HEALTH COMMISSION. CITY AND COUNTY OF SAN FRANCISCO Gavin C. Newsom, Mayor Department of Public Health. David J. Sanchez, Jr., Ph.D.

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1 James M. Illig President Sonia E. Melara, MSW Vice President Edward A. Chow, M.D. Commissioner HEALTH COMMISSION CITY AND COUNTY OF SAN FRANCISCO Gavin C. Newsom, Mayor Department of Public Health Margine A. Sako Commissioner David J. Sanchez, Jr., Ph.D. Commissioner Mitchell H. Katz, M.D. Director of Health Jim Soos Acting Executive Secretary Steven Tierney, Ed.D. TEL (415) Commissioner FAX (415) Catherine M. Waters, R.N., Ph.D. Commissioner Web Site: 1) CALL TO ORDER MINUTES JOINT CONFERENCE COMMITTEE FOR SAN FRANCISCO GENERAL HOSPITAL Tuesday, 3:00 p.m Potrero Avenue, Conference Room 2A6 San Francisco, CA Commissioner Chow called the meeting to order at 3:10 p.m. Present: Commissioner Edward Chow, M.D., Chair Commissioner Catherine Waters, R.N., Ph.D., Member Commissioner David J. Sanchez, Jr., Ph.D., Member Staff: Sue Carlisle, M.D., Jeff Critchfield, M.D., Sue Currin, Elaine Dekker, Millie Foley, Valerie Inouye, John Luce, M.D., Todd May, M.D., Kathy Murphy, Marti Paschal, Roland Pickens, Dan Schwager, Sue Schwartz, Sharon McCole Wicher, Lann Wilder, Troy Williams, Lisa Winston, M.D. 2) APPROVAL OF THE MINUTES OF THE APRIL 14, 2009 SAN FRANCISCO GENERAL HOSPITAL JOINT CONFERENCE COMMITTEE MEETING Action Taken: The Committee approved the minutes of the April 14, 2009 San Francisco General Hospital Joint Conference Committee. 101 Grove Street San Francisco, CA

2 3) HOSPITAL ADMINISTRATOR S REPORT Sue Currin, Chief Executive Officer, presented the report. Primary Stroke Center Certification Review Linda Brown from the Joint Commission surveyed the Designated Stroke Program at San Francisco General Hospital on April 20th. She interviewed staff, reviewed medical records of stroke patients and studied the Quality Improvement Data. Ms. Brown left impressed by the program and stating that San Francisco General Hospital Designated Stroke Program had no findings for this survey and no requirements for improvement. Furthermore, Ms. Brown acknowledged that it is unusual for a hospital to have a "perfect" survey and that it was a pleasure to review such an outstanding program. These surveys are only as successful as the Stroke Program team behind them. A special thanks to Claude Hemphill MD, Christine Martin, Renee Allen, Ken Coehlo, and David Kutys. Congratulations to all. SFGH H1N1 (Swine) Influenza Update San Francisco General Hospital and Trauma Center has followed the guidance provided by SF DPH through Health Alerts and daily conference calls in terms of testing and treatment protocols. Up-todate information and full protocols were obtained from the SF DPH H1N1 (Swine) Influenza website: At this time H1N1 is considered a mild illness and SFGH is managing and treating patients as seasonal flu in accordance with latest SF DPH alert. Testing by the DPH laboratory will be done for suspected cases that meet select criteria, such as patients requiring hospitalization. The hospital has managed patients using our normal prevention practices which meet national and local recommendations: Body Substance Precautions in combination with Respiratory Isolation (High for inpatients; Low for outpatients). SFGH has had no admissions due to N1H1 influenza. SFGH case counts are as follows: 115 patients tested for influenza, of these 3 were positive for influenza; type A (non-swine per SF DPH laboratory). Special Note: 1 patient presented to Urgent Care Clinic with symptoms and compatible travel history; SFGH rapid test was negative but due to epidemiologic criteria the specimen was forwarded to SF DPH and results were non-typable Influenza A, meets probable Swine Flu case definition. One patient with underlying medical conditions on immunosuppressive therapy was admitted to the ICU and had a rapid influenza test positive for Influenza A, forwarded to SFDPH on 5/11/09 for typing; results pending. Antiviral treatment initiated based upon clinical symptoms and positive rapid test. San Francisco Cases Counts (5/12/09) San Francisco residents who are considered probable or confirmed H1N1 (swine) flu cases: Probable Cases: 1 Confirmed Cases: 5 Employee Influenza Compliance The Employee Influenza Compliance update was attached to the report. UCSF Ancillary Services The services purchased from UCSF are integral to the operations of the hospital. Providing the negotiated COLA s for represented staff is necessary for UCSF to continue to provide services. Page 2

3 SFGH would need to provide these services directly, or find an alternative agency to provide these services, if they were not purchased from UCSF. Important considerations include: The Affiliation Agreement only covers the direct costs of services, it does not include overhead costs, such as human resources, legal, accounting, purchasing. It is probable that if the City provided the comparable services, there would need to be an increase in City FTE s to cover these overhead services. The cost of employee benefits, as a percentage of salaries is lower for UCSF employees. The UCSF percentage is approximately 19%, whereas the City percentage is approximately 32%. All previous analyses determined that it was less costly to purchase employee services from UCSF than to contract with another agency: Outpatient Dialysis: In an attempt to reduce the number of represented staff on the Affiliation Agreement, SFGH and UCSF agreed to stop providing outpatient dialysis services and have the patients be seen in the community. The SF Board of Supervisors rejected the proposal to transfer this service to the private sector on three consecutive fiscal years: 2003, 2004 and On that last occasion, the Board asked the Health Department not to put forth this proposal in In addition, we were unable to find a community program that would agree to provide outpatient dialysis for patients requiring isolation, custody patients and patients with special needs (dialysis done while on a gurney instead of a chair). Biomedical Engineering: SFGH Facilities Management has twice looked at alternative sourcing of this essential service, most recently in On both occasions, bench marking data did not support the contracting out of these services. Current salaries are comparable to other acute care facilities in the Bay Area. SFGH and UCSF continue to work on cost-saving initiatives. In the past year, we have reduced the biomed staff by 2 FTEs and we are working with our vendors to reduce costs related to periodic maintenance of our equipment. Clinical Laboratories: SFGH considered pursuing an alternative to the UC contract for this hospital based service and began a RFP process with assistance from Deloitte & Touche. The effort was abandoned when it became apparent that the City would end up paying significantly more than the Affiliation Agreement. The increased costs resulted from the American College of Surgeons requirement to maintain onsite laboratory services in designated Trauma Centers to meet lab results turn around times for trauma patients. Current salaries are comparable to other acute care facilities. According to Allied for Health, the average hourly CLS salary in the Bay Area is $43.72; the average UCSF CLS salary is $ Highland Hospital s CLS salary range is $36.16 $48.61; the UCSF CLS salary range is $35.16 $ Respiratory Therapy: UC contracted salaries are comparable to those found in other acute care hospitals in the City. The average starting pay for a Registered Respiratory Care Practitioner (RCP) at SFGH is $35.94 per hour. The average starting salary in the Bay Area is $36.53 per hour. Additionally, there are no comparable Civil Service classifications at this time that match the job descriptions of these critical care essential personnel. The civil Page 3

4 service position listed is for service in a non-acute facility. Acute care RCP positions are extremely difficult to recruit. BEACON Patient Safety Conference The 3 rd Annual BEACON Patient Safety Conference Power of Creativity was held on April 21, 2009 at the South San Francisco Conference Center. Attendees from the 38 Beacon Collaborative Hospitals included 115 staff from San Francisco General Hospital and Trauma Center. Three of the breakout sessions were presented by SFGH staff. Sue Currin, CEO and Edgar Pierluissi, MD gave an innovative presentation Rethinking Inpatient Geriatric Care: Acute Care for the Elderly (ACE) Units. Focusing on the Culture of Safety, Leslie Dubbin and Leslie Holpit discussed Preventing Adverse Events: The Rapid Response Team and RN Professional Role and Franco Herrera, Jennifer Berke, Juliet Lane, Joy Graham and Ken Coelho spoke about The Role of Emerging Technology in Engaging Hospital Staff and Promoting a Culture of Quality and Patient Safety. The San Francisco General lead sessions had an outstanding showing and active engagement with attendees and peers. Rite Aid Acquisition by Walgreens Approved On May 1, 2009, the Federal Trade Commission (FTC) approved acquisition by the Walgreen Company of Rite Aid pharmacies in San Francisco and western Idaho. On May 26, 2009, all Rite Aid pharmacies currently affiliated in 340B contract pharmacy arrangements with CHN primary care clinics will open its doors as Walgreens pharmacies. Sliding scale and Healthy San Francisco enrollees who receive CHN prescription benefits may therefore continue to have prescriptions filled at the same location, and the pharmacy name will be Walgreens instead of Rite Aid. Flyers in English, Chinese and Spanish announcing the change were forwarded for distribution to patients by CHN clinic and Rite Aid pharmacy staff. Information with specific transition timelines was also provided to all CHN providers. Prescription Copayment Changes Beginning April 30, 2009, patients enrolled in DPH sliding scale programs, and with incomes at or below 100% of the Federal Poverty Level (FPL), are no longer required to make prescription copayments. Previously for sliding scale program enrollees, only homeless patients and those on general assistance (GA) were exempt from prescription copayment. The change in groups exempt from copayment aligns the prescription benefit for sliding scale programs with those for Healthy San Francisco. Healthy San Francisco enrollees who are homeless, on GA, or with incomes below 100% FPL have been exempt from prescription copayment since the inception of the program. Avon Center Waits For Mammograms As the San Francisco Chronicle reported in February 2009, external factors contributed to significant delays in access to mammograms at the Avon Breast Center. These factors included the high demand for the service, the nationwide shortage of radiologists and the fast-moving health care technology environment that is hard to keep up with given limited resources. Still, we have made significant improvements in wait times in the last few months. Mammography waits have dropped from 128 days to seven to 14 days for diagnostic tests, and from 300 to 90 days for routine screenings. The mammovan is back in service with new state of the art equipment and is acting as an additional exam room for the Avon Center. We expect it to be back out in the community in September. The shortage of radiologists has been addressed by UC sending a radiologist to help read mammograms and perform procedures three times per week. We are pleased with these improvements. They were reported to the public in the May 6 edition of the San Francisco Chronicle. Page 4

5 Patient Flow Report for April 2009 A series of charts depicting changes in the average daily census for Medical/Surgical, Acute Psychiatry, 4A Skilled Nursing Unit, and the San Francisco Behavioral Health Center were attached to the report. Quality Council Minutes The Quality Council minutes for March 2009 were attached to the report. Commissioners Comments/Follow-Up Action Commissioner Chow requested a follow-up report to see the possible impact of the prescription copayment changes on the percentage of outpatient prescriptions that are picked up. 4) PATIENT CARE SERVICES REPORT Sharon McCole Wicher, Interim Chief Nursing Officer, presented the Patient Care Services Report. April RN Vacancy Report Overall 2320 RN vacancy rate for areas reported is 4.08%. SFGH Ratio Staffing Data, By Number of Shifts 4/01/09 to 4/30/09 SFGH was able to meet staffing ratios in all areas except in Telemetry where there was one shift when the area was unable to meet minimum ratios and Medical Surgical where there was one shift when the area was unable to cover breaks. Recruitment/Retention/Training/Professional Development RN Internship Program/New graduate Training: Medical-Surgical training program will begin on May 11 for 25 new hire RNs. The training program includes hospital orientation, clinically focused med-surg classes with skill training and unit based preceptorships. Recruitment: Provided in the vacancy report. Retention/Professional Development: Nurse s week activities were held the first week of May at SFGH including a DPH wide reception on May 6. Gene Marie O Connell spoke at the NLC sponsored presentation in Carr Auditorium on May 6 which was followed by the reception held in the cafeteria. Award presentations included: the O Connell Leadership Award, the Daisy Award, the SFGH Friends of Nursing Award and the Mildred Creer Public Health Nursing Award. Nursing Excellence An all day retreat for the nursing directors and the co-chairs of the hospital-wide Nursing Practice Council was held on April 27. Agenda for the day included initial work on the SFGH Nursing vision with goals and a strategic plan for the nursing excellence journey in pursuit of Magnet designation. Nursing staff will be asked to endorse and comment on the draft vision statement during the Nurse s week reception. A second retreat is planned for June to complete the strategic plan. Page 5

6 ED Diversion Report April 2009 The Emergency Department had a Diversion rate total of 21% (152 hours) for the month of April The ED encounters for the month of March were 3491 and 646 patient admissions. During Diversion the ED held 288 admitted patients waiting for inpatient bed assignment (ICU-8, 4B/5D-145 Med/Surgical-135). PES March April 2009 PES had 535 patient encounters during March 2009 and 488 in April PES admitted a total of 151 patients to SFGH inpatient psychiatric units in April 2009 which was down from 164 in March In April, a total of 337 patients were discharged from PES, with 26 to ADUs, 13 to other psychiatric hospitals and 298 to community/home. In April, PES was on Condition Yellow for a total of 3.6 hours, which was up from 0.0 hours in March. There was a decrease in Condition Red from March to April. PES was on Condition Red for hours during 15 episodes in April. The average length of Condition Red was 8.39 hours. In March, PES was on condition Red for hours, during 17 episodes, averaging hours. The Average length of stay in PES for the month of April was hours, which was a decrease from hours in March. 5) MEDICAL STAFF REPORT Jeff Critchfield, M.D., Chief of Staff, presented the Medical Staff Report. SFGH Medical Staff Leadership MEC welcomed Neil Powe, MD, incoming Chief of the Medicine Service. The official vote on his appointment is forthcoming, pending his appointment to the SFGH Medical Staff. Dr. Bennie Jeng, Chief of Ophthalmology, has announced his resignation as of July Dr Michelle Bloomer, an assistant professor at Parnassus and the VA campuses will serve as the Interim Service Chief. Dr. Bloomer completed her Ophthalmology residency and fellowship at UCSF. Dr. Andrew Murr will again chair the Search Committee for the new Ophthalmology Service Chief. The Annual Medical Staff Dinner will be held on June 16, :30pm. To focus also on the Medical Staff, the following most experienced clinicians and leaders who have moved on from their positions as Chiefs of Clinical Services will be acknowledged and honored for their outstanding stewardship: - William Schecter, MD (Surgery) - William Taeusch, MD (Pediatrics) - Stuart Seiff MD (Ophthalmology) - Robert Okin, MD (Psychiatry) - Talmadge King, MD (Medicine) - Alan Gelb, MD (Emergency Medicine) - Philip Darney, MD (OB/GYN). Page 6

7 Additionally, Dr. Michael Drennan, Chief, CPC, has been invited to talk about the significant activities ongoing in the DPH clinics. SFGH Medical Staff Bylaws Proposed Revisions MEC, upon a unanimous affirmative vote, approved the proposed revisions to the SFGH Medical Staff Bylaws. Dr. Todd May, Chair of the Bylaws Committee, presented the proposed changes and explained that the major revisions are on the incorporation of the Professional Code of Conduct in the SFGH Medical Staff Bylaws. The proposed changes will be submitted to the members of the Medical Staff, and thereafter to the Governing Body for approval. Radiology Annual Report The report included updates about the following: Service s efforts to improve physician staffing in mammography, major equipment projects (new CT Installation completed, MRI and Interventional in progress), PACs (entirely digital), Exam stats level (continues monitoring and improving turnaround times), reporting critical results (continues to target resident education to improve documentation), and unread exams down to 0.9 % (QC team in place on all shifts). HIV Tests offered in ER The article was about the dramatic increase in HIV testing nationwide in emergency rooms such as SFGH since 2007, and in response to a mandate of the Centers for Disease Control and Prevention. As a result of the increased patient testing, new and unexpected HIV-positive cases have been identified. Dr. Beth Kaplan, who oversees the program in the SFGH ER, stated that the new cases are challenging ER workers to focus on new indicators that might warrant testing. Commissioners Comments/Follow-Up Action Commissioner Chow volunteered to review the Medical Staff Bylaws. 6) FINANCE REPORT The Revenue and Expenditure Report for the 3 rd Quarter FY was attached to the report. 7) CHART PATIENT EXPERIENCE SURVEY The CHART Patient Experience Survey Update July 2007 June 2008 was attached to the report. Commissioners Comments/Follow-Up Action Commissioner Chow requested a six month follow-up report on the impact of the SFGH Pain Initiatives on the CHART question regarding how often patients pain was well controlled. 8) PUBLIC COMMENT None. 9) CLOSED SESSION: A) Public comments on all matters pertaining to the closed session None. Page 7

8 B) Vote on whether to hold a closed session (San Francisco Administrative Code Section 67.11) Action Taken: The Committee voted to hold a closed session. The Committee went into closed session at 4:30 p.m. Present in the closed session were Commissioner Chow, Commissioner Sanchez, Commissioner Waters, Sue Carlisle, M.D., Jeff Critchfield, M.D., Sue Currin, Millie Foley, John Luce, M.D., Todd May, M.D., Kathy Murphy, Marti Paschal, Roland Pickens, Dan Schwager, Troy Williams. C) Closed session pursuant to Evidence Code Sections 1157(a) and (b); ; Health and Safety Code Section 1461; and California Constitution, Article I, Section 1 APPROVAL OF CLOSED SESSION MINUTES OF APRIL 14, 2009 Action Taken: The Committee approved the April 14, 2009 closed session minutes. CONSIDERATION OF CREDENTIALING MATTERS Action Taken: The Committee approved the Credentials Report. CONSIDERATION OF PEER REVIEW, QUALITY OF CARE AND PERFORMANCE IMPROVEMENT D) Reconvene in Open Session The committee reconvened in open session at 4:50 p.m. 10) ADJOURNMENT 1. Possible report on action taken in closed session (Government Code Section (a)2 and San Francisco Administrative Code Section 67.12(b)(2).) 2. Vote to elect whether to disclose any or all discussions held in closed session (San Francisco Administrative Code Section 67.12(a).) Action Taken: The Committee voted not to disclose discussions held in closed session. The meeting was adjourned at 4:50 p.m. Jim Soos Acting Executive Secretary to the Health Commission Page 8