Minutes of the Health Commission Meeting Tuesday, October 5, 2004 4:00 p.m. SUNSET MENTAL HEALTH BUILDING 1990 41st Avenue San Francisco, CA 94116 1) CALL TO ORDER The meeting was called to order by Commissioner Chow at 4:15 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. Commissioner Chow announced that, due to personal and professional reasons, Commissioner Penn has resigned from the Health Commission and the Mayor has accepted his resignation. Commissioner Chow announced changes to the Commission’s committee structure and assignments. Effective November 1, the Population Health and Prevention Joint Conference Committee and the Community Health Network Joint Conference Committee will be merged into one Joint Conference Committee. Commissioner Chow, Commissioner Guy and Commissioner Sanchez will be the members of the new committee. Commissioner Illig has been appointed to serve on the Health Commission’s Budget Committee. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF SEPTEMBER 21, 2004 Action Taken: The Commission approved the minutes of the September 21, 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/Radiology - Request for retroactive approval of two contract modifications with Medical Contracting Services and The Registry Network, Inc., to increase the combined contract amount by $825,000, from $75,000 to $900,000, to provide intermittent, as-needed, professional services of per diem and traveling radiology technologists with 7 day a week on-call availability, for San Francisco General Hospital, for the period of July 1, 2004 through June 30, 2005. (3.2) PHP-Community Programs/AB 75 Project - Request for approval of a contract renewal with AmeriChoice, in the amount of $171,638, to provide fiscal intermediary services for the FY 2004-05 CHIP Hospital and Physician Program, for the period of November 15, 2004 through March 31, 2006. (3.3) BHS-Mental Health - Request for approval of a retroactive contract modification with the Fred Finch Youth Center, in the amount of $373,143 for FY 2004/05, for a total contract value of $2,064,001, to provide Therapeutic Behavior Services, Rate Classification Level 12 and 14, and Dual Diagnosis mental health services for adolescents, for the period of January 1, 2003 through June 30, 2005. (3.4) BHS-Mental Health - Request for approval of a retroactive renewal contract with Instituto Familiar de la Raza, Inc., to provide mental health services to children, youth, families and adults residing in San Francisco, in the amount of $1,803,761, for the period of July 1, 2004 through June 30, 2005. Commissioners’ Comments Commissioner Guy asked if the decrease in the contract amount would have an impact on programs. Estella Garcia from Instituto Familiar de la Raza said that the funds that are being transferred from the contract were for fiscal intermediary services, which was an entirely administrative role. IFR’s programs have been funded at the baseline level. (3.5) BHS-Substance Abuse - Request for approval of a retroactive contract renewal with Catholic Healthcare West dba St. Mary’s Hospital and Medical Center, for the provision of acute psychiatric inpatient hospital services, in the amount of 1) $170,000 in City funds targeting uninsured adolescents, and 2) $3,093,539 in Medi-Cal funds for all acute inpatient hospital providers targeting Medi-Cal beneficiaries, for the period of July 1, 2004 through June 30, 2005. Commissioners’ Comments Commissioner Sanchez asked if the “Needs Improvement” score in program compliance on the last monitoring report was an isolated incident. Ms. Bennett from Catholic Healthcare West said it was an isolated incident, there has been a reorganization and now there is a system in place to prevent this from happening in the future. (3.6) BHS-Substance Abuse - Request for approval of a retroactive contract renewal with Catholic Healthcare West dba Saint Francis Memorial Hospital, for the provision of 24-hour adult acute psychiatric inpatient hospital services, in the amount of 1) $50,000 in City funds targeting uninsured adults, and 2) $3,093,839 in Medi-Cal funds for all acute inpatient providers targeting Medi-Cal adult beneficiaries, for the period of July 1, 2004 through June 30, 2005. (3.7) BHS-Substance Abuse - Request for approval of a retroactive contract renewal with Ohlhoff Recovery Programs, in the amount of $388,431 per year for a four-year contract total amount of $1,553,722, to provide residential and outpatient substance abuse treatment services targeting women and adolescents, for the period of July 1, 2004 through June 30, 2008. Secretary’s note - the contract was changed from a four-year contract to a one-year contract, July 1, 2004 to June 30, 2005. Commissioners’ Comments Commissioner Guy asked how the agency is addressing issues raised in the corrective action plan. Barbara Farrell, Executive Director of Ohloff Recovery Programs, replied that the agency has enriched the program to make it more interesting and engaging for youth. This should be reflected in the next client satisfaction survey. Commissioner Sanchez was glad to see such a well-defined corrective action plan. (3.8) BHS-Mental Health/Substance Abuse - Request for approval of a retroactive contract renewal with the Regents UCSF-Center on Deafness, in the amount of $477,681, to provide mental health/substance abuse outpatient services, for the period of July 1, 2004 through June 30, 2005. Commissioners’ Comments Commissioner Guy is interested in the strategies the Center on Deafness will use to improve outreach, and asked for a report to the Community Health Network Joint Conference Committee in six months. (3.9) CHPP-Health Promotion - Request for approval of a contract modification with Study Center, Inc., in the amount of $390,422 for a total contract value of $3,810,183, to provide additional fiscal sponsor services for the Tobacco Free Project Community Capacity Building Training Center, for the period of July 1, 2004 through June 30, 2005. (3.10) CHPP-Health Promotion - Request for approval of a retroactive renewal contract with Polaris Research & Development, in the amount of $464,800, to provide Black Infant Health Improvement Program services targeting African American parents, for the period of July 1, 2004 through June 30, 2005. Commissioners’ Comments Commissioner Guy asked that the client satisfaction survey results be brought to the Population Health and Prevention Joint Conference Committee in early 2005. (3.11) CHPP-AAHI - Request for approval of a retroactive renewal contract with Black Coalition on AIDS, in the amount of $400,176, to provide fiscal agent and support services to the African American Coalition for Health Improvement and Empowerment (AACHIE) as the community partner for the DPH African American Health Initiative (AAHI), serving African Americans city-wide, for the period of July 1, 2004 through June 30, 2005. (3.12) SFGH - Resolution granting the Executive Administrator of San Francisco General Hospital the authority to administer the Adult Residential Facility and Social Rehabilitation Program at the Behavioral Health Center. Action Taken: The Health Commission approved the Budget Committee Consent Calendar with the modification to a one-year contract term for Item 3.7. Commissioner Illig and Commissioner Umekubo abstained from voting on Item 3.5 and Item 3.6. Commissioner Sanchez abstained from voting on Item 3.8. Item 3.8 was referred to the Community Health Network Joint Conference Committee for a follow-up report in six months. Item 3.10 was referred to the Population Health and Prevention Joint Conference Committee for a report in early 2005. 4) DIRECTOR’S REPORT Mitch Katz, M.D., Director of Health, presented the Director’s Report. Chiron Loses License to Manufacture Vaccine This morning, Chiron Corporation announced that the United Kingdom regulatory body has temporarily suspended the company's license to manufacture Fluvirin influenza virus vaccine, preventing the company from releasing any of the product during the 2004-05 flu season. DPH receives approximately 98 percent of its vaccine from Chiron. Currently, the Department is suspending all flu clinics and is awaiting instruction from the CDC regarding the possible release of a limited amount of vaccine manufactured by Aventis. As of this morning, Maxim, who receives its vaccine from Aventis, was continuing to hold flu clinics at three San Francisco sites. Two Maxim flu clinics are scheduled for tomorrow. We are advising the public to call their primary care providers regarding available flu vaccine. Dr. Katz will keep the Health Commissioners informed as this event develops. Transitions in LHH Administration Larry Funk, the Executive Administrator of Laguna Honda Hospital (LHH) announced yesterday that he wished to focus his work for the next several years exclusively on the LHH replacement project. To do that, he resigned as Executive Administrator of LHH effective October 31, 2004. Dr. Katz will be appointing him as a Transition Coordinator for the new building effective November 1, 2004. In this job he will supervise the choice and purchase of finishing and equipment for the new LHH and organize the transition of all clinical and support services from the old building to the new building. This is a critical assignment that follows closely Larry’s commitment to the new LHH, as exemplified by his extraordinary work on Proposition A. Dr. Katz is pleased to announce that he has appointed John Kanaley the new Executive Administrator of LHH effective November 1, 2004. John has been with DPH as Senior Associate Administrator at SFGHMC since 2000 when he was recruited from Kaiser Permanente, Fresno. John has more than 23 years of progressively responsible experience in the Health Care Administration, Building Management and Engineering / Construction Fields and hold a master’s degree in Public Health from California State University Fresno. Dr. Katz has worked very closely with John on a number of projects including the SFGH rebuild process. He is certain he will be a great leader for LHH. During the next 3 weeks Larry and John will be working together to assure an orderly transition. He congratulated both of these great staff members for their commitment to the Department. Mildred Crear, Director of Maternal and Child Health, Retiring Mildred Crear, Director of Maternal and Child Health (MCH), will be retiring in November 2004. Mildred began her 41 years of service to DPH in 1963 as a public health nurse. Through her visionary leadership several programs evolved that improved the health of diverse populations in San Francisco, including Family Planning, Black Infant Health, Fetal Infant Mortality Review, Child Care Health Consultant Program, and the Universal Home Visiting Program that offers every new mother a home visit from a public health nurse. Under Mildred’s direction, Nutrition Services have also improved the health of women, infants, children and families. Mildred is widely and affectionately known for her ability to expand services and generate revenue, her compassion for people, inspirational leadership, and her comforting bright smile. Mildred’s retirement dinner is November 19, 2004. For more information please contact Renee Anderson at Renee.Anderson@sfdph.org or Twila Brown at Twila.Brown@sfdph.org or 575-5712. Sally Liska to Provide Hurricane Response in Haiti Sally Liska, Director of DPH’s Public Health Laboratory, has taken her vacation time to assist with hurricane response in Haiti. Sally will be providing technical assistance to help setting up laboratory capacity for monitoring enteric (cholera, typhoid, and paratyphoid) and other diseases. Dr. Katz and the Health Commission are proud to work with a competent and dedicated professional like Sally who is generously donating her time and expertise to provide assistance to communities in crisis. TCM Grant Funded Community Behavioral Health Services has just been awarded a Targeted Capacity Expansion grant for Methamphetamine Treatment by the federal Center for Substance Abuse Treatment. The new program will be a collaboration between Stonewall/Magnet, STOP, Continuum and CBHS to replicate and evaluate the successful UCSF methamphetamine treatment model in the Continuum setting. It was fully funded at $500,000 per year for three years. Congratulations to the CBHS team and its partners on this exciting new project. LEAP Walkathon The CHNs Look To End Abuse Permanently (LEAP) program will host the first annual "Walk for Healthy Relationships" walkathon and family resource fair at Sharon Meadow in Golden Gate Park on Saturday, October 30th from 10:30 to 2pm. LEAP provides domestic violence training and resources to SFGH, primary care sites and community-based clinics in San Francisco. They also maintain the CHN Intimate Partner Violence/Family Violence Web page and help design and run domestic violence support groups at SFGH. The walkathon is intended to raise awareness about domestic violence and to raise funding to support the work of the LEAP program. For more information, contact Dr. Leigh Kimberg at (415) 292-1300 or e-mail walkforheatlhyrelationships@yahoo.com. InSPOT to Debut tomorrow In another innovative use of the Internet, Internet Sexuality Information Services (I.S.I.S) and the STD Unit are kicking off a new partner notification option tomorrow for men who have sex with men (MSM) using peer-to-peer e-mail postcards or "e-cards." At www.inspot.org, MSM who have been diagnosed with an STD can choose from a number of hip, funny and to-the-point e-cards to let their partners know they may have been exposed as well and should get tested. The site was designed with input from community advisory members. Dr. Jeff Klausner will be hosting the press event tomorrow at 10:30 a.m. at Harvey Milk Plaza to promote the site and discuss its role in the prevention of STD. He will be joined by Deb Levine and Ted Kennedy of I.S.I.S. The Health Commissioners are welcome to attend. Dr. Katz introduced Supervisor Fiona Ma, who thanked the Commission for having a meeting in the Sunset. She also acknowledged Dr. Katz and Terry Wong for all their hard work. Commissioners’ Comments Commissioner Illig commended the Department for the InSPOT website. It is a very clever way to confidentially and anonymously notify partners. Commissioner Illig would like the Health Commission to look at the grants that it receives and expends in a new way, and will examine this issue and make recommendations as a member of the Budget Committee. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF OCTOBER Commissioner Sanchez presented the October Employee Recognition Awards: Awardee Division Nominated By Patricia Erwin, MPH Program Manager, Medical Director, Ocean Park Health Center Ginger Smyly and Newcomers Health Program Christina Carpenter, Community Programs Lisa Johnson, M.D. Medical Director, Ocean Park Health Center 6) OVERVIEW OF DPH SERVICES IN SAN FRANCISCO’S SUNSET DISTRICT AND DEMOGRAPHICS OF ZIP CODES 94116 AND 94122 Jim Soos, Senior Health Program Planner, Policy and Planning presented an overview of the demographics of the two zip codes that predominantly make up the Sunset (Attachment A). Supervisor Ma commented about the pedestrian fatalities in the neighborhood. She works very closely with the Police Captain of the Taraval Station to try to keep the fatalities down. The Sunset district has the highest rate of ticket giving, has had two DUI stings along 19th avenue, crosswalk stings, and other efforts. She is working on installing more countdown signals. Commissioners’ Comments Commissioner Guy asked how many of the pedestrians who were killed resided in the two zip codes. Mr. Soos said most of the people lived in the district. She asked how families are defined. Mr. Soos said his report uses the same definition as the census-related by blood or by marriage, with or without children. Domestic partners are not included in the definition. Terry Wong, Executive Director of Sunset Mental Health, said one of the issues is multiple families living in one house, and asked if this is reflected in the household income data. Mr. Soos replied that the census looks at household income, which would include the incomes of multiple families in one household. So the income level in one household may look higher than it would be when compared with another single family. He will delve into the data further to see if this can be culled out-based on household size. Commissioner Chow said it is surprising that self-inflicted death is one of the top five causes of death. Do we have an explanation? Mr. Soos said he only has the raw data. Commissioner Chow would like to delve into this issue more deeply in terms of how it compares to the rest of the city, what are the actual numbers and is this issue more pressing in the community than in others that warrants additional support. 7) PUBLIC TESTIMONY ON THE HEALTH NEEDS IN THE SUNSET COMMUNITY - Eileen Ditmer raised the issue of lack of board and care housing for clients in the Sunset and generally. When people lose their housing in this community, they do not have anyplace to go. Hotel placements are not appropriate for many DPH patients. Other places have dedicated housing that she cannot access. Commissioner Monfredini asked why not, and Ms. Ditmer replied that those slots are dedicated to agencies’ own client bases, and there is plenty of demand. Dr. Katz added that he would have Marc Trotz look at the available supportive housing units. Commissioner Guy said to remember that the new Laguna Honda includes independent living and this should be included in the problem-solving discussion. - Dr. Terry Wong, Director of Sunset Mental Health, said the center has 1,100 open cases and four separate programs: adult, children, socialization and dual diagnosis. There are 2,400 unduplicated clients per year. In the services they provide, they are finding that they are barely able to provide these services with the staff they have. The client population is 30% Chinese, 20% Russian, 5% Korean and 10% children. They are faced with a dilemma about preserving cultural competency. The areas of the city where Asians families are moving do not have culturally appropriate services, and the patients come to the Sunset. They are overwhelmed and unable to meet the demand. In addition, they serve a lot of children but do not have separate children’s program so borrow from the adult program to provide Chinese language services to children and their families. Approximately 25% of the Chinese population they provide services to do not live in the 94122 or 94116 zip codes. Commissioner Monfredini asked for actual data, and Dr. Wong is in the process of getting this. Commissioner Chow wants to ensure that there is an appropriate number of bilingual staff to meet the needs of the clinic. The other issue is adding language capacity to other neighborhoods so people do not need to come all the way to the Sunset if they do not live here. Commissioner Monfredini asked how to take this to the next level, realizing that there isn’t money now, but may be in the future. Dr. Katz said this discussion should happen with Dr. Cabaj. Commissioner Sanchez noted that there are a lot of schools and child care facilities in this area, and DPH should look at expanding Wellness Center. Dr. Wong said they provide services to the Lincoln Wellness Center, partner with the Sunset Neighborhood Beacon Center and provide on-site services to many schools. Commissioner Chow asked for a progress report on this issue to the CHN JCC. Commissioner Guy wants the follow up to include children’s services as well. - Sasha Mosalov - Sunset Russian Tobacco Education Project, located at Ocean Park. The program began four years ago and includes popular smoking cessation programs, media messages through the Russian television. Continue to broaden healthy living programs in the Russian Community and do workshops through Ocean Park and Jewish Community Services. Provide yoga classes, healthy eating classes - Olga Radom, said the Russian community is invisible, but still has many problems, including depression, heart problems, cancer, diabetes, etc. There is a large population of Mongolian people that speak Russian and this community needs help. Commissioner Monfredini asked who is emigrating from Russia. Ms. Radom said it is families with kids, older folks, and often single political asylees. She gave the Commission a report that profiles the Russian-speaking Newcomer community in San Francisco (on file in the Health Commission Office). Commissioner Monfredini asked if it is acceptable in the Russian culture to acknowledge depression. Ms. Radom said many problems lead to depression, for example it is hard for older people to learn English, so this leads to a large gap between kids and older people. Also, very educated people from Russia cannot get comparable jobs here, and that is depressing. - Patricia Simpson, patient from Ocean Park Health Center, said that she is at the clinic because she does not have insurance. She thanked the Commission for having the public health system. It has saved her life and she knows how hard it is. She said services in the Sunset make a huge difference for the patients particularly given how difficult it is to get from the Sunset to other areas of the City. From a patient point of view, access is very difficult. It took five months to get a clinic appointment, and it will take two months to get a follow-up appointment. She urged the Commission to find some way to increase the number of physicians and nurses and increase access. - Lisa Johnson, M.D., gave the Commission a fact sheet (on file in the Health Commission Office) and reiterated other speakers’ comments around access and language capacity. Her main concern is the San Francisco Health Plan. They have 2,600 SFHP enrollees, the majority of whom are healthy workers, who tend to be middle age and have health issues. People come from throughout the city because of the language capacity. She would like to establish a reasonable patient panel size and be able to limit enrollment to a level where they can provide services. Dr. Katz said that if DPH were to limit SFHP enrollments, this would have disastrous fiscal impact. If we make cuts to people with insurance, those services would still be provided, but to people with no insurance. It is true that we run open systems even though we don’t have enough appointments. This is a tough issue. When the economy improves, he is committed to improving primary care. Commissioner Illig said that other clinics in San Francisco should be considered part of our system, and the focus should move beyond DPH services. The Department should work harder to partner with all the services in San Francisco that have capacity, for example the Sister Mary Phillipa clinic. Dr. Katz said that the partnership with Sister Mary Phillipa is working quite well. He has also met with the Community Clinic Consortium about partnering on a similar model. Commissioner Chow asked that the JCC track this through reports from the Primary Care director. - Mark Bernstein, M.D. advocated for the socialization program at Sunset Mental Health. He said they get many patients from throughout the city, and that it is a very important program. He thanked the Commission for coming to the center, and said that many patients from his program are at the meeting. 8) PUBLIC COMMENT/OTHER BUSINESS None. 9) ADJOURNMENT The meeting was adjourned at 5:55 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. 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.