Minutes of the Health Commission Meeting Tuesday, November 18, 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 3:06 p.m. Present: Commissioner Edward A. Chow, M.D., President Commissioner Roma P. Guy, M.S.W., Vice President - left at 4:45 p.m. Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner David J. Sanchez, Ph.D. Absent: Commissioner Michael Penn, Ph.D. Commissioner John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE MEETING OF NOVEMBER 4, 2003 Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez) approved the minutes of the November 4, 2003 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Monfredini chaired, and Commissioner Chow attended, the Budget Committee meeting. Commissioner Umekubo and Commissioner Penn were absent. (3.1) PHP-AB75 Project - Request for approval to authorize adoption of the County Description of Proposed Expenditure of California Healthcare for Indigents Program (CHIP) funds for fiscal year 2003-04. (3.2) CHN-Primary Care - Request for approval of a retroactive renewal contract with Bayview Hunters Point Multipurpose Senior Center, in the amount of $55,554, to provide therapeutic day treatment services for frail elders and disabled persons living in the Southeast quadrant of San Francisco, for the period of July 1, 2003 through June 30, 2004. (3.3) AIDS Office-HIV Prevention - Request for approval of a retroactive contract modification with Better World Advertising to increase the contract amount by $150,000 for a new contract total of $520,000, to provide HIV prevention social marketing campaign services targeting behavioral risk populations, for the period of January 1, 2003 through December 31, 2003. Commissioners’ Comments (at Health Commission meeting) Commissioner Parker asked what outcome objectives are being measured. Mr. Windt, Executive Director of Better World Advertising, described the evaluation that was done for FY 2002-03, and submitted a copy of the evaluation. Jimmy Loyce added the AIDS report would focus on the connection between research, prevention, health service, and infection rates. (3.4) AIDS Office-HIV Health Services - Request for approval of a retroactive renewal contract with Positive Resource Center, in the amount of $140,000, to provide employment development services targeting people living with HIV/AIDS who are seeking to enter/re-enter the workforce, for the period of July 1, 2003 through June 30, 2004. CHPP-Health Promotion - Request for approval of a sole source retroactive contract renewal with Booker T. Washington Community Services Center, in the amount of $285,000, to provide SevenPrinciples Project services targeting African Americans, for the period of September 30, 2003 through September 29, 2004. Commissioners’ Comments Commissioner Monfredini requested an update to PHP JCC in Spring 2004 on the status of hiring a permanent executive director. (3.6) BHS-Mental Health - Request for approval of a retroactive contract renewal with the Homeless Children’s Network, in the amount of $255,697 per year, for a total contract value of $1,022,716, to provide mental health services for the period of July 1, 2003 through June 30, 2007. (3.7) BHS-Mental Health - Request for approval of a retroactive contract renewal with NICOS Chinese Health Coalition, in the amount of $67,872, to provide mental health outpatient services for the period of July 1, 2003 through June 30, 2004. Commissioner Chow abstained from voting on this item. (3.8) BHS-Mental Health - Request for approval of a retroactive contract renewal with Progress Foundation, in the amount of $9,729,503, to provide mental health, residential, outpatient and day treatment services targeting adult residents of San Francisco, with special services for senior, African American, Asian, Latino and homeless communities, for the period of July 1, 2003 through June 30, 2004. Commissioners’ Comments Commissioner Monfredini commended the agency for its consistent high scores across programs. Mr. Fields noted that DPH is working with its larger service providers such as Progress Foundation to develop a measurable outcome strategy that looks at the systemic effectiveness, rather than evaluating unit-by-unit, program by program. (3.9) BHS-Mental Health - Request for approval of a retroactive contract renewal with West Bay Pilipino Multi-Service Center, in the amount of $67,200 per year, for a four-year contract total of $268,800, to provide mental health services targeting immigrants transitioning to community care, for the period of July 1, 2003 through June 30, 2007. Commissioners’ Comments Commissioner Monfredini asked for the performance report to be presented to the CHN JCC when it is completed. Commissioner Chow noted that this is one of the few contracts that serve the Filipino community. He asked how many Filipino youth are being served by DPH and where these services are provided. Ms. Chan Sew said DPH serves approximately 400 Filipino youth under 19. They receive services through this contract, through the Balboa Teen Clinic, through RAMS, and programs like the Family Mosaic program that has a Tagalog-speaking staff person. Commissioner Chow asked for a special report to the CHN JCC about the various services that serve the Filipino and other smaller Asian communities. Ms. Chan Sew noted that Japanese Community Youth Center is in the process of completing a needs assessment for Asian youth in San Francisco. (3.10) BHS-Mental Health - Request for approval of a retroactive contract renewal with Westside Community Mental Health Center, Inc., in the amount of $6,393,212, to provide mental health services and fiscal intermediary services targeting adults and youth/adolescents, for the period of July 1, 2003 through June 30, 2004. (3.11) BHS-Mental Health/Substance Abuse - Request for approval of a retroactive contract renewal with Walden House, Inc., in the amount of $9,135,851, to provide residential mental health and substance abuse treatment services, for the period of July 1, 2003 through June 30, 2004. This contract was continued to the December 2nd Health Commission meeting. (3.12) BHS-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 $7,287,312, to provide substance abuse and mental health services targeting adults and children, for the period of July 1, 2003 through June 30, 2004. Commissioners’ Comments Commissioner Monfredini congratulated the agency for its performance. The agency had some difficult years but those are behind us and the services are excellent. Commissioner Chow commended the agency for receiving three-year accreditation by the Commission for the Accreditation of Rehabilitation Facilities. (3.13) BHS-Substance Abuse - Request for approval of a retroactive contract renewal with Haight Ashbury Free Clinics, Inc., in the amount of $5,617,050, to provide substance abuse treatment services for residential, outpatient, day treatment, prevention and outreach programs, for the period of July 1, 2003 through June 30, 2004. Commissioners’ Comments Commissioner Monfredini asked how the agency plans to turn around its services. Ben Eiland from Haight Ashbury Free Clinics replied the infrastructure has been put in place and the programs are improving. Commissioner Monfredini asked for a progress report through the CHN JCC to the Budget Committee in three months. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez) approved the Budget Committee Consent Calendar, with the exception of Item 3.3, which was discussed separately, and Item 3.11, which was continued to the December 2nd Health Commission meeting. Commissioner Chow abstained from voting on Item 3.7. After separate discussion, the Commission approved Item 3.3. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Governor Schwarzenegger Yesterday, Arnold Schwarzenegger was sworn in as the 38th governor of California. As he pledged in his campaign, Governor Schwarzenegger's first acts in office included an Executive Order rescinding the recently increased vehicle license fee, and a call for three special legislative sessions to address workers' compensation reforms, drivers' licenses for undocumented immigrants, and the State budget. The vehicle license fee funds local government and realignment for health, mental health and social service programs and a rescission of the discounted fee requires an equal contribution from the State General Fund to keep county budgets whole. The Executive Order orders reinstatement of the General Fund offset for local government and refunds to taxpayers who have already paid the higher fee. However, these funds must first be appropriated by the Legislature, which the Governor has requested they do in special session. The Governor's second executive order suspended all proposed State regulations for 180 days and called for a 90-day review of current regulations imposed under the Davis administration to determine if they cause "undue harm to California's economy." Grants Awarded to DPH by the San Francisco Health Plan Dr. Katz announced that five grants totaling $426,085 were awarded to DPH by the San Francisco Health Plan through its “Access Enhancement Fund.” Sincere thanks go to the Health Plan for their support and congratulations go to the awardees for their following proposals: UCSF/SFGH/Children’s Health Center to extend evening and weekend hours; Ocean Park Health Center to implement and evaluate a chronic care model for treatment of diabetes; Chinatown Public Health Center with the Department of Ophthalmology to purchase equipment for a mobile program that would provide ophthalmologic services at many sites in DPH; SFGH Urgent Care Expansion to purchase equipment for a six-fold increase in urgent care exam rooms; and UCSF/SFGH/Children’s Health Center to expand asthma clinic appointments by 45%. Occupational and Environmental Health Section (OEHS) Clean and Green The new OEHS Clean and Green Programs assist San Francisco regulated businesses in developing more ecologically sustainable business practices. The OEHS Clean and Green Program was launched in 2002 and focused first on toxics use reduction and product substitution. The Clean and Green Program is currently focusing on the automotive industry and 47 of these businesses are now operating "clean and green". Dr. Katz reported that OEHS received a $36,000 grant by the San Francisco Foundation to support our Hazardous Material's program's Clean and Green business development with the SF Mission District auto repair facilities. The project will develop a Toxics Reduction Campaign with input from neighborhood businesses and then train local businesses on regulatory compliance, on strategies to reduce their use of toxic chemicals, and opportunities to reduce pollution. State Rehabilitation Council Appointment Congratulations to Eric Ciasullo, Director, HIV/AIDS Return to Work Initiative, for his recent appointment to the State Rehabilitation Council. Mr. Ciasullo is also president of the Board of Directors of the National Association of People With AIDS and has fought the HIV/AIDS epidemic for more than 15 years. Natural Gas Rate Increases Last week, the Public Utilities Commission notified all departments that natural gas rates are going up. Using the most likely scenario, the potential impact to DPH is over $840K. TB Program News Beginning November 3, 2003, the San Francisco TB Control program in collaboration with the Department of Public Health Laboratory will begin using the QuantiFERON-TB Test (QFT) to screen selected patients for TB, in place of the tuberculin skin test (TST). The QFT is an FDA approved blood test for use as a diagnostic aid in the detection of latent tuberculosis infection (LTBI). The QFT test will initially be available through the TB control program, and DPH is planning expansion of availability to all Health Department clinics in San Francisco currently providing TB testing. Naloxone Distribution Last weekend DPH became the first public agency in California to begin distributing anti-overdose medication to heroin addicts. The Naloxone program requires people who receive the drug to be trained in how to administer it to overdose patients. Last year in a study partially funded by DPH, 24 addicts were trained and given Naloxone. Study results showed that participants witnessed 20 overdoses, using Naloxone successfully in 14 cases. The other six overdose victims were not given Naloxone for various reasons. Naloxone has almost no side effects, it works by blocking opioid receptor sites in the brain. McMillan Sobering Center KTVU Channel 2 sent a reporter and crew to take a look at the new McMillan Sobering Center recently. They will be airing a special seven-minute segment on Sunday, November 30, during their 11 p.m. news magazine hour, “Second Look.” Thanks to Barry Zevin, MD, Medical Director, and his staff for coordinating the activities of the reporter and crew. DHS Star Performer Award Congratulations to Leah Thiebaut and Lannie Heaney, DPH Foster Care Public Health Nurses, for being recognized by DHS as a "DHS Star Performer". This is the fifth year DHS is doing this. The program is specifically intended for DHS employees to recognize their accomplishments, yet these two individuals were nominated, as they were thought very highly of by colleagues at DHS in their role as vital partners to the smooth and efficient delivery of health care services for children in foster care. The award will be presented at a private reception today at Herbst Theater. Emergency Drill Last Thursday EMS and Emergency Operations Section (EMSEO), and Community Health Epidemiology and Disease Control (CHEDC) coordinated the local exercise of the statewide health and medical disaster exercise. This exercise evaluated the City and County of San Francisco's capability to respond to medical and health needs following the deliberate dissemination of a biological agent within a fictitious indoor concert. Following the discovery of the release of a biological agent within San Francisco, CHEDC dispatched and coordinated epidemiological surveillance teams to identify patients, and potential patients. CHEDC also issued health alerts to clinicians and health care facilities citywide, and worked with the Public Information Officer to develop critical public information. At the Department’s Operating Center (EOC), EMSEO queried and coordinated the medical response of every hospital and ambulance provider within San Francisco. Representatives from DPH Human Resources and Operations provided logistical support, including securing personnel and vehicles, which would be necessary during a real incident. Additionally, the Office of Emergency Services Amateur Communication System provided redundant communications with DPH health care institutions, and regional OES. As in any exercise, DPH identified areas for improvement, but also learned that steps the Department has taken since September 11, 2001 have materially improved its ability to respond to a biological or other critical incident. Community Health Network/San Francisco General Hospital Credentials Report: November 2003, Health Commission - Director of Health Report (From 11/10/03 MEC and 11/18/03 JCC) 11/03 7/03 to 11/03 New Appointments 18 71   Reinstatements 1 Reappointments 31 127   Delinquencies 0 0   Reappointment Denials 0 0 Resigned/Retired 8 62 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Changes in Privileges   Additions 3 66   Voluntary Relinquishments 0 1   Proctorship Completed 26 41 Current Statistics - as of 11/1/03 Active Staff 426 Affiliate Professionals (non-physicians) 166 Courtesy Staff 520 Total Members 1,112 Applications In Process 17 Applications Withdrawn Month of Jan 2003 1 7(07/03 to 11/03) SFGH Reappointments in Process Def 2003 to Mar 2004 205 Commissioners’ Comments Commissioner Chow asked if the new blood test for TB would differentiate people with BPG. Dr. Katz said it would. Commissioner Chow asked if this testing in more expensive. Dr. Katz said they are currently piloting the program, but he anticipates that test will eventually be used in all places where testing is done. Dr. Katz said it is likely the test itself is more expensive, but is more efficient in terms of staff time, so it should not be more expensive to administer. Commissioner Guy asked how much San Francisco gets from the Vehicle License Fee. Gregg Sass said the total VLF currently is $192.4 million comprised of $79.8 million for health and welfare and $112.6 million of discretionary funds. The amount eliminated by the Governor was $129.9 million comprised of $53.9 million of H&W and $76 million of discretionary. For this fiscal year, Mr. Sass anticipated that the increased fees would only be there for the last 9 months of the current year and did not budget $38.3 million. So the current year reduction is $91.6 million citywide. Next year the cut would be the full $129.9 million. Assuming DPH’s share is approximately 20% of discretionary GF, it would have exposure of $18M this year and $26M next year, but there is great pressure to get the cuts backfilled by the State and it is too early to predict what the final effect will be. The commitment to backfill H&W is a concern as it could theoretically be funded from the discretionary component. But Mr. Sass was also told that there is public safety money in that portion which would be politically risky to raid. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF OCTOBER Individual Awardee Division Nominated by Dorlee Chavez, RN Southeast Health Center Cheree Richson, Principal Clerk, Southeast Health Center Team Awardees Division Nominated by Barry Zevin, MD Jorge Solis Wylie Liu McMillan Stabilization Pilot Project Barbara Garcia, PHP Deputy Director Commissioner Chow presented a Certificate to Sister Miriam Walsh for her 21 years of dedicated service at Laguna Honda Hospital Pastoral Care. 6) HEALTH CARE ACCOUNTABILITY ORDINANCE UPDATE AND CONSIDERATION OF A RESOLUTION URGING THE BOARD OF SUPERVISORS TO INCREASE THE HOURLY FEE AND A RESOLUTION TO AMEND THE MINIMUM STANDARDS Anne Kronenberg, Deputy Director of DPH, provided the Commission with an update on the Health Care Accountability Ordinance (HCAO). HCAO requires that City contractors or lessees provide health coverage or pay a fee to DPH to offset the City’s costs of caring for the uninsured. The goal of the ordinance is to insure the workforce. Business may comply with HCAO by offering insurance that meets the minimum standards or make payments to DPH to offset care for the uninsured. A third option, a local health coverage plan, has been determined to be economically unfeasible. Minimum Standards - Background and Recommendation The Health Commission has sole responsibility to evaluate and update the minimum standards. Current minimum standards, set in 2001, are not in line with available small business health plan options. At the previous HCAO update to the Commission, staff believed that AB 2178 was a partial solution for small businesses, but PacAdvantage products do not meet the minimum standards. Insurance costs are increasing and co-payments are more expensive. The staff recommendation is keep the components of the benefit package the same, but increase allowable co-payment amounts. (Ms. Kronenberg pointed out that, since the report was developed, there has been discussion about an alternative recommendation. This was discussed later in the presentation.) The increase would allow employers to purchase 2 of 3 PacAdvantage plans, 3 of 4 Kaiser plans and 1 of 3 Blue Shield Plans. Increased Fee to DPH - Background and Recommendation Companies can choose to make a payment to DPH rather than providing insurance. The fee is $1.50 per hour per employee, with a maximum fee of $60 per week per employee. In FY 2002-03 DPH collected $153,755. The Health Commission may review the fee and recommend a change to the Board of Supervisors. The monthly maximum for the HCAO fee is $240, which is less than the project monthly insurance premium cost for 2004. Staff believes that the HCAO fee should not cost less than the average monthly premium, so recommends increasing the fee from $1.50 per hour to $2.00 per hour. The weekly maximum would be $80 and the monthly maximum $320 per employee. Ms. Kronenberg said they still believe that small businesses should have access to plans that meet the minimum standards. There may be another option to have a two-tiered system whereby larger businesses would be required to meet the current minimum standards, and the revised standards would only apply to small businesses. Larger businesses have the ability to negotiate for packages, and can negotiate one that meets our standards. Smaller businesses do not have this option. Staff does not have a recommendation yet, and would like more time to develop this alternative. Dr. Katz added that, regardless of what the Department and Commission may desire in a health insurance product, there are realities in the marketplace and it does no good to specify requirements that do not exist. However, in talking to the advocates, it was felt that the larger employers might use the revised standards to water down their current health benefits. This led to the idea of a bifurcated system. Dr. Katz has asked staff to research the issue further, and identify the most appropriate definition of small business. Dr. Katz said they also considered the option of reducing the scope of benefits, but ultimately decided against making this recommendation. Public Comment Karl Kramer, San Francisco Living Wage Coalition, asked the Commission not to approve an increase to the co-pay, and re-examine the creation of a city administered health insurance pool. The taxi drivers’ legislation, passed in 2002, mandates a similar pool. This would take the insurance companies out of the loop. He supports increasing the fee the businesses pay. Richard Heasley, Executive Director of Conard House, representing the Mental Health Contractors Association, said the sooner the City pool becomes available, the better. There is no funding for this unfunded mandate, and it is not clear if the City will fund the payment increase. He is also concerned that this requirement only impacts a small number of on-call employees at his agency, and inserts the City in the agency’s labor negotiating process. Debbi Lerman, Human Services Network, said the HSN supports delaying the decision on this issue, as the recommendations have not been fully aired. One concern is dealing with on-call, temporary workers who only occasionally work 15 hours per week. In addition, there was a commitment by the City to provide a pass-through to non-profits to fund this requirement, and this has not been consistent. Need to ensure that there are affordable, mid-level plans available. Dale Butler, SEIU 790, SEIU is concerned about the co-payment increases. He said the ordinance has been a powerful tool for getting for-profit businesses to provide health insurance. He supports further examination of the bifurcated approach. Dale Hess, San Francisco Convention and Visitors Bureau, said it has been a struggle to find carriers to provide coverage to part-time employees that meets this ordinance. No carrier is willing to talk to businesses about covering people who work 15 to 20 hours. He is also confounded by the requirement to pay individuals who do not live in San Francisco the $1.50 per hour, but employees who live in San Francisco do not get the money-it goes to SFGH. He supports the creation of a local insurance pool. He also said that any insurer that offers insurance to City employees should be required to provide insurance to this group of employees. Commissioners’ Comments Commissioner Chow asked Rich Waller, Office of Contracts Administration, how many employees are covered by this ordinance. Mr. Waller said there are approximately 3,500 contracts that are subject to this ordinance, but he does not know how many employees are covered by these contracts. This is identified through individual, investigative audits. To date they have audited 73 contracts. Commissioner Sanchez asked if the audits found differences in compliance rates between non-profit and for-profit companies. Mr. Waller said that there is no difference. Commissioner Parker endorses universal health coverage, and the basic problem is that small businesses cannot get insurance for their employees. There will never be universal coverage until there is something for small businesses. Commissioner Parker said this issue has not been adequately examined, and the co-payment should not be increased until there is more information. Commissioner Monfredini said that she supports the two-tiered system. She wants small businesses to be able to provide insurance, and not have to make the decision to fire employees in order to meet the requirements. She supports delaying action until more research has been done. Commissioner Sanchez supports further analysis of a two-tiered system. Commissioner Guy supports further research of a two-tiered system, with a few cautions. The problem of spiraling health care costs cannot be solved at the local level. We need to maneuver through the system, and find ways to provide insurance to our workers. Commissioner Chow also supports further analysis of this issue. The public raised an interesting idea of requiring businesses that provide insurance through the Health Service System to provide a product for this pool of workers. Commissioner Chow said a local pool was not economically viable for 400 employees. But if we identify a greater number of people, perhaps we can re-examine a local program. Dr. Katz will reevaluate the feasibility of developing a local pool, although there are significant challenges. Dr. Katz said he can bring this issue back to the Commission in two months, about the two-tiered system and other steps that can be taken. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Sanchez) deferred action on the two resolutions. 7) CHARITY CARE REPORT AND CONSIDERATION OF A RESOLUTION SUPPORTING SAN FRANCISCO’S CHARITY CARE ORDINANCE AND URGING FULL COMPLIANCE WITH ITS PROVISIONS Colleen Johnson presented the Fiscal Year 2001 San Francisco Charity Care Report. This report is required by the Charity Care Ordinance, which was passed by the Board of Supervisors and signed by the Mayor in 2001. The goal of the ordinance is to enable the City and County of San Francisco to evaluate the need for charity care in the community and to plan for the continued fulfillment of the City’s responsibility to provide care to indigents and the uninsured. The ordinance contains both reporting and notification requirements. Hospitals subject to the ordinance are CPMC, Chinese Hospital, St. Francis Memorial Hospital, St. Luke’s Hospital and St. Mary’s Medical Center. SFGH is exempt from reporting, it has voluntarily complied with the ordinance for both years that reporting has been required. In addition, Kaiser voluntarily complied with the ordinance for this reporting cycle, and UCSF has indicated that it intends to comply with the ordinance for FY 2003. (Public hospitals and HMOs regulated by the State Department of Managed Care are exempt from reporting under the ordinance.) Chinese Hospital participates in the Hill-Burton program, and Hill-Burton charity care is excluded from the City’s and State’s definition of charity care. Ms. Johnson provided a summary of the information that was provided by the reporting hospitals. The five reporting hospitals received 142,620 applications for charity care. Between 113 and 123 applications were denied. Though charity care services are provided to residents throughout the City, the largest proportions of charity care services continue to be provided for patients who reside in the Tenderloin, the Mission, Bayview/Hunters’ Point and Potrero Hill neighborhoods. A total of 83,285 charity care services were provided by the reporting hospitals. SFGH provided 81% of those services. St. Mary’s and St. Luke’s each provided 8%. The types of charity care-inpatient, outpatient, emergency-provided by each hospital varied. Hospitals’ charity care expenditures ranged from approximately $900,000 at St. Francis to approximately $56 million at SFGH. When comparing the percentage of all licensed beds to the percentage of charity care provided, SFGH provided a disproportionate amount of charity care services. Together, all six reporting hospitals provided $35 million in charity care in excess of the benefits from tax exemption. However, when SFGH is excluded, the five non-public reporting hospitals received tax benefits of $21.2 million beyond what they provided in charity care. Two of the five hospitals-St. Mary’s and St. Luke’s-provided charity care in excess of tax benefits. Looking forward, legislation that expands charity care reporting and policy requirement was introduced by Senator Ortiz, but died in the 2002 legislative session. It may be addressed again in 2003. There will be changes to the State charity care guidelines. Public Comment Fred Seavey, SEIU 250, said the Union supported this ordinance to educate people about their ability to get health care via charity care, and ensure that policy makers have an array of information about services available. The report clearly indicates the failure of the City’s largest hospital to provide any significant charity care. CPMC enjoyed tax breaks of $61 million, sent $100 million in profits to its parent company in Sacramento, yet only provide $1.5 million in charity care. Leslie Bennett, Consumers Unions, supports the ordinance and the reports that have been generated by DPH. The reports provide a full picture of the charity care provided in San Francisco. It is unfortunate that even though the ordinance has been in effect for more than a year, there are still hospitals that do not comply. They support all efforts to bring hospitals into compliance, including levying fines. Commissioners’ Comments Commissioner Monfredini said DPH should ask the City Attorney to begin the process of civil action against non-complying hospitals. Also, she is disappointed that St. Luke’s denial rate increased since it was taken over by Sutter. Finally, she is disappointed that CPMC provides so little charity care and gets such large tax breaks. She noted that the Hospital Council should have been at the meeting to address the Commission and answer questions. Commissioner Sanchez said this reports gives DPH a baseline of data; now DPH need to take that to the next steps of pursuing civil action. He said it is so frustrating for the Health Commission to sit through Proposition Q hearings where hospitals say they are going to do various things, and then see that they are not in compliance, and do not provide their share of charity care. Commissioner Chow complemented Ms. Johnson for her continued diligence with the report and getting the Commission the most updated information. It is disappointing that the Hospital Council has not provided the Commission with any comments. This report was distributed early at their request. This is an important report. Action Taken: The Commission (Chow, Monfredini, Parker, Sanchez) approved Resolution #18-03, “Supporting San Francisco’s Charity Care Ordinance and Urging Full Compliance with its Provisions,” (Attachment A). 8) PUBLIC COMMENTS - Kevin Horne spoke about the restrictions in the methadone maintenance program. Mandatory detox can lead to serious convulsions or even death. He asked that a panel of doctors discuss this problem. 9) ADJOURNMENT The meeting was adjourned at 5:35 p.m. Michele M. Olson, Executive Secretary to the Health Commission