Minutes of the Health Commission Meeting Tuesday, November 19, 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 Michael Penn, Ph.D. Commissioner John I. Umekubo, M.D. Absent:  Commissioner David J. Sanchez, Ph.D. Commissioner Chow announced that Commissioner Michael Penn has been appointed to the Budget Committee. 2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF NOVEMBER 5, 2002 Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Penn, Umekubo) approved the minutes of the November 5, 2002 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Monfredini chaired, and Commissioner Umekubo and Commissioner Penn attended, the Budget Committee meeting. (3.1) AIDS Office - Request for approval to accept and expend, retroactively, grant funds from the Department of Health and Human Services, Office of Minority Health, in the amount of $650,000, for the second year of funding, for HIV Care and Related Services for Women and Minorities, for the period of September 30, 2002 to September 29, 2003. (3.2) PHP-CHPP - Request for approval of a retroactive sole source contract renewal with the International Institute of San Francisco, in the amount of $208,576, to provide preventive health services to refugees of all ages for the period of October 1, 2002 through September 30, 2003. This contract is retroactive due to delays in issuing the notice of renewal. The contractor has continued to provide services and is currently not receiving payment. (3.3) PHP-CHPP - Request for approval of a retroactive sole source contract renewal with the San Francisco Study Center, in the amount of $518,342, to provide technical assistance to the Bayview Hunters Point Health Environment Resource Center (HERC) for the period of July 1, 2002 through June 30, 2003. This contract is retroactive due to delays in determining the amount available for the renewal of the contract. The contractor has continued to provide services and is currently not receiving payment. Commissioners’ Comments Commissioner Monfredini asked that an update on the transition to an independent agency be presented to the Budget Committee in April. (3.4) CHP-Behavioral Health Services - Request for approval of a retroactive sole source contract renewal with Central City Hospitality House, in the amount of $567,618, to provide drop-in and self-help services for the homeless, for the period of July 1, 2002 through June 30, 2003. This contract is retroactive because of extended contract negotiations. The contractor continued to provide services and receive payment under an interim agreement approved by the Health Commission on July 12, 2002. Fred Milligan, DPH Program Manager, clarified that the audit referred to on page 3.4.1 was the audit for FY 2001 not FY 2002. The audit was completed a number of months ago. Commissioners’ Comments At the request of Commissioner Monfredini, Executive Director Jackie Jenks described the agency’s five-year strategic plan, for which they have identified preliminary funding needs. Commissioner Monfredini commented that this is a scary time and commended the agency for the strategic plan. (3.5) CHP-Behavioral Health Services - Request for approval of a retroactive sole source contract renewal with the Regents of the University of California, in the amount of $3,524,567 per year, to provide citywide case management mental health services targeting Psychiatric Emergency Services clients and County Jail inmates with mental illness, for a two year period of July 1, 2002 through June 30, 2004 for a combined total of $7,049,134 for the two year period. The contract is retroactive due to the need for the contractor to revise contract documents to incorporate changes in funding after finalization of the Department’s fiscal year 2002-03 budgets. The contractor has continued to provide services and is currently not receiving payment. (3.6) CHP-Behavioral Health Services - Request for approval of a retroactive sole source contract renewal with the West Bay Pilipino Multi-Service Center, in the amount of $60,000 per year, to provide mental health services targeting immigrants transitioning to community care, for a four year period of July 1, 2002 through June 30, 2006 for a combined total of $240,000 for the four year period. The contract is retroactive due to the need for the contractor to revise contract documents to incorporate changes in funding after finalization of the Department’s fiscal year 2002-03 budgets. The contractor has continued to provide services and is currently not receiving payment. (3.7) PHP- Behavioral Health Services - Request for approval of a retroactive contract renewal with the North of Market Senior Services, in the amount of $711,105, to provide outreach, outpatient, and drop-in substance abuse services, for the period of July 1, 2002 through June 30, 2003. The contract is retroactive due to the need for the contractor to revise contract documents to incorporate changes in funding after finalization of the Department’s fiscal year 2002-03 budgets. The contractor has continued to provide services and is currently receiving payment under a six-month interim agreement approved by the Health Commission on April 16, 2002. (3.8) PHP- Behavioral Health Services - Request for approval of a retroactive contract renewal with the Progress Foundation, in the amount of $8,687,056, to provide mental health, residential, outpatient, and day treatment services, targeting adult residents of San Francisco with special services to Senior, African American, Asian, Latino and Homeless communities for the period of July 1, 2002 through June 30, 2003. The contract is retroactive due to the need for the contractor to revise contract documents after finalization of the Department’s fiscal year 2002-03 budgets. The contractor has continued to provide services and receive payment under a six-month interim agreement approved by the Health Commission on April 16, 2002. (3.9) PHP- Behavioral Health Services - Request for approval of a retroactive contract renewal with Baker Places, Inc., in the amount of $7,595,370, to provide residential, rehabilitation and intensive day treatment services, for the period of July 1, 2002 through June 30, 2003. The contract is retroactive due to the need for the contractor to revise contract documents to incorporate changes in funding, including COLA, after finalization of the Department’s fiscal year 2002-03 budgets. The contractor has continued to provide services and receive payment under a six-month interim agreement approved by the Health Commission on April 16, 2002. Commissioners’ Comments Commissioner Umekubo asked about the lack of client satisfaction survey. Pablo Bravo from Baker Places and Linda Wang from CMHS will get a response to the Health Commission office explaining if the Needs Improvement rating for client satisfaction was an error and if not, how the agency has addressed this deficiency. (3.10) PHP- Behavioral Health Services - Request for approval of a retroactive contract renewal with Baker Places, Inc., in the amount of $3,056,019, to provide residential treatment and detoxification services, targeting gay males, dual diagnosed clients co-existing with HIV and homeless clients for the period of July 1, 2002 through June 30, 2003. The contract is retroactive due to the need for the contractor to revise contract documents to incorporate changes in funding after finalization of the Department’s fiscal year 2002-03 budgets. The contractor has continued to provide services and receive payment under a six-month interim agreement approved by the Health Commission on April 16, 2002. Commissioners’ Comments Commissioner Monfredini asked that the client satisfaction survey analysis for FY 01-02 be report to the Budget Committee through the Heath Commission Office when it is completed. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Penn, Umekubo) approved the Budget Committee consent calendar. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. City Departments Received Budget Instructions City Departments, including the Department of Public Health, received a very sobering briefing from the Mayor’s Budget Office last week concerning the status of the City budget. As Commissioners will remember, this year’s City budget was balanced using $100 million of one-time sources that will not be available for the 2003-04 year. The theory behind using these one-time fixes was that the economy would improve in fiscal year 2002-03, thereby avoiding the need to make more difficult cuts. Unfortunately, the economy has not improved and is not projected to improve. Proposition L, which would have brought about $30 million dollars of revenue to the City by increasing tax on properties sold for $1 million or more, was turned down by the voters. The result is that the City is projecting a $170 million shortfall for 2003-04. This shortfall assumes no wage increases for City employees. To eliminate this shortfall, all departments will be asked to decrease reliance on the General Fund by 3% in the current fiscal year. The plans must be submitted by December 9, 2002 to the Mayor’s Office. For the Health Department this is $9 million and would decrease our General Fund from $290 million to $281 million. DPH will bring the plan to the Health Commission on December 3, 2002. Although DPH is still developing the plan it will include additional revenues as well as programmatic cuts. In terms of the budget for 2003-04, DPH will need to maintain the $9 million dollar cuts to the General Fund. This is an important point because it means that any one-time General Fund reductions DPH makes for this year will necessitate identification of new cuts for the following year. On the other hand, to the extent that DPH can identify ongoing revenue or ongoing programmatic cuts, DPH will not need to make cuts twice. Beyond living within a decreased General Fund of $281 million in fiscal year 2002-03 DPH will need to make an additional 5% of cuts to absorb known citywide cost increases. This would amount to an additional $16 million of cuts. Finally, the Mayor’s Office has asked each Department to supply a contingency plan for 5% of additional cuts that may or may not be necessary depending on the City’s financial situation. DPH will bring the fiscal year 2003-04 budget to the Health Commission on February 5th and February 18th of 2003. Veterans of the City budget cycle know that the initial budget scenario is often the most bleak. However, veterans also know to pay attention to where the scenarios begin. This is the most demanding in terms of cuts that DPH has received in the past seven years. Although DPH is still working on the actual details, the Commission and the public should be aware that there have been no fundamental changes in the need for General Fund from last year. Therefore, DPH is likely to propose similar cuts to those proposed in prior years. Care Not Cash On November 5, 2002, San Francisco voters passed Proposition N, the “Care Not Cash” initiative. This measure will reduce General Assistance payments to San Francisco’s homeless residents from a maximum of $395 per month to $59 per month and replace the cash with housing and food services. If housing and food services are not available, the client will receive the full cash award. It is due to take effect on July 1, 2003. While the Department of Human Services (DHS) will be the primary department to implement “Care Not Cash,” DPH will work with DHS to ensure that mental health, substance abuse, primary care, and other services are available to homeless clients, and that the two departments coordinate services for this population. Proposal to provide Health Care Services to Taxi Cab Drivers Yesterday, the Board of Supervisor’s passed legislation on the first reading to increase taxi fare rates by a vote of 8 - 1. Part of the ordinance requires that the Controller submit recommendations to the Board by October 2003 exploring the feasibility of enacting a health benefit package for drivers. The fare increase would be used as the funding source for the program. Supervisor Ammiano asked the Department to consider the possibility of providing health care for taxi drivers through the Community Health Network and DPH said it would be happy to put together such a package. Because taxi cab drivers are by definition, low income workers, providing medical care for this population is consistent with DPH mission. It would be possible for the Department to put together a coordinated service package for taxi cab drivers that includes primary medical care, pharmaceuticals and inpatient services. The major limitation of such a package is that it is not health insurance. Members would not be eligible for services outside DPH network and there would be no portability of the package if they left employment. As stated in the ordinance, if the City fails to enact this program (unless the Controller deems it is not feasible) the fare increase would expire. Dr. Katz will keep the Commission apprised of future developments. Transgender Life Care Project The Transgender Life Care Project, a collaboration between UCSF and the Department’s Community Mental Health Services, funded by a grant from Substance Abuse and Mental Health Services Administration, is now fully operational. The primary aim of this project is to provide mental health care to transgender and questioning individuals in a primary care setting. Services are being offered at the Castro-Mission Health Center as well as at the UCSF Health Studies for People of Color program. Children’s System of Care On October 21st, the Work Group on Community-Based Systems of Care from the American Academy of Child and Adolescent Psychiatry presented a symposium on "Community Mental Health Strategies For America's Children" in San Francisco. The symposium presented the San Francisco Children’s System of Care as an exemplary model in the development of children’s mental health services. A number of Department staff gave presentations. Over 150 psychiatrists and providers attended the symposium. CDC Syphilis Funding The Centers for Disease Control and Prevention (CDC) has allocated $400,000 to eliminate syphilis in San Francisco. As required by the funder, 30% of all syphilis elimination monies will be awarded to community-based agencies. The STD Division will be putting these funds out to bid as soon as they are authorized to do so by the CDC. The remainder of the funds will be used to hire additional staff to perform investigations and community outreach as well as to supplement advertising and stipend budgets. Women’s Health Fair Today from 9 am to 3 pm, Tom Waddell Health Center hosted a Women’s Health Fair for homeless and low-income women. This event, planned with a special emphasis on breast and cervical health, provided an excellent opportunity for patients to receive drop-in pap smears and to learn about local community resources. Event coordinators also made arrangements for scheduled mammogram screenings, women’s support groups and a variety of educational opportunities. Flu Shots in Housing This is the second year that the Department's Housing and Urban Health (HUH) has systematically provided flu vaccinations for residents of our supportive housing facilities. Carol Baillie, RN and Albert Pappallardo, RN of HUH, in collaboration with the Adult Immunization Clinic and volunteer medical students from UCSF School of Medicine, have provided free immunizations for residents of the Le Nain, Pacific Bay Inn and Camelot Hotels, the Broderick Street Residential Care Facility as well as staff and clients of the St. James Infirmary and the 5th Street Multiservice Center. Overall more than 200 immunizations were provided. DPH hopes that this effort will result in fewer cases of flu this winter as well as a reduction in clinic and emergency room utilization. COMMUNITY HEALTH NETWORK SAN FRANCISCO GENERAL HOSPITAL CREDENTIALS REPORT November 2002 Health Commission - Director of Health Report (From 11/04/02 MEC and 11/12/02 JCC) 11/02 7/02 to 10/02 New Appointments 23 119 Reinstatements 1 Reappointments 51 104 Delinquencies 0 0 Reappointment Denials 0 0 Resigned/Retired 11 71 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Changes in Privileges Additions 3 8 Voluntary Relinquishments 3 13 Proctorship Completed 6 52 Current Statistics - as of 09/01/02 Active Staff 480 Affiliate Professionals (non-physicians) 151 Courtesy Staff 480 Referring Staff 44 Total Members 1083 Applications In Process 38 Applications Withdrawn Month of Sept 2002 2 4 (07/02 to 10/02) SFGH Reappointments in Process Dec.2002. to Mar. 2003 139  Commissioners’ Comments Commissioner Umekubo asked if there is any indication that Medi-Cal rates will increase. Dr. Katz said that is unlikely. In fact, the city will probably receive further cuts due to the State budget. Grant funding is almost impossible to get for on-going services. Staff is currently working to see if we can increase our sponsorship percentages for hospital services and behavioral health services. Commissioner Guy asked the estimate of the number of taxi drivers who would benefit from the health care services program. Dr. Katz said that there are 6,000 taxi cab drivers. 1,400 of these drivers own a taxi medallion, and presumably they would not need this program. But because of the independent contractor nature of the taxi business, it is hard to identify a specific number. Commissioner Guy is pleased that DPH will be working closely with DHS to implement Proposition N. She emphasized the importance of helping the two thirds of General Assistance recipients who are housed to maintain their housing and not move into the shelter system. Commissioner Parker asked if the assumption that there will be no cost of living increases next year applies to step increases as well. Dr. Katz said employees would still receive step increases. Commissioner Chow, on behalf of the Commission, acknowledged Matisse Enzer who donated their time and resources… Dr. Josh Bamberger accepted the certificates on their behalf. 5) PRESENTATION OF THE ANNUAL ENVIRONMENTAL HEALTH UPDATE Rajiv Bhatia, M.D., Director Environmental and Occupational Safety and Health, presented the Annual Environmental Health Update. This update will attempt to put the work the division is doing in a comprehensive strategic framework. Environmental Health has the opportunity to work in many arenas that impact people’s overall health-media, schools, housing and workplaces. They also work through a variety of means. The overall goal of the division is to provide an integrated approach to healthy people and environments. The organization consists of Compliance Programs (more than 75% of the staff), Occupational and Environmental Health, Children’s Environment and a newly established Health Inequities Research Unit. Elements of Approach Ensuring our mandates Taking a systems and interdisciplinary view of current issues Working through collaborations Supporting community capacity Developing evaluation tools and methods Dr. Bhatia gave updates on fiscal trends, public data access, healthy housing activities, environmentally friendly businesses, Safe Devices Committee, Day Labor Project, Food Systems Project, and Impact Assessment Project. Fiscal Trends - All of the new work the division has done has been done without any net increase in staff size or program cost. They have been successful in getting the revenues from the compliance programs that allow them a good deal of financial stability. Public Data Access - The goal is to have all of the data on the Internet for web-based program data access. The first program on line was food violations. Healthy Housing Activities - Environmental Health has a comprehensive approach to healthy housing that now includes code enforcement program, regular inspections of SRO housing, home assessments for asthmatics, property management training and asthma friendly housing. Safe Devices Committee - a partnership with staff and unions to select the safest devices and improve working conditions. It has been successful in new device selection and the staff participation in the process supports education and awareness. SFDPH Clean and Green - a partnership between the State, city agencies and businesses that use hazardous materials. We provide training and resources for environmentally friendly business practices, and certify businesses. Day Labor Project - day laborers suffer a number of health issues-violence and victimization, unsafe working conditions, fear of accessing medical services. One of the immediate successes of this effort was to engage the State in this effort. Environmental Health provides education and training on a monthly basis where the day laborers are at, have held focus groups, is working toward a vocational training program and will be working on employee outreach. Food Systems Project - one of the major projects in the unit. Food and health is a multidimensional problem. Environmental Health felt there was an opportunity to promote bringing healthy produce closer to the San Francisco consumers and provide more healthy choices. Current activities include developing the Community Food Systems Council, a partnership between DPH and the San Francisco Foundation. They are conducting a feasibility study for a SFUSD Farm-to-School program and producing a community food assessment guidebook. They are conducting community food assessments in Bayview Hunters Point and planning for a Food System Alliance Conference. Anticipated impacts include increased use of farmer’s markets, promotion of community-supported agriculture, school-based connections to farming through gardens, curriculum and food choices and cultural support fur healthy food choices. Impact Assessment Project - came out of the fact that in environmental impact assessments, health is considered in limited ways and there are limited opportunities for meaningful community participation. The strategy is to work with Planning and Redevelopment to try to model ways to complement their existing environmental review processes. The first community applications were food security strategies, the rent dislocation ordinance, Green School Yards program and review of San Francisco’s minimum wage ordinance. Challenges to developing Health Impact Assessment include ensuring that decision makers take this seriously, integrating it with existing institutional procedures and generating supporting stakeholder capacity and resources. Looking forward to 2003 Responding to the West Nile Virus Retail Food Program Planning Integration of Children’s Programs Application of HIA Action curriculum for high schools Commissioners’ Comments Commissioner Chow asked how HIA will be applied, and are there any mandates that these types of assessments be done. Dr. Bhatia said that California law sets a threshold for what needs to be done in an environmental impact assessment, and HIA goes beyond this threshold. The goal of Environmental Health is to develop a program that they can demonstrate works. Commissioner Chow asked if the compliance revenues cover the cost of all Environmental Health programs. Dr. Katz said that the fees do not cover the cost of the programs, and there is some general fund dollars, as well as grant funding. Commissioner Chow asked if other jurisdictions have HIA programs. Dr. Bhatia said that no other jurisdictions have this type of program. Dr. Katz commended Dr. Bhatia for broadening the perspective and mission of Environmental Health. Commissioner Penn supports public access to the data, and asks how the public is made aware that the website exists. Dr. Bhatia said that they have good relations with community organizations that are interested in this data-in fact were advocating for the data. With regard to the food inspections, media outreach was done. Commissioner Penn asked how physicians were made aware that services for asthmatics are available. Dr. Bhatia said the most extensive outreach they did was presentations to community clinics and letters to asthma patients. Commissioner Umekubo asked how DPH is addressing the issue of poor nutrition and obesity in school children. Dr. Bhatia said that Environmental Health is addressing a piece of this problem, basically how to bring farm produce into San Francisco and the schools. There are a number of other efforts in DPH to collaborate with the school district on this issue. Commissioner Umekubo urged the Department to keep raising the bar. Commissioner Guy said that there are not many health departments who have the vision to use tools such as HIA. She encourages the Department to pursue environmental equity and wants to continue to work on this through the Population Health and Prevention Joint Conference Committee. She asked if there is continued analysis on the role of income on health, as was done with the analysis of the minimum wage ordinance. Dr. Bhatia replied the minimum wage work was very important but it is a very large issue. The next phase of the effort, however, is not technical analysis. Commissioner Parker said that the Department has launched a strong program addressing environmental justice. This is a good starting point for individuals in the community because often community members wait for mandates and laws to make changes, but we are educating people to take action sooner rather than later. 6) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH ANNUAL REPORT Items 6 and 7 were presented together. Anne Kronenberg, Director of Policy and Planning, gave an overview of the strategic planning efforts. The strategic planning effort began in 1999 with the hope that through this process the Department would: work with the community to identify health improvements; strengthen prevention efforts; identify populations DPH should more appropriately serve; develop program priorities to maximize the effectiveness of limited resource; and respond to funding trend. After many hours of work and 52 town hall meetings with community and staff, the Health Commission adopted the Strategic Plan on January 8, 2001. Frances Culp provided an overview of the 2001-2002 Annual Report. The Annual Report follows the Strategic Plan’s framework and outlines progress toward achieving the goals and objectives of the Strategic Plan. The Annual Report includes information about who the Health Department is, who it serves and how it is funded, as well as how the programs and services support the Strategic Plan planning goals and objectives. There are more than 6,000 Health Department employees, certified in 16 languages. The Department has more that 50 advisory groups, and contracts with over 120 organizations. The Community Health Network (CHN) provided care to 121,946 clients during 2001-2002. Nine percent of these patients were classified as homeless, and the percentages of African-Americans and Latinos who rely on CHN is significantly higher than the City’s overall population. Community Mental Health Services provided care to 21,535 clients, many of whom have more than one mental diagnosis, most often substance abuse disorders. Community Substance Abuse Services served 14,127 clients. Heroin is the most commonly used drug. San Francisco City Clinic served 12,008 clients, 75% of whom are male. The Department’s budget in FY 2001-2002 was $982.1 million. $306.4 million came from the General Fund, representing 31% of the budget. Medi-Cal revenue comprised 26% of DPH’s budget. Reliance on the General Fund grew from last year, when General Fund and Medi-Cal each represented 29 percent of the budget. Ms. Culp highlighted programs for each of the Strategic Plan goals. She emphasized that this is not a comprehensive list, just examples of how the Department is moving forward to accomplish its mission. Goal 1: Access, emphasize services to target populations Lessons learned from 9/11/01 - the Disaster Registry Program; EMS Section improvements; the DPH Disaster Plan; Public Health Laboratory, which is now able to analyze specimens for the presence of anthrax. YouthPOWER Healthy Kids New supportive housing programs Goal 2: Disease and injury are prevented Healthy Penis 2002 Support for Women with Cancer at Chinatown Public Health Center Effort to reduce medication errors DPH’s “Chill Out” campaign, to encourage safer driving practices Goal 3: Services/programs are cost-effective, resources maximized Pharmaceutical cost savings, via manufacturer patient assistance programs, better antibiotic drug use, formulary management and special pricing negotiated with drug manufacturers Rebuilding SFGH - second phase of planning Food violations on-line Goal 4: Partnerships with communities are created and sustained OBOAT (Office-based Opiate Addiction Treatment) - planned with local methadone providers, physicians and pharmacists, worked with the State on regulations and received federal funding Nursing excellence program Bosnian Community Wellness Program Jim Soos, Policy and Planning, discussed the challenges for the coming year, and discussed the Department’s direction. The two challenges that will have the most impact are budgetary concerns at all levels of government and a shifted emphasis on terrorism and bio-terrorism preparedness in the wake of the September 11, 2001 attacks on the U.S. Budgetary issues. Federal - three issues that will impact DPH this year: DSH cliff; the Upper Payment Limit, which will be implemented in California in Federal Fiscal Year 03-04; and changes to the Selective Provider Contracting Program. State - three issues in the State budget will also impact the Department’s realization of the Strategic Plan: a proposed DSH administrative fee increase; the hospital outpatient settlement; and a projected $15 billion State budget gap. Terrorism/bioterrorism - the Strategic Plan was adopted prior to September 11, 2001, and the activities of many sections have necessarily been diverted toward terrorism and bio-terrorism preparation. This is particularly true for Community Health and Epidemiology and Disease Control, the Public Health laboratory, EMS and SFGH. The Department’s direction for the coming year includes the SFGH and LHH rebuild efforts, clinic retrofits, the development of a five-year Prevention Plan, implementation of Behavioral Health and homeless services. Anne Kronenberg provided the Commission with recommendations for the Strategic Plan. Streamline the plan - not eliminating the four goals, but simplifying the strategies that fall under the goals. There is a lot of overlap so staff proposes paring down the strategies from 25 to 14. This will place greater emphasis on the four primary goals and reduce confusion about which strategy applies to which program. Consolidate that Strategic Plan and Annual Report into one update. This would result in a more comprehensive Annual Report that looks at the Department from a programmatic perspective as well as from (check tape). This would give an overall perspective of what the Department wants to accomplish. Commissioners’ Comments Commissioner Chow commended staff for the comprehensive report and said that it has wide applicability. He also acknowledged Commissioner Guy for her leadership to create the Strategic Plan. The Commission will work with staff to implement the recommendations. Commissioner Chow said that the underutilization of drug and alcohol services by Asian Americans might be due to the fact that some Asian-focused programs receive funding directly from the federal government. So the need may be there but people are accessing services outside of the Department. He also asked for information about if the drop in the proportion in Medi-Cal revenue equates to a real decrease in actual Medi-Cal dollars, and what the implication of this is. Dr. Katz will get this information to the Commissioners. Dr. Katz said there is research that shows a lower incidence of drug and alcohol abuse by Asian Pacific Islanders. Commissioner Chow commended staff for an excellent report, and hopes the City is aware of the Department’s efforts. Commissioner Monfredini commended staff for the report, and appreciates that the Strategic Plan was presented as part of the Annual Report because there is such synergy. Some of the facts in the reports concern her, for example that heroin is the number one drug of choice. She would like this issue to be followed more carefully. The funding issues are very daunting and will be tremendous barriers to implementing the Strategic Plan. Commissioner Umekubo noted that from 1996-1999 hospital admissions due to alcohol and drugs increased. One encouraging statistic was the decrease in ED drug episodes. Dr. Katz said that experts agree that the number one reason heroin use has increased is because the price has markedly dropped. Commissioner Penn supports combining the Annual Report and the Strategic Plan, particularly with regard to challenges. This will also present a more balanced view of the Department to the public-rather than just identifying accomplishments, present the challenges as well. Commissioner Guy supports efforts to make the Strategic Plan a more effective and dynamic plan. For the next year, the Joint Conference Committees need to be more successful in incorporating the Strategic Plans into its dialogues. She asked if bioterrorism is changing anything in terms of cost or how staff does its work. Dr. Katz said yes for both questions. The person who is currently working on the smallpox vaccination plan was doing immunizations as her full-time job. Tomás Aragon has spent most of the past six months working on communication methods between DPH and other hospitals. He has tried to keep the work generalized, and as an opportunity to develop a plan to deal with a variety of epidemics, not just a terrorist attacks. Commissioner Parker said the report is very encouraging because, regardless of all the challenges, it shows that the Department is on the right track. The Department has all the necessary data, and now just needs to bring it together to address health needs and health disparities. The Department has evolved tremendously since he became a member of the commission. Commissioner Umekubo left at 6:45 p.m. 7) PRESENTATION OF THE STRATEGIC PLAN UPDATE See above. 8) PUBLIC COMMENTS None. 9) ADJOURNMENT The meeting was adjourned at 6:00 p.m. Michele M. Olson, Executive Secretary to the Health Commission