Minutes of the Health Commission Meeting Tuesday, November 20, 2001 at 3:00 p.m. Gerald Simon Auditorium Laguna Honda Hospital 375 Laguna Honda Boulevard San Francisco, CA 94116 1) CALL TO ORDER The meeting was called to order by President Roma P. Guy, M.S.W., at 3:20 p.m. Present: President Roma P. Guy, M.S.W. Vice President Edward A. Chow, M.D. Commissioner Arthur M. Jackson Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner David Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. - arrived at 3:25 p.m. 2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF NOVEMBER 6, 2001 Action Taken: The Commission approved the minutes of the November 6, 2001 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner David J. Sanchez, Jr., Ph.D.) Commissioner Sanchez chaired, and Commissioner Jackson and Commissioner Monfredini attended, the Budget Committee meeting. (3.1) CHN-Quality Management - Request for approval of a contract modification with Steven Hirsch and Associates to provide additional JCAHO-related consulting services, in the amount of $31,100 for a total revised contract amount of $80,600, for the period of July 1, 2001 through June 30, 2002. (3.2) Community Health Programs - Request for approval of a retroactive sole source contract with Central City Hospitality House (CCHH), in the amount of $558,797, to provide drop-in and self-help services for the homeless, for the period of July 1, 2001 through June 30, 2002. Commissioners’ Comments Commissioner Jackson asked if an executive director has been hired for the agency. Ester Chavez, director of the Tenderloin Self Help Center, responded the one has been selected and will start on December 1st. (3.3) PHP-CHPP - Request for approval of a retroactive contract renewal with San Francisco Study Center in the amount of $504,729, to provide Health Environmental Resource Center support services in the Bayview Hunters Point area, for the period of July 1, 2001 through June 30, 2002. Commissioners’ Comments Commissioner Sanchez asked if alternate treatments are being used for asthma. Karen Pierce responded that there is a contract for acupuncture services that serves adults and children. The adult program is held at the Southeast Health Center. Ms. Pierce said the feedback has been incredible. Betty McGee, Program Director of HERC, responded that she has seen significant improvements, but no formal data has been collected. Formal research will be done later. (3.4) AIDS Office-Surveillance - Request for approval of a contract modification with University of California Berkeley Survey Research Center, in the amount of $80,000, bringing the contract total to $249,362, to provide services for the San Francisco Behavioral Risk Factor Survey targeting San Francisco residents, for the period of June 1, 2001 through December 31, 2001. (3.5) AIDS Office-Prevention - Request for approval of a new contract with Field Research Corporation, in the amount of $77,400, to provide telephone survey services, for the period of November 1, 2001 through December 31, 2001. Commissioners’ Comments Commissioner Monfredini asked what the expected outcomes of the two surveys are. Jimmy Loyce responded that the outcome will be to use the knowledge gained to stop the spread of AIDS. The data will be part of what is used to get federal dollars. Commissioner Jackson asked the difference between the survey that is being done by the U.C. Berkeley Survey Research Center (Item 3.4), and the survey being done by the Field Research Corporation (Item 3.5). Mr. Loyce responded that the first survey will be a random sample of San Franciscans to determine people’s general knowledge, attitude and behaviors with regard to HIV. The second is a public opinion poll to gauge public interest and support for HIV/AIDS prevention services. (3.6) PHP-Mental Health - Request for approval of a retroactive sole source contract renewal with California Mental Health Directors Association, in the amount of $100,000 per year, for a total four-year contract amount of $400,000, to provide management services for the San Francisco Mental Health Plan, for the period of July 1, 2001 through June 30, 2005. (3.7) PHP-Mental Health - Request for approval of a contract renewal with Westside Community Mental Health Center, Inc., in the amount of $1,650,364, to renew a Single Point of Responsibility program serving severely mentally ill adults, for the period of July 1, 2001 through June 30, 2002. (3.8) PHP-Mental Health - Request for approval of a retroactive sole source contract modification with Crestwood Behavioral Health, Inc., in the amount of $3,529,937 per year, for a total contract amount of $7,059,874, to provide skilled nursing facility services, for the period of July 1, 2001 through June 30, 2003. (3.9) PHP-Substance Abuse - Request for approval of a retroactive contract renewal with YMCA Urban Services, in the amount of $348,160, to provide outpatient and prevention substance abuse services, for the period of July 1, 2001 through June 30, 2002. Commissioners’ Comments Commissioner Jackson asked if the program focussed on the prevention of heroin use among youth. Mr. Stillwell stated this program is not specifically focussed on heroin, but has engaged the youth in their geographic and cultural contexts, which is necessary address the issues that cause drug use. (3.10)PHP - Mental Health/Substance Abuse - Request for approval of a retroactive contract renewal with Bayview Hunters Point Foundation for Community Improvement, Inc., in the amount of $7,805,900, to provide substance abuse and mental health services, for the period of July 1, 2001 through June 30, 2002. Maria X. Martinez, Community Programs, CHN, presented the contract with the Bayview Hunters Point Foundation. She stated that this contract was before the Commission in November and December of 2000, and summarized the work that has been accomplished since that time in the areas of organization development, wage and labor issues and compliance with the Sunshine Ordinance. Ms. Martinez then discussed the program review. She stated that the monitoring reports for fiscal year 1999-00 show an overall rating of acceptable/commendable for all but four programs. The Third Street Clinic and Bayview Clubhouse received ratings of Improvement Needed/Below Standards in Program Performance. The Thunderseed Program received a rating of Improvement Needed/Below Standards in Program Performance. And the Tenderloin Clinic received a rating of Improvement Needed in Program Compliance. Ms. Martinez stated that the Foundation has implemented corrective actions in all of these areas. Ms. Martinez stated that, in addition to the findings stated above, there are some qualitative issues with various programs. Ms. Martinez described these problems, as well as the objectives that have been established for the agency to rectify these problems in the areas of Recruitment and Retention, Strategic Planning, Communication and Board of Directors. Ms. Martinez stated that the Department recommends that that Budget Committee and the Health Commission approve the following recommendations for the Bayview Hunters Point Foundation contract: Renew the contract for one year, fiscal year 2001-2002,with the exception of the CIRT Program, which would be terminated effective February 28, 2002, thereby reducing the contract by $43,202. Convert CIRT program to civil service positions and integrate into CMHS in same model as Emergency Response to Fires Team. DPH review with the Foundation the allocation of senior level positions across programs to determine if there are ways to better leverage available resources. Prioritize the hiring of CMHS positions as follows: two 0.5 FTE psychiatrists at Tenderloin Clinic and Clubhouse. In the interim, fill vacant psychiatrist positions with temporary psychiatrists; fill all vacant clinical positions at Clubhouse/Socialization; and convert two Third Street psychologist positions that have been vacant for some time to social worker/counselor positions. Integrate agency objectives into FY 01-02 contract language. Formalize the centralized monitoring approach to working with the Foundation. Return to the Health Commission in six months for an update and review of status, with an update after four months through the Joint Conference Committee. Commissioners’ Comments Commissioner Sanchez asked the executive director to respond to the recommendations. Karen Patterson-Matthew, Executive Director of Bayview Hunters Point Foundation, said that the agency has been working with the Department over the last several months. She stated that the vacancy factor has been a challenge, but they have made some reclassifications that should help. Ms. Patterson-Matthew stated the following with regard to the Department’s recommendations. First, the CIRT program has never been adequately funded, and therefore has had difficulty responding to the needs in the community with so few resources. She said perhaps moving this into the department will give the program a greater opportunity to survive and succeed. She stated that the agency has tried to address the vacancy problems by reclassifying positions and increasing salaries. With regard to the recommendations for psychiatrist vacancies, the agency does have a formal agreement where they will be able to have psychiatrists assigned until the positions are filled. She stated that the agency has prioritized the recruitment efforts to fill the vacancies at the Tenderloin Clinic and Clubhouse. With regard to converting the psychiatrist positions, they have already been reclassified. She stated that the agency would certainly come back to the Commission with an update on their status. Commissioner Sanchez said that he was happy to see consensus on the recommendations, and thanked the staff for their diligent work with the agency. Commissioner Monfredini stated that she is concerned about the contract, and needs to hear that the executive director agrees with the Department’s recommendations. Ms. Patterson-Matthew responded that she agrees with the conditions, honors them and will respond to them. Commissioner Monfredini added that the Department has been diligent and committed to working with this agency, and she hopes that the Commission does not see these continuing problems again. Commissioner Jackson said that he is concerned about the Clubhouse day treatment program and the Tenderloin Clinic, and asked if progress was being made at both of these facilities. Ms. Patterson-Matthew feels they are making progress, and have worked with SEIU to reclassify positions so they pay higher salaries. Commissioner Jackson stated that he wants staff to keep a close eye on the hiring progress at the clinic and the day treatment program, and report back to the Committee with a status report every 30 days. At the full Commission meeting, Commissioner Guy asked the status of the negotiations with the union. Faye Rull from SEIU stated that significant progress has been made, and negotiations are nearing an end, but a few minor details have to be worked out. Ms. Patterson-Matthew stated that they have worked hard to make progress on the collective bargaining agreement. Public Comment Damon Hale, Director of Violence Prevention and Intervention Services for Bayview Hunters Point Foundation, spoke about the recommendation to remove the CIRT program from the contract. He said that the CIRT services are critical and, that while the recommendation is absolutely necessary, the Department should be required to have a plan on how they will improve this service. There should be prudence and caution when moving forward with this recommendation. Action Taken: The Commission approved the Consent Calendar of the Budget Committee, including the following recommendations for Item 3.10: Renew the contract for one year, fiscal year 2001-2002,with the exception of the CIRT Program, which would be terminated effective February 28, 2002, thereby reducing the contract by $43,202. Convert the CIRT program to civil service positions and integrate into CMHS in same model as Emergency Response to Fires Team. DPH review with the Foundation the allocation of senior level positions across programs to determine if there are ways to better leverage available resources. Prioritize the hiring of CMHS positions as follows: two 0.5 FTE psychiatrists at Tenderloin Clinic and Clubhouse (in the interim, fill vacant psychiatrist positions with temporary psychiatrists; all vacant clinical positions at Clubhouse/Socialization; and convert two Third Street psychologist positions that have been vacant for some time to social worker/counselor positions. Integrate agency objectives into fiscal year 2001-02 contract language. Formalize the centralized monitoring approach to working with the Foundation. Return to the Health Commission in six months for an update and review of status, with an update after four months through the Joint Conference Committee and a status report to the Budget Committee on the hiring progress every 30 days. Commissioner Jackson abstained from Item 3.7. At the start of the Health Commission meeting, President Guy commended Larry Funk and his staff for opening up their facility, and thanked members of the audience for attending the meeting. 4) DIRECTOR’S REPORT State Budget The Governor has frozen spending on more than $2 billion in the current year until the Legislature can be convened to consider final budget reductions to meet an estimated $4.5 billion shortfall in this fiscal year. Among the cuts proposed are $30 million for California's trauma centers, of which San Francisco General Hospital was scheduled to receive $970,000, and a delay of the implementation of parent coverage under Healthy Families until July 2003. The Legislature has been called to a special session in January that will run concurrently with the regular session and will meet exclusively to consider matters related to the current year budget. It is our understanding that the Mayor has contacted the Governor to support maintaining funding for California's trauma centers. The Department will continue to closely monitor these budget issues and work with the Mayor's office to minimize reductions in critical health services. Recent DPH Health Fair a Potential Model of Service Provision Housing and Urban Health led a collaboration of health department employees to conduct a health fair at two residential hotels. Staff from HUH, the AIDS Office and from TB Control and Prevention provided flu shots, HIV testing and counseling, STD screening and treatment, tuberculosis screening and urgent care medical services for the residents of the Le Nain and Pacific Bay Inn. The day was a great success with over fifty residents seeking out services and may be replicated as a model of service provision in the near future. HIV Medication Adherence Support Services Grant The University of California, San Francisco's Department of Medicine recently received funding for a five-year project to evaluate HIV medication adherence support services among HIV infected urban poor. The study will randomize a cohort of 400 HIV+ urban poor to directly observed therapy, the Health Dept.'s Action Point Adherence Project and to regular care. Funding for this project should be an opportunity to evaluate the effectiveness of Action Point and Directly Observed Therapy. Continued Increase in San Francisco Syphilis Cases Director of the STD Section, Dr. Klausner, presented information about the increase in syphilis in San Francisco at the 2001 Infectious Disease Society of America (IDSA) Meeting that was held in San Francisco the weekend of October 26th, 2001. One of the biggest concerns about the increase in syphilis cases in the City is that of the 1,130 partners reported during 2001, only 8% had enough locating information for a disease intervention specialist to begin an investigation and notify them of their exposure. The STD Section then held a meeting on October 30, 2001 with over 20 community leaders to educate them about the increase in syphilis in San Francisco and to get their ideas for interventions that would work and wouldn't work with MSMs in the City. The following print items highlight the syphilis issue: On October 25, 2001, a press release was issued focusing on the increase in early syphilis in San Francisco. The story was then featured in an article in the San Francisco Chronicle and a number of local talk and news shows. Large ads are being run twice a month in the Bay Area Reporter, the largest free weekly paper in the City with a predominantly gay readership to inform MSMs about the continued increase in syphilis. The first ad was a bar graph, which depicted the increase in cases from 1998 to 2001. An editorial note about the increase in syphilis in the City was included in the October Monthly STD Report which is distributed to over 800 providers in the City. The Note contained a recommendation to screen all sexually active gay and bisexual men twice each year for syphilis. Outreach to Reduce Unsafe Sexual Activities in San Francisco Sex Clubs The STD Section is continuing to work closely with the City's sex clubs, adult bookstores and selected bars/clubs to ensure that syphilis information is available, condoms are accessible and signage is posted notifying patrons that unsafe sexual activities will not be tolerated. In October, a member of the syphilis rapid response team attended a meeting of 25 bookstore managers in the City. Copies of a newly developed poster were handed out that graphically depicts a chancre on a penis. These posters will be hung in all of the bookstores along with newly developed signage setting out the "safer sex rules" for the establishment. Referral cards for the STD Program will be readily available to clients and increased numbers of condoms will be located throughout the bookstores, both in the lobby as well as the arcade. Trauma Plan Approval On November 5, 2001, the State of California Emergency Medical Services Authority completed their detailed review and approved the San Francisco 2001 Trauma Care System Plan. The EMS and Trauma System improvements outlined in the plan include: Developing measures to ensure adequate oversight of the trauma system; Redesignating SFGH as the trauma center; Establishing formal audit committees for trauma quality improvement; Improving pediatric trauma care; and Performing a needs assessment and feasibility analysis for air medical access. These changes will measurably improve the care of trauma victims throughout San Francisco. The EMS Section will keep you abreast of progress on this important program. Trauma Center Consultation Site Survey On November 15 and 16, the American College of Surgeons [ACS] conducted a consultative site survey to assess the SFGH Trauma Center. This survey evaluated the hospital’s current state of preparation for a Level I Trauma Center verification site survey and identified areas for improvement. The surveyors were provided with SFGH’s responses to a 165 item pre-survey questionnaire 6 weeks prior to this site visit. This survey covered all aspects of the continuum of trauma care at SFGH including: hospital administration and organization; physician trauma education and on-call scheduling practices; trauma performance improvement; nursing education and competency; disaster program; roles and responsibilities of the Trauma Director, Trauma Coordinator and Trauma Surgeons. The consultative visit ended with a session reviewing all findings and provided SFGH with an action plan of required adjustments to the Trauma Center’s program. The ACS recommended that SFGH schedule a Level 1 Trauma Center Verification and Designation site survey to occur in one year. Substance Abuse and Mental Health Services Administration (SAMHSA) Grant. Community Mental Health Services (CMHS), has been awarded a three-year SAMHSA grant for $1,200,000. The goals of the project are: To develop and implement transgender specific and sensitive mental health services in a primary health care setting in order to meet the needs of MTF transgenders with co-occurring multiple problems; To build service networks among a coalition of community collaborators, including health providers, consumers, and researchers, that can assure appropriate assessment, treatment, evaluation, information dissemination, and referral services for the targeted transgender community; and To provide transgender sensitive and culturally competent outreach in the targeted communities through expansion of existing community outreach efforts to MTF transgenders. SFGHMC Successfully Completes JCAHO Clinical Labs Survey I am proud to announce that San Francisco General Hospital Medical Center successfully passed their JCAHO Clinical Laboratory Survey with an impressive score of 98% and no Type I’s. From November 5 - 7, two surveyors visited and assessed the departments of clinical laboratories, pathology, nuclear medicine, and primary clinics which conduct point-of-care testing. Congratulations to Valerie Ng, MD, Chief of Clinical Laboratory Services and Mary Clancy, Director of Clinical Laboratories and their staff for all of their hard work and success! In addition, a special thanks to Robert Christmas, Chief Operating Officer-LHH for all of his assistance and expertise in preparing us for a successful survey. Emergency Response Combined Exercise On November 15, SFGH participated in the State wide disaster exercise by hosting a combined Fire - Police - HazMat - Hospital drill on the campus. Over 100 emergency response workers from Police, Fire, SFGH, OES and EMSA participated in this large scale training event. SFFD and SFPD committed mobile command vans and fire apparatus to the exercise. The focus of the 4 hour training and drill was on inter-agency cooperation and coordination in response to a hazardous materials and incendiary device response. Additional participants included the City of San Francisco’s Metropolitan Medical Response Team, Public Information Officers from Fire, Police and SFGH and the Office of Emergency Services. An hour long debriefing was held in Carr Auditorium following the event to identify lessons learned and an action plan for future responses. Recommendations for improvement include: improved radio communications, implementation of unified command, location adjustments for field command post, improved perimeter control and improved drill time sequencing. Participants committed to continued inter-agencies training efforts in the future. 21st Annual SFGHMC Employee Recognition Banquet On November 16th, San Francisco General Hospital Medical Center honored over 400 employees for their years of services and special accomplishments (list attached.) Gene O’Connell, SFGHMC Executive Administrator, acknowledged that everything the hospital achieves is all made possible by the dedication and hard work of all employees. This year’s banquet included music by B. Jack and beautiful rendition of “America the Beautiful” by Bernice Gary, a SFGH employee. SFGHMC was also honored to have both Health Commissioners Roma Guy and Arthur Jackson present to acknowledge the hard work and dedication of all SFGH MC employees. Please join me in congratulating all SFGHMC employees in their success and accomplishments. COMMUNITY HEALTH NETWORK, SAN FRANCISCO GENERAL HOSPITAL, NOVEMBER 2001 (from 11/05/01 MEC and 11/13 SFGH) 11/01 2001 YTD New Appointments 12 83   Reinstatements 0 6 Reappointments 45 398   Delinquencies: 0 0   Reappointment Denials: 0 0 Resigned/Retired: 18 147 Disciplinary Actions 0 0 Restriction/Limitation- Privileges 0 0 Changes in Privileges   Additions 3 19   Voluntary Relinquishments 5 25   Proctorship Completed 38 156 Current Statistics - as of 11/1/01 Active Staff 361 Affiliate Professionals (non-physicians) 183 Courtesy Staff 479 Referring Staff 43 Total Members 1,066 Applications In Process 100 Applications Withdrawn Month of October 2001 3 SFGH Reappointments in Process Through March 2002 211 Commissioners’ Comments Commissioner Monfredini, with regard to outreach to reduce unsafe sexual activities in sex clubs, asked who distributes the information at the sex clubs, who ensures that this information is indeed disseminated and what control the Department has to see that this happens. Dr. Katz responded that, as it stands now, the City and County does not regulate sex clubs, and there are no rules that require that the clubs must distribute literature. However, when there is an outbreak, health officers have additional authority to say that clubs that do not comply with Department rules can be closed as a health hazard. However, in the absence of an outbreak, the Department has very little power. Commissioner Umekubo asked what the implications of the Governor’s cuts for the trauma money are for the Department. Dr. Katz responded that the money was going to fund necessary staffing to fulfill the mission of the Trauma Center. In the absence of receiving that money, the Department either will need to reallocate dollars from some other source, or will not be meeting the mission. Commissioner Parker asked if STD incidence data could be reported quarterly. Dr. Katz responded that he would make sure that there is a monthly report on STDs to Commissioners, in addition to information on outbreaks of other communicable diseases. Commissioner Parker suggested that this information be brought to the JCCs and discussed under emerging issues. Commissioner Parker added that there seems to be a movement afoot to get two helipads in San Francisco, and asked the Department to keep the Commission updated. Commissioner Guy congratulated the Department for its Trauma Plan approval and the successful JCAHO Clinical Lab Survey. Commissioner Chow congratulated the Department on the SAMHSA grant. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEES RECOGNITION AWARDS FOR THE MONTH OF NOVEMBER Commissioner David Sanchez, Ph.D., presented the Department of Public Health employee recognition awards for the month of November to the following teams: Team #1 Division Nominated by Medicine Psychiatric Services Laguna Honda Hospital Charles H. Stinson, M.D., LHH Chief of Psychiatry Lorraine Killpack, Ph.D. James Zelaya-Wagner, MSW Team #2 Division Nominated by Telecommunication Services Laguna Honda Hospital Larry Funk, Cheryl Austin, and Anthony Wagner Patricia Brown Alva Collins Mark Del Fante Linda Fields Beverly Johnson Freida Warren 6) LAGUNA HONDA HOSPITAL ANNUAL REPORT (Larry Funk, Executive Director, Laguna Honda Hospital) Larry Funk, Executive Director of Laguna Honda Hospital, welcomed the Health Commission to Laguna Honda Hospital. He stated that this year celebrates 135 years of service by Laguna Honda Hospital to the community of San Francisco. Laguna Honda Hospital fits into the overall mission of the Department of Public Health by providing quality long-term care and rehabilitative services, as well as a variety of outpatient services to support the elderly and disabled in the community. He said that transitioning to a resident-centered treatment approach has required significant change, but that is the direction the facility has been moving toward. Terry Hill, M.D., Laguna Honda Hospital Medical Director, continued the presentation by giving an overview of the demographics of Laguna Honda Hospital’s population. Dr. Hill stated that the population of LHH is shifting, with the big news being that the younger male population has grown significantly. Since 1990, the younger male population has tripled. Dr. Hill stated that there has also been growth in the number of patients with serious behavioral problems. Dr. Hill summarized the initiatives that have been undertaken to improve patient flow and integration, which are as follows: Community reintegration program Expediting admissions from SFGH Clinical clusters Flow to the LHH Adult Day Health Center to help make the transition to community living. Health at Home Collaboration Bridge Committee Peer Mentors Program IHSS Discharge Liaison Program Collaboration with Housing and Urban Health Risk and Relocation Committee Mary Louise Fleming, Director of Nursing, continued the presentation by discussing workforce issues and partnerships with academia and the community. She highlighted three key programs that have been established to meet the changing needs of the population: The Psychosocial Cluster; Substance Abuse Treatment Program; and the Medical Cannabis Program. Ms. Fleming then discussed partnerships to improve recruitment, retention and training. She stated that although the country is facing a nursing shortage, Laguna Honda Hospital has positioned itself over the last few years by partnering with community agencies and schools to attract the best and the brightest into long-term care. She stated that they have partnered with San Francisco State University, and that 15 Laguna Honda Hospital nurses are in the master’s program at SFSU. In addition, LHH is a site for educational classes, and currently they host a health policy class on Tuesday evenings. The hospital has also established a strong partnership with UCSF, and collaboration with the university resulted in a $90,000 grant to increase the proportion of culturally and ethnically diverse students in the program. Laguna Honda Hospital also became a member of the Stanford Geriatric Education Center, and is part of a five-year grant in which the study of ethno-geriatrics is a prime mission. Ms. Fleming then described the Temporary Transitional Work Program, which has successfully placed 100 percent of eligible injured workers into work assignments within the organization. She ended by acknowledging the Laguna Honda Hospital volunteers. Nancy Arata, Chief Financial Officer, gave the FY 2000-01year-end finance report for Laguna Honda Hospital, which ended the year with a surplus of $4.7 million. The hospital received $107 million in net patient revenues, which represented a 12 percent increase over the prior year. The majority of this increase came from a one-time allocation from the State for distinct part skilled nursing facilities, and an increase to hospital’s reimbursement rate. The hospital experienced expense overages in pharmaceutical supplies, linen expenditures, legal fees and energy expenses. They were underbudget in the area of salaries and benefits. Mr. Funk then discussed the host of opportunities that the Laguna Honda Hospital rebuild project presents for improving patient flow and increasing integration. Patient care, improving quality, enhancing patient flow and creating operational and cost efficiencies are some of the principles that guide these discussions. Staff will continue to explore these opportunities working with SFGH and DPH. Commissioners’ Comments Commissioner Monfredini asked for a further breakdown of the younger male population, specifically 18-25. Dr. Hill will get her this information. She was pleased with the high number of discharges, as compared to when she first began on the Health Commission, and congratulated staff for this. Commissioner Monfredini then asked if the Department of Justice investigations were nearing conclusion. Tony Wagner said that they are attempting to bring the two Department of Justice investigations to a close. Commissioner Jackson stated that it has been a pleasure to serve on the Laguna Honda Hospital Joint Conference Committee because all of the staff is so enthusiastic about their mission. Commissioner Umekubo echoed Commissioner Jackson’s comments about serving on the Joint Conference Committee. Staff is really committed to having Laguna Honda be the best long-term care facility in the country, which Commissioner Umekubo feels is entirely possible. Commissioner Sanchez stated that Laguna Honda is a center of excellence that requires tremendous team effort. Commissioner Parker stated that the staff gives a sense of hope and encouragement, and does so much with so little. He stated that the hospital is very effective in treating its target population, and has done this through the integration of services. Commissioner Chow stated that the vision for the hospital that was discussed a number of years ago-to become academically-based, a center of excellence, and premier rehabilitation center, to have a continuum of care on campus-is coming to fruition. In addition, the goal of having more people discharged from the hospital and into the community is critical. He said that we must continue to look at what the future holds for the hospital given the changing demographics of the patient population, and continually explore how to best serve these populations. Commissioner Guy stated that Commissioner Chow is really summarizing the view of the Health Commission that the Commission really wants to go in this direction. The Commission appreciates the work that staff does on a daily basis to carry out this change, which does not happen easily in a large institution. Commissioner Guy commended staff for their excellent report. Public Comment Robert Neil, President of the Resident Council at Laguna Honda Hospital, stated that he supports staff’s efforts for renewed vision. He is a participant in the planning but also a recipient. He stated that he did not support the introduction of the use of cannabis at Laguna Honda, and that the impacts on the people who do not participate were not considered. He supports the development of the rehabilitation program. Commissioner Umekubo left the meeting at 4:55 p.m. 7) LAGUNA HONDA HOSPITAL REPLACEMENT PROJECT UPDATE (Larry Funk, Executive Director, Laguna Honda Hospital) Larry Funk introduced Dr. Terry Hill and Mary Louise Fleming who discussed the resident-focussed holistic care approach to the rebuild of the facility. Dr. Hill stated that the design of the new facility is an outcome of all of the information that was presented in the annual report. Michael Lane continued the presentation by summarizing the project budget and schedule. The project is on budget for 1,200 beds, after having been over budget by approximately $57 million. The current design has increased square footage for both new and remodeled construction. This translates into significant increases in resident care and resident activity square footage than what was in the original design. Mr. Lane stated that the budget will need to be monitored, and they will do another round of estimates in March, after they complete the second last stage of design. Derrick Parker from Anshen and Allen discussed the resident communities and services and the building design. The design of the facility must reflect the diverse resident community, as well as the various resident services that are provided on site. Mr. Parker said that the journey to the new Laguna Honda begins by considering the experience of the single resident. In July 2000 the program allocated only one single bed for every 50 multi-bed rooms. Staff encouraged the architects to find more opportunities for more privacy in rooms. Mr. Parker said that after much study, they developed the triple room, which allows individuals privacy by simply closing a door. The design then aggregates these rooms into a household of 15 residents, who share a common living room. Sixty percent of residents will either have single room or triple room. Forty percent of the rooms are “toe to toe,” with each person having his own window. At the center of each floor is the neighborhood core. In response to a question from Commissioner Guy, Mr. Parker discussed parking on site. The new facility will have approximately 50 more parking spaces than the number currently on site. Staff is also widening the access road to Woodside, which will be shared with the Youth Guidance Center. Mr. Lane concluded the presentation by summarizing communications with residents and the community around the rebuild project. The project team has regular meetings with Laguna Honda Hospital residents though the Residents Council, the Family Council and quarterly town hall meetings. A Community Advisory Group meets quarterly, and staff has regular meetings with neighborhood groups. In addition, updated project information is available on the Internet at www.dph.sf.ca.us/LHHReplace/ Mr. Lane concluded by thanking the members of the rebuild team. Commissioners’ Comments Commissioner Chow asked about the elevation from the bottom of the walkway to the facility. Mr. Lane responded that it is approximately three stories. Dr. Katz has asked the architect to consider a funicular, which they have but at this point there is no funding. Dr. Katz stated that one possibility is working with MUNI, since the bus stops serves LHH staff and visitors. Commissioner Chow asked where the Asian unit and other clusters would be located. Mr. Funk stated that they have identified the locations of all 40 clusters, and will be presenting this to the Laguna Honda Hospital Joint Conference Committee. Commissioner Parker asked if a person would have to go outside to get from place to place on the campus. Mr. Lane responded that residents will be able to get anywhere on the campus without going outside. Commissioner Parker then asked who will live in the assisted living facility. Mr. Funk responded that the concept is that the assisted living facility will be a resource for the entire Department. Commissioner Parker asked if the tobacco revenue will be close to what was originally estimated. Mr. Funk responded that the Mayor’s Office of Public Finance has reduced the estimates by 25 percent. Mr. Lane added that they have not yet had to issue any general obligation bonds for the project. Commissioner Guy thanked the project team for building the consensus that was needed to move forward with this project. Commissioner Monfredini asked about solar energy capability. Mr. Lane responded that this will be a “green building”, and they have committed to a 30 percent reduction in energy usage. Public Comment Robert Neil said that all the efforts have proved to be worthwhile, and his work was published in a calendar. 8) OVERVIEW OF DEPARTMENT OF PUBLIC HEALTH SERVICES IN SUPERVISORIAL DISTRICT 7 (Colleen Johnson, Interim Director, Office of Policy and Planning) Colleen Johnson presented an overview of District 7 demographics, as well as an overview of services provided by the Department of Public Health to residents of that district. There are approximately 69,000 residents in District 7, who are generally older than residents in other districts in San Francisco. With regard to health data, the leading causes of death for men in District 7 are similar to the rest of the city, and are HIV/AIDS infection, ischemic heart, lung cancer, stroke, and suicide. The leading causes of death for women in District 7 are heart disease, stroke, lung cancer, breast cancer and pneumonia. DPH Sites in District 7 Laguna Honda Hospital and Rehabilitation Center Special Programs for Youth OMI Family Center Community Mental Health Services System of Care Contractors Oakes Children’s Center Recreation Center for the Handicapped Robertson Place (Baker Places) Team II Adult Outpatient Services Eleven private mental health service providers Other Facilities UCSF Medical Center - Parnassus Heights Ms. Johnson then described the utilization of the Community Health Network by District 7. She cautioned the commissioners that this data might be skewed by the fact that residents of Laguna Honda Hospital, who have a high utilization, are District 7 residents and included in the data. Ms. Johnson stated that District 7 residents over 64 are less likely than residents citywide to access CHN services. With regard to utilization of CMHS, District 7 children and seniors were more likely than adults to access CMHS services. Commissioners’ Comments Commissioner Monfredini stated that the Ocean Park Health Center is very close to District 7. She stated that there are large pockets of homelessness in District 7 that are largely ignored. 9) OTHER BUSINESS/PUBLIC COMMENTS None. 10) ADJOURNMENT The meeting was adjourned at 6:05 p.m. Michele M. Olson, Executive Secretary to the Health Commission