Minutes of the Health Commission Meeting Tuesday, May 4, 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 3:04 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. President Monfredini presented the April Department of Public Health Employee Recognition Award to Bruce Josloff of the Environmental Health Management Division. 2) APPROVAL OF MINUTES OF THE REGULAR MEETING OF APRIL 6, 1999 Public Speakers: Stephen O. Murray, Ph.D., Instituto Obregon, voiced criticism on the April 6, 1999 minutes, the content of public comments, and will file complaints with the Sunshine Ordinance Task Force. Gil Criswell requested the April 20, 1999 minutes reflect clarification of his statements. In submitting his Spectrum article, he stands by his article, "Bath Houses and Sex Clubs." HIV should be treated like any other STD with treatment; and he is not in favor of HIV surveillance. Reid Condit, Ad Hoc Bath House Committee, requested revision of the April 6 minutes regarding the LGBT Advisory Committee letters, discussion of the regulations for sex clubs, and the spelling of his first name. Jean Fraser, Deputy City Attorney, commented that reconsideration of past approved minutes would need to be an agenda item at a Commission meeting. Commissioner Chow pointed out the words "any and all" need to be deleted from Resolution #14-99 in the April 20, 1999 minutes. Action Taken: The Commission unanimously adopted the minutes of April 20, 1999 with the corrections. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) (3.1) DPH Administration – Annual report of membership organizations and a proposed ordinance to amend the City’s Administrative Code to add and delete membership organizations for the next fiscal year. (3.2) PHP-HIV Prevention Services – 60 day progress report on the Tenderloin AIDS Resource Center as requested at the March 2, 1999 Health Commission Meeting. (3.3) PHP-HIV Prevention Services – 60 day progress report on California AIDS Intervention Training Center - Venue-Based Individual Outreach, as requested at the March 2, 1999 Health Commission meeting. (3.4) PHP-CHS-Mental Health & Substance Abuse - Request for approval of retroactive modification to the contract with New Leaf —Services for Our Community to: continue the provision of outpatient substance abuse methamphetamine treatment on demand services as awarded through RFP #019-98 in the amount of $136,663 for the period of January 1, 1999 through June 30, 1999; and replace Ryan White/CARE funds with mental health Short-Doyle/Medi-Cal match funds to continue the provision of outpatient HIV/mental health services for the period of March 1, 1999 through June 30, 1999 (annual amount of $371,465 to continue both services). (DPH contracted with New Leaf for services totaling $1,347,911 during FY 1997-98). Action Taken: The Commission approved the Consent Calendar of the Budget Committee. 4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) (Provides information on activities and operations of the Department). ADMINISTRATION Community Budget Hearings Dr. Katz participated in the community budget hearings organized by Finance Chair Supervisor Leland Yee. A hearing dedicated to issues of children, youth and their families was held in the Mission. A number of important issues, including childcare, school health, recreational services and physical and mental health services for children, youth and their families were raised. The hearing in the Bayview Hunters Point area was dedicated to discussion of public health and the environment. Community leaders spoke eloquently about the serious environmental hazards in the Bayview area, including the Superfund sites, particulate matter in the air due to industry, asthma, breast cancer and problems with the sewage treatment plant. Dr. Katz will attend another hearing set for tonight on the issue of homelessness in the Castro. These hearings have been very well attended and have provided valuable input into the City budget process. EEO Director’s Departure After 11 ½ years with the Department of Public Health Gloria Louie is leaving to take a new job at the Airport. Gloria started with DPH as an EEO specialist moving to the EEO Director position after 5 years. Under Gloria’s direction and leadership, the annual EEO report now clearly delineates the Department’s strengths and areas where improvement is needed. Gloria’s new position at the Airport begins May 17th. She will be responsible for developing and implementing the Airport's diversity and EEO programs for employees and for setting diversity standards for contractors doing business with the Airport. Jimmy Loyce has agreed to act as the Interim EEO Director and to conduct the search for Gloria’s replacement. City Attorney to Move to Airport Louise Renne has informed the Department that Paula Jesson will be transferring to the Airport’s Legal Division of the City Attorney’s Office on May 17th. Paula asked me to convey her deep appreciation for the opportunity to have worked for the Health Commission and Department staff for the past eleven years. Paula will be missed by all of us. State Director of Health Services Last week, Governor Davis appointed Diana M. Bonta, R.N, PhD., as the Director of the Department of Health Services. Ms. Bonta officially starts her position in June 1999. Ms. Bonta currently serves as the Director of Health and Human Services for the City of Long Beach. She has held the position since 1988. Prior to that she served as Deputy Executive Director of the Los Angeles Regional Family Planning Council. During her early career in health she was a Regional Administrator for the California Department of Health Services. She is currently Chair of the American Public Health Association. The Senate must confirm her appointment. Early Treatment for HIV Last week House Democratic Leader Representative Richard Gephardt (D-MO), Representative Nancy Pelosi (D-CA), and Senator Robert Torricelli (D-NJ) introduced legislation to provide early treatment for HIV -- Early Treatment for HIV Act. The legislation was introduced in both Houses of Congress and would give States the option to expand their Medicaid programs to provide treatment for low-income, HIV-positive individuals who have not yet developed symptoms of AIDS. As the Health Commission is aware, early treatment for HIV improves the lives of those infected by the disease. The legislation would extend access to drug therapies and primary care. Federal HIV treatment guidelines recommend the use of anti-viral therapy early in the course of HIV infection before development of symptoms. However, Medicaid does not define individuals with early infection as disabled and, as a result, many low-income individuals are unable to receive HIV-related drugs and health care through the program. The Presidential Advisory Council on HIV/AIDS has asked the President to support the Early Treatment for HIV Act. Fifty-nine other members of the House joined Representatives Gephardt and Pelosi as original co-sponsors of the bill. The Department is clearly supportive of these congressional efforts and thanks the co-sponsors for introducing this much needed legislation. Central Administration- Y2K Compliance The Department prepared its quarterly Y2K progress report for the Health Commission’s consideration. Due to the long length of today’s Commission agenda, the Department will not make a formal presentation on Y2K implementation. However, we are available to answer any questions regarding Y2K compliance. A formal presentation will be made during our next quarterly progress report in August 1999. Building a Healthier San Francisco Collaborative The Department is continuing to work with San Francisco hospitals, the Hospital Council of Northern and Central California, United Way of the Bay Area, and community-based agencies in the "Building a Healthier San Francisco (BHSF) Collaborative." The Collaborative is working to foster broader, more effective partnerships to respond to San Francisco’s health and human service needs. The Collaborative was originally formed in 1995 as a result of SB 697, which required private, non-profit hospitals to complete a community needs assessment and develop Community Benefit Plans to address needs. Last month, the Collaborative presented the findings of its recently completed "San Francisco Community Assessment" report at three community forums. The report provides the most comprehensive profile currently available of the health and social conditions of San Francisco residents, using Healthy People 2000 goals and Bay Area Partnership indicators as benchmarks. The report is meant to inform community residents and leaders, advocates, policymakers, and service providers about many of the critical issues facing San Francisco, and to serve as a springboard for action to address those issues. The Collaborative will begin focusing on specific priority health issues to address at the community level. As part of this process, the Collaborative will expand to include other community representatives in planning and implementation. The Department will make a presentation on this updated Community Assessment at the Health Commission’s first meeting in June 1999. We will provide the Commission with complete copies of the report at that time. The public may obtain copies by contacting the Northern California Council for the Community at (415) 772-4430. The report will also soon be accessible via the web at www.ncccsf.org. POPULATION HEALTH AND PREVENTION Dupont Pharmaceuticals Grant This morning at the Mayor’s Office, Dupont Pharmaceuticals announced a $1 million award to San Francisco for HIV/AIDS prevention. Dupont Pharmaceuticals is inviting other companies to participate, with an ultimate goal to raising at least $5 million. Mayor Brown has committed to matching Dupont’s grant in an effort to inspire other companies to follow their lead. The Mayor appointed Thomas Coates, Ph.D., Professor of Medicine and Director of the UCSF AIDS Research Institute; Sean Sasser, a member of the President’s AIDS Advisory Council and a leading community advocate for prevention services for youth; and Dr. Herminia Palacio from the Health Department, to co-chair a coalition of health, business and community leaders. The Coalition, which will be known as the S.F. HIV Prevention Outcomes Coalition, will determine the priorities for spending the award. Programmatically the Coalition will focus on decreasing seroconversions in San Francisco by replicating successful models of HIV prevention, as well as developing new models. The San Francisco HIV Prevention Planning Council has identified a number of unmet needs and research gaps. This coalition will help to meet these needs, especially for underserved populations. In this way, the work of the two committees will be closely linked. Women’s Health May is an important month for women's health. On May 6 and 7, the University of California National Center of Excellence in Women's Health in collaboration with the Institute for Health and Aging, have organized a health summit on older women's health. The summit will bring together researchers, advocates, leadership and media in a unique dialogue on issues of older women. Several Department of Public Health staff have been involved in the planning and are attending the summit. "Time for Healing...Time for Change." May 13, the Department of Public Health Breast and Cervical Cancer Services (BCCS) program, in collaboration with Network for Elders, is taking the town hall model developed in the Bayview Hunters Point to women in the Western Addition. The first breast cancer- focused town hall was held at the Bayview Opera House and was attended by approximately 130 women. The planning group for this second town hall anticipates participation from more than 200 women. Funding came from the Breast Cancer Fund and the Women's Foundation. A wide range of neighborhood organizations has been involved in the planning process. Maxine Hall Health Center Director has been particularly helpful in providing meeting space and resources to the group Community Substance Abuse Services On May 3-4, Community Substance Abuse Services, the Lindesmith Center and the Harm Reduction Training Institute hosted a conference on "Bridging the Gap Integrating Traditional Substance Abuse and Harm Reduction Services." Dr. Katz delivered the opening remarks at the conference. Numerous federal, state and local organizations provided funding for the conference. Over 600 people attended the two-day conference. The conference objectives were: To introduce principles for integrating traditional substance abuse treatment and harm reduction services; To provide health professionals with practical strategies to integrate services for clients in drug treatment, mental health, medical and other service settings; To facilitate the development of the harm reduction approach to drug treatment through the interaction of health professionals and the clients they serve; To examine the issues surrounding methadone; To facilitate the delivery of self-selected, client oriented drug treatment; To make a positive impact on the realities of drug treatment within the criminal justice system; To equip clinical administrators and supervisors with the tools they need to integrate traditional and harm reduction strategies within the policies and practices of health systems; and To introduce health professionals to new ways of reaching clients who might otherwise not access drug treatment. STD Prevention and Control In honor of STD Awareness Month, April 1999, the STD Prevention and Control Section implemented a number of activities to raise awareness about STD screening and prevention. Throughout the month of April, posters were displayed in 15 bus shelters around San Francisco, and advertisements for STD screening ran in three weekly papers, on television and on the radio. The STD Section provided urine based STD screenings in four San Francisco High Schools, in shelters, community based organizations, at street fairs and in other locations around the city. In addition, the Community Health Network primary care centers provided drop-in STD testing throughout the month. Children’s Environmental Health Promotion As part of the Department's ongoing effort to prevent asthma, nine staff of the Children's Environmental Health Promotion Section are currently teaching a 6-week class on asthma to 3rd - 5th graders at four San Francisco elementary schools. The CEHP were trained by the American Lung Association and are being hosted by the San Francisco Unified School District and Healthy Start Family Outreach Workers, to teach the curriculum at three Bayview Hunters Point elementary schools and one South of Market school. The students participating in the program will learn how to recognize symptoms, when to ask for help, how to safely engage in physical activity and how to prevent asthma attacks. The curriculum has been shown to build the self-confidence of students and help them lead active lives. Community Health Promotion and Prevention Branch On April 24, 1999 Ginger Smyly, MPH, CHES, Deputy Director of CHP&P, was honored by the San Francisco Business and Professional Women Inc. with the Professional Woman of the Year Award for 1999. COMMUNITY HEALTH NETWORK Chinatown Public Health Center On April 20th, the Chinatown Public Health Center participated in a successful community disaster drill coordinated by NICOS, a coalition of health and mental health agencies serving Chinatown. This year's drill planning and coordination was assisted by DPH Health Educator, Wesley Wong. A mock disaster scene occurred at Portsmouth Square and "victims" were assessed in the field by NERT trained volunteers. The Cathay Radio Club provided volunteer ham radio operators who helped describe conditions in the community, as well at the participating health agencies, and sent messages to the radio coordinating site located at Chinese Hospital. The Chinatown Public Health Center has been an active member of these drills and their planning for the past 10 years. Annual Volunteer Luncheon's at SFGH and LHH Great Successes Mayor Willie Brown spoke at both LHH and SFGH's Annual Volunteer's Luncheons on April 20 and 24th respectively. He thanked the volunteers at both hospitals for their service. He also gave his full support to the Laguna Honda Hospital Replacement Bond measure currently winding its way through the City and County's approval process. Emergency Department The San Francisco Chronicle's Readers' Choice award arrived two weeks ago. If you recall, SFGH Emergency Department was rated first place in their readers' poll for best place to go in a medical emergency. Department of OB/GYN Dr. Philip Darney, professor and interim chief of OB/GYN, was honored last week with the Chancellor's Award for Public Service for his efforts to supply women with contraceptives on the local, national and international levels. He is world renowned for his significant achievements in research, education and program development in family planning. Dr. Darney's nominators praised his outstanding efforts to ensure access to family planning services for vulnerable women in the Bay Areas and highlighted his creation of the New General Health Center for adolescents. National Hospital Week May 9-15 is National Hospital Week, a time of celebration and renewal. Each year, hospitals and community health centers join together to recognize the people who make it all possible, health care workers and volunteers. This year's theme, "People Care. Miracles Happen," recognizes the special contributions of the people who keep hospital doors open 24 hours a day, 365 days a year. Celebrate Healthy Babies Southeast Health Center will participate in "Celebrate Healthy Babies Health Fair" at Providence Church in the Bayview on Saturday, May 8, from 10;00 a.m. to 3:00 p.m. DPH’s Black Infant Health Improvement Project hosts the fair. Dental check-ups, blood pressure, and STD and pregnancy tests will be offered. Emergency Department Dr. Katz acknowledged Lynda Frattaroli, LCSW, who did an outstanding job last Friday, weaving public, private and international agencies to secure help for two tourists who were attacked in the downtown area. City Attorney Louise Renne announced that Jean Fraser, Deputy City Attorney, will be the head of the Health and Human Services Division in the City Attorney’s Office. Two additional new attorneys will be hired in this Division. Note: Three individuals were escorted out of the meeting after their attempts to disrupt the meeting. Public Speaker: Ronnie Barh, Act UP/S.F., encouraged reopening of bath houses. 5. PRESENTATION OF THE VECTOR CONTROL PARTNERSHIP Ben Gale, Director of the Environmental Health Section, gave an overview of the Rodent Survey Pilot Program. Due to the loss of Federal funds in the early ‘80’s, the Department had to significantly modify its rodent control program. The Mayor’s Office provided $50,000 to fund a cadre of individuals to be trained by Environmental Health staff to assist property owners and residents in abating rodent infestations. Through a cooperative effort with the Department of Human Services, (DHS); the Department of Public Works, (DPW); the San Francisco Urban League of Gardeners, (SLUG); and Young Community Developers, Inc. (YCD), the Department was able to recruit ten candidates to train. SLUG, under contract with DPW, was identified to be the lead agency. SLUG selected YCD to be the implementation arm of the contract. DHS provided additional funds to cover the actual cost of the program and was responsible for putting together the entire package using DPW, SLUG and YCD. Additionally, DHS provided basic computer training to the trainees. The ten candidates underwent a comprehensive curriculum divided between classroom and field training. The curriculum focused on basic rodent biology, identification and survey techniques. In addition, because these individuals will deal with the public, the training included interpersonal communication skills, writing, basic computer training, and CPR. At the end of the 18-day training period, six candidates graduated to become the core of this new program, which began in March of this year. Now, one month later, the four remaining candidates have graduated. These individuals are working with Environmental Health staff in neighborhoods with significant rodent activity complaints. Through their assistance, the Department has already conducted 235 community/neighborhood surveys, and distributed 8,000 informational packets (in three languages). This program addresses the rodent control problem in the City. It also has provided the trainees with a career path in public health or the pest control industry. DPH has been working with local pest control companies to develop entry level positions for program graduates. The participants in the Vector Program are Haruna Abubakar, John W. Farrell, Michael Lewis and Frederick Smith. Commissioners acknowledged the trainees and complimented the Environmental Health staff for this innovative training program. 6. CONSIDERATION OF A RESOLUTION ON THE BOND PROGRAM TO REBUILD LAGUNA HONDA HOSPITAL Dr. Katz presented information requested by the Commission in the following areas: Information on other counties that own and operate skilled nursing facilities Information on the number of individuals who might be served from expanding the community programs (i.e., adult day health care, senior nutrition, etc.) Detailed discussion of the financing mechanisms An analysis of the ongoing operating budget of the new rebuilt hospital under scenarios of both increasing and decreasing Medi-Cal reimbursement rates. Also included is information of skilled nursing beds within the State by county, various financial spreadsheets discussing the capital financing options, application of tobacco settlement receipts (along with the impact on various home values), the City and County’s overall bond debt capacity, and detailed information on Medi-Cal funding for Laguna Honda at various assumptions on increases and decreases in reimbursement. For a copy of the full report, contact the Commission Office at 554-2666. Monique Moyer, Director of the Mayor’s Office of Public Finance, discussed the City’s debt capacity. Commissioners Comments and Questions: Can the Governor use the tobacco funds for other areas? Yes, but there is support for Laguna Honda Hospital at the State level. Thanked staff for comprehensive analysis for the Laguna Honda Hospital bond. Would the property tax fluctuate depending on tobacco tax monies actually received? Yes. If Laguna Honda Hospital uses the facility for less skilled nursing beds, would the facility be used for other services: Yes, the mix of patients may show needs for other health services. Will the present Laguna Honda Planning Committee remain in place? Yes. Monique Zmuda, Chief Financial Officer, pointed out the projected operating budget and the impact of less revenues coming to Laguna Honda Hospital. Public Speakers: Supports the Laguna Honda Hospital Bond as recommended by the Laguna Honda Hospital Planning Committee. Bill Price, Senior Action Network Gil L. Thornalley, supporter of LHH Kay Bromley, former resident family member Sonny Zuniquini, former resident family member Frederick Hobson, S.F. Health Plan Board Tom Nolan, Project Open Hand Anthony Sacco, retired Union member Stephen Vernon raised the question of allocation of resources to institutional care instead of community-based services; need for improved integration of services. Norma Satten, Health Task Force with Planning for Elders in the Central City, expressed need to have resources allocated into home and community-based services. Dr. Katz stated the resolution should read: "…at least" 140 assisted living units … in the first Further Resolved. President Monfredini requested active support from all of the Commissioners for this LHH bond. Commissioner Chow requested two amendments to the resolution as follows: The third Further Resolved to read: "… that the San Francisco Health Commission requests that the Department use its best efforts to secure the maximum reimbursement allowable from payers for the services of a distinct part skilled nursing facility", and To add another Further Resolved: "… that the San Francisco Health Commission encourages continued planning on the citywide effort to expand the array of home and community-based services for elderly and disabled adults." Action Taken: The Commission unanimously adopted Resolution #16-99, "Supporting Rebuilding Laguna Honda Hospital and Placing a Bond Measure on the November 1999 Ballot" with Commissioner Chow’s amendments. 7A) REVIEW OF THE DEPARTMENT OF PUBLIC HEALTH 9-MONTH REVENUE AND EXPENDITURE REPORT FOR FY 1998-99 Monique Zmuda, Department of Public Health Chief Finance Officer, reported the following: The Department of Public Health is projecting a year-end shortfall of $19.2 million for FY 98-99 based on estimated expenditures and revenues for the third quarter ending March 31, 1999. Revenue shortfalls of $40.1 million are projected to be offset by expenditure savings of $20.9 million. The projected shortfall is primarily due to: 1) reduced revenues at San Francisco General Hospital resulting from patient census that is above the budgeted level and a higher than expected volume of uncompensated care; and 2) reduced revenues at Laguna Honda Hospital resulting from reductions in patient census necessary to comply with the Department of Health Services and Department of Justice Plans of Correction. This projection assumes approval of $5.6 million in General Funds to offset revenue losses at Laguna Honda Hospital. It also assumes approval of a $1.1 million supplemental appropriation for Population Health and Prevention to offset increased pharmaceutical expense for mental health services. 7B) CONSIDERATION OF SUPPLEMENTAL APPROPRIATION FOR $19.2 MILLION IN GENERAL FUNDS TO REDUCE THE DEFICIT AT SAN FRANCISCO GENERAL HOSPITAL FOR FY 1998-99 Ms. Zmuda reported: The Department of Public Health is projecting a $40.1 million revenue shortfall this fiscal year. Expenditure savings of $20.9 million will offset a portion of the revenue loss. However, the net remaining shortfall to the Department of Public Health for FY 1998-99 is expected to be $19.2 million based on third quarter projections. The Department is requesting a $19,187,662 supplemental appropriation to offset revenue shortfalls in FY 1998-99. If approved, the requested General Funds will be applied to reduce Medicare and patient revenues at San Francisco General Hospital. This request will allow appropriation authority to offset revenue losses with General Funds necessary to balance the budget for the Department of Public Health for the remainder of the fiscal year. No expenditure appropriations are requested. Public Speakers: Protested public health cuts, SFGH Pharmacy cuts, long wait lines at the SFGH Pharmacy. William C. Brady, Emergency Coalition to Save Public Health Ed Kinchley, SFGH Emergency Department Rev. Ignatius DeGroot, St. Anthony’s Catholic Church, submitted a petition with signatures to reopen the Family Health Center’s pharmacy and give medications free of charge for patients who cannot afford them Fern Ebeling, SFGH In order to hear all of the speakers, President Monfredini limited speakers to one minute each. Mary Magee, Local 790 Melchor Bustamante, patient Michael Lyon Dr. Colleen Townsend, SFIRA Taejon Ahn, UCSF/SFGH Dr. Pamela Swedlow, SFGH Dept. of Psychiatry Jamie Noone, SFIRA Rose Montgomery, Transgenders United for Equality Pablo Roman-Alcala, Healthworks Mark Whitman Nora Roman, Emergency Coalition to Save Public Health Dr. Jonathan Lee, SFGH Commissioner Sanchez, after listening to the public speakers, suggested the Commission revisit the pharmacy issue and review the standards for quality of care. He proposed an amendment to the requested supplemental with an additional $900,000. Dr. Katz reminded the Commission to look at the overall priorities of the Commission and whether the Pharmacy would be the top priority. Commissioner Guy felt the proposed additional supplemental would be inappropriate for now. Looking at the overall strategy, she would not want to jeopardize the $19.2 million supplemental request by this additional $900,000. Commissioner Hill reminded the public of the Mayor’s large commitment to cover the SFGH deficit. He encouraged the community to get real about the overspending at SFGH. Commissioner Parker does not presently know how much funding is actually needed for the Pharmacy. Commissioner Umekubo suggested to proceed with the proposed $19.2 million supplemental but relook at the Pharmacy issue with more data on the waiting times. After urging the Department to continue looking for other resources and data on the Pharmacy, Commissioner Sanchez withdrew his proposed $900,000 amendment to the $19.2 million supplemental. Action Taken: The Commission unanimously approved the $19.2 million General Fund supplemental appropriation to reduce the deficit at SFGH for FY 1998-99. Commissioner Chow suggested the quality assurance issues around the Pharmacy issue be on the next agenda for the Joint Conference Committee of the Community Health Network. Commissioner Guy stated that the Strategic Plan requested by the Commission will help address the priorities of the Commission. 8) CONSIDERATION OF ADOPTION OF A NEW REGULATION FOR ISSUANCE OF REFUSE COLLECTION PERMITS FOR NON-FEDERAL FACILITIES AT TREASURE ISLAND AND YERBA BUENA ISLAND (‘TI & YBI"); AND ADOPTION OF A REVISION OF AN EXISTING REGULATION FOR ISSUANCE OF REFUSE COLLECTION PERMITS FOR FEDERAL FACILITIES ("1992 REGULATION") Dr. Katz presented the following: The Department of Public Health permits refuse collectors in the City and County to ensure that waste is collected and disposed of in a sanitary and safe manner. Currently, we lack a mechanism to issue permits for Treasure Island and Yerba Buena Island because of their recent change in status. Adopting the proposed TI & YBI Regulation will provide the City with a means to issue refuse collection permits for refuse collection from non-federal facilities on Treasure Island and Yerba Buena Island. We are simultaneously revising the existing Regulation regarding the permitting process for federal facilities to make it consistent with the proposed TI & YBI regulation. Additionally, the proposed TI & YBI Regulation and the proposed revisions of the existing Regulation implement the requirements of the City’s 1932 Refuse Collection and Disposal Ordinance. The two proposals will provide the Department with a process for the orderly issuance of refuse collection permits for refuse collection from six federal facilities in the City and from the non-federal facilities in Treasure Island and Yerba Buena Island. At the Commission’s April 6, 1999 meeting, the Commission solicited and heard public comments from representatives of two refuse collection companies, Norcal Waste Systems, Inc., and Bay Cities Refuse Service, Inc. Among the issues raised were Bay Cities contention that the permit that it currently holds for refuse collection from the Islands is exclusive; and Norcal’s assertion that the proposed revision of the existing Regulation expands the scope of the regulation to all federal facilities within the City. Regarding the exclusivity of refuse collection permits, it is the City’s long standing position that refuse collection permits issued by the City are not exclusive. This position was upheld in a 1992 case before the Superior Court, WRT v. DPH, Case #943626, and reaffirmed by the San Francisco Board of Permit Appeals in 1994. Regarding expanding the scope of existing Regulation, EHS recognizes that the language of the revision may be misconstrued to include other federal facilities located in the City. It had not been EHS’ intention to expand the Scope of the existing Regulation. Hence, EHS is reinstating the original language limiting the scope of the revised Regulation to the six sites identified in the 1992 Regulation. Supporting documents submitted were: Background document detailing specifics pertaining to the two proposals Copy of the proposed TI & YBI Regulation Copy of the Department’s existing Regulation wherein the proposed revisions are highlighted.. Additionally, a clean copy of the revised Regulation, which incorporates all the proposed changes, was included. Copy of the Department of City Planning’s Certificate of Determination, and a copy of a January 19,. 1999 letter from EHS to the Department of City Planning. Copy of an April 20, 1999 Memorandum from Deputy City Attorney William Chan to the Health Commission and Dr. Mitch Katz. This memorandum summarizes the rational for the two EHS proposals and addresses the issues raised by the public at the Commission’s April 6, 1999 meeting. Deputy City Attorney William Chan has reviewed and approved, as to form, the resolutions, the proposed revisions of the existing Regulation and the proposed TI & YBI Regulation. The Health Commission is authorized to adopt the two proposals under the City Charter, Section 3.500. Additionally, these proposals need not go before the Board of Supervisors. Public Speakers: Alan Sparer, Sunset Scavenger and Golden Gate Disposal, indicated his withdrawal of original objections. Albert Bianchi, representing Bay Cities Refuse, requested entitlement to exclusivity and requested his letter to the Commission dated April 1, 1999 be included in the records. Action Taken: The Commission unanimously approved Resolutions #17-99, "Adopting Regulation for the Orderly Issuance of Refuse Collection Permit for Non-Federal Facilities at Treasure Island and Yerba Buena Island" and #18-99, "Revising the Federal Facilities Refuse Collection Permit Regulation to Harmonize it With Refuse Collection Permit Regulation for Non-Federal Facilities at Treasure Island and Yerba Buena Island." 9) CONSIDERATION OF THE SAN FRANCISCO GENERAL HOSPITAL QUALITY ASSURANCE PLAN Dr. John Luce, Medical Director for Quality Management, presented Administrative Policy #17.1, Quality Improvement Program. The purpose of the Quality Improvement (QI) Program is to promote organizational performance improvement in the delivery of patient care. This policy defines the systematic process used to measure, assess and improve care delivered to patients and the organizational functions which support the delivery of this care. Action Taken: The Commission unanimously approved the San Francisco General Hospital Quality Assurance Plan. 10) PUBLIC COMMENTS Lincoln Madison expressed his criticism of Dr. Katz’s recent statements in the press regarding bath houses. President Monfredini offered to meet with Mr. Madison. 11) CLOSED EXECUTIVE SESSION: A. PUBLIC COMMENT ON ALL MATTERS PERTAINING TO THE CLOSED SESSION None. B. 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 7:20 p.m. Commissioners Monfredini and Hill left at 8:17 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 – ANTICIPATED LITIGATION DEPARTMENT OF JUSTICE REVIEW OF LAGUNA HONDA HOSPITAL The Commission came out of Closed Session at 9:10 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).) None. 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 the Closed Session. The meeting was adjourned at 9:15 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission