Minutes of the Health Commission Meeting Tuesday, July 18, 2006 at 3:00 p.m. 101 GROVE STREET, ROOM 300 San Francisco, CA 94102 1) CALL TO ORDER Commissioner Illig called the meeting to order at 3:30 p.m. Present: Commissioner James M. Illig, Vice President Commissioner Edward A. Chow, M.D. Commissioner Roma P. Guy, M.S.W. Commissioner Donald E. Tarver, II, M.D. Commissioner John I. Umekubo, M.D. Absent: Commissioner Lee Ann Monfredini, President Commissioner David J. Sanchez, Jr., Ph.D. Commissioner Illig wished Tracy Brown, executive director of Tenderloin Health, a speedy recovery from his recent heart attack. Commissioner Illig also acknowledged the passing of Sister Diane Grassilli, President of the Sisters of Mercy Burlingame Region, who died suddenly on Sunday night. Sister Grassilli was an inspiration to many and a shaping force whose love, intellect, leadership and compassion live on in the ministry and people of Catholic Healthcare West. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF JUNE 20, 2006 Action Taken: The Commission (Chow, Guy, Illig, Tarver, Umekubo) approved the minutes of the June 20, 2006 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Chow chaired and Commissioner Tarver attended the Budget Committee meeting. The Budget Committee requested that Items 3.1, 3.6, 3.8 and 3.10 be moved from the Approval list to the Discussion and Approval list. Items for Approval (3.2) Central Administration–Policy & Planning – Request for approval to accept and expend State grant funds, including 46 recurring grants, by the San Francisco Department of Public Health for FY 2006-2007. (3.3) PHP–STD Prevention & Control – Request for approval accept and expend retroactively a three-year grant from the San Mateo Medical Center, to establish an HIV/AIDS Research Center in the Bay Area, in the amount of $360,000, for the period of 7/1/2006 to 6/30/2009, with $110,374 of funding for FY 06-07, of which $161,280 ($53,760 annually) is a sole source contract with UCSF Department of Infectious Disease, for the period of 7/1/2006-6/30/09. (3.4) PHP–Newcomers Health Program – Request for approval accept and expend a grant from the California Department of Health Services, Refugee Health Section, in the amount of $55,000, for the support of the Refugee Preventive Health Program, to manage and follow-up on chronic health conditions among newly arriving refugees, asylees, parolees and victims of trafficking in San Francisco; for the period of July 1, 2006 through June 30, 2007 with expected continuation for four additional years, and which includes a sub-contract with the International Institute of San Francisco in the amount of $28,900 for the same time period. (3.5) PHP-Housing & Urban Health – Request for approval of a contract renewal with North and South of Market Adult Day Health Corporation, in the amount of $466,771, which includes a 12% contingency, to provide adult day health services, tenant support and behavioral health services for frail, former homeless elderly (age 62 and over) residents at the new Mission Creek Senior Community Adult Day Health Center, for the period of July 1, 2006 through December 31, 2007. (3.7) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive renewal contract with UCSF AIDS Health Project-Mental Health Crisis Services, in the amount of $823,815, 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, 2008. (3.9) BHS – Request for approval of a contact renewal with the Children’s Council of San Francisco, in the amount of $783,745, with an annual contract amount of $195,936, which includes a 12% contingency, to provide mental health consultation to family child care centers targeting providers caring for at-risk children of preschool age, for the period July 1, 2006 through June 30, 2010. Items for Discussion and Approval (3.1) DPH-Primary Care – Request for approval of a new contract with Shanti, in the amount of $367,604, which includes a 12% contingency, to provide continued services to the Lifelines program and serve as the fiscal intermediary to the Mammography Van, for the period of July 1, 2006 through June 30, 2008. Commissioners’ Comments Commissioner Chow asked staff to provide a breakdown of the gift funds allocated toward this contract and anticipated general fund expenditures. (3.6) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive renewal contract with Latino Commission in the amount of $412,720, which includes a 12% contingency, to provide residential substance abuse services to individuals who are affected by HIV/AIDS, for the period of March 1, 2006 through August 31, 2007. Commissioners’ Comments Commissioner Tarver asked what factors contributed to the low client satisfaction rating. Marshia Herring, AIDS Office, said the issue was about the format of the client satisfaction survey. The Latino Commission will be reformatting the survey. Commissioner Tarver asked that technical or process issues with client satisfaction be included in the program compliance rating, rather than the Client Satisfaction rating, which should be a reflection only of client satisfaction with the program. (3.8) AIDS OFFICE-HIV Prevention – Request for approval of a retroactive renewal contract with PHFE Management Solutions, in the amount of $78,400, which includes a 12% contingency, to provide Fiscal Intermediary Support for the Positive Reinforcement Opportunity Project, for the period of July 1, 2006 through June 30, 2007. Commissioners’ Comments Commissioner Chow asked why the objective about clients testing negative for methamphetamines was removed from the contract. Ms. Wolf said that the PROP program would not longer be providing this service—it is now being provided through Walden House. (3.10) BHS – Request for approval of a contract renewal with Victor Treatment Centers, Inc., in the amount of $625,465, with an annual contract amount of $372,301, for a total contract of $625,465, which includes a 12% contingency, to provide children's behavioral health services, for the period of July 1, 2006 through December 31, 2007. Commissioners’ Comments Commissioner Tarver asked how DPH could reduce the length of time youth are in this level of residential care, and what alternatives exist for placing youth in San Francisco facilities. Ms. Chan-Sew said there are specific initiatives to prevent out of home placement. She would be happy to discuss these with Commissioner Tarver. DPH just began a partnership with Westside that is focused on the African American population and will utilize a new approach to dealing with families. With regard to out-of-county placement, there is insufficient capacity in San Francisco to deal with our needs. Commissioner Tarver asked how the Department assures that out-of-county providers are culturally competent for our population. Neal Sternberg, Executive Administrator, Victor Treatment Center, said cultural diversity is very important to them. Staff make up is representative of the local communities where they are located. They spend a lot of time and resources training staff on the range of children that come from all over the State. (3.11) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive renewal contract with Project Open Hand, in the amount of $2,032,698, which includes a 12% contingency, to provide Delivered Meal/Grocery Center services to individuals who are affected by HIV/AIDS, for the period of March 1, 2006 through August 31, 2007. Secretary’s Note – Commissioner Illig abstained from voting on this item. (3.12) AIDS OFFICE-HIV Prevention – Request for approval of a new 2.5-year contract with Tenderloin AIDS Resource Center HIV Prevention Services, in the amount of $420,000, which includes a 12% contingency, to provide Needle Exchange Services for Youth in San Francisco, for the period of July 1, 2006 through December 31, 2008. Secretary’s Note – Ms. Packer stated that, as of July 1, 2006, TARC is officially named Tenderloin Health Continuum of Care. Commissioners’ Comments The Budget Committee requested an update to the Population Health and Prevention Joint Conference Committee on the merger between TARC and Continuum. (3.13) BHS – Request for approval of a contract renewal with Huckleberry Youth Programs in the amount of $186,685, with an annual contract amount of $111,121, for a total contract amount of $186,685, which includes a 12% contingency, to provide Early and Periodic Screening, Diagnosis and Treatment mental health services programs for youth, for the period of July 1, 2006 through December 31, 2007. Commissioners’ Comment Commissioner Chow asked if Huckleberry House is advocating to referring agencies to try to have more African Americans referred to diversion programs rather than detention and incarceration. Mr. Fisher, Executive Director, Huckleberry House, said that the latest data shows that 44% of EPSTD program clients are African American. The agency works closely with the Police Department and Juvenile Probation. This past year, they started to do outreach in the schools. (3.14) CHN-SFGHMC Radiology – Request for approval of two retroactive contract renewals with Medical Contracting Services and The Registry Network, Inc, and new retroactive contracts with On Assignment Healthcare Staffing and Platinum Select, LP, in the shared contract amount of $1,800,000, to provide intermittent, as-needed, professional services of per diem and traveling radiology technologists with seven-day-a-week availability, for San Francisco General Hospital Medical Center, for the period of July 1, 2006 through June 30, 2007. (3.15) CHN-SFGHMC Nursing Operations – Request for approval of five retroactive contract renewals with Arcadia Health Services, Inc. dba Arcadia Staff Resources, HRN Services, Inc., Medstaff, Inc., Nurse Providers, Inc. and Professional Resources Enterprises, Inc. dba United Nursing International, in the shared contract amount of $2,700,000, to provide supplemental, temporary per diem and traveling nursing personnel services for San Francisco General Hospital Medical Center, for the period of July 1, 2006 through June 30, 2007. Commissioner Tarver said it seems from the information in the packet that Arcadia has not been performing at the same level as the other contractors. Ms. Digdigan said that last year was the first time Arcadia contracted with the city, and they were learning the ropes about doing business in the city. Arcadia met with her to discuss ways to improve services, and Ms. Digdigan would like to do business with them for one more year. (3.16) BHS – Request for approval of contract renewal with Instituto Familiar de la Raza, Inc., in the amount of $2,771,160, with an annual contract amount of $1,847,440, for a total contract of $2,771,160, which includes a 12% contingency, to provide behavioral health services, for the period of July 1, 2006 through December 31, 2007. (3.17) BHS – Request for approval of contract renewal with Addiction Research and Treatment, Inc., in the amount of $7,474,557, which includes a 12% contingency, with an annual contract amount of $5,581,003, for a total contract of $8,371,504, to provide substance abuse outpatient treatment services, for the period of July 1, 2006 through December 31, 2007. (3.18) BHS – Request for approval of a new contract with BAART Behavioral Health Services, in the amount of $705,600, which includes a 12% contingency, to provide opiate substance abuse treatment services, for the period of July 1, 2006 through December 31 2007. (3.19) Central Administration - Approval to accept and expend funds from the Health Resources and Services Administration (HRSA) Hospital Preparedness Program (Year 4 Funding) in the amount of $565,230.32 Action Taken: The Commission (Chow, Guy, Illig, Tarver, Umekubo) approved the Budget Committee Consent Calendar. Commissioner Illig abstained from voting on Item 3.11. The Commission requested an update on the merger of Tenderloin AIDS Resource Center and Continuum at the Population Health and Prevention Joint Conference Committee. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Health Director, presented the Director’s Report. Health Access Plan Dr. Katz updated the Commission on the number of important steps forward for the Health Access Program (SF HAP) since he last updated the Commission. On June 23rd, the Universal Healthcare Council issued its final report to the Mayor. The UHC recommended development and implementation of the SF HAP. (Copies of the report were distributed to the Health Commission and are available for the public at our web site). Following this, the Mayor introduced enabling legislation to implement the SF HAP. Two weeks ago the Budget Committee of the Board of Supervisors voted to combine Supervisor Ammiano’s Workplace Security Ordinance with the legislation enabling the HAP. The Workplace Security Ordinance requires that large and medium-sized businesses pay health care expenditures for its employees. Employers can fulfill these expenditures in a variety of ways including providing commercial insurance or paying into the SF HAP. The combined ordinance is called the San Francisco Health Care Security Ordinance. The Mayor and Supervisor Ammiano met, and with the help of their staffs and ours, and representatives from labor and business were able to modify the legislation so that both the Mayor and the Supervisor could support it. Compared to earlier versions of the Workplace Security Ordinance, the new combined legislation increased the number of hours employees would have to work to qualify—from 2 to 12 per week—which will reduce the amount that businesses would have to contribute. The mandate on businesses to pay specified amounts for their workers begins on July 1, 2007 for businesses with more than 50 employees. By April 2008, smaller firms with between 20 and 49 employees would then begin making contributions. Under the legislation, companies—depending on size—would be required to spend $1.06 or $1.60 per hour per employee toward health care. Companies already offering health coverage but not spending at the minimum level would be required to increase their health expenditures. The legislation would cap at $180 per worker per month, the maximum amount a larger business would need to spend on the employee’s health care. Any broader cost increases in the first three years of the plan would be held to an annual rate of 5 percent to give companies more time to adjust. These changes have increased support for the program in the business community, although concerns are still being raised that the legislation will result in job loss or companies moving out of San Francisco. Yesterday, the Budget Committee of the Board of Supervisors unanimously approved the authorizing legislation with 5 votes. A detailed explanation of the funding of the SF HAP, including the funding contributed through the employer mandate was distributed to the Health Commissioners, as well as the legislation. With the legislative intent clarified, we are now ready to move into implementation. As this is a complex program, implementation will require different tasks from different bodies. The legislation directs the Director of Public Health to convene an advisory Health Access Working Group, with input from the Mayor and the Board of Supervisors. This group will provide expert consultation on setting membership rates, designing the range of benefits and health care services for participants and evaluation utilization, outcomes, and costs. The City’s Office of Labor Standards and Enforcement (OLSE) will be responsible for enforcing the health care expenditures. The San Francisco Health Plan is establishing a number of committees to develop the infrastructure to enroll, track, and pay providers for delivering services to the members of the SF HAP. The Health Department will be focused on increasing capacity and reinvisioning its service models so that it can be in the best possible position to take on this new program. The goal is for this program not to be a separate door, but rather to be the way that the Department delivers health care services throughout the department. To help both the San Francisco Health Plan and the Health Department in implementing this program, the Board of Supervisors allocated $1 million of start up funding. DPH will use its share of this money to increase primary care capacity and the ability to track utilization and outcomes. Dr. Katz will review the details of the program with the Joint Conference for our Integrated Delivery System and keep the Commission as a whole informed of new developments. Budget Update The first hearing to approve the FY 2006-07 budget is before the Board of Supervisor's today. The budget passed out by the Budget Committee includes an increase of $58.6 M from the General Fund. This includes: $ 14.8 M - Mayor's Budget, $ (1.0 M) - Budget Analyst cuts, $10.3 M - Budget Committee Add-backs, and $34.5 M - MOU/Inflation/Benefit changes. Mayor’s Budget The Mayor's Office restored funding associated with the Substance Abuse Residential Rate Equalization and reversed proposed increases in the Pharmacy Co-pay. $15.851 M was added for capital including $11.976 M for the SFGH Rebuilding Planning and EIR and $1.5M for build-out of a civil service laundry. The Mayor's Office also funded $150,000 for HIV support groups and $1.2 M for Medical Respite operating expenses. Budget Analyst The Budget Analyst proposed $1.0 M in reductions. They primarily consisted of $418,000 in equipment costs based on updated vendor quotes, reversal of a $257,000 backfill of expiring UASI grants, correction of budgeting errors totaling $229,000. The Department concurred with these reductions. Budget Committee The Budget Committee added $10.3 M in General Fund. This included funding for an additional 1% CBO COLA. Add-backs at SFGH consist of $100,000 for Trauma Center Wrap Around Services, $1.0 M for the Health Access Program, and restoration of the Workers Compensation Clinic. At LHH, the Committee added $80,000 for Dementia Units and a Healing Patio.   The Public Health add-backs total $3.565M:   Mission Creek Senior Housing in Mission 359,000 Bed Bug Abatement 63,000 Ryan White Cut Contingency 1,000,000 HIV/AIDS Housing LGBT Q Youth 75,000 HIV/AIDS Services for African American Men 275,000 Comprehensive AIDS Housing Plan 20,000 HIV/AIDS Housing Subsidies 1,000,000 Alternative Medicine for Persons with HIV 108,000 STD Prevention in Castro 132,000 Needle Exchange Services in Haight Ashbury 125,000 AIDS-Intensive Case Mgmt for Methamphetamine Users 250,000 Additional 1% COLA for CBOs 158,451   3,565,451 Add-backs for Mental Health total $3.497M:   Trauma Recovery Center 1,154,000 6th Street Drop In Center 635,000 Crisis Response Team 268,000 Victim Relocation Program 500,000 Outreach and Job Placement 80,000 LYRIC/New Leaf Case Management 90,000 Additional 1% COLA for CBOs 770,406   3,497,406 For Primary Care, add-backs total $341,000:   Senior Medical Social Workers 45,000 Women's Health Services 200,000 Senior Health Project 40,000 Dimension's Clinic 55,892   340,892 Substance Abuse add-backs total $864,000:   Drug Overdose Prevention in SRO and Shelters 75,000 Methamphetamine Treatment Reinstatement 200,000 Outpatient Substance Abuse for Women 70,000 Substance Abuse Enhancement for Gay Men and HIV 50,000 Additional 1% COLA for CBOs 469,200   864,200 In Jail Health, $32,000 was added for an additional 1% COLA for the CBOs. Asthma Task Force The Board of Supervisors awarded the Asthma Task Force $102,000 at their add back hearing in June 2005, and the Task Force allocated funds to several of the priority projects of the Strategic Plan, which was then administered by DPH staff. Dr. Katz distributed to the Commissioners a report to the Board of Supervisors showing the spending objectives and outcomes that were achieved this fiscal year. ATF efforts to generate matching funding from other sources are also identified. Dr. Katz applauds the successful work of the Asthma Task Force and their ability to advocate for patients and their families and are grateful to have them as partners in helping improve the health of the City. SFGH Associate Administrator for Support Services Dr. Katz welcomed SFGH's new Associate Administrator for Support Services, Delvecchio Finley. Delvecchio will assume the administrative responsibility for the following hospital departments: Environmental Services, Food Services, Environmental Health and Safety, Security, Disaster Preparedness, Messenger Service, Laundry and Linen Distribution and the Mail Room. His educational background includes a degree in Chemistry from Emory University and a Master of Public Policy degree at Duke University, where he also attained Graduate Certification in Health Policy, Law, and Management. Prior to accepting this position, Delvecchio was the Division Administrator for several UCSF medical divisions here at SFGH, including the Positive Health Program (HIV/AIDS), Occupational and Environmental Medicine, and Hematology/Oncology. Dr. Katz thanked Kathy Jung for carrying the double duty of covering for these areas as well as Facility Services. Now that the first phases of the hospital rebuild project have been funded and are getting underway, Kathy will take the lead for the Department in directing these activities. She will also continue to have administrative responsibility for Facility Services, Bio-Medical Engineering, and Materials Management. The Department is pleased to have Delvecchio join the hospital's Executive Staff and look forward to having him as part of our team. Please join me in welcoming Delvecchio. Reaching Youth in Bayview Hunters Point Dr. Katz distributed reprint from UCSF’s Newsbreak publication featuring Dr. Mark Ghaly and the work he and a number of pediatric residents from UCSF School of Medicine are doing in Bayview Hunters Point. Dr. Ghaly and his colleagues are filling an important pediatrician gap in a community whose children face a number of health challenges such as higher rates of asthma and exposure to violence. As the Commissioners knows, Dr. Ghaly is continuing this important work in the Bayview as Medical Director at Southeast Health Center. Dr. Dan Receives John F. Murray Award Congratulations to Dr. “Dan” Wlodarczyk who received this year’s John F. Murray Award recognizing a member of the UCSF faculty for academic excellence and dedication to the humanitarian mission of San Francisco General Hospital. This award was established in 2003 and solicits nominations from Medicine faculty based at SFGH and Medicine residents. Among the many accolades from his colleagues, Dr. Dan was noted for his compassion, his gift as a teacher and healer, and his reputation as a role model for young residents. Robert Perry Retires Dr. Katz noted the retirement of Robert Perry, who has been an employee with the City and County of San Francisco for 22 ½ years. Robert was one of two originating Revenue Analysts assigned to the Patient Accounting department in 1990 to start the Revenue Enhancement Unit. The Unit expanded the hospital and clinic’s ability to charge for their services. On the first year of the Revenue Enhancement Unit, SFGH revenues increased from $4 million to $20 million. Today SFGH continues to generate millions of dollars in additional revenue due to the hard work and diligence of Robert Perry. Robert’s background as an RN and work experience with healthcare payers such as Blue Cross and Blue Shield have made him a valuable asset to the Dept of Public Health. Robert leaves with our thanks for many years of excellent service to the Department and our best wishes for a happy, healthy and successful retirement. The Commission presented Mr. Perry with a retirement certificate. Community Health Network, San Francisco General Hospital, July 2006 Credentials Report     07/06 07/06 to 07/06 New Appointments 18 18   Reinstatements 0 0 Reappointments 44 44   Delinquencies 0 0   Reappointment Denials 0 0 Resigned/Retired 20 20 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Deceased 1 1 Changes in Privileges       Additions 5 5   Voluntary Relinquishments 6 6   Proctorship Completed 5 5   Proctorship Extension 0 0 Current Statistics – as of 07/1/06     Active Staff 461   Courtesy Staff 569   Affiliate Professionals (non-physicians) 199   TOTAL MEMBERS 1,229   Applications In Process 52   Applications Withdrawn Month of June 2006 2 2 (07/06 to 07/06) SFGH Reappointments in Process Aug. 2006 to Nov. 2006 192   Commissioners’ Comments Commissioner Illig said that at today’s Board of Supervisors meeting, Commissioner Ammiano thanked Dr. Katz for helping make the Health Access program a reality. The Commission thanks him as well. Commissioner Guy thanked everyone for their hard work on the Health Access Program. This is a wonderful resource for San Francisco. Commissioner Chow is pleased that this very complicated program, which gives the ability to offer the opportunity for care to all San Francisco workers, has come to fruition. In the absence of nationwide action on health care access for all, local and region-wide solutions seem to be the answer. The challenge now is to show that the theoretical can become functional. San Francisco is the city that knows how. Commissioner Umekubo said this is a proud moment for our city, and demonstrates how progressive San Francisco is. Commissioner Tarver congratulated all parties for this groundbreaking effort. He also commended Dr. Katz and the citizenry that advocated on behalf of health care for the successful budget. He personally pledged to help implement the Health Access program. He is confident that the Department can meet the objectives, but he is apprehensive about how CBHS will move along with this effort. Commissioner Illig said that now that the legislation is adopted, the responsibility for implementing moves to the Health Department. This is not just politics. This is a transformative experience for health care in San Francisco. Some of the implementation issues will be discussed at the Joint Conference Committee, but Commissioner Illig would like regular updates to the Commission as well. 5) PRESENTATION OF THE EMPLOYEE RECOGNITION AWARDS FOR JULY This presentation was continued to the August 15, 2006 Health Commission meeting. 6) CONSIDERATION OF A RESOLUTION APPROVING THE DPH SUSTAINABLE FOOD POLICY Christina Carpenter, Health Promotion Consultant, Community Health Promotion and Prevention, presented an overview of the proposed DPH Sustainable Food Policy. The purpose of the policy threefold: raise awareness about sustainable food systems and nutrition; promote nutritious and sustainable food practices; and encourage food at DPH activities that conveys respect and thoughtfulness for clients and colleagues. Sustainable foods criteria: locally produced, organic, fair trade, minimally processed, humanely raised, vendor participates in SF Green Business program and vendor is MBE/WBE/LBE. The proposed policy addresses: Food at events and programs: Provide one nutritious and fresh fruit/veggie option and water and/or 100% juice option; for sustainable foods, website based guidelines for employees that rate vendors ability to meet criteria at www.sfdph.org/foodpolicy. Institutional food service: within six months to a year, develop a 3-5 year procurement plan that increasingly integrates sustainable food criteria outlined in this policy; report on implementation of the plan within one year and on a regular basis thereafter. Contractors: Bids/RFAs involving institutional food service subcontractor requirements: provide foods meeting nutritional guidelines; create workgroup of CBOs and DPH to develop a procurement plan to increasingly integrate sustainable foods; report on plan implementation in one year and regularly. Public Comment Peggy Da Silva, Veritable Vegetable, said her organization is a women-owned business operating out of the Southeast sector of the city that provides food in the city. As a wholesaler, they would be happy to help San Francisco provide sustainable fruits and vegetables. It is easy to buy and sell organic—you just need the will to do it. Sean Brooks, Director of Programs, San Francisco Food Bank, said the Food Bank’s concern is that the proposed policy will increase the incidence of hunger in our community. The Food Bank provided 25 million pounds of food to low income individuals and families last year. The policy should provide clear guidelines and expectations prior to implementation, and not leave it to the non profits to develop the implementation plan. Mr. Brooks submitted a letter (on file in the Health Commission office). Project Open Hand submitted a letter regarding the proposed policy (on file in the Health Commission office). Commissioners’ Comments Commissioner Guy said that the staff is trying to do a paradigm shift. This is a new process, and details need to be worked out. The staff is asking the Health Commission to approve these guidelines and give support to this direction. There is good research and understanding about the relationship between food and health. She agrees with some of the concerns that have been raised. That said, DPH is not trying to ram this policy down people’s throats. Commissioner Illig commended Ms. Carpenter and Ms. Hennessey-Lavery for their willingness to sit down with him to talk about the contractor piece of the policy. Project Open Hand is committed to serving food to very poor people. The organization is committed to providing fresh food to their clients. But they serve 2,500 meals a day. He is supportive of starting the conversation about healthy foods, and noted that these are guidelines. Contractors are going to be looking to the institutional food providers to see if vendors are willing to comply. Commissioner Chow asked if the Health Commission approves all Department policies, or whether these policies are adopted administratively. Dr. Katz said the Health Commission has approved some, but not all, Health Department policies. Commissioner Chow suggested that, as it says in the resolution, the Health Commission is approving the overall policy, and not the policy and procedures. Commissioner Tarver said the resolution should direct the Department to develop procedures with certain caveats. The policy should incorporate ethnically and culturally appropriate foods. Commissioner Tarver raised many challenges to individuals and families accessing healthy, sustainable and locally grown food. Commissioner Tarver offered the following amendment, which was accepted by the Commission: “And be it Further Resolved, that the Health Commission directs the Department to implement the policy with attention to the medical and cultural needs of our diverse populations as well as the costs and access factors that influence accessibility to healthier food.” Action Taken: The Health Commission (Chow, Guy, Illig, Tarver, Umekubo) approved Resolution 11-06, “Adopting the DPH Healthy and Sustainable Food Policy,” as amended (Attachment A). 7) UPDATE ON THE PROGRAM ON HEALTH, EQUITY AND SUSTAINABILITY June Weintraub, Sc.D., Environmental Health Section, presented an update on the Environmental Health Section’s Program on Health, Equity and Sustainability (PHES). The programs that fall under PHES are tied together by a common mission: to advance urban health and social and environmental justice through ongoing integration of local government and community efforts and through valuing the needs, experiences and knowledge of diverse San Francisco residents. PHES’s major programs are: Food Systems; Children’s Environmental Health Promotion; Workers’ Rights (Jornaleros Unidos con el Pueblo); Water Epidemiology; and Community Planning. Dr. Weintraub highlighted accomplishments and activities from each of these areas. Dr. Weintraub described the Healthy Development Measurement Tool, which is one of the Community Planning programs. The goal of this innovative program is to support more accountable, evidence-based and health-oriented planning and policymaking. The tool provides land use planners, public agencies and community stakeholders with a set of metrics to assess the extent to which urban development projects, plans and policies affect health. The next steps for the development of the tool are to edit the tool based on City Agency and technical expert comments, develop the tool methodology, pilot the tool and develop web-based functionality. Dr. Weintraub also described Chloramine Conversion Support, which is one of the Water Epidemiology programs. DPH worked with the San Francisco PUC when the PUC converted to chloramine in February 2004. DPH provided an extensive informational Q&A, a NDMA white paper and an NDMA fact sheet. DPH investigated health concerns regarding dermatitis. Commissioners’ Comments Commissioner Chow commended the presentation. He heard a preliminary presentation at the Population Health and Prevention Joint Conference Committee. This is a cutting edge area for public health, at not a very high expense.Commissioner Guy added that, through the Population Health and Prevention Joint Conference Committee, the Health Commission is really trying to educate people that this is public health, and trying to emphasize aspects of this section of DPH’s work. This program is central to public health in terms of prevention. Commissioner Tarver appreciates the report. What is the status of the farm at Laguna Honda Hospital? Mr. Kanaley said that the farm is being developed. Dr. Bhatia added that EHS is working with Laguna Honda to see that the farm could be sustainable. Commissioner Tarver asked if the SFGH rebuild could be developed as a green building. He asked if there have been any additional reports on chloramine. Dr. Weintraub said that there have not been additional reports, but people who filed the original complaints continue to make reports. Commissioner Umekubo asked about the relationship between chloramine and fish toxicity. Dr. Weintraub said that the chloramine could react with fishes’ hemoglobin, which affects their ability to carry oxygen. The PUC de-chloraminates the water before dumping it into any large bodies of water. It is a very complex system. Commissioner Illig reminded the Commission that the first Health Impact Assessment was presented to the Living Wage Task Force when he was chair of that body. He asked if EHS has made presentation to other commissions. Dr. Bhatia said the Planning Commission has been aware that EHS is developing this tool for the Eastern Neighborhoods Initiative. There has been one presentation to the Planning Commission. They will go back to the Planning Commission once they have done a pilot test of the Healthy Development Measurement Tool. It would be helpful to have a forum on the relationship between health and land use planning, one that is not project specific. He would be happy to facilitate such a forum, and asked the Health Commission to outreach to colleagues on other commissions. 8) PUBLIC COMMENT/OTHER BUSINESS None. 9) ADJOURNMENT The meeting was adjourned at 5:30 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.