Minutes of the Health Commission Meeting Tuesday, January 16, 2001 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 Roma P. Guy, MSW, at 3:05 p.m. Present: Commissioner Edward A. Chow, M.D. Commissioner Roma P. Guy, M.S.W. Commissioner Lee Ann Monfredini (left at 7:15 p.m.) Commissioner Harrison Parker, Sr., D.D.S. Commissioner David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. (arrived at 3:45 p.m.) Jean Fraser, former Deputy City Attorney for the Department of Public Health and presently the Executive Director for the San Francisco Health Plan, officially said au revoir to the Commission and the Department. She also introduced Aleeta Van Runckle, the new Deputy City Attorney in charge of the Health Department legal team. President Guy expressed appreciation to Ms. Fraser for her legal advice to the Commission and the Department. 2) CONSIDERATION OF A RESOLUTION DESIGNATING THE DEPARTMENT OF PUBLIC HEALTH AS THE LEAD AGENCY FOR ADMINISTRATION OF FUNDS FROM THE SUBSTANCE ABUSE AND CRIME PREVENTION ACT OF 2000 (PROPOSITION 36) Barbara Garcia, Director of Population Health and Prevention, provided an overview on Proposition 36. Commissioner Chow pointed out the amount of allocated funds may not be sufficient and expressed concern on the practicality of implementation. Commissioner Parker supports the Department being the lead agency but also expressed concern for equity to the populations most affected (i.e., African Americans). Ms. Garcia stated the Department is advocating for increased funding for San Francisco, at the same time, addressing those populations (i.e., African American and Latinos) disproportionately impacted. Action Taken: The Commission (Guy, Chow, Monfredini, Parker, Sanchez) adopted Resolution #2-01, "Urging the San Francisco Board of Supervisors to Designate the Department of Public Health as the Lead Agency for Administration of Funds from the Substance Abuse Crime and Prevention Act of 2000, (Proposition 36), and to Establish a Substance Abuse Crime and Prevention Trust Fund." 3) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH STRATEGIC PLANNING INITIATIVE, AND CONSIDERATION OF A RESOLUTION ENDORSING THE INITIATIVE Tangerine Brigham, Director of Policy and Planning, presented the Department’s Strategic Plan – Leading the Way to a Healthier Community 2000. A copy of the Plan is available at the Commission office. Ms. Brigham reported that the Department embarked on this effort in August 1999. Since that time, over 100 individuals (staff, consumers, contractors, health advocates, representatives from other City departments, labor and the public) have donated their time and their expertise towards developing the Strategic Plan. In addition, the Strategic Planning Steering Committee held 52 town hall meetings with the community and staff to seek their input into developing the recommendations. On December 4, 2000 the Department held a community town hall meeting to present the Strategic Plan, its Goals and recommendations to the public. When the Department undertook on this effort, the Health Commission requested that the Strategic Plan be developed and finalized prior to the Health Commission’s consideration of the Department’s proposed 2001-02 budget. Therefore, the Strategic Plan is being presented before deliberation on the budget. The Commission has directed the Department to begin to incorporate the Strategic Plan with the FY 2001-02 DPH budget. Ms. Brigham reviewed the overall strategic direction. The Department’s strategic direction has the following goals: San Franciscans have access to the health services they need, while the Department emphasizes services to its target population Disease and injury are prevented Services, programs and facilities are cost-efficient and resources are maximized Partnerships with communities are created and sustained to assess, develop, implement and advocate for health funding, policies, programs and services Ms. Brigham acknowledged the Planning staff, committee members, and community representatives who participated in the planning process. Public Speakers: Renee Saucedo, S.F. Day Labor Program, advocated for policy to upgrade health care; health care system continues to be inadequate Richard Heasley, S.F. Mental Health Contractors Association, appreciates the input process and recognition of the contractors’ role in the health system; supports salary parity for CBO’s and the multiyear parity adjustment; urged passage of resolution Nora Roman, ECSPH, urged Commission to vote no on the resolution; strategic plan should meet needs and not dependent on funding; health care, patients and staff are in crises; do something about State and Federal funding levels; be voices for the people Teresa Palmer, M.D., Laguna Honda Hospital, urged Commission to vote no on the resolution; do not decrease acute services; would be an act of courage to say no to the Strategic Plan; include direct caregivers Lynn Carman, lawyer, thinks this is not a Strategic Plan; quoted functions of the Commission according to the City Charter Michael Lyon, Emergency Coalition, thinks this is not a plan, it’s restructuring Kelly Wilkinson, Episcopal Community Services, expressed importance of partnerships with DPH Bea Stephens, Westside Community Mental Health, supports the plan on access, support for mental health contractors and safety in the communities Eve Meyer, S.F. Suicide Prevention, described problems with CBO’s infrastructure and finances; urged Commission to refuse a cap on the Department’s budget Karen Patterson Matthew, Bayview Hunters Point Foundation and Mental Health/Substance Abuse Contractors’ Association, supports work of the strategic planning process and stream-lining of the contracting process; in the face of limited resources, DPH has involved all areas Dick Hodgson, S.F. Community Clinic Consortium, supports the joint planning between DPH and the clinics in the Consortium Dale Butler, SEIU 790, appreciates being invited to participate; there are negative impacts from salary savings on labor issues; real test is implementation without loss of services; Department has to honor Union contracts; urged meetings with Unions on budget issues Teresa Gaytan, Local 250, expressed disappointment with the Strategic Plan Kent Woo, NICOS Chinese Health Coalition, submitted a November 20, 2000 letter indicating comments on race and ethnicity, health data, cultural competency, local access, and community advisory councils. Frances Cain, Neighbor to Neighbor, is disappointed with the Strategic Plan; urged a plan of action to achieve universal health care and the Commission to take a leadership role Note: A petition of 200 signatures for a commitment to quality, accessible healthcare for the people of San Francisco was submitted. Due to the 4:30 p.m. time specific item on the agenda, the Commission went to item #4 and came back to the Strategic Plan at 8:00 p.m. Commissioners’ Comments: Commissioner Chow commented on his input into revisions for the resolution; the broadness of the resolution is good; the implementation is the important part; the plan is to be used as a guideline. Commissioner Monfredini expressed her support for the resolution (she had to leave prior to the vote). Commissioner Umekubo thanked Ms. Brigham, the staff, and community representatives who worked on the plan. Commissioner Sanchez thanked the Department for the many hours of work; need to be creative with the plan in order to sustain adequate health. He also clarified that SFGH is included in the resolution where the "role in the delivery of health care" is discussed. This is a work in progress. The Department is still at risk as a Health Department; need to get out of deficit model. Commissioner Parker does not see a plan due to vagueness; does not get a sense of what the Department is doing; can’t accomplish everything; need more definite things; where are we trying to go? It’s better than nothing. President Guy feels the fundamentals for a plan are there; these are improvements due to data and are beginnings of a rationale where we want to go; implementation at the Joint Conference Committee; this public document is needed for a reference point. Action Taken: The Commission (Guy, Umekubo, Chow, Parker, Sanchez) adopted Resolution #3-01, "Endorsing the San Francisco Department of Public Health’s Strategic Plan – Leading the Way to Healthier Community 2000." President Guy requested a 3-month update (April) to the full Commission and requested the Joint Conference Committees to discuss the plan. 4) TIME SPECIFIC AT 4:30 P.M. PROPOSITION Q (HEALTH CARE PLANNING ORDINANCE) HEARING ON THE FOLLOWING: St. Luke’s Hospital and Sutter Health will have an affiliation that would further the charitable missions of each of the organizations and preserve vital health care services in San Francisco. Under an affiliation, St. Luke’s would become part of Sutter Health, the Northern California network that includes more than two dozen Northern California hospitals and physician organizations. Jack Fries, Chief Executive Officer of St. Luke’s Hospital, introduced Philip L. Pillsbury, Jr., Chair of the St. Luke’s Board of Directors. Mr. Pillsbury and Patrick E. Fry, Chief Operating Officer and Executive Vice President of Sutter Health, had submitted to the Commission and Dr. Katz, a letter describing the proposed affiliation of St. Luke’s with Sutter Health. In addition to background information on St. Luke’s and Sutter Health, the letter describes the history of the proposed affiliation and the terms of the affiliation. The terms of the affiliation include the structure, governance, management, employees, medical staff and clinical services, charity care, and the Sutter financial commitment. A copy of the letter is available at the Commission Office. Mr. Pillsbury emphasized that the St. Luke’s Board will continue to be a community-based Board. The following persons spoke on behalf of Sutter Health in support of the affiliation: Jim Grey, Chairman of Sutter Health South Andy Pansini, member Board, Novato Hospital Pat Fry, Chief Operating Officer, Sutter Johnathan Goh, Chief Financial Officer, St. Luke’s Dr. Coleman, member St. Luke’s Board Bishop William Swing, Episcopal Dioceses of Northern California Sally Soto, R.N., 43 years at St. Luke’s Public Speakers: President Guy requested public testimony be heard first from a wheelchair bound patient from St. Luke’s. John Chao, patient at St. Luke’s Sub-Acute Ward and President of the Resident Council, urged support for the affiliation with Sutter Health. The affiliation will bring vital stability to St. Luke’s. Several petitions with over 2000 signatures were submitted to the Commission. President Tom Ammiano of the Board of Supervisors expressed concern about the future of St. Luke’s; there’s no guarantee on the level of charity care; need to have State Attorney General Bill Lockyer intervene. Supervisor Chris Daly, District #6, concerned about the future charity care at St. Luke’s; urged Commission not to support this merger. Supervisor Aaron Peskin, District #3, supports Local 250 and other Supervisors; urged Commission to seek guarantee of the present level of services. Supervisor Jake McGoldrick, District #1, urged Commission not to move this forward unless guarantees to the public remain. Supervisor Gerardo Sandoval, District #11, urged Commission to take time and make the right decision; need to continue serving residents in his district. Rob Eshelman for Supervisor Matt Gonzalez, District #5, asked Commission to consider negative impacts from this affiliation with Sutter Health, who is known to cut services; urged Commission to bring in State Attorney General Lockyer for enforcement. Supervisor Mark Leno, District #8, urged Commission to have guarantees in writing; the level of services and charity care should not be diminished; culturally competent services should not be jeopardized. Supervisor Sophie Maxwell, District #10, announced she will chair the Public Health and Environment Committee; wants to make sure St. Luke’s continues services. Margaret Cruz, community leader, submitted petitions with 3000 signatures to show community support and the community’s initiative for the affiliation. Ena Eguirre expressed support for the affiliation. Amy Yacorzynski, Mission High School, stated health is a major concern for students. Sal Rosselli, SEIU Local 250, stated workers are committed to save St. Luke’s; the Sutter Health track record is to cut services and charity care; urged Commission to seek specific requests. Josie Mooney, SEIU 790, President of S.F. Labor Council, stated people need St. Luke’s not Sutter Health; described how Sutter Health puts profits before patient care; gave examples of broken promises; feels the City could be an alternative; urged Commission not to support the affiliation but to support an alternative. Marie Bentley, Local 250, stated Sutter Health has to put guarantees in writing. Angela Alioto, former Supervisor, pointed out a bigger picture in health care; urged Commission to look at the terms and conditions of the affiliation and the impact on the entire City; get involved with the negotiations. Mark Dennis, Mission High, doesn’t want to be turned away from St. Luke’s; need to keep St. Luke’s opened. Marianela Munoz, student, wants St. Luke’s to remain opened; helps to be healthy; wants Sutter Health to keep St. Luke’s opened. Theresa Hernandez and Yana Wong, Mission High, want St. Luke’s to stay opened. Jacques Bolivar, S.F. Hispanic Chamber of Commerce, supports affiliation to allow for continuance of St. Luke’s. Edie Zoleman, volunteer, says City would be poorer without St. Luke’s; charity means love. John Borsos, SEIU Local 250, described broken promises of Sutter Health in the East Bay. Daysi Coreas, student, uses St. Luke’s; teens deserve respect. Ted Alfaro, Mission High Principal, says without St. Luke’s kids won’t come to school; kids come from all over the City to go to St. Luke’s. Anita Halpern, parent of patient at St. Luke’s, described the care her son receives. Nora Roman, ECSPH, pointed out there’s no data on charity care; Public Health, not a corporation needs to take over St. Luke’s. Walter Johnson, S.F. Labor Council, stated Sutter Health is expert in surgery due to its cuts in health; urge to stop the bleeding; yes for St. Luke’s, no for Sutter Health. Gary Virginia, AIDS patient, stated SFGH is overburdened with AIDS care; gave examples of Sutter Health cases on preventable deaths; look for other solutions; demand facts on charity care. Teresa Palmer, M.D., Laguna Honda Hospital, urged Commission to look at alternatives to Sutter Health; need Attorney General Lockyer to have a health impact report; this affiliation would be a further dismantling of health. Paula Fiscal, Coalition to Save St. Luke’s, emphasized the need to look at what will the public and community get. Fred Naranjo, Coalition to Save St. Luke’s, stated the community wants the affiliation; gave notice to Sutter Health that it would be held accountable; Sutter Health needs to be given a chance; community members have not been denied by Sutter Health to serve on the St. Luke’s Board; submitted a petition with 1000 signatures. Rev. Thomas Hernandez, leader, stated St. Luke’s needs to be kept open; the City should be united on this. Annette Dougherty, physical therapist, indicated paychecks still bounce; St. Luke’s needs added financial support. Robin Affrime, Yolo County Communicare Health Centers; described her County’s positive affiliation with Sutter Health. Laura Norell, M.D., St. Luke’s, said St. Luke’s will close without the affiliation. Carol Ruth Silver, former Supervisor, supports the affiliation to save St. Luke’s; there are no other alternatives. Bill Price, Senior Action Network, advocated full service with no cuts; local control is necessary; wants guarantees through Attorney General Lockyer. Marshall Kubota, M.D., Medical Director of Santa Rosa Hospital, described positive experiences with Sutter Health; stronger residents’ programs; listed new outpatient services; still is a disproportionate share hospital. Dave Monks, Noe Valley Democratic Club, urged Commission to investigate and have a legal document that’s enforceable. Robert Haaland, supports community efforts to maintain services and local control. Nancy Lewis, CAN, opposes affiliation; does not guarantee services and safe staffing levels. Alexis Gonzalez, St. Anthony’s Foundation, expressed concern on the impact on her clinic patients. Michael Lyon, Emergency Coalition, posed the question would Sutter Health want to take over St. Luke’s if services were maintained? Erma Ellis, Local 250, needs guarantee from Sutter Health to continue St. Luke’s mission. Theresa Sparks, Transgender Civil Rights Task Force, asked for stronger guarantees from Sutter Health; many transgenders live in the St. Luke’s section of the City. Susan Englander, RN, Ph.D., concerned about more hospital consolidations; Sutter Health has own interests. Charles Minster, Local 1141, stated in an economic boom there’s a need to take care of patients and workers. John Linden, St. Luke’s employee, stated St. Luke’s needs financial help from Sutter Health. Linda Gay Taylor, St. Luke’s Hospital, hopes Sutter Health stands by its word. A. Millstein, St. Luke’s, described lack of supplies and disaster level at St. Luke’s; need this affiliation. Lynn Carman, attorney and ECSPH, talked about charity care by other hospitals; this is a public health crisis. Denise D’Anne, District #6, says health care is a right not an industry; avoid profit motives; need universal health care. Connie Taylor, Eden Hospital and Local 250, described negative aspects of a Sutter Health takeover. Sally Ann Buchmann, MA, RD, Local 790, urged Commission to look hard and thoroughly into matter and bring in Attorney General Lockyer. Julie McCowan, respiratory therapist, gives care to the most vulnerable; supports fellow employees. Sara Angulo, Local 250, wants increased care for patients; protections should be built into affiliation. Jose Morales, SAN, asked whether the neighborhood, employees, and everyone would be happy with the solution? Jack Fries, Chief Executive Officer of St. Luke’s, stated Sutter Health has to be a corporate partner. He indicated Sutter Health will maintain the historical level of charity care at St. Luke’s. The affiliation with Sutter Health is the strongest offer ever made to St. Luke’s. Commission Comments: Whatever happens to St. Luke’s will impact SFGH; encouraged a quarterly dialogue with the Commission on the status of the affiliation Data on quality care in other counties with Sutter Health is needed Inquired into legal ways to enforce charity care Requested information on approvals needed by the State Attorney General and how any new laws apply to this situation Does not see specific commitments to charity care Has to be assurance what will be good for the public; will a commitment to the public be continued? Noted conflicting information on charity care levels of commitment Concern for charity care and the loss of autonomy at the governance level; need more information and documents to study Bill Aseltyne, legal counsel for Sutter Health, submitted a letter from Sutter Health on its commitment to charity care. Dr. Katz expressed his view that as it presently stands, the affiliation has not progressed and would be harmful to public health. He sees progress on charity care but is not pleased with the language. He does not see the St. Luke’s Board to have more autonomy. He does not view the affiliation as a bailout. Sutter Health was being sued by St. Luke’s; and the affiliation is an agreement for dismissal of the lawsuit. The larger picture for health care is that there will be narrowing of the market and a serious antirust issue at hand. The Commission will calendar this item for the February 6, 2001 meeting at a time specific (4:30 p.m.) Commissioner Chow pointed out that while the Commission will calendar a proposed resolution to determine whether the affiliation is/is not detrimental to the health service of the community, the Commission can continue the item if more information is needed. President Guy thanked Commissioners, staff, and the public for attending this lengthy meeting. The meeting was adjourned at 8:35 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission