Minutes of the Health Commission Meeting Tuesday, August 20, 2002 at 3:00 p.m. 101 Grove Street, Room #300 San Francisco, CA 94102 1) CALL TO ORDER The meeting was called to order by Commissioner Chow at 3:15 p.m. Present:  Commissioner Edward A. Chow, M.D., President Commissioner Roma P. Guy, M.S.W., Vice President Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner David J. Sanchez, Ph.D. (arrived at 4:20 p.m.) Absent:  Commissioner Arthur M. Jackson Commissioner John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF JULY 16, 2002 Action Taken: The Commission (Chow, Guy, Monfredini, Parker) approved the minutes of the July 16, 2002 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Monfredini chaired and Commission Parker attended the Budget Committee meeting. Commissioner Jackson and Commissioner Umekubo were absent. (3.1) DPH-Central Administration/MIS - Request for approval of a new contract with Siemens Medical Solutions Health Services Corporation, in the amount of $966,150, to assist in the transition from an outsourced patient billing system to an in-house patient billing system, for the term of September 1, 2002 through June 30, 2003. Commissioners’ Comments Commissioner Monfredini emphasized that DPH is under a tight timeline and she wants assurances this project will be completed in a timely manner. Ronald Castleberry from Siemens said he feels confident in a six-month timeline. (3.2) AIDS Office-Prevention - Request for approval of a retroactive sole source contract renewal with Continuum HIV Day Services, in the amount of $745,875, for the Homebase Program, which provides transitional HIV support services for incarcerated persons and the HOPE Study, a research project, which assesses the effectiveness of the Homebase Program, for the period of July 1, 2002 through June 30, 2003. (3.3) AIDS Office-Prevention - Request for approval of a retroactive contract renewal with Centerforce, Inc., in the amount of $764,000, to provide HIV prevention and education services to incarcerated and post-release populations at San Quentin State Prison, Central California Women’s Facility and Fresno County Jail, for the period of July 1, 2002 through June 30, 2003. (3.4) AIDS Office-Prevention - Request for approval of a new, retroactive contract with Centerforce, Inc., in the amount of $59,004, to provide HIV prevention and education services to incarcerated and post-release African-American men at San Quentin State Prison whose post-release address is within the San Francisco Eligible Metropolitan Area, for the period of July 1, 2002 through December 31, 2002. Commissioners’ Comments Commissioner Parker asked how many patients would be served by this new program. Nick Gardner from Centerforce said that they are expecting to serve 2200 to 2600 individuals in the next six months for both programs; 300-400 will be African American men. (3.5) AIDS Office-HIV Research - Request for approval to accept and expend retroactively a subcontract from Public Health Foundation Enterprises, Inc. (PHFE), in the amount of $325,345, to fund a project for “San Francisco HIV Vaccine Clinical Trials”, for the period of June 1, 2002 to May 31, 2003. (3.6) CHP-Maternal and Child Health - Request for approval to accept and expend a grant from the California Department of Health Services, in the amount of $113,788, to support healthy eating and childhood overweight prevention services, for the period of August 1, 2002 to September 30, 2003. (3.7) PHP-AB 75 Project - Request for approval to accept and expend retroactively a grant allocation from the State Department of Health Services through its California Healthcare for Indigents Program (CHIP), in the amount of up to $4,136,456, to provide reimbursement for health services delivered to indigent persons for the term FY 2002-03. (3.8) PHP-Epidemiology and Disease Control - Request for approval to accept and expend retroactively a supplemental grant from the State Department of Health Services, in the amount of $893,885, to further develop and implement plans for public health preparedness and response to bio-terrorism for the period of July 1, 2002 to August 30, 2003. The grant includes a sole-source contract with the Regents of the University of California for $18,031 for the same period. (3.9) PHP-Behavioral Health Services - Request for retroactive approval of a renewal contract with Lifemark Corporation, in the amount of $434,222, to provide fiscal intermediary services to the Personal Assisted Employment Services (PAES) for dental services, for the period of July 1, 2002 through June 30, 2003. + This item was continued from the July 16, 2002 meeting. Commissioners’ Comments Commissioner Parker asked if the treating dentists see the patients promptly. Poo Yee Lindhalh said patients are treated rapidly. Commissioner Parker asked if a participant has ever missed out on a job interview because of having to wait for dental services. Ms. Lindhalh replied that this program serves the very disadvantaged, and it takes participants a while to get through the system to the point where they can go to a job interview, so usually this situation does not present itself. (3.10) PHP-Behavioral Health Services - Request for approval of a contract modification with San Francisco State University, in the amount of $20,000 per year, for the period of July 1, 2002 through June 30, 2004, of a four-year contract, to provide professional substance abuse counselor training and certification services, for a total contract value of $340,000, for the period of July 1, 2000 through June 30, 2004. (3.11) PHP-Behavioral Health Services - Request for approval of a retroactive contract renewal with Morrisania West, Inc., in the amount of $517,605, to provide day treatment substance abuse services to African American youth and young adults, for the period of July 1, 2002 through June 30, 2003. (3.12) PHP-Behavioral Health Services - Request for retroactive approval of a new sole source contract with San Francisco Suicide Prevention, in the amount of $304,000, to provide fiscal intermediary services for the San Francisco Office-Based Opiate Treatment one-year pilot project, for the period of July 1, 2002 through June 30, 2003. Commissioners’ Comments Because this is a new contract for a new program, Commissioner Monfredini requested a six-month status report to the CHN Joint Conference Committee. (3.13) Primary Care - Request for approval of a retroactive renewal contract with Haight Ashbury Free Clinics, Inc., with a total four-year contract amount of $207,100, to provide primary care and HIV screening services to low-income residents of San Francisco, for the period of July 1, 2002 through June 30, 2006. (3.14) CHN-SFGH Trauma Program - Request for approval of a new contract with Gerson/Overstreet, in the amount of $75,000, to provide aeromedical access needs assessment and feasibility study for the Trauma Center at San Francisco General Hospital, for the period of September 1, 2002 through August 31, 2003. Commissioners’ Comments Commissioner Monfredini asked when the feasibility study would be done. Mr. Overstreet from Gerson/Overstreet Architects said he is prepared to begin the project immediately. Ms. O’Connell’s expectation is that after the feasibility study is done the Department will be able to answer any questions about licensing and community issues, and be able to move forward with a helipad. Ms. O’Connell stated that Gerson/Overstreet outlined in detail all of the steps that need to be done, and the study will be completed by February or March. She added that the expectation for remaining a Level 1 trauma center is that there will be a helipad, and DPH will not fully meet the requirements of the Trauma Plan until there is a helipad. (3.15) CHN-SFGH - Request for retroactive approval of a new contract with the Regents of the University of California, in the amount of $280,000, to provide orthotics and prosthetics for medically indigent adult clients of the Community Health Network, for the period of July 1, 2002 through June 30, 2003. (3.16) CHN-SFGH Nursing Operations - Request for approval of contract renewals with the following firms for a combined total of $1,500,000: C.W. Healthcare, Inc., HRN Services, Inc., Maxim Healthcare Services, Inc., Medical Staffing Network, Inc., Medstaff, Inc., Nurse Providers, Inc. and United Nursing International, for the provision of supplemental, temporary, per diem and traveling nursing personnel services for the San Francisco General Hospital, Community Health Network, for the period of September 1, 2002 through August 31, 2003. Commissioners’ Comments Commissioner Monfredini expressed her unhappiness with the three contracts (Medical Staffing Network, C.W. Healthcare and Maxim) that had unacceptable or improvement needed performance ratings. Ms. Digdigan from San Francisco General Hospital said that by the end of October she would have a better sense if the three contractors will be able to perform. She said that since these contracts were only started in May she is giving them 90 more days to improve service. She added that she would ideally like to have more than three contracts to call during time of high demand. Commissioner Monfredini requested that Medical Staffing Network be called as a last resort, and staff should look for a contractor to replace them. Commissioner Parker supports the 90-day period to see if there are performance improvements, and asked that a report on these three contracts be given to the San Francisco General Hospital Joint Conference Committee in 90 days. (3.17) CHN-Jail Health Services - Request for approval of a retroactive renewal contract with Haight Ashbury Free Clinics, Inc., in the amount of $3,749,029, to provide psychiatric and substance abuse treatment services for inmates in the San Francisco County Jail system, for the period of July 1, 2002 through June 30, 2003. Action Taken: The Commission (Chow, Guy, Monfredini, Parker) approved items 3.1 through 3.17 of the Budget Committee consent calendar, with the exception of item 3.10. Item 3.10 was continued until Commissioner Sanchez arrived, at which time the Commission (Chow, Monfredini, Parker, Sanchez) approved it. Commissioner Guy abstained. Item 3.12, report back to the Community Health Network Joint Conference Committee in six months. Item 3.16, report back to SFGH Joint Conference Committee in 90 days. Selective Provider Contracting Program Waiver Federal approval of California’s Selective Provider Contracting Program (SPCP) waiver is in jeopardy. The SPCP, established in 1982, provides critical Medicaid funding for California’s disproportionate share hospitals (under the SB 1255 program) and teaching hospitals (under the Graduate Medical Education program). Like other waivers, the SPCP waiver is subject to renewal every two years. However, during the current renewal process, the federal government has suggested that a key component of the waiver may be disallowed, resulting in a $300 million reduction in federal Medicaid funds to California’s safety net hospitals over the next two years. For San Francisco General Hospital, this would mean a reduction of $9.1 million. The Department has been working closely with the Mayor’s Office of Legislative Affairs, with the City’s federal lobbyist, and with our health and hospital partners in California to do all we can to ensure federal approval of this critical Medicaid waiver. Governor's Visit On July 24th, the Governor held a press conference at San Francisco General Hospital. The purpose of the press conference was to highlight the Governor's commitment to HIV/AIDS and to encourage the passage of the State budget to ensure continued availability of funding for critical health programs. The Governor toured Ward 5A, the inpatient AIDS/Oncology unit, and then addressed the media on the front lawn. Federal Nurse Reinvestment Act On August 1st, President Bush signed the Nurse Reinvestment Act, which is intended to ease the nationwide nursing shortage. The new law: provides scholarships and loans to nursing students who agree to serve for two years in a hospital with a critical nurse shortage; includes a loan cancellation incentive for nurses who receive masters or doctoral degrees to teach at nursing schools; offers nurses continuing education, geriatric training, "career ladder" programs, internship and mentor programs. Though the legislation has been enacted, Congress must now appropriate money to fund the bill. The Department of Public Health will continue to work with the City’s federal lobbyist to support this important bill. Outreach at 7th and Berry Streets On July 27th, a homeless encampment located on City owned property at 7th Street and Berry was dismantled. Several homeless outreach staff including the HOPE and MOST teams provided assistance to the 75 - 100 individuals residing in the encampment. DPH staff from the HOPE and MOST teams provided medical assistance and mental health services. Staff from the CATS/MAP First Response team provided transportation and assistance completing Shelter Plus Care applications. Barbara Garcia and Charlie Morimoto were both present to oversee any additional assistance. Laguna Honda Environment Impact Report Approved I am pleased to report that the Board of Supervisors unanimously approved the Laguna Honda Hospital Replacement Project Environmental Impact Report (EIR) August 12th. The approval of the EIR enables the first phase of infrastructure construction to commence on schedule this fall. I want to thank Commissioners Chow, Jackson and Sanchez, as well as the staff and residents of Laguna Honda who attended the Board hearing to support approval of the EIR. Non-Names Reporting A new state regulation for reporting HIV infection went into effect July 1, 2002. It requires all health care providers and laboratories in California to report positive HIV antibody results to the local health officer. Blood banks and anonymous test sites are exempt from this regulation. The regulation is referred to as “non-names reporting” since the client’s name won’t be included in the report. One of the purposes of this regulation is to have a better assessment of the epidemic through better tracking. Prevention Works As the Commission is aware, DPH, along with other city agencies and community partners, has been actively conducting public awareness campaigns concerning driver safety and in particular watching for pedestrians. I am pleased to report that between 2000 and 2001 there was a significant reduction in the number of pedestrian fatalities and injuries in San Francisco. In 2001, 19 pedestrian deaths were recorded; this is down 40 percent from 32 pedestrian deaths recorded in 2000. Similarly, there were 916 pedestrian injuries in 2001, down 5% from 965 injuries in 2000. Other Bay Area jurisdictions did not experience the same magnitude of declines in pedestrian injuries suggesting that San Francisco’s reductions may be attributed to public awareness campaigns and are not just a result of regional downtrends in traffic. Childhood Immunizations Improving There is good news from the Communicable Disease Prevention Unit about immunizations among young children in San Francisco. According to the most recent citywide survey , a record 81.5% of two-year-olds were up-to-date with the immunizations needed to protect them against seven serious diseases. The retrospective analysis also revealed that, broken down by race and ethnicity, there were gaps between the overall coverage rates and those of Latino and African American children. The gaps, however, have decreased substantially from three years ago. Since 1999, the coverage rate for African American children increased from 57% to 70%, and for Latino children, the rate increased from 63% to 75%. An overall level of 90% coverage is optimal. The dramatic increase in immunization coverage is a result of a comprehensive effort with a special focus on reminder/recall systems by local pediatric immunization providers, the San Francisco Immunization Coalition and the Department of Public Health. The citywide survey is conducted every three years. The information obtained from the survey (attached) will be shared with all local pediatric providers and for planning future immunization projects, especially among minority populations. New Deputy CFOs Hired I am pleased to announce we have hired two new Deputy Chief Financial Officers who will assist Gregg Sass in managing the financial operations of the Department. Anne Okubo has been hired to replace Larry Doyle who retired last June. I am sure that you remember Anne from her tenure here as Budget Manager. For the last two years, Anne has been serving the City as the Director of Finance and Administration for the Emergency Communications Department. We are pleased to have Anne back in the Department. Valerie Inouye has been hired to fill Gregg’s previous position as Deputy Finance Director for San Francisco General Hospital, Primary Care, Health at Home and Jail Health. Valerie is a certified public accountant and has over 20 years’ experience in healthcare financial management, most recently as Controller at Stanford Hospital and Clinics. Valerie will be another excellent addition to DPH’s finance team. Director of Operations for Community Programs Hired Michelle Ruggels, previously the Community Mental Health Services Budget Manager, has been hired to the position of Director of Operations for Community Programs. In this role, she will supervise and coordinate the budget staff, facilities and other operational functions across the Community Programs Division with the goal of streamlining and integrating activities wherever possible. Commissioners’ Comments Commissioner Parker emphasized that prevention works across the board, and this is demonstrated by the pedestrian safety outcomes. It is also cost efficient. With regard to the Federal Nurse Reinvestment Act, do we have any idea how this will be implemented? Dr. Katz replied that it is still in the planning stages, and is not yet funded by Congress. He added that nurses have been taken for granted, and the fact that the president signed this legislation is a statement in and of itself that nurses matter. Commissioner Guy echoed Commissioner Parker’s points about prevention because it is often difficult to see successes, yet two were presented in the Director’s Report. With regard to immunization, the report shows foreign-born children were less likely to be immunized. Is this because they came to the county at a later age or are there other factors. Dr. Katz said there will always be a gap for foreign children because the study does not take in to account opportunity for immunization. So, if a child came when she was three, this is only counted as a non-immunization. But because San Francisco has the Healthy Kids program, which covers immigrants, the next survey should show the gap decreasing. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF AUGUST Commissioner Chow presented the August Employee Recognition Awards. Individual Awardee Division Nominated by Marcos Bañales, Health Worker III SFGH - Jail Health Services, Forensic AIDS Project Isela Gonzalez, Health Worker III Adult and Pediatrics Asthma Clinic Team Division Nominated by Nancy Madden, N.P.  Shannon Thyne, M.D.  Rajeev Venkayya, M.D. SFGH - Children’s Environmental Health Promotion Karen Cohn, Program Manager 6) PRESENTATION OF THE ANNUAL JAIL HEALTH REPORT Joe Goldenson, Medical Director, Forensic Services, presented the Jail Health Report. Jail Health Services views the period of incarceration as an opportunity to treat and provide prevention services to the inmate population who typically does not access these services in the community. The presentation focused on collaborative projects, future directions and systemic challenges. Five programs were highlighted: Forensic Support Services (Mentally Ill Offender Grant I); Connections (Mentally Ill Offender Grant II); Hepatitis Prevention Program; Homebase Outcomes Project Evaluation (HOPE); and STD. Kate Monaco Klein presented the Homebase/HOPE Study. The project is designed to increase post-release use of medical and social services, decrease post-release medication non-adherence, decrease post-release HIV risk behaviors and decrease recidivism. 76 clients have been enrolled and 28 have completed the Homebase project. Preliminary data shows that 61% graduated, 33% discharges, and 4% MIA. 67% of the control group clients were reincarcerated at least one time and 60% of the Homebase clients were reincarcerated at least one time. This outcome has lead staff to realize that it took a long time for their clients to become homeless, HIV positive and substance abusers so it will take a long time to change these behaviors. Ms. Monaco Klein also presented the Hepatitis Prevention Program, which is a collaborative effort with Jail Health Services and DPH Hepatitis Prevention Program. The pilot project, which began in January, offers risk assessment, counseling, testing, vaccination and follow-up services. In the first quarter of the Hepatitis B Vaccination pilot program 89% of participants received their second vaccination. She added that staff is moving toward multi-infection counseling. Jo Robinson, Director of Jail Psychiatric Services and Assistant Director of Jail Health Services, presented the Mentally Ill Offenders Grants information. Over the past ten years there has been a 35% increase in inmates with mental illness in San Francisco jails, which is a result of the increasing criminalization of the mentally ill. In 1998 legislation was adopted that approved $104 million statewide for the Mentally Ill Offender Crime Reduction Grants demonstration project, which is designed to curb recidivism among persons with mental illness. The grants require collaboration and communication between law enforcement, corrections, mental health and other agencies. San Francisco received two projects. MIO I-Forensic Support Services is a four-year, $5 million grant. MIO II-Connections was a three-year, $3.5 million grant but has been cut to two years due to the state budget crisis. Forensic Support Services provides assertive case management services with a long-term commitment to participants. It is fully enrolled with 249 participants but has yet to be fully assessed. The diagnostic picture is that they are seeing inmates with severe mental health problems. MIO II provides short-term criminal justice case management with a mental health bridge. This program works closely with the Sheriff’s Department, JPS, Pre-trial Diversion, Center for Juvenile and Criminal Justice, Progress Foundation and others. There are 83 active participants who have mental health and substance abuse diagnoses. There are three levels of evaluation: address changes at the gate-keeping county agencies; address changes at the community-service level; and address changes at the individual level. Issues and Needs More mental health professionals needed to assess for Courts Judges don’t know what to do with this population Limited treatment resources - judges concerned about releasing to outpatient treatment Loss of SSI while in jail Need for special training Housing shortage Conservatorship Organic brain disease Dr. Joe Goldenson reported on the chlamydia screening program in the jail. Jail Health Services instituted a STD screening program where males ages 18-30 and females ages 18-35 are screened. People who are positive are treated in the jails, and STD has devoted resources to locate and treat people in the community once they have been released from jail. In order to evaluate the impact of the jail’s chlamydia screening program, they compared chlamydia rates at two health centers, Southeast and Ocean Park. When the screening started Southeast clinic had a much higher rate of positivity than Ocean Park did. Over the four years of the program the rate has declined at Southeast while remaining constant at Ocean Park. Because a high proportion of people screened in the jails come from neighborhoods in the south east sector of the city, the data suggest that chlamydia screening in the jails has been a factor that has contributed to this decrease. This reinforces their belief that efforts in the jail to identify and treat problems have major impacts on the community. Future Goals and Directions Develop outreach to this population in the community Research to determine barriers to DPH services already being provided in the community Develop coordinated services among JHS, DPH, other City departments and community agencies Educate incarcerated individuals about prevention and primary care opportunities in the community While incarcerated, connect them to a neighborhood clinic Have social service agencies come into the jail to initiate entitlements Commissioners’ Comments Commissioner Guy is very excited that these initiatives that were undertaken by the staff have demonstrated that further collaboration among services providers has successful outcomes. The chlamydia program clearly demonstrates that collaboration and access work. She asked how this can be continued vis-à-vis budget issues, the reorganization that is going on in DPH and other factors. Many of our inmates have complex, severe mental health diagnoses, which can make them a difficult population to work with. Large number of inmates with schizophrenia. These efforts will need funding. Commissioner Monfredini asked if inmates are required to be in compliance with medication orders while in jail. Dr. Goldenson said that they have the same rights to refuse medication as someone who is not incarcerated. Dr. Katz added that there is a bill by Assemblymember Thompson that sets conditions for allowing mandatory medication. Commissioner Monfredini asked if inmates are referred to a counselor or psychiatrist when they leave. Ms. Robinson said that they give every inmate that leaves who requests it a two-week supply of medication, a prescription and an appointment. And there are five social workers (in addition to those funded through the MIO grants) whose job is to work with the courts and the clients to get them placed in the community and do follow up. Commissioner Monfredini asked if housing a problem. Ms. Robinson said that through one of the grants there is housing upon discharge. But this is only available for people who are participating in that grants. Commissioner Parker said substance abuse is a core problem. We need to get the community involved. DPH is doing its job but cannot succeed alone to reduce substance abuse, which is the foundation of many problems. Need to provide more prevention. Dr. Goldenson said that at times the magnitude of the problem can be depressing but there is hope, for example Proposition 36. This allows people with substance abuse problems to get treatment rather than being put in jail. Commissioner Parker said that when these people are released from jail, who welcomes them? Who gives them a job? Who gives them housing? The community has to be involved. Commissioner Chow asked how many inmates succeed after they are released and if not, what are the barriers. Ms. Robinson said that the hope is that the research done on the mentally ill offenders grants-which is being done on all California programs-should give us the information we need on how effective these interventions are. This should be complete in approximately 1 ½ years. Dr. Katz reminded the commissioners that the jail programs are just one, often short, intervention in very complex lives. We need to make sure we set the right goal for jail health services. Dr. Chow said it is very important to see how many of the participants in these innovative programs actually get connected in the community. This will be studied in both the mental health and STD programs. Dr. Goldenson said that a number of years ago they did a study looking at how many people who had tested positive in jail for TB went to a TB clinic post-release. Some interventions led to an increase from 3% to 30%. 7) PRESENTATION OF THE HEALTHCARE ACCOUNTABILITY REPORT Mitch Katz presented an update on the Health Care Accountability Ordinance. He gave some background on what the Health Commission, when it approved the program, specified be offered in the insurance product. This is the right thing for the Health Department and the right thing for employers. Because of the way it was written there were a number of exemptions. The ordinance is very complicated to implement. The final rules and regulations were only issued in May. Therefore the Department has not been able to undertake an actuarial study, but Dr. Katz anticipates that by October or November they will have the data to undertake the actuarial analysis. He can report in December or January so that the Health Commission can make recommendations for further direction. There are two alternatives for possible consideration. One is to use a Taft-Hartely framework, which is currently available for union employees. Secondly there is state legislation that, if passed, would enable individual employers mandated to provide insurance will be considered a “small employer” and be allowed to participate in the State’s small employer purchasing pool. Dr. Katz that DPH contracts were reviewed and a number were found to be exempt. Of those that fall under the ordinance most contractors are able to comply. In summary, they have not been able to meet the timelines and the lack of complaints about this ordinance by agencies and employers is because of the work that has been done. Judith Blackwell, the City Purchaser, spoke on behalf of the Office of Contract Administration (OCA). She said they have worked very well with DPH. The regulations that were issued were a result of several extensive meetings with various parties including advocacy groups, non-profits, the health care community and many others. Now they are in the implementation stage. 56 audits have been done to ensure compliance with the ordinance, and OCA is working to ensure that compliance language is included in all future contracts. Public Comment Dale Butler, SEIU 790 - this legislation has had a real life impact on people’s lives. From the very inception of the ordinance, DPH, OCA, the labor community and Bay Area Organizing Committee have worked very well together. The next step is to figure out other places to go-there are still a lot of people out there without health insurance. Sister Kathleen Healy, Bay Area Organizing Committee (BAOC) - commended the work of the Office of Contract Administration in implementing this ordinance, and thanked the Commission for the high standards that were set at a low cost for the employee. BAOC understands the delays but looks forward to the ordinance being fully implemented. And they are especially interested in hearing how the program could work for other insured populations in San Francisco. Commissioners’ Comments Commissioner Monfredini is proud of what we have done but we need viable data to proceed. Commissioner Guy said that the Commission should get another report in January. She was initially disappointed because of the lack of data, which led to her concern about whether or not this was a viable mechanism for providing health insurance. Ms. Blackwell, Dr. Katz and BAOC have convinced her that this question cannot be answered without data. She wants the City to influence passage of the state legislation. The requirement to cover 15-hour per week workers will be difficult to comply with. Commissioner Chow is particularly concerned about options for covering employees who work 15 to 20 hours per week. He added that the Commission would need to review the standards in June 2003 so having the data in January is crucial to allowing the Commission to make recommendations in June. 8) PUBLIC COMMENTS Elizabeth Frantes - offended by Supervisor Leno’s medical marijuana proposal because not many people were consulted in its creation. He wants the city to get in the business of growing medical cannabis, which will take years. She does not want access to medical marijuana limited. We need growers coops now. In the name of being a medical cannabis sanctuary please do something. 9) 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 (Chow, Guy, Monfredini, Parker, Sanchez) voted to hold a closed session. The Commission went into closed session at 5:13 p.m. Present in the closed session were Commissioner Chow, Commissioner Guy, Commissioner Monfredini, Commissioner Parker, Commissioner Sanchez, Mitch Katz, M.D., Norm Nickens, Anthony Grumbach, Deputy City Attorney, 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 $100,000, Cordero v. CCSF, San Francisco Superior Court Case #324064 Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez) approved the $100,000 settlement. D) Reconvene in Open Session The Commission reconvened in open session at 5:45 p.m. 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).) 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, Monfredini, Parker, Sanchez) voted not to disclose discussions held in closed session. 9) ADJOURNMENT The meeting was adjourned at 5:45 p.m. Michele M. Olson, Executive Secretary to the Health Commission