Minutes of the Health Commission Meeting Tuesday, November 16, 1999 3:00 p.m. City Hall Board of Supervisors Chamber (Room #250) 1 Dr. Carlton B. Goodlett Place 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 3:00 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 THE REGULAR MEETING OF NOVEMBER 2, 1999 Action Taken: The Commission unanimously adopted the minutes of November 2, 1999. 3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner Ron Hill) (3.1) DPH-Administration – Request for approval to accept a gift of a bus for Laguna Honda Hospital from Laguna Honda Hospital Volunteers, Inc., valued at $125,106. Commissioner Hill acknowledged the generosity of the LHH Volunteers, including their $250,000 contribution towards the passage of Proposition A, the Laguna Honda Hospital Replacement Bond. Jean McClatchy-Bricker, President of the Laguna Honda Volunteers, was introduced. (3.2) PHP-CHS-Community Mental Health Services – Request for approval to enter retro-actively into an expanded cooperative program agreement with the Department of Rehabilitation, San Francisco District, including a required match of $181,355, to provide vocational services to mentally ill psychiatric clients, for the period of July 1, 1999 to June 30, 2000. (3.3) PHP-CHS-CMHS – Request for approval of retroactive contract renewal with Homeless Children’s Network (HCN), in the amount of $51,052, to provide early and periodic screening, diagnosis and treatment (EPSDT) program for homeless children, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with HCN for services totaling $24,995 during FY 1998-99). (3.4) PHP-CHS-CMHS – Request for approval of retroactive contract renewal with Mercy Psychiatric Services Corporation (MSC), in the amount of $498,066 per year for a total of $1,992,264, for the provision of day treatment mental health services targeting adolescents, for the period of July 1, 1999 through June 30, 2003. (DPH contracted with MSC for services totaling $982,180 during FY 1998-99). Commissioner Hill requested an update on the contractor’s cultural competency plan by reporting the update to the Joint Conference Committee on Population Health and Prevention. Commissioner Umekubo abstained on this item due to conflict of interest. (3.5) PHP-CHS-CMHS – Request for approval of retroactive contract renewal with Westside Community Mental Health Center, Inc. (WCMHC), in the amount of $1,557,269, to renew a Managed Care program serving severely mentally ill adult clients, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with MCMHC for services totaling $13,932,677 during FY 1998-99). (3.6) PHP-CHS-CMHS – Request for approval of retroactive contract renewal with the Regents of the University of California, Clinical Practice Group (UCSF/CPG), in the amount of $2,849,948, to renew a Managed Care program serving severely mentally ill adult clients, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with UCSF/CPG for services totaling $2,793,130 during FY 1998-99). Commissioner Sanchez abstained on this item due to conflict of interest. (3.7) PHP-CHS-CMHS/CSAS – Request for approval of retroactive contract renewal with Baker Places, Inc., for a total of $8,048,976, to provide residential, rehabilitation, intensive day treatment and detoxification services, for the period of July 1, 1999 through June 30, 2000. (DPH contracted with Baker for services totaling $13,650,662 during FY 1998-99). In response to Commissioner Hill’s inquiry on the agency’s master contract, Executive Director Jonathan Vernick stated his hope that the consolidation of contracts would also lead to the integration of requested information and integration of the monitoring process. (3.8) PHP-CHS-CSAS – Request for approval of retroactive contract renewal with Haight Ashbury Free Clinics, Inc. (HAFC), in the amount of $4,656,016 per year, to provide substance abuse services consisting of residential, outpatient, day treatment, prevention, outreach and administration, targeting substance abusers or those at risk for substance abuse -- including services specific to women, African-American families, Asians/Pacific Islanders, people with HIV or at-risk of HIV infection, homeless persons and parolees—for the period of July 1, 1999 through June 30, 2000. Darryl Inaba, Interim Executive Director; and Willard Harris, President of the Board, thanked the Commission and Department for their support in providing technical assistance on the agency’s financial difficulties. A corrective plan has been put in place. Commissioner Hill, acknowledging the long relationship between the Department and the agency, requested a progress report be given to the Budget Committee in 90 days (February 15, 2000). (3.9) PHP-CH&S-Seroepidemiology and Surveillance – Request for approval to accept and expend a grant in the amount of $800,000 from the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, to conduct an evaluation of the HIV and STD Prevention program decision-making processes with a sole source subcontract with the Regents of the University of California, San Francisco, Center for AIDS Prevention Studies, for $37,588, for the period of September 30, 1999 through September 29, 2003. Commissioner Umekubo requested a copy of the evaluation report. (3.10) PHP-CH&S-Seroepidemiology and Surveillance – Request for approval to accept and expend a grant in the amount of $359,813 from the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, to study the characteristics of the HIV epidemic in the San Francisco area for the period of September 30, 1999 through September 29, 2002. (3.11) PHP-HIV Prevention – Request for approval of contract term extensions with the following contractors for AIDS prevention services for the period of January 1, 2000 through March 31, 2000: Aguilas, Inc.; 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; Kaiser Foundation Research Institute; Mission Neighborhood Health Center; Polaris Research and Development, Inc.; Stop AIDS Project; The Support Center; Tenderloin AIDS Resource Center; UCSF-Office of Research Affairs; UCSF-AIDS Health Project; and UCSF-Urban Health Study. Commissioner Sanchez abstained on the UCSF contracts due to conflict of interest. Commissioner Chow commented on the long history and valuable partnership with Haight Ashbury Free Clinics, Inc. He encouraged the Department to provide technical assistance in the finance area. Commissioner Parker pointed out an error in the total program costs for #3.2. He also requested clarification on staffing and clients served in #.3.3. Action Taken: The Commission unanimously 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). COMMUNITY HEALTH NETWORK Public Mandate and Proposition A Victory We are pleased with the stunning Proposition A - Laguna Honda bond victory November 2nd. An overwhelming 73% of the electorate supported the initiative. The Department of Public Works has drafted a Request for Qualifications for selection of a design team. That document is under review by the City Leadership Team (Tony Irons, Louise Renne, Tony Wagner, Larry Funk and myself) and should be finalized and advertised within the next few weeks. We anticipate that the selection of the design team will be completed within two to three months and award of a contract to be approximately one month later. Tony Irons, the City Architect, is the point person on the Laguna Honda Replacement Project. Monique Moyer, the City's Public Finance Officer, will develop a schedule for sale of bonds to coincide with the cash flow needs of the project. I want to extend my heartfelt thanks to all of the Commissioners for your leadership and support. State Licensing & Certification Resurvey of LHH A team of seven State Licensing & Certification staff conducted a resurvey of Laguna Honda from October 26th through November 3rd to monitor compliance with its approved Plan of Correction submitted in September. The survey team provided a brief exit conference November 3rd and presented preliminary findings subject to Licensing & Certification supervisorial review and HCFA approval. The preliminary findings showed that most of the items contained in the Plan of Correction had been satisfactorily completed. However, in some program areas, additional deficiencies were reportedly observed. The State survey staff reported that pursuant to consultation with their Regional Office and HCFA, they would transmit the survey report to the Hospital in approximately ten days. The Hospital staff has begun addressing the deficiencies identified by the survey team and will respond to the State report when it is received. POPULATION HEALTH AND PREVENTION STD Urine Screening Program In September a urine-screening program for gonorrhea and chlamydia was implemented at the Emergency Department of SFGH for anyone between the ages of 15-25 who had a urine specimen taken for other clinical purposes. To date, 57 clients have been tested and five were positive, for a positivity rate of 8.8%. Clients with positive tests are followed up by Disease Control Investigators and referred to City Clinic for treatment, as needed. City-Wide Influenza Coordinating Committee (CWIC) This year, the Communicable Disease Prevention Unit has launched a collaborative effort between private, public, and community-based organizations to coordinate citywide efforts aimed at influenza prevention. This new effort compliments our traditional influenza program, which has used vaccine from the state to target San Franciscans at high risk for the complications of influenza. CWIC has received considerable interest and support from the community; we look forward to expanding the citywide network in years to come. For more information, please contact Shelley Arnold, Influenza Program Coordinator at 554-2852. SFGH Credentials Report 11/99 YTD New Appointments 38 171     Reinstatements 1 Reappointments 37 364     Delinquencies 0 0 Reappointment Denials 0 0 Resigned/Retired 16 181 Disciplinary Actions 0 0 Restriction/Limitations – Privileges 0 0 Changes in Privileges     Additions 1 27     Voluntary Relinquishment 0 6 President Monfredini acknowledged her fellow Commissioners, Dr. Katz, his staff, and the Laguna Honda Hospital Volunteers for their hard work and support for Prop A, the Laguna Honda Bond Initiative. Commissioner Chow thanked the voters for their overwhelming mandate for the Laguna Honda Hospital Bond. Commissioner Guy expressed her appreciation to the Laguna Honda Hospital Volunteers for their leadership, compassion and generous contribution towards Prop A. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR NOVEMBER 1999 On behalf of the Commission, President Monfredini presented the November Employee Awards to: Individual - Division - Nominated by: Denise Jones, Ph.D., Program Director Community Health Services, Mental  Health/ Children, Youth Family Section, Foster Care Mental Health Program - Sai-Ling Chan-Sew, Director Patricia Johnson, Central Administration, Office of  Contracts Management - Galen Leung,Director Brian Katcher, Pharm.D., PH&P, Community Health Promotion and Prevention Branch - Larry Meredith, Ph.D Maryanne Mock, LCSW Program Director, Southeast Children and Family Therapy, Center, Children Youth & Family Section, Community Mental Health Services - Sai-Ling Chan-Sew, Director 6) TIME SPECIFIC: 3:30 P.M. – PROP Q HEARING ON UCSF/MT. ZION MEDICAL CENTER President Monfredini outlined the format for this Proposition Q hearing and announced the Commission will hear testimony till at least 6:30 p.m. This hearing was televised on Citywatch, Channel 54. Written comments can be sent to Sandy Mori, Executive Secretary to the Commission. At the December 7, 1999 Commission meeting, the Commission will determine whether the closure of UCSF/Mt. Zion will or will not be detrimental to the health service of the community. Dr. Lee Goldman, representative for UCSF/Mt. Zion, gave a report on the future of UCSF/Mt. Zion Hospital, with assumptions, key points, a consensus plan, and the changes based on financial and space issues. For a copy of the report, contact the Commission Office (554-2666). Dr. Brian Goodell, representative for UCSF/Stanford Health Care, gave an overview of the UCSF/Mt. Zion restructuring, with the background of the decision, what will stay at Mt. Zion service changes and transition plan, and the effects of the changes and mitigation. For a copy of the report, contact the Commission Office (554-2666). Dr. John Brown, EMS Medical Director, submitted an impact analysis for the intended closure of UCSF/Mt. Zion Emergency Department. For a copy of the analysis, contact the Commission Office (554-2666). This impact evaluation assesses the effect a proposed hospital Emergency Department closure or downgrade has upon community access to emergency care according to guidelines found in local policy EMS Agency Policy. In June of this year, the EMS Section released Policy #8001, The Emergency Department Downgrade of Closure Impact Evaluation Policy. The EMS Section developed this policy using the State Emergency Medical Services Authority’s Impact Evaluation Policy Guidelines and input from a public comment process. This report offers an assessment of the impact of the closure of the Mt. Zion Emergency Department on the Emergency Medical Services System in San Francisco. Briefly summarized, there are three potential major untoward effects: Hospital diversion rates will increase this winter Emergency medical response capability during a major disaster will be decreased Patients will continue to go to the Mt. Zion Hospital with emergent medical conditions These events would be detrimental the community’s health and well being. Dr. Katz, representative for Mayor Brown’s views, reported that the Mayor strongly supports Mt. Zion and expresses his concern on losing another Emergency Room. This loss of capacity would compromise health care in the City and County of San Francisco. Mayor Brown is in contact with State and Federal leaders regarding financial support for Mt. Zion. If there is no way of keeping Mt. Zion’s in-patient and Emergency Room open, he would ask UCSF/Stanford Healthcare to develop more emergency room slots at UCSF prior to closing any ER beds at Mt. Zion. Supervisor Sue Bierman, Chairperson of the Public Health and Environment Committee of the Board of Supervisors, encouraged the Commission to join the Board, Mayor, State and Federal legislators to keep Mt. Zion open. Tomas Lee, aide to Board President Tom Ammiano, gave a historical background of Mt. Zion and reported President Ammiano had introduced a resolution opposing the closure of Mt. Zion. President Ammiano is working with the Mayor, State and Federal legislators to find funding to save Mt. Zion. John Schweizer, Chief of Staff for State Senator Jackie Speier, and representing Senators Dianne Feinstein and Barbara Boxer, Congresswoman Nancy Pelosi, and Assemblyman Kevin Shelley, stated if the City commits funding to Mt. Zion, the State will be asked again for State funding for Mt. Zion. Sharon Johnson, Chief of Staff for State Senator John Burton, expressed support for Mt. Zion and opposes the closure. Commissioners’ questions and comments: What is the role of Adult Urgent Care? The loss of critical care beds and the loss of skilled nursing beds have a negative impact. Why is not the size and capacity of Mt. Zion being increased? Would UCSF reconsider configuration? San Franciscans have always risen to the task. This is an opportunity to relook at a community institution and work collaboratively with State and Federal legislators. Health institutions are under severe duress. What are the estimates for seismic costs for in-patient and ambulatory units? Closing another hospital would be detrimental to the health of the City. Commission will be able to ask more questions to the UCSF/Stanford Health Care representatives. Let Commission know the status of the physician contract. Public Speakers: Points raised by speakers: Increased diversion not solely due to closure of Mt. Zion Keep Mt. Zion open Need to address funding for health care Lack of affordability for health care December 7 is too late for a decision; need a commitment today Worst day to close ER is December 23 Need a healing and transition period Need for facilities to take care of more uninsured Request another audit of UCSF Negative impact on the Western Addition and Russian emigrees Full public disclosure after dissolution of UCSF/Stanford merger Treat health care similar to public safety issues Closure of Mt. Zion is criminal and a disgrace Overwhelming number of speakers opposed the closure Begin negotiations to create a public hospital owned by the people Merger was a ploy to get rid of Mt. Zion Patient care, not research, should be a priority List of public speakers: Dr. William Goodman, President, S.F. Medical Society Jackee Bryson Nathan Nayman, Hospital Council Laurel Hedgson, Mt. Zion Emergency Department Richard Hansen, Richmond Democratic Club Dr. Reuven Jaffe Julie Jones, Mt. Zion Emergency Department Shirley Hansen Michael Lyon, Emergency Coalition to Save Public Health Thomas J. Peitz, M.D., S.F. Emergency Physicians Association Fred Alvarez, Bayview Community Collaborative Fred Mayer, Pharmacists Planning Services, Inc. Charlotte Breckenridge, Bayview Community Collaborative Roman Abad, Mt. Zion food service worker Bill Chin, Mt. Zion cook Dorris M. Vincent, Bayview Hunters Point resident Greg Smith, Bay Area Council Lynn S. Carman, citizen and attorney Don Bechler, Health Care for All Lawrence Baker, UCSF Stanford Health Care, AFSCME Union Meredith Mendelsohn for Dr. Laura Esserman, UCSF Cancer Center Valentin Kheyfets Ella Zabova, Mercy Terrace Apartments Boris Moldansky, Russian Association of Veterans of WW II Libby Sayre for Karen MacLeod , UPTE-CWA 9119 Marie Malliett, Communications Workers of America, District 9, AFL/CIO Lisa Tate, UPTE Vicky Dayan, CNA Jacqui Gough, CNA Amy Casey, Nurses for Social Responsibility Cathy Imbelluro, R.N., UCSF Stanford Steve Kwan Edith McMillan Richard Ow, labor member Nora Roman, R.N., Committee for Health Rights in the Americas Thomas Shuster, R.N., UCSF Mt. Zion nurse Luisa M. Gomez, AFSCME Dr. Herb Goodman, UCSF/Mt. Zion Hospital Spike Kahn, AFSCME Union, Local 829 Deborah Campbell, community activist and CNA nurse Corey Menotti, AFSCME Union, Local 829 Mary Higgins, UCSF employee Allen White David Twedell, SEIU Local 250 Commissioners’ comments: Mitigating items remain on the hours for adult urgent care and cultural competency at the UCSF Campus Questions may still be submitted to the Executive Secretary for the UCSF/Mt. Zion representatives Support a facilitation process with legislators and rethink the reconfiguration plan Commission decision will not be legally binding UCSF mission includes research, teaching, public service, and patient care Timing of the Mt. Zion closure on December 23 would be a disaster; irresponsible not to discuss this now Dr. Katz and Health Commissioners to re-open dialogue 7) OTHER BUSINESS/PUBLIC COMMENTS None. The meeting was adjourned at 6:45 P.M. Sandy Ouye Mori, Executive Secretary to the Health Commission