Minutes of the Health Commission Meeting Tuesday, March 1, 2005 at 3:00 p.m. 101 GROVE STREET, ROOM 300 San Francisco, CA 94102 1) CALL TO ORDER Commissioner Monfredini called the meeting to order at 3:30 p.m. Present: Commissioner Lee Ann Monfredini, President Commissioner Roma P. Guy, M.S.W., Vice President Commissioner Edward A. Chow, M.D. Commissioner James M. Illig Commissioner David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF FEBRUARY 15, 2005 Action Taken: The Commission approved the minutes of the February 15, 2005 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Illig chaired, and Commissioner Chow and Commissioner Sanchez attended, the Budget Committee meeting. (3.1) CHN-SFGH Radiology – Request for approval of two contract modifications with Medical Contracting Services and The Registry Network, Inc., to increase the combined contract amount by $663,000, from $900,000 to $1,563,000, to provide intermittent, as-needed, professional services of Per Diem and Traveling Radiology Technologists with on-call availability 7 days a week, for San Francisco General Hospital, for the period of July 1, 2004 through June 30, 2005. Commissioners’ Comments Commissioner Chow asked how SFGH plans to hire permanent radiology technicians, given the competitive recruiting environment. Mr. Hollingsworth, Director of Radiology at SFGH, replied that the hospital is competitive in terms of salary. However new employees are often offered night and weekend shifts, which can serve as a disincentive. One particular difficulty has been recruiting people into the more specialized positions, such as CT, interventional radiology and others. Commissioner Sanchez asked where most of the applicants come from. Mr. Hollingsworth replied that most are from City College of San Francisco. (3.2) PHP-Epidemiology and Disease Control – Request for approval to enter, retroactively, into a performance agreement between Public Health Foundation Enterprises, Inc. and the San Francisco Department of Public Health, Epidemiology and Disease Control, to develop a secure electronic system by which clinical laboratories can report San Francisco residents’ hepatitis test results to the San Francisco Department of Public Health, in the amount of $108,944, for the period of December 30, 2004 to December 29, 2005. (3.3) PHP-CHSS-TB Control – Request for retroactive approval of a contract renewal with the Regents of the University of California (UCSF), in the amount of $1,500,000, to provide tuberculosis training, technical assistance and medical consultation services to healthcare providers and other professionals in the field, through the Regional Training and Medical Consultation Center, for the period of January 1, 2005 through December 31, 2005. Commissioner Sanchez abstained from voting on this item. (3.4) AIDS Office-Health Services - Request for approval of a contract renewal with Haight Ashbury Free Clinics Incorporated in the amount of $253,373 to provide HIV Integrated Services targeting persons who are infected with HIV/AIDS for the period of March 1, 2005 through October 31, 2005. Gregg Sass, DPH CFO, gave an update on the financial condition of the agency. The agency met its last two payrolls, came current on the required employee retirement contributions and hopes to finalize additional financing within the next week. Mr. Sass is getting weekly updates. HAFC’s problems are complicated and difficult, but primarily expenditures exceed cash receipts. It is going to take a great deal of effort on the agency’s part to turn the situation around. Mr. Sass and Barbara Garcia have been working closely with agency staff and board. Mr. Sass recommends approving the two contracts that are before the Commission because the start date is March 1 and clients need to continue to receive treatment and staff needs to be paid. DPH can make adjustments to contracts with 30-day notice if need be. Mr. Sass will bring monthly updates to the Budget Committee. Commissioners’ Comments Commissioner Chow asked if Mr. Sass is confident HAFC could administer these funds, and how closely he would be working with the agency. Mr. Sass anticipates weekly cash forecast updates, and if anything significant happens, the agency is to notify him immediately. Mr. Sass has also requested a long-term plan to restructure the balance sheet, and bring expenses and revenues into line. Commissioner Chow asked the Chair of the Board if there is a commitment to meeting DPH’s needs. Darrly Inaba, CEO, replied that he has tried to solidify banking relationships and adjudicate the embezzlement. He appreciates the Department’s assistance during this difficult time. Eric Flowers, president of the Board, said the Board of Directors is fully aware of the operational and structural issues facing the agency. The form of governance needs to be made more current. He is taking steps to bring professionals with the time and skill sets to the board, and have all the directors understand the business that HAFC is in. They are evaluating all their contracts to identify services that do not fit economically or business-wise with the free clinics, and opportunities to make programs more viable. As Board chair, his priorities include: refortifying the board; working with bridge financing; restructuring balance sheet to give more flexibility and adaptability; fundraising. Commissioner Illig asked for assurances that the agency is going to cut costs immediately, because they are losing hundreds of thousands of dollars monthly. Mr. Flowers said this analysis is being done now. Commissioner Illig is particularly concerned with the contract with jail psychiatric services. The agency needs to carefully evaluate whether it is able to continue to provide this service to DPH. Commissioner Sanchez urged the Board to reach out to the Foundation resources that are available in San Francisco. Mr. Flowers said they have been in contact with the San Francisco Foundation, Community Clinic Consortium and others to identify best practices. Commissioner Illig asked how the agency is going to reach the targeted units of services. Ms. Long Dixon said that there would be discussion with the agency about how to address this. She reiterated to the Committee that these services were being put out to bid. Commissioner Chow asked for detailed information about what types of services are provided in a primary care encounter. Ms. Long Dixon will send this information to the Commissioners. (3.5) AIDS Office-HIV Health Services - Request for approval of a contract renewal with Haight Ashbury Free Clinics Incorporated in the amount of $354,889 to provide Residential Detox and Substance Abuse Services targeting person who are infected with HIV/AIDS for the period of March 1, 2005 through August 31, 2005. Secretary’s Note – The amount of the contract is $308,222. Commissioners’ Comments Commissioner Illig asked why there are vacant beds. Ben Eiland, Director of Substance Abuse Services, said they were having problems with one of the three residential programs, specifically that they were unable to find individuals who were appropriate for the service. In fact, the agency had considered discontinuing this service. But in the last 90 days, the center has been at capacity. There is a new site manager who does a lot more community outreach. Commissioners’ Comments (at the Health Commission meeting) Commissioner Monfredini said the agency is in trouble and must get out of it. She reiterated that Mr. Sass is there to provide assistance to the agency, and they should take advantage of that. She does not want the DPH or Health Commission to be the last to know about problems. The agency provides extremely valuable services, and the Health Commission wants to continue doing business with them. However the lines of communication have to be open. Action Taken: The Health Commission approved the Budget Committee Consent Calendar, with Commissioner Sanchez abstaining from voting on Item 3.3. There will be monthly updates to the Budget Committee on Haight Ashbury Free Clinics. 4) DIRECTOR’S REPORT Anne Kronenberg, Deputy Director of Health, presented the Director’s Report. Laguna Honda Hospital Admissions Policy At the direction of Mayor Newsom, DPH returned Laguna Honda Hospital’s admissions policy to what it was prior to March 2004. As the Commission will recall, last March Dr. Katz initiated changes to Laguna’s admissions policy in order to give priority to patients transferring from San Francisco General Hospital. This policy change was implemented as a cost-saving measure to reduce the number of decertified Medi-Cal days experienced at San Francisco General Hospital. Prior to the policy change, 54 percent of Laguna’s admissions were from San Francisco General Hospital. After the new policy was implemented, admissions from SFGH represented 75 percent of Laguna Honda Hospital's new admissions. The policy changed saved the Department an estimated $1.7 million. However, the policy change caused a great deal of distress for Laguna Honda staff and members of the community. Because Laguna Honda Hospital has traditionally focused more on meeting the needs of people at the end of their lives or people with medical disabilities, many felt uncomfortable with the increase of people coming from General for shorter stays and with multiple and complex service needs. In order to bridge the revenue gap created by the policy’s reversal, additional reductions totaling $1.7 million will need to be included in the base budget. Ryan White Title I Award Announced This afternoon, the AIDS Office received verbal notification that the CARE Title I award for the San Francisco EMA for FY 2005-06 is $28,297,777. The award represents a $1.55 million – approximately 5.5 percent – reduction from last year’s allocation. An official analysis of the award will be available from the AIDS Office within the next 48 hours, once they receive additional information from the federal Health Resources and Services Administration. Local Disease Prevention Demonstration Project Today, the Board will consider final passage of an ordinance that will enable pharmacies in San Francisco to sell syringes without a prescription. As the Commission is aware, lack of access to sterile syringes results in higher rates of HIV and hepatitis C infection. The Local Disease Prevention Demonstration Project will establish an effective harm reduction strategy to ensure that drug users who continue to inject have access to new, sterile syringes for each injection to prevent transmission of these blood-borne pathogens. Under the program, pharmacists will be able to sell up to 10 syringes to an adult without a prescription. In addition, pharmacists will provide purchasers with information on how to access drug treatment, how to access testing and treatment for HIV and hepatitis C, and how to safely dispose of used syringes. The Department has been working with a coalition of stakeholders, including Walgreen’s, Rite-Aid, UCSF, and the San Francisco AIDS Foundation, to design and implement this program. San Francisco Behavioral Health Center Earlier this year, Dr. Katz updated the Commissioners on the progress with the San Francisco Behavioral Health Center. Dr. Katz discussed the State’s recommendation to apply for a single 41-bed Adult Residential Facility (ARF) license, instead of dual ARF and Residential Treatment Facility licenses for the first floor. With the Commission’s approval, DPH submitted the revised application on January 28, 2005. Dr. Katz is pleased to report that DPH has been awarded the 41-bed ARF license. This development will allow the Department to complete the reprogramming of the SFBHC to a multiple levels of care for mentally ill patients in San Francisco. He thanked the Commissioners, members of the Blue Ribbon Committee, members of the SFBHC Advisory Committee, and all the SFGH staff whose efforts have taken the Department so far in this reprogramming process. Staff will now begin working to implement the ARF program. He will continue to update the Health Commission on our progress. Community Forum on “Superinfection” reports from New York City On Tuesday February 22nd, more than 200 people attended a community forum designed to answer questions that individuals and community based HIV service providers had about reports of a new strain of HIV disease reported in New York. Steven Tierney, Director of HIV Prevention, Sally Liska, Director of the DPH Microbiology Labs and others made presentations and answered questions. The DPH message was simple: If you are sexually active you should get an HIV test every six months; if you are HIV positive good health care is available and we can help you get it. All individuals should know their risk and negotiate safety for themselves and their partners. San Francisco Drug Court 10th Anniversary Celebration and Fundraiser. On March 15th, the San Francisco Drug Court will commemorate a decade of service at the 10th Anniversary Celebration and Fundraiser to be held at the Delancey Street Foundation. Drug Court has become an important integrated effort between DPH and the criminal justice system and has proven effective in diverting substance abusers into community based treatment. This event is a celebration of the individuals who have contributed to the program’s success over the past 10 years and an opportunity to look forward to the next decade. Gordon Park-Li, Chief Executive Officer of the San Francisco Superior Court, will be honored for his innovative vision and dedicated support of Drug Court. Proceeds will benefit the San Francisco Drug Court Scholarship Fund to assist Drug Court participants and alumni achieve their educational, vocational, and housing goals. Commissioners’ Comments Commissioner Illig asked if the Mayor’s Office would add $1.7 million to the DPH general fund allocation to offset the Mayor’s reversal of the admissions policy. Mr. Sass said the first step is to remove $1.7 million from base budget revenue projections, and then continue to work collaboratively with the Mayor’s Budget Office on options to balance the Department’s budget. Commissioner Illig asked that the AIDS Office provide the Budget Committee with a report about the specifics of the CARE allocation, what programs are going to be impacted and the Planning Council’s priorities. Commissioner Monfredini asked if reduction in the CARE allocation is unexpected. Mr. Loyce replied that it is about what they anticipated. Commissioner Chow asked for an update on the “supervirus.” Mr. Loyce replied that there is not enough scientific evidence to support whether or not this strain will have the same impact as the other virus. DPH surveillance staff is monitoring this issue closely. Commissioner Guy congratulated staff for the extraordinary amount of leadership and work that has gone into reprogramming the Behavioral Health Center. 5) PRESENTATION OF THE DEPARTMENT OF CHILDREN, YOUTH AND THEIR FAMILIES DRAFT COMMUNITY NEEDS ASSESSMENT Margaret Brodkin, Executive Director, DCYF, presented the draft Community Needs Assessment. She discussed the San Francisco’s innovative programs: children’s fund; universal health care for children, youth and young adults; wellness centers; local earned income tax credit; community response network; and improved well-being indicators. At the same time, families face threats and challenges, including an exodus of families with children out of the city, violence and racial disparity in terms of education, health status and other indicators. The Community Needs Assessment is a report on San Francisco’s service delivery system for children, youth and their families, and a roadmap to how the City as a whole can work together to better address unmet needs and make San Francisco a more family-friendly city. Recommendations: Service delivery systems must expand their scope, their network and their mission: That the San Francisco Unified School District and community agencies become better partners in meeting the needs of students. That business, government, financial institutions and community agencies join together to create more and better career preparation and job opportunities for youth. That the juvenile justice system be restructured to build stronger relationships with community agencies in operating its facilities, such as Log Cabin Ranch, and in reducing unnecessary incarceration. That recreation centers become true community centers, inviting neighborhood organizations and individuals in to collaborate as managers, services providers and decision-makers. That facing the #1 threat to child health, lack of physical activity and good nutrition, become a citywide campaign. City and community agencies each have a responsibility to work together to improve the quality, funding and management of services: That DPH, Juvenile Probation, and the Human Services Agency continue to develop stronger interagency case management systems for families involved in all three systems. That the major city agencies serving children and youth develop coordinated interagency contract monitoring, performance standards and evaluation systems. That public and private agencies collaborate to identify technical assistance needs and share opportunities for training, consolation and other strategies to improve skills. That peer-learning networks be developed in a variety of service delivery fields, such as youth development and family support. That a wide variety of funding strategies be undertaken to address the chronic financial shortfalls in providing needed services. Public and private agencies must increase the accessibility of their services through more effective outreach, addressing barriers to participation and adapting to new needs of their clients: That the city use its broad service delivery network, its internet capacity, the small business community and the media to disseminate information to families about services that are available and benefits to which they are entitled. That city agencies commit to work collectively to solve the long-standing challenge of safety transporting children and youth to the service and educational locations they desire. That more neighborhood agencies develop the capacity to effectively serve children, youth and families from diverse cultures and ethnicities. That the city agencies providing services to families develop comprehensive service hubs near the seven street corners where most troubled families reside. That public and private sector service agencies modify their hours and locations to accommodate the real needs of families. City government must actively partner with community groups and individuals who are most affected by the city’s policies and services. It must develop strategies that empower those groups and individuals to plan programs and participate in the policymaking process: That all arms of government work to give youth a more active voice in the development of programs and policies that affect them. That opportunities for community voices to guide the policymaking process be expanded, and that city departments continue to explore ways to facilitate this. Commissioners’ Comments Commissioner Chow said it would be helpful to identify specific initiatives that could be focused on and accomplished in the next year or two. He noted that even though San Francisco has a small number of children, it has a wealth of model programs. This is a significant accomplishment. Commissioner Illig asked how much of DCYF’s budget is contracted out. Ms. Brodkin replied that the majority is contracted. Commissioner Illig asked if the Needs Assessment recommends carving out a percentage of Proposition 63 funds for children’s services. Ms. Brodkin said yes. Commissioner Chow suggested that the report include more detailed data on the various Asian populations. Commissioner Monfredini would like the chance to review the entire needs assessment, rather than just the executive summary. Commissioner Guy said that DPH does work collaboratively with DCYF and other agencies, both programmatically and fiscally. The Health Commission is fully invested in the wellness centers, and if there is an effort to expand these into the middle schools, the Health Commission wants to be involved. Commissioner Guy pointed out that the Adolescent Health Coordinator is now at DCYF, and she is looking forward to this collaboration. She pointed out that the Health Commission has a youth health advisor to the CPS Joint Conference Committee. The major concern of the report of violence is a citywide issue and a public health issue, and DPH wants to continue to address this tragic problem collaboratively. 6) PUBLIC COMMENT/OTHER BUSINESS Alfonso Newton said the Mayor is bringing a lot of homeless addicts into the Post Hotel, and this has had a negative impact. They need more security in the building. Steve Rodriquez, speaking on behalf of the Post Hotel tenants, said the agreement with DPH is that the management would have 24-hour security. There is only security from 6:00 p.m. to 3:00 a.m. This is a problem. A lot of other provisions of the agreement have not been met. Sarah Norr, Central City SRO Collaborative, said the Post Hotel was an independent living environment for low-income people. There was no security, no on-site manager. Now there are a lot of people who are not capable of independent living, and this has negatively affected other tenants’ quality of life. Housing the homeless is an important goal, but must take into account the needs of the long-term tenants. Either put resources into the hotel to make it supportive housing, or end the program. Commissioner Monfredini referred the three speakers to Marc Trotz, Director of DPH Housing and Urban Health. 7) ADJOURNMENT The meeting was adjourned at 5:00 p.m. Michele M. Seaton, 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.