Minutes of the Health Commission Meeting
Tuesday, May 5, 1998, 3:00 p.m.
At 101 Grove Street, Room #300
San Francisco, CA 94102
1) CALL TO ORDER
The regular meeting of the Health Commission was called to order by President Lee Ann Monfredini, at 3:00 p.m.
Present:
- Commissioner Debra A. Barnes
- Commissioner Roma P. Guy, M.S.W.
- Commissioner Ron Hill
- Commissioner Lee Ann Monfredini
- Commissioner Harrison Parker, Sr., D.D.S.
- Commissioner David J. Sanchez, Jr., Ph.D.
- Commissioner Edward A. Chow, M.D.
2) APPROVAL OF MINUTES OF THE MEETING OF APRIL 21, 1998
Action Taken: The Commission unanimously adopted the minutes of April 21, 1998.
3) CONSENT CALENDAR OF THE BUDGET COMMITTEE
(Commissioner David J. Sanchez, Jr., Ph.D.)
(3.1) CHS-CMHS - Request to authorize Community Mental Health Services to enter retroactively into a cooperative program agreement with the Department of Rehabilitation San Francisco District, including a required match of $160,605, to provide vocational services to mentally-ill psychiatric clients for the period of July 1, 1998 through June 30, 1999.
(3.2) PH-CHP&P - Request for approval of the following six contract renewals, in the amount of $917,023, for comprehensive tobacco control services, (which includes three sole source contracts with the Polaris, S.F. Study Center, and O'Rorke) all for the period of July 1, 1998 through June 30, 1999. These services and amounts have been reviewed and approved by the local Tobacco Free Coalition and have been approved by the State in their FY 1998-2001 Comprehensive Tobacco Control Plan for San Francisco.
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(3.4) PH-CHS-CHP&P-AIDS Office - Request for approval for three sole sources and contract approval with three agencies: 1) Black Coalition on AIDS, (DPH contracted with BCOA for services totaling $450,460 during FY 1996-97); 2) Mobilization Against AIDS, (DPH did not contract with MAA during FY 1996-97); and 3) Native American Health Center, (DPH did not contract with NAHC during FY 1996-97), as follows:
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| Amount | |||
| $ 91,268
$224,821 per year |
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| $ 80,341
$190,737 per year |
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| $120,352 $384,978 per year |
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Commissioner Hill thanked the staff who stayed on to ensure the continuation of services.
Commissioners Sanchez and Barnes thanked the Department staff for their leadership during the transition period with no major disruption of services.
Commissioner Guy acknowledged the transition challenges being handled by the Department staff.
As of April 3, 1998, the National task Force on AIDS Prevention does not receive any funds from the Department.
(3.5) PH-CHS-CHP&P-AIDS Office - Request for approval of retroactive renewal contract with California AIDS Intervention Training Center (CAITC), in the amount of $136,015, for the provision of HIV prevention program targeting behavioral risk populations, for the period of January 1, 1998 through December 31, 1998. (DPH contracted with CAITC for services totaling $145,172 during FY 1996-97).
This item was postponed to a future meeting.
(3.6) PH-CHS-CHP&P-AIDS Office - Request for approval of retroactive renewal contract with Polaris Research and Development, Inc., in the amount of $239,923, to provide logistical and technical support to the HIV Prevention Planning Council for the continued development of a strategic HIV prevention plan, for the period of January 1, 1998 through December 31, 1998. (DPH contracted with Polaris for services totaling $781,093 during FY 1996-97).
Action Taken: The Commission unanimously approved the Consent Calendar of the Budget Committee, except for #3.5.
4) DIRECTOR'S REPORT (Provides information on activities and operations of the Department). (Mitchell H. Katz, M.D., Director of Health)
ADMINISTRATION
1998 State of the City Public Health Address
Yesterday, I presented the third annual 1998 State of the City Public Health Address to the Board of Supervisors. My presentation featured an overview of the health status of San Francisco residents, identified major public health issues facing San Francisco, and described how the City and the Department of Public Health are responding to these changes.
The address highlighted several key issues including substance abuse treatment slots, mental health managed care, the shelter program at Mission Rock, HIV/AIDS prevention and treatment services, long-term care, the uninsured and Medi-Cal managed care. Board members asked follow-up questions regarding Laguna Honda Hospital facility issues, immunization rates, African-American youth smoking rates, and health issues facing the Asian-American community.
I would like to acknowledge and thank Nyasha Junior of the Policy and Planning Office who compiled the statistical portion of the report.
Procedures for Accepting Documents in Response to a Request for Proposals
It is the policy of the City and County of San Francisco and the Department of Public Health to select vendors for the provision of goods and services through a competitive process. Inherent in such processes is the principle of fairness and equal, unbiased treatment of all potential interested parties. A competitive process also helps to identify additional potential contractors and providers of services.
To avoid having to exclude proposals that may be meritorious, the Department of Public Health is revising its standard procedure. The new procedure states that proposals are due at 12 noon. Proposals received after the noon deadline but before 12:01 the following day will be accepted due to extenuating circumstances at the sole discretion of the Director of Health. Agencies that submit proposals within this grace period must provide a letter explaining the extenuating circumstances by 5 p.m. of the second day. Decisions of the Director of Health to accept or reject the proposal during the grace period will not be appealable. Following the 24-hour grace period no late proposals will be accepted for any reason and there will be no appeal.
The Department will implement this new procedure beginning July 1, 1998. The Contract Officers for all Requests for Proposals and similar competitive processes that have been released but for which the due date is after July 1, 1998, will notify all interested parties of the change in procedures, and the bidders' conference minutes will reflect this change. We anticipate that this change will enable a number of proposals to be considered that would otherwise have to be turned away.
PUBLIC HEALTH
Wedge Project
The Asian and Pacific Islander Wellness Center will honor Carol Badran, Coordinator of the Wedge Project, at a May 14 event to be held at the Asian Art Museum of San Francisco in Golden Gate Park. Ms. Badran will be presented the Ally Award. The Wedge Project is in its eleventh year of bringing AIDS education and personal histories of people infected with HIV to high school and middle school students.
Adolescent Health Conference
The Adolescent Health Working Group, convened by the Bureau of Children, Youth and Families, planned and produced the Bay Area's first Adolescent Health Conference in mid-April. The Group's members represent a cross-disciplinary approach to improving the health of our youth and their access to quality health care. Over 325 individuals representing a variety of youth service-related agencies attended the Conference, which provided information, resources and practical skills for working with and for youth. Many attendees expressed their desire for future adolescent health conferences and declared their interest in participating in a Bay Area Adolescent Health Consortium. Congratulations to Janet Shalwitz, MD, and her staff whose efforts produced this successful event.
Immunization Grant
San Francisco childhood immunizations lag behind the Healthy People Year 2000 goal of 90%. Our rates are slightly lower than San Mateo, Alameda and Contra Costa Counties. The rates differ for children of different ethnicity. Only 55% of Latino and 54% of African-American children are up-to-date at 2 years of age. In order to address these inequities, the Department of Public Health has applied for and recently received $200,000 from the State to create a high risk immunization network targeting children at highest risk of under-immunization. This network will involve public and private health care providers, WIC and health plans to work together collaboratively and share information in order to reach and retain these children. This network will be focused on children and families seen in the Southeast Sector and the Tenderloin District. In addition, the Department is in the final stages of an in-depth door-to-door population based study covering the Mission Neighborhood trying to find out the reasons for low immunization rates and how best to reach parents and children.
COMMUNITY HEALTH NETWORK
CHN Administrative Appointments
I am pleased to announce effective immediately, the permanent appointment of Anthony Wagner as Executive Administrator of the Community Health Network. Mr. Wagner was appointed Deputy Administrator of the Network in 1996 and had been serving as its Interim Executive Administrator since February of this year.
It also pleases me to announce that Mr. Wagner has made two major appointments for the CHN. Gene O'Connell has been appointed the Administrator of San Francisco General Hospital, and Larry Funk Administrator of Laguna Honda Hospital and Rehabilitation Center.
These three administrators have been outstanding in their performance during their interim periods. I know the Commission joins me in congratulating the new CHN management team and wishing them success in their new and challenging endeavors.
Appointment of CHN Continuum Medical Directors
Melissa Welch, MD, the CHN Chief Medical Officer, announced the appointments of three CHN Continuum Medical Directors. These appointments are effective May 1, 1998 and include the appointments of David Ofman, MD, CHN Medical Director of Primary Care; Joe Goldenson, MD, CHN Medical Director of Forensic Services and Chief of Forensic Services; and John Luce, MD, CHN Medical Director of Quality and Utilization Management and Medical Director for Managed Care
As CHN Continuum Medical Directors, each will work in a paired, administrative leadership model, and report to Dr. Welch and Gene O'Connell, CHN Director of Patient Care Services.
National Association of Public Hospital (NAPH) Awards
Dr. Robert Okin, Chief of Psychiatry at SFGH, has been awarded the 1998 NAPH Jim Wright Vulnerable Populations Award. This annual award honors the memory of Jim Wright and his efforts to serve the many vulnerable populations who come to our nation's safety net institutions. The CHN/SFGH "Emergency Department Case Management Program," which was submitted to NAPH as the CHN nomination for this award, was selected from a total of 49 entries submitted nationwide.
I am also pleased to announce that Dr. Beth Kaplan from SFGH Emergency Services and her team received an honorable mention in the category of Healthy Communities for the second CHN nomination "Improving the Health Care Response to Domestic Violence." This award is an important recognition of their efforts in pioneering a model response for health care workers in domestic violence recognition and intervention.
Join the CHN in congratulating Dr. Okin, Dr. Kaplan and their teams for the NAPH awards as recognition of their outstanding achievements.
Development of a Revised LHH Bond Program
Staff from the Community Health Network have reviewed the complexities and issues involved in the revision of the Laguna Honda Hospital Bond Program and the very short lead time available to make the November 1998 ballot. Staff has consulted with the Department of Public Works representatives and our architects as part of the review. Based upon that review, we believe that in order to produce a high-quality plan that considers a broader spectrum of service modalities for senior healthcare services and long term care that additional planning time is necessary. Therefore, the LHH Bond will be placed on the ballot in November 1999 instead of November of this year.
LHH Hospice Receives Honor
The Board of Supervisors has awarded a Certificate of Honor to the Laguna Honda Hospice and Palliative Care Service Unit. This award was sponsored by Supervisor Jose Medina whose father recently passed away after months of receiving high-quality care from the staff of the Hospice Unit. The award is yet another indicator of the quality of care provided at Laguna Honda in a variety of program areas.
National Hospital Week
Laguna Honda will celebrate National Hospital Week from May 11th through the 15th. With a variety of special events and activities recognizing the staff, volunteers and residents, the week's festivities will be highlighted with an outdoor picnic/barbecue in the Clarendon Valley on Friday, May 15th from 11:30 to 1:30 p.m. All Commissioners will be invited to attend.
New DHS Requirements
Senate Bill 945 requires the Department of Health Services (DHS) to ensure that each new applicant for certified nurse assistants, home health aides, and owners and administrators of home health agencies submit fingerprints to DHS. The new requirement for fingerprint and criminal background screening prior to certifying new applicants and renewing any current certification is effective on or after July 1, 1998. Mr. Wagner has appointed Adianne Tong, Mary Louise Fleming, and Carol Sam to serve on a task force to review this legislation and to develop a plan to assure that CHN staff complies with the regulation.
The Laguna Honda Story
The "Laguna Honda Hospital Story" has been published by the CHN and is ready for distribution. The LHH Story is a four-page newspaper that discusses the mission of LHH and the way in which LHH affects the lives of its residents in a clinical and personal way.
On behalf of the Commission, President Monfredini offered congratulations to Tony Wagner, Gene O'Connell, and Larry Funk for their permanent administrative appointments.
5) PRESENTATION OF THE CITYWIDE DIVERSION REPORT
Dr. John Brown, EMS Agency Medical Director, presented a citywide hospital diversion update (Attachment A). He also submitted the EMS Section Diversion Action Plan, the current diversion statistics as of April 1998, and a study of diverted patients (December 1997.)
There were discussions with Commissioners on the following areas:
- Number of walk-ins during diversion
- Comparison of diversion data with other areas in the State
- Questions of inappropriateness of patients coming to the Emergency Room
- Joint training for critical care staff
- Shortage of nurses
- Interpretation of the data
- Benchmark for minimum standards per City
- Public education on the appropriate use of the Emergency Room
President Monfredini requested another update on citywide diversion on October 6, 1998. When received, Dr. Katz will forward the Statewide Task Force report to the Commission. The first draft is being targeted for completion in July, with a final report completed in September.
6) TIME SPECIFIC: 4:00 P.M.
PUBLIC HEARING, IN ACCORDANCE WITH THE HEALTH CARE PLANNING ORDINANCE (PROPOSITION Q, 1988), TO CONSIDER THE IMPACT OF THE FOLLOWING CHANGE OF HEALTH CARE SERVICES IN THE COMMUNITY FROM DAVIES MEDICAL CENTER:
DAVIES MEDICAL CENTER (DMC) HAS SIGNED A LETTER OF INTENT WITH CALIFORNIA PACIFIC MEDICAL CENTER (CPMC) AND SUTTER HEALTH FOR THE ACQUISITION OF DAVIES MEDICAL CENTER BY CALIFORNIA PACIFIC MEDICAL CENTER
For this item, President Monfredini abstained due to a conflict of interest. Vice President David J. Sanchez, Jr., Ph.D., presided over this item.
A 3-minute break was taken.
Vice President Sanchez reviewed the process and procedures for this Proposition Q hearing. The Commission had received a letter from Greg Monardo, President and CEO of Davies Medical Center, indicating the following specific strategies:
CPMC's stated plans for the merger will maintain DMC's programs and services, including the following specific strategies:
- Maintain DMC's:
- Emergency Department
- Acute Medical/Surgical Unit
- Ambulatory Surgery Unit
- Critical Care Unit
- Expand and Develop DMC's:
- Acute Rehabilitation Unit
- Inpatient Psychiatry Department
- Microsurgery Department
- Skilled Nursing Facility
In addition, the plans include the consolidation of DMC's and CPMC's medical staffs.
CPMC is an acute care hospital with 913 licensed beds and 25 residential licensed beds in its Alzheimer's Unit. CPMC is an academic medical center that provides primary care, acute and critical care, obstetrics, and tertiary care programs including transplantation, cardiac care and surgery, neurosurgery, neonatology, geriatrics, and complementary medicine through its Institute for Health and Healing.
The intent of the strategy described above is to build upon both DMC's and CPMC's outstanding clinical and community reputations to strengthen programs, services and patient care. Our hope is to maintain as many as possible of our employees as we work toward these goals.
DMC and CPMC had the following speakers:
- Greg Monardo, DMC President and CEO
- Greg Buncke, M.D., DMC Chief of Staff
- William Owen, M.D., HIV Specialist
- Brian Christianson, Neighborhood Representative
- Tony Brayer, M.D., CPMC Chief of Staff
- Martin Brotman, M.D., CPMC President and CEO
A letter was submitted from Edward P. York, President of the Duboce Triangle Neighborhood Association.
- Public Speakers:
- Fred Seavey, Local 250
- Karen Kircher, SF/United Cerebral Palsy
Commissioner Barnes expressed concerns about the continuation of clinical trials for HIV patients and labor issues. She emphasized the need for management to meet with the labor union representatives and address employee-related issues.
Vice President Sanchez requested more details of the proposed acquisition. He specifically requested updates on CPMC's most recent Prop Q hearings (i.e. transfer of obstetrics services from Chinese Hospital to CPMC and the relocation of the Urgent Care Center to the Pacific Campus Emergency Department.)
Commissioner Guy requested statistics and quantitative data to justify the projected expanded services. She noted that in this era of downsizing and managed care, there is a contradiction in expanding services.
Commissioner Parker noted the projected growth in services contradict the direction to have fewer employees.
The Commission continued this item to the May 19, 1998 meeting in order to receive more detailed information and data regarding the acquisition. At the June 2, 1998 meeting, the Commission will vote on determining whether this acquisition will or will not have a detrimental impact on the health care service in the community.
7) OTHER BUSINESS/PUBLIC COMMENTS
None.
8) CLOSED EXECUTIVE SESSION:
A. PUBLIC COMMENT ON ALL MATTERS PERTAINING TO THE CLOSED SESSION.
None.
B. VOTE ON WHETHER TO HOLD CLOSED SESSION TO CONFER WITH LEGAL COUNSEL. (SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.11(a).)
Action taken: The Commission unanimously voted to hold a closed session.
C. CLOSED SESSION PURSUANT TO GOVERNMENT CODE SESSION 54956.9 AND SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.11(b).
CONFERENCE WITH LEGAL COUNSEL - EXISTING LITIGATION.
NAME OF CASE: HARRIS V. CCSF ET AL, UNITED STATES
DISTRICT COURT #C97-3379 CW
D. RECONVENE IN OPEN SESSION:
1. POSSIBLE REPORT ON ACTION TAKEN IN CLOSED SESSION. [GOVERNMENT CODE SECTION 54957.1(a)(2) AND SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.14(b)(2).].
Action taken: The Commission unanimously approved the $100,000 settlement for this case.
2. VOTE TO ELECT WHETHER TO DISCLOSE ANY OR ALL DISCUSSIONS HELD IN CLOSED SESSION (SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.14(a).)
Action taken: The Commission unanimously voted not to disclose any discussions held in closed session.
The meeting was adjourned at 5:50 p.m.
Sandy Ouye Mori, Executive Secretary to the Health Commission