Minutes of the Health Commission Meeting September 4, 2001 at 3:00 p.m. 101 Grove Street, Room #300 San Francisco, CA 94102 1) CALL TO ORDER The meeting was called to order by President Roma P. Guy, M.S.W., at 3:05 p.m. Present:  President Roma P. Guy, M.S.W. Vice President Edward A. Chow, M.D. Commissioner Arthur M. Jackson 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 THE MINUTES OF THE REGULAR MEETING OF AUGUST 21, 2001 Action Taken: The Commission approved the minutes of August 21, 2001. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner David J. Sanchez, Jr., Ph.D.) Commissioner Sanchez chaired, and Commissioner Monfredini and Commissioner Jackson attended, the Budget Committee meeting. (3.1) DPH-Administration - Annual Report of Gifts Received in FY 2000-01 (3.2) CHN-Primary Care - Request for approval of a four-year contract with the Bar Association of San Francisco Volunteer Legal Services program to provide SSI advocacy and overall administration of the Homeless Advocacy Program, in the amount of $445,808, for the period of July 1, 2001 through June 30, 2005. (3.3) PHP-CSAS - Request for approval to accept and expend retroactively a Center for Substance Abuse Treatment grant in the amount of $1,105,000, to expand and evaluate substance abuse treatment services, for the period of August 1, 2001 through July 31, 2002, with a sole source contract with the Regents of the University of California San Francisco for $177,300 for evaluation services for the same period. Commissioner Sanchez abstained on this item. (3.4) PHP-AIDS Office - Request for approval of a contract renewal with Shanti Project in the amount of $395,324, to provide emotional and practical support services, for the period of July 1, 2001 through June 30, 2002. (3.5) PHP-AIDS Office - Request for approval of a contract renewal with San Francisco AIDS Foundation HIV Prevention Project in the amount of $585,782, to provide HIV prevention and needle exchange services, for the period of July 1, 2001 through June 30, 2002. (3.6) PHP-AIDS Office - Request for approval of a contract renewal with San Francisco AIDS Foundation in the amount of $135,988, to provide HIV Prevention Telephone Hotline services, for the period of July 1, 2001 through June 30, 2002. (3.7) PHP-AIDS Office - Request for approval of a contract renewal with San Francisco AIDS Foundation in the amount of $744,880, to provide client advocacy and financial benefits services, for the period of July 1, 2001 through June 30, 2002. (3.8) PHP-AIDS Office - Request for approval of a sole source and new contract with Better World Advertising in the amount of $337,707, to provide a social marketing and media campaign for HIV testing, for the period of September 1, 2001 through December 31, 2001. (3.9) PHP-AIDS Office - Request for approval of a contract modification with Better World Advertising in the amount of $250,000 to provide services for the ‘HIV Stops with Me’ campaign, for the period of January 1, 2001 through December 31, 2001, bringing the contract total to $307,000 for the year. Commissioners’ Comments With regard to agenda items 3.8 and 3.9, Commissioner Monfredini asked during the Budget Committee when outcome reports from the campaign efforts would be available. Commissioner Monfredini expressed concern that infection rates are increasing more quickly than anticipated, and wants to know if these efforts are working. Steven Tierney responded that it will take less than a year for the outcome report. Commissioner Sanchez stated that the advertising campaigns being developed by Better World Advertising will meet the needs of the Department’s multi-lingual outreach efforts. Commissioner Chow asked if the contractors for agenda items 3.7, 3.8 and 3.9 had submitted the required cultural competency reports. Commissioner Sanchez responded that, at the Budget Committee, staff had said that the reports had been submitted. Commissioner Parker, commenting on the Annual Gift Report, gave special recognition to the volunteers at San Francisco General Hospital and Laguna Honda Hospital for their work and monetary donations over the years. Action Taken: The Commission approved the Consent Calendar of the Budget Committee, with Commissioner Sanchez abstaining on Agenda Item 3.3. 4) DIRECTOR’S REPORT  (Mitchell H. Katz, M.D., Director of Health) 2001 Public Managerial Excellence Award Winners Announced I am proud to announce that Marc Trotz, Director Housing and Urban Health is one of the five winners of this year’s Public Managerial Excellence Awards for San Francisco City managers. When he joined the Health Department four years ago, the conventional wisdom was that it was impossible to take people directly from long-term homelessness and place them in permanent housing. The concern was that people who had been homeless for a long time would be unable to adjust to living with others. Marc has proven that you can take people directly off the street and provide them with permanent housing, as long as you do so with supportive services. He has also proven that it can be done affordably. I am sure you all join me in congratulating Marc on this well deserved honor. Each winner will receive a monetary award, be highlighted in a video production sponsored by KPIX Channel 5 and recognized at an Awards Luncheon on October 24th at the Westin St. Francis Hotel. Hospital Seismic Safety Legislation SB 842 (Speier), a key seismic safety relief bill, passed another committee hurdle last week. As you know, current seismic safety law requires hospitals to meet significant compliance milestones in 2008 and 2030. Seismic relief legislation last year extended the 2008 deadline to 2013 for hospitals meeting certain requirements. SB 842 would provide further relief by granting hospitals a five-year extension of 2008 requirements if they agree to meet 2030 requirements by 2013. SB 842 would also allow a five-year extension of the 2008 requirements by mutual agreement between the hospital and the Office of Statewide Health Planning and Development, in accordance with a work progress plan. SB 842 would become operative only if a hospital seismic safety bond bill is also enacted by the Legislature in 2001 and placed on the ballot in 2002. SB 717 (Speier), which would enact that bond measure, is currently on suspense in Assembly Appropriations. The Assembly Appropriations Committee must still pass SB 842 and then the full Assembly before it is presented to the Governor. Fire Updates A 3-alarm fire broke out Friday afternoon in a 37-unit four-story apartment building at the corner of Stanyan and Frederick Streets. DPH/EMS, DHS, Mayor's Office on Homelessness, OES and Recreation and Parks were all on scene along with the Red Cross. The 46 residents were primarily younger, no frail elders, children or people with disabilities. Rec/Park opened Kezar Pavilion as a temporary reception center for residents. Some residents were vouchered into hotels, but for the most part were able to find temporary housing on their own initiative. The owner intends to repair the building as quickly as possible and reopen it to the tenants. We have good news to report about the fire last month at Capp and 20th Streets. The City Team, with DHS caseworkers taking the lead role, has been successful in placing all but 2 of the original 15 families into new permanent housing. We will continue to work with the two remaining family groups. Trauma Plan I am pleased to share with you the following comments from the California EMS Authority: "This is to acknowledge receipt of the City and County of San Francisco Trauma Care System Plan 2001. You have the distinction of being the first agency to submit your plan as of the deadline and we appreciate your timeliness. A preliminary review of the plan indicates that it is generally consistent with the requirements of the California Code of Regulations. A detailed review of the plan will now be conducted and you may be contacted for additional information if necessary. The final decision regarding the plan will be submitted to you in writing.” Congratulations to our EMS team for a job well done! Red Light Running Campaign This is National STOP Red Light Running Week and the Department has a number of prevention activities planned with DPT, SFFD, SFPD and private ambulance companies. The front of the building here at 101 Grove St. has a "STOP on Red...You'll only kill a few seconds" banner hung across the entrance. Public service announcements will be running on several radio stations and on Thursday, staff from the STOP Red light Running campaign will distribute "RED means STOP" antenna balls to the public at noon on the corner of Polk and Grove Streets. A copy of the Department's press release is attached to the Health Commission's packet. We also have samples of the give aways available for you and encourage you to put the I STOP FOR RED LIGHTS bumper stickers on your vehicles. Commissioners’ Comments Commissioner Sanchez commended Dr. Katz for having invited Dr. Diana Bontá, Director of the California Department of Health Services, to spend three days in San Francisco. Commissioner Sanchez continued that it was astounding to see Dr. Bontá meet with San Francisco’s communities, its non-profit agencies and Department staff, and really get an understanding of the needs of the community. Commissioner Umekubo asked for staff’s assessment of whether or not Senate Bill (SB) 717 would be successful. Colleen Johnson, Acting Director of Policy and Planning, responded that there is motivation at the State level to get some seismic safety relief. However, because the State is having fiscal problems, legislative relief will be easier than monetary relief. Commissioner Chow asked for clarification about SB 717 being tied to Senate Bill (SB) 842, and if both needed to be approved by the Legislature to go forward. Ms. Johnson responded that if SB 842 is approved but SB 717 is not, then SB 842 would not go forward. However, the Legislature can amend the language in SB 842 to allow for SB 717 to be approved in 2002, rather than in 2001, as it currently states. Commissioner Chow then asked what the Department’s position is on the extension offered by SB 842. Dr. Katz responded that the Department is going to proceed with the plan for San Francisco General Hospital regardless of the bill, because it is clear that the hospital needs to be replaced. However, Dr. Katz continued, a State bond measure would make financing a lot easier. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF AUGUST Commissioner Monfredini presented the employee recognition awards.   Nominees Division Nominated by Hector (Anthony) Almanza, Institutional Police Officer CHN - SFGH, Institutional Police Sgt. Craig Koss, Institutional Police, SFGH Gerard (Jerry) Komp, Supervising Pharmacist CHN - SFGH, Pharmaceutical Services Fred Hom and Sharon Kotabe, SFGH/CHN Directors, Pharmaceutical Services 6) MEDICAL MARIJUANA PROGRAM UPDATE (Colleen Johnson, Acting Director, Policy and Planning) Colleen Johnson, Acting Director of Policy and Planning, presented the Commissioners with an update on the Voluntary Medical Cannabis ID Card Program. The program has just completed its first year of operation. Ms. Johnson provided the Commission with a brief background on the Voluntary Medical Cannabis ID Card Program. The program was developed as a result of Proposition 215, the Compassionate Use Act, which was approved by the voters in November 1996. The Health Commission passed resolutions in April 1997 and December 1999 strongly supporting implementation of the Compassionate Use Act and a voluntary medical cannabis identification card program, respectively. In May 2000, the Board of Supervisors passed an ordinance authorizing the Department of Public Health to issue the cards. Ms. Johnson then detailed the process for participating in the program. Patients with a valid physician referral and designated caregivers are eligible for the program. Applicants can live in any of the following Bay Area counties: San Francisco, Sonoma, Marin, Napa, Santa Clara and San Mateo. Applicants must present a physician’s statement, signed Medical Release Form, a photo identification card, proof of residence and payment in the amount of $25, for the costs associated with processing the card. Applications are submitted to and processed by the Vital Statistics Office. The authenticity of physician referral is verified, as is the physician’s standing with the State Medical Board. Ms. Johnson said that applicants are often issued cards on the same day. Ms. Johnson stated that the names, addresses and phone numbers of the applicants are not kept on file, and that all original documents are returned to the applicant. (Dr. Katz added later in the discussion that the Department also does not keep records of physicians who sign letters.) According to Ms. Johnson, utilization of the program for the first year (July 1, 2000 through June 30, 2001) was as follows: 2,018 cards were issued. Of those, 1,749 were for patients, 269 were for caregivers 1,681 unique patients 262 unique caregivers Median term of each card: 23 months Most of the City’s cannabis buyers’ clubs required the DPH card Ms. Johnson then described Laguna Honda Hospital’s creation of an interdisciplinary task force to examine the use of medical cannabis at Laguna Honda, which is home to approximately 1,000 people. A pilot program was developed to enable patients to access their rights under Proposition 215 and use cannabis for medical purposes. The 90-day pilot program was just completed and is currently being assessed. Ms. Johnson added that, to make it easier for Laguna Honda residents to participate in the program, Vital Statistics’ staff went to the facility on Saturdays to receive and process applications. Ms. Johnson stated that Laguna Honda Hospital is the only inpatient facility in the State to have such a program. Ms. Johnson said that both the District Attorney’s Office and the San Francisco Police Department are supportive of the program. In addition, Ms. Johnson said that State Senator John Vasconcellos has sponsored a bill, SB 187, which would create a statewide voluntary medical cannabis identification card program, which is modeled on San Francisco’s program. Ms. Johnson then described the next steps: Supervisor Mark Leno has called for a hearing at the Board of Supervisors, to take place in October Continued participation in Supervisor Leno’s Task Force Continued advocacy for SB 187 Further evaluation of the Voluntary Medical Cannabis ID Card Program Commissioners’ Comments Commissioner Monfredini is concerned that this card is valid for two years, and that this gives people a lot of time to duplicate cards. Ms. Johnson responded that the card is valid for the time period that the physician deems appropriate, which has an upper limit of two years. Also, the cards are designed so they cannot be reproduced. Ms. Johnson spoke with a sergeant at the Narcotics Division of the San Francisco Police Department who said he has not seen any reproductions. Commissioner Parker asked if there have been any problems getting physicians to participate, and what has been the physician’s relationship with the patient beyond just writing the prescription. Dr. Katz responded that the Department does not require a physician to sign a letter he or she does not feel it is warranted. Dr. Katz knows of instances where doctors would not sign the letter. Commissioner Umekubo asked if there have there been any problems with forgery of physician letters. Ed Hernandez, Director of Records and Statistics, responded that he is aware of only one instance of this happening. Commissioner Chow asked about the Laguna Honda pilot project, specifically how the program is controlled at Laguna Honda, and if the medical orders include a prescription for the use of cannabis for medical purposes. Dr. Katz responded that staff has to deal with the fact that while Proposition 215 provides for access for compassionate use, it does not allow for medical professionals to write specific doses or having these doses administered by nursing staff. Staff has developed the program so that patients must have a signed recommendation from a physician, which is commonly a Laguna Honda physician, and must comply with house rules, such as no smoking indoors or outdoors around people who do not want to be near smoke. Commissioner Guy asked if staff anticipates any concerns being raised at the Board of Supervisors hearing that should be discussed by the Health Commission prior to that hearing taking place. Ms. Johnson responded that she expects the hearing to demonstrate widespread support for the program. Public Comment Michael Aldrich, Ph.D., Executive Director of C.H.A.M.P (Californians Helping Alleviate Medical Problems), stated that C.H.A.M.P. worked for two years with Dr. Herminia Palacio to develop a confidential card system. Dr. Aldrich said that the card system in San Francisco is simple, efficient, and keeps the confidentiality of the patients. C.H.A.M.P. requires that patients get the DPH card before they get the C.H.A.M.P. card. Tappié Dufresne, staff person at C.H.A.M.P., said it was a pleasure to work with Laguna Honda Hospital staff to implement the Compassionate Use Act at the facility. Their clientele has not had problems obtaining the ID card. They had thought the $25 fee would be a problem, but it has not been. Wayne Justmonn, San Francisco Patients Resource Center, said he was the first medical cannabis ID card holder in San Francisco, and he supports the Department’s program. The ID card gives him credible access to medical cannabis. He knows that his freedom and his rights will be honored in San Francisco. 7) NURSE WORKFORCE RETAINER AND RECRUITMENT REPORT (Gene O’Connell, Executive Administrator, SFGH) Sue Currin, RN, Chief Nursing Officer at San Francisco General Hospital Medical Center, began the presentation of the Nursing Workforce Report. Ms. Currin said that the presentation would summarize the findings of a nursing workforce survey that was conducted in January 2000 by the Nursing Leadership Council and the Department of Public Health. Ms. Currin then introduced Leslie Holpit, RN, Interim Director of Recruitment and Retention. Ms. Holpit stated that nationwide the average age of the nursing workforce is 43, which is a substantial increase from 10 years ago. There is also a nationwide decrease in the number of women who are choosing nursing as a career, as well as a shortage of nursing faculty and nursing programs. Ms. Holpit said that there are 235,566 registered nurses in California, with an average age of 48 years. Only nine percent of the workforce is under 30. California has the lowest RN/population ratio in the United States. Ms. Holpit said that studies indicate that California will need 25,000 more RNs by 2006 and 60,000 more RNs by 2020. San Francisco Department of Public Health RN Workforce Ms. Holpit then described the Department of Public Health RN workforce. At the time of the Nursing Leadership Council’s survey, there were 2395 RNs in the DPH workforce. 1446 of the RNs were permanent, and 949 were per diem. 29 percent of the RN workforce in DPH is over 50 years of age. Only four percent are under 30 years of age. There were 914 respondents to the Nursing Leadership Council survey, 59 percent of whom worked at SFGH and 21 percent of whom worked at Laguna Honda Hospital. 31 percent stated they planned to leave their job within five years. Multiple answers were given when asked what would encourage them to stay, including opportunities for career advancement and improved working conditions. Ms. Holpit then described the nursing vacancy situation in the Department. While the statewide turnover rate at hospitals is 18 percent, San Francisco General Hospital had about a 10 percent turnover last year, so they compare very well. The overall vacancy rate is 11%-12%, but the vacancy rate is higher in some specialty areas, such as Acute Psychiatry and the operating room. Ms. Holpit then summarized recommendations that have been made by various professional organizations to increase the supply of nurses, including, improving linkages between academic programs and service organizations, increasing prelicensure entry slots, and making nursing programs more accessible to prelicensure students and to RNs who choose to further their education. Ms. Holpit then described the recruitment and retention activities that San Francisco General Hospital is undertaking: Recruitment Activities Participating in career fairs and conferences, particularly with the schools of nursing Partnering with the School to Career Partnership Program, which gives high school students exposure to a career in nursing Developed a recruitment brochure. This will be the first brochure issued by SFGH since 1991. Working with the Treasure Island Development Authority to get temporary housing on Treasure Island Exploring the possibility of offering child care nearby, possibly Mission Child Development Center Participating in the Bay Area Health Care Recruiter Organization Exploring a training grant with the Department of Labor and the San Francisco Private Industry Council to develop a training program that would increase the number of prelicensure candidates who would move into registered nurse programs, as well as allow nurses who are already licensed to go back to school for a bachelor’s degree or master’s degree Initiated a Med/Surg new graduate training program Formalizing recruitment goals and plan Retention Activities Establishing a retention and recruitment committee, which will consist primarily of bedside caregivers and staff nurses Developing an on-going nurse recognition program that would occur throughout the year, in addition to the activities of Nurse Week, which is in May Developing a “Why Nurses Work at SFGH” campaign Developing a formal retention plan. Ms. Holpit then discussed the features of the desired training program that staff would like to obtain grant funding for, potentially through the Department of Labor. They would like to develop a training program that is built on a career ladder model. They would begin with prelicensure and then expand the existing program capacity to meet all steps of the ladder. And they would provide support or incentives for the individuals participating in the program by reducing their work hours, but providing them with full pay. Commissioners’ Comments Commissioner Jackson asked if nurses were leaving nursing, or leaving the Department of Public Health. Ms. Holpit responded that they do not know at this time, but that this year they are instituting the practice of exit interviews so they will be able to get this information. Commissioner Jackson then asked if exit interviews are standard. Dr. Katz replied that they are not. Commissioner Umekubo asked if enrollment in nursing schools has been decreasing or remaining constant. Ms. Holpit replied that, on a national level, nursing school enrollment has been decreasing. However, in California, this decrease has been less significant. Commissioner Umekubo then asked what barriers to nursing school enrollment exist. Ms. Holpit responded that there are multiple barriers, which are geographically specific. One factor is that private nursing programs have closed because of the high cost of running the programs. Another factor is that the UC system, the Cal State system and the community college system have different admission requirements. Still another factor is that high school students do not have adequate math and science skills, so they often are not successful nursing programs. Commissioner Umekubo asked how the Department rewards good nurses. Ms. Holpit responded that she will be pursing this in her retention committee, and getting input from the nurses. She stated that the literature indicates that nurses would like to be respected, and would like to participate in decision making. Commissioner Sanchez asked if the hospital has considered flexible schedules, such as working less than five days a week. Commissioner Sanchez emphasized that the hospital should collaborate with other city agencies and think creatively about helping people pay for people’s education. In addition, the Department could look at housing assistance for nurses, much like the San Jose program that is designed for teachers. Commissioner Monfredini said that respect for nurses is a key issue, and helps the nurses be loyal to the institution. Commissioner Monfredini asked if the trend was for more nurses to work per diem in order to have more flexibility and control of their lives. She also asked about the utilization of mandatory overtime, which sometimes overburdens nurses. Ms. Holpit replied that, in recruitment literature, there is a finding of more people who are looking for more of a balance between work and non-work, and that per diem may be the only way they can get this flexibility. Ms. Currin stated that the utilization of mandatory overtime has decreased significantly in the past six months, and various methods are used to limit the usage, such as Nurse Managers working nights and weekends. Ms. Currin said that the nursing staff has responded well. Ms. Currin said that the impending nursing ratios that are supposed to be issued by the State Department of Health Services in January 2002 will exacerbate the situation. Commissioner Parker said that he appreciates the efforts that are being made to address this issue on a local level, but emphasized that this is a nationwide problem that must be addressed at that level as well. Commissioner Jackson stated that, in terms of recruitment, a lot can be done to reach out nationwide to recruit people from other states to San Francisco. In addition, the recruiting efforts can begin at the junior high school level. Commissioner Jackson continued that the Department should evaluate on-site day care, giving perks to good nurses, and having good communication between all levels of staff. Commissioner Chow stated that the core challenge is to bring new nurses into the career. He said that the nursing career has to have a higher visibility as a career path and a career choice. Unless nursing has a more prestigious reputation, it will continue to be more difficult to recruit for than other health care professions. Commissioner Chow said that one way to make this a more attractive career might be to have additional educational requirements. Prestige is needed to entice young people into careers. Commissioner Chow said that giving nurses something to feel satisfied about in their jobs would improve retention. Commissioner Guy said that this is a substantial issue that needs to be followed at the Joint Conference Committees, where there can be more discussion about the impact of the various efforts on recruitment and retention. Commissioner Guy continued that there is a complexity of nursing care, a changing role of nurses, and a changing nature of patient needs and focus, and the educational system needs to reform itself to meet these changing needs. The Department should attempt to influence educational institutions in San Francisco. Commissioner Guy stated that the fact that San Francisco General Hospital is a teaching hospital does impact nursing, and needs to be considered. Commissioner Guy also said that there needs to be acknowledgment that the Department’s training costs are going to increase, particularly when the educational institutions are leaving the training to the hospitals. The Department needs to consider where funding for training will come from. 8) OTHER BUSINESS/PUBLIC COMMENTS None. 9) CLOSED SESSION A) Public comments 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) Action Taken: The Commission (Chow, Jackson, Monfredini, Parker, Sanchez, Umekubo) voted to hold a closed session. The Commission went into Closed Session at 5:45 p.m. Commissioner Guy left the meeting at 5:45 p.m., and was not present for the Closed Session. C) Closed session pursuant to Government Code Section 54956.9 and San Francisco Administrative Code Section 67.10(d) Conference with Legal Counsel - Existing Litigation Proposed settlement of $15,000 in the David Wellhausen v. CCSF, Superior Court, Case #303-115 The Commission came out of Closed Session ended at 5:55 p.m. D) Reconvene in Open Session 1) Possible report on action taken in closed session (Government Code Section 54957.1(a)2 and San Francisco Administrative Code Section 67.12(b)(2).) Action Taken: The Commission (Chow, Jackson, Monfredini, Parker, Sanchez, Umekubo) approved the settlement of $15,000 in David Wellhausen v. CCSF, Supervisor Court Case #303-115. 2) Vote to elect whether to disclose any or all discussions held in closed session (San Francisco Administrative Code Section 67.12(a).) Action Taken: The Commission (Chow, Jackson, Monfredini, Parker, Sanchez, Umekubo) voted not to disclose any discussions held in Closed Session. 10) ADJOURNMENT The meeting was adjourned at 5:55 p.m. Michele M. Olson, Executive Secretary to the Health Commission