Minutes of the Health Commission Meeting Tuesday, June 20, 2006 at 3:00 p.m. LAGUNA HONDA HOSPITAL 1) CALL TO ORDER President Monfredini called the meeting to order at 3:20 p.m. Present: Commissioner Lee Ann Monfredini, President Commissioner Edward A. Chow, M.D. 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. Commissioner James M. Illig, Vice President 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF JUNE 13, 2006 Public Comment Patrick Monette-Shaw is disturbed that Commissioner Monfredini applauded the defeat of Proposition D in the minutes of the meeting. Action Taken: The Commission (Chow, Monfredini, Sanchez, Tarver, Umekubo) approved the minutes from the June 13, 2006 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Sanchez chaired and Commissioner Chow and Commissioner Tarver attended the Budget Committee meeting. Commissioner Sanchez said that the Budget Committee would be recommending to the full Commission that all multi-year contracts would be for a maximum of 2.5 years, rather than 4.5 years. The Commission supports the concept of four-year contracts, but wants to ensure that they are available to all contractors on a fair and consistent basis. To accomplish that, the Commission will ask the Department to develop department-wide criteria for multi-year contracts that are consistent across all divisions. Budget Committee members asked that Items 3.4, 3.5, 3.14, 3.18 and 3.20 be moved to the discussion calendar. Items for Approval (3.1) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive multi-year renewal contract with Asian Pacific Islander Wellness Center – San Mateo County Outreach and Case Management Program, in the amount of $126,692, which includes a 12% contingency, to provide Case Management, Treatment Advocacy and Outreach/Case Finding, to the target population of HIV+ Asian Pacific Islanders in San Mateo County who are diagnosed with AIDS or disabling HIV disease, for the period of March 1, 2006 through August 31, 2008. (3.2) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive multi-year renewal contract with Westside Community Mental Health, in the amount of $919,855, which includes a 12% contingency, to provide home care/hospice/attendant care services to individuals affected by HIV/AIDS, for the period of March 1, 2006 through August 31, 2010. Secretary’s Note – Commissioner Tarver abstained from voting on this item. (3.3) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive multi-year contract renewal with Mission Neighborhood Health Center, in the amount of $230,067, which includes a 12% contingency, to provide Integrated Case Management services to individuals affected by HIV/AIDS, for the period of March 1, 2006 through August 31, 2008. (3.6) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive renewal contract with AIDS Community Research Consortium - HIV Care Program – “Spanish Living Now Program”, in the amount of $441,057, which includes a 12% contingency, to provide treatment adherence/advocacy services targeting persons with HIV who reside in San Francisco, for the period of March 1, 2006 through August 31, 2010. (3.7) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive renewal contract with AIDS Legal Referral Panel – Client Advocacy/Legal Services Program, in the amount of $125,664, which includes a 12% contingency, to provide legal assistance, consultation, or representation for individuals diagnosed with AIDS or disabling HIV disease, for the period of March 1, 2006 through August 31, 2007. (3.8) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive renewal contract with Catholic Charities, in the amount of $790,217, which includes a 12% contingency, to provide Attendant Care services for individuals diagnosed with AIDS or disabling HIV disease, for the period of March 1, 2006 through August 31, 2010 (4.5 Multi Year Renewal). (3.9) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive renewal contract with Immune Enhancement Project in the amount of $562,630, which includes a 12% contingency, to provide complementary therapy services to individuals who are affected by HIV/AIDS, for the period of March 1, 2006 through August 31, 2010. (3.10) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive renewal contract with San Francisco Food Bank, in the amount of $448,794, which includes a 12% contingency, to provide food solicitation and liquid supplement services to individuals who are affected by HIV/AIDS, for the period of March 1, 2006 through August 31, 2010. (3.11) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive renewal contract with San Francisco Suicide Prevention, in the amount of $492,292, which includes a 12% contingency, to provide Nightline phone and crisis hotline services to individuals who are affected by HIV/AIDS, for the period of March 1, 2006 through August 31, 2010. (3.12) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive renewal contract with UCSF Pediatric AIDS Program, in the amount of $708,368, which includes a 12% contingency, to provide primary care, case management, developmental psychology and nutritional counseling to HIV positive/HIV indeterminate children and adolescents from low-income families who are affected by HIV/AIDS, for the period of March 1, 2006 through February 28, 2010. (3.13) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive renewal contract with UCSF AIDS Health Project – HIV Cognitive Impairment/Dementia HUB of Expertise Services, in the amount of $721,466, which includes a 12% contingency, to provide cognitive impairment services to individuals who are affected by HIV/AIDS, for the period of March 1, 2006 through August 31, 2010. (3.15) AIDS OFFICE-HIV Prevention – Request for approval of a 2.5 year renewal contract with Aguilas, Inc. HIV Prevention Services, in the amount of $680,040 which includes a 12% contingency, to provide HIV Health Education and Risk Reduction and Prevention with Positive services to behavioral risk populations in San Francisco, for the period of July 1, 2006 through December 31, 2008. (3.16) AIDS OFFICE-HIV Prevention – Request for approval of a 2.5 year renewal contract with Instituto de la Raza HIV Prevention Services, in the amount of $999,600, which includes a 12% contingency, to provide HIV Health Education and Risk Reduction and Prevention with Positive services to behavioral risk populations in San Francisco, for the period of July 1, 2006 through December 31, 2008. (3.17) AIDS OFFICE-HIV Prevention – Request for approval of a 2.5 year renewal contract with Larkin Street Youth Services HIV Prevention Services, in the amount of $484,400, which includes a 12% contingency, to provide HIV Health Education and Risk Reduction services to behavioral risk populations in San Francisco, for the period of July 1, 2006 through December 31, 2008. (3.19) AIDS OFFICE-HIV Prevention – Request for approval of a 2.5 year renewal contract with St. James Infirmary HIV Prevention Services, in the amount of $380,368, which includes a 12% contingency, to provide HIV Health Education and Risk Reduction services to behavioral risk populations in San Francisco, for the period of July 1, 2006 through December 31, 2008. (3.21) AIDS OFFICE-HIV Prevention – Request for approval of a renewal contract with UCSF AIDS Health Project – Basic and CET Training Services, in the amount of $327,040, which includes a 12% contingency, to provide HIV Prevention Services, for the period of July 1, 2006 through June 30, 2008. (3.22) AIDS OFFICE-HIV Prevention – Request for approval of a 2.5 year renewal contract with UCSF Stonewall HIV Prevention Services, in the amount of $886,922 which includes a 12% contingency, to provide HIV Health Education and Risk Reduction services to behavioral risk populations in San Francisco, for the period of July 1, 2006 through December 31, 2008. (3.23) PHP/CHSS-TB Control – Request for approval of a contract renewal with UCSF at San Francisco General Hospital (SFGH), in the amount of $286,003, which includes a 12% contingency, to provide physician and radiologist services to patients referred to the SFGH Tuberculosis Clinic, for the period of July 1, 2006 through June 30, 2007. Items for Discussion and Approval (3.4) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive renewal contract with Patricia Sullivan Consulting in the amount of $700,000, which includes a 12% contingency, to provide consulting services to the HIV Health Services Section for the Quality Management Program, for the period of March 1, 2006 through August 31, 2008. (3.5) AIDS OFFICE-HIV Health Services – Request for approval of a new contract with Patricia Sullivan Consulting, in the amount of $139,534, which includes a 12% contingency, to provide professional consulting services to support the Southeast Partnership CoE Evaluation and Technical Assistance Project for the AIDS Office–HIV Health Services Section, for the period of August 1, 2005 through June 30, 2006. Commissioners’ Comments Commissioner Chow appreciates that Ms. Sullivan has provided information about how she develops culturally competent training. Ms. Long said the AIDS Office identifies the providers to do the training, and Ms. Sullivan contracts with them to provide the services. For both contracts, Ms. Sullivan is the coordinator for the quality management program, so the bulk of the funds she receives is for the coordination function and various presentations. Ms. Sullivan does a lot of the hands-on work for the quality management program. Commissioner Tarver asked why the unit cost varies between the two contracts. Ms. Long said that the unit cost for 3.4 is less expensive because it involves people from the community doing a lot of the training. Many more people, paid at a different rate, fall under the unit cost for 3.5. Commissioner Tarver asked that future summaries include these factors. (3.14) AIDS OFFICE-HIV Prevention – Request for approval of a 2.5 year renewal contract with Asian Pacific Islander Wellness Center HIV Prevention Services, in the amount of $979,042, which includes a 12% contingency, to provide HIV Health Education and Risk Reduction services to behavioral risk populations in San Francisco, for the period of July 1, 2006 through December 31, 2008. Commissioners’ Comments Commissioner Chow asked if the program serves exclusively transgender individuals, as seems to be indicated by the demographic information. Ms. Packer said the program reaches gay and bisexual men and youth and transgender, but the demographic form is just for the transgender program. She will provide the Commissioners with the demographics for the other programs. (Secretary’s Note – Ms. Packer submitted this information after the Health Commission meeting). Max Rocha, API Wellness Center, added that that demographic information in the Commissioners’ packet is for unduplicated transgender contacts for last year, not individual clients. Commissioner Tarver said the transgender breakdown should be more specific, for example male-to-female or female-to-male. Ms. Packer said they could do this. Commissioner Tarver noted that John Santos, executive director of API Wellness Center, is retiring at the end of the summer, and he commended Mr. Santos’s stewardship of the agency over the past years. (3.18) AIDS OFFICE-HIV Prevention – Request for approval of a 2.5 year renewal contract with San Francisco LGBT Community Center HIV Prevention Services, in the amount of $417,000, which includes a 12% contingency, to provide HIV Health Education and Risk Reduction services to behavioral risk populations in San Francisco, for the period of July 1, 2006 through December 31, 2008. Commissioners’ Comments Commissioner Tarver asked why the unit cost is so high. Ms. Packer said that a lot of factors come into the unit cost, which differs between agencies. Commissioner Tarver said that the cost appears high, and more detail as to what goes into these costs might be helpful next time. Commissioner Chow asked how many people are in each group. Anthony Philip, LGBT Community Center, said there are approximately 12 people in each group. Ms. Packer said the HIV Prevention is looking at costs across programs. (3.20) AIDS OFFICE-HIV Prevention – Request for approval of a 2.5 year renewal contract with UCSF Stonewall – Prevention With Positive Program - HIV Prevention Services, in the amount of $592,000, which includes a 12% contingency, to provide HIV Prevention for HIV Positive and Negative Individuals / Planning for RNA Testing services , for the period of July 1, 2006 through December 31, 2008. Commissioners’ Comments Commissioner Tarver asked what Magnet is doing to outreach to the African American community. Steven Gibson, Magnet Executive Director, described to collaborations they have to outreach to this population. Mr. Gibson said they are also increasing outreach to clients who do not come into the Castro. (3.24) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive multi-year renewal contract with Lutheran Social Services, in the amount of $1,412,290, which includes a 12% contingency, to provide financial services to individuals affected by HIV/AIDS, for the period of March 1, 2006 through August 31, 2008. Michelle Long, Director, HIV Health Services, said the AIDS Office was very excited about the opportunity to develop 4.5-year contracts, as has been done in other DPH divisions, and worked carefully to select appropriate providers. She asked the Budget Committee to consider the 4.5-year contracts. They tried to select contractors where the scope of work would not change much and providers that have significant history with the AIDS Office. Commissioners’ Comments Commissioner Chow said that the Commission understands the benefits of multi-year contracts, and agrees with these in principle. His concern is that with the potential for changes in the epidemic, there needs to be flexibility to respond to these changes. In addition, he wholeheartedly supports criteria for multi-year contracts that apply equally to all contracts across division. (3.25) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive multi-year renewal contract with Shanti Project, in the amount of $1,923,470, which includes a 12% contingency, to provide HIV Health Services Planning Council Support to individuals affected by HIV/AIDS, for the period of March 1, 2006 through August 31, 2010. (3.26) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive renewal contract with Maitri AIDS Hospice, in the amount of $5,355,610, which includes a 12% contingency, to provide residential nursing, attendant and dementia care services to individuals who are affected by HIV/AIDS, for the period of March 1, 2006 through August 31, 2010. (3.27) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive renewal contract with Haight Ashbury Free Clinic, Inc., in the amount of $1,703,896, which includes a 12% contingency, to provide residential detox and substance abuse services to individuals who are affected by HIV/AIDS, for the period of March 1, 2006 through August 31, 2008. Commissioners’ Comments Commissioner Tarver asked how many members HAFC has on its board. Mr. Eckstrom, HAFC Executive Director, said they have room for 30 members on the board of directors. Commissioner Tarver asked why the agency’s client satisfaction and program compliance scores decreased from last year. Ms. Long said it appears the program compliance standards have to do with the level of data entry being below the standards. Wendy Mitchell, HAFC data entry clerk, said HAFC wrote up a new procedure to ensure adequate data entry and this is reviewed at the end of each month. Ms. Long said the issue with client satisfaction was the way the survey results were written up, and they suggested that the agency receive technical assistance for their client satisfaction process. (3.28) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive renewal with Community Awareness & Treatment Services, in the amount of $965,555, which includes a 12% contingency, to provide residential mental health services to African American and transgender women who are affected by HIV/AIDS, for the period of March 1, 2006 through August 31, 2010. Commissioners’ Comments Commissioner Tarver asked why the contracted percentage for mental health referrals is less than for primary care referrals. Janet Goy, CATS Executive Director, said the reason for that is that they do serve a very complex population, and they found they could do a little better than 60 percent for mental health, but that 70 percent is a reach. Commissioner Tarver urged the agency to keep in touch with the Department to see how they can improve these connections. Commissioner Chow, as a general comment about all of the AIDS Office contracts, commended staff for the matrixes that they include in the contract summaries. (3.29) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive renewal contract with Community Awareness & Treatment Services, in the amount of $976,534, which includes a 12% contingency, to provide men’s residential substance abuse services to individuals who are affected by HIV/AIDS, for the period of March 1, 2006 through August 31, 2010. (3.30) AIDS OFFICE-HIV Prevention – Request for approval of a 2.5 year renewal contract with San Francisco AIDS Foundation HIV Prevention Services, in the amount of $3,243,777, which includes a 12% contingency, to provide HIV Health Education and Risk Reduction – Gay Life and Needle Exchange services to behavioral risk populations in San Francisco, for the period of July 1, 2006 through June 30, 2008. (3.31) AIDS OFFICE-HIV Prevention – Request for approval of a 2.5 year renewal contract with Tenderloin AIDS Resource Center HIV Prevention Services, in the amount of $1,158,914, which includes a 12% contingency, to provide HIV Health Education and Risk Reduction services to behavioral risk populations in San Francisco, for the period of July 1, 2006 through December 31, 2008. (3.32) AIDS OFFICE-HIV Prevention – Request for approval of a 2.5 year renewal contract with STOP AIDS Project HIV Prevention Services, in the amount of $3,059,076, which includes a 12% contingency, to provide HIV Health Education and Risk Reduction and Prevention with Positive services to behavioral risk populations in San Francisco, for the period of July 1, 2006 through December 31, 2008. (3.33) DPH-Central Admin/Policy & Planning – Request for approval to submit a resolution to the Board of Supervisors to enter into a contract exceeding $10,000,000 with the San Francisco Community Health Authority. Secretary’s Note – Commissioner Umekubo abstained from voting on this item. (3.34) DPH-Central Admin/Policy & Planning – Request for approval of a contract renewal with San Francisco Community Health Authority (SFCHA) in the amount of $11,405,158 to provide universal health insurance services targeting San Francisco children, young adults and young parents, for the period of July 1, 2006 through June 30, 2007. Commissioners’ Comments Commissioner Chow noted that the contract has increased over last year, and asked how many more people would get covered through the program. Ms. Fraser said the increase in the contract amount is a result of two things. First, a five percent increase in premiums. The second portion is an expected growth of 2,000 to 2,500 enrollees in the young adult program. Commissioner Tarver urged the Department and the San Francisco Health Plan to work together to develop combined formularies, as different formularies cause clients much confusion. He also said we should find a better way for people in San Francisco who are newly involved in the health plan to be able to find a provider that meets patients’ language, cultural and other needs. Commissioner Chow said asked Ms. Fraser to describe how the health plan considers additions to its formulary. Ms. Fraser said the issue of multiple formularies is very vexing. SFHP’s P&T committee meets quarterly and allows the opportunity for physicians to petition for drugs to be added to the formulary, and there is a process to request non-formulary drugs. Secretary’s Note – Commissioner Umekubo abstained from voting on this item. (3.35) PHP-Housing & Urban Health – Request for approval of a retroactive contract renewal with San Francisco AIDS Foundation, in the amount of $4,052,179, which includes a 12% contingency, to provide full and partial rental subsidies targeting people with disabling HIV or AIDS, for the period of March 1, 2006 through August 31, 2007. Commissioners’ Comments Commissioner Tarver asked what thought has been given to increasing turnover in subsidies through programs such as job training and career resources. Ms. Antonetty said that this contract does not provide any funding for job training. However the SFAF has case managers who connect patients to these kinds of resources. Ms. Antonetty said the turnover of the housing wait list is very slow, and there are currently 2,430 active people waiting. Strategies to increase turnover include establishing a citywide task to prepare to respond to the reductions in time people can have housing subsidies. This task force will address the turnover issues. (3.36) PHP-Housing & Urban Health – Request for approval of a new contract with Tides Center, in the amount of $1,620,064, which includes a 12% contingency, to provide property management services, for the period of August 1, 2006 through June 30, 2007. (3.37) CHN-Facilities – Request for approval of a new contract with Fong + Chan Architects, in the amount of $579,025 which includes a 12% contingency, to provide facilities compliance services, for the period of July 1, 2006 through June 30, 2007. (3.38) CHS-PAES Dental – Request for approval of a renewal contract with AmeriChoice, in the amount of $1,284,186, which includes a 12% contingency, to provide fiscal intermediary services to the Personal Assisted Employment Services for dental services, for the period of July 1, 2006 through June 30, 2009. Commissioners’ Comments Commissioner Sanchez commended staff for the additional information that was received as a follow up to the last Health Commission meeting. Secretary’s note - The term of this contract changed to one year, with a new contract amount of $428,062. Action Taken: The Commission (Chow, Monfredini, Sanchez, Tarver, Umekubo) approved the Budget Committee Consent Calendar. The terms for the following contracts were changed to 2.5 years: 3.2, 3.6, 3.8, 3.9, 3.10, 3.11, 3.12. 3.13, 3.25, 3.26, 3.28 and 3.29. The Commission asked the Department to develop department-wide criteria for multi-year contracts. Item 3.38, the term of the contract was changed to one year, with a new contract amount of $428,062. Commissioner Tarver abstained from voting on Item 3.2. Commissioner Umekubo abstained from voting on Item 3.33 and 3.34. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Health Director, submitted his Director’s Report to the Commission. In addition to the written report, Dr. Katz updated the Commission on the proposed San Francisco Health Access Program. National Association of Counties Award The Department is pleased to have won a 2006 Achievement Award from the National Association of Counties (NACo) for its Charity Care Project, which is led by Office of Policy and Planning. NACo's annual Achievement Award Program recognizes innovative county government programs, and promotes them as models throughout the United States. NACo will include a summary of the Charity Care Project on its Web site (www.naco.org), and in its database of Model Programs. Additionally, the Charity Care Project will be recognized at NACo's 10th Annual Awards Reception as part of its annual conference this August in Chicago. The Charity Care Project was created in 2002 in response to a reporting and notification Ordinance promulgated by San Francisco’s Board of Supervisors. It has three primary objectives: Annual analysis and reporting of charity care policies and expenditures for San Francisco hospitals. Coordination with community stakeholders to monitor and focus community benefits provided by hospitals in exchange for non-profit, tax-exempt status. Planned distribution of specific healthcare treatment and services for poor and underserved populations to increase their access to healthcare. Benefits of the project to date include increased public awareness of free healthcare services, improved tracking of hospitals’ charity care and community benefits, and an overall increase of $22.4 million in reported charity care expenditures. Community partners on the Project include representatives from Consumers Union, Health Access, Operation Access, Service Employees’ International Union (SEIU) Local 250, San Francisco Community Clinic Consortium, the Hospital Council of Northern and Central California, Kaiser Permanente Medical Center, California Pacific Medical Center, Saint Francis Memorial Hospital, St. Luke’s Hospital, St. Mary’s Medical Center, and the University of California, San Francisco Medical Center. State Survey at SFBHC Completed Representatives from the Department of Mental Health (DMH) conducted the annual survey of the San Francisco Behavioral Health Center (SFBHC) – Mental Health Rehabilitation Center (MHRC) from June 14th through June 16th. The annual survey covered all aspects of the MHRC program. One surveyor reviewed the clinical areas including reviewing medications, treatment plans, and documentation in the medical records by staff. He complimented the psychiatrists for their discharge summaries that served as excellent communications to the next provider. A second surveyor focused on program compliance issues such as providing the required number of group hours per client, services for monolingual clients, and reviewing unusual occurrences. A third surveyor reviewed the administrative areas such as personnel files, nurse staffing hours, and in-services for staff. The survey team complimented the MHRC leadership and staff for providing excellent care and services to its clients. Dr. Katz congratulated Sharon Wicher and the SFBHC staff for this excellent review and evaluation. 2006 Community Health Grants The California Pacific Medical Center's 2006 Community Health Grants Program has awarded $10,000 to the SF Asthma Task Force and Asthma Resource Center of San Francisco, Inc. to focus on investigation of causal factors of pediatric asthma hospitalizations in San Francisco. Often our understanding of the cause of asthma hospitalizations is based on assumptions of patient non-compliance with medical treatment or an exacerbating environmental exposure. But we have not taken a comprehensive look at other contributing factors such as competing needs for family survival, out-of-pocket costs for prescriptions, medical provider standard of care for asthma diagnosis and treatment, transportation access, language and educational barriers to care, lack of asthma education, inadequate control of environmental risk factors, etc. The grant objectives are to: Identify causal factors for pediatric asthma hospitalizations for CPMC and St. Luke’s patients Propose appropriate resources and interventions for the causal factors identified, and research their feasibility. Develop collaboration with the African American Community Ambassadors/ Hospital Navigators Program for potential application of proposed resources and intervention DPH is grateful to Cal Pac for the opportunity to explore these important aspects of asthma in our community. Positive Resource Center SSI Advocacy The results are in after two years of SSI advocacy provided by the Positive Resource Center (PRC) for adult mental health clients in San Francisco. Aside from enhancing the lives of individuals with mental illness through income assistance, PRC's SSI advocacy project also earned a 5:1 return-on-investment for the City and County of San Francisco. For every dollar that the Department of Public Health (DPH) invested in PRC's SSI advocacy services from 2003-05, the county earned five times more through the activation of retroactive SSI-linked Medi-Cal payments for past health services previously provided by the county to client beneficiaries. The long-term client benefits, and effectiveness, of SSI advocacy have been fairly well documented, but the ROI results further demonstrate the worthiness of devoting resources to SSI advocacy services. Dr. Katz very much appreciates all of the DPH/CBHS clinicians who helped their disabled clients go through the SSI application process. Thanks also for the leadership of Maria X. Martinez, Deputy Director of DPH Community Programs, and the vital assistance provided by Maria Barteaux's billing staff, Nick Hancock, MaryAnn Sullivan, and Lion Barnett. Mental Health Services Act (MHSA) Update The RFP for MHSA services was published on May 26th. A pre-proposal conference to answer questions about the RFP was held on June 2nd, and written questions were accepted until June 14th. The deadline for proposal submission is June 28th at 12:00 noon. Many community members indicated their interest in serving on the review panels, and 55 people participated in a review panel orientation. The community review panels insure that the spirit of the MHSA planning process will continue in the selection of service providers for these funds. New STD Prevention Program The San Francisco STD Program, in collaboration with Better World Advertising, has developed a new syphilis awareness campaign, called BUCK SYPHILIS, to take the place of the Healthy Penis Campaign. The new campaign promotes the notion that syphilis testing be viewed as an easy part of general health maintenance and overall well being, and aims to avoid the resurgence of the disease as has been seen in other cities. The campaign will utilize a variety of ads featuring local men highlighting the challenges they have overcome in their lifetimes and emphasize that testing and treatment for syphilis is easy in comparison. Ads will be placed in transit stations, in print media, and on popular websites used by men who have sex with men (MSM) to meet sex partners. Many of those involved in the campaign will take part in the Department of Public Health float at Gay Pride on Sunday, June 25th. Environmental Health Journal Article The Environmental Health Section investigation of dermatitis complaints that occurred starting in February 2004 after the SFPUC replaced chlorine with monochloramine for secondary disinfection was recently published in the open-access peer review journal, Environmental Health: A Global Access Science Source. The investigation indicated that the reported complaints were heterogeneous. Many of the respondents had underlying or preexisting conditions offering an alternative plausible explanation for their symptoms. Overall, results did not support the need for a wider study, and did not suggest a compelling reason to reconsider the use of monochloramine for residual water disinfection. The manuscript may be accessed at: http://www.ehjournal.net/content/5/1/18 . Understanding Racism and Health Inequities Workshop a Success Last Friday the African American Health Initiative and the Health Education Training Center presented a workshop for DPH managers entitled, "Understanding the Impact of Race and Racism on Health Inequities and Health Disparities." The event, held at Ft. Mason, drew staff from throughout DPH including DPH Executive Staff, MCAH, CBHS, SFGH Nursing, Health at Home, SFGH Patient Safety, COPC, Jail Health, and others. The purpose of the workshop was to explore and address the impact of race and racism on health behaviors, quality health services, and differential outcomes. The trainer, Melanie Tervalon, MD, MPH, is one of the leading theorists and practitioners in "cultural humility" and exploration of the impact of race and racism on health care and health outcomes. The workshop included creating a mutual definition of race, interpersonal racism, "institutional" racism and identifying how racism is structured into governmental regulations, policies, and practices. A number of those in attendance have suggested that we invite Dr. Tervalon back to DPH for additional presentations. San Francisco Health Access Program This morning was the last meeting of the Mayor’s Universal Healthcare Council. Dr. Katz said the Council universally accepted the San Francisco health access model. This model will provide services through the San Francisco Health Plan to San Francisco’s uninsured population, estimated at 82,000. It is not an insurance plan in that it does not provide coverage outside of San Francisco and it requires individuals upon entering the program to commit to applying for any other health benefit for which he/her is eligible. An actuarial study determined that the cost would be $201 per member per month, which is significantly less than a basic Kaiser plan bought at a group level. Based on the population, the cost of the plan is $198 million. The county currently spends $104 million providing care for this population. The remaining dollar figure will be paid for through the employer mandate and individual enrollment. Tomorrow the Mayor and Supervisor Ammiano will both be introducing pieces of enabling legislation. There is widespread support for this program. Dr. Katz is very excited because San Francisco would become the first locality to provide universal health access. Dr. Katz said that the first person could be enrolled in approximately nine months. Commissioners’ Comments Commissioner Monfredini asked if DPH is responsible for the roll out of the program. Dr. Katz said that DPH will be the sole department responsible for this program, but will rely heavily on the San Francisco Health Plan. Commissioner Monfredini asked how many people would be enrolled immediately. Dr. Katz said they would probably turn the program on for 12,000 people, not all of who will be served through DPH. They would try to enroll another group every three months. Commissioner Tarver said this is a groundbreaking effort. He asked how the public and non-public outpatient facilities would be able to expand to accommodate the expanded population, when clinics already have waiting lists. And also, what will be the connection to behavioral health. Dr. Katz said that this program would allow DPH to bring in additional dollars, which would allow for expanded capacity. There is also a willingness on the part of the Mayor’s Office and the philanthropic community to look for additional resources. With regard to behavioral health, the program covers psychiatric care and psychiatric hospitalization. For the fuller range of behavioral health services, they would look to DPH’s existing CBHS. Commissioner Umekubo thanked Dr. Katz and all participants for this amazing effort. It is a great start, although it would be ideal of dental and vision services could also be included. Commissioner Sanchez said this is an exceptional model, and he applauded our community partners for participating. Commissioner Chow said this is an extremely exciting proposal and asked if this program would operate as a fee-for-service model or more of a managed care model. Dr. Katz said that employers and employees would pay directly to SFHP. The City and County would pay the subsidy to SFHP. SFHP will contract with its providers, with various arrangements. Everyone would have to choose a provider. Commissioner Chow asked how the City would ensure that employers do not switch from a richer insurance program and put their employees on this plan. Dr. Katz said one of the requirements is that employers have not provided health insurance in the past year. In addition, this program does not subsidize large employers.   Individual  Award Division Nominated By Debbie Tam, R.N.,C Laguna Honda Hospital Mivic Hirose, LHH Chief Nursing Officer Team Award Division Nominated By LHH Department of Education and Training Laguna Honda Hospital Administrator Gayling Gee, LHH Associate Jill LeCount, R.N., M.S., C.N.S Susan Spencer, R.N., M.S. John Butts, R.N. Corrina Chen     6) LAGUNA HONDA ANNUAL REPORT John Kanaley, LHH Executive Administrator, presented the Laguna Honda Hospital (LHH) Annual Report. Mr. Kanaley introduced the Adult Day Health Center Fan Dancers, who won the recent LHH talent contest. The fan dancers—King Sin Tso, Ri Kai Chen, Yukchun Cheung, Mei Lin, Im Cheong and Lin Ming—performed for the Commission. Mr. Kanaley provided a variety of resident demographic information, including race/ethnicity, gender, age and payor mix. He also provided information about the sources of new SNF admissions to LHH. Mr. Kanaley highlighted some of the many of the 2005-2006 strategic goals, and programs that were implemented to accomplish these goals: Clinical Programs – Continue to enhance preventive and therapeutic clinical programs. Safety and Security – Develop and implement an enhanced Safety/Security program that will provide a safe and secure environment for residents, staff and visitors. Finance – Maximize revenue for all programs and services. Organizational Structure, Communication and Leadership – Develop a hospital-wide organizational structure for operations, leadership, communications and training. Information Systems – Participate in the design and implementation of a single DPH-wide clinical and financial information system, and update the hospital infrastructure to support advanced technology. Performance Improvement, Licensing and Regulatory Preparedness – Develop and implement the LHH Performance Improvement Plan. Human Resources – Ensure adequate and culturally competent staff. Laguna Honda Replacement Project – Develop a systematic approach to successfully operationalize the Replacement Project. Operational Structure of new hospital – Initiate the operational planning for moving into the new hospital. Mr. Kanaley said the primary challenges from the past year were the 2006 licensing survey and the Proposition D ballot initiative. Mr. Kanaley then presented the 2006-2007 strategic goals. Clinical Programs – Continue to focus improvements on specialty areas such as dementia, HIV/AIDS, II/DD, Rehabilitation and community re-entry; roll out medication management and patient safety initiatives (unit dose and omni cell systems); manage behavioral health through a multidisciplinary approach. Education and Training – Complete the DET infrastructure with FY07 budgeted positions; solidify the hospital wide training programs and put them into practice; implement the Organizational Effectiveness training program; train, train, train. Safety and Security – Continue Threat Assessment Team through performance improvement of SMART training, assist teams, Dr. Gray, SIRT; continue to focus on the Site Security Analysis, focusing on cameras, security rounds, posts and hours of operation; review and revise the Safety Management and Emergency Preparedness plans. Organizational Structure, Communication and Leadership – Develop cultural values as part of LHH’s Strategic Plan; implement the communication plan for external positive publicity; complete the infrastructure improvements, both budgeted and not budgeted; continue to feed the valley to the goats; build the new laundry. Budget, Finance and Revenue – Analyze billing reports; improve on MDS coding; validate billing for new services; maximize revenue; improve departmental budget accountability. Information Systems – Finish the development and implementation of a cable management strategy for current buildings, interfaces with the new and the old; continue to develop staff computer skills; improve on and invest in desktop support; move forward with the implementation of Soarian Clinical Systems. Quality Management – Improve resident-to-resident altercation PI process; improve departmental performance standards; conduct resident, family and staff satisfaction surveys; maintain a continuous state of preparedness for the regulatory survey process. Human Resources – Improve employee morale; minimize vacancies; maximize retention; improve cultural competency. Laguna Honda Replacement Project – Move forward with construction and coordination; conduct operational planning; continue transitional planning; plan for assisted living services; continue participating in the Pebbles Project. Public Comment Patrick Monette-Shaw – DPH managers and staff gave misinformation to the public about Proposition D. He is deeply disappointed that voters had been misinformed. The 27 percent of the voters who supported Proposition D are not going away. Paul Hendrickson – He and Mr. Kanaley grew up in the same neighborhood in Worcester, Mass. It is like having an old friend from home. He has no major complaints about Laguna Honda, although he has some ideas. Commissioners’ Comments Commissioner Monfredini is so pleased with Mr. Kanaley’s work over the past 18 months. He and his team are really bringing about change and moving the institution forward. 72 percent opposition to Proposition D is also very telling about the quality of Laguna Honda Hospital. She said the rebuild is very exciting, and coming quickly to fruition. She commended Mr. Thomas for taking this project to the next phase. She asked Mr. Kanaley how he plans to retain his quality leadership team. Mr. Kanaley anticipates holding strategic plan retreats every year. Next year there will be two to three retreats, which will be completed in time for budget submissions. And this year the retreats will be kicked off with team strengthening. Mr. Kanaley is committed to staff education, and his door is always open. Commissioner Chow said that a true evolution has occurred at Laguna Honda in terms of issues the hospital has had to face. This is not an easy place to run, and the hospital has gone through a period of public distractions over the past two years. The executive leadership has created the infrastructure and the dialogue to move the institution forward. Commissioner Sanchez said it has always been an honor to serve on the Laguna Honda Hospital Joint Conference Committee. It is critical to hear different opinions from staff, and incorporate this into how you lead the institution. He lauds the continued emphasis on education and training. Commissioner Umekubo thanked Mr. Kanaley for the wonderful report. Tremendous progress has been made since he last served on the JCC. Mr. Kanaley has an incredible management team, and he supports continued retreats. He is pleased with the strategic goals. Hospital staff has been working under difficult conditions, and it is important that they continue as a team with a common mission. Commissioner Tarver asked for more information about the multi-disciplinary approach to dually diagnosed clients. Dr. Killpack said the Department of Psychiatry has integrated efforts with nursing, social work and activity therapy. Each unit has psychologists that provide behavior management trainings and develop behavioral care plans. They have a long, well established psychology training program training graduate psychology students. Mivic Hirose said an interdisciplinary team is integral to the behavioral care plan—psychology, pharmacy, bedside CNAs, etc. With regard to training, SMART training began a year ago. By June 30th, all of the clinical staff and all clinical units will be trained. Commissioner Tarver asked what outcomes are planned for cultural competency. He asked if there are other ethnically focused units, in addition to the Asian focus units. And he asked how the institution connects to community-based African American services. Mr. Kanaley said they have not really established measurable outcomes for cultural competency. They have a Latino-focused unit, and have had conversations about an African American unit. Mozettia Henley said LHH is in the process of developing initiatives to better serve this population. One initiative is to have an African American women’s health group. They are also working with City College around developing a culturally competent work force. Commissioner Tarver asked Ms. Gray to get him a breakdown of discharges from LHH and discharges from SFGH. Commissioner Tarver commended Mr. Kanaley and all of his staff for their work. Mr. Kanaley thanked Dr. Katz for the opportunity to lead Laguna Honda, and the Commission for all of its support. Commissioner Monfredini asked the status of a discharge unit at LHH. Ms. Hirose said she and Ms. Gray have been discussing this issue. Nursing is focusing on self-administering of medication. Social workers are focusing on money management, taking Muni and other activities. And the Activities Therapy division is conducting community outings for people approaching discharge. With the community re-entry grant they received last year, they have intensive discharge planning on two units. They would like to create a discharge-planning unit that is focused on their skilled nursing population. Commissioner Monfredini thanked Commissioner Chow and Commissioner Sanchez for their work on the LHH JCC. 7) LAGUNA HONDA REBUILD UPDATE John Thomas, Program Manager, LHH Replacement Program, presented a rebuild update. In summary, the program for the 780-bed facility currently under construction is $482 million. Construction began for the South and East Residence buildings and the Link Building in July 2005. Approximately $113 million of the overall program budget has been expended to date. Major milestones anticipated this are: By September 2006, completion of slab-on-grade and deck concrete pours at the South Residence and Link Buildings; completion of structural foundation and steel erection at the Link “Knuckle” building and the East Residence. By December 2006, “dry-in” of the South Residence and Link Buildings; completion of slab-on-grade and deck concrete pours at the South Residence. Contracting Milestones: negotiate Phase 1 of the existing hospital remodels work with Turner and sub-contractors; add assisting living planning component to the Anshen & Allen contract. Commissioners’ Comments Commissioner Chow said the rebuild work is really impressive, and he encouraged all commissioners to take a tour of the site. 8) PUBLIC COMMENT/OTHER BUSINESS None. 9) ADJOURNMENT The meeting was adjourned at 6:05 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 noted 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.