Minutes of the Health Commission Meeting Tuesday, January 4, 2005 at 3:00 p.m. 101 GROVE STREET, ROOM 300 San Francisco, CA 94102 1) CALL TO ORDER The meeting was called to order by Commissioner Chow at 3:10 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. Absent: Commissioner John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF DECEMBER 21, 2004 Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez) approved the minutes of the December 21, 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) PHP-Housing & Urban Health – Request for approval of a retroactive new contract with Episcopal Community Services, in the amount of $210,666, to provide supportive housing services at the Folsom-Dore Apartments, targeting homeless adults, for the period of January 1, 2005 through September 30, 2005. Commissioners’ Comments Commissioner Illig appreciates the Department’s response to some of the issues raised by the Commission, including Board composition and agency contribution (3.2) AIDS Office-Research – Request for approval of a renewal contract with PHFE Management Solutions, in the amount of $90,053, to provide fiscal administrative services for the “Post Marketing Surveillance for the OraQuick Rapid HIV-Antibody Test” project, targeting persons who have received an OraQuick test at a CDC or State government-funded site, for the period of January 1, 2005 through June 30, 2005. Secretary’s Note – This contract is presented by AIDS Office-Prevention, not AIDS Office-Research. Commissioners’ Comments The Committee requested, at the suggestion of Jimmy Loyce, a report to the Community Programs and Service Joint Conference Committee on the outcomes of the study. This will be scheduled in March 2005. (3.3) BHS-Mental Health – Request for approval of a retroactive renewal contract with the San Francisco Psychoanalytic Institute and Society, in the amount of $101,957, to provide high quality childcare mental health services, for the period of July 1, 2004 through June 30, 2005. Commissioner Illig asked what kinds of services are provided to the children. Sandy Schaaf, Executive Director of San Francisco Psychoanalytic Institute and Society replied that they serve three childcare centers. They help center staff and parents learn how to manage children before they develop escalating problems. Commissioner Illig asked if each individual contractor is monitored. Ms. Chan-Sew said that agencies are individually monitored, and the overall program is evaluated. (3.4) BHS-Mental Health – Request for approval of a retroactive renewal contract with Children's Council of San Francisco, in the amount of $238,377, to provide Quality Child Care Consultation Services targeting center-based and family child care providers, for the period of July 1, 2004 through June 30, 2005. (3.5) BHS-Mental Health – Request for approval of retroactive renewal contracts with six contractors, for a total for all agencies per year of $403,200, to provide children's mental health services under the Homeless Mental Health Initiative for the period of July 1, 2004 through June 30, 2005, as follows: Asian Women's Shelter, $60,000; Catholic Charities/CYO, $85,000; Compass Community Center, $40,000; Hamilton Family Center, $85,000; La Casa de las Madres, $40,000; and St. Vincent de Paul/Riley Center, $50,000. (3.6) BHS-Mental Health – Request for approval of a retroactive renewal contract with Seneca Center for Children and Families, in the amount of $3,081,574, to provide residential, day treatment and therapeutic behavioral health services, for the period of July 1, 2004 through June 30, 2005. (3.7) PHP-BEHM – Request for approval of a renewal contract with Dillard Environmental Services in the amount of $200,000 to provide hazardous waste management and transportation services, for the period of January 1, 2005 through June 30, 2007. Commissioners Comments (at the Health Commission meeting) Commissioner Chow appreciates the staff’s edification of the High Quality Child Care Mental Health Initiative and the Homeless Mental Health Initiative. He would like the Joint Conference Committee to explore these two initiatives further. Action Taken: The Health Commission (Chow, Guy, Illig, Monfredini, Sanchez) approved the Budget Committee Consent Calendar. Item 3.2 was referred to the Community Programs and Service Joint Conference Committee for a report in March 2005 on survey findings. The High Quality Child Care Mental Health Initiative and Homeless Mental Health Initiative were also referred to the Community Programs and Services Joint Conference Committee. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., presented the Director’s Report. FY 05-06 Budget Preparation The Department of Public Health is working on the budget for FY 05-06. The Mayor’s Office of Finance estimates that the City-wide deficit will be $130 million, after taking mid-year reductions into account. This figure includes negotiated MOU increases for Civil Service classes, but does not include increases that that will result from contracts up for negotiation. DPH’s contract for nurses and nurse supervisors are among these. Budget reduction targets have not been set by the Mayor for large departments, including Public Health. Smaller departments have been asked to absorb their own inflationary cost increases within their existing general fund. Larger departments are continuing to meet with the Mayor’s Office of Finance to set individual targets. In the meantime, DPH staff has completed initial forecasts of revenue for next year, and have also identified the structural, inflationary, and regulatory items that will affect Department expenses in the coming year. Dr. Katz plans to make an initial presentation to the Health Commission on these items at the January 18th meeting. Project Homeless Connect On December 8, 2004, over 300 volunteers participated in the second Project Homeless Connect. The goal of the event is to reach out to homeless people living on streets of the Tenderloin/South of Market and help connect them to medical, behavioral health, benefits, legal, and housing services. The event operated out of two main service sites – 201 Turk Street Community Center and 6th/Folsom Recreation Center. By all accounts the day was a huge success. The two centers provided services to over 600 people. Fifty-four chronically homeless persons were housed in stabilization units that day and were connected to ongoing intensive case management. On-site medical services were highly utilized with the majority of patients having little or no prior connection to the primary care system. Nine people who came into the two sites had severe medical conditions and needed to be transferred to SFGH. The Department provided a tremendous amount of support for the day through many sections. Judith Klain provided planning and logistics support. The next Project Homeless Connect is scheduled for February 24, 2005. Homeless Count The Department of Human Services is coordinating this year’s Homeless Count, which is required by HUD to be eligible for McKinney funding. The goal of the Homeless Count is to document the size and locations of San Francisco’s unsheltered homeless population, leading to better services and increased funding to address homelessness. The Homeless Count is a volunteer effort. Volunteers will be placed teams and assigned to designated routes. This year’s Homeless Count will be taking place on January 25, 2005 from 7:00 pm until 12:00 a.m., and will be staged from 101 Grove Street. Those interested in volunteering should call 557-5241 or e-mail: Shelagh.Little@sfgov.org. Commendation For Environmental Health Inspectors Today, the San Francisco Board of Supervisors will consider Supervisor Peskin’s commendation acknowledging the public health efforts of the Department’s environmental health inspectors. The resolution recognizes the innovative and inspirational work of Principal Health Inspector Lisa O’Malley and her Health District Four team—Mary Freschet, Dawit Furgassa, Jackie Greenwood, Uzziel Prado, Mel Seid, Calvin Tom, Melinda Tyler and Nancy Yee. The Health District Four team is being acknowledged for its visionary approach to compliance, enforcement, training and the educational needs of residents and business owners. The Rodent Abatement program for Chinatown, collaboration with the Department of Building Inspection, and field-based education and training for food industry workers exemplify this approach. Dr. Katz congratulated these inspectors for their exemplary leadership and public health service. Commissioners’ Comments Commissioner Illig asked the Department to co nsider the cost of contractor COLAs as one of the inflationary, structural costs to the Department. Dr. Katz replied that he intends to present this information on January 18, 2005. 5) CONSIDERATION AND POSSIBLE ACTION REGARDING THE DIRECTOR’S PROPOSED REDUCTIONS TO HEALTH DEPARTMENT EXPENDITURES FOR FISCAL YEAR 2004-2005 BUDGET (BEILENSON HEARING) The Beilenson Hearing FY 2004-2005 Mid-Year Reduction Plan is attached (Attachment A). Public Comment J.W. Sheffield, Clinical Social Worker at Maxine Hall Health Center, asked the Commission to reconsider the elimination of the Senior Medical Social Worker classification. He submitted information on the Senior Medical Social Worker position (on file in the Health Commission office). Ines Ascencio, Senior Medical Social Worker at Southeast Health Center, said if her position were eliminated, they would not be able to meet the needs of the Spanish speaking community that they serve. These social workers provide direct services and bring in revenue. Susan Schneider said the ten Senior Medical Social Workers have dedicated their careers to the most complex DPH patients, and provide direct services. She urged to Health Commission to reconsider these cuts. Sharon Pretti, licensed clinical social worker at Laguna Honda, said the social worker supervisors provide direct services, and the loss of these positions will mean a delay in services. Paul Kelley, hospice social worker at Laguna Honda, said money is always an issue. He is deeply concerned about the cutbacks. The loss of the social worker positions will delay critically needed services. Sue Carlisle, M.D., Associate Dean for UCSF at San Francisco General Hospital, expressed concern about the reduction to amount of the affiliation agreement between UCSF and SFGH. This past year, in meetings with the Mayor’s Office, they identified $1.1 million in one-time expenses that could be used to offset cuts with the expectation that the situation would improve. There was also an additional allocation that way taken away. This means doctors will have to ration care. Valerie Ng, M.D., Chief of Medical Staff, SFGH, said the cut to the affiliation agreement is very difficult to manage. This means the medical staff can no longer provide the level of services that is provided today. The medical staff will be discussing how to ration care. This is very hard to undertake. Karla Thurston, member of San Francisco Community Clubhouse, spoke against cuts to mental health services. Rickard Soich, Continuum, said services to low-income people are valuable services. The cuts will be detrimental to people with multiple diagnoses. Denis Beaulne, Member of Continuum, said every year the clients need to be stressed out over potential cuts. He submitted a letter signed by members of Continuum HIV Day Services (on file in the Health Commission office). Joseph Contreras, member of Continuum, urged the Health Commission to reconsider any cuts that may impact these important services. Barbara Rothkrug, Public Health Nurse, said that the proposed cuts with impact maternal child health services. The proposed reductions will impact Spanish-language services, billing and other services. Linda Mullen, Public Health Nurse at Curry Senior Center, said without public health nurses, there would be more emergency services, hospitalization and institutionalization. She submitted a column written by Joan Ryan about the work of DPH public health nurses (on file in the Health Commission office). Paul Wagoner, San Francisco Community Clubhouse, said this program provides critical services. Jeanine Bray, Activity Therapist at LHH, said with more and more disturbed people coming to Laguna Honda, it is critical that the Senior Medical Social Worker positions be maintained. Ray Stuart, Medical Social Worker at LHH, spoke in support of the Senior Medical Social Worker positions. Social workers are key in discharge planning, which is one of the Mayor’s priorities. Mr. Stewart submitted a petition in support of the social worker positions (on file in the Health Commission office). Cindy Gyori, Hyde Street Community Services, said they have made many modifications to their services based on new emphases on new City priorities and have participated in all of the Mayor’s homeless initiatives. Now they are being asked to cut services. Also, people who do not need services do not exist in the Tenderloin. She submitted letters with information on the population they serve and the impacts of the cuts (on file in the Health Commission office). Michael Blecker, Executive Director of Swords to Plowshares, spoke against the cuts to services to people who are not categorized as seriously mentally ill. Veterans’ issues should be considered seriously. Bart Casimir, Swords to Plowshare, said that post traumatic stress disorder is a serious mental illness. Antoinetta III, chair of the Tom Waddell Advisory Board, said there is no more fat to trim from organizations that are being cut. Even small cuts have large impacts on people. Will Dempsey, client of the Tenderloin Mental Health Clinic, said that a $40,000 savings would cost much more over the long term. If we really want to save money, keep services. Eve Meyer, ED of San Francisco Suicide Prevention, spoke in opposition to the cuts to mental health services to people with “minor” mental illness. Catastrophic mental health increases suicide, pushes people up to more critical needs. Mark Molnar, Shanti, said that hundreds of volunteers provide 2,000 hours of services to people with HIV and AIDS. The volunteer is often a client’s only connection to the outside world. It is not smart thinking to cut volunteer programs. Manuel Vasquez, Mission Mental Health, said that the proposed cuts are a contradiction to the Strategic Plan that was recently approved by the Health Commission. Do not cut services that are unique to San Francisco. Ellie Dwyer, Clinic Director at Mission ACT, said that Mission ACT has lost two staff positions, which has meant a reduction in services to the patients that cost the City the most money. These kinds of cuts are working at cross-purposes with the Mayor’s goal of reducing homelessness. Tara Stacker, Shanti, spoke on behalf of the more than 200 volunteers who would be impacted by theses cuts. These volunteers provide more than 2,000 hours of services. Volunteers provide practical and emotional support. Stacey Mandel-Sonner, Shanti, spoke in support of Shanti’s services, and read a statement from a client that receives aid from a Shanti volunteer. James Rousku, client at Shanti, said he and many people like them depend on Shanti’s services. Rosalyn Roddy, social worker at Southeast Child/Family treatment center, said the population they serve in Visitation Valley is disenfranchised and extremely diverse. The leadership provided by the Senior Medical Social Worker is critical to providing services. The loss of this position would mean the loss of the girls’ group and Spanish-language capacity. Toho Soma, Shanti volunteer, said the clients he has worked with have taught him so much. San Francisco has been a global leader in the treatment of HIV. Now the services that put San Francisco a notch above are being cut. He read a statement from one of his clients (on file in the Health Commission office). Eric Sutter, Shanti peer advocate, spoke in support of the numerous clients and volunteers that would be impacted by the proposed cut. Tracy Brown, Executive Director of Tenderloin AIDS Resource Center, spoke in support of the HIV/AIDS services that are proposed to be cut. Alternative therapies are critical for their patients, and help them stay engaged in care. Sophia Lau, Chinatown Public Health Center, spoke in support of the nutritionist at the health center. They have the only project in the State of California that targets obesity in the monolingual Chinese population. Jane Russell White opposed cuts to alternative medicines that help her survive. Due to services from Shanti, the Black Coalition on AIDS and the Quan Yin Healing Arts Center, she is able to lead a normal life. She read a letter from her Shanti volunteer. Bobby Martin, client at Hyde Street Community Services, said all the clients there want to protest the cuts to mental health services. Hulda Brown, vice president of Quan Yin Healing Arts Center, said San Francisco is known for its services to HIV services, but these services continue to be cut. Quan Yin provides people with services they cannot get elsewhere. Enrique Lopez-Castro, who works at Instituto Familiar de la Raza as an intern, said the Latino immigrant community is concerned about cuts to the Mental Health System. The immigrant community has many mental health issues and do not have access to the system due to legal status. If there are not enough therapists that speak the language, services are effectively eliminated. Rebecca King Morrow, Public Health Nurse, said that there is a nursing shortage, and DPH nurses have many opportunities. If these positions are cut, DPH is not going to get these nurses back. Nurses can get other jobs, but patients cannot get other services. Martha Hawthorne, Public Health Nurse at Castro Mission Health Center, said although she will remain after the budget cuts, her job will become undoable and she will have to choose who will and will not get care. She is pleased that 11 nursing positions have been restored, but the 11 that are being cut will decimate the system. Helen Yuen, Advisory Council Member of Chinatown Health Center, asked the Commission to keep the nutritionist at the Health Center. This is a critical position. Laurie C. said that cuts to mental health services will have long term effects, and asked the Health Commission not to cut $40,000 from Hyde Street Community Services. April Lax, Senior Social Worker at Health At Home, read a letter from Health at Home social workers. Losing these positions will make a bad situation worse. Sandra Aseltine, Senior Medical Social Worker at Tom Waddell, said senior medical social workers provide a variety of direct services. She submitted a petition in support of reinstating the social worker positions (on file at the Health Commission Office) Carla Wilson, Quan Yin Healing Art Center, clarified that MediCal and Medicare does not cover acupuncture. With the proposed cuts, more than 600 people currently accessing alternative therapy will lose services. She submitted a written statement about the impact of the cuts (on file in the Health Commission office). Barbara Farrell, ED of Ohlhoff Recovery Services, said the goal should be to have more mental health services, rather than cutting services for things that are not considered “serious.” Jessica Berman, Shanti, thanked the Health Commission for advocating to restore funding for Shanti’s breast cancer services. She asked the Commission to further advocate to restore services for HIV/AIDS peer resource services. Michael Lyon, Gray Panthers and Coalition for Public Health, said this is not Beilenson Hearing, because that should be held by the Board of Supervisors. Aleeta Van Runkle, Deputy City Attorney, responded to this issue and advised that the Health Commission is the appropriate place for this hearing to be held, due to the nature and timing of the proposed reductions. Carl Stokes, spoke on behalf of Quan Yin and Shanti, and said that volunteers take care of everything that can fall apart for the clients. All the cuts are bad. Laurie Hampton, co-founder of Justice for Homeless San Francisco, said she has already felt the impact of past cuts. The nurses are the ones that mainly serve people with chronic mental health problems. Robert Haaland, SEIU 790, spoke in opposition to all the healthcare cuts. The Health Commission should take an active role in this process by saying these programs should not be cut, and instead figure out how to save the programs. These are desperate times. Union members have participated in creative budget problem solving. Halt the layoffs and look at other options. Dale Milfay, Chair of San Francisco NAMI, asked the Health Commission to stop these draconian cuts. These cuts will result in more homelessness. If mental ill people are not indigent, they do not get taken care off. Do not make cuts on the backs of the poor. Kent Woo, NICOs, thanked the Commission for working to save the anti-gambling initiative, and asked the Commission to oppose cuts to mental health services. This will lead to discrimination against mentally ill people without a payer source. Otto Duffy, Tom Waddell Advisory Board, said the cuts should come from the top, not the bottom. It is important that people take advantage of every opportunity to fight for these services. Another opportunity to increase revenue is to have MediCal reimbursements go directly to DPH, rather than the general fund. Doris Hom, Public Health Nurse, said people with health insurance, family and friends, and who speak English should be considered lucky. Public Health Nurses are the last resort, and the plug in the dyke of overwhelming health problems. Public health nurses save lives and money. Sam Katheberg, Bayview Clubhouse, said society is only as good as the way it treats its minorities, indigent, poor and people who are different. The cuts will have a huge impact on services at the Bayview Clubhouse. Commissioners’ Comments Commissioner Guy asked Dr. Katz to clarify the cuts over the past year to the UC affiliation agreement. Dr. Katz said that the affiliation agreement states that the City and County of San Francisco will pay for the cost of UC providing services at SFGH. UC and the City have confirmed that with the current delivery of services, the agreement is underfunded by approximately $3 million. Ms. O’Connell and UC leadership met with the Mayor’s Office to discuss revenue maximization opportunities, but identified no new options. The Mayor allocated $2.3 million in additional funding to the agreement in FY 04-05, and this has been withdrawn. The reduction needs to be implemented over an 18-month period. Ms. O’Connell is working collaboratively with the Associate Dean to determine how to live within this smaller amount. It is unlikely that major service cuts will happen in this fiscal year, which could mean larger cuts beginning July 2005. Commissioner Guy said there needs to be transparent discussions with the Health Commission about these decisions, particularly if services are going to be cut. Commissioner Illig was troubled to hear the amount of direct services that are provided by the Senior Medical Social Worker positions. Will the people that are currently in these positions be able to remain in the Health Department? Dr. Katz DPH might lose some to retirement, but others will move to a clinical social worker position or some other position. Commissioner Sanchez said there is a distinct relationship between a continuum of care and the provision of quality care. The model over the past year has been to redefine and reconfigure in an attempt to deal with constant cuts. But soon there will be nothing left. Cutting edge models, such as the SFGH/UCSF dental clinics, are gone. But the battle is not lost yet, and we must work together to come up with new revenue models. Commissioner Illig said DPH cut 130 administrative FTEs last year. This past November, the Department was faced with $15.5 million in cuts. These have been reduced, but there are severe cuts to vulnerable populations. As a member of the Budget Committee, he will look more diligently at every one of the general fund contracts to make sure money is spent as effectively as possible and meets the Strategic Plan. Commissioner Mondredini would like to see all these cuts restored, but she is particularly concerned about cuts to programs that are volunteer-based. These programs cost pennies, yet provide overwhelming services. Commissioner Chow asked what the next steps were in terms of the proposed cuts. Dr. Katz said it was the Health Commission’s legal responsibility to notice the proposed reductions and hold the Beilenson hearing. With that done, the Health Commission’s responsibility ends. Dr. Katz noted that over the past three years, DPH’s general fund allocation as dropped by $73 million, and this does not take into consideration the expanded scope of DPH services. It is due to the committed and talented staff that programs are still running effectively, and this is quite an achievement. Commissioner Chow thanked the public for coming to the meeting, and putting a human face to the reductions. The Commission cannot do much to prevent the current round of cuts, as the Department cannot overexpend its budget. However, today’s testimony will stay with each commissioner as we move into next year’s budget discussions. 6) PUBLIC COMMENT/OTHER BUSINESS Howard L. Chabner – written summary attached.* 7) ADJOURNMENT The meeting was adjourned at 6:01 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 changes or corrections to these minutes will be reflected in the minutes of the next 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. Written Summaries of 150 Words Or Less That Have Been Submitted By Members of the Public *Howard L. Chabner, Item 6 - I am gravely concerned about what is happening to Laguna Honda, its residents and its historic mission. An elderly relative who is severely disabled due to a serious, progressive, debilitating medical condition lives there. In the past year the medical care has remained very good but Laguna has significantly deteriorated. There have been sexual assaults on defenseless residents, other incidents of violence, arson and threats by residents (and their visitors) with serious, violent psychiatric disorders and significant substance addiction. This is due directly to the new mission and admissions policies, which have resulted in admissions of dangerous patients. The latest policy removes “long term care” from Laguna’s mission. Please protect Laguna residents, continue its historic mission of providing long-term skilled nursing and medical care to disabled and elderly San Franciscans with serious medical conditions, and stop the betrayal of the voters who approved the rebuild bond.