Minutes of the Health Commission Meeting Tuesday, October 21, 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 3:22 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 David J. Sanchez, Ph.D. Commissioner John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE MEETING OF OCTOBER 7, 2003 Action Taken: The Commission approved the minutes of the September 16, 2003 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE The Budget Committee Consent Calendar was considered by the full Health Commission. Commissioner Monfredini chaired the meeting for this item. (3.1) CBHS-Mental Health - Request for approval of a retroactive contract modification with Community Vocational Enterprises, Inc., in the amount of $313,506 per year for a total contract value of $6,774,535, to provide janitorial vocational services for the period of July 1, 2003 through June 30, 2007. Commissioners’ Comments Commissioner Monfredini emphasized the need to have accurate information about units of service in the Budget Committee report. (3.2) CBHS-Mental Health/Substance Abuse - Request for approval of a retroactive contract renewal with New Leaf: Services for our Community, in the amount of $1,482,443, to provide outpatient substance abuse and mental health services targeting lesbian, gay bisexual and transgender communities, for the period of July 1, 2003 through June 30, 2004. Commissioners’ Comments Commissioner Penn requested that, in future contract summaries, the key elements of any Corrective Action Plans are clearly identified in the contract summary. (3.3) AIDS Office-HIV Research - Request for approval to accept retroactively and expend a grant from Public Health Foundation Enterprises, Inc., in the amount of $441,992, for a safety trial of Tenofovir as pre-exposure prophylaxis among high-risk men who have sex with men, for the period of October 1, 2003 to September 30, 2007. (3.4) PHP-Occupational and Environmental Health - Request for approval to accept retroactively and expend a grant from the Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, in the amount of $212,584, for the support of the first year of a four-year project to improve working conditions for day laborers in the Mission District in San Francisco, for the period of September 30, 2003 to September 29, 2004. Action Taken: The Commission approved the Budget Committee Consent Calendar. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Syphilis Community Plan The STD Program has released a Community Plan to stop the spread of syphilis. Twenty-four individuals from agencies and organizations throughout the City worked for six months to produce the first strategic, coordinated plan in the nation to combat syphilis among gay and bisexual men. A copy of the plan is attached and it may also be accessed on the Internet at http://www.dph.sf.ca.us/Reports/StopSyphCommPlanExecSum.pdf . Community Behavioral Health Services Staff Honored Barbara Garcia, Director of Community Programs, will be a featured speaker at the Blue Cross State Sponsored Programs Annual Community Appreciation Awards on October 23rd. Recognition awards and mini-grants well be presented to recognize and thank community partners for their work on behalf of low-income families. A Recognition Award well be given to Diedra Epps-Miller, MA, Director, Southeast Health Center for her work with asthma and health care advocacy within the African American community. Posthumous awards will be given to Dr. Patricia Evans and Dr. Evelyn Lee for their community activism and advocacy. A mini-grant will be given to Silver Avenue Family Health Center to support their Centering Pregnancy Program, which provides incentives for early prenatal care. 5th Annual Latino Behavioral Health Conference Community Programs will be hosting the 5th Annual Latino Behavioral Health Conference on October 24th. This year’s conference is entitled “Healing our Community-Building Bridges” and features panel discussions on spirituality, mentorship, the judicial system, and high-risk youth resiliency. Direct Access to Housing David Lazarus of the San Francisco Chronicle recently ran a series of articles in the Business Section on the issue of homelessness. The articles highlighted the cost-effectiveness of housing and, in particular, cited the Department’s Direct Access to Housing (DAH) Program as one of the solutions to homelessness that is within reach. As detailed in my last report to the Commission, DAH has also been recognized as a model program by the President’s Interagency Council on Homelessness, which recently awarded DAH $3.5 million to increase the number of supportive housing units in San Francisco. Commissioners’ Comments Commissioner Penn asked how the Syphilis Community Plan is being publicized beyond the website. Dr. Katz will get this information for him. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF OCTOBER Commissioner Parker presented the Employee Recognition Awards for the month of October. Individual Awardees Name Title Nominated by Julie Russell, R.Ph Pharmacy QI/Medication Use and Safety Officer SFGH PIPS Committee Sam Ammons, LPT Psych. Tech., Mission Mental Health Deborah Hughes 6) CONSIDERATION OF A RESOLUTION SUPPORTING THE REBUILD OF SAN FRANCISCO GENERAL HOSPITAL Gene O’Connell, Hospital Administrator, SFGH, presented an update on the SFGH Rebuild. During the October 7th discussion, the Health Commission raised issues and asked questions about the master planning process. The presentation addressed these issues. Co-location with UCSF - At the conclusion of the co-location consultation, UCSF did not wish to continue discussions. The new dean of the UCSF Medical School has expressed interest in revising the discussions and DPH is open to further exchange. Community Outreach - An MOU has been written to codify the communications plan, and the hospital will conduct monthly open neighborhood meetings for project updates. Alternative sources of funding - Staff is exploring the feasibility of obtaining funding from other sources such as parking revenue bonds, Certificates of Participation, Federal and State grants and a Statewide bond for hospital rebuilds. Parking Issues - As an alternative to new parking structures at Potrero, staff is investigating the option of developing satellite parking sits with shuttle service. At Mission Bay, there is adequate area to develop sufficient parking. Mission Bay’s water table - The planning concept for Mission Bay South has anticipated building foundations and utilities in high water table areas. There are additional costs associated with this condition. Proximity to Pac Bell Park - Increased traffic congestion is expected during major events that may affect circulation to the proposed hospital, and the EIR would consider such an impact. Muni Third Street Light Rail - In the first phase, the Third Street Light Rail will be extended to Visitation Valley and will have multiple stops along the Mission Bay area. This phase should be completed by 2005. The second phase will improve access for residents of Chinatown and North Beach to Mission Bay. Ms. O’Connell said that based on the October 7th public testimony, staff reconsidered the rebuild strategy. They are no longer considering taking people’s homes, and have identified preliminary means by which project costs can be reduced. The scope of both projects have been changed. Carlos Villalva, SFGHMC Architect, continued the presentation with the review of the concept alternatives. He described five approaches to reducing cost and complexity: Reductions in the total number of beds Substitution of program components with less expensive alternatives Deferral of selected program components for a later date Elimination of non-critical components Reconsideration of earlier proposals. Mr. Villalva discussed the retrofit concept, which is being revived as an option. Senate Bill 1953 stipulates that retrofitting acute care facilities to a life safety standard, SPC-2, by 2008 is an option to meet the mandate. Retrofitting the hospital was estimated to cost almost $300 million. Construction would take approximately eight years and have a significant impact on day-to-day hospital operations. In addition, we would still be required to build a new acute care facility to the highest standard, SPC-5, by 2030, which means that one of the two concepts under consideration would eventually need to be implemented. In closing, Ms. O’Connell asked the Health Commission to consider a resolution supporting the following points: Assures that the SFGH Medical Center meets the seismic safety standards of SB 1953 by 2013, so that it will not close by 2008; Seek alternative funding sources to supplement a general obligation bond; Reconvene discussions with UCSF regarding co-location opportunities for both hospitals; Improve outreach strategies to continually inform the community on the rebuild planning process, and to receive public input. Public Comment Dr. Talmadge King, Chief of Medical Services at SFGH, said the only option for a viable hospital is Mission Bay. His department must keep a strong connection with the Mission Bay campus. Dr. Morrie Schambelan, Chief of Endocrinology at SFGH, said the only real option that would appeal to the faculty and help recruitment and retention of new faculty is to move the hospital to Mission Bay. Sue Carlisle, M.D., Interim Associate Dean at SFGH, said the best way to maintain quality staff and serve the community is to have the highest quality medical center. Patching the current facility is not the way to go. Rebuilding on the Potrero site would also destroy the ability to serve the patients, and to recruit physicians to serve these patients. She urged the Commission to rebuild on Potrero. Valerie Ng, Chief of the Medical Staff at SFGH, said she has received a number of calls from medical staff who are concerned with the scaled back proposal for Mission Bay. She reiterated the medical staff’s position to rebuild a world-class facility at Mission Bay. This is where the synergies and possibilities exist. Lucy Johns said great progress has been made since the last Health Commission meeting. She still has concerns about the number of beds that are being proposed. She requested that the Commission consider amending the resolution to include steering committee input on the future bed needs. Christopher Sabre noted that a number of concerned citizens are in attendance at the meeting. The community has not seen the resolution or have time to review the report. Commissioners’ Comments Commissioner Parker asked if San Francisco would need to build a new hospital by 2030, even if we retrofitted the current hospital to meet the SB 1953 mandate. Mr. Villalva said that by 2030 all hospital must meet the SPC5 requirement, so retrofitting the building to SPC2 is only good until 2030. Commissioner Umekubo commended the administration for trying to get the costs down. However he is still concerned about the high cost. What is the feasibility of state grants, parking revenue bonds, and the other potential funding sources that have been identified? Dr. Katz said that the only way State funds would be available is if the overall economy improves. Many other hospitals are facing similar requirements and deadlines, so the most likely method of State aid is that the State would do a statewide bond that public and community hospitals could tap into to meet this mandate. Because we have already maintained a subsidized rate for our patients and staff at our garages, it is unlikely that parking revenues would be large enough. Staff made a major effort to make both the Potrero and Mission Bay options more doable. But they have not had much time and they can do better on both scenarios. The underlying priority is to have a public hospital. They will continue to do more work and continue to meet with the community to develop two more feasible options. Commissioner Umekubo asked what is feasible for a general obligation bonds. Dr. Katz said $500 million to $600 million. Commissioner Sanchez said having a new Dean of Medicine at UCSF give us renewed opportunities for cooperation. Over the past few months, DPH and other city departments have received federal funding for bioterrorism. SFGH is a critical part of the city’s bioterrorism response, so there might be an opportunity to get new Federal funds if we think creatively and cooperatively. Ms. O’Connell said that NAPH is surveying its hospitals about their ability to get funding for infrastructure, so this issue might appear on the national radar screen. Commissioner Chow asked if the steering committee would be involved in the next phase. Dr. Katz said that the steering committee and advisory groups would continue to be part of the planning process. Commissioner Penn asked how likely it is that the City would get the land, and if there have there been discussions with Catellus. Ms. O’Connell said they have not had discussions with Catellus. It is vacant and it is for sale. Commissioner Penn emphasized that research space has to be a priority. What is the incentive for UCSF to pay for research space? Ms. O’Connell said that UC has not made any commitment to building new research space. Commissioner Penn would also like future planning efforts to include operational issues. Commissioner Penn applauded staff for its website and for its plan to hold monthly community meetings. Commissioner Monfredini said she wholeheartedly supports SFGH. She has not yet seen a proposal that is financially feasible, and as much as she hates the alternative, with 2008 rapidly approaching, we might have to retrofit rather than rebuild. She does not know if the electorate would approve a bond any higher than $300 million. Commissioner Guy said the Commission and staff know what the dream is, and the challenge is making this a reality. This resolution helps the Department pursue its vision, but also keeps the effort grounded in reality. She added that the operation of the new facility would cost more money. Commissioner Parker said there will have to be a new hospital by 2030. From a practical point of view, if it is expensive now, it will be even more costly as we approach the deadline. Commissioner Chow reiterated that the resolution does not endorse either concept, nor does it support retrofit. More work needs to be done. When the Laguna Honda Hospital rebuild was being planned, the political limit for bonds was $300 million. Circumstances have not changed. Action Taken: The Health Commission unanimously approved Resolution 17-03, “Supporting that San Francisco General Hospital Medical Center meets Senate Bill 1953 Safety Standards by 2013, Encouraging Efforts to Identify Alternative Funding Sources, Supporting Further Discussions with UCSF on Co-Location and Encouraging Improved Community Outreach Strategies,” with one amendment to added a resolved clause that reads “FURTHER RESOLVED, that the San Francisco Health Commission wishes to continue discussions with the State Legislature on the timeline of SB 1953 in order to ensure that comprehensive planning can take place, including further discussions about co-location opportunities.” (Attachment A). 7) PUBLIC COMMENTS None. 8) 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 Health Commission voted to hold a closed session. The Commission went into closed session at 5:30 p.m. Present in closed session were Commissioner Chow, Commissioner Guy, Commissioner Monfredini, Commissioner Parker, Commissioner Penn, Commissioner Sanchez and Commissioner Umekubo, Norm Nickens, EEO, Martin Lum, EEO, Lisa Berkowitz, Deputy City Attorney, Mitch Katz, Director of Health and Michele Olson, Health Commission Executive Secretary. C) Closed session pursuant to Government Code Section 54956.9 and San Francisco Administrative Code Section 67.10(d) Approval of a settlement of $250,000 in Mamie Wei vs. Ray Contreras and CCSF et al, Northern District, Case # C02-5887, SF City Attorney’s Office File # 031122 D) Reconvene in Open Session The Commission reconvened in open session at 6:17 p.m. 1. 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).) Action Taken: The Health Commission approved the settlement of $250,000 in Mamie Wei vs. Ray Contreras and CCSF et al. 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 Health Commission voted not to disclose any or all discussions held in closed session. 9) CLOSED SESSION A) Public comments on all matters pertaining to the closed session None. B) Vote on whether to hold a closed session Action Taken: The Health Commission voted to hold a closed session. The Commission went into closed session at 6:30 p.m. Present in closed session were Commissioner Chow, Commissioner Guy, Commissioner Monfredini, Commissioner Parker, Commissioner Penn, Commissioner Sanchez and Commissioner Umekubo. C) Closed session pursuant to Government Code Section 54957 and San Francisco Administrative Code Section 67.10(b) PUBLIC EMPLOYEES PERFORMANCE EVALUATION: DIRECTOR OF HEALTH, DR. MITCH KATZ EXECUTIVE SECRETARY TO THE HEALTH COMMISSION, MICHELE M. OLSON D) Reconvene in Open Session The Commission reconvened in open session at 8:00 p.m. 1. 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 Health Commission voted not to disclose any or all discussions held in closed session. 10) ADJOURNMENT The meeting was adjourned at 8:00 p.m. Michele M. Olson, Executive Secretary to the Health Commission