Minutes of the Health Commission Meeting
Tuesday, October
20, 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 Commissioner
Edward A. Chow, M.D., at 3:15 p.m.
Present:
Commissioner Edward A. Chow, M.D. (arrived at 3:30 p.m.)
Commissioner Roma P. Guy, M.S.W.
Commissioner Ron Hill
Commissioner Lee Ann Monfredini
Commissioner Harrison Parker, Sr., D.D.S.
Absent:
Commissioner Debra A. Barnes
Commissioner David J. Sanchez, Jr., Ph.D.
2) APPROVAL OF MINUTES OF THE MEETING OF SEPTEMBER 29, 1998Action Taken: The Commission unanimously
adopted the minutes of September 29, 1998.
3) CONSENT CALENDAR OF THE BUDGET COMMITTEE
(Commissioner Lee Ann Monfredini)
President Monfredini chaired the Budget Committee meeting in the absence of
Commissioner Sanchez.
(3.1) Update from The Lewin Group regarding compliance on Board diversity.
Commissioner Monfredini indicated her support for the letter in that the spirit of the
policy is being addressed.
Commissioner Hill observed that no new information is provided in the letter.
Commissioner Guy commented that this letter has to be improved if the contractor
continues to do business in San Francisco.
PH&P-CHP&P-HIV Prevention Services – Request for approval of retroactive
renewal contract with San Francisco AIDS Foundation (SFAF), in the amount of $505,721, for
the provision of HIV prevention services targeting behavioral risk populations, for the
period of July 1, 1998 through June 30, 1999. (DPH contracted with SFAF for services
totaling $5,204,521 during FY 1997-98).
President Monfredini requested all contractors to submit their documents in a timely
fashion.
PH&P-CHP&P-HIV Prevention Services – Request for approval of retroactive
renewal contract with Support Center for Nonprofit Management (SCNM), in the amount of
$91,000, for the provision of organizational development and capacity building
professional services for the period of July 1, 1998 through December 31, 1998.
(DPH
contracted with SCNM for services totaling $695,567 during FY 1997-98).
PH&P-CHP&P-HIV Prevention Services – Request for approval of retroactive
renewal contract with Black Coalition on AIDS (BCOA), in the amount of $246,687, for the
provision of HIV prevention services for the period of July 1, 1998 through June 30,
1999. (DPH contracted with BCOA for services totaling $914,604 during FY 1997-98).
President Monfredini commended the contractor for its progress.
(3.5) PH&P-CHP&P-HIV Prevention Services – Request for approval of
retroactive renewal contract with Iris Center, in the amount of $127,747, for the
provision of HIV prevention services targeting behavioral risk populations for the period
of July 1, 1998 through June 30, 1999. (DPH contracted with Iris for services
totaling $1,626,811 during FY 1997-98).
(3.6) PH&P-CHP&P-HIV Prevention Services – Request for approval of
retroactive contract renewal with Filipino Task Force on AIDS (FTFOA), in the amount of
$65,282, for the provision of HIV prevention services targeting behavioral risk
populations for the period of July 1, 1998 through June 30, 1999.
(DPH contracted
with FTFOA for services totaling $194,810 during FY 1997-98).
PH&P-CHP&P-HIV Prevention Services – Request for approval of retroactive
contract renewal with Urban Indian Health Board, Inc./Native American AIDS Project
(UIHB),
in the amount of $135,363, for the provision of HIV prevention services targeting
behavioral risk populations for the period of July 1, 1998 through June 30, 1999.
President Monfredini requested a 3-month (January 19, 1999) update report on board
diversity and program compliance issues. She encouraged the Department to continue
providing TA to this contractor.
(3.8) PH&P-CHP&P-HIV Prevention Services – Request for approval of
retroactive renewal contract with Central City Hospitality House (CCHH) in the amount of
$74,818, for the provision of HIV prevention program targeting behavioral high-risk youth
for the period of July 1, 1998 through June 30, 1999. (DPH contracted with CCHH for
services totaling $595,397 during FY 1997-98).
President Monfredini requested a confirmation by letter of the addition of new board
members at the October Board meeting.
(3.9) PH&P-CHP&P-HIV Prevention Services – Request for approval of
retroactive renewal contract with Lavender Youth Recreation and Information Center
(LYRIC), in the amount of $103,000, for the provision of HIV prevention program targeting
behavioral high-risk youth for the period of July 1, 1998 through June 30, 1999.
(DPH contracted with LYRIC for services totaling $153,000 during FY 1997-98).
(3.10) PH&P-CHP&P-HIV Prevention Services – Request for approval of
retroactive renewal contract with Stop AIDS Project, in the amount of $500,029, for the
provision of HIV prevention services targeting behavioral risk populations for the period
of July 1, 1998 through June 30, 1999. (DPH contracted with Stop AIDS Project for
services totaling $961,341 during FY 1997-98).
Commissioner Hill encouraged the contractor to include an HIV positive person on its
Board.
(3.11) PH&P-CHP&P-HIV Prevention Services – Request for approval of
retroactive new contract with Mobilization Against AIDS International (MAAI), in the
amount of $190,737, for the provision of HIV prevention services targeting behavioral risk
populations for the period of July 1, 1998 through June 30, 1999.
(DPH contracted
with MAAI for services totaling $80,341 during FY 1997-98).
President Monfredini requested a 3-month (January 19, 1999) update report on the
monitoring Report.
Larry Meredith stated that the quality assurance issues for these HIV prevention
contracts will be referred to the Joint Conference Committee for Population Health and
Prevention.
(3.12) PH&P-CHP&P-Behavioral Health Prevention Services – Request
for approval of sole source and new contract with NICOS Chinese Health Coalition, in the
amount of $100,000, for the provision of community capacity building services to identify,
treat and prevent problem gambling in the Chinese community for the period of November 1,
1998 through June 30, 1999.
Commissioner Monfredini requested a written update report be submitted to the
Commission in February 1999.
PH&P-CHS-SAS – Request for retroactive approval of the multiyear renewal
contract with Mission Council on Alcohol Abuse for the Spanish Speaking, Inc. in the
amount of $317,664 per year, to provide substance abuse outpatient and prevention services
for the period of July 1, 1998 through June 30, 2002. (DPH contracted with Mission
Council on Alcohol Abuse for the Spanish Speaking, Inc. for services totaling $308,412
during FY 1997-98).
(3.14) PH&P-CHS-SAS – Request in conformance with Proposition I, public
notification requirements for approval of a new site for Jelani House, Inc., at 1221
Newhall, for residential substance abuse services for families. (DPH contracted with
Jelani House, Inc., for services totaling $1,187,959 during FY 1997-98).
(3.15) Administration – MIS – Request for approval of two new sole
source contracts with Shared Medical Systems, Inc. (SMS), to include mutual
indemnification provisions in the amount of $19,686,189, for the remote computing option
contract, for the period of January 1, 1999 through June 30, 2004, and in the amount of
$6,192,691, for the product and services contract for the period of January 1, 1999
through June 30 2002. (DPH contracted with SMS for services totaling $5,744,749
during FY 1997-98).
President Monfredini expressed her appreciation for the letter submitted by the
contractor.
Commissioner Guy acknowledged the contractor needs to continue improvement on board
diversity, noting that no ethnic minorities serve on the Board.
Commissioner Hill requested a follow-up letter to the Commission addressing the board
diversity policy by March 1999.
Commissioner Parker stated that in order for the contractor to get on the right track,
the contractor should have a plan in place as a response to Policy #24.
Action Taken: The Commission approved the Consent Calendar of the Budget Committee,
with the specific requests.
Commissioner Chow was not present for this vote.
4) DIRECTOR'S REPORT (Mitchell H. Katz, M.D., Director of Health)
(Provides information on activities and operations of the Department).
ADMINISTRATION
When the State of California gave San Francisco money to implement Mental Health
Managed Care, there was a very short timeline for startup. To expedite the process
and meet the State's timeline, DPH asked Westside to act as a fiscal intermediary while we
geared up the Mental Health systems infrastructure for managed care. As the
Commission will recall, the Department's FY 1998-99 budget included the conversion of
these contract employees from Westside to Civil Service status.
I want to express my appreciation for the tremendous job the DPH Human Resource staff,
under Ed Gazzano and Rod Auyang's leadership, converting 103 fiscal intermediary contract
employees to City employees in a very short period of time.
I want to acknowledge the team effort of key staff and their outstanding performance:
- Joel Hurwitz and his staff, expeditiously reviewed, analyzed, and issued recommendations
for the classification of 72 new jobs. To date, we have no grievances.
- Arleen Lum, Bob Thomas, Don Weidner, Steve Pacarar, and Lincoln Mah, conducted the Civil
Service Exam process for 12 different job classifications in less than three months.
This team qualified hundreds of applicants.
- Regina Pera and her staff did a terrific job of issuing all the requisitions,
shepherding them out of the Mayor's Office, controller, and DHR, securing and coordinating
preemployment physicals, and developing individually tailored packets for each employee
converting. These packets were instrumental in gaining the respect and confidence of
our system from our new employees.
COMMUNITY HEALTH NETWORK
Plan of Correction for Resurvey Submitted
On October 16th, LHH submitted its Plan of Correction for the September resurvey to
the State
Licensing and Certification Office. The Hospital anticipates a response from the
State and HCFA within two weeks. I will keep the Commission apprised of our progress
on this important issue.
CHN Conducts Internal Assessment
As part of the internal assessment phase of its Strategic Planning process,
Community Health Network (CHN) conducted a Cultural Pulse Check of Staff. Part
of an ongoing process to foster genuine dialogue, CHN leaders met with over 50 groups of
CHN staff – City and UCSF employees from every site and level of the CHN – to
learn what values, beliefs and assumptions drive everyday decisions and behavior.
CHN management is now determining what "disconnects" exist between our
organizational goals and values, and what was learned from these discussions.
Appointment of Associate Administrator for Long Term Care and Laguna Honda Hospital
Director of Nursing
I am pleased to announce the appointment of Mary Louise Fleming, RN, MSN, to the
Community Health Network (CHN) position of Associate Administrator for Long Term Care and
Director of Nursing for Laguna Honda Hospital. Mary Louise is well qualified to accept
this position and brings a great deal of experience, knowledge, leadership ability and
enthusiasm to meet the new challenges she will face. Since 1993, she has held a
number of different positions within the Department of Public Health. Most recently
she served as the Program Director for the Mental Health Rehabilitation Facility and led
the program through its successful start-up process. In her new greatly expanded
role she will continue to have administrative oversight for the Mental Health
Rehabilitation Facility (MHRF).
Mary Louise has been involved in the long-term care planning process with Community
Mental Health Services since the early 1990's and has also participated with the CHN level
of care assessment team for Laguna Honda this past year. She is highly regarded for
her commitment to consumer-focused care and her ability to develop and implement
innovative programs.
Appointment of Compliance Officer for the Community Health Network
I am pleased to announce the appointment of Dominic Reo as the Compliance Officer
for the Community Health Network. This newly created position will be responsible
for the oversight, design, development, implementation and evaluation of the compliance
plan/program. Mr. Reo comes to us from the private sector with a vast background as
Director of Contracting, Managed Care Administrator, Health Care Consultant and Manager of
Operations in the Bay Area and San Diego. I am sure the Commission joins me in
welcoming Dominic, as we look to him for guidance and leadership in the changing health
care environment.
Jerry Rankin Resigns as Director of the Office of Managed Care
I'm sorry to report that Jerry Rankin resigned his post as the Director of the
Office of Managed (OMC) Care for the CHN to join Healtheon, a healthcare information
technology firm, as a consultant.
Jerry worked at San Francisco General/CHN for 18 years, starting in 1980 as an
administrative resident from UCSF. Over the years his contributions have included:
- Helping to obtain staffing, equipment, space, and information systems for departments
from Environmental Services to Nuclear Medicine;
- Developing the 1994 CCSF/UCSF Affiliation Agreement Capital Development section,
including the initial work on the Ambulatory Care and Research Facility, and bringing home
the SFGH Garage Project;
- The SFO Airport Medical Services Clinic;
- The 911 Ambulance System, including acquisition of the building which now houses CHN
Headquarters; and
- Taking the CHN through its first two years of Managed Care, and establishing a firm
foundation for the future.
Joanne Burik will assume the interim directorship of the Office of Managed Care; I have
every confidence that the strong team in the OMC will continue its fine work. I am
sure you all join me in wishing Jerry continued success in his upcoming career change.
Surgical Services Reception for Primary Care
The CHN/UCSF Surgical Faculty at SFGH hosted a reception in honor of their CHN
primary care colleagues October 8th. Dr. William Schecter, Chief of Surgery, and Dr.
David Ofman, CHN Medical Director for Primary Care, conceived the reception as a means to
foster communication and collegiality amongst the Surgical and Primary Care
Services.
Over 100 individuals attended the reception with representatives from General Surgery,
Orthopedics, Otolaryngology, Ophthalmology, Urology, Neurosurgery, Oral and Maxillofacial,
Anesthesia, Obstetrics and Gynecology, Emergency Services, Primary Care Clinics, Mental
Health Rehabilitation Facility, Forensics, and Laguna Honda Hospital.
Presentations were given by each service. Soothing, live jazz music, provided by Dr.
Bob Markison of the SFGH Surgical Service, added a touch of class to the affair.
A SFGH Surgical Specialty Source Book was developed by Dr. Schecter with the input of
his surgical colleagues and distributed at the reception. Additionally, the
Department of Surgery developed a handbook introducing their faculty. Drs. Schecter
and Ofman are to be commended for their integration efforts. The ability to meet and
confer with colleagues in a relaxed, non-clinical setting was positive in fostering good
working relationships.
Chinatown Public Health Center (CPHC) Participates in Disaster Drill
The CPHC participated in a successful neighborhood disaster drill October 7th,
which involved several health agencies and was led by NICOS (coalition of health and
mental health agencies serving the Asian/Chinese community) Disaster Preparedness
Committee. Community involvement included a Communication Coordinating Center
located at Chinese Hospital; the Cathay Radio Clubs' Ham radio operators who provide
mobile linkages among sites; the Fire Department and NERT (Neighborhood Emergency Response
Team volunteers trained by the Fire Dept.) trained volunteers; and the Mayor's Office of
Emergency Services. During the last three years over 150 monolingual Chinese
speaking volunteers have been trained in disaster response. These drills are
essential for public safety because Chinatown is densely populated and has many
unreinforced masonry buildings. The Health Center is an active member of NICOS and
the disaster committee.
LHH Artists Honored at the De Young Museum
On October 14th, 18 resident artists from Laguna Honda were participants in the
Annual Exhibit 'Art with Elders' at the De Young Museum. The Activity Therapy
Department collaborates with the 'Art with Elders' program to provide a professional art
instructor for LHH residents. These instructors help channel the artists endeavors
into various visual art forms.
It was a special treat for the LHH residents who participated to have their artwork
displayed at a world class museum like the De Young. I wish to recognize Bill
Frazier, Director of Activity Therapy, and all of his staff for the fine work they have
done in enhancing programs for LHH residents.
LHH Annual Employee Recognition Dinner Dance
Last Thursday night the LHH hospital staff celebrated its annual Employee
Recognition Dinner Dance event with a sumptuous buffet dinner and dance at the Patio
Espanol. Honors were given to 264 co-workers who celebrated employment
anniversaries ranging from 5 to 35 years
Three employees with 35 years of service were recognized: Lola Dembowski and
Margaret Lebrane from Nursing Services, and Freida King from the Billing Department
Annual Hospitalwide Picnic
On October 24 Laguna Honda Hospital will host its annual hospitalwide picnic for
all employees, family and friends, at Flood Park in Menlo Park. The picnic will run
from 10:30 am to 5:30 pm, with food being served between 11:00 am and 2:00 pm. A
variety of games and special entertainment events will be part of the festivities.
All members of the Commission are invited to attend.
CHN Participates in UCSF School of Nursing Dean's Search Committee
Chancellor Michael Bishop of the University of California San Francisco (UCSF)
appointed Anthony Wagner to the Search Committee for the Dean of the School of
Nursing. The UCSF School of Nursing is a leader in nursing education, research, and
clinical practice. The School is responsible for the preparation of teachers,
administrators, advanced practice nurses, and research scientists who serve the profession
nationally and internationally. The Nursing School is among the top three in the
country in terms of NIH research dollars.
POPULATION HEALTH AND PREVENTION
HIV 'Detuned Eliza' Test
The HIV/AIDS Seroepidemiology and Surveillance Section of the San Francisco
Department of Public Health has recently established a demonstration project to evaluate
the use of a new HIV test, the 'detuned ELISA' at the HIV counseling and testing sites
under the direction of the AIDS Health Project and at the municipal sexually transmitted
disease clinic. The detuned ELISA is a test which can determine if someone is likely
to have acquired HIV infection in the past six months. This test is a supplement,
HIV blood test which is done only for persons who test positive for HIV. The detuned
ELISA is still under investigation and is expected to receive FDA approval soon. San
Francisco is the only city in the country offering this service.
Resignation
It is with regret that I announce the resignation of Barry Brinkley, HIV Prevention
Director. We will miss Barry's commitment to HIV prevention services, vision of what
was possible, and his collaborative problem solving perspective and leadership.
Although Barry's resignation is effective immediately, I am confident that the HIV
Prevention staff will continue to achieve the goals and objectives of the unit.
Larry Meredith will assume day-to-day responsibilities as Acting Director while the search
for a new Director is conducted.
5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR
OCTOBER 1998
President Monfredini presented the October Employee Recognition Awards to the
following:
| Individual C. Jeffrey Bramlet
Willie Crawford
Rose Fuapopo
Richard Lee
Bonnie Seaman |
Division DPH – Occupational Safety &
Health
CHN – Facilities Maintenance
CHN – Facilities Maintenance
DPH - Population, Health & Prevention
SFGH – Rehabilitation Unit |
Nominated by Vickie L. Wells
Anne Kronenberg, Ex. Asst.
Richard Ortiz
John F. Brown, Medical Dir., EMS SectionStaff |
| Mission Rock Health Care Team |
Division |
Nominated by |
| Nancy Cropley, R.N. Ann Dallman, M.D.
David Dietrich
Jan Goode, R.N.
Silver Hall
Andrew Hayes, MSW
Jean Cruz Holdaway,
Health Worker
Danielle Hurwitz, Health Worker
Bill LaRock, Nurse Practitioner
Kelly Surin, Clerk Typist
James Wagner |
CHN - Homeless Programs (for all) |
Marian Pena, Acting Dir. Tom Waddell Health
Center (for all) |
| CommunityMental Health Services Team |
Division |
Nominated by |
| Claire Skiffington and Mary Covington-Walsh |
Community Mental Health Services |
Larry Doyle, Chief Finance Officer |
6) UPDATE ON RECONFIGURATION OF THE EMERGENCY MEDICAL SERVICE SYSTEM
(EMS)Dr. John Brown, EMS Medical
Director, provided a status report on the EMS Sections implementation of the Community
Consensus Document, "Optimizing the Configuration of San Francisco's EMS", which
was presented to the Health Commission on February 20, 1996. He reported that of the
241 recommendations made in that document, 49 have been completed, 174 are in progress, 16
are in the process of being addressed, and we have been unable to complete two due
regulatory changes in the EMS environment. For a copy of the full report, call the
Commission Office (554-2666).
Some of the important achievements accomplished to date have been:
- Community Education
: The development of the Community Education Committee, the
Stop Red Light Running Campaign, and the Development of Public Access Defibrillation
Standards.
- Communications: The development and implementation of Criteria Based
Dispatching.
- Response and Transportation: The merger of the Paramedic Division into the
San Francisco Fire Department.
- Destination and Specialty Care: The addition of Chinese and the Veteran's
Administration Hospital as alternative receiving hospitals, and the development of a
Diversion Action Plan to improve the hospital diversion situation.
- Disaster Medical Response: The regionalization of disaster response,
including the development of the Metropolitan Medical Task Force and the Bay Area Disaster
Medical Assistance Team.
- Regulatory Function: The implementation of CQI in the Quality Improvement
Council, and the implementation and ongoing evaluation of the new Standard Treatment
Protocols.
- Global Recommendations: The cultivation of alternative funding sources for
EMS (MMTF grant, Stop Red Light Running funds from DPT), and the expansion of EMS response
(all calls answered regardless of ability to pay).
The 1998-99 Strategic Plan for the EMS Section was also presented. This was
generated with the input of staff and community advisory committees. The emphasis
for this fiscal year is on expanding involvement in community education, improving DPH and
citywide disaster preparedness, and increasing our role in research and instituting the
necessary improvements in data collection and feedback into decision making processes.
Richard Shortall, EMS Chief of the Fire Department, and Dr. Marshall Isaacs, EMS
Medical Director of the Fire Department, presented a 6-month status report of the Fire
Department's EMS activities. For a copy of the full report, contact the Commission
Office (554-2666).
The report covered these areas:
- Ambulance Deployment
- Workforce Integration
- Combined Communications Center
- System Performance
- Basic Life Support Pilot Study
- Medical Direction
- Quality/Risk Management
- Firefighter/Paramedic Students
- Multicasualty Incidents/Special Events
- Response Times
- Research
Mr. Shortall and Dr. Isaacs reported that the S.F. Fire Department is in a learning
stage regarding EMS call volume, EMS system status management and its impact on the
patients and the workforce. The S.F. Fire Department is committed to working as a
team with its EMS workforce to examine issues of workload and its relation to quality of
patient care and quality of life issues for our paramedics.
The Department supports a number of recommendations that will decrease the workload on
the busiest ambulances during the short-term, as well as long-term solutions that will
result in a reasonable workload and quality of life for its employees. This will
ensure their ability to provide the highest quality rapid prehospital emergency medical
care for the residents of an visitors to San Francisco.
Dr. Katz commended the EMS staff for their work.
The Commission thanked the staff for a comprehensive report that was a joint effort
between the Fire and the Public Health Departments.
7) UPDATE ON CITYWIDE DIVERSION
Dr. John F. Brown, EMS Medical Director, presented an update on hospital diversion
at San Francisco Hospitals.
Mr. Nathan Nayman, Hospital Council, commented on the complexity of the issue, with
staffing as the core issue along with the shortage of critical care nurses.
Commissioners Comments:
- What is the role of the Pacific Coast Hospital and is there an innovative way to use
beds at this hospital?
- Are hospitals maintaining their beds?
- Need for standardized diversion criteria data along with the diversion principles.
- Something logical is not working.
- Are we being asked to have a lower standard of care?
- The leadership needs to address this diversion problem.
- Because this has been going on for a while, a solution should be devised before
December. Much discussion now has to move to a solution.
- A pilot project should be considered
- Being on critical care diversion is a crisis situation; solutions are needed
Dr. Katz stated that the Department needs to use a different strategy from last year.
The Commission requested a plan be brought to the Commission at the November 17, 1998
meeting.
The Commission took a 10-minute recess.
8) PRESENTATION OF THE SENIOR DISASTER REGISTRY
Dr. John F. Brown, EMS Section Medical Director, provided a progress report of the
Disaster Registry for Seniors and Disabled Persons. For a copy of the full report,
contact the Health Commission Office (554-2666).
Dr. Brown reported the following:
The Department of Public Health Emergency Preparedness Planning efforts focused on
department-wide planning and coordination. This project takes this expertise into the
community.
A guiding principle of this and all of our disaster work, is an emphasis on personal
preparedness. This is a particular challenge for many of our seniors and disabled
persons living in San Francisco. In a continued effort to improve personal
preparedness, we are working with community-based agencies to promote community
preparedness.
To this end, the Disaster Registry Project builds upon the relationship that many of
our community agencies have with these individuals. Also, efforts are now being
directed towards working with outreach agencies to find those seniors and disabled persons
who may not yet have an established relationship with a community agency.
The San Francisco Disaster Registry Project is an unprecedented effort to address the
disaster-related needs of seniors and persons with disabilities in the City.
Disaster planning experiences has shown the benefits of preorganized, specialized
capability in disaster response, and the Registry presents a natural evolution of this
concept in disaster response. As such, the Registry has become an integral part of
the Department of Public Health's overall disaster response strategy. The Registry
is well suited to facilitate disaster response within the focus populations in view of
social and demographic trends that can be expected through the year 2020 and further into
the new millennium.
The EMS Section of the Department of Public Health has assumed the lead role for
program planning, implementation, and evaluation for the Disaster Registry Project.
Over the last several months, we have actively begun to implement the program. We
have reconvened the Disaster Registry Task Force and begun a pilot project to test a
number of recruitment, data management, and response planning strategies. This
report contains the background of the project and an overview of the three main program
components and their status:
- Populating the registry via recruitment and outreach,
- Registry databases, and
- Response plan
The Disaster Registry Project began in 1987 with draft legislation that was introduced
to the Board of Supervisors as a result of community concern over frail elderly and
disabled persons' vulnerability to disasters. The 1989 Loma Prieta earthquake
highlighted the need for disaster preparedness within these populations. In 1990,
the Board of Supervisors passed Ordinance 259-90 directing the Department of Public Health
to establish and maintain a registry identifying those persons who wish to be contacted
after a major disaster. DPH then assumed the responsibility for the Disaster
Registry as part of its overall disaster planning efforts.
DPH participates in citywide preparedness efforts to reduce injury and earth in the
event of a disaster. In response to a major disaster, DPH may need to allocate
services to provide emergency care to those in need. The Department's mission
includes restoration or continuation of public and environmental health services, (i.e.,
sanitation, safe food, potable water, vector control, infectious disease control, and
laboratory services), and hazardous or toxic substance control. Disaster response
coordination by DPH is guided by the following principles:
- No one should suffer avoidable health problems in the aftermath of a disaster because of
an inability to maintain access to critical services or supplies, such as attendant care,
life support equipment, medications, food, or water.
- Agencies responding to a disaster should have access to information on persons who are
especially vulnerable to disasters. These persons include those who are homebound,
require full-time attendant care, or require life support equipment or medications.
Public Speaker: Margaret Baran, IHSS Consortium Executive Director
Commissioners Comments:
- A simpler system of information is needed
- Data needs to be streamlined and available to all appropriate agencies
- Specific simple information is important
- Back-up people to the system is needed
- This senior disaster registry could be a model for other vulnerable populations
President Monfredini requested a written follow-up report to the Commission in five
months (April 1999).
9) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH YEAR END FINANCIAL REPORT FOR FY
1997-98
Monique Zmuda, Chief Finance Officer, reported the following:
A surplus of $18.1 million is projected for the close of fiscal year 1997-98 based on
actual expenditures and revenues received though June 30, 1998. This is a $1.9
million increase from the 8-month projection of $16.2 million.
Major components of the projected surplus of $18.1 million include: 1) $8.8
million in a one-time FQHC revenues received in FY 1997-98; and 2) a $25 million
savings in Medi-Cal SB 1255 intergovernmental transfer expense that will be deferred until
FY 1998-99. This is offset by: 1) $28 million in reserves against revenue
estimates for contractual allowances and bad debt at San Francisco General Hospital; and
2) a $2.2 million deficit at Laguna Honda Hospital.
Adjustments to the FY 1997-98 surplus of $18.1 million include: 1) a reserve of
$8.1 million for future FQHC or other audit disallowances; and 2) offset by
elimination of the $6.4 million in reserves from prior year SB 90 revenue. The net
result of these two adjustments if a $16.4 million surplus available to close out to the
City's General Fund. This $16.4 million contribution to the City's General Fund will
fulfill the Department's commitment to return funds to the City. This contribution
was assumed in the FY 1998-99 budget process and is necessary to balance the Department's
current year budget.
Ms. Zmuda provided the following information on contractual allowances and bad debt at
San Francisco General Hospital:
In early September 1998, the Department of Public Health Finance staff (with the help
of our cost report consultants, Toyon and Associates) found that the reserve against
revenues for contractual allowances and bad debt was significantly understated.
Contractual allowance is defined as the difference between the charges for services and
actual reimbursement from Medi-Cal, Medicare and private insurance. Bad debt is
defined as the difference between the charges for services and the payments made by
individuals who are assigned to the self-pay financial code. Contractual allowances
are made as adjustments (reductions) to revenues. For accounting purposes, bad debt
is considered an expense, rather than an offset to revenue. However, in order to
remain in balance, bad debt expense must always be offset by additional revenues.
In analyzing the discrepancies in earlier estimates, it was found that bad debt had
either not been written off, or not written off in a timely manner in the past.
Additionally, estimates of Medi-Cal revenue were overstated due to several factors,
including higher than actual projections of the conversion of Medi-Cal "pending"
to Medi-Cal, understated contractual allowances for inpatient and ancillary charges, and
understated allowances for charges in the Mental Health Rehabilitation Facility.
It is important to note that the Hospital's Finance staff have changed prior practices
of estimating contractual allowances and writing off bad debt. Hospital staff will
now analyze contractual allowances and bad debt on a monthly basis and make monthly
adjustments to financial reports. In addition, the Hospital will install an
automated procedure for posting contractual allowances in revenue accounts that will be
monitored each month. Also, monthly analysis will occur on the aging of accounts
receivable to reduce the length of time that accounts remain as receivable. Finally,
the Controller's staff will conduct a review of our revenue postings on a monthly basis in
order to validate DPH estimates.
Additionally, Ms. Zmuda reported on the deferral of 425 million for SB 1255
Intergovernmental Transfer:
In the year end close, the Department and the Controller's staff discussed the
appropriate accounting of the SB 1255 expenditures (intergovernmental transfer of $25
million) and the revenues ($42 million, of which $25 million is used to offset the expense
of the transfer, and $17 million is used as a general net revenue at SFGH.) Because
the expense is made in one fiscal year, and the revenue is received in the next year, the
Controller recommended that the Department defer SB 1255 expenditures so that revenues and
expenditures are recorded in the same fiscal year. This deferral results in a net
savings of $25 million if FY 1997-98, thereby offsetting the loss in revenue discussed
above. It should be noted that the Department will lose $17 million in revenue in
the future when the program is cancelled, or replaced. However, there are currently
no indications that the SB 1255 program will be cancelled in the foreseeable future.
The deferral of the $25 million has been discussed and approved by the Mayor's Budget
Director.
Commissioners' Comments:
- The budget information regarding the bad debt is horrible
- This budget report will have serious consequences on the commitments already made in the
budget for FY 1998-99
- The budget of SFGH should be reviewed closely at the Joint Conference Committee of SFGH
- Not all of the Commissioners have had a conversation with the Chief Finance Officer on
this budget problem
Dr. Katz stated that there will be dramatic impact on this year's budget. On
November 17, 1998, the Department will bring to the Commission a plan to address these
budget issues.
10) CONSIDERATION OF APPROVING THE SFGH MEDICAL STAFF BYLAWS FOR THE RULES AND
REGULATIONS MANUAL, THE CREDENTIALING PROCEDURE MANUAL, AND THE COMMITTEE MANUAL
Dr. Sylvia Villarreal, SFGH Chief of Staff, presented the proposed revisions to San
Francisco General Hospital Bylaws – Rules and Regulations, Committee Manual and
Credentialing Procedure Manual. The revisions to all three were recommended for
approval by the Medical Executive Committee on September 21, 1998, and by the Joint
Conference Committee-SFGH on October 13, 1998.
Action Taken: The Commission approved the SFGH Medical Staff Bylaws for the Rules and
Regulations Manual, the Credentialing Procedure Manual, and the Committee Manual.
11) CONTINUANCE OF THE UPDATE ON S.F. MENTAL HEALTH PLAN, AND CONSIDERATION OF A
REVISED RESOLUTION FOR SINGLE ACCESS OF CARE
Dr. Katz provided an update on the data and cost projections on the single standard
of care for mental health services.
At this time, the Department proposes the policy on a single standard of mental health
care be maintained.
President Monfredini referred the monitoring of this program to the Joint Conference
Committee for Population Health and Prevention, which is chaired by Commissioner
Guy. President Monfredini commented that she would like the Department to come up
with financial options first before asking the Board of Supervisors.
Public Speakers:
- Evelyn Lee, NICOS
- Reuben D. Goodman, mental health consumer
- Jennifer Friedenbach, Coalition on Homelessness
- Mary Sue Planck, Mental Health Board
Commissioner Guy thanked the Mental Health staff and Dr. Katz for acknowledging the
reaffirmation of the Commission's single standard of mental health care policy.
Commissioners Hill and Chow thanked Dr. Katz and the Department staff for the excellent
update report.
Commissioners Hill, Guy, and Parker will attend the Board of Supervisor's Health,
Family and Environment Committee on October 22, 1998 for the hearing called by Supervisor
Sue Bierman.
12) OTHER BUSINESS/PUBLIC COMMENTS
None.
13) 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 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.
JAMES MITCHELL V CCSF, SUPERIOR COURT NO. 966-217, IN THE AMOUNT OF 20,000
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 approved the settlement only with the stipulation that the
City Attorney obtain a specific document from the plaintiff. If the document is not
obtained, the Commission will reconsider this item.
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 voted to not disclose any discussions held in Closed
Session.
The meeting was adjourned at 7:10 p.m.
Sandy Ouye Mori, Executive Secretary to the Health Commission
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