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Civil Grand Jury reports (Volume 1976-77) online

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circumstances, in implementing the transition of state hospital
care of the mentally ill to community based care. In other cities,
it has proved disastrous. There has been progress but there re-
mains much more to do. We wish him well and thank him for his
cooperation with the Grand Jury.

San Francisco General Hospital

San Francisco General Hospital moved into its new quar-
ters in 1976. It has a bed capacity of 650.

The medical staff, supplied by the University of Calif-
ornia, is excellent as is the leadership it provides.

The hospital trauma center which treats 13 traffic and
crime victims on an average day, is recognized as one of the best



in the country and has a recovery rate "far superior to that of any
other emergency unit." This is one area of the hospital which
serves all San Franciscans. Because of the trauma center and San
Francisco General Hospital's improving reputation for overall care,
there are changing patterns in delivery of medical care. This is
putting new demands on the hospital. At one time it was the place
where anybody who needed medical aid could go — mostly the very
poor, the drug addicts, the derelicts and the prisoners.

San Francisco General Hospital, in its 1977-78 budget re-
quests, projected a patient load in excess of 400. The budget
approved by the Mayor and the Board of Supervisors provided staff-
ing for only 350 beds. A hospital bed costs money when it is not
occupied. During the month of March the hospital census was up
to 409. Then came the crisis of the shortage of critical care
nurses .

Critical Care Nurse3

It takes a special kind of person to be a critical care
nurse plus the fact that special training is needed. Because of
the intensity and stress of their work they "burn out", after a
period of time, and turn to less demanding work. As a result,
the turnover is high. Since the General Hospital has a relatively
high number of critical care cases, this demands special planning
for nurse coverage in this area.

As early as October the Grand Jury was told there was a
shortage of emergency nursing staff. In March, the hospital began
diverting ambulance cases to other hospitals and at one time, in
April, all intensive care cases were diverted to other hospitals.
Suddenly, there was a need for 3_6 critical care nurses Immediately 1
Only then were funds "found" and approval given to hire 21 critical
care nurses. This is poor planning! It is difficult for those
who have the responsibility to act, if they do not have the author-
ity! It is estimated that because of this crisis, the hospital
lost $2.5 million in revenues, plus the confidence of the medical
staff and most importantly, the confidence of the public. The
census then went down to 291.

A hospital is a dynamic institution with ever changing
needs. Timely decisions are needed and this is impossible under
its present form of governance. Getting through the layers of
bureaucratic red tape is too slow. As a result, the decisions
when reached are non-responsive to the problem. This is very
wasteful. What is even more appalling is the fact that this
could very easily happen again!



The Grand Jury reviewed with interest the report of the
Coordinating Council on "The Transformation of San Francisco
General Hospital Into A Community Hospital" which was submitted
in 1973. It also considered the alternative of contract manage-
ment, also, the complete takeover of the hospital by the Univer-
sity of California as was done in Sacramento when U.C. Davis
took over the Sacramento County Hospital. However, this Grand
Jury has neither the time nor the expertise to conclude this
matter but we deemed it our duty to suggest these options.

Dr. Silverman is especially aware of the multi-lingual
and multi-cultural makeup of San Francisco and has made intensive
efforts to acquire staff with bi-lingual ability. As a first step,
the hospital received federal funds through the Mayor's Office
to train interpreters in the City's languages and in medical
terminology. Twenty-seven men and women who received a six-week
training course are now working in various departments of the
hospital, including the information desk, the emergency room,
outpatient clinics and others. This program is financed by CETA.


The addition of 28 extra officers had been approved to
increase the security force. It was proposed that the new offi-
cers wear blazers, be unarmed and devote more emphasis on being
helpful (providing information, etc.) and preventing trouble. The
Grand Jury concurs with this approach. In addition to increasing
the hospital's security staff, there would be better outside
lighting and locks, an alarm system and other equipment. A T.V.
monitoring system was also to be installed. Upon later informa-
tion, we learned that the hiring of the additional officers has been
cancelled. The other safety measures, however, are being imple-


Parking is a big problem for both staff and visitors
which is yet to be solved. There are 600 parking spaces and
1600 are needed. The Muni shop next to the hospital would be
ideal if Muni could be convinced to relocate.

The proposed budget for San Francisco General Hospital
for 1978-79 was $59.2 million. Following the passage of Proposi-
tion 13, this was reduced to $5*» million.

A new accounting system will go into effect on July 1st
as part of the FIRM project (a new financial management and payroll
system). This project is covered under the Controller and Data
Processing elsewhere in this report.



There has been a sharp increase in payments for patients
covered by Medi-cal, Medicare and private insurance collections.
This pays for approximately 60% of the hospital's budget. All
billings are processed through EDP at City Hall. Significant
amounts of money are being lost because the billings, at times,
are two months in arrears. The monthly bills are being "bumped"
at City Hall because other data of higher priority goes ahead.
The EDP system is running dangerously high to full capacity.
A requirement analysis is being made and the hospital may have its
own computer in the future. An independent computer with capacity
in billing and data processing is also being considered.

The administration of the San Francisco General Hospital
has vastly improved under Mr. Charles Windsor who has been its
Administrator for two years . He appears to be aware of the
problems and tries very diligently to implement improvements.
The Grand Jury thanks him for his complete cooperation.

Laguna Honda Hospital

The image of Laguna Honda has vastly changed from a re-
tirement home for the aged to a virtual hospital which cares for
the most difficult cases, many of which will remain there for

The average daily census is 920. A large majority of
these patients require extensive skilled nursing care. They are
of all ages and there is a waiting list. It is estimated that ap-
proximately 2,000 elderly San Franciscans who, because of lack of
finances, live in retirement homes or hospitals outside of the

For the specialized care given to a patient at Laguna
Honda, it costs $55 a day. Medi-Cal pays only $27.00. The people
of San Francisco pay the deficit. No nursing home facility can
afford to provide decent food, sanitation and adequate medical care
for the elderly and infirm on the unrealistic payment schedules of
the government. This is evidenced by the controversial closing
of the San Franciscan Center on Post Street.

Laguna Honda is having its problems in bringing the hos-
pital up to standards established by the Life Safety Code. Sprink-
lers are being installed and stairways are being enclosed. At
present, it is on a six months extension on its accreditation. It
also has to receive a yearly waiver from the Health Department for
open wards. As a result a study Is being initiated to decide
the future of Laguna Honda. The study will attempt to assess the
projected needs of the next twenty years and how Laguna Honda can
best serve these needs. One major consideration will be whether



to continue putting millions of dollars into the old building or
would it be more realistic to build a new one. It is estimated
that by the year 2000, the proportion of those over 75 years of
age will double. Long term care for the aged is fast becoming
one of the biggest items on the health agenda and this will call
for putting it into the mainstream of medicine.

Clarendon Hall is still in the process of being remodeled.
It will add 170 new skilled nursing beds. The work is expected to
be completed by September, 1979.

Mr. Henry Sicabaig is the Administrator of the hospital
and appears to be doing a very commendable Job. The Grand Jury
was impressed with the sense of caring and devotion the entire
staff showed toward the patients as the different wards were

The nursing care, under the supervision of Miss Virginia
Leishman, appears to be excellent. This was especially apparent
in the "total care" wards where the patients are helpless. They
must be fed, bathed, turned, etc. Their mouths were in good con-
dition and their skin, especially their backs, revealed no pressure

The Grand Jury also visited a "locked ward". Patients
are not restrained but just kept locked in the ward so they will
not wander away. They were neatly dressed, seemed alert, friendly
and not heavily sedated.

Laguna Honda has a contractual agreement with the National
Cash Register Company for computer and programming services. A
study by Ernst and Ernst has revealed that this is no longer ade-
quate or efficient. A mini-computer was requested. Mr. Henry
Nanjo, Director of EDP at the City Hall is making a complete re-
quirement analysis before any changes are made.

San Franciscans should be rightfully proud to have an
institution such as Laguna Honda, especially since so much is
heard of neglect and actual maltreatment of the aged and infirm.
It should be pointed out that the State should shoulder more of
the financial responsibility. Federal regulations do not cover
special institutions like Laguna Honda. At some time in the
future, hopefully, this could change.

Since the passage of Proposition 13, it has been de-
cided to halt new admissions to Laguna Honda. As there are approx-
imately 30 deaths or discharges a month, the census will go down
by attrition.



There is a great need for skilled nursing care beds for
the aged and infirm in San Francisco which has an especially high
population of elderly. The state, at present, is paying $^0 a
day per patient to the Post Street Center which has lost its

This Grand Jury strongly recommends that the state be
made to recognize its responsibility and duty to these citizens
by bringing the support of Laguna Honda up to a more realistic

Jail Medical Services

The responsibility for the medical care of inmates in
San Francisco's Jails was transferred to the Department of Public
Health in 1975. As determined by the Court's Special Master in
June 1977, medical services in the Jails were in near compliance
with the Court's order.

The Grand Jury found this a troubled area.

In November, 1977, Dr. Silverman appointed Tom Peters,
Ph.D., as Administrator and Dr. Neil Walter as Medical Director.

The physical aspects of the Jails appear elsewhere in
this report under the Sheriff's Office.

There is a $190,000 appropriation to renovate medical
facilities at San Bruno and to build a four to six bed infirmary
at the Hall of Justice Jail.

It is proposed to build four "seclusion" cells in the in-
firmary at San Bruno. These are for inmates who act "bizarre" and
are now in the regular cell blocks but, for various reasons, it
would be better that they be placed in a "seclusion" cell in the
infirmary .

There is staff inequity as a paramedic receives more
salary than an experienced public health nurse. Sixty percent
of the staff are CETA employees and therefore, temporary.

We question the necessity of a full time pharmacist at
San Bruno.

The manner of dispensing drugs is open to many abuses.
There is no way to identify the inmates (no arm bands, etc.).

There appeared to be a large number of prescribed drugs
being distributed." We were told that approximately half of the



inmates are on "pain" pills.

There are several doctors who all work part-time at the
Jails. There is no set policy and all work independently. They
are there for a short time and some are more liberal than others
in prescribing drugs and some are even intimidated into doing so!
This is bad for the morale of the nurses as they then consider
themselves as mere "pill pushers."

Hall of Justice Jail

Dr. Peters is attempting to secure a medical person at
the receiving desk on the 6th Floor where all the newly arrested
are processed.

All new inmates are placed in a holding cell. They can
be there from fifteen minutes to twelve hours. It is important
that certain inmates, especially alcoholics be medically evaluated
on admission. (In May, one male alcoholic, age 28 years, who had
been in Jail less than an hour, was found dead).

Dr. Peters is planning on acquiring a medical record
technician and centralizing all medical records. He is also
making provisions that the medical record of the prisoner would
go wherever he went. As a result the updating would be better.

The Grand Jury realizes that Dr. Peters has not had
sufficient time to implement his program. He appears progressive
and capable and we thank him for the cooperation he extended to
us .

Recommendations ;

1. Medical evaluation by qualified personnel of certain
newly arrested inmates, especially alcoholics.

2. A four or five bed infirmary at the Hall of Justice
Jail so that the nurses may observe certain inmates.

3. Pharmacy inspection.

4. Securing more Registered Nurses.

5. Replacement of temporary personnel with permanent



Emergency Medical Services

Dr. F. William Blaisdell, Chief of Surgery at San Fran-
cisco General Hospital, took a six-month leave from the hospital
to make a study of San Francisco's emergency services.

The Grand Jury concurs with the findings in Dr.
Blaisdell 's report and would especially make these recommendations:

1. The City require patients carrying medical insurance
to pay for their emergency treatment. At present $1 million a year
is spent in providing free ambulance service and free emergency
care. It is estimated that 70% of the cost of these services could
be reimbursed to the City through insurance and other payments .

2. Permit City ambulances to deliver heart attack victims
and other patients to private hospitals of their own choice while
adding private ambulance service as a back-up for the City-
operated ambulances .

3. Establish a preventive maintenance program for the
City's badly deteriorated fleet of 11 ambulances.

The Grand Jury would like to congratulate Dr. Blaisdell
on his excellent report. He has served San Francisco well.


Dr. Silverman is to be highly commended for the progress
he has made in this monumental task of reorganizing the Department
of Public Health.

His ultimate goal to centralize all administration at
101 Grove Street and to develop a program wide management informa-
tion system.

Dr. Silverman is especially quality and cost conscious.
He presents a prudent budget and tries to get the most and the best
out of the taxpayer's dollar. The Grand Jury approves.

Recommendations ♦

1. That Dr. Silverman have civil service exempt key

2. It has come to the attention of the Grand Jury that
certain civil service employees who have well-documented cases of
incompetence and malfeasance against them are not dismissed. When



brought before independent and impartial arbitrators, the verdict
often goes in favor of the employee. This is not only expensive
to the citizens who have to pay for incompetence but it could be
dangerous when applied in the field of health. We recommend that
corrective action be taken.

3. This Grand Jury is cognizant of the fact that the
City makes a country wide search to obtain the best qualified
administrators and this is laudable. After proving his capabili-
ties, we recommend that the administrator, who is a specialist in
his field, be given a certain amount of flexibility so that he will
have the opportunity to "administrate."

Robert D. Au
Reynold T. Rey

Helen I. Abbett, Chairman



The Department of Public Works provides and cares
for the new and existing physical plant of the City, excepting
facilities that come under the Public Utilities, the Port and
the Airports Commissions. Its work is performed by the Bureaus
of Engineering, Architecture, Sanitary Engineering, Building
Inspection, Water Pollution Control, Street Repair, Building
Repair, and Street Cleaning and Planting and the Central
Permit Bureau. The budget for Fiscal Year 1978-79 is about
$40,000,000. There are nearly 2000 employees, of which 1650
are permanent, 175 are temporary, and 175 are CETA. The
activities and accomplishments of this department are described
in detail in their Annual Report.

A management review is currently being made by
Touche Ross & Co. The first phase is an overview of the
department, costing $80,000, which will be completed about
October 1978. It will be followed by a more detailed study
costing $120,000 which will be authorized if the first phase
indicates a need for it.

On several occasions, we visited with the Director,
S. Myron Tatarian, and received excellent cooperation. His
greatest concern is that he does not receive enough funding
to maintain buildings and streets. For example, there are
about 850 miles of streets in the City. He would like to
resurface about 50 miles each year, but has been able to
resurface only 7 this year. He also has difficulties with the
Civil Service Commission. There is often a delay in filling
vacancies, which can be prolonged If papers are mislaid or if
the person handling the matter is away for a few days. In
another instance, he stated twenty-three departments were
competing to hire a secretary from a roster of seventeen
applicants. Obviously in this situation, the applicant was
making the selection, not the employer.

The Department of Public Works does not have per-
formance evaluations, or productivity standards for its
employees. New employees are given an Interview when hired,
and their duties are explained at that time. The Civil Service
Commission has a goal of Implementing performance evaluations
in all City departments by January 1979. We hope that these
evaluations will be initiated in the Department of Public
Works before that time.

Like so many other departments, Public Works
"anticipates" or guesses at the time its employees will work
at the end of each pay period. This is because they are paid



the morning following the end of their pay period, and
several days are required to process and issue their checks.
For employees not working as "anticipated" corrections have
to be sent in to adjust time rolls. This practice should be
discontinued because it is a clerical mess, opening the door
to a variety of errors, oversights, and overpayments.

The assistance given us by Mr. Tatarian and his
staff is much appreciated.


The Real Estate Department, headed by Wallace
Wortman, Director of Property, provides services in the
appraisal and negotiation facets of real estate matters for
the City's departments and offices. The two major Real Estate
programs have been:

1. the acquisition of land for waste water treatment
facilities; and

2. the ongoing leasing program for City departments
requiring space not available in City-owned buildings. The
department is also involved in school expansion, acquisition

of property for parks, street widenings and extensions, disposal
of surplus property, advice pertaining to real estate matters,
management of City-owned properties, special study and appraisal
projects, and maintenance of records oertaining to City, Unified
School District and Community College District property.

The Rehabilitation Assistance Program (RAP) is a
program which mandates code enforcement and makes voluntary
home improvement loan programs (65? interest loans). The
Upper Haight Ashbury and Inner Richmond districts are progres-
sing slowly as it is difficult to get contractors to do these
Jobs as the contracts are small ($5 .000 to $7,000) and 90 days
are required for approval.

The Wastewater Treatment Project has commenced
building the North Point Station and the Southern Station. The
V/estside Station (the "Great Highway") is expected to start
soon. The project, approximating two billion dollars, is
budgeted as follows :

1. The federal and state governments will pay
87-55?; and



2. The City government will pay 12. 5%.

As a result of Proposition "J" the City has three
million dollars a year to buy open space. The 17-3 acres the
City leases to the Olympic Club is to be left as is. To build
middle-income housing on the space would destroy the watershed
and seriously interfere with the Master Plan. The Olympic
Club has a total of 353.3 acres of which 17.3 acres are leased
from the City.

Recommendations ;

1. The City should have a short-term lease with the
Olympic Club with options to raise the monthly rent of the
City-owned property; and

2. Appropriate City departments should be centralized
in a location that facilitates communication and efficiency
which in turn provides greater productivity.


This department purchases materials, supplies,
equipment and contracts for equipment and services. It repairs
automotive and other types of equipment. It operates a central
reproduction unit for office forms. It maintains a running
inventory of equipment and disposes of surplus.

The department is headed by Mr. Joseph C. Gavin who
purchased or contracted for approximately $175 million during
Fiscal Year 1977-78. Mr. Gavin advises that his operation com-
pares favorably with similar activities municipal and private.

No physical inventory of City owned property or
equipment has been taken for many years. Apparently additional
personnel are needed to do this although Mr. Gavin hopes to
obtain scanner-type equipment to take inventory by computer.

There is no control over the creation of forms and
many are duplications of those already in existence. Many
become obsolete and forgotten although they are still being
stocked. The prooosed budget for 1978-79 for the Reproduction •
Division is $353,300.

A great number of the City motor vehicles are worn
out and quite often the cost of repair far exceeds their



current value. Not all departments send their vehicles in
for preventive maintenance but only when there is a breakdown.

Recommendations :

1. A comprehensive program for the systematic maintenance and
replacement of the City's motor vehicles is sorely needed.
Without this type of program there is much waste. Standards
for size and cost should be set. Ease of repair and
depreciation should receive the utmost consideration when
bids are being considered for the purchase of new vehicles,
and in fact any equipment.

2. Bring inventories of City-owned property up to date and
institute a schedule whereby all City departments take a
physical inventory on a calendar basis.

3. Form a committee to inventory and review all existing
office forms and to institute a permanent program for their
design, storage and distribution.

Thomas J. Cook

Michael J. O'Brien

Reynold T. Rey , Chairman



The Board is comprised of eleven elected representa-
tives who each serve four year terms. The eleven members
represent the eleven districts of the City. They were
impaneled under the new district structure on January Q, 1^78.
We feel that it is too early to form any Judgements of the new
district elections, but there is some indication that the
Supervisors are more concerned with the special needs of their

Online LibraryCalifornia. Grand Jury (San Francisco)Civil Grand Jury reports (Volume 1976-77) → online text (page 19 of 32)