Minutes of the Health Commission Meeting Tuesday, May 17, 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 Edward A. Chow, M.D. Commissioner James M. Illig Commissioner Donald E. Tarver, II, M.D. Absent: Commissioner David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF MAY 3, 2005 Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Tarver) approved the minutes of the May 3, 2005 Heath Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Illig chaired and Commissioner Chow attended the Budget Committee meeting. (3.1) DPH-Central Admin. – Request for approval of a renewal contract with P. B. Strategies, LLC, in the amount of $438,387, to provide strategic planning and project management services for ongoing primary care capital improvement projects, for the period of July 1, 2005 through June 30, 2007. Commissioners’ Comments Commissioner Chow asked the status of the Tom Waddell elevator. Ms. Kronenberg replied that $64,000 was allocated for the design of the elevator. Of that, $37,000 has been spent. There allocation does not include funding for the installation of the elevator. Ms. Kronenberg added that the elevator has never been part of the scope of work of this contract. Commissioner Chow suggested that this project be included P.B. Strategies’ scope of work, and the contractor agreed. (3.2) PHP-MIS – Request for approval of a renewal contract with Echo Consulting Services of California, in the amount of $460,237, to provide ongoing system maintenance and application support services for the INSYST software application used by Community Behavioral Services, for the period of July 1, 2005 through June 30, 2006. Commissioners’ Comments Commissioner Chow asked if the CBHS system is going to utilize the Soarian system. Fred McGregor of CBHS replied that Siemens does not have a behavioral health product and would not be able to develop one for several years. CBHS would like to put out an RFP for a new behavioral health system that could interface with the Soarian system. They hope to have this funded through Proposition 63. (3.3) PHP-MIS – Request for approval of a renewal contract with InfoMC, in the amount of $288,792, to provide ongoing system maintenance and application support services for the eCURA software application used by Community Mental Health Services, for the period of July 1, 2005 through June 30, 2006. (3.4) PHP-BEHM – Request for approval of a renewal contract with San Francisco Foundation Community Initiative Fund, in the amount of $168,000, to provide fiscal sponsor services for the San Francisco Food Council, for the period of July 1, 2005 through June 30, 2007. Commissioners Comments Commissioner Chow asked the status of city-owned farmers markets accepting EBT cards. Dr. Ona replied that the Alemany Farmers Market would finally accept EBTs. In addition, Environmental Health continues to support the acceptance of EBTs at other farmers markets in the city. (3.5) PHP-AIDS Office – Request for approval of a retroactive contract renewal with Patricia Sullivan, in the amount of $282,240, to provide consulting services to HIV Health Services, for the period of March 1, 2005 through February 28, 2006. Commissioners’ Comments Commissioner Illig asked how the Department decides which programs are contracted out and which are done in-house. Michelle Long Dixon replied that the quality management program is relatively new to CARE-funded programs. When it became a HRSA mandate, there was a hiring freeze, and it is not a full time job. Ms. Long Dixon said that this is a scope of work that is best managed by a consultant. Commissioner Illig said that he would like to see performance measures in the contract summaries that are presented to the Budget Committee. (3.6) CHN-Jail Health Services – Request for approval of a renewal contract with Medical Diagnostic, in the amount of $672,000, for the provision of mobile X-Ray services for inmates of the County Jail, for the term of July 1, 2005 through June 30, 2009. (3.7) CHN-SFGH – Request for approval of a renewal contract with the Regents of the University of California, in the amount of $376,320, to provide Orthotics and Prosthetics for Medically Indigent Adult clients of the Community Health Network, for the period of July 1, 2005 through June 30, 2006. (3.8) CBHS-Mental Health – Request for approval to accept and expend retroactively a grant from the California Department of Mental Health, in the amount of $207,487, for Community Program Planning as part of the Mental Health Services Act (MHSA) (Prop 63), for the period of January 1, 2005 through September 30, 2005, and a contract modification with Bay Area Communication Access for $3,000, for ASL interpretation, for the same period. Action Taken: The Commission (Guy, Chow, Illig, Monfredini, Tarver) approved the Budget Committee Consent Calendar. 4) DIRECTOR’S REPORT Mitchell H. Katz, Health Director, presented the Director’s Report. Blue Ribbon Committee on SFGH’s Future Location The Mayor has appointed a 26-member Blue Ribbon Committee to make a recommendation on where SFGH should be rebuilt—either on the existing campus in Potrero Hill or at Mission Bay, co-locating with the planned women’s, children’s and cancer hospitals for UCSF Medical Center. Dr. Sandra Hernandez will chair the committee and Dr. Katz has been asked to co-chair with her. Members come from disciplines throughout the City, including health care, education, advocacy and community, labor, government, philanthropy and business. Dr. Ed Chow will serve on this Committee as representative for the Health Commission. As this Commission is aware, much work has already been done related to this rebuilding effort and the Blue Ribbon Committee will have this body of work as a resource to help determine their recommendation. It is anticipated that the committee will return a recommendation to the Mayor and Board of Supervisors by the end of the summer. Four meetings over the next few months are planned. Dr. Katz thanked the Mayor and the San Francisco Foundation for their leadership in bringing together this important Committee and look forward to the challenge we have ahead of us. Mayor Appoints Citywide Task Force on Crystal Methamphetamine On April 26th San Francisco became the first city in the nation to coordinate resources in a citywide effort to deal with Crystal methamphetamine. This drug, around for many years, is experiencing a significantly increased impact in the last 18 months. The correlation between crystal use and HIV and STD infections has highlighted the need for a comprehensive plan of attack. The Mayor appointed Steven Tierney, Director of HIV Prevention at DPH to Co-Chair this task for with Supervisor Bevan Dufty. Other DPH appointees include Jimmy Loyce, Jeff Klausner and Bob Cabaj. The Task Force will develop a plan of action and a set of concrete recommendation and deliver them to the Mayor within six to 10 months. HIV Vaccine Awareness Day May 18th is HIV Vaccine Awareness Day. The HIV Research Section has been working with ISIS, a technology-based health education agency, to launch a new educational campaign about the need for vaccine research. SFisReady.org is designed to alleviate fears and myths about participation in research and inspire San Franciscans to take part in vaccine trials. San Francisco is one of only 28 cities internationally to host these trials as part of the HIV Vaccine Trails Network and one of only 12 US cities. This year, the Research Section needs nearly five times as many volunteers as last year. When clinical trials are successful, they advance to another phase of study where the number of participants needed increases dramatically. Dr. Susan Buchbinder, Director of the HIV Research Section, will be appearing live tomorrow night on Gay.com to answer questions about Vaccine Trials and the work that is being done here in the City. West Nile Virus Update As the Commissioners are aware, West Nile Virus continues to be in the news as a potential health threat again in California. Last year, there were no cases of WNV within the City, but a number of dead birds tested positive for the virus. This year, the Department is once again working with a number of other City agencies to educate the public about preventing WNV by taking precautions such as wearing long clothing and using mosquito repellent. We are also focusing on decreasing wet, swampy areas that host mosquito breeding areas within the City, including on city-owned property. The Bureau of Environmental Health has received nearly 100 calls from residents reporting mosquito activity throughout the City, nearly double the amount of calls received last year at this time. We have also activated a new WNV hotline, 252-3806 and are distributing brochures in five languages and designing outreach efforts to different communities. Each month we are issuing a press release with a different focus on prevention and awareness. To date, no positive birds have been identified in San Francisco but we anticipate that with the wet spring and warm weather ahead, the WVN will reemerge in the bird population here as it has already in other Bay Area Counties. AIDS Community Research Consortium of San Mateo Honors Michelle Long Dixon The AIDS Community Research Consortium (ACRC) of San Mateo County selected Michelle Long Dixon to receive the ACRC 2005 Outstanding Community Service Award at its spring gala, "Innovation: Embracing and Empowering a New Community" last month. The award was given for inventive leadership to HIV/AIDS community based organizations. Also honored were Steve Westly, California State Controller; Michael Edell, American Heart Association; and Gilead Sciences, Inc. Community Health Network -San Francisco General Hospital Credentials Report 05/05 07/04 to 05/05 New Appointments 11 186   Reinstatements 0 0 Reappointments 27 395   Delinquencies: 0 0   Reappointment Denials: 0 1 Resigned/Retired: 8 137 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Deceased 0 0 Changes in Privileges   Additions 4 70   Voluntary Relinquishments 0 41   Proctorship Completed 33 151   Proctorship Extension 4 4 Current Statistics - as of 05/1/05 Active Staff 456 Affiliate Professionals (non-physicians) 194 Courtesy Staff 540 TOTAL MEMBERS 1,190 Applications In Process 37 Applications Withdrawn Month of May 2005 0 8 (07/04 to 05/05) SFGH Reappointments in Process June 2005 to Sept 2005 180 Commissioners’ Comments Commissioner Illig asked if the Blue Ribbon Committee’s recommendation would come to the Health Commission. Dr. Katz said it would. Commissioner Chow is honored to represent the Commission on the Blue Ribbon Committee. Commissioner Chow again noted how important it was that San Francisco General Hospital passed JCAHO and noted that a hospital in Alameda County is faced with losing its accreditation. He also noted that the Alameda County grand jury has criticized the Alameda Medical Center for not managing the system’s finances. San Francisco’s Department of Public Health should be proud of how it manages its budget, even in times of budget difficulties. 5) PRESENTATION OF THE EMERGENCY MEDICAL SERVICES (EMS) ANNUAL AWARDS Commissioner Monfredini presented the annual Emergency Medical Services awards. EMS FIELD PROVIDER AWARD TO: Niels Tangerlini, EMT-P, San Francisco Fire Department For incredible accomplishments initiating and assisting programs to serve the homeless, the elderly, and children at risk for asthma, and as a talented educator. EMS HOSPITAL PROVIDER AWARD TO: Joanne Handley, RN, St. Mary’s Medical Center For outstanding performance, integrity and problem-solving talents as an ED nurse, and for tirelessly providing guidance for improving the EMS system. EMS COMMUNITY SERVICES AWARD TO: Connie Berry, Mayor’s Office of Emergency Services & Homeland Security For selfless and outstanding performance as the dedicated Chief of the Auxiliary Communications Service and for restoring confidence in a valuable asset for the City. EMS DISPATCHER AWARD TO: Louise Lopez, Emergency Communications Dept. For outstanding performance as a trainer and dispatcher and for exceptional talent in troubleshooting the transition to medical call taking by police dispatchers. RAYMOND LIM EXCELLENCE IN EMS AWARD TO: Chris Wachsmuth, RN, San Francisco General Hospital Medical Center For outstanding performance and leadership throughout a distinguished career as a talented manager, and visionary for hospital emergency medicine & aeromedical access. 6) BEHAVIORAL HEALTH UPDATE Bob Cabaj, M.D., Director, Community Behavioral Health Services, presented an update on Community Behavioral Services. Major initiatives in the past year have been: integrating Mental Health and Substance Abuse; Wellness/Recovery model implementation; dialectical behavioral therapy; community perspective/proper level of care; advanced access; and MHSA/Proposition 63 planning. Dr. Cabaj presented data on services and client populations. He also updated the committee on the status of on-going programs, including: OBOAT continues and expands beyond the pilot Buprenorphine added as a treatment options Methadone Van – successful operation at two sites. Police Trainings Reverse Staff Experience with the Police Collaborative projects with the Police such as studying suicides and prior police contacts AB 2034 continues successes Single Point of Responsibility Med Impact – pharmacy benefits manager and medications for indigent patients Dr. Cabaj described the Children’s System of Care, which includes initiatives such as gun violence prevention, SafeStart initiative, the High Quality Child Care Mental Health Consultation Initiative and the Homeless Children’s Mental Health Initiative. New Initiatives/Programs Alternatives Grant shows success in reducing re-institutionalization in African-American men discharged from IMDs Methamphetamine Treatment/Intervention Fire setting Prevention, Education and Treatment Project Horizons Dual Diagnosis Day Treatment Program Post Traumatic Stress Disorder Clinic Collaboration with Mental Health Association Enhanced services for with women with HIV Active CBHS involvement in Project Connect New Medication Use Improvement Committee replaces old P&T Committee Commissioners’ Comments Commissioner Tarver asked Dr. Cabaj to elaborate on CBHS’s transgender services. Dr. Cabaj said a program at the Castro Mission Health Center provides direct counseling to transgender people and consulting to primary care staff that work with transgender people. The Center for Special Problems has a specific transgender track with psychotherapy and other interventions for transgender clients. Theoretically a transgender person could get care anywhere in the system because staff are trained, but they recognize that people prefer to go to people with expertise in their area. Commissioner Tarver asked if there is a process to recruit and retain transgender therapists. Dr. Cabaj said they do try to recruit, and this is definitely a category of interest. Commissioner Tarver asked what the goals were for the SPR program in terms of clients graduating from this program. Dr. Cabaj said that they have set a goal of 17 percent turnover within one year. This is not always easy to do because clients are so dependent on the care. They are looking at a step-down process so a person is still tied to the program, but not receive the same level of care. Commissioner Tarver asked what approaches are used to streamline placements within the system of care. Dr. Cabaj said there used to be multiple admission screenings for every level of care, each one different for each program. CBHS now uses a standardized evaluation tool that looks at the symptoms and presentation of particular individual to match them with a level of care, and this is applied uniformly throughout the system. Commissioner Tarver emphasized the need for the CBHS MIS system to be compatible with Primary Care and the rest of DPH. Commissioner Illig urged CBHS to have a role in the Mayor’s Long Term Care Coordinating Council so that the behavioral health perspective is represented. He asked if CBHS is evaluating any of the budget proposals that related to the restructuring of CBHS, even if these proposals are not included in the Mayor’s budget. Dr. Cabaj replied that it is clear that methadone and the rest of the substance abuse system needs to be put through an RFP process. He would like to tie this effort to the Mental Health Services Act, but the sequence will depend on the proposed budget. Commissioner Illig asked what the outcomes are for substance abuse residential treatment. Dr. Cabaj said that CBHS is developing more performance-based outcomes, rather than just looking at deliverables. There are outcomes per contract, but this is not ideal. Commissioner Illig asked how CBHS interacts with Project Homeless Connect. Dr. Cabaj replied that the two major avenues for dealing with these clients are methadone and intensive case management. Commissioner Chow said that there is a lot of good data for services to children and youth, but he is still unclear what the department’s goals are for these services, and what the unmet needs are in the community. The report has great data for looking at a picture in time. Dr. Cabaj said that Proposition 63 asks the same questions, in terms of unmet needs. They are currently trying to answer this question, and exploring this with consultants. Commissioner Guy said the Department has made inroads with decreasing waiting times for services. The integration is a strategic goal for the Health Commission. She is interested in the question of unmet need and the impact Proposition 63 will have. She asked if the cultures of substance abuse and mental health have coalesced. Dr. Cabaj said cultural norms are finally changing, but this will take time. The change agent group has been the driving force. 7) PRESENTATION OF EMS SYSTEM CAPACITY ASSESSMENT AND REPORT John Brown, M.D., EMS Medical Director, presented the EMS System Surge Capacity and Capability Assessment undertaken this year by the EMS and Emergency Operations Section of the Health Department. This assessment of health preparedness, focusing on the emergency medical care system, was done in conjunction with the preparation of the Health Resources and Services Administration 2005 grant application, and has also been useful in obtaining Urban Area Security Initiative grant resources to improve hospital and EMS preparedness. The assessment describes the work that each hospital facility and the other EMS providers have done in preparing for a disaster, whether related to a natural or terrorism event, and the areas where there is a gap in system preparedness. The assessment used HRSA benchmarks and looked at hospital bed surge capacity, personnel surge capacity for decontamination procedures, hospital personnel for 24/7 surge operations, personal protective equipment, decontamination systems, trauma and burn care and pharmaceutical cache. Dr. Brown discussed the gaps that exist in each area. In conclusion, Dr. Brown said the San Francisco EMS System has surge capacity gaps in the areas of essential personnel, essential equipment, personal protective equipment, decontamination capabilities, pharmaceuticals, communications and training. Recommendations Use information to predict system needs during DOC activations and plan for MCI/Disaster response operations Continue system gap analysis by monitoring key categories for gap reductions Continue support for SFGH air medical access Pursue continuation of grant funding to help with closing readiness gaps Dr. Brown acknowledged and thanked the hospitals, clinics and ambulance providers for the hard work they have contributed to this important assessment and for their continued support of disaster preparedness in our health care system. Commissioners’ Comments Commissioner Tarver asked how participating hospitals test the assumption that they would achieve 100% call back during a disaster. Dr. Brown said that this should be incorporated into the planning exercises and would give them a range. Commissioner Tarver asked if there is a mechanism for immediate privileges to provide services at other hospitals. Dr. Brown replied that San Francisco’s policy is to have physicians report to an incident commander or go to a volunteer reception area and present a current license and photo identification. This gives them the emergency credentialing to provide basic life support. What they are working toward is have advanced credentialing of personnel that would be responding to disasters. Commissioner Chow said there are certain gaps that are easy to close and others that are more problematic and costly. He asked if the gap analysis assumes that hospitals would have to meet staffing mandates. Ms. Garay replied that normal staffing ratios would apply even during an emergency. Commissioner Chow asked how hospitals would deal with a personnel shortage. Dr. Brown said the first approach is to work with regional partners with the hope that the disaster would not affect all regions equally. The other aspect is to bring in Federal medical disaster teams. Dr. Katz added that one of the take home points is what to do when there are not enough of the resources that are needed. The goal is understanding this ahead of time so people can thoughtfully develop the next best solution ahead of time. Commissioner Illig asked if there is a companion assessment for the region. Dr. Brown replied that the HRSA grand requires this, so as other counties finish theirs they will be able to marry the data. This will be key to regional planning. Commissioner Illig suggested that the boards of each of the hospitals in San Francisco get a copy of the assessment. Commissioner Guy asked what the Health Commission should pay closest attention to in the next year. Dr. Brown said the Commission should continue to monitor the gaps that have been identified and support efforts to obtain grant funding to close these gaps. He also asked for continued Commission support for air medical access. The Health Commission would be helpful in encouraging other City departments to participate in planning and hospitals to continue their emergency response drills. Commissioner Monfredini said there is a greater chance of a natural disaster than a terrorist attack, and this planning and equipment is applicable to many types of disasters. The Health Commission can immediately support requests for critical equipment. However, it is important to remember that some situations cannot be planned for. 8) PUBLIC COMMENT/OTHER BUSINESS Michael Sullivan – 150 word summary submitted; see attached. Shirley Bierly, Senior Action Network and California Legislative Council for Older Americans, asked the Health Commission to find funding for the CHIPPS (Community and Home Injury Prevention Project for Seniors) Program. This program assists many people in San Francisco and allows seniors to maintain their independence. The program needs $145,500. Vittorio D’Angeli, Dimensions Clinic, said without the support of the Castro Mission Health Center, Dimensions would cease to exist. He urged the Health Commission to consider this when considering any budget cuts to Castro Mission. George Williams, Senior Action Network, said the CHIPPS program gave his wife more time living independently. He was able to care for her at home rather than sending her to an institution. The CHIPPS program taught him what to do. Danzel Cohen, representing Balboa High School Teen Clinic, came to the meeting because he thought the clinic was going to be closed. He has learned that it is not going to close, so he thanked the Health Commission for having these kinds of services. Jonathan Morales, student at Balboa High School, said the teen clinic has helped him a lot. Belindah Lee, member of the Youth Advisory Board for the Balboa High School Teen Clinic, said the clinic has helped her a great deal, especially with mental health services and primary care. She hopes that there will be more campus services. 9) ADJOURNMENT The meeting was adjourned at 6:00 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. Written Summaries of 150 Words of Less that have been Submitted by the Members of the Public Michael Sullivan, Item 8, Public Comment – Please request that the Board of the Laguna Honda Foundation reconsider its decision to suspend the work of the Foundation. I do not know why Louise Renne is shutting down the Foundation. I heard it’s about the uncertainty of the hospital rebuild. The Foundation’s mission goes well beyond the rebuild. The by-laws clearly state the purpose of the Foundation is to “support healthcare, including research and education at Laguna Honda Hospital.” I’m sure there are many projects that need funding as we wait on the rebuild decision. Closure can’t be about money, staff presented the Board with a solid, doable budget for FY 05-06. If the Foundation is suspended it may never get off the ground again. $325,000 in probable grants will not be given to a suspended foundation. I do not know the real reason the Foundation is being shut down. You will have to ask Louise Renne why.