Minutes of the Health Commission Meeting Tuesday, September 6, 2005 at 3:00 p.m. 101 GROVE STREET, ROOM 300 San Francisco, CA 94102 1) CALL TO ORDER Commissioner Monfredini called the meeting to order at 3:10 p.m. Present: Commissioner Lee Ann Monfredini, President Commissioner Roma P. Guy, M.S.W., Vice President Commissioner Edward A. Chow, M.D. Commissioner James M. Illig Commissioner David J. Sanchez, Jr., Ph.D. Commissioner Donald E. Tarver, II, M.D. Commissioner John I. Umekubo, M.D. Commissioner Monfredini said the Health Commission’s thoughts are with the residents of Louisiana, Alabama and Mississippi who were so extremely devastated by Hurricane Katrina. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF AUGUST 16, 2005 Action Taken: The Commission approved the minutes of the August 16, 2005 Heath Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Illig chaired, and Commissioner Chow and Commissioner Sanchez attended, the Budget Committee meeting. (3.1) DPH-SFGH – Request to approve a resolution to the Board of Supervisors to accept revenues newly estimated to exceed $1,000,000 under a contract with Accordis, Inc. previously approved by the Health Commission on July 6, 2004. (3.2) PHP–Community Behavioral Health Services - Request for approval to accept and expend a no-cost extension of funds from the Targeted Capacity Expansion grant from SAMHSA/CSAT, in the amount of $309,049, extending the grant through September 2006 and continuing aftercare services by assisting clients enrolled during the third year of the grant, for the period of September 30, 2005 to September 29, 2006 and a sole source contract modification with Walden House for $68,801 for the same time period. (3.3) PHP–AB 75 Project - Request for approval to accept and expend retroactively a grant allocation in the amount of $2,622,282, from the California Healthcare for Indigents Program, State Department of Health Services, to provide reimbursement for health services delivered to indigent persons, for the FY 05-06 term. (3.4) PHP-Housing & Urban Health - Request for approval of a retroactive new contract with Tenderloin Housing Clinic, in the amount of $285,600, which includes a 12% contingency, to stabilize the lives of single room occupancy hotel tenants in the Mission District of San Francisco, for the period of July 1, 2005 through June 30, 2006. (3.5) PHP-Housing & Urban Health - Request for approval of a retroactive multi-year contract renewal with Tenderloin Housing Clinic, in the amount of $228,480/yr, for a total contract amount of $913,920, which includes a 12% contingency, to provide quality-of-life improvements, hotel fire prevention and community stabilization in single room occupancy hotels in the Tenderloin and South of Market Neighborhoods of San Francisco, for the period of July 1, 2005 through June 30, 2009. Commissioners’ Comments Commissioner Illig commended HUH staff for developing an outcome objective based on stabilization. He asked if other agencies providing services would have a similar objective. Mr. Williams replied that he is working with other agencies to incorporate this objective into their contracts. Commissioner Illig asked if the agency has plans to expand its board. Kerry Abott of Tenderloin Housing Clinic said that they are in the process of adding community members back to the board. They had been under a court ruling to having only attorneys on the board, but this was recently overturned by the California Supreme Court. (3.6) PHP-Housing & Urban Health - Request for approval of a retroactive multi-year contract renewal with Chinatown Community Development Center, in the amount of $285,600/yr, for a total contract amount $1,142,400, which includes a 12% contingency, to provide comprehensive community outreach and education regarding fire prevention and community stabilization in single room occupancy hotels in the Chinatown and North Beach Neighborhoods of San Francisco, for the period of July 1, 2005 through June 30, 2009. (3.7) PHP-Housing & Urban Health - Request for approval of a retroactive multi-year contract renewal with Chinatown Community Development Center, in the amount of $224,000/yr, for a total contract amount $896,000, which includes a 12% contingency, to provide advocacy, outreach, information and support to families with children living in single room occupancy hotels in the Chinatown, Tenderloin, South of Market and Mission neighborhoods of San Francisco, for the period of July 1, 2005 through June 30, 2009. Commissioners’ Comments Commissioner Chow is interested in how CCDC works with the Latino community. Angela Chu from CCDC replied that they have subcontracts with agencies that serve the Latino populations. Commissioner Sanchez lauded the partnership, and urged them to work with Mission Language Vocational School, which serves Latin American and Asian students. (3.8) AIDS Office-HIV Health Services – Request for approval of a retroactive contract renewal with UCSF/Pediatric HIV/AIDS Program, in the amount of $155,979 plus a 12% contingency for a total amount of $174,696, to provide primary care, case management, psychosocial and nutritional counseling services to HIV+/HIV indeterminate children and adolescents from uninsured or underinsured low-income families that have no other source of health care, for the period of March 1, 2005 through February 28, 2006. Secretary’s Note – this contract was deferred to the September 20, 2005 Health Commission meeting. (3.9) AIDS Office-HIV Health Services – Request for approval of a retroactive contract renewal with University of Pacific School of Dentistry, in the amount of $555,529, to provide centralized dental services targeting uninsured or underinsured low-income San Francisco residents living with HIV/AIDS, for the period of March 1, 2005 through February 28, 2006. Commissioners’ Comments Commissioner Chow asked what measures UOP is taking to increase the percentage of people that complete their treatment plan. Dr. Dugoni from UOP replied that they are working to proactively prompt patients to return for treatment. (3.10) AIDS Office-HIV Prevention – Request for approval of a retroactive contract renewal with Haight Ashbury Free Clinics, Inc., in the amount of $100,000 plus a 12% contingency, for a total amount of $112,000, to provide needle exchange services targeting intravenous drug users, for the period of July 1, 2005 through June 30, 2006. Commissioners’ Comments Commissioner Illig expressed disappointment that Haight Ashbury Free Clinics did not send a representative to the Health Commission meeting. Mr. Loyce will call the agency’s executive director. Action Taken: The Commission approved the Budget Committee Consent Calendar, with the exception of Item 3.8, which was deferred to the September 20th Health Commission meeting. 4) DIRECTOR’S REPORT Anne Kronenberg, Acting Director of Health, presented the Director’s Report. Emergency Shelter for Survivors of Hurricane Katrina Ms. Kronenberg said that San Francisco has volunteered to take survivors of Hurricane Katrina. Over Labor Day weekend, staff from the Department has been involved with other City agencies and community based organizations in planning an emergency shelter in the basement of St. Mary's Cathedral and possibly other locations as well. The City is coordinating its efforts with the African American community and faith-based organizations to ensure that culturally sensitive issues are addressed as we make plans to care for the new arrivals. Although details regarding the time and number of individuals who may be arriving are still speculative, the City is working on plans to accommodate a minimum of 300 survivors. Public Health is gearing up to provide a number of services, depending on the status of the individuals, that may include triage, acute and chronic care medical services, TB screening, and mental health counseling. Laguna Honda Hospital has already delivered linens and towels to the shelter and has committed to providing laundry services for those items. Because this will be a long-term commitment, we are working with other healthcare partners throughout the Bay Area such as Catholic Healthcare West in anticipating needs and identifying resources. City officials, CBO's and a number of volunteers from the business community are making plans to provide the survivors with necessary services such as temporary and permanent housing, clothing, job training, on-going mental health support, school enrollment for children, benefits enrollment and a variety of other services that individuals recovering from this traumatic event will need. We are touched by the number of volunteers and the generous donations that San Franciscans have been bringing to this recovery effort. Ms. Kronenberg is grateful to the leadership within the Department who, over the past few days, has responded enthusiastically to the City's call to mobilize resources and staff in preparing for these Hurricane survivors. She will keep the Health Commission informed as DPH moves forward in this citywide response to providing emergency shelter and services to our fellow disaster survivors. Many members of the public as well as DPH staff have called asking how they can help. DPH has been informed that the Mayor’s Office has established SFGives, a directive to all City agencies to be responsive to requests for assistance and to provide needed help and expertise to the Gulf States affected by Hurricane Katrina. SFGives is also an opportunity for local residents to help individuals affected by Hurricane Katrina by making a financial contribution to the relief effort. If you are able to contribute to those in need, contact the American Red Cross at 1 800-HELP NOW (1-800-435-7669 English / 1-800-257-7575 Spanish). For further information call the SFGives phone line at 415/558-2706. Gift from Avon Foundation Ms. Kronenberg is pleased to report a new gift of $1 million from the Avon Foundation to San Francisco General Hospital Medical Center. This gift will allow for continued growth and maturity of the programs established at SFGHMC with funding from the initial gift from the Avon Foundation in 2001. The key program components receiving funding are: (1) expansion of Genetic Counseling and Genomic Diversity Program, (2) bridge funding of the Mammography Van Community Outreach Program, and (3) completion of the Surgical Procedure Suite in the Avon building to accommodate minor surgical procedures such as breast biopsies. Water & HIV A pilot study with relevance to the HIV community in San Francisco by Professor Jack Colford's research group at UC Berkeley was published in June in the Journal of Water and Health. The study builds on the results of an earlier study by SFDPH that found higher risk of cryptosporidiosis for people with AIDS who drank tap water. In this new study, 50 people who were HIV positive were randomized to either have an active water filter on their drinking water tap (n=24), or to have a sham filter (n=26). They kept diaries of highly credible gastrointestinal illness (HCGI) but were not formally diagnosed with cryptosporidiosis or any other pathogen. The study was conducted among HIV+ persons who did not necessarily have a diagnosis of AIDS. Forty-five people completed the study. The adjusted relative risk of HCGI was 3.34 times greater in those with the sham device compared to those with active water filters. The risk associated with drinking unfiltered tap water is consistent with the risks suggested by the earlier Aragon study. An important consideration in interpreting this study is that this was a small pilot study, designed to test the study protocol and derive preliminary estimates of rates of disease in order to determine the sample size necessary to achieve statistical significance in a formal study. This study corroborates the Department’s current recommendation that people with HIV either boil, filter, or use bottled water. Newcomers Health Program Collaborative The Newcomers Health Program, in collaboration with Bay Area Community Resources, Ocean Park Health Center and Family Health Center, has received four years of funding to launch the Let’s Be Healthy! (Будем здоровы) Project. A primary matching grant of $374,000 was received from the Robert Wood Johnson Foundation’s (RWJF) Local Initiative Funding Partners, and local funding partners, The California Endowment, Mount Zion Health Fund and the Jewish Community Endowment Fund, have matched it with nearly $300,000 additional dollars. Let’s Be Healthy! (Будем здоровы) is a health and well-being promotion project for the City’s estimated 25,000 Russian-speaking newcomers. The project, whose name in Russian (Будем здоровы, pronounced “boo-gdee-am zta-ro-wvee) is commonly used as a greeting of well-being for friends and family, expects to support Russian-speaking community members in leading healthier lifestyles by increasing awareness, creating an environment that supports healthy lifestyles, and sustaining these efforts by developing community leadership. In addition, a chronic disease management component, which includes group medical visits for Russian-speaking patients with the metabolic syndrome and provider education, will be implemented through collaboration with Ocean Park Health Center and Family Health Center providers and staff. Paul Carlisle Accepted as Fellow Paul Carlisle, MPT, GCS, Rehabilitation Coordinator at Laguna Honda Hospital and Rehabilitation Center, has been accepted as a Fellow to the California Health Care Foundation Leadership Program. The goals of this two-year fellowship are to provide education and training to clinically trained healthcare professionals to acquire experiences, competencies and skills necessary for effective vision and leadership of our health care system in order to positively influence health care policy and delivery in California. Graduates of the fellowship acquire broadened management and sharpened leadership skills, and gain unique and thorough insight into the trends and challenges facing health care leaders in California. Mr. Carlisle, a senior physical therapist and geriatric clinical specialist, will be joining the 2005–2007 class of Fellows. Other LHH staff who are alumnae of the CHCF Leadership Program include Lisa Pascual, MD, Chief of Rehabilitation Services at LHH and SFGH, (Class of 2001–2003) and Mivic Hirose, RN, Chief Nursing Officer (Class of 2002–2004). Community Health Network, San Francisco General Hospital, September 2005 Credentials Report 09/05 07/05 to 09/05 New Appointments 20 33     Reinstatements 0 0 Reappointments 43 78     Delinquencies: 0     Reappointment Denials: 0     Resigned/Retired: 16 29 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Deceased 0 0 Changes in Privileges     Additions 5 10     Voluntary Relinquishments 5 4     Proctorship Completed 2 6     Proctorship Extension 0 6 Current Statistics - as of 09/1/05 Active Staff 467 Affiliate Professionals (non-physicians) 193 Courtesy Staff 552 TOTAL MEMBERS 1,212 Applications In Process 24 Applications Withdrawn Month of September 2005 0 0 (07/05 to 09/05) SFGH Reappointments in Process Oct. 2005 to Jan. 2006 164 Commissioners’ Comments Commissioner Monfredini thanked Catholic Healthcare West, particularly Commissioner Umekubo and Commissioner Illig, for being part of an extraordinary charitable effort. Commissioner Chow said the television media did not have a lot of good information on the impact of the hurricane. He is proud of people like the Mayor, Anne Kronenberg and other DPH staff and all of San Francisco for their response and offers to help. San Francisco should also be proud of its emergency preparedness plans. It would be helpful if other Bay Area counties could partner with San Francisco is providing services to hurricane survivors so that more people could be served. San Francisco can galvanize a Bay Area-wide response. Ms. Kronenberg replied that regional planning for disaster preparedness had already begun, which provides a good framework. In addition, San Jose has offered to take hurricane survivors. Ms. Kronenberg said the City has learned from the lessons of the 1989 earthquake and El Nino and the Health Department is committed to getting people permanent housing rather than keeping them in shelters. Commissioner Illig is proud of San Francisco’s response. He asked if FEMA has committed to reimbursing the City for its efforts. Ms. Kronenberg said that the State did not want San Francisco to provide services to survivors, and said that if San Francisco took this step, it would do so without FEMA reimbursement. The State has since been shamed into taking action. DPH will work to get FEMA reimbursement. Commissioner Guy said the Health Commission fully supports this effort, as does the citizenry. Commissioner Guy said there are clear racial and economical aspects to the impact of this natural disaster. She is particularly concerned with preparedness for the aged and those with chronic, long-term health issues. The effects of this disaster will be long term. Commissioner Sanchez said that San Francisco stepping forward and using its experiences would create different pathways, for example the Presidio Trust, refurbished units at Hunters Point and other models. We need to think in terms of families, not just number of people. He also suggested partnerships with institutions of higher learning and the Northern California Community Funds. Commissioner Tarver thanked DPH staff for their tremendous efforts, which came at personal expense. The disparities in New Orleans and the entire region are acute. It is so appropriate that San Francisco, which brings so many culturally competent services, is stepping up to the plate. There might be a reticence on behalf of some people to participate in mental health therapy, but this can be overcome with patience and persistence. Trauma might also be delayed and we need to keep this in mind. Commissioner Umekubo thanked Ms. Kronenberg and DPH staff for their tremendous response to this tragedy. He encouraged staff to ask other providers for assistance. In times like this, people are paralyzed and do not know what to do to help. A natural disaster could happen anywhere, and this episode taught us a lesson that we as a country need to mobilize for a disaster. 5) CONSIDERATION OF A RESOLUTION APPROVING A DEEMED APPROVED USE ORDINANCE FOR OFF SITE ALCOHOL SALES Ana Validzic, MPH, YouthPower Project Coordinator, Community Programs and Prevention, presented the proposed Deemed Approved Use Ordinance. Alcohol is a contributing factor for many diseases and injuries. Research has found that alcohol outlet density significantly impacts alcohol consumption as well as its related problems (e.g., drunk driving, homicides, and suicides). Currently, San Francisco has over 3,600 alcohol licenses, which is approximately one alcohol outlet for every 200 residents. This is the highest concentration of licensed alcohol outlets of any county in California. The Deemed Approved Use Ordinance establishes performance standards for off-sale alcohol outlets and provides funding for additional enforcement of the performance standards by the San Francisco Police Department. To assist off-sale alcohol outlets, the Deemed Approved Ordinance provides funding for a new education and outreach program through the Department of Public Health to help businesses establish “Good Neighbor” policies and to avoid violations of local nuisance laws. To facilitate communication and a partnership among off-sale alcohol outlets, the Deemed Approved Ordinance establishes a new citizen advisory board, the Alcohol Outlet Advisory Board, comprised of neighborhood representatives, youth, storeowners, and members of business associations. The Alcohol Outlet Advisory Board will serve as a forum for complaints, compliments, and suggestions regarding the ordinance, its application, and specific off-sale alcohol outlets. The Health Department, San Francisco Community Action Live (SFCAL) and a citywide prevention youth council of the Youth Leadership Institute (YLI) are working with Supervisor Sophie Maxwell’s office to enact a Deemed Approved Use Ordinance in San Francisco. Maureen Sedonaen, president of the Youth Leadership Institute, said the DAUO is pro business, helps communities take charge of their neighborhoods and gives people a tool to improve life and vitality of businesses and residents. Ms. Sedonaen added that over the last few years, more than 120 young people in San Francisco have worked to bring this ordinance to fruition. Commissioners’ Comments Commissioner Chow asked if alcohol outlets support this ordinance. Ms. Sedonaen said they have been working with individual merchants and store owners in the Tenderloin, South of Market and Bayview who support the ordinance. Action Taken: The Commission approved Resolution 13-05, “Supporting the Deemed Approved Use Ordinance,” (Attachment A). 6) HEARING IN ACCORDANCE WITH THE HEALTH CARE PLANNING ORDINANCE (PROPOSITION Q): CLOSURE OF ST. LUKE’S HOSPITAL PSYCHIATRIC/BEHAVIORAL HEALTH INPATIENT UNIT Anne Kronenberg said DPH has been attempting to move people from institutionalization into the community. Four years ago, DPH made the decision not to close a unit at the San Francisco General Hospital psychiatric inpatient unit. In return, DPH committed to decreasing administrative days at SFGH by moving patients to the appropriate levels of care within our own system. In addition, DPH said it would rely less on sending people to community hospitals such as St. Luke’s and St. Mary’s. This has been happening for the past four years. The result is that private hospitals have reduced their inpatient beds and the accompanying services. One of the reasons St. Luke’s is before the Health Commission today is a result of a policy decision DPH made four years ago. Jim Strong, CFO, Director of Operations for St. Luke’s Hospital, said a team of staff from St. Luke’s would describe the reason for the closure and how the hospital is committed to not abandoning its patients. Dr. Marc Snyder, Chief of the Emergency Department and member of the Board of Trustees, said St. Luke’s needs to close its psychiatric unit because of St. Luke’s on-going financial distress, low program volume, changes in the community standard of care and availability of more appropriate and comprehensive care elsewhere. Dr. Snyder said that the average census in the psychiatric unit is five to six patients per day. Patients are not being abandoned, as there will still be competent staff in the emergency room to evaluate and stabilized patients and if they need acute care they would be transferred to other facilities. He is hopeful that they will be able to expeditiously transfer patients so as not to delay treatment. Diana Netherton, Chief Nurse at St. Luke’s Hospital, said this year the inpatient psychiatric unit has had an average daily census of six patients. Last year the daily census was seven. Low volume dilutes a program’s quality over time. They have been unable to fill positions because of the instability of the program. The trend in low volume is because the standard of care is caring for people in a community setting, rather than in locked-down wards. The therapeutic milieu is focused on community of care. They are aware that closing psychiatric services will impact the people that work for them. They are confident that they would be able to absorb the RNs either at St. Luke’s or at other Sutter facilities. Current program staff are: 12 mental health workers, 10 RNs, 1 clerk and 2 physicians. Tom Travers, Director of Nursing Operations, has responsibility for the psychiatric ward. There has been a difficulty filling nursing positions, as well as maintaining skills due to a low volume. There are also facility limitations, and the setting is not conducive to patient safety. He does not think St. Luke’s will abandon the psychiatric patients. They will serve them in the emergency room. They are emphasizing acute care in the Mission, and the psychiatric unit simply does not have the volume to sustain service. Dr. William Miller, Chief Medical Executive of St. Luke’s, said St. Luke’s has experienced a few decades of decline, and Sutter Health has infused them with resources to give them new life. In the past few months they have built a new cardiac care center, a new orthopedic center and a new pediatric center. In the next few years they plan to do a complete renovation of the emergency department. They are in the process of expanding their oncology services. He presented a number of quality initiatives, including receiving JCAHO accreditation, the Leap Frog Initiative, a Medicare pneumonia initiative and participating in the 100,000 Lives Project. As they go through this period of growth, they must evaluate the programs they want to focus on. This is the backdrop upon which the decision was made to close the inpatient psychiatric unit. Jim Strong concluded the presentation by saying that over the last four years, Sutter Health has contributed $163 million to modernizing a hospital that has a rich history in San Francisco but was almost bankrupt. The hospital is basically a primary care hospital, and they have to be judicious in which services they provide. St. Luke’s relationship with CPMC has allowed St. Luke’s to share expertise with doctors and other healthcare professionals. For example, cardiologists from CPMC are now performing diagnostic cardiac cath procedures at St. Luke’s. Mr. Strong invited the Commissioners to visit the hospital. Commissioners’ Comments Commissioner Monfredini expressed extreme displeasure that Sutter Hospital and CMPC have not sent representatives to this meeting. She is also displeased that St. Luke’s did not provide any information about the proposed closure to the Health Commission prior to the hearing. She asked how much money St. Luke’s is losing per year. Mr. Strong said the hospital lost $23 million in 2004. The average daily census for 2005 is 56 acute care patients. Clearly the revenue base and payor mix are undesirable. Commissioner Monfredini asked who generated the idea to close the inpatient psychiatric unit. Mr. Strong said it was entirely a St. Luke’s decision. CPMC and Sutter were not part of the decision-making process. Commissioner Illig understands the plan has been to minimize the use of inpatient beds, yet he read in the SFGH JCC minutes that there is such a backlog of patients at SFGH PES that we are now considering Code Yellow and Code Red. This does not make sense. Ms. O’Connell said the hospital made a real effort to not use other hospitals in the city, but instead focus on using DPH beds, and DPH, through patient flow efforts, has reduced the use of PES. As a result over the last few years they have referred a low number of patients to St. Luke’s. That said, SFGH is the only psychiatric emergency facility in San Francisco. PES has the capacity for 16 and over the last few months there has been the demand for up to 24 patients. This has forced SFGH to look at doing things differently. Working closely St. Francis, Ms. O’Connell believes they will be able to handle to inpatient issue. The real challenge is in the emergency department, and St. Luke’s needs to be able to continue to hold and stabilize patients in its emergency room. In the future they are going to have to ask all hospitals to hold patients if PES is full. Commissioner Illig asked if SFGH refers to CPMC’s facility. Dr. Cabaj said that DPH does not contract with CPMC because of their lack of compliance with the City’s Sunshine Ordinance. But there is spillover occassionlly. Dr.Cabaj reiterated that DPH has not contracted with St. Luke’s for inpatient services for the past two years. Commissioner Chow asked how many patients were transferred from SFGH to St. Luke’s. Dr. Cabaj said that this year, which began on July 1, they transferred eight clients to St. Luke’s. Last year they transferred 155 and the year before 154. This is consistent with the data provided by St. Luke’s. Commissioner Chow asked how much money the closure would save and when it is effective. Mr. Strong said they anticipate $1.5 million per year in savings. The closure is effective October 1. Commissioner Tarver asked why there has been such a decline. Dr. Cabaj said that the patient days and volume were relatively consistent in 2003 and 2004. Commissioner Sanchez asked if DPH offered to contract with St. Luke’s. Dr. Cabaj said yes, but St. Luke’s declined. Commissioner Sanchez asked if they did accept a contract, would that change the number of patients that are in the facility. Mr. Strong replied that St. Luke’s offered the default rate and DPH offered less than the default rate. So they were unwilling to sign to contract. Commissioner Sanchez is frustrated that the Health Commission has had to ask questions and comment today on the details of the closure because St. Luke’s didn’t provide any information in advance of the hearing. Mr. Strong said that he would submit all the information in the required testimony by 5 p.m. Wednesday, September 7, 2005. Commissioner Tarver asked St. Luke’s to provide information about total FTEs allotted to the inpatient psychiatric unit, including those that are vacant. He wants to get a total picture of what the staff complement is supposed to be, as opposed to what it currently is. Mr. Travers said there are 3.2 RN FTEs, 3.2 mental health worker positions, 1.4 clerk positions, a .5 psychologist position and two physicians. Commissioner Guy would also like additional information about the future of St. Luke’s, which Dr. Miller touched upon in his presentation. St. Luke’s has been a contributor to all San Franciscans, and most particularly our vulnerable citizens. St. Luke’s needs to share this information and be accountable to it, otherwise people are forced to learn through the newspaper and telephone calls. Mr. Strong said that their boards and medical staff continue to discuss a potential merger with CPMC. When the Boards of Trustees make a decision about what the merger is going to look like, they will present this information to the Health Commission. Commissioner Guy said the Commission works on behalf of the community and they cannot tolerate further fraying. Commissioner Monfredini asked Jim McCaughey of CPMC to comment on the possible merger with St. Luke’s Hospital. Mr. McCaughey said the merger is not a fait accompli but the two hospitals are working diligently to make this happen. He reiterated that they would return to the Health Commission once a decision was made. The primary goal is to retain acute care services at St. Luke’s, and the closure of the inpatient psychiatric unit is supportive of this direction. Commissioner Illig asked what steps St.Luke’s is taking to meet the State’s seismic safety standards. Mr. McCaughey said they have looked a various scenarios, but have not chosen an option yet. Commissioner Illig asked if all scenarios include an impatient facility at St. Luke’s Hospital. Mr. McCaughey said they do. The first priority is the renovation of the emergency department. Commissioner Illig read from the May Sacramento Business Journal in which a former Sutter CEO said St. Luke’s would stay with mental health. Commissioner Illig asked again about transferring patients from St. Luke’s to the CPMC psychiatric inpatient unit. Mr. McCaughey said he has discussed this with the chief of psychiatry, and there is the capacity to be part of the solution. Commissioner Tarver asked why Sutter isn’t infusing resources into psychiatry. He also asked for the JCAHO comments about the psychiatric unit. The issue is not lack of need. Also, psychiatry patients also have medical needs, and these needs are likely addressed at St. Luke’s, in their community. Commissioner Guy asked the follow-up information to include information about the timeline for a potential merger. Commissioner Chow asked St. Luke’s to include in the information they are responding to whether the Sutter system is willing and able to care for the eight patients that had been served by the St. Luke’s psychiatric unit. This would go a long way in mitigating the impact of the proposed closure. These patients need to have a place to go to. Commissioner Monfredini asked St. Luke’s to include in its packet information on the mental health outpatient services, and whether or not they intend to continue these services. Mr. Strong said they intend to continue to provide pharmaceutical services through the outpatient pharmacy. However, the outpatient counseling services that are also located on the unit are intended to close when the inpatient unit close. They intend to work with Progress Foundation to provide outpatient services to these patients. Commissioner Monfredini said it was a large omission in not informing the Commission about this. She asked Dr. Cabaj to find out if DPH has a formal contract with St. Luke’s for outpatient mental health services. Commissioner Chow asked if the two psychiatrists positions would be eliminated. Mr. Strong said they would continue to contract with one of the two physicians to provide the consultation and call services so that they have 24/7 coverage by a psychiatrist. Commissioner Sanchez said that it seems as though St. Luke’s is not keeping with its unique historical mission of being an integral part and partner in serving the indigent. He wants to see that the mission will remain constant. They have the community, staff, and physicians. It is a fantastic place. So instead of having closed discussions, St. Luke’s should be forward with its plans. He is concerned that this flagship institution is going to be dismantled. Jim McCaughey said the goal is to maintain St. Luke’s mission. Commissioner Monfredini asked Health Commission and DPH staff to discuss with the City Attorney whether or not an additional Proposition Q hearing is required to discuss the closure of the Outpatient Mental Health Program at St. Luke’s. This greatly concerns her because the proposed closure is October 1. Public Comment Joseph Smooke, Executive Director of Bernal Heights Neighborhood Center, has concerns about closing this unit. Why have the numbers dropped so precipitously, when they have served so many more patients in the past? Is there a strategy behind this? The need certainly has not diminished. Dr. Eugene Gaenslen, Physicians Organizing Committee, asked why we are discussing yet another step backward for our City. Sutter Corporation is not being held to its promise that they would not close any facilities. There are not enough psychiatric services in San Francisco. We should be addressing the problem of dire psychiatric need in San Francisco, not closing St. Luke’s. He submitted a written copy of his testimony, which is on file in the Health Commission office. Judson True, aide to Supervisor Sandoval, read a statement from Supervisor Sandoval. St. Luke’s is only one of two hospitals in the south of market area. Many people in District 11 rely on St. Luke’s for care. Sutter’s statement that they are going to close the inpatient psychiatric services means that patients are forced to travel longer distances for their care. Sutter Health can easily afford to operate St. Luke’s at its current capacity. A copy of Supervisor Sandoval’s statement is on file in the Health Commission Office. Mauricio Vela voiced his concern about the closure of the inpatient psychiatric services at St. Luke’s. Sutter needs a real planning process with real community input and to disclose the future of St. Luke’s. Alma DiStefano volunteered at St. Luke’s when she was in high school. She recently had to visit a friend in the inpatient psychiatric unit. To take this resource away from the Mission without even providing outpatient care is a big deal. They are playing with people’s lives. She also does not understand how they can only be serving six patients. Dr. Eugene Yee, attending psychiatrist at St. Luke’s Hospital, said he’s seen myriad executive staff come and go from St. Luke’s. The staff has never been informed about changes. The reason the census has gone down is that the staff has decreased. When they had the appropriate staffing, they could carry a larger census. They historically had 30 beds available. There are 5-10 referrals a week that they have to turn down. He is also concerned about outpatient psychiatric services. He is being fired. Roy Recio said that San Franciscans need mental health services. St. Luke’s is the only resource for the Excelsior neighborhood. He hopes the Health Commission makes a decision that will help the neighborhood and the community. Sara Angulo, housekeeper at St. Luke’s Hospital for 21 years, said Sutter help can easily afford to keep all services open at St. Luke’s, including the psychiatric inpatient unit. During the past two years, CPMC report nearly a quarter of a billion in profit. John Kosinski, Health Care Workers, said his members deal with the arrogance of Sutter and St. Luke’s on a daily basis. Not once have they had any meetings with the community about the plan to rebuild St. Luke’s to meet seismic safety standards. Sutter does not respect the Health Commission and does not respect San Francisco. CPMC makes $100 million a year in profits. Sutter has the resources to keep this hospital operational and dedicated to the community. Unfortunately the goal of Sutter is to maximize profits. Emily Gordon, Aide to Supervisor Tom Ammiano, read a statement from Supervisor Tom Ammiano. St. Luke’s Hospital has been a vital community institution for thousands of residents. It is located in a part of the city that is medically underserved and also provides charity care in amounts that far exceed any other private hospital in the city. Sutter’s announcement to cut inpatient psychiatric services at St. Luke’s is a clear sign that it is operating under its own agenda without any real consideration of the community’s health needs. A copy of Supervisor Ammiano’s statement is on file in the Health Commission Office. Teresita Gatan said many people rely on psychiatric services at St. Luke’s. People in the Mission, Bernal Heights, Bayview and Excelsior need to have services in their community. Sutter has broken a number of promises. Karl Kramer, a resident of the Mission and member of the community committee to save St. Luke’s Hospital, said that for more than a century St. Luke’s has provided quality medical services to people south of market and West of Twin Peaks. There needs to be a real planning process where community members and the public are truly involved in planning for services. There needs to be more transparency from Sutter on what their plans are for St. Luke’s. Fe Purganan, employee at the SF Behavioral Health Center, said if Sutter closes St. Luke’s psychiatric services, the patients would come to SFGH, which is already overburdened. Please make Sutter think twice about closing the unit. Gillian Gillet, co-chair of the San Jose/Guerrero Coalition to Save Our Streets, said they have been surveying the neighborhood around St. Luke’s. The reason many people in the neighborhood will not go to St. Luke’s is that people perceive a decline in services and that they should go to CPMC. It seems that St. Luke’s is losing ground. There needs to be long-term planning for the health infrastructure in the City. Michael Music, Hospitality Coordinator at St. John the Evangelist, said St. Luke’s is about healing, healing is about relationships and relationships are about honestly. He quoted Reverend Thomas Brotherton: “If it’s difficult, we’ll help you; if you don’t know how, we’ll show you; if you simply refuse, we’ll make you.” Written Testimony submitted regarding the Proposition Q Hearing (all on file in the Health Commission Office) Mike McLoone, St. Luke’s psychiatric unit serves many low-income people. Any reduction in San Francisco’s capacity to serve this population will result in crisis. Sutter needs to be reminded of its promises to the California Attorney General to keep the psychiatric ward open. Chris Colwick, most of St. Luke’s psych. patients are homeless or low-income and have very few options for services. If they do not receive proper care from Sutter, there is a good chance they will need even more costly and intensive services. Sutter was not supposed to do this according to an agreement with the State Attorney General. 7) PUBLIC COMMENT/OTHER BUSINESS None. 8) ADJOURNMENT The meeting was adjourned at 6:00 p.m. Michele M. Seaton, Executive Secretary to the Health Commission Attachment: (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.