Minutes of the Health Commission Meeting Tuesday, January 5, 1999, 3:00 p.m. at 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 3:09 p.m. Present: Commissioner Debra A. Barnes Commissioner Roma P. Guy, M.S.W. Commissioner Ron Hill Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Absent: Commissioner Edward A. Chow, M.D. Commissioner David J. Sanchez, Jr., Ph.D. 2) APPROVAL OF MINUTES OF THE MEETING OF DECEMBER 15, 1998 Action Taken: The Commission unanimously adopted the minutes of December 15, 1998, with a correction on page 12, the first sentence to replace "all" with "most." 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) (3.1) PHP-CMHS – Request for approval to enter into an agreement with the San Francisco Health Plan, pursuant to which Community Mental Health Services will provide or arrange for the provision of behavioral health services to the Health Plan's Healthy Families and IHSS program members in exchange for a capitated rate. (3.2) PHP-CMHS – Request for approval to enter into an agreement with the Brown and Toland Medical Group, pursuant to which Community Mental Health Services will provide crisis services to Brown and Toland members through Comprehensive Child Crisis Services. (3.3) PHP-CMHS – Request or approval of sole source and new contract with the John Stewart Company, in the amount of $166,320, for the provision of case management services to tenants of the Jordan Apartments who have been homeless and/or dually diagnosed, for the period of January 1, 1999 through June 30, 2000. Commissioners Hill and Barnes both repeated the Commission's request to include all appropriate documents in the Commission packet. However, in order to prevent any delay for this contract, Commissioner Barnes is willing today to consider the late compliance letter to Policy #24. Commissioner Hill emphasized the intent of the policy on sexual orientation demographics is not to out anyone, but to voluntarily declare sexual orientation. PHP-CMHS – Request for retroactive approval of contract renewal with San Francisco Study Center (SFSC), in the amount of $391,826 per year, for the provision of management and fiscal intermediary services for the Oasis Community Center Program, the Socialization Program (STEP) and the Center for Special Problems for the period of July 1, 1998 through June 30, 2002. (DPH contracted with SFSC for services totaling $420,379 during FY 1997-98). (3.5) PHP-CSAS – Request for retroactive approval of multiyear contract renewal with Community Awareness and Treatment Services, Inc. (CATS), at no cost to the Department, in the amount of $259,746 per year in client fees, to provide multiple offense driving-under-the-influence (DUI) services for the period of July 1, 1998 through June 30, 2002. (DPH contracted with CATS for services totaling $4,109,836 during FY 1997-98). (3.6) PHP-CSAS – Request for approval of retroactive sole source and first modification to the renewal contract with Chemical Awareness and Treatment Services, Inc. (dba Community Aware-ness and Treatment Services, Inc.) (CATS), in the amount of $2,743,490 to provide overnight shelter and support services to homeless residents of San Francisco for the period of July 1, 1998 through June 30, 1999. (DPH contracted with CATS for services totaling $4,109,836 during FY 1997-98). Commissioner Barnes, expressing concern for the need for early intervention and prevention for the homeless population, inquired about the data collection efforts of the Department. Barbara Garcia, CSAS Director, gave an overview of staff training, prevention efforts, and coordination work to increase bed capacity. (3.7) PHP-HIV Services – Request for approval of retroactive renewal contract with San Francisco AIDS Foundation (SFAF), in the amount of $537,613, for the provision of client advocacy, benefits counseling, emotional and practical support and voucher distribution services to people with HIV/AIDS for the period of October 1, 1998 through June 30, 1999. (DPH contracted with SFAF for services totaling $4,136,118 during FY 1997-98). (3.8) CHSS-BEHM – Request for approval of retroactive sole source and contract renewal with the Regents of the University of California (UCSF), in the amount of $54,927 per year, for the provision of expert environmental toxicology consulting services to the Department's Environmental Health employees and Fire Department employees, for the period of July 1, 1998 through June 30, 2000. (DPH contracted with UCSF for services totaling $14,314,598 during FY 1997-98). At the full Commission, Commissioner Parker requested a 90-day progress report on #3.1 and #3.2. He also inquired about the frequency of monitoring reports and the census of the Mission Rock Shelter. Action Taken: The Commission approved the Consent Calendar of the Budget Committee with the specific requests of Commissioners. 4) DIRECTOR'S REPORT (Mitchell H. Katz, M.D., Director of Health) (Provides information on activities and operations of the Department). ADMINISTRATION Notes from the Front - - Inpatient Ward Attending at SFGH During the last half of December, I had the honor of serving as an inpatient attending on the medical wards at San Francisco General Hospital (SFGH). It felt good to once again spend the majority of my time providing direct care to patients and teaching the next generation of physicians. It was also nice to see many old friends and meet other staff members for the first time. I think that the Commission would be very proud of how wonderful the medical and nursing care are at SFGH. I felt privileged to work at such a fine institution. At the same time, my intensive inpatient experience affirmed to me the importance of our looking for alternatives to institutionalization. For the majority of patients on my service, substance abuse, rather than medical issues were the major cause of their hospitalization. We need to continue to increase treatment slots through our treatment on demand planning. We also need to think creatively about how to care for individuals who have been through our substance treatment programs and yet are still addicted. My time on the service emphasized the importance of having sufficient bed capacity at Laguna Honda Hospital (LHH). There were several patients who were awaiting placement to LHH and were, therefore, occupying an acute care bed. These patients would be better served at LHH with its therapeutic activities. Moreover, our inability to use the bed for someone with an acute illness increases hospital diversion and decreases revenue to the hospital. Because space at LHH is very limited we must continue to think of alternatives for people who need hospital discharge. During my time on the service, it was also apparent to me that there were patients for whom hospitalization could have been prevented through case management models to increase adherence to medications and to provide support in dealing with chronic illness. Overall, the weeks on the medical ward rejuvenated me professionally, and I approach the new year with renewed enthusiasm about making our system work for all our patients. Expanded Shelter Capacity DPH and DHS were actively involved with the Mayor's Office of Emergency Services throughout the holiday season, to ensure individuals and families had adequate shelter from the cold weather. With the support of the Mayor we initiated a no-turn away policy at all the City run shelters. The Mission Rock population (previously capped at 300) has been running between 415 – 500 individuals. Family shelter capacity remains a challenge. St. Joseph's will be opening 25 beds tomorrow, making a total of 85 new family spaces available since December 1st. POPULATION HEALTH AND PREVENTION Quality Assurance Review, Pediatric Immunizations at CHN Clinics The California Department of Health Services visited SFDPH on November 12, 1998 to conduct a review of pediatric immunization practices at CHN clinics. The State focused their review on two sites, Castro/Mission Health Center and Maxine-Hall Health Center. This review was based on the National Vaccine Advisory Committee's Standards. Overall, the review team found these two sites in high compliance with the standards. These included readily available vaccine services, free or low cost immunizations, no barriers to receiving vaccines, parent education, a client reminder/recall system, and high immunization levels. The reviewers also noted a very successful 2, 4, 6, 12 and 15-month immunization campaign, the transition to a computerized medical record, and the development of the "Immunization ShoeBox" with the San Francisco Immunization Coalition. The "Immunization ShoeBox" is a simple tool that allows doctor's offices to check on the immunization status of all children of a given age in their practice. This allows identification of all children who are not "up-to-date." In addition, the State suggested that relationships with WIC and the Child Health and Disability Program (CHDP) be fostered, to promote immunization awareness. Hepatitis A A volunteer food handler at Mission Rock was identified with Hepatitis A. He had been wearing gloves while serving, but the Department is taking precautions with regard to potential exposure of clients. Dr. Tomas Aragon is coordinating IgG shots for individuals who may be at risk through Mission Rock and Tom Waddell. In addition, the Department is sending a letter to Emergency Department's and care providers for them to consider hepatitis in the differential diagnosis of individuals presenting to care facilities with non-specific symptoms who may have been exposed. COMMUNITY HEALTH NETWORK Opening of the CHN Urgent Care Center I am pleased to announce the opening of the CHN Urgent Care Center on January 5, 1999. The Urgent Care Center is a joint project of the Primary Care and Emergency Care Divisions of the CHN and is designed to better meet the urgent care needs of CHN patients. We are also pleased to formally announce the appointments of Susan Obata, M.D., as Medical Director; and Lissette Duarte, R.N., as Charge Nurse of the Urgent Care Center. The Urgent Care Center is located in 6M (Children's Health Center) at San Francisco General Hospital, and will treat adults alongside the existing Pediatrics Urgent Care Clinic. The Urgent Care Center will be an after-hours operation, with Monday - Friday hours of 5 - 10 p.m., and Saturday, Sunday, holiday hours of 12 noon - 7 p.m., 365 days a year. The telephone number of the Urgent Care Center is 206-8052, and the Fax number is 206-8054. Insurance Plan for In-Home Support Services (IHSS) Workers Following extensive negotiations with the Department of Corporations, the San Francisco Health Plan has received approval to provide an insurance plan for IHSS workers. The plan, to be called "Healthy Workers" will offer medical insurance to approximately 4500 IHSS workers in San Francisco. The San Francisco Health Plan will act as the Plan Administrator, and implementation of the program will be conducted through the Office of Managed Care. Initial outreach is expected to occur in January 1999, with potential enrollment beginning after February. Congratulations to the staff at the Health Plan and in the Office of Managed Care for bringing the proposal to reality and improving the availability of health care to this important population. Special recognition should go to Commissioner Harrison Parker who advocated for the establishment of this program. LHH Holiday Show for Residents a Success The Laguna Honda Hospital Volunteers Inc. hosted its annual Holiday Show for residents in Simon Auditorium on Friday, December 18th. This traditional variety show featured dozens of performers and was hosted by Michael Pritchard, Terry Lowry and Fred LaCosse, and was televised live on TCI Cable, channel 27. Over 400 LHH residents attended the live performance while others watched it via cable television. The Department of Public Health expresses its gratitude to the LHH Volunteers Inc. for once again hosting this important resident holiday event. 5) CONSIDERATION OF THE 86 SAN FRANCISCO GENERAL HOSPITAL POLICIES AND PROCEDURES, AND THE FOLLOWING ADMINISTRATIVE POLICIES AND PROCEDURES: SAN FRANCISCO GENERAL HOSPITAL ADMINISTRATIVE POLICIES AND PROCEDURES EMERGENCY RESPONSE PLAN PRISONER/PATIENT TREATMENT AND TRANSPORT THROUGH SAN FRANCISCO GENERAL HOSPITAL MEDICAL CENTER DEPARTMENTAL POLICIES AND PROCEDURES PRISONER/PATIENT: FEMALE REQUESTING PERSONAL PHYSICIAN FOR PREGNANCY RELATED ISSUES ACCEPTANCE OF PATIENT TRANSFER FOR SAN FRANCISCO GENERAL HOSPITAL (NON PSYCHIATRIC) Action Taken: The Commission approved the 86 SFGH Administrative Policies that have been adopted, reviewed or revised by the Joint Conference Committee at SFGH since October 1995. Action Taken: The Commission approved proposed revisions to the following Administrative Policies: San Francisco General Hospital Administrative Policies and Procedures (Admin. P&P 1.4) Emergency Response Plan (Admin. P&P 5.01) Prisoner/Patient Treatment and Transport Through San Francisco General Hospital Medical Center (Admin. P&P 7.1) Departmental Policies and Procedures (Admin. P&P 16.7) Prisoner/Patient: Female Requesting Personal Physician for Pregnancy Related Issues (Admin. P&P 16/14) Acceptance of Patient Transfer for San Francisco General Hospital (non psychiatric) (Admin. P&P 20.7) 6) CONSIDERATION OF A RESOLUTION AMENDING THE ORDINANCE, WHICH REQUIRES AN APPLICANT FOR A BUILDING PERMIT TO CONDUCT SOIL SAMPLING AND MANAGE HAZARDOUS WASTE PURSUANT TO A SITE MITIGATION PLAN Ben Gale, Director of the Environmental Health Section, presented an overview of the history and needs, legislative digest, and proposed ordinance for the relocation of the Substantive Health Protection Requirements in Article 20 of the Public Works Code. Existing provisions of the San Francisco Municipal Code (known as the "Maher Ordinance") require an applicant for a building permit to conduct soil sampling and manage hazardous waste, pursuant to a site mitigation plan. The Environmental Health Section of the Department of Health oversees the implementation of the site mitigation plan. The Department of Building Inspections issues the building permit upon instructions by the Department of Health. The Maher Ordinance is currently codified in Article 20 of the Public Works Code. This legislation amends the Maher Ordinance by relocating the Substantive Health Protection provisions to the Health Code. The legislation makes accompanying changes to the provisions that remain the Public Works Code to reference the new Health Code provisions. No substantive changes to the law would be made by this legislation. Action Taken: The Commission adopted Resolution #1-99, "Recommending the Relocation of the Substantive Health Protection Requirements of the Hazardous Waste Program, Presently Codified in Article 20 of the Public Works Code, to a New Article Codified in the Health Code." 7) CONSIDERATION OF A PLANNING PROCESS FOR THE REBUILDING OF LAGUNA HONDA HOSPITAL Dr. Katz reported the following: At the Health Commission meeting of December 15, 1998 I presented a White Paper detailing a series of possible options for Laguna Honda Hospital. The Department's recommendation was that we rebuilt Laguna Honda Hospital on the existing Forest Hill site. This recommendation is consistent with Resolution 28-98 adopted by the Health Commission on July 21, 1998. We also recommended that we use a combination of funding from the tobacco settlement and other Federal or State sources to finance this rebuilding. At this time we would like to establish a Planning Committee that will make recommendations to the Health Commission, the Board of Supervisors and the Mayor on the rebuilding of Laguna Honda Hospital. The recommendations will cover programmatic issues (e.g., number of beds, bed configuration, services provided), financial issues (e.g., current asset value of tobacco settlement, potential for obtaining additional Federal of State funding, considerations of bond funding), and technical building issues (e.g., advantages and disadvantages of different configurations of buildings). The Mayor has asked our City Attorney, Hon. Louise Renne, to lead the effort on reaching consensus on rebuilding Laguna Honda Hospital. She has agreed to chair the Committee. I will be the Co-Chair. The Policy Committee will include members of the Long Term Care Task Force, consumers and their advocates, institution and community-based long term care providers, labor leaders, business leaders, civic leaders, and residents of Laguna Honda Hospital. It will also include the Director of the Department of Public Works and representatives from the Mayor's Offices of Public Finance and Budget. From the Health Department, besides myself, Anthony Wagner and Lawrence Funk will sit on the Policy Committee. Tangerine Brigham will staff the Committee. Once the Policy Committee has convened, we intend to establish subcommittees for program, finance, and technical build issues. These subcommittees will do the bulk of the work and allow for broader participation by both Department and non-Department personnel in the process. All meetings will be open to members of the public who wish to attend. We will aim for the Policy Committee to complete analysis and develop recommendations for the Health Commission by the end of March, and bring recommendations to the Commission in April. Dr. Katz reported the Policy Committee, which will consist of 20-25 people, will be appointed in the next two weeks. The Committee will be meeting at least twice a month. Public Speakers: Norma Satten, Planning for Elders in the Central City, supported the planning process and offered PECC participation Joan Braconi, Local 250, expressed concern on the timing of the planning process in relation to a ballot initiative Dr. Katz commented that the policy question of the timing for a ballot initiative will be addressed by the Policy Committee, with the possibility of coming back to the Commission with a revised timeline. Commissioner Guy strongly emphasized the need for the Laguna Honda rebuilding be a part of the AB 1040 planning and there be integration of the different planning efforts (i.e., Laguna Honda Hospital, AB 1040, 1115 Waiver, Universal Health Care). She encouraged the AB 1040 Task Force to look at the bed capacity in connection with what the different bed capacities represent. She wants to know from the AB 1040 Task Force what the community consensus is on the bed capacity question. Commissioner Parker raised a question on the policy issue of the tobacco settlement monies being earmarked for Laguna Honda Hospital. He also asked how the Department is addressing the cost per bed to rebuild the facility. Commissioner Barnes supports the planning process but expressed concern on the timeline being realistic, especially in relationship to the March site visit from HCFA to Laguna Honda Hospital. Dr. Katz acknowledged that HCFA expects progress on a building plan for Laguna Honda Hospital, or HCFA will push for further census reductions at Laguna Honda Hospital. Dr. Katz will give regular updates in his Director's Report to the Commission, as well as provide the Commission with minutes from the Policy Committee meetings. By consensus, the Commission supports the proposed planning process with regular updates from Dr. Katz. 8) UPDATE ON THE 1115 WAIVER PLANNING PROCESS Tangerine Brigham, Director of Policy and Planning, presented the background, history, goals and objectives of the 1115 Waiver planning process, and 1115 Waiver feasibility analysis. For a copy of the full report, contact the Commission Office at 554-2666. Ms. Brigham reported that at this time, the 1115 Waiver Planning Committee is not making a recommendation with respect to whether the City & County of San Francisco should proceed with a 1115 Waiver. A decision would not be make in isolation from other planning efforts (i.e., AB 1040, universal health care). Ms. Brigham reported that the 1115 Waiver Planning Committee felt strongly that we should not proceed without additional input from Medi-Cal recipients on SSI. The concerns of this population regarding managed care are clearly of great importance. The Department also believes that we should proceed on our long-term care planning, as well as evaluate the San Francisco Mental Health Plan prior to making a final determination as to whether we will pursue an 1115 Waiver. In addition, the Department believes that we should continue to pursue an alternative Medi-Cal managed care model, such as a County Organized Health System (COHS). Several counties have indicated their interest in working together to reintroduce a COHS bill on the federal level in early 1999. Commissioners' Comments: Expressed appreciation for a comprehensive report on a complex issue Need for a sunset to this planning effort Appears that some of the stakeholders are not as interested after looking at the financial information Need to wait for results from the AB 1040 Task Force Acknowledge the large amount of work done, but a waiver does not look too promising Is a County Organized Health System a real possibility? Put the 1115 Waiver Planning Committee on hold for six months, with an update from Dr. Katz in three months Public Comment: Nathan Nayman, Hospital Council, suggested using the diverse talent of the 1115 Waiver Planning Committee to create a think tank for the future President Monfredini thanked the Department and requested an update in three months (April), with a possible policy recommendation to the Commission. 9) OTHER BUSINESS/PUBLIC COMMENTS Public Comments: Donna Calame, Executive Director of the IHSS Public Authority, thanked the Commission, especially Commissioner Parker, for their support for the Healthy Workers Program. 10) CLOSED EXECUTIVE SESSION: A. PUBLIC COMMENT ON ALL MATTERS PERTAINING TO THE CLOSED SESSION. None. VOTE ON WHETHER TO HOLD CLOSED SESSION TO CONFER WITH LEGAL COUNSEL. (SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.11(a).) Action Taken: The Commission voted to hold a closed session. The Commission went into closed session at 5:00 p.m. C. CLOSED SESSION PURSUANT TO GOVERNMENT CODE SESSION 54956.9 AND SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.11(b). CONFERENCE WITH LEGAL COUNSEL - EXISTING LITIGATION. 1. FREDERICK HOWARD ET AL V. CCSF, SUPERIOR COURT CASE #985-937, PROPOSED SETTLEMENT: $75,000 The Commission came out of the closed session at 5:05 p.m. 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 proposed $75,000 settlement. 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 5:06 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission