|Service and Contractor(s)||Previous Amount||Modified Amounts||New Contract Amounts|
|Air Duct Cleaning|
|Air Duct Cleaning Specialists||$ 49,500||No Change|
|Waters Environmental Services||$100,000|
|Angotti & Reilly, Inc.||$200,000||$500,000|
|Yerba Buena Engineering||$ 75,000|
|Door and Wall Protectors|
|Elischer Construction||$ 35,000||$ 45,000|
|Fire Curtains Maintenance|
|United California Glass||$ 50,000|
|Waters Environmental Services||$100,000|
|Anderson Carpet & Linoleum||$125,000||$275,000|
|United California Glass||$ 40,000||$ 90,000|
|High Pressure Steam Cleaning|
|Steam On Wheels||$ 49,500||No Change|
|Robert W. Poyas, Inc.||$ 35,000||$ 60,000|
|The Shooter Co.||$ 50,000||$ 80,000|
|Bay City Boiler & Engineering||$ 50,000|
|Modular Furnishing Modification|
|Galindo Installation & Moving||$ 40,000|
|Motorized Doors and Gates Maintenance|
|United California Glass||$ 45,000|
|William Decker & Co.||$75,000||$150,000|
|Sabel Painting Co.||$100,000||$200,000|
|Birds Away||$ 49,500||No Change|
|Agbayani Construction||$ 50,000||No Change|
|Pribuss Engineering||$ 100,000||No Change|
|Acker & Guerrero Roof Co.||$ 150,000||No Change|
|Lawson Roofing Co.||$100,000|
|Western Roofing Services||$100,000|
|Total of Contracts Not Modified||$448,500(c)|
|Combined Totals (a+b+c)||$5,373,540|
Secretary’s note – A revised report was submitted to the Budget Committee, correcting the contract totals.The new title is:“Request for Approval of Thirteen (13) Contract Modifications and Eleven (11) New Contracts to Increase the Total Combined Amounts by $2,920,020, from $1,933,500 to $4,853,520 for the Period of July 1, 2003 through June 30, 2005.
Patrick Monette Shaw said if the funds for this contract were not included in the DPH budget, then the item should be tabled.
Action Taken:The Commission (Chow, Guy, Monfredini, Parker, Penn, Umekubo) approved Items 3.1 through 3.6, 3.10 through 3.13, and 3.15 through 3.17 of the Budget Committee Consent Calendar.
At Commissioner Parker’s request, Items 3.7, 3.8 and 3.9 were voted on separately.The Commission (Chow, Guy, Monfredini, Penn, Umekubo) approved these items, and Commissioner Parker, after noting dissatisfaction with the agencies’ low Client Satisfaction ratings, voted no on these three contracts.
Item 3.14 was continued to the next Health Commission meeting.
4) DIRECTOR’S REPORT
City Budget Process
The Mayor's Office issued initial budget instructions for the remaining six months of FY 2003-2004 and for development of the FY 2004-2005 budget.
Current Fiscal Year
Due to the State's fiscal crisis, the City currently faces additional possible losses in State funding in FY 2003-2004. These losses range from $25 million from the local impact of the Governor's mid-year reduction proposal to $92 million from the potential loss of vehicle license fee revenues. This is in addition to the $52 million in State revenue losses to date.
General Fund departments have been instructed to prepare a prioritized State budget contingency plan by January 16th. The plan is to address the possible loss of 7.5% of our currently year General Fund support or approximately $19 million. Given the likely severity of these reductions, the savings may be a mix of ongoing and one-time adjustments, with an implementation date of April 1st. We expect to know more about the need to implement the plan by the end of January when the backfill funding for the vehicle license revenues and the Governor's mid-year cuts are reviewed by the Legislature.
In addition to the contingency plan, the Mayor has instructed departments to lower the budgeted rate of attrition to 6% or lower by eliminating vacant positions and reducing attrition savings rates. The list of vacant position elimination is due January 16th.
FY 2004-2005 Budget Preparation
Assuming there are no additional State losses and the current levels of employee take-home pay, the Mayor's Office is projecting a $160 million local shortfall for FY 2004-2005. While this is less than previous years, it hinges on successfully renegotiating the majority of the City's 40 labor agreements.
The major components of the shortfall are the reduction of the starting balance and reserves totaling $40 million, loss of one-time revenue sources totaling $65 million, fixed labor cost increases and benefit cost increases totaling $80 million and debt, welfare and other cost increases of $30 million and growth in the City's general revenue totaling $55 million. There is however, significant budget uncertainty in the State budget in FY 2004-2005 and the City's Retirement Board is currently considering actuarial assumptions changes that may increase the employers contribution rates by as much as $50 million.
The Mayor's Office has instructed departments to assume the absorption of a target equal to citywide benefit cost increases which total $55 million citywide within their General Fund target. Although we do not have a final numbers, we expect that this will be approximately 5.5% of our General Fund subsidy or approximately $14 million. Only ongoing changes may be proposed. In addition, departments are instructed to submit a State contingency plan equal to 15% of the budget year General Fund support or $35 million.
Beginning in early December, the Adult Immunization Clinic (AIC) began to see a significant increase in demand for flu shots. In the six days between December 5th and December 12th, the AIC gave out 2,244 doses of flu vaccine to the public. Friday, December 12th, was the busiest day with the AIC giving out 472 doses of flu vaccine within 7 hours.
Due to the severity of influenza cases this year and the deaths of children from influenza, most pediatric offices were out of vaccine. Parents came in large numbers to the AIC to get vaccine for their children. The AIC, which generally provides vaccination services to adults, changed its children’s vaccination policy to accommodate the needs of parents requesting the vaccine for their children. The AIC provided flu injections to individuals 15 months old and above. For children between the ages of six months and 15 months, the AIC provided pre-filled syringes of pediatric vaccine for parents to transport to their pediatrician’s offices in order to avoid safety concerns in the event of egg allergies.
With the supplies of adult flu vaccine nearly depleted by Friday, December 12th, the Adult Immunization Clinic began restricting adult vaccine to high-risk individuals over the age of four. The remaining pediatric vaccine will still be offered to children between 6 months and 15 months, with 6 month through 15-month-old doses to be taken to the pediatrician.
As of today, we currently have 100 adult doses for high-risk individuals, and 220 pediatric doses for children between 6 months and 35 months. No additional adult vaccine can be purchased. However, an additional 100 doses of pediatric vaccine has been ordered and will be delivered in early January 2004. The AIC will continue to offer pediatric doses to children who are between 6 months and 35 months of age and the AIC will give priority for children who have not received their first dose for this year.
Flu Season Press Conference
Dr. Susan Fernyak, Director, Community Health Epidemiology & Disease Control, is hosting a press conference tomorrow morning to higlight the Department's recent activities regarding the current flu season. Today, all San Francisco medical providers received an Influenza Health Advisory asking that clinicians report certain categories of laboratory confirmed cases of the flu to the Department. Additionally, we are advising health care providers to institute a program of respiratory, and hand hygiene in waiting rooms to minimize transmission. This will involve making available respiratory masks for patients presenting with symptoms of respiratory illness. Finally, because of the shortage of vaccine, we are directing health care providers to vaccinate only those individuals at righ risk, which includes children age six to 24 months, adults age 65 and over, pregnant women in second or thrid trimester, and persons over age two with underlying chronic conditions. A second category of priority recipients are houshold contacts of high-risk persons and health care workers. I will keep the Health Commission informed of any trends or changes as the flu season evolves.
New Grants Process
This month the Department released a redesigned online Grants Application Tool, available to all staff through the Intranet. The new Grants home page highlights four main areas, including:
Women’s Health Fair
Tom Waddell Health Center held it’s Second Annual Women’s Health Fair on December 9th. Included in the fair was the UCSF Mammovan, a self breast exam teaching station, PAP exams, massage, and information booths sponsored by community based organizations for women. There was also a group session titled “Self Care & Relaxation: the Mind Body Connection.” More than 50 women participated in the event and each one received a gift bag with donated soaps, lotions, and cosmetics.
Public Health Nurses Nominated for DHS Award
Congratulations to Leah Thiebaut and Lannie Heaney, DPH Foster Care Public Health Nurses for being recognized by San Francisco’s Department of Human Services (DHS) as “DHS Star Performers”. This award is usually intended for DHS employees however these individuals from DPH Foster Care were nominated for their role as vital partners in the smooth and efficient delivery of health care services for children in foster care
Harvesting Health Art Contest
The Occupational and Environmental Health (OSH) Section is pleased to announce that 15 winners were chosen for the "Harvesting Health: Food, Health and the Environment" art contest. The art contest, which was sponsored by the American Public Health Association Local Host Committee, the San Francisco Food Systems Council, and DPH’s OSH Section, solicited artwork from students in the San Francisco Unified School District that illustrated how growing, sharing and eating good, nutritious food contributes to the health and well-being of communities and populations. The overall aim of the contest was to increase awareness of and respect for how good food is grown, processed, eaten and recycled. Winning entries are on display throughout the month of December at the San Francisco’s Main Library in the Children's Section. In addition, winning artwork can be viewed by clicking on the "Harvesting Health Art Contest winners" link located on the San Francisco Food Systems website at: www.sffoodsystems.org.
COMMUNITY HEALTH NETWORK: SAN FRANCISCO GENERAL HOSPITAL
Health Commission - Director of Health Report
(From 12/08/03 MEC and 12/16/03 HC)
|12/03||7/03 to 12/03|
|Changes in Privileges|
|Current Statistics - as of 12/1/03|
|Affiliate Professionals (non-physicians)||170|
|Applications In Process||13|
|Applications Withdrawn Month of Jan 2003||2||8 (07/03 to 12/03)|
|SFGH Reappointments in Process Def 2003 to Mar 2004||2175|
Anne Kronenberg, Deputy Director of Health, presented the Secretary’s Report.
Commissioner Monfredini commended the extraordinary staff of the Adult Immunization Clinic.
Commissioner Chow asked that a copy of the flu advisory be sent to all the Commissioners.He asked for a further explanation of budget shortfalls for the current fiscal year and the next fiscal year.Gregg Sass, DPH CFO, said that the worst-case scenario for this fiscal year is $19 million.However, since the Mayor’s Office has asked for this savings is to be achieved in one quarter, the on-going impact could be fourfold.In terms of next year’s budget, Mr. Sass said that over the past two years, DPH has had significant revenue surpluses to cover costs.This option might not be available this year.Second, staff is analyzing structural issues that need to be funded in the baseline, for example Jail Health and the upcoming nurse/patient ratios, which add up to $20 million.Further, DPH has been asked to absorb approximately $14 million in benefits increases, and finally propose cuts of $35 million.
Commissioner Guy asked if flu information is on the website.Ms. Kronenberg said that the flu advisory would be posted on the web. Commissioner Guy asked if there have been any deaths in San Francisco attributed to the flu. Ms. Kronenberg said no. (Dr. Terry Hill, Laguna Honda Hospital Medical Director, clarified later in the meeting that there had been a flu-related death at LHH.)
5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF DECEMBERCommissioner Umekubo presented the employee recognition awards.
|Individual Awardees||Division||Nominated by|
Ghodsy Davary, RN
Laguna Honda Hospital Housekeeping Department
Mivic Hirose, Dr. Timothy Skovrinski,Dr. Brenda Austin, Lucy Fisher
Maxwell Chikere,General Service Manager
Laguna Honda HospitalHousekeeping Department
Robert Christmas; LHH, Chief Executive Officer
|Team Awardees||Division||Nominated by|
Laguna Honda Hospital Quality Management Team
Laguna Honda Hospital, Dept. of Quality Management
Larry Funk, LHH, Executive Administrator
6) LAGUNA HONDA HOSPITAL REPLACEMENT PROJECT UPDATE
Michael Lane, Project Manager, Laguna Honda Hospital (LHH) Replacement Project, presented an update on the Laguna Honda Hospital Replacement Project. He reiterated the vision for the Project:the facility will provide housing and a complete continuum of long-term healthcare services. It will be among the most innovating, technologically advanced, efficient, flexible, humane and natural facilities in the work. It will, by design, encourage rehabilitation and independent living while setting the standard for enhancement of the quality of life. Mr. Lane provided examples of how the new facility will reflect the vision statement.
Mr. Lane overviewed the project risks as the project moves forward. The two biggest risk areas are budget and schedule.The project team is undertaking a risk analysis that will identify the areas of greatest risk for both areas. Budget variables include subcontractor costs, insurance costs, additional design services, activation cost, change orders during construction and FFE funding availability. Schedule variables include delays in the work, OSHPD approvals, other regulatory approvals such as PG&E, UCSF lease for the laundry facility, weather and unforeseen underground conditions.
Mr. Lane then showed the Commission a virtual tour of the new facility.
Commissioner Monfredini asked for clarification about the problem with the contractor. Mr. Lane said that the retention of a general contractor would expedite the contracting and construction process. They needed authority from the Board of Supervisors to take this approach.
Commissioner Penn asked how minority and women owned subcontractors would be involved in the project. Mr. Lane said that the Human Rights Commission established minority-participation goals for the project. In January, they will embark upon community outreach to educate both minority and women-owned contractors and other local contractors about the project and the process.
Commissioner Guy pointed out that there will be a new Mayor, a new administration and, over the next few years, new members of the Board of Supervisors. She is pleased that there will continue to be detailed mockups of the rooms because they serve as important educational tools. She asked about the challenge facing the laundry lease. Is this a major challenge, or something that can be taken care of quickly? Mr. Lane said he thinks they have overcome the major challenges. She asked what the greatest challenges are for the next twelve months. Mr. Lane said the CM at risk analysis is relatively new for the city, and this will show where the greatest challenges will be.
Commissioner Chow asked if Internet access would be available throughout the hospital. Mr. Lane said they are currently focused on having the capability but have not worked through the operational issues. For example, there will be the capability to have Internet access at the bedside, but how this will work is still in progress.
Commissioner Parker asked if there are local hiring goals. Mr. Lane said that there are local M/WBE goals have already been established that will be part of the CM at risk. In addition, the contract manager has internal goals for hiring local firms. Also, the City and County of San Francisco has a 50 percent local hiring goal. Commissioner Parker asked if there is a reserve fund in case the project runs over budget. Mr. Lane said there is no reserve fund, so in the event that this happened, there would first be additional value engineering and then they’d look at scope reduction. The best information they have now indicated they won’t have to take these steps.
Commissioner Umekubo commented that he and Commissioner Sanchez have the honor of serving on the LHH JCC. They have been pleased with how the project is proceeding. He stated that the OSHPD staffing shortages have been a big concern to the JCC, and asked Mr. Lane to comment. Mr. Lane said that this has been a very problematic issue. They have already paid $4 million in fees, yet cannot get service. They should have gotten their first increment permits in November, and haven’t yet received them. They are now having problems with increment two. The team continually meets with and talks to OSHPD. Larry Funk has been involved through the California Healthcare Association, and has been lobbying the Governor’s Office. OSHPD does not have the resources to support the Laguna Honda project.
Commissioner Monfredini asked if the State cashed the DPH check. Mr. Lane said yes. Commissioner Monfredini said this is unconscionable.
Commissioner Parker asked if there is a commitment to the assisted living facility. Mr. Lane said that the Mayor’s Office of Housing has committed $15 million, and they are confident they will be able to find a partner to develop this project. Mr. Funk said that the 140 Assisted Living Facility would be a new part of the continuum of care. The existing tenants will have all been transitioned into the new facility.
Commissioner Guy said that challenges should continue to be brought to the Health Commission’s attention through the LHH JCC. Mr. Funk said that the CHA has been effectively lobbying the Governor’s Office about the OSHPD issue, because the Governor understands that the hospital projects that are being delayed at OSHPD will provide jobs and help jumpstart the California economy.
7) LAGUNA HONDA HOSPITAL STRATEGIC PLANNING UPDATE
Larry Funk, LHH Executive Administrator, presented an overview of the strategic planning process undertaken by Laguna Honda Hospital. LHH initiated a strategic planning process that included three retreats and several workshops. Six goals for 2003-04 were developed through consensus at these meetings. There are myriad benefits of defining specific strategic goals for LHH, including:
Demonstrating that LHH goals are consistent with the DPH Strategic Plan
Providing clear direction for decision making and action in an uncertain legislative and budgetary environment
Garnering resources and recruiting personnel
Evaluating the effectiveness of LHH and its services
Differentiating LHH as a public health institution from other health care facilities
Symbolizing LHH’s commitment to all aspects of public health
Recognizing LHH’s special obligations as part of the DPH integrated safety net
The Strategic Goals are as follows:
Goal 1 – LHH will focus on recruitment, retention and professional staff development
Goal 2 – LHH will continue to enhance fiscal/resources accountability and advocacy.
Goal 3 – LHH will continue to provide comprehensive patient care planning and programming that enhances access and quality of care.
Goal 4 – LHH will continue development and implementation of the LHH Performance Improvement Plan
Goal 5 – LHH will support the design, implementation and evaluation of a new information system supporting the continuum of care in partnership with Siemens Corporation and other DPH departments.
Goal 6 – LHH will develop a systematic approach to successfully operationalize the LHH Replacement Project.
LHH staff, including Mr. Funk, Terry Hill, M.D. Medical Director, Mary Louise Fleming, Director of Nursing, and Mivic Hirose, Assistant Director of Nursing, provided specific examples of how each strategy would be implemented.
Refine goals with input from the Health Commission
Produce plans for each new program
Identify desired outcomes and performance criteria
Develop budget proposal for each program
Implement proposals and evaluate outcomes
Progress reports to DPH Administration, LHH JCC and Commission
Continue to collaborate on strategic planning with other DPH divisions
Adjust the LHH Strategic Goals as indicated by data
Commissioner Chow applauded staff for moving the focus from solely long-term care to integration within the DPH continuum of care.
Commissioner Monfredini asked if the LHH Foundation is a new 501(c)3. Mr. Funk replied that the foundation is now established and the bylaws are being drafted. The hope is that the foundation will be up and running by April. Commissioner Monfredini asked if JCAHO accreditation is required for long-term care facilities. Mr. Funk said it is not required, but staff wants to evaluate whether accreditation would benefit the facility. Commissioner Monfredini suggested offering services to residents of the facility to help them accept and process the fact that they will be moving into a different, albeit nicer, home.
Commissioner Chow asked that the foundation bylaws be presented to the LHH Joint Conference Committee and the Health Commission. He would also like the donations report to the Commission in the same manner that the SFGH Foundation donations are reported.
Commissioner Umekubo said it is nice to be back on the LHH JCC. This is a very vibrant time for LHH. The institution wants to change its image from a custodial facility to a more dynamic program that focuses on reintegrating people into the community. This takes time and resources. He said the focus of the JCC has been to ensure quality of care and patient safety and discuss quality initiatives, as well as action plans, at each meeting. The consensus and mindset is that there is always room for improvement.
Commissioner Penn applauded staff for laying out a seamless, integrated plan. He was unaware of the amount of research that happens at LHH and encouraged staff to continue to allow this to flourish.
Commissioner Parker said he has seen more improvement at LHH in the last two years than in the 15 years he has been involved with the institution. He feels comfortable with the quality of work and the direction for the future. One critical issue that has not been addressed at the national, state or local level is the nursing shortage. People keep talking about the problem, but there has been no improvement. Something dramatically different needs to be done. Mary Louise Fleming, Director of Nursing, described the efforts that LHH is taking to address the shortage.
Commissioner Guy thanked leadership for taking LHH into the 21st century. The complexity of the patient population in light of cultural norms, standard of care and staff training is a challenge. The Commission understands this. What are the biggest challenges and concerns at the clinical level? Dr. Terry Hill said the main issue is having adequate staffing on the units. The facility is understaffed even to meet the needs of the average nursing home patients. LHH patient population is vastly more complicated. Dr. Tim Skovrinksy said there is a large block of residents between the ages of 40 and 50 with multiple psychosocial problems with underlying medical issues.
Commissioner Chow asked if LHH had a resident immunization program. Dr. Hill replied that there has been a strong resident immunization program at the facility, and the focus the past few years has been on staff immunization. However, the efficacy in the vaccine in the frail elderly is 30-60%. Commissioner Chow requested a marketplace study on rehabilitation services, and added that LHH’s innovative programs could be attractive to philanthropies and other funders.
8) FEDERAL AND STATE LEGISLATIVE UPDATE
Colleen Johnson, Assistant Director, DPH Office of Policy and Planning, presented the State and Federal Legislative Update.
As set forth in the Strategic Plan, the Department’s advocacy objectives are to:
Increase funding for core public health;
Support the costs of caring for the safety-net populations;
Address unnecessary eligibility disparities in categorical funding; and
Increase revenues and reimbursement rates consistent with the Department’s other Strategic Planning goals and objectives.
Ms. Johnson summarized significant Federal legislation including Medicare Prescription Drug legislation, Medicaid DSH, 340B Inpatient Drug Pricing and the Community Access Program. Ms. Johnson also provided an update on the Federal Budget.
Medicare Drug Benefit
Access to affordable prescriptions for individuals covered by Medicare has been one of the most noteworthy legislative issues in the last year. This was the subject of contentious negotiations in Congress. The final bill, which was passed by Congress on 11/25 and was signed by the President on December 8, allocates $400 billion over the next 10 years, mostly for prescription drug coverage for 40 million people 65 and older or disabled. The primary provision of the legislation is the drug benefit.
Due to legislation passed long before the current economic crises, DSH allotments nationwide decreased by over $1.1 billion (over 11.5 percent of the program) from 2002 to 2003. This decrease is commonly referred to as the DSH “cliff” and, without remedy, will have a significant negative impact on the Department and other safety net providers in California. The DSH cliff was expected to reduce Medicaid revenues to California’s safety net providers by $184 million per year, including a $6.2 million reduction to revenues at San Francisco General Hospital. Provisions in the Medicare bill gives all states a 16 percent increase in FY 2004 allotments over FY 2003 allotments.
340B Inpatient Drug Pricing
Many public hospitals, including San Francisco General Hospital, receive a significant discount on outpatient pharmaceuticals through the Public Health Service Act’s 340B drug discount program.
Public Hospitals that are allowed to save on outpatient drugs pay 20 to 26 percent more for inpatient drugs. While the provision does not require pharmaceutical companies to provide the same 340B discounts that are available on outpatient purchases, it removes a major disincentive that has made it very difficult for drug manufacturers to offer lower prices on inpatient drugs to 340B hospitals.
Community Access Program
Creates a demonstration program to finance collaboration among safety net providers that improve healthcare access, reduce emergency room use and save money. In September, the San Francisco Community Clinics Consortium awarded a new $441,000 grant to work with DPH to create a chronic disease management registry.
Federal Advocacy in Remainder of 2003 and 2004
Continue to work with delegation on earmarks
Continue to work in coalition on critical issues.
Ms. Johnson summarized State legislation that impacted the Department of Public Health. She also gave detailed information about the Governor’s bond proposal, and a status of the Vehicle License Fee (VLF) backfill.
Two measure on the March ballot:a $15 billion bond and a spending-limit measure
The bond replaces $10.7 billion approved by Davis and challenged in court
Require a balanced budget that sets money aside for tough economic times
State cannot spend more than it takes in revenue
Requires that 1% of state revenue be put in a rainy-day account starting in the 2006-07 and the annual contribution would grow to 3%, eventually reaching 5% of General Fund revenue or $8 billion, whichever is greater.
The $15-billion bond issue and the spending-limit measure are joined, so if voters reject either one, both will fail to become law
The Governor could declare a fiscal emergency and present a remedy to the Legislature. Lawmakers would not be allowed to recess until they enact that or an alternative plan with a simple majority vote -- or a two-thirds majority if the plan includes new taxes
$15 billion bond initiative
Governor’s proposed mid-year cuts
Reduce Medi-Cal rates by 10%
Cap enrollment in Healthy Families, ADAP, CCS, Medi-Cal non-emergency services for documented and undocumented immigrants
Continue to work with Mayor’s Office in accordance with DPH’s State Legislative Plan
Commissioner Chow asked if there is a strategy for addressing the budget and VLF backfill. Ms. Johnson said that there would probably be deeper cuts proposed, including many proposed by Governor Davis last year. There is uncertainty if the bond will pass. The spending cap constitutional amendment and bond both must pass or neither take effect.
Commissioner Guy said it appears the Governor is going to propose the majority of cuts in health.
9) PUBLIC COMMENTS
The meeting was adjourned at 7:15 p.m.
Michele M. Olson, Executive Secretary to the Health Commission