Minutes of the Health Commission Meeting Tuesday, September 20, 2005 at 3:00 p.m. 101 GROVE STREET, ROOM 300 San Francisco, CA 94102 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 Donald E. Tarver, II, M.D. Commissioner John I. Umekubo, M.D. Absent: Commissioner David J. Sanchez, Jr., Ph.D. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF SEPTEMBER 6, 2005 Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Tarver, Umekubo) approved the minutes of the September 6, 2005 Heath Commission meeting with two corrections. Dr. Eugene Yee was corrected to read Dr. Eugene Lee, and Commissioner Tarver’s comments on page 11 were corrected to read “medical patients also have psychiatric needs.” 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Illig chaired and Commissioner Chow attended the Budget Committee meeting. (3.1) DPH-STD Prevention & Control – Request for approval of a retroactive contract renewal with PHFE Management Solutions, in the amount of $78,400, including a 12% contingency, to provide fiscal intermediary services for the Positive Reinforcement Opportunity Project for gay and bisexual men and other men who have sex with men and report using methamphetamines, for the period of July 1, 2005 through June 30, 2006. (3.2) AIDS Office-HIV/AIDS Statistics & Epidemiology – Request for approval of a retroactive new contract renewal with PHFE Management Solutions, in the amount of $146,947, including a 12% contingency, to provide fiscal intermediary services for the Core Surveillance Project for HIV/AIDS, for the period of September 1, 2005 through August 31, 2006. Commissioners’ Comments Commissioners would like outcomes and demographics for services provided through fiscal intermediary contracts. (3.3) AIDS Office-HIV Health Services – Request for approval of a retroactive contract renewal with UCSF/AIDS Health Project, in the amount of $294,219, to provide mental health crisis services to multiply-diagnosed San Francisco residents living with HIV and to homeless, out of treatment women with children/families, youth, people of color, transgender, indigent/very low income, previously incarcerated and immigrant or undocumented individuals, for the period of March 1, 2005 through February 28, 2006. (3.4) AIDS Office-HIV Health Services – Request for approval of the following four new contracts for the provision of outpatient mental health services to persons with HIV and AIDS for the period of November 1, 2005, through February 28, 2007: Instituto Familiar de la Raza for $149,333; New Leaf for $229,913; Regents of the University of California San Francisco – AIDS Health Project for $506,083; and Westside Community Mental Health Service for $179,200. All four contracts utilize FY 2005-2006-2007 Federal Ryan White CARE Title I (CARE I) funds in the amount of $233,276 for the period of November 1, 2005, through February 28, 2006, and $699,830 for the period of March 1, 2006, through February 28, 2007, pending approval of the Federal CARE Title I Grant, and City and County General Funds in the amount of $17,367 for the period of November 1, 2005 through June 30, 2006. In addition, a 12% contingency, amounting to $114,056 will be applied to the contracts. Secretary’s Note – this contract was continued to the next Health Commission meeting. (3.5) CBHS-Community Programs – Request for approval of a retroactive new sole source contract with Central City Hospitality House, in the amount of $636,160, including a 12% contingency, to provide mental health socialization and wellness services, for the period of July 1, 2005 through June 30, 2006. Commissioner Illig asked how the Department was planning to work with Central City Hospitality House to ensure that their program is as effective as possible and is well equipped to compete in an RFP process. Ms. Korfmacher said DPH has already started its technical assistance to Central City Hospitality House, and this will continue. (3.6) CBHS-Health Promotion & Prevention – Request for approval of sole source contract renewal with Booker T. Washington Community Services Center in the amount of $335,275, including a 12% contingency, to provide logistical and administrative support services for the SevenPrinciples Project targeting African Americans for the period of September 30, 2005 through September 29, 2006. Commissioner Illig asked if Booker T. Washington plans to expand its board of directors. Ms. Scott replied that they are planning to expand the board, and are carefully selecting candidates. Commissioner Chow asked how they are evaluating the measures. Ms. Smyly said that the Family Health Outcomes Project is the evaluator, and FHOP did a presentation at the Community Programs and Services Joint Conference Committee last spring that showed promising data around awareness of infant mortality and disparities. She would be happy to give another update to the JCC. They use a variety of tools including surveys and pre- and post-tests. The jury is still out on the community access teams. Commissioner Illig asked the Department to provide a report at a future Community Programs and Services Joint Conference Committee that summarizes all Department initiatives across divisions that address African American health disparities. (3.7) CBHS-Maternal Child Health – Request for approval of retroactive renewal contract with Polaris Research & Development in the amount of $457,845, including a 12% contingency, to provide Black Infant Health Improvement Program services targeting African American parents for the period of July 1, 2005 through June 30, 2006. Commissioner Illig asked what the outcomes are for this program. Ms. Johnson of MCH replied that the State requires the BIH program serve 25 percent of African American births, which equates to 150 new enrollees in the program each year. When women have this level of intervention, she estimates they have a 98 percent level of successful outcomes. Commissioner Chow asked if the program has resulted in improvements to Black Infant Health, and where these accomplishments are noted. Ms. Johnson replied that they are seeing very solid birth outcomes. Ms. Smyly added that there is a wide range of interventions around birth disparities. The BIH program is just one component, which is to provide support to African American women who are of low or medium risk for adverse outcomes. Based on the State’s model, 98% of women had healthy babies and obtained better parenting skills. Commissioner Illig asked the representative from Polaris to address concerns about the Board of Directors (only four members and no term limits) and strongly recommends that the agency change its bylaws to increase Board membership with defined terms. (3.8) DPH – Central Administration – Acceptance of the Annual Gift Report Commissioner Illig asked if DPH had received any funding from the Laguna Honda Hospital Foundation. Mr. Sass said it had not, and the Foundation is in suspension. Commissioner Illig said that the Health Commission heard testimony from LHH Foundation staff that the Foundation raised money and received grants. He is troubled that the Department is not connected at all to these funds, and he said the Laguna Honda Hospital Joint Conference Committee would be following up on this issue. Commissioner Chow thanked the public for its generosity, and thanked Avon for its contributions. Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Tarver, Umekubo) approved the Budget Committee Consent Calendar, with the exception of Item 3.4, which was deferred to the October 4th Health Commission meeting. 4) DIRECTOR’S REPORT Anne Kronenberg, Acting Director of Health, presented the Director’s Report. Emergency Shelter for Survivors of Hurricane Katrina As reported at the September 6th Health Commission meeting, DPH has been actively involved with the planning and provision of services for individuals and families evacuated from the Gulf States due to the disaster caused by Hurricane Katrina. The Red Cross, with support from the Human Services Agency and the Department of Public Health set up a shelter and service center in the basement of Saint Mary’s Cathedral in anticipation of FEMA sending 300 evacuees during the week of September 5th. As it turned out, FEMA did not send evacuees to San Francisco, however, many individuals began to spontaneously migrate to San Francisco. Evacuees found their way to San Francisco because they had family or friends here. Although the numbers are still preliminary, it is believed over 400 families have arrived in San Francisco. Red Cross is continuing to process new cases daily. The Health Department began staffing the Service Center September 6th. DPH staff included two public health nurses and two behavioral health providers, one nurse practitioner or physician and on-call psychiatrist. Our community partners, including Westside Mental Health, Bay View Hunters Point Foundation and Catholic Charities CYO, supplemented staff. Services were provided on site at the service center until September 19th. The Saint Mary’s Service Center closed yesterday due to declining numbers of evacuees. Services were shifted to the American Red Cross headquarters on Second Street, the Human Services Agency, and Ella Hill Hutch Community Center. Referrals for health care services will now be made directly to the DPH Urgent Care Clinic on the SFGH campus. Preliminary analysis of the documentation taken at the Service Center by DPH staff indicated that there were 158 unduplicated medical encounters seen at Saint Mary’s Cathedral. More than seventy percent of the people seen at the Service Center came in for new or refill prescriptions. Sixty-three percent of the medication refills were for chronic conditions such as diabetes, hypertension, asthma and depression. Many referrals were made to Community Health Network clinics and Urgent Care at SFGH. The Communicable Disease Control and Prevention unit (CDCP) from DPH provided citywide health alerts to providers and immunizations for those that needed them. DPH staff will continue to triage and refer evacuees who have registered with the Red Cross. The Department will continue to provide information to other health providers, including hospitals, on where to refer patients who need additional services and resources. Ms. Kronenberg is very proud of the work that staff performed over the course of the last two weeks providing needed services to the survivors of Hurricane Katrina. San Francisco General Hospital San Francisco General Hospital’s annual unannounced Skilled Nursing Facility (SNF) survey from the Department of Health Services began Monday, September 19th and is expected to continue through the week. SFGH has two SNFs on campus, one located in the Main Hospital on 4A with 30 beds, and the other is located at the San Francisco Behavioral Health Center (formerly known as the MRFH) with 60 beds. Capp Street Fire Three individuals lost their lives in a three-alarm fire on September 15th at 19th and Capp. Four residents and five fire fighters were transported to San Francisco General Hospital. As of today, two firefighters are still at SFGH being treated for burns on their lower legs. A civilian from Capp Street remains in critical but stable condition in the ICU. The fire affected buildings at 395 Capp and 3338 19th Streets. Damage to the 19th Street building was limited to one unit with minimal water damage. The 12-unit building on Capp Street was seriously gutted and tenants will not be able to return in the near future. The population of the Capp Street units was single, mono-speaking Latino men. We did not open a shelter, but a MUNI bus transported the survivors to the Second Street Office for casework purposes. The Red Cross was on the scene immediately and helped coordinate the evacuation process and provided vouchers for temporary housing. The owner of the Capp Street building was at the scene and reported a tenant list of 37. However, DPH staff believes the facility housed many more than those on the tenant list. The Mission SRO Collaborative became involved the next day and provided Spanish-speaking counselors and services for the survivors. Ms. Kronenberg is grateful to Charlie Morimoto and Ben Aymes for their excellent response on behalf of the Department. Commissioners’ Comments Commissioner Monfredini commended DPH staff, particularly Anne Kronenberg, for their work with Hurricane Katrina survivors. Not only did staff volunteer their time, but also quietly went about doing their daily work. 5) CONSIDERATION OF A RESOLUTION DETERMINING WHETHER THE CLOSURE OF ST. LUKE’S HOSPITAL PSYCHIATRIC/BEHAVIORAL HEALTH INPATIENT UNIT WILL OR WILL NOT HAVE A DETRIMENTAL IMPACT ON HEALTH CARE SERVICE OF THE COMMUNITY Commissioner Monfredini thanked St. Luke’s for providing the information that was requested by the Health Commission at the September 6th meeting in the 24-hour time period. Commissioner Monfredini noted that there was a misstatement in the September 19th letter from St. Luke’s Hospital to the Health Commission. In that letter St. Luke’s states it does not have a contract with the Department of Public Health for outpatient mental health services. However, Commissioners received a copy of such a contract from DPH staff, which was signed by the St. Luke’s CFO in April. Therefore, the statement that St. Luke’s does not have to comply with the Sunshine ordinance is also inaccurate. She asked Mr. Strong to clarify the statement that St. Luke’s does not have a contract. Mr. Strong, Director of Operations and Chief Financial Officer, said that St. Luke’s license does not provide for outpatient psychiatric services. The contract with DPH is with St. Luke’s subsidiary community health care clinic, which is a group of physicians. This contract is to provide physician services to see psychiatric patients. Commissioner Illig pointed out that the contract states that the contract is with St. Luke’s Hospital. After reviewing documents and confirming the federal ID number, Mr. Strong said that the contract with DPH should not say Sutter or St. Luke’s Hospital, but rather the St. Luke’s Health Care Center. The contract clearly had a number of mistakes, and he takes responsibility for that. Commissioner Monfredini asked if the Sunshine Ordinance would apply to a contract with the St. Luke’s Health Care Center, given that they have their own Board of Trustees and board meetings. Dr. Cabaj stated that DPH has had the contract with St. Luke’s for seven years. St. Luke’s legal counsel has not had the opportunity to review this issue. Commissioner Guy said that Sunshine laws apply and were not honored. Mr. Strong summarized some of the outstanding issues and questions that have been raised by the commissioners. Mr. Strong said with regard to the future of St. Luke’s, they are in discussions with CPMC about a merger, but he has also given the commissioners copies of St. Luke’s Strategic Direction Recommendations, which were adopted by the Board of Directors in 2003. Mr. Strong said that St. Luke’s has been working with the San Francisco Health Plan to increase the number of patients that St. Luke’s sees. Mr. Strong presented ethnicity information about St. Luke’s general patient population and specific information about the inpatient psychiatric unit. In that unit, the ethnicity is: White-45%, Hispanic-13%, Asian Pacific Islander-5%, African American-34%, native American-1%, Other-3%. Mr. Strong pointed to the outreach mechanisms that are used to communicate with staff, community and others, and said that St. Luke’s has a community advisory council. Mr. Strong reiterated that patients would be seen, stabilized and appropriately triaged through the health care system, and if there is not a place to transfer these patient to, patients would continue to be served at St. Luke’s, on a one on one basis, until they are able to stabilize and transfer the patient to an appropriate setting. Commissioner Tarver said that 53% of the patients are Latino or African American so considerations of culturally competent services are very important. He expected more detailed information in terms of provisions in place to triage culturally competent psychiatric services. Mr. Strong said that the management team, which has been assembled over the past two years, recognized that St. Luke’s is special and must provide culturally competent care. Most of their physicians are bilingual. The organizations they have met with, including Progress Foundation and other outpatient programs, are very well versed in cultural competency. Commissioner Tarver said that repeated studies show that approximately one third of patients in inpatient psychiatric programs are African American. They are more often misdiagnosed and subject to over medication. This is more likely to happen in an emergency room, rather than with a team of psychiatrists. He feels that this will result in people being provided substandard services. Mr. Strong said that St. Luke’s has been involved in the African American disparity project and are well aware of the disparities. A psychiatrist with strong ties to St. Luke’s has agreed to provide psychiatric consult services and follow up with these patients. Commissioner Tarver noted that, with this closure, San Francisco would lose acute psychiatric resources. So it is not just about having an informed and competent psychiatrist to provide consultations. It is an overburdened resource, and alternatives have already been utilized to the fullest extent. There will be long-term repercussions to removing this unit from St. Luke’s. Commissioner Tarver reiterated his opinion that money could be infused into psychiatry, and Sutter has the income to do so. Commissioner Monfredini reiterated that this Proposition Q hearing only covers the closure of St. Luke’s inpatient unit, not the elimination of the outpatient mental health services. Commissioner Monfredini said it is up to the Commission to decide whether or not it would call for a Proposition Q hearing. Deputy City Attorney Aleeta Van Runkle said that it is the Health Commission’s prerogative at this point to hold a hearing. Her understanding is that St. Luke’s has already taken action to cease the services. If the Health Commission wants to require St. Luke’s to post notice pursuant with the Administrative Code and hold a hearing, it can certainly do so. Deputy City Attorney Van Runkle said that the voters were very clear when they passed Proposition Q in 1988 that it covers any reduction in service as well as a closure of a facility and that it applies whether it is St. Luke’s Health Center or St. Luke’s Hospital. Commissioner Illig said that Proposition Q is very clear that it is the Health Commission’s job to advise policymakers when there is a negative health impact of any closure. Commissioner Illig said that St. Luke’s is about to merge with CPMC, which is a cash cow, so that takes care of the issue of means. What the Commission is considering today is not the closure of a six-bed facility. Rather it is the closure of a 31-bed facility that has been starved to six beds, and that this is just the tip of the iceberg. Until the Health Commission hears that there is an agreement with CPMC about keeping these kinds of services open and keeping St. Luke’s open, commissioners are going to pay very close attention. Mr. Strong replied that it is very clear that the Health Commission wants more transparency. Both CEO and Board Chairs have said that, if the merger between CPMC gets approved, they would come before the Health Commission to brief commissioners. Commissioner Guy asked Mr. Strong to address the plans for the Neonatal Intensive Care Unit. Dr. William Miller said St. Luke’s has an outstanding women and children’s program, and they look forward to it growing in the future. There is a process currently underway to evaluate if the level of services provided by the neonatal intensive care would be changed to a Level 1 nursery, where critically ill babies are transferred to UCSF or CPMC, or remain a level 2 nursery, which is a neonatal ICU. Over the next four to six weeks they will make a recommendation to St. Luke’s administration. If the decision is to downgrade to level 1, they will notify the Health Commission, intend to have a Proposition Q hearing and will provide the Health Commission with all supporting documentation. Commissioner Monfredini stressed to Mr. Strong that if there are any service reductions proposed for St. Luke’s Hospital or St. Luke’s Health Center or CPMC if the two entities merge, that they need to comply with Proposition Q. Public Comment Richard Marquez, Mission SRO Collaborative and Mission Agenda, said that this is the beginning of the end. He strongly opposes the removal of inpatient psychiatric unit. This is a unit by unit dismantling of a community asset. Sutter/CPMC makes people crawl for services. St. Luke’s has belonged to San Francisco for over 130 years, and is a prized resource for the southeast sector of the city. Karen Garrison, Bernal Heights Neighborhood Center and St. Luke’s Advisory Council, said that over 80 percent of St. Luke’s patients are either Medi-Cal or Medicare. It is vital that the uninsured and underinsured have access to medical and psychiatric services. Closing this department sets a bad precedent for closing other non-revenue producing units. The question is what’s next. Dr. Bonita Palmer, a physician at St. Luke’s, said that even prior to the proposed closure of the psych. unit it was clear that people were not receiving adequate or culturally competent mental health care. This will be exacerbated by the closure of this unit. Health care is a vocation, not a business. She had felt nothing but gratitude towards Sutter for the revitalization of St. Luke’s, but she is opposed to the proposed closure. Michael Lyon, Gray Panthers, said the southeast sector of the city is already underserved medically, and the entire city is underserved psychiatrically. All Sutter cares about it getting approval to build a new medical center on Cathedral Hill. The City should consider using St. Luke’s facilities as a solution to its rebuild challenges. Tom Gallagher, Bernal Heights Democratic Club, said poor people in Bernal Heights are under tremendous pressure, and he is concerned about reducing services to this population. While it was heartening to listen to the universal health care report, it is not available to people over 18, so the private sector has to be made to serve some of this population Bebe Castain, Bernal Heights resident and St. Luke’s patient, is concerned about the future of St. Luke’s and is worried that the closure of the inpatient psychiatric unit is just the first of future closures. St. Luke’s needs to stay a community hospital and the community needs a written agreement from Sutter to maintain core services. Dr. Eugene Lee, attending psychiatrist at St. Luke’s, shared his deep anger and resentment at St. Luke’s for their disregard of front line support and medical staff. They were not allowed to be any part of the discussions and decisions. There have been a series of management decisions that have forced the inpatient psychiatric unit to have a low census. The Reverend John Kirkly, St. John the Evangelist Church, said that there is not a lack of need for acute psychiatric beds. This closure will further exacerbate the crisis that already exists. The issue isn’t lack of resources but a lack of creativity and priority. It is so important to provide services in the community context. Alma DiStefano said people should not have travel across town to visit friends, parents or children to visit a person in a mental health inpatient facility. Many people are very busy with their mental health issues and cannot come to these hearings and speak for themselves. Sara Angulo, housekeeper at St. Luke’s, said the patients’ access to care has to be protected. Any future change in the facility must be made public. Zenaida Javier, St. Luke’s Hospital employee, said Sutter can easily afford to keep psychiatric services open. Sutter reported a half a billion dollars in profits in 2003. Mauricio Vela said St. Luke’s needs to be there for the community and the families. The planning process has been terrible, and the process needs to include the community and the unions. The community needs the Health Commission’s help to hold St. Luke’s and Sutter Health accountable. San Francisco needs more services, not less. Jim McCaughey, Vice President of Planning at CPMC, said St. Luke’s remains a viable provider of health care services for a large number of San Franciscans. St. Luke’s and CPMC are committed to keeping the Commission informed about merger decisions. For nearly a decade the number of patients seeking care has declined, St. Luke’s has been working with CMPC to develop an affordable plan for the delivery of care and preserving the mission. It is increasingly difficult to sustain a broad range of services at St. Luke’s. He believes a deeper relationship with CMPC will continue the progress that has been made. He submitted a written copy of his testimony, which is on file in the Health Commission office. Makula Godwin is a staff nurse at SFGH and a independent film maker who has documented devastating social and economic impacts of closures of hospitals that serve the underserved. The needs of psych patients at SFGH are getting worse. Every one of the 97 beds at SFGH is impacted. SFGH often depends on St. Luke’s when its units are full. Please, patients before profits. Bruce Hicks, St. Luke’s employee, said the damage has already been done with the psychiatric unit. One of the psychiatrists that lost his job speaks eight languages. It seems that the tendency is to go with the high-tech, moneymaking units and not the others. John Kosinski, Health Care Workers Unit, said Sutter knew what they were getting into when the bought St. Luke’s Hospital. They made an agreement with the Attorney General not to reduce services, and even before the agreement expires, they are cutting services. We cannot trust Sutter. The Board of Supervisors today passed an emergency resolution requesting that the Boards of Directors at CPMC and St. Luke’s postpone the merger. The Board of Supervisors does not trust Sutter. Please vote that the closure has a detrimental impact. Dr. Lynn Shepler, psychiatric, applauds the Commission for holding St. Luke’s accountable to Sunshine laws. The state has lost hundreds of inpatient psychiatric beds. Facilities cherry pick what services they are going to provide. Larry Bevan said people do not want any more promises from St. Luke’s and Sutter. The reality is there are no inpatient psych units, but the need keeps growing. He, as a case manager, tried to get one of his patients into an inpatient facility and there were no beds available in the northern half of the state. We need to look at what the city needs, and we are at the tipping point for inpatient psychiatric services. Commissioners’ Comments Commissioner Illig said he heard that Kaiser is interested in buying St. Luke’s. Mr. Strong said St. Luke’s board voted to continue discussions just with CPMC, not with anyone outside the Sutter system. Commissioner Illig asked if CPMC is willing to put its plans in writing with regard to St.Luke’s. Mr. McCaughey said the discussions are to execute the merger, and he will brief the Commission on these plans before the merger happens. Mr. Strong said he would like to have his legal counsel discuss with DPH legal counsel whether a consistent standard is being applied to St. Luke’s hospital. Deputy City Attorney Van Runkle noted for the record that she is not aware of a different standard. The standard is the same for all organizations. Commissioner Guy said St. Luke’s is in no way being treated exceptionally with regard to Proposition Q. The Commission is trying to hold them to the floor of standards. Commissioner Chow supports the finding of a detrimental impact for many reasons. He is concerned that there is a lack of psychiatric beds, and that the city is reaching an impacted level. PES is backed up and there is the need to have condition red and condition yellow policies. St. Luke’s closure will be detrimental. It may be true that St. Luke’s has a low census. But facilities can create a low census, through lack of staffing, facilities issues, and other mechanisms. Further, he would have hoped that St. Luke’s would have made a stronger commitment to meet its mission to serving the community. He was very disappointed when he read the new 21st Century mission of St. Luke’s. Nowhere does the mission describe or acknowledge the uniqueness of St. Luke’s. It is a generic mission statement that leads him to question the commitment to serve its historical community. This does not mean that St. Luke’s should not look at ways of solving budget issues. But we need to look beyond how we meet the needs of the bottom line. He is further alarmed about plans for neonatal intensive care. The standard of care in San Francisco is to have a neonatal intensive care unit in order to take care of unforeseen emergencies. Ultimately, hospitals need public support. Sutter’s resources could really create strong services to the St. Luke’s community, and there is no vision for that. There is no reason why San Francisco cannot have strong community hospitals. But this requires partnership. He hopes to see this as we move forward. Commissioner Guy expressed her disappointment about the disintegration of the partnership with St. Luke’s over the past five years. She supports the resolution. Commissioner Monfredini said that Commissioner Sanchez has indicated his support for the resolution. Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Tarver, Umekubo) amended the resolution to say that the closure will have a detrimental impact. Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Tarver,Umekubo) amended the resolution to add the following to the last Further Resolved clause: and that the Health Commission will schedule a Proposition Q hearing within 90 days. Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Tarver, Umekubo) approved Resolution 14-05, “Determining that the Closure of St. Luke’s Hospital Psychiatric/Behavioral Inpatient Unit Will Have a Detrimental Impact on the Health Care Service of the Community,” as amended (Attachment A). 6) ANNUAL CHILDREN’S HEALTH COVERAGE REPORT FOR 2005 Jim Soos, Senior Health Program Planner, Office of Policy and Planning, presented the Children’s Health Coverage Report for 2005. The report covers the three public programs that provide insurance to children and youth in San Francisco: Medi-Cal, Healthy Families Program and Healthy Kids and Young Adults (HKYA). Mr. Soos highlighted accomplishments from 2004-2005: There is universal health insurance for children in San Francisco: 99.2% of San Francisco children have health coverage! Healthy Young Adults launched in January 2005, and 1,755 are enrolled already. Healthy Kids member satisfaction continues at 90% plus on all measures, for all ethnicities. HEDIS sores show good access and utilization. These three programs combine to attempt to provide seamless and comprehensive coverage for children, youth and young adults. Medi-Cal covers children to age 21, Healthy Families covers kids to 19 and HKYA provides coverage to age 25. Medi-Cal covers lowest income, then Healthy Families, then HKYA. HKYA is the only program for undocumented kids. Medi-Cal remains the largest program statewide and in San Francisco. Total enrollment in the three programs in San Francisco is 55,997. Enrollment mirrors San Francisco’s diverse populations, with Excelsior, Mission and the Bayview providing the largest number of enrollees. The City of San Francisco funds HKYA, but the State and Feds fund the other programs. Universal coverage for children costs San Francisco $5.8 million per year. Someday the program will receive Federal S-CHIP money worth approximately $1 million per year as a contribution to Healthy Kids. Jean Frasier, Executive Director of the San Francisco Health Plan, presented information specifically related to SFHP. SFHP is the number one choice of enrollees in all programs, and the CHN is the number one choice for SFHP members. SFHP is above the State average on all of the HEDIS measures, and is number one in the State on four of the seven measures. One of the main challenges to the program has been retention. Children lose coverage for a variety of reasons, including failure to return the Annual Eligibility Review, age out of the program, move out of county, fail to pay premiums or obtain other coverage. SFHP works hard to keep members enrolled: Transition from monthly to annual premium for HKYA Monthly maintenance of current member address and contact information Retention efforts three months prior to re-enrollment Frequent reminders of assistance with re-enrollment Ms. Frasier concluded the presentation by presenting Challenges/Next Steps: Dealing with forced increase in premiums for Healthy Families Program and Healthy Kids & Young Adults; San Francisco getting its share of the S-CHIP money; Finding the right next step in the drive toward universal coverage. Commissioners’ Comments Commissioner Monfredini is very pleased with and inspired by the report. Commissioner Umekubo asked if the paperwork is the main reason people fall out of the program. Ms. Frasier said it is far and away the most common reason. She reiterated that SFHP has implemented an annual eligibility review, instead of quarterly. Commissioner Umekubo said the work is extraordinary, and encouraged them to keep up the good work. Commissioner Tarver said that, given the extraordinary statistic that 89% of San Francisco’s African American children are enrolled in Medi-Cal, it is interesting that the level of African American people enrolled in the Healthy Young Adult program is so low. Ms. Frasier said there are a variety of reasons for this. First, many of the people enrolled in Medi-Cal are enrolled in private providers. SFHP does not have access to their names, and it has been difficult to outreach to them as they age out of the program. Also, Medi-Cal covers people to the age of 21. Commissioner Guy said the Department, the Health Commission and the City have worked on universal health care for many years. And San Francisco has been systematically successful in expanding coverage. This report gives her faith that what San Francisco does in terms of universal health care works. Commissioner Illig noted that 14% of enrollees in the SFHP chose St. Luke’s Hospital as their primary care provider. Commissioner Illig asked about efforts to expand coverage to parents. Ms. Soos replied that DPH is looking at a number of discreet populations to see who can be covered. The City is considering implementing a local Healthy Parents program. Commissioner Illig said he heard that Kaiser has taken 3,000 members from SFHP their system. Ms. Frasier said that Kaiser has participated in the Healthy Kids program since its inception, and will take 2,500 to 3,000 SFHP clients. Commissioner Chow said this is an extraordinary effort. The goal of the health plan is to provide access, and they have done this very well. Commissioner Chow said that the premise of the plan, and one reason for success, is that is works as a private/public partnership between all the providers in San Francisco. He encourages more of this type of cooperation. 7) PUBLIC COMMENT/OTHER BUSINESS None. 8) ADJOURNMENT The meeting adjourned at 6:00 p.m. Michele M. Seaton, Executive Secretary to the Health Commission