Minutes of the Health Commission Meeting November 21, 2000 3:00 P.M. at 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 3:10 p.m. Present: Commissioner Edward A. Chow, M.D. Commissioner Roma P. Guy, M.S.W. Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. 2) APPROVAL OF MINUTES OF THE SPECIAL MEETING OF OCTOBER 31, 2000 AND THE REGULAR MEETING OF NOVEMBER 7, 2000 Action Taken: The Commission unanimously adopted the minutes of the special meeting of October 31, 2000 and the regular meeting of November 7, 2000. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner David J. Sanchez, Jr., Ph.D.) (3.1) Update on Bayview Hunters Point Foundation Barbara Garcia, PHP Director, gave an update on the background, initial findings, comprehensive review of contract monitoring, development of joint personnel monitoring committee, and labor issues and union negotiations. She also reported that this investment is crucial for the improvement and future of Bayview Hunters Point Foundation and the communities it serves. On December 5th, the contract renewal will be on the Budget Committee agenda. Commissioner Monfredini acknowledged the great amount of time and resources invested into this agency. She wanted reassurance from the Executive Director and the consultant that appropriate organizational changes would be addressed. Karen Patterson Mathew, Executive Director of Bayview Hunters Point Foundation, concurred; the CompassPoint consultant described his role in the technical assistance to this agency. Public Speaker: Linda Zaretsky, Local 790, supports the process and close collaboration of all parties involved; problems continue to exist; still no job descriptions available. Commissioner Sanchez looks forward to new inclusion and renewal of this contract. (3.2) PHP-HIV Prevention Services – Request for approval of a retroactive contract renewal with San Francisco AIDS Foundation HIV Prevention Project (SFAF), in the amount of $580,486, to provide HIV prevention and needle exchange services targeting injection drug users, for the period of July 1, 2000 through June 30, 2001. (DPH contracted with SFAF for services totaling $2,662,268 during FY 1999-2000). (3.3) PHP-Immigrant Health Services – Request for approval of a contract renewal with International Institute of San Francisco (IISF), in the amount of $311,377, to provide health services to new immigrants for the period of October 1, 2000 through September 30, 2001. (DPH contracted with IISF for services totaling $323,440 during FY 1999-2000). (3.4) PHP-EMSA – Request for approval of a renewal contract with the Regents of the University of California at San Francisco (UCSF), in the amount of $893,164, to provide San Francisco Fire Department Medical Director services, for the period of January 1, 2001 through June 30, 2003. (DPH contracted with UCSF for services totaling $11,454,369 during FY 1999-200). Commissioner Sanchez abstained due to conflict of interest. (3.5) PHP–Health Promotion – Request for approval of a contract modification with O’Rorke Public Relations & Advertising, in the amount of $70,005, for a total contract of $80,000, to provide media services to the Stop Red Light Running program, for the period of November 1, 2000 through June 30, 2001. (DPH contracted with O’Rorke for services totaling $292,578 during FY 1999-2000). (3.6) PHP-Health Promotion – Request for approval to accept and expend a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), in the amount of $430,728, for the support of a two-year strategic planning process project focusing on community and youth violence in the Bayview Hunters Point and Mission districts, for the period of September 30, 2000 through August 31, 2002. (3.7) PHP-CSAS – Request for approval to accept and expend a Targeted Capacity Expansion grant from Substance Abuse and Mental Health Services Administration (SAMHSA) and the Center for Substance Abuse Treatment (CSAT), in the amount of $2,400,000, for expansion of residential services for addicted pregnant and postpartum women, for the period of September 30, 2000 to September 29, 2003, and approval of three sole source contracts with Jelani, Inc., for $898,655; Women and Children Family Services, for $699,630; and Homeless Prenatal Program, for $175,000, all for the period of September 30, 2000 to September 29, 2003. (3.8) PHP-CSAS – Request for approval to accept and expend a new two-year grant from the Substance Abuse and Mental Health Services Administration (SMAHSA) and the Center for Substance Abuse Treatment (CSAT), in the amount of $470,000, for implementation of a mobile methadone program, for the period of September 30, 2000 to September 29, 2002. (3.9) PHP- CSAS – Request for approval of a retroactive contract renewal with Center on Criminal and Juvenile Justice (CJCJ), in the amount of $218,744 per year, to provide supportive living substance abuse services to parolees, for a total four-year contract of $874,976 for the period of July 1, 2000 through June 30, 2004. (DPH contracted with CJCJ for services totaling $200,000 during FY 1999-2000). (3.10) PHP-CSAS – Request for approval of retroactive contract renewal with Haight Ashbury Free Clinics, Inc. (HAFC), in the amount of $4,670,682, to provide comprehensive substance abuse treatment services, for the period of July 1, 2000 through June 30, 2001. (DPH contracted with HAFC for services totaling $10,631,027 during FY 1999-2000). (3.11) PHP-CMHS – Request for approval to accept and expend a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), in the amount of $2,110,871, consisting of $177,477 in one-time funds and $672,290 in on-going funds, for the support of the adult and children’s systems of care in community mental health services. (3.12) CHN-Jail Health Services – Request for approval of a retroactive contract renewal with Haight Ashbury Free Clinics, Inc. (HAFC), in the amount of $3,130,966 to provide psychiatric and substance abuse treatment services for inmates in the San Francisco County Jail system, for the period of July 1, 2000 through June 30, 2001. (DPH contracted with HAFC for services totaling $10,631,027 during FY 1999-2000). (3.13) CHN/SFGH & LHH Facilities – Request for approval of fourteen (14) contract modifications with the following firms: Acker & Guerrero Roof Co. Inc., Adolph Schmidt General Contractors, Agbayani Construction, Inc., Anderson Carpet & Linoleum Sale Co. Inc., Angotti & Reilly Inc., Ayoob & Peery Plumbing, Baca & Sons Painting, Floortrends Inc., McClure Electric, Monticelli Painting & Decorating, Robert Poyas, Inc., Sabel Painting Co., Sierra Electric Co. and The Shooter Co., to increase the combined contract amount by $2,025,000, from $2,400,000 to $4,425,000, to provide intermittent, as-needed facility maintenance services above baseline civil service staffing, for the period of July 1, 2000 through June 30, 2002. (DPH contracted with the above-named contractors for services totaling $3,000,000 during FY 1999-2000). (3.14) DPH Administration – Request for consideration and approval of a supplemental appropriation by FY 2000-01 in the amount of $1,532,400 to fund needed equipment at San Francisco General Hospital. Action Taken: The Commission approved the Consent Calendar of the Budget Committee. Commissioner Sanchez abstained on #3.4. 4) DIRECTOR’S REPORT (Anne Kronenberg, Acting Director of Health) (Report on activities and operations of the Department, and may include activities within the Community Health Network and Population Health and Prevention Divisions). ADMINISTRATION Federal Budget Congress has decided to delay the completion of the FY 2001 budget bill for Labor/Health and Human Services/Education and other matters, including Balanced Budget Act relief, at least until it reconvenes for a "lame-duck session" on December 5, 2000. Congress hopes at that time to have final election results for both the Congress and the Presidency that will guide their decisions. There is concern that partisan fighting will defeat the Medicaid/Medicare giveback bill. Further, growing tensions between the Administration and Congressional leadership over other legislative issues may cause the Labor/HHS spending bill to be re-opened, which will delay its passage, open its provisions to revisions and delay the release of new funding, such as additional Ryan White CARE Act dollars. Proposition 36 Effective July 1, 2001, Proposition 36 requires that nonviolent drug possession offenders receive drug treatment and supervision in the community, rather than incarceration. Certain offenders convicted of nonviolent drug possession offenses will receive probation and, as a condition of probation, the court will require participation in and completion of an appropriate drug treatment program. The court may require participation in drug treatment services for up to one year and up to six additional months of follow-up care. The court may also impose, as a condition of probation, participation in vocational training, family counseling, literacy training and/or community service, and it may require that the offender contribute to the cost of his/her placement in a drug treatment program. The initiative appropriates $60 million in State General Funds for 2000-01 and $120 million each year thereafter until 2006 at which time funding would be subject to the State’s budget process. Funding shall be allocated to counties through a formula that will be determined by the State Department of Alcohol and Drug Programs (DADP). The formula shall include, but not be limited to: per capita arrests for controlled substance possession violations; and substance abuse treatment caseload. The DADP may also reserve funding for direct contracts with drug treatment service providers in areas where demand for drug treatment services is not adequately met by existing programs. Reimbursable activities would include licensed and certified drug treatment programs, including outpatient treatment, narcotic replacement therapy, drug education or prevention courses and half-way house treatment, but specifically excluding drug treatment programs offered in a prison or jail facility. Proposition 36 funds may also be used for vocational training, family counseling, literacy training, probation department and court monitoring costs, and other miscellaneous costs other than drug testing services. The Legislative Analyst’s Office estimates that after several years this initiative will save the State between $100 million and $150 million annually due primarily to lower costs for prison operations. Counties are anticipated to experience a net savings of about $40 million annually due to lower jail populations. On Wednesday, November 29, 2000 San Francisco will hold a public symposium entitled "Rational Drug Policies in San Francisco: Post Proposition 36". It will be held at the Westbay Conference Center. This conference is being organized by the District Attorney, Supervisor Newsom, the Sheriff and the Department of Public Health. The goals of the conference are to develop a clearer understanding of Proposition 36 and the choices it offers, and to begin identifying how San Francisco can appropriately respond to this measure. The Department’s Population Health and Prevention division is participating in the symposium. POPULATION HEALTH AND PREVENTION NIH Summarizes Evidence that HIV Causes AIDS The National Institutes of Health (NIH) has recently updated a fact sheet describing the extensive scientific evidence that HIV causes AIDS. The fact sheet describes the criteria that the scientific community generally uses to prove a link between an infectious agent and a disease, and presents a concise summary of how HIV meets the criteria as the agent that cause AIDS. This NIH fact sheet, an important source of information for all who wish to learn more about how we know that HIV is the cause AIDS, can be found on the internet at http://www.niaid.nih.gov/factsheets/evidhiv.htm. A copy is attached for your review. Children’s Mental Health Services The San Francisco Children and Families Commission approved an additional allocation of $650,000 in Prop 10 dollars to expand the CMHS Child, Youth and Family Service's Childcare Mental Health Consultation and Service Program. Communicable Disease Control - Pertussis (whooping cough) Outbreak on Treasure Island The Communicable Disease Control Unit, Community Health Epidemiology & Disease Control (CHEDC) has verified that at least 7 to 15 Federal Job Corps trainees on Treasure Island have recently developed pertussis (whooping cough). There are 480 trainees (that live in 2 dormitories) and 200 staff. Pertussis is a contagious disease that is easily spread in close living quarters. Adults can transmit this disease to infants or young children who may become very ill or even die. To control the outbreak and prevent transmission to young children or infants when trainees and staff go home over the holidays, we are recommending, in collaboration with the CDHS and CDC, that all exposed trainees and staff with possible pertussis (cold-like symptoms) be given antibiotics. Because vaccine protection wanes, even fully-immunized adolescents and adults are at risk of contracting and developing pertussis. Dr. Barbara Long, UCSF Pediatrician and Attending at the Job Corps Wellness Center, has secured a donation of azithromycin from Pfizer, Inc. to treat everyone. Dr. Tomas Aragon, Director of CHEDC, is coordinating the Department’s role in this immunization effort. Mental Health Over 300 people attended the Spirituality and Mental Health Training conference last week. The workshops and general audience panels received excellent reviews. The success of this conference points to the substantial interest in this subject for both now and in the future. AIDS Office The AIDS Office project N'HOW (Neighborhood Health on Wheels) mobile medical van is now providing services in the Mission, the Polk and Bayview Hunter's Point each week. Additional sites will be added over the next few months. N'HOW provides free and anonymous HIV testing, STD screening and urgent care, as well as counseling and referrals to community health centers. For further information please call (877-599-6469) Stop AIDS Project The StopAIDS project was recently provided with funding by the HIV Prevention Section's "Fund for Innovation". The project is a unique outreach and health promotion project carried out on the internet. The project is designed to reach gay and bisexual men who use the internet chat rooms to meet other men. On November 9th the New York Times featured the project and credited the SF Department of Public health as the funding source for this creative and important initiative. Children, Youth and Families "Services and programs for Children, Youth and Families" has been completed and is ready for distribution. This resource guide includes descriptions and contact information for most of the DPH child/youth serving programs as well as many of our contracted services. Attached is a copy. COMMUNITY HEALTH NETWORK SFGH Credentials Report 11/00 2000 YTD New Appointments 06 166   Reinstatements 0 10 Reappointments 57 397   Delinquencies 0 0 Reappointment Denials 0 0 Resigned/Retired 30 160 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Changes in Privileges       Additions 08 12   Voluntary Relinquishments 02 02 Commissioner Monfredini would like to know if a car seat is given to infants born at SFGH. Ms. Kronenberg will forward that information to the Commissioners. Commissioner Chow complimented the comprehensive Children and Youth Directory. He inquired about the capability for updating the information and designating a website for it. Commissioner Parker inquired about the positive impact of Proposition 36 on the drug treatment programs. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR NOVEMBER 2000 On behalf of the Commission, Commissioner Lee Ann Monfredini presented the award to: Joel Martinez, Environmental Health Technician, Environmental Health - Solid Waste Program, nominated by Scott Nakamura, Principal Environmental Health Inspector 6) PRESENTATION OF THE 1ST QUARTERLY DEPARTMENT OF PUBLIC HEALTH REVENUE/EXPENDITURE REPORT FOR FY 2000-01 Monique Zmuda, Chief Finance Officer, presented the 1st quarterly financial projection of revenues and expenditures for this fiscal year. These projections are based on revenues collected and billed, and expenses incurred for the first three months of the fiscal year, ending September 30, 2000. Based on this data, the Department of Public Health is projecting a yearend deficit of $723,000 for FY 2000-01. This amount represents less than 1/8th of one percent (1%) of the Department’s total operating budget of $949 million. Projections include revenue surplus of $2.4 million and over expenditures of $3.1 million. Ms. Zmuda commented the next quarterly report will incorporate the additional expenses of the SFGH outpatient pharmacy ($1.1 million) for this fiscal year. She also pointed out that in the area of jail health services, the number of inmates and specialty services has increased. There will be a presentation of Jail Health Services on December 12, 2000. President Guy referred to the JCC-LHH for a thorough discussion of the over expenditures on personnel salaries. 7) UPDATE ON THE IMPLEMENTATION OF POLICY #24: POLICY ON CONTRACTORS’ COMPLIANCE WITH NON DISCRIMINATION AND CULTURAL COMPETENCY Norm Nickens, Deputy Director of EEO, Affirmative Action and Cultural Competency, gave an update on implementation of Policy #24. After hearing comments from Commissioners, Mr. Nickens will come back with some proposed policy changes to Policy #24. Commissioner Chow encouraged ways to have qualitative and quantitative measures; using small numbers is not necessarily appropriate; may want to look at the amount of the contract; promoted the use of external and DPH cultural competency experts (i.e., an advisory committee), including community-based providers; San Francisco is a great city where cultural competency can be a model and not just bureaucratic regulation. Commissioner Monfredini advocated not to lose the spirit and core of this policy. Commissioner Umekubo promoted the outcome measures and positive outcomes for our patients and clients. Commissioner Sanchez pointed out differences between policy and implementation; DPH can set the standard. He pointed the cultural competence expertise and diversity of the DPH administrative staff (i.e., Dr. Melissa Welch). President Guy recommended changes and modifications to Policy #24 come back to the Commission. She would like to see the HRC Form 6. She also pointed out that agencies that are out of compliance need to provide an update within a given period of time and not wait for a whole year. 8) OTHER BUSINESS/PUBLIC COMMENTS None. The meeting was adjourned at 4:35 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission