Minutes of the Health Commission Meeting Tuesday, February 1, 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. – arrived at 3:25 p.m. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF JANUARY 18, 2005 Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez) approved the minutes of the January 18, 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) CHN-SFGH & LHH – Request for approval of three contracts with the following firms: Aureus Radiology, LLC, On-Call Therapists, Inc., Physical and Preferred Healthcare Registry, Inc., for a combined total amount of $261,100, to provide intermittent, as-needed rehabilitation therapy personnel services (Physical, Occupational and Speech Therapists), for San Francisco General Hospital and Laguna Honda Hospital, for the period of February 1, 2005 through January 31, 2007. (3.2) PHP-BEHM – Request for approval of a contract modification with General Environmental Services, in the amount of $150,000, to provide hazardous waste management and transportation services, for the period of August 1, 2004 through June 30, 2007, for a total contract value of $200,000. (3.3) AIDS Office-HIV Health Services – Request for approval of a contract modification with AIDS Emergency Fund in the amount of $176,258, for a new contract total of $813,811, to provide emergency assistance grants to low-income persons with HIV+/AIDS, for the period of March 1, 2004 through February 28, 2005. Commissioners’ Comments Commissioner Illig is concerned that this contract modification does not have any information about contract monitoring. He also expressed concern that there continues to be unexpended CARE funds. And he expects to see a 12 percent contingency included in AIDS Office contracts. This is a very reasonable way for the Department of Public Health to expedite contract approval, which was one of the recommendations of the City’s Nonprofit Contracting Task Force. Mr. Loyce said that the contracts for the next fiscal year would include the contingency. (3.4) AIDS Office-HIV Health Services – Request for approval of a retroactive new contract with Haight Ashbury Free Clinic, Inc., in the amount of $112,299, to provide complementary therapy services targeting medically indigent persons with HIV, for the period of July 1, 2004 through June 30, 2005. Commissioner Illig asked why the AIDS Office chose to contract with a new provider instead of funding the existing providers of these services. Michelle Long Dixon said they had to follow the recommendations of the solicitation, which necessitated contracting with Haight Ashbury Free Clinics. Ms. Dixon said they were able to contract with two of three of the agencies currently providing this type of service because they ranked high enough as a result of the solicitation process. (3.5) AIDS Office-HIV Health Services – Request for approval of a retroactive new contract with Patricia Sullivan, in the amount of $297,410, to provide consultant services for the purchase and distribution of vouchers to CARE-funded service providers, for the period of January 1, 2005 through February 28, 2005. Secretary’s Note – this item was removed from the agenda. (3.6) AIDS OFFICE-Research – Request for approval of a retroactive renewal contract with PHFE Management Solutions, Inc., in the amount of $164,927, to provide fiscal administrative services for the “HIV Prevention Trials Network (HPTN Core)” project, for the period of July 1, 2004 through June 30, 2005. (3.7) AIDS Office-Prevention – Request for approval of a retroactive renewal contract with PHFE Management Solutions, Inc., in the amount of $85,116, $sum amount)to provide fiscal administrative services for the “HIV/AIDS Surveillance Data Management Activities” project, for the period of January 1, 2005 through December 31, 2005. (3.8) BHS-Mental Health/Substance Abuse – Request for approval of a retroactive contract renewal with Regents of the University of California, in the amount of $2,822,252, to provide mental and substance abuse services targeting low-income and uninsured or underinsured clients with AIDS/HIV disease or disabling HIV disease, for the period of July 1, 2004 through June 30, 2008. Commissioners’ Comments Commissioner Illig asked if there has been any discussion about consolidating this contract with AIDS Office contracts for similar services. Ms. Wang said that Mental Health must oversee the contracts that are funded with MediCal dollars. This does not necessarily preclude a consolidated contract. Ms. Okubo, Deputy Finance Director, said DPH is establishing protocols to consolidate contracts. Commissioner Illig raises this issue because he is very interested in helping DPH implement the Nonprofit Contracting Task Force recommendations. Commissioner Sanchez abstained from voting on this item. Action Taken: The Health Commission (Chow, Guy, Illig, Monfredini, Sanchez) approved Items 3.1, 3.2, 3.3, 3.4, 3.6, 3.7 and 3.8 of the Budget Committee Consent Calendar, with Commissioner Sanchez abstaining from voting on Item 3.8. Item 3.5 was removed from the agenda. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Budget Targets In the presentation to the Health Commission last month, staff estimated that the net effect of inflationary, regulatory, structural and revenue neutral and revenue increases would result in a departmental shortfall of $26.5 million in General Fund support. The Mayor's Office has given DPH a General Fund reduction target of $13 million, which is roughly half of the departmental shortfall. In addition, DPH has been asked to propose an additional $10 million in contingency reductions, which, if taken, would reduce the Department's general fund $23 million in total. Finally, the Department has been advised that it can utilize up to $10 million in one-time funding to propose one-time efficiency investments in infrastructure that will provide long-term savings to the Department. San Francisco Behavioral Health Center Update Dr. Katz provided an update on major developments that have occurred since the Health Commission passed resolutions endorsing the Mental Health Rehabilitation Facility (MHRF) Blue Ribbon Committee’s recommendations to provide multiple levels of care at the MHRF and pursuing licensure with the State Departments of Mental Health and Social Services. Dr. Katz announced that the following recommendations have been fulfilled to date: An Advisory Committee was formed in May 2004 to assist with the implementation and evaluation of changes to MHRF staffing and programming. In June 2004, SFGH obtained licensure for a 47-bed Mental Health Rehabilitation Center (MHRC) on the 3rd floor from the Department of Mental Health. The MHRF was renamed the San Francisco Behavioral Health Center. Also in June 2004, the State Department of Health Services conducted a licensing and certification survey and approved 59 skilled nursing beds on the 2nd floor. In September 2004, SFGH took steps to obtain licensure from the Department of Social Services (DSS) for a 27-bed Adult Residential Facility (ARF) and shared plans for a 14-bed residential treatment facility with day treatment on the 1st floor. SFGH submitted an application to DSS in October 2004, which was not approved. However, DSS officials encouraged SFGH to make a major change in plans by designating all 41 beds on the 1st floor as an ARF. It was suggested that treatment options could be pursued through programming and not licensing. DSS has given SFGH until February to resubmit the application. In January 2005, the Advisory Committee reviewed DSS’s recommendations and discussed revised revenue projections and patient care implications. Although revenue projected for the proposed residential treatment facility would be lost, not being able to reopen the 1st floor would pose greater consequences on finances and patient care. As a result, the Advisory Committee endorsed SFGH to resubmit the application as an Adult Residential Facility for all 41 beds of the 1st floor. Based on this recommendation we will be going forward on obtaining an Adult Residential Facility license for 41 beds on the 1st floor. Once we obtain the license we will look at how we can programmatically incorporate treatment into the model. U.S. Department Of Health & Human Services Releases Guidelines Recommending Antiretroviral Postexposure Prophylaxis After Non-Occupational Exposures To HIV Last week the U.S. Department of Health & Human Services (DHHS) released guidelines recommending antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposures to HIV (nPEP). These guidelines supercede a 1998 DHHS statement that concluded that there was insufficient evidence about the efficacy of nonoccupational postexposure prophylaxis to recommend either for or against its use. Dr. Katz highlighted these changes in position because of the role that San Francisco played in this debate. The first feasibility study of nPEP was begun in San Francisco in 1998. It was a collaborative project between the San Francisco Department of Public Health and the University of California, San Francisco. Our data showed that it was feasible to offer nPEP and that there was no increase in subsequent exposures of unsafe sex due to the availability of nPEP. The San Francisco Department of Public Health has provided nPEP on a clinical basis since 1997 and has emphasized the importance of providing prevention counseling in addition to the medication. HUH Clinic Opening The Housing and Urban Health Clinic will celebrate its grand opening on Thursday, February 3rd from 2 to 5pm. The HUH Clinic is the first community based primary care clinic to open within the Health Department's Primary Care Network in over 20 years. This unique clinic received its FQHC designation through a Federal grant to serve the chronically homeless. Over 2,500 residents of supportive housing can access the medical and psychiatric services offered at the clinic five days a week. These services are designed to assist people placed in supportive housing to maintain their housing indefinitely despite on-going mental illness, substance use disorders and chronic medical conditions. Black History Month Celebration February is Black History Month, an opportunity for all Americans to honor African American heroes and leaders and to learn about and reflect on the vast contributions of African Americans to our history and culture. The managers of African and African American descent are hosting a Black History Month Celebration on Thursday, February 24, 5:30 – 7:30 p.m. at CHN Headquarters, 2789 25 Street. Please join us for refreshments, entertainment and an opportunity to honor Norm Nickens, Flo Stroud, Gene Coleman and Doris Ward for the contributions to the health of African Americans in San Francisco. Children’s Dental Health Month On February 4th, DPH’s Dental Bureau in collaboration with the San Francisco Dental Society will kickoff Children’s Dental Health Month with Give Kids a Smile Day. Dental screenings will be provided to 500 children from five pre-schools and 10 elementary schools. Crest has donated toothbrush and toothpaste kits and educational materials in Spanish and English for the event. Commissioners’ Comments Commissioner Illig supports the change in licensing at the Behavioral Health Center. Commissioner Chow clarified that the HUH clinic would be part of the DPH Community Health Center system. Commissioner Umekubo asked if the Behavioral Health Center would be able to care for people with dementia. Dr. Katz replied that the idea behind having more than one license was to provide a wider range of services. The first floor is an unlocked floor, not a locked psychiatric facility. 5) ELECTION OF PRESIDENT AND VICE PRESIDENT OF THE HEALTH COMMISSION FOR 2005 Commissioner Chow thanked DPH staff for all the work they have done to advance public health in San Francisco during the past five years that he served as either President or Vice President of the Health Commission. He is proud to be part of this Commission. Commissioner Chow nominated Commissioner Monfredini to serve as President of the Health Commission. Action Taken: The Commission (Chow, Guy, Illig, Sanchez, Umekubo) elected Commissioner Monfredini to serve as President of the Health Commission for 2005. Commissioner Monfredini abstained. Commissioner Monfredini nominated Commissioner Guy to serve as Vice President of the Health Commission vice president. Action Taken: The Commission (Chow, Illig, Monfredini, Sanchez, Umekubo) elected Commissioner Guy to serve as Vice President of the Health Commission for 2005. Commissioner Guy abstained. Commissioner Monfredini thanked everyone for their support, and looks forward to serving with her fellow commissioners and staff as president. She and Commissioner Guy will announce Commission committee appointments at the next Health Commission meeting. Commissioner Guy thanked everyone for their support and thanked Commissioner Chow for his years of service on Commission leadership. 6) CONSIDERATION OF A RESOLUTION APPROVING THE 2005 STATE LEGISLATIVE PLAN Colleen Chawla, Deputy Director, Office of Policy and Planning, presented highlights from the Department’s 2005 State Legislative Plan. The legislative plan provides guidance to the City’s policy positions on legislative, regulatory and budget issues that impact DPH and the health of San Franciscans. To implement its Legislative Plan, DPH works in collaboration with the Mayor’s Office, the Board of Supervisors, other City departments, the City’s State lobbyist, community partners in both the public and private sectors and in coalition with issue-based and industry-based advocacy groups. Ms. Chawla highlighted a few key areas: HIV/AIDS - Oppose legislation that would implement names-based reporting of HIV; Hospitals – support legislation to provide funding or financing for costs associated with compliance with hospital seismic safety standards; Health Insurance Expansion/Uninsured – support legislation that expands health care coverage to uninsured California residents; Homeless – sponsor legislation that would make supportive housing services a Medi-Cal eligible service; Medi-Cal Funding and Program Change – monitor the Medi-Cal redesign process and support and oppose legislation in accordance with the redesign principles that have been adopted by the Health Commission; Mental Health – monitor legislation and adopt positions as appropriate to ensure that the implementation of Proposition 63 is consistent with the intent of the Mental Health Services Act and will enable San Francisco to advance its Housing First model for homeless mentally ill residents; Realignment – monitor and adopt positions as appropriate on legislation that would modify the current realignment funding system; Substance Abuse – sponsor legislation to create a category of State licensure for mobile methadone treatment. Commissioners’ Comments Commissioner Chow said that in 2006, the Federal government will take back the Medicaid drug program and will be creating its own formulary. He asked what the State is doing to protect its very broad formulary. Ms. Chawla said the advocacy would be at both the State and Federal level, and is covered by the Medicaid Redesign section of the Legislative Plan. Commissioner Illig said the Governor has proposed to cut the salaries of the IHSS workers, which will have an indirect impact on DPH services. He urged Ms. Chawla to monitor this issue as well. Ms. Chawla said she works closely with her counterpart at the Department of Human Services on issues such as these. Action Taken: The Health Commission approved Resolution 02-05, “Approving the Department of Public Health 2005 State Legislative Plan,” (Attachment A). 7) PROPOSITION 63, MENTAL HEALTH SERVICES ACT, UPDATE Barbara Garcia, Deputy Director of Health, Director, Community Programs and Bob Cabaj, M.D., Director, Community Behavioral Health Services, presented an update on planning for implementation of the Mental Health Services Act (MHSA). MHSA was passed by California voters in November 2004 and provides funding for the transformation of the mental health system. Funds are generated by a one percent tax on incomes of over $1 million. MHSA has five major funding areas: Prevention and Early Intervention; Services to Children; Adults and Older Adults; Education and Training; and Innovative Programs. For fiscal year 04/05, 45 percent of the funds are for education and training, 45 percent are for capital facilities and technology needs, 5 percent is for local planning and 5 percent is for State implementation. This first block of funding can be expended over a ten-year period. For the next three fiscal years, 60 percent of the funding must be used on services to children, adult and older adults, 20 percent to prevention and early intervention, 10 percent for education and training and 10 percent for capital facilities and technology. After fiscal year 07/08, there is no longer a prescribed percentage of funds that must go to pre-determined categories. Dr. Cabaj said there are a number of important dates for 2005: January 1 – Tax collection begins. County planning expenses can be reimbursed to this date. April 1 – First of two installments of planning funds available. San Francisco to receive $207,487. June or July – Second installment of planning funds available. October 1 – Community Services and Support funds become available to counties—approximately $420 million statewide. Ms. Garcia discussed San Francisco’s planning process. DPH is creating a Behavioral Health Innovations Task Force. The 40 members of the task force will be selected for their expertise and representation. Mayor Newsom appointed Ms. Garcia to chair the task force. There is a month-long application process and the first meeting will be March 2nd. Members will reflect the ten areas identified by MHSA. DPH will ensure equitable representation of all stakeholders on the task force, especially consumers and family members. The task force will meet in neighborhoods to allow for public comment. The task force will create vision for the three-year plan and prioritize behavioral health needs. It will not allocate funds. There will also be focused sub-committees. Ms. Garcia said DPH plans to submit its three-year plan to the State in August. Draft plans must have a 30-day review and public hearing sponsored by the Mental Health Board. The Department will bring the proposed plan to the Health Commission for review and approval. Public Comment Antonio Morgan, a mental health consumer, said that Proposition 63 would result in more services. A lot of people got involved to get this act passed, and it will help 40,000 people in California. Robert Wheeler, program manager at Mental Health Association of San Francisco, said the Mental Health Association worked hard over the past years to get the Mental Health Services Act. Proposition 63 will help people get the right services at the right time in the right place. He thanked DPH for creating an inclusive process thus far and he is pleased to see committees on consumer issues, family issues and vocational services. Sandra Santana-Mora, Edgewood Center for Children and Families, spoke representing the Proposition 63 campaign committee. The Committee had two main goals: raise money and educate San Franciscans about the need for these services. This committee will remain together and continue to monitor implementation. She thanked the Department for its inclusiveness in this process. Rebecca Turner, Chair of the San Francisco Mental Health Board, said the Board is extremely excited about the passage of Proposition 63 and they are very committed to this being an open process. They take very seriously their role to hold a public hearing once the draft plan is released. Commissioners’ Comments Commissioner Guy said the planning timeline seems very tight, and she wants to acknowledge this. She said this is a significant and rare opportunity. She is looking forward to seeing the primary prevention and early intervention services that come out of the planning process. Commissioner Illig asked if there is a provision in the law that Proposition 63 funds cannot be used to supplant existing funds. Dr. Cabaj replied that Proposition 63 does include provisions about supplantation, but this language is currently being interpreted. Commissioner Illig said San Francisco differs from the rest of the State in two major ways: its innovative integration with Substance Abuse Services; and its partnerships with community-based organizations to provide services. Commissioner Sanchez said that this is a real opportunity to make a qualitative difference in the system, and in the lives of families. There are substantive partnerships with our educational instructions and non-profit organizations. We are fortunate in the Bay Area to have a whole cohort of professionals who are eager to get involved in developing new service models. Commissioner Umekubo said that mental health has been neglected and underfunded for so long, and this is a breath of fresh air. He asked how much money San Francisco would get. Dr. Cabaj said the estimate is $420 million statewide. The allocation formula is still being determined. If it is based solely on population, San Francisco’s share would be approximately $17 million but staff is working closely with the State to educate them about the uniqueness of San Francisco’s services. Commissioner Monfredini asked how long the planning committee would meet. Ms. Garcia said that after October, the group would probably meet quarterly to provide oversight and guidance on implementation. Commissioner Monfredini asked what would happen if people tried to stop this tax from continuing. Ms. Chawla said the only way to change the law is to go back to the voters. Commissioner Chow asked if the San Francisco Medical Society would be represented on the task force. Ms. Garcia said they must apply. Commissioner Chow asked staff to consider whether or not the Mental Health Board should hold its public hearing before the Health Commission does, so that the plan that is presented to the Health Commission includes comments received by the Mental Health Board. 8) PROFILE OF INJURY REPORT Michael Radetsky, Injury Prevention, Community Health Education Section, presented the Profile of Injury Report. He was joined by Dr. Elizabeth McGloughlin of the Trauma Foundation, who was the principle author of the report. Dr. McGloughlin said the report is a collaboration between the San Francisco Injury Center, the Department of Public Health, San Francisco Violent Injury Reporting System, San Francisco Department of Parking and Traffic and the California Office of Traffic Safety. The report provides injury data drawn from death certificates and hospital discharge records for 2001, with specialized information spanning the years 2000-2002. Dr. McLoughlin summarized the major causes of injury deaths in San Francisco: drugs and poisonings, 32 percent; falls, 14 percent; firearms, 11 percent; motor vehicle traffic crashes, 12 percent; suffocation, 9 percent; fire/burn, 3 percent; and other, 19 percent. Dr. McGloughlin highlighted the high percentage of pedestrian deaths that resulted from motor vehicle crashes. She also highlighted the high number of falls among seniors. Falls are the leading cause of injury hospitalization for San Francisco seniors 65. There is a financial cost to these falls but as importantly, a loss of independence. This is demonstrated by the data on where patients are discharged after falls. 57 percent of patients age 65-84 are discharged to a long-term care or other care facility, and 39 percent go home. For patients over 85, 69 percent go to a long-term care facility and only 26 percent go home. Dr. McGloughlin presented data on drug/poisoning-related injuries and violent deaths and injuries. Dr. McGloughlin noted that the report includes a list of resources for prevention that is intended to help readers find provide programs and help providers collaborate with each other. This is not an exhaustive list and she welcomes any additions. Mr. Radetsky summarized the Department’s current injury prevention programs and violence prevention programs. There have been a variety of media campaigns to address red light running, speeding, drunk driving and other traffic safety issues. The Community Health Education Section funds a variety of community groups through the Pedestrian and Traffic Safety Project, including the Boys and Girls Club, OMI Neighbors in Action and many others. The CHIPPS (Community & Home Injury Prevention Program for Seniors) Program is a prevention project for senior falls, scalds and burns. The Department takes a harm reduction approach to poisoning/overdose prevention. The Department has done outreach to injection drug users on the dangers of mixing alcohol and other drugs and using the emergency room. DPH has also distributed Naloxone and have trained 500 people and 57 “saves” have been reported. DPH is also very involved in violence prevention, with a DPH-wide violence prevention network and a road map for violence prevention. Commissioners’ Comments Commissioner Umekubo asked how San Francisco compares to other metropolitan areas in terms of age-adjusted mortality. Dr. McGloughlin said this information is unavailable, mainly due to the fact that San Francisco is uniquely a city and county, and the data is reported by county. In addition, San Francisco is one of the only cities that does a profile of injury report. Commissioner Chow said it is important to see how San Francisco stands with other comparable areas, and would like to see if this could be done in the next report. Commissioner Guy said that, over the years of this report, the community’s consciousness about injury has been raised. This has allowed the dialogue to be brought to the next level, and gives us a baseline by which to compare San Francisco to San Francisco. This allows us to see if our interventions are working. Commissioner Guy said the CHIPPS (Community & Home Injury Prevention Program for Seniors) program is a worthy and cost-effective program. The Health Commission has to figure out how to continue this program. Commissioner Illig appreciates the report, particularly in terms of grant writing. He suggested that this presentation be made to the Hospital Council, Commission on Aging and the Mayor’s Long-Term Care Coordinating Council. Commissioner Chow said the CHIPPS program has demonstrative cost savings, and this might be one of the grants that is picked up by the general fund. 9) PUBLIC COMMENT/OTHER BUSINESS No name given, commented on her treatment at San Francisco General Hospital Urgent Care. Nothing has happened with regard to the complaint she filed against the physician that treated her. 10) ADJOURNMENT The meeting was adjourned at 5:30 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.