Minutes of the Health Commission Meeting Tuesday, March 15, 2005 at 3:00 p.m. LAGUNA HONDA HOSPITAL Gerald Simon Auditorium 375 Laguna Honda Blvd. San Francisco, CA 94116 1) CALL TO ORDER Commissioner Monfredini called the meeting to order at 3:10 p.m. Present: Commissioner Lee Ann Monfredini, President Commissioner Roma P. Guy, M.S.W., Vice President Commissioner Edward A. Chow, M.D. Commissioner James M. Illig Commissioner John I. Umekubo, M.D. Absent: Commissioner David J. Sanchez, Jr., Ph.D. Commissioner Monfredini announced that the budget hearings on the proposed FY 2005-2006 Department of Public Health budget would be Tuesday, March 29, 2005, 3:00 p.m. and Thursday, April 7, 2005, 3:00 p.m. Both hearings will be held at 101 Grove Street, Room 300. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF MARCH 1, 2005 Action Taken: The Commission (Chow, Guy, Monfredini, Illig, Umekubo) approved the minutes of the March 1, 2005 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Illig chaired, and Commissioner Chow attended, the Budget Committee meeting. (3.1) BHS – Request for site approval for relocation of New Leaf: Services For Our Community from 1853 Market Street to 1390 Market Street/103 Hayes Street. Commissioners’ Comments Commissioner Illig requested that a site map be included with all site approval requests. (3.2) BHS-Mental Health – Request for approval of a retroactive renewal contract with NICOS Chinese Health Coalition, in the amount of $67,872, to provide mental health services, for the period of July 1, 2004 through June 30, 2005. Commissioner Chow abstained from voting on this item. (3.3) EMS-Emergency Operations Section – Request for approval of a new contract with EMSystem, LLC, in the amount of $771,637, to provide patient tracking software and maintenance services, for the period of March 15, 2005 through May 30, 2008. Secretary’s Note – This item was removed from the agenda at the request of the Department. (3.4) CHN-SFGH – Request for approval to submit a resolution to the Board of Supervisors to accept a gift of funding valued at $138,766 from the Avon Foundation via the San Francisco General Foundation, for technical and logistical services associated with the Mobile Mammograph Facility donated to the City in 2004 by the University of California, San Francisco, for mobile mammography services to indigent and under-served women in San Francisco, and a contract modification with Shanti Project increasing the amount of the contract by $56,160, for a new total of $225,840, without affecting the original contract period of July 1, 2004 through June 30, 2006. Commissioners’ Comments Commissioner Chow asked how the funds that are not allocated to Shanti would be used. Roland Pickens replied that the remainder of the funding is for technician services. Action Taken: The Commission (Chow, Guy, Monfredini, Illig, Umekubo) approved the Consent Calendar of the Budget Committee. Commissioner Chow abstained from voting on Item 3.2. Item 3.3 was pulled from the agenda at the request of the Department. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, said the annual unannounced visit from State licensing is underway at Laguna Honda Hospital. The surveyors arrived on Sunday and are anticipated to leave on Thursday. 5) PRESENTATION OF THE EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF MARCH Commissioner Chow presented the Employee Recognition Awards for the Month of March. Individual Awardee Division Nominated By David Woods, Pharm.D. Laguna Honda Hospital Robert Christmas, LHH COO, Director of Pharmacy Team Awardee Division Nominated By Clarendon Hall Bridge Demolition Project Planning Team: James Johnson Philippe Taquin Diana Kenyon Viktor Kirienko David Woods Steve Koneffklatt William Frazier Angela Platzer Debbie Tam Monica McGuire Lilia Hendrix Lolita Caceres Pamela Ketzel Maxwell Chikere Arla Escontrias Jimmy Matthews Horace Smith Alice Wong Laguna Honda Hospital Cheryl Austin, Robert Christmas, Gayling Gee Mivic Hirose Paul Isakson, M.D. Tim Skovrinsky, M.D. Serge Teplitsky 6) PRESENTATION OF THE LAGUNA HONDA HOSPITAL 18-MONTH STRATEGIC PLAN, AND CONSIDERATION OF A RESOLUTION APPROVING THE STRATEGIC PLAN John Kanaley, Laguna Honda Hospital Executive Administrator, presented the Laguna Honda Hospital 18-Month Strategic Plan. The strategic plan includes mission and vision statements, goals, objectives and outcomes/indicators. The plan was developed through a number of executive staff retreats. Mr. Kanaley said the recent changes to the admissions policy, as well as concerns expressed at Supervisor Elsbernd’s February 28th committee hearing, are reflected in the Strategic Plan. Mission: As part of the Department of Public Health safety net, the mission of Laguna Honda Hospital is to provide high-quality, culturally competent rehabilitation and skilled nursing services to the diverse population of San Francisco. Skilled nursing service includes long-term care for residents who cannot be cared for in the community and/or short-term care for these who can be rehabilitated and discharged to a lower level of care within the community. Vision: Laguna Honda Hospital will be a center of excellence in providing a continuum of care that integrates residents in the least restrictive setting, thereby supporting their highest level of independence. Goals: Clinical Programs – Continue to enhance preventive and therapeutic clinical programs. Safety and Security – Develop and implement an enhanced Safety/Security program that will provide a safe/secure environment for residents, staff and visitors. Finance – Maximize revenue for all programs and services. Organizational Structure, Communication and Leadership – Develop a hospital-wide organizational structure for operations, leadership, communications and training. Information Systems – Laguna Honda Hospital will participate in the design and implementation of a single DPH-wide clinical and financial information system and will upgrade the hospital infrastructure to support advanced technology. Performance Improvement, Licensing and Regulatory Preparedness – Develop and implement the Laguna Honda Hospital Performance Improvement Plan. Human Resources – Ensure adequate and culturally competent staff. Laguna Honda Hospital Replacement Project – Develop a systematic approach to successfully operationalize the Replacement Project. Operational structure of new hospital – Initiate the operational planning for moving into the new hospital. Dr. Katz said that Laguna Honda Hospital is a very large tent with a lot of capable people who are capable of caring for the full range of San Franciscans who need long-term care. Public Comment Howard Chabner said safety is the primary concern and dangerous patients cannot be admitted. He told a story of a middle-aged able-bodied woman who has been a danger to others. The dangerous admissions must stop. Patrick Monette-Shaw complimented John Kanaley for restoring long-term care to the mission statement. There are a number of flaws in the strategic plan. If behavioral health patients were more appropriately placed, the facility would not need more behavioral health programs or additional security. Further, the public needs to know if there are licensing changes. Dr. Brenda Austin asked the Commission to support access to Proposition 63 monies to fund new programs that support patients with mental health disorders. The psychosocial units have been very successful. Many resources have been lost, and the population is more complex. Programs help people transition to the community or adjust to a long-term care environment. David Bisho, President, West of Twin Peaks Central Council, said budget problems are no excuse to change the admissions policy. The Council demands that the frail elderly and disabled be the first priority. He submitted a copy of the 1999 admissions policy. Sonny Quiniquini said staff, patients and relatives were never consulted about the change in the admission policy. He disagrees with the change. Where did the change come from and who approved it? Benson Nadell, San Francisco Ombudsman, said because of the diversity of individuals being treated, goal seven should be modified to include adding staff to handle the increasingly complex and diverse patients. This is going to cost additional money, and this should be acknowledged. Sr. Miriam Walsh said the main issue is that they are not prepared, and do not want to be prepared, to serve people who are violent and have psychiatric issues. Commissioners’ Comments Commissioner Illig commended the management team for developing the strategic plan, modifying the mission statement to address community concerns and having a vision statement that emphasizes keeping people in the least restrictive setting. Commissioner Chow said the Laguna Honda Hospital Joint Conference Committee reviewed the strategic plan. It is extremely comprehensive and was developed in a short timeframe. It was a team effort. Commissioner Umekubo said there has been a change in long-term care that has resulted in more and more pressure on long-term care institutions. Nursing homes are being forced by acute care hospitals to do sub-acute care. In addition, the population is changing. The strategic plan is a good guide. Commissioner Guy applauded senior staff and front line staff for navigating Laguna Honda into the future. This is a struggle, and communication is critical. She is pleased that the vision statement includes the hospital being a center of excellence and she wholeheartedly supports and will advocate for staff resources and whatever else is required to meet this vision. Commissioner Monfredini congratulated Mr. Kanaley on the strategic plan. It is a living, working document. She asked for monthly reviews at the Joint Conference Committee of goals and objectives to make sure we are still on target. Action Taken: The Commission (Chow, Guy, Monfredini, Illig, Umekubo) approved Resolution 04-05, “Approving the Update of the Laguna Honda Hospital Strategic Plan,” (Attachment A). 7) LAGUNA HONDA HOSPITAL REPLACEMENT PROJECT UPDATE Michael Lane, Project Manager, LHH Replacement Project, presented an update on the replacement project. Design began in 2000. Construction work that was bid in 2002 had come in on budget. In April 2003, the entire Replacement Program was on budget. Cost per bed in April 2003 was $335,000. Escalation in healthcare construction in the last 12-18 months is in the range of 2-3% per month. The project had budgeted 3.8% per year based on historical averages and pre-2003 market conditions. First round of bids for the South, Link and East buildings was in October 2004. April 2003 to October 2004 is 18 months, which represents escalation in the range of 24-36%. Re-bidding and soliciting contractor-proposed value engineering proposals between November 2004 and March 2005 saved over $5.5 M. The bids for these buildings are $84.5M over budget. These first three building contain 780 beds. Cost per bed for these 780 beds is $521,000. The following elements of the program have not been bid: Remodel of the Existing Building Site Work, and existing building demolition. West Building (420) Beds Recommendation from the team is to proceed with the South and Link Buildings at full scope. Replacement Team will provide an updated cost on unbid work (listed above) taking the current market into consideration. Replacement Team to work with the Controller’s Office to develop options for moving forward. Public Comment Ed Kinchley, SEIU, representing the three locals that represent workers at Laguna Honda, said that it makes sense to continue with the construction and asked the Commission to make a clear commitment to working with the Mayor and labor to find the money to build 1200 beds. If we delay longer, the costs will increase even more. Alicia Gershon, Protection and Advocacy, said a number of people could leave Laguna Honda today if adequate community resources were available. She urged the Health Commission to let the Targeted Case Management Team complete its needs assessment. She would support the current resolution as long as it factored in an adequate assessment for the need for different types of services. Jessie Lorenz, Independent Living Resource Center, said the discussion needs to be about the current patients at Laguna Honda who do not want to be there, and serving people in the future who want to remain in the community. Virginia Leishman believes in independent living, but long-term care is necessary. How many beds are we talking about? She voted for 1200 beds. San Francisco lost a resource with the MHRF, and when she voted for that, she expected it to remain, not be changed. Patrick Monette-Shaw said there are inconsistencies in the rebuild report in terms of comparisons with other hospitals, cost overrun estimates and others. He said the Commission should wait until the City Attorney determines whether or not tobacco funds could be used before making a decision. Michael Lyon, Gray Panthers, said it is obvious that the City’s commitment to providing health care is in question. We need to look at a different way. Oletha Hunt said she is a 19-year employee at Laguna Honda. What is the point of voting if this is how it is going to be? The City needs Laguna Honda, and the Commission needs to work with labor to find the money for 1200 beds. If we mess this up, voters will not support rebuilding SFGH. Kim Tavaglione, SEIU 250, said in the past when labor, community and the City worked together on problems, there has been success. What is missing in the most recent discussions is a holistic approach to providing healthcare in San Francisco. There is room for everyone. Sunny Quiniquini asked how much the current cost overrun is. There should be no modification to the plan without voters’ permission. The voters have lost trust. Tom McDonough said people voted for 1200 beds and there should be no cost overruns. Commissioners’ Comments Commissioner Monfredini asked if there was a point when the Health Commission should have revisited the project budget in terms of cost escalation assumptions. Mr. Lane said it seemed prudent to wait until the bids came in before presenting to the Health Commission. Unfortunately the price is not out of line with what the market is charging. Commissioner Monfredini noted that no general obligations bonds have been used for the project up to this point. Commissioner Chow clarified that the $84 million is the overrun for the three buildings that were put out to bid. He asked for confirmation that the work up to this time has been within budget. Mr. Lane said yes. Commissioner Chow asked if we know the cost estimate for the full build out. Mr. Lane said not at this time. Commissioner Chow asked Mr. Lane what the average cost of an acute hospital bed is. Mr. Lane replied that Turner Construction estimates $1.1 million - $1.3 million per bed. Commissioner Chow confirmed that Mr. Lane’s recommendation builds the infrastructure that is necessary for the full build out. Mr. Lane said yes, this is the case. Mr. Lane added that one reason he is not recommending proceeding with the East Building is that, although there is the budget for 180 beds, once this decision is make it cannot be changed. Commissioner Illig asked how much the hospital could get reimbursed through SB 1128. Dr. Katz explained that this legislation allows DPH to bill the federal government for partial costs of new construction, but at the time patients are being served. So this funding cannot be accessed until the new facility is occupied. Commissioner Illig asked if all beds are at the same level. Mr. Lane said that some beds are acute, but in terms of footprint, all the buildings are quite similar. Commissioner Umekubo said everyone is disappointed about the cost overruns. The project seems to be a victim of bad timing. Hopefully the Department and City can be creative and find the funding. Commissioner Guy, in preparation for when the Health Commission does take action, said it would be helpful to update the Laguna Honda Hospital white paper to carefully look at the choices and examine the consequences. This would help the public, staff and decision makers understand all the factors. Dr. Katz agreed with this suggestion and said this would mesh nicely with what the Controller’s Office is doing, which is developing finance options. Commissioner Monfredini said it is important that all options be explored before deciding the most appropriate way to proceed with the rebuild. The Health Commission asks that Dr. Katz prepare a white paper on the various option and present it to the Health Commission within a 60-day timeframe. Among the options, she asked that the following be analyzed: Is it economically feasible to stay in business, in terms of operating costs versus reimbursement, with the number of beds in the current proposal; can we justify the number of beds in the current proposal given the cost per bed; is it financially viable for the Department of Public Health to stay in the long-term care business; what is the feasibility of partnership with private or non-profit organization to develop on the Laguna Honda campus an independent/assisted living facility, with a smaller SNF on the campus. Commissioner Chow requested that demographics of the population we are trying to serve be part of the white paper, and also an analysis of whether there is a mix of services that are not needed. Commissioner Chow said that Mr. Lane’s recommendation to proceed with the two buildings does not preclude any future configuration, so the Commission should agree that the can proceed. Commissioner Illig recommended that the Health Commission take action to allow the project to continue, given that circumstances have changed. The draft resolution will be scheduled for the March 29, 2005 Health Commission meeting. 8) PUBLIC COMMENT/OTHER BUSINESS Alex Kudren said the voters should have been asked if long-term care should have been removed from the mission statement. He commended the Mayor, Dr. Katz and the Commission for restoring it. Patrick Monette-Shaw said it is premature to issue a final resolution unless they know what the options are. Further, the white paper cannot be revisited. Michael Lyon would like to know what has been done to lower the expected number of SNF patients per 1,000 people. It is really naïve to expect that the white paper will contain unbiased information. 9) ADJOURNMENT The meeting was adjourned at 5:50 p.m. Michele M. Seaton, Executive Secretary to the Health Commission Health Commission meeting minutes are approved by the Commission at the next regularly scheduled Health Commission meeting. Any changes or corrections to these minutes will be reflected in the minutes of the next 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.