Minutes of the Health Commission Meeting
Tuesday, January 20,
1998 3:00 p.m.
101 Grove Street, Room #300 San Francisco, CA 94102
1) CALL TO ORDER
The regular meeting of the Health Commission was called to order by President Edward A.
Chow, M.D., at 3:10 p.m.
Commissioner Debra A. Barnes Commissioner Edward A. Chow, M.D. Commissioner Roma P.
Guy, M.S.W. Commissioner Ron Hill Commissioner Lee Ann Monfredini Commissioner Harrison
Parker, Sr., D.D.S. Commissioner David J. Sanchez, Jr., Ph.D.
2) Approval Of Minutes Of The Meeting Of January 6, 1998. Action Taken: The
Commission unanimously adopted the minutes of January 6, 1998, with the correction that
the meeting was called to order by President Edward A. Chow, M.D.
3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Lee Ann Monfredini)
(3.1) PH-CHP&P-Perinatal - Contract extension and modification and sole source
request in the amount of $74,000 with Polaris Research & Development for technical
assistance, media and outreach services for the Perinatal Outreach and Education Project,
for the period of January 1, 1998 through June 30, 1998. Total amount of contract,
including this modification is $197,000 for the period of July 21, 1997 through June 30,
1998. (DPH contracted with Polaris for services totaling $781,093 during FY 1996-97).
A letter indicating intentions of the company to remain minority-owned was submitted to
the Commission. Commissioners commented the plan was good and requested a written progress
report be submitted to the Commission in six months (July 1998).
(3.2) CHN-Facility Management - Contract extension and modification and sole source
request in the amount of $25,000 with Kate Keating Associates, Inc. for signage design and
consulting services for the Community Health Network for the period of January 1, 1998
through June 30, 1998. Total amount of contract, including this modification, is $74,000
for the period of June 16, 1997 through June 30, 1998. (DPH contracted with Kate Keating
for services totaling $49,000 during FY 1996-97).
(3.3) CHN-LHH-Med. Services - Retroactive contract renewal and sole source request with
the UCSF School of Nursing in the amount of $74,000, for the provision of primary care
services by a gerontological nurse practitioner (GNP) and an equivalent advanced practice
nurse or clinical nurse specialist (CNS) to participants in the Adult Day Health Care
Center, for the period of October 1, 1997 through September 30, 1998. (DPH contracted with
UCSF for services totaling $13,848,952 during FY 1996-97).
Commissioner Sanchez abstained due to conflict of interest.
Action Taken: The Commission approved the Consent Calendar of the Budget Committee,
with Commissioner Sanchez abstaining on #3.3.
4) DIRECTOR'S REPORT. Provides information on activities and operations of the
Department. (Mitchell H. Katz, M.D., Interim Director of Health)
Update on Restructuring
I want to update the Commission on the Department's restructuring. Approximately two
years ago, the Department created the Chief Financial Officer position, which is held by
Monique Zmuda. However, the Chief Financial Officers of the Public Health Division and the
Community Health Network did not report to the Chief Financial Officer. The need to
facilitate communication on fiscal matters through a centralized structure has become
especially important with the recent loss of our Chief Financial Officer at San Francisco
General Hospital, Peter Praetz, and the Chief Financial Officer of the Public Health
Division, Keith Hearle. To allow Ms. Zmuda time to focus fully on fiscal matters, some of
her other functions will be reassigned. AB 75 will be administered through the Public
Health Division. Grants will be supervised by Anne Kronenberg, as well as capital projects
for Central Administration.
Therefore, effective immediately, we have decided these two divisional CFO's as well as
their respective staffs, once hired, will report directly to our Chief Financial Officer.
Ms. Zmuda will be active along with the Divisional Directors, Rich Cordova and Robert
Prentice, in recruiting and hiring these positions. The centralization of our financial
structure is designed to better coordinate accounting of our revenues, expenses, and
overall financial status. The change does not affect the process of deciding on funding
priorities. These decisions will still, of course, be made first at the divisional level
by the Community Health Network (CHN) and the Public Health Division, respectively, and
brought forward through the Director to the Commission, the Mayor, and the Board.
When we last briefed the Commission on restructuring, the organizational structure of
the Workers' Compensation program had not yet been determined. Currently, Occupational
Safety and Health (OSH) section of the Public Health Division coordinates Workers'
Compensation for employees at 101 Grove, Mental Health, Substance Abuse and the Health
Centers. San Francisco General Hospital and Laguna Honda Hospital coordinated their
Workers' Compensation programs through their Departments of Human Resources. Effective
immediately, we will be centralizing all workers compensation issues in the OSH section of
the Public Health Division. OSH will work closely with our Human Resources Department in
coordinating this effort. Placing responsibility within OSH acknowledges the important
role that prevention can play in preventing future workers compensation injuries. OSH will
use reports of recent workers compensation injuries to set priorities on future prevention
programs. The costs of the Workers' Compensation program wilremain with the respective
Finally the Public Health Division has filled an important position. Barbara Garcia has
been appointed Director of Community Substance Abuse Programs. After an extended tenure as
the Executive Director of "Salud para la Gente" in Watsonville, California, Ms.
Garcia was recruited to take lead responsibility for the integration of AIDS, mental
health and substance abuse services for the Substance Abuse and Mental Health Services
Administration (SAMHSA) for the federal Department of Health and Human Services in
Washington, D. C. Ms. Garcia wanted to return to direct service at the local level when
DPH hired her as the Director of Homeless Programs.
In her new capacity as Director of Substance Abuse Services, Ms. Garcia will
participate on the management team of the Community Health Services Branch of the Public
Health Division, where she will assist the management team in the challenge of moving
toward a more integrated model of care based on the health profile of the people we serve.
We thank her for her excellent past leadership in homeless programs and welcome her to her
Mayor's Blue Ribbon Committee On Universal Health Care Coverage
A series of community forums will be held to discuss preliminary findings of the
Mayor's Blue Ribbon Committee on Universal Health Care. The forums will be an opportunity
to provide information on the Blue Ribbon Committee's progress to date to consumers,
employers, community based organizations, City agencies, health care providers and other
interested parties. Committee members will also receive feedback from the community on the
The forums will take place in various locations around the City. The forums will
be open to all interested parties, including residents, community-based organizations,
providers, advocacy groups, health plans and associations.
The first forum will be held tomorrow, January 22, 1998 from 5:00 p.m. to 7:00
p.m. at 101 Grove Street in Room 300. This forum is geared to the business community.
Department staff can hear a presentation on the Committee's preliminary findings on
Monday, January 26, 1998 from 1:00 - 3:00 p.m. at 101 Grove Street in Room 300. In
addition, Department staff are welcome to attend any other the other community meetings.
The Department is planning on making a presentation before the Health Commission at its
next meeting. The Department will begin distributing flyers and information regarding the
forums later this week.
Governor's Proposed 1998-99 State Budget
The Governor released his proposed 1998-99 budget on January 9, 1998. The budget
reflects California's improved economy, with an additional 4.7% in General Fund (GF)
revenues. The Health and Welfare GF portion of the budget totals $15.1 billion, a 4.1%
increase over the current fiscal year (1997-98). The Health and Welfare budget represents
27% of the State's total proposed GF expenditure for 1998-99, which is $55.4 billion.
In general, the proposed Health and Welfare budget is favorable, and does not
include proposals seen in previous years to reduce health-related funding and programs. In
addition, there are no significant health-related revenue increases that will impact the
Department. Likewise, the State is not proposing reductions in their administrative fees
for MAA/TCM or DSH.
Of the health-related program augmentations in the budget, the ones which will most
impact the Department are the $3.5 million GF newborn hearing screening program, which is
part of the Governor's new Early Childhood Development Initiative, and the $15.6 million
GF increase in HIV/AIDS prevention and treatment funding, primarily for the AIDS Drug
Assistance Program (ADAP).
Medi-Cal Reimbursement: No increases in Medi-Cal reimbursement are proposed in 1998-99.
Federal Funding: The Governor has budgeted $11.3 million for emergency medical services
for undocumented residents. Although the budget narrative states that federal law
authorizes payment to States for the full cost of these services - projected to be $655
million in California in 1998-99 - unlike previous years, the budget does not assume an
unrealistically high federal reimbursement level. Proposition 99 Funds: Revenues are
estimated to decline by 1.5%, to $446 million, due to decreased tobacco sales.
Realignment: Revenues are up about $125 million for a total of $2.8 billion. This will
provide a modest increase in Department revenues.
Early Childhood Development Initiative
The Governor is proposing a $54 million Early Childhood Development Initiative to
assist children from birth to age three. The Initiative's provisions include:
Newborn hearing screening program for an estimated 116,000 newborns (half of whom would
be Medi-Cal or CCS-eligible); requires all CCS-approved hospitals to offer screening to
all newborns; and establishes three regional intervention centers to provide training,
education, outreach and referral services to health care providers and patients -- $3.5
million GF increase. Other provisions include: training for child care providers;
pre-kindergarten for low-income children; increased family information services; and
expansion of infant and toddler child care -- $51.5 million GF increase
Assumes enrollment of 200,000 children in 1998-1999, and 440,000 children in 1999-2000
-- well below the original 580,000 target level. State GF will be used for the 1998-99
match, rather than using other locally-designated health care funding -- $34.1 million.
Healthy Families and Medi-Cal outreach -- $21 million.
The State budget assumes a continued decline in Medi-Cal cases, with a projected 2.9%
decrease in 1998-99 Optional benefits: Unlike previous years, the Governor is not
proposing to eliminate any optional Medi-Cal benefits Medi-Cal expansion related to
Healthy Families legislation: expands coverage to children ages 14-18 whose families are
at 100% of the federal poverty level -- $22 million GF increase Long-term care rate
adjustment: while the State has the option to reduce LTC rates as a result of the Boren
Amendment repeal, the budget does not include any reductions. Instead, adjustments will be
considered after the State convenes interested parties to explore alternatives -- no GF
reduction Services for Legal Immigrants and Undocumented Residents: State-only long-term
care services for undocumented residents: continued funding while litigation is pending
State-only prenatal care for undocumented residents: no specific mention, but the Governor
does refer to exclusion of State-only programs for undocumentedesidents; these funds were
not in the final budget for 1997-98, yet the state is currently required by court order to
continue the program -- no GF change Medi-Cal services to legal immigrants: State will
increase GF budget to provide non-emergency health care services to legal immigrants who
arrived after August 22, 1996 (no longer covered by federal funds) -- $25.3 million GF
The 1998-99 State budget includes an estimated $96 million GF increase for public
health programs, including:
Childhood Lead Poisoning Prevention Program: preventive screening and case management
services -- $14.3 million increase over two years HIV/AIDS prevention and treatment: State
budget expands HIV/AIDS prevention and treatment by a total of $35.9 million state and
federal funds, for ADAP, which is anticipated to serve over 25,000 clients with a 53-drug
formulary -- $15.6 million GF increase Control and survey of emerging infectious diseases
and foodborne pathogens: to expand investigation and surveillance of infectious disease
and food safety programs -- $3.1 million GF Housing for tuberculosis patients: for those
unwilling to comply with treatment or homeless and unable to comply -- $2.9 million Grants
to medical schools and specialized training programs: to increase the number of family
practice health care providers -- $5.6 million Breast Cancer Early Detection Program:
majority of funds are from CHIP Unallocated Account funds -- $11.2 million increase over
two Ovarian and prostate cancer research grants: r researching the causes, prevention,
early detection, diagnosis, and treatment of ovarian and prostate cancer -- $23 million
increase Teen abstinence education and pregnancy prevention programs: $7.2 million in
federal funds, requiring matches of 3:4/ local:federal, for initiation of new programs --
no State GF contribution
The proposed budget allocates $24.6 million for the Department of Mental Health and the
California Department of Corrections to coordinate the Sexually Violent Predator (SVP)
Program. The purpose of the SVP is to identify and evaluate dangerous repeat offenders
prior to release from prison, and, when appropriate, refer them to trial for civil
commitment. The budget assumes the SVP program will be ruled constitutional. In addition
to the SVP program, the budget provides $20.4 million to maintain Children's System of
Care programs in 43 counties, and $15 million in Proposition 98 funding for the
School-based Early Mental Health Initiative, targeted at grades K through 3.
Proposition 99 expenditures include: $67.7 million for anti-tobacco education
programs; $19.3 million for tobacco-related disease research; $49.9 million for CHDP;
$179.6 million for clinic and county indigent health programs; and $8.7 million for the
Breast Cancer Early Detection Program, including $7.4 million for screening services and
$1.3 million for enhanced quality assurance.
Department of Social Services
In the CalWORKs program, a $665 million increase for child care for CalWORKs
participants and the working poor is budgeted (total budget: $1.8 billion). The 4.9% grant
level reduction is continued, as is suspension of the Cost-Of-Living Adjustment (COLA).
The budget includes $1 billion for employment support services, such as alcohol and drug,
mental health, Cal Learn, transportation, and job training, for an estimated 376,000
participants per month. In the SSI program, proposed grant levels remain the same for the
first time in several years. The 2.6% federal COLA for SSI is passed through to take
effect January 1, 1999, however, the State COLA continues to be suspended.
Department of Aging
The budget includes an additional $9.1 million GF for expanded Adult Day Health Care,
Community-Based Services Programs, Alzheimer's Day Care, Respite Services, and various
other social services.
Other Provisions of Interest
Proposed constitutional amendment, required to be passed by the voters, to lower the
Gann appropriations limit (amount unspecified). Continuation of the State's commitment to
litigation against the tobacco industry through a $5.47 million GF increase and 21 staff
positions to support ongoing litigation
1998 Ryan White CARE Act Awards Announcement
The FY 1998 Ryan White CARE Act total award is $36,394,914. This award breaks down to
$18,744,145 in formula and $17,650,769 in supplemental. The FY 1997 CARE Title I total was
$37,194,634 so the new award reflects a decrease of $799,720 or approximately 2%.
You will see our award was very high relative to similar EMA's. Congratulations to
Judith Klain, Michelle Dixon and the staff of the AIDS Office.
Grant Award From Miriam & Peter Haas Fund
The Miriam and Peter Haas Fund has awarded a grant of $60,000 to Community Mental
Health Services, Children, Youth and Family Section to support a mental health consultant
working with the Children's Section. The consultant is to develop a plan to support
children's mental health services in a managed care environment. This is a second, and
final grant award from the Fund.
Childhood Lead Prevention Program Data Evaluation
On January 13, 1998, the Childhood Lead Prevention Program finalized a report which
presents the findings of a comprehensive analysis and evaluation of screening
case-management, and environmental data collected since the program's inception in 1991.
The report was developed to fulfill legislative mandates, analyze screening and case
finding trends over time, and assist in the development of a city-wide lead screening
policy. The evaluation also provided evidence of the extent of lead-base paint hazards in
San Francisco which helped promote the passage of legislation requiring lead-safe work
practices on the exterior of any building built before December 31, 1978.
Indoor Air Quality Investigation
On November 30 a washing machine at the Mission Family Center malfunctioned, spilling
700 gallons of water, which made its way from the 2nd floor down to the first floor, where
another Public Health facility (Mission ARC) is located. The water flooded the Mission ARC
space and damaged some of the building materials quite severely. The building owner was
quick to call in a water damage specialist, who began drying the building out immediately.
However, the smell was enough to cause some occupants of Mission ARC to feel sick, and
four employees did seek medical treatment (and were temporarily assigned to other
locations). The OSH Section was called in to evaluate the situation and determine if the
cleanup had been adequate, and if the smell/health symptoms were indicative of active
mold/fungal growth, which would have been consistent with the allergic symptoms seen by
the Occupational Health Services physicians.
Before that could be determined however, it was necessary to test the damaged building
materials for asbestos. The Asbestos Program determined that some of severely damaged
floor tiles did contain asbestos, and needed to be replaced immediately. Once this was
completed, the OSH Section did a thorough inspection of the inaccessible building spaces
to ensure that mold/fungi were not actively growing, and that the spaces had been
adequately dried. Fortunately, no evidence of mold growth was found, and since the smell
had subsided, the employees were cleared to go back into the building. The landlord is
still doing some remedial work to those building structures that were damaged by the
flood, thus displacing some of the employees. To date, no more complaints have been
COMMUNITY HEALTH NETWORK
One Less Gun... One More Life
The CHN is playing an active role in the One Less Gun... One More Life campaign. The
CHN along with other SF hospital community based organizations and the SF Police
Department held their first gun exchange on Saturday, January 17, at Ella Hill Hutch
community center in the Western Addition. Four guns were exchanged for gifts valued at
$40.00. Although only four guns were exchanged the group views this first exchange as a
Mayor Brown attended the exchange and gave his support along with a number of members
of the Board of Supervisors.
The UCSF/CHN Retreat
On January 23 and 24 the CHN Leadership Group, Chiefs of Service and I will join the
UCSF School of Medicine Faculty for their Annual Leadership Retreat. The subject of this
year's retreat is the partnership of UCSF with the Community Health Network focusing on
four primary discussion areas.
the evolving organizational and strategic relationships of Community Health Network and
the UCSF faculty the planning and decision making relationships between UCSF department
Chairmen and the respective Chiefs within the CHN the future role of research at the SFGH
campus in relation to Mission Bay development and as a reflection of the CHN's academic
mission the potential new relationships between the Department of Public Health and UCSF.
The retreat end-products will consist of recommendations for future action to
develop the expanded partnership. A summary of the findings and recommendations will be
presented at the CHN Joint Conference Committee in March.
Laguna Honda Hospital Isolate Influenza A
Laguna Honda Hospital had its first isolate of Influenza A on the evening of December
23rd. Medical staff instituted the antiviral prophylaxis program the following day. Most
of LHH's residents have been immunized. However, the vaccine is not 100% protective.
Therefore, antiviral medication is used to prevent the spread of virus. Since the
institution of medication there have been no further cases of influenza identified.
Kaiser Permanente Strike Update
The California Nurses Association has issued a strike notice to affect Kaiser
Permanente's Hospitals and ambulatory care centers. A two day strike is scheduled for
January 28-29. The Kaiser San Francisco Strike Planning Team will be conducting a
telephone conference call on January 21st to discuss patient care operational issues with
local area hospitals. Chris Wachsmuth will be representing CHN/SFGH. The work action by
CNA comes at a particularly difficult time as citywide hospital census remains high,
Emergency Departments report high visit volumes and critical care and total diversion
rates remain elevated.
System Diversion UpdateThe EMS Section has suspended the ability of hospitals to divert
critical care patients 14 times this month for a total of 198 hours this is 41% of
the time. This amount of diversion activity is unprecedented in our system. The San
Francisco Fire Department is reporting a 25% increase in ambulance requests. As stated
above the planned work stoppage at Northern California Kaiser hospitals could further
impact the overcrowding situation. The EMS Section is closing monitoring this
situation.Abbie Yant, Administrator of the EMS Section, is a member of a State Task Force
on Hospital Overcrowding and Ambulance Diversion. The Task Force was initiated and staffed
by the State EMS Authority and has representatives from Department of Health Services,
California Hospital Association, and Local EMS Agencies. The State Office of Health
Planning, Office of Emergency Services and the Department of Corporations and Kaiser will
be asked to participate in future discussions. The Department of Health
their regional offices, polled all hospitals in California early last week and confirmed
that hospitals are operating above projections throughout the State. Flu like and other
respiratory illnesses are contributing to the increases, but many other conditions are
being seen in emergency departments as well. There is also a shortage of critical care and
emergency department qualified nurses throughout the State which makes adding nursing
staff very difficult.
Diversion statistics for the period January 1 through 11, 1998 were:
Critical Care diverted 24.7% or 65 hours and 17 minutes. Total diversion was 16%
or 42 hours and 28 minutes.
Diversion statistics for the period December 1 through 14, 1997 were:
Critical Care diverted for 56% or 194 hours. Total diversion hours were 2% or 6 hours.
Sharon Nevins Appointed to OSHPD Committee
I am pleased to announce that Sharon Nevins, Interim Chief Financial Officer for Laguna
Honda Hospital, has been appointed to the Office of Statewide Health Planning and
Development's Health Data and Public Information Committee. I am sure you join me in
congratulating Ms. Nevins on this appointment.
Black History Month Celebration
Black History month will be observed at Laguna Honda Hospital during February. A
hospitalwide event will take place February 20th featuring a choir, fashion show and
entertainment held in Simon Auditorium. "Celebrate and Educate" is the theme for
this year's activities. The Activity Therapy Department will also provide additional
activities on resident units throughout the month of February.
The December 1997 statistics are available in the Commission Office.
President Chow requested the Department to report in the Director's Report comparative
statistics for its monthly statistics.
5) ELECTION OF PRESIDENT AND VICE PRESIDENT OF THE HEALTH COMMISSION
Commissioner Guy nominated Commissioner Monfredini for President. Commissioner Hill
seconded the nomination.
Action Taken: The Commission unanimously voted to elect Commissioner Monfredini as
President for 1998.
Commissioner Parker nominated Commissioner Sanchez for Vice President. Commissioner
Barnes seconded the nomination.
Action Taken: The Commission unanimously voted to elect Commissioner Sanchez as Vice
President for 1998.
Outgoing President Chow thanked everyone for their support during these past two years
of his presidency. President Monfredini thanked the Commissioners for their support for
her presidency. Vice President Sanchez thanked the Commissioners for their hard civic
volunteer work on the Commission and thanked Commissioner Chow for his leadership over the
last two years as President.
6) Time Specific: 4:00 P .M.
Public Hearing, In Accordance With The Health Care Planning Ordinance (Proposition Q,
1988), To Consider The Impact Of The Following Change On Health Care Services Of The
Community At Chinese Hospital: Relocation Of The Chinese Hospital Obstetrics Service To
California Pacific Medical Center
For this item, Commissioner Chow and Commissioner Monfredini abstained due to conflicts
of interest. Vice President Sanchez presided over this item on the agenda.
Mr. Thomas Harlan, CEO of Chinese Hospital, had submitted the following information to
Chinese Hospital has maintained a proud history of service to the San Francisco Chinese
community since its opening in 1925. The provision of health care services in 1998 has
become much more complex and expensive than it was many years ago. In keeping with Chinese
Hospital's mission to provide community access to high quality, cost effective and
culturally competent services, it continues to form community partnerships to provide
segments of the spectrum of health care services. For example, Chinese Hospital purchases
tertiary services (heart surgery, organ transplants, etc.) and other high technology
services, such as outpatient MRI, from several San Francisco tertiary hospitals. In
addition, Chinese Hospital also purchases services at the other end of the spectrum,
including skilled nursing and home care services.
The Chinese Hospital Board of Trustees decided to relocate the hospital's obstetrics
service in the Fall of 1997 following several years of deliberation. This was precipitated
by an extensive analysis performed by a multidisciplinary task force convened by the Board
in early 1997. Several factors compelled the Chinese Hospital Board of Trustees to
consider options for relocation:
For the past several years, evolving market conditions have generated a perceived
consumer need for hospital perinatal services encompassing immediate availability of
"Level 3" intensive care newborn nursery services. This has been exacerbated by
the ready availability of such services in San Francisco. The perinatal service at Chinese
Hospital includes only a "Level 1" well baby nursery service. San Francisco
Chinese patients and their physicians have increasingly selected perinatal units with
"Level 3" nurseries, which has resulted in a declining obstetrics service census
at Chinese Hospital. There were 505 deliveries in 1991, 177 deliveries in 1997, adversely
impacting the viability of the service.
Upon the recommendation of its medical staff and after careful consideration of
the alternatives, the Chinese Hospital Board of Trustees determined that rather than close
the perinatal service, the Hospital should suspend the perinatal service temporarily while
it pursues an exclusive affiliation with a local provider for the provision of perinatal
services, including the availability of a higher level of nursery service, for Chinese
Hospital's patients. A temporary suspension should permit Chinese Hospital to reactivate
the beds and its perinatal service if the affiliation should fail to meet the Hospital's
objectives of ensuring delivery of quality perinatal care with a higher level of nursery
service in a manner that is responsive to the special needs of the Chinese community,
including the need for bilingual and bicultural services, reasonable access and
availability of services for indigent patients.
Accordingly, Chinese Hospital has entered into a Memorandum of Understanding (MOU) with
California Pacific Medical Center (CPMC), a general acute care hospital, whose obstetrics
department includes Levels 2 and 3 nurseries. Under the MOU, CPMC would be the exclusive
provider of perinatal services for patients of Chinese Hospital, including enrollees of
Chinese Hospital's affiliated health care service plan (the Chinese Community Health Plan)
and other managed care contracts of the Hospital, as well as referred Medi-Cal, indigent
and self-pay patients. CPMC and Chinese Hospital have a history of service relationships
(including perinatal services), and all but one of the Chinese Hospital obstetricians and
pediatricians have clinical privileges and currently practice at CPMC. CPMC has agreed to
create a joint Advisory Board to monitor and address the Hospital's concerns regarding
cultural competencies, access and availability of perinatal services at CPMC.
The MOU was executed on December 16 1997 and implementation is scheduled to commence on
February 6, 1998, pending the Department of Health Services approval of the hospital's
request for suspension. Specifically, Chinese Hospital has requested suspension of its
perinatal service and beds for a period not to exceed the first 12 months of its
affiliation with CPMC, commencing February 6, 1998. Prior to the end of such period,
Chinese Hospital would evaluate the affiliation with CPMC and make a decision whether to
continue with the affiliation (and request reclassification of the beds), to ask for an
extension of the suspension for further evaluation, or to request that the perinatal
service and beds be reactivated.
In the MOU with CPMC, elements comprising the areas of quality, cultural competence and
staffing continuity were developed by representatives from both institutions, including
Board, medical staff, perinatal services and management. In addition to these elements,
the hospitals have negotiated a 15-year initial term -- and the ability for Chinese
Hospital's referred "self-pay" obstetrics patients to obtain access to CPMC at
Chinese Hospital's current "self-pay" rate structure.
Public Speakers: in support of the relocation. Rose Pak, Chair, Community Relations
Committee, Board of Trustees, Chinese Hospital Association. Albert G. Chin, Immediate Past
President, Board of Trustees, Chinese Hospital Association. Pearl J. Yee, M.D., Chief of
Obstetrics and Gynecology, Chinese Hospital Medical Staff, Chinese Hospital Association.
Thomas M. Harlan, CEO, Chinese Hospital Association. George M. Lee, M.D., Vice President
Medical Affairs; and Chair, Department of Obstetrics and Pediatrics, California Pacific
Dr. Poon, Chinese Hospital, spoke against the relocation.
Vice President Sanchez stated that today's hearing is to listen to the testimony and
receive any written testimony in the next seven days. At the February 3, 1998 Commission
meeting, the Commission will make a decision on whether the relocation will or will not
have a detrimental impact on the health care service of the community.
7) Update Of The Bayview Hunters Point Health And Environmental Task Force Work Plan,
And Consideration Of A Resolution Supporting The Development Of Initiatives For Asthma And
Breast And Cervical Cancer
Cynthia Selmar, Co-Chair of the Task Force and Center Director for Southeast Health
Center, provided an update on the work of the Task Force. She also reported that Karen
Pierce has been hired as the Project Coordinator for the Task Force.
Since the last presentation to the Commission in June 1997, media attention given to
data on the health problems of residents in the Bayview Hunters Point community resulted
in a hearing at the Board of Supervisors' Health, Family and Environment Committee. The
Task Force was asked by the Committee to develop specific proposals. The Task Force
decided to focus on health issues that already had some initial activity -- asthma and
breast and cervical cancer. Basically, the Task Force suspended long-term planning to take
advantage of the short-term opportunity with the Board, with the clear understanding to
return to long-term planning.
With respect to the work plan, Ms. Selmar acknowledged Nyasha Junior of Policy and
Planning, who has been working with the Task Force on its efforts to develop a work plan.
The Task Force is requesting Commission support for the development of initiatives in
response to the Board's request (i.e., asthma and breast and cervical cancer).
The Commission requested a progress report on the work plan in 90 days (May 1998).
Public Speakers: Francine Carter, Co-Chair of the Task Force. Ray Tompkins, member of
the Task Force and Bayview. Hunters Point Research Committee.
Action Taken: The Commission unanimously adopted Resolution # 3-98, "Endorsing
Efforts to Develop Proposals to Address Asthma and Breast and Cervical Cancer in Bayview
Hunters Point", (Attachment A).
8) Consideration Of A Resolution For San Francisco General Hospital Providing Level I
Trauma Care For Adults And Children Within San Mateo County
Richard Cordova, Executive Administrator for the Community Health Network, introduced
Dr. Robert Mackersie, Chief of Staff and Surgery Service. Dr. Mackersie provided the
following background information:
The 1993 Strategic Plan for San Francisco General Hospital, as approved the Health
Commission, includes a recommendation to regionalize the trauma service as a way to
maximize the utilization of resources for the Trauma Center.
Since November 1993, SFGH has piloted in partnership with the San Mateo Emergency
Medical Service Agency, the referral of trauma victims in the northern part of San Mateo
County. The experience during this pilot year has been successful in that the patients
have received timely trauma services, at the same time the volume has not impacted
services devoted to City residents. Further, the financial status of these patients has
resulted in the hospital not absorbing any costs associated with unsponsored patients
since arrangements have been made to bill the County of San Mateo for these patients.
Based on this positive experience, the San Mateo County has now asked SFGH to become
the Trauma Center for the northern part of San Mateo County. The southern portion will be
covered by the Trauma Center located in Stanford University Medical Center. This
configuration of trauma services for San Mateo County is a result of a lengthy study
conducted by the San Mateo Emergency Medical Service Agency, which concluded that this is
a the best configuration for their County.
The Trauma Center at SFGH has been in existence for 30 years and has been verified as a
Level 1 by the American College of Surgeons providing the nationally recognized level of
trauma care to anyone who is injured. The opportunity exists to extend these services to
people in neighboring counties while enhancing the Trauma Center's ability to continue our
tradition of care within the City's geographic boundaries.
Commissioner Barnes expressed concern on the impact on emergency, critical care, and
Commissioner Guy commented that the data from the San Mateo Pilot Project would have
been helpful for this presentation. Dr. Katz will provide the data on the pilot project to
Commissioner Sanchez encouraged the Department to collect data in the next six months,
looking at the impact of regionalization on services in San Francisco. He also encouraged
the Department work with colleagues in the region in analyzing the data.
The Commission requested the Department to come back in July and report a 6-months'
experience and progress with this program.
Commissioner Barnes proposed an amendment to the proposed resolution in the last
resolved by adding, "as long as there is no negative impact on the delivery of
emergency and trauma services to the people in the City and County of San Francisco."
Action Taken: The Commission unanimously adopted Resolution # 4-98, "Supporting
the Regionalization of Level 1 Trauma Services at San Francisco General Hospital Into San
Mateo County, and Counties in Need of Trauma Care, as Long as There is no Negative Impact
to the City and County of San Francisco."
9) Consideration Of A Resolution For Providing Health Insurance To In-Home Supportive
Services (Ihss) Workers
Julia Velson of San Francisco General Hospital presented a proposal which provides
health insurance to individuals who provide In-Home Supportive Services (IHSS) to Medi-Cal
recipients residing in San Francisco.
Ms. Velson introduced:
Donna Calame, Director of the IHSS Public Authority. Rick Zawadski, Consultant, IHSS
Public Authority. Karen Sherr, Local 250. Shahnaz Nikpay, Director of the S.F. Health Plan
Monitor the financial aspect of the plan Evaluate data collected for one year This is a
pilot project for universal health care Monitor this health plan separately at the Joint
Conference Committee of the Community Health Network
Public Speaker: Shahnaz Nikpay, S.F. Health Plan
Action Taken: The Commission unanimously adopted Resolution # 5-98, "Approving a
Proposal to Provide Health Insurance to In-Home Supportive Services Workers Providing Care
to Medi-Cal Recipients Who Reside in San Francisco."
10) Other Business/Public Comments
The meeting was adjourned at 6:20 p.m.
Sandy Ouye Mori, Executive Secretary to the Health Commission