James M. Illig President Edward A. Chow, M.D. Vice President Sonia E. Melara, MSW 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 Mark Morewitz, MSW Executive Secretary Steven Tierney, Ed.D. TEL (415) 554-2666 Commissioner FAX (415) 554-2665 Catherine M. Waters, R.N., Ph.D. Commissioner Web Site: http://www.sfdph.org MINUTES JOINT CONFERENCE COMMITTEE FOR SAN FRANCISCO GENERAL HOSPITAL Tuesday, 3:00 p.m. 1001 Potrero Avenue, Conference Room 2A6 San Francisco, CA 94110 Present: Staff: Commissioner Edward A. Chow, M.D., Chair Commissioner Catherine M. Waters, RN, Ph.D. Commissioner David J. Sanchez, Jr., Ph.D. Iman Nazeeri-Simmons, Troy Williams, Hal Yee M.D., Kathy Jung, Valerie Inouye, Sue Carlisle M.D., Roland Pickens, Todd May M.D., Marti Paschal, Dan Schwager, Tim Patriarca, Sue Schwartz, Sharon McCole Wicher, Kathy Murphy Mark Morewitz, The meeting was called to order at 3:04pm. 2) APPROVAL OF THE MINUTES OF THE OCTOBER 12, 2010 SAN FRANCISCO GENERAL HOSPITAL JOINT CONFERENCE COMMITTEE MEETING Action Taken: The Committee unanimously approved the minutes of the October 12, 2010 San Francisco General Hospital Joint Conference Committee. 3) HOSPITAL ADMINISTRATOR S REPORT Roland Pickens, Chief Operating Officer, gave the report. 101 Grove Street San Francisco, CA 94102-4505
Program Updates: 1. Walgreens Affiliation Changes On November 3, several changes regarding the Walgreens affiliation were implemented. The assigned Walgreens pharmacy for three of the CHN clinics (Castro Mission Health Center, Children s Health Center, and Adult Medicine Clinic) were changed, as well as the Walgreens pharmacy designated to fill emergency and urgent prescriptions after the SFGH, AG Pharmacy and other Walgreens pharmacies in the CHN network are closed. Leadership and staff of clinics affected by the change in affiliated Walgreens (including staff of SFGH specialty clinics, SF Clinic Consortium, SF Health Plan) were provided patient information flyers in English, Chinese and Spanish (attached). Pharmacy location assignments for all clinics other than those named remain the same. The affiliated pharmacy changes apply only to clinics affiliated with a Walgreens pharmacy. Clinics currently affiliated with AG Pharmacy will continue to be affiliated with AG Pharmacy. 2. San Francisco Health Plan Provider Recognition Award On October 21, Centering Pregnancy received a 2010 Provider Recognition Award in Community Service from the San Francisco Health Plan. In 1999, the nurse-midwifery service at SFGH and the SFGH Women s Clinic became the first California site for CenteringPregnancy, an empowerment model of group-based prenatal care. In Centering, women are taken out of the exam room and into group space for prenatal care, and over the course of pregnancy, participate in 10 sessions that integrate assessment, health education, and social support. These areas are addressed through a process that promotes each participant s sense of her authority in health care decision-making as well as in other aspects of her life. The SFGH program initially served recent immigrant Latinas, and in 2003 expanded to include a program for English-speaking adolescents and in 2007, English-speaking adults. Centering is now the opt-out model of care for nurse-midwifery clients and a limited offering for physician clients; roughly 250 women receive care in this model each year. All SFGH Centering is now conducted off-site at three different community-based organizations serving low-income families. In this collaborative model, groups are led by a team made up of a medical provider from SFGH, plus a health worker from the agency, which has led to improved access to support services for participating women and their families. 3. SFGH Foundation Hearts Grants Awards The San Francisco General Hospital Foundation hosted a staff appreciation reception on October 28 in the hospital cafeteria. During the reception, over $1.2 million in Hearts Grants were awarded to the following SFGH programs: Renal Center's Intradiayltic Exercise Program $2,958.00 Quality of Life Project $3,133.00 Sleep Study Program $3,200.00 Quality & Safe Care through Storytelling $3,472.95 Page 2
Peri-Op Services Improvements $4,000.00 Cultural Humility Task Force $4,300.00 The Wraparound Project Empowerment Center $4,490.00 Use of Distractions for ED Pediatric Patients $4,550.00 Patient Feedback/Education Kiosks in Acute Care Psychiatry $4,800.00 Preventing Teen Pregnancy by Improving Depo-Provera Use $4,800.00 Postpartum Teaching for the New Generation $4,810.00 MHRC Music Therapy Program $4,908.56 Chronic Pelvic Pain Educational Program $4,969.00 Work: Not To Be Taken for Granted $5,000.00 ACE Enhancement Project $5,000.00 Allergenic Mattress/Pillow Cover Reserve Supply $5,635.53 SF Community Fair Outreach $7,050.00 Health at Home $10,000.00 Expectant Parents & Healthy Newborn Activities $10,000.00 Dorothy Washington Scholarship Fund $10,500.00 Improvements for Peri-Op Waiting Room $11,500.00 Dialysis Patient Comfort Project $16,960.00 Traumatic Brain Injury Patient Education $21,241.00 ICU Family Room Upgrade $22,500.00 Thermal Speciment Label Printers for Patient/Staff Safety $25,000.00 Palliative Care Education $24,000.00 Healing Environment in Women's Health Center $32,500.00 Shared Governance Initiative $25,000.00 AdultRigid Contact Lens Program $25,000.00 Wellness Center Renovation Project $60,000.00 5C Team Building Training $20,500.00 Neonatal Simulation Equipment Program $42,017.11 Telepathology System $45,045.00 Culture of Excellence $44,971.00 Interpreter Services $50,000.00 Launch of Spiritual Care & CPE Program $50,000.00 ED Patient Flow Improvement $50,000.00 Videostroboscopy Unit for 4M Clinic $57,731.20 Community Primary Care Spirometry Program $61,205.00 Patient Simulator for Clinical Education $92,500.00 Expanding Cardiac Cath Lab Capacity $77,700.00 GeneXpert for Infection Diagnosis $121,033.00 CVP Capital Renovation Project $25,000.00 Next Steps in Diabetes Care at SFGH: Getting the Word Out $9,950.00 Cancer, Awareness, Resources and Education Program $5,000.00 Cancer, Awareness, Resources and Education Program $20,000.00 Perry Outreach Program $50,000.00 Center for Vulnerable Populations $50,000.00 HIV/AIDS Respite Housing Program $25,000.00 Vocational Rehabilitation Services $5,000.00 Page 3
4. Passage of Health Care Reform: Strategies for Inclusiveness On October 26, CEO Sue Currin participated in Passage of Health Care Reform: Strategies for Inclusiveness, a program sponsored by the Northern California Grantmakers, the Council on Foundations, and the California Wellness Foundation. The objectives of the program were to: 1) examine the implications of the passage of health care reform on strategic and inclusive grantmaking; 2) learn the lessons health care providers have experienced at the community level; and 3) identify what foundations can do to help health care providers prepare for an increasingly diverse population. 5. Patient Flow Reports for October 2010 A series of charts depicting changes in the average daily census was attached to the original minutes. Medical/Surgical Average Daily Census was 218.5, which is 3% above the number of budgeted beds and 89% of physical capacity of the hospital. 11% of the Medical/Surgical days were lower level of care and 6% were decertified/non-reimbursed days. Acute Psychiatry ADC for Psychiatry beds, excluding 7L, was 57.9, which is 92% of budget and 90% of physical capacity (7A, 7B, 7C). ADC for 7L was 6.1 which is 88% of budget (n=7) and 51% of physical capacity (n=12). Latest Utilization Review data from the Mental Health billing system, month of June 2010, shows 70% non-acute days (24% lower level of care and 46% non-reimbursed). This data is based on discharges, and do not include our 7L Forensic patients or days where the patients have not been discharged. 4A Skilled Nursing Unit ADC for our skilled nursing unit was 29.6, which is 6% over our budgeted beds and 98.6% of physical capacity. San Francisco Behavior Health Center ADC for the San Francisco Behavior Health Center was 102.9, which is 3% below both our budgeted beds and our physical capacity. Including bed holds, these units are operating at 98.9% of budgeted beds and physical capacity. Commissioner Comments/Follow-Up Commissioner Chow asked for an update as progress is made with working with Walgreen s to expand the number of pharmacies associated with the DPH affiliation. Commissioner Sanchez commented that there was discussion about the SFGH Foundation and the flow of its funds at the last full Health Commission meeting. He stated that it is helpful to see the specifics of how the money is distributed within the SFGH departments and programs. 4) PATIENT CARE SERVICES REPORT Sharon McCole Wicher, Chief Nursing Officer gave the report. Page 4
1. October 2010 2320 RN VACANCY RATE: The Overall 2320 RN vacancy rate is 2.4%. 2. SFGH Ratio Staffing Data: By Number of Shifts 10/01/10-10/31/10 Ms. McCole Wicher stated that SFGH was able to cover all shifts except two in med-surgery and eight in psychiatry; most of the shift coverage issues related to staff sickness. 3. Professional Nursing Practice- October 2010 Recruitment: provided in the vacancy report. Retention/Professional Development: Two faculty members from the SFSU School of Nursing visited SFGH and met with 38 staff RNs who are interested in continuing their academic education. These RNs possess an Associate degree in nursing, and hope to enter the Advanced Placement Option program at SFSU to earn a BSN. SFSU and SFGH will work together to create a cohort for fall 2011 with classes on-site at SFGH. An academic counselor from City College of San Francisco met with SFGH MEAs, CNAs and LVNs to review pre-requisites and strategies for entering the RN program at CCSF. The two hour session which included a review of participants academic transcripts was attended by approximately 20 staff. Nursing Excellence: Positive Conversations classes have continued in October and November. The Shared Governance Design Team begins the house-wide roll-out of the Nursing Shared Governance model and processes on November 2 to the Nursing Executive meeting. During the first three weeks of November the Design Team will make presentations in every clinical nursing area across the campus. Staff RNs are invited to apply for membership on the four councils. Each council consists of a minimum of 50% direct care RNs. Members will be selected by the Design team in December with council meetings beginning in January 2011. To facilitate communication and support all nursing staff in this new model of professional practice, a website has been created: http://sites.google.com/site/sfghnsgsharedgov/ National Database of National Quality Indicators (NDNQI) From October 4 through October 24, SFGH Department of Nursing participated in a second RN satisfaction survey through NDNQI. Participation in this survey, by eligible clinical RN s, was 83% compared with 72% participation in 2009. SFGH exceeded the national participation response by 10%. Unit based RN champions were the driving force in the success of staff participation. The results and benchmarking data will be available at the beginning of 2011. Eligible RNs are full or part-time, regardless of job title, who spend at least 50% of their time in direct patient care, and have been employed a minimum of 3 months on the unit. Unit-based PRN or per-diem RNs employed by the hospital are eligible, agency or contract RNs are not eligible. (NDNQI, 2010) Specific survey used- Practice Environment Scale. The NDNQI RN Survey with Practice Environment Scale contains the Practice Environment Scale of the Nursing Work Index (PES-NWI) (Lake, 2002), in addition to Job Enjoyment (adapted Page 5
from Brayfield and Rothe, 1951; Taunton et al., 2004), work context items, and nurse characteristic items. (NDNQI, 2010) 4. ED Diversion Report-October 2010 The Emergency Department had a Diversion rate total of 23% (168 hours) for the month of October 2010. The ED used 1.12% hours of Trauma Override during EMSA Diversion suspension. The ED encounters for the month of October totaled 4651 patients which was an increase from the 4607 in September. Hospital admission totaled 860 which was an increase from the 843 admitted in September. Commissioner Comments/Follow-Up Commissioner Waters stated that she was excited about Shared Governance process. Commissioner Sanchez suggested that SFGH explore developing a resource center to show different career pathways for military veterans returning to the local workforce. Ms. McCole Wicher stated that this an area that can be explored further. 5) MEDICAL STAFF REPORT Todd May, M.D., Chief of Staff gave the report. PATIENT CARE Update on Behavioral Health/Primary Care Integration Project Ms. Barbara Garcia, DPH Deputy Director, and Dr. Irene Sung, CMO for Community Programs, presented an update to MEC about recent efforts undertaken by DPH to integrate community programs and primary care. Over many years, Ms. Garcia has led a variety of efforts to improve access to the full complement of health services provided by DPH to better respond to the needs of the community. In the last five years, DPH has integrated the Mental Health and Substance Abuse programs into a new entity called Community Behavioral Health Service (CBHS). As DPH continues to expand Healthy San Francisco and prepares for future changes under health care reform, the Department continues system integration between Community Primary Care (CPC) and Community Behavioral Health Services. Ms. Garcia discussed current and forthcoming staffing changes in the clinics to support the integration. She highlighted that this move is necessary to strengthen the Department s ability to respond to the changing health care environment and to ensure culturally competent and integrated services for future generations in SF. The new organizational structure of Community Programs was presented and discussed. Dr. Sung added that the integrated primary care and behavioral health services in the clinics will enable early identification and initiation of treatment of behavioral issues, especially for children. Ms. Garcia expressed her eagerness to work closely with the SFGH MEC in her forthcoming role as DPH Director. Positive Health Program Universal Antiretroviral Therapy Initiation MEC was informed by the Pharmacy and Therapeutics Committee that the Positive Health Program has developed guidelines recommending evaluation of all HIV-positive patients for initiation of treatment with antiretroviral therapy, regardless of CD4 count. These guidelines will be posted on the CHN intranet site. Page 6
LEADERSHIP Elena Fuentes-Afflick, MD, Chief, Pediatrics Dr. Fuentes was among 65 new members elected to The Institute of Medicine (IOM) at its 40 th annual meeting on October 11, 2010. Election to the IOM is considered one of the highest honors in the fields of health and medicine, and recognizes individuals who have demonstrated outstanding professional achievement and commitment to service. Shannon Thyne, MD, Pediatrics Dr. Thyne received the IZ Champion Award from the San Francisco Immunization Coalition for her work to immunize family contacts of newborns. Pertussis (whooping cough) is an epidemic in California and Dr. Thyne s effort with SFGH colleagues is an important intervention to reduce the risk of death for this vulnerable population. The model developed by Dr. Thyne has been adopted at UCSF Medical Center. Disaster Medicine Research Symposium for Physicians This symposium on December 15, 2010 is sponsored by the San Francisco Medical Society, UCSF EMS/Disaster Group, and SF EMS Agency. Featured speakers include SFGH faculty members John Brown MD and Chris Stewart MD. ADMINISTRATION/REGULATORY/COMPLIANCE OB-GYN Privileges List Revisions MEC approved minor revisions to the OB/GYN Privilege List. Changes involve language clarifications about proctoring criteria for UCSFtrained attendings. Psychiatry Privilege List Revisions MEC approved minor revisions to the Psychiatry Privilege List. Changes reflect more explicit definition of ages for children, adolescents and adults. OPPE OPPE forms for January-June 2010 have been sent to Service Chiefs for completion. Members were reminded that OPPE will be a focus of the forthcoming Joint Commission consultative survey, scheduled for December 13-17, 2010. OR Committee s Rolling Time Out Form The OR Committee has finalized the Rolling Time Out Form, part of a strategy to prevent wrong site surgery. Various drafts of the form have been in use in the OR over the last year and the final version will be presented for approval at this month s OR Committee. ANNUAL SERVICE REPORTS/CLINICAL SERVICE RULES AND REGULATIONS Community and Primary Care Annual Report: Dr. Drennan highlighted CPC s central role in the SFDPH mission. The report outlined the following: Scope of Services The clinics serve 43,000 patients including 28,000 HSF or SFHP members with 120,000 medical visits and 205,000 total visits (including dental, podiatry, social work, etc.). Performance Improvement Efficiency/productivity reports for PCPs, capacity targets set based on active panel per clinical FTE, quality reports for PCPs including chronic disease management and preventive care metrics, and innovations in primary care delivery and chronic disease management. The QI metrics form the basis for a new outpatient-oriented OPPE program. Research Partnerships include public health research projects, SFGH/UCSF research projects, service grants with research components, health center-based research projects (e.g., colorectal cancer screening), evaluation of the HSF program (impact on access, utilization, quality indicators), and practice management. Change initiatives Improving access, behavioral health/primary care integration, EMR implementation, and quality initiatives. Page 7
Challenges Leadership (clinical redesign requires increased leadership efforts; expanded roles for medical directors limits their time; aging leadership), reliance on general fund, accommodating increasing access to primary care for HSF and other populations, maintaining/enhancing quality of care, and creating standards for Special Population Clinics (panel size, etc). CPC Service Clinical Rules and Regulations MEC approved the updated 2010 CPC Rules and Regulations presented by Dr. Drennan for annual review and approval. The only substantive changes include the following: Reorganization of the CPC Section into Community Health Care Section (Behavioral Health and CPC integration) and the delineation of the complementary roles of Chief of CPC Service and CPC Medical Director roles. Appendix A Clinical Privilege form now delineates expanded privilege list Inclusion of OPPE process in provider reviews Dermatology Service Annual Report Dr. Toby Maurer highlighted the following: Volume increase The Service anticipates a 50% increase in outpatient visits this year compared to last year (12,000 to 18,000), primarily due to the increase in HSF enrollments. The wait time for new appointments has increased from 4 to 12 weeks Faculty and Staff Dr. Maurer noted that the service only has 1.75 FTE attending staff, but is supported by a number of volunteer physicians from the community and by some UCSF Dermatologists New this year Added new medical and dermatologic surgery volunteers and a volunteer NP; acquired a donated laser for outpatient procedures; expanded Dermatology residency Telemedicine To handle increasing volume, the service plans to pilot a teledermatology triaging program within the CHN, starting with the Ocean Park Health Center. The Service is working with primary care clinicians to (1) provide initial management advice and (2) expedite scheduling of patients who must be seen in Dermatology Clinic. Quality Improvement Implementing new ideas for informing patients of their biopsy results, tracking skin cancer patients in an effort to reduce those lost to follow up, creating a skin cancer registry New Directions Augment attending and resident staffing, expand multi-disciplinary clinics, and further develop International/Tropical Dermatology programs established with Kenya, Uganda, and India. Dermatology Rules and Regulations MEC approved the updated 2010 Dermatology Clinical Service Rules and Regulations presented by Dr. Toby Maurer for annual review and approval. Minor changes include minimal language revisions, expanded discussion of critical alerts, and the updated privilege list. OB-GYN Rules and Regulations MEC approved the updated 2010 OB-GYN Rules and Regulations presented by Dr. Rebecca Jackson for annual review and approval. Dr. Jackson and colleagues reviewed and updated the entire document, resulting in major revisions throughout. Most revisions reflect updates to current practice and procedures. New sections include housestaff training and supervision, clinical service consultation criteria, and the OPPE program. There is substantial expansion and updating of the PIPS program and updating of proctoring and monitoring procedures. Page 8
Commissioner Comments/ Follow-Up Commissioner Chow asked for clarification on the difference in the role of CMO and Clinical Service Chief. Dr. May stated that the CMO focuses on quality and service access issues; the Service Chief focuses primarily on credentialing and other administrative issues. Ms. Murphy stated that staff within Community Programs are now credentialed through SFGH. These staff providing outpatient services have a different, less complex, credentialing process. Commissioner Chow asked Mr. Morewitz to check with Bob Cabaj, M.D., Medical Director of CBHS, to get clarification about the process by which CBHS providers credentials are reviewed. Commissioner Chow asked how COPC quality data is reviewed at the SFGH JCC. Ms. Neezi- Simmons stated that the data is discussed at the PIPS Committee and then the PIPS Committee minutes are reviewed and discussed at the SFGH JCC meeting. Commissioner Chow asked the SFGH quality assurance staff to work closely with the COPC staff on COPC quality outcomes. The following items were reviewed, discussed and approved: OB-GYN Privileges List Revisions Psychiatry Privilege List Revisions Community and Primary Care Annual Report CPC Service Clinical Rules and Regulations CPC Service Clinical Rules and Regulations Dermatology Service Annual Report Dermatology Rules and Regulations OB-GYN Rules and Regulation 6) QUALITY COUNCIL OCTOBER 2010 REPORT Iman Nazeeri-Simmons, Chief Quality Officer reviewed the Quality Council Report and Sue Schwartz, Performance Improvement Manager, reviewed the SFGH 2010 Publicly Reported Quality Care Data Annual Report Dr. May highlighted the high rate of breast-feeding compared to state levels. Dr. Carlisle asked if the patient survey is a standard instrument. Ms. Schwartz stated that it is a standard federal survey. Ms. Nazeeri-Simmons stated that SFGH is working to improve measures in which they have control because in the next few years reimbursement will be tied to quality measures. Comments/ Follow-Up Commissioner Chow asked if SFGH rehabilitation patients can go to the new Laguna Honda Hospital for their outpatient rehab care. Ms. Inouye stated that prior to the opening of the new building, Laguna Honda Hospital did not execute contracts with insurers. Commissioner Chow directed Mr. Morewitz to bring this issue to the next Laguna Honda Hospital JCC meeting as a recommendation so that Laguna Honda Hospital can increase its potential revenue. Commissioner Waters asked the total number of respondents for the patient survey. Ms. Schwartz stated that there are about 400 respondents a year which is approximately a 26% respond rate. Action Taken: The Committee approved the 2010 Publicly Reported Quality Care Data Annual Report. Page 9
Action Taken: The Committee approved the Quality Council October 2010 Report. 7) APPROVAL OF THE SFGH GOVERNING BODY BYLAWS Kathy Murphy, Deputy City Attorney presented the Governing Body Bylaws. Action Taken: The Committee approved the Governing Body Bylaws and recommended them for the full Health Commission to approve. 8) APPROVAL OF THE SFGH ENVIRONMENT OF CARE ANNUAL REPORT Roland Pickens, Chief Operating Officer, presented the report. Action Taken: The Committee approved the report and recommended it for the full Health Commission to approve. 9) APPROVAL OF SFGH CONTRACTS Iman Nazeeri-Simmons, Chief Quality Officer presented the list of contracts. Action Taken: The Committee approved the list of contracts. 10) APPROVAL OF THE HOSPITAL PLAN FOR PROVISION OF PATIENT CARE (SFGH ADMIN. POLICY 8.09) Iman Nazeeri-Simmons, Chief Quality Officer presented the Plan. Commissioner Chow stated that the organization chart in the Plan is not the most current version. Ms. Nazeeri-Simmons stated that the chart will be updated. Action Taken: The Committee approved the plan and recommended it for the full Health Commission to approve. 11) APPROVAL OF THE SFGH PERFORMANCE IMPROVEMENT AND PATIENT SAFETY PROGRAM (SFGH ADMIN. POLICY 17.1) Iman Nazeeri-Simmons, Chief Quality Officer presented the SFGH Performance Improvement and Patient Safety Program (SFGH Administrative Policy 17.1). Action Taken: The Committee approved the policy and recommended it for the full Health Commission to approve. 12) PUBLIC COMMENT 13) CLOSED SESSION: A) Public comments on all matters pertaining to the closed session 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. Page 10
The Committee went into closed session at 4:34 p.m. Present in the closed session were Commissioner Chow, Commissioner Waters, Commissioner Sanchez, Iman Nazeeri-Simmons, Troy Williams, Hal Yee M.D., Roland Pickens, Sue Carlisle M.D., Todd May M.D., Marti Paschal, Dan Schwager, Kathy Murphy Mark Morewitz, C) Closed session pursuant to Evidence Code Sections 1157(a) and (b); 1157.7; Health and Safety Code Section 1461; and California Constitution, Article I, Section 1 APPROVAL OF CLOSED SESSION MINUTES OF OCTOBER 12, 2010 Action Taken: The Committee approved the October 12, 2010 closed session minutes without changes. CONSIDERATION OF CREDENTIALING MATTERS Action Taken: The Committee approved the Credentials Report. CONSIDERATION OF PEER REVIEW, QUALITY OF CARE, PERFORMANCE IMPROVEMENT Action Taken: The Committee approved the PIPS minutes. D) Reconvene in Open Session 1. 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).) 2. Vote to elect whether to disclose any or all discussions held in closed session (San Francisco Administrative Code Section 67.12(a).) (Action item) Action Taken: The Committee voted not to disclose discussions held in closed session. Commissioner Sanchez stated that the funeral service for Dr. Rapaport was wonderful. He also stated that Dr. Rapaport was a honorable man and a skilled physician and administrator. Commissioner Chow thanked everyone for a wonderful and productive year and stated that SFGH is the best public hospital in the nation. 14) The meeting was adjourned at 5:04pm. Page 11