comparemela.com

By saying aye. Thank you, commissioners. There is no Public Comment request for that item. And if anyone does have Public Comment request, i am the person to see. Hand me the forms. Item 3 is the directors report. Good afternoon, commissioners. Grant colfax, director of health. You have your directors report in front of you. I wanted to highlight a few issue, and i think the major issue that i wanted to highlight today was, as you know, we have had major patient care incidents at laguna honda hospital, and june 18 i was joined by my yor breed and the president of the board of supervisors yee to report directly to the public and to the community about patient abuses about patient abuse issues involving 23 laguna honda residents. This misconduct does not represent who we are as the Health Department and as the San Francisco Health Network, and it will not be tolerated. Laguna honda has had a positive effect on the live of generation of san franciscans and continues to be a good place for our residents. D. P. H. Leadership has taken immediate steps to correct problems including notification of all patients and family and caregivers, wellness checks for all laguna honda residents, all staff training on preventing and reporting patient abuse, and improvements in drug dispensing and monitoring policies, separation of six Staff Members involved and changes in hospital leadership. The c. E. O. Of the hospital, the prior c. E. O. Of the hospital has resigned. We immediately notified the California Department of Public Health and San Francisco police department, and each agency is investigating. Acting c. E. O. Maggie rakowsky is in place to lead the way forward, and they present a turn around plan to the commission, mayor, and the board of supervisors by september 1. And president loyce, i know you wanted to add to the comments, so i will defer to you. We are deeply saddened by what has occurred and this misconddo not represent who we are as a health care system. We contact all the appropriate places as soon as we learned what happened. D. P. H. Leadership has taken immediate steps to correct the problem, and i am confident that with the terrible circumstance comes the opportunity to make meaningful changes and will ensure the safety of patients at laguna honda hospital and the provision of quality care going forward. There are many wonderful staff and workers at laguna honda. It is an invaluable institution that has had positive effect on the lives of generation of san franciscans. Laguna honda continues to be a good place for our residents, and we are taking steps to ensure that and then build upon its strong foundation. Thank you. I also wanted to highlight some other departmental wide issues. One is announcing our new chief Information Officer eric raffin. I think hes here. Eric joined the Health Department on july 8, and he comes from d. P. H. Most recently from San Mateo Health where he was c. I. O. As six years. Eric has many accomplishments including creating a Health Information Technology Governance program, establishing a program in project Management Office and implementing a Health Information exchange. So he is the right person at the right place at the right time for the Health Department. Prior to working in local government, eric spent nearly 17 years with the department of Veterans Affairs and several executive leadership roles including overseeing major transformations in health care and Health Care Technology for a broad and vast v. A. System. So were really excited to have eric on board. I think you will see during his tenure, his vision moving forward. We are just thrilled to have him. Please welcome eric. Welcome. U i am also really pleased to announce that the San Francisco Health Network has signed the first commercial contract, and this is with canopy health. The contract was sign july 1 and will allow ucf to access Obstetrics Services at Family Health center at San Francisco General Hospital t only 24 7 Midwife Program in San Francisco. And starting july 15, ucf canopy patients receiving care at Mount Zion Mission bay and interested in the midwife assisted delivery will be given the option to select this as their birthing hospital and place to receive outpatient obstetric care related to the delivery. This was a lot of work on behalf of the contracts and hospital team, i want to acknowledge that work and greg wagner and his team in particular in terms of putting forward this first commercial contract. So very exciting three years in the making. In terms of epic, we are only a few short weeks away from what will be one of the most pivotal moments in the history of the Health Department, the implementation of the Epic Electronic Health record, and we will see how it goes on august 3. I will say the team is working very hard. All hands on deck in terms of being ready at all levels. And we are confident i am confident that we are as prepared as we possibly can be to make august 3 launches a success and then also to emphasize to the commission and to the rest of the department, this is not just a one day, everything turns on and then were done. This is a major cultural work flow change and Information Exchange going forward. So the team and the culture of the department is ready for that. I rook forward on how that is going the next time we meet. I have some exciting news with regard to surpassing our true north goal for hypertension equity for black, africanamerican patients. Equity continuing to be a major goal of the department, youll recall, and we did exceed our True North Equity goal for the 20182019 fiscal year in the metric focussing on percentage of black africanamerican patients with hypertension whose last Blood Pressure was controlled in the past year. So from january of 2015 to june 2019, hypertension and Blood Pressure control for black africanamerican patients has improved from 53 to 67 and the disparity gap between theover all population to black africanamerican the disparity gap between the overall population compares to blackafricanamerican population is decreased from 3 to 8 . This is a significant step in reducing Health Disparities in our city, and again, proof of concept that it can be done, although we have still quite a ways to go. And finally, i just want to acknowledge the Health Department marching during sf pride. We had quite a contingent joined by the president of the Health Commission. Commissioner loyce, thank you. We marched together at the sf pride parade and had one of the largest contingents ever with almost 150 people in our group. Patients from positive health care from positive Health Program also participated in the parade as they do each year. And obviously we never miss an opportunity to educate the public on Public Health, and we passed out condoms and materials supporting access to preexposure prophalaxys to prevent h. I. V. Infection and lots of different people including the Health Department and the Public Health foundation. Within the departments, the Public Health foundation, bridge h. I. V. , and community equity, and promotion and laguna honda hospital, and vsfg. And a really exciting time that i was really pleased to see the publics reaction to the Health Department and the value they have for the department that was an inspiring event. It shows we remain deeply committed in the values of San Francisco and in the work that we do. So very exciting afternoon for marching and promoting Health Equity in San Francisco. Thank you, commissioners. Thank you, dr. Colfax. We will go to Public Comment and come back to answer other questions. We have dr. Derrick carr. Good afternoon, commissioners and director colfax. Im dr. Derrick kerr. There are several intriguing features about the recent removal of laguna hondas c. E. O. And quality director. The 23 patients reportedly abused at laguna honda were under the direct care of nurses, yet the chief nursing officer was not held accountable. Instead, the quality director, a person who does not govern clinical practice and to whom nurses do not report, was removed. What was the rationale . Now, Troy Williams t quality director for San Francisco General Hospital, is taking over laguna hondas quality management, yet on his watch, General Hospital has been cited by state inspectors for its impermissible policy on reporting patient abuse. In fact, General Hospital was threatened with a fine and the loss of payments in part for this policy that allowed underreporting of patient abuses since 2016. Lastly, the d. P. H. Compliance officer was appointed acting c. E. O. Of laguna honda. If she maintains this dual role as the compliance overseer and laguna honda c. E. O. , it could create a conflict of interest. Suppose somebody reports a violation involving laguna honda. Would ms. Rakowsky be defending against it as well as as the laguna honda c. E. O. . In short, the Compliance Office should be independent from Hospital Administration. Thank you. Thank you, dr. Kerr. Next speaker. Colon gomez. Good afternoon, commissioners. Speak into the microphone please. Good afternoon, commissioners and dr. Colfax. I am also referring to the events at laguna honda hospital that was reported to the press on june 28. I will say my concerns in brief. 23 residents were subjected to privacy violations over a period of three years, and yet today the director of privacy is in charge of laguna honda . And there is no mention that the privacy at laguna honda and direct subordinate of this director is being held accountable for the privacy violations. Secondly a quick check with state shows at least 27 reports were made by the Quality Department for alleged abuses over a period of two years. 15 of which amounted to deficiencies. Such reporting was the responsibility of the quality director and i was never concerned that there was a wall of silence here. However, this quality director has been removed and replaced by the quality director of zuckerberg. Another quick check with the head shows that zuckerberg has one deficiency in the same category as laguna honda. That deficiency is for failure to report allegations of abuse. This is the same quality director that had two negligent deaths in two consecutive months while in charge. They have a 30bed nursing skilled care facility that did not pass the annual recertification survey not once but twice. This director is now in charge of laguna honda with 769 beds. On june 28, dr. Colfax stated that the misconduct of six employees happened in just two neighborhoods at laguna honda. Such misconduct is not effort throughout the facility, yet there is no mention or everyday that any of the supervisors, manager, or the Department Head of these two neighborhoods were held accountable for the six employees and their actions. And yet the c. E. O. And quality director have been removed. If the removal of the c. E. O. And quality director Consolidation Services and i am concerned with the choices being made. And i wonder what may have breed so profoundly hurtful, offensive, and heart breaking will be equally as concerning for the decisions being made. In closing, i would like to submit to the commissioners cop piste of the notice of the two negligences and the notify of diefficiencies for failing to report abuse and the deficiencies at both properties and a brief summary of my statement. Thank you very much. Thank you, mr. Gomez. Is there further Public Comment . Hearing none, the directors report is now with the commission for comments or questions. Dr. Chow . I want to go back to the first item of the report that you actually did not verbalize, and this is in regards to the governors budget. How does the governors budget affect our budget at this point . So thank you, dr. Chow. So at this point we have not been in detailed discussions with the state given this change in terms of the budget. But were having ongoing conversations and this is basically just recently passed so how it gets implemented will be a little bit unclear to us. But i think particularly around the medical expansion that we would anticipate just as we saw with implementation of the broader a. C. A. That coverage for people who currently are either without coverage or in healthy San Francisco would transfer over to this Coverage Program in particular. And we are working on the details and conversation with the state about that. I understand since its a recent passage, and it would seem to me it would be appropriate to have that reported to the finance Committee Just to bring us up to date. We can certainly do that. Yes, absolutely. Thank you very much. Commissioners . And i guess one other comment. And i thank president loyce for the comments made on laguna honda. I do think as a member of the commission that i fully support the actions on the part of the leadership, the president , and the director himself for our actions as we must make the corrective actions needed. And im hoping that the public will be tolerant of some time in order for us to be able to make these changes. President thank you, commissioner chow. No further comments or questions from the commission, next item please. Item four is general Public Comment. I have not received any requests for this item. Just double checking. Okay. So we can move on to i a tem five, which is report back from todays community and Public Health committee meeting. Yes. Thank you. Community and Public Health meeting that met immediately before this meeting today. During the meeting we had two presentations. The first from jen from the Environmental Health branch regarding the tobacco and Smoking Program including a Retail Tobacco rules and regulations. The rules that govern the tobacco permitting process here in San Francisco and also presentation about the density of tobacco permits broken down by supervisory district and the tools that are available to retailer who is either hold or are seeking permits. We also learned about the flavored tobacco ban roll out in some of the success that the department has had in both education and outreach compliance and inspections and enforcement. And in that roll out. And seems to have been very successful and then a brief update on the ecigarette ban. We also received an update from dr. Jonathan fukes from the center for learning and innovation about developing our people locally and nationally. The focus of the presentation was on internal Workforce Development where our priority training areas are including racial humility issues, project management, and Sexual Orientation and gender identity guidelines. In addition, we had a presentation about some of the external Capacity Building assistance being offer bid the department through a grant from the c. D. C. And some of the success that has come about from their consulting, for example, in florida with very high increases in the uptake of prep, in the time that the department had been consulting with Florida Department of Public Health through the c. D. C. Grant. We also had a presentation about the summer h. I. V. Aids Research Program in which the department provides mentorship opportunities for undergraduates students in h. I. V. Aids research. And there is a great class in place right now and i believe there were 90 applications for six slots that were available. And we will be having their final presentations on, i believe, august 9. And we will have some of the commissioners participating then. Thank you, commissioner. Commissioners, questions, comments . Shall we move on . All right. I will note there is no Public Comment requests for that item. Item six is a discussion item, prop q hearing for the closure of st. Marys cardiovascular program, and i will note that item 7 is another prop q hearing for the closure of st. Marys spine center. The two will be presented separately, but they are related. And i will note to the public that this item will be voted on at the august 6 meeting, not today. And i would add to that that the commission will not be making any responses to Public Comment today. Just a reminder to the commission that i have conflicts on both of these, so i will excuse myself and dr. Baba will sit in as acting director. All right. Hello and good afternoon. Im claire lindsey, a Senior Health planner in the office of policy and planning with the Health Department. I am here for the first of two proposition q hearings on two closures at st. Marys Medical Center. On april 29, 2019, st. Marys notified the Health Department of the two closures. The first being the closure of the Cardiovascular Surgery program. And the second being the closure of the spine center which is a licensed hospital Outpatient Clinic. So you all received a memo with more detailed information on the closures and today i am just going to be providing a brief summary of the information that was given to me by st. Marys. I will begin with an overview of proposition q and the first agenda item is the closure of the cardiovascular program. I want to note that dr. David cline, president of st. Marys Medical Center and Saint Francis Memorial Hospital is here along with the Vice President of philanthropy and external relations and a former Health Commission member. They are both here to speak on behalf of st. Marys if you have any questions. So in november of 1988, the city of San Francisco passed proposition q which requires private hospitals in San Francisco to provide Public Notice to the Health Commission prior to closing a hospital inpatient or outpatient facility, eliminating or reducing any level of services provided, or prior to the leasing, selling, or transfer of management. So the proposition q hearings allow the Health Commission to make a determination about whether any of the reported changes will or will not have a detrimental impact on the community of San Francisco. In recent years the Health Commission has reviewed five proposition q closures. So st. Marys notified the Health Commission on april 29 of these two anticipated changes that are going to be taking place by july 31. And first, st. Marys will be closing the Cardiovascular Surgery program and second closing the spine center which, like i said s a licensed hospital Outpatient Clinic that is cooperated by the sf spine group which is a single physician group. Today is the first proposition q hearing on these closures and the second one is scheduled for august 6. Today i will begin with the closure of the Cardiovascular Surgery program. St. Marys Medical Center currently offers a full Service Cardiac care at the campus and that includes a fully digital card Catheterization Lab and a designated steme center which designates a hospital specially equipped to treat significant heart attacks caused by a major coronary artery blockage. With the closure, Cardiovascular Surgery is the only aspect of cardiac care that will no longer be offered. The other services listed on the side, they will continue to be provided. So the chart to the right of the slide shows the annual Cardiovascular Surgery volume by San Francisco hospitals from 20142017. As you can see, st. Marys has over time had the lowest surgical volume compared to other area hospitals with an average case of cardiovascular surgeries of about 30 to 35 cardiovascular surgeries. Then the other San Francisco area hospitals that offer this type of surgery range between 200 and 600 surgeries annually. So of the cases seen at st. Marys Medical Center, about 69 are xeshl commercially insured. 29 have medicare and only 2 or medical patients. 85 of the Cardiovascular Surgery patients are over the age of 60, and then 47 are asian, which is proportionally much higher than the asian population for the city of San Francisco, which is 35. 9 . Then final note, i just want to say that 81 of Cardiovascular Surgery patients seen at st. Marys are San Francisco residents. To provide a proper assessment of the impact that this closure will have, i want to provide the background in context. This is one form of treatment used for cardiovascular disease and most specifically Heart Failure and coronary heart disease. Cardiovascular disease is largely preventible, yet it is still the leading cause of death for men and women in the United States and more locally, four out of the top 20 leading causes of deaths in San Francisco are also cardiovascular diseases, and they account for about 25 of all San Francisco resident death. Cardiovascular disease in pedestrian also disproportionately impacts vulnerable populations. For example, hospitalizations and emergency room visits for cardiovascular diseases in San Francisco are highest among residents in the southeast half of the city, and among those who live in households earning less than 30 o of the federal poverty level. The neighborhoods with the highest hospitalizations and emergency room visit rates for hypertension and chronic Heart Failure are in the tenderloin, the south of market, bayviewhunters point, and Treasure Island neighborhoods. There is a few other important considerations in assessing the impact of this closure. One of them is the relationship between surgery volume and patient outcomes. So reporting on cardiovascular operative volume indicate that low volume can impact the proficiency of the Surgical Team as it reduces the number of hours that are spent refining and maintaining surgical skill with the team. Studies have shown that high volume cardiovascular hospitals have low arer mortality rates and lower incidents of complications compared to lower volume hospitals like st. Marys. But that being said, after a cursory review of outcome metrics for cardiovascular surgeries in San Francisco area hospitals, so things like mortality and 30day readmission, st. Marys outcomes are the same as other San Francisco hospitals, in that they are average. Secondly, because of significant technological improvements, minimally Invasive Surgery procedures have become more common, and more efficient without risking the safety of patients, even the most vulnerable, but despite this trend, most hospitals in San Francisco that offer Cardiovascular Surgery have shown to have steady surgical volume. So these surgical invasive surgical procedures are still very much needed in San Francisco. Then another trend that impacts Cardiovascular Surgery volume is there is an anticipated shortage of cardiothoracic surgeons due to a declining enrollment in cardiovascular specialties by medical t students. With the decrease in the number of providers and number of locations for receiving Cardiovascular Surgery, this may impact the ability of individuals to receive the needed Surgical Services in a timely manner. Finally as i previously noted when looking at st. Marys demographic information, Cardiovascular Surgery is a procedure that most often effects individuals over the age of 60. And as San Francisco anticipates the greatest population growth to be within the older adult age group, there may be an increase in the present of cardiovascular surgeries and the number of cardiovascular procedures that are required of the population. St. Marys reported multiple efforts to try and bolster the Cardiovascular Surgery volume by working with other hospitals that offer Cardiovascular Surgery. But due to the failed attempts to increase the surgical volume, st. Marys does not expect the surgical volume to increase to a degree that would make a difference in their ability to operate from both a financial and clinical safety perspective. So this slide currently shows the remaining Cardiovascular Surgery programs in both San Francisco and in the greater bay area. So briefly mentioned, st. Marys will continue to provide cardiac care at the campus. However, there will be an average of at least 30 Cardiovascular Surgery patients annually who will be impacted by the closing of the Cardiovascular Surgery program. The the closure could have residual impacts on other patients with heart conditions who currently see cardiologists at st. Marys in the event they need a surgical procedure. The closure may limit the ability of current cardiologists to treat complex patients when surge vi no longer an option at the hospital. Once the closure of the Surgery Program is complete, cardiologists will be referring patients to facilities listed on the prior slide because all of them are within 50 miles of st. Marys hospital. Then st. Marys has also adopted a safe protocol and go to ecsf as other closer hospitals. In terms of the staff impact, they do not anticipate labor force changes. The nurse wills continue to be employed by the hospital if they are general surgery trained. The current surgeon wills continue to practice at other area hospitals. The an thesology Group Service wills continue to be provided for other surgical procedures st. Marys. And golden gate profusion wont be providing the services at st. Marys anymore, but they have contracts with other area hospitals as well. So in conclusion, despite st. Marys low surgical volume and a general trend in having min cally invasive technology, San Francisco has a growing older Adult Population and Cardiovascular Services will be increasingly more important. And, accumulation with the residual impacts like i said before of the closure and that the complexity of patients able to be seen by the remaining cardiologists at st. Marys may be impacted. And then finally, there will be an average of, as we said, at least 35 Cardiovascular Surgery patients annually who will no longer be able to choose st. Marys as a location of the complete cardiac care. So the closure of st. Marys Cardiovascular Surgery program is a reduction in services in San Francisco and for the aforementioned reasons, it will have a detrimental impact on the community. The memo that you ul a received included draft resolutions for the closure, but that concludes my comments on the issue. I will take any questions at this time. I did not receive any Public Comment requests for this item. Could we have st. Marys representatives speak to this issue . Thank you very much. And thanks to the commission. Really appreciate it, dr. Colfax and dr. Baba and appreciate secretary and claire lindsays assistance for a great presentation. We appreciate the confidence that enough st. Marys and Saint Francis. I am dr. David klein, the president of both. Saint francis for three years and st. Marys for three weeks, so im fairly new to the role at st. Marys, but i have been in touch with the plans for the closure through my leadership role in dignity health. I think that was a very nice outline of the pertinent fact, and i dont want to be repetitive, but i think a couple of points are worth repeating. Its been a tail of i a trigs at st. Marys. Of attrition at st. Marys. 12 years ago they were doing 1200 cases and was the leader in the market. And now we are down to this year looks like we will close the year with 15 heart surgeries. There is a number of reasons for it. One of them, of course, all the programs are seeing diminishments in the number of heart surgeries due to the new technology. Moving to a minimally invasive world, which is, in fact, better for patients in a lot of cases and the number of open procedures is decreasing. We currently only have three physicians that are practicing and doing open heart surgery at st. Marys. There has been a number of attempts to recruit more doctors in that role, and just not available as was pointed out. The number of cardiovascular surgeons are diminishing in the country as that surgery gives way to the minimally invasive techniques that are out there. And as a former surgeon, it is for such complicated surgery that required an integrated team with a lot of experience working together, the low volume as was mentioned does not support high quality. Even though the quality results have stood up with the test of time, as we see diminishment in the number of case, it is hard to maintain staff proficiency. This is a very well oiled machine and if they do one or two a nt mo, you can imagine it is hard for it to always come out the way we would like it to, so the optimal skills of our very experienced team is being challenged as our volumes drop. We plan to continue to be in the cardiac business and a robust cath lab and hybrid suite and those procedures can be done for the most part and proven nationally that you can go those procedures without an open heart program. We have arranged for an emergency transport to a number of institutions pointed out on the map including parnassis which is a few minutes down the road in the event that we need to have an emergency transferred. As was also mentioned, we anticipate no reduction in the f. T. E. S. All the employees that were working on the cardiac surgery because we had such low volume have other skills and other duties and have all been and will be reassigned to other areas in the hospital, so we see no reduction plan. And i think lastly and importantly, just the fact that we are asking for closure at this point doesnt preclude us in the feature if things change in the nature of the business changes where it makes sense, we can always adapt the technology and resume surgery in the future, but for right now we believe its in the best interest of the community and facility to terminate those procedures. Happy to answer any questions. Thank you. It is now in the hands of commissioners. Commissioners, questions . There was no Public Comment . There was no Public Comment on this item. Commissioner green. Yes. I do have a few questions. Thank you for your information. Have you seen an increase in the number of with the number of case that was dropped . What is your standoff doing to increase the uptake of the noninvasive. I cant speak to st. Marys directly as to whether they have seen a volume increase and i can speak nationally the number of minimally invasive procedures have increased. I think that probably realistically we will see a slight decrease in the Cath Lab Procedures because there are some physicians who feel they may need an open heart team to pack them up and we are anticipating some decrease in the complicated Cath Lab Procedures as we close the program. That is a great question. If i am understanding this correctly t cardiac surgeons have prifr ledges in other hospitals. They do. And is there a plan to enable the cardiologists to do the same . In other words, to be able to have the continuity of a team even in different hospital sites and there seems to be enough room to absorb the patient volume that you would have to transfer. Is that true . Also a great question. I think in the cardiac surgeon, they have privileges elsewhere and wouldnt be able to with the amount of business they do at st. Marys. I think many of the cardiologists do follow patients and have privileges, but i think there might be some gaps, and we certainly would have those discussions as to if they would like to follow the patients and need to have privileges, particularly at the centers we will be transferring patients to. I think that is important. One other question. When i was looking at the data, the last time they did the complication rates and the publication was 2016 and you have had a halving of the number of cases since 2016. Do you have any updated data . Is a surgeon knowing about volume and with the complications and with the minimal volume. I can. I will have to come back on august 6 with the actual data from st. Marys. I am not aware of a big shift of quality concerns. I think we have a good team, but i think as we persist with lower and lower volumes, i think that is a real question. I will try to get you the exact numbers when we come back. Thank you, commissioner. And first one follow up on the cardiologists. And you say the cardiologists use your hospital and use the cardiac lab and anticipate the immediate for cardiac surgery sometimes and really do have privileges at the other hospitals . We certainly can. As you look at what is left in San Francisco, there is actually only one other private hospital, and i assume that staff who made this really meant pernassis or only mission bay that is doing card i cant go surgery. It is both. Its both. They do open heart surgery. Its both. Lets clarify that in the document because otherwise it sounds like there is even less. Kazer is not available to the kaiser is open to commercial cases. Are you aware of this . I think in emergency situation, obviously if a patient is having an acute m. I. Or a heart attack, they can go to kaiser and from a transfer standpoint, that is not the case because they tend to be restricted to their patients in their but we are not at all sure and it might be an emergency and then they would need to actually be either out of network because the nonkaiser patient would be out of network. That is exactly right. Any emergency, every hospital, every General Hospital, has to care for a patient in an emergency whether they are in network or out of network. Yes, i understand. An i think in the situation of st. Marys we are closest to the ucsf pernassis campus. An i think we should in terms of information and the severity of this change actually have that from our staff and in terms of what actually happens in this case. Very similar to other cases in which we have talked about out of Network Hospitals because now were limited to only, you know, facilities that certain commercial programs may not, in fact, be in network. And can we then assure that these people are not hurt . If they are, then this could be added information concerning adversity of closing the unit. I am very saddened that going from 1200 because i was part of watching and being part of participating and having our patients from our different my own affiliated plans really use st. Marys. And before you got there, i am sure you knew that a world Status Program was created, which also included actually assisting the city of shanghai in part of its cardiac work. And to watch this program then as you say decline so, it used to be the top and i am glad you brought that out. I think we should note that. That st. Marys had a premier program and that this closure is really tragic if it is going to be occurring because for whatever reason, we have lost that opportunity. I am also troubled by one of our physicians who have written in public testimony to us concerning and that goes with this cardiology problem, but he also brings up an important issue. Dr. Chan who then submitted to us a letter indicating that his letters from china town have been triaged to st. Marys because people find him as the cardiologist that they can approach and trust within their ethnicity and language capacity. And he and i certainly know that his colleagues. They have used st. Marys and at this point you see about 47 of the asians. I am concerned how the asian population will then receive that same treatment. Can our staff find out cpmc or kaiser is going to accept them . Or anyway, i think thats another negative. Sadly, for whatever reason, st. Marys has been unable to grow the volume to where its needed. I dont question your ability or i mean your data, of course, and in terms of higher volume creating Better Outcomes and is commendable that has not occurred at st. Marys, or that, in fact, you have been able to achieve the continuation of a superb program. That makes it even more difficult to say that you are closing. Yes, sir. Commissioner i think most of these are questions for staff to try to clarify. I think you would probably also and the increase of noninvasive, because even pcca is invasive, but certainly, a decrease of the use of cardiac surgely andpy pass in terms of the well, for cardiac disease that while that has occurred and may be increasing, it really according to the data has not been a decrease of morbidity but increase in quality of life that has actually brought that. That is correct. And when, in fact, we were looking or need to look at the question of quality, of trying to look at improvement in mortality, cardiac surgery is still a problem. And we point out very well we will have a shortage of cardiac surgery science and then cardiac surgeons and which may be one of the reasons that you are having problems and i think we need to note not that the newer techniques as replacing this and we have to put that balance back in in our document. Great. Director, does that make any sense . The emphasis i am trying to lay here, and i understand the Business Case that you are offering. It is very sad to hear that. But i think then this also calls for us to be much more vigilant about this problem. Lastly, i thought it would be important to quantify what the remaining facility do have with Services Available and the capacity to accept even 30 patients more per year. And we have heard about the o. B. Problems already throughout the city. And i think it would be good to have documentation for that because as we go into the future, this would be helpful in understanding and another one of the needs of the city. And the procedures and acute versus planned. With the presence in San Francisco, it is possible that some of the cases are going to another center of excellence in the region. And so i would be curious and as we look at how much capacity we need in San Francisco proper and i think we need to focus on those who might need the surgery acutely because that feeds into the transports to other hospitals and the whole cascade of changing teams and availability of the actual procedures. The other question i had is, have you analyzed at all its more than just the operating room and is also the Supportive Care after surgery and the postop care. You are really talking about much larger team of individuals to have positive outcomes. Have you thought about that. Ok. The second hearing today is about the closure of the spine center so, i do want to say that before i begin to note that, due to the recent alignment between the health and Catholic Health initiatives the California Attorney general is required to review and approve the closure of the spine center and so when saint marys submits the letter requesting the attorney general review, the attorney general will have 90 days to review and decide whether or not they approve of the closure. So, because of the attorney general timeline, the spine center will likely be closing after july 31st. Saint marys will keep staff and the commission abreast of any updates to that timeline about the closure. So, the spine center, like i said earlier, is a licensed clinical Outpatient Clinic and it function as a joint operation between dignity, saint marys Medical Center and the San Francisco spine Surgeons Group and ill probably refer to them as the group as we go on. So the group is a single physician practice that is made up of four Healthcare Providers and they specialize in the treatment of spine disorders and orthopedic surgery. The spine center is located at saint marys Medical Center in suite 450. The spine center averages 1800 individual patients a year and their Services Include less invasive treatments like exercise, manual manipulation, nutritional counseling to minutially treatments and spine surgery. So here is some information on patient demographics of the spine center. The majority of patients have commercial insurance followed by medicare. Medical is less than 1 of the Patient Population thats seen at the spine center. 43 of the spine Center Patients are between 41 and 65 and 38 are age 65 and above. So in late 2018, saint marys organized discussions with the San Francisco spine Surgeons Group to adjust the current staffing so that the spine center itself operated like a traditional hospital out patient clinic and prior to this, these conversations, the s. F. Spine group provided all of the Physician Services and then half of all non Physician Services so that left saint maries to utilize Hospital Administration for the other half of the clinic. And they node fight they would open a clinic. The location has moved, its a private clinic its moved from suite 450 to suite 600 at 1 shader street. Both saint maries and the San Francisco spine group dont anticipate any interruption or change in Heath Care Services provided to current or featured patients of the spine center. Specifically the group has confirmed that theyre going to be carrying over the same insurance contracts and they will continue to accept patients from their current payer mix which includes medical. They will maintain Emergency Department call coverage and the group will also provide outpatient Spine Services to their existing patients and maintain the same volume seen at the spine center. As i just mentioned, its not anticipated that this closure will have an impact on patients and there will not be an interruption in services nor the type or amount of services that are provided. The labor impact is not known yet. The spine center has not shared whether or not theyre going to be retaining all of the saint marys employees as administrative staff in the new clinic office. So, st. Johns marys said theyy mitigate and layoff. So in conclusion, should the sf spine group maintain the level of care provided through the spine center currently at their new clinic and should saint marys reassign any impacted employees in mitigate any layoffs then this closure should not have a detrimental impact on the community of San Francisco. That concludes my comments on that. Any comments . I think that was nicely summarized. This is different than the cardiac Surgery Program if that services arent going to change. Were sitting from a hospital operated to a private group. We did attempt to recruit some neuro surgeons from ucsf but as we look at it it makes sense to just leave it in the hands of the surgeons that have been carrying for these patients for years. As also, the closure date as isa little bit fussy, its a 90day process. Were finding in other hospitals it could take up to six months so it will take a while. Regardless of how they determine i meant the intent to the prop q hearings and well keep the commission informed of any changes or updates to the closure as they occur. Glad to answer any questions. Any Public Comment . No Public Comment for this item. Its in the hands of the commission. Dr. Green. The spine center has a stellar reputation and for giving multi disciplinary care for people with back pain. We have the issue with pain and pan management from everything i know theyve done an excellent job dealing with the Opioid Crisis issues and helping people deal with back issues in non medicine case. Theyre enhanced in this new setting and resources and said this private group would not hold them back from expanding the services and continuing to give this multi disciplinary care. I agree. The care could actually improve. Its care. Yes. Dr. Chung. Yes, thank you. I appreciate the clarity of the presentation. Its all different from when weve had other hospitals coming and they had a service which was fully hospital controlled and then moved it on. Nevertheless, i think when we asked that there be a followup it would be appropriate to have a followup to be sure that the allege lack of reduction of services and availability, i mean, that the promise to say they will continue to accept the same patients theyve always had and such access is available actually has occurred. Granted that since we dont know when the a. G. Will, if it does, approve your changed, it would be something we probably need to put into be contingent upon if such changes would occur. Its more problematic because you have a set of employees and i guess the best we can do here, if staff is suggesting if there werent an impact on staff, then from their point of view, this would not be detrimental because all these services would remain valuable. Im wondering, within the timeframe or is it that saint marys would continue to perhaps send some sort of report also at the time this occurs as to what happened to staff so that if we were doing a sort of it is not detrimental contingent the way its stated this would be a followup saying that, well, this is actually what has happened. Were happy to do that. We have five impacted employees. Originally i think it was stated as six but one position was reduced in 2017. Of the five, two have been given positions at our raidology department. Throw of them and theyre waiting to determine, what the spine group will utilize them. I feel confident they will need staff to run that office. Right now they havent made the staffing decisions but we have three and theyre in the balance and we will be glad to give you a followup on what happens with them. So, what would be the best way to handle this . I was wondering when you come back will you have a better sense . We might. It will be a month and we might have a better idea of their Operational Plan and well report on that at that time. Thank you. Thank you. Mrs. Lindsey, do you have anything you want to add to your report . No, thats it. Thank you, very much. Thank you, everyone. Item 8 is the laguna hospital gifts fund budget. This is an action item. You will approve the budget for the fiscal year 1920. Im the Program Director for the Program Manager for the laguna hospital. I appreciate the opportunity to address you today. I want to give thanks to mark norwits for getting me here today. La gina honda hospital seeks the 20192020 gift fund budget. Laguna honda hospital proposes a budget totaling 426,170 to support programs and 15 programming categories. The cover memo to this agenda item the gift fund balance was 2 million 2. 77 million with a year to date expenditures

© 2025 Vimarsana

comparemela.com © 2020. All Rights Reserved.