Minutes of the Health Commission Meeting
Tuesday, November 17, 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 Commissioner Edward A. Chow, M.D., at 3:15 p.m.
Present:
Action Taken: The Commission unanimously adopted the minutes of November 3, 1998.
3) CONSENT CALENDAR OF THE BUDGET COMMITTEE
(Commissioner Ron Hill)
(3.1) Consideration of a sliding fee schedule for the Community Health Network.
A resolution reflecting the new sliding fee scale was considered. Commissioners gave input on amendments to the resolution and requested staff bring back more information on implementation issues of the sliding fee scale.
PH&P-CHSS – Request for approval to accept and expend a new two-year grant from the U.S. Department of Commerce, Telecommunication and Information Administration, in the amount of $597,898, to provide full implementation of the Reggie Project for the period of October 1, 1998 to September 30, 2000.
CHN-Primary Care – Request for approval of retroactive four-year sole source and renewal contract with Mission Neighborhood Health Center (MNHC), in the amount of $178,202 per year, for the provision of primary medical care services to medically indigent adults residing in the Mission District, for the period of July 1, 1998 through June 30, 2002. (DPH contracted with MNHC for services totaling $856,819 during FY 1997-98).
Commissioner Hill requested the update on staff compliance come back to the Commission in a year.
(3.4) PH&P-CHS-MH & SAS – Request for retroactive contract renewal with Ohlhoff House, Inc. in the amount of $103,000 per year to provide outpatient substance abuse services for the period of July 1, 1998 through June 30, 2002. (DPH contract with Ohlhoff House for services totaling $102,900 during FY 1997-98).
(3.5) PH&P-CHS-MH & SAS – Request for approval of retroactive contract renewal with Walden House in the amount of $6,079,107 to provide comprehensive mental health, substance abuse, and other medical residential and outpatient services to adults and adolescents for the period of July 1, 1998 through June 30, 1999. (DPH contracted with Walden House for services totaling $8,099,548 during FY 1997-98).
(3.6) PH&P-CHS-MH & SAS – Request for approval of increased use of site, under Proposition I requirements, at 1175 Howard Street (detoxification facility) and retroactive renewal contract with St. Vincent de Paul Society of San Francisco (SVdP) in the amount of $1,139,714 per year to provide substance abuse drop-in, detoxification and substance abuse/mental health shelter services for the period of July 1, 1998 through June 30, 2002. (DPH contracted with SVdP for services totaling $860,709 during FY 1997-98).
(3.7) PH&P-CHS-MH & SAS – Request for approval of retroactive renewal contract with New Leaf…Services for Our Community in the amount of $860,861 per year to provide outpatient substance abuse and mental health treatment services for the period of July 1, 1998 through
June 30, 2002. (DPH contracted with New Leaf for services totaling $1,347,911 during FY 97-98).
(3.8) PH&P-CHS-Mental Health – Request for approval of retroactive multiyear renewal contract with Family Service Agency of San Francisco (FSA) in the amount of $4,210,152 per year to provide children's mental health services, adult care management, geriatric services, brief therapy services and fiscal intermediary services for the period of July 1, 1998 through June 30, 2000. (DPH contracted with FSA for services totaling $4,698,820 during FY 1997-98).
PH&P-CHS-Mental Health – Request for approval of retroactive annual renewal contract with Family Mosaic Project contractor in the amount of $268,300 to contract for sub-acute residential treatment services for the period of July 1, 1998 through June 30, 1999 with the following agency: Victor Treatment Centers.
This item was continued to the December 1, 1998 Budget Committee agenda.
(3.10) PH&P-CHS-Mental Health – Request for approval of retroactive annual renewal contract with Family Mosaic Project contractor in the amount of $91,500 to contract for sub-acute residential treatment services for the period of July 1, 1998 through June 30, 1999 with the following agency: Catholic Youth Organization-St. Vincent's School for Boys.
Commissioner Hill clarified that the Commission has not requested sexual orientation demographics of the adolescent client population at CYO. With the letter dated November 12, 1998 from CYO indicating non-compliance, Commissioner Hill would not recommend this contract for approval and encouraged the Department to seek alternative contractors for this service.
Commissioner Barnes expressed disappointment in the CYO letter and commented that the letter is unacceptable. Each contractor needs to comply with Policy #24.
Commissioner Sanchez emphasized the need to ensure uniformity around compliance to Policy #24.
Commissioner Hill recommended that because the CYO representative made it clear on its unwillingness to comply with Policy #24, he recommended not to approve this contract and that staff proceed to find another provider for this service, and for staff to transition the clients appropriately. CYO will be funded for services already provided since July 1, 1998.
(3.11) PH&P-CHP&P-TB Control – Request for approval of sole source and renewal contract with Regents of the University of California at San Francisco (UCSF), in the amount of $2,081,451, for the continued operation of the Model Tuberculosis (TB) Prevention and Control Center, for the 15-month period of December 31, 1998 through March 31, 2000. (DPH contracted with UCSF for services totaling $14,794,533 during FY 1997-98).
A letter to the U.C. Board of Regents is being sent regarding compliance to Policy #24.
Commissioner Chow would want S.F. State University to also comply with Policy #24.
Commissioner Sanchez commented with the election of our new Governor, new diverse appointments to U.C. and the State University systems governing bodies would be possible.
(3.12) PH&P-CHS-HIV Housing – Status report on Catholic Charities' compliance with Health Commission Policy #24.
Commissioner Hill stated that non-compliance by Catholic Charities is unacceptable.
David Lloyd of Catholic Charities referred to the October 27, 1997 letter and would hope a resolution could be worked out as was done in 1994 and 1997. Mr. Lloyd encouraged the Commission to keep in mind the rich history of HIV services from Catholic Charities to AIDS patients.
Commissioner Barnes strongly encouraged the agency to look for alternative methods to comply with Policy #24.
Commissioner Hill requested the Department to come back with a transition plan and alternatives to this contractor. He is willing to have Catholic Charities come back in 30 days (December 15, 1998) with a full compliance plan.
President Monfredini emphasized this is the absolute last opportunity for Catholic Charities to comply with Policy #24.
(3.13) PH&P-CHP&P-HIV Prevention – Request for approval of contract term extensions with the following contractors for AIDS prevention services for the period of January 1, 1999 through March 31, 1999: Asian and Pacific Islander Wellness Center; CAL-PEP; California AIDS Intervention Training Center; Glide Foundation; Haight-Ashbury Free Clinics, Inc.; Instituto Familiar de la Raza; Iris Center; Mission Neighborhood Health Center; Polaris Research and Development, Inc.; Stop AIDS Project; The Support Center; Tenderloin AIDS Resource Center; and the Regents of the University of California (UCSF-AIDS Health Project and UCSF-Urban Health Study).
Action Plan: The Commission approved the Consent Calendar of the Budget Committee with the specific requests. Item #3.9 was continued to December 1, 1998. Commissioner Sanchez abstained on #3.11.
4) DIRECTOR'S REPORT (Mitchell H. Katz, M.D., Director of Health)
(Provides information on activities and operations of the Department).
ADMINISTRATION
Pregnancy-Related Services for Undocumented Residents
The Milagro Doe v. Belshe trial, originally scheduled this month, has been postponed until February 1999. Milagro Doe is one of the major lawsuits challenging the State's regulations to terminate State funding for pregnancy-related services to undocumented women. Under a court order in this case, the State continues to be prohibited from terminating funding at least until the trial is held. It is likely the case will be dropped in February, due to the new State administration. The Department is in touch with community advocates who will work with the Davis administration to determine the best approach for ensuring undocumented residents continue to be eligible for pregnancy-related services. This may be done through legislation and/or administrative action to withdraw the proposed regulations and rescind the existing executive order.
California Medical Association Council on Legislation Autumn Workshop
This weekend I was asked to attend the California Medical Association Council on Legislation Autumn Workshop as a consultant on the topic of HIV reporting. Unfortunately, the California Medical Association policy on HIV reporting is quite different from that adopted by this Health Commission. The California Medical Association supports HIV reporting by name rather than by unique identifier. The Council on Legislation also explicitly recommended to the California Medical Association that they not support legislative bills that would use a unique identifier method as a means of reporting HIV seropositivity to local Health Officers. At the meeting I explained the many reasons why our Health Department and Commission support HIV reporting by a unique identifier system. Unfortunately, our views did not sway the group.
November Elections
There were two San Francisco propositions on the November ballot affecting the Department of Public Health.
Proposition B was a measure requiring City departments to prepare annual customer service plans. The measure seeks to ensure that departments continuously address and improve their customer focus when providing services to the public. By February 1st of each year, all departments will be required to file their annual customer service plans with the Board of Supervisors. Proposition B amends the City Charter. Proposition B passed with 56% of the votes.
As the Health Commission is aware, the Department participated in the Mayor's Blue Ribbon Committee on Universal Health Care. Proposition J was based on the work of that Committee. Proposition J asked City residents whether it should be City policy to help the estimated 130,000 uninsured San Francisco residents obtain health care coverage. Proposition J was a declaration of policy and not a City Charter amendment. It passed with 64% of the votes.
I am pleased that both propositions passed. They further our efforts to improve the level of services to the public.
Medicaid 1115 Waiver Planning
Over the past several months, the Medicaid 1115 Waiver Planning Committee created by the Health Commission has been meeting to determine the feasibility of submitting an 1115 Waiver to the State for consideration. Thus far, the Committee has done the following:
- adopted guiding principles for the development of a waiver,
- held interviews with key stakeholders to determine their perspectives on a Medicaid waiver,
- developed sub-committees to examine fiscal/data, services delivery and system design issues, and
- reviewed detailed data on the historic utilization and costs of the Medi-Cal population in San Francisco.
The Committee identified a broad variety of issues during its deliberations, such as, expansion of managed care, service expansion for high utilizers and preservation of the safety net. The Committee is also looking at what coordination should exist between the Medicaid waiver planning process and other planning initiatives (e.g., long-term care, and the Mayor's efforts at universal health coverage and Healthy Families).
One of the guiding principles adopted by the Committee is that a Medicaid 1115 Waiver should only be sought if it results in improvements (fiscally, programmatically, structurally or in quality of care) in San Francisco's health care delivery system. On December 9, 1998, an analysis on the feasibility of pursuing a waiver will be presented to the Medicaid 1115 Waiver Planning Committee. This feasibility analysis will provide options for San Francisco to either generate savings in the Medi-Cal program or obtain federal reimbursement for currently unfunded services. With potential savings and/or additional funds, San Francisco may be able to expand health care coverage for some uninsured populations. After the feasibility analysis has been reviewed and commented on by the Medicaid 1115 Waiver Planning Committee, the Department will present the report to the Health Commission in January 1999.
Death with Dignity
DPH was one of the participating organizations in a conference called "California Conference on Physician Assisted Dying", held at UCSF November 13. Conference sponsors included Mayor Brown, the Death with Dignity National Center, and the San Francisco Medical Society. The conference lecturers and panelists lead an open and thoughtful discussion about current and proposed policy guidelines for optimizing end-of-life care and choices, and about the societal implications of such policies. By hosting this conference of national and international experts in the area, the City and County of San Francisco demonstrated its commitment to providing leadership in this important, if controversial, issue.
POPULATION HEALTH AND PREVENTION
Children, Youth and Family Services Section (CYFSS)
The Children, Youth and Family Services Section of Community Mental Health Services will be honored nationally tomorrow in New York City by Mutual of America Life Insurance Company-Corporate at its Third Annual Community Partnership Award event.
The Community Partnership Award is given to recognize the leadership of public, private and social sectors who have partnership for the greater good of their communities and can serve as inspiration and models for others to form partnerships. The award is an annual national competition.
CFYSS is being honored for its leadership and successful collaborative efforts with Edgewood Center for Children and Families and San Francisco's Department of Human Services, in the establishment of a nationally recognized kinship care program for the City and County of San Francisco. Sai-Ling Chan-Sew, LCSW, Director, will be accepting the award.
COMMUNITY HEALTH NETWORK
Mammography Accreditation
As reported to the Commission earlier, the Department submitted the required films for mammography reaccredidation to the Department of Health Services on August 13, 1998. The current accreditation expired September 30. Although it took a number of months, I am pleased to report that both SFGH Mammography Units passed the clinical image review by the California Department of Health Services and are fully accredited. The first unit was accredited October 27, the second one November 16. The California Department of Health Services, Radiologic Health Branch, accredits each machine, and the FDA accredits the facility. The Food and Drug Administration issued an interim notice allowing mammography services to be performed legally until the formal certificate is received.
Report on Laguna Honda's Plan of Correction
On November 9, representatives from the State Licensing & Certification Office requested supplemental information on six items contained in the Hospital's amended Plan of Correction. This information was submitted to the State on November 10. Written notification on the results of the Hospital's resurvey and Plan of Correction is expected any day. I will advise the Commission on the outcome upon receipt of the written notification.
Appointment of the CHN Information System Manager
I am pleased to announce the appointment of Patricia Skala as the CHN Information System Manager for Long Term Care, Forensics and Home Healthcare. Pat will be responsible for CHN Information Systems development and implementation for Laguna Honda, the Mental Health and Rehabilitation Facility, the SFGH Skilled Nursing Unit, as well as for Forensics and the Health at Home Program.
Pat brings a wealth of healthcare information systems experience to this position. She comes to this position from her prior DPH assignment as the Information Systems Manager for Population Health and Prevention. Pat's experience includes: serving as the Clinical Systems Supervisor at Davies Medical Center from 1993-95, as the Data Base Manager at California Pacific Medical Center from 1988 - 1993, and as Case Mix Manager at St. Mary's Medical Center from 1975 - 1988.
SFGH Annual Employee Banquet
The 18th SFGH Annual Employee Recognition Banquet co-sponsored by Campus Hospital Employees Activities Resource Services (CHEARS) was held November 6, 1998 in the hospital's main dining room. Approximately 300 individuals attended the event, which was a resounding success. The banquet honored both SFGH and UCSF employees who have, or will have acquired,
10 + service award year anniversaries by December 31, 1998. SFGH service award pins for corresponding years of service were given to honorees.
In addition, Gene O'Connell (Executive Administrator, SFGH) presented the following special awards to SFGH employees:
- Executive Administrator's Award: SFGH Volunteer Services
- Department/Team Achievement Award:
- CCU Nursing
- Skilled Nursing Facility (Unit 4A)
- Rehabilitation Services Department
- Individual Achievement Award:
- Tom Jensen (Community Focus)
- Michelle Singh, RN (Department of Psychiatry)
- In addition, 65 individuals received "Above & Beyond" recognition awards for providing exemplary customer relations service.
Individual Division Nominated by
Darryl Burton PH&P/CHS/CSAS Operations Barbara A. Garcia, Director of CSAS
Olga Gutierrez PH&P/Comm. Mental Health Serv. Vickie L. Wells
Esther Marania, R.N. CHN/SFGH – Unit 5C Sheryl Calson, R.N., Anne Hughes, R.N.
Julie Peck PH&P/Breast & Cervical Cancer Serv. Collins R. Munns
6) PRESENTATION OF THE ANNUAL STATE LEGISLATIVE REPORT
Patricia Dunn of the Office of Planning and Policy, presented an overview of the Department's Report on the 1998 State Legislative Session.
Commissioner Guy commented on the importance of legislation pertaining to school health issues.
Commissioner Chow expressed h is continued support for maintaining confidentiality by not reporting names for HIV reporting.
7) PRESENTATION AND CONSIDERATION OF A RESOLUTION REGARDING INCREASING ALTERNATIVES TO INSTITUTIONAL CARE
Dr. Katz presented his proposed strategic direction for Department of Public Health to increase alternatives to institutional care.
Public Speakers: Joan Braconi, Local 20 and Donna Calame, citizen interested in long-term care
Commissioners' Comments:
- Supportive of the concept to increase alternatives to institutional care
- Quality of care needs to be maintained while decreasing use of institutional care
- Certain trends (i.e., increase in aging population, increase in homelessness and degree of poverty) point out need for this strategic direction
- Institutional care will still be a need
- Need to discuss this strategic direction in a public forum
- Deinstutionalization has previously been attempted
- Dialogue on prevention in the community is needed
- This is a temporary, band-aid solution without much impact on the system
- Citizens do not deserve services to be cut
Commissioner Barnes offered a friendly amendment to the proposed resolution with the addition of maintaining quality of care.
Action Taken: The Commission adopted Resolution #35-98, "Supporting a Strategic Direction of Developing Alternatives to Institutional Care and Requesting the Department to Develop Specific Proposals to Decrease Institutional Care and Increase Alternative Programs,".
Commissioner Sanchez left at 5:50 p.m.
8) PRESENTATION OF A DEPARTMENT OF PUBLIC HEALTH FIRST QUARTER FINANCIAL REPORT FOR FY 1998-99, AND CONSIDERATION OF A RESOLUTION SUPPORTING THE DEPARTMENT'S EXPENDITURE PLAN
Monique Zmuda, Chief Finance Officer, presented the following:
The Department is projecting a shortfall in the range of $16 to $22 million for FY 1998-99 based on estimated expenditures and revenues for the first quarter of the fiscal year ending September 30, 1998. Major components of the projected gap include: 1) reduced revenues from uncompensated care at San Francisco General Hospital; and 2) reduced revenues at Laguna Honda Hospital attributable to the recent requirement to reduce census per the Department of Health Services and Department of Justice Plans of Correction.
Plan to Address Projected Revenue Shortfall
A proposed plan to address the projected fiscal year revenue shortfall has been developed by Department staff. This plan, which totals $21.9 million, includes an estimated $18.1 million in expenditure savings and 3.8 million increased revenues.
Expenditure savings of $18.1 million include: 1) estimated savings in salaries and fringe benefits of $7.0 million; 2) reduced overtime, registry and per diem personnel of $0.4 million; 3) a freeze on discretionary equipment purchases of $1.0 million; 4) deferral of non-essential capital improvements of $2.5 million; 5) reductions of carry forward expenditures from FY 1997-98 into FY 1998-99 of $3.0 million; 6) reduced marketing expenses at the Community Health Network of $0.6 million; 7) reduced administrative expenses of $0.5 million; 8) deferral of the opening of an additional unit at San Francisco General Hospital of $1.0 million; and 9) contractual services savings of $2.0 million. In addition, Department staff will explore additional expenditure savings from the deferral of new initiatives and accrual of one time savings from start up delays of new programs.
Increased revenues of $3.8 million include: 1) one time additional revenue from cost report settlements of $1.5 million; 2) additional Medi-Cal revenue of $1.5 million resulting from renegotiated reimbursement rates; 3) Medi-Cal revenue from additional eligible patients of $0.6 million; and 4) Medi-Cal reimbursement for administrative expenses of $0.2 million.
Salary and fringe benefit savings will be achieved by a Department-wide hiring plan. The hiring plan will identify vacant positions and determine a priority for filling positions or for holding vacant non-essential positions. Financial staff in each Division, in consultation with program managers and human resources staff are developing monthly hiring plans that are reviewed and approved by the Director of Health. This hiring plan was implemented at the end of October.
Dr. Katz is requesting support for this strategic direction and will make quarterly updates to the Commission.
Commissioner Guy noted this expenditure plan promotes budget cuts instead of a request for a supplemental. She cautioned the Department on the SFGH census being realistically reduced. She sees the demands to be increasing.
Commissioner Parker inquired whether this shortfall is similar with other hospital shortfalls.
Commissioner Hill commended staff for coming up with a very difficult plan.
Action Plan: The Commission adopted Resolution #36-98, "Endorsing the Department of Public Health's Deficit Reduction Plan to Balance the FY 1998-99 Budget.".
9) PRESENTATION OF A PLAN TO ADDRESS DIVERSION
Dr. John Brown, Director of the Emergency Medical Services Agency, presented the Diversion Action Plan.
Nathan Nayman of the Hospital Council also reported that representatives from the Hospital Council, the State Department of Health Services, and the Federal Health Care Financing Administration met to explore potential waivers. Mr. Nayman emphasized to the Commission that the fundamental problem is the shortage of critical care nurses.
Commissioners Chow, Hill and Barnes expressed their appreciation for the action plan and commended the EMS agency for effectively bringing the appropriate parties together.
Commissioner Barnes requested diversion statistics in the Director's Report through February 1999.
Commissioner Guy encouraged the Department to monitor and evaluate this action plan.
10) OTHER BUSINESS/PUBLIC COMMENTS
None.
11) CLOSED EXECUTIVE SESSION:
A. PUBLIC COMMENT ON ALL MATTERS PERTAINING TO THE CLOSED SESSION.
None.
B. VOTE ON WHETHER TO HOLD CLOSED SESSION TO CONFER WITH LEGAL COUNSEL. (SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.11(a).)
Action Taken: The Commission voted to hold a closed session.
C. CLOSED SESSION PURSUANT TO GOVERNMENT CODE SESSION 54956.9 AND SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.11(b).
CONFERENCE WITH LEGAL COUNSEL - EXISTING LITIGATION.
NAME OF CASE: ANNIE TRUSTY V CCSF
SUPERIOR COURT #991-985
PROPOSED SETTLEMENT OF $15,000
D. RECONVENE IN OPEN SESSION:
1. POSSIBLE REPORT ON ACTION TAKEN IN CLOSED SESSION. (GOVERNMENT CODE SECTION 54957.1(a)(2) AND SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.14(b)(2).)
Action Taken: The Commission approved the proposed $15,000 settlement.
2. VOTE TO ELECT WHETHER TO DISCLOSE ANY OR ALL DISCUSSIONS HELD IN CLOSED SESSION (SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.14(a).)
Action Taken: The Commission voted to not disclose any discussions held in closed session.
The meeting was adjourned at 7:05 p.m.
Sandy Ouye Mori, Executive Secretary to the Health Commission