Minutes of the Health Commission Meeting Minutes of the Health Commission Meeting Minutes of the Special Closed Executive Session of the Health Commission   Health Commission Meeting Tuesday, March 2, 1999, 3:00 p.m. 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 3:10 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. 2) APPROVAL OF MINUTES OF THE MEETING OF DECEMBER 15, 1998 Action Taken: The Commission unanimously adopted the minutes of February 16, 1999. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) (3.1) Consideration of a resolution accepting a gift from New Life Clinic of Free Hypnotherapy Sessions for Smoking, Cessation, Weight Loss and Stress Reduction for City Employees. See Resolution #8-99, "Approving New Life Clinics Services to Employees of the City and County of San Francisco, their Adult Relatives and Friends." CHN – Request for approval of retroactive renewal contracts with PT & OT Registry, TherAmerica, On-Call Therapists and Preferred Therapy Registry for the provision of temporary, as-needed rehabilitation personnel services for a combined amount not to exceed $450,000 for the period of February 1, 1999 through June 30, 2000. (DPH contracted with the above registries for services totaling a combined $276,000 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). The Department will return in 60 days (May 4, 1999) with a follow-up report. (3.4) PHP-HIV Prevention Services – Request for approval of retroactive renewal contract with Glide Foundation, in the amount of $53,008, for the provision of HIV counseling, testing, risk reduction and partner notification services, for the period of January 1, 1999 through December 31, 1999. (DPH contracted with Glide for services totaling $523,418 during FY 1997-98). (3.5) PHP-HIV Prevention Services – Request for approval of retroactive renewal contract with California AIDS Intervention Training Center (CAITC), in the amount of $138,001, for the provision of HIV, venue-based, individual counseling services for the period of January 1, 1999 through December 31, 1999. (DPH contracted with CAITC for services totaling $391,207 during FY 1997-98). Commissioners Hill and Sanchez requested a 60-day (May 4, 1999) follow-up report. (3.6) PHP-HIV Prevention Services – Request for approval of retroactive renewal contract with California AIDS Intervention Training Center (CAITC), in the amount of $142,398, 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 CAITC for services totaling $391,207 during FY 1997-98). (3.7) PHP-HIV Prevention Services – Request for approval of retroactive renewal contract with Support Center for Non-Profit Management (SCNPM), in the amount of $120,000, for the provision of organizational development and technical assistance for the period of January 1, 1999 through December 31, 1999. (DPH contracted with SCNPM for services totaling $870,561 during FY 1997-98). (3.8) PHP-Employment Development Unit – Request for approval of new contract with AIDS Benefits Counselors (ABC), in the amount of $85,508, for the provision of workplace entry and re-entry services for people living with HIV/AIDS, for the period of March 1, 1999 through June 30, 1999. (DPH contracted with ABC for services totaling $201,014 during FY 1997-98). DPH-Administration – Request for a supplemental appropriation in the amount of $6,932,000 million for Laguna Honda Hospital to include: 1) $5,810,000 million to offset reduced operating revenues; and 2) $1,122,000 million for financial feasibility planning to determine options to replace the hospital. Action Taken: The Commission approved the Consent Calendar of the Budget Committee. 4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) (Provides information on activities and operations of the Department). POPULATION HEALTH AND PREVENTION Asthma and Managed Care On February 18th, the health directors of six Bay Area county health departments and the CEOs or medical directors of their respective Medi-Cal managed care plans met for a half day to review regional data on asthma. The discussion focused on ways in which public health and managed care can collaborate to improve the management of and prevent the onset of asthma. The meeting was organized under the auspices of the Public Health Institute’s Regional Asthma Management and Prevention (RAMP) initiative and the Association of Bay Area Health Officials (ABAHO). The presentation of hospitalization rates for asthma in four counties (San Francisco, Alameda, Contra Costa and Solano) showed consistently high rates among ethnic minority—especially African American—children living in zip codes associated with poverty, which underscored the importance of health departments and Medi-Cal managed care plans working together. Follow-up will include development of a plan to combine improved clinical practices in managed care plans with public health interventions emphasizing community education and environmental prevention activities. It was also agreed that, if a successful model can be developed to address asthma, it can serve as a foundation from which to develop a broader collaboration to focus on other population health priorities. Jennifer Mann from the Community Health Epidemiology Section provided valuable assistance in the collection and presentation of the data. Bob Prentice was a lead organizer of the event and represented the San Francisco Department of Public Health at the meeting. The Black Infant Health Improvement Project The Black Infant Health Improvement Project sponsored its Fourth Annual Afrocentric Parenting Conference on February 12, 1999. The Conference was dedicated to Agnes Morton, a recently retired Public Health Nurse and community activist. One hundred eighty health and social service providers, community members, and parents gathered at the daylong conference to share skills and knowledge about the needs of African American families. Participants represented 67 agencies and nine counties. The theme of the conference was "Revitalizing the Village." The Honorable Phrasel Shelton, a juvenile and family Court Judge for San Mateo delivered the keynote address. The conference explored a variety of parenting issues including self-esteem, conflict resolution, discipline, and teaching methods. COMMUNITY HEALTH NETWORK SFGH Nurse Honored Sue Trupin, R.N., whose outstanding professional achievements include her pioneering efforts to help grandparents suffering from severe depression brought on by the burden of raising their grown children's children, has been named the first "Welcome Back Awards" health care honoree, sponsored by Eli Lilly. She is one of five individuals who will be honored at an inaugural ceremony in May in Washington, D.C. Ms. Trupin, a 16-year veteran at SFGH Adult Medical Clinic, has helped countless middle-aged women receive treatment for their depression, while helping them gain control over other health problems. She has been instrumental in educating primary care physicians about the complexity of their patients' lives and its impact on health. Please join me in praising Ms. Trupin for her outstanding work. David Ofman, M.D., selected for the NAPH Medical Leadership Forum. Dr. David Ofman joins Drs. Melissa Welch and Sylvia Villarreal in being selected to participate in the NAPH Medical Director Leadership Program. This program will focus on skills necessary for Safety Net Providers to lead clinical change in a managed care environment. Congratulations to Dr. Ofman for this honor. February Celebrations at the MHRF The Mental Health Rehabilitation Facility had a busy February celebrating Black History Month and the Lunar New Year. One of the many popular activities for Black History Month was a visit from the first woman cable car grip: Fanny Barnes. She was hired in January 1998 and proved that another "men only" job could be successfully performed by a woman. The Lunar New Year was celebrated at the MHRF on February 24th. Twenty-five young members of a lion dance troop entertained patients and staff with firecrackers, drums, cymbals, and five lion dancers. Two CHN employees, Kitty and Lincoln Mah, are the parents of the Mako, a lion "head" and drummer. In-Home Support Service Insurance Program The insurance program for In-Home Support Service workers officially began on March 1st. Approximately 1000 members became eligible for health benefits in its first month of operation. Congratulations to all the parties involved in bringing this valuable program to reality, the IHSS Public Authority, SEIU Local 250, the San Francisco Health Plan and the CHN Office of Managed Care. 5) CONSIDERATION OF PROPOSED REVISIONS TO THE CLINICAL SERVICE RULES AND REGULATIONS, AND PRIVILEGE SHEETS: a) Otolaryngology (Joint Conference Committee - January 12, 1999) b) Pediatrics (Joint Conference Committee - January 12, 1999) c) Psychiatry (Joint Conference Committee - January 12, 1999) d) Orthopedics (Joint Conference Committee - February 9, 1999) Action Taken: The Commission unanimously approved the revisions to the Clinical Service Rules and Regulations, and Privilege Sheets for Otolaryngology, Pediatrics, Psychiatry and Orthopedics. 6) PRESENTATION OF THE CHILDREN’S SERVICE PLAN FOR 1999-00 FROM THE DEPARTMENT OF CHILDREN, YOUTH AND THEIR FAMILIES Deborah Alvarez-Rodriguez, Director of the Department of Children, Youth and Their Families, presented the 1999-2000 Children’s Service Plan. Commissioner Guy pointed out the lack of health indicators for STD’s, AIDS, drug poisoning, homeless youth, the African American high risk community, and Latino youth issues. Ms. Alvarez-Rodriguez stated that these health indicators will be developed. She also pointed out that she will be looking at the distribution of funds to target populations. Commissioner Chow stated his concern for Asian immigrant children and youth The Commission thanked Ms. Alvarez-Rodriguez for the comprehensive plan. 7) REPORT ON DEPARTMENT OF PUBLIC HEALTH QUARTERLY EXPENDITURES AND REVENUE FOR FY 1998-99 Monique Zmuda, Chief Finance Officer, presented the Second Quarterly Report for FY 1998-99; Ms. Zmuda reported the Department will bring detailed proposed reductions later this month. Commissioner Chow expressed his concerns that adequate resources be allocated towards readiness for the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) survey in May. He stressed the importance of passing accreditation and does not want the reduction of ancillary services to negatively impact the JCAHO survey. Dr. Katz stated the proposed reductions would not affect areas for accreditation. Commissioner Hill stated his concerns that not enough resources are being allocated for accreditation. He expressed his concern for staff burn-out and San Francisco General Hospital being over capacity. Commissioner Sanchez raised the question at what point does the Commission say the Department cannot go any further; and do we need a baseline census? Commissioner Guy encouraged the Department to restate how much it costs to run the Department. She sees the Department trying to resolve the deficit within the Department. She is quite concerned about safety and other Department programs. She requested the Department to analyze the impact on other parts of the Department. She also appreciates the truth from staff. 8) CONSIDERATION OF A RESOLUTION REGARDING THIS YEAR’S SAN FRANCISCO GENERAL HOSPITAL’S BUDGET DEFICIT, AND DIRECTING THE DEPARTMENT TO CAP THE EMERGENCY ROOM CENSUS AT SAN FRANCISCO GENERAL HOSPITAL IN ORDER TO BRING THE HOSPITAL CENSUS TO BUDGETED 1998-99 LEVELS Dr. Katz indicated that San Francisco General Hospital has been taking care of an increasing number of indigents and that over the past few years there has been an accumulation of the census, with this year being very high. It is difficult to live within the budget when the needs are higher than the budgeted census. He proposed to limit the capacity of the emergency department at San Francisco General Hospital to meet its physical and staffing capacity. This action will also reduce some of the high census at SFGH. San Francisco General Hospital accepts more than 50% of the ambulances. The Department will look at other ways to decrease the hospital census. President Monfredini emphasized that nurses and physicians should not be part in a situation that jeopardizes the safety of patients and staff. Public Speakers: Alan Gelb, M.D. advocated increasing bed capacity, not decreasing ambulance arrivals. Wade Rose, Catholic Healthcare West, Executive Vice President, indicated the proposed policy will affect all of the other hospitals. Catherine Dodd, Kaiser Hospital, advocated for collaboration between the Department of Public Health and the private hospitals. Nathan Nayman, Hospital Council, advocated the Department to work with other healthcare leaders on the larger health policy issues. President Monfredini reminded everyone that this issue has been around for a while. She stated that this is an emergency situation and is sorry this action will affect the other hospitals. Commissioner Chow observed that all hospitals have increased census, and expressed his disappointment that the capacity of the City has not yet been addressed. He raised the larger question of what is the capacity need for acute care. He also reminded the private, non-profit hospitals of their tax exempt status and their public benefits from this. Commissioner Hill stated that the Commission has no policy to address the large number of patients showing up at San Francisco General Hospital. No one is saying no to the poorest of the poor. He is concerned about staff burn-out and resignations. He proposed an amendment in the proposed resolution limiting the hospital census to 282 until the budget issues are resolved. Commissioner Parker expressed his frustration over this present predicament and sees very few solutions. He observed that it appears that we never get out of this quagmire. He encouraged the Commission to take the same stand it took on California Pacific Medical Center, determining this situation to be detrimental to the community. Commissioner Guy observed that the capacity question needs to be addressed. This present situation should not be a surprise. She feels the census of 282 is a fantasy. Commissioner Sanchez expressed that the budgeted census of 310 would be a minimum. The Department’s mission needs to be articulated; and the bed capacity needs to be increased. Commissioner Umekubo feels this is the tip of the iceberg on the capacity question. The proposed resolution is a temporary solution. He encouraged the Department to look at other ways to solve these problems. He suggested an amendment to the resolution indicating the need for the Department and the other hospitals to continue collaboration. Dr. Katz reported he will bring back to the Commission before the end of March several proposed ways to address this deficit. Commissioner Hill requested assurance that personnel are in place to address the increased hospital census. Commissioner Chow suggested instead of including a census of 282 in the resolution, there needs to be assurance of adequate personnel at the increased census level. Action Taken: The Commission (Chow, Guy, Parker, Monfredini, Sanchez, Umekubo) adopted the amended Resolution #7-99, "Authorizing the Department of Public Health to Limit the Capacity of the Emergency Department at San Francisco General Hospital to the Physical Capacity and Budgeted Staffing Level." Commissioner Hill voted no. 9) UPDATE FROM THE LONG TERM CARE TASK FORCE (AB 1040) Tony Wagner, Co-Chair of the AB 1040 Task Force, gave an update on the work of the Task Force regarding key planning issues, labor issues, statewide issues, upcoming Task Force meeting topics, and coordination with the Laguna Honda Hospital Replacement Planning Committee. For a copy of the full report, contact the Commission Office at 554-2666. Commissioner Chow raised concerns about the governance structure and its relationship to the 1115 Waiver Committee and the Universal Healthcare issue. He would want to know what linkages will be established among all of these entities. He also indicated that duplicative efforts or more bureaucracy should be avoided. Commissioner Guy expressed her deep disappointment in the AB 1040 Task Force’s feeling that it is inappropriate to take a position on the number of beds needed at Laguna Honda Hospital. Mr. Wagner will bring back the governance structure recommendation from the Task Force. 10) PUBLIC COMMENTS Ed Kinchley, SEIU 790, indicated with the closing of the satellite pharmacy, there was no meet and confer. Jeff Wong, California Pharmacists Association, opposed closing of the San Francisco General Hospital satellite pharmacy. The meeting was adjourned at 5:45 p.m. _____________________ Sandy Ouye Mori, Executive Secretary to the Health Commission MINUTES OF THE SPECIAL CLOSED EXECUTIVE SESSION OF THE HEALTH COMMISSION Tuesday, March 2, 1999, 1:00 p.m. at 101 Grove Street, Room #300 San Francisco, CA 94102 1) CALL TO ORDER The special meeting of the Health Commission was called to order by President Lee Ann Monfredini, at : 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. 2) PUBLIC COMMENT ON ALL MATTERS PERTAINING TO THE CLOSED SESSION None. 3) VOTE ON WHETHER TO HOLD CLOSED SESSION TO CONFER WITH LEGAL COUNSEL. (SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.11(a).) Action Taken: The Commission unanimously voted to hold a closed session. The Commission went into Closed Session at 1:10 p.m. 4) CONFERENCE WITH LEGAL COUNSEL - ANTICIPATED LITIGATION: X____ AS DEFENDANT AS PLAINTIFF CLOSED SESSION PURSUANT TO GOVERNMENT CODE SECTION 54956.9(b)(3)(B), REGARDING THE DENIAL OF A CONTRACT WITH CATHOLIC YOUTH ORGANIZATION (CYO), AND CONSIDERATION OF A PROPOSED CONTRACT WITH CATHOLIC CHARITIES WITH RESPECT TO COMPLIANCE WITH HEALTH COMMISSION POLICY #24 The Commission came out of Closed Session at 1:35 p.m. 5) RECONVENE IN OPEN SESSION: A. 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).) None. B. 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 not to disclose any discussions held in Closed Session. The meeting was adjourned at 1:37 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission