Minutes of the Health Commission Meeting Tuesday, August 3, 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 Vice President Roma Guy at 3:08 p.m. Present: Commissioner Edward A. Chow, M.D. Commissioner Roma P. Guy, M.S.W. Commissioner Ron Hill Commissioner Harrison Parker, Sr., D.D.S. Commissioner David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. Absent: Commissioner Lee Ann Monfredini 2) APPROVAL OF MINUTES OF THE REGULAR MEETING OF JULY 20, 1999. Action Taken: The Commission unanimously adopted the minutes of July 20, 1999. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) (3.1) CHN-Primary Care-Homeless – Request for approval of retroactive contract renewal and sole source request with Bayview Hunter’s Point Foundation (BVHP), in the amount of $419,467, for the provision of mental health outreach/case management services to the homeless, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with BVHP for services totaling $7,048,785 during FY 1998/99). (3.7) PHP-HIV Health Services – Request for approval of retroactive contract renewal with Bayview Hunter’s Point Foundation (BVHP), in the amount of $92,610, for the provision of HIV complementary therapy services, for the period of March 1, 1999 through February 29, 2000. (DPH contracted with BVHP for services totaling $7,048,785 during FY 1998/99). Items #3.1 and #3.7 were approved with the understanding that in 90 days, the contractor will bring back to the Budget Committee a strategic plan for the agency. The contractor, along with a member of its Board of Directors, will report every month to the Joint Conference Committee for Population Health and Prevention on its progress in developing its strategic plan. The Department was directed to provide technical assistance to the contractor. If the strategic plan is not acceptable to the Department and the Commission, the Department will be directed to look for other contractors. Commissioner Hill stated his commitment to these services needed in the Bayview Hunters Point community. Commissioner Sanchez pointed out the network of resources in the Bayview community and encouraged the contractor to revisit its mission in the community. Commissioner Umekubo supported the recommendations. Karen Patterson, Executive Director of the agency, clarified that much of their funding is not specific to the Bayview area and that the agency serves a diverse population. She also pointed out that the HIV complementary therapy contract does not reflect the whole organization. (3.2) PHP-AB 75 Project – Request for approval to apply for, accept and expend retroactively a grant allocation in the amount of up to $4,910,208 from the State Department of Health Services, through its California Healthcare for Indigents Program (CHIP), to provide reimbursement for health services delivered to indigent persons for the term FY 1999/00. (3.3) PHP-HIV Prevention Services – Request for approval of contract renewal with Mobilization Against AIDS International (MAAI), in the amount of $73,068, for the provision of HIV prevention services, including HIV risk reduction education and counseling services, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with MAAI for services totaling $335,466 during FY 1998/99). (3.4) PHP-HIV Prevention Services – Request for approval of retroactive contract renewal with Instituto Familiar de la Raza, Inc., in the amount of $69,073, for the provision of venue-based group outreach, multiple session workshops and evaluation, for the period of July 1, 1999 through December 31, 1999. (DPH contracted with Instituto for services totaling $8,731,281 during FY 1998/99). (3.5) PHP-HIV Prevention Services – Request for approval of retroactive contract renewal with Black Coalition on AIDS (BCOA), in the amount of $246,687, for the provision of HIV prevention services, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with BCOA for services totaling $1,047,956 during FY 1998/99). (3.6) PHP-HIV Prevention Services – Request for approval of retroactive contract renewal with Black Coalition on AIDS (BCOA), in the amount of $227,397, for the provision of HIV prevention services, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with BCOA for services totaling $1,047,956 during FY 1998/99). The Department will bring back a progress report to the Budget Committee in October. (3.8) PHP-Health Promotion – Request for approval of new contract with Polaris Research and Development, in the amount of $158,000, for the provision of comprehensive evaluation services for the Mangini tobacco settlement funded prevention program, for the period of September 1, 1999 through June 30, 2001. (DPH contracted with Polaris for services totaling $492,330 during FY 1998/99). (3.9) PHP-Health Promotion – Request for approval of new contract with O’Rorke Public Relations and Advertising in the amount of $477,500, for the provision of media services for the Mangini tobacco settlement funded prevention program, for the period of September 1, 1999 through June 30, 2001. (DPH contracted with O’Rorke for services totaling $191,987 during FY 1998/99). (3.10) PHP-CSAS – Request for approval of retroactive multi-year contract renewal and sole source with the San Francisco Drug Abuse Advisory Board (SFDAAB), in the amount of $51,787 per year, for the provision of advisory services, for the period of July 1, 1999 through June 30, 2003. (DPH contracted with SFDAAB for services totaling $51,787 during FY 1998/99). (3.11) PHP-CMHS – Request for approval of contract renewal with the Regents of the University of California Clinical Practice Group (UCSFCPG) for the provision of professional mental health managed care model of services, for the period of July 1, 1999 through June 30, 2001. Maximum compensation allocated for these services for all network providers is $3,300,000 for FY 99/00. (DPH contracted with UCSFCPG for services totaling $40,000 during FY 1998/99). Commissioner Sanchez abstained due to conflict of interest. (3.12) PHP-CMHS – Request for approval of retroactive contract renewal with Walnut Creek Hospital (WCH) for the provision of : (1) acute psychiatric inpatient hospital services for indigent children and adolescents in the amount of $60,000 in City funds (2) Medi-Cal funded psychiatric inpatient hospital services for Medi-Cal eligible children and adolescents for the period of July 1, 1999 through June 30, 2000. The total dollar amount for psychiatric inpatient hospital services for Medi-Cal beneficiaries for all six hospital providers is $5,000,000. (DPH contracted with WCH for services totaling $80,000 during FY 1998/99). (3.13) PHP-CMHS – Request for approval of retroactive contract renewal with Ross Hospital (RH) for the provision of : (1) acute psychiatric inpatient hospital services for indigent children and adolescents in the amount of $60,000 in City funds, and (2) Medi-Cal funded psychiatric inpatient hospital services for Medi-Cal eligible children and adolescents for the period of July 1, 1999 through June 30, 2000. The total dollar amount for psychiatric inpatient hospital services for Medi-Cal beneficiaries for all six hospital providers is $5,000,000. (DPH contracted with RH for services totaling $80,000 during FY 1998/99). Commissioner Parker requested clarification of #3.1 and 3.7. Commissioner Chow reminded the Department of the need to provide information on the efficacy of acupuncture in HIV treatment. Action Taken: The Commission approved the Consent Calendar of the Budget Committee, with the specific recommendations for Bayview Hunters Point Foundation. 4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) (Provides information on activities and operations of the Department). ADMINISTRATION Proposition 187 Governor Davis and civil rights organizations have agreed not to pursue their respective lawsuits regarding the implementation of Proposition 187. As you may recall, Proposition 187 was approved by the voters in 1994 and prohibited the provision of most publicly funded services to undocumented persons. The measure limited public health care services to emergencies only and requires providers to report persons who appear to be undocumented to the Attorney General’s Office and the Immigration Naturalization Service. The Department of Public Health and the Board Supervisors approved resolutions opposing the measure. In addition, Governor Davis opposed Proposition 187 because of his belief that parts of the ballot were unconstitutional. In March 1998, the United States District Court Judge Pfaelzer issued a final judgement finding Proposition 187 unconstitutional and permanently enjoining the State from implementing and enforcing the law. Specifically, the Court found the following sections of Proposition 187 unenforceable: law enforcement agency cooperation with INS, exclusion of undocumented persons from public social services, exclusion of undocumented persons from publicly-funded health care, exclusion of undocumented persons from public-post elementary and secondary institutions and State Attorney General cooperation with INS. The Court’s ruling was based on the fact that Proposition 187 was preempted by federal law (e.g., the 1996 Welfare Reform Act). This agreement preserves the decision handed down by Judge Pfaelzer in 1998. The components that remain in Proposition 187 relate to establishing State criminal penalties for the manufacturer and use of false documents to conceal illegal immigration status. The agreement indicates that the State is allowed to enforce any restriction that has been adopted under federal laws, such as the 1996 Welfare Reform Act. It is expected that the agreement will result in the dismissal of two court cases, which challenge the rights of undocumented residents to attend public schools. The Department is pleased that an agreement has been reached on this issue. The Department strongly believes that all residents are entitled to quality health services, irrespective of their immigration status. Public Charge On July 22, 1999, the Department of Public Health submitted its comments to the Immigration and Naturalization Service (INS) on the proposed public charge rule. As you may recall, this is the first time that the federal government has defined "public charge." The rule indicates that health-related benefits are not subject to public charge consideration (e.g., Medicaid, children’s health insurance program, WIC, prenatal care, etc.). While we are extremely pleased with the federal government clarification of public charge, we believe that the proposal should be clarified in two areas – long-term institutionalization and sponsorship. The proposed rules indicates that long-term institutionalization (except in the cases of rehabilitation) is subject to public charge. However, the proposal does not indicate what period of time constitutes long-term in a skilled nursing or mental health facility. With respect to sponsorship, we have recommended that the INS forms be modified to eliminate questions that ask sponsors whether they or members of their family have received public benefits. The federal government accepted comments on the proposed rule until July 26, 1999. While the proposed rule went into effect immediately (as of May 26, 1999), the federal government is in the process of finalizing the rule based on comments submitted by interested parties. Within the Department of Public Health, we established a Public Charge Work Group to develop strategies to inform our staff and clients about the new rule. Attached to my Director’s Report, you will find copies of the following: a flyer which will be distributed to clients throughout the Department (the flyer will be translated into Spanish, Chinese, Vietnamese, Russian and Tagalog); a memorandum which were distributed to all Department staff with today’s paychecks; and a memorandum from me to our contractors discussing public charge (this memo also had flyers that contractors could distribute to their clients). In addition, on August 12, 1999 and August 17, 1999, the Department of Public Health will hold public charge training sessions for certain staff. The Northern California Coalition on Immigrant Rights has agreed to participate and present at these training sessions. The training sessions are designed to discuss the new proposed public charge rule and to provide staff with information on how to inform clients about this provision. After these initial trainings, the Department will also conduct more in-depth training with eligibility and registration workers. State Budget Last week, Governor Davis signed the three budget trailer bills that implement budget provisions relating to health and human services for fiscal year 1999-00. The bills are AB 1107 (Cedillo), (D-Los Angeles), AB 1111 (Aroner) and SB 708 (Senate Budget and Fiscal Review Committee). This means that the State budget process is completed. As a result of the State budget, certain immigrant rights, Medi-Cal and Healthy Families legislation were absorbed by the budget and will no longer continue through the legislative process. It should be noted that the Governor’s signing of SB 708 makes a number of changes in AB 1107 and AB 1111. AB 1107 is the omnibus budget trailer bill that implements provisions in the budget relating to health, mental health and developmental services. Key provisions are: Authorizes a state-only program to provide prenatal care services to undocumented women. This will ensure services to approximately 70,000 pregnant women annually. Expands Healthy Families eligibility to families up to 250% of the federal poverty level. An additional 172,000 children will be eligible. The bill also permits a family contribution sponsor to pay the required annual family premium. While the program will be expanded to include immigrant children who entered after August 22, 19996, they will only qualify for 12 months of benefits. The continuance in the program would then be dependent upon the federal government providing funding. Within Medi-Cal, the bill: (1) allows Medi-Cal eligibility for low-income, two parent working families earning up to 100% of the federal poverty level, (2) simplifies the adult Medi-Cal application and eligibility determination process and (3) reduces the State administrative fee for disproportionate share hospital program by $30 million. Establishes the Family Planning Access, Care and Treatment (Family PACT) Waiver Program to provide services to those under 200% of the federal poverty level. Establishes the minimum number of actual nursing hours per patient required in skilled nursing facilities at 3.2 hours. AB 1111 is the omnibus social services budget trailer bill. It implements provisions in the budget relating to social services. The key provision of this bill related to health is the establishment of a public health nursing program in the child welfare services program to coordinate health services. The foster care public health nurse will coordinate with county mental health and local health departments. Finally, SB 708 does the following: Caps future funding for long-term care and renal dialysis services to undocumented persons to 110% of the 1999-00 estimated caseload. Limits state-only funding for ancillary health care services to Medi-Cal patients in Institutes for Mental Disease to the current budget year. As mentioned at the previous Health Commission meeting, if the sunset on this repealed or extended, counties will face an additional $12 million annual cost. Deputy Director for EEO Appointed I am pleased to announce that Norm Nickens has been appointed as Deputy Director for Equal Employment Opportunity Programs (EEO), Affirmative Action and Cultural Competency as of September 1, 1999. Since January 1998 he served as Deputy Director for Community Health Services. As Deputy Director for EEO, Affirmative Action and Cultural Competency Norm will coordinate the Department’s efforts to ensure a diverse workforce, enforce existing prohibitions on discrimination, implement the Commission’s policy on cultural competency, and seek to expand the Department’s contracting under the San Francisco Minority/Women’s/Local Business Ordinance. Previously Norm served as Assistant Director of the AIDS Office from July of 1994 through December of 1997. Promoting the Department's On-line Accessibility In an effort designed to promote DPH web site and e-mail accessibility, I have directed all Departmental managers to add both addresses to new and re-ordered business cards and letterhead. It is my hope that this effort will result in an increased use by the public of the information posted on our web site as well as allow us to be more accessible to the public through e-mail. POPULATION HEALTH AND PREVENTION Asthma Supervisor Becerril called a hearing on asthma July 22nd at the Public Health and Environment Committee. A wide range of health care providers, school counselors, educators, day care providers, researchers, city officials and asthma sufferers presented testimony. The Department, represented by Larry Meredith, Jennifer Mann, Karen Cohn and David Ofman presented an overview of asthma hospitalization and death data plus a summary of the department's outreach, care, education, prevention and collaboration activities. Asthma has been increasing nationally, as well as in San Francisco. While the department has mobilized its outreach, and prevention efforts, broader, public-private partnerships are needed. Four overlapping areas require coordinated attention: expanding access to quality asthma treatment and follow-up care; training and education for parents, teachers, childcare workers and the general public; research, particularly prevalence studies; and prevention, through the reduction of indoor and outdoor environmental. Immigrant Health Newcomers Health Program, HIV Prevention Unit, Richmond Neighborhood Coalition and Jewish Family and Children's Services collaborated to print an HIV prevention brochure in Russian. Please contact Patricia Erwin, Newcomers Health Program through e-mail or at 705-8552 to request copies for distribution. Wedge Program On the weekend of July 10, 1999, Free Zone, in conjunction with Dimensions health clinic, co-sponsored the Health and Wellness track at the "Young, Loud, and Proud" Conference for hundreds of lesbian, gay, bisexual, transgender, and questioning youth at Mission High School. Workshops, run primarily by youth facilitators, covered topics ranging from how the tobacco industry targets queer youth to health issues facing transgender youth. "Free Zone" is a collaboration between SFDPH's Wedge Program, the California Lavender Smoke-free Project, Health Initiatives for Youth (HIFY), and Lavender Youth Recreation and Information Center (LYRIC). The project was created to address the unmet health education needs of queer and questioning youth under 20 years old in San Francisco. Activities include a weekly drop-in group for queer youth and their friends and a media campaign in SF schools. For more information, look us up at http://members.aol.com/freezonesf or call Mazdak or Shivaun at 415-554-9098. Violence Prevention Jennabeth Ward, Violence Prevention Coordinator for the Health Promotion Section, was awarded a certificate of appreciation from Neighborhoods in Transition - a Multi-Cultural Partnership and Neighborhood Safety Partnership last month. The Mayor’s Criminal Justice Council funds both of these groups. The certificate was awarded on the occasion of Ms. Ward's final meeting with the Violence Prevention Network. Ms. Ward is leaving the Department after 9 ½ of service, the last five of which she served as Violence Prevention Coordinator. Family Violence Prevention On July 19 the San Francisco Collaborative Organized to Prevent Abuse (SFCOPA), a project of the Health Promotion Section trained 20 foster-family finding agency staff on the impact of domestic violence on children. In a 6-hour training, the cycle of violence was discussed, particularly as it pertains to the families of foster-children. Patricia Van Horn from UCSF's Child Trauma Project who is informed in the physiological changes to the brain which result from young children's witnessing of violence was the key presenter. She provided tips on how foster families can best help the children in their homes. The final presentation focused on how to intervene with youth and adult survivors of domestic violence, and how to access community resources. "It's Time to Go Outside" - Smoke-Free Home TV Ad Campaign The Tobacco Control Program created a media campaign urging smokers with children at home to smoke outside. Television ads were developed in English and Cantonese and aired 278 times in May. Over 300 viewers called to request an education packet after seeing the ad. Surveys returned by viewers indicated that the percentage of smokers who went outside increased from 20.8% to 38.6% after seeing the ad. STD Prevention and Control A Centers for Disease Control (CDC) Epidemiologic Intelligence Service (EIS) Officer (Gwen Hammer, PHD) has been assigned to the San Francisco STD Program for a two year period from 7/1/99 - 6/30/01. She is an epidemiology, occupational health and safety policy expert who will be working with the STD, HIV and CD Sections on outbreak evaluation and response and long term primary prevention studies. A CDC funded Public Health Prevention Specialist, Katy Turner, MPH, was also assigned to the STD Program effective September. She will focus on developing, implementing and evaluating a genital herpes prevention and control program in San Francisco, which will be the first such program in the United States. Action Point Open House Action Point held an open house last Thursday evening to announce its move to 125 6th Street. The program works with HIV infected persons to help them adhere to the complicated medical treatments necessary to fight the disease. The agency is using innovative approaches to help clients stick to the complicated drug regiments including beepers indicating the time to take medication and a weekly payment to individuals who stick to their drug taking schedule. COMMUNITY HEALTH NETWORK LHH Has New Medical Director I invite the Health Commission to join me in welcoming Dr. Terry Hill as the new Medical Director at LHH. For the past 5 years Dr. Hill has been the CEO of the Geriatrics Medical Group and Medical Director for several skilled nursing facilities and a continuing care retirement community. He has been the Chair of the Nursing Facility Workgroup and a member of the Executive Committee of the California Coalition for Compassionate Care. I am sure the Commission joins me in welcoming Dr. Hill to his new position at LHH. Grand Rounds LHH Dr. William Thomas, a nationally renowned pioneer in implementing improved long-term care programs and environments known as the "Eden Alternative", presented a special Grand Round at LHH in July. The session was attended by approximately 400 caregivers from all over the Bay Area. Dr. Thomas also toured LHH and provided consultation to staff on short-term improvements that could be made at LHH while planning the new facility. Drs. Derek Kerr and Maria Rivero have been certified as Eden Alternative Associates. Emergency Department Changes To improve patient care and house staff education, and to help decrease diversion, the Emergency Department has implemented significant operational changes. As of August 1, 1999: There will no longer be separate surgical and medical areas. Patients will be triaged by acuity rather than the nature of their illness or injury. Areas will be renamed. Eastside will become Zone 1; Observation Ward, Zone 2; Medical Ward, Zone 3 and Westside, Zone 4. Signs will be posted to direct visitors and staff. All attending physicians will be Board Certified emergency physicians (part-time non-emergency staff will no longer be used). Clerical staff will be de-centralized. Each patient will be assigned a nurse (instead of a team) who is responsible for coordinating the patient's care. Departure Chief of Otolaryngology Kelvin Lee, M.D., the Chief of Otolaryngology, will be leaving at the end of the summer. Dr. Lee has been an outstanding clinician, teacher and leader among the medical staff. Breastfeeding Poster Contest The WIC program coordinates the Breastfeeding Activities for the County and recently held a poster contest. The Awards Reception was held today and WIC received a Proclamation from the Mayor announcing August 1 - 7th as San Francisco Healthy Breastfeeding Awareness Week. Women's Health Center The Women's Health Center has received a $9,400 grant from March of Dimes to help establish a breastfeeding center. The Women's Health Center currently has a breastfeeding support group every Friday morning. This group has been operating for the past year and a half and has been extremely successful in offering individualized support to women who have a problem breastfeeding or who have sick or premature babies. It has also fostered new friendships among our clients. The new Breastfeeding Center will provide supplies such as electric breast pumps which women can rent. Other breastfeeding support supplies are available. There will also be a video and book lending library. Potrero Hill Jobs and Health Fairs A job and health fair will be held August 6th from 1 - 7 at the Potrero Hill Park & Recreation Center at 801 Arkansas Street. The Potrero Hill Health Center in collaboration with Potrero Hill Family Resource Center will provide interactive information and services. UCSF Dental students will provide dental screenings. Entertainment will be provided by MAKE A CIRCUS! Please contact Arla Escontrias 206-2332 if you would like to Volunteer. Maxine Hall Immunization Fair Maxine Hall will host it's annual Immunization Fair August 20th from 8 a.m.- 3 p.m. The Fair will focus on back to school immunizations for children living in the Fillmore and Western Addition Districts. Staff will provide information about Maxine Hall and other community based programs. Please contact Arla Escontrias for more details. Report from Deputy City Attorney Jean Fraser, Deputy City Attorney, reported that the Department of Justice announced its closing of the investigation into billing practices at teaching hospitals (i.e., San Francisco General Hospital). 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH WEB SITE Anne Kronenberg, Executive Assistant to Dr. Katz and Director of External Affairs, provided an overview of the Department’s development of an accessible user-friendly web site. The Internet Policy Committee (IPC) developed policy procedures and guidelines. Department of Public Health’s presence on the web was in late January 1998. The webmaster is Barry Siler. The current web site includes the following information about the Department: Health Commission members, background, agendas, minutes, resolutions, policies, reports and Employee Recognition Award winners Department of Public Health Mission Statement and organization charts Alphabetical listing of all Community Health Network and Population Health and Prevention programs with links to information pages on programs Department of Public Health data and reports Clinic locations, hours and services Employment listings Vital statistics, birth and death information Laguna Honda information page designed to give up to the minute information on the November bond process HIV/AIDS prevention and service information Epidemiology and disease control information Vaccination and immunization requirements Links to many related health sites, including the Centers for Disease Control, State Department of Health Services, Cityspan, Fire Emergency Services, and much more Internet usage on the Department of Public Health Web Site (http://www.dph.sf.ca.us) has grown exponentially from a year ago. Since May 1998, the number of visits to the DPH web site increased by nearly 800%. An analysis of the past 12 months indicates a pattern of activity that validates the importance of the internet web site to the public. Ms. Kronenberg acknowledged the work of webmaster Barry Siler and other Department of Public Health staff – Jessica Wolin, Donna Childers, and Dave Counter. Commissioner Guy commended the Department for having the web site as a priority for the benefit of the public. She suggested for the web site the Department’s budget information developed by Chief Finance Officer Monique Zmuda would benefit the public.   6) UPDATE ON THE DEPARTMENT OF PUBLIC HEALTH STRATEGIC PLANNING Jimmy Loyce, Deputy Director of Health, and Tangerine Brigham, Director of Policy and Planning, presented a document providing the framework for a strategic planning initiative for the Department of Public Health. A copy of this document is available in the Commission Office. This document is structured in the following manner. The introduction section provides information on the value of strategic planning and how strategic planning can be beneficial to the Department. The next section entitled "Framework for Strategic Planning" summarizes the external and internal factors which impact the services provided by the Department of Public Health. The next several sections discuss the Department’s proposed strategic planning goals, key assumptions, strategic questions, outcomes and planning process. After a discussion of the strategic planning process, this document discusses the relationship of this strategic planning effort to divisional planning efforts within the Community Health Network and Population Health and Prevention. The final section of this document discusses the proposed communications plan for ensuring that all staff and interested parties are well informed about the strategic planning initiative as it proceeds. Background materials on the Department’s mission, organization, core functions, Federal and State regulations defining County mandates, the demographics of San Francisco, external changes in the health industry, and internal strategic planning issues were presented. The timeframe for this planning process would be: Phase I (Completion: November 1999) Task: Develop proposed strategic approach to financing issues for FY 2000-01 budget Phase II (Completion: January 2001) Task: Develop proposed strategic direction and overall plan Ms. Brigham acknowledged planner Richard Hodgson for his work on the Strategic Planning document. Public Speaker: John Gressman, SF community Clinic Consortium, supported the planning process and encouraged the Department to collaborate with all of its partners. Commissioners’ Comments: commended staff for a comprehensive presentation and encouraged expansion of evaluation procedures and inclusion of all DPH partners include the document on the web site SF Medical Society should be included in the planning process encouraged external input from the community to occur prior to the development of the budget for FY 2000-01 encouraged the use of existing planning documents and data tools from the public or advisory groups (i.e., youth reports, drug treatment, 1115 waiver, AB 1040, homeless death review) public input should be formally honored letters should be sent to all of the DPH advisory groups regarding the Strategic Planning in order to have some influence on the Department’s budget for FY 2000-01 update reports should be given at all of the Joint Conference Committees importance of evaluation and outcomes to measure effectiveness of programs encouraged Department to be more specific about where the Department wants to go shifting of priorities need to be noted encouraged the Department to make this a dynamic process with engagement from the line staff and public Ms. Brigham clarified that in the first phase, the task would be to develop a proposed strategic approach to impact on a limited basis the finance issues for the FY 2000-02 DPH budget. Dr. Katz stated the Department will utilize existing reports and will get input from the community advisory groups. He promoted the idea of bringing monthly updates to the full Commission so that the public can provide input all along the Strategic Planning process. He pointed out that the mission of the Department should drive this Strategic Planning process. This process is not about restructuring the Department. He also encouraged input on specifics from the Commissioners. Vice President Guy thanked the staff for its report. 7) OTHER BUSINESS/PUBLIC COMMENTS None. 8) CLOSED EXECUTIVE SESSION: A. PUBLIC COMMENT ON ALL MATTERS PERTAINING TO THE CLOSED SESSION. None. B. VOTE ON WHETHER TO HOLD A CLOSED SESSION TO CONFER WITH LEGAL COUNSEL. (SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.11(a).) Action Taken: The Commission voted to hold a closed session. The Commission went into closed session at 5:35 p.m. C. CLOSED SESSION PURSUANT TO GOVERNMENT CODE SECTION 54956.9 AND SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.11(b). CONFERENCE WITH LEGAL COUNSEL - EXISTING LITIGATION PATRICIA LOVELOCK V. CITY AND COUNTY OF SAN FRANCISCO, OFFICER GONG, ANDY LITOWSKY, CHIEF STEPHEN LA PLANTE, SUSAN WORD, PAUL LINDE, CITY AND COUNTY OF SAN FRANCISCO AND DOES 1-20. U.S. DISTRICT COURT #C98-3879 CRB. PROPOSED SETTLEMENT $6,000 The Commission came out of closed session at 5:55 p.m. D. RECONVENE IN OPEN SESSION: 1. POSSIBLE REPORT ON ACTION TAKEN IN CLOSED SESSION. (GOVERNMENT CODE SECTION 54957.1(a)(2) AND SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.14(b)(2).) Action Taken: The Commission approved the $6,000 settlement. 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 discussion held in closed session. The meeting was adjourned at 6:00 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission