Minutes of the Health Commission Meeting Tuesday, March 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 to 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 Harrison S. Parker, Sr., D.D.S. Commissioner David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. Absent:  Commissioner Lee Ann Monfredini 2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF MARCH 5, 2002 Commissioner Chow noted two corrections to the March 5, 2002 minutes: Item 3, page 3, should be amended to read: “Action Taken: The Commission approved the Consent Calendar of the Budget Committee.” Item 4, page 4, should be amended to add “San Francisco General Hospital Credential Report” before the list of recommendations from SFGH MEC. Action Taken: The Commission approved the minutes of the March 5, 2002 meeting with the amendments noted above. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Jackson chaired and Commissioner Umekubo attended the Budget Committee. 3.1) PHP-Housing - Request for approval of a new retroactive sole source contract with Chinatown Community Development Center, the lead agency and fiscal agent for the Families in SROs Collaborative, in the amount of $100,000, for the period of March 1, 2002 through June 30, 2002. 3.2) PHP-TB Control - Request for approval of a two-year sole source contract renewal with the Regents of the University of California in the amount of $3,561,410, to provide Model Tuberculosis Prevention and Control Center services to local and national TB health care providers, professionals and fundraisers, for the period of January 1, 2002 through December 31, 2003 Commissioner Sanchez abstained on this item. 3.3) PHP-STD Prevention & Control - Request for approval of a new retroactive contract with Providence Health Foundation in the amount of $110,000, to provide STD prevention outreach services in the Bayview Hunters Point community targeting African American youth, for the period of March 1, 2002 through June 30, 2002. Commissioners’ Comments Commissioner Jackson asked for a description of some of the agency’s venue-based events. Jacqueline Siller, Population Health and Prevention, said that the agency holds basketball games and concerts, among other activities. Commissioner Umekubo asked if this funding is one-time. Ms. Siller replied that it is one-time funding for a feasibility funding to determine if it is possible to find and treat all youth in Bayview Hunters Point. If so, the Department will use this program as a model for other San Francisco neighborhoods. 3.4) CHN-SFGH/Pharmacy - Request for approval of a contract renewal with Pharmaceutical Care Network, in the amount of $9,240,000, for pharmacy benefits management services targeting CHN indigent clients, for the period of April 1, 2002 through March 31, 2003. At the Budget Committee, Sharon Kotabe, Director, CHN Director of Pharmacy, presented both the Pharmaceutical Care Network contract and the MedImpact contract. Budget Committee Public Comment Clifford Wong, pharmacist from the private sector, said that the $9.24 million contract is underbudgeted. The Pharmacy Oversight Committee has not been able to get data from administration. Based on numbers, $7 million for private pharmacies alone. He does not understand how the $9.24 million is derived. Faye Roe, Local 790, representing the workers in the SFHG pharmacy, said the Oversight Committee, which was formed last year, was supposed to provide input into the program. During that process, committee members asked for data, and they only recently received it. Local 790 has requested a meet and confer. They would like the Commission to give a three-month contract with the provider to allow for time for a meet and confer to take place. Budget Committee Commissioners’ Comments Commissioner Umekubo asked if there is a significant problem with down time in the system. Sally Hinckle from PCN said that they have not had any down time, and they have backup systems in place. Commissioner Umekubo asked how well the help desk is utilized. Ms. Hinckle said the majority of the phone calls are from the pharmacies that have questions about the patients they are trying to serve. But members can call as well. Commissioner Jackson said that the contract has increased access at community pharmacies and at San Francisco General Hospital. He asked if 30-day prescription period is working. Ms. Kotabe said that this change has been in place only since February 1; to date she has not received any negative comments. Item 3.4 was moved to the Health Commission meeting for full discussion. 3.5) PHP-Mental Health - Request for approval of a contract renewal with MedImpact, in the amount of $2,400,000, to provide pharmacy benefits management services targeting Community Mental Health Services indigent clients, for the period of July 1, 2002 through March 31, 2003. 3.6) PHP-Family Mosaic - Request for approval of two new retroactive contracts and modifications to five current contracts for the Family Mosaic Project for a total amount of $351,107, to provide various wrap-around services through the following seven (7) agencies, targeting seriously emotionally disturbed children, for the period of December 1, 2001 through June 30, 2002. Contractor Prior FY 01-02 Approved Amount Proposed FY 01-02 Amount Difference High Gear Achievers, Inc. $11,000 $33,000 $22,000 RISE Institute $165,000 $198,088 $33,088 Jamestown Learning Center (JLC) $165,000 $145,000 ($20,000) Catholic Youth Organization - Saint Vincent’s School for Boys $30,600 $83,616 $53,016 Victor Treatment Centers $354,557 $530,000 $175,443 FamiliesFirst N/A $62,560 $62,560 OTTP/SSG N/A $25,000 $25,000 3.7) PHP-AIDS Office - Request for approval of the FY 2002-2003 Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 Title I, Title II and General Fund contracts for a combined total of $34,624,350 for the period of March 1, 2002 through February 28, 2003 for Title I funds, April 1, 2002 through March 31, 2003 for Title II funds and July 1, 2002 through June 30, 2003 for General Fund programs with the following agencies: AIDS Community Research Consortium $83,331 AIDS Emergency Fund $625,583 AIDS Legal Referral Panel $189,785 American College of Traditional Chinese Medicine $261,444 Ark of Refuge $89,345 Asian Pacific Islander Wellness Center $429,114 Baker Places $167,164 Bar Association of San Francisco $73,541 Catholic Charities $142,403 California AIDS Intervention Training Center $139,736 Community Awareness & Treatment Services, Inc. $533,836 Continuum HIV Day Services $772,782 Dolores Street Community Services $174,033 Family Service Agency of San Francisco $171,549 Family Support Services of the Bay Area $262,493 Glide Foundation $109,957 Haight Ashbury Free Medical Clinics, Inc. $949,678 Immune Enhancement Project $211,239 Instituto Familiar de la Raza $345,294 Iris Center $141,664 Legal Services for Children $167,997 Lutheran Social Services $522,067 Lyon-Martin Women’s Health Services $322,737 Maitri AIDS Hospice $927,317 Marin County $1,265,178 Mission Neighborhood Health Center $134,961 New Leaf $190,609 Positive Resource Center $513,768 Project Open Hand $1,273,692 Quan Yin Healing Arts Center $120,251 Saint Mary’s Medical Center. $569,685 San Francisco Community Clinic Consortium $322,090 SFDPH CHN-Dental Services $217,143 SFDPH CHN-Forensics Services $317,389 SFDPH CHN-Health at Home $444,755 SFDPH CHN-Primary Care $2,566,083 SFDPH CHN-SFGH $1,778,717 SFDPH CHN-SFGH-Positive Health Practice $174,516 SFDPH CHN-Tom Waddell $153,662 SFDPH PHP Mental Health Services $272,217 SFDPH PHP Public Health Laboratory $55,306 SFDPH PHP STD Services $167,097 SFDPH PHP Substance Abuse Services $236,107 SFDPH PHP Housing Services $6,301,326     Ark of Refuge, Inc $266,782     Baker Places $1,628,448     Black Coalition on AIDS $363,133     Catholic Charities $1,322,595     Larkin Street Youth Center $607,605     Lutheran Social Services $147,662     San Francisco AIDS Foundation $3223,848     Walden House $71,547 San Francisco Food Bank $91,058 San Francisco Suicide Prevention $101,794 San Mateo County $2,419,142 Shanti Project $514,896 Tenderloin AIDS Resource Center $556,231 UCSF/AIDS Health Project $923,370 UCSF/Center on Deafness $29,906 UCSF/Pediatric AIDS Program $161,446 UCSF/School of Dentistry $434,287 UCSF/Substance Abuse Services $600,946 UCSF/ Women’s Specialty Clinic $209,663 University of the Pacific-School of Dentistry $513,392 Urban Indian Health Board, Inc. $48,300 Walden House $1,605,462 Westside Community Mental Health Services $192,522 $34,624,350 Jimmy Loyce stated that these contract amounts reflect the reduction that the Department received from HRSA in its Ryan White CARE allocation. A member of the Board of Supervisors has introduced a $575,000 supplemental appropriation to backfill for part of the reduction, and a hearing on this supplemental appropriation will take place tomorrow. If the supplemental appropriation is approved, some contracts will be increased. This process will be based on the prioritization developed by the HIV Health Services Planning Council. Commissioner Umekubo abstained on this item. Action Taken: The Commission approved Items 3.1 through 3.7 of the Consent Calendar of the Budget Committee, with the exception of Item 3.4, and with Commissioner Sanchez abstaining from Item 3.2 and Commissioner Umekubo abstaining from Item 3.7. Item 3.4 was discussed separately by the Commission Public Speakers Faye Roe, Local 790, said the Pharmacy Oversight Committee has requested information through-out the year, and has not received it. The committee also requested a meet and confer and they have not received that either. The union’s position is to approve the contract for three months rather than one year to give the committee time to meet and confer and discuss its concerns with DPH. Michael Lyon, Labor-Community delegate to the Pharmacy Oversight Committee, is opposed to a one-year unrestricted renewal of the contract because he feels it is terribly underfunded. More importantly, it would remove the impetus to go forward with a 340B pricing. Commissioners’ Comments Commissioner Jackson asked staff to respond to the issues raised by the public. Dr. Katz said that the contract with PCN came out of a compromise between the City and union to move forward with a pharmacy benefits contract and keep the SFGH pharmacy open. This has been done. With regard to the issue of 340B public health pricing, if the Department is able to find a way to get 340B pricing, this would not be precluded by the PCN contract. Dr. Katz does not recommend approving a 3-month contract. Staff will provide the Commission with any information at whatever interval it is requested. Dr. Katz added that the Commission retains the ability to end any contract with a 30-day notice. Commissioner Jackson said that access has improved and the program seems to be a win-win for everybody. Commissioner Chow said that the compromise made sense. The SFGH pharmacy remains a critical service to the SFGH patients. While the points raised are important, they do not warrant delaying with this contact which has improved access. Commissioner Chow asked staff to provide an update to the Community Health Network Joint Conference Committee in three to four months on the status of the 340B proposals, the discussion around having a combined PBM contract and the oversight committee. Commissioner Sanchez said he is pleased at the positive evaluation the contractor received. PCN has exceeded the contract requirements in many areas, including number of pharmacies and invoicing. Commissioner Umekubo commented that the program has been successful and he was pleased with the monitoring report. Commissioner Parker said that the PCN contract is not a panacea for all of the Department’s pharmaceutical problems. However, the program does meet the four Strategic Plan goals: accessibility, cost-effectiveness, prevention and partnerships with the community. Commissioner Parker wants to move forward with this contract with the possibility of modifying it as we go along. Commissioner Guy said that if there are concerns that are not being taken care of in the oversight committee, there should be a meeting with Dr. Katz or the Commission to allow these concerns to be aired. That said, she supports moving forward with the contract. Action Taken: The Commission, after separate discussion, approved Item 3.4 of the Consent Calendar of the Budget Committee. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. San Francisco General Hospital Medical Center’s JCAHO Dates The Joint Commission on the Accreditation of Healthcare Organizations will be surveying San Francisco General Hospital, the Mental Health Rehabilitation Facility, and Bridge to Wellness (Long-Term Care) from April 22nd to April 26th, a month earlier than originally anticipated. Preparation activities are on track including posting of public notices of the survey throughout the campus and in local newspapers. Although JCAHO is only one month away, Gene O’Connell and her leadership feel confident that SFGHMC staff is on track for the survey. Over the past two weeks, staff throughout the hospital have showcased their Performance Improvement (PI) Poster Boards as part of a PI Poster Board contest. A team including Gene O’Connell, Renee Navarro, Hiroshi Tokubo, and Ken Jones rated each performance improvement board on a pre- determined set of criteria including content, creativity, relevance, clarity and visibility. The winners include: 6A Pediatric Pain Management with emphasis on sickle cell and trauma Sterile Processing and Distribution (SPD) Cost Saving and Waste Reduction 3M Fine Needle Aspiration Dietary Cook-Chill Advance Meal Delivery System Honorable Mentions to: 5M and 6C Breast Feeding Support Environment of Care (EOC) Improving Employee knowledge of EOC, Health and Safety, Injury/Illness Prevention DOJ/OCR Site Visit to Laguna Honda The Department of Justice and Office of Civil Rights is currently conducting a site visit at Laguna Honda. It is expected that they will conclude the investigation tomorrow. Dr. Katz will keep the Commission apprised of the results of the site visit. UCSF Mammography Van at Primary Care Clinics After much work and collaboration, the Mammovan has arrived at SFGHMC and is open for operations. The Mammovan is the results of continued collaboration between SFGH Radiology, DPH Patient Navigators and UCSF. The Van is located in Parking Lot A and will operate at SFGH Monday - Friday 8am - 5pm. While based at SFGH, the Van will also be providing services to the community-based Health Center patients in addition to providing services to the patients on the SFGH waiting list. Once the SFGH backlog is cleared, the Van will begin making routine visits to various Health Centers. LHH Resident's Celebrate St. Patrick's Day The San Francisco United Irish Society hosted the 35th Annual St. Patrick's Day celebration at Laguna Honda on Sunday, March 10th for 250 residents in Simon Auditorium. Over 300 volunteers and performers participated in hosting this traditional cultural event. A variety show of Irish dancers, musicians and singers entertained residents for 1 1/2 hours, and provided refreshments for all. The Department extends its gratitude to Mr. J.J. Whelan and the United Irish Society for organizing this wonderful event. Appointment of Ann Stangby to the Hospital Bioterrorism Preparedness Planning Task Force Ann Stangby, Emergency Response Coordinator for San Francisco General Hospital Medical Center has been appointed by the State of California Department of Health Services (DHS) and Emergency Medial Services Authority (EMSA) to serve on the Hospital Bioterrorism Preparedness Planning Task Force. The task force will focus on how the 2-year $10 million Bioterrorism Preparedness For Hospitals (BFOP) Grant should be allocated throughout California. Increases in Early Syphilis Continue An increase in cases of early syphilis is continuing in San Francisco. In the first two months of 2002, 55 early cases of syphilis have been reported; 39 of which are Primary and Secondary (P&S) cases. 83% (46/55) of these cases are among gay men. By comparison, in 2001, only 18 early cases were reported for the first two months of the year; 12 of which were P&S cases. 67% (12/18) of these cases were among gay men. Many men continue to report large numbers of anonymous partners met in anonymous sex venues such as sex clubs, adult bookstores, on the Internet, in parks and in bathhouses. Community Health Network San Francisco General Hospital MARCH 2002 Health Commission - Director of Health Report (from 03/11/02 MEC and 03/12/02 JCC) 03/02 2002 YTD New Appointments 18 44 Reinstatements 0 0 Reappointments 47 127 Delinquencies: 0 0 Reappointment Denials: 0 0 Resigned/Retired 15 58 Disciplinary Actions 0 0 Restriction/Limitation- Privileges 0 0 Changes in Privileges Additions 2 2 Voluntary Relinquishments 1 1 Proctorship Completed 0 7 Current Statistics - as of 03/1/02 Active Staff 360 Affiliate Professionals (non-physicians) 121 Courtesy Staff 481 Referring Staff 47 Total Members 1,009 Applications In Process 72 Applications Withdrawn Month of February 2001 3 SFGH Reappointments in Process Through July 2002 160 Commissioners’ Comments Commissioner Parker asked about the status of the helipad development. Dr. Katz replied that the Department received a trauma grant that includes funding for a feasibility study of a helipad at San Francisco General Hospital. The study would be completed in six months and results would be presented to the Commission. Commissioner Parker asked how well the mammography van is being publicized and if the van would travel throughout to other neighborhoods. Ms. O’Connell said it has been extensively publicized, and she was recently interviewed by Spanish language media. The mammogram van will stay at SFGH with referrals from primary care clinics throughout the city to take care of the current backlog. As soon as the backlog is cleared, the van will travel throughout the city. Commissioner Parker said that, with regard to the increase in syphilis, it appears that staff is doing everything they know how to do, but is not getting results. Dr. Katz said that the rate of infection might be worse without the current programs, but it is hard to feel success when numbers are increasing rapidly. He said that the best minds at national, state and local level are working on this, but everyone needs to keep thinking. Commissioner Sanchez commented that between the CDC, the Department of Public Health and UC Berkeley’s School of Public Health, people should be able to identify different approaches to preventing new cases of syphilis. Dr. Katz said that they are currently doing real time syphilis screening at Steamworks in Berkeley. Commissioner Chow asked that this issue be followed through the Population Health and Prevention Joint Conference Committee, and that a report be presented to the committee in three months. Commissioner Guy said we need a campaign to deal with this epidemic, and the Health Commission needs to understand the nature of the epidemic. She said that outcomes of public education and behavior change are not apparent right away. This needs to be evaluated over time. 5) MIS/TECHNOLOGY UPDATE Dave Counter, Director, Management Information Systems, presented the MIS/Technology Update. DPH IT supports over 350 sites throughout San Francisco. IT provides network and computing infrastructure, application systems and technical support services. The annual budget is $23 million including salaries, vendor contracts and operations support, including equipment. Each DPH division has an IT steering committee to identify and prioritize the needs of each division. On an annual basis the steering committees undertake a complete analysis of funding needs for the next year and present this to an IT Executive Oversight Committee. DPH IT infrastructure has two key areas: network infrastructure and computing infrastructure. The network infrastructure utilizes state of the art technology to give high-speed data transmission backbone throughout the City and County of San Francisco. It also includes local area networks to connect the various segments of the Department to the central backbone. The computing infrastructure has three tiers: large computers that are not in San Francisco; computers in San Francisco; and about 5,000 personal computers and devices and printers. The Application Systems are in three categories: clinical applications; financial applications and administrative applications. Clinical - Lifetime Clinical Record, clinical orders and results, progress notes, pharmacy, radiology, public health laboratory, OR/ICU-CCU/Pediatrics, AIDS/Reggie, Medical Records, Dietary, Quality Management. Financial - Patient accounting, patient registration, managed care, cost accounting, city financial systems, materials management, patient eligibility, environmental health, Health at Home. Administrative - Master patient index, resource scheduling, payroll/labor distribution, e-mail, contracts management, Vital Statistics/GIS, and nurse staff scheduling and others. DPH IT provides a variety of support services including operations support, disaster recovery/business continuity, vendor contract management and training/project management. Mr. Counter gave an overview of some of the current key projects Upgrading the network infrastructures at SFGH, primary care clinics and Laguna Honda Hospital Evaluating wireless technology and prototyping Implementing Physician order entry at SFGH Automating the ER Functions at SFGH Voice Recognition technology is being used for the SFGH Radiology Department Beginning the implementation of a swipe card registration system so patient can present his/her card and have immediate recognition Future Plans, Challenges and Opportunities Regulatory Compliance, including HIPAA Transaction Codes, privacy and security, JCAHO data requirements and HCFA reimbursement changes. Infrastructure Development- including expanding network and computing capacity, pursuing wireless technology, which will have a major impact on the department, expanding Internet deployment and the use of biometrics for security purposes. Applications Development - digitized radiology, integrated clinical and financial data. Opportunities - The Siemans’ contract is up in two years and the Department will prepare a Request for Proposal next year to put out to bid. Another opportunity is collaboration with UCSF. The Department has developed a strong collaboration with technology staff at UCSF, who are facing many of the same challenges. Another opportunity is converged technology, which is the convergence of data, medical devices, voice technology and facilities engineering technologies to produce “smart buildings”. They are using this approach with the new Laguna Honda Hospital development. Winona Mindolovich presented a demonstration of the Lifetime Clinical Record (LCR). The project to develop the LCR began in 1994, and it began receiving data in 1996. Currently there is an average of 8700 hits per day. The LCR has been designed primarily for primary care providers. However, they are developing and adding components to assist inpatient physicians. Some of the information the provider can view from the LCR includes patient demographics, appointments, visit history, clinical services and inpatient medication orders. Clinical alerts, progress notes, outpatient prescriptions, vital sights, immunizations and many other kinds of information can also be entered and viewed in the LCR. Ms. Mindolovich said that the laboratory is the most frequently used area, with Radiology being second. Commissioners’ Comments Commissioner Chow asked where the Lifetime Clinical Record is available. Ms. Mindolovich said that it is available at the Health Centers, the Jail, Laguna Honda Hospital and San Francisco General Hospital. Commissioner Chow asked if physicians are actually entering information into the system. Ms. Mindolovich said they were but without a mandate, she does not believe they will get full compliance. Commissioner Chow asked if the system was being developed as a project of the City and County or is it proprietary to Siemans. Ms. Mindolovich said that Siemans owns the product, but DPH has customized it. Commissioner Umekubo asked if other materials could be scanned into the LCR. Mr. Counter responded that it is not possible to scan outside materials, but can use other mechanisms, for example linking into other servers to get the data that way. Commissioner Umekubo asked if voice recognition currently utilized by Radiology would it be available to other clinicians to use for progress notes. Mr. Counter said that Radiology reports are very structured and there are very few errors using voice recognition software. Progress notes are not as structured as a radiological report and the technology is not quite as clean. Commissioner Parker asked what extent the community based organizations (CBOs) have access to or utilize technology. Mr. Counter said that many CBOs have minimal or no knowledge of technology and do not have the budget. The Department is trying to budget for and provide them with the technology they need. Technical assistance is costly and this will be a challenge. Commissioner Parker asked if the use swipe cards for registration would make any significant difference in terms of fraud. Mr. Counter thinks it will give a cleaner identification of the individual. Commissioner Guy asked if the 30% maintenance budget falls within the industry standard. Mr. Counter replied that in looking at comparable organizations the industry standards is 4%-5% of operating budget for IT. DPH hovers around 2.5%. Commissioner Guy asked what applications the wireless technology would have. Mr. Counter said that in 3-4 years approximately 40% of access to data systems will be wireless. In terms of how it would work in the DPH environment, Mr. Counter said that the Laguna Honda Hospital rebuild is being designed be fully wireless. Medical devices such as EKGs are also going to be wireless. Commissioner Guy asked if there are any gaps in the system. Mr. Counter said the biggest problem is the desktop, which can become obsolete in 12-18 months. Another major concern for the future is security, particularly cyberterrorism. Staff is working with firewall consultants, but in some ways, there is currently no good solution. Commissioner Chow asked what happens if the system shuts down. Mr. Counter said they have back up systems, data storage and downtime procedures. He said that when clinical services are dependent on information technology, system troubles can have a tremendous impact on health care operations. So they have always been careful with clinical systems to have downtime procedures well developed. 6) ANNUAL PREVENTION UPDATE Barbara Garcia presented the Annual Prevention Update. There are two distinct parts to the report: an inventory of prevention services and the Firearm Injury Prevention Report. Brian Katcher, Pharm. D., Community Health Promotion and Prevention presented the inventory of prevention services. He described the approaches to prevention. Primary prevention reduces the incidence of new cases. Some examples are exercise and tobacco avoidance. Secondary prevention detects the existence of problems early in their development and intervenes there. Examples include cholesterol screening and mammograms. Tertiary prevention alleviates the impact. Examples include angina drugs and bypass surgery. Mr. Katcher described the methodology that was used for preparing the Prevention Inventory. Staff began with the CDC’s An Ounce of Prevention: What Are the Returns, a pamphlet that identifies cost-effective strategies that address areas of major health impact and cost, and added to this list. The inventory is department-wide, and staff queried managers of various programs in a way that resulted in consistent data. Mr. Katcher gave a sampling of programs that are part of the prevention inventory including immunizations, prenatal visits, nutrition education, tobacco control and lead ordinances, cancer and cholesterol screenings and smoking cessation classes. Prevention Inventory: Inventory Highlights Wide array of prevention interventions taking place throughout the Department More than $24 million spent on prevention activities, 20 percent of which is primary prevention The programs have a great impact on CHN population and a great impact on community populations The inventory does not capture all DPH prevention, for example the activities of the Housing and Urban Health Division Identifies gaps, for example it is clear that the Department needs to address physical inactivity as a major health problem. Provides a context for Community Health Promotion and Prevention Mr. Katcher described some of the Department’s prevention programs. The Pedestrian, Bicycle and Traffic Safety program is a collaboration of 15 community-based agencies funded to do local pedestrian and bike safety projects that focus on the most vulnerable populations using multiple strategies. During the last year there has been a 50 percent reduction in pedestrian deaths. The Senior Falls Prevention Program has been a successful pilot program for 15 years. Firearm-related Injury Prevention Planning is another area, and Mr. Katcher introduced Carolyn Klassen, Community Health Promotion and Prevention, and Mary Vasser, Deputy Director of the UCSF Injury Center at SFGH, to present the San Francisco Firearm Injury Reporting System. Ms. Vasser said that the project was a collective effort of several agencies including DPH, the UCSF Injury Center, the San Francisco Police Department, the Trauma and Emergency Department registries at SFGH and the Medical Examiner’s Office. Ms. Vasser said that the first major effort to begin to develop a firearm violence surveillance system began in 1999. San Francisco is one of the 11 pilot sites for the national effort, and is in the third year of a three-year project. The project is being coordinated by the Injury Center at the Harvard School of Public Health. The vision for the San Francisco Firearm Reporting System (SFFIRS) is to provide a framework for a public health approach to reducing violence in San Francisco. This begins with a better ability to define the problems, disseminating the information to policy makers, community organizations and other interested groups, then working together to generate changes in policies and to improve planning efforts that will lead to interventions. The data will also serve as the cornerstone for evaluating these efforts. Ms. Vasser emphasized that the data is just a starting point. Policy-level changes will be needed to make change happen. Carolyn Klassen presented the data from the report. Well over half of all firearm deaths in San Francisco were from homicide, while national average is 38 percent. Overall San Francisco’s rate is well below that of the State of California, and meets the objectives of Healthy People 2000. However, African Americans males living in San Francisco have a homicide rate that is 34 percent higher than the national African American homicide rate. Ms. Klassen demonstrated the scope of information that is available with SFFIRS that is not available with data usually collected (for example from a death certificate) by presenting two different scenarios. While death certificate captured basic demographics, SFFIRS can show criminal history, the location of the suspect’s residence as compared to the incident location, relationship to the suspect, presence of drugs and alcohol and other data. With SFFIRS data, it is know known that in 1999: 70 percent of victims of homicides and assault had a criminal history before the date of the incident; of the known suspects, 74 percent also had criminal history Of the 96 surviving assault victims, 63 percent reoffended in San Francisco before 2001. 38 assault victims with criminal histories who were treated and released by the SFGH ED reoffended within the next calendar year. Victims with a criminal history were twice as likely to know the suspect who shot them as victims without criminal histories. 60 percent of victims with criminal histories tested positive for alcohol and drugs; 37 percent of victims without a criminal history tested positive for alcohol and drugs. 24 percent of homicide and assault victims were not residents of San Francisco; 27 percent of the known suspects also resided outside of the county. Ms. Klassen said the next steps are: Meet with the Task Force to discuss data collection, policy, planning and research issues Translate the report findings to a format that will be useful for community-based practitioners and prevention efforts Expand data collection to include approximately 1000 cases of injuries and deaths due to all forms of violence, and will be collecting additional variables on referrals and recidivism reduction program. Ms. Klassen concluded by saying that this linkage provides practitioners for the very first time with the foundation necessary to identify gaps and risk factors in the present system and provides the opportunity to develop intervention measures that will break the cycle of violence both in San Francisco and regionally. Commissioners’ Comments Commissioner Sanchez said that a few years ago the California Wellness Foundation funded various efforts to reduce violence, including the tattoo removal program, the RAP alternative high school for youth at risk and other programs. It was a multidisciplinary effort with the medical community, schools, non-profit groups and others joining the effort. He asked if there was any way to revisit and re-examine the data from these past programs to see what interventions continue to be successful. Ms. Vasser replied that some of these programs did not have funding for evaluation. She and others are in the process of meeting with all of the various groups and there is a lot of interest in this program. For example, she working with the Emergency Department at San Francisco General Hospital to see what interventions are available during the short window of time when the victims are in the emergency room. Commissioner Guy asked if there are communities where there is data on best practices policy interventions, so that we can relate this raw data to actual interventions or community building practices. This would help the Health Commission to make a connection related to policy. She asked if this falls within what the scope of the SFFIRS. Ms. Vasser said they are trying to link with the appropriate people through the task force to set up some feasible interventions or focus on certain segments of the population. Commissioner Guy said that the report clearly demonstrates that efforts cannot stay within the geographic or political boundaries of a city to address the problem. It is a regional issue and needs to have a regional approach. Ms. Vasser said that Ginger Smyly started a Bay Area Youth Violence Work Group to bring together different agencies and identify best practices. Ms. Klassen added that within the Department, Ms. Smyly is bringing together all the community leaders who work on violence prevention. Commissioner Jackson said that many interventions are to change behavior and asked where and what interventions are available prior to that behavior. Where are we intervening with very young people on alcohol and drugs? We are going to have to do something to break the cycle as opposed to trying to re-educate people. This is a critical part of prevention. Ms. Garcia said that the Department is developing a report that provides a summary of all of the programs that target youth. Commissioner Jackson said that we do not give youth enough opportunity to speak with mental health professionals. Commissioner Parker said that only two percent of the Department’s budget is spent on prevention, so why are people surprised that we are not addressing the problem. We need to change our thinking before we expect things to change. Commissioner Chow said that this is good beginning to cataloging our prevention services, but where do we go from here and how to we expand our services. Dr. Katz said that we have to know where we are now, and until this report we have never looked at all of the prevention interventions that were done in the clinical setting. The question is how to increase prevention throughout DPH. When the 10% cuts were developed for the FY 2002-2003 budget, prevention cuts were not proposed. If there were more resources, the Department would fund more prevention. Without more funding, the Department needs to re-focus. Dr. Katz said he has been attempting focussing on community care and providing more integrated care. 7) AMENDMENTS TO HEALTH COMMISSION RULES OF ORDER Commissioner Chow summarized the proposed amendments to the Health Commission Rules of Order. He suggested that a change be made to page seven to state that a minimum of two members of the Health Commission serve on the Community Health Network Joint Conference Committee. Action Taken: The Commission approved the amendments to the Health Commission Rules of Order with the change noted above. 8) PUBLIC COMMENTS Patrick Monette Shaw said that the Bay Area Reporter reported that the CARE advisory body had met two to three times in the last few weeks, and he is researching to see if these meetings were appropriately noted. Also, Mr. Shaw has documents from DPH that indicate that the number of syphilis tests has remained flat, and the number of cases has decreased. Mr. Shaw is tired of hearing false information from the Department that rates are increasing. 9) ADJOURNMENT The meeting was adjourned at 5:45 p.m. Michele M. Olson, Executive Secretary to the Health Commission