Initiative, grants for health empowerment Violence and Truancy Reduction – SafeStart, school-based violence prevention, safety and truancy reduction, Community Response Network, grants to CBOs. Youth Empowerment – Youth Empowerment Fund The allocation plan allocates money to systemwide investments to forge a network of services, and includes allocations for community building, information and communication, accountability, capacity building, training and support and access. The allocation plan will be presented to the Board of Supervisors in December 2006, and issue a Request for Proposals in February 2007. Funding and services will be in place by July 1, 2007. DCYF wants to work closely with DPH and build upon the current system so that together we can improve services to children. Commissioners’ Comments Commissioner Monfredini commended Ms. Brodkin for her report. Commissioner Guy recalls the debate over whether to fund clinics in the schools or wellness centers in the schools. This report shows success around the wellness center approach. That said, the partnership with DCYF needs to grow around health and wellness and primary prevention. She would like the Population Health and Prevention Joint Conference Committee to hold a more detailed discussion about moving this partnership forward and clear identify the commitment is around violence prevention. She also supports working together around neighborhood investments. It is really exciting to bring wellness into the middle schools. Commissioner Chow would like the report to include more demographics about San Francisco children, what children are targeted through DCYF services, etc. One concern is that school-based services are directed toward children in public schools, and he would like to reach the entire segment of children. Commissioner Chow is interested in what appeared, through data and community discussions, as the most pressing need for children and youth. The way it is presented, it seems that all needs are presented on an equal plane. In addition, it is important to understand what programs are impacting what populations, and how to build on this. Ms. Brodkin said the prioritization process is very complex. DCYF tries to fund programs that no other department will fund, and then partner with entities such as the Health Department that provide many other youth services. Commissioner Sanchez is very excited about the plan. There are a number of challenges, but this can be overcome. Many city agencies and programs have had budget cuts in the area of children and youth services. This applies to the school district, YGC, Health Department, and others. These entities could work together to create a new model of reviewing and measuring program quality and outcomes. Each city department cannot do it alone. Commissioner Illig commended the report. He asked how DCYF determined that DPH provided $51 million in funding to children and youth. September Jarrett, DCYF, said that most of the budget information came from the departments and the Controller’s Office. Commissioner Illig noted that DCYF does not provide direct services, but rather funds CBOs to do the work. DCYF does a great job working with collaboratively with CBOs, an area that DPH is trying to improve. Commissioner Illig added that the Department of Aging and Adult Services is funding neighborhood centers for seniors and disabled adults. Commissioner Tarver said that the Health Commission should continue to become educated about the specific breakdown of services provided by DPH. This data can be part of the discussion at the Population Health and Prevention Joint Conference Committee. He would also like to see additional detail about allocations made for services targeting children and youth most at risk, what the strategic approach is for these populations and what the intended outcomes are. Ms. Brodkin said they developed a need index, broken down by zip code, and developed a formula whereby they gave every zip code a need indicator. This index will provide a foundation for determining where the funding needs to be targeted toward. Commissioner Monfredini asked what the next steps are. Ms. Brodkin said the plan will be presented to the Recreation and Park Commission, rewritten based on feedback, and then presented to the Board of Supervisors. That said, the most important next step is to find the appropriate forum where DCYF can continue the discussion with DPH. 6) 1st QUARTER FINANCIAL REPORT Gregg Sass, Chief Financial Officer, presented the 1st quarter financial report. Projections include a revenue surplus of $9.593 million and expenditure deficit of $8.152 million and the Department is projecting a small overall favorable surplus of $1.441 million.   REVENUES EXPENDITURES TOTAL   Revised Current Surplus/ Revised Current Surplus/ Surplus/ Division Budget Projection (Deficit) Budget Projection (Deficit) (Deficit) Department of Public Health         SFGH  $608,286,000  $615,886,000  $7,600,000  $608,286,000  $615,884,000  $ (7,598,000)  $2,000 Laguna Honda 183,365,000        187,405,000            4,040,000        183,365,000        187,405,000          (4,040,000)                         -   Primary Care 52,502,000          52,055,000             (447,000)          52,502,000          52,417,000                 85,000             (362,000) Health at Home 10,454,000 10,454,000                         -            10,454,000            8,679,000            1,775,000            1,775,000 Jail Health 24,881,000 24,881,000                         -            24,881,000          25,255,000             (374,000)             (374,000) Public Health 112,596,000 110,996,000          (1,600,000)        112,596,000        111,796,000               800,000             (800,000) Mental Health 215,677,000 215,677,000 -        215,677,000        214,477,000            1,200,000            1,200,000 Substance Abuse 72,093,000 72,093,000 -          72,093,000          72,093,000                         -                           -   TOTAL DPH  $1,279,854,000  $1,289,447,000  $9,593,000  $1,279,854,000  $1,288,006,000  $(8,152,000)  $1,441,000 The Revised Budget in the table above includes: Annual Appropriation Ordinance for DPH, carry forwards from  prior year, Inter Governmental Transfer (IGT), Transfer In and Project Related expenses. The Revised Budget in the table above includes: Annual Appropriation Ordinance for DPH, carry forwards from prior year, Inter Governmental Transfer (IGT), Transfer In and Project Related expenses. Mr. Sass highlighted financial issues at San Francisco General Hospital and Laguna Honda Hospital. At SFGH, revenues are conservatively projected to be $7.6 million over budget associated with the high patient volume in the first quarter. The average daily census at SFGH exceeds the budgeted census by 5%. Expenditures are projected to be over budget by $7.598 due to unfavorable variances in personal services and fringe benefits. The labor shortages at SFGH combined with a high patient census requires the use of as-needed staff and overtime. Mr. Sass anticipates that SFGH will need to seek a revenue supplemental to fund additional personnel costs. LHH is projected to end the year on budget with overspending covered by surplus revenues. Revenues are projected to be $4.04 million more than budget due to a $10.88 increase in the Medi-Cal base per diem rate. Expenditures are projected to be $4.04 million over budget due to unfavorable variances in salaries and fringe benefits. Staffing increases were necessary in response to a licensure survey by the State. That survey continued through August, which contributed to high spending in the first quarter. LHH is implementing cost reduction initiatives including closure of a nursing unit and reductions in nursing spending on units that are overstaffed in relation to budget. LHH hopes to reduce total overspending to an amount less than $4 million. Mr. Sass anticipates that LHH will need a revenue supplemental to fund the additional personnel costs. Commissioners’ Comments Commissioner Monfredini said it is scary that Laguna Honda is over budget and it is only November. She is sure that Mr. Sass and Mr. Kanaley can find a solution to this problem. Commissioner Illig asked how last year’s deficit at Laguna Honda was addressed. Mr. Sass said the Board of Supervisors approved the retroactive supplemental appropriation. Commissioner Chow said he and Commissioner Sanchez have been getting budget updates at the Laguna Honda Hospital Joint Conference Committee and Mr. Kanaley, Ms. Inouye, Ms. Hirose and others are working diligently to bring the deficit down. A real concern is that budget reductions will result in the hospital being understaffed and, as a result, experience more patient safety incidents. Commissioner Tarver said it seems artificial that mental health expenditures exactly match mental health revenues. The way the numbers are presented, we cannot capture information such as is CBHS seeing more patients who it can bill for Medi-Cal in the first quarter. Mr. Sass said that in Mental Health by and large the 60 percent Medi-Cal mix is pretty standard across the board and is a predictable Medi-Cal to local funding ratio. Commissioner Tarver said he would like the Department to look at revenue enhancement for civil service component. The Department is certifying more people who are eligible for SSI than before, and why wouldn’t these efforts result over time in increased revenue? Mr. Sass replied that the budget is growing year over year, and takes the SSI revenue into account. Commissioner Tarver asked staff to look at ways of tracking CBHS’s financial picture in a real-time manner. Commissioner Chow said DPH has been able to improve billing and collections for Primary Care. 7) EMERGENCY PREPAREDNESS UPDATE Anne Kronenberg, Deputy Health Director, Director, Office of Policy and Planning, presented an emergency preparedness update. The Office of Policy and Planning acts as the coordinating body for the Department’s disaster preparedness planning. OPP chairs a weekly DPH Homeland Security Steering Committee with representatives from Communicable Disease Control and Prevention, Environmental Health, Community Programs, Emergency Medical Services, Public Health Laboratory and Occupational Safety and Health. DPH has made great strides in the areas of disaster/emergency preparedness. The report is divided into three main categories: Overall DPH Preparedness Planning; Infectious Disease Planning; and Surge Capacity Planning. DPH Preparedness Planning Department Operations Plan DPH Improved Department Operations Center Respiratory Control Program Infectious Disease Planning Mass Prophylaxis Planning Homeland Security/Disaster Pharmaceutical Caches Biological Detection System Plan Infectious Disease Emergency Response Planning Laboratory Preparedness and Planning for Bioterrorism and Pandemic Flu Sentinel Event Enhanced Passive Surveillance Project Pandemic Influenza Planning Launch of Infection Control Working Group/Avian Flu Guidelines Radiological Incident Planning Hazardous Materials Incidents Suspicious Substance Response Multi-Casualty Incident Planning EMResource – Hospital Resource Tool EMTrack – Patient Tracking Disaster Registry Program Community Behavioral Health Services Emergency Response Hospital Council Emergency Task Force Multi-Casualty Working Group. Ms. Kronenberg said that DPH has benefited from a number of large Homeland Security/bioterrorism grants since September 11, 2001. DPH was told that all 27 of the UASI funded planning positions would have their future funding expire in December 2006. Now there appears to be a strong possibility of extending seven positions through June 2007. The BT/CDC grant has decreased significantly over the last five years. Many general funded positions have significant additional responsibilities in the area of Homeland Security/disaster preparedness. So the concern is how do we maintain and sustain the programs we have now without the staffing? Conclusions 5 years after September 11 and one year after Katrina we are more prepared. We have more to do—planning is an on-going process. Influx of funding has enabled us to purchase critical equipment that will be needed in a disaster. Funding also provided opportunity to bring in staff to write plans, do outreach and implement plans and projects. DPH will be challenged to maintain its current pace after it loses key staff in 2007. Priorities: MCI plan, surge plan, IDER plan (including pandemic flu). DPH must continue the collaboration with hospitals. DPH must expand its collaboration with clinics and other community-based providers. Commissioners’ Comments Commissioner Monfredini asked which tool would be used to track already hospitalized patients in an emergency. Ms. Kronenberg said that would be EM Track. This tool is being written specifically for San Francisco, and she hopes that it will be a very useful tool. Dr. Brown added that DPH is using the system to track a small portion of patients on a regular basis so that personnel will get used to using the system and hospitals will get used to receiving reports. Commissioner Monfredini said San Francisco is way ahead of other cities in terms of planning. The key question is how to sustain planning efforts. She asked what the Health Commission could do to help. Ms. Kronenberg said that Health Commission support would be needed to retain at least some of the staff to make sure the plans do not just sit on a shelf. Dr. Brown said they would need on-going support in the areas of pharmaceuticals. We have to commit to maintaining some stock over the long term. Also encouraging our partners to do their part. Finally, there needs to be good regional planning and regional cooperation. Dr. Fernyak said many staff that does day-to-day response are grant funded, and these grants are ending. So the challenge is how to continue to do the day-to-day response. Another challenge is in the area of training, which is dependent on the availability of staff to provide the training. Commissioner Illig is concerned about the disaster registry, which contains outdated information. He urged DPH to work with contractors and the Department of Aging and Adult Services to update the list. Dr. Brown said the data was updated on an annual basis, with people in the registry having to positively respond that they want to remain in the registry. Outreach to agencies and individuals has also increased. The goal is to target outreach to areas most in need. Commissioner Illig asked if the Health Commission could receive the after-training reports. Ms. Kronenberg said that there have been discussions with the Mayor’s Office about the role of commissioners in a disaster. The Mayor’s Office is working on this issue in terms of providing training specific to commissioners and other policy makers. Commissioner Illig asked if agreements in place about caches of equipment that are stored in other hospitals. Ms. Kronenberg said they are very close to finalizing MOUs. Commissioner Chow asked DPH to work with the Medical Society’s Board to schedule an update around the county’s plan and the Medical Society’s role in disaster response. Commissioner Chow said there are people who have a hard time supporting themselves for three days when there is not an emergency, so this message will not apply to certain areas of the city and certain populations. There needs to be a community response for those communities that need it. This is a continued deficiency in the plan. It is a myth that 700,000 San Franciscans could survive for three days independently. Ms. Kronenberg said DPH is beginning planning at a neighborhood level, looking at all facilities that DPH funds, and pulling them together to provide a community response. Commissioner Tarver asked to see the CBHS Response Plan prior to the plan being finalized. Commissioner Tarver said it is important to meet the medication needs of the chronically mentally ill in the event that pharmacies are compromised during and after an emergency. Dr. Brown said they are pursuing a regional chronic pharmaceutical cache, which includes psychotropic drugs. They have also expanded scope of practice for EMS providers to allow them to administer Ativan, under direction. Commissioner Tarver said another element of our response would be a helipad. He asked if San Francisco has the ability to land helicopters where needed during an emergency. Dr. Brown said that there is a policy regarding use of various sites for helicopter landings. Commissioner Guy supports the funding strategies for sustaining these planning efforts. She agrees with Commissioner Chow that a gaping hole in our preparedness is the lack of a community response. San Francisco should use Chinatown’s efforts as a model, and San Francisco should fund these efforts. It makes sense to work on the systems response, but we need to incorporate community response. Commissioner Guy said that April is Public Health Month and May is Emergency Preparedness Month so this is an appropriate timeframe to do outreach, education and investment around community response, as well as to be accountable to what we have done. Commissioner Guy suggested that the CBHS Emergency Response Plan be presented and discussed more fully at the CHN JCC. Commissioner Chow will work with Ms. Kronenberg, Ms. Garcia, NICOS and the Chinatown community to advance a community emergency response plan. Commissioner Sanchez said youth should be incorporated into emergency response planning, and DCYF should incorporate emergency response into its children’s services plan. He encouraged staff to seek outside, foundation funding. 8) PUBLIC COMMENT/OTHER BUSINESS Daisy Anarchy, Sex Workers Organized for Sexual, Labor and Human Rights, is hoping to get Health Department leadership on the issue of private booths. She is opposed to the Health Department funding $300,000 for a community needs assessment, which will be used to lobby against protective legislation regarding private booths. DPH needs to sever ties with agencies that are working on behalf of employers who are putting their employees at risk. 9) CLOSED SESSION This item was continued to the November 21, 2006 Health Commission meeting. A) Public comments on all matters pertaining to the closed session B) Vote on whether to hold a closed session C) Closed session pursuant to Government Code Section 54957 and San Francisco Administrative Code Section 67.10(b) PUBLIC EMPLOYEES PERFORMANCE EVALUATION: MITCHELL H. KATZ, M.D, DIRECTOR OF HEALTH D) Reconvene in Open Session 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).) 10) ADJOURNMENT The meeting was adjourned at 6:50 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.