Minutes of the Health Commission Meeting Tuesday, February 1, 2000 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 Roma P. Guy, M.S.W. Commissioner Ron Hill Commissioner Harrison Parker, Sr., D.D.S. Commissioner John I. Umekubo, M.D. Absent: Commissioner Edward A. Chow, M.D. Commissioner Lee Ann Monfredini Commissioner David J. Sanchez, Jr., Ph.D. 2) APPROVAL OF MINUTES OF THE REGULAR MEETING OF JANUARY 18, 2000 Action Taken: The Commission unanimously adopted the minutes of January 18, 2000 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) (3.1) DPH-Administration – Request for approval to accept and expend a gift of $96,154 bequeathed to San Francisco General Hospital by the estate of Kathleen Mason. (3.2) CHN-Office of Managed Care – Request for approval of an Administrative Services Agreement between the Department of Public Health, CHN and UCSF Stanford Health Care, on behalf of UCSF Medical Center and the UCSF Stanford Medical Group Facility at UCSF, to provide administrative services to their enrollees of the San Francisco Health Plan, for the period of January 1, 2000 to December 31, 2000. (3.3) PHP-CSAS – Request for approval to accept and expend a new grant from the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, in the amount of $475,000, for three years, for the creation of a community based medically managed detoxification program, with a sole source modification to the contract with Baker Places. Inc. (3.4) CHS-HIV Health and Prevention Services – Request for approval of new retroactive contract with CompassPoint Nonprofit Services, formally known as the Support Center for Nonprofit Management, in the amount of $252,000, to provide consultation and technical assistance services targeting HIV Health Service CARE providers, for the period of November 1, 1999 through February 29, 2001. Action Taken: The Commission approved the Consent Calendar of the Budget Committee. 4) DIRECTOR’S REPORT (Report on activities and operations of the Department, and may include activities within the Community Health Network and Population Health and Prevention Divisions) (Mitchell H. Katz, M.D., Director of Health) POPULATION HEALTH AND PREVENTION Pedestrian Safety In response to the increase in pedestrian injuries and fatalities, the Community Health Education Section (formerly Health Promotion) of CHP&P is involved in a number of collaborations that support community actions for safer streets. The Mission and Tenderloin neighborhood "Safe Communities" planning grant was funded by the State Department of Health Services January 1, 2000. St. John's Educational Threshold Center, San Francisco Neighborhood Safety Partnership and Walk San Francisco will work with the Health Department to develop local strategic planning to reduce pedestrian injuries. The State will consider proposals for implementation funding based on this planning process. The California Office of Traffic Safety (OTS) has awarded CHP&P a 2-year grant of approximately $450,000 for a "San Francisco Pedestrian Safety Project," scheduled to start in April 2000. This project will include data linkage efforts, bringing together Police, ER, Paramedic and Parking and Traffic Engineering data to develop a basis for targeting and evaluating interventions, with the collaboration of Community Health Epidemiology and the SF Injury Center. The Community Health Education Section will initiate a Community Capacity Building effort that will provide mini-grants to community groups organizing to improve pedestrian safety. The Community Health Education Section has been part of the Traffic Calming Technical Working Group of the San Francisco County Transportation Authority. A recommended set of guidelines for traffic calming, with a priority on pedestrian and bicycle safety, and a proposal for continued involvement by the Health Department in the community education and advocacy aspects of traffic calming, went to the Commissioners on January 24, 2000. Michael Radetsky, from the Health Education Section, will be a "resource person" for the workshop on "Pedestrian Safety, Traffic Calming & Walkability" at a day-long forum being put on by the U S Department of Transportation at the Fairmont Hotel on February 8, 2000. Crisis Intervention at Cobb School Sai-Ling Chan-Sew of CMHS received a call from the Department of Children, Youth and Families (DCYF) January 19th, requesting help with a critical incident at Cobb School. A paroled father, under restraining order to stay away from his son, had called the school and threatened to harm the principal if she prevented his visitation. Sai-Ling was asked to go to school to facilitate a discussion between the police, SFUSD administration, and DCYF, regarding the best plan for the identified student. She facilitated a meeting with all the parties that afternoon. She then met with the staff and parents to identify issues of immediate concern for the rest of the student body. On January 20th, Sai-Ling returned to the school with Keith Hutchinson, the director of Child Crisis and met with administrators the principal, and teachers. They went through the issues listed the day before, and created action plans and point person for the plan. Staff expressed moderate to high level of anxiety and fear. Sai-Ling spoke to some of the staff individually, and Keith deployed two Child Crisis staff to be stationed at the school for the remainder of the day to speak with teachers and staff. The father turned himself in later that same day. COMMUNITY HEALTH NETWORK New Mission Pediatric Clinic Site Beginning February 7, 2000, the Castro-Mission Health Center (CMHC) will be stationing its Monday afternoon Mission Pediatric Clinic at the site of CARECEN (Central American Resource Center), 1245 Alabama Street near 24th Street. The target population is Spanish speaking families with infants to 12 year-olds. Wellness services will be provided, including immunizations. For continuity of care, referrals will be made to primary care providers at San Francisco General Hospital's Children's Health Center (6M) or the Family Health Center, and CMHC. SFGH Credentials Report 1/00 1999 YTD New Appointments 23 211    Reinstatements 4 Reappointments 32 417    Delinquencies 0 0 Reappointment Denials 0 0 Resigned/Retired 12 201 Disciplinary Actions 0 0 Restriction/Limitations – Privileges 0 0 Changes in Privileges    Additions 1 29    Voluntary Relinquishment 0 6 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH FY 1999-00 REVENUES AND EXPENDITURES FOR THE FIRST SIX MONTHS PRESENTATION AND CONSIDERATION OF A DEFICIT REDUCTION PLAN FOR FY 1999-00 Monique Zmuda, Chief Financial Officer, gave the 2nd quarter FY 1999-00 Revenue and Expenditure Report, with a proposed reduction plan addressing the deficit (Attachment) Commissioner Parker pointed out the biggest problem is the shrinking reimbursement rates, having to sacrifice our infrastructure, thereby having our healthcare system to crumble. He encouraged the Department to find other ways to correct the deficit. Commissioner Umekubo observed that as Department revenues stay the same or decrease, the Department is always "catching up." President Guy appreciates the Department giving the facts, even though it is not good news. These trends at the State and Federal levels have been anticipated. Additionally, our population mix is changing; and there is a need for more chronic care and less acute care. That is why the Commission requested the Department to develop a Strategic Plan. Simultaneously with the development of this Strategic Plan, the Department has to address a deficit within the present fiscal year. To compound this dilemma, there are no new monies to invest in any changes in direction or priorities. The Commission, by consensus, directed the Department to move forward with its deficit reduction plan. Public Speakers: Johnnie Burnside, SFGH patient, opposed the move of the UC Renal Dialysis Unit from SFGH to another neighborhood; this will cause hardship to patients. Ann Kyle, SFGH patient, wants Renal Dialysis unit to stay at SFGH. Shannon Coughlin, CHRIA, patient advocate, promotes universal healthcare; is in close contact with patients and providers; encouraged Commission not to live within the budget. Nora Roman, R.N., Emergency Coalition to Save Public Health, stated the healthcare system is already decimated and is in a crisis; SFGH is behind in submitting Medicare billing; look at ways not to cut the budget. Dale Butler, SEIU Local 790, stated this is an unacceptable plan to cover the deficit; referred to a booklet "State of Health Issuance" at: http//chpps.berkeley.edu/hpp/ 6) PRESENTATION OF THE UNIVERSITY OF CALIFORNIA AT SAN FRANCISCO AFFILIATION AGREEMENT Tony Wagner, CHN Executive Administrator; Gene O’Connell, SFGH Executive Administrator; and Dr. Philip Hopewell, UCSF Associate Dean, presented the SFGH/UCSF Affiliation Agreement, which is the framework for the relationship between SFGH and UCSF, and sets forth the agreements and understandings of the parties respective to their responsibilities, rights, obligations and expectations. The contract defines the services purchased by SFGH and the amount paid to the University. They included in their presentation: History Budget Process Monitoring and Evaluation 1999-2000 Budget Description of Services Utilization of House Staff University Contributions In the changing health care environment that affects both SFGH and UCSF, there are now challenges to both organizations. Within the context of the DPH Strategic Goals and the budget process, both UCSF and SFGH are in the process of reviewing all services. The full report is available at the Commission Office (554-2666). Commissioner Umekubo requested clarification on physician professional fees and where those revenues go. These revenues are retained by the University and used to pay for clinical and academic programs only at SFGH. Commissioner Hill thanked the Department and UCSF for the very informative report. Commissioner Parker expressed his appreciation for the information and orientation on the Affiliation Agreement. He feels it is essential to have this partnership and observes the partnership to be working well. President Guy sees the DPH/UCSF partnership as positive; and in these changing times, the budget problems need to be solved as partners. The trend is more focused on population health and community-based care. She also raised the question of productivity studies and their availability. Ms. O’Connell stated the UCSF Affiliation Agreement has a budget amount of $52,135,170. The preparation of the annual contract budget is done in conjunction with the preparation of the SFGH budget and according to the process outlined in the Affiliation Agreement. The SFGH Administrator and CHN Chief Financial Officer provided the Associate Dean’s Office with utilization projections and anticipated changes in the scope of purchased services. The contract budget is then brought to the Executive Administrator of the Community Health Network. Dr. Hopewell emphasized the interdependence between SFGH and UCSF and the mutual benefits for both parties, including the community as a whole. He cited examples of national models at SFGH in partnership with UCSF, such as the HIV Clinic and the Tuberculosis Center. He also referred to the impact of the research projects at SFGH. Many areas of research (i.e., homelessness, long-term care, and substance abuse) are relevant to the community. Acknowledging this is the first time the Health Commission has been presented with an actual document on the U.C. Affiliation Agreement, Dr. Katz indicated his goal is to give the Health Commission an opportunity to understand the Agreement and be able to set priorities in relation to the budget. It would be important information to have the number of clinic encounters in relationship to the FTE’s in the Agreement. Decisions made on the Agreement would affect the Department and UCSF differently; but priorities for the clinical services would need to be made as partners in the Agreement. Public Speakers: Lee North, UCSF patient, expressed support for Dr. Amy Kendrick and his disappointment on her dismissal from the UC HIV Clinic. Frederick Hobson, Board member of the S.F. Health Plan and U.C. Positive Health Clinic patient, supports Dr. Amy Kendrick; described his experiences with various physicians at SFGH and UCSF; urged the Commission to include in the UCSF Affiliation Agreement standards for quality assurance, patient ratios, access to care, and notification to patients on changing their physicians. President Guy commented that the information on the Affiliation Agreement helps to set the stage for overall Department budget discussions. She thanked Ms. O’Connell and Dr. Hopewell for their informative presentation. 7) OTHER BUSINESS/PUBLIC COMMENTS Public Speaker: William Kramer, AFSCME, advocated keeping the UCSF Renal Dialysis Center open and opposed the sale of the Renal Center to a for-profit company. President Guy announced her Commission assignments for the Committees The meeting was adjourned at 5:00 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission