Minutes of the Health Commission Meeting Tuesday, September 12, 2006* at 3:00 p.m. 101 GROVE STREET, ROOM 300 San Francisco, CA 94102 1) CALL TO ORDER Commissioner Monfredini called the meeting to order at 3:10 p.m. Present: Lee Ann Monfredini, President James M. Illig, Vice President Roma P. Guy, M.S.W. David J. Sanchez, Jr., Ph.D. Donald E. Tarver, II, M.D. John I. Umekubo, M.D. (arrived at 3:30 p.m.) Absent: Edward A. Chow, M.D. President Monfredini announced that the September 19th Health Commission meeting will be held at the Southeast Community Facility Alex Pitcher Jr. Community Room, 1800 Oakdale Avenue, San Francisco, CA 94124. The meeting will begin at 3:00 p.m. The Budget Committee meeting will be held at 101 Grove, Room 300, beginning at 1:00 p.m. President Monfredini welcomed former Commissioner Harrison Parker to the Health Commission meeting. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF AUGUST 15, 2006 Action Taken: The Health Commission (Guy, Illig, Monfredini, Sanchez, Tarver) approved the minutes of the August 15, 2006 Health Commission meeting. There was one correction to Commissioner Tarver’s comments on Page 5. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Sanchez chaired and Commissioner Tarver attended the Budget Committee meeting. The Budget Committee requested that the following items be moved from the Approval calendar to the Discussion and Approval calendar: 3.4 and 3.6. Items for Approval (3.1) DPH-Finance – Request for approval of a resolution authorizing the Department of Public Health, Laguna Honda Hospital & Rehabilitation Center, to accept a gift of funds, in the amount of $50,000, to provide supplementary assistance for the support of the Hospice Unit, which provides healthcare services to adult disabled or chronically ill citizens of San Francisco. (3.2) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive renewal contract with Baker Places Inc., in the amount of $157,521, which includes a 12% contingency, to provide HIV substance abuse detoxification services for individuals diagnosed with AIDS or disabling HIV disease, for the period of March 1, 2006 through August 31, 2007. Secretary’s Note – Commissioner Tarver abstained from voting on this contract. (3.3) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive renewal contract with Native American Health Center, in the amount of $184,800, which includes a 12% contingency, to provide Centers of Excellence services for Native American individuals diagnosed with HIV or AIDS, for the period of July 1, 2006 through December 31, 2007. Commissioners’ Comments (at the Health Commission meeting) Commissioner Illig said his understanding was that the Centers of Excellence were funded with CARE funds. Michelle Long from the AIDS Office said there are two Centers of Excellence that are funded by the general fund: The Native American Health Center and the Forensic AIDS Project. (3.5) BHS – Request for approval of a retroactive contract renewal with Lincoln Child Center, in the amount of $234,748, with an annual contract amount of $156,499, which includes a 12% contingency, to provide children’s mental health services, for the period of July 1, 2006 through December 31, 2007. Items for Discussion and Approval (3.4) PHP-CHPP – Request for approval of a retroactive renewal contract with Black Coalition on AIDS, in the amount of $365,117, which includes a 12% contingency, to provide fiscal agent and support services to the African American Coalition for Health Improvement and Empowerment, as the community partner for the DPH African American Health Initiative, serving African Americans city-wide, for the period of July 1, 2006 through June 30, 2007. Commissioners’ Comments Commissioner Tarver asked what the violence prevention modality entails. Ms. Smyly said that BCA said the contract includes pilot projects funded by mini-grants of no more than $5,000. There is no longer a violence prevention modality included in this contract. Last year’s contract included a violence prevention component. She provided the Budget Committee members with the correct budget summary. (3.6) BHS – Request for approval of a retroactive contract renewal with the Regents of the University of California, in the amount of $345,610, which includes a 12% contingency, to provide program evaluation services for the Children’s System of Care, for the period of September 30, 2006 through September 29, 2007. Commissioners’ Comments Commissioner Sanchez said the Budget Committee is looking for assurances that the original charge of the grant can be completed within the fiscal year or the time that has been allotted. Commissioner Tarver said he was at the MST celebration, and it is a wonderful program that has achieved much success. He was surprised, therefore, that the contract monitoring report indicates poor performance. The Department must have the data to show that this model program is in compliance and is successful. He is looking for assurances that these problems will be rectified in the future. Dr. Abram Rosenblatt, program director, said they had a number of challenges this past year, including two key staff people leaving and one staff going out on disability. This year, they are recruiting for the project director and they are confident they will be able to accomplish all the required tasks. Ms. Chan-Sew said DPH is very proud of what has been accomplished through the SAMHSA grant, and she wants this success to be documented, evaluated, and the information disseminated. The project did take on a new evidence-based project, which required some ramping up. This contract includes a very detailed workplan, and she will work very closely with the contractor to fulfill the workplan. (3.7) PHP-Housing & Urban Health – Request for approval of a new contract with Lutheran Social Services, in the amount of $226,505, which includes a 12% contingency, to provide supportive housing services and rental subsidies at the Folsom-Dore Apartments, targeting homeless adults, for the period of October 1, 2006 through June 30, 2007. (3.8) PHP-Housing & Urban Health – Request for approval of a retroactive new contract with Mission Creek Senior Community, in the amount of $603,120, which includes a 12% contingency, to provide rental subsidies to 51 Direct Access to Housing residents who are frail, formerly homeless seniors, for the period of July 1, 2006 through December 31, 2007. (3.9) BHS – Request for approval of a retroactive contract renewal with Community Awareness and Treatment Services, in the amount of $7,203,526, which includes a 12% contingency, to provide substance abuse treatment services, for the period of July 1, 2006 through December 31, 2007. Commissioners’ Comments Commissioner Tarver asked how agencies that have used the McMillan Sobering Center in the past were notified of the change. Mr. Stillwell said notices were sent out to all non-profits CBHS does business with. In addition, the Mobile Assistance Project will continue to operate 24 hours a day, and CBHS will work closely with them to make sure there are adequate overnight resources available. Commissioner Sanchez commended the agency on its outstanding monitoring scores. (3.10) BHS – Request for approval of a retroactive contract renewal with Jelani, Inc. in the amount of $3,222,099, which includes a 12% contingency, with an annual contract amount of $1,986,916, to provide residential substance abuse services for women and families, for the period of July 1, 2006 through December 31, 2007. (3.11) BHS – Request for approval of retroactive renewal contract with the Bayview Hunter's Point Foundation for Community Improvement in the amount of $6,776,264 per year, which includes a 12% contingency, to provide mental health and substance abuse services for the period of July 1, 2006 through September 30, 2007, for a total contract value of $8,864,916. Commissioners’ Comments Commissioner Sanchez is pleased with the collaborative between BVHPF, Potrero Hill Neighborhood Center and Morrisania West. He commended the agency’s monitoring report scores. Commissioner Tarver asked if the agency is still faced with space issues. Jacob Moody, BVHPF executive director, said one of the properties that they lease for their mental health program is for sale, at a price that the agency cannot afford. They have begun to look for property in the neighborhood. They are also moving forward with integration of programs, but there is still the need for administrative space. Commissioner Tarver asked if the agency is considering housing clinicians offsite at other locations. Mr. Moody said the agency is very open to being completely integrated into the neighborhood and taking advantage of places where there is space. He has been in discussion with the director of the Southeast Health Center about placing clinicians there. (3.12) Central Administration – Request for approval of a revenue supplemental appropriation of $950,000 to provide clinical services to youth receiving services as a result of the SB 163 State initiative. Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Tarver) approved the Budget Committee Consent Calendar. Commissioner Tarver abstained from voting on Item 3.2. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. DPH Response to Multi-Casualty Incident The City’s Emergency Medical Services System and Hospital Emergency Departments responded to a multi-casualty incident on the afternoon of August 29 when a driver struck and injured 19 pedestrians. The EMS System activated a Red Alert and the Multi-Casualty Incident Plan. Ambulances from the Fire Department and private providers transported 14 patients to local hospitals. Of these, eight patients--including three triaged as having potentially life-threatening injuries--were transported to San Francisco General Hospital’s Trauma Center. The SFGH Emergency Department and Trauma Physicians, nurses and support staff quickly mobilized to prepare for incoming casualties when the first reports of this incident were communicated to the hospitals via the EMResource system Red Alert at 1:08 p.m. The first patient was received at the Trauma Center at 1:15, followed in rapid succession by six more patients. Due to the complexity of this multiple-location event, the last patient arrived at SFGH at 2:20. All patients were thoroughly evaluated and stabilized, and a total of five patients were admitted for further treatment and observation, including one patient with spinal injuries admitted to the ICU. As of today, two of these patients remain at San Francisco General. Mayor Newsom visited the ED and spoke to the treating clinicians as well as a number of family members of those injured. We were able to provide media updates throughout the afternoon of the incident, followed by a formal press event later in the week when media interest was still high and the outcome of most of the patients was evident. While this tragic event underscores the need for ongoing preparedness efforts, Dr. Katz is pleased to report that the City’s Hospital and Trauma Center and overall EMS system responded in a well-coordinated and practiced manner to ensure the best possible outcome for those injured. SFGH Medicare 2567 Report On September 6, SFGH received the Medicare 2567 Report summarizing the findings of the Center for Medicare and Medicaid Services (CMS) Validation Survey that was conducted June 26-29.  The cover letter confirms that SFGH made significant strides complying with the Plan of Correction (POC) that was submitted in response to the December 2005 survey. There were four Conditions of Participation that were not met: Governing Body Quality Assessment and Performance Improvement Nursing Services Pharmaceutical Services SFGH is now in compliance with three of the above-mentioned conditions. Only Pharmaceutical Services remains out of compliance. The POC for this Medicare 2567 Report is due in the CMS San Francisco Regional Office by this weekend, Saturday, September 16. SFGH leadership, medical and hospital staff have been developing plans of correction using our internal preliminary list of deficiencies. Fortunately, all of the items identified on the Medicare 2567 Report were already identified on our preliminary list. If the POC is accepted by CMS, there will be a third, and hopefully final, unannounced survey. New Health Access Program Administrator Dr. Katz announced that Tangerine Brigham will be rejoining the Department on October 23rd as the Health Access Program (HAP) Administrator to lead us in the planning, design, and implementation of HAP. In this position, she will be chairing the two HAP Departmental committees, Program/Operations and Fiscal/IT, and will ensure that all of the Department’s preparation for HAP is coordinated. Many of you will recall Tangerine as the former Director of Policy and Planning. She left the Department in May 2001 after 10 years of service in the City, including eight years in DPH. Most recently, Tangerine was the Program Officer for Community Health at the San Francisco Foundation. She holds a masters degree in Public Policy from the University of California, Berkeley, and a Bachelor of Arts degree in economics from UCLA. Health at Home Health at Home received an unannounced survey from the Department of Health Services, Licensing and Certification Division on August 21st. An RN surveyor spent 3 ½ days interviewing managers, staff, and patients, making home visits with nurses and therapists, and reviewing medical records, employee personnel files, and selected agency policies and procedures. There were no “condition-level” citations. However, she cited some instances of errors in documentation of the reasons for missed patient visits and the accompanying physician notification, and on the need for more thorough documentation on home health aide supervision. At the exit summation, the Surveyor indicated that the overall quality of care provided by Health at Home is very good. Once the Surveyor’s written report is received and the agency’s plan of correction is submitted and accepted, re-certification of the agency will be completed. Medi-Cal Reimbursement for Mobile Methadone Clinics: AB 631 (Leno) passed the Legislature on August 31st. Senator Kuehl presented the bill in the Senate without using the word “methadone” – she used mobile narcotic treatment units instead. The Governor has until September 30th to sign it. Our lobbyists have been working with the Governor's staff to explain that this bill is not about driving drugs around to addicts -- it's about reimbursing the City for a successful program we're already doing, which provides identical treatment to addicts who refuse to come into the clinics. Dr. Katz will keep the Commission posted. DPH PrEP Survey Pre-exposure prophylaxis (PrEP), or the use of antiretroviral drugs by HIV-negative people prior to HIV exposure in an attempt to prevent HIV infection, is currently being tested in clinical trials in San Francisco (www.projectt-sf.org) and around the world. To evaluate anecdotal reports and a previous survey suggesting substantial PrEP use in the community, the DPH HIV Research Section conducted surveys of 851 gay and bisexual men recruited at various venues in SF, at the SF City Clinic, and at the Palm Springs White Party (an annual circuit party). About one-fifth of the men had heard of PrEP, with the most common sources of information being the media and friends. Men who reported unprotected anal sex in the past 6 months were more likely to have heard of PrEP. Only one respondent said he had used PrEP (although his responses suggest he may have meant post-exposure prophylaxis (PEP), or one month of antiretroviral therapy started shortly after a high-risk exposure). A substantial majority (68 percent) said they would use PrEP in the future if proven to be safe and effective. Contrary to prior reports, this study found that community PrEP use appears to be rare. Research efforts should focus on determining whether PrEP is safe and effective for HIV prevention. Meanwhile, given potential harms associated with unmonitored use, PrEP is not currently recommended outside clinical trials. Sign the Steel Beam Party at Laguna Honda Hospital Replacement Project Dr. Katz hopes the Commissioners will join the Laguna Honda Hospital staff and hundreds of residents, neighbors and volunteers this Friday, Sept 15th, from 1-4 p.m., when we celebrate a construction milestone at a “Sign the Steel Beam” party. Everyone who attends will have the opportunity to sign their name on a large steel beam before it gets installed in the new East Building. The event comes with live music, celebration and a number of surprises. Stroke Centers San Francisco is well on its way to becoming the first city in the nation that will have all of its hospital healthcare systems achieve the status of designated “Stroke Centers.” Stroke is the second leading cause of death to San Franciscans. As a designated Stroke Center, hospitals will have the ability to rapidly prioritize potential stroke victims, perform blood tests and CT scans to identify reversible causes of stroke, provide expert neurological consultation quickly and provide treatment and rehabilitation for stroke victims. Stroke centers must meet rigorous criteria established by the Joint Commission on the Accreditation of Hospitals and Health Care Facilities. The Department hosted a press conference last week at SFGH to highlight the training currently being given to the City’s paramedics, emergency personnel and dispatchers that will support stroke patients during their transport to the receiving hospitals. Gene O’Connell, Dr. John Brown, Medical Director of EMS and Dr. J. Claude Hemphill, Director of SFGH’s Stroke Program, were joined by representatives from the American Stroke Association, SFFD Paramedics, other hospitals and a young stroke patient who talked about her treatment at an accredited Stroke Center. Speakers emphasized the importance of recognizing the symptoms of a stroke, stroke prevention and improved stroke care once a patient arrives at the hospital. Within the next several months, SFGH, St. Mary’s, St. Francis, Sutter at Davies, and Chinese Hospital will become designed Stroke Centers. UCSF has already achieved this designation. Tobacco Free Project The Tobacco Free Project staff contributed a chapter on "The Community Action Model in a Public Health Department Setting Case Study: Tobacco Divestment on College Campuses," which was recently published in Tackling Health Inequities Through Public Health Practice: A Handbook for Action, a publication of The National Association of County & City Health Officials. Pedestrian Safety Chris Murphy, Director of the California Office of Traffic Safety, (OTS) has officially congratulated the San Francisco Department of Public Health for successfully completing the objectives of the DUI Enforcement and Education Program grant, which ended in February 2006. His letter of August 25, 2006 states, "The Department's traffic safety contribution increases the relevance and impact of our California Traffic Safety Program to the overall national program." OTS credits the grant efforts for a substantial decrease in the number of San Francisco's young adults, ages 21 – 34, involved in fatal and injury collisions when they had been drinking. This project was part of the Traffic and Pedestrian Safety Program in Community Health Promotion and Prevention. 5-A-Day Month September is “5-A-Day” month. On September 20th, nutritionists and staff from the Feeling Good Project, the Chinese 5-A-Day Project and the WIC program will be promoting good nutrition by reminding shoppers at the Civic Center Farmer’s Market to eat at least five servings of fruits and vegetables every day to maintain good health. From 10 a.m.- 1 p.m., staff will also be giving out cookbooks, answering nutrition questions and distributing gifts to the farmers. The Civic Center Farmer’s market supports family farms and brings fresh, seasonal produce, fish, olive oil, nuts, honey, flowers and baked goods to the middle of San Francisco. New Medical Director at TWHC Dr. Katz welcomed Deb Borne, MD, as the new Medical Director for Tom Waddell HC Homeless Programs and Community Sites. Dr. Borne comes to DPH from Brooklyn, NY where she spent the past five years working in the Bronx serving a high-risk population as part of her National Health Service Corps assignment. She has much experience with HIV, multi-diagnosis, and impoverished patients. Dr. Borne previously completed her Family Practice Residency Program training at SFGH, so this is a welcome return for this excellent new COPC Medical Director. Community Health Network, San Francisco General Hospital, September 2006 Credentials Report 09/06 07/06 to 09/06 New Appointments 28 45     Reinstatements 0 0 Reappointments 60 84    Delinquencies: 0 0    Reappointment Denials: 0 0 Resigned/Retired: 20 39 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Deceased 0 1 Changes in Privileges    Additions 12 13    Voluntary Relinquishments 6 11    Proctorship Completed 25 5    Proctorship Extension 0 0 Current Statistics – as of 09/1/06     Active Staff 474   Courtesy Staff 559   Affiliate Professionals (non-physicians) 202   TOTAL MEMBERS 1,235   Applications In Process 48   Applications Withdrawn Month of September 2006 0 4 (07/06 to 09/06) SFGH Reappointments in Process Oct. 2006 to Jan. 2007 172   Commissioners’ Comments Commissioner Guy is delighted that Ms. Brigham is back to help DPH meet the challenge we have embarked upon. Commissioner Sanchez noted the outstanding protocols that were followed during the multi-casualty tragedy. The Mayor mentioned at a seminar at USF the San Francisco is funding programs in the schools, and Commissioner Sanchez asked if any of this funding would be used for wellness centers, school nurses and other health resources. Dr. Katz said his understanding is that the funding is for the wellness centers through the Department of Children, Youth and their Families. The intention is to use this money until every school has a wellness center. Commissioner Tarver asked Dr. Katz if he has any initial thoughts about what the expectations are for the meeting in the Bayview next week. Dr. Katz said the idea behind the report is to take the somewhat separate conversations and activities that have been happening, combine them, and take a broad, geographic look at the major issues. The Department examined what services were provided, where the programs were located, where the gaps are and what the next steps are. Based on this report, the Commission would support policy directions based on next steps. Commissioner Illig commended the Department on its response to the hit-and-run tragedy. The fact that our response worked so well shows that DPH is ready. He wants to acknowledge Health at Home for passing the licensing survey with flying colors. This is a very complex service, and HAH should be commended. Commissioner Monfredini said the response to the hit-and-run tragedy was wonderful. Everyone worked together in wonderful form. She knows that San Francisco General Hospital will respond to the CMS survey in a timely manner. She welcomes Ms. Brigham back to the Department. 5) PRESENTATION OF THE EMPLOYEE RECOGNITION AWARDS FOR SEPTEMBER Commissioner Guy presented the Employee Recognition Awards for September. Team Award Division Nominated By Tom Waddell Health Center Patient Visit Redesign Team DPH Barbara Wismer, M.D. · Sandra Aseltine · Amy Bolanos · Cynthia Collins · Angela Davidson · Paul Hathaway · Chris Nguyen · Rosario Noble · Julie Brown-Modenos     Commissioners’ Comments Commissioner Tarver applauded the redesign effort and asked if it could be replicated at other clinics. Dr. Drennan, Director of Primary Care, said the consultants focused on a large clinic redesign. Also, Tom Waddell has very specific logistics. However, what they learned at Tom Waddell will be transferable to other sites. 6) PRIMARY CARE UPDATE Michael Drennan, M.D., Director, Community Oriented Primary Care (COPC), presented COPC’s annual report. The report charts the progress over the past year in COPC and outlines the key components of the administrative, clinical and quality of care infrastructures that support COPC. Dr. Drennan said that COPC developed a number of utilization reports over the past year and a half that help COPC understand what they do now and plan for the future when capacity will be expanded. Dr. Drennan described a number of the reports that are prepared and distributed to clinics to track patient utilization and productivity. The reports provided various patient demographic information including gender, age, ethnicity, neighborhood, primary language and payor source and other information. Dr. Drennan gave an overview of the Primary Care quality improvement infrastructure. Quality Improvement (QI) Committee remains the main vehicle for monitoring quality improvement activities in the COPC clinical sites. The CPC Clinical Service is part of SFGH Medical Staff, and quality improvement activities are funneled through SFGH’s QI structure and ultimately reported to the San Francisco General Hospital Joint Conference Committee. Quality Improvement Goals: Goal 1: Develop more effective and more standardized Quality Improvement Committees at each COPC clinical site. Goal 2: Integrate CPC QI activities into SFGH Medical Staff and SFGH Quality Management Office. Goal 3: Integrate CPC QI activities with QI activities of SFGH based Primary Care clinics and the Ambulatory Care Committee (ACC) of the SFGH Medical Staff. Goal 4: Improve procedures for responding to external audits at CPC sites. Community Primary Care conducts annual Client Satisfaction surveys of patients/clients system-wide, results of which may guide quality improvement efforts in the individual clinics and COPC overall. Dr. Drennan gave an overview of COPC’s finances. Primary care has a very large self-pay category, which leads to a heavy reliance on the general fund. In FY 2005-2006, general fund accounted for 67 percent of revenues. The revenue mix may change as a result of the HAP program. Dr. Drennan said COPC has a variety of innovative chronic care programs, and highlighted the diabetic collaborative efforts and other chronic care initiatives. Dr. Drennan updated the Committee on behavioral health integration with Primary Care. Lack of psychosocial resources continues to plague Primary Care. The Department did not receive the as much money as was anticipated from the Mental Health Services Act. Dr. Drennan described some of the primary care services provided at behavioral health sites. Community projects include Community Health Programs for Youth, Southeast Health Center initiatives and Project Homeless Connect. Future Challenges: Access to care needs highlighted by SFHAP Need 10-15,000 new patients into DPH primary care clinics, similar numbers for SFCCC and others Complex patients, aging population Much from data projects useful in assessing capacity, monitoring patient utilization, provider productivity and quality measures Clinic Productivity Monthly reports track visits per clinic hour Clinical time at 75% of total provider time Adequate support staff needed to improve provider efficiency Chronic Disease Management Challenges Sustaining gains made through innovative pilots Spreading beyond initial pilot sites Spreading to other chronic conditions Produce and maintain information infrastructure Expansion of quality indicator projects Primary Care capacity to handle SFHAP Additional staff needs: provider, support staff Capital improvements: expanded exam room and group meeting/counseling space IT and other infrastructure improvements Staffing mix and role redefinitions Planning efforts with SFHAP partners COPC internal planning SFHP, COPC, SFCCC early planning efforts DPH Implementation work group Dr. Katz said that primary care is an area of tremendous growth and change, and it is the area that most needs to be nourished and flourish. DPH is incredibly lucky to have a tremendous primary care leadership team. He is optimistic about primary care’s future. San Francisco has an advantage of being a leader in the primary care movement and has the benefit of primary care experts. DPH also has, for the first time, some money to for dedicated consultant resources with individual projects. This has been a major boon. A huge amount of progress has been made addressing the capital needs of the clinics. So DPH has the right people, the right ideas, money and adequate physical space. The HAP brings in a sizeable amount of new money, and offers the opportunity for everyone to win. There are a lot of reasons to be excited, and there is a lot of room for Health Commission suggestions about how to bring primary care to the next level. Commissioners’ Comments Commissioner Umekubo thanked staff for the report. With regard to capacity, we are looking at potentially 2,000 patients added to a system that already serves 62,000 unduplicated patients. Workflow is key for a primary care clinic to run efficiently, and inefficient systems lead to bottlenecks. Every day is a challenge in primary care, and he appreciates what DPH staff does day in and day out. He is seeing a change in patients’ healthcare, in terms of outcomes, new medications, etc. COPC’s diabetes numbers are excellent. The challenge is to try to streamline processes as much as possible. He is aware that there is a movement away from new medical school graduates to go into primary care. This is a scary challenge. Dr. Drennan said that 15 years ago, the number of doctors going into primary care was increasing, but now it is decreasing. He encourages all the clinics to be involved in training programs, and place resident trainees in the clinics. The medical school just went through a large change that attaches first-year residents to high-need urban environments. Commissioner Sanchez noted that the medical staff at Laguna Honda Hospital has established a community medicine training program, which is so important to the continuity of care and emphasizing Laguna Honda’s value to the education community. Primary care, including family practitioners, schools, wellness centers, refugee clinics, and everyone involved in caring for working families, is well-suited to provide leadership in this area. It is great to have institutions that have a unified mission, offer the highest level of quality care, create bridges to the community and provide quality services. Commissioner Guy said the Health Department and Health Commission have the responsibility to bring primary care in San Francisco into the 21st century. She agrees with the future challenges that have been brought to the Commission’s attention. Other issues she wants COPC and the new HAP administrator to address: DPH’s relationship to the San Francisco Community Clinic Consortium; the acknowledgement that staff is going to be asked to embark upon a new initiative and do new things that will entail a lot of hard work; problem solve about how mental health is going to be integrated into this venture. She also wants to discuss when it is appropriate to have another discussion about this at the CHN JCC. Commissioner Illig asked if COPC would be implementing Dr. Bodenheimer’s primary care model. Dr. Drennan said this model provides a jumpstart and COPC is looking at opportunities for Dr. Bodenheimer to get involved in DPH efforts. Commissioner Illig applauded the new data collection and analysis tools, and asked if the data would be used to develop new outcomes. For example, if primary care patients are high utilizers of SFGH’s emergency department, we have the data to identify those patients and identify ways to treat these patients differently. Roland Pickens, San Francisco General Hospital, said the Medical High Utilizer Program is very active at San Francisco General, and he would be happy to update the Community Health Network Joint Conference Committee. Commissioner Illig asked if there is a way for DPH to reduce wait times for new appointments, using Community Clinic Consortium clinics and St. Mary’s Clinic. This should be an outcome. Dr. Drennan said that there are opportunities to create new appointment space for new appointments and returning patients. In addition, each health center needs to dedicate some of its time to urgent care. Commissioner Illig was under the impression that FQHC accounted for a larger portion of COPC’s revenues. He would also like to explore the unique model of the Curry Senior Center, and asked if the Department is looking at similar models elsewhere. Commissioner Tarver is concerned about where CBHS sits within the Community Health Network. It is not fully incorporated into the CHN. One major challenge to integration is cultural, rather than financial. The primary care clinics are really not designed as multi-care sites, and both the mental health needs and medical needs of mental health patients are underserved. It is a culture change, and the Health Commission should provide policy direction on where it wants the integration efforts to go. With regard to recruitment, Commissioner Tarver wants to ensure that people being recruited reflect the language and cultural diversity of our patients. Medically trained personnel at all levels will be returning from military service abroad, and DPH should make connections with this community as part of its recruitment efforts. He would like to see the Commission foster the shared mission of mental health and primary care, and the overlap of patients. He would like to see more joint positions, joint funding, and other efforts. Sheila Kerr said that one effort to integrate mental health into primary care is through the diabetes initiative. Commissioner Monfredini asked what the next steps are, in terms of an update to the CHN JCC, given that Tangerine Brigham starts her new job in October. Commissioner Illig said that there should be a report to the CHN JCC prior to Dr. Katz reporting to the Board of Supervisors in January. The consensus is to schedule a report to the CHN JCC in December. 7) PRESENTATION OF THE NEW EMPLOYEE ORIENTATION VIDEO Frances Culp, Senior Health Program Planner, presented the new employee orientation video that was created at the request of the Integration Steering Committee. While employees receive a formal orientation through Laguna Honda Hospital and San Francisco General Hospital, other employees do not receive anything beyond informal orientations through their supervisor and/or employee handbooks and materials. The video is designed to contain specific, important information that is useful to new employees, but general enough to apply to all employees regardless of their positions. DPH will begin airing the video at existing orientations at SFGH and LHH, and include it in the Human Resources processing procedures at 101 Grove. Commissioners’ Comments Commissioner Tarver said this department-wide video is greatly needed. It gives employees a sense of the scope of DPH activities as well as a sense of connection to these activities. It was a welcome addition to inform staff about their opportunities to participate in public forums. Commissioner Tarver said the video is also relevant to current employees, and he looks forward to it being available on the Department’s Intranet. The other potential audience is DPH contractors. Commissioner Guy asked at what point during an employee’s orientation would the video fit in. Ms. Culp said to start with, it will play as part of the orientations at San Francisco General Hospital and Laguna Honda Hospital, right at the beginning of orientation. Other employees will see the video when they come to 101 Grove to be processed by Human Resources. Commissioner Umekubo congratulated staff on the video. It flowed very well, was engaging and contained a lot of information. Commissioner Illig asked how the video was paid for. Ms. Culp said that the video was produced by SFGTV, who did it at a reasonable price. DPH paid for it out of facilities funds. 8) PUBLIC COMMENT/OTHER BUSINESS Michael Petrelis said the Health Commission meetings need to be broadcast on Channel 26. This provides great transparency for commissions, and it one more way to involve everyone in San Francisco government. The Health Department takes up the biggest chunk of the city’s budget, and the Health Commission has a lot of influence. Citizens should be able to know what is going on. 9) ADJOURNMENT The meeting was adjourned at 5:40 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.