Minutes of the Health Commission Meeting SPECIAL HEALTH COMMISSION MEETING Thursday, April 7, 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 Monfredini at 3:10 p.m. Present: Commissioner Lee Ann Monfredini, President Commissioner Roma P. Guy, M.S.W., Vice President Commissioner James M. Illig Commissioner David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. Absent: Commissioner Edward A. Chow, M.D. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF MARCH 29, 2005 Public Comment Patrick Monette-Shaw spoke regarding the comments in the minutes about needing more from the unions. Employees have already given up a lot of money. You don’t need more from the unions. Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) approved the minutes of the March 29, 2005 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Illig chaired and Commissioner Sanchez attended the Budget Committee meeting. (3.1) PHP-Occupational & Environmental Health, Childhood Lead Prevention Program – Request for approval to accept and expend a grant from the State Department of Health Services, in the amount of $52,550, to develop and implement a local infrastructure and framework for a successful lead hazard reduction, compliance and enforcement program, for the period of July 1, 2005 to June 30, 2006. (3.2) EMS-Emergency Operations Section – Request for approval of a new contract with EMSystem, LLC, in the amount of $914,465, to provide patient/hospital/disaster service worker tracking software, hardware and maintenance services, for the period of April 15, 2005 through May 30, 2008. Commissioners’ Comments Commissioner Sanchez asked if this investment would enable DPH to be compatible with the other systems that have been developed throughout the state. Nick Nudell from EMS said that this contract moves San Francisco in that direction, as it reduces the number of systems currently being used in our area from three to two. Dr. Brown said that Santa Clara County has had good outcomes from this system, and this system will allow better coordination regionally. (3.3) BHS-Mental Health – Request for approval of a retroactive contract with the University of California, San Francisco-Child Services Research Group, in the amount of $385,099, to provide program evaluation services for the Children’s System of Care, for the period of September 30, 2004 through September 29, 2005. (3.4) BHS-Mental Health –Request for approval of modifications to two contracts for the Family Mosaic Project, to provide wrap-around services targeting seriously emotionally disturbed children: 1) Brainstorm Tutoring, in the amount of $40,000, for a total contract amount of $80,000 for the period of July 1, 2004 through June 30, 2005, and 2) Victor Treatment Center, in the amount of $75,000, for a total contract amount of $509,350 for the period of July 1, 2004 through June 30, 2005. (3.5) CHN-Laguna Honda Hospital/Nursing – Request for approval of a contract modification with Nurse Providers, Inc., to increase the contract amount by $100,000, from $245,000 to $345,000, to provide supplemental, temporary per diem nursing personnel services for Laguna Honda Hospital, for the period of July 1, 2004 through June 30, 2005. Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) approved the Budget Committee consent calendar. Commissioner Sanchez abstained from voting on Item 3.3. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Mental Health Rehabilitation Center Licensing and Certification Survey On March 21st, four surveyors from the State Department of Mental Health (DMH) arrived at the Mental Health Rehabilitation Center (MHRC) for its first annual unannounced licensing and certification survey. The first survey's intent is to see how the care, treatment and services are provided to the clients and the policies and procedures that have been developed. In addition, this survey is also seen as a consultative visit to assist the development of systems and activities that will be used when the 2006 annual survey takes place. The DMH surveyor team was very complimentary of the staff and program. They stated that for a new MHRC, San Francisco was much further along than most programs during their first survey and that San Francisco was one of the easier sites that they have ever surveyed. Grant Awarded to Balboa Teen Health Center and Maternal Child and MCAH The Balboa Teen Health Center (BTHC) and the Maternal Child and Adolescent Health (MCAH) Office of Family Planning were awarded a five-year, $127,000/year Community Challenge Grant from the State Office of Family Planning. These funds will support health education services at BTHC, and several other community sites. Community Behavioral Health Services California Endowment Grant Community Behavioral Health Services (CBHS) has been awarded a grant in the amount of $121,047 to develop and conduct trainings for DPH program managers/analysts and community contractors on the application of the Cultural and Linguistic Appropriate Services (CLAS) standards. The CLAS standards were adopted several years ago by the Health Commission as guidance for the Public Health Department. In addition, they also serve as a basis for the development of Cultural Competency Annual Reports required by the Department of Contractors. The Department's Cultural Competence Task Force will assist in the overview and implementation of this grant. The grant is to train DPH staff across all departmental sections. New Director of Cultural Competency and Equal Employment Opportunity Appointed Dr. Katz is pleased to announce that Jason Hashimoto has joined the Department as the Director of EEO, Cultural Competency and Affirmative Action. While Jason gets up to speed with all his new job responsibilities, Tina Yee, Director of Cultural Competence and Client Relations for the Community Behavioral Health Services has agreed to serve in the role of Director of Cultural Competency for the entire Department. New Director of SFGH Social Services Appointed Dr. Katz is pleased to announce the appointment of Sharon Kwong as the new Director of SFGH Social Services. Sharon Kwong has been with the Department of Public Health since 1985, the first two years as the Medical Social Worker at Laguna Honda Rehabilitation Hospital and then fifteen years at San Francisco General Hospital as the Medical Social Worker for the Cardiology and Medicine Service. Three years ago, she was promoted as the Medical Social Service Clinical Supervisor at San Francisco General Hospital and the last the four months, she was the acting Chief of Medical Social Service at San Francisco General Hospital. Sharon received her Baccalaureate of Social Welfare from the University of California at Berkeley and her Master of Social Work from San Francisco State University. Medical Cannabis Dispensaries The Department of Public Health was recently asked to attend two committees exploring the issues surrounding the dispensing of medical cannabis. Staff participated on both the Mayor’s Medical Cannabis Task Force and on the advisory group convened by Supervisor Mirkarimi. The Board of Supervisors passed a 45-day moratorium on the establishment of any new cannabis dispensaries; this moratorium may be extended up to 20 months. This will allow the Board to hold public hearings and consider guidelines for the operation of the existing and any new dispensaries. The Department of Public Health issues medical cannabis identification cards, but has no jurisdiction over the dispensaries. Budget Hearing at the Board of Supervisors On Thursday, March 31, DPH staff presented an overview of the Department's base budget and contingency plan to the Budget and Finance Committee of the Board of Supervisors. The presentation included an overview of budget initiatives for 2004-05 and a discussion of the mid-year cuts. The presentation of the base budget for 2005-06 summarized the regulatory, inflationary and structural issues, offsetting increases to revenues, and a discussion of budget cuts proposed to deliver a balanced budget and meet contingency targets. Dr. Katz anticipates the need to make more detailed presentations later in the Spring after the Mayor releases his proposed budget. Tobacco Free Project Staff Published in American Journal of Public Health The April 2005 issue of the American Journal of Public Health published an article written by the staff of the Tobacco Free Project titled "The Community Action Model: A Community-Driven Model Designed to Address Disparities in Health" on pages 611-616 in the Public Health Matters section. This article was based on a paper presented at the Centers for Disease Control and Prevention Forum "Social Determinants of Health Disparities: Learning from Doing," held in Atlanta in October 2003. The April 2005 journal also features a graphic poster on page 554 that was developed by one of the Tobacco Free Project's funded Community Action Model projects, Literacy for Environmental Justice /Youth Envision/Good Neighbor Program which addressed food security linked with tobacco in the Bay View. LHH Staff Published in American Journal of Hospice and Palliative Medicine Several Laguna Honda staff members recently had an article published in the March/April 2005 issue of the American Journal of Hospice and Palliative Medicine. The article titled, “Central nervous system aspergillosis in an immunocompetent patient: Cure in a hospice setting with very high-dose itraconazole,” was authored by Akilesh Palanisamy, MD; Derek Kerr, MD, CNA; Michelle Fouts, PharmD; and Stephanie D. Chao, BS. California Chronic Care Learning Communities Initiative Four CHN clinics, Silver Avenue Family Health Center, Chinatown Public Health Center, Potrero Hill Health Center and Family Health Center at SFGH, are part of the California Chronic Care Learning Communities Initiative Collaborative (CCLC), launched by the California Association of Public Hospitals (CAPH) Safety Net Institute (SNI) with a grant from the California HealthCare Foundation (CHCF). The initiative develops learning communities to improve care of chronic diseases in public hospital systems. The CHN clinic teams meet with other California public hospital teams in a year-long learning collaborative to address challenges of improving care of diabetes and related conditions, using the Chronic Care Model. Dr. Lisa Johnson of Ocean Park Health Center, along with SFGH Drs. David Ofman and Tom Bodenheimer, have been serving as faculty members to this project. The collaborative teams use a patient disease registry (CDEMS – the Chronic Disease Electronic Management System) to provide population-based care. SFGH Information Services Department has created an electronic link between the CHN Invision System and CDEMS, providing daily updates of demographic and diabetes-related lab data for the 700+ diabetic patients in the pilot cohort. This registry tool greatly facilitates population based care of a chronic illness (diabetes), and will be an important model for CHN disease registries in the future. Commissioners’ Comments Commissioner Monfredini said it is important to remember, particularly in times of budget cuts, all the good things that the Health Department does. There are a number of examples in Dr. Katz’s Director’s Report. Commissioner Illig asked if the new Director of Cultural Competency and EEO has the same authority as the previous director. Dr. Katz replied that the position has not changed. Commissioner Sanchez said it is astounding that the Department, which has undergone major budget cuts, is still able to receive grant awards and be models of excellence. 5) CONSIDERATION OF A RESOLUTION HONORING PUBLIC HEALTH WEEK, “EMPOWERING AMERICANS TO LIVE STRONGER, LONGER!” Michael L. Radetsky, MPH, Injury Prevention, Community Health Education Section, presented a resolution honoring public health week. This year’s them is “Empowering Americans to Live Stronger, Longer!” The Department’s focus has been on physical activity. The goal is to make physical activity accessible everywhere in San Francisco, in addition to emphasizing its importance to individuals. The Department has sponsored a lunchtime walk, a free tai chi class and two public presentations. Public Comment Patrick Monette Shaw said the Health Commission should fund the CHIPPS Falls Prevention Program instead of the Department settling a sexual harassment case. Commissioners’ Comments Commissioner Guy thanked the public advocates for their support of primary prevention. Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) approved Resolution 07-05, “Honoring Public Health Week, April 4-10, 2005,” (Attachment A). 6) APPROVAL OF FY 2005-2006 PATIENT RATES Gregg Sass, DPH Chief Financial Officer, presented the proposed FY 2005-2006 Patient Rates for services provided by San Francisco General Hospital, Laguna Honda Hospital, Primary Care Clinics, Community Mental Health Services, Community Substance Abuse Services and the Department of Public Health. The Department reviews these rates annually, and when appropriate, revises rates to recover the cost of providing services. A 10 percent increase in patient rates is proposed at San Francisco General Hospital with the exception of trauma care. Increases are based on a survey of patient rates charged by other Bay Area and Southern California medical centers. The trauma rate structure is revised to be comparable to other hospitals providing trauma services. A 10 percent increase in patient rates is proposed at Laguna Honda Hospital for acute, rehabilitation and skilled nursing facility services based on prevailing industry rates. Proposed increases in patient rates charged for Community Mental Health Services and Community Substance Abuse Services range from three percent to 32 percent. Patient rates for both substance abuse and mental health services are established to maximize reimbursement from the State. No rate increases are proposed for services provided by Vital Records, with the exception of indexing the out-of-county cross files fee to the rates of the State and a new fee for reproduction of documents. Proposed increases for vaccines provided by the Adult Immunization Clinic range from zero percent to 25 percent based on prevailing industry rates. Patient charges serve as the basis for reimbursement from third party providers. However, reimbursement received from third party payors may differ from rates charged to patients. Typically, payors such as Medi-Cal, Medicare and some HMOs reimburse providers for services at rates that are lower than published charges. The payors that typically reimburse DPH at the published rates include out-of-plan HMOs, private insurers and private pay patients with the ability to pay. Reimbursement from third party providers is a significant source of revenue for the Department of Public Health. Revenue associated with FY 05-06 patient rates is estimated to be $1.1 million. This increase has been incorporated into the FY 05-05 budget. Commissioners’ Comments Commissioner Illig asked if it is true that the charges cannot exceed costs. Mr. Sass said it is true that the charges do not exceed the costs. The fees are based on cost of services provided. Unlike most of the fees set by the City, in a hospital setting fees have a different economic structure. Commissioner Illig asked if there was any possibility of increasing the fee for the medical cannabis card. Mr. Sass said that the current fee is based on the cost to provide the service. Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) approved the proposed FY 05-06 Patient Rates. 7) CONSIDERATION OF A RESOLUTION APPROVING THE SUBMISSION OF THE FY 2005-2006 DPH BUDGET Mitchell H. Katz, M.D., Director of Health, said that the Commission had for its consideration a resolution approving the submission of the FY 2005-2006 Budget. The Commission heard much public testimony at the last meeting, and more was to be presented today. Public Comment Susan Horne said the Star Center at SAGE has taught her how to minimize anger, reduce stress through acupuncture and meditation, and she has built her self esteem. Tangela Brackenridge, with her daughter Unique, said she and her daughter graduated from Jelani House, which is one of the only programs that serves mothers with their children. Heather Weigand, speaking in support of Walden House, said Walden House changed her life. She spoke in support of all substance abuse treatment providers in San Francisco. Please consider treatment as an area not to cut. Carolyn Gurtiza spoke in support of Walden House, which made her believe in herself and have courage. Isabel spoke in support of Walden House. She is really grateful to Walden House. It helped her and her son. Nikki Witt said Walden House has given her a new life. She looked for a long time for a rehabilitation center that serves transgendered people. Walden House has given her the opportunity to be proud of herself. Richard Rosenblum is proud to work at Walden House because of the work that he does. He works with people who have HIV, mental illness and substance abuse problems. This is a unique service. The clients see immediate results. Norma Weissman spoke in support of Walden House. It has always been there for her, and changed her life. Melisa Earl said Walden House helped her become the person she is today. Walden House has the programs that will help her reunite with her children. Gretchen Richardson spoke in support of Walden House. She has ten years clean, is back with her children and has a job. Walden House provides an array of services, and it would be a shame to cut these services. Venitto Lewis spoke in support in Walden House. She is a day treatment client. If it was not for Walden House, she does not know where she would be. Sofia Enriquez spoke in support of the Latino Commission, which is one of the only places in San Francisco that serves mothers and children. Without this program, she would not have her daughter with her. Sheri Gomes said Walden House helped her understand her addiction and build her self-esteem. She cannot thank them enough. Vera Miller spoke in support of Walden House. Walden House has made her want to give back. She knows she can do great things, but needs Walden House. Rita Alderucci spoke in support of Walden House. She has been unsuccessfully fighting her addiction alone for the past 15 years, and she is thankful for this type of program. Jasmine spoke in support of Walden House. If Walden House had not taken her in, her daughter would not have a mother. If it is cut, she will have nowhere to go. Cindy Collins spoke in support of Walden House. They have accepted her for who she is, and has provided an array of services. The program has given her a second chance. Katherine Fuentes spoke in support of Walden House. They have given her many resources to keep from using drugs. Fermin Loza spoke in support of Walden House. He works at a day treatment program where people get many services, have an opportunity for parenting and work programs and other services. People show up to day treatment and outpatient services, and they should not be cut. Dr. Mardel Gabrielle spoke in support of Walden House. Providers like Walden House have spent a lot of time assessing the special needs of their populations. A wide array of services is needed, including parenting programs, programs for dually diagnosed and others. These people need treatment. Val spoke in support of Walden House asked that the Commission consider a substantial budget allocation, not cuts, for services such as Walden House. They are people who are rebuilding their lives and restoring their families, and they will try to give back. Billie Marie Dillon spoke in support of Walden House, said she has spent all of her life incarcerated, and Walden House was kind enough to let her in. It is imperative that the funding for Walden House continue. Dave Farullo, Director of Citywide Case Management, said their program helps reduce rehospitalizations and incarceration. They will not be able to do that job without residential treatment. Supportive housing is great after people have stabilized, but it is not a substitute for residential treatment. Abner Boles, Executive Director, Westside Community Mental Health, is concerned that the cuts that are being proposed will have an impact on San Francisco’s ability to get Proposition 63 funds from the State. To decimate community treatment facilities without targeting inpatient care is pound foolish. Steve Fields, Executive Director of Progress Foundation, said that residential treatment is not a more expensive substitute for supportive housing. The data shows that if residential treatment programs are closed, hospitals and skilled nursing facilities will be backed up. Jonathan Vernick, Executive Director of Baker Places, said one of the contract objectives in residential treatment centers is that for all of the clients that enter the residential programs, there needs to be a 50 percent net reduction in use of acute hospital days after treatment. There is no allocation in the budget for the cost that will result from the elimination of this treatment modality. Arthur Bosse, National Council on Alcoholism, urged the Commission to tell the Mayor and Board of Supervisors to find cuts elsewhere. San Francisco is headed in the right direction in developing a continuum of care, but cannot cut a level of treatment. Frances Hernandez spoke in support of SAGE Star Center. She suffered for years from child exploitation and domestic violence. If it was not for SAGE, she does not think she would be speaking before the Health Commission. She urged the Commission to keep this program open. Karen Brandman, clinical supervisor at SAGE, said it is a financial mistake to cut preventive services from the budget. SAGE provides stabilization services that keep people from having to go to another level of care. Once someone becomes homeless in San Francisco, the costs go way up. Saundra Domingue spoke in support of the SAGE center. She is a survivor of drug use, physical abuse and sexual exploitation. The only way she was able to survive was by working with SAGE. It was a healing place for her. Now she is able to transfer this to the clients that she works with. Tamara spoke in support of the SAGE center. It saved her life. Please do not cut the budget, but increase it instead. Patricia Davis said San Francisco recovery programs have helped her tremendously. She lost her entire family. She is now in the SAGE program, which is helping her deal with faith and loss. Irma Garcia spoke in support of the Latino Commission. This program has a transgender residential program. Without these kinds of programs, there would be more suicides, more people in jail, and more people in the hospital. Maria spoke in support of the Latino Commission. It provides a lot of help. Armando Perez spoke in support of the Latino Commission. This is the only San Francisco program in San Francisco that serves Latinos and that provides a full range of programs. He invited the Commission to the graduation ceremony on April 15th, at 440 Potrero (at 17th). Cynthia Zecic spoke in support of the SAGE program. SAGE focuses on underlying sexual abuse, and is a peer model. People who have been out there are now working there. She has learned an immense amount, and clients’ trust is increased when they talk to people who have been through the same thing. This gets people into therapy more quickly. Danilo Peoroso spoke in support of the Latino Commission. He has been in many programs in many states, but with the Latino Commission he has been sober for two years. Please do not cut the programs. Orestes Cardenas spoke in support of the Latino Commission. He took drugs for many years, but is clean and sober today. He wants to continue. Recovery homes help people. Svetlana Pivchik spoke in support of SAGE, which is a unique organization that provides mental health, substance abuse and trauma recovery services for people who have experienced sexual exploitation and violence. Even though she did not speak fluent English as the time she received services, she was able to benefit from the treatment because of their cultural programs. The provide services in many languages. Norma Hotaling, SAGE, said we should be celebrating the stories that we are hearing today, rather than only hearing these triumphs in times of budget cuts. SAGE provides expanded services to create one of the most integrated mental health, substance abuse and trauma recovery services. Ms. Hotaling distributed information to the Health Commission, which is on file in the Health Commission Office. Chris McGuire spoke in support of Conard House said she sees success stories on a daily basis. She specifically spoke in support of the Jackson Street program. The program is multilingual and caters to the Asian community. Richard Heasley, Executive Director of Conard House, submitted a letter asking the Commission to hold one or more hearings to discuss the effectiveness of eliminating a treatment modality, with the findings reported to the Mayor’s Office and Board of Supervisors (letter on file at the Health Commission Office). There has been no hearing, no vetting, and no local data on the proposed budget cuts. Mark Stanford, SEIU Local 535, encouraged the Commissioners to read the document submitted by Steve Fields. Proposition 63 funds are in serious jeopardy with these cuts. Jorin Bukosky from Progress Foundation said his program is not an alternative to homelessness. They are an alternative to hospitalization. We will not save money by converting to supportive housing. It is a fallacy to assume that the proposed changes will save money. Angel Rubalcava spoke in support of Latino Commission and other residential programs. These programs save lives. People will continue to go into institutions and jails. This is not a joke, it is people’s lives. Molly Connery spoke in support of SAGE and other agencies that have helped her. A lot of her generation has been lost. She has gotten her life back, and is on her way back, because of these agencies. She can either be your local crime or your miracle. Jimmy White spoke in support of Redwood Center. He has had countless visits to the SFGH ER. He is grateful to AA, but it was not enough for him. He has the desire to live, and please do not take that away from him. Kavoos Bassiri ,CEO of RAMS, is deeply concerned about the budget cuts. Behavioral health services are inordinately targeted in the proposed budget. He is concerned about the impact on ability to get Proposition 63 funds. And budget cuts should not dictate the philosophy of care. Jenny Wiley spoke on behalf of the Friendship House is concerned about the philosophy of the cuts. Money should not be used as an excuse to hurt people’s lives. She is concerned about supportive housing not providing treatment. The Friendship House is incorporating housing into their substance abuse treatment program. They support AA and NA, but with treatment. Michael Gastes spoke in support of Redwood Center, said it is important that people have safe treatment opportunities. Robert Johnson spoke in support of the Redwood Center, said this program took the time to work with him. It is a family to him. Please do not take this program away. Jamie Matter spoke in support of Haight Ashbury Treatment Center. He is speaking on behalf of Haight Ashbury clients who cannot be here today because they are working. They are able to keep their jobs because they do not have to go into residential treatment. A wide variety of modalities save between $4 and $11 dollars for every dollar spent. Aaron Thompson spoke in support of the Redwood Center. If this center is closed, people like him, who cannot get clean in a city environment, will have no opportunity for recovery. Felicity Price spoke in support of Jelani House. Please keep Jelani House open. This program helped her get her life in order and her children back. Sonia Brewster spoke in support of Jelani House. It helped her be sober for 13 years, she has housing and a job. She sees a lot of addicted women who are pregnant and homeless and want help. She is glad she is there to help them. Ethel Williams spoke in support of Jelani House. It would be a disservice if this program were closed. This is one of the only family-oriented treatment houses. Keeping women and children together during treatment helps the City with the budget. Garla Garth spoke in support of Jelani House, which helped her save her life. It taught her how to be successful in society, be a good parent, and many other things. If this program were cut, there would be more drug use and deaths. Mina Jack spoke in support of Jelani House. Putting people in housing without providing them treatment is not helpful. Think of 6th and Market, magnified. Crime will go up. She has been clean by herself before, but could not stay clean. Ronald Hemmings spoke in support of the Redwood Center. He asked to Commission to reconsider the proposal. By closing the program, the city is putting lives in danger. LaCresha Parker spoke in support of Bayview Hunters Point Foundation Youth Services Department, and asked the Commission to fund the beautification program that is proposed to be cut. This program is keeping kids off of the street. Tracy Chin said the BVHPF beautification program has helped her life. She has been doing her homework, catching up in school. If the program shut down, she would be a failure in school again. Dominique Jones has been going to the beautification program for a year. Without the program she would be on the streets or dead or at YCG. Zanaida said that without Bayview Hunters Point Foundation, she would be at YGC. The program has helped her get her grades up and is a second home. Jocelyn said the Health Commission should keep the BVHPF beautification program open. Jazz said without the BVHPF beautification program, she does not know what she would do. Alan Mickey Shipley was recently appointed to the Proposition 63 Task Force. Contrary to the belief of the Mayor and Board of Supervisors, Propsition 63 funds cannot be used to supplant budget cuts or for supportive housing. They are for innovative mental health programs. Dr. Lesleigh Franklin spoke in support of the Iris Center and the system of care. Her program is very different from AA. They deal with child abuse, trauma, sexual exploitation—the whole person. She submitted additional information, which is on file in the Health Commission Office. Michele Rendolin spoke in support of Jelani House. She received housing assistance, much needed counseling, parenting training and a wide array of services. Please reconsider the budget cuts. Nsoah Chionesu spoke in support of Bayview Hunters Point Foundation acupuncture services. He asked why studies were not done in San Francisco. Before deeming services non-essential, DPH should look at local programs. Gapri spoke in support of Jelani House. NA and AA are self-help groups. Residential treatment is the best way. Please help them help others. Ben Eiland spoke in support of the Haight Ashbury Free Clinics. The Commission only has to listen to the testimony today to know that hundreds of thousands of dollars were saved through treatment programs. Patrick Monette-Shaw said the Health Commission should reject the budget. Laguna Honda does not need additional security, and this money should be spent to save programs like Jelani House. James Burge spoke in support of Jelani House. This was his first program, and hopefully his last. Jail did not rehabilitate him. Jelani might not be the biggest, but it is unique. David Henderson spoke in support of Jelani House. He was an addict and thief, and is now a productive adult. He owes this to Jelani. Margaret Gold, Executive Director of Jelani House, spoke on behalf of the Jelani programs. They have residential and outpatient programs for men, pregnant women and families. Where are her families going to go? Chris Fisher spoke in support of Bayview Hunters Point Foundation acupuncture services. This service is non-threatening, humane and effective. Please keep it open. Larry Evans spoke in support of Jelani House. These programs give a man a chance to stand up and be proud of where he came from and what he stands for. There is not enough money, and the Commission has to work to get money back in the county. Cedric Akbar spoke in support of Positive Directions Equals Change. The people need the program, and the community needs the program. Shedrick Ferguson spoke in support of Positive Directions Equals Change. People will die if cuts are made. Dale Robertson spoke in support of Positive Directions Equals Change. Please do not cut the program. Ronnie Robison spoke on behalf of Bayview Hunters Point Foundation. Acupuncture has helped him with his alcohol abuse. George Turner, Bayview Hunters Point Foundation center for problem drinkers, said there is a lot of violence and substance abuse in the Bayview. Any agency that provides services in that community is to be commended. But Bayview Hunters Point Foundation is unique, with the comprehensive nature of services. Alfredta Nesbett, Bayview Hunters Point Foundation, spoke against the cuts in acupuncture and outpatient substance abuse services in the Bayview. Acupuncture services are vital in fighting addiction. This is a holistic approach to addressing addiction. Barbara Farrell, CATS, said it is counterintuitive to cut substance abuse programs to save money. Human beings suffering from addiction have been stigmatized. This budget has disproportionate cuts to substance abuse. People can work so hard for sobriety, but they need the support structure. Felicia Houston, Program Director at A Women’s Place, cautioned the Commission to not make broad and drastic cuts to substance abuse services that would undermine the system of care. People in early recovery need treatment. Jennifer Stephens spoke on behalf of A Women’s Place, said if it is as easy to send clients to AA and NA, she wish she would have known this ten years ago. Many of her clients come from SROs, where they were unable to be successful. Afera Days said please support A Women’s Place. She does not know where she would be without this program. Juanine Timmons spoke in support of A Women’s Place. This program allowed her to know her self worth and becomes a better citizen. Thomas Booth spoke in support of Walden House. He would not have made it with just AA. Walden House helped him get back on his feet. Geoffrey Grier, San Francisco Recovery Theater, said it is amazing to have everyone speak out about his or her success, but a shame they have to come during budget cuts. He implored the Commission to look at its mission. The cuts will carve out services to segments of San Francisco’s citizens. Protect these citizens. Armando Martinez spoke in support of Bayview Hunters Point Foundation. NA and AA are good for beginning recovery, but other services need to be available to make recovery successful. Acupuncture has helped him stay clean for three years. Please reconsider the cuts. Denise spoke on behalf of Positive Directions Equals Change. Please give people the opportunity to get their lives back. Ron Perez, Treatment on Demand Council and staff to the Roads to Recovery Program. He thanked all the programs that were represented today. They have been crucial to the success of the Roads to Recovery Program. When treatment is started in custody, the success rate is much higher. Cregg Johnson, Treatment on Demand Planning Council and Positive Direction Equals Change. Bayview Hunters Point and Sunnydale need more services. Don’t cut programs in these communities. Steven Clark spoke in support of Positive Direction Equals Change, said Bayview needs more services, not less. They do wrap-around services and provide services beyond what the contract requires. People are dying. Roban San Miguel, Executive Director of Family Mosaic Project, said San Francisco has a unique circle of care but if these cuts are implemented, this circle will be decimated. Debbi Lerman, San Francisco Human Services Network, expressed appreciation for the language of the resolution. It acknowledged that we have to protect the safety net, and acknowledges that the lack of COLAs equates to service cuts. She implored Commissioners to use all their influence to fight the cuts. Commissioners’ Comments Commissioner Monfredini stated that it is the Commission’s job to develop a budget and send it to the Mayor. The Commission should determine what is most appropriate and develop a list of priorities that they believe are the most important to keep in the Health Department and those that the Commission is willing to give up in order to keep the things that are extremely important. She asked each commissioner to state his or her feelings on this, and include an attachment to the resolution that will serve as a guide to the Mayor and the Board of Supervisors. Commissioner Illig shared his priorities for preserving essential direct services. His top priorities in the current baseline list that he cannot support reducing are: 1) residential mental health treatment services; 2) residential substance abuse services; 3) outpatient substance abuse services; 4) SRO Collaborative. This totals $4,586,926. To replace these cuts, he believes the Health Commission should move the following from the contingency list to the baseline list: 1) close the SFGH Dialysis Unit; 2) close a health center and sell the building; 3) operate all health centers at 80% of the time. Although closing a neighborhood health center and operating the rest four days a week are drastic measures, they would communicate the message that another year of public health cuts would decimate the health care safety net that San Franciscans have build and supported for decades. If the Mayor and Supervisors cannot find the revenue needed to sustain these programs, at least the patients could be transferred to the parallel system of community-based clinics. Commissioner Illig also suggested that the Health Commission hold public policy discussions about the residential treatment system. He also supports Barbara Garcia’s suggestion to rebid the programs and refine the expectations. Commissioner Umekubo asked Dr. Katz if the Department has a contingency plan for filling the gap if a health center were to be closed or operations reduced. Dr. Katz said this is a hard question to answer, but he provided some facts. There are eight community health centers. With streamlined operations, the clinics are paying for 60 cents on the dollar, so it would have a dramatic effect on revenue and the number of FTEs. In terms of capacity by other clinics, there has been a very successful experiment with St. Mary’s. The other FQHC clinics have expressed a willingness to enter into a similar relationship with DPH. He would also try to see the degree to which the doctors and nurse practitioners could remain in the clinic without the rest of the staff. One of the biggest challenges is that, in the existing system, many of our clients have a three-month wait. Commissioner Umekubo’s priorities are that residential mental health treatment services, residential substance abuse services and outpatient substance abuse services are restored. His other priority is the Health at Home Chronic Care Program. These services are critical to keeping people out of acute care. He supports moving the closure of dialysis unit, the closure of a public health clinic, and reducing the level of services at the primary care clinics from the contingency list to the base. Commissioner Sanchez supports Commissioner Illig’s priorities for restoration: residential substance abuse services, outpatient substance abuse services, and residential mental health treatment. His concern is that the neighborhood health center system is a nationally recognized model of culturally competent care. Rather than saying today that a particular clinic be closed, he would like to study the network, data and client base and perhaps reconfigure the system. He would accept the closure of dialysis and a reduction of primary care operations. Commissioner Guy supports Commissioner Illig’s recommendation around mental health residential treatment and outpatient and residential substance abuse services. She can accept workers’ compensation clinic as a cut. She does not want to close the dialysis unit. The Commission should consider closing a health center, but she is concerned about reducing the health centers by 20%, given the cuts that the clinics sustained last year. The Commission must look systematically at the impact of shrinking the safety net and reducing the strategic priorities. The Commission did not get enough time to really examine these changes. There has to be real public dialogue around this, and she asked that the Health Commission undertake this either through additional public hearing or committee meetings. She noted that the UC Affiliation Agreement has to be looked at and updated. The safety net has changed since this was last examined, and our partners at UC would appreciate that this agreement be re-examined. Given all the work the Health Department has done around supportive housing, it would be a mistake to equate supportive housing to residential treatment. There is crossover, but they are not the same. She hopes the priorities indicate to the Mayor and the Board of Supervisors that the Health Commission does not support the death knell to the entire system of residential care. Commissioner Monfredini explained that she specified Potrero Health Clinic on her list because she feels it is the Health Commission’s responsibility to make these kinds of decisions, rather than just leaving it up to the Board of Supervisors. She believes the dialysis center should be closed because, as a member of the SFGH JCC, she sees the condition it is in, and knows that the patients will be served. This is also the case with the Workers’ Compensation Clinic. She is committed to making substance abuse and mental health services whole, and is willing to reduce primary care operations to save these services. She is willing to hold the chronic care team relatively safe on the contingency list. Commissioner Illig asked if the SRO Collaborative would likely be funded through another department. Dr. Katz said it is likely that the collaborative would be funded through the Department of Building Inspection, so he recommends keeping this proposed reduction on the baseline reduction list. Commissioner Monfredini asked for Dr. Katz’s input on budget priorities. Dr. Katz disagrees with one of the Commissioners’ priorities, that being outpatient substance abuse services for non-special populations. The number of outpatient substance abuse slots did not result from careful planning. Further, the cost of these services range from $14,000 per year to $27,000 per year, with no understanding about the reason for the cost differential. Additionally, the evidence of methadone is overwhelming, and there is a shortage of methadone capacity. He recommends leaving $900,000 in the base of rebid substance abuse services, and increasing methadone slots. Commissioner Guy wants to understand better why one program costs more than the other, but right now there is not time to adequately understand this. Given that, does Dr. Katz’s recommendation leave enough in the budget so that, when the policy discussions do take place, will there be enough of a system left? Commissioner Monfredini noted that one facet of the future policy discussions include looking at how people can be connected to the right program so that they do not have to cycle through various recovery programs. Commissioner Illig disagrees with cutting any funding for substance abuse services. He supports additional methadone, he agrees with rebidding the system, but the total amount of funding should remain the same. Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) approved amending the proposed resolution to add the following: “Whereas, the proposed budget reflects enhanced safety and resident care services at Laguna Honda Hospital and enhanced nursing services at San Francisco General Hospital;” Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) approved amending the proposed resolution to add the following: “Whereas, the Health Commission has prioritized the proposed budget reductions and has specified budget reductions that, if implemented, would have an adverse effect on the public health safety net, and these priorities are listed in Attachment A; and, “Whereas, the Health Commission has identified those reductions that would have the least impact on the safety net, and these are also listed in Attachment A; and, “Further Resolved, that the Health Commission urges the Mayor and the Board of Supervisors to consider the Health Commission priorities listed in Attachment A of this resolution when approving the budget; and be it” Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) approved amending the proposed resolution to add the following: “Whereas, the Health Commission finds it unacceptable that City departments must absorb the cost of structural inflationary increases, given that annual increases in the cost of doing business are expected and normal; and, “Further Resolved, that the Health Commission urges the Mayor to adopt the budget principle of funding, for each City Department, annual structural inflationary increases; and be it” Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) approved Resolution 06-05, “Approving the Submission of the Department of Public Health’s Base and Contingency Budget for Fiscal Year 2005/06, and Urging the Mayor and the Board of Supervisors to Develop Strategies for Avoiding Serious Cuts to the County’s Health Safety Net Services,” (Attachment B), as amended. Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) approved Attachment A to Resolution 06-05 (Attachment B). 8) PUBLIC COMMENT/OTHER BUSINESS Patrick Monette-Shaw spoke about Laguna Honda Hospital, and read from a newspaper opinion piece. He said the increased security and behavioral health programs at Laguna Honda Hospital need to be taken out of the budget. 9) CLOSED SESSION Item 9 was continued to the April 19, 2005 Health Commission meeting. A) Public Comments on All Matters Pertaining to the Closed Session B) Vote on Whether to Hold a Closed Session (San Francisco Administrative Code Section 67.11) 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 $200,000 IN ENCISCO v. CCSF, ET AL, SAN FRANCISCO SUPERIOR COURT, No. 433-927 D) Reconvene in Open Session 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).) 10) ADJOURNMENT The meeting was adjourned at 7:30 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.