Minutes of the Health Commission Meeting Tuesday, February 16, 1999, 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 3:05 p.m. Present: 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. Commissioner John I. Umekubo, M.D. 2) APPROVAL OF MINUTES OF REGULAR MEETING OF FEBRUARY 2 AND THE SPECIAL MEETING OF FEBRUARY 8, 1999 Action Taken: The Commission unanimously adopted the minutes of the February 2 and February 8, 1999 meetings. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) DPH-Administration – Request for approval of a resolution to accept, sell and expend a gift of stock with an estimated value of $49,200 bequeathed to Laguna Honda Hospital by the Barbara Wylie Trust and a gift of $78,871 bequeathed to Laguna Honda Hospital from the estate of Ermeth Dirovizza. (3.2) CHN-SFGH – Request for retroactive approval to accept and expend a new two-year grant from the State Department of the Youth Authority in the amount of $71,000 to provide a laser tattoo removal machine and maintenance costs for the period of January 1, 1999 to December 31, 2001. (3.3) CHN-SFGH HIS – Request for approval of retroactive contract with Deliverex, Inc. to provide medical record storage, retrieval and delivery services for San Francisco General Hospital's Health Information Services in an amount not to exceed $375,000 for the period of January 1, 1999 through June 30, 2000. (DPH contracted with Deliverex for services totaling $354,000 during FY 1997-98). (3.4) CHN-Pharmacy – Request for approval of second modification to the contract with Asereth Medical Services, Inc. (AMS), in the amount of $840,000, for a total contract amount of $2,600,000, for the provision of temporary pharmacy personnel services for the period of February 1, 1998 through June 30, 1999 (DPH contracted with AMS for services totaling $1,760,000 during FY 1997-98). This item was deferred to after discussion on item #7 on the agenda. Subsequently, this item was approved. (3.5) HP – Substance Abuse Services – Request for approval of retroactive sole source and renewal contract with the San Francisco Drug Abuse Advisory Board (SFDAAB) in the amount of $51,787 for the provision of substance abuse advisory services for the period of July 1, 1998 through June 30, 1999. (DPH contracted with SFDAAB for services totaling $51,787 during FY 1997-98). (3.6) PHP-HIV Prevention Services – Request for approval of retroactive renewal contract with Haight Ashbury Free Clinic, Inc. (HAFC), in the amount of $81,689, for the provision of HIV counseling, testing, risk reduction and partner notification services, for the period of January 1, 1999 through December 31, 1999. (DPH contracted with HAFC for services totaling $15,119,656 during FY 1997-98). (3.7) PHP-HIV Prevention Services – Request for retroactive renewal contract with Haight Ashbury Free Clinic, Inc. (HAFC), in the amount of $169,509, for the provision of HIV prevention, case management and venue based individual outreach for the period of January 1, 1999 through June 30, 1999. (DPH contracted with HAFC for services totaling $15,119,656 during FY 1997-98). The Department has placed this contractor on probation for this specific contract. The contractor submitted a written response to the monitoring report. Commissioner Hill reminded the Department that documents for Commissioners should be included in the Commission packets or could be faxed to Commissioners in sufficient time for their review. Otherwise, the agenda item will be continued to the next meeting. Commissioner Hill recommended approval with the request the contractor come back in 90 days (May 18, 1999) with a follow-up report to the monitoring report. (3.8) PHP-HIV Prevention Services – Request for retroactive renewal contract with Mission Neighborhood Health Center (MNHC), in the amount of $134,257 for the provision of HIV prevention program services targeting behavioral risk populations and evaluation of HIV prevention services, for the period of January 1, 1999 through December 31, 1999. (DPH contracted with MNHC for services totaling $868,910 during FY 1997-98). (3.9) PHP-HIV Prevention Services – Request for retroactive renewal contract with CAL-PEP in the amount of $268,533, for the provision of HIV prevention program services targeting behavioral risk populations and venue-based individual outreach services, for the period of January 1, 1999 through December 31, 1999. (DPH contracted with CAL-PEP for services totaling $243,138 during FY 1997-98). Action Taken: The Commission approved the Consent Calendar of the Budget Committee. 4) DIRECTOR'S REPORT (Mitchell H. Katz, M.D., Director of Health) (Provides information on activities and operations of the Department). ADMINISTRATION Federal Legislation Congresswoman Nancy Pelosi (D-CA) is co-sponsoring two bills which will directly impact the health and well being of San Francisco. For several years, San Francisco has attempted to meet the health and psychosocial needs of persons with HIV or AIDS. Congresswoman Pelosi will be introducing the Early Treatment for HIV Act. This bill would expand Medicaid coverage for asymptomatic, HIV-positive, low-income individuals, making it possible for these persons to receive drug treatment and primary care before they develop symptoms of AIDS. This Act would extend medical care to persons with HIV and reduce the number of uninsured persons with HIV through expanded Medicaid eligibility. In addition, the Congresswoman has introduced a bill to address California's inability to access the Vaccine for Children program under Healthy Families. The bill would amend Title XIX of the Social Security Act to clarify that those children who would have received free immunizations because they were on Medicaid or uninsured, can continue to do so now that they are enrolled in their state CHIP program. California is one of 23 States, which need this legislative amendment. This amendment is needed to ensure that children participating in Healthy Families are immunized on time and that there are no disincentives for providers to provide vaccinations. We would like to acknowledge Congresswoman Pelosi for her advocacy on behalf of health issues in San Francisco. California Healthy Families Program California's Healthy Families Program has been in existence for seven months. A total of 64,971 children have been enrolled into the program statewide. Current Statewide estimates are that 328,000 are eligible for the program – therefore, in the first seven months of the program, almost 20% of the eligible children have been enrolled. In San Francisco, 3,507 children have been enrolled into the program. The City and County of San Francisco ranks fourth in the State for Healthy Families enrollment. City Hall Open House The Mayor and the Neighborhood Alliance co-sponsored an all day Open House at City Hall February 6th. Each City department had a table with brochures describing services and staff on hand to answer questions for constituents. Although the rain kept the numbers in attendance low, the turnout was enthusiastic and positive. The Health Department had a huge volunteer turnout. In addition to brochures, DPH gave away key chains, balloons, magnets, condoms and 7 car seats to deserving members of the public. Many thanks to those who helped plan the successful event. POPULATION HEALTH AND PREVENTION TB Advisory Council Last November, Department of Public Health TB Controller, L. Masae Kawamura, M.D., was appointed to the Advisory Council for the Elimination of Tuberculosis by Donna E. Shalala, the U.S. Secretary of Health and Human Services. The Council meets quarterly in Atlanta, Georgia and makes recommendations to the Secretary of Health and Human Services and the Director of the Centers for Disease Control and Prevention (CDC). The Council considers policies, strategies, objectives and priorities addressing the development and application of new technologies. In addition, the Advisory Council reviews the progress that has been made toward eliminating tuberculosis. The Council consists of ten members, including the Chair, that are selected by the Secretary from among the nation's most knowledgeable and respected authorities. I am sure you join me in extending congratulations to Dr. Kawamura for this prestigious appointment. COMMUNITY HEALTH NETWORK Creativity in Psychiatric Education Award The San Francisco General Hospital Department of Psychiatry received the American College of Psychiatrists Award for Creativity in Psychiatric Education in the United States. The award recognizes SFGH's Ethnic/Minority Inpatient Programs that take into account the impact of culture and ethnicity on the way mentally ill patients' deal with distress. Congratulations to all those involved with the design and staffing of this excellent program. SFGH Appointments 2/99 YTD New Appointments 20 37 Reappointments 40 72 ----Delinquencies 0 0 ----Reappointment Denials 0 0 Resigned/Retired 9 19 Disciplinary Actions 0 0 Restriction/Limitations – Privileges 0 0 Changes in Privileges ----Additions 2 3 ----Voluntary Relinquishment 0 0 Current Statistics – as of 2/2/99 Active Staff 358 Affiliate Professionals 129 Courtesy Staff 607 Referring Staff 30 Total Members 1124 Applications in Process 60 Reappointment In Process 74 Reappointment Requested not Received 47 (Due through 4/99) 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR FEBRUARY 1999 On behalf of the Commission, President Monfredini presented the February Department of Public Health Employee Awards to the following employees: Biasbas, Esperanza, PH & P/Fiscal Rivard, Thomas, PH & P/Comm. Health and Safety Services, Bureau of Environmental Health Rosello, Benedicta, PH & P/Comm Health and Safety Services/STD Team #1 - PH & P/Community Health and Safety Services, Bureau of Environmental Health Ambrose, Jim Awwad, Mamdouh Cone, Sue Cushing, Stephanie Fosdahl, Patrick Golden, Gayle Halbach, Ed Jin, Pam Junior, Delores Lee, Albert Leong, Liz Lum, Les McCaulou, Cherie Morris, Caitlin Padilla, Sylvia St. Jean, Virginia Stewart, Paula Tang, Jin Tong, Edmond Cynthia Woo Team #2 - PH & P and Community Health Network Batres, Ilma Carrillo, Ernestina Castiglione, Phil Frattaroli, Lynda Gillen, Janet Gonzales, Gloria Hagan, Tom Hartfield, Marcus Hines, Alexander Kaplan, Gay LaRock, Bill Mitchell, Penney O'Brien, Kathy Patchell, Tony Peck, Julie Pena, Marian Sampera, Ana Shafae, Bette Trabing, Mily White, Ricka 6) PRESENTATION OF THE CHILDREN'S SERVICE PLAN FOR 1999-00 FROM THE MAYOR'S OFFICE OF CHILDREN, YOUTH AND THEIR FAMILIES This item was continued to the March 2, 1999 agenda. 7) CONSIDERATION OF A RESOLUTION APPROVING THE DEPARTMENT OF PUBLIC HEALTH'S SUBMISSION OF A BASELINE BUDGET FOR FY 1999-00 Dr. Mitch Katz presented supplemental information on proposals to reduce pharmacy expenditures at San Francisco General Hospital and more information on patient census. President Monfredini reiterated that the Health Commission will take responsibility as a governing body to make policies affecting the public health of the City. Commissioner Hill expressed his concern from a realistic and practical point of view that public health funds are limited. He has researched at the Federal, State and local levels to find there is no money to bail out San Francisco. He sees the Health Commission as a policy-making body with the Department staff implementing these policies. He believes that SFGH cannot be maintained with the present open-door policy. The present situation at SFGH is making it an unsafe place for patients and employees. As a member of the governing body, he is committed to stand behind the Department staff. It is his opinion that all outpatient pharmacy should immediately be stopped. Public Speakers: Opposed recommendations for pharmacy cuts: Sang-Ick Chang, M.D., CHN Pharmacy Council Daz Lamparas, Local 790 Brett Nair, Local 250 Opposed 4P Closure: Paul Lee, Detox Discharge Planner Supported Welfare Workers: Cindy Wiesmer, POWER Larry Lattimore Supported more funds for DPH budget: Ed Kinchley, SFGH Doris Mitchell, Local 250 Dale Butler, Local 790 Tim Otto, RN, SFGH Kent Woo, NICOS Jennifer Freidenbach, increase in med detox beds Joe Wilson, Coleman Advocates Letters submitted to the Commission regarding the budget: Neil Gendel, Healthy Children Organizing Project Beverly Rashidd, African American Health Initiatives Planning Committee Commissioner Chow asked for clarification from the Deputy City Attorney regarding the San Francisco Welfare and Institution Code Section 17000 obligation to provide medical services to indigent residents of the County. Presently, the Department has an open-door policy to meet the present demands. Jean Fraser, Deputy City Attorney, stated that Section 17000 only applies to non-sponsored patients. The County is not obligated to give services to Medi-Cal patients. Commissioner Chow also expressed concern for the proposed pharmacy co-pay policy. The Commission continued this item after the 5:00 p.m. time specific agenda item. 7A) CONSIDERATION OF A PROPOSED RESOLUTION REGARDING POLICIES PERTAINING TO PHARMACY SERVICES Action Taken: The Commission adopted Resolution #5-99, "Approving Changes in Outpatient Pharmacy Services at San Francisco General Hospital," which was amended by Commissioner Chow. Commissioners Hill and Parker voted no. 8) 5:00 P.M. TIME SPECIFIC: CONSIDERATION OF A RESOLUTION DETERMINING WHETHER THE CALIFORNIA PACIFIC MEDICAL CENTER CONSOLIDATIONS WILL OR WILL NOT HAVE A DETRIMENTAL IMPACT ON THE HEALTH SERVICE OF THE COMMUNITY Dr. Martin Brotman, Chief Executive Officer of California Pacific Medical Center (CPMC), reviewed the proposed consolidation and presented more information requested by the Commission regarding licensed and actual beds. Commissioner Parker asked Dr. Katz whether the proposed changes would have a negative impact on the Department. Dr. Katz replied due to the major shortage of skilled nursing beds in the City, the proposed decrease in skilled nursing beds at CPMC would have a negative impact on the Department. Commissioner Hill reminded CPMC of its obligation to provide charity care. Dr. Brotman indicated CPMC can commit to provide charity care. Commissioner Chow noted that there is a decrease in the total number of skilled nursing beds. Commissioner Guy stated that she is not convinced that the shortage of nurses is the reason for the lack of ability to maintain the skilled nursing beds. She also requested information on CPMC's charity care and the community benefits programs. Additionally, she would like CPMC to collaborate more with the Department. Commissioner Sanchez stated that he sees redefined leadership addressing these issues. Public Speakers: Advocated that proposed consolidations are detrimental John Borsos, Local 250 Denis Tryon, CPMC Eric Hall, California Nurses Association Pat Hendricks, Local 250 Dale Butler, Local 790 President Monfredini requested factual information about charity care provided by CPMC. She also encouraged dialogue between CPMC and the Department about diversion. Commissioner Chow, Hill and Guy expressed that the decrease in skilled nursing beds is detrimental. President Monfredini stated she does not see CPMC's consolidations to be detrimental. Action Taken: The Commission (Chow, Guy, Hill, Parker, Sanchez, Umekubo) adopted Resolution #6-99, "Determining Whether the Clinical Consolidations at the Davies and California Campuses of California Pacific Medical Center, Will or Will Not Have a Detrimental Impact on Health Care Service of the Community". President Monfredini voted no. President Monfredini encouraged a meeting with CPMC and the Department regarding the skilled nursing beds. The Commission took a 5-minute recess at 6:23 p.m. and resumed the meeting at 6:28 p.m. The Commission continued its discussion of item #7. Commissioner Parker feels that the Department is the safety net for the residents of San Francisco. There are unlimited needs and limited funds; so he posed the question of how large the safety net should be. With more services and more needed funds, more taxes would be an option. He believes there should be short term and long range plans in place. Commissioner Guy encouraged the dialogue to continue and more data to be forthcoming. There is a need to build a consensus on institutional care and public health in a modern environment. She believes the outpatient pharmacy should close, with a focus on the needs of the MIA's. She also encouraged a continuous monitoring report on the closing of 4P. She supported a census level of 310 beds, with the staff being able to say no at certain levels at SFGH. Commissioner Sanchez thanked the public for the testimony. He expressed support for the Department's recommendations. Additionally, he stated that the safety net should be non-negotiable. Commissioner Umekubo expressed concern for the clinical impact on patient care. There should be on-going monitoring of the results from these decisions. He supported the Department's recommendations and suggested to see what the private sector can do to decrease the impact on SFGH. Commissioner Hill again expressed the Department cannot continue spending money it does not have. There has to be a clear policy direction about SFGH. Commissioner Guy would like to have an honest and frank dialogue in order to turn this situation around. Action Taken: The Commission adopted Resolution #4-99, "Approving the Department of Public Health's Submission of a Baseline Budget for Fiscal Year 1999-00" with an amendment being added. 9) OTHER BUSINESS/PUBLIC COMMENTS None. The meeting was adjourned at 7:05 p.m. Sandy Ouye Mori, Executive Secretary to the Health Commission