Minutes of the Health Commission Meeting Tuesday, May 4, 2004 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 Commissioner Chow at 3:30 p.m. Present: Commissioner Edward A. Chow, M.D., President Commissioner Lee Ann Monfredini, Vice President Commissioner Roma P. Guy, M.S.W. Commissioner James M. Illig Commissioner David J. Sanchez, Ph.D. Commissioner John I. Umekubo, M.D. Absent: Commissioner Michael Penn, M.D., Ph.D. 2) APPROVAL OF THE MINUTES OF THE MEETING OF APRIL 20, 2004 Action Taken: The Commission amended the minutes as follows: page three, line two, was revised to read “Commissioner Monfredini replied that there are a number of reasons a contract would be approved retroactively, for example Federal or State government funding is awarded late.” The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Umekubo) approved the minutes of the April 20, 2004 Health Commission meeting as amended. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Sánchez chaired, and Commissioner Guy attended, the Budget Committee meeting. (3.1) CHN - Request for approval of two contract renewals with the following firms: Asereth Medical Services, Inc. and Rxrelief and approval of a new contract with NOR-CAL Medical Temps, for a combined total amount of $1,200,000, to provide as-needed supplemental pharmacy personnel services to the Community Health Network, for the period of July 1, 2004 through June 30, 2005. Commissioners’ Comments Commissioner Guy wants assurance that all employees hired through these contracts have all the necessary documentation. Dr. Kotabe stressed that SFGH does get the certification prior to the person reporting to work, but waiting for copies of the documents can delay the person’s start time. Dr. Kotabe is confident that next year at this time this will not be an issue. Commissioner Sanchez said some of the concerns within the health profession are that so many training, education and research programs are being dismantled, which leads to a smaller workforce pool. Having to use registry is one outcome of these changes. Dr. Kotabe said that state and national pharmaceutical associations are focused on the workforce issue, and California is lucky in that two new schools of pharmacy have opened in the State in the past two years. Commissioner Guy said that if the steps taken by the contractors to improve fill rates do not work, Ms. Kotabe should report this to the SFGH JCC immediately, rather than waiting until the next contract renewal. (3.2) CHN-Laguna Honda Hospital - Request for approval of a new contract with the University of the Pacific School of Dentistry, in the amount of $250,000, to provide on-site dental clinic services to Laguna Honda Hospital, for the period of July 1, 2004 through June 30, 2014. Commissioners’ Comments Secretary’s Note - the term of this contract is changed from a 10-year term to a five-year term, with a five-year renewal. Commissioner Sanchez asked if the dental clinic at SFGH operates under a similar arrangement as the one proposed for Laguna Honda Hospital. Galen Leung, DPH Contracts Manager, replied that the Affiliation Agreement governs the services provided at SFGH by UC, rather than a contract. Elsewhere in the Department, such services are governed by a contract, which must be put out to bid per city law. Commissioner Sanchez said one of the major priorities is to provide quality care, and the Department has been lucky to have such quality institutions help it provide services. He emphasized the need to ensure that when institutional commitments are made, they are carried out. There must be quality assurance oversight. Commissioner Guy asked that the Laguna Honda Joint Conference Committee provide the quality assurance oversight for this program. Dr. Hill said the performance indicators would be brought to the LHH JCC. (3.3) CHN-Jail Health Services - Request for approval of a renewal contract with Haight Ashbury Free Clinics, Inc., in the amount of $3,574,769, to provide psychiatric and substance abuse treatment services targeting inmates in the San Francisco County Jail system, for the period of July 1, 2004 through June 30, 2005. Commissioners’ Comments Commissioner Guy said that if the contingency budget is fully implemented, there would be a reduction to this contract that would have a tremendously negative impact on the quality services that are provided. The extent of the impact should be articulated to the Mayor and the Board of Supervisors. (3.4) DPH-Central Administration - Request for approval of a resolution approving an extension of the terms of the Fiscal-Year 2003-04 contracts for the Department of Public Health’s Population Health and Prevention and Community Health Network. (3.5) PHP-STD Prevention and Control - Request for approval of a retroactive contract renewal with Internet Sexuality Information Services, Inc., in the amount of $101,900, to provide syphilis elimination services targeting gay and bisexual men living in San Francisco who use the Internet to find sex partners, and STD prevention information to adolescents and young adults living in San Francisco who are at risk of contracting an STD, for the period of October 1, 2003 through December 31, 2004. Commissioners’ Comments Commissioner Guy asked how the program is evaluated. Deb Levine, executive director of ISIS, said they use a variety of methods including on the street surveys, focus groups before banners are launched, tracking where people go through the site and others. (3.6) AIDS OFFICE-HIV Statistics and Epidemiology - Request for approval of a retroactive contract renewal with CompassPoint Nonprofit Services, in the amount of $70,000, to provide HIV Non-Name Reporting System-Technical Assistance, for the period of March 1, 2004 through June 30, 2004. Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Umekubo) approved Items 3.2, 3.3, 3.5 and 3.6 of Budget Committee Consent Calendar. Commissioners’ Comments Commissioner Umekubo asked if the issue of documentation has been addressed. Dr. Kotabe said both contractors are putting in systems to make sure that the documentation is available before the staff signs on. Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Umekubo) approved Item 3.1 of the Budget Committee Consent Calendar. Action Taken: Item 3.4 - The resolution was amended to reflect the individual abstentions of commissioners: Commissioner Chow - NICOS; Commissioner Guy - San Francisco State University; Commissioner Illig - St. Mary’s Hospital; Commissioner Sanchez - the Regents of the University of California; and Commissioner Umekubo - St. Mary’s Hospital. The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Umekubo) approved the resolution as amended. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Radiology Technologists at SFGH All the radiology technologists at San Francisco General Hospital called in sick on Friday April 30th and most were out sick on Saturday and Sunday as well. Because of this SFGH had to cancel scheduled outpatient radiology services on Friday and Saturday but was otherwise able to meet all emergency and inpatient needs with the use of radiology supervisors, on-call staff, Laguna Honda staff, and registry staff and by triaging only those patients who had to have a radiologic examination performed. SFGH was able to use the services of radiology technology registries that are not normally used by arranging emergency contracts with two additional registries. The emergency nature of these contracts was approved by President Chow. Radiology technologists have been voicing for some time their belief that their wages are significantly below market rate and were especially upset after three technologists announced that they were leaving last week to work for other hospitals. Because the radiology technologists are union represented and under contract, a sick out is a violation of their contract. Therefore, the City Attorney’s Office is investigating the incident and is expected to make recommendations to the City shortly. By Monday morning, staffing in Radiology was back to normal. CPMC Award The African American Health Initiative (AAHI) has been awarded a $50,000 Community Investment Grant from the California Pacific Medical Center Foundation to address violence as a public health issue with a specific focus on community empowerment. Building on AAHI's current use of empowerment models, community residents identify issues and develop strategies for implementation. The initial phase of the grant will partner with the California Pacific Medical Center's Outpatient Psychiatry Department, the San Francisco Police Department’s Community Liaison Outreach Unification Team, the S.F. Housing Authority, the S.F. Sheriff’s Department and DPH’s Community Empowerment Center to improve community wellness. Community residents and faith-based participants will partner with neighborhood police in training to get a better understanding of root causes of violence while developing individual relationships via communications, respect and exploring the issues of trust. Several neighborhood teams throughout the City will be developed to intervene, prevent and reduce violence. Avon Foundation Comprehensive Breast Center The Grand Opening Ceremony for the Avon Foundation Comprehensive Breast Center at the SFGH Medical Center will take place on Thursday, May 13, 2004 from 4:00 to 6:00 p.m. Maria Cora, MA, Coordinator of the SFDPH Office of Women's Health has been appointed to the newly formed SF General's Breast Care Community Advisory Council which will hold its first meeting earlier in the day on May 13, 2004. Second Annual Avon Symposium The Second Annual Avon Symposium “Delivering the Continuum of Breast Cancer Care to the Underserved” will be held on Friday, May 14th from 8:00 a.m. to 5:00 p.m. at the Golden Gate Club, Presidio of San Francisco. Interested individuals can register online at: http://cc.ucsf.edu/avon2004; or contact Kaya Balke at (415) 597-9132 for additional questions. Lesbian Mental Health Conference Community Behavioral Health Services (CBHS) is sponsoring a conference entitled, “SF LGBT Pride Celebration: Current Challenges in Lesbian Mental Health,” on Friday, June 25th. This conference will be of particular interest to Primary Care providers as well as other DPH staff working in the field of mental health. For registration material and a complete description please go to: http://www.dph.sf.ca.us/MentlHlth/lesbianMentalMlthbroch406252004.pdf . Commissioners’ Comments Commissioner Guy asked when the radiologist contract is going to be renegotiated, and if there might be another sick out during that timeframe. Dr. Katz said there is an opportunity to modify the radiologist’s contract in July. 5) APPROVAL OF FISCAL YEAR 2004-2005 PATIENT RATES Gregg Sass, DPH Chief Finance Officer, presented the Fiscal Year 2004-2005 Patient Rates. The San Francisco Health Code requires that the Department of Public Health must determine reasonable rates charged to patients receiving services. Annually the Department reviews patient rates and when appropriate, revises rates to recover the cost of providing services. Approval of the ordinance will revise rates charged to patients for health, mental health, substance abuse and other public health services. The financial impact of these price increases is very minimal, given the population that is served by DPH. The payors that typically reimburse DPH at the published rates include out-of-plan HMOs, private insurers and private pay patients with the ability to pay. Net patient revenue is estimated to increase by approximately $1 million. Commissioners’ Comments Commissioner Illig asked if the fees are intended to cover actual costs of specific services, or are structured so that they cover overall unreimbursed costs. He is concerned that the Department is trying to make up for the money it loses from HMOs and MediCal by charging uninsured patients with assets. Mr. Sass said that fees are not targeted toward self-pay individuals. DPH’s rates are consistent with those charged by other hospitals in the area. With regard to uninsured patients, Mr. Sass said there is a sliding fee scale, and people are billed. But most of these charges are written off to either charity care or bad debt. Mr. Sass emphasized that if people cannot afford to pay, they do not pay. Dr. Katz added that unlike Medicaid, in a sliding scale DPH does not penalize people for assets, but rather for what they earn. However, there is a certain group that is not eligible for the sliding fee scale (above 400% fpl), does not have insurance, and would be billed for services. Commissioner Illig is concerned that DPH has charges that are different from its costs. Commissioner Chow noted that SFGH’s patient rates are moderate, which is reflected in the Cost-to-Charge Ratio reports that are submitted to the State. San Francisco General Hospital’s costs were more than 70% of its charges; in comparison to CPMC’s costs were 20% of its charges. Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Umekubo) approved the proposed FY 2004-2005 Patient Rates. 6) PRESENTATION OF FISCAL YEAR 2004-2005 DEPARTMENT OF PUBLIC HEALTH CONTINGENCY BUDGET Dr. Katz asked the Commission to continue this item to the meeting of May 11, 2004. The Mayor’s Office is making much citywide progress on reducing the City’s shortfall. The Mayor’s Office feels certain that DPH will not be required to submit $37 million in cuts, as was previously requested. However, the size of the reduction DPH will be required to submit is unknown at this time. Rather than put clients, providers, and others through the trauma of listening to and advocating for $37 million in cuts, the Mayor’s Office asked that the Commission hold off on this discussion and hear the actual, more realistic budget cuts at its next meeting. Commission Chow stated that the Commission officers are suggesting one budget hearing, on Tuesday, May 11, with a Commission resolution to be considered at that time. This would allow for a public hearing and Commission deliberation prior to the Mayor finalizing his budget for publication. Public Comment Michael Lyon. Last year’s rejection of the contingency cuts gave the Board of Supervisors much more support for restoring a number of the proposed cuts. Commissioners’ Comments Commissioner Guy said it has been helpful for the Health Commission to have a voice during the budget process, and for people to have a voice at the Health Commission, and two public hearings have provided the best method of accomplishing this. She is uncomfortable having only one hearing. Commissioner Monfredini said that it is not without precedent to have one budget hearing. She said that the process up to this point has been very respectful. The administration is very focused on minimizing cuts to direct services. Although this is a different process, she feels comfortable that the Commission will have time to digest the proposal and forward thoughtful input. Commissioner Illig suggested that this year the Health Commission continues to hold hearings about specific budget proposals throughout the budget process, be it after the Mayor releases his budget or after the Board of Supervisors undertakes its deliberations. The Health Commission can have an effect on the policy makers. He asked the City Attorney for an opinion about purview of the Health Commission throughout this process. Commissioner Sanchez said the Health Commission has set the benchmark by the oversight it provides through the joint conference committee structure. Commissioner Chow said that the Health Commission would be able to continue discussion on the resolution to the May 18th meeting if it felt that more time was needed. Action taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Umekubo) continued this item to the meeting of May 11, 2004. 7) PUBLIC COMMENT None. 8) ADJOURNMENT The meeting was adjourned at 5:05 p.m. Michele M. Olson, Executive Secretary to the Health Commission