Minutes of the Health Commission Meeting
Tuesday, June 3, 2003
At 3:00 p.m.
101 Grove Street, Room #300
San Francisco, CA 94102
1) CALL TO ORDER
The Commission was called to order by Commissioner Guy at 3:10 p.m.
Commissioner Roma P. Guy, M.S.W., Vice President
Commissioner Lee Ann Monfredini
Commissioner Harrison Parker, Sr., D.D.S.
Commissioner Michael L. Penn, Jr., M.D., Ph.D.
Commissioner David J. Sanchez, Ph.D.
Commissioner John I. Umekubo, M.D.
Commissioner Edward A. Chow, M.D.
2) APPROVAL OF THE MINUTES OF THE MEETING OF MAY 20, 2003
Action Taken: The Commission (Guy, Monfredini, Parker, Penn, Sanchez,
Umekubo) approved the Minutes of the May 20, 2003 Health Commission meeting
with the correction that Commissioner Parker requested inclusion of his
comment on Item #8 that the Youth Health Advisor provides an opportunity
for fresh, new thoughts to the Commission. The primary purpose of this
position is to seek outside input to help solve youth problems. Training
this individual for the future is a secondary purpose.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Monfredini chaired, and Commissioners Penn and Umekubo attended,
the Budget Committee meeting.
(3.1) CHN-Health Information Services – Request for approval
of three contract renewals with the following firms: Mediscript Medical
Transcription, Pacific Medical Transcription and Transcription Stat,
Inc., for a combined total amount of $905,000, to provide as-needed
medical transcription services for the Health Information Services,
San Francisco General Hospital, Community Health Network, for the period
of July 1, 2003 through June 30, 2005.
(3.2) AIDS Office-Prevention – Request for approval of a retroactive
renewal contract with CompassPoint Nonprofit Services, in the amount
of $105,310, to provide organizational development and technical assistance,
for the period of April 1, 2003 through December 31, 2003.
(3.3) AIDS Office-Prevention – Request for approval of a retroactive
new contract with San Francisco Study Center, in the amount of $160,000,
to coordinate a community-wide planning process targeting the HIV prevention
services provider community and HIV prevention services staff, for the
period of March 1, 2003 through June 30, 2003.
(3.4) CHSS-Immunizations – Request for approval of a retroactive
new sole source contract with Mount Zion Health Fund, in the amount
of $207,191, to provide support services to the San Francisco Immunization
Coalition, for the period of October 15, 2002 through June 30, 2005.
(3.5) CBHS-Substance Abuse – Request for approval of a contract
renewal with Ohlhoff Recovery Programs, in the amount of $376,615, to
provide residential and outpatient substance abuse treatment services
targeting women and adolescents, for the period of July 1, 2003 through
June 30, 2004.
Action Taken: The Commission (Guy, Monfredini, Parker, Penn, Sanchez,
Umekubo) approved the Budget Committee consent calendar.
4) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., Director of Health, presented the Director’s
Mayor Brown held a press conference this morning releasing his proposed
$4.8 billion FY03-04 budget. The budget absorbs the $347 million deficit
faced by the City and avoids many of the prior anticipated cuts. We were
pleased to be asked by the Mayor in the last week of May to reinstate
3 million dollars in services previously cut from next years budget including
some mental health and substance abuse outpatient programs and adult dental
care. (spreadsheet attached)
We learned late last night that SEIU 790, 250 and 535 (miscellaneous
employees) overwhelmingly ratified the negotiated union contract. As a
result of the agreement with SEIU, members will pick up the 7.5 percent
employee share of retirement, and DPH will restore the MHRF as a locked
subacute facility for a year and retain City staffed laundry services.
Federal Tax Cut Includes Increase for Medicaid
Last week, the President signed a $350 billion tax cut and economic stimulus
bill that includes $20 billion to address state fiscal relief, including
a temporary increase to the Federal Matching Assistance Percentage (FMAP)
for Medicaid. California’s FMAP is expected to increase from 50%
to 54.35% through State fiscal year 2004, resulting in approximately $1.29
billion in additional Medicaid funding. Increasing the FMAP results in
a cost shift from the State to the federal government, but is not designed
to provide relief to local jurisdictions. However, in instances where
we use county funds to draw down the federal match, such as the distinct
part nursing facility and hospital outpatient supplemental programs that
San Francisco sponsored in the State Legislature over the past three years,
we may be able to expect an increased federal share of approximately $2.2
I know you all join me in congratulating your own Health Commission Secretary,
Michele Olson who gave birth on Saturday to a baby boy, Harrison Francis
Seaton. He weighed 8lbs at birth and was 22 inches long. Harrison and
Michele are home from the hospital and settling in, happy and healthy.
June 17th VIP Event
As mentioned in an earlier report, the Department of Public Health will
be conducting a practice exercise at Bill Graham Auditorium, June 17,
2003 to test the City’s ability to respond to a health emergency.
During the exercise, DPH staff will set up a mass clinic to provide mock
vaccinations to over 2,000 volunteers. You are cordially invited to attend
a special VIP briefing and tour of the exercise at 2:00p.m. on June 17th.
I hope you will be able to join us.
Director of CDC Visits SFGH
Julie Louise Gerberding, MD MPH, Director of the Centers for Disease
Control and Prevention is in San Francisco for two weeks attending at
San Francisco General Hospital. Dr. Gerberding served as Professor of
Medicine at the University of California, San Francisco before her appointment
to the CDC. At noon today, Dr. Gerberding presented at SFGH Grand Rounds.
Her lecture, Twenty-First Century Public Health: Protection, Prevention
and Health Promotion was very well received.
Graduate Student Award
Gloria Garcia-Orme, Director of Patient Relations at San Francisco General
Hospital, was awarded the Graduate Student Award for Distinguished Achievement
from San Francisco State University, where she received her masters in
nursing. This is the highest honor that SFSU grants to graduate students
and is in recognition of outstanding scholarship or creative work, professional
activity, and service to the SFSU nursing department, college, and community.
On May 13th, the HIV counseling and testing program at Glide was the
first government funded Counseling, Testing and Referral (CTR) program
in California to provide HIV rapid testing. Glide's CTR program is funded
by the Department and is one of several CTR programs around the State
currently participating in the State Office of AIDS pilot of rapid testing.
Following the evaluation of the pilot, the AIDS Office/HIV Prevention
Section will work with the other Department funded CTR programs in San
Francisco to prepare them for HIV rapid testing.
- Benica Henry of Family Right and Dignity of the Coalition on Homelessness
requested that the City consider accountability to families in the budget.
There is funding available for housing and shelter for other populations
of single adults, but no funding for families. Families deserve their
fair share of the budget, and currently receive the smallest portion
of the budget.
- Commissioner Monfredini noted that the June 17 VIP briefing and tour
of the health emergency practice exercise is scheduled for the same
time as the Health Commission Budget Committee. She expressed her desire
to attend the VIP event. Dr. Katz indicated his willingness to change
the time of the briefing and tour to allow Commissioners to attend.
- Commissioner Sanchez noted that colleagues from San Francisco who
move on to national roles frequently return for visits, such as Dr.
Gerberding. He also congratulated Gloria Garcia-Orme on her award, and
congratulated Commissioner Penn on his recent M.D. degree from UCSF.
- Commissioner Umekubo noted that in terms of the FMAP, California ranks
49th of all the states, and requested clarification on how the FMAP
affects local communities. Dr. Katz responded that since Medicaid programs
are State-Federal programs, as the Federal contribution increases, the
State contribution decreases, providing relief to states, without affecting
local communities. In California, there has been creative legislation
to bypass the State, whereby local funds are used to match and draw
down the federal portion of the funding. Does not mean a higher rate,
just a larger proportion of the existing rate is Federal. Commissioner
Umekubo followed up by asking if the State spends more on Medi-Cal,
does it receive more in Federal funding? Dr. Katz responded in the affirmative.
- Commissioner Penn asked who will be evaluating the effectiveness of
the mock vaccination exercise. Dr. Katz responded that DPW, SFFD, and
SFPD will be monitoring the exercise, a survey of participants will
be conducted to determine whether they understood the education provided
to them, and finally, how many people can be “vaccinated”
in one day during the exercise.
- Commissioner Umekubo asked whether there are any confirmed cases of
SARS in San Francisco. Dr. Katz responded that there is still one probable
case, and the Department is waiting for serum results. It is probable,
because the patient fits the criteria for SARS. There have been no further
imported or local cases.
5) PRESENTATION OF A RESOLUTION SUPPORTING SAN FRANCISCO WOMEN’S
Barbara Garcia, Deputy Director of Health for Community Health Programs
presented the Resolution “Supporting San Francisco Women’s
Health Plan”. She noted that it was a follow-up to the Women’s
Health Report presented at the May 20, 2003 Health Commission meeting.
Action Taken: The Commission (Guy, Monfredini, Parker, Penn, Sanchez,
Umekubo) approved Resolution #12-03, entitled “Supporting San Francisco
Women’s Health Plan: Partnering in Wellness with Women and Girls
in San Francisco 2003-2006”. Attachment B.
6) STATE BUDGET UPDATE
Colleen Johnson, Assistant Director of Policy and Planning, presented
the State Budget Update.
Ms. Johnson noted that it is difficult to interpret the May Revise because
it is not a full budget picture. It only includes the differences from
the 2003-04 budget proposal the Governor released in January, and does
not include much detail about the proposed changes. The summary included
is the best information available at the time the report was prepared.
Additional information has become available since, which is included in
The projected deficit represents an increased deficit of $3.6 billion
over the January estimate. Since the release of Governor Davis’
January Budget, the State economy and State General Fund (GF) revenues
have generally followed the January forecast. However, expenditures related
to caseload growth and Proposition 98 in addition to the cancellation
of the sale of the second installment of the tobacco securitization bond
($2 billion) due to declining market conditions have increased the budget
The impact on health services is less severe than DPH had anticipated,
and less than the Governor proposed in January. DPH estimates that if
the Governor’s May Revise were adopted as proposed, the Department
would lose approximately $13 million in State and Federal dollars for
critical health services. This estimated is revised down by approximately
$5 million as a result of clarifications in the May Revise. DPH did not
budget these reductions into its fiscal year 2003-04 budget as the Mayor
has created a reserve for additional reductions that may occur as a result
of the State budget.
In January, the Governor proposed a Realignment II package that would
have transferred $8.3 billion of State-funded health and human service
programs to counties along with a dedicated revenue stream comprising
income, tobacco and sales taxes to fund these programs. The May Revise
proposes a scaled back realignment program, totaling $1.8 billion, effective
July 1, 2003.
The revised Realignment II would dedicate revenues from two new taxes
(a $0.23 cigarette tax in 2003-04, an additional $0.40 in 2004-05; and
an additional 10.3% personal income tax bracket) to fund several social
service programs and the following health programs at their current levels:
AB 34/2034 ($20 million statewide) and the Children's System of Care ($55
million statewide). The DPH impact: DPH currently receives approximately
$2.7 million for the mental health programs included in the Realignment
II proposal for 2003-04 ($2.2 million in AB 2034 funding and $500,000
for Children’s System of Care). Since Realignment II assumes that
programs would be funded at existing levels, this proposal should have
no fiscal impact.
Realignment is a crucial component of the structural reform on which
the Governor predicated his budget. The Governor has requested that the
Legislature consider the elements of Realignment II as originally proposed
in his January budget during the remainder of their current legislative
session for implementation in 2004-05. In addition to the two mental health
programs the Governor includes in the May Revision to Realignment II,
as noted above, there are several additional health programs that the
Governor proposed in January:
- All of Medi-Cal Long Term Care (including all skilled nursing facilities
and assumption of 100% of non-federal share of IHSS)
- Alcohol and Drug Programs (Drug Medi-Cal, drug court, Prop 36, and
"non-Medi-Cal alcohol and other drug services)
- A new "Healthy Communities" realignment (15% Medi-Cal Share
of Cost, Adolescent Family Life Program, Black Infant Health Program,
Indian Health Program, Local Health Department MCH Program, Expanded
Access to Primary Care, Grants-in-Aid for Clinics Program, Rural Health
Services Development Program, Seasonal Agricultural and Migratory Workers
Program, County Health Managed Care Program, California Health Care
for Indigents Program, Rural Health Services Program, Public Health
Realignment can provide county Health Departments with flexibility to
allocate funding based upon local needs. However, in order to be successful,
the revenues provided in the first year of realignment must be at least
as great as program expenditures. For future years, the revenue source
must be stable with a growth rate that is equal to or greater than anticipated
growth in the realigned programs. Further, it may be problematic to include
both caseload-driven, mandated services with discretionary programs in
a realignment package, as mandated programs with significant caseload
growth can consume funding for discretionary programs.
Medi-Cal provider rate reductions continue at 15 percent as proposed
in January. This is expected to save $1.4 billion ($720.5 million State
GF). This reduction impacts fee-for-service, managed care (not including
mental health managed care), and Family Pact. Reducing Medi-Cal rates
has the potential to significantly impact access, quality of care, and
the availability of care not only for Medi-Cal beneficiaries, but also
for the uninsured.
In addition to the 15 percent rate reduction, the May Revise also contains
a rate increase for long-term care facilities at an average of 3.8 percent.
This increase, which is part of DPH’s annual long-term care rate
review and adjustment process, is estimated to increase State General
Fund costs by $59.8 million. This partially mitigates the loss of reimbursement
for long-term care services at Laguna Honda and San Francisco General
resulting in a net decrease of approximately 11.2 percent and restoring
approximately $1.7 million of the $6.3 million loss DPH had estimated
was the result of the Governor’s January budget proposal.
As is the case with long-term care rates, the May Revise contains a three
percent rate increase for Medi-Cal managed care that will mitigate losses
that result from the 15 percent rate reduction. This increase is estimated
to increase State General Fund costs by $112.5 million, resulting in a
net decrease for Medi-Cal managed care plans of approximately 12 percent.
It is difficult to assess the impact of this proposal on DPH because it
does not impact DPH directly but rather affects the San Francisco Health
Plan, which may need to reduce reimbursement to providers like DPH. However,
DPH estimates that this proposal would restore approximately $445,000
of the $2.2 million loss DPH estimated was the result of the Governor’s
January budget proposal.
In addition to being subject to the 15 percent provider rate reduction,
the ADHC rate would be further reduced as a result of the Governor’s
proposal to “unbundle” some required services. Currently,
ADHC providers are required to include specific service components in
their programs and are paid one daily rate for all the services they provide.
However, the May Revise proposes to “unbundle” the rate, remove
speech therapy, physical therapy, occupational therapy, and transportation,
and rebundle the services at a new, lower reimbursement rate. The therapies
and transportation may then be billed separately subject to prior authorization.
This proposal is estimated to save the State $18.8 million in General
Fund. These additional rate reductions are anticipated to further reduce
revenues for Laguna Honda’s ADHC services by approximately $230,000.
The Governor’s January budget proposed implementing quarterly status
reports for adults in the Medi-Cal Program as of October 2003. The May
Revise maintains this proposal, which assumes that 193,123 adults will
be dropped from coverage in 2003-04 due to ineligibility or failure to
return the required forms, for a total savings of $85 million. As in all
Medi-Cal programs, an equal loss in federal funding would also be lost,
totaling $170 million. The vast majority of adults who would lose coverage
as a result of quarterly status reports would otherwise be eligible for
Medi-Cal at the time of their termination from the program.
Prior to May of this year, Medi-Cal beneficiaries were required to re-qualify
for Medi-Cal on an annual basis. The mid-year reductions passed by the
Legislature on May 1st, require families to submit forms twice yearly,
starting August 1, 2003. The Legislature estimates that semi-annual reporting
will achieve half of the savings ($85 million total and $42.5 million
State GF), suggesting that approximately 97,000 enrollees statewide and
1,100 enrollees in San Francisco will lose their Medi-Cal coverage. If
quarterly status reports were implemented, 2,176 San Franciscans would
lose their Medi-Cal coverage and become uninsured. DPH estimates that
this proposal would result in increased expenditures as a result of providing
uncompensated care to the newly uninsured and decreased revenues from
Medi-Cal for serving those who will become uninsured totaling approximately
The May Revise maintains current eligibility levels for the 1931(b) Medi-Cal
program, rescinding the January proposal to reduce eligibility under this
program. Currently, low-income working parents qualify for Medi-Cal if
their incomes do not exceed 100 percent of FPL. In January, the Governor
proposed reducing income eligibility for this program to approximately
61 percent of FPL, which would have resulted in the loss of Medi-Cal coverage
for 292,890 parents statewide and a savings of $236 million ($118 million
State GF). The May Revise rejects this proposal and proposes maintaining
the current program. Maintaining the 1931(b) Medi-Cal program ensures
that 3,299 San Franciscans that rely on this program will retain their
health insurance and DPH would avoid increased expenditures associated
with caring for the newly uninsured and decreased revenues from Medi-Cal
for serving those no longer eligible totaling approximately $3.8 million.
The Governor’s January budget rescinded the Aged and Disabled Expansion
Program and the May Revise continues to rely on this proposal to balance
the State’s budget. The Aged and Disabled Expansion Program allows
persons with incomes between the SSI/SSP benefit level ($9,084 per year)
and 133 percent of FPL ($11,943 per year) to receive Medi-Cal benefits
with no share of cost. Rescinding this expansion would result in a share
of cost for approximately 68,840 Medi-Cal beneficiaries statewide that
have incomes above the SSI/SSP benefit level, resulting in reduced expenditures
of $127.6 million (63.8 million State GF). The budget also includes resources
to initiate an effort to increase enrollment of aged, blind and disabled
beneficiaries into Medi-Cal managed care. While this proposal is estimated
to impact approximately 750 Medi-Cal beneficiaries in San Francisco, the
actual impact on DPH is unclear since it is the Administration’s
intention to shift the cost of care from the State to the patient, not
In January, the Governor proposed elimination of 18 optional Medi-Cal
benefits. The May Revise restores four of these (non-emergency transportation,
hospice, orthotics, prosthetics) and continues to rely on elimination
of 14 optional benefits for a savings of $420 million ($210 million State
GF) beginning in October 2003. However, because these beneficiaries are
very low income, it is likely that they will be unable to pay their share
of cost and DPH will provide services without this reimbursement. This
proposal is estimated to reduce annual Medi-Cal revenues to DPH by approximately
$500,000. The mid-year package of bills passed by the Legislature on May
1st modified the Medi-Cal dental benefits, mandating cost-saving measures,
such as requiring documentation for certain claims and limiting the use
of laboratory-processed crowns, for a savings of $101.6 million ($50.8
million State GF). DPH estimates that it will lose approximately $500,000
in Medi-Cal revenue as a result of the elimination of these 14 optional
benefits, primarily as a result of the elimination of adult dental services.
The May Revise provides $69 million in federal funds to offset reimbursable
mandates to counties for AB 3632 services. However, counties estimate
the cost of providing these services is approximately $120 million and
growing. The federal Individuals with Disabilities Education Act passed
in 1975, required state education agencies to provide mental health assessments
and services to students with disabilities. AB 3632, passed in 1984, transferred
responsibility for providing these mental health services from local education
agencies to local mental health agencies. This mental health program is
known as the AB 3632 program and is an entitlement program, paid for through
the SB 90 State mandates reimbursement process. There has been a disagreement
between the State and counties in recent years as to whether counties
are entitled to reimbursement for treatment services provided under AB
3632 at 100 percent of cost or 10 percent of cost. This budget proposal
is seen by some as the State’s acknowledgement that counties may
be entitled to more than 10 percent of cost. Because counties believe
that the State is required to fully fund this program and because this
proposal only funds one-half of the projected cost, the impact of this
budget proposal is unclear. DPH currently receives approximately $1.4
million for this program each year and believes that it will continue
to receive this amount in 2003-04.
The May Revise continues to propose reducing rates for Mental Health
Managed Care by ten percent. These funds are used to pay for private providers
and private fee-for-service inpatient hospital services. A ten percent
reduction to Mental Health Managed Care would result in a reduced allocation
to DPH of approximately $365,000, which would have been eligible for a
federal Medicaid match of an additional $365,000, for a total loss of
The May Revise reduces State discretionary funding for alcohol and drug
services, by $11.5 million in State General Fund, bringing total discretionary
alcohol and drug spending down to $5.8 million. DPH estimates that this
would reduce its funding by $308,000.
The Governor’s January budget provided only $2.3 million in new
State funds for ADAP and proposed raising an additional $7.2 million from
co-payments to be paid by ADAP clients. The Governor proposed co-payments
of $30 to $50 per prescription per month for individuals earning over
200% of the federal poverty level ($17,960 for an individual). The budget
also proposed to establish a waiting list to address the remaining $16
million shortfall in the program. The Governor’s May Revise, however,
reduces the co-payments to between $5 and $15 and adds additional funding
to the program, reducing the ADAP shortfall to $13 million. Despite these
improvements, advocates remained concerned about the potential impact
of the co-payments as well as insufficient funding for the program. Institution
of co-payments for ADAP is not expected to have a direct financial impact
on DPH since co-payments represent a shift of cost from the State to the
patient. The only impact on DPH would be increased administrative burden
that would result from collecting these new co-payments.
Having removed the California Healthcare for Indigents Program (CHIP)
from the revised Realignment II proposal, the May Revise proposes a major
reduction in CHIP funding for fiscal year 2003-04, citing reduced tobacco
tax revenues. Proposition 99 provides funding for CHIP, among other programs,
through a 25-cent tax on cigarettes and tobacco products. CHIP provides
funds to counties, hospitals and physicians for uncompensated care to
the medically indigent. It is estimated that DPH will lose approximately
$1.7 million in funding for CHIP as a result of the Governor’s proposal.
This represents a 52% reduction compared to fiscal year 2002-03 levels.
The Governor’s May Revision suspends 34 state-mandated local programs
for 2003-04. Suspension alleviates the responsibility of local governments
to provide the service, as well as the State to reimburse for them. The
May Revision also indicates that the Governor will pursue legislation
to repeal 27 of the 34 deferred mandates beginning in fiscal year 2004-05.
There are five mandates that relate to health and mental health, all of
which the Governor intends to repeal in 2004-05. This was the least clear
component of the Governor’s budget. In mental health, the programs
proposed for suspension and, ultimately, repeal, are significant and DPH
is not sure if it is the Governor’s intention to suspend the entire
categories of service or just a portion of those categories. DPH currently
receives a total of $5.3 million for the State-mandated local programs
scheduled for suspension and, ultimately, repeal. (Short-Doyle Case Management,
$2.7 million; Residential Care Services, $2.6 million, SIDS Contacts,
$300.) If the mandate were suspended, DPH would lose this revenue.
The May Revise relies heavily upon the Legislature’s passage of
the budget by the constitutional deadline of June 15th. If California
does not have a budget by the beginning of the fiscal year on July 1st,
Wall Street may no longer consider California an acceptable credit risk
and the State may no longer have the ability to borrow to bridge the deficit.
Adding further pressure to the State to pass an on-time budget, the State
Controller estimates that California will run out of cash to pay its bills
by the end of the summer and the California Supreme Court ruled on May
1st that State employees could be paid only minimum wage if no budget
was in place by the beginning of the fiscal year.
This work may also be done by the State’s elected leaders, together
called the Big Five, comprising the Governor, the President pro Tempore
of the Senate, the Speaker of the House, the Senate Minority Leader and
the Assembly Minority Leader. Once an agreement is reached, the full membership
of each House will vote on the final budget bill.
In addition to the fiscal authority provided in the budget bill, statutory
changes are often required to implement changes proposed in the budget
by the Governor or the Legislature. Separate bills, called “trailer
bills” are introduced to implement these changes and are heard concurrently
with the budget bill.
Passage of the budget requires a two-thirds vote in each House. Assuming
all Democrats vote together, two Republican Senate votes and six Republican
Assembly votes will be needed.
Once the budget is passed by the Legislature, the Governor has 12 working
days to sign or veto the budget bill. The Governor also has the authority
to “blue pencil” (reduce or eliminate) any item contained
in the budget. The Governor cannot, however, blue pencil trailer bill
language. The budget bill and its trailer bills become law as soon as
they are signed by the Governor.
- Commissioner Monfredini asked whose idea it was to move the debt forward
by borrowing. Ms. Johnson replied that the Republicans are supporting
this plan, but only through existing taxes. They would not support new
taxes to service the debt.
- Commissioner Monfredini asked what happens if Governor Davis does
not sign the budget within the 12 days. Ms. Johnson responded that the
bill would become law without his signature, but he would lose the ability
to use his blue pencil for any budget line item vetoes.
- Commissioner Monfredini asked whether the recall effort will affect
the budget process. Ms. Johnson replied in the negative, indicating
that she is not aware of when that election would occur if the petition
drive is successful, but that election would include all of the candidates
for governor as well as the question of whether to recall.
- Commissioner Guy asked about the impact of the State budget on Laguna
Honda operations. Dr. Katz responded that the City maintains reserves
to deal with the State budget. If the current budget passes the Department
is okay. If the State budget does not include the proposed tax increases,
the City does not have sufficient reserves.
- Commissioner Umekubo noted that providers have been active and vocal
in their opposition to the provider rate cut, and he is encouraged to
see that there have been some successes with this issue.
7) SAN FRANCISCO GENERAL HOSPITAL REBUILD UPDATE
Tony Wagner, Chief Executive Officer of Hospital Systems, presented the
San Francisco General Hospital Rebuild Update.
Mr. Wagner presented the background of the rebuild effort, noting the
SB 1953 requires that all California acute care hospitals must meet new
seismic safety standards by either retrofitting existing buildings or
by rebuilding a new hospital by 2013. The planning process to date has
Phase I: Exploratory Phase
Phase II: Long Range Service Delivery Plan (LRSD)
Phase III: Institutional Master Plan (IMP)
Phase IV: Collocation Feasibility
Mr. Wagner noted that Phase I focused on the meeting of the SB 1953 mandate.
The Health Commission approved Resolution #1-01 in January 2001, entitled:
“Supporting the Rebuilding of San Francisco General Hospital”,
supporting the rebuild of SFGHMC by 2013. A seven-week planning process
was initiated to explore the feasibility and cost of rebuilding.
Phase II was initiated in January 2002 to develop a long-range service
delivery plan for the City’s public health safety net system as
it impacts the rebuilding of SFGHMC. The LSRD program recommendations
- Initiate discussions with the UCSFMC to explore opportunities to partner
or collocate SFGHMC and UCSFMC at Mission Bay.
- Concurrently explore options for rebuilding SFGHMC at the current
- Incorporate best practices for moving ambulatory care services out
of the hospital and into the community.
- Expand the SFGHMC Level I Trauma Service and develop a medical air
- Explore opportunities to collaborate with UCSFMC on a Mothers’
and Children’s Hospital.
Phase III began in July 2002 with the goals to: 1) Ensure that the facility
plans stay true to the vision of the LRSD program goals, and 2) Interpret
SFDPH strategic healthcare planning objectives into forward thinking healthcare
delivery concepts. The key planning components for services include: acute
care, trauma/ED, behavioral health, outpatient services, research and
education, and a mothers’ and children’s hospital. The team
examined various configurations at both sites, and developed 41 possible
scenarios. All potential options were considered. The 41 scenarios were
evaluation based on criteria, including: patient access to care, adjacency
to critical services, adjacency of diagnostic and treatment and support
services, staffing efficiencies, adjacencies supporting academic medical
center’s mission, and access to research space.
IMP outreach was designed to:
- Inform relevant stakeholders about the Rebuild planning.
- Receive input from stakeholders to be used in the Rebuild planning
- Provide presentations to a wide variety of audiences, including DPH
staff, neighbors, consumers, and citywide groups.
- Afford stakeholders the opportunity to comment on the product of each
phase: scenarios, concepts, preferred concept.
- Present stakeholders input along with the product of each phase to
the Steering Committee and the Health Commission.
Approximately 228 attendees were present at 12 meetings.
Questions and concerns raised through these presentations included:
- Will the rebuild take funds from existing services?
- Would UCSF be as hospitable as SFGH?
- Lack of coordination between hospitals/duplication of services.
- Mission Bay is too far away.
- Mission Bay is contaminated landfill.
- Burial mounds exist at Mission Bay.
- Helipad if Rebuild is at Potrero.
Findings from these presentations include:
- Most people are favorably disposed to the rebuild.
- Low attendance at some presentations suggests that the Rebuild is
not a top priority.
- Little distinction is made between acute care and clinical services.
Stakeholder conclusions include:
- Consumers prefer the Potrero site
- Citywide groups would like to see more coordination with UCSF and
- Neighbors may oppose the Rebuild at the Potrero site due to the helipad.
Next steps will include focusing outreach for the next phase on encouraging
people to attend the Combined Advisory Committee (CAC) meetings, recruiting
representatives for the CAC from additional neighborhoods, and adapting
the presentation to address consumer interests and concerns more clearly.
The process of Phase IV, Collocation, included the objective to define
the best-case scenario for collocation, and was jointly pursued by both
UCSF and SFGH. There are significant differences in the missions and financial
support mechanisms for both institutions: SFGH/DPH provides care for all
funded largely through public sources. UCSF includes education and research,
and the medical center is self-funding. Governance and fiduciary responsibility
is non-negotiable; a single, fully integrated institution is not possible
at this time. No exact national model exists; Bellevue/NYU and Harborview/UW
are close, but not exact.
The best-case scenario practically for collocation would be two adjacent
hospitals with a single ED/trauma center on the SFGH side and single children’s
service on the UCSF side. There could be some shared ancillary and support
services with long-term flexibility to share built into the campus plan.
The conclusion is that unless substantive advantages to collocation can
by identified for UCSF Medical Center, collocation is not an option for
Mr. Wagner presented two recommendations:
- No further collocation discussions are indicated at this time.
- Three scenarios should be further developed into design concepts:
- An acute care hospital, Level I trauma center and outpatient services
be located on the Potrero site.
- An acute care hospital, Level I trauma center and outpatient services
be located on the Mission Bay site.
- An acute care hospital and Level I trauma center be located on
the Mission Bay site with outpatient services at the Potrero site.
- Commissioner Umekubo asked whether scenario two is stand-alone or
collocation with UCSF. Mr. Wagner responded that currently it is stand-alone.
The medical staff indicated that they prefer to rebuild at Mission Bay
whether stand-alone or collocation. Dr. Katz added that this arises
from the medical faculty as it would give them more access to research
facilities since UCSF is more likely to build additional research facilities
at Mission Bay than they are at the current SFGH Campus.
- Commissioner Umekubo asked about land availability at Mission Bay.
Mr. Wagner responded that there are 24 acres available at Mission Bay.
The Department does not own the property at Mission Bay as it does at
- Commissioner Parker expressed his respect for the process, noting
that it takes time to consider everyone’s input, and expressed
the need to keep up the pace. He noted that with partnerships, all partners’
liability increases, and the Department has a need to control its own
mission and destiny. We’ve been bending over backward to make
everyone happy, which it’s clear we can’t do, and we need
to move forward. There is no luxury to procrastinate. With this in mind,
- Rebuilding SFGH at the Potrero site
- Maintaining the trauma center at Potrero
- Establishing a helipad at Potrero
- Maintaining the UCSF affiliation
- Finalizing the design for needed facilities
- Developing the cost analysis and plan
- Presenting a very clear and confident plan regarding the chosen
- Ultimately, the voters and Board of Supervisors will have the last
voice in this. It’s important that when this goes to the Board
and voters that DPH be clear about the reasons for our choice, and that
they have sufficient time for review and comment. The Department also
needs time to develop the bond initiative.
- Commissioner Sanchez thanked the staff for listening to the different
voices in preparing this report. The Department needs to make a decision
to move. Mission Bay consists of three different worlds: basic research,
clinical research, and applied. The mission for the Department and SFGH
is clear. We need to stay the course, our doors are always open, and
we need to move on.
- Commissioner Monfredini supports the rebuild at Potrero. She indicated
that she can’t imagine how the Department would afford the property
at Mission Bay, and it already owns the property at Potrero.
- Commissioner Penn expressed two concerns: 1) Convincing people that
the bond measure makes sense. DPH needs to make a strong case of why
this needs to happen, 2) Feasibility of Mission Bay is next to impossible.
Purchase price of the land alone makes it impossible. A fundamental
issue is to what extent does DPH value the research enterprise at SFGH
and keep it the same or increase it in the future. The Department wants
to maintain a positive relationship with UCSF, and while that won’t
change, the Department needs to be mindful of it. DPH’s mission
is different from UCSF. He suggested: 1) that DPH know how many faculty
are at SFGH who have laboratory space and do research, and the square
footage of lab space at SFGH, and 2) what percentage of SFGH staff also
have appointments at UCSF. Mr. Wagner responded that the Department
can’t take for granted the passage of the bond issue. The Department
needs to make a cogent case that answers all of the public’s questions.
DPH needs to go through a similar process as was done with the Laguna
Honda rebuild. He additionally noted that research enriches UCSF. DPH
can’t ignore this, even though it’s not part of the funding
currently. He does have the two pieces of information Commissioner Penn
requested and can provide it.
- Commissioner Umekubo asked under scenario two, what happens with the
Potrero site. Mr. Wagner responded that the Department could bring much
of its far-flung programs to the campus.
- Commissioner Umekubo asked about a timetable for the final decision.
Mr. Wagner responded that by October DPH needs to have a concept on
which it can move forward. By July 2004, it needs to have the okay to
move ahead with the bond issue.
- Commissioner Umekubo commended the staff for doing its due diligence.
Dr. Katz responded that the process has been useful in the collocation
discussions. For the EIR, it is important that more than one viable
site be considered, and the Department will need to show it has done
its due diligence in investigating other siting. Mission Bay represents
the only available land mass with the Department’s service area.
He did note, however, the challenge of running a hospital while also
building a hospital at the same site. The process demands that it is
not by intuition or history that we end up at that site, but that we’ve
looked at a number of viable sites, and chosen the most viable.
- Commissioner Guy reported that Commissioner Chow relays his support
in pursuing the three recommendations. Commissioner Guy also expressed
her support to move in this direction. DPH needs to get out all of the
questions as to these options as the timing is now getting narrower.
She thanked the staff, and particularly Mr. Wagner, for leading the
Department into the next decade. She added that community relations
need to be strategic also. The broader Mission community also needs
to be considered, not just the area around the current Potrero site.
Mr. Wagner responded that there are plans to engage the wider community.
- Commissioner Sanchez noted the need to engage key supporters for the
bond issue, including the UCSF academic faculty. Mr. Wagner responded
that the SFGH Foundation will be key to making those connections.
- Commissioner Parker asked that given the fall timeline, will DPH need
to collect more data, or is that data available, and can the Department
keep on schedule. Mr. Wagner responded that the staff has components
of the needed data, and needs direction from the Health Commission regarding
which scenarios to develop. He indicated that staff has enough time
to complete its work on time. He added that research is most key; the
medical staff will support the rebuild if research stays on Campus,
which is possible on the existing Potrero Campus. The August 19 Health
Commission meeting will provide a preliminary update on the concepts,
but is not the final decision point.
- Commissioner Guy thanked the staff for including the letter from UC
in the Commission packets, as it helps to answer many of the public’s
8) PUBLIC COMMENTS
There were no public comments.
The meeting was adjourned at 5:30 pm.
Jim Soos, Acting Executive Secretary to the Health Commission