Minutes of the Health Commission Meeting Tuesday, April 20, 2004 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 Commissioner Monfredini at 3:05 p.m.  Present: Commissioner Lee Ann Monfredini, Vice President Commissioner Roma P. Guy, M.S.W. Commissioner James M. Illig Commissioner Michael Penn, M.D., Ph.D. Commissioner David J. Sanchez, Ph.D.  Commissioner John I. Umekubo, M.D. – arrived at 4:15 p.m. Absent: Commissioner Edward A. Chow, M.D., President 2) APPROVAL OF THE MINUTES OF THE MEETING OF APRIL 6, 2004 Action Taken: The Commission (Guy, Illig, Monfredini, Penn, Sanchez) approved the minutes of the April 6, 2004 Health Commission meeting.  3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Sanchez chaired, and Commissioner Guy and Commissioner Penn attended, the Budget Committee meeting. (3.1) PHP-Environmental Health Management – Request for approval of a new contract with La Raza Centro Legal, in the amount of $311,760, to develop and establish a structure and the resources to improve the health and safety of day laborers’ and to begin implementation of interventions that would improve their working conditions, for the period of May 1, 2004 through April 30, 2008. Commissioner Penn asked how many day laborers are in San Francisco, and how many are served by this program. Anamaria Loya, Executive Director of La Raza Centro Legal, said that the exact number of day laborers in San Francisco is unknown. On any given day, approximately 220 day laborers go to the Day Laborer Program. Twice that number is estimated to be on the streets. Commissioner Guy asked if this grant is one-time or on-going. Ms. Yu of DPH said the grant has been approved for four years, but must request annual renewals. Commissioner Guy requested an update to the Population Health and Prevention Joint Conference Committee midway through the grant period. This is a very exciting program. (3.2) PHP-CHPP – Request for approval of a contract modification with O’Rorke, Inc., in the amount of $25,000 for one year (2003-04) for a total contract value of $72, 800, for the provision of public relations services for the Pedestrian Safety Campaign, for the period of July 1, 2003 through June 30, 2005. Commissioner Guy asked if there is an evaluation component to this campaign. Mr. Radetsky said there is a feedback component in that they look at how many people are getting the information. However there is not a formal evaluation component. (3.3) PHP-CHSS-TB Control – Request for approval of a sole source contract renewal with the Regents of the University of California, in the amount of $228,000, to provide physician and radiologist services to patients referred to the SFGH Tuberculosis Clinic, for the period of July 1, 2004 through June 30, 2005. Commissioner Sanchez abstained from voting on this item. (3.4) AIDS Office-HIV Prevention Services – Request for approval of a retroactive new contract with CompassPoint Nonprofit Services, in the amount of $105,000, to provide Organizational Development and Technical Assistance services targeting SFDPH HIV prevention service providers and SFDPH HIV prevention programs, for the period of January 1, 2004 through December 31, 2004. Secretary’s Note – Jimmy Loyce noted that the source of funds for this contract is CDC and State Prevention dollars, not CARE I as indicated on the contract summary. Commissioner Penn asked for further details on the types of technical assistance that is being provided. Cristina Chan from Compass Point said they offer management consulting, assistance meeting ELI data entry requirements, assistance developing evaluation tools and other services. Commissioner Guy asked if the budget cuts are impacting this program. Ms. Chan replied that Compass Point regularly discuss with the AIDS Office the priority services and the funds available to provide these services. For the last few years the priority has been the ELI system. They then meet with program managers to determine which other services to provide, be it organizational management, board development, evaluation, etc. Commissioners’ Comments (at Health Commission) Commissioner Illig, regarding item 3.4, asked for clarification of the Health Commission’s policy on retroactive contract approval. Commissioner Monfredini said that the Commission’s policy is to not approve contracts when the retroactivity is the fault of DPH.  Action Taken: The Commission (Guy, Illig, Monfredini, Penn, Sanchez) approved the Budget Committee Consent Calendar. Commissioner Sanchez abstained from voting on Item 3.3. 4)DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. TV Turn Off Week The Maternal Child Health program is promoting April 19th through the 25th as "TV Turn Off Week," an event celebrating its 10th year of bringing public attention to the serious unintended consequences of excessive television watching by young children and their families. This year, organizers are putting a special focus on learning about healthy and active lifestyle alternatives to TV viewing. A website, www.tvturnoff.org, offers lots of family fun alternatives to TV watching. WIC Working on Obesity Prevention The San Francisco Women, Infants and Children Supplemental Nutrition Program (WIC) was chosen by the California State WIC program to participate in a special nutrition education project: Finding the Teacher Within. The two-day training focused on improving nutrition education by using “learner-centered” approaches that encourage active participation by the WIC clients. WIC continues to draw from a variety of innovative and dynamic methods of nutrition education to promote obesity prevention.  HIV Prevention Campaign Targets Day Laborers A new HIV prevention media campaign targeting monolingual Spanish-speaking day laborers has begun with a billboard at the interaction of Cesar Chavez and Mission Streets. The effort will continue throughout the summer with messages in bus shelters, bus interiors, and neighborhood billboards depicting maps showing where men can find health and other supportive services. Latinos comprise 14 percent of the City’s population but nearly 20 percent of new HIV cases. The $250,000 campaign is the result of a joint funding initiative between DPH and Bristol-Myers Squibb Virology, and is being managed by UCSF Center for AIDS Prevention Studies. The San Francisco-based firm, Cabra Diseno, developed the campaign messages through extensive interviews and focus groups with the day laborers themselves.  Castro-Mission Health Center, News Update Castro-Mission Health Center (CMHC) in collaboration with the DPH AIDS Office will launch the Routine HIV Testing Pilot project to integrate into primary care routine HIV testing of patients who wish to be tested with the HIV rapid test. Providers will ask all primary care and women’s clinic patients if they would like a HIV test and obtain their written consent to participate in the pilot project. The medical assistant will perform the HIV rapid test and the results will be processed while the patient waits. The provider will meet with the patient once again to give the result. CMHC nursing staff trained as HIV test counselors will follow up immediately if the test is “preliminary HIV+”. For these patients, a confirmatory test specimen will be taken and a return appointment scheduled. Access at Castro Mission Health Center In July 2003, CMHC converted 50 percent of its primary care providers’ appointments to Open Access, which schedules same-day and next-day appointments, and eliminated add-on double and triple booking appointments. In the two years prior to implementation of Open Access, the no-show rate hovered around 25 percent. Between October 2003 and January 2004, the no-show rate for Open Access appointments averaged just 7.2 percent. The success of Open Access at CMHC has required close team collaboration across disciplines involving daily problem solving between operations, medical records, nursing, and medical staff and an active support of the CHN Information Systems. Website Update The MIS Office has issued new information on the number of visits to the website last month, along with some key data on what information visitors accessed. Nearly 7,300 individuals visited the website each day –for a total of 225,840 visits during March – and stayed an average of nine minutes. Seventy-one percent of the hits are from within the U.S. and 11 percent are from international addresses. Of no surprise, the Employment Opportunity page is the most frequently visited. Other topics that have a popular appeal are the variety of pages focusing on STDs, information about pelvic exams and pap smears, ordering birth and death records and the SFGH/CHN site. Dr. Katz is pleased with the growing popularity of the website and congratulated all the staff who continue to update its content and keep the information current and meaningful.  National Infant Immunization Week The San Francisco Immunization Coalition is hosting a special presentation on Wednesday, April 28th, from 11 a.m. to 2 p.m. at Mission Neighborhood Health Center. San Francisco Giants Third Baseman Edgardo Alfonzo and Senator Jackie Speier will be featured speakers at this special community event that includes activities for children, healthy snacks and toy give-a-ways.  Workshop on Land Use and Public Health in Washington, D.C. The National Association of County and City Health Officials and the American Planning Association have asked the DPH Occupational and Environmental Health Section and the SF Department of Planning Citywide Policy Division to participate in a national workshop on land use and public health in Washington DC. In the U.S., DPH is one of a handful of local health agencies that is actively working on land use issues.  Residential Care Conference  A “Residential Care Conference,” is scheduled for Friday, April 23rd, from 8:30 a.m. to 4:30 p.m. at St. Mary’s Conference Center, 1111 Gough Street at Geary. Barbara Garcia, Bob Cabaj, MD and Marc Trotz will serve as speakers and panelists. The conference will address the complex mental health needs of adult and geriatric residents and their families. The event is co-sponsored by Family Service Agency, Community Behavioral Health Services and a number of other related agencies. For more information call 474-7310. 2004 Consumer and Family Mental Health Fair Community Behavioral Health Services (CBHS) salutes May as Mental Health Month with the 3rd Annual Consumer and Family Mental Health Fair, Monday, May 24th, 12 p.m. to 4 p.m. at the San Francisco Main Library, lower level. There will be videos on various mental health topics, entertainment, refreshments, and a number of information booths with representation from the City’s various consumer and family self-help organizations, and mental health and substance abuse programs. For information, please contact Wanda Deams at 255-3694. Chinese Community Health Summit CBHS is pleased to be a co-sponsor of the upcoming Chinese Community Health Summit, which will be held Wednesday, May 26th, from 8:00 a.m. to 4:30 p.m. at the Holiday Inn Golden Gateway at 1500 Van Ness Avenue. The Summit is being organized by NICOS Chinese Health Coalition and will focus on developing strategies to address health care access and prevention needs of San Francisco’s Chinese community. CBHS staff will present on various panels at the Summit. For pre-registration please contact Jeanne Kwong at (415) 255-3427. Commissioners’ Comments Commissioner Penn asked for the background on the HIV Prevention Campaign. Mr. Loyce said that this was a partnership with Bristol Myers Squibb, the Office of Mayor Brown and the Department of Public Health, with BMS giving money and the City providing matching funds. Commissioner Penn asked how easy it would be to implement Open Access throughout the DPH system. Dr. Katz said Open Access is a national movement. It has been implemented in most of Mental Health. Castro Mission was the first Primary Care site. Commissioner Guy asked if the HIV Prevention Campaign is coordinated with the grant for the Day Laborer Program that was approved by the Budget Committee. Mr. Loyce said that the AIDS Office was involved in the application process for that grant. Commissioner Monfredini read in the paper that an executive director was chosen for the Laguna Honda Hospital Foundation. The woman seems like a wonderful candidate. Commissioner Monfredini supports the Foundation’s independence, and wants to ensure that the Foundation and the Health Commission have good communication. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF APRIL Commissioner Guy presented the April Employee Recognition Awards. Individual Awardee Division Nominated by Sharon McCole Wicher, RN, MS SFGH - Behavioral Kathy Ballou and Director of Nursing for Health Division/Admin. Alex Anagnos Psychiatry at SFGHMC Team Awardees Division Nominated by Community Health Education Team Community Programs Ginger Smyly Christina Goette Carpenter, MPH Alyonik Hrushow, MPH Susanna Hennessey-Lavery, MPH Michael Radetsky, MPH Mele Smith, MPH 6) THIRD QUARTER FINANCIAL UPDATE Gregg Sass, DPH Chief Finance Officer, presented that Third Quarter Financial Report. The report presents the third quarterly financial projection of revenues and expenditures for the Department of Public Health for fiscal year 2003-04. These projections are based on revenue collected and billed, and expenses incurred for the first eight months of the fiscal year ending February 29, 2004. DPH is currently projecting a net surplus of $6.522 million. Projections include a revenue surplus of $13.605 million and over expenditures of $7.083 million.  The Department will seek a supplemental appropriation to address the structural issues at San Francisco General Hospital and Laguna Honda Hospital. These appropriations will not require additional General Fund and will be entirely covered with surplus revenues. The supplemental appropriation request is for $12.3 million, with $11.115 million for San Francisco General Hospital and $1.152 million for Laguna Honda Hospital.  Projection of Year End Results Eight months ended 02-29-03  (For use for Controller’s Nine Month Report) Commissioners’ Comments Commissioner Illig asked if the proposed supplemental is what is being considered by the Board of Supervisors to backfill CARE cuts. Mr. Sass said no, that is a different supplemental. The proposal for the backfill is to use unexpended or carryover funds. Dr. Katz added that there was discussion about using DPH’s surplus to backfill CARE cuts. If this had occurred, the surplus would have been unavailable to offset cuts in the contingency budget, and neither the Health Commission nor the Board of Supervisors would have the ability to look at priorities across the Department. Instead, Dr. Katz suggested an alternative to use the $500,000 specifically allocated by Supervisor Daly, as well as rollover dollars to backfill the contracts. Commissioner Illig asked if this proposal would fund all of the cuts for the 12 months of the grant. Dr. Katz said the contracts are funded for two months at the reduced level. Commissioner Monfredini noted that the supplemental would be forwarded to the Board of Supervisors. 7) CONSIDERATION OF A RESOLUTION AUTHORIZING THE DEPARTMENT OF PUBLIC HEALTH TO JOIN THE STATE DEPARTMENT OF GENERAL SERVICES PHARMACEUTICAL PURCHASING PROGRAM TO EXPLORE THE COST BENEFITS OF PARTICIPATION, AND APPROVING PARTICIPATION IN STATE DEPARTMENT OF GENERAL SERVICES PHARMACEUTICAL PURCHASING CONTRACTS THAT PROVIDE FAVORABLE COST BENEFITS FOR THE DEPARTMENT OF PUBLIC HEALTH Sharon Kotabe, Pharm.D., Associate Administrator, Pharmaceutical Services, Community Health Network, presented a proposal to participate in the State Department of General Services (DGS) Pharmaceutical Purchasing Program. At this time DPH does not know whether the DGS program would result in lower pharmaceutical pricing than it receives through the current vendor, Novation. DGS will disclose their contract pricing formularies and other program details to those local government agencies that agree to join the program. The Department wants to explore the cost benefits of participation. Commissioners’ Comments Commissioner Penn asked if participation requires DPH to purchase through the program. Dr. Kotabe said that agreement to participate in the DGS program does not obligate the City to purchase through this program Action Taken: The Commission (Guy, Illig, Monfredini, Penn, Sanchez) approved Resolution #8-04, “Urging the San Francisco Board of Supervisors to Authorize the Department of Public Health to Explore Joining the State Department of General Services Pharmaceutical Purchasing Program to Ascertain the Potential Cost Benefits of Participation,” (Attachment A).  8) BEHAVIORAL HEALTH INTEGRATION UPDATE Bob P. Cabaj, M.D., Director, Community Behavioral Health Services, gave an update on the integration of Community Behavioral Health Services. Dr. Cabaj highlighted accomplishments and challenges for the Executive Team, Clinical Services, Client Relations, Cultural Competency, Provider Relations, Quality Management, Placement, Evaluation, Information Systems, Research and Grant Development. Accomplishments include: Developed a five-year integration plan Designed and instituted new organizational structure Developed cross-training model for line staff Co-located referral and assessment services and integrated Mental Health and Substance Abuse assessment team functions Creating an integrated Mental Health and Substance Abuse Client Council Conducted survey to broaden use of peers for peer/case management activities Establishing integrated CBHS Cultural Competence Advisory Committee Integrating the provider complaints/grievance process Creating uniformity in contracts between Mental Health and Substance Abuse; the blended contract document is being developed by the Citywide Task Force Instituted CBHS Compliance Committee and developed uniform incident reporting, follow-up and evaluation structure, to be implemented by June 2004 Centralized Mental Health and Substance Abuse assessments and placement authorizations Working to address issues related to the large number of organizations providing placements and operating independently.  Improving ability to evaluate effectiveness of programs; identified activities to develop core client outcomes.  Developed plan to provide information on best practices in clinics Examples of integration in action are the TAP and Access Team, the McMillan Stabilization Center, Advanced Access, Administrative cross-training and the Behavioral Health Court. Next Steps - Challenges Truly integrating two separate entities Adjusting resistance to changing clinical approaches Addressing different levels of licensure and credentialing Maximizing revenues within resource constraints Keeping systems consumer friendly and welcoming in the face of resource limitations Commissioner Sanchez left at 4:30 p.m. Commissioners’ Comments Commissioner Monfredini commended Dr. Cabaj for condensing a complex process into a clear, comprehensive report. Commissioner Illig is amazed at the progress that has been made. Non-profit services providers deliver the vast majority of services. How much are providers involved in preparations and planning groups? Dr. Cabaj said community organizations were fully involved in the process, with the head of every major CBO as part of the planning group. This last phase was more internally focused. The clinical integration will not happen without the CBOs full involvement. Dr. Cabaj noted that many CBOs have already been providing integrated services, but the funding streams can still be limiting. Commissioner Guy asked if there has been resistance as a result of licensure issues. Dr. Cabaj said everyone must be credentialed. Staff held a community presentation that began to address the credentialing issues substance abuse providers might face. One of his fears was the different backgrounds of mental health providers and substance abuse providers. But this has not been as much of a problem as he expected. Commissioner Guy said that it has been a challenge to get the patient voice in the evaluation tool, and she looks forward to seeing how this can be incorporated into the integrated Behavioral Health system. She asked how this initiative is affected by the budget crisis. Dr. Cabaj said that whether the City is in a budget crisis or not, integration is the correct approach. It is a better system for the client. This process will help the Department know what community services will need to be strengthened even during budget cuts.  Commissioner Umekubo said that Commission is very quality driven, and asked how the evaluation component is progressing and when can the Commission could expect to see the final product. Dr. Cabaj is hoping to have evaluation reports in Fall 2004. One challenge is the shortage of technology and hardware. This will be reported through the Community Health Network Joint Conference Committee. Commissioner Penn commended Dr. Cabaj for his leadership in this effort. It is incredibly challenging to bring together two independent systems that serve the same client population. He asked how outcome evaluation for the integration would be funded. Dr. Cabaj said he is using grant monies to do evaluation. He views this as part of clinical reporting, and is using data he already has to see where the differences are. Commissioner Penn asked if this approach could be used for other DPH programs. Dr. Katz said the Department is moving toward this. Commissioner Penn asked if this integration is resulting in job losses. Dr. Cabaj said no one officially lost his or her job. A few people retired, and some vacant positions are proposed to be eliminated. Commissioner Penn asked if there are budget savings opportunities. Dr. Cabaj said there would be savings opportunities, for example in contract monitoring. Also, the goal is to have only one community advisory board.  Commissioner Illig asked which other counties have moved in this direction. Dr. Cabaj said San Diego has been a model of full integration, and other counties, such as Alameda, have done administrative integration. San Francisco is not using the Alameda model because in that case Mental Health virtually subsumed substance abuse services. Dr. Katz told the Commission that DPH had a failed attempt at integration when it was done only on the administrative level. 9) PUBLIC COMMENT None. 10) 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 (Guy, Illig, Monfredini, Penn, Umekubo) voted to hold a closed session. The Commission went into closed session at 5:00 p.m. Present in closed session were Commissioner Guy, Commissioner Monfredini, Commissioner Penn, Commissioner Umekubo, Mitch Katz, M.D., Director of Health, Deputy City Attorney Sallie Gibson, Larry Funk, Executive Administrator of Laguna Honda Hospital, Norm Nickens, Deputy Director, EEO and Cultural Competency Programs and Michele Olson, Health Commission Executive Secretary.  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 $175,000 in the Joyce Vanman vs. City and County of San Francisco, Superior Court File Case #318-756, City Attorney File #011206 Action Taken: The Commission (Guy, Illig, Monfredini, Penn, Umekubo) approved the settlement of $175,000 in the Joyce Vanman vs. City and County of San Francisco, Superior Court File Case #318-756, City Attorney File #011206. D) Reconvene in Open Session The Commission reconvened in open session at 6:05 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 (Guy, Illig, Monfredini, Penn, Umekubo) voted not to disclose discussions held in closed session. 11) ADJOURNMENT The meeting was adjourned at 6:05 p.m. Michele M. Olson, Executive Secretary to the Health Commission Note: These Minutes will be adopted at the next Health Commission meeting. Any amendments to these Minutes made by the Health Commission will be recorded in the Minutes for the next Health Commission meeting.