|
| General Fund Change for FY 00-01 | |
| Medi-Cal | +$460.1 million |
| Public Health | +$120 million |
| Managed Risk Medical Insurance Board | +$58.7 million |
| Mental Health | +$65.9 million |
| Alcohol and Drug Programs | +$3.1 million |
| Prevention and Treatment Initiatives | +$90 million |
| Total | +$ million |
Because the detail of the Governor’s May Revisions are not yet available reconciliation between the programmatic highlights and the fiscal summaries is difficult. Following summarizes the major additional proposals included for FY 2000-01.
The May Revision adopts components of several active legislative proposals. If these provisions of the Governor’s proposal are adopted, it is likely that the specific bills that address these changes will stop moving through the legislative process. It is important to note that these proposals do not necessarily comprise the budget that will ultimately be enacted. The Legislature works on budget issues on a parallel track with the Administration. In late May and early June, the Administration and the Legislature will meet to negotiate and finalize the State budget for FY 2000-01. The Department will continue to keep abreast of budget issues that affect San Francisco.
Charity Care Hearing
Last week the Board of Supervisors held a hearing on charity care provided by private non-profit hospitals in San Francisco. At the hearing labor leaders and community groups criticized the City’s private non-profit hospitals for not providing enough care for the poor and indigents. Representatives of the hospitals defended their level of care and provided evidence of their involvement in community benefits.
Non-profit hospitals receive tax exemptions from real estate taxes. In return they are ethically required to provide a non-specified public benefit. The appropriate level of public benefit has never been specified. There has also been quite a lot of debate about what should be considered "community benefits". At one extreme everyone would agree that providing medical care for indigents is charity care. At the other extreme some question whether benefits such as blood pressure screening at shopping malls should be considered community benefits because they also serve to provide useful marketing for hospitals.
The Health Department was asked to provide technical support on the appropriate definitions of charity care and to provide recommendations to the Board of Supervisors on this area. In addition, there is a statewide task force looking at uncompensated charity care. Ken Jensen and Tony Wagner from our CHN sit on this Task Force.
Strategic Planning Update
Since my last update to the Health Commission regarding the Department’s strategic planning initiative several activities have taken place.
The Populations and Programs Subcommittee has developed draft priorities for the programs the Department should provide, based on its previous recommendations for populations the Department should serve. The Subcommittee anticipates presenting its recommendations to the Steering Committee on June 14, 2000. In addition, the Subcommittee has drafted another component of its work plan on how to evaluate the effectiveness of the strategic planning initiative. Both the program priorities and evaluation will be presented to the Steering Committee for approval. Plan implementation guidelines have been developed by the Steering Committee and are being routed to the Subcommittees for review and comment.
The second installments of the monthly community and staff strategic planning informational flyers are being prepared for distribution throughout the City and Department respectively. The Health Commission will receive copies. Over the past month, the Steering Committee co-chairs have presented the Department’s strategic planning initiative to three community advisory boards (Tom Waddell Clinic, Long Term Care Pilot Project, HIV Prevention Planning Council). In addition, strategic planning presentations were given to the Department’s contractors and SFGH medical service chiefs. A town hall meeting for SFGH staff will be held tomorrow, Wednesday, May 17, 2000 at the Carr Auditorium from 1:30 – 3:00 p.m. Additional meetings with community advisory boards are set for the next two weeks and community town halls in four additional supervisorial districts are being planned for June 2000.
POPULATION HEALTH AND PREVENTION
Community Health Promotion and Prevention
The Community Health Promotion & Prevention Branch has been awarded a two-year grant of $93,755 from the California Telehealth and Telemedicine Center. This grant will address the digital divide by developing telehealth capacity for African Americans in San Francisco. The project will result in an Internet presence for African American community groups, who will collaborate with DPH in developing and maintaining their own health-related Web pages. Congratulations to Brian Katcher, who wrote the grant and will be overseeing its implementation
HIV Health Services
Laura Thomas, Planner for the HIV Health Services Section will be receiving an AIDS Hero Award for her longtime and courageous service to the HIV/AIDS community at the AIDS Candlelight Memorial on Wednesday, May 17, 2000.
STD Prevention and Control
STD education and urine screening was offered at the CATS nightclub on several weekends during April and early May, starting April 16th. Youth and young adults, one of the highest risk groups for STDs, frequent the nightclub. The event was written up in the SF Examiner/Chronicle, was featured on all major TV stations, is one of this week’s feature stories in Newsweek magazine and is highlighted on WebMD.
COMMUNITY HEALTH NETWORK
Status of Psychiatric Beds at SFGH
As the Commission is aware, the budget that the Department submitted to you in February 2000 included a plan to move patients who were no longer acutely in need of psychiatric hospitalization to more appropriate levels of care. SFGH psychiatric ward had a large number of such patients because of a number of factors including a shortage of viable alternative placements. In the budget we created a set of alternatives including supportive housing, placements in IMDs, board and care placements, and a specialized unit at Laguna Honda Hospital.
Although there has been tremendous enthusiasm for the creation of appropriate alternatives for people who no longer need acute hospitalization, there has also been dismay about the loss of psychiatric beds at SFGH. Last week the Mayor convened representatives from the psychiatric ward at SFGH, Supervisors Ammiano, Becerril, Kaufman, Newsom and Yaki as well as the Controller, Monique Zmuda and myself.
At the meeting the Mayor expressed his conviction that people should be cared for at the most appropriate setting. To prevent the ward from closing, however, he recommended that we hospitalize at SFGH Medi-Cal and Medicare patients who would have once been transferred to one of the private non-profit hospitals because of insufficient space at SFGH. He further agreed to pay the difference between what the other non-profit hospitals charge us and what it would cost us to care for these patients at SFGH.
At this point the plan is to fill the 21 beds with paying patients. Although we are still finalizing the numbers, we estimate that $1.8 million in revenue will be generated by the Department of Psychiatry, $400,000 of funding for private hospitals will be transferred from Mental Health to SFGH, and a new general fund allocation of $800,000 will be made to pay for the additional cost to provide inpatient services at SFGH. This assumes that the hospital is able to maintain the improved acuity rate (decreased administrative days and decreased decertified days) they have been doing in recent months. If the ward is not able to maintain the improved acuity rate, and if the number of decertified and administrative days climbs again, $800,000 will not be enough to maintain the ward and we would have to again look toward closing it and once again sending these patients back to private non-profit hospitals.
The Mayor’s Office and the Controller’s Office have informed us that half of the money will be kept on reserve. And the Department of Psychiatry will be required to report on its ability to meet the performance goals. The Psychiatry Department will be asked to go before the Finance Committee to release these dollars.
San Francisco Stunned by Tragedy
The entire City of San Francisco was shocked and saddened by the tragic murder of Ella Wong. Ella had been the LHH Administrative Secretary since March 1999. Ella was well liked and well respected by fellow staff members. LHH held a memorial service for Ella, attended by Health Commissioners Roma Guy and Lee Ann Monfredini. Contributions can be made in Ella's memory to the American Diabetes Association. I am sure you join me in wishing our sincere condolences to Ella’s family on their tragic loss.
Laguna Honda Hospital Pharmacy Services
The Clinical pharmacy services and the geriatric pharmacy teaching program at Laguna Honda Hospital were featured in a recent edition of UCSF Magazine. Subtitled, "What is Aging?" the March 2000 edition of the magazine focuses on research and health related issues of aging. The article on pharmaceutical services at Laguna Honda Hospital spoke to the medical complexity of patients cared for within the CHN, and the commitment of CHN staff to improve our patients' quality of life.
Maxine Hall Health Center's Appreciation Day.
Maxine Hall Health Center recently held its 5th Annual Staff Appreciation Day. The event sponsored by the Centers management team, combines general staff appreciation, with Nurses and Secretaries Week. The management team prepares and serves food to the entire staff. Following the brunch, a staff initiated auction was held to raise funds for the teen clinic. The event, which included a white elephant auction, raffle, donation of personal services (gardening, baked goods, foot massage, quilting, etc.) raised over $1,000. Special thanks to Dody Domish, Dr. Nina Weiss, Sue Thornley and Monique El Amin for a superb job in organizing the fundraising event.
2000 San Francisco Lesbian, Gay, Bisexual, Transgender Pride Parade
Bring your family and friends and march with the DPH contingent at the San Francisco Pride Parade celebration on Sunday, June 25th at 10:30 a.m. Share the experience of hearing people cheer and seeing their smiles when our contingent proudly walks down Market Street! Contact Arla Escontrias, at 206-2332 for more details, pager (650) 997-4264, email arla_escontrias@chnsf.org
SFGH Credentials Report 5/00
2000 YTD
New Appointments 19
80
Reinstatements 0
4
Reappointments 33
162
Delinquencies 0
0
Reappointment Denials 0
0
Resigned/Retired 14
68
Disciplinary Actions 0
0
Restriction/Limitations – Privileges 0
0
Changes in Privileges Additions 0
2
Voluntary Relinquishment 0
0
A special Certificate of Appreciation from George Smith, Mayor’s Office Homeless Coordinator, was presented to Willie Crawford, Facilities Manager for 101 Grove. Mr. Crawford was not only instrumental in assisting the Mayor’s Office to conduct a training session for census takers for the homeless population, but also he had been extremely helpful in setting up the temporary Mission Rock Shelter for the homeless.
Commissioner Chow pointed out that Dr. Katz’s description and explanation on the issue of the 21 SFGH patient psychiatry beds is very accurate in comparison to the newspaper coverage. Commissioner Chow requested, upon completion of the City budget process, an update on the cultural competency capacity in relation to the 21 psychiatry beds.
Commissioner Chow inquired whether a document on charity care was available from the private sector hospitals, (i.e., Hospital Council). He suggested, at the appropriate time, an agenda item on charity case be calendared for a Commission meeting.
Commissioner Umekubo commented that the public and private hospitals need to discuss and collaborate on the issues and definitions around charity care.
Dr. Katz stated the Department will be providing any technical information on charity care, both to the Commission and the Board of Supervisors.
President Guy reinforced the Commission’s support for the appropriate level of care for patients coming into SFGH and the CHN system.
5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE AWARDS FOR MAY
On behalf of the Commission, President Guy presented the May Department of Public Health Employee Awards to the following:
| Individual Nominee | Division | Nominated by |
| Susan Langdon | San Francisco City Clinic, STD Prevention and Control, Population Health and Prevention | Wendy Wolf, Deputy Director, STD Prevention and Control |
| Nora Macias | " " " " " " | |
| Team Nominees | Division | Nominated by |
| Paul Carlisle, MPT, GCS | Rehabilitation Center, Laguna Honda Hospital | Patrick Monette-Shaw, Secretary II, Rehabilitation Center, Laguna Honda Hospital |
| Marilyn Brandt, MS, OTR | " " | " " |
| Pamela Horenstein, MS, CCC, SLP | " " | " " |
| Lisa U. Pascual, MD | " " | " " |
Commissioner Hill left at 3:45 p.m.
6) UPDATE ON THE BRIDGE COMMITTEE, WHICH WAS CREATED TO RESPOND TO THE IDENTIFIED NEEDS OF PATIENTS IN THE DEPARTMENT OF PUBLIC HEALTH NETWORK OF CARE, WHOSE MEDICAL AND PSYCHOSOCIAL NEEDS COULD BE BETTER MET IF A DIFFERENT ARRAY OF ALTERNATIVES TO INSTITUTIONALIZED SETTINGS WERE AVAILABLE
Jimmy Loyce, Deputy Director of Health, and Dr. Melissa Welch, Chief Medical Officer of the CHN, presented the work of the Bridge Committee, which formed as a result of a recommendation from the Reducing Reliance on Institutions meeting in January 1999. The Bridge Committee, chaired by Dr. Welch, brought together staff within the CHN working with the most medically and psychiatrically complex patients. A copy of the full report is available in the Commission Office.
The Bridge Committee’s first year report included the following:
- Resource Sub-Committee
- Placement Sub-Committee
- Other Focused Work
- Laguna Honda Screening Process and Special Units
- Mental Health Rehabilitation Facility
- Conservatorship task Force
- Site Visits
- Medical Hills
- Napa State Hospital
- New Models of Care
Policy Issues
Recommendations
Attachments to the report included:
- Group identified as difficult to place
- Criteria for referrals to Bridge Committee
- Persons designated to make referrals to Bridge Committee
Dr. Welch and Mr. Loyce would like the Bridge Committee to continue resolving the ongoing and critical issues of the most difficult to manage patients. The Committee will look at issues of non-bed resources, intra-agency collaborations, cost benefit analysis of new models of care and ongoing special housing needs.
Commissioners’ Comments:
Dr. Welch pointed out the high utilizers of SFGH inpatient services and the Bridge Committee patients are two different populations.
Dr. Katz commended the Bridge Committee for its work and emphasized this is another step towards integration and intra-department problem-solving, with the goal of doing better for the patients.
President Guy thanked the staff for an excellent presentation. She pointed out the work of the Bridge Committee reflects the Commission’s direction for the Department to act as one Department, and to be patient-driven. She expressed her sincere appreciation for all of the contributions by the members of the Bridge Committee. She is deeply encouraged by their work.
7) TIME SPECIFIC AT 4:30 P.M.
PRESENTATION OF THE RESEARCH STUDY ON HIGH UTILIZERS OF THE SAN FRANCISCO GENERAL HOSPITAL
INPATIENT MEDICAL SERVICES
Gene O’Connell, Executive Administrator for SFGH, introduced Dr. Talmadge King, Chief of Service, and Dr. Alicia Fernandez, Director of Inpatient Medical Services, who conducted research on high utilizers of SFGH Medical Inpatient Services. Their findings reinforce the previous policy direction set by the Commission to focus on supportive housing and community alternatives to hospitalization.
A copy of the slide presentation is available in the Commission Office.
Dr. Fernandez highlighted the following areas:
Summary
Implications
Specific Objectives
Future Directions
Dr. Fernandez invited Commissioners to attend the following a one-day conference:
Title: Creating a Coordinated System of Care for High Utilizers of the SFGH In-Patient Medical Service
Date: Monday, June 26th, 8:30 a.m. to 4:30 p.m., Laurel Heights Conference Room
Sponsors:
Co-Sponsors:
Participants: Staff from acute clinical services, outpatient’s services, psychiatric services, social services, housing, etc.
Note: Commissioner Monfredini left at 5:15 p.m.
Commissioners’ Comments and Questions:
Dr. Fernandez pointed out that the data show primary care alone is not enough; there are psychosocial needs that also have to be addressed:
President Guy thanked Dr. Fernandez and Dr. King for the informative presentation and encouraged them to move forward with their research.
8) OTHER BUSINESS/PUBLIC COMMENTS
None.
The meeting was adjourned at 6:05 p.m.
Sandy Ouye Mori, Executive Secretary to the Health Commission