Minutes of the Health Commission Meeting Tuesday, January 18, 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. Commissioner John I. Umekubo, M.D. President Chow announced that the election of Health Commission officers, which normally takes place at the first meeting after January 15th of each year, is being postponed to give Mayor Newsom additional time to make Commission appointments. President Chow also announced that Commissioner Roma Guy would be reappointed to the Health Commission on Friday, January 21, 5:00 p.m. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF JANUARY 4, 2005 Action Taken: The Commission approved the minutes of the January 4, 2005 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) BHS-Substance Abuse - Request for approval of retroactive contract renewal with Addiction Research and Treatment, Inc. dba BAART, in the amount of $5,740,202, to provide substance abuse treatment services, for the period of July 1, 2004 through June 30, 2005. (3.2) BHS-Substance Abuse - Request for approval of a retroactive renewal contract with Curry Senior Center, in the amount of $510,188, to provide substance abuse treatment and mental health services, for the period of July 1, 2004 through June 30, 2005. (3.3) BHS-Substance Abuse - Request for approval of a retroactive renewal contract with Westside Community Mental Health Center, Inc., in the amount of $2,850,755, to provide substance abuse treatment services, for the period of July 1, 2004 through June 30, 2005. Commissioners’ Comments Commissioner Guy asked why the program received such a low performance score, and what steps the agency is taking to ensure that the next evaluation results in higher scores. Abner Boles, Executive Director of Westside Community Mental Health, replied that there were two primary reasons for the low score: staff turnover and a new approach to serving their population. The agency has applied for additional technical assistance from the AIDS Office, hired a Director of Clinical Services and carved out a quality assurance position, all steps that should improve performance. Moreover, additional management should positively impact staff turnover. Commissioner Guy urged the staff and the agency to problem solve throughout the year. (3.4) BHS-Mental Health - Request for approval of a retroactive renewal contract with Westside Community Mental Health Center, Inc., in the amount of $6,420,746, to provide mental health services and fiscal intermediary services targeting adults and youth/adolescents, for the period of July 1, 2004 through June 30, 2005. Action Taken: The Health Commission approved the Budget Committee Consent Calendar. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. State Budget On January 10th, the Governor released his proposed budget for FY 2005-06. Notable health-related proposals include redesign of the Medi-Cal program designed to generate administrative savings of $12.3 million, expansions of health insurance coverage for children, a new Obesity Initiative, creation of California Rx - Prescription Drugs for the Uninsured, expansion of the Genetic Disease Testing Fund to test and treat newborns for genetic disease, a revenue decrease for Proposition 99, increases in Realignment revenues to cover unfunded 02-03 and 03-04 caseloads, suspension of SSI COLAs, and changes to the outpatient prescription drug program for dually eligible Medi-Cal/Medicare recipients. Collaboration between UCSF School of Pharmacy and Laguna Honda Hospital This month, Laguna Honda Hospital’s Volunteer Services and Pharmacy departments are implementing a new collaborative program between the UCSF School of Pharmacy and Laguna Honda. Under the program, known as "Patient as a Person," first year UCSF pharmacy students will observe and experience patient care as hospital volunteers. Each student will visit with a specific resident for at least a half an hour per week in order to better understand the patient's perspective. Approximately 120 students representing a diverse set of language skills are participating in the program. Laguna Honda staff is hopeful that this program will not only be a great benefit to the residents but also that some of the students will remain at Laguna Honda as ongoing volunteers and/or members of the pharmacy team. Drug Discount Card Enrollment Week The Department, along with the Bernal Heights Neighborhood Center, Self-Help for the Elderly, Network for Elders, Senior Action Network, Department of Human Services and the Mayor’s Office of Disability are sponsoring a "Drug Card Blitz Week" from Jan 31st to February 4th. The weeklong event is designed to help seniors and individuals with disabilities learn more about the changes in Medicare and assist them in signing up for benefits that could save them money on their prescriptions. Organizers have planned a press conference for Tuesday at noon in front of City Hall with Supervisor and Board President Aaron Peskin. The enrollment events are being offered throughout the City in English, Chinese, Spanish, Tagalog, Samoan, and Russian. San Francisco Local Homeless Coordinating Board Restructuring On January 10th, the Board of Supervisors passed a resolution restructuring the Local Homeless Board (Local Board). The restructuring is based upon a consensus proposal that came from the Local Board itself. The existing 35-member Local Board will be disbanded and replaced by a new nine-member body. The Mayor and the Board of Supervisors will each have four appointments and the Controller one appointment from the following constituencies: representatives of homeless, formerly homeless, community and advocacy organizations, service-provider agencies, business and corporate sectors and the foundation community. The Local Board will have two full time staff members, an Executive Director and an Administrative Assistant who will handle the day-to-day operations of the Board. DPH staff, in addition to staff from the Department of Human Services, the Mayor’s Office of Housing, and the Mayor’s Office of Community Development, will continue to support Local Board efforts and provide relevant information and act as a resource for the Local Board. Community Health Network, San Francisco General Hospital, Credentials Report, January 2005. 01/05 07/04 to 01/05 New Appointments 8 134   Reinstatements 0 0 Reappointments 43 225   Delinquencies: 0   Reappointment Denials: 0 Resigned/Retired: 4 99 Disciplinary Actions 0 Restriction/Limitation-Privileges 0 0 Deceased 0 0 Changes in Privileges   Additions 4 50   Voluntary Relinquishments 6 24   Proctorship Completed 12 77 Current Statistics - as of 01/1/05 Active Staff 449 Affiliate Professionals (non-physicians) 188 Courtesy Staff 546 TOTAL MEMBERS 1,183 Applications In Process 29 Applications Withdrawn Month of January 2005 0 5 (07/04 to 01/05) SFGH Reappointments in Process Feb. 2005 to May 2005 150 Commissioners’ Comments Commissioner Illig asked how the Local Homeless Board would dovetail with the Mayor’s Homeless Task Force. Dr. Katz replied that the Local Homeless Board should be at the forefront of helping to implement the 10-year plan. In the past this has not happened. Ms. Kronenberg added that the implementation group appointed by Mayor Newsom and chaired by Angela Alioto holds quarterly public hearings, and is anticipated to be in existence for a short time period. The restructured local homeless board will be the place where all homeless policy is discussed, and would deal with the day-to-day specifics of homeless policy. Commissioner Illig asked if the city still receives McKinney funds. Ms. Kronenberg replied that while funding has decreased, the city will receive approximately $10 million. Commissioner Chow asked who initiated the pharmacy program at Laguna Honda Hospital. Ms. Kronenberg said that Sharon Kotabe, CHN Pharmacy Director, was instrumental in developing this program. Commissioner Monfredini asked why SFGH is responsible for the bus shelter at the hospital. Ms. O’Connell said that the bus shelter is on SFGH property but clean up is not the hospital’s responsibility. Ms. O’Connell said they have been working collaboratively with MUNI to make sure the shelter is clean. 5) PRESENTATION OF THE EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF JANUARY Commissioner Umekubo presented the Employee Recognition Awards for the month of January. Team Awardee Division Nominated By Contracts On-Line Project Team Donna Childers Jeff Burton Irina Tomashevsky Galen Leung Rob Longhitano PHP Anne Okubo and Fred McGregor 6) STATE AND FEDERAL LEGISLATIVE UPDATE Colleen Chawla, Deputy Director, Office of Policy and Planning, presented the State and Federal Legislative Update. Ms Chawla said that increased local, state and federal advocacy is a key strategy to achieving partnerships with communities that assess, develop, implement and advocate for health funding and policies. DPH works in coalition with County Health Executives Association of California (CHEAC), California Conference of Local Health Officers (CCLHO), California State Association of Counties and the California Association of Public Hospitals. By its participation in coalitions, DPH ensures that the City’s interests are represented. Ms. Chawla gave highlights of the Federal Legislative Session, which included the Medicare Prescription Drug Improvement and Modernization Act of 2003, Medicaid DSH, 340B Inpatient Drug Pricing and Emergency Services for undocumented immigrants. The federal budget included three earmarks for DPH: $1.5 million for HIV/AIDS services provided to Medicare and Medicaid eligible populations; $1.5 million for supportive housing for persons with mental illness or substance abuse disorders; and $750,000 for supportive housing and services for recently released ex-offenders. Ms. Chawla said that looking ahead, federal legislative activity would include Medicaid reform and Ryan White reauthorization. Ms. Chawla presented an overview of the 2003-2004 State Legislative Session. This session was marked by deficits of more than $45 billion over the two fiscal years of the session. Highlights include Medi-Cal redesign. The current plan, released with the 2005-2006 budget proposal, lacks specificity but would include changes to hospital financing, a cap on adult dental services, monthly premiums for recipients with incomes above the federal poverty level, and moving aged, blind and disabled into manage care. Ms. Chawla said the final 2004-2005 State budget had few of the health services reductions that were originally proposed in January 2004. Looking ahead, Ms. Chawla said that the State is facing a significant budget shortfall of $9 billion and discussion about significant changes to the Medi-Cal program and hospital financing. Commissioners’ Comments Commissioner Illig asked how much unreimbursed emergency care is provided at SFGH. Ms. Chawla said SFGH does not ask immigration status, so there is no estimate. Dr. Katz said if SFGH did keep track, it would be millions of dollars, so the Department needs to see what mechanism would be used to allocate dollars to determine if there needs to be a change in how such services are tracked. Ms. Chawla added that the pot of money is only $250 million nationwide. Commissioner Illig asked if the Federal earmarks would be included in DPH’s FY 2005-2006 budget. Dr. Katz said that grant funds exist as a separate document, and once the funds are certified by the Controller, and the Health Commission and Board of Supervisors approves the except and expend resolution, these funds can be spent. Dr. Katz said we cannot assume that these funds could be used to decrease the general fund reduction target. Commissioner Guy asked if the Health Commission’s position on Senator Kuehl’s SB 921, which failed this past legislative year, would still be in effect if Senator Kuehl reintroduces her legislation. Ms. Chawla replied that the Health Commission would need to re-examine the new legislation to ensure that it is consistent with the previous policy statement. Commissioner Guy asked for more detail on the California Rx program. Ms. Chawla said that California Rx is a voluntary program and relies exclusively on the participation of pharmacies. Commissioner Umekubo asked how the City advocates to CMS for special waivers, passage of regulation, and other activities. Dr. Katz replied that the way the regulations are written, counties cannot apply directly to CMS and must work through the State. This has been a difficult process. The Department would generally advocate through a member of San Francisco’s Congressional delegation. Commissioner Guy asked if the changes to the 340B inpatient drug program would result in savings to the Department. Dr. Katz said this change establishes a mechanism, but it depends on whether the pharmaceutical companies choose to offer the same discount as they offer on outpatient pharmaceuticals. Commissioner Sanchez said that the issue of undocumented patients would continue to be football in the national policy arena, and should be a key component of our health policy debates. And because San Francisco is a sanctuary city, it is unlikely we would follow a protocol that required tracking information on illegal immigrants. Commissioner Monfredini reminded the Commissioners that nationally, things are going in a different direction from San Francisco’s priorities. Commissioner Chow asked if the DSH prgoram is solid. Ms. Chawla said this funding would go through 2010 at the current level. He asked if there is general agreement as to whether Ryan White would be reauthorized. Ms. Chawla said there is general consensus is that the CARE Act will be reauthorized but there are many proposals about how it will be structured, and discussion about San Francisco being overfunded. The current program expires in September 2005. Commissioner Illig added that over the last number of years San Francisco has expanded its representation on the CARE Coalition, including seats by the Health Services Planning Council, DPH, Continuum, AIDS Foundation and HIV/AIDS Provider Network. So there are more voices from San Francisco counteracting the perception that San Francisco gets too much money. Commissioner Chow asked if rate reductions are part of the proposed State budget. Ms. Chawla said there are not. 7) CONSIDERATION OF A RESOLUTION APPROVING THE CHILDHOOD NUTRITION AND PHYSICAL ACTIVITY TASK FORCE REPORT RECOMMENDATIONS Iman Nazeeri-Simmons, Adolescent Health Coordinator and Christina Carpenter, Health Promotion Consultant, presented the Childhood Nutrition and Physical Activity Task Force Report Recommendations (Power Point Presentation, Attachment A). The citywide task force was convened by the Board of Supervisors in December 2003, and included representatives from DPH, DCYF, SFUSD, Youth Commission, Department of Recreation & Parks, the medical community, size advocates, youth organizations and others. The task force was charged with creating citywide policy recommendations for improving childhood nutrition and physical activity. The recommendations are prioritized within the categories of nutrition and physical activities, with the top four strategies in each area as the priority areas. Additionally, the recommendations are broken out into three topic areas: environmental - structural improvements in the physical environment to improve access and utilization; organizational - city agencies and departments; and awareness/behavior change - individual education and behavior change. Nutrition Recommendations Recommendation 1: Ensure that at least one reasonably large outlet/vendor that sells healthy, nutritious foods is easily accessible to residents in all sectors of San Francisco. Recommendation 2: Increase the enrollment and retention of eligible clients into the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and Food Stamps programs. Recommendation 3: Increase the proportion of mothers who exclusively breastfeed their babies. Recommendation 4: Expand information and resources for understanding healthful nutrition and physical activity Physical Activity Recommendations Recommendation 5: Ensure that organizations have environments that provide optimal opportunities for youth to engage in physical activity. Recommendation 6: Develop partnerships across public and private agencies to increase physical activity opportunities. Recommendation 7: The San Francisco Board of Supervisors and the Mayor will issue recommendations of ideal levels of physical activity for children and youth to City and County departments. Recommendation 8: Implement citywide awareness campaign(s) addressing nutrition and physical activity developed by youth for San Francisco. The task force also made the recommendation to create revenue streams to fund the nutrition and physical activity recommendations, and developed several strategies including a fee or tax on soft drinks and/or fast food, advocating for a streamlined application process in all Federal nutrition programs and establishing a public/private partnership to leverage the philanthropy community, among others. Ms. Carpenter said there are a number of DPH activities that fall into the current recommendations, including the Food Systems Council, Food Alliance, the Good Neighbor Project, Youth Development Standards of Practice, the Citywide Chronic Disease Prevention Consortium and resource development and grant writing. Commissioners’ Comments Commissioner Monfredini expressed some areas of concern, including sending negative messages to women who choose not to breastfeed. There should be some allowance for new mothers who find this too difficult. She would also like any money that San Francisco receives be used for free educational seminars for people, rather than a conference. She also emphasized the fact that many parents are very scared for their children in terms of playing outside, and may indeed encourage their children to stay inside. All of these factors demonstrate that obesity is a multi-faceted problem with no easy answer. Commissioner Guy said that this initiative brings a primary prevention dialogue into our City’s discourse and this is significant, and we need to bring this to the next level. San Francisco needs healthy environments and the Department of Public Health’s involvement in this effort can make it successful. Commissioner Sanchez said so many variables come into play in terms of nutrition and physical activity. Structured, supervised activities are a priority for all of us, yet there is a continual reduction in community gymnasium hours, recreation supervisors and other programs. One recommendation is to ask the San Francisco 49ers and San Francisco Giants to fund physical activity programs for the next two years at the high school and middle school levels. Commissioner Umekubo said that this initiative increases the awareness that it is difficult to find safe outdoor venues for children to play. He is also concerned about the underutilization of food stamps. Ms. Nazeeri-Simmons said that California is one of four states that require fingerprinting to become eligible for food stamps, and this is a major factor in underutilization. USDA does not require fingerprinting. There is a pilot project in place that waives fingerprinting and provides a one-day enrollment process. Commissioner Illig said there is not a lot of government funding for healthy food, so the role is to get other parts of government to do better in this area. One area where DPH could have additional impact is through the residential treatment programs, where there is no standard for the type of food that is served. Commissioner Chow would like to know how the Department and Health Commission could help move beyond the pilot project level for the food stamp initiative. Dr. Katz is not optimistic in this area in that the State is headed toward more fingerprinting, not less. Action Taken: The Commission approved the Resolution 01-05, “Endorsing the Recommendations of the Childhood Nutrition and Physical Activity Task Force Report,” (Attachment B). 8) FY 2005-2006 BUDGET PRESENTATION: INFLATIONARY, STRUCTURAL, REGULATORY, REVENUE-NEUTRAL AND REVENUES Mitchell H. Katz, M.D., Director of Health, presented an overview of revenue, inflationary, structural, regulatory and revenue-neutral budget issues for FY 2005-2006. The citywide budget shortfall is currently forecast to be $130 million. As of the date of this report, a specific target has not been set for DPH. Smaller departments have been asked to absorb their own increased costs of doing business within their existing general fund and develop a five percent general fund contingency plan. For DPH, increased costs of MOUs and employee benefits are projected to be $32 million. The Mayor’s Finance Office is carefully considering available options, and understands the effect a $32 million reduction would have on services. Dr. Katz said that before the issue of general fund decreases could be addressed, he must take into account the unavoidable costs of doing business resulting from inflationary pressures and structural problems. Inflationary issues include MOU increases to salaries and increase in costs of benefits, increased pharmaceutical utilization, increases in rent and savings in natural gas utilization. Inflationary increases total $33.6 million. There are myriad structural issues, totaling $11.7 million, which must be addressed. These include position corrections and salary savings deficits, Private Provider Network, contractor indirect and professional and specialty services structural shortfall at SFGH, among others. (Note: all budget documents are available on the DPH website at www.dph.sf.ca.us/budget/, and in the Health Commission Office.) Dr. Katz also described the 15 revenue-neutral programs that are being proposed in the budget. These services are funded entirely through revenues linked to services and include a 23-hour chest pain unit at SFGH, Folsom-Dore hotel rooms for chronic homeless, improved pharmacy TAR approval and collection at LHH and the California Children Services Medical Therapy Program at MCH, among many others. Dr. Katz said the Department is increasing revenues in the FY 2005-2006 budget by $18.2 million. The bulk of the increase is at SFGH, and reflects the continuation of trends seen over the past several years. Laguna Honda and Environmental Health are also budgeting increased revenues. Dr. Katz said he also recognizes the necessity of addressing the effects of inflation on contractors and the UC Affiliation Agreement. The Mayor’s Finance Office wishes to address the issue of COLAs on a citywide basis. For DPH, the cost for each one percent COLA increase is $2.2 million. Dr. Katz summarized the issues: Inflationary Issues $33,608,751 Structural Issues $11,652,907 Total Revenue Neutral Programs ($597,556) Revenue Increases ($18,189,776) Total $26,474,326 Public Comment David Semore said it is really sad that the Department is left with cutting core services. He submitted a letter summarizing his testimony (on file in the Health Commission Office). There is money coming forward from Proposition 63. He is against all the health cuts. Debbie Lerman, Human Services Network, expressed thanks to Dr. Katz for how he handled the contractor indirects. Her focus now is on the non-profit contractor COLAs. This is not a trivial issue. The cost increases for non-profits is a structural issue, and the City needs to acknowledge this. Without COLAs, there will be service reductions. Commissioners’ Comments Commissioner Illig asked if the estimated cost of the contractor COLA is based on personnel costs only or the total cost of doing business. Mr. Sass replied that he believes it is personnel cost only, and he will confirm. Commissioner Illig asked if there are internal and/or external planning processes by which service priorities are set, such as is the case with CARE funds. Dr. Katz said this does not really happen in other DPH areas because so many entities have the opportunity to reprioritize, such as the Mayor and the Board of Supervisors. His goal is to have the decision-making process as transparent as possible, but he is open to better methods. Commissioner Guy said that there is discourse at the Health Commission as to what the priorities are, including through the strategic planning process. For example supportive housing is a priority, and this is reflected in the budget. Commissioner Chow commended all staff for providing the level of detail that was in the report. 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 voted to hold a closed session. The Commission went into closed session at 6:20 p.m. Present in closed session were Commissioner Chow, Commissioner Guy, Commissioner Illig, Commissioner Monfredini, Commissioner Sanchez, Commissioner Umekubo, Dr. Mitch Katz, 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 $12,500 IN PENTECOST v. SAN FRANCISCO UNIFIED SCHOOL DISTRICT AND DEPARTMENT OF PUBLIC HEALTH, COMMUNITY MENTAL HEALTH SERVICES, CASE No. SN 04-02023, FILE No. 021183 Action Taken: The Commission approved the settlement of Pentecost v. San Francisco Unified School District and Department of Public Health, Community Mental Health Services, in the amount of $12,500. D) Reconvene in Open Session The Commission reconvened in open session at 6:25 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 voted not to disclose discussions held in closed session. 11) ADJOURNMENT The meeting was adjourned at 6:25 p.m. Michele M. Olson, Executive Secretary to the Health Commission Attachments: (2) 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.