Minutes of the Health Commission Meeting
Tuesday, March 15, 2005
at 3:00 p.m.
LAGUNA HONDA HOSPITAL
Gerald Simon Auditorium
375 Laguna Honda Blvd.
San Francisco, CA 94116
1) CALL TO ORDER
Commissioner Monfredini called the meeting to order at 3:10 p.m.
- Commissioner Lee Ann Monfredini, President
- Commissioner Roma P. Guy, M.S.W., Vice President
- Commissioner Edward A. Chow, M.D.
- Commissioner James M. Illig
- Commissioner John I. Umekubo, M.D.
- Commissioner David J. Sanchez, Jr., Ph.D.
Commissioner Monfredini announced that the budget hearings on the
proposed FY 2005-2006 Department of Public Health budget would be
Tuesday, March 29, 2005, 3:00 p.m. and Thursday, April 7, 2005, 3:00
p.m. Both hearings will be held at 101 Grove Street, Room 300.
2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF MARCH 1,
Action Taken: The Commission (Chow, Guy, Monfredini, Illig, Umekubo)
approved the minutes of the March 1, 2005 Health Commission meeting.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Illig chaired, and Commissioner Chow attended, the Budget
(3.1) BHS – Request for site approval for relocation of New Leaf:
Services For Our Community from 1853 Market Street to 1390 Market
Street/103 Hayes Street.
- Commissioner Illig requested that a site map be included with all site
(3.2) BHS-Mental Health – Request for approval of a retroactive renewal
contract with NICOS Chinese Health Coalition, in the amount of $67,872,
to provide mental health services, for the period of July 1, 2004
through June 30, 2005.
- Commissioner Chow abstained from voting on this item.
(3.3) EMS-Emergency Operations Section – Request for approval of a new
contract with EMSystem, LLC, in the amount of $771,637, to provide
patient tracking software and maintenance services, for the period of
March 15, 2005 through May 30, 2008.
- Secretary’s Note – This item was removed from the agenda at the request
of the Department.
(3.4) CHN-SFGH – Request for approval to submit a resolution to the
Board of Supervisors to accept a gift of funding valued at $138,766 from
the Avon Foundation via the San Francisco General Foundation, for
technical and logistical services associated with the Mobile Mammograph
Facility donated to the City in 2004 by the University of California,
San Francisco, for mobile mammography services to indigent and
under-served women in San Francisco, and a contract modification with
Shanti Project increasing the amount of the contract by $56,160, for a
new total of $225,840, without affecting the original contract period of
July 1, 2004 through June 30, 2006.
- Commissioner Chow asked how the funds that are not allocated to Shanti
would be used. Roland Pickens replied that the remainder of the funding
is for technician services.
Action Taken: The Commission (Chow, Guy, Monfredini, Illig, Umekubo)
approved the Consent Calendar of the Budget Committee. Commissioner Chow
abstained from voting on Item 3.2. Item 3.3 was pulled from the agenda
at the request of the Department.
4) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., Director of Health, said the annual unannounced
visit from State licensing is underway at Laguna Honda Hospital. The
surveyors arrived on Sunday and are anticipated to leave on Thursday.
5) PRESENTATION OF THE EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF
Commissioner Chow presented the Employee Recognition Awards for the
Month of March.
|David Woods, Pharm.D.
||Laguna Honda Hospital
||Robert Christmas, LHH COO, Director of Pharmacy
|Clarendon Hall Bridge Demolition Project Planning
- James Johnson
- Philippe Taquin
- Diana Kenyon
- Viktor Kirienko
- David Woods
- Steve Koneffklatt
- William Frazier
- Angela Platzer
- Debbie Tam
- Monica McGuire
- Lilia Hendrix
- Lolita Caceres
- Pamela Ketzel
- Maxwell Chikere
- Arla Escontrias
- Jimmy Matthews
- Horace Smith
- Alice Wong
|Laguna Honda Hospital
- Cheryl Austin,
- Robert Christmas,
- Gayling Gee
- Mivic Hirose
- Paul Isakson, M.D.
- Tim Skovrinsky, M.D.
- Serge Teplitsky
6) PRESENTATION OF THE LAGUNA HONDA HOSPITAL 18-MONTH STRATEGIC PLAN,
AND CONSIDERATION OF A RESOLUTION APPROVING THE STRATEGIC PLAN
John Kanaley, Laguna Honda Hospital Executive Administrator, presented
the Laguna Honda Hospital 18-Month Strategic Plan. The strategic plan
includes mission and vision statements, goals, objectives and
outcomes/indicators. The plan was developed through a number of
executive staff retreats. Mr. Kanaley said the recent changes to the
admissions policy, as well as concerns expressed at Supervisor
Elsbernd’s February 28th committee hearing, are reflected in the
Mission: As part of the Department of Public Health safety net, the
mission of Laguna Honda Hospital is to provide high-quality, culturally
competent rehabilitation and skilled nursing services to the diverse
population of San Francisco. Skilled nursing service includes long-term
care for residents who cannot be cared for in the community and/or
short-term care for these who can be rehabilitated and discharged to a
lower level of care within the community.
Vision: Laguna Honda Hospital will be a center of excellence in
providing a continuum of care that integrates residents in the least
restrictive setting, thereby supporting their highest level of
- Clinical Programs – Continue to enhance preventive and therapeutic
- Safety and Security – Develop and implement an enhanced
Safety/Security program that will provide a safe/secure environment for
residents, staff and visitors.
- Finance – Maximize revenue for all programs and services.
- Organizational Structure, Communication and Leadership – Develop a
hospital-wide organizational structure for operations, leadership,
communications and training.
- Information Systems – Laguna Honda Hospital will participate in the
design and implementation of a single DPH-wide clinical and financial
information system and will upgrade the hospital infrastructure to
support advanced technology.
- Performance Improvement, Licensing and Regulatory Preparedness –
Develop and implement the Laguna Honda Hospital Performance Improvement
- Human Resources – Ensure adequate and culturally competent staff.
- Laguna Honda Hospital Replacement Project – Develop a systematic
approach to successfully operationalize the Replacement Project.
- Operational structure of new hospital – Initiate the operational
planning for moving into the new hospital.
Dr. Katz said that Laguna Honda Hospital is a very large tent with a lot
of capable people who are capable of caring for the full range of San
Franciscans who need long-term care.
- Howard Chabner said safety is the primary concern and dangerous
patients cannot be admitted. He told a story of a middle-aged
able-bodied woman who has been a danger to others. The dangerous
admissions must stop.
- Patrick Monette-Shaw complimented John Kanaley for restoring long-term
care to the mission statement. There are a number of flaws in the
strategic plan. If behavioral health patients were more appropriately
placed, the facility would not need more behavioral health programs or
additional security. Further, the public needs to know if there are
- Dr. Brenda Austin asked the Commission to support access to
Proposition 63 monies to fund new programs that support patients with
mental health disorders. The psychosocial units have been very
successful. Many resources have been lost, and the population is more
complex. Programs help people transition to the community or adjust to a
long-term care environment.
- David Bisho, President, West of Twin Peaks Central Council, said
budget problems are no excuse to change the admissions policy. The
Council demands that the frail elderly and disabled be the first
priority. He submitted a copy of the 1999 admissions policy.
- Sonny Quiniquini said staff, patients and relatives were never
consulted about the change in the admission policy. He disagrees with
the change. Where did the change come from and who approved it?
- Benson Nadell, San Francisco Ombudsman, said because of the diversity
of individuals being treated, goal seven should be modified to include
adding staff to handle the increasingly complex and diverse patients.
This is going to cost additional money, and this should be acknowledged.
- Sr. Miriam Walsh said the main issue is that they are not prepared,
and do not want to be prepared, to serve people who are violent and have
- Commissioner Illig commended the management team for developing the
strategic plan, modifying the mission statement to address community
concerns and having a vision statement that emphasizes keeping people in
the least restrictive setting.
- Commissioner Chow said the Laguna Honda Hospital Joint Conference
Committee reviewed the strategic plan. It is extremely comprehensive and
was developed in a short timeframe. It was a team effort.
- Commissioner Umekubo said there has been a change in long-term care
that has resulted in more and more pressure on long-term care
institutions. Nursing homes are being forced by acute care hospitals to
do sub-acute care. In addition, the population is changing. The
strategic plan is a good guide.
- Commissioner Guy applauded senior staff and front line staff for
navigating Laguna Honda into the future. This is a struggle, and
communication is critical. She is pleased that the vision statement
includes the hospital being a center of excellence and she
wholeheartedly supports and will advocate for staff resources and
whatever else is required to meet this vision.
- Commissioner Monfredini congratulated Mr. Kanaley on the strategic
plan. It is a living, working document. She asked for monthly reviews at
the Joint Conference Committee of goals and objectives to make sure we
are still on target.
Action Taken: The Commission (Chow, Guy, Monfredini, Illig, Umekubo)
approved Resolution 04-05, “Approving the Update of the Laguna Honda
Hospital Strategic Plan,” (Attachment A).
7) LAGUNA HONDA HOSPITAL REPLACEMENT PROJECT UPDATE
Michael Lane, Project Manager, LHH Replacement Project, presented an
update on the replacement project.
- Design began in 2000. Construction work that was bid in 2002 had come
in on budget. In April 2003, the entire Replacement Program was on
- Cost per bed in April 2003 was $335,000.
- Escalation in healthcare construction in the last 12-18 months is in
the range of 2-3% per month.
- The project had budgeted 3.8% per year based on historical averages
and pre-2003 market conditions.
- First round of bids for the South, Link and East buildings was in
- April 2003 to October 2004 is 18 months, which represents escalation
in the range of 24-36%.
- Re-bidding and soliciting contractor-proposed value engineering
proposals between November 2004 and March 2005 saved over $5.5 M.
- The bids for these buildings are $84.5M over budget.
- These first three building contain 780 beds.
- Cost per bed for these 780 beds is $521,000.
- The following elements of the program have not been bid:
- Remodel of the Existing Building
- Site Work, and existing building demolition.
- West Building (420) Beds
- Recommendation from the team is to proceed with the South and Link
Buildings at full scope.
- Replacement Team will provide an updated cost on unbid work (listed
above) taking the current market into consideration.
- Replacement Team to work with the Controller’s Office to develop
options for moving forward.
- Ed Kinchley, SEIU, representing the three locals that represent
workers at Laguna Honda, said that it makes sense to continue with the
construction and asked the Commission to make a clear commitment to
working with the Mayor and labor to find the money to build 1200 beds.
If we delay longer, the costs will increase even more.
- Alicia Gershon, Protection and Advocacy, said a number of people could
leave Laguna Honda today if adequate community resources were available.
She urged the Health Commission to let the Targeted Case Management Team
complete its needs assessment. She would support the current resolution
as long as it factored in an adequate assessment for the need for
different types of services.
- Jessie Lorenz, Independent Living Resource Center, said the discussion
needs to be about the current patients at Laguna Honda who do not want
to be there, and serving people in the future who want to remain in the
- Virginia Leishman believes in independent living, but long-term care
is necessary. How many beds are we talking about? She voted for 1200
beds. San Francisco lost a resource with the MHRF, and when she voted
for that, she expected it to remain, not be changed.
- Patrick Monette-Shaw said there are inconsistencies in the rebuild
report in terms of comparisons with other hospitals, cost overrun
estimates and others. He said the Commission should wait until the City
Attorney determines whether or not tobacco funds could be used before
making a decision.
- Michael Lyon, Gray Panthers, said it is obvious that the City’s
commitment to providing health care is in question. We need to look at a
- Oletha Hunt said she is a 19-year employee at Laguna Honda. What is
the point of voting if this is how it is going to be? The City needs
Laguna Honda, and the Commission needs to work with labor to find the
money for 1200 beds. If we mess this up, voters will not support
- Kim Tavaglione, SEIU 250, said in the past when labor, community and
the City worked together on problems, there has been success. What is
missing in the most recent discussions is a holistic approach to
providing healthcare in San Francisco. There is room for everyone.
- Sunny Quiniquini asked how much the current cost overrun is. There
should be no modification to the plan without voters’ permission. The
voters have lost trust.
- Tom McDonough said people voted for 1200 beds and there should be no
- Commissioner Monfredini asked if there was a point when the Health
Commission should have revisited the project budget in terms of cost
escalation assumptions. Mr. Lane said it seemed prudent to wait until
the bids came in before presenting to the Health Commission.
Unfortunately the price is not out of line with what the market is
charging. Commissioner Monfredini noted that no general obligations
bonds have been used for the project up to this point.
- Commissioner Chow clarified that the $84 million is the overrun for
the three buildings that were put out to bid. He asked for confirmation
that the work up to this time has been within budget. Mr. Lane said yes.
Commissioner Chow asked if we know the cost estimate for the full build
out. Mr. Lane said not at this time. Commissioner Chow asked Mr. Lane
what the average cost of an acute hospital bed is. Mr. Lane replied that
Turner Construction estimates $1.1 million - $1.3 million per bed.
Commissioner Chow confirmed that Mr. Lane’s recommendation builds the
infrastructure that is necessary for the full build out. Mr. Lane said
yes, this is the case. Mr. Lane added that one reason he is not
recommending proceeding with the East Building is that, although there
is the budget for 180 beds, once this decision is make it cannot be
- Commissioner Illig asked how much the hospital could get reimbursed
through SB 1128. Dr. Katz explained that this legislation allows DPH to
bill the federal government for partial costs of new construction, but
at the time patients are being served. So this funding cannot be
accessed until the new facility is occupied. Commissioner Illig asked if
all beds are at the same level. Mr. Lane said that some beds are acute,
but in terms of footprint, all the buildings are quite similar.
- Commissioner Umekubo said everyone is disappointed about the cost
overruns. The project seems to be a victim of bad timing. Hopefully the
Department and City can be creative and find the funding.
- Commissioner Guy, in preparation for when the Health Commission does
take action, said it would be helpful to update the Laguna Honda
Hospital white paper to carefully look at the choices and examine the
consequences. This would help the public, staff and decision makers
understand all the factors. Dr. Katz agreed with this suggestion and
said this would mesh nicely with what the Controller’s Office is doing,
which is developing finance options.
- Commissioner Monfredini said it is important that all options be
explored before deciding the most appropriate way to proceed with the
rebuild. The Health Commission asks that Dr. Katz prepare a white paper
on the various option and present it to the Health Commission within a
60-day timeframe. Among the options, she asked that the following be
analyzed: Is it economically feasible to stay in business, in terms of
operating costs versus reimbursement, with the number of beds in the
current proposal; can we justify the number of beds in the current
proposal given the cost per bed; is it financially viable for the
Department of Public Health to stay in the long-term care business; what
is the feasibility of partnership with private or non-profit
organization to develop on the Laguna Honda campus an
independent/assisted living facility, with a smaller SNF on the campus.
- Commissioner Chow requested that demographics of the population we are
trying to serve be part of the white paper, and also an analysis of
whether there is a mix of services that are not needed. Commissioner
Chow said that Mr. Lane’s recommendation to proceed with the two
buildings does not preclude any future configuration, so the Commission
should agree that the can proceed.
- Commissioner Illig recommended that the Health Commission take action
to allow the project to continue, given that circumstances have changed.
The draft resolution will be scheduled for the March 29, 2005 Health
8) PUBLIC COMMENT/OTHER BUSINESS
- Alex Kudren said the voters should have been asked if long-term care
should have been removed from the mission statement. He commended the
Mayor, Dr. Katz and the Commission for restoring it.
- Patrick Monette-Shaw said it is premature to issue a final resolution
unless they know what the options are. Further, the white paper cannot
- Michael Lyon would like to know what has been done to lower the
expected number of SNF patients per 1,000 people. It is really naïve to
expect that the white paper will contain unbiased information.
The meeting was adjourned at 5:50 p.m.
Michele M. Seaton, Executive Secretary to the Health Commission
Health Commission meeting minutes are approved by the
Commission at the next regularly scheduled Health Commission meeting.
Any changes or corrections to these minutes will be reflected in the
minutes of the next meeting.
Any written summaries of 150 words or less that are provided by persons
who spoke at public comment are attached. The written summaries are
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