Minutes of the Health Commission Meeting Tuesday, April 8, 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 3:11 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. - left at 6:00 p.m. 2) APPROVAL OF THE MINUTES OF THE MEETING OF MARCH 18, 2003 Action Taken: The Commission approved the minutes of the March 18, 2003 Health Commission meeting. Commissioner Chow noted that the Health Commission received a letter from Walden House requesting amendments to the January 21st minutes. The Commission had already approved these minutes when the letter was sent. Commissioner Chow said that Walden House’s letter would be placed in the public file for the February 5th meeting so that it is part of the public record. Commissioner Chow expressed sorrow at the death of Alfonso Acampora, Executive Director of Walden House. The Commission sends its gratitude to Mr. Acampora’s family. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE (3.1) PHP-AIDS Office - Request for approval of a retroactive contract renewal with Institute for Community Health Outreach, in the amount of $327,711 per year, for a total contract amount of $655,422, to provide HIV prevention services to behavioral risk populations, for the period of January 1, 2003 through December 31, 2004. (3.2) PHP-AIDS Office - Request for approval of a retroactive contract renewal with Mobilization Against AIDS International, Inc., in the amount of $427,138 per year, for a total contract amount of $854,276, to provide HIV prevention services to behavioral risk populations for the period of January 1, 2003 through December 31, 2004. (3.3) PHP-AIDS Office - Request for approval of new contract with Shanti, in the amount of $320,533, to provide HIV Health Services Planning Council support services for the period of April 1, 2003 through February 29, 2004. Commissioners’ Comments Because this is a new role for the agency, the Budget Committee asked that a six-month status report be presented to the Population Health and Prevention Joint Conference Committee. (3.4) PHP-AIDS Office - Request for approval of a retroactive contract renewal with Public Health Foundation Enterprises, Inc., in the amount of $156,437, to provide HIV research services targeting men who engage in high risk behavior, for the period of July 1, 2002 through June 30, 2003. Lauren Connor, DPH Program Manager, noted that the term of the contract should be corrected in the Health Commission agenda and Summary Report. The term is September 1, 2002 to July 31, 2003. (3.5) PHP-Behavioral Health Services - Request for approval of new contract with Community Vocational Enterprises-Industrial Maintenance Engineers, in the amount of $231,232, to provide job training and counseling services targeting mentally ill adults, for the period of July 1, 2002 through June 30, 2003. Action Taken: The Commission approved the Budget Committee Consent Calendar. For Item 3.3 the Commission requested a six-month status report to the Population Health and Prevention Joint Conference Committee. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report Severe Acute Respiratory Syndrome (SARS) “Severe Acute Respiratory Syndrome” or SARS is a new emerging infection that has currently been recognized in 19 countries in Asia, Europe and the Americas. It is thought to result from the corona family of viruses that can cause the common cold in humans, but can cause more serious disease in animals. At this time, there is no treatment or vaccine for SARS. To date, there are over 150 cases of SARS in the U.S. The majority of ill people caught the disease outside the U.S. in areas where there has been community transmission of SARS: People’s Republic of China (i.e. mainland China and Hong Kong), Vietnam and Singapore. Symptoms include high fever, cough and difficulty breathing. At this time, DPH believes that SARS is primarily spread to others through prolonged exposure to large droplets (via the respiratory route). Individuals are thought to be infectious while they are symptomatic. For these reasons, individuals who have returned from Asia, but are not symptomatic, do not have to change their daily routine and are free to go to work and school. In addition, DPH is not recommending that members of the general public wear masks to protest themselves. At this time, locally we have one probable case of SARS under investigation. DPH has developed a “Frequently Asked Questions” sheet on SARS in both English and Chinese (attached). DPH will be translating this sheet into Vietnamese, Spanish and Tagalog. The FAQ’s have been distributed to all San Francisco clinicians and will be distributed to the media later this week. In addition, DPH has developed a Health Advisory that was distributed to all San Francisco Emergency Departments, hospital and infection control staff and practicing clinicians. The alert and additional links are available on-line at: http://www.dph.sf.ca.us/HealthInfo/SARS/SARS.htm. DPH Environmental Health Inspectors Respond to Families Living in SROs In mid-2001, DPH funded a community-led, citywide census of families with children living in SROs in San Francisco. The census found 450 families and 760 children living in 158 hotels (40% of the hotels visited). 78% of children were age 0-12 with many having spent their entire lives in an SRO; 40% of children were age 0-5; and over half of the families had at least one child age 0-5. Following the publication of these findings, the Environmental Health section of DPH responded by meeting regularly with community groups and systematically inspecting over 100 hotels this past year. Due to the high proportion of children under age five and the concern about lead exposure, Children’s Environmental Health section joined the inspection teams. Ninety-eight percent (98%) of the hotels inspected were found to have health code violations, including structural violations, vermin, poor sanitation, and lead violations. Diligent follow-up on the part of DPH inspectors and their close collaboration with community groups resulted in over 96% of the hotels abating their health code violations. The Environmental Health inspectors will continue to monitor these hotels to assure that the violations do not gradually return. Social Work Month March was Social Work Month in San Francisco and Dr. Katz took this opportunity to salute all the DPH social workers for their continuing commitment to the underserved of San Francisco. DPH rely on social workers throughout the system, in the clinics, in medical and psychiatric settings, in the jails and in patient psychiatry. They are clinicians, case managers, and discharge planners. Dr. Katz expressed his appreciation to DPH social workers for their had work and dedication to their mission. CDC Rapid Response Team Deployed to Assist with Syphilis Case Management In mid-March, in response to a 25% increase in syphilis cases since the first of the year, a three person CDC Rapid Response Team was detailed to San Francisco to assist local staff with syphilis case management. All three CDC staff have established good working relationships with the local syphilis response team. Working together, cases and contacts are being followed up in the shortest possible time and DPH is reinstituting the Private Medical Doctor (PMD) visitation program. STD Awareness Month April is STD Awareness Month in San Francisco. A variety of activities are planned, including STD screening events at gay bars and clubs. For the second year in a row DPH will be having a Spring Cleaning STD Awareness Campaign that entitles individuals who test for syphilis during the campaign to receive discounts on merchandise from participating merchants. North of Market Senior Services Renamed Curry Senior Center In honor of Francis J. Curry, M.D., a young boy from North Beach who delivered newspapers in the Tenderloin, washed dishes in area restaurants to earn money for medical school, and grew up to become Director of Public Health of San Francisco, North of Market Senior Services has been renamed Curry Senior Center. . Dr. Curry never forgot the places he knew or the people he met during his early years and he made it his personal mission to provide services to seniors that promote independent living while maintaining their dignity and self-esteem. Dr. Curry opened North of Market Senior Services in 1972. Thirty years later the agency has developed into a multi-purpose agency serving approximately 2,600 seniors throughout the Tenderloin/South of Market area. Curry Senior Center is proud to take the name of its founder to illustrate its continuing devotion to his mission. Relocation of Adult Immunization Clinic The Adult Immunization Clinic has moved to a new and bigger space at 101 Grove St., Room 102. The clinic is open to the public 9 a.m. to 4 p.m. daily. Commissioners’ Comments Commissioner Parker asked if the SRO units were violation free when the families moved in. Ms. Kronenberg said that they have no indication that the rooms did not have violations. However, families typically did not report the violations because they were happy to have a room. 5) RESOLUTION HONORING DR. EVELYN LEE Commissioner Chow presented a resolution honoring the life and work of Dr. Evelyn Lee. Dr. Lee passed away suddenly on March 26, 2003. The Commission conveys its heartfelt condolences to her family. Mr. Kent Woo, Executive Director of NICOS, accepted the resolution on behalf of the family. Commissioners’ Comments Commissioner Guy stated that Dr. Lee made a tremendous contribution to improving the quality of life for all San Franciscans. She inspired many people. Action Taken: The Commission approved Resolution # 6-03, “Resolution Honoring Dr. Evelyn Lee”, (Attachment A). 6) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF APRIL Commissioner Chow presented the April Employee Recognition Awards. Individual Awardees Division Nominated by Tom Hoynes DPH Jail Health Services/ STD Mary Evans and Wendy Wolf IS Desktop Support Team Awardees Division Nominated by Melvin Javonillo Elouise Joseph Anthony Kwok Steve Lee Bill Nay Hung Quach Timothy Wong SFGH Information System Department Anson Moon Patient Flow Team Awardees Division Nominated by Lynne Eggers, RN, LCSW Liz Gray, MSN, RN Elayne Hada, RN CHN Community Mental Health Service Barbara Garcia 7) FISCAL YEAR 2003-04 CONTINGENCY BUDGET UPDATE, AND CONSIDERATION OF A RESOLUTION REGARDING THE FY 2003-04 CONTINGENCY BUDGET Mitchell H. Katz, M.D., Director of Health, presented an update on the proposed FY 2003-04 Contingency Budget. San Francisco’s financial situation continues to be very fluid. February payroll tax returns, hotel and sales tax collections were lower than anticipated, resulting in the City revising its revenue projections. At this time the City is projecting a shortfall for FY 03-04 of $347 million. This shortfall is reduced to $200 million when the six percent base budget reductions from all City departments are factored in. The Mayor’s Budget Office is proposing the close this gap through increased $45 million in increased State funding, $80 million from City employees’ retirement contributions, and $75 million of citywide Departmental contingencies. As the Health Department represents approximately 25% of the City’s discretionary General Fund, the Mayor’s Budget Office may reduce DPH’s General Fund by an additional $18.75 million. If the City were not able to get the $80 million of savings and/or if the more optimistic State projections do not hold, then the Department could be asked for the full 10% General Fund reduction, which is $27 million. At this time the Mayor’s Budget Office has said that they will be subtracting $12 million from DPH’s General Fund. DPH has increased its projected current year year-end surplus by $2.6 million. The Department is also projecting a net increase in revenue for next year of $4.1 million. The Mayor’s Budget Office has accepted this $6.7 million as the first installment of the Health Department contingency. In addition, the Mayor’s Budget Office has decided to enter into the budget an additional $5.3 million of General Fund cuts from the Health Department. The full list of these cuts is attached (Attachment B). The focus of the cuts was in administrative areas and/or support services. Forty positions were eliminated throughout the Department. In addition, cuts were made in: Medical Care Substance Use Services O/P and Prevention Program; Baker Places-Westside Lodge Day Treatment; HIV Health Services, Employee Assistance Program and Health at Home. Commissioner Chow presented the Health Commission resolution regarding the contingency budget. Public Comment John Gould spoke in support of the Maxine Hall Clinic. Sandra MacKay, Public Health Nursing, spoke in support of public health nurses, particularly those at the Castro-Mission clinic. Hywel Simms, Executive Director of Shanti, said the budget for 03-04 will at least disable, if not destroy, the public health system. Costs will rise of budget cuts are made and the city will lose a valuable resource if Shanti is cut. Jennifer Oberly, Shanti professional volunteer, said cutting seven staff would result in 100 volunteers not getting connected to 1200 clients, to whom they provide 25,000 hours of service. Jennifer McGaugh, Women’s Services Coordinator at Shanti, spoke against cuts in program services. She read a letter from one of Shanti’s clients. Janie Willey, on behalf of Shanti and the Black Coalition on AIDS. Shanti has connected her to a safe place to live and allowed her to regain self-respect. She urged the Commission not to cut their funding. Veronica Cauley, client of Shanti, advocated for continued funding for Shanti. She added that the computer system at SFGH can discourage people from receiving services. Frank Demusiac, spoke in support of the acupuncture program at Tom Waddell Clinic. Please don’t cut the program. Timothy Bradley receives excellent care at the Minna Clinic. He asked the Commission not to cut mental health funding. Sandra Roberts spoke in support of the OMI Family Center and Westside Lodge. Dr. Ray Cendanna, psychiatrist at OMI Family Center, said that the mental health of children, adolescents and adults will be negatively affected by the budget reductions. Those people with few options will have even less. Malik Looper expressed concern about the budget process. The budget cuts will result in destabilization of families. He is also opposed to the closure of the OMI Family Center. Governor Johnson spoke on behalf of his foster son, advocating against the closure of the OMI Family Center. OMI Family Center has helped his foster son. Selene Mitlyng, OMI Family Center, spoke against cuts to the program. Clients will not go across town to other clinics to receive services. They will go to SFGH, which costs the City more money in the long run. Isa Hershoff-Looper, counselor at the OMI Family Center, submitted a petition in support of keeping the center open. She also read a letter from Assembly member Leland Yee. James Gregg, psychology trainee at OMI Family Center, spoke against the closure of the center. There is already a shortage of training programs in San Francisco. Regina Blosser, OMI Neighbors in Action, spoke against closing the OMI Family Center. Joy Almquist, student nurse, spoke in support of Mission-Castro Clinic and Westside Lodge. Philip Robinette spoke against cutting OMI Family Center. James Huey asked the Commission to keep the OMI Family Center open. Rick Arce spoke in support of the OMI Family Center. Florence Hightower and Kenneth Hightower spoke in support of the OMI Family Center. Jewel Bartlett spoke in support of the OMI Family Center. David Riley spoke in support of the OMI Family Center. James Gregg read the testimony of Martha H. in support of the services at the OMI Family Center. Scottie Kenyon spoke in support of the OMI Family Center. It’s shortsighted to cut health services. Jeremiah Jeffrey, client of Westside Lodge, spoke in support of the program. If you cut the budget, you’ll be cutting lives. Dave Jameson spoke in support of the services at Westside Lodge. Jonathan Vernick, Executive Director of Baker Places, said that the cut to the lodge is a cut of 20 beds and 64-day treatment slots, which would impact services to 250 people over the course of a year. These cuts will not save money in the long run. Judith Stevenson, Director of Operations for Baker Places, spoke against cuts to the Westside Lodge. The reduction of 20 beds will negatively impact the patient flow effort. Sonia Bailey, Westside Lodge, spoke against cuts to the program. Grace Fong, OMI Family Center client, asked that the center be kept open permanently. David Fried spoke in support of the OMI Family Center. Charles Anderson spoke in support of the OMI Family Center. Valerie Gentle asked the Commission to keep the OMI Family Center open. Cynthia Finis spoke in support of the OMI Family Center, which does so much work for the community. Mary Gennoy spoke on behalf of patients in pain for in home support services. Barbara Farrell, Executive Director of Ohlhoff Recovery Services, said further reductions to the public health system would be devastating. Janice Cohen, M.D., said the proposed budget represents criminal failure from our leadership. Do not approve any more cuts in public health. She submitted a series of recommendations (on file). Jarman Michaels spoke in support of Tom Waddell Health Center. Barbara Rothkrug, public health nurse at Castro-Mission Health Center, submitted testimony of two patients (on file), and spoke against cuts to Health at Home and psychiatric services. Edmond Larry spoke in support of Tom Waddell Clinic. Henry Prybysh, patient of Tom Waddell, spoke in support of the clinic. Zoila Veliz spoke in support of Mission-Castro clinic. Submitted petition with more than 750 signatures opposed to clinic cuts (on file). Juanita Camarena spoke in support of services at Mission-Castro clinic. Aminta Serrano spoke in support of services at Mission-Castro clinic. Maria Wilson spoke in support of services at Mission-Castro clinic and read some statements from clinic clients. Luis Barrera spoke in support of public health nursing and the Mission Castro Health Center. Terese Nguyen, PHN, spoke in support of public health nursing. Sam Kupferberg spoke in support of the Bayview Clubhouse. Michael Lyon spoke against the budget cuts and suggested additional revenue sources. Dr. Kevin Grumbach, Chief of Family Community Medicine at SFGH, submitted a letter on behalf of the Chiefs of Service at SFGH (on file). The worst case budget scenario brings the system to the point of collapse, and Health Commission leadership is critical. Martha Hawthorne, public health nurse at Castro Mission Health Center, is grateful for the temporary reprieve but very concerned about the contingency budget. They are already over capacity and further cuts will cripple them. Micah Frazier, representing the Harm Reduction Coalition, to support harm reductions programs and Castro Mission Health Center and the Dimensions Clinic. Nancy Lewis, FNP within the CHN to ask the Health Commission on behalf of the NP group in the CHN to please save primary care services. Bruce Folsom, Geriatric Day services, to explain to the Commission how dependent elderly persons are for medical and psychiatric services to prevent hospitalizations. Evangelist LaVonne Macintosh, came to commend the services provided by the Maxine Hall Health Center. Luther Ricker, to say that if Tenderloin Self Help Center goes away it will be a tremendous loss. Anonymous, to say that it would be very sad if clinics were to close. Dr. Deborah Brown, physician at Castro-Mission Health Center, said that if the clinics were cut by 50 percent, there would be chaos. Cutting the number of providers would also not be workable. Doctors cannot see two patients at one time. Dr. Shira Shavit, resident physician from SFGH, said that when community programs are cut, SFGH is impacted. It is a sad day when these budget cuts are proposed. Philippa Ruttgaizer, RN at the MHRF, said patients at the MHRF have been on the discharge fast track. Some of the patients’ families do not drive and will not be able to visit patients who are not in San Francisco. Eve Meyer, San Francisco Suicide Prevention, thanked the Commission for its resolution. Sasha Mosalov spoke against cuts to the Ocean Park Health Center. He submitted a petition in support of keeping the clinic open (on file). Ellen Sakoloff, PHN, spoke in support of saving public health nursing, which she feels are very vulnerable for cuts. Spoke in support of prevention. Leigh Ann Surgent, RN at St. Anthony Free Medical Clinic and SFGH, said the Community Clinic Consortium clinics provide hundreds of thousands of visits to people in San Francisco. Cuts though DPH would devastate their clinics. M.P.R. Howard spoke in support of the Tom Waddell Health Center. He is a former chair of the TWHC advisory board. Ken Hodnett spoke against cuts to the Castro-Mission Health Center. The staff provides excellent services. Dr. Allegra Melillo, SFGH physician, said healthcare is already in a crisis situation. The ER is filled with patients who have already been admitted, but there are no available rooms. Cutting community clinics would lead to more overcrowding. Kara Graziano spoke against the baseline budget cut at the OSHUN program. Martha Ryan, director of the Homeless Prenatal Program, thanked the Commission for opposing the contingency budget. Continue to urge the Mayor to look elsewhere. Dr. Maggie Jones, Primary Care Resident at SFGH, said she glad the primary care clinics might not be reduced by 50 percent, because the patients they serve are extremely complicated. Doctors spend a lot of time advocating for their patients. Anne Rosenthal, medical resident at SFGH primary care, said she is horrified to the prospect of cuts to basic medical services and to the salaries of physicians. Kim Tavaglione, Local 250, spoke against cuts to Health at Home. These cuts are neither cost efficient nor in the best interest of patient care. She also spoke against cuts to the MHRF. Employees have a lot of good ideas but are not being listened to. Larry Bevan, Local 250, commended the Commission for opposing the contingency cuts. He is still concerned about the cuts, because he does not think they will save money. Richard Fuller, patient at Health Center 1, said that closing the health care centers will back up the emergency rooms. HIV will not go away just because the system can no longer provide treatment. Dr. Jacek Skarbinski, SFGH primary care resident, spoke against the budget cuts. Emergency and acute care services are already on the verge of collapse. Dr. Sara Levin, Internal Medicine Resident, said cuts to primary care would decimate health care services. She also spoke against pay cuts to residents. Dr. Greg Zaharchuk, Radiology Resident at SFGH, spoke against pay cuts to residents. It is a small amount of money for the budget, but a large amount for the individuals. Dr. Jeff Critchfield, Vice Chief of Medicine at SFGH, thanked the Commission for its position on the contingency budget. He also urged the Commission to fight the fear, and offered the services of the SFGH medical staff to help do so. Patrick Monette-Shaw’s testimony: “A little over a year ago, Tom Nolan was faced with a budget shortfall at Project Open Hand. As Open Hand’s Executive Director, Nolan voluntarily took a self-imposed pay cut, because he believed leaders should share the burden by not punishing workers at the bottom of the pay scale by having them shoulder all of the budget pain. Mitch Katz should learn from Nolan’s example. Dr. Katz should volunteer to cut his own salary. Combining Katz’s $214,000 base pay with his $4,000 bonus, cutting 10% of his City income would find him still earning $196,000. Cutting 20% of his salary - as suggested by Board of Supervisor’s Tom Ammiano -- would find Katz earning $174,000 … more than sufficient to live on, even with an adopted child to feed. Dr. Katz: It’s time to demonstrate some leadership. Cut your salary now, to help save healthcare services and to save City jobs”. Commissioners’ Comments Commissioner Monfredini agrees with all of the speakers, and is grateful that the Department identified additional revenue to give back to the City. Commissioner Chow is glad that the Department was able to identify new revenue and that the Mayor’s Budget Office accepted this revenue. The proposed resolution attempts to address all of the concerns raised by the Commission at the March 18th meeting. He thanked the public for its advocacy, and urged them to continue to advocate to the Mayor and the Board of Supervisors. The entire community needs to work to protect the Strategic Plan vision. Commissioner Sanchez said the resolution conveys a strong message, but there is a long, tough fight ahead at all levels-City, State and Federal. Commissioner Parker said no data has been presented to the Commission that justifies any budget cuts. The federal government has found the money to fight a war, and will find the money to rebuild a country they are currently supportive. So they are able to fund health care, and need to step up to the plate. Commissioner Penn thanked the public speakers for reminding the Commission about how wonderful our public health system is. He encouraged people to advocate to the Mayor and Board of Supervisors. He also thanked the Department staff for continuing to evaluate the proposals to see if there are other alternatives. Commissioner Guy said that there is a vision about what the Department of Public Health should be, and this vision is being threatened. We need to hold fast to this vision in our negotiations. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Penn, Sanchez) approved Resolution # 7-03, “Rejecting the Department of Public Health’s Contingency Budget for fiscal year 2003-04, and Urging the Business Community, Organized Labor, and Residents to Work with the Mayor and the Board of Supervisors to Avoid Devastating Cuts to the County’s Health Safety Net Services,” (Attachment C). 8) PUBLIC HEALTH WEEK: HEALTHY EATING AND PHYSICAL ACTIVITY The American Public Health Association has identified April 7-13, 2003 as “National Public Health Week.” This year’s theme is “Getting in Shape for the Future: Health Eating and Active Living.” Barbara Garcia, DPH Deputy Director, highlighted various Department activities commemorating Public Health Week. There will be two “brown bag” lunch presentations and a participatory demonstration of “Tai Chi in the Park” at the Civic Center. In addition DPH will launch its web page that begins to develop web-based resources for developing nutrition and physical activity programs and services. Commissioners’ Comments Commissioner Monfredini said that the web page has a tremendous amount of resources. It is important to get this information out to the public. Commissioner Guy said that the budget testimony reflects what public health is about right now, which is health care financing. Healthy living is a combination of healthy eating, exercise, and healthy, supportive food systems. Public Health Week activities reflect these different factors. Commissioner Chow wants to continue to receive updates on the Department’s long-term emphasis on healthy food systems. 9) PUBLIC COMMENTS Patrick Monette-Shaw’s testimony: “The City’s budget deficit for next FY reportedly is $350 million. Currently, the City’s total payroll is $800 million. Fully 42.5% of the payroll is consumed by 3,143 employees earning greater than $90,00 annually; these 3,143 represent just 11% of the City workforce, yet they are collectively paid $340 million ($10M shy of the deficit). That’s right, 11% of City employees earn 42.5% of the City’s payroll. DPH employees comprise 22.6% of these 3,143 employee, as DPH has 709 employees earning upper-strata salaries. DPH’s “managerial” employees gobble $79.3 million (23.3%) of the $340 million in salaries paid to City employees earning more than $90K. Before this Health Commission recommends slashing healthcare services to the City’s most vulnerable, and approves chopping jobs from the bottom of the ladder, you should examine just how much management “fat” exists at the top of the salary food chain, and chop at the top, first”. 10) ADJOURNMENT The meeting was adjourned at 6:55 p.m. Michele M. Olson, Executive Secretary to the Health Commission