>> it is important that -- everyone have a role at the port of san francisco and everybody feels welcome >> good morning and welcome to march 18, rules committee meeting. i'm supervisor walton and joined by supervisor safai and engardio. thank you for filling in today. mr. clerk, i like to first of all hear if you have any announcements. >> yes, public comment will be taken on each item on the agenda. when your item comes up and

public comment is called please line up to speak at your right. you may submit comment in writing in either of the follow ways, e-mail my san francisco at victor.young .sfgov.org. you may also send to 1 dr. carlton b goodlett place. please silence cell phones and electronic devices. items are expected to appear on the board of supervisors agenda of march 26, 2024. that completes my announcement. >> motion to excuse supervisor ronan. >> on that motion, supervisor engardio, aye.

supervisor safai, aye. vice chair walton, aye. the motion passes without objection. >> thank you. please call item 1. >> item 1, motion approving/rejecting the mayor's nomination of lieutenant leonard poggio to the entertainment commission, term ending july 1, 2026. (clerk of the board) (charter, section 4.117, provides that this nomination is subject to approval by the board of supervisors and shall be the subject of a public hearing and vote within 60 days from the date the nomination is transmitted to the clerk of the board. if the board fails to act on the nomination within 60 days from the date the nomination is transmitted to the clerk, then the nominee shall be deemed approved. >> thank you so much. i believe mr. poggio is here. you have the floor. >> thank you. good morning. vice chair walton, supervisor safai, supervisor engardio and member ozf the public. my name is len end poggio. i want to begin by expressing sincere thanks to the mayor for nominating me to the entertainment commission law enforcement representative seat. i also want to express my sincere hope i receive this committee approval as part of the conformation process.

you have copies of my resume that detail 22 years and counting with the san francisco police department. i believe i had a truly diverse and rewarding career and most importantly, i believe i would be able to directly apply this experience to the commission to serve the people of san francisco. i want to share just a little more about myself as well as my goals and vision if i'm seated on this commission. first, i am born, raised and still living in san francisco. i am a proud product of the san francisco public school system. i live with my wife patricia who immigrated to the city from peru in her 20's where she was able to attend nursing school and currently serves many community today as a registered nurse. we have chosen to raise our two children here in san francisco where they currently attend elementary school.

san francisco entertainment and night life industry is what makes this city a world class destination. it is part of what brings people into the city to enjoy it and to contribute to the economic footprint. my top priority would be to insure san francisco keeps fostering this vibrant industry throughout our city. i have often been asked how i would balance the concerns and interest of small business with the concerns and interest of the public safety community. my answer is simple, small business and certainly the night life and entertainment industry relies on a safe environment to truly thrive and prosper. my goal on this commission would be to maintain this balance as well as communication and partnership. thank you for your time this morning, thank you for your consideration and i'm happy to address any questions or comments you may have. >> thank you mr. poggio.

colleagues, any questions or comments? supervisor safai. >> thank you lieutenant for coming forward. this is a extremely important position on the entertainment commission, so i'll say first and foremost, the fact you are strongly recommended by david falzon gives me the confidence i need in your ability and also based on your resume and other work. i just want to highlight a couple incidents that happened in my district to give you a opportunity to ask how you respond to that. unfortunately in 2017, the entertainment commission had to deal with the situation in my district a club by the name of la facia, a security guard shot and killed a prateren there and later prosecuted for homicide and it had been a unruly establishment for a few years and last year another night

club, there was a shooting inside, three people were injured. there was a 18 month history of violence in the establishment. theirliances were revoked, so i just wanted to and give you a opportunity to talk about how the entertainment commission can better enforce safety and accountability for the entertainment industry. these are outliers. we have wonderful wonderful establishments all over san francisco, but unfortunately every now and then we have those that turn into places of violence, so i want to give you a opportunity to address that. >> absolutely. thank you supervisor for that question. i feel anything certainly with enforcement there needs to be a measured approach and we need to be able to look at a establishment and if something terrible like that happens a homicide or act of violence we need to look and see okay, is it is a outlier? what caused that and what has been the history on this establishment and certainly if

we have 18 months of progressive acts of violence we need to address that. we need to work with the establishment and build up the security plan and make sure they have working cameras and meet the public safety in the venue and surrounding areas. if we have a place that is just contributing to acts of violence and not following the rules we have to absolutely move to close that place, but one thing i want to do is if seated on the commission is, i want to actually have you know, bridge the gap between the san francisco police department and the entertainment commission. have monthly meetings with the permit officers. every captain has a permit officer assigned to the station, so hopefully we can address the issues at the front end oppose all having our

phones ringing at 2 a.m. informing us of another homicide. >> thank you. >> thank you supervisor safai and with thank you lieutenant poggio. i don't see other colleagues, so let's go to public comment. >> yes, members of the public who wish to speak should line up at this time. each speaker is allowed two minutes. othere there is a soft chime with 30 seconds left. anybody who would like to comment on this matter? >> good morning. my name is lieutenant pat mucormic. let me talk about lieutenant poggio. i have known him over 22 years now and worked hand in hand. sergeant at tenderloin and currently staff services for over 10 years now. i know lieutenant poggio very well. what he brings to the position of the entertainment commission.

he was born and raised in san francisco. he glanced over that but that is pretty important. he knows san francisco. he's born and raised here. he lives here and lives here with his wife and children. he is a product of the public school system and knows san francisco. that is the most important part about leonard poggio. he is graduate of schools. i wrote down a few ideas the traits of leonard poggio as i know him. he is consenss, a thinker, he is fair and impartial, leonard is decision maker and that is really what you want on this entertainment commission. sometimes it will be hard decisions whether it is to suspend a license of a business, because they are bringing too many problems to their naerbd, neighborhood or community or maybe convene with a business, outline expectations and go forward with the outline if you don't

meet the expectations you will be closed. he's a doer. he knows exactly what makes entertainment safe, having been a police officer and knows what makes it successful. he is what you want on the board. he brings that voice of reason. he will add input but won't-but it is constructive input. he won't back down if it is something dangerous he'll let you know and advocate going forward. i wholeheartedly endorse lieutenant poggio for the entertainment commission. thank you. >> good morning supervisor. i'm brandon scale and work as a investment director affstanford graduate school of business. today i speak to you as a individual private citizen and not a representative of the university. i was born and raised and

currently reside in the sunset district. i have known leonard since first grade at jefferson elementary. always been intelligent, hard-working, generous with his time, driven, accomplished and perhaps mow admirable, humble. leonard is widely respected by his peers, someone who people go to seeking council or for his thoughts on community matters. he is a dedicated and caring father who coaches his two young children and others in youth sport. strong moral compass, knows how to lead and listen and strongly urge you to support his nomination to the entertainment commission. thank you. >> good morning committee. my name is-city work er and work with leonard over 15 years. i have been in the police department 27 years. in that time, i have known

leonard and agree wholeheartedly with the comments the other speakers made, he's intelligent, he's a great leader of our department and i can think of no better person to serve on a committee like this. having been born and raised here, he knows the city and i have a few other things. i endorse leonard poggio for a position on the entertainment commission. i have known him 20 years. he is highly intelligent hard working-he l [indiscernible] teaching me how to do my job and be successful. his education in public administration, master coupled with decades of services as a public safety professional make the ideal candidate to serve on this commission. i believe his vision and dedication will greatly benefit the commission and community it serves. thank you. >> thank you. >> thank you. any other comment ers on this

matter? no additional commenters. >> thank you mr. clerk. seeing no other speakers, public comment is now closed. i just want to say thank you to lieutenant poggio for wanting to step and serve in this role. entertainment commission, all our commissioners are important. always appreciate someone willing to serve, because it will take a lot of your time and commitment to do well, so thank you so much and i don't see anything else from colleagues so i like to make a motion to appoint lieutenant leonard poggio to seat 7 and send to full board with recommendation. >> we like to amend the motion to reject throughout the legislation? >> correct. >> yes, on the motion to delete reject throughout the legislation and approve appointment, on that motion, supervisor engardio, aye. supervisor safai, aye.

vice chair walton, aye. that motion passes without objection. >> thank you. motion passes. before i call item number 2, i would like to thank jamie from sfgotv for being with us and making sure that this meeting is publicized today. mr. chair, please call item 2. >> item 2, ordinance amending the administrative code to establish a permanent homeward bound program administered by the human services agency and the department of homelessness and supportive housing for individuals experiencing homelessness, at risk of experiencing homelessness, or who have formerly experienced homelessness, such as individuals residing in permanent supportive housing, to receive paid travel and relocation support to a destination where the individual has someone to receive them. there is request this matter sent out as a committee report. >> thank you so much. i know we have presenters from the department of homelessness and supportive housing, but i believe supervisor safai has a

few words. >> we said a few last week. appreciate the opportunity to hear from the department, but can't emphasize enough how important it is to really elevate and codify this program in the chapter 20 of the administrative code. 11 thousand individuals have been served from this program since inception. at the height around 800 to a thousand individuals were given support to reunify with their families. that is the basis of this program. unhoused individuals that have been left here or are suffering on the streets, giving them the opportunity to reunify with their families so we truly believe this is the right step, it codifys it as a permanent program and asks for corpination between hsa and hsh and we appreciate now we have

gotten the mayor's attention. there is a stated goal of getting it going again, so we have questions for hsh about that, but i want to thank trent roar, director roar and suzy smith from hsa and dylan and emily cohen from hsh for their work and collaboration on this. also want to thank rescue sf and the input from the coalition on homelessness for working with us on this legislation. this is a important tool in the tool kit that san francisco has. it has gone by the way side for a number of years and we think that a lot of the holistic approach hsh has now, they offer a number of different services, but having the department of human services agency play a much more vital role and engaging on this program again, i think it is going to make it more robust, so because they have direct contact with many families as they are applying for general assistance. we think that is it had time. we were walking the beat last

thursday with the captain of the tenderloin station. there were individuals on the street talking about the homeward bound program. there was definitely interest and engagement and that's usually what it takes to get people to partake in this. i know supervisor engardio has a question, so if you want to ask that question now, or you want to wait until after the presentation. okay. thank you mr. chair. >> thank you so much supervisor safai. i know we have deputy directors susan smith as well as deputy director emily cohen and dylan schneider from homelessness and supportive housing and it looks like director cohen will be presenting. >> good morning. thank you for having me. emily cohen deputy director department of homelessness and supportive housing joined by colleague suzy smith, human service agency. we where going to briefly walk

through the relocation assistance program and happy to take questions how the proposed legislation would impact operations. as the supervisor mentioned, since 2005 san francisco helped over 11 thousand households experiencing or at risk of homelessness reunit with support network and stable homes outside the city through different types of relocation assistance. there was a program called homeward bound. we now have multiple programs that provide this service, and under the ordinance is under the umbrella of homeward bround. there are two city programs that offer relocation assistance. one is the department of homelessness and supportive housing problem solving problem and the other is the human services agency program and we'll get into that in a mofement we also have a temporary emergency response that is a low barrier approach

to relocation assistance being administered through the drug market agency coordination center and that program is called, journey home and also a important part of this package. the type of programs that are currently providing relocation assistance is our department problem solving program,b which really is what it sounds like. somebody comes in seeking services, housing or shelter and we have a conversation with them about their own strengths, assets, social network that can help them avoid homelessness and help problem solve in that moment. we also have flexible financial resources that we can make available to support folks at that time, and relocation assistance is our primary utilization of this program. people can use it for a variety of things, but relocation assistance is for the top offering. this is done at community based access points throughout the

city and is available to adults, families and transitional age youth experiencing homelessness. we launched in summer 2022 after administering the homeward bound program since 2016. on average, our program costs about $365 per person for reunification assistance, and we have supported over approximately 339 people in fy22 and on track to do that again this year. the human services agency focuses their program as folks know, they administer county adult assistance program, so when somebody comes into sign up or renew their cap benefits they are offered the ability to reconnect with friends is and family and stabilize their

housing. this is offered to housed or unhoused people who are on cap and administered at their office on mission street. since april-sorry. the average cost per person in this program is slightly higher, $481, but either way you look, incredibly affordable intervention that can immediately end homelessness and hopefully connect with a support network to move forward. you will see this program in fy22-23 was relaunched midyear, and fis cal year to date 12. they are continuing to ramp up, but combined we have served over 525 people since july of 22. and happy to take any questions from the committee. >> thank you so much director cohen. supervisor engardio. >> thank you.

my question is-it refers to if someone has used this program within 5 years. they are ineligible it use it again. if we give someone a bus ticket and find them a home and come back two months we have to wait four more years before we can offer it again? i don't understand that part, why not keep trying to help people? >> thank you for the question. before i get into that i want to thank supervisor safai and staff for working with us on amendments this legislation. his office was collaborative and appreciate the amendments made. this is one made-we did not reach agreement on. probably the obviously one. our problem solving problem currentsly allows people to access the financial assistance once a year and we think is is a more reasonable amount of time to access homeward bound

assistance. we don't want to constantly provide travel out of state for people who might not be sticking-[indiscernible] if we can resolve someone's homelessness and see no reason at this price point to prohibit people accessing the program more frequently. >> i notice there is a caveat. it says, you can wave the 5 year requirement on case by case basis if the executive directors of each department. do they both have to agree or how does that work? >> i'm not sure frankly how this will work. this is something we need to develop rules and regulations for. it adds administrative burden to the operation of the program, but the idea, if we can demonstrate that this relocation assistance will end homelessness we can wave this rule and send them home sooner. it would be simpler to remove the section all together or reduce the 5 years to 1 or-i think there is a agreement we

can all reach on that, but i believe and don't want to speak for the supervisor, but i believe that was his intent with the language in the legislation. >> just one last question, with two different departments coming together do you see seemlessness or different cultures? sometimes each department has its own culture, how do you see it working together? >> the legislation does a nice job allowing each department to create their own oprating procedureing and rules for the operation of their programs so in that way, it is not a problem. the part where we really need to come together is on data and reporting and i think we are well suited to do that. we have already been collaborating on the design of a web based dashboard publicly available to continuously track progress on relocation assistance. again, this is one of the programs that is such a important tool in the tool bosh. we want to offer to people who

have support network out of county and it isn't something we want to pressure people into doing. we don't want to transport someone home to be homeless in another community. it needs to be used intentionally and in real genuine partnership with the client who will be using the program, but i think it should be readily available and we are prepared to collaborate on the data reporting. >> great. thank you. >> thank you supervisor engardio. supervisor safai. >> thank you chair. thank you supervisor engardio for those questions. i mean, i think what is clear is, this was a program that pre-dated the creation of the department of homeless supportive housing. homeward bound began under the human e service agency. one reason why it was effective is because the individual screeners within human services agency were having direct contact with individuals as they were coming in seeking

assistance. some that has changed to more over the phone. i think some that is now going to come back and the program was kind of-became somewhat a after-thought for department of human service agency. i think one thing i'm trying to get and the reason we put this in here is we want more clear data reported. as you saw even now, hsa only served 12 people with the program so far. they used to serve 800 to a thousand a year and it is also something a matter of getting it out there, getting the information out. as i said, i was with the foot beat officer in the tenderloin and they were beginning to talk about it again. i don't think it is part of the tool kit, not just for officers but out pch reach worker and hot team, others beginning to say do you have a family member, are you from the city and if not we can reconnect you. as deputy director cohen said, this isn't sending someone-they

to have a family member, business support and check day 30, 60, 90. we are insuring this is successful. to your question about the time with which someone could use the program again, hsa, the director felt very-they wanted to have a complete-once you used it once you can't use it again. they wanted complete ban. that was the feedback from director roar. we wanted the strike a balance. i'm still not convinced 5 years is the right because it seems there could be individuals struggling with mental health or addiction and as they recover more maybe they can be served quicker, but we certainly don't want this to be a revolving door, so i would entertain making the time period shorter, but the reason we made the amendment was because that discretion still lies with the different departments if they have a individual that they believe

they are on the cusp of we can reunify with their family and know they can get the help, we builts in a waver. it isn't a ban, but we have discretion and sure the departments will be able to coordinate with the individuals they know and have constant contact with. i don't think it will be that difficult. the thing i want to emphasize, when we ran prop c a year all most 18 months ago, a lot that was about getting data and having the department have information readily available. happy to hear that there is going to be more information clearly staeted stated how the program is being utilized, how many people are being served. that was the intent. i want to ask director cohen, because last year served about 360 people. the mayor said it is on her radar. happy to know it is on her

radar, but she said they want to get back up to the time period, the number from the period before. do pyou have a plan on how you achieve that to get back up to a thousand people served by this program? >> thank you supervisor for the question. this is going to be a collaborative effort between both departments utilizing all three pathways into relocation assistance and this relies on tremendous amount of outreach to people experiencing homeless, making sure everybody who works with people unsheltered or in shelter and in service is trained and aware of the resource and make it easier to access. so, the mayor made significant reforms last year reinstating the cap, homeward bound program and bringing the program back and it is about getting the word out and making sure everyone who works in the homeless response system knows how to access this as quickly and easily as possible. >> it seems like we might have achieved the goal by getting

this out there, because that is part of the problem, it wasn't being utilized and put forward and not something being offered to individuals so happy to hear that. appreciate it. just going back to the time period, i'm happy to amend and make that a shorter period. i think probably 2 or 3 years probably is the right number, but again, we have the discretion in there of the different departments, so i'm happy to make that. maybe make a 24 month period. why don't we do two years if hsa is okay with that. director smith, did you want to comment on that? >> that's fine. every two years is a fine limit. thank you. >> thank you. i like to make a motion to amend that portion line 19 of page 4 where it says within the previous 5 years to previous 2 years and then leave remainder

language the same. >> thank you supervisor safai. real quick for clarification, is this substantive? >> deputy city attorney ann pierson, no it is not and can be moved today. >> thank you very much. on the motion. >> on the motion to amend, supervisor engardio, aye. supervisor safai, aye. vice chair walton, aye. the motion to amend passes without objection. >> thank you. motion passes without objection. you have a motion? >> yes, sir, mr. chair. i like to make a motion to send this amended item to the full board as a committee report with positive recommendation. >> thank you. mr. clerk on the motion. >> we need to take public comment. >> yeah, right. >> thank you. >> the motion is recommend as

amended as committee report, pending public comment. can we have our first speaker, please? >> good morning. my name is jordan, pronouns are she, they and a permanent supportive housing tenants. you haven't started running my time. i have been circumspect by homeward bound. it is operating as if there are adequate safeguards in place against grayhound therapy. reading the legislation i'm opposed to include [indiscernible] in terms of elg lt for the program. this isn't happening in a vacuum. this is a happening at a moment with eviction crisis in permanent supportive housing, including constructive evictions. what is going to happen when tenants are coerce in the

program? this could undermine goals and push more people out and we have to think about this with a transand queer lens and i am like shocked right now that transand queer service organizations haven't been consulted on this because there could be a chance transand queer people experiencing homelessness or permanent supportive housing tenants will ends up like coerced to go back to unsupportive family in states that literally ban our existence. after what happened with nex benedicts i'm not having this. i don't want trans and queer people sent back to states like oklahoma. we know the supervisor who did this isn't known for doing community outreach and not known for listening to people who actual experiences. this is a disgrace.

i yield my time. f you! >> i think part of the problems is we project homeward bound, it needs to me a total rebuild, so one of my friends, he relocated to hawaii mptd would they help him? he's been in hawaii probably like 5 years now and alaska. if there is a bus to hawaii, let me know. the other thing is, i'm a refugee. i'm economic refugee from the state of illinois. if you were to ship me back, i would need information about resources of work, housing, food, other things and maybe my

family probably doesn't have those things. they might let me stay for a couple months, but other thing is accountability measures. where is the accountability measures to hold staff, anybody accountable? that's the other part are we need better tracking. how are these people doing 1, 2, 3, 4, 5 years down the line? are they homeless there? did they come back to san francisco or on the radar or go to another city? i think the other part of it is, what do the homeless, the people [indiscernible] we don't have anything about that. this in part, but we need a total redesign to look at this to see if it is really working

for people. >> any other speakers for this matter? there does not appear to be additional speakers for item 2. >> thank you. public comment is now closed. supervisor safai. >> just before i move the motion again, i want to state clearly for the record, this is a voluntary program. no one will be forced into this program. this is something that someone has to willingly take and there has to be a loved one on the other end of the line. we are not just sending people to random places. we are not forcing people to go. we want to expand the universe of people served by this, because again, going back reflecting on the walking in the tenderloin this past thursday, there was a individual on the street, distraught and looked like they

were having a crisis and asked if they wanted to participate in the program and they said i have housing, but they were not from san francisco and it didn't seem they had a loved one in the network of support. we want to give people the opportunity to reunify with family if that is a option to help improve their life. i like to make a motion to send this amended item to full board as a committee report. >> thank you mr. clerk. on the motion. >> yes, on that motion, supervisor engardio, aye. supervisor safai, aye. vice chair walton, aye. motion passes. the matter will be recommended to the board of supervisor as committee report as amened. >> thank you mr. clerk. motion passes. would you please call item number 3? >> item 3, hearing on the

status of university of california san francisco's (ucsf) proposed acquisition of dignity health's clinical presence, including but not limited to st. mary's medical center and st. francis memorial hospital, and the impact of the proposed merger on staffing plans and patient care; and requesting the department of public health and ucsf to report. >> thank you mr. clerk. i will pass this portion of the meeting over to supervisor safai. >> thank you chair. thank you colleagues for scheduling this really important hearing today. i called this hearing to address the crucial concerns on the impact of ucsf acquisition of saint mary's and saint francis on staffing and patient care. i thank many workers here today. many nurses and medical staff that came straight-many came straight from work. working night shift and some took time off to be here to

participate in this. while ucfs has a stated commitment to maintaining a workforce healthcare services post acquisition, we can't ignore the significant changes this brings to healthcare in san francisco. this definitely is a change and i was out on the steps this morning in solidarity with the nurses and the nurses united and american federation of state and county employees and share concerns about plans for key services and patient access at saint mary medical center and saint francis hospital. these are two very very different facilities then ucsf current care. they are vital for our infrastructure. they serve many vuliable populations so it is critical we address their concerns early on and get the information out to the public. it is clear workers know what to expect and community knows

what to expect and we have a clear plan how we are going to continue this essential role on this delivery of service and understanding what ucsf plan is for employee, staff, patients for everyone to understand what the implications of this merger are. ucsf and dignity hospital are two named, serve very different populations of people and that is also very important point. evidence has demonstrated healthcare considerations, there is also a concern about healthcare price and all that can have a impact on low income populations, so all that is really important to talk about today. the san francisco health commission prop q report from february 20 concluded that the acquisition won't have a detrimental impact on healthcare service, but we want to make sure that we get

clearly stated on the record how ucsf plans to fulfill commitment to maintain the workforce currently at these two hospitals, saint mary and saint francis and committed to serving the undersever said population. thank you chair walton. i look forward hearing from the presenters today. i'll go over that quickly. we will have ucsf, [indiscernible] going to present, vice president of strategic partnerships. we are going to also have claire altman from dph, is she here? yes. and then we'll have a few nurses from each of the different hospitals speaking and talking about the different vital services and one

representative from the california nurses association speak. if we can have ucsf come up and begin the presentation, mr. it chair, if that's okay. >> just real quick, supervisor safai, i want to remind all presenters you are given a certain amount of time to present to try to stay mindful that during this hearing. >> right. sorry i didn't highlight. i think 80 asked you to stay 6 to 8 minutes for your presentation for the first one from ucsf. asked you to stay 6 to 8 minutes for your presentation for the first one from ucsf. >> good morning. my name is shay strong, i'm the vice president of partnership for ucsf health affiliate network and been with ucsf over

8 years now. it is an honor for me to present before you all today and similarly, and given i started my career working first at saint francis and continued on representing saint francis, saint mary and dignity help over 10 years it is my pleasure to represent ucsf. in my years at ucsf, conversation about accessing care centered on two main topics. the first is that, members of our community want and need care from ucsf and ucsf does not have capacity on the hospital units and clinic and challenges only increased over the years. acquisition of saint francis and saint mary represent a new direction for ucsf to address these challenges and make helt care more accessible to all members of the community. the acquisition offers a path to create a new community

hospital division centered on less complex healthcare service, whereby, ucsf will retain and grow service offered, retain and grow the open medical staff adding both ucsf faculty clinicians and private practice. retain and cr grow employee base, make investment to improve facility and equipment, and continue to provide financial assistance and charity care at the same levels provided at saint francis and saint mary meeting the care needs of patients, most of whom are memberoffs the san francisco community. there is benefit to both the city county of san francisco and ucsf health creating a stronger saint francis and saint mary. to name a few for san francisco this means preserving emergency

rooms, maintaining all services for the unhoused, enhancing behavioral health service and expanding access to key services in some of the most critical points of the city. for ucsf, this means creating more capacity for complex care while deepening connection with community based health services. at present, community hospital confront challenging healthcare environmenting including hospitals in the community rchlt saint francis and are saint mary face challenges including competition to recruit. significant expense requirements to support infrastructure upgrades and investments in needed patient care equipment, and rising costs. in addition, they face significant operating losses. without acquisition by ucsf, saint francis and mary will result in unwanted consequence

including reduction in services and the possible closure of one or both facilities. at present, it is our understanding that combine the hospitals are losing over $10 million a month. again, access to ucsf healthcare is constrained beyond capacity. we are 90 percent full, get more request then capacity allows to managementf we have the largest physician group in city county of san francisco and often no place to see patients. a very busy emergency department and we know a third of our patients could be seen in the community setting. this acquisition is a moment to better service san francisco. saint francis and saint mary will continue to offer the programs provided. ucsf will invest in the peopleal programs and infrastructure that allow to saint francis and mary to serve

patient. enhance patient outcomes, quality and safety by connecting the best of community based care with academic clinical excellence. through this transaction, saint francis and saint mary will be maintained as full service community hospitals and services they provide today will be maintained. saint francis and saint mary maintain medi-cal and medicare enrollment and continue to license as separate general acute care facilities and continue to have a open medical staff. the workforce of saint francis and saint mary is retained with no lay' offs. the staff employed by ucsf health community hospitals and non profit entity that will own the two hospitals. collective bargaining agreement will be on honored and once transferred to ucsf the facility will not have catholic affiliation. we estimate investment of $75

million to hundred mill for deferred maintenance project and needed improvements. as mentioned with this transaction, ucsf is moving beyond the complex specialty care known for to integrated full service health system that includes jeent comprehensive community based care and academic care enabling patients to access the right care and place and time. community hospitals dedicated infrastructure and configuration of services that is different from ucsf health who will replace dignity health as the sole member of what will become known as ucsf community hospitals, a private non profit corporation that own the two hospitals which are part of the ucsf health affiliate network. the structure makes it easier to facilitate a seemless transition of the infrastructure and operation of the hospital, including

maintaining existing license and contract and minimize disruption for patients, clinicians and team members. when we look at the rich history of saint francis and saint mary, ucsf recognize we will be building upon the legacy and strengths. our commitments include honoring our shared commitment to providing quality affordable care to all. expanding key existing service like cardology and surgery in year one, bolster the emergency department and hospital medicine programs and investing in infrastructure upgrades. we are committed to thoughtful peoplesentered transition with safety, stability, minimal disruption and support as the top priorities for what will become through the acquisition ucsf health saint francis hospital and ucsf health saint francis mary hospital.

we hold three community meetings with neighbors even before the deal was closed. we directly connected with all most 30 different community groups and had all most 50ucsf staff participate in a walk around saint francis hospital so we could introduce ourselves to that community and learn about their needs. we know saints francis and saint mary have been deeply embedded in the neighborhood for years and we are committed to continuing the relationships and we have been regularly engaged with labor partners, including california nurses association. we proactively notify labor partners when the transaction announced in july and agreements signed february. we met with cna in october. we responded with request for information recognizing the transaction has not been finalized and provide response october 18 and february 9 and

we are committed working with cna and labor martners going forward. we welcome and will seek opportunities to engage with our community as we continue down the path of ucsf health, saint francis and saint mary. thank you. >> thank you for that presentation. i think you touched on some of the questions i have, but i want to go over some things i heard so bear with me, because i think there is a lot of concern. the first concern i saw you say on differed maintenance, there is a plan to make investments from 75 $75 to hundred million dollars. can you talk over what time period and can you tell me, is that going to address the concerns of seismic safety standards at both hospitals so they can remain full service as you probably know as i know you

know, they have until 2030 to comply with the structural seismic safety standards, unless there is changes in state law. can you talk about that for a moment? >> thank you supervisor safai. so, as mentioned, the 75 to hundred million investment in year 1, that really is basic infrastructure needs resulting in differed maintenance we know we have to make and things like the roof, or critical equipment for patient care. beyond that we factor seismic and renovations into the financial projections. in terms of seismic, we believe that for each hospital the cost is over a hundred million and right now we have dignity- >> [indiscernible] >> each. >> $200 mill for each hospital. >> that is in addition to the- >> in addition to 75 to hundred million. >> that's right. right now we rely on dignity's

existing seismic plans and once we close the transaction we'll conduct our own seismic plans. >> what's the-i understand you have to do the assessment and take existing information, but we are on the clock or the hospitals are on the clock. do you have a commitment to make those improvements prior to 2030? >> yes, we factored those in the financial plan and will conduct our assessment of the seismic needs and assess the needs throughout the ucsf patient care ecosystem to determine timing for investment in seismic. just like we do for our other facilities. >> this plays into the next question, that allows both hospitals to eare main full service which impact staffing. i saw you say no jobs will be impacted, but i want to ask clearly, would any of the

nurses or healthcare workers lose their jobs as a rut of any of the changes in this acquisition and what's the staffing plan moving forward? >> no. no nurses, no staff period will lose their job as a result of the transaction, and upon close we will assess the opportunity to expand the existing services and develop a staffing plan to support that expanded service plan. >> okay. grated good to hear. just so we understand and bouncing around, but you talked about sharing information and putting information out there. are you all planning on having written documents that document some of the things we talk about today in terms of your seismic investment, your financial investments, your staffing plans, your commitment

to keep staffing levels at the same level and expand those staffing levels? how do you intend to memorialize that and to concerns from many in the room today? >> as information has become available throughout the course of the transaction, we pulled it together and shared it with partners, including cna. i mentioned october 18 february 9 we shared request for information based on the data available at that point in time, and through the prop q hear we committed to coming back to report out on the status of the transaction post close and sharing data, again with our labor partners as it is available throughout the course of the transaction. >> when is the transaction intended to be closed? >> so, the target for close is within this current fiscal year for ucsf. the fiscal year ends at the end of june and it would be subject

to a number of factors primarily out of our control. >> right. some time in the next few months? >> yes. >> once that is closed and information will be shared, do ayou intend to have written documents to memorialize the commitments you are making? jurks >> yes. >> what shape do those take? >> i can't comment on the exact shape. >> are they mou with the labor force or how is it you memorialize? >> i think they continue to reflect in the rfi. i'm not aware if we do mou with labor partners but i can find out. >> what is rfi? >> request for information. >> right, okay. i will transition to charitable giving. when you look in 2021 a last year we have data for, saint francis provided $6.9 million in charitable giving and saint

mary, $4.2 million which totaled over $11 million in charitable giving. just those these two hospitals together with that amount of charitable giving is over 75 percent of what ucsf does in the total universe of charitable giving for 2022. just want to hear-i understand you said the level of service, type of care, but is ucsf committed to maintaining or enhancing charitable giving and care at both of the hospitals? >> yes. ucsf is committed to maintaining charitable care about both of the hospitals. >> okay. and then part that is providing service to unhoused population and a lot of the individuals that live in those two neighborhoods or around south of market or tenderloin, so how

does ucsf-how will you insure that the services are maintained and continued to the community of unhoused and how do you intent to enhance those services as you acquire these two hospitals? >> i can speak to our intent to maintain those services. i will say that, with the transaction like this, more and more information becomes available as we move along and so, there are gaps in our knowledge i think will be cleared up as we make closer to close, but it is our commitment as it relates to those services and all services to maintain the level that exists today and i think it is also our intent to expand those services to the extent appropriate if we find out more information. >> okay. and then, subset that, i think one is the burn center and one is psychiatric services.

just want to hear a commitment--the saint francis burn center offers 16 license beds, provides over 3 thousand patient days and 250 patient discharges in 2022. there is no where in ucsf universe of care that offers that type of service, so just want to make sure you are committed to maintaining the burn center and for an extended period of time, fwut is ongoing commitment because that is a vital service not offered in san francisco in any other locations. >> that is correct. we are committed to maintaining that and in fact, there are a number of serves saint mary or saint francis offer that ucsf does not offer, the burn unit is one of them, the sister mary phillip is another, the behavioral health program at saint mary is another. each hospital has acute rehab.

it is our commitment to maintain all services and those that are currentsly offered. >> i want to put a fine point on two of them on top of burn center, one is psychiatric service. if you look at both hospitals respectively, they present all most 50 percent of the entire psychiatric service provided in san francisco county. i are want to stay on the record to continue the psychiatric serve and expand. one thing we talked about prior to the meeting particularly at saint mary, there is a lot of beds unfilled and capacity not fully utilized, so the psychiatric care as we talk more and more about helping unhoused and helping those with severe mental health needs is a important part of the delivery service in san francisco, so i want to make sure there is a firm commitment to expand and

maintain psychiatric care at these two hospitals. >> yes, correct. we are committed to maintaining psychiatric service at both hospitals and any outpatient clinics and also to expanding service as appropriate. >> just to transition to rehab beds, i know that you all-not you all yet, but saint francis, saint mary have 56 licensed in-patient med ical rehab center beds in their delivery of service, and it is over 42 percent of the rehab discharges in the city and county of san francisco. again, i know i'm sounding like a broken record, but i can't emphasize enough and these folks know first hand because they are delivering the service on the front line. these are vital vital hospitals and service for san francisco county.

50 percent of psychiatric, 40 percent of rehab, burn--these are all things that if they go away, san francisco is going to be in dire straights, so just want to again, firm commitment to rehab service and maintain the level of beds and service available there. >> we agree it if they go away san francisco will be in dire straights and we are committed to maintain the rehab beds. >> for extendsed period of time, not just a year or two? >> yes. >> okay. i think one of the last ones is icu. again, here is another example. 37 at saint mary, 10 at saint francis. i think that is over 60 percent of what ucsf offers currently. icu beds. just want to ask on the record firmly that there is a firm commitment to maintaining that

level of care? >> there is a commitment to maintaining the level of icu care and for all services that you mentioned and all the services that exist today, we made a commitment to maintain services in san francisco into perpetuity. >> okay. i want to just give you a opportunity to talk about one of the acquisitions that you all had recently with children's hospital in oakland. go ahead. sorry. >> thank you supervisor safai. just one question to get spec fity because you mentioned making commitment to charitable giving. is the commitment at same or above the level current? >> the commitment is at least at the same level. >> thank you. >> thank you. so, i want to give you a

opportunity to talk about, there was commitments and obligations talked about for children's hospital in oakland when ucsf acquired those and some people that went on the record that talked about that acquisition, particularly dr. pam macky had children about existing patient population, care and talked about not providing service to the same level of care that was previous there, prior to acquisition. and talked about a pattern of--these are the words of dr. pam, talking about feeling as though there was systemic racism after that acquisition, so want to give you a opportunity to talk about how-what happened in that acquisition of children's in

oakland respondsing to the characterization of systemic racism after that acquisition and want to hear what ucsf's position is, again, because this is a very very important acquisition for our city. this is a very vulnerable population. i don't need to tell knin in anyone in the room it is overwhelmingly bipoc so this is something under the micro scope in a big way. i'm not as familiar, but the data and information provided to me in the research i did, there was concerns after the acquisition of children's, so i want to give you a opportunity to talk about that. >> sure. thank you. i apologize as well. i'm not as familiar with the concerns around systematic racism as a result of the children's acquisition. i will speak from a place of ucsf health values to say that,

people are certainly at the center of it. we take diversity, equity inclusion, we take our position in the community seriously, as well as our patients and who they represent and insuring that our staff, our physicians, our clinicians overall represent the communities we serve. and i know that i appreciate the comments that you read off supervisor about reducing services and i know that we have published a document outlining some of the service impacts after ucsf 2014 acquisition of children's oakland and what we want to call out specifically, since 2014 we expanded and strengthen said patient care and services and invested in infrastructure.

just to name a few services that are new or expanded or strengthened, dermatology, rheumtology, jnder affirming care, headache, mental health, heart surgery and list goes on to name a few expanded and renovated facilities, there was a outpatient center in oakland, pediatric icu, [indiscernible] we invested over $200 million in oakland since 2014 with 90 million in outpatient, 54 intensive care and inpatient and seismic safety. oakland campus investments are projected to be over $1.5 billion to build a state of the art facility. >> i think that the just of

what i got is public insurance, those are less means were given a secondary priority or longer waiting line or not the same level of care in terms of even at the surgery level and i understand that healthcare is driven by cost and the ability to provide. what i'm trying to underscore and hear about it in the questions and presentations is that, there is a population of people that are not-they don't have insurance that are indugent and in more need and it isn't necessarily something that feeds the bottom line of a hospital, so this level of care is really really important for san francisco, can't state that enough, and want to insure has part of the transition that will continue to be prioritized

and those with less means will continue to be able to be served in that level of care. >> yes. that is the true statement and i will say, we know dignity health is the largest provider of medi-cal services in california, and ucsf and san francisco sees all most as many medi-cal patients as zfhgh and many other health systems in san francisco and we are committed to continue that. >> thank you. if we have further questions we'll call you back up. my colleagues have any questions other then what--okay. thank you. >> thank you. >> the next we'll hear from is dph, please. claire altman.

and we have you slotted for 5 minutes. >> good morning. supervisor, walton, safai and engardio. claire altman, department of public health and so for today i'll speak to the helt commission review of the ucsf acquisition of dignity hospitals. in discussing the health commission role, i like to provide background to prop q. prop q passed by voters in 1988 and requires private hospitals in san francisco to provide at least 90 days of public notice prior to either closing inpatient or out patient hospital facility prior to eliminating or reduce the level

of services provided or leasing selling or transfer of management. the health commission holds public hearings on the proposed action and through prob q, the health commission makes determination whether or not the action will or will not have a detrimental impact on healthcare service in the community. the health commission does not center the authority to change the proposed action. for this prop q the health commission held two hearings on the ucsf acquisition. i want to note the california tern general has oversight authority over non profit healthcare mergers and acquisition and as of today the ag has not made a determination on this acquisition. sorry, what? >> [indiscernible] >> i have to check on the exact timeline. i know it can fluctuate based

on the size of the acquisition. for the next two slides i'll cover information that was covered by or reviewed by the health commission. saint mary and saint francis are very important community hospitals that provide services to san francisco. some of these services are on this slide, but not comprehensive. it was mentioned, but saint mary and saint francis both operate important behavioral health including the inpatient unit which is the only inpatient psychiatric unit for adolescent in san francisco and saint francis-dignity operate unique service the only bern center in the city. with the acquisitions the hospitals will remain full service community hospitals and ucsf committed to maintaining all saint fwransis and saint mary existing programs and

services. they also committed to maintain the current capacity of both hospitals emergency departments and stated they do have plans for some early investments in the emergency departments. then i also like to just mention that there are some important services that are colocated on saint mary campus but not operated by dignity health and that includes the crest wood behavioral health mental health center and centfield hospital and ucsf said the agreements remain in place. as mentioned, ucsf committed to maintaining all existing services at these hospitals. one thing to note about services is that since the hospital and clinics are no longer subject to ethical religious directives for catholic healthcare nor dignity health statement of common

values, since the facilities are not subject to policy based restrictions some serves like access to reproductive health or direct abortions is expected to expand. regarding staffing as mentioned, ucsf committed to retention of all employees of both hospitals and saint mary and saint francis will retain open staff medical models. regarding patients, saint francis, saint mary and ucsf are important partners providing charity care and caring for the helt care safety net population and stated they will continue that commitment to improving the helt of all vulnerable populations regardless of ability to pay. they stated patients will continue to have access to all services and all providers that they have today and that the hospitals will continue to honor all insurance agreements presently available at saint mary and saint francis. and then finally, regarding the

community, ucsf stated that they have plans to continue regular outreach to community organizations and to elected officials as the process to integrate the hospitals continue. for my last slide, mentioned march 5 the health commission pass said resolution regardsing the acquisition and the resolution concludes the health commission finds the acquisition will not have a detrimental impact on healthcare service in san francisco, contingents upon ucsf maintaining commitment to service, staff, patients and facilities. the resolution is calling for the health commission to receive updates from ucsf health every 6 months through june of 2027 and this will allow the health commission to continue to monitor the progress on hospital integration, monitor progress on commitments made as a part of this transaction including maintain payer contracts and

then also allow the health commission to monitor the impact on patients chiefly the impact on patients with medi-cal, medicare, who are uninsured or may have healthy san francisco and so with that, thank you for your time. >> thank you. i have one question and i want to call ucsf back up real quick. so, your commission said, this acquisition will not have a detrimental impact on healthcare service as long as ucsf fulfills all its commitments. what do you believe the implications are to the vulnerable population in san francisco if they don't fulfill--let's say they only fulfill 75 percent or 80 percent, what is would be the overall impact of san francisco? >> thank you for the question

supervisor. i think so right now we have been told from ucsf is they committed to maintaining all service so that is the basis of our review and understanding is the services are maintained . i think part of the purpose of these 6 month updates is so we can monitor and be looking at what that overall impact is. i think as of right now, whether they full nil certain impacts, we don't know the extent of the impact that may have in san francisco, but that's really one of the purposes of having these monitoring reports every 6 months. >> i guess my question is, we have a lot of eggs in one basket in the two hospitals, so is there a overall plan for the department of public health to look at insuring that there is back up plans and other facilities throughout san francisco?

>> again, with these monitoring updates a part of the discussion with the health commission is always around well then, what can be done or should we have discussion about how these services are fulfilled, so i think again, going back to the 6 months updates, that is where we'll have more information about that. >> you don't have to answer this, but i want to say it on the record for dph's-to consume. when sutter took over saint luke's hospital, it was the only facility in the city that had subacute care, and as part of their agreement, somehow the agreement was silent on sutter maintaining subacute care as saint luke's, so low and behold, they eliminated it and we fought them to maintain that and all we got was a few beds

at another facility. many people died because they were moved, as you know, if you move subacute patients, and dph has been talking for years about expanding that and looking for agreement and pathways. one of the places was saint mary's hospital, because there were a lot of available beds. another was chinese hospital. but we are still waiting and i have been on the board 7 years, this happened in my very first term, so that is what i'm trying to underscore, there is a lot of services here the city is overly reliant on. dph needs to have a more effective plan to look at other hospitals to bolster the services that are extremely concentrated in these two hospitals. >> thank you for that. >> thanks. if i can have ucsf come back up because a question i didn't ask and highlighted on the

presentation from dph was about healthy san francisco. so, this is one of the areas i think in 2021, ucsf and their entire network only served 16 healthy sf patients. that is the data i have. where, zuckerberg general served all most 11 thousand healthy san francisco patients. i just want to make sure that this is something to underscore in terms of the work that will continue to be done, but also want to understand why ucsf isn't serving that many healthy sf patients. >> if i could speak to saint mary and saint francis and the plans in the future. so, as part of ucsf community hospitals, we will contract separately from ucsf health and seek to maintain all payer agreements that exist today at

saint mary and saint francis. >> but, can you speak to a little why-is there a reason why ucsf isn't serving healthy sf patients now? >> i can't speak to that directly. i think there are contracting implications we can talk about in a follow up discussion. >> okay, thank you. i appreciate that. next up, we'll bring some of the nurses to speak. i think first is [indiscernible] and also matt jones. abina is with saint francis, amy with saint mary and matt with ucsf icu nurse and you have a few minutes to speak. >> good morning supervisor. my name is abina a registered nurse at saint francis 38 years. i am the chair person of the

patient care committee. a nurse rep at saint francis hospital. i was actually born and raised in the city. i was born at saint francis hospital. i still reside in the city and raised my kids here. i'm here today to share that workers on the ground have major concerns about uc planned acquisition of saint francis and saint mary. two helt care institutions that have long served as a usual lifeline to most vulnerable communities in san francisco, tenderloin, homelessness and those in need of psychiatric service. there is little detail on impact on critical service line and without maintenance of the subs patient care would suffer. saint francis and mary combined provide about a quarter of the city care to the homeless community. ucsf provided less then 5 percent. this is vacuum of service

should down side. san francisco is in time of need of a lot of service, not less and any less is detrimental to the vulnerable population and the community at large. you should be concerned there is a lack of concrete commitment and plans presented to the public. we the nurses at saint francis and saint mary are not looking to stop the deal, but i want to insure it is done right without leaving the hospitals weakened. for the hospitals to be viable we need questions answered. we alaunsh with community serve to know how ucsf is planning to move ahead and the acquisition and commitment they make to maintain service. this note, i want to say that in the past as a community hospital i worked there so many years, i have seen many transition with different entities come in, chw and dignity health and common spirit came in and slowly they take away little services. just little details. just moving one services to

another facility and not leaving in the present community for the patients to be able to have access to. something like that is very minute, but it makes a difference with a patient that lives in the tenderloin and where i work at saint francis to travel to saint mary hospital. even just leaving small services at the community hospital is important for our patients. thank you. >> thank you so much. that is is a really good point and ask that on the record again. appreciate it. >> thank you. >> next up we have amy prebal from saint mary. >> yes. hello supervisor. my name is amy prebal, the icu nurse at saint mary and been in the icu the last 8 years and started in 2007 as a new nurse from ucsf. i went to saint mary because i like the community. i like the community, i like

the size of the hospital and i wanted to work closely with people and patients in a smaller environment. that is why i'm still at saint mary. i'm the chief nurse up there and also cna member since i started. like al bina said, the lack of engagement and transparency from ucsf over the recent acquisition of saint mary and saint francis hospitals has been trying for all of the staff. we feel very left out of the process, both the planning process and of course solutions to keep our hospitals up and running and successful. one thing we are hearing is, the ownership structure will look like-what the ownership structure will look like, it

will be a two tiered separate entity. this is confusing for nurses. i'm not sure what it means that we will be ucsfu but not ucsf. it leaves us feeling very disenfranchised and of course we like explanations for what that means and why we are not going to be completely part of ucsf. there is also failure to prioritize staff retention and recruitment at both dignity facilities right now, and this should be alarming to the community as well as as much as it to all the staff at saint mary and saint francis. we have consistent short staffing on all units. it is very stressful and work environment is unsafe at times but we are nurses and we take care of our patients, that's what we do.

we are asking ucsf to promise all the nurses in the community that they are committed to hire and maintain safe staffing levels and meet demands of the services for all the hospitals. some things that are also confusing to us is, we don't know what the construction at ucsf going on now, how that will effect the transition and also from the earlier comment about the charity care. we know, we serve under privileged and saint mary especially and elder population that counts on us to be there. and we often hear how much money we lose every month and heard that for years. i have at least. i guess my question is also, if ucsf is going to promise to maintain the charity care saint mary and francis does, but already pointing out we lose $10 million a month, i don't

know how the numbers work and how they will maintain that. that is another question that comes to mind after listening. and that's it. thank you for listening. >> thank you so much for sharing and your questions. next up we have matt jones from ucsf, icu. >> hi. thanks for having us today. matthew jones and been a nurse 12 years and 7 at ucsf. i work in adult medical icu at the main campus at parnassus. like saint francis and mary, ucsf struggles maintaining safe staffing levels. it would not be a viable option for ucsf to absorb additional service saints francis and mary currently provide. our nurses across the board shared they have zero capacity on the ground to fill in the gaps should saint francis and saint mary besxh unviable, yet,

we cannot afford to let the two hospitals fail. ucsf needs to come to the table with clear commitments and drem straight why outright ownership of saint francis and mary isn't something they are exploring. ucsf pursued indirect ownership of affilulate hospital we have seen lack of accountability among leadership. children hospital in oakland, the administration often points fingers at each other when things go wrong. the uc regents are not responsible for oversight there and ucsf claims children hospital is exempt from state oversight. as a result, ucsf over the years hollowed out cho from within siphoning crucial services. we cannot have the same happen to saint francis and saint mary. uc ownership means there are clear lines of accountability and decision making insuring these two hospitals thrive in the years to come. thanks. >> thank you so much.

next up we'll have mike rayborn from california nurses association. >> good morning. thanks for having us today. mike mike rayburn. i have been a research analyst with california nurses association for the past 12 years. i am here to briefly share some of details about the important role saint mary and saint francis play and healthcare infrastructure of san francisco and highlight the needs to protect the essential services these facilities provide to the community through this transition of ownership change. first, i think this has come out in several of the testimonies, the data is clear saint francis and saint mary serve disproportionate percentage of the city most vulnerable populations. especially when compared to ucsf.

saint mary and saint francis have provided care for 27 percent of all unhoused patients in san francisco who visited a hospital in need of care in 2022. that's two very small hospitals within the city providing care to 27 percent that population compared to ucsf, one of the largest hospitals in the city which provided 4 percent of care for unhoused. this is a significant discrepancy i think to put it mindly. saint mary and saints francis played a role in terms of the provision of charity care in the city. according to data from the san francisco department of public health annual charity care report released last year, the combined the two hospitals provided a higher rate of charity care as a portion of net patient revenue then any other hospital in the city, other then san francisco

general. while saint francis and saint mary spent 2.9 percent of their combined net patient revenue on charity care, ucsf spent a fraction that. 0.32 percent actually, which is less then half the state average which includes for profit hospitals. additionally, according to the data presented in the report, the total number of patients that received charity care amounted to 92 percent of patients that received charity care at the much larger ucsf. this is noteworthy, because during that period, saint francis and mary had patient discharges less then 1/3 of the patient discharges at ucsf. that means over the 5 year period covered in the city report, the much smaller hospital of saint mary and saint francis cared for far fewer patients overall then the

much larger ucsf, but actually provided charity care to nearly the same number of individuals. aastonishing statistics and think it speaks to the fact that to the concerns the nurses have about ucsf commitment to maintaining charity care levels and access to care of unhoused and low income patients at saint mary and saint francis. they say they are commitmented but how long is there any enforcement there? i don't want to be too redundant but i planned talking about key service lines saint mary and saint francis provide for the city of san francisco. they have been mentioned a few times, but i'll just-pays to be redundant. the saint francis burn center, only burn center in the city, one of only a few in northern california. for 2022, saint mary and saint francis were responsible for half of all inpatient dist

charges in the city for psychiatric services. that's 50 percent of the psychiatric service for the city in these two hospitals. and lastly, saint mary and saint francis account for half of all inpatient rehabilitation beds in the city and in 2022 had about 42 percent of the inpatient rehab dist charges, so those are just three examples of key services provided at these facilities. of course there is many more and they are vital to the city and they need to be protected and i just want to end by saying that it is important we do all we can now before the uc takeover is finalized to insure we get enforceable really specific commitments from ucsf about maintaining the services and access to care at saint mary and saint francis. the city needs them to be maintained as robust acute care

hospitals, not only now, not only until 2030 when the seismic ratings expire, but decades into the future and we should be able to demand ucsf make those commitments in a enforceable way. they are important institutions and deserve our protection. i appreciate your time. thank you. >> thank you. before i ask anymore questions, because i know people have been waiting a long time, i want to-if okay with the chair, open up to public comment. >> yes, members of the public who wish to speak should line up to speak at this time. each speaker is allowed two minutes . there is soft chime with 30 seconds left and louder chime when your time expired. can we have our first speaker approach the podium? >> good morning.

my name is shannon the director of reproductive freedom for all california formally [indiscernible] prochise california representing more then 370 thousand members state-wide and 44 thousand members in san francisco. also proud member of the bay area abortion rights coalition launched by department on status of women. we are in strong support of the acquisition of saint francis memorial hospital and saint mary medical center which guarantee all patient receiving care are able to access comprehensive reproductive and lgbtq inclusive care. in 2019, reproductive freedom for all california opposed the expanded partnership between ucsf and dignity health due to highly restrictive policies. the requirement to follow either the ethical religious directives for healthcare services or the organizational statement of common values both the erd and statement of common

values are non medical documents that forbid many reproductive health service. ucsf made clear moving forward both hospitals will not be subject to religious directive, statement of common values. all health clinical policies will apply at ucsf health saint francis hospital and ucsf health saint mary hospital, including commitment to comprehensive reproductive care. with the assurance that ucsf health clinical policies will apply at both hospitals, we are pleased to support the acquisition. ucsf is a national leader in reproductive healthcare. we grateful to commitment to insuring high quality healthcare for all san franciscans and all patients who come to san francisco to receive exceptional equitable inclusive care. thank you.

>> good morning committee members. gary, vice prez dpnt of policy and public affairs for life 360. we endorse proposed acquisition of saint francis hospital and saint mary medical center. the staffing crisis in a time communities are losing healthcare options this acquisition will help safe guard local care and provide capacity for complex care. for the sake of community health and wellbeing vital to insure two of san francisco longest service community hospitals and unique service they provide remain accessible. ucsf commit to maintain service and personnel guarantees uninterrupted primary specialty care for patients and integration under the ucsf banner connect patients with world class expertise and cutting edge medical invasion. as we heard, these two hospitals are already in

critical danger of closing and that would be catastrophic. ucsf is stepping up to preserve heth care for san francisco communities. everything we heard today speaks to the urgent need to save these two hospitals. in light of the partnership with ucsf and serving highly vulnerable populations we respectfully urge favorable consideration and support for this proposal. >> good morning supervisors and all the people in the room. couple of you know, i'm in this room a lot. generally when i'm in this room it is 5 different [indiscernible] this is one of the first times i have been in the room everyone is on the same page. how we are going to do it might be different, but we all want to insure we don't lose healthcare for citizens of san francisco. that's why everyone in the room today.

i respect the labor group here today, not because you are a labor group. i don't care about that, but i care that you are all people dealing with patient care and i appreciate you taking your time for be pg here today. everyone of you all, thank you very much. i represent the tenderloin, saint francis is right all most smack dag in the tenderloin because the tenderloin is moving up the hill so the geographic is changing. sooner or later we will be at california street. >> you can have the whole city. >> sooner or later. thank you, sir. it is real aef important to us because as chair alluded, we can lose those hospitals. we can't lose saint francis. most of our trauma and crisis is in the tenderloin in the city. saint francis is 6 minutes away from the center of it tenderloin. ucsf next nearest hospital is 18 minutes away. those 12 minutes is life and

death. it is life and death, so we cannot-ucsf invaded the tenderloin when covit started and been here since. all most daily with their vaccination teams, the outreach teams, the overdose, narcan teams. they have shown me their commitment to charity cases and people in need, so i respect them for who they are. i think we should do whatever we can to make sure it happens and insure there is oversight, because we got to do that, but i want this to be a good thing for the labor groups and the city and also you. thank you all. [applause] >> vice president walton, supervisor safai and engardio, my name is sonia, and some of you know me through my civic and community involvement, but however, in the last 20 years,

i have been the executive director of rally station service at saint francis memorial hospital. this is a program that was adopted by saint francis hospital over 30 years ago in collaboration with the family courts in san francisco. during my tenure, we expanded service to san mateo in marin counties. we are a one of a kind program. over the past year we served over 500 families and hopefully we improve their mental health. this is possible thanks to the commitment, financial and otherwise of saint francis memorial hospital and i am very glad to report, ucsf is committed to continuing the program if it acquires the two hospitals. i'm here to say, this is a

great union. on a personal level i get my healthcare out of both institutions and i'm very satisfied with it and i think that together they are going to make a difference for all san franciscans. thank you very much. >> hi. sor ry, i hate public speaking. my name is mary robert and a registered nurse at ucsf mission bay on surgical oncology union, one of two adult units located at ucsf mission bay. i'm here to raise concern about the acquisition of saint francis and saint mary and uc rap idexpansion across the state. to recruit and retain nurses we must have high fair standsards in all the uc hospitals and this means all newly acquired nurses need to be covered by the cna contract. we are concerned uc has not

committed to include all newly acquired hptds in our state wide collective bargaining agreement. cna recognize at the collective bargaining representative for all uc registered nurses and nurse practitioners. so, nurses working at the purchase hospitals must become members of the state wide cna bargaining unit and covered equally by our union contract. 19 thousand registered nurses and rn represented by california nurse association are committed to hold accountable the needs of our patients across the system. thank you: [clapping] >> hi, guys. my name is mark rod riguez and nurse for 20 years

[indiscernible] [laughter] i want to thank ucsf for giving us more information today then they have since they started this acquisition. [applause] holly molly, i learned so much and just right now. we need more transparency for all this. it is incredible. we are doing our adp today. we are starting moving towards ucsf today. themails went out. as a nurse, i know if it ain't written, it wasn't done, so this is written, it is done. we need to hold them more accountable. health commission, our last acquisition was common spirit. the attorney general held them accountable for 5 years and you're only holdsing them for 2 or 3, so we need more.

that's all i got to say. thank you. [applause] >> good morning. my name is martha cool, a registered nurse for 43 years and spent 40 of those years at children's in oakland. children's had 10 years of experience being taken over by ucsf health. i want to speak today to provide examples of what happens when ucsf takes over there. there are many but will focus on one. my example st. current. ucsf is focus on profit making services rather then other services of up most importance. they expanded projical surgical service and provide increased hours of nursing staff on-call to cover these services 24/7. this is in contrast to ucsf threat to disban the safe team rather then treat the nurses

the same as the surgical services. let me explain what the safe team does. children's is designated site within alameda county children and teens sexually assaulted come for comprehensive medical and forensic evaluation. there are no other provider in the county. in the words of a safe team nurse, provides 27/7 call service so a child that enters acute sexual trauma can have trauma informed individualized care in a timely manner. this is a beacon in our community. this unequal treatment for these two services is offensive and we do not believe that safe team patients should be treated any less deserving of care then surgery patients. the patient population at children's is incredibly diverse, comes from all over northern california, all most all the patients face complex

social environmental and economic difficulties making the care needed more complicated and time consuming. the cost the patients has risen astronomically and the transfer and many patients have to go to the city for care. >> time elapsed. >> [indiscernible] can be seen as a form of structural racism- >> the speaker time elapsed. my apology. >> [indiscernible] [applause] >> my name is gale and i'll read a statement written by a nurse practitioner who termination at children's hospital oakland directly impacted the quality of care for a specialized complex patient population as a result of a ucsf merger. she writes, may name is cary,

registered nurse and work at children hospital oakland my career of 32 years. for the last 14 years i was a codirector of the [indiscernible] in the neurology department and provided direct patient care, case manenment for hundreds of complex patients and the coprincipal investigator on several research projects. in august 2020 i received my annual review with highest possible rating but october of 2020 received a letter saying i are was being terminated. no one in my department was aware of the decision. i was told in a etmooing withmied a ministration my termination was based on utilization percentage, a term i never heard of. following my termination, the administration received letters of support from everyone of my colleagues explaining no one else in the department was qualified to provide the care to the vulnerable and complex

patient population. they received dozens of letters from patients and families expressing distress at the decision. a petition asking the hospital to reinstate me was signed by over 70 families. in response to the support, the hospital proceeded to shut down the clinic. this caused majority of the patients to be transferred to stanford or worse, completely stop receiving the care that they need and deserve. this decision was made because of the administration at ucsf so far removed from the direct patient care and needs of our community. they terminated a dedicated highly qualified provider without considering how it takes away specialty care for vulnerable patient population. this was a poor decision as many of the- >> speaker time elapsed. [applause] >> my name is benjamin and work

at saint fran sss in the burn center and been a nurse in the icu for 3 years and [indiscernible] saint francis and saint mary continue to serve the under served and unhoused population of san francisco at expotential rates far more compared to uc. the two hospitals have specialty services highlighted. one of which is burn center. the only certified burn center in san francisco and few in the surroundsing counties. as a nurse in the center, we want into sure we want to continue we have highly qualified staff, beds, training and [indiscernible] in time of need. as a nurse at saint francis, we ask ucsf to be forthcoming with more information and continue

to-continue to meet behind closed doors and all we get a radio silent. up until today we have gotten radio silence but today more information then we have from all the request for information prior to this meeting. we just want to insure all services remain offered to the unique communities these two hospitals serve and we don't wants any service to go away as a result of the acquisition. [applause] >> good morning supervisor. i'm [indiscernible] a registered nurse at saint francis hospital for 23 years. i work in acute rehab unit and this decision raised significant concerns and ripples of apprehension within our community regarding the future of the essential services and access to care. we cannot overlook the track record of ucsf with such acquisitions as it is worrisome. when it took over children

hospital in oak lbd, service eliminated or consolidated making care much less accessible for patients, especially those from lower income families. we cannot allow history to repeat itself and ucsf has yet to provide satisfactory answers regarding the plans for healthcare workers. we ask for accountability and transparency from ucsf. today we raise our voices not in opposition, but in advocacy. as member ozf the california nurse association we will continue to fight for transparency, accountability and preservation of vital healthcare subs in the community. we call on ucsf [indiscernible] prioritize the needs of our community and uphold the values of accessible and equitable healthcare for all. thank you. [applause] >> good morning. my name is [indiscernible] i

have been in nursing for 32 years, 2 years as lvn, 20 as a rn. i have been with ucsf in the behavioral health inpatient unit since 1998. ucsf must be held accountable and continue to serve the most vulnerable communities. saint mary and saint francis currently care for. instead of privately planning behind closed doors for its own benefits, power and revenue, uc sf must work with nurses residents community groups and city leadser tuesday fulfill the mission to serve the public as a public institution. what are the priorities? my unit langly porter adult psychiatric inpatient had many challenges with staffing and work place violence. i would like to add that we are

reeling from last year's hiring freeze. the shortage of nurses is not that there is inherently no nurses, ucsf said because they didn't have it in the budget to hire enough nurses to keep us staffed according to the law. we are all most-i can tell you every day at ucsf there are units that are functioning below the legal guidelines, so boots on the ground. when i'm hearing about the merger and how we are going to absorb hospitals that are losing millions of dollars, but ucsf isn't staffing what we have appropriately or by the legal guidelines, i can't help but wonder what is going on. thank you. [applause]

>> any additional speakers for public comment at this time? appears to be our last speakert a this time. >> thank you. public comment is now closed. supervisor safai. >> thank you mr. chair. if we can have ucsf come back up. i don'ts want to mispronounce your name. straten. shea. there is a number of questions that have come up subsequentially. and some i think you touched on, but i really want to hear-we need a little bit more clear answers on it. so, first foremost and touched on this a little bit, but i just hearing the questions here today, hearing presentations here today from the front line nurses and others, there is

just a general sense of information not being forthcoming. why has that information not been forthcoming and why one of the gentleman said, heard more today in this hearing then we had the entire time that we have been trying to communicate with ucsf. can you talk how your information flow is happening? how you are communicating with california nurses association and other represented bodies and how you intend to do better to hear the nurses and involve them in the process moving forward? >> thank you supervisor safai. so, as i said earlier, ucsf has met with the cna bargaining unit that represents ucsf nurses and on two occasions, october 18 and february 9, we submitted responses to request for information from cna and at your pleasure, i'm able to

share both of those with you all via e-mail after the hearing so you can see the extent of the responses there. as it relates to dignity cna bargaining unit, since the transaction has not enclosed, we have not engaged with bargaining units at dignity health. we inunderstand dignity health has engaged with bargaining units and we look forward post close to the opportunity to engage with the bargaining units that represent saint mary and saint francis. >> do you have a team that interacts directly with representative labor? >> we do. >> i would just say, i trust that october 18 and february 9 are real and you can provide those documents, but i guess what i'm hearing because i have been on the other side myself, i think there is a opportunity to have a better flow of communication, particularly

when you stated things on the record here today, it is good to memorialize that, put that in writing and present to the other side so they can then distribute that information and get more information out there in a clear manner, because something is breaking down in the flow of communication and would be better to involve them. i understand you are waiting for the closure, i understand you are waiting, but my experience has been, if you engage early on even if that process is ongoing, you can have a parallel process, so i encourage you to utilize that process a little bit more aggressively. the second thing i want to bring up is, there ownership structure and giving you the opportunity to talk about that a little bit more. i heard a few times and not hundred percent clear, so are these two hospitals, are they going to be part of ucsf and will they be governed by the board of regents?

i understand you are intending to set up a non profit, but will that oversight body then report to your ceo which is also subject to state law governance and oversight and the uc board of regents? >> yes, thank you. this is a acquisition. it is not an affiliation or partnership, and ultimately the private entity reports up to uc board of regents. there is no tiered ownership structure. it is one uc and within this community it is ucsf health. >> but, i guess what i'm trying to ask is, will there be a board that's governing these two new hospitals a non profit board that reports to your ceo and then reports to uc board of reej gents? and the board is uc regents as you stated and from there there

will be an advisory board created within these entities that will then include participation by the ceo and will report up to the ucsf health uc and uc regents. >> do you have documents that clearly describe the plans for that as well? >> we da. >> i think that is good to share with representative groups that are in the room so they have a better understanding, because just hearing you explain it again- >> it is complex. >> complex, but just to state clearly, the ownership structure-ucsf will own, it isn't a separate entity but owned by ucsf and governed by. >> fully owned. >> finally, and then hands it over to colleagues if they have any questions. this is something that is not unique to these existing hospitals and ucsf, it is something we are experiencing

in san francisco as well as part of our public hospitals and there is a staffing shortage and a lot of the facilities with nurses and medical assistance and rn's are short-staffed and ask for additional overtime or additional shifts and work in again just from their voice and unsafe conditions, because of the amount of time and work and i just want to give you a opportunity if there is existing short-staffing from the opinion of people that are presented here today, and not safe staffing levels, what's the plan to insure that these facilities will be staffed at the appropriate level? not just maintaining, but it sounds like the need for increasing. >> so, first i want to respectfully say ucsf staffs according to law, and it is our understanding that saint mary and saint francis are also staffed according to law.

i think we are in the process of a fairly extensive integration process where we are now able to start walking the halls of saint mary and saint francis, understanding more about staffing, about the units, the programs and things like that and i think through that process and prior to closing, we will have a staffing plan to support what exists today and then from there build upon that based on expanded services. >> okay. i don't have further questions unless you have anything else you wanted to add? >> i did want to talk charity care because it has been mentioned a lot and a complex topic. i'll read a bit here. the charity care numbers that we report to the city are based on charges and number of patients and include write off for medi-cal patients where services are partially covered

and necessary for treatment. patients impover rshed but not medi-cal we write off all together. write off for medicare patients. in compliance with hci requirement jz those are the numbers reflected today. for the financial statements, we are reporting the difference between our costs and what we get reimbursed. this includes the difference between reimbursement and cost for medicare and medi-cal. ucsf provides a billion dollars annually charity care when looking at uncomp sated medicare and medi-cal service. we provide all most as much inpatient medi-cal as zhgh and more then saint mary and saint francis today. finally, and again, with respect--i just want to emphasize, these hospitals are in danger of closing, and we

are preserving them. we are committing to preserving the hospitals. we are committing to maintaining the staff, maining the services. it is our pleasure to do so. i think there was a question earlier about the impact on the san francisco ecosystem if we do not fulfill our commitment and from a personal perspective i would say that the healthcare ecosystem in san francisco is vulnerable in many ways. any one program not fulfilled can have a significant impact on san francisco overall and that is part of the calculus of why this makes sense for ucsf and san francisco, because if these hospitals do fail, if one of them closes, if the services are down-sized, not only will ucsf be impacted but the community as a whole. thank you. >> thank you. colleagues any additional questions or comments? >> supervisor engardio, you have anything? i want to thank everyone for

coming out. i appreciate hearing from everyone at this hearing and supervisor safai really asked the bulk of the questions i have. when this happens of course we have to make sure that services and patient care is maintained. we have to make sure worker rights are protected. we have to make sure all the services offered at both sites are not effected so i want to thank supervisor safai calling the hearing and bringing us here to get spl some of the questions answered and get the transparency needed when we have a merger like this or acquisition like this, so thank you supervisor safai, thank you for everyone coming out. all the presenters and everyone working to make sure this is as seemless as possible. supervisor safai, would you like to file- >> i'll close us out mr. chair.

i just want to say thanks again for all the nurses. i know many of them not [indiscernible] and share their personal stories and experience in the work place. i know that can be anxiety provoking, so i appreciate you all giving your time today. i think it was wundserful testimony speaking from your heart. we can't learn and know what is happening and make better decisions for our city without hearing from you directly, so i appreciate that and sharing that today. i want to thank ucsf coming and putting firm commitments on the record. we like to see that fallowed up with commitments in writing to the representsative groups that are here. thank you dph, i know you play the role in oversight. we have no say at the board of supervisors on whether this deal happens or not.

there are things we can do ultimately in the permitting and oversight process, but we have no control ultimately over the acquisition itself. i will say it is vital, it is absolutely vital and i learned in this process and want to thank all the people that have been a part of putting this information together from cna and the front line nurses and others in the healthcare delivery field. i didn't know when we started the process how the two hospitals played such a vital role in our service delivery for san francisco. how vital it is in terms of the indigent care, the burn unit, the psychiatric units, rehab-all the level of service many san san franciscans take for granted. you all know because you are out doing the work and phenomenal to hear the level of commitment, 30, 40, 20 years of

service and newly arrived and can tell there is a strong commission and passion to deliver the care for san francisco and i think that makess us one of the best cities in the state of california because so many immolate what we are doing here. we have to insure that there is real commitment. that there is real information being provided and that there is a strong commitment to insure that these two hospitals stay open and maintain this level of service. we have our commitment here today. we will do everything we can to hold accountable, to keep the conversations going and insure that you all feel supported, so thank you mr. chair for indulgeing me today. i know this is a little longer then we had talked about, but i think it was a important piece of information to get out there for the city and county of san francisco. >> i make a motion to file this hearing. >> thank you. on the motion. >> yes, on the motion to

consider the matter heard and filed, supervisor engardio, aye. supervisor safai, aye. vice chair walton, aye. the motion passes without objection. >> thank you. motion passes. mr. clerk, do we have anymore business before us today? >> that completes the agenda for today. >> thank you. we are adjourned. [meeting adjourned]

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>> a lot of housing advocates to speak out again poison pills that president peskin my name is jay the san francisco oregon director for mba action and from the action coalition owe a lot of housing advocates as well as some of our elected leaders joining us to push back against this i want to brieflyt mention this is not unfortunately, the first thing by the had