Minutes of the Health Commission Meeting Tuesday, October 19, 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 3:05 p.m. Present: Commissioner Edward A. Chow, M.D. Commissioner Roma P. Guy, M.S.W. Commissioner Ron Hill Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. 2) APPROVAL OF MINUTES OF THE REGULAR MEETING OF OCTOBER 5, 1999 Action Taken: The Commission unanimously adopted the minutes of October 5, 1999. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) (3.1) Update on the Black Coalition on AIDS for the provision of HIV prevention services. (3.2) CHN-Pharmacy – Request for approval of contract renewal with Asereth Medical Services, Inc. in the amount of $800,000, for the provision of as-needed supplemental pharmacy personnel services, for the period of October 1, 1999 through June 30, 2000. (DPH contracted with Asereth for services totaling $2,600,000 during FY 1998-99. (3.3) CHN-SFGH – Request for approval of new contract with Catalyst Systems, LLC, in the amount of $56,000, for the provision of software, training, and Title 22 mandated system validation services for the patient Classification System in use by the Department of Nursing at San Francisco General Hospital, for the period of November 1, 1999 through June 30, 2000. (3.4) CHPP-Health Promotion – Request for approval of contract modification with Polaris Research and Development, in the amount of $20,825 for a total contract amount of $118,330, to provide comprehensive evaluation services to the Tobacco Free Project, for the period of July 1, 1999 through June 30, 2001. (DPH contracted with Polaris for services totaling $730,150 during FY 1998-99). (3.5) CHPP-Health Promotion – Request for approval of contract modification with San Francisco Study Center (SFSS), in the amount of $341,905 for a total contract amount of $680,800, to provide fiscal sponsor services for the Community Capacity Building Training Center for the Tobacco Free Project, for the period of July 1, 1999 through June 30, 2001.  (DPH contracted with SFSS for services totaling $1,444,242 during FY 1998-99). Commissioner Umekubo inquired about evaluations for these programs. (3.6) CHPP-Health Promotion – Request for approval of contract renewal with Men Overcoming Violence (MOVE), in the amount of $84,643, for the provision of family violence prevention services, for the period of October 1, 1999 through September 30, 2000. (DPH contracted with MOVE for services totaling $93,914 during FY 1998-99). (3.7) CHPP-Health Promotion – Request for approval of renewal contract with San Francisco Neighborhood Legal Assistance Foundation (SFNLAF), in the amount of $55,000, for the provision of family violence prevention support services, for the period of October 1, 1999 through July 31, 2000. (DPH contracted with SFLAF for services totaling $95,000 during FY 1998-99). (3.8) CHPP-HIV Prevention – Request for approval of retroactive contract renewal with Central City Hospitality House (CCHH), in the amount of $76,438, for the provision of HIV prevention services targeting behavioral risk youth, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with CCHH for services totaling $595,397 during FY 98-99). (3.9) CHS-Substance Abuse – Request for approval of sole source award and modification to the four-year contract with Asian American Recovery Services, Inc. (AARS), adding: $1,735,822 for the term of October 1, 1999 through June 30, 2000 for a total amount $3,053,870 in the second year of the four-year contract, and $1,230,866 for each of the remaining two years of the contract for a new annual amount of $2,548,914 for a revised total four-year agreement of $9,469,746 to maintain the provision of San Francisco Target Cities Project’s Drug Court, Acupuncture, PAES Treatment Access, and administrative support services. (DPH contracted with AARS for services totaling $1,318,048 during FY 1998-99). (3.10) CHPP-STD Prevention and Control – Request for approval to accept and expend a new two year grant from the Centers for Disease Control and Prevention in the amount of $514,106 for evaluation of the program entitled Screening Males for Chlamydia Trachomatis, for the period of September 30, 1999 to September 29, 2001. (3.11) CHN-Primary Care-Dental Services – Request to enter into an agreement between the Delta Dental Plan of California and the Department of Public Health through the Community Health Network as a participating provider to provide specific dental services to enrollees in the Healthy Families program, in the amount of up to $100,000 annually. Commissioner Chow requested an update on the evaluations for the tobacco projects. President Monfredini referred this to the appropriate Joint Conference Committee and then to the full Commission in December. Commissioner Parker requested clarification on the operations of the Delta Dental Plan. President Monfredini commended the Black Coalition on AIDS for its progress in the organization. Action Taken: The Commission unanimously approved the Consent Calendar of the Budget Committee. President Monfredini sadly reported the passing of Jean Jacobs, a leader in children and youth services and the founder of Coleman Advocates for Children and Youth. 4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) (Provides information on activities and operations of the Department). ADMINISTRATION President Strengthens Outreach for CHIP and MEDICAID Last week President Clinton announced plans to increase enrollment in Children’s Health Insurance Program (CHIP) and in Medicaid. As the Health Commission is aware, Healthy Families is California’s CHIP program. Approximately 12 million children lack health insurance nationally and half are eligible for either CHIP or Medicaid. Acknowledging the barriers to enrollment, President Clinton has directed the Secretaries of Health and Human Services, Education, and Agriculture "to focus children's health insurance outreach on a place where we know we can find uninsured children: schools." The President has asked the Department of Health and Human Services to coordinate this effort and develop a set of recommendations to improve enrollment through schools. The report is due to the President in six months. The Department will follow the development of these recommendations. COMMUNITY HEALTH NETWORK Senator Feinstein Announces $750,000 for Laguna Honda Hospital On October 16th, Senator Dianne Feinstein toured Laguna Honda Hospital. Senator Feinstein announced $750,000 of new federal money for the development of assisted living units at Laguna Honda Hospital. The money is part of a package which the U.S. Senate approved as a joint House-Senate conference report to fund the departments of Veterans Affairs, Housing and Urban Development, and related agencies for fiscal year 2000. The money will ease the cost to rebuild the public hospital if voters pass a bond measure in this November's election. Department staff will continue to monitor legislation and supplemental funding from the Federal and State government that can be applied to the cost of replacing Laguna Honda, and further defray increases to local property tax. I will keep the Commissioners apprised of progress on this important issue. POPULATION HEALTH AND PREVENTION Community Conference in Bayview On October 9th, the BVHP Health and Environmental Project (HEAP) and the Southeast Alliance for Environmental Justice (SAEJ) sponsored a conference to review health and environmental issues in the Bayview called "The Landscape of our Dreams." The conference focused on the BVHP Health and Environmental Task Force Community Survey, funded by grants from the California Endowment and San Francisco Foundation. Residents, researchers, agency staff, health educators and public health representatives met at the conference to discuss survey results. This interactive dialogue with community residents not only ensures HEAP’s accountability to the BVHP community but also enables residents to direct HEAP’s 2000-2001 agenda. The Conference unanimously endorsed development of a comprehensive and multifaceted approach to alcohol and drug prevention and treatment as next year’s top priority. Particular thanks go to Karen Pierce, Coordinator, BVHP-HEAP and Kevin Grumbach, MD, UCSF. Copies of the Community Survey are attached. Community Health Promotion and Prevention Award The California Telehealth and Telemedicine Center have awarded Community Health Promotion & Prevention and the Booker T. Washington Community Service Center in the Western Addition $8,800. These California Endowment funds will be used to buy computers and provide training to neighborhood residents so that they can better access and use the Internet for interactive health communication. Congratulations to Brian Katcher and Ginger Smyly, who wrote the grant. RAISE Health Promotion and the Children, Youth and Families Sections have been awarded a one-year community-planning grant to support RAISE (Raise African American Infant Survival: Erase disparities). The purpose of the project is to develop a Community Action Plan to decrease the disparity in infant mortality rates between African Americans and all other racial-ethnic groups. The project is funded under the Centers for Disease Control and Prevention, REACH 2010 Initiative to decrease health disparities among racial ethnic groups in key health issues. Isabel Auerbach (Perinatal Outreach/HP,) Tracy Moore (Black Infant Health Improvement Project/HP,) Joanne Kimata (Policy and Planning), Mildred Crear (CFY) and Ginger Smyly (HP) developed the grant and will be involved in its implementation. The planning will involve community participants, providers, and advocacy groups, starting with review and analysis of data and other assessments, review of best practices and development of the plan and evaluation for the San Francisco project. A two-three year demonstration grant is anticipated to follow Phase I, planning. Youth United Through Health Education The STD Program will receive a total of $31,950, over the next three years, for their participation in a University-wide AIDS Research Program. This collaborative project with the University of California, San Francisco will evaluate the Youth United Through Health Education Project (YUTHE). The YUTHE Project is a community-based peer led HIV/STD prevention program focused on increasing STD screening and treatment among African American adolescents in the Bayview Hunters Point neighborhood. The proposed research will include recruiting adolescents to complete a total of 600 street based surveys and 600 anonymous questionnaires in selected clinic-based settings in Bayview and in the control community of the Western Addition. The proposed evaluation research will use multiple data collection methods to assess changes in STD rates, and STD screening behavior in the intervention community compared with the control community. SF-COPA September 17th the San Francisco Collaborative Organized to Prevent Abuse sponsored a conference titled, "Behavioral Health and Domestic Violence: Creating Treatment Plans that Work." Over 200 individuals from the Department participated in the conference held at the State Building. The conference began looking at developing protocols and procedures to formally address domestic violence issues for our clients. Instrumental in the planning process of the conference were PHP personnel from various branches: Karen Ashcraft from Target Cities, Sylvia de Trinidad and Nora Goodfriend-Koven from the Health Promotion Section, Jean Miranda from the EAP, Rudy Aguilar from Community Substance Abuse Services, Mark Walden from Community Mental Health Services/Children's section, and Deputy Director Maria X Martinez. 1999 SF Kindergarten Retrospective Study The Communicable Disease Prevention Unit has completed the 1999 Kindergarten Retrospective Study that looks at the rates of immunization of kindergartners at the time they were two years old. The overall immunization rate for San Francisco is 70%, with rates among African-American children and Latino children at 57% and 63% respectively. Statewide the overall rate is 64% with African-American children at 55% and Latino children at 60%. All of San Francisco's numbers reflect an improvement from the last Kindergarten Retrospective Study done in SF in 1996; the overall rate was 60% and African-American and Latino children were at 54% and 55%, respectively. While we are doing better than the state average and reporting in significantly better than we were three years ago, the rates among African-American and Latino children show there is still much work to be done in reaching out to these communities. The Department, working with the San Francisco Immunization Coalition, has determined that low-cost immunization services are widely available throughout the City. We will continue our work and outreach with the Coalition to target the populations at greatest risk of falling behind their immunizations. SFGH Credentials Report 10/99 YTD New Appointments 20 138     Reinstatements 4 Reappointments 33 327     Delinquencies 0 0 Reappointment Denials 0 0 Resigned/Retired 17 166 Disciplinary Actions 0 0 Restriction/Limitations – Privileges 0 0 Changes in Privileges     Additions 0 26     Voluntary Relinquishment 0 6 Commissioner Chow requested immunization data within the Department and requested the Department to report the data to the full Commission. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR OCTOBER 1999 On behalf of the Commission, President presented the October Employee Awards to: Individual Nominee Division Nominated by: 1. Angelina Ehrlich Central Administration Director’s Office Staff Contact: Monique Zmuda 554-2610 2. Mivic Hirose CHN/SFGH-Medical Surgical Nursing Gene O’Connell 206-3517 A surprise award was given to Anne Kronenberg, Executive Assistant to the Director of Health, nominated by Dr. Mitch Katz. 6) PRESENTATION OF SCHOOL-BASED HEALTH SERVICES Jimmy Loyce, Deputy Director of Health, presented this update: During the FY 1999-2000 budget process, the Board of Supervisors placed $550,000 on reserve (one- time only) in the Department of Children, Youth and their Families (DCYF) budget for School-Based Health Services. The Board asked DCYF to convene a School Health Task Force with representatives from the Department of Public Health, the San Francisco Unified School District and numerous public and private agencies including private health plans, youth advocates, and health service providers. The Task Force was charged with developing an implementation plan for the delivery of school-based health services with fiscal sustainability beyond FY 1999/2000 because the reserved funds were one-time only. DPH, as an active participant on the Task Force, is presenting the report to the Health Commission before it is presented to the Board of Supervisors of DCYF. The presentation to the Board will detail school-based health service plans and ask for a release of funds from reserve. Commissioner Guy would like to see active coordination and management of this plan, including the costs for the plan. She still senses too much fragmentation for administration. Commissioner Sanchez would like to see a model where the school is a point of reference, with community resources being brought in with teachers and health providers. Private foundations could be outside resources. Anne Okubo, DPH Task Force member, stated that the Task Force is recommending a model that links community resources and existing school sites, with the intent to avoid duplication. Commissioner Chow expressed his concern on the lack of a coordinated approach. He sees a lot of data but no road map for the future. Public Speakers: Ali Weinhouse, Lincoln High School, supports health services on site Kate Favetti, Parent Teacher Student Association, supports work of Task Force Taj James, Coleman Advocates, supports the collaborative efforts Gilbert F. Criswell Cable Channel 53 Public Access, encouraged fiscally sound and responsible programs Commissioner Parker encouraged built-in incentives for all involved parties. Commissioner Guy requested cost information if the Department is in charge and from where monies would come. Dr. Katz stated the Department will give the Commission’s feedback to the Task Force and will bring back to the Commission a futher developed proposal. The Department will bring any policy change to the Commission for consideration. 7) PRESENTATION OF THE ANNUAL DEPARTMENT OF PUBLIC HEALTH REPORT Joanne Kimata, Planner with Policy and Planning, presented the 1998-99 Annual DPH Report. Ms. Kimata stated the report will be widely disseminated to officials, contractors, community-based groups, and administrators. The report is available on the DPH Website. The following individuals were acknowledged for their contributions to the contents of the report: Jessica Wolin, Randy Reiter, Diane Miller, Louise Nathe, Ken Cobry and his journalism students at SFSU, and Tangerine Brigham. The Annual Report includes: TABLE OF CONTENTS Message from the Director Health Commission Organizational Chart Hearing From You Assess and Research the Community’s Health Develop and Enforce Health Policy Provide Quality Health Services Partner with the Community The Department’s Advisory Groups The Department’s Contractors Appendix Demographics of Our City Health Status of San Franciscans The Department’s Clients and Services 1998-99 Financial Information The Department’s Workforce President Monfredini and Commissioners Guy and Sanchez commended the staff for an excellent, well laid-out report. 8) PRESENTATION OF HARM REDUCTION: A NEW APPROACH TO SUBSTANCE ABUSE SERVICES Dr. Alice Gleghorn and Dr. Josh Bamberger gave an overview of harm reduction, and its implementation in the Department’s activities. Dr. Gleghorn stated the philosophy of harm reduction is that the Department of Public Health programs and staff work with clients to improve their health status within the context and limits of their behaviors. The Department recognizes that individuals may engage in behaviors that can recognize their health and well-being. Staff take an approach that helps clients understand the risks associated with their behaviors, and encourages them to make choices which will reduce the total physical, social, economic, and emotional harm to themselves, their family, and their community. The issues around harm reduction are: Harm reduction interventions do not include condoning illegal activities, but do not make moral judgements about individual actions. Harm reduction strategies stress self-determination and individual responsibility for behaviors. Program eligibility criteria can make harm reduction practices difficult to implement The principles for integrating harm reduction into health services and traditional substance abuse treatment services are: Providers of services for those who misuse or abuse alcohol or other drugs shall deliver care in a culturally competent, nonjudgmental manner which demonstrates respect for individual dignity, personal strength, and self-determination. Service providers are responsible to the wider community for delivering interventions which will reduce the economic, social and physical consequences of substance abuse and misuse. Because those engaged in active substance use are often difficult to reach through traditional service venues, in order to reduce risk and service continuum must seek creative opportunities and develop new strategies to engage, motivate and intervene with potential clients. The goal of services for those who misuse and abuse substances is to decrease the short and long term adverse consequences, even for those who continue to use drugs. Comprehensive services for those who misuse or abuse drugs and/or alcohol must include strategies that reduce harm for those clients who are unable or unwilling to stop using and for their loved ones. Relapse or periods of return to substance use should not be equated with or conceptualized as "failures of treatment." Medical services are an important component of comprehensive services; those who misuse or abuse drugs and/or alcohol should not be denied medical services, and patients prescribed medications for the treatment of medical and psychiatric conditions, including addiction, must have full access to substance abuse treatment services. Each program within a system of comprehensive services will be stronger by working collaboratively with other programs in the system. Dr. Katz pointed out criticisms on harm reduction: enabling, promoting the legalization of drugs, and the numbers may not decrease. He specifically gave the harm reduction example of the methadone programs. Commissioners’ comments: acknowledge there are more questions than answers to the problem one size does not fit all recognition that there’s no 100% cure need for specificity in any proposed resolution on where to utilize harm reduction principles and research data need to be included in the proposed resolution financial implications need to be addressed success in needle exchange with strong documentation The Department will come back to the Commission with a proposed resolution. Commissioner Parker expressed how he’s impressed with Barbara Garcia’s leadership over the Population Health and Prevention division. 9) OTHER BUSINESS/PUBLIC COMMENTS* Public Comments: Gilbert F. Criswell, Cable 53 Public Access, again encouraged the Commission to televise its meetings; requested signage for the November 16th Prop Q hearing on Mt. Zion Hospital; and encouraged the Commission to improve health services for children. Commissioner Sanchez emphasized the Department’s local and national leadership in public health (i.e. – school based health programs, asthma programs in the African American community). The meeting was adjourned at 5:30 P.M. Sandy Ouye Mori, Executive Secretary to The Health Commission