Minutes of the Health Commission Meeting Tuesday, March 16, 1999, 3:00 p.m. 101 Grove Street, Room #300 San Francisco, CA 94102 1) CALL TO ORDER The regular meeting of the Health Commission was called to order by President Lee Ann Monfredini, at 3:10 p.m. Present: Commissioner Edward A. Chow, M.D. Commissioner Roma P. Guy, M.S.W. Commissioner Ron Hill Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. 2) APPROVAL OF MINUTES OF THE SPECIAL CLOSED SESSIONS OF FEBRUARY 26 AND MARCH 2, 1999, AND THE REGULAR MEETING OF MARCH 2, 1999 Action Taken: The Commission unanimously adopted the minutes of the Special Closed Sessions of February 26 and March 2, 1999, and the regular meeting of March 2, 1999. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) Status update on Shared Medical Systems, Inc.'s compliance to Policy #24 regarding board diversity. Commissioner Hill requested the contractor to return in 6 months (September 21, 1999) with another update. (3.2) PHP-HIV Prevention Services – Request for approval of retroactive renewal contract with Haight Ashbury Free Clinic, Inc. (HAFC), in the amount of $105,649, for the provision of HIV- prevention, venue-based, individual outreach for the period of January 1, 1999 through December 31, 1999. (DPH contracted with HAFC for services totaling $15,119,656 during FY 1997-98). Commissioner Hill requested a progress report be brought back to the Commission in 90 days (June 15, 1999). Commissioner Sanchez requested the report to include an update on retention and staff development. (3.3) PHP-CHS-Special Projects – Request for approval of Sole Source and new contract with San Francisco AIDS Foundation (SFAF), in the amount of $357,023 for the provision of site management and case management services for the period of March 17, 1999 through June 30, 2000. The sole source request is for an annual amount of $223,178 per year, for the period of March 17, 1999 through June 30, 2003. (DPH contracted with SFAF for services totaling $4,136,118 during FY 1997-98). PHP-HIV Prevention Services – Request for approval of retroactive renewal contract with Glide Foundation, in the amount of $232,495, for the provision of HIV-prevention services targeting behavioral risk populations, for the period of July 1, 1998 through June 30, 1999. (DPH contracted with Glide for services totaling $523,418 during FY 1997-98). (3.5) PHP-HIV Prevention Services – Request for approval of retroactive renewal contract with Stop AIDS Project, Inc. (STP), in the amount of $214,129 for the provision of HIV-prevention program services targeting behavioral-risk populations, for the period of January 1, 1999 through December 31, 1999. (DPH contracted with STP for services totaling $863,894 during FY 1997-98). (3.6) PHP-CSAS – Request for approval of retroactive Sole Source and modification to the contract with Haight Ashbury Free Clinics, Inc.-San Francisco Target Cities Project (HAFC), in the amount of $541,314 to augment the provision of acupuncture services and start up to provide new intensive outpatient services for persons in the Personal Assisted Employment Services (PAES) program for the period of October 1, 1998 through June 30, 1999. (DPH contracted with HAFC for services totaling $15,119,656 during FY 1997-98). (3.7) PHP-CSAS – Request for approval for a modification to the contract with the Latino Commission, in the amount of $647,000, to provide community substance abuse residential and aftercare services for Latino men, and to extend the contract term through June 30, 2000. The total contract amount will be $675,000 for the period of October 1, 1998 through June 30, 2000. (DPH did not contract with Latino Commission during FY 1997-98). Public Speakers: (supported or opposed the site for this contractor) Jose M. Santiago, Jr. Casa Aztlan Orlando Cuadra, Casa Aztlan Victor del Llano Conrad Navarro Thomasa Canon Dan Hill Abigail Rodas, Latino Commission Richard Rendon, S.F. Pretrial Diversion Pedro Soto, Casa Aztlan D. Rodriguez Elaine Deck, Adult Probation Department William Morrow, citizen Gisella Morrow, citizen Shirlee Silva Josyshine Richau, citizen Fatu Taula, neighborhood Helen Smith, citizen Manuel Sanchez Letters from Adele Lewis and the Lowell Market, and a neighborhood petition with 200 signatures were submitted in opposition to this site. Commissioner Sanchez requested a 6-month (September 21, 1999) update on this contract. Commissioner Umekubo inquired about other site opportunities. Commissioner Hill encouraged the neighbors to reach out to the residents of this program. President Monfredini expressed her support to those in need and pointed out that 24-hour supervision is included in this program. Commissioners Guy and Chow encouraged the contractor and Department to work with the community on its concerns. (3.8) PHP-CSAS – Request for approval of retroactive Sole Source and modification to the contract with Jelani House in the amount of $280,000, for residential and outpatient substance abuse services to women and their children for the period of July 1, 1998 through June 30, 1999. (DPH contracted with Jelani for services totaling $1,187,959 during FY 1997-98). (3.9) PHP-HIV Health Services - Request for approval of the FY 1999-2000 Ryan White Comprehensive AIDS Resource Emergency Act of 1990 (CARE) Title I, Title II and General Fund contracts for a combined total of $37,717,304 for the period of March 1, 1999 through February 29, 2000 for Title I funds, April 1,1999 through March 31, 2000 for Title II funds and July 1, 1999 through June 30, 2000 for General Fund programs with the following agencies: AIDS Benefits Counselors . . . . . . $279,288 AIDS Emergency Fund . . . . . . $662,392 AIDS Legal Referral Panel . . . . . . $200,952 American College of Traditional Chinese Medicine . . . . . . $276,827 Asian Pacific Islander Wellness Center . . . . . . $555,705 Baker Places . . . . . . $1,574,209 Bar Association of San Francisco . . . . . . $77,868 Black Coalition on AIDS . . . . . . $373,912 Catholic Charities . . . . . . $1,511,458 Chemical Awareness & Treatment Services, Inc. . . . . . . $594,043 Community Dental Care, Inc. . . . . . . $651,429 Continuum HIV Day Services . . . . . . $1,081,275 Dolores Street Community Services . . . . . . $138,205 Family Service Agency . . . . . . $194,694 Family Support Services of the Bay Area . . . . . . $207,555 Glide Foundation . . . . . . $138,732 Haight Ashbury Free Medical Clinics, Inc. . . . . . . $1,005,557 Immune Enhancement Project . . . . . . $223,668 Instituto Familiar de la Raza . . . . . . $255,310 Iris Center . . . . . . $150,000 Larkin Street Youth Center . . . . . . $637,130 Legal Services for Children . . . . . . $190,915 Lutheran Social Services . . . . . . $794,966 Lyon Martin Women's Health Services . . . . . . $381,727 Maitri AIDS Hospice . . . . . . $736,410 Marin County . . . . . . $1,506,758 Mission Neighborhood Health Center . . . . . . $140,919 New Leaf . . . . . . $309,138 Project Open Hand . . . . . . $1,348,637 Quan Yin Healing Arts Center . . . . . . $127,327 Saint Mary's Medical Center . . . . . . $1,234,862 San Francisco AIDS Foundation . . . . . . $3,992,666 San Francisco Community Clinic Consortium . . . . . . $341,042 SFDPH Community Health Network - Forensics Services . . . . . . $356,524 SFDPH Community Health Network - Health at Home . . . . . . $434,319 SFDPH Community Health Network - Primary Care . . . . . . $2,287,696 SFDPH Community Health Network - SFGH . . . . . . $3,186,419 SFDPH PPH Mental Health Services . . . . . . $288,234 SFDPH PPH Public Health Laboratory and STD Services . . . . . . $239,697 SFDPH PPH Substance Abuse Services . . . . . . $250,000 San Francisco Food Bank . . . . . . $97,220 San Francisco Suicide Prevention . . . . . . $107,784 San Mateo County . . . . . . $2,279,135 Shanti Project . . . . . . $882,369 The Support Center . . . . . . $250,000 Tenderloin AIDS Resource Center . . . . . . $179,120 UCSF/AIDS Health Project . . . . . . $1,002,692 UCSF/Center on Deafness . . . . . . $40,236 UCSF/Pediatric AIDS Program . . . . . . $170,945 UCSF/Substance Abuse Services . . . . . . $721,942 UCSF/ Women's Specialty Clinic . . . . . . $222,000 University of the Pacific-School of Dentistry . . . . . . $543,600 Urban Indian Health Board . . . . . . $261,378 Walden House . . . . . . $1,775,685 Westside Community Mental Health Clinic . . . . . . $244,733 Commissioner Hill pointed out that agencies with program performance problems are not being included at this time. Commissioner Umekubo abstained on the St. Mary's Hospital item. Commissioner Sanchez abstained on the UCSF items Action Taken: The Commission approved the Budget Committee items, with Commissioners Sanchez and Umekubo abstaining on UCSF and St. Mary's Hospital items respectively on #3.9 4) DIRECTOR'S REPORT (Mitchell H. Katz, M.D., Director of Health) (Provides information on activities and operations of the Department). ADMINISTRATION