Minutes of the Health Commission Meeting Tuesday, April 15, 2003 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 President Chow at 3:15 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. Commissioner Michael Penn, Ph.D. Commissioner John I. Umekubo, M.D. Absent: Commissioner David J. Sanchez, Ph.D. 2) APPROVAL OF THE MINUTES OF THE MEETING OF APRIL 8, 2003 Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Penn, Umekubo) approved the minutes of the April 8, 2003 Health Commission meeting, with three technical corrections. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Monfredini chaired, and Commissioner Penn and Commissioner Umekubo attended, the Budget Committee meeting. (3.1) DPH-Environmental Health Services - Resolution approving an ordinance amending the San Francisco Municipal Code Business and Tax Regulations Code by amending Sections 35, 120, 248, 249.1, 249.7, 249.12, 249.13 and 249.14, and the San Francisco Municipal Code Health Code, by amending Section 258 relating to fees for licenses or permits for inspections by the Department of Public Health. (3.2) PHP-AIDS Office - Request for approval of a retroactive multiyear contract renewal with CAL-PEP, in the amount of $335,444, to provide HIV prevention services targeting defined behavioral risk populations, for the period of January 1, 2003 through December 31, 2004. (3.3) PHP-AIDS Office - Request for approval of a retroactive multiyear contract renewal with Health Initiatives for Youth, in the amount of $83,983 per year, for a total two-year contract amount of $167,966, to provide Health and Youth Development Training prevention services targeting agencies providing services to defined behavioral risk youth populations, for the period of January 1, 2003 through December 31, 2004. (3.4) PHP-AIDS Office - Request for approval of a retroactive multiyear contract renewal with Shanti, in the amount of $605,340, to provide HIV prevention services targeting defined behavioral risk populations, for the period of January 1, 2003 through December 31, 2004. Commissioners’ Comments Commissioner Penn requested a six-month follow-up report to the Population Health and Prevention Joint Conference Committee, specifically on outreach activities and bringing different ethnicities into the program. (3.5) PHP-AIDS Office - Request for approval of a retroactive contract renewal with Bay Area Young Positives, in the amount of $111,334, to provide outreach and linkage prevention services targeting defined behavioral risk youth populations, for the period of January 1, 2003 through December 31, 2003. (3.6) PHP-AIDS Office - Request for approval of a retroactive contract renewal with Stop AIDS Project, in the amount of $320,086, to provide Prevention for HIV Positive Persons services through the Positive Force program targeting defined behavioral risk populations, for the period of January 1, 2003 through December 31, 2003. Commissioners’ Comments Commissioner Penn requested a six-month follow-up report to the Population Health and Prevention Joint Conference Committee. (3.7) PHP-AIDS Office - Request for approval of a retroactive contract renewal with Walden House, in the amount of $137,629, to provide HIV prevention services to behavioral risk populations, for the period of January 1, 2003 through December 31, 2003. Barbara Garcia, Deputy Director of Health, updated the Budget Committee on the agency’s status and the activities that have been undertaken with the agency’s management and the Attorney General’s Office. They have been working diligently with Walden House around their financial status, including their refinancing with Cal Mortgage, which is planned for April, the hiring of a CFO, which happened recently, and monthly financial statements to the DPH CFO. DPH has begun strong coordination with the Attorney Generals Office in looking for certain future developments by the agency, including: reorganization and recruitment of new board members; a financial audit of the organization; and arrangements for interim executive leadership. DPH staff will be attending a meeting with the agency and the Attorney General’s Office. In summary, the Department is working diligently with Walden House and the Attorney General’s Office to address all the outstanding issues. Commissioners’ Comments Commissioner Monfredini is still extremely concerned about the viability of the agency, and will continue to be until the issues are resolved. She asked if Mr. Welch had resigned from the Board of Directors. Debbie Lowis, Walden House Administrative Director, replied that this issue was a subject of today’s board meeting. Compass Point is also at the Board meeting. Commissioner Monfredini said that DPH staff would continue to monitor agency closely and she hopes the agency is getting its financial house in order, and that all inappropriate expenditures have ceased. She confirmed that they had hired a CFO, and Ms. Lowis said yes, with today as his first day on the job. Commissioner Monfredini asked DPH staff to keep the Commission updated. Ms. Lowis said the agency is dedicated to moving forward. Commissioner Penn asked for a status report on the bond financing. Ms. Lowis replied that a meeting is scheduled on Monday, April 21 with Cal Mortgage. There is certain reluctance at Cal Mortgage because of the State budget issue and one of the agenda items on the April 21st agenda is to discuss whether Walden House’s refinancing can be considered on the June approval docket. (3.8) PHP-AIDS Office - Request for approval of a retroactive contract renewal with UCSF-Stonewall Project, in the amount of $105,110, to provide HIV prevention services targeting defined behavioral risk populations, for the period of January 1, 2003 through December 31, 2003. (3.9) PHP-AIDS Office - Request for approval of a retroactive contract renewal with Better World Advertising, in the amount of $370,000, to provide HIV prevention services to behavioral risk populations, for the period of January 1, 2003 through December 31, 2003. (3.10) PHP-STD Prevention and Control - Request for approval of a retroactive contract renewal with Internet Sexuality Information Services, Inc., in the amount of $93,900, to provide syphilis elimination services targeting defined behavioral risk populations, for the period of January 1, 2003 through December 31, 2003. (3.11) PHP-Emergency Medical Services - Request for approval to accept retroactively and expend a grant from the California State EMS Authority, in the amount of $587,034, for the support of Trauma Care services at San Francisco General Hospital, for the period of July 1, 2002 to June 30, 2003. (3.12) BHS-Substance Abuse - Request for approval of a contract renewal with Center for Human Development, in the amount of $153,265 per year, for a total contract amount of $613,061, to provide substance abuse prevention and education services to youth in San Francisco schools, for the period of July 1, 2003 through June 30, 2007. Gregg Sass, DPH Chief Financial Officer, highlighted to the Committee that the next number of contracts reflects a new feature, which is a contingency budget. The contingency is not currently funded, but is available in the event the Board of Supervisors approves additional funding for COLAs, addbacks or service augmentation. This new process is being implemented on a pilot basis. (3.13) BHS-Substance Abuse - Request for approval of a contract renewal with National Council on Alcoholism, in the amount of $238,745 per year, for a total contract value of $954,979, to provide a 24-hour telephone referral help line and the Youth Aware Life Skills substance abuse prevention program, for the period of July 1, 2003 through June 30, 2007. (3.14) BHS-Substance Abuse - Request for approval of a contract renewal with Friendship House Association of American Indians, Inc., in the amount of $305,169 per year, for a total contract value of $1,220,675, to provide residential substance abuse treatment services targeting adult American Indians and homeless individuals, for the period of July 1, 2003 through June 30, 2007. (3.15) BHS-Substance Abuse - Request for approval of a contract renewal with Homeless Prenatal Program, in the amount of $183,007 per year, for a total contract amount of $732,028 to provide outreach and case management services targeting poor and homeless pregnant women and/or mothers who abuse substances, for the period of July 1, 2203 through June 30, 2007. (3.16) BHS-Substance Abuse - Request for approval of a contract renewal with Morrisania West, Inc., in the amount of $579,718, for the provision of day treatment substance abuse services targeting African American youth and young adults, for the period of July 1, 2003 through June 30, 2004. (3.17) BHS-Substance Abuse/Mental Health - Request for approval of a contract renewal with Chemical Awareness and Treatment Services, Inc., dba Community Awareness and Treatment Services, in the amount of $3,183,888, to provide substance abuse and mental health services targeting adult men and women, for the period of July 1, 2003 through June 30, 2004. (3.18) BHS-Mental Health - Request for approval of a contract renewal with Recreation Center for the Handicapped, in the amount of $97,391 per year, for a total contract amount of $389,563, to provide behavioral day treatment services for dually diagnosed, mentally ill and developmentally challenged clients, for the period of July 1, 2003 through June 30, 2007. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Penn, Umekubo) approved the Consent Calendar of the Budget Committee. For Item 3.4 and Item 3.6, the Commission requested six-month follow-up report to the Population Health and Prevention Joint Conference Committee. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Little Hoover Commission Report Last Thursday, the Little Hoover Commission released a report on California’s public health system.   The report cites California's public health system for control of infectious disease and possible bioterrorism as the weakest link in the State's homeland defense.   The Commission asserts, among other things, that California’s public health system is decentralized with public health functions occurring across many state departments, that attention that should be spent on public health preparedness is instead being diverted to maintaining programs for the uninsured, and that the system lacks leadership, communication and coordination.   The Commission makes several recommendations to improve the public health system.   Among them are to create a public health department – separate from Medi-Cal and other public insurance programs – that would include the State Department of Health Service’s current public health programs, all of the Emergency Medical Services Authority’s functions, and the Office of Statewide Health Planning and Development; establish the position of California Surgeon General to lead the public health department; establish a public health board to advise the California Surgeon General on public health issues; and have the State take the lead on coordinating federal, state and local efforts, as well as those of strategic partners, to improve communications, capacities and preparedness. Contrary to the findings in the report, I do believe that local health departments like ours are better prepared now than we were two years ago, due in large part to the infusion of federal bioterrorism preparedness funds, which are not only helping us prepare for a response to bioterrorism, but also helping us build infrastructure capacity to respond to any disease outbreak.   While there is always going to be more work that needs to be done, our bioterrorism planning and preparedness efforts will continue to result in the ability to better respond to a variety of public health challenges.   The full report can be viewed online at http://www.lhc.ca.gov/lhcdir/report170.html . AB 2034 Homeless Outreach Program Update The AB2034/MOST Program at the South of Market Mental Health Clinic was funded by the State in late 2000 to serve 120 homeless individuals who are severely mentally disabled and who have not successfully linked in the past to community-based mental health services.   Many of the enrolled clients have histories of frequent hospitalizations and/or incarcerations.   The program provides intensive clinical and wrap around services and is based on the recovery philosophy. Currently there are 121 clients enrolled in the program.   Outcome data indicate that enrollment has led to a 46% reduction rate for hospitalization days, a 72% reduction rate for incarceration days, and a 79% reduction rate for homeless days. New Larkin Street Drop-in Center opens Larkin Street opened its new 7,500 square foot drop-in center at 1138 Sutter Street this month.   The new center is expected to serve approximately 200 more youth annually than the old location due to its larger size and upgraded facilities. The Mayor’s Office of Community Development and the Community Program’s Division of the Department of Public Health gave a combined total of $400,000 towards the development of the new center. The Drop-in center is the gateway to Larkin Street’s 17 other housing and job training programs.   Title 9 State Regulations DPH representatives from CSAS, SFGH and CBHS have worked closely with state and federal officials to revise methadone treatment regulations.   Revisions for California’s Title IX regulations are currently being drafted by the state; these revisions are expected to dramatically improve patient enrollment and retention in methadone treatment programs.   In addition, the state recently approved several additional beneficial changes including: SB 1807 Office Based Opiate Treatment, 180-Day detoxification exemption, and 30-Day Take Home Dose exemptions. Drug and Alcohol Screening Project to Begin In 2000, San Francisco was selected by the Join Together Organization out of the Boston University School of Public Health to become one of 15 Demand Treatment! Cities.   This project will provide brief screenings for drug and alcohol use and provide interventions or referrals for treatment, as necessary, in four public health centers (Silver Avenue, Ocean Park, SEHC, and Family Health Center at San Francisco General Hospital).   A one-page self-administered screening tool was developed and translated into five languages (Spanish, Russian, Chinese, Korean, and Cambodian). There will be half-day trainings for each of the clinics conducted by the California Society for Addiction Medicine (CSAM) to orient staff about the nature of substance abuse, interpreting the results of the screening; conducting brief interventions, and making referrals.   This program is expected to be implemented into the intake process of each clinic this month. COMMUNITY HEALTH NETWORK SAN FRANCISCO GENERAL HOSPITAL CREDENTIALS REPORT (From 4/7/03 MEC and 4/8/03 JCC) 4/03 7/02 to 3/03 New Appointments 12 179      Reinstatements 1 Reappointments 46 256      Delinquencies 0 0      Reappointment Denials 0 0 Resigned/Retired 11 105 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Changes in Privileges      Additions 6 23      Voluntary Relinquishments 8 23      Proctorship Completed 14 137   Current Statistics – as of 4/1/03 Active Staff 421 Affiliate Professionals (non-physicians) 158 Courtesy Staff 494 Referring Staff 44 Total Members 1119   Applications In Process 37 Applications Withdrawn Month of Jan 2003 2 13(07/02 to 3/03) SFGH Reappointments in Process Apr. 2003 to Jul. 2003 118 Commissioners’ Comments Commissioner Umekubo asked if the Little Hoover Commission studied other States, in addition to California. Dr. Katz said the report was specific to California. Commissioner Chow asked for an update on SARS. Dr. Katz said there have been three suspected cases of SARS in San Francisco, two of which turned out to be other diseases. There is still one outstanding suspected case. Yesterday Dr. Fernyak, Director of Epidemiology and Disease Control, participated in a press conference held by Supervisor Ma to help dispel rumors and disseminate information. Commissioner Penn asked if the AB 2034 program would continue to be funded. Dr. Katz replied that the program is currently not on the list of cuts, and the Department is hoping to institutionalize this model as the way services are provided. Hopefully the State will continue to fund the program. Commissioner Guy asked if the Department is taking a position on the proposals recommended by the Little Hoover Commission, and if there are any State legislators who plan to carry legislation to implement these recommendations. Dr. Katz said that the State Department of Health Services is currently under a directive to reduce staff by 15 percent, which is contrary to what the report calls for. He will do some more research and provide additional information to the Health Commission. 5) PRESENTATION OF THE ANNUAL PREVENTION UPDATE - PREVENTION FRAMEWORK Ginger Smyly, Director, Community Health Promotion and Prevention, discussed the development of the Prevention Framework. At the initiation of the Population Health and Prevention Joint Conference Committee, Barbara Garcia convened a planning group to develop the prevention framework. Staff wanted to insure a cross representation of various health department sections and the group included Section Directors and representatives from the AIDS Office, Health and Safety and Community Programs. After the framework and guiding principles were developed, a prevention planning work group was formed in order to implement the framework and propose a Department-wide prevention plan. They are now mid-way through the planning process and have focused on the top health outcomes for San Franciscans, the determinants, causes and risk factors of those health outcomes. They will be able to report back on the outcomes of this current phase in the Fall. One difficulty is developing a strategic plan without knowing the outcome of the budget process. However, times like these provide an opportunity to demonstrate the importance of prevention programs. Commissioners’ Comments Commissioner Guy said that this effort is to redefine primary prevention and provide leadership and focus to prevention activities. There are issues of resources. If the Department is going to really implement this program, resources will be needed and evaluations will have to be performed to demonstrate concrete outcomes. This is a culture change that will impact all areas of the Department, and will take some time. Commissioner Parker thanked the Commission for its support of this effort to develop a prevention framework. The Overview of Health is the roadmap, as is Healthy People 2010. The Department is attempting to change the approach of diagnosis and treatment, where prevention is not emphasized, to one where prevention is on equal footing. He said if the framework includes secondary and tertiary prevention it should be clearly specified in the document. He added that goals should drive the framework, and be specified first. Ms. Smyly said that the planning group consciously decided to not put goals first. The roadmap will be much more Section by Section, rather than encompassing the entire Department. Commissioner Umekubo said prevention is such an important aspect of health and the emphasis, as a medical provider, is not on prevention but on episodic treatment of sickness. Prevention is also so challenging, and each strategy requires persistence and patience. The health community needs to keep prevention continuously on the radar screen. Hypertension is a good example of where prevention could be so much more effective. Ms. Smyly said that while the committee is focusing on social determinants, they are taking issues like heart disease and looking at how to address this problem from a primary, secondary and tertiary approach. Commissioner Penn encouraged the prevention committee to summarize what data and what best practices are available. In terms of seeking the elimination of health disparities, DPH investigators need to do the studies that will get answers. The current literature does not provide the answers. Commissioner Monfredini is concerned that the Department will not have the money to sustain this effort, and asked how DPH is going to fund this effort. Dr. Katz said that prevention is an area where creativity can impact numerous people without additional resources. He used the example of folic acid supplementation. He is hopeful that this plan will allow DPH to grow its prevention efforts when California is back in good economic times. There is also the opportunity to sponsor or advocate for legislation, for example related to smoking, infant car seats, etc., that require prevention activities. Commissioner Monfredini wants assurances that when economic times are better, prevention activities will be enhanced. Ms. Smyly said that they are identifying interventions that can be implemented with little money. In addition, they will be ready to pounce when there are additional funding opportunities. Commissioner Chow said it is to the Department’s credit that it articulated in the budget that prevention continues to be of primary importance. He suggested that the Department identify pilot programs that carry certain initiatives from beginning to end and, if possible, these pilot projects should be identified in the next progress report. 6) INFORMATION TECHNOLOGY UPDATE AND APPROVAL OF THE SIEMENS REMOTE COMPUTING OPTION CONTRACT AND SIEMENS PRODUCTS AND SERVICES CONTRACT Dave Counter, Director, Management Information Systems, presented the Information Technology Strategic Systems Plan Proposal. DPH maintains two sole source Master Agreements with Siemens for mission-critical Information Technology (IT) systems: the Remote Computing Options contract and the Products and Services contract. Both of these contracts expire on June 30, 2004. DPH IT Future Directions Integrate clinical and financial systems Enhance quality and access to clinical information Enhance revenue management Establish a unified clinical and fiscal systems solutions for SFGH, Laguna Honda, Jail Health Services, Primary Care and Behavioral Health Implement systems solutions for regulatory compliance (SB-1875, HIPAA) Enhance computing and network infrastructure capabilities DPH is proposing to establish new contracts with Siemens. This proposal meets the Department’s criteria because it addresses DPH IT priorities, delivers the latest and best technology, delivers a finance plan in accordance with operational base budget, meets the criteria of the Administrative Code and provides support services to augment DPH staff resources. Risk of failure is minimized by the stability and strength of the company, strict contract terms, conditions and warranties, and a three-year contract term and assessment. Mr. Counter discussed the elements of the Siemens technical proposal, contract proposal and fiscal proposal. Benefits of Siemens IT Strategic Proposal Utilizes Section 21.30 to establish multi-year, sole-source contract plan Cost-effective by fixing fees at current base budget levels, including new long-term care system Expenditure authority allows for additional enhancements pending future available funding Integration of clinical and fiscal functionality Enhances DPH clinical capabilities Maintains critical IT system operations while transitioning SFGH, LHH, Primary Care and Jail Health Services to a new standard set of applications Mr. Counter introduced Janet DeLeon, the Senior Vice President for Siemens Corporation who has responsibility for the United States, and Ron Castleberry, the Regional Vice President for Siemens Western Operations. He acknowledged Dr. Bob Brody, the Department’s IT Executive Oversight Committee, his Senior IT staff and Ron Alvarez. Commissioners’ Comments Commissioner Monfredini supports this proposal, as it will greatly enhance the Department’s operation. She thanked Ms. DeLeon and Siemens for coming to the meeting. Commissioner Chow indicated that Dr. Navarro, Chief of the Medical Staff at SFGH, called him to express her and the medical staff’s support for this proposal. He asked Dr. Brody to comment on the proposal. Dr. Brody said that the Department has had a long partnership with SMS and Siemens and have had a lot of success in building a system that has brought together the entire clinical system. This proposal is the logical next step. Commissioner Chow asked him if the staff is ready for this type of system. Dr. Brody said that some physicians may not be ready to submit notes using a computer, so they are working with Siemens to develop alternatives, such as voice recognition software. Commissioner Penn asked how the contract protects the Department’s ability to access state-of-the-art technology as it is developed. Mr. Counter said that the tailoring of the system to the DPH environment is part of the contract, as well as providing technical and professional support. Commissioner Penn asked who has implemented the Soarian system. Ms. DeLeon said that two health systems in Pennsylvania, Chester Hospital system in Virginia, and 22 other sites have some phase of the system, however, no system yet is fully live. Commissioner Penn is concerned that DPH have enough time in the three-year contract to fully evaluate if the technology works. Mr. Counter feels that 48 months provides enough time to evaluate-24 months to implement then at least one year to evaluate. Commissioner Penn asked when DPH might know if Behavioral Health will be implemented. Mr. Counter said Siemens will do a gap analysis of behavioral health needs to see what can be accomplished with Soarian technology. In addition, Denver Health has integrated behavioral health services into existing medical services, and DPH staff can use Denver staff as resources. Mr. Counter said he could have a report on this in July. Commissioner Guy asked Dr. Katz to comment on the contract. Dr. Katz said that several section heads have expressed support for this proposal because it will improve services and save time. This is a great deal for DPH. Commissioner Guy supports the proposal and has confidence in its benefits. She would like an update to the CHN and LHH Joint Conference Committees in the Fall to follow-up on issues such as behavioral health integration, clinician use of the system, etc. She asked Laguna Honda staff to comment on the possibility of “cultural lag” to accept this new technology. Dr. Terry Hill, Laguna Honda Hospital Medical Director, has convened a group of clinicians to be involved in the redesign of the technology. Physicians do understand the impact this will have on nursing. Mary Louise Fleming, Director of Nursing, said the nursing staff is excited about this project but is aware that it will take a lot of work. However, they do not have the time to continue to do things the way they are done now. The nursing staff is also excited to work with Siemens to pioneer a long-term care system. Larry Funk added that the Laguna Honda staff is excited about the opportunity this presents. This is an affordable and technological system that will allow LHH to fully integrate. Commissioner Umekubo asked if the Soarian technology could be customized. Ms. DeLeon said that it could be. Commissioner Umekubo emphasized that clinicians be involved in the development and implementation of the technology. Commissioner Chow asked if the perpetual license allows the Department to get application upgrades at no cost. Mr. Counter said that the on-going fees include all future upgrades. Commissioner Chow asked if waiting until 2007 to update the billing operations would mean that, until that time, that system would be less than state-of-the-art. Mr. Counter said that it is important to allow that function, which was just recently brought in house, to fully stabilize. However, the director of that unit is involved in the development of the system from the get go. Commissioner Chow asked if hardware is included in the budget. Mr. Counter replied that the Soarian system will run remotely so no cost is required for hardware. In terms of the desktop, the technology allows for cheaper desktop systems. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Penn, Umekubo) approved Resolution #8-03, titled “Approving Renewal of Two (2) Master Contract Agreements with Siemens Medical Solutions Health Services Corporation (Remote Computing Option and Products and Services),” (Attachment A). 7) APPROVAL OF THE SAN FRANCISCO GENERAL HOSPITAL MEDICAL STAFF BYLAWS AMENDMENTS Valerie Ng, M.D., Chief of Medical Staff Elect, SFGH, presented the proposed amendments to the San Francisco General Hospital Medical Staff Bylaws. The SFGH medical staff has approved the amendments. The majority of the revisions are cosmetic. A summary of the revisions is attached (Attachment B). Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Penn, Umekubo) approved the amendments to the San Francisco General Hospital Medical Staff Bylaws and Rules and Regulations. 8) APPROVAL OF A REVENUE SUPPLEMENTAL APPROPRIATION FOR EXCESS EXPENDITURES AT SAN FRANCISCO GENERAL HOSPITAL AND LAGUNA HONDA HOSPITAL Gregg Sass, DPH Chief Finance Officer, requested approval of a revenue supplemental appropriation of $14.2 million for expenditures that exceed budget at San Francisco General and Laguna Honda hospitals. Both hospitals are projecting revenues and expenses greater than budget for FY 02-03. The requested supplemental revenues and SFGH of $13.6 million are due to: $4.3 million more than budget for SB 1255 $2.1 million more than budget for Capitated Health Plan revenues $5.0 million in Medi-Cal prior year settlements $2.2 million in other outpatient revenue Requested supplemental revenues at Laguna Honda Hospital of $613,000 are due to surplus revenues in Skilled Nursing Facility Medi-Cal revenues. Mr. Sass said that the issues that created over expenditures in the current fiscal year will either not recur or have been addressed in the FY 03-04 budget through budget initiatives, contract changes, MOU increases and increases to specific accounts. The requested supplemental appropriation is fully funded from revenues and will not require additional General Fund. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Penn, Umekubo) approved the revenue supplemental appropriation for excess expenditures at San Francisco General Hospital and Laguna Honda Hospital. 9) PUBLIC COMMENTS None. 10) CLOSED SESSION: CONSTITUTIONAL PRIVACY RIGHTS/CONFIDENTIAL MEDICAL INFORMATION A) Public comments on all matters pertaining to the closed session None. B) Vote on whether to hold a closed session to protect individual privacy rights under the State and U.S. Constitution and to maintain confidentiality of protected information under State and Federal law. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Penn, Umekubo) voted to hold a closed session. The Commission went into closed session at 5:35 p.m. Present in closed session were Commissioners Chow, Guy, Monfredini, Parker, Penn and Umekubo; Raquel Smith, SFUSD; representing the appellant; Mark Bradshaw, SFUSD, representing the appellant; Mitch Katz, M.D., Director of Health and Michele Olson, Health Commission Executive Secretary. C) Closed session to protect individual privacy rights under the State and U.S. Constitution and to maintain confidentiality of protected information under State and Federal law. FOR ACTION: Consideration of an appeal by a City employee of a denial of the determination for catastrophic illness status pursuant to Section 16.9-29 of the San Francisco Administrative Code Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Penn, Umekubo) voted to uphold the decision of the Director of Health to deny the appeal. D) Reconvene in Open Session The Commission reconvened in open session at 5:54. Possible report on action taken in closed session (Government Code Section 54957.1(a)5 and San Francisco Administrative Code Section 67.12(b)(4).) 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, Monfredini, Parker, Penn, Umekubo) voted not to disclose any discussions held in closed session. 11) ADJOURNMENT The meeting was adjourned at 5:55 p.m. Michele M. Olson, Executive Secretary to the Health Commission