Minutes of the Special Health Commission Meeting Tuesday, October 21, 2003 at 1:30 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 1:40 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, M.D., Ph.D. Commissioner David J. Sanchez, Ph.D. - arrived at 2:45 p.m. Commissioner John I. Umekubo, M.D. 2) CONSIDERATION OF SUPERVISOR CHRIS DALY’S PROPOSED CHARTER AMENDMENT REGARDING THE DEPARTMENT OF PUBLIC HEALTH AND CONSIDERATION OF A RESOLUTION REGARDING THE CHARTER AMENDMENT Supervisor Daly provided the Health Commission with an overview of his proposed charter amendment. During last year’s budget, Supervisor Daly’s priority was health, and he made a commitment to doing fixing the structural problems in the budget. The proposed Charter Amendment is an attempt to level the playing field for the Health Department. The amendment would do many things, including establish a baseline for funding of approximately $300 million and give the Health Commission and Department more autonomy. Supervisor Daly said he concurs with the Health Commission to eliminate designated seats for the Health Commission. Supervisor Daly said the Charter Amendment specifically mentions San Francisco General Hospital, Laguna Honda Hospital and the community clinics, and states that they would continue to operate. The process for closing a community clinic would be similar to the process used for closing a district police station. With regard to mental health and substance abuse services, Supervisor Daly said that at one point he was in favor of setting mandates for waiting lists, but he is now offering language that the Department sets goals for wait lists for specific modalities. The Charter makes specific mention of the Mental Health Rehabilitation Facility (MHRF). The type of services provided at the MHRF could be changed by going through the Health Commission and the Board of Supervisors. With regard to community clinics, Supervisor Daly’s intent is to have DPH continue to provide the type of care through the clinics that it is currently provided. Supervisor Daly said he wanted to include homeless funding in the DPH baseline because he fears that these funds could be cut from other departments. He is currently working on removing some of the housing money from the baseline, for example redevelopment money. Other programs, such as shelter services, should come under the health baseline, and can be work ordered to departments such as DHS. Supervisor Guy asked Supervisor Daly what the next steps are in the approval process, given that there is such a quick turn around time for the proposed Charter Amendment. Supervisor Daly replied that it is scheduled for the Rules Committee on October 27. There is the opportunity for two Rules Committee meetings before it goes to the Board for consideration on the March ballot. Supervisor Daly said that it is on the fast track because he is concerned about what will happen during the next budget cycle. Commissioner Chow asked Deputy City Attorney Aleeta Van Runkle for more information about the timeline and what changes can occur at the Board of Supervisors. Ms. Van Runkle’s understanding is that the Board has one opportunity to amend the legislation, which is at the October 27 Rules Committee meeting, then the legislation moves forward to a second Rules Committee meeting on November 3. There is a very tight timeframe, and only one opportunity to amend the legislation. Both the vote at the November 3rd Rules Committee meeting and the November 18th Board of Supervisors meeting are up or down votes. Public Comment Ed Kinchley, SEIU 790, takes offense at the term special interest in the resolution. He thanked Supervisor Daly’s office for helping the Health Department be what it is today. Local 790 has not had sufficient opportunity to have a process, and in principle is not in favor of set asides; however, other departments have them. They will continue to be in dialogue with Supervisor Daly’s office, on things such as whether it should state that it is within the authority of DPH to eliminate health clinics and adequate staffing. Debbi Lerman, San Francisco Human Services Network, their steering committee is still meeting and has not taken a position, but want to express appreciation to Supervisor Chris Daly in this attempt to protect health services in this city. They are still discussing concerns: doesn’t necessarily protect community-based organizations, which are an essential part of the city’s health services; second, there are a lot of important safety net services in other departments that may be squeezed out when the baseline is put in place. Brian Green, the conservator of his sister, who is currently at the MHRF. How will the timing work if the MHRF is included in the Charter Amendment given the work of the blue ribbon committee? John Kozinsky, Local 250 Healthcare Workers Union, doesn’t think unions should be labeled a special interest group. He thanked Supervisor Daly for his leadership. He does have reservations at this point, the Supervisor’s office has been very receptive, and hopes to have continued dialogue. Dick Hodgson, Community Clinic Consortium, is very excited about stabilizing the health care safety net in San Francisco. This is the opportunity to strengthen the partnership between community health centers and DPH. They will be finalizing their position tomorrow and will forward this to Supervisor Daly. Support it in concept and hope it will go forward. Bill Barnes, staff to Supervisor Daly, said that, with regard to safety net services in other departments, the State mandates certain of these programs, so they are protected this way. The measure does not prohibit future discussions about the MHRF. What it requires is transparency in these decisions. Dr. Katz said that overall the legislation would be a great help to the department. The thrust is good for the Department of Health, but there is a question about whether it is good for the rest of the city. It strengthens the role of the Commission and gives the department much greater predictability. Also provides the incentive to achieve savings because the savings can be retained. Commissioners’ Comments Commissioner Guy and Commissioner Chow thanked Supervisor Daly for the work he did during last year’s budget on behalf of health and the Health Department. Commissioner Chow asked for clarification that Supervisor Daly is looking at removing non-health focused homeless programs. Mr. Barnes replied that homelessness is an important health issues because people who are homeless have higher mortality and lower health outcomes, and Supervisor Daly believes that programs such as hospice care, respite care, licensed care facilities and Direct Access to Housing stay in the Health Department. The next draft of the Charter Amendment will clarify what programs will be part of the baseline. Commissioner Guy said the Charter Amendment comes from a genuine attempt to protect the baseline budget. She is happy to hear that there is going to be further discussion about which homeless services will be part of the baseline. Commissioner Chow clarified that the language about community clinics is to support what is currently done, encompassing both the DPH health centers and the non-profit clinics. Commissioner Chow clarified the intent of the resolution language about special interests on the Health Commission. As always, the Commissioners should consider the good of the whole, rather than representing any one group. Commissioner Chow is concerned with the language that all Commissioners must have knowledge of government, finance or labor relations. Mr. Barnes replied that Supervisor Daly is committed to more consumer involvement, even though this may not be accomplished through slots. Commissioner Monfredini does not want designated Commission seats because there needs to be flexibility to address different priorities and, again, Commissioners must always keep the good of the whole at the forefront. Commissioner Guy added that history has shown that bodies that have slots narrow their perspective. Commissioner Parker suggested increasing the number of Commissioners, primarily because the workload of the Commission is going to dramatically increase and Commissioners are part time. And having a Commissioner from each district will make the public feel that they have more of a connection to the Health Commission. Mr. Barnes stated that in the proposed Charter Amendment, the Mayor retains the Commission appointments, and he or she represents the entire city. Supervisor Daly had considered increasing the size, but decided that the current size would best allow a continuation of the sense of camaraderie that has existed on the Commission; this could not happen if there were more members. Commissioner Umekubo feels that that the specified slots pigeonhole the Commission and would not provide flexibility to meet emerging issues. Commissioner Penn said increasing the size of the Commission deserves further consideration. A lot of the work gets done in the joint conference committees, and Commissioners are only part time. Commissioner Monfredini, regarding a larger Commission, is concerned that it would be difficult to get a quorum with 11 members, and believes it is easier to make decisions at seven than at 11. Commissioner Chow added that there has been past discussion about the Commission size, and he feels that seven is a workable, effective number. Commissioner Guy is concerned about forensics. Every year, although the Health Commission tells the Board what level of funding is needed to adequately fund this service, the Department does not get adequate funding. She does not want this deficit built into the baseline. Mr. Barnes replied that the Commission would have more autonomy to create a budget and prioritize services. Further, the ability for the Department to retain its revenue will allow the Department to meet its needs. Commissioner Penn said the manner in which mental health programs and goals are laid out in the Charter Amendment in detail, but AIDS and cancer are mentioned but not specified, is rather arbitrary. He feels that more specific language should be included in the Charter Amendment. Commissioner Parker said the availability of funds is what drives new services; if there is no money, there are no services, and if there is a pot of money available for a dedicated service, then that is what gets funding. It frustrates the Commission when they say their hands are tied about what programs they can and cannot fund. Commissioner Sanchez said this is a unique approach to supporting public health. We need resources for comprehensive departments of public health. His question is what baseline would allow the Health Commission to meet its mandates? This has never been evaluated or discussed. Also, the Charter Amendment focuses on diseases that are on the radar screen now, but he is concerned that it might limit our ability to address other diseases and public health issues that might arise. Will this new model move us to the next level? If this is the first step, then let’s do it and have more discussion and dialogue as it goes through the approval process. There needs to be much more dialogue about what the overall impact would be. Commissioner Guy commented that it would have been preferable to have had more time to review this proposal. A Charter Amendment is not a small thing and, because the devil is in the details, there should have been more discussion about all the details. Charters are principles, not operation manuals. In addition to the diseases identified in the Charter, there are other important health issues as well-health disparities, cardiovascular disease, etc. Commissioner Guy applauds Supervisor Daly’s commitment to transparency. Commissioner Chow added that the Charter must be realistic, and he is pleased that Supervisor Daly is willing to change mandates to goals. Action Taken: The Health Commission unanimously approved Resolution # 16-03, “Supporting Increased Autonomy and Fiscal Authority for the Health Commission and Department of Public Health, Supporting the Concept of Stable, Predictable and Adequate Funding for Health Services, and Urging Modifications and Enhancements to the Proposed Health Department Charter Amendment,” (Attachment A). 3) PUBLIC COMMENTS None. 4) ADJOURNMENT The Special Meeting was adjourned at 3:15 p.m. Michele M. Olson, Executive Secretary to the Health Commission