Minutes of the Health Commission Meeting Tuesday, February 18, 2003 at 3:00 p.m. 101 Grove Street, Room #300 San Francisco, CA 94102 1) CALL TO ORDER The meeting was called to order by President Chow at 3:10 p.m. Present: Commissioner Edward A. Chow, M.D., President Commissioner Roma P. Guy, M.S.W., Vice President Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner Michael Penn, Ph.D. Commissioner David J. Sanchez, Ph.D. Commissioner John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE SPECIAL MEETING OF FEBRUARY 5, 2003 Action Taken: The Commission approved the minutes of the February 5, 2003 Special 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 and HAH - Request for approval of a contract renewal with Toyon Associates, Inc., in the amount of $385,562, to provide reimbursement and revenue optimization services to San Francisco General Hospital and Health at Home Agency, for the period of April 1, 2003 through March 31, 2004. (3.2) CHN-SFGH/Health Information Systems - Request for approval of a sole source renewal contract with Deliverex, Inc., in the amount of $640,000, for the purpose of storing, retrieving and delivering medical records for San Francisco General Hospital’s Health Information Services, Medical Staff Services and Radiology Departments, for the period of March 1, 2002 through June 30, 2004. Commissioners’ Comments Commissioner Monfredini requested a follow-up report to the San Francisco General Hospital Joint Conference Committee in four months. (3.3) PHP-Environmental Health and Occupational Health and Safety - Request for approval to accept and expend retroactively a new grant from the U.S. Environmental Protection Agency through the State Department of Health Services, in the amount of $50,548, for beach water quality monitoring and public notification programs, for the period of November 1, 2002 to September 30, 2003. (3.4) AIDS OFFICE-HIV Prevention Services - Request for approval of a retroactive sole source contract renewal with Harder + Company, in the amount of $273,345, to provide technical support services to the HIV Prevention Planning Council, for the period of January 1, 2003 through March 31, 2004. Commissioners’ Comments Commissioner Monfredini asked if things have improved at the HIV Prevention Planning Council. Mr. Loyce replied that a number of things have improved and there is a good relationship between the Planning Council and the AIDS Office. Commissioner Monfredini requested a status report in July to Population Health and Prevention Joint Conference Committee. Action Taken: The Commission approved the Budget Committee Consent Calendar, with the following reports through the Joint Conference Committees: a four-month status report to the San Francisco General Hospital Joint Conference Committee on Item 3.2, and a six-month status report to the Population Health and Prevention Joint Conference Committee for Item 3.4. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, submitted the Director’s Report to the Commissioners. Federal Budget Passed Acting more than four months after the start of the 2003 fiscal year, Congress last Thursday completed its work on the 2003 federal budget by passing a $397.4 billion omnibus spending bill that funds every aspect of the government outside of the military. The legislation, which comprises eleven separate FY 2003 appropriations bills, includes an across-the-board reduction of 0.6% to 0.7% but exempts several programs from the reductions, such as health care programs for veterans and the Women, Infants and Children Supplemental Nutrition Program. Though the spending plan includes increases in the National Institutes of Health, the Centers for Disease Control and Prevention, and Medicare reimbursement, it does not include much-needed fixes for the health care safety net, specifically postponement of scheduled reductions in the Medicaid Disproportionate Share Hospital Program and increases to the States’ federal matching assistance percentages. The federal spending does, however, include two DPH-specific funding allocations - $750,000 for the Department’s master-leased housing program for chronically homeless and multiply diagnosed individuals, as well as $750,000 for HIV/AIDS programs for women and persons of color. San Francisco’s congressional delegation and, in particular, Congresswoman Pelosi, deserve our gratitude for their support of these important initiatives. Healthy Kids Initiative Press Conference On January 27th, First 5 California held a press conference with its Chair, actor/director Rob Reiner in the lobby of SFGH to promote the Healthy Kids health insurance program. The San Francisco’s Healthy Kids program provides comprehensive health insurance coverage program for children under age 19 living in families with incomes up to 300% of the federal poverty level who are not eligible for other public health insurance programs. Healthy Kids insurance expansions are also available in San Mateo, Santa Clara and Solano Counties. First 5 was established after the passage of Proposition 10, which added a 50 cent-per-pack tax on cigarettes to fund education, health, and child care programs. . Black History Month Activities The African American Health Initiative and the Managers of African Descent co-sponsored a number of events celebrating February as Black History Month. An African-American Health Summit was held on January 31st and February 1st. Other events included the African American Health Initiative, Third Annual Educational Cultural Event and Black Infant Health, Afro-Centric Parenting. An African American Behavioral Health Conference will be held on February 21st. For more information, call 255-3427. Behavioral Health Integration Forum A community forum will be held on Friday, February 28th, to present an overview and solicit community comment on the Behavioral Health Services planning process. The forum will be held from 10 a.m. to 12 noon, at 101 Grove St., Room 300. For more information call Carolyn Lieber at 255-3740. Prevention Plan Update Working towards the development of a five-year prevention plan for the Department, a Prevention Planning Workgroup will be meeting biweekly for the next six months. The workgroup is made up of representatives from each of the sections represented at the extended Community Programs management team. Its function is to do preliminary work, including research and data review on health determinants as well as best practices. Successful Licensing Survey at Laguna Honda A team of 15 State Licensing and Certification evaluators completed its annual survey of Laguna Honda Hospital on Friday, February 14th. The State team conducted an exit conference in which it announced preliminary findings of no substandard care issues identified. The evaluators will submit their final survey report in the next few weeks. DPH commends the staff of Laguna Honda for their excellent performance during this year's survey. NACCHO Newsletter Features DPH Social Justice Programs The Winter 2003 issue of NACCHO Exchange, the newsletter of the National Association of County and City Health Officials, focuses on health inequities and features an article by Rajiv Bhatia, M.D., M.P.H., Department of Public Health’s Director of Occupational and Environmental Health. The article, entitled Addressing Health Inequities in a Local Public Health Agency: Exploratory Strategies, describes some of the efforts towards health equity being undertaken by the Department, such as using participatory action research methods to address the lack of affordability and access to nutritious food in low-resource neighborhoods. The publication can be viewed at http://archive.naccho.org/Documents/naccho-exchange-winter-2002.pdf. Achievement Joan Jovero McNicholl, Pharm. D., recently earned the designation of Board Certified Pharmacotherapy Specialist (BCPS) from the Board of Pharmaceutical Specialties. This is the pharmacy’s highest credential in the practice of pharmacotherapy. Through board certification, pharmacotherapy specialists demonstrate a defined level of education and training, as well as mastery of the knowledge and skills necessary to meet the public’s demand for expert pharmaceutical care. Dr. McNicholl’s practice as CHN ambulatory care clinical pharmacist includes medication management clinics at Southeast Health Center, Silver Avenue Health Center and the SFGH Adult Asthma Clinic. 2003 NAPH Fellows Selected Colleen Johnson, DPH's Assistant Director of Policy and Planning, and Sue Currin, SFGH's Chief Nursing Officer, were selected among many outstanding candidates to participate in the National Association of Public Hospitals' Fellows Program for 2003. This year's program encourages the development and dissemination of a new model for collaboration between government affairs and communications/public relations staff among member hospitals. DPH congratulates them both for their acceptance into this distinguished program. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF FEBRUARY Individual Awardees Division Nominated by David (Shao) He IS Administrator II Emergency Medical Services Michael Petrie, EMS Administrator Fredy Ramos Env. Serv. Supervisor Environmental Services Melvin O. Pipkins, Environmental Services Director, SFGH Team Awardees Division Nominated by Syphilis Response Team Felipe Acosta Bart Bartolini Gloria Calero Joseph Engelman Larry Hanbrook Jacqueline Siller Terrance Sha Ilene Zolt STD Prevention and Control Services Jeff Klausner, M.D. 6) FISCAL YEAR 2003-2004 BUDGET REVIEW AND CONSIDERATION OF A RESOLUTION REGARDINGTHE PROPOSED FISCAL YEAR 2003-2004 HEALTH DEPARTMENT BUDGET Mitch Katz, M.D., presented a revised Department of Public Health FY 03-04 budget and a resolution for the Health Commission consideration. Since the February 5, 2003 budget hearing, DPH staff compiled data requested by the Commission. They were also able, in a few cases, to work with community partners fashion better solutions that the ones previously proposed. Dr. Katz gave a power point presentation, which is Attachment A. Public Comment Adrienne Warren - closing the MHRF will cost more money than it saves. Angela Cassidy - opposed closing the MRHF. Greg Rosko - keep the MRHF open. Jeffrey Gordon, please to keep the MHRF open. Rochelle Robinson, keep the MHRF open. Lenorris McCoy, supports saving the MHRF. The MHRF changed his life. Leslie Will - There should be no budget cuts. The MHRF should remain open. He does not even think the proposal is legal. He submitted a written copy of his testimony (on file). Shumlic Saenz, Western Addition Recovery House, it is hard to get into a recovery program. These cuts will be drastic. David Lusk, Western Addition Recovery House, is opposed to the budget cuts. Pam Fisher, President of NAMI, opposed to cuts in mental health, which will create bigger holes in the system. She is opposed to cutting the MHRF. Carolyn Johnson, opposed to budget reductions in Haight Ashbury Free Clinics Recovery program. Dr. Mardell Gavriel urge the Commission to save residential drug treatment. Erika Horn, opposed to cuts in day treatment programs. Michelle Green, opposed to cuts in the Haight Ashbury Free Clinics OSHUN program. Buurta Coxell, Thunderseed program, urged the Commission not to cut these critical services. Edward Sawyer, opposed to cuts in day treatment. Ernest Mayen, opposed to cuts in Bayview Thunderseed program. Steve Slaton, opposed to cuts in the Bayview Thunderseed program. Nat Jordan, Program Director, Bayview Thunderseed program, is opposed to all cuts. Damon Eaves, opposed to the cuts in the HOPE team. Without support of specialized outreach, many people cannot tolerate systems. And the Department needs to restore the homeless death count. He submitted a written copy of his comments (on file). Arthur Bosse, ED of the National Council on Alcoholism in the Bay Area. The largest barrier to treating addiction is money. He urged the Commission not to cut substance abuse programs. Barbara Farrell, ED Ohlhoff Recovery Programs, opposed to cuts in the CBO substance abuse infrastructure. Intervention and treatment is prevention. Donald Frazier, SF Association of Drug and Alcohol Program Contractors and co-chair of the HIV Service Planning Council. Traditional twelve step programs have no cultural significance in African American, Latino or Native American communities. Do not cut the drug treatment programs. Tom Barton, shop steward in dietary department at the MHRF. The city should not be making cuts while giving management bonuses. Eloise Westbrook - opposed to cuts in dental services Piers MacKenzie, opposed to the elimination of the MHRF. If the facility is closed, where will people, including his daughter, find comparable treatment? Karla Thurston, opposed to closing the Bayview Clubhouse. Increase funding for mental health services. Norma Hotaling, ED SAGE program, opposed to all the cuts, and recovery works. Hunter Gatewood, social worker at the MHRF. Opposed to changes in the MHRF. The patients they serve are not stable. The question is not where are current patients going to go. The question is what will happen to the people who need to come here? He submitted a copy of his written testimony (on file). Mr. Ramirez, opposed to cuts in substance abuse services. AA does not work for everyone. If people think it is expensive to keep these programs, it’s more expensive to keep people in jail. Keith Lindell, opposed to cutting the HOPE team. Matt Crawford, please do not close the MHRF. The MHRF saved his friend’s life. Mickey Shipley, opposed to closing the MHRF. He is disgusted that the mental health and substance abuse consumers have to take the cuts on their backs. Susana MacKenzie, opposed to closing the MHRF. The affects of the closure have not been adequately analyzed. Dr. Verna Chapman-Lewis, HAFC OSHUN program. The program provides respite, refuge and respect to more than 150 women. Opposed to cuts in this program. Kaceem Bennett - HAFC Center for Recovery, opposes cuts to services when services should be increased. Melvin Beetle, Senior Action Network, said 22 percent of homeless seniors have mental illness, and do not take the health away from them. Health care and mental health care is a universal right. Karen Pavalotti, Local 250, opposed to plan to convert the MHRF. Have dollars for the DPH bonuses been cut from the budget? She urged the Commission to not approve this budget. Ed Warshauer, Local 790, if the budget cuts are made, they will result in death. This process is not properly completed. The process needs to be slowed down. Lindsay Berger, Youth Commission Public Health Committee, said DPH should not cut programs for people who cannot be served by another, for example the Ark House. Also concerned about cuts to outreach budget. Opposed to cutting the Thunderseed program and Haight Ashbury Free Clinics. She submitted the Youth Commission Public Health Committee’s written statement (on file). Kathleen Dobson, Health At Home Certified Home Health Aide, opposed to cuts in Health at Home. They cannot be replaced by in-home support services. Rebecca Morrow, R.N. urged the Commission to have the wisdom and courage to say no to this budget proposal. Ben Eiland, HAFC, said that treatment programs are very different from 12-step recovery programs. The Health Commissioners are the advocates for these services. Treatment works. Ed Kinchley, works in the ER at SFGH. His job would be impossible without interpreters at the hospital. The cuts will mean a decrease in quality of services. The Commission has not saved all prevention and promotion services. Vote no on the cuts. Mary Magee, opposed to all of the proposed budget cuts. Cuts in interpreter services, patient referral services, substance abuse services all have major ramifications. Vote no on the cuts. David Galvez Decorra spoke in support of the Latino House. The program really helps the Spanish-speaking people. Roberto Zendevas, from the Latino Commission, opposed to substance abuse cuts. Julio Loyola, supports services to the Day Laborer Program, and said the programs help people with mental and physical illness. Oscar Fuentes, said the Latino Commission program works well and should not be cut. Yehiel Yisrael, Morrisania West, said the city needs more substance abuse and mental health programs, not less. He submitted a written copy of his testimony (on file). Nsoah Chionesv, Acupuncture Services at BVHPF, said substance abuse treatment gives clients tools to increase options. Acupuncture is an important tool. Willie Burnett, said acupuncture helped him move away from drugs. Eve Meyers, said the Commission cannot support these cuts. The community must have mental health services and the Commission must say no. Martha Ryan, ED of the Homeless Prenatal Program, said without adequate substance abuse services to treat these women, they go right back into the jails or die on the street. Substance abuse services are prevention. Joe Brosnahan, opposed to cutting the BVHPF acupuncture program. Michael Lyon, said the PBM was supposed to save money but it has not done so. Woman (did not state her name) spoke in support of BVHPF acupuncture services. These services are important to her recovery. Janice Hicks, client of BVHPF acupuncture program, urged the Commission to save the program. Alfedth Nesbitt, BVHPF, is opposed to the elimination of the acupuncture program. She is also opposed to cuts in any mental health or substance abuse services. Jackie Jenks, ED Central City Hospitality House, said that none of the programs slated for cuts are expendable. The closure of the Tenderloin Self-Help Center means 10,000 people will lose these services. This is a prevention program. She submitted written information (on file). Esther Chavez, Tenderloin Self-Help Center, said the cuts would mean 200-300 people a day would not get services. More homeless people will be on the streets. Nathan, interpreter at SFGH, said that SFGH’s mission is contradicted by the proposed cuts in interpreter services. There are already too few interpreters. Juidell Preston, on behalf of Epiphany House, because of them she’s almost a year clean. Women in recovery need these services. Don’t cut substance abuse or mental health. Cut something else. Rosalio Gomez, medical interpreter at SFGH, opposed to all cuts, specifically in interpreter services. The department cannot function with only half of its staff. Gregory Senegal, said every provider needs the opportunity to present alternate proposals to the Commission. Mark Ryan, volunteer at the Tenderloin Self-Help Center, which has been successful in helping people who have been thrown off of GA jobs. The harm reduction services helped him. They do not provide cash, but they do provide care. Chris Lehr, urged the Commission not to cut the HOPE team. Gene Hartman, supports the services at the BVHPF acupuncture program and is opposed to the cuts. Alphonso Moore, client of Walden House, said do not cut services to people who want recovery. The end result will be jails, institutions or death. Shelli Fein, National Council on Alcoholism, urged the Commission to oppose all budget cuts. Larry Beven, Local 250 shop steward, urged the Commission to oppose the cuts and put these decisions on the elected officials. Let them explain these cuts to the public. The MHRF provides a safe, secure facility thanks to the support from this Commission. Do not end this support. Starr Davies spoke in support of the OSHUN center. She has had three success stories through OSHUN. Rachel Maclean, DOPE project, said it is ironic that these cuts are taking affect when the care not cash initiative is being put into affect. She is opposed to all of the cuts. Jerry Minkos, opposed to cuts in dental services. Ed Bell, MHRF employee, supports the MHRF and opposes changes. The patients who need locked care will have to go out of county, which presents a hardship for their families to visit. Sasha Cutler, PHN at SFGH, said without interpreter services the mother of Elizabeth Dominguez would not have been able to get counseling services last week after her daughter was killed. Reject the budget. J.K. Terry, MHRF employee, is opposed to eliminating the MHRF. Closing it will not save money. Jessica Leavitt, client in the Ohlhoff recovery program, said because of drug treatment she is seven months clean and sober, a student at City College, and has a part-time job. Janis Bennett, said that through the Ohlhoff women’s program she has a relationship with her children and herself. She is now a productive member of society. Don’t cut these programs. Nancy Cooper, director of Ohlhoff’s women’s program, said it took over a year to open up a 9-bed treatment facility. They have a 90-women waiting list for one bed. Do not make any more budget cuts affecting substance abuse treatment. Jessica McCandless, said that through the Ohlhoff women’s program she is a student, has a relationship with her family. Please don’t make any budget cuts. Andrea Young, client at Ohlhoff and user of acupuncture services. Without these services she would be out on the streets. Testimony submitted in writing by members of the public Mary Will - I am objecting to Dr. Katz’s proposed cuts to our mental health programs. The people at the MHRF are very ill and require a locked facility when they are being treated for delusions, paranoia, hallucinations, and often voices. They must have the MHRF to help them return to the community. They need half way houses, day treatment programs, and transitional housing as well. It is unconscionable to take this away from people, most of whom can’t speak for themselves. My son is now at the MHRF. He is soon to be released to a halfway house, and the change in him has been dramatic! It is almost like a resurrection. It is criminal to close the MHRF. One more thing: I am able to visit my son every day, but this would be impossible if he were elsewhere-Vallejo or Napa, for example. It would be a terrible hardship on those who don’t drive. Mary-Lynn Garrett - My name is Mary-Lynn. I am a colleague and fellow professional in the homeless outreach field. I am making a special effort to be here and speak on behalf of my fellow professionals on the HOPE team. HOPE fulfils its name in the following ways. The (1) meet homeless where they are: on the street and in their episodes of inebriation and in their moments of clarity when they can choose to go. 2) HOPE is unique in that it asks SF’s homeless to make a change. When that choice is made, HOPE makes sure they get the services to make that change possible, by making these services accessible to the client. 3) Finally, HOPE collaborates with other services to design a supportive community and refer them to housing! Robert and Sandra Arkoff - The limited time allowed for intensive psychiatric hospitalizations is insufficient to allow stabilization or provide ongoing treatment. Upon release people often stop medication and quickly become unable to manage their psychiatric needs repeated costly hospitalizations often occur. The MHRF is currently providing invaluable transitional services to our son. We understand that San Francisco is considering leasing 30 beds in outside facilities to provide services. How distressing if our son again needs help but would be # 31 on a waiting list. His life and that of many others is painfully difficult. This wonderful facility is helping him through a difficult time, hopefully to a better life. There are now over 140 beds at the MHRF, if half of those need a locked facility where will they receive care? If as many as one quarter of them return to the psychiatric unit at General where is the savings? Jay Wright, 2314 Public Health Team Leader - I am still convinced that there is an alternative to closing the MHRF. I sincerely hope that the Commissioners comprehend the value of this wonderful facility. During the last meeting, you heard from many residents of the MHRF that expressed their concerns over its fate. As you can see, not only are the staff fighting to keep the MHRF open, but the people we serve are willing to do their part. That is because it is worth fighting for! I have worked at private, locked psychiatric facilities and there is a stark difference between them and the MHRF. Our residents receive more individual time with the staff and doctors, they have more opportunities to work and go to school, and they have a much calmer and pleasant environment. In short, the MHRF provides a much more therapeutic milieu. There are options out there to save money. I have heard them discussed among the staff. If only Dr. Katz would ask, he would get some great suggestions. Jennifer Baity Carlin - In the Health Commission meeting of 2/5/03, Dr. Katz’s budget made reference to the proposed “re-programming” of the MHRF. The MHRF will be closed, not “re-programmed” and its residents (who are in need of this intermediate level of care) will be sent largely to residential care where they are doomed to failure. If they could make it in residential care without psychiatric rehabilitation in the first place, they would be placed there straight out of acute Psychiatry. Using euphemisms in cases like this to make these cuts more palatable may actually have the power to kill people. The proposal to add 30 more locked out-of-county beds dramatically underestimates what will actually be needed. I highly recommend that you visit the MHRF and see for yourself who the residents are and how the closure will affect them. I also urge you to look at alternate ways of funding the MHRF instead of closing it. Thank you Mary Senchyna, LCSW - The Mental Health Rehabilitation Facility provides services that do not exist elsewhere. The M.H.R.F. provides a period of time to stabilize, job and education training, case management, counseling for substance abuse and assistance learning self care practices. Our clients have severely decompensated and in the short period at SFGH Acute have not stabilized enough to access these services in the community. When they are able to access these services independently we discharge them to adequate permanent housing or further lower cost treatment. The average stay for our clients is 3 to 12 months depending on their needs. The cuts would mean people would end on the streets or in jail or forever in city funded locked facilities or the revolving door of PES and acute stays at SFGH. All these possibilities will ultimately cost the city much more money than what it costs to run the M.H.R.F. Commissioners’ Comments Commissioner Guy said that these are not welcome cuts. Every service DPH provides is part of the safety net. These decisions did not arrive over the course of a day. The Health Commission should in fact tell the Mayor and Board of Supervisors that these cuts are not what we want and will be detrimental to the safety net. However, it is not appropriate to allow the Mayor and Board of Supervisors to make the cuts-the Health Commission should give the most strategic recommendations. The City’s revenue base is not sufficient to provide the necessary services. Commissioner Chow emphasized that the resolution approves the submission of the budget, not approval of the budget itself. The resolution asks the Mayor and Board of Supervisors to identify other revenues so that these cuts do not have to be made. Commissioner Penn said it is critical to his decision making to know what other cuts were considered and not finally selected. Dr. Katz replied that all DPH programs were considered. Staff made the decision not to cut programs at San Francisco General Hospital and Laguna Honda that generate revenue. At Jail Health, DPH is required to provide care. Given that, there were minimal cuts in these programs. In looking at the other areas, staff made the decision in Mental Health to eliminate day treatment programs because other counties do not provide them and they are quite expensive. They also made the decision not to cut mental health residential treatment or outpatient treatment, because there is no lower level of treatment than outpatient. In Substance Abuse, no cuts were made to detox, methadone or residential treatment. Commissioner Monfredini supports the resolution because she respects the fact that the DPH team put it together, even thought the cuts are unacceptable. She also asked that the President and the Vice President of the Commission meet with the Mayor and convey to him just how distasteful these cuts are. Commissioner Sanchez respects the great deal of work that has been done by DPH staff but the Commission is steadfast against cuts in the safety net. The budget as proposed dismantles the quality and continuity of patient care. At what point do we say that there will no longer be a safety net or seawall? Any more cuts will indeed dismantle the safety net. Commissioner Umekubo said the real problem is the chronic underfunding of the health care safety net. This problem lies with the State and Federal government, and we need to raise the advocacy to that level. If they do not wake up, the safety net around the country will collapse. Action Taken: The Commission approved amending the proposed resolution by moving the first Resolved clause to become the third Resolved clause. Action Taken: The Commission approved amending the proposed resolution by adding the following: “Further resolved that the impact of the cuts to the base budget, if implemented, be studied and reported by the Department to the Health Commission, with subsequent dissemination of this information to the Mayor and Board of Supervisors.” Action Taken: The Commission approved amending the proposed resolution by adding the following: “Whereas the Health Commission has traditionally supported a safety net system for San Francisco’s low-income, uninsured and vulnerable populations that is equal or superior to the standard of the State Medicaid program.” Action Taken: The Commission approved changing the language in seventh Whereas clause so that it now reads: “Whereas, despite the size of the fiscal shortfall, the Department has attempted to preserve all prevention and promotion activities, all children’s program, and all residential mental health and substance abuse programs;” Action Taken: The Commission approved adding language to the first Resolved clause so that it now states: “Resolved, that the Health Commission strongly urges the Mayor and the Board of Supervisors to identify new revenues, fees or taxes, including State, Federal and extramural opportunities, that could close the City’s budget shortfall without reducing vitally needed safety net services;” Action Taken: The Commission approved changing language to the second to last Resolved clause so that it now reads: “Further Resolved that although the Health Commission is aware that the contingency plan will by necessity create even larger gaps in the safety net, the Commission nonetheless believes that it is its responsibility to review such a plan prior to submission to the Mayor’s Budget Office, and directs the Department to submit such a plan to the Health Commission at the appropriate time;” Action Taken: The Commission adopted Resolution # 1-03, “Resolution of the Health Commission approving the Department of Health’s Base Budget for Fiscal Year 2003-04, and Urging the Mayor and the Board of Supervisors to Develop Strategies for Avoiding Serious Cuts to the County’s Health Safety Net Services,” (Attachment B), with the amendments. 7) PRESENTATION OF THE SECOND QUARTER REVENUE AND EXPENDITURE REPORT Gregg Sass, DPH Chief Finance Officer, presented the 2nd Quarter Revenue and Expenditure Report. This report presents the second quarterly financial projection of revenues and expenditures for the Department of Public Health for fiscal year 2002-03. The projections are based on revenue collected and billed, and expenses incurred for the first six months of the fiscal year ending December 31, 2002. Projections include revenue surplus of $20 million and over expenditures of $11.7 million. Based in this data DPH is projecting a year-end surplus of $8.3 million for FY 02-03. The Mayor instructed Departments to reduce reliance on the General Fund by three percent, or $8.7 million for DPH. The projections reflect that the Department is a little short of that target at this time. DPH has also committed to an additional surplus of $2 million towards balancing the FY 03-04 budget. The current projections do not show DPH producing this additional surplus. As discussed in the FY 03-04 budget plan, staff believes that a very tight hiring freeze commencing in February 2003 will result in producing this surplus. If this additional surplus is not achieved, additional FY 03-04 service cuts will be required. 8) CONSIDERATION OF A RESOLUTION SUPPORTING THE WORK OF THE TASK FORCE TO END EXPLOITATION OF YOUTH This item was considered by the Commission prior to Item 7. Iman Nazeeri-Simmons, Adolescent Health Coordinator, provided background to the Task Force to End Exploitation of Youth. In June 2002 the Coalition to End the Exploitation of Kids (CEEK) presented testimony to the Health and Human Services Committee of the San Francisco Board of Supervisors. CEEK’s presentation brought to light the seriousness of the sexual exploitation of children and youth in San Francisco, and resulted in Supervisor Tom Ammiano authoring legislation to establish the End the Exploitation of Youth Task Force. The Task Force was created in August 2002 and met twice a month for six months. The Task Force developed recommendations, which include: 1) establishing a 24-hour hotline, 2) coordinating community street outreach and services, and 3) opening a secured housing program for girls 12 to 17. The Task Force will present its report to the Board of Supervisors on February 25. A copy of the report was presented to the Commission. In response to the recommendations, DPH is planning to reprogram an existing eight-bed residential treatment program to serve sexually exploited girls between the ages of 12 and 17. Funding for this program will be obtained through a combination of EPSDT, Medi-Cal, private funding and the State Department of Social Services. Commissioners’ Comments Commissioner Monfredini thanked the Commissioners for their support of the resolution. Commissioner Sanchez said a breakfast held in support of this effort had excellent testimony, and he thanked Ms. Nazeeri-Simmons and the Department for their work. Action Taken: The Commission approved Resolution # 2-03, “Supporting the Work of the Task Force to End the Exploitation of Youth,” (Attachment C). Commissioner Monfredini left at 7:30 p.m., just prior to Item 7, which was taken up after item 8. 9) PUBLIC COMMENTS None. 10) ADJOURNMENT The meeting was adjourned at 7:45 p.m. Michele M. Olson, Executive Secretary to the Health Commission