Minutes of the Health Commission Meeting
Tuesday, June 2, 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 Ron Hill
- Commissioner Lee Ann Monfredini
- Commissioner Harrison Parker, Sr., D.D.S.
- Commissioner David J. Sanchez, Jr., Ph.D.
2) APPROVAL OF MINUTES OF THE MEETING OF MAY 19, 1998
Action Taken: The Commission unanimously adopted the minutes of May 19, 1998.
3) CONSENT CALENDAR OF THE BUDGET COMMITTEE
(Commissioner David J. Sanchez, Jr. Ph.D.)
(3.1) CHN-ASO Request for approval of retroactive managed care contract extension with the Regents of the University of California (UCSF) for the period of July 1, 1997 through October 31, 1997 and a retroactive new managed care contract with UCSF Stanford Healthcare for the period of November 1, 1997 through June 30, 1998 for tertiary care services for a combined amount not to exceed $1,700,000 for the period of July 1, 1997 through June 30, 1998. (DPH contracted with UCSF for services totaling $13,848,952 during FY 1996-97).
This item was separated into two areas:
- Retroactive managed care contract extension with the Regents of the University of California for the period 6/-1/97 through 10/31/97. (Commissioner Sanchez abstained on this item due to conflict of interest.)
- Retroactive new managed care contract with UCSF Stanford Healthcare for the period of 11/01/97 through 6/30/98 for tertiary care services for a combined amount not to exceed $1,700,000 for the period of 7/01/97 through 6/30/98.
Commissioner Barnes requested at the July 7, 1998 Budget Committee meeting an updated compliance plan for the Commission policies on Board and staff composition.
(3.2) PH-CHS-CSAS Request for approval of the first modification to the contract with Chemical Awareness and Treatment Services, Inc. (CATS) in the amount of $248,646 to continue the provision of Emergency Shelter Services for homeless people for the period of June 1, 1998 through June 30, 1998. (DPH contracted with CATS for services totaling $2,566,823 during FY 1996-97).
(3.3) PH-CHS-AIDS - Request for retroactive approval of the majority of the FY 1998-99 Ryan White Comprehensive AIDS Resource Emergency Act of 1990 (CARE) Title I and Title II services with a combined total of $25,804,786 for the period of March 1, 1998 through February 28, 1999 for Title I and April 1, 1998 through March 31, 1999 for Title II, with the following contractors:
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Commissioner Hill expressed concern on the AIDS Benefits Counselors agency regarding administration and finances. He requested the Department to monitor the agency on these issues and a written report be submitted to the Commission.
Commissioner Barnes requested another monitoring report on Ward 86 within two weeks, with the report being submitted to the Commission.
Commissioner Sanchez abstained on UCSF contracts.
(3.4) CHN - Request for retroactive approval of contract modification with Asereth Medical Services in the amount of $1,595,000 for the provision of temporary pharmacy personnel for the period of February 1, 1998 through June 30, 1999, for a total contract amount of $1,760,000.
Action Taken: The Commission approved the Consent Calendar of the Budget Committee, with Commissioner Sanchez abstaining on UCSF CARE contracts in #3.4, and Commissioner Monfredini abstaining on the CPMC/VNA Care contract in #3.4.
DIRECTOR'S REPORT
(Provides information on activities and operations of the Department)
(Mitchell H. Katz, M.D., Director of Health)
ADMINISTRATION
FY 98-99 Budget
Yesterday, the Mayor delivered his budget to the Board of Supervisors. Programs and initiatives funded by the Department of Public Health continue to be a priority of the Mayor. The Mayor's health priorities include substance abuse, mental health, housing, AIDS/HIV services and services for children.
The Mayor's recommended budget for FY 1998-99 for the Department of Public Health totals $709.3 million, excluding Grant Funds. This is an increase of $38.9 million. The budget includes $181.6 million in General Funds. This is an increase of $28.8 million in new General Funds for the Department of Public Health.
The Mayor's budget includes:
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Compassionate Use of Medical Marijuana
There have been several recent developments on the compassionate use of marijuana (Proposition 215). This Commission has previously supported the responsible implementation of Proposition 215. The Commission has supported the Health Department promulgating standards for the distribution of marijuana at cannabis clubs in San Francisco. In addition, the Commission has supported individual Department of Public Health physicians recommending marijuana to their patients for appropriate indications.
Last Monday, the Cannabis Cultivators Club of San Francisco on Market Street was closed pursuant to a court order. The court order concluded that the operation of the Cannabis Cultivators Club was in violation of federal law. However, the court did not rule on whether or not Proposition 215 was constitutional. The court order does not affect the possession of marijuana by a seriously ill patient for the patient's personal use upon physician's recommendation.
In light of the closure of the Cannabis Cultivators Club, City leaders including the Mayor, the District Attorney, the City Attorney and Supervisors Ammiano and Leno, along with myself, have met to discuss available options. The goal is to determine a mechanism by which the City can ensure that residents who need marijuana can have access to it. Such a mechanism would have to be consistent with existing law. A Board resolution has been introduced requesting that pertinent City agencies implement a program to ensure access to medical marijuana as provided by Proposition 215. I will keep the Commission apprised of new developments on this issue.
PUBLIC HEALTH
Prevention
Nearly one hundred people from the Department of Public Health and the University of California, San Francisco, participated in a half-day retreat last Friday to discuss ways in which the Department and the University can collaborate on research to support prevention initiatives. Following an overview of population health data presented by Tomas Aragon, M.D., participants broke out into a series of small groups organized around risk factors associated with morbidity and mortality. The sessions explored territory for possible collaboration and there was a strong sentiment to continue the efforts to create specific joint research projects. A Steering Committee was proposed to structure future activities and to more clearly define the nature of the collaboration. It was an exciting step forward in combining the resources of the Health Department and the University to focus on population health issues.
Illegal Disposal Site Yosemite Avenue
Environmental Health staff, in cooperation with the City Attorney's Office, was recently awarded an injunction and a judgement for civil penalties of $3.6 million against the property owner of 1301 Yosemite Avenue. The judgement is based upon recovery of costs associated with the City's enforcement efforts, attorney fees, and civil penalties for violations of the Public Resources Code and the Business and Professions Code.
Last August, Environmental Health, through the City Attorney's Office, filed a complaint in Superior Court against the property owner for creating a public health and environmental hazard on the property. Specifically, a non-permitted construction and debris box company deposited significant amounts of solid and hazardous waste illegally on the property.
The court has ordered the property owner to properly remove all of the accumulated solid waste from the 1.5-acre parcel within 24 days. Failure to comply will result in the City and the California Integrated Waste Management Board to enter the site to take enforcement action. A $300,000 State grant is available to the City to initiate clean up, should that become necessary.
Concurrently, the City is pursuing the operator and partner of the illegal debris box company. The Courts issued a compliance order in April and a trial date is set for August, should that be necessary.
The importance of this case is that it sends a strong message to illegal dumpers that degradation of the environment will not be tolerated, and strong enforcement will be sought for responsible parties.
COMMUNITY HEALTH NETWORK
Status of Laguna Honda's Annual Licensing and Certification Survey
The Administrative staff of Laguna Honda has been engaged in a dialogue about the State Licensing and Certification annual survey and the Hospital's plan of correction since May 12th. The Licensing and Certification staff has made two requests for additional information regarding program enhancements and facility issues in response to the State's allegation of substandard care. The Hospital's plan of correction may have some effect on the future census level at Laguna Honda.
The Hospital submitted the additional information requested by Licensing and Certification on June 1st and is expecting a follow-up survey in the very near future. I will keep the Commission apprised of the State's response to the plan of correction.
Follow-up on the Department of Justice (DOJ) Findings Letter on Laguna Honda
Mr. Wagner and other representatives from the CHN and the City Attorney's Office are planning a meeting with DOJ staff in early June to initiate discussions regarding the Findings Letter received May 6th. This meeting will be the first of what we expect will be many sessions with the DOJ.
Commissioner Chow reiterated his support for patients having access to marijuana as prescribed by a physician.
Commissioner Guy requested updates on the marijuana issue because it is difficult to sort out the accuracy of the information in the press. She also would like the Department to monitor the reductions in pharmacy funding and fringe benefits.
President Monfredini would like monitoring updates on the illegal disposal site at 1301 Yosemite Avenue.
5) CONSIDERATION OF REVISIONS TO THE SAN FRANCISCO GENERAL HOSPITAL CREDENTIALING PROCEDURE MANUAL OF THE MEDICAL STAFF BYLAWS
Dr. Robert Mackersie, Chief of Staff, presented revisions to the SFGH Credentialing Procedure Manual.
Action Taken: The Commission unanimously approved the proposed revisions to the SFGH Credentialing Procedure Manual of the Medical Staff Bylaws.
6) TIME SPECIFIC:3:30 P.M.
CONTINUATION OF 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'S MEDICAL CENTER
President Monfredini stated that today's hearing is a continuance from May 19, 1998 and that at the June 16, 1998 Commission meeting, a determination will be made.
Representatives present from Catholic Healthcare West and St. Mary's Medical Center were Wade Rose, Rosemary Fox, and Daniel Ostrow. Mr. Rose stated that John Williams, CEO/President of Catholic Healthcare, West Bay area Region, was scheduled to be present but was called to another meeting. The Commission had been provided with an extensive report outlining the process used in reaching the decision to close the Obstetrics Inpatient Unit at St. Mary's Medical Center, a patient plan, a communication plan, an employee plan, and a financial summary.
Commissioners' Comments and Concerns:
- Clarification on the definition of casual staff
- Impact on training programs
- Letter to patients being available in other languages
- Need for a plan for non-English speaking patients who may have not been informed of the closure
- Transportation be available for patients referred to other OB facilities
President Monfredini thanked the representatives for a thorough report. At the June 16, 1998 meeting, the Commission will consider a resolution determining whether the closure of the OB Inpatient Unit will or will not have a detrimental impact on the health care service of the community.
7) TIME SPECIFIC:4:00 P.M.
CONSIDERATION OF A RESOLUTION DETERMINING WHETHER THE ACQUISITION OF DAVIES MEDICAL CENTER (DMC) BY CALIFORNIA PACIFIC MEDICAL CENTER (CPMC), WILL OR WILL NOT HAVE A DETRIMENTAL IMPACT ON HEALTH CARE SERVICE OF THE COMMUNITY (HEALTH CARE PLANNING ORDINANCE, PROPOSITION Q)
Vice President Sanchez provided a chronological background of the Proposition Q hearings for this issue from the May 5, May 19 and today's meetings. He reviewed the Commission's procedures and responsibilities for the Proposition Q hearing. Commissioner Sanchez emphasized the importance of the purpose of the Prop Q hearings being to notify and provide information to the public in order to give the public an opportunity to comment on any impact on the health care service of the community. Additionally, he summarized the various documents requested by the Commission from CPMC, DMC, and Sutter Health. For today's hearing, the following documents were requested by Vice President Sanchez:
Articles of Incorporation of Sutter Health, filed with the California Secretary of State's Office. The Articles show that Sutter Health is incorporated as a nonprofit, public benefit corporation.
Bylaws of Sutter Health. The Bylaws contain standard information regarding the organization and governance of the corporation, (e.g., board meetings, committee structure and purposed, etc.)
Board of Directors Roster for Sutter Health. At least eight out of twelve of the Directors at-Large must be on the Boards of the local affiliates, and at least one Director always must be a representative of San Francisco, Marin and Sam Mateo Counties.
Organizational Chart showing the relationships among the Sutter Health Board and Management. The System Leadership Council has two representatives from CPMC. CPMC has additional representation on the Clinical Leadership Council.
Commissioners' Concerns:
- CPMC's commitment to rehab and SNF beds
- Is the CPMC CEO position accountable to the CPMC Board or the Sutter Health Board?
- Governance authority over services
- Long-term care commitment for the future
- Financial documents not provided
- Documents received today instead of with the Commission packet
- Review of the documents generated more questions
Dr. Martin Brotman, President/CEO of CPMC, stated that he would be happy to make a future presentation of the growth plans for CPMC and a status report on the maintenance of the DMC services.
Public Speaker: John Borsos, Local 250
Commissioner Chow commented that in making a determination, the Commission's support would be contingent on the maintenance of the services currently provided by DMC and the maintenance of local governance through CPMC. Commissioner Chow proposed the Commission consider a resolution determining the acquisition will not be detrimental to the health care service of the community.
Commissioner Barnes stated given the fact that more documents were submitted today, she needed more time to study them; and she needed more financial information. She could not make a determination until there is more clarity on the affiliation agreement between DMC and CPMC and more financial information on the acquisition.
Commissioner Sanchez stated that the CPMC CEO would be held responsible to notify the Commission on any future Prop Q requirements. Commissioner Sanchez felt at this point in time, the proposed resolution would be the best compromise.
Commissioner Guy commented that although the documents presented today should have been submitted earlier, the service components at DMC will be continued and enhanced. CPMC should also look at the issue of its level of charity care. She feels that progress has been made in working in a managed care arena.
Action Taken: The Commission (Chow, Guy, Hill, Sanchez, Parker) adopted Resolution #22-98, "Determining Whether the Acquisition of Davies Medical Center (DMC) by California Pacific Medical Center (CPMC, Will or Will Not Have a Detrimental Impact on Health Care Service of the Community".
Commissioner Barnes voted no.
8) PUBLIC HEARING AND CONSIDERATION OF A RESOLUTION ON THE MAYOR'S BLUE RIBBON COMMITTEE REPORT FOR UNIVERSAL HEALTH CARE
Due to the lateness of the hour, President Monfredini proposed this item be continued to June 16, 1998, but listen to public testimony.
Public Speakers:
- Kirk Willett, Mid-Peninsula Hospice
- John Borsos, Local 250
At the request of the Commission, Dr. Katz reviewed the potential impact of the Universal Health Care Plan on the public safety net, (Attachment B).
Commissioner Chow, who will be in Boston on June 16th, expressed his support for the proposed resolution, Supporting the Recommendations of the Mayor's Blue Ribbon Committee on Universal Health Care, (Attachment C).
Commissioner Guy commented on the need for more discussion on the governance issue and other services.
Commissioner Barnes emphasized the need for prudent attention to the safety net. She expressed concern on the proposed governance and the need for a lot of education to populations who may not voluntarily sign up for health insurance. She also pointed out the need to learn from our experiences with the San Francisco Health Plan.
By consensus, the Commission will continue this public hearing to June 16, 1998 and will then consider the proposed resolution.
9) OTHER BUSINESS/PUBLIC COMMENTS
None.
The meeting was adjourned at 6:10 p.m.
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Sandy Ouye Mori, Executive Secretary to the Health Commission