Minutes of the Health Commission Meeting Tuesday, July 20, 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 3:02 p.m. Present: 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. Absent: Commissioner Edward A. Chow, M.D. Commissioner Roma P. Guy, M.S.W. 2) APPROVAL OF MINUTES OF THE REGULAR MEETING OF JULY 6, 1999. Action Taken: The Commission unanimously adopted the minutes of July 6, 1999. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) (3.1) PHP-HIV Prevention Services – Request for approval of retroactive contract renewal with Instituto Familiar de la Raza, Inc., in the amount of $71,188, for the provision of venue-based group outreach and evaluation, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with Instituto for services totaling $3,357,218 during FY 1998-99). (3.2) PHP-CHPP – Request for approval of retroactive contract renewal with CAHEED, Inc., in the amount of $130,000, for the provision of Black Infant Health Improvement Program outreach and prenatal education support services for the period of July 1, 1999 through June 30, 2000. (DPH contracted with CAHEED for services totaling $174,000 during FY 1998-99). (3.3) PHP-CHPP – Request for approval of retroactive contract renewal with Mobilization Against AIDS International (MAAI), in the amount of $193,545, for the provision of HIV prevention services, including HIV risk reduction education and counseling services targeting behavioral risk populations, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with MAAI for services totaling $135,363 during FY 1998-99). (3.4) PHP-CHPP – Request for approval of retroactive contract renewal contract with Native American AIDS Project/Urban Indian Health Board Inc. (UIHB), in the amount of $137,491, for the provision of HIV prevention services, including HIV/STD prevention education multiple session groups, venue-based group outreach and evaluation targeting behavioral risk populations, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with UIHB for services totaling $190,737 during FY 1998-99). Commissioner Hill expressed his confidence in the contractor’s response to the monitoring report. The Department will bring the monitoring report to the Budget Committee after August 27, 1999. 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 Board of Supervisors Approval of FY99-00 Budget The Board of Supervisors considered the FY99-00 budget at its meeting yesterday. The Mayor and the Controller certified $10 million of additional funding for FY99-00, mainly from additional State funding for Department of Human Services programs, expenditure savings from reductions to DHS caseload projections, and the collection of $2.5 million from a settlement with Bank of American related to claims filed by the City. These additional funds were appropriated by the Board of Supervisors to increase salaries and benefits to IHSS workers, to fund add-backs to the Police Department, City Attorney, and Muni, as well as directed to new program intiatives. Increases to the Health Department’s budget which amount to $520,000 are as follows: $205,100 increase to SFGH for additional staffing and equipment for the pharmacy $190,000 increase to AIDS Services to continue the Native American Project $75,000 increase to AIDS Services for Project Open Hand $50,000 increase to Prevention to continue the Gambling Initiative In addition, the Board of Supervisors added $1.2 million Citywide to fund an additional 1% cost of living adjustment in January for General Fund-supported community based organizations’ personnel costs. The amount of additional funding for Health Department contractors is not yet known. The FY99-00 budget, including these adjustments, is scheduled for final approval by the Board of Supervisors next Monday July 26th. Long-Term Care Integration Pilot Project The first six months of the detailed phase of planning for a long-term care integration pilot project were completed between January and June 1999. The Long-Term Care Pilot Project Task Force held a day-long retreat on June 4, 1999, facilitated by the Department, to receive and discuss the recommendations presented by its five Design Teams about topics related to: (1) resource allocation and financing: (2) implementation; (3) consumer and caregiver issues; (4) supportive housing; and (5) governance structure. The Task Force has now voted on the specific recommendations of the Design Teams. On June 18, 1999, the Task Force voted to approve a recommendation from the Governance Structure Design Team that a separate long-term care public authority be created to carry out the directives of AB 1040, with the power to decide on reimbursement mechanisms for long-term care services, including institutional and home and community-based services. In response to this position, the Department will be investigating: (1) steps for the formation of a new long-term care public authority; (2) administrative, service, and financial functions that will need to be performed; (3) a staffing pattern; (4) costs; and (5) potential funding sources. Beginning in September 1999, a financial feasibility analysis to determine the viability of the pilot project will be undertaken. This will investigate start-up and operating costs for the pilot project for the first phase of the pilot project, under fee-for-service managed care and start-up costs for the second phase, under capitated managed care. It will also investigate sources of funds to cover identified costs. This analysis will be completed by the end of December 1999. Beginning in October 1999, a study of existing case management programs and services will be undertaken. This will determine the feasibility of creating a centralized case management pool (at the long-term care services agency level) to support emerging provider networks. It will also determine how to integrate assessment, case management, and service authorization functions (at the provider network level). This study will be completed by the end of December 1999. In early 2000, following the conclusion of the detailed phase of planning, a comprehensive report on the long-term care pilot project will be presented to the Commission. This will include a comprehensive set of recommendations from the Task Force, the financial feasibility analysis, the case management study, and the investigation of costs to form a new long-term care public authority. In February 1999, the State Department of Health Services, Office of Long-Term Care (OLTC) submitted a concept paper to HCFA as a basis for discussions related to waiver issues, and the planning and design of California’s Long-Term Care Integration Pilot Program. Numerous conversations have taken place between HCFA Region 9, HCFA Baltimore, and OLTC regarding waivers for San Francisco’s pilot project. The Department will be coordinating with OLTC to provide more detailed information concerning the needed waivers for San Francisco’s pilot project as OLTC resolves the State’s waiver strategy for the Long-Term Care Integration Pilot Program with HCFA. 1999 Managerial Excellence Awards I am pleased to announce the Department’s nominees for the 1999 Mayor’s Fiscal Advisory Committee Managerial Excellence Awards: Barbara Garcia - Director of Population Health and Prevention Eric Miller - Hospital Associate Administrator Galen Leung - Director of Office of Contract Management Winners will be announced in late September, with the awards luncheon scheduled in October. I am sure you join me in congratulating the Department’s deserving nominees. POPULATION HEALTH AND PREVENTION New PH&P Work groups A Criminal Justice Integration work group has been established to ensure better coordination and integration of related activities within PH&P. The Sheriff's Office, Drug Court, Diversion, Mayor’s Criminal Justice Council and Probation Offices are all participants in this work group. A Heroin Subcommittee has been established for the Treatment on Demand Council to provide policy and program recommendations to DPH in the areas of overdose prevention, soft tissue infection and HEP C. Preparing for Biological Terrorism On July 8, 1999 DPH staff along with representatives of other city agencies participated in a "tabletop" exercise to prepare for a possible biological terrorist attack. The exercise was sponsored by the Office of Emergency Services and included DPH staff from SFGH, EMS, PH Lab, Disease Control, Mental Health and Central Administration. Special Projects – Action Point There will be an Open House for the new Action Point Adherence Project on July 29th from 5-7 pm. Action Point is located on 125 6th Street between Mission and Howard. The project works with HIV infected persons to help them adhere to the complicated medical treatments that are necessary to fight HIV. COMMUNITY HEALTH NETWORK LHH Survey Results Received Laguna Honda has received the results of the annual Licensing and Certification Skilled Nursing Facilities and Acute surveys from the State. There were no findings of substandard care. The SNF survey cited Laguna Honda once again for the census in the open wards exceeding the Federal limit of 4 beds per room, and cited a number of private and semi-private rooms which do not meet Federal room size requirements. The Hospital’s Leadership Group is preparing a Plan of Correction addressing the deficiencies noted in the survey, which will be submitted to the State before the end of the month. Representatives from the CHN and LHH will also meet with Region IX HCFA Representatives to discuss census issues and the Laguna Honda Replacement Bond on the November 2nd ballot. I will continue to keep the Commission apprised of this important issue. Bill Moyers at LHH The final scenes are being filmed at LHH's hospice today. A special production on the end of life care will air during the fall season. CHN Personnel Announcements I'm happy to welcome the new Chief of Anesthesia at SFGH, Dr. Sue Carlisle, appointed to this position July 1st. Dr. Carlisle comes to SFGH from the main UCSF campus. She was an Assistant Professor of Anesthesia and Medicine at UCSF from 1990-1992; Associate Professor from 1992-1996; and Professor of Anesthesia and Medicine, UCSF 1996-1999. I am also pleased to announce the appointment of Mozettia Henley to the position of Program Director for the Mental Health Rehabilitation Facility. Dr. Henley assumed the responsibilities of the Acting Program Director in October, 1998 and has been a part of the MHRF Executive Team as Director of Nursing since the start of the program in September, 1996. Her strong clinical and management experience and her commitment to and passion for the rehabilitative mission of the MHRF make her the ideal leader for the continued development of the program. And last but not least, Laguna Honda has a new Chief Financial Officer, Nancy Arata. Ms. Arata comes to us from the Santa Clara Valley Medical Center where she served as Controller. California Healthcare Association Anthony Wagner was elected to a 2nd four-year term to the American Hospital Association's House of Delegates Regional Policy Board for Region 9. Region 9 includes California, Oregon, Washington, Nevada, Hawaii and Alaska. SFGH Appointments 7/99 YTD New Appointments 03 95 Reappointments 28 236 Delinquencies 0 0 Reappointment Denials 0 0 Resigned/Retired Pending 102 Disciplinary Actions 0 0 Restriction/Limitations – Privileges 0 0 Changes in Privileges Additions 5 27 Voluntary Relinquishment 0 5 Current Statistics – as of 7/9/99 Active Staff 349 Affiliate Professionals 133 Courtesy Staff 537 Referring Staff 60 Total Members 1179 Applications in Process 106     5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR JULY 1999 On behalf of the Commission, President Monfredini presented the sole recipient of the Employee Recognition Award. Individual Nominee Division Nominated by Sharon Goudeau, MSW, Psychiatric Social Worker CHN/SFGH Dept. of Psychiatry, Unit 6B Mily Trabing, LCSW, Director Psychiatric Social Work 6) REPORT ON THE IMPACT OF ALCOHOL, TOBACCO AND OTHER DRUGS ON THE HEALTH OF SAN FRANCISCANS Randy Reiter, presented a report, on the prevalence and impact of alcohol, drug and tobacco use in San Francisco. This is one in a series of reports presented to the Commission by the Population Health and Prevention Division on health related issues and their impact on the residents of our City. Commissioners’ Comments: Data for dual diagnosis (i.e., mental health and substance abuse) should be included Comparisons with other counties should be included in future reports How low economic status relates to high drug rates? Encouragement to the Department to disseminate information with collaborators (i.e., school district) Request for clarification on the decrease in alcohol-related hospitalizations Inquiry on whether gay men were included in the amphetamine graph President Monfredini thanked the Department for an informative but depressing report. 7) PRESENTATION ON THE STATE FISCAL YEAR 1999-00 BUDGET Tangerine Brigham, Director of Policy and Planning, presented the State 1999-00 Budget. 8) PUBLIC COMMENTS Richard Cornwall, Health Watch, expressed his opinion that the Commission has undemocratic procedures, citing his examples. The meeting was adjourned at 4:10 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission