Minutes of the Health Commission Meeting Tuesday, January 20, 2004 at 3:00 p.m. 101 Grove Street, Room #300 San Francisco, CA  94102 1) CALL TO ORDER President Chow called the meeting to order at 3:15 p.m. Present:  Commissioner Edward A. Chow, M.D., President Commissioner Roma P. Guy, M.S.W., Vice President Commissioner Lee Ann Monfredini Commissioner Michael Penn, M.D., Ph.D. Commissioner David J. Sanchez, Ph.D. Absent:  Commissioner Harrison Parker, Sr., D.D.S. Commissioner John I. Umekubo, M.D. Commissioner Chow announced that the Commission’s hearing on the proposed FY 2004-2005 budget will be on Thursday, February 5th at City Hall at 3:00 p.m. 2)  APPROVAL OF THE MINUTES OF THE MEETING OF JANUARY 6, 2004 Action Taken:  The Commission (Chow, Guy, Monfredini, Penn, Sanchez) approved the minutes of the January 6, 2004 meeting with one correction.  Commissioner Penn was absent at that meeting.  3)  APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Monfredini chaired, and Commissioner Penn attended, the Budget Committee meeting.  Commissioner Umekubo was absent. (3.1)  CHN/SFGH-Nursing Operations – Request for approval of contract modification with the following firms:  HRN Services, Inc., Medical Staffing Network, Inc., Medstaff, Inc., Nurse Providers, Inc. and United Nursing International, to increase the combined contract amount by $1,350,000, from $1,350,000 to $2,700,000, to provide supplemental, temporary per diem and traveling nursing personnel services to San Francisco General Hospital, for the period of September 1, 2003 through June 30, 2004. At the request of the Commission, staff provided hourly wage comparisons between traveling nurses and staff nurses.  The traveler’s base is $64 per hour.  DPH RN is $37.25 per hour wage, and $46.56 per hour when benefits are included.  (3.2) CHN-Primary Care-Tom Waddell Health Center – Request for approval to retroactively accept and to expend new subcontract funds from the Tenderloin AIDS Resource Center, in the amount of $597,710, for early intervention outpatient services to homeless persons at risk of or infected with HIV disease, for the period of September 30, 2003 to March 31, 2007. (3.3) CHP-Maternal and Child Health – Request for approval to accept and expend funds from the California Department of Health Services, in the amount of $99,918, for nutrition education in community settings to low-income families in San Francisco, for the period of January 1, 2004 to September 30, 2004. Commissioners’ Comments Commissioner Monfredini requested an outcome evaluation report to the Population Health and Prevention Joint Conference Committee. (3.4) CHPP-Immigrant Services – Request for approval of a new contract with Bay Area Community Resources, in the amount of $60,374, to provide outreach and health education services targeting Russian-speaking refugees, asylees and immigrants, for the period of January 1, 2004 through December 31, 2004. (3.5) AIDS Office-HIV Prevention – Request for approval of a retroactive sole source contract renewal with PHFE Management Solutions, in the amount of $193,181, to provide staffing for the final phase of the Zimbabwe HIV Prevention Trials Network protocol 015 (Explore) study, for the period of July 1, 2003 through June 30, 2004. (3.6) AIDS Office-HIV Prevention – Request for approval of a retroactive sole source contract renewal with PHFE Management Solutions, in the amount of $180,118, to provide staffing for the HIV Vaccine Trials Network Leadership Group study, for the period of August 1, 2003 through July 30, 2004. (3.7) AIDS Office-HIV Prevention – Request for approval of a contract renewal with UCSF/Urban Health Study, in the amount of $272,759, to provide HIV prevention services targeting defined behavioral risk populations, for the period of January 1, 2004 through June 30, 2004. Commissioners’ Comments Commissioners Monfredini and Penn reiterated the importance of getting the data to DPH. Commissioner Sanchez abstained from voting on this item. (3.8) AIDS Office-HIV Prevention – Request for approval of a contract renewal with Walden House, Inc., in the amount of $137,629, to provide HIV prevention education services targeting high-risk populations, for the period of January 1, 2004 through December 31, 2004. Commissioners’ Comments Commissioner Monfredini congratulated the staff for a commendable program. Commissioner Penn asked if the agency has found an auditor.  Don Frasier of Walden House said that Deloitte decided to continue to perform the agency’s audit. (3.9) BHS-Mental Health/Substance Abuse – Request for approval of a retroactive contract renewal with the Regents of the University of California-AIDS Health Project, in the amount of $683,962, to provide mental health and substance abuse services targeting clients with AIDS/HIV disease or disabling HIV disease who are low income and uninsured or underinsured, for the period of July 1, 2003 through June 30, 2004. Commissioners’ Comments Commissioner Penn stated that is it difficult when reviewing contracts to see two-year-old monitoring reports.  Linda Wang said that one of the goals of the integrated Behavioral Health system is to get the monitoring reports done in a more timely manner, rather than reviewing two-year old reports when the contracts are considered for approval. Commissioner Monfredini thanked Ms. Rinaldi for her attention to detail over the years. Commissioner Sanchez abstained from voting on this item. Action Taken:  The Commission (Chow, Guy, Monfredini, Penn, Sanchez) approved the Budget Committee Consent Calendar, with Commissioner Sanchez abstaining from voting on Item 3.7 and Item 3.9. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. State Budget Governor Schwarzenegger announced his proposed budget on Friday, January 9th. The State’s $26 billion budget deficit reflects a $9 billion year-end deficit in FY 2002-2003, a current year (FY 2003-2004) shortfall of $3 billion, and a budget year (FY 2004-2005) shortfall of $14 billion. The Governor’s proposed solution to close the budget gap relies mostly on borrowing ($12 billion) and reductions in program spending ($11 billion). A combination of fund shifts, debt service savings, transfers, and other revenues are used to close the remaining $3 billion gap. As expected, there are a number of proposals that would, if enacted, have a significant effect on the Department. The majority of the health reduction proposals, which total $880 million, are the same as those proposed by Governor Davis as mid-year reductions in the last fiscal year and would primarily impact Medi-Cal. Our preliminary estimates of the Governor’s proposed reductions show that they could reduce DPH revenues by approximately $4.4 million. These proposals include: A 10 percent Medi-Cal provider rate reduction (in addition to the 5 percent reduction made in the Budget Act of 2003); Altering the Medi-Cal prospective payment system rate setting methodology for federally qualified health centers (FQHCs); Capping enrollment in the AIDS Drug Assistance Program (ADAP); Eliminating the Children’s System of Care mental health program; and Capping enrollment in the Healthy Families and California Children’s Services (CCS) Programs. The Governor’s proposed budget also included vague language about his intentions to restructure both the Medi-Cal program and programs serving immigrants to realize budget savings in future years. As you know, this is merely the starting point for the State’s 2004-05 budget. The Legislature will soon begin introducing budget bills and will hold preliminary budget hearings. In May, the Governor will introduce his revised budget proposal (the May Revise), which will contain more sound income figures based upon April income tax revenues. Literacy for Environmental Justice Launches its’ Pilot Good Neighbor Partnership On December 19th, Youth Envision, a project of Literacy for Environmental Justice, launched its pilot Good Neighbor partnership with Super Save in the Bay View. As one of the Tobacco Free Project's Community Capacity Building Projects, Youth Envision focuses on improving access to healthy food in existing corner stores, the primary food resource in the neighborhood. They mounted the “Good Neighbor” campaign to encourage corner stores to replace tobacco, alcohol and tobacco subsidiary food products with fresh and healthier food alternatives in exchange for campaigns to promote community patronage. Youth Envision held a press conference at Super Save and is working with Supervisor Sophie Maxwell on a Good Neighbor task force to sustain the effort. The press event was covered by the Bay Guardian, Independent, and KPFA. Dr. “Dan” Wlodarczyk Receives Community Service Award St. Paul of the Shipwreck Catholic Church hosted its 19th Annual Dr. Martin Luther King Solidarity Mass last Sunday with the theme “Be…The Dream.” After the mass, Community Service Awards