Minutes of the Health Commission Meeting Tuesday, December 7, 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 Chow at 3:15 p.m. Present: Commissioner Edward A. Chow, M.D., President Commissioner Roma P. Guy, M.S.W. Commissioner James M. Illig Commissioner Lee Ann Monfredini, Vice President Commissioner David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. – left at 6:05 p.m. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF NOVEMBER 16, 2004 Action Taken: The Commission approved the minutes of the November 16, 2004 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Sanchez chaired and Commissioner Guy and Commissioner Illig attended the Budget Committee meeting. (3.1) DPH Central Administration-Policy & Planning – Request for approval of a contract modification with San Francisco Health Plan (SFHP) to increase the contract amount by $1,935,661, from $5,947,401 to $7,883,062, to provide universal health insurance services targeting San Francisco children, for the period of July 1, 2004 through June 30, 2005. Commissioner Umekubo abstained from voting on this item. (3.2) CHN-Administration – Request for approval of a modification to a sole source contract with the Regents of the University of California, (UCSF), to extend the contract term through June 30, 2005 and increase the compensation amount by $850,000, from $2,550,000 to $3,400,000, for the provision of tertiary care services targeting medically indigent adults, In-Home Supportive Service workers and San Francisco County Jail patients. Commissioner Sanchez abstained from voting on this item. (3.3) AIDS OFFICE–HIV Health Services – Request for approval of a retroactive renewal contract with Mission Neighborhood Health Center, in the amount of $430,000, to provide early intervention services targeting uninsured HIV-positive Latino immigrants, at or below the poverty level, with a special focus on monolingual Spanish speakers, for the period of July 1, 2004 through June 30, 2005. (3.4) PHP-BEHM - Request for approval of a renewal contract with Onyx Environmental Services LLC in the amount of $325,000 to provide hazardous waste management and transportation services for the period of January 1, 2005 through June 30, 2007. (3.5) PHP-CHPP – Request for approval of a retroactive sole source renewal contract with Booker T. Washington Community Services Center in the amount of $319,415 to provide logistical and administrative support services for the Seven Principles Project targeting African Americans for the period of September 30, 2004 through September 29, 2005. Kelvin Carter, Executive Director of Booker T. Washington, said in the nine months since he’s become the ED, he’s seen a lot of changes. There has been board revitalization, a retreat, and he is looking forward to moving forward on this collaborative. (3.6) PHP-CHPP – Request for approval of a retroactive sole source renewal contract with the Regents of the University of California Family Health Outcomes Project in the amount of $201,600, to provide evaluation services to the Seven Principles Project for the period of September 30, 2004 through September 29, 2005. Commissioners’ Comments Commissioner Guy would like a more detailed report on the outcomes and interventions at the Community Programs and Services Joint Conference Committee. Dr. Oliva from UCSF said she is prepared to present outcomes at the Commission’s convenience. Commissioner Guy asked the Commission Secretary to work with the Department and UCSF to schedule this presentation. Commissioner Sanchez abstained from voting on this item. (3.7) PHP-CHPP – Request for approval of a contract modification with San Francisco Study Center to provide fiscal agent services to administer State Office of Traffic Safety Mini-Grants to Community-Based Organizations for programs to prevent Driving Under the Influence (DUI) and programs to increase pedestrian safety, for the period of January 1, 2005 through December 31, 2006, for a total contract value of $201,600 for the contract term of January 1, 2004 through December 31, 2006. (3.8) BHS – Request for approval of a retroactive renewal contract with Asian American Recovery Services in the amount of $3,260,560 per year to provide substance abuse services targeting men and women of Asian/Pacific Islander descent for a total contract amount of $9,781,679 for the period of July 1, 2004 through June 30, 2007. (3.9) BHS – Request for approval of a retroactive renewal contract with Bayview Hunters Point Foundation For Community Improvement, Inc. in the amount of $6,598,880 to provide substance abuse and mental health services targeting adults and children for the period of July 1, 2004 through June 30, 2005. Secretary’s note – Jim Stillwell noted corrections to the contract summary (page 3.9.1). The annualized differences amounts are: General Funds - $302,591; Work Order - $367; Contract FTE – 3.23 (Prior Transaction FTE should read 77.05, rather than 102.55). Karen Patterson Matthew, Executive Director of Bayview Hunters Point Foundation, said she hopes that the contract monitoring reports are able to become more current. Commissioners’ Comments Commissioner Illig asked why this contract is delayed five months. Jim Stillwell said that this is a very complex contract, but he agrees that contracts need to get to the Health Commission in a timelier manner. Commissioner Illig said the Department needs to present more current monitoring data when presenting contracts for approval. Commissioner Guy urged the agency to comply with the Fire Marshall’s directive as soon as possible. She asked how the issues with the Jail Detoxification program would be addressed. Ms. Patterson Matthew said the move to a full time medical director would allow greater capacity for intakes. But there are other programmatic factors as well. (3.10) BHS – Request for approval of retroactive renewal contract with Morrisania West, Inc. in the amount of $680,046 to provide day treatment substance abuse services targeting African American youth and young adults for the period of July 1, 2004 through June 30, 2005. (3.11) BHS – Request for approval of a retroactive renewal contract with St. Vincent de Paul Society of San Francisco in the amount of $1,624,064 per year to provide substance abuse treatment and substance abuse/mental health shelter services targeting homeless adults for the period of July 1, 2004 through June 30, 2008, for a total contract amount of $7,055,091. (3.12) BHS – Request for approval of a retroactive renewal contract with Walden House, Inc. in the amount of $8,930,989 to provide residential mental health and substance abuse treatment services for the period of July 1, 2004, through June 30, 2005. Commissioners’ Comments Commissioner Illig continued to express concerns about the monitoring information being from FY 2002-2003, even though the Department has been concerned about this agency. Gregg Sass, DPH CFO, said there is continuous monitoring of agencies throughout the year, and this is particularly the case with Walden House. Walden House provides monthly financial updates to him and has been very conscientious in communicating with him. Commissioner Illig will work with staff to implement the recommendations of the Mayor’s Contracting Task Force. (3.13) BHS – Request for approval to extend the term of the following San Francisco Mental Health Plan (managed care) contracts through fiscal year 2006/07. The contractors are group providers, organizational providers and interagency providers. The total amount of funding for all providers for fiscal year 2004/05 is estimated to be $3,093,839, for a total projected amount for all managed care contracts of $9,281,517 through fiscal year 2006/07. (The providers are: California Pacific Medical Center/Sutter Health; Catholic Healthcare West dba St. Mary’s Medical Center/Sister Mary Philippa Clinic; Regents of the University of California Langley Porter Hospital and Clinics; St. Luke’s Hospital/Sutter Health; Survivors International; Jewish Family and Children’s Services; West Coast Children’s Center; San Francisco General Hospital Psychosocial Medicine.) Commissioner Illig and Commissioner Umekubo abstained from voting on this item. (3.14) BHS – Request for approval of a retroactive renewal contract with St. Vincent’s School for Boys in the amount of $498,313 to provide mental health outpatient services for the period of July 1, 2004 through June 30, 2005. (3.15) CHN - SFGH – Request for approval to accept and expend a grant from the Gordon and Betty Moore Foundation in the amount of $2,071,817 for an RN Internship Program at SFGH for the period of December 1, 2004 through November 30, 2007. Action Taken: The Health Commission approved the Budget Committee Consent Calendar. Commissioner Illig abstained from voting on Item 3.13. Commissioner Sanchez abstained from voting on Item 3.2 and Item 3.6. Commissioner Umekubo abstained from voting on Item 3.1 and Item 3.13. Item 3.6 was referred to the Community Programs and Service Joint Conference Committee for a detailed presentation on interventions and outcomes. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Mayor’s State of Homelessness Address Mayor Gavin Newsom today delivered his first state of homeless address to an overflow crowd here in this Health Commission hearing room this morning. The Mayor reiterated his strong commitment to “Housing First” as a cornerstone of his administration’s focus on the chronically homeless and lauded the Department’s Direct Access to Housing program as a national and international model of excellence. Among his announcements, the Mayor highlighted a new partnership with CBO’s to provide permanent supportive housing for the 38 chronically homeless women of “Women’s World.” He is also dedicating 50 new stabilization units (coming on line tomorrow) and 75 new units of permanent supportive housing (coming on line next spring) to the Homeless Outreach Teams. Mayor Newsom indicated that he is moving away from the “Continuum of Care” model to the “Housing First” model. He will continue to emphasize immediate placement of individuals in permanent supportive housing with the wrap around services essential to help them stabilize and remain housed. Mayor’s Office Issues Budget Instructions Last week, the Mayor issued an overview of the City’s financial position and the instructions for the FY 2005-06 Budget. While the City’s financial condition is improved assuming the mid-year reductions are made, a $345 million challenge remains over the next two fiscal years. This includes a $130 million shortfall in FY 2005-06. Unlike in prior years, the Mayor has only issued targets for departments with less than $20 million in General Funds. The remaining ten departments, including DPH, are meeting with the Mayor’s Office over the next few weeks to define our financial issues for the budget year and come up with a target. Dr. Katz will keep the Health Commission informed of the progress. Congress Passes Federal Budget with Earmarks for DPH Late last month, Congress passed the FY 2005 omnibus appropriations bill. The portion of the bill funding the Departments of Labor, Health and Human Services, and Education (Labor-HHS) included $93.3 billion in mandatory spending and $143.3 billion in discretionary funding, a 2.8 percent increase over fiscal year 2004. Included in the federal budget were three earmarks for DPH: $1.5 million from the Center for Medicare and Medicaid Services for HIV/AIDS services provided to Medicare and Medicaid eligible populations; $1.5 million from the Substance Abuse and Mental Health Services Administration for supportive housing for persons with mental illness or substance abuse disorders; and $750,000 from the Department of Justice for supportive housing and services for recently released ex-offenders. These funding opportunities are the result of the hard work and continued support of House Democratic Leader Nancy Pelosi. Dr. Katz offered the Department’s sincerest appreciation to the Democratic Leader for her continued commitment to improving the health of San Franciscans. Asthma Telemedicine Program Yesterday, Mayor Newsom visited the Asthma Telemedicine Program (ATP) at Bret Harte Elementary School. The ATP has been an outstanding success. Eighty-three students from three elementary schools were able to participate this year. Twenty-five percent of these students were not even aware that they had asthma until DPH reached out to them. One hundred percent of students received a comprehensive evaluation including Spirometry, a consultation with an asthma expert via a telemedicine link, asthma education and a home visit. ATP has been able to communicate to all their primary care physicians the complete results of the evaluation and they are now assessing the impact of the program on our student’s asthma health. This year, ATP will be able to offer the Asthma Telemedicine Program in eight schools. The Mayor’s visit offered us the opportunity to highlight the importance of school-based programs for asthma care and the need for all of us in the asthma community to work more closely together. Tommy Thompson Resigns Last Friday, Secretary of Health and Human Services, Tommy Thompson, announced his resignation. Secretary Thompson is the eighth Cabinet member to resign since President Bush won reelection in November. A successor has not yet been named, though it has been reported that Center for Medicare and Medicaid Services Administrator Mark McClellan is the most likely successor. Flu Vaccine Update On Friday, Nov. 19th the CDPU staff, in partnership with St. Francis Hospital, facilitated a mass flu clinic utilizing Maxim Health Systems’ nurses and “left-over” flu vaccine (Maxim is a private for profit organization). St. Francis provided appropriate space, staff and security. DPH staff made hundreds of calls over a two-day period to make people appointments, organized the logistical layout, and provided bi-lingual staff to assist during the clinic. A total of 712 mostly elderly individuals were vaccinated over an 8-hour period. No one spent more than 30 minutes at the clinic. Dr. Katz is proud that DPH was able to ensure that excess Maxim vaccine was not redirected to other jurisdictions and was instead made available for more high risk San Franciscans. DPH has currently distributed all of the vaccine (20,930 doses) that was provided free of charge by the State. Additional vaccine is now available for purchase directly from distributors. However, all orders must come through DPH. DPH forwards all orders to the State, who is coordinating vaccine distribution with the federal Centers for Disease Control and Prevention. The provider community was alerted via fax that vaccine is available for purchase and so far DPH has submitted orders on behalf of over 160 San Francisco providers. The information and the order form are also available on the DPH website. Restrictions on who is eligible for injectable flu vaccine remain in place. Healthy individuals, including health care workers, are encouraged to seek Flu Mist. The Adult Immunization Clinic at 101 Grove now has both Flu Mist (with no restrictions) and injectable vaccine available in their clinic. Flu Mist is $30 a dose; a shot is $20 per dose. End of West Nile Virus Season It is an axiom of public health that you know you’ve done a good job when nothing happens. Dr. Katz is therefore pleased to report that the West Nile Virus season has ended and San Francisco had no reported cases of this infection in humans. He thanked Dr. Rajiv Bhatia and the great staff of the Environmental Health Division as well as the other City departments that worked with DPH to coordinate the West Nile Virus Prevention plan including the Department of Public Works, the Recreation & Parks Department, the Public Utilities Commission, the Department of the Environment, and the Fire Department. Of course it is possible to have a case post season and of even greater concern is preventing human cases next year, given that this is the first year that we had documented West Nile Virus infections in birds. JCAHO Mock Survey SFGH spent six days in October and November preparing for their anticipated 2005 triennial accreditation by conducting a Joint Commission on Accreditation of Healthcare Organizations (JCAHO) “mock” survey. Three consultants, all former JCAHO surveyors, conducted the survey using the new tracer methodology to assess the hospital’s compliance to the recently revised JCAHO standards. Hiroshi Tokubo, Director for Quality Management, Lawrence Marsco, JCAHO/Regulatory Affairs Manager, members of the SFGH Executive Committee, and Quality Management staff worked closely with the consultants, escorting them as they traced the care and services of predetermined patients from the point of entry into the hospital (e.g. emergency department, clinic, SFBHC) to their inpatient unit. The mock survey was a useful exercise for the hospital. A summary of identified areas for improvement was presented at Management Forum and a strategic approach to ensure a successful 2005 survey will be the topic of discussion at future SFGH Executive Committee and Medical Executive Committee meetings. Family Health Center Selected for the CAPH/SNI Chronic Care Learning Community Initiative The Family Health Center is one out of nine ambulatory care clinics in the state selected to participate in the California Chronic Care Learning Communities (CCLC) initiative sponsored by the California Association of Public Hospitals and Health Systems/Safety Net Institute. Sites participate in learning sessions that provide chronic care and systems change tools to better manage chronic diseases in their patient population. Sites choose a project and disease focus and share their successes with other participants at the learning sessions. The Family Health Center will be focusing on improving management of diabetes mellitus through partnering with a community health center and expanding upon their diabetes registry. Chinatown Public Health Center, Silver Avenue Family Health Center, and Potrero Hill Health Center were also selected to participate. Commissioners’ Comments Commissioner Illig asked if there is any new information from the Mayor’s Office about the mid-year budget cuts. Dr. Katz replied that he has no new information from the Mayor’s Office, but when the Mayor presented his proposal to the Board of Supervisors, the full $15.5 million reduction to DPH was there. He has no specifics on particular programs, but he believes the Mayor will restore the two small programs the Health Commission recommended. There is currently a discussion about whether the $1.5 million earmark for HIV/AIDS services could be use to offset the budget cuts. There is room for some sort of compromise, but this issue has not yet been fully resolved. Two members of the Board of Supervisors have developed an alternative proposal that would restore some funding to DPH. Commissioner Chow asked for a status report on the Proposition 63 planning effort. Dr. Katz said the Department should know the approximate dollar amount in the next four weeks. The Department will do its best to have the most inclusive planning process. No money has been awarded yet. Commissioner Umekubo commended the Department for its faxed information to providers regarding the disease, as well as the resources that are available to pursue potential cases. Commissioner Chow said the fax program is an excellent method of communicating with medical providers in San Francisco. 5) CONSIDERATION OF A RESOLUTION URGING THE ACCEPTANCE OF FOOD ASSISTANCE AT THE ALEMANY FARMERS MARKET Rajiv Bhatia, M.D., Director, Environmental Health Section, presented this item. Farmers markets are important outlets for low-income residents since they can provide high quality produce for reasonable prices. The Alemany Farmers Market is an especially important food resource for low-income and ethnic minority San Franciscans since it is located in the southeast sector of the City where a large number of food assistance recipients reside. This market, which is run by the City and County of San Francisco, has been reluctant to implement the technology necessary to accept food assistance, which is now in the form of electronic benefits transfers. Dr. Bhatia announced that the Alemany Farmers Market is now administered by the Department of Real Estate, and DPH has been successful in working with them to agree to address the barriers and implement a program to allow food assistance to be accepted at Alemany Farmers Market. Action Taken: The Commission approved Resolution 24-04, “Urging the Acceptance of Food Assistance at the Alemany Farmers Market,” (Attachment A). 6) PRESENTATION OF THE 2003 CHARITY CARE REPORT AND CONSIDERATION OF A RESOLUTION SUPPORTING REPORT RECOMMENDATIONS Anne Kronenberg, Deputy Director of Health, overviewed the process that was used to develop this report. At the Commission’s urging, the Department formed a work group that worked collaboratively on the preparation of the report. She thanked the work group participants for their support and looks forward to continuing this process next year. Colleen Chawla, Deputy Director, Office of Policy and Planning presented the 2003 Charity Care Report. She reminded the Commission that the Charity Care Ordinance, which was enacted in 2001, requires nonprofit hospitals to do two things: report to DPH specific information on charity care services; and notify patients of their charity care policies. To prepare for this report, in the summer of 2004, DPH convened a Charity Care Working Group that was comprised of all of the reporting hospitals, the Hospital Council, SEIU Local 250 and the Consumers Union. Charity Care Data 110,545 patients received charity care in FY 2003. This was an increase of 8,800 from the previous year. 111,924 services were provided. This was down 4,500 from the previous year but up 40,000 from FY 01 The vast majority of charity care services are outpatient Total charity care expenditures were $69,528,589 All reporting hospitals submitted copies of their charity care policies pursuant to the Charity Care Ordinance. Earlier this year, San Francisco’s nonprofit hospitals adopted the voluntary charity care guidelines put forward by the California Healthcare Association. These voluntary guidelines call for the provision of free care for patients with incomes at 200 percent of the federal poverty limit or below. In addition, some San Francisco hospitals have adopted charity care policies that are more generous than the voluntary guidelines. These new policies will be reflected in the fiscal year 2004 charity care summary report. The nonprofit reporting hospitals (excluding Kaiser) received corporate and property tax benefits valued at approximately $64.7 million in FY 2003. The report shows that in every case except St. Luke’s, the tax benefit that reporting hospitals derive as a result of their nonprofit status exceeds the level of charity care provided. The FY 2003 Charity Care Report includes highlights of an array of innovative community benefits programs hospitals provide to improve health in the community. Ms. Chawla also described the Public Health Institute’s Demonstration Project “Advancing the State of the Art in Community Benefit.” The goal of this project is to implement institutional reforms to enhance the use of charitable resources to address unmet health needs in local communities. Participation in this project is one of the report’s recommendations. Recommendations Hospitals should pursue innovative approaches to increase the provision of outpatient charity care to residents of the following high-risk neighborhoods: Bayview/Hunters Point, Potrero Hill; Tenderloin, Civic Center; Bernal Heights, Mission. The Department and the San Francisco hospital community should work closely with the Public Health Institute and review the feasibility of implementing the institutional reforms recommended in the Advancing the State of the Art in Community Benefit demonstration project. The Department should continue to work with San Francisco’s nonprofit hospitals and the Department of Human Services to provide hospitals with the information they need to deem as eligible for charity care patients on public assistance. The Charity Report Working Group should continue its discussions in an effort to improve and increase the provision of charity care to low-income and uninsured San Franciscans. Public Comment Jason Beers, from Operation Access, which is a group of doctors and nurses that volunteer their time to serve the uninsured, congratulated the volunteers and hospitals that work with the program and welcomed more participants. Jessica Rothaar, Health Access, strongly supports the concept of charity care as defined in the San Francisco ordinance. She commended the report as very useful, and Health Access supports the Report’s recommendations and would like to be included in the Charity Care Working Group. Terry Giovannni, Director of Community Health Programs at CPMC, commended DPH staff for reaching out to the hospital community. The working group provides a wonderful venue to discuss the important issue of access to health care. San Francisco has structural issues that have to be addressed. He fully endorses the recommendations of this report and the Public Health Institute’s recommendations. Jim McCaughey, Vice President of Planning at CPMC, said CPMC endorses the report’s recommendation. The 2003 numbers represent a substantial policy change in terms of the provision of charity care. CPMC is working actively on the first recommendation to increase access of care outside of the emergency room and outside of the walls of the hospital. Ron Smith, Hospital Council, thanked DPH for the inclusive process. It provided a full opportunity for hospitals to be able to provide input. There are problems in preventive, pre-hospital care than must be addressed, and he welcomes the continuation of the Working Group as a venue for further discussions. Abby Yant, Saint Francis Hospital, thanked DPH for providing this inclusive process. This laid the groundwork for future discussions. The hospitals want to be sure that the limited resources they have are directed in a way that make the most sense. St. Francis is honored to be part of the Public Health Institute’s demonstration project. Fred Seavey, SEIU Local 250, thanked DPH for its work. The facts continue to show a system design problem in San Francisco whereby the majority of charity care is provided by a few hospitals while other hospitals that do not provide much charity care still get substantial tax breaks. We need to strengthen the accountability measures. Jeffrey Sterman, Kaiser Permanente, explained that Kaiser is a different animal, but does not want to turn away from its charity care duties. Kaiser provides a lot of different community benefits programs. Mr. Sterman, in response to Commissioner Chow’s questions, clarified that the number of visits included in the Charity Care report are unreimbursed patients. Jim Hickman, president of the St. Luke’s Hospital Foundation, said the hospital is proud to be a major provider of charity care in San Francisco. Barry Lawler, director of Community Health at St. Mary’s Medical Center, said the working group was a good process. The Sister Mary Phillipa Clinic is now a partner with DPH and serves the same clients. Kieran Flaherty, UCSF Governmental Relations, said the working group was a very good process and the recommendations will be brought to the UCSF leadership. Commissioners’ Comments Commissioner Monfredini said the Commission is extraordinarily pleased with the quality of the report. She thanked the hospitals for sending representatives, respecting this process and becoming partners. Commissioner Chow acknowledged the hospitals that participated voluntarily. He asked Gene O’Connell to give her perspective on the process. Ms. O’Connell said this year has been a turning point in terms of collaborating with other hospitals. The collaboration with St. Mary’s and St. Francis, as well as the work on the African American Health Disparity project, are all wonderful programs. Commissioner Illig said this is an excellent report and is an outcome of the collaboration the Health Commission has requested. Including community benefits makes sense. He is concerned that including SFGH in the report skews the data, and he would like to see a table that compares the hospitals without SFGH. He is concerned that some hospitals do not have outpatient clinics, but utilize other mechanisms to provide these services. Ms. Chawla said that in her view if a hospital provides outpatient medical care, whether they provide it themselves or pay for someone else to provide it, falls under the definition of charity care. Commissioner Illig said that individual physicians should get credit for unreimbursed care that they provide. Commissioner Guy echoed the appreciation to the hospitals and the quality of the report. The recommendations are strong and clear. She appreciates the evolution of the ordinance. The intent of the ordinance is the social contract with the community, and this should remain the framework. MediCal reimbursement is a real issue, but it is a different question and may or may not be appropriate in the context of the Charity Care Ordinance. The work group should look is issue. Commissioner Umekubo said the problem of the uninsured is everyone’s problem—public and private—and should be addressed collaboratively. The working group is a springboard to develop other proposals. One recent collaborative success is the McMillan Sobering Center. He hopes that there is another tangible example in the near future. Commissioner Sanchez thanked the Department for the quality report. The data is very useful and important for planning efforts. He thanked the hospitals for committing to continued dialogue. Action Taken: The Commission approved Resolution 25-04, “Supporting Recommendations Contained in the Fiscal Year 2003 Charity Care Report,” (Attachment B). 7) HOUSING AND HOMELESS ANNUAL REPORT Marc Trotz, Director, Housing and Urban Health and Anne Kronenberg, Deputy Director of Health, presented the Housing and Homeless Annual Report. Ms. Kronenberg said that ending homelessness is a top priority for the City and for DPH. DPH is one of the largest homeless service providers in San Francisco, and homeless people are high utilizers of health services. San Francisco’s Ten Year Plan to End Chronic Homelessness includes the following elements: Phase down of shelters/transitional housing in favor of permanent housing Ensure that support services are linked to housing Provide nutritional support Develop prevention/intervention linked to jail and hospital discharge Coordinate City resources and expand Housing Authority role Provide employment/training opportunities. Ms. Kronenberg said the Ten Year Plan dovetails nicely with the DPH Strategic Plan in that it is a harm reduction model, includes partnerships with local, regional and national organization, requires collaboration across the Department, and focuses on outcomes-based services and prevention. The Plan uses the National Alliance to End Homelessness Framework of preventing new households from becoming homeless (Closing the Front Door), providing effective interventions for people currently homeless and providing immediate access to housing so people can exit homelessness (Opening the Back Door). Ms. Kronenberg gave a few examples of the myriad programs DPH provides to “Close the Front Door:” Community Health Promotion & Prevention Services – Community Empowerment Center, Black Infant Health Improvement Program, Tobacco Free Project; SRO Task Force SRO Collaboratives CBHS Treatment Services Health at Home Marc Trotz discussed DPH’s approach to “Opening the Back Door:” Direct Access to Housing program - nine sites with 583 units. Placement & Discharge Planning Project Homeless Connect Services for Currently Homeless Community Behavioral Health Services – Homeless Outreach Team, AB 2034 Permanent Housing Program Primary Care – New Housing and Urban Health Clinic, Tom Waddell Health Center/Other clinics, McMillan Stabilization Center Hospital Services – San Francisco General Hospital, Laguna Honda Hospital, San Francisco Behavioral Health Center. Emerging Issues Changes to the Section 8 Housing Program. There is a major push by the current administration to make significant changes and the Department needs to keep an eye on this. If there are large changes to the program, there will be another wave of people sliding into homelessness. Samaritan Act – The goal of this legislation is to end chronic homelessness through coordinated provision of housing, health care, mental health and substance abuse services and other services. If authorizing legislation passes, DPH HUH will likely get an allocation Ten Year Plan Implementation – many key recommendations are already being implemented Recommendations Medical Respite – the city continues to need a large-scale respite program that would include 75 to 100 beds of semi-private sleeping spaces along with comprehensive on-site medical and behavioral health services. Expansion of the Homeless Outreach Team – it is clear that the team needs additional outreach workers to establish an effective citywide presence. Expansion of permanent housing placement – there needs to be a steady flow of housing units targeted to this population. Commissioners’ Comments Commissioner Guy appreciates the fact that the 10-year homeless plan has been seamlessly integrated into the DPH plan. The discharge relationship in the DPH continuum of care is critical to success, as are the independent living units that will be built at Laguna Honda Hospital. Commissioner Illig thanked staff for the comprehensive report. He asked if HUH works with CBHS contractors that provide residential treatment services to prevent them from evicting clients. Mr. Trotz said the Department is still in the process of wresting control back from the network of residential mental health and substance abuse services, but progress is being made. It is critical that DPH controls these units in terms of access, evictions and other issues. Commissioner Umekubo asked what the federal government’s responsibility is in terms of homeless veterans. Mr. Trotz said the ICH (Interagency Council on Homelessness) grant, which was a combination of federal agencies, would target this. This is will be a groundbreaking collaboration with the Veterans Administration. Commissioner Sanchez asked if there is any creative thinking from other institutions, such as the Presidio Trust and the Treasure Island facility, to provide additional housing for this population. Mr. Trotz said Swords to Plowshares did one project at the Presidio, but he is not hopeful that there will be other opportunities. A lot of has been done on Treasure Island with 400 homeless units on the island. But there is a lot of potential housing stock in San Francisco. Commissioner Monfredini asked what services are available for people who are one paycheck away from homelessness. She does not want this population to get lost. Mr. Trotz said there are a number of programs provided by the Department of Human Services that help this population. But there are not enough resources for things like eviction prevention. Commissioner Chow asked if SROs are considered permanent housing and what changes, if any, can be made to these units. Mr. Trotz said that even during difficult times the City has not lost one SRO unit. The SRO Collaboratives are funded through the Department of Building Inspection. 8) PUBLIC COMMENT/OTHER BUSINESS 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) voted to hold a closed session. The Commission went into closed session at 6:05 p.m. Present in closed session were Commissioner Chow, Commissioner Guy, Commissioner Illig, Commissioner Monfredini, Commissioner Sanchez, Dr. Mitch Katz, Director of Health, Gene O’Connell, SFGH Hospital Administrator, Alison Moed, R.N., Director, Risk Management, Mark Lipton, Deputy City Attorney, Don Margolis, Deputy City Attorney, Jonathan Lee, Deputy City Attorney, Karen Kirby, 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 $22,500, SCHINDLER ELEVATOR CORP. v. CITY AND COUNTY OF SAN FRANCISCO, SAN FRANCISCO SUPERIOR COURT No. 420-546 Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez) approved the settlement of Schindler Elevator Corp. v. City and County of San Francisco in the amount of $22,500. D) Reconvene in Open Session The Commission reconvened in open session at 6:10 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) 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) voted to hold a closed session. The Commission went into closed session at 6:10 p.m. Present in closed session were Commissioner Chow, Commissioner Guy, Commissioner Illig, Commissioner Monfredini, Commissioner Sanchez, Dr. Mitch Katz, Director of Health, Gene O’Connell, SFGH Health Administrator, Alison Moed, R.N., Director, Risk Management, Don Margolis, Deputy City Attorney, Jonathan Lee, Deputy City Attorney, Karen Kirby, 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 $23,000, AUDREY EICHORN v. CITY AND COUNTY OF SAN FRANCISCO, USDC No. C03-2661 JSW Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez) approved the settlement of Audrey Eichorn v. City and County of San Francisco in the amount of $23,000. D) Reconvene in Open Session The Commission reconvened in open session at 6:22 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) 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 (San Francisco Administrative Code Section 67.11) Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez) voted to hold a closed session. The Commission went into closed session at 6:22 p.m. Present in closed session were Commissioner Chow, Commissioner Guy, Commissioner Illig, Commissioner Monfredini, Commissioner Sanchez, Dr. Mitch Katz, Director of Health, Jonathan Lee, Deputy City Attorney, Karen Kirby, 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 $1,537,500, IN JOHN R. ULRICH, JR. v. CITY AND COUNTY OF SAN FRANCISCO, ET AL, USDC C99-05003 TEH Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez) approved the settlement of John R. Ulrich, Jr. v. City and County of San Francisco, et al, in the amount of $1,537,500. D) Reconvene in Open Session The Commission reconvened in open session at 6:30 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) voted not to disclose discussions held in closed session. 12) ADJOURNMENT The meeting was adjourned at 6:30 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.