Minutes of the Health Commission Meeting Tuesday, February 15, 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 Roma Guy, MSW, at 3:05 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 FEBRUARY 1, 2000 Action Taken: The Commission unanimously adopted the minutes of February 1, 2000, with the following corrections: The meeting was called to order by President Roma Guy, MSW Under the U.C. Affiliation Agreement presentation, the information about the revenues from professional fees being $16 million, which is outside of the U.C. Affiliation Contract, will be added to the minutes. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) (3.1) DPH-Administration – Review of the 1998-99 annual audit and management letters for San Francisco General Hospital and Laguna Honda Hospital. (3.2) CHN-Balboa Teen Health Center – Request for approval to accept and expend a new three-year grant from the California Endowment, in the amount of $370,185, to provide a three phase education program targeting Balboa High School youth, for the period of February 1, 2000 to January 31, 2003; and a sole source contract funded by this grant with Harder and Co., in the amount of $28,000, for the same time period. Commissioner Parker inquired about an evaluation component. Commissioner Hill requested an update in six months (August). (3.3) PHP-HIV Health Services – Request for approval to accept and expend grant funds from the State of California in the amount of $1,099,869 annually to fund a demonstration project to serve incarcerated individuals for the total project period of December 1, 1999 through June 30, 2002; and sole source contracts funded by this grant with Centerforce, Inc., in the amount of $1,799,643 and Haight Ashbury Free Clinics Inc., in the amount of $257,487, for the period of January 1, 2000 through June 30, 2002. (3.4) PHP-CHSS-Disease Prevention – Request for approval of a retroactive modification to an existing three-year contract with Northeast Medical Services, to provide immunization program services to children 0-4 years old. This modification will add $13,302 to services provided in years two and three of the contract (July 1, 1999 – June 30, 2001), and extend the contract for one additional year, in the amount of $53,218, for the period of July 1, 2001 – June 30, 2002. The total contract amount for the four-year period of July 1, 1998 – June 30, 2002 will be $199,570. (DPH contracted with Northeast for services totaling $212,916 during FY 1998-99). (3.5) PHP-Homeless – Request for approval of new contract with the Ark of Refuge, Inc., in the amount of $60,842, to provide emergency shelter services targeting young adults 18-23 years old, for the period of February 15, 2000 through May 15, 2000. (DPH contracted with Ark of Refuge for services totaling $282,480 during FY 1998-99). Public Speakers: Rachel Callaghan opposed funding of this contract; the program is fiscally irresponsible; has caused dissension in the neighborhood. Darlene Crisp, Noe Valley Community Workgroups, encouraged the Commission not to approve contract until the CAC is formed; all of the neighborhood groups were not included; requested specific concerns to be included in the contract; public not well informed of this meeting. Mitch Thompson, LYRIC/EVRC/QYOC, requested funding for outreach services to queer youth; there’s an existing group working with this population. Commissioner Hill reinforced the need for services of this youth population. Commissioner Parker requested information on the contractor and the program. Executive Director Yvette Flunder provided an overview and history of her agency. (3.6) PHP-Homeless – Request for approval of retroactive contract modification with Baker Places, Inc., in the amount of $1,345,397, to provide residential substance abuse services for triple-diagnosis (HIV/AIDS, substance abuse and mental health) uninsured or underinsured, adult residents of the City and County of San Francisco, for the period of March 1, 1999 through June 30, 2000. (DPH contracted with Baker Places for services totaling $10,112,961 during FY 1998-99). (3.7) PHP-Homeless – Request for approval of retroactive contract modification with Catholic Charities, in the amount of $905,286, to provide supportive housing services for persons with disabling HIV/AIDS and very low income (as defined by HUD), for the period of March 1, 1999 through June 30, 2000. (DPH contracted with Catholic Charities for services totaling $2,540,469 during FY 1998-99). (3.8) PHP-Homeless – Request for approval of new contract with John Stewart and Company, in the amount of $300,801, to provide fiscal agent and property management services targeting the SSI Evaluation Program, for the period of March 1, 2000 through June 30, 2001. (3.9) PHP-CSAS – 90-Day Status Report from Haight Ashbury Free Clinics, Inc. Executive Director Darryl Inaba introduced his Board Chairman, former Chairperson and Chief Fiscal Officer. Monique Zmuda, Chief Finance Officer of the Department of Public Health, indicated there has been much improvement and positive corrective actions on the fiscal matters of this agency; and she will continue monitoring this contractor. Action Taken: The Commission approved the Consent Calendar of the Budget Committee, with the understanding that for #3.9 the Haight Ashbury Free Clinics, Inc., will continue to be monitored by the Department’s Chief Finance Officer. 4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) ADMINISTRATION Federal Budget On February 7, 2000, the Clinton Administration released its proposed FY 2001 budget. The Administration’s budget highlights the nation’s economic prosperity. The proposal calls for an investment of nearly $110 billion over 10 years to expand health insurance coverage, increase funding for safety net providers, long-term care, public health, quality initiatives, and biomedical research, and strengthen Medicare ($432 billion over 10 years). Attached to my Director’s Report are the summary pages of the President’s budget that relate to health care and health insurance coverage. The President’s budget estimates that the health insurance proposal would expand coverage to five million uninsured Americans and expand health care access to millions more over the next 10 years. The plan centers on expanding the scope of the Children’s Health Insurance Program (CHIP) to extend coverage to parents of children who now are eligible for CHIP ($76 billion). To prevent employers from dropping coverage, the plan would allow employers to pool state funding with employer contributions toward private insurance. An additional $5.5 billion would be used to enroll an additional 400,000 children in CHIP and Medicaid and $1.9 billion is budgeted to expand coverage to children through age 20. The President’s budget extends permanent access to Medicaid for persons leaving welfare to work who take jobs that provide no insurance, and includes tax credits for Medicare buy-in, to offset the cost of COBRA premiums, and for small firms who purchase health insurance for their workers. The President’s safety net initiative allocates $125 million to coordinate systems of care, increase the number of services delivered, and establish an accountability system to assure adequate patient care for uninsured and low-income populations. The President also proposed an increase of $50 million for community health centers and supports total funding of this initiative at $1 billion over five years. In the area of long-term care, the Administration’s budget proposes a $28 billion, 10-year investment in long-term care. Under this initiative, the Administration would provide tax credits for people with long-term care needs or their caregivers, provide funding for services which support family caregivers, improve equity in Medicaid eligibility for people in home- and community-based settings, encourage partnerships between low-income housing for the elderly and Medicaid, and encourage the purchase of long-term care insurance by federal employees. With regard to public health, the Administration’s budget proposes nearly an additional $125 million (an 8% increase over FY 2000) for the Ryan White CARE Act, an increase of $50 million for HIV prevention, and an additional $100 million to impact the AIDS epidemic abroad. The President proposes an $82 million increase for substance abuse prevention and treatment and an additional $100 million (a 16% increase from FY 2000) for mental health services. The Administration’s budget also includes funding increases for infectious disease surveillance, family planning, childhood immunizations, food safety, asthma and clinical trials for cancer under Medicare. The Quality of Health Care initiatives in the President’s budget include a patients’ bill of rights, rules guaranteeing medical privacy, new funds to improve the prevention of medical errors and new funds for the investigation and prosecution of fraudulent drug sales via the Internet. The President’s budget also provides an increase of $1 billion for biomedical research at the National Institutes of Health. The President’s budget initiatives under Medicare include a voluntary prescription drug benefit, improved access to preventive services and reforms related to fiscal solvency, price competition and Medigap. The Department has not yet had the opportunity to assess the impact (either financially or programmatically) of the President’s proposed budget on the City and County. However, we will continue to closely monitor all health-related budget actions. State Legislative Issues On January 3, 2000, the Legislature convened for the second year of its two-year session. Bills introduced in the first year of the session that did not make it to the Governor’s desk in 1999 are called "two-year bills." The last day for two-year bills to pass through their house of origin was January 31, 2000. Of the 290 two-year bills tracked by the Department, 143 bills remain active in this second year of the legislative session and 147 bills failed to meet the January 31, 2000 deadline and, therefore, died in their house of origin. Of the legislation that remains active, there are two bills of particular interest to the Department and strongly supported by the City. SB 269 (Ortiz) would increase the basic funding allotment to local health jurisdictions for core public health functions in order to control the spread of communicable diseases. AB 499 (Aroner) would create an assisted living demonstration project for low-income Medi-Cal beneficiaries. Among the bills that died were eight that would have earmarked all or a portion of the State’s share of tobacco settlement funds for various, specified purposes. The final day for legislators to introduce new bills in this session is February 25, 2000. Legislation of note that has been introduced thus far in 2000 include: AB 1800 (Thomson) which would make significant reforms to the involuntary treatment of mental illness; SCR 59 (Burton) which creates the Joint Committee on Mental Health Reform to look at mental health reform broadly; and SB 1368 (Brulte) which would, under certain circumstances, allow a child 30 days old or younger to be surrendered without penalty by the parent. The Department is currently assessing the impact of the remaining bills and other new health-related legislation. Exploratory Committee for Bond Measure Proposed On Thursday, February 10th, Supervisors Leno and Ammiano announced the formation of an exploratory committee to look into the possibility of a bond initiative for the November ballot. The initiative would address both the infrastructural needs of SFGH and the primary care clinics of the CHN, as well as the concept of placing city health clinics in San Francisco’s public schools. State law SB 1953 (the Hospital Earthquake Safety Bill) mandates substantial earthquake retrofitting of SFGH and other hospitals by the year 2030. We must turn in our plans to meet the stringent standards by January 1, 2001 and must make smaller incremental improvements by the years 2002 and 2008. Along with the need to address the infrastructual and seismic deficiencies of SFGH, the San Francisco Unified School District has expressed great interest in having school-based clinics on site. The siting of direct health care services to our young people could go a long way in helping us leverage funds to offset the cutbacks we have seen in Federal and State funding. Cost estimates for these bond measures are preliminarily set at $50 million for SFGH and $50 million for school-based clinics. I will continue to keep the Health Commission updated as this bond initiative evolves. POPULATION HEALTH AND PREVENTION CSAS - Appointment of New Director I am very pleased to announce that Phyllis Harding has been appointed as the Director of Community Substance Abuse Services. She will begin her new position tomorrow. Phyllis has an extensive wealth of experience in the health field and recently has demonstrated strong leadership in her current position as the Senior Associate Administrator of Mental Health, Substance Abuse & Forensic Services for the Community Health Network, Department of Public Health. Some of her accomplishments include the paired leadership responsibility for Forensic Services which is comprised of Jail Medical Services, Jail Psychiatric Services and the Rape Treatment Center. Phyllis was largely responsible for the operation of the Mental Health Rehabilitation Facility which included the hiring of staff, supervision of program development, licensing application and certification review. During her work with the SFGH administration, she worked with 4 acute psychiatric inpatient units, the forensic psychiatry unit, the acute detoxification unit and a variety of outpatient services which included case management programs, services for special populations, psychiatric emergency services, and substance abuse services. Phyllis has also shown leadership with her participation for the past 3 years on the Treatment on Demand Planning Council where she has also served as the Chair of the Community Input Committee. I would also like to recognize and thank Jim Stillwell for the outstanding job that he has done these past several months serving as the Interim CSAS Director. I appreciate his stepping in and providing the leadership for CSAS. Jim will now be able to resume his position as the CSAS Budget and Finance Director. Welfare-To-Work Dental and Optical Program Begins PH&P, the CHN and the Department of Human Services are collaborating on a San Francisco-only Welfare-to-Work Dental and Optical Program. The goal is to make dental and optical services more accessible to single adults in the PAES Program who do not have MediCal or DentiCal benefits. Although believed to be very high, there is no existing data on the prevalence of dental disease or the impact on employment for the welfare-to-work population. The research data collected from this effort will be used to write proposals to continue these important programs. Community Health Promotion and Prevention Branch Awarded a Grant Community Health Promotion and Prevention Branch was awarded an annual grant of $80,640 from Mount Zion Health Fund. The grant, which was awarded to the collaboration of Refugee Medical Clinic of San Francisco General Hospital and the International Institute of San Francisco (IISF), will provide preventive health education and enhanced interpreter services for Russian-speaking and Bosnian patients at Refugee Medical Clinic. The grant will establish patient education programs on preventive health topics using culturally and linguistically appropriate methods. Staff will also compile health education materials in Russian and Bosnian that can be distributed to patients and support the existing interpreter services at the Clinic. With these expanded resources we will be able to integrate preventive health education programs with the quality interpreter services already provided by the collaboration to improve the health and well being of patients. For more information please contact Patricia Erwin through email or at 705-8552. Trans Health Night at Dimensions Clinic The first Trans Health Night at the Dimensions Clinic was held on January 27, 2000. Approximately 20 youth attended the event, with lots of good food and many volunteers. Medical services were enhanced for the evening to accommodate regular walk-in services as well as for the TG youth in attendance. The evening ended with a community forum focused on what transgender youth think about health, their health needs, and to provide input on how to make Dimensions a more FTM- and MTF-friendly place. The Dimensions' direct services staff, most of whom are Spanish speaking, come from Castro-Mission Health Center, Special Programs for Youth, New Leaf, Larkin Street Youth Center, AIDS Office, and LYRIC. They have been instrumental in establishing Dimensions Clinic as an excellent place for queer youth to receive a variety of integrated health care services. COMMUNITY HEALTH NETWORK Administrative Responsibilities at SFGH Re-Assigned Phyllis Harding’s areas within San Francisco General Hospital Medical Center have been reassigned. Christine Wachsmuth, who is the Associate Administrator over Emergency and related services, will now assume administrative responsibility for Psychiatric Emergency Services. Leslie Holpit, who is currently the Director of Nursing for Psychiatry, will now also handle administrative responsibilities for Inpatient Psychiatry and Outpatient Behavioral Health Programs. Ms. Holpit has been with San Francisco General Hospital since 1989. SFGH Credentials Report 2/00 2000 YTD New Appointments .6 29    Reinstatements 0 4    Reappointments 27 58 Delinquencies 0 0 Reappointment Denials 0 0 Resigned/Retired .4 16 Disciplinary Actions 0 0 Restriction/Limitations – Privileges 0 0 Changes in Privileges    Additions 0 …1    Voluntary Relinquishment 0 …0 Commissioner Umekubo requested clarification on what a bond measure would include. Dr. Katz stated the bond would cover buildings but not equipment and operations of the building. The policy issue of the primary care clinics as part of the Department’s Strategic Plan would come to the Commission for a decission (i.e., total number of primary care clinics in the City). Because the deadline for a bond to be approved by the CIAC is the first week in May, the Commission would need to consider the bond in April. The Department would make a future presentation on the bond issue. President Guy commented the Commission may want to hold public hearings in March. Commissioner Umekubo would also like to hear from the private hospital sector regarding SB 1953. Nathan Nayman, Hospital Council, stated that California Health Care Association is working on SB 1953 and will provide information to the Commission. There will also be a statewide bond initiative regarding SB 1953, which requires all hospitals to be seismically safe within a specific timeline. 5) CONSIDERATION OF A RESOLUTION ON THE DEPARTMENT OF PUBLIC HEALTH BUDGET FOR FY 2000-01 As a continuance from the Commissioner's Special Meeting on February 8, 2000 on the proposed Department of Public Health budget for FY 2000-01, President Guy announced that public testimony would be received today. Dr. Katz, after additional consideration, recommended the following revisions to the budget proposal to reduce contract services in primary care: The Department's original budget proposal was to reduce contract agencies by $600,000. Of this amount, approximately $250,000 was targeted toward reducing contracts with Clinic Consortium agencies. Dr. Katz now suggests that no reductions to these primary care contracts occur. Dr. Katz is not certain that there is sufficient capacity in the Primary Care Network to absorb these patients. In addition, Dr. Katz recommends that the outreach/case management program operated by the Bayview Hunters Point Foundation be reduced by $125,000, rather than the originally proposed amount of $200,000. This reduction, as well as the $100,000 reduction to Central City Hospitality House, was made so that a greater proportion of homeless funding would be spent to preserve housing rather than maintaining outreach to homeless persons. The proposed increase of General Funds to housing in this budget is $2 million. The Department believes existing DPH homeless and mental health outreach services will be able to make up any decreases from these two contracts. Finally, the Bayview Hunters Point Foundation, Critical Incident Response Team (CIRT) contract, will be decreased by $25,000 because DPH provides complimentary services. The Department believes this reduction is possible without an overall loss of services to the community. FY 2000-01 Budget Reductions in Primary Care – Contract Clinic Services FY 99-00 FY 00-01 FY 00-01 Initial Proposed Revised Contract Reduction Reduction Central City $ 531,505 $ (100,000) $ (100,000) BVHP Mental Health/Outreach/CM 491,467 (200,000) (125,000) Mission Neighborhood Health Center 181,809 (181,809) - North of Market Health Center 192,734 (25,000) - Haight Ashbury Free Clinic 50,722 (50,722) - BVHP CIRT 150,831 (25,000) (25,000) $1,527,068 $ (582,531) $ (250,000) Dr. Katz also provided additional information about reductions in the need for acute care beds. Public Speakers: Eve Milton, Potrero Hill Health Center CAB, opposes closure of the Center; described her granddaughter's experience at SFGH and the Center. Nick Pasquariello, Potrero Hill Health Center CAB, supports dental services at the Center; closure is an ill-conceived idea and has not been adequately discussed. Ann Togia, SASA Foundation, advocated for funding and substance abuse services for the Samoan community; Treatment on Demand Council has identified Samoans as a priority. Jeff Wong, Pharmacist, opposes closure of SFGH outpatient pharmacy and Potrero Hill Health Center; patients will not get adequate services at community pharmacies. Annette Pinto, SFGH Psychiatry, described the gay focus psych unit; opposes closure of any inpatient psych wards; will result in more homelessness. Mily Trabing, SFGH psychiatry, described the patient population in the inpatient psych wards; realistic alternatives have not been developed. Anthony Joseph Arroyo, SFGH volunteers, opposes closure of inpatient psych units; will lead to homelessness. San Francisco Organizing Project had nine speakers: Opposed SFGH pharmacy closure and any cuts at SFGH Thanked Department for reinstating funds for Mission Neighborhood Health Center Thankful for services for low income people at SFGH SFGH pharmacy is an important service for the community Urged not to cut funds for low income people Need more funds for SFGH pharmacy SFGH is important for poor people Will not be able to get same access to medications at the neighborhood pharmacies. Dr. Katz clarified in Spanish that the same free medications would be available at the neighborhood pharmacies. Lawrence Blon, private citizen, opposed elimination of beds and pharmacy; people will go without medications. Mitch Thompson, LYRIC/EVRC/QYOC, advocated for needs for gay youth; need to outreach homeless youth. Jen Plummer, QYOC, described her work with queer youth who are marginalized from their families; gay youth collective is already established; described outreach services. Dr. Kevin Grumbach, CHN/UCSF, advocated for the preservation and enhancement of essential services at SFGH; not fully reflecting the pain for consumers; encouraged Commission to disagree with the cuts and see if the Commission is asking for enough funds from the Mayor. Michelle Tactay, QYOC, advocated help for queer youth. Rene Muslin, CCHH/QYOC, need for outreach to queer youth in the Mission, Castro, and Tenderloin; described services. Anne Cassia, QYOC, advocated funding for queer youth proposal, which is a priority for the Treatment on Demand Council. Sandi Andrews, QYOC, advocated for queer youth. Enola D. Maxwell, Potrero Hill Neighborhood House, expressed disappointment with the President of the United States; need for more health care; how can anyone discontinue Potrero Hill Health Center? Described mental illness in the African American community. Shannon Coughlin, Committee for Health Rights in the Americas, expressed outrage at cuts; urged hearings be held at SFGH and the clinics so that direct care providers can attend; read a letter from three nurses at SFGH. Nora Roman, Emergency Coalition to Save Public Health, represents patients and staff; hopes Commission has guts to vote no to proposed cuts; suggested other solutions to budget problems; separate out the administration budget; need for long-term solutions. John Tighe, SFGH, opposed cuts in infrastructure at SFGH; will lead to staff reductions and closure of units. Dr. David Ofman, CHN Medical Practice Group, expressed support and concerns on the proposed budget; the merger of Potrero Hill Health Center is not worth disrupting commitment to a community; concerned about reductions at SFGH; advised a step-wise approach. Dr. Norma Jo Waxman, UCSF-Dept of Family and Community Medicine, disagrees with current hiring freeze; decreased reimbursements are the problem; health care is a right, not a privilege. Chet Villalba, Mental Health Board, thanked Commissioners for listening; visited Potrero Hill Health Center and interviewed patients; read statements from the CHN brochure. Eugene Menifee, ICHO, needs shelters and detox facilities. Naim Harrison, Positive Direction=Change, expressed more services are needed in the Bayview Hunters Point areas; there's an attitude of "as long as it doesn't affect me". James Ellison, citizen, wants to give back to the community; drug treatment services needed in the Bayview; other areas have facilities. M.P.R. Howard, Tom Waddell Clinic CAB and Citywide CAB, medical trends towards privatization and dismantling of health systems; how many bodies will we find on our doorsteps? Paulette Spencer, Potrero Hill Health Center Advisory Board, opposes closure of Center; improves quality of life in community. Helyanna Brooke, Mental Health Board, applauded Dr. Katz but encouraged the Commission to say no to the proposed budget in this time of prosperity. Mary Montoya opposes closure of pharmacy and Potrero Hill Health Center, which is important to the social fabric of the community. Larry Bevan, SFGH/MHRF, described the special cultural units at SFGH; expressed concern on where people will go until alternatives are available; have to put prevention in place. Oletha Hunt, CNA at LHH, described LHH different than ever before; residents need more care; invited Commissioners to spend a day at LHH; have to be fair to residents and staff. David Twedall, Local 250, described working under time constraints; inadequate budget with no community input and consultation; no choice but to have senior staff leave. Magdelena Soul, disabled low income patient, cuts at SFGH pharmacy and dental clinic at Potrero Hill Health Center are not right; disabled are too sick to attend meetings; think about people, not bureaucracy. Teresita Gatan, Local 250, how can you give quality care when there's not enough staff. Martha Hawthorne, Local 790, opposed all budget cuts; complete disregard for people working in the system; described a patient case. Mary Magee, SFGH Birth Center, described vacancies in unit; take moral imperative and make investment of more monies for public health care. Dr. Talmadge E. King, Chief, Medical Services at SFGH, described SFGH as an outstanding hospital; very efficient; being run close to the margin; stand up for this and do what's right; cannot take more in the Family Health Center; Commission should resist making a hasty decision. President Guy asked for a modernized Public Health Department, this budget along with a strategic plan, and data to reflect a future direction. Commissioner Sanchez thanked the community, providers, and staff for the insightful testimony. He sees erosion of the safety net and does not see cutting quality assurance any further. He recalled the history and evolution of the primary care clinics in the community; and these clinics are at risk. He has strong reservations on the proposed budget and would vote no on the proposed budget. Commissioner Parker sees a vision becoming a nightmare. There's talk about a robust economy and these cuts. There's no sense to fund the Department at last year's level. It has gone from band-aid to no aide. Why try to protect the General Fund? It's there to spend. He cannot support the proposed budget. Commissioner Umekubo strongly supported addressing the number of decertified days in the acute care hospital and feels the proposed budget addresses this problem. Inefficiencies need to be addressed. There would be no cuts in services and no lay-offs. The closing of the pharmacy and Potrero Hill Health Center make sense. Additionally, there's a need to look at the total primary care system. He encouraged the Commission to move ahead with the changes and closely monitor them. Commissioner Chow expressed support for the new initiatives with the understanding that the alternative settings are operational before transferring out patients from acute care beds. It is not a matter of closing a whole unit of an inpatient psych ward. He promoted the idea of requesting more funds as a hedge in the budget during this transition. He sees the pharmacy proposal as a real patient benefit by subsidizing the neighborhood pharmacies. He would defer the closure of the Potrero Hill Health Center and put the entire issue of how many community primary care clinics we should have as part of the Strategic Plan. Selecting this one clinic might be premature at this time. Commissioner Hill expressed his gratitude to Dr. Katz and his staff for their hard work. Commissioner Hill strongly supports the pharmacy closure and agrees with Commissioner Chow's suggestion to defer the Potrero Hill Health Center closure. The Department needs to move forward with the new initiatives and encourage his colleagues to step up to the plate to talk to City Hall officials. President Guy encouraged her colleagues to go to City Hall to support the Department staff. She advocated for continuing dialogue and problem-solving with patients, providers, and the community. She also supports deferring Potrero Hill closure and requested the Department to re-look at the idea of selling Department property. There might be other uses for that building. Otherwise, she supports all of the other new initiatives. All of the Commissioners, except one, supported deferring Potrero Hill Health Center closure for now. Commissioner Hill recommended asking for $18 million plus the $12 million for COLA's. However, there was no second to his motion. Action Taken: The Commission amended the proposed resolution by adding the following: "Whereas, an additional $6 million would be needed to fully realize the savings from the reduction of the decertified beds at San Francisco General Hospital" Yes: Commissioners Chow, Guy, Hill and Umekubo No: Commissioners Parker and Sanchez Action Taken: The Commission amended the proposed resolution by adding more funds to the General Fund request: "Whereas, the Department's budget still requires an additional General Fund allocation of approximately $19.6 million in order to balance to its expenditures " "Further Resolved, that the Health Commission directs Department of Public Health to request additional General Funds in the amount of $25.6 million to avoid service reductions". Yes: Commissioners Chow, Guy, Hill and Umekubo No: Commissioners Parker and Sanchez Action Taken: The Commission adopted Resolution # 1-2000, "Approving the Department of Public Health’s Proposed Budget for FY 2000-01, Approving the Reallocation of Funds to Develop New Programs to Reduce the Need for Acute and Emergency Care, and Approving Cost Reductions Necessary to Absorb Cost Increases" with the amendments. Yes: Commissioners Chow, Guy, Hill and Umekubo No: Commissioners Parker and Sanchez 6) UPDATE OF THE DEPARTMENT OF PUBLIC HEALTH STRATEGIC PLANNING INITIATIVE Tangerine Brigham, Director of Policy and Planning, provided an update on the Department's Strategic Planning Initiative, including the following: Inclusion of the strategic planning financing approaches in the Department's proposed fiscal year 2000-01 budget Recent strategic planning town hall meetings Analysis of health mandates, and Recruitment of consumers to the Strategic Planning Committees. She also provided an updated work plan providing the Health Commission with our progress to date. A copy of the full report is available in the Commission Office (554-2666). Commissioner's comments: Important to talk to the difference community groups and to outreach to those communities Discussion of the primary care community clinics should be integrated into Strategic Planning Need to develop benchmarks to evaluate performances and quality of services Happy to see community people on the strategic planning committee, and Issue of a potential bond measure for the clinics should be part of strategic planning; Commission would hold public hearings on the bond issue, potentially in March; need to include and collaborate with the School District representatives and need to inform the various constituencies. Public speaker: M.P.R. Howard observed that a few people from the neighborhoods attended the Town Hall meetings; need to inform the neighborhoods about these meetings. 7) OTHER BUSINESS/PUBLIC COMMENTS None. The meeting was adjourned at 7:45 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission