Minutes of the Health Commission Meeting

Tuesday, July 6, 1999
3:00 p.m.

101 Grove Street, Room #300
San Francisco, CA 94102

1) CALL TO ORDER

The regular meeting of the Health Commission was called to order by President Lee Ann Monfredini, at 3:05 p.m.

Present:

  • Commissioner Edward A. Chow, M.D.
  • Commissioner Ron Hill
  • Commissioner Lee Ann Monfredini
  • Commissioner Harrison Parker, Sr., D.D.S.
  • Commissioner David J. Sanchez, Jr., Ph.D.

Absent:

  • Commissioner Roma P. Guy, M.S.W.
  • Commissioner John I. Umekubo, M.D.

2) APPROVAL OF MINUTES OF THE REGULAR MEETING OF JUNE 15, 1999.

Action Taken: The Commission unanimously adopted the minutes of June 15, 1999.

3) CONSENT CALENDAR OF THE BUDGET COMMITTEE
(Commissioner Ron Hill)

(3.1) PHP-CHS-Housing – Request for approval of retroactive contract renewal with Ark of Refuge, Inc., in the amount of $282,480 per year, for the provision of residential substance abuse treatment services, for the period of March 1, 1999 through February 29, 2000. (DPH contracted with Ark of Refuge for services totaling $258,940 during FY 1997-98).

(3.2) PHP-CHS-Housing – Request for approval of contract renewal with San Francisco AIDS Foundation (SFAF), in the amount of $200,000, for the provision of partial rental subsidy services for people with HIV who are imminently homeless, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with SFAF for services totaling $ 5,204,521 during FY 1997-98).

(3.3) PHP-CHS-Housing – Request for approval of contract renewal with San Francisco AIDS Foundation (SFAF), in the amount of $231,364, for the provision of housing wait list services for people with HIV, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with SFAF for services totaling $ 5,204,521 during FY 1997-98).

This item had been approved at a previous meeting.

(3.4) PHP-CHPP-HIV Prevention Services - Request for approval of contract renewal with San Francisco AIDS Foundation HIV Prevention Project (SFAF), in the amount of $574,956, for the provision of HIV prevention services, including syringe exchange services, to injection drug users, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with SFAF for services totaling $ 5,204,521 during FY 1997-98).

(3.5) PHP-CHPP-HIV Prevention Services - Request for approval of contract renewal with San Francisco AIDS Foundation (SFAF), in the amount of $505,721, for the provision of HIV prevention services targeting behavioral risk populations, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with SFAF for services totaling $ 5,204,521 during FY 1997-98).

(3.6) PHP-CHS-CSAS – Request for approval of a contract renewal with Center for Juvenile and Criminal Justice (CJCJ), in the amount of $200,000, to provide substance abuse supportive living services to parolees, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with CJCJ for services totaling $200,000 during FY 1997-98).

(3.7) PHP-CHS-CSAS – Request for approval of Sole Source and new contract with Homeless Prenatal Program, in the amount of $112,262, to provide substance abuse prevention services to homeless or very low income women, for the period of July 1, 1999 through June 30, 2000.

(3.8) PHP-CHS-CSAS – Request for approval of multi-year contract renewal with MV Transportation, in the amount of $79,540 per year for four years, for the provision of emergency transportation services for mental health clients, for the period of July 1, 1999 through June 30, 2003. (DPH contracted with MV for services totaling $79,540 during FY 1997-98).

(3.9) CHN-Primary Care-Homeless – Request for approval of Sole Source and contract renewal with Central City Hospitality House (CCHH), in the amount of $528,265 per year, for the provision of case management services for homeless persons, for the period of July 1, 1999 through June 30, 2001. (DPH contracted with CCHH for services totaling $595,397 during FY 1997-98).

Due to a recent financial restructuring within this contract agency, the Department recommended the provision of technical assistance and a 3-month renewal on the current contract, with the understanding that the contract renewal for FY 1999-2000 will be considered after the 3 months.

(3.10) CHN-Primary Care-Homeless – Request for approval of Sole Source and contract renewal with Bar Association of San Francisco (BASF), in the amount of $115,457 per year, for the provision of SSI advocacy and technical assistance, for the period of July 1, 1999 through June 30, 2001. (DPH contracted with BASF for services totaling $291,363 during FY 1997-98).

(3.11) CA-Finance – Request for approval of proposed FY 1999-2000 patient rates for services rendered by the Department through the Community Health Network and Population, Health and Prevention.

For the future for comparison purposes, Commissioner Sanchez requested patient rate information from other private and public hospitals.

Commission Parker requested clarification on the decrease/increase in funding of contractors on the Budget Committee agenda.

Commissioner Chow requested summary information on contractors indicating unit costs and funding sources (i.e., general fund, grants). He also requested clarification on the Bar Association contract.

Action Taken: The Commission approved the Consent Calendar for the Budget Committee with the specific recommendation, excluding #3.3.

4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health)
(Provides information on activities and operations of the Department).

ADMINISTRATION

FY 99-00 Budget – Board Add Backs

The Board of Supervisor’s Finance Committee concluded budget hearings in mid-June. Minor cuts in the DPH budget were recommended by the Budget Analyst and approved by the Finance Committee. These cuts, totaling $254,251, included reductions that will delay the hiring of new positions in Mental Health and Maternal & Child Health until August 1, 1999. These new programs are funded with new revenue sources.

The Finance Committee also added back additional funding citywide for new and existing programs. DPH received a total of $1.7 million in one time funding. Funding for four of the programs have been placed on reserve. DPH will work with the Board this month and next to release these funds held on reserve. The full Board is scheduled to approve the FY 99-00 budget later this month.

One time funding added to the FY 99-00 budget includes:

Children’s Mental Health Initiative – On Reserve

$ 270,000

Women’s Community Clinic

34,000

Mission SRO Fire Suppression Collaborative – On Reserve

245,000

Names Project – Rent

21,000

Shanti – Full Circle of Care

75,000

Healthy Families Public Outreach

50,000

New Leaf Mental Health Services

75,000

Bridge Project – Homeless Health

67,000

Treatment on Demand

50,000

Asthma Resource Center

100,000

SAGE Freestanding Facility – Substance Abuse

125,000

Methadone Access Physician Training – On Reserve

50,000

Acute Diversion for Mental Health – On Reserve

300,000

Total

1,662,000

Governor’s Budget – Prop 99 Funding Reduction

The FY 99-00 State budget has been signed into law by Governor Davis. Preliminary estimates indicate that Prop 99 funding to DPH will be reduced by $2.76 million. Most of this reduction, $2.5 million will result in funding reductions to San Francisco General Hospital. The remainder will be for reduced reimbursement to community hospitals and private physicians for indigent care. The Prop 99 program is administered by the AB75 project in DPH.

I will keep you informed of efforts to replace this funding loss.

Policy and Planning

I am sorry to report that Patricia Dunn, Senior Health Planner in the Office of Policy and Planning will be leaving the Department at the end of this week. For the past 2 years, Patricia has done the legislative monitoring, analysis and planning for the Department. Through her many efforts Ms. Dunn has helped streamline our State legislative tracking system. Pat also worked on such diverse issues as immigrant health and HIV/AIDS. Patricia has been a tremendous asset to the Department and will be sorely missed, as she leaves DPH to continue her good work at the Gay and Lesbian Medical Association.

Federal Legislation

I am pleased to report that the Work Incentives Improvement Act of 1999 (S. 331 – Jeffords) was passed by the United States Senate by unanimous bipartisan support (99-0). Both Senators Boxer and Feinstein support S. 331. The bill would has five components which would:

  • amend the Social Security Act to expand the availability of health care coverage for working individuals with disabilities,
  • establish a Ticket-to-Work and Self-Sufficiency Program in the Social Security Administration to provide such individuals with meaningful opportunities to work,
  • provide for a permanent extension of disability insurance program demonstration project authority,
  • make technical amendments to the Contract with America Advancement Act of 1996 and the Social Security Act and
  • make amendments to the Internal Revenue Code.

S. 331 could substantially increase the number of insured persons by giving states the option to allow workers with disabilities to buy into their Medicaid program. Eliminating the income, asset and resource limitations, which prevent such persons from qualifying for the Medicaid, would do this. This measure can eliminate the disincentives for persons with disabilities to work. The Department believes that S. 331 will be critical in efforts to assist those with disabilities, chronic illnesses, HIV/AIDS, etc. remain in the workforce.

POPULATION HEALTH AND PREVENTION

Mental Health Suicide Conference

On September 23, 1999 the Department of Public Health along with United Behavioral Health, UCSF and the SF Medical Society will present the "Suicide Prevention and Early Intervention Conference." The goals of the conference are: 1) to educate clinicians and administrators in the fields of mental health, substance abuse, public health/primary care, and managed care about suicidality treatment and current research and 2) to develop a suicide prevention action plan for the Department of Public Health.

STD’s and Art Workshop

The STD Program is implementing a summer STD’s and Arts Workshop. The program will hire 10 youth and a coordinator to perform at a variety of community based events throughout the City. The Program is designed to create an environment for youth to perform and to develop self-esteem and confidence.

The youth will attend group sessions and will receive information about STD’s, HIV, drugs, teen pregnancy, effective decision making, abstinence and violence prevention. Since dramatic arts are a medium youth like, we hope that this program will provide the opportunity for participants to express themselves through singing, dance, drama and poetry. For more information about this Program, please call Jacque McCright at 554-8476.

Children’s Environmental Health Promotion

CEHP in collaboration with the Public Utilities Commission (PUC) - Water Quality Bureau (WQB) implemented a project for testing lead in water. 5,419 enrollees of the Women, Infant, Children Supplemental Nutrition Program (WIC) were offered this free service. Sixty-one percent of the clients completed the survey and took the sample bottle home. Forty-four percent of those who took the bottle home were able to return the collected sample for analysis. Nine samples were found to have concentration of lead above 15ppb, USEPA's level of concern. Repeat sampling was done for six clients from at least two different water sources: bathroom and kitchen faucets. Three clients declined any retesting services, and received education about lead over the phone and by the mail. Seven of the nine clients with water lead levels exceeding USEPA's level of concern received an educational home visit from CLPP's health educators as a second follow-up. The remaining two clients moved from the initial address reported at the time of the survey, and no forward address was given for them. A comprehensive report of the project findings is in progress, and is being coordinated by Frances Gonzalez and Haroon Ahmad at 554-8930.

Community Health Promotion and Prevention

On Thursday June 24th, the San Francisco Alcohol Policy Coalition met for the first time. The goal of the Coalition is to reduce alcohol-related problems in San Francisco. Participants include representatives of community organizations that work on alcohol related issues in San Francisco. Supervisor Leland Yee attended the meeting and provided an overview of legislation he has introduced that calls for "good neighbor" policies on the part of alcohol outlets in the Tenderloin. The Director of the Oakland Alcohol Policy Network provided information about efforts to get local control over alcohol sales and advertising. Currently, the California Alcohol and Beverage Control Agency has jurisdiction over these policies.

The San Francisco Alcohol Policy Coalition will meet again on August 26th and will begin to develop strategies to address specific alcohol related issues in San Francisco communities.

COMMUNITY HEALTH NETWORK

Board of Supervisors Approves Ballot Measure for Laguna Honda Hospital.

On June 21st, the Board of Supervisors took final action to place a $299 million General Obligation Bond on the November 2, 1999 ballot to replace Laguna Honda Hospital. With voter approval, this measure would create 1,200 new skilled nursing beds (and a small number of acute beds) and 140 assisted living units. I want to express my appreciation to the members of the Health Commission for their support of this important measure. The Department will participate in a public education program related to the community’s increasing need for long term care services in the future, and Laguna Honda’s role in helping meet those needs. I will keep the Commission apprised of our progress on this important project.

Senator Speier to Host Town Hall Meeting at Laguna Honda.

State Senator Jackie Speier will convene a Town Hall meeting this Saturday, July 10th, at Laguna Honda Hospital’s Simon Auditorium from 10-11:30 a.m. The Senator will express her support for the replacement of Laguna Honda Hospital and address other areas of interest to her constituents. All members of the Commission and the public are invited to attend.

Mayor’s Appointment

Mayor Willie Brown has appointed Melissa Welch, M.D., CHN Medical Director, to the Health Services Commission. She was sworn in and began her service on June 15th, 1999. The Health Services Commission oversees the City’s Health Services Systems.

5) CONSIDERATION OF A RESOLUTION ON FAMILY FOCUSED CARE

Mr. Jimmy Loyce, Jr., Deputy Director of Health, reported that the Children’s System of Care Planning Council (CSCPC) includes representatives from the Department of Public Health, SFUSD, Juvenile Probation Department, Department of Human Services, and community-based organizations that serve children, families, and parents.

The CSCPC has a Family Focused Care Committee, which develops family focused strategies to assist children and their parents who are part of the children’s service provider network. This Committee developed "A Message from Parents and Families to Service Providers," which is one of inclusion, respect, and cultural competence.

Mr. Loyce acknowledged the presence of some of the Committee members.

Public Speakers: supportive of the proposed resolution

  • Teresa Gallegos, parent
  • Lucy Arellano, parent of a special child

Commissioners’ Comments:

  • Will this be a part of the Department of Public Health Strategic Plan?
  • Could this document be used against issues of privacy of minors? Need to include language in the resolution addressing this issue.
  • What does the Department do different from the State standard?
  • Impressed with participation by various entities

Deputy City Attorney Jean Fraser proposed additional language to the last "Further Resolved" to add "…within the confines of State and Federal privacy laws."

Action Taken: The Commission adopted amended Resolution #23-99, entitled "Supporting the Family Focused Care Committee of the Children’s System of Care Planning Council, ‘A Message from Parents and Families to Service Providers’."

6) CONSIDERATION OF A RESOLUTION AMENDING THE MUNICIPAL CODE TO MOVE REGULATION AND PERMITTING OF MASSAGE PARLORS FROM THE POLICE TO THE HEALTH DEPARTMENT

Dr. Mitch Katz presented the following:

Board President, Tom Ammiano, introduced an ordinance calling for the transfer of authority for regulation of the massage industry from the Police Department to the Department of Public Health. This ordinance is tentatively scheduled for hearing before the Public Health and Environment Committee of the Board of Supervisors on August 12. Dr. Katz wants the Health Commission to review this ordinance prior to the Board of Supervisors’ review.

Regulation of the massage industry is currently within the jurisdiction of the Police Department. Massage establishment owners, massage establishment workers, massage therapists and massage therapy businesses within San Francisco, are required to obtain permits from the Police Department. Applicants pay a fee for an initial permit followed by an annual fee thereafter. Requirements for a permit are different for business owners versus massage workers. The current requirements fore a massage permit are focused on restricting prostitution. Owners or workers found practicing without a current permit are subject to arrest.

In 1994 the San Francisco Board of Supervisors convened the Task Force on Prostitution, sponsored by then Supervisor Terence Hallinan, to address issues related to the sex work industry in San Francisco. One conclusion of the Task Force Final Report (March 1996) was that the regulation of massage establishments by the Police Department was a considerable conflict of interest. It recommended that the regulation of massage establishments be transferred to the Department of Public Health. The principal reason for this recommendation was that the practice of massage and the existence of massage establishments was a public health issue rather than a public safety issue.

There is a broad community consensus from the massage establishment owners, massage establishment workers, independent massage therapists and massage therapy business owners, that regulation should focus on the issues of health and environmental safety. The Police Department agrees.

The Department of Public Health has had internal discussions and feels that the scope of work involved with regulation of the massage industry is an appropriate public health activity. The Department believes that the shift in regulatory authority is consistent with the Department’s Public Health Mission.

Mr. Tomas Lee, aide to Board of Supervisors’ President Tom Ammiano, expressed support for the transfer of authority for regulation of the massage establishments from the Police Department to the Department of Public Health. Mr. Lee pointed out that it has been 20 years since this ordinance has been updated.

Dr. Katz reported that both the Environmental Health and STD Control Divisions would work together to implement this ordinance. When a health official finds the presence of illegal activities, a referral to the Police Department would be made.

Public Speakers:

  • Heather Hindmarsh, member of the American Massage Therapy Association, would support the resolution if two categories were established for licensing of massage therapists
  • Connie Buckle, Hotel Monaco Health Spa, emphasized the 200 hours for training and does not support the transfer to the Department of Public Health
  • Michelle Aldrich supported the resolution and a holistic approach to therapy
  • "Ojocion" Marcella Ingram, certified massage therapist, did not take a position on the resolution due to her being informed of this agenda item today

Commissioner Sanchez, as a former Police Commissioner, acknowledged Police Chief Lau, and the Police Commission’s support for this transfer of authority to the Department of Public Health and the Health Commission. The licensing, training, and oversight of massage establishments all relate to public health.

Action Taken: The Commission adopted Resolution #24-99, "Transferring Authority of Regulation of the Massage Industry from the Police Department to the Department of Public Health by Repealing San Francisco Police Code, Article 27, and Adding Article 28, Sections 1800 to 1828, to the San Francisco Health Code, Authorizing the Director of Public Health to Regulate Massage Establishments and Massage Services, Setting New Criteria for the Issuance and Revocation of Massage Permits, Changing Certain Operating Requirements of Massage Establishments, Setting New Penalties for the Violation of Massage Provisions, and Continuing an Application Fee, an Identification Card Fee, and a Permit Fee."

7) CONSIDERATION OF A RESOLUTION OUTLINING RECOMMENDATIONS FROM THE WORKING COMMITTEE ON PHYSICIAN-PRESCRIBED METHADONE

Dr. Herminia Palacio, Special Policy Advisor to the Director of Health, presented an update on the design of a program to permit office-based physician prescription of methadone for the treatment of heroin addiction. She presented the report of the Physician Prescription of Methadone Working Group and an analysis of the report. For a copy of the report, call the Commission Office, at 554-2666.

The recommendations covered the following areas:

  1. Program Administration
  2. Patient Eligibility, Assessment and Enrollment
  3. Physician Participation: Eligibility, Training and Certification
  4. Counselor Participation: Eligibility, Training and Certification
  5. Patient Treatment Plans and Counseling Requirements
  6. Regulatory Parity and Other Enhancements to Existing Narcotic Treatment Programs ("Methadone Clinics")
  7. Pharmacy Participation

Public Speakers:

  • Michelle Aldrich, supported the resolution and the concept of integrating drug treatment into the physician’s office
  • Norma Hotaling, SAGE Project, supported the resolution
  • Reda Sobky, MD, PhD, Fort Help Methadone Program, expressed the biggest obstacle to care is funding and existing obstacles to expand services

Commissioner Parker expressed his support for the bold steps taken by the Department. He also encouraged outreach for physician support through the S.F. Medical Society.

Commissioner Sanchez commended the Department for an exceptional protocol with experts from all levels. He supported the Department to proceed with this program and encouraged staff to publish the program in major publications.

Commissioner Chow proposed an amendment to the resolution in the final "Resolved" to delete "implementation" and insert "concept."

Dr. Palacio proposed the establishment of an Implementation Team to coordinate and oversee the next phase of project development:

  • Complete legislative and regulatory analyses
    • See regulatory waivers and/or new legislation, as necessary
  • Perform project cost projections
    • Perform actuarial analyses
    • Explore options for third-party reimbursements for specific services (e.g., physician time, counselor time, pharmacy charges)
    • Seek and secure additional necessary funding for service delivery costs
    • Seek and secure necessary funding for infrastructure costs (e.g., for central data base development and maintenance)
    • Seek and secure funding to support quality assurance and evaluation activities
  • Develop training materials
  • Secure funding for and perform focus groups
  • Secure funding for and feasibility study
  • Develop quality assurance and evaluation measures

Dr. Palacio estimates being able to field a pilot study of the program model in approximately one year, i.e., July 2000. The feasibility study will be conducted over the next twelve months, and will provide us with information and experience that will be critical for determining at what rate the new treatment model would be phased into full-scale operation.

She acknowledged and thanked all of the members of the Physician Prescription of Methadone Working Group.

Action Taken: The Commission adopted amended Resolution #25-99, "Supporting the Concept and Further Development of a San Francisco Program for Office-Based Physician Prescription of Methadone for the Treatment of Opiate Addiction."

8) OTHER BUSINESS/PUBLIC COMMENTS

None.

The meeting was adjourned at 5:15 p.m.

Sandy Ouye Mori, Executive Secretary to the Health Commission