Budget Last week a number of newspaper articles appeared describing our financial situation. I wanted to review with the Commission our current position. In preparing potential budget cuts to bring to you on the March 23rd Special Health Commission Meeting, Health Department executive staff discussed proposals with affected staff, union leaders, and community members. The goal of these discussions was to make sure that we were choosing the least painful cuts for the Health Department and to gain greater insight into the implications of these cuts. As these discussions broadened, we received newspaper inquiries about our financial situation. I was reluctant to discuss our proposals with the media because the proposals had not yet been brought to the Commission. After hearing in greater detail about some of the proposed service cuts that the Health Department might have to make, Mayor Brown asked me on Friday, to work with his Budget Office to attempt to identify sufficient dollars to prevent any further service cuts. He asked that I continue to pursue administrative savings and delete positions through attrition that could be used to close the deficit. In addition he asked DPH to continue to implement the Commission's prior policy decisions with regard to the pharmacy, 4P Detox Unit, and placing the SFGH hospital ED on diversion when we are at our staffed and budgeted census. We are working closely with Matthew Hymel, the Director of the Mayor's Budget Office, and Ed Harrington, the Controller, to close the revenue shortfall. The Health Department will still bring to the Health Commission on March 23rd, a full report, detailing the sources of the Health Department deficit. We plan on coming back to the Commission in April when we have further information about how much of the deficit the Mayor is able to help to close. On a related front, lines at San Francisco General Hospital Outpatient Pharmacy were extremely long last week. This was due to several causes. First, many patients who have MediCal and could receive their prescription at another pharmacy were not fully aware that they could go to a neighboring pharmacy. To alleviate this problem we are actively educating Medicaid patients that they have a right to have their prescriptions filled at the neighborhood pharmacy of their choice. We know that in the short time that this pharmacy program has been implemented, already half of our MediCal patients who used use our pharmacy are now having their prescriptions filled at neighboring pharmacies. As the education effort continues and the other half have their prescriptions also filled at neighboring pharmacies, we believe that the lines at the Outpatient Pharmacy will significantly shorten. Last weeks lines were also lengthy because three pharmacy staff were sick and a computer malfunctioned on Tuesday night. COMMISSION Congratulations go to the Commission's own secretary, Sandy Mori who was honored yesterday in Sacramento as one of the State's "1999 Women of the Year". Each Assembly member and Senator selects a woman from their respective districts. From the 12th Assembly District, Assemblyman Kevin Shelley selected Ms. Mori for her community work in the areas of aging, civil rights and public policy. On behalf of the entire Department of Public Health, congratulations Sandy on your outstanding work and efforts, it's an honor to know you are part of our team. POPULATION HEALTH AND PREVENTION 75 Housing Units for Homeless Open in Tenderloin Hotel The Pacific Bay Inn, located at 520 Jones, between O'Farrell and Geary, will officially welcome its first new tenants, along with the Mayor and other City and agency officials, on Tuesday, March 23rd at an Open House from 11:30 – 1:30 pm. A project of Episcopal Community Services (ECS) of San Francisco, the hotel is the City's first facility to open under the new Direct Access to Housing Program. Utilizing a successful formula for combining private ownership, non-profit service providers and public efforts, the Pacific Bay Inn is a collaborative between Episcopal Community Services (ECS) of San Francisco, the San Francisco Department of Public Health, Baker Places, Inc., and Mercy Services Corporation. Pacific Bay Tenants, all of whom are making the transition from life on the streets, exiting homeless shelters and completing treatment programs, will find a service-rich environment. As you are well aware, genesis for the Pacific Bay Inn began with $1.5 million in new funding from the City's FY 1998-99 budget for the Direct Access to Housing Program. Additionally, the Hilton Foundation, through the Bay Area Office of the Corporation for Supportive Housing, provided the project with a $625,000 grant. The second Direct Access to Housing project is scheduled to open in May 1999, bringing 94 additional units of supportive housing on line. We would be honored to have the Commission present at the celebration next Tuesday. Nurseweek Excellence Award Congratulations to Maternal Child Health Director Mildred Crear, a winner in Nurseweek magazine's 1999 Nursing Excellence Award competition. Mildred was selected in the Management and Administrative category from a pool of well over 300 candidates statewide. Winners were announced at a gala awards dinner at the Westin Hotel, Los Angeles, on March 13, 1999. Underground Storage Tank Upgrade Deadline Staff of the Hazardous Materials Unified Program Agency (HMUPA) have worked closely with the City Attorney's Office to develop an effective enforcement strategy for those underground storage tank (UST) sites that did not comply with the December 22, 1999 upgrade deadline. By March 1, 1999 only 11 of 309 UST sites remained out of compliance. None of these out of compliance sites were City facilities. This extraordinary compliance result is due largely to the collaborative effort of the Department of Public Works Bureau of Construction Management and those city departments that operate UST's. For those sites remaining out of compliance, HMUPA staff will be aggressively pursuing appropriate enforcement actions in collaboration with the City Attorney's Office. COMMUNITY HEALTH NETWORK The Senate Rules Committee, of which Senator John Burton is Chairman, has appointed LaFrancine Tate to the State Board of Registered Nursing. She will be one of the two Public Members. Her term will end June 1, 2000. Fran serves as Special Assistant to Gene O'Connell and Anthony Wagner. I am sure you join me in congratulating her on the prestigious appointment. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR MARCH 1999 On behalf on the Commission, President Monfredini presented the Employee Recognition Award to Ron Patton, of the Community Health Network/San Francisco General Hospital, Psychiatry Unit. 6) PUBLIC HEARING AND CONSIDERATION OF AMENDMENTS TO THE HEALTH COMMISSION POLICY #24 REGARDING ETHNICITY, GENDER, AND SEXUAL ORIENTATION DIVERSITY OF CONTRACTORS Dr. Katz presented the amendments to the current Policy #24 with the change in the title of the policy to Contractors' Compliance with Antidiscrimination Protection and Cultural Competency. Dr. Katz reported that the Department will work with contractors to work out the implementation tools. The goal is not to increase bureaucracy but to develop user-friendly tools to implement this policy. Each Commissioner expressed support for the amended policy and thanked the Department and City Attorney's Office for their work on this important policy. Commissioner Chow requested the Department to look at the interpretation of the relevant work force, not to have duplicative requirements from contractors, and not to create more bureaucracy and paperwork for contractors. Commissioner Hill stated that this policy will have legal strength with a better reporting system. He also reminded the Commission of the importance of sexual orientation diversity of the workforce and to be mindful of the spirit of the original policy. Commissioner Parker expressed his comfortableness with the revised policy. Commissioner Guy encouraged the Department to be proactive in getting feedback from contractors and that there be on-going interface with Department staff and contractors. Commissioner Sanchez felt the cultural competency area could be an operational model for public health. Commissioner Umekubo stated that specific accountability tools are included. President Monfredini thanked Dr. Katz for maintaining the spirit of the original Policy #24. She felt it would take six months to a year for implementation. Public Speakers: Jim Illig, S.F. HIV Contractors Association, emphasized importance of sexual orientation as part of the diversity of Board and staff of contractors. Richard Heasley, Mental Health Contractors Association, acknowledged receipt of amended Policy #24. Action Taken: The Commission unanimously approved Resolution #9-99, "Contractors Compliance with Antidiscrimination Protections and Cultural Competency.". 7) PRESENTATION OF THE ANNUAL EMERGENCY MEDICAL SERVICES RECONFIGURATION REPORT Dr. John Brown, Director of the Emergency Medical Services Agency; Dr. S. Marshall Isaacs, Emergency Medical Services Medical Director; and Richard Shortall, Emergency Medical Services Chief, presented an Executive Summary of the San Francisco Fire Department and the Emergency Medical Services Division Annual Report. For the past 18 months, the San Francisco Fire Department has been responsible for the operational provision of Emergency Medical Services (EMS) dispatch and communications, first response, early defibrillation, basic life support (BLS), advanced life support (ALS), ambulance transport, multicasualty incident (MCI) management, and specialized rescue services for the residents of and visitors to San Francisco. Since the merger of the Department of Public Health Paramedic Division into the San Francisco Fire Department in July 1997, a number of significant changes have taken place with regard to the delivery of prehospital emergency medical services. The dedication and skill of the Department's paramedics, emergency medical technicians, firefighters and officers who now work together to meet the Department's vision, are a part of the commitment of the Department's EMS Division. The report includes an update on the merger; response to rising EMS call volume and workload; overview of the EMS Section, including operations, special operations, administration, in-service training, and the EMS Academy; medical direction; and the S.F. International Airport and the Airport Rapid Resuscitation Early Shock Trial Program. Commissioner Parker thanked the Health and Fire Departments for their integration of services. Commissioner Chow thanked the staff for the good report and expressed concern on the location of defibrillators at security check points. Commissioner Guy observed that no data has been presented regarding response times. She also is interested in what are the challenges in the fourth phase. The staff will return on May 18, 1999 to present a comprehensive EMS Section as part of EMS Week. 8) PRESENTATION OF AN ASSESSMENT AND EVALUATION OF TREATMENT MODALITIES FOR SUBSTANCE ABUSE Barbara Garcia, Director of Community Substance Abuse Services, and Dr. Herminia Palacio, Special Assistant to the Director of Public Health, made presentations on the Substance Abuse Modalities. The report provided an overview of substance abuse services and new and future trends in the provision of integrated services to reduce harm from drug use. For a copy of the report, contact the Commission Office at 554-2666. Dr. Palacio reported that recommendations regarding physicians prescribing of methadone will be brought to the Commission. Commissioner Guy requested data and statistics around the Treatment on Demand services in order to assess and analyze whether the Department is still going in the right direction. She is supportive of looking at more treatment modalities, with the understanding that the Department provide appropriate information to the Commission. Commissioner Chow requested a presentation and data on acupuncture as a treatment modality. After hearing the Commissioners' requests, he will provide the following information for the March 23 meeting on the 1998-99 budget: Treatment on Demand budget Role of the Department of Public Health acupuncture program in drug treatment Treatment on Demand slots Dr. Katz also emphasized that any recommendations from the workgroups on physicians prescribing methadone will come to the Commission prior to reporting to the Board of Supervisors. 9) CONSIDERATION OF PROPOSED REVISIONS TO THE SAN FRANCISCO GENERAL HOSPITAL MEDICAL STAFF BYLAWS – ACCOMPANYING MANUALS: RULES AND REGULATIONS CREDENTIALING PROCEDURE MANUAL COMMITTEE MANUAL Dr. Sylvia Villarreal, Chief of Staff at San Francisco General Hospital, presented the proposed revisions, which were recommended for approval at the March 8, 1999 Medical Executive Committee, and March 9, 1999 JCC-SFGH. Action Taken: The Commission unanimously approved the revisions to the San Francisco General Hospital Medical Staff Bylaws - Accompanying Manuals: Rules and Regulations Credentialing Procedure Manual Committee Manual Dr. Villarreal thanked the Commission for its support and for being there to listen to the concerns of the Medical Staff. 10) OTHER BUSINESS/PUBLIC COMMENTS None. The meeting was adjourned at 5:40 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission