Minutes of the Health Commission Meeting Tuesday, July 2, 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 Commissioner Edward A. Chow, M.D., at 3:10 p.m. Present:  Commissioner Edward A. Chow, M.D., President Commissioner Roma P. Guy, M.S.W., Vice President Commissioner Arthur M. Jackson Commissioner Harrison Parker, Sr., D.D.S. Commissioner John I. Umekubo, M.D. Absent: Commissioner Lee Ann Monfredini Commissioner David J. Sanchez, Ph.D. 2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF JUNE 18, 2002 Action Taken: The Commission (Chow, Guy, Jackson, Parker, Umekubo) approved the minutes of the June 18, 2002 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Jackson chaired, and Commissioner Umekubo attended, the Budget Committee meeting. Commissioner Monfredini was absent. (3.1) PHP-AIDS Office - Request for approval of a new retroactive contract with New Direction 21st Century in the amount of $90,000, to provide HIV prevention and education services to young African Americans, for the period of June 1, 2002 through December 31, 2002. (3.2) PHP-Community Health Education - Request for approval of a renewal contract with O’Rorke Public Relations and Advertising in the amount of $75,000, to provide public relations and media services to the Traffic Safety Project, for the period of July 1, 2002 through June 30, 2003. 3.3) PHP-Substance Abuse Services - Request for approval of a contract renewal with Women and Children’s Family Services, Inc., (WACFS) in the amount of $200,631, to serve the remaining clients and close out the residential and outpatient substance abuse services to current clients, for the three-month period of July 1, 2002 through September 30, 2002. (3.4) PHP-Housing & Urban Health - Request for approval of a new sole source contract with Lutheran Social Services in the amount of $120,966, to provide transitional housing and supportive services, for the period of July 1, 2002 through June 30, 2003. (3.5) PHP-Substance Abuse Services - Request for approval of a sole source contract renewal with Latino Commission on Alcohol and Drug Abuse in the amount of $1,013,555 per year, for a total four-year contract of $4,054,220, to provide residential substance abuse treatment targeting adult male Latinos and pregnant and post partum Latina women, for the period of July 1, 2002 through June 30, 2006. Items 3.3, 3.4 and 3.6 were discussed together. Commissioners’ Comments Commissioner Jackson commended the staff for successfully transitioning the funding and clients so that services could continue. (3.6) PHP-Mental Health Services/Family Mosaic Project - Request for approval of renewal contracts with Family Mosaic Project in the amount of $1,100,186, to provide various wrap-around services through the following nine (9) agencies targeting seriously emotionally disturbed children, for the period of July 1, 2002 through June 30, 2003: JLC Services $140,000 Victor Treatment Centers $511,000 RISE Institute $200,000 Families First $ 81,120 High Gear Achievers, Inc. $ 51,000 Big Brothers/ Big Sisters of San Francisco $ 15,362 OTTP/SSG $ 20,000 New College of California $ 8,000 Catholic Youth Organization - St. Vincent’s School for Boys $ 83,616     (3.7) DPH-Emergency Medical Services Agency - Request for approval of a Memorandum of Agreement with the Police Department for Emergency Medical Aircraft Use of the Public Safety Helipad at Hunters Point Naval Shipyard. Commissioners’ Comments Commissioner Umekubo asked how much longer it would take paramedics to travel to San Francisco General Hospital from the new location as compared to Pier 94. Mr. Petrie responded that it was one minute less from the Pier 94 location. Action Taken: The Commission (Chow, Guy, Jackson, Parker, Umekubo) approved the consent calendar of the Budget Committee. 4) DIRECTOR’S REPORT Mitch Katz, M.D., Director of Health, presented the Director’s Report. City Budget Last Thursday, the Budget Committee voted to restore funding for several proposed service reductions. The list of add-backs, which totals $9.8 million Citywide, is attached to this report. The Board restored funding for a number of DPH services, including several mental health and substance abuse service programs. Add-backs for the Department of Public Health, including a 1 percent cost of living increase for non-profit contractors and the University of California, total approximately $4.2 million. With these add-backs, the Budget Committee forwarded the City’s budget proposal to the full Board. However, several unions are still considering the City’s proposal regarding retirement pick-up. If these unions reject the proposal, DPH will be asked to make additional reductions based upon the outcome of these votes. The budget will be introduced at the Board on July 15th with the final vote scheduled for July 29th. Two Direct-Access-to-Housing Hotels to Open in August Beginning next month, clients referred by the MOST/AB2034 Team, HIV providers and other DPH providers will be able to move into the 54 units at the Star Hotel (2176 Mission Street) and 55 units at the Camelot Hotel (124-126 Turk Street). Baker Places, Tenderloin AIDS Resource Center, and Lutheran Social Services will provide on-site supportive services at both hotels. Syphilis Education and Prevention The new DPH Syphilis Awareness Campaign, "Healthy Penis 2002," was launched at a press conference June 27th. The campaign introducing the characters of “Healthy Penis” and “Phil the Syphilis Sore” was featured in articles in the Chronicle, the Examiner, and the Los Angeles Times. Life sized characters of “Healthy Penis” and "Phil the Syphilis Sore" marched in Sunday’s Gay Pride Parade and will visit various clubs in the City. Campaign materials such as bus shelter and retail establishment posters, “stress grips” in the shape of campaign characters, and informational palm cards have been developed and distributed to Castro Street businesses, and members of the target audience. A campaign web site has been established (www.healthypenis2002.org) which provides information about the campaign, and information about STDs and STD resources. Client Satisfaction Survey CSAS completed a consumer satisfaction survey June 2002. The scope of the survey process included all CSAS contracted programs in all modalities, more than 150 programs in more than 40 agencies. Surveys were available at each treatment and prevention site during a 4-day window at each site. Survey tabulation has begun, and it indicates that more than 60% of consumers responded. The survey employs standardized forms, computerized optical scanning equipment, and standardized time frames. Results can be compared over time or with other departments and communities. This is the second year of a major collaboration between Community Mental Health Services and CSAS. Results from both years will be available in a report by mid-August. OBOAT pilot (Office-Based Opiate Addiction Treatment) On July 11th a training will be held for physicians, pharmacists, counselors and other medical provider staff at the OBOAT pilot sites. The training, provided by the California Society of Addiction Medicine and members of the OBOAT steering committee, will prepare pilot site clinical staff for OBOAT clients. Commissioners’ Comments Commissioner Chow asked how many of the Health Department’s one-time Board of Supervisors’ addbacks were restored. Dr. Katz said that approximately two thirds were added back and one third were not. The San Francisco AIDS Foundation’s HIV housing subsidy program and the NICOs anti-gambling program were not restored. Commissioner Chow said that while the COLA is only one percent, it does recognize our contractors’ needs. Commissioner Chow asked for clarification that the Budget Committee’s recommendation does not include funding for DPH to relocate the Laguna Honda Hospital laundry and continue to operate it with civil service. Dr. Katz confirmed this. Commissioner Umekubo is happy to see that the one percent COLA for contractors and UC is part of the Board of Supervisors’ Budget Committee’s recommendation. He commended CSAS for the response rate to Client Satisfaction Survey and asked how many people were surveyed. Dr. Partida said that they surveyed all of the providers and received 780 responses thus far. Commissioner Guy said that the Commission needs to support unconventional and sometimes controversial approaches to syphilis prevention. Dr. Katz said that controversy gets people to recognize that what is going on is different and requires attention. Commissioner Jackson asked if the Laguna Honda nursing positions that were deleted were restored. Dr. Katz replied that about half of the positions were restored. 5) CONSIDERATION OF A RESOLUTION APPROVING A PROPOSITION J CONTRACT TO OUTSOURCE LAUNDRY SERVICES AT LAGUNA HONDA HOSPITAL, FOR THE PERIOD OF JULY 1, 2002 THROUGH JUNE 30, 2004 Mitch Katz, Director of Health, presented the Proposition J Resolution for outsourcing laundry services at Laguna Honda Hospital. This has been a difficult budget year and the recommendation to outsource the laundry services was made to help the City and County with its budget shortfall. Dr. Katz emphasized that no one wants to lose long-term employees. The current cost estimate for FY 2002-2003 to perform the service by city employees is in excess of $6.1 million, which includes one-time costs related to the operation of an off-site civil services staffed laundry. In subsequent years the cost to the City to operate a civil service staffed off-site laundry will be in excess of $4.2 million. Staff used two different estimates to determine the cost savings of outsourcing the laundry. The Department currently pays $.32 per pound for San Francisco General Hospital’s laundry. However, when that contract was recently put out to bid, SFGH got a bid of $.29 per pound. The savings are great using either number. Cost savings for FY 2002-2003 are $3,297,580 at $.32/pound and $3,628,601 at $.29/pound. Savings in later years are not quite as large due to the first year capital costs, but there will still be an annual savings of between $1.3 and $1.6 million. The Department will retain 15.5 FTEs for the duties of linen distribution. They want to work productively with labor to place employees from the laundry into other positions. They were able to do this when they converted San Francisco General Hospital’s laundry services. Dr. Katz presented an amended resolution asking for the Commission’s approval to submit the cost analysis to the Controller’s Office. He reiterated staff had to look at what was necessary to close the budget without making service cuts and this was an example of where the Department could achieve substantial savings without making budget cuts. Public Comment Vincent Harrington, attorney representing SEIU Local 250 and SEIU Local 790 - The Commission has no authority to adopt this contract and the Commission’s decision is meaningless. This process can go forward only if the Mayor makes a decision pursuant to their contract that he cannot provide the services he is mandated to provide unless he undertakes this contract. The contract between the SEIU and the City requires that there be extend discussions, and an arbitrator would determine if the Mayor could make this decision. The Commission’s action will be in vane. Sal Rosselli, President of SEIU 250 - he has never been so ashamed of city government as he is now. The union has found millions of dollars of savings that could be made rather than laying off laundry workers. This action is fundamentally unfair. The City made an agreement with these workers and now is taking this away. Outside vendors that provide laundry services are sweatshops. The laundry workers spend hundreds of hours just a few years ago to save Laguna Honda Hospital. They will organize now to stop the contracting out from happening. Laura Blue, RN - asked the Commission not to cut more staff at Laguna Honda Hospital. The staffing level in their MOU has never been met. Last year staff lost more than 3,000 hours of unused educational time. The cuts to the laundry is another example of how when the budget gets tough, the city turns to Laguna Honda. Rebecca Morrow, PHN - the voters made their wishes clear with regard to Laguna Honda and cutting the laundry services is not consistent with what the voters want. There is nothing that frustrates a nurse more than to need an item and not get it. Nurses have a relationship with the laundry workers that allows them to work together and there will not be this relationship with a contractor. This will compromise patient care. Brian Uyero, LHH Laundry - If you close Laguna Honda Hospital, you close down what this city is all about-helping people who cannot help themselves. He has been working at Laguna Honda Hospital for 10 years. Raquel Nacdao Icban, RN at Laguna Honda - nurses will not be able to deliver quality care if the laundry services are contracted out. Nurses cannot get their requested earned time off. The acuity of patients has skyrocketed. The laundry services are a vital part of delivering care to residents. Josie Mooney, Executive Director SEIU 790 and president of the San Francisco Labor Council - asked the Commission to look at the faces of the laundry workers and imagine what it will be like when they do not have jobs. If the services are contracted out two classes of disenfranchised workers will be created: those that are without jobs and those that will be doing the laundry at another location with certainly no benefits. She dissents from the proposal and hopes the Commission will dissent as well. Ben Ruvalcaba, LHH Laundry - he has worked in private laundry and they pay cheap wages. The benefits and wages at Laguna Honda are good. The laundry workers-and all staff-worked hard on the campaign to save Laguna Honda Hospital and the people of San Francisco voted to rebuild it. This included the laundry. They were told no one would lose their jobs, and now they are proposing to contract for cheap labor. He needs this job. And it is a violation of the contract, which has a provision for no contracting out. Dr. Katz said that there are requirements of any City and County of San Francisco contractor with regard to minimum wage requirements and the provision of benefits and while it is true that the contractor is not known at this time, the contractor will have to comply. And while these wages and benefits are not as great as what is provided to civil service, they do exist. Dr. Katz added that the Deputy City Attorney has reviewed the resolution and believes that it is appropriate for the Commission to consider and adopt the proposed resolution. Commissioners’ Comments Commissioner Jackson clarified that this resolution only facilitates getting the information to the Controller and the Board of Supervisors but that the decision lies with the Board of Supervisors. He asked if funds are available for cross training. Dr. Katz replied that currently there is not, although the Board of Supervisors has discussed this. Commissioner Jackson asked if a contractor could provide quality services. Robert Christmas, Chief Operating Officer at Laguna Honda Hospital, replied he is aware that there some concerns about the services that are provided by existing contractors. Commissioner Jackson does not want to see any jobs contracted out, but he is committed to the additional nurses that were proposed in the base budget. These positions are his first priority for the budget is the nurses even though he values the work of the laundry services. He will continue to advocate to the Board of Supervisors that the laundry should not be contracted out. Commissioner Parker asked if the decision to do SFGH’s laundry done by a contractor was made for financial reasons. Dr. Katz said that it was the result of a previous recession. Commissioner Parker asked if budget savings would be accrued if the laundry staff are placed in other civil service jobs. Dr. Katz said that if there is a truly vacant position that can be filled by a laundry worker, then savings would still be accrued. But this is only feasible if the Mayor’s Office releases the job requisition. Commissioner Parker said that even though this proposal attempts to address the budget shortfall, it goes against the spirit of what the Department stands for in terms of wages and benefits. We are better off discussing how we get the necessary funds or how we spread the deficit out in a more equitable manner. Dr. Katz said that the Board of Supervisors would have to give an addition $4 million to the Health Department to continue these services, which is still a possibility. Commissioner Parker asked if the Laguna Honda Hospital rebuild proposal included on-site laundry services. Dr. Katz said initially yes, but as the project moved along, in order to rebuild 1,200 beds the decision was made to relocate the laundry at Oyster Point. Commissioner Guy said that since the Commission’s budget discussions began in January there was realization that the Department was going to have to absorb some cuts. She has publicly prioritized the addition of the nursing positions to the staff at Laguna Honda Hospital over the retention of the laundry and her position has not changed. However the Health Commission’s position opposing any cuts, including the laundry, also has not changed. Commissioner Umekubo asked what likelihood there is that the workers will find other civil service jobs. Dr. Katz said that he could not guarantee that all workers will be placed but Laguna Honda Hospital has a large workforce, and they have six months, which gives enough time to plan. It should be possible with everybody’s cooperation to make it work. Commissioner Chow said that the position of the Health Commission is to support the Department’s base budget and oppose all of the cuts included in the 10 percent budget reduction proposal that the Department was required to submit to the Mayor’s Office. The resolution being considered today does not change that position. The resolution is a concurrence with the analysis of the cost savings as does not call for closing the laundry. However, if the Board of Supervisors’ final budget does not include funding for the laundry, then Laguna Honda Hospital will have no laundry services as of the end of December. This resolution makes the Health Commission part of the solution to address this problem, should it happen. Action Taken: The Commission (Chow, Guy, Jackson, Umekubo) approved Resolution #08-02 titled “Concurring with the Analysis of the Department Staff and Pending Controller’s Certification that the Laundry Services can be performed for the Department of Public Health Laguna Honda Hospital by Private Contractor for a Lower Cost than Similar Work Performed by City and County Employees”. Commissioner Parker voted against the resolution. 6) CONSIDERATION OF A RESOLUTION APPROVING ORDINANCE AMENDMENTS TO THE SAN FRANCISCO HEALTH CODE TO UPDATE LEAD HAZARD DEFINITIONS TO BE CONSISTENT WITH STATE AND FEDERAL DEFINITIONS Joe Walseth, Childhood Lead Prevention Program, presented the proposed amendments to Article 26 of the San Francisco Health Code. The ordinance amends the current code in two respects. First, to broaden the scope of services that Childhood Lead Poisoning Prevention currently provides to include case management services to children up to 21 years of age. The second respect would be to change the standards by which the Department conducts environmental investigations with respect to children who have been identified as being lead poisoned to be consistent with federal and state standards, which are more protective of children’s health. There is the need to update the lead hazard definitions to be consistent with State and Federal definitions. Dr. Katz said that these amendments do not fundamentally change the way the Department provides services. Commissioners’ Comments Dr. Umekubo asked what the protocol is for screening children and what mechanism is used to screen children who do not live in houses that are identified as lead hazards. Dr. Katz said the issue of whether there should be universal screening of children for lead poisoning is quite controversial. The official bodies say mandatory, universal testing of children but there is tremendous provider variability. Commissioner Parker said the Department should advocate for legislation that would address the certification of residential units being a lead-free environment as part of transfer of ownership title. Dr. Katz said staff would research if there are other localities in the United States that have such legislation and bring this information back to the Commission. Action Taken: The Commission (Chow, Guy, Jackson, Parker, Umekubo) approved Resolution #09-02 titled “Approving Ordinance Amendments to the San Francisco Health code to Update Lead Hazard Definitions to be Consistent with State and Federal Definitions.” 7) PUBLIC COMMENTS Elizabeth Frantes - there is a club on 10th Street and the workers there are providing marijuana medication to Laguna Honda’s residents. It is a wonderful place, with online access. This is the first cannabis sports bar. There is a lot of harassment of women at cannabis clubs, and this does not happen at the new club. The club needs help and support from the Department to continue to provide services. 8) ADJOURNMENT The meeting was adjourned at 4:45 p.m. Michele M. Olson, Executive Secretary to the Health Commission