Minutes of the Health Commission Meeting Tuesday, May 2, 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 3:06 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 John I. Umekubo, M.D. Absent:  Commissioner David J. Sanchez, Jr., Ph.D. President Guy announced that Commissioner Umekubo has been selected for "Profiles in Excellence" by KGO-TV Channel 7; and Channel 7 will be video taping Commissioner Umekubo at the beginning of the meeting. 2) APPROVAL OF MINUTES OF THE REGULAR MEETING OF APRIL 18, 2000 Action Taken: The Commission unanimously adopted the minutes of the meeting of April 18, 2000. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) (3.1) PHP-Prevention Services– Follow-up reports for the following contractors: Black Coalition on AIDS, UCSF Urban Health Study, CAL-PEP, and CompassPoint. Commissioner Hill expressed his appreciation for the positive updates on these contractors. (3.2) PHP-CMHS – Request for approval of the FY 1999-00 Performance Contract between the State Department of Mental Health and the Department of Public Health, Community Mental Health Services. (3.3) CHN-Laguna Honda Hospital – Request for approval to accept and expend $693,750 in funds from the U.S. Department of Housing and Urban Development for the Laguna Honda Assisted Living/Housing for Seniors Project, for the five-year period of fiscal years 1999-00 to 2003-04. (3.4) CHN-SFGH/LHH Nursing Operations – Request for approval of a contract modification to extend, for three months, the contract with Nurse Providers, Inc., for the provision of supplemental temporary nursing personnel, the responsibility for which is shared among this contractor and two other contractors for a total of $2,025,000, for the period of July 1, 1999 through September 30, 2000. The shared contract amount will be increased by $100,000 for the original period of July 1, 1999 through June 30, 2000, and by $325,000 for the extension period of July 1, 2000 through September 30, 2000. The wording on this item was modified to read as follows: Request for approval of a contract modification to extend with Nurse Providers, Inc., to add $425,000 to the contract for the provision of supplemental temporary nursing personnel, the responsibility for which is shared among this contractor and two other contractors for a total of $2,025,000, for the period of July 1, 1999 through June 30, 2000. The requested approval is for the same amount of funds as the original wording for this item, but it is for a shorter time period due to new estimates of usage of these services for the remainder of the fiscal year. (3.5) CHN-SFGH– Request for approval of new contract with Degenkolb-Structus, LLC, in the amount of $550,000, to provide an engineering assessment and compliance plan for San Francisco General Hospital in conformance with seismic safety regulations for hospitals (Senate Bill 1953), for the period of May 1, 2000 through January 31, 2003. (3.6) PHP-HIV Prevention Services – Request for approval of a retroactive contract renewal with Aguilas Inc., in the amount of $46,014, to provide prevention workshops and meetings targeting Latino men, for the period of January 1, 2000 through December 31, 2000. (DPH contracted with Aguilas for services totaling $23,007 during FY 1998-99). Commissioner Hill requested an update in three months (August 15, 2000). (3.7) PHP-HIV Prevention Services – Request for approval of a two-year contract renewal with Glide Foundation in the amount of $53,008 per year, for the provision of HIV counseling, testing, risk reduction and partner notification services, for the period of January 1, 2000 through December 31,2001 for a total of $106,016. (DPH contracted with Glide for services totaling $473,628 during FY 1998-99). (3.8) PHP-Housing Services – Request for approval of a contract modification with Episcopal Community Services (ECS) in the amount of $35,000, for additional support services to the tenants of the Canon Kip Community House, which serves homeless and recently homeless very low-income residents, for a total contract value of $65,000, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with ECS for a total of $1,172,999 during FY 1998-99). (3.9) PHP/CHN – Request for approval of a continuing modification resolution to extend current Department of Public Health contracts on a month to month basis until December 31, 2000, or until the 2000-2001 renewal contract is certified, whichever comes first. Commissioner Parker inquired about compliance to Commission Policy #24. An update on compliance to Policy #24 will be presented to the full Commission in June. Action Taken: The Commission approved the Consent Calendar of the Budget Committee. 4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) ADMINISTRATION 2000 State of the City Public Health Address Yesterday I delivered the State of the City Public Health Address before the Board of Supervisors. All members of the Health Commission have been provided copies of the report. The Department has given this Address for the last four years to provide the public and our elected officials with information on the health status of the community. My remarks focused on the funding challenges facing the Department, our need to offer more community-based alternative for the socially and medically complex populations we serve, and the need for continued funding for primary prevention, substance abuse and mental health services. I would like to acknowledge the tremendous work done by Rachelle Lee of the Office of Policy and Planning in working on this report. Population Health and Prevention compiled the overview of the health status of San Francisco. The report will be available on the Department’s web site at www.dph.sf.ca.us. POPULATION HEALTH AND PREVENTION Robert Wood Johnson Foundation Award I am pleased to inform the Commission that The Robert Wood Johnson Foundation has approved a grant of $887,667 to the Department to support a 48-month evaluation of the impact of a local purchasing alliance on health insurance status in San Francisco. Dr. Herminia Palacio will be in charge of directing this grant. The grant is being made under the Foundation's program, "Changes in Health Care Financing and Organization." Million Mom March On Mother's Day, Sunday, May 14, 2000 the Department of Public Health will participate in the Million Mom March in Oakland. The Million Mom March is a mobilization for common sense gun laws.. The Community Health Education Section is coordinating DPH involvement in the March. LBT Women's Health Forum Approximately 300 providers, consumers and advocates, attended April 7th Lesbian, Bisexual Transgendered Women’s Health Forum sponsored by Public Health, Kaiser Permanente, the University of California, Cal Pacific Medical Center, and others. The LBT Forum was designed to promote the Institute of Medicine Report on Lesbian Health and to educate providers about the needs of their LBT clients. Breakout panels focused upon making healthcare accessible, sensitive and sophisticated for LBT patients and to assist providers in becoming more aware and more comfortable discussing LBT health issues with their clients and patients. A draft "Standards of Care" was distributed for feedback and will be edited and presented to the Health Commission for consideration. Commissioners Guy and Monfredini attended the Forum. Community Health Education Michael Radetsky, Health Educator in Community Health Education, has been invited to serve as a panelist on "Pedestrian Safety for Everyone" at the California Office of Traffic Safety Summit in San Diego, April 24 - 27, 2000. He will discuss lessons learned working on pedestrian safety with seniors, and in the Mission and Tenderloin communities in San Francisco. Commissioner Parker requested clarification on the closure of the outpatient pharmacy, the use of neighborhood pharmacies, and the impact on savings in the budget. Commissioner Monfredini commented that the LBT Health Forum was extraordinary. However, she was disappointed that the mainstream press did not cover the forum. Commissioner Umekubo reinforced the need to decrease the number of decertified beds at SFGH. He supports Dr. Katz’s direction and urged the Commission to monitor this. Commissioner Chow expressed h is commitment to the pharmacy proposal because there will be better care for our patients. Commissioner Hill firmly supported the closure of the outpatient pharmacy and encouraged the Department to move on this so that patients will have better service. President Guy expressed her support of the direction for psychiatry. She encouraged the Commission at the Joint Conference Committee to have detailed and open discussions on the implementation phases. 5) CONSIDERATION OF A SUPPLEMENTAL FOR THE DEPARTMENT OF PUBLIC HEALTH IN THE AMOUNT OF $10 MILLION FOR FY 1999-00 Monique Zmuda, Chief Financial Officer, presented her report. Action Taken: The Commission unanimously approved the $10 million supplemental for FY 199-00. 6) PRESENTATION ON PRIMARY CARE Dr. Melissa Welch, Chief Medical Officer of the Community Health Network, presented a report on primary care, which included: Overview of Historical Perspective Primary Care Division, Community Health Network - Map of Clinics Encounter Data, Productivity and Access Selected Accomplishments and Challenges Next Steps: CHN Primary Care Internal Assessment Dr. Welch also provided the following documents: Health Commission Resolution of Primary Care (#160-89) Fiscal Year 1999-2000 Monthly Encounter Totals Attending Physician Productivity Selected Primary Care Quality Improvement Activities Immunization Shoebox Project Primary Care Provider Assignment Attitudes and Practices on Complementary and Alternative Medicine: A Survey of the CHNSF Medical Staff CHN Primary Care Directory The full report is available in the Commission Office. Supplemental materials were also submitted, which included: Demographics of primary care clinic patients Trends in encounters by Medical Providers in 1999-2000 Attending Physician Productivity Dr. Welch acknowledged Jan Murphy, Primary Care Administrator; and Dr. David Ofman, Medical Director of Primary Care, who prepared the Primary Care Report. Presently, the Department is conducting a CHN Primary Care Internal Assessment. This assessment will be integrated into the overall Department Strategic Plan. Commissioners’ Comments: Excellent, informative, comprehensive report Encouraged collaboration with other groups Need to clarify the Department’s relationship with the S.F. Community Clinic Consortium Need to look at demographics of groups served by the clinics Need data of the underserved Unclear on where we are going and how to get there; important but difficult issue Integrate mental health with primary care Important to address non-MD alternative therapies The number of clinics should be assessed Important to hear all voices and promote consensus building throughout the process Data needed on the percentage of total patients being served in the clinics President Guy requested the primary care recommendations go to the Joint Conference Committee for CHN prior to coming to the full Commission. President Guy thanked Dr. Welch and the Department for an excellent report on primary care. 7) OTHER BUSINESS/PUBLIC COMMENTS None. The meeting was adjourned at 5:20 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission