Minutes of the Health Commission Meeting Tuesday, October 15, 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 3:10 p.m. Present: Commissioner Edward A. Chow, M.D., President (left at 5:50 p.m.) Commissioner Roma P. Guy, M.S.W., Vice President Commissioner Lee Ann Monfredini (left at 5:45 p.m.) Commissioner Harrison Parker, Sr., D.D.S. Commissioner Michael Penn, Ph.D. (arrived at 3:55 p.m.) Commissioner David J. Sanchez, Ph.D. Commissioner John I. Umekubo, M.D. Commissioner Chow announced that Mayor Brown appointed a new Health Commissioner, Michael Lawrence Penn. 2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF OCTOBER 1, 2002 Action Taken: The Commission approved the minutes of the October 1, 2002 Health Commission meeting with one amendment. Commissioner Chow noted that two letters from Patrick Monette-Shaw, dated September 28, 2002, would be added as attachments to the October 1, 2002 minutes and included in the file. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Monfredini chaired, and Commissioner Umekubo attended the Budget Committee meeting. (3.1) CHN-Office of Managed Care - Request for approval of a retroactive sole source contract renewal with the Regents of the University of California, San Francisco, in the amount of $1,700,000 to provide tertiary care services targeting medically indigent adults, In-Home supportive services workers and San Francisco County jail patients, for the period of July 1, 2002 through June 30, 2003. Commissioners’ Comments Commissioner Monfredini clarified that this contract is not a managed care contract. It is for those patients requiring services that cannot be provided at SFGH, so DPH contracts with UCSF to provide these services.      Commissioner Sanchez abstained from voting on this item. (3.2) AIDS Office-HIV Health Services - Request for approval of a retroactive contract renewal with Shanti Project, in the amount of $405,829, to provide practical support services, for the period of July 1, 2002 through June 30, 2003. Commissioners’ Comments For all future contracts that are retroactive, Commissioner Monfredini asked that a note be included in background documentation that explains why the contracts are retroactive. Galen Leung and Gregg Sass agreed. (3.3) CBHS-Mental Health - Request for approval of a retroactive contract renewal with Westside Community Mental Health Center, Inc., in the amount of $1,872,816, to renew a Single Point of Responsibility (SPR) Program for severely mentally ill adults, for the period of July 1, 2002 through June 30, 2003. (3.4) CBHS-Mental Health - Request for approval of a retroactive contract renewal with the Regents of the University of California, on behalf of the UCSF Clinical Practice Group, in the amount of $2,882,527, to renew a Single Point of Responsibility (SPR) Program serving severely mentally ill adults, for the period of July 1, 2002 through June 30, 2003. Commissioner Sanchez abstained from voting on this item. (3.5) CBHS-Substance Abuse - Request for approval of a retroactive contract renewal with Center for Human Development, in the amount of $136,844 per year, for a total contract amount of $547,376, to provide substance abuse prevention and education services to youth in San Francisco schools, for the period of July 1, 2002 through June 30, 2006. (3.6) CBHS-Substance Abuse - Request for approval of a retroactive contract renewal with Mount Saint Joseph-Saint Elizabeth Epiphany Center for Families in Recovery, in the amount of $336,751, to provide prevention services, adult intensive outpatient services and start-up costs for a new pregnant/parenting program, for the period of July 1, 2002 through June 30, 2003. Barbara Garcia gave a status report of the transition of the WACSF program. WACSF officially closed on September 30th. They had approximately six programs, all of which will have been transferred successfully when the Health Commission approves one final contract on November 5th. Aviva House was transferred to the Latino Commission, De Paul and Mia House will be transferred to Lutheran Social Services, Pomeroy will be transferred to Jelani and Lee Woodward will be the last transfer. The property ownership should be transferred to DPH ownership within the next six months. Commissioners’ Comments Commissioner Monfredini asked if we lost any clients during the process. Ms. Garcia said they stopped accepting new clients into the program in February so that they could manage the existing clients. They do not anticipate any disruption in service. (3.7) CBHS-Substance Abuse - Request for approval of a retroactive contract renewal with SAGE Project, Inc., in the amount of $537,692 per year, for a total contract value of $2,150,768, to provide substance abuse and mental health services, for the period of July 1, 2002 through June 30, 2006. (3.8) PHP-Bureau of Environmental Health Management - Request for approval of a new contract with Onyx Environmental Services, LLC, in the amount of $100,000 per year, for a total contract value of $200,000, to provide hazardous waste management and transportation services, for the period of October 1, 2002 through June 30, 2004. (3.9) PHP-Bureau of Environmental Health Management - Request for approval of a contract modification with San Francisco Foundation Community Initiative Funds, in the amount of $50,000, to provide fiscal agent services for a research project on food management strategies and community-based action planning, for a total revised contract amount of $100,000, for the term of July 1, 2002 through June 30, 2003. Commissioners’ Comments Commissioner Monfredini commented that many people might not understand the meaning of “food security” and suggested that they use the phrase “access to safe and nutritious foods.” In the post 9/11 world “food security” has a much more limited connotation. She asked how the Food Systems Council is spreading the word about this effort to the community. Paula Jones of the Food Systems Council said that they are working with members of the Westpoint community.      Commissioner Sanchez abstained from voting on this item. (3.10) PHP-Housing and Urban Health - Request for retroactive approval of contract renewals for the following 16, FY 2002-04 Housing and Urban Health contracts, for a combined total of $7,272,226: Contractor Description Contract Term Total Funding Ark of Refuge, Inc. Transitional housing for LGBTQQ Youth 7/1/02-6/30/03 636,208 Baker Places, Inc. Support services in 10 SROs 7/1/02-6/30/03 621,594 Baker Places, Inc. Direct Access to Housing 7/1/02-6/30/03 543,083 Baker Places, Inc. Emergency Housing - Hotels 7/1/02-6/30/03 915,747 Chinatown Community Development Corporation Outreach, training, and advocacy services to SRO hotels 7/1/02-6/30/03 250,000 Episcopal Community Services Support services in a SRO 7/1/02-6/30/03 101,626 Episcopal Community Services Support services 7/1/02-6/30/04 446,000 Episcopal Community Services Support services and property management in a master-leased SRO 7/1/02-6/30/03 956,781 Episcopal Community Services Support services in a SRO 7/1/02-6/30/03 121,669 John Stewart Company Property Management services in a master-leased hotel 7/1/02-6/30/03 585,170 Mission Housing Development Corp. Outreach, training, and advocacy services to SRO hotels 7/1/02-6/30/03 250,000 Page Street Guest House Licensed Residential Care 7/1/02-6/30/03 832,424 San Francisco AIDS Foundation Rent subsidies for persons with HIV/AIDS 7/1/02-6/30/04 605,150 Self Help for the Elderly Residential Care for elders with dementia 7/1/02-6/30/03 117,278 Tenderloin AIDS Resource Center Case management in Emergency Housing 7/1/02-6/30/03 89,496 Tenderloin Housing Clinic Outreach, training, and advocacy services to SRO hotels 7/1/02-6/30/03 200,000 Total: $7,272,226 Commissioners’ Comments Commissioner Monfredini requested on behalf of the Commission that future reports with multiple contracts include the performance monitoring reports for each contractor. She asked how many individuals sleep on the streets and if the Department tracks people who enter and exit our shelters. Mr. Trotz replied that on any given night, an estimated 5,000 to 6,000 individuals are on the street. He added that most of these units are permanent housing so there is not a lot of turnover. The Mayor’s Office has implemented a pilot program to better track people through the system. Action Taken: The Commission approved the Budget Committee Consent Calendar, with Commissioner Sanchez abstaining from voting on Items 3.1, 3.4 and 3.9. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Dr. Katz Annual Month of Medicine Attending at Laguna Honda Hospital Last week Dr. Katz began his annual month of attending on the medical service at Laguna Honda Hospital. He covered wards for physicians who were sick or on vacation. Dr. Katz evaluated ill patients, written orders for flu vaccinations for an entire ward (true public health!) and attended an Interdisciplinary team (IDT) meeting that included medicine, nursing, social work, nutrition, and activity therapy staff. As the Commission is aware, there has never been any question about the quality of medical or nursing care. Where LHH needed to make significant improvement is on the quality of life for residents. Dr. Katz reported that there has been a major increase in the number of recreational activities for LHH, coupled with much more detailed planning for discharge and rehabilitation. The IDT’s are functioning well with residents and staff actively participating. These meetings, Dr. Katz believes, are the cornerstone of LHH’s ability to deliver high quality care and increased quality of life for all its residents. Dr. Katz was honored to serve with such a committed and professional staff. Buprenorphine Approved as a Schedule II Drug for Office-Based Opiate Dependence Dr. Katz reported that Buprenorphine has been approved as a schedule II drug for office-based treatment of opiate dependence. This drug, while not as strong as methadone, will allow LHH to treat new opiate users (who have not yet built up a high tolerance for opiates), and persons who have been stable for a prolonged period of time on a relatively low dose of methadone. Effective immediately, DPH or UCSF physicians working at SFGH who have completed the training module can provide Buprenorphine to appropriate clients. Several of LHH physicians in both the primary care clinics and at SFGH have completed the training. There is a question regarding the number of patients who can be treated by any one delivery system that we are currently researching. Regardless, LHH cabinet staff agreed this morning that LHH will be using Buprenorphine to treat opiate dependence in appropriate patients no later than December 1, 2002 and will work with the community consortium clinics and the medical society to offer such treatment in non-DPH settings throughout San Francisco as well. Community Mental Health Advanced Access Pilot In the previous fiscal year, over 18,000 individuals received outpatient care from Community Mental Health Services (CMHS). In order to improve access to outpatient care for adults and older adults, CMHS is beginning an initial pilot of the advanced access model for managing demand for services and the resources to meet that demand. Training of clinic leadership will take place in October, followed by the testing of new strategies by clinics to streamline the process for accessing services. Grant for Behavioral Health Treatment at Direct Access to housing Sites Through the work of Dr. Josh Bamberger of Housing and Urban Health, the Department has received an award of $1.8 million from the federal Substance Abuse and Mental Health Services Administration. The grant is part of a program that awarded $14 million nationally to strengthen substance abuse treatment, mental health, services, and primary care for homeless individuals. Housing and Urban Health will use the award of $600,000 per year for three years to integrate behavioral health treatment into the services available at the six Direct Access to Housing sites. The funds will be used for behavioral health counseling, off-site substance abuse and mental health treatment, and methadone maintenance. Tom Waddell Renovation Tom Waddell Health Center has begun a renovation project. The goals of this project are to increase patient flow and confidentiality (timely with HIPAA), create a new dental clinic and increase health and safety for staff and patients. During the initial phase, in which the Urgent Care Clinic is impacted, Tom Waddell is offering additional clinics at the McMillan Drop-in Center. Older Adults and Traffic Safety Michael Radetsky, from the Community Health Education Section, served as a member of the California Task Force on Older Adults and Traffic Safety, which recently issued a final report with recommendations. The report, a product of an 18-month planning effort, is the first step in a coordinated statewide effort to improve traffic improve for older Californians and can be found on-line at: www.eldersafety.org/oats/finalrpt.pdf. Community Health Network San Francisco General Hospital October 2002 Health Commission - Director of Health Report (From 10/07/02 MEC and 10/08/02 JCC) 10/02 9/02 to present New Appointments 16 103 Reinstatements 0 1 Reappointments 35 69 Delinquencies: 0 0 Reappointment Denials: 0 0 Resigned/Retired: 22 49 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Changes in Privileges Additions 1 7 Voluntary Relinquishments 6 7 Proctorship Completed 10 42 Current Statistics - as of 10/01/02 Active Staff 401 Affiliate Professionals (non-physicians) 151 Courtesy Staff 492 Referring Staff 44 TOTAL MEMBERS 1088 Application In Process 45 Applications Withdrawn Month of Ocober 2002 2 2 (09/02 to present) SFGH Reappointments in Process Nov. 2002 to Feb. 2003 159 Commissioners’ Comments Commissioner Chow asked if there are limits on the number of methadone patients per physician. Dr. Katz said that no physicians can prescribe methadone through the physician’s office, only through a state licensed program. The Department is attempting through OBOAT to use methadone in an office-based setting. Ultimately there may be two tracks with people more mildly dependent being treated with Buprenorphine and those who are more severely dependent being treated with methadone. Commissioner Umekubo asked if there were any advantages to Buprenorphine over methadone. Dr. Katz replied that it may have less of a chance of being abused, but other than that no. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF OCTOBER Commissioner Lee Ann Monfredini presented the Employee Recognition Awards for the month of October. Employee’s Name Division Nominated by Roban San Miguel Community Substance Margery Brooks, Abuse Services Michael Seely Central Administration Christia Mea and Stephanie Samatra Eileen Shields Central Administration Anne Kronenberg, Mildred Crear, Jack Breslin, and Barbara Garcia 6) CONSIDERATION OF A RESOLUTION APPROVING A GARBAGE COLLECTION TRUCK LICENSING FEE Jack Breslin, Assistant Director, Bureau of Environmental Health Management, gave some background to the proposed ordinance. In 1987 the Board of Supervisors passed an ordinance that charged DPH with enforcing a Mandatory Refuse Collection Ordinance. A fee was attached to licensing the garbage trucks that covered the cost of the program. In 1996 it was found necessary to increase these fees. While legislation was prepared and forwarded to the Board of Supervisors and the Health Commission, it was never presented or approved by either entity. The scavenger companies began paying these fees at that time and the Tax Collector has been collecting the money. As a result of a public inquiry staff discovered that the new fee structure had never been approved. The legislation before the Commission is to retroactively present the legislation as it was originally intended to be presented six years ago so that the City can legitimately charge and collect the fees. Action Taken: The Commission approved Resolution #12-02, “Approving an Ordinance Increasing the License Fee for Garbage Trucks and the Amount Deposited into the Mandatory Refuse Collection Service Fund by Amending Section 249.6 of the San Francisco Business Tax Regulations Code and Section10.100-7 of the San Francisco Administrative Code and Ratifying Past Actions Taken in Connection with Such Licensing Fee” (Attachment A). 7) PRESENTATION OF THE SAN FRANCISCO GENERAL HOSPITAL REBUILD/INSTITUTIONAL MASTER PLAN (IMP) STATUS REPORT Anthony G. Wagner, Chief Executive Officer of Hospital Systems, gave an update on the rebuild planning effort. The Long Range Service Delivery Plan (LRSDP) that was approved by the Health Commission on July 16th will be used to provide the programmatic guidance for the SFGH Institutional Master Plan (IMP). Staff will be coming to the Commission for guidance at various key decision points throughout the process. The Combined Advisory Committee will be an integral part of the planning process. There is also the SFGHMC Rebuild Steering Committee and the IMP Work Group. A number of work groups were established to follow up on unresolved issues raised in the LRSDP, including OB/Peds, Ambulatory Care, Finance and Community Outreach. The SFGHMC executive medical and administrative staffs have been and will continue to be involved in the planning process. Mr. Wagner gave an update on co-location with UCSF. DPH has continued to meet with UCSF under the leadership of Dr. Katz. There are many compelling reasons to continue to explore co-location but there are significant challenges. It is impossible to resolve these challenges prior to going to the ballot in November 2003. There are two general options available. The first is to plan for a November 2003 bond election without co-location. The second option is to seek a waiver for an extension of the 2013 deadline, which allows for further evaluation and planning with UCSF. The two options are not mutually exclusive. The Department is pursing Option 1 while concurrently meeting with UCSF and advocating for an extension. Work Groups Finance - looking at construction-related and operations-related financing issues. Inpatient Pediatrics and Obstetrics - will develop further recommendations for SFDPH consolidating its inpatient pediatric, NICU, newborn nursery and obstetric services with another provider. Community Outreach - to share planning objectives with established neighborhood and community groups and seek input and criticism. Ambulatory Care Services - this group will make recommendations concerning the organization of ambulatory care services in the long term and with respect to the SFGH rebuild. The LRSDP made two recommendations related to ambulatory care: shifting primary care visits from SFGH to DPH community-based clinics and a projected increase in total primary care visits; and the development of a “Super Clinic.” In addition to these issues, a number of other matters will be considered, including access issues, improving quality of care, achieving more cost-effective care and potential partnerships with other safety net ambulatory care providers. Institutional Master Plan Update Ignatius Tsang, Project Director of the SOM/Tsang joint venture IMP team, updated the Commission on the IMP process. The team consists of planners, architects, engineers, cost estimators, real estate, economists and community relations consultants. The development of the new IMP is a unique opportunity for DPH to explore models of health care delivery system to meet the needs of San Francisco in the 21st Century, to enhance partnership with UC, to improve care, improve seismic safety and improve access to community care. The IMP will unfold over the next 14 months in four steps in sequence: Development of a baseline estimate of program requirements for SFGH Identification of various scenarios that accommodate the programmatic requirements, while also considering site specific aspects Consideration of concept proposals that give physical form and size to leading scenarios, and which have estimates for cost, feasibility and other real-world constraints Preparation of a final IMP document that will characterize the full range of changes recommended for SFGH, to be submitted for public review and approval. A subset of the work includes helping DPH to prepare a bond proposal for the November 2003 election. SFGH must meet new State-mandated seismic safety requirements for its acute care facility by 2013. In order to meet that deadline, planning and design for a new complying facility must begin by January 2004. So, financing must be in passed by the voters in November 2003. The final IMP document will describe the entire health care delivery system, not all of which will be on the ballot. If a bond measure passes in November 2003, a design team would be hired. It would take about four years to design the project, two years for OSHPD approval, and construction would take approximately five years. The new hospital would open in January 2013. Currently the group is developing programmatic baselines. Scenarios will be developed for Health Commission review on December 3, 2002. Concepts will be presented to the Commission on February 18th. The Commission will be asked to select a concept as a bond measure proposal on March 18, 2003. The Finance Committee will recommend the amount of the bond measure. The bond measure then goes to the CAIC and Board of Supervisors for approval. If the Board of Supervisors approves it, the voters will vote on the bond in November 3, 2003. If the bond measure is passed, the final IMP will be completed on December 31, 2003. The overall objective of the IMP is to guide an informed decision-making process for the IMP that results in the selection of the best alternative for rebuilding SFGH. The near-term objective for the October 15 Health Commission meeting is to develop baseline projections of demand in all areas that will impact institutional master planning so they may be used to create a variety of program-based scenarios. The general approach is to: leverage existing data/information, especially Lewin’s LRSD program recommendations, wherever possible Ensure findings focus on level of detail for IMP Enable the teasing apart and re-aggregation of services in scenario development. Mr. Tsang described what a baseline is. It involves refinement and augmentation of the Lewin projections as needed to support the IMP process. It is premised on simple continuation of current programs and services on the Potrero campus, albeit in facilities that are seismically compliant. It accounts for population/demographic forecasts and anticipated changes in market demand for SFGHMC’s health care services through 2015. The baseline is not a scenario, but is the basis for the many scenarios that will be evaluated. It does not attempt to address current known deficiencies, which will be addressed in scenarios. And it does not consider co-location, as other scenarios may. The baseline serves as the bridge between the Lewin LRSD program projections and the SFGHMC IMP process. Charlie Cosovich with Kurt Salmon Associate (KSA), the strategic planner, reviewed the baseline in more detail and its significance by category. KSA started by developing basic demand projections and understanding the demography around these projections. They are working with population and demography figures that were developed in the Lewin LRSD process. From there need to define DPH’s and SFGH’s current and future role in San Francisco, as well as its future goals. The next step will be working on how various assumptions about service demand and goals translate into space and from there into plans for an IMP, particularly in the areas of Acute Care, Ambulatory Care and Diagnostic and Treatment Services. In the scenario development process, which will begin in the next week, a variety of qualitative and subjective information will be evaluated, including future budgeting, political environments, access requirements, transportation pattern, clinical models and others. Mr. Cosovich then gave detailed descriptions about the baseline development for Acute Care, Ambulatory Care and Diagnostic and Treatment services. For each category they need to work through six overarching questions: where do the numbers come from; what are the numbers; how are the numbers best split apart for scenario development; what are the sensitivities; how do the numbers translate to space figures; and what are the space figures. Next Steps Develop research demand projections Develop education demand projections Develop support and administration requirements Develop scenarios Translate all service units into facilities programs Develop concepts/proposals Mr. Wagner clarified that there will be an additional Health Commission meeting in March, so meetings will be on March 4th and March 18th. In addition, two additional work groups will be established: Operating Room and Diagnostic and Treatment. Public Comments Christopher Sabre, member of the East Mission Improvement Association and neighbor of the hospital, expressed a number of concerns. First, that there is no one plan, instead a number of scenarios and a short time period to consider. Second, he is concerned about a helipad at SFGH being placed in a residential neighborhood at the expense of safety and quality of life and concerned about 108 feet towers going into open space areas. The neighborhood was not included enough in Laguna Honda Hospital and he is concerned that this will happen at SFGH. Commissioners’ Comments Commissioner Chow asked where they are at with the assumptions about the size of the hospital, and if the group is finding that the facility will be larger or smaller or similar size to the Lewin recommendation. Mr. Tsang said they are still working to validate this. Mr. Wagner added that they do not have any specific information at this time, and that this will come out of this planning process. The December 3rd meeting will have a lot more information from the workgroups. Commissioner Chow said he is the Commission’s representative on the steering committee and the team is working very diligently and intensely. There are multiple layers of planning-hospital, campus, health delivery system. If the bond does not go on the November 2003 ballot, this will not have been a futile effort. The helipad issue needs to be responded to on a short-term basis. This issue would need to be addressed even if the hospital did not need to be rebuilt. Commissioner Monfredini feels comfortable at this time with the update. She said that hospitals should be able to jointly plan with other hospitals how to best deliver health care to all San Francisco. Dr. Katz said to the extent that hospitals are willing to make their plans public, then these plans can be taken into account and perhaps do complementary planning. Mr. Wagner will raise this at the next meeting of the Northern California Hospital Council. Commissioner Penn asked how the clinicians and service providers at SFGH would be involved in the process and how we can ensure that the planning meets their needs. Mr. Wagner said that presentations to SFGHMC Executive Medical and Administrative staffs allow staff to react and to give guidance to the planning process. In addition, SFGH Medical and Administrative staff is part of all the workgroups. Finally, there are a number of clinicians and SFGH representatives on the Rebuild Steering Committee and Advisory Committee. Commissioner Penn asked if clinicians will be involved in the scenario development or just asked to approve the scenarios. Mr. Wagner said they would be involved both before and after the development of the scenarios. Commissioner Chow added that the Joint Conference Committees are another opportunity for clinician involvement. Commissioner Penn said that the planning effort should evaluate how other hospitals in the nation have addressed some of the issues San Francisco is facing. Commissioner Parker commented that the Department and the city at large has the opportunity to overhaul the entire system rather than putting band aids on the existing system. We need to make sure it is done right. Further, the plans need to be presented to the public in a clear and direct manner. This also allows DPH to have a fresh start with its partners, including UCSF and the Community Clinic Consortium. DPH and the Commission will have a problem if they present a bond with unfinished details. He does not think we should postpone having a bond issue on the ballot primarily because of the economy, because a delay means the project will cost more in the future. Commissioner Umekubo commented that co-location makes sense fiscally, and asked Mr. Wagner to clarify the timelines for Options 1 and 2. When will we know which option we are going to pursue? Mr. Wagner replied that it is unlikely we will know by the March Health Commission meetings, primarily because UC’s deadline is later. Having said that, DPH is pursuing the November 2003 timeline but not giving up that something might happen legislatively to extend DPH’s deadline. Dr. Katz said that if we want to co-locate, we cannot go for a bond in November 2003. There just is not enough time to do the planning and UC is still evaluating a number of scenarios. UC’s deadline is 2030. If there is no change in legislation and we have to go to the ballot in 2003 or close SFGH in 2008, then this precludes co-location. Dr. Katz, Gene O’Connell and Mr. Wagner are meeting with State Senator Jackie Speier in November to discuss potential revisions to the State legislation. There has been discussion with merging the 2013 deadline with 2030 deadline. If this were to happen, DPH and UC would be on the same timetable. It is significant that no politician has wanted to take on the issue of delaying seismic safety. Commissioner Sanchez asked for clarification that co-location with UCSF would not be one of the scenarios. Dr. Katz replied that this is true for a November 2003 bond measure. Commissioner Sanchez said that DPH needs to understand the reality of the UC Regents’ process. He emphasized the need for clinician input. And we need to understand that the term “research” opens up battles between academic research and clinical research. As a public hospital our primary mission is the delivery of services. Commissioner Guy wants to make sure that in the next report there is a clear link between which assumptions led to which scenarios/recommendations. The Health Commission will make a judgment call and then ask the community for its vote/support. Commissioner Guy said that the underdeveloped area of this planning process is ambulatory care. How are we going to evaluate decentralizing care on the magnitude of 20,000 to 60,000 visits, particularly when this is not included in the bond? She also emphasized that the helipad is a separate issue. It is important but is not part of the bond proposal. The question of outreach is never-ending. We need to both bring the community into the planning process plus outreach to them. Mr. Wagner said that they plan to visit the established venues of various groups, and he emphasized that if the commissioners have any suggestions to forward them to him. Commissioner Guy appreciates the complexities around co-locating with UC. 8) PRESENTATION OF THE CENSUS 2000 REPORT Colleen Johnson, Assistant Director, Office of Policy and Planning presented highlights of Census 2000. The nation’s population grew by 32.7 million people between 1990 and 2000. The San Francisco-Oakland-San Jose metropolitan area grew 12.6 percent during that period and is the 5th largest metropolitan area in the country. San Francisco’s population has not grown as rapidly as the metropolitan area, the State or the rest of the nation. In fact the populations of both California and the U.S. grew at nearly twice the rate of San Francisco. Despite this relatively slow growth rate, San Francisco is the 62nd largest county in the country. The age of San Francisco’s residents is significantly different from that of the state and nation. San Francisco’s 21 and under population represents only 18 percent of the whole city population, compared to 32.9 percent and 31.4 percent in California and the U.S., respectively. Conversely, the percentage of San Francisco’s population that is over 80 years old is nearly double that of California and the U.S. The female population exceeds the male population at older levels. The median age range in San Francisco is 35 to 39 for both men and women. However, the proportion of women who are over age 65 is significantly higher than the proportion of men over age 65. Like all of California, the percentage of White residents in San Francisco is significantly below that of the nation. The percentage of San Francisco’s Asian/Pacific Islander population is triple that of the State and 10 times that of the nation. San Francisco has the 9th highest number of Asian residents of all U.S. counties. Between 1990 and 2000 there was a significant decrease in the percentage of Black or African American residents. Conversely, the Hispanic/Latino and Asian/Pacific Islander populations have grown significantly. Consistent with San Francisco’s racial and ethnic diversity, Census 2000 shows that one out of every three San Francisco residents is foreign born. Thirteen percent of all San Francisco households are linguistically isolated. In San Francisco more than half of the linguistically isolated households speak an Asian or Pacific Island language. In San Francisco, 36.1% of residents reported that they had a disability. Disability status in Census 2000 was self-reported and is not necessarily an indicator of a person who has been deemed disabled by a physician. San Francisco’s reported disability data is similar to that at both the State and national levels. Educational attainment and income are socio-economic characteristics of a population that can be linked to health disparities and outcomes. San Francisco residents are more likely to have completed a higher level of education than other residents of the State or U.S. At the same time, 10.5 percent of all San Franciscans have less than a 9th grade education. There are significant differences between racial and ethnic groups. Asian/Pacific Islanders have the highest proportion of residents with less than a 9th grade education. And approximately 50% of Black/African Americans and Hispanic/Latino residents have a high school education or less, compared to just 15 percent of Whites. With regard to income, the relatively high income of White San Franciscans raises the per capita income citywide for all incomes and ethnicities. Per capita income for African Americans is less than half that of White San Franciscans. San Francisco has a higher proportion of residents receiving SSI, which indicates that San Francisco has higher proportions of low-income aged, blind and disabled residents. The percentage of persons on public assistance decreased significantly for San Francisco between 1990 and 2000. This may indicate that lower income San Franciscans are moving out of San Francisco as a result of the increased cost of living. Between the 1990 and 2000, the rate of poverty in San Francisco decreased by nearly one and one-half percentage points, which could be attributable to the high cost of living. The income gap between the most and least affluent is wider in San Francisco than for the State. Twenty five percent of the City’s African American population is living in poverty compared to seven percent of Whites and 11 percent of the citywide population. Thirty five percent of San Franciscans own their own home, compared to 57 percent in California and 66 percent in the U.S. Asians and Latinos are more likely to live more than one occupant to a room. Twenty two percent of African Americans spend more than 50 percent on rent, compared to 15 percent of Whites and 18 percent of Asians and Latinos. Nearly 40 percent of San Francisco households are one-person households. Census 2000 collected data on people living in institutional and non-institutional group quarters. Of the institutionalized populations, 41 percent of those in “hospitals/wards, hospices and schools for the handicapped “ were “wards in general hospitals for patients who have no usual home.” This percentage is four times that for both the State and the country. This figure provides further data to substantiate the problem of decertified days and SFGH. There were 1.4 million new uninsured in the U.S. for a total of 41.2 million uninsured in the United States. California had 18 percent uninsured, which is the third highest in the nation. Ms. Johnson concluded by saying that from a socio-economic perspective, the data show that there continues to be several gaps to bridge to overcome health disparities and this data will help in the planning of future services for the Commission and the Department. Commissioners’ Comments Commissioner Guy commended staff for the report. This information can be used in the evaluation of the DPH Strategic Plan. This data will be helpful for the Board of Supervisors budget deliberations and advocacy at the State level. The data reinforces that the Laguna Rebuild, including the independent living decision was a good policy decision, that the African American Health Initiative was a good policy decision. Just to name a few. Commissioner Umekubo asked Ms. Johnson to break down the increase in the growth in San Francisco’s population since 1990 in terms of how much of the growth is due to immigration, how much due to births, etc. The department is basing some of its scenarios for pediatrics and OB/Gyn at SFGH on this information so it is important to have a firm understanding of the population increase. Ms. Johnson will get this information to the commissioners. Commissioner Parker asked if it is possible to get more information about the African Americans leaving San Francisco, specifically the demographics of the people who are leaving. Ms. Johnson can compare data by race and ethnicity between 1990 and 2000. The census does not elucidate why people left, but can give information about the demographics about the population change. This will provide indirect evidence of why people left. 9) PUBLIC COMMENTS None. 10) 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 (Guy, Parker, Penn, Sanchez, Umekubo) voted to hold a closed session. The Commission went into closed session at 5:50 p.m. Present in closed session were Commissioner Guy, Commissioner Parker, Commissioner Penn, Commissioner Sanchez, Commissioner Umekubo, Dr. Mitch Katz, Larry Funk, Norm Nickens and Michele Olson. C) Closed session pursuant to Government Code Section 54956.9 and San Francisco Administrative Code Section 67.10(d) Approval of a settlement in the amount of $20,000 in the Willie Johnson v. Laguna Honda Hospital, United States District Court for the Northern District of California, Case No. C00-4813, File No. 020360 Action Taken: The Commission voted to approve the settlement in the amount of $20,000. D) Reconvene in Open Session The Committee reconvened in open session at 6:00 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 (Guy, Parker, Penn, Sanchez, Umekubo) voted not to disclose any discussions held in closed session. ADJOURNMENT The meeting was adjourned at 6:00 p.m. Michele M. Olson, Executive Secretary to the Health Commission