HEALTH COMMISSION CITY AND COUNTY OF SAN FRANCISCO

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1 Sonia E. Melara, M.S.W. President Edward A. Chow, M.D. Vice President Cecilia Chung Judith Karshmer, Ph.D., PMHCNS-BC David J. Sanchez, Jr., Ph.D. David B. Singer Belle Taylor-McGhee HEALTH COMMISSION CITY AND COUNTY OF SAN FRANCISCO Edwin M. Lee, Mayor Department of Public Health Barbara A. Garcia, M.P.A. Director of Health Mark Morewitz, M.S.W. Executive Secretary TEL (415) FAX (415) Web Site: MINUTES JOINT CONFERENCE COMMITTEE MEETING FOR LAGUNA HONDA HOSPITAL AND REHABILITATION CENTER, 1:00 p.m. John T. Kanaley Community Center 375 Laguna Honda Boulevard San Francisco, CA ) CALL TO ORDER Present: David J. Sanchez, Jr., Ph.D., Chair Judith Karshmer, Ph.D., PMHCNS-BC, Member Excused: Staff: Cecilia Chung, Member Mivic Hirose, Barbara Garcia, Maggie Rykowski, Jennifer Carton-Wade, Regina Gomez, Adrianne Tong, Chia Yu Ma, Michael Llewelyn, Colleen Riley, MD, Christine Hanson, Marcellina Ogbu, Judith Klain, Loretta Cecconi, Madonna Valencia, Roland Pickens, Mark Morewitz The meeting was called to order at 1:02pm. 2) APPROVAL OF MINUTES FOR MEETING OF NOVEMBER 21, 2013 Patrick Monette Shaw requested that item 4 of the minutes be amended to state that his belief is that the presence of the Sheriff s Department at the meeting was a direct result of his telling Ms. Hirose that she was not qualified to be Chief Executive Administrator when he saw her at City Hall. He also stated that having the Sheriff at the JCC meeting leaves LHH security short staffed. Action Taken: The minutes of the LHH JCC meeting of November 21, 2013 were unanimously approved.

2 3) HOSPITAL REPORT Mivic Hirose, Executive Administrator, gave the report. Patrick Monette-Shaw requested that all the Health s speak into the microphone. He stated that he did not see LHH discharge data for those patients transferred out of San Francisco County, in the Hospital Report; he requested this information as a verbal public information request. He added that it is a waste of City resources to have a member of the Sheriff s Department at the LHH JCC meetings. He also stated that it is fiscally irresponsible. Comments/Follow-Up: Sanchez thanked Ms. Hirose for the report and congratulated LHH staff for providing continued high quality care almost three years since its move to the new building. 4) FY nd QUARTER GIFT FUND BALANCE REPORT ChiaYu Ma, Deputy Finance Officer, gave the report and presented a funding request to purchase a wheelchair for a LHH patient; LHH applied to MediCal but was turned down for funding for this item. The following written comment was submitted by Derek Kerr, MD: A document titled "Gift Fund Expenditure Budget" was posted on the Health Commission website - but was not made available at any LHH-JCC meeting. It shows that since , funding for Art with Elders dropped by 22%, while expenses for Bus Trips fell by 19%. Now, 6 months into , expenditures for these two activities have fallen even further. Patrick Monette-Shaw made a public information request for the revised Gift Fund budget mentioned by Dr. Kerr, in the previous public comment. He also stated that when he was secretary for Rehabilitation Services, he used to assist with writing successful requests to MediCal for items such as the wheelchairs. He encouraged LHH to invest in a skilled secretary for LHH Rehabilitation Services. Comments/Follow-Up: Sanchez requested that the JCC receive all information posted on the SFDPH website. He also stated that the wheelchair is an important piece of equipment for the LHH resident. Karshmer also stated that the wheelchair is important for the LHH resident and added that at this juncture, the LHH JCC should act in the patient s immediate best interest. Action Taken: The LHH JCC approved the request to use the LHH Gift Fund to purchase a wheelchair for a LHH resident. Page 2

3 5) HEALTH AT HOME ANNUAL REPORT Maggie Rykowski, Administrator for Health At Home (HAH) and Rehabilitation Services, gave the report. Comments/Follow-Up: Karshmer asked for clarification on whether Health at Home compares its cost-ofdoing-business to other similar agencies. Ms. Rykowski stated that she can bring this data back to the LHH JCC at a later time. Karshmer encouraged Health at Home to attempt to collect anecdotal data for those patients that did not return patient satisfaction surveys. Ms. Rykowski stated that one reason for a low return of surveys may be that the survey may be written at a reading level too high for some patients; she added that Health At Home is unable to revise the survey due to regulations. However, HAH is exploring ways to increase the response rate. Sanchez congratulated Ms. Rykowski and the Health At Home staff for their impactful work. He recommended that the presentation be given to the full Health Commission. 6) REHABILITATION SERVICES UPDATE REPORT Jennifer Carton-Wade, Interim Director Rehabilitation Services, gave the presentation. Comments/Follow-Up: Karshmer asked for clarification on how the Health At Home and LHH Rehabilitation Services therapists work together. Ms. Carton-Wade stated that attempts are being made to enable the therapists from both SFDPH units to have access to each other s patient notes to assist in continuity of care. Director Garcia stated that integration efforts have also been initiated between LHH and SFGH rehabilitation services. Sanchez thanked Ms. Carton-Wade for her work and congratulated the SFDPH for its efforts to integrate services. Patrick Monette Shaw stated that he was secretary of the LHH Rehabilitation Services unit when the previous SFDPH director, Dr. Mitch Katz, requested a new community integration initiative for LHH patients which shortened stays for some patients. He added that the new initiative focused on discharging patients who LHH could claim little/no revenue for 60 days. Regarding the out-of-county LHH discharges, he questioned the quality of care these patients receive. He also stated that to increase Rehabilitations staff in an attempt to raise revenue may be a mistake due to the competition of other professional rehabilitation services in San Francisco. 7) CONSIDERATION OF HOSPITAL-WIDE POLICIES & PROCEDURES Regina Gomez, Director of Quality Management, was present to answer any questions from the Committee members. Action Taken: The LHH JCC unanimously approved the hospital-wide policies and procedures. Page 3

4 8) CONSIDERATION OF MEDICAL STAFF PRIVILEGES FORM REVISION Colleen Riley, MD, LHH Medical Director stated that upon further review, LHH determined that the proposed revision to medical staff privileges does not meet requirements of Title 22. Therefore, the item was not discussed. The following written comment was submitted by Derek Kerr, MD: You're told by Dr. McShane and Ms. Hirose that; "In 2010, Laguna Honda's census decreased from 1024 to 780 patients". Therefore, an August 2009 policy needs revision. According to JCC minutes, the last time the census hit 1024 was in It's been 850 since July 2008, and reached 792 in March well before this policy was written. Even so, why would a 24% census drop require a 100% time extension; from 2 years to 4 years, to perform 2 medical procedures? Has each doctor's patient load been halved? Are there fewer medical patients who need medical procedures? Was the original policy more stringent than the community standard? Please ask for a more plausible explanation, and whether competence is retained after a possible 4-year hiatus between procedures. 9) GENERAL PUBLIC COMMENT Patrick Monette Shaw stated that this meeting is another example of how the SFDPH is wasting financial resources by having a Sheriff s Deputy present at the meeting. 10) 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) C) Closed Session Pursuant to Evidence Code Sections 1156, , 1157, and : Health and Safety Code Section 1461; and California Constitution, Article I, Section 1. D) Reconvene in Open Session REVIEW OF MINUTES OF THE CLOSED SESSION MEETING OF NOVEMBER 21, 2013 CONSIDERATION OF STAFF CREDENTIALING 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 of All Discussions Held in Closed Session. (San Francisco Administrative Code Section 67.12(a).) Page 4

5 Action Taken: The Committee voted to disclose that it approved the Staff Credentialing Report and the November 21, 2013 closed session minutes. 13) ADJOURNMENT The meeting was adjourned at 2:21pm. Page 5