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 Michele M. Seaton 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 1) CALL TO ORDER MINUTES JOINT CONFERENCE COMMITTEE FOR LAGUNA HONDA HOSPITAL MEETING Wednesday, September 17, 2008 3:00 p.m. Conference Room A300 375 Laguna Honda Boulevard San Francisco, CA 94116-1411 Commissioner Sako called the meeting to order at 3:00 p.m. Present: Absent: Staff: Commissioner Margine Sako Commissioner David Sanchez (excused) Luis Calderon, Gayling Gee, Regina Gomez, Mivic Hirose, John Kanaley, Timothy Skorvinski, M.D., Marc Slavin, Hosea Thomas, M.D., Adrianne Tong, Rowena Tran, Aleeta Van Runkle and David Woods, Pharm. D. The Committee immediately went into closed session. 2) CLOSED SESSION A) Public Comments on All Matters Pertaining to the Closed Session Patrick Monette-Shaw litigation is not ongoing and attorney/client privilege is no longer in order. These meetings should be open to the public. The committee should release the results of the closed door session. 101 Grove Street San Francisco, CA 94102-4505
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 3:05 p.m. Present in closed session were Commissioner Sako, Luis Calderon, TCM Director, John Kanaley, Executive Administrator, Regina Gomez, Director of Quality Management, Mivic Hirose, RN MS, Chief Nursing Officer, Gayling Gee, R.N., Associate Administrator, Clinical Support Services, Timothy Skorvinski, M.D., Assistant Medical Director, Marc Slavin, Director, Government and Community Relations, Hosea Thomas, M.D., Chief of Medical Staff, Adrianne Tong, Deputy City Attorney, Rowena Tran, Operations Manager, Aleeta Van Runkle, Deputy City Attorney and David Woods, Pharmacy Director. C) Closed session pursuant to Government Code Section 54956.9 and San Francisco Administrative Code Section 67.10(d) FOR DISCUSSION: DEPARTMENT OF JUSTICE SETTLEMENT AGREEMENT D) Reconvene in Open Session The Committee reconvened in open session at 3:30 p.m. 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 Taken: The Committee voted not to disclose any discussions held in closed session. 3) APPROVAL OF MINUTES OF THE MEETING OF AUGUST 20, 2008 Action Taken: The Committee approved the minutes of the August 20, 2008 Joint Conference Committee meeting. 4) EXECUTIVE ADMINISTRATOR S REPORT John Kanaley, LHH Executive Administrator, presented his Administrator s report. EMPLOYEES OF THE MONTH September 2008 Alice Wong, Adult Day Health Center Assistant Director. ANNOUNCEMENTS/INFORMATION Laguna Honda Welcomes 700 Goats The goats will return to Laguna Honda Hospital this Sunday to begin grazing on the steep hillsides adjacent to the hospital. This is the fourth year that Page 2
the goats will graze across 22 acres of brush and vines, providing an ecologically sustainable service to clear out heavy undergrowth and to help reduce the fire risk that comes with drier weather. The goats will be here for the remainder of the month. The company responsible for the goats is GOATS R US. BUDGET REPORT - FY 08-09 Salary Monitoring YTD shows a negative variance of $669,000 with a year end projection to be over by $4 million. We have been short staffed in the Finance Department and have not been able to get the full picture of this projection. Hopefully with the unit closures pending, we will be able to improve on the negative variance. FY 09-10 Budget The budget process for LHH this year will be different than any other year we have completed our budget. For the first time, we will be establishing a baseline budget based on the new building operational plans. We are starting from scratch, and are developing staffing plans for the new building based on a new delivery plan of care. These staffing plans will be built based on developing process flows, time and motion studies, and comparative benchmark data. We appreciate the Support of the Commissioners during this process. CENSUS REPORT STAFFING REPORT Nursing Unit Census Daily Average for July 2008 SNF Census Beds Occupied: 864.45 Beds Held: 4.77 Admits: 0.84 TOTAL SNF Census: 870.06 Acute Census: capacity (16) M7 Acute Census: 1.77 L4 Acute Census: 1.81 TOTAL PAID BEDS: 873.64 The hospital staff vacancy rate reported as of September 2008 is less than 2.5%. There is a discrepancy between the HR vacancy report and the Annual Salary Ordinance. This difference is as much as 65 FTE s. A re-evaluation of our vacancy reporting is underway. REGULATORY UPDATE This section is being moved into Closed Session. Page 3
PATIENT FLOW Waiting List As of January, 2008, when we began to no longer accept SNF patients, we have not been maintaining a waiting list. We are still admitting to our Hospice, Rehab and Positive Care units as beds on those units become available. TARGETED CASE MANAGEMENT The TCM report for August 2008 was attached to Mr. Kanaley s Report. Each month, LHH presents the overall number of discharges. The following are for July 2008: CATEGORIES NUMBERS Rehabilitation 8 Respite 0 TCM 3 LHH 4 AMA AWOL 0 5 Positive Care 4 TOTAL 24 TRANSITION STEERING COMMITTEE Mr. Kanaley presented the progress report for September. Additionally, the planned unit closures are tentatively scheduled for the year. The 5 units to be closed are E-3 (which is already closed) E- 4, F-5, O-7, and K-7. Public Comment Patrick Monette Shaw suggested that the Commission adopt an attendance policy for JCC attendance. Also, staff cannot electioneer on city property. He is concerned about the level of TCM discharges and TCM caseloads. Medi-Cal cuts will eventually be restored and this money needs to be earmarked for LHH. 5) LAGUNA HONDA HOSPITAL REPLACEMENT PROJECT UPDATE John Kanaley, LHH Executive Administrator, presented the Replacement Project update. South, East and Link Residence Buildings The new hospital is approximately 70% complete. Installation of the interior wall framing and installation of drywall continues in the Link and South Residence Buildings. Mechanical, Electrical and Plumbing installation is underway in all three buildings. Stucco at the Link Building is underway and is scheduled to be complete within two months and the scaffolding will be removed by mid-november. Stucco is currently being applied to the East Residence Building and will be completed by the first of next year. Resident mock-rooms in the South Residence Building is under construction and is projected to be complete by the end of the year. The Knuckle Building Interior wall framing has been completed. Rough-in of the mechanical electrical and plumbing is nearly completed. Drywall will be installed in October. The permanent loading dock and bulk oxygen storage is under construction. Page 4
Furniture, Fixtures & Equipment consultants continue to work with hospital staff and the Replacement Team to prepare to purchase new furniture and medical equipment for the new building. Clarendon Hall The Contractor has completed the West and South Wing interior abatements last month. The North Wing interior abatement is currently underway. The exterior abatement of the West Wing will be complete by the end of October. Most of the utilities have already been disconnected throughout the building and the remaining utility, electricity, should be disconnected in October. Interior demolition of the West Wing will began in early September with exterior demolition to begin at the end of the month. At which point, the West Wing will be cut from the rest of the building, and demolished. The remainder of the demolition will proceed in this fashion, and the building is to be demolished in pieces. Hospital Remodel This fall seismic upgrade construction will begin on the 3 rd floor. Elevators 1 & 2 will be permanently out of service. A wall will be built at the eastside of the 3 rd floor hallway and in the cafeteria. Moran Hall will serve as the interim cafeteria dinning room until the cafeteria is open in the new building. Actual construction dates will be announced later. Tree Allee Modifications Final work at the Tree Allee has started and is scheduled to be completed by the end of this year. The work will include: repaving the ADA ramp, installing a handrail, and modifying the stairs with additional steps. Public Comment Patrick Monette Shaw is shocked at the amount of transition budget going to marketing. He recommended that Volunteers Inc. or the LHH Foundation fund the grand opening celebration. 6) OPERATIONS REPORT Gayling Gee R.N., Associate Administrator of Clinical and Support Services presented the Operations Report. DEPARTMENT OF EDUCATION & TRAINING Organizational Development: Effective Transitioning DET has successfully worked with the Adult Day Health Center to help facilitate an effective transition from the basement of Clarendon Hall to the new building. The process was undertaken in collaboration with our Stanford Geriatric Education Center partners, who provided geriatrician consultation and a post-move evaluation tool along with HRSA funds to reimburse LHH for DET time devoted to this important project. The transition process has been enthusiastically supported by the ADHC staff and the success has been validated by the post-transition evaluation: 87.6% of interdisciplinary staff members who completed the evaluation (n=15) found the process very helpful or extremely helpful (4 or 5 on a Likert scale). 85.7% of interdisciplinary staff members who completed the evaluation believed adverse physical or mental issues that could be attributed to the move were of little or some extent. Psychosocial support for clients and families continues and a Transition Curriculum has been developed and approved by LHH administration. The process has since been written up by Jill LeCount, Director of Education and Training (lead facilitator, project lead) and Charles Rivera, ADHC Program Director for consideration by the California Hospital Association as a Best Practice. Page 5
The Transition Curriculum is currently being used to guide the Health Information Services (HIS) transition from a centralized to a decentralized model, wherein analysts will be assigned to each neighborhood in the new building. The curriculum will also be used for units moving to the new building and is currently being adapted for use on the 4 units scheduled for closure. Although the unit closure transitions are a much greater challenge, Employee Assistance Program and Human Resource support has been enlisted and lessons learned from other moves are invaluable to inform continuous process improvement. A key feature of each kick-off meeting is brainstorming to identify concerns and vision for best case scenario outcomes which develops into the teams critical tasks, timeline, and outcomes. ADHC GYM DEDICATION On Wednesday, September 3, 2008 the Adult Day Health Center dedicated their newly renovated relocated rehabilitation gym to the memory of David Yeung. David Yeung was a dedicated Certified Nursing Assistant who devoted over 24 years of direct service to the clients of the Adult Day Health Center. Mr. Yeung un-expectantly passed away this past March. After 25 years, the Adult Day Health Center was re-located from Clarendon Hall to the renovated Unit E-3. Staff, caregivers, LHH Administration, and Mr. Yeung s widow attended the festive but restrained event. The purpose of the event was to commemorate the ADHC s successful re-opening as well as recognize the years of caring and compassionate care which David had provided for our many clients. 7) CLINICAL CARE REPORT Timothy Skorvinski, M.D., Assistant Medical Director, and Mivic Hirose, RN MS, Chief Nursing Officer, presented the Clinical Care Report. Fiestas Patrias, Independence Day in Central America In the month of September Central America, Mexico and Chile, celebrate their independence from Spain with Fiestas Patrias. The interdisciplinary team of the Spanish Focus Community, Unit E5, with the support oflaguna Honda Hospital Administration will celebrate this important event with the residents, families, friends, volunteers and employees. We will have music, decorations, residents will enjoy delicious traditional food and drinks such as tamales, pupusas, rice, beans, tortilla chips, salsa (pico de gallo), guacamole, fresh fruit, Mexican refreshments, horchata, tres leches cake and other refreshments. The Spanish Focus Community residents are from Guatemala, El Salvador, Nicaragua, Mexico, Chile, Cuba, and Puerto Rico, along with 3 residents born in the USA who together will join in and celebrate this important event. Outstanding Research in Wound Care Award On September 19th, Amy Narciso, RN, MSN, CNS, WCC will be presented the Outstanding Research in Wound Care Award by the National Alliance of Wound Care. As Laguna Honda s Clinical Nurse Specialist and Wound Care Certified (WCC) practitioner, Amy plays a critical role in direct care, education and resource management for improving resident outcomes. Amy s leadership has resulted in improvement in pressure ulcer prevention, assessment, treatment, and overall reduction of facility acquired pressure ulcers. Accompanying Amy to Orlando, Florida where the award will be presented at a national conference sponsored by the Wound Care Education Institute will be Nursing Director Bronwyn Gundogdu. Please join us in congratulating Amy. Page 6
Fond Farewell and Many Thanks to Betty Hebert, CNA On September 24th, the Nursing Department will say a very special goodbye to our longest serving employee, Betty Hebert, CNA. Betty first started working as a Certified Nursing Assistant at LHH in 1968. After an initial orientation for 2 months on Unit O6, Betty worked on unit E5 for 12 years and O5 for 3 years before her permanent stint in Clarendon Hall where she worked for 26 years. On the closure of Clarendon Hall this year, Betty relocated back to the main building, first working in the Asian Focus Unit C4 until her final reassignment back into Unit O6, where she started 40 years ago. Please join us in wishing Betty the very best. More Kudos for Anne Hughes, LHH Advanced Practice Nurse Dr. Anne Hughes, RN, PhD, FAAN, Advanced Practice Nurse in Palliative Care at LHH has recently been selected by the Hospice and Palliative Care Nursing Association to receive the New Investigator Award based on her dissertation research and its contribution to hospice and palliative nursing knowledge. Anne has just published another data-based article. This recent paper is published in the September/October issue of the Journal of the Association of Nurses in AIDS Care, based on her research and is entitled, "Can you give me respect? Experiences of the Urban Poor on a dedicated AIDS nursing home unit." Anne will join other DPH members, Norma Del Rio, MSW at Health at Home, and September Williams, MD at LHH, at St Luke's Hospital's Palliative Care Conference on September 17th, "From Cure to Quality of Life: The Shifting Nature of Hope at the End of Life." Anne and Norma Del Rio will also be participating in a Palliative Care Workshop for DAAS social worker and case workers on September 26th. Mid-Autumn (Moon) Festival The Mid-Autumn Festival, also known as the Moon Festival or Lantern Festival, is a popular Asian celebration of abundance and togetherness, dating back over 3,000 years to China's Zhou Dynasty. The Mid-Autumn Festival falls on the 15th day of the 8th lunar month of the Chinese calendar. Today, on Sept 17th, LHH will host its annual "Moon Festival luncheon. Chinese residents throughout LHH will have the opportunity to enjoy an authentic Chinese Luncheon and listen to traditional Chinese music. Residents will also experience the traditional Mid-Autumn Festival dessert called Mooncakes. For over 30 years, this culturallyrich luncheon has been sponsored by "The Chinatown Opti-Mrs Club of San Francisco", a North Beach Chinatown based social group dedicated to enhance the Chinese social experience for the Chinese residents of San Francisco. 8) PUBLIC COMMENT None. 9) CLOSED SESSION A) Public Comments on All Matters Pertaining to the Closed Session None. B) Vote on Whether to Hold a Closed Session (San Francisco Administrative Code Section 67.11) Action Taken: The Committee voted to hold a closed session. Page 7
The Committee went into closed session at 4:07 p.m. Present in closed session were Commissioner Sako, Luis Calderon, TCM Director, John Kanaley, Executive Administrator, Gayling Gee, R.N., Associate Administrator, Clinical Support Services, Regina Gomez, Director of Quality Management, Mivic Hirose, RN MS, Chief Nursing Officer, Timothy Skorvinski, M.D., Assistant Medical Director, Marc Slavin, Director, Government and Community Relations,, Hosea Thomas, Chief of Medical Staff, Adrianne Tong, Deputy City Attorney, Rowena Tran, Operations Manager and David Woods, Pharmacy Director. C) Closed Session Pursuant to Evidence Code Sections 1156, 1156.1, 1157, 1157.5 and 1157.6; Health and Safety Code Section 1461; and California Constitution, Article I, Section 1 FOR DISCUSSION: CONSIDERATION OF QUALITY IMPROVEMENT REPORT D) Reconvene in Open Session The Committee reconvened in open session at 4:32 p.m. 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).) 3. 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 any discussions held in closed session. 10) ADJOURNMENT The meeting was adjourned at 4:32 p.m. Michele M. Seaton Health Commission Executive Secretary Page 8