Minutes of the Health Commission Meeting Wednesday, July 5, 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 Vice President John I. Umekubo, M.D., at 3:05 p.m. Present: Commissioner Edward A. Chow, M.D. Commissioner Ron Hill Commissioner Harrison Parker, Sr., D.D.S. Commissioner John I. Umekubo, M.D. Absent: Commissioner Roma P. Guy, M.S.W. Commissioner Lee Ann Monfredini Commissioner David J. Sanchez, Jr., Ph.D. 2) APPROVAL OF THE REGULAR MEETING OF JUNE 20, 2000 Action Taken: The Commission adopted the minutes of the meeting of June 20, 2000. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) (3.1) CHN–SFGH and LHH – Request for approval of three (3) contract renewals with the following firms in the combined amount of $1,700,000, to provide supplemental, temporary nursing personnel for the period of July 1, 2000 through June 30, 2001. (DPH contracted with the vendors for services totaling $2,025,000 during FY 1999-2000). HRN Services, Inc. Nurse Providers, Inc The Registry Network Commissioner Hill recommended approval for the contract for Nurse Providers, Inc. and approval for the other two contractors, contingent upon receiving their monitoring reports. Commissioner Parker noted that the pool of nursing registries has decreased. (3.2) PHP-Health Promotion and Prevention – Request for approval to accept and expend $450,000 in funds from the State Department of Health Services, Maternal and Child Health Branch, for the prevention of domestic violence, for the period of July 1, 2000 through June 30, 2003. At the full Commission, on #3.1, Commissioner Umekubo inquired about the measurement of competency levels of the nursing contractors. For #3.2, he emphasized in the area of domestic violence prevention the importance of language capacity for the Asian community; and he requested an impact report upon completion of the grant. Commissioner Chow encouraged the Department to coordinate and collaborate with existing domestic violence programs in the Asian community. Action Taken: The Commission approved the Consent Calendar of the Budget Committee with the specific contingency for #3.1. 4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) ADMINISTRATION FY 00-01 Budget The Finance Committee of the Board of Supervisors held budget hearings on June 21 and 28. The Budget Analyst initially proposed budget cuts totaling over $3.5 million in salaries and fringe benefits. However, through negotiations with Department staff and recommendations of Finance Committee members, the final cut was just over $100,000. This cut was for delayed hiring of MCH and LHH positions. In addition, reserves were placed on 1/3 of overtime and workers compensation expenses, as well as for inpatient psych at SFGH. As in past years, the Finance Committee added back funding for new and existing programs. DPH received a total of $5.7 million in add back funding and technical adjustments. The full Board is scheduled to approve the FY 00-01 budget later this month. Funding added back to the DPH budget includes: Excelsior Clinic for Women & Children $150,000 One-time funding NICOS – Gambling Prevention 65,000 One-time funding Community Health Institute Acupuncture Clinic 237,000 One-time funding Hospitality House 20,000 One-time funding RAMS – Children’s Mental Health 63,000 One-time funding TOD – Asian Pacific Islander Women 70,000 One-time funding Peer-based Mental Health Treatment 100,000 One-time funding Homeless Queer Youth Services 200,000 One-time funding Circle of Care Collaborative 75,000 One-time funding New Leaf Mental Health 75,000 One-time funding TOD – Samoan Family Focus 100,000 On-going funding Women’s Community Clinic 50,000 One-time funding Children’s Mental Health – Parent Helpline 67,000 One-time funding Central American Resource Center – Health/Dental 90,300 One-time funding SF AIDS Foundation – Rent Subsidies 200,000 One-time funding Native American AIDS 150,000 On-going funding Mission SRO Collaborative 245,000 One-time funding Chinatown SRO Collaborative 250,000 One-time funding Wage Increase for Non-Profits 1,949,210 Technical Adjustment Community Mental Health Enhancements 1,000,000 Technical Adjustment CHN/SFGH Bond Preparation 261,000 Technical Adjustment Capital Expansion of Tom Waddell Clinic 254,000 Technical Adjustment   $5,671,510   I would like to thank DPH budget staff including Monique Zmuda, Anne Okubo, Nelly Lee, Michelle Ruggels, Dick Acken, Carlos Villalva, Larry Kuester, Jim Stillwell, and Brenda Walker for the many long hours, detailed analysis, and perseverance in this long budget process. POPULATION HEALTH AND PREVENTION Last week both local and national press attention was focused on a study conducted by the Seroepidemiology & Surveillance Branch of the San Francisco Department of Public Health AIDS Office. The study was based on using a new technique called detuning to identify HIV antibody positive blood samples from persons who have recently seroconverted. The testing from the anonymous testing sites (ATS) showed that the HIV incidence among men who have sex with men (MSM) increased from 1.3 in 1997 to 2.6 in 1998 to 3.7 in 1999. This is an almost tripling in the HIV incidence rate. The data are important because we and other health departments have reported for some time now increases in the rate of male rectal gonorrhea and increases in reports of unsafe sex. There are limitations of the data. Although we saw significant increases in HIV incidence among the HIV counseling and testing participants we did not see similar increases among MSMs seen at the STD clinic during the same time period. The STD sample was smaller and we are currently investigating differences in the sampling that may explain these differences. There are many hypotheses as to why there is more unsafe sex behavior. These hypotheses include people are less frightened of contracting HIV/AIDS because of the improved treatment; people are fatigued from several years of HIV prevention efforts; increases in substance use among MSM are fueling the epidemic; and, younger MSMs have not fully heard the HIV prevention message. The problem with all of these explanations and others offered is that sexual behavior is an extremely complex issue. No one thing determines why people have safe or unsafe sex. Two immediate risks from such data are that people will blame men who have sex with men for being irresponsible or they will blame HIV prevention efforts for not being effective. Neither is an appropriate response. Gay men have been hard hit by the epidemic, psychologically, socially, and spiritually, by the loss of so many persons. Were it not for the existing HIV prevention efforts it is quite possible that infection rates would be even higher in San Francisco. Nonetheless, because the advent of protease inhibitors and triple combination therapy have profoundly changed the HIV/AIDS landscape we do need to think more about what are the most effective methods of prevention in these times. I expect that there will be more releases of data like this one at the Durban International Conference and subsequently. I will be working with researchers like Drs. McFarland, Schwarcz, Buchbinder and our HIV Prevention Section headed by Steve Tierney to forge an appropriate response to this data. I will keep the Commission fully apprised. State Passes SB648: Antibiotics for Chlamydia Partners On Tuesday, 6/27/00, the State Assembly Health Committee passed SB648, the bill sponsored by the Health Officers Association and the California Medical Association (CMA) and put forward by Senator Ortiz-D (Sacramento) which will allow physicians to legally prescribe antibiotics to partners of patients with chlamydia without an examination. This is an important step forward for chlamydia prevention and control in California and should reduce both the spread of chlamydia in the City as well as prevent the serious complications that can result from chlamydia infection. Early Intervention Initiative In response to the concern of the growing rates of HIV in the African American community, the AIDS Office HIV Health Services Section applied to the State Office of AIDS and was awarded funding for a new Early Intervention Program (EIP) for the Bayview Hunters' Point (BVHP) neighborhood. The EIP program, located at the Department's Southeast Health Center, is operational and enrolling clients. They have exceeded their projected unduplicated client count to date. This program is unique in that it provides medical evaluation and treatment, case management and health education services to HIV positive persons. Southeast Health center staff have formed a coalition with community providers such as the Black Coalition on AIDS, the NIA Multi-Service Center (a project of California AIDS Intervention Training Center/Institute for Community Health Outreach), and the BVHP Foundation to round out the continuum of care in the BVHP with prevention, STD/HIV testing, mental health, substance abuse, outreach and adherence services. Annual funding for this program is $350,000. The Program Manager is Joseph Cecere. COMMUNITY HEALTH NETWORK Response to Chronicle Chaplaincy Story Last week's Chronicle news feature "This Little Light" examined the SFGH Chaplaincy Service and offered a powerful picture of chaplains Bob Walter and Mary Jo Chalmers. According to the reporter, Manny Fernandez, the newspaper received a tremendous response from the public with more than 50 e-mails lauding the feature. Bob Walter reported that he has received nearly 20 inquiries from people interested in becoming volunteer chaplains. Medical Staff Honors -- 2000 Renee Navarro, MD, was named chief-elect, a post she will hold until July 2001 when she assumes the position of chief. A UCSF associate professor of anesthesiology, Dr. Navarro was appointed to the UCSF faculty in 1990 and has been based at SFGHMC since. She currently serves as chair of the SFGHMC medical risk management committee, chair of the operating room committee, medical director of the PACU, and on the admissions committee for the UCSF School of Medicine. She is a former acting chief of the SFGHMC anesthesia service. In 1996, she was selected by Alpha Omega Alpha medical honorary as outstanding UCSF alumna of the year. Upcoming Summer Fairs The summer always provides us with a flurry of street fairs to promote the CHN and our prevention messages. Following is a partial list of upcoming events. If any of the Commissioners are in the location of these health fairs, please feel free to drop by the Department's booth. July 8 6th Annual Potrero Hill Jobs and Health Fair July 14 Central American Resource Center Neighborhood Health Fair (Carecen) July 29-30 Third Street Fair Commissioner Chow inquired about the potential impact on public health from the one-day strike ate St. Mary’s Medical Center, St. Francis Hospital and Seton Medical Center. Dr. Katz reported from a public health perspective, there would not be much impact; and the ER should not be affected. Commissioner Umekubo commended Dr. Katz and the Finance staff in all of the Divisions for their services with the Department budget for FY 2000-01. 5) UPDATE ON THE STATE BUDGET FOR FY 2000-01 Tangerine Brigham, Director of Policy and Planning, provided an update on the State budget for FY 2000-01, indicating changes since the Governor signed the budget on June 30, 2000. The total budget is 99.4 billion, an 18% increase over last year’s budget. For more information, contact the Commission Office. Health-related items included Medi-Cal, the Aging with Dignity Initiative, Public Health, Behavioral Health, and Healthy Families. Ms. Brigham pointed out the State budget is consistent with the Commission priorities by doing the following: Increases public health funding for core infrastructure Increases funding for mental health services Increases funding for children and youth services and programs Does not lower reimbursement rates for skilled nursing facilities Reduces the Medi-Cal DSH administrative fee Increases Medi-Cal rates Expands health insurance through Medi-Cal The proposed budget does not: Allocate substantial increased State General Fund to substance abuse or HIV/AIDS services, and Does not eliminate the expenditure cap for skilled nursing services to undocumented persons Commissioners’ Comments: The budget, in general, has improved; the Department has more gains than setbacks The additional funds to create a non-names based HIV reporting system is consistent with the Commission’s policy Expressed concern on any impact on skilled nursing services to undocumented persons Rate increases for nursing facilities are positive for long term care Commissioner Umekubo commended Dr. Katz and his staff for their work on the State budget, much of the work being accomplished with State elected officials from San Francisco. Dr. Katz thanked Monique Zmuda, Anne Okubo, Ken Jensen, Nancy Arata and Brenda Walker for their fiscal expertise. 6) ONE YEAR EVALUATION OF THE HEALTHY WORKERS PROGRAM Dr. Katz gave an overview of a one-year evaluation of the Healthy Workers Program. As part of Dr. Katz’s commitment to universal health care, he would like to see how the Healthy Workers model can help towards providing universal health insurance coverage in the City and County of San Francisco. Commissioners’ Questions/Impressions: What are the true costs for the actual delivery of services? Raises the question of capacity. Was there truly excess capacity? This is an example of looking at better ways to serve indigents Raised the issue of out-of-network expenses Because the data is for the first year and the population is small, it is difficult to analyze the data. Need to look at a stable population As part of the Department’s Strategic Planning, the Department would move towards universal health care This model is the principle of taking dollars spent on health care and channeling them to a health insurance plan Pleased with the complete data from this new program This model is a new way to improve health care coverage Dr. Katz thanked the Commission for their comments. The Department will continue to analyze the data to work towards a universal health care plan. 7) OTHER BUSINESS/PUBLIC COMMENTS None. 8) CLOSED SESSION: A. PUBLIC COMMENT ON ALL MATTERS PERTAINING TO THE CLOSED SESSION None. B. VOTE ON WHETHER TO HOLD A CLOSED SESSION. (SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.11(a).) Action Taken: The Commission voted to hold a closed session. Closed session began at 5:32 p.m. Individuals present in the closed session were Commissioners Umekubo, Chow, Hill and Parker, Dr. Katz and Sandy Mori. C. CLOSED SESSION PURSUANT TO GOVERNMENT CODE SECTION 54956.9 AND SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.11(b). PROPOSED SETTLEMENT OF $33,000 IN RABAH V. CCSF AND FAMILY SERVICE AGENCY OF SAN FRANCISCO ET AL, SUPERIOR COURT CASE NO. 304867 D. RECONVENE IN OPEN SESSION: 1. POSSIBLE REPORT ON ACTION TAKEN IN CLOSED SESSION. (GOVERNMENT CODE SECTIONS 54957.1(a)(2) AND SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.14(b)(2).) Action Taken: The Commission approved the proposed settlement of $33,000 2. VOTE TO ELECT WHETHER TO DISCLOSE ANY OR ALL DISCUSSIONS HELD IN CLOSED SESSION (SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.14(a).) Action Taken: The Commission voted not to disclose any discussions held in closed session. The meeting was adjourned at 5:45 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission