Minutes of the Health Commission Meeting Tuesday, November 9, 2004 at 3:00 p.m. 101 GROVE STREET San Francisco, CA 94102 1) CALL TO ORDER The meeting was called to order by Commissioner Monfredini at 3:25 p.m. Present: 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 Edward A. Chow, M.D., President Commissioner Monfredini announced that the December 21, 2004 Health Commission meeting will be held at San Francisco General Hospital’s Carr Auditorium. The Health Commission will hold a meeting at Laguna Honda Hospital in February or March 2005. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF OCTOBER 26, 2004 Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) approved the minutes of the October 26, 2004 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Guy chaired and Commissioner Illig attended the Budget Committee meeting. (3.1) CHP-Housing and Urban Health – Request for approval of a retroactive contract renewal with Fort Help, Inc., in the amount of $66,135, to provide opiate replacement therapy targeting Direct Access to Housing participants, for the period of September 30, 2004 to September 29, 2005. (3.2) CHP-Housing and Urban Health – Request for approval of a retroactive contract renewal with Baker Places, Inc., in the amount of $397,725, to provide behavioral health services targeting Direct Access to Housing participants, for the period of September 30, 2004 to September 29, 2005. (3.3) CHP-Housing and Urban Health – Request for approval of a retroactive new contract with Catholic Charities CYO, in the amount of $83,708, to provide comprehensive housing and case management services, for the period of July 1, 2004 through June 30, 2005. (3.4) CHP-Housing and Urban Health – Request for approval of a retroactive new contract with Larkin Street Youth Services, in the amount of $80,327, to provide case management services targeting multiply-diagnosed homeless persons, for the period of July 1, 2004 through June 30, 2005. (3.5) CHP-Housing and Urban Health – Request for approval of a retroactive new contract with Chinatown Community Development Center, the lead agency and fiscal agent for the SRO Families Collaborative, in the amount of $100,000, for the period of November 1, 2004 through June 30, 2005. (3.6) AIDS OFFICE-HIV Prevention – Request for approval of a retroactive contract renewal with Better World Advertising, in the amount of $157,000, to continue to provide the HIV prevention social marketing campaign, for the period of October 1, 2004 through December 31, 2004. Public Comment Melenie Eleneke spoke in support of the program. (3.7) AIDS OFFICE-HIV Prevention – Request for approval of a retroactive new contract with San Francisco Study Center, in the amount of $167,726, to provide health planning and formative research for social marketing campaigns to prevent HIV and promote health, targeting those living with HIV and those populations at highest risk, for the period of October 1, 2004 through December 31, 2004. (3.8) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive new contract with San Francisco AIDS Foundation, in the amount of $1,163,600, to provide client advocacy, benefits counseling, outpatient mental health and practical support services targeting low-income and/or homeless persons with HIV/AIDS in San Francisco, for the period of July 1, 2004 through June 30, 2005. (3.9) CHP-Primary Care – Request for approval of a retroactive contract renewal with Tides Center, in the amount of $56,000, to provide Women’s Community Clinic services, for the period of July 1, 2004 through June 30, 2005. (3.10) BHS – Request for approval of a retroactive contract renewal with Jelani, Inc., in the amount of $3,418,606, to provide residential and outpatient substance abuse treatment services targeting women, children and families, for the period of July 1, 2004 through June 30, 2005. Commissioners’ Comments Commissioner Guy requested an update to the Community Programs and Services Joint Conference Committee regarding challenges faced by the agency and how, if at all, outcome objectives would be modified. (3.11) BHS – Request for approval of a retroactive contract renewal with the San Francisco Pretrial Diversion Project, in the amount of $76,833 per year, for a total contract value of $307,332, to provide mental health/substance abuse residential/outpatient services, for the period of July 1, 2004 through June 30, 2008. Action Taken: The Health Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) approved the Budget Committee Consent Calendar. Item 3.10 was referred to the Community Programs and Services Joint Conference Committee for a follow-up report. 4) DIRECTOR’S REPORT Mitch Katz, M.D., Director of Health, presented the Director’s Report. State Election Update The November 2nd ballot contained a number of health-related initiatives. Dr. Katz reported that Proposition 63, the Mental Health Services Act, which was supported by the Health Commission, passed last Tuesday and will fund the expansion of mental health programs around the State. Proposition 63, funded by a tax on income over $1 million annually, will raise an estimated $275 million in the current fiscal year, $750 million in the 2005-06 fiscal year, and increasing amounts thereafter. Funding will be allocated to counties for mental health services by a formula that will be devised through the State’s regulatory process. Unfortunately, Propositions 72 and 67, also supported by the Health Commission, did not pass on November 2nd. Proposition 72 was a referendum on SB 2, the Health Insurance Act of 2003, which would have required large and medium-sized employers to offer health insurance to their employees and, in some cases, their employees’ dependents. Since Proposition 72 failed, SB 2 and the employer health insurance mandate was overturned. Proposition 67, which would have added a surcharge on calls made within California to fund uncompensated emergency services, also failed. The voters did, however, overwhelmingly pass Proposition 71, which creates the “California Institute for Regenerative Medicine” to regulate stem cell research and provide funding, through grants and loans, for research and research facilities in California. Proposition 71 authorizes the issuance of bonds annually for ten years to a total of $3 billion. Jimmy Loyce Named Acting Director of EEO, Affirmative Action and Cultural Competency At the last Health Commission meeting, Dr. Katz announced that Norm Nickens, DPH’s Director of EEO, Affirmative Action and Cultural Competency would be leaving to take a position in the Retirement System. Dr. Katz announced that Jimmy Loyce, Deputy Director of Health for AIDS Programs, has agreed to serve as Acting EEO Director until a replacement for Mr. Nickens can be found. Mr. Loyce will be assuming these new duties in addition to maintaining his existing role in the AIDS Office. Dr. Katz thanked Mr. Loyce for his willingness to take on these responsibilities. LHH Clinical Leadership Report, October 28, 2004 Paul Isakson, MD Gayling Gee, RN, MS Mivic Hirose, RN, MS Tim Skovrinski, MD Serge Teplitsky, RN LHH Medical Staff Appointments Reappointments: William Flynn, M.D. – Psychiatry – (Active/Daytime) Denise Rettenmaier, M.D. – Internal Medicine – (Active/N & W) Resignations: Yoshio Hall, M.D. – Internal Medicine – (Active/N & W) Carole Deitrich, NP – Internal Medicine – (Active/Daytime) LHH Credentials Year-to-Date Report 7/1/2004 to 10/28/2004 New Appointments 1   Reinstatements 0   Withdrawal 0 Reappointments   10   Delinquencies: 0   Reappointment Denials: 0 Resigned/Retired 6 Disciplinary Actions      0 Restriction/Limitation of Privileges 0 Changes in Privileges 0   Additions         0   Voluntary Relinquishments   0 Commissioners’ Comments Commissioner Illig said that since Proposition 72 passed in San Francisco, there may the opportunity to have a conversation with the Board of Supervisors about doing a local version of SB 2. Commissioner Guy asked what the local process would be for setting priorities for the mental health money. Barbara Garcia, Deputy Director of Health, said it would be an open process with a large leadership group of 40-60 people. They are looking for involvement with the community and other City departments. Commissioner Guy asked for updates at the Community Programs and Services Joint Conference Committee. Dr. Katz said it is a complicated piece of legislation, and he would update the Commission on a regular basis. 5) CONSIDERATION OF A RESOLUTION PROCLAIMING NOVEMBER 20TH THROUGH DECEMBER 20TH OF EACH YEAR “SURVIVOR OF HOMICIDE VICTIMS AWARENESS MONTH” Barbara Garcia, Deputy Director of Health, Director, Community Programs, presented a resolution that would proclaim November 20th to December 20th of each year “Survivor of Homicide Victims Awareness Month.” This resolution came out of the Family Involvement Team’s work in Bayview Hunters Point, specifically around the increased number of homicides over the past year. This is an emergency crisis in our community, and the Department will use this resolution as a way to better support families of homicide victims. Lynn Westry from the Family Involvement Team spoke about the need for this awareness. Survivors of homicide victims struggle with the tragedy from year to year. The resolution will add support to families that have been brutally impacted by violence and support the peace making movement. It will help survivors feel encouraged, supported and strengthened. There will be a survivors’ kick off on November 19th on the steps of City Hall. Action Taken: The Health Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) approved Resolution 18-04, “Proclaiming November 20th to December 20th of Each Year as Survivor of Homicide Victims Awareness Month in San Francisco,” (Attachment A). 6) CONSIDERATION OF A RESOLUTION ENDORSING THE UPDATE OF THE DEPARTMENT OF PUBLIC HEALTH’S STRATEGIC PLAN Jim Soos, Senior Health Program Planner, Policy and Planning, presented a resolution endorsing the Strategic Plan Update. The Update was presented at the October 26, 2004 Health Commission meeting. The resolution officially endorses the Strategic Plan and asks the Department to do three things: use the plan in the development of the Department’s budget; develop and implementation and evaluation plan; and report periodically to the Joint Conference Committees and the Health Commission. Action Taken: The Health Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) approved Resolution 19-04, “Endorsing the Update of the San Francisco Department of Public Health’s Strategic Plan,” (Attachment B). 7) CONSIDERATION OF A RESOLUTION APPROVING THE FISCAL YEAR 2004-2005 MID-YEAR BUDGET REDUCTIONS Mitchell H. Katz, M.D., Director of Health, presented the proposed 2004-2005 mid-year budget cuts. The current year budget was balanced on the assumptions that Propositions J and K would pass. Failure of these measures requires immediate reductions to offset $97 million in assumed revenues over the next 18 months. Even after offsetting reductions are enacted, a significant shortfall—approximately $130 million—remains for next fiscal year. The Mayor instructed departments to submit contingency plans before close of business November 4, 2004. All departments are to use a January 15th effective date for all layoffs and contractor reductions. Departments are to being to plan now for additional reductions. Budget instructions to address the remaining $130 million shortfall for next fiscal year will be issued on November 30th. The Health Department’s original target of $23 million was reduced to $15.5 million by the Mayor to preserve $6 million in substance abuse services. Dr. Katz summarized the Health Department reductions: Public Comment Manuel Vasquez, Director of Mission ACT, expressed his objections to the cuts to the indigent population. The budget proposal will have significant impacts on immigrant populations as well as homeless populations. Ellie Dwyer, Clinic Director at Mission ACT, said they would continue to prioritize housing as their number one service. Mission ACT has been developing a step down proposal and wants to pursue this plan to use public dollars effectively. Rachel Matillano, HIV/AIDS Services at API Wellness Center, is concerned that the AIDS services that are being cut make core services more effective in the long run. There will be other, ongoing cuts in the CARE funds. Donnie Tugano, API Wellness Center, asked the Commission not to cut AIDS services. La Vonne McIntosh, is concerned about cuts to public health nurses. There are people with heart disease, asthma, AIDS, so please consider the quality of care that money cannot buy. Itti Kamjinda and Somrudee spoke in support of people with HIV in San Francisco. Giselle Clark-Ibanez, Case Manager with Shanti’s Lifeline Program, read statements from Sandra Fuller and Kathy Bonanno, and submitted a statement from Valerie Bell, all Lifeline clients (Attachment C). Lance Toma, Deputy Director, API Wellness Center, spoke against the proposed cuts in HIV/AIDS services. Alison Block, Shanti’s Lifeline Project, said many women would feel helpless and isolated without these services. Kristi Oshiro spoke in support of Lifeline’s services. Lifeline offers critical services. Lifeline is able to meeting many people with depth and compassion. Diedre Gilmore, Program Manager at Lifelines, said her program enables under and uninsured women who are diagnosed with breast cancer the ability to access care and adhere to their treatment regime. Without Lifeline services, 100 women currently undergoing treatment will be unable to access Lifeline’s services. Dr. Jeffrey Leiphart, Medical Director for Lifelines, spoke in support of Lifeline services. Jenna Nielsen, Lifelines volunteer, spoke in support of Lifelines. Jamie Schele spoke in support of Lifelines. She shared two testimonials from Lifelines patients who could not be at the Health Commission meeting (Attachment D). Melenie Eleneke, Filipino Task Force on AIDS, spoke in support of the numerous agencies that provide services to the API community. Bob Reyes said the HIV virus kills the immune system, and he is grateful for the new medications. But he relies on the services that help him not have to fight the disease alone. Please save the services. Phillip Watson, Shanti AIDS Project, said that a number of people are going to be left behind with these budget cuts. Please consider the shut-in folks who are behind closed doors who will not receive services. Jessica Berman, Shanti, spoke in support of Lifeline services and HIV support services. Shanti services save lives and money. Charles Siron, a consumer of services that are proposed to be cut, and co-chair of the CARE Council. He asked the Commission to give him and others hope. With the CARE cuts and the proposed cuts, a lot of providers will be lost. Bartholomew Casimir, asked the Health Commission to continue HIV services. Dr. Valerie Ng, chair of the Medical Staff at SFGH, expressed concern about the $1.2 million cut to the contract with UCSF. SFGH and UCSF have a 50-year unique and successful partnership. This cut will negatively impact patient care, as there are no more one-time fixes available. The services cuts will also have the unfortunate affect of decreasing revenue. Bill Hirsch, Director of AIDS Legal Referral Panel, said San Francisco provides the model of care for AIDS services, and this model is unraveling. The AIDS Legal Referral Panel leverages $1 million in other funds each year. This is in jeopardy without funding for core services. James Rouska spoke in support of Shanti’s services. San Francisco has great services. He is shocked that Shanti’s services are being cut when other agencies are not as friendly or helpful. Mark Molnar, Shanti HIV/AIDS Services manager, said that cutting peer advocacy and emotional support would have an impact on clients’ ability to remain housed and in primary care. Sonja Sawyer, San Francisco State CLAER Project, thanked the Commission for adopting the survivor’s month resolution. Jimmy Dale Hobbs spoke in support of Shanti’s HIV services. Staff takes a personal interest in all clients. Jose Biffano, representing the Latino community. The Latino community needs help. Without help there will be many problems. Shanti has provided help. They have problems with translation and the only service available is Shanti and Instituo Familiar de la Raza. Maryanne Pirring, Mission ACT, wants to keep the center open for jobs, staff and community. Ruben Garcia, SEIU 790, spoke on behalf of employees in public and non-profit sectors. The union does not believe employees have been involved in any of these decisions. The Department should go back to the drawing board. Some of the cuts are totally inappropriate, such as cuts in chronic care public health nurses. A lot of members cannot come to Health Commission meetings during business hours. Rebecca Morrow, Public Health Nurse and SEIU 790 representative, said public health nurses objected strongly to having to choose between chronic care and maternal health. Just a few weeks after the decision was made, chronic care nurses are being cuts. She views this as retaliatory. Otto Duffy, Tom Waddell Health Center Advisory Board, said the cuts should not be set in stone and should be flexible. Also, no cuts in homeless health care services should be made without the input of Tom Waddell staff. Mark Misruk, Positive Resource Center, said many clients’ lives depend on the services provided. Ed Kinchley, Medical Social Worker at SFGH and SEIU 790 representative, is opposed to all cuts. All cuts impact core services. Cuts in primary care go against the DPH mission. Vote no on these cuts. John Michael Stevison spoke in support of Shanti services. Debbi Lerman, San Francisco Human Services Network, is troubled by the definition core services, and the budget cuts are targeted toward mental health and HIV services. These reductions will cause other harm. Please tell the Mayor that the majority of these cuts are unacceptable. Laurie Hampton, client of Tom Waddell clinic, said it is very hard to get appointments. Staff is overworked. She is not getting the health care she needs to function. Bill Barnes said the CARE cuts where not added back under the assumption that they would only remain if Propositions J and K passed. There will be more Ryan White money and we need to show a local commitment to backfilling the CARE cuts. Kevin Burns, executive director of Shanti, urged the Commission to remember that these services partner with primary care and are designed to keep people engaged in primary care. The services they provide are core services. Iris Biblowitz, Tom Waddell Clinic, implored the Health Commission to not cut mental health, clinics, dialysis and other services. There has to be a fiscal commitment to public health so that the tenuous safety net stays in place. Alexander Li, Medical Director at Chinatown Health Center, advocated for continued funding for a model TB program. Public Health Nurse, said the services they provide to clients greatly improve people’s lives. She described one of the hundreds of clients who has benefited by public health nursing services. Kent Woo, executive director of NICOS, spoke in support of the Chinese anti-gambling project. Ellen Sablowitz spoke in support of public health nurses. Over half of the public health nurses are proposed to be cut. The new chronic care team has just been established. Dr. Katz commented on the process. The Mayor released a list of citywide reductions to the press and public last Thursday. The Mayor very clearly understands the pain the cuts will cause. Dr. Katz sees no possibility that the Mayor’s Office will not cut $97 million, and can do so without the approval of the Board of Supervisors. Commissioners’ Comments Commissioner Monfredini said every single program on the list is important to the Department of Public Health. But unfortunately there will be cuts in DPH. Her goal is to submit a proposal to the Mayor that he will accept. Commissioner Illig said it was clear that when the budget was approved, the assumption was that if Propositions J and K did not pass, there would be a deficit. The Health Commission and other departments should have immediately started public hearings on these cut to educate the public about the importance of the ballot measures. Commissioner Illig said the services that are on the reduction list are crucial to homeless services. He is concerned that more than $4 million in cuts is directed toward people with HIV and AIDS. Shanti is unique in San Francisco in that they primarily use volunteers to provide services and he is troubled that this agency is so heavily targeted. He asked the Commission to consider saving the breast cancer program and social work manager positions. Commissioner Guy emphasized that the Commission has to send something to the Mayor’s Office and respond to the voters’ disapproval to the revenue initiatives. Cutting these programs will have a direct consequence on San Francisco. We are dismantling public health. The Department has been struggling with the restructuring of public health nurses, but cutting nurses further dismantles the system. The community needs to come together to see how we build upon the dismantled system that is left. Reducing primary care goes against all research and best practices. She does not have the answer today. But the resolution should reflect that nothing in the proposed cuts does anything to maintain public health. Commissioner Sanchez said San Francisco had one of the best public health care systems in the nation, but the safety net is gone. San Francisco has one of the highest rates of cancer in the country. Our community, including the SFGH Foundation and the Avon Foundation, made a commitment to create the most supportive, effective programs possible. The Department has lost a number of committed, creative staff people. The safety net cannot withstand any of the proposed cuts. Commissioner Umekubo said budget hearings always serve as a wake up call and illustrate the problems facing health care, both public and private. He agrees with his fellow Commissioners that all the services are greatly needed. The Health Commission has to decide its direction and take a stand. He does not know the solution but he does know that the consequences are unacceptable. Commissioner Guy said there must be a more open budget process throughout the city, and more discussion about how to maintain a public health infrastructure. This needs to be done internally, with the minds and perspective of the thousands of DPH staff, and externally with the community. Commissioner Illig suggested reactivating three of the cuts that were proposed on October 26th and using the revenue to restore direct services: the restaurant inspection fee increases; reductions to HIV Prevention Services; and elimination of the SFGH dialysis program. Commissioner Monfredini would like to propose restoring small programs for six months that have the best chance of being approved by the Mayor’s Office, specifically the Shanti Lifelines program. DPH was given a multi-million grant from AVON to provide breast cancer services and we must maintain a local commitment. In addition, she would like to consider taking the NICOS anti-gambling program off the cut list. Commissioner Guy said it is more important to retain primary care than to fund new initiatives. She would like the Mayor to hear this. She wants Dr. Katz to work with senior management to discuss and develop the best proposal. Action Taken: The Health Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) approved the following amendments to the proposed resolution: FURTHER RESOLVED, that the Health Commission requests that the Shanti Lifelines Breast Cancer Case management and the NICOS Anti-gambling initiative be funded for the remainder of FY 2004-2005; and be it FURTHER RESOLVED, that the Health Commission urges the Mayor and Board of Supervisors to maintain at least half of the HIV/AIDS integrated case management/peer advocacy services and mitigate the cuts to the primary care network, including the managerial medical social workers; and be it Action Taken: The Health Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) approved Resolution 20-04, “Authorizing the Proposed FY 2004-2005 Mid-Year Budget Cuts,” (Attachment E), as amended. 8) PRESENTATION OF THE FY 2004-2005 1ST QUARTER FINANCIAL REPORT Gregg Sass, DPH Chief Financial Officer, presented the FY 2004-2005 1st Quarter Financial Report. This report presents the first quarter financial projections of revenues and expenditures for the Department of Public Health for Fiscal Year 2004-05. Projections include a revenue surplus of $6,996,000 and expenditure deficit of $6,817,000. These variances are largely offsetting, and based on this data, the Department of Public Health is projecting to end the year essentially even with a small year-end surplus of $179,000. 9) PUBLIC COMMENT/OTHER BUSINESS 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, Sanchez, Umekubo) voted to hold a closed session. The Commission went into closed session at 6:50 p.m. Present in closed session were Commissioner Guy, Commissioner Illig, Commissioner Monfredini, Commissioner Sanchez, Commissioner Umekubo, Mitch Katz, M.D., Director of Health, Rick Sheinfield, 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 A $10,000 CREDIT TO THE CITY IN ROMIC ENVIRONMENTAL TECHNOLOGIES CORP. v. CCSF Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) voted to approve the settlement accepting a $10,000 credit from Romic Environmental Technologies Corp. D) Reconvene in Open Session The Commission reconvened in open session at 6:55 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 item) Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) voted not to disclose any discussions held in closed session. 11) ADJOURNMENT The meeting was adjourned at 6:55 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.