Minutes of the Health Commission Meeting Tuesday, December 21, 2004, at 3:00 p.m. CARR AUDITORIUM San Francisco General Hospital 22nd Street at Potrero Avenue San Francisco, CA 94110 1) CALL TO ORDER The meeting was called to order by Commissioner Chow at 3:00 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, Jr., Ph.D. Absent: Commissioner John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF DECEMBER 7, 2004 Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez) approved the minutes of the December 7, 2004 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Sanchez chaired and Commissioner Guy and Commissioner Illig attended the Budget Committee meeting. (3.1) AIDS Office-HIV Prevention - Request for approval of the FY 2005-2006 Federal Centers for Disease Control and Prevention (CDC) - HIV Prevention Services six (6) month contract extensions for a combined total of $1,431,474 for the period of January 1, 2005 through June 30, 2005 with the following agencies: Ark of Refuge, Inc. $88,292 Asian Pacific Islander Wellness Center (APIWC) $206,348 CAL-PEP $83,348 Glide Foundation $143,155 ICHO $163,855 Instituto Familiar de la Raza $190,072 Mission Neighborhood Health Center $71,351 Mobilization Against AIDS International $213,569 St. James Infirmary $51,335 Shanti Project $151,335 Walden House $68,814 TOTAL: $1,431,474 (3.2) AIDS Office-HIV Prevention - Request for approval of four FY 2005-2006 Federal Centers for Disease Control and Prevention (CDC) - HIV Prevention Services six-month contract renewals with the Regents of the University of California - San Francisco (UCSF) for a combined total of $635,572 for the period of January 1, 2005 through June 30, 2005 with the following programs: Department Service Description 6 Month Amt UCSF - AIDS Health Project Prevention Provider Trainings $73,000 UCSF - AIDS Health Project HIV Counseling & Testing $237,258 UCSF - Stonewall HIV Prevention Services Targeting BRP’s $52,555 UCSF - Urban Health Study HIV Prevention Services Targeting BRP’s $272,759   TOTAL: $635,572 Commissioner Sanchez abstained from voting on this item. (3.3) PHP-Housing & Urban Health - Request for approval of a new contract with Episcopal Community Services, in the amount of $210,180, to provide supportive housing services at the Folsom-Dore Apartments, targeting homeless adults, for the period of January 1, 2005 through September 30, 2005. Secretary’s note - At the request of DPH staff, this contract was continued to the next Health Commission meeting. (3.4) PHP-AB 75 Program - Request to authorize adoption of the County Description of Proposed Expenditures of the California Healthcare for Indigents (CHIP) Program Funds for Fiscal Year 2004-2005. (3.5) PHP-Occupational and Environmental Health - Request for approval to accept and expend retroactively a performance agreement in the amount of $63,887.65, from the California Department of Food and Agriculture, for the detection of the Glassy Winged Sharp Shooter and the inspection and prevention of Pierce’s Disease, for the period of July 1, 2004 to June 30, 2005. (3.6) PHP-Community Health Epidemiology and Disease Control - Request for approval to accept and expend retroactively a grant in the amount of $910,514, from the Centers for Disease Control and Prevention, to develop the means to provide oral medications to 100 percent of the San Francisco population within 48 hours in the event of a catastrophic bio-terrorism event for, the period of August 31, 2004 through August 30, 2005, and a contract with the San Francisco Study Center, in the amount of $622,150, for the period of January 1, 2005, through August 30, 2005. (3.7) BHS-Mental Health - Request for approval of a retroactive new contract with Lincoln Child Center, in the amount of $154,627, to provide children’s mental health services, for the period of July 1, 2004 through June 30, 2005. (3.8) CHN/SFGH-Medical Staff Services - Request for approval of a contract renewal with CheckPoint Credentials Management Services, in the amount of $210,000, to provide credential verification services, on an as-needed, supplementary basis, of clinicians who provide patient care at San Francisco General Hospital, Laguna Honda Hospital and the Community Health Network primary care clinics, for the period of February 1, 2005 through January 31, 2008. Secretary’s Note - a corrected Contract Summary Form is included in the Health Commission file. The “Findings and Commendations” section now reads: Checkpoint is a mature and responsible contractor. The volume of work sent to this vendor has been minimal during the past 12 months because SFGH and LHH MSS staffs have been able to keep up with medical staff new applications and reappointments because there has been no turnover in the staff. Also, it was anticipated that the MSS credentialer at LHH would be laid off with the LHH new applications and reappointment files having to be sent to the vendor. This did not occur as a result of the credentialer’s position being saved. Action Taken: The Health Commission (Chow, Guy, Illig, Monfredini, Sanchez) approved the Budget Committee Consent Calendar, with Commissioner Sanchez abstaining from voting on Item 3.2. Item 3.3 was continued to the next Health Commission meeting. 4) DIRECTOR’S REPORT Proposition 63 Task Force Yesterday, Mayor Newsom held a press conference to announce the formation of a task force to draft the City’s plan to guide use of state Proposition 63 funds. As you know, Proposition 63, called the Mental Health Services Act, passed last November and is intended to “expand mental health services” in California. Locally, it is expected to provide as much as $50 million annually to expand services for the mentally ill. Mayor Newsom is looking to Prop 63 as an opportunity for the city to move forward with its “Housing First” policy while helping the most vulnerable - and visible - homeless. The task force will be led by Barbara Garcia, DPH’s Deputy Director of Health for Community Programs, and will comprise representatives from the private sector, the public sector, non-profit providers, mental health consumers, and other stakeholders. Task force members will oversee the planning process, helping to determine service priorities. Newly Re-emerging STD Infection This morning’s Chronicle reported on the re-emergence of lymphogranuloma venereum, or LGV, a form of chlamydia. The Department’s STD Branch has noted a minor but growing number of cases (8 to date) of LGV among men who have sex with men (MSM). This particular strain infects the lymphatic system and, if left untreated, can cause scarring of the genitals and colon and produce swelling and bursting of lymph glands near the groin. These scars may interfere with normal functions of the urinary or gastrointestinal system and lead to severe illnesses or rarely, death. Treatment involves a three-week course of antibiotics. The new infections follow recent reports of a large outbreak (92 cases) among MSM in the Netherlands and additional cases in Belgium, France, Sweden, and Atlanta, Georgia. We are advising all healthcare providers to treat all cases of rectal chlamydia with a three-week regimen of antibiotics. DPH’s STD Branch will continue to monitor this infection closely. Twila Brown Named Interim Director of Maternal Child Health Dr. Katz is pleased to announce that Twila Brown, Director of Children’s Medical Services, will be assuming the position of Interim Director of Maternal Child Health following the retirement of Mildred Crear on December 3, 2004. Twila brings with her a wealth of talents and experience in children, women and family health, including 9 years with the San Francisco Department of Public Health. Twila began her career at Children’s Hospital in Oakland and worked over 20 years for the Alameda County Health Department in Nursing and Program Administration. She was a Nurse Practitioner at Juvenile Hall for four years. Twila has been recognized in the community for her collaboration and family advocacy efforts and was recognized as one of California’s top nurse administrators in 2001. Community Health Network San Francisco General Hospital - Credentials Report DECEMBER Health Commission - Director of Health Report (From 12/13/04 MEC and 12/14/04 JCC) 12/04 07/04 to 12/04 New Appointments 17 117   Reinstatements 0 0 Reappointments 27 198   Delinquencies: 0   Reappointment Denials: 0 Resigned/Retired: 8 91 Disciplinary Actions 0 Restriction/Limitation-Privileges 0 0 Deceased 0 0 Changes in Privileges   Additions 7 43   Voluntary Relinquishments 0 24   Proctorship Completed 26 51 Current Statistics - as of 12/1/04 Active Staff 446 Affiliate Professionals (non-physicians) 182 Courtesy Staff 538 TOTAL MEMBERS 1,166 Applications In Process 21 Applications Withdrawn Month of December 2004 0 5 (07/04 to 12/04) SFGH Reappointments in Process Jan. 2005 to Apr. 2005 167 Commissioners’ Comments Commissioner Illig asked what the relationship is between the Mayor’s Proposition 63 Task Force and the group that has already been meeting under CBHS. Dr. Katz said the CBHS group held preliminary meetings, but going forward there would be one process spearheaded by the Mayor’s Task Force. Commissioner Illig asked if the first year of money has to be spent on certain things. Dr. Cabaj replied that in February the City would get an allocation of pre-start up planning money. The second wave of money will probably come in April or May 2005, which can be used for data, education and capital investment. Clinical dollars will come in October 2005. It is this last allocation that the Mayor would like directed toward supportive housing. Commissioner Guy asked for clarification about the Proposition 63 planning process, and if any recommendations would come before the Health Commission. Dr. Cabaj said Barbara Garcia would set guidelines, based on guidelines issued by the State in January. The City is currently developing an application process for people who would like to serve on the planning committee. The plan will go to the Health Commission for review, as well as to the Mental Health Board. They are also proposing to have numerous public forums. Commissioner Illig asked for a budget update, and specifics about the $6 million restoration to mid-year budget cuts. Dr. Katz said that a number of proposed cuts got restored, including Shanti Lifelines Case Management for Breast Cancer, NICOS anti-gambling initiative, all of the previously CARE funded HIV advocacy programs, the general fund funded AIDS Foundation program cut was partially restored, all staff in Tom Waddell, physician at Castro Mission, and the Health Educator at Chinatown Health Center. Commissioner Chow suggested that the press release on the newly re-emerging STD infection should also be sent to all practitioners in San Francisco. 5) PRESENTATION OF THE EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF DECEMBER Commissioner Monfredini presented the Employee Recognition Awards for the month of December. Team Awardee #1 Division Nominated By SF Behavioral Health Center Work Group SFGH Behavioral Health Gene O’Connell and Sue Currin Sharon McCole Wicher Alex Anagnos Linda Sims Ernestina Carrillo Fred Alexander Kathy Jung Hiroshi Tokubo Lawrence Marsco Greg Griffa Bob Thomas Louise Houston Team Awardee #2 Division Nominated By SFGH Bed Control Task Force SFGH Gene O’Connell and Sue Currin Terry Dentoni Jay Kloo Jerry Forquell Suzanne Rosales Carmel Gallagher Jan Allison Kjeld Molvig Tina Lee 6) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH ANNUAL REPORT, 2003-2004 Anne Kronenberg, Deputy Director of Health, and Frances Culp, Senior Health Program Planner, Policy and Planning, presented the Department of Public Health’s Annual Report for Fiscal Year 2003-2004. Year in Review Highlights Successful McMillan Stabilization Project pilot Revised outpatient prescription benefits, saving DPH $2.9 million Peer support through Community Behavioral Health Services New 90-unit Empress Hotel, which opened in October 2003 MHRF Blue Ribbon Committee Gun Violence Prevention, Response, Aftercare and Recovery Work Group Needs assessment for Bayview-Hunters Point residents regarding HIV services Renovation of SFGH’s Cardiac Catheter Laboratory Developed project to allow food stamp recipients to shop at farmer’s markets First Emergency Medical Technician training in Bayview Hunters Point Grand opening of the Avon Comprehensive Breast Center, May 2004 Developed ways to reduce the use of restraints and prevent falls at Laguna Honda Hospital Ms. Culp said that the Department is proposing to present the Annual Report to the Health Commission in August or September so that the information is more current. Commissioners’ Comments Commissioner Illig asked that copies of the annual report be available to DPH contractors. Dr. Katz said he would have hard copies of the annual report produced using the discretionary funds from the San Francisco Public Health Foundation. Commissioner Chow asked that NICOS and Project Open Hand be added to the list of contractors that do business with DPH. Commissioner Guy would like to reconsider the idea of having the Health Status Report included in the Annual Report. The data that this report provides gives a wonderful context for the Annual Report. Ms. Kronenberg that the Department lost the staff person who did the Health Status Report, due to a general fund cut. The thought is that the Department could do a Health Status Report every three or four years, since mortality data does not change significantly on a year-to-year basis. Commissioner Guy emphasized that epidemiology is important to public health, and wants to make sure that this is not lost. Commissioner Chow said future reports could include references to various data reports, be they done by DPH or other entities. In addition, highlights should also cover the important public health work that is done. There needs to be a balance, and an acknowledgement that reduced staff resources have an impact on doing these kinds of reports. Commissioner Sanchez said San Francisco is blessed with exceptional medical training institutions that might be able to collect data that is germane to DPH, as we are limited in our ability to do this in-house. 7) APPROVAL OF SAN FRANCISCO GENERAL HOSPITAL ADMINISTRATIVE POLICIES AND PROCEDURES: HOSPITAL PLAN FOR PROVISION OF PATIENT CARE, IN-PATIENT UTILIZATION REVIEW PROGRAM, PERFORMANCE IMPROVEMENT AND PATIENT SAFETY PROGRAM, EMPLOYEE PERFORMANCE AND COMPETENCY REPORT, AND ENVIRONMENT OF CARE (EOC) SAFETY ANNUAL REPORT Gene O’Connell, Executive Administrator, SFGHMC, presented an overview of San Francisco General Hospital. Clinical Accomplishments 2003-2004 Opened the Avon Comprehensive Breast Center. Annually, will increase by 5,000 the numbers of mammograms to underserved women. Received transfer of the Mammovan from UCSF, and secured a grant from Avon Foundation to fund the operation of the van for two years Renovated the Cardiac Catheter Laboratory and furnished it with the latest equipment Fulfilled one of the recommendations of the Mayor’s MHRF Blue Ribbon Committee by establishing and opening the Mental Health Rehabilitation Center. Submitted application for the Adult Residential Facility. Acquired an Ophthalmology Van to provide services to patients of the community clinics Expanded Urgent Care Clinic services from 38.5 hours a week to 74 hours a week Fully complied with the new requirements regarding maximum intern hours SFGH Goals: FY 2004-2005 Improve staff retention and recruitment Assess and re-design processes and resources to maintain operational efficiency Maintain favorable variances to budget for both patient revenue and operating expenses Improve access to outpatient and diagnostic services Complete Level 1 Trauma Center verification and designation approval process Plan and design air medical access for SFGH Plan for the replacement hospital Participate in the transition to a single DPH information system Ensure patient placement at the appropriate level of service within the continuum of care Meet all regulatory standards and regulations Valerie Ng, M.D., Chief of Staff at SFGH, presented Medical Staff highlights for 2004. Many members of the Medical Staff received national, state and local honors. Medical Staff issues include a chronic shortage of space, money and personnel. Yet commitment to the clients and patients of SFGH remains undiminished. Medical Staff Advocacy resulted in, among other things: Mobile Eye Van Methadone Van Avon Comprehensive Breast Center SF Hearts Campaign Disparities in Health Care for African Americans project Week of the Uninsured Sue Currin, Chief Nursing Officer, presented the Hospital Plan for Provision of Care. The purpose of the plan is to define organization-wide processes and activities that maximize coordination and provision of care. Revisions to the policy are: updated demographics of community served; updated financial mix of outpatient and emergency visits, inpatient discharges; revised Scope of Service statement with updated stats on beds, census, visits, discharge days, active and courtesy members of the medical staff; and updated organizational chart and provided FY 04-05 SFGH goals. John Luce, M.D., PIPS committee chair, presented the Performance Improvement and Patient Safety Program (PIPS) and the Inpatient Utilization Program. The purpose of PIPS is to promote and define an organization-wide process for performance improvement in patient care, decreasing medical errors and enhancing patient safety. The change to the policy is that Attachment A, the SFGH Patient Safety Plan, was completely rewritten to comply with 2004 JCAHO patient safety requirements. The Inpatient Utilization Review Program is designed to promote and support quality patient care and increase effective and efficient utilization of available facilities and services. Changes to the policy: Acute Medical-Surgical - Change in the mix of staff-“Utilization Review Coordinator’ replaced “Case Manager” Psychiatry - Plan completely revised to reflect current practices, definitions/criteria and procedures implemented to improve patient flow Skilled Nursing Facility - changed “MHRF” to “SFBHC” Kathy Jung, Assistant Administrator, presented the Environment of Care Safety Management Program. The intent of the program is to provide a safe and effective environment of care for patients, visitors, volunteers and staff in accordance with organizational and regulatory requirements. Rod Auyang, Human Resources Manager, presented the Employee Performance and Competency Report. The purpose, in accordance with Title XXII and JCAHO, is to: provide assessment of staff competency; identify training needs; describe educational programs; describe levels of competence, patterns, trends, competency maintenance activities; report staff competency to the Governing Body and SFGH leadership. Between 98% and 99.2% of employee performance evaluations meet or exceed standards. Staff that received ratings of “unmet standards” are not permitted to provide direct patient care unless closely supervised or have shown improvement to the extent of not compromising patient safety. The FY 03-04 campus-wide clinical competencies were patient safety, emergency response and infection control. Changes to New Employee Orientation are presentation on trauma, presentation on patient safety, national patient safety goals, performance improvement and risk management, emergency responses to fire and disaster preparedness and emergency response. Commissioners’ Comments Commissioner Illig asked if SFGH has had difficulty meeting the nursing ratios. Ms. O’Connell said it was a challenge but SFGH has been able to meet them. The new ratios that were to take effect in January 2005 would have been a real challenge. Commissioner Sanchez is proud to serve with people who provide such quality, compassionate services. Commissioner Chow noted that SFGH has maximized revenues, and the General Fund allocation funds only 20 percent of expenditures. Commissioner Guy said that SFGH staff and leadership, in partnership with UCSF, have really met the challenge of shrinking resources. She appreciates and respects what they do. She is interested in hearing specific concerns and impacts of further reductions. Ms. O’Connell replied that one major concern is the underfunding over the past three to four years of capital improvements and maintenance. The other concern is the recent reduction to the UC contract, which is already underfunded. Commissioner Illig appreciates the opportunity to continually learn about SFGH. He asked if SFGH has information on patient satisfaction and employee satisfaction. Ms. O’Connell said that, with regard to patient satisfaction, the hospital participates in the PEP-C survey. Mr. Tokubo added that the hospital is currently participating in a study with Stanford University where all physicians and housestaff and 10 percent of other staff will be surveyed. Commissioner Illig asked how the hospital measures cultural competency. Mr. Tokubo said it is measured on a number of levels, and the hospital has served as a national model. Commissioner Illig would like SFGH and the entire department to be held to the same reporting standards as the contract agencies are held to. Commissioner Guy noted that the administrative cuts to the Department would impact the ability to do things like cultural competency. Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez) approved the revisions to the San Francisco General Hospital Administrative Policies and Procedures. 8) APPROVAL OF AMENDMENTS TO THE GOVERNING BODY BYLAWS Kathy Murphy, Deputy City Attorney, CHN, presented proposed amendments to the Governing Body Bylaws for San Francisco General Hospital. The Governing Body Bylaws specific to SFGH are required for accreditation purposes. It is a single document that sets forth Charter provisions relating to the size of the Governing Body, how members are appointed, the length of their terms and how vacancies are filled. The proposed amendments update this document and reflect current areas of emphasis by JCAHO. Additionally, modifications were made consistent with the Dr. Katz’s recent changes to the Joint Conference Committees. Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez) amended Article IV, Section 3, paragraph N, to read: “To annually evaluate the Hospital’s performance in relation to its vision, mission and goals.” Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez) amended Article IX, Section 4, removing the part of the title that read “are not public.” Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez) approved the Governing Body Bylaws, as amended. 9) PUBLIC COMMENT/OTHER BUSINESS None. 10) ADJOURNMENT The meeting was adjourned at 5:20 p.m. Michele M. Olson, Executive Secretary to the Health Commission Health Commission meeting minutes are approved by the Commission at the next regularly scheduled Health Commission meeting. Any written summaries of 150 words or less that are provided by persons who spoke at public comment are attached. The written summaries are prepared by members of the public, the opinions and representations are those of the author, and the City does not represent or warrant the correctness of any factual representations and is not responsible for the content.