Minutes of the Health Commission Meeting Tuesday, September 3, 2002 At 3:00 p.m. 101 Grove Street, Room #300 San Francisco, CA 94102 1) CALL TO ORDER The meeting was called to order by Commissioner Edward A. Chow, M.D., at 3:05 p.m. Present: Commissioner Edward A. Chow, M.D., President Commissioner Roma P. Guy, M.S.W., Vice President Commissioner Arthur M. Jackson Commissioner Harrison Parker, Sr., D.D.S. Commissioner John I. Umekubo, M.D. Absent: Commissioner Lee Ann Monfredini Commissioner David J. Sanchez, Ph.D. 2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF AUGUST 20, 2002 Action Taken: The Commission (Chow, Guy, Jackson, Parker, Umekubo) approved the minutes of the August 20, 2002 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Jackson chaired and Commissioner Umekubo attended the Budget Committee. Commissioner Monfredini was absent. (3.1) CHN - Primary Care - Request for approval of a retroactive contract renewal with Bayview Hunters Point Multipurpose Senior Center, in the amount of $55,554, to provide therapeutic day treatment services for frail elders and disabled persons living in the Southeast quadrant of San Francisco, for the period of July 1, 2002 through June 30, 2003. Commissioners’ Comments Commissioner Jackson noted that the demographics of the Bayview are changing, and asked if the agency’s client population would begin to reflect this change. Cathy Davis, Executive Director of the Bayview Hunters Point Multipurpose Senior Center said that may happen, but while the demographics of the community are changing, the elderly population has not changed that much. (3.2) CHN - SFGH - Request for approval of a retroactive contract renewal with Dobri D. Kiprov, M.D., dba Bay Area Mobile Apheresis Program, in the amount of $215,000, to provide intermittent, as-needed, on-call mobile therapeutic apheresis services, for the period of July 1, 2002 through June 30, 2004. (3.3) PHP - Epidemiology - Request for approval of a new retroactive sole source contract with Regents of the University of California, in the amount of $60,000, to provide Preventive Medicine Resident services to DPH Community Health Epidemiology, for the period of July 1, 2002 through June 30, 2003. (3.4) PHP - CHPP - Request for approval of a retroactive sole source contract renewal with Polaris Research and Development, in the amount of $400,000, to provide Black Infant Health program services targeting African American parents and community members, for the period of July 1, 2002 through June 30, 2003. (3.5) PHP - CHPP - Request for approval of a retroactive sole source contract renewal with Men Overcoming Violence (MOVE), in the amount of $74,965, to provide training and support to service providers who work with men, women and youth regarding domestic violence, for the period of July 1, 2002 through June 30, 2003. Commissioners’ Comments Commissioner Umekubo commended the organization on its diverse client base. (3.6) CBHS - Substance Abuse - Request for approval of a retroactive contract renewal with Iris Center, in the amount of $975,984, to provide substance abuse services for women, for the period of July 1, 2002 through June 30, 2003. Commissioners’ Comments Commissioner Umekubo asked if the Department was satisfied with the agency’s progress toward improving its performance outcomes. Jim Stillwell replied that DPH worked extensively with the agency to correct its deficiencies. This was done partly by restructuring programs and partly through administrative changes and technical assistance. He is happy with the agency’s progress. (3.7) AIDS Office - HIV Prevention - Request for approval of a retroactive contract renewal with Lavender Youth Recreation and Information Center (LYRIC), in the amount of $60,000, to provide HIV prevention and education services to African American men who have sex with men, for the period of July 1, 2002 through December 31, 2002. Action Taken: The Commission (Chow, Guy, Jackson, Parker, Umekubo) approved the Budget Committee consent calendar. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. State Budget Early Sunday morning, the Legislature sent its 2002-03 State budget to the Governor. The budget does not increase the vehicle license fee or the tobacco tax as once proposed, but rather bridges the budget gap with revenue enhancements, such as a temporary suspension of the net operating loss deductions for businesses and implementation of a four percent reduction in State government administration. The Legislature’s agreement on these revenue enhancements avoided significant reductions in health and human service programs. Though final amendments to the budget bills are not yet in print, it appears that the budget eliminates the Medi-Cal quarterly status reports and provides for the Healthy Families parent expansion to begin in October 2002. The Governor’s Office has stated that he is likely to sign the budget on Thursday. As you know, the Governor has the ability to line out individual items in the budget bill. Therefore, I will be able to provide you with a more complete analysis of the State budget at your next meeting. AB 915 (Frommer) At the Department’s recommendation, the City sponsored AB 915 (Frommer), which provides supplemental Medicaid reimbursement for outpatient services at public hospitals and adult day health services operated by public entities. AB 915 creates an ongoing program that allows public providers to use local general funds to draw down a federal Medicaid match to help cover the difference between Medi-Cal reimbursement and the cost of providing care. This bill mimics the successful program the City and the Department sponsored last year, which provided additional Medicaid funding for public distinct part nursing facilities like Laguna Honda. AB 915 is expected to generate approximately $6 million in additional revenues for the Department annually. The bill is currently on the Governor’s desk awaiting signature and the Department will continue to work with the Mayor’s Office and the City’s lobbyist to advocate for the Governor’s signature. Active Aging Community Task Force (AACTF) Project The Community Health Education Section has been asked to serve as the lead for the San Francisco Active Aging Community Task Force (AACTF) Project. The task force will bring together representatives of community-based organizations, as well as the aging, public health, medical, education, and recreation communities. Together they will work to increase public awareness about the benefits of physical activity for older adults and to implement community-based physical activity programs aimed at reducing the risk of chronic disease and falls in older adults. The task force will also serve as a platform for discussion of policy and environmental changes that favor physically active lifestyles. DPH Prevention Framework In an effort to better coordinate the various DPH prevention activities, Prevention leadership convened a meeting of section heads on August 12th to develop a DPH wide prevention framework. The group has subsequently developed a draft framework, which includes goals, guiding principles, proposed steps and resources. As part of the process, the Prevention Group will become a workgroup under the guidance of the Department’s Integration Task Force and prevention will be discussed every quarter at the Community Programs Management Team Meeting. The Prevention Group will finalize the framework on September 23. End the Exploitation of Girls Task Force Spearheaded by Supervisor Tom Ammiano, the Board of Supervisors approved the creation of a task force that will provide policy recommendation and advice to the Board on how to treat the needs of sexually exploited and abused youth. Specifically, the task force will make recommendations regarding the creation of services, the creation and support of a 24-hour hotline, the creation of 24-hour street outreach, and the creation of a safehouse to meet the needs of these youth. Maria Cora, the Women’s Health Coordinator, represents the Department on the task force, and Iman Nazeeri-Simmons, the Adolescent Health Coordinator, is providing staff support. Community Mental Health Services Open House On Thursday, September 12th, from 1 p.m. to 6 p.m., Community Mental Health Services will host an Open House in its new facility at 2712 Mission Street. This is an opportunity to learn about the range of programs being provided under one roof, such as Mission Mental Health, Mission ACT, Bed Committee, Residential Care, Long-term Care Team and Discharge Liaison Team. A Self Care & Self-Healing Community Education program will run from 1 p.m. to 2:30 p.m., with the dedication and reception from 3:30 p.m. to 6 p.m. Emergency Medical Services’ Open House Everyone is invited to visit the new Emergency Medical Services Section offices, located at 68 12th Street, Suite 220 at the intersection of South Van Ness and 12th Street, during their Open House on Tuesday, September 10th from 10 a.m. to 6 p.m. The facility will serve as the Department’s Operations Center in times of disaster. Snacks, tours and handouts on our current disaster and EMS programs will be provided. Commissioners’ Comments Commissioner Umekubo commended staff for their work on AB 915. California ranks 49th or 50th in terms of matching federal dollars. He asked what happens to the Turk Street command center during an emergency. Dr. Katz said that Turk Street is the citywide command center. Each department then has its own center, which for DPH will be at the new EMS site. Commissioner Guy commended the Department for taking it upon itself to create and pursue funding opportunities. 5) PRESENTATION OF THE YEAR-END 2001-02 REVENUE AND EXPENDITURE REPORT Gregg Sass, DPH Chief Finance Officer, presented the year-end 2001-2002 Revenue and Expenditure Report. This report presents the preliminary estimates of the year-end financial projection of revenues and expenditures for the Department of Public Health for fiscal year 2001-2002. Based on this data, the Department is projecting a year-end surplus of $48.6 million for FY 2001-02. This surplus represents 4.8% of the $1.013 billion adjusted budget of FY 2001-02. These projections are based on revenue collected and billed, and expenses incurred for the 12 months of the fiscal year ending June 30, 2002. Mr. Sass emphasized that the report still needs to be audited, and also that it includes approximately $12 million in requested carry-forwards that are still subject to approval by the Controller’s Office and the Mayor’s Office. Mr. Sass highlighted four important points from the report. First, the surplus represents a reduced general fund contribution to the Health Department, rather than a profit. Second, the surplus enabled the Health Department to help balance the city’s budget for FY 2001-02. The Department was required to contribute $30.4 million help balance the budget, and has met and exceeded that requirement. The third point is that the surplus is almost entirely a result of increased revenues, primarily at San Francisco General Hospital, Laguna Honda Hospital, Primary Care and Mental Health. This is significant because the Department was able to meet its budget reduction target and return funds to the general fund without significant service cuts. Finally, the surplus provided almost $20 million in general fund to carry over to the FY 2002-03 budget, which enables the Department to continue to maintain services levels. Mr. Sass presented two tables which show preliminary 4th quarter financial data by department. The second table is adjusted for SB 855 payments and revenues. While this adjustment does not change the final outcome it more accurately depicts San Francisco General Hospital’s actual revenues and expenditures. Mr. Sass said that some programs, particularly in Substance Abuse, Mental Health and Substance Abuse were significantly impacted by the hiring freeze. Mr. Sass highlighted some of the large revenue variances. Most of San Francisco General Hospital’s revenue variances are non-recurring, including cost report adjustments and additional SB 855 revenues. However the MediCal and FQHC payment rate increases will continue. The majority of the hospital’s variance in expenditures is due to increased patient volume and increase in the PBM program. Laguna Honda Hospital has a $12 million surplus, which is primarily related to increased reimbursement in distinct part skilled nursing care. Primary Care also benefited from the increase in the FQHC payment rates and there is an additional $2 million prior year settlements. The large negative variance in Jail Health is a result of the continuing under budgeting of salaries and benefits in the Jail Health budget. This was an expected loss. Commissioners’ Comments Commissioner Parker asked why there was a surplus in the Healthy Kids Project. Mr. Sass said that the Healthy Kids surplus is a result in delays in starting the new program. Commissioner Jackson asked if there would ever be a time when DPH would be able to keep its surplus revenue. Dr. Katz replied that it is conceivable, but reminded the Commission that there have been times when the Department has needed a supplemental appropriation. In addition, the Mayor’s office has already allowed the Department to keep $20 million of the surplus. Further, the Mayor’s Office has said they would use the additional surplus to offset any reductions that might occur this budget the year. Finally, the Department’s most pressing needs require on-going dollars, and the surplus is largely one-time funds. Commissioner Guy said that the Department has a relationship with the City that allows it to get general fund dollars to further the mission of the Health Department, which is somewhat unique to San Francisco. In addition, it is important that the budget be transparent and credible, and that the Department clearly shows what its budget needs are. The jails continue to be significantly underfunded, and this is one area where help would be appreciated. Commissioner Umekubo commended all the divisions for their great work. He specifically mentioned the success of San Francisco General Hospital and Laguna Honda Hospital for controlling their pharmacy costs. Commissioner Chow said that the City has been extremely supportive of the various initiatives the Department has undertaken, and this is very fortunate. The additional surplus gives the Department the opportunity to advocate that the approved positions be released as soon as possible. 6) PRESENTATION OF THE CHARITY CARE REPORT Colleen Johnson, Assistant Director, Policy and Planning, presented the Charity Care Report. In July 2001 the Board of Supervisors passed the Charity Care Policy Reporting and Notice Requirement ordinance. The ordinance passed in order to enable the City and County of San Francisco to evaluate the need for charity care in the community and to plan for the continued fulfillment of the City’s responsibility to provide care to indigents and the uninsured. At the time the ordinance was passed there were 156,000 uninsured residents, many who rely on charity care to access needed primary and acute care services. The ordinance’s definition of charity care is consistent with the definition of the California Office of Statewide Planning and Development. The ordinance also provided a specific definition of hospitals that qualify as reporting under the ordinance. The hospitals are St. Francis, St. Mary’s, St. Luke’s, California Pacific Medical Center and Chinese Hospital. San Francisco General Hospital (SFGH) is exempt, voluntarily reported its charity care. The Ordinance requires that hospitals report very specific information: Charity care charges Cost to charge ratio information Accepted and denied applications Zip codes of accepted and denied applicants Unduplicated patients Types of services received by charity care patients Copies of all charity care policies There are also notification requirements, which are verbal notification and posting of notices in English, Spanish and Chinese in the emergency department, billing office and waiting rooms. This is the first report under the ordinance. Hospitals were largely compliant. Where hospitals were unable to comply, they addressed these areas in their compliance plans. Ms. Johnson noted that Chinese Hospital participates in the Hill-Burton program, which is excluded from the City’s and State’s definition of charity care because of the link to low-cost financing. Because Chinese Hospital will provide charity care only under the Hill-Burton program until its Hill-Burton debt is repaid, most of the items required by the ordinance are not relevant to Chinese Hospital at this time. 142,738 applications for charity care were accepted by the five reporting hospitals in 2001. 89 percent of these applications were accepted at SFGH. St. Luke’s and St. Mary’s each accounted for 5% of charity care applications. Between 113 and 123 applications were denied. Hospitals were required to report charity care patients by zip code. (St. Luke’s Hospital, who served 6,722 charity care patients, was unable to provide this data.) While charity care usage was concentrated in certain supervisorial districts, specifically Districts 6, 9 and 10, residents of all supervisorial districts received charity care. 83,285 charity care cases were provided by the reporting hospitals. 81 percent of these cases were served by San Francisco General Hospital. St. Mary’s and St. Luke’s each constitute 8.1 percent of charity care cases. Of all charity care provided, 45% were outpatient services, 38% were inpatient services and 17% emergency services. In each service area, SFGH provided the majority of charity care services. Hospitals reported their charity care charges and their cost to charge ratios, which are the percentage of charges that are actual costs. Using this ratio provides a more accurate comparison. Cost to Charge Ratio Hospital Cost to Charge Ratio St. Francis 28.36% St. Mary’s 29.77% St. Luke’s 38.6 % CPMC 28 % Chinese 56.7 % SFGH 74 % Hospital’s charity care expenditures ranged from approximately $900,000 at St. Francis to approximately $56 million at SFGH. All hospitals provided copies of charity care policies. These policies varied in detail and scope. All had an application and internal tracking and handling policies. None but SFGH had an appeals process. Necessary documentation and eligibility criteria varied. All hospitals provided copies of posted notices. Only SFGH provided posted notices in Spanish and Chinese in addition to English. Chinese Hospital provided notices in Chinese. (They requested and were granted an exemption from the Spanish language posting because their records indicate that no persons of Latino or Hispanic descent accessed services at the hospital.) With regard to compliance plans, St. Francis and St. Mary’s said that partial data on missing information could be provided by FY 2003. St. Luke’s missing information can be provided by December 2002. CPMC has said they will not be able to comply with the requirement to report medical facilities to which patients are referred. Ms. Johnson presented the data from a number of different perspectives to attempt to assess the data provided. Per Patient Expenditures - In FY 01 reporting hospitals spend between $265 and $2,362 per patient served. St. Mary’s had the lowest per patient cost and provided most of its care on an outpatient basis. CPMC had the highest per patient cost and serves most of its charity cases in the emergency room. Hospital Beds v. Charity Care Services Provided - the five reporting hospitals have 3,214 licensed beds between them. When comparing the percentage of all licensed beds to the percentage of charity care provided, SFGH provided a disproportionate amount of charity care services. Charity Care Expenditures v. Hospital Expenditures - The percentage of charity care compared to total operating expenses ranged from 0.3% (CMPC) to 15.9% (SFGH). Private non-profit hospitals incur a number of benefits from their non-profit status, including private donations, low-cost financing and exemption from federal, state and local taxes. The report compared the value of the charity care provided with the value of the tax-exempt status. Tax exemptions v. charity care expenditures Together, all six reporting hospitals provided $35 million in charity care in excess of the benefits from tax exemption Excluding SFGH, the five non-public reporting hospitals received tax benefits of $21.2 million beyond what they provided in charity care Two of the five non-public reporting hospitals provided charity care in excess of tax benefits Looking forward SB 1394 (Ortiz) - would have expanded charity care reporting and policy requirements; pre-empted local charity care ordinances. This bill died in the 2002 legislative session but may be addressed again in 2003. State Charity Care Guideline Changes - expands charity care reporting and policy requirements. Public comment closes 9/20/02. Interest from Nassau County New York The fiscal year 2002 charity care reports begin to be due in November. Ms. Johnson said that having more than one year’s data would allow staff to make recommendations on potential policy changes. Dr. Katz said that it is wonderful that so many hospitals not only complied but also are providing charity care. The report demonstrates that there is a wide range of charity care being provided by community hospitals. He does not undervalue the other work that hospitals do-teaching, providing under-reimbursed services, etc. This effort came out of a discussion about what San Francisco really needs, and that is more charity care. There are some hospitals that need to be encouraged to provide more charity care. Public Comment Ron Smith, Executive Director of the Hospital Council, said many of his member hospitals did not receive the report until today, so he hopes that the Health Commission will allow comment on this report at a future meeting. There is no legal connection between the city’s definition of charity care and income tax regulation. The tax law says that the promotion of health constitutes a charitable purpose. 80% of the health of San Franciscans is provided by community hospitals. Hospitals look at promoting the health of the community from a broader perspective than DPH defines charity care. Commissioners’ Comments Commissioner Guy appreciates that so many hospitals have complied with the ordinance. Now that DPH has actual data that can be reviewed further through the joint conference committees as a basis for developing further recommendations. Given that San Francisco General Hospital and Chinese Hospital voluntarily reported their charity care, she urges Kaiser and UCSF to voluntarily provide reports so that DPH can have a more complete community assessment. She understands and acknowledges that this is not the only way hospitals are part of the community. Commissioner Umekubo concurred with Commissioner Guy. UC and Kaiser provide charity care, so it would be helpful to have the complete picture. Commissioner Parker stated that DPH is the safety net for the City and rightly so provides the bulk of charity care for San Franciscans. The report is not to show that DPH is competing with community hospitals or to embarrass other hospitals, but rather to provide a framework for the City to ensure and maintain the safety net. Commissioner Jackson hopes that in the future there will be more consistent eligibility requirements for charity care. Commissioner Chow said that this has been a controversial issue, and for the first time DPH has had this data. The CHN Joint Conference Committee provides an opportunity for continued dialogue and input from the Hospital Council and other hospitals. Part of that discussion can include a discussion of the State changes. Now, the question is how DPH can enhance charity care. He also asked that a copy of the report be forwarded to the Board of Supervisors with the Commission’s recommendation that Kaiser and UC voluntarily submit reports, and asked the Department to ask Kaiser and UC to voluntarily report their charity care. 7) PRESENTATION ON DPH EMERGENCY, DISASTER AND TERRORISM PREPAREDNESS ACTIVITIES John Brown, M.D., Director, Emergency Medical Services, gave a power point presentation on DPH/EMSS Disaster Preparedness, specifically, improvements that have been made since the events of September 11, 2001. Organization EMS is in the process of reinforcing their disaster organization, which uses the Incident Command System/Standardized Emergency Management System. EMS has undertaken a rewrite of the DPH Disaster Plan, which is approximately 90% finished. It is designed to be a process, not a static document. Improved Communications ability. All EMS units have the ability to use the city’s 800 mHZ system. All hospitals have quadruple redundant communications systems. Tests are done on a weekly basis. DPH has developed a health advisory network, which is a way to communicate directly with San Francisco physicians during an emergency. Pager system for DPH command and control staff Disaster/MCI links with hospitals MCI Level 1 policy implemented Regular DPH and hospital communication checks Bioterrorism Working Group Implemented the Bio Threat Response Plan, completed 9/1 Tabletop exercises on Anthrax, Smallpox Epidemiology Response Team training Hospital Preventive Treatment Centers Emergency Response Map Training Components On-line resources available to all providers SFGH/UCSF Satellite courses with CDC DPH Employee Disaster Training Site-specific refreshers given by SFGH, Tom Waddell and other clinic staff Exercises conducted at SFGH, EOC and DOC Facilities New Department Operations Center (open house on September 10, 10 a.m. to 6:00 p.m.) Site Security Garage and two street access Room for all 4 ICS branches Helicopter Access Emergency Air Access policy & training Hunter’s Point Public Safety Helipad - 1st FAA approved site SFGH Pad feasibility study has begun Equipment and Supplies Weapons of Mass Destruction Incidents - EMS has pharmaceutical caches, disaster caches, hospital provider preparation, and 55 EMS ambulances prepared. Materials examples: chemical exposure, radiation injury, biological threats, and conventional explosions Direction for the Future Completion of the DPH Disaster Plan rewrite Improvement of Air Medical Access Replenishment of Pharmaceutical Caches Exercising with National Pharmaceutical Stockpile Trauma System full implementation Exercise involving all EMS system components Ongoing training improvements Staffing for bioterrorism and disaster registry programs Improvement in DPH to Community MD communications (HAN) link Sentinel Event Program (SEEPS) Additional Multi-Casualty Incident Capacity Commissioners’ Comments The main city center is on Turk Street and is the coordination center for the Mayor and his staff and the incident command team for the city. Each department has its own command center, and each department would have a different role to play. Some department staff would go to the EOC, and some to the DOC. Commissioner Parker asked if there is any division between natural disaster training and the terrorism preparedness training. Dr. Brown said EMS is attempting to develop systems that would be effective to respond to any type of disaster. They have been participating with State and Federal agencies on training specific to bioterrorism preparedness. Commissioner Parker asked what the appropriate level of NERT participants is. Dr. Brown, currently have 5,000. The goal is to have 65,000 to 70,000 participants. Commissioner Chow asked if the exercises take into account simultaneous disasters that require the Fire Department to be in multiple locations. Dr. Brown said there was a drill on this specific type of incident, and seemed to work well for them. The drill is focusing on the reserve capacity integrated into the response, and how to expand and incorporate volunteers. Commissioner Umekubo asked Dr. Brown to elaborate on plans to improve communications with community physicians. Dr. Brown said that communication now is via fax and e-mail. Because physicians may not constantly check e-mail EMS wants to move toward other electronic messenger modes, such as pagers. Commissioner Guy asked if the kits are on both private and public ambulances. Dr. Brown said yes, all permitted ambulances are required to have MCI kits. Commissioner Guy asked if 9/11 changed EMS’s priorities and readiness, and is this the direction DPH needs to go. Dr. Brown said that there is danger in skewing preparedness in one particular way, but thus far EMS has been able to enhance overall capabilities to respond to many types of incidents. Commissioner Jackson asked if appropriate pharmaceuticals and other resources would be available in an emergency. Dr. Brown said it depends on the situation. For example if there was a building collapse, could serve a smaller number of people. If it was more preventive, for example small pox, they could serve a larger number. 8) RESOLUTION APPROVING THE LAGUNA HONDA HOSPITAL REPLACEMENT PROJECT ENVIRONMENTAL IMPACT REPORT Larry Funk, LHH Executive Administrator, presented the proposed resolution approving the Laguna Honda Hospital Replacement Project Environmental Impact Report. John Malamut from the City Attorney’s office explained the action item before the Health Commission. The project has had significant review by oversight bodies including the Planning Commission and Board of Supervisors. However, none of these entities has the ability to approve the entire project, only pieces of the project. The Health Commission has the authority to approve and adopt the Laguna Honda Hospital Replacement Project. Before doing so, the California Environmental Quality Act (CEQA) requires that the Commission consider findings, adopts a Mitigation, Monitoring and Reporting Program and find that nothing has significantly changed since the time the Planning Commission approved the FEIR. In adopting the proposed resolution, the Commission does all three things. Commissioner Chow amended the resolution to clarify language. The second point of the second resolved clause will now read “(2) approval of Alternative Three will not require important revisions to the FEIR as there are no new significant environmental effects or substantial increase in the severity of previously identified significant effects;” Action Taken: The Commission (Chow, Guy, Jackson, Parker, Umekubo) adopted Resolution # 10-02 titled “Adopting Findings Pursuant to the California Environmental Quality Act and Approving the Laguna Honda Hospital Replacement Project,” with the amendments noted above. 9) PUBLIC COMMENTS Thomas Lister, HIV positive individual, said that he was infected with HIV by someone who denied that he was HIV positive. He filed a civil suit against this individual who was a former Health Commissioner, Ron Hill. A $5 million judgement was awarded. The District Attorney’s Office has not gone after Mr. Hill. He asked the Health Commission to contact the District Attorney’s Office on his behalf because this is a health issue. 10) CLOSED SESSION A) Public comments on all matters pertaining to the closed session None. B) Vote on whether to hold a closed session (San Francisco Administrative Code Section 67.11) Action Taken: The Commission (Chow, Guy, Jackson, Parker, Umekubo) voted to hold a closed session. The Commission went into closed session at 5:30 p.m. Present were Commissioner Chow, Commissioner Guy, Commissioner Jackson, Commissioner Umekubo, Dr. Katz and Michele Olson. C) Closed session pursuant to Government Code Section 54956.9 and San Francisco Administrative Code Section 67.10(d) Conference with Legal Counsel - Existing Litigation Proposed settlement of an employee grievance for $93,938.15, Gabriel Castillo Grievance, ERD No. 83-02-0790. Action Taken: The Commission (Chow, Guy, Jackson, Parker, Umekubo) approved the employee grievance for $93,938.15. D) Reconvene in Open Session The Commission reconvened in open session at 5:59 a.m. Possible report on action taken in closed session (Government Code Section 54957.1(a)2 and San Francisco Administrative Code Section 67.12(b)(2).) Vote to elect whether to disclose any or all discussions held in closed session (San Francisco Administrative Code Section 67.12(a).) Action Taken: The Commission (Chow, Guy, Jackson, Parker, Umekubo) voted not to disclose any discussions held in closed session. 11) ADJOURNMENT The meeting was adjourned at 6:00 p.m. Michele M. Olson, Executive Secretary to the Health Commission