Minutes of the Health Commission Meeting Tuesday, September 21, 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 3:20 p.m. Present: Commissioner Edward A. Chow, M.D., President Commissioner Lee Ann Monfredini, Vice President Commissioner Roma P. Guy, M.S.W. Commissioner James M. Illig Commissioner David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. Absent: Commissioner Michael L. Penn, Jr., M.D., Ph.D. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF SEPTEMBER 7, 2004 Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Umekubo) approved the minutes of the September 7, 2004 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Sanchez chaired and Commissioner Guy attended the Budget Committee meeting. (3.1) CHN-SFGH/Trauma – Request for approval of a new contract with Gerson/Overstreet, in the amount of $520,000, to provide aeromedical access design and permitting services for the Trauma Center at San Francisco General Hospital, for the period of October 1, 2004 through December 31, 2006. (3.2) PHP-CHPP – Request for approval of a retroactive renewal contract with Bayview Hunters Point Health and Environmental Resource Center, in the amount of $580,543, to provide preventive health outreach education, training and capacity building services on asthma and cancer, for the period of July 1, 2004 through June 30, 2005. Commissioners’ Comments Commissioner Guy asked for an explanation of the shortfalls that were described in the monitoring report. Karen Pierce said that the issues that were identified were from the previous monitoring report and have been resolved. (3.3) BHS-Substance Abuse – Request for approval of a retroactive contract renewal with Iris Center, in the amount of $1,093,102 per year for a total contract amount of $4,372,408, to provide outpatient, prevention and intensive outpatient substance abuse services targeting low-income women, women of color and lesbian/bisexual/transgender women, for the period of July 1, 2004 through June 30, 2008. Secretary’s Note – this contract was modified from a four-year term to a two-year term. The period is from July 1, 2004 through June 30, 2006, and the total contract amount is $2,186,204. (3.4) BHS-Substance Abuse – Request for approval of a retroactive contract renewal with Haight Ashbury Free Clinics, Inc., in the amount of $5,800,063, to provide substance abuse treatment services for residential, outpatient, day treatment, prevention and outreach programs, for the period o f July 1, 2004 through June 30, 2005. Commissioners’ Comments Commissioner Sanchez noted that the Community Health Network Joint Conference Committee received a detailed update about HAFC at its August meeting. He thanked Dr. Darryl Inaba, Executive Director of HAFC, and Tim Covington, President of HAFC’s Board of Directors, for coming to the Budget Committee meeting. Dr. Inaba said that staff is committed to continuing services to the vulnerable population they serve. The organization instituted widespread fiscal controls to prevent anything like this from happening again. Commissioner Guy reiterated that HAFC would provide regular financial status reports to Gregg Sass, DPH Chief Financial Officer. In addition, the CHN JCC will receive quarterly report. She asked if the Board of Directors supports the steps management has taken. Mr. Covington replied that the Board is fully behind the direction management is moving. The Board has reinvented itself from an advisory body to a hands-on board, and follows program quality very carefully. The Board has embarked upon a $2.5 million fundraising campaign. Commissioner Guy asked about the Glide Outpatient program, and how program performance could improve. Rudy Aguilar, DPH Contract Manager, said that DPH has worked very closely with this program, including providing training on chart entry and reporting requirements. Commissioner Guy asked for a six-month status report to the Budget Committee on this program. At the Commission meeting, Commissioner Illig asked if money that is being work ordered for this contract from DHS is Care Not Cash Funding. Mr. Stillwell said it was. Other contracts have received similar funding. (3.5) BHS-Mental Health – Request for approval of a retroactive renewal contract with Institute for Community Health Outreach, in the amount of $94,389, to provide HIV Early Intervention Program services, including health education and case management, targeting HIV+ people of color living in the Bayview-Hunters Point community, for the period of July 1, 2004 through December 31, 2004. Commissioners’ Comments Commissioner Guy requested that a report on the joint State/DPH monitoring be presented to the Population Health and Prevention Joint Conference Committee. Ms. Long Dixon recommended doing so in December. Action Taken: The Health Commission (Chow, Guy, Illig, Monfredini, Sanchez, Umekubo) approved the Budget Committee Consent Calendar with the modification to a two-year contract term for Item 3.3. Item 3.4 was referred to the Budget Committee for a six-month status report to the Budget Committee and to the Community Health Network Joint Conference Committee for quarterly updates. Item 3.5 was referred to the Population Health and Prevention Joint Conference Committee for a follow-up report in December. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Mayor’s Disability Council Discussion on Laguna Honda Hospital On September 17th, the Mayor’s Disability Council dedicated the majority of its meeting to a discussion of Laguna Honda Hospital (LHH). Michael Lane gave a presentation of the physical plant of LHH and our planned rebuild, Liz Gray gave a presentation of our new targeted case management program, and I spoke about our current policies and practices. Commissioner Illig was also present. Although a few negative comments were made about LHH during the hearing, especially regarding the concern that the money used to support LHH would be better spent on community-based care, the majority of council members and public speakers spoke about the need to maintain both LHH and community resources. Governor Acts on Syringe Bills Yesterday, Governor Schwarzenegger signed SB 1159 (Vasconcellos), called the Disease Prevention Demonstration Project, which will allow licensed pharmacists to sell up to 10 syringes to an adult without a prescription. It is well known that limited access to sterile syringes contributes to the transmission of HIV, hepatitis C, and other blood-borne infections among injection drug users, their sex partners, and their children. DPH worked closely with the Mayor’s Office to assert the city’s strong support of this important public health bill throughout the legislative process. In order to participate in the Disease Prevention Demonstration Project, City Councils or County Boards of Supervisors must authorize the sale of nonprescription hypodermic needles or syringes through local ordinance. Once authorized, the local health department must maintain a list of all pharmacies participating in the program and make available to those pharmacies written information on how to access drug treatment, how to access testing and treatment for HIV and hepatitis C, and how to safely dispose of sharps waste. Pharmacies participating in the program are required to provide this information either in writing or orally to purchasers of syringes. Additionally, pharmacies must provide for safe sharps disposal by either having an onsite collection and disposal program or by making safe disposal containers available to purchasers. The Disease Prevention Demonstration Project is designed to evaluate the long-term effect of pharmacy-based syringe sales to prevent the spread of blood-borne pathogens, including HIV and hepatitis C, and requires a report to the Legislature at the end of the project. The program becomes effective January 1, 2005 and terminates on December 31, 2010. Unfortunately, Governor Schwarzenegger vetoed another syringe access bill, AB 2871 (Berg), which would have allowed needle exchange programs to operate in cities and counties without the need for biweekly declarations of local emergency by Boards of Supervisors or City Councils. Though this has not been a problem in San Francisco, other jurisdictions have had difficulty maintaining the ongoing support of their local governing bodies that is necessary to authorize needle exchange programs. Gordon & Betty Moore RN Internship Program San Francisco General Hospital has been awarded a grant of $2.34 million over three years to create a Registered Nurse (RN) Internship program. The program will recruit US-educated nurses with Associate degrees nurses and foreign-trained nurses with Bachelor of Science degrees in Nursing into a six-month program that will provide extended training in specialty skills. These specialty areas include: medical-surgical; emergency; critical care; perioperative; labor & delivery; newborn nursery; and psychiatric training. It will be an intensive competency-based program that will combine specialty-focused theory with clinical preceptorship and mentorship components. Formalized preceptor training to experienced RNs who are committed to enhancing their teaching skills will be integral to the program, as will developing mentorship skills for current RN staff. I’d like to specifically recognize and thank Sue Currin, Chief Nursing Officer at SFGH, for her leadership and vision in pursuing funding opportunities for this exceptional program. Balboa High School Bike Club Over the summer, at the request of a student, Balboa Teen Health Center nurse practitioner Roni Robertson launched a bike club for students of Balboa High School. The Bike Hut in San Francisco and Trips for Kids in Marin County graciously lent the students and teachers bicycles and helmets, and provided safety and repair instruction. In June, July, and August, the students, teachers, and clinic staff went on three trips in San Francisco, Tennessee Valley, and China Camp. On each trip, clinic staff provided a nutritious, home cooked lunch as a way to model healthy eating and regular physical activity. Now that school has started, the bike club continues and has become more popular. It is open to all students, regardless of ability to ride. However, none of the students owns a bike. In response, Roni and Michael Baxter of Community Health Programs for Youth wrote a $50,000 grant proposal to the California Endowment to support the bike club, including the purchase of 50 bikes, locks, helmets, and water bottles to be given to students who consistently participate. The club is also working with the San Francisco Unified School District to install a bike rack on campus. Anyone wishing to donate a new or used bike, lock, helmet, or biking equipment to the club should contact Roni Robertson or Michael Baxter at 469-4512. 3 For Life Update As I reported at your last meeting, on September 18th, DPH launched the 3 For Life pilot project in partnership with the Asian Liver Center at Stanford University to improve awareness and early intervention for hepatitis B in San Francisco’s Asian community. Of the 240,000 Asians in San Francisco, it is expected that 10% or more may be chronically infected with hepatitis B. The project offers low-cost testing for hepatitis B and vaccination for hepatitis A and B at the Richmond District YMCA, from 11am to 2pm on the first and third Saturdays of each month. The clinic debut was preceded by a highly successful press conference on September 16th, which received coverage in most major television, radio and print media outlets. Over 100 adults (98% of whom were Asian) came to the first clinic. In the course of the three-hour clinic, 96 people were vaccinated - the majority of whom received the combination hepatitis A and B vaccine. Every client was also tested for hepatitis B and will receive the results in one week's time from the lab at Stanford University. This was an exceptional accomplishment. Hepatitis B is currently one of the top five causes of premature mortality in the Asian community in San Francisco – yet it is completely preventable through vaccination. The 3 For Life project could save hundreds of lives through testing and vaccination. COMMUNITY HEALTH NETWORK: SAN FRANCISCO GENERAL HOSPITAL SEPTEMBER (From 09/13/04 MEC and 09/14/04 JCC)   09/04 9/04 to 06/05 New Appointments 23 44   Reinstatements 0 0 Reappointments 37 89   Delinquencies:   0   Reappointment Denials:   0 Resigned/Retired: 9 50 Disciplinary Actions   0 Restriction/Limitation-Privileges 0 0 Deceased 0 0 Changes in Privileges       Additions 12 13   Voluntary Relinquishments 4 13   Proctorship Completed 10 20 Current Statistics - as of 09/1/04     Active Staff 437   Affiliate Professionals (non-physicians) 182   Courtesy Staff 514   TOTAL MEMBERS 1,133   Applications In Process 49   Applications Withdrawn Month of September 2004 1 2 (09/04 to 06/05) SFGH Reappointments in Process Oct 2004 to Jan 2005 165   Commissioners’ Comments Commissioner Sanchez is pleased that the Moore Foundation is funding the nursing internship program at San Francisco General Hospital. Commissioner Illig asked if other cities have the level of needle exchange programs that we do, and if the new legislation will minimize the need for needle exchange programs. Dr. Katz said that the hope is the need for needle exchange will decrease, since people can buy needles at pharmacies. But there are certain groups the Department would still want to serve through its program, because of the other health services provided to them in addition to the provision of needles. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF SEPTEMBER This item was continued to the October Health Commission meeting. 6) REVIEW OF RECONFIGURATION OF EMS SERVICES IN THE FIRE DEPARTMENT AND CONSIDERATION OF A RESOLUTION Dr. Katz began the presentation by saying that he has been working with Chief Joanne Hayes-White on reconfiguration of fire-based EMS over the last few months. This has been a successful collaboration and he fully endorses the proposal. Chief Hayes-White said that one of the priorities of her administration was to examine the Fire Department’s operational configuration. One result of this examination was that the way the Department deployed medical resources was in need of work. She formed a work group in April with stakeholders to develop a new configuration. Chief Hayes-White announced that Mayor Newsom had appointed an emergency physician to the Fire Commission. Dr. Marshall Isaacs said the goal of Chief Hayes-White’s workgroup was to look at current resources and see if they could be deployed in a way that would ensure the highest quality medical care while at the same time ensuring that the paramedics and EMTs were satisfied and not overworked. Dr. Isaacs gave a brief history of the paramedic merger that began in 1997 and an overview of the current status. The goals of the merger were: rapid paramedic response, assure adequate transport resources, and to capitalize on economies of scale with infrastructure, training and administration. Dr. Isaacs said merger planners underestimated the cultural difference, over estimated the Fire Department’s physical infrastructure and that there was incomplete call data compounded by an unprecedented rise in call volume. Added to that was the inability to encourage fire fighters to cross train as paramedics, high attrition due to high ambulance call volume and the need to divert resources to emergency response after September 11. Dr. Isaacs said the merger has resulted in improved response times to critically ill patients. There are more ambulances and paramedics. There is better coordination at all levels. EMS Chief Glenn Ortiz-Schuldt described the options analyzed by the work group, which were: Model 1 – Fire Department transport tier with accelerated hiring of single function (H1) paramedics Model 2 – All private ambulance transport Model 3 – Private ambulances for Code 2 runs Model 4 – Public/Private partnership As a result of the discussions, another model was formed that took the best parts of each model and joined them together. That resulted in Model A. Model A Strength Increase in ambulances address work load Transition off 24 hour ambulance shifts Continues revenue stream Retains ambulances as training platforms Possible savings with single function paramedics and EMTs Increased diversity in recruitment pools Creates natural farm system for recruitment of H3s and H2s Can match hiring to retirements Provides enhanced H3 job satisfaction and retention Creates 70 paramedic response platforms—42 engines, 24 ambulances, 4 rescue captains Provides career opportunities for single function paramedics and EMTs Enhances flexibility and efficiency Maintains current reliance on private providers Optimizes disaster response Model A Weaknesses Loss of 24-hour ambulance shifts Overall increase of 29 FTEs Commissioners’ Comments Commissioner Monfredini asked how the emergency communication would change under the new configuration so that there would not be triple dispatch. Chief Hayes-White said that the move to 42 ALS engines would allow only one engine arrive, rather than both an ALS and BLS engine. Commissioner Monfredini is hoping that this new model is embraced by the Fire Department and incorporated into the culture. Commissioner Illig asked if the Mayor has weighed in on this. Dr. Katz said that the Mayor is supportive of Model A. Commissioner Illig asked if the hiring of single function EMTs and paramedics would just exacerbate the cultural differences. Dr. Isaacs replied that the Chief and everyone working on this are committed to preventing this from happening. Chief Fazackerley added that the Department is extremely sensitive to this. There will not be a need to create the firehouse living experience for the single-function EMTs and paramedics. They have seen improvement between cultures when expectations are clearly defined and understood. The single function positions will minimize this. Commissioner Illig asked what the current revenue stream is. Dr. Fazackerley said the Fire Department recoups approximately $16 million in ambulance revenue. Commissioner Guy asked what the unions’ positions are on this change. Chief Fazackerley said that his understanding is that both SEIU Local 798 and SEIU Local 790 support elements of the plan, but he does not know their official opinions. Commissioner Sanchez said another element of emergency medical services is the availability of trauma resources once the patient is picked up. He is pleased that the Fire Department is working closely with the community colleges to recruit staff. He encouraged staff to pursue extramural funding from foundations and other entities to fund training and recruitment efforts. Commissioner Guy said this model presents an opportunity to rectify the some of the problems of the merger. Commissioner Chow asked if, under the proposed model, ALS engines would respond to all EMS calls. Dr. Katz said this is an unresolved issue, but currently the plan is that an ALS engine would not respond to every call. Code 3 calls would get the ALS engine, then the ambulance staffed with a paramedic and the EMT. For Code 2, only the ambulance would respond. The other unresolved issue is whether the paramedic position would have the public safety retirement benefit. Public Comment Larry Bradshaw, Paramedic Shop Steward for Local 790, said that he and others are worried about this plan. The key issue for success or failure is who staffs the transport tier. The latest version of the plan has civilian EMS personnel for transport tier who are paid substantially less and would be second class citizens. He asked the Commission to urge hiring EMS personnel as full uniformed personnel. Lori Beth Slonsky – has grave concerned about the new configuration. She asked the Commission to insist that the Fire Department hire uniformed personnel and that they be treated equally. Otherwise it would be institutional discrimination. Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Umekubo) voted to continue this item to the October 26th Health Commission meeting. 7) APPROVAL OF THE DEPARTMENT OF PUBLIC HEALTH’S DRAFT STATEMENT OF INCOMPATIBLE ACTIVITIES Kathy Murphy, Deputy City Attorney, presented the Department of Public Health’s draft Statement of Incompatible Activities. This item was continued from the August 3, 2004 Health Commission meeting. The Ethics Commission will hold hearings on all departments’ statements, and has final approval over the statements. The Ethics Commission may adopt the DPH statement as is, or send it back for modification. The statements are subject to meet and confer requirements. The Civil Service Commission is also holding hearings on departmental statements. Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Umekubo) accepted the Draft Statement of Incompatible Activities and approved forwarding the draft statement to the Ethics Commission. 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, Illig, Monfredini, Sanchez, Umekubo) voted to hold a closed session. The Commission went into closed session at 5:08 p.m. Present in closed session were Commissioner Chow, Commissioner Guy, Commissioner Illig, Commissioner Monfredini, Commissioner Sanchez, Commissioner Umekubo, Mitch Katz, M.D., Director of Health, Matthew Rothschild, Deputy City Attorney, Gene O’Connell, Executive Administrator, SFGHMC, Alison Moed, SFGH Risk Management Director 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 $100,000 IN DESHAY V. CCSF, UNLITIGATED CLAIM NO. 04-01138 Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Umekubo) approved the settlement in the amount of $100,000 in Deshay v. CCSF, Unlitigated Claim No. 04-01138. D) Reconvene in Open Session The Commission reconvened in closed session at 5:20 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, Illig, Monfredini, Sanchez, Umekubo) voted not to disclose discussions held in closed session. 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 (Chow, Guy, Illig, Monfredini, Sanchez, Umekubo) voted to hold a closed session. The Commission went into closed session at 5:21 p.m. Present in closed session were Commissioner Chow, Commissioner Guy, Commissioner Illig, Commissioner Monfredini, Commissioner Sanchez, Commissioner Umekubo, Mitch Katz, M.D., Director of Health, Matthew Rothschild, Deputy City Attorney 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 $29,000 IN ESCAMILLO V. CCSF, CLAIM No. 03-04261 Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Umekubo) approved the settlement in the amount of $29,000 in Escamillo v. CCSF, Claim No. 03-04261. D) Reconvene in Open Session The Commission reconvened in open session at 5:30 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, Illig, Monfredini, Sanchez, Umekubo) voted not to disclose discussions held in closed session. 11) CLOSED SESSION A) Public comments on all matters pertaining to the closed session None. B) Vote on whether to hold a closed session Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Umekubo) voted to hold a closed session. The Commission went into closed session at 5:50 p.m. Present in closed session were Commissioner Chow, Commissioner Guy, Commissioner Illig, Commissioner Monfredini, Commissioner Sanchez and Commissioner Umekubo. C) Closed session pursuant to Government Code Section 54957 and San Francisco Administrative Code Section 67.10(b) PUBLIC EMPLOYEES PERFORMANCE EVALUATION: DIRECTOR OF HEALTH, DR. MITCH KATZ EXECUTIVE SECRETARY TO THE HEALTH COMMISSION, MICHELE M. OLSON D) Reconvene in Open Session The Commission reconvened in open session at 7:20 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, Illig, Monfredini, Sanchez, Umekubo) voted not to disclose discussions held in closed session. 12) ADJOURNMENT The meeting was adjourned at 7:20 p.m. Michele M. Olson, Executive Secretary to the Health Commission Health Commission meeting minutes are approved by the Commission at the next regularly scheduled Health Commission meeting. Any written summaries of 150 words or less that are provided by persons who spoke at public comment are attached to the hard copy of the minutes. The written summaries are prepared by members of the public, the opinions and representations are those of the author, and the City does not represent or warrant the correctness of any factual representations and is not responsible for the content.