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>> good morning and welcome to the thursday october 17th regular meeting of the neighborhood and services and safety committee, and my name is david camp os, we are joined by mar, and yee is not able to be here today and i would like to begin by having a motion to excuse supervisor yee. if we can take that without objection? >> also i want to acknowledge that the clerk of the committee derek evans and the sfgtv staff who are covering the meeting. >> do we have any announcements? naoe. make sure to silence all cell phones and electronic devices, complete the speaker cards and copies of documents to be submitted should be

submitted to the clerk. >> thank you very much. >> if you could call the first item. >> item one is a hearing for the outpatient dialysis center to explore the impacts of the patient health and worker well-being of the department's dialysis services are contracted out for the company and the impact of moving it from the current location. >> i have introduced this and i appreciate the department of public health and all of the folks from the city agencies that are here and i want to thank all of the members of the public including many folks it is difficult to make it to the city hall and i understand the importance of it for them and i will be brief and simply say that it very well be that what is being proposed by the

department of public health is the right thing to do, maybe it is the right way to do it. but i do believe that there is a certain significance to what is being proposed and that when someone as important as moving this kind of service is being proposed, that we owe it to ourselves and to the public in particular and owe it to the workers and the patients who benefit from the services and rely on the services for literally their liveihood. to make sure that we are making the right decision and executing in the right way. with that, i would like to ask representatives from the department of public health to please come up and talk about the proposal. and as i understand it, we have rolin pickens from san francisco, general hospital.

and as well as michael herosi who the executive officer of honda and as well as mr. wagner and greg wagner who is the chief financial officer and former budget director of the city and county of san francisco. so, thank you very much. welcome to the committee. and the floor is yours. >> thank you very much, supervisor campos. >> again, chief operating officer at sf general. and i am joined by keorosi the executive administrator at laguna hospital and dr. sam james of the center at sfgh. and we are happy to take a few moments to review the current state of affairs of the dialysis center and the plans that are moving forward and we provided you with a copy and i have brought up the presentation on the screen here.

>> do you have any extra copies for the public >> sure. i got some. i got about... >> thank you. >> 6 copies. >> thank you. >> if any member of the public would like to have one of those proceed. >> you will see in the packet, absolutely, and you will see in your packet, the sfghg center is currently operated by ucsf under a contract and there are approximately 229 patients who are followed by the ucsf and the physicians to provide the outpatient dialysis services. of those 229 patients, only about 197 or so actually receive their services at the sfgh renal center and more than 130 are actually followed by the nephorologists because we

lack the physical capacity to see them. and that would be our preference. and so in terms of why, the relocation proposal from sfgh to laguna honda? it is a matter of space and regulatory compliance. we want to make sure that the patients have the space that they need and the space to take care of all of our patients within our network and not have to have the nephorologists go to the centers because we lack that capacity at sfgh. this next slide gives. >> before you do that. >> i want to ask you something, in the prior slide, have you one of the last bullet is eliminates negative operating financial margins, can you talk about that? how much are we talking about? >> it comes up in a slide. >> okay, never mind. >> thank you. >> and so, again just a brief history, this opened back in

1967, through a grant. and was operated by the ucsf medical center up until 2003. and at that time, the department of medicine and the school of medicine, took over the operation and then also, again in 2003, the department of medicine, transferred operation to sfgh and dph because they were no longer able to do the operation and so dph contracts with ucsf to provide that continuity going back to the beginning of the facility. and in the terms of current operations we have 13 chairs, for dialysis and run several different shifts trying to optimize the capacity. and the shifts were added over the last two years, just to provide more, and so they are very early morning shifts weekend shifts and late evening shifts just to maximize the capacity of those limited 13 chairs. and in addition, to those 13

chairs, there is also a home dialysis component, which is called capd, continuous dialysis and there are about 30 patients who come in to the dialysis center at sfgh to receive their education, orientation and how to do the dialysis at home and they are usually able to,self manage and be able to come in periodically and it is one of the better home dialysis programs in the city and state and they have done a great job doing that. just a brief overview of just some of the data in terms of numbers over the past few years. you can see that the number of sessions has increased as the need for dialysis has increased in terms of just chronic and real disease being and increasing burden on the population and in addition to those expansion of the

additional shifts we have been able to see more patients within those 13 chairs. but at this point, we are maxed out. and we can't provide any more access in the space that we have. and in terms of that space, i think that this is the crux of the issue. in 2010. centers for medicare and medicaid services introduced new fire life safety codes, those codes, for the buildings that currently houses the dialysis center does not meet both the fire and life safety codes and so we have been and continue to live on borrowed time and at any point, when cms comes back to do the regulatory investigation, we will not pass, we don't meet the requirements for the physical, constraints of a building. and a brief overview, in terms of the patients who actually receive services at the sfgh location, and this gives you a

zip code and break down and district break down. and also it shows miles to sfgh and smiles to laguna honda. and so we recognize, transportation, is an issue, and as part of this process, we are committed to doing anything that we can to bring resources to help to mitigate any transportation barriers that might be presented as a result from the move from san francisco general to laguna. >> can i ask you about this slide, what does it mean when it says ward 17 and com sites? what is the difference between the two? >> the award 17 is the building, the building 100 at sfgh, that is where the current facility is located and community sites represents the number of patients who are followed by the sfgch but they are actually out in the

community sites, say north beach, