Minutes of the Health Commission Meeting Tuesday, April 4, 2006 at 3:00 p.m. 101 GROVE STREET, ROOM 300 San Francisco, CA 94102 1) CALL TO ORDER President Monfredini called the meeting to order at 3:10 p.m. Present: Commissioner Lee Ann Monfredini, President Commissioner James M. Illig, Vice President Commissioner Edward A. Chow, M.D. Commissioner Roma P. Guy, M.S.W., Commissioner David J. Sanchez, Jr., Ph.D. – left at 5:30 p.m. Commissioner Donald E. Tarver, II, M.D. – left at 5:30 p.m. Commissioner John I. Umekubo, M.D.< 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF MARCH 21, 2006 Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Tarver) approved the minutes of the March 21, 2006 Health Commission meeting. 3) DIRECTOR’S REPORT Anne Kronenberg, Deputy Director of Health, presented the Director’s Report. Supplemental Appropriations On Wednesday, March 22nd, the Budget and Finance Committee recommended approval of $1,127,000 in project funding to begin planning for the rebuild of San Francisco General Hospital. The total projected cost of planning, which will include design work and completion of the environmental impact report, is projected to cost $25,000,000 and will span two years. Additional funding for the 2006/07 fiscal year, which will enable the project to continue, will be considered as part of the 2006/07-budget process. This will enable the Department to complete detailed planning and provide accurate cost estimates to the voters when a General Obligation Bond is placed on the ballot. General fund appropriations for this project will be repaid from the proceeds of General Obligation Bonds when those bonds are approved by the voters and issued. On March 29th, the Committee also recommended approval of $1,755,000 for three projects at our neighborhood clinics. $450,000 will fund a workflow process improvement review at 12 clinics. $405,000 will fund wiring and data systems upgrades and exam room equipment at 6 clinics, and $900,000 will fund additional wiring at 9 clinics. The Board of Supervisor’s takes final action on these appropriations today. Mental Health Services Approves Community Services and Supports Plan Dr. Katz is happy to report that the California Department of Mental Health (DMH) has approved the Community Services Supports (CSS) three-year program and expenditure plan. This approval brings DPH the opportunity to begin spending funds from the November, 2004 voter-approved Prop 63, now known as the Mental Health Services Act (MHSA), which provides increased funding, personnel and other resources to support mental health programs for children, transition age youth, adults, older adults and families. The first round of approved funding covers the remaining three months of the current fiscal year. DPH has been authorized to expend $1.3 million for CSS programs and administrative costs, plus $1 million in one-time funding for items such as rent subsidies for transitional age youth, community violence and trauma recovery services and equipment to support two Access Team sites. On March 30th, the Department’s Community Behavioral Health Services (CBHS) division held a community forum to receive input from the public on how to use MHSA funds for peer-related services for adults. CBHS is holding an additional forum on April 7, 3-5 p.m. here at 101 Grove St., Room 300, to hear from the community on how to use peer-related funds for Children and Transitional Age Youth. DPH Response Team In an effort to provide counseling and assistance to families whose young members become involved in a violent incident, DPH has established a Response Team as a component of the Comprehensive Child Crisis Services. DPH has also obtained a dedicated blackberry for SFPD to notify DPH of woundings/homicides incidents and for SFGH to notify the Response Team when there are fatalities. Medical Director at Southeast Health Center Dr. Katz announced that Mark Ghaly, MD, has started as the Medical and Center Director at Southeast Health Center in the Bayview Hunters Point Community. Mark is a pediatrician with expertise in program development and providing care to low-income children. He is one of the founders of the Healing Arts Center in Bayview Hunters Point that serves teens and provides medical care as well as an array of other services and opportunities. The center is a collaboration of community groups, UCSF, and SFDPH. We welcome Mark to the Department and know he will make important contributions to our programs and patients. Journal Article Published Christina Goette Carpenter, Ginger Smyly, Iman Nazeeri-Simmons and Ana Validzic published an article in the Fall 2005 issue of the Journal of Community Youth Development describing the Youth Development Policy adopted by the Health Commission in 2004. The article, "Using Policy to Promote Youth Development" describes the background and rationale for the policy. It also provides an overview of the policy components. The article can be viewed on line at: http://www.cydjournal.org/2005Fall/carpenter.html. Chronicle Editorial Attached Dr. Katz attached to his report a March 23rd editorial from the San Francisco Chronicle that supports Assembly Bill 2560, which would require the state to establish a “Public School Health Center Program” to promote the concept of teen health centers in public schools. The Bill is being considered by the Assembly Health Committee today. Dr. Katz will inform the Commissioners of the outcome of the vote on AB2560 at the next Health Commission meeting. Commissioners’ Comments Commissioner Illig requested that the Department’s response to the proposal to establish a Community Living Trust Fund be presented at the next Health Commission meeting, either as part of the Director’s Report or as an agenda item. Commissioner Illig also requested an update on changes at Southeast Health Center at the next CHN JCC meeting. 4) PUBLIC HEALTH WEEK- 100th ANNIVERSARY OF THE 1906 EARTHQUAKE AND CONSIDERATION OF A RESOLUTION RECOGNIZING PUBLIC HEALTH WEEK Brian Katcher, Pharm. D., Public Health Pharmacist, CHPP, Community Programs, presented an overview of the DPH website that looks at the 1906 earthquake and fire and draws from it three public health stories, all of which underline the theme of what public health is. The three stories that emerged are care of the injured, sanitation and plague. The presentation included many pictures of the city after the earthquake, including the military hospitals that were set up at Golden Gate Park and camps set up all over town. Sanitation was a major problem, and there was a public health response, including the construction of emergency latrines. Everything was done to prevent a cholera outbreak, and efforts were largely successful. There was, however, a small typhoid outbreak. After the earthquake and fire there was a dramatic increase in the rat population, which led to 160cases of plague in 1907. There was a concerted effort to rid the city of rats, with the involvement of health officials, businesses, labor and ordinary citizens. Garbage ordinances were established and miles of concrete poured. The lessons learned were that, in each case, the local health authorities were able to promptly assess the nature of the problem, and the policies needed to address them and assure the right outcome required a broad collaboration with all sectors of society. Commissioners’ Comments Commissioner Monfredini commented on role of the military in 1906, noting both the Army and Navy were located here and could deploy quickly. This was an excellent report with wonderful pictures and stories. Commissioner Guy appreciates the report because it is important to look at our history, and appreciate how the definition of public health has changed. For people who are in the middle of struggles such as disaster preparation, health access, fitness, etc., it is not always easy to see the long-term outcomes. There were a lot of lessons learned from the 1906 earthquake and fire, which resulted in a number of positive changes. Commissioner Sanchez reaffirmed the commitment of those who responded to the 1906 emergency. This report highlights many of the interventions and collaborations that happened around the earthquake and fire. Many resources that were in place, such as military bases and VA hospitals, are no longer here. Building a helipad for medical airvac services is critical. He also noted that the report illustrates that San Francisco was and is a city of immigrants. San Francisco has always been about living and sharing and facing challenges together. Commissioner Illig said many healthcare institutions are looking back and celebrating their history. He commented on the importance of making decisions based on science instead of fear. It bothers him that public health is getting hijacked by fear—bioterrorism, avian flu terrorism, etc. Commissioner Tarver commented on how disaster response varies when underrepresented communities are impacted, specifically Chinatown in 1900 and New Orleans in 2005, as compared with how disaster affected the mainstream in 1906. We always must be mindful that different communities are impacted by disaster differently and the Department should work proactively to prevent this from happening. Action Taken: The Commission approved Resolution #06-06, “Resolution Honoring Public Health Week, April 3-9, 2006,” (Attachment A). 5) DISASTER PREPAREDNESS/HOMELAND SECURITY UPDATE Anne Kronenberg, Deputy Health Director, Director, Office of Policy and Planning, Mary Ellen Carroll, Senior Health Planner and Susan Fernyak, M.D., Director, Communicable Disease Prevention and Control, presented an update on the work the Department has done around disaster preparedness and homeland security. Ms. Kronenberg said DPH has made every effort to do planning that is logical and addresses issues San Francisco is likely to face, rather than planning from fear. DPH is responsible for the medical response of a mass casualty incident, whether the result of human action or a natural event. DPH’s responsibilities fall into the following areas: emergency medical services; infectious disease emergency response; environmental hazard identification, assessment and response; community health services; and response to Chemical, Biological, Radiological, Nuclear and Explosive (CBRNE) events. Grant funding has allowed the Department to dedicate staffing to disaster preparedness activities and has driven the increase in planning, training and equipment related to disaster preparedness and response. The main sources of funding for these activities are Federal UASI, State Homeland Security, Centers for Disease Control, Cities Readiness Initiative and the HRSA National Bioterrorism Hospital Preparedness Program. DPH has been allocated more than $18 million from 2001 to 2005. Grant funding has allowed the Department to increase its staffing levels over the last two years by approximately 20 personnel funded by Homeland Security/CDC grants. Ms. Kronenberg’s presentation highlighted the three areas where DPH, through the Office of Policy and Planning, is doing its planning. This encompasses the work of Communicable Disease Prevention and Control, Emergency Medical Services and Environmental Health. In addition, she noted that SFGH has an emergency plan and is part of the Hospital Council’s planning efforts. The Department has made great strides in disaster preparedness. Accomplishments include: Updated and expanded the Department’s Emergency Operations Plan Unified and standardized training for the National Incident Management System (NIMS) New and improved Department Operations Center with a training program and frequent drills EMResource, a new and improved hospital resource tool, and EMTrack, a new and improved electronic patient tracking system Protecting Employees through efforts like the Avian/Pandemic Flu Task Force, respiratory protection program and determining potential roles of employees in different disaster scenarios Expanding surge capacity and capability Environmental Health Emergency Response – on call 24 hours, seven days a week Pandemic Influenza and other infectious disease emergency responses, including mass prophylaxis, clinical outreach, lab response, EPI Go kits, disease control and Biowatch/BDS. This year’s focus is to ensure that all of the planning that needs to get done is completed. Funding for all 19 UASI funded planning positions expires in December 2006. The BT/CDC grant has decreased significantly over the past five years, and positions funded through this grant are at risk. The efforts cannot be successful DPH figures out how to sustain the programs. One way to do this is to have more existing Department staff to take on emergency preparedness planning and response roles. Second, Ms. Kronenberg is hopeful that there will be other sources of funding to allow the Department to keep some of the wonderful grant-funded staff. Ms. Kronenberg said DPH is going to play a large role in any disaster scenario in San Francisco, and the Office of Emergency Services (OES) understands this. Director Conroy has quarterly meeting with heads of Police, Fire, Sheriff and DPH. Ann Stangby, Chief of Disaster Preparedness Division at OES, said up until the past 18 months there was no partnership between the Health Department, the health community and OES, and there is one now. This is really important. Commissioners’ Comments Commissioner Guy inquired about role of ABAG, and stressed the importance of transportation systems and regional planning. Commissioner Chow asked about the future of Federal funding. Ms. Stangby discussed Super UASI and regional funding versus local allocations that will change how funds are designated. The range of funding may vary and competing interests in the region will lobby for funding. Commissioner Sanchez said some grant-funded positions were added when other Health Department activities were being cut. Others positions existed and were moved to grants. The Department should look to other foundations to assist with financial support and co-funding to assure sustainability. This is an excellent report. Commissioner Illig noted that 29 positions were added for this effort, in addition to some moved from other jobs in DPH. Ms. Kronenberg said there was a prohibition on using this funding to supplant current staff and activities, which meant that the staff took on new roles. Commissioner Illig said that communication is a critical part of disaster response, and asked how DPH trains workers to report in emergencies. Further, how do we communicate when the phones are down? Ms. Kronenberg said response training would occur. Commissioner Illig expressed concern that if 101 Grove collapses, the Public Health laboratory would be out of commission. Finally, he urged the Department to share the after action reports on the tabletops and other exercises. Commissioner Monfredini said in the past the City has dealt with emergencies, such as Jonestown, the 1989 Loma Prieta earthquake and the Dan White verdict, that have tested its ability to respond and has generally done well Commissioner Tarver commended the presentation and accomplishments and use of funds, and he had a number of comments. First, there are silos in DPH that are disorganized and it is not clear how employees are reached during an emergency. Are there up to date contact information and lists? Second, not all DPH sites have a clinical database of who is expected to respond in an emergency. Third, how could non civil service staff (contractors) be provided with emergency credentials to prevent charlatans from misrepresenting DPH? Fourth, he emphasized the importance of the helipad. Fifth, he would like the role of the commissioners during an emergency to be clearly defined. Lastly he asked if San Francisco has a plan to deal with pets during a disaster. Commissioner Monfredini said that during an emergency, commissioners should stay out of the way unless they are MDs or have specific roles to fill in an emergency. Commissioner Chow said local preparedness requires neighborhood plans with tabletop and planned exercises. County support is needed to address unique needs of individual communities. 6) PUBLIC COMMENT/OTHER BUSINESS None. 7) ADJOURNMENT The meeting was adjourned at 6:00 p.m. Michele M. Seaton, Executive Secretary to the Health Commission