Minutes of the Health Commission Meeting Tuesday, October 18, 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 3:10 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, MD. Commissioner David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF OCTOBER 4, 2005 Action Taken: The Commission approved the minutes of the October 4, 2005 Heath Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Illig chaired and Commissioner Chow and Commissioner Sanchez attended the Budget Committee meeting. (3.1) PHP-Housing and Urban Health – Request for approval of a contract renewal with Episcopal Community Services, in the amount of $507,863, which includes a 12% contingency, to provide supportive housing services at the Folsom-Dore Apartments, targeting homeless adults, for the period of September 30, 2005 through June 30, 2007. (3.2) PHP-Housing and Urban Health – Request for approval of a contract renewal with Catholic Charities CYO, in the amount of $74,779, which includes a 12% contingency, to provide case management services targeting homeless or marginally housed families living with HIV/AIDS with dependent children and a concurrent substance abuse and/or mental health diagnosis, for the period of July 1, 2005 through June 30, 2006. (3.3) PHP-Housing and Urban Health – Request for approval of a new sole source contract with Plaza Apartment Associates, L.P., in the amount of $379,617, which includes a 12% contingency, to provide studio apartments at the Plaza Apartments, targeting homeless adults, for the period of November 1, 2005 through June 30, 2006. Additionally, this contract includes eight annual renewal options valued at an average annual amount of $702,337, for a total nine-year contract of $5,998,314, which includes a12% contingency, and an end date of June 30, 2014. Commissioners’ Comments Commissioner Sanchez asked why this is a nine-year contract. Erin Carlson from the Redevelopment Agency said the tax credit guidelines require the building to be maintained as a non-profit development for 15 years. The building owner wants to be sure that the partnership is for a long time, so that he is not penalized for violating the terms of the tax credit. Commissioner Illig asked who owns the building after the tax credit expires. Ms. Antonetty said the tax credit is set up so that after the 15 years, the building ownership reverts to the non-profit partner. Commissioner Illig confirmed that the DPH subsidy plus rent paid by tenants covers the operating costs. Ms. Antonetty said yes. Commissioner Chow asked if there is an occupancy limit per unit. Ms. Antonetty said they have developed criteria around this that largely mimics the Redevelopment Agency’s criteria. For example, a unit can house up to two adults and one child under a certain age, or one adult and an older child, or two adults. Given the fact that most of the tenants will come from the DPH system, many will be single adults. Commissioner Illig said many more of these projects are needed. This is permanent housing. Ms. Antonetty said that this is a unique opportunity because the building is brand new. There are other exciting developments in the works as well. (3.4) CHPP-Health Promotion – Request for approval of a contract modification with San Francisco Study Center, Inc., to extend the funding period to June 30, 2007 and increase the contract in the amount of $1,817,025, to provide additional fiscal sponsor services for the Tobacco Free Project Community Capacity Building Training Center, for a total contract value of $2,729,371, for the period of July 1, 2005 through June 30, 2007. Commissioners’ Comments Commissioner Illig said the Commission is very concerned about outcomes, particularly the quit rates. He thanked Ms. Hrushow for providing this data. Some people think that cessation programs do not work, but the data shows otherwise. Commissioner Chow said these projects clearly make sense, and the fiscal intermediary has assisted in making these initiatives successful. Commissioner Chow and Commissioner Illig reiterated that when the Commission considers a fiscal intermediary contract, staff needs to provide information and outcomes on the program that the intermediary is administering. (3.5) CHPP-Community Health Education Section – Request for approval of a retroactive contract renewal with Youth Leadership Institute, in the amount of $121,318 for two years, to provide technical assistance and training services for the YouthPower Project to support the youth-driven Community Action Teams to reduce substance abuse in their community, for the period of October 1, 2005 through September 30, 2007. Commissioners’ Comments Commissioner Illig asked what the community action teams do. Ms. Ana Validzic said the teams are made up of high school and middle school students, and they do a variety of things. For example, last year a group of students went to liquor stores and were successful in getting owners to remove liquor posters and put up other, youth-created posters. The participants receive a youth stipend. Commissioner Sanchez said the School District has a peer mentoring program. He encouraged Ms. Validzic to contact the district to see that are efforts are consistent and complementary. Commissioner Chow said that client satisfaction applies to this contract, even though the contract summary indicates that it does not. It is very important that the Commission and the public know that the participants think highly of the program. Commissioner Illig noted that none of the YLI boardmembers live in San Francisco, and there are no African Americans on the board. He is particularly concerned about the latter, given that one of the target neighborhoods is Bayview Hunters Point. He asked the agency representative to convey this to the Board of Directors. (3.6) CHPP-Refugee Health – Request for approval of a retroactive contract renewal with the International Institute of San Francisco (IISF) in the amount of $251,783 to provide preventive health services, including outreach, medical interpretation, health education and referrals to documented refugees immigrants for the period of October 1, 2005 through September 30, 2006. (3.7) CBHS – Request for approval of a retroactive modification to the contract with Resource Development Associates, in the amount of $172,907, for a total contract amount of $408,422, to provide consulting services to develop the Mental Health Services Act (Proposition 63) plan, for the period of February 8, 2005 through September 30, 2005. Secretary’s note – the contract term is through January 31, 2006, not September 30, 2005 as noted in the contract summary documents. (3.8) CBHS – Request for retroactive approval of a contract renewal with Positive Resource Center, in the amount of $420,000 per year, for a total contract value of $1,680,000, to provide advocacy and training services for disabled, uninsured clients, for the period of July 1, 2005 through June 30, 2009. (3.9) AIDS Office-HIV Health Services – Request for approval of a retroactive contract renewal with Mission Neighborhood Health Center, in the amount of $92,027, to provide case management, treatment advocacy and nutrition counseling services targeting HIV positive Latinos, for the period of July 1, 2005 through February 28, 2006. (3.10) CHN-SFGH & LHH – Request for approval of two contract modifications with On-Call Therapists, Inc. and Preferred Healthcare Registry, Inc., to increase the shared contract amount by $164,900, from $232,075 to $396,975, to provide intermittent, as-needed rehabilitation therapy personnel services (Physical, Occupational and Speech Therapists) for San Francisco General Hospital and Laguna Honda Hospital, for the period of February 1, 2005 through January 31, 2007. (3.11) CHN-Education & Training – Request for approval of a retroactive contract renewal with HealthStream, Inc., in the amount of $496,250, for healthcare training courseware for employees and partners of the Community Health Network, for the period of September 1, 2005 through August 31, 2009. Commissioners’ Comments Commissioner Chow asked if the completion of the mandatory training is reflected in employee evaluations. Riley Surber from San Francisco General Hospital replied that completion of training is tied to annual performance reviews. Action Taken: The Commission approved the Budget Committee Consent Calendar. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. FAST TRACK Emergency Exercise Last Wednesday, October 12, the Department participated with other City agencies in a terrorist exercise called “FAST TRACK.” The exercise was designed and planned by the Homeland Security Units of various departments to test the City’s response to multiple violent incidents occurring within a short time period. The City’s EOC (Emergency Operations Center) the DPH DOC (Department Operations Center) and SFGH Emergency Center were activated and staff were informed of what was happening in the City. Anne Kronenberg worked closely with the Mayor’s office at the EOC in helping to coordinate the Department’s role and response. The event allowed DPH to test a number of scenarios including large group injuries and mortalities and communication models between agencies and within our own Department. DHP also had to address the matter of Surge Capacity and the need for Mutual Aid, including how to move large groups of patients to regional partner counties. We continue to learn from these exercises and expand our responses accordingly. Infectious Disease Emergencies The "Infectious Disease Emergencies: A Preparedness and Response Guide for San Francisco Clinicians" is a tool designed to help with San Francisco's communicable disease control efforts. The Sentinel Event Enhanced Passive Surveillance (SEEPS) project developed and published the Guide to help clinicians prepare for, recognize and respond to infectious disease emergencies. The Guide describes the roles and responsibilities of the SFDPH and clinicians during infectious disease emergencies, outlines which diseases and conditions clinicians should recognize and report, provides detailed clinical and infection control information on priority diseases including bioterrorism related diseases, and provides guidance for getting prepared for general disasters and infectious disease emergencies. The guide also contains forms, regulations, and contact numbers. The infectious disease chapters include Anthrax, Avian Influenza, Botulism, Brucellosis, Smallpox, Tularemia, Viral Hemorrhagic Fevers, and Plague. Each chapter includes detailed information on: epidemiology, clinical Features, differential diagnosis, laboratory diagnosis, treatment and prophylaxis, environmental testing, and infection control. Disease chapters will be updated as needed and additional disease chapters will be added in the future. The Guide is being distributed to 3,000 San Francisco clinicians registered with the health alert notification database. This includes emergency rooms, infection control practitioners, ambulance companies, jails, family practice doctors, nurse practitioners, disaster workers, and others. The guide will also be distributed to police, fire, Office of Emergency Services, and other city agencies as appropriate. The entire guide is available for download on our website: www.sfdph.org/cdcp . Updates and revisions will be posted there as well. State Medical Cannabis ID Program In compliance with recent state legislation, the Health Department is initiating a State Medical Marijuana ID card program beginning November 7th . This statewide card will replace the local DPH card program, which has been registering medical cannabis patients since 2000. The new card program will move from 101 Grove to the lobby at San Francisco General Hospital. In preparation for the change over, Dr. Joshua Bamberger will be hosting a Community Forum to discuss the specifics of the new card program. The meeting is scheduled for October 24th, 6 p.m. in Room 300 here at 101 Grove St. We anticipate a lot of interest among the medical cannabis community as this new program evolves. Update on San Francisco Medical Cannabis This afternoon the Board of Supervisors is considering Supervisor Mirkarimi’s proposed ordinance to create permanent guidelines for Medical Cannabis dispensaries. An interim zoning moratorium on clubs or dispensaries where marijuana is grown, purchased or distributed with a medical recommendation has been in effect since April 1st. The ordinance being considered today would require that medical cannabis dispensaries obtain a permit to operate from DPH. DPH would then copy and send applications to the Police Department for criminal background checks on applicants and security inspections, Fire Department for relevant code compliance and the Planning Department for Planning Code compliance. After these departments have completed their review and returned the applications to DPH, a hearing would be required within 45 days to determine whether the permit application complies with City policy. Applications that meet City standards would be approved at the hearing. DPH would also be responsible for issuing regulations governing the permitting and operation of dispensaries, and for inspecting dispensaries at least twice per year, assuring the accuracy of dispensaries' scales, and issuing fines and suspensions for violations. If passed, the ordinance would give existing dispensaries 18 months to obtain a permit. The Board will also consider a separate bill today that sets a permit application fee of $6,110 to cover the costs to all City departments of investigating and processing applications and an annual license fee of $3100 to cover the cost of annual inspections, enforcement and other costs to the City. 2005 Public Managerial Excellence Awards Congratulations to Diana Guevara, Director of Patient Financial Services, on being selected as a recipient of the 2005 Public Managerial Excellence Award. MFAC (the Municipal Fiscal Advisory Committee to the Mayor), the San Francisco Chamber of Commerce, and SPUR will honor Diana and six other honorees at the 25th anniversary MFAC Awards Luncheon on Wednesday, December 7th . The awards provide an opportunity to salute leadership, innovative spirit, achievements and success to outstanding city managers. Flu Season Kicks Off The Department kicked off flu on October 5th with a media event at the Adult Immunization Clinic here at 101 Grove St. DPH encouraged seniors and those at risk to get flu shots early and reminded the public about the simple prevention techniques all of us can employ to stay healthy such as hand washing and covering coughs and sneezes. The CDC is recommending that those most vulnerable to the flu get immunized by October 24th when the vaccine will be made available to the general public. At this point, we are unsure how today’s Chiron announcement about their flu vaccine shortage will affect local supplies. Dr. Katz will keep the Commissioners informed as we move into flu season and the demand for vaccine increases. Sharps Containers at 101 Grove St. Dr. Katz recently directed the facilities manger of 101 Grove St. to install safe sharps containers in all restrooms here at 101 Grove St. The installation of these containers makes it convenient for anyone visiting or working here to dispose of needles safely and conveniently. Dr. Katz reported that these boxes are being used and are very much appreciated by those who must give themselves injections. In keeping with this Commission’s policy of harm reduction, he will encourage other facilities to install sharps boxes for safe needle disposal in restrooms as well. Acting Program Manager for LHH Rebuild Dr. Katz reported that the Department of Public Works has appointed Don Condon as Acting Program Manager during the transition period for the Laguna Honda Hospital Replacement Program. Don replaces Michael Lane who left earlier this month to accept a position with Kaiser Permanente in the East Bay. Two New HIV Health Services Grants Last week HIV Health Services received notification of two new grants. The first is a CARE Title III Capacity Development grant to develop an In-Depth Needs Assessment and Clinical Best Practices Development for HIV Positive Transgender Individuals. This grant funds a year-long development process that will result in the creation and implementation of the nation's first definitive set of clinical best practice guidelines specifically developed for the care of HIV-positive transgender populations. The program also includes a training component for providers in the best practices model. The other grant is from the Office of Minority Health, Community of Color Community-based Organization Capacity Building Project to implement an innovative project designed to enhance, strengthen and expand the skills, capacity and self-sustainability of people of color-based HIV/AIDS care and prevention organizations in the San Francisco-EMA. This three-year long project focused on basic infrastructure issues includes a user-friendly training model that incorporates organizational staff at all levels, broad-based, individualized technical assistance, and the development of a national training model. Commissioners’ Comments Commissioner Monfredini welcomed Dr. Katz back from Vietnam. Commissioner Umekubo commended staff for creating the Sentinel Event Enhanced Passive Surveillance (SEEPS) guide. Commissioner Tarver asked if there would be other disaster trainings. Dr. Katz said there would be others, and the current goal is one citywide exercise per month. Dr. Katz will receive debriefing reports after each event. Commissioner Tarver would like the Health Commission to hear some of the findings. Commissioner Tarver asked if DPH contractors are provided with sharps disposal kits or removal resources. Dr. Katz said he believes that any individual could go to a Walgreen’s and ask for a DPH sharps bucket, and return the bucket when they are done. He will see if this is the case for non-profit agencies as well. Also, a person could call a disposal hotline for assistance with removal. With the needle exchange program, DPH funds the removal of the dirty needles. Commissioner Sanchez said there have been so many disasters over the past few years. Disaster preparedness drills are critical. He noted that Judy and Richard Guggenhime wrote an editorial in the San Francisco Chronicle regarding the importance of air medical access in San Francisco. This resource is critical to San Francisco. Commissioner Guy would like the Population Health and Prevention Joint Conference Committee to monitor the State cannabis card program. She asked if the move to a State card is an improvement. Dr. Katz said the greatest improvement is that the card is valid throughout California. The downside is that the State has created a system that requires that part of the documentation be the physician’s letter. In addition, the name of the client will be included in the record. DPH currently does not keep patient’s names. 5) UPDATE ON CONTRACT MONITORING RECOMMENDATIONS FROM THE NON-PROFIT CONTRACTING TASK FORCE Anne Okubo, Deputy Director of Finance, gave update on the Health Department’s implementation of the Non-Profit Contracting Task Force recommendations. The Board of Supervisors created the task force in 2003. The task force was charged with reviewing city contracting policies and procedures and making recommendations to improve and streamline contracting processes. DPH is implementing the recommendations in two phases. Phase one focused on standardization. Standardized templates for the scope of work, budget and invoices were developed. Efforts to streamline contracts resulted in the contingency contract model, which was approved by the Health Commission and piloted in CBHS last year. The pilot proved to be successful and now the contingency contract model is used DPH-wide. The Contracts On-Line (COOL) system was developed as part of Phase one. COOL serves as a repository of contract documents that is accessible to both contractors and DPH. Recently DPH offered COOL to the Office of Contract Administration to implement the Task Force recommendation to increase automation and reduce redundancy. Phase two of the implementation is focused on joint monitoring of contracts, training of department staff and in the future, tiered assessment of contracts. The recommendation to facilitate electronic processing of contract payments will occur in Phase two. DPH initiatives have dovetailed with the task force recommendations. For example, the integration of CBHS has led to consolidated mental health and substance abuse contracts. Gregg Kats, Controller’s Office, updated the Commission on the work that has been done to implement the Task Force’s recommendations around streamlining the contract monitoring process, as well as the Controller’s Office’s broader efforts to support the City’s non-profit community. The goal is to ensure the fiscal integrity of the City’s system of health and human services provided by nonprofit contractors, and there are three key components: Streamline and standardize citywide nonprofit contract monitoring procedures and policies Ensure the finance-related preparedness of nonprofits through training and auditing Increase the efficiency of the contracting process, and strengthen the City’s ongoing partnerships with the nonprofit community Mr. Kats described the work that has been done around contract monitoring and streamlining, including upgrading systems, improving access to frequently-requested information, developing standardized fiscal and compliance monitoring procedures and establishing criteria and creating process for tiered assessment of contractors, among others. Next steps include training for nonprofit contractors and DPH staff on new policies and procedures for standard monitoring, reporting to the Board of Supervisor’s Government Audit & Oversight Committee, monthly interdepartmental working group meeting to share monitoring results and coordinate follow-up and ongoing collaboration with the Non-Profit Contracting Task Force. Debbi Lerman and Sandy Mori, representatives of the Non Profit Contracting Task Force, presented the Task Force’s perspective on the implementation of the recommendations. Ms. Lerman said the process began four years ago to address contractor frustration with the contracting process. The Task Force had equal representation from contractors and city staff. The Task Force meetings helped develop a mutual understanding of the problems and developed recommendations. The institution of the Review/Appellate Panel in January 2005 has helped to move the recommendations forward. Ms. Mori said the non-profit sector feels strongly about these recommendations and views this effort as a real partnership with the city. Ms. Mori acknowledged Ms. Okubo’s involvement in the Task Force as the DPH representative. Her knowledge and expertise has been extremely helpful. Ms. Mori said that training—of city staff and non-profit staff—is critical to success. While they appreciate the COOL system, it has some limitations and should be made available to all city departments. The non-profit representatives plan to request that the Board of Supervisors have quarterly reports, rather than reports every six months. Commissioners’ Comments Commissioner Illig was a member of the Task Force. The Task Force spent many hours making sure that departments, supervisors and the Mayor were educated in the problems non-profits experience in dealing with the city. The Health Commission needs to pay attention to the implementation of the recommendations, and should also be receiving regular reports. One recommendation that the Budget Committee is going to track is the recommendation that all contracts are certified before the start date. The DPH initiatives for 12% contingency and 18-month contracts will help meet this goal. He wants to make sure that all DPH divisions comply with these recommendations so that services can continue and providers can be paid. He emphasized that the Health Commission and the Budget Committee is focused on outcomes. City departments need to improve coordination by standardizing forms, monitoring and other things. Commissioner Tarver asked if any of these recommendations are going to be applied to the civil service side of the Department. Commissioner Illig said that the Budget Committee is going to focus on outcomes of City programs as well. Commissioner Tarver asked if this process would allow the Department to better monitor the expenditure of grant funds, to ensure that money is spent the way it is supposed to be. Ms. Okubo said that State and Federal grants are part of the audit function, and through this process they know whether money is spent the way it was supposed to be spent. Commissioner Tarver asked if outcomes are going to be standardized. Ms. Okubo said the standardizing program monitoring is by far the most difficult and is still a work in progress. The Controller has been working very closely with DPH to standardize program monitoring, and they are close to developing a format that will focus heavily on qualitative outcomes. Commissioner Tarver looks forward to updates on this effort. Commissioner Sanchez said that this truly is a change in culture. Many non-profits have contracts with other entities, for example philanthropic organizations or state and federal governments, each with different requirements. In addition, non-profits receive different levels of technical assistance. So this is a challenge. Commissioner Chow was impressed with the June 2003 Task Force report. The recommendations provide a light at the end of the tunnel. He said the tiered assessment of contractors should acknowledged size and volume differences among agencies. The outcomes and client feedback are critical elements of program review done not only by the Budget Committee but also by the joint conference committees. Commissioner Guy appreciates the leadership around this issue, including Ms. Okubo, Mr. Sass and Commissioner Illig. Over the next three months she wants to understand how the Health Commission can support this transformation. She is interested in what training works and what does not. Commissioner Guy looks forward to the Budget Committee’s leadership on this, particularly in helping frame the issues the joint conference committees should focus on. Commissioner Illig asked that every time this issue gets reported to the Board of Supervisors, there is a report to the Health Commission on the Health Department’s progress. 6) BLUE RIBBON COMMITTEE ON SAN FRANCISCO GENERAL HOSPITAL’S FUTURE LOCATION REPORT AND CONSIDERATION OF A RESOLUTION ACCEPTING THE REPORT Gene O’Connell presented the report from the Blue Ribbon Committee on San Francisco General Hospital’s Future Location (SFGHBRC). Mayor Newsom created the SFGHBRC in May 2005 and charged it with making a recommendation on where SFGH should be rebuilt—on the existing Potrero Hill campus or at Mission Bay, collocating with UCSF. The committee was chaired by Dr. Sandra Hernandez and co-chaired by Dr. Mitch Katz. It met from June to September 2005. The criteria that was used to assess the locations were: Access and Service Issues: this criteria examines the impact of each location with respect to access to services (ambulatory, inpatient, specialty and emergency), care coordination and quality of care. Cost and Financing Issues: this criteria examines the impact of each location with respect to the costs (land acquisition, construction and operating) and financial mechanisms. Program Issues: this criteria examines the impact of each location with respect to faculty retention and recruitment, research facility needs and future space planning needs of each hospital. Neighborhood and Staff Issues: this criteria examines the impact of each location with respect to potential disruption arising for construction of a new hospital. The SFGHBRC’s consensus recommendation is that San Francisco General Hospital be rebuilt on the existing Potrero Hill campus. This recommendation is based on better access to services at Potrero, more coordinated access to service at the Potrero campus, the higher costs of building at Mission Bay and space limitation at Mission Bay. The SFGHBRC also made recommendations on future planning, including ascertaining whether a general obligation bond could be approved, identifying additional mechanisms for financing the hospital replacement and forming a planning and/or campaign committee in the immediate future. Issue for mitigation with a Potrero Location Reduce disruption from construction Medical helipad UCSF/SFGH Relationship, including UC’s acknowledgement that they are responsible for research and that it is their responsibility to develop a research facility at San Francisco General Hospital. Dr. Katz said that this was a very useful planning effort because it addresses the question about why the two hospitals do not collocate. This group of experts studied this question and the recommendation is to rebuild at Potrero, not to collocate. The report fully explains the rationale for this recommendation. So in terms of the rebuild, decisions have been made on the size, the scope and now the location. The next major decision has to do with where on the Potrero Campus. Staff has looked at a number of possibilities. Building on the north side of the campus is viable, but it would impact UC’s ability to rebuild the research facility. The west lawn site is also viable for discussion. There is a previously approved contract to develop architectural drawings for a west lawn building. In addition, there will need to be a broad-based citizen’s committee to help educate San Franciscans about this project. Commissioners’ Comments Commissioner Chow was a member of the Blue Ribbon Committee. It was an extraordinary process of bringing together a broad group of people to discuss this issue. No one on the committee felt stifled. The university was very frank about its needs, and people greatly appreciated this. With the frank discussion, the impartial members of the committee—and those who were wondering why the two institutions could not collocate—began to understand what was happening. Commissioner Chow is 100 percent behind the recommendation that came out of this process. Mission Bay is clearly not an option. We need to move forward, and we need to look at other potential funding sources. Commissioner Illig asked if retrofit was considered, rather than a rebuild. Dr. Katz said SFGH, while built to the seismic safety standards of the time, does not have any steel in it. The lack of steel makes it impossible to retrofit. This alternative was reviewed. Commissioner Chow added that these questions were asked and addressed at the Blue Ribbon Committee as well. Commissioner Illig asked how we arrived at 267 beds. Dr. Katz said that this number resulted from three methodologies: an internal assessment, and external assessment, and average daily census. It is based on the size we are currently running. Commissioner Illig said he lives in the neighborhood and would be happy to speak in support of a helipad at community meetings. Commissioner Guy noted that three commissioners live in the neighborhood. She applauded the committee for its work. She supports the point around exploring other sources of income in addition to a general obligation bond. She highlighted the point that UC acknowledged its partnership with SFGH, not only through the affiliation agreement, but also in research. The research component needs space, and this must be incorporated into the design. Commissioner Tarver commends the SFGHBRC on this report, and adds his support for the helipad. It makes him nervous that the city does not have air medical access. He said he would have been more vociferous if the decision had been made to separate acute psychiatric beds from the rest of the acute care hospital. It is critical that these services remain connected. He asked if there is a possibility that the psychiatric inpatient unit be incorporated into the new structure. Dr. Katz gave some background about why the State decided to exclude psychiatric beds from SB 1953. DPH had decided not to rebuild these beds. In terms of redesign, adding beds is a question of money. So the decision was made based on making the rebuild as affordable as possible. In both design scenarios, there will be some sort of bridge to the existing hospital. Ms. O’Connell said that they would continue having acute psych/med unit in the new hospital. PES will be part of the new building. Commissioner Tarver encouraged rethinking, even at a greater cost, of integrating hospital psychiatric services. Commissioner Tarver is concerned about specifying the number of beds in this resolution, given that there is still planning to be done. He recommended removing this from the resolution, as well as the statement about psychiatry wards staying at their current locations. Commissioner Monfredini asked Dr. Katz to incorporate Commissioner Tarver’s concerns into next steps. Commissioner Umekubo said the primary concern the medical staff brought to his attention was that the main reason they wanted to move to Mission Bay was the availability of and access to research space. Now that we have UC’s commitment to build research space on the Potrero site, he would like this to be monitored to see that comes to fruition. Action Taken: The Health Commission amended the resolution to remove the fourth whereas clause. Action Taken: The Health Commission approved Resolution 15-05, “Accepting the Mayor’s Blue Ribbon Committee on San Francisco General Hospital’s Future Location’s Recommendation to Rebuild SFGH at its Current Potrero Avenue Campus,” (Attachment A), as amended. 7) MENTAL HEALTH SERVICES ACT THREE-YEAR PLAN AND CONSIDERATION OF A RESOLUTION APPROVING THE PLAN Barbara Garcia, Deputy Director of Health, Director, Community Programs, presented an overview of the Mental Health Services Act three-year plan. MHSA Goals To define serious mental illness as a condition deserving priority attention To provide prevention and early intervention services and medical and supportive care To reduce long term adverse impact of untreated serious mental illness To provide consumer-driven, family-focused services To expand successful, innovative service programs The planning process was spearheaded by the Behavioral Health Innovations Task Force, which was comprised of 42 members appointed by the Mayor and met seven times in neighborhoods throughout San Francisco. There were 11 population-based subcommittees, each of which met six times to address five topics. Overview of the Draft Plan $5.3 million allocated for Community Services and Supports (CCS) Approximately $5 million for capital facilities, education and training, early innovation/prevention and innovative programs. 51 percent of CCS funds ($2.3 million) must be used for Full Service Partnerships. (122-153 individuals and families will be part of the initial FSP population.) 49 percent of CCS funds ($2.2 million) available for use in system develop and outreach and engagement activities. 15 percent of CCS funds ($795,000) allocated to administrative expenses. System Development Activities Prioritized by Task Force Children, Youth and Families – funding for community-based violence and trauma recovery services, integrating psychiatric services within pediatric settings, increasing capacity to serve LGBT, API, Indigenous, Latino and African American children, youth and families, and school-based services. Transitional Age Youth – funding to integrate behavioral health services within primary care settings, for supportive services, for outreach and engagement services, youth run and youth developed services. Adults – funding for supportive services for housing, vocational rehabilitation, support for peer-run center and residential treatment. Older Adults – funding to support a senior recovery center, supportive services for housing, and mental health services in primary care settings. Public Comment Belinda Lyon, Executive Director of the Mental Health Association, said the Mental Health Services Act is about more than additional money. It is about a true transformation of the system that is client-centered and recovery-oriented. She thanked DPH, particularly Barbara Garcia, for bringing such an extensive group of people into the planning process. The Mental Health Association will submit extensive comments to the Mental Health Board, but she wants to bring a few issues to the Health Commission’s attention. First, the language of the executive summary needs to be restated in the plan. Second, they need to make a plan for what they would do with additional money. Commissioners’ Comments Commissioner Monfredini thanked Ms. Garcia for her leadership on this issue. Commissioner Illig asked if the $5.3 million allocation is per year, or over three years. Ms. Garcia said it is per year, for three years. Commissioner Illig asked why the executive summary was not included in the plan. Ms. Garcia said the document is a grant application to the State, so they did not include the statement about underfunding need. However, San Francisco continues to work with the State on this issue. Commissioner Illig asked if all the funding would be put out to bid. Ms. Garcia said that DPH made a commitment to the group that the dollars would not be allocated automatically to DPH. So 75-80 percent of the dollars would be put out to bid, and the Health Department would compete through the bid process. Commissioner Illig was impressed with the plan’s consumer involvement, focus outcomes and inclusion of vocational rehabilitation. Commissioner Tarver is very impressed with the report and the extensive planning process that took place. He is sure that participants left the meetings feeling enlightened and encouraged. This report reflects San Francisco’s unique system of care that is culturally competent. This does not exist in other systems. He appreciates the focus on the impacts of violence and trauma. Vocational rehabilitation is an important component of treatment. Commissioner Chow commended the public, consumer-oriented process. He is somewhat concerned that the Asian American population is often silent in these processes, and he is concerned that they are not highlighted in this plan. Within a consumer-driven process, this is particularly exacerbated. He would like the Department to examine how to best serve the unique mental health needs of this population. DPH has excellent services, but there is additional need. He supports moving forward with this plan, but wants to be more proactive in surfacing the needs that come from the community. Ms. Garcia said that through the RFP process they would look at underserved communities, including the Asian community. This was very acknowledged within the task force. Commissioner Guy said the process was extensive but also anticipatory in a preventive way. She acknowledges the disappointment about the State allocation. $5 million is not going to fund a transformation. She would like to know how the expenditures, some of which are quite small, are going to be evaluated. Ms. Garcia said that what is before the Commission today is an application to the State for the allocation. But she strongly believes that the Department needs to use the work that was done to develop a plan for San Francisco that is not constrained by funding. Commissioner Sanchez applauded staff and community for the work that has been accomplished in a limited timeframe. Action Taken: The Commission amended the fourth whereas clause of the resolution to read: “Whereas, the community planning process was informed by more than 75 public meetings, targeted outreach to mental health consumers, families of consumers, historically unserved communities, including the Asian Americans, Latinos and Indigenous Population, and underserved communities, usage analyses and evidence based practices and policies;” Action Taken: The Commission approved Resolution 16-05, “Supporting the City’s Application to the State of California to Fund the Community Services and Supports Component of the Mental Health Services Act,” as amended (Attachment B). 8) PUBLIC COMMENT/OTHER BUSINESS None. 9) CLOSED SESSION A) Public comments on all matters pertaining to the closed session None. B) Vote on whether to hold a closed session Action Taken: The Commission voted to hold a closed session. The Commission went into closed session 6:15 p.m. Present in closed session were Commissioner Monfredini, Commissioner Guy, Commissioner Chow, Commissioner Illig, Commissioner Sanchez, Commissioner Tarver and Commissioner Umekubo. C) Closed session pursuant to Government Code Section 54957 and San Francisco Administrative Code Section 67.10(b) PUBLIC EMPLOYEES PERFORMANCE EVALUATION: EXECUTIVE SECRETARY TO THE HEALTH COMMISSION, MICHELE M. SEATON D) Reconvene in Open Session The Committee reconvened in open session at 7:15 p.m. 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).) Action Taken: The Commission voted not to disclose any or all discussions held in closed session. 10) ADJOURNMENT The meeting was adjourned at 7:15 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.