Minutes of the Health Commission Meeting June 19, 2001 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 Guy, M.S.W., at 3:10 p.m. All Commissioners were present: President Roma P. Guy, M.S.W., President Vice President Edward A. Chow, M.D. Commissioner Arthur M. Jackson Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner John I. Umekubo, M.D. Commissioner David J. Sanchez, Jr. Ph.D. arrived at 4:00 p.m. 2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF JUNE 5, 2001 Action Taken: The Commission adopted the Minutes of June 5, 2001. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Monfredini chaired the Budget Committee, with Commissioner Jackson participating) (3.1) DPH - Request for approval of a proposed ordinance to revise patient rates for the Department of Public Health for FY 2001-02. (3.2) DPH-Central Administration/MIS - Request for approval of a contract modification to the product and services agreement with Siemens Medical Solutions Health Services Corp to add $800,000 for a Patient Access Systems and Process Integration project, for a total revised contract amount of $7,167,691, for the term January 1, 1999 through June 30, 2002. (DPH contracted with Siemens for services totaling $4,872,954 during FY 2000-01). (3.3) AIDS Office - Request for approval of a sole source and new contract with University of California at Berkeley (UCB), Survey Research Center, in the amount of $169,362, to provide piloting, planning, programming and telephone interviewing services for the San Francisco Behavioral Risk Factor Survey services that will target San Francisco residents, for the period of June 1, 2001 through December 31, 2001. (3.4) AIDS Office - Request for approval of a contract modification with Mobilization Against AIDS International (MAAI) in the amount of $46,967, for a new contract total of $90,467, to provide additional HIV prevention interventions to transgender individuals, for the period of January 1, 2001 through December 31, 2001. (DPH Contracted with MAAI for services totaling $289,204 during FY 2000-01). (3.5) CHPP-Promotion - Request for approval of a contract renewal with Polaris Research and Development, in the amount of $150,000, to provide evaluation services for the Tobacco Free project, for the period of July 1, 2001 through June 30, 2002. (DPH contracted with Polaris for services totaling $434,516 during FY 2000-01). (3.6) CHPP-Promotion - Request for approval of a contract renewal with O’Rorke Public Relations and Advertising, in the amount of $85,000, to provide media services to the Tobacco Free Project, for the period of July 1, 2001 through June 30, 2002. (DPH contracted with O’Rorke for services totaling $109,200 during FY 2000-01). (3.7) CHPP-Promotion - Request for approval of a contract renewal with San Francisco Study Center (SFSC), in the amount of $708,856, to provide fiscal agent services for the Community Capacity Building Training Center for the Tobacco Free Project, for the period of July 1, 2001 through June 30, 2002. (DPH contracted with SFSC for services totaling $2,448,129 during FY 2000-01). (3.8) PHP-Substance Abuse - Request for retroactive approval of a modification for SAGE Project, Inc., for capital expenditure in the amount of $75,000, to complete the renovation of the building begun in FY 1999-00, specifically the building-wide sprinkler system, for a total contract value of $483,699, for the period of June 1, 2001 through June 30, 2002. (DPH contracted with SAGE for services totaling $397,915 during FY 2000-01). (3.9) PHP-Mental Health - Request for approval of a modification to the multiyear contract with Ramsell Corporation doing business as Professional Management Development Corporation, in the amount of $130,000, to provide fiscal intermediary services under the San Francisco Mental Health Plan, and to extend the term of the existing contract for the period of July 1, 2000 through June 30, 2002, for a total contract value of $1,544,020. (DPH contracted with Ramsell for services totaling $707,010 during FY 2000-01). (3.10) PHP-Mental Health - Request for approval of a retroactive contract modification with Recreation Center for the Handicapped (RCH), in the amount of $136,552, to provide behavioral day treatment services for dually diagnosed, mentally ill and developmentally challenged clients, for a total contract value of $337,924, for the period of July 1, 1997 through June 30, 2001. (DPH is in the process of contracting with RCH for services totaling $84,481 during FY 2000-01). (3.11) PHP-Mental Health - Request for approval of a retroactive contract modification with Regents of the University of California San Francisco (UCSF) Center on Deafness, in the amount of $294,791, to provide mental health services and case management for adults, substance abusing clients, HIV/AIDS clients and a special education program for children targeting the deaf and hard of hearing population, for a total contract value of $1,344,135, for the period of July 1, 1997 through June 30, 2001. (DPH contracted with UCSF for services totaling $10,581,353 during FY 2000-01). (3.12) PHP-Mental Health - Request for approval of a retroactive contract modification with Support for Families of Children with Disabilities (SFCD) to increase funding in the amount of $99,000, to cover the period of April 1, 2001 through June 30, 2001, to continue to provide a variety of mental health services targeting families of children with mental health issues and special needs, for a total contract amount of $369,000 for the period of April 1, 2000 through June 30, 2001. (DPH contracted with SFCD for services totaling $270,000 during FY 2000-01). Action Taken: The Commission approved the Consent Calendar of the Budget Committee. Public Comment Jaime Arisilla works as a consultant Support for Families for Children with Disabilities and the Department of Mental Health. He stated that he recently received a letter concerning the cancellation of his consulting contract, and that he was concerned about his contract. In response, Sai-Ling Chan-Sew, Director, Children’s Services, discussed the funding difficulties. She stated that the speaker had options open to him to work on other contract aspects. 4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) ADMINISTRATION Department Reorganization In an effort to move us further toward implementation of the Department's Strategic Planning goals and objectives, Dr. Katz made some changes to the organizational structure. As the Department has continued to evolve over the past several years, these changes reflect the nature of who DPH is and what it does. The reorganization reinforces the Department's strategic direction in four major ways: First, the new structure integrates primary care, behavioral health, housing and maternal and child health into one division. This will enhance service integration and enable the Department to improve access to care for multiple service users. Second, the reorganization creates a Hospital Systems division, which combines oversight of the rebuilds of both Laguna Honda Hospital and San Francisco General Hospital with the Department's quality management and managed care activities. This will allow the Department to focus on critical institutional infrastructure activities in a coordinated and comprehensive manner. Third, the new structure more evenly weighs the major activities of the Department, thereby creating a flatter management structure and enhancing the Department's ability to create a fully integrated service system. Fourth, by creating a single planning office we move ourselves closer to functioning as a single department. This new structure will enable the Department to be more responsive to the needs of our clients and assist us in achieving the goals and objectives set forth in the Strategic Plan. Attached is a copy of the new organizational chart and more detailed information about the reorganization for your review. COMMUNITY HEALTH NETWORK World Birth Day Project The New York Times Television has solicited the participation of both the Birth Centers of SFGHMC and UCSF to represent births in the United States for a special "World Birth Day" production. This project will film the births of infants at nine locations around the world, all born at about the same time on July 2nd and 3rd. Other filming sites are China, India, Ethiopia, Egypt, Germany, England, Brazil and Mexico. The documentary will air on New Years Day 2002 on the Learning Channel in the USA and the Discovery Channel around the world. The long-term goal is to follow this piece with additional programs over time, showing the different lives these children lead as they grow up in different parts of the world. SFGH Receives NAPH Award for Integrated Soft Tissue Infection Service Dr. Katz announced that San Francisco General Hospital’s Integrated Soft Tissue Infection Service (ISIS) has received honorable mention award from the National Association of Public Hospitals (NAPH) in the category of the "Safety Net Health Innovation." Over 26 public hospitals across the nation submitted nominations for three award categories. Gene O’Connell and Gayling Gee will be in attendance at the June 28th conference in Santa Fe to accept the award on behalf of San Francisco General Hospital. Congratulations to the ISIS Team: Gayling Gee, Hobart Harris and David Young, and Jacquie Caesar, for their enthusiasm and commitment to the ISIS program. LHH Executives Receive Recognition Dr. Katz reported that Mary Louise Fleming, Laguna Honda Director of Nursing, has been selected for the Robert Wood Johnson Executive Nurse Fellows Program. Only 20 nurses nationwide were selected for this prestigious 3-year program. The award provides for research projects at Laguna Honda as well as the opportunity for more educational program development and national exposure for Mary Louise, our resident care programs, Laguna Honda Hospital and the Department of Public Health. Dr. Katz reported that Dr. Terry Hill had been voted President elect of the California Association of Long Term Care Medicine, an organization representing the Long Term Care Continuum in California. This organization is the state affiliate of the American Medical Directors Association. Dr. Hill’s leadership capabilities in Long Term Care are impressive and have been duly recognized by this progressive statewide organization. Commissioners’ Comments Commissioner Monfredini asked about the burden placed upon the Director when so many different people report directly to him Commissioner Parker asked about items not on the chart. Dr. Katz responded that those units still exist, but that the goal was to list everything on one page Vice President Chow stated that, under the new chart, organizations can focus on things important to them, and is more a reflection of the ways the Department operates today President Guy stated that she supports the reorganization, and that it reflects transitions that the Department has experienced 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEES RECOGNITION AWARDS FOR THE MONTH OF JUNE Commissioner Umekubo presented the following Employee Recognition Awards. Housing and Urban Health, Population Health and Prevention, Housing and Urban Health: Marc Trotz Margot Antonetty Daisy Leyva Community Health Network/ San Francisco General Hospital, Emergency and Trauma Services: Renee Cibulka Bobbie Earsey Arla Escontrias Linda Henson Kitty Mah Gloria Rodriguez Ann Stangby The Commissioners thanked each of these teams for their contributions. 6) UPDATE ON EMERGENCY MEDICAL SERVICES (EMS) SYSTEM ACTIVITIES John Brown, M.D., Medical Director, Emergency Medical Services, updated the Commission on the Emergency Medical Services Section. He spoke about the strategic plan for EMS to focus on core EMS functions. He stated that in the year 2000, the EMS system received over 67,000 calls for emergency assistance. Dr. Brown stated that the EMS Section recently approved a large scale pilot program, entitled the “Rapid Paramedic Response System.” He stated that, under this system, the SFFD would staff 25 ALS (advanced life support) engines and 19 one-paramedic and one-EMT ambulances. Dr Brown told the Commission that statistically and clinically relevant data would be used to evaluate the program. He also stated that the program would increase the number of ALS units available, and decrease the time for response. Dr. Brown also highlighted the Disaster Registry Program, the Public Access Defibrillator Program, and emergency department overcrowding and diversion. He stated that total diversion suspension was three times higher overall in the year 2000 than in 1999. Dr. Brown also discussed the Trauma Systems Plan, which calls for a new approach towards the care of critically injured patients, and all who are injured within the City. The Executive Summary for each of Dr. Brown’s presentations, “San Francisco Department of Public Health, Emergency Medical Services Section, Annual Report, Year 2000,” and “Ambulance Diversion and Emergency Department Overcrowding in San Francisco” were enclosed as was enclosed as attachments. Dr. Marshal Issacs, EMS Director of the San Francisco Fire Department, spoke to the Commission. He discussed the recent history of San Francisco’s EMS system. Dr. Issacs also spoke about the Rapid Paramedic Response System. He stated that the program is the single most important development in modern EMS history in San Francisco, and will result in the most rapid, high quality, out of hospital emergency medical care. Dr. Issacs stated that the program contains some controversy, and the Fire Department is doing its best to address concerns. Public Comment Nora Roman appeared on behalf of Larry Bradshaw, a City paramedic. He believed that the rapid paramedic response proposal traded quality for faster response time, and this choice placed quantity over quality. Ms. Roman stated that City data does not track patient outcomes. Nora Roman, Emergency Coalition to Save Public Health, is actively involved in the pre-hospital system. She stated that there is no community advisory board advising the EMS system. Ms. Roman stated that the Coalition opposes the plan as it now stands, and that she is concerned about paramedics working 24-hour shifts. She asked the Commission not to rush into this proposal. Jonathan Meade has worked as a City paramedic for over 21 years. He stated that Dr. Brown’s and Dr. Issac’s presentation was sugar coated, public relations presentation. Mr. Meade spoke about 60 paramedics who have left the job over the last three years. He stated that the Fire Department grinds its paramedics into the ground. Dale Butler, SEIU 790, stated that he has never witnessed a more self-serving spin on facts by management. He stated that dozens of paramedics have quit, and four have died, because the Fire Department insists on 24-hour shifts. Mr. Butler stated that paramedics go out on more calls than other firefighters. He stated that he opposes the proposal because it is bad for the residents. Dr. Thomas Pikes, President of San Francisco Emergency Physicians Association, stated that he had received the presentations from Drs. Brown and Issacs. Dr. Pikes stated that most calls only require one paramedic at a time. He added that it is necessary to get ALS to patients as soon as possible, and that one paramedic on the engine will meet that goal. Commission Comments Vice President Chow asked about the approval process. In response, Dr. Brown described three different advisory committees, which include members of the general public and providers. He stated that all policies go out with a public announcement and through a web site. President Guy reminded that the agenda item consisted of an update and a review of the annual report, and was not an action item. Commissioner Monfredini asked about paramedic staffing. Dr. Issacs stated that there are very few open slots within the Fire Department ranks. Commissioner Jackson stated that the main concerns are about whether the person lives. He asked whether a paramedic arriving five minutes earlier will improve patient outcomes. Dr. Brown stated that outcome data today only shows whether patient lived to hospital, but that the pilot program contains better outcome measures. Commissioner Sanchez asked questions concerning collecting data on attrition and recruitment, and whether these issues are factors in patient health and safety. Commissioner Parker inquired whether the 24-hour shift issue is a health or labor issue. Dr. Issacs stated that the vast majority of paramedics support the 24-hour issue. Dr. Katz articulated a brief history of the paramedic issues. He then identified the advantages of placing paramedics on fire engines. Dr. Katz stated that the report was silent on whether an ambulance should have one or two paramedics. He stated that a superior system is transports at least one paramedic to the patient sooner, and with the existing workforce, the only way to do that is through the one paramedic on the engine and one paramedic in the ambulance proposal. Vice President Chow suggests that the JCCs look at these issues President Guy stated that she looks forward to the Trauma System Report next month, and for the JCCs to review these issues. She stated that the agenda could be reviewed for the next several months. 7) MINIMUM STANDARDS OF HEALTH INSURANCE COVERAGE FOR THE HEALTH CARE ACCOUNTABILITY ORDINANCE The Commission continued its consideration of the minimum standards of health insurance, and the Proposed Resolution that it began during the meeting of June 5, 2001. Dr. Katz provided an overview of new issues for the Commission. He discussed mental health coverage in the Proposed Resolution. Dr. Katz also suggested two changes to the Proposed Resolution: 1) to make the effective date of coverage begin be no later than 30 days following the start of employment by the employee (to comport with the Health Care Accountability Ordinance), and 2) to change the language of the Proposed Resolution to state that employers must offer (instead of provide) insurance. Dr. Katz also stated that the insurance product required by the Proposed Resolution is available in the marketplace. Public Comment Dale Butler, SEIU, Local 790, invited Larry Winston of Dublin Insurance, Inc., to speak. Mr. Winston stated that his company provides pooled insurance at a favorable rate to management. He told the Commission that his company provides an insurance plan with a $10 co-pay that mirrors or is better than the plan in the Proposed Resolutions good as outlined plan Elizabeth Frantes stated that the insurance program is a joke and an insult. She said that HMO systems do not work. Ms. Frantes added that employee-based insurance does not work, there is no job security. She further stated that the proposal does not cover San Francisco residents and was rushed through. Nathan Nayman is with the Committee on Jobs. He stated that the business community supports the provision of health insurance to individuals, but that the process for implementing the Ordinance was flawed. Mr. Nayman stated that the process was not inclusive, and a rush to pass the Ordinance and approve the basic benefit package. He told the Commission that they are creating a two-tiered health insurance program, and an elite group of employees who will not have to pay a share of premiums. Glynn Washington, Human Services Network, stated his strong support for the proposal. He stated that the ordinance has serious flaws. He asked about possible ERISA violations in the implementation of the Ordinance and the Health Commission minimum standards. Mr. Washington asked for a body to be created that understands non-profit and small business concerns, and which could respond to questions with real answers. Debbie Lehrman, Human Services Network, echoed Mr. Washington’s support for the Ordinance. She stated that it is vital to have some one to provide policy expertise and technical assistance in the construction and implementation of the regulations. She asked the Commission to ensure the involvement of informed policy staff to make the Ordinance a success. After public comment, Dr. Katz stated that the Ordinance assigns specific roles, and that the Health Department and Commission have tried to fulfill their role. He said that the person responsible for the administration of the Ordinance is the Director of Purchasing. Dr. Katz added that the City is committed to training. Commissioners’ Comments In response to Commissioners’ questions, Dr. Katz clarified that the Proposed Resolution called for a maximum co-payment for skilled nursing care of $100 per admission President Guy and Vice President Chow requested quarterly updates from the Department Commissioner Monfredini raised the issue of different levels of health insurance coverage, depending on whether the employee is working on a City Contract. Dr. Katz replied that the employer does not have to provide health insurance to the worker who is not a covered employee under the Ordinance, or could provide a different benefit package or higher deductible Commissioner Jackson questioned whether it is legal to provide two employees of the same firm with different levels of health insurance. In response, Aleeta Van Runkle, Deputy City Attorney, stated that the Office of the City Attorney has reviewed the Ordinance for ERISA issues, and that the Office believes that the Ordinance would survive a legal challenge brought under ERISA. Action Taken: The Commission amended the language of the Proposed Resolution in two ways, to read: “RESOLVED, that the effective date of coverage be no later than 30 days following the start of employment by the employee on a covered contract, subcontract, lease, or sublease”… and to read, under the co-payment schedule: “Skilled Nursing Services $100/admission” (minimum 100 days/year) On the motion to accept the Amended Resolution, seven Commissioners (Guy, Chow, Jackson, Monfredini, Parker, Sanchez, and Umekubo) voted aye. The motion passed. The Resolution approved by the Commission was enclosed as an attachment. 8) PROGRAM REPORT ON WELLNESS CENTERS Sai-Ling Chan-Sew, Director, Children’s Services, Community Mental Health, presented an update on the High School Wellness Program. She was accompanied by: Trish Bascum, Director of the School Health Program of the San Francisco Unified School District; Nani Coloretti, Fiscal Manager for the Department of Children, Youth and their Families; and Deborah Rodriguez-Alvarez, Director of the Department of Children, Youth and their Families. According to Ms. Chan-Sew, the program is in effect in seven high schools, and approximately 4000 students have sought services, and was created in response to student feedback. According to the report, the program provides students access to health education, reproductive counseling, substance abuse counseling, mental health services, and referrals to primary health care, all through the school sites. The PowerPoint presentation made to the Commission was enclosed as an attachment. Commissioners’ Comments Commissioner Monfredini asked about a student’s first interaction with the wellness team, and how quickly the team can react to a crisis (possible suicide or abuse) situation. The Commissioner described the program as wonderful. Commissioner Sanchez congratulated and thanked all of the partners involved in the wellness program, and asked all to continue to work together to expand options. Commissioner Umekubo also complimented the program leaders. He asked specifically about the Balboa Teen Clinic. Sai-Ling Chan-Sew stated that the clinic was fully staffed. Vice President Chow asked about the plans for reaching the high schools not yet included in the program. Ms. Chan-Sew responded that she was not sure, and was working on staffing the present centers. Vice President Chow asked if the identified priorities extended throughout all schools, and Ms. Chan-Sew responded that they did. Vice President Chow also asked about the timetable for evaluating the program. Deborah Rodriguez-Alvarez, Director of the Department of Children, spoke in more detail concerning the evaluation strategy. President Guy thanked Ms. Rodriguez-Alvarez for the key leadership that she provided to make the program possible. 9) OTHER BUSINESS/PUBLIC COMMENTS None. 10) CLOSED SESSION A. Public comments on all matters pertaining to the closed session None. B. Vote on whether to hold a closed session pursuant to Government Code Section 54957 and San Francisco Administrative Code Section 67.10(b) Action Taken: The Commission voted to hold a closed session. The closed session began at 6:30 p.m. C. Closed session pursuant to Government Code Section 54957 and San Francisco Code Section 67.10(b) Public Employee Hiring: 1551 Executive Secretary to the Health Commission D. Reconvene in Open Session Possible report on action taken appointing the Executive Secretary to the Health Commission (Government Code Section 54957.1(a)(5), and San Francisco Administrative Code Section 67.14(b)(4)) Vote to elect whether to disclose any or all discussions held in closed session (San Francisco Administrative Code Section 67.14(a)) Action Taken: No report issued. The Commission voted not to disclose any discussions held in closed session. The closed session ended at 6:40 p.m. 11) ADJOURNMENT The Commission adjourned the meeting at 6:40 p.m. Arthur R. Greenberg, Interim Executive Secretary to the Health Commission