Minutes of the Health Commission Meeting Tuesday, February 5, 2002 at 3:00 p.m. Board of Supervisors Chambers City Hall, 2nd Floor 1 Dr. Carlton B. Goodlett Place San Francisco, CA 94102 1) CALL TO ORDER The meeting was called to order by President Edward A. Chow, M.D. at 3:10 p.m. Present: President Edward A. Chow, M.D. Vice President Roma P. Guy, M.S.W. Commissioner Arthur M. Jackson Commissioner Lee Ann Monfredini Commissioner Harrison S. 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 JANUARY 22, 2002 Action Taken: The Commission approved the minutes of the January 22, 2002 Health Commission meeting. At this time, President Chow announced the Health Commission’s 2002 committee assignments, which are as follows: Joint Conference Committee for Community Health Network (CHN) Edward A. Chow, M.D., Chair Roma P. Guy, MSW, Member David J. Sanchez, Jr., Ph.D., Member Joint Conference Committee for Laguna Honda Hospital David J. Sanchez, Jr., Ph.D., Chair Arthur M. Jackson, Member Joint Conference Committee for Population Health and Prevention (PH&P) Harrison Parker, Chair Roma P. Guy, MSW, Member Joint Conference Committee for San Francisco General Hospital (SFGH) H0 h Lee Ann Monfredini, Chair John Umekubo, M.D., Member Budget Committee Arthur M. Jackson, Chair Lee Ann Monfredini, Member John I. Umekubo, M.D., Member IHSS Public Authority Harrison Parker, Sr., DDS S.F. Health Authority John I. Umekubo, M.D. SFGH Foundation David J. Sanchez, Jr., Ph.D. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Jackson chaired, and Commissioner Monfredini and Commissioner Umekubo attended, the Budget Committee meeting. (3.1) CHN/SFGH/OR-MIS - Request for approval of a new perpetual software license agreement, system implementation and application training services with iPath Software, in the amount of $440,761, to provide an integrated Operating Room Management Information System for San Francisco General Hospital. (3.2) CHN-Housing and Urban Health - Request for approval to extend the term of 17 CARE funded HIV Health Housing Services contracts, in the amount of $2,215,939 with the following eight contractors, for the four-month period of March 1, 2002 through June 30, 2002: Ark of Refuge, Inc. 94,160 Baker Places, Inc.(4) 442,024 Black Coalition on AIDS(2) 124,637 Catholic Charities(3) 442,307 Larkin Street Youth Services(3) 222,786 Lutheran Social Services(2) 52,057 SF AIDS Foundation 812,715 Walden House 25,252 (3.3) PHP-Mental Health - Request for approval of a retroactive contract renewal with the Regents of the University of California, on behalf of the UCSF Clinical Practice Group, in the amount of $2,642,106, to renew the Single Point of Responsibility Program serving severely mentally ill adults, for the period of July 1, 2001 through June 30, 2002. (3.4) PHP-Mental Health - Request for approval of a retroactive contract modification with Children’s Council of San Francisco, in the amount of $171,760, for fiscal year 2000-01 and $191,593 per year for fiscal years 2001-02 through 2003-04, for a total four-year contract amount of $746,539, to provide Quality Child Care Consultation Services, for the period of July 1, 2000 through June 30, 2004. (3.5) PHP-Mental Health - Request for approval of a retroactive contract modification with Homeless Children’s Network, in the amount of $142,889, for fiscal year 2000-01, and $227,750 for fiscal year 2001-02, reducing a four-year contract to a two-year contract, for a total contract amount of $370,639, to provide Quality Child Care services, for the period of July 1, 2000 through June 30, 2002. (3.6) PHP-Substance Abuse - Request for approval of a retroactive contract modification with North of Market Senior Services, in the amount of $400,619, to provide substance abuse services for the period of July 1, 1998 through June 30, 2002 for a total contract value of $1,735,949. (3.7) PHP-Substance Abuse - Request for approval to retroactively accept and expend a grant from the California Department of Alcohol and Drug Programs, in the amount of $154,402, for the Youth Development and Crime Prevention Initiative, for the period of June 28, 2001 to June 30, 2002. (3.8) PHP-AIDS Office - Request for approval of a new contract with CompassPoint Nonprofit Services, in the amount of $191,990, to provide consulting and training services, for the period of December 1, 2001 through February 28, 2002. (3.9) PHP-AIDS Office - Request for approval of a retroactive sole source contract renewal with Centerforce, Inc., in the amount of $599,863, to provide HIV prevention services targeting incarcerated and post-release populations at San Quentin State Prison and Central California Women’s Facility, for the period of July 1, 2001 through June 30, 2002. (3.10) PHP-AIDS Office - Request for approval of a retroactive sole source contract renewal with California AIDS Intervention Training Center, in the amount of $248,779, to provide case management and health education services to various residents of the Bayview Hunters Point area, for the period of July 1, 2001 through June 30, 2002. (3.11) PHP-AIDS Office - Request for approval to extend the term of 56 CARE funded HIV Health Services contracts with the following 43 contractors, for the four-month period of March 1, 2002 through June 30, 2002: AIDS Emergency Fund $220,797 AIDS Legal Referral Panel 66,984 American College of Traditional Chinese Medicine 92,276 Asian & Pacific Islander Wellness Center 135,485 Baker Places, Inc. 59,000 Bar Association of San Francisco 25,956 California AIDS Intervention Training Center 24,260 Catholic Charities 53,272 Chemical Awareness and Treatment Services 198,014 CompassPoint Nonprofit Services, Inc. 36,870 Continuum HIV Day Services 270,094 Dolores Street Community Services 61,424 Family Service Agency of San Francisco 60,548 Family Support Services of the Bay Area 95,077 Glide Foundation 38,809 Haight-Ashbury Free Clinics, Inc. 335,187 Immune Enhancement Project 74,556 Instituto Familiar de la Raza 76,534 Iris Center 50,000 Legal Services for Children 59,294 Lutheran Social Services 186,493 Lyon-Martin Women’s Health Services 113,909 Maitri AIDS Hospice 327,293 Mission Neighborhood Health Center 47,635 New Leaf 78,046 Positive Resource Center 168,096 Project Open Hand 449,546 Quan Yin Healing Arts Center 42,442 Saint Mary’s Medical Center 258,952 San Francisco Community Clinic Consortium 113,681 San Francisco Food Bank 32,139 San Francisco Suicide Prevention 35,928 Shanti Project 143,360 Tenderloin AIDS Resource Center 196,322 UCSF AIDS Health Project 325,900 UCSF Center on Deafness 13,412 UCSF Pediatric AIDS Program 56,982 UCSF School of Dentistry 144,762 UCSF/SFGH/Dept of Psychiatry/Substance Abuse Serv. 220,712 UCSF Women’s Specialty Clinic 74,000 University of the Pacific School of Dentistry 181,200 Walden House 566,642 Westside Community Mental Health Center 70,950 Commissioner Umekubo abstained from voting on this item. Action Taken: The Commission approved the Consent Calendar of the Budget Committee, with Commissioner Umekubo abstaining from voting on Item 3.11. 4) DIRECTOR’S REPORT With the consent of the Commission, in order to expedite the hearing on the proposed budget, the Director’s Report was presented after Items 5 and 6. Dr. Katz presented the report to the Commission for their review. Due to the time, President Chow said that comments could be made at the next meeting. Federal Budget Yesterday, the President released a $2.13 trillion budget proposal for fiscal year 2002-03, a 9% increase over current year spending. The proposal seeks large spending increases for defense and national security but attempts to hold funding for domestic programs relatively flat. Discretionary spending on programs not related to defense or national security would rise about 2% under the proposal. Overall, the President is requesting $489 billion for the Health and Human Services Agency, a 9 % increase, with the bulk of the increase allocated to enhance bioterrorism preparedness. The Administration is seeking a one-year spending increase of $4.5 billion for bioterrorism preparedness, $1.6 of which would go to States and localities, including local public health systems. Additionally, it includes $109 billion to "modernize" Medicare and create a prescription drug benefit and provides tax credits to help the uninsured purchase insurance coverage. At the same time, however, the budget proposes to save $9 billion over five years by reducing the Medicaid upper payment limit to 100 percent, reduces spending on chronic disease prevention, infectious disease control and health promotion, and provides flat funding for the Ryan White CARE Act, childhood immunization and environmental health programs. The Department will continue to closely monitor the federal budget and keep the Health Commission apprised of its progress. Healthy Families Program Parent Expansion Approved On January 24, the federal Center for Medicare and Medicaid Services approved California’s waiver request to expand the Healthy Families program to low-income, working parents. Though the Governor’s budget, which was proposed prior to federal approval of the waiver, postpones implementation of the parent expansion until July 2003, the Governor has indicated that he is supportive of expediting implementation if $200 million can be allocated in the 2002-03 budget to fund it. It is anticipated that approximately 300,000 uninsured California parents will be eligible for the Healthy Families program. Racial Disparities and Low Birth Weight Conference The Racial Disparities and Low Birth Weight Conference was co-sponsored January 24 th by Blue Cross, March of Dimes, SF DPH African American Health Initiative, SF DPH Maternal and Child Health, San Francisco Health Plan and the San Francisco Perinatal Forum. Dr. Karla Damus, Albert Einstein College of Medicine, Bronx, gave an overview of low birth weight. Dr. Michael Lu, UCLA, focused on the racial disparities and low birth weight issue. Dr. Patricia Evans, SF DPH Maternal and Child Health presented the San Francisco low birth weight data and maps to illustrate where the greatest problems exist. 135 attended including health care staff, community based agencies, health plans and community members. This conference was a great example of the San Francisco Department of Public Health partnering with other agencies to address a complex issue. Increasing Syphilis Rates Challenge Prevention Efforts Preliminary data for the year 2001 showed a significant increase of syphilis cases in San Francisco. In 2001 there were 186 reported cases compared to 71 cases in 2000. The increase is most significant in the MSM community, which experienced a 9% increase in cases from 2000 to 2001. STD Services continues to work with community partners, sex clubs, adult bookstores and local health departments outside of SF to control the outbreak. Of note, recent cases may be mostly associated with oral sex. While the transmission of syphilis through oral sex is known, and there have been community outbreaks related to syphilis transmission primarily through oral sex, these findings challenge current HIV and STD prevention efforts that support oral sex as "safer sex." Draft Firearm Injury Reporting System Report Presented to the PHP JCC A draft of the San Francisco (SF) Firearm Injury Reporting System (SFFIRS) was presented at the February PHP JCC. This report is the product of a collective effort among several city agencies involved in the tracking and reporting data on deaths and injuries due to firearm violence. In 1998, representatives from the Police Department, Medical Examiner’s Office, Emergency Department and Trauma Center at SF General Hospital, the SF Injury Center at the University of California, and this Department agreed to contribute to the development of a shared multi-agency database. Recognizing that the capability to reduce deaths and injuries dues to violence is not based on any single agency, the report goes beyond reporting of standard demographics. The new reporting system will also provide linkage of data regarding both victims and perpetrators from police reports, medical examiner investigations, and hospital records. This centralized database will ultimately enhance our understanding of modifiable risk factors among both victims and perpetrators, promote a unified approached to reducing deaths and injuries due to violence, and serve as a basis for evaluating the impact of prevention efforts. Black History Month Educational and Cultural Program The African American Health Initiative's Managers of African Descent invites DPH employees and the public to attend the Second Annual Educational and Cultural Program celebrating Black History Month. The program will take place on Wednesday, February 6, 2002 at the Community Health Network Administration Building, 2789-25th Street, from 4:30 - 7:00 PM. This year’s honorees are Arthur Coleman, MD, MPH and Agnes Morton, RN, MS, MPH. Reorganization of Community Health Network Youth Programs Community Health Network Youth Programs were reorganized January 1st. The Balboa Teen Health Center, the Cole Street Youth Clinic, and the Larkin Street Medical Clinic will now be under the direction of Michael Baxter, constituting the newly created Community Health Programs for Youth (CHPY). Special Programs for Youth (SPY), under the direction of Thabiti Mtambuzi, will focus exclusively on the multiple health needs of incarcerated youth and youth at high risk of contact with the juvenile justice system. LHH Annual Survey Laguna Honda Hospital recently received the written results of its annual State Licensing and Certification Survey, which occurred December 6-13, 2001. The survey reported no findings of substandard care, and was in general a very good survey. I extend my congratulations to the staff of Laguna Honda for their excellent performance resulting in this successful survey. COMMUNITY HEALTH NETWORK, SAN FRANCISCO GENERAL HOSPITAL JANUARY 2002 Health Commission - Director of Health Report (from 01/07/02 MEC and 01/15/02 JCC)   01/02 2002 YTD New Appointment 12 12   Reinstatements 0 0 Reappointments 53 53   Delinquencies: 0 0   Reappointment Denials: 0 0 Resigned/Retired: 30 30 Disciplinary Actions 0 0 Restriction/Limitation- Privileges 0 0 Changes in Privileges       Additions 0 0   Voluntary Relinquishments 0 0   Proctorship Completed 3 3 Current Statistics - as of 01/1/02     Active Staff   364 Affiliate Professionals (non-physicians)   121 Courtesy Staff   492 Referring Staff   45 Total Members   1022 Applications In Process   96 Applications Withdrawn Month of December 2001   2 SFGH Reappointments in Process Through April 2002   232 5) SECOND QUARTER FISCAL YEAR 2001-2002 REVENUE AND EXPENDITURE REPORT Monique Zmuda, DPH Chief Finance Officer, presented the Second Quarter Fiscal Year 2001-2002 Revenue and Expenditure Report. The projections in the report are based on revenue collected and billed, and expenses incurred for the first six months of the fiscal year, ending December 31, 2001. Based on this data, the Department of Public Health is projecting a year-end surplus of $26.1 million for FY01-02. Of this amount, $25.1 million is a result of revenues and $1 million a result of under expenditures. Ms. Zmuda said that the Mayor has implemented a citywide deficit reduction plan for the current fiscal year. The Department of Public Health’s contribution to this plan is $10 million. Thus, the Controller will apply $10.4 million of the $26.1 million projected surplus to reduce the General Fund from the Department’s current year budget. The department is requesting that the remaining $15 million be applied to balance next year’s budget. Ms. Zmuda said that the Mayor’s Office has preliminarily approved this request. 6) FISCAL YEAR 2002-03 BUDGET REVIEW President Chow said that the Commission will take action on the budget at its February 19th meeting. President Chow reminded the public that the February 19th meeting would be held in the Commission’s regular location, 101 Grove Street, Room 300. Monique Zmuda presented a summary of the proposed Fiscal Year 2002-2003 Budget. The presentation took place in two parts: the base budget and the proposed 10 percent general fund reduction proposal, which all City departments are required to submit to the Mayor’s Office. Ms. Zmuda described the Mayor’s budget instructions which, among other things, allowed no new general fund for departments, and required that departments absorb a 5.5% civil service COLA. For the Health Department, this translated to $26 million. With regard to the requirement that all departments must submit proposals to reduce their general fund allocations by 10 percent, Ms. Zmuda emphasized to the Commission that the Department will not know until April at the earliest whether, or even if, these reductions will be required. It will take some time for the City to determine what revenues are available in the current year, what if any surpluses exist in the current year, and what the revenue picture will be for next year. The Department’s proposed FY 2002-2003 budget is $1.047 billion, which includes increased funding of $65 million. The base budget includes a 5.5% COLA for employees, a $2.7 million equipment budget and a $4 million Capital Improvement Project budget. However it does not contain a Cost of Living Adjustment (COLA) for contractors, non-profit agencies and the University of California. Ms. Zmuda said that it would cost the Department of Public Health an additional $9 million to provide a 5% contractor COLA. The base budget also eliminates those programs for which one-time funding was allocated by the Mayor and Board of Supervisors last year. Ms. Zmuda described various adjustments to the base budget, including the annualization of the Mayor’s Children’s Insurance Initiative, an increase of 22 beds to SFGH’s budgeted census to make the budgeted census consistent with the actual census, the addition of 23 nursing positions at Laguna Honda Hospital and various other adjustments. Ms. Zmuda then described the 10% reduction proposal. The Department has identified $25 million of potential reductions, which is less than the $30 million target given by the Mayor’s Office. Ms. Zmuda said that increases in revenues and operating reductions were used to balance the base budget so to reach the reduction target, program reductions are required. Ms. Zmuda described the principles that were considered in developing the general fund reduction proposals. Ms. Zmuda then summarized the impact of the 10% general fund reduction: Reduction to Interpreter Services at SFGH Reduction to SFGH Pharmacy formulary and an increase in the mandatory co-payment from $2 to $5 per prescription Elimination of Inpatient Pediatric Services at SFGH Reduction of 30 beds at the SFGH Mental Health Rehabilitation Facility Deletion of staff at Health at Home Elimination of general fund support to consortium clinics’ primary care services Reduction of clinical capacity at Primary Care sites Reduction of adult dental services at Primary Care sites Reduction of psychiatric services in the jails Reduction of medical services in the jails, including women’s specialty services, STD screening, sick call capacity and elimination of discharge medications upon release Contracting out laundry services at Laguna Honda Hospital, rather than relocating current civil service program Reduction to the nursing staff improvements, behavioral health staffing and reductions to patient safety and expedited admission program at Laguna Honda Hospital Reduction to administrative positions Reduction to staff in Office of Managed Care Reduction of subsidies for transitional housing, rent subsidies and residential care Elimination of HIV Emotional and Practical Support Service contracts Reduction to HIV hotline services Reduction to Outpatient Private Provider Network serving mentally ill Reduction of inpatient psychiatric acute inpatient services at community hospitals Reduction of psychiatric long-term care services Reduction to neurobehavioral long-term care services Elimination of transitional residential treatment services Elimination of day treatment programs for adults Reduction to mental health outreach services to adults Reduction to mental health outpatient clinic capacity Elimination of Community Substance Abuse Services (CSAS) prevention program with uncertain outcomes Elimination of funding for new CSAS programs that have not yet started Elimination of administrative support for the CSAS advisory board Elimination of funding for in-custody program that could be funded through Prop. 36 Elimination of funding for prevention interventions in the jails Reduction of funding to CSAS programs that have not successfully met their targeted units of services in the past Reduction to CSAS outpatient treatment program capacity Reduction to substance abuse consultation services at SFGH Reduction to substance abuse intervention and transportation service Elimination of one CSAS residential treatment program Elimination of one CSAS youth supportive services program The recommendation from the Department to the Commission is to approve the base budget with the $15 million increase to the general fund and the $35 million increase to new revenues, and which contains the annualization of the current programs and increases to meet the demands for additional hospital care, skilled nursing services and children’s mental health services. The recommendation from the Department to the Commission on the 10% reduction proposal is to urge the Mayor and Board of Supervisors to identify sufficient funding to maintain vital healthcare services provided by the Department of Public Health. Dr. Katz believes that the proposed base budget will allow the Department to continue its services intact. However, it does not provide for everything-it does not have the funding for one-time Board of Supervisors addbacks, it does not fund expiring grants and, of particular challenge to the Department, it does not contain a contractor COLA. That said, the base budget is still a good budget. Dr. Katz said that the 10 percent list was extremely difficult to come up with, because the Department is already well run and nothing could be eliminated without having an impact. Dr. Katz said that, if the Department were forced to cut its budget, the proposals that have been put forward are legitimate but undesirable. For example, did not want to eliminate the creation of a new laundry or reduce dental services. But the Department did its best to ensure that if the city is forced to do with the same amount of general fund, the reduction proposals not be impossible to implement. Dr. Katz thanked his staff for the huge amount of work that went into creating the budget document. Public Speakers: April Martin Chartrand, former member of the San Francisco Mental Health Board, opposes cuts in mental health. Mickey Shipley, San Francisco Network of Mental Health Clients, opposes cuts in mental health. Lonnie Hicks, Family Service Agency, opposes the proposed cuts, stating that effective core services will not be able to be maintained on such a small scale. He said that the proposals would lead to transferred costs, not cut costs. Jeffrey Springfield, Conard House client, opposes cuts in mental health. David Silva, Program Director for Family Service Agency (FSA) Geriatric Mental Health Services, described the services and the clients of two programs that are proposed to be eliminated. These are the only two programs of its kind in San Francisco. Dr. William Flynn, FSA Richmond-based Day Treatment Program, described the impact the proposed reductions in day treatment would have on clients, some of whom are so unstable they need daily contact to avoid hospitalization. Jeannie Underwood, FSA geriatric program client, described her experience getting help with the agency. She received excellent psychiatric care and has been able to get her life together. She urged the Commission not to close the program. Judy Bell, FSA day treatment center client, said FSA has helped her tremendously by providing her with a safe environment, and urged the Commission not to cut the program. Gary Galvin, FSA geriatric program client, opposes the proposed cuts. Dr. Monique Vance, UCSF Lakeside Senior Medical Center, which exclusively cares for patients over 65. The patients she cares for have multiple medical problems, for whom day treatment services are critical. Without day treatment there will be increases in nursing home placements, ER visits and inpatient hospitalizations. Maria Sverdlik, FSA day treatment program client, opposes cuts in the day treatment programs. Mrs. Gao, FSA day treatment program client, supports the day treatment program, which has helped her tremendously. Barbara Husar spoke about her experiences with the Geary Blvd. day treatment program she attends. Without day treatment many people would be left to roam the streets or fill the hospitals and prisons. Mary Gray, client of a day treatment center, said that without day treatment services, she could land on the street, and asked the Commission to please do not close the Geary Blvd. day treatment program. Belen Encarnacion, spoke in support of geriatric day treatment services. The proposed budget cuts will not reduce expenses and are not fiscally responsible. Benson Nadell, longterm care ombudsman program, spoke about the proposed cuts in psychiatric and long-term treatment programs; day programs with medication monitoring and socialization are essential, and cuts will result in unforeseen consequences. Marie Wren, FSA, said that 30 other seniors attended the meeting but did not speak. The severity of their clients’ psychiatric problems makes it impossible for them to attend other available services until they are stabilized. The FSA program is the only dual diagnosis, harm reduction program for seniors in San Francisco. Richard Heasley, Conard House and President of the S.F. Mental Health Contractors Association, made three points. 1) There should be contractor COLAs in the base budget. He asked the Commission to include in its recommendation the consideration of an ordinance that gives contractor COLAs the same status as civil service COLAS. 2) The 10% savings is not a saving, it is a shift. 3) Residential treatment is the bridge between institution and community care. Steve Fields, Progress Foundation and co-chair of the Mental Health Forum, discussed the Forum’s three priority areas: case management services, supported housing and transitional residential treatment. They are interrelated, and the budget eliminates one of the elements. David Farielli, Citywide Case Management, said lack of a contractor COLA will lead to service reductions. Talked about the essential linkage between case management and services such as day treatment, and is also concerned about cuts to jail health. Jonathan Vernick, Executive Director of Baker Places, said that the10 percent reduction that eliminates all adult residential services would eliminate the continuity of care of the current system. Karen Patterson Matthew, Executive Director of Bayview Hunters Point Foundation, supports a contractor COLA and opposes the elimination of day treatment as a modality within the system of care; she urged the Commission to reject the general fund reductions. Abdullah spoke in support of services to the homeless. Mark Stanford, SEIU 535, said the proposals are an absurd response to the condition the department is in. Eve Meyer, San Francisco Suicide Prevention, opposes the cuts in Mental Health and opposes DPH giving $10 million of its own surplus to other departments. Donna Wolfe, Bayview Clubhouse and the Tenderloin Clinic, supports a non-profit COLA. In addition, these services cannot afford any more cuts. Bea Stephens, Westside Community Services, opposed to the 10 percent cuts, and the base budget should have a contractor COLA. There needs to be parity with Department employees. Chris Miller, ILRC-CAB, opposes the 10 percent budget reduction proposal; the cuts will not save money, just shift where people are going to get their services. Ken Reggio, Episcopal Community Services, said that the lack of a contractor COLA will have a service impact, and gives no recognition that the cost of doing business this year is more than doing the same level of business the previous year. Mr. Howell, mental health services consumer, said that without the day treatment services, he would be either dead or a permanent patient of a medical facility. Dr. Renee Navarro, Chief of Medical Staff at SFGH, paraphrased a resolution passed by the SFGH Medical Executive Committee regarding the proposed budget: that the budget statement be amended to reflect the significant cuts in patient care that will result from lack of sufficient funding for the UCSF physicians’ COLAs and merits; that the physician members of healthcare service delivery not be singled out under the auspices of being a contract service; that Nuclear Medicine not be completely eliminated from the base budget; and that the 10 percent reductions not be implemented. Dr. Earnest Ring, Chief of Radiology Service at SFGH, opposes outsourcing Nuclear Medicine to UCSF; the financial information is not adequate and further study is required. Dr. Steve Shocket, Director of Pediatric Urgent Care at SFGH, opposes elimination of Pediatrics. SFGH provides services for children that are not available in any other hospital in the city, including pediatric trauma services. Dr. Chris Stewart, Director of Inpatient Pediatrics at SFGH, said that these services are necessary for all of the city’s children, and reiterated that it the trauma center for San Francisco. The nearest pediatric trauma facility is in Oakland, where they would have to be transferred after a major trauma. Dr. Colin Partridge, SFGH Pediatrician, opposes the cuts to SFGH Inpatient Pediatric Services; the minimal cost savings is not worth the lost services. Amy Cunningham, San Francisco AIDS Foundation, opposes the cuts in the rental subsidy program. People will lose their housing and become homeless. Dana Van Gorder, San Francisco AIDS Foundation, opposes the proposal to reduce HIV/AIDS hotline funding. Dick Hodgson, San Francisco Community Clinic Consortium, opposes all of the cuts, but specifically opposed to the elimination of funding for Haight Ashbury Clinic, Mission Neighorhood Health Center and Lyon Martin Women’s Health Services. Paul Wagner, Bayview Clubhouse client, supports maintaining the program. Diane Roberts, Director of Inpatient Services at St. Francis Memorial Hospital, opposes the $2.8 million mental health cuts for inpatient treatment; will result in an increased number of mental ill people on the streets, and in the SFGH and St. Francis emergency rooms. Dr. William Taeusch, Chief of Pediatrics at SFGH, opposes eliminating the SFGH Pediatric Unit. The elimination saves only $150,000, which could be saved elsewhere. He also urged the Commission to look at a consolidated women and children’s hospital in San Francisco. Michael Lyon, Coalition to Save Public Health, said the Department should not even propose the 10 percent cuts. Bayview Clubhouse member, said that the emphasis on case management at the expense of programs that encourage mutual client empowerment will push back mental health. John Rhodes, member of the Bayview Clubhouse, opposes the cuts to the Bayview Clubhouse. Joanna Rinaldi, AIDS Health Project, urged the Commission to oppose the cuts. She asked the Commission to urge the Mayor to strengthen the safety net. Bob Rybicki, Executive Director of Shanti, supports funding for the Lifelines program, which is just getting off the ground and is critically needed. Karla Thurston, Bayview Clubhouse member, supports keeping the clubhouse open. Nat Jordan, Bayview/Thunderseed Day Treatment, opposed to the cuts to the program. Dr. Ramona Davis, Medical Director of the Bayview/Thunderseed Day Treatment program, supports retaining the program. Christine Taylor, Seneca Residence, spoke in support of the Tenderloin Self-Help Center and other programs that provide mental health services. Conley Ogletree, currently homeless and being helped by the Tenderloin Self-Help Center; the program will not withstand the cuts. Jeremy Burke, opposes cuts to the Tenderloin Self Help Center. Joseph McInerney, spoke in support of day treatment programs on behalf of the Tenderloin program. Donald Frazier, Director of Drug and Alcohol Contractors Association, recommends a COLA for community-based agencies in the base budget and that the advisory boards be allowed to continue their administrative duties. Rebecca Yuz, Self-Help for the Elderly, said that without the subsidy from the Department the program will have to raise its rates charged to low-income elderly. Janet Goy, CATS, expressed concerns about cuts to the Mobile Assistance Program. Max Haptonstahl, CATS, opposes cuts to the Mobile Assistance Program. Jackie Jenks, Executive Director of Central City Hospitality House, which operates the Tenderloin Self-Help Center, opposes the proposal to eliminate funding for the center; it serves 10,000 individuals per year and services are not available elsewhere in the Tenderloin. Esther Chavez, Program Director, Tenderloin Self-Help Center, opposes the elimination of funding for the program. Susan Shensa, St. Anthony Foundation, supports the Central City Hospitality House; please do not close. Ray Williams, member of the Tenderloin Community, opposes cuts to the Central City Hospitality House and Tenderloin Self-Help Center. Woman representing LGBT community spoke in support Central City Hospitality House, and described how they helped her become a successful person. Lawrence Smith opposes cuts to the Tenderloin Self-Help Center. Donald Turner opposes cuts to the Tenderloin Self-Help Center. L.S. Wilson, Boardmember for Central City Hospitality House, opposes the proposed cuts to the program; there are not enough service now, and thousands of individuals be impacted. Thomas Carney, Central City Hospitality House, opposes any cuts in this organization; it is stupid to cut self-help programs. Karen Washington has been served by the Tenderloin Self-Help Center for many years, and opposes any cuts to the program. George Tirano, transitional work coordinator at the Hospitality House, said that many critical programs are provided at the Tenderloin Self-Help Center for 250 clients a day. Herman Taft, opposes cuts to the Tenderloin Self-Help Center. Sergio Conjura, Mission Resource Center, spoke in support of the Central City Hospitality House; it provides critical services and please do not cut. Allison Lum, Mayor’s Disability Council, supports Central City Hospitality House, the baseline cut and the 10% cut would mean the elimination of the program. Abel Ferreira urged the Commission not to cut the contract for the Tenderloin Self-Help Center. Arnitial Donely opposes cuts in the Central City Hospitality House/Tenderloin Self-Help Center contract. Roy Harrison supports the Bayview Clubhouse and opposes the proposed cuts. Mary Martindale, Jail Psychiatric Services/Haight Ashbury Free Clinics said the elimination of funding for jail psychiatric services would dismantle the program. These cuts carry the risk of lawsuits as well as harm to the inmates. Susannah MacKaye, Jail Psychiatric Services/Haight Ashbury Free Clinics, opposes the elimination of funding. The cuts will impact the ability to provide a critical linkage to the community and continuity of care. Alex Georgeokopolous, Jail Psychiatric Services/Haight Ashbury Free Clinics, discussed the discharge planning services for inmates, which would be reduced as a result of the proposed elimination of funding, which are legally required. John Poh, nurse practitioner for Jail Medical Services, said that the cuts to jail health services would have a tremendous negative impact, and he opposes the cuts. Jennifer Freidenbach, Substance Abuse/Mental Health Workgroup of the Coalition on Homelessness, urged the Commission not to settle for the baseline budget-it is not good enough. The 10 percent cuts impact community based organizations by 30, 50 or 100 percent. Roger Kat opposes cuts to mental health and drug treatment services. Luther Richert opposes cuts in Central City Hospitality House. Barbara Farrell, Ohlhoff Recovery Programs, speaking on behalf of the Treatment on Demand Planning Council, voiced opposition to reduction of substance abuse services. Gene Coleman, representing the Citywide Drug and Citywide Alcohol Abuse advisory boards, spoke in support of continuing funding for these two advisory boards. Mr. S.D. Paris-Adams expressed problems with his experience receiving mental health services. Teresita Gatan, SEIU Local 250, urged the Commission to oppose the proposed budget. Shoshana Hall, Jail Health Services, described the various health services that are provided at the jail, and urged the Commission to oppose cuts to jail health. Sabel Samomé spoke in support of funding for Central City Hospitality House. Chris Sam spoke in support of funding Larkin Street, TARF and the Tenderloin Self-Help Center Serena Lourie spoke on behalf of St. Mary’s Medical Center and opposes the proposed cuts to the inpatient mental health program, and described the impacts on the adolescent mentally ill. Rod Walton, Board of Directors of Central City Hospitality House, spoke in opposition to the elimination of funding for Tenderloin Self-Help Center. The poor and needy are carrying the City’s budget shortfall. Anne Hayward, Tenderloin Self-Help Center, opposes the cuts; the program helps people maintain their lives. Dr. Alan Gelb, Chief of the Emergency Department at SFGH, also representing Dr. Philip Hopewell, spoke in support of merit and COLA increases for the UC contract. The City’s contract with UC has proved to be fiscally beneficial to the City. The lack of these increases will result in loss of services to SFGH clients, including cuts in the ER. Dr. Teresa Palmer, Coalition to Save Public Health, said that instead of a 10 percent reduction, the Department should propose a 10 percent increase. Larry Bevan, Local 250 shop steward, opposes the proposed reduction in beds at the Mental Health Rehabilitation Facility (MHRF). The result will be a logjam at PES. Helenya Brooke, Mental Health Board, urged the Commission to urge the Board of Supervisors to look closely at other sources of revenue for these critical services. Andrea Leong, Mental Health Board, urged the Commission to reject the proposed mental health cuts. Without day treatment services, mentally ill individuals will not have a safety net. Janet Shalwitz, Coleman Advocates for Children and Youth, opposes cuts to nursing services to San Francisco Unified School District as well as further cuts to SFGH. She said that the cuts are out compliance with the requirements of the children’s baseline budget. Dr. Elizabeth Murphy, endocrinologist at SFGH and UCSF, opposes the transfer of Nuclear Medicine Division at SFGH. Cutting the division will not reduce the number of patients, only delay their care. Joe Wilson, Coleman Advocates for Children and Youth, expressed concern that the cuts have disproportionate impact on vulnerable populations including mentally ill and children and youth. He urged the Commission to stand up to the mayor. Dr. Bob Lull, Chief of Nuclear Medicine at SFGH, spoke about the impact of the elimination of inpatient Nuclear Medicine services. This would make SFGH the only inpatient hospital in the bay area without nuclear medicine. John Hay, works at the MHRF, opposes the proposal to cut 30 beds from the MHRF. Bryan Uyeno, shop steward and employee of Laguna Honda Hospital, urged the Commission not to contract out the laundry facility. Gregory Price spoke about contracting out laundry services at Laguna Honda Hospital. Ben Ruvalcaba, Laguna Honda Hospital employee, opposed to contracting out of the laundry; not fair to the workers. Damone Hale, Delinquency Prevention Commissioner, implored Dr. Katz to engage the community organizations in a meaningful way to plan the reductions. William Schecter, M.D., Chief of Surgery at San Francisco General Hospital, spoke in support of keeping Nuclear Medicine services at San Francisco General Hospital, and spoke about the variety of services that would be impacted; cannot have a modern, first-class hospital without Nuclear Medicine. David Arvio, employee of CHMS, conveyed to the Commission the difficulty of his job and urged the Commission not to make cuts in mental health Delphine Brodie, St. James Infirmary, conveyed to the Commission that there are not enough services right now, and do not cut further. Funding, and not cuts, for harm-reduction based treatment on demand is needed. Alfredta Nesbitt, asked the Commission to reconsider the proposed cuts in substance abuse services because treatment does work. Commissioners’ Comments Commissioner Jackson said that the baseline budget is a start, but there are a few items that need to be addressed. He said that the 10 percent cut is abhorrent to every Commissioner. However, if cuts do need to be made, they should be made by Department of Public Health staff, and not left up to the Mayor by sending him no recommendation. The Commission needs to convey strongly that these cuts are unacceptable. Commissioner Jackson reminded people that these cuts are not a foregone conclusion. Commission Jackson asked staff to further evaluate the laundry proposal. Commissioner Monfredini said that this is not what the Commission wants to do, but it would not be wise to let the Mayor identify cuts on his own. Commissioner Monfredini has been on the San Francisco General Hospital Joint Conference Committee for at least three years, and at least once a year it is brought to the committee’s attention that $2 million is needed to upgrade the Nuclear Medicine equipment. It is interesting that now the staff feels that what they have is valuable, and Commissioner Monfredini wants this issue to be evaluated over the next two weeks. Commissioner Umekubo commented that this is always a difficult time for everyone. He appreciates the testimony about the needs created by and the impact of the proposed cuts in services. It is unfortunate that the Commission has the reduction mandate, and he is hopeful that the plan will be rejected. The Commission needs to clearly convey to the Mayor and Board of Supervisors the implication of these cuts. Commissioner Sanchez commented that the public testimony was very enlightening, and demonstrated that the Department and the community have been providing quality, comprehensive services. He said that further review of the baseline budget is needed, and the 10% reduction plan is unacceptable. Commissioner Chow commended people for their pertinent and passionate testimony. If there has to be reduction strategy, the Commission has to clearly explain the interrelated impact of these cuts. He asked the Department to address the following concerns and questions over the next two weeks. 1) If Jail Services is reduced as proposed, will we fall out of compliance, and what other dangers does it create? 2) The institutionalization of some addbacks should be brought to the attention of the Mayor’s Office. 3) The Commission should make a statement in the resolution in support of a contractor COLAs. 4) The Department should re-examine the Nuclear Medicine issue. With regard to Jail Services, Dr. Katz responded that we are not currently operating under a consent decree, and nothing in the proposal will automatically cause the jail to fall out of compliance. However, there is a risk that someone would bring a suit against the Department. The other questions will be addressed over the next two weeks. Commissioner Parker commented upon the compelling testimony that was given, and said that any budget cuts would end up costing more down the line. He added his voice in terms of encouraging the Mayor and the Board of Supervisors to minimize any budget cuts in the Health Department, and encouraged the Mayor to increase the budget if at all possible. All stakeholders-all City Departments-need to come to the table to help. Commissioner Guy said that now that the cuts are clearly identified, the Commission can work with staff and advocates to advocate against the cuts. She said that the baseline budget is a major achievement that moves forward the Department’s Strategic Plan. She acknowledged the efforts of staff to bring in grants, and acknowledged the Mayor for annualizing the Universal Healthcare for Children program. Commissioner Guy asked the Department to address the following questions over the next two weeks: 1) when do we take addbacks and put them into the base budget? 2) Maybe we do have to make a structural effort to get contractor COLAs incorporated into the base budget-they really are a structural part of who we are, and we need them. 3) It is hard to jeopardize the progress that has been made in the mental health system in the 10 percent cuts. 4) How is it possible to cut Jail Services even more? This is a structural problem that needs to be addressed by the Board of Supervisors. 7) PUBLIC COMMENTS None. 8) ADJOURNMENT The meeting was adjourned at 8:30 p.m. Michele M. Olson, Executive Secretary to the Health Commission