Minutes of the Health Commission Meeting Tuesday, April 19, 2005 at 3:00 p.m. 101 GROVE STREET, ROOM 300 San Francisco, CA 94102 Commissioner Monfredini introduced Dr. Donald Tarver, who was appointed by Mayor Newsom last week to serve on the Health Commission. Commissioner Monfredini said that Commissioner Tarver would be attending each of the Commission’s Joint Conference Committee meetings, after which his committee assignments would be decided. 1) CALL TO ORDER Commissioner Monfredini called the meeting to order at 3:15 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 David J. Sanchez, Jr., Ph.D. (left at 6:10 p.m.) Commissioner Donald E. Tarver, II, M.D. Commissioner John I. Umekubo, M.D. Commissioner Tarver expressed appreciation to friends, family, health worker colleagues and clients who have supported him over the 18 years that he has served as a community psychiatrist within the San Francisco Department of Public Health. He thanked Mayor Newsom for this appointment to the Health Commission and he looks forward to doing his best to responsibly preserve and promote culturally competent and accessible public health services of the utmost quality for all members of the San Francisco public. He thanked in advance each of his experienced and committed fellow commissioners, Health Director Dr. Mitchell Katz, the dedicated staff of the Health Department and the passionately informed members of the public for the wise assistance he expects they will provide him as he assumes this new role as Health Commissioner. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF APRIL 7, 2005 Action Taken: The Commission approved the April 7, 2005 Health Commission meeting minutes. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Illig chaired and Commissioner Sanchez attended the Budget Committee meeting. (3.1) PHP-CHPP – Request for approval to accept and expend a performance agreement from the California Department of Health Services, in the amount of up to $70,000, at a reimbursement rate of $110 per abstracted case, in support of a project to develop a national database and reporting system for violent injuries, for the period of January 1, 2005 to September 29, 2009. (3.2) BHS – Request for approval of a new contract with Continuum HIV Day Services, in the amount of $1,364,160, to provide HIV treatment adherence services, for the period of May 1, 2005 through June 30, 2006. (3.3) BHS – Request for approval of a renewal contract with MedImpact Healthcare Systems, Inc., in the amount of $9,587,052, to provide pharmacy benefit management and Patient Assistance Program (PAP) services to access low-cost medications for indigent clients, for the period of July 1, 2005 through June 30, 2007. (3.4) ADMINISTRATION – Request for approval of a new contract model for an 18-month contract. Commissioners’ Comments Commissioner Sanchez said grant funding is often delayed. And he is also concerned about the difference between appropriation and actual contract amount. Anne Okubo said that the 18-month contract proposal is analogous to the Board of Supervisor’s Interim Appropriation Ordinance. Commissioner Illig clarified that only 12 months is encumbered. Ms. Okubo said yes. She added that this is an administrative change, and does not functionally change the contracting process. It streamlines the process, eliminates the need for a continuing resolution and allows contractors to receive payment until the annual contract renewal is ready. Once the annual renewal is ready, the six-month interim is cancelled and the annual renewal is brought to the Health Commission for review and approval. Commissioner Illig asked if grants would be put on the 18-month process. Ms. Okubo said yes, and added that this would better accommodate grant-funded contracts that begin in September. Currently these grants are split over two contract years, which creates additional accounting requirements. Commissioner Illig shared Commissioner Chow’s concern that if the Department builds in an extra six months, then it would build in a delay. Ms. Okubo said if there were a three or four month extension, some contracts would not meet that timeframe and would have to come back to the commission for extensions. Commissioner Illig said the Commission expects that with this change, contracts will not come for approval late unless it is a very extreme circumstance. Commissioners’ Comments (at the Health Commission meeting) Commissioner Chow would like an assurance that staff will still try to be as expeditious as possible in getting contracts approved, rather than taking all the time that is given to them. Anne Okubo said the goal is to get contracts renewed within the six-month time frame, as is the case with most contracts currently covered by the Continuing Resolution. Commissioner Chow said with that assurance, he will support staff’s recommendation. Action Taken: The Commission approved the Budget Committee Consent Calendar. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Health Director, presented his report. New Health Commissioner Dr. Katz extended his warmest welcome to Dr. Donald Tarver, the newest member of San Francisco’s Health Commission. His professional training in psychiatry and his extensive experiences working in communities of color as well with sexual minorities will be invaluable to the Department and to the Commission. Dr. Katz attached is CV for the Commission’s information DPH Budget At the April 7th meeting, the Health Commission approved re-prioritization of the initiatives in the Department's budget submission. The revised submission was provided to the Mayor's Office last week along with the Commission's resolution urging the Mayor and Board of Supervisors to preferentially protect health and human services and to identify new revenues fees or taxes to enable us to provide needed COLAs to contractors or to the University of California. The budget is now under review by the Mayor's Office and Dr. Katz will advise the Commission on their decisions as soon as they are available. The deadline for the publishing of the Mayor's budget is June 1st. JCAHO Survey at San Francisco General Hospital Eight surveyors from Joint Commission on Accreditation of Healthcare Organizations and the Institute of Medical Quality/California Medical Association arrived yesterday morning at San Francisco General Hospital, to begin a five-day survey of the hospital. Unlike past surveys, this survey was unannounced, which will also be the case with all future surveys. Dr. Katz thanked President Monfredini for attending the Opening Conference, making herself available on such short notice, and for offering her support to the staff and to the surveyors. The survey covers all areas under the hospital’s license. This includes the acute services, outpatient clinics, the Emergency Department, the skilled nursing units, behavioral health, ancillary and diagnostic services, as well as, support services, administration and physical plant. Partnership between DPH and Catholic Healthcare West In October 2003, Catholic Healthcare West (CHW) approached the Department of Public Health with the goal of exploring the possibility of developing a clinical partnership that would be mutually beneficial to both organizations. In the spring of 2004, a formal memorandum of understanding (MOU) was signed laying the groundwork for a promising collaborative relationship between CHW’s St. Mary’s Hospital and Saint Francis Memorial Hospital. The agreement provides for timely urgent care and primary care appointments at St. Mary’s Medical Center’s Sister Mary Philippa Clinic for unaffiliated patients presenting at SFGH’s Urgent Care and Patient Referral Center. Between June 2004 and March 2005, a total of 1,059 unaffiliated patients have been referred from SFGH to St. Mary’s Hospital’s Sister Mary Philippa Clinic. The most common medical conditions were: Orthopedics (33%), General Medicine (31%), Cardiology (27%), Diabetes (6%), and Asthma (3%). The MOU also outlined a plan for providing CHW with access to the DPH Lifetime Clinical Record (LCR) in order to provide better coordination of care to shared patients. In January 2005 LCR access was established at St. Mary’s Sister Mary Philippa Clinic. LCR access at Saint Francis was temporarily delayed due to the relocation of the St. Francis Emergency Department but is scheduled to be complete next month. This will allow St. Francis to provide better care to patients who have previously received care at San Francisco General Hospital but who are brought to St. Francis due to our ambulance policy of bringing seriously ill patients to the nearest hospital. This private/public partnership presents new opportunities to work together to improve the health care delivery system in San Francisco. Project Homeless Connect On April 21st, the fourth Project Homeless Connect (PHC) will occur at Bill Graham Civic Auditorium. Project Homeless Connect is an event organized by the Mayor’s Office with strong participation from DPH and DHS. The purpose is to assist homeless individuals to connect to our system of care. Since September 2004, PHC has connected over 2,000 homeless people to medical care, substance abuse and mental health services, legal counseling, CAAP and SSI benefits, shelter, housing and more. More than 575 volunteers from government, non-profit agencies, private organizations and community individuals participated in the last event. Volunteers may register at www.projecthomelessconnect.com. Windsor Hotel Fire The Windsor Hotel had a fire last Wednesday, April 13th. It seems to have been caused by a tenant falling asleep while smoking. Due to the sprinkler system, the damage was confined to one room. Unfortunately, the resident was badly burned and is being treated at SFGH. Tom Waddell HC Chosen as Visit Redesign Site Tom Waddell Health Center was selected to participate in a patient visit redesign collaborative, funded by the California Health Care Foundation and jointly sponsored by the California Health Care Safety Net Institute, the Primary Care Development Corporation, and Coleman Associates. It is one of 12 projects from six public health care systems in California. A multidisciplinary team (Sandra Aseltine, Cynthia Collins, Paul Hathaway, Chris Nguyen, Rosario Noble, and Mark Sorensen) will work with Coleman over the next six months to reduce patient visit time in Tom Waddell’s primary care clinics. Shortened patient visit time should lead to improved patient and staff satisfaction and improvements in clinic efficiency and productivity. Adult Immunization Clinic DPH's Adult Immunization and Travel Clinic was featured in the Bay Guardian on March 30th in its “Superlist” series. Called “Check Before You Trek,” the feature highlighted various travel clinics in the Bay Area, calling DPH's clinic “by far the most cost-efficient resource.” The Clinic, in Room 102 here at 101 Grove Street, sees patients on a drop-in basis Monday through Friday from 9am to 3:30pm. Travel consultation is free if you purchase medication, such as malaria pills or shots. Community Health Network, San Francisco General Hospital Credentials Report, April 2005   04/05 07/04 to 04/05 New Appointments 10 176 Reinstatements 0 0       Reappointments 22 351 Deliquencies: 0 0 Reappointment Denials: 0 1       Resigned/Retired: 9 128 Disciplinary Actions 0 0       Restriction/Limitation-Priveleges 0 0       Deceased 0 0       Changes in Privileges     Additions 5 65 Voluntary Relinquishments 5 36 Proctorship Completed 27 124       Current Statistics - as of 04/1/05     Active Staff 455   Affliliate Professionals (non-physicians) 193   Courtesy Staff 541   TOTAL MEMBERS 1,189         Applications In Process 29   Application Withdrawn Month of April 2005 2 6 (07/04 to 04/05) SFGH Reappointments in Process May 2005 to Aug. 2005 161   Dr. Katz introduced Ken Steele, CEO of St. Mary’s Hospital and Cheryl Fama, President of St. Francis Memorial Hospital. Mr. Steele thanked Dr. Katz and Gene O’Connell for their leadership and dedication. He looks forward to future partnerships. Ms. Fama said it is the mission of St. Francis and Catholic Healthcare West to serve this community and this partnership brings this commitment to a new level. Commissioners’ Comments Commissioner Monfredini said the partnership with CHW is extraordinary, and she thanked Mr. Steele and Ms. Fama. She hopes this idea catches on with other hospitals. Commissioner Illig asked if there is any precedent for this level of partnership. Dr. Katz said there are other examples, but this is the best, closest partnership. Commissioner Chow complimented CHW and the Department of Public Health for putting this partnership together. The initial discussions about charity care many years ago envisioned this type of relationship that results in increased direct services. He suggested that the Hospital Council pursue this model and other partnership opportunities. Commissioner Sanchez said this partnership reinforces the similar missions of DPH, St. Mary’s and St. Francis. This partnership focuses on human need and compassion. Commissioner Umekubo has been an advocate for public/private partnerships because institutions on both sides serve similar populations and experience the same problems. Commissioner Tarver added his commendations to Dr. Katz and Catholic Healthcare West. It is essential that patients, when they present for services, have somewhere to go. He asked if psychiatric referrals could be tracked through this process. Dr. Katz said DPH does track the psychiatric referrals. In addition, DPH sends patients whose primary psychiatrist is at St. Mary’s to that facility. Commissioner Tarver also asked that psychiatrists at community clinics have access to the LCR. Dr. Katz said that DPH has been trying to expand this. Commissioner Guy said the partnership with CHW is a new path for the Health Department, and is a role model. The Health Commission truly appreciates that this was a difficult effort. She acknowledged all the work that has gone into charity care, because this creates the atmosphere for creative minds to explore possibilities. 5) JAIL HEALTH SERVICES ANNUAL UPDATE Joe Goldenson, M.D., Director, Jail Health Services, presented the Jail Health Annual Update, which focuses on quality assurance activities. Wesley Capon, nurse manager in charge of the JHS quality assurance program, presented an overview of quality improvement activities. Quality Improvement Activities Continuous Quality Improvement Morbidity and Mortality Review Interdisciplinary Death Reviews Case Conferences Peer Review Patient Satisfaction Surveys Utilization Management The Continuous Quality Improvement and Utilization Management Program (CQI-UM) is the mechanism utilized to monitor every facet of performance, identify and resolve deficiencies in patient care, modify programs to ensure ongoing compliance and enhance productivity and efficiency. Mr. Capon presented a sampling of some of the CQU-UM studies that are done in the jails, including sample ETOH Detox. Audit, sample Safety Cell Placement Audit, and CQU studies for hypertension, diabetes and reproductive services. Mr. Capon also presented result of patient satisfaction surveys for medical, dental, psychiatric and forensic AIDS services. Pending studies include SFGH Emergency Department transfers, OB-Gyn appointments, PPDs and asthma care. Gregg Sass presented an overview of the funding for Jail Health Services. Jail Health Services are funded through the General Fund. There are very few, if any, revenue streams. He described the history of Jail Health funding, as well as changes that were made during the last budget year. Structural adjustments were made to fund the jail health shortfall. In addition, the Sheriff’s Department proposed to outsource Jail Health Services as a cost-saving measure. MOU concessions and other adjustments to Jail Health costs reduced expenses by $3 million, and the proposal to outsource was not implemented. In addition, the general fund for Jail Health was transferred from DPH to the Sheriff, and DPH provides the services through a work order. In Fiscal Year 2005-2006, Jail Health costs will increase due to changes in Nursing MOUs, increases in fringe benefits and other inflation. Dr. Katz added that he has a few patients who he truly believes would not be alive today but for the services they received while in jail. San Francisco has a superior jail health system. It is a more expensive service than what is provided in other counties, but that is because San Francisco takes health seriously. Dr. Katz prefers the work order arrangement, which puts the costs of health care to inmates in the Sheriff’s budget, because then the costs of incarceration are more complete. Commissioners’ Comments Commissioner Chow commended staff for having many quality indicators and asked if there are benchmarks by which to measure Jail Health’s scores. Mr. Capon said in general Jail Health seeks 85 percent or better. However some indicators need to be achieved 100 percent of the time. Commissioner Chow asked how staff decides which surveys are done at what intervals. Dr. Goldenson replied that the surveys are chosen based on what is going on in the jails, such as any untoward events, trends and other information. In addition, there is a core group of studies that are done on a regular basis. Commissioner Tarver commended staff for the extent of the quality reviews that are done. He asked why the client satisfaction surveys for psychiatric services show a significant decrease in satisfaction from October 2003 to October 2004. Dr. Goldenson said he would discuss this with the director of Jail Psychiatric Services and get and answer to Commissioner Tarver. Commissioner Tarver asked if there is any ability to follow up on referrals that are made to the community, once people are released from custody. Dr. Goldenson said that for all patients, they give prescriptions and one month of medications. They lost discharge planning in the last budget, and are in the process of trying to get grant funding to replace this important function. Commissioner Monfredini understands the impact of the budget cuts over the past few years. However, these cuts are not going to be restored so it is important to understand how we move forward. Commissioner Umekubo applauded the CQI efforts. He asked why some of inmates who have hypertension are not treated. Dr. Goldenson said all patients are evaluated and treated if indicated within two to three days, but when some patients initially come in, their prescriptions and/or medications cannot be verified. Jail Health Services puts a lot of emphasis on starting medication as soon as someone walks in the door. The nurses do as much as they can to verify that inmates are on medication. Commissioner Guy asked how Jail Health Services serves inmates whose primary language is not English. Dr. Goldenson said they have bilingual staff, access to interpreters at San Francisco General Hospital and access to telephone translation. Commissioner Guy noted that frequently, jail is the first time an inmate has had any primary care. It is important that there are linkages within the DPH system so that when inmates are released, their health care continues. The Commission needs to pay attention to this issue, and should use the Joint Conference Committee to look at this issue. Commissioner Sanchez stated that the discussion around jail health has been going on for many years. He commended the staff for presenting the key quality areas. State prisons have been cited in many of these areas for a void of quality, and the fact that San Francisco Jail Health Services has such positive protocols is commendable. Commissioner Chow said connecting inmates to community primary care is a Commission priority, and he asked for an update on current activities through the Community Programs and Services Joint Conference Committee. Dr. Katz added that Barbara Garcia has established a group that is working on this issue. Commissioner Illig asked if the Sheriff could decide to outsource Jail Health. Mr. Sass said this could be proposed in the future, but he is unaware of any proposal to do so this year. Dr. Katz added that this would need Board of Supervisors’ approval. Commissioner Illig asked if Jail Psychiatric Services is funded through the work order. Mr. Sass said it is included in the work order. Commissioner Guy maintains the same position as last year, which is that the Department of Public Health, which is responsible for services, should have control over the budget, and that the budget be adequately funded. Her concern is that the trend is toward providing the “industry standard” and San Francisco is so much greater than the industry standard. When this budget is housed in the Health Department, health advocates fight for it. There is no health advocacy in the criminal justice arena. Commissioner Chow understands both sides, but he is pleased that, through the work order arrangement, the true cost of Jail Health services is known and the Health Department no longer must absorb the underfunding, as it was forced to do in the past. Commissioner Monfredini said many issues were discussed at today’s meeting, and asked how the Commission moves its priorities forward. Dr. Katz said it is important to understand the implications of the new arrangement, although there is not an opportunity at this time to change this. The Health Commission and Health Department’s priority in these discussions is maintaining the high quality of services. 6) SOARIAN UPDATE David Counter, Director, Information Systems, presented an update on the Siemens Soarian Project. The project involved replacing obsolete systems in several areas of the hospital—San Francisco General Hospital/Primary Care Laguna Honda Hospital, Jail Health Services—with a new generation of web-based technology. Current systems were installed almost 20 years ago. The Health Department entered into a partnership Siemens as an early adopter site. He reminded the Commission that the project would be completed within the DPH base budget while maintaining IT operations. Mr. Counter described the components and enhancements that will result from the new system. The initial implementation schedule was very ambitious. There have been delays in the development of Soarian software. Siemens rolled out the programs to their Beta sites and various changes and enhancements were required. So the implementation schedule has changed. Clinical implementation will now be completed by 2007 and financial implementation will be completed by 2008. DPH has been able to negotiate, in recognition of these delays, additional no-cost enhancements for key DPH areas. These enhancements fall into two categories: Financial/Technical; and Clinical. Financial/Technical Enhancements Soarian Revenue Management Laguna Honda Invision Conversion Claims Denial Management Assistance Expanded Open Link configuration Clinical Enhancements Physician Order Processing (CPOE) Soarian Critical Care Module Soarian Medication Oncology Module Soarian Emergency Department Module Clinical implementation support at 4,500 hours Mr. Counter noted that these enhancements would have had to be funded through above-base-budget appropriations. Now they will be covered through the existing contract, which leaves money in future years that can be used for other technology needs or for DPH-wide needs. DPH Soarian Project – Current Status and Next Steps Short Term Clinical and Financial system implementation is proceeding on current scheduled, and they do not anticipate any further delays. Clinical Access Module for enterprise-wide results live in Summer 2005. Interim project to convert Laguna Honda to Invision Patient Accounting for consolidated business office functions. Implement Soarian Critical Care at SFGH. Long Term Separate Clinical and Financial schedules allow for clinical emphasis on nursing automation. Complete computing and network infrastructure upgrades at SFGH, LHH and Primary Care. Implement Medication Oncology and Emergency Department Plan for Behavioral Health Clinical and Financial system implementation and integration with Soarian (Proposition 63). Mr. Ron Castleberry, Siemens’ regional director, said the partnership with DPH benefits both partners. There have been struggles, which is always the case. It is important to have first adopters to identify problems. The value of the relationship is very significant and it was important to provide enhancements as a result of some of the challenges. Commissioners’ Comment Commissioner Monfredini is excited about this partnership. It will bring us into the next century and allow us to provide quality services to our clients. Commissioner Monfredini asked if this system would allow for electronic physician signatures. Mr. Counter said yes, and discussions are underway about how this change would be implemented. Commissioner Umekubo asked if a web-based system would allow a physician to access the system from wherever Internet is available. Mr. Counter said yes. Commissioner Umekubo asked if drug alerts would be built into the CPOE module. Mr. Counter said the system allows for order sets, once standardized, to include clinical-decision support, which is based on clinical best practices. Commissioner Umekubo asked if physicians at SFGH going to be involved in developing these data sets. Mr. Counter said that Dr. Bob Brodie leads this effort. Commissioner Tarver asked why the Behavioral Health Module is a long-term project. Mr. Counter said the RFP for behavioral health would be issued this summer. It will take 18-36 month, after the RFP is complete, to install the update. Commissioner Tarver said this is long overdue, so he appreciates anything that can be done to expedite this process. 7) PUBLIC COMMENT/OTHER BUSINESS Peter Davidson, Director of the UFO study at UCSF, said San Francisco Needle Exchange is unique in providing culturally competent services to young injectors. These services help prevent young injectors from becoming lifelong injectors. Rob Gifin, Director of At the Crossroads Program, spoke on behalf of San Francisco Needle Exchange. The clients his organization refers to this program consistently rate the services highly. There are so many programs that have tons of money being poured into them that achieve very little. This is not the case with San Francisco Needle Exchange. And most importantly, this agency is the only lifeline to the youth in the Haight who need these services. Mary Howe, Director of the Needle Exchange Program, said there would be a public health disaster if this program closed. They operate on a shoestring budget, and it is irresponsible to cut this program. Proposals were only evaluated on how they were written. Better-funded agencies have grant writers. Small agencies do not so are at a disadvantage. Maria Chavez from the Harm Reduction Coalition said she is aware of the RFP process and the Health Department’s commitment to needle exchange. But it is important that the Health Commission is aware that the agencies that will be funded for needle exchange to not provide needle exchange to youth. She urged the Commission to fund grassroots organizations such as San Francisco Needle Exchange. Pete Morse said public health literature shows that needle exchange location is critical to the delivery of services. The funding process that pits geographically disparate organizations that serve different target populations against larger organizations is unfair. None of the bigger organizations provide comparable services. Every neighborhood should have a competent needle exchange program. Alya Briceno spoke on behalf of San Francisco Needle Exchange. She has worked with them for the past four years and she is disappointed that they will not be funded. It is San Francisco’s responsibility to fund these services. SFNE is a place where the unique come together and quality services are provided. It is the glue that holds young injection drug users together. Shemena Campbell, HIV test counselor at SFNE, said that in the three years she has done HIV testing, she has had no positive HIV results and no Hepatitis C positive results. This is due to the needle exchange program. Without these services readily available, young injectors will get HIV and Hepatitis C and will be an enormous burden on the public health service. She asked the Commission to advocate for the program. Emalie Huriaux, outreach coordinator at the Women’s Community Clinic, spoke in support of San Francisco Needle Exchange. She works closely with the program. They are unique in focusing on women, especially low-income women and women of color. SFNE helped them develop their overdose response curriculum. They provide culturally competent services that save lives and city dollars. Danny Homer said if the needle exchange program closes they will see more HIV and Hepatitis C infections among young people, especially in the Haight and Golden Gate Park. Dr. Pamela Ling, who has provided free medical care at San Francisco Needle Exchange program for four years, said the services are unique and are a priority. This is such a special program and she urged the Health Commission to think creatively about how to fund it. Mattie Scott spoke in support of the Maxine Hall Health Center, to prevent it from being closed. She has been going there since 1996, and the services she received there helped save her life. They have a women’s support group that meets weekly. Kyle Pederson submitted written testimony opposing cuts to HIV/AIDS prevention services. (On file in the Health Commission office.) Commissioners' Comments Commissioner Monfredini asked Jimmy Loyce get information to the Health Commission as to whether the youth population served by San Francisco Needle Exchange will continue to be served regardless of who the contractors are. Mr. Loyce said the AIDS Office has always been cognizant of the need to cover all populations. He will get this information to the Commission. Commissioner Illig said that there is an appeals process for the RFP process. He also urged the public speakers to work with the HIV Prevention Planning Council. Commissioner Tarver expressed hope that there will be some means by which these relationships could be continued. Commissioner Guy said commissioners need more information about how this result came about so that they can form informed opinions. The Commission needs to know if the population is going to be served as they have in the past, or even more effectively. Commissioner Sanchez said the Health Commission held two budget hearings where hundreds of people expressed pain that would result from budget cuts. The Commission values and listens to all public comment, and this is democracy in progress. 8) CLOSED SESSION A) Public Comments on All Matters Pertaining to the Closed Session None. B) Vote on Whether to Hold a Closed Session (San Francisco Administrative Code Section 67.11) The Commission went into closed session at 6:10 p.m. Present in closed session were Commissioner Chow, Commissioner Guy, Commissioner Illig, Commissioner Monfredini, Commissioner Tarver, Commissioner Umekubo, Mitchell H. Katz, M.D., Health Director, John Kanaley, Laguna Honda Hospital Executive Administrator, Adrianne Tong, Deputy City Attorney, Larry Hecimovich, Deputy City Attorney and Michele Seaton, Health Commission Executive Secretary. C) Closed Session Pursuant to Government Code Section 54956.9 and San Francisco Administrative Code Section 67.10(d) APPROVAL OF A SETTLEMENT IN THE AMOUNT OF $200,000 IN ENCISCO v. CCSF, ET AL, SAN FRANCISCO SUPERIOR COURT, No. 433-927 Action Taken: The Commission approved the settlement in Encisco v. CCSF, et al, in the amount of $200,000. D) Reconvene in Open Session 1. Possible Report on Action Taken in Closed Session (Government Code Section 54957.1(a)2 and San Francisco Administrative Code Section 67.12(b)(2).) 2. Vote to Elect Whether to Disclose Any or All Discussions Held in Closed Session. (San Francisco Administrative Code Section 67.12(a).) Action Taken: The Commission voted not to disclose any discussions held in closed session. 9) ADJOURNMENT The meeting adjourned at 6:25 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.