Minutes of the Health Commission Meeting Tuesday, December 13, 2005 at 3:00 p.m. CARR AUDITORIUM SAN FRANCISCO GENERAL HOSPITAL 1001 Potrero Blvd. 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, MSW, 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. Absent: Commissioner John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF DECEMBER 6, 2005 Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Tarver) approved the Health Commission meeting minutes from December 6, 2005 with two corrections. Commissioner Tarver abstained from voting on Item 3.13, not 3.14, as was stated in the minutes. On page 8 of the minutes, “Public Affairs Director” was included as Jeffrey Sterman’s title. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Illig chaired, and Commissioner Sanchez and Commissioner Chow attended, the Budget Committee meeting. (3.1) PHP-Communicable Disease Control and Prevention – Request for approval to enter into a renewal of a performance agreement between Public Health Foundation Enterprises, Inc. and San Francisco Department of Public Health Communicable Disease Control and Prevention Section, in the amount of $288,426, for the period of December 30, 2005 to December 29, 2006. (3.2) AIDS Office-HIV Prevention – Request for approval of a retroactive renewal contract with San Francisco Study Center, in the amount of $234,196, which includes a 12% contingency, to provide technical assistance and evaluation support services for HIV Prevention providers, SFDPH providers and the HIV Prevention Section, for the period of July 1, 2005 through December 31, 2005. (3.3) CBHS – Request for approval of retroactive contract modification with Asian American Recovery Services, in the amount of $268,737, for a total contract amount of $9,012,803, to provide fiscal intermediary services and management for mental health/substance abuse services, and for site approval for relocation of programs from 1663 Mission Street to 679 Bryant Street, for the period of July 1, 2005 through December 31, 2006. Commissioner's Comments Commissioner Illig noted that the contract approval includes a site relocation, and there was no one at the meeting to speak to this item. (3.4) PHP-Housing and Urban Health – Request for approval of a new contract with North and South Market Adult Day Health Corporation, in the amount of $184,800, which includes a 12% contingency, to provide adult day services and tenant supportive services for homeless, at-risk homeless, frail, elderly (age 62 years and above) residents at the new Mission Creek Senior Community Center, for the period of February 1, 2006 through June 30, 2006. Commissioners’ Comments Commissioner Chow asked what services North and South Market Adult Day Health Corporation would provide. Ms. Antonetty said the building already has support services, provided by Mercy, but DPH is going to enhance these services through a contract with North and South Market Adult Day Health Corporation, mainly at the adult day health center. Commissioner Sanchez said it is great to have this project in a mixed neighborhood. He asked if there has been any negative response from the community. Sharon Christen, Mercy Housing Project Director, said this project is a cooperative effort between the Redevelopment Agency and DPH to find a means to house disabled elders. There have been no neighborhood issues. Commissioner Illig asked if referrals come from Housing and Urban Health (HUH). Ms. Antonetty from HUH replied that for 51 of the 140 units, referrals would come from DPH through HUH, Community Behavioral Health Services and San Francisco and Laguna Honda hospitals. (3.5) AIDS Office-HIV Health Services – Request for approval of a retroactive new contract with Patricia Sullivan Consulting, in the amount of $155,635, which includes a 12% contingency, to provide professional consultation services to support the Community of Color Community-Based Organizations Capacity-Building Project, for the period of August 1, 2005 through July 31, 2006. (3.6) AIDS Office-HIV Health Services – Request for approval of a retroactive new contract with Patricia Sullivan Consulting, in the amount of $75,661, which includes a 12% contingency, to provide professional consultation services to support the Transgender Capacity Building – In-Depth Needs Assessment and Clinical Best Practices Development program, for the period of September 30, 2005 through September 29, 2006. Secretary’s Note – Items 3.5 and 3.6 were discussed together. Commissioners’ Comments Commissioner Chow asked how much Ms. Sullivan gets for administration of the contracts. Ms. Long replied that for the Community of Color Capacity Building contract, she receives approximately $21,000. For the Transgender Capacity Building it is approximately $6,300. Commissioner Chow asked the value of all the contracts Ms. Sullivan has with DPH. Ms. Long will get this information to the commissioners, but said that Ms. Sullivan is also the coordinator for the Quality Management Program, which is a $250,000 program. Commissioner Illig asked how many agencies are targeted through the Community of Color Capacity Building Project. Ms. Long said they are targeting 20 agencies throughout the San Francisco EMA. Commissioner Illig said Commissioner Tarver has suggested that the pre- and post-test instruments be developed this year and be made a key explicit undertaking to extend beyond the usual and subjective satisfaction surveys and measure outcomes. At the Health Commission meeting, Jimmy Loyce said that the AIDS Office would report to the Population Health and Prevention Joint Conference Committee in six months to update the on what outcomes were developed and how they are working in the community. (3.7) CBHS – Request for approval of a retroactive contract renewal with Bayview Hunters Point Foundation for Community Improvement, Inc., in the amount of $5,931,509, for a total contract amount of $6,643,290, which includes a 12% contingency, to provide substance abuse and mental health services targeting adults and children, for the period of July 1, 2005 through June 30, 2006. Prior to the presentation of the CBHS contracts, Dr. Cabaj, Director of Community Behavioral Services, recapped CBHS’s efforts to change the monitoring process so that reports include real-time information and give outcomes in addition to deliverables. One challenge is the contract cycle. This is being addressed through 18-month contracts whenever possible. In addition, they want to look at the data system, which is inadequate, having been designed as a billing system. They will be building in quality of life indicators. DPH has requested State funds to upgrade the information system. For the coming year’s contracts they will give a summary of the FY 04/05 information, but also a six-month summary of the FY 05/06 contract with the contract report. Further, program managers will also be doing program review. Finally, CalOMS (California Outcomes Measurement System), a data collection and outcomes measurement system, is being implemented by the State. This will provide additional information around alcohol and substance abuse. Jim Stillwell, CBHS, introduced Jason Moody, BVHPF’s new Executive Director. The committee welcomed him. Commissioners’ Comments Commissioner Illig urged the agency and CBHS to think creatively about what behavior changes they are trying to achieve, not just to count deliverables. Commissioner Chow asked if there is any data that says that acupuncture helps people stay with treatment or successfully complete treatment. Mr. Stillwell said they do not have any comparative data. He has not been impressed with outcomes of acupuncture as a separate modality. However, it is offered as an adjunct to methadone as an incentive to get people into treatment. Commissioner Chow said the cost per dose of methadone in the jail seems high when compared to other programs. Mr. Stillwell said this was just put out to bid, so that price will change. (3.8) CBHS – Request for approval of a retroactive contract renewal with Walden House, Inc., in the amount of $8,264,519, to provide residential mental health and substance abuse treatment services, for the period of July 1, 2005 through June 30, 2006. Mr. Stillwell introduced Rod Libbey, Acting CEO of Walden House. Mr. Libbey will become the permanent CEO in November. Gregg Sass, DPH CFO, said that Walden House just had its audit released for the year ending June 2005. The auditors issued a clean opinion and the agency has a positive cash flow. Commissioners’ Comments Commissioner Illig asked what the best outcome for these services is. Donald Frazier, Walden House Chief Development Officer, said that the best outcomes are quality of life indicators, employment and housing at the end of treatment. CBHS has the same goals, and Walden House would like to work with DPH to evaluate and revise contract outcomes. (3.9) CBHS – Request for approval of a contract modification with Golden Bear Associates in the amount of $63,020 for a new total contract amount of $98,020, to provide technical assistance to Child, Youth and Family System of Care for the period of July 1, 2005 through June 30, 2006. (3.10) CBHS – Request for approval of a retroactive contract renewal with Catholic Healthcare West dba St. Mary's Hospital and Medical Center, for the provision of acute psychiatric inpatient hospital services, in the amount of 1) $120,000 per year in City funds targeting uninsured adolescents and 2) $3,093,539 per year, in Medi-Cal funds for all acute inpatient hospital providers targeting Medi-Cal beneficiaries, for a total contract amount of $5,398,746, for the period of July 1, 2005 through December 31, 2006. Secretary’s Note – Commissioner Illig abstained from voting on this item. Commissioners’ Comments Commissioner Illig is concerned about McAuley’s poor compliance scores. Katrina Bennett from CHW said that client satisfaction is very difficult for this population. (3.11) CBHS – Request for approval of a retroactive contract renewal with Catholic Healthcare West dba St. Francis Memorial Hospital, for the provision of 24-hour adult acute psychiatric inpatient hospital services, in the amount of 1) $50,000 per year in City funds, targeting uninsured adults and 2) $3,093,539 per year, in MediCal funds for all acute inpatient providers targeting MediCal adult beneficiaries, for a total contract amount of $3,717,100, (composed of $75,000 in City funds and $3,243,839 in MediCal funds) for the period of July 1, 2005 through December 31, 2006. Secretary’s Note – Commissioner Illig abstained from voting on this item. (3.12) CBHS – Request for approval of a retroactive contract renewal with Catholic Healthcare West dba McAuley Day Treatment, in the amount of $575,309 per year, for a total contract amount of $2,899,557, for the provision of acute psychiatric inpatient hospital services, for the period of July 1, 2005 through December 31, 2009. Secretary’s Note – Commissioner Illig abstained from voting on this item. (3.13) CBHS – Request for approval of a retroactive contract renewal with Family Service Agency of San Francisco, in the amount of $5,521,291 per year, for a total contract amount of $8,281,937, for the provision of mental health services, for the period of July 1, 2005 through December 31, 2006. Action Taken: The Health Commission (Chow, Guy, Illig, Monfredini, Sanchez, Tarver) approved the Budget Committee Consent Calendar. Commissioner Illig abstained from voting on Items 3.10, 3.11 and 3.12. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Federal Appropriations Update Members of Congress typically seek funding set-asides or “earmarks” for their districts in the appropriations bills that fund federal agencies. DPH has been working with San Francisco Representative Nancy Pelosi to secure funding for DPH priorities in the FY 2006 appropriations bills currently being considered in D.C. The Department was awarded an $800,000 earmark in the Commerce-Justice-State Appropriations bill to expand transitional services to inmates recently released from jail. Services provided through this program focus on reducing recidivism in the criminal justice system, facilitating reentry into the community, decreasing homelessness and decreasing inappropriate reliance on the City’s strapped emergency health system. These earmarked funds will be used to provide case management and supportive housing coupled with onsite behavioral health services that facilitate stabilization and reentry into the community. DPH has two additional requests pending in the Labor-Health and Human Services-Education Appropriations bill, which Congress intends to pass before breaking for a holiday recess later this month. The first is for $1.5 million for the Direct Access to Housing Program. These funds would be used to expand access to supportive housing for chronically homeless and disabled persons struggling with medical, mental health and/or substance abuse issues. The second request is for $1.5 million to provide targeted outpatient health care services for women and people of color living with HIV/AIDS. Services would be provided at San Francisco General Hospital’s Ward 86, and at the Castro-Mission and Southeast Health Centers. The House and Senate initially struck a deal to eliminate all earmarks from the Labor-Health and Human Services-Education Appropriations bill. This would have been the first time in about a decade that the bill included no earmarks for either Republicans or Democrats (the Republican majority removed Democratic earmarks from the FY 2004 bill). However, the House voted down the version of the bill without earmarks. Several issues contributed to the bill’s defeat, including proposed cuts to rural health and education. Overall, the defeated bill cut funding for the Department of Health and Human Services $976 million below the FY 2005 level. Reports are that later this week the Republican majority will bring to a vote a revised version of the bill that moves more funding into rural health but continues to exclude earmarks. Whether or not the revised version of the bill will secure the additional votes needed for passage is hard to predict, but the outlook for earmarks continues to be bad. Medicare Part D Starting January 2006, all Medicare beneficiaries will be eligible for some form of prescription drug coverage under a privatized plan established by the Centers for Medicare and Medicaid Services (CMS.) The underlying structure of the drug benefit is the establishment of a variety of prescription drug plans (PDPs) approved by CMS from which Medicare beneficiaries may select their coverage. Premiums, deductibles, and prescription copays will depend on patient income and PDP selected. CMS has approved 58 PDPs in California, and 10 of these PDPs have been designated as “No Premium with Full Low Income Subsidy” for dual eligible (Medicare-MediCal, or “Medi-Medi”) beneficiaries. The majority of CHN patients (approximately 25,000) are “Medi-Medi”, or “dual eligible” patients who will not pay premiums and have low copay amounts. Dual eligible patients will be auto-enrolled into a PDP by CMS if they do no self-select by December 31, 2005. A smaller group (approximately 2,000 CHN patients) currently receives benefits from Medicare only. A majority of these ‘Medicare only’ patients fall into the CMS category known as “limited income seniors” (LIS) and are eligible for subsidized premiums and copays. A smaller group of CHN patients with Medicare only coverage are not eligible for LIS provisions of the prescription drug program. A letter has been prepared to be mailed to all Medicare beneficiaries notifying the changes to begin January 1, 2006. CMS made PDP plan and formulary information public on October 18. Pharmacy Management had identified three of the 10 “Medi-Medi” PDPs that closely resemble our formularies and had either submitted application to participate or had already enrolled in the prescription drug plans. A training session by CMS staff on Part D and the use of tools and educational materials was held on November 29 in Carr Auditorium. Finally a workgroup comprised of CHN, SFGH, CBHS and LHH staff was convened to recommend DPH-wide policy decisions on copay, premiums, and deductibles related to the PDP. The recommendations will be made public as soon as it is ready for distribution. State Medical Cannabis Program to begin in January Dr. Katz announced that DPH will be implementing the State Medical Marijuana Program and issuing State ID cards beginning January 9, 2006. Applications will be accepted at the main entrance to San Francisco General Hospital during the same hours as with the previous program, M-F 1-4pm. Thanks to local advocacy efforts, DPH will return all identifying documents (including the application and the letter of recommendation from the physician) when a card is issued and still be in compliance with State regulations. Although DPH is glad to be able to return all records to the patient and caregiver, since records will not be kept, all lost cards will require a complete re-application process. For more information about this program and a link to the necessary forms, please go to the website at: https://www.sfdph.org/services/mcidinfo.htm. As this Commission knows, San Francisco has been a leader in the creation and issuance of medical cannabis ID cards. Staff looks forward to this new program giving medical marijuana patients and their caregivers expanded protection across the state. New Direct Access to Housing Opens at Plaza Hotel Dr. Katz reported that DPH will be moving clients into another Direct Access to Housing facility next week when 106 new studio units come on line at the Plaza Hotel located at Howard & 6th St. The targeted clients are chronically homeless people with special needs, including up to 18 Targeted Case Management patients from Laguna Honda Hospital, many in wheelchairs with a variety of special needs. Clients will come to the Plaza from referrals by Homeless Outreach Team, SFGH, Community Behavioral Health Services, Intensive Case Management, Shelters and Community Clinics. A number of units will accommodate clients coming directly from shelters and from the streets in the SOMA area. A dozen former tenants are also expected to return to the Plaza. He anticipates that all units will be filled by mid-January. Specialty Care Unit E3 Opens at LHH, Update Laguna Honda Hospital's new Specialty Care Unit, focusing on residents who are substantially challenged by developmental disabilities, opened on Monday, December 12th with the relocation of three residents into the unit. An orientation program for the newly appointed unit E3 nursing and activity therapy staff was provided on December 8th. This session provided staff with an overview of developmental disabilities and definitions, rights, differentiation between mental retardation and mental illness, and a review of normal growth and development. This was the first of many educational sessions planned for the unit focusing on developing staff’s knowledge of this specialty group. On December 15th, E3 staff, IDT members and other representatives of the health care team will visit the ARC and Creativity Explored – day programs serving the intellectually disabled and developmentally delayed community – with the goal of increasing our familiarity with their programs as well as strengthening ties between LHH and these organizations. Staff is excited about the opening of this specialty unit, as it signifies continued progress in providing the best care possible for the various groups of residents LHH serves. Project Homeless Connect: Year End Review Since its inception in October 2004, the Department of Public Health’s Community Programs has been working alongside the Mayors Office, helping to spearhead San Francisco's Project Homeless Connect (PHC). PHC is truly a public/ private/ community collaboration. Every other month, 189 non-profit agencies and private businesses (and this keeps growing) join over 1,000 volunteers (95% community and corporate individuals) to assist 1,000+ homeless San Franciscans connect to the city’s health and human service system of care. Since its inception, 8,368 clients have been served at one of the bi-monthly PHCs. For Public Health, this means: 1369 people seen at medical 73 TB tested 580 referred to mental health and substance abuse treatment 97 HIV tested 443 received methadone detox 231 in stable housing 488 referred to shelter 265 flu shots 702 eye exams Through the generosity of the corporate sector 378 people received free prescription eye glasses (Lenscrafter), 786 people were able to make phone calls to their families anywhere in the US (Sprint/Nextel) 62 people received new and/or fixed wheelchairs (Whirlwind Wheelchairs Inc.), and the list goes on. The Mayor has challenged the private sector to raise $5 million matched by City government to go directly into increasing supportive housing. The next PHC is February 16th and we continue to encourage DPH employees to participate. Information about PHC is available on the website: www.projecthomelessconnect.com Community Health Network, San Francisco General Hospital, Credentials Report, December 2005 12/05 07/05 to 12/05 New Appointments 10 98     Reinstatements 0 0 Reappointments 43 184    Delinquencies: 0 0    Reappointment Denials: 0 0 Resigned/Retired: 10 67 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Deceased 0 0 Changes in Privileges        Additions 3 29    Voluntary Relinquishments 2 19    Proctorship Completed 17 54    Proctorship Extension 0 6 Current Statistics – as of 12/1/05     Active Staff 477   Courtesy Staff 572   Affiliate Professionals (non-physicians) 191   TOTAL MEMBERS 1,240   Applications In Process 23   Applications Withdrawn Month of December 2005 1 1 (07/05 to 12/05) SFGH Reappointments in Process Jan. 2006 to Apr. 2006 288   Commissioners’ Comments Commissioner Monfredini, regarding Medicare Part D, asked how DPH is outreaching to its specific clientele. Dr. Katz said it is being handled differently throughout the system depending on the patient. Some places are using eligibility workers. In other places the clinicians are helping clients navigate the system. There are three plans that most closely mirror the medications DPH clients are on, and all providers have been informed of these three plans. Commissioner Tarver attended the DPH provider training on Medicare Part D, and it was a wonderful effort. The training was so excellent and so well attended that it might behoove the Department to convene a follow-up provider meeting as well as a consumer forum. Commissioner Guy attended a consumer orientation this past July with Senior Action Network. Is DPH connected to this effort? Dr. Katz said the Department is connected. Commissioner Chow said that one of the most serious areas of concern is Medicare-only patients in the lower income group in terms of the one-time change rule. Another issue is that all dual-eligible clients would have a co-pay. There may be a need to work with CMS to modify the rules. 5) EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF DECEMBER Commissioner Monfredini presented the Employee Recognition Awards for the month of December. Team Award #1 Division Nominated By SFGH Trauma Team: Patti O’Connor, RN Robert MacKersie, M.D. Linda Doyle Lillian Li Lauris Jensen, RN Andrea Kozimor, RN SFGH Sue Currin Team Award #2 Division Nominated By SFGH Quality Management SFGH Gene O’Connell 6) SAN FRANCISCO GENERAL HOSPITAL ANNUAL REPORT Gene O’Connell, SFGH Executive Administrator, gave an overview of the San Francisco General Hospital Annual Report. She reported that today’s hospital census is 361. She reviewed the hospital’s mission, vision statement and value statement. She then gave an overview of patient demographics, including age, gender, race, neighborhood and payer sources. She said SFGH served seven percent more patients this year than last year. She reviewed the net patient revenue, which has increased from $114 million in FY01 to $184 million in FY05. Ms. O’Connell highlighted some of the FY05 accomplishments, in the context of the hospital’s 2004-2005 goals. Goal 1 – Improve Staff Retention $2.3 million grant from the Moore Foundation to fund an RN Internship Program, Preceptor Development Training and Mentor Program An additional 14.8 RN FTEs were allocated to comply with state-mandated nursing ratios Sign on bonuses and increased salaries for radiology technicians Recently negotiated sign on bonuses and increased salaries for pharmacists to decrease the vacancy rate The hospital’s overall vacancy rate decreased from 9.1% in 2003-04 to 7.9% in 2004-05 Goal 2 – Assess and redesign processes and resources to maintain operational efficiency Redesigned Department of Education Training and the Utilization Review Department in Fall 2004 Reorganized Trauma Program and Emergency Services under the Director of Patient Care Services Redesigned outpatient prescription drug benefit for clients enrolled in Healthy Workers Goal 3 – Maintain favorable variances to budget for both patient revenues and operating expenses Documented ICD-9 Codes Implemented business plans Ensured that providers have PIN numbers Increased cash collections by 10% over prior year Improved patient flow and community placements Goal 4 – Improve access to outpatient and diagnostic services Implemented Video Medical Interpretation (VMI) Obtained funding for MammoVan and began operations in February 2005 Eye Van operational in September 2004 Expanded Urgent Care Added six new exam rooms in Family Health Center Implemented eConsult Pilot Project in GI and Liver Clinics Partnered with Catholic Healthcare West Goal 5 – Complete Level 1 Trauma Center verification and designation Completed the ACSCOT survey and granted verification status as a Level I Adult and Pediatric Trauma Center Goal 6 – Plan and design air medical access for SFGH EIR in process Gerson/Overstreet Architects hired November 2004 to complete helipad design and permitting that is necessary for completion of EIR Goal 7 – Plan for the replacement hospital Mayor Newsom appointed the Blue Ribbon Committee charged to determine SFGH’s future location. The recommendation is to build on Potrero campus Goal 8 – Participate in the transition to a single DPH information system Implemented a single Medical Record Number policy throughout CHN Formed workgroups to standardize medical terms used in assessments throughout the CHN Implemented a single enterprise-wide billing system Collaborated to renegotiate Siemens contract to include Critical Care, Medical Oncology and Emergency Department Systems for SFGH at no increase in cost Goal 9 – Ensure patient placement at the appropriate level of service within the continuum of care Three floors of SFBHC successfully licensed and opened Continue to explore ways to decrease administrative and decertified days through the Bed Utilization Committee Development of a shared database between Med-Surg and Psychiatry continues Implemented the on-line bed tracking system Continue to hold meetings daily to review patient status and determine placement needs Goal 10 – Meet all regulatory standards and regulations Successfully completed a number of accreditation and licensing surveys, including JCAHO Participated in the third PEP-C Survey with noticeable improvements Participated in numerous patient safety initiatives Ms. O’Connell reviewed the 2005-2006 goals. There are two new goals: promote patient safety; promote organizational and staff cultural competency. Ms. O’Connell’s executive staff reviewed the policies and procedures. Sharon McCole-Wicher, Director of Behavioral Health Services, presented the Plan for Provision of Care, the purpose of which is to define organization-wide processes and activities that maximize coordination and provision of care. Revisions to the policy: updated demographics of community served; updated financial mix of outpatient and emergency visits, inpatient discharges; revised Scope of Service statement with updated statistics on beds, census, visits, discharge days, active and courtesy members of the medical staff; updated organizational chart and provided 04-05 SFGH goals. John Luce, M.D., Chief Medical Officer and Medical Director, Quality Management, presented the Performance Improvement and Patient Safety Program (PIPS). The purpose of PIPS is to promote and define an organization-wide process for performance improvement in patient care, decreasing medical errors and enhancing patient safety. Dr. Luce described the work of the committee. Changes to the policy: creation of Patient Safety Officer position. Dr. Luce also reviewed the Inpatient Utilization Review Program. This program is designed to promote and support quality patient care and increase effective and efficient utilization of available facilities and services. There are no changes to this policy. Rod Auyang, Human Resources Manager, presented the Employee Performance and Competency report. The purpose of the report is to provide assessment of staff competency, identify training needs, describe educational programs, describe levels of competence and report staff competency to the governing body and SFGH leadership. Between 98.4% and 99% of performance evaluations met or exceeded standards. Staff rated with “unmet standards” did so primary due to problems with time management, communication or quality of work. Staff who do not meet standards are not permitted to provide patient care duties unless closely monitored or show improvement to the point where patient care is not compromised. Dr. Andre Campbell, Chief of Medical Staff, gave a medical staff update. He discussed medical staff honors and awards and medical staff changes. He described issues of medical staff resiliency, including the death of an esteemed colleague in Nuclear Medicine, a loss of seven faculty members in Radiology and a maximum 80-hour housestaff workweek. Medical staff issues: chronic longstanding shortage of space—including research space—money and personnel. Yet commitment to clients and patients remains undiminished. Challenges on the horizon include the budget deficit and its impact on patient care, disaster preparedness, bird flu, air medical access and the hospital rebuild. In conclusion, Dr. Campbell said there are many challenges but the medical staff remains dedicated to patient care. Radiology issues are being address. Medical staff continues to win teaching awards. And the academic community remains vibrant. Public Comment Bob Ivory, R.N., works in the emergency department, is the shop steward for SEIU and a newly appointed member of the labor monitoring committee. Staffing at SFGH is critical. As the hospital expands its trauma catchments areas beyond San Francisco borders, and embarks on other initiatives that will bring more patients, it is critical to expand the hospital to accommodate these efforts. Efforts have been made by the hospital to help to put a band-aid on the issue, including short-term travelers, on-going recruitment efforts, etc. The labor monitoring committee looks forward to working with administration to pinpoint staffing problems and arrive at common sense plans of correction. Commissioners’ Comments Commissioner Monfredini said this is an excellent report. She has the pleasure of serving with the executive staff as chair of the San Francisco General Hospital Joint Conference Committee. Commissioner Illig is pleased that staff satisfaction and morale is one of the values. Does the hospital do staff satisfaction surveys? Ms. O’Connell said that it seemed inappropriate to lay off so many staff people at the hospital, and then turn around and asked if staff was satisfied. So they deferred looking at this issue. Subsequently they participated in the Stanford Study around staff and patient satisfaction, which looked at key issues. It has been very valuable to be able to hear directly from staff. This is an 18-month process, after which they would have more data. Commissioner Illig’s point is that when administration checks in with staff, this improves retention. Commissioner Illig lauded the high rate of performance evaluations at SFGH. Ms. O’Connell said that while she wholeheartedly supports surveys, but it is almost impossible to take staff away from other mandated reports that staff must perform. It will at least be done annually. Commissioner Guy said it might be useful to have a discussion at the SFGH JCC to look at other ways of getting at patient satisfaction that are not prohibitively expensive or time consuming. Ms. O’Connell said there are a lot of targeted efforts to identify patient satisfaction—through clinics, the Avon Center, etc. Commissioner Chow said this is one of the most illuminating reports he has seen. SFGH is deserving of the moniker “best public hospital in the country.” Staff has accomplished much during times of tremendous change. Commissioner Chow said there is an opportunity to build community ownership through a community advisory committee, and perhaps the hospital should consider establishing such a committee. He said that many activities that measure patient satisfaction are probably already being done. With regard to employee performance reviews, Commissioner Chow assured the Commission that Laguna Honda is being held to the same standards as SFGH. Commissioner Guy appreciates the contradiction of all the achievements that have been made at the same time so many cuts were made. She also wants to highlight again the fact that the hospital is budgeted for 302 beds but continually must operate at a higher census. These contradictions are tiring realities and the community must fully appreciate this. We need to find vehicles to articulate this. Commissioner Guy said the Video Medical Interpretation project is a remarkable achievement, which entailed much trial and error. She asked why Medicare has increased over the past year. Ms. O’Connell said there are two primary reasons. First, SFGH is doing a better job eligibilizing people. Second, many SFGH patients who age into Medicare are choosing to continue to receive services at SFGH, rather than switching to another provider. Dr. Katz added another reason, which is improved treatment of HIV patients, who are now living long enough to become eligible for Medicare. Commissioner Sanchez said this is one of the most comprehensive, qualitative reports that has been presented to the Health Commission. SFGH is the best public hospital in the country. The retention and recruitment issues are eye opening. What the staff has done is commendable, particularly with the administrative support being dismantled through cuts. Commissioner Tarver commended staff for the excellent report. It is reassuring to see SFGH being able to get beyond silos, even with the budget cuts. He is looking for Laguna Honda to benefit and borrow from SFGH’s successes. He looks forward to the results of the George Washington University study. He asked what the hospital’s response has been to the PEP-C survey findings regarding discharge instructions. Ms. O’Connell replied that staff is changing the discharge instructions, and she hopes to see improved results in this area. Commissioner Tarver said it is important to look at a person not just as an SFGH patient, but also as part of the entire DPH system. He said there is so much good news at SFGH, and asked what the plan is to publicize these accomplishments. He also asked the status of security at the hospital. Ms. O’Connell said securing the institution has been challenging. Staff has tried to address security issues. Recently the biggest concern has been the emergency department, and the security enhancement project for that area is underway. Future projects include card key and code access. Commissioner Tarver wants to engage in a discussion around the dialysis unit to reach a solution so that the unit is not closed at SFGH without an alternative. Ms. O’Connell replied that she just purchased six new dialysis chairs so she will not be offering up the unit as a budget cut again. She has been in consultation with Laguna Honda regarding on-site dialysis at LHH. Commissioner Chow said UC has made a strong commitment to research space at SFGH and asked Ms. O’Connell for a status report. Ms. O’Connell said staff has met with UC to discuss space needs, and there is a disagreement about size. Overall, however, it was a positive discussion. The next step is for the City to determine the SFGH rebuild site so that UC could decide on the research space location. SFGH medical staff has developed a position paper, which Dr. Campbell will send to the commissioners. Commissioner Monfredini said it would be interesting to see if discharge planning is improved when the patient has a family or friend involved in the process. She added that security must continually be addressed. Finally, she thanked Ms. O’Connell for being an incredible team leader. Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Tarver) accepted the report and approved the policies and procedures. 7) APPROVAL OF A REVENUE SUPPLEMENTAL APPROPRIATION FOR SAN FRANCISCO GENERAL AND LAGUNA HONDA HOSPITALS This item was continued to the January 10, 2006 Health Commission meeting. 8) PUBLIC COMMENT/OTHER BUSINESS None. 9) CLOSED SESSION A) Public comments on all matters pertaining to the closed session None. B) Vote on whether to hold a closed session Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Tarver) voted to hold a closed session. The Commission recessed for five minutes and moved to San Francisco General Hospital Conference Room 2A6. The Commission went into closed session at 6:00 p.m. Present in closed session were Commissioner Chow, Commissioner Guy, Commissioner Illig, Commissioner Monfredini, Commissioner Sanchez and Commissioner Tarver. C) Closed session pursuant to Government Code Section 54957 and San Francisco Administrative Code Section 67.10(b) PUBLIC EMPLOYEES PERFORMANCE EVALUATION: DIRECTOR OF HEALTH, MITCHELL H. KATZ, M.D. D) Reconvene in Open Session The Commission Reconvened in open session at 8:00 p.m. Possible Report on Action Taken in Closed Session (Government Code Section 54957.1(a)2 and San Francisco Administrative Code Section 67.12(b)(2).) Vote to Elect Whether to Disclose Any or All Discussions Held in Closed Session (San Francisco Administrative Code Section 67.12(a).) Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Tarver) voted not to disclose discussions held in closed session. 10) ADJOURNMENT The meeting was adjourned at 8:00 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 noted 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.