Minutes of the Health Commission Meeting Tuesday, August 18, 1998, 3:00 p.m. At 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 3:03 p.m. Present: 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 AUGUST 4, 1998 Action Taken: The Commission adopted the minutes of August 4, 1998. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner David J. Sanchez, Jr. Ph.D.) (3.1) DPH-Administration – Request for approval of gift acceptance of two buses valued at $6,000 each, donated to Laguna Honda Hospital by Free Wheelers Association, Inc. (3.2) CHN-SFGH – Request for approval of contract modifications with PT & OT Registry, TherAmerica, On-Call Therapists and Preferred Therapy Registry, for the provision of temporary as-needed rehabilitation personnel services, for the period of February 1, 1998 through January 31, 1999, for a combined total not to exceed $275,000 per year. PH&P-CHS – Request for approval of retroactive multiyear renewal contract and sole source with Glide Foundation, in the amount of $67,440 per year, for the provision of outreach and HIV testing services in the Tenderloin, for the period of July 1, l998 through June 30, 2001. PH&P-CHS-CSAS – Request for approval of retroactive first modification to the contract with Haight Ashbury Free Clinics, Inc. (HAFC) in the amount of $612,777, to provide assessments and pretreatment services for the San Francisco Drug Court, in-custody substance abuse treatment and case management, life skills training, acupuncture and substance abuse counseling for the San Francisco Target Cities Project, for the period of October 1, 1997 through September 30, 1998. Commissioner Barnes noted the retroactivity of this contract. PH&P-CHS-CSAS – Request for retroactive renewal contract with the University of California San Francisco – Institute for Health Policy Studies, in the amount of $350,000 to complete the evaluation of the Federal San Francisco Target Cities Project, for the period of October 1, 1997 through September 30, 1998. Commissioner Sanchez abstained on this item due to conflict of interest. Commissioner Barnes requested a copy of the evaluation be forwarded to the Commission. (3.6) PH&P-CHS-Family Planning – Request for approval to accept retroactively and expend a new three-year grant from the California Department of Health Services, Office of Family Planning, in the amount of $123,000, to provide specialized outreach and counseling services to adolescents at high risk for teen pregnancy for the period of August 1, 1998 through June 30, 2001. (3.7) PH&P-Mental Health Services – Request for retroactive approval of new sole source contract with Walnut Creek Hospital to provide:  1) Acute psychiatric inpatient hospital services for children and adolescents, funded in the amount of $10,000, and 2) Medi-Cal funded psychiatric inpatient hospital services for adults for the period of July 1, 1998 through June 30, 1999. The total dollar amount for adult psychiatric inpatient hospital services for Medi-Cal beneficiaries for all six (6) hospital providers is $5,000,000. (3.8) PH&P-CHP&P-Health Promotion – Request for retroactive renewal contract with C.A.H.E.E.D., Inc., in the amount of $177,000, for the provision of outreach, support and prenatal education services, for the period of July 1, 1998 through June 30, 1999. (3.9) PH&P-CH&SS-Public Health Laboratory – Request for approval to enter retroactively into an agreement with the California Department of Health Services in the amount of up to $358,910 to provide HIV-I Viral Load Tests for the period of July 1, 1998 through June 30, 1999. Commissioner Chow, in referring to #3.4, requested the Department to report on the use and effectiveness of acupuncture as a treatment modality for substance abuse.  In collaboration with the contractor's and Department's work with acupuncture, the Department will bring data and latest research on acupuncture to the Commission in three months. President Monfredini commented on the repetition of retroactive contracts on the Budget Committee agenda.  She stated that this practice is unacceptable to the Commission and requested the Department to address this problem. Action Taken: The Commission approved the Consent Calendar of the Budget Committee, with Commissioner Sanchez abstaining on #3.5 4) DIRECTOR'S REPORT  (Mitchell H. Katz, M.D., Director of Health) (Provides information on activities and operations of the Department).  ADMINISTRATION State Budget Last week, the California Legislature passed the FY 1998-99 State budget and over forty budget trailer bills.  The Governor, who is expected to act on the proposed budget this week, may delete or reduce specific programs and may sign or veto any of the accompanying trailer bills.  The budget proposes a $75.3 billion spending plan, $58.6 million of which is State General Fund dollars, and a reserve of $130 million, over $700 million less than the Governor proposed.  Since the current reserve is so small, the Governor is likely to reduce the Legislature's proposed spending amounts by several hundred million dollars. There was a significant compromise reached regarding a reduction in Vehicle License Fees (VLF).  The VLF proposal includes a billion dollar tax cut for FY 1998-99, which may increase to as much as $3.2 billion by 2003.  The agreement also includes backfilling the VLF cut based upon a continuous State General Fund appropriation.  This would compensate local governments for losses in health and social services realignment dollars.  The major components of the VLF agreement are as follows. A 25% VLF reduction, effective 1/1/99, potentially growing to 67.5% in future years. The current tax of 2% will continue to be assessed beginning 1/1/99, but vehicle owners will only pay 1.5% with the State making a continuous appropriation from the State General Fund to offset the loss in revenues. A complicated set of triggers could result in VLF reductions of $500 million to $2.1 billion in 2000 through 2004 if revenues are from $1.5 billion to $3.7 billion above the current forecast. Pursuant to the trigger structure, approximately half of any revenues above the forecast would go to additional tax cuts, with the remaining half available for spending. On the positive side, $70 million has been allocated for the California Food Assistance Program, permitting legal immigrants between the ages of 18 and 64 who were denied eligibility for federal food stamps to obtain these services under this State program.  There was also agreement to allocate $19.5 million for a State-only SSI/SSP program for legal immigrants who entered the country prior to the passage of federal welfare reform and are ineligible for federal benefits.  In addition, CalWORKs recipients will receive a cost of living adjustment and elimination of the 4.9% grant reduction put into effect in 1990. The following are significant health-related items in the legislative budget which are at risk of being deleted or reduced by the Governor.  The Department has supported these funding proposals: A $40 million reduction of the State's Disproportionate Share Hospital administrative fee. A $7.7 million augmentation for communicable disease control efforts. Elimination of the 33 1/3% State "takeback" in the Medi-Cal Administrative Activities/Targeted Case Management program. $37 million for prenatal care for undocumented women. Changes to the Healthy Families Program costing approximately $3 million including: increasing the income threshold to 250% of poverty and expanding eligibility to include recently arrived immigrant children. Various Medi-Cal rate increases for primary and preventive care, outpatient hospital services, ambulances, in-home nursing and optometrists. Augmentations totaling $6 million for the HIV/AIDS services. $1.1 million in grants to support long-term care planning efforts under AB 1040. $5 million for the California Statewide Supportive Housing Initiative. Expand transitional Medi-Cal for CalWORKs families from 1 to 2 years. Tobacco Litigation Update On July 20, 1998, a San Diego Superior Court Judge combined five major California lawsuits against the tobacco industry.  The plaintiffs -- including the State, San Francisco, Los Angeles, and thirteen other Counties -- want reimbursement for tobacco-related costs incurred by State and local health programs, such as Medi-Cal.  In 1996, San Francisco became the first city in the country to file suit against the tobacco industry.  The litigation was on hold while Congress debated passing a national anti-tobacco bill.  Now that the federal bills have died, the California-based lawsuits are moving ahead with a trial anticipated in February or March, 1999.  In a separate effort partnering with other State and local governments, negotiations are continuing for a multibillion-dollar national settlement. On August 6, 1998 the State of California reached an agreement with its cities and counties to share the nearly $18 billion it could receive in a settlement.  This is an unprecedented agreement, which acknowledges the significant role cities and counties play in preventing and treating tobacco-related illnesses.  Four other States have already settled cases against the tobacco industry:  Minnesota, Florida, Mississippi, and Texas.  Of those, the only local governments to share in the proceeds were four Counties in Texas, and this occurred only after major lobbying by that State's legislature.  Under the recent agreement in California, half of any settlement funds would go to the State.  The Cities of San Francisco, Los Angeles, San Diego and San Jose would each get 10% of the other half, and the remainder would be allocated among the remaining California counties based on population. Healthy Families Earlier this month, the Managed Risk Medical Insurance Board provided statewide enrollment figures for Healthy Families.  As of August 1, 1998, 5,265 children were enrolled in the program. I am pleased to announce that San Francisco is number two in the State for Healthy Families enrollment by county with 768 enrollees.  In addition, the San Francisco Health Plan had 9.2% of overall statewide enrollment (484 of 5,265) making it number five for enrollment by health plans. I would like to congratulate the Community Health Network and other providers within the San Francisco Health Plan for their extensive education and outreach activities.  In conversations with the State, I have stressed that while San Francisco is conducting education and outreach activities to ensure enrollment in this program, additional enrollment may decline unless the State can address the immigration concerns within the Latino community. Finally, I would like to congratulate Dr. Janet Shalwitz, Medical Director of our Maternal Child and Adolescent Health Program, for being selected to serve on the Healthy Families Quality Improvement Work Group.  Dr. Shalwitz's wealth of experience will provide a needed perspective with respect to adolescent health issues. San Francisco's Universal Health Care Efforts The Mayor will be placing a Declaration of Policy on the November 1998 ballot for voters to consider.  Proposition J is a declaration of policy for the City and County to assist uninsured residents in obtaining affordable health care coverage.  Proposition J does not discuss any implementation aspects related to the recommendations of the Mayor's Blue Ribbon Committee on Universal Health Care. As you are aware, San Francisco has the opportunity to make health insurance affordable by: Enabling employers to participate in a purchasing poll that leverages their contributions for health care coverage, and Providing a subsidy for low-income workers and the indigent.  I believe that it is important to have San Francisco residents consider and concur on  the overall policy objective, before discussing and considering any implementation issues related to expanding health care coverage to the uninsured.   The Department will provide the Health Commission with a copy of the Proposition J and the accompanying ballot arguments when they become available.   POPULATION HEALTH AND PREVENTION Mental Health I regret to inform you of the decision of Luz Mary Harris, Ph.D. to leave the Department of Public Health to pursue other professional opportunities after 21 years of commendable public service.  During her tenure, Dr. Harris has served in several capacities, including Assistant Director of Children, Adolescent and Family Mental Health Services, Director of Health Center #5 (Ocean-Park Health Center), Interim Director of Homeless Programs, Director of Cluster II and Director of Crisis and Emergency Mental Health Services.  She helped develop several initiatives in children's mental health services, including the Family Mosaic Project, and was instrumental in developing and implementing the MOST team for treating mentally disabled homeless people, the Mobile Crisis team and the initial planning and program design for the ACCESS system.  I want to thank Dr. Harris for her years of dedicated service and wish her the best in her new endeavors. COMMUNITY HEALTH NETWORK Appointments of CHN Chief Financial Officer and Controller I am very pleased to announce the appointment of Ken Jensen as Chief Financial Officer of the Community Health Network.  Ken has a twenty-year career as CFO of major health care systems in the Bay Area.  Most recently, Ken has served as CFO of Summit Medical Center in Oakland.  He has also served as CFO at Brookside Hospital in San Pablo, Children's Hospital at Stanford and Highland Hospital in Oakland.  Ken worked at San Francisco General Hospital in the early 90's as Management Services Office within UC's Diagnostic Services Department.  In this capacity, Ken worked closely with the Dean's Office and Hospital administration to develop the affiliation agreement, create the physician's plan at SFGH, and to reduce costs and increase effectiveness of diagnostic services at the Hospital.  Ken began his appointment on August 10.  As Chief Financial Officer of the Community Health Network, Ken manages all financial functions at San Francisco General Hospital, Primary Care, Forensics Services, and Laguna Honda Hospital including accounting, patient billing, budget, and financial planning.  Ken's responsibilities also include serving as a member of the CHN Leadership Team. I am also pleased to announce the appointment of Fanny Lee as Controller of SFGH and the primary care clinics.  Fanny has ten years of financial experience at major hospitals in Southern California.  Fanny has worked at Good Samaritan Hospital in Los Angeles, and St. Francis Hospital in Lynwood, California, where she served as Controller.  Prior to her role as Controller, Fanny served as budget manager at St. Francis Hospital, and as Senior Financial Analyst at Kaiser Permanente.  She holds an MBA degree in Finance from USC.  Fanny also started working for us on August 10.  She is in charge of managing day to day financial operations including accounting, budgeting, and reimbursements for the Hospital and the clinics. We are very fortunate to have recruited these two talented financial managers for our CHN management team.  Please help me welcome them to the Department of Health. Laguna Honda Hospital I am pleased to announce the appointment of Mr. George Fribance as the Associate Administrator for Operations at Laguna Honda Hospital effective today.  Mr. Fribance has earned a Bachelor of Science in Business Administration from Drake University and a Masters of Public Health in Hospital Administration from UC Berkley.  He has 24 years of progressively responsible experience in healthcare administration including positions at Alta Bates, Providence, and Enloe Hospital in Chico where he recently served as Associate Administrator.  I welcome him as a valuable addition to the Administrative Team at Laguna Honda. Dr. Mary Anne Johnson Leaving Laguna Honda Hospital Dr. Mary Anne Johnson will be leaving Laguna Honda to join UCSF as the Vice Chief of Geriatrics.  She will be Chief of Clinical Geriatrics and Extended Care at San Francisco Veterans Administration Hospital.  Dr. Johnson will continue to work at LHH on regulatory issues until her departure in September 1998.  I'm sure the entire Health Commission joins me in extending our very best wishes and appreciation.  Two farewell gatherings have been  scheduled:  At CHN Headquarters: August 24th  -  4:00 p.m. At LHH 3rd Floor Patient Library: August 27th  -  3:00 p.m. Again, all our best wishes for Mary Anne.  Her leadership at Laguna Honda and the CHN will be surely missed. Cal-OSHA Inspection Cal-OSHA has completed their inspection at San Francisco General Hospital.  The focus of the inspection was occupational exposures to infectious diseases, and use of engineering controls, such as safe needle devices, to prevent such exposures.  Based on preliminary findings, it appears that SFGH may receive some citations as a result of this inspection.  The inspection has identified areas where our programs can be improved and has highlighted our need to better document actions taken.  The Cal-OSHA inspector will be holding a closing conference in September with SFGH Administration.  SFGH staff is working collaboratively with Cal-OSHA and is developing action plans to abate all identified deficiencies. 1998 July statistics are available in the Commission Office. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARD(S) On behalf of the Commission, President Monfredini announced the August awardees for the Employee Recognition Awards: Individual  (Employee Name) Division Nominated by Ann Prato CHN/Laguna Honda Hosp./ Ronald B. Duber, OTR Daniel K.C. Lam, OTR Gina M. Di Grazia, OTR William R. Kerry, OTR Ana V. Wade Judy Penhiter CHN/Forensics Erse Dirlam-Ching Susan Larson CHN/Health at Home Mary Kay McKown, RN, MS, Rehabilitation Supervisor Team Division Nominated by David Boone CHN/Laguna Honda Hosp Lawrence J. Funk, Exec.Admin. Alicia Fortaleza Steve Koneffklatt Sharon Kotabe Sal Tandoc William Frazier 6) PRESENTATION OF AN UPDATE AND PROGRESS ON TRAUMA SERVICES TO SAN MATEO COUNTY Robert MacKersie, M.D., and Carol Shagoury, R.N., M.S., presented an update on the provision of trauma services to Northern San Mateo County by San Francisco General Hospital.  They provided a historical overview, San Mateo County Trauma Patient Statistics, a program evaluation, and recommendations.  A copy of the complete report is available in the Commission Office. Gene O'Connell, Executive Administrator of San Francisco General Hospital and Director of Patient Care Services of Community Health Network, reported that SFGH has contracted Bishop and Associates to provide consultation services to the Trauma Center for the purpose of examining and improving cost management and financial performance, providing strategies for trauma care, contracting and outreach, and assisting us in identifying areas for future growth and service improvement. Commissioners' Comments: There is a need to keep data on the trauma population and finances. There needs to be a system in place to look at and analyze financial data. There are many positive aspects of this program; and there is not a negative impact on the delivery of emergency and trauma services to the residents in the City and County of San Francisco. Dr. Katz reported that this program is positive financially for the Department.  He assured the Commission that with the information and data from Bishop and Associates, the Department will include financial information in a report to the Commission in December 1998. President Monfredini requested the report be calendared for a Commission meeting in December 1998. 7) OTHER BUSINESS/PUBLIC COMMENTS None. The meeting was adjourned at 4:20 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission