>> i would like to thank her for the support and my mother who is the ceo and founder jackson and they have done, years and years of work, around at risk yoegt. and both in the san francisco business professional woman, as well as in the national coalition of 100 women and she is the leader in the community and highly respected and we are very grateful that you are on the commission and we wish you the best. and to see that you guys support her for the vice president. thank you. >> thank you. >> is there any further public comment? on this subject of the vice president election? >> if not, we will proceed

then, with our election the office is open for nominations, at this point. and if we could clarify, i am sorry, before we move forward that the term is a shorter term, and due and this is filling the vacancy of commissioner melara and that term will be up in march, when new elections for the are into the new election for the officers are in place. >> thank you. >> and it also got postponed and so this is the term that will go, and to march, and the bi laws and at which time, we are schedule to have new elections of officers. >> and so, nominations are in order, commissioners sanchez? >> yes, i would just say that i can't remember the exact date where we have the board retreat which was a public retreat and

everybody was there and we had staff and officers, and citizens, and at that time, members were asked if in fact they would like to make a statement pertaining to the candidacy, and for the vice president, and at that point, i thought then and i still think now, the commissioner gave a eloquent presentation of why she thought that we could all work together, if in fact she were nominated as the vice president of this commission and so keeping that in time, this is quite a while ago, when this was on at again da way back when, and i would move that the commissioner mcgee be nominated by the vice president of this health commission. >> and so i accept that as a nomination for vice president, are there further nomination? s >> yes, i so, if you recall, commissioners, that at that

meeting i did particularly, and i want to consider possibility and from my hat in the ring for the candidacy. but after, i had more thoughts on that, and because looking at what the commission needs and in full term and i understand that there are other candidates that are better for you know, to really shepherding those priorities and i actually would like to, and this is referring to the process, and it is commissioner david singer, and the reason why i think that he is a good candidate, for us to consider as well, is because of some of the prioritis that people have mentioned, and also because we are under the affordable care act, and we have a lot of infrastructure to

build, and commissioner singer, brings with them, those experience in helping to like shepherd and guide the commission and the health department, in those processes. for instance, the medical electronic medical records and also in the infrastructure of our operation and finances, and these are all really crucial elements in order to provide the much needed surface with so many community members have expressed earlier. and so the money has to come from somewhere and how we relocate and purchase, and we really need a key eye on that. >> okay. so commissioner singer has been also placed on nomination. and that should actually ask commissioner singer because we have had actually commissioner taylor-mcghee that she was going to be a candidate, commissioner singer are you willing to serve as candidate? >> i am and i am excited to be

on the same ballot as commissioner taylor-mcghee. >> okay. >> thank you, is there any further nominations to add to this ballot? >> i move the nominations be closed. >> okay. >> is there a second. >> second. >> okay. no further discussion, and all of those in favor of closing the nominations say aye. >> aye. >> all of those opposed? nominations are now closed. and i think that in this process, we will then have a hand vote which will be counted by our executive secretary, over there. and we will do it in alphabetical order. and the first with the commissioner singer please? >> and so, all of those in favor, commissioner singer please raise your hands? >> thank you. >> i know four. >> all of those now in favor of commissioner, taylor-mcghee, please raise your hands.

>> thank you. >> thank you. >> and so, by a vote of 4 to 2, commissioner singer will serve as our vice president. and i would like to say that both candidates would have been equally effective in different ways and i am pleased to work with and have worked either of them, and i am going to see that we continue to have a move forward with the series and i am actually pleased that we are going to fill this position so that it will help us or help me any way. thank you. >> and congratulations, and thank you commissioner taylor-mcghee for also, considering this same office. >> yes, and the chair. >> no. >> okay. >> and yeah, the commissioner singer and then, we will get to commissioner sanchez. >> go ahead. >> and i think, that and this is very important thing for us to remember, is that there were

some passionate people here, with us today, with some real insights into what is going on into their community and we would not have that lens and focus on that without commissioner taylor-mcghee efforts and i think that it is incumbent upon us to make sure that we explore these issues and come to understand some of the things that people are concerned about in the community. and come back to them with answers. >> thank you, and i think that is what we requested from the director and i couldn't, agree more fully. and having worked here, for these many years. that we must come up this time with an answer to the or to our issues. of health disparities, there is no question about that. commissioner sanchez? >> yes mr, chair, yes in keeping with the spirit of commissioners, that are going after many, many years, and

having a vote taken which we did. and having votes shared kh, we did. i would therefore, move that in the spirit of unity, and of this commission, we log this as a vote for the vice presidency and move forward tha. would be my motion, and sort of in tradition and, many of another commissions as votes are taken and i would therefore, make this a motion, so that we could move forward. and we have already had the discussion, to vote and now we will close it for the next part and that will be my motion. >> and do you... >> yes, is the motion is that we then make the election all of that, and at this point, the commissioner votes that it be logged as you nan maous and move forward. >> is there a second to that motion? >> not hearing a second to the

motion, the motion will die at this point. >> okay. >> yes. >> and i just want to make a comment and i think that i really appreciate the level of expertise, commissioners each bring to this commission and i certainly have learned a lot. and i think that another things that i really appreciate and it is a practice that i actually did as well, and during my years and it is shared leadership and it is often encouraged and so, it is not like we have elected one commissioner that is going to like stay on the leadership positions forever, i think that has been rotating and it has been rotating process, and i say that that is something that public should know as well.

and so, this way we can really meet the need that the health department currently needs. and also, give everyone an opportunity in the future. you know, to fill these opportunities and much needed responsibilities. >> okay. >> yes, i thank you commissioner and i remind everybody that every commissioner is equal, in regards to whether they are an officer or not. and as a matter of fact, we serve at the pleasure, of the commissioners. and that no one single commissioner actually makes the decision, the decisions are made by the commission as a whole. and, personally, i would like to thank commissioner taylor-mcghee for the work that she has taken on. and we spoke about that, at the time, when i was looking for various positions and i think that it is most come mendable, and i know that she will

continue to give every effort to not only the african american initiative, but all of the work that she does, on behalf of our commission for the health of the city. including of being at our san francisco health plan. so, again, our thanks and i agree that the votes, do not reflect that we are not in harmony. what they do reflect is differences in emphasis on how one might wish to look at those who are helping with our commission, and i view it in that manner. and i am hoping that everybody else will view it in the same way. >> are there any further comments? >> if not, then, let us proceed to the next item. >> yes, thank you, commissioners item 8 is a revised san francisco general hospital, staff bylaws, dr. marks is here to present. >> the memo in the packets,

commissioners that he will review and the summary of the changes. >> good afternoon, commissioners president, and the two of you that i have not met yet, i am jim marks and i am chief of the medical staff, at san francisco general hospital. and you have before you, the revisions to our by laws and our rules, and regulations, which i think that are about 150 pages. and these have been approved by our credentials committee and medical executive committee and joint conference committee are now before you. and there is a simpler two-page summary that highlights the changes, and rather than go through that, i will just kind of bucket them into three groups that i will briefly describe. one of them are those that address the increased accountability of the medical staff, and clearly defining, the requirements around the board certification and the dea

certificate identification, and completing of the hospital orientation and other regulatory requirements and attendance, and committees, and etc.. and the other such big group of changes are just, updating for example, and committees structures and committee and new committees that have come and the old committees that have left, and then the third big area is really the elimination of probably more formal language for what i would just call, more simple speak, and that is very clear. and so, i am very happy to take any questions that you have about the changes. >> and if i may, to the san francisco general hospital, jcc has reviewed these and then forward them for your recommendation, and for your approval. >> okay, so these specific are before us as business from the jcc. and were there any public comments? >> i have not received any public comment requests for this item. >> commissioners the item is before you, discussion is in

order. >> i would move approval. and also congratulations our medical officer who did a fantastic job of the staff and it was presented and great detail, twice, and before the jcc for discussion, and for the peer review and so i would move and. >> thank you, commissioner. >> okay. >> yes, please? >> parks, thank you very much, for the wond bylaws that made good nighttime reading >> help with the sleep and i am sorry, we got this and to be in the hr and really important because they also relate to health, equality andvy 10.13, the medical staff and xwhitties and in the revision you limited the well-being committee to working with the medical staff and so i just want to ask you are the residents, and then the anxillary staff that are rotating through campus, can they access the well-being, eep

services as well? and it sounds like it is a broader scope there and a broader function. good, the last thing is item 12.2-2, disclosure confidencal information and so i am really in favor of, you know, when there is a position with an impairment or a safety issue that there is broad notice to make the system safer, and on the other hand we have to balance it with what is confidencal employment and hr related privacy issues for the particular physician or the staff employee. and so this one, asks that on the initiation of a corrective action, and you could then, notify, the health network and i just was thinking of well, there is not really an action there and it is sort of like a suspicious and i am just a little worried because of the way that a lot of reporting has been going to the state level and we are being increasingly to support the suspicion which are not quite, actionable yet and i just want to make sure that the due process is involved before there is a

breach of confidentiality and there might be, employment related risks there and so, yeah. >> and yes, i don't recall all of the discussion on there, but cathy murphy, the city attorney served on the bylaws committee and we certainly, considered that and we had her input as you know, the trade off in informing the network and confidencalty. >> yeah. >> i guess that if you could reassure me that if there is a process there, that there is either a scrutiny, and the executive level of the safety concern and a warning and alert. and i will feel satisfied and just to have a suspicious and then it goes across the system, and it crosses kind of... >> perhaps i could help with this one, because i know where this came from. and which is that if in fact an issue came that needed to be reported is basically an

action, and organizations within the organization within the health network, we actually only have two credentially organizations but as sf general or laguna honda which is all of our services all are through san francisco general and so, if, if somebody in fact also has privileges at the other hospitals, this is the only one. >> the issue is that the other hospital should be aware of it. >> yeah. >> normally, we will have, combined the two facilities, for many reasons, they each have a different license. and this is the reason for sharing, the peer review. and for sharing, the suspicious if you wish to call it. and in fact it is gone beyond a suspicious and the sense that it is a (inaudible) report and it is the initiation of the investigation and the 805 is actually an action and we got to meet the restriction and things like that and i am okay with your assurance that there

is a good review before there is..., and i can assure you have tha. >> and there it is for only going to the laguna honda, medical staff and, that that is the effectiveness of this. >> and commissioner, this was an incident that we had where we had a... working and if order for us to have a common reflection of their work from a network perspective that this was... attempt to do it. >> these are really subtle issues and we correct it, and director garcia and this was, a specific instance and this was very, carefully considered and it this was the appropriate way to manage it going forward and we want to be sure that we (inaudible). >> yeah, from the commission, standpoint, we are involved as governors of both organization and it would be unusual that if we were notified of the

corrective action or initiation in one area, but we could not let our sister institution for which you are responsible know about it also, and like say general and so it is like, the network of hospitals, and that we need to see that the peer review information is able to be transferred to the other if, in fact, it is the same practitioner who is practicing and so how could we then, and how we are going to let the other people know that there was a question and but that there is a question in the case of a correcter action and it is up to the other institution and the people does it effect, what we are doing here? >> if you can work it, and when you are not able to pass it over, and then we are sitting as the governor ans and we know it over here, and we can't do anything over there. at least, leave it to inquirery. and that is >> thank you very much.

>> directors? >> yeah, normally. back in the motion to approve and congratulate dr. marks and quite an extensive team of his that is extensive in terms of the positions and staff members and hours for the end, and making sure that and that the bylaws sit with the best practice and in the year 2014. that is right, foyer got to accept the second. >> and any further discussions or if not, then we are prepared for the vote. >> and all of those in favor of accepting the revisions to the bylaws and regulations aye. >> aye. >> all of those opposes? the ayes have pass and so has the buy laws revisions and many rules of regulations, and thank you very much, dr. marks and

please convey our thanks to the entire bi laws and that feels good after a year plus. >> thank you. >> and commissioners the next item is the healthcare accountability ordinance and the resolution. >> give me just one second. >> we will go back. >> all right, well good afternoon, commissioners and thank you so much for the opportunity to speak with you today, and i am francis culp and i am a senior planner with the office of policy and planning here at dph. and we are going to talk about the healthcare accountability ordinance, minimum standards and review process that we went

through and the recommendations that we are bringing to you and you will have in your packet a report that was written on the process and the recommendations that have two attachments one is a table with the recommendations, and one is the resolution that will be asking you to vote on today. >> the healthcare accountability ordinance or hcao, was a ground breaking and innovative piece of legislation that was passed in san francisco, by the board of supervisors, and in 2001, and as part of the minimum compensation, ordinance and that, that whole package of changes, and what it brings to the city is a pathway for more people in our city to have employer-based health insurance, and the minimum standards help to make sure that that employer based health insurance is meaningful insurance, and so, they are not under insured as well. and so, when it is the

effective date on it was july first, 2001, after it passed earlier in the year. and the covered, and those who have to have to work with the hcao, are employers who are working with the city, and to either a contract, or a (inaudible) and there are certain exceptions that employers can get and those are detailed more in your report. but, most employers working with the city have to provide a health insurance that meets the minimum standards they have another option. that option is to pay a fee to the department of public health to offset the cost of of providing care to the uninsured the care fee changes from year to year it is at $4.25 per hour, for a maximum of $170 per week. >> and that is actually based on hmo premiums and the coast

of hmo premiums and i believe that many people prefer this, including the employers to offer the insurance, rather than paying the fee and so what we want to do is price, the fee, to be with the cost of health insurance and we don't want it to be a better deal, but then to actually pay the fee. and so we work with the controller's office every year, to update that amount. >> and at any rate, with the minimum standards, we are asked for the ordinance to look at them, and once every two years, and review them and revise them if necessary and since we have been doing this back in 2003, we have actually found that it is always necessary to make some changes. and the health insurance, market is extremely volatile, and really there is no sign of that, getting any better, and last time that we reviewed and there is a lot of change and

volatilety in the market and what is offered and what kind of packages are offered for the employers to purchase for their employees. and so we really have to tweet the minimum standards to make sure that the employer can actually buy plans that will then work with the minimum stan aders or they are forced into paying the fee. >> the health department's role is to do the review and recommend the revisions that how the commissions roll is their sole role is to vote on the revisions and the recommendations that we make to you, or ask for the changes or whatnot. >> and so, starting back in 2003, when we did the first, and when we came first to the health commission and with the changes, and we had not actually used a stake holder process and we did it intinally and at that point, the health commission asked us to go back and work with the stake holders from the people that koim ko the meeting and asked if they could be part of the process and so ever since that time,

based on what the health commission instructed us to do, and we have use aid stake holder process, where we have interested parties from a variety of different perspectives that help us to review the minimum standards and advise us on recommendations, and that they are interested in seeing, and we try to really work on it, on the process and we have 14 organizations this year that we worked with, and non-profit and forprofit employers and labor representatives and brokers and health plans and other city and council san francisco departments and i should mention that the departments in the city that actually does everything else with the hcao, and does the auditing and making sure that the employers are doing what they are supposed to do is the office of labor standards and enforcement and so we work very closely with the olsc and they were involved in this as well. and we have 6 meetings and we originally thought that we would do four.

but it turned out that we needed to add a couple on, because we honestly sort of under estimated what the affordable care act, and how much it would prove and... (inaudible) in the situation and we ended up having a lot more educational time in the beginning and even some of the brokers there were kind of grappling with the questions that they had in not grapled with yet and so it was a to take on and so the group was actually nice enough to come a few extra times to the meeting and the goals were simple and at least straight forward i should say that they were to for the group and they were asked to help us to develop these recommendations that would be in place for january first, 2015. and also, to balance affordability and availability of health plans that will be under the minimum stan ard and

that is really on the both sides and the employer and employees we want to be sure has choice in this whole structure. and so, really quickly, and i don't want to spend too much time on this because i am sure that you quite familiar but to be sure that we are on the same page as i talk more about the insurance details that i have done a quick glossary for you and i will start with the co-insurance and we will be talking about these things more later, the co-insurance is the percentage of the charge of the medical care that you would share with the insurers and so 100 dollar visit if you got a 20 percent co-insurance, and you paid, 20 dollars and the insurer pays 80 and the provider gets paid, the detukt able is the amount that you are paying in full for a service, and until you hit that deductible amount and then you start paying the co-pays, and the co-insurance, amounts, and whatever your particular plan

requires of you. and so you are paying that $100 visit in full until you have enough visit and that deductible kicks in, the out of pocket maximum is the amount that you can or would pay up to in a year, and that then, it would be for the insured person, and they would be responsible for no other cost, so, this is a really for the people with and who have catastrophic incidents and the costs go high and at that point, they are no longer responsible and the insurance takes over 100 percent. >> and a couple of other terms that we will be talking about today are the health reimbursement accounts and the health savings accounts and these became part of the option and part of the minimum standards a couple of years ago and as you will see, we are continuing with that. and as you can see the fee there, they are both different kinds of accounts that the

insurered person can access, to pay, or to pay part of their cost associated with the insurance. and what this does in the minimum standards, is that it gives the employer, if the minimum standards and these minimum standards have to last two years, even as the market changes and so in case, the employer for whatever reason or reasons, is really having a struggle finding a health plan, and maybe it is just a one thing, and it is the out of pocket maximum that is $500 too high. and for what we say that the minimum standards have to be and then the employers can get a $500, dollar, hra or hsa and pay for it that way, and on behalf of the employee and the main question that we asked around that a lot and really made sure was that a burden on the employee could be the employee be caught with the special cost that we don't know about, and could the emoy