Minutes of the Health Commission Meeting
Tuesday, January 10, 2006
101 GROVE STREET, ROOM 300
San Francisco, CA 94102
1) CALL TO ORDER
Commissioner Monfredini called the meeting to order at 3:20 p.m.
- Commissioner Lee Ann Monfredini, President – left at 5:35 p.m.
- Commissioner Roma P. Guy, MSW, Vice President
- Commissioner James M. Illig
- Commissioner David J. Sanchez, Jr., Ph.D.
- Commissioner Donald E. Tarver, II, M.D.
- Commissioner John I. Umekubo, M.D.
- Commissioner Edward A. Chow, M.D.
President Monfredini announced appointments to the Community Health
Network Joint Conference Committee (CHN JCC). Commissioner David Sanchez
will chair the CHN JCC, and Commissioner Tarver will serve the other
2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF
DECEMBER 13, 2005
Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Tarver,
Umekubo) approved the minutes from the December 13, 2005 Health
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Illig chaired and Commissioner Sanchez and Commissioner
Tarver attended. f the Budget Committee meeting.
(3.1) PHP-Emergency Medical Services Agency – Request for approval to
accept and expend, retroactively, a new grant from the California
Emergency Medical Services Authority, in the amount of $240,860, to
supplement on-call physician coverage for trauma services at San
Francisco General Hospital Trauma Center, for the period of July 1, 2005
to June 30, 2006.
(3.2) CBHS – Request for approval of a retroactive contract renewal with
Lincoln Child Center, in the amount of $156,498, which includes a 12%
contingency, to provide children’s mental health services for the period
of July 1, 2005 through June 30, 2006.
(3.3) CBHS – Request for approval of a retroactive renewal contract with
Ohlhoff Recovery Programs, in the amount of $376,583, which includes a
12% contingency, to provide behavioral health services to women and
adolescents, for the period of July 1, 2005 through December 31, 2006
for a total contract amount of $632,659.
(3.4) CBHS – Request for approval of a retroactive contract modification
with Catholic Charities of San Francisco, in the amount of $86,375 per
year, for 2 years, for new total contract value of $815,630, to provide
supportive housing/mental health services to disabling HIV/AIDS homeless
for the period of July 1, 2003 through June 30, 2007.
(3.5) CBHS – Request for approval of a retroactive contract renewal with
Regents of the University, in the amount of $345,610, which includes a
12% contingency, to provide program evaluation services for the
Children’s System of Care for the period of September 30, 2005 through
September 29, 2006.
(3.6) CBHS – Request for approval of a retroactive contract renewal with
Regents of the University of California, in the amount of $366,160, to
provide crisis intervention & stabilization, clinical case management
and linkage services for the period of July 1, 2005 through June 30,
- Commissioner Tarver asked why the program was unable to meet its units
of service. Edwin Batongbacal from CBHS said that the agency achieved
55% of its units of service in FY 03-04. DPH staff looked at the
problem, which was mainly a result of staff turnover and the inability
to recruit. The agency has achieved its FY 04-05 goals.
(3.7) CBHS – Request for approval of a retroactive contract renewal with
St. Vincent School for Boys, in the amount of $392,895/year, which
includes a 12% contingency, to provide mental health outpatient services
for the period of July 1, 2005 through June 30, 2007, for a total
contract value of $785,790.
Secretary’s note – Staff clarified that the contract is with Catholic
Charities, with whom St. Vincent School for Boys has merged.
(3.8) DPH-Environmental Health – Request for an approval of a new
contract with Mission Economic Development Association, in the amount
$73,538, which includes a 12% contingency, to provide fiscal management
and business plan development services for the ongoing Day Labor
Program, for the period of January 1, 2006 through September 29, 2006.
- Commissioner Illig ask Jenny Chacon from Environmental Health to
convey to MEDA his concern about the number of people on the board. Ms.
Chacon said MEDA now has only one vacancy, and MEDA staff is aware of
the commissioner’s concerns.
- Commissioner Sanchez said that MEDA has provided years of service to
the Mission community. He is pleased to see the Department looking at
different pathways for approaching the day laborer population. The
Mission Language Vocational Center is involved with day laborers as
well. Ms. Chacon said they are working with Rosario Anaya.
(3.9) AIDS Office-HIV Prevention – Request for approval of a retroactive
new contract with UCSF-Stonewall Project, in the amount of $200,000, to
provide HIV prevention services to men who have sex with men, for the
period of July 1, 2005 through June 30, 2006.
- Commissioner Illig asked if this contract is connected to the money
for methamphetamine treatment that he read about in the Bay Area
Reporter. Dr. Siever, UCSF Stonewall Project, said that this is a
different contract. Magnet has two contracts with DPH, one with the AIDS
Office and one with STD. Further, Stonewall Project has multiple
programs with DPH. The programs referenced in the Bay Area Reporter are
not related to this contract.
- Commissioner Tarver said he is going to advocate for expanded funding
for the Magnet Program.
(3.10) CBHS – Request for approval of a retroactive contract renewal
with Mental Health Management, Inc. dba Canyon Manor, in the amount of
$4,538,881 per year, which includes a 12% contingency, for a total
two-year contract value of $9,077,761, to provide 24 hour locked mental
health rehabilitation services for the period of July 1, 2005 through
June 30, 2007.
Secretary’s Note – Canyon Manor is a for profit organization, not a
non-profit as noted in the Health Commission contract summary.
- Commissioner Illig expressed concern that one of the outcome
objectives relates to number of patients returned to PES. Under what
circumstances would patients return? Richard Evatz from Canyon Manor
said that when patients become too acute for Canyon Manor’s level of
care, they have to go to an acute level of care. Usually patients return
to Canyon Manor. They have psychiatrists on staff, but are not licensed
to provide acute care level of services.
- Commissioner Tarver said that L facilities are a vital part of the
continuum of care but it behooves us to re-examine lengths of stay,
costs, etc. He asked how Canyon Manor evaluates length of stay,
discharge plans, etc. Mr. Stillwell said there has been a lot of
pressure over the past years to move people from acute to subacute. So
while subacute is expensive, it is much less costly than an acute
hospital. That said, DPH staff continually look at the best place for
these patients, and there is monthly utilization review. The nurse is
out there every few weeks to evaluate whether patients can be discharged
to the community, and there are on-going discussions with residential
care facilities. Commissioner Tarver asked if the TCM project is
involved in the UR meetings. Susie Reichert, Senior Administrative
Analyst for Community Programs/Placement, said TCM is not done in the
locked facilities. Ms. Garcia said that in December alone DPH staff
moved 200 people from SFGH. Crestwood really assisted DPH in making this
happen. As a result of the HMA Report, a Placement Committee is in place
and is working on this issue. Commissioner Tarver requested Canyon
- Commissioner Illig recommended that this contract be approved for 15
months so that the Health Commission could review progress after one
year. So the term of the contract is July 1, 2005 through September 30,
(3.11) CBHS – Request for approval of a retroactive contract renewal
with Regents of the University of California, in the amount of
$719,765/yr, which includes a 12% contingency, to provide mental health
and substance abuse services targeting low income, uninsured or
underinsured clients with HIV/AIDS or disabling HIV for the period of
July 1, 2005 through June 30, 2009 for a total contract value of
- Commissioner Illig said this is the best set of outcome measures that
he has seen in a long time.
(3.12) CBHS – Request for approval of a retroactive contract renewal
with Regents of the University of California, in the amount of
$4,041,202, which includes a 12% contingency, to provide citywide case
management mental health services targeting Psychiatric Emergency
Services clients and County Jail inmates with mental illness, for the
period of July 1, 2005 through June 30, 2007 for a total contract value
(3.13) CBHS – Request for approval of a retroactive contract renewal
with Crestwood Behavioral Health, Inc., in the amount of
$6,500,000/year, which includes a 12% contingency, to provide 24 hour
skilled nursing facility services for the period of July 1, 2005 through
September 30, 2006, for a total contract value of $9,100,000.
Secretary’s Note – Crestwood is a for profit organization, not a
non-profit as noted in the Health Commission contract summary.
Commissioner Tarver asked who often the patients are reviewed for
discharge potential. Mr. Stillwell said there is a monthly utilization
review, with special emphasis on improving the medical quality of these
clients. Commissioner Tarver asked if the conservator is involved in the
UR visits. Patricia Blum, Vice President of Crestwood Behavioral Health,
said the conservator is there quarterly at a minimum. Commissioner
Tarver asked that information regarding unduplicated clients and cost
per unit. Commissioner Tarver said there should be other creative,
clinical outcomes and treatment goals.
(3.14) CBHS – Request for approval of a retroactive contract renewal
with Progress Foundation, in the amount of $9,724,850, which includes a
12% contingency, to provide residential mental health services for the
period of July 1, 2005 through June 30, 2006.
- Commissioner Illig asked Steve Fields, executive director of Progress,
why the number of FTEs is being reduced. Mr Fields said the In-Reach
shelter program was cut mid year, which resulted in a decrease of 3.25
FTEs. The other 1.0 FTE reduction is a mathematical error. Commissioner
Illig was disturbed that three of the four objectives were not rated due
lack of CBHS data. Mr. Fields said that there must be discussions with
CBHS about how to measure what the Department and agency partners are
trying to accomplish. CBHS only wants to include measures it can track
and because CBHS’s system is basically a billing system, it cannot track
many of the outcomes that Progress measure. This must change.
Commissioner Illig asked if the agency has been paid under an interim
agreement. Mr. Fields said the interim agreement expired December 31,
2005, and the delay in getting before the Health Commission has
disturbed his cash flow, and this is upsetting.
- Commissioner Tarver asked why the contract was delayed. Mr. Fields
does not know. Stephen. Banuelos, CBHS program manager, said CBHS is
more behind than usual on contractors.
(3.15) CBHS – Request for approval of a contract modification with
Calvin Y. Louie, CPA dba Louie & Pak, LLP, in the amount of $6,191,325
per year, which includes a 12% contingency to provide fiscal
intermediary services for the period of July 1, 2005 through December
31, 2006 for a total contract amount of $7,812,724.
(3.16) CBHS – Request for approval of a retroactive renewal contract
with the SAGE Project in the amount of $2,259,266, with an annual amount
of $502,059, which includes a 12% contingency to provide outpatient
mental health services for the period of July 1, 2005 through December
31, 2009, for a total contract amount of $2,530,377.
- Commissioner Illig encouraged SAGE to expand its board beyond six
- Commissioner Tarver has referred many patients to SAGE. It is a
Action Taken: The Health Commission (Guy, Illig, Monfredini, Sanchez,
Tarver, Umekubo) approved the Budget Committee Consent Calendar. For
Item 3.10, the end of the contract was changed from June 30, 2007 to
September 30, 2006.
4) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., Director of Health, presented the Director’s
SFGH Summary of DHS/CMS Validation Survey
On Monday, December 19th, a Department of Health Services (DHS) survey
team, consisting of two RNs and 2 Pharmacists, appeared at SFGH to
conduct an unannounced Centers for Medicare & Medicaid Services (CMS)
Validation Survey. At the conclusion of the 4-day survey, five patient
care issues were identified that required immediate correction:
monitoring of patients on lithium; monitoring of diabetics on atypicals;
IV admixture preparation outside of the pharmacy; procedure for
addressing patients in clinical distress in acute psychiatry; and adding
phenylephrine to the crash cart.
The Interim Plan of Correction (POC) developed by the SFGH Executive
Staff was accepted by CMS. SFGH was subject to daily visits by DHS until
significant compliance with the Interim POC was demonstrated. On
Tuesday, January 2, 2006, CMS/DHS abated the five patient care issues.
It is expected that CMS/DHS will issue SFGH a full validation survey
report that will contain additional findings. The Hospital Executive
team has already identified action plans to address the additional
Medical Marijuana Program Moves to SFGHMC
The Department began implementing the State Medical Marijuana Program
(MMP) yesterday (January 9th) at San Francisco General Hospital. Staff
processed 17 applications for the new MMP ID card. A number of patients
seen at San Francisco General Hospital yesterday were familiar with the
State Medical Marijuana Program and had obtained information and
applications from the DPH and State MMP websites. News media (Channel 2,
KCBS radio and KQED California Report) were on site to report on the new
The MMP is located in the lobby of San Francisco General Hospital and
operates Monday - Friday 1:00 - 4:00 p.m. The fee is $50 to process an
MMP application ($25 for Medi-Cal). Patients must bring a letter from
their doctor stating the patient has a medical condition where the use
of medical marijuana is appropriate. Patients may designate one
caregiver. The card, which is valid for one year, can be used in any
county in California.
San Francisco’s MCID's are valid in San Francisco county until the
expiation date (up to 24 months).
Proposition 63 Testimony
A number of staff from Behavioral Health Services will testify before a
panel review in Sacramento January 17th how the San Francisco Plan
(Plan) intends to use the monies assigned for clinical services
(Community Services and Supports [CSS]) under the Mental Health Services
Act (Prop 63).
The review panel is convened by the California Department of Mental
Health (DMH) and is composed of consumers and professionals
knowledgeable about county mental health services. Dr. Katz anticipates
the hearing process will involve a series of requests for changes and
clarifications before the panel recommends the Plan to Steve Mayberg,
MD, Director of DMH. The monies will be released after Dr. Mayberg’s
approval. DPH expects to receive over $5.3 million in new clinical
services monies that will fund some administrative support and, if the
Plan is approved as currently written, will include the following
The majority (51%) of CSS funding will provide Full Service Partnerships
(FSP). FSP’s are case management with wrap-around services provided
through a personal services coordinator, to accomplish "whatever it
takes" to improve the client’s life in significant areas such as
housing, health, relationships, education and employment. FSP programs
will be funded by CBHS through MHSA with a combined total capacity to
serve 122 to 153 individuals and their families across four age groups:
children, youth & families; transition-age youth; adults; and older
adults. A detailed breakdown of funding per age group is below.
The remainder of CSS funding will be used for System Development to
improve the service delivery system for all mental health clients and
families. These efforts will include strategies for reducing ethnic
disparities and for outreach to seriously mentally ill or emotionally
disturbed residents of San Francisco who are currently receiving little
or no services. It is anticipated that the monies will be available by
March, and services will be provided by a combination of civil service
and community based organizations to be determined by an RFP process.
Full Service Partnership (FSP) Age Group Funding Proposal
Children Youth and Families:
- $120,000 will be used to serve 100 children and youth each year for
three years in community-based violence and trauma recovery services,
including a peer-support component for youth.
- $120,000 will be used in integrating psychiatric services within
pediatric settings for early identification of mental health and
- $121,490 will be used to increase organizational and clinical capacity
to specifically serve Lesbian, Gay, Bisexual, and Transgender,
Asian/Pacific Island, indigenous, Latino and African American children
and youth with culturally appropriate services.
- $80,000 will be used in school-based services including wellness
- $152,835 will be used to integrate behavioral health services within
primary care settings that serve transitional age youth.
- $200,000 will be used to provide supported services for housing,
including co-op housing, independent living and board and care.
- $300,000 will be used to do outreach and engagement and to support
youth-run and youth-developed services using the Youth Development
- $131,490 will be used for supportive services for housing, including
peer case management.
- $100,000 will be used for Vocational Rehabilitation. Through a
partnership with the Department of Rehabilitation, this funding will
expand to $400,000, as they will match $3 for each $1 of CSS money
- $130,000 will be used to support a peer-run center that will include
crisis drop-in and a 24-7 warm line.
- $80,000 will go to residential treatment.
- $180,000 will be used to support a senior recovery center that offers
peer support and outreach.
- $300,000 will be used to provide supportive services for housing
including peer case management.
- $172,835 will be used for mental health services in primary care
settings, including dementia behavior management.
- Commissioner Illig asked if civil service would compete fairly with
non-profits through the RFP process for Proposition 63 funds. Ms. Garcia
said that the majority of the dollars are going to non-profits through
an RFP process.
- Commissioner Tarver asked for an update on SFGH’s census. Ms.
O’Connell said the censuses decreased in December. However today it is
331, with the greatest increase in Med Surg.
- Commissioner Guy conveyed the Commission’s appreciation of the staff
work that was involved in the CMS survey.
5) MATERNAL AND CHILD HEALTH ANNUAL REPORT
Twila Brown, Director, Maternal and Child Health (MCH) and Ellen Stein,
M.D., MCH Medical Director, presented the MCH 2004-2005 Annual Report.
The report provides program highlights, an overview of federally
mandated MCH health status indicators, MCH integration of the DPH
Strategic Plan and data analysis of the inequality in African American
fetal infant health mortality.
The MCH Program is a traditional public health program that implements
four public health functions: assessment, policy development, quality
assurance and access. MCH services are population based, prevention
focused, systematic in approach and social justice infused. The MCH
Section is primarily state and federal funded and is currently organized
into five units with subsections: Children’s Medical Services; Maternal
Child and Adolescent Health; Family Planning; Nutrition Services; and
Public Health Nursing.
Title V health status performance indicators and Bay Area data analysis
is used to guide MCH program planning and priority setting, and to
develop planning interventions to produce better health outcomes for
fetal and infant births and to impact infant death, prenatal care, birth
weights, breastfeeding, dental care, children living in foster care,
etc. Health priorities for the San Francisco MCH population include
reducing infant mortality in African Americans, increasing early entry
into prenatal care to 90% and increasing preconception and
interconception care, among others.
Dr. Stein described the data analysis methods and findings around birth
trends. The birth rate in San Francisco dropped significantly for all
ethnicities except Whites. The change in birth rates was greatest in the
Black and Hispanic populations. Dr. Stein described the Perinatal
Periods of Risk (PPOR) model, which is used for reviewing infant
mortality. Dr. Stein also described the Bay Area Data Collaborative
(BADC), which uses regional birth data that has the statistical power to
analyze ethnic disparities. PPOR Regional BADC data shows that the fetal
infant mortality rate in the Black population was more than double that
of Whites, Hispanic and Asian/PI. Data also shows that the greatest
number of Black fetal/infant deaths occur during the
preconceptional/maternal health period. Risk factors include access to
health care, infection, stress and work, general state of health prior
to pregnancy, injuries and abuse, family planning, nutrition,
tobacco/alcohol/drug use and previous pregnancy outcomes.
Medical model approaches to perinatal inequities have not been
effective. Non-randomized trials were either weak or unable to be
sustained. Randomized trials showed no benefit. San Francisco has
developed a different model.
Response: Supporting Change
- Black Infant Health Program/Fetal Infant Mortality Review
- CenteringPregnancy Consortium –combines an empowering medical model
with community groups and services; develop local peer-support systems;
sharing best practices; develop Bay Area-specific new materials;
comparing medical outcomes on a county, regional and state level.
- Preconception Care
- Bay Area Data Collaborative
- Universal Home Visiting
- Public Health Nursing Intervention
- Seven Principles.
- Decreasing Revenue at national, state and local levels.
- Universal Home Visiting – program sustainability; weekend PHN visits,
non-invasive jaundice screening.
- Nursing Shortage
- Black Infant Health Sustainability
- Dental Access
- Pregnant Women – dental disease contributes to prematurity.
Professional outreach and education. Many doctors will not accept these
- Children – pediatrician applied fluoride
- Service Integration, particularly around nursing services.
Ms. Brown showed a video of the Black Infant Health Program.
- Commissioner Guy said the Population Health and Prevention Joint
Conference Committee heard this presentation and was impressed with the
methods through with MCH has identified the areas of need and developed
appropriate interventions. She also appreciates the genuine health
status model, rather than a clinical model. Evaluations show that this
model works. The work pinpoints the problem of health disparities and
shows how DPH’s response could help address these disparities.
- Commissioner Tarver said this is a great example within DPH about
using best practices that have been developed elsewhere as well as
internally. Have there been any thoughts of developing programs or
outreaching to girls who are of pre-pregnancy age? Dr. Stein said that
preconceptional health must to be provided to women of all ages. Ms.
Brown said the preconceptional program is a life health model.
- Commissioner Sanchez congratulated MCH for the Bay Area Data
Collaborative, which provides the ability to generate the data needed to
validate interventions, best practices, etc. Each county has a community
foundation, and Commissioner Sanchez urged the collaborative to make
similar presentations to these foundations.
- Commissioner Umekubo commented that the infant mortality rates are
used to gauge health care systems’ effectiveness. He is curious about
how San Francisco compares nationally. Dr. Stein said they would have to
look at the national health indicators to develop an appropriate
6) STATE AND FEDERAL LEGISLATIVE REPORT
Scott Boule, Deputy Director, Office of Policy and Planning, presented
the State and Federal Legislative Report. The priority that the Office
of Policy and Planning places on legislative advocacy flows from the
Department’s Strategic Plan. Office of Policy and Planning works within
the City’s system to undertake direct advocacy, coalition work and the
development of a two-year State Legislative Plan. Mr. Boule highlighted
areas of interest.
- Record Deficits – 2005 deficit is the third largest ever. Non-defense
discretionary spending is a small portion.
- Republican emphasis on spending cuts, particularly of entitlement
programs – Medicaid cuts; HHS cuts. DPH really felt the impact of the
HHS cuts, due to lack of earmarks.
- Additional tax cuts proposed
- Medicaid will continue to be on the chopping block.
Ryan White CARE Act Reauthorization
- Program authorization expired in September 2005. This is not unusual,
but puts program in a vulnerable position.
- Bush Administration did develop reauthorization principles, which are
harmful to both San Francisco and California. The extent to which the
principles will be in the final bill is unclear
- No legislation has been introduced yet. Mayor Newsom submitted a
letter in August 2005. “Listening Sessions” are being held later this
Medicare Prescription Drug Benefit
- Shift to private plans – Medicare Advantages vs. PDPs; varying
formularies and cost sharing
- Impact on Dual Eligibles – the majority of DPH patients fall into this
category. Patients now get drugs through Medicare instead of Medi-Cal.
There are cost sharing requirements.
- New challenges for AIDS Drug Assistance Program (ADAP), including new
- Improving budget situation
- Impact of the special election
- Few bills signed into law
Medi-Cal Hospital Financing Waiver
- Implementing legislation signed in October, implementing a five-year
waiver; includes a hold harmless provision.
- Unresolved issues remain: new reimbursement mechanism (Certified
Public Expenditures); funding in years 3, 4 and 5; coverage initiative;
managed care expansion.
- Behvioral Health Innovations Task Force – appointed by Mayor, met
seven times from May to August 2005.
- Disappointing award for clinical services expansion. DPH has met with
the Department of Mental Health and the Oversight Commission around this
issue, and has prepared a plan in the event additional funding is
State Medical Cannabis Card
- State card replaces the DPH card program. The program moved from 101
Grove to SFGH. Statewide implementation began in August.
- Delayed implementation – Board of Supervisors Resolution regarding
protecting confidentiality. San Francisco’s approach protects
Mr. Boule noted that the Legislative Report includes a summary of the
health-related bills that were enacted in 2005, as well as a status
report on bills that are tracked by the Department of Public Health. He
noted a few of these bills, including AB 228 (Koretz), AB 547 (Berg), AB
417 (Aghazarian) and AB 1768 (Leno).
- Federal – covering the uninsured; reauthorization of Ryan White, which
is a critical DPH priority; additional spending cuts; implementation of
the Medicare Drug Benefit.
- State – infrastructure bond/seismic safety. DPH’s priority is to make
sure there is money for San Francisco General Hospital; Medi-Cal waiver
for assisted living services; mobile methadone treatment; unresolved
issued in the hospital financing waiver; and continuing to push for fair
allocation of funds under Proposition 63.
- Commissioner Monfredini asked if confidence is justified in terms of
Ryan White reauthorization. Mr. Boule said that we could be confident
that reauthorization legislation will move forward, but San Francisco
has a lot to worry about. San Francisco needs a hold harmless provision.
Undoubtedly there will be an increase in the amount that San Francisco’s
annual allocation can be reduced. Commissioner Monfredini asked Mr.
Boule for his initial reaction to the Governor’s budget. Mr. Boule said
that with regard to the state budget, there is not a lot of new money
for health. But one of DPH’s priorities is the infrastructure bond.
- Commissioner Illig said the Ryan White CARE fund had two parts:
formula and supplemental. The hold harmless agreement relates to the
formula allocation. He is concerned that over the past few years, San
Francisco’s supplemental requests have not been as successful as in the
past. There are other troubling recommendations, including the
requirement that 75 percent of funding go for core services, with no
definition of core services. Commissioner Illig recommended that the
Health Services Planning Council present its priorities to the
Population Health and Prevention Joint Conference Committee. Mr. Boule
said that the key factor in San Francisco’s supplemental applications
the shrinking amount of money that is available nationwide for
supplementals, not necessarily inadequate applications. Dr. Katz added
that some of the recent supplemental problems have been political
problems. Commissioner Illig asked if the Department should consider
name-based reporting. Dr. Katz said this is a policy decision for the
Health Commission. As of now, the Health Commission’s current policy
about name-based reporting stands. Commissioner Illig asked if there has
been success with the long-term care waiver. Mr. Boule said
Assemblymember Yee put forth legislation that would have allowed a
supportive housing waiver to move forward. This is stalled, and the
legislation is being reworked.
- Commissioner Umekubo said one of the insidious components of the
Medi-Cal waiver is the reduction in physician fees, and the Department
should keep an eye on this. Mr. Boule said there was a 4.4% reduction in
physician services under Medicare, but there is a proposal to reverse
this. Congress has not yet voted on the proposal.
- Commissioner Tarver asked if DPH has a directory of contracts with
private hospitals. Mr. Boule will follow up with the Contracts Office.
Commissioner Tarver asked the status of funding for the Trauma Recovery
Program. Mr. Boule said that unfortunately the Governor vetoed this
legislation. Assemblymember Leno has committed to reintroducing
legislation in 2006.
- Commissioner Guy added that the Department anticipated the reduction
in CARE funds, and discussions around the integration of HIV/AIDS
services into Primary Care and Community Behavioral Health should
continue. There is going to be less money. Commissioner Guy asked that
the Health Commission be kept apprised of legislative activity around
both universal health care and prescription drug access.
- Commissioner Tarver looks forward to the Joint Conference Committee
discussion around the integration of HIV/AIDS services.
7) APPROVAL OF A REVENUE SUPPLEMENTAL APPROPRIATION FOR SAN FRANCISCO
GENERAL AND LAGUNA HONDA HOSPITALS
Gregg Sass, Chief Financial Officer, said the Department is requesting
approval of a revenue supplemental appropriation of $10.259 million for
expenditures that exceed budget at San Francisco General and Laguna
Honda Hospitals. No general funds are requested. Revenues at San
Francisco General are expected to exceed budget by $8.596 million.
Revenues at Laguna Honda Hospital are expected to exceed budget by $10
million. Surplus revenues at San Francisco General Hospital primarily
consist of higher than expected revenues for Medi-Cal as a result of
Medi-Cal reform. Surplus revenues at Laguna Honda Hospital are due to a
large increase in the Medi-Cal base per diem rates. The increased
revenue from the base per diem may be partially offset by a
corresponding reduction in supplemental payments (DP/NF). The revenue
increase is a conservative estimate of the net effect of the increase
and the offsetting reduction.
The supplemental will fund thee areas:
- $4.486 million unfavorable variance in Personal Services and Fringe
Benefits due to high patient volume General Hospital;
- $2.915 million unfavorable variance due to need to retrofit a chiller
than can no longer be repaired;
- $2.858 million unfavorable variance at Laguna Honda Hospital primary
as a result of changes in staffing necessitated by a recent licensing
survey at Laguna Honda.
- Sam Alicia Duke spoke on behalf of a community fund that could be
funded through the excess revenues. This would be a good step in
increasing community resources to help disabled and elderly individuals
live in the community. Tomorrow is the grand opening of Eugene Coleman
Community House. We need more of these developments throughout the city.
- Norma Sattan, Planning for Elders in the Central City, said they would
like the Health Commission to consider using some of this excess money
to create a community fund to provide more home and community-based
long-term care services.
- Marie Jobling, co-chair of the Long-term Care Coordinating Council,
said nobody should be at Laguna Honda Hospital or any other institution
because of lack of community resources. The barrier is the development
of alternatives, and this money provides a rare opportunity. If these
revenues were put in a community trust fund, the Health Commission would
be able to promote community alternatives without taking the money from
someone else. She asked that the Health Commission consider for action
at a future meeting the creation of a community fund.
- Elizabeth Zirker, Protection and Advocacy, supports the idea of using
supplemental revenues to establish a community fund. San Francisco has
made great efforts to comply with the Olmstead Act, but is not yet in
compliance. San Francisco can take this opportunity to be creative to
supplement adult day health, expand TCM, etc. This is an opportunity
separate from the discussion around the Laguna Honda Hospital rebuild.
- Meg Cooch, Planning for Elders in the Central City, said the time is
now for the Health Commission to act for alternatives to institutional
care. Here is some unallocated money that can be directed into
community-based services. The Long Term Care Coordinating Council has a
plan toward which this money could be allocated.
- Tricia Webb said she is a living example of a person who lives in the
community with services. She is independent. She does not have to depend
on being institutionalized to get the services she needs. More people
need these services, and this money should be put toward long-term care.
- Commissioner Monfredini asked Mr. Sass to clarify that the
supplemental appropriation before the Health Commission is to fund
overexpenditures due to cost of doing business at San Francisco General
Hospital and Laguna Honda Hospital. Mr. Sass said that is correct.
- Commissioner Illig said this is an important opportunity that the
Health Commission needs to move on. When the Controller came forward to
the Health Commission in May with his report on Laguna Honda Hospital,
one of the options was using the savings from operating a smaller LHH to
create a community trust fund. This money is a windfall and provides an
opportunity to start a community fund now. He recommends that the
President refer this issue to one of the joint conference committees and
come back to the Health Commission in the near future to consider
creating a special fund with $7 million in excess revenues. If the
Health Commission does not appropriate this money now, it will be used
later for other things. Dr. Katz said what is before the Commission
today is a supplemental to cover overexpenditures at SFGH and LHH. It is
in the province of the Commission to recommend to the Board of
Supervisors that they appropriate the remaining revenues differently. He
supports the suggestion to refer this issue to a joint conference
- Commissioner Tarver wants the Health Commission to have a role in
setting priorities for how any excess money is spent, including the
creation of a trust fund for Laguna Honda Hospital.
- Commissioner Sanchez said he supports the supplemental appropriation,
and also supports further discussion around additional revenues.
- Commissioner Guy supports the discussion about the community trust
fund taking place at the Community Health Network Joint Conference
Committee (CHN JCC), primarily because this committee has a broader
overview of the policy issues the Health Commission wants to examine and
has members from across the Department. This does not preclude a
presentation to the Laguna Honda Hospital Joint Conference Committee as
well. In addition, several community members were de-linking the idea of
the community trust fund from Laguna Honda, which is another reason she
thinks the initial discussion should take place at the CHN JCC.
Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Tarver,
Umekubo) approved the $10.259 million revenue supplemental
appropriation. The issue regarding the creation of a long-term care
community trust fund was referred to the Community Health Network Joint
Conference Committee for consideration and reported back to the Health
Commission within 60 days.
8) PUBLIC COMMENT/OTHER BUSINESS
The meeting was adjourned at 5:45 p.m.
Michele M. Seaton,
Executive Secretary to the Health Commission
Health Commission meeting minutes are approved by the Commission at the
next regularly scheduled Health Commission meeting. Any changes or
corrections to these minutes will be noted in the minutes of the next
Any written summaries of 150 words or less that are provided by persons
who spoke at public comment are attached. The written summaries are
prepared by members of the public, the opinions and representations are
those of the author, and the City does not represent or warrant the
correctness of any factual representations and is not responsible for