Minutes of the Health Commission Meeting Tuesday, July 19, 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 - left at 5:00 p.m. Commissioner Edward A. Chow, M.D. Commissioner James M. Illig Commissioner David J. Sanchez, Jr., Ph.D. Commissioner Donald E. Tarver, II, M.D. Commissioner John I. Umekubo, M.D. Absent: Commissioner Roma P. Guy, M.S.W., Vice President Lee Ann Monfredini announced that she has appointed Commissioner Tarver to the Laguna Honda Hospital Joint Conference Committee and the San Francisco Breast Care Community Advisory Committee. There will be some restructuring of the Joint Conference Committees in the next 30 days, and she will announce additional committee assignments when they are made. Commissioner Monfredini announced that the August 2nd Health Commission meeting is cancelled. Commissioner Monfredini announced that the St. Luke’s Prop. Q hearings regarding their proposed closure of the inpatient psychiatric unit are scheduled for September 6th and September 20th. She noted that Proposition Q requires two hearings, one to take public testimony and one for the Health Commission to take action. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF JUNE 21, 2005 Action Taken: The Commission approved the minutes of the June 21, 2005 Heath Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE (3.1) DPH-Central Admin. – Request for approval of a retroactive contract renewal with San Francisco Community Health Authority, in the amount of $8,810,383, to provide universal health insurance services targeting San Francisco children ages 0 through 24, for the period of July 1, 2005 through June 30, 2006. Commissioners’ Comments Commissioner Sanchez said this initiative was undertaken because the State program was not meeting the needs of young people in our community. He has mixed feelings about supporting an increase per child, rather than per family, because it will have an impact. Jim Soos said it was clearly the Department’s desire not to increase premiums, but unless they increased premiums to meet the State Healthy Kids program, they stand to lose $900,000 in federal funds each year. Mr. Soos added that the goal of the program is to make sure no family goes uncovered and premium assistance is available. (3.2) CHN-SFGH & LHH Facilities – Request for approval of fifteen renewal contracts with the following thirteen firms: Acker & Guerrero Roof Co., Inc., Agbayani Construction, Inc., Air Duct Cleaning Specialists, Birds Away/Pigeons Away, William Decker & Co., Elischer Construction, Inc., Galindo Installation & Moving Services, Monticelli Painting & Decorating, Inc., Pribuss Engineering, Inc., Steam on Wheels, United California Glass Co., Western Roofing Service Co. and Yerba Buena Engineering & Construction, Inc., and six new contracts with Lights On Wheels, Migale Painting Co., Mintie Corporation, Pioneer Contractors, Inc., Schram Construction, Inc. and SF Silver Glass & Mirror, to increase the total combined amounts by $1,747,000, from $2,678,000 to $4,425,000 to provide the Community Health Network intermittent, as-needed facility maintenance services above baseline civil service staffing for the period of July 1, 2005 through June 30, 2007. (3.3) PHP-Emergency Medical Services – Request for approval to accept and expend a grant from the State Emergency Medical Services Authority, in the amount of $127,272, to establish a Trauma and Burn Supply Cache, for the period of June 6, 2005 to October 31, 2005. (3.4) CHN-Primary Care Youth Programs – Request for approval to accept and expend retroactively a grant from the State Office of Family Planning, in the amount of $635,000, to support, enhance and expand health education services to youth in schools and community clinics/agencies, for the period of July 1, 2005 to June 30, 2010, and two sole source contracts with 1) Huckleberry Youth Programs and 2) Family Service Agency/TAPP program, in the amount of $26,121 and $5,000 respectively per year, for the same time period. (3.5) AIDS Office-HIV Health Services – Request for approval to accept and expend retroactively a new grant from the Centers for Medicare & Medicaid Services, in the total amount of $1,488,000, for the period of July 1, 2005 to June 30, 2006. (3.6) AIDS Office-HIV Health Services - Request for approval of the following five contracts funded with FY 2005-2006 Federal Center for Medicare & Medicaid Services (CMS) funds for $985,297 plus a 12% contingency of $118,236 for a total amount of $1,103,533 for the period of July 1, 2005 through June 30, 2006. Agency CMS Amount 12% Contingency Total Amount Mission Neighborhood Health Center $250,000 $30,000 $280,000 Positive Resource Center $150,000 $18,000 $168,000 Quan Yin Healing Arts Center $106,351 $12,762 $119,113 UCSF AIDS Health Project $203,946 $24,474 $228,420 UCSF Positive Health Practice $275,000 $33,000 $308,000   $985,297.00 $118,236.00 $1,103,533.00 Comments Commissioner Illig asked if this is the money that Congresswoman Pelosi obtained for San Francisco. Ms. Long said it was. Commissioner Illig asked and if there were any restrictions on the funding. Ms. Long said there were surprisingly few strings attached to this grant. Commissioner Illig asked who decided how the funding would be allocated to this targeted population. Ms. Long said many of the contractors were part of the last Congressional earmark and were doing a good job. In addition, through a variety of forums the AIDS Office had heard of the desire for additional complementary therapies. (3.7) AIDS OFFICE-HIV Health Services - Request for approval of a contract modification with Shanti, in the amount of $179,734, for a total 2-year contract amount of $889,457 ($305,563 for year one and $583,894 for year two), to provide HIV Health Services Planning Council Support services, for the period of March 1, 2004 through February 28, 2006. Public Comments Randy Allgaier, chair of the HIV Health Services Planning Council, provided information and clear up confusion about the current Planning Council Support allocation and contract. His statement is on file in the Health Commission office. Charles Ceron, co-chair of the HIV Health Services Planning Council, provided testimony on the activities and successes of the Planning Council. He became involved in the Planning Council to take control of his life and give hope to himself and others. He urged the Commission to take a look at the work of the council and how it has benefited the community. Staff is important to making good decisions. Laura Thomas, member of HIV Health Services Planning Council, said that the council is better staffed, better supported and better trained than it has been in the past 15 years. She urged to Health Commission to approve the proposed funding allocation. She looks forward to the opportunity to return to a future Health Commission meeting to provide more information about what the Planning Council does and how it prioritizes services. Commissioners’ Comments Commissioner Chow thanked Shanti and the Planning Council for responding to the questions that were raised by the Health Commission, and helping Commissioners understand why the administrative increases were necessary. He is pleased to understand the various levels of work the Planning Council has done. He noted that administrative costs are always under a microscope, and that has included the Department of Public Health for the past three years. He wanted to be sure that the agency was being sensitive about increasing administrative cuts during a time of service reduction. Commissioner Illig said it is important for the Health Commission to be more educated about what the Planning Council does. His concern was that the administrative costs were being increased at the same time that services cuts were being made. He believes the scope of work for the Council needs to be expanded, and asked Ms. Long to comment on her opinion about the Planning Council becoming an advisory body for all funds, rather than just CARE funds. Ms. Long said that the Planning Council’s priorities are considered in all the work that the AIDS Office does, there is good communication between the AIDS Office and the Planning Council and there is no disconnect between what the Planning Council discusses and the work of the Department. Commissioner Illig suggested that the Planning Council present to the Joint Conference Committee after they have developed their priorities and funding allocation. Commissioner Sanchez said the dialogue is important and supports a presentation to the Joint Conference Committee. It is important that there be a cohesion between the CARE dollars and the rest of the AIDS Office programs. (3.8) AIDS Office-HIV Health Services - Request for approval of a retroactive contract renewal with AIDS Emergency Fund, in the amount of $604,400, plus a 12% contingency of $72,528, for a total amount of $676,928, to provide emergency assistance grants to low income HIV+/AIDS individuals, for the period of March 1, 2005 through February 28, 2006. (3.9) AIDS Office-HIV Health Services - Request for approval of a retroactive contract renewal with Westside Community Mental Health Center, Inc., in the amount of $182,511, plus a 12% contingency of $21,901, for a total amount of $204,412, to provide attendant care and homemaker services targeting HIV+ residents of San Francisco, for the period of March 1, 2005 through February 28, 2006. (3.10) AIDS Office-HIV Health Services - Request for approval of a retroactive contract renewal with Immune Enhancement Project, in the amount of $111,633, plus a 12% contingency of $13,396, for a total amount of $125,029, to provide complementary therapy services targeting severe-needs persons diagnosed with HIV/AIDS disease, for the period of April 1, 2005 through February 28, 2006. (3.11) AIDS Office-HIV Health Services - Request for approval of a retroactive contract renewal with Community Awareness and Treatment Services, in the amount of $191,450, plus a 12% contingency of $22,974, for a total amount of $214,424, to provide residential treatment, which includes housing, food, HIV and substance abuse counseling, linkage to primary medical care, transportation and recreational activities to substance abusing, HIV-infected, indigent male adult residents of San Francisco, for the period of March 1, 2005 through February 28, 2006. (3.12) AIDS Office-HIV Health Services - Request for approval of a retroactive contract renewal with Community Awareness and Treatment Services, in the amount of $189,245, plus a 12% contingency of $22,709, for a total amount of $211,954, to provide supportive housing, stabilization, counseling, case management and psychological support services to improve the accessibility, timelines and continuity of care for HIV+ women and transgender residents of San Francisco, for the period of March 1, 2005 through February 28, 2006. (3.13) AIDS Office-HIV Prevention - Request for approval of a contract modification with UCSF AIDS Health Project, in the amount of $73,000, to extend the contract term and increase the contract total to $146,000, to provide training services to HIV Prevention providers, for the period of January 1, 2005 through December 31, 2005. (3.14) AIDS Office-HIV Prevention - Request for approval of a retroactive contract renewal with Harder+ Company Community Research, in the amount of $117,303, plus a12% contingency of $14,076, for a total amount of $131,379, to provide technical support to the HIV Prevention Planning Council, for the period of January 1, 2005 through December 31, 2005. Commissioners’ Comments Commissioner Chow noted that the support for the HIV Prevention Planning Council was 1.2 percent of the total allocation, which is comparable to the HIV Health Services Planning Council’s level of support. Commissioner Illig asked how staffing of the Prevention Planning Council differs from that of the HIV Health Services Planning Council. Mr. Tierney replied that the AIDS Office still provides staff support to the HIV Prevention Planning Council—it is a combined staffing model. (3.15) PHP-Housing & Urban Health – Request for approval of a renewal contract with Baker Placer, Inc., in the amount of $1,688,439, which includes a 12% contingency, to provide a payment emergency housing, targeting homeless DPH clients at Single Room Occupancy hotels, for the period of July 1, 2005 through June 30, 2006. Commissioners’ Comments Commissioner Chow asked how the agency addressed areas that needed improvement. Jonathan Vernick, Executive Director of Baker Places, said it has been a long road, but the agency has a new fiscal officer and has restructured the fiscal department. Commissioner Illig expressed concern about the relatively small number of board members. Mr. Vernick agrees that they need to expand the board and he expects to move forward on that. (3.16) PHP-Housing & Urban Health – Request for approval of a renewal contract with Mercy Services Corporation, in the amount of $582,936, which includes a 12% contingency, to provide property management services in a Direct Access to Housing site, targeting homeless, extremely low-income persons with special needs, including substance abuse, mental health and physical disabilities, for the period of July 1, 2005 through June 30, 2006. (3.17) PHP-Housing & Urban Health – Request for approval of a renewal contract with John Stewart Company, in the amount of $2,036,508, including $984,300 in Tenant Rental Income, to provide property management services serving the Direct Access to Housing sites, for the period of July 1, 2005 through June 30, 2006. (3.18) PHP-Housing & Urban Health – Request for approval of a multi-year renewal contract with San Francisco AIDS Foundation, in the amount of $2,582,483, which includes a 12% contingency, to provide full and partial rental subsidies, targeting people with disabling HIV or AIDS, for the period of July 1, 2005 through June 30, 2009. (3.19) PHP-Housing & Urban Health – Request for approval of a renewal contract with Tenderloin Neighborhood Development Corporation, in the amount of $524,477, which includes a 12% contingency, to provide supportive housing services, targeting homeless seniors, for the period of July 1, 2005 through June 30, 2006. (3.20) PHP-Housing & Urban Health – Request for approval of a multi-year renewal contract with Catholic Charities CYO, in the amount of $1,347,612, which includes a 12% contingency, to provide supportive services in a residential, permanent housing environment at the Peter Claver Community, targeting homeless, low-income adults with HIV/AIDS, for the period of July 1, 2005 through June 30, 2008. (3.21) PHP-Housing & Urban Health – Request for approval of a multi-year renewal contract with Caduceus Outreach Services, in the amount of $206,434, which includes a 12% contingency, to provide case management, psychiatric treatment and policy advocacy services, targeting homeless adults, for the period of July 1, 2005 through June 30, 2007. (3.22) PHP-Housing & Urban Health – Request for approval of a multi-year renewal contract with Homeless Children’s Network, in the amount of $100,687, which includes a 12% contingency, to provide individual, family and group counseling as well as crisis intervention and response to very low income residents living with HIV/AIDS and/or disabling physical, substance abuse and/or mental health problems at the Senator and the San Cristina Hotels, for the period of July 1, 2005 through June 30, 2008. (3.23) PHP-Housing & Urban Health – Request for approval of a renewal contract with Lutheran Social Services, in the amount of $144,993, which includes a 12% contingency, to provide third-party rent payee services to residents of the Department of Public Health’s Direct Access to Housing sites, for the period of July 1, 2005 through September 29, 2006. (3.24) PHP-Housing & Urban Health – Request for approval of a new contract with Richmond Area Multi Services, in the amount of $1,331,770, which includes a 12% contingency, to provide permanent supportive housing services in a residential care environment at the Broderick Street Adult Residential Program, targeting homeless adults, for the period of July 1, 2005 through June 30, 2006. (3.25) PHP-STD Prevention & Control – Request for approval of a retroactive contract renewal with PHFE Management Solutions, in the amount of $193,850, plus a 12% contingency of $23,262, for a total amount of $217,112, to provide fiscal intermediary services for the Syphilis Prevention Project, for the period of January 1, 2005 through December 31, 2005. (3.26) PHP-STD Prevention & Control – Request for approval of a retroactive contract renewal with PHFE Management Solutions, in the amount of $65,115, plus a 12% contingency of $7,814, for a total amount of $72,929, to provide fiscal intermediary services for the YUTHE Chlamydia Awareness Project, for the period of January 1, 2005 through December 31, 2005. (3.27) PHP-CHPP-AAHI – Request for approval of a renewal contract with Bayview Hunters Point Health and Environmental Resource Center, in the amount of $504,221, to provide health and wellness services, for the period of July 1, 2005 through June 30, 2006. Commissioners’ Comments Commissioner Chow asked if there would be specific outcome objectives related to things such as a decrease in asthma rates or cancer rates. Ms. Smyly said there are specific outcome objectives, which she will provide through the Health Commission Executive Secretary. (3.28) PHP-CHPP-AAHI – Request for approval of a renewal contract with Black Coalition on AIDS, in the amount of $351,920, to provide fiscal agent and support services to the African American Coalition for Health Improvement and Empowerment as the community partner for the DPH African American Health Initiative, serving African Americans city wide, for the period of July 1, 2005 through June 30, 2006. (3.29) CHP-Primary Care – Request for approval of a retroactive contract renewal with San Francisco Bar Association, in the amount of $316,747, to provide Supplemental Security Income application assistance to the chronically homeless and mentally ill in San Francisco, for the 26-month period of May 1, 2005 through June 30, 2007. (3.30) BHS – Request for approval of a contract renewal with The Tides Center, in the amount of $57,120, to provide primary care services in its Women’s Community Clinic, for the period of July 1, 2005 through June 30, 2006. Action Taken: The Commission (Chow, Illig, Monfredini, Sanchez, Tarver, Umekubo) approved the Budget Committee Consent Calendar. Commissioner Umekubo abstained from voting on Item 3.1. Commissioner Sanchez abstained from voting on Item 3.6 as it pertains to UCSF and abstained from voting on Item 3.13. Commissioner Tarver abstained from voting on Item 3.15. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Budget Status Update On June 30th, the Budget and Finance Committee of the Board of Supervisors approved the FY 2005-06 budget for submission to the full Board. Compared with the 04-05 budget, the General Fund has increased $39.5 million. This amount includes $13.9 million of add-backs by the Budget and Finance Committee, consisting of $11.4 from the General Fund and $2.5 in departmental revenues. Also included in the $39.5 million is funding for the nurses MOU and the SRO Collaboratives. Programs that had been cut in the Mayor's budget that were restored consist of $1.6 million for HIV/AIDS programs, $2.6 million for the SFGH Dialysis Unit, $0.4 million for the residential substance abuse beds, $3.3 million for outpatient substance abuse, $0.1 million for the Sheriff's Jail Recovery and Education Programs, $0.8 million for the pharmacy co-pay, and $1.8 million for at-home nursing. Several of the FY 2004-05 mid-year cuts were restored including $1.1 million for the single standard of mental health care, and $0.8 million for at-home nursing, and $0.1 million for the SRO family support collaborative. Additional funding was added to the budget consisting of $1.6 million to back-fill the reductions in the FY 2005-06 CARE grant, $0.1 million to implement the Asthma Task Force's recommendations, and $0.6 million for peer-based harm reduction for the homeless in the Tenderloin. The full Board of Supervisors met today and considered the above budget. In addition to approving the budget, the Board added $1,000,000 to HIV/AIDS for augmenting existing services, and $937,705 to continue the Worker’s Compensation Clinic. Citywide the Board increased the Minimum Compensation Ordinance to $10.50 an hour. This will affect DPH contractors who will have their contracts increased to pay for this augmentation. Also, the Board approved $3,280,000 for senior services and long term care reserve in the Department of Human Services. However, these dollars will help many of our clients as well. The Board also restored funding for the full pharmacy co-pay, so there will be no co-pay for people below 100% FPL. Commissioner Guy Among 1000 Women for Nobel Dr. Katz congratulated Commissioner Roma Guy whose name was included among a project entitled “1,000 Women for the Nobel Peace Prize 2005.” The names of all 1,000 nominees for the project, which seeks to recognize the work of women as peacemakers, was announced at press conferences all over the world on June 29th. Commissioner Guy’s nomination appropriately recognizes her as a social justice activist and policy leader in public health, women's rights, poverty, and homelessness, who has worked all her adult life to improve conditions for women. She helped found the San Francisco Women's Building, and developed community-based institutions including a battered women's shelter and a family resource center. Coauthor of "Historical Perspectives on Homelessness, The Police and the Homeless", she has helped to redefine housing as a public health issue and has developed an innovative curriculum at San Francisco State University. The project’s team is putting together a book about the lives, strategies and visions of all the nominees and a 1,000 postcards exhibition with photos, short biographies and testimonies. For more information, a website has been established at www.1000peacewomen.org. Five-Alarm Fire in the Mission District A fire broke out in the Mission District July 8th at 2:30 a.m. that quickly went to five-alarms. The fire impacted three apartment buildings on 16th Street across from Mission Dolores. A total of 31 apartments were damaged and 66 people left homeless. A temporary shelter was set up at Mission Delores. DPH was notified at 4:20 a.m. and Charlie Morimoto responded to assist at the scene. It was fortunate that no one was seriously injured. Six people received minor injuries primarily due to smoke inhalation. Some people were on medications, which were successfully retrieved from the apartments. Most of the residents had family or friends for temporary housing. A total of seventeen people were given vouchers for temporary stay at the Oasis Hotel. The Department of Human Services is providing case management services to assist those left homeless to locate permanent housing. Evaluation of HIV Testing Published A Center’s for Disease Control & Prevention (CDC) study performed in collaboration with the San Francisco Department of Public Health and four other cities showed the successes of San Francisco’s efforts to promote HIV testing. The study focused on the outcome of unrecognized HIV infection (persons who are found to be HIV-infected in venue-based screening who did not know that they were infected.) Dr. Katz reported that San Francisco had the lowest rate of unrecognized HIV infection as shown below. This indicates that we are doing a better job than other cities in getting high-risk persons in for HIV testing.   HIV prevalence and proportion of unrecognized HIV infection among men who have sex with men by city Unrecognized HIV infection City Total tested No. % Baltimore 462 115 (62) Los Angeles 382 31 (42) Miami 222 19 (46) New York City 336 32 (52) San Francisco 365 20 (23) YouthPOWER Project to Redecorate Liquor Stores on Third Street Students from the YouthPOWER Project at the Thurgood Marshall Academic High School redecorated five corner stores on Third Street by replacing alcohol advertisements with positive pictures of the Bayview Hunters Point community and San Francisco. These youth also painted walls and provided signs stating it is illegal to sell alcohol to minors. Students will start this project on July 18th and finish by July 30th. Surveys completed by YouthPOWER Project found an average of 20 alcohol advertisements inside these stores. Removing some or all of the alcohol advertisements will decrease the influence these ads have on young people to drink. Likewise, putting positive pictures of the Bayview Hunters Point community will make the interior of these stores more pleasant for young customers. On July 18th YouthPOWER received numerous press coverage. Reporters and cameras from Fox Channel 2, ABC Channel 7, and NBC Channel 11 interviewed and filmed the youth. Reporters and photographers from the SF Chronicle and SF Examiner also came. YouthPOWER is a program through the SFDPH - Community Health Education Section to reduce youth alcohol, substance use and violence in Bayview Hunters Point. For more information, please contact Ana Validzic at 415/581-2478 or ana.validzic@sfdph.org. Project Homeless Connect 6 The next Project Homeless Connect is scheduled for Friday, August 5th. As the Commissioners know, Mayor Newsom’s Project Connect has been a highly successful series of events attracting thousands of volunteers. Those who give their time to the event—which includes private citizens, City staff and corporate employees—spend the day assisting individuals who are homeless connect to a variety of services. This next event will feature two new partners, the San Francisco Food Bank and San Francisco Bar Association’s Volunteer Legal Services Program. The Food Bank will be providing a bag of food containing fruits, energy bars and other grocery items to every client that attends Project Homeless Connect 6. The Volunteer Legal Services Program (VLSP) will provide free legal aid, improving the legal services at all Project Homeless Connect events. As it has done at all Project Homeless Connect events, the Department will be well represented by both volunteers and staff working out of our programs. Energy Balance Kick-Off “Energy Balance”—a new labeling program at SFGH Cafeteria, designed to help visitors, patients and staff make informed choices at the cafeteria line—made its debut Thursday, July 7th. The main goal of this health promotion campaign is to provide cafeteria patrons with information that will help them make informed dietary choices by providing labels on all of the food items that answer the following questions: “How many calories, how much saturated fat and how much sodium are contained in the cafeteria selections?” Cafeteria selections that contain less than 500 calories, 7% saturated fat and 1,000 mg of sodium are awarded an “Energy Balance” logo. By using this information in combination with education on balancing calorie consumption and exercise, cafeteria patrons have a good foundation to build on a healthy lifestyle for themselves and their families at work and at home.   Community Health Network, San Francisco General Hospital, Credentials Report July 2005 07/05 07/05 to 07/05 New Appointments 13 13     Reinstatements 0 0 Reappointments 39 39     Delinquencies: 0     Reappointment Denials: 0 Resigned/Retired: 24 24 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Deceased 0 0 Changes in Privileges     Additions 7 7     Voluntary Relinquishments 3 3     Proctorship Completed 4 4     Proctorship Extension 6 6 Current Statistics - as of 07/1/05 Active Staff 463 Affiliate Professionals (non-physicians) 197 Courtesy Staff 549 TOTAL MEMBERS 1,209 Applications In Process 48 Applications Withdrawn Month of July 2005 0 0 (07/05 to 07/05) SFGH Reappointments in Process Aug. 2005 to Nov. 2005 166   Commissioners’ Comments Commissioner Monfredini asked what cuts remain to the Health Department. Dr. Katz said they lost dollars for administration and operation, travel and a small amount for equipment. Overall, the Department sustained very few cuts. It has been a tumultuous budget season, with the largest swing in recent memory between the proposed budget reductions and the actual budget reductions. Commissioner Monfredini thanked her fellow commissioners for having an exemplary process and sending a prioritized budget list to the Board of Supervisors. She also congratulated Commissioner Guy for being nominated for the Nobel Peace Prize. Commissioner Illig is thrilled with the budget restoration, but the process is absurd. It is unacceptable that clients need to fear losing services, come to public hearings, write letters, etc. just to have cuts be restored. People must speak to the leaders across the street, and urge them to do things differently. Commissioner Chow said budget process, particularly the prioritization process, allows additional scrutiny and oversight of the various divisions of the Department of Public Health and allows the Commission and public to evaluate outcomes. So even though the end result for the Health Department was quite different, the process was not fruitless. Commissioner Tarver noted that the mid-year budget cuts have had an impact, which should be acknowledged. He has requested information about how the administrative budget cuts have impacted the number of African American staff. He also recommended that the Department and Commission get ahead of the curve for next year’s budget, to plan for the time when the budget situation would be improved, and develop Health Commission priorities for restoration. Commissioner Umekubo said Commissioners never get used to hearing the impact of budget cuts through public testimony. Each decision he made was very difficult, and if he had his choice he would not have cut any programs. But the process necessitated that the decisions be made, and it was an educational process. He is delighted that this year the Department came out all right. Commissioner Sanchez is pleased with the restorations, but emphasized that we are still not at the level that would allow for total success. He thanked everybody who came to the various public meetings to express their opinions, concerns and opposition. That fact that the whole community gets involved in this process demonstrates that democracy is alive and well in San Francisco. 5) PRESENTATION OF THE EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF JULY Commissioner Sanchez presented the employee recognition awards for the month of July. Individual Awardee #1 Division Nominated By Wanda Materre, Health Worker Community Behavioral Health Services Mrs. Knight, CBHS Client Individual Awardee #2 Division Nominated By Brenda Walker, Director of Budget & Finance AIDS Office Jimmy Loyce, Michelle Long 6) CONSIDERATION OF A RESOLUTION APPROVING THE STRATEGIC ALLIANCE’S RECOMMENDATIONS ON HEALTHY FOOD AND PHYSICAL ACTIVITY Christina Carpenter, Health Promotion Consultant, Community Health Promotion and Prevention Branch, presented the Strategic Alliance’s recommendations on healthy food and physical activity. The Alliance’s recommendations are important for several reasons: They present a platform for Governor Schwarzenegger’s summit on Obesity and Physical Activity that he is holding on September 15, 2005. At this summit he will engage a range of industries and agencies and ask them to commit to taking action to create healthier settings Californians. They help set directions/guidance for a wide range of entities for significant and important change as it relates to creating safe, healthy and active environments for our communities. The strategies outlined are in alignment with the Health Department’s Prevention Strategic Plan and the Department’s Strategic Plan goals. They build on the work of the Childhood Nutrition and Physical Activity Task Force Recommendations that the Health Commission endorsed in January of this year. The Citywide Chronic Disease Prevention Consortium supports these recommendations. These recommendations are forward thinking and far reaching, supporting our efforts as we develop primary prevention and policy level responses to this epidemic of obesity, physical inactivity and associated chronic diseases. If adopted, the Health Department will be the first to formally support these recommendations, helping set the stage for California to be a leader in supporting healthy communities. Additionally, Supervisor Maxwell will introduce a resolution supporting the Alliance recommendations to the Board of Supervisors for endorsement as well. Leslie Mikkelsen, Managing Director of the Prevention Institute, said the context of the recommendations is that instead of focusing on individual lifestyle choices, environment and culture must be taken into consideration. The primary goal is to create environments where healthy options are the easy options. She highlighted some of the recommendations: Provide equitable access to public facilities Improve access to healthy foods Implement and adopt “Complete Streets” policies Eliminate food marketing to children Public Comment Dr. Philip Ziring, DPH MCH pediatrician, spoke in support of the Strategic Alliance recommendations. Of primary concern among his colleagues the prevalence of obesity in children. The resulting health impacts are going to be very expensive. It is very difficult for local governments to take on the entire universe that impacts healthy eating. He encouraged focusing on families of very young children through childcare centers, family day care, etc. Jeffrey Sterman, Kaiser Permanente, urged the Commission to be forward thinking about these recommendations, as it has been with tobacco and AIDS programs. San Francisco should be at the forefront and Kaiser stands at the ready to be a partner in this effort. Commissioners’ Comments Commissioner Monfredini said the reality is that McDonald’s often looks really good to working mothers and fathers who have to get dinner after picking their kids up from daycare. She believes in this effort, but there has to be recognition that parents are exhausted. Are there health education programs available to people to help them in this area? Mr. Sterman said that Kaiser has a number of health education programs and he will commit to talking with Kaiser’s health education department to develop a specific curriculum around this area. Ms. Carpenter added that the Health Department does some cooking demonstrations in the community. Commissioner Sanchez said DPH has been involved in a number of innovative healthy food programs in the school. The challenge is to sustain these programs, because at the same time other efforts are being eliminated due to budget cuts. This is an exciting effort, but needs to be based in reality. Commissioner Chow suggested amending the resolution to endorse the Strategic Alliance principles, upon which the recommendations are based, and commend the specific recommendations to the Governor’s Summit for discussion. Commissioner Tarver encouraged consideration of other ideas such as healthy worksites, flexibility during the workday to exercise, and other things. There are opportunities to have a more healthy culture without costing a lot of money. Commissioner Umekubo, as a family practitioner, struggles with this issue with patients every day. Education is very important, but so is the environment. He and others are looking for ideas and best practices, which hopefully will come out of the Governor’s Summit. Action Taken: The Commission (Chow, Illig, Monfredini, Sanchez, Tarver, Umekubo) amended the resolution so that the last Further Resolved clause reads, “that the Health Commission supports the principles of the Strategic Alliance to promote healthy food and activity environments; and commends the Taking Action recommendations to the Governor’s Summit for consideration. Action Taken: The Commission (Chow, Illig, Monfredini, Sanchez, Tarver, Umekubo) approved Resolution 11-05, “Endorsing the Principles of the Strategic Alliance: ‘Taking Action for a Healthier California,’” as amended (Attachment A). 7) PRIMARY CARE UPDATE Michael Drennan, M.D., Director of Primary Care, presented the 2005 Annual Report for Community Oriented Primary Care (COPC). Dr. Drennan said there have been many changes to COPC due to reorganizations, budget reductions and other factors. A number of people have new roles and he is pleased to bring this update to the Commission. COPC is a synthesis of primary care, community medicine and public health. Principles include primary care, a defined population, organized methods to assess communities, programs targeting health needs of the community and involvement by the community. Dr. Drennan described COPC staffing as well as the demographics of COPC’s target population, including age, ethnicity, gender, neighborhood, insurance status and primary language. He then discussed COPC in terms of the Department of Public Health’s Strategic Plan goals. In terms of access to care, COPC provides personal health services and population based services. Examples include linkage with primary care physicians, expanded health services, street and community outreach, tuberculosis screening and nutrition education services. In 2003-2004, there were 121,411 medical provider encounters and 210,074 total encounters at the health clinics. This is an increase over the previous year, so even with the changes, the clinics have been able to improve efficiency and provide more encounters. Dr. Drennan described primary care’s quality improvement efforts. Dr. Lisa Johnson is the new director of this effort. The 2005 focus is to update and streamline policies and procedures and reporting forms, including the establishment of requirements for mandatory morbidity review. They are also holding “QI 101” workshops, and providing health center-specific consultations. Dr. Drennan described COPC’s finances in terms of revenue and payor sources. There has been an emphasis on revenue enhancements efforts, including improved PFS efforts to target lost collections, improve payor source linkage, feedback to staff, billing, compliance training, and the establishment of a Revenue Enhancement Committee chaired by the DPH CFO. New revenue initiatives have been approved for FY 05-06 include expanded podiatry and expanded primary care nurse practitioners in mental health clinics. Chronic Disease Care Improvement Activities include three chronic disease care conferences in the past years, diabetes monitoring reports, chronic disease collaboratives for diabetes at Chinatown, Silver Avenue, Potrero Hill and the Family Health Center at SFGH, and IDEALL (a DM and language, literacy program). They also have the eye van and an access enhancement grant. Dr. Drennan updated the Commission on various activities related to the integration of primary care and behavioral health services, as well as efforts to end health disparities. Future Challenges Strategic Planning renewed April 2005, with multi-year plan due December 2005. Access to care for unaffiliated individuals – specific efforts target the Emergency Department, Urgent Care Clinic and SFGH discharge, Jail Health and mental health and substance abuse programs. Loss of the Patient Referral and Assistance Program at SFGH. This has had an impact getting people connected to primary care. They are partnering with the San Francisco Community Clinic Consortium on the 10,000 referral project. There is improved COPC referral information, and they have provided expanded access to the lifetime clinical record to help providers determine if a patient is already connected to a clinic. Open Access Scheduling. Potrero Hill and Castro Mission have had pilot programs since February 2003. At these clinics the no show rates have been cut in half and productivity has increased. This has been a great system change and they are looking at implementing at other clinics. Patient Visit Redesign. The goal is to decrease total patient visit time to improve productivity, patient and staff satisfaction. Capital Improvements Chronic Disease Management Challenges – sustaining gains made through Primary Care Indicators Project – promoted by Dr. Katz Reducing preventable emergency room and institutional care Emergency Preparedness in COPC Commissioners’ Comments Commissioner Sanchez thanked Dr. Drennan for his comprehensive overview of this very complex system. Commissioner Chow said the Commission has been waiting a number of years to see the vision for primary care. This report provides a cohesive vision. He is interested in the new quality improvement efforts, and asked where the Health Commission would be involved in the quality review process. Dr. Drennan said currently COPC reports through the PIPS committee at SFGH. COPC makes an annual report to the PIPS Committee. In addition, Ms. Garcia is reinventing quality improvement within Community Programs with the goal of developing better linkages. Commissioner Chow would like additional oversight, above and beyond the annual report. He asked the President to work with Dr. Katz and Dr. Drennan to determine the best forum for more consistent quality assurance oversight. Commissioner Umekubo said that Primary Care is discussed in various QI meetings at SFGH, but there is not a lot of discussion at the monthly Joint Conference Committee closed sessions. He would welcome more involvement. Dr. Katz said there are two levels of quality review. One is the regular review of quality measures and quality initiatives, which are most appropriately discussed at the CPS Joint Conference Committee, or at whichever JCC primary care is represented. The other quality issue is review of sentinel events, which are less common. These are reviewed through the PIPS structure and would be discussed, if necessary, at the SFGH Joint Conference Committee. Commissioner Chow asked how the Department is working with the Community Clinic Consortium. Dr. Drennan noted that the Consortium Clinics now have access to the Lifetime Clinical Record, which was a major advance. Dick Hodgson from the San Francisco Community Clinic Consortium said they are ramping up the 10,000 referrals project, with the goal of implementing it over 18 months. Commissioner Tarver said there are serious access challenges. Many of the health centers have a 90-day waiting list for appointments, and some do not have capacity for new patients. He would like to get periodic updates on the results of the various efforts that are underway to improve access. Dr. Lisa Johnson said one of the challenges is getting accurate data about the cohort of clients that are served by a particular provider at a particular clinic. Better data would allow for more efficient service of current clients, which would open space for new clients. Commissioner Tarver encouraged the sharing of best practices at the various clinics, because different clinics try different things. He also emphasized the need to recruit and hire clinicians of color. Commissioner Illig said there needs to be a stronger linkage between DPH clinics and the community clinics because they serve the same people. Perhaps there could be cross evaluation between different clinics. He also recommended that staff begin analyzing potential budget reduction scenarios now, so that if next year the Department is in the same fiscal situation, we are not forced to bring last minute recommendations like closing a clinic. Dr. Katz said that while there is more to be done with community clinics, a lot of steps have been taken over the past few years. Community Clinic Consortium patients get pharmaceutical, radiology, obstetrics and specialty care services from DPH. Dr. Katz would also like to evaluate efficiencies on number of visits and number of unduplicated clients, rather than just waiting times. Mr. Hodgson said there are more and more people coming through the door, and the entire system is struggling to meet the need. Commissioner Chow would also like Primary Care leadership to inform the Commission about where they would like to rebuild, in the event the opportunity arises. Commissioner Sanchez said the Department is fortunate to have such effective primary care leadership, because the infrastructure has been reduced over the past number of years. 8) UPDATE ON SUPERVISOR DALY’S PROPOSED CHARTER AMENDMENT ESTABLISHING BASELINE FUNDING FOR THE DEPARTMENT OF PUBLIC HEALTH AND CONSIDERATION OF A RESOLUTION REGARDING THE CHARTER AMENDMENT Scott Boule, Assistant Director of Policy and Planning, provided an overview of a charter amendment that Supervisor Daly has proposed that establishes baseline funding for the Department of Public Health. It establishes an Emergency Health Care Services Fund that would be separate from all other city funds. Resources from the Fund would be available for all aspects of the Department’s operation or to pursue the goal of universal health care. Fiscal Year 2004-05 would serve as the base year and, starting in FY06-07, the Fund would receive a General Fund appropriation equal to funding provided for DPH during the base year. DPH’s General Fund appropriation that year was $231 million. In addition, the Department received $8.4 million in supplemental funds and $26.5 million was appropriated for jail health services, bringing total base year funding to $259.9 million. Each year, that amount would be adjusted by the percentage increase or decrease in aggregate City and County discretionary revenues. All other public health funds from any source, including state and federal sources or a dedicated local sales tax would go into the Fund as well. The charter amendment allows for adjustments to the base, and specifies how this happens. Supervisor Daly has also proposed an increase in the sales tax to generate additional revenue specifically for health services. Supervisor Daly believes that adding this Charter Amendment makes passage of the dedicated sales tax more likely by assuring voters that the additional revenue generated for public health from the sales tax will not be offset by reductions in amounts from the General Fund. On July 7th, the Rules Committee forwarded this Amendment without recommendation to the full Board. It is being considered today. The deadline for inclusion on the November ballot is July 29th. Public Comment Dick Hodgson, San Francisco Community Clinic Consortium, said the Community Clinic Consortium supports this proposal with one caveat. They would like to see a clearer definition of community-based providers, and clarification about the specific role of the Consortium Clinics. Commissioners’ Comments Commissioner Illig is torn by this proposal. On the one hand, this would solve the problem of annual budget tug of wars that the Health Department engages in. On the other hand, this would take 25 percent of the discretionary funding off the table, and prohibit any discussion about important competing issues. Commissioner Tarver supports the effort to provide parameters to support public health, and he is supportive of the charter amendment. Commissioner Chow said the charter amendment runs contrary to the idea that the elected legislative body is responsible for determining budget allocations to meet the needs of the community. At the same time, the budget process is often irrational, and Health Commission deliberations and recommendations are often not heeded. That said, he believes it is up to the people to determine through the election whether this is something they want. Commissioner Sanchez also has mixed feelings about the proposal, but the bottom line is that the Health Department needs more resources. Commissioner Umekubo supports the amendment because it ensures adequate funding for public health. Action Taken: The Commission (Chow, Illig, Sanchez, Tarver, Umekubo) approved Resolution 12-05, “Supporting Increased Fiscal Authority for the Health Commission and Department of Public Health and Supporting the Concept of Stable, Predictable and Adequate Funding for Health Services,” (Attachment B). 9) UPDATE ON PROPOSED REGULATIONS TO MEDICAL CANNABIS DISPENSARIES Scott Boule, Assistant Director of Policy and Planning, presented an overview of two pieces of medical cannabis legislation that are pending before the Board of Supervisors. Currently, there is an interim zoning moratorium throughout the City on clubs or dispensaries where marijuana is grown, purchased or distributed with a medical recommendation. Supervisors Mirkarimi and Sandoval have both introduced legislation to create permanent guidelines for Medical Cannabis dispensaries that would replace the interim measure. Supervisor Mirkarimi’s legislation has a direct impact on the Health Department, significantly expanding its role in the regulation of medical cannabis. It requires that medical cannabis dispensaries obtain a permit to operate from DPH, which will cost $7,396. This fee will cover the cost of administering the program. DPH would then copy and send the applications to the San Francisco Police Department for criminal background checks on applicants, the Department of Building Inspection and Fire Department for relevant code compliance and security inspections, and the Planning Department for Planning Code compliance. When these departments have completed their review and returned the applications to DPH, the Department would hold a hearing to determine whether the permit application complied with City policy. Applications that meet City standards will be approved at the hearing. DPH would be responsible for issuing regulations governing the operation of dispensaries, including requirements that dispensaries provide specific information to patients, prohibit alcoholic beverages and require employees to use protective gloves when handling cannabis. The Mirkarimi legislation also limits possession and dispensary profits, hours, sale of drug paraphernalia and other aspects of operation, and requires that dispensaries have a business license costing $2,182 annually and a business registration certificate from the City. The Health Department would also be responsible for inspecting dispensaries at least twice per year, assuring the accuracy of dispensaries' scales and issuing fines and suspensions for violations. The final decision of the Director of Health to grant, deny, suspend or revoke a permit, or to impose administrative sanctions could be appealed to the Board of Appeals. Both the Mirkarimi and Sandoval bills address zoning, amending the Planning Code to prohibit dispensaries in residential-house and residential-mixed zoning districts and implementing additional restrictions based on a dispensary's proximity to schools, neighborhood centers, drug treatment centers, other dispensaries and other entities. Supervisor Mirkarimi would give existing dispensaries 18 months to obtain a permit, and Supervisor Sandoval would allow only 12 months to do so. Both bills will likely be heard in committee sometime in August before being passed to the full Board for consideration. Staff will keep the Commission apprised of the legislation as it moves forward. Commissioners’ Comments Commissioner Illig said the medical aspect of marijuana has already been established, DPH does its part, and there is no reason for the Department to be further involved. The rest of the issue is in the purview of zoning, planning and land use. He suggested sending a letter to the Board supporting Supervisor Sandoval’s legislation and opposing Supervisor Mirkirimi’s legislation. Dr. Katz said that the Health Department wants to maintain access to cannabis. However if DPH is charged with regulating the entire system, it takes away from the primary mission of the Health Department. Commissioner Chow said that both pieces of legislation come from a well-meaning attempt to address concerns from constituencies about the proliferation of dispensaries. However, if the Health Department is to play a larger role, the Board of Supervisors has to recognize that it would have an impact on the already lean DPH workforce. We should urge the Board to focus on simplicity and recognize the Health Department’s mission. Commissioner Tarver is concerned about adding an entirely new bureaucracy to the Department of Public Health. 10) PUBLIC COMMENT/OTHER BUSINESS None. 11) ADJOURNMENT The meeting was adjourned at 6:45 p.m. Michele M. Seaton, Executive Secretary to the Health Commission