Minutes of the Health Commission Meeting
Tuesday, January 22, 2002
101 Grove Street, Room #300
San Francisco, CA 94102
1) CALL TO ORDER
The Health Commission meeting was called to order to President Roma P.
Guy, M.S.W. at 3:10 p.m.
- President Roma P. Guy, M.S.W.
- Vice President Edward A. Chow, M.D.
- Commissioner Lee Ann Monfredini
- Commissioner Harrison Parker, Sr., D.D.S.
- Commissioner David J. Sanchez, Jr., Ph.D.
- Commissioner John I. Umekubo, M.D.
- Commissioner Arthur M. Jackson
2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF JANUARY 8, 2002
Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez,
Umekubo) approved the minutes of the January 8, 2002 Health Commission
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Sanchez chaired, and Commissioner Monfredini attended,
the Budget Committee meeting.
(3.1) CHN-SFGH Nursing Operations - Request for approval of new
contracts with Code Blue Solutions, LLC, Maxim Healthcare Services and
Medical Staffing Network, Inc., and contract modifications with C. W.
Healthcare Services, HRN Services, Inc., Medstaff, Inc., Nurse
Providers, Inc. and United Nursing International, for a combined total
of $1,500,000 for supplemental, temporary per diem and traveling nurse
personnel services for San Francisco General Hospital, Community Health
Network, for the period of September 1, 2001 through August, 31, 2002.
(3.2) CHP-Primary Care - Request for approval of a new retroactive
sole source contract with Shanti Project, in the amount of $175,000, to
provide LifeLines project services that support women living with breast
cancer, for the period of October 1, 2001 through June 30, 2002.
(3.3) PHP-Emergency Medical Services - Request for approval to accept
and expend a new grant from the California State Emergency Medical
Services Authority, in the amount of $912,440, to promote access to
trauma care at the Trauma Center, San Francisco General Hospital, for
the period of July 1, 2001 to June 30, 2002.
(3.4) PHP-AIDS Office - Request for approval to retroactively accept
and expend a subcontract from the Regents of the University of
California, San Francisco, Office of Research Administration, in the
amount of $241,549, for a collaborative study of prevention for
HIV-positive persons, for the period of September 30, 2001 to September
Commissioner Sanchez abstained from voting on this item.
Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez,
Umekubo) approved the Consent Calendar of the Budget Committee, with
Commissioner Sanchez abstaining from voting on Item 3.4.
4) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., Director of Health, presented the Director’s
Anne Kronenberg Appointment Director of Policy and Planning
I am delighted to announce that I have appointed Anne Kronenberg to be
the Director of Policy and Planning for the Department.
As the Commission is aware, Anne has served as the Director’s
Executive Assistant for the past almost eight (8) years. During that time,
she has taken on increasingly large programmatic responsibilities. For
example, she has served as our First Responder for fires and other City
emergencies and disasters, has sat on the SRO Task Force, has served on
the Local Homeless Board, and has become the coordinator of homelessness
policy for the Department. During this time she has fulfilled her
responsibilities as liaison to the San Francisco Board of Supervisors and
the Director of External Affairs.
In her new role, Anne will continue to be the Department’s liaison
with the Board of Supervisors. In this way we will consolidate all
external government relations within one office as our Federal and State
policy liaisons have traditionally done through the Office of Policy and
Planning. She will also continue to supervise our excellent Public
Information Officer, Eileen Shields, who will join this larger office.
Besides providing excellent supervision to the Office of Policy and
Planning, I believe Anne’s appointment will enable the terrific staff of
the Policy and Planning Office to contribute to our development of
policies around homelessness and emergency preparedness.
Special admiration and gratitude goes to Colleen Johnson who has served
as the Interim Director of Policy and Planning since the departure of
Tangerine Brigham. Colleen has done a fantastic job and has been commended
to me by the offices of numerous State and Federal elected officials. She
will continue in a leadership position within the Office of Policy and
Governor’s 2002-03 Budget Summary
On January 10, 2002, the Governor released his proposed FY 2002-03
State Budget. The $100 billion budget proposes to bridge a $12.5 billion
shortfall for the remainder of this fiscal year and 2002-03 through
several fund shifts, loans, bond initiatives and federal revenue
assumptions. However, the Legislative Analyst has reported that the
Governor’s budget is “overly optimistic.” The Governor’s combined
current year and budget year revenue estimates are $3.3 billion above the
Legislative Analyst’s estimate. Additionally, because the Governor’s
proposal relies heavily on one-time solutions and, therefore, pushes a
number of expenses into the future, the Legislative Analyst predicts this
budget would leave the State with a $4 billion operating deficit in
To minimize the impact of the budget shortfall on health programs, the
Governor is relying on:
- the issuance of a $2.4 billion bond backed by Tobacco Settlement
Fund revenues, the proceeds of which will be placed in the General
Fund to support health programs;
- $666 million in increased reimbursement from the federal Health and
Human Services Agency in the current year, including a $400 million
increase in federal share of Medi-Cal as part of an economic stimulus
- an additional $350 million in federal reimbursements to offset
current and prospective state and local government expenditures
related to terrorism, including bioterrorism.
To the extent these and other revenue assumptions do not materialize,
the Legislature will be faced with making additional cuts. Following are
the major changes to health programs that the Governor has proposed:
- Disproportionate Share Hospital (DSH) Program - Increases the
State’s DSH administrative fee from the current level of $29.8
million to $85 million. This is estimated to result in reduced
revenues at San Francisco General Hospital of approximately $2
- Co-payments - Establishes co-payments up to the federal maximum for
Medi-Cal services and reduces provider rates by that amount. This will
make collection of these monies a provider responsibility and will
result in reduced provider revenues in the event that not all
co-payments are collected. Though the details of this proposal have
not been released, it is anticipated that this initiative will have
minimal impact on the Department of Health. For outpatient services,
most of the Department’s outpatient services are reimbursed based on
cost through the Federally Qualified Health Center (FQHC) program, and
may not be subject to the co-payments. For inpatient services, this
initiative may impact the University of California, San Francisco,
more than the Department, as the University receives fee-for-service
- Physician Rates - “Temporarily” suspends about half
(approximately $155 million) of the physician rate increases approved
two years ago. The Governor has said he will protect providers of care
for children and long-term care.
- Hospital Outpatient Rates - The Administration will proceed with the
implementation of the settlement of the Orthopedic Hospital Lawsuit,
providing $350 million in one-time payments and a 30% outpatient rate
increase. Again, because the majority of the Department’s hospital
outpatient services are billed under the FQHC program, this is likely
to have minimal impact on the Department.
Healthy Families Parent Expansion
The Governor’s budget postpones the expansion of the Healthy Families
program to parents until July 2003.
Child Health and Disability Prevention (CHDP) Program
The Governor’s budget proposes to shift the CHDP caseload (for a
savings of $69.5 million) to the Medi-Cal and Healthy Families Programs.
For children ineligible for Medi-Cal or Healthy Families, the Governor
proposes an increase of $17.5 million for community clinics, under the
Expanded Access to Primary Care program. The details of this proposal have
not yet been established and, therefore, the impact on the Department is
unclear. The Department currently receives $98,000 to administer the CHDP
program in San Francisco.
The budget proposal includes an increase of $133.7 million for the
Early and Periodic Screening, Diagnosis and Treatment services program and
a $16.7 million increase in reimbursements for Therapeutic Behavioral
Services. The Department will propose program enhancements to children’s
mental health services with these additional allocations. However, the
Governor is also proposing reductions of $4.2 million in the Children's
System of Care Program. Although the distribution of this reduction is not
known, the Department’s increase in EPSDT and Therapeutic Behavioral
Services will be greater than a reduction in our system of care
Substance Abuse Services
The Governor proposes reducing Drug Medi-Cal by $7.6 million in the
current year and by $9.6 million in the budget year. Further reductions of
$14.8 million are proposed for 2002-03 in non-Drug Medi-Cal services,
technical assistance contracts and the drug court program. These
reductions are expected to result in a loss to the Department of $200,000
for perinatal drug treatment services and $300,000 for drug court
services. Based on other changes made to Drug MediCal in the current year,
an additional reduction of $800,000 to the San Francisco allocation is
incorporated into next year’s budget.
Citing his support for a housing bond for the November 2002 ballot, the
Governor has reduced the supportive housing initiative by $17.5 million.
The Department recently completed a $3 million funding application under
this initiative that will likely be rejected if this program reduction is
The budget includes a $22.4 million increase in AIDS Drug Assistance
Program to fully fund the program.
The Legislature has been called into special session to address current
year budget shortfalls. In regular session, which will run concurrently
with the special session, the Legislature will be developing its own
budget proposals for the 2002-03 fiscal year. The Department will continue
to monitor the State budget process and will work closely with the
Mayor’s office and the City’s lobbyist to minimize the impact of the
budget deficit on health programs.
State Nurse Staffing Ratios
This morning, the Governor released proposed nurse-to-patient ratios
for California's acute care hospitals. This is the first-ever attempt by a
state to establish a predetermined ratio of nurses to patients in the
various services of acute-care hospitals. These ratios were developed by
the Department of Health Services following more than two years of work
and public input. Ratios are proposed for several service areas, including
medical/surgical units (1:6, becoming 1:5 after 12-18 months), emergency
department (1:4), trauma (1:1), critical patients (1:2), and psychiatry
(1:6). Regulations have not yet been drafted for this proposal, so
additional specifics are not available. However, the proposed ratios will
be subject to the State's normal regulatory process, which includes a
45-day public comment period that is anticipated to begin this Spring and
public hearings that could begin as early as June. The Department will
certainly be following this issue very closely and will be an active
participant in the regulatory process.
Healthy Kids Enrollment Events
The San Francisco Health Plan launched the Healthy Kids program the
weekend of Jan 12th and 13th with three celebration and enrollment events.
From the Beacon Center in Chinatown to Mission Dolores Auditorium and the
Bayview Opera House, over 2,000 children and families attended. Families
submitted applications for Medi-Cal, Healthy Families, and Healthy Kids.
The San Francisco Health Plan is currently counting the number of
applications for the various programs and following up on incomplete
applications, so it does not yet have a count on the increased enrollment
in the various programs. The weekend events mark the official kick-off of
Healthy Kids and follow Mayor Brown’s proclamation of January 13th as
“Healthy Kids Day.” The events also mark the beginning of an extensive
outreach and enrollment campaign to insure every eligible child in San
New Director of Community Substance Abuses Services Hired
Dr. Jorge Partida has accepted the Directorship of Community Substance
Abuse Services and will join the Department in February 2002. Dr. Partida
is a clinical psychologist and has extensive experience with behavioral
health systems, family systems, health psychology, gay and lesbian issues,
and diversity and culture. In his previous position,
Dr. Partida served as the director of the Psychology Program for JFK
University’s Graduate School of Professional Psychology. Previous to
that, he was the Director of Behavioral Health Services at St.
Elizabeth’s Hospital in Chicago and Executive Director of a youth
services organization. He has also hosted two weekly Univision television
Women and Children’s Family Services Update
At the December 18, 2001 Health Commission Meeting, Community Substance
Abuse Services (CSAS) outlined significant fiscal and programmatic issues
identified within Women and Children’s Family Services (WACFS).
Previously, CSAS had reduced the contract and developed a work plan for
the organization. Staff from the Department has met with the WACFS board
twice to monitor progress and, according to CSAS, the agency has
accomplished the following:
Management Infrastructure: Stabilized their fiscal department through
the engagement of qualified temporary accounting staff; initiated the
evaluation process of the Executive Director (scheduled to be completed by
January 31, 2002), and began a management audit.
Fiscal: Submitted the FY 00/01 audit by the December 31, 2001 deadline,
addressing five prior audit findings. Two findings were new, which
corroborated program-monitoring information regarding agency salaries and
employee time reports.
Program: Responded to all 99/00 monitoring report recommendations with
a plan of correction, which will continue to be monitored for completion.
The monitoring reports for FY 00/01 reflecting program performance, client
satisfaction and agency compliance were mailed to the agency on January 8,
2002. It is expected that specific recommendations will be addressed in
writing by February 15, 2002.
Newcomers Health Program Awarded California Endowment Grant
The Newcomers Health Program--a collaboration of the Community Health
Education Section and International Institute of San Francisco--was
awarded a $555,000 three-year grant from The California Endowment. This
grant will allow the expansion of a Bosnian community health education
program begun in 1999 with State funding.
The staff of the Bosnian Community Wellness Program will provide health
education workshops and psychosocial support groups for Bosnians, in
addition to establishing a resource center for Bosnians to learn about and
access health and social service information. Staff will also conduct
leadership training with community members and offer them opportunities to
use their skills from the training in providing services and conducting
activities for their community. By the end of this grant period our
overall goal is to have built the capacity of this community to improve
their own health and well being.
Increasing Syphilis Rates Challenge Prevention Efforts
Preliminary data for the year 2001 showed a significant increase of
syphilis cases in San Francisco. In 2001 there were 186 reported cases
compared to 71 cases in 2000. The increase is most significant in the MSM
community, which experienced a 9% increase in cases from 2000 to 2001. STD
Services continues to work with community partners, sex clubs, adult
bookstores and local health departments outside of SF to control the
outbreak. Of note, recent cases may be mostly associated with oral sex.
While the transmission of syphilis through oral sex is known, and there
have been community outbreaks related to syphilis transmission primarily
through oral sex, these findings challenge current HIV and STD prevention
efforts that support oral sex as "safer sex."
Draft Firearm Injury Reporting System Report Presented to the PHP
A draft of the San Francisco (SF) Firearm Injury Reporting System (SFFIRS)
was presented at the February 2002 PHP JCC. This report is the product of
a collective effort among several city agencies involved in the tracking
and reporting of data on deaths and injuries due to firearm violence.
In 1998, representatives from the Police Department, Medical
Examiner’s Office, Emergency Department and Trauma Center at SF General
Hospital, the SF Injury Center at the University of California, and this
Department agreed to contribute to the development of a shared
multi-agency database. Recognizing that the capability to reduce deaths
and injuries dues to violence is not based on any single agency, the
report goes beyond reporting of standard demographics. The new reporting
system will also provide linkage of data regarding both victims and
perpetrators from police reports, medical examiner investigations, and
hospital records. This centralized database will ultimately enhance our
understanding of modifiable risk factors among both victims and
perpetrators, promote a unified approached to reducing deaths and injuries
due to violence, and serve as a basis for evaluating the impact of
- Commissioner Guy congratulated Anne Kronenberg for her appointment
as Director of Policy and Planning, and thanked Colleen Johnson for
serving as interim director in addition to her regular duties.
- Commissioner Chow asked if the Department would be in compliance
will the minimum nursing staffing ratios that were announced by the
Governor. Dr. Katz responded that the Department’s overall ratios
meet the new State requirement. However the Department is in
compliance based on team nursing, which is a RN/LVN combination. It is
still to be determined whether or not LVNs can play a role in meeting
the staffing ratio requirements.
5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE
RECOGNITION AWARDS FOR THE MONTH OF JANUARY
On behalf of the Commission, Vice President Chow presented the awards
to the following:
Elaina Chin, Pharmacist
DPH/Community Health Network, County Jail #2, Jail Health
Yuki Kubo-Hendricks, Director, Pharmaceutical Services
James Budke, M.D.
Laguna Honda Hospital, Nursing and Medical Services, Unit G6 -
Mary Louise Fleming, Director of Nursing; Mivic Hirose, Associate
Director of Nursing; and Terry Hill, M.D., Medical Director
Bronwyn Gundogdu, R.N.
Rosario Enriquez, RN
In addition, Commissioner Chow recognized Diane Keefer and Gail Davis,
PHN, both of whom are retiring, for their years of dedicated service to
the Department of Public Health.
6) ELECTION OF PRESIDENT AND VICE PRESIDENT OF THE HEALTH COMMISSION
Commissioner Umekubo nominated Commissioner Chow as President of the
Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez,
Umekubo) elected Commissioner Chow as President of the Health Commission
Commissioner Monfredini nominated Commissioner Guy as Vice President of
Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez,
Umekubo) elected Commissioner Guy as Vice President of the Health
Commission for 2002.
Commissioner Monfredini left the meeting at 3:45 p.m.
7) DEPARTMENTWIDE CAPITAL PROJECT UPDATE
John Kanaley, Sr. Associate Administrator for Support Services,
presented the Departmentwide Capital Project Update. The presentation
showed the status of capital projects currently underway within the
Department of Public Health and the proposed projects for FY 2002-2003.
The Department of Public Health is overseeing approximately $18 million
in facility maintenance and capital project funds at DPH sites: $8.3
million at San Francisco General Hospital; $6.9 million at Primary Care
centers; $2.6 million at Laguna Honda Hospital; $100,000 at Population
Health/Mental Health; and $200,000 at the Community Health Network. In
addition, there are a variety of other funded projects including the
rebuild of Laguna Honda Hospital.
San Francisco General Hospital projects include seismic safety
upgrades, ADA restroom remodels, energy upgrades, service delivey and
master planning, life safety, the women’s imaging center, the Ambulatory
Surgery Center, the Cardiac Cath laboratory, methadone clinic expansion
and facility maintenance.
Laguna Honda Hospital funded projects include seismic safety upgrades,
fire alarm system replacement, an access ramp to the garden and the
rebuild of the hospital.
Projects that are funded for the Primary Care centers include the
Maxine Hall interior remodel, Tom Waddell interior renovations, HVAC and
ventilation assessments at all sites and renovations of selected sites for
patient care space upgrades.
Projects that are funded for DPH Administration include tenant
improvements at CHN headquarters, various energy conservation projects,
renovation of Vital Records and the relocation of Epidemiology and the
Immunization Clinic at 101 Grove.
Mr. Kanaley summarized the fiscal year 2002-2003 requests:
- San Francisco General Hospital - Campus cardkey installation,
radiology master planning, nurse call replacement, Vascular IR Suite
design, fire alarm replacement phase I, CT upgrade and facility
- Laguna Honda Hospital - Campus cardkey installation, ADA upgrades at
main hospital, Clarendon Hall fire alarm, ADA access ramp, MIS cabling
upgrade, piping replacement and facility maintenance.
- Primary Care Centers - Expansion of Potrero Clinic, Tom Waddell fire
alarm, North of Market Clinic staff areas and facility maintenance.
- Population Health and Prevention - Functional upgrades at 101 Grove,
door locks and windows at 101 Grove, PHP facility maintenance and
Mental Health facility maintenance.
Mr. Kanaley then summarized the challenges the Department faces as it
moves forward into the next fiscal year.
- SFGH Rebuild
- Facility Maintenance - the age of the buildings is becoming a
significant cost factor, and inefficient layouts and obsolete
infrastructure limit the use of buildings.
- Capital/Facility Maintenance Funding - recent budget increases will
be curtailed, and facility maintenance budgets are below industry
standards. Currently the Department’s facility maintenance budget is
less than $1 per square foot, and the industry standard is $3.75 to $4
per square foot.
- Technology Changes
- Commissioner Guy stated that having this annual report at this time
has been very helpful, and the Commission would like the report to be
given on an annual basis. She asked Mr. Kanaley if he thought the
current allocation of funds would allow the projects to be completed.
Mr. Kanaley responded that the funds they are requesting should be
adequate complete the projects they are seeking approval for. In the
event the budget appears to be inadequate, the Department will rescope
the project to meet the budget.
- Commissioner Umekubo asked if other sources of funding are available
for fuel cell and micro-turbine technologies and solar projects, or is
the Department going to have to fund these kinds of projects with its
own money. Mr. Kanaley replied that a $100 million solar energy bond
was recently approved, and the Department will aggressively seek
funding from this bond.
- Commissioner Chow asked if the findings from the recent Joint
Commission mock survey are incorporated into this plan. Mr. Kanaley
said the findings from the recent study are not, but all previous life
safety findings have been either been corrected or there are plans in
progress to correct. At this time San Francisco General Hospital is
working with a professional who is preparing a report that might
identify additional projects. These will have to be addressed in the
following two years. Commissioner Chow asked the status of
retrofitting 101 Grove. Dr. Katz stated that there currently is no
plan to retrofit the building. The changes that have been made are to
make better use of existing space.
8) EVALUATION OF THE USE OF PBM FOR MEDICAL PATIENTS
Sharon Kotabe, Director of Pharmaceutical Services, CHN, presented the
12-month evaluation of the use of PBM for medical patients. In October
2000 the Health Commission approved a new method for prescription services
which called for a Pharmacy Benefits Manager. PCN was selected as the CHN
PBM. Services began in November 2000.
The PBM contract had two major goals: to improve access to prescription
services to indigent CHN patents; and to improve prescription services for
indigent CHN patients.
Ms. Kotabe said that patients did take advantage of having more than
one access point, and did get prescriptions filled at locations throughout
the city. This implies easier access. In addition, total prescription
volume has increased 5 percent in the last six months of the contract.
With regard to improved service, Ms. Kotabe said that the PBM contract
provides seven days a week, 24 hour per day services, plus free delivery
at some pharmacies. The wait time was decreased, with approximately 90
percent of patients getting their prescriptions filled in under an hour
and the majority waiting no more than 30 minutes. The system has
linguistic capability for 18 different languages. In addition, electronic
interface allows prescriptions filled anywhere in the network to be
transferred to the patient’s electronic medical record. And the PBM
implemented systems to obtain “real-time eligibility,” which allows
patients to get prescriptions on the same day they are seen by the
The PMB pharmacies fill approximately two thirds of the prescriptions
and the remaining one third are filled by the SFGH Outpatient Pharmacy.
Ms. Kotabe then discussed the attempt to identify patient satisfaction
with the PBM network. They did a member satisfaction survey in 2001, but
received very few responses. However, they received no negative responses.
Ms. Kotabe said the PBM Oversight Committee began meeting in March 2001
and continues to meet monthly.
Ms. Kotabe said that, nationwide, pharmacy and pharmaceutical costs
have increased 10-15 percent since 1999, and are projected to rise 15-20
percent at least through 2005. The pharmacy budget has been flat for the
last three years, but actual expenditures have mirrored the national
trends. In order to try to mitigate the impact of the increase in
expenses, the Pharmacy Department, working closely with the medical staff,
has instituted various measures to decrease costs. The impact of these
changes was $3.03 million in FY 01-02. The average cost per prescription
is $50.97 for the PBM and $56.68 for SFGH (this includes labor, benefits
and indirect costs).
- Ms. Kotabe described the next steps to deal with increased cost and
- 10-day supply of discharge prescriptions for Medi-Cal patients
30-day supply for PBM prescriptions from the current 100-day supply
(exceptions for prescriptions to treat chronic conditions). This change
will not cause the patient to have to go back to the provider. The
pharmacy will dispense in 30-day increments with refills.
Changes under consideration
- Single PBM contract for CHN and mental health patients
- Opportunities offered by SB 340 pharmacy law changes. In this model
the patients would not have their choice of any of 100-plus pharmacies
in San Francisco. Instead we would match each of our FQHC clinics with
a particular community pharmacy.
Ms. Kotabe concluded by discussing some of the lobbying and legislative
efforts, including 340B pricing for inpatient drug purchases and a
demonstration project proposal with the Office of Pharmacy Affairs, the
Federal body that oversees 340B pricing.
Ms. Kotabe said that overall the Department believes that the
implementation of the PBM has been a success from the point of view of
increasing access to prescriptions and improving service for our patients.
The increased cost and utilization are of concern, and she assured the
Commission that the Department will work very hard to keep costs down
without decreasing access or services.
- Commissioner Umekubo asked Ms. Kotabe to clarify the State and
Federal components of the 340B pricing plan. Ms. Kotabe said there are
different efforts at the two levels that can accomplish the same goal.
Previously, State law prevented the Department from implementing the
program on a one clinic one pharmacy basis, such that they could not
access 340B pricing without wholesaling. SB 340 allows clinics to get
wholesaler license, so they could access the pricing. The Federal
demonstration project proposal would allow the Department to maintain
the network so patients have access to all network pharmacies, not
just one. This cannot be done currently. Commissioner Umekubo asked
how much of the increase is the actual cost of the drug and how much
is the utilization of the drug. Ms. Kotabe responded that it is
difficult to quantify. However, they have attempted to put into place
systems so that extremely expensive drugs are not overutilized. The
national trend is that utilization drives costs more than the drug
- Commissioner Sanchez commended the staff for the patient
satisfaction responses. Commissioner Sanchez asked for a further
breakdown of the costs. Ms. Kotabe responded that the costs for both
the PBM and SFGH include direct and indirect costs.
- Commissioner Parker asked if the increased prescriptions come from
an increase in prescription writing on the part of physicians. Ms.
Kotabe does not have this data. Commissioner Parker wanted to be clear
that all appropriate indirect costs were included in the
cost-comparisons, so that the comparison between the PBM and SFGH
could be accurate. Dr. Katz will provide the Commission with more
- Commissioner Guy stated that the report clearly shows that the
Department achieved the objective of increased access and increased
service, but not the objective of cost savings. Commissioner Guy asked
if a combined PBM would mean Mental Health would have to decrease the
number of pharmacies they use. Ms. Kotabe said that Mental Health
would retain its multiple sites. Commissioner Guy said she really
wants to examine this from a programmatic level, because the impact on
mental health patients might be great. Also, she was still surprised
to see that 34 percent of patients are still getting prescriptions
filled at the SFGH pharmacy, and asked if this going to remain the
breakdown. Ms. Kotabe stated she thinks it will remain at this level.
- Commissioner Chow said that the low response to the survey is
problematic, and perhaps the oversight committee can identify other
ways of getting responses back. Ms. Kotabe said they are looking at
incentives to help people return surveys. Commissioner Chow asked who
the oversight committee reports to, and the response was Dr. Katz.
Commissioner Chow asked Fred Hom, one of the Committee co-chairs, to
highlight some of the issues raised in the oversight committee. Mr.
Hom said that they are working on a report to submit to Dr. Katz with
findings and recommendations. In general the oversight committee
thought it opened access but that the increased costs is a concern.
9) PUBLIC COMMENT
Frederick Hobson told the Commission that he resigned from the Drug
Advisory Board, and submitted a packet of information to the
Commissioners. He asked the Commission to look into the overwhelming
number of contractors on the board, rather than members of the public. In
addition, the Board has a history of disrespectful and discriminatory
treatment of the LGBT members on the Advisory Board.
The meeting was adjourned at 5:05 p.m
Michele M. Olson, Executive Secretary to the Health Commission