were presented to Supervisor Sophie Maxwell and Dr. Daniel Wlodarczyk, Acting Medical Director of Southeast Health Center. Supervisor Maxwell and Dr. Wlodarczyk received this honor in recognition of their work in the community that reflects the spirit of Dr. Martin Luther King. COMMUNITY HEALTH NETWORK: SAN FRANCISCO GENERAL HOSPITAL CREDENTIALS REPORT December 2003 (From 12/08/03 MEC and 12/16/03 JCC) 12/03 7/03 to 12/03 New Appointments 8 89 Reinstatements   1 Reappointments 24 158 Delinquencies 0 0 Reappointment Denials 0 0 Resigned/Retired 13 70 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Changes in Privileges     Additions 2 69 Voluntary Relinquishments 0 1 Proctorship Completed 27 67 Current Statistics - as of 12/1/03   Active Staff 428 Affiliate Professionals (non-physicians) 170 Courtesy Staff 524     Total Members 1,122 Applications In Process 13   Applications Withdrawn Month of Jan 2003 2 8(07/03 to 12/03) SFGH Reappointments in Process Def 2003 to Mar 2004 217   Commissioners’ Comments Commissioner Chow asked if the Governor backfilled the VLF loss to local governments.  Gregg Sass said Governor Schwarzenegger did use emergency powers to restore the reduced VLF.  However, the Governor’s budget proposal includes a $1.3 billion take back of local property tax revenues that would otherwise go to cities.  5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF JANUARY Commissioner Chow presented the January Employee Recognition Awards. Individual Awardees Division Nominated by Lorraine Anderson Population Health and Prevention - Environmental Health Section Ken Sato, Principal Environ. Health Inspector Team Awardees Division Nominated by Emergency: Evacuation Floor Team Leaders Population Health and Prevention - Shawn R. Holle, Safety Analyst Pam Axelson Norma Baldeviso Ishmael Bihl Richard Bitanga Robin Buckley Jeffrey Burton Tamara Davidson Karen Heckman Robert Longhitano Carlos Quintanilla Ernest Wong Disease Control, Microbiology Lab, Immunization, Facilities, Contracts, CHS Fiscal, OSH and MIS 6) ELECTION OF PRESIDENT AND VICE PRESIDENT OF THE HEALTH COMMISSION FOR 2004 Action Taken: The Commission (Chow, Guy, Monfredini, Penn, Sanchez) voted to continue the Election of Officers to the next Health Commission meeting. 7) PRESENTATION OF THE MENTAL HEALTH REHABILITATION FACILITY BLUE RIBBON COMMITTEE REPORT AND CONSIDERATION OF A RESOLUTION SUPPORTING THE BLUE RIBBON COMMITTEE RECOMMENDATION Mitchell H. Katz, M.D., Director of Health, presented the Mental Health Rehabilitation Facility (MHRF) Blue Ribbon Committee Report. The MHRF Blue Ribbon Committee was created by Mayor Brown in September 2003 as a result of an agreement the unions made with the City to pick up employee retirement contributions and defer pay raises to keep the MHRF open as a skilled nursing facility for one year.  The committee was charged with: Determining the future of the MHRF beyond 03-04 and determining the optimal programmatic design for the facility given available services and unmet needs; Reviewing information about the mission, history, function, financing, successes and challenges of the MHRF; Surveying existing models for providing services to persons with chronic mental health problems; Holding meetings run by consensus building process The Committee was chaired by the Director of Health and included representatives from unions, academia, DPH staff, Family and Friends of the MHRF, administrators from other mental health facilities and that Department of Aging and Adult services.  The committee held nine public hearings, received presentations, assessed pros and cons of various models of care, took public comment and met separately with union representatives and Friends and Family. The first recommendation is to create a hybrid model with different levels of care on each floor.  The 3rd floor would be a Mental Health Rehabilitation Center with a psychosocial rehabilitation focus rather than a medical/nursing model.  The 2nd floor would be a Skilled Nursing Facility and maintain care for current MHRF geriatric, non-ambulatory and neurobehavioral patients.  Staffing would be similar to existing staffing at the MHRF.  The 1st floor would be a 27-bed Residential Care Facility and a 14-bed Residential Treatment Facility with day treatment.  There would be less restrictive care for patients who have difficulty getting admitted to existing DPH contracted facilities.  This model meets the clinical needs of complex medical and psychiatric patients, provides treatment and housing options for those that need less restrictive care and provides easier transitions between levels of care.  The second recommendation is to establish a transition team to evaluate and implement changes to the MHRF.  This would include community and institutional mental health providers, union representatives and Family and Friends of the MHRF.  With regard to the budget, the current MHRF model requires $13.3 million in General Fund subsidy.  The proposed model would require an $11.1 million General Fund subsidy.  Dr. Katz asked the Blue Ribbon Committee members who were present at the Commission meeting to address the Commission. Melanie Myers, SEIU 250 – this proposal is a compromise that she voted for.  It provides more services than the original proposal and keep patients in San Francisco.  This proposal will improve the flow of patients at the MHRF and make transition into the community easier.  The model is not perfect and she is pleased that there will be a transitional work group. John Nickens, Progress Foundation – the hybrid proposal represents the next best effort what this facility can do for the people of San Francisco.  It provides for fluidity in treatment.  It may not be the final step, but it is the next step.  He and Progress Foundation are committed to providing assistance to the Department during the transition of the new model. Linda Chafetz, Professor at UCSF School of Nursing – The process was sensitive to all stakeholders.  MHRF employees worked with Friends and Family representatives to bring forward thoughtful proposals.  This is a good compromise. Jenny Hua, IFPTE Local 21 – she supported the model because it fosters hope for the clients.  It will help them safely transition to different levels of care.  She emphasized the need for staff training. Piers Mackenzie, Family and Friends of the MHRF – Family and Friends of the MHRF voted by a narrow majority to support the hybrid model.  They have a number of concerns about the affect of conversion of the first floor, and change in the MHRF’s mission.  However, they feel the proposed model is a good compromise.  Friends and Family are happy to have a place on the transition team. Philippa Rutgaizer, RN at the MHRF and SEIU representative – she is pleased with the process and hopes that licensure is successful so that the facility can continue to provide these services to the residents of San Francisco. Public Comment Jennifer Baity Carlin, dual diagnosis specialist at the MHRF and SEIU member. She opposed last year’s proposal, and is pleased to be able to support the hybrid model.  While it is not the perfect solution, it is a good compromise.  The need is there for all levels of care, but there are budget constraints.  Staff training is essential.  Kimberly Tavaglione, SEUI Local 250, said this was a compromise decision if money were no object, there would be levels of care for all who need it.  But this is not an option.  The members are committed to making this model successful.  If it is not successful, the unions will let the Commission know.  Ed Warshauer, SEIU Local 790, said that the proposed model is a far better model than what was proposed last year.  SEIU 790 is committed to working with the Department to make this work.  One of the key components of the resolution is the monitoring group.  He told the committee that there would be a mental health initiative on the November 2004 ballot that would generate additional funds.  If this is the case, he would like the opportunity to reexamine the MHRF to possibly revert it back to a SNF. Brian Green, conservator for his sister who is a resident at the MHRF, said that the MHRF was a unique facility with a vision and purpose that have been dropped in this process.  The original vision was never implemented.  There has been gross mismanagement.  This is a much better model than last year’s proposals.  And there is no programmatic design.  He submitted copies of patient complaints for the public record.  Criss Romero, IFPTE Local 21, said that Local 21 had two representatives on the Blue Ribbon Committee and represents seven or eight staff at the MHRF.  The union would likely request a meet and confer with the Director of Health to discuss position cuts and impact of Local 21 membership.  Dr. Katz clarified that though there were a number of union representatives on the Blue Ribbon Committee, DPH will still have to go through the meet and confer process with all of the affected unions.   Commissioners’ Comments Commissioner Sanchez thanked everyone for his or her comments, particularly given the acrimonious debate over losing this quality of care during last year’s budget discussions.  The compromise is the result of good work by DPH staff, union members, advocates, and others and he is happy to support it. Commissioner Guy supports the compromise, as well as the need to have a transition work group.  She also understands the reality that the budget position still has not improved.  She asked if there is enough time to get appropriate licensure.  Dr. Katz said he believes we could get licensed by July 1.  What is unusual about this proposal is that there are four types of care under one roof, which has never been done before.  But there is no reason why it cannot be done.  The fact that this is a consensus proposal will help with both regulatory and financial challenges.  Commissioner Guy appreciates that Friends and Family were and will continue to be involved. Commissioner Penn said it is difficult to achieve consensus and he is impressed with the product.  He is impressed with the fluidity of the model, and that patients can tangibly see other patients moving safely through the system.  He asked if there are any comparable models.  Dr. Katz said San Mateo had a similar model—it eliminated a portion of their SNF and added a residential component.  Commissioner Penn said there should be a formal process for the monitoring committee so there can be continued accountability as the model moves forward.  He asked the top three concerns about the new model.  Dr. Katz said the licensure process, ensuring that the Mayor and Board of Supervisors does not tinker with the consensus model and the meet and confer process.  His thought is that the transition team would meet in April or May.  Commissioner Penn asked who is in charge of the MHRF.  Dr. Katz said it ultimately reports to Gene O’Connell, as the SNF is on the hospital’s license. Commissioner Chow asked that the SFGH JCC monitor the transition and implementation of the new model.  While the proposed model may not meet all needs, it does lead to treatment fluidity—and perhaps a better patient care—as well as cost savings.  Commissioner Monfredini said that it is wonderful to have this option available, as the original proposal was not anything the Commission wanted to accept.  Action Taken:   The Commission (Chow, Guy, Monfredini, Penn, Sanchez) approved Resolution #1-04, “Accepting the Recommendations of the Mental Health Rehabilitation Facility ((MHRF) Blue Ribbon Committee and Authorizing that the Changes in MHRF Staffing be Submitted for the Department of Public Health 2004-05 Budget and that Changes in MHRF Licensure be Pursued,” (Attachment A).  8) PUBLIC COMMENT None. 9) CLOSED SESSION: A)  Public comments on all matters pertaining to the closed session None. B) Vote on whether to hold a closed session (San Francisco Administrative Code Section 67.11) Action Taken:  The Commission (Chow, Guy, Monfredini, Penn, Sanchez) voted to hold a closed session.  The Commission went into closed session at 4:55 p.m.  Present in closed session were the Commissioners, Dr. Mitch Katz, Larry Funk, Norm Nickens, Deputy City Attorney Sallie Gibson and Michele Olson. C) Closed session pursuant to Government Code Section 54956.9 and San Francisco Administrative Code Section 67.10(d) Approval of a settlement in the amount of $80,000 in the Sofia Rillanos vs. City and County of San Francisco, Superior Court File #418598, City Attorney File #031508 Action Taken:   The Commission (Chow, Guy, Monfredini, Penn, Sanchez), voted to approve a settlement in the amount of $80,000 in the Sofia Rillanos vs. City and County of San Francisco. D)  Reconvene in Open Session   The Commission reconvened in open session at 5:15 p.m. Possible report on action taken in closed session (Government Code Section 54957.1(a)2 and San Francisco Administrative Code Section 67.12(b)(2).) Vote to elect whether to disclose any or all discussions held in closed session (San Francisco Administrative Code Section 67.12(a).) Action Taken:   The Commission (Chow, Guy, Monfredini, Penn, Sanchez) voted not to disclose discussions held in closed session. 10)  ADJOURNMENT The meeting was adjourned at 5:15 p.m. Michele M. Olson, Executive Secretary to the Health Commission