Minutes of the Health Commission Meeting Tuesday, December 19, 2006 at 3:00 p.m. 1001 Potrero Avenue Carr Auditorium San Francisco, CA 94102 1) CALL TO ORDER President Lee Ann Monfredini called the meeting to order at 3:12 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. John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF DECEMBER 5, 2006 Action Taken: The Commission approved the minutes of the December 5, 2006 Health Commission meeting with the following additions. Resolution 16-06: Endorsing the goal of universal Hepatitis B screening and vaccination for Asian and Pacific Islander residents of San Francisco and Resolution 17-06: Supporting Recommendations contained in the Fiscal Year 2005 Charity Care Report have been included with the minutes of 12/5/06. Commissioner Chow requested that Commissioner comment go before public comment. In addition, due to a technical error, comment was not recorded for the budget hearing. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Sanchez chaired and Commissioner Tarver and Commissioner Chow attended the Budget Committee meeting. The Budget Committee requested that items 3.4, 3.5, 3.11, and 3.12 be moved to the “Discussion and Approval Section.” All other items were moved for “Approval”. In addition, Commissioner Tarver abstained from voting on item 3.3. Items for Discussion and Approval 3.4 BHS – Request for approval of a retroactive contract renewal with New Leaf: Services for Our Community, in the amount of $4,724,858, which includes a 12% contingency to provide outpatient substance abuse and mental health services targeting lesbian, gay, bisexual, and transgender communities for the period of July 1, 2006 through December 31, 2008 (2.5 yrs). * Contract summary, Monitoring report summary, Client demographic information form Commissioner Comment Commissioner Tarver stated that the Commission needs to look at how to improve our relations with vendors. He stated that ED’s agonize over this and that if New Leaf could control the number of MediCal clients they see they could increase the units of service. This is not the case, as New Leaf receives its referrals from Access and these include a number of uninsured persons. If New Leaf did not see these clients then this would leave a gap in service. He stated that the fix may be along the lines of budget modifications or that you revise it so that there isn’t an experienced cut. CBHS Director Bob Cabaj stated that MediCal is not a guaranteed revenue source and there is only so much General Fund money to spread around to the programs. Commissioner Tarver stated that he was under the impression that there was a 2 million dollar surplus in CBHS. Bob Cabaj stated that it is unprecedented for a provider to use the Health Commission as a venue for contract negotiations and that New Leaf did not follow the protocol to work on this issue with CBHS. He added that if the contract is not passed there will not be any funds for the organization. Mr. Cabaj also clarified that all General Fund money has already been allocated. Commissioner Chow stated that if he looks at the total contract amount there is an increase in the total contract. He stated that the way it is separated he can not see what the MediCal portion is. Gregg Sass stated that they view CBHS as a General Fund department and that makes it difficult to break out the various payee sources. Commissioner Sanchez stated that President Monfredini and he have met with other non-profits related to this issue, and that both the and President Monfredini had to cancel their own meetings to be there and that Deputy Director Garcia was following up with those providers who were present. He stated frustration regarding the fact that the whole point of those meetings was to ensure better communication and have updates brought back by staff on the process after having all of the appropriate people involved. He stated that this was the process that they had invested in to address this issue and that they need to close ranks and come to some positive outcomes. Commissioner Tarver stated that he would like to approve the contract with the condition that the Budget Committee receives an update on the negotiations at an appropriate time. Bob Cabaj stated that they would return to the Budget Committee with an update. Commissioner Chow stated that if they didn’t pass this contract, there would be no money for New Leaf at all. He stated that the issue of those who are not being served could perhaps be a separate issue. He requested that next time he would like the Executive Director, Joe Neisen to be here. Ms. Baker stated that he had a family commitment out of state. 3.5 BHS – Request for approval of a retroactive contract renewal with Edgewood Center for Children and Families, in the amount of $6,338,622, which includes a 12% contingency, to provide mental health services, for the period of July 1, 2006 through December 31, 2007 (18 months). * Contract summary, Monitoring report summaries, Client demographic information forms Commissioner’s Comment Commissioner Tarver asked whether a resolution has been brought forward in support of increased funding at the state level. Commissioner Sanchez asked if Margaret Brodkin has been involved in this funding issue. Ms. Rueben stated that she works with Ms. Brodkin on other projects. Commissioner Sanchez responded that perhaps Ms. Brodkin may have some funding sources to explore. Commissioner Chow clarified that the funding problem was not with this particular contract but with the reimbursement rates provided by the state. Ms. Rueben stated that this was the case and the predicament was that residential treatment was reimbursed purely by the state and that the mental health services contract was adjunct funding. Commissioner Chow stated that if they were going to consider a resolution in support, they would need this type of knowledge. Ms Rueben stated that she is working with DPH staff to work through the data to make sure it is easily understandable as it is very complicated. Commissioner Sanchez stated that the Commission looks forward to supporting a resolution honoring the contributions this agency has provided over the last 150 years. He added that if at-risk children are not treated at Edgewood they end up in the streets or in locked facilities. 3.11 AIDS OFFICE-HIV Prevention – Request for approval of a renewal contract with Black Coalition on AIDS, in the amount of $437,441, which includes a 12% contingency, to provide HIV prevention services – Prevention with Positives and Health Education and Risk Reduction, to behavioral risk populations in San Francisco, for the period of January 1, 2007 through June 30, 2008 (1.5 years). * Contract summary, Monitoring report summaries, Client demographic information form Commissioner’s Comment Commissioner Tarver asked what the number of unduplicated clients was. Andre Robinson, Interim Director of Programs, stated that the unduplicated client number was 248. Commissioner Tarver asked how the Coalition tracked this data and whether they used PEMS. Tracy Packer responded that this is the same situation as contracts from last week in that they are transitioning the tracking system from PEMS to the Core Values database (Access platform). She stated this would be instituted at Black Coalition on AIDS as it is rolled out. Commissioner Tarver asked if there is some focus on tracking target populations, and will this new database have the ability to track them? Mr. Robinson and Alfred McGugin, Director of Client Services, both stated that they are looking to satisfy the needs of both the organization and the city. 3.12 AIDS OFFICE-HIV Prevention – Request for approval of a renewal contract with Tenderloin AIDS Resource Center dba Tenderloin Health, in the amount of $387,072, which includes a 12% contingency, to provide HIV prevention services – Counseling & Testing, to behavioral risk populations in San Francisco, for the period of January 1, 2007 through June 30, 2008 (1.5 years). * Contract summary, Monitoring report summary and response, Client demographic information form Tracy Packer presented and stated that they are still recognizing TARC and Continuum as separate entities for now. Ms. Packer gave background on the project; TARC and Tom Waddell have been working together to provide HIV testing at Tom Waddell as sponsored by TARC. As seen in the monitoring report, there were bumps in the road regarding working together around standardizing quality assurance. The corrective response to this in that they have assigned an almost full time staff person to work as a liaison between the two organizations on quality assurance issues. As a result, the units of service were lower, but they were still within acceptable range. Commissioner’s Comments Commissioner Tarver stated that the service units were low in the beginning and were raised towards the end of the year. He stated that he thinks the new contract should be based on the higher, more successful units of service. Tracy Brown, Executive Director, stated that they did this because there wasn’t time for the staff to recruitment for clients. He stated that for this year, they are going to focus on recruitment and this will necessitate a lowering of the volume of testing. Commissioner Tarver asked if there is the capacity at Tom Waddell for the increase in testing. He also asked if Tom Waddell knew to refer clients to TARC. Tracy Brown responded that the referral piece is something they are trying to incorporate by networking with partners. Tracy Packer also stated that there is a testing workgroup that would discuss and network around this issue. Commissioner Sanchez stated that volunteer and intern programs provide citizens a unique pathway into service and he suggested an orientation for all volunteers and interns. Tracy Packer responded that they have a training process for anyone that is a counselor and that they have a strong connection with City College. They also have a database that maintains and flags those who need to take more CEU’s so that everyone is on the same level. Tracy Brown added that they wouldn’t be able to function without their interns and volunteers. Commissioner Chow asked what the relationship between Tom Waddell and TARC and how this is working. Tracy Brown stated that Tom Waddell has been a partner with TARC for a long time and has run a long term HIV program together that is funded by Ryan White funds. He added that the current project resulted from a realization that clients coming to TARC were not being tested at either Tom Waddell or TARC, so they came together to create a bridge program. Commissioner Chow asked if testing could be done at both sites and if the clients are the same. Tracy Brown responded that the clients are not the same. Commissioner Chow stated that this means they have extended there patient base. Tracy Brown added that tests are sponsored by TARC and done at Tom Waddell. Commissioner Chow stated that it sounds like this has become very collaborative. For Approval 3.1 PHP-Housing & Urban Health – Request for approval of a retroactive contract renewal with Episcopal Community Services, in the amount of $1,914,189, with an annual contract amount of $1,277,126, for a total contract of $2,143, 892 which includes a 12% contingency, to provide supportive housing services targeting homeless adults, for the period of July 1, 2006 to December 31, 2007 (18 months). *Contract summary, Monitoring report summary, Client demographic information form 3.2 PHP-Housing& Urban Health – Request for approval of a retroactive renewal contract with Tenderloin Neighborhood Development Corporation, in the amount of $1,740,860, including a 12% contingency, to provide supportive housing services targeting homeless seniors, for the period of July 1, 2006 through June 30, 2009 (3 years). * Contract summary, Monitoring report summary and responses, Client demographic information 3.3 BHS – Request for approval of a retroactive contract renewal with Westside Community Mental Health Center, Inc., in the amount of $9,203,307, to provide mental health services, including crisis management, outpatient services and school-based day treatment targeting adults and youth/adolescents, for the period of July 1, 2006 through June 30, 2008 (2 years). * Contract summary, Monitoring report summaries, Client demographic information form 3.6 BHS – Request for approval of a retroactive contract renewal with the Center on Juvenile and Criminal Justice, in the amount of $1,367,060, which includes a 12% contingency, to provide residential substance abuse treatment services, for the period of July 1, 2006 through December 31, 2010 (4.5 years). *Contract summary, Monitoring report summary, Client demographic information form 3.7 PHP-EHS – Request for approval of a retroactive contract renewal with Mission Economic Development Association, in the amount of $108,054, which includes a 12% contingency, to provide ongoing fiscal management and business plan development services for the Day Labor Program, for the period of October 1, 2006 through September 29, 2007 (1year). * Contract summary, Monitoring report summary 3.8 PHP-Housing & Urban Health – Request for approval of a retroactive contract renewal with Catholic Charities CYO, in the amount of $150,006, which includes a 12% contingency, to provide comprehensive housing and case management services at Rita da Cascia, for the period of July 1, 2006 to June 30, 2008 (2 years). * Contract summary, Client demographic information form 3.9 PHP-Housing & Urban Health – Request for approval of a retroactive contract renewal with San Francisco Network Ministries Housing Corporation, in the amount of $87,209, which includes a 12% contingency, to provide supportive housing services to homeless women leaving the commercial sex industry, for the period of July 1, 2006 to December 31, 2007 (1.5 years). * Contract summary, Monitoring report summary and responses, Client demographic information form 3.10 PHP-Housing & Urban Health – Request for approval of a retroactive renewal contract with Tenderloin AIDS Resource Center dba Tenderloin Health, in the amount of $596,443, which includes a 12% contingency, to provide emergency hotel rooms and client-centered emergency on-site services to medically stable homeless individuals living with HIV/AIDS, for the period of March 1, 2006 to June 30, 2008 (2.3 years). * Contract summary, Monitoring report summary and responses, Client demographic information 3.13 MCH – Request for approval of a retroactive sole source contract renewal with Support for Families of Children with Disabilities, in the amount of $623,110, which includes a 12% contingency, to provide support for families whose children have special needs, for the period of July 1, 2006 through June 30, 2010 (4 years). * Contract summary, Award letters, Client demographic information form 3.14 BHS – Request for approval of a retroactive contract renewal with Morrisania West, Inc., in the amount of $338,669, which includes a 12% contingency, to provide substance abuse services targeting African American youth and young adults, for the period of July 1, 2006 through December 31, 2007 (18 months). * Contract summary, Monitoring report summary, Plan of Correction, Client demographic information form 3.15 BHS – Request approval of service sites for the Family Service Agency: 1) to relocate an existing program, Adult Case Management, and 2) for two new programs, Full Service Partnership for transitional age youth, Full Service Partnership for adults, to 1663 Mission Street. * Calendaring memo Action Taken: Commissioner Tarver abstained from item 3.3. The Commission passed the consent calendar. 4) DIRECTOR’S REPORT Mitch Katz, MD, Director of Health presented the Director’s Report. Seven Principles Project The Seven Principles Project held a "Cultural Competency Providers Training: Reducing African American Infant Mortality in San Francisco" for 36 providers on November 30, 2006. Together with partners Blue Cross of California, San Francisco Health Plan, National Center of Excellence in Women's Health, and the Maternal, Child, and Adolescent Health Section of DPH, the Project recruited a cross-section of providers who serve African American women and their families to improve their knowledge and skills for working with African Americans. Language Access Technology Awards At the December 6, 2006, California Association of Public Hospitals and Health Systems (CAPH) Annual Conference, a one-time-only Language Access Technology Leadership Award was presented to the member systems who have shown the way regionally, statewide and nationally. An award went to San Francisco General Hospital Medical Center and Alameda County Medical Center for being the first hospitals in the nation to pilot Videoconferencing Medical Interpreting. Gloria Garcia-Orme, Director of Operations for Primary Care, Patient Relations and Language Services accepted the award for San Francisco General Hospital Medical Center. SFGHMC LEAD Program Team The SFGHMC LEAD Program team gave a presentation at the December 6th CAPH Annual Conference. The presentation consisted of the newest effort, LEADing Organizational Change: Advancing Quality through Culturally Responsive Care, which was dedicated to helping California’s public hospitals integrate culturally and linguistically competent care into their delivery systems. The SFGHMC program focused on improving the quality of diabetes care, specifically foot care, for African-American patients. The LEAD grant was sponsored by the California Endowment. National Association of Public Hospitals and Health Systems (NAPH) Selects Chair The National Association of Public Hospitals and Health Systems (NAPH) represents more than 100 of America’s most important safety net hospitals and health systems. NAPH also conducts research on a wide range of issues that affect public safety net health systems. Gene Marie O’Connell, RN, MS was recently named the new Chair of NAPH for fiscal year 2007-2008. COMMUNITY HEALTH NETWORK SAN FRANCISCO GENERAL HOSPITAL DECEMBER 2006 Health Commission - Director of Health Report (From 12/04/06 MEC) 12/06 07/06 to 12/06 New Appointments 18 116     Reinstatements 0 0 Reappointments 41 214    Delinquencies: 0 0    Reappointment Denials: 0 0 Resigned/Retired: 9 71 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Deceased 0 1 Changes in Privileges    Additions 5 31    Voluntary Relinquishments 3 21    Proctorship Completed 11 35    Proctorship Extension 1 0 Current Statistics – as of 12/1/06 Active Staff 497 Courtesy Staff 573 Affiliate Professionals (non-physicians) 204 TOTAL MEMBERS 1,274   Applications In Process 26 Applications Withdrawn Month of December 2006 2 4 (07/06 to 12/06) SFGH Reappointments in Process Jan. 2007 to Apr. 2007 130 Commissioner’s Comments Commissioner Monfredini stated that she was very proud of the articles and all of the staff and that she was bursting with pride as a woman in regards to the final article on Gene. Commissioner Sanchez stated that he holds high respect for this hospital and concurs with Commissioner Monfredini. Commissioner Illig stated that we need many more articles like this. He also added that he is going to get in touch with the editor of the SF Chronicle to try and get more articles like it so to raise the awareness of the community as we are advocating for the SFGH rebuild. Commissioner Chow stated that the articles raised the awareness of the general public about what we do. He also states that SFGH is the best public hospital in the country and that the article confirms that. He stated that this is a commendation to everyone that works at SFGH. Commissioner Guy stated that she supports what Commissioner Monfredini said and that the profiles show the individuals covered as public servants and also as public leaders and that she wanted to honor everyone who does this work. She also stated that the voters of San Francisco have shown that they honor public health and this public hospital work and she wanted to honor that as well. Commissioner Tarver stated that he wanted to commend all of the people in the articles and that as staff; everyone is connected beyond where they live in the organization and then additionally to the community. He also stated that these articles serve to counter misconceptions and provide justification for not only a rebuild but an expansion of SFGH. Commissioner Umekubo thought this article was well done. He stated that in the private sector they were allowed insight into the work that it is done at SFGH. 5) PRESENTATION OF THE EMPLOYEE RECOGNITION AWARDS President Monfredini presented the employee recognition awards.   Team Award Division Nominated By SFGH Nursing Directors: SFGH Gene O’Connell Sharon Wicher (Behavioral Health) Kathy Ballou (Acute Psychiatry Operations) Ana Sempera (Medical) Terri Dentoni (Perioperative/Critical Care) Robert Sypher (Emergency Department) Yuhum Digdigan (Surgical/Nursing Operations) Nela Ponferrada (Maternal Child) Team Award Division Nominated By SFGH Environmental Services SFGH Delvecchio Finley ALL Staff     Johnson Gong, General Services Manager accepted the certificate on behalf of Environmental Services. The following staff was also present: Francisco Saenz, Assistant General Services Manager, Mauricio Alfaro, PM Supervisor, Rui Ping Tang, PM porter (and employee of the year for 2006), Rosa Rivera, Assistant General Services Manager, James Clark, PM Porter and Shop Steward for Local 250. Commissioners’ Comments Commissioner Sanchez wanted to acknowledge the fact that we are very fortunate to have the San Francisco General Foundation. Once a year they provide a great annual lunch for staff but more importantly they raise funds to support the safety network that San Francisco General Hospital provides. 6) PROPOSED REVISION OF SFGH RULES AND REGULATIONS REGARDING HISTORY AND PHYSICAL EXAMINATION (H&P) REQUIREMENTS Andre Campbell, MD, SFGH Chief of Staff presented the proposed revision of SFGH rules and regulations regarding history and physical examination (H&P) requirements. SFGH RULES AND REGULATIONS – Proposed Revision 1.G. For outpatient and elective surgery, a complete history and physical examination (H&P) shall be performed and recorded by a member of the surgical team within thirty (30) days prior to surgery. The physician or other individual qualified to perform the H&P must write an update note addressing the patient’s current status and/or any changes in the patient’s status within 7 days prior to the surgery. This update note shall address any areas where more current data is needed, confirm that the necessity for the procedure is still present, and that the H&P is still current. The update note must be on or attached to the H&P. The H&P, including all updates, must be included in the patient’s medical record prior to surgery. If the history and physical examination (H&P) and update note is not in the medical record prior to surgery, the surgery shall be canceled unless the attending surgeon documents in the medical record that a delay would likely result in a critical emergency. Action Item: Revision of SFGH Rules and Regulations regarding history and physical examination requirements was approved. 7) SAN FRANCISCO GENERAL HOSPITAL ANNUAL REPORT Gene O’Connell, CEO, San Francisco General Hospital, presented the San Francisco General Hospital Annual Report. Components of the Annual Report 2005-2006 Annual Report 2005-2006 List of Accomplishments Environment of Care Annual Report Performance Improvement/Patient Safety Reporting Grid For Commission Approval Policies and Procedures Hospital Plan for Provision of Care No changes except statistics Utilization Review Policy No changes Performance Improvement and Patient Safety (PIPS) Policy Integrated patient safety into the Performance Improvement policy Established Patient Safety Council, subcommittee of the PIPS Committee Patient Safety at San Francisco General Why Patient Safety? Adverse health care events are leading causes for death and injuries in hospitals Increase practice that reduce patient harm and injuries Create safe environment for patient and staff Adopting safe practices in clinical settings Continuously improve patient care Measure progress Identify areas for improvements Institute for Healthcare Improvement (IHI) 100,000 Lives Campaign – focusing on specific initiatives shown to save lives: Rapid Response Team Preventing Adverse Drug Events Acute Myocardial Infarction care Ventilator Associated Pneumonia Prevention Surgical Site Infection Prevention Joint Commission on Accreditation of Healthcare Organizations (JCAHO) National Patient Safety Goals: Accurate patient identification Communication among caretaker Medication safety and reconciliation Infection control Fall prevention Quality/Patient Safety Reporting SFGH measures progress on quality and patient safety initiatives by: Collecting and reporting data to track our efforts over time and implement changes to improve patient care. Data manually collected by staff Reporting to external bodies which provide comparisons to national benchmarks Failure to report required measures may affect accreditation of the hospital. Follow the Patient… Representative Patient: 60-Year-Old, African-American Male Primary care patient in General Medical Clinic Smoking History X 40 Years Diabetic Presents to Emergency Dept. with Chest Pain likely due to an Acute Myocardial Infarction (AMI) 1. In E.D., Patient is given recommended initial treatment of Aspirin and Beta Blocker on Arrival During the admission process, medication reconciliation is initiated for all patients. The purpose of medication reconciliation is: To prevent medication errors at patient transition points (e.g. admission, transfer, and discharge) such as: Errors in transcription Duplication of therapy Drug-drug and drug-disease interaction To promote a culture of patient safety 2. Patient Admitted to the Medical Telemetry Unit for Acute Myocardial Infarction (A.M.I.) 3. Patient admitted to Med/Surg Unit With history of diabetes and current medication, patient was identified as a fall risk. Falling Star symbol placed on door and unit board to visually communicate fall risk to all staff. 4. Patient identified as a smoker, started in PATCH Smoking Cessation Program: PATCH – Providing Assistance for Tobacco Cessation in the Hospital: Accurate identification of smokers by Admitting and Health Educator Cessation counseling by Health Educator Nicotine withdrawal therapy while inpatient Nicotine patches (two weeks) at Discharge Follow up calls and referral to Stop Smoking RN in GMC clinic. 5. Shortly after admission, the patient experiences shortness of breath and changes in vital signs. The Medical Emergency Response Team (MERT) was called by the evening nursing staff. IHI Rapid Response Team Initiative Implemented at SFGH in April 2006 Brings critical care experience to the medical surgical and psychiatric bedside Allows early detection of declining patient conditions, making early treatment more likely to succeed MERT Expected Outcomes Reduce the number of codes outside of the ICU Ensure appropriate level of care Ensure quick transitions to higher level of care areas when necessary Decrease admissions to higher level of care areas Since MERT established in April 2006: Average MERT calls per month = 18 Decrease in average number of Code Blue calls: Year 2005: 9.25 Code Blues/Month April 2006-Present: 6.50 Code Blues/Month Appropriate Level of Care 50% Patients with MERT activation were stabilized and remained on Med/Surg Unit 50% Patients with MERT activations were transferred to a higher level of care. 6. Patient is transferred to the ICU for shortness of breath and put on a ventilator – question about a possible allergic reaction to a medication. Adverse Drug Event Taskforce Reviewed current process for identifying, reporting and monitoring adverse drug events (ADE) Developed recommendations to improve process. ADE Task Force Recommendations Increase education of staff through “campaign” to increase reporting Strengthen “Trigger Drug Program” Involve patients Involve Poison Control Center Recognize the need for a designated ADE Program Coordinator – Requesting a Full time Clinical Pharmacist ICU Care Issue Preventing Ventilator Associated Pneumonia: Initial data from CHART project, March 2006, shows room for improvement (Head of Bed at 30º) 7. One month after patient discharged – CHART Patient Survey sent Mail survey sent monthly to sample of inpatients 56 Questions, including required CMS questions; Grouped in 7 Dimensions of Care Answers on scale of: Never, Sometimes, Usually, Always/Definitely Response of ‘Never’, ‘Sometimes, and ‘Usually’ are considered negative. Results are compared to CHART average SFGH return rate – 32% 8. Patient returns for follow-up care with his primary care provider in General Medical Clinic Receives recommended diabetic foot screening Diabetes Collaborative Program: Providing opportunities for African American diabetic patients to develop action plans for self-care. Implementing a foot screening protocol Providing training to health care providers in the General Medicine Clinic on culturally competent diabetes care for African Americans In 2007, Patient Safety will continue to be our #1 goal Computerized Physician Order Entry Electronic Clinical Documentation IHI Ventilator Associated Pneumonia Initiative IHI Surgical Site Infection Initiative Abnormal Test Result Task Force Medication Management and Medication Error Reduction Commissioners’ Comments Commissioner Illig asked where the other 60% of primary care is undertaken for clients coming to the emergency room. Anson Moon stated that half of the patients at SFGH have a medical home within CHN and the other half do not. Gene O’Connell added that they do ask incoming patients if they have a medical home and that they do track that. Commissioner Illig asked if SFGH is asking behavioral health clients to do the surveys. Gene O’Connell responded that it is only for the Cardiac Unit and those with addresses. Commissioner Umekubo congratulated the staff on all of their accomplishments. He stated that it was phenomenal that the hospital achieved all of this with all of the surveyors that have been here this year. He added that the pharmacy project took a lot of collaboration and that it was important for patient safety and he feels this project exposes a lot of holes. He stated that one of the things also noticed was the good rate of nursing call light response. Lastly he wanted to mention the sense of pride one feels when working with staff at SFGH. Commissioner Chow stated that the accomplishments listed in the packet are great and that the recognition on a national level confirms SFGH’s place as the best public hospital. He stated that one of the goals was working on computerized records and physician ordering and that he would like an update on how this was going. Gene O’Connell stated that the medical staff is coming along with compliance with the new system. She stated that there were some stumbling blocks with M Tower regarding the technology available and that they have addressed that. She added that Sue Currin is working with the nursing staff on the LCR and that they are all still working with interfaces. She stated that they are also looking at other systems and are looking to expand such things and the Diabetes Patient Registry. Commissioner Chow asked what SFGH’s goals were for next year. Gene O’Connell stated that they have already put together their goals for next year and that she will send them to the Commissioners. She also listed the following as Commissioner Chow also commended the hospital on the pneumococcal testing program and that based on outside data that the results achieved are really good. Commissioner Guy stated that it is important at the JCC level to see how the HAP program is affecting the hospital. She stated that they want to see where the problems are coming up in these areas. She added that the issue of operating above hospital bed census needs to be addressed, and that she thinks this is really important and that work-load needs to be addressed. Commissioner Guy stated that she also wanted to commend the hospital on cancer care. Commissioner Chow asked if there was a way to change the structure of the budget to reflect. Dr. Katz stated that on the pure revenue side, we have markedly increased our revenue going into the budget cycle. He stated that the tendency with fiscal staff is to be conservative so to be able to function within the stated budget. He stated that as the rolling census is trending up they will have to reevaluate staffing. Commissioner Guy stated that she would like to see this followed up in the JCC and that we should respect the workforce and all they put in to the hospital. Commissioner Tarver commended Gene O’Connell and the hospital staff and stated that the hospital has been really good with integrating the outpatient population and that the hospital staff understands that patients are citizens of the city and don’t just exist in the hospital. He added that one of the top diagnoses is depression and that behavioral health is among the types of services that require integration. He stated that they should look at integrating the databases so as to know the life of a patient on the medical and psychiatric sides. He added that you can’t separate people between the medical and psychiatric sides of their life. He also said that he wanted to see some progress on consolidating pharmacies as he has had the experience of having to prescribe different medications for patients in both the CBHS and CHN sides. Commissioner Sanchez stated that SFGH is a leader and that they rise to the challenges presented to them. Action Taken: The following was approved: Policy 8.9 Hospital Plan for Provision of Patient Care – Changes to statistic only Policy 17.1 Performance Improvement and Patient Safety Program (PIPS) Integrated patient safety into the Performance Improvement policy Established Patient Safety Council, subcommittee of the PIPS Committee Policy 12.04 Inpatient Utilization Review Program – No Changes The following was accepted: Overview of San Francisco General Hospital SFGHMC Goals and Accomplishments for Fiscal Year 2005-2006 SFGHMC 2006 Environment of Care/Safety Management Annual Report 8) PUBLIC COMMENT/OTHER BUSINESS Yvonne Martinez from Local 790 SEIU stated that there has been some progress on several issues. She stated there is now a secretary at South East Geriatric. She also stated that they were successful in reversing what could have been the dismantling of the OMI. She also wanted to thank the staff that worked with her on this project. She added that she hoped Mr. Hope who was in the film also found some resolution before the end of the year. 10) ADJOURNMENT The meeting was adjourned at 5:17 PM Rebekah R. Varela,Acting 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.