Minutes of the Health Commission Meeting Tuesday, July 20, 2004 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 Chow at 3:00 p.m. Present: Commissioner Edward A. Chow, M.D., President Commissioner Lee Ann Monfredini, Vice President Commissioner Roma P. Guy, M.S.W. Commissioner James M. Illig – left at 5:30 p.m. Commissioner Michael Penn, M.D., Ph.D. Commissioner David J. Sanchez, Ph.D. – left at 5:00 p.m. Commissioner John I. Umekubo, M.D. – arrived at 3:15 p.m. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF JULY 6, 2004 Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Penn, Sanchez) approved the minutes of the July 6, 2004 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Sanchez chaired, and Commissioner Guy and Commissioner Penn attended, the Budget Committee meeting. (3.1) SFGH-Health Information Systems – Request for approval of a retroactive renewal contract with Deliverex, Inc., in the amount of $660,000, for the purpose of storing, retrieving and delivering medical records for San Francisco General Hospital’s Health Information Services, Medical Staff Services and Radiology Departments, for the period of July 1, 2004 through June 30, 2005. (3.2) Laguna Honda Hospital-Nursing – Request for approval of a retroactive renewal contract with Nurse Providers, Inc., in the amount of $245,000, to provide supplemental, temporary per diem nursing personnel services for Laguna Honda Hospital, for the period of July 1, 2004 through June 30, 2005. (3.3) CHPP-Injury Prevention – Request for approval to accept and expend a grant from the California Office of Traffic Safety, in the amount of $319,706, for the support of a 27-month project to improve pedestrian safety in San Francisco, for the period of October 1, 2004 to December 31, 2006, and a contract with the San Francisco Study Center, in the total amount of $90,000, for the same time period. (3.4) AIDS OFFICE-HIV Health Services – Request for approval of a retroactive new contract with Patricia Sullivan, in the amount of $198,768, to provide consultant services for Quality Management: Standards of Care training, and Transgender Cultural Competency materials design to CARE-funded service providers, for the period of March 1, 2004 through February 29, 2005. (3.5) BHS-MH/SA – Request for approval of a retroactive contract renewal with New Leaf: Services For Our Community, in the amount of $1,485,434 per year, for a total contract value of $5,941,736, to provide outpatient substance abuse and mental health services targeting lesbian, gay, bisexual and transgender communities, for the period of July 1, 2004 through June 30, 2008. Secretary’s Note – this contract was continued to the August 3, 2004 Health Commission meeting. Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Penn, Sanchez) approved Items 3.1 through 3.4 of the Budget Committee Consent Calendar. Item 3.5 was continued to the August 3, 2004 Health Commission meeting. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Regulation of Massage Industry Beginning July 1st, DPH became responsible for permitting and regulating the massage industry in San Francisco. This was previously under the purview of the SF Police Department. The Environmental Health Division is now responsible for visiting sites and performing regular inspections to ensure that they meet all of the required health and safety codes. The STD Program is responsible for performing outreach, education and community capacity building within the industry and has hired staff with prior experience working with sex workers to implement the outreach program. It is anticipated that funding for the outreach position will come from the revenues collected from the permitting process. Update on EIR for Proposed SFGHMC Helipad Activities are continuing for the SFGH medical helipad Environmental Impact Report (EIR), which is being prepared by Turnstone Consulting under the direction of the city’s Planning Department. On July 14th, two types of medical helicopters made a number of approaches and departures over the SFGH Campus between 12 Noon and 1:00 pm. These flights were conducted as part of the noise study being conducted by Harris Miller Miller & Hanson, a noise and vibration control consulting firm. At 1:30 pm, SFGH sponsored a community event, which included a landing of one of the helicopters at Rolph Playground located on Potrero and Cesar Chavez. Other activities included tours of the medical helicopter and an SFFD ambulance and fire engine. SFGH provided written materials on injury prevention, 911 access and disaster preparedness and visits with Trauma Center staff. Laguna Honda Hospital Laguna Honda Hospital successfully passed a State Licensing & Certification skilled nursing resurvey conducted at the facility from July 13th to July -15th. During this resurvey, the hospital staff demonstrated substantial compliance with all applicable State and federal standards, and was able to limit possible denial of payment for admissions to a six-day period from July 9th to July 15th. The hospital administration is discussing proposed penalties with Licensing & Certification and the Centers for Medicare and Medicaid Services (CMS), and will file an appeal with CMS if necessary to avert application of any penalties. A full report will be presented to the Laguna Honda Joint Conference Committee on Thursday. Department of Health Annual Survey of SFGH SNF Beds One week after the opening of the Mental Health Rehabilitation Center in the San Francisco Behavioral Health Center (SFBHC) (formerly known as the MHRF), the State Department of Health Services arrived unannounced on Monday, July 12th, for their annual Licensing and Certification Survey of San Francisco General Hospital Medical Center's Skilled Nursing Facilities: SFBHC/SNF (2nd floor) and SFGHMC 4A/SNF. The survey lasted four days, concluding with an exit conference on July 15th. SFGHMC passed the survey without any 'Substandard of Care' deficiencies. The next step for the SFBHC is to obtain licenses for its other two components: the Residential Treatment Facility and the Adult Residential Facility. AVON Foundation Gift to SFGH for Mammovan At the closing ceremony of the AVON Walk for Breast Cancer on Sunday, July 11th, AVON’s President Kathleen Walas awarded five gifts totaling $1.7 million to Bay Area breast cancer organizations through its new “Supporting the Safety Net” initiative. As one of the recipients, San Francisco General Hospital Medical Center (SFGH) received $500,000. The money will be used to support the mobile mammography unit, which is being donated to SFGH by the UCSF Comprehensive Cancer Center; and to purchase women's ultrasound equipment for breast and ob-gyn services. Equipped with digital mammography equipment that is compatible with the units installed at the newly dedicated SFGH AVON Foundation Comprehensive Breast Center, the Mammovan is a moveable extension of the SFGH Breast Center. With the Mammovan, an additional 3,500 women will be screened per year. SevenPrinciples Cultural Competency Training for Providers On July 27th, Community Behavioral Health Services is sponsoring a training entitled “Reducing African American Infant Mortality in San Francisco.” This will be a hands-on training for physicians, nurse practitioners, certified registered nurse midwives, nurses and other health professionals serving African American women of reproductive age and their infants. The training will take place from 9am to 1pm at the UCSF Laurel Heights Campus. Please contact Dino Duazo at 415-581-2490 for additional information. DPH Program Recognized with 2004 Bay Area American Heart Association Leadership Award Cynthia Selmar, Director of the African American Health Initiative, and LeConte Dill, Health Educator at the Bayview Health and Environment Resource Center (HERC), received the 2004 Bay Area American Heart Association Leadership Award for their direction and guidance as Chair and co-Chair of the Bay Area African American Programs Task Force and in recognition of their leadership in the implementation of the San Francisco Search Your Heart Program. Congratulations to Cynthia and LeConte. COMMUNITY HEALTH NETWORK SAN FRANCISCO GENERAL HOSPITAL July 2004 Health Commission - Director of Health Report (From 07/12/04 MEC and 07/13/04 JCC)   07/04 7/04 to 06/05 New Appointments 21 21     Reinstatements 0 0 Reappointments 46 46     Delinquencies   0     Reappointment Denials   0 Resigned/Retired 29 29 Disciplinary Actions   0 Restriction/Limitation-Privileges 0 0 Changes in Privileges         Additions 7 7     Voluntary Relinquishments 6 6     Proctorship Completed 5 5 Current Statistics - as of 07/1/04   Active Staff 439 Affiliate Professionals (non-physicians) 181 Courtesy Staff 519 Total Members 1,139 Applications In Process 57   Applications Withdrawn Month of Jan 2003 2 2(07/04 /to 06/05 SFGH Reappointments in Process Def 2003 to Mar 2004 196   Commissioners’ Comments Commissioner Chow suggested that the Laguna Honda Hospital Credentials Report be forwarded to the Health Commission, as is done with the San Francisco General Hospital Credentials Report. Staff agreed to do this. Commissioner Guy supports the overall direction of the Health Department taking over the permitting of massage establishments, as it is important to separate the health aspects of massage from potential criminal activities. Commissioner Monfredini said a concern had been expressed that some establishments say they are massage parlors, but provide other services, and she asked if DPH inspectors would be put in awkward positions in terms of enforcement. Dr. Katz replied that if staff witnessed illegal activity, they should report it. Commissioner Illig asked if the Health Commission would receive a comprehensive report on the final budget at the August 3 meeting. Dr. Katz said he would provide a full report. Commissioner Guy thanked Ms. O’Connell for her leadership with the Avon grant. Commissioner Monfredini is so pleased that the Mammovan will be back under the auspices of SFGH. Commissioner Chow said that Avon has expressed happiness with its partnership with San Francisco. The community has truly embraced Avon, and this offers a wonderful opportunity. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF JULY Commissioner Monfredini presented the Employee Recognition Awards for the month of July. Team Awardees Division Nominated by Community Programs Budget Team Population, Health and Prevention - Community Programs Michelle Ruggels, Director of Operations, and Barbara Garcia, Director of Community Programs Richard Acken Florence Atangan Duane Einhorn Nicholas Hancock Victoria Lau Antonia C. Malgieri Kanwar Singh Maureen Singleton Philip Tse 6) HEALTHCARE ACCOUNTABILITY ORDINANCE UPDATE AND CONSIDERATION OF A RESOLUTION AMENDING THE MINIMUM STANDARDS AND SUPPORTING OTHER MODIFICATIONS TO THE HEALTHCARE ACCOUNTABILITY ORDINANCE Anne Kronenberg, Deputy Director of Health, and Frances Culp, Health Program Planner, presented the Healthcare Accountability Ordinance Update. DPH’s Office of Policy and Planning last reported to the Health Commission in November 2003. At that time the Health Commission deferred approval of the suggested modifications to the Minimum Standards and employer fee, requesting that stakeholders meet to discuss and agree on modifications. Staff convened a stakeholders group that included some of the original drafters of the legislation, with representatives from non-profit organizations, labor, Human Services Network, Health Authority and the Office of Contract Administration. The group came to consensus on the proposed recommendations. Minimum Standards Recommendation Co-payments for office visits. $15 per visit for a Closed Panel HMO and $20 per visit for all other HMO models. Other services must be offered with no set copay amount. Employee’s out-of-pocket maximum shall not exceed $2,500. Maintains the HMO plan, comprehensive set of benefits, no deductible, and employee pays no premium cost. Employer Fee Issues and Recommendation Fee increase from $1.50 per hour with a $60 monthly maximum to $2 per hour with an $80 monthly maximum. Raising the fee will allow premium costs to rise without making the average premium more expensive than the fee. Additional Changes to HCAO Postpone requirement to cover those working 15 to 19 hours per week. Expand definition of student interns. Exempt non-profit relief workers. Have the effective date be the first day following the first month after the employee is hired. Encourage City Departments to work pass-through into the budget. In addition, DPH has agreed to reexamine the issue of developing a local health coverage program. When this was last analyzed, DPH staff and the Commission agreed that such a program was not economically feasible. However, given the strong interest on the part of stakeholders, a subcommittee has been formed to revisit the issue. Donna Levitt from the Office of Labor Standards Enforcement, the unit that is responsible for enforcement of HCAO, said that she strongly supports DPH’s recommendations. Her office will be suggesting additional amendments, and will forward the entire package to the Board of Supervisors in August. Public Comment Debbie Lerman, Human Services Network, spoke in support of the recommendations. Their member agencies are committed to making the ordinance work. Kelly Wilkinson, Associate Director of Episcopal Community Services, supports the recommendation. Her organization is committed to having a healthy workforce, and the amendments will help. Richard Heasley, Executive Director of Conard House, said the ordinance is a work in progress and the recommendations clarify and streamline the ordinance. Dale Butler, SEIU 790, said labor supports the findings of the working group. However, there is a loophole that some employers are inappropriately using to not provide insurance to employees. He urged the Commission to ask Dr. Katz to take a close look at the loophole (12Q.2.13) and seek further amendments. Jean Fraser, San Francisco Health Plan, spoke in support of the recommendations and said everyone at the table was compassionate and committed to creating a proposal that encourages health insurance coverage. Commissioners’ Comments Commissioner Chow asked staff to clarify the best time to implement these changes. Would covered entities be required to change their insurance to meet the minimum standards to comply with the amended ordinance? Ms. Kronenberg said the effective date was set arbitrarily, with the goal of getting agencies to comply with the ordinance as quickly as possible. Commissioner Illig is pleased that such a broad range of people participated in these discussions. He clarified for the Commission that the only contracts that are covered under this ordinance are those that are funded through the General Fund. This is just the first step. His concern is that there are provisions in the law that go beyond what the City currently provides to its own employees. Commissioner Guy asked that the Office of Labor Standards Enforcement work with the DPH to review the ordinance with respect to the loophole raised by Mr. Butler, and recommend further amendments to rectify this issue. Action Taken: The Commission approved Resolution #10-04, “Amending the Minimum Standards and Supporting Other Modifications to the Healthcare Accountability Ordinance,” (Attachment A). 7) LIVING WITH DIGNITY POLICY COMMITTEE’S PRESENTATION OF THE “LIVING WITH DIGNITY IN SAN FRANCISCO” REPORT Sandy Mori, Living with Dignity Policy Committee member, introduced the Living With Dignity Policy Committee’s “Living with Dignity in San Francisco” Report. This is a strategic plan to improve community-based long-term care and supportive services for older adults and adults with disabilities. The plan is a significant milestone in that it provides clear direction for strengthening the service delivery system, focuses on lower-cost services, and will prevent the need for higher cost interventions. Bill Haskell and Nancy Giunta of the Department of Aging and Adult Services described the components of the plan. The target population is older adults and adults of all ages with disabilities who require some level of long-term support. Vision for the Improved Service Delivery System – No Wrong Door Improved access to services – when consumers enter the system, they will be directed to the appropriate services. A well-coordinated service delivery system – providers will no longer be separate; they will be part of a public-private partnership that will consist of a coordinated network of service providers. Increased Collaboration – community-based service providers will collaborate with Aging and Adult Services, Human Services, Public Health, Mayor’s Office of Housing, and the Mayor’s Office on Disability. Culturally appropriate services – historically underserved racial, ethnic and cultural communities will be targeted; neighborhood partnerships will improve awareness of and access to services. The plan includes five broad goals, 19 targeted strategies and 86 specific objectives. Each objective has a lead agency, shared responsibilities and due dates. The goals are: Goal 1: Establish Better Coordination of Services Goal 2: Increase Access to Services Goal 3: Improve Service Quality Goal 4: Secure Financial and Political Resources Goal 5: Expand System Capacity San Francisco received a Community Partnerships for Older Adults grant from the Robert Wood Johnson Foundation. This funding will help San Francisco accomplish the goals of the Living with Dignity Plan. Ms. Giunta described the four initiatives that will be funded through this grant. The initiatives are: strengthen and sustain neighborhood partnerships; improve case management collaboration; enhance recruitment, training and retention of homecare workers; and implement public relations and marketing strategies. Ms. Mori requested support from the Department of Public Health in specific areas, including participation in the Hospital Discharge Planning Workgroup, LHH staff participation in a Community Placement Workgroup, Behavioral Health Staff participation in a Mental Health Access Workgroup, and staff participation in a Public Policy and Financing Workgroup. LHH staff should form a LHH Assisted Living Workgroup and DPH staff should participate in an Accessible Housing Workgroup. Herb Levine, Executive Director of the Independent Living Resource Center and member of the Living With Dignity Policy Committee, summarized the presentation. Dr. Katz said that the initiative has all the right elements. Commissioners’ Comments Commissioner Illig clarified that the Long Term Care Coordinating Council, members of which will soon be appointed by Mayor Newsom, includes the Director of DPH or his designee. Commissioner Illig is committed to making this plan a reality, and he urged Dr. Katz to appoint a high-level staff person to this Council. Commissioner Monfredini is impressed with the report, and aware DPH will have to be a part of the implementation in order for the plan to be successful. Her concern is that the Department’s administrative and support staff was greatly reduced during this budget process, and people are performing multiple tasks. This needs to be taken into consideration when assigning this new task for a staff person. Commissioner Guy congratulated the Policy Committee on the report. She reiterated the point about being aware of the staffing challenges. It is important for DPH to be involved in this effort because the DPH tertiary care facilities, Laguna Honda and San Francisco General, are a part of this community. Ms. Mori asked that the Policy Committee be able to work with Dr. Katz to prioritize DPH’s participation in the work groups, in recognition of staff constraints. Commissioner Umekubo noted that the projected increase in the older population makes the report even more necessary. He said it is important that the private hospitals be included in the Hospital Discharge Planning Workgroup. It is critical that proper funding be obtained to ensure adequate resources for this population. His other concern is whether there will be an adequate workforce for all the services it is hoped to provide. Commissioner Penn is impressed by the report. He asked who is ultimately accountable for implementation. Mr. Haskell replied that accountability would be shared; the Long Term Care Coordinating Council would be reporting to the Mayor. Commissioner Chow said that his hope is that within the next four years there will be a fuller complement of resources. He suggested that the recommendations be referred to the Director of Health and the Strategic Planning Process to determine where DPH could be of the most assistance. He asked Dr. Katz to report back to the Commission how specifically DPH will be involved. 8) McMILLAN STABILIZATION PROJECT UPDATE Barry Zevin, M.D., Medical Director, Community and Homeless Services, presented an update on the McMillan Stabilization Project. This project was one of the recommendations of the Emergency Room Diversion Task Force, which was convened in 2002 to identify burdens on San Francisco Emergency Rooms. The intent of the pilot project was to divert homeless alcoholics to a safe, more effective and less costly level of care. This is an unprecedented public/private partnership. The City and County of San Francisco and the Hospital Council of Northern and Central California fund the pilot project. The pilot project was implemented in July 2003. The target population is homeless or marginally housed chronic alcoholics who have frequent public intoxication, are dually- and triply-diagnosed and are uninsured. Services are provided 24 hours a day, seven days a week. There are 20 sobering beds at existing McMillan Drop-in Center. Clients are transported by MAP Van, ambulance and police. Goals and Outcomes Goal 1: To provide better care for homeless alcohol-dependent persons and improve their health outcomes. Outcome measurements include discharge status, utilization of treatment system and providers’ impressions of health outcomes. 329 patients were assessed for case management services. 45 were discharged to medical detox and 107 to social detox. Goal 2: To decrease the number of inappropriate ambulance trips transporting homeless alcoholic-dependent person to the emergency department. Outcomes include the appropriate triage and transportation of client on the street to reduce the number of ambulance transports of intoxicated persons, the time emergency departments are on diversion and paramedic time on task. Goal 3: To decrease the number of inappropriate homeless-dependent persons seen in the emergency room. Outcomes include inappropriate ED use, due to sole need to become sober, and pick-ups by MAP van after clearance from participating hospital. MAP van transports to McMillan have increased over 50 percent from last year. Successes Commitment to goals Strong planning and collaboration Development of protocols Inter-departmental communication Integration Access to services Staffing Next Steps Increase access to appropriate levels of care Evaluation support Outreach and education Client involvement in continuous improvement Access to public benefits Project sustainability Public Comment Niels Tangherlini, San Francisco Fire Department, said there has been a lot of training, education and orientation involved, which helped increase the number of ambulance transports to the McMillan Center. He is looking forward to continued collaboration with all the agencies involved. Janet Goy, Executive Director of CATS, said it has been a pleasure to be part of this collaboration and see what intensified services can do for the most complex patients who come through their door. Abby Yant, Saint Francis Memorial Hospital, is pleased that they have gotten the support for this population and that best practices have been established for these services. This is but one solution to hospital emergency department diversion. Commissioners’ Comments Commissioner Chow asked staff to convey to the Hospital Council that this partnership is very important and the Health Commission is appreciative of the Council’s continued participation in this project. Commissioner Guy asked if this project has been helpful in reducing homeless deaths. Dr. Zevin said that the driving force behind this project is that the most severely ill homeless people he sees are chronic alcoholics and opiate users. This project provides the ability to catch and engage these individuals before they die on the streets. This, however, is difficult to track. Commissioner Umekubo thanked everyone involved in this project. He asked if the number of beds at McMillan is adequate. Dr. Zevin replied that at the moment it seems to be adequate. This will be closely monitored and reported in the annual report. Dr. Zevin added that there are homeless chronic inebriates who appropriately belong in emergency departments due to significant illness. Commissioner Umekubo asked if case management numbers could increase. Dr. Zevin said that the hours case managers work were adjusted, with the hope that more people can be assessed for case management services. Commissioner Monfredini is pleased with the project, and thanked the Hospital Council for their support of the program. Commissioner Penn said that this is a wonderful example of collaboration and integration. 9) PUBLIC COMMENT None. 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, Monfredini, Penn, Umekubo) voted to hold a closed session. The Commission went into closed session at 6:20 p.m. Present in closed session were Commissioner Guy, Commissioner Chow, Commissioner Monfredini, Commissioner Penn, Commissioner Umekubo, Mitch Katz, M.D., Director of Health, Norm Nickens, Deputy Director, DPH-EEO, Lisa Berkowitz, Deputy City Attorney 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) Action Taken: The Commission (Chow, Guy, Monfredini, Penn, Umekubo) voted to approve a settlement in the amount of $96,400 in the Yvette Castillo vs. City and County of San Francisco, Superior Court File Case #416-346. Reconvene in Open Session D) The Commission reconvened in open session at 6:30 p.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, Monfredini, Penn, Umekubo) voted not to disclose any or all discussions held in closed session. 11) ADJOURNMENT The meeting was adjourned at 6:30 p.m. Michele M. Olson, Executive Secretary to the Health Commission