Minutes of the Health Commission Meeting Tuesday, October 17, 2006 at 3:00 p.m. 101 GROVE STREET Room 300 San Francisco, CA 94102 1) CALL TO ORDER President Monfredini called the meeting to order at 3:15 p.m. Present: Lee Ann Monfredini, President James M. Illig, Vice President Edward A. Chow, M.D. Roma P. Guy, M.S.W. David J. Sanchez, Jr., Ph.D. Donald E. Tarver, II, M.D. John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF OCTOBER 3, 2006 Action Taken: The Commission approved the minutes of the October 3, 2006 Health Commission meeting with the following changes. On Page 2, comments under Item 3.5 were amended to read “UOP” rather than “UCSF.” On page 11, the following was added to Commissioner Tarver’s comments: “Commissioner Tarver said it might behoove staff to re-examine the potential for moving the outside stairs on Building 30 to support aesthetic appeal and to increase available horizontal space.” 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Sanchez chaired and Commissioner Tarver attended the Budget Committee meeting. Commissioner Chow joined the meeting for the discussion of Item 3.11. The Budget Committee requested that the following items be moved from the “Approval” section of the agenda to the “Discussion and Approval” section: 3.1, 3.2, 3.3 and 3.6. Items for Approval (3.4) CHPP-Health Promotion – Request for approval of a sole source contract renewal with the Regents of the University of California-Family Health Outcomes Project, in the amount of $225,120, which includes a 12% contingency, to provide evaluation services to the DPH Seven Principles Project, for the period of September 30, 2006 through September 29, 2007. (3.5) CHPP – Request for approval of sole source contract renewal with Booker T. Washington Community Services Center, in the amount of $348,553, which includes a 12% contingency, to provide logistical and administrative support services for the SevenPrinciples Project, targeting African Americans, for the period of September 30, 2006 through September 29, 2007. Items for Discussion and Approval (3.1) PHP-AIDS Office – Request for approval accept and expend retroactively a new grant from the Centers of Disease Control and Prevention, in the total amount of $456,829, for the period of September 30, 2006 to September 29, 2008 and approve a contract with Public Health Foundation Enterprises Management Solutions, in the amount of $192,711 for year one and $175,027 for year two, for the period of September 30, 2006 to September 29, 2008. (3.2) CBHS – Request for approval of a retroactive contract renewal with Catholic Healthcare west dba Saint Francis Memorial Hospital, in the amount of $504,000, which includes a 12% contingency, to provide 24-hour adult acute psychiatric inpatient hospital services, for the period of July 1, 2006 through December 31, 2010. (3.3) CBHS – Request for approval of a retroactive contract renewal with Catholic Healthcare West dba St. Mary’s Medical Center, in the amount of $856,800, which includes a 12% contingency, to provide adolescent acute psychiatric inpatient hospital services, for the period of July 1, 2006 through December 31, 2010. Secretary’s Note – Commissioner Illig and Commissioner Umekubo abstained from voting on this item. Commissioners’ Comments Commissioner Tarver asked why there is such a large difference in the rates for adolescent beds and the rates for adult beds. Ms. Chan-Sew said that they have been doing business with St. Mary’s Hospital for many years. Katrina Bennett, Executive Director, said the cost for adolescents is approximately $1,300 per day, which is more than what they receive from the DPH contract. There are different requirements for this unit. Abby Yant, St. Francis Hospital said that St. Francis, in the spirit of cooperation with the memorandum of understanding between CHW and DPH, and the fact that there is a crisis in San Francisco regarding inpatient psychiatric facilities, agreed to the rates, although they do not cover the costs for this year. They are hoping that in the next fiscal year the rates could be increased. 27 different individuals were served through this contract. The contract was increased the contract from $50,000 to $100,000. Commissioner Tarver said more resources are needed to place people in the appropriate level of care and he appreciates St. Mary’s and St. Francis cooperating and negotiating to allow for expanded access. (3.6) PHP-Policy & Planning – Request for approval of a modification to increase the contract with Anita Ruiz Contreras, by $60,450, for the new total amount of $109,200, which includes a 12% contingency, to provide Trauma Nurse Core Course training services for San Francisco Hospital Nurses, for the period of April 7, 2006 through November 30, 2006. Commissioners’ Comments Commissioner Sanchez said this is a very important training protocol, and he asked for more detail about the evaluation and review that will be undertaken at the end of the training sessions. Ms. Ruiz Contreras said there is an evaluation component, both in terms of evaluating the course and evaluating the instructors. If performance falls below a certain level, the instructors must be counseled and subsequent courses that they teach are monitored. Mary Ellen Carroll said that at the end of the training program, 300 nurses would have been trained. Staff is currently evaluating whether to continue this training under a different source of funding. Commissioner Tarver is interested in hearing the final report once it is completed. Ms. Carroll said she would incorporate this into the November disaster preparedness report that will be presented to the Health Commission. (3.7) CBHS – Request for approval of a contract modification with Central City Hospitality House, in the amount of $439,303 for a total amount of $1,584,391, which includes a 12% contingency, to provide mental health socialization and wellness services and pursuant to the Mental Health Services Act Supportive Services for Housing and a Peer Based Center, for the period of July 1, 2006 through December 31, 2007. Commissioners’ Comments Commissioner Tarver asked if satisfaction surveys were done last year. Dr. Cabaj said that this is the first full year of the contract, and as such the official satisfaction survey has not been done yet. Dr. Cabaj added that the contract funding includes funding for additional staff. (Secretary’s Note – the information regarding FTEs was submitted by the Contracts Office after the meeting.) Commissioner Tarver said that the Budget Committee has requested that the contract monitoring reports that come before the Commission also be reviewed by program managers who are presenting the contract and agency representatives to ensure that the reports are accurate. (3.8) CBHS – Request for approval of a retroactive contract renewal with Conard House, in the amount of $8,488,789, with an annual amount of $5,659,193 which includes a 12% contingency, to provide residential, outpatient, supportive housing and vocational training mental health services, for the period of July 1, 2006 through December 31, 2007. Commissioners’ Comments Commissioner Sanchez commended the agency for its high performance standards. Commissioner Tarver is aware that there is a really tight pool of public payees, and he has had clients who have a great deal of difficulty getting appropriate rep payees. Stephen Banuelos, CBHS, said the CBHS rep payee program is relatively new, and operationally just started this year. They are looking to expand by 100 clients. This is something CBHS is working with the agency on. Conard House has a long history of rep payee services through HSA. The contract is designed to incrementally increase the number of clients that are served. Commissioner Tarver asked if there is a wait list of people waiting for a rep payee, and are there services available for people who are not in IMDs. Richard Heasley, Executive Director of Conard House, said they open wait lists when they know there are going to be open slots. Mr. Heasley said 30 of the 100 from the new group are going to be non-IMD clients. In total, Conard House serves approximately 1,000 clients through its rep payee program. Their system has unlimited capacity to expand on demand so as the need is expressed, the agency can respond. (3.9) CBHS – Request for approval of a retroactive contract renewal with Family Service Agency of San Francisco, in the amount of $7,459,730, which includes a 12% contingency, to provide mental health services, for the period of July 1, 2006 through June 30, 2007. Commissioners’ Contracts Commissioner Tarver asked for a clarification about the unit of service cost for Children’s Tenderloin case management services. Tom Mesa, CBHS, said that the contract summary page shows the minute rate rather than the hourly rate, which is the unit of service. The hourly rate is $112.80 per unit. (3.10) CHPP-AAHI – Request for retroactive approval of renewal contract with Bayview Hunters Point Health and Environmental Resource Center, in the amount of $529,734, which includes a 12% contingency, to provide health and well services, for the period of July 1, 2006 through June 30, 2007. Commissioners’ Comments Commissioner Sanchez said that he could see the level of frustration in the documents that were presented to the Health Commission. He appreciates the challenges that contractors and the Department go through to make things work. Ms. Smyly said that programmatically the agency does really well and continues to meet its units of services. The Department has also challenged Bayview HERC to provide services a different way, with an emphasis on advocacy, and this will be a challenge. Commissioner Tarver asked Betty McGee, Bayview HERC Executive Director, if she was able to resolve her problems with the Department. Ms. McGee said that she feels they are on the right track, and that with continued cooperation with DPH staff they can continue to do good work. She added that the environmental advocacy is a new challenge and, given time, they will do this well. Commissioner Tarver asked if HERC has a relationship with Southeast Health Center. Ms. McGee said yes. (3.11) Central Administration – Consideration of a Board of Supervisors resolution retroactively approving listed contract modifications. Gregg Sass, DPH Chief Financial Officer, presented Item 3.11 at the Health Commission meeting as well as the Budget Committee meeting. Mr. Sass said the City Attorney has recently ruled that the Health Department contract approval process does not meet the requirements of the City Charter. The new interpretation means that many more contracts would need Board of Supervisors approval than has been the case in the past. Mr. Sass said the Health Department has always been respectful of the public nature of its contract approval process. Contracts are brought before the Health Commission with contract monitoring information and opportunities for public input and scrutiny by Commissioners. Mr. Sass said the Health Department is working with the City Attorney to prepare a Board of Supervisors resolution to approve contract modifications that have already been approved by the Health Commission. The Health Department is working with the City Attorney, Controller, Purchaser and other parties to prepare an amendment to the Administrative Code as a long-term solution. Commissioners’ Comments (at Health Commission meeting) Commissioner Illig is very distressed by this issue. In the past, the City Attorney’s Office has told contractors that San Francisco cannot do master contracts. Yet now the City Attorney is saying that contracts that span more than one year are really one contract, which is contradictory to previous statements. He applauds staff for coming up with a quick and efficient solution. Commissioner Guy asked if this new way of doing business changes anything. Mr. Sass said that the change to the Administrative Code would allow the Department to do things as they are done currently. Commissioner Chow said it seems as if using the sole source avenue as a legislative fix is a little oblique. Dr. Katz replied that this has been a very frustrating issue. The only way to change the Charter is to go to the voters. The Administrative Code can be changed legislatively to reflect that, for non-profit contractors, it is not sensible to rebid services every year. Short of changing the Charter, this is the best solution. Dr. Katz added that when the amendment to the Administrative Code is prepared, it would be submitted to the Health Commission. Action Taken: The Commission approved the Budget Committee Consent Calendar. Commissioner Illig and Commissioner Umekubo abstained from voting on Item 3.3. 4) DIRECTOR’S REPORT Anne Kronenberg, Deputy Director of Health, presented the Director’s Report. Pertussis Vaccine for New Moms at SFGH The Communicable Disease Prevention Unit has established a pilot project with the State Immunization Branch enabling Labor and Delivery at SFGH to vaccinate new moms with Tdap (tetanus, diphtheria, pertussis) prior to discharge from the hospital. Until now, L&D was only able to access 20 doses a month for their 100+ deliveries. CDC recommends administering this new vaccine to adults in order to protect babies from pertussis (whooping cough), a disease prevalent in the adult population and deadly to young infants who cannot begin the vaccination series against the disease until they are two months of age. IDSA 44th Annual Meeting On Saturday, October 14, 2006 Dr. Katz delivered an invited talk on Emergency Preparedness for Epidemics at the Infectious Diseases Society of America (IDSA) 44th Annual Meeting. District 10 Town Hall Meeting Mayor Newsom and Supervisor Maxwell are holding a Town Hall meeting at noon Saturday, October 28 at the Southeast Community Facility, located at 1800 Oakdale Avenue. Department representatives have been invited to participate and to listen to community priorities. Jimmy Loyce will be representing DPH at the forum. A resource fair will be held before the Town Hall meeting at 11:00 am. All Commissioners are invited to attend this event. Health Fair on Treasure Island Treasure Island Homeless Development Initiative (TIHDI) and DPH are co-sponsoring the first annual Treasure Island Health Fair on October 28 from 11:00 a.m. - 3:00 p.m. DPH will have representation from Primary Care, Nutrition, Dental, STDs, Child Passenger Safety, and Family Mosaic. Other participating agencies will offer information on HIV Education and Support Services, Substance Abuse, and screenings for Asthma, Blood Pressure and Diabetes. Curry Senior Center Open House The Commissioners will be receiving an invitation to attend the Curry Senior Center Open House on November 8, from 4-6 p.m. Formerly known as the North of Market Senior Center, the Curry Senior Center has undergone a major seismic upgrade resulting in four new exam rooms, a new laboratory, registration area, two counseling/interview rooms, ADA improvements and a new ventilation system. The $2.5 million construction budget was a combination of seismic bond funds and financing from the Mayor’s Office of Community Development, (MOCD) Community Development Block Grant (CDBG) funding. Methamphetamine Study Launched The National Institute of Health has funded three studies by the San Francisco Department of Public Health AIDS Office to determine whether medications have potential to both treat methamphetamine addiction and to reduce HIV risk behavior associated with methamphetamine use. In San Francisco, the rates of methamphetamine use are ten to twenty times higher than in the general population. Historically, pharmacological interventions have been shown to be effective in treating heroin, alcohol, and nicotine dependence. Three medications are planned for testing: bupropion (Wellbutrin), which is also used to treat depression and nicotine dependence; mirtazapine (Remeron), another antidepressant; and aripiprazole (Abilify), a mood stabilizer. While all the drugs are FDA-approved, none is approved for the treatment of methamphetamine dependence. Participants will be randomized to receive one of the drugs or placebo. All participants will receive substance use counseling and HIV risk-reduction counseling. Researchers are hopeful that in combination with counseling, pharmacological interventions will reduce methamphetamine craving and withdrawal. Individuals interested in enrolling in the studies should call 415/554-9013 or visit www.sfbump.com. Grant Colfax, MD, is principal investigator for this study. Chinese Gold Chef Competition Staff from the Chinatown Public Health Center participated in a semi-finalist cook-off competition this afternoon for healthy, low-fat Chinese cooking at the Lady Shaw Center. The competition, entitled “Chinese Healthy Gold Chef Cooking Contest,” also featured keynote speaker Dr. Desiree Backman, Manager of the California 5-a-Day Campaign. Today’s winning semifinalists will advance to the finals scheduled for October 21 at the San Mateo Fair Grounds. The event sponsors include Sing Tao Daily, Self Health for the Elderly, Chinatown Public Health Center and Lifemark Group. Tobacco Free Panelist Tobacco Free Project staff member Mele Lau-Smith was a participant for the plenary panel at the 5th Annual Conference of APPEAL (Asian Pacific Partners for Empowerment, Advocacy and Leadership), October 12-13. The theme of the conference was, "Towards Justice for AAPIs: Applying Lessons from Tobacco Control to Obesity". The plenary panel was an interactive session to discuss how the lessons learned in tobacco control could be applied to the obesity epidemic. Community Health Network, San Francisco General Hospital, October 2006 Credentials Report (From 10/02/06 MEC)   10/06 07/06 to 10/06 New Appointments 24 73     Reinstatements 0 0 Reappointments 34 144    Delinquencies: 0 0    Reappointment Denials: 0 0 Resigned/Retired: 5 59 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Deceased 0 1 Changes in Privileges    Additions 1 25    Voluntary Relinquishments 2 17    Proctorship Completed 5 30    Proctorship Extension 0 0 Current Statistics – as of 10/1/06     Active Staff 479   Courtesy Staff 557   Affiliate Professionals (non-physicians) 207   TOTAL MEMBERS 1,243   Applications In Process 24   Applications Withdrawn Month of October 2006 0 4 (07/06 to 10/06) SFGH Reappointments in Process Nov. 2006 to Feb. 2007 189   Commissioners’ Comments Commissioner Chow asked if the pilot project allows for 100 vaccines per month. Ms. Kronenberg said that the pilot program allows SFGH to have as many doses per month as it needs. Commissioner Chow asked staff to get him additional information about why the State is calling this a pilot program, as opposed to just increasing access to the vaccine. Commissioner Guy asked if there is another purpose for the District 10 hearing, or is it an open forum to provide testimony to the District 10 Supervisor. Ms. Kronenberg said that it is an open forum, and every department in the city that deals with constituents has been invited to attend the meeting. 5) EMPLOYEE RECOGNITION FOR THE MONTH OF OCTOBER Commissioner Illig presented the Employee Recognition Awards for the month of October. Individual Award Division, Nominated By Janet Moomaw, LCSW DPH Marilyn O’Conner Barbara Wismer Meredith Florian Ann Dallman Karen Bayle Margaret Farny Alisa Oberschelp Chuck Marion Douglas Price-Hanson Individual Award Division Nominated By Charlie Mirimoto DPH Barbara Garcia Individual Award Division Nominated By Jo Ellen Vormohr, M.D. Mary Ann Angel and Shotsy Faust DPH, San Francisco Behavioral Health Center Linda Sims 6) CONSIDERATION OF A RESOLUTION ENDORSING THE SAN FRANCISCO TOBACCO FREE COALITION PROPOSED SECOND HAND SMOKE POLICIES Alyonik Hrushow, San Francisco Tobacco Free Project and Nancy Abdul-Shakur, co-chair of the Tobacco Free Coalition, presented the Coalition’s second hand smoke policy campaign. The focus of the campaign is to close loopholes in smoking laws passed 11 years ago and to expand protection from second hand smoke to outdoor areas and multi-unit housing complexes. In 2006, the Air Resources Board (ARB) declared second hand smoke a toxic air contaminant. The ARB’s decision to do so was based on a rigorous four-year review of epidemiological and toxicological literature on second and smoke and its impacts. ARB found that there is no safe level of exposure. The Tobacco Free Coalition is advocating for a comprehensive policy to provide protection from second hand smoke. The coalition plans to work with members of the Board of Supervisors in the next few months to put forth this proposal. The Coalition is asking the Health Commission to endorse the policy by adopting a resolution. Second hand smoke policy components are: Enclosed Areas 100% of lobbies of hotels, motels Designate 75% of guest rooms smoke free in hotels, motels All bars including hookah bars Tobacco shops Outdoor Areas Outdoor dining areas of restaurants, cafes, coffee shops Service areas, waiting lines Within 20 feet of entrances, exits, operable windows, intake vents of private, non-residential buildings Recreation areas, including street fairs, commercial piers, 100% of sports stadiums Multi-Unit Residences Prohibit smoking in indoor common areas Designate at least 75% of existing units as smoke free. Phase in smoke free units as existing tenants vacate units Designate at least 90% of new units as smoke free Second Hand Smoke Defined as a Nuisance Ms. Abdul-Shakur concluded the presentation by requesting that the Health Commission endorse the Tobacco Free Coalition’s proposed policies to expand protections from second had smoke. Commissioners’ Comments Commissioner Monfredini is concerned about people not being able to smoke in their own residences. Ms. Alyonik said existing tenants would not be affected by this provision. As units become vacant, units would have to be designated non-smoking. Commissioner Monfredini said that Trinity Housing is building a rather large residential building on Market Street, providing much needed housing to low-income people. She is concerned that people will have to choose between being housed and being able to smoke, and perhaps 90% is too ambitious. Commissioner Monfredini agrees that second hand smoke is toxic, yet housing is a health issue. She is grappling with this issue of 90% of new units. Commissioner Guy said that second-hand smoke is toxic. It does not mean that we do not have to make difficult choices. Commissioner Guy said as an example her sister cannot smoke in her San Francisco apartment because the property owner’s rules do not allow smoking. Commissioner Guy said the Department could concretely identify if it is a problem that people are choosing not to go into HUH housing programs because they cannot smoke. Smoking kills and second hand smoke is killing children. Commissioner Tarver was working at SFGH when they banned smoking in the psychiatric unit. There was a lot of opposition due to the perspective that psychiatric patients need to smoke. Behavior can change, and this has been successful. Commissioner Monfredini asked if smoking is allowed at DPH supportive housing facilities. Richard Heasley, Executive Director at Conard House, said that there is no prohibition against smoking at the Plaza. In the rest of the supportive housing run by Conard House, smoking is allowed in the rooms and there is an issue of second hand smoke traveling through the hallways, the ventilation systems, etc. Mr. Heasley added that there would be nothing to prohibit Conard House with complying with this policy, given a reasonable amount of time to grandfather in current tenants. Commissioner Tarver asked if people could smoke medical cannabis. He also noted the fact that many SROs have had fires due to smoking factors. He also noted that the supportive housing units take a harm reduction approach to other substance use, and there seems to be some inconsistency. Ms. Hrushow said they view second hand smoke differently than other substances, in that it impacts other people. Furthermore, second hand smoke has no therapeutic value like medicinal marijuana. Commissioner Umekubo supports the resolution and thanked the coalition for continuing to come up with creative ideas to eliminate this problem. He feels very strongly about this since his father died from lung cancer. Commissioner Illig said that this policy is based on sound science, and the Health Commission should endorse a change in society’s attitude toward tobacco. Commissioner Chow said that second hand smoke has become such a problem that even large hotel chains are moving toward complete non-smoking facilities. It is critical that we stamp out this habit that has no value, and the Health Commission should do everything to discourage its use. Commissioner Sanchez said that this policy is a reaffirmation of the Health Commission’s desire to protect people from the impact of second hand smoke. Commissioner Monfredini supports the resolution, but wants to state her concern about rental units, particularly for low-income residents. Ms. Hrushow assured Commissioner Monfredini that people who smoke would not be prohibited from living in supportive housing or any other apartment building. Action Taken: The Commission approved Resolution 14-06, “Endorsing the San Francisco Tobacco Free Coalition Proposed Policies to Expand Protections from Second Hand Smoke,” (Attachment A). 7) NON-PROFIT CONTRACTING TASK FORCE UPDATE Anne Okubo, Deputy Finance Director, presented an update on the implementation of Non-Profit Contracting Task Force recommendations. The Board of Supervisors is holding a hearing on the implementation of recommendations on November 13th. Milestones include: Best Practices – an interdepartmental work group composed of representatives of DPH, Human Services Agency, Department of Children, Youth and Families and Mayor’s Office of Community Development met to discuss best practices around contract consolidation, timely payments, standardized and simplified contract forms and eliminating unnecessary requirements. Dispute Resolution Procedure – the Task Force adopted a procedure to address contract disputes. Electronic Invoicing – in an effort to streamline processes and assure timely payment, DPH issued a policy to accept electronic invoices from non-profit contractors. Survey of Non-Profit Contracting – In June the Office on Contract Administration surveyed non-profit contractors to illicit feedback on Task Force recommendations. Thirty-two DPH contractors responded. Ms. Okubo gave a brief summary of survey findings for DPH contractors. Ms. Okubo said the Human Services Network has expressed concerns about a number of issues including timeliness of reports, late certification, unnecessary requirements, lack of standardization, submission of multiple documents and concerns about COOL. DPH staff will be meeting with representatives of the mental health contractors association for more feedback Public Comment Judith Stevenson, Human Service Network, chair of Contract Reform Committee, said HSN has filed a report with the Health Commission (on file in the Health Commission Office), which they also plan to present to the Board of Supervisors, that presents significant disagreement on the perception of the Department. The survey that was done is incomplete in that many agencies do not feel comfortable giving true feedback about DPH practices. If the Health Commission wants to know how contractors feel, it needs to get input from contracts. There is an enormous amount of process in DPH, but very little outcome in terms of streamlined, effective contracting processes. Kavoos Bassiri, Chair of San Francisco Mental Health Contractors Association and Executive Director of RAMS, spoke in support of the problems that were raised in HSN’s memo to the Health Commission. Overall what they are asking for is a partnership when it comes to contracting, and problem solving with each program. For example, outcomes should be more meaningful. Sherilyn Adams, Larkin Street Youth Services, echoed the words in the HSN report. The thing that they find most alarming is that they have not been able to move toward a systemic solution. Instead problems are addressed on an individual basis. Streamlined processes, timely payments and joint solutions mean that agencies can go about the business of taking care of clients. Debbie Lerman, Human Services Network Administrator, said they got input from 50-60 contractors. Issues that seem dry on the service really go to the heart of the City-non-profit contractor relationship. DPH practices seem to be getting worse, particularly around late certifications, while other departments have improved. DPH leadership has worked with the contractors and is in support of the recommendations but this has not been incorporated into the DPH culture and embraced by middle management. There are specific requests outlined in the memo, such as concrete performance measures and written policies and procedures. They would also like more regular reports to the Health Commission. Eve Meyer, San Francisco Suicide Prevention, said every year CBHS contractors are required to fill out a checklist of documents they have in their offices and where they are displayed. One year she was given a failing grade because she did not initial in each of the blanks, but rather signed at the end of the page. She was enraged because she could not figure out what this had to do with anything. Commissioners’ Comments Commissioner Sanchez said that the issues raised today provide an opportunity to open up our process, listen to our contract partners and find ways to improve how we do business. There are many factors in creating and sustaining a level of partnership, including a level of trust. Ms. Okubo said that the Health Department is very complex, with more than 300 contracts. That said, she appreciates the written input from the Human Services Network, as she appreciates specific recommendations. The HSN report was distributed to program staff throughout the Department. She offered to meet, along with Michelle Long, with the Human Services Network to review and address the concerns. Commissioner Illig said there are 176 agencies that contract with DPH. Almost $400 million of DPH’s budget goes to contractors. It is clear that the agencies that do business with DPH are our partners, but they are not being treated that way. It is telling that the Human Services Network is willing to stand up, file its own report to the Board of Supervisors, and say the Health Department is not improving. This demonstrates the challenges of running a large, bureaucratic department. Many lower level employees have too tight a control over contracts. The Health Commission should ask for specific performance outcomes, one of which should be an anonymous vendor satisfaction survey. Also, the Health Commission needs to receive reports more frequently than every six months. The Commission needs an ongoing way of staying on top of these issues and ensuring progress. Commissioner Guy said the Health Commission needs to take if very seriously if there is an issue of leadership directives around contracting not funneling down to middle management. Commissioner Chow appreciates the Human Services Network being so frank. He is disappointed that such a large number of contractors feel as though progress has not been made in DPH. He suggested that the Budget Committee monitor this issue. Commissioner Umekubo is surprised at the information he received. The contracting process has been in evolution since he began on the Health Commission. He supports looking at all avenues to streamline the contract process. That said, contract monitoring is a pivotal Health Commission role, and this needs to be continued. Commissioner Tarver said the Department’s efforts to extend contracts for a longer period of time would continue to pay off in terms of the flow of funds to contractors. There was also the allocation of funds for cost of doing business. These efforts and others are an indication of DPH’s partnership with contractors. The Health Department and Health Commission want to be responsive to contractor concerns. The criticism that the Department operates in silos is valid and has been noted by others, including the HMA report. The Health Commission’s contract review process should be expanded so that program managers as well as fiscal staff are involved in presentations. It seems that a contractor needs to be able to access multiple staff within DPH so that contractors never feel beholden to one contract staff. He will continue to lend his voice to trying to be responsive and supportive of efforts to improve processes. Commissioner Illig suggested that the Commission ask that the monthly meetings between Human Services Network and the Purchasers Office focus on the Health Department for the next six months. Commissioner Monfredini appreciates the HSN memo, and is very concerned about two specific issues. The first is the feeling by contractors that they cannot raise issues without fear of retribution. She is also concerned that an individual staff person could cause so many contract delays. Commissioner Monfredini asked that a meeting be set up with she and Dr. Sanchez, representatives from the Human Services Network, and DPH staff including Barbara Garcia, Finance and the AIDS Office. She agrees with the vendor survey and asked who could develop this. Ms. Okubo said that the Contracts Office would put together a draft survey in a couple weeks. Gregg Sass added that the contractors have to be involved in developing the survey. Commissioner Monfredini asked Commissioner Illig to work with staff in the development of the vendor survey. Gregg Sass added that DPH has some excellent program managers who do excellent work, so a report card on program management by division will be helpful. Commissioner Guy said that the survey must be credible, involve contractors, and be well thought out. So take the necessary time to develop the survey. Commissioner Monfredini asked when the next report should be presented. Dr. Katz said people have been trying to implement recommendations, but clearly these efforts are not meeting the goals. Mr. Sass, Ms. Garcia and Dr. Katz will know what they are doing differently in the next month or so, so he can report back at the second meeting in November. 8) DEPARTMENT OF PUBLIC HEALTH ANNUAL REPORT Anne Kronenberg, Deputy Health Director, Director, Office of Policy and Planning, presented the Department of Public Health’s Annual Report. Ms. Kronenberg gave an overview of the inside of the Department, including the number of DPH employees, community advisory groups and DPH contract partners. She gave an overview of DPH clients, including demographics and the number of people who receive DPH services. Ms. Kronenberg then described selected DPH initiatives in the context of the DPH Strategic Plan. Goal 1 – San Franciscans Have Access to Health Services Avon Breast Cancer Center LHH Opens Specialty Care Unit – Care for cerebral palsy, epilepsy, autism and mental retardation Let’s Be Healthy Goal 2 – Disease and Injury are Prevented 3 for Life Safe Device Committee Direct Access to Housing Program Goal 3 – Services, programs and facilities cost-effective and resources maximized Expanded Nurse Training, Recruitment and Retention SFGH Rebuild – Blue Ribbon Committee LHH Replacement Project – Phase one will add 780 beds ready by 2008 Primary Care Center Retrofits – Curry Center complete, Silver under construction, Tom Waddell to begin in January Public Health Laboratory PCR Equipment Goal 4 – Partnerships with communities sustained Advancing Cultural Competency – grant funded reference manual and five training modules San Francisco Food, Nutrition and Agriculture Directory - 3rd Edition released in September 2005, available on line. Environmental Health issued regulations for effective bedbug prevention and control – training owners and operators Pandemic Influenza planning for the business community – working on a concept of operations plan in the event of a pandemic Commissioners’ Comments Commissioner Illig commended the annual report. The breadth of services that the Department provides always astounds him. He asked that AIDS Office data be included in the “Who We Serve” section of the report. His vision is that in the future, every program will have identified outcomes, which will be reported in the Annual Report. Ms. Kronenberg said that, with the establishment of the SF Stat System, more and more of this data will be able to be presented over the next few years. Commissioner Guy commended Ms. Kronenberg and staff for the Annual Report. As an annual report, it serves to inform the public about what the Department does. However it is not that effective with respect to informing the Health Commission about how the Department has advanced Strategic Plan objectives. The purpose of the Strategic Plan cannot be completely incorporated into an annual report. So the Health Commission and Department need to re-examine how the Health Commission review the value of the Strategic Plan and use health assessment tools to evaluate the health status of San Franciscans. Commissioner Chow commended the report, and offered suggestions. Commissioner Chow echoed Commissioner Guy’s desire to have a comprehensive review of the Strategic Plan. Commissioners should think about how they want this review to come forward. Commissioner Chow added that an appendix of reports that the Health Department has published throughout the year would enhance the report. 9) PUBLIC COMMENT/OTHER BUSINESS Daisy Anarchy, Sex Workers Organized for Labor, Human and Civil Rights, presented documents to the Health Commission, including a draft resolution that has been submitted to the Commission on the Status of Women regarding labor conditions of exotic dancers (on file in the Health Commission). Exotic dancers have given written statements to the Commission on the Status of Women about the labor conditions. DPH should not be funding a “community needs assessment” with St. James Infirmary. Her organization believes in the complete legalization of consensual adult prostitution, but does not believe that private booths and rooms should be allowed in exotic dance venues because this leads to coercion, sexual assault and rape in these establishments. Yvonne Martinez, SEIU 790, shared her frustration about how difficult it is to get things done in DPH. It has been three months since 50 employees at Southeast Geriatric Clinic had advocated for more staff. She is pleased to report that while the clinic has received some staff, there is still no one at the clinic to answer the phone and clinical staff still must do this. 10) CLOSED SESSION A) Public comments on all matters pertaining to the closed session None. B) Vote on whether to hold a closed session Action Taken: The Commission voted to hold a closed session. The Commission went into closed session at 6:20. Present in closed session were Commissioner Monfredini, Commissioner Illig, Commissioner Chow, Commissioner Guy, Commissioner Sanchez, Commissioner Tarver and Commissioner Umekubo. C) Closed session pursuant to Government Code Section 54957 and San Francisco Administrative Code Section 67.10(b) PUBLIC EMPLOYEES PERFORMANCE EVALUATIONS: MITCHELL H. KATZ, M.D, DIRECTOR OF HEALTH EXECUTIVE SECRETARY TO THE HEALTH COMMISSION, MICHELE M. SEATON D) Reconvene in Open Session The Commission reconvened in open session at 7:30 p.m. Possible Report on Action Taken in Closed Session (Government Code Section 54957.1(a)2 and San Francisco Administrative Code Section 67.12(b)(2).) Vote to Elect Whether to Disclose Any or All Discussions Held in Closed Session (San Francisco Administrative Code Section 67.12(a).) Action Taken: The Commission voted not to disclose any discussions held in closed session. 11) ADJOURNMENT The meeting was adjourned at 7:30 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.