Minutes of the Health Commission Meeting Tuesday, March 4, 2003 At 3:00 p.m. 101 Grove Street, Room #300 San Francisco, CA 94102 1) CALL TO ORDER The meeting was called to order by President Chow at 3:15 p.m. Present: Commissioner Edward A. Chow, M.D., President Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner Michael Penn, Ph.D. Commissioner David J. Sanchez, Ph.D. Commissioner John I. Umekubo, M.D. Absent: Commissioner Roma P. Guy, M.S.W., Vice President 2) APPROVAL OF THE MINUTES OF THE MEETING OF FEBRUARY 18, 2003 Action Taken: The Commission (Chow, Monfredini, Parker, Penn, Sanchez, Umekubo) approved the minutes of the February 18, 2003 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Monfredini chaired, and Commissioner Penn and Commissioner Umekubo attended, the Budget Committee meeting. (3.1) Behavioral Health Services-Substance Abuse - Request for approval of a retroactive contract renewal with Addiction Research and Treatment, Inc. d.b.a. BAART, in the amount of $4,984,920 per year, for a total contract value of $9,969,840, to provide methadone maintenance and outpatient counseling services targeting opiate addicted residents including pregnant/post-partum women, for the period of July 1, 2002 through June 30, 2004. (3.2) Behavioral Health Services-Substance Abuse - Request for approval of a retroactive contract modification with the Regents of the University of California, in the amount of $224,920, to provide substance abuse services targeting clients with AIDS/HIV disease or disabling HIV disease who are low income and uninsured or underinsured, for the period of July 1, 2002 through June 30, 2003. (3.3) Behavioral Health Services - Request for approval of a new sole source contract with Positive Resource Center, in the amount of $200,000, to provide SSI client advocacy services targeting uninsured patients of the SFDPH Mental Health Centers, for the period of April 1, 2003 through March 31, 2004. (3.4) CHN/SFGH Radiology - Request for approval of two (2) contract renewals with Medical Contracting Services and The Registry Network, Inc., for a combined total amount of $900,000 to provide intermittent, as-needed, professional services of Per Diem and Traveling radiology technologists with on-call availability 7 days a week, for San Francisco General Hospital, for the period of March 1, 2003 through June 30, 2004. Commissioners’ Comments Commissioner Monfredini requested a six-month update on this contract to the San Francisco General Hospital Joint Conference Committee. (3.5) AIDS Office-HIV Health Services - Request for approval of the FY 2003-2004 Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 Title I, Title II and General Fund contracts for a combined total of $33,438,524 for the period of March 1, 2003 through February 29, 2004 for Title I funds, April 1, 2003 through March 31, 2004 for Title II funds and July 1, 2003 through June 30, 2004 for General Fund programs with the following agencies: AIDS Community Research Consortium $83,331 AIDS Emergency Fund $625,583 AIDS Legal Referral Panel $189,785 American College of Traditional Chinese Medicine $261,444 Ark of Refuge $89,345 Asian Pacific Islander Wellness Center $475,770 Baker Places $167,164 Bar Association of San Francisco $73,541 Catholic Charities $142,403 Community Awareness & Treatment Services, Inc. $544,836 CompassPoint Nonprofit Services Inc. $44,269 Continuum HIV Day Services $506,296 Dolores Street Community Services $174,033 Family Service Agency of San Francisco $171,549 Glide Foundation $93,500 Haight Ashbury Free Medical Clinics, Inc. $949,678 Harder + Company $76,900 Immune Enhancement Project $211,239 Institute for Community Health Outreach $139,736 Instituto Familiar de la Raza $345,294 Iris Center $141,664 Legal Services for Children $133,213 Lutheran Social Services $522,067 Lyon-Martin Women’s Health Services $322,737 Maitri AIDS Hospice $927,317 Marin County $1,260,249 Mission Neighborhood Health Center $134,961 New Leaf $190,609 Positive Resource Center $263,768 Project Open Hand $1,208,164 Quan Yin Healing Arts Center $120,251 Ramsell Consulting Services $100,178 Saint Mary’s Medical Center. $569,685 San Francisco Community Clinic Consortium $322,090 SFDPH Community Health Network -Forensics Services $317,389 SFDPH Community Health Network -Health at Home $444,755 SFDPH Community Health Network - Primary Care $2,566,083 SFDPH Community Health Network -SFGH $1,643,776 SFDPH Community Health Network-SFGH-Positive Health Practice $174,516 SFDPH Community Health Network-Tom Waddell $153,662 SFDPH PHP Mental Health Services $272,217 SFDPH PHP Public Health Laboratory $55,306 SFDPH PHP STD Services $167,097 SFDPH PHP Substance Abuse Services $236,107 SFDPH PHP Housing Services $8,006,815    Ark of Refuge, Inc $266,782    Baker Places $1,897,157    Black Coalition on AIDS $363,347    Catholic Charities $1,332,802    Larkin Street Youth Center $631597    Lutheran Social Services $144,819    San Francisco AIDS Foundation $3,298,602    Walden House $71,547 San Francisco Food Bank $91,058 San Francisco Suicide Prevention $101,794 San Mateo County $2,412,486 Shanti Project $433,984 Tenderloin AIDS Resource Center $556,231 UCSF/AIDS Health Project $985,572 UCSF/Men of Color Program $15,000 UCSF/Pediatric AIDS Program $161,446 UCSF/Substance Abuse Services $228,242 UCSF/ Women’s Specialty Clinic $209,663 University of the Pacific-School of Dentistry $513,392 Urban Indian Health Board, Inc. $48,300 Walden House $1,605,462 Westside Community Mental Health Services $192,522 To Be Determined-HIV Health Services Planning Council Support $250,000 $33,438,524 Commissioners’ Comments Commissioner Penn asked who works with agencies when they under perform, and who has the ultimate authority for funding decisions. Is it DPH or the HIV Health Services Planning Council? Michelle Long Dixon replied that DPH monitors the programs and works with agencies that have difficulties to develop a plan of correction. If the agency continues to perform below standards, they are no longer funded. Commissioner Monfredini said that one of the contractors receiving funding has had financial difficulties, even though the program performs well, and she asked Ms. Long Dixon to carefully watch this agency. Donald Frasier, Director of Contracts with Walden House, said the overall agency financial issues are being addressed. Action Taken: The Commission (Chow, Monfredini, Parker, Penn, Sanchez, Umekubo) approved the Budget Committee Consent Calendar, with Commissioner Umekubo abstaining on Item 3.5 and Commissioner Sanchez abstaining on Items 3.3 and 3.5. The Commission requested a six-month status report to the San Francisco General Hospital Joint Conference Committee for Item 3.4. 4) DIRECTOR’S REPORT Mitch Katz, M.D., Director of Health, presented the Director’s Report. President’s Medicaid Reform Proposal The Administration’s budget includes a new Medicaid reform initiative that would substantially change the current structure of the program. Under the proposal, states would have to maintain comprehensive Medicaid coverage for the estimated two-thirds of beneficiaries whose income levels are low enough that the federal government mandates that they be covered. However, for beneficiaries covered at the states’ discretion, states would be allowed to revise Medicaid rules and regulations, simplify and alter eligibility requirements and revise or reduce benefits. States would no longer have to apply for federal waivers to deviate from federal standards for Medicaid eligibility and benefits. The proposal would provide states with a fixed amount of money, rather than matching funds, for the beneficiaries that they decide to cover. States that decide to join the new optional Medicaid program would receive a total of $3.25 billion in additional federal subsidies in 2004 to fund new programs and $12.7 billion over seven years, but federal funding would decrease for the three years after that, resulting in a net of no cost to the federal government. Last month, the National Governors’ Association decided that it would not endorse the Administration’s Medicaid reform proposal. AIDSVAX Trial The results of the first -ever HIV Vaccine efficacy trial were released last week. Though the results were disappointing in that there was no evidence of overall protection against HIV infection among the uninfected vaccine volunteers, the trial’s successful completion raised interesting questions and will provide critical information for future trials and for vaccine design. The AIDSVAX trial was a double-blind placebo trial testing whether a protein resembling the gp120 present on the HIV envelope engendered an antibody response that could prevent HIV infection. Seven injections of vaccine or placebo were given to each of 5,400 volunteers-150 of whom participated through the San Francisco Department of Public Health HIV Research Section. Volunteers also received the best-known behavioral risk reduction counseling with each injection. While there was no demonstrated efficacy overall in the trial, nor in the subset of 4,856 white and Latino volunteers, VaxGen did report that they detected potential efficacy in the remaining subset of 547 volunteers (black, Asian or “other race”). However, the trial was not designed to address this question of differential efficacy in different racial/ethnic groups, and the numbers are too small to draw definitive conclusions about these preliminary results at this time. Smallpox vaccinations for health care providers to begin in San Francisco San Francisco will receive 300 doses of smallpox vaccine this week and vaccinations will begin the week of March 31st, 2003. We anticipate that approximately 50 people will be vaccinated from DPH, SFGH, and three other San Francisco hospitals. We will not be vaccinating anyone with a contraindication or patient care responsibilities. Each vaccinee will receive extensive education and informed consent prior to vaccination. The vaccinations will be given at 101 Grove Street in the Adult Immunization Clinic on the first floor. Three DPH nurses will be trained to administer the vaccine. Occupational Health at DPH and other hospitals will follow vaccinees and be available to evaluate possible adverse reactions. In addition, a total of 10 San Francisco dermatologists, infectious disease specialists, neurologists, and opthomologists will be able to evaluate and care for any serious reactions to the vaccine. In addition, we will be training a group of staff from all 10 San Francisco hospitals to serve as vaccinators in the event of a smallpox emergency. Advanced Access Advanced Access is the new scheduling program being adopted by Community Mental Health Services to allow for same day patient appointments regardless of the reason for the appointment. At a meeting of outpatient clinic directors and clinic medical directors at the end of January 2003, 12 out of 15 clinics reported that they are now able to see new individuals for intake evaluations and medication evaluations within 24-48 hours of receiving the request. Of the remaining clinics, the longest waits were up to two weeks for an intake evaluation and medication evaluation. Nutrition and Physical Activity Last fall, the Health and Human Services Committee of the Board of Supervisors held a hearing on childhood obesity and how DPH and SFUSD are addressing the issue. At the hearing, testimony overwhelmingly demonstrated that increased health problems related to poor nutrition and lack of physical activity, including diabetes and other precursors to heart and stroke disease, have taken their toll in the health of children. Supervisor Maxwell will soon be introducing a resolution to form a broad-based task force to assess the extent of the problem, identify resources and best practices, and develop a comprehensive plan to address the problem of overweight, obesity and lack of physical activity in children and youth. Barbara Garcia and Anne Kronenberg met with representatives of various community-based agencies, health providers, advocates and the SFUSD to commit to staffing and participating on the task force and working cooperatively and proactively with others. Cover the Uninsured Week - March 10-16 A diverse group of Bay Area organizations are organizing an unprecedented week-long series of events to focus attention on the plight of the uninsured. Activities during the Cover the Uninsured Week (March 10-16) will include a town hall meeting, medical student debate, screening and enrollment opportunities, a labor-business roundtable, and interfaith services. Bay Area events are similar to hundreds of others being planned in communities across the United States for the week. Information on local events can be found online at http:\www.covertheuninsuredweek.org. San Francisco Children and Families DV Free: Multidisciplinary Approaches to Addressing Family Violence Conference San Francisco SafeStart and the San Francisco Department of Public Health will host a citywide conference on childhood exposure to violence. The conference will be held on April 22, 2003. Special guest speakers include State Attorney General Bill Lockyer and Dr. Alicia Lieberman from UCSF Child Trauma Research Project. Conference information and registration may be obtained online at http://www.dcyf.org/safestart Commissioners’ Comments Commissioner Chow informed the Commission that the Community Health Network Joint Conference Committee received a smallpox vaccination update last week and the committee was pleased that the City is not only planning for Phase I, but is also developing a comprehensive plan for post-event vaccination. 5) CONSIDERATION OF A RESOLUTION APPROVING THE CONTINUED PROVISION OF SURGICAL AND ANESTHESIA SERVICES BY SAN FRANCISCO GENERAL HOSPITAL FOR LAGUNA HONDA HOSPITAL RESIDENTS AND PATIENTS, AND A NEW AGREEMENT THAT MEMORIALIZES THIS ARRANGEMENT Larry Funk, Executive Administrator, Laguna Honda Hospital, presented the resolution. This resolution memorializes the long-standing practice of LHH residents using SFGH for surgical and post anesthesia recovery services. By doing so, LHH can continue to be licensed as a General Acute Care Hospital with distinct part NF services without having to build surgical suites and a post anesthesia recovery room pursuant to a section of the California Health and Safety Code which permits such an arrangement. This arrangement also avoids construction costs for these services at LHH and duplication of services in the DPH Integrated delivery system. Action Taken: The Commission (Chow, Monfredini, Parker, Penn, Sanchez, Umekubo) approved Resolution # 3-03, titled “Approving the Continued Provision of Surgical and Anesthesia Services by San Francisco General Hospital for Laguna Honda Hospital Residents and Patients, and a New Agreement that Memorializes this Arrangement,” (Attachment A). 6) CONSIDERATION OF A RESOLUTION APPROVING THE APPLICATION FOR LICENSURE OF THE CHRONIC RENAL DIALYSIS CENTER BY SAN FRANCISCO GENERAL HOSPITAL TO PROVIDE SERVICES TO PATIENTS OF THE CITY AND COUNTY OF SAN FRANCISCO WITH END-STAGE RENAL DISEASE Gene O’Connell, Executive Administrator, SFGH, presented the resolution. UCSF has operated the Renal Dialysis Center as SFGH since 1967. The center provides outpatient chronic dialysis services to 113 CHN patients directly, and facilitates services for another 56 CHN patients at the few remaining local freestanding dialysis centers. Over the past several years the University sustained operational difficulties, which forced it to make the decision to withdraw from this segment of the healthcare market. Consequently, after several failed attempts by UCSF to have another provider of service assume operation of the Renal Dialysis Center at SFGH, the UCSF Department of Medicine at SFGH gave the hospital notice of its intent to cease operation on June 30, 2003. This decision would have serious consequences, including the further reduction of the already insufficient number of outpatient chronic dialysis chairs in San Francisco and increased additions to the SFGH Emergency Department for patients in renal failure. SFGH determined that in order to ensure continued uninterrupted service to its patients, the UCSF Renal Dialysis Center license should be transferred to SFGH. The costs that will be incurred by SFGH to operate the Renal Dialysis Center were included in the DPH budget submitted for FY 2003-2004. The application materials are ready to be submitted to the Department of Health Services for licensing. Dr. Talmadge King, Chief of the Department of Medicine at SFGH, said maintaining the Center on the SFGH Campus along with the experienced and dedicated staff is so important, and on behalf of the staff of the unit he thanked the Department and Commission. Commissioners’ Comments Commissioner Sanchez said it is so important that the dialogue took place on behalf of this very special population. Commissioner Umekubo said closure of the outpatient dialysis center would be detrimental because there are already too few outpatient slots and people end up in acute conditions. He asked Ms. O’Connell about the projected expansion of the program. Ms. O’Connell said they currently contract out 56 patients for dialysis. They would like to pursue an analysis to see if it is economically feasible to eventually expand. Commissioner Penn asked about the annual costs associated with running this program. Gregg Sass said total annual expenses are $3.2 million. The majority of the cost is funded through revenues, primarily MediCal and Medicare. Approximately $457,000 is not covered through revenues. Commissioner Monfredini is supportive of this resolution. Commissioner Chow said that this solution allows the hospital to build upon this critical service. Action Taken: The Commission (Chow, Monfredini, Parker, Penn, Sanchez, Umekubo) approved Resolution # 4-03, titled “Approving the Application for Licensure of the Chronic Renal Dialysis Center by San Francisco General Hospital to Provide Services to Patients of the City and County of San Francisco with End-Stage Renal Disease,” (Attachment B). 7) PRESENTATION OF THE AIR MEDICAL ACCESS FEASIBILITY STUDY AND CONSIDERATION OF A RESOLUTION ACCEPTING THE SAN FRANCISCO GENERAL HOSPITAL AIR MEDICAL ACCESS FEASIBILITY STUDY Gene O’Connell, Executive Administrator, SFGHMC, gave an introduction to the Air Medical Access Feasibility Study. The Health Commission, as part of its approval of the San Francisco Trauma Care System Plan, requested that SFGH conduct a needs assessment and feasibility analysis for a medical helipad at SFGH. This study is being presented today. Chris Wachsmuth, R.N., SFGH Emergency Department Administrator, began the power point presentation. SFGH is the only Level 1 Trauma Center serving 1.5 million people living, working and visiting San Francisco and northern San Mateo County. The San Francisco Trauma Care System falls short of national standards, and of the top 25 cities in the U.S. is the only city without air medical access. This study is the first to examine the need for direct air access to the trauma center and the feasibility of a medical helipad at SFGH. The Air Medical Access Study was designed to provide a thorough, objective evaluation of the need for and feasibility of consistently available air medical access at SFGH. Dr. Robert Mackersie, Director of the SFGH Trauma Center, provided a clinical perspective of the importance of air access to the trauma center, specifically that rapid rescue saves lives. Helicopters are designed specifically to get the right patient to the right place at the right time. He also talked about the ”Golden Hour,” which is sometimes the golden 15 minutes or the golden half-hour. Virtually all major trauma centers in the United States, and certainly all major metropolitan areas, have direct air medical access. The one public safety helipad in San Francisco is at Hunters Point Naval Shipyard, which is remote, poorly lit, a superfund site and has bad road access. In addition, there are risks and delays with secondary transfers from that site to an ambulance to the hospital. San Francisco’s trauma system vulnerabilities include geography, traffic congestion and urban density. There is also inability to assure definitive treatment within the Golden Hour because: trauma patients regularly fly over SFGH; multiple casualty incidents; simultaneous, unrelated injuries can overwhelm Trauma Center capacity; no pediatric trauma center; and no “back up” trauma center in San Francisco. Mike McClintock, Gerson/Overstreet, presented the findings of the Needs Assessment and the Feasibility Analysis. The Needs Assessment looked at risks to San Francisco Community from lack of air access both to and from the Trauma Center, the benefits of air medical access and anticipated flight activity. The Feasibility Analysis included site identification and evaluation, structural/elevator analysis, site development and costs, regulatory and permits, safety analysis and a preliminary noise assessment. Five site options were considered and two roof options were selected, with the “C” wing ranked first and the “A” wing ranked second. The existing roof can support a helipad without seismic retrofit. A review of safety records since 1972 showed that overall, medical helicopter transport is safer than general aviation or automobiles. With regard to anticipated flight activity, the initial program estimate is an average of one flight per week, including transfers from SFGH to a Pediatric Trauma Center. The long-term program outlook is two flights per day, primarily due to additional trauma and critical medicine referrals to SFGH and critical medicine transfers to other San Francisco hospitals. Noise was identified as being the overriding concern of hospital neighbors. 24-hour noise monitoring was done at three sites in the community and helicopter noise contours were developed. Under a worst-case scenario of two daytime and one nighttime flights to and from the hospital, without any noise abatement measures, there would be minimal impact on the adjacent community. Further study is recommended during the environmental review process. Chris Wachsmuth discussed some of the community concerns that had been raised in the community meetings, including noise, safety and urban density, quality of life, current intrusion of news/traffic helicopters on Potrero Hill and reduced property values. She also discussed the next steps in the process, which would be in two phases. Phase I - Planning and Design Project Design: 7-10 months Permitting/Approvals: 7-10 months Environmental Impact Review: 12-16 months. (The EIR process allows for considerable public input on noise, safety and quality of life.) Phase II - Construction Bid: 3 months Construction: 3-4 months Final Approval: 1 month The total time for the entire project is estimated to be two years. Cost is estimated to be $3 million, with $825,000 for planning and design and $2.175 million for construction. The Department will be pursuing various funding sources including State, Federal and Homeland Security funds as well as foundation grants and philanthropic gifts. Dr. John Brown, Medical Director, San Francisco EMS System, said that the City’s trauma plan that was submitted to the State in 2001 identified many vulnerabilities of San Francisco’s current trauma care. He urged the Commission to approve moving forward with a helipad for the following reasons: 1) Ground transportation delays as well as geography and congestion factors; 2) Lack of a pediatric trauma center in San Francisco; 3) Lack of a back up for the single Level 1 Trauma Center; and 4) Lack of rapid access to transfer patients in and out of San Francisco in the time of a disaster. Public Comment Cathy Ramacciotti, East Mission Neighborhood Improvement Association, is concerned that helicopters landing at SFGH puts many people at risk-residents, visitors, patients, etc. This needs to be thought through more carefully. Liz Killian, said there has been a lack of meaningful outreach to the community. They requested many things that were not addressed, including information about helicopter safety. The noise analysis was incomplete. Babette Drefke, Potrero Hill resident, said this proposal gives no consideration to the people who live around the hospital. Is it better to save one life than to destroy many with rumbling sounds? The hospital is next to a school. Jean Millar, UCSF Medical Center Critical Care Transport Program, said the most compelling concern over the past few years is how strained the ground emergency transport system can become in a disaster. She is supportive of the proposal to have a helipad at the trauma center. Jim Beals, is disappointed with the process by which this proposal was developed. Residents of the neighborhood were not contacted about meetings. The golden rule is as important as the golden hour. Fusako Hara, said there is a right and wrong way to implement a plan, and the neighborhood was not informed about this plan. Most of her neighbors were unaware of this effort. Also, there was no detailed information provided at the meetings, or it was inconsistent. Also, there should have been a neighborhood meeting after the study was published. Christopher Sabre, East Mission neighbor, said helicopters are dangerous and noisy. The report is not detailed enough. During an emergency, people will not be transported to the hospital, but have to go to another area. SFGH is one of the best trauma centers in the country even though it does not have a helipad. He thinks that SFGH should wait until it decides where the new hospital will be built. Joseph Cook, President of Calstar, which was founded by San Francisco foundations and corporations. Over the past 20 years they have transported approximately 20,000 patients to numerous trauma centers. They have been able to provide very little service to San Francisco, even during times of natural disasters, primarily because of lack of air medical access. Abbie Yant, St. Francis Memorial Hospital, said her brother’s life was saved by helicopter transport to a trauma center. She co-chaired the San Francisco The Hunters Point site is too far from any medical center in San Francisco. She supports the feasibility study and moving forward. David Jayne, East Mission resident, said that helicopter access will not help San Francisco residents. He is a Potrero Avenue resident and there are a lot of negative impacts to living across the street from the hospital. In addition, a helicopter could land on the green in front of the hospital. Ron Smith, Hospital Council, said that the leader of every hospital voted unanimously to have air medical access at SFGH trauma center. ER doctors have concerns about diversion, would like to meet with the Health Commission to discuss methods to minimize diversion. But they support the helipad. Dr. Marshal Isaacs, Medical Director SFFD, spoke on behalf of Fire Chief Mario Trevino and EMS Chief Jane Smith to support air medical access to the SFGH Trauma Center. Alice Palantski, Potrero Hill resident, said her primary concern about the feasibility study is that it was more a promotion for having a helipad rather than a true feasibility study. It did not address community concerns. The community was not truly embraced, and she urged the Commission to table action today so more studies could be done. Anidia Zabala, said she is supportive of the helipad specifically because of the medical issues, even though she lives right by the hospital. Whatever the costs, she supports the helipad. Dick Millet, Potrero Hill resident, said the community outreach has been inadequate. He said it is premature for the Health Commission to adopt the resolution. A helicopter will not serve the residents of San Francisco very well. We should establish a pediatric trauma center at SFGH. Judith Berkowitz, urged the Commission to not take action on the study today. She asked for a delay of one month. There was not enough time to properly review the document. There was only one meeting called by the hospital. The helipad should be at Mission Bay. Eleanor Fallon, RN, Stanford Life Flight, said it is an anomaly that San Francisco does not have a helipad. The rooftop is a good location because it is controlled and well illuminated. She said that in Palo Alto, where she works, they have been able to keep the noise complaints to a minimum. Ross Fay, Calstar, said it is a standard of care to have air medical access. He urged the commission to bring the helipad to San Francisco, which is where the dream of air transport began. Ted Miclan, M.D., Acting Chief of Orthopedics, SFGH, said that the trauma center is critical to quality medical care in San Francisco. Art Gotisar, Reach Air Ambulance pilot, has been flying for more than 20 years. Given a proper EIR and proper permitting, the proposed site is a viable site. Helicopter pilots are aware of community noise concerns and there are methods used to minimize noise impacts on neighborhoods. Maria Leone had her statement read by Judith Berkowitz. She asked that the hearing be postponed to allow more time for community input. San Franciscans will not benefit from the helipad. Dr. Bill Schecter, Chief of Surgery at SFGH and Potrero Hill homeowner, urged the Commission to proceed with the helicopter feasibility studies. We should have had this 30 years ago. Dr. Alan Gelb, Chief of ED, SFGH, said delays in arriving to the hospital lead to significant morbidity or death. Helicopter to the trauma center would decrease morbidity and mortality. In addition, an adequate number of patients are needed to maintain the level of skills. Please support this measure. Angela Rubin, Potrero Hill resident, said that the helipad would affect property values on Potrero Hill and negatively impact the quality of life. Helicopters are extremely disruptive. Also, the people in the neighborhood have not been adequately informed of the negative impacts. David Haslett, Potrero Hill resident, said that San Francisco does need the best care possible, but since Mission Bay is being built, that location should be considered for the helipad. Mary Anne Alumbaugh, ER nurse and trauma patient, said she needed every minute of the golden hour. She was transported by helicopter to a trauma center. The same thing that happened to her could happen to anyone. Written Comment: Ed Rogers, as a neighbor of San Francisco General Hospital, I encourage the Health Commission to DEFER ACTION on the SFGH Helipad Study and report for the following reasons: 1) there has been inadequate involvement and communication with those SFGH neighbors who will be most affected by the proposed helipad: few, if any, of the homeowners and tenants within a six block radius of SFGH received any direct communication from the Hospital about the proposed project and study even though they will be significantly affected if the study is accepted and implemented. 2) There has been grossly inadequate opportunity for public review of and comment on the report itself, which was made available to the public only on Friday of last week - one business day before the scheduled Hospital Commission vote to accept the study and proceed with its recommendations. Additionally, while many neighbors have expressed concerns about noise and safety as they have recently been made aware of the possibility of a helipad at SFGH, I think there is also a financial cost being levied on the homeowners in the affected area, which has received little consideration. If the project is approved, area home values will surely be impaired by the introduction of low-flying air traffic over the high-density residential areas in the proposed flight paths to SFGH. I should also point out that I do not believe that homeowners and residents in the affected area are responding with the “Not-in-my-backyard” attitude so prevalent in San Francisco today. Rather, what I hear from the most vocal homeowners is a reaction to being largely excluded from the planning process and offered no protections or mitigation opportunities. For instance, what is to keep the flight volumes as the proposed two flights per day as reported in today’s Chronicle? Simple common sense would suggest that once the facility is operational, economics alone will recommend maximizing utilization of the helipad and likely result in somewhat more than two flights per day. I encourage the Health Commission to take a leadership role on this issue and DEFER ACTION on the SFGH Helipad Study until appropriate public review and comment has occurred. Commissioners’ Comments Commissioner Monfredini thanked the staff for the detailed study. She attended two community meetings, both in the evening, and found them to be informative. Time is so critical to health outcomes. She is supportive of moving forward on this resolution. Commissioner Sanchez thanked everyone for attending the meeting and sharing their thoughts. When Buena Vista School was built, it was done so in partnership with the SFGH Pediatrics Department, which provided services on weekends. The need for air medical access and air evacuation units today is more important than ever. Further, in order to maintain the quality of care at our Level 1 Trauma Center, SFGH needs to recruit the highest quality people and continue to provide the number of service, and needs this air access. He supports this proposal, as do many people in the Mission community. Commissioner Parker supports the feasibility study for a helipad at SFGH. Air medical access has proven successful in saving lives. He sympathizes with the residents that live near the hospital, and would like to see if the Commission could get data from other cities about negative impacts and how they were mitigated. The Department needs to be prepared for natural disasters, terrorism attacks and multi-casualty incidents and having a helipad is part of this obligation. Commissioner Umekubo thanked everyone for his or her testimony. He hopes that as this moves through the Environmental Review process, every mitigation measure is pursued. Having a helipad at SFGH helps not only San Francisco residents but also the entire Bay Area community. Further, there is a variety of quality of care issues related to the helipad. Commissioner Umekubo also asked that copies of the study be sent to the surrounding neighborhood organizations and that copies for public review be at the Public Library, at SFGH and at 101 Grove. Commissioner Penn encouraged the staff to increase outreach efforts to make sure community individuals do not fall through the cracks, and suggested that the community be more formally involved. This issue presents the opportunity to increase the quality of care that SFGH provides. The skill level at the SFGH ER is incredibly high and this needs to be maintained and passed on to future doctors. Commissioner Chow said the benefits of the helipad, particularly an enhancement of access to the trauma center to San Francisco residents, are critical. His experience in the Vietnam War demonstrated how medical helicopters save lives. The goal is to have a helipad but also identify mitigation measures that will allow the neighborhood to maintain quality of life. Dr. Katz said it is important to note that this is a feasibility study, not an implementation plan. The answers to the question “is it feasible to have a helipad at SFGH” is yes, from financial, logistical, medical and standard of care perspectives. Now that we know it is feasible, detailed noise analyses can be done. He thinks it is in the Board of Supervisors purview to see if there can be restrictions on the number of helicopters, including traffic helicopters that fly in the area. The Department will redouble its community outreach efforts in the next phase, as well as add more time for review. Action Taken: The Commission (Chow, Monfredini, Parker, Penn, Sanchez, Umekubo) approved Resolution # 5-03, titled “Accepting the San Francisco General Hospital Feasibility Study,” (Attachment C). 8) PUBLIC COMMENTS None. 9) ADJOURNMENT The meeting was adjourned at 6:14 p.m. Michele M. Olson, Executive Secretary to the Health Commission