Minutes of the Health Commission Meeting
Tuesday, July 16, 2002
At 3:00 p.m.
101 Grove Street, Room #300
San Francisco, CA 94102
1) CALL TO ORDER
The Health Commission meeting was called to order by Commissioner
Edward A. Chow, M.D.,
at 3:05 p.m.
- Commissioner Edward A. Chow, M.D., President
- Commissioner Roma P. Guy, M.S.W., Vice President
- Commissioner Arthur M. Jackson
- Commissioner Harrison Parker, Sr., D.D.S.
- Commissioner David J. Sanchez, Ph.D.
- Commissioner Lee Ann Monfredini
- Commissioner John I. Umekubo, M.D.
2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF JULY 2, 2002
Commissioner Edward A. Chow, M.D., asked that the notation after 3.5
saying Items 3.3, 3.4 and 3.6 were discussed together be changed to “Items
3.3, 3.4, and 3.5 were discussed together.” The spelling of vane on page
5 under public comment should be changed to vain.
Action Taken: The Commission approved the minutes of July 2, 2002 with
the above two corrections.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Jackson chaired and Commissioner Guy attended the Budget
Committee meeting. Commissioners Umekubo and Monfredini were absent.
(3.1) Central Administration - Request for the approval of a resolution
authorizing the Department of Public Health to accept and expend 51
recurring grants from the State of California for FY 2002-03.
(3.2) AIDS Office - HIV Health Services - Request for approval of a new
retroactive sole source contract with Ramsell Corporation, in the amount
of $128,831, to provide Quality Management Program Coordination services
for providers of CARE-funded services, for the period of June 1, 2002
through February 28, 2003.
- Commissioner Jackson asked if this were a nine-month contract and
noted that three of seven members have the same name. Ms. Dixon
confirmed both inquiries.
- Commissioner Guy asked if they had reviewed the instruments of
evaluation. Ms. Dixon said yes.
- Patrick Monette-Shaw. He is concerned about the number and dollar
amount of sole-source contracts being approved. $28 million so far. LA
County is having a problem with this. Urged the Commission to have the
AIDS Office and DPH start the contract process earlier.
(3.3) CHS-Mental Health - Request for approval or a renewal contract
with Lifemark Corporation, in the amount of $475,720, to provide fiscal
intermediary services to the Personal Assisted Employment Services (PAES),
for the period of July 1, 2002 through June 30, 2003.
- Both Commissioner Guy and Commissioner Jackson asked that the
information be clarified so that it reflects that the renewal supports
the dental piece and does not provide optical services. Po Yee Lindahl
stated that the optical portion of the contract has been removed (now
being down through Human Services) and there were some holdover
invoices that needed to be processed. The holdover is included in the
total amount. There is no vision money in the FY01-02 contract.
- Commissioners Guy and Jackson suggested this item be held over until
the August 20, 2002 meeting to clarify and reflect the nature of the
contract, given that it a continuance would not impact billing.
(3.4) PHP- TB Control - Request for approval of a sole source renewal
contract with the Regents of UCSF at San Francisco General Hospital (SFGH),
in the amount of $238,764, to provide physician and radiologist services
to patients referred to the SFGH Tuberculosis Clinic, for the period of
July 1, 2002 through June 30, 2003.
- Commissioner Guy noted the increase in the Latino population (24%).
Tony Paz said this is the representation that has been consistent.
Commissioner Guy asked if there is a trend in increases in any
particular population. Tony Paz responded that among the foreign-born,
especially Asian, the rates are high. In US-born, African-American
population goes up and down but we are currently on the downward side.
Commissioner Guy would like a presentation on TB scheduled for a
future Health Commission, through the Population Health and Prevention
New Chief Financial Officer
I am pleased to announce that Gregg Sass will be the Department’s new
Chief Financial Officer. Gregg has served as the Department’s Chief
Financial Officer in the Community Health Network for the past year. Gregg
brings 29 years of experience of health care finance, including five years
as a partner at KPMG Peat Marwick, and seven years as controller and chief
financial officer for three San Francisco hospitals. Gregg replaces
Monique Zmuda, Chief Fiscal Officer, who has leaving the Department after
18 years at DPH to become the City’s new Deputy Controller. Angelina
Ehrlich, Ms. Zmuda's secretary, will be joining her in the Controller's
Office. Ms. Ehrlich has been with the Department for 24 years. We wish
both Monique and Angelina the best in their new positions and thank them
for many years of excellent service to the Department.
As several unions have rejected the City’s proposal regarding
retirement pick-up, the Department was asked to make an additional $1
million in reductions to its budget. The Department was able to meet this
$1 million goal through revenue adjustments, largely as a result of
anticipated reinstatement of proposed State reductions to the
Disproportionate Share Hospital program. The Board had its first hearing
on the budget yesterday and will take final action on the budget on July
Suicide Prevention Workgroup
At the request of the Board of the Supervisors in response to the
recent tragedy and suicide by a San Francisco high school student, the
Mental Health Children, Youth and Family Section has convened a Suicide
Prevention Workgroup. The workgroup is charged with reviewing the various
factors leading to suicide in young people as well as reviewing the
existing protocol for suicide intervention and prevention among City
departments, and public and private agencies. The committee will be making
recommendations to the Board on ways to address current gaps in services.
Treatment on Demand to be the Beneficiary of Marathon Pledge Program
The Treatment on Demand (TOD) Planning Council will be a beneficiary of
the 2002 San Francisco Chronicle Marathon Pledge Program, scheduled for
July 28th. The TOD Planning Council was selected along with five other
agencies, which build community, treat the sick, prevent child abuse and
ensure the public’s safety in disasters.
Conference on Lesbian Health & Wellness
The 2nd Annual Conference on Lesbian Health & Wellness, themed
“Healthy Choices for Lesbians,” was held Saturday, June 29th. The
conference marks the beginning of a 3-year collaborative process between
researchers and lesbian communities. María Cora, Coordinator of our
Office of Women and Girl’s Health, co-presented one of the keynote
speeches on “Multiple Marginalization: Health Disparities of Lesbians of
STD Program’s Continuing Response to Increase Syphilis Cases
The STD Program has begun live STD chats on Gay.com. More than 100
subscribers logged onto the first chat. Advertisements have been placed in
magazines and websites that target men who have sex with men. Already the
ad on one website has had 10,000 click-throughs in the first month, all
from the West Coast. The website banner ads focus on the increase in
syphilis in the City and allow people to click directly into the STD
Laguna Honda Staff Co-Authors New England Journal of Medicine
I am pleased to report that John Hollingsworth, Dr.PH, Quality
Management Analyst at Laguna Honda, has co-authored an article that was
published in the July 11th edition of the New England Journal of Medicine.
The article, entitled "A Controlled Trial of Arthroscopic Surgery for
Osteoarthritis of the Knee," has received a great deal of national
attention including airing on NBC Nightly News, a variety of radio
stations and appearing in newspapers and magazines. Dr. Hollingsworth has
added significant new information to the medical community's body of
knowledge about treating osteoarthritis of the knee and has brought
well-deserved recognition to the Department of Public Health. I
congratulate Dr. Hollingsworth for his fine work.
EMS Section Has Moved
As of yesterday, the Department’s Emergency Medical Services (EMS)
Section has relocated to 68 12th Street, Suite 220. The new EMS Section
offices will house the Department’s new Emergency Operations Center
where designated personnel will report in the event of an emergency.
St. Luke's Temporary Closure
In an unusual action, St. Luke's closed their Emergency Room last week
as a preemptive move to an announced strike. Dr. Katz discussed the
closure with the head of the hospital who said he was under the
understanding that they could close because the Emergency Room was closing
to everyone, not just to people without insurance. DPH's jurisdiction
centers around the Emergency Medical Service agency. The State ordered St.
Luke's to reopen by Tuesday, which they did. There may be upcoming court
cases and fines against St. Luke's.
- Commissioner Jackson asked what was St. Luke's motive? Dr. Katz said
that the motive is hard to prove. The hospital also closed its Labor
and Delivery Room. St. Luke's said it was because they could not
afford to hire managerial or registry nurses.
- Commissioner Parker asked if the Suicide Prevention workshop is
permanent. Dr. Katz explained that DPH is just organizing it. Sai-Ling
Chan-Sew is in charge and if it proves successful, DPH would look for
it to be on-going. Staff will prepare a report for the Board of
Supervisors and get feedback. The response will be multi-faceted, not
just a workshop. Commissioner Parker said the STD website is very
impressive and that DPH has raised a high level of awareness. He asked
how DPH can measure the positive effect of this website? Dr. Katz said
DPH hopes to see the syphilis rates decrease. For the first time in
three months, there has been a drop, which may be a combination of
- Commissioner Guy said it was important to see how the issue of
suicide is related to the programs that go on in the Wellness Centers
as part of wellness for the school population. Dr. Katz said DPH has
the expertise to put together a good plan.
- Commissioner Sanchez said that when the representatives from Sutter
were at the Health Commission, there were some basic assumptions about
charity care and services. Is there a review process to assure the
quality assurance and to have Sutter account for their actions? Dr.
Katz said that once the Attorney General has investigated, there is no
mechanism to assure that they hold up their end of the agreement.
- Commissioner Chow noted that the Health Commission considers this
Special Presentation to Monique Zmuda, Chief Fiscal Officer and
Angelina Ehrlich, Executive Secretary.
Commissioner Chow presented a plaque to Ms. Zmuda, who has left DPH
after 18 years to become Deputy City Controller. She was the first Health
Commission Secretary. As a Fiscal Officer she was instrumental in getting
many things organized, has stayed within budgets, held to assignments and
presented excellent budget reports. It is very difficult to have Ms. Zmuda
Angelina Ehrlich also received a plaque in absentia. Ms. Ehrlich worked
for the Department for 24 years and has joined Ms. Zmuda in the
5) REPORT ON THE LONG RANGE SERVICE DELIVERY PROGRAM RECOMMENDATIONS
FOR THE SAN FRANCISCO GENERAL HOSPITAL MEDICAL CENTER REBUILD
Dr. Mitch Katz, Director of Health, said that the programs that are
being planned pose complicated questions, especially in terms of how
things will fit together 10 years from now. He compared it to how much
health care has changed since 1992, when San Francisco had just hit its
peak of AIDS deaths. If you had gone to SFGH then, you would have found
about 40 people with end-stage AIDS. Today, you would find only four or
five. In 1992, no one would have been able to predict this. All DPH can do
is get the best thinkers--analytical thinkers who know the community--and
work on it. DPH has worked with the Lewin Group to answer a number of
threshold questions that need to be answered. The Lewin Group held many
community meetings and DPH has excellent support from individuals who
serve on the Long Range Service Delivery Committee. Dr. Katz introduced
Keith Hearle who presented the Lewin Group’s recommendations. He
concluded by saying that the Health Commission has decided to accept the
report as one in progress. DPH will continue to seek comment before coming
to a final resolution.
Keith Hearle thanked a number of his colleagues in the Lewin Group and
DPH staff. He also commended the input from the Planning Committee.
Mr. Hearle reviewed the reason for the rebuild. California legislation
(SB 1953, 1801) mandates that all acute care hospitals meet new seismic
safety standards by 2013 or close their services by 2008. This is going on
There are still some open questions about the program plan. What are
the best ways to meet client needs over the next 10-40 years? The long
range planning process tries to look at a variety of issues, such as
predicting the range and type of services. Where will these services be
delivered? How much will they cost? Two Planning Groups are working on the
process: a Community Group of about 45 members and an Internal Group
comprised of SFDPH and UCSFMC clinicians. The planning framework started
with certain assumptions about San Francisco and San Francisco General
Hospital Medical Center (SFGHMC), and with open questions/choices
centering on critical issues that require additional analysis or
decisions. The planning principles included improving access to care and
quality of care; implementing best practices; advancing professional
training; conserving debt capacity; operating efficiently; and meeting
SFDPH Strategic Goals.
Certain assumptions were embraced: SFDPH will continue to operate a
full continuum of public health care programs; SFDPH would continue its
core mission as a safety net provider and Level I trauma center; social
problems will persist; SFDPH will continue its affiliation with UCSF; City
resources are limited; SFGHMC will comply with SB 1953; and the rebuilt
SFGHMC will incorporate a flexible design and accommodate changes in
technology and medicine.
There are a number of choices requiring further discussion:
- Which site options for SFGHMC rebuild should be pursued? The two
options are co-location with UCSF at Mission Bay or rebuild at Potrero.
- How should SFDPH’s ambulatory care programs be configured?
- Should SFGHMC seek to increase volume for Level I Trauma?
- Should SFGHMC seek to increase it Emergency Department (ED)
- Should SFGHMC develop programs to attract elderly patients?
- Should the rebuild assume continued provision of inpatient
pediatrics and Obstretics or should beds be consolidated with another
- How should behavioral health services be configured?
- Should SFGHMC rebuild include skilled nursing beds in new space?
The choices have benefits as well as implementation issues and
challenges. Lewin offered recommendations regarding the choices based on
data analysis and projections; interviews with community experts; input
from SFDPH planning groups; survey of national best practices and models;
and expert judgment.
Which site options for SFGHMC rebuild should be pursued?
Option 1. Co-location with UCSF at Mission Bay.
SFGHMC services/programs would be split between two campuses.
- Acute services, ED, Trauma and high end specialty services located
at Mission Bay (MB)
- Acute psychiatry at MB is an option
- Co-located facility vision: "two towers" with one owned
and operated by SFDPH, a second by UCSF
- Joint operation of some ancillaries and support services
- One ED (at SFGHMC) and Trauma Service
- Governance would not be shared; approach to shared decision making
- Potrero would become a behavioral health and ambulatory care campus
- Strengthens existing relationship
- Enhances quality of care
- Enhances faculty oversight/supervision
- MB more accessible for trauma
- Lower project cost
- Lower operating cost
- Coordinated GME and research programs
- Creates additional financing options
- Greater public support?
- Sufficient capacity must be co-located by UCSF to achieve benefits
- Land availability
- Differences in missions and populations served
- UCSF commitment needed by January 2003 for SFDPH to meet SB1953
- Request Letter of Intent (Programs/services to be co-located;
resource commitments; decision-making structure; roles and
responsibilities for budgeting of shared services, financing project
costs and meeting capital needs)
Option 2. Rebuild SFGHMC at current Potrero Avenue site.
- CCSF/SFDPH own the land
- SFDPH would not operate an additional campus
- SFGHMC services not "split" between two campuses
- Continue ties to Potrero Avenue neighborhood
- Greater impact of rebuild on patient care during construction
- Neighborhood concerns regarding Helipad and impact of rebuild
- Benefits of UCSF co-location less likely
How should SFDPH’s ambulatory care programs be configured?
Shift 30,000-40,000 lower acuity ambulatory care visits from SFGHMC to
The volume in community clinics is already trending upward and more
capacity is needed.
Benefits: Provides care closer to home; improved patient satisfaction;
SFDPH goal to move care into community; consistent with strategies of
other public health care systems; facilitated by technology advancements.
Challenges: Current sites capacity constrained; new capital investment
in renovation or new sites needed to implement this initiative; requires
addressing medical staff/teaching issues in off campus sites; some
patients may prefer hospital-based care.
Organize Ambulatory Care as a SuperClinic at Potrero
Benefits: Integrated "one stop shopping" model is preferred
by patients; supports "Center for Vulnerable Populations"
concept; supports ACRC planning; moves services from red brick buildings;
positive outcomes achieved by other public health systems
Challenges: Facilities options need to be developed; higher project
cost and funding needs
Should SFGHMC seek to increase volume for Level I Trauma?
Benefits: Ensure high quality care and access to specialized care;
promote public health and safety; positively impact hospital's payer mix.
Supporting trauma also enhances SFGHMC reputation as foremost public
hospital in the US. Regionalization and development of a Helipad would
bring additional patients/ensure viability of Level I Trauma service. The
successful expansion is unlikely without medical air transport capability;
San Francisco is one of the only large metro cities without medical air
Challenges: Volume growth is important to continuing to meet Level I
Trauma requirements-SFGHMC trauma volume has declined and just meets the
threshold requirement; no other SF hospital has public plans to become a
Level I Center; the risk of not expanding could mean that SF no longer can
support Level I.
Should SFGHMC seek to increase it Emergency Department (ED)
Benefits: Allows SFGHMC to conform to current standard of 2,000 visits
/treatment station (now operating at ~3,000); would contribute to improved
patient flow; would lower diversion rates.
Challenges: Operating and capital cost implications; takes pressure off
initiatives to reduce ED utilization.
SFDPH should not include SNF capacity in new hospital construction
Benefits: Would reduce cost of new construction; would facilitate joint
SFDPH long-term care planning; consistent with LHH program plans;
consistent with trend by other hospitals to no longer operate
hospital-based SNF's particularly in new capacity.
Challenges: Proximity to acute surgical/medical beds facilitates
patient flow; SNF beds also reduce administrative (disallowed) days;
dedicated capacity needed.
Few general acute care county hospitals in California maintain SNF
Should SFDPH pursue a strategy to retain its elder population?
Benefits: Meets needs of aging SFDPH clients, including those at LHH;
positive financial impacts; poor elderly will have greater needs and
reduced resources; serving needs of patients with complex psychosocial
needs is SFDPH center of excellence.
Challenges: Assuring that needs of SFDPH "core populations"
(those without options) are met first; program development needed;
implications for facility design and cost; without "champions,"
success is uncertain.
Most Medicare patients in SFGHMC's target market area go elsewhere
SFDPH should develop collaborative partnerships in providing inpatient
pediatrics and obstetrics services.
Consolidate obstetrics with UCSF
Benefits: Consolidated program would have higher volume (1300
deliveries at SFGHMC, 1700 at UCSF); research shows that quality improves
with higher program volume; births projected to decline further; improved
access to UCSF specialists and neonatologists; some high-risk services
already transferred to UCSF.
Challenges: Requires carefully crafted partnership agreement; ensuring
continuation of unique SFGHMC competencies; maintaining midwifery program;
potential loss of MediCal reimbursement; community concern about not
providing inpatient maternity care.
Consolidate inpatient pediatrics with UCSF
Benefits: Children and adolescents are better served in a dedicated
facility providing specialized care; some complicated cases already are
served by UCSF; SFGHMC census of pediatric cases is low (ADC=4); would
reduce problems in maintaining specialized staffing.
Challenges: Requires carefully crafted partnership agreement to assure
continued access for SFDPH patients; ensuring continuation of unique
SFGHMC competencies (drug exposed, abused, foster care); impact on
Behavioral Health Choices
Continue exploring options for psychiatric care in the Mission Bay,
- Moving acute psychiatry along with acute medical/surgical beds to
Benefits: Continued integration of hospital-based psychiatric care for
SFGHMC; psychiatry not “left behind;” coordination of PES & ER.
Challenges: Project cost; implications for land need; maintaining
services for MHRF clients; integrating psychiatric care into ambulatory
services provided at Potrero Avenue site.
Maintaining acute psychiatry beds at Potrero campus if SFGHMC moves
acute medical/surgical beds to Mission Bay
Benefits: Opportunity to have comprehensive continuum of Behavioral
Health service at one site; maintains coordination with MHRF; facilitates
development of “Center for Vulnerable Studies;” and facilitates
integrating behavioral health service with primary care at the Potrero
Challenges: Assuring medical presence for medically complex behavioral
health clients; coordinating care at two sites (PES & ER services.
Med/psych patients. Diagnostics); Psychiatry “left behind,” increased
stigma for psychiatric patients; risks regarding future resource
commitments to the Behavioral Health programs at Potrero Avenue Campus.
Maintain current number of acute psychiatry beds. With risks to
inpatient programs at other hospitals and forces contributing to higher
demand, SFGHMC should maintain the current number of inpatient psychiatric
Include a 30-bed comprehensive medical-psychiatric inpatient unit in
new hospital construction. (SFGHMC and SFDPH clients have a high level of
psychiatric and medical “co-morbidities.”)
LEWIN GROUP RECOMMENDATIONS
The SFDPH should continue discussions with UCSF to co-locate hospital
capacity; definitive agreement must be reached by January 2003; if not,
rebuild at Potrero.
Adopt programmatic changes:
- Shift primary care visits from SFGHMC to CHN primary care centers.
- Expand off-campus ambulatory care capacity.
- Expand Level I trauma through regionalizing and developing medical
- Organize ambulatory care on Potrero campus as a “SuperClinic.”
- Increase physical capacity of ED, consistent with current standards.
- Partner with UCSF to consolidate pediatrics and obstetrics.
- Exclude SNF beds from SFGHMC rebuild.
- Incorporate design features to improve patient flow, flexibility and
- Institutional planning process should assess implications for SFGHMC
operating at two campuses (MB & Potrero):
- Operating the Potrero site as a Behavioral Health and ambulatory
care campus, including acute psychiatry, MHRF, ambulatory care and
- Locating acute psychiatry beds and PES in new space with the acute
medical-surgical SFGHMC beds.
- Operating ambulatory care services at two campuses, with a “SuperClinic”
and Urgent Care at Potrero, and sub-specialty capacity on the same
site as the acute care beds.
- July 16, 2002 Recommendations presented to Health Commission for
- July 2002-03 IMP/SFGHMC Rebuild Facility Planning groups meet
- January 2003 IMP/Facility Plan presented to Health Commission for
- Plan presented to Mayor, Supervisors, City Depts., community
- November 2003 Election bond measure
- 2013 Completion of SFGHMC Rebuild
REBUILD NEXT STEPS
- Institutional Master Plan
- Finance Plan
- Program Planning Implementation
- Community Education
Anthony Wagner thanked Dr. Katz and the Health Commission for allowing
them to go through the process. It is difficult to envision what is best
for San Francisco as it relates to the delivery system. We are planning a
hospital that would be occupied in 2013 that would have to last us for
another 50 years. A number of technological changes will come along that
will help us solve many of our concerns. Mr. Wagner also thanked the
Planning staff at SFGH and community group members. The next six months
are critical. Staff will come back with final recommendations and a report
that gives their best thinking. They will also have started a process of
blending the programmatic piece with the facility. They have had an
initial meeting already with in-house staff and DPW, the Institutional
Master Plan is underway and the Finance planning group also meeting.
Program planning implementation and continued discussion with UCSF. There
are very sophisticated community groups in this City the community
education piece needs to get underway.
There is still an opportunity for synergy connection with LHH and
SFGHMC even though LHH is ahead in its planning process.
- Susan Sniderman, MD, SFGH Pediatrics and Newborn. Thanked the Lewin
Group for their work and liked the process. Feels involved. She is
Acting Chair of the Department of Pediatrics and in charge of the
nursery. In the long run, would be good to have a unified program with
UCSF. She attends at both UC and SFGH. UC is not a very
drug-hospital-psychotic-friendly place. Problems with translations,
sensitivity to cultures, to women with severe psychiatric disabilities
and the expertise her colleagues have developed. If you do something
sooner, we need to think carefully that these sensitivities are
- Gladys Sandlin, Mission Neighborhood Health Center. The Center has a
long-term relationship with many services at SFGH. They are currently
going through their own rebuild. The Center serves people no one else
serves-mostly minorities. Very excellent, culturally competent
services currently exist at SFGH. Asian and Latinos are population of
the future. We need to have community hearings in the evening after
work hours. Ms. Sandlin submitted a position paper (on file).
- Rae Ann Emery, East Mission Improvement Association. Was here about
a year ago when the rebuild plan first came up. Currently serving on
the Committee. Thanked the Planning staff for keeping them updated on
the meetings. Represents the immediate neighbors of SFGH. Everything
that’s done at SFGH will affect their property values and sense of
well being. Opposed to the helipad. Opposed to taking up existing
parking. Would like to be able to support the program but would prefer
to support two sites or the larger site at Mission Bay. Would like to
be considered in future groups to be interviewed one-on-one.
- Ed Kinchley, SEIR 790. Mr. Kinchley distributed a letter to the
Health Commission (on file). The governance structure, which is now
separate, needs to be maintained separate if there are separate
structures. As you look through the report, the process has raised
more questions than it has answered. Hope we continue the process.
Concerned about the impact on the community-the Mission District-and
how moving services would impact the community. This does not appear
to have been looked at thoroughly.
- Philip Darney, M.D., Chief Obstetrics and Epidemiology, SFGH. Has
been delivering babies for 22 years at SFGH. Concerned about the
geography. Important to provide services where people live. We provide
a unique service. Should not consider consolidation until we know we
have a place on our side of town for our kind of patients.
- Eleanor Dhey, M.D., Acting Director of Obstetrics. Echoes what Drs.
Sniderman and Darney have said. SFGH has a distinct set of services
that serves a unique set of clients. She worries the patients will not
make it across town. They will be lost on both a literal and surface
level. In the long term, how can we preserve the strength of SFGH. She
does not think UC can accommodate another 100 deliveries to their
already full schedule of deliveries.
- Phil Hopewell, M.D., UCSF/SFGH. His statements are his personal
feelings, not those of the University. He has been at SFGH for 30
years and supports the co-location at Mission Bay. UC has not made a
decision at all and does not know their desires. Co-location may be
difficult to achieve but would offer three advantages: 1.
Increasingly, medicine for trauma is highly complex and our ability to
sustain the infrastructure and care is in question. 2. The physicians
who provide care are highly specialized and highly compensated. How
long could we provide that level of support? 3. Access to research.
SFGH is an academic center that focuses on the needs of our patients.
If there is a decision to relocate at the Potrero campus, then we also
need to accommodate research infrastructure.
- Thomas Gwynn. Was impressed by report from Lewin. Was president of
Board of SFGH volunteers. Increase cooperation and enhancement of this
relationship. Hopes the door with UCSF stays open. There has been
active community involvement and hopes it continues.
- Peter Winkelstein, SPUR. Chairs a hospital taskforce to help
hospitals deal with the seismic issues and looking at city’s overall
needs. Very productive. Would like the Commissioners to consider
thinking about ways to combine those clinics at other facilities.
Opportunity to look at public-private partnerships. Don’t have to be
the only people in the clinic. The neighborhoods have different and
special needs and could be tailored to those needs. Going to have to
be flexible in our thinking because no one knows what the services are
going to be like 15 years from now.
- Mary Lou Licwinko, SF Medical Society. Speaking as a long-range
planning committee member. She attended every meeting. She urged the
Health Commission to accept the Lewin Report. Impressed by process as
it included neighborhood, incorporated suggestions, especially many
from the community that otherwise would not have been included. Made
lots of progress bringing together disparate points of view. This is a
working document that should have community input further into the
- Helynna Brooke, Community Mental Health Board. Very fond of SFGH.
Chose to have her son there many years ago. She has two concerns but
very impressed with the plan: 1) Psychiatric services separate from
acute care. Outpatient separation is confusing, especially to the
elderly, and 2) Her mother is low income. Primary care providers are
at UC and she is not impressed by the care her mother is getting.
- Sue Bierman. Has been attending both LHH and SFGH community
meetings. Interested about both institutions. Her son works in public
hospital in NY and was very impressed by the personal care at LHH.
Planning process gives her a connection with the City. The community
is very faithful about attending the meetings. She will help with
whatever our final outcome is. A few years ago her daughter was rushed
to SFGH after a bike accident. She was very impressed by the care. She
will be following the rebuild process closely.
- Lucy Johns, M.P.H., submitted written comments supporting
co-location with UCSF and asking that the scope of ambulatory care
within the CHN system (on file).
- Commissioner Parker asked if the bond would provide a changing
atmosphere in terms of the Department’s mission and strategic
planning. Five areas addressed: response of rebuild relating to SB
1953; endorsement for increase in ED capacity; Level I Trauma Center
being supported by a helipad; community centers/clinics services be
increased and waiting times reduced; affiliation with UCSF to
continue. He is not making specific recommendations about co-location
but wants to see his points considered in the final plan. It would be
our responsibility to see that the recommendations are followed
regardless of where they come from.
- Commissioner Sanchez observed that it is an excellent, working
document. It raises questions in many areas. The speakers today show a
high respect for quality care and services. SFGH as a campus now a
campus with UCSF faculty. It is not a new pathway; it has been like
that for years. The majority of faculty is there because it is where
they want to train, practice and provide services. The mission of SFGH
is different than that of the UCSF as a whole. These two systems have
worked well together at SFGHMC. We have to plan for the future but the
timeline is clicking away. Mission Bay was going to be a biomedical
center from its inception. Lots of folks at UC think Mission Bay is
their area. We have two unique, excellent institutions. There is
already a model of collaboration to provide faculty and staff services
to this city and we need to ensure that the quality of services
continues. There are culturally competent services at SFGHMC that one
may not see at UC or Mission Bay. DPH’s timeline is different than
UC’s. There should be a summary of the plan in neighborhood
newspapers as well as a Saturday Health Career Day to share with the
community the model DPH is looking at. This report is very important
first step to help us think about the mission of both institutions.
- Commissioner Jackson observed that DPH has already been partners in
many ways with UC. When we know where we are going, we are going to
have to have an extraordinary education piece. He thinks it is still a
challenge in San Francisco that people still go to the Emergency Room
to get services. We must educate staff about how this new system is
going to work. How do people get the services they need in the most
efficient way? Build this future on information and knowledge. There
has been little discussion about internal transportation from site to
site. We could develop our own transport system rather than having
people rely only on public transportation. Must stay a Level I Trauma
Center and part of that is having a helipad site. These are
challenging economic times. People are working hard and we will need
to say to them that unless they support the bond, they will lose a
very valuable resource. Marketing and sales challenge to the whole
Department and staff.
- Commissioner Guy noted that today’s report is a good beginning.
She made suggestions about what the next progress report should
include. In terms of vision, how does the rebuild of the acute medical
center, the heart of our tertiary care, fit into our system?
Commissioner Sanchez spoke of our rich relationship and affiliation
with UC, which provides research, practice and delivery. Worth it to
take a look at it every 30 years. Letting the option of program drive
us. DPH should be open to the question of co-location but she would
like a progress report on what happens to research if we do not
co-locate. Our relationship with UC needs to continue regardless of
what campus SFGHMC is located on. DPH’s timeline is different with
UC. Ours takes precedence so we do have to make a decision. Our
potential co-location partner needs to respect our timeline. She
acknowledges questions of finance and cultural differences.
Organizational cultural differences are important, as is the community’s
diversity. In the planning process we need to accommodate those who
cannot come during the day, and anticipate some of the questions such
as the downturn in the economy. DPH needs to turn to its congressional
delegation for help. The Trauma Center has to be regionalized and this
means a helipad. Have to work with the public and neighbors. It is a
difficult question and brings up NIMBY-ism but can struggle with it
respectfully. She is still not clear on the SNF questions. Just
because we have LHH does not mean we put all our SNF beds there. We
need more SNF. Various ambulatory care questions need to be discussed
further at the joint conference committees, including Southeast’s
long waiting times, the physical capacity of ambulatory care capacity,
and Potrero Hill as the site for the SuperClinic. On behavioral
health, need to deal with the stigma question. One way to handle it is
to configure a Center of Excellence. It is true what research and
community says-medical needs and psychiatric needs must go together.
Some complexity to it if we go to co-location. We should be looking at
Best Practices data from others who have tried to see what works and
what does not.
- Commissioner Chow said that the process has been one that has
included many hearings and we are not here arguing the information but
what to do with the information. The process has been more than many
of us anticipated. One thing that has come out today is that the
cultural competency is not just words that reflect language or
demographics. It is what distinguishes the care at SFGH. Implicit in
all of this is cultural competence. Whatever we do, it has to fit the
population we target. There are a number of issues that require
continued discussion, the first being co-location and where to rebuild
the hospital. If we stay on Potrero, how do we assure we have
continued research excellence? Need to get this responded to. If we
are going to go with co-location, we need to find examples that it
works and that culturally competent care continues in that venue. Who
is the dominant partner? If we continue with co-location, how is it
that people will receive competent services? The second issue is
Trauma, which is not in question, regardless of where we are. In order
to keep Trauma, there needs to be air transport. We have a waiver at
the moment that we are going to do that. Commissioners have expressed
a need for emergency capability for terrorism and our own natural
[earthquake] vulnerability. SNF issues require a continued look and
whether SNF should be part of the rebuild at SFGH or just LHH. We have
heard more about OB and pediatrics. Without pediatrics, can we have
Trauma? Ambulatory care is another topic that needs to be discussed
separate from what and where we build. It is not just a facility
issue. What are the different capacities? For example, in Chinatown,
we can use the second floor with the elevator. If we have more staff
at Southeast, we could take care of more people. The issue of
public-private partnership is important. We already have a
relationship with the Consortium. Where does this stand and what does
this mean for providing community care? On the question of ambulatory
care and the SuperClinic, we have to hear a lot more about where and
how we deliver care. There are facility implications but first there
needs to be a policy issue around ambulatory care. In terms of SFGH
rebuild, the Joint Conference Committees have to hear these issues.
Combine this with how we carry out the Trauma. If it’s a good idea
to have better behavioral health services more integrated-whether we
have or don’t have a Mission Bay, this needs further development.
Pediatric services should be further discussed at SFGH. Elder care is
a market issue. If it changes the configuration of how the hospital is
built, then it has implications for how and where the structure gets
built. Finally, the need for community input and education needs to be
at times that are convenient for both. We need to get more public
input from immediate community and survey our own patient population
and what they feel are the needs. We have an ambitious agenda over the
next few months.
Anthony Wagner assured the Commission that staff would continue to
engage the two teams. Lewin will continue to report back to us and work
Dr. Katz thanked the Commission for their comments, which will help
staff in doing the next stage. In thinking about his own job for the next
year, he wants to prepare a terrific bond measure. It is complicated,
there are lots of questions, and more study that needs to be done. But he
is convinced that we will do it and it will be a great program, whether it
is at Potrero or co-located. It will be the best and it is the best public
hospital in the US and will remain so. Staff has nine months to complete
the program plan, which must be done by April 2003. All the questions do
not need to be answered prior to the bond going on the ballot. LHH
continues to change in response to request of residents, staff, architects
and the project team. It is not possible to answer every question about it
in the next nine months. We do have to get the answers to the questions
raised today and put together the very best program plan and seek
community input. Ultimately, it is the voters who will decide. There is a
lot of hard work ahead of us and we look forward to it.
Commissioner Guy asked if January is a good deadline. Dr. Katz said
that it pushes staff to the limit but if they are not further along in the
co-location discussion in two months, then that is the end. January is the
drop-dead time for an MOU. Based on LHH, the bond measure does not have to
specify the location, but has to specify the program. The public may
accept some openness. By October staff will know whether DPH is going on
its own or going on with UC.
6) CONSIDERATION OF A RESOLUTION ADOPTING THE ENVIRONMENTAL IMPACT
REPORT FOR THE LAGUNA HONDA HOSPITAL REBUILD PROJECT
Larry Funk, Executive Administrator for Laguna Honda Hospital,
introduced Michael Lane, project manager for the Laguna Honda Hospital
Mr. Lane described the new design. There are three resident buildings
and a link building. This is the design concept they have been working on
since 2001. The design has evolved out of the valley-clinically better to
get into more daylight and avail themselves of the open space. In order to
contain construction operation, they will be using the valley area as a
staging area and not spill into the community. They will be retaining
existing buildings and will be future location of assisted living and be
directly accessible to support services. Looking at the valley floor,
there will be therapy pools, physical therapy and a gymnasium. There is a
desire to expand rehabilitation services out into the valley area if
Dr. Chow asked how many rehabilitation beds there would be. Mr. Lane
replied 60. The floor above the rehabilitation center would come into the
Town Center with the library, gift shop, art for elders and activity
Mr. Lane continued to explain the floor plate. The typical floor plate
has 15 households with dining and living rooms on either end. Comes
together for a core space that has four dining rooms, activity therapy
space, nurse’s station and galley. A triple room opens to a common area.
Other floor plan is a double. They are making an effort to restore the
valley and provide garden access. Landscaping will develop gardens between
households. The landscape architect is working with residents on how to
plan for them.
Budget update. They are going into construction document design and
were looking at a $30 million design development over-run. Overall floor
plate increased 1200 sf. As they went through design process, the
geo-technical information showed the foundation had to go down further.
Took another look at escalation and reduced it. Refined design more in
handling soil and foundation. Deferred renovation of administrative wings
A, B, and C but kept renovation in buildings that had to connect.
Planning Process. EIR (Environmental Impact Report) was issued on
12/1/01. Public hearing was held on 1/10/02 and public comment closed on
1/16/02. Received Rec & Park Commission approval, a Comments and
Responses Document was issued; Civic Design review and Committee Approval
from Planning Commission.
Four households filed an appeal with the Board of Supervisors this week
on the EIR. The appellants said the EIR failed to address the impact on
the surrounding community. The design should have triggered an amendment
with the Master Plan. Planning Commission said neither of these points
have merit and they will respond. The crux of the issues with the
households is that they said they did not know where the buildings were
going to go. The timing of this appeal is frustrating because they were
sending documents to the printer to be ready for the July 22nd hearing.
Staff held a number of neighborhood and community meetings where this did
not come up. The Board will hear the appeal of the EIR either August 5th
or 12th. Could prove very significant if the Board upholds the appeal.
Would set us back six months and millions of dollars. Would have to cut
more from the project to keep this on schedule. Unfair to have gone
through the process and would have to go through it again with no
guarantee that someone else would come up with something again. Have
received many letters from community groups already and have worked to
On the overall schedule, have Central Plant out for bid. Would let us
locate it out of the valley. Coming out in August with a roadway plan.
Waiting to hear about the laundry location. In 2003, we will have
completed design and will begin demolition of first stage. If all moves
forward, would have the final move in of the new facility in 2009.
- Commissioner Jackson noted that there has been good outreach to the
community. A couple people are harsh in their criticism. In the
overall picture, the staff has done their job and this last minute
appeal is unfortunate, especially because we do not have a Planning
Commission at the moment. Every time there is an appeal, it costs
money and we have to cut space or reduce something. He does not know
if the public understands this. We don’t want to lose space. It is
the staff-from medical to clerical-at LHH that makes LHH what it is.
- Commissioner Sanchez said that it was fantastic to see the staff
open up and listen to the cohort of health providers within the
context of what LHH is about. There has been an on-going dialogue and
they have continually taken the message back to the community. It is
an exceptional process and a dedicated group at LHH who provide high
- Commissioner Guy observed that it has been an amazing process. She
appreciates Mr. Lane’s leadership and management. The unanimous vote
of the Planning Commission is what we want to hold onto and the Forest
Hill Association is important strategically. She has confidence that
the process the groups have taken will rule the day. NIMBY-ism is real
and part of the democratic process. We are fortunate that Mr. Lane is
leading and managing the project. Many good people brought us to this
moment, including Dr. Katz, Tony Wagner and Larry Funk.
- Commissioner Parker thanked Mr. Lane for his leadership and
acknowledged his frustration with the appeal. What are the alternative
plans? Are they primarily prompted by the historic issue or the
neighborhood views? The choice to renovate Clarendon Hall or move
independent living to the back. In terms of reading this, is there a
reason that prompted the alternatives? Michael Lane replied that the
plan is fixed with the wings. Original concept talked about assisted
living in Clarendon Hall. Clinical needs said to move the assisted
- Commissioner Chow said that the work is well-planned. Many
neighborhood associations support the project and the Board of
Supervisors will understand that. This is an important process for a
large project. It already has been two years and has run relatively
smoothly. You have been able to maneuver between the challenges while
keeping the amenities that people want. These are important
- Commissioner Chow announced that this item would be continued to the
call of the Chair.
7) PUBLIC COMMENTS
Patrick Monette-Shaw. Testified in May the PositiveResource Center had
a subcontract with LaFrance. Several problems. Two months late in
concluding the final report. Report still in draft stage. LaFrance now
four months late. Appears LaFrance is not submitting contracts. Performed
poorly. Ask the Health Commission to investigate this contractor’s
non-compliance. Report should go to CARE Council.
The meeting was adjourned at 7:00 p.m.
Eileen Shields, Public Information Officer