Minutes of the Health Commission Meeting Minutes of the Health Commission Meeting Tuesday, September 19, 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 P. Guy, MSW, at 3:20 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. 2) APPROVAL OF THE REGULAR MEETING OF SEPTEMBER 5, 2000 Action Taken: The Commission adopted the minutes of the meeting of September 5, 2000. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) (3.1) CHN-Finance – Request for approval of a contract modification to extend for six months a contract with Toyon Associates, Inc., to provide reimbursement and revenue optimization services for San Francisco General Hospital, Laguna Honda Hospital and Health at Home Agency, in the amount of $222,133 for the period of October 1, 2000 through March 31, 2001, for a contract total of $560,664 for the period of October 1, 1999 through March 31, 2001. (DPH contracted with Toyon for services totaling $338,531 during FY 1999-2000). (3.2) CHN-Laguna Honda Hospital – Request for approval to accept and expend new grant funds in the amount of $453,098 from the U.S. Department of Health and Human Services, for construction of one of the two temporary central power plants for the Laguna Honda Hospital replacement project, for the period of August 2000 to September 2001. (3.3) CHN-Pharmacy – Request for approval of a new contract with RX Relief in the amount of $250,000, to provide as-needed supplemental pharmacy personnel services, for the period of October 1, 2000 through June 30, 2001. (3.4) CHN-Primary Care-YGC/SPY – Request for approval of a contract renewal with St. Mary Pharmacy Management Services (SMPMS), in the amount of $135,000, for the provision of as-needed pharmacy services for clients of Youth Guidance Center and associated programs, for the period of July 1, 2000 through June 30, 2001. (DPH contracted with SMPMS for services totaling $3,853,509 during FY 1999-2000). (3.5) CHN-Primary Care – Request for approval of a sole source contract with Central City Hospitality House (CCHH), in the amount of $531,505, to provide drop-in and self-help services for the homeless, for the period of July 1, 2000 through June 30, 2001. (DPH contracted with CCHH for services totaling $531,505 during FY 1999-2000). Commissioner Hill stated this contract would be approved, with the stipulation that an update be brought back to the Budget Committee in two months (November 21st.) (3.6) PHP-CSAS – Request for approval of a sole source contract modification with Henry Ohlhoff House, Inc. (HOH), in the amount of $166,360, to augment a new residential care substance abuse service program targeting women with children and/or women who lost custody of their children, and who are enrolled in the Personal Assisted Employment Services (PAES) Program, for the period of July 1, 2000 through June 30, 2002. The total four-year contract amount is $631,257 for the period of July 1, 1998 through June 30, 2002. (DPH contracted with HOH for services totaling $149,881 during FY 1999-2000). (3.7) PHP-CSAS – Request for approval of a contract renewal with Latino Commission on Alcohol and Drug Abuse (LCADA), in the amount of $463,590 per year, to a total four year contract of $1,854,360, to provide residential substance abuse services targeting adult male Latino residents of San Francisco, for the period of July 1, 2000 through June 30, 2001. (DPH contracted with LCADA for services totaling $509,353 during FY 1999-2000). Commissioner Hill requested data on clients reflecting success of the program. (3.8) PHP-HIV Prevention – Request for approval of a contract renewal with Black Coalition on AIDS (BCOA), in the amount of $246,687 per year, for two years, for a total contract amount of $493,374, to provide HIV prevention education and evaluation services, for the period of July 1, 2000 through June 30, 2002. (DPH contracted with BCOA for services totaling $822,098 during FY 1999-2000). (3.9) PHP-HIV Prevention – Request for approval of a contract renewal with Black Coalition on AIDS (BCOA), in the amount of $232,028 for FY 2000/01, and $228,028 for FY 2001/02, for a total contract amount of $460,056, to provide HIV prevention education and evaluation services for the period of July 1, 2000 through June 30, 2002. (DPH contracted with BCOA for services totaling $822,098 during FY 1999-2000). (3.10) PHP-HIV Prevention – Request for approval of a contract renewal with Lavender Youth Recreation and Information Center (LYRIC), in the amount of $104,291 per year, for two years, for a total contract amount of $208,582, to provide HIV prevention services to youth between ages of 12 and 24, for the period of July 1, 2000 through June 30, 2002. (DPH contracted with LYRIC for services totaling $104,291 during FY 1999-2000). (3.11) PHP-HIV Prevention – Request for approval of a contract renewal with San Francisco AIDS Foundation (SFAF), in the amount of $514,955 per year, for two years, for a total of $1,029,910, to provide HIV prevention services targeting men who have sex with men, for the period of July 1, 2000 through June 30, 2002. (DPH contracted with SFAF for services totaling $5,484,482 during FY 1999-2000). Public Speaker: Tate Swindell, Act-Up S.F., spoke against approval of the contract; critical of Director’s salary and no response to his public testimony. (3.12) PHP-Housing – Request for approval of a new retroactive contract with The Ark of Refuge, Inc., in the amount of $674,798, to provide Transitional Housing Program services targeting Lesbian, Gay, Bisexual, Transgender, Queer and Questioning Young Adults 18-23 years of age, for the period of April 1, 2000 through June 30, 2001. (DPH contracted with Ark for services totaling $353,822 during FY 1999-2000). Marc Trotz, Director of Housing Services, reported on the ongoing efforts with the neighbors with community meetings, input into the contract, the formation of a community advisory committee to Dr. Katz, and addressing neighborhood concerns. Public Speakers: Anne Farrar opposed the approval of the contract and the contractor; stated she is not a NIMBY; feels this program does not make sense. Judith Hoyem owns a home across the street from the facility; feels facility is inappropriate for young people at risk; asked Commission to scrutinize the budget for this contract. Joe Foster feels this is a misguided program; important to have neighborhood interaction; asked Commission to look at the budget. Felix Smith is a new neighbor; concerned about services provided to these youth. Debra Stein hosted a series of meetings as a pro bono mediator; recognized all parties who have worked towards the contract; good cross-section of neighbors who have participated; urged Commission to validate the negotiation process by approving the contract. Brian Cheu;, LYRIC, gave background on the project and expressed support for the project. (3.13) CHSS – Request for approval of a retroactive renewal of a sole source contract with the Regents of the University of California San Francisco (UCSF), in the amount of $83,585, to provide SFFD Medical Director services, for the period of July 1, 2000 through December 31, 2000. (DPH contracted with UCSF for services totaling $11,235,592 during FY 1999-2000). For #3.12, Commissioner Monfredini asked for clarification on meals being brought in and the role of a pro bono lobbyist. For #3.7, Commissioner Chow expressed concern for a 4-year contract since it is a new start-up and recommended a 1-year contract. Phyllis Harding, CSAS Director, concurred with the recommendation. Action Taken: The Commission approved the consent calendar of the Budget Committee, with #3.7 being a 1-year renewal. 4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) ADMINISTRATION Appointment of Jimmy Loyce to AIDS Office Director It gives me pleasure to announce today that James ("Jimmy") Loyce, has accepted the position of Director of the AIDS Office. As the Commission is aware, Jimmy has extensive experience in developing and administering HIV/AIDS services and prevention interventions. He served as the Associate Director of the AIDS Office from 1991 to 1994. From 1994 to 1998 he was the Executive Director of the AIDS Program for Los Angeles (APLA). Increasingly, the Department has recognized the importance of providing HIV prevention services for HIV positive people. We have also recognized the importance of providing health services, such as substance treatment and mental health, to persons who are HIV negative so that they can stay negative. Given this, our separation of HIV/AIDS into separate divisions of Health Services and Prevention no longer is appropriate. Also with so many reports of increasing episodes of unsafe sexual behavior I felt it was crucial for the Department to have greater focus around HIV/ AIDS issues. I can’t imagine anyone who can better provide that focus than Jimmy. Jimmy will retain the title of Deputy Director of Health for AIDS Programs. He will continue to report directly to me as a way of ensuring that HIV/AIDS issues have the highest prominence in the Health Department. Federal Guideline on Language Assistance to Persons with Limited English Skills In late August, the U.S. Department of Health and Human Services issued a written policy guidance to assist health and social services providers in ensuring that persons with limited English skills can effectively access critical health and social services. This was done under DHHS’ Office for Civil Rights (OCR) which by law is responsible for ensuring compliance with the law. The guidance is a result of President Clinton’s Executive Order 13166 that addresses serving persons with limited English skills. The executive order requires each federal agency to have written policies on providing effective service to those with limited English proficiency who are served by federally funded programs. The guidance outlines the legal responsibilities of providers who receive federal financial assistance from DHHS -- such as hospitals, HMOs and human service agencies -- to assist people with limited English skills. The guidance emphasizes that providers have flexibility in designing effective programs to meet the language needs of the nation's increasingly diverse populations. Some of the state-administered programs where access for persons with limited English proficiency may be especially important include the State Children's Health Insurance Program (SCHIP), Medicaid and Temporary Assistance to Needy Families (TANF). DHHS has informed states of the new policy that is designed to enhance the nation’s "ability to reach our national goal of eliminating racial and ethnic disparities in health, and will assist in increasing opportunities for persons with limited English proficiency to improve their socioeconomic status." As outlined in the guidance, satisfactory service to limited English proficient clients should include: having polices and procedures in place for identifying and assessing the language needs of the individual provider and its client population; a range of oral language assistance options, appropriate to each facility's circumstances; notice to LEP persons of the right to free language assistance; staff training and program monitoring; and a plan for providing written materials in languages other than English where a significant number or percentage of the affected population needs services or information in a language other than English to communicate effectively. This guidance will be provided the program managers within both the Community Health Network and Population Health and Prevention. In addition it will be provided to our Affirmative Action/EEO Director, Norm Nickens. I fully endorse the federal government’s most recent guidelines and will work to ensure that they are implemented within the Department of Public Health. POPULATION HEALTH AND PREVENTION Hunters Point Shipyard Parcel E Land Fill Fire On August 16, DPH staff participated in the response to a fire at the Parcel E landfill on Hunter’s Point Shipyard in the context of our role in assessing health risks due to hazardous materials incidents. DPH staff made recommendations to ensure the safety of firefighters and ensured CCSF staff working downwind of the fire. Since our understanding was that the fire was limited to the surface vegetation and would be contained shortly, DPH did not consider additional evaluation was required at the time. On September 11th DPH learned from a Navy fact (released September 8th, 2000) that areas of the fire were still smoldering underground and because of the potential for hazardous materials releases the Navy had initiated air, soil, and water samples on September 8th. While DPH does not have regulatory responsibility of the site, we do want to be able to effectively evaluate risks to residents in the community and workers on the shipyard. While it is challenging to evaluate risks given that it is unknown what is burning, dilution of smoke, the direction of prevailing winds, and the mixed use nature of the landfill all indicate that health risks to San Francisco residents are likely to be minimal. DPH has requested that analytical results from the air sampling be forwarded to us as soon as available. Preliminary review of one air-monitoring sample did not reveal the presence of any unusual or concerning exposures. The navy currently plans to manage the remaining smoldering areas by installing a "cap" to suffocate the fire. We will continue to obtain information from the Navy and the EPA as it becomes available in order to best assess the risks to San Francisco residents and employees. Community Health Epidemiology Community Health Epidemiology and Disease Control has been awarded a three-year CDC grant to integrate hepatitis prevention and control activities into existing prevention services. The primary focus will be on hepatitis C prevention and control. The project director will be Dr. Tomas Aragon. CHP&P Awarded Grant I am pleased to announce that CHP&P was recently awarded a 2-year $800,000 grant from the State’s Office of Traffic Safety for its proposal to utilize a community-based mini-grant program to improve traffic and pedestrian safety in San Francisco. This mini-grant will expand traditional traffic safety participation to include a broader range of community members, community-based agencies and other partners to plan, implement and evaluate innovative solutions to pedestrian and traffic safety challenges. Women's Health The Changing Face of Women's Health, a national exhibition, makes its San Francisco Bay Area debut October 7th at the Exploratorium. This exhibition makes a dramatic statement in terms of just how far women's health has come and allows a woman to identify her individual risk factors. Funded by the Centers for Disease Control and Prevention, the National Institutes of Health, metropolitan Life Foundation and Pfizer Women's Health, this exhibition is the first major touring presentation dedicated solely to the latest scientific information about women's issues. This exhibition embraces the concept that women's health issues are created and shaped by society, biology and personal behavior. Exploratorium Museum staff have worked extensively with local women's health providers to develop a local imprimatur on this national exhibit which should prove exciting and informative. HIV Prevention The Neighborhood Health on Wheels Van (N'HOW) has begun operation. The N'HOW Van is part of the Prevention for HIV Positives Demonstration Project within the HIV Prevention Section. N'HOW provides access to HIV, STD and Hepatitis testing services, urgent medical care and HIV Prevention education, counseling and referral services. N'HOW is designed to bring services to individuals at high risk for HIV infection, where they reside. The current operation is located in the Polk Gulch area and has been very successful in attracting new clients, providing them counseling and testing services and referring them to primary care and related services. Future sites will include the Mission, Bayview-Hunters Point, the Western Addition and the Castro. N'HOW is staffed by a Nurse Practitioner, a Physician-Medical Director and three Health Workers. This project is expected to identify individuals in need of medical care and build the bridges they need to get them to Community Health Centers and other DPH programs. For more information, please call James Rapues at 554-9131. STD Prevention and Control Last month, the STD Program pilot tested the feasibility of postal screening for chlamydia and gonorrhea. As of mid August, approximately 500 kits were distributed either through the mail or were picked up at two popular community based locations (Walgreen’s and Gold's Gym) in a predominantly MSM area of the City. To date, approximately 100 specimens (20%) have been returned for testing. Results on 42 of the 100 specimens yielded one positive for GC and two for CT, for a positivity rate of 7.1%. Results of the screening have been so favorable that Walgreen’s has indicated that they would be willing to continue to have them available on site and one of the City's sex clubs, Blow Buddies, has indicated an interest in making them available to their clients. COMMUNITY HEALTH NETWORK Laguna Honda’s Annual Survey Begins On September 11th a team of seven State Licensing and Certification Surveyors arrived unannounced at Laguna Honda to initiate the annual recertification survey. Six additional Surveyors, including specialists in Acute Services, Pharmacy, Nutrition and Medical Records have now joined the State team. The Surveyors reported that they expect to continue their survey process through this week. I will advise the Commissions of the date and time of the exit conference. Laguna Honda Replacement Project Planning Process Begins Michael Lane, representatives from the Executive Architecture Team, Tony Wagner and staff will initiate the LHH Replacement Project Planning process by convening a public information meeting on Thursday, September 18th at 7:00pm at St. John’s Church, 501 Laguna Honda Boulevard. This meeting will provide an overview of the planning process, project schedule, and a question and answer session. This meeting will be the first of many opportunities for the public to provide input into the planning process. The week of September 25th, the project team will make similar presentations to LHH residents, volunteers and staff. I have asked the Project Team to provide a comprehensive status report at the Laguna Honda Commission meeting November 7th. Conference on Community-Based Long Term Care The CHN Division of Primary Care and Laguna Honda Hospital are collaborating on a conference entitled "Community-Based Long-Term Care. The Role of the Primary Care Provider", to be held on October 6th at Laguna Honda. Presented by the California Association of Long-Term Care Medicine, other collaborators include the California Geriatric Education Center, the Stanford Geriatric Education Center, the Goldman Institute on Aging and On Lok. The conference will focus on practical tool and decision-making framework developed to help physicians and other health professionals link patients to community-based long-term care services. Positive Health Program Receives State Support Congratulations to the staffs of the Positive Health Program and the AIDS Research Institute (ARI) who received a $1.25 million funding in a special ceremony held in the SFGH Comfort Garden last week. California State Assemblyman Kevin Shelley presented the check to Dr. Volberding. The funds will be distributed among ARI programs including the clinical and research programs on Ward 86. Chinese Women Support Group from Chinatown Health Center The Chinese Women Cancer Support Group at Chinatown Public Health Center was identified on the Website and interviewed by a journalist in Hong Kong doing a story on breast cancer. This is an excellent exchange of ideas and program information and sharing experiences of Chinese women living with breast cancer in the United States with people abroad. SFGH Credentials Report 9/00 2000 YTD New Appointments 14 137 Reinstatements 1 9 Reappointments 43 295 Delinquencies 0 0 Reappointment Denials 0 0 Resigned/Retired 19 118 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Changes in Privileges     Additions 1 2 Voluntary Relinquishments 0 0 Public Speakers: David Pasquarelli, Act-Up S.F., described deaths of Gay men from protease inhibitors; believes HIV does not cause AIDS and AIDS is over; submitted a letter to Charlotte Kent, STD Prevention and Control, regarding data on male rectal gonorrhea. Todd Swindell, ACT-UP S.F., believes HIV is theoretical; described stereotypes of Gay men; Gay men have been vilified. Mike Petrelis, AIDS Statistics.Com, submitted the HIV Prevention Strategic Plan Through 20005; stated Gay men should practice safe sex; San Francisco is HIV hypocritical, no numbers reported on rectal gonorrhea; why is the Department not giving numbers? Commissioner Chow commended the Department for continuing to be in the forefront of AIDS/HIV. Commissioners congratulated Jimmy Loyce for his new area of responsibilities. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR SEPTEMBER 2000 On behalf of the Commission, Commissioner Parker presented the award to: Individual Nominee Division Nominated by Jean Cruz-Holdaway, CHN Tom Waddell Health Center Damon Eaves, MSW, Health Worker II Homeless Outreach Program (Hope) Coordinator, Hope Team 6) CONSIDERATION OF A RESOLUTION DETERMINING WHETHER THE SUSPENSION OF THE LICENSE FOR 20 ACUTE CARE BEDS AND INPATIENT/OUTPATIENT SURGERY AT PACIFIC COAST HOSPITAL WILL OR WILL NOT HAVE A DETRIMENTAL IMPACT ON THE HEALTH SERVICE OF THE COMMUNITY Audrey Magneson, representative of Pacific Coast Hospital, was present. Action Taken: The Commission unanimously adopted Resolution #11-00, "Determining Whether the Closure of 20 Acute Care Beds and Inpatient/Outpatient Surgery at Pacific Coast Hospital Will or Will Not Have a Detrimental Impact on the Health Care Service of the Community." 7) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH DENTAL SERVICES Samantha Stephen, MS, RDH, Director of Dental Services, presented an Overview of the Department’s Dental Services. Commissioners’ Comments: Commended staff for a comprehensive report Acknowledged the first Oral Health Report from the Surgeon General and the first time a Dental Services presentation was calendared for the Commission agenda Encouraged the Department to have a liaison with the School District for dental services Policy issue is how the Department and Commission view dental services and health services Emphasized need to outreach to private dentists and the challenge to serve the homeless population Suggested periodontists serve children Oral health should be integrated into overall health Fluoridation needs to be supported Integrate oral health into the Department’s Strategic Plan Need to educate physicians and re-educate dentists 8) PRESENTATION AND CONSIDERATION OF A RESOLUTION FOR RED LIGHT RUNNING PREVENTION WEEK Dr. Larry Meredith, Director of Community Health Promotion and Prevention, presented an overview of the Stop Red Light Running Program. The following persons involved in collaborative efforts for the program were introduced: Bridget Smith, Director, Livable Streets, Department of Parking and Traffic; David Valle-Schwenk, Coordinator, Red Light Photo Enforcement Project, Department of Parking and Traffic; Quijuan Maloof, Stop Red Light Running Program, CHP&P; and Kevin Camora, Pedestrian Survivor and Advocate Kevin Camora, small business owner and video producer, showed a video on a pedestrian fatality case. Action Taken: The Commission unanimously adopted Resolution #12-00, "Endorsing Stop Red Light Running Week." 9) OTHER BUSINESS/PUBLIC COMMENTS None. 10) PUBLIC COMMENT ON ALL MATTERS PERTAINING TO THE CLOSED SESSION None. The Commission went into closed session at 5:30 p.m. and came out at 6:30 p.m. Individuals in the closed session were Commissioners Guy, Umekubo, Chow, Hill, Monfredini and Sanchez. 11) CLOSED SESSION PURSUANT TO GOVERNMENT CODE SECTION 54957 AND SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.10(b): PUBLIC EMPLOYEES PERFORMANCE EVALUATION: DIRECTOR OF HEALTH, DR. MITCH KATZ EXECUTIVE SECRETARY TO THE HEALTH COMMISSION, SANDY OUYE MORI 12) RECONVENE IN OPEN SESSION: 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 6:35 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission