Minutes of the Health Commission Meeting Tuesday, February 2, 1999, 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 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. Commissioner John I. Umekubo, M.D. On behalf of the Commission, President Monfredini presented outgoing Commissioner Debra A. Barnes with a special plaque for her dedicated and hard work during her tenure on the Commission. Commissioner Hill presented flowers to Ms. Barnes. Each Commissioner thanked Ms. Barnes for her contribution and expertise to the Commission. Ms. Barnes thanked and acknowledged her colleagues on the Commission, the Department staff, and Ms. Mori for all of their support to her as a Commissioner. 2) APPROVAL OF MINUTES OF THE SPECIAL COMMISSION MEETING OF JANUARY 13, AND THE REGULAR MEETING OF JANUARY 19, 1999 Action Taken: The Commission unanimously adopted the minutes of January 13 and January 19, 1999, with the correction of page 1 of the January 13 meeting to read "special" meeting. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner David J. Sanchez, Jr., Ph.D.) Status Report on Urban Indian Health Board, Inc./Native American AIDS Project's compliance to board diversity. (3.2) Report on compliance with Health Commission Policy #24 by Catholic Charities The Department reported that Catholic Charities is in compliance. Commissioner Hill acknowledged the struggle on the compliance issue but thanked Catholic Charities for its hard work towards compliance. PHP-HIV Health Services – Request for approval of retroactive contract renewal with Shanti Project in the amount of $286,065, for the provision of emotional and practical support services to people with HIV/AIDS, for the period of October 1, 1998 through June 30, 1999. (DPH contracted with Shanti for services totaling $290,639 during FY 1997-98). PHP-HIV Prevention Services – Request for approval of retroactive renewal contract with Tenderloin AIDS Resource Center (TARC), in the amount of $163,047, for the provision of HIV prevention services targeting behavioral risk populations, for the period of January 1, 1999 through December 31, 1999. (DPH contracted with TARC for services totaling $426,186 during FY 1997-98). Commissioner Sanchez requested this item be continued for 30 days in order for the Department to review this contractor for specific measurable improvements on its monitoring report. In order to minimize cash flow issues for the contractor, Commissioners Sanchez and Hill recommended a 30-day contract extension of the previous contract. This item will be recalendared for the March 2, 1999 Budget Committee agenda. (3.5) PHP-HIV Health Services – Request to approve the contract term extensions of 66 CARE funded HIV health services contracts with the following 48 contractors for three months from March 1, 1999 through May 31, 1999: AIDS Benefits Counselors AIDS Emergency Fund AIDS Legal Referral Panel American College of Traditional Chinese Medicine Ark of Refuge Asian & Pacific Islander Wellness Center Baker Places, Inc. Bar Association of San Francisco Bayview Hunters Point Foundation Black Coalition on AIDS Catholic Charities Chemical Awareness and Treatment Services Community Dental Care, Inc. Continuum HIV Day Services CPMC/Visiting Nurses and Hospice Family Service Agency of San Francisco Family Support Services of the Bay Area Glide Foundation Golden Gate Community/Bridge for Kids Haight-Ashbury Free Clinics, Inc. Immune Enhancement Project Instituto Familiar de la Raza Iris Center Larkin Street Youth Center Legal Services for Children Lutheran Social Services Lyon Martin Women's Health Services Mission Neighborhood Health Center New Leaf Project Open Hand Quan Yin Healing Arts Center Saint Mary's Medical Center San Francisco AIDS Foundation San Francisco Community Clinic Consortium San Francisco Food Bank San Francisco Suicide Prevention Shanti Project The Support Center Tenderloin AIDS Resource Center UCSF Center on Deafness UCSF Dept. of Psychiatry/AIDS Health Project UCSF Dept. of Psychiatry/Substance Abuse Srvcs UCSF Pediatric AIDS Program UCSF Women's Specialty Clinic University of the Pacific School of Dentistry Urban Indian Health Board Walden House Westside Community Mental Health Center Commissioner Sanchez abstained on the five UCSF CARE funded contracts. Action Taken: The Commission approved the Consent Calendar of the Budget Committee, with the exception of #3.4, which will be continued to March 2, 1999. Commissioner Sanchez abstained on the UCSF CARE funded contracts in #3.5. Commissioner Umekubo abstained on the St. Mary's Medical Center CARE funded contract in #3.5. 4) DIRECTOR'S REPORT (Mitchell H. Katz, M.D., Director of Health) (Provides information on activities and operations of the Department). ADMINISTRATION New Health Commissioner On behalf of the entire Department of Public Health, I wish to extend a welcome to the newest member of our Health Commission, Dr. John I. Umekubo. For those of you who might not know Dr. Umekubo, he is a graduate of St. Louis University School of Medicine and is presently affiliated with St. Mary's Medical Center and California Pacific Medical Center. He is a member of the Teaching Faculty of St. Mary's Medical Center and also the Medical Director of San Francisco Community Convalescent Hospital. Welcome Dr. Umekubo, we look forward to working closely with you over the years. President Clinton's Proposal for Health Care for the 21st Century Yesterday the President sent Congress a $1.77 trillion spending plan for federal fiscal year 2000 (October 1, 1999 to September 30, 2000). As you may be aware, the federal budget has an unprecedented surplus – at $107 billion in 1999 and $131 billion in 2000 -- based on estimates from the Congressional Budget Office. President Clinton's State of the Union address underscored his commitment to improving access to health care. The President's budget provides significant funding to maintain the viability of Social Security and improve Medicare. The President's budget also proposes to restore SSI, Medicaid and Food Stamps eligibility to certain legal immigrants at a cost if $1.3 billion over the next five years. Many legal immigrants lost eligibility to these programs with the signing of the 1996 welfare reform law. The President's health initiatives are in the following areas: Long-Term Care Addressing Growing Long-Term Care Needs – this $6.34 billion initiative would support the elderly and disabled with long-term care needs by creating a $1,000 tax credit to compensate families for the cost of long-term care services ($5.5 billion), by developing a National Family Caregiver Program ($625 million), by educating Medicare beneficiaries about long-term care options ($10 million), by offering long-term care insurance to federal employees at group rates, helping more older Americans remain in their communities through new broad-based assisted living initiatives ($100 million), developing a nursing home quality initiative ($110 million) and allowing States to develop new community-based long-term care options. Eliminating Barriers to Employment for Individuals with Disabilities Improving Economic Opportunities for Americans with Disabilities – this $2 billion initiative would remove significant barriers to work for people with disabilities, and includes: (1) the Work Incentives Improvement Act which will provide workers with disabilities the option to buy into Medicaid and Medicare, (2) tax credits for persons with disabilities, and (3) a significant increase in assistive technologies to make it possible for persons with disabilities to work. Expanded Health Insurance Options Encouraging Small Businesses to Offer Health Insurance – this initiative promotes health care coverage through a new tax credit for small businesses who decide to offer coverage by joining coalitions and by making the contributions of private foundations which support these coalitions tax exempt. Improving Access to Health Insurance through Medicaid and CHIP – this proposal increases access to health insurance by restoring Medicaid and CHIP eligibility for legal immigrants affected by welfare reform, extending Medicaid eligibility to foster children up to age 21, improving transitional Medicaid an providing states with $1.2 billion over 5 years for children health outreach activities. Providing New Options for Americans Aged 55 to 65 to Obtain Health Insurance – this $1.4 billion proposal gives this vulnerable population three new ways to gain access to health insurance by: (1) allowing Americans aged 62 to 65 to buy into Medicare, (2) assisting vulnerable displaced workers 55 and over by offering those who have involuntary lost their jobs and health care coverage a similar Medicare buy-in option and (3) giving Americans 55 and over who have lost their retiree benefits access to their former employer's health insurance. Commitment to Public Health Augmenting Biomedical Research – this $320 million initiative for the National Institute on Health will allow more research in preventing the complications of diabetes, combating diseases associated with aging and developing vaccines for tuberculosis, malaria and AIDS. Improving Health Care Access for Uninsured Workers – this initiative will invest $1 billion in local communities to integrate providers that traditionally treat the uninsured; providers would receive funds to develop the financial information and telecommunications systems, and expand services. Protecting Our Children From Tobacco – the President is calling for additional measures at the national level to reduce youth smoking by: (1) raising the price of cigarettes, (2) reaffirming the FDA's full authority to keep cigarettes out of hands of children, (3) funding critical public health efforts to prevent youth smoking and enact measures to hold the tobacco industry accountable for reducing youth smoking, and (4) protecting farmers and farming communities. Reducing Racial Disparities in Health Status – the budget includes $145 million for health education, prevention and treatment services to minority populations. The budget also proposes an additional $50 million to address HIV and AIDS issues in minority communities. The President's budget also provides $1.5 billion for Ryan White HIV/AIDS Treatment grants, $50 million for a childhood asthma initiative in Medicaid, $359 million for mental health block grants, $40 million to support graduate medical education at children's hospitals, $750 million for Medicare cancer clinical trails, $25 million to control the spread of infectious disease, $230 million for bio-terrorism programs, $240 million for family planning service grants and a $170 million increase for the Indian Health Service. Finally, the President is calling on the following: Protecting Patients Through a Strong, Enforceable Patients Bill of Rights – this health care bill of rights would contain a range of protections including guaranteed access to needed specialists, access to emergency room and services and access to a meaningful independent and external appeals process. Protecting Privacy of Medical Records – would create comprehensive privacy legislation to protect sensitive medical records. California Healthy Families Program California's Healthy Families Program has been in existence for seven months. A total of 62,918 children have been enrolled into the program statewide. In San Francisco, 3,471 children have been enrolled into the program (5.5 % of total). The City and County of San Francisco ranks third in the State for Healthy Families enrollment. It was estimated that 2,100 to 4,200 children were eligible for the program in San Francisco. As the enrollment statistics indicate, San Francisco has enrolled more than the estimated minimum number of eligible children. While San Francisco's enrollment is encouraging, we are concerned that enrollment by African-Americans, Caucasians and Latinos is less than expected. These ethnic groups comprise 0.67 %, 1.2% and 4.7% of San Francisco's enrollment, respectively. Over 90% of San Francisco's enrollment has been within the Asian/Pacific Islander community. Statewide enrollment for African-Americans and Latinos has been less than estimated. To address some of the outreach problems in certain communities, the State will: allocate $1 million to enable community-based organizations to develop and implement outreach strategies, continue seeking policy guidance from the Immigration and Naturalization Service on public charge in Healthy Families -- some legal immigrant and undocumented resident parents are concerned about public charge issues when enrolling their children into the program, and issue a revised Healthy Families and Medi-Cal application (which is currently being focus-tested) by April 1999. Congresswoman Nancy Pelosi is co-sponsoring legislation clarifying federal law for the Vaccine for Children's program. This legislation will ensure that those children who would have received free immunizations because they were on Medicaid or are uninsured can continue to do so now that they are enrolled in their state CHIP program (such as California's Healthy Families Program). 1998 San Francisco Combined Charities Campaign Citywide, the Combined Charities Campaign raised $688,689.52, a 22% increase over 1997's contributions. Our Department raised a total of $88,432.00, a 30% increase from the previous year: Central Administration - $12,181 SFGH $32,441 LHH $35,814 PH&P $ 7,996 I want to thank DPH employees for their generosity. NAPH Health Policy Fellowship Program Jimmy Loyce, DPH Director of Integrated Care, was selected to the NAPH's Health Policy Fellowship Program. This yearlong national program provides senior health administrators the opportunity to examine in-depth policy issues facing safety net hospitals. I am sure you join me in congratulating Jimmy on this prestigious appointment. POPULATION HEALTH AND PREVENTION Community Substance Abuse Received a Grant The Community Substance Abuse Services Agency has received a grant for $25,000 from The Lindesmith Center to fund the upcoming conference, "Bridging the Gap: Integrating Traditional Substance Abuse and Harm Reduction Services". The conference will take place May 3-4 in San Francisco, and will feature keynotes by Dr. Alan Marlatt and Dr. Pat Denning, and workshops and panel discussions with local, national and international experts in the field. COMMUNITY HEALTH NETWORK Laguna Honda Hospital Replacement Planning Committee The Laguna Honda Hospital Replacement Planning Committee has been formed. The Committee will be chaired by Louise Renne, Esq. and co-chaired by myself. The first meeting of the Planning Committee is next Tuesday, February 9, 1999 from 3:00 p.m. to 5:00 p.m. in the Latino/Hispanic Community Room of the San Francisco Public Library (100 Larkin Street). I have provided all members of the Health Commission with a copy of the Planning Committee's briefing binder. The Planning Committee will be charged with making recommendations on the rebuilding of Laguna Honda Hospital (LHH). The Committee's recommendations will form the basis for a submission to the Board of Supervisors on the timeline and type of facility that is needed. The Planning Committee will make its recommendations to the San Francisco Health Commission. Three sub-committees will examine the following issues: Finance Subcommittee -- The Finance Subcommittee will be charged with examining the costs and financing issues related to rebuilding the Hospital. Program Subcommittee -- The Program Subcommittee will be charged with making recommendations on the appropriate array of programs and services that should be contained within the rebuilt Hospital and on the campus of Laguna Honda. Technical Build Subcommittee -- The Technical Build Subcommittee will be charged with assessing the technical aspects of any rebuilding option. The subcommittees will make their recommendations to the Laguna Honda Hospital Replacement Planning Committee. Because we recognize that there will be significant interest in the Laguna Honda Hospital planning process, the Department has established an informational site within our Internet for the public to access information. The Department will continue to make meeting notices and other materials available via paper copy. The web-site address is www.dph.sf.ca.us/LHHReplace and will be operational effective Friday, February 5, 1999. I would like to thank Mr. Barry Siler in the Management Information Systems Unit for developing this web-site for us. Long-Term Care Pilot Project Task Force At its last meeting, the Long-Term Care Pilot Project Task Force had a discussion on the Laguna Honda Hospital planning effort. I attended that meeting to provide the Task Force with an overview of the Laguna Honda Hospital planning process and to obtain any recommendations that the Task Force might have on the size of a rebuilt Hospital. The Task Force reiterated the need to ensure that there is an interface between the planning for Laguna Honda Hospital and the long-term care pilot project. Some members emphasized the importance of rebuilding at least 1200 beds. Others emphasized the importance of increasing the proportion of resources going to non-institutional long-term care settings. After this discussion, the Task Force felt that is was inappropriate to take a position on the number of beds needed at Laguna Honda Hospital at this time. There was concern that focusing on the number of beds was not the right approach to take and that all potential development possibilities on the Laguna Honda Hospital campus needed exploration. Some members of the Task Force also felt that it was inappropriate to view the replacement of Laguna Honda Hospital as a trade-off between skilled nursing facility beds and community-based alternatives to institutionalization. It was felt that both types of long-term care were needed. Task Force members appreciated the fact that a planning committee and process had been created to address the replacement of the Hospital. In summary, the Task Force raised the following points: It would like representation on the Laguna Honda Hospital Replacement Planning Committee, and Multiple uses should be examined for the Laguna Honda Hospital site to ensure the most appropriate use of resources. CHN Leadership visits CSAS Providers Anthony Wagner, Gene O'Connell and Melissa Welch, M.D. joined Barbara Garcia in touring several sites providing substance abuse services to DPH clients. The tour included the McMillan Drop-in Center, Mission Rock Shelter, Baker Places at 4th Avenue and 7th Street. Participation of CHN sponsored Candidates in NAPH Programs Drs. Melissa Welch, CHN Chief Medical Officer and Sylvia Villarreal, Chief of Staff of San Francisco General Hospital have been selected to participate in the National Association of Public Hospitals Physician Leadership Institute for Safety Net Providers. They will participate over the next year with other nationwide physician leaders. On behalf of the entire Department I wish to extend congratulations to Melissa and Sylvia on this well deserved appointment. Influenza Identification at Laguna Honda Hospital Laguna Honda Hospital had its first case of Influenza A isolated in an elderly female resident who had been immunized for Influenza A in the fall. Hospital staff has initiated Amantadine or Rimantadine Prophylaxis for residents in keeping with CDC recommendations in order to prevent an Influenza outbreak. This case has also been reported to all required health authorities. 5) ELECTION OF PRESIDENT AND VICE PRESIDENT OF THE HEALTH COMMISSION FOR 1999 Commissioner Chow nominated Commissioner Monfredini for President, seconded by Commissioner Hill. Action Taken: The Commission voted to close nominations. Action Taken: The Commissioners (Chow, Guy, Hill, Sanchez, Umekubo) voted for Commissioner Monfredini to be President. Commissioner Parker voted no. Commissioner Hill nominated Commissioner Guy for Vice President, seconded by Commissioner Parker. Action Taken: The Commission voted to close nominations. Action Taken: The Commission unanimously voted for Commissioner Guy for Vice President. President Monfredini announced the following Commission Committee assignments for 1999: Budget Committee Ron Hill, Chair David J. Sanchez, Jr., Ph.D. John I. Umekubo, M.D. Joint Conference Committee for QA – San Francisco General Hospital (SFGH) Edward A. Chow, MD, Chair Harrison Parker, Sr., DDS Lee Ann Monfredini Joint Conference Committee for QA – Community Health Network (CHN) Edward A. Chow, MD, Chair David J. Sanchez, Jr., Ph.D. John I. Umekubo, M.D. Joint Conference Committee for QA – Laguna Honda Hospital (LHH) Lee Ann Monfredini, Co-Chair Roma Guy, MSW, Co-Chair Ron Hill Joint Conference Committee for QA – Public Health and Prevention (PHP) Roma Guy, MSW, Chair Harrison Parker, Sr., DDS Lee Ann Monfredini External Committees CARE Council: Lee Ann Monfredini IHSS (In Home Supportive Services) Public Authority: Harrison Parker, Sr., DDS SFGH Foundation: Lee Ann Monfredini San Francisco Health Authority: Ron Hill Executive Committee - Mayor's Criminal Justice Council: Lee Ann Monfredini 6) PRESENTATION AND PUBLIC HEARING OF THE PROPOSED FY 1999-00 DEPARTMENT OF PUBLIC HEALTH BUDGET Monique Zmuda, Chief Finance Officer, presented the proposed Department of Public Health FY 1999-00 Budget Request, which included the following areas: Mayor's Budget Instructions Mission Driven Budget Strategic Budget Issues Organization of the Department of Public Health Population Health and Prevention Administrative Reclassification Revenues Baseline Revenues Grant Revenues State Budget Expenditures Baseline Expenditures Reallocation of Funding from Institutional to Community Care Expenditure Reductions Capital Revenue Generating Programs Above Base Budget Needs For a copy of the full report, contact the Commission Office at 554-2666. Ms. Zmuda reported that the Department recognizes that large shortfalls in third party revenues are used to support expenditures and cannot be solely offset by increases from the General Fund. Therefore, several administrative and policy proposals to reduce the revenue gap are included in the FY 1999-00 budget submission. These initiatives include reducing vacant positions and making administrative cuts to expenditures. They also include reconfiguring selective services to reduce their costs, while maintaining access and quality. Finally, the Department proposes the reallocation of resources from institutional programs at San Francisco General Hospital to community-based care. This is proposed in order to make long term changes to the delivery system, and to enhance the financial stability of our hospitals. As the Commission is aware, Department staff strongly believe that the movement of patients from institutional care to community care is in the best interest of the patients that we are committed to serve. If the Mayor is able to allocate sufficient funding to the Health Department to offset these large revenue reductions, then the Department's budget will be in balance for next fiscal year. If the total amount needed is not available, then the Department will continue to work with the Mayor and his staff over the coming weeks to balance the budget. If additional expenditure reductions are required that impact on service delivery or have implications for Commission policy commitment, the Department will return to the Commission with al alternative budget proposal. If the Department's budget is balanced and additional funding is available for new programs, the Department requests authorization from the Commission to work with the Mayor to develop proposals which are consistent with the mission based initiatives presented in this budget proposal. Commissioners' Comments Commended Department staff for a comprehensive budget proposal Inquired whether there were any savings from the reorganization of the Department Concerned about the significant increase of unsponsored patients Be clear about the consequences of this baseline budget for a single standard of care for mental health Requested clarification of the pharmacy issues Have a realistic census at San Francisco General Hospital for the budget Given the economic problems, the Department needs to come up with priorities Public Speakers: Speakers advocated for children and youth health prevention services, infant care, dental services for children, culturally competent services for the Asian Pacific Islander communities, declaration for a state of emergency for housing, mental health services, jail treatment services, methadone slots, treatment on demand for youth, peer model of harm reduction, community-based proposals for housing, a Police Crisis Intervention Program, a housing trust fund, apprenticeship training programs for welfare workers, and full funding for treatment on demand. Gilda Serrano, parent, Advocates for Youth Margaret Brodkin, Coleman Advocates for Children Jerea Paul, Infant-Parent Program Laurel Kloomoll, Parent's Place Taj James, Coleman Advocates Mai Ho, Asian Perinatal Advocates Howie Chow, M.D., UCSF At 5:00 p.m., the Commission had a time-specific item. At 5:50 p.m., the Commission resumed public testimony. Public Speakers: (continued) Marie Hoemke, Healthy Start Joe Wilson, Coleman Advocates Jennifer Friedenbach, Coalition on Homelessness Maggie Cockrell, self Ron Perez, SF Sheriff's Department Lateefa Simon, Center for Young Women's Development Hank Wilson, Act-Up Golden Gate Lucy Arellano, Haight Ashbury Free Clinic Lucille Flato, SHAC Marykate Conner, Caduceus Outreach Services Renzo Sereni, Liberation House Robert Johnson, Liberation House Jose Morales, SF Tenants' Union Agnes Mercurio, SAGE Project David Smith, M.D., founder of Haight Ashbury Free Clinics Jesse Turner, Mission Agenda Chris Daly, Mission Agenda Darrell Cornelius, Mission Agenda James Tracy, Mission Agenda Jill Turner, Mission Agenda Frog, Magic Robert Haaland, SF Tenant's Union Lucille Maurice, housing Jane Kahan, Mental Health Association of S.F. Ms. Weisner, workfare worker John Mollens, welfare recipient POWER representative President Monfredini stated that this budget proposal will be calendared again on the February 16, 1999 agenda. The Commission will make a decision on the budget on February 16, 1999. The Department presented a proposed resolution, (Attachment C), for the Commission's consideration. The resolution will be calendared for the February 16, 1999 meeting. 7) CONSIDERATION OF AMENDMENTS TO THE SAN FRANCISCO GENERAL HOSPITAL GOVERNING BODY BYLAWS Gene O'Connell, Executive Administrator of San Francisco General Hospital, proposed amendments addressing the following: The role of the Community Health Network Executive Administrator as it relates to SFGH activities Deletion of term limits for Commissioners and the change in the method for appointment of the Director of Health, pursuant to the new City Charter Authority for the Joint Conference Committee to review and approve additions, modifications, and deletions to the Hospital Policy and Procedure Manual, and Minor updates to better reflect current practices Commissioners Chow, Monfredini and Parker, who discussed these amendments at the Joint Conference Committee at San Francisco General Hospital, recommended approval. Action Taken: The Commission approved the proposed amendments. Ms. O'Connell reported that the JCAHO visit is scheduled for May 17-21, 1999. 8) 5:00 TIME SPECIFIC: PROPOSITION Q HEARING ON CALIFORNIA PACIFIC MEDICAL CENTER (CPMC) CONSOLIDATIONS CPMC representatives, Sara Kelley, Richard Liszewski, Bobby Kimball, Linda Monte, and Vernon Giang presented the following: California Pacific Medical Center has been working diligently during the past six months, since we integrated the Davies Campus, to design and reorganize a merged medical center that provides the most efficient access to our joint high quality services and facilities. All proposed changes are based on patient demand and our mission to provide our community with the best possible care. As described in previous communications, the planned changes will ultimately result in a net increase of operational beds. The proposed changes are motivated by the following factors: Our need to increase beds on our rapidly growing Obstetrics and Delivery Service, now providing care to approximately 5000 families - and newborns each year. Additionally, as you know, January 1, 1998, federal legislation, the Mothers and Newborn Act, mandated a 48 to 96 post-partum stay (according to delivery type), which immediately doubled our post-partum length of stay. In order to provide the needed space, we will reorganize units on the California West and East Campuses, and Davies Campus. This will affect both SFN and acute rehabilitation beds. Our interest is in increasing access to our renowned state-of-the-art acute rehabilitation unit on the Davies Campus. Consolidating all acute rehabilitation beds to our Davies Campus will enable us to provide high quality care in a specialized center that includes a pool for hydrotherapy, in-house supportive rehabilitative services and ample parking for patients, families and visitors. An inconsistent and decreasing annual census in our SNF units require consolidation that allows for maximum flexibility and adaptability to ensure high quality and efficient care. Our changes would move some SNF beds to the Davies Campus, while still maintaining beds on the California East Campus. The Commission was given a chart indicating the changes, locations, and number of beds regarding the consolidations. Because of the lack of clarity and confusion from the answers to questions related to skilled nursing beds, acute beds, and total operational beds, the Commission requested more information on the full picture of these consolidations. Public Speakers: Raised concerns related to staffing, decrease in quality of patient care, loss of jobs, and non-compliance to Proposition Q requirements. John Borsos, Local 250 Eric M. Hall, California Nurses Association Allan Apelo, RN, CPMC Catherine Lee, LVN, CPMC President Monfredini stated this item will be on the February 16, 1999 agenda. The Commission will make a determination on whether the consolidation, of which some have already been implemented, will or will not have a detrimental impact on the health service of the community. 11) OTHER BUSINESS/PUBLIC COMMENTS None. The meeting was adjourned at 7:05 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission