Minutes of the Health Commission Meeting

Tuesday, December 17, 2002
At 3:00 p.m.
Carr Auditorium
22nd Street at Potrero Avenue
San Francisco, CA 94110

1) CALL TO ORDER

The meeting was called to order by President Chow at 3:25 p.m.

Present: 

  • Commissioner Edward A. Chow, M.D., President
  • Commissioner Roma P. Guy, M.S.W., Vice President
  • Commissioner Lee Ann Monfredini
  • Commissioner Harrison Parker, Sr., D.D.S. (arrived at 3:30 p.m.)
  • Commissioner Michael Penn, Ph.D.
  • Commissioner David J. Sanchez, Ph.D.
  • Commissioner John I. Umekubo, M.D.

2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF DECEMBER 3, 2002

Action Taken: The Commission approved the minutes of the December 3, 2002 Health Commission meeting.

3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE

Commissioner Monfredini chaired, and Commissioner Umekubo and Commissioner Penn attended, the Budget Committee meeting.

(3.1) CHN-SFGH - Request for approval of a Board of Supervisors resolution for a Proposition J contract for the provision of laundry processing services at San Francisco General Hospital, for the period of July 1, 2002 through June 30, 2004.

Public Comment

  • Ben Rubilcalva - He is opposed to contracting out the laundry at Laguna Honda Hospital and San Francisco General Hospital. The contracting firms do not pay a living wage.
  • John Kazinski, Local 250 - He is opposed to contracting out the laundry at both Laguna Honda Hospital and San Francisco General Hospital. The union wants the San Francisco General laundry jobs back, and they will take this battle further.

(3.2) CHN-SFGH & LHH Facilities - Request for approval of fourteen (14) contract modifications with the following firms to increase the combined contract amount by $900,000, from $7,987,796 to $8,887,796, to provide intermittent, as-needed facility maintenance services above baseline civil services staffing, and extend the current period, July 1, 2000 through December 31, 2002, by six months through June 30, 2003.

 

Acker & Guerrero Roof Co., Inc.

Floortrends Inc.

Adolph Schmidt General Contractors

McClure Electric, Inc.

Agbayani Construction, Inc.

Monticelli Painting & Decorating, Inc.

Anderson Carpet & Linoleum Sale Co., Inc.

Robert Poyas, Inc.

Angotti & Reilly, Inc.

Sabel Painting Co.

Ayoob & Peery Plumbing

Sierra Electric Co. and

Baca & Sons Painting

The Shooter Co.

Commissioners’ Comments

  • Commissioner Penn asked that, when the new contracts are brought before the Health Commission in six months, staff include information about what firms are minority-owned.

(3.3) CHN-Primary Care - Request for approval of a retroactive contract renewal with Mission Neighborhood Health Center, in the amount of $191,615, to provide Primary Care Services for medically indigent adults residing in the Mission District, for the period of July 1, 2002 through June 30, 2003. The contract is retroactive due to administrative delays present at the provider. There was no interim agreement or payment for services provided during this time.

(3.4) AIDS Office - Request for approval of a retroactive contract renewal with Mission Neighborhood Health Center, in the amount of $440,000 per year for two years, for a total contract value of $880,000, to provide early intervention medical care, case management and health education services targeting uninsured HIV-positive Latino immigrants at or below the poverty level, with a special focus on monolingual Spanish speakers, for the period of July 1, 2002 through June 30, 2004. This contract is retroactive due to the late passage of this year’s State budget. An interim agreement from July through October was provided to allow payment to the contractor until the renewal contract was completed.

(3.5) AIDS Office - Request for approval of a sole source contract renewal with Mission Neighborhood Health Center, in the amount of $70,440, to provide HIV treatment outreach, counseling, testing and referral services targeting HIV positive Latino/as living in and around the Mission District, for the period of January 1, 2003 through September 29, 2003.

Items 3.5, 3.6 and 3.8 were discussed together.

(3.6) AIDS Office - Request for approval of a sole source contract renewal with Dolores Street Community Center, in the amount of $65,850, to provide HIV peer advocacy and group intervention services targeting Latino residents of San Francisco’s housing programs and emergency shelters who are living with or at risk for HIV/AIDS, for the period of January 1, 2003 through September 29, 2003.

(3.7) AIDS Office - Request for approval of a retroactive sole source contract renewal with Institute for Community Health Outreach, in the amount of $150,000, to provide case management and peer advocacy services to HIV positive Native Americans and Alaska Natives, for the period of July 1, 2002 through June 30, 2003. This contract is retroactive due to the late award of General Funds from the Board of Supervisors following the budget process. There was no interim agreement or payment for services provided during this time.

(3.8) AIDS Office - Request for approval of a sole source contract renewal with the Regents of the University of California San Francisco-Positive Health Practice, in the amount of $158,556, to provide outreach, case management, nutritional and peer advocacy services for the Men of Color Program, for the period of January 1, 2003 through September 29, 2003.

Commissioners’ Comments

  • Commissioner Penn said that this program does very important work with African American men, and asked Dr. Malcolm John from UCSF-Positive Health Practice if he would report back to the Budget Committee the lessons they have learned in developing culturally specific models of care for HIV so that DPH can stay on top of this problem in the African American community.

Commissioner Sanchez abstained from voting on this item.

(3.9) AIDS Office - Request for approval of a retroactive contract renewal with CompassPoint Nonprofit Services, in the amount of $94,350, to provide organizational development and technical assistance services for prevention providers and the AIDS Office HIV Prevention Section, for the period of July 1, 2002 through December 31, 2002. The contract is retroactive due to funding negotiations with the grantor. There was no interim agreement or payment for services provided during this time.

(3.10) AIDS Office - Request for approval of a new contract with Harder + Company Community Research, in the amount of $90,000, to provide a systems capacity assessment in the Tenderloin and Bayview Hunters Point areas of San Francisco, for the period of December 1, 2002 through June 30, 2003.

Commissioners’ Comments

  • Commissioner Penn asked if Harder & Company has done previous work in Bayview Hunters Point. Steven Tierney said yes and added that when Harder & Company begins the assessment process it will meet with and hire people from the community to formulate the survey questions.

(3.11) AIDS Office - Request for approval of a new contract with the Regents of the University of California San Francisco-Stonewall Project, in the amount of $70,000, to provide HIV prevention services to methamphetamine-using gay men throughout San Francisco, for the period of December 1, 2002 through June 30, 2003.

Commissioner Sanchez abstained from voting on this item.

(3.12) AIDS Office - Request for approval of a resolution approving an extension of the terms of the calendar year 2002 Federal Centers for Disease Control and Prevention funded contracts on a month-to-month basis through March 31, 2003 or when the 2003 renewal contract is certified, for the following twenty organizations:

Ark of Refuge, Inc.

Instituto Familiar de la Raza

Asian Pacific Islander Wellness Center

Mission Neighborhood Health Center

Bay Area Young Positives

Mobilization Against AIDS International

Better World Advertising

New Directions 21st Century

CAL-PEP

Regents of the University of California

CompassPoint Nonprofit Services

Shanti Project

Glide Foundation

South of Market Health Center

Harder + Company Community Research

St. James Infirmary

Health Initiatives for Youth

Stop AIDS Project

Institute for Community Health Outreach

Walden House

(3.13)PHP-Community Health Epidemiology - Request for approval of a retroactive multi-year sole source contract modification with the Regents of the University of California Berkeley, in the amount of $158,664, effective September 1, 2002, to provide mathematical analysis for the Community Health Epidemiology Section, for a total contract amount of $465,163, for the period of May 1, 2000 through February 28, 2005.

Commissioner Sanchez abstained from voting on this item.

(3.14) PHP-Community Health Promotion - Request for approval of a retroactive sole source contract renewal with the Regents of the University of California (UCSF), in the amount of $180,000, to provide evaluation services to the SevenPrinciples Project, for the period of September 30, 2002 through September 29, 2003. This contract is retroactive due to an extended period of negotiation and document revisions for contract development. UCSF routinely declines the option of an Interim Agreement and is, therefore, currently not receiving payment for these services.

Commissioner Sanchez abstained from voting on this item.

(3.15) PHP-Housing and Urban Health - Request for approval of a sole source contract modification with Lutheran Social Services, in the amount of $114,165, to provide additional transitional housing and supportive services at De Paul House and MIA House targeting women and their children who are in substance abuse recovery and are survivors of domestic violence, for the period of July 1, 2002 through June 30, 2003, for a total contract amount of $247,131.

(3.16) PHP-Maternal Child Health - Request for approval of a sole source renewal contract with Support for Families of Children with Disabilities, in the amount of $101,087, to develop program materials and to provide a designated Family Liaison to assist in the development of services for California Children’s Services, for the term of July 1, 2002 through June 30, 2003. This contract is retroactive due to the need for the contractor to revise contract documents after finalization of the Department’s FY 2002-03 budget. The contractor has continued to provide services and will receive payment upon Health Commission approval of this contract and certification by the Controller.

(3.17) PHP-Mental Health - Request for approval of six new retroactive contracts for the period of December 1, 2002 through June 30, 2004, with six contractors (listed below) awarded pursuant to Request for Proposal (RFP) #16-2002, for shelters to provide preventive, early intervention and other mental health services to homeless young children (birth to five years old) and their families, who are residing in shelter programs in San Francisco. The total amount of the contracts for FY 2002-03, from December 1, 2002 through June 30, 2003 is $210,000, and the total amount of the contracts for FY 2003-04 is $360,000, for a total amount of $570,000. The contracts are retroactive to December 1, 2002 due to delays in negotiating rates for units of service and the need for contractors to revise budget documents.

 

Contractor

Service

Total Award

Asian Women’s Shelter

Mental Health Services in Shelters

$95,000

La Casa de las Madres

Mental Health Services in Shelters

$63,333

Catholic Charities

Mental Health Services in Shelters

$134,583

St. Vincent De Paul Society / The Riley Center

Mental Health Services in Shelters

$79,168

Compass Community Services

Mental Health Services in Shelters

$63,333

Hamilton Family Center

Mental Health Services in Shelters

$134,583

(3.18) PHP-Mental Health - Request for approval of a retroactive contract renewal with Richmond Area Multi-Services, Inc., in the amount of $1,496,704 per year, to provide mental health services targeting children and youth, for the period of July 1, 2002 through June 30, 2004, for a total contract value of $2,993,408. This contract is retroactive due to the need for the contractor to revise contract documents to incorporate COLAs and other allocation changes after finalization of the Department's FY 2002-03 budget. The contractor has continued to provide services and receive payment under a six-month interim agreement approved by the Health Commission on April 16, 2002.

(3.19) PHP-Mental Health - Request for approval of a retroactive contract renewal with Richmond Area Multi-Services, Inc., in the amount of $2,487,741 per year, to provide mental health services targeting adults, for the period of July 1, 2002 through June 30, 2004, for a total contract value of $4,975,482. This contract is retroactive due to the need for the contractor to revise contract documents to incorporate COLAs and other allocation changes after finalization of the Department's FY 2002-03 budget. The contractor has continued to provide services and receive payment under a six-month interim agreement approved by the Health Commission on April 16, 2002.

(3.20) PHP-Mental Health - Request for approval of a retroactive contract renewal with Instituto Familiar de la Raza, Inc., to provide mental health services to children, youth, families and adults residing in San Francisco, in the amount of $4,541,337, for the term July 1, 2002 through June 30, 2003. This contract is retroactive due to the need for the contractor to revise contract documents to incorporate a COLA after finalization of the Department's FY 2002-03 budget. The contractor has continued to provide services and receives payment under a six-month interim agreement approved by the Health Commission on April 16, 2002.

Commissioners’ Comments

  • Commissioner Monfredini asked about the small number of board members. Estella Garcia, IFR Program Director, said that the agency is in the second year of a Compass Point assisted planning process, part of which is Board expansion.

(3.21) PHP-Mental Health - Request for approval of a retroactive sole source contract renewal with San Francisco League of Urban Gardeners (SLUG), acting as fiscal agent for Southeast Neighborhood Jobs Initiative Roundtable (SNJIR), in the amount of $50,500, to provide outreach services targeting African-American residents of the Bayview Hunters Point, Potrero Hill and Visitacion Valley neighborhoods, for the period of July 1, 2002 through June 30, 2003. This contract is retroactive due to the need for the contractor to revise contract documents to incorporate a Cost of Living Adjustment (COLA) after finalization of the Department’s FY 2002-03 budgets. The contractor has continued to provide services and receive payment under a six-month interim agreement approved by the Health Commission April 16, 2002.

(3.22) PHP-Mental Health - Request for approval of a retroactive contract renewal with the San Francisco Study Center, in the amount of $1,187,774 per year, to provide mental health and fiscal intermediary services, for a total contract value of $2,375,548, for the period of July 1, 2002 through June 30, 2004. This contract is retroactive due to the need for the contractor to revise contract documents to incorporate allocation changes after finalization of the Department’s FY 2002-03 budget. The contractor has continued to provide services and receive payment under a six-month interim agreement approved by the Health Commission on April 16, 2002.

(3.23) PHP-Mental Health - Request for approval of a retroactive contract renewal with Westside Community Mental Health Center, Inc., in the amount of $5,480,582, to provide mental health crisis, outpatient, residential care facilities coordination, school-based day treatment, special education partnership and fiscal intermediary services targeting adults and youth/adolescents, for the period of July 1, 2002 through June 30, 2003. This contract is retroactive due to the need for the contractor to revise contract documents to incorporate allocation changes after finalization of the Department’s FY 2002-03 budget. The contractor has continued to provide services and receive payment under a six-month interim agreement approved by the Health Commission on April 16, 2002.

Commissioners’ Comments

  • The Commissioners requested a report to the Community Health Network Joint Conference Committee at the end of the fiscal year to see if the agency is meeting its units of service.

(3.24) PHP-Substance Abuse - Request for approval of a retroactive contract renewal with Asian American Recovery Services, in the amount of $6,520,807, to provide substance abuse services targeting men and women of predominantly Asian/Pacific Islander descent, as well as fiscal intermediary services, for the period of July 1, 2002 through June 30, 2003. This contract is retroactive due to the need for the contractor to revise contract documents to incorporate the COLA after finalization of the Department’s FY 02-03 budgets. The contractor has continued to provide services and receive payment under a six-month interim agreement approved by the Health Commission April 16, 2002.

(3.25) PHP-Substance Abuse - Request for approval of a retroactive contract renewal with Bayview Hunters Point Foundation for Community Improvement, Inc., in the amount of $7,948,186, to provide substance abuse and mental health services targeting adults and children, for the period of July 1, 2002 through June 30, 2003. This contract renewal is retroactive due to delayed completion of contract negotiations and the contractor’s subsequent revision of the applicable program budgets. The contractor has continued to provide services and receive payment under a six-month interim agreement approved by the Health Commission April 16, 2002.

Commissioners’ Comments

  • Commissioner Monfredini recommended approval of the contract through June 2003. However, she has many concerns about the contract performance. The monitoring report in the Commission’s packet indicated a number of areas of concerns. Although the monitoring report was for 2000-2001, and many steps have been taken to address the areas that needed improvement, the Commission does not have the most up to date information on the agency’s performance. Therefore Commissioner Monfredini requested a meeting with Barbara Garcia, Director of Community Programs, Karen Patterson Matthew, Executive Director of Bayview Hunters Point Foundation, the Foundation’s Board President and the other Budget Committee members to discuss the present performance report and any remaining areas of concerns. This meeting is to take place before January 31, 2003.

(3.26) PHP-Substance Abuse - Request for approval of a retroactive contract renewal with Chemical Awareness and Treatment Services, Inc. (dba Community Awareness and Treatment Services, Inc.), in the amount of $3,268,384, to provide residential, transportation, drop-in and overnight intervention substance abuse services, for the period of July 1, 2002 through June 30, 2003. This contract is retroactive due to the need for the contractor to revise contract documents to incorporate the COLA after finalization of the Department’s FY 2002-03 budgets. The contractor has continued to provide services and receive payment under a six-month interim agreement approved by the Health Commission April 16, 2002.

(3.27) PHP-Substance Abuse - Request for approval of a retroactive contract renewal with Friendship House Association of American Indians, Inc. of San Francisco, in the amount of $272,472 per year for four years for a total contract value of $1,089,888, to provide residential substance abuse treatment and fiscal agent services targeting homeless American Indian adults in San Francisco, for the period of July 1, 2002 through June 30, 2005. This contract is retroactive due to the need for the contractor to revise contract documents to incorporate Cost of Living Adjustments (COLAs) and other allocation changes after finalization of the Departments FY 2002-03 budget. The contractor has continued to provide services and to receive payment under a six-month interim agreement approved by the Health Commission on April 16, 2002.

(3.28) PHP-Substance Abuse - Request for approval of a retroactive contract renewal with Haight Ashbury Free Clinics, Inc., in the amount of $5,358,980, to provide substance abuse services for residential, outpatient, day treatment, prevention and outreach programs, for the period of July 1, 2002 through June 30, 2003. This contract is retroactive due to the need for the contractor to revise contract documents to incorporate COLAs and other allocation changes after finalization of the Department’s FY 2002-03 budget. The contractor has continued to provide services and receive payment under a six-month interim agreement approved by the Health Commission on April 16, 2002.

Commissioners’ Comments

  • Commissioner Umekubo requested an update to the Community Health Network Joint Conference Committee in February on those programs that required a Plan of Correction.

(3.29) PHP-Substance Abuse - Request for approval of a retroactive contract renewal with Horizons Unlimited of San Francisco, Inc., in the amount of $1,229,158, to provide day treatment, outpatient and prevention services targeting Latino youth, for the period of July 1, 2002 through June 30, 2003. This contract is retroactive due to the need for the contractor to revise contract documents to incorporate Cost of Living Adjustments and other allocation changes after finalization of the Department’s FY 02-03 budget. The contractor has continued to provide services and receive payment under a six-month interim agreement approved by the Health Commission on April 16, 2002.

(3.30) PHP-Substance Abuse - Request for approval of a retroactive contract renewal with Positive Direction Equals Change, in the amount of $290,912, to provide outpatient, outreach and case management substance abuse treatment services with a family focus to African-Americans in the Bayview/Hunters Point neighborhood, for the period of July 1, 2002 through June 30, 2003. This contract is retroactive due to the need for the contractor to revise contract documents to incorporate Cost of Living Adjustments (COLAs) and other allocation changes after finalization of the Department's FY 2002-03 budget. The contractor has continued to provide services and receive payment under a six-month interim agreement approved by the Health Commission on April 16, 2002.

(3.31) PHP-Substance Abuse - Request for approval of a retroactive contract renewal with YMCA Urban Services, in the amount of $1,406,568, to provide outpatient and prevention substance abuse services for youth, for a four-year period from July 1, 2002 through June 30, 2006. This contract is retroactive due to the need for the contractor to revise contract documents to incorporate the COLA after finalization of the Department's FY 2002-03 budgets. The contractor has continued to provide services and receive payment under a six-month interim agreement approved by the Health Commission April 16, 2002.

(3.32) PHP-Substance Abuse - Request for approval of a retroactive contract renewal with Youth Leadership Institute, in the amount of $242,667, to provide substance abuse services targeting teenagers and young adults, for the period of July 1, 2002 through June 30, 2003. This contract is retroactive due to the need for the contractor to revise contract documents to incorporate Cost of Living Adjustments (COLAs) and other allocation changes after finalization of the Department's FY 2002-03 budget. The contractor has continued to provide services and receive payment under a six-month interim agreement approved by the Health Commission on April 16, 2002.

Action Taken: The Commission approved the Consent Calendar or the Budget Committee. The following items were referred to joint conference committees for further discussion and follow-up reports: 3.11 to the Population Health and Prevention Joint Conference Committee (PHP JCC) in 90 days; 3.23 to the Community Health Network Joint Conference Committee (CHN JCC) at the end of the fiscal year; and 3.28 to the CHN JCC in February 2003. In addition, for Item 3.25 there will be a meeting prior to January 31, 2003 with Barbara Garcia, Director of Community Programs, Karen Patterson Matthew, Executive Director of Bayview Hunters Point Foundation, the Foundation’s Board President and the other Budget Committee members to discuss the most current performance report and any remaining areas of concerns.

4) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report.

Smallpox Vaccination

In order to educate Department staff on issues related to smallpox vaccination, the Community Health and Epidemiology Section held six brown bag sessions at different sites within the Department. The Department will be offering approximately 1,200 doses of smallpox vaccine in January 2003. The Community Health and Epidemiology Section is in the process of surveying 5,000 DPH health care workers to determine eligibility and willingness to be vaccinated. Because the vaccine contains a live virus that poses a risk to the individual being vaccinated, a rigorous informed consent process is being developed.

Mental Health Advanced Access

Community Mental Health Services is implementing the Advanced Access model for managing demand for services with the goal to improve timely access to assessment and treatment services. Trainings of outpatient mental health clinic leadership on advanced access are underway. Outpatient mental health clinics have submitted plans for testing a variety of strategies to improve access and the target date for full implementation is February 1, 2003.

Prevention Framework

The Community Programs Prevention Workgroup held its first meeting to establish a five-year Department-wide Prevention Plan. This group, along with the help from Prevention and Community Epidemiology Sections staff, will do the preliminary work including research, review of data, identifying determinants for specific health issues and best practices. The group will meet biweekly for the next seven months.

Behavioral Health Planning Update

A plan is being developed to integrate the administrative, clinical and fiscal functions of Community Mental Health Services and Community Substance Abuse Services into a comprehensive behavioral health delivery system by July 1, 2005. The goal of the integration is to improve the clinical outcomes, maximize resources and increase client, provider and employee satisfaction. Community focus groups and the work of 11 committees will inform the plan. The 12 focus groups are composed of providers, consumers, advocates, criminal justice representatives, advisory board members, allied agencies, and family/care-takers of consumers. The committees are mainly composed of Department staff but also include some of the external stakeholders mentioned above.

SFGHMC Holiday Party and Toy Drive

The San Francisco General Hospital Medical Center (SFGHMC) Management Forum held its annual Holiday Party and Toy Drive on December 10th. This year's response was impressive. Over 50 managers from all areas of the Medical Center contributed hundreds of new toys to the SFGHMC Volunteers. The toys will be distributed to needy children who are in the hospital and health centers during the holidays.

Commissioners’ Comments

  • Commissioner Umekubo asked what risk of adverse outcome is presented by the smallpox vaccination. Dr. Katz replied that the risk of death is one to two per million and the risk of serious but recoverable affects is 15 to 20 per million. With regard to short-term adverse affects, most people will be sufficiently ill to be unable to work for a week or so.
  • Commissioner Chow asked who would accept liability for DPH employees who suffer an adverse outcome from the vaccination. Dr. Katz replied that these illnesses would be covered under the City’s Workers’ Compensation Program.
  • Commissioner Penn asked how the Department arrived at the decision to offer 1,200 doses of the smallpox vaccine. Dr. Katz said that prior to the survey of DPH workers, each city was asked to request a number of doses. In Phase I, it is likely that 30-50 vaccinations would be administered. The goal is to vaccinate enough DPH workers to be able to evaluate sick patients and perform vaccinations.
  • Commissioner Parker asked if there would ever be a situation that would lead to mandatory vaccination. Dr. Katz responded that in general the government cannot mandate vaccination, even if there has been an outbreak of smallpox, unless the Health Officer determines that an individual is at risk of infecting others.
  • Commissioner Guy stated that smallpox vaccinations were discontinued because of the assessment by health experts that the risks of vaccination were higher than the risks of non-vaccination. This has not changed. What has changed is the political perception. There is no new evidence. She appreciates that health providers are attempting to bring rationality to this process.
  • Commissioner Sanchez said it is important to keep focused on our responsibilities as a Health Department and Health Commission, and look to evidence and research to guide our decisions.

5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF DECEMBER

Individual Awardees

Division

Nominated by

Barbara Kawaguchi

SFGH - Administration

Mozattia Henley, DNS
Alban Gaw, M.D.
Ernestina Carrillo, LCSW
Alex Anagnos, RN, MS
Cherice Brown, RN, MS
John Butts, RN, and
Terry Ellis, LCSW

Mary Magee, RN

SFGH - Birthing Center

Phil Numoto, Director,
Env. Health and Safety

Thelma Viray

SFGH - Skilled Nursing Facility

Susan Currin, Chief Nursing Officer

  

Medical Social Services Team

Division

Nominated by

Tahnee Gantt, LCSW
Margaret Amaral, LCSW

SFGH - Medical Social Services and Trauma

Joseph J. Headlee, Social Work Supervisor Recovery Center

6) PRESENTATION OF THE SAN FRANCISCO GENERAL HOSPITAL MEDICAL CENTER ANNUAL REPORT

Gene Marie O’Connell, Executive Administrator, Sue Currin, RN, Chief Nursing Officer, and Renee Navarro, M.D., Chief of Staff, presented the 2001-2002 San Francisco General Hospital Medical Center Annual Report.

Ms. O’Connell described the demographics of the patients served by SFGH in 2001-2002. They served 92,879 patients, 47 percent female and 53 percent male. Nine percent of the patients were homeless. Ms. O’Connell described the utilization trends from 1993-94 in primary care services, outpatient medical/surgery specialty services and emergency and urgent care services. The percentage of time the Emergency Department is on diversion has been increasing and was 32 percent in 2001-2002.

SFGH’s budget is $403 million. Patient revenue accounts for $190 million and General Fund accounts for $77 million (19 percent). The majority of the funds are used for Med/Surg Inpatient.

Dr. Navarro and Ms. Currin highlighted how the hospital is meeting the DPH Strategic Goals.

Goal 1: San Franciscans have access to health services they need, while Department emphasizes services to its target population

Strategy 1: Ensure that the Community Health Network continues its vital role in the delivery of health care.

  • Improve Trauma Services - developed a Traumatic Brain Injury Program and prepared for ACS verification site visit in 2003
  • Emergency and Disaster Response - completed the Hazard Vulnerability Analysis and participated in the annual Health and Medical Disaster Exercises
  • Pharmacy Services - implemented a Pharmacy Benefits Management System
  • Case Management - continued the ED Case Management Program and established the Medical High Utilizer Care Management Program.

Strategy 2: Improve Integration of physical and behavioral health services for target, vulnerable and at-risk population who needs multiple services

  • Integration of medical, mental health and substance abuse services - continued the ISIS Clinic and created a Medical Behavioral Unit.
  • Mental Health Rehabilitation Facility - expanded vocational services program and developed a Dual Diagnoses Program.
  • Substance Abuse Services - extended length of stay for OTOP, opened the Ozanam Center Medically Assisted Detoxification Program and initiated three new client specialty groups for STOP
  • Clinical Institute Withdrawal Assessment for Alcohol

Goal 2: Disease and injury are prevented

Strategy 1: Strengthen prevention activities of the Department

  • Disease Prevention Programs - planning for the new Avon Foundation Comprehensive Breast Center, working toward a Baby Friendly certification, responded to the results of the PEP-C Survey
  • Patient Safety Programs - established the Performance Improvement and Patient Safety Program, upgraded automated dispensing machines, established a Clinical Pharmacy Management Program
  • Injury and Violence Prevention Programs - transferring IP to the Sheriff’s Department, formed campus-wide Security Management and Response team and developed a zero tolerance policy, and strengthened the Infant Security Task Force

Goal 3: Services, programs and facilities are cost efficient and resources are maximized

Strategy 1: Continue to adapt a financial strategy that enhances revenue and reduces expenditures to ensure that the overall public health system operates cost-effectively

  • Improvements in Patient Flow - extended services at the Discharge Lounge and increased budgeted SNF beds
  • Utilization Review - decreased decertified days and established Bed Utilization Committee
  • Mental Health Patient Flow Pilot

Strategy 2: Make Overall Improvements in Financing and Operations

  • Efforts to maximize revenue - evaluated Nuclear Medicine Department, hired a new contractor to conduct eligibility outreach, established a task force to reorganize the charge capture process and increased pricing based on benchmarking study. Also investigating 340B drug pricing program.

Strategy 3: Address the Infrastructure Needs on the SFGH Campus

  • Improving infrastructure at SFGH - developed Long Range Service Delivery Plan and enhanced information systems technologies

Strategy 4: Improve Recruitment, Retention and Training of Staff

  • Established the Nursing Retention and Recruitment Committee, and have decreased turnover to 7 percent, compared to the nationwide rate of 16 percent
  • Employee Performance and Competency

Goal 4: Partnership with communities are created and sustained to assess, develop and advocate for health funding, programs and services.

Strategy 1: Develop Opportunities to Partner with Other Providers and the Community on Common Health Issues

  • Alternatives to Inpatient Care - reorganized Health at Home, continued the Bridge to Wellness Program.

Ms. Currin said that the JCAHO survey was held in 2002 and the hospital was awarded three-year accreditation. The hospital received a score of 97 on the Long-Term Care Survey, a score of 87 on the Hospital Survey and a perfect score for the Bridge to Wellness Program.

Ms. O’Connell presented the FY 2002-03 Strategic Goals:

  • Develop the Facility Master Plan for the Rebuild of SFGH
  • Complete Level 1 Trauma designation approval process from the American College of Surgeons
  • Complete the helipad feasibility study and plan for air medical access
  • Complete program development and open the Avon Foundation Comprehensive Breast Center
  • Maximize revenue through improved documentation and charge capture
  • Implement information systems that support organizational priorities and implement information systems projects
  • Implement changes to place mental health patients at the appropriate level of care within Psychiatric Emergency Services, Acute Psychiatry, MHRF and community treatment facilities
  • SFGH will continue to maintain compliance with JCAHO and State licensing standards
  • SFGH will work towards decreasing turnover of staff and vacancies

Public Comment

  • Dr. Michael Humphreys thanked the Health Commission and DPH staff for supporting the transfer of the renal center.

Commissioners’ Comments

  • Commissioner Monfredini applauded Ms. O’Connell and her team for the extraordinary report. She is proud to be part of the San Francisco General Hospital Joint Conference Committee.
  • Commissioner Umekubo said the hospital has made tremendous strides and progress over the past years and this is a reflection of the leadership of Ms. O’Connell, the staff and the medical staff. SFGH is not just a part of DPH-it is the backbone. The rebuild presents a lot of opportunity to be more efficient both with infrastructure and with programs. The Commission wants a state-of-the-art hospital.
  • Commissioner Sanchez said that SFGH is an astounding institution. There have been major cuts and instead of throwing in the towel, staff has continued to accomplish new things. In addition, the institution has great respect for the community it serves.
  • Commissioner Penn did his Ph.D. work on the SFGH campus and always felt a culture of service and compassion there.
  • Commissioner Parker is impressed with the many projects and advancements that have been made since he has been on the Commission, such as the soft tissue program and the discharge lounge. These advancements tell the community that SFGH cares and is here to serve, and is looking for better ways to do the job, regardless of the challenges.
  • Commissioner Guy appreciates the depth and breadth of services at SFGH. This motivates the Commission to do a higher level of work. The community needs SFGH. Partnership with UC is important but there have been challenges. The Health Commission supports next year’s goals.
  • With regard to the Avon Grant, it is critical that the hospital provide adequate space for group support meetings, which are a critical part of breast cancer recovery and longevity. Ms. O’Connell said that group work has been incorporated into the grant and is very much part of the treatment and recovery model.
  • Commissioner Chow stated that he has been through four SFGH JCAHO commission surveys and the performance evaluations have always been a struggle. He cannot recall another institution that has received a 98% rating and commended staff for this major accomplishment. In the near future the hospital and department will face challenges from forces outside of DPH control. It will take creativity and sacrifice to deal with these challenges. Ms. O’Connell has done a great job connecting to other parts of the system-Laguna Honda, Mental Health Services, etc. This is the best public health system in the world, which could not be possible with out the fine work of the administration, hospital staff and medical staff.

7) SAN FRANCISCO GENERAL HOSPITAL MEDICALCENTER POLICIES AND PRODEDURES: INPATIENT UTILIZATION REVIEW PROGRAM; HOSPITAL PLAN FOR PROVISION OF PATIENT CARE; PERFORMANCE IMPROVEMENT AND PATIENT SAFETY PROGRAM (PIPS); ENVIRONMENT OF CARE SAFETY COMMITTEE; AND EMPLOYEE PERFORMANCE AND COMPETENCY REPORT

Commissioners’ Comments

  • In reference to the Environment of Care Report, Commissioner Chow asked if there is adequate water supply for the campus in the event of an emergency. Mr. Kanaley replied that there are three water supplies from around the region as well as a back-up system on campus. However they wanted to augment the current resources.

Action Taken: The Commission approved the San Francisco General Hospital Medical Center Policies and Procedures: Inpatient Utilization Review Program; Hospital Plan for Provision of Patient Care; Performance Improvement and Patient Safety Program (PIPS); Environment of Care Safety Committee; and Employee Performance and Competency Report.

8) PUBLIC COMMENTS

9) ADJOURNMENT

The meeting was adjourned at 5:40 p.m.

Michele M. Olson, Executive Secretary to the Health Commission