Minutes of the Health Commission Meeting Tuesday, September 21, 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 3:05 p.m. Present: Commissioner Edward A. Chow, M.D. 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 Ron Hill 2) APPROVAL OF MINUTES OF THE REGULAR MEETING OF AUGUST 31, 1999. Action Taken: The Commission unanimously adopted the minutes of August 31, 1999. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Lee Ann Monfredini) Note: Commissioner Monfredini chaired the Budget Committee, with Commissioner Guy participating until the arrival of Commissioners Sanchez and Umekubo. (3.1) DPH-Administration – Request for approval to accept and expend two gifts bequeathed to SFGH from the estate of LeMar Hoaglin and the estate of Beatrice Druhe. (3.2) PHP-CHP&P-HIV Prevention – Progress report on the Urban Indian Health Board/Native American AIDS Project. (3.3) CHN-Primary Care-Homeless – Request for approval of modification to the contract with Central City Hospitality House (CCHH), in the amount of $399,439, for a total contract amount of $531,505, to provide drop-in and self help services for the homeless for the period of July 1, 1999 through June 30, 2000. (DPH contracted with CCHH for services totaling $595,397 during FY 1998-99). (3.4) PHP-CHP&P-HIV Prevention – Request for approval of renewal contract with Glide Foundation, in the amount of $232,495, for the provision of prevention services targeting behavioral risk populations in the Tenderloin neighborhood of San Francisco, for the period of July 1, 1999 through June 30,2000. (DPH contracted with Glide for services totaling $577,333 during FY 1998-99). (3.5) PHP-CHP&P-HIV Prevention – Request for approval of renewal contract with Iris Center: Women’s Counseling and Recovery Services, in the amount of $127,747, for the provision of HIV prevention services targeting females who have sex with male intravenous drug users (IDUs), females who have sex with male and/or female IDUs, females who inject drugs and have sex with females, females who have sex with females or with males, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with Iris for services totaling $1,837,854 during FY 1998-99). (3.6) PHP-CHP&P-HIV Prevention – Request for approval of a new contract with New Leaf: Services for our Community, in the amount of $168,750, for the provision of HIV prevention services targeting methamphetamine using males who have sex with males, including males who have sex with males and females, males who inject drugs and have sex with males or have sex with males and females, and at-risk transgenders, for the period of October 1, 1999 through December 31, 2000. (DPH contracted with New Leaf for services totaling $1,168,618 during FY 1998-99). Public Speaker: Gilbert Criswell, Channel 53 Public Access Journalist and member of the Thomas Paine for Common Sense in Government, questioned whether this contractor should be in compliance with Proposition I for this new contract; raised the investigation by the Human Rights Commission on alleged discriminatory practices by this contractor; and criticized the wording of the agenda item. (3.7) PHP-CHP&P-HIV Prevention – Request for approval of renewal contract with Stop AIDS Project (SAP), in the amount of $506,242, for the provision of HIV prevention services targeting males who have sex with males and males who have sex with males and females, and males who inject drugs and have sex with males or have sex with males and females, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with SAP for services totaling $793,094 during FY 1998-99). Public Speaker: Gilbert Criswell, Channel 53 Public Access Journalist and member of the Thomas Paine for Common Sense in Government, stated these are duplicative services; and this contractor should not be funded. (3.8) PHP-CHP&P-HIV Prevention – Request for approval of retroactive renewal contract with UCSF AIDS Health Project, in the amount of $455,676, for the provision of HIV counseling, testing and referral/partner counseling and referral services targeting populations with high behavioral risks for HIV infection, for the period of January 1, 1999 through December 31, 1999. (DPH contracted with UCSF for services totaling $7,888,724 during FY 1998-99). (3.9) PHP-CHP&P-HIV Prevention – Request for approval of renewal contract with UCSF AIDS Health Project, in the amount of $176,914, for the provision of HIV prevention services targeting behavioral risk populations, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with UCSF for services totaling $7,888,724 during FY 1998-99). (3.10) PHP-CHP&P-HIV Prevention – Request for approval of renewal contract with Westside Community Mental Health (WCMH), in the amount of $133,382, for the provision of prevention/ general education services targeting females and transgenders who have sex with males and inject drugs for the period of July 1, 1999 through June 30, 2000. (DPH contracted with WCMH for services totaling $13,932,678 during FY 1998-99). (3.11) PHP-CHP&P-Immigrant Health Services – Request for approval of sole source renewal contract with International Institute of San Francisco (IISF), in the amount of $323,440, for the provision of refugee and immigrant preventive health services through the Newcomers Program, for the period of October 1, 1999 through September 30, 2000. The sole source is for an annual amount of $323,440 for the period of October 1, 1999 through September 30, 2003. (DPH contracted with IISF for services totaling $477,643 during FY 1998-99). (3.12) PHP-CHS-Housing – Request for approval of renewal contract with Baker Places, in the amount of $657,568, to provide client-centered mental health and substance abuse services, including outreach, counseling and case management, as a part of a comprehensive array of health services delivered by the Health, Housing and Integrated Services Network at supportive housing sites, targeting homeless and recently homeless very low-income clients of the City/County of San Francisco for the period of July 1, 1999 through June 30, 2000. (DPH contracted with Baker for services totaling $13,647,803 during FY 1998-99). (3.13) PHP-CHS-Housing – Request for approval of renewal contract with Caduceus Outreach Services, in the amount of $95,480, to provide case management and psychiatric treatment services, policy and advocacy on behalf of the clients and recruitment, training and support of pro-bono psychiatrists who deliver the psychiatric services to very low-income, formerly homeless adults with psychiatric disabilities who reside in the City/County of San Francisco for the period of July 1, 1999 through June 30, 2000. (DPH contracted with Caduceus for services totaling $95,480 during FY 1998-99). (3.14) PHP-CHS-Housing – Request for approval of renewal contract with Catholic Charities of San Francisco (CCSF), in the amount of $410,626 to provide residential housing with comprehensive support services at Peter Claver Community, targeting homeless, low-income persons with disabling HIV or AIDS, who may have histories of substance abuse or mental illness, between the ages of 18 and 59 years who reside in the City/County of San Francisco for the period of July 1, 1999 through June 30, 2000. (DPH contracted with CCSF for services totaling $2,540,469 during FY 1998-99). (3.15) PHP-CHS-Housing – Request for approval of sole source renewal contract with Community Housing Partnership (CHP), in the amount of $84,624, to provide support services to the tenants of the Rose Hotel to assist them in gaining and maintaining housing and stability as part of a comprehensive array of health services delivered by the Health, Housing and Integrated Services Network at supportive housing sites, targeting homeless and recently homeless very low-income residents of the City/County of San Francisco for the period of July 1, 1999 through June 30, 2000. (DPH contracted with CHP for services totaling $84,624 during FY 1998-99). (3.16) PHP-CHS-Housing – Request for approval of new retroactive sole source contract with Mission Housing Development Corporation, the lead agency and fiscal agent for the Mission SRO Collaborative, in the amount of $245,000, for the provision of SRO tenant outreach, community stabilization, SRO/landlord fire safety and prevention, SRO hotel code enforcement monitoring and SRO emergency planning and response, for the period of July 1, 1999 through June 30, 2000. (3.17) PHP-CMHS – Request for approval of modification to the contract with St. Mary Pharmacy Management Services (SMPMS), to extend the term for five months for a total contract period of July 1, 1998 through March 1, 2000 and to increase compensation by $633,045 for a total contract amount of $3,559,511. (DPH contracted with SMPMS for services totaling $2,926,466 during FY 1998-99). (3.18) PHP-CSAS – Request for approval of renewal contract with Larkin Street Youth Center (LSYC), in the amount of $263,179 per year, for the provision of prevention and intervention substance abuse services targeting homeless youth aged 12 to 21 years, for the period of July 1, 1999 through