Minutes of the Health Commission Meeting Tuesday, May 6, 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 David J. Sanchez, Ph.D. Commissioner John I. Umekubo, M.D. Absent:  Commissioner Michael Penn, Ph.D. 2) APPROVAL OF THE MINUTES OF THE MEETING OF APRIL 15, 2003 Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez, Umekubo) approved the minutes of the April 15, 2003 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Lee Ann Monfredini chaired, and Commissioner Umekubo attended, the Budget Committee meeting. Commissioner Penn was absent. (3.1) PHP-AIDS Office - Request for approval of a retroactive contract renewal with Ark of Refuge Inc., in the amount of $176,585, to provide an HIV Prevention Mentorship Program, for the period of January 1, 2003 through December 31, 2003. (3.2) PHP-AIDS Office - Request for approval of a retroactive multiyear contract renewal with Asian and Pacific Islander Wellness Center, in the amount of $412,697 per year for a total of $825,394, to provide HIV prevention services, for the period of January 1, 2003 through December 31, 2004. (3.3) PHP-AIDS Office - Request for approval of a retroactive contract renewal with South of Market Health Center, in the amount of $78,392, to provide HIV prevention services targeting defined behavioral risk populations, for the period of January 1, 2003 through December 31, 2003. (3.4) PHP-AIDS Office - Request for approval of a retroactive multiyear contract renewal with UCSF AIDS Health Project, in the amount of $357,770, to provide Prevention Provider Training and Prevention for HIV Positives Persons Training services to HIV service providers, for the period of January 1, 2003 through December 31, 2004. Commissioner Sanchez abstained from voting on this item. (3.5) PHP-AIDS Office - Request for approval of a retroactive multiyear contract renewal with UCSF AIDS Health Project, in the amount of $474,515 per year, for a contract total of $949,030, to provide HIV counseling and testing, and REACH program services targeting defined behavioral risk populations, for the period of January 1, 2003 through December 31, 2004. Commissioners’ Comment The Commission requested a follow-up report to the Population Health and Prevention Joint Conference Committee, specifically regarding program outcomes. Commissioner Sanchez abstained from voting on this item. (3.6) PHP-AIDS Office - Request for approval of a resolution approving an extension of the terms of the calendar year 2002-2003 contracts for the following twenty-two organizations: Aguilas, Inc., Asian Pacific Islander Wellness Center, Black Coalition on AIDS, Centerforce, Continuum HIV Day Services, Haight Ashbury Free Services, Inc., Harm Reduction Coalition, Institute for Community Health Outreach, Instituto Familiar de la Raza, Iris Center, Larkin Street Youth Center, Lavender Youth and Recreation Center, Mission Neighborhood Health Center, Positive Resource Center, Public Health Foundation, Regents of the University of California, San Francisco AIDS Foundation, Shanti Project, South of Market Health Center, Stop AIDS Project, Tenderloin AIDS Resource Center, Westside Community Mental Health Center. (3.7) CBHS-Substance Abuse - Request for approval of a contract renewal with Baker Places, Inc., in the amount of $3,401,223 per year for a contract total of $6,802,446, to provide residential detoxification substance abuse treatment services, for the period of July 1, 2003 through June 30, 2005. (3.8) CBHS-Substance Abuse - Request for approval of a contract renewal with Positive Directions Equals Change, in the amount of $294,112 per year for a total contract amount of $1,176,448, to provide outpatient substance abuse treatment services targeting African American residents of the Bayview District, for the period of July 1, 2003 through June 30, 2007. This contract was amended to become a two-year contract, rather than a four-year contract. The term of the contract is July 1, 2003 through June 30, 2005. (3.9) CBHS-Substance Abuse/Mental Health - Request for approval of a contract renewal with SAGE Project, Inc., in the amount of $537,692 per year for a total contract amount of $2,390,860, to provide substance abuse and mental health services targeting women, men, transgender individuals and youth, for the period of July 1, 2003 through June 30, 2007. This contract was amended to become a two-year contract, rather than a four-year contract. The term of the contract is July 1, 2003 through June 30, 2005. (3.10) CBHS-Substance Abuse/Mental Health - Request for approval of a contract renewal with St. Vincent de Paul Society of San Francisco, in the amount of $1,817,852, to provide substance abuse treatment and substance abuse/mental health shelter services targeting homeless adults, for the period of July 1, 2003 through June 30, 2004. (3.11) CBHS-Mental Health - Request for approval of a contract renewal with Community Vocational Enterprises, Inc., in the amount of $1,342,507 per year for a total contract amount of $5,370,028, to provide vocational support services and employment targeting mentally ill customers, for the period of July 1, 2003 through June 30, 2007. (3.12) CBHS-Mental Health - Request for approval of a contract renewal with Swords to Plowshares, in the amount of $475,572 per year for a total contract amount of $1,902,288, to provide mental health services targeting homeless, disabled and disenfranchised veterans, for the period of July 1, 2003 through June 30, 2007. (3.13) CBHS-Mental Health - Request for approval of a contract renewal with Volunteer Center of San Francisco, in the amount of $226,335 per year for a total contract amount of $905,340, to provide outreach services targeting San Francisco mental health clients, for the period of July 1, 2003 through June 30, 2007. (3.14) CBHS-Mental Health - Request for approval of a contract renewal with Calvin Y. Louie, CPA, in the amount of $5,693,828, to provide fiscal intermediary services for the Community Mental Health Services supplemental residential care facilities, for the period of July 1, 2003 through June 30, 2004. (3.15) CBHS-Mental Health - Request for approval of a contract renewal with Catholic Charities of San Francisco, in the amount of $160,720 per year, for a total contract amount of $642,880, to provide supportive housing/mental health services to homeless residents of San Francisco targeting persons with disabling HIV/AIDS, for the period of July 1, 2003 through June 30, 2007. (3.16) CBHS-Mental Health - Request for approval of a retroactive contract renewal with St. Luke’s Hospital for the provision of 24-hour acute psychiatric inpatient hospital services in the amount of (1) $50,000 in City funds targeting uninsured adults, and (2) $4,000,000 in Medi-Cal funds for four hospital providers targeting Medi-Cal adult beneficiaries, for the period of July 1, 2002 through June 30, 2003. Commissioners’ Comments Commissioner Monfredini asked staff to convey to St. Luke’s/Sutter the importance of having a representative at the Budget Committee when they have a contract before the committee. (3.17) CBHS-Mental Health - Request for approval of a new contract with Mills-Peninsula Hospitals, in the amount of $105,000, to provide acute care, administrative day services and crisis intervention services for adolescents not covered by Medi-Cal, for the period of May 1, 2003 through June 30, 2004. (3.18) CBHS-Mental Health - Request for approval of a retroactive contract renewal with Lincoln Child Center, in the amount of $68,000, to provide residential mental health services to high-risk children and youth, for the period of July 1, 2002 through June 30, 2003. (3.19) CBHS - Request for approval of a resolution approving an extension of the terms of the following FY 2003-04 contracts: Addiction Recovery and Treatment (dba Bay Area Addiction and Treatment) Alameda County Alta Bates Hospital Asian American Recovery Services Baker Places, Inc. Bayview Hunters Point Foundation for Community Improvement Big Brothers/Big Sisters of San Francisco Caduceus Outreach Services California Medivan (dba MV Transportation) California Mental Health Directors Association Catholic Charities Catholic Healthcare West/MSC Psychiatric Services Catholic Healthcare West/St. Francis Hospital  Catholic Healthcare West/St. Mary’s Hospital Catholic Youth Organization - St. Vincent’s School for Boys Center on Juvenile and Criminal Justice Children's Council Network of San Francisco Community Vocational Enterprises/Industrial Maintenance Engineers Conard House Continuum HIV Day Services Crestwood Behavioral Health Edgewood Children Services Episcopal Community Services Family Service Agency of San Francisco Families First Goodwill Haight Ashbury Free Clinics, Inc. High Gear Achievers, Inc. Homeless Children's Network Horizons Unlimited Instituto Familiar de la Raza Iris Center JLC Services Japanese Community Youth Center Jelani House Jewish Family and Children’s Services Mt. Diablo Medical Pavilion Larkin Street Youth Services Latino Commission Lifemark Corporation Lyon Martin Primary Health Care Meadowland Janitorial Mental Health Management (dba Canyon Manor) Mission Council on Alcohol Abuse for the Spanish-Speaking Mission Neighborhood Health Center Mt. St. Joseph-St. Elizabeth  New College of California New Leaf…Services for Our Community North of Market Senior Services Oakes Children's Center  Ohlhoff Recovery Services Polaris Research & Development, Inc. Potrero Hill Neighborhood House Progress Foundation Regents of the University of California  Richmond Area Multi-Services  RISE Institute San Francisco Drug Abuse Advisory Board San Francisco League of Urban Gardeners  San Francisco Mental Health and Education Funds, Inc. San Francisco Pre-trial Diversion Project San Francisco Psychoanalytic Institute and Society San Francisco State University San Francisco Study Center San Francisco Suicide Prevention Seneca Center South of Market Health Center Special Service for Groups (SSG) St. Mary’s Prescription Pharmacy Support for Families of Children with Disabilities Victor Treatment Centers Walden House West Bay Filipino Multi-Services Center Westside Community Mental Health Center, Inc. YMCA Youth Leadership Institute (3.20) CHPP-Promotion Section - Request for approval of a contract renewal with Polaris Research and Development, Inc., in the amount of $150,000, to provide comprehensive services for the Tobacco Free Project, for the period of July 1, 2003 through June 30, 2004. Commissioners’ Comments The Budget Committee requested a follow-up report to the Population Health and Prevention Joint Conference Committee, specifically regarding the findings from Polaris’s evaluation of tobacco control programs. (3.21) PHP-STD Prevention and Control - Request for approval of a retroactive contract renewal with Better World Advertising, in the amount of $90,000, to provide a syphilis awareness social marketing campaign, for the period of January 1, 2003 through December 31, 2003. (3.22) PHP-Children’s Environmental Health Promotion - Request for approval of a retroactive sole source multi-year contract renewal with San Francisco State University, in the amount of $149,259 for year-one and $110,633 for year-two, for a contract total of $259,892, to provide Childhood Asthma Initiative services targeting children ages 0-5, for the period of July 1, 2002 through June 30, 2004. Commissioner Guy abstained from voting on this item. (3.23) CHN-Office of Managed Care - Request for approval of a contract renewal with San Francisco Health Plan, in the amount of $4,877,185, to provide universal health insurance services targeting San Francisco children, for the period of July 1, 2003 through June 30, 2004. Commissioner Chow and Commissioner Umekubo abstained from voting on this item. (3.24) DPH-Central Administration - Request for approval of DPH annual patient rates effective July 2003. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez, Umekubo) approved the Budget Committee consent calendar, including Resolution # 9-03, “Approving and Extension of the Terms of Fiscal Year 2002-2003 AIDS Office Contracts for the Department of Public Health, (Attachment A); and Resolution #10-03, “Approving an Extension of the Terms of Fiscal Year 2003-04 Behavioral Health Contracts for the Department of Public Health,” (Attachment B). Commissioner Sanchez abstained from voting on Items 3.4 and 3.5. Commissioner Chow abstained from voting on Item 3.23. Commissioner Guy abstained from voting on Item 3.22. Commissioner Umekubo abstained from voting on Item 3.23. The contract periods were changed for Item 3.8, Positive Directions Equals Change, and 3.9, SAGE Project, Inc. The contract period for both is July 1, 2003 through June 30, 2005. The Commission asked for the following reports to Joint Conference Committees: Items 3.5, 3.20 and 3.22. 4) DIRECTOR’S REPORT Anne Kronenberg, Deputy Director of Health, presented the Director’s Report. Budget Update Last week the Mayor’s Budget Office implemented another $10 million reduction in the Health Department’s General Fund in order to help balance the City’s budget. Of the $10 million, $5 million is detailed on the attached spreadsheet, (Attachment C). The spreadsheet shows that to reach $5 million, DPH had to make additional cuts to the mental health day treatment program, substance abuse outpatient treatment program, as well as a number of other valuable programs. DPH has been able to protect from cuts the residential mental health and residential substance abuse programs, the housing program, the Health and Environmental Resource Center (HERC), the Problem Gambling Initiative, the OMI Clinic and Primary Care. The Mayor’s Office has also input a $5 million reduction to jail health services. The cuts will result in decreased services to inmates through decreased staffing. Also attached is a $22 million list of additional cuts that will occur if Union negotiations do not result in a 7.5 % give back of retirement contributions, (Attachment D). This arrangement has already been accepted by two Unions that represent Department workers - Local 21 and MEA. Negotiations are in progress with SEIU 250 and 790, as well as UAPD and the union that represents the interns and residents at SFGH. Governor Signs Mid-Year Budget Cuts Yesterday, Governor Gray Davis signed a mid-year budget cut package that will save the State $3.7 billion - a first step towards erasing California’s $34.6 billion deficit. The agreement makes reductions of approximately $330 million in health programs, including implementation of semi-annual Medi-Cal status reporting for a savings of $42.5 million and reduction in the utilization of Medi-Cal dental services for a savings of $50 million. The majority of the reductions in health programs come from a $194 million decrease in Medi-Cal administration. Next week, the Governor will release his May Revision to the 2003-04 State Budget proposal, which will have to bridge the remainder of the budget gap. Clearly, the May Revision will need to contain significant programmatic reductions in order to create a balanced budget. DPH will continue to closely monitor the health provisions of the budget proposal and will present a comprehensive report to the Health Commission at the June 3rd meeting. Anthony Wagner Retiring After a period of 15 years serving the Department, Anthony Wagner, Executive Administrator of Hospital Systems, will be retiring on June 30th. Tony has successfully led the Department’s efforts to rebuild both San Francisco General Hospital and Laguna Honda Hospital and, as such, has played an integral role in shaping the future of the City’s public hospitals. In addition, Tony has for many years represented the Department on a number of community and professional organizational boards. DPH is deeply grateful to Tony for his commitment to public health, his dedication to public service, and the lasting legacy of leadership within the Department. The Health Commission joins me in wishing Tony well in his retirement and future endeavors. Health Emergency Practice Exercise June 17, 2003 Current world events have heightened sensitivities about how crucial it is for DPH to be prepared for a sudden disaster. On Tuesday, June 17th, the Department will conduct a practice exercise to test its ability to quickly respond to a large-scale health emergency. For this exercise the Department will need the help of 250 DPH staff volunteers and 2,000 community volunteers. Staff volunteers representing a wide variety of the Department’s job classifications are needed to perform such tasks as helping triage volunteer patients, translation, conducting medical evaluations and screening, filling out paperwork, serving as “pretend” vaccinators, and generally assisting with logistical issues. In addition to DPH staff volunteers, 2,000 community volunteers are needed to act as patients who are representative of the diverse population of the City -families, the elderly, children, people with disabilities, and non-English speakers. With supervisor approval, staff volunteers will be needed all day from 8:00 am to 5:00 pm. Community volunteers will need to participate for 2-hour shifts between 10:00 am to 3:00 pm. For more information or to volunteer, contact Judith Klain at 206-2303 or on DPH email. SFDPH Nursing Philosophy and Nurse Week Celebration Events In 2002 the Department’s Nursing Leadership Council (NLC) was challenged to develop a philosophy of nursing which embraces all the qualities necessary to caring for clients who have complex health care needs. Following are the results of their efforts. The Nursing Philosophy (Attachment E) will be rolled out to DPH nurses this week, in conjunction with the Nurse Week Celebration Events scheduled throughout the Department. This year’s Nurse Week Celebration Events are as follows: Wednesday, May 7th, 11 a.m. - 2 p.m., Laguna Honda Hospital, A300 Speaker: Ed O’Neil, MPH, PhD Topic: Leadership for DPH Nurse Leaders Thursday, May 8th, 4 p.m. - 6 p.m., 101 Grove Street, Room 300 Speaker: Jo Anne Powell, RN, MS Topic: History of Nursing in San Francisco For ALL DPH Nurses Friday, May 9th, 12 p.m. - 1 p.m., San Francisco General Hospital, Carr Auditorium Presentation of O’Connell Society Award by Gene O’Connell Speaker: Mary Foley, RN, MS Topic: The Future of Nursing For ALL DPH Nurses Update on Hepatitis Prevention During the 6-month period between May and November 2002, StopHep sponsored a pilot project at Gold’s Gym in the Castro District offering low-cost hepatitis vaccination. During that time 552 shots were administered to 347 clients - one every 17 minutes during the 6 hours a week the clinic was open. DPH is pleased to report that efforts appear to have contributed to a measurable improvement in the rates of hepatitis vaccination among men who have sex with men (MSM). Data from the City’s Anonymous and Confidential HIV testing sites indicate that 31% of MSM being tested in 2002 had been immunized for hepatitis A, compared to 15% in 2001. Immunization rates for hepatitis B was reported at 36% in 2002, compared to 19% in 2001. Hearing on Crystal Methamphetamine and HIV The Board of Supervisors’ City Services Committee will hold a special public hearing tomorrow night, May 7th, from 6pm to 8pm to look at the impact of crystal methamphetamine (speed) use and abuse in the gay community. There will be a special focus on HIV/STD infections with speed use. The HIV Prevention section organized the presentation for the committee. Behavioral Health, the STD Branch and DPH-funded community-based providers will provide testimony. Homeless Perinatal Conference The Seventh Annual San Francisco Bay Area Regional Homeless Perinatal Conference - Survivors: Homeless Children and Their Families is scheduled for Friday, May 9th, at the Elihu Harris State Building Auditorium at 1515 Clay Street in Oakland. This conference, hosted by Oakland Assembly-woman Wilma Chan, is sponsored by the Maternal, Child and Adolescent Health Services divisions of the Health Departments of Alameda, Contra Costa, San Francisco, San Mateo, and Santa Clara Counties and the City of Berkeley. For more information contact Antoinette Walton at (415) 575-5676. Focus on Diabetes Conference An important conference on diabetes is scheduled for May 21st at the Koret Auditorium in the San Francisco Public Library. Focus on Diabetes is a free all day event focusing on improving and standardizing the care of persons with diabetes within the CHN and Community Consortium Clinics. For more information contact Pam Speich at 206-3539. Mozettia Henley Moves to Laguna Honda As of yesterday, Mozettia Henley, DNS, MSN, Program Director for the Mental Health Rehabilitation Facility (MHRF), will be assuming her new role as Nursing Supervisor at Laguna Honda Hospital. Mozettia’s commitment to rehabilitating mental health patients and fostering a model of care where the patient actively participates in goal setting with staff have made the MHRF a well-respected rehabilitation program and long-term care facility in the Bay Area. DPH sincerely thanks and appreciates Mozettia’s many years of service to the MHRF, San Francisco General Hospital, and to the care and rehabilitation of San Francisco’s neediest mental health patients. Top 100 Influential Women in the Bay Area Gene Marie O'Connell has been named by the San Francisco Business Journal as one of the top 100 Influential Women in the Bay Area. She is joined in this prestigious recognition by former Health Director Sandra Hernandez, MD. The Health Commission joins me in congratulating Ms. O'Connell on receiving this award. Because it is also Nurse Week, it should be noted that Gene began her career as a staff nurse in gynecology and urology, before moving on to nurse educator, director of emergency nursing, director of nursing and then Chief Operating Officer, prior to becoming the CEO of SFGH. Remembering Two Outstanding Public Health Leaders It is with sadness that DPH reports the death of two dynamic and inspirational members of the Maternal and Child Health (MCH) section. Dr. Patricia E. Evans, Maternal and Child Health Medical Director, died unexpectedly on April 19th. Dr. Evans made immeasurable contributions to the MCH Section. She relentlessly promoted health care issues, the MCH programs and the population they serve. Dr. Evans served on numerous local and national community advisory, educational and professional boards. She leaves MCH with her inspirational character challenging everyone to uphold her high standards of excellence in all the work DPH does. Dr. Henry "Hank" Richanbach, retired Medical Director for the Children's Medical Services Program died on April 14th. Dr. Richanbach served as Medical Director from 1988 until his retirement in 1998. As a developmental pediatrician, he was an early authority on attention deficit disorder in children, studied childhood disabilities, and helped formulate state legislation to provide resources to disabled children. Public Comment Francine, participant in the Lee Woodward Counseling Center, said the program has helped her turn her life around. Anonymous woman spoke in support of the Lee Woodward Counseling Center. Programs for women and children do not exist anymore. This is a women’s place. Bonnie Curry spoke on behalf of Lee Woodward Counseling Center. She has collected a number of petitions in support of the program. She asked the Health Commission and City Hall to do what it takes to keep the program open. Dr. Lucia Sommers spoke on behalf of the Central City Hospitality House, and about the public health impacts of the closure of the Tenderloin Self Help Center. With the closure, 200-300 people a day would be on the streets, in the emergency room. Tylene Cooker spoke on behalf of Lee Woodward Counseling Center. Please keep the program open. Angeline Walter asked the Commission to keep the doors at Lee Woodward Counseling Center open. Esther Chavez, director of the Tenderloin Self Help Center, spoke against the budget cuts to the Self Help Center, and described the impacts on the clients. Luther Richert, Central City Hospitality House, said the program is one of the few in San Francisco that understands that solutions to homelessness are complex and multi-layered. Do not give up on this program. Elana Galante, Central City Hospitality House, described the experiences of some of the Central City Hospitality House clients. Many lives will be lost if the program is closed. Myra Wallace spoke in support of Central City Hospitality House. Thomas Berberich, volunteer at Central City Hospitality House Tenderloin Self Help Center. The program’s doors need to be kept open. There are so many good services. Mark Anthony, client of Central City Hospitality House, spoke in support of the program. Harm reduction, job placement, computer skills and other programs are critical. Frances Terry said that everybody who needs help should get it. Central City Hospitality House has helped numerous people. Commissioners’ Comments Commissioner Parker commented on the timeliness of the Health Emergency Practice Exercise and asked if it focused on a particular type of disaster or disasters in general. Ms. Kronenberg said it is focused on smallpox. Commissioner Guy encouraged the Commissioners to forward concerns and questions about the budget to staff prior to the June 3rd meeting, to the extent possible. 5) HEALTH AT HOME UPDATE Kathy Eng, Director, Health at Home, presented the annual Health at Home Update. Health at Home’s mission is to provide compassionate and culturally-sensitive care, promote safe and independent living in the home environment and avoid institutional care. This is their eighth year of service and they served more than 800 clients in FY 2002-03. There are two components to Health at Home services. The first is licensed home health service, which includes acute, skilled and intermittent care. Reimbursement for these services are from Medicare, MediCal, private insurance and general fund. The second component is continuing care, which is additional, time-limited care to prevent deterioration and admission into higher level of care of people discharged from Health at Home. The General Fund provides 65 percent of Health at Home’s funding, and third party payers, including Medicare, Medi-Cal, Ryan White Care funds and private payers provide 35 percent of the funding. Ms. Eng provided an overview of funding, a profile of the clients served and a profile of Health at Home staff. She also discussed the top ten primary diagnoses. 90 percent of clients have one of these diagnoses. Health at Home is seeing increased referrals for complex wound care, IV therapy and substance abuse and psychiatric co-morbidities. Ms. Eng gave an overview of the FY 01-02 CARE Contracts. The goal is to provide comprehensive home health care services to persons living with AIDS/HIV, fostering the ability to live independently at home and avoid institutionalization. CARE funding is $465,652. The cost of providing these services is $1.3 million. Health at Home provides palliative care to 451 acute and continuing care clients. Pediatric Services planning has been underway, with referrals from CCS and the SFGH Medi-Cal population. Health at Home has served four pediatric patients in the last nine months. Ms. Eng discussed efforts to be cost-efficient and maximize resources and develop community partnerships, in accordance with Strategic Plan goals three and four. Challenges CHN provider and patient needs may conflict with home care standards CMS extends Olmstead Act to Home Health Acutely ill patients may not be safe at home and may need higher level of care Delays in discharge extend Home Health length of stay. Staff recruitment and retention hinder services Shortage of therapists and lack of competitive salaries RN shortage Infrastructure Needs Expanding home care technology and IS Space needs Managing a diminishing 03-04 budget Budget reduction: $432,000 and 9.1 FTE Decreased HHA capacity Affects 8 clients Commissioners’ Comments Commissioner Parker said the data points to a trend of younger people being served, but it does not seem like the Department has a grasp on the reasons why this trend has emerged. What are the root causes and how can they be addressed. This is not limited to Health at Home, but throughout the Department. Ms. Eng said they could extract the patients who are served by the CARE contracts to see if this changes the average age of people who are served. Commissioner Umekubo asked if Health at Home is still experiencing problems with physicians signing all necessary paperwork. Ms. Eng said that this is no longer a problem. Commissioner Umekubo asked if they collect patient satisfaction data, and how patients rate pain management. Ms. Eng said that pain management is covered in case conferences, but that question is not asked on the patient satisfaction survey. He asked if the Novius system is combined with Lifetime Clinical Record. Ms. Eng, it is a separate system but they do access the other medical records when patients come to the program. He asked if the number of bilingual staff meets their needs. Ms. Eng, not completely, so have contracts with agencies that provide interpreter services. Commissioner Chow asked if pain management should be rated, whether or not it is mandated. Pam Bohmann said there are two pain assessment questions on the OASIS assessment, and HAH has done well on pain management. However, it is not a question on the satisfaction survey. Commissioner Chow commented that, with regard to adverse outcome data, the level of unexpected death is higher than the norm. Ms. Bohmann said there are two main factors: at time of admission, diagnostic workup was not complete enough to make the assessment that the person would die in the next six months, even though it is clear the patient is declining. Then there are cases when the death is truly unexpected. Commissioner Chow asked that the quality indicators be continually monitored by the Community Health Network Joint Conference Committee in a six-month period. Commissioner Guy asked if the violent incidents against staff have increased. Ms. Eng said that there have been less incidence reports, which may be due to staff communicating potential situations to other staff members. Commissioner Guy asked if staff would really be able to bring laptops and other technology to home visits. Ms. Eng said staff might decide not to bring the laptop into the home, but rather do paperwork in their automobiles, office or other convenient location. Commissioner Guy would like the CHN JCC, in the next six months, to have a more detailed discussion about Health at Home’s dependence on the general fund. The Health Commission supports this program as part of the continuum of care but, with budget constraints, the use of the general fund will be challenged. DPH needs to look at the areas where the cost of services exceed the reimbursement source, and make sure that the general fund is patching the most crucial areas. Commissioner Sanchez would like the agency to re-examine the role of technology in home care services. There is a lot of opportunity to integrate and improve treatment with technology and DPH needs to be attuned to what is best for the patients. Ms. Eng is a member of the IS Steering Committee, which meets monthly. The six-month report will include an update on the technology issue. 6) ASTHMA TASK FORCE UPDATE Rajiv Bhatia, M.D., Director, Environmental Health, introduced the Asthma Task Force co-chairs, Deanna Rossi and Dee Epps-Miller, who presented the report and recommendations. The mission of the San Francisco Asthma Task Force is to prevent asthma and to improve the quality of life for people with asthma, especially the under-served, who live or work in the City and County of San Francisco, by the use of advocacy, legislative action and citywide strategies. The Task Force was established in May 2001 by the Mayor and Board of Supervisors in response to growing community concern about asthma. There are 20 voting and 10 non-voting members. The Task Force is charged with the responsibility to develop a citywide strategic plan to manage and prevent asthma, and to facilitate and monitor the implementation of the strategic plan. The Task Force created four subcommittees: Environmental Committee, Schools and Child Care Committee, Clinical Care Committee and Community Committee. It held 14 focus groups and 42 stakeholder interviews. The strategic plan has 36 recommendations. In general, the recommendations for each of the subcommittees address the following: Clinical Care Committee Proposes institutional standards or care and comprehensive access to care Advocates for expanding professional and patient education Addresses lack of patient follow up and provider feedback with continuous quality improvement systems for clinics, hospitals, doctors and the city as a whole Environmental Committee Addresses indoor air quality issues through public housing inspections, development of healthy housing standards, advocacy, collaboratives and property owner incentives Addresses outdoor air quality issues through increased air monitoring and reduced emissions Community Committee Surveillance/tracking implemented to measure school absenteeism due to asthma, execute school-based prevalence studies, track high risk patients, and implement immediate asthma death reporting Advocates for public awareness through a targeted public education campaign and an entity that can coordinate asthma activities for all of San Francisco Schools and Child Care Committee Identifies children with asthma through computerized tracking and through asthma action plans Advocates for comprehensive asthma policies, staff training, emergency protocols and on-site clinical care Addresses indoor air quality and funding for environmental and health programs Next Steps Present strategic plan to Board of Supervisors Implementation/Action Plans Public Comment Neil Gendel, Healthy Children Organizing Project, spoke in support of the tremendous work of the Asthma Task Force. His organization focuses on children ages 0-5, and asthma really affects children in this age group. The goal is to make private homes, public housing and school facilities trigger-free. He hopes DPH will be able to expand its efforts in the future. Commissioners’ Comments Commissioner Monfredini asked what happens after the Board of Supervisors approves the Strategic Plan. Ms. Rossi said they are starting the prioritization process and hope to begin implementing some of the recommendations. With the help of Supervisor Maxwell, they would like to see a few of the recommendations established as policy within 12 months. Commissioner Parker is thankful that Supervisor Maxwell addressed the asthma problem legislatively. The Task Force should work very closely with Supervisor Maxwell to help the Board draft appropriate policy and legislation. DPH has an opportunity in that this issue is now on City Hall’s radar screen, and the Department has to take advantage of this opportunity. DPH needs to advocate for what it wants, even if the data is not perfect. Commissioner Umekubo said there have been tremendous advancements in asthma treatments. As with any chronic disease, the more educated the client, the better the outcome and it is very time intensive for the provider and patient. Education is critical to parents of children with asthma. There are many resources available, including pharmaceutical companies. Ms. Epps-Miller said both Blue Cross and the San Francisco Health Plan have extensive asthma information resources and devices. She is not sure of pharmaceutical companies’ involvement. Vicki Legion, of the Yes We Can Partnership, said community health workers are very important in educating parents and children, in their homes and in their own languages, about asthma management. Nationally, only 20 percent of community clinics have the needed prevention supplies. Commissioner Guy asked that the data be submitted to the Health Commissioners so that the Commission can make appropriate and educated recommendations. Commissioner Chow said that almost all HMOs have an asthma management program and/or guidelines. But these are not uniform, and are often not publicized outside of the organization. There is a great opportunity to bring these efforts together under a broad coalition. Commissioner Chow was surprised by the level of asthma in the Asian community. This population should be included in the citywide initiative. Jennifer Mann said San Francisco’s Asian hospitalization rates are higher than in the rest of the state. This community has to be carefully targeted. In San Francisco, African Americans have the highest rates of hospitalization. Commissioner Chow suggested bringing a resolution to the Health Commission endorsing the recommendations. Ms. Kronenberg asked the Task Force to consider drafting a resolution for the Health Commission’s consideration at a future meeting. Commissioner Sanchez said it is very difficult to get data from various communities about a disease that is so multifaceted. He commended the Task Force and the Department for the work they have been able to do. There are foundations that are interested in funding environmental justice efforts and these opportunities should be pursued. 7) PUBLIC COMMENTS None. 8) ADJOURNMENT The meeting was adjourned at 6:30 p.m. Michele M. Olson, Executive Secretary to the Health Commission