Minutes of the Health Commission Meeting Tuesday, April 18, 2006 at 3:00 p.m. 101 GROVE STREET, ROOM 300 San Francisco, CA 94102 1) CALL TO ORDER President Monfredini called the meeting to order at 3:00 p.m. Present: Commissioner Lee Ann Monfredini, President Commissioner James M. Illig, Vice President Commissioner Edward A. Chow, M.D. Commissioner Roma P. Guy, M.S.W. Commissioner David J. Sanchez, Jr., Ph.D. Commissioner Donald E. Tarver, II, M.D. Commissioner John I. Umekubo, M.D. President Monfredini, on behalf of the Health Commission, noted the passing of former Commissioner Arthur Jackson. She and other commissioners were honored to work with him, and he was a wonderful man. A memorial service will be held on April 30, 2:00 p.m., at the War Memorial Green Room. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF APRIL 4, 2006 Action Taken: The Commission approved the minutes of the April 4, 2006 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Sanchez chaired and Commissioner Chow and Commissioner Tarver attended the Budget Committee meeting. (3.1) PHP-STD Prevention & Control – Request for approval of a retroactive contract renewal with Better World Advertising, in the amount of $95,200, which includes a 12% contingency, for continuation of the “Healthy Penis” syphilis social marketing campaign, for the period of January 1, 2006 through December 31, 2006. Commissioners’ Comments Commissioner Tarver urged Better World Advertising to include more people of color in its focus groups. He requested that the next time the contract comes before the Health Commission, the executive summary include a description of other measures Better World Advertising uses to solicit and incorporate diverse feedback. (3.2) CBHS-MIS – Request for approval of a sole source contract renewal with InfoMC, in the amount of $300,782, which includes a 12% contingency, to provide ongoing system maintenance and application support services for the eCURA software application used by Behavioral Health Services, for the period of July 1, 2006 through June 30, 2007. (3.3) CBHS-MIS – Request for approval of a sole source contract renewal with Echo Group, in the amount of $464,470, which includes a 12% contingency, to provide ongoing system maintenance and application support services for the INSYST software application used by Behavioral Health Services, for the period of July 1, 2006 through June 30, 2007. Action Taken: The Commission approved the Consent Calendar of the Budget Committee. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Commissioner Arthur Jackson Dies The Department of Public Health was saddened by the news that former Health Commissioner Arthur Jackson died at his home last week after a long battle with kidney disease. Commissioner Jackson’s commitment to the City & County of San Francisco was evidenced by his lifelong dedication to public service throughout his life. He served as Health Commissioner from 1992-1996 and again from 2001-2002. Many within the Department and a number of Commissioners now serving had the privilege of knowing and working with this extraordinary man who gave so freely of his time and talent to the service of the community. A memorial service is planned for April 30 at 2 p.m. in the Green Room of the War Memorial Veterans Building. Donations may be made in his name to the National Kidney Foundation of Northern California, 131 Steuart Street, Suite 520, San Francisco, CA 94105. Hundred Year Anniversary of the 1906 Earthquake 1906 earthquake survivors, City officials, media from around the globe and thousands of others gathered this morning at Lotta’s Fountain to commemorate the 100 year anniversary of the ‘Great Quake’. The ‘06 earthquake and subsequent fire was the largest natural disaster in United States history until the catastrophic events last fall in New Orleans and the gulf coast. DPH staff has been involved for months with centennial planning efforts. Tomorrow the City will stage a major eight-hour earthquake drill/exercise. The City’s Emergency Operation Center (EOC) and all Departmental Operation Center’s (DOC) will be activated to test preparedness and response plans. The DPH DOC will be operational for nine hours, with a change in personnel mid-day to test both the A and B staffing shifts. All the hospitals in San Francisco are voluntarily participating in the exercise. Tomorrow afternoon, City officials will gather at Fisherman’s Wharf to discuss scenarios for three possible major disasters in the city's future: a terrorist attack with a radioactive dirty bomb, the arrival of a mega-epidemic carried by birds, and an earthquake. DPH has three representatives at the seminar. This week, every employee working for the City and County of San Francisco was issued a Disaster Service Worker (DSW) identification card. The card identifies workers as DSW by a magnetic strip on the back and will be used in the event of an emergency to assign staff to disaster/emergency service activities. Rally for Day Laborers and Lead Paint Safety Last week the Department’s Childhood Lead Prevention Program, the Day Labor Program and the Mayor’s Office of Housing held a rally for Day Laborers to demonstrate how workers can keep themselves and their families safe from exposure to lead hazards and other toxic substances while making home repairs. The rally featured a contractor demonstrating lead-safe working techniques, Day Labor participants distributed visors with lead-safe messages and a number of Day Laborers addressed the occupational plights of their jobs such as low wages, human rights violations and the instability of temporary employment. DPH continues to work closely with a number of agencies to keep all workers and their families safe from lead poisoning. SFGH Participates in Caesar Chavez Birthday Festival SFGH sponsored a health care information booth at the Caesar Chavez Birthday Festival and Parade celebration held earlier this month on the grounds of the Horace Mann Elementary School in the Mission. Posters and literature in English and Spanish highlighted personal disaster preparedness and provided updated information on the medical helipad project. Those who attended also received emergency response maps from the SFGH Foundation and self-care health information. Ana Ghosh and Anna Cornejo, both native Spanish speakers, and Health Educator Amena Panni and Chris Wachsmuth, RN, represented the Department. Dr. Katz noted that the community was very interested in disaster preparedness and the medical helipad project. Most of the feedback about the medical helipad project was positive. Not surprisingly, there continues to be questions about noise, safety and the effects on the neighborhood adjacent to SFGH. SF Business Times Names O’Connell as Tops in Business Women The San Francisco Business Times has named Gene Marie O'Connell, our executive administrator of SFGH one of the “Most Influential Women in Business in the Bay Area” for the fourth year in a row. Dr. Katz congratulated Ms. O’Connell on this significant recognition. 3 for Life Recently DPH’s Communicable Disease Prevention Unit (CDPU), in partnership with the Asian Liver Center at Stanford University, completed a pilot project entitled 3 For Life, which targeted foreign-born Chinese residents for hepatitis B testing and vaccination. During the course of one year, we screened over 1200 adults, administered more than 3000 shots and trained 120 volunteers. The project achieved a remarkable 87% completion rate for those eligible for the series of hepatitis shots. Data collected indicated that 10% of the clients screened are chronically infected with hepatitis B and 40% are immune due to previous infection, leaving 50% vulnerable to infection and in need of immunization. Nearly 54% have health insurance yet only 16% said their doctor had ever suggested hepatitis testing to them (only 25% among those with chronic infection). This one piece of information speaks to the need for education among the city’s primary care providers around the importance of screening for hepatitis B status. Currently, the greater San Francisco Bay Area has the highest incidence of liver cancer in California and the country, and chronic hepatitis B infection is one of the top five causes of premature mortality in the San Francisco Asian community. A group from UCSF is about to re-launch the project with expanded services around education and care. Abstracts about the project have been submitted and accepted a multiple national conferences around the country. California Injury Prevention Network The California Injury Prevention Network (CIPN), started by the Community Health Education Section under a State grant funded by the Kids’ Plates program, is now on line and accepting members. The Network will enable injury prevention professionals throughout California to share resources, to network, and to have blog discussions. In light of the recent cancellation of the annual California Conference on Childhood Injury Control due to budget cuts, CIPN may play an even more important role in disseminating information and encouraging programs to share information. To view the public areas of the site, go to http://www.healthysf.org/cipn/index.html. Nursing Scholarship Fund Raiser San Francisco General Hospital Medical Center is sponsoring the Second SFGH Gala Fundraiser event benefiting the Dorothy Washington Nursing Scholarship Fund on Thursday, May 4, beginning at 6 p.m. at the Ritz-Carlton, 600 Stockton Street. Keynote Speaker is Kamala Harris, District Attorney. Katie Moe, 206-5928 or katherine.moe@sfdph.org is the contact person to purchase tickets. The deadline is Monday, April 24th. Tickets are $175. Update on School Health Bill Dr. Katz updated the Commissioners on AB 2560, which would require the state to establish a Public School Health Center Program to promote the concept of teen health centers in public schools. This bill is currently pending in the Assembly Education Committee, after having passed the Assembly Health Committee on April 5 by a vote of 10-2. Staff will continue to follow this important legislation. Website Hits New Highs The DPH website continues to be a popular destination. In March 2006,the number of page views of the DPH Internet site surpassed one million to a total of 1,068,391 pages viewed. The average number of page views per day was 34,464 and the average visitor spent 10:46 minutes on the site. It may interest the Commissioners to know that 107,191 visits were made to the web page displaying the current restaurant violations posted by the Bureau of Environment Health, making it the Department’s most popular site on the internet. The second most popular site is Genital Warts with STD Basics at third place. Community Health Network - San Francisco General Hospital, April 2006 Credentials Report     04/06 07/05 to 04/06 New Appointments 7 139   Reinstatements 0 0 Reappointments 64 385   Delinquencies: 0 0   Reappointment Denials: 0 0 Resigned/Retired: 10 112 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Deceased 0 0 Changes in Privileges       Additions 3 50   Voluntary Relinquishments 5 44   Proctorship Completed 7 118   Proctorship Extension 0 6 Current Statistics – as of 04/1/06     Active Staff 467   Courtesy Staff 571   Affiliate Professionals (non-physicians) 196   TOTAL MEMBERS 1,234   Applications In Process 32   Applications Withdrawn Month of April 2006 0 2 (07/05 to 04/06) SFGH Reappointments in Process May 2006 to Aug. 2006 203   Dr. Katz added that Governor Schwarzenegger has announced his support for the establishment of a State Public Health Director. This is an initiative that a number of public health advocates in California have been working on, and this announcement is good news. 5) PRESENTATION OF THE FY 2006-2007 CONTINGENCY BUDGET AND CONSIDERATION OF A RESOLUTION Gregg Sass, DPH Chief Financial Officer, presented the FY 2006-2007 contingency budget. Mr. Sass reminded the Commission that the Health Commission approved and the Department submitted the base budget in February that produced a general fund reduction of $7.3 million. This reduction exceeded the Mayor’s base budget instructions to absorb a $7.1 million cut. The Mayor’s Office has advised DPH of the need to develop a plan to further reduce its general fund subsidy by 3%. As a result, the contingency budget is being presented to the Commission. To the extent the Department can met its contingency reductions with revenue increases, the difficult task of expenditure reductions are avoided. In that vein, the primary component of the contingency budget is $6.5 million in additional revenues from higher than budgeted Medi-Cal payments, capitation revenue and Short Doyle Medi-Cal, and resumed payments by the State for SB90/AB3632. Approximately $1.3 million of the increased revenues will be allocated to Laguna Honda Hospital to address deficiencies identified in the recent Department of Health Services licensing survey. The Department has identified two initiatives to further reduce general fund expenditures while avoiding reductions in services. These reductions total $1.6 million, with a $1.9 million annualized savings. The first initiative is the closure of the Workers Compensation Clinic at SFGH. The second reduction is an equalization of rates that DPH pays for residential substance abuse services. DPH would reduce the contract rate for several providers to 120% of the median rates in effect in FY 2005-2006. The goal is to implement this reduction of payment rates without affecting the number of units of service provided. However, the clinical focus of the affected programs may change. Adjustment of rates on September 1st will save $712,153 for FY 2006-2007. Public Comment Jonathan Vernick, Executive Director of Baker Places, said the rate equalization initiative pays no attention to the public policy goals programs are trying to accomplish and the outcomes programs are achieving. The Health Commission should not continue to send cuts to the Mayor and Board of Supervisors for them to make the decision to restore the programs. Mike Richards, Program Director at Acceptance Place, said Acceptance Place provides the only culturally competent services for the population it serves. Maintaining the program is the most cost-beneficial this to do. Dr. Allan Furhman, Clinical Director, HAFCI Center for Recovery (CFR), said CFR clients have challenges that other programs cannot deal with but which CFR works to address. Many CFR clients would not be accepted anywhere else. The program saves the Department money. Dr. Mardell Gavriel, Walden House, said two programs that serve the most chronically mentally ill people in the system would have to change there focus as a result of the rate equalization initiative. If rates are reduced, the clients would increase their hospitalization rates and emergency room visits. Donald Frasier, President of the San Francisco Association of Alcohol and Drug Program Contractors, said the programs that will be affected by the rate equalization initiative are the most unique in the county serving patients with the highest need. It is misleading to use the term equalization when the result would be closed programs. Lewis Eldridge, Deputy Director, Haight Ashbury Free Clinics, said clients served by CFR are the most vulnerable in the city. CFR cannot be cut. Deborah Camarillo, Executive Director, Latino Commission, spoke on behalf of two programs—Casa Quetzal and Casa Aviva. The rate equalization initiative would mean a cut in these programs. The Latino Commission has the only bi-lingual residential services in San Francisco. More beds are needed, not fewer. Sharon Love, Center for Recovery, said CFR taught her that there is a better life, how to take her medications on time, and other important things. The program is really needed. Irish Kobelt, Center for Recovery, said drug addiction and dual diagnosis go hand in hand, and CFR deals with both. Programs such as these need to be maintained. Cutting programs that serve addicts would be counterproductive. Debbie Lerman, San Francisco Human Services Network, said the reduction initiatives were chosen without any public process and without any discussion about public policy implications. The agencies are never consulted during the process, and are not allowed to help. Commissioners’ Comments Commissioner Monfredini asked when the deadline for submitting the contingency budget is, and when the Board of Supervisors would consider the budget. Dr. Katz said the deadline for submitting the contingency budget has passed, and will be considered with the City’s budget in June. There is the hope that the contingency cuts will not have to be taken. Commissioner Chow asked if CCSF patients needing workers compensation services would be able to go to any provider in the City. Dr. Katz if the Workers Compensation Clinic is closed, he anticipates that the Department of Human Resources would designate a network of providers that people could see. Commissioner Chow asked if some substance abuse providers are disproportionately affected by rate equalization, and are some cut to such extent that they would have to close. Dr. Katz said providers that receive a rate higher than 120% of the median would receive a cut. Those close to the median would make a small cut. Those much higher would have a much greater cut. In addition, there are many factors that go into how different rates have been set. Dr. Katz said staff would provide information about the specific details of the cuts to the Health Commission. Commissioner Guy said if the budget cuts were to come to pass, she could support the cut to the Workers Compensation Clinic. She did not support the substance abuse and behavioral health cuts last year, and she does not want to do so now. She also emphasized the need to make decisions together. She asked the Commission to consider not accepting the substance abuse cuts, because we need a break from the dance that has developed around proposing budget cuts. Commissioner Sanchez thanked that staff for preparing these options. DPH has unique partners in the non-profit service providers. Each agency serves very different populations. He agrees with Commissioner Guy and does not want to support the cuts to substance abuse because of the impact it would have on the most vulnerable and most diverse population in San Francisco. Commissioner Umekubo has been impressed with staff for identifying revenue to help us meet the Mayor’s budget instructions. He asked if there was the potential for one-time Medi-Cal settlements, which would further reduce the need for expenditure cuts. Mr. Sass said DPH has been very successful with Medi-Cal settlements, but there are not a lot of opportunities for future settlements. The Department is involved in a class action regarding disproportionate share, but it is difficult to estimate when this will be resolved. Commissioner Umekubo supports removing the expenditure cut to substance abuse. Commissioner Tarver asked if the settlement reserves could be reduced further, so that expenditure cuts could be minimized. Mr. Sass said it is not unusual to see audit adjustments in the range of $2 million. So they feel that the settlement reserve amount is appropriate. Commissioner Tarver is concerned that the Workers Compensation Clinic provides culturally competent care and other providers may not. Commissioner Tarver does not want to support arbitrary or politically minded budget cuts. He is also concerned that the Department’s clinical leaders are not consulted to the extent they should be about budget cuts. DPH has to develop its budget contingencies well in advance. He supports removing the substance abuse rate equalization initiative so that the Health Commission has more time to analyze it. Commissioner Illig is impressed with how well the Department is able to find additional revenues. Commissioner Illig noted that DPH included in its budget a 2% COLA, and defended this to the Mayor’s Office. Commissioner Illig is going to propose to his colleagues that no budget cuts come to the Health Commission without having first gone to a joint conference committee. That said, programs should not be arbitrarily cut because of their rates. There are a number of reasons rates vary, and these reasons must be more clearly understood. Commissioner Illig asked if there is a way for additional money coming from audit settlements could be shared with providers. Mr. Sass said that most audit adjustments result in DPH is having money taken away. This is not passed on to contractors. Commissioner Chow would like more data about the impact of rate equalization on each of the programs prior to taking it completely off the table. A $21,000 cut to a multi-million program may not be that great of an impact, but another cut to another program might mean closure. Commissioner Monfredini said that the contingency budget must be submitted to the Mayor’s Office, and it is clear that the contingency budget requires an additional 3% general fund reduction. She believes that the economic condition of the City is greatly improved over last year and that there is a good chance that the contingency budget would not be needed. Commissioner Chow is not in favor of leaving it to the Mayor’s Office to identify the cuts in order for DPH to meet its contingency budget requirements. Commissioner Illig proposes sending over the budget with an $850,000 placeholder in the budget, but will not support any cuts to substance abuse services. Commissioner Guy does not support the methodology behind the rate equalization initiative. She would rather close one program and save $712,000 than to have five programs close as a result of the initiative. Commissioner Chow asked the Department to look at an across-the-board cut in substance abuse and other programs to see if that is a better way of meeting the savings requirement. Dr. Katz believes the Mayor’s Office would honor the Health Commission if the Health Commission offered another budget reduction it thought was more appropriate. Commissioner Tarver recommends referring the rate equalization portion of the contingency budget to the CHN JCC, to come back to the Health Commission at its May 2nd meeting. Commissioner Chow offered an amendment to the resolution that would allow for the contingency budget to be sent to the Mayor with the direction to the Health Department staff to review the details of the substance abuse reductions to minimize the loss of substance abuse beds. Commissioner Sanchez spoke against the amendment, and indeed any cuts to substance abuse services. The agencies that are being cut are the very agencies that stepped forward at DPH’s request to serve diverse, vulnerable populations. There can be another way. Commissioner Illig spoke against the amendment because the Board of Supervisors has already adopted a policy statement that substance abuse cuts are unacceptable. Action Taken: The Commission (Chow, Guy, Monfredini, Tarver, Umekubo) amended the resolution to add to the Resolved clause “with the details of the substance abuse reductions to be further reviewed by the Department and the Health Commission to minimize the loss of residential substance abuse beds.” (Commissioner Illig and Commissioner Sanchez voted no.) Action Taken: The Commission approved Resolution #07-06, “Approving the Submission of the Department of Public Health’s Contingency Budget for Fiscal Year 2006/07,” as amended, (Attachment A). (Commissioner Illig and Commissioner Sanchez voted no.) 6) HEARING TO CONSIDER BROWN AND TOLAND BUSINESS PRACTICES AND THEIR IMPACT ON THE CHINESE COMMUNITY Commissioner Chow said he has been advised by the City Attorney not to participate in this hearing, and asked his colleagues to entertain a motion to recuse him from the discussions. Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Tarver, Umekubo) approved a motion to recuse Commissioner Chow from participating in this hearing. Dr. Katz provided the Commission with a context for today’s hearing. The Mayor, the Board of Supervisors and the City Attorney have spoken out against the aggressive tactics of Brown and Toland in trying to get doctors to sign exclusivity agreements. They have done so because of how harmful these practices are to medical care in San Francisco. Brown and Toland is the largest and most dominant medical physician organization in San Francisco so physicians who hope to maintain viable medical practices often have to be beholden to Brown and Toland. Having a dominant practice is a problem in any city, but it is particularly harmful as Brown and Toland is offering incentives to physicians to be exclusively in its networks. This risks damaging the independent parts of our system, and particularly Chinese Hospital. All San Franciscans stand to lose to the extent that these kinds of practices result in higher prices, fewer choices and one organization determining how people should get medical care. This is an appropriate issue for the Health Commission to consider. Public Comment Brenda Yee, CEO, Chinese Hospital, said Chinese Hospital is the last independent hospital in San Francisco and continues to stand strong in providing quality, culturally competent medical care to more than 27,000 San Franciscans. It provides critical services to the Chinese Community. Without the health system, the quality of life of the monolingual Chinese community would be detrimentally impacted. Eric Leung, M.D., said the Chinese Community Health Care Association is committed to serving the safety net population through Medi-Cal, Medicare and the San Francisco Health Plan. CCHCA doctors provide many services to the Asian American community. For the past 10 years Brown and Toland and CCHCA have had a collaborative relationship without the need for exclusivity. The requirement for exclusivity means that Chinese physicians would have to resign from CCHCA. They believe doctors should have the benefit of preferred status without having to resign from CCHCA. Dexter Louie, M.D., has been practicing in Chinatown for the past 30 years. He is assistant medical director with the Chinese Community Health Plan. CCPH is very unique. It is community owned by the Chinese Hospital and the goal of the plan is access to culturally competent, culturally sensitive medical care. The plan serves 27,000 members, 7,000 of whom are with the San Francisco Health Plan. The plan is community oriented. Joseph Woo, M.D., Chief of Medical Staff at Chinese Hospital and member of CCHCA board, reiterated that Chinese Hospital is community owned, is the only independent hospital in San Francisco and the only Chinese Hospital in the country. He represents 270 medical staff at Chinese Hospital who are committed to serving the Chinese community without having to resign in order to participate in Brown and Toland. Stuart Fong, Chinese Hospital Infection Control Coordinator and Risk Manager, talked about Chinese Hospital’s role in the Hepatitis B screening program. One in ten Asian Americans has Hepatitis B. Screening is critical because Hepatitis B has no symptoms. Please preserve access to these services. Elena Tinloy, Director of Clinical Services at Chinese Hospital, read a statement from Dr. Tina Kwan. Dr. Kwan said CCHCA is the largest non-county medical group providing services to the San Francisco Health Plan, caring for more than 7,000 health plan enrollees. If pediatricians were forced to resign from CCHCA, they would not have a vehicle to deliver care to health plan families. She appreciates the Health Commission’s support to ensure that CCHCA physicians could continue to provide services to the Health Plan and other members of the community. Angela Sun, Executive Director of the Chinese Community Health Resource Center, said management of health problems in the immigrant community can be stymied by language and cultural barriers. The health resource center, which is funded by Chinese Hospital, CCHP and CCHCA, was established in 1989. Its mission to meet the need of the monolingual population. She urged the Commission to save culturally competent services and access. Written Testimony submitted for the Record. Jean Fraser, CEO, San Francisco Health Plan – My apologies for not being able to stay to testify in person. CCHCA and SFGH have been partners in providing excellent quality of care to low and moderate income San Franciscans since the beginning of SFHP in 1997. CCHCA is our third largest medical group and a critical part of the network. Keeping CCHCS intact is critical to meting SFHP’s mission, especially since Brown and Toland has to date refused to contract with SFHP. We urge you to support CCHCA in this effort. Commissioners’ Comments Commissioner Monfredini asked if Brown and Toland had a representative at the meeting. Mark Ficker, Chief Financial Officer, Brown and Toland, said Brown and Toland made a commitment not to discuss any of these issues in public, and will not do so today. Brown and Toland is committed to settling this issue. Commissioner Monfredini asked how long Chinese Hospital has been involved with Brown and Toland. Dr. Leung replied at least 10 years. Dr. Leung said at one point there was the offer to merge with Brown and Toland but CCHP wanted to keep its identity. Commissioner Illig asked if negotiations are still under way. Ms. Yee said yes. Dr. Leung said that preferred physicians have a number of benefits: sign-on bonus, share of year-end dividends, etc. In order to join the preferred network, doctors are asked to resign from all other medical groups and serve Brown and Toland exclusively. This is what has presented the biggest problem to Chinese Hospital. Commissioner Illig asked if it is possible to join another physician’s group. Dr. Leung said that most physicians could not sustain a viable practice without being part of Brown and Toland. Commissioner Umekubo asked about the perks associated with preferred membership. Mr. Ficker replied that there is no differential in pay, however there is a different bonus structure. The sign-on bonus is to help doctors to buy equipment for participation in the AMR system. Brown and Toland pays for much of the implementation. Commissioner Sanchez said it is an honor to have such distinguished medical providers in the audience. He is pleased that they chose to bring this issue to the Health Commission’s attention. What they are going though is exactly what the medical community has been going through for the past number of years. The UCSF/Stanford merger resulted in a two-class system among medical providers, and this was unacceptable. Chinese Hospital has been serving the community for more than 100 years. This institution must continue to maintain its leadership in the community. We need these kinds of dialogues to focus on quality care and culturally competent health care providers. He hopes this is one of the outcomes of these discussions. Commissioner Guy appreciates that this issue was brought before the Health Commission, because it will have a huge impact on public health and on San Francisco General Hospital. Regardless of Brown and Toland’s intent, exclusivity and a two-tiered system would lead to the elimination of Chinese Hospital. Chinese Hospital was born out of the fact of a stigma against the Chinese community. Chinese Hospital is an integral part of this community and she does not want to lose this resource. She supports the strategy of bringing this issue to the public. She supports agendizing the resolution at the next Health Commission meeting. She supports the principle that it is destructive to promote exclusivity. Commissioner Monfredini agrees with Commissioner Guy and supports the resolution. She hopes that the negotiation stays open on both sides. This Commission is committed to keeping Chinese Hospital open as a resource to our community. She urged both sides to come to the negotiating table in good faith. Commissioner Umekubo, as an independent practitioner, said there is no question that this exclusivity is detrimental to the Chinese community. For the physician, there is no win to this situation. Commissioner Tarver spoke in support of a resolution, to be voted on at the next Health Commission meeting. Continuation of culturally competent services such as those provided by Chinese Hospital is a priority for this community. He said to look at what happens when medical groups monopolize within a community. 7) PUBLIC COMMENT/OTHER BUSINESS None. 8) ADJOURNMENT The meeting was adjourned at 6:30 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.