Minutes of the Health Commission Meeting Tuesday, November 15, 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 3:20 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 Donald E. Tarver, II, M.D. Commissioner David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. – left at 5:50 p.m. President Monfredini thanked Commissioner Sanchez and Commissioner Tarver for filling in at the November 8, 2005 San Francisco General Hospital Joint Conference Committee. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF NOVEMBER 1, 2005 Action Taken: The Commission approved the minutes of the November 1, 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) PHP-Housing and Urban Health – Request for approval of a contract modification with Lutheran Social Services, in the amount of $52,500, for a contract total of $221,192, which includes a 12% contingency, to provide money management and third-party rent payment services to residents of the Department of Public Health’s Direct Access to Housing sites, for the period of July 1, 2005 through September 29, 2006. (3.2) PHP-Epidemiology – Request for approval of a contract modification with the San Francisco Study Center, in the amount of $314,790, for a new three-year total of $363,619, which includes a 12% contingency, to provide fiscal agent services for the San Francisco Immunization Coalition, for the period of July 1, 2005 through June 30, 2008. Commissioners’ Comments: Commissioner Chow asked if the registry is just for children with MediCal. Andrew Resignato, director of the Immunization Coalition, replied that the money the Commission is approving with this contract is from the State and focuses on the MediCal population. However, the coalition’s focus is on all children, and other sources of funds are available for this effort. (3.3) PHP-AB75 – Request for approval to authorize adoption of the County Description of Proposed Expenditure of California Healthcare for Indigents Program (CHIP) Funds for Fiscal-Year 2005-06. (3.4) PHP-AIDS Office – Request for approval to accept and expend a new grant from the Health Resources and Services Administration, in the amount of $110,343, for the period of September 30, 2005 to September 29, 2006. (3.5) AIDS Office-HIV Health Services – Request for approval to accept and expend a new grant from the Office of Minority Health in the total amount of $849,167, for “Community of Color CBO Capacity Building Project”, for the period of August 1, 2005 to July 31, 2008. Commissioners’ Comments Commissioner Illig, commenting on Item 3.4 and 3.5, asked what standards would be used to judge if the grants were successful. Jimmy Loyce, AIDS Office Director, said that for the transgender program, the measures are the number of transgender individuals that participate in developing the trainings, the number of staff that get trained and patient satisfaction. The Office of Minority Health grant is targeted toward agencies that are underdeveloped in a variety of areas. These agencies are identified either through the contract monitoring or by the agency itself. Staff will identify best practices, apply these practices and evaluate whether the agency has successfully implemented them. (3.6) AIDS Office-HIV Health Services – Request for approval of a retroactive contract renewal with Dolores St. Services, in the amount of $194,916, which includes a 12% contingency, to provide paraprofessional support services and assistance with activities of daily life allowing clients to continue living independently. The services include non-medical and non-nursing assistance such as housecleaning, preparing meals, escort to medical appointments, assistance with personal care and other activities of daily living for individuals with HIV infection, for the period of March 1, 2005 through June 30, 2006. Commissioners’ Comments Commissioner Illig is aware that the agency has recently undergone administrative changes, and asked the executive director to comment on these changes. Eric Quezada, Executive Director, said currently the agency is working with the Redevelopment Agency to address issues of capital improvement and long-term sustainability of Cohen House. Marcia Herring from the AIDS Office said it has been a real challenge working with the agency because for a time there was only three staff. As soon as Mr. Quezada identifies a day-to-day manager, the AIDS Office will provide technical assistance. Commissioner Illig said agencies’ Boards of Directors are have the responsibility to ensure that programs continue regardless of whether an E.D. or program director or anyone else leaves. Commissioner Chow asked when the additional staff would come on board. Mr. Quezada said he is hiring the R.N. and psychiatric coordinator right now. He anticipates hiring another program manager in January. (3.7) AIDS Office-HIV Health Services – Request for approval of a retroactive contract renewal with San Francisco Food Bank, in the amount of $103,936, which includes a 12% contingency, to provide food solicitation and liquid supplement to social service agencies in San Francisco that provide food services to low-income residents who are diagnosed with HIV, for the period of March 1, 2005 through June 30, 2006. (3.8) AIDS Office-HIV Health Services – Request for approval of a retroactive contract renewal with Mission Neighborhood Health Center, in the amount of $937,527, which includes a 12% contingency, to provide Early Intervention Medical Services and Bridge Project services, for the period of July 1, 2005 through June 30, 2007. (3.9) AIDS Office-HIV Prevention – Request for approval of a retroactive two-year contract renewal with Continuum HIV Day Services, in the amount of $67,200 per year, for a total contract amount of $134,400, which includes a 12% contingency, to provide Home Base Program: HIV Corrections Initiative services, which include prevention case management, single session groups and evaluation services, for the period of July 1, 2005 through June 30, 2007. (3.10) CBHS – Request for approval of a retroactive contract renewal with the NICOS Chinese Health Coalition, in the amount of $69,221 per year, for a total of $276,918, including a 12% contingency, to provide mental health services, for the period of July 1, 2005 through June 30, 2009. (3.11) CBHS – Request for approval of a retroactive contract renewal with Morrisania West, Inc., in the amount of $614,570, for a total contract amount of $688,318, which includes a 12% contingency, to provide substance abuse services targeting African American youth and young adults, for the period of July 1, 2005 through December 31, 2006. (3.12) CHPP – Request for approval of a retroactive sole source contract renewal with the Regents of the University of California-Family Health Outcomes Project, in the amount of $201,600, including a 12% contingency, to provide evaluation services to the DPH Seven Principles Project, for the period of September 30, 2005 through September 29, 2006. (3.13) CHN-SFGH – Request for approval of a new contract with Saint Francis Memorial Hospital, in the amount of $240,000, to provide outpatient Tertiary Radiation Oncology care services, targeting medically indigent adults, In-Home Supportive Service workers and San Francisco County Jail patients, for the period of November 1, 2005 through June 30, 2006. Commissioners’ Comments Commissioner Illig asked Ms. Currin to confirm that St. Francis submitted its cultural competency report. Commissioner Chow asked what mechanism would be used to decide which facility patients are referred to for radiation oncology services. Ms. Currin said at the present time St. Francis is limited in its capacity, so to start would be utilized mainly as a backup to U.C. However, St. Francis is expanding its facility, and in six to nine months will have increased capacity. (3.14) CHN-SFGH – Request for approval of a contract renewal with the Regents of the University of California, San Francisco, in the amount of $1,133,333, to provide Tertiary Care services, targeting medically indigent adults, In-Home Supportive Service workers and San Francisco County Jail patients, for the period of November 1, 2005 through June 30, 2006. Commissioners’ Comments Commissioner Illig asked that the contract review include patient satisfaction. Ms. Currin said she is working with U.C. to develop a tool to survey the patients that are served as part of this contract. Commissioner Chow said that the findings from U.C.’s survey of all patients would be acceptable. (3.15) CBHS – Request for approval of a retroactive contract renewal with Baker Places, Inc., in the amount of $3,426,688, for a total contract value of $6,853,376, including a 12% contingency, to provide substance abuse services, for the period of July 1, 2005 through June 30, 2007. (3.16) CBHS – Request for approval of a retroactive contract renewal with Baker Places, Inc., in the amount of $9,883,682, including a 12% contingency, to provide mental health services, for the period of July 1, 2005 through December 31, 2006. Barbara Garcia, Deputy Director of Health, Director, Community Programs, gave the Budget Committee background information about changes with the agency over the past few years. In Fiscal Year 2003, the agency was cut $2.7 million. DPH has been working very closely with Baker to implement this cut. To respond to this loss, and to strategize how to preserve and increase MediCal revenue, Baker Places moved and re-licensed four facilities. There were unanticipated move costs that Baker Places absorbed. During this same fiscal year, the CFO left the agency. In FY 2004, Baker began reducing services. It also became over dependent on its line of credit. DPH worked with the agency to develop a recovery plan that required them to leverage their property assets to pay off their line of credit. DPH also assisted the agency with contract flexibility so that the agency could deal with structural issues that included an increase in workers compensation costs. Most recently, DPH has been working with Baker to strengthen their fiscal capability and monitoring them to ensure that their rates reflect costs. The agency did hire a permanent fiscal officer, and they have a new auditor as well. On December 2nd, Baker will be one of the first agencies to undergo the multi-department performance review that was recently implemented through the Controller’s Office. Commissioners’ Comments Commissioner Illig said one of his main concerns is the fact that substance abuse outcomes and mental health outcomes are monitored so differently from each other. Ms. Garcia said the Department recognizes this and is working to change this through the integration process. Commissioner Illig said that one of the joint conference committees needs to take a look at the range of housing that DPH provides, including supportive housing, medically-supported detox, adult diversion and others. Commissioner Chow asked how in practice Baker links its substance abuse and mental health programs. Ms. Garcia said Baker is a good example of an agency that has multiple funding sources, which affords more flexibility to integrate. Jonathan Vernick, executive director of Baker Places, added that the mental health and substance abuse clients are basically the same population. At the agency level they have been able to mix the money and provide the services. The challenge had been the monitoring of these mixed programs, but the new combined monitoring process should address this. (3.17) CBHS – Request for approval of a retroactive contract renewal with Asian American Recovery Services, in the amount of $8,816,803, including a 12% contingency, to provide mental health/substance abuse services, for the period of July 1, 2005 through December 31, 2006. (3.18) CBHS – Request for approval of a retroactive contract renewal with Jelani, Inc., in the amount of $2,540,675 per year, for a total contract value of $5,081,350, including a 12% contingency, to provide residential and outpatient substance abuse treatment services targeting women, children and families, for the period of July 1, 2005 through June 30, 2007. Secretary’s Note – The contract term was changed to one year. The contract is for the period of July 1, 2005 through June 30, 2007. Commissioners’ Comments Commissioner Illig asked Margaret Gold, the agency’s executive director, to talk about some of the steps that have been taken to improve the agency’s performance. Ms. Gold said the past year has been a learning experience, but also provided the opportunity to make changes. She closed some programs, and is hoping to open a transitional program to enhance treatment modality. Commissioner Illig believes Jelani needs a larger board to provide the agency with the help it needs. (3.19) CBHS – Request for approval of a retroactive contract renewal with Westside Community Mental Health Center, Inc., in the amount of $7,307,323, which includes a 12% contingency, to provide mental health services and fiscal intermediary services targeting adults and youth/adolescents, for the period of July 1, 2005 through December 31, 2006. (3.20) CBHS – Request for approval of a retroactive renewal contract with Seneca Center for Children and Families, in the amount of $3,081,574 per year, for a total contract amount of $9,117,642, including a 12% contingency, to provide residential, day treatment and therapeutic behavioral health services, for the period of July 1, 2005 through June 30, 2008. (3.21) CBHS – Request for approval of a retroactive renewal contract with Hyde Street Community Services, Inc., in the amount of $2,349,911 per year, for a total contract amount of $9,185,552, including a 12% contingency, to provide outpatient mental health services targeting adults in the Tenderloin area, for the period of July 1, 2005 through December 31, 2008. Commissioners’ Comments (at Health Commission meeting) Commissioner Illig noted that the Budget Committee requested that the contract summaries that are given to the Health Commission as part of the Budget Committee packet are sent to the contractors as well. Action Taken: The Commission approved the Budget Committee Consent Calendar. Commissioner Tarver abstained from voting on Item 3.15 and Item 3.16. Commissioner Chow abstained from voting on Item 3.10. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Royal Visit Prince Charles and his wife, the Duchess of Cornwall, visited the Empress Hotel on Tuesday, November 8th. The Empress is DPH’s newest supportive program providing housing for 90 previously chronically homeless people. The Royal couple was extremely knowledgeable and interested in the issue of homelessness, asked insightful questions regarding substance use and mental health issues. As it should be, the attention of the event was focused on the tenants of the building, with many residents having the opportunity to have genuine conversations about their lives and the success and struggles that they continue to have as they recover from life on the streets. It was an extremely positive experience for all participants as well as bringing worldwide attention to the issue of homelessness and the power of supportive housing. Many thanks to Marc Trotz and his staff for the fine work they did in making the visit a memorable event for everyone. Golden Guardian Exercise The Department participated in today’s Golden Guardian Exercise. This Bay Area wide exercise was designed to test the coordination of the activities of city, county and State government, first responders, volunteer organizations and private industry in response to terrorism. Today’s exercise was predicated don the use of explosive devices (IED) and a chemical release. The event occurred in multiple sites within the State of California. This exercise will enhance interagency coordination and cooperation, provide training to staff, test response and recovery capabilities, activate the Standardized Emergency Management System (SES) and the mutual aid system. San Francisco’s role in the exercise provided mutual aid. Two hundred volunteers acted as patients and arrived by Ferry to Pier 31, where they were triaged and transported to San Francisco hospitals. San Francisco continues to test its emergency response systems to ensure that in the event of a disaster, we are prepared to respond appropriately. Board of Supervisors Hearing on HMA Report On November 14th the Audit and Government Efficiency Committee of the Board of Supervisors held a hearing on the HMA report. Dr. Katz submitted the Department’s response to the report, which he attached to the commissioners’ copies of the Director’s Report. The hearing went well with the majority of testimony focusing on the size and role of Laguna Honda Hospital (LHH) within the City’s long-term care system. JCAHO Survey Scheduled at SFGH The JCAHO Laboratory Survey, which will include the Clinical Laboratories, Anatomic Pathology Laboratories and Nuclear Medicine, is scheduled for November 15 – 18, 2005. There will be one surveyor who will follow the tracer methodology; therefore, the entire hospital needs to be prepared. The survey will cover such areas as the National Patient Safety Goals, any recommendations for improvements (RFIs) from the 2005 hospital survey, point of care testing (POCT), and provider performed microscopy procedures (PPMP). In preparation for this survey, the entire hospital staff and the medical staff—including house staff—have paid particular attention to these areas. SFGH Medical Helipad Project Update Dr. Katz reported that more progress has been made in moving the SFGH Helipad Project ahead. The Initial Study for the draft EIR was published on October 29, 2005. Written comments on the Initial Study and scope of the EIR will be received by the Planning Department during a 30-day public comment period that ends on November 30 at 5p.m. The full text of the Initial Study is available on the SFGH Medical Helipad web page www.dph.sf.ca.us/helipad. It is also available for public review at the Main Public Library, at SFGH neighborhood branches [Potrero, Mission, Bayview] and at the SFGH Hospital Library on campus. The next step in the EIR process is to write and publish the draft EIR. A 45-day public comment begins with the publication of the draft EIR and a public hearing before the Planning Commission will also take place. Design drawings for the rooftop medical helipad are currently in development in support of the EIR. Mobile Eye Van Wins Award The California Association of Public Hospital and Health Systems (CAPH) have co-awarded San Francisco General Hospital and the Community Health Network Primary Care top honors in the 2005 Management Excellence Award for the SFGH Mobile Eye Van. The entry category was Using Technology to Improve Patient Care. Since first hitting the road on September 8, 2004, the Eye Van has provided services to over 1000 patients and has substantially helped improve our efforts to screen for diabetic eye disease. In collaboration with LensCrafters, the Eye Van staff has provided eye exams and glasses to over 400 homeless individuals during two Project Homeless Connect Events in June and August of 2005. Alexander Li, MD from Chinatown Health Center, and Gene O'Connell, Stuart Seiff and Terry Dentoni from SFGH will accept the award during the upcoming CAPH Annual Conference. New Specialty Care Unit to Open at LHH Consistent with its vision to be a “center of excellence...supporting residents’ highest level of independence,” Laguna Honda Hospital and Rehabilitation Center (LHH) is developing a new specialty resident care unit to better meet the needs of residents who are substantially challenged by cerebral palsy, epilepsy, autism, or mental retardation. The new unit will provide programs and services specializing in enhancing the clinical care of intellectually disabled/developmentally delayed (ID/DD) residents. Staff has found that a focused program helps LHH staff provide improved services for residents with special needs. The focused programming will help staff to better coordinate services for ID/DD residents, many of whom participate in community programs, and provide them with better synchrony to their day program. The new unit was selected in part for its close proximity to hospital-wide activities and ready access to transportation, which would facilitate access to community services. The unit is targeted to open on December 6, 2005. Nurse managers and medical social workers at LHH are working closely with the selected ID/DD residents and their families to prepare them for the move, and get input on services and programs that they would like to have on the unit. Culturally Responsive Care Grant San Francisco General Hospital has been selected to participate in the second cohort of the LEADing Organizational Change: Advancing Quality Through Culturally Responsive Care. The LEAD program is funded by The California Endowment and is a partnership between the UCSF Center for the Health Professions and the California Health Care Safety Net Institute. The one-year, $50,000 grant will be used to further the work of the African American Health Disparity Project which develops and implements hospital -based interventions that improve the health of African Americans. Avian Flu Task Force Formed As a response to the increasing attention on the avian influenza worldwide, the Communicable Disease Control and Prevention Section (CDCP) has taken the lead in forming the City’s Avian/Pandemic Influenza Task Force. This group is an extensive collective of City and County Departments and Agencies, including SFPD, SFFD, Sheriff's Department, DHR, SFO, DPW, Port, Rec and Park, Medical Examiner, ACC, SFPUC, DHS, MUNI, DPT, ECD, OES, and the Mayor's Office. The goals of the group are to stay updated and informed on the current situation with avian influenza and its potential to evolve into a pandemic state; ensure that each department or agency is working to develop their own response plans; and finally, to ensure that all plans are coordinated city-wide. The Task Force will be meeting every 2-4 weeks for the next several months. In addition, CDCP sent out an Influenza/Avian Flu Health Advisory on Tuesday November 8 to all SF clinicians, hospitals and infection control practitioners. The Advisory and other up-to-date information can be found on the CDCP website: www.sfcdcp.org. Overdoses and Harm Reduction. The number of fatal overdoses in San Francisco has dropped ever since harm reduction programs were implemented in the county. Drug overdose may soon surpass auto accidents as the leading cause of accidental deaths in California; but in San Francisco, the death from drug overdoses is at its lowest level in nearly a decade. The number of overdose deaths in San Francisco, which has one of the highest rates of drug use in the state, has fallen from 178 in 1998 to 144 two years ago. (Since then, the number may have dropped even further to fewer than 100 deaths annually.) Meantime, the statewide figures went up 42% for the same time period. San Francisco has embraced a number of harm reduction practices in recent years. For example, in 2003, San Francisco became the first county in the state to publicly fund naloxone distribution. Naloxone is a medication that can revive an overdosing opiate addict within minutes. Addicts in San Francisco have reported saving 116 fellow-addicts with the medication. UCSF Urban Health Study Preliminary data from an Urban Health Study (University of California-San Francisco) suggested that intravenous drug users (IDUs) who received SSI benefits were more stably housed, less reliant on illegal income, used drugs less frequently, and shared needles less often than IDUs without SSI benefits. In other words, it appears that SSI benefits contribute to general life stability and a reduction in drug-related harm. This finding is consistent with many other studies that have shown that drug users who receive income supports and/or subsidized drug treatment are less likely to be homeless, engage in illegal activities, or use drugs. Police Crisis Intervention Training Dr. Katz brought the Health Commissioners up to date on the Department’s Police Crisis Intervention Training, a program designed to help police officers work more effectively with mental health consumers and give them options for helping those individuals who come in contact with law enforcement officers. Last month marked the 15th completed training session bringing the total number of officers taking the course to 420. The San Francisco Police Department alone writes 3,000 to 6,000 5150’s per year, giving San Francisco the highest 5150-rate in the state. This 40-hour training course is a collaboration between a number of agencies and Departments: CBHS, SFPD, Mental Health Board, Jail Psychiatry, San Francisco General Hospital, Progress Foundation, Bay View Clubhouse and behavioral health consumers. The officers begin the training by visiting clinics and acute diversion units. Early in the program, a consumer group, "Stamp out Stigma," shares stories of their personal experiences with psychiatric treatment and law enforcement. The officers also tour inpatient units at San Francisco General Hospital. This is followed by a session on disabilities, child crises services, older adult services, as well as a chance to quiz Bob Cabaj, MD about Community Behavioral Health Services. At the conclusion of the training program, Chief Heather Fong and many of her Command Staff provide the officers with certificates. One of the key benefits of this program is that CBHS staff and officers get to know each other, which helps provide clients the best possible chance to be directed to the health services they need. When officers are aware of the behavioral health service sites, they are more likely to guide clients to clinics. Another outgrowth of this program is the Advanced Officer Training in Mental Health, which is presented up to four times each month at the SFPD Academy. Officers receive lectures on suicide assessment and how to work effectively with Mobile Crisis. A total of 391 officers have gone through the Advance Training program. In recognition of the time and effort put out by CBHS and affiliated employees, the SFPD has provided a series of trainings at the SFPD Academy to DPH staff. The training includes simulations of law enforcement activities such as safety training, progressive use of force and even driving simulations. SFPD also provided Mobile Crisis Director, Carolyn Kaufman, the opportunity to take a forty-hour course leading to Police Officer Safety Training Instructor Certification so that officers taking her classes can receive POST credits. DPH is very pleased with these training programs and believe that they continue to benefit both clients as well as educating police officers on how to deal with clients and, more importantly, how to get mental health consumers into more appropriate treatment. Passing of Jeff Jew Dr. Katz received the sad news last week that Jeff Jue, LCSW, former Director of San Francisco Community Mental Health Services, passed away due to complications from a respiratory illness. Jeff was a social worker/administrator for 32 years. He served as director of mental health and drug and alcohol programs in California for over 25 years, with stints as mental health director for Merced, Sonoma, and San Francisco counties. Jeff was 62, and a native of San Francisco. We extend our deepest sympathy to his family. Community Health Network, San Francisco General Hospital, November 2005 Credentials Report 11/05 07/05 to 11/05 New Appointments 20 78     Reinstatements 0 0 Reappointments 26 158     Delinquencies: 0     Reappointment Denials: 0 Resigned/Retired: 15 52 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Deceased 0 0 Changes in Privileges     Additions 9 20     Voluntary Relinquishments 4 15     Proctorship Completed 13 41     Proctorship Extension 0 6 Current Statistics - as of 11/1/05 Active Staff 477 Courtesy Staff 566 Affiliate Professionals (non-physicians) 192 TOTAL MEMBERS 1,235 Applications In Process 23 Applications Withdrawn Month of November 2005 0 1 (07/05 to 11/05) SFGH Reappointments in Process Dec. 2005 to Mar. 2006 224 Commissioners’ Comments Commissioner Tarver asked if the mental health training would extend to the Sheriff’s Department. Dr. Katz said there is a similar training with the Sheriff, which is more intensive due to the Sheriff’s role at San Francisco General Hospital, Laguna Honda Hospital and the clinic. Commissioner Umekubo asked if San Francisco’s lack of an air medical access helipad negatively impacted the Golden Guardian exercise. Dr. Katz said that the exercise takes into account available and unavailable resources, including the lack of helipad, but certainly in a real emergency not having a helipad would have an impact. Commissioner Chow asked how the HMA report would be brought through the Department and the Health Commission. Dr. Katz said that chapter one of the report is an operational chapter, and the Department has already started work in this area. The Commission has been very clear in its support for integration, which is the focus of many of the recommendations. So the Commission’s role with regard to chapter one is accountability. Today’s update is a minor status report on chapter 2. He will come to the Commission in three to four months to give a progress report. Commissioner Guy agrees with the process of accountability. She believes that the Laguna Honda Hospital Joint Conference Committee (LHH JCC) should sort out the policy versus accountability issues. Commissioner Illig said that the LHH JCC is getting monthly updates. His concern is that this is the first update the Commission has gotten since the report was issued in July. He said that DPH’s contract partners need to be pulled into planning, and should be represented on the Clinical Operations Committee. Dr. Katz said the clinical operations group has not been formed yet. People want a greater sense of what a greater sense of the Committee’s goals before establishing the committee. Commissioner Monfredini said Dr. Katz and the Commission should work together to determine how to provide accountability to the HMA Report. 5) PRESENTATION OF THE EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF NOVEMBER Commissioner Chow presented the employee recognition awards for the month of November.   Individual Awardee Division Nominated By Linda Deboi-Quesada Maternal Child & Adolescent Health Renee Anderson Team Awardee Division Nominated By CBHS Adult Services Team-The Alternatives Program CBHS LaDonnis Elston · Elias Santiago · Gilberto Alexander · John Bailey · Roland Washington · Louai Bilal · Herbert Leung · Damon Eaves · Charles Allen 6) 1ST QUARTER FINANCIAL REPORT Gregg Sass, Chief Financial Officer, presented the 1st Quarter Financial Report. The report presents the first quarter financial projections of revenues and expenditures for DPH for FY 2005-2006. Projections include a revenue surplus of $18.6 million and expenditure deficit of $5.2 million, for a net favorable surplus of $13.4 million. Mr. Sass presented an overview of each division in the Health Department. For San Francisco General Hospital, year-end projections show a surplus of $5.4 million, largely as a result of additional Medi-Cal for 2005-06. Expenditures are projected to be over budget by $3.6 million, which is primarily attributed to high patient volume in the first quarter of the year compared to budget. Year-end projections indicate a surplus of $7.3 million at Laguna Honda Hospital, largely due to $10 million in unbudgeted revenue due to a large increase in the Medi-Cal base per diem rates. Primary care year-end projections indicate a deficit of $2.013 million due to unfavorable variances in Salaries and Fringe Benefits. Mr. Sass concluded by saying that with only three months of the fiscal year on which to base projections, and nine months remaining, it is difficult to project the year-end fiscal position with precision. However favorable revenue variances at SFGH and LHH provide high confidence that the Department will end the year with an overall surplus and enable the Department to fund a supplemental appropriation for payroll deficits at those sites. Projected FY 2005-06 Year-End Surplus/Deficit REVENUES EXPENDITURES TOTAL Revised Current Surplus/ Revised Current Surplus/ Surplus/ Division Budget Projection (Deficit) Budget Projection (Deficit) (Deficit) Department of Public Health SFGH $ 589,785,000 $ 516,381,000 $ (73,404,000) $ 589,785,000 $ 510,938,000 $ 78,847,000 $ 5,443,000 SB855 Adjustment (82,000,000) - 82,000,000 (82,000,000) - (82,000,000) - SFGH Adjusted $ 507,785,000 $ 516,381,000 $ 8,596,000 $ 507,785,000 $ 510,938,000 $ (3,153,000) $ 5,443,000 Laguna Honda 164,756,000 174,756,000 10,000,000 164,756,000 167,455,000 (2,699,000) 7,301,000 Primary Care 42,533,000 42,533,000 - 42,533,000 44,546,000 (2,013,000) (2,013,000) Health at Home 8,547,000 8,547,000 - 8,547,000 8,436,000 111,000 111,000 Jail Health 23,087,000 23,087,000 - 23,087,000 22,447,000 640,000 640,000 Public Health 96,905,000 96,905,000 - 96,905,000 96,917,000 (12,000) (12,000) Mental Health 191,815,000 191,815,000 - 191,815,000 190,166,000 1,649,000 1,649,000 Substance Abuse 68,238,000 68,238,000 - 68,238,000 67,996,000 242,000 242,000 TOTAL DPH $ 1,103,666,000 $ 1,122,262,000 $ 18,596,000 $ 1,103,666,000 $ 1,108,901,000 $ (5,235,000) $ 13,361,000 The Revised Budget in the table above includes: Annual Appropriation Ordinance for DPH, carry forwards from prior year, Inter Governmental Transfer (IGT) for SB855, Transfer In and Project Related expenses. Commissioner’s Comments Commissioner Tarver asked if budget projections are ever finally confirmed or reconciled. Mr. Sass said there is not an exact answer, but the annual audit confirms that DPH’s financial reports are acceptable and appropriate. Commissioner Guy is concerned about Primary Care, because this is such an important part of our system. 7) HEARING TO CONSIDER THE FUTURE OF ST. LUKE’S HOSPITAL, INCLUDING THE IMPACT OF THE ELIMINATION OF OUTPATIENT MENTAL HEALTH FACILITIES ON THE HEALTH CARE OF THE COMMUNITY Martin Brotman, M.D., President and CEO of California Pacific Medical Center (CPMC) and interim CEO of St. Luke’s Hospital presented the Health Commission with an update on the affiliation between CPMC and St. Luke’s Hospital. Dr. Brotman introduced the team that he brought with him to the meeting, including Robert Tomasello, Chair of CPMC’s Board of Directors, and Dr. Brian Goodell, Interim COO of St. Luke’s Hospital. The presentation focused on the current situation, the merge update, management transition, plans for future development and community stakeholders. St. Luke’s projected losses for calendar year 2005 are $31 million. Budget projections for 2006 show a $27 million deficit. The acute daily census in October was 47, and 57 year to date for 2005. There has been significant investment in sustaining St. Luke’s. Since the affiliation with Sutter Health in 2001 more than $164 million has been invested. Since January 2002, operations subsidies to the hospital are more than $102 million and the operations subsidy to the Health Care Center have been $18 million. Dr. Brotman provided examples of investment, including ICU monitors, diabetes center, emergency department upgrades, cardiac center, MRI upgrade and other investments. In October 2005 both the St. Luke’s Board of Directors and CPMC’s Board of Directors approved the affiliation agreement whereby St. Luke’s would become the fourth campus of CPMC. CPMC has a track record of turning around failing hospitals. This agreement is subject to approvals by Episcopal Charities and Sutter Health. The merger will be complete after approval by the California Attorney General. Upon approval there will be one CPMC budget, one expanded board of directors and one management team. There will be separate medical staffs, at least for the short term. There will be two community advisory boards. Dr. Brotman was appointed interim CEO of St. Luke’s by the St. Luke’s Board of Directors on November 1, 2005. Dr. Brotman discussed the new approach to delivering healthcare at St. Luke’s. The problem at St. Luke’s is not bad cost-management. The major thrust of the solution is on the revenue side, and that means improving the attractiveness of St. Luke’s to doctors and then, through doctors, to patients in the community. The new approach is to: Work in collaboration with key stakeholders to revitalize St. Luke’s Solidify and enhance ambulatory care delivery in the community Collaborate with community-based organizations that have expertise in service diverse populations within the South of Market area Develop culturally competent community resources: education, social services, financial counseling, care management “Right-size” the acute care hospital: Goal: 10 more patients per day Focus on core acute services: emergency, lab, radiology, pharmacy, anesthesia, surgical services, medical/surgical nursing care Assess other services as they enhance or support the core acute services Immediate investment: $30 million plus in new Emergency Department; Improvements to Maternity service facility. Dr. Brotman said a turnaround committee has been formed to affect management transition. The committee is accountable to the Board of Directors at St. Luke’s Hospital and includes board chairs from each hospital, the CEO, Executive Vice President and Site Administrator and medical staff leaders. There are three working groups—Operations Integration, Communications and Community Development and Service Enhancements and Work Culture. The timeline is for a three-year revitalization program. Dr. Brotman said that CPMC would engage with community stakeholders in considering the future of St. Luke’s. They are seeking a legitimate forum in which all stakeholders that share the concerns about the health care delivery system, particularly in South of Market, participate in decision-making. If we work in collaboration, we can find solutions together. Dr. Brotman’s second commitment, beyond the investment CPMC will make in St. Luke’s, is that CPMC would come to the appropriate table when those responsible for health care decisions say this is the proper forum. Commissioners’ Comments Commissioner Monfredini asked if there is an effort to get physicians on board at St. Luke’s and to entice doctors to the hospital. Dr. Brotman said the physician strategy is underway. He has been meeting with physicians for the past three and a half years. Dr. Goodell has taken on this effort and is meeting with as many physicians as soon as possible. Physicians must come to St. Luke’s in order for the recovery to work. Commissioner Monfredini asked Mr. Tomasello if CMPC’s board is committed to supporting a facility that is not as profitable as other CMPC campuses, and in fact loses money. Mr. Tomasello replied that he was pleased that the Board made the decision to look at the community’s best interest even in difficult economic times. The first meeting of the turnaround committee was very encouraging. Commissioner Monfredini wants the CPMC board to wrap its arms around St. Luke’s. Mr. Tomasello said that the board got beyond economics and he is enthusiastic about its commitment to move forward. Commissioner Guy welcomes the commitment to investing services in St. Luke’s. Not all patients are equal, and not all come with health insurance. So an additional 10 patients may not generate the anticipated revenue. She wants to partner with CPMC on any changes that will happen at St. Luke’s and asked for confirmation that proposed changes would be disclosed to the Health Commission. Dr. Brotman replied that CPMC is a full-disclosure hospital and if they have a problem they would discuss it with the Health Commission. Commissioner Guy asked what happens if patients are uninsured. Dr. Brotman said that the financial forecasts include the current payor mix, including uninsured, and an expanded payor mix. Commissioner Illig thanked CPMC for taking on St. Luke’s. He is struck by the different cultures of St. Luke’s and CPMC and CPMC and the Health Commission. A trust needs to develop between all entities. The community expects St. Luke’s to stay open as an acute care hospital with an emergency department, serving poor people in that part of the city. He asked if CPMC could commit to St. Luke’s beyond three years. Dr. Brotman said his intent is that the hospital be there. It is his intent to succeed. CPMC is not going to work for three years then close the hospital. He suggests providing regular updates to the Commission. Commissioner Illig asked how confident Dr. Brotman is about fundraising for St. Luke’s, given that they are embarking on a capital campaign at the same time. Dr. Brotman is very confident in St. Luke’s fundraising outcomes. Commissioner Illig asked where the money for St. Luke’s seismic retrofit would come from. Dr. Brotman said they project they will need to rebuild St. Luke’s by 2016. He does not know where the money would come from. Commissioner Chow said part of this hearing is to clear the air about what happened with outpatient mental health services and what was the disposition of the patients that had been receiving services. He also asked if the Commission and public could expect to see St. Luke’s charity care levels similar to what they were in the past. Commissioner Chow said the Commission considers St. Luke’s a safety net hospital and he wants to see this continue. Dr. Brotman said the charity care commitment would be preserved. The St. Luke’s community will be represented on the board and they will hold the organization to this commitment. Jim Strong, Director of Operations and CFO for St. Luke’s Hospital responded to the outpatient mental health question. He said that patients were referred to outpatient services by three mechanisms: referred by Community Behavioral Health Services (CBHS); seen in the inpatient psychiatric unit and discharged with a referral for outpatient services; and screened through the Emergency Department and recommended for outpatient services. Mr. Strong said those from the ED are generally being served by SFGH. CBHS is re-referring its patients. Mr. Strong said that the doctors communicated with each patient, but he does not know the specific client disposition. Commissioner Chow wants to know to where the 30 patients were referred. Mr. Strong will get this information to the Health Commission within 72 hours. Commissioner Chow asked if CPMC was seriously considering a split OB. Dr. Brotman said he does not know the answer right now. Commissioner Chow said if there is to be a change, CPMC must comply with Proposition Q. Commissioner Umekubo thanked CPMC for coming before the Commission, and asked the status of the sub-acute care unit. Dr. Brotman said the sub-acute unit is still at St. Luke’s. However the goal is for St. Luke’s to be an acute hospital, not a chronic-care facility. Sub-acute is very expensive in an acute care setting and will be very closely examined. Commissioner Tarver said there is a grave deficit at the institution due to the closure of the inpatient psychiatric ward. It is imperative to provide referrals when care is going to cease. St. Luke’s should have known long before services ended how and where the patients were going to be served. He is dismayed by the lack of information about patient disposition. He asked what the potential is for CPMC to restore psychiatric services to St. Luke’s within the next several years. Dr. Brotman said that at one time psychiatry was threatened at CPMC. Now the services are provided by CPMC, with different campuses having different services. Patients’ needs could be addressed by making sure that psychiatric patients are served by the CPMC system or by recreating a unit at St. Luke’s, but he does not know the answer at this time. Commissioner Tarver urged CPMC to enhance psychiatric services in the southeast part of the city. Commissioner Sanchez reinforced St. Luke’s critical mission and history to the people of San Francisco. He congratulated Dr. Brotman for getting the Skirball Grant. The key is to work with the community to plan around this grant. St. Luke’s has always been a community partner and a partner with San Francisco General. It is good to hear Dr. Brotman discuss the plans for the hospital and the commitment to not downsize. Commissioner Monfredini asked Dr. Katz if he had any comments. Dr. Katz said that when St. Luke’s has a patient that needs services St. Luke’s does not provide, that patient is transferred to San Francisco General Hospital. One small way to help the system is if CPMC would provide the necessary services, as it has the capacity to do so and St. Luke’s is part of its system. Commissioner Monfredini wants the Health Commission to consider a resolution regarding this merger at the December 6th Health Commission meeting. Commissioner Chow asked that the resolution memorialize CPMC’s commitments. Commissioner Tarver and Commissioner Guy asked that the resolution emphasize public process and community input. 8) PUBLIC COMMENT/OTHER BUSINESS None. 9) ADJOURNMENT The meeting was adjourned at 6:35 p.m. Michele M. Seaton, Executive Secretary to the Health Commission 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.