Minutes of the Health Commission Meeting Tuesday, May 18, 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 3:08 p.m. Present: Commissioner Roma P. Guy, M.S.W. Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. Absent: Commissioner Edward A. Chow, M.D. Commissioner Ron Hill On behalf of the Commission, President Monfredini presented Deputy City Attorney Paula Jesson with a special Certificate of Appreciation for her dedicated work with the Department for the past 11 years. Ms. Jesson will be working at the Airport. Ms. Gloria Louie, who also will be going to the Airport, will be given a Certificate of Appreciation for her 11 ½ years as the Department’s EEO Director. 2) APPROVAL OF MINUTES OF THE REGULAR MEETING OF MAY 4, 1999. Action Taken: The Commission unanimously adopted the minutes of May 4, 1999. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner David J. Sanchez, Jr. Ph.D.) (3.1) CHN– Request for approval of renewal contract with Health Management Systems, Inc. (HMS) for electronic claims processing, retroactive claims reprocessing, managed care consulting and data processing services for the Community Health Network, for the period of July 1, 1999 through June 30, 2003. Reimbursement for the claims processing services is based on contingency fees from revenues collected. (DPH contracted with HMS for services totaling $1,980,000 during FY 1997-98). Commissioner Sanchez requested an update and review in a year (May 2000) regarding compliance with Policy #24. (3.2) CHN-HAH – Request for approval of a new sole source contract with Nations Healthcare/Home Medical of America for the provision of home infusion therapy services in an amount not to exceed $85,080 for the period of June 1, 1999 through February 28, 2000. (3.3) PHP-HIV Prevention Services – Progress report on the Haight Ashbury Free Clinics, Inc. (HAFC) - Prevention Case Management and Venue-Based Individual Outreach contract (POHC99001060), and request for approval to renew contracted services in the amount of $339,019, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with HAFC for services totaling $15,119,656 during FY 1997-98). Public Speaker: Stephen Kavanaugh expressed concerns on effective condom distribution by the contractor. (3.4) PHP-CHS-Mental Health and Substance Abuse – Request for approval of modification to the contract with UCSF Langley Hospitals and Clinics for the provision of mental health services by a mental health provider group to amend the maximum compensation provision. (DPH contracted with Langley for services under a managed care contract for $20,000 for three months during FY 1997-98). Commissioner Sanchez abstained on this item. (3.5) PHP-CHS-Mental Health and Substance Abuse – Request for approval of retroactive contract renewal with the County of San Mateo, San Mateo County General Hospital Long Term Care Services (SMGH), in the amount of $138,700 per year, to provide 24-hour skilled nursing geropsychiatric services for the period of July 1, 1998 through June 30, 2002. (DPH contracted with San Mateo County for services totaling $2,563,183 during FY 1997-98). Action Taken: The Commission unanimously approved the Consent Calendar of the Budget Committee, with Commissioner Sanchez abstaining on #3.4. 4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) (Provides information on activities and operations of the Department). ADMINISTRATION Governor’s May Revision to the FY 1998-99 and 1999-00 Budgets Overview The Department of Finance released the May Revision to the current State fiscal year budget and Governor Davis’ proposed fiscal year 1999-00 budget on May 14th. On a positive note, the revision reflects revenues higher than anticipated in the Governor’s January budget by a total of $4.3 billion for the two fiscal years (by $1.6 billion in the current year and by $2.7 billion in FY1999-00). The revision document assumes the unexpected revenue is a one-time occurrence. This assumption led the Governor to propose using most of the surplus for one-time expenditures. In general, the $4.3 billion is proposed to be allocated as follows: $1.2 billion for improving education, in part required by Proposition 98; $1 billion for infrastructure development; $500 million for mandatory –caseload driven – spending primarily for Social Services, with a portion for Child Health Disability Prevention; $250 million for Vehicle License Fees (VLF) set aside (in anticipation that VLF will be further reduced 25 to 35 percent in FY 2000-01); $800 million for other policy initiatives, litigation and salary increases; and $570 million to bring the State General Fund Reserve to $985 million. The Senate and Assembly budget committees have been holding hearings on the Governor’s budget and proposed augmentations for several weeks, and will hold hearings this week on the May Revision. There are major differences among the Assembly and Senate budget committee proposals and the Governor’s proposal. The Budget Conference Committee is expected to convene by the end of May to resolve the differences between the Assembly and Senate budget proposals, so that negotiations with the Governor can begin. The constitutional deadline for the Legislature to return a budget to the Governor is June 15, 1999 for FY 1999-00, which begins July 1, 1999. With respect to health and mental health, the May Revise proposes increasing State funding by $209.4 million in FY 1999-00. The revision also proposes a $110 million reserve for the expansion of the Healthy Families Program, rate increases for Medi-Cal managed care providers, implementation of nursing home industry reforms, and wage increases for In-Home Supportive Services (IHSS) providers. The Administration in conjunction with interest groups and the Legislature will develop details and specific allocations for these proposals. The total proposed State General Fund expenditures for health and human services in FY 1999-00 are $16.7 billion, 26.4 percent of the budget. Specific health-related components of the May Revision follow. Proposition 99 Statewide funding for the California Healthcare for Indigents Program (CHIP) as proposed in the May Revision will be reduced 48 percent since the budget was enacted for FY 1998-99. While part of the reduction is due to tobacco tax revenues, a significant portion is due to the Administration’s shifting of some Proposition 99 funds away from county services in order to fund mandated state programs. For San Francisco, this would result in an estimated reduction of $3.7 million, $3.3 million for San Francisco General Hospital and the remainder for support to private providers of health care to the uninsured. The Senate and Assembly Budget Committees have taken different actions on Proposition 99 allocations, so this will be a major issue in Budget Conference Committee and in negotiations between the Legislature and the Administration. The Department is working closely with the Mayor’s Office, the City’s Sacramento lobbyist, and members of our delegation to restore the funding for Proposition 99 CHIP services. AIDS Drug Assistance Program (ADAP)/HIV Programs ADAP costs are projected to decrease due to additional federal funds and program efficiencies. The Governor proposes allocating $9.2 million saved in the State ADAP to various HIV/AIDS programs, including: $1.9 million to expand access to the Early Intervention Program; $1 million for Residential Care Facilities for the Chronically Ill; $3 million for HIV prevention programs, with a focus on African American and Latino men who have sex with men and high risk youth in counties with the highest rates of HIV infection in youth; $1.3 million to provide targeted prevention, outreach, and care to communities of color; and $2 million for HIV/AIDS prevention program evaluation and behavioral surveillance research. The Senate and Assembly Budget Committees have passed differing allocations for these programs, as well as for additional programs such as diagnostic testing, Partner Counseling and Referral Services, and HIV testing at family planning clinics. The Department is working with the California HIV Advocacy Coalition, the Mayor’s Office, and the City’s Sacramento lobbyist to support allocation of sufficient funding for these programs. Other Health-Related Proposals Medi-Cal expenditures are estimated to increase by $184.4 million over the January estimate despite a continuing caseload decline, due to rising costs and utilization. An additional $184.8 million General Fund is allocated to Medi-Cal for the following: family planning; increased reimbursement rates for children’s hospitals; mental health services; new drugs; new vaccines; medical equipment and supplies; and Medi-Cal services related to Department of Developmental Services clients. Healthy Families enrollment estimate is now 250,000, down 54,000 from the January estimate, decreasing General Fund expenditures by $5.2 million. However, the Governor continues to propose a $2 million General Fund increase to apply Medi-Cal income deductions to Healthy Families applicants, expected to result in an additional 14,200 children being enrolled. Further expansion of the program will be considered as part of the $110 million increase noted above for various health-related purposes. A California Health Interview Study ($1 million General Fund and $1 million private and federal funds) would be conducted statewide regarding individual health status, risk behaviors, insurance coverage, and service utilization. The Child Health and Disability Prevention Program (CHDP) would be increased by $1.3 million ($0.8 million General Fund), for a new initiative to provide Hepatitis A and Rotavirus vaccines. Chlamydia Prevention education would be expanded, with a focus on high-risk uninsured women and their partners, through a $1.3 million General Fund increase. The California Poison Control System would receive increased funding of $2 million General Fund. The Department of Mental Health would receive an increase of $8.2 million General Fund for increased census in state hospitals, evaluation costs for Mentally Disordered Offenders, and the Brain Damaged Adults Program. Anticipated changes in mental health managed care include adjustments for inpatient services and in specialty mental health professional services, resulting in a net increase of $4.4 million (-$2.5 million General Fund, +$6.9 million reimbursements). The May Revision does not propose allocation of additional public health subvention funding to local public health services for communicable disease control efforts, although the Assembly and Senate Budget Committees passed augmentations of $7.7 million and $10 million, respectively, for this purpose. In addition, the May Revision does not propose funding ancillary services provided for patients in Institutes for Mental Disease (IMDs). This funding is needed due to the Governor’s January proposal to use State funding to repay the federal government for an audit exception resulting from billing for ineligible ancillary Medi-Cal services provided to individuals in IMDs. Consequently, the Governor discontinued allocation of state or federal funds for these services, which include physical health care, medications, laboratory costs, and some specialty mental health services. The Governor’s budget shifts responsibility for these services to counties beginning in FY 1999-00, with no assistance from State funds. 1999 State of the City Public Health Address Last week I delivered the State of the City Public Health Address before the Board of Supervisors. All members of the Health Commission have been provided copies of the report. The Department has given this Address for the last four years to provide the public and our elected officials with information on the health status of the community. My remarks focused on the funding challenges facing the Department, our need to meet the health needs of a growing elderly and disabled population, the spread of communicable diseases, and the need for continued funding for substance abuse and mental health services. I would like to acknowledge the tremendous work done by Richard Hodgson of the Office of Policy and Planning in working on this report. Population Health and Prevention compiled the overview of the health status of San Francisco. The report will be available on the Department’s web site at www.dph.sf.ca.us. Clean Needle and Syringe Exchange I would like to report that Assembly Bill 518 (Mazzoni – Marin County) passed the Assembly on its third reading last week. This bill would allow for clean needle and syringe exchange projects within California. As you know, the City and County of San Francisco has operated a needle exchange program under a continuing two-week State of Emergency declared by the Board of Supervisors. If this bill is passed by the Legislature and signed by the Governor, San Francisco and other counties could develop these programs under State law. The Department of Public Health, working with the Mayor’s Office, will continue to support these programs, which we believe, dramatically curtail the spread of HIV, Hepatitis and other communicable diseases within our community and within the State. Health and Human Services Region IX Director I am pleased to report that Catherine Dodd, RN, MS, has been appointed as Regional Director of the Department of Health and Human Services for Region IX. Ms. Dodd will be the principal liaison between the federal government and the states of Arizona, California, Hawaii and Nevada on a range of health and social service issues. Ms. Dodd has worked on health issues for a significant number of years in the Bay Area. She most recently served as the Director of Government and Community Relations for Kaiser Permanente Golden Gate Service Area. Ms. Dodd has significant clinical experience including having worked at San Francisco General Hospital as a Quality Management Nurse Analyst and as the Director of the Women’s Health Center. Catherine has worked with diverse and the vulnerable populations, and is knowledgeable about larger state and federal policy issues. I am pleased that the HHS Secretary Donna E. Shalala has appointed Ms. Dodd and hope that the Health Commission joins me in congratulating her on this appointment. POPULATION HEALTH AND PREVENTION Children's Environmental Health Promotion As part of the Department's ongoing efforts to promote the health of children with asthma, Children's Environmental Health Promotion and the San Francisco Unified School District produced a well-attended half day presentation on "Taking the Lead Toward Population-Based Disease Management." The program focused on a model asthma intervention program for school children in Los Angeles County and their use of a comprehensive health management software program for case management and aggregate data analysis. Gail Herrick, Public Health Nurse put the program together. DPH/SF State University Masters in Public Health Program Over the past year students and faculty from the SFSU Masters in Public Health program have worked with staff from the Department of Public Health to conduct critical needs assessments in communities in San Francisco. Staff who served as preceptors include: Patricia Erwin, Newcomer's Program; Martha Ryan, Homeless Prenatal Program; Ginger Smyly, Community Health Promotion and Prevention; Laura Thomas, HIV Services Section; Jeff Klausner and Jacque McCright, STD Prevention and Control; Jennifer Mann, Community Health Epidemiology and Disease Control. On May 28, 1999 the students will present the results of the assessments including: The Challenges of Adequately Serving Bosnian Refugees Childcare: A Cornerstone for Stability The Health Status of African Americans: Awareness and Opinions from DPH Staff Needs, Barriers and Priorities: A City-Wide HIV/AIDS Service Provider Survey Determinants of Effective STD Prevention Interventions Among Young African Americans Content and Challenges for Data Analysis: A community Based Survey in Bay View Hunter's Point The presentation will be held at The Main Library on May 28 from 1:00 - 4:30. San Francisco Alcohol Policy Coalition The first meeting of the newly formed San Francisco Alcohol Policy Coalition will be held on June 24th from 4:00-6:00 at 101 Grove St.. At this meeting a Coalition of community members, community based organizations and the Department of Public Health will begin crafting a policy agenda for reducing alcohol-related problems in San Francisco. The Marin Institute, a leader in this field, will provide assistance. St. James Infirmary The STD Program is collaborating with BaySwan (Bay Area Sex Worker Advocacy Network) to establish an evening clinic for sex workers. The Clinic will be called the St. James Infirmary and will initially operate out of City Clinic. The Clinic will be open on Wednesday evenings from 6 - 9 p.m. starting June 2 to end of year 1999 and will be staffed by STD Program personnel, BaySwan staff and volunteers. The St. James Infirmary staff will conduct a comprehensive medical, social and emotional needs assessment of sex workers in San Francisco as well as provide reproductive/sexual health/medical care, STD/HIV education, risk reduction counseling, HIV counseling and testing and specialty referrals including alcohol and substance abuse, needle exchange, occupational health, psychiatric services, HIV post exposure prevention and rheumatological disorders. The Clinic will also provide free condoms and STD/HIV brochures. California Mental Health Disaster Assistance Conference On May 26th and 27th, Community Mental Health Services and the State Department of Mental Health will co-host the first California Mental Health Disaster Assistance Coordinators Conference. Items on the program include school violence, mutual assistance, and disaster mental health response and recovery programs, in collaboration with the American Red Cross and Veterans Administration. Linda Wang, CMHS Disaster Coordinator is responsible for the planning and arrangements. COMMUNITY HEALTH NETWORK San Francisco General Hospital JCAHO Survey This Week After months of hard work, the Joint Commission on Accreditation of Health Organizations began its tri-annual week long survey of San Francisco General Hospital Medical Center (SFGH/MC) yesterday. The surveyors will be at the hospital through Friday. I want to thank the Commission for your participation and support. I will certainly keep all of you informed of the outcome. Laguna Honda Hospital Replacement The Laguna Honda Hospital Replacement Planning Committee continues to meet. The proposal to replace the facility has been filed with the Board of Supervisors for consideration. The Finance Committee of the Board of Supervisors will hold a hearing on this matter in June 9th, at 10:00, with a full Board review June 14th. AIDS HERO Award for 1999 I am pleased to announce that Tom Waddell Health Center HIV team has been awarded an AIDS Hero Award for 1999. For the past 10 years this dedicated group has cared for homeless people, drug users, people with metal health disorders and those who are unable to find accessible and acceptable care elsewhere. On Sunday May 16, 1999 at the San Francisco AIDS Candlelight Vigil, the HIV team is being honored for 10 years of service to HIV positive people. SFGH Appointments 5/99 YTD New Appointments 08 79 Reappointments 08 182 Delinquencies 0 0 Reappointment Denials 0 0 Resigned/Retired 10 73 Disciplinary Actions 0 0 Restriction/Limitations – Privileges 0 0 Changes in Privileges Additions 10 22 Voluntary Relinquishment 03 04 Current Statistics – as of 5/4/99 Active Staff 358 Affiliate Professionals 134 Courtesy Staff 567 Referring Staff 50 Total Members 1109 Applications in Process 59 Reappointment In Process 48 Reappointment Requested not Received 32 (Due through 8/99) The CHN Utilization Data Report was given to the Commissioners. Commissioner Guy requested progress information on a universal health care bill at the State level, especially since the Health Commission has a priority for universal health care. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR MAY 1999 On behalf of the Commission, President Monfredini presented the award to one employee: Lisa Palladino, PH & P Environmental Health, nominated by Jack Breslin 6) PRESENTATION OF THE EMERGENCY MEDICAL SERVICES REPORT Dr. John Brown, Emergency Medical Services Medical Director, announced that during EMS Week (May 16-22, 1999) two individuals are being honored for their work in Emergency Medical Services. The provider award was presented to Michael Kniess, SFFD Paramedic; and the public award went to Librada Cavanan, operator and caregiver of Palarca Rest Home. Dr. Brown gave updates on the following: Public Access Defibrillation Program Basic Life Support Ambulance Pilot Program Hospital Diversion Senior and Disabled Disaster Registry 1998 Activity Summary Dr. Marshall Isaacs, FACP, EMS Medical Director; and Richard Shortall, EMT-P, EMS Chief, presented the Fire Department’s EMS Division Annual Report. 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. Commissioners Comments: Commended the improvement in the senior disaster registry program Impressed with the smoothness of the merger Interested in the impact of HMO’s on the utilization of emergency medical services With the training and job classification issues, what obstacles would come up in the next phase Critical priorities would be supervision and training Inquired about the resuscitation and patient destination protocols and policies President Monfredini thanked both the Health and Fire Departments for the comprehensive, easy to read reports. 7) PRESENTATION OF A YOUTH SUICIDE PREVENTION BRIEFING PAPER Dr. Larry Meredith, Director of Health Promotion, reported that Board of Supervisors’ President Tom Ammiano introduced an ordinance calling for the creation of a youth suicide prevention initiative. The Department, working with the Youth Commission and community experts, formed a planning group and developed a briefing paper. Eve Meyer, S.F. Suicide Prevention; Dr. Janet Shalwitz, Maternal, Child, and Adolescent Health; and Jack Rabin, Community Mental Health Services, outlined the Recommendation and Next Steps. Commissioners’ Comments: The Commission would want to develop support for this report Costs, data on programs, and profiles of youth are needed Community needs to work together to protest and respond to youth suicides Centralized data collection and integration of efforts are needed in an overall prevention program President Monfredini requested the Department to bring back to the Commission a proposed resolution on youth suicide prevention. Commissioner Umekubo left at 5:00 p.m. 8) OTHER BUSINESS/PUBLIC COMMENTS Public Speakers: William C. Brady raised questions on parts of the May 4, 1999 Health Commission Minutes and the budget cuts and waiting times at the SFGH Pharmacy. The meeting was adjourned at 5:15 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission