Minutes of the Health Commission Meeting Tuesday, February 3, 1998 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 3:00 p.m. Present: Commissioner Debra A. Barnes                                                     Commissioner Edward A. Chow, M.D. Commissioner Roma P. Guy, M.S.W. Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner David J. Sanchez, Jr., Ph.D.                                   Absent: Commissioner Ron Hill                                                                      11) CLOSED EXECUTIVE SESSION A) Public comment on all matters pertaining to the Closed Session.  None. B) Vote on whether to hold a Closed Session pursuant to Government Code Section 54957 and San Francisco Administrative Code Section 67.10(b): Appointment/Hiring: Director of the Department of Public Health. To consider submission to the Mayor of the name(s) of qualified applicant(s) for the position of Director of the Department of Public Health, pursuant to Charter Section 4.102. Action Taken: The Commission voted to hold a Closed Session. C) Reconvene in Open Session: 1)Possible report on action taken regarding the submission to the Mayor of the name(s) of qualified applicant(s) for the position of Director of the Department of Public Health, pursuant to Charter Section 4.102. Action Taken: The Commission unanimously approved Resolution #7-98, "Submitting the Name of Mitchell H. Katz, M.D. to the Mayor for Appointment as Director of the Department of Public Health," (Attachment A). 2)Vote to elect whether to disclose any or all discussions held in Closed Session (San Francisco Administrative Code Section 67.14(a).). Action Taken: The Commission voted not to disclose any discussions held in Closed Session. 2) Approval Of Minutes Of The Meeting Of January 20, 1998.  Action Taken: The Commission unanimously adopted the minutes of January 20, 1998. President Monfredini announced the following Health Commission assignments: Budget Committee: David J. Sanchez, Jr., Ph.D., Chairman Debra A. Barnes Ron Hill                                                                                  Joint Conference Committee for Quality Assurance - Community Health Network: Edward A. Chow, M.D., Chairman                              Ron Hill Lee Ann Monfredini                                                      Joint Conference Committee for Quality Assurance - Public Health: Roma Guy, MSW, Chairperson                                David J. Sanchez, Jr., Ph.D. Harrison Parker, Sr., DDS                                     Joint Conference Committee for Quality Assurance - San Francisco General Hospital: Edward A. Chow, M.D., Chairman                   Lee Ann Monfredini Harrison Parker, Sr., DDS                                  Joint Conference for Quality Assurance - Laguna Honda Hospital: Lee Ann Monfredini, Chairperson                    Roma Guy, MSW                                              Public Authority Harrison Parker, Sr., DDS                                                    SFGH Foundation San Francisco Health Authority Debra A. Barnes Executive Committee, Mayor's Criminal Justice Council Lee Ann Monfredini                                   3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner David J. Sanchez, Jr., Ph.D.) (3.1) Consideration of a supplemental appropriation of $420,032 for the Conversion of Contract Employees in Mental Health Services to Civil Service. (3.2) PH-CH&S-STD Prevention and Control - Resolution authorizing the Department of Public Health, Sexually Transmitted Diseases Prevention and Control, to accept and expend a new grant in the amount of $167,680 from the California Department of Health Services, STD Branch, for the period of April 1, 1998 to March 31, 1999, to conduct an STD Training Program. (3.3) Central Administration-MIS - Contract modification and sole source increase with Systems Support Technologies (SST), in the amount of $249,000 for the provision of technical support services for information systems, for the period of June 17, 1997 through June 30, 1998. This modification will bring the contract total to $1,063,000. (DPH contracted with SST for services totaling $582,028 during FY 1996-97). (3.4) PH-CHP&P-Tobacco Free Project - Request for approval of two contract modifications for comprehensive tobacco control services, in the amount of $1,261,500, for the period of January 1, 1998 through June 30, 1999: one with O'Rorke Public Relations and Advertising (O'Rorke), for $900,000 to place anti-tobacco ads on network and cable television; and the other with Polaris Research and Development (Polaris) for $361,500 to evaluate media campaigns, enforcement of the City's tobacco-related ordinances and prevention intervention. (During FY 1996-97 DPH contracted with O'Rorke for services totaling $257,400, and with Polaris for services totaling $781,093).  This item was continued to a future meeting. (3.5) CHN-Central Administration - Reconsideration of a supplemental appropriation request for $10,206,224 to fund increases to salaries and operating accounts in order to meet increased demand for inpatient and outpatient services for FY 1997-98, funded through MediCal, Medicare and private insurance revenues, and to include a transfer of funding from Visiting Nurse Hospice group (VNH) contracts to Community Health Network (CHN) Home Health Agency. Action Taken: The Commission approved the Consent Calendar of the Budget Committee, except #3.4 was continued to a future meeting. Due to a San Francisco Examiner article on the Women's Alcoholism Center, which is funded by the Department, Commissioner Sanchez requested a status report and a copy of the audit on this contractor at the next Budget Committee meeting. Note: Later during the meeting, Commissioner Sanchez requested this issue be referred to the Joint Conference Committee for Quality Assurance - Public Health, not the Budget Committee. 4) DIRECTOR'S REPORT. Provides information on activities and operations of the Department. (Mitchell H. Katz, M.D., Interim Director of Health) ADMINISTRATION Prenatal Care for Undocumented ResidentsLast week, the State Court of Appeals issued an order which allows the State to cut off State-funded prenatal services, although there will be further legal proceedings that could change this situation. On January 29, 1998 the State agreed that the earliest the regulations will be implemented is March 1, 1998 for new applicants, and April 1, 1998 for current beneficiaries.  As previously reported, the Court of Appeals order was issued in the Alameda Superior Court case. In that case, the trial judge ruled that the State regulations were improperly issued, and could not be implemented until federal regulations were promulgated. The State appealed this decision and asked the Court of Appeals to issue an order that would allow the State to implement the regulations while the Court of Appeals considered the merits of the appeal. The Court of Appeals issued that order. However, the Court of Appeals has yet to decide the merits of the appeal, and is expected to do so before March 1st. A second lawsuit challenging the State's regulations on prenatal services was filed in Los Angeles Superior Court. In that case, plaintiffs allege that the regulations are invalid because they fail to incorporate a public health program for immunizations and the control of communicable disease, an exception provided under Federal law. Plaintiffs also allege that the notices the State plans to send to terminate Medi-Cal benefits do not comply with legal requirements. There is likely to be a hearing in this lawsuit before March 1, 1998. Due to press reports that State funding could be terminated as early as February 1, 1998, there has been a great deal of confusion and concern about the status of prenatal care services. At this time, the State does not intend to issue any notices to beneficiaries to clarify the status, until approximately March 21st when they are required to notify current beneficiaries that State-funded services will be terminated.  The Department will notify staff that all women continue to be eligible for prenatal care regardless of immigration status. We have also been talking to community-based immigrant and health care rights advocates about possible outreach and media strategies for ensuring all women know that they are eligible for and should continue to seek prenatal care.  Healthy Families UpdateLast week, the California Managed Risk Medical Insurance Board passed regulations to implement the Healthy Families Program. The regulations: (1) define the intent of the program; (2) specify the program's eligibility, application and enrollment process; (3) state the health, dental and vision benefits; and (4) provide the health plan rate methodology and family contributions. MRMIB still anticipates a July 1, 1998 implementation date. Over the past several weeks, MRMIB has dealt with finalizing the definition of community provider plan, specifying which individuals and entities can receive the application assistance fee, revising the co-payment for dental and vision services, addressing health plan 'low-balling' of rates and cultural and linguistic competency among health plans. The Health Care Financing Administration has responded to the California's Healthy Families State Plan and has asked the State to clarify a number of the programmatic components -- continuous eligibility, application assistance fee, crowd-out, premiums and co-payments, and program budget. Upon further review, MRIMB and DHS have determined that it cannot implement the purchasing credit component of the program until January 1, 1999. These children would still be eligible for the purchasing pool program It was also announced that Department of Health Services had awarded the Medi-Cal/Healthy Families outreach and education contract to Runyon , Saltzman and Einhorn, along with the public relations firm Hill and Knowlton. The first phase of the education/outreach campaign will be targeted for Medi-Cal beginning this month, and the second phase targeting Healthy Families is scheduled to begin in May 1998.  Health plans contract proposals are due February 20, 1998 while dental and vision plan proposals are due February 13, 1998. MRMIB anticipates selecting an administrative vendor for the program later this month. Managed Health Care Improvement Task ForceEarly last month the California Managed Health Care Improvement Task Force adopted its executive summary for its report to the Governor. Under the original time line, the final report was to be released by the end of January 1998. As of this date, the final report has not been released.  As you may recall, the Task Force was appointed by the Governor to review, report and make recommendations on the State's managed care system. The Task Force has also been asked to make recommendations on streamlining the State's oversight and regulation of managed care. The Task Force's recommendations fall into the following major areas: Improving Regulation : a new state entity to regulate managed health care, it is currently regulated by the Department of Corporations. Making Competition Work for Consumers and Patients : enhance purchasing groups, develop and use risk adjustment, standardize insurance contracts and develop new quality information. Improving Quality of Care : improve the dispute resolution process, disclose financial incentives for providers in managed care plans, support physician-patient relationship, provide consumers with unbiased, standardized information, improve the delivery of care and practice of medicine, serve vulnerable populations, address women's health issue and adjust educational program needs at academic medical centers. The Governor did not sign several pieces of managed care legislation last year pending release of the Task Force's final report. At this point, the Department cannot determine what impact this final report will have on pending legislation or on the State's regulation of managed care plans. Mayor's HIV/AIDS SummitApproximately 900 people attended the Mayor's day-long AIDS Summit on January 27th at the Masonic Auditorium. The Mayor called the Summit to examine the challenges and opportunities created by medical advances in AIDS/HIV treatment and to recommend policy changes so that the City responds effectively in the new AIDS environment. In addition to remarks by Mayor Brown, presentations were made by experts and researchers who spoke on various issues and related changes in the epidemic.  Immediate results of the Summit include: Creation of the Mayor's AIDS Leadership Forum, Sandra Hernandez, MD, will host the first meeting of the Forum in April, 1998. Announcement of a City-wide media campaign to promote the Department of Public Health's HIV/AIDS Employment Development Unit, whose creation is one of the Summit's principal recommendations. Appointment of Dick Pabich, a long-time AIDS activist and Summit Coordinator, to a new post of AIDS Public Policy Coordinator. The Department is pleased to acknowledge the excellent, day-long volunteer efforts of 30 DPH employees, many of whom are seasoned veterans of previous Mayoral Summits.  DPH Launches WebsiteI am pleased to announce that beginning this week, the Department of Public Health has an official World Wide Web at http://www.dph.sf.ca.us. The site, which includes information and services from all three DPH divisions and a special Health Commission menu, is also linked to CitySpan, San Francisco's official City Website at http://www.ci.sf.ca.us. We will continue to update, reconfigure and improve the site over the coming months based on your feedback. Many thanks to the Central Administration Network and Systems staff who have worked endless hours, including evenings and weekends, to make the website a reality. We owe a special thanks to Cecile Lavoie, Webmaster; Vickie Zulueta, Central Administration, MIS Manager; Bill Hurja, Network Manager; Drew Camens, Systems Engineer; Kjeld Molvig, CHN Webmaster; and Eileen Shields, DPH Central Oversight. PUBLIC HEALTHCommunity Health Services I am sorry to inform you that Pat Reynolds, Director of the Community Health Services Branch of the Public Health Division, will be leaving us on February 13 to accept a position with the Stuart Foundation. We are grateful for her contributions and we wish her well in her return to the Stuart Foundation, where she worked prior to her tenure at the Department of Social Services. We will miss her personally and professionally. Public Health AdministrationAs part of the collaboration between the Public Health Division and San Francisco State University, the first of a series of Urban Health Seminars will be held February 4, in Room 300, from 3:00-5:00 p.m. on "The Future of Public Health." The keynote address will be delivered by Rick Brown, Ph.D., Professor of Public Health at UCLA and immediate Past President of the American Public Health Association (APHA). The panel of respondents will include Joyce Lashoff, Ph.D., also a Past President of APHA and a former Professor of Public Health at UC Berkeley; George Flores, M.D., M.P.H., Health Officer for Sonoma County; Lisa Moore, Dr. P.H. Associate Professor of Health Education, SFSU and, Bob Prentice, Ph.D., Director of the Public Health Division for the San Francisco Department of Public Health. Commissioners, staff and the public are invited to attend. On a related matter, you might also be interested to know that San Francisco State University has received its final approval to go ahead with its new Masters Public Health program this fall. As has been reported previously, the new MPH program will be conducted jointly with the Department of Public Health. Public Health Focus at UCSF/CHN RetreatAt the recent retreat of UCSF and the medical staff of the Community Health Network, Bob Prentice was invited to discuss areas of potential collaboration between the University and Public Health. Until now, the Affiliation Agreement with UCSF has been primarily restricted to the medical staff at SFGH. At the request of Phil Hopewell, M.D., the new Associate Dean and Chief of Pulmonary Medicine, this year's retreat explored ways in which not only the CHN medical staff but UCSF as a whole might act as partners in achieving public health objectives. The presentation and small group discussions focused on research, development of the population health profile, incorporation of public health into clinical training and institutional collaboration on large public health projects. AppointmentI am pleased to announce the appointment of Ms. Ginger Smyly to the position of Deputy Director, Community Health Promotion and Prevention. Ginger has been an active participant in the development of community-based prevention perspectives, plans and programs for the new Prevention Branch of Public Health. Among other duties, Ginger will be responsible for the development of health promotion and prevention programs in the areas of health promotion, injury control, violence prevention and chronic disease prevention. Smoking Ban in BarsOn January 28, the State Assembly narrowly passed AB 297, which would repeal the bars, taverns and gaming club provisions of the California Smokefree Workplace Act. The bill would rescind the prohibition and permit smoking in bars and casinos at least until the year 2001. Thirty-one Republicans were joined by eleven Democrats in passing this tobacco industry-backed bill. The tobacco industry and gambling interests have been waging a battle to repeal the smoke-free bar provision. The industry's lobbying corps has been active in persuading swing democrats to vote for repeal. The public relations campaign has been organized by the tobacco industry funded National Smokers Alliance. Although this bill passed the Assembly, a different response is expected from the State Senate. John Burton, who will replace Bill Lockeyer as leader of the Senate on February 5, opposes rescinding the ban and has indicated that there will be no Senate action on the smoking ban for weeks if not months according to a January 30th article in the San Francisco Chronicle. The Environmental Health Section has previously been designated by the Board of Supervisors to enforce State Labor Code Section 6404.5 which prohibits smoking in bars. An informal survey by Inspection staff reveals that 75 to 80% of the facilities visited were complying with this statute. The month of January was devoted to providing educational information relative to their responsibilities. Beginning in February, bars found not complying are being issued citations to the weekly administrative hearings conducted by the Department to warn them that arrest citations (traffic like tickets) will be issued by the Department to establishments refusing to comply. Patrons who continue to smoke after being requested to step outside by proprietors are also subject to citation by the Police Department. Women's Alcoholism CenterAs the Commissioners may be aware, there was a recent article that came out regarding Women's Alcoholism Center. Community Substance Abuse Services are reviewing these issues very closely and will be providing an update on these issues in the near future. COMMUNITY HEALTH NETWORKPreparation for upcoming DHS survey of our MHRF/4A Facility. We are preparing for the upcoming MHRF/4A survey via a series of administrative sessions every Monday morning. The sessions include review of organization charts, policies and procedures, physical plant issues, residents rights, CNA certification and staff education/orientation, pharmacy and medication issues, and resident funds issues. We will be conducting a mock survey February 4-5. The actual survey will be unannounced. Food Borne Illness Incident at a S.F. Downtown HotelEarly Sunday morning, January 26, 1998, the combined Fire/Paramedic Dispatch Center responded to calls from numerous participants of a convention group visiting a San Francisco downtown hotel. Participants were complaining of nausea, vomiting and abdominal pain. With the tremendous cooperation of the hotel staff, a triage center was set up at the hotel. The hotel supplied blankets, cots, water, juice and crackers. The Assistant Medical Director of the Fire EMS Department was dispatched to the hotel to provide care for patients. Sixty-three patients were triaged and seven were transported to nearby hospitals. Overall the Emergency Medical Services response was of the highest quality. The Fire Department Communication Captains Cavanaugh and Leonard; the San Francisco Fire Department Assistant EMS Medical Director, E. Isaacs; Public Information Officer, Edward Campbell; all crew members of Engine/Rescue Battalion 1; and Nancy Nowicki, Rescue Captain, EMS Division, along with the hotel staff, deserve special recognition.  Our Epidemiologic and Environmental Health team headed by Tomas Aragon, M.D. have been assessing the cause of the incident. The epidemiology is consistent with food borne illness. We have interviewed over 200 convention participants. At this time it is still unclear what the source was that caused the illness. Immunization Station in the Hawkins Village Medical Clinic The Silver Avenue Family Health Center is pleased to announce the opening ofthe "Immunization Station" in the Hawkins Village Medical Clinic. As part of the primary care and public health services offered, the clinic has identified Wednesday afternoons to focus on administering immunizations to the school children, community organizations, and residents of Visitacion Valley, Bayview Hunters Point, and the southern part of Excelsior. Immunization clinic hours are 1:00 p.m. to 4:00 p.m. on Wednesdays. Hawkins Village Medical Clinic is open Mondays through Thursdays, 1:00 p.m. to 4:00 p.m. The immunization clinic officially opened on January 21, 1998. The Hawkins Village Medical Clinic is a Proposition J funded satellite clinic of the Silver Avenue Family Health Center. The immunization team assigned to the clinic represents a coordinated effort by Silver Avenue Family Health Center, the Department of Epidemiology in the division of Public Health, and San Francisco General Hospital's Department of Pediatrics. Medical Supervision is provided by Dr. Dick Brown of the Department of Pediatrics. The staff of Silver Avenue Family Health Center and Hawkins Village hope this service will fill a very important void in the lives of valley residents. 5)CONSIDERATION OF A RESOLUTION DETERMINING WHETHER THE RELOCATION OF OBSTETRICS SERVICE FROM CHINESE HOSPITAL TO CALIFORNIA PACIFIC MEDICAL CENTER WILL OR WILL NOT HAVE A DETRIMENTAL IMPACT ON HEALTH CARE SERVICE OF THE COMMUNITY Vice President Sanchez presided on this item. Commissioner Monfredini and Commissioner Chow abstained on this item due to conflict of interest. Action Taken: The Commission adopted Resolution #6-98, "Determining Whether the Relocation of Obstetrics Service from Chinese Hospital to California Pacific Medical Center Will or Will Not Have a Detrimental Impact on Health Care Service of the Community," (Attachment B). Commissioner Monfredini and Commissioner Chow abstained. Rose Pak, a Trustee of Chinese Hospital, offered support to the Commission and the Department on any outreach efforts to the community. 6) STATUS REPORT ON THE MAYOR'S BLUE RIBBON COMMITTEE ON UNIVERSAL HEALTH CARE COVERAGE Tangerine Brigham, Director of Policy and Planning, gave an update on the work of the Mayor's Blue Ribbon Committee, which has been meeting since November 1996 to develop recommendations on how the County might best pursue expanded health care coverage for the uninsured. The 30-member Committee includes providers, consumers, insurers, employers, community-based organizations, labor, and health advocates. For a copy of the status report, contact the Commission Office at 554-2666. Ms. Brigham highlighted the following areas of work by the Committee: San Francisco's Uninsured Population                                           Designing a Health Insurance Program Proposed Purchasing Alliance/Pool Model Purchasing Program Components eligibility scope of benefits health plan providers financing administrative structure governance Pilot Program Impact on Department of Public Health Community Forums Ms. Brigham reported that the Committee has not issued its final recommendations. She requested guidance from the Commission as the Committee prepared its recommendations to the Mayor. Commissioners' Comments: How will be work of the Blue Ribbon Committee fit into the 1115 Waiver? Business community should be included in discussions A Community Forum was not held in Chinatown A universal plan may be inclusive but may not be viable Is copayment of $15.00 unrealistic? An important part of the cost and the impact on the public health system is to project which populations will be left out Public Speaker: Steve Leoni, consumer advocate recommended a mental health representative be included on the 1115 Waiver Planning Committee. Ms. Brigham reported that the final recommendations from the Committee to the Mayor will come out in the Spring. Dr. Katz encouraged the Commission to help problem-solve the question of how to do universal health care and yet maintain the public health system. 7) PRESENTATION OF THE PROPOSED DEPARTMENT OF PUBLIC HEALTH BUDGET FOR FY 1998-99, AND A PROPOSED RESOLUTION FOR A POLICY TO EXPAND HOUSING SERVICES, PREVENTION SERVICES, MANAGEMENT INFORMATION SERVICES (MIS), AND TO CREATE A DEPARTMENTAL RESERVE Note: The Proposed Department of Public Health Budget for FY 1998-99 is available for review at the Commission Office. Monique Zmuda, Chief Finance Officer, presented the following: The proposed budget for next year is divided into two sections: 1) the base budget, which includes expenses and revenues needed to maintain the current level of services; and 2) service enhances, which are proposed separately for your review, consistent with the Mayor's budget instructions. This budget incorporates the implementation of key policy issues already approved by the Health Commission, including expansion of substance abuse treatment consistent with the Treatment on Demand Program, increased funding to provide equal access to mental health treatment for indigent and uninsured San Francisco residents. It contains the implementation of health coverage for in-house supportive service workers by leveraging Federal funds through the Department of Human Services. In the Proposed FY 1998-99 Budget, we request the Health Commission to consider and approve a policy to expand health and supportive housing services to the homeless, and to expand and develop key primary prevention initiatives (African American health, injury prevention, substance abuse prevention, and children's health). Also requested is approval of a policy to increase Management Information Systems (MIS) support in order to link public health system to our network and to replace critical MIS hardware components to operate our existing systems. Finally, approval is requested for a policy statement to reinvest current year surplus revenues to fund infrastructure requirements, including the establishment of prudent revenue reserve for next year. This policy is presented to the Commission in the form a resolution, which is attached for your review and consideration for the next Health Commission meeting. Also included in the Budget is increased funding for critical infrastructure improvements in order to maintain support services for the Department's health delivery system. In the area of expansion of services, the FY 19998-99 Budget proposes to augment existing services in the areas of environmental health, maternal and child health, adolescent health, urgent care, and primary care. Also included are proposals to develop a medical/psychiatric program and a dementia care program for Laguna Honda Hospital residents. Once approved by the Health Commission, the Department's budget proposal will be forwarded to the Mayor's Office. Ms. Zmuda highlighted the Proposed FY 1998-99 Budget for the revenues, expenditures, and general fund support, (Attachment C). Her presentation covered these subjects: Organization Completion of Reorganization of Public Health Division                         Baseline Budget Pending Supplemental Appropriations Base Supplemental Appropriation                     Volume Supplemental Appropriation                             Revenues Revenue Projections                                                        Lost Grants Revenues State Budget Current Year Projected Surplus                                       New Initiatives Treatment on Demand Equal Access to Care - Mental Health Services Prevention Housing Infrastructure Lost Grants Service Enhancements COLA's Revenue Generating New Initiatives Universal Health Care HIV/AIDS Capital Requests Public Speakers: Mark Stanford, Local 535 Joe Rubino, Conard House Richard Heasley, Conard House Jennifer Freidenbach, Coalition for Homelessness Commissioners' Comments: The presentation of the budget proposal is a comprehensive package The proposed capital reserve policy should be in a separate resolution A reserve policy is needed for the Department Some of the other policy issues in the proposed resolution should be in separate resolutions What is the Department leaving out of the Target Cities Project? Support was expressed for the roof at Laguna Honda Hospital and the specialty wards for medical/psychiatric patients, geropsychiatric patients, and neuropsychiatric patients Support was expressed for rodent control and COLA's For the future, in order that specific attention be given to the budget, a single item for the budget presentation and discussion should be calendared on the agenda The Commission will vote on the Proposed FY 1998-99 Budget at the February 17, 1998 meeting. 8) STATUS REPORT ON PROVIDER NETWORK OUTREACH FOR THE SAN FRANCISCO MENTAL HEALTH PLAN Jo Ruffin,. LCSW, Director of Community Mental Health Services, reported that on April 1, 1998, as part of the State's Medi-Cal Mental Health Managed Care Plan, Community Mental Health Services (CMHS) will assume responsibility and receive State and Federal funding for all specialty mental health services for San Francisco Medi-Cal beneficiaries. On that date, CMHS will formally begin operations of the San Francisco Mental Health Plan, which has been implemented in phases over the last three years. The State approved CMHS' Implementation Plan in August. Today's presentation centered on the Mental Health Division's operational readiness for start-up of the San Francisco Mental Health Plan. For a copy of the report, contact the Commission Office at 554-2666. Ms. Ruffin presented a functional structure chart, (Attachment D), of the S.F. Mental Health Plan, and introduced here key staff who will implement the Plan. The status report included the progress in the provider network development, access and authorization, and claims processing. The infrastructure for the Mental Health Plan includes the following: access/authorization eligibility policy provider network system of care, an array of services information systems member problem resolution and grievance process quality management                                                                      Community Mental Health will come back with a progress report at the end of May. Commissioners' Comments: The overview and presentation were excellent. The level and quality of this report was valuable and comprehensive. The Mental Health Plan gives a positive excitement about managed care. The Mental Health Plan addressees all of the elements needed for managed care. A full-time Medical Director and an interdisciplinary effort focusing on the client are positive aspects of the plan. 9) OTHER BUSINESS/PUBLIC COMMENTS None. Commissioner Guy and Commissioner Sanchez left the meeting. 10) CLOSED EXECUTIVE SESSIONA. PUBLIC COMMENT ON ALL MATTERS PERTAINING TO THE CLOSED SESSION.  None. B. VOTE ON WHETHER TO HOLD A CLOSED SESSION TO CONFER WITH LEGAL COUNSEL. (SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.11(a)). C. POSSIBLE CLOSED SESSION PURSUANT TO GOVERNMENT CODE SECTION 54956.9 AND SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.11(b). CONFERENCE WITH LEGAL COUNSEL - SETTLEMENT OF EXISTING LITIGATIONVALERIE SMITH V. CITY AND COUNTY OF SAN FRANCISCO (SFGH), SUPERIOR COURT #985-455, CONSIDERATION OF A SETTLEMENT IN THE AMOUNT OF $8,500 Action Taken: The Commission voted to go into Closed Session. D) RECONVENE IN OPEN SESSION: 1)POSSIBLE REPORT ON ACTION TAKEN IN CLOSED SESSION. (GOVERNMENT CODE SECTION 54957.1(a)(2), AND SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.14(b)(2).) Action Taken: The Commission approved the settlement of $8,500 for Valerie Smith v. CCSF (SFGH) Superior Court #985-455. 2)VOTE TO ELECT WHETHER TO DISCLOSE ANY OR ALL DISCUSSIONS HELD IN CLOSED SESSION. (SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.14(a).) Action Taken: The Commission voted not to disclose any discussions held in Closed Session. The meeting was adjourned at 7:15 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission