Minutes of the Health Commission Meeting Tuesday, June 6, 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 Edward A. Chow, M.D. Commissioner Lee Ann Monfredini On behalf of the Commission, President Guy presented a special Certificate of Appreciation to Shirley Rodriques, Administrative Assistant to Tony Wagner, CHN Executive Administrator. Ms. Rodriques has been with the Department for 14 years and has been an invaluable member of Mr. Wagner’s staff for the past two years. She will be the Executive Assistant to the General Manager of the Public Utilities Commission. Mr. Wagner expressed his appreciation for her dedicated work. Action Taken: The Commission unanimously adopted the minutes of May 16, 2000. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) (3.1) CHN-Pharmacy – Request for approval of a new contract with Asereth Medical Services, Inc., in the amount of $1,100,000, for as-needed supplemental pharmacy personnel services, for the period of July 1, 2000 through June 30, 2001. (DPH contracted with Asereth for services totaling $1,418,820 during FY 1998-99). This item was postponed to a future meeting. (3.2) PHP-CHPP – Request for approval to accept and expend a two-year grant from the California Health Foundation and Trust, in the amount of $93,756, for the development of Telehealth capacity for African Americans living in San Francisco. (3.3) PHP-Housing Services – Request for approval of a new contract with Episcopal Community Services (ECS), in the amount of $1,548,696, to provide senior housing and supportive services at the Le Nain Hotel, targeting homeless, low income seniors, for the period of June 1, 2000 through June 30, 2002. (DPH contracted with ECS for a total of $1,172,999 during FY 1998-99). (3.4) PHP-CHS – Request for approval of a renewal contract with Lifemark Corporation, in the amount of $360,899 per year, to provide fiscal intermediary services to the Personal Assisted Employment Services (PAES) program, for the period of July 1, 2000 through June 30, 2002, for a total of $721, 798 for the two year period. (DPH contracted with Lifemark for services totaling $1,955,088 during FY 1998-99). (3.5) PHP-CHPP – Request for approval of a retroactive contract modification with San Francisco Study Center (SFSC), in the amount of $422,500, to provide support services to the Health Environmental Resource Center (HERC), and the African American Health Initiative (AAHI), targeting African Americans with asthma and/or cancer health concerns, primarily in the San Francisco Bayview Hunters Point area, for the period of January 1, 1999 through June 30, 2000. The contract total with this modification equals $972,500. (DPH contracted with SFSC for services totaling $1,620,515 during FY 1998-99). (3.6) PHP-CSAS – Request for approval of retroactive contract modification with Youth Leadership Institute (YLI), in the amount of $549,962, to expand existing substance abuse prevention services and to augment new early intervention and outpatient services targeting youth between the ages of 12-17 years, for the period of March 1, 2000 through June 30, 2001. The total four-year contract amount is $1,350,258, for the period of July 1, 1997 through June 30, 2001. (DPH contracted with YLI for services totaling $195,906 during FY 1998-99). (3.7) PHP-CSAS – Request for approval of retroactive new contract with YMCA of San Francisco, in the amount of $550,000, to provide comprehensive substance abuse outreach, prevention, education and counseling services through a youth center, targeting San Francisco youth who are at risk for substance abuse, for the period of March 1, 2000 through June 30, 2001. (3.8) PHP-CMHS – Request for approval of a new contract with Calvin Y. Louise, CPA, for a maximum of $15,557, to provide fiscal intermediary services for the $3,000,000 Community Mental Health supplemental residential care facilities, for the period of July 1, 2000 through June 30, 2001. (3.9) PHP-CMHS – Request for approval of sole source contract renewal with Echo Consulting Services of California, Inc., in the amount of $341,432, to provide maintenance and support services for the mental health billing information software, INSYST, for the period of July 1, 2000 through June 30, 2001. (DPH contracted with Echo for services totaling $189,270 during FY 1998-99). (3.10) PHP-CMHS – Request for approval of sole source contract renewal with InfoMC, in the amount of $143,500, to provide maintenance and support services for the mental health managed care cCURA3 software, for the period of July 1, 2000 through June 30, 2001. Action Taken: The Commission approved the Consent Calendar of the Budget Committee, with #3.1 being postponed to a future meeting. 4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) ADMINISTRATION Mayor’s FY 00-01 Budget On May 31 the Mayor presented his FY 00-01 budget. The Mayor’s proposed budget for DPH is $860 million. It includes all new initiatives and programs in the base budget as approved by the Health Commission in February. In addition it includes the following enhancements: SFGH psychiatric inpatient services - $3.0 million to maintain 92 acute psychiatric inpatient beds ($1.8 million in revenues, $800,000 in new General Fund and $400,000 transferred from Community Mental Health Services other private psychiatric hospital funding). Population Health & Prevention Programs – $1.2 million for children’s medical services, TB Control, STD, adult immunization, laboratory, Records and Statistics, medical marijuana ID cards. Housing - $1.5 million for 92 long-term housing units for medically fragile seniors and 50 units for psychiatric clients in need of placement from institutional care. Mental Health - $3.7 million in new revenues primarily for mental health services to children and youth. Substance Abuse - $700,000 in new General Funds for additional Treatment on Demand and $600,000 in new revenues for 35 additional methadone treatment slots and expanded youth substance abuse treatment services. $2.7 million in new General Fund to increase contractor salaries to $9/hour and to provide cost of living increases to contractor salaries. Funding to maximize patient flow to the most appropriate level of care - $700,000 of new General Funds. $500,000 in revenues for out-of-area managed care expenses for SFGH. Equipment - $4.0 million. Capital - $7.0 million for SFGH seismic and ADA projects, LHH fire alarm replacement, Maxine Hall health center renovations, SFGH wound care expansion and psychiatric ward upgrades. LHH replacement project - $3.5 million. The Mayor’s proposed budget includes $248 million in General fund support for DPH. This is a $15 million increase in General Funds from the current year amount of $233 million. The Mayor’s proposed budget does not include civil service salary MOU increases that are estimated to be an additional $15 million. Taken together the General Fund increase over last year will amount to approximately $30 million. SFGH/Primary Care Bond Delayed At the end of last week I received notification from the City's Capital Advisory Infrastructure Committee (CAIC) asking that the Health Department complete further planning on a SFGH/Primary Care Bond prior to submitting it to the voters. Although our bond proposal received a lot of positive feedback, several questions were raised as to how it fit into the department's overall strategic mission and facilities plan. Although we were disappointed that the bond proposal was not ready to submit to voters this November, we do believe that we will be successful in placing the proposal on the ballot in the near future. This additional planning period will give us more opportunity to meld the capital plan with our strategic plan. The background work that was put into the bond proposal will form the nexus of our revised plan. Also, as I noted in my report of next year's budget, we received $7 million for capital improvements, which is a $2 million increase from last year. This will enable us to proceed on some key capital projects. Bayview Community Meeting Over 200 people attended a Bayview-Hunters Point Community Meeting last night at Providence Baptist Church to explore solutions to the gang violence and drug activity affecting the neighborhood. The Reverend Calvin Jones, and numerous other ministers including the Reverend Amos Brown coordinated the meeting. DPH staff acted as facilitators for the breakout groups. Both Jimmy Loyce and Tony Wagner were in attendance. The meeting resulted in a number of recommendations including: organization of a "youth sit" at Joseph Lee Recreation Center in mid-June, encouraging more parent involvement, getting Bayview community organizations to make contact with youth in need, and offering reentry programs for individuals when they are released from prison. Organizers spoke passionately stating that the violence the neighborhood is experiencing is not just a Bayview problem, but it is a city problem, a nationwide problem. POPULATION HEALTH AND PREVENTION Superior Court Hazardous Waste Violation Decision On May 16th, 2000, San Francisco Superior Court Judge William Cahill, issued a tentative decision on a hazardous medical waste violation at 490 Post Street, a medical and dental office building, imposing $1.1 million in civil penalties against the property owner. Environmental Health Section inspectors Seretha Warren and Jeff Nalle had found that Brugnara Properties had repeatedly mixed hazardous medical waste with other solid waste (garbage) and had illegally attempted to dispose of contaminated medical waste without a valid permit. These activities, documented from February 23, 1999 to November 20, 1999 jeopardized the safety of employees handling the refuse. After the owner ignored our inspectors' multiple attempts to resolve the violation, the City Attorney's Office brought a lawsuit against the corporation. The investigations, actions, and thorough documentation by environmental health staff were instrumental to both the resolution of the hazardous situation and the success of the litigation. Chlamydia and Gonorrhea Testing From August 1999 through April 2000, men and women age 15-25 years who had urine collected for clinical purposes at the SFGH Emergency Department were also tested for chlamydia and gonorrhea. (ED patients are notified of the program via posters at registration.) Among the 234 women tested, 15 were subsequently treated for chlamydia and 8 for gonorrhea. Among the 54 men tested, two were treated for chlamydia, none for gonorrhea. PH&P Personnel Recognized Steven Tierney, Director of HIV Prevention, was elected to the Board of Directors of the AIDS Alliance for Children Youth and Families at the annual meeting in May. He was also elected Vice President of this national organization for the next year. Dr. Patricia E. Evans, Medical Director of Maternal and Child Health, was selected to present at the Scientific Section of the Statewide Maternal and Child Health Conference held in San Diego. Her paper entitled "Foster Care Children and Managed Care: Determining Levels of Risk" was presented on May 31, 2000. COMMUNITY HEALTH NETWORK Interim Chief Nursing Officer/Inpatient Director I am pleased to announce the assignment of Joseph Pendon, RN, MSN, as Interim Chief Nursing Officer/Inpatient Director effective June 12, 2000. Joseph currently serves as Director of Medical Surgical Nursing at San Francisco General Hospital Medical Center.. Joseph came to the hospital from Contra Costa Regional Medical Center. In his ten years with them, he assumed multiple roles focused on inpatient operations. As a Nurse Program Manager/Special Project support person and as Director of Perinatal Services, Joseph was able to build upon his managerial/leadership skills. Please join me in welcoming Joseph to the SFGH leadership team. On behalf of the Commission, President Guy presented a special certificate of appreciation to Dolores Gomez, RN, MS, Associate Administrator for Acute Care Services and Chief Nursing Officer for San Francisco General Hospital Medical Center. She has taken a new position with Kaiser South Bay as a Patient Care Team Leader. Dolores Gomez first joined our organization as an Assistant Director of Nursing eight years ago. Dr. Katz, Gene O’Connell, and Tony Wagner expressed their appreciation for here administrative skills and patient care expertise. Commissioner Umekubo expressed his concerns for the ambulatory care facility and looks forward to a future ballot initiative in 2001. Commissioner Sanchez pointed out the basic work has been done for the bond and there may be creative ways to create total access. Commissioner Hill stated the importance of moving ahead and continuing to promote the bond. President Guy sees this as an opportunity to go back and look at the inclusion of school-based clinics and non-profits into the bond. 5) UPDATE ON IMPLEMENTATION OF HEALTH COMMISSION POLICY #24: CONTRACTORS’ COMPLIANCE WITH ANTIDISCRIMINATION PROTECTION AND CULTURAL COMPETENCY Norm Nickins, Deputy Director of EEO, Affirmative Action, and Cultural Competency, presented an update on the implementation of Policy #24. The Department is requesting contractors to respond on an agency basis not a program basis. So far, 10 final reports out of 175 contracting agencies have been submitted. The deadline is June 30, 2000. Commissioners’ Comments: State, Federal and Office of Minority Health all have materials and definitions for cultural competency. Requested copy of community standards for provisions of quality, health care services for lesbian/gay/bisexual, transgender clients. Requested update on the Department’s Civil Service programs’ compliance to Policy #24; the Department needs to have its own internal objectives for cultural competency Requested the annual EEO report to include cultural competency Complimented the Department on the implementation of the policy; very complex issue and not easy to implement with the different programs and different ethnic groups The single point of contact helps to ease the burden on contractors Need to look at ADA cost factors for compliance Dr. Katz pointed out that he has not received one complaint on the revised Policy #24, in comparison to the complaints received on the previous policy. President Guy thanked Mr. Nickens for his update. 6) PRESENTATION OF THE POPULATION HEALTH AND PREVENTION COMPLIANCE PLAN, UPDATE ON THE COMMUNITY HEALTH NETWORK COMPLIANCE PLAN, AND CONSIDERATION OF A RESOLUTION FOR A DEPARTMENTWIDE COMPLIANCE POLICY Dr. Katz pointed out the importance of functioning as one whole Department. He promoted a single Departmentwide compliance policy with a single compliance team, with the understanding that each Division may have different needs. The Commission has already approved a policy for the Community Health Network to create and implement a compliance program. This program has been developed and is underway. The Population Health and Prevention Division of the Department of Health has also begun compliance activities consistent with Federal and State regulations. Cynthia Bautista, Compliance Officer for PHP, and Diane Keefer, Compliance Officer for the CHN, presented an update on the current compliance plan and accomplishments in the area of compliance. For a copy of the full presentation, contact the Commission Office (554-2666). The report covered the following areas: What is Health Care Compliance? A History of Compliance in Health Care Operation Restore Trust (ORT) Outcomes of ORT Other Legislation Impacting Compliance Guidelines for Providers Seven Key Elements of Compliance Program Leadership commitment, including the designation of a chief compliance officer, charged with operating and monitoring the program Development of written standards of conduct, which include policies and procedures that promote compliance The development and implementation of effective education and training A process to receive complaints and procedures to protect anonymity and go guard against retaliation Enforcement of compliance standards and the existence of guidelines for disciplinary action when there are any violations The use of audits and evaluation techniques to monitor compliance The investigation and remediation of identified problems and policies addressing the hiring of new employees Compliance Efforts and Accomplishments Where the Department is Going with the Compliance Program Commissioners complimented the Department for a comprehensive report and pointed out the challenge in the implementation phase, and the potential costs associated with this compliance program. President Guy requested a progress report on the implementation of the Compliance Program be presented to the Commission in January 2001. Action Taken: The Commission (Guy, Umekubo, Hill, Parker, Sanchez) adopted Resolution #6-00, "Affirming the Commitment of the Health Commission and the Department of Public Health to Compliance with all Applicable Federal, State and Local Laws, and the Program Requirements of Federal, State and Private Health Plans, and Directing the Department of Public Health to Develop and Implement a Departmentwide Compliance Program." 7) OTHER BUSINESS/PUBLIC COMMENTS None. The meeting was adjourned at 4:45 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission