Minutes of the Health Commission Meeting

Tuesday, January 20, 1998 3:00 p.m.

101 Grove Street, Room #300 San Francisco, CA 94102


The regular meeting of the Health Commission was called to order by President Edward A. Chow, M.D., at 3:10 p.m.


Commissioner Debra A. Barnes Commissioner Edward A. Chow, M.D. Commissioner Roma P. Guy, M.S.W. Commissioner Ron Hill Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner David J. Sanchez, Jr., Ph.D.

 2) Approval Of Minutes Of The Meeting Of January 6, 1998. Action Taken: The Commission unanimously adopted the minutes of January 6, 1998, with the correction that the meeting was called to order by President Edward A. Chow, M.D.


(3.1) PH-CHP&P-Perinatal - Contract extension and modification and sole source request in the amount of $74,000 with Polaris Research & Development for technical assistance, media and outreach services for the Perinatal Outreach and Education Project, for the period of January 1, 1998 through June 30, 1998. Total amount of contract, including this modification is $197,000 for the period of July 21, 1997 through June 30, 1998. (DPH contracted with Polaris for services totaling $781,093 during FY 1996-97).

A letter indicating intentions of the company to remain minority-owned was submitted to the Commission. Commissioners commented the plan was good and requested a written progress report be submitted to the Commission in six months (July 1998).

(3.2) CHN-Facility Management - Contract extension and modification and sole source request in the amount of $25,000 with Kate Keating Associates, Inc. for signage design and consulting services for the Community Health Network for the period of January 1, 1998 through June 30, 1998. Total amount of contract, including this modification, is $74,000 for the period of June 16, 1997 through June 30, 1998. (DPH contracted with Kate Keating for services totaling $49,000 during FY 1996-97).

(3.3) CHN-LHH-Med. Services - Retroactive contract renewal and sole source request with the UCSF School of Nursing in the amount of $74,000, for the provision of primary care services by a gerontological nurse practitioner (GNP) and an equivalent advanced practice nurse or clinical nurse specialist (CNS) to participants in the Adult Day Health Care Center, for the period of October 1, 1997 through September 30, 1998. (DPH contracted with UCSF for services totaling $13,848,952 during FY 1996-97).

Commissioner Sanchez abstained due to conflict of interest.

Action Taken: The Commission approved the Consent Calendar of the Budget Committee, with Commissioner Sanchez abstaining on #3.3.

4) DIRECTOR'S REPORT. Provides information on activities and operations of the Department. (Mitchell H. Katz, M.D., Interim Director of Health)


Update on Restructuring

I want to update the Commission on the Department's restructuring. Approximately two years ago, the Department created the Chief Financial Officer position, which is held by Monique Zmuda. However, the Chief Financial Officers of the Public Health Division and the Community Health Network did not report to the Chief Financial Officer. The need to facilitate communication on fiscal matters through a centralized structure has become especially important with the recent loss of our Chief Financial Officer at San Francisco General Hospital, Peter Praetz, and the Chief Financial Officer of the Public Health Division, Keith Hearle. To allow Ms. Zmuda time to focus fully on fiscal matters, some of her other functions will be reassigned. AB 75 will be administered through the Public Health Division. Grants will be supervised by Anne Kronenberg, as well as capital projects for Central Administration.

Therefore, effective immediately, we have decided these two divisional CFO's as well as their respective staffs, once hired, will report directly to our Chief Financial Officer. Ms. Zmuda will be active along with the Divisional Directors, Rich Cordova and Robert Prentice, in recruiting and hiring these positions. The centralization of our financial structure is designed to better coordinate accounting of our revenues, expenses, and overall financial status. The change does not affect the process of deciding on funding priorities. These decisions will still, of course, be made first at the divisional level by the Community Health Network (CHN) and the Public Health Division, respectively, and brought forward through the Director to the Commission, the Mayor, and the Board.

When we last briefed the Commission on restructuring, the organizational structure of the Workers' Compensation program had not yet been determined. Currently, Occupational Safety and Health (OSH) section of the Public Health Division coordinates Workers' Compensation for employees at 101 Grove, Mental Health, Substance Abuse and the Health Centers. San Francisco General Hospital and Laguna Honda Hospital coordinated their Workers' Compensation programs through their Departments of Human Resources. Effective immediately, we will be centralizing all workers compensation issues in the OSH section of the Public Health Division. OSH will work closely with our Human Resources Department in coordinating this effort. Placing responsibility within OSH acknowledges the important role that prevention can play in preventing future workers compensation injuries. OSH will use reports of recent workers compensation injuries to set priorities on future prevention programs. The costs of the Workers' Compensation program wilremain with the respective Division.

Finally the Public Health Division has filled an important position. Barbara Garcia has been appointed Director of Community Substance Abuse Programs. After an extended tenure as the Executive Director of "Salud para la Gente" in Watsonville, California, Ms. Garcia was recruited to take lead responsibility for the integration of AIDS, mental health and substance abuse services for the Substance Abuse and Mental Health Services Administration (SAMHSA) for the federal Department of Health and Human Services in Washington, D. C. Ms. Garcia wanted to return to direct service at the local level when DPH hired her as the Director of Homeless Programs.

 In her new capacity as Director of Substance Abuse Services, Ms. Garcia will participate on the management team of the Community Health Services Branch of the Public Health Division, where she will assist the management team in the challenge of moving toward a more integrated model of care based on the health profile of the people we serve. We thank her for her excellent past leadership in homeless programs and welcome her to her new position.

Mayor's Blue Ribbon Committee On Universal Health Care Coverage

A series of community forums will be held to discuss preliminary findings of the Mayor's Blue Ribbon Committee on Universal Health Care. The forums will be an opportunity to provide information on the Blue Ribbon Committee's progress to date to consumers, employers, community based organizations, City agencies, health care providers and other interested parties. Committee members will also receive feedback from the community on the proposed recommendations.

 The forums will take place in various locations around the City. The forums will be open to all interested parties, including residents, community-based organizations, providers, advocacy groups, health plans and associations.

 The first forum will be held tomorrow, January 22, 1998 from 5:00 p.m. to 7:00 p.m. at 101 Grove Street in Room 300. This forum is geared to the business community. Department staff can hear a presentation on the Committee's preliminary findings on Monday, January 26, 1998 from 1:00 - 3:00 p.m. at 101 Grove Street in Room 300. In addition, Department staff are welcome to attend any other the other community meetings. The Department is planning on making a presentation before the Health Commission at its next meeting. The Department will begin distributing flyers and information regarding the forums later this week.


Governor's Proposed 1998-99 State Budget

The Governor released his proposed 1998-99 budget on January 9, 1998. The budget reflects California's improved economy, with an additional 4.7% in General Fund (GF) revenues. The Health and Welfare GF portion of the budget totals $15.1 billion, a 4.1% increase over the current fiscal year (1997-98). The Health and Welfare budget represents 27% of the State's total proposed GF expenditure for 1998-99, which is $55.4 billion.

 In general, the proposed Health and Welfare budget is favorable, and does not include proposals seen in previous years to reduce health-related funding and programs. In addition, there are no significant health-related revenue increases that will impact the Department. Likewise, the State is not proposing reductions in their administrative fees for MAA/TCM or DSH.

Of the health-related program augmentations in the budget, the ones which will most impact the Department are the $3.5 million GF newborn hearing screening program, which is part of the Governor's new Early Childhood Development Initiative, and the $15.6 million GF increase in HIV/AIDS prevention and treatment funding, primarily for the AIDS Drug Assistance Program (ADAP).

Health-Related Revenues

Medi-Cal Reimbursement: No increases in Medi-Cal reimbursement are proposed in 1998-99. Federal Funding: The Governor has budgeted $11.3 million for emergency medical services for undocumented residents. Although the budget narrative states that federal law authorizes payment to States for the full cost of these services - projected to be $655 million in California in 1998-99 - unlike previous years, the budget does not assume an unrealistically high federal reimbursement level. Proposition 99 Funds: Revenues are estimated to decline by 1.5%, to $446 million, due to decreased tobacco sales. Realignment: Revenues are up about $125 million for a total of $2.8 billion. This will provide a modest increase in Department revenues.

 New Initiatives

 Early Childhood Development Initiative

The Governor is proposing a $54 million Early Childhood Development Initiative to assist children from birth to age three. The Initiative's provisions include:

Newborn hearing screening program for an estimated 116,000 newborns (half of whom would be Medi-Cal or CCS-eligible); requires all CCS-approved hospitals to offer screening to all newborns; and establishes three regional intervention centers to provide training, education, outreach and referral services to health care providers and patients -- $3.5 million GF increase. Other provisions include: training for child care providers; pre-kindergarten for low-income children; increased family information services; and expansion of infant and toddler child care -- $51.5 million GF increase

 Healthy Families

Assumes enrollment of 200,000 children in 1998-1999, and 440,000 children in 1999-2000 -- well below the original 580,000 target level. State GF will be used for the 1998-99 match, rather than using other locally-designated health care funding -- $34.1 million. Healthy Families and Medi-Cal outreach -- $21 million.

Existing Programs


The State budget assumes a continued decline in Medi-Cal cases, with a projected 2.9% decrease in 1998-99 Optional benefits: Unlike previous years, the Governor is not proposing to eliminate any optional Medi-Cal benefits Medi-Cal expansion related to Healthy Families legislation: expands coverage to children ages 14-18 whose families are at 100% of the federal poverty level -- $22 million GF increase Long-term care rate adjustment: while the State has the option to reduce LTC rates as a result of the Boren Amendment repeal, the budget does not include any reductions. Instead, adjustments will be considered after the State convenes interested parties to explore alternatives -- no GF reduction Services for Legal Immigrants and Undocumented Residents: State-only long-term care services for undocumented residents: continued funding while litigation is pending State-only prenatal care for undocumented residents: no specific mention, but the Governor does refer to exclusion of State-only programs for undocumentedesidents; these funds were not in the final budget for 1997-98, yet the state is currently required by court order to continue the program -- no GF change Medi-Cal services to legal immigrants: State will increase GF budget to provide non-emergency health care services to legal immigrants who arrived after August 22, 1996 (no longer covered by federal funds) -- $25.3 million GF increase

Public Health

The 1998-99 State budget includes an estimated $96 million GF increase for public health programs, including:

Childhood Lead Poisoning Prevention Program: preventive screening and case management services -- $14.3 million increase over two years HIV/AIDS prevention and treatment: State budget expands HIV/AIDS prevention and treatment by a total of $35.9 million state and federal funds, for ADAP, which is anticipated to serve over 25,000 clients with a 53-drug formulary -- $15.6 million GF increase Control and survey of emerging infectious diseases and foodborne pathogens: to expand investigation and surveillance of infectious disease and food safety programs -- $3.1 million GF Housing for tuberculosis patients: for those unwilling to comply with treatment or homeless and unable to comply -- $2.9 million Grants to medical schools and specialized training programs: to increase the number of family practice health care providers -- $5.6 million Breast Cancer Early Detection Program: majority of funds are from CHIP Unallocated Account funds -- $11.2 million increase over two Ovarian and prostate cancer research grants: r researching the causes, prevention, early detection, diagnosis, and treatment of ovarian and prostate cancer -- $23 million increase Teen abstinence education and pregnancy prevention programs: $7.2 million in federal funds, requiring matches of 3:4/ local:federal, for initiation of new programs -- no State GF contribution

Mental Health

The proposed budget allocates $24.6 million for the Department of Mental Health and the California Department of Corrections to coordinate the Sexually Violent Predator (SVP) Program. The purpose of the SVP is to identify and evaluate dangerous repeat offenders prior to release from prison, and, when appropriate, refer them to trial for civil commitment. The budget assumes the SVP program will be ruled constitutional. In addition to the SVP program, the budget provides $20.4 million to maintain Children's System of Care programs in 43 counties, and $15 million in Proposition 98 funding for the School-based Early Mental Health Initiative, targeted at grades K through 3.

Proposition 99

 Proposition 99 expenditures include: $67.7 million for anti-tobacco education programs; $19.3 million for tobacco-related disease research; $49.9 million for CHDP; $179.6 million for clinic and county indigent health programs; and $8.7 million for the Breast Cancer Early Detection Program, including $7.4 million for screening services and $1.3 million for enhanced quality assurance.

Department of Social Services

In the CalWORKs program, a $665 million increase for child care for CalWORKs participants and the working poor is budgeted (total budget: $1.8 billion). The 4.9% grant level reduction is continued, as is suspension of the Cost-Of-Living Adjustment (COLA). The budget includes $1 billion for employment support services, such as alcohol and drug, mental health, Cal Learn, transportation, and job training, for an estimated 376,000 participants per month. In the SSI program, proposed grant levels remain the same for the first time in several years. The 2.6% federal COLA for SSI is passed through to take effect January 1, 1999, however, the State COLA continues to be suspended.

Department of Aging

The budget includes an additional $9.1 million GF for expanded Adult Day Health Care, Community-Based Services Programs, Alzheimer's Day Care, Respite Services, and various other social services.

Other Provisions of Interest

Proposed constitutional amendment, required to be passed by the voters, to lower the Gann appropriations limit (amount unspecified). Continuation of the State's commitment to litigation against the tobacco industry through a $5.47 million GF increase and 21 staff positions to support ongoing litigation


1998 Ryan White CARE Act Awards Announcement

The FY 1998 Ryan White CARE Act total award is $36,394,914. This award breaks down to $18,744,145 in formula and $17,650,769 in supplemental. The FY 1997 CARE Title I total was $37,194,634 so the new award reflects a decrease of $799,720 or approximately 2%.

You will see our award was very high relative to similar EMA's. Congratulations to Judith Klain, Michelle Dixon and the staff of the AIDS Office.

Grant Award From Miriam & Peter Haas Fund

The Miriam and Peter Haas Fund has awarded a grant of $60,000 to Community Mental Health Services, Children, Youth and Family Section to support a mental health consultant working with the Children's Section. The consultant is to develop a plan to support children's mental health services in a managed care environment. This is a second, and final grant award from the Fund.

Childhood Lead Prevention Program Data Evaluation

On January 13, 1998, the Childhood Lead Prevention Program finalized a report which presents the findings of a comprehensive analysis and evaluation of screening case-management, and environmental data collected since the program's inception in 1991. The report was developed to fulfill legislative mandates, analyze screening and case finding trends over time, and assist in the development of a city-wide lead screening policy. The evaluation also provided evidence of the extent of lead-base paint hazards in San Francisco which helped promote the passage of legislation requiring lead-safe work practices on the exterior of any building built before December 31, 1978.

Indoor Air Quality Investigation

On November 30 a washing machine at the Mission Family Center malfunctioned, spilling 700 gallons of water, which made its way from the 2nd floor down to the first floor, where another Public Health facility (Mission ARC) is located. The water flooded the Mission ARC space and damaged some of the building materials quite severely. The building owner was quick to call in a water damage specialist, who began drying the building out immediately. However, the smell was enough to cause some occupants of Mission ARC to feel sick, and four employees did seek medical treatment (and were temporarily assigned to other locations). The OSH Section was called in to evaluate the situation and determine if the cleanup had been adequate, and if the smell/health symptoms were indicative of active mold/fungal growth, which would have been consistent with the allergic symptoms seen by the Occupational Health Services physicians.

Before that could be determined however, it was necessary to test the damaged building materials for asbestos. The Asbestos Program determined that some of severely damaged floor tiles did contain asbestos, and needed to be replaced immediately. Once this was completed, the OSH Section did a thorough inspection of the inaccessible building spaces to ensure that mold/fungi were not actively growing, and that the spaces had been adequately dried. Fortunately, no evidence of mold growth was found, and since the smell had subsided, the employees were cleared to go back into the building. The landlord is still doing some remedial work to those building structures that were damaged by the flood, thus displacing some of the employees. To date, no more complaints have been received.


One Less Gun... One More Life

The CHN is playing an active role in the One Less Gun... One More Life campaign. The CHN along with other SF hospital community based organizations and the SF Police Department held their first gun exchange on Saturday, January 17, at Ella Hill Hutch community center in the Western Addition. Four guns were exchanged for gifts valued at $40.00. Although only four guns were exchanged the group views this first exchange as a success.

Mayor Brown attended the exchange and gave his support along with a number of members of the Board of Supervisors.

The UCSF/CHN Retreat

On January 23 and 24 the CHN Leadership Group, Chiefs of Service and I will join the UCSF School of Medicine Faculty for their Annual Leadership Retreat. The subject of this year's retreat is the partnership of UCSF with the Community Health Network focusing on four primary discussion areas.

the evolving organizational and strategic relationships of Community Health Network and the UCSF faculty the planning and decision making relationships between UCSF department Chairmen and the respective Chiefs within the CHN the future role of research at the SFGH campus in relation to Mission Bay development and as a reflection of the CHN's academic mission the potential new relationships between the Department of Public Health and UCSF.

 The retreat end-products will consist of recommendations for future action to develop the expanded partnership. A summary of the findings and recommendations will be presented at the CHN Joint Conference Committee in March.

Laguna Honda Hospital Isolate Influenza A

Laguna Honda Hospital had its first isolate of Influenza A on the evening of December 23rd. Medical staff instituted the antiviral prophylaxis program the following day. Most of LHH's residents have been immunized. However, the vaccine is not 100% protective. Therefore, antiviral medication is used to prevent the spread of virus. Since the institution of medication there have been no further cases of influenza identified.

Kaiser Permanente Strike Update

The California Nurses Association has issued a strike notice to affect Kaiser Permanente's Hospitals and ambulatory care centers. A two day strike is scheduled for January 28-29. The Kaiser San Francisco Strike Planning Team will be conducting a telephone conference call on January 21st to discuss patient care operational issues with local area hospitals. Chris Wachsmuth will be representing CHN/SFGH. The work action by CNA comes at a particularly difficult time as citywide hospital census remains high, Emergency Departments report high visit volumes and critical care and total diversion rates remain elevated.

System Diversion UpdateThe EMS Section has suspended the ability of hospitals to divert critical care patients 14 times this month for a total of 198 hours – this is 41% of the time. This amount of diversion activity is unprecedented in our system. The San Francisco Fire Department is reporting a 25% increase in ambulance requests. As stated above the planned work stoppage at Northern California Kaiser hospitals could further impact the overcrowding situation. The EMS Section is closing monitoring this situation.Abbie Yant, Administrator of the EMS Section, is a member of a State Task Force on Hospital Overcrowding and Ambulance Diversion. The Task Force was initiated and staffed by the State EMS Authority and has representatives from Department of Health Services, California Hospital Association, and Local EMS Agencies. The State Office of Health Planning, Office of Emergency Services and the Department of Corporations and Kaiser will be asked to participate in future discussions. The Department of Health Svices, through their regional offices, polled all hospitals in California early last week and confirmed that hospitals are operating above projections throughout the State. Flu like and other respiratory illnesses are contributing to the increases, but many other conditions are being seen in emergency departments as well. There is also a shortage of critical care and emergency department qualified nurses throughout the State which makes adding nursing staff very difficult.

CHN Diversion

Diversion statistics for the period January 1 through 11, 1998 were:

 Critical Care diverted 24.7% or 65 hours and 17 minutes. Total diversion was 16% or 42 hours and 28 minutes.

Diversion statistics for the period December 1 through 14, 1997 were:

Critical Care diverted for 56% or 194 hours. Total diversion hours were 2% or 6 hours.

Sharon Nevins Appointed to OSHPD Committee

I am pleased to announce that Sharon Nevins, Interim Chief Financial Officer for Laguna Honda Hospital, has been appointed to the Office of Statewide Health Planning and Development's Health Data and Public Information Committee. I am sure you join me in congratulating Ms. Nevins on this appointment.

Black History Month Celebration

Black History month will be observed at Laguna Honda Hospital during February. A hospitalwide event will take place February 20th featuring a choir, fashion show and entertainment held in Simon Auditorium. "Celebrate and Educate" is the theme for this year's activities. The Activity Therapy Department will also provide additional activities on resident units throughout the month of February.

The December 1997 statistics are available in the Commission Office.

President Chow requested the Department to report in the Director's Report comparative statistics for its monthly statistics.


Commissioner Guy nominated Commissioner Monfredini for President. Commissioner Hill seconded the nomination.

Action Taken: The Commission unanimously voted to elect Commissioner Monfredini as President for 1998.

Commissioner Parker nominated Commissioner Sanchez for Vice President. Commissioner Barnes seconded the nomination.

Action Taken: The Commission unanimously voted to elect Commissioner Sanchez as Vice President for 1998.

Outgoing President Chow thanked everyone for their support during these past two years of his presidency. President Monfredini thanked the Commissioners for their support for her presidency. Vice President Sanchez thanked the Commissioners for their hard civic volunteer work on the Commission and thanked Commissioner Chow for his leadership over the last two years as President.

6) Time Specific: 4:00 P .M.

Public Hearing, In Accordance With The Health Care Planning Ordinance (Proposition Q, 1988), To Consider The Impact Of The Following Change On Health Care Services Of The Community At Chinese Hospital: Relocation Of The Chinese Hospital Obstetrics Service To California Pacific Medical Center

For this item, Commissioner Chow and Commissioner Monfredini abstained due to conflicts of interest. Vice President Sanchez presided over this item on the agenda.

Mr. Thomas Harlan, CEO of Chinese Hospital, had submitted the following information to the Commission:

Chinese Hospital has maintained a proud history of service to the San Francisco Chinese community since its opening in 1925. The provision of health care services in 1998 has become much more complex and expensive than it was many years ago. In keeping with Chinese Hospital's mission to provide community access to high quality, cost effective and culturally competent services, it continues to form community partnerships to provide segments of the spectrum of health care services. For example, Chinese Hospital purchases tertiary services (heart surgery, organ transplants, etc.) and other high technology services, such as outpatient MRI, from several San Francisco tertiary hospitals. In addition, Chinese Hospital also purchases services at the other end of the spectrum, including skilled nursing and home care services.

The Chinese Hospital Board of Trustees decided to relocate the hospital's obstetrics service in the Fall of 1997 following several years of deliberation. This was precipitated by an extensive analysis performed by a multidisciplinary task force convened by the Board in early 1997. Several factors compelled the Chinese Hospital Board of Trustees to consider options for relocation:

For the past several years, evolving market conditions have generated a perceived consumer need for hospital perinatal services encompassing immediate availability of "Level 3" intensive care newborn nursery services. This has been exacerbated by the ready availability of such services in San Francisco. The perinatal service at Chinese Hospital includes only a "Level 1" well baby nursery service. San Francisco Chinese patients and their physicians have increasingly selected perinatal units with "Level 3" nurseries, which has resulted in a declining obstetrics service census at Chinese Hospital. There were 505 deliveries in 1991, 177 deliveries in 1997, adversely impacting the viability of the service.

 Upon the recommendation of its medical staff and after careful consideration of the alternatives, the Chinese Hospital Board of Trustees determined that rather than close the perinatal service, the Hospital should suspend the perinatal service temporarily while it pursues an exclusive affiliation with a local provider for the provision of perinatal services, including the availability of a higher level of nursery service, for Chinese Hospital's patients. A temporary suspension should permit Chinese Hospital to reactivate the beds and its perinatal service if the affiliation should fail to meet the Hospital's objectives of ensuring delivery of quality perinatal care with a higher level of nursery service in a manner that is responsive to the special needs of the Chinese community, including the need for bilingual and bicultural services, reasonable access and availability of services for indigent patients.

Accordingly, Chinese Hospital has entered into a Memorandum of Understanding (MOU) with California Pacific Medical Center (CPMC), a general acute care hospital, whose obstetrics department includes Levels 2 and 3 nurseries. Under the MOU, CPMC would be the exclusive provider of perinatal services for patients of Chinese Hospital, including enrollees of Chinese Hospital's affiliated health care service plan (the Chinese Community Health Plan) and other managed care contracts of the Hospital, as well as referred Medi-Cal, indigent and self-pay patients. CPMC and Chinese Hospital have a history of service relationships (including perinatal services), and all but one of the Chinese Hospital obstetricians and pediatricians have clinical privileges and currently practice at CPMC. CPMC has agreed to create a joint Advisory Board to monitor and address the Hospital's concerns regarding cultural competencies, access and availability of perinatal services at CPMC.

The MOU was executed on December 16 1997 and implementation is scheduled to commence on February 6, 1998, pending the Department of Health Services approval of the hospital's request for suspension. Specifically, Chinese Hospital has requested suspension of its perinatal service and beds for a period not to exceed the first 12 months of its affiliation with CPMC, commencing February 6, 1998. Prior to the end of such period, Chinese Hospital would evaluate the affiliation with CPMC and make a decision whether to continue with the affiliation (and request reclassification of the beds), to ask for an extension of the suspension for further evaluation, or to request that the perinatal service and beds be reactivated.

In the MOU with CPMC, elements comprising the areas of quality, cultural competence and staffing continuity were developed by representatives from both institutions, including Board, medical staff, perinatal services and management. In addition to these elements, the hospitals have negotiated a 15-year initial term -- and the ability for Chinese Hospital's referred "self-pay" obstetrics patients to obtain access to CPMC at Chinese Hospital's current "self-pay" rate structure.

Public Speakers: in support of the relocation. Rose Pak, Chair, Community Relations Committee, Board of Trustees, Chinese Hospital Association. Albert G. Chin, Immediate Past President, Board of Trustees, Chinese Hospital Association. Pearl J. Yee, M.D., Chief of Obstetrics and Gynecology, Chinese Hospital Medical Staff, Chinese Hospital Association. Thomas M. Harlan, CEO, Chinese Hospital Association. George M. Lee, M.D., Vice President Medical Affairs; and Chair, Department of Obstetrics and Pediatrics, California Pacific Medical Center.

Dr. Poon, Chinese Hospital, spoke against the relocation.

Vice President Sanchez stated that today's hearing is to listen to the testimony and receive any written testimony in the next seven days. At the February 3, 1998 Commission meeting, the Commission will make a decision on whether the relocation will or will not have a detrimental impact on the health care service of the community.

7) Update Of The Bayview Hunters Point Health And Environmental Task Force Work Plan, And Consideration Of A Resolution Supporting The Development Of Initiatives For Asthma And Breast And Cervical Cancer

Cynthia Selmar, Co-Chair of the Task Force and Center Director for Southeast Health Center, provided an update on the work of the Task Force. She also reported that Karen Pierce has been hired as the Project Coordinator for the Task Force.

Since the last presentation to the Commission in June 1997, media attention given to data on the health problems of residents in the Bayview Hunters Point community resulted in a hearing at the Board of Supervisors' Health, Family and Environment Committee. The Task Force was asked by the Committee to develop specific proposals. The Task Force decided to focus on health issues that already had some initial activity -- asthma and breast and cervical cancer. Basically, the Task Force suspended long-term planning to take advantage of the short-term opportunity with the Board, with the clear understanding to return to long-term planning.

With respect to the work plan, Ms. Selmar acknowledged Nyasha Junior of Policy and Planning, who has been working with the Task Force on its efforts to develop a work plan.

The Task Force is requesting Commission support for the development of initiatives in response to the Board's request (i.e., asthma and breast and cervical cancer).

The Commission requested a progress report on the work plan in 90 days (May 1998).

Public Speakers: Francine Carter, Co-Chair of the Task Force. Ray Tompkins, member of the Task Force and Bayview. Hunters Point Research Committee.

Action Taken: The Commission unanimously adopted Resolution # 3-98, "Endorsing Efforts to Develop Proposals to Address Asthma and Breast and Cervical Cancer in Bayview Hunters Point", (Attachment A).

8) Consideration Of A Resolution For San Francisco General Hospital Providing Level I Trauma Care For Adults And Children Within San Mateo County

Richard Cordova, Executive Administrator for the Community Health Network, introduced Dr. Robert Mackersie, Chief of Staff and Surgery Service. Dr. Mackersie provided the following background information:

The 1993 Strategic Plan for San Francisco General Hospital, as approved the Health Commission, includes a recommendation to regionalize the trauma service as a way to maximize the utilization of resources for the Trauma Center.

Since November 1993, SFGH has piloted in partnership with the San Mateo Emergency Medical Service Agency, the referral of trauma victims in the northern part of San Mateo County. The experience during this pilot year has been successful in that the patients have received timely trauma services, at the same time the volume has not impacted services devoted to City residents. Further, the financial status of these patients has resulted in the hospital not absorbing any costs associated with unsponsored patients since arrangements have been made to bill the County of San Mateo for these patients.

Based on this positive experience, the San Mateo County has now asked SFGH to become the Trauma Center for the northern part of San Mateo County. The southern portion will be covered by the Trauma Center located in Stanford University Medical Center. This configuration of trauma services for San Mateo County is a result of a lengthy study conducted by the San Mateo Emergency Medical Service Agency, which concluded that this is a the best configuration for their County.

The Trauma Center at SFGH has been in existence for 30 years and has been verified as a Level 1 by the American College of Surgeons providing the nationally recognized level of trauma care to anyone who is injured. The opportunity exists to extend these services to people in neighboring counties while enhancing the Trauma Center's ability to continue our tradition of care within the City's geographic boundaries.

Commissioner Barnes expressed concern on the impact on emergency, critical care, and diversion.

Commissioner Guy commented that the data from the San Mateo Pilot Project would have been helpful for this presentation. Dr. Katz will provide the data on the pilot project to the Commissioners.

Commissioner Sanchez encouraged the Department to collect data in the next six months, looking at the impact of regionalization on services in San Francisco. He also encouraged the Department work with colleagues in the region in analyzing the data.

The Commission requested the Department to come back in July and report a 6-months' experience and progress with this program.

Commissioner Barnes proposed an amendment to the proposed resolution in the last resolved by adding, "as long as there is no negative impact on the delivery of emergency and trauma services to the people in the City and County of San Francisco."

Action Taken: The Commission unanimously adopted Resolution # 4-98, "Supporting the Regionalization of Level 1 Trauma Services at San Francisco General Hospital Into San Mateo County, and Counties in Need of Trauma Care, as Long as There is no Negative Impact to the City and County of San Francisco."

9) Consideration Of A Resolution For Providing Health Insurance To In-Home Supportive Services (Ihss) Workers

Julia Velson of San Francisco General Hospital presented a proposal which provides health insurance to individuals who provide In-Home Supportive Services (IHSS) to Medi-Cal recipients residing in San Francisco.

Ms. Velson introduced:

Donna Calame, Director of the IHSS Public Authority. Rick Zawadski, Consultant, IHSS Public Authority. Karen Sherr, Local 250. Shahnaz Nikpay, Director of the S.F. Health Plan

Commissioners' Comments:

Monitor the financial aspect of the plan Evaluate data collected for one year This is a pilot project for universal health care Monitor this health plan separately at the Joint Conference Committee of the Community Health Network

Public Speaker: Shahnaz Nikpay, S.F. Health Plan

Action Taken: The Commission unanimously adopted Resolution # 5-98, "Approving a Proposal to Provide Health Insurance to In-Home Supportive Services Workers Providing Care to Medi-Cal Recipients Who Reside in San Francisco."

10) Other Business/Public Comments

The meeting was adjourned at 6:20 p.m.

Sandy Ouye Mori, Executive Secretary to the Health Commission