June 30, 2003. (DPH contracted with LSYC for services totaling $990,093 during FY 1998-99). Public Speaker: Michael Petrelis, AIDS Accountability Project, expressed objection to funding for the Stop AIDS Project and the UCSF AIDS Health Project; and encouraged the Department to fund other leading causes of death. Gilbert Criswell, Channel 53 Public Access Journalist and member of the Thomas Paine for Common Sense in Government, objected to the approval of #3.6 and #3.7; advocated no funding to the Stop AIDS Project; and any other points raised earlier during the Budget Committee. See comments under #3.6 and #3.7. Commissioner Chow requested clarification on #3.17. Action Taken: The Commission unanimously approved the Consent Calendar of the Budget Committee, with Commissioner Sanchez abstaining on #3.8 and #3.9. 4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) (Provides information on activities and operations of the Department). ADMINISTRATION Laguna Honda Hospital Replacement Planning Last week, Senator Speier and Assemblyman Kevin Shelley held a press conference to discuss Senator Speier’s Bill, SB 1128. SB 1128 would allow a county which provides skilled nursing care (i.e., where the skilled nursing facility is a distinct part of an acute care hospital), to be eligible to receive supplemental reimbursement for capital projects, such as hospital replacements. The Bill was co-authored by Senator John Burton and Assembly Member Kevin Shelley. SB 1128 has been forwarded to Governor Davis for consideration. The criteria for participation under SB 1128 are that the facility: provides services to Medi-Cal recipients, be a distinct part of an acute care hospital providing skilled nursing care and supportive care, have no less than 300 licensed skilled nursing beds, have an average Medi-Cal patient census of at least 80% of the total patient days, and be owned by a County. Laguna Honda Hospital and Rehabilitation Center meets the eligibility criteria for SB 1128. San Francisco qualifies as a City and County. Under SB 1128, supplemental reimbursement is only for the skilled nursing component of a capital project that serves Medi-Cal patients. The supplemental Medi-Cal reimbursement occurs after the new facility is built and occupied. The supplemental payment is based on a facility incurring increased capital costs. The supplemental funds would most probably be reflected as an increase in the current Medi-Cal reimbursement rate received by the skilled nursing facility. The increase in the Medi-Cal reimbursement is associated solely with the additional costs incurred for capital construction. No State General Fund expenditures are included under SB 1128. The locality transfers required matching funds to the federal government through the State. The federal government provides additional funding based upon a negotiated and agreed amount related to the rebuilding costs. The federal funds are sent through the State to the locality. The locality will ultimately receive funding in excess of the original amount that was transferred to the federal government. This is referred to as "leveraging." At this time, the exact amount of federal funding is not known. This will be part of a negotiation process with the federal government. The supplemental funds will be used to pay off the debt service (i.e., principal and interest of the construction project) from the capital construction costs. The supplemental funds will reduce the amount of money that property taxpayers will pay for the Laguna Honda Hospital replacement project. The Department would like to acknowledge the support that it has received from all members of the City’s Sacramento delegation. We are very appreciative of Senator Speier for authoring Senate Bill 1128. The Department will keep the Health Commission apprised of SB 1128. Sacramento County’s Indigent Care Program Earlier this month, Sacramento County argued before the State’s Supreme Court that it should be able to end or restrict medical care to the poor during recessions and if economic downturns exist. Sacramento’s County Counsel bases its argument on State laws which were passed in 1992 during the last major recession and designed to relieve counties of their historic obligations to provide health care to those who cannot receive services elsewhere. It is Sacramento County’s belief that eliminating or curtailing health services to individuals at certain income levels is legal. The State Court of Appeals in Sacramento had ruled in the County’s favor. However, an injunction was issued by the Sacramento Superior Court blocking the County from making reductions in health care to the indigent. The California Supreme Court is expected to issue its decision within 90 days. At issue is the scope of a locality’s obligation under California Welfare and Institutions Code Section 17000. The Supreme Court decision could have far reaching implications for all California counties. The City Attorney and the Department will closely follow this issue and report the Supreme Court’s findings to the Health Commission. National Poll Supporting Safety Net Hospitals A recent National Association of Public Hospital poll finds overwhelming support among voters for preserving and protecting safety net hospitals. The poll was the first ever done to examine the public’s attitude towards public safety net hospitals and the role these hospitals have in America’s health care system. The poll indicated that voters in urban and suburban areas, irrespective of political party affiliation, believed that more tax dollars should go to support safety net hospitals and health systems. Key findings of the poll include: 96% of the respondents said that it is important that safety net hospitals and clinics be available 86% of the respondents said that tax dollars should go towards supporting safety net hospitals and clinics 61% of the respondents said that they would personally be willing to contribute more to support safety net hospitals In addition to the general findings regarding safety net hospitals, the poll also found that a high percentage of urban and suburban Americans have been uninsured at some point or believe they will be uninsured in the future. This NAPH poll was conducted in May 1999 by the research firm Lake, Snell, Perry & Associates. The findings were published on September 13, 1999, in the Health Affairs journal. Healthy Families First Year Report The Healthy Families Program celebrated its one-year anniversary this summer. The Managed Risk Medical Insurance Board, the State agency administering this program, recently released the first year report. During the first year, Healthy Families enrolled 40% of the target population. At the end of June 1999, 134,000 children have been enrolled in the program. As of September 1999, over 161,000 children had been enrolled in the program statewide. San Francisco’s current enrollment within Healthy Families is 5,400. The basic profile of children enrolled into the Healthy Families program is as follows: average family income for a family of three is $20,620; for a family of four, the average income if $24,843, 51% of children enrolled are boys and 49% are girls, 75% of the families have four persons or less, 54% of children enrolled in the program are Latinos, 18% are Caucasians, 15% are Asian-Pacific Islanders, 3% are African-Americans and 10% of the population did not provide ethnic identity information, 27.5% of the children are ages 1 –5, 49% are aged 6 – 12 and 23.5% are aged 13 – 18, and English is the primary language in 49% of the households, Spanish is the primary language in 37% of the households, and Asian languages (Cantonese, Korean, Vietnamese) in 11% of the households. The first year report notes that North East Medical Services (NEMS) and four other community-based organizations within the State helped enroll a significant number of children into either Healthy Families or Medi-Cal. The report also provides information on where children are enrolled in Healthy Families within the State. San Francisco zip codes 94112, 94113, and 94134 are listed as being among the top 25 zip codes statewide with the highest Healthy Families enrollment. POPULATION HEALTH AND PREVENTION Recognition My congratulations to Katrina Pierce, Family Nurse Practitioner at Tom Waddell Clinic. Katrina has been chosen to receive the Dolores Housing Program Award for her energy and dedication in attending to the needs of homeless people in the Mission and Castro neighborhoods, and providing housing for those living with HIV/AIDS. Suicide Prevention Responding to Surgeon General David Satcher’s "call to action" to combat suicide in America, San Francisco will be hosting a "Suicide: Prevention and Early Intervention" Conference on September 23, from 8:00 a.m. to 4:40 p.m. at UCSF Laurel Heights Conference Center. The conference will feature several nationally prominent speakers, including keynote speaker Virginia Trotter Betts, MSN, JD, RN, Senior Policy Advisor to Secretary of the U.S. Department of Health and Human Services and the Surgeon General; Michael J. Bennett, MD, Associate Professor of Psychiatry at Harvard Medical School; and Jan Fawcett, MD, a leading researcher in depression and suicide. The local perspective on suicide in San Francisco will be addressed by Peter Forster, MD, Medical Director for the Community Mental Health Services in San Francisco, and Associate Clinical Professor of Psychiatry at UCSF. For more information contact Carol Peng at (415) 551-0520 or Pam Beach at (415) 547-5917. Latino Health Fairs A Latino Behavioral Health Fair will be held at the Mission Cultural Center for Latino Arts, 2868 Mission Street, Saturday September 25th from 2:00 p.m. to 6:00 p.m. The fair is free and is sponsored by CMHS and CSAS, among many others. A Latino Conference sponsored by CMHS, CSAS, and Concordia Seminars will take place on October 15, at Bethel Church, 24th Street and Valencia. Deadline for registration is October 8th; registration fee is $25. For more information call 255-3028. Special Projects - Action Point The Urban Health Study of UCSF, in collaboration with the Department of Public Health, has been granted funds of $275,000 each year for three years to evaluate the Action Point Adherence Project. These funds come from the Health Resources Service Administration, Special Projects of National Significance. Congratulations to all those in the department who participated in writing the grant, including Jessica Wolin, Laura Thomas and Joshua Bamberger. The grant will allow the Urban Health Study to evaluate the effect of Action Point to improve quality of life, biologic markers and life expectancy among the urban poor, HIV positive individuals who access services at the Action Point Center on Sixth Street. STD Control The STD Annual Morbidity Summary was released today. In 1998 there was a 24% increase in cases of gonorrhea among San Francisco residents, from 1497 in 1997 to 1852 in 1998. This represents a continued increase from 1996 when there were 1449 cases but is still much less than previous counts in the early 1980's when there were more than 16,000 cases of gonorrhea. Cases of rectal gonorrhea continue to increase from 129 cases in 1997 to 158 cases in 1998. The number of reported cases of chlamydia increased by 16%, from 2253 in 1997 to 2611 in 1998. Since chlamydia infection is predominantly asymptomatic, increases in cases may represent enhanced screening efforts among adolescents, family planning clinics and the County jail rather than increased transmission. Syphilis continues to decline with a 29% decrease in total cases from 187 in 1997 to 132 in 1998. The number of early or recently acquired cases declined by 45% from 73 in 1997 to 40 in 1998. San Francisco STD Services is engaged in an effort to eliminate syphilis within the County with expanded awareness and screening among high-risk populations and increased outbreak control activities. Data on visits to City Clinic, screening programs and community outreach activities will be forthcoming in a supplementary report. COMMUNITY HEALTH NETWORK Appointment The CHN is pleased to announce that Laguna Honda Hospital has a new medical director, Dr. Terry Hill. Dr. Hill attended medical school at UCSF and did volunteer work for the San Francisco Department of Public Health in the 1980s. He was a resident and chief resident at Highland General Hospital in Oakland, then a geriatrics fellow and NIH research fellow at Stanford. For the past five years he has practiced in Oakland. Until coming to Laguna Honda he was Medical Director for Geriatric Services at Summit Medical Center as well as medical director of several community nursing facilities. He served on the Alameda County Long Term Care Planning Council. Dr. Hill is a Clinical Assistant Professor in the Stanford Department of Medicine and is on the core faculty of the Stanford Geriatric Education Center. He chairs a statewide effort to improve palliative care in skilled nursing facilities, funded by the Robert Wood Johnson Foundation, and is active in local, state and national organizations devoted to geriatrics and long term care. Melissa Welch, M.D., Ph.D. Promotion I am pleased to announce the promotion of Dr. Melissa Welch, Chief Medical Officer of the Community Health Network of San Francisco to Associate Medical Professor to the Department of Medicine, School of Medicine, University of California, San Francisco. Dr. Welch is certainly most deserving of this appointment and has demonstrated her competence and leadership skills, both administratively and clinically within the Community Health Network. Chinatown Public Health Center Grants Chinatown Public Health Center has received two mini-grants starting September 1, 1999 to develop the Chinese Cancer Survivors Leadership Development Program. The grantors were American Cancer Society, California Division and West Bay Breast Cancer Early Detection Program (BCEDP). The project plans to recruit and train 20-25 Chinese speaking cancer survivors to become spokespersons on cancer issues in the Chinese community. Some will appear in Chinese media talk shows to speak on cancer issues in the Chinese community and to share their experiences living with cancer. Some will become volunteers in various cancer programs and serve as linkages to available resources and services. The goal of this program is to increase awareness on cancer and the importance of early detection and screening in the Chinese community. Health Educator, Lei-Chun Fung coordinates the program, at Chinatown Public Health Center. SFGH Medical Staff Appointments 9/99 YTD New Appointments 15 118 Reappointments 26 294 Delinquencies 0 0 Reappointment Denials 0 0 Resigned/Retired 9 149 Disciplinary Actions 0 0 Restriction/Limitations – Privileges 0 0 Changes in Privileges:    Additions 1 23    Voluntary Relinquishment 0 6 Current Statistics – as of 9/8/99 Active Staff 326 Affiliate Professionals 132 Courtesy Staff 534 Referring Staff 54 Total Members 1070 Applications in Process 121 Reappointments in Process 161 Commissioners Guy and Chow, pointing out the various areas in the Healthy Families Program that need attention, requested periodic updates on this program to the full Commission. Public Speaker: Michael Petrelis, AIDS Accountability Project, questioned the availability to the public of the annual STD Report; raised questions on statements in the report; and again raised when will a Town Hall meeting be held with the gay community. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR SEPTEMBER 1999 On behalf of the Commission, President Monfredini presented awards to the following employees: Team Division SFGH Payroll Team CHN – SFGH Human Resources Nenita Bautista Elena Domingo Martha Espana Anna Kwan Jorge Martinez Betty Matthes Grace Ogden Vilma Ruiz Peter Tan Nursing Office Payroll Team Henry Brogonia Arnold Dignadice Carol Sites 6) CONSIDERATION OF AN AMENDMENT TO THE SAN FRANCISCO GENERAL HOSPITAL GOVERNING BODY BYLAWS REGARDING THE MEDICAL STAFF BYLAWS Gene O’Connell, Executive Administrator of San Francisco General Hospital, reported that the Joint Commission and the California Medical Association issued recommendations following the survey of SFGH last May. One of the supplemental recommendations, also known as "Type II Recommendations", was that neither the Medical Staff Bylaws nor the Governing Body Bylaws preclude a unilateral amendment of the medical staff documents. To address this issue, it is proposed that a sentence be added to Article VIII, Section 2.D on page 9 of the Governing Body Bylaws, as follows: "Neither the Governing Body nor the Medical Staff may unilaterally amend the Medical Staff Bylaws or Rules and Regulations." The SFGH Medical Staff will propose that this same sentence be added to the Medical Staff Bylaws at the time that they recommend their next set of amendments. This amendment was already discussed at the September 14, 1999 Joint Conference Committee-San Francisco General Hospital. The JCC-SFGH supports the proposed amendment. For a future discussion, Commissioner Chow raised two questions: Article VII: Hospital Administrations, Section 3C, should "Executive" be added in front of "Committee"? Article VIII: Medical Staff, Section 1B, should "Executive" be added in front of "Officer"? These questions will be researched and referred to the appropriate process. Action Taken: The Commission unanimously approved the following amendment to the Governing Body Bylaws: "Neither the Governing Body nor the Medical Staff may unilaterally amend the Medical Staff Bylaws or Rules and Regulations". 7) 4th QUARTER REPORT OF DEPARTMENT OF PUBLIC HEALTH REVENUES AND EXPENDITURES FOR FY 1998-99 Monique Zmuda, Chief Financial Officer, presented the following: The Department of Public Health is projecting a year-end surplus of $0.8 million for FY 1998-99 based on expenditures and revenues for the fourth quarter ending June 30, 1999. Revenue shortfalls of $23.8 million are projected to be offset by expenditure savings of $24.6 million. This projection includes three General Fund supplemental appropriations approved by the Board of Supervisors last fiscal year. The supplemental appropriations include: 1) $5.6 million to offset revenue losses at Laguna Honda Hospital; 2) $1.1 million to provide pharmaceutical services to indigents for mental health services; and 3) $19.2 million to offset revenue shortfalls at San Francisco General Hospital. PROJECTED FY 1998-99 YEAR-END SURPLUS/DEFICIT The fiscal year will officially close in late October or November after the year-end audit is completed in October. Estimates of the year-end surplus of $0.8 million could be adjusted either upward or downward prior to the official close. Possible adjustments that could occur during the close include: the Controller’s close out of prior year accounts; increases or decreases in reserves for audit disallowances, as required by the annual audit; increases or decreases in estimates of bad debt, accounts receivable or other audit adjustments; changes in the general fund subsidy calculation prepared by the Controller; or a final determination of the amount of expenditures to be carried forward into the next fiscal year. In addition, there are two possible adjustments in the Population Health and Prevention Division that could impact the year-end surplus. One potential adjustment is a $4.7 million reduction in revenues due to an outstanding receivable from FY 1991-92 that may be recognized by the Controller in FY 1998-99. However, this $4.7 reduction may be offset by a $4.2 million decrease in expenditures associated with the close out of prior year encumbrances that are no longer necessary. The net impact of these two adjustments will result in a surplus of $0.3 million. President Monfredini and Dr. Katz complimented Ms. Zmuda on her professional work. Commissioner Chow reinforced the importance of having an overall Department Chief Financial Officer. He also expressed his concern about primary care in terms of revenues and the efficient delivery of services. He would like to have an in-depth discussion on primary care within the overall health care system. Commissioner Umekubo requested clarification on the outstanding receivables for FY 1991-92. Commissioner Guy emphasized the need to understand the Department of Psychiatry in relation to primary care. 8) PROJECTED FY 1998-99 YEAR-END SURPLUS/DEFICIT The fiscal year will officially close in late October or November after the year-end audit is completed in October. Estimates of the year-end surplus of $0.8 million could be adjusted either upward or downward prior to the official close. Possible adjustments that could occur during the close include: the Controller’s close out of prior year accounts; increases or decreases in reserves for audit disallowances, as required by the annual audit; increases or decreases in estimates of bad debt, accounts receivable or other audit adjustments; changes in the general fund subsidy calculation prepared by the Controller; or a final determination of the amount of expenditures to be carried forward into the next fiscal year. In addition, there are two possible adjustments in the Population Health and Prevention Division that could impact the year-end surplus. One potential adjustment is a $4.7 million reduction in revenues due to an outstanding receivable from FY 1991-92 that may be recognized by the Controller in FY 1998-99. However, this $4.7 reduction may be offset by a $4.2 million decrease in expenditures associated with the close out of prior year encumbrances that are no longer necessary. The net impact of these two adjustments will result in a surplus of $0.3 million. President Monfredini and Dr. Katz complimented Ms. Zmuda on her professional work. Commissioner Chow reinforced the importance of having an overall Department Chief Financial Officer. He also expressed his concern about primary care in terms of revenues and the efficient delivery of services. He would like to have an in-depth discussion on primary care within the overall health care system. Commissioner Umekubo requested clarification on the outstanding receivables for FY 1991-92. Commissioner Guy emphasized the need to understand the Department of Psychiatry in relation to primary care. 8) PUBLIC COMMENTS Gilbert Criswell, Channel 53 Public Access Journalist and member of the Thomas Paine for Common Sense for Government, raised the following issues: When will the Commission conduct its meetings at City Hall and be televised for the public? Eliminate the Stop AIDS Project. Focus on prevention for the general public. The meeting was adjourned at 4:30 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission