Health Commission Minutes, March 3, 1998

Minutes of the Health Commission Meeting

Tuesday, March 3, 1998 3:00 p.m.

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

1) CALL TO ORDER

The regular meeting of the Health Commission was called to order by President Lee Ann Monfredini,

at 3:10 p.m.

Present:

Commissioner Debra A. Barnes

Commissioner Edward A. Chow, M.D.

Commissioner Roma P. Guy, M.S.W.

Commissioner Lee Ann Monfredini

Commissioner Harrison Parker, Sr., D.D.S.

Commissioner David J. Sanchez, Jr., Ph.D.

Absent: Commissioner Ron Hill
3) CONSENT CALENDAR OF THE BUDGET COMMITTEE
(Commissioner David J. Sanchez, Jr., Ph.D.)

(3.1) Presentation of the Second Quarterly Report for the Department of Public Health Budget for FY 1997-98.

This item was referred to the full Commission.

(3.2) PH-CHS-Community Mental Health Services - Request for approval of the Mental Health Performance Agreement for Fiscal Year 1997-98.

(3.3)CHN-SFGH - Renewal contract with Paralign Revenue Management, Inc. for the Uncompensated Care Recovery Program at San Francisco General Hospital, for the period of April 1, 1998 through June 30, 2000.
(3.4)CHN-ASO - Retroactive new contract and sole source with Ciber Network Services, Inc. in the amount of $49,215, for information systems consultation and technical support for the period of July 1, 1997 through June 30, 1998.
(3.5)CHN-Primary Care-Homeless - Retroactive renewal contract and sole source request with Catholic Charities in the amount of $402,143 per year, to provide case management services for the period of July 1, 1997 through June 30, 1999. (DPH contracted with Catholic Charities for services totaling $2,063,852 during FY 1996-97).

(3.6)PH-CHS-CSAS - Retroactive modification to the contract with Jelani House, Inc. in the amount of $303,972, to provide an augmentation of HUD substance abuse outpatient and residential treatment services to homeless women and their children, for the period of February 1, 1998 through June 30, 1998. The total contract amount, including this modification, is $1,187,959. (DPH contracted with Jelani for services totaling $2,332,316 during FY 1996-97).

(3.7)PH-CHS-CMHS - Retroactive contract modification with Volunteer Center of San Francisco (VCSF), increasing the contract in the amount of $29,150 for the period of January 1, 1998 through June 30, 1998, and $58,300 per year for the period of July 1, 1998 through June 30, 2001, to provide community outreach services. The new contract values will be $154,897 for the period July 1, 1997 through June 30, 1998, and $184,047 per year for the period of July 1, 1998 through June 30, 2001. (DPH contracted with VCSF for services totaling $125,747 during FY 1996-97).

The Department will provide a copy of the program review to the Commission.

Action Taken:The Commission unanimously approved the Consent Calendar of the Budget Committee.
ADMINISTRATION

State of Emergency Update: Emergency Shelters

As the Commission recalls, San Francisco declared a State of Emergency on February 5th. Within six hours of the declaration, three emergency shelters had opened in Recreation and Park facilities:

Kezar Auditorium in the Haight;

Joseph Lee Recreation Center in BVHP; and at the

6th and Folsom Recreation Center in the SOMA area.

Within an equally short time period, staff from the Department of Public Health arranged for medical, mental health and substance abuse services to be available on a 24-hour basis at all sites. The Department also assumed responsibility for many of the logistics involved in staffing, transporting of materials and supplies, providing security, laundering of blankets and linens, facility inspection, technical assistance, outreach to homeless individuals, project financing, and on-going interagency coordination.
Red Cross personnel from as far away as Atlanta, GA, arrived to provide shelter management. Three daily hot meals were prepared and delivered by the Salvation Army.

When it became apparent the emergency would continue for a number of months due to projected weather patterns, the City began looking for alternative sites to allow the recreation and park facilities to return to their actual intent. A 28,000 square foot warehouse owned by the Port of San Francisco was identified at 76 Mission Rock at Third Street. A great deal of renovation was necessary to make the site habitable. The proclaimed State of Emergency helped city agencies quickly procure materials and supplies for the repairs. A special thanks to Willie Crawford, 101 Grove Facility Manager, and Eric Miller, Plant Services Director, and his staff who helped expedite and oversee construction.

Red Cross continued shelter management until the three Recreation and Park sites closed, but closed shop as of today. The City was faced with a dilemma and needed to provide some alternative emergency shelter management on site. It became apparent that DPH and DHS staff could not continue to respond at the pace they had for the past month, staffing ongoing Departmental programs as well as the emergency shelters. The Mayor's Office asked DPH to identify a contract agency that could fill the shelter management role. Under the terms of the emergency declaration, Community Awareness and Treatment Services (CATS) was named as the Mission Rock shelter management agency. The contract modification will be coming to the Commission for review March 17.

The three Recreation and Park emergency shelters began to close last week and transition services to the new Mission Rock site. Joseph Lee closed on February 25; 6th and Folsom closed February 26, and Kezar closed yesterday, March 2nd. The three facilities were restored to their original condition and all scheduled Recreation and Park programs have resumed.

The new site is currently providing separate living accommodations for 400 men, women and transgenders. Other services being offered include medical services, TB screening, information and referral, case management, benefits assistance, substance abuse and mental health counseling. Animal Control is providing pet carriers and veterinary services.

Prior to moving to the new site, the Department surveyed the residents of the existing shelters, asking them for feedback and information about their previous experiences with shelter residency and services. We were able to learn a great deal about the individuals who were using the emergency shelters and used this information in designing our services for Mission Rock. It is interesting to note that nearly 43% of the individuals being sheltered at the emergency shelters had not used shelters before. We are anxious to continue our outreach efforts to this population and bring them into mental health programs, substance abuse and, ultimately, primary care.

The transition to close the three operating shelters and move into a new facility required a tremendous coordination effort. I am extraordinarily proud of the dozens of Departmental staff who worked diligently and conscientiously to facilitate this move. Special thanks to Anne Kronenberg, Barbara Garcia, Marian Pena, Eileen Shields, Mary Anne McGuire-Hickey, Chris Wachsmuth, Jan Murphy, Johnson Ojo, Ben Gale, Abbie Yant, Linda Wong, Madeline Daley, David Ofman, Tony Patchell, Tom Hagan, and all the others who spent many long hours making this project a success. My sincere thanks to the many staff who worked so diligently to assure the success of the emergency shelter sites.

DPH Human Resources Reorganization

I am happy to announce as of March 2, 1998 Human Resources centralized its services to better reflect the Department's new organizational structure. In its previous decentralized model, Human Resources was organized to mirror the Department's separate divisions. San Francisco General Hospital, Laguna Honda Hospital and Community Health/Central Office, each had their own Human Resource office which performed all human resource and labor relations functions under the coordination of a Human Resources Director.

Human Resources centralized services in an attempt to be more responsive to DPH's new organizational three division structure: Central Administration, Public Health, and the Community Health Network. Human Resources is now organized according to functional responsibilities department-wide; Operations, Labor Relations and Merit Systems. Each section provides services for all components of the Health Department. This new structure became effective March 2, 1998.

Prenatal Care for Undocumented Residents

On February 18, 1998 a Los Angeles Superior Court Judge issued a Temporary Restraining Order (TRO) in the case of Milagro Doe vs. the California Department of Health Services. The TRO prohibits the State from implementing regulations to eliminate State funding of prenatal care for undocumented residents which were to take effect March 1, 1998.

The State subsequently issued a statement indicating that the regulations will not take effect until April 1, 1998. Advocates are hopeful that further court action will delay implementation even longer. A hearing is set today in the Milagro case. The Judge will be asked to issue an injunction to continue prohibiting the State from implementing the regulations until a final decision on the merits of the case is rendered.

I have sent a memorandum to all staff reaffirming the Department's policy to continue providing prenatal care to all San Francisco residents who need it, and that staff should continue to follow normal procedures.

PUBLIC HEALTH

HIV and the Urban Poor

I am pleased to report that this afternoon the Department is hosting a conference on HIV and the Urban Poor. Researchers and service providers throughout San Francisco have been invited to attend and present their findings. As the Commission is aware, San Francisco has been on the leading edge of research on HIV in the homeless and jailed prisoners and the impact of poverty on HIV transmission and progression. Also, San Francisco has pioneered unique service models, including the Tom Waddell Clinic, the HIV/AIDS Care Unit at San Francisco General Hospital and at Laguna Honda Hospital. About 100 participants attended the meeting. A full report on the presentations will be prepared and I will forward it to the Commission.

Afrocentric Parenting Conference

On February 13, the Third Annual Afrocentric Parenting Conference was held at the San Francisco Christian Center. The conference was sponsored by the Black Infant Health Improvement Project, an infant mortality prevention program now lodged in the Community Health Promotion and Prevention Branch. The conference brought together parents, extended family members, community leaders and health and human service providers to share information, resources, network, and enhance skills and knowledge with the purpose of improving the health of the African American family. Well over 150 participants conferred all day. The session closed with an inspirational address by Ron Johnson on financial health and responsible family life. Tracy Moore, program assistant to the Black Infant Health Project, was recognized for her contribution to the success of the conference.

COMMUNITY HEALTH NETWORK

CHN Administrative Transition

As part of the CHN's administrative transition, I am pleased to announce two key appointments. Last week I asked Gene O'Connell to act as Interim Administrator of SFGH. She will continue to retain the title and role of CHN Director of Patient Care Services. Gene has been with the Department of Health since 1984, and has served as SFGH's Director of Nursing and Chief Operating Officer. She has a Masters degree in Nursing Administration from UCSF. In 1994 she received the Public Managerial Leadership Award from the San Francisco Chamber of Commerce.

In addition, I asked Larry Funk, Associate Administrator at Laguna Honda Hospital, to serve as Interim Administrator for LHH. Mr. Funk received a Masters of Science from San Francisco State University, a Masters of Public Administration from Golden Gate University, and is a Diplomat of the American College of Healthcare Executives.

I have the utmost confidence both Gene and Larry will provide strong leadership in managing these two institutions.

Appointment of the Community Health Network (CHN) Chief Medical Officer

I am pleased to announce the appointment of Melissa Welch, MD, MPH, to the position of Chief Medical Officer (CMO) for the CHN, effective March 2, 1998. Dr. Welch is a former graduate of the SFGH primary care, internal medical program, and former Medical Director of the CHN's Maxine Hall Health Center. She is currently an Assistant Clinical Professor of Medicine at UCSF, and has worked for the last four years in the Division of General Medicine at Moffitt. Dr. Welch brings a diverse array of outstanding community, academic and leadership experiences from both the public health and university settings to her new role as Chief Medical Officer.

As the Chief Medical Officer, Dr. Welch will work in a paired collaborative relationship with Gene O'Connell, providing operational leadership for the entire continuum of care, including primary care, emergency care, acute care, specialty care, long term care, forensics, mental health and substance abuse services. She will also provide physician input to the CHN Leadership Team, and participate with other leaders in policy and decision-making within the CHN.

SFGH Clinical Laboratory JCAHO Survey

The Joint Commission has extended accreditation of the SFGH Clinical Laboratory Services for two years as a result of a JCAHO survey conducted December 11-15, 1997. This survey was part of the overall JCAHO process, granted under Clinical Laboratory/Improvement Amendments of 1988 (CLIA) authority. The survey included a complete assessment of four CLIA Licensed Laboratories:

Main Laboratory,

Anatomic Pathology,

Nuclear Medicine, and

Neo-Natal Intensive Care.

The Joint Commission extended their congratulations on the important achievement of accreditation without Type I recommendations. Opportunities for improvements were recommended for the following areas: the inventory of toxic material in storage, policy and procedures regarding therapeutic phlebotomy, and the availability of safety eye wash devices in proximity to storage of toxic materials.
We congratulate the staff for their hard work in preparing for this survey and for their success in achieving JACHO accreditation.

CHN Audits

Medi-Cal and Medicare agencies audits our cost reports and claims every year. I'd like to notify the Health Commission on a number of financial audits currently underway or soon to begin.

Medicare - LHH

Representatives from the Federal MediCare Program will be at Laguna Honda Hospital for two weeks to audit the Medicare cost report for the fiscal year-end 1996. Major areas of audit include review of recoverable operating expenses, capital costs, and allocations between inpatient and other program areas. In addition, the Intermediary will review the allocations statistics and the basis for recovery of hospital-based physician services.

MediCal - SFGH

Auditors from the State Department of Health Services are currently auditing our inpatient and outpatient MediCal claims and cost reports for fiscal year 1994-95. Outpatient claims includes both fee for service and FQHC reimbursement at SFGH. Auditors are challenging the hospital's date of FQHC certification and have suggested that our certification begin in May 1995, instead of June 1994. Ms. Zmuda has called for a meeting with the State to show why SFGH certification for the entire year should be sustained.

MediCal FQHC Health Centers

Our FQHC cost report audits for fiscal years 1994-95 and 1995-96 will begin March '98.

Medicare Audit SFGH

Medicare auditors are scheduled to conduct their audit of SFGH for FY 1995-96 from June through August 1998.

Year-End Financial Audit

This annual outside audit is conducted of both hospitals each year, upon completion of the fiscal year. Auditors are on site from July through August to audit our financial statements and accounts receivables, among other financial transactions which make up the year-end close.

MediCal Audit SFGH 1995-96

Because of the large number of audits and due to recent resignations of the SFGH Controller and Chief Financial Officer, we have requested that the 1995-96 audit be postponed until September 1998.

We will keep the Health Commission informed of the results and the fiscal implications of these audits upon their completion.

Annual State Survey at Laguna Honda Hospital

On February 23 representations from the State Department of Health Services Licensing and Certification began their annual standard certification survey at Laguna Honda. The survey includes representatives from the Health Care Financing Administration to monitor the survey process. Specialty consultants are also part of the survey team to review Acute Services, Medical Services, Respiratory Therapy, Nutrition Services, and Pharmacy Services. The Hospital Executive Committee is meeting daily to monitor and coordinate the survey process. The Commissioners will be advised of the date and time of the exit conference.

Dedication of Laguna Honda Hospital Farm

On March 4, the LHH Farm will be named in honor of Virginia Leishman, R.N. Virginia is the immediate past Director of Nursing, who recently retired following forty-four years of service. Residents and staff have been invited to attend the festivities between the hours of 3:00 and 4:00 p.m. Tony Wagner, Interim CHN Director, will unveil the dedication plaque and officially rename the farm in Virginia's honor.

Update on Home Health Agency

The Community Health Network's home health agency, Health at Home (HAH), currently provides an average of 1250 visits per month to an on-going patient census of approximately 220 clients on service at a given time. This is twice the volume of visits provided during the same time last year. A supplemental budget approved this month by the Board of Supervisors will augment the program by over $1 million. This will allow the program to increase the number of service providers as well as support staff needed to sustain the developing agency infrastructure. Health at Home is currently staffed with 43.0 F.T.E.

The fours areas of the city where HAH has served the highest number of clients are the Tenderloin, Mission, Excelsior and Bayview/Hunters Point. The majority of clients, 62%, are over 60 years of age, and 90% of all referrals have come from SFGH and the Community Health Centers. Other target populations for home health services include infusion patients, mental health clients, patients needing rehabilitation therapy, and people with terminal illnesses desiring palliative care. The Department has proposed in a supplemental request to the Board of Supervisors that additional Visiting Nurses and Hospice (VNH) contracts be moved to the HAH. The Board will be deciding this issue in the coming months.

Health at Home will be moving from its pilot location at Ocean-Park Health Center on 24th Avenue to a vacant DPH facility at 45 Onondaga Avenue in the near future.

(3.1) Presentation of the Second Quarterly Report for the Department of Public Health Budget for FY 1997-98.

Monique Zmuda, Chief Finance Officer, presented the following:

A surplus of $9.2 million is projected for FY 1997-98 based on actual expenditures and estimated revenues through the second quarter ending December 31, 1998. This projected surplus excludes $8.8 million in one-time FQHC revenue that is anticipated this fiscal year and will be carried forward for FY 1998-99 to fund one-time equipment and facilities maintenance expense. One-time equipment and facilities expense funded by FQHC revenues was included in the FY 1998-99 budget that was approved by the Health Commission at its last meeting. This projected surplus also excludes $6.8 million in Medi-Cal SB 855 Disproportionate Share revenue that will be accrued this fiscal year but received next fiscal year.

The second quarter projected surplus of $9.2 million is a $4.9 million decrease from the first quarter projection of $14.1 million. However, this decrease is primarily due to the exclusion of the $6.8 million surplus in Medi-Cal SB 855 revenue that will be received in FY 1998-99.

Fiscal year projections include revenue and expense associated with a number of supplemental appropriations already approved by the Health Commission. These supplemental appropriation requests already approved by the Health Commission and assumed in fiscal year projections include:

SFGH Unit 4B increased nursing staff as required by the Local 790 MOU ($189,738);

Additional cytology exams provided by San Francisco General Hospital's pathology lab ($134,820);

Additional workers comp services provided by San Francisco General Hospital's Workers Compensation Clinic ($643,223);

Home health care for AIDS patients provided through the Community Health Network ($1,033,415);

Increased Medi-Cal SB 855, Disproportionate Share Payment Program, to benefit San Francisco General Hospital ($33,000,000);

Base expense adjustment to correct historical infrastructure under funding in the Community Health Network ($10,283,861); and,

Additional revenue and expense associated with increased patient volume in the Community Health Network (9,540,179).

The first four supplemental appropriation requests (Unit 4B, cytology exams, workers comp, and home health) have been approved by the Board of Supervisors. The remaining three supplemental appropriation requests are pending approval by the Board of Supervisors.
Fiscal year projections do not include a supplemental appropriation to provide health and mental health services t the new Treasure Island jail facility. Funds for Treasure Island were placed on reserve by the Board of Supervisors pending the opening of the jail facility later in the fiscal year. Expense projections will be revised to include this supplemental appropriation when an opening date for the Treasure Island jail is determined.

The Department will continue to monitor the revenues and expenditures monthly. Ms. Zmuda will bring to the full Commission an 8-month report for FY 1997-98.

Commissioners expressed appreciation to Ms. Zmuda and Anne Okubo for their thorough financial reports. The Commission also acknowledged the recruitment efforts to fill vacant finance positions in the Department.

5) CONSIDERATION OF POLICY ISSUES REGARDING THE CONSUMER BILL OF RIGHTS AND RESPONSIBILITIES FROM THE PRESIDENT'S ADVISORY COMMISSION ON CONSUMER PROTECTION AND QUALITY IN THE HEALTH CARE INDUSTRY

Tangerine Brigham, Director of Policy and Planning, presented a proposed Consumer Bill of Rights and Responsibilities in health care, (Attachment A).

The Consumer Bill of Rights was developed by the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry and has been endorsed by President Clinton. The Advisory Commission was charged with advising the President on changes occurring in the health care system and recommending measures as may be necessary to promote and assure health care quality and value, and protect consumeres and workers in the health care system.

Ms. Brigham reported the following:

The Consumer Bill of Rights provides standards by which consumers, health care professionals, health care administrators and health plans can follow. Its objectives are to:

Strengthen consumer confident by assuring that the health care system is fair and responsive to consumers' needs,

Reaffirm the importance of a strong relationship between patients and their health care professionals, and

Reaffirm the critical role consumers play in safeguarding their own health.

As part of its charge, the Advisory Commission has closely looked at the lack of health care coverage. It recognizes that a fundamental principle in reforming the health care system is to ensure access. It has proposed the following goals for consumer protection in a quality-focused health care system:

Health care coverage is the best consumer protection, and efforts should be made to extend health care to the estimated 41 million uninsured Americans;

Consumers faced with catastrophic illness are often faced with losing health insurance coverage and require assistance;

Coverage must be made affordable for all consumers, employers and other purchasers

Vulnerable groups (such as persons with mental or physical disabilities, low-income individuals, children and limited English speakers) require special attention;

Small businesses and the self-employed purchased need assistance purchasing health coverage; and,

Consumers should be included in clinical research.

In several ways, the Department currently incorporates many of the principles articulated in Consumer Bill or Rights. As part of the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) survey and licensure process, we are required to document our patient rights and organizational ethics standards at San Francisco General Hospital. Laguna Honda Hospital's accreditation by the State Department of Health Services requires that the Hospital have a Patient's Rights and Responsibilities Policy. The community-oriented primary care clinics also a consumer rights and responsibilities policy which is posted at the facilities. In addition, over the last few years we have made changes to improve our customer service in clinical settings. We support the Consumer Bill or Rights and Responsibilities, and believe that its principles should be incorporated within the Department's health care delivery model.
Public Speaker: Frederick Hobson, Consumer Board member, S.F. Health Authority

Action Taken: The Commission unanimously adopted Resolution #10-98, "Supporting the Consumer Bill of Rights and Responsibilities, as Endorsed by President Bill Clinton and Recommended by the Advisory Commission on Consumer Protection and Quality in the Health Care Industry," (Attachment B).
None.
The meeting was adjourned at 4:40 p.m.

Sandy Ouye Mori, Executive Secretary to the Health Commission