HEALTH COMMISSION. CITY AND COUNTY OF SAN FRANCISCO Edwin M. Lee, Mayor Department of Public Health

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1 Steven Tierney, Ed.D. President Sonia E. Melara, MSW Vice President Edward A. Chow, M.D Commissioner James M. Illig Commissioner Margine A. Sako Commissioner HEALTH COMMISSION CITY AND COUNTY OF SAN FRANCISCO Edwin M. Lee, Mayor Department of Public Health Barbara A. Garcia, MPA Director of Health Mark Morewitz, MSW Executive Secretary David J. Sanchez, Jr., Ph.D TEL (415) Commissioner FAX (415) Catherine M. Waters, R.N., Ph.D. Commissioner 1) CALL TO ORDER MINUTES HEALTH COMMISSION MEETING Tuesday,, 4:00 p.m. 101 GROVE STREET, ROOM 300 or ROOM 302 San Francisco, CA Web Site: Present: Commissioner Steven Tierney, Ed.D., President Commissioner Sonia E. Melara, Vice President Commissioner Edward A. Chow, Vice President Commissioner James Illig, President Commissioner Margine Sako Commissioner David J. Sanchez Commissioner Catherine Waters The meeting was called to order at 4:05pm. Commissioner Tierney stated that due an issue with posting of the incorrect agenda for the February 15 th meeting, the Commission did not take action. It therefore needed to vote on whether to disclose matters discussed in the closed session. Action Taken: The Commission voted not to disclose matters discussed in closed session at the February 15, 2011 meeting. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETINGS OF FEBRUARY 1, 2011 AND FEBRUARY 15, Action Taken: The minutes of the of the February 15, 2011 and the February 1, 2011 meetings were unanimously approved. 3) DIRECTOR S REPORT Barbara A. Garcia, Director of Health presented the report which is a current overview of the state of public health in San Francisco. The report can be viewed at:

2 Health Commissioners Reappointed I was privileged to attend the swearing in of Commissioner Margine Sako and Commissioner Sonia Melara on Wednesday, February 23 in City Hall with Mayor Ed Lee. I know the Commission members join me in congratulating Commissioners Sako and Melara on their reappointments. Speaking on behalf of my office and the Department, I look forward to continuing to work with this very experienced Commission to develop effective health policies and provide direction for the Department during these difficult and challenging economic times. Moving Toward Integration of Behavioral Health and Primary Care The Department continues to move forward in our commitment to fully integrate primary care and behavioral health. During the week of January 24 th, 23 social workers, psychologists and health workers were trained in a model of behavioral health delivery in primary care. Even beyond integration, the ultimate goal is to increase our patients access to behavioral health services. The model we are using addresses many psychosocial issues such as anxiety and depression, diabetic self-management that arise within the context of primary care. This is especially important because the behavioral health team will often see a patient on the same day that he or she sees a primary care provider. The model of integration makes follow-up of patients routine through the use of registries and other tracking tools. I am happy to report that implementation of behavioral health in the primary care setting has already begun in nine of the 11 primary care sites. Tom Waddell and Housing and Urban Health implementation will begin next fiscal year. Guidance for Bleach-Free Cleaners in Child Care Facilities The San Francisco Asthma Task Force will be publishing a report on bleach-free disinfectants and sanitizers for use in child care facilities. The report indicates the association between bleach exposure and new-onset asthma, as well as exacerbation of existing asthma. This project was initiated by the Task Force to reduce environmental risks for asthma for both children and childcare workers. Many workers in the child care industry requested that the Task Force address this issue. Food Insecurity Topic of City Visions Program on KALW Paula Jones, Director of Food Systems in the Environmental Health Section, was a guest on KALW s (FM 91.7) radio program City Visions, on Monday, February 28, from 7:00 to 8:00 p.m. The title of the show, "Scarcity in a City of Means: Food Insecurity in San Francisco," explored the concerns and challenges faced by individuals, families, policymakers and organizations that feed the hungry, in their separate and combined struggles to overcome the obstacles that result in inadequate nutrition for thousands of San Francisco s residents. Tdap Clinics Will Save Parents $70 We are still working out the final details for three upcoming Tdap Immunization Clinics, but we have made a lot of progress to date. These free clinics are being planned in response to the new California school immunization law (AB 354) requiring all students entering 7th-12th grades in the fall of 2011 to show proof of a Tdap shot (pertussis vaccine booster). Children without proof of a Tdap vaccination will be denied school entry. This law affects an estimated 25,000 students in San Francisco. Information about the new immunization law and the SFDPH clinics can be found at Page 2

3 New MCAH Director Please join me in welcoming Mary Hansell, Dr.P.H., R.N, as the new Maternal Child and Adolescent Health (MCAH) Director. Mary comes from San Mateo County where she was Director of Family Health Services for San Mateo County Health Systems. She replaces Twila Brown who is retiring from the position. City Insider Features Juxtaposition of IMMUNITY Campaign Billboard I was pleased to see that Heather Knight, reporter for San Francisco Chronicle, picked up on the placement of the Department s IMMUNITY Campaign billboard in Union Square next to one promoting Budweiser. While we are not in the business of partnering with breweries to get out health messages, we were delighted that this feature appeared in the Sunday Chronicle with a colored photo and a short interview with Dr. Fernyak about the importance adult immunizations. I am including a copy of the article in this Director s Report. Addendum: 2/28/2011 Homeless Services During Cold Weather I wanted to let the Commissioners know what Department staff have been doing over the past few days in response to the cold weather that settled into San Francisco last week. SF FIRST called up additional staffing, provided extra shifts of outreach, and helped staff the Sobering Center and additional beds in the temporary shelter at St. Anthony s. In part, through our efforts, we kept both Ozanam and the Sobering Center full, and assisted 151 individuals (78 on Friday night, 73 on Saturday night) out of the cold, and into warm beds. Page 3

4 LAGUNA HONDA HOSPITAL AND REHABILITATION CENTER February, 2011 Health Commission - Director of Health Report (February 10, 2011 MEC) 2/01 01/10 to 2/11 New Appointments 0 21 Reinstatements 0 0 Reappointments 2 50 Delinquencies: 0 0 Reappointment Denials: 0 0 Resigned/Retired: 3 25 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Deceased 0 0 Changes in Privileges Additions Voluntary Relinquishments Proctorship Completed Proctorship Extension Current Statistics as of 2/01/2011 Active Staff (includes 1 NP) 87 Applicants 3 TOTAL MEMBERS 90 Ms. Garcia gave a brief update on the status of Lyon-Martin Health Services. She stated that the DPH has met with the Board of Lyon Martin and the San Francisco Community Clinic Consortium. DPH is considering assisting Lyon Martin with its cash-flow issues. Lyon Martin has hired a CEO and worked with a consultant to help diversify the payer mix. She also stated that Supervisor Mirkarimi is holding a March 2, 2011 hearing on Lyon-Martin. Page 4

5 4) GENERAL PUBLIC COMMENT There was no general public comment. 5) FINANCE AND PLANNING COMMITTEE REPORT Commissioner Jim Illig, Committee Chair, stated that the Committee reviewed the Contracts Report, heard an update on Competitive Solicitations for 2010-and 2011, and a request for relocation from Fort Help. The Committee recommended approval of the Contracts Report and the request of relocation of Fort Help. The Committee also heard a presentation by Gregg Sass, DPH CFO, on the process by which the full DPH budget is created. Commissioner Illig requested that Mr. Sass come back to the Committee with additional information on how the $1.5 billion DPH operating budget is developed and approved. Action Taken: The Contracts Report was unanimously approved Action Taken: The Relocation of Fort Help was unanimously approved. 6) NOTICE OF THE HARM REDUCTION THERAPY CENTER RELOCATION Jim Stillwell, Deputy Director of Community Behavior Services, introduced Pat Denning, Project Director for the Harm Reduction Therapy Center Relocation. Action taken: The relocation was unanimously approved. 7) SFGH REBUILD UPDATE Sue Currin introduced the SFGH Rebuild Team: Terry Saltz, SFGH Rebuild Program Director, Mark Primeau, DPH Capital Projects Consultant, Ron Alamaida, Department of Public Works. Mr. Saltz stated that the tunnel has been completely removed. The construction site is now forty feet deep at the hospital side and twenty-five feet deep at the Potrero Street side. There have been no reported adverse incidents related to the construction site. Mark Primeau reviewed the issues of the bond sales and the workflow schedule as it relates to the expenditures. Ron Alamaida reviewed the schedule summary and discussed the work timeline. Commissioner Comments/Follow-Up Commissioner Sako asked if the extension of hours impact the overall cost of the project. Mr. Alamaida stated that the added hours has added cost to the project budget but that it makes sense to do this type of work in the early phase of the project when there are few sub-contractors onsite. Commissioner Sako asked how often an update on the workflow schedule is given to the SFGH JCC. Ms. Currin stated that the JCC gets quarterly updates and that there is also a project oversight committee which meets monthly to review these issues. Commissioner Chow thanked the Rebuild team for making the changes to the presentation that were suggested at the JCC. He asked the other Commissioners to offer input on how the reports could be improved for future presentations. Page 5

6 Commissioner Illig asked if there are costs associated with the bond underwriter. Mr. Sass stated that there is a cost associated with this process which includes the purchase, underwriting, and packaging of the bonds. Commissioner Illig noted that the bond sales chart and budget status numbers do not match. Mr. Primeau said he would check on this discrepancy and will send clarification to the Commission through Mr. Morewitz. Mr. Primeau stated that although the project does not have to comply with the Local Hiring Enterprise Ordinance, it is well above the twenty-percent requirement. Commissioner Sanchez commended Webcor for opening up employment opportunities for students and local community members. Ms. Garcia acknowledged the excellent work of the Rebuild Team and stated that she has encouraged them to meet with the LHH Rebuild team to review lessons learned during the LHH project; she has also instructed them to have tight policy oversight over work-change orders. 8) LAGUNA HONDA HOSPITAL REVISED GIFT FUND POLICY Mivic Hirose, Executive Administrator and ChiaYu Ma, LHH Deputy Finance Director, introduced the revised policy. Commissioner Comments/Follow-Up: Commissioner Chow asked if there is another fund to accept donations for purposes other than resident services. Ms. Ma stated that there is a distinct fund for those who want to donate to non resident services. Commission Chow suggested that the LHH JCC get a report of the processes related to the nonresident use fund. Commissioner Illig asked if every individual expense related to the Gift Fund will have to be approved. Ms. Hirose stated that the Gift Fund Committee annually approves the categories appropriate for using the Fund s donations but will not be pre-approving each individual expense request. Public Comment: Maria Rivero, M.D., submitted the following written public comment: This policy is the result of a Gift Fund mismanagement scandal described in TV reports and newspapers. The plundering of the Gift Fund occurred because the Health Commission in denial. 1. Where were you when the Gift Fund Policy was changed in clear violation of the Administrative Code? 2. Where were you when $350,000 was plundered from the patients, for staff perks? 3. Where were you when LHH administration stopped giving Quarterly Reports of Gift Fund Expenditures? 4.Why didn t you order an audit when we first pointed out violations? 5. Why did you dismiss our concerns as a red herring until a State Citation and a public scandal compelled an audit? 6. Why are you allowing Mitchell Katz and the LHH administration to issue misleading public denials of wrongdoing? Problems will reoccur unless you are willing to listen to and protect whistleblowers who speak out about mismanagement. Derek Kerr, M.D. stated that the Gift Fund was not misused by the care-giving staff and suggested that better oversight of administrative spending was needed. He made the following suggestions: include the text of the Administrative Code in the policy, compare the current purpose of the policy with the historic purpose of previous policies, add a staff social worker to the Gift Fund Management Committee, and simplify the Gift Fund access for care teams. Page 6

7 Patrick Monette-Shaw stated that is has been a year since the whistleblower complaint regarding the LHH Gift Fund was filed. He stated that it was incumbent of the Health Commission to make sure the policy was corrected. He asked Commissioner Tierney to make sure the Gift Fund page is put back on the LHH web site. Action Taken: The Revised Gift Fund Policy was unanimously approved. 9) BUDGET HEARING Gregg Sass, Chief Financial Officer, gave the presentation of the draft DPH Base budget. Ms. Garcia stated that $16 million left over from unspent federal funds will be used to assist the DPH from proposing any cuts at this time. Ms. Garcia also stated that there are strict requirements that the DPH must adhere to prepare for health care reform and the result is a reduction in some service areas and an expansion in others. The Base budget contains a large amount of new DPH positions to assist in meeting the Health Care Reform requirements. She also reminded the Commission that UCSF is tied to the successful adherence of these requirements because of its role in providing medical care at SFGH. There is a request for an increase in UCSF MOU increase which is necessary for SFGH to maintain its current level of services. Ms. Garcia also stated that there may be a need to cut $32M in services in the Contingency Budget and that any such proposed cuts will be based on the DPH Mission and past directives from the Commission. She has communicated with the Mayor s Office that it would be preferable that addbacks be identified by the amount of funds instead of individual service items so that the DPH will have the ability to create the most effective budget. The following are highlights of the discussion of this item. Commissioner Tierney asked for a status update on the DPH s preparation to adhere to requirements for the 1115 Waiver and Health Care Reform requirements. Tangerine Brigham, Deputy Director, stated that the State timely access to care requirements are very rigid: primary care appointments must be offered within 10 business days of patient request; specialty care appointments offered in 15 business days; and mental health service appointments offered within 15 business days. In addition, the DPH must have a 24-hour nursing line to assist patients and reduce the flow into clinics and hospitals. To comply with these requirements, the DPH must expand its primary care, specialty care, and mental health services. Ms. Brigham stated that the penalty for not meeting these access requirements would be a 5% reduction in the SFGH safety net care pool reimbursement. In addition, Ms. Brigham also stated that the DPH must meet the quality of care measures within the DSRIP. Commissioner Chow asked for an estimate of the approximate number of patients in each tier created through the 1115 Waiver. Ms. Brigham stated that there are approximately 70-75,000 patients who are currently in the system for which DPH must meet the accessibility standards. Ms. Brigham stated that the DPH will strive to ensure that all Community Oriented Primary Care (COPC) clinics and the three SFGH primary care clinics utilize the nurse advice line services to help promote access to care and increase the number of appropriate appointments to primary and urgent care. Page 7

8 Commissioner Sako asked for additional information on the 1115 Waiver required health outcomes in future presentations. Ms. Brigham stated that CMS has not yet given specifics on the health outcome requirements related to population-focused improvement for DSRIP. Ms. Brigham stated that the previous waiver funding under the Health Care Coverage Initiative covered HCCI-eligible participants enrolled in Healthy San Francisco. This new waiver and the Low Income Health program are very different from the previous waiver. It requires DPH to establish a new program for LIHP that is separate and distinct given the range of services and administrative program requirements. Commissioner Illig suggested that since the DPH is requesting COLAs for UCSF that they also include COLAs for other non-profit organizations. Ms. Sass stated that the request to fund the UCSF COLAS is based on the fact that SFGH generates a substantial amount of revenue that impacts other DPH programs; as a major provider of medical care at SFGH, UCSF is integral to generating this revenue in addition to providing a high level of sophisticated care. Commissioner Illig strongly encouraged the DPH to reconsider the amount of DPH positions being proposed in this budget because of the high cost of fringe and retirement benefits. Public Comment: Debbi Lerman, SF Human Services Network Administrator, commended the DPH staff and Ms. Garcia for creating a Base Budget without service cuts. She encouraged the DPH to urge the Mayor to the stop the expected $30 million in contingency cuts. She hopes the add-fronts are implemented to prevent the usual stressful public comment process. She also stated that it has been devastating to non-profits not to have COLAs for multiple years. Jackie Jenks, Executive Director, and Jenny Wiley, Program Director, Hospitality House, stated that they appreciate the DPH for not proposing CBO cuts. They also stated that COLAs for non-profits are important to maintain long-term fiscal health. Commissioner Tierney requested that Ms. Currin give some context to the proposed COLA increases for UCSF employees. Ms. Currin stated that of the 2,000 UCSF employees at SFGH, about half are impacted by the proposed increased COLAs. The MOU for these employees is negotiated at the state level and not within UCSF. The DPH has repeatedly assessed that contracting with UCSF employees is more cost efficient than hiring DPH employees. This is due in part to the less expensive fringe benefits and COLAs. Ms. Currin stated that physicians at SFGH are paid approximately 25% lower than other public health physicians across the country. Commissioner Illig asked if it would be possible to contract SFGH medical services to another provider. Ms. Currin and Dr. Carlisle M.D., UCSF Associate Dean, stated that SFGH has attempted to contract out services (e.g. outpatient dialysis) but that it was not as cost effective and it was not possible to find community providers interested in bidding for the service because of the patient payer mix. Commissioner Sanchez stated that the patient population served by SFGH is the highest need and most complex. It is difficult to find providers who are willing to provide such high quality and intensity of services to these populations. Commissioner Sako suggested that Dr. Carlisle develop a standard information sheet that explains the cost-saving and other benefits of the UCSF/SFGH affiliation. Page 8

9 Dr. Carlisle stated that they are exploring various models to find one that will meet the requirements, insure high level quality of care and provide excellent training opportunities for the medical residents. 10) OTHER BUSINESS JOINT CONFERENCE COMMITTEE REPORTS Commissioner Tierney stated that the next SFGH JCC would be on March 8, 2011 at 3pm and the next LHH JCC will be on March 24 th at 4pm. COMMITTEE AGENDA SETTING There was no discussion of this issue. 11) CLOSED SESSION PUBLIC EMPLOYEE PERSONNEL ISSUES, DIRECTOR OF HEALTH, BARBARA A.GARCIA D) Reconvene in Open Session Action Taken: The Commission voted not to disclose the discussion of items from the closed session. 12) ADJOURNMENT The meeting was adjourned at 7:46pm. Page 9