Minutes of the Health Commission Meeting Tuesday, October 3, 2006 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 3:30 p.m. Present: Lee Ann Monfredini, President James M. Illig, Vice President Edward A. Chow, M.D. Roma P. Guy, M.S.W. David J. Sanchez, Jr., Ph.D. Donald E. Tarver, II, M.D. Absent: John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF SEPTEMBER 19, 2006 Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Tarver) approved the minutes of the September 19, 2006 Health Commission meeting. Commissioner Tarver asked that the September 19th minutes reflect that Dr. Sumchai submitted documents to the Health Department administration for archiving, and Dr. Parker submitted a written copy of his testimony. Commissioner Illig noted that the October 24th Community Health Network Joint Conference Committee meeting will be focused on a follow-up to the meeting in Bayview, with a dialogue with staff and community leaders about specific health outcomes. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Sanchez chaired and Commissioner Chow and Commissioner Tarver attended the Budget Committee meeting. The Budget Committee requested that Items 3.1, 3.2 and 3.3 be moved from the “Approval” section of the agenda to the “Discussion and Approval” section of the agenda. Items for Approval (3.4) PHP-EMSA – Request for approval of a modification to the contract with First Watch Solutions, to increase the compensation by $25,000, for a new total of $100,800, which includes a 12% contingency, for an enhancement to the First WatchTM software application for the Real Time Syndromic Surveillance Information Project, for the period of March 1, 2005 through February 28, 2009. Items for Discussion and Approval (3.1) PHP–AB 75 Project – Request for authorization of the County Description of Proposed Expenditure of California Healthcare for Indigents (CHIP) funds for Fiscal Year 2006-07. Commissioners’ Comments Commissioner Tarver would like to work with Samantha Stevens to discover what it would take to be able to provide root canals for posterior teeth, as an alternative to extractions. Samantha Stevens replied that for the entire low-income population of the city, they have 5.4 FTE dentists. Additional funding would allow additional root canals. (3.2) PHP-Comm. Programs/AB75 Project – Request for approval of a contract renewal with AmeriChoice, in the amount of $129,200, to provide fiscal intermediary services for the FY 2006-07 CHIP Hospital and Physician Program, for the period of November 15, 2006 through March 31, 2008. Commissioners’ Comments Commissioner Tarver asked if there is any way Americhoice and DPH could require the providers who submit claims to provide ethnicity data. Ms. Culp replied that she would follow up on this issue with Jeffrey Leong, the DPH CHIPS administrator. (3.3) PHP-Environmental Health/Policy & Planning – Request for approval of a modification to the contract with Industrial Emergency Council, to increase the compensation by $70,800 for a new total of $181,216, which includes a 12% contingency, to provide Medical Specialist Rescue and Advanced Hazmat Life Support training for San Francisco Fire Department paramedics and firefighters, for the period of June 19, 2006 through November 31, 2006. Commissioners’ Comments Commissioner Sanchez said San Francisco is very limited in its capacity as it does not have a helipad and he asked that they consider incorporating this limitation into a training exercise. Deputy Chief Navarro from the San Francisco Fire Department said in the 1980s there was a training exercise with the National Guard regarding air medical access. (3.5) AIDS Office-HIV Health Services – Request for approval of a retroactive renewal contract with UOP School of Dentistry, in the amount of $2,530,352, which includes a 12% contingency, to provide centralized comprehensive dental services to HIV/AIDS-affected individuals, for the period of March 1, 2006 through August 31, 2010 (4.5 years). Commissioners’ Comments Commissioner Tarver asked how UCSF supports alternatives to tooth extraction. Dr. Arthur Dugoni from UOP said saving the tooth is their first priority, and they offer services such as root canals. When they have to extract a tooth, they are able to provide a prosthesis to replace the tooth. Commissioner Chow said the contract documents do not clearly describe the types and number of services UOP is providing. Ms. Long said they have a price per procedure. They receive an annual report at the end of the year detailing the services. They did not include this list in the contract documents, but she could provide information on the range of services provided in the future. Ms. Long added that DPH only pays for a portion of the services the university provides. Commissioner Sanchez noted that the unknown ethnicity category is 39 percent, which is rather large. He thought that with the training that our providers receive, they would be more able and willing to identify ethnicity to provide accuracy to this information. He also asked for information about the cultural competency of the dentists in the program. The program manager from UOP said he was surprised at the large number of patients with unknown ethnicity. Patients are referred to UOP’s program from other agencies, and UOP assumes that the data in REGGIE is complete, including ethnicity data. He generally checks for eligibility but will add ethnicity data. He ran two reports, one for the full 2005-2006 contract year, and one for the first seven months of this contract year. For FY 2005-2006, 11 patients are missing ethnicity data. For this year, 12 patients do not have ethnicity data. The data still indicates that the largest percentage of patients is white. He is committed to increasing outreach to more diverse, underserved communities. He will report on these efforts at the next contract cycle. Commissioner Sanchez said that a few years ago SFGH closed a major dental clinic that focused on minority, multilingual population with diverse providers. When this program closed, he expected to see some of this population served by UOP, but their ethnicity data has not changed much. He would like to increase access to these great services. This is a priority for the Budget Committee. Commissioner Chow said that given the fact that this is a multi-year contract, he would like the UOP School of Dentistry to report to the Health Commission through the AIDS Office on the outreach efforts. Commissioner Sanchez asked that this issue be brought back to the Budget Committee in one year for an update. (3.6) AIDS Office-HIV Health Services – Request for approval of a retroactive renewal contract with Dolores Street Community Center, in the amount of $841,649, which includes a 12% contingency, to provide attendant care services, at Richard Cohen House, to HIV/AIDS-affected individuals, for the period of March 1, 2006 through August 31, 2010. (3.7) AIDS Office-HIV Health Services – Request for approval of a retroactive renewal contract with Quan Yin Healing Arts Center, in the amount of $1,104,445, which includes a 12% contingency, to provide Complementary Alternative Medicine (CAM) or Complementary Therapies, for individuals diagnosed with HIV or AIDS, for the period of July 1, 2006 through December 31, 2010. Commissioners’ Comments Commissioner Tarver appreciates the challenges with the REGGIE data system. He asked Carla Wilson, Executive Director, to comment on her challenges. Ms. Wilson said the system has been both a blessing and a burden. Her agency has dealt with the limitation through one-on-one telephone calls to partner agencies around data input. She is optimistic about the future. Commissioner Tarver asked if the organization provides TB screening to employees. Ms. Wilson said they have not had the budget to provide this service. Commissioner Tarver encouraged her to link employees to DPH sites where they can get free testing. Ms. Wilson said that they would be mandating that staff be tested on an annual basis. (3.8) BHS – Request for approval of a retroactive contract renewal with Haight Ashbury Free Clinics, Inc., in the amount of $8,364,259, which includes a 12% contingency, to provide substance abuse treatment services, for the period of July 1, 2006 through December 31, 2007. Jim Stillwell said that he, Barbara Garcia, Director of Community Programs, Gregg Sass, Chief Financial Officer, Duane Einhorn, program manager and others have been meeting with HAFC’s management team once or twice a month to review program and financial information. Mr. Stillwell noted that page 3 of the contract summary report has incorrect information, in that the Counseling, Rehabilitation and Aftercare program actually fell below one of its objectives. However, overall agency performance is acceptable. Commissioners’ Comments Commissioner Tarver asked if there is a staff person in CBHS and or HAFC that has relationships with the Parole Officers to enhance flow and referrals. Ben Eiland said they have monthly meetings with the parole department to dialogue about ways to make sure clients get where they need to get. Commissioner Tarver asked if DPH is optimistic about the agency being able to meeting the objectives in the BASN program. Rudy Aguilar, Community Substance Abuse Services, said he feels optimistic. Commissioner Chow asked if staff feels the agency has the adequate resources to provide the services they are being contracted for. Mr. Stillwell said HAFC has a very active management team and he feels confident that they will be able to fulfill the contract. Commissioner Sanchez asked Mr. Eckstrom, HAFC Executive Director, if he feels confident about the future of the organization. Mr. Eckstrom said that thanks to the quality of their staff, they have been able to provide quality program. The Board of Directors is also very active in addressing the future success of the agency. Commissioner Tarver added for the record that the program description on page 3.8.20 should say “San Francisco men, women, transgender men and transgender women." Commissioners’ Comments (at Health Commission meeting) Commissioner Sanchez said that the Deputy Director of Finance has been working with the Budget Committee and Department divisions to develop criteria for multi-year contracts. Interim criteria have been approved and Ms. Okubo will return to the Budget Committee and Health Commission in November with a final document. Commissioner Monfredini asked the Budget Committee members to comment on their confidence in Haight Ashbury Free Clinic. Commissioner Sanchez replied that DPH staff meets with the agency regularly and will continue to do so. Both DPH staff and agency staff expressed confidence in the agency’s ability to fulfill the contract. Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Tarver) approved the Budget Committee consent calendar. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Ryan White CARE Update Congress adjourned for the November election on September 30th without reauthorizing the Ryan White CARE Act. On September 28th, the House passed a reauthorization bill that would have meant a $1 million loss to San Francisco for the first three years and a $10 million loss in year four. San Francisco currently receives more than $27 million per year in Ryan White funding to provide care for persons with HIV and AIDS. The Senate failed to reach agreement prior to the September 30th deadline. The Senate resumes work on the bill when it returns to its lame-duck session in December, and the hope is that a reauthorization bill that is more favorable to cities like San Francisco can be passed. State Legislation Updates: SB 1661, AB 2968, and AB 631 Last week produced a flurry of good legislative news for The Department. On Friday, September 29th, the Governor signed SB 1661 (Cox), legislation that extends the hospital rebuild deadline an additional two years. Hospitals, including SFGH, that are rebuilding in response to SB 1953 seismic standards now have until 2015 to rebuild provided they meet specific milestones including a good faith effort to comply with the rebuild requirements. SFGH is reviewing the legislation to see whether San Francisco will meet the milestones detailed in the bill. The Governor also signed AB 2968 on Saturday, September 30th, which creates a Medi-Cal reimbursement rate structure for community living support services to assist San Francisco beneficiaries who would otherwise be homeless, living in shelters, or institutionalized. This is a San Francisco-specific waiver that will provide community-based care targeted to individuals seeking to leave Laguna Honda Hospital (LHH) or persons at imminent risk of entering LHH absent such services. Prior to this legislation, Medi-Cal provided a single reimbursement rate for the range of services beneficiaries need when they were in an inpatient institutional setting. However, no such designated reimbursement rates existed for community-based living services in San Francisco. This created significant barriers to the provision of community-based care for Medi-Cal beneficiaries, especially those who are homeless, who have multiple and complex service needs that often require these services in a residential setting such as a Residential Care Facility for the Elderly (RCFE). While Medi-Cal reimbursement was available for coordinated services to meet a wide range of patient needs in inpatient settings, like LHH, the City was forced local general funds to coordinate care provided in the community. This significantly limited these efforts, and some types of residential settings were not covered, including RCFEs. Implementation of this legislation will mean more options for lower income individuals in need of long-term care, simplification of uncoordinated and complex reimbursement, and reductions in inappropriate inpatient care, consistent with the Supreme Court’s Olmstead decision. Finally, Assemblyman Mark Leno’s Office informed us that Governor Schwarzenegger had signed AB 631 (Leno) into law. This changes regulations around methadone treatment to allow the utilization of methadone vans to provide comprehensive treatment services to opiate addicts. The new legislation effectively allows our successful methadone van program to move from "pilot" status to becoming a "real" treatment program, and also allows us to begin enrolling MediCal clients into van treatment services once the bill becomes law January 1, 2007. Cryptosporidiosis: A Surveillance Success The Bay Area Cryptosporidiosis Surveillance Project, a project of the Environmental Health Section's Program on Health Equity and Sustainability, was responsible for the early detection of an outbreak of cryptosporidiosis in Santa Clara County in August 2006. Epidemiologist Michelle Kirian, coordinator for the project, noticed an increased number of cases from Santa Clara County and informed the county collaborators on August 14, 2006. Four days later, on August 18, the number of cases exceeded the action level set in the San Francisco Public Utilities Commission (SFPUC) Cryptosporidium Detection Action Plan, and the multi-agency emergency plan was activated. The first order of business was to rule out the possibility of any association with drinking water. Case interviews suggested an interactive water fountain at Cesar Chavez Park in San Jose as a possible source. Concurrently, several salmonellosis cases reported to the Santa Clara County Health Department also had history of exposure to the same fountain. Water samples revealed the presence of Cryptosporidium, and the fountain was closed on August 25, 2006. The early detection and rapid identification of the likely source of the outbreak undoubtedly prevented a larger outbreak, and illustrates the importance and efficacy of DPH's Bay Area Cryptosporidiosis Surveillance Project, which is funded under a work order from the SFPUC. LHH and Volunteers Inc. Celebrate 50 Years Late last month, Laguna Honda Hospital held its annual Volunteer Recognition Tea, a collaboration between the Volunteer Services Department and Volunteers Inc. Volunteers Inc. is a private non-profit organization whose mission is to enhance the well-being and quality of life for the residents of Laguna Honda Hospital. They accomplish this through financial support of resident activities and purchase of equipment and services that directly benefit the residents. This year's Tea marked the 50th anniversary of Volunteers Inc. The majority of volunteers were recognized for donating between 1000 to 8000 cumulative hours. One volunteer achieved the 14,000-hour mark and another exceeded 16,000 cumulative hours. Volunteers received pins for years of service in the 5-year, ten-year, fifteen-year, and twenty-year categories. For cumulative years of service, volunteers received special recognition and orchids for 41 and 46 years of service. The event was hosted by Terry Lowry, former TV personality and member of the Volunteers Inc. Board. Laguna Honda Welcomes Back Goats In a true public health interpretation of encouraging San Franciscans to eat local, organic, sustainable food, approximately a 1,000 Boar Goats are eating their way through 23 acres of poison oak and blackberry brambles on the grounds of Laguna Honda Hospital over the next 10 days. This is the second year the goats have dined al fresco on the hills at Laguna Honda Hospital. We anticipate the goats will have an annual, standing reservation at LHH to help us manage the vegetation. The goats are a popular attraction among the neighborhood residents. Walking for a Better Heart at LHH Staff at Laguna Honda Hospital is participating in the American Heart Association’s Walk While We Work program this Friday, October 6, at noon. All participants are encouraged to take the 10,000 Step Challenge in the fight against heart disease and stroke. The event will end with a BBQ for all residents and staff. Ethnic Physician Leadership Summit Commissioner Edward Chow, MD and Dr. Katz were speakers at the 2006 Ethnic Physician Leadership Summit in Los Angeles on September 30th. Dr. Chow spoke on “Delivering Care to Ethnic Minorities” and Dr. Katz spoke on “Immigrant Health.” CBHS Director Recognized Congratulations to Robert P. Cabaj, MD, Director of the Department of Public Health's Community Behavioral Health Services, who was awarded the National Association of Lesbian and Gay Addiction Professionals Finnegan-McNally Founders Award. Dr. Cabaj received the award this past weekend for “his support of the NALGAP mission to improve substance abuse prevention and treatment services for Lesbian, Gay, Bisexual and Transgender individuals continuously for over 25 years.” Commissioners’ Comments Commissioner Chow asked if AB 2968 is the legislative solution San Francisco was looking for in order to have funds for community-based care to people outside of Laguna Honda. Dr. Katz said yes, this waiver is what San Francisco was looking for. It is San Francisco-specific legislation in that San Francisco is the only city that has a Laguna Honda. Commissioner Chow said this is a tremendous accomplishment and he congratulated staff. This has taken years of work. Commissioner Illig congratulated DPH staff on the AB 2968 waiver. This is one of the recommendations from the HMA report and DPH worked very hard to get it. With regard to the Ryan White CARE Act, there was a lot of behind the scenes work by DPH and others to ensure that this iteration of the bill did not get through. If it had passed, it would have devastated San Francisco. The fact that this did not pass as written provides an opportunity to advocate for better legislation, and he looks forward to working with staff and Congresswoman Pelosi on this issue. Commissioner Monfredini said she has been hearing many comments about how hard the DPH website is to navigate, and asked if there are resources to improve the website. Ms. Kronenberg will work with the webmaster on this issue. 5) CONSIDERATION OF A RESOLUTION OPPOSING PROPOSITION 85 Commissioner Illig said he asked that this resolution, and the one following regarding Proposition 86, be placed on the agenda because one role of the Health Commission is to educate the public about issues that impact health and health access. Anne Kronenberg formally introduced Jim Soos as the new Assistant Director of Policy and Planning. Mr. Soos said that Proposition 85 would impose a waiting period and require parental notification when a young woman is seeking to terminate a pregnancy. The Department believes Proposition 85 is not in the city’s best medical interest. The City has officially opposed Proposition 85. Ms. Kronenberg added that Dr. Katz has submitted an op-ed piece and letter to the editor on this proposition. Commissioners’ Comments Commissioner Illig asked how Proposition 85 differs from Proposition 73, which was defeated in last year’s special election. Mr. Soos said that he could see no difference between the two. Commissioner Chow noted that Proposition 85 requires parental notification, not parental permission. This might be the difference between Proposition 85 and Proposition 73. He supports the resolution opposing the proposition. Action Taken: The Health Commission (Chow, Guy, Illig, Monfredini, Sanchez, Tarver) approved Resolution 12-06, “Resolution Opposing Proposition 85 – Waiting Period and Parental Notification Before Termination of Minor’s Pregnancy,” (Attachment A). 6) CONSIDERATION OF A RESOLUTION SUPPORTING PROPOSITION 86 Jim Soos, Assistant Director of Policy and Planning, presented a resolution supporting Proposition 86, the Tobacco Tax Act of 006. This is a state initiative that, if passed, would raise the state’s tobacco tax by an additional $2.60 per pack. It is estimated to produce more than $2 billion in annual revenue to fund children’s health insurance, emergency room care, nursing education, disease prevention, medical research and programs that will reduce smoking. Mr. Soos said the city has not taken an official position on Proposition 86. Commissioners’ Comments Commissioner Chow said he heard claims that large private hospital chains are going to take most of the money. He asked if there are counter arguments that make sense and if there is an estimate as to how much money public hospitals would receive. Ms. Soos does not have specific financial information but in conversation with Gene O’Connell there is the potential for significant funds for San Francisco General Hospital. Commissioner Tarver said he has spoken to smokers about this ballot initiative and has mixed feelings. Many people are truly addicted and will have a hard time stopping smoking, and the tax will have a larger impact on poor people. Commissioner Illig said that as a recovering smoker, who struggled with addiction for years, he supports this effort. He said that there are several stores within the vicinity that sell individual cigarettes, which is a health code violation. Commissioner Chow asked if Dr. Katz has a position as the Director of Health. Dr. Katz said he is in favor of the proposition, but noted that not everyone agrees with how the money is going to be allocated. For example, CMA is in support of the proposition, but has not put its full clout behind the initiative. Action Taken: The Health Commission (Chow, Guy, Illig, Monfredini, Sanchez, Tarver) approved Resolution 13-06, “Resolution Supporting Proposition 86 – the Tobacco Tax Act of 2006,” (Attachment B). 7) APPROVAL OF SAN FRANCISCO GENERAL HOSPITAL MEDICAL STAFF BYLAWS Andre Campbell, M.D., Chief of SFGHMC Medical Staff, presented proposed changes to the SFGHMC Medical Staff Bylaws and Rules and Regulations. These changes have been approved by the medical staff. The proposed changes are in the following areas: Requirement for practitioners to possess a National Provider Identifier (NPI) Deletion of Medical Record Review Subcommittee as a PIPS subcommittee Change in Cancer Committee Composition Additional non-discrimination language pursuant to NCQA guidelines Applicant’s Right to be Informed language Addition of Patient Safety Coordinating Committee as a new PIPS subcommittee Pharmacy and Therapeutics Committee – clarification of reporting requirements to the Medical Executive Committee Functions of Chiefs of Clinical Services – additional language to comply with JCAHO Standards and Elements of Performance regarding focused review Disaster Privileges – additional language to comply with JCAHO Standards and Elements of Performance regarding the implementation of emergency situations and disaster privileges Medical Histories and Physical Examinations – additional language to comply with JCAHO Standards and Elements of Performance regarding monitoring of medical histories and applicability to non-inpatient services Commissioners’ Comments Commissioner Monfredini asked if the Chief of Staff oversees credentialing during an emergency or if he or she has to carry out this function him or herself. Dr. Campbell said the Chief of Staff is responsible for this duty, but does not have to credential every single person him or herself. Commissioner Chow asked if there was a logic given for certain people taken off the Cancer Committee and others being added. Dr. Campbell said that these changes resulted from a direct request from the Cancer Committee. Commissioner Chow asked if the Tumor Registry Clerk was a clerical position and, if so, why this person is a voting member of the committee. Deputy City Attorney Kathy Murphy said her understanding is that the Tumor Registry Clerk is actually a nurse practitioner on staff. She will find out exactly what the title should be. Commissioner Monfredini said that she does not want to second guess the Cancer Committee but she is less than thrilled that Urology will no longer be an official member of the committee. Commissioner Chow said that future iterations of the medical staff bylaws should consider not explicitly listing members of the committee. Action Taken: The Health Commission (Chow, Guy, Illig, Monfredini, Sanchez, Tarver) approved the San Francisco General Hospital Medical Staff Bylaws and Rules and Regulations. 8) SAN FRANCISCO GENERAL HOSPITAL MEDICAL CENTER REBUILD UPDATE Dr. Katz presented an update on the SFGHMC rebuild. Dr. Katz reminded the Commission that SB 1953 requires the acute care hospital to be rebuilt by 2013 or closed by 2008. There have been a variety of planning efforts to analyze replacement alternatives. In October 2005 the Mayor’s Blue Ribbon Committee gave the direction to rebuild the hospital at the Potrero campus. The Department of Public Health retained Anshen & Allen to undertake a site feasibility study to determine if a new hospital could be constructed on the west campus without demolition of any existing buildings. The study found that: A compliant hospital can be built on the west lawn without demolishing the historic buildings or other buildings. The space program can be accommodated within the existing zoning height limits. The new building will be lower than the existing acute care hospital. A large “super-floor” basement is recommended for diagnostic and interventional functions to minimize the building height and maximize access to inexpensive building area. The construction envelope as depicted can accommodate a building of 230 beds, a size consistent with the current capacity (assuming 120 psych and skilled nursing beds remain in the existing hospital) and also affords a building capacity of up to 267 beds. The proposed site circulation relocates ambulance traffic from a residential street to a campus service road. The new hospital can be constructed for $622 million. The FF&E budget is estimated at $158 million. Dr. Katz introduced Derek Parker, Zigmund Rubel, Mark Primeau and Kathy Jung, all of whom worked very hard on this project. Commissioners’ Comments Commissioner Guy asked what the next steps are. Dr. Katz said they are engaged already in the next steps, thanks to the Mayor and Board of Supervisors appropriating money for a capital project before a bond is put before the voters. They are in the RFP process for the Environmental Impact Report and will soon be going through the RFP process for architectural services for the design of the building. DPH will be at SFGH Carr Auditorium on Thursday for a presentation to community partners in the Mission, Bayview and Potrero neighborhoods. Commissioner Monfredini thanked Derek Parker for his vision in making this happen. Commissioner Illig asked if any consideration was given to building over 101. Dr. Katz said that they did not ask the architects to look at this option. Commissioner Illig asked if any consideration was given to removing the stairs from the red brick buildings. Mr. Parker said they took the approach of is there a way to build in the area without touching the historic buildings, within the existing height limit and connection with the H building. Commissioner Illig asked if they considered building more than one superfloor. Mr. Parker said they did not need to do this, and to do so would create more risk. Commissioner Illig asked if the emergency room would be in the new building. Mr. Parker said it would be in the new building on the north side. Commissioner Illig asked if the helipad location was considered. Mr. Parker said the location was not determined, but there are a number of feasible locations. Dr. Katz added that the Department, with the Health Commission’s support, is moving forward with the helipad now for the existing H building. The cost of the helipad is minimal. These are two separate discussions. Commissioner Tarver said it might behoove staff to re-examine the potential for moving the outside stairs on Building 30. Commissioner Tarver is in favor of an attachment to the H building, which will afford easier access to services that remain in the existing facility. It will also decrease feelings of alienation. Commissioner Tarver asked how they arrived at the escalation factor. Dr. Katz said they used historical data and looked at what other projects were using. Commissioner Tarver said he looks forward to hearing about what services will move to the new hospital and which would remain in the current facility. Commissioner Tarver asked if consideration has been given to green building. Mr. Parker said they are doing this at Laguna Honda Hospital, and will be applying for LEEDS certification with the US Green Building Council. He hopes to do the same with San Francisco General Hospital. Commissioner Chow said this proposal is the result of being able to do more concrete planning. This is a wonderfully thought out proposal. He asked when the Health Commission would get its next progress report. Dr. Katz said he would prepare the timeline for the Commission, but that this should be reported every four months. Ms. Jung will bring the specific project timeline to the San Francisco General Hospital Joint Conference Committee. With regard to the bond issue, this will not be brought forward until it is ready. That said, in order to meet the 2015 deadline, they need to stay pretty close to their current schedule. The best guess is that they would bring a bond to the voters in 2008. Commissioner Guy asked if there are any accountability benchmarks that the State legislation requires that the Department must comply with. Kathy Jung, SFGHMC Facilities Director, said that the hospital has to be under construction by December 2011. Hospital plans must be submitted by December 31, 2008. The hospital must receive building permits by December 31, 2011. Staff is analyzing all of these deadlines to see that SFGHMC can meet them. Commissioner Guy asked when the soil report would be done. Ms. Jung said that she has the responses to the RFQ in hand, and they are starting the process of interviewing the respondents. They should have work done in the next six months. Commissioner Guy is hearing that there is consensus at the Board in support of this project. She asked if there is still controversy around the number of beds. Dr. Katz said that this plan allows for between 230-267 beds. There is also acceptance that 120 beds—psychiatry and SNF beds—would remain in the H building. People have also supported the idea that the existing H building could include more beds, and serve as a flexible backup. Given all this, the decision about 230 beds or 267 beds for the new building does not have to be made right now. Gene O’Connell, SFGHMC Executive Administrator, presented the bed analysis that was done by the Camden Group. This independent consultant, who was not working for DPH, came to similar conclusions about the number of beds. This group worked very closely with DPH, reviewed the 2002 Lewin Group report and other analyses done about bed size. The Camden report shows that most likely SFGHMC will not be able to reduce its lengths of stay more than it already has. DPH does need to look at how many beds per unit and other design details. Also, most hospitals are building single rooms but SFGHMC has found it very cost effective to build 2-4 patient rooms. Ms. O’Connell reiterated that the more they can use the existing H building, the more the new hospital can accommodate additional rooms. Commissioners’ Comments Commissioner Tarver asked if PES would remain in the H building. Ms. O’Connell said yes. Commissioner Guy asked if the Camden Report was presented to the Board of Supervisors. She wants to anticipate any potential barriers. Dr. Katz did not present the report to the Board. His sense is that as long as there is flexibility, most people are satisfied that we are on the right track. 9) 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 5:55 p.m. Present in closed session were Commissioner Chow, Commissioner Guy, Commissioner Monfredini, Commissioner Illig, Commissioner Sanchez, Commissioner Tarver, Mitchell H. Katz, M.D., Director of Health, Kathy Murphy, Deputy City Attorney, Bob Cabaj, M.D., Director, CBHS 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) Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Tarver) Approved a Settlement in the Amount of $50,000 in Fred Finch Youth Center v. Public Health/CMHS, Claim No. 06-00904. D) Reconvene in Open Session The Commission reconvened in open session at 6:05 p.m. 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). 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 (Chow, Guy, Illig, Monfredini, Sanchez, Tarver) voted not to disclose any discussions held in closed session. 10) PUBLIC COMMENT/OTHER BUSINESS Daisy Anarchy, Sex Workers Organized for Labor, Human and Civil Rights, submitted a packet of materials to the Health Commission (on file in the Health Commission Office). The materials include a request to meet with Dr. Katz, a request that Dr. Klausner resign from DPH and a Sunshine Ordinance request for documents. Commissioner Illig told Ms. Anarchy that San Francisco has a non-profit sunshine act that requires agencies that contract with the City to comply with sunshine laws and also to allow public testimony at two Board of Director’s meetings. 11) ADJOURNMENT Commissioner Monfredini announced that the January 2, 2007 Health Commission meeting would be rescheduled to the January 9, 2007. The meeting was adjourned at 6:05 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 noted 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.