Minutes of the Health Commission Meeting Tuesday, May 18, 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 Chow at 3:05 p.m. Present: Commissioner Edward A. Chow, M.D., 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 4:10 p.m.) Absent: Commissioner Lee Ann Monfredini, Vice President 2) APPROVAL OF THE MINUTES OF THE MEETING OF MAY 11, 2004 Action Taken: The Commission (Chow, Guy, Illig, Penn, Sanchez) amended the minutes to include additional written testimony that was submitted during the hearing. The written testimony was from: Barry Zevin, M.D.; China Express Deli – support for Mission Mental Health ISC and Mission ACT; La Corneta Taqueria – support for Mission ACT and Mission Mental Health; Various Mission Merchants (Café Venice, Chow’s, Walgreen’s, 23rd and Mission Produce, The Balloon Place) – support for Mission ACT and Mission Mental Health; Sally Kaufman, M.D., President, Friends of Sunset Mental Health – petition in support of Sunset Mental Health; Petition in support of Mission Mental Health and Mission ACT; Chinatown Public Health Center Staff – letter/petition in support of Madeline Ritchie. The Commission (Chow, Guy, Illig, Penn, Sanchez) approved the minutes of the May 11, 2004 Health Commission meeting as amended. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE (3.1) CHN-Laguna Honda – Request for approval of a contract renewal with Bernd Kutzscher, M.D., in the amount of $149,790, to provide ophthalmology and optometry services for the residents of Laguna Honda Hospital, for the period of July 1, 2004 through June 30, 2007. Secretary’s Note – Dr. Terry Hill said the information in the Health Commission’s packet incorrectly states that ophthalmologic surgery is performed at SFGH. Dr. Hill has given the doctors authorization to do the surgery at Seton Medical Center. Commissioners’ Comments Commissioner Guy asked how many patients this doctor sees. Dr. Hill does not have the specific number, but said that the doctor sees almost all of the long-term patients at the hospital. Commissioner Penn asked why patients are not kept within the DPH system and sent to SFGH instead of Seton Medical Center. Galen Leung said that this service was put out to bid last year, and a number of these questions were raised. No one at UCSF bid for this service, Dr. Kutzner does not have admitting privileges at SFGH and there was a need for continuity of care for patients. Commissioner Sanchez thanked Dr. Hill for his years of medical leadership at LHH, and wished him well in his endeavors. (3.2) CHN-SFGH – Request for approval of a renewal contract with the Regents of the University of California, in the amount of $376,320, to provide orthotics and prosthetics for medically indigent adult clients of the Community Health Network, for the period of July 1, 2004 through June 30, 2005. Commissioners’ Comments Commissioner Guy thanked Kermit Clayton for developing and implementing this program. Mr. Clayton is retiring later this year. Commissioner Sanchez abstained from voting on this item. (3.3) CHN-SFGH Medical Staff Services – Request for approval of a renewal contract with Medical Staff Services Registry, Inc., in the amount of $75,000, to provide as-needed credential verification services for San Francisco General Hospital, for the period of June 1, 2004 through June 30, 2006. (3.4) CHN-SPY-YGC – Request for approval of a contract renewal with St. Mary Prescription Pharmacy, in the amount of $415,000, to provide as-needed outpatient pharmacy services for the clients of the Community Health Network, Special Programs for Youth/Youth Guidance Center and associated programs, for the period of June 1, 2004 through June 30, 2007. This item was continued to the June 1, 2004 Health Commission meeting. (3.5) BHS-Mental Health – Request for approval of a retroactive contract renewal with Alameda County Health Care Services Agency, in the amount of $1,620,464 per year for four years, for a total contract amount of $6,481,857, to provide fiscal management services and access to 24-hour, skilled-nursing, neuro-behavioral care for individuals with Organic Brain Syndrome impairment, for the period of July 1, 2003 through June 30, 2007. Commissioners’ Comments Commissioner Guy asked Linda Wang to give a brief history of why DPH decided to enter into this partnership. Ms. Wang said that a number of counties found that they had on their acute inpatient units people they had difficulty placing due to complex medical or psychiatric problems. The member counties decided to partner, as it would be difficult for any county to undertake this service by itself. (3.6) BHS-Substance Abuse – Request for approval of a resolution to enter into, accept and expend a combined Negotiated Net Amount and Drug Medi-Cal Agreement with the California State Department of Alcohol and Drug Programs (DADP) in the amount of $57,686,688 for the period of July 1, 2004 through June 30, 2008. Action Taken: The Commission (Chow, Guy, Illig, Penn, Sanchez) approved the consent calendar of the Budget Committee, with Commissioner Sanchez abstaining on item 3.2. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., presented the Director’s Report. May Revision to the State Budget On Thursday, May 13th, Governor Schwarzenegger released the May Revision to his 2004-05 budget proposal released in January. The May Revision provides updated revenue and expenditure estimates, as well as modifications to the Governor’s January budget and policy proposals. In the May Revision, the Governor outlines a plan to close a $14 billion deficit for 2004-05, eliminate the structural deficit in 2005-06, and implement structural reforms that provide future savings. The budget anticipates $3.6 billion in new resources compared to the January proposal and reflects savings gained from multiyear agreements between the Governor and local governments, higher education and others. The Administration proposes to use these new funds and savings to scale back or eliminate many of the reduction proposals that were put forth in January. Following are the health-related proposals that were contained in the January budget but that are rescinded by the May Revise: 10 percent Medi-Cal provider rate reduction; Enrollment caps on Healthy Families, the AIDS Drug Assistance Program, the California Children’s Services Program, State-only funded immigrant programs; Rebasing of rates in the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program; and Block granting of all health and social service programs for immigrants. However, the May Revision continues to rely on the following health service reductions that could decrease revenues to DPH by a total of $2.6 million in fiscal year 2004-2005: Restructuring of the federally qualified health center (FQHC) Medi-Cal prospective payment system (estimated impact on DPH - $1.8 million) Elimination of the children’s system of care program for mental health services (estimated impact on DPH - $500,000) Increasing the county share of cost from 10 to 20 percent for the Early and Periodic Screening, Diagnosis and Treatment Program (estimated impact on DPH - $200,000) Reimbursing services provided under the Drug Medi-Cal program at fiscal year 2002-03 rates (estimated impact on DPH - $100,000) In the next month, the Legislature will consider the individual items proposed by the Governor in his May Revision as well as on other budget issues that the Governor may not have addressed. It is anticipated that the new budget will be enacted by the Constitutional deadline of June 30th. Community Health Education Section Program Featured In APHA Magazine The SevenPrinciples for African American Infant Survival and Community Unity Project was featured in the May 2004 issue of the official magazine of the American Public Health Association. The project examines the promise of four interventions to reduce African American infant mortality, improve the health of the African American community, and reduce the disparities in infant mortality rates. The project is a joint project of the Community Health Education Section, Booker T. Washington Community Service Center, CAHEED, Jelani House, and the Family Health Outcomes Project of UCSF. The project is nearing completion of its third demonstration year and is projected to continue for at least three additional years. The SevenPrinciples project was included into the APHA's health disparities model programs' database launched during Public Health Week this year. The article and the database represent part of the APHA's focus on the elimination of health disparities." Feeling Good Project Testifies at Assembly Hearing Laura Brainin-Rodriguez, Coordinator of DPH’s Nutrition Services’ Feeling Good Project, presented testimony at a hearing by Assemblyman Mark Leno and the Assembly Select Committee on Childhood Obesity and Related Diabetes on the work taking place at DPH and the San Francisco Unified School District. Eric Hernandez, Child Health and Disability Prevention Program Nutritionist, presented information on DPH’s Eat Well, Live Better project. 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, 12pm to 4pm, 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. State Licensing Follow Up Visit at Laguna Honda Hospital Four State Licensing and Certification Division evaluators conducted an unannounced visit of Laguna Honda Hospital between May 13th and -15th to review implementation of plan of correction measures identified in the February 2004 annual survey. The survey team presented no findings of substandard care, but noted a few deficiencies. The State will send Laguna Honda its written findings to which the Hospital will respond with a plan of correction. The revisit will be discussed at the Laguna Honda Hospital Joint Conference Committee on May 27th. COMMUNITY HEALTH NETWORK SAN FRANCISCO GENERAL HOSPITAL May 2004 Health Commission - Director of Health Report (From 05/10/04 MEC)   05/04 7/03 to 05/04 New Appointments 25 148 Reinstatements 0 0 Reappointments 54 377 Delinquencies   0 Reappointment Denials   0 Resigned/Retired 08 133 Disciplinary Actions   0 Restriction/Limitation-Privileges 0 0 Changes in Privileges     Additions 05 105 Voluntary Relinquishments 5 2 Proctorship Completed 13 141 Current Statistics - as of 05/1/04   Active Staff 429 Affiliate Professionals (non-physicians) 176 Courtesy Staff 514 Total Members 1,119 Applications In Process 22   Applications Withdrawn Month of Jan 2003 0 11(07/03 to 05/04 SFGH Reappointments in Process Def 2003 to Mar 2004 173   Commissioners’ Comments Commissioner Guy asked if the proposed budget takes into consideration the State budget. Dr. Katz replied that the DPH budget does not factor in any State budget impacts. If the proposals are approved by the Legislature, the Mayor’s Office has established a citywide State Budget set-aside. DPH should not expect further reductions based on the final State budget. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF MAY This presentation was continued to the June 15, 2004 Health Commission meeting. 6) PRESENTATION OF THE EMERGENCY MEDICAL SERVICES (EMS) ANNUAL AWARDS Commissioner Chow presented the Emergency Medical Services Annual Awards. EMS FIELD PROVIDER AWARD TO: Alaina McNeill, EMT-1 King-American Ambulance Co. For outstanding performance and professionalism as an EMT-1 conducting neonatal and inter-facility transports, as well as EMS calls, for the King-American Ambulance Co. EMS HOSPITAL PROVIDER AWARD TO: Marlena Tang, M.D. Kaiser Permanente Medical Center For selfless and outstanding performance and leadership as an ED physician, the Medical Director of City College’s Paramedic Training Program, and as a paramedic instructor. EMS COMMUNITY SERVICES AWARD TO: Jorge Solis, RN McMillan Center For outstanding performance as the talented and compassionate Co-Director of the McMillan Center Stabilization Project for chronic inebriates since its inception in August 2003. EMS DISPATCHER AWARD TO: Janet Selinger Emergency Communications Dept. For outstanding performance as a trainer and dispatcher and for exceptional talent in processing and properly directing medical calls for service. RAYMOND LIM EXCELLENCE IN EMS AWARD TO: Michael Callaham, M.D. University of California Med. Ctr. For outstanding performance and leadership throughout a 20-year distinguished career as a pioneer and visionary of the EMS system in San Francisco. Special Recognition of the City College of San Francisco Emergency Medicine Technician (EMT) Class, Evans Campus 7) PRESENTATION OF THE EMERGENCY MEDICAL SERVICES (EMS) ANNUAL REPORT John Brown, M.D., EMS Medical Director, presented the Emergency Medical Services (EMS) Annual Report. 2003 Highlights – EMS System Planning and Development Major revisions of EMS System Policies SFFD Paramedic Service Provider Agreement Addition of Pro Transport –1 as BLS provider Approved Kaiser SSF as new receiving hospital McMillan Center Pilot as alternate receiving facility Established a Regional Trauma Medical Audit Committee – have begun the process with San Mateo County and Santa Clara County. 72% of incidents where fire apparatus was first unit on scene also had ALS capability. So increasing the proportional of paramedics who arrive first at the scene Implementation of new ambulance diversion policy Secured $250,000 of ASI Funding for implementation of LEMSIS Termination of SFFD Paramedic Training Program Approval of program, and first graduating class of paramedics from CCSF Training Program Continued work on Optimization of SF EMS System 2003 Highlights – Community Programs Over 100 Public Access Defibrillation Sites 8,400 participants in Disaster Registry 2003 Highlights – Emergency, Disaster and Terrorism Preparedness EMS radio check compliance at 90 percent Training of DPH DOC and EOC staff on disaster roles Led department-wide UASI strategic planning Key participant in citywide SHSGP, RSA and UASI grant programs. Challenges Improving 911 Dispatch Times and AMPDS Priority Coding – need to get more dispatches safely into the Code 2 arena, need to reduce the Code 3 Dispatch Queue Interval; Target for next year is 7 ½ minutes for Code 3 Response Interval. Decreasing Emergency Department Overcrowding and Ambulance Diversion Instituting Mass Gathering Ordinance – working with Supervisor Dufty’s Office; organized approach to 2003 Halloween in the Castro produced a 90% drop in calls for EMS service. There are some logistical issues to overcome. Gurney car ordinance – potential detriment to patient care and disaster preparedness Decreasing Trauma Center vulnerabilities Securing ongoing funding for development of Local EMS Information System Increasing effectiveness and frequency of disaster drills and training. Develop DOC back-up power, cable and CAD access. Coordinate Medical/Health disaster-terrorism preparedness Dr. Brown discussed some of the disaster planning and response efforts, including Disaster Registry Program and Department Operating Center Upgrades. Dr. Katz said that the EMS system is extremely complex. It has both the everyday issues of 24-hour, seven-day-a-week, emergency response. At the same time, the system must plan for disasters. The system’s efforts depend on cooperation, and it does not control the resources explicitly. So it is quite challenging. The agency has professionalized the EMS system and has put a structure in place to continuously strive for improvements. Commissioners’ Comments Commissioner Umekubo was happy to see that the all the hospital have improved over past performance in the HearNet response rate. What were the problems? Dr. Brown said that in some cases it was an equipment problem, in some cases a training problem and in some cases a procedural problem. Commissioner Umekubo noted that one of the findings of the 9/11 investigation was that there was a breakdown in communication between fire fighters and police officers, and asked how this could be avoided in a similar situation in San Francisco. Dr. Brown replied that the Emergency Communications Department is the essence of the solution. All public safety agencies, as well as outside agencies, communicate. In addition, San Francisco already has so many things in place that other agencies only understand the value of after a disaster. Commissioner Penn thanked Dr. Brown for his passion and dedication to this important work. He commended Dr. Brown for using a number of means to accomplish his tasks. He asked how easily the undertriage rate could be brought down to the standard level of 5-10%. Dr. Brown said they had found a disturbingly high number of trauma deaths at community hospitals. The EMS system secured grant funding and undertaking a preventable death study and hope to find identifiable system changes that could be made. Through quality assurance review, they have identified one problem of people who seem to have a minor head injury that turns out to be serious. Commissioner Chow asked the status of getting a generator at the EMS building. Dr. Brown said this has been an excruciatingly difficult process. They have secured the funding and are working with the Department of Real Estate to address other issues. Commissioner Chow would like an update to the CHN JCC on the status of the generator. Commissioner Chow said that the city has so much great capability now to respond quickly to emergencies. Dr. Brown said that the new Fire Chief is very supportive of EMS. 8) PRESENTATION OF THE CULTURAL COMPETENCY REPORT Norm Nickens, Deputy Director, EEO and Cultural Competency, presented the annual Cultural Competency Report. Mandates Charter mandated discrimination complaint process, Response to external discrimination complaints Compliance with ADA – Title 1 Conduct language proficiency testing for DPH employees Monitor compliance with Equal Access to Services Ordinance Oversight, implementation and monitoring of Health Commission Cultural Competency Policy MOU mandated citywide Employee Assistance Program. Recommendations Cultural Competence Task Force Increase accountability of DPH managers and programs in the area of cultural competency Require annual reports to the Commission from DPH Section/Divisions to identify cultural competency goals and accomplishments Integrate submission of annual contractor cultural competency reports into COOL system Clarify responsibility of program managers in monitoring contractor annual report Develop minimum cultural competency requirements for all DPH programs Process should be time-phased and sequenced Clarify role of EEO Office in reviewing non-discrimination, grievance, reasonable accommodation and language access policies Identify how existing data collection can support evaluation of impact of cultural competency activities on healthcare outcomes Identify and disseminate best practice models from contract and departmental programs Recognize efforts of contractors who have developed model programs/policies Link departmental cultural competency objectives to other outcome measures and other DPH initiatives. Cultural Competency Training Develop web-based documents and tools to assist program managers and contractors on how to develop, implement and evaluate cultural competency goals and objectives Expand partnerships to within DPH and CCSF to support cultural competency training Establish minimum cultural competency training requirements for all staff EEO Complaint Resolution Establish minimum standards for frequency of Harassment-Free training for all employees Establish monthly training schedule at SFGH, LHH and 101 Grove Develop prevention model based on training, coaching, intervention, mediation, discipline, and complaint investigation. Bilingual Services Offer regularly scheduled language proficiency testing Expand pilot training on how to provide bilingual services Consider mandating training for all employees receiving bilingual pay Address issues of access to trained, tested, bilingual (non-interpreter) staff Develop standard for bilingual signage Update/validate bilingual testing to assess level of proficiency Review compliance with Equal Access to Services Ordinances Mr. Nicken’s said that the City’s Department of Human Resources is considering absorbing the DPH Employee Assistance Program into their department. Commissioners’ Comments Commissioner Illig said that many contractors approach the Department’s cultural competency program with cynicism and arrogance. The CLAS standards were guidelines, but seemed to be morphed into requirements. Further, these are unfunded mandates. The standards are different for community organizations than they are for the Department. Further, many community organizations were founded to serve specific communities. If this effort is approached a little differently, more contractors will come on board. He would like to see more focus on the linkage of cultural competency to outcomes. Commissioner Illig added that cultural competency should be a citywide effort, and asked if there is an effort to do this. Mr. Nickens said that DHS is developing a policy; his understanding is that the Citywide Task Force on Contracting considered this but decided against it. Mr. Nickens said that there are citywide solutions being developed. Commissioner Chow said the Health Commission policy came out of the desire to set a higher bar for providing culturally competent services to San Francisco’s numerous demographics. This is a challenging effort. While the CLAS standards are guidelines, the Health Commission has asked that cultural competency be appropriately incorporated into contractor evaluation. The partnerships with community providers are extremely important, and the Department can learn from agencies. He added that the goal of cultural competency to create better health outcomes. Commissioner Penn said that often, cultural competency is considered synonymous with language. In the African American community, cultural competency is something different and extremely important given health disparities in this community. He is concerned that DPH’s efforts are not capturing this distinction. He asked if there is a formal action plan, with milestones and timelines, for having cultural competency be a formal component of contract evaluation, as well as Departmental participation in cultural competency. Mr. Nickens replied that they have stepped back from this effort to look at the broader timeline issues. Commissioner Penn asked Mr. Nickens to provide the Commission with examples of exemplary reports/models from community-based organizations. Commissioner Sanchez said that foundations are very interested in board diversity, and are asking agencies to submit breakdowns. He is encouraged that there continue to be federal agencies, such as the Office of Minority Health, that provide oversight over these efforts. Commissioner Sanchez said that both the department and contractors have come along way. He remembers a time when a potential contractor adamantly declined to diversify board or staff. Commissioner Umekubo said he is please by how the effort has evolved over time. Cultural competency is important, yet somehow seems to take a back seat to care delivery issues. The Health Commission needs to be a leader on this issue, and keep hospitals and other service providers focused on the importance of this issue. It is not a focus of Continuing Medical Education. Mr. Nickens said there is a State Legislative Task Force that is looking at mandating cultural competency continuing education requirements for some professions. Commissioner Guy said the recommendations clearly outline how the Department is going to systematically take this to the next level. She supports moving toward a system of excellence, rather than just centers of excellence. The Department is currently updating its strategic plan, and this systems approach to cultural competency should be part of the next iteration. She is concerned that during difficult budget times, there may not be adequate staffing to meet all the expectations. She encouraged further partnership with the Mayor’s Office of Disability. Commissioner Chow said he would like to provide continuing support and monitoring of this effort at the CHN Joint Conference Committee on a quarterly basis. 9) PUBLIC COMMENT None. 10) ADJOURNMENT The meeting was adjourned at 6:45 p.m. Michele M. Olson, Executive Secretary to the Health Commission