Minutes of the Health Commission Meeting Tuesday, October 1, 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 President Chow at 3:10 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. Commissioner John I. Umekubo, M.D. Commissioner Chow announced two changes to Joint Conference Committee assignments. Commissioner Umekubo will be a member of the Laguna Honda Hospital Joint Conference Committee. Commissioner Parker will replace Commissioner Umekubo on the San Francisco General Hospital Joint Conference Committee. 2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF SEPTEMBER 17, 2002 Action Taken: The Commission approved the minutes of the September 17, 2002 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Monfredini chaired, and Commissioner Umekubo attended, the Budget Committee meeting. (3.1) PHP- STD Prevention and Control - Request for approval to accept and expend retroactively a new three-year grant from the Centers for Disease Control, in the amount of $160,000 for the first year, to fund the Outcome Assessment Through Systems of Integrated Surveillance (OASIS) project, for the period of September 30, 2002 to September 29, 2003. (3.2) PHP-Community Health Services/AB75 Project - Request for approval of a renewal contract with Lifemark Corporation, in the amount of $190,000, to provide fiscal intermediary services for the California Healthcare for Indigents (CHIP) Hospital and Physician Program, for the period of November 15, 2002 through March 31, 2004. (3.3) CHP-Primary Care - Request for approval of a retroactive sole source contract renewal with Tides Center-Women’s Community Clinic, in the amount of $50,500, to provide health services to uninsured women, for the period of July 1, 2002 through June 30, 2003. Commissioners’ Comments Commissioner Monfredini noted that for the past several years, funding for this contract has been taken out of the budget than added back in by the Board of Supervisors. She said it would make more sense to add the program permanently to the budget. (3.4) CBHS-Mental Health and Substance Abuse - Request for approval of a retroactive contract renewal with Walden House, in the amount of $7,648,465, to provide residential mental health and substance abuse treatment services, for the period of July 1, 2002 through June 30, 2003. Commissioners’ Comments Commissioner Monfredini asked why the organization has been late with its financial reports for the past two years. Mr. Stillwell said they have replaced the accounting system twice within the past two years. The late financial reports are still a concern for the Department. Commissioner Monfredini expressed concern that the organization’s executive director was not at the meeting. Walden House does good work but the Commission takes this problem very seriously. She asked for a letter from the executive director with a detailed explanation about what steps have been taken to address the problems, and asked that a status report be given to the Budget Committee in 90 days. She requested Walden House’s executive director’s presence at that meeting. Commissioner Umekubo said it is disturbing that the agency has done business with the Department for 30 years yet has had trouble getting its financial information to the Department on time. Commissioners’ Comments - Health Commission Meeting Commissioner Parker asked that the letter from the executive director include a description of the 13.5 positions that are being eliminated. Action Taken: The Commission approved the consent calendar of the Budget Committee, with the direction that for Item 3.4, the contract with Walden House, an update be presented to the Budget Committee in 90 days, that the executive director attend that Budget Committee meeting, and that he submit a letter explaining in detail why the report was late. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Legislative Update On September 21st, the Governor signed AB 915 (Frommer), a State bill sponsored by the City and County of San Francisco and the Department of Public Health. AB 915 establishes the Medi-Cal Outpatient Certified Public Expenditure Program to allow local health jurisdictions and the University of California to use local General Fund dollars to obtain federal financial participation for the unreimbursed costs of providing hospital outpatient services and adult day health services to Medi-Cal patients. In fiscal year 2002-03, the Department estimates that it will be able to receive $5 million in supplemental Medicaid reimbursement under this new program. Many thanks go to the Mayor’s Office and the California Association of Public Hospitals who were critical to securing the passage of this important bill. Yesterday, however, the Governor vetoed two important harm reduction bills authored by Senator John Vasconcellos. SB 1785 would have allowed pharmacies to sell adults up to 30 syringes without a prescription. SB 1734 would have allowed authorized needle exchange programs to distribute needed materials, such as sterile water, cotton and alcohol pads, without fear of arrest, and would have changed the requirement that local governments reissue a state of emergency declaration every 14 to 21 days, allowing the declaration to be revisited annually. Though the Governor did not prepare a veto message for SB 1785, he stated in his veto message for SB 1734 that existing law related to needle exchange programs “strikes an appropriate balance between the public health and public safety concerns.” This is an unfortunate setback for harm reduction and public health policy in California. The City strongly supported both of these bills and the Department will continue to work on these important issues with our community partners in the upcoming Legislative session. Smallpox Tabletop Exercise An interdepartmental Smallpox Tabletop Exercise took place September 9th. The purpose was to: (1) identify and prioritize critical areas and major deficits for smallpox preparedness in San Francisco, (2) identify issues that need to be addressed for a smallpox response, and (3) meet the partners who would be involved in the event of a smallpox release, discuss their roles, and learn from their perspectives. Participants included DPH, the Mayor's Office of Emergency Services, Fire, the San Francisco Medical Society, Kaiser Permanente, UCSF, the California Department of Health Services, federal Department of Health and Human Services, the FBI, and the federal Centers for Disease Control and Prevention. The outcome from this tabletop will be a Smallpox Action Plan for San Francisco. Russian-Speaking Newcomers Celebration and Community Assessment Newcomers Health Program hosted a Russian-speaking newcomers community celebration entitled “Let’s Be Healthy” on September 20th. During the event findings were shared from the Newcomers Health Program recently completed community assessment report of the Russian-speaking newcomer population in San Francisco. Participants also had an opportunity to learn about services and resources available to the Russian-speaking population. Roma Guy, Health Commissioner, and representatives from the California Refugee Health Section and Refugee Medical Clinic participated in the program and highlighted the contributions of the community and the benefits of the assessment for the health and well being of the community. Over one hundred people attended the successful event. North of Market Senior Services Remodel North of Market Senior Services will be holding a “groundbreaking” ceremony for their remodel project on October 10th at 12:30pm. The remodel will enhance the health and social services continuum already provided by North of Market Senior Services by creating 13 units of permanent housing for homeless seniors, and consolidating the social day care center Substance Abuse Treatment Services and the Senior Sobriety Center on the ground floor of 315 Turk St. The building is adjacent to the main service site at 333 Turk St., which now houses the primary care clinic, a congregate dining room, case management, public health nursing case managers and, until the completion of the remodel, substance abuse treatment services. Weighty Matters Conference On September 17th, the Department’s Public Health Nutrition Services and Child Health and Disability Prevention programs hosted a one-day conference to expand the skills and perspectives of service providers related to the management and prevention of childhood obesity. This successful event, entitled “Weighty Matters: A Conference Featuring Practical Weight Management Approaches for Children,” was attended by 244 health care providers from agencies throughout the Bay Area. Mammogram Screening in Bayview Hunter’s Point On September 9th and 10th, Southeast Health Center participated in a Breast Cancer Screening event at the Bayview Hunters Point YMCA. The event was sponsored by Big BAM, a New York foundation focused on providing free mammograms to low-income women. In San Francisco, Big BAM partnered with Giants Baseball for the event. Approximately 50 women were screened. An additional 60 women were scheduled for a second screening event to be held at Southeast Health Center on October 30th. Many thanks to Cheree Benton for coordinating this very successful community wellness activity. CHN Staff Selected as Fellows Dr. Katz announced that Mivic Hirose and Christine Wachsmuth, CHN Associate Hospital Administrators, were selected as Fellows in the California HealthCare Leadership Program, sponsored by the Centers for Health Professions at UCSF. Mivic and Chris join 25 top healthcare leaders in receiving this prestigious recognition and opportunity to study in this 2-year program. SFGH 2002 CALS/JCAHO Survey - Revisited In the 2002 CALS/JCAHO Survey, SFGH received 12 Type I Recommendations and a grid score of 84. After careful consideration, the SFGH Executive Committee agreed to appeal eight of the 12 Type I Recommendations. Last week, SFGH was notified that JCAHO had accepted seven of the eight appeals. In addition, the grid score increased from 84 to 87. Of the seven successful appeals, three of the initial Type I Recommendations were deleted altogether. In addition, four of the Type I Recommendations were reduced to Supplemental Recommendations, leaving only five Type I Recommendations that now require a six-month written progress report. Congratulations to everyone who worked on these successful appeals. Commissioners’ Comments Commissioner Monfredini asked how much time people have to get vaccinated after a smallpox infection. Dr. Katz said that most people over 36 or 37 years of age born in the U.S. have been vaccinated and will at least get partial immunity. Using as an example a case identified in Nevada, if DPH succeeded in vaccinating everyone in 4-5 days, there would be no danger of a smallpox outbreak. One confirmed case of smallpox would trigger this plan. Commissioner Chow asked if it is going to be the recommendation that people who have already had the vaccination be revaccinated. Dr. Katz said yes. Commissioner Chow asked what protocol San Francisco would be following in terms of people such as health care workers getting vaccinated ahead of time. Dr. Katz said this is still being developed at the Federal level and is a very complex issue. Commissioner Parker asked if DPH has been able to evaluate the level of healthiness of the people participating in the Newcomer Program as compared to the population that has been in the United States for a long time. Dr. Katz said that each wave of newcomers has brought its own issues. With regard to the Russian community he has heard the issues being inadequate prior medical care and mental health issues. He will ask to program if it has collected data. Commissioner Umekubo asked if DPH is looking at all the hospitals to participate in the Smallpox Action Plan. Dr. Katz replied that the plan is not yet finished but the plan would ask both private and public hospitals to participate. Every facility would be required. 5) PRESENTATION OF THE TOBACCO CONTROL UPDATE Alyonik Hrushow, Director of the Tobacco Free Project (TFP), gave a power point presentation (Attachment A) about the Tobacco Free Project. The presentation gave background on the tobacco epidemic and its impact on California and San Francisco. Ms. Hrushow summarized the 2001-2004 TFP Plan that includes policy advocacy, enforcement of tobacco control laws, media, community capacity building projects and cessation programs. Ms. Hrushow described the evaluation outcomes for each of the interventions. Ms. Hrushow also discussed some of the global advocacy efforts to counter transnational tobacco and said that the rationale for such efforts is that, because Philip Morris is housed in the United States, DPH has a moral duty. Moreover, 25 percent of Californians are foreign born and have high smoking rates. The kind of marketing that is going on in other countries is no longer permitted in the United States. In closing, Ms. Hrushow said that as Prop. 99 funds are decreasing and tobacco industry expenditures are increasing the program would at some point come before the Health Commission. Dr. Katz commended Ms. Hrushow for her multi-pronged approach, and for her success in the face of very large tobacco companies that do not have the public’s health in mind. Public Comment Gordon Mar, Chinese Progressive Association, expressed strong support for the good work of the Tobacco Free Project and is impressed by comprehensive approach to tobacco control. The community capacity building projects have been key to the success. All diverse communities are represented. He reiterated the importance of looking at the issue from a global perspective because San Francisco has so many immigrants. Carol McGruder, San Francisco African American Tobacco Free Project, said that the Tobacco Free Project is very inclusive. Tobacco control is not a luxury. African American elders have been impacted by smoking. As we look at shrinking dollars, remember that tobacco prevention is a necessity. The tobacco industry is targeting Africa, Asia and Latin America and DPH needs to focus on these communities. Michelle Rivero, American Lung Association, is the newly elected co-chair of the Tobacco Free Coalition. Projects that are funded by the Tobacco Free Project have a big impact on the community. She helps people in multi-family housing units organize and advocate for smoke-free policies, which gives them a lot of empowerment. She asked the Commission for its continued support for the Tobacco Free Project. Commissioner Chow asked if people are generally cooperative. She said yes, generally. This might be due to the laws that have passed and people getting used to behavioral changes. Evelyn Castillo, American Lung Association, Director of Tobacco Control and member of the Tobacco Free Coalition. She applauds the success and strategic efforts of the Tobacco Free Project. The group is very community driven. The community capacity building model is the most effective and culturally appropriate model. International efforts are critical. She urged the Commission to consider using Proposition A funds for global tobacco control efforts. Commissioners’ Comments Commissioner Parker said that society has to make an economic commitment to address the tobacco industry’s marketing strategies. The tobacco industry will circumvent prevention strategies so DPH has to continually change its approach. In terms of citations for selling tobacco to minors, he asked if there is data on what percentage of those citations are in “mom and pop” stores, in chain stores, etc. Ms. Hrushow said they do not have that data for San Francisco. There have been proposals to give cities more teeth. Commissioner Umekubo asked if the trend for decreased prevalence of youth smoking is a national trend. Ms. Hrushow said that it is decreasing for youth overall. The prevalence in the 18-24 age group has increased. Commissioner Sanchez supports the focus on the diverse communities. He asked if the increase in spending was specific to tobacco products or related to their subsidiary operations. Ms. Hrushow said it is specifically related to tobacco products. Commissioner Guy stated that the comprehensive approach to this effort, as well as the “think locally act globally” perspective, is supported and appreciated by the Health Commission. With regard to the budget, the success of the Tobacco Free Project and other groups has led to reduced funding so it would be helpful in the next round to identify specific needs. Commissioner Chow said that the global approach is important and it is quite clear that the program has a limited Asian focus (understanding that CPA gets a direct grant from the State). Are there other programs in San Francisco that are not part of this report that target the Asian community, and should these be included in some way in the report? Smoking is a large problem in the Asian community, there are many immigrants, and there should continue to be a focus. 6) RESOLUTION APPROVING THE PROPOSAL FOR SMOKELESS TOBACCO SETTLEMENT FUNDS Alyonik Hrushow, Tobacco Free Project, presented a resolution approving the proposal for smokeless tobacco settlement funds. San Francisco has received a settlement of $313,465. Action Taken: The Commission approved Resolution #11-02 (Attachment B), “Approving the Proposal for the Use of Smokeless Tobacco Settlement Funds.” 7) PRESENTATION OF THE STATE BUDGET UPDATE Colleen Johnson, Assistant Director, Office of Policy and Planning, presented an update on the State budget. Legislative Highlights AB 915 (Frommer) - On September 21st, Governor Gray Davis signed AB 915. Sponsored by the City and County of San Francisco and DPH, this bill establishes a Medi-Cal Outpatient Certified Public Expenditure Program, which will allow DPH to use local General Fund dollars to obtain federal financial participation for the unreimbursed costs of providing hospital outpatient services and adult day health services to Medi-Cal patients. This will result in an estimated $5 million for DPH. AB 2197 (Koretz) - Provides Medi-Cal benefits to low-income, non-disabled Californians with HIV. An estimated 1,700 people living with HIV will benefit in the first year. The expansion is funded with savings derived from moving Medi-Cal beneficiaries with AIDS into managed care. 2002-2003 State Budget Overview The governor signed a $98.9 billion State budget on September 5th. Addressed a $23.6 billion gap $79.2 billion General Fund revenues and transfers, which is a 7.1% increase over 2001-2002 $76.7 billion General Fund expenditures The Governor vetoed $235 million from the Legislature’s budgeted, 75% of which was from Health and Human Service programs. However, the cuts were less severe than anticipated and the budget still retains many of the programs the governor had previously proposed for significant reductions. Health-Related Provisions DSH - increased the State administrative fee by $55.2 million. This is estimated to reduce SFGH revenues by $2 million Provider Rates - cut in half provider rates that were increased two years age. Anticipated to have a minimal effect on the Department. The legislature rejected the proposal to reinstitute quarterly State reporting. Does not implement express lane eligibility, which would simplify enrollment in Medi-Cal Healthy Families - indefinitely postpones parent expansion and does not extend the Medi-Cal to Healthy Families bridge one additional month. Children’s System of Care was reduced by $13.8 million, which is estimated to reduce the Department’s allocation by $420,000. AB 2034 is reduced by $10 million, which is estimated to reduce the Department’s allocation by $184,000. AB 3632 (Services to Special Education Pupils) - the budget imposed a moratorium on reimbursements. This will affect the Department’s cash flow but not reimbursement, as legislation was passed to clarify that counties are entitled to 100% reimbursement. EPSDT - Implemented 10% county share of cost on growth. Estimated to cost DPH an additional $80,000. CSAS Community Treatment Programs were reduced by $7.5 million. The effect on DPH is unknown. Drug Court Partnership Program - appropriates $4.9 million to a modified program. The Department receives $300,000 for the current drug court program. The future allocation is unknown at this time. Perinatal Services - Transfers $1.5 million in federal block grant funds to continue this program. Ensures continued funding for the Department to continue this program. Trauma Services - Provides $20 million for trauma services. Anticipated to result in a grant to the Department of $750,000. Supportive Housing - eliminates all funding for this program. This does not impact DPH’s supportive housing initiatives. HIV/AIDS Programs - maintained funding for all HIV/AIDS programs and increased ADAP (AIDS Drug Assistance Program) by $20.4 million to fully fund the program. CHDP - Provides $8.8 million for the CHDP Gateway Program. No direct impact on DPH. Looking Forward Ms. Johnson said that is it likely that there will be additional budget cuts in FY 2002-2003. The State budget relies on $1.1 billion in increased federal funding, $300 million of which is anticipated Medicaid revenues. Congress may not act to appropriate these funds before it adjourns in October. The FY 2003-2004 budget deficit is expected to exceed $10 billion. The current budget relies on one-time revenue boosts, revenues accelerations and expenditure deferrals, borrowing from future years’ revenues, and accounting shifts and transfers. It did not make deep budget cuts. So next year’s $10 billion deficit will be felt more significantly. The State Legislature will likely take a new look at realignment funding in 2003 and, given the State’s anticipated financial picture, these discussions will be extremely difficult. DPH receives approximately $145 million-15% of the total budget-in realignment. Dr. Katz said that the Department is getting better at working with the State, and AB 915 is a big success that would not have happened a few years ago. The Medi-Cal issue will be large-there may be significant reductions. Commissioners’ Comments Commissioner Chow, speaking about AB 2197, asked if bringing these people under managed care would disrupt their care. Dr. Katz said that if it approved by CMS it would only affect people who do not have insurance. Further, it relies on people voluntarily moving from fee-for-service to managed care. Commissioner Parker asked if the safety net is getting stronger or weaker? It seems that DPH is slowly losing ground. Dr. Katz said that, when looking at shear dollars, the Department’s budget still had been increasing even taking into account inflation. This is the first fiscal year that DPH’s budget did not keep up with inflation. The biggest hole is facilities. Public Comment - Patrick Monette Shaw - AB 2197 will not just have an effect on the uninsured. He said it is inappropriate to be asking people who have cognitive deficits to volunteer for this program, since they cannot comprehend what it is they are deciding. And there are other diseases that lead to death and it is not right to extend Medi-Cal to a portion of the community and not others. 8) PUBLIC COMMENTS Rueben David Goodman asked for an investigation of SFGH’s Emergency Psychiatric Services. The SFPD takes people to EPS to harass people and to avoid investigating assaults against mentally ill people. He has been subject of a hate crime but the police did not investigate but instead took him to EPS. Plus they served him pork, which he does not eat, at EPS. He asked the Commission to stop serving pork. Patrick Monette-Shaw - Before conducting Dr. Katz’s performance evaluation in closed session and awarding him a bonus, it would be a travesty of justice if Katz is again so rewarded while human suffering caused by AIDS healthcare service cuts occurred. Katz’s staff is possibly directly responsible for loss of $2.2 million in CARE Act funds last February; San Francisco is set to lose additional CARE funds next year. Katz’s AIDS managers possible errors include failing to ensure SF remained in compliance with federal conditions of award, violating Sunshine requirements, untimely contracts execution, over-allocating Administrative Expenses, and unspent CARE funds, among others. Katz is directly responsible for his management team. As you surely know, CARE ACT services have been eliminated this FY, ten service subcategories may vanish next FY, and untimely deaths may occur. No more bonuses as usual! 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 voted to hold a closed session. The Commission went into closed session at 5:10 p.m. Present in the closed session were the Health Commissioners, Dr. Mitch Katz, Sai-Ling Chan-Sew, Deputy City Attorney Frederick Sheinfield and Michele Olson. C) Closed session pursuant to Government Code Section 54956.9 and San Francisco Administrative Code Section 67.10(d) Approval of settlement in the amount of $1,900 in the Mariano v. San Francisco Unified School District and Department of Public Health, Community Mental Health Services, Special Education Hearing Office, Case Nos. SN 02-00356 and 02-00632, City Attorney File No. 021183 Action Taken: The Commission voted to approve the settlement in the amount of $1,900 in Mariano v. San Francisco Unified School District and Department of Public Health, Community Mental Health. D) Reconvene in Open Session The Commission reconvened in open session at 5:15 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).) 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 voted not to disclose any discussions held in closed session. 10) CLOSED SESSION A) Public comments on all matters pertaining to the closed session None. B) Vote on whether to hold a closed session Action Taken: The Commission voted to hold a closed session. The Commission went into closed session at 5:20 p.m. Present in the closed session were the Health Commissioners. C) Closed session pursuant to Government Code Section 54957 and San Francisco Administrative Code Section 67.10(b) PUBLIC EMPLOYEES PERFORMANCE EVALUATION: DIRECTOR OF HEALTH, DR. MITCH KATZ EXECUTIVE SECRETARY TO THE HEALTH COMMISSION, MICHELE M. OLSON D) Reconvene in Open Session The Commission reconvened in open session at 7:25 p.m. 1. 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 voted not to disclose any discussions held in closed session. 11) ADJOURNMENT The meeting was adjourned at 7:26 p.m. Michele M. Olson, Executive Secretary to the Health Commission