Minutes of the Health Commission Meeting
Tuesday, November 6, 2001
1) CALL TO ORDER
The Health Commission meeting was called to order by President Roma P. Guy, M.S.W., at 3:10 p.m.
2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF OCTOBER 16, 2001
Action Taken: The Commission (Chow, Guy, Jackson, Monfredini, Parker, Sanchez) approved the minutes of the October 16, 2001 Health Commission meeting.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE, (Commissioner David J. Sanchez, Jr., Ph.D.)
Commissioner Sanchez chaired, and Commissioner Jackson and Commissioner Monfredini attended, the Budget Committee meeting.
Action Taken: The Commission (Chow, Guy, Jackson, Monfredini, Parker, Sanchez) approved the Consent Calendar of the Budget Committee, with the exception of Item 3.10, the contract with Bayview Hunters Point Foundation, which was continued to the November 20, 2001 Health Commission meeting.
4) DIRECTORíS REPORT
The Department has been actively engaged in assuring that San Francisco is prepared for a bio-terrorist attack. Through our participation in the Federal MMST program, we have stockpiled sufficient antibiotics to handle a large-scale exposure to treatable agents. We also have the appropriate equipment and implementation plans to evacuate parts of the City, isolate infected persons, decontaminate sites, and set up field clinics to treat the population.
We have been working closely with the non-profit hospitals in San Francisco, as well as community-based physicians and other providers. The cooperation we have received across the City has been phenomenal.
Our Toxics Unit, headed by Richard Lee, under the purview of Dr. Bhatia, has responded along with the haz-mat team to provide consultation and testing of potentially hazardous materials. Our public health laboratory, under the direction of Dr. Sally Liska rapidly developed a protocol that enables them to do anthrax testing. Dr. Bhatia has performed walk throughs of work places and consultations on how to prevent occupational exposures.
Dr. John Brown and Michael Petrie of the EMS agency have done an excellent job of preparing Emergency Departments for the possibility of dealing with exposed or infected persons.
Dr. Tomas Aragon has coordinated all our bio-terrorist activities, has been carrying the on-call pager for clinician questions 24 hours a day and done grand rounds at every hospital in the City.
I gave a lecture at UCSF on Monday on the Public Health response to bio-terrorism. It was broadcast to several local shows throughout the City. I have attached a copy for Commission.
National Coalition of STD Directors
Dr. Klausner, the Director for STD Services, is working closely with the National Coalition of STD Directors and CDC to try to get America On Line to begin posting warnings in some of their MSM chatrooms about the risks of exposure to STDs. NCSD has already drafted and sent a letter to AOL asking that they air PSAs and other health related messages in their chatrooms and CDC has agreed to convene a meeting of experts from around the country to discuss STDs and the Internet.
First System-wide CMHS MD Meeting
The first system-wide CMHS MD meeting took place on October 17th at the Fort Mason Center in San Francisco. The meeting was attended by more than 50 psychiatrists who work in association with CMHS including city and contract agency clinics, Inpatient Services, Mental Health Rehabilitation Facilities, and all City and Contract agency Special Services. The agenda included opening remarks from CMHS Director Jo Ruffin. CMHS Medical Director, Dr. Bob Cabaj also reviewed data from the Pharmacy Benefits Manager covering the costs involved in prescribing medication to clients. The meeting offered a forum for psychiatrists to get to know each other and to help foster a sense of camaraderie and cohesiveness within the mental health services system. The meetings will be held quarterly.
National Lead Poisoning Prevention Week
The Childrenís Lead Prevention Program developed a number of activities to mark National Lead Poisoning Prevention Week, which took place the week of October 22nd-27th. Lead prevention program staff publicized new State Department of Health Services regulations requiring medical providers to test blood lead levels of children at 12 and 24 months of age if they receive services from publicly funded programs for low-income children. Also medical providers are required to test these children between the ages of 25 and 72 months if they have not been previously tested. In addition staff participated in a number of health fairs and neighborhood press events during the week. Informational bookmarkers in English, Spanish, and Chinese were delivered to the San Francisco Public Library for distribution.
HIV Prevention Receives Supplemental Grant for Hepatitis C Work
The HIV Prevention Branch recently received a $65,000 supplement to the Prevention for Positives grant to evaluate Hepatitis C infection among people at risk for HIV. Specifically this funding will be used to enroll 400 HCV positive individuals in a study to determine if the results of HCV viral load testing changes behavior such as alcohol intake, safe needle use and accessing treatment for HCV infection.
National Rehabilitation Awareness Celebration at LHH
On November 14, Rehabilitation Services at LHH will be hosting an Open House in recognition of the National Rehabilitation Awareness Celebration. LHH staff members, CHN staff, community support groups, healthcare providers and leaders are invited to learn about the types of services and programming provided by Rehabilitation Services at LHH.
Redesign of the CHN Registration Eligibility System
The Patient Financial Services office of the CHN has organized a committee that includes SFGH and Primary Care (campus and community clinics) representatives in order to redesign the current registration eligibility system. This includes studying the application of existent technology such as I.D. swipe cards with patient data that could be used when a patient/client presents for services at a clinic, greater utilization of appointment-making staff to do confirmation of demographic patient information on the phone, and pre-registration. The goal is to realize efficiencies in staff utilization and to expedite patient flow in health centers. This process will not address everyoneís needs; specifically a substantial number of drop in or walk in patients (around 30% of the Primary Care Network workload) that would not be pre-registered. This committee has been in existence since the Summer 2001.
San Francisco General Hospital Diversion Report
The Emergency Department (ED) recorded 39 episodes of diversion for 165 hours representing a rate of 23% in September 2001. This is an 18% decrease in diversion since August 2001.
The 39 episodes of diversion are categorized as follows:
The ED was impacted by capacity and high patient acuity during the episodes of total diversion and trauma override. During this time, 186 patients were awaiting admission to in-patient beds (ICU-24 4B/StepDown-74 MedSurg-88). In September of 2000, the ED was on diversion 37% of the month. Trauma Override was invoked 8% of the month in September 2000.
Total diversion was recorded for 37 episodes, a total of 162 hours or a 22.5% rate for September 2001. Trauma override was recorded for 2 episodes, a total of 3 hours or a .5% rate for September 2001. This is a 2.5% decrease in trauma override from August 2001. While on Trauma override the ED held 302 patients awaiting inpatient beds. See attachment for full report.
Associate Hospital Administrator Appointment
Effective December 3rd, Roland Pickens will assume the position of Associate Hospital Administrator for Diagnostic Services. Roland brings to our organization a unique and timely combination of skills and experience. His professional experience in health care management spans the broad spectrum, encompassing positions within the for-profit hospital industry including psychiatric and substance abuse programs, not-for profit and academic medical centers, the Veterans Administration system, and our own Department of Public Health.
As Administrator for Diagnostic Services, Roland will be responsible for all of SFGHMC Diagnostics including the departments of Radiology, Nuclear Medicine, Infection Control, Clinical Laboratory, Pathology, and Medical Specialty Clinics in Pulmonary, GI, Cardiology, and Dermatology.
Chronicle Special Report
A series of articles about the City's homeless programs appeared in Sunday's Chronicle by reporter Patrick Hoge. Many Departmental staff were interviewed over the course of the last six months for this series and we provided numerous documents and records--some of which are reflected in Sunday's edition. I have attached a copy of the entire special report for your review.
5) STATE LEGISLATIVE UPDATE
Colleen Johnson, Acting Director, Office of Policy and Planning, presented the legislative update for year one of the 2000-2002 California Legislative Session. The report provides a review and final status report for health-related legislation tracked by the Department during the first year of the two-year legislative session.
Ms. Johnson stated that the Departmentís Strategic Plan identifies advocacy as a key strategy to achieving partnerships with communities that also advocate for health funding, policies, programs and services. The Departmentís advocacy objectives are:
The Department monitored 520 health-related bills, of which 165 became law and 30 were vetoed. In the 2001 legislative year, three of the Departmentís top priorities were successful. Funding was secured for trauma services for San Francisco General Hospital. The Department was able to access supplemental Medicaid payments for skilled nursing care at Laguna Honda Hospital. And health insurance for children was expanded under AB 495. Seismic safety was another top priority for the Department but the legislature did not make much progress on this issue during the legislative session.
Ms. Johnson stated that many factors go into the City and Countyís decision to take a position on a particular piece of legislation. The Department impacts legislation through its relationship with the Mayorís Office of Legislative Affairs. No Department takes individual positions on legislation-they are citywide positions. Ms. Johnson stated that positions are based on many factors: the timing of legislation; where the legislation is in the process; what amendments are likely to be made; and what the Cityís coalition partners are doing.
Ms. Johnson then highlighted some of the health-related bills that were enacted in 2001which fell into the following categories: children and youth; communicable disease; emergency medical services; environmental health; environmental justice; health care facilities; health insurance expansion; health professionals; Healthy Families/Medi-Cal for children; injury prevention; long-term care; managed care; Medi-Cal; mental health; pharmacies/pharmaceuticals; seismic safety; standards and regulations; State budget; substance abuse; and womenís health.
Ms. Johnson then summarized the disposition of the Departmentís 2001 legislative priorities, and discussed the Departmentís legislative priorities for 2002.
6) SUBSTANCE ABUSE UPDATE: HEROIN
Jim Stillwell, Acting Director of Community Substance Abuse Services and Dr. Josh Bamberger, Medical Director for Community Health Promotion and Prevention, presented the Substance Abuse Update, specifically focussing on heroin.
Mr. Stillwell stated that the Departmentís response to heroin use is informed by the Treatment on Demand Planning Council (TOD), the Heroin Sub-Committee of the TOD, and public health data resources. Mr. Stillwell stated that heroin use is an extensive and costly problem in San Francisco. He said that the Department of Public Health is focusing on the health effects of heroin use, and the four major effects are overdose, soft tissue infection, Hepatitis C infection and addiction. The Department has responses targeting each of these effects.
Dr. Bamberger discussed the epidemiology of heroin use, and discussed the programs that the Department has developed.
Dr. Bamberger stated that most heroin overdose deaths occur among users found alone, and 25 percent of these deaths occur within seven days of leaving jail or a drug treatment program. The Department embarked on a ďfix with a friendĒ campaign to encourage a person to call 911 if he or she is with someone who overdoses. The Department has also been working with the San Francisco Police Department to not arrest individuals after they have called 911 to report an overdose. The most leading edge program was a study that entailed distribution of Naloxone to heroin users, which resulted in eight lives being saved.
Soft Tissue Infection Prevention and Treatment
Dr. Bamberger stated that the Departmentís response to soft tissue infection was presented in depth to the Commission at a previous meeting, but the components of this effort are the ISIS Clinic at San Francisco General Hospital, medical care at every needle exchange location, the new Mission Resource Center and the expansion of needle availability.
Hepatitis C Infection
Dr. Bamberger stated that 90 percent of heroin users in San Francisco are HCV antibody positive. Dr. Bamberger said that the Department has a long way to go in addressing this problem, and looks forward to presenting more detail to the Commission when the plan is further developed.
Heroin Addiction Treatment
Mr. Stillwell then provided the Commission with an overview of the treatment programs currently available in San Francisco. In the next report, the Department will discuss the progress of OBOAT and mobile methadone. Mr. Stillwell said that the addiction treatment policy strategies are Proposition 36, Drug Court, harm reduction, and 24-week detoxification.
Mr. Stillwell stated that the next steps in the response to heroin use are the following:
Mr. Stillwell then introduced Terry Mitchell, co-chair of the Treatment on Demand Planning Council, who described the process by which the Councilís Heroin Committee developed its recommendations, which are alternative treatments, overdose prevention, soft tissue infection treatment and Hepatitis C treatment.
Colin Eaton, chair of the Heroin Committee, described alternative treatments, including 26-week methadone detox, peer counselors and mentorship.
Rachel McClean discussed the measures that the committee would like to see implemented around overdose prevention that have not yet been implemented. Specifically, the Heroin Committee would like the efforts to be community-based; that a standardized curriculum be developed; and that abstinence-based programs participate in overdose prevention training. Ms. McClean stated that, on the whole, they are pleased with what has been done so far.
Jennifer Plummer spoke about soft tissue infection. She congratulated the Department for its efforts, but stated that the Council would like to see an expansion of needle exchange sites, an expansion of drug treatment slots and the development of a 24-hour wound care clinic at a site other than SFGH. The Council would also like the Departmentís needle exchange contracts to include more needles and a change to the Police Departmentís policy of confiscating clean needles.
Norma Hoteling spoke about Hepatitis C treatment, of which she said there are three main components: Hepatitis C prevention incorporated into outreach and service provision; Hepatitis C prevention public education; and Hepatitis C treatment in the form of Interferon and alternative treatments.
7) UPDATE ON THE DEPARTMENT OF PUBLIC HEALTHíS FIRST QUARTER
REVENUES AND EXPENDITURES, AND PLAN TO ADDRESS CITYWIDE REVENUE SHORTFALL
Monique Zmuda, Chief Financial Officer, presented the 1st quarterly financial projection of revenues and expenditures for the Department for fiscal year 2001-2002. Based on this data, the Department is projecting an annual surplus of $3.4 million, but as this is based on only three months of data, it is a very preliminary projection. Projections include a revenue surplus of $9.6 million and over-expenditures of $6.2 million.
Ms. Zmuda then discussed the General Fund reduction plan for the current fiscal year. The Mayorís Budget Office has estimated that, in fiscal year 2001-2002, there will be a $60-$100 million revenue shortfall citywide. The Mayor has asked for a $60 million reduction, which translated into a $7.4 million general fund reduction for the Department of Public Health. Ms. Zmuda said the Departmentís plan includes $2.4 million in additional revenue and $5 million in expenditure reductions. Ms. Zmuda said they are looking at a selective hiring freeze in administrative and support positions. At this time, she does not think it will be necessary to freeze any positions at San Francisco General Hospital, Laguna Honda Hospital or Jail Health Services, or other clinical positions. She said that the Childrenís Insurance Initiative is underway but enrollment is slower than expected, so there is an estimated $1 million savings from the $4 million was budgeted. The reduction plan also includes deferring $1 million of the $5 million primary care capital improvement allocation. Ms. Zmuda emphasized that the citywide revenue shortfall is only projection at this time. The Mayorís $60 million reduction plan will be presented to the Board of Supervisors, and there will be another review in January, at which time Ms. Zmuda will report to the Commission if any further reductions are necessary.
Planning for next yearís budget has begun. The Controller is expected to estimate a $200 million shortfall for fiscal year 2002-2003.
Commissioner Monfredini left the meeting at 6:00 p.m.
8) OTHER BUSINESS/PUBLIC COMMENTS
9) CLOSED SESSION
A) Public comment on all matters pertaining to the closed session
B) Vote on whether to hold a closed session (San Francisco Administrative Code Section 67.11)
C) Closed session pursuant to Government Code Section 54956.9 and San Francisco Administrative Code Section 67.10(d)
D) Reconvene in Open Session
The meeting was adjourned at 6:15 p.m.
Michele M. Olson, Executive Secretary to the Health Commission