Minutes of the Health Commission Meeting Tuesday, February 19, 2002 at 3:00 p.m. 101 Grove Street, Room #300 San Francisco, CA 94102 1) CALL TO ORDER The Health Commission 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 FEBRUARY 5, 2002 Action Taken: The Commission amended the February 5, 2002 Health Commission Minutes to include the testimony of the following individuals who submitted their testimony in writing: Dennis McLaughlin, Laguna Honda Employee and member of SEIU Local 250, opposes contracting out laundry services and laying off workers represented by Local 250; the Department must honor the principles in the contract with the City that relate to contracting out. Oletha Hunt, chief shop steward for Local 250 at Laguna Honda Hospital and a CAN for the past 15 years, opposes contacting out the laundry department and the dietary and housekeeping departments; the contract with the Local 250 workers does not allow contracting out. Dr. Angela Wong, UCSF pediatric resident, opposes the closure of the SFGH pediatric ward. The unit provides specialized services including trauma services and staff specially trained to address child physical and sexual abuse. In addition the closure will impact socially high-risk families, some of whom would not be able to visit their children if they were shipped throughout the Bay Area. Dr. Greg Harlan, UCSF pediatric resident, opposes the closure of the SFGH Pediatric Ward; this ward is essential to the children of San Francisco. Iris Biblowitz, nurse at the Windsor Hotel, wrote that many of the people she works with at the Windsor Hotel have recently been homeless or have serious physical and mental illness or addictions. With the budget cuts she can foresee more deaths. She asked if we are about to push our public health department to the point of no return. George C. Lytal, President & CEO, Crestwood Behavioral Health, is specifically concerned with the proposed 50 percent reduction in funding for both mental health and neurobehavioral services for San Francisco residents; the proposed reductions to the mental health budget will have an extremely detrimental impact on clients and increase the city’s costs for police, court and jail services, and lead to higher admissions to the city’s acute care hospitals. The Commission approved the minutes as amended. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Jackson chaired, and Commissioners Monfredini and Umekubo attended, the Budget Committee meeting. (3.1) PHP-AIDS Office - Request for approval of a retroactive sole source contract renewal with California AIDS Intervention Training Center, in the amount of $150,000, to provide case management and peer advocacy services to uninsured/underinsured HIV positive Native Americans and Alaska Natives at or below the poverty level, for the period of July 1, 2001 through June 30, 2002. Michelle Long Dixon said that she will present an update to the Population Health and Prevention Joint Conference Committee in 60 days. Commissioners’ Comments Commissioner Umekubo has concerns with the report because of the various deficiencies that were pointed out in the report. It seemed that many deficiencies were not rectified within the year between the two reviews. Commissioner Umekubo asked Pat Norman, the Executive Director of the California AIDS Intervention Training Center (CAITC), to respond. Ms. Norman stated that CAITC took responsibility for the program in April 2001, which was after the review was done, and the deficiencies have been corrected as of February 2002. Commissioner Umekubo pointed out that the current report still identifies deficiencies. Ms. Long Dixon said that there are still some deficiencies, and staff has met with the agency again to get a clear understanding of what the remaining issues are, and will go back out to review the program next month. Commissioner Monfredini said she was sorry the new agency has to take the heat for the past agency’s mistakes, but all agencies must comply with the rules and regulations that are required by the Department. Ms. Norman replied that the services have been exemplary, and Commissioner Monfredini agreed. Ms. Norman said that CAITC has addressed a number of the requirements, for example they developed a policy and procedures manual, and they will follow through on the commitment they made to comply with all DPH requirements. (3.2) PHP-AIDS Office - Request for approval of a retroactive contract with Urban Indian Health Board, Inc., in the amount of $72,450, to provide treatment advocacy to uninsured or underinsured HIV positive Native Americans and Alaska Natives at or below the poverty level, for the period of October 1, 2001 through February 28, 2003. Commissioners’ Comments Commissioner Jackson asked if the unduplicated clients that will be served by the CAITC contract (Item 3.1) are different from the unduplicated clients served by this contract. Ms. Long Dixon said that there may be some overlap of clients, and staff has asked the agencies to communicate about the clients that they have in common. Commissioner Umekubo said that there were some allegations that the Native American AIDS Project (NAAP) left the Urban Indian Health Board because it is homophobic, and asked if this has been addressed in the Cultural Competency Report. Mr. Waukazoo, the Executive Director of the Urban Indian Health Board, said that the Advisory Board of NAAP decided on its own last April to find another fiscal intermediary. This allegation is untrue. Ms. Long Dixon added that there was a complaint made, but it was never substantiated. (3.3) PHP-AIDS Office - Request for approval of a retroactive contract renewal with Ark of Refuge, Inc., in the amount of $134,017, to provide HIV health services for HIV positive transgender persons, for the period of October 1, 2001 through February 28, 2003. Commissioners’ Comments Commissioner Umekubo asked if the system for tracking units of service is now working. Ms. Long Dixon responded that the tracking system still needs work, and the program manager is working with the agency staff to ensure that the system is on track, and will test it next month. (3.4) PHP-AIDS Office - Request for approval of a retroactive new contract with UCSF School of Dentistry, in the amount of $325,715, to provide decentralized dental care services targeting uninsured/underinsured HIV positive San Francisco residents, for the period of June 1, 2001 through February 28, 2002. Commissioner Sanchez abstained from voting on this item. (3.5) PHP-Community Health - Request for approval of a retroactive contract modification with the Regents of the University of California, Berkeley, to provide professional research analysis services, for the period of May 1, 2000 through February 28, 2005. This modification is to extend the contract term an additional four years and increase the funding in the average amount of $63,170 per year, for a new contract total of $306,499. Commissioner Sanchez abstained from voting on this item. (3.6) PHP-Community Health - Request for approval of a retroactive sole source contract renewal with San Francisco Study Center, in the amount of $351,351, to provide technical assistance and support services for the DPH African American Health Initiative, for the period of July 1, 2001 through June 30, 2002. Action Taken: The Commission approved the Consent Calendar of the Budget Committee, with Commissioner Sanchez abstaining from voting on 3.4 and 3.5. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Additional Proposition 36 Funding The Department received an additional $325,554 this month for the administration of the Substance Abuse and Crime Prevention Act (SACPA), also known as Proposition 36. The funds originate from State Senate Bill 223 (Burton), which provides funding in federal fiscal year 2001 for drug testing costs in the amount of $8.4 million statewide from the Substance Abuse and Treatment Block Grant Award. In addition to purchasing drug tests, DPH will use San Francisco’s allocation to hire a case manager and to increase treatment slots. These funds supplement the $2,298,950 San Francisco received in FY 2000-01 for the administration of the Act. Federal Funding for Treatment on Demand The 2002/03 Federal budget, approved by Congress in December, earmarked one million dollars for San Francisco’s Treatment on Demand effort. Recommended by US Representative Nancy Pelosi, the money will fund the development and evaluation of innovative substance abuse services in San Francisco. Second Annual Black History Month Celebration On February 6, 2002, the African American Health Initiative Managers of African Descent presented its Second Annual Black History Month Celebration honoring Blacks in Health, Medicine and Science. This year, Dr. Arthur Coleman, who has practiced in the Bayview Hunters’ Point Community for over 50 years and former DPH Public Health Nurse, Agnes Morton, Director, NIA/Ujima Wellness Center were honored and will have a permanent tribute in the AAHI’s “Gallery of Excellence in Community Health and Medicine.” Their portraits are displayed here, at today’s Commission Commissioners’ Comments Commissioner Umekubo asked how many outpatient treatment slots they anticipate with the federal funding for treatment on demand. Dr. Katz will get this information to the Commissioners. Commissioner Chow asked if there is further information regarding the Upper Payment Limit issue. Dr. Katz responded that the federal budget and the guidelines for HRSA definitely enforce the 100 percent limit, and he does not think this is going to change. However, he thinks they are going to develop a different mechanism to help county hospitals serve the uninsured. The UPL used to be the vehicle. Dr. Katz believes another vehicle will be developed. Commissioner Parker asked if the additional Treatment on Demand money and Proposition 36 money has already been included in the budget. Monique Zmuda said these funds have not yet been included in the budget, but clarified that they are dollars for the current fiscal year, not for FY 2002-2003. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF FEBRUARY Employee’s Name Division Nominated by Efren Velonza Southeast Health Center Cheree Benton, Principal Clerk Supervisor Sam Cherry Institutional Police Officer, CHN/Tom Waddell Clinic Marian Peña, Center Director In addition, Commissioner Guy acknowledged Delia Garcia, who is leaving the Health Department to work in the regional offices of the Health Resources and Services Administration. The Commission wished Ms. Garcia much luck in her new position. 6) FISCAL YEAR 2002-03 BUDGET REVIEW AND ADOPTION OF A RESOLUTION APPROVING THE DEPARTMENT OF PUBLIC HEALTH’S BASE BUDGET FOR FY 2002-03, AND URGING THE MAYOR AND THE BOARD OF SUPERVISORS TO MAINTAIN THE DEPARTMENT OF PUBLIC HEALTH’S SAFETY NET SERVICES Monique Zmuda, DPH Chief Finance Officer presented the Fiscal Year 2002-2003 budget and resolution. Ms. Zmuda summarized the changes that were made to the base budget since the February 5, 2002 Health Commission presentation. These changes to the budget do not impact the General Fund. The adjustments to the base are: The Nuclear Medicine proposal was revised. SFGH will continue to provide Nuclear Medicine services at the hospital. Costs will be reduced by $500,000 and revenue will be increased by $175,000. Revenues from MediCal for ancillary services will be increased by $400,000. Total General Fund savings of $1.1 million remains unchanged. The IHSS Healthy Workers Program. The Department of Public Health helps provide insurance to IHSS workers by transferring money to the Department of Human Services (DHS) to draw down federal money, which is then used to purchase health insurance for these workers. The Department then receives revenue from capitation. The enrollment to this program has increased by approximately 1,000 from last year, so revenues from capitation were increased by $1.4 million and the work order to DHS was increased to accommodate this increase. The proposal to reduce Maternal and Child Health Services at the school district was withdrawn. Instead, the Department will reduce contract funding that remains unspent in the current year. Ms. Zmuda said that since the last presentation, the Department has learned that the CARE Title I grant award may be reduced by up to $2 million. If this happens, these services will have to be reduced by up to $2 million. The 10 percent General fund reduction proposal remains unchanged from the February 5th budget presentation. Ms. Zmuda said that based on public testimony and comments made by Commissioners at the February 5th meeting, the Department is recommending that the Commission approve the base budget, urge the Mayor and the Board to identify permanent funds for valuable “add back” programs, urge the Mayor and the Board to provide a COLA to contractors and UC and urge the Mayor and Board to identify sufficient funding to maintain vital healthcare services provided by the Department of Health and avoid service reductions that would occur with a 10 percent General Fund reduction. Ms. Zmuda said that no decision will be made on the 10 percent reduction plan until April at the earliest, and that this budget process will be a very didactic process over the next few months. Public Testimony Jennifer Friedenbach submitted the Drop-In Center Planning Process and Proposal; there is a lot of evidence that this will save the Department a lot of money, and she would appreciate the Commission’s support for this proposal. Ms. Friedenbach said that the base budget still includes the $100,000 cut to Central City Hospitality House. Eve Meyer, San Francisco Suicide Prevention, thanked the Commission for advocating for the contractor COLA. One of the rays of hope was the work group on after hours mental health services, and she supports the effort. The after hours services would help the system tremendously. Dr. Philip Hopewell, UCSF Associate Dean at SFGH, spoke in support of the recommendation that the budget include cost of living increases for the university contract. He made two points: a failure to fund the inflationary increase equates with a reduction in services; because of the interrelationship of the services UC provides with the services provided by SFGH, in essence a reduction in UC’s budget is essentially the same as a reduction in the hospital’s budget. Roger Kat, consumer of psychiatric services in San Francisco, likes the fact that the Commission is opposed to the cuts being implemented, and described an experience he had seeing a person die on the streets. L.S. Wilson, Coalition on Homelessness, opposes all the cuts, but specifically speaking in support of the after hours proposal. The 5150 process is intrusive and counter-therapeutic. When individuals do not get help until they are in severe crisis, they are more expensive to serve. The $200,000 that they have for this program is not enough. Daryl Inaba, Haight Ashbury Free Clinics, said that is difficult to continue to do business without COLAs, and the lack of a COLA will mean a service cut. He described the impact the 10 percent reduction proposal will have on various services. Steven David Paris-Adams, spoke about inadequate mental health services. CMHS has not investigated his complaints. Patrick Monette-Shaw, requested a HIV/AIDS Prevention/Intervention Inventory. Many of the current programs do not work, and the Department should not have to cut other programs. Mr. Monette-Shaw submitted written testimony as well. Michael Lyon, Coalition to Save Public Health, said none of the cuts that were proposed should even be considered, and they should not be forwarded to the Mayor’s office. He said that even if the baseline budget does go through, there are hundreds of vacant positions in the clinics and hospitals that need to be filled. The Department needs more money, not less and not the same amount. Lonnie Hicks, Family Service Agency, thanked the Commission for the work that has been done over the last two weeks. The baseline budget is a cut in itself, and the implications of this are not clear. He thinks that the Commission should take a serious look at what the cuts will cost. Need this information to make good decisions. Marie Wren, Program Director for Geriatric Services West, a Family Service Agency program. The seven speakers who spoke last week were a very energizing experience. She thanked the Commission for the proposed resolution to not go ahead with the cuts, but is disappointed that the cuts are still in the revised budget. She takes issue with less costly services for more people being prioritized over more costly services for fewer people. David Silva, Family Service Agency, said the proposed cuts in day treatment services will result in 34 percent cost increases in other areas of the system. Wade Sudduth said that cuts in mental health programs will result in increased crime and homelessness. He is scared that the cuts will mean he has no place else to go. Paul Wagner, opposes cuts to the Bayview Clubhouse. Conley Ogletree from Tenderloin Self Help Center urged the Commission not to cut the budget. If budgets are cut, they won’t be able to live the way they are now. Everybody loses. Dr. Louise Foo, Conard House, spoke in support of Jackson Street Residential Program. It it’s the only program of its kind in the city that serves monolingual Asian clients. The elimination of residential treatment will mean an increased burden on the police and the hospital system. Rita Lam, pharmacist, urged the Commission to oppose cuts to the SFGH pharmacy that are proposed under the 10 percent reduction proposal. The proposal eliminates three classes of drugs, all of which are vital to providing effective care to their clients. All drugs are cost effective and improve quality of life. Cuts will increase hospitalizations and mortality and morbidity. Maria Martin and Lindsey Berger, Youth Commission and Youth Commission Public Health Committee, said they are disappointed that budgets for police are increasing but budgets for public health are decreasing. The budget priorities should be to maintain school services; advocate for LGBTQ youth services; support better coordination of services; programs should rely on each other for support; and if money is going to be taken away from programs that are not working well, put the money into fixing the programs. Jackie Jenks, Central City Hospitality House, said that the elimination of the $100,000 in the base budget would result in the closure of the Tenderloin Self-Help Center and many other services. Due to a clerical error, the funding has always been considered an addback, and it should be in the base budget. Luther Rickert, Central City Hospitality House, thanked the Commission for doing what it can to maintain the safety net but there are still gaping holes, including inadequate mental health services. He also wants Commission to restore the $100,000 addback in the base budget. Arnital Donely, Central City Hospitality House, spoke in support of the self-help center. The program is very important to the Tenderloin infrastructure. A lot of agencies cannot take any cuts; they have already been reduced too much, and there are less grants, less federal funding, etc. Shelly Shores, works for Conard House Jackson Street Residential Services and is a mental health consumer. With the help she has received from these services, she is functioning in society, is able to raise her son, and is able to help others. Reductions in mental health would mean that crime and homelessness will increase. Eric Politzer, Ark of Refuge, said in two weeks, the Ark House will be celebrating its first anniversary. The proposed cuts in addbacks would result in a cut to the Ark House. The program is so vital, it should permanently in the baseline. Currently have a full house-15 young adults-and a waiting list of seven. Alan Mickey Shipley, urged the Commission to opposed cuts in staffing to the CAAB, and to oppose cuts Jackson Street residential program. If the cuts go through, mental health consumers will end up on the street. Elizabeth Frantes, said that Healthy Children program should be paid for by the State. This program discriminates against single adults, and the $3 million for the annualization of the program could be better used to fund some of the proposed cuts. Michael Bartolomes, spoke in support of the Bayview Clubhouse, and is opposed to all of the mental health cuts. Karen Patterson Matthew, Bayview Hunters Point Foundation, urged the Commission to also look at substance abuse cuts, as they also have a detrimental impact. She supports the contractor COLAs. She said that the COLAs are still “inside of the box” along with the 10% reduction proposals and the Commission should urge the mayor to look “outside the box.” Richard Heasley, Conard House, thanked the staff and the Commission for listening to what they had to say, for understanding, and for having the courage to pass the resolution that is before them. Commissioners’ Comments Commissioner Monfredini supports the resolution and said that she does hear everything the public has to say and that it is difficult to hear how severe these cuts will impact our community. However, the Commission was asked to submit a 10 percent reduction proposal, she hopes that the Mayor and the Board of Supervisors will see fit to maintain some of these key services and not take the cuts. Commissioner Chow asked for a clarification on whether whole classes of drugs are proposed to be eliminated as part of the 10 percent proposal. Dr. Katz said that in some instances, this might happen. For example, the pharmacy is providing antihistamines, but not non-sedating antihistamines. With regard to statins, are not treating an illness, rather a risk factor. And there are other ways to treat the risk factor, such as changes in diet and exercise. Commissioner Sanchez said that this has been a unique opportunity to hear extensive testimony, read correspondence, talk to people, etc. What the Commission and the public are saying is that the system of care cannot sustain these cuts. He thanked the people who came out to testify and the staff. Commissioner Sanchez emphasized that there is still work to do, and he and other Commissioners will work with foundations and other funders to further fill the gap. Commissioner Parker said that it is too costly to lose ground after all of the gains that have been made in the system of care. Commissioner Guy thanked staff for their work, and emphasized two points that she did not make at the previous meeting. The first is dental services. The Department has struggled very hard to include dental services, and it is hard to lose them now. Second, there have been a lot of struggles over locating housing services in San Francisco due to NIMBYism. It is important that the existing sites are not lost, otherwise it will take many years of consensus building to get these programs back into the community. Commissioner Jackson said that the clarity by which the Department brought the budget issues forward has been great. When we take a step backward in services, it is incredibly difficult to get those services back. The city cannot allow people to be returned to the streets and cannot add to the homeless population, and everybody suffers if people are put back on the street. Commissioner Chow said that the Department has a continuum of care and as things are removed from the continuum, gaps in service emerge. Commissioner Chow said that with regard to the addbacks, the Mayor and the Board of Supervisors have the ability to look at funding these programs. However, the rules to the Department thus far are that, even if the Department or Commission feels a program funded through an addback is valuable, there is no opportunity to advocate for adding these to the base. Commissioner Chow said that the Commission is looking for the option of recommending the institution of programs that turn out to be valuable. Action Taken: The Commission amended the proposed resolution by adding “strongly” to the first, second and third “further resolved” clauses, so that the clauses read “the Health Commission strongly urges the Mayor and Board of Supervisors…” Action Taken: The Commission disapproved a motion to further amend the resolution by adding “declines to endorse” rather than “does not endorse” to the last “further resolved” clause. Action Taken : The Commission unanimously adopted Resolution #03-02, “Approving the Department of Health’s Base Budget for Fiscal Year 2002-03, and Urging the Mayor and the Board of Supervisors to Maintain the Department of Health’s Safety Net Services,” with the amendments. 7) PUBLIC COMMENTS Michael Lyon, member of the Pharmacy Oversight Committee, is concerned that the information that was provided by the Director of the Pharmacy regarding the per prescription cost comparison is inaccurate. The amount assigned to overhead is way too much-should be $15 rather than $31. Mr. Lyon said that one pharmacy cut has already been made, and that is that people can only get a 30-day supply of drugs. This did not go through the Pharmacy Oversight Committee. 8) 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 voted to go into closed session. The closed session began at 5:10 p.m. People attending the closed session were the Health Commissioners (except for Commissioner Parker), Dr. Mitch Katz, Deputy City Attorney Stacy Lucas, Gene O’Connell, Norm Nickens and Michele Olson. 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 a litigated claim for $65,000, Fouchia v. CCSF and Jacquelyne Caesar, San Francisco Superior Court, Case No. 319456 D) Reconvene in Open Session The Commission reconvened in Open Session at 5:20 p.m. 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, Guy, Jackson, Monfredini, Sanchez, Umekubo) voted to approve the settlement. 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, Guy, Jackson, Monfredini, Sanchez, Umekubo) voted to approve the settlement. 9) ADJOURNMENT The Health Commission meeting was adjourned at 5:20 p.m. Michele M. Olson, Executive Secretary to the Health Commission