Minutes of the Health Commission Meeting
Tuesday, June 7, 2005
101 Grove Street, Room 300
San Francisco, CA 94102
1) CALL TO ORDER
The meeting was called to order by Commissioner Guy at 3:10 p.m.
- Commissioner Roma P. Guy, M.S.W., Vice President
- Commissioner James M. Illig
- Commissioner David J. Sanchez, Jr., Ph.D. (left at 5:60 p.m.)
- Commissioner Donald E. Tarver, II, M.D.
- Commissioner John I. Umekubo, M.D. (arrived at 3:25 p.m.)
- Commissioner Edward A. Chow, M.D.
- Commissioner Lee Ann Monfredini, President
2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF MAY 17,
Action Taken: The Commission (Guy, Illig, Sanchez, Tarver) approved the
minutes of the May 17, 2005 Heath Commission meeting.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Illig chaired and Commissioner Sanchez attended the Budget
Committee meeting. Commissioner Guy attended the meeting through Item
(3.1) CHN-SFGH Radiology – Request for approval of a contract
modification with Aureus Radiology, LLC, a sole source contractor, to
increase the contract amount by $60,000, from $40,000 to $100,000, to
provide as-needed Digital Mammography Radiology screening services in a
mobile van setting on behalf of San Francisco General Hospital’s Avon
Breast Center, for the period of October 1, 2004 through September 30,
(3.2) CHN-Pharmacy – Request for approval of two contract renewals with
the following firms: Asereth Medical Services, Inc. and NOR-CAL Medical
Temps, for a combined total amount of $2,400,000, to provide as-needed
supplemental pharmacy personnel services to the Community Health
Network, for the period of July 1, 2005 through June 30, 2007.
(3.3) CHN-SFGH – Request for approval of a renewal contract with
Pharmaceutical Care Network, in the amount of $250,000, to provide
third-party administrative services, and $2,300,000 in pass-through
prescription dispensing fees to Rite Aid Corporation and AG Pharmacy,
targeting indigent CHN clients and 12% contingency of $306,000, for the
period of July 1, 2005 through June 30, 2006.
(3.4) CHN-Jail Health Services – Request for approval of a renewal
contract with Haight Ashbury Free Clinics, Inc., in the amount of
$3,379,504, to provide psychiatric and substance abuse treatment
services targeting inmates in the San Francisco County Jail system, for
the period of July 1, 2005 through June 30, 2006.
Jo Robinson, the director of Jail Psychiatric Services, shared some of
the JPS outcomes, in response to questions that commissioners raised
when the Jail Health Report was presented in April. Ms. Robinson said
the jail mental health program consists of diversion, treatment while in
planning and discharge planning. In diversion, this year they admitted
51 clients into the Behavioral Health Court, and the BHC was one of four
Behavioral Health Courts in the country selected to do an outcome study.
With regard to treatment, this year JPS provided services to 5,000
people, with 32,000 follow up visits for these patients. Since 2002,
there have been no deaths by suicide in the jail. With regard to
discharge planning, during the last fiscal year they had a Social
Security Administration staff person come into the jail on a weekly
basis and begin the application process while the person is still in
custody. There were 103 community placements from jail to community
residential treatment program, and 390 inmates who went through CBHS
Gregg Sass, DPH Chief Financial Officer, addressed the Haight Ashbury
Free Clinics’ (HAFC) fiscal issues. The issue has been and continues to
be cash flow. The agency was a victim of alleged theft by the former
CFO. Once that was discovered, the agency discovered additional
financial problems. DPH regularly meets with HAFC representatives to
closely monitor the situation. HAFC has done a great deal of work to
develop a comprehensive turnaround plan to get the organization back on
track. The plan includes governance restructure, hiring an interim CEO
and CFO, providing weekly cash forecasts through June 2006, and most
importantly working directly with DPH staff, including Jimmy Loyce,
Barbara Garcia and Joe Goldenson, to plan for how the clients in their
programs would be served in the event the agency does not survive.
Should something happen, there would be a window of time in which to
effect the transition.
- Commissioner Guy asked what would happen if HAFC did not contract with
Jail Health Services in the future. Mr. Sass said it appears that the
best approach in the event the agency is no longer in operation is to
hire the staff currently providing the services as DPH employees. John
Eckstrom, Interim CEO, said jail psychiatric services are an integral
part of what they provide in terms of services and the organization
wants to maintain that breadth. He would like to improve the connections
between clients in the jail and the agency’s community programs that are
available when people get out of jail.
- Commissioner Illig said normally the Health Commission would feel less
than confident with an organization that is having this much financial
difficultly. It is because of Mr. Eckstrom’s relationship with Mr. Sass
that the Commission feels comfortable approving this contract. The
Health Commission wants HAFC to succeed. He believes the agency is going
to receive the support it needs from the community that has supported it
throughout the past 30 years. The Commission expects continued good
communication with DPH staff.
- Raymond Banks was in jail psych services last year and he thought they
had a laissez-faire approach to sanitation at the jail. His concern is
that the models sound impressive, but they need to pay attention to the
nuts and bolts of the operation. There are people that cannot take care
of themselves. Commissioner Illig urged Mr. Banks to also convey these
concerns to the Sheriff, who is responsible for jail cleanliness.
(3.5) SFGH-Health Information Systems – Request for approval of a
renewal contract with Deliverex, Inc., in the amount of $690,000, for
the purpose of storing, retrieving and delivering medical records for
San Francisco General Hospital’s Health Information Services, Medical
Staff Services and Radiology Departments, for the period of July 1, 2005
through June 30, 2006.
(3.6) PHP-CHSS-TB Control - Request for approval of a contract renewal
with UCSF at San Francisco General Hospital, in the amount of $228,000,
to provide physician and radiologist services to patients referred to
the SFGH Tuberculosis Clinic, for the period of July 1, 2005 through
June 30, 2006.
Commissioner Sanchez abstained from voting on this item.
(3.7) PHP-MIS – Request for approval of a renewal contract with Dataway,
in the amount of $468,319, for the provision of Information Technology
support services for the Department of Public Health, for the period of
July 1, 2005 through June 30, 2006.
(3.8) PHP-STD Prevention & Control – Request for approval of a
retroactive contract renewal with UCSF/Center for AIDS Prevention
Studies, in the amount of $280,194, to provide Efficacy of Condom Skills
randomized, controlled trial services targeting English speaking women
and men who seek diagnostic SDT examination and treatment at the SF City
Clinic with a new problem visit during the study period, for the period
of November 1, 2004 through October 31, 2005.
Commissioner Sanchez abstained from voting on this item.
(3.9) PHP-Community Health Services – Request for approval of a renewal
contract with AmeriChoice, in the amount of $413,056, which includes a
12% contingency, to provide fiscal intermediary services to the Personal
Assisted Employment Services, for dental services, for the period of
July 1, 2005 through June 30, 2006.
- Commissioner Sanchez asked if this program picked up any of the
clients that were formerly served by the UC Dental Clinic at SFGH. Ms.
Martinez replied that at the time of the closure she explored having
community clinics serve the clients. This did not work out, and now she
is analyzing the feasibility of having these clients served at Tom
Waddell. The PAES program is for a specific population, and the dental
needs of participants are severe and cannot be treated at DPH sites.
(3.10) CBHS - Request for approval of retroactive new contract with City
College of San Francisco, in the amount of $100,800, to provide mental
health/substance abuse training/certification services, for the period
of July 1, 2004 through June 30, 2005.
- Commissioner Sanchez hopes that this program could rotate through the
new student health center that City College is breaking ground on.
Commissioners’ Comments (at Commission Meeting)
- Commissioner Tarver noted the overrepresentation of African Americans
receiving Jail Health Services and asked for additional details about
discharge planning and connections to community services. Dr. Goldenson
said that discharge planning and transitional services for mental health
programs have not been reduced, and continue through this contract. The
discharge planning cuts that have been made over the past few years have
been in medical services.
- Patrick Monette-Shaw – he would like to understand how people
retroactively teach people to use condoms. This is not an effective use
of DPH money.
Action Taken: The Commission (Guy, Illig, Sanchez, Tarver) approved the
Budget Committee Consent Calendar, with the exception of Item 3.6 and
Action Taken: The Commission (Guy, Illig, Tarver, Umekubo) approved Item
3.6 and Item 3.8 of the Budget Committee Consent Calendar.
4) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., presented the Director’s Report.
Budget Status Update
On May 31st, the Mayor released his FY 2005-06 Proposed Budget. Improved
financial performance City wide made it possible for the Mayor to
restore many of our proposed reductions and avoid many of most
significant service reductions. In addition, new funding was added
including $4.5 million in COLAs for nonprofit contractors (including UC),
an additional $1.5 million in structural fixes for the UC contract, and
$6.9 million in new capital projects. Due to the improvements in the
City's finances, no cuts were made to primary care, public health or
home nursing, residential substance abuse, or mental health services.
Financial savings that remain include $3.2 million to be recovered from
restructuring outpatient Substance Abuse services to reduce per unit
cost and increase available methadone slots; $1 million for AIDS
practical support programs; $0.4M for AIDS prevention programs; $1.5
million in pharmacy co-pay for persons without general assistance; $1.0
million from closure of the Workers Compensation Clinic at SFGH; and
$0.3 million for closure of the Dialysis unit at SFGH. In addition, the
budget included the annualized reductions that were taken mid-year
totaling $7.6 million.
Following issuance of the Mayor's budget proposal, an error was
identified in the amounts budgeted for AIDS grants for the prior year
(2004-05). Correction of that error reduced the reported reduction in
AIDS grant expenditures from $12 million to $3 million.
The Beilenson Hearing is scheduled for the June 21st meeting of the full
Board of Supervisors. The hearings to review the Health Department
budget will be heard by the Budget and Finance Committee on June 20th
and June 27th.
AB 631, also known as the mobile methadone bill, passed off the Assembly
Floor 65-3 and now proceeds to the senate. AB631 will create a category
of licensure for mobile methadone maintenance treatment programs (MMT)
in California. If passed, AB631 this will enable us to receive MediCal
reimbursement for services provided. Approximately 21 % of the MMT
clients are MediCal beneficiaries but SFDPH assumes the full cost of
their treatment. This is because the Department’s methadone van is
operating as a temporary pilot project authorized by the State and
federal Drug Enforcement Agency, but without formal State licensure. AB
631 will not only remedy this issue in San Francisco, but also expand
access to MMT statewide.
SFGH Rebuild Blue Ribbon Committee
Members of the Mayor’s Blue Ribbon Committee on San Francisco General
Hospital’s Future Location met for the first time last week at the San
Francisco Foundation Offices. The Committee’s charge is to make a
recommendation to the Mayor, this Health Commission and the Board of
Supervisors on where SFGH should be rebuilt. Gene O’Connell presented an
overview of SFGH, its role as both a community hospital and a Level 1
Trauma Center and the highlights of the population it serves. The
committee then reviewed the body of work that has already been done and
began a discussion on the unique characteristics that both UCSF and SFGH
bring to this challenge. Dr. Edward Chow is a member of the Committee
representing this Health Commission. The committee will be meeting again
on June 30 and continue its discussion of the major issues that need to
Mental Health Services Act
Last week the State Department of Mental Health released estimates on
the probable allocation from the Mental Health Services Act (formerly
Prop 63) for the portion of funding that would support the clinical
services expansion. San Francisco was formulated to receive far less
than what had been preliminarily projected--$5,332,900 verses the
anticipated amount of more than $10 million. This estimate is 55% of the
totals that will be allocated, so San Francisco's total per year will be
closer to $10 million rather than the anticipated $20 million or more.
Efforts are underway with the Mayor's office and our lobbyists in
Sacramento to see if anything can be done to change to allocation.
It appears that San Francisco was under-funded due to the high portion
of general fund and high use of state and federal grants that fund
behavioral health services. The estimate also failed to account for a
number of other significant factors for San Francisco and the Bay Area:
- The high cost of living influence on service delivery in the Bay Area.
The State used 200% or below of the poverty level as the measure of the
poverty population. The recommended percentage is 300% - 400%, which
would help the Bay Area.
- The large number of people who come to San Francisco for services that
were not provided in their original places of residence.
- The impact these individuals contribute to our growing homeless
- The additional costs involved in providing culturally, ethnically, and
linguistically sensitive services. These are the majority of services
already being provided and will need to be continued.
Project Homeless Connect 5
Project Homeless Connect (PHC) held its fifth event on June 3rd at Bill
Graham Civic Auditorium. Nine hundred eighty seven (987) homeless
clients were seen that day; 123 received medical services, 40 were
referred to mental health and substance abuse services, 28 people were
tested for HIV, 50 people were referred to methadone treatment, 31 were
placed in stabilization housing, 51 people were put in shelter, 94
people received legal counseling, 90 received CAAP services, 84 people
received SSI counseling, 150 people received eye exams, 53 people
received eyeglasses and 6 wheelchairs were stripped down and repaired.
Deloitte and Touche assisted with this event by donating thousands of
sweatshirts and socks for homeless clients. They also provided 900
volunteers, along with the 850 regular community volunteers. Project
Homeless Connect is an inspiring event where private individuals,
community agencies, private companies, the mayor’s office and city and
county providers work together to help connect the homeless to services.
The next event is on August 4, 2005. If people are interested in
volunteering please sign up on the website at
Universe Within Investigation
During the past two weeks the Department has been investigating an
exhibit at the Masonic Auditorium. The exhibit shows dead bodies that
have been plastinated. The process of plastinating human bodies involves
sterilizing the body, injecting it with silicon, and then letting the
bodies cure for a 6-month period.
Although exhibits of plastinated bodies can be a legitimate method of
teaching people about the human body, there are several problems with
this particular exhibit. The biggest problem is that it does not appear
that the individuals whose bodies are being exhibited gave their consent
for their bodies to be used in this way. Second, the bodies are dripping
silicon, which they should not be doing. We do not believe that the
dripping represents a health hazard. Cultures of the fluid have been
negative. Nonetheless, we have required that the exhibitors rope off the
bodies so that the public will not try to touch them.
Supervisor Ma will be introducing legislation to require full consent of
the person or their immediate family prior to their body being exhibited
in this way in San Francisco.
George Lau appointed to Fire Commission
Dr. Katz congratulated George Lau, accountant at 1380 Howard and
treasurer of Local 21, who has been appointed to the Fire Commission by
Mayor Newsom. He was sworn in May 25.
Southeast Community Facility Commission
On May 25, 2005 Dr. Katz gave testimony at the Southeast Community
Facility Commission about the health issues in the Bayview Hunter’s
Point Neighborhood. Former Health Commissioner Dr. Harrison Parker was
present and recommended that the Health Department sponsor Health Fairs
in the Bayview to promote prevention themes. Dr. Katz thought this was
an excellent idea and the Southeast Community Facility Commission agreed
to co-sponsor with the Health Department a Health Fair focused on
increasing exercise. He will alert the Commission as soon as there is a
Dr. Dan Wlodarczyk, director of Southeast Health Center and long-time
DPH employee, was recently recognized by the San Francisco Chronicle,
KCBS radio and CBS Channel 5, to receive the Jefferson Award for Public
Service. The Jefferson Awards were begun in 1972 by Mrs. Jacqueline
Kennedy, to honor individuals at both a national and a local level for
their community and public service. On a local level, Jefferson Awards
recipients are ordinary people who do extraordinary things without
expectation of recognition or reward.
- Commissioner Illig is pleased that, for the most part, the programs
that the Commission said should not be cut were kept whole. He is
particularly interested that the CHIPPS program was funded, and that
there is new money for supportive housing for seniors. He congratulated
Dr. Wlodarczyk, who served for a time on the board of Project Open Hand.
He is an amazing individual.
- Commissioner Umekubo asked if anyone in the United States is allowed
to plastinate. Dr. Katz said the bodies were plastinated in China, and
were brought in through customs. Dr. Katz does not think there are any
rules about who in the United States would be able to plastinate and no
one in the U.S. does it.
- Commissioner Guy said that the Health Commission might need to
consider rescheduling its June 21st meeting to accommodate the Board of
Supervisors Beilenson Hearing. She also said the joint conference
committee should discuss and monitor the restructuring and rebidding of
substance abuse services. She has some concerns about “one shoe fits
all” in terms of the expansion of methadone. Dr. Katz said that if the
cuts remain in the budget, the Department would convene a meeting of all
the existing service providers and those who wish to be service
providers, and pose to them what we’re trying to achieve and hear their
5) LAGUNA HONDA REPLACEMENT PROGRAM: CONTROLLER’S REPORT AND
Dr. Katz introduced Ed Harrington, the City Controller, and asked him to
provide a summary of the report he recently issued. Mr. Harrington said
that his office prepared the report at the Mayor’s request, and looked
at a variety of options for rebuilding Laguna Honda Hospital. He
concluded that there are only two options worth considering:
Option 1 – Use all reasonably available funds to complete a 1,200 bed
skilled nursing facility at Laguna Honda.
Option 2 – Use most funds to complete three buildings at Laguna Honda
with 780 skilled nursing beds and use the remaining funds plus
operational savings to purchase other long-term care services in
assisted living, supportive housing, home care or other community-based
settings. Total people served under this option would exceed 1,800.
Mr. Harrington reviewed the funds that are currently programmed for the
rebuild project, which are General Obligation Bonds, Tobacco Settlement
funds and other (primarily interest), for a total project budget of $401
million. There are two new sources of funding available to the project.
The first is to issue Certificates of Participation (COPs) to be repaid
using federal revenue available through SB1128. The second is to use the
next $100 million of tobacco settlement funds for construction, in
addition to the $92 million in settlement funds that have already been
Option 1 would use the $629 million in funding to cover the most
probable cost estimate for a 1,200 bed skilled nursing facility ($600
million to $640 million). Option 2 would use $482 million to complete
the first three buildings with 780 skilled nursing facility beds, and
use $59 million to build 235 assisted living and/or supportive housing
beds at Laguna Honda. In addition, funds would be available to pay for
the annual cost of care for another 790 individuals in various
- Commissioner Illig asked if the $120 million in COPS was based on 780
beds or 1,200 beds. Mr. Harrington replied that it is based on the debt
services, which is $299 million regardless of what type of facility is
built. Commissioner Illig asked if other counties building SNF
facilities have used SB 1128. Dr. Katz said SB 1128 was modeled after a
successful bill, which has now closed, that allowed several acute care
hospitals to rebuild. SB 1128 was specific to San Francisco and San
Diego. Commissioner Illig asked if the funding that Senator Feinstein
obtained for Laguna Honda assisted living planning is still available.
Mr. Lane said the HUD grant money is available for assisted living and
is valid until September 2007. Commissioner Illig asked if there is any
time period in which a decision needs to be made, separate from
approving moving forward with the third building. Mr. Harrington would
like decisions so that the project could issue debt next year and not
lose the chance to repay itself.
- Commissioner Umekubo asked if San Francisco has the community capacity
to serve the people who are not served at Laguna Honda. Mr. Harrington
said there are several options for caring for these people, and
providers in the community have indicated that the capacity is either
currently available or could be in the future.
- Commissioner Tarver said the estimates were rather high in terms of
cost per bed. He asked if the Controllers’ Office would independently
evaluate these costs. Mr. Harrington said they intentionally used the
higher, more conservative, cost estimate. Many people thought it likely
that people coming from Laguna Honda Hospital into a different level of
care would require the higher level of services.
- Commissioner Guy asked if operating costs would be available, and how
people could be sure that the money that might be saved building
assisted living beds rather than SNF beds would be used for community
services. Mr. Harrington said they would set up a trust fund to serve at
least 1,200 people for the next 25 years. The remainder of the money is
somewhat up to goodwill.
- Commissioner Illig asked if a consultant is preparing another study of
Laguna Honda Hospital. Mr. Harrington replied that a consultant, in
conjunction with DPH and the Controller’s Office, is doing a report on
long-term care in San Francisco. It is a more global report but will
certainly inform decisions around Laguna Honda. This report should be
finished in the middle of June.
Mitchell H. Katz, M.D., continued the presentation by focusing on the
implication of the report for the Health Department and the Health
Commission. Based on the report, the Health Commission should assume
- There is enough money to build at least 780 beds (plus the 50%
contribution to the 140 units of assisted living, and the adult day
health center envisioned in the bond).
- It is possible to use certificates of participation and the tobacco
funds to build the entire 1200 beds initially envisioned.
- The major policy question for the Health Commission is whether to
build the full 1200 beds or use the money saved by building and
operating only 780 beds to increase other types of community-based
long-term care (e.g., board and care, assisted living, supportive
housing, and independent living).
Making this decision will require review of detailed information. Some
of this data is available for today’s presentation. The information not
available will be presented at a future meeting. Data required for
decision making includes, at a minimum:
- Laguna Honda Hospital (LHH)
- Available services
- Resident characteristics
- Where patients are admitted from
- Where patients are discharged to
- Ability and preferences of existing residents and residents who would
be entering LHH to be cared for in the community
- Projections of need versus supply of skilled nursing beds for the
- Costs (present and future) of operating LHH
- Community-based long-term care
- Available services
- Census of different community providers
- Client characteristics
- Obstacles to expansion
- Projection of needs and supply of services
With regard to decision timing, Dr. Katz said that the City does not
need to make an immediate decision about whether to build 780 or 1,200
beds because the final 420 beds cannot be build until Clarendon Hall is
demolished, which is projected to be in 2009. However to maximize the
repayment using SB 1128 a decision to go forward with the 1,200 beds
should be made by December 2005.
Dr. Katz presented the data that is available today, which includes a
description of services at Laguna Honda, the census, resident
characteristics and discharge information. He also described the
Targeted Case Management (TCM) Program, which has been in operation
since March 2004. To date, all residents at Laguna Honda have been
screened by the TCM Program and approximately 80 percent are candidates
for being discharged to a community setting. However, this does not mean
that these residents wish to be discharged or that the appropriate
community resource exists at the current time.
Dr. Katz reiterated that this is just the initial discussion, and there
are many questions that need to be answered and data that must be
- Sandy O’Neill, member of Board of Directors of San Francisco
Independent Living Center, and member of the Long Term Care Community
Advisory Board, said TCM came out of a civil rights challenge, assisted
living is not about “beds,” but rather about living. We’re talking about
more people being locked up at Laguna Honda Hospital. Many patients want
to leave Laguna Honda Hospital. ILRC-SF supports neither Option 1 nor
Option 2, but urges the Commission to consider other options in
consultation with other appropriate groups and agencies.
- Howard Chabner has an elderly relative at Laguna Honda Hospital who
has in general received excellent care there. He urged the Health
Commission to approve rebuilding Laguna Honda with the full 1,200 beds.
The voters approved the bond based on their agreement that San Francisco
needs 1,200 long-term care beds.
- Patrick Monette-Shaw said the Controller’s report is riddled with
errors. In addition, if the number of SNF beds is reduced, so is the
revenue from SB 1128. The tobacco settlement revenue account is the
trust fund for this project. He feels it is a fait accompli that there
would only be 780 beds.
- Jennifer Walsh spoke in support of option 2, which serves 1,000 more
people in community settings. San Franciscans do not need more skilled
nursing care, but rather assisted living and other independent living
arrangements. People at Laguna Honda Hospital want to move out but are
afraid of the process. Please support Option 2.
- Elissa Berrol said she has friends, family members, lovers and
coworkers who have disabilities and she has taken it for granted that
they could live independently. Some people need SNF beds, but if we
increase funding for assisted living beds and other community options,
more people could live independently. By voting for Option 2, the Health
Commission votes for independence.
- Sandy Mori, member of the Long Term Care Coordinating Council and
Laguna Honda Rebuild Committee, said it is wonderful to have a dialogue
around this important policy issues. The long-term care community is
excited about Option 2, and she urges the Commission to evaluate this
carefully. She also urged the Commission to involve the Department of
Aging and Adult Services in these discussions.
- - Elissa Gershon, staff attorney at Protection and Advocacy, commended
San Francisco for setting up the Targeted Case Management Program and
for considering in the discussion of the Laguna Honda rebuild the issue
of community services. These discussions must go hand in hand—for every
SNF bed that is not built, what additional community services could be
funded? They do believe that, in addition to Option 1 and Option 2, the
Health Commission should be looking at other alternatives, such as not
even building 780 beds.
- Elizabeth Boardman, member of the Long Term Care Coordinating Council,
urged the Commission to evaluate a proposal she submitted regarding a
day health housing model (on file in the Health Commission Office). This
is a very interesting alternative and exists in one form in San
Francisco at On Lok. She is very sympathetic with the proposed Option 2.
As she understands it, there is no funding for assisted living for
people who are poor. This needs a legislative remedy.
- Brian Uyeno, employee at Laguna Honda Hospital, said he worked hard to
pass Proposition A in 1999 for two reasons. First, to protect his job.
But more importantly he wanted the hospital rebuilt because the city
needs it—the people need it. In 1999, DPH did a study that indicated San
Francisco would need more than 1,200 beds. No study has been done that
proves otherwise. He hopes the Health Commission maintains its
commitment to a 1,200 bed facility.
- Oletha Hunt, employee at Laguna Honda Hospital, is concerned that the
hospital is being treated like something that can be thrown around with
no concern about the people who live there. It is not fair to the
patients. People work hard at Laguna Honda for the patients. There is no
place better than Laguna Honda. They do not want to keep people at
Laguna Honda who do not want to be there. They want to discharge
- Perpie Magdaloyo, an employee at Laguna Honda Hospital, worked hard to
pass Proposition A in 1999 because she wants to know that Laguna Honda
would be available for her and other San Franciscans when they need it.
She urged the Health Commission to support the 1,200 beds that the
- Kim Tavaglione, United Healthcare Workers, said the Asian community
has always been very committed to taking care of their extended families
in their own homes. In the United States, this is not always possible
and Laguna Honda is going to be an alternative that is much more
utilized by the Asian community. Caring for elders is a daunting task.
Furthermore, San Franciscans are not having children, so there will not
be as many people to take care of them. San Francisco should build a
1,200-bed, world class SNF.
- Gloria Watts, employee at Laguna Honda Hospital, said she campaigned
for Proposition A in 1999 and told voters that the hospital would be
built for San Franciscan who needed care. They give great care to all
who need it. They need 1,200 beds.
- - John Kosinsky, United Healthcare Workers West, said there have already
been many discussions and research, prepared by DPH, that showed there
should be 1,200 beds at Laguna Honda, but yet again we are engaged in
the discussion about how big the hospital should be. His union
wholeheartedly supports community care, but not at the expense of other
people who need care. It is our responsibility to build a Laguna Honda
that is there for people who need it. The longer the decision around
Laguna Honda hospital takes, the harder it will be to rebuild San
Francisco General Hospital.
- Larry Bevan, shop steward with SEIU United Healthcare Workers, said
that we need to look at the long-term picture, which shows that the
population is aging, and there are greater needs for everything. The
need for 1,200 skilled nursing beds still exists. SNFs tend to be snake
pits, and this is not the case at Laguna Honda. Laguna Honda is a jewel.
The public is going to lose faith and will not vote to rebuild SFGH.
- Linda Abullarade, employee at Laguna Honda Hospital, said the staff at
Laguna Honda strive to make residents a part of the community, and needs
to be rebuilt at 1,200 beds.
- Donna Calame, executive director of IHSS Public Authority, would hope
that the care at Laguna Honda is better than other facilities, because
it gets twice a much as a community SNF, plus a $100/day patch. So it
would be a shame if they did not provide a greater level of care. She is
committed to expanding homecare services. It means so much to people
with disabilities to remain in the community. Institutionalization of
disabled people is wrong. There has not been enough community discussion
about community alternatives.
- Commissioner Illig commended Dr. Katz for involving others in this
discussion, including the Long Term Care Coordinating Council, and added
the Mayor’s Disability Council to the list. He asked Dr. Katz where the
Department stands with the Nursing Facility waiver, which is referred to
in the TCM reports. Dr. Katz said there has been some confusion around
the TCM report, and clarified that report says that 80 percent of the
residents at LHH have been assessed as not needing to be in Laguna Honda
Hospital and to be able to be discharged into community based care,
assuming that was their preference and that the care was available. It
is not accurate to say that 80 percent of Laguna Honda residents do not
need skilled nursing care. The Nursing Facility Waiver is a State
program that enables an enriched service array, especially around home
nursing and attendant care. People who without the waiver would not be
able to live outside of Laguna Honda could possibly do so with the
waiver. The State currently has a waiting list. DPH wants to continue to
add people to the waiting list to put appropriate pressure on the State
to enable additional people to join the program.
- Commissioner Tarver would like to see a summary of the waiver
applications in terms of level of need and, if the waivers were granted,
where they would be served.
- Commissioner Illig commented that some of the factors that are new
since 1999 are the Olmstead Act and two visits for the Department of
Justice. These issues have to be fully presented and discussed in terms
of implications for the future. The Health Commission needs to fully
examine how San Francisco can provide more services to more people, both
on the Laguna Honda campus and off.
- Commissioner Tarver would like additional distinctions of patients at
Laguna Honda, and their disparate needs.
- Commissioner Umekubo said it is appropriate to re-examine assessments
that were done six years ago. His concern is that the types of patients
that are going to grow in the future are those with Alzheimer’s disease
and we need the ability to care for these individuals in facilities from
which they cannot get out. He asked for additional information on
PACE—Program for All-Including Care for the Elderly. Dr. Katz said On
Lok was the model program, but other programs have developed. They
typically are adult day health care, some include a housing component,
although the majority of clients are in independently living outside of
On Lok. His understanding is that capacity could grow in this area. The
limitations around PACE include availability of housing, income and
change of providers. It has the ability to take care of people with
- Commissioner Tarver said Community Behavioral Health Services should
be brought in to discussions about different models of care for people
who live in skilled nursing facilities, in community care and other
areas. People have a range of needs.
- Commissioner Guy asked that Health at Home be involved in the rebuild
discussions as well. She supports paying attention to the language in
the report, and clearly stating that the need for a skilled nursing
facility does not always equate with being elderly. She asked what the
appropriate process and timeline is for discussion and decision, and
wants the Laguna Honda Hospital Joint Conference Committee to be
involved. Dr. Katz said the August 16th meeting would work well for
presenting the additional information necessary to decision making.
Commissioner Guy said there would be many discussions around this. The
Commission clearly understands how important this is to the community.
She welcomed any additional information from the public.
- Commissioner Tarver thanked the public for coming to the meeting. The
Health Commission pays attention to, and is moved by, public comment.
6) CONSIDERATION OF A RESOLUTION AUTHORIZING THE LAGUNA HONDA HOSPITAL
REPLACEMENT PROJECT TO PROCEED WITH THE EAST BUILDING
Michael Lane, Project Manager, Laguna Honda Hospital Replacement
Project, presented a resolution authorizing the Laguna Honda Hospital
Replacement project to proceed with the construction of the East
Building in addition to the South and Link Buildings, for a total of 780
On March 29, 2005, the Health Commission approved Resolution 05-05
allowing the City to proceed with the construction of the South and Link
Buildings and any associated work with no scope reductions. Since that
time, the City Controller prepared a report outlining options for how to
proceed with the replacement of the hospital. The Controllers’ report
indicates that there is enough funding to build at least 780 beds, and
both options proposed by the Controller specify proceeding with the
South, Link and East buildings.
Action Taken: The Commission (Guy, Illig, Tarver, Umekubo) approved
Resolution 08-05 “Concurring With the Recommendation to Proceed with the
Construction of the East Building at Laguna Honda Hospital,” (Attachment
7) PUBLIC COMMENT/OTHER BUSINESS
Howard Chabner recounted an incident where an able bodied woman
assaulted an elderly patients. This woman put the entire ward of elderly
ladies at risk, and required a large amount of nursing care that could
have gone to other patients. Cal OSHA remains concerned about safety and
the DOJ is concerned. All of these problems are a direct result of the
Shawn Allemby spoke on behalf of her mother, Fran Allemby, and her
experience working with staff at SFGH Emergency Psychiatric Services.
She protests SFGH’s conserving her mother because her mother has
children who are willing and able to care for her and do not want her to
be sent away to a locked facility. She is currently seeking probate
conservatorship over her mother. She is very disappointed about how she
and her mother have been treated. She submitted a copy of her testimony
(on file in the Health Commission Office)
Darryl Jones said she has been a target of the police syndicate for 17
years. The hospitals have abused her over and over. Recently she was
subject to an illegal 5150. She is concerned about the way the community
is run, and the mental health facilities.
Patrick Monette-Shaw read from page 12 of his report regarding his
lawsuit that is currently in appeals court and other issues. Building
fewer than 1,200 beds is a bait and switch. The Health Commission and
Board of Supervisors should stop playing politics with Laguna Honda.
The meeting was adjourned at 6:20 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
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