Minutes of the Health Commission Meeting Tuesday, June 7, 2005 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 Guy at 3:10 p.m. Present: Commissioner Roma P. Guy, M.S.W., Vice President Commissioner James M. Illig Commissioner David J. Sanchez, Jr., Ph.D. (left at 5:60 p.m.) Commissioner Donald E. Tarver, II, M.D. Commissioner John I. Umekubo, M.D. (arrived at 3:25 p.m.) Absent: Commissioner Edward A. Chow, M.D. Commissioner Lee Ann Monfredini, President 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF MAY 17, 2005 Action Taken: The Commission (Guy, Illig, Sanchez, Tarver) approved the minutes of the May 17, 2005 Heath Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Illig chaired and Commissioner Sanchez attended the Budget Committee meeting. Commissioner Guy attended the meeting through Item 3.4. (3.1) CHN-SFGH Radiology – Request for approval of a contract modification with Aureus Radiology, LLC, a sole source contractor, to increase the contract amount by $60,000, from $40,000 to $100,000, to provide as-needed Digital Mammography Radiology screening services in a mobile van setting on behalf of San Francisco General Hospital’s Avon Breast Center, for the period of October 1, 2004 through September 30, 2005. (3.2) CHN-Pharmacy – Request for approval of two contract renewals with the following firms: Asereth Medical Services, Inc. and NOR-CAL Medical Temps, for a combined total amount of $2,400,000, to provide as-needed supplemental pharmacy personnel services to the Community Health Network, for the period of July 1, 2005 through June 30, 2007. (3.3) CHN-SFGH – Request for approval of a renewal contract with Pharmaceutical Care Network, in the amount of $250,000, to provide third-party administrative services, and $2,300,000 in pass-through prescription dispensing fees to Rite Aid Corporation and AG Pharmacy, targeting indigent CHN clients and 12% contingency of $306,000, for the period of July 1, 2005 through June 30, 2006. (3.4) CHN-Jail Health Services – Request for approval of a renewal contract with Haight Ashbury Free Clinics, Inc., in the amount of $3,379,504, to provide psychiatric and substance abuse treatment services targeting inmates in the San Francisco County Jail system, for the period of July 1, 2005 through June 30, 2006. Jo Robinson, the director of Jail Psychiatric Services, shared some of the JPS outcomes, in response to questions that commissioners raised when the Jail Health Report was presented in April. Ms. Robinson said the jail mental health program consists of diversion, treatment while in planning and discharge planning. In diversion, this year they admitted 51 clients into the Behavioral Health Court, and the BHC was one of four Behavioral Health Courts in the country selected to do an outcome study. With regard to treatment, this year JPS provided services to 5,000 people, with 32,000 follow up visits for these patients. Since 2002, there have been no deaths by suicide in the jail. With regard to discharge planning, during the last fiscal year they had a Social Security Administration staff person come into the jail on a weekly basis and begin the application process while the person is still in custody. There were 103 community placements from jail to community residential treatment program, and 390 inmates who went through CBHS access clinics. Gregg Sass, DPH Chief Financial Officer, addressed the Haight Ashbury Free Clinics’ (HAFC) fiscal issues. The issue has been and continues to be cash flow. The agency was a victim of alleged theft by the former CFO. Once that was discovered, the agency discovered additional financial problems. DPH regularly meets with HAFC representatives to closely monitor the situation. HAFC has done a great deal of work to develop a comprehensive turnaround plan to get the organization back on track. The plan includes governance restructure, hiring an interim CEO and CFO, providing weekly cash forecasts through June 2006, and most importantly working directly with DPH staff, including Jimmy Loyce, Barbara Garcia and Joe Goldenson, to plan for how the clients in their programs would be served in the event the agency does not survive. Should something happen, there would be a window of time in which to effect the transition. Commissioners’ Comments Commissioner Guy asked what would happen if HAFC did not contract with Jail Health Services in the future. Mr. Sass said it appears that the best approach in the event the agency is no longer in operation is to hire the staff currently providing the services as DPH employees. John Eckstrom, Interim CEO, said jail psychiatric services are an integral part of what they provide in terms of services and the organization wants to maintain that breadth. He would like to improve the connections between clients in the jail and the agency’s community programs that are available when people get out of jail. Commissioner Illig said normally the Health Commission would feel less than confident with an organization that is having this much financial difficultly. It is because of Mr. Eckstrom’s relationship with Mr. Sass that the Commission feels comfortable approving this contract. The Health Commission wants HAFC to succeed. He believes the agency is going to receive the support it needs from the community that has supported it throughout the past 30 years. The Commission expects continued good communication with DPH staff. Public Comment Raymond Banks was in jail psych services last year and he thought they had a laissez-faire approach to sanitation at the jail. His concern is that the models sound impressive, but they need to pay attention to the nuts and bolts of the operation. There are people that cannot take care of themselves. Commissioner Illig urged Mr. Banks to also convey these concerns to the Sheriff, who is responsible for jail cleanliness. (3.5) SFGH-Health Information Systems – Request for approval of a renewal contract with Deliverex, Inc., in the amount of $690,000, 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, 2005 through June 30, 2006. (3.6) PHP-CHSS-TB Control - Request for approval of a contract renewal with UCSF at San Francisco General Hospital, in the amount of $228,000, to provide physician and radiologist services to patients referred to the SFGH Tuberculosis Clinic, for the period of July 1, 2005 through June 30, 2006. Commissioner Sanchez abstained from voting on this item. (3.7) PHP-MIS – Request for approval of a renewal contract with Dataway, in the amount of $468,319, for the provision of Information Technology support services for the Department of Public Health, for the period of July 1, 2005 through June 30, 2006. (3.8) PHP-STD Prevention & Control – Request for approval of a retroactive contract renewal with UCSF/Center for AIDS Prevention Studies, in the amount of $280,194, to provide Efficacy of Condom Skills randomized, controlled trial services targeting English speaking women and men who seek diagnostic SDT examination and treatment at the SF City Clinic with a new problem visit during the study period, for the period of November 1, 2004 through October 31, 2005. Commissioner Sanchez abstained from voting on this item. (3.9) PHP-Community Health Services – Request for approval of a renewal contract with AmeriChoice, in the amount of $413,056, which includes a 12% contingency, to provide fiscal intermediary services to the Personal Assisted Employment Services, for dental services, for the period of July 1, 2005 through June 30, 2006. Commissioners’ Comments Commissioner Sanchez asked if this program picked up any of the clients that were formerly served by the UC Dental Clinic at SFGH. Ms. Martinez replied that at the time of the closure she explored having community clinics serve the clients. This did not work out, and now she is analyzing the feasibility of having these clients served at Tom Waddell. The PAES program is for a specific population, and the dental needs of participants are severe and cannot be treated at DPH sites. (3.10) CBHS - Request for approval of retroactive new contract with City College of San Francisco, in the amount of $100,800, to provide mental health/substance abuse training/certification services, for the period of July 1, 2004 through June 30, 2005. Commissioners’ Comments Commissioner Sanchez hopes that this program could rotate through the new student health center that City College is breaking ground on. Commissioners’ Comments (at Commission Meeting) Commissioner Tarver noted the overrepresentation of African Americans receiving Jail Health Services and asked for additional details about discharge planning and connections to community services. Dr. Goldenson said that discharge planning and transitional services for mental health programs have not been reduced, and continue through this contract. The discharge planning cuts that have been made over the past few years have been in medical services. Public Comment Patrick Monette-Shaw – he would like to understand how people retroactively teach people to use condoms. This is not an effective use of DPH money. Action Taken: The Commission (Guy, Illig, Sanchez, Tarver) approved the Budget Committee Consent Calendar, with the exception of Item 3.6 and Item 3.8. Action Taken: The Commission (Guy, Illig, Tarver, Umekubo) approved Item 3.6 and Item 3.8 of the Budget Committee Consent Calendar. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., presented the Director’s Report. Budget Status Update On May 31st, the Mayor released his FY 2005-06 Proposed Budget. Improved financial performance City wide made it possible for the Mayor to restore many of our proposed reductions and avoid many of most significant service reductions. In addition, new funding was added including $4.5 million in COLAs for nonprofit contractors (including UC), an additional $1.5 million in structural fixes for the UC contract, and $6.9 million in new capital projects. Due to the improvements in the City's finances, no cuts were made to primary care, public health or home nursing, residential substance abuse, or mental health services. Financial savings that remain include $3.2 million to be recovered from restructuring outpatient Substance Abuse services to reduce per unit cost and increase available methadone slots; $1 million for AIDS practical support programs; $0.4M for AIDS prevention programs; $1.5 million in pharmacy co-pay for persons without general assistance; $1.0 million from closure of the Workers Compensation Clinic at SFGH; and $0.3 million for closure of the Dialysis unit at SFGH. In addition, the budget included the annualized reductions that were taken mid-year totaling $7.6 million. Following issuance of the Mayor's budget proposal, an error was identified in the amounts budgeted for AIDS grants for the prior year (2004-05). Correction of that error reduced the reported reduction in AIDS grant expenditures from $12 million to $3 million. The Beilenson Hearing is scheduled for the June 21st meeting of the full Board of Supervisors. The hearings to review the Health Department budget will be heard by the Budget and Finance Committee on June 20th and June 27th. AB631 Update AB 631, also known as the mobile methadone bill, passed off the Assembly Floor 65-3 and now proceeds to the senate. AB631 will create a category of licensure for mobile methadone maintenance treatment programs (MMT) in California. If passed, AB631 this will enable us to receive MediCal reimbursement for services provided. Approximately 21 % of the MMT clients are MediCal beneficiaries but SFDPH assumes the full cost of their treatment. This is because the Department’s methadone van is operating as a temporary pilot project authorized by the State and federal Drug Enforcement Agency, but without formal State licensure. AB 631 will not only remedy this issue in San Francisco, but also expand access to MMT statewide. SFGH Rebuild Blue Ribbon Committee Members of the Mayor’s Blue Ribbon Committee on San Francisco General Hospital’s Future Location met for the first time last week at the San Francisco Foundation Offices. The Committee’s charge is to make a recommendation to the Mayor, this Health Commission and the Board of Supervisors on where SFGH should be rebuilt. Gene O’Connell presented an overview of SFGH, its role as both a community hospital and a Level 1 Trauma Center and the highlights of the population it serves. The committee then reviewed the body of work that has already been done and began a discussion on the unique characteristics that both UCSF and SFGH bring to this challenge. Dr. Edward Chow is a member of the Committee representing this Health Commission. The committee will be meeting again on June 30 and continue its discussion of the major issues that need to be addressed. Mental Health Services Act Last week the State Department of Mental Health released estimates on the probable allocation from the Mental Health Services Act (formerly Prop 63) for the portion of funding that would support the clinical services expansion. San Francisco was formulated to receive far less than what had been preliminarily projected--$5,332,900 verses the anticipated amount of more than $10 million. This estimate is 55% of the totals that will be allocated, so San Francisco's total per year will be closer to $10 million rather than the anticipated $20 million or more. Efforts are underway with the Mayor's office and our lobbyists in Sacramento to see if anything can be done to change to allocation. It appears that San Francisco was under-funded due to the high portion of general fund and high use of state and federal grants that fund behavioral health services. The estimate also failed to account for a number of other significant factors for San Francisco and the Bay Area: The high cost of living influence on service delivery in the Bay Area. The State used 200% or below of the poverty level as the measure of the poverty population. The recommended percentage is 300% - 400%, which would help the Bay Area. The large number of people who come to San Francisco for services that were not provided in their original places of residence. The impact these individuals contribute to our growing homeless population. The additional costs involved in providing culturally, ethnically, and linguistically sensitive services. These are the majority of services already being provided and will need to be continued. Project Homeless Connect 5 Project Homeless Connect (PHC) held its fifth event on June 3rd at Bill Graham Civic Auditorium. Nine hundred eighty seven (987) homeless clients were seen that day; 123 received medical services, 40 were referred to mental health and substance abuse services, 28 people were tested for HIV, 50 people were referred to methadone treatment, 31 were placed in stabilization housing, 51 people were put in shelter, 94 people received legal counseling, 90 received CAAP services, 84 people received SSI counseling, 150 people received eye exams, 53 people received eyeglasses and 6 wheelchairs were stripped down and repaired. Deloitte and Touche assisted with this event by donating thousands of sweatshirts and socks for homeless clients. They also provided 900 volunteers, along with the 850 regular community volunteers. Project Homeless Connect is an inspiring event where private individuals, community agencies, private companies, the mayor’s office and city and county providers work together to help connect the homeless to services. The next event is on August 4, 2005. If people are interested in volunteering please sign up on the website at www.projecthomelessconnect.com. Universe Within Investigation During the past two weeks the Department has been investigating an exhibit at the Masonic Auditorium. The exhibit shows dead bodies that have been plastinated. The process of plastinating human bodies involves sterilizing the body, injecting it with silicon, and then letting the bodies cure for a 6-month period. Although exhibits of plastinated bodies can be a legitimate method of teaching people about the human body, there are several problems with this particular exhibit. The biggest problem is that it does not appear that the individuals whose bodies are being exhibited gave their consent for their bodies to be used in this way. Second, the bodies are dripping silicon, which they should not be doing. We do not believe that the dripping represents a health hazard. Cultures of the fluid have been negative. Nonetheless, we have required that the exhibitors rope off the bodies so that the public will not try to touch them. Supervisor Ma will be introducing legislation to require full consent of the person or their immediate family prior to their body being exhibited in this way in San Francisco. George Lau appointed to Fire Commission Dr. Katz congratulated George Lau, accountant at 1380 Howard and treasurer of Local 21, who has been appointed to the Fire Commission by Mayor Newsom. He was sworn in May 25. Southeast Community Facility Commission On May 25, 2005 Dr. Katz gave testimony at the Southeast Community Facility Commission about the health issues in the Bayview Hunter’s Point Neighborhood. Former Health Commissioner Dr. Harrison Parker was present and recommended that the Health Department sponsor Health Fairs in the Bayview to promote prevention themes. Dr. Katz thought this was an excellent idea and the Southeast Community Facility Commission agreed to co-sponsor with the Health Department a Health Fair focused on increasing exercise. He will alert the Commission as soon as there is a date. Jefferson Award Dr. Dan Wlodarczyk, director of Southeast Health Center and long-time DPH employee, was recently recognized by the San Francisco Chronicle, KCBS radio and CBS Channel 5, to receive the Jefferson Award for Public Service. The Jefferson Awards were begun in 1972 by Mrs. Jacqueline Kennedy, to honor individuals at both a national and a local level for their community and public service. On a local level, Jefferson Awards recipients are ordinary people who do extraordinary things without expectation of recognition or reward. Commissioners’ Comments Commissioner Illig is pleased that, for the most part, the programs that the Commission said should not be cut were kept whole. He is particularly interested that the CHIPPS program was funded, and that there is new money for supportive housing for seniors. He congratulated Dr. Wlodarczyk, who served for a time on the board of Project Open Hand. He is an amazing individual. Commissioner Umekubo asked if anyone in the United States is allowed to plastinate. Dr. Katz said the bodies were plastinated in China, and were brought in through customs. Dr. Katz does not think there are any rules about who in the United States would be able to plastinate and no one in the U.S. does it. Commissioner Guy said that the Health Commission might need to consider rescheduling its June 21st meeting to accommodate the Board of Supervisors Beilenson Hearing. She also said the joint conference committee should discuss and monitor the restructuring and rebidding of substance abuse services. She has some concerns about “one shoe fits all” in terms of the expansion of methadone. Dr. Katz said that if the cuts remain in the budget, the Department would convene a meeting of all the existing service providers and those who wish to be service providers, and pose to them what we’re trying to achieve and hear their ideas. 5) LAGUNA HONDA REPLACEMENT PROGRAM: CONTROLLER’S REPORT AND DEPARTMENTAL DATA Dr. Katz introduced Ed Harrington, the City Controller, and asked him to provide a summary of the report he recently issued. Mr. Harrington said that his office prepared the report at the Mayor’s request, and looked at a variety of options for rebuilding Laguna Honda Hospital. He concluded that there are only two options worth considering: Option 1 – Use all reasonably available funds to complete a 1,200 bed skilled nursing facility at Laguna Honda. Option 2 – Use most funds to complete three buildings at Laguna Honda with 780 skilled nursing beds and use the remaining funds plus operational savings to purchase other long-term care services in assisted living, supportive housing, home care or other community-based settings. Total people served under this option would exceed 1,800. Mr. Harrington reviewed the funds that are currently programmed for the rebuild project, which are General Obligation Bonds, Tobacco Settlement funds and other (primarily interest), for a total project budget of $401 million. There are two new sources of funding available to the project. The first is to issue Certificates of Participation (COPs) to be repaid using federal revenue available through SB1128. The second is to use the next $100 million of tobacco settlement funds for construction, in addition to the $92 million in settlement funds that have already been received. Option 1 would use the $629 million in funding to cover the most probable cost estimate for a 1,200 bed skilled nursing facility ($600 million to $640 million). Option 2 would use $482 million to complete the first three buildings with 780 skilled nursing facility beds, and use $59 million to build 235 assisted living and/or supportive housing beds at Laguna Honda. In addition, funds would be available to pay for the annual cost of care for another 790 individuals in various community-based settings. Commissioners’ Comments Commissioner Illig asked if the $120 million in COPS was based on 780 beds or 1,200 beds. Mr. Harrington replied that it is based on the debt services, which is $299 million regardless of what type of facility is built. Commissioner Illig asked if other counties building SNF facilities have used SB 1128. Dr. Katz said SB 1128 was modeled after a successful bill, which has now closed, that allowed several acute care hospitals to rebuild. SB 1128 was specific to San Francisco and San Diego. Commissioner Illig asked if the funding that Senator Feinstein obtained for Laguna Honda assisted living planning is still available. Mr. Lane said the HUD grant money is available for assisted living and is valid until September 2007. Commissioner Illig asked if there is any time period in which a decision needs to be made, separate from approving moving forward with the third building. Mr. Harrington would like decisions so that the project could issue debt next year and not lose the chance to repay itself. Commissioner Umekubo asked if San Francisco has the community capacity to serve the people who are not served at Laguna Honda. Mr. Harrington said there are several options for caring for these people, and providers in the community have indicated that the capacity is either currently available or could be in the future. Commissioner Tarver said the estimates were rather high in terms of cost per bed. He asked if the Controllers’ Office would independently evaluate these costs. Mr. Harrington said they intentionally used the higher, more conservative, cost estimate. Many people thought it likely that people coming from Laguna Honda Hospital into a different level of care would require the higher level of services. Commissioner Guy asked if operating costs would be available, and how people could be sure that the money that might be saved building assisted living beds rather than SNF beds would be used for community services. Mr. Harrington said they would set up a trust fund to serve at least 1,200 people for the next 25 years. The remainder of the money is somewhat up to goodwill. Commissioner Illig asked if a consultant is preparing another study of Laguna Honda Hospital. Mr. Harrington replied that a consultant, in conjunction with DPH and the Controller’s Office, is doing a report on long-term care in San Francisco. It is a more global report but will certainly inform decisions around Laguna Honda. This report should be finished in the middle of June. Mitchell H. Katz, M.D., continued the presentation by focusing on the implication of the report for the Health Department and the Health Commission. Based on the report, the Health Commission should assume that: There is enough money to build at least 780 beds (plus the 50% contribution to the 140 units of assisted living, and the adult day health center envisioned in the bond). It is possible to use certificates of participation and the tobacco funds to build the entire 1200 beds initially envisioned. The major policy question for the Health Commission is whether to build the full 1200 beds or use the money saved by building and operating only 780 beds to increase other types of community-based long-term care (e.g., board and care, assisted living, supportive housing, and independent living). Making this decision will require review of detailed information. Some of this data is available for today’s presentation. The information not available will be presented at a future meeting. Data required for decision making includes, at a minimum: Laguna Honda Hospital (LHH) Available services Census Resident characteristics Where patients are admitted from Where patients are discharged to Ability and preferences of existing residents and residents who would be entering LHH to be cared for in the community Projections of need versus supply of skilled nursing beds for the future Costs (present and future) of operating LHH Community-based long-term care Available services Census of different community providers Client characteristics Costs Obstacles to expansion Projection of needs and supply of services With regard to decision timing, Dr. Katz said that the City does not need to make an immediate decision about whether to build 780 or 1,200 beds because the final 420 beds cannot be build until Clarendon Hall is demolished, which is projected to be in 2009. However to maximize the repayment using SB 1128 a decision to go forward with the 1,200 beds should be made by December 2005. Dr. Katz presented the data that is available today, which includes a description of services at Laguna Honda, the census, resident characteristics and discharge information. He also described the Targeted Case Management (TCM) Program, which has been in operation since March 2004. To date, all residents at Laguna Honda have been screened by the TCM Program and approximately 80 percent are candidates for being discharged to a community setting. However, this does not mean that these residents wish to be discharged or that the appropriate community resource exists at the current time. Dr. Katz reiterated that this is just the initial discussion, and there are many questions that need to be answered and data that must be obtained. Public Comment Sandy O’Neill, member of Board of Directors of San Francisco Independent Living Center, and member of the Long Term Care Community Advisory Board, said TCM came out of a civil rights challenge, assisted living is not about “beds,” but rather about living. We’re talking about more people being locked up at Laguna Honda Hospital. Many patients want to leave Laguna Honda Hospital. ILRC-SF supports neither Option 1 nor Option 2, but urges the Commission to consider other options in consultation with other appropriate groups and agencies. Howard Chabner has an elderly relative at Laguna Honda Hospital who has in general received excellent care there. He urged the Health Commission to approve rebuilding Laguna Honda with the full 1,200 beds. The voters approved the bond based on their agreement that San Francisco needs 1,200 long-term care beds. Patrick Monette-Shaw said the Controller’s report is riddled with errors. In addition, if the number of SNF beds is reduced, so is the revenue from SB 1128. The tobacco settlement revenue account is the trust fund for this project. He feels it is a fait accompli that there would only be 780 beds. Jennifer Walsh spoke in support of option 2, which serves 1,000 more people in community settings. San Franciscans do not need more skilled nursing care, but rather assisted living and other independent living arrangements. People at Laguna Honda Hospital want to move out but are afraid of the process. Please support Option 2. Elissa Berrol said she has friends, family members, lovers and coworkers who have disabilities and she has taken it for granted that they could live independently. Some people need SNF beds, but if we increase funding for assisted living beds and other community options, more people could live independently. By voting for Option 2, the Health Commission votes for independence. Sandy Mori, member of the Long Term Care Coordinating Council and Laguna Honda Rebuild Committee, said it is wonderful to have a dialogue around this important policy issues. The long-term care community is excited about Option 2, and she urges the Commission to evaluate this carefully. She also urged the Commission to involve the Department of Aging and Adult Services in these discussions. - Elissa Gershon, staff attorney at Protection and Advocacy, commended San Francisco for setting up the Targeted Case Management Program and for considering in the discussion of the Laguna Honda rebuild the issue of community services. These discussions must go hand in hand—for every SNF bed that is not built, what additional community services could be funded? They do believe that, in addition to Option 1 and Option 2, the Health Commission should be looking at other alternatives, such as not even building 780 beds. Elizabeth Boardman, member of the Long Term Care Coordinating Council, urged the Commission to evaluate a proposal she submitted regarding a day health housing model (on file in the Health Commission Office). This is a very interesting alternative and exists in one form in San Francisco at On Lok. She is very sympathetic with the proposed Option 2. As she understands it, there is no funding for assisted living for people who are poor. This needs a legislative remedy. Brian Uyeno, employee at Laguna Honda Hospital, said he worked hard to pass Proposition A in 1999 for two reasons. First, to protect his job. But more importantly he wanted the hospital rebuilt because the city needs it—the people need it. In 1999, DPH did a study that indicated San Francisco would need more than 1,200 beds. No study has been done that proves otherwise. He hopes the Health Commission maintains its commitment to a 1,200 bed facility. Oletha Hunt, employee at Laguna Honda Hospital, is concerned that the hospital is being treated like something that can be thrown around with no concern about the people who live there. It is not fair to the patients. People work hard at Laguna Honda for the patients. There is no place better than Laguna Honda. They do not want to keep people at Laguna Honda who do not want to be there. They want to discharge patients. Perpie Magdaloyo, an employee at Laguna Honda Hospital, worked hard to pass Proposition A in 1999 because she wants to know that Laguna Honda would be available for her and other San Franciscans when they need it. She urged the Health Commission to support the 1,200 beds that the voters passed. Kim Tavaglione, United Healthcare Workers, said the Asian community has always been very committed to taking care of their extended families in their own homes. In the United States, this is not always possible and Laguna Honda is going to be an alternative that is much more utilized by the Asian community. Caring for elders is a daunting task. Furthermore, San Franciscans are not having children, so there will not be as many people to take care of them. San Francisco should build a 1,200-bed, world class SNF. Gloria Watts, employee at Laguna Honda Hospital, said she campaigned for Proposition A in 1999 and told voters that the hospital would be built for San Franciscan who needed care. They give great care to all who need it. They need 1,200 beds. - John Kosinsky, United Healthcare Workers West, said there have already been many discussions and research, prepared by DPH, that showed there should be 1,200 beds at Laguna Honda, but yet again we are engaged in the discussion about how big the hospital should be. His union wholeheartedly supports community care, but not at the expense of other people who need care. It is our responsibility to build a Laguna Honda that is there for people who need it. The longer the decision around Laguna Honda hospital takes, the harder it will be to rebuild San Francisco General Hospital. Larry Bevan, shop steward with SEIU United Healthcare Workers, said that we need to look at the long-term picture, which shows that the population is aging, and there are greater needs for everything. The need for 1,200 skilled nursing beds still exists. SNFs tend to be snake pits, and this is not the case at Laguna Honda. Laguna Honda is a jewel. The public is going to lose faith and will not vote to rebuild SFGH. Linda Abullarade, employee at Laguna Honda Hospital, said the staff at Laguna Honda strive to make residents a part of the community, and needs to be rebuilt at 1,200 beds. Donna Calame, executive director of IHSS Public Authority, would hope that the care at Laguna Honda is better than other facilities, because it gets twice a much as a community SNF, plus a $100/day patch. So it would be a shame if they did not provide a greater level of care. She is committed to expanding homecare services. It means so much to people with disabilities to remain in the community. Institutionalization of disabled people is wrong. There has not been enough community discussion about community alternatives. Commissioners’ Comments Commissioner Illig commended Dr. Katz for involving others in this discussion, including the Long Term Care Coordinating Council, and added the Mayor’s Disability Council to the list. He asked Dr. Katz where the Department stands with the Nursing Facility waiver, which is referred to in the TCM reports. Dr. Katz said there has been some confusion around the TCM report, and clarified that report says that 80 percent of the residents at LHH have been assessed as not needing to be in Laguna Honda Hospital and to be able to be discharged into community based care, assuming that was their preference and that the care was available. It is not accurate to say that 80 percent of Laguna Honda residents do not need skilled nursing care. The Nursing Facility Waiver is a State program that enables an enriched service array, especially around home nursing and attendant care. People who without the waiver would not be able to live outside of Laguna Honda could possibly do so with the waiver. The State currently has a waiting list. DPH wants to continue to add people to the waiting list to put appropriate pressure on the State to enable additional people to join the program. Commissioner Tarver would like to see a summary of the waiver applications in terms of level of need and, if the waivers were granted, where they would be served. Commissioner Illig commented that some of the factors that are new since 1999 are the Olmstead Act and two visits for the Department of Justice. These issues have to be fully presented and discussed in terms of implications for the future. The Health Commission needs to fully examine how San Francisco can provide more services to more people, both on the Laguna Honda campus and off. Commissioner Tarver would like additional distinctions of patients at Laguna Honda, and their disparate needs. Commissioner Umekubo said it is appropriate to re-examine assessments that were done six years ago. His concern is that the types of patients that are going to grow in the future are those with Alzheimer’s disease and we need the ability to care for these individuals in facilities from which they cannot get out. He asked for additional information on PACE—Program for All-Including Care for the Elderly. Dr. Katz said On Lok was the model program, but other programs have developed. They typically are adult day health care, some include a housing component, although the majority of clients are in independently living outside of On Lok. His understanding is that capacity could grow in this area. The limitations around PACE include availability of housing, income and change of providers. It has the ability to take care of people with extensive needs. Commissioner Tarver said Community Behavioral Health Services should be brought in to discussions about different models of care for people who live in skilled nursing facilities, in community care and other areas. People have a range of needs. Commissioner Guy asked that Health at Home be involved in the rebuild discussions as well. She supports paying attention to the language in the report, and clearly stating that the need for a skilled nursing facility does not always equate with being elderly. She asked what the appropriate process and timeline is for discussion and decision, and wants the Laguna Honda Hospital Joint Conference Committee to be involved. Dr. Katz said the August 16th meeting would work well for presenting the additional information necessary to decision making. Commissioner Guy said there would be many discussions around this. The Commission clearly understands how important this is to the community. She welcomed any additional information from the public. Commissioner Tarver thanked the public for coming to the meeting. The Health Commission pays attention to, and is moved by, public comment. 6) CONSIDERATION OF A RESOLUTION AUTHORIZING THE LAGUNA HONDA HOSPITAL REPLACEMENT PROJECT TO PROCEED WITH THE EAST BUILDING Michael Lane, Project Manager, Laguna Honda Hospital Replacement Project, presented a resolution authorizing the Laguna Honda Hospital Replacement project to proceed with the construction of the East Building in addition to the South and Link Buildings, for a total of 780 beds. On March 29, 2005, the Health Commission approved Resolution 05-05 allowing the City to proceed with the construction of the South and Link Buildings and any associated work with no scope reductions. Since that time, the City Controller prepared a report outlining options for how to proceed with the replacement of the hospital. The Controllers’ report indicates that there is enough funding to build at least 780 beds, and both options proposed by the Controller specify proceeding with the South, Link and East buildings. Action Taken: The Commission (Guy, Illig, Tarver, Umekubo) approved Resolution 08-05 “Concurring With the Recommendation to Proceed with the Construction of the East Building at Laguna Honda Hospital,” (Attachment A). 7) PUBLIC COMMENT/OTHER BUSINESS Howard Chabner recounted an incident where an able bodied woman assaulted an elderly patients. This woman put the entire ward of elderly ladies at risk, and required a large amount of nursing care that could have gone to other patients. Cal OSHA remains concerned about safety and the DOJ is concerned. All of these problems are a direct result of the flow project. Shawn Allemby spoke on behalf of her mother, Fran Allemby, and her experience working with staff at SFGH Emergency Psychiatric Services. She protests SFGH’s conserving her mother because her mother has children who are willing and able to care for her and do not want her to be sent away to a locked facility. She is currently seeking probate conservatorship over her mother. She is very disappointed about how she and her mother have been treated. She submitted a copy of her testimony (on file in the Health Commission Office) Darryl Jones said she has been a target of the police syndicate for 17 years. The hospitals have abused her over and over. Recently she was subject to an illegal 5150. She is concerned about the way the community is run, and the mental health facilities. Patrick Monette-Shaw read from page 12 of his report regarding his lawsuit that is currently in appeals court and other issues. Building fewer than 1,200 beds is a bait and switch. The Health Commission and Board of Supervisors should stop playing politics with Laguna Honda. 8) ADJOURNMENT The meeting was adjourned at 6:20 p.m. Michele M. Seaton, Executive Secretary to the Health Commission Attachments: (1) Health Commission meeting minutes are approved by the Commission at the next regularly scheduled Health Commission meeting. Any changes or corrections to these minutes will be reflected in the minutes of the next meeting. Any written summaries of 150 words or less that are provided by persons who spoke at public comment are attached. The written summaries are prepared by members of the public, the opinions and representations are those of the author, and the City does not represent or warrant the correctness of any factual representations and is not responsible for the content.