Minutes of the Health Commission Meeting Tuesday, April 7, 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 3:02 p.m. Present: Commissioner Debra A. Barnes Commissioner Edward A. Chow, M.D. Commissioner Ron Hill Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Absent:      Commissioner Roma P. Guy, M.S.W. Commissioner David J. Sanchez, Jr., Ph.D. 2) APPROVAL OF MINUTES OF THE MEETING OF MARCH 17, 1998 Action Taken: The Commission unanimously adopted the minutes of March 17, 1998. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Lee Ann Monfredini) President Monfredini pointed out that too many of today's contracts are retroactive and requested the Department to continue its improvement on this matter. (3.1) CHN-Tom Waddell-Homeless Programs - Request for approval of new contract and sole source request with the Bar Association of San Francisco (BASF)in the amount of $194,028 to provide advocacy and legal and technical assistance to severely disabled individuals applying for Supplemental Security Income, for the period of date of certification through June 30, 1999. (DPH contracted with BASF for services totaling $77,868 during FY 1996-97). President Monfredini requested the contractor to send a letter to the Department in five months (October 1998) with an update on its continuing progress towards compliance on its Board composition. (3.2) CHP&P-HIV Prevention - Request for approval of retroactive renewal contract with CAL-PEP, in the amount of $256,496, for the provision of HIV prevention program services targeting behavioral risk populations and venue-based individual outreach services, for the period of January 1, 1998 through December 31, 1998. (DPH contracted with CAL-PEP for services totaling $228,138 during FY 1996-97). (3.3) PH-CHS-STD Prevention & Control - Request for retroactive approval of renewal contract and sole source with the Regents of the University of California at San Francisco (UCSF) - Adolescent Medicine Department, in the amount of $208,440 per year, for the continued provision of research and evaluation activities to prevent infertility due to sexually transmitted diseases, for the period of February 27, 1998 through February 26, 2000. (DPH contract with UCSF for services totaling $13,848,952 during FY 1996-97). (3.4) PH-CHS-CSAS - Request for retroactive renewal contract with Haight Ashbury Free Clinics, Inc. (HAFC) in the amount of $3,199,751 to provide Target Cities Project fiscal agent, SSI evaluation, SSI client referral and monitoring, and HUD monitoring services, and a Sole Source request to implement the Long-Term Care Integration Pilot Project in the amount of $104,775, for a total contract amount of $3,304,526, for the period of October 1, 1997 through September 30, 1998. (DPH contracted with HAFC for services totaling $10,606,732 during FY 1996-97). (3.5) PH-CHS-CSAS - Request for retroactive approval of multiyear contract renewal with Institute of Advanced Driver Education and Training (IADET), in the amount of $211,375 (in client fees only), to provide First Offense Driving Under the Influence (DUI) services for the period of July 1, 1997 through June 30, 2001. (DPH contracted with IADET for services totaling $202,778 in client fees during FY 1996-97). (3.6) PH-CHS-CMHS - Request forapproval ofretroactive modification to the contract with Ross Hospital to provide: 1) an augmentation of acute psychiatric inpatient hospital services for children and adolescents in the amount of $60,000. The total contract amount including this modification is $80,000; and 2) Medi-Cal funded psychiatric inpatient hospital services for adults for the period of  July 1, 1997 through June 30, 1998. No change in the total dollar amount of $4,000,000 for adult psychiatric inpatient hospital services for Medi-Cal beneficiaries for all six (6) hospital providers. (DPH contracted with Ross for services totaling $20,000 during FY 1996-97). (3.7) PH-CHS-CMHS - Request for approval of retroactive contract modification with St. Mary's Hospital and Medical Center (D.B.A. McAuley Neuropsychiatric Institute) to provide:  1) augmentation of adolescent inpatient, partial hospitalization, transitional (outpatient) services in the amount of $77,600. The total amount of the contract is $377,600 including this modification; and 2) Medi-Cal funded psychiatric inpatient hospital services, for the period of July 1, 1997 through June 30, 1998. No change in the total amount of $4,000,000 for all six (6) hospital providers. (DPH contracted with St. Mary's for services totaling $1,045,368 during FY 1996-97). (3.8) PH-CHS-CMHS - Request for approval of new contract with Family Service Agency (FSA) for private outpatient psychiatric services in the amount of $100,000, for the period of April 1, 1998 through June 30, 1998; and $470,000 for the period of July 1, 1998 through June 30, 1999, to provide outpatient care to medically indigent and medical psychiatric clients under a managed care model of care. (DPH contracted with FSA for services totaling $4,422,837 during FY 1996-97). (3.9) PH-CHS-CMHS - Request for approval of new contract with Family Service Agency (FSA) for psychiatric services in the amount of $50,000 for the period of April 1, 1998 through June 30, 1998; and $250,000 for the period of July 1, 1998 through June 30, 1999 to provide a residential care facility program to San Francisco Mental Health Plan enrollees under a managed care model of care. (DPH contracted with FSA for services totaling $4,422,837 during FY 1996-97). (3.10) PH-CHS-CMHS - Request for approval of new contract with the Regents of the University of California San Francisco (UCSF) Langley Porter Hospital and Clinics for mental health services in the amount of $20,000, for the period of April 1, 1998 through June 30, 1998; and $100,000 for the period of July 1, 1998 through June 30, 1999, to provide mental health treatment services for clients who are eligible to receive services under the new model of care and the San Francisco Mental Health Plan. (DPH contract with UCSF for services totaling $13,848,952 during FY 1996-97).  This item was postponed to a future meeting. (3.11) SB 1255 Supplemental -Consideration of a Supplemental Appropriation Request to fund an intergovernmental transfer payment of $30,000,000 for fiscal year 1997-98 in order to qualify for  SB 1255 supplemental payment funds, and Medi-Cal Graduate Medical Education funding. Action Taken: The Commission unanimously approved the Consent Calendar of the Budget Committee, with #3.10 being postponed to a future meeting. 4) DIRECTOR'S REPORT(Provides information on activities and operations of the Dept.). (Mitchell H. Katz, M.D., Director of Health) ADMINISTRATION Proposition 187 In 1994, California voters passed Proposition 187 which denied undocumented residents access to publicly-funded education, health care and social services, and required public agencies providing these services to report persons "suspected" of being undocumented to immigration authorities. The Health Commission and the San Francisco Board of Supervisors adopted resolutions opposing Proposition 187. Since its passage, several lawsuits have been filed questioning the constitutionality of the ballot measure. On March 17, 1998 the United States District Court issued a final judgment finding Proposition 187 unconstitutional and permanently enjoining the State from implementing and enforcing the law. Specifically, the Court found the following sections of Proposition 187 unenforceable: Law enforcement agency cooperation with INS, Exclusion of illegal aliens from public social services, Exclusion of illegal aliens from publicly funded health care, Exclusion of illegal aliens from public elementary and secondary schools, Exclusion of illegal aliens from public post secondary educational institutions, and State Attorney General cooperation with INS. The Court's ruling was based on the fact that Proposition 187 is preempted by federal law (i.e., the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, also known as the Welfare Reform Act). California is required to enact regulations pursuant to the federal Welfare Reform Act and not Proposition 187. The Court also found that the State had no power to legislate in the area of immigrant eligibility for federal, state and local benefits. In addition, a 1982 Supreme Court decision (Plyler v. Doe) held that States could not deny basic public education to children based on their immigration status. As the Health Commission is aware, the federal Welfare Reform Act places restrictions on the type and level of federal benefits that "non-qualified aliens" and legal immigrants can receive and imposes time restrictions on the receipt of public assistance (i.e., Temporary Assistance to Needy Families). We are very pleased with the Court's ruling. Prenatal Care Last month the Los Angeles County Superior Court ruled that the State could not implement regulations eliminating prenatal care for undocumented women. The Court ruled that the regulations failed to ensure that women would continue to receive access to screening and treatment for communicable diseases. It is our understanding that the State is considering appealing this decision.  In February 1998 the Department reiterated its policy to continue providing pregnancy-related services to undocumented women. A notice was sent to all Department staff informing them to continue following normal operating procedures. The Department continues to work with immigrant rights advocacy organizations to ensure that undocumented women are aware of their ability to access Medi-Cal for this service.  President's Commission on Consumer Protection and Quality in the Health Care Industry On March 13, 1998 the President endorsed the final report of his Advisory Committee on the President's Commission on Consumer Protection and Quality in the Health Care Industry. As the Health Commission is aware, this Advisory Committee was established to advise the President on changes occurring in the health care system and how to promote and ensure consumer protection and health care quality.  The Commission's final report has over 50 recommendations to improve health care quality. As part of their final report, the Commission recommended adoption of a clear statement of purpose for the health care system. The Commission recommended that the following statements be articulated by the President: the purpose of the health care system must be to continuously reduce the impact and burden of illness, injury, and disability; and to improve the health and functioning of the people of the United States. In addition to addressing consumer protection and health care quality, the Commission also urged the President to continue efforts to reduce the number of uninsured and underinsured Americans.  The Department believes that the work of the Commission is critical to ensuring improvements in our health care delivery system. Implementation of any recommendations from the report will be at the direction of President Clinton's Administration. Healthy Families On March 24, 1998 the federal government approved California's Children's Health Insurance Program -- Healthy Families Program. California is the sixth State to win approval for its plan. The Managed Risk Medical Insurance Board (MRMIB) still anticipates implementing the program effective July 1, 1998.  The federal government is not allowing California to access the federal Vaccine for Children's Program (VFC) under Healthy Families. VFC was established to serve children who are either enrolled in Medicaid or who are uninsured. A Healthy Families participant meets neither of these criteria. There is concern that the financial cost of vaccines may exceed the annual capitation rate that providers receive under the program -- making participation difficult. The federal government has encouraged the State to look at the possibility of creating a State-Only Vaccine Program. Under this program, the State may use federal dollars to purchase vaccines for children enrolling in this program. Electronic Data Systems will be the administrative vendor for the program providing day-to-day operational support. Considerable concern was voiced when the State originally selected a health plan -- WellPoint/Blue Cross of California -- as the administrative vendor. There was concern over conflict of interest in awarding the administrative vendor contract and a health services contract to the same health plan. The Health Department wrote to the State specifically opposing the idea of an administrative vendor also having a health services contract. After being awarded the contract, WellPoint/Blue Cross of California declined to accept the award for operational reasons. MRMIB then awarded the contract to Electronic Data Systems which has performed these types of administrative functions in other States and is not a provider of health care services.  As the Health Commission is aware, Healthy Families enrollment is voluntary. The State is holding a series of informational workshops on Healthy Families and has begun the pre-enrollment campaign. The Department is committed to ensuring that local public health staff are seen as vital components of any outreach and education campaign for this program. The Department's Community Health Network anticipates providing health care services to children enrolled in Healthy Families through its contract with the San Francisco Health Plan. PUBLIC HEALTH Kellogg Foundation Site Visit I am happy to report that the Kellogg Foundation site visit on April 3, 1998 went well. We learned at the visit that only 28 sites of the 75 sites that applied were being visited. I was particularly grateful to have the President and Vice President of the Health Commission present to show their support of our proposal. Site visitors received tours of San Francisco General Hospital, Bayview Hunters Point neighborhood, Southeast Heath Center, and Mission Neighborhood Health Center. They saw a demonstration of our lifetime clinical record and spoke with Bayview Hunter's Point residents. Drs. Sandra Hernandez and Sophia Chang spoke about local foundation support for the safety net system. We will hear by approximately April 15th whether we have been chosen to submit a formal application. The Foundation expects to award 10 sites a five year grant ranging from 2.5 to 5.0 million dollars. Adolescent Smoking PrevalenceThe Centers for Disease Control issued new national data on the prevalence of smoking among adolescents The l997 national data was collected through high schools, and only included older adolescents. The latest available California data was collected in l996 from 12-17 year olds, and is only preliminary since the survey is conducted over a two year period. California data is collected through random phone surveys, which tends to yield lower smoking rates, perhaps due to the possible proximity of parents. The 1996 California data is not available by ethnicity. Since the sample size of adolescents surveyed in San Francisco is too small for statistical significance, no local adolescent data has been made available through these prevalence surveys.The rate of increase among California adolescents from 1993 to 1996 was 30%. Specifically, the percentage of California adolescents who smoked within the past 30 days increased from 9.2% in 1993 to 12.0% in 1996. Nationally, this figure was 80% from 1991 (12.6 to 1997 (22.7%). At this time it is difficult to compare the two sets of data because of the differences in collection methods and the preliminary nature of the latest California data. However, there are parallel trends insofar as overall higher prevalence rates, and particularly large increases among African-American youth. Policy and Planning Section I am pleased to announce the appointment of Jessica Wolin as the Director of Planning for the Public Health Division. Ms. Wolin was most recently a senior planner for the Policy and Planning Unit. She has impressive credentials in public health planning, having worked for the Alameda County Health Services Agency and for the California Department of Health Services. Through the good graces of Tangerine Brigham, Ms. Wolin had been assigned to assist the Public Health Division over the past several months pending a formal reassignment. During this period, Ms. Wolin chaired the Public Health Division Planning Group, organized a successful all-staff meeting, produced the News & Views newsletter, organized events for Public Health Week and assisted in joint planning with the Community Health Network. I am sure you join me in congratulating Jessica on her new appointment. STD Prevention and Control Section Joe Engelman, M.D., M.P.H., from our STD Prevention and Control Section, has just returned from his second trip to Vietnam as a guest of the Center for AIDS Prevention Services to provide training on the diagnosis, treatment and prevention of sexually transmitted diseases at the Dermatovener-eology Hospital in Ho Chi Minh City. During their first visit in September 1997, Dr. Engelman and colleagues were impressed by the dedication of Vietnamese clinicians and officials to reducing the prevalence of STDs and HIV, although the disease control efforts were still developing. They made recommendations on how to improve clinical and laboratory services, to institute Pap smear screening and to expand HIV counseling and testing.  On their most recent visit, Dr. Engelman was able to spend time seeing patients, where he discovered a large degree of self-treatment. Easy availability of antibiotics resulted in a high percentage of patients whose diagnosis of an STD was made more difficult by self-administered medication. The director of the hospital concurred in the recommendation to combine pharmacy education with a national campaign to tighten regulations on dispensing medications.  Dr. Engelman was also able to visit clinics in outlying areas, including a clinic that serves low-income commercial sex workers, where he recommended intensified screening activities, including Pap smears. Dr. Engelman's visits to Vietnam provide an excellent example of how the training and experience we gain in our local programs can contribute productively to an international public health effort. MOU with the San Francisco Unified School District I am pleased to announce the signing of a Memorandum of Understanding with the San Francisco Unified School District, in which the Department of Public Health will serve as medical consultant to the School District. Among other provisions, the agreement establishes that the Medical Director of Maternal, Child and Adolescent Health, the Medical Director of Children's Medical Services and the Medical Director of Children's Mental Health shall provide clinical and programmatic consultation to School District staff. This agreement enables the School District to take full advantage of the medical expertise in the Department, and it formalizes a collaborative relationship on a wide range of programs and services. A newly reconstituted School Health Planning Committee will soon be convened to design and carry out the larger program goals of the partnership. World TB Day The Department sponsored a press conference at the San Francisco Zoo on March 24 in observance of World TB Day. The event provided us with an opportunity to update the public about TB against the background of Calle, the elephant, who is currently undergoing her own effective, if not unconventional, TB treatment. Masae L. Kawamura, MD, Director of San Francisco TB Control, was joined by visiting officials from the CDC, Sara Royce, MD, Chief, TB Control Branch; California Department of Health Services; Zoo Veterinarian Freeland Dunker, DVM; and two TB patients who offered testimonials about their diagnosis and treatment. The past year was peppered with high profile TB cases, including Calle the elephant and three unrelated cases at the Pacific Exchange. 1997 was the fourth consecutive year of decline in TB cases and we are happy to report that San Francisco has experienced its lowest TB rate in history. The decrease was almost exclusively due to the decline in African American TB cases and indicates effective TB control is being established in our most vulnerable populations. Targeted screening of higher risk groups through outreach efforts, community awareness and the use of preventive therapy with increased focus on the homeless and HIV infected is believed to be making its impact. Despite these promising statistics, TB case rates in San Francisco remains four times the national rate and double the California rate. HIV, substance abuse, poverty, homelessness and immigration continue to fuel the high rates. Prevention of TB cases among foreign born San Francisco residents will be the major challenge in the coming yearas the percentage of TB cases in this group increases. Multidrug resistant TB remains low, but is an important challenge as these cases may increase because of the increase of resistant TB elsewhere in the world.  Occupational Safety and Health The OSH Section routinely receives calls about indoor air quality in the City and County of San Francisco (CCSF) buildings. CCSF employees may be concerned about "stuffy/stale" air, or may have symptoms which they feel are caused by the indoor air quality in their facility. This is sometimes called "Sick Building Syndrome". In an effort to help CCSF Supervisors and/or Building Facilities Managers respond to and deal with these concerns, the Occupational Safety and Health (OSH) Section has developed an "Indoor Air Quality Action Kit". This kit presents a systematic, user-friendly approach for identifying and resolving indoor air quality issues. If, after using the kit, the problem has not been resolved, then the information collected by the client can be utilized by the OSH staff in a more detailed evaluation. The kit can also be used to evaluate and improve indoor air quality in buildings where there are no reported problems, but the management wants to be proactive about indoor air quality. This kit available to other CCSF Departments, as well as DPH facilities. The kit can be obtained by calling the OSH Section at 554-2793. Violence Prevention Workshop The Community Health Promotion and Prevention Section of Public Health in collaboration with the Violence Prevention Network sponsored a one day planning workshop last month at the Hall of Flowers. I was pleased to give the welcoming address on the "Root Causes of Violence". The day was divided into three issue areas focusing on the Economics, Mental Health, and Oppression surrounding violence in our society. Each topic was kicked off with a panel discussion by experts in the field followed by group sessions where participants brainstormed solutions as the beginning steps of developing a violence prevention action plan. This conference was a continuation of the October forum which focused on "Community Rick Factors for Violence: Guns, Alcohol, Media, Witnessing Acts of Violence, Incarceration, and Community Deterioration". Group discussions and continuing meetings of the Violence Prevention Network will be utilized to complete the draft of a violence prevention plan for San Francisco. This effort is one of the final components of the Department of Health Services funded Violence Injury Prevention Project. COMMUNITY HEALTH NETWORK Laguna Honda Hospital Annual Survey Exit Conference A 15-member team comprised of State Licensing and Certification surveyors and HCFA representatives concluded a three week certification and survey on Friday, March 13 with an exit debriefing. This meeting was attended by Health Commission President Lee Ann Monfredini and members of the CHN Executive Leadership group.  The survey team described their observations and preliminary findings. These preliminary findings will be reviewed by District Licensing and Certification supervisors before finalized and returned to the facility. The survey team reported several items that are of great significance to the Department and to the future of Laguna Honda Hospital. These items include: A preliminary finding of substandard quality of care which they allege is created by the open wards, lack of privacy and safety issues primarily related to the facility. A preliminary recommendation that continuation of the long standing waiver for the open wards not be granted. A preliminary recommendation that continuation of the long standing waiver on semi-private rooms that do not meet HCFA size requirements not be granted. A recision of the waivers would pose a direct threat to the reimbursement for a majority of the residents in the main building at Laguna Honda. The LHH Executive Team will develop a response and plan to the issues identified in the survey preliminary finding. The Commission will hear a special report on this issue later in this meeting.  March Was Nutritional Services Month - Some Interesting Facts About LHH Services Laguna Honda Hospital serves 1,700,000 meals per year to hospital residents and staff while further providing food service to Adult Day Health Care and the Senior Nutrition Program. The Nutritional Services Department also has been a placement site for the Internship for Dietetics with San Francisco State University for over seven years. During this period, over 30 dietitians have been trained (and one has joined the LHH staff). Last year LHH was evaluated by the American Dietetics Association (ADA) and was given an outstanding rating for its role in the training of dietitians. The ADA requested that Laguna Honda's role be enhanced to a full nine-week program.  Additionally, six students from Merritt College in Oakland were trained in the "Dietetic Assistant" program. Since 1982, LHH has been a part of graduate education for the combined Masters of Public Health and Nutrition Degree from University of California at Berkeley. We commend the Nutritional Services Department through the assistance they provide to our neighboring institutions of higher education! Sharon Nevins Resigns I regret to announce that Sharon Nevins, Laguna Honda Hospital's Chief Financial Officer for more than two years, recently announced her resignation effective March 19, 1998. Sharon has been an extremely valuable member of the LHH Executive Committee. The CHN Leadership Group commends her for taking a leadership role in rectifying significant budgetary problems which existed when she arrived at LHH two years ago. I wish to thank Sharon for all of her contributions and wish her the very best in her future endeavors. Mr. Wagner and Mr. Funk are working with Ms. Zmuda for replacement to this very key position. Commissioner Chow requested that a presentation on the Department's collaborative efforts with the San Francisco School District be calendared for a future Commission meeting. President Monfredini requested the Department to explore the feasibility of an Employee Recognition Program and bring a policy to the Commission for consideration. Commissioner Chow encouraged the Department to integrate some of the principles of the recommendations from the President's Commission on Consumer Protection and Quality in the Health Care Industry into the work of the 1115 Waiver and Universal Health Care Blue Ribbon Task Force. 5) CONSIDERATION OF A RESOLUTION PROCLAIMING NATIONAL NURSES' WEEK, MAY 6-12, 1998 Gayling Gee, CHN Administrator, presented a resolution in commemoration of National Nurses' Week, May 6-12, 1998. She introduced nurses who represent the health care continuum in the Department. Over 1,000 nurses work for the Department. Action Taken: The Commission unanimously adopted Resolution #14-98, "Endorsing the Designation of May 6-12, 1998 as Nurses' Week in the City and County of San Francisco," (Attachment A). 6) CONSIDERATION OF A RESOLUTION ON AMENDMENTS TO THE SAN FRANCISCO COUNTY ADULT DAY HEALTH PLAN Gay Kaplan, Co-Chair of the San Francisco Adult Day Health Care Planning Council and Program Director for North of Market Senior Services, presented the revised Adult Day Health Care (ADHC) County Plan. The primary role of the Planning Council is to develop ADHC programs and to develop an ADHC County Plan. (Attachments B and C). Ms. Kaplan acknowledged the work of Nyasha Junior with the Planning and Policy section of the Department. Ms. Junior facilitated the planning process and authored the County Plan. Commissioner Chow pointed out that Service Area #1 (Chinatown/North Beach area) needs an ADHC service provider. Action Taken: The Commission unanimously adopted Resolution #15-98, "Authorizing Approval of Revision of the San Francisco Adult Day Health Care County Plan," (Attachment D). 7) A. PRESENTATION AND CONSIDERATION OF A RESOLUTION  FOR THE PROPOSITION 99-FUNDED FY 1998-2001 COMPREHENSIVE TOBACCO CONTROL PLAN Larry Meredith, Ph.D., Director of Health Prevention and Promotion, introduced Alyonik Hrushow of the Tobacco Control Project. Ms. Hrushow presented the Tobacco Control Plan. The Plan addresses the following three State-mandated priority areas: 1. Reduce exposure to environmental tobacco smoke and support efforts to help people break their addiction to tobacco. 2. Reduce youth access and availability to tobacco through commercial and social sources. 3. Counter pro-tobacco influences in the community such as advertising, , marketing, promotion and sponsorships. This priority includes addressing the impact of transnational tobacco, particularly in communities with large immigrant populations which are affected transnational tobacco marketing. The Plan is based on the following budget allocations: $819,000 in FY 1998-99; $779,000 in FY 1999-00; and $779,000 in FY 2000-01 Other "core program elements" that a were integrated into the Tobacco Control Plan and Budget include: 1. Maintenance of a community coalition. The State requires that the Tobacco Control Project provide staff support and technical assistance to the coalition. Other requirements include provision of a mission statement for the coalition and procedures for involvement in strategic planning. Additionally, involvement of representatives from high risk populations, those with expertise in tobacco control, and organizations not receiving tobacco control funding is required. Coalition members are involved in strategic planning and program implementation and as media spokespersons. 2. Clearly identified and measurable outcome objectives that focus on community norm changes. An example of a community norm change is the decreasing social acceptance of smoking associated with the implementation of smoke-free workplace policies. 3. An evaluation plan for each measurable objective and data collection system to determine the effectiveness of strategies. Ten percent (10%) of the budget must be allocated towards an evaluation component. 4. Strategically used paid media and public relations to support policy and education activities. 5. Up to three "planning objectives" are permitted with an action plan as the outcome. These have been incorporated into the community capacity building and coalition core elements. 6. Building the capacity of communities and agencies to address tobacco control issues. 7. Mobilization of the community to support educational, policy and enforcement activities. 8. Active promotion of the statewide toll-free numbers for cessation services in several languages. The State's position is that the statewide service is a cost-effective means of providing cessation services. No more than 10% of the budget per year may be allocated to smoking cessation services. Commissioner Chow expressed concern that only two groups are being targeted within this 3-year plan. Commissioner Barnes agreed that the Plan should not be locked into serving only two groups during this 3-year time period. Dr. Meredith stated that the Department would negotiate with the State to have the Plan include a needs assessment to determine target groups with the highest needs for smoking cessation programs. Action Taken: The Commission (Monfredini, Chow, Hill, Parker) adopted Resolution #16-98, "Supporting the Department of Public Health's FY 1998-2001 Comprehensive Tobacco Control Plan and Budget," (Attachment E). Commissioner Barnes voted no. Action Taken: The Commission unanimously voted to reconsider the previous motion. Action Taken: The Commission unanimously adopted Resolution #16-98, "Supporting the Department of Public Health's FY 1998-2001 Comprehensive Tobacco Control Plan and Budget," (Attachment E), with the understanding that the Department will negotiate with the State to have the Plan include a needs assessment to determine the target groups with the highest needs for smoking cessation programs. B. PRESENTATION AND CONSIDERATION OF A RESOLUTION FOR THE PROPOSED MANGINI SETTLEMENT-FUNDED TOBACCO PREVENTION PLAN Ms. Hrushow presented the plan and budget for expending the $1.5 million Mangini settlement funds for tobacco prevention. These funds are designated for purposes of preventing youth from smoking. The three components of the program will consist of media, enforcement, and community-based interventions. For a copy of the plan, contact the Commission Office (554-2666). The timeline for the plan will be: Phase I: April-August 1998. Release funds for personnel and operating costs as well as the enforcement component. Implementation of the media, evaluation and community based interventions cannot proceed without the staff and operating costs. The enforcement component will be implemented by the Departments of Weights and Measures and Police, as described below. Funding will be made available through work orders from the Department. Phase II: May-September 1998. Develop RFP's for the media and evaluation services and select contractors through the competitive process. Release funds placed on reserve for media and evaluation after contractors have been selected. Phase III: August-December 1998. Develop RFP for community based interventions and select contractors through competitive bid process. Request release of funds placed on reserve for this component after contractors are selected. Commissioner Parker expressed his concern on the evaluation component. Commissioner Chow encouraged staff to look at ads already developed for youth. Action Taken: The Commission unanimously adopted Resolution #17-98, "Approving the Plan for Expending Mangini Settlement Funds for Tobacco Prevention," (Attachment F). 8) CONSIDERATION OF A RESOLUTION DIRECTING THE DEPARTMENT OF PUBLIC HEALTH TO DEVELOP A PLAN IN RESPONSE TO PHYSICAL PLANT ISSUES AT LAGUNA HONDA HOSPITAL Tony Wagner, Interim Executive Administrator of the Community Health Network, presented the background and history of the physical plant issues at Laguna Honda Hospital, (Attachment G). Commissioners' Comments: The Commission and Department need to respond to the physical plant issues. As a quality of life issue, the City needs to view Laguna Honda Hospital as a first priority. In the development of a plan, the Department needs to consider other options in addition to a general obligation bond. If a proposed bond is to pass, there needs to be a high level of commitment to convince the voters on the importance of this health issue. The waiver being in jeopardy forces corrections to be made at Laguna Honda Hospital. It is time to stop making excuses and delaying addressing the physical plant issues. Dr. Katz reiterated the need to develop a creative plan and convince the tax payers to support the plan. Public Speaker: Howard Wallace, Local 250 , supported the development of a plan. Action Taken: The Commission unanimously adopted Resolution #18-98, "Directing the Department of Public Health to Respond to the Physical Plant Issues at Laguna Honda Hospital," (Attachment H). 9) OTHER BUSINESS/PUBLIC COMMENTS Dale Butler, Local 790, announced a press conference for Wednesday, April 15, 1998 on safety devices for healthcare workers. The meeting was adjourned at 5:00 p.m Sandy Ouye Mori, Executive Secretary to the Health Commission