Minutes of the Health Commission Meeting Tuesday, May 19, 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 3:05 p.m. Present: Commissioner Debra A. Barnes Commissioner Edward A. Chow, M.D. Commissioner Roma P. Guy, M.S.W. Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner David J. Sanchez, Jr., Ph.D. Absent: Commissioner Ron Hill 2) APPROVAL OF MINUTES OF THE MEETING OF MAY 5, 1998 Action Taken: The Commission unanimously adopted the minutes of May 5, 1998. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner David J. Sanchez, Jr., Ph.D.) (3.1) CHN - Request for retroactive approval of contract modification with Asereth Medical Services in the amount of $2,670,000 for the provision of temporary pharmacy personnel for the period of February 1, 1998 through January 31, 2000 for a total contract amount of $3,000,000. This item was postponed to a future meeting. (3.2) PH-CHP&P-AIDS Office - Request for retroactive contract renewal with UCSF AIDS Health Project, in the amount of $435,251, for the provision of HIV Counseling, Testing, Referral and Partner Notification, for the period of January 1, 1998 through December 31, 1998. (DPH contracted with UCSF for services totaling $13,848,952 during FY 1996-97). Commissioner Sanchez abstained on this item due to conflict of interest. (3.3) PH-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). Commissioner Sanchez requested this contractor come back to the Budget Committee in 60 days (July 21, 1998) with a status report on any compliance issues in the monitoring report. (3.4) PH-CHP&P-AIDS Office – Request for approval of retroactive renewal contract with Haight Ashbury Free Clinics, Inc. (HAFC) in the amount of $100,913, 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 HAFC for services totaling $10,606,732 during FY 1996-97). (3.5) PH-CHP&P-AIDS Office – Request for approval of retroactive renewal contract with Mission Neighborhood Health Center (MNHC), in the amount of $120,491, for the provision of HIV prevention program services targeting behavioral risk populations, for the period of January 1, 1998 through December 31, 1998. (DPH contracted with MNHC for services totaling $794,025 during FY 1996-97). (3.6) PH-CHP&P-AIDS Office – Request for approval of retroactive renewal contract with Stop AIDS Project, Inc. (SAP), in the amount of $230,321 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 SAP for services totaling $937,172 during FY 1996-97). (3.7) PH-CHP&P-AIDS Office – Request for approval of retroactive renewal contract with Glide Foundation in the amount of $50,653, for the provision of HIV counseling, testing, risk reduction and partner notification services, for the period of January 1, 1998 through December 31, 1998. (DPH contracted with Glide for services totaling $ 226,161 during FY 1996-97). (3.8) PH-CHS-CSAS - Request for approval of retroactive sole source contract renewal with Chemical Awareness and Treatment Services, Inc. (CATS) in the amount of $58,171 in client fees to the Department to provide 30-month multiple offense / driving under-the-influence, chemical dependency and poly-drug abuse treatment services for the period of January 1, 1998 through June 30, 2001. (DPH contracted with CATS for services totaling $2,566,823 during FY 1996-97).  (3.9) PH-CHS-CMHS - Request for approval of new contract with Pathmakers of California, a mental health provider group, in the amount of $160,000, for the provision of professional mental health services for the period of June 1, 1998 through June 30, 1999. (3.10) PH-CHS-CMHS – Request for retroactive approval of contract modification with Family Service Agency (FSA) in the amount of $100,000 for the period of April 1, 1998 through June 30, 1998 to provide outpatient care to medically indigent and Medi-Cal psychiatric clients. Total amount of contract including this modification is $670,000. (DPH contracted with FSA for services totaling $4,422,837 during FY 1996-97). Action taken: The Commission approved the Consent Calendar of the Budget Committee, except for #3.1, with Commissioner Sanchez abstaining on #3.2. 4) DIRECTOR'S REPORT (Provides information on activities and operations of the Department) (Mitchell H. Katz, M.D., Director of Health) ADMINISTRATION State Budget The Governor released his annual May revision of the budget Thursday, May 14th. Projected General Fund (GF) revenues are up by $4.21 billion over the original January estimates. The revised budget includes $15.2 billion GF expenditures for Health and Welfare programs, an increase of $121.3 million from the Governor's January budget proposal. Of great concern is the Governor's proposal to reduce the Vehicle License Fee (VLF) by 75% over five years. The proposal would reduce the VLF by 50% effective January 1, 1999, and again by 50% effective January 1, 2002. This would create a total estimated revenue decrease of $6.6 billion over the five-year period. The proposal is opposed by the Legislature's Democratic members, and is expected to be a major issue in budget negotiations. The VLF generates $3.9 billion annually in revenues that are constitutionally dedicated to local governments. A percentage of VLF in combination with ½ cent sales tax revenues provides funding for the State/Local Realignment Initiative. Annually, on a statewide basis, approximately $63.8 million of VLF revenue is allocated for mental health services, $765 million for health services and $13 million for social services. In 1997-98, the Department is anticipated to receive a total of approximately $57.6 million from VLF: $53.8 million for health services and $3.8 million for mental health services. These funds provide vital health services to vulnerable at-risk populations. Moreover, the City and County of San Francisco General Fund receives approximately an additional $130 million discretionary VLF funds, much of which benefit public safety. The Department of Human Services receives approximately $351,000 in VLF. The exact impact of the Governor's proposal is unknown at this time, since it is a partial, phased-in reduction, and many of the implementation details have not been disclosed. The Governor and Department of Finance say this proposal will not affect counties because lost VLF funds will be replaced with State General Fund money, dollar for dollar, and the current allocation schedule will remain in place. However, this is not entirely reassuring because there is no constitutional guarantee on the allocation of State General Fund (GF) for health and social services realignment programs. State GF dollars are subject to annual legislative or administrative attempts to divert the funds elsewhere. For example, if State GF are not provided and this proposal is implemented January 1, 1999, the Department could potentially witness a $15 – $20 million reduction in State revenues next fiscal year. In addition, there are many unanswered questions, such as increased local reliance on the annual State budget process, and greater vulnerability and diminished reliability of the State's GF as a source for funding realignment programs. The Department will work closely with the Mayor's Office and San Francisco's lobbyist in Sacramento to monitor this proposal and its impact on health and mental health funding. Following are summaries of other key health-related proposals: An increase in $12.4 million State GF to eliminate the State's "take-back" of county funds in the Medi-Cal Administrative Claiming Fund and the Targeted Case Management Claiming Fund (MAA/TCM). In 1997-98, San Francisco's portion of the take-back is $1.4 million. In 1998-99, elimination of the take-back could result in a revenue increase of up to $1.25 million for San Francisco. Tobacco tax revenues are growing – up $10 million for fiscal years 1997-98 and 1998-99. The May Revision proposes to allocate these funds to health education, county health services, and research programs focused on reducing tobacco use, particularly among youth and young adults. However, the California Healthcare for Indigents Program (CHIP) continues to project a $4.6 million decrease in 1998-99. For San Francisco, this would result in a decrease of $500,000 to $600,000. The Department will continue to monitor this proposal and assess the fiscal impact on San Francisco. The May revision includes full-year funding (for 1997-98) for pregnancy-related services for undocumented immigrants as now required by court order. The Department is in the process of determining the fiscal impact of this. An increase of $36.1 million GF for mental health services to CalWORKs recipients to correct and supplement the original budget of $9.1 million GF. An increase of $14.5 million ($7.2 million GF) for the addition of smoking cessation products to the Medi-Cal contract drug list. The AIDS Drug Assistance Program: appropriates an additional $2.6 million in federal Ryan White CARE Act funds; an increase of $4.7 million for addition of new drugs to the ADAP formulary; and a net savings of $8.9 million due to increased efficiencies resulting from centralization of pharmaceutical services offset by increased program utilization.  A 2.84% increase for a Cost of Living Adjustment (COLA) for SSI/SSP, however no COLA is proposed for CalWORKs grants. According to the State constitution, the legislature must pass the budget by June 15, 1997; the fiscal year begins on July 1, 1997. Pregnancy-Related Services for Undocumented Residents As you know, in early March 1998 the Los Angeles Superior Court issued an injunction in the Milagro Doe case, which prohibited the State from implementing the regulations to terminate State funding for pregnancy-related services for undocumented women. The State subsequently filed a writ asking the California Appellate Court to overturn the injunction, and on May 7, 1998, the Appeals Court issued a decision refusing to do so. This means that the State is prohibited from terminating funding for several months -- at least until the trial in this case is held, or until a further appeal is heard. The trial is currently scheduled for November 1998. Managed Care Earlier this month, Governor Wilson unveiled a proposal to create a new Department of Managed Health Care. You may recall that this was one of the major recommendations coming from the Managed Health Care Improvement Task Force. The new Department of Managed Health Care would focus solely on providing oversight to the managed care industry. The Governor believes that this department will improve the State's role in ensuring quality and affordable health care for those who have insurance. In order to monitor health plan accountability, this new department would have a Division of Consumer Services. The Department of Corporations (DOC) is currently responsible for the administration, enforcement, and regulation of health care service plans. In addition, the DOC oversees commodities, securities and franchise investments, and lenders and fiduciaries. The Governor's proposal would eliminate the Department of Corporations. The lender and fiduciary programs of DOC would be consolidated into the Department of Financial Institutions (DFI) which oversees banks, S&Ls, credit unions and industrial loan companies. The DFI would be renamed the Department of Financial Services. The reorganizations are scheduled to take effect on July 1, 1999. PUBLIC HEALTH University of California Breast Cancer Grant I am proud to announce that the Community Health Epidemiology Section has been awarded a one-year grant in the amount of $84,911 from the University of California, Breast Cancer Research Program. The grant will provide for a half-time Project Coordinator and two half-time Interviewers to be hired from the BVHP community. It will also provide incentives to study participants and for a Project Research Assistant. The Principal Investigator on the grant is Daramola Cabral Evins, DrPH, PA and included the collaboration of coinvestigators Drs. Arthur Coleman from the BVHP Health Care Task Force and Marion UCSF Department of Epidemiology and Biostatistics. The purpose of this research is to determine why breast cancer mortality is higher in African American women compared to whites, and what role inadequate follow-up care plays in explaining these racial/ethnic disparities. This has been an issue voiced by the African American community, and is of great concern to the Health Department. Stop Red Light Running Campaign The Emergency Medical Services Section released the results of a study that provides new insight into the minds of red light runners. The study shows that most red light runners regard themselves as good drivers and believe other red light runners are the problem, not them. In fact, many don't regard themselves as red light runners—even after admitting to having run a red light more than once. The findings are based on focus groups of San Francisco residents who admitted to running a red light more than once. The focus groups, conducted in March 1998 as part of the agency's Stop Red Light Running Campaign, were designed to get to the root causes of the behavior. Other than a few overlapping habits and opinions, red light runners break down into two distinct categories: distracted drivers and aggressive drivers.  Key Findings: Distracteds Do nearly everything while driving, including eating, putting on make-up, daydreaming and project planning. Think other red light runners are the real problem. Run red lights for lots of reasons, including speeding, afraid to stop because of tailgaters, and, of course, not paying attention. Aggressives Have great animosity toward other drivers. Believe drunk drivers are more likely to hurt someone than red light runners. Run red lights for lots of reasons: "I'm in a hurry. I think I can gun the light and make it." "I'm just there when it turns red," and "The yellow is too short." Don't feel bad about running red lights if there are no other cars around, such as at night or early morning. One startling difference is in the way the two groups viewed drivers involved in fatal accidents. The distracteds were outraged at these drivers and believed they deserved "jail time" because "a car is a weapon." The aggressives were more sympathetic: "Everyone makes mistakes," and "The knee-jerk reaction would be to condemn them but you can understand how it happens." Future campaign efforts will be directed towards these groups of individuals. San Francisco Housing Authority Session At the request of the U. S. Department of Housing and Urban Development, the Environmental Health Section prepared a half-day training workshop to staff of the San Francisco Housing Authority. The specific purpose of the workshop was the provide training and information on mold and mildew problems found in homes. The workshop brought in local and guest presenters from areas of expertise which included indoor air quality, vector and rodent biology, and general sanitation. Approximately 20 students participated in the workshop conducted at the Housing Authority office on April 15th. Pool Safety Training In preparation for the swimming pool season, Environmental Health staff organized a free training session for owners/managers/pool technicians May 12th at the Cathedral Hill Hotel. The purpose of the training was to provide information on pool safety, sanitation, and maintenance. Additionally, the workshop focused on the new State law requiring Ground Fault Circuit Interrupters (GFCI) installation. This law was came about as a result of a tragic pool death that occurred in San Mateo County last year involving a young girl swimming in a pool that was not equipped with a GFCI device. The Department's Public Information Officer is working with Environmental Health to develop a PSA advisory alerting pool/spa owners of the new requirement. Hazardous Waste Database The Hazardous Waste Program is developing a database and mapping program to identify the location and levels of contamination at known sites within the City and County of San Francisco. This database will provide greater information to interested environmental and business groups regarding the location of these contaminated sites. Presently, there does not exist within the City a single source that provides this information. Two student interns from Woster Polytechnic Institute in Massachusetts are developing this project. The Interns will complete the project in approximately seven (7) weeks. COMMUNITY HEALTH NETWORK Department of Justice Findings Letter The CHN Executive Staff in consultation with the City Attorney's staff has begun to develop a response to the DOJ Findings Letter on Laguna Honda Hospital. Laguna Honda Administrators have communicated factual information about the Findings Letter, to the Board of Supervisors, the press, employees, union business representatives and volunteers. A press briefing and tour of Laguna Honda was provided on May 7th. The Hospital has received strong community support via a number of telephone calls received after the release of the DOJ Findings Letter. The census and admissions at the facility remain strong, which is an ongoing indicator of the community's confidence in the overall quality of services provided. I will keep the Commission apprised of our progress on this significant issue. Annual Licensing and Certification Survey The State Licensing and Certification Division and HCFA have requested additional information about Laguna Honda's Plan of Correction to the 1998 Annual Certification Survey that was submitted on May 8. The Hospital is continuing its dialogue with Licensing and Certification and HCFA representatives and providing additional information to ensure inter-agency collaboration. I will keep the Commission informed. Hospice Unit Featured in AARP In the May 1998 American Association of Retired Persons Bulletin (AARP), Laguna Honda Hospital Hospice was featured in a three page report. The article described several Hospice programs across the country, including Laguna Honda's 28-bed facility. Color photographs of LHH's Hospice garden with a resident and caregiver was included in the article. This nationally distributed newsletter praised the hospice concept and shed light on this healthcare specialty. I commend all the staff at Laguna Honda Hospice for the high quality service provided to the community. LHH Celebrates Hospital Week In honor of National Hospital Week, Laguna Honda hosted a number of events and activities during the week of May 11-15. A staff and resident table tennis tournament was held in Simon Auditorium as well as exercise and fitness classes taught by Drs. Rivero, Stinson and Zoe Austin, P.T. The week culminated with a barbecue in Clarendon Valley for residents, staff and volunteers followed by Laguna Honda Hospital Employee Night at 3 Com Park where over 100 employees enjoyed watching the Giants play the Mets. Nomination to the American Academy of Nursing Anne M. Hughes, RN, NP, Clinical Nurse Specialist for HIV and Oncology at SFGH has been nominated for membership in the American Academy of Nursing. The American Academy of Nursing is an organization of 1200 distinguished leaders in nursing who have been recognized for their outstanding contributions to the profession and to health care. Anne is the immediate past president of a national nurse's organization, the Association of Nurses in AIDS Care. She has been active in nursing and HIV/AIDS issues since she came to SFGH in 1989. She believes that her nomination to the academy is also recognition of the entire nursing services at the CHN/SFGH. I am sure you join me in congratulating Anne on this well-deserved recognition. Update on Health at Home Health at Home, the department's home care agency has been experiencing exceptional growth. Two hundred visits per month were being conducted in July 1997; today the volume is 1500 visits per month with over 300 patients on service. The most common diagnoses being treated by Health at Home include respiratory conditions, cardiac conditions, cancers and HIV/AIDS. CHN Patient Care Council Mr. Wagner reports that Gene O'Connell and Dr. Melissa Welch (the CHN Director of Patient Care Services and Chief Medical Officer, respectively), completed the final draft of the CHN Patient Care Council which was approved by CHN Leadership on May 13, 1998. The Patient Care Council (PCC) is the operational arm of the CHN. The Council will be comprised of membership representatives from the entire CHN Continuum of Care: the UCSF Dean's Office, DPH Public Health Division, CHN Quality and Utilization Management, the Consortium Clinics, and the Office of Integrated Care (TBD). CHN Presentation at City-Wide Community Advisory Board CHN Leadership was invited to the meeting of the City-Wide Community Advisory Board for the community clinics on May 13, 1998. Mr. Wagner provided a status report on the reorganization of the CHN and offered his vision and goal for the Network to be the best public health delivery system in the country. Dr. Melissa Welch explained her role as the CHN Chief Medical Officer and described the function of the CHN Patient Care Council. Reports from representatives of advisory boards to individual clinics were also presented. April statistics are available in the Commission Office. Commissioners Chow and Guy requested a presentation of the Stop Red Light Running Program. Data and public education issues should be highlighted. Commissioner Barnes encouraged the Department to bring a well thought out plan to the voters for the Laguna Honda Hospital ballot initiative. On behalf of the Commission, President Monfredini expressed unanimous strong support for a Laguna Honda Hospital bond. Commissioner Parker inquired on the Department's capacity to provide health promotion and prevention regarding AIDS. Commissioner Sanchez commended the Department for the data and statistics provided to the Commission. Dr. Katz acknowledged Diane Miller's work on these monthly reports. 5) CONSIDERATION OF A RESOLUTION CREATING AN EMPLOYEE RECOGNITION PROGRAM FOR DEPARTMENT OF PUBLIC HEALTH EMPLOYEES At the request of President Monfredini, Dr. Katz presented the Department's plan for an Employee Recognition Program: DPH agrees with the Commission that a Department-wide employee recognition program should be developed recognizing outstanding performers at all staffing levels. The plan should include those working with patients, as well as those individuals who work behind the scene. The program should select awardees that unite DPH programs and encourage teamwork. We want to make sure we are rewarding our top "assist" players as will as our top "scorers". The award should be both formal, at the Commission level, and informal, recognizing the winner in front of everyone at the job site, peers, subordinates, consumers and bosses. Recognition shouldn't be confused with incentive programs. Recognition draws attention to employees who perform. Incentive programs use techniques to induce people to achieve a specific objective. Research shows that although incentives are effective in motivating employees, that the simple act of recognizing people as individuals is essential for long term success. Many recognition programs in the City have come and gone because there was not a commitment from management. DPH is committed to the creation of an employee recognition program for the long haul. This is a time of great change in the Health Care industry. The new employee recognition program will be a nice way to show appreciation to our front line staff. Program Goal We have discussed the desired objectives of an employee recognition program and strongly believe that the program's objectives should support DPH's vision and goals. The purpose of the employee recognition program is as follows: To say thank you to an outstanding employee or team of employees for their exceptional work and service. To recognize those employees who exhibit excellent performance in fulfilling their jobs assignments. To communicate a focused message to the rest of the Department, highlighting results. Program Criteria Nomination forms will be available at the Department's Human Resource offices. Supervisors and managers may nominate an outstanding employee, a team of employees, or individuals may nominate themselves. To be considered for nomination an employee or team of employees must display success in at least four of the following areas: Outstanding on-the-job performance in carrying out day-to-day duties and responsibilities. Employees who deserves special recognition for the work they perform on behalf of our clients, or the public. This may be noted by management, or in letters written by consumers in appreciation of exceptional service. Development of an innovative idea or suggestion resulting in a change of service delivery or a cost savings. Improvement in individual or team work methods resulting in timesavings, workflow or general safety improvement. Development of a program whose main intent is to provide a particularly innovative or needed service to the public that has the by-product of shedding positive light on public health. (i.e.: something like the SFGH Tattoo removal program) Ability to work with other employees and assist wherever needed or requested. An employee who is always dependable and follows through with assignments without prodding or reminders. For the first few months, managers will be responsible for getting the word out to all employees in each Division. Human Resources will be the coordination point for the Department and will distribute a flyer with a nomination form attached. This will be posted on all bulletin boards at job sites. In addition, the Director will announce and publicize the program in his biweekly e-mail newsletter, "Fast Facts from Dr. Katz". The Commission directed Dr. Katz to operationalize this program, with input from the Commissioners. Commissioners' Comments: It should be the discretion of the selection committee on the number of awardees each month. Reliability, instead of dependability, should be emphasized. Avoid "popularity" contests. Teamwork as well as individuals, can be recognized. A frontline employee should be involved in the selection process. Selection process should be even-handed and democratic. Eliminate the phrase "without prodding or reminders." Action Taken: The Commission unanimously adopted Resolution #21-98, "Supporting the Development and Implementation of a Department of Public Health Employee Recognition Program, (Attachment A). 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 OF THE COMMUNITY AT ST. MARY'S MEDICAL CENTER, 450 STANYAN, SAN FRANCISCO, CA: CLOSURE OF THE OBSTETRICS PROGRAM AT ST. MARY' MEDICAL CENTER Rosemary Fox, Vice President/Chief Operating Officer, presented this information: After careful evaluation and consultation with our medical leadership, the decision was made to discontinue the Obstetrics Inpatient Service at St. Mary's. Since reopening the unit in August 1996, there has been an average of approximately 120 deliveries a year. The national market standard for a quality OB impatient program is approximately 2000 births per year. Despite numerous initiatives to increase obstetrics, volume deliveries have not shown growth. Maintenance of a small service such as ours, makes recruitment and retention of staff, as well as maintenance of the skills, very difficult. Our operating losses for the 18-month period that the program was in service were greater than $2 million, and an additional capital investment of $2-3 million would have been required by the end of 1998 under OSPHD guidelines. Several market factors also contributed to the decision to close the unit: declining child-age bearing population in San Francisco, consumer expectations for full service obstetric services, and an inability to recruit OB/GYN practices. St. Mary's will retain its prenatal and postpartum services on an outpatient basis, and parenting classes will continue through our WomanKind Program. Our OB physicians enjoy medical staff privileges at California Pacific Medical Center, St. Luke's, UCSF, and our sister hospital, Seton Medical Center in Daly City. Ambulatory OB and prenatal services will be continued while deliveries occur at these other facilities. Fortunately, we were able to offer positions at our Catholic Healthcare West facilities to all the nursing staff. President Monfredini inquired about St. Mary's Board support for this closure and the availability of counseling for future mothers transitioning to another hospital. Commissioner Chow inquired about the care of indigent patients. Commissioner Guy requested a letter indicating St. Mary's commitment to serve indigent patients and indicating its public responsibility. After Ms. Fox indicated the unit is presently closed due to lack of staffing and concern for quality of care, President Monfredini expressed disappointment on St. Mary's and Catholic Healthcare West's lack of compliance to this Proposition Q hearing. She encouraged Ms. Fox to have the CEO of Catholic Healthcare West present at the June 2, 1998 hearing. Commissioners requested information on what actually has been done regarding this closure, what patients have been told, and what has been the disposition of patients and employees. President Monfredini continued the public hearing of this item to June 2, 1998. At the subsequent meeting of June 16, 1998, a determination will be made by the Commission. Later in the meeting, President Monfredini informed our Deputy City Attorney Paula Jesson, about the non-compliance of St. Mary's Hospital on Proposition Q. A letter from the Commission will be sent to St. Mary's Medical Center documenting its non-compliance to Proposition Q procedures. 7) TIME SPECIFIC: 4:30 P.M. CONTINUATION OF A 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 President Monfredini abstained from participating in this issue due to conflict of interest. Vice President Sanchez presided over this item. Greg Monardo, CEO of Davies Medical Center, and Dr. George Lee, representing California Pacific Medical Center CEO Martin Brotman, M.D., made presentations on more information requested from the Commissioners. Legal Counsel from Sutter Health, Bill Aseltine, responded to legal issues. Public Speakers: Supporting the Acquisition: Robert Reichert, Davies patient Dione Bowers, Davies patient Samuel Crocker, Davies volunteer Opposing the Acquisition: Frederick Hobson, SF Tomorrow Board of Directors Phyliss Tunson, Davies employee Marcy Fraser, individual Sal Rosselli, President of Local 250, SEIU Carla Woodworth, California Physicians Alliance Commissioner Parker stated that the labor issues should be resolved prior to a Health Commission decision. He would consider consumer support, future provision of charity care, and the long-range goals of Sutter Health and CPMC. He also is interested in why Davies did a turnabout with CPMC after Davies sued CPMC. Commissioner Chow requested a copy of Attachment 1, referred to in the CPMC Board resolution. He also wants to know the level of charity care, a better picture of which services will continue, and the commitment to skilled nursing beds given our Laguna Honda Hospital situation. Commissioner Guy stated the Commission is not receiving complete information; and the governance question in relation to the role of Sutter Health needs to be answered. Commissioner Sanchez requested more information on the Board of Trustees and a copy of the plan for this acquisition. He stated it is the civic duty and responsibility of the Health Commission to conduct a Proposition Q hearing in a public forum. The information given to the Commission thus far raises more questions for further information. Commissioner Barnes' priority is to continue the services and to represent the interests of the residents of the City and County of San Francisco. It is still unclear as to which party(ies) have the ultimate decision-making authority. She requested further financial and governance structure information and a copy of any affiliation agreement. She also encouraged more information to employees and that more discussions with employees take place. Dr. Lee explained the governance structure, emphasizing that CPMC will be the decision-maker at the local level. He pointed out that Sutter Health is the parent organization and that there is no plan to decrease services at Davies Medical Center. Mr. Monardo submitted to the Commission tax information requested from Local 250. Vice President Sanchez stated this item will be on the agenda for June 2, 1998. 8) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH COLLABORATIVE EFFORTS WITH THE SAN FRANCISCO SCHOOL DISTRICT Due to the lateness of the hour, the Commission continued this item to a future meeting. 9) PRESENTATION OF THE RECOMMENDATIONS FROM THE MAYOR'S BLUE RIBBON COMMITTEE FOR UNIVERSAL HEALTH CARE Tangerine Brigham, Director of Policy and Planning, presented the report from the Mayor's Blue Ribbon Committee on Universal Health Care. See Attachment B. President Monfredini acknowledged the excellent work of Ms. Brigham and how proud the Commission is of her work with the Mayor's Blue Ribbon task Force. President Monfredini, Vice President Sanchez, and Commissioners Guy and Parker attended this morning's Mayor's press Conference where Dr. Sandra Hernandez presented the Report for Universal Health Care. Commissioners Guy, Barnes and Chow expressed concerns on the impact on the public safety net, the Department, and incentives for employers and small businesses. Because of the importance of this subject and the need to have public comments on the report, President Monfredini continued this item to the June 2, 1998 Commission meeting. She encouraged Commissioners to call Ms. Brigham with questions. Commissioner Chow requested the Department to present to the Commission the impact of the plan on the public safety net and related problems in carrying out the Department's mission. Public Speaker: Frederick Hobson, SF Health Authority 10) OTHER BUSINESS/PUBLIC COMMENTS None. The meeting was adjourned at 6:40 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission