Minutes: Special Health Commission Meeting Wednesday, February 5, 2003 At 3:00 p.m. Board of Supervisors’ Chamber 1 Dr. Carlton B. Goodlett Place, 2nd Floor 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 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 David J. Sanchez, Ph.D. Commissioner John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF JANUARY 21, 2003 Action Taken: The Commission approved the minutes of the January 21, 2003 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) CHN/SFGH-Radiology - Request for approval of a contract modification with The Registry Network, Inc. to increase the amount of the contract from $395,000 to $640,000 and reduce the term of the contract from September 1, 2001 through August 31, 2003 to September 1, 2001 through February 28, 2003, to provide intermittent, as-needed, professional radiology technologists services, with on-call availability 7 days a week. (3.2) PHP-Community Health and Safety Services - Request for approval of a retroactive sole source contract renewal with American Lung Association of San Francisco, in the amount of $98,214, to provide Childhood Asthma Initiative services, for the period of July 1, 2002 through August 31, 2003. This renewal is retroactive due to State funding adjustments that delayed contract development and calendaring. The contractor has not been receiving payments under an interim agreement. (3.3) AIDS Office-HIV Health Services - Request for approval of a new one-time only contract with Project Open Hand, in the amount of $375,000, for delivered meals, for the period of January 1, 2003 through February 28, 2003. (3.4) AIDS Office-HIV Health Services - Request for approval of a new one-time only contract with UCSF AIDS Health Project, in the amount of $81,922, to provide outpatient mental health services, for the period of January 1, 2003 through February 28, 2003. Commissioner Sanchez abstained from voting on this contract. (3.5) AIDS Office-HIV Health Services - Request for approval of a new one-time only contract with San Francisco Food Bank, in the amount of $72,003, for food solicitation services, for the period of January 1, 2003 through February 28, 2003. Action Taken: The Commission approved the Budget Committee Consent Calendar, with Commissioner Sanchez abstaining from voting on Item 3.4. Commissioner Chow announced the 2003 Health Commission Committee assignments. Budget Committee Commissioner Monfredini, Chair Commissioner Penn, Member Commissioner Umekubo, Member Community Health Network Joint Conference Committee Commissioner Chow, Chair Commissioner Guy, Member Commissioner Sanchez, Member Laguna Honda Hospital Joint Conference Committee Commissioner Sanchez, Chair Commissioner Umekubo, Member Population, Health and Prevention Joint Conference Committee Commissioner Guy, Chair Commissioner Parker, Member Commission Penn, Member San Francisco General Hospital Joint Conference Committee Commissioner Parker, Chair Commissioner Monfredini, Member IHSS Public Authority Commissioner Parker San Francisco Health Authority Commissioner Umekubo SFGH Foundation Commissioner Sanchez 4) DIRECTOR’S REPORT No Director’s Report was presented. 5) PROPOSED FISCAL YEAR 2003-04 HEALTH DEPARTMENT BUDGET Mitchell H. Katz, M.D., Director of Health, presented an overview of the proposed fiscal year 2003-04 Health Department Budget (Attachment A). Public Comment Latanya Hurst spoke in support of saving the Mental Health Rehabilitation Facility (MHRF). Adrienne Warren said DPH need to assist the mentally ill and maintain the MHRF. Emeal Powell spoke in support of saving the MHRF. Her son is a resident of the MHRF. Angela Billy Cassidy, spoke in support of saving the MHRF. He submitted a copy of his testimony (on file). Michael Baker, client of the MHRF. The MHRF runs perfectly well, so don’t take the chance of change putting people on the street. Mr. Baker submitted a list of other MHRF residents who are opposed to the cuts (on file). Rochelle Robinson, resident of the MHRF, supports the facility, which gives a brand new meaning to healthcare. She submitted a copy of her testimony (on file). Iain Reid spoke in support of saving the MHRF. He submitted a copy of his statement (on file). Allah Davies, MHRF resident, advocated for keeping the MHRF open. He submitted a copy of his statement (on file). Ronald Wimbush spoke about how important the MHRF is. An anonymous speaker spoke in support of the MHRF. Abner Boles, Ph.D., Executive Director of Westside Community Mental Health, said the proposed budget preserves are being preserved, but there are cuts in services to children and families that are truly prevention services. He urged the Commission to preserve programs that serve children and families. Kate Walker, Mental Health Board, spoke in support of the day treatment centers. Greg Senegal is opposed to cuts in Walden House’ contract. Dr. Brian Greenberg, representing Walden House, spoke against the proposed cuts. Karen Redus, Walden House, said 12-step programs do not work for everyone and she is opposed to the cuts to Walden House’s continuing care program. Fermin Loza spoke in support of Walden House’s continuing care program. Andrew Hayes asked the Commission to reconsider the importance of specialized outreach to homeless people. He submitted a copy of his testimony (on file). Reverend Yvette Flunder, Executive Director, Ark of Refuge, asked the commission to direct another $90,000 to the program the program can continue at its current census. Chris Miller, peer counselor at the MHRF, said the changes to the MHRF are not going to work for the patients. It will end up costing more money for hospitals and jail. David Mallorich spoke against the cuts at the MHRF. Greg Rosko spoke in support of the MHRF. Emmet Scanlan, MHRF resident, opposed to closing the MHRF. San Francisco has the money to maintain this facility. Marilyn Williams MHRF resident, opposed to closing the MHRF. Abdullah Megahed spoke against the budget cuts. Cynthia Petticord spoke in support of the work of the Hope Team. She submitted a copy of her testimony (on file). Jonathan Vernick, Baker Places, supports the principles that were used to develop this budget, however, some of the cuts in day treatment affect residential treatment programs, such as Robertson Place, and he is opposed to such cuts. Jerry “Frosty” Wiseman spoke in support of the HOPE outreach team. Please continue their funding. Deborah Smith, employee of the MHRF, opposes changes in the MHRF. Danielle Evans, Tenderloin Housing Clinic, spoke in support of the HOPE team. She has seen the team save lives. Steve Fields, Executive Director of Progress Foundation, spoke on behalf of the Human Services Network. Urged the Health Commission to take a stand for health care and opposed to the cuts. The Health Department should no longer have to take this level of cuts when there are sacred cows in the budget. Eve Meyer, San Francisco Suicide Prevention, said suicide is the end stage of mental illnesses and addictions. Urged the Health Commission to say no to these cuts. Criss Romero, IFPTE Local 21, urged the Department to allow staff to express their opinions. If the process is going to move forward, honest, truthful information needs to be given to staff and patients. Patrick Monette Shaw - Dr. Katz just testified that DPH was unable to hire these six nurses, because it had to cut these positions in the current fiscal year; he now wants to chop the unfilled positions next year. However, on page 155, Dr. Katz claims -- playing the blame game -- the nursing positions went unfilled because funding hadn’t been “added back” by the Board of Supervisors. In realty, the Union’s assert that the Mayor’s office had not released the requisitions to fill the positions; requisitions don’t land on the Mayor’s desk unless funding has been identified by DPH. If you keep postponing hiring nurses for Laguna Honda Hospital, by the time you get around to funding nursing positions instead of these Party Packs, the nursing shortage will be so severe you will not be able to attract nurses to public health positions in San Francisco. Shame on you for prioritizing Party Packs ahead of public health nurses! These "Party Pack" toys are funded using public health funds diverted from direct healthcare services. Rex Spray, RN, President of SEIU Local 790 RNs, understands the difficult situation facing the Department. The deficit is real, but they believe the proposed budget is a short-term solution. Matt Crawford opposed to closing the MHRF. Charles Collin, E.D., Family Services Agency, spoke in opposition to cuts in day treatment. Last year the Commission was able to maintain day treatment and should do so this year. He is also concerned about the second round of budget cuts. Pier Schwartz, Family Service Agency, is opposed to the proposed day treatment cuts. There are no alternatives in place for seniors who receive these services. Frank Ngo, SFGH interpreter services, opposed to cuts in interpreter services at SFGH. Chauncy Taylor, employee at the MHRF, said closing the MHRF will put people who suffer from many mental illnesses on the streets. Georgia Creel, President of Drug Abuse Advisory Board, spoke in support of the SF Drug Abuse Advisory Board and the City-wide Alcoholism Advisory Board. Ramona Davis, M.D., spoke in support of the Bayview Thunderseed Day Treatment Program. Case management is not a replacement for day treatment. Please reconsider these cuts. Rebecca Morrow, Public Health Nurse and SEIU member, concerned about the cuts to the most vulnerable people in the city. Randy Joy is opposed to draconian budget cuts. He strongly supports the HOPE team and the Healthy Realization project. These decisions will result in death. Dr. George Davis, Executive Director of Bayview Hunters Point Adult Day Health Center, asked the Commission to not cut the program. Dennis Raab, MHRF employee, is opposed to closing the facility. Many people will have to be transferred to facilities outside of the city, which is more expensive and not fair to patients and families. The acuity of patients has increased who are not fit to return to the community. These people will only come back into the emergency psychiatric system. Richard Heasley, Executive Director of Conard House, said the cut to their Jackson Street residential treatment facility is being driven by revenue rather than treatment efficacy. These beds are hard to find, hard to permit, and hard to license so this is a shortsighted decision. Mr. Heasley also spoke on behalf of the Mental Health Contractors Association. Please take a strong stand in the language in the resolution in favor of public health and challenge the premise that underlies the Mayor’s budget instructions. Jackie Jenks, Executive Director of Central City Hospitality House. She appreciates the difficult position the Health Department is in, and said the list of the mental health, substance abuse and primary care are devastating and urged the Commission to tell the Mayor that the cuts are unacceptable. She said the self-help center is more than just a referral service. Esther Chavez, Director of Tenderloin Self-Help Center, urged Commission to oppose closing the center. Luther Richert, Central City Hospitality House, said the self-help center is much more than a referral service. They provide myriad services to homeless people. Suzana McKenzie urged the Commission to consider the human costs that will result from eliminating the MHRF. Lori St. John Baldwin said SFGH should be given more money, not asked to cut programs. It is the Health Commission’s duty to convey this. Philippa Ruttgaizerm, MHRF employee, is opposed to the closure. The residents need the current level of care. Piers MacKenzie spoke in support of the MHRF. His daughter has made great progress through her care at the MHRF. Toni Maines, said that the Patient Referral and Assistance at SFGH has evolved. She submitted a written copy of her testimony (on file). Carol Cheung urged the Commission not to cut services at Chinatown Public Health Center. Barbara Farrell, Ohlhoff Recovery Program, urged the Commission to oppose cuts in substance abuse services. Merrill Buice, San Francisco Human Service Network, urged the Commission to send the Mayor a strong message to preserve safety net services for vulnerable San Franciscans. She submitted a copy of her testimony (on file). Kent Woo, NICOS Chinese Health Coalition, thanked the Department for using the Strategic Plan to guide the budget reductions, to maintain Healthy Kids, cut administration before programs, and prioritize prevention. He is concerned about cuts to the SRO program. Renee Saucedo, Day Laborer Program, said they will not accept cuts being made on the backs of day laborers. Hundreds of people depend on the HOPE team. Without HOPE, the day laborers will not access the health services they need. She is appalled that the Commission is considering eliminating translation services. Eduardo Palomo spoke in support of health services for the Day Laborer Program. Without them there will be an epidemic in the city. Julio Loyola, Day Laborer Program, spoke in support of the HOPE program. Many Latinos need this help in order to survive. Ben Rubilcalva, employee at Laguna Honda Hospital, is opposed to contracting out the laundry. Shira Shavit, M.D., Family Practice Resident at SFGH, spoke in support of the translators at the hospital. 50% to 70% of her patient panel is monolingual non-English speakers. She depends on interpreter services-there are not enough currently. Reini Jensen, SFGH Physician Resident, urged the Commission to demand from the Mayor that more money be allocated to health care in San Francisco. Support staff at the health centers is already at a minimum and should not be cut further. Ed Kinchley, SFGH/SEIU 790, said that if many of the proposed cuts are made, people will not be able to find prevention services or primary care services that they need. Need outreach and referral. It is discriminatory to cut interpreter services. Michael Lyon said the Health Commission is not the appropriate body to make cuts that will kill hundreds of people in San Francisco. They need to say no more. No justice, no peace. Terry Bautista, California Healthcare Interpreters Association, is opposed to cuts in translation services at SFGH. She submitted a copy of her testimony (on file). Jennifer Friedenbach, Coalition on Homelessness, said the Fire Department and the Police Department would never accept cuts of these levels. The Health Commission cannot send a budget to the Mayor that reduces substance abuse services, day treatment, mental health and homeless services. Michael Weinberg, field representative for SEIU Local 535, said there has to be other alternatives to solve the budget. The cuts that are proposed are too severe to the citizens of the city. L.S. Wilson, Coalition on Homelessness, urged the Health Commission to reject all these cuts and demand that the Mayor find savings that do not target poor people. He distributed a fact sheet to the Commissioners (on file). Raychel Headspeth spoke in support of Walden House. Walden House helped her change her life and she urged the Commission not to cut funding. Delphine Brody, Mental Health Association of San Francisco, is opposed to the cuts in community-based mental health services. Jayne Snook has a brother in the MHRF. Please do not close this facility. These are not just budget cuts, these are lives. Stand up and say no to the cuts. Pamela Fischer, President of National Alliance for the Mentally Ill, said her son has been helped tremendously by Walden House and Baker Places. She is broken hearted that the system is being nibbled away at because it is a house of cards. Teresita Gatan, SFGH employee, said the care the hospital provides to patients is being compromised by cutbacks. She asked the Health Commission to recommend more funding to the Health Department rather than accept cuts. William Bradley Bauman is a graduate of the MHRF. The MHRF has many programs such as yoga, art, money management, library, volleyball and many others. Do not change the program. Karen Patterson Mathew, Executive Director of Bayview, spoke in opposition to the cuts. Kathleen Dobson, Health at Home, is opposed to the proposal to eliminate three home health aides. Helping people heal in their homes is less costly than having them heal in a hospital. She submitted a written copy of her testimony (on file). Bryan Uyeno, Laguna Honda Hospital laundry worker, spoke in opposition to contracting out the laundry. By contracting out, the other laundry companies will pay poor wages and have poor working conditions. Sixty three workers will be displaced. Byron Holcomb, Laguna Honda Hospital laundry worker, is opposed to the cuts in the Health Department, and asked the Commission to use the higher power it was given when making these decisions. Sonny Quiniquini, Laguna Honda Hospital laundry worker, is opposed to contracting out the laundry. Without the workers DPH would not have a Laguna Honda Hospital today. It has the money because the Health Department executives received bonuses. Mary Kate Connor, Executive Director of Caduceus Outreach Services, said these cuts disproportionately target people with mental illnesses and substance abuse problems. Clearon Johnson said thanks to the services she received she is a productive member of society. Larry Bevan, Local 250 shop steward, expressed concern about the reprogramming of the MHRF. He submitted a copy of his testimony (on file). Josie Mooney, Executive Director of SEIU 790, said some of the proposed cuts are in outright violation of the MOU. These proposals should not have been made solely by the Department-should have included unions, community, non-profits and others. Margaret Brodkin, Executive Director, Coleman Advocates for Children and Youth, thanked the Department for supporting the Healthy Kids Program. But the Commission should reject the concept of across-the-board cuts throughout the city. Not every department is equal. Demand a humane and progressive budget. Sally Ann Buchmann, shop steward and SFGH employee, said the MHRF should continue in its current form. She also supports retaining bilingual services at the hospital. She cannot do her job without the translators. She also supports the substance abuse program. Don’t balance budget on overworked city workers and the poor. Vincent Villarreal, Psychiatric Emergency Services, the proposed cuts will mean more patients in emergency services. The MHRF clients go to PES, and are glad that the MHRF is there for them. Without the MHRF, the people will get worse. Feo Jacobsen, SFGH Department of Psychiatry, is opposed to the closure of the MHRF. Deborah Logan, SFGH Department of Psychiatry, is opposed to closing the MHRF and cutting substance abuse services. Mental health and substance abuse services cuts are disproportionately represented in the proposed budget reductions. Mental health patients have the right to be treated in their community. Otto Duffy, Tom Waddell Clinic Community Advisory Board member, said the proposed budget cuts will create more activism among consumers, which is one silver lining. He’s opposed to the proposed cuts. Testimony submitted in writing by members of the public Brad Shapiro - My name is Dr. Brad Shapiro, and I am a family physician who provides care to homeless families in San Francisco through the Homeless Families program based at Tom Waddell Health Center. Given the extraordinary breadth and depth of the proposed cuts in mental health, substance abuse, and homeless outreach services, I feel the need to register my strong conviction that these cuts will have a severe impact on many San Francisco residents. These deleterious effects will be most concentrated among the people with the least ability to deal with them and will perpetuate the circumstances that drive people into homelessness. As you know, medical and mental illness as well as substance abuse are major causes of homelessness. Cutting necessary services will not result in cost savings and will cause increased suffering. Please consider cutting services and tax breaks to the wealthy and healthy who can take care of themselves rather than removing the final safety network for people in desperate need. Damon Eaves - Dr. Katz said that it doesn't make sense to have outreach workers giving information on programs if there are no programs for the clients to go to. The HOPE team was not a referral program. Based out of Tom Waddell Health Center, composed of two social workers and a health worker, our mission was to engage, build rapport, and offer services to the homeless, street based clients who were unable to do it on their own. The services offered are already in existence. This 3-person team provides services to hundreds every month at the Mission Hotel, Jefferson Hotel, the Man's Place Shelter, Day Labor Program intensive outreach and our weekly Health Realization group. There used to be 11 members on the HOPE team, now there are three, so we have experienced cuts, we don't expect to be left untouched. All we are saying is we have been "touched" already. Our job is to create a bridge between the most needy clients and the services in place for THEM. The reality is, that to have the service is not enough because many of the most needy clients are unable to access or tolerate the system without assistance and advocacy. To save 244k, this vital link is going to be dismantled? Irene Lucero - Greetings. My name is Irene and I have been working at the MHRF since the day it was open. It has been a terrible disappointment to see the MHRF close down, that also brought a tremendous impact to both our residents and staff emotionally and mentally. I have considered MHRF as my second home, I started at a young age of 22 and I’m now 28 years old and I have seen a great influence of the care we gave to our residents, the full dedication and hard work that all my colleagues have exerted for the past six years, and it was very fulfilling to see our residents discharged and placed in the community where they are supposed to be, as well as see them achieve their highest level of functioning. I am truly hoping and pray that the County will come out with possibilities and ways that could prevent our facility to be close. Indeed, I do understand the billion of dollars deficit but I hope that the County realizes that a lot of lives and families are relying on these organization. And no matter what happens, I will stay until the bitter end and will give my full support to the residents, staff and to the MHRF. Lets all be together and fight to save the MHRF. God bless and hope for the best. Craig Allen Diaz - we want the residents to run the MHRF with a new name and director from residents, staff, or outsider (score)--ranks. We want current employees of over a month’s seniority, and a good work record to get a $5000 -- to--$7000 "exception" or lay-off bonus. We will continue a strong medical presence. The new MHRF will be run lean and tight on only residents' monies. The City will save much money in these times of SF budget troubles. We residents especially want the right to refuse drugs!!!! This will be a communal democracy, a housing place for low-income people. We admit there will be big cuts in the budget. We will build and continue connections with SFGH, with visits to residents at SFGH. We demand the right to refuse drugs!!!! We demand an open door!!!! We demand housing now and in the future!!!! Jay Wright - My name is Jay Wright. I have worked at the MHRF since it opened in 1996. The DPH plan to reduce the budget deficit by taking the drastic step of closing the MHRF is a tragedy. This facility has provided excellent care for over six years and has been a home to over 150 residents. Not only will the proposed closure displace hundreds of workers, not all residents function at a level that will allow them to remain in the MHRF if "reprogrammed" to a RCF, so they will have to move. There are other ways to reduce the operational expenses of the MHRF, but at a MHRF meeting Gene O’Connell reportedly said, "There is no Plan B" when asked what other options were being discussed as an alternative to MHRF closure. Please tell Mitch Katz to go back to the drawing board, talk to the unions and come up with some viable options! The MHRF really is worth saving, just ask the residents! Thank you. Anonymous - To those to whom much power is given: the use of power must be considered. Anonymous - I am a peer counselor who knows the value of mental health care. If these budget cuts go through, we will be telling those who have mental illnesses that they are no longer a value to this society. We are telling them that they don’t matter. We are telling them that we are a county that encourages freedom but we are not willing to support basic human rights. People that are ill need to be taken care of, the hungry fed, the homeless sheltered. Where are our American and family values? Evelyn Bishop - I have been at the MHRF for 8 months. I have been at other “mental health” facilities from anywhere from two days to two months, including Bellevue Hospital in NYC. At the MHRF, we are required to take correct medications for a variety of ailments, from schizophrenia to manic depression, which includes schizoid defective disorder, which means that people spend their time talking to themselves, which can be very annoying, but which the staff at the MHRF handle with aplomb and calm. At the MHRF, I have had the time and the care to admit to having been raped and also owning up to suicidal tendencies, which helped the staff steer me to the correct medications. I no longer have illusions, hear voices, or long for death to take away my mental pain. I choose to endorse the MHRF for its long-term care assistance, in helping me become housed and job ready. Dominic Chan, Assistant Director of the Hospital Division of SEIU Local 250 - The proposed conversion of the MHRF into residential care facility raises some serious questions about what will happen to the current clients. About 75-80 percent of the current clients would not be able to stay in the new facility. What happens to these people and the families that come to see them? Is the City and County going to send them all over the state to wherever they can find room? What is the plan for dealing with these clients who have long-term mental illnesses? Also, by changing the MHRF’s license, the Health Commission would be going against the will of the voters. In 1987, San Francisco voters approved Measure C, which was a $26 million bond measure to build the MHRF. The building opening in 1996. I am sure that the voters would not be happy that the facility that was built specifically for long term mentally ill patients would only serve that mission for seven years. Local 250 urges the Commissioners to seriously reconsider converting the MHRF. Ed Bell - I am an employee at the MHRF, Mental Health Rehab Worker, Class 2303, Certified Nurse Assistant. The re-licensing of the MHRF to a no level residential facility will put many, if not all of our psychiatric patients at risk of homelessness, decompensation and suicide. The patients of the MHRF are residents of San Francisco who have the opportunity to lead productive lives upon ready discharge to go to work, school, live on their own or back with their families. These residents are our mothers, fathers, grandparents, our brothers and sisters, our children and our neighbors. They deserve to continue to receive vial services, quality services and hope for a productive place in society. The MHRF gives them this voice just the way it is. I urge you to not place these patients/people in a situation of uncertainty and unsafe conditions. Jennifer Baity Carlin - Closing the MHRF, a locked psychiatric facility on the campus of San Francisco General Hospital will not save money. While it may magically make $8.1 million disappear from Dr. Katz's new budget, what would happen if the MHRF were closed is this: The patients would be discharged into unlocked community facilities where their emotional and behavioral needs could not be met (which is why they are there in the first place.). Then they would either assault someone (costing money in police and medical care response), use drugs (costing money in increased ER and inpatient psychiatric visits), stop taking their medication (which usually lands them back in acute psychiatry as well) and (if they were still alive) would be brought to the ER or Psychiatric Emergency Room at SF General or sent to high cost locked facilities out of San Francisco. Guess what? All that costs money too. Thank you. Lynn Carman - I represent Dr Teresa Palmer, Mr. Ed Kinchley, and the Coalition to Save Public Health-SF in a legal action to compel the City and County of San Francisco to abide by California Health and Safety Code 1442.5. The Superior Court has issued alternative writ of mandamus, which commands the Board Supervisors to comply with public notice requirement of Section 1442.5 before adopting a budget, which reduces the level of medical services at San Francisco General Hospital. The Board of Supervisors has adopted a policy, which the City Attorney states complies with the Superior Court order. The Board’s motion, M02-204, calls on the Director of Public Health to notify the Board of any budget provisions, which would reduce the level of medical services in any health facility in the City and County of San Francisco. Under the motion, Director Katz is to post the 1442.5-mandated public notices at the entrances of all health facilities of the City and County of San Francisco with the information required by the statute at least 14 days before the full Board of Supervisors holds the 1442.5-mandated public hearing in advance of adopting such budget provisions. Superior Court Judge Robertson has continued his order to July 31st to see if the City complies with the order, and has directed me to apply to the Court for contempt proceedings if the order is violated. Dr Katz states unequivocally that his budget proposal will cut the level of medical services. Therefore, we expect Dr Katz to comply with the motion MO2-204, under both motion M02-204 itself and the continued Superior Court order prompting the motion. I request this letter be made a part of the public record of this hearing. Information to be supplied to the Board of Supervisors pursuant to its HS 1442.5 obligations must include the service reductions that would result from cuts or freeze to the UCSF-DPH contract. Patrick Monette-Shaw - DPH’s proposed fiscal year 2003-'04 budget priorities are totally out-of-whack. DPH’s base budget eliminates funding for the LHH Increased Nursing Model - intended to provide residential skilled nursing care to 1,065 low income and homeless clients with cognitive and physical disabilities -- by $525,919. Page 13: Dr. Katz’s Alice-in-Wonderland logic rationales this cut stating: “We have never been able to provide increased nursing model at LHH.” Well, duh! Instead of filling the 6 FTE Nursing positions, DPH is proposing a $150,000 increase for syphilis prevention. DPH is now distributing a “Party Pack” incentive to STD survey respondents; it contains a toy penis, toy syphilis sore, a condom, lubricant, and amazingly, jelly beans. A third squishable toy, at unknown cost, is reportedly being manufactured: A toy antibiotic pill. Where is the evidence-based proof these “packs” will prevent syphilis cases? Until this Commission prioritizes Nursing above these toys, Nursing will never become a priority! Sharifa Rahman - I have worked at the MHRF as a mental health worker for two years. I have seen many of our patients who were not able to live in the community when they came to us, improve with our help to the point where they became able to live in the community. Most of our current patients are not able to live in the community (this includes RCFs). It would be a tragic loss if the MHRF were to be converted to a RCF. I beg you to stop this proposal and seriously examine the facts and needs. (Peter Shaw, activity leader at the MHRF, added to the letter “I agree with all the above. I’ve worked at the MHRF since 10/96.) Anonymous - I was patient at the MHRF. Please don’t close it down. Greg Peter Gery Rosk - I want the MHRF to stay open and I hope the MHRF will stay because it is a very nice place to live at the MHRF and it is a very good hospital. I like everyone at the MHRF and I hope that the MHRF will have a good place to stay in. M. Williams - This is a letter to inform you that I, as a two-month member of the MHRF facility would like to see this building stay open. The reason for this is that we the patients require nursing care and this facility provides it. At a board and care facility, we would not be as well taken care of. The staff tries to provide for our needs as well as possible, and we the patients feel that they are fulfilling a needed role in the community. The reason for this is that what with people falling mentally ill, there is need for a facility of this type. I don’t feel that it is right to slash the budget as MHRF fulfills an important role in the community, a place for mentally ill people to get better. Enola Maxwell, Potrero Hill Neighborhood House, submitted a packet of information about the ZAP Program (on file). The Family Service Agency of San Francisco submitted a packet of information (on file). Commissioners’ Comments Commissioner Monfredini asked the Department to look closely at the day treatment cuts to see if the proposed level of cuts could be reduced. She would also like a breakdown of the HOPE program budget. Commissioner Parker emphasized that we are all in this predicament together and we need to work together to close the budget gaps. He will accept any suggestions from the community. He requested a consolidated list of all the programs that are proposed to be eliminated or modified, with a clearer description of the impact the modification will have on services. Commissioner Umekubo said we are faced with a situation where we either have to cut or get more money. We have to leave no stone unturned to pursue more funding. He is not sure if the budget before him today is the least detrimental possible, and we need to keep an open mind. What this situation demonstrates is the under funding of health care from top to bottom. We need to be creative and minimize the damage. Commissioner Sanchez said that the safety net no longer exists. The citizens of this city have dedicated money to build a health care system that includes a new Laguna Honda, San Francisco General Hospital, and the MHRF. This quality system is being dismantled, and we need to explore creative ways to salvage a level of quality care. Commissioner Penn said the Commission needs to be clear what message it sends to the mayor. It does not make sense to ask departments across the city to make equal cuts. The long-term impact of health cuts are so much greater than cuts in other areas. This must be made clear to the mayor. Second, while the philosophy of maintaining direct services sounds good, reducing ancillary services has a ripple effect. The Commission does not have a good idea of the potential fiscal and long-term health impacts of these cuts, and needs more information to make informed decisions. We cannot cut interpreter services-this budget should be increased. We need to work with non-profits who are getting cut to see if the amount of the cut can somehow be reduced. Finally, we do not have the benefit of the individual division heads’ thoughts, and what alternatives were considered. Need to advocate for more money and not blindly accept the cuts. Commissioner Guy said the health care system is growing but the safety net is not. She supports that framework that the proposed budget was created within. The Strategic Plan does point the way, but the goals of the plan will be challenged by these budget cuts. The Department cannot improve its situation on its own, but needs the State and Federal governments. She supports areas that the Department wants to expand. She would rather make the tough budget decisions rather than having the Board of Supervisors do it without the informed deliberation of the Health Commission. Commissioner Chow summarized the follow up that was requested by the Commission: analyze additional revenue sources; advocate for reducing DPH’s target; provide additional information to more fully understand the impacts; put the MHRF changes into context explain how the change affects the mission; more details on what the day treatment changes really mean-are they essential or just nice to have; rationale for a 50 percent reduction to interpreter services; reexamination of the patient referral system function, so that perhaps while there are no nurses, there is staff to make appointments. Commissioner Chow emphasized that the Department should be commended for developing a budget based on a set of principles. 6) PUBLIC COMMENTS None. 7) ADJOURNMENT The meeting was adjourned at 7:56 p.m. Michele M. Olson, Executive Secretary to the Health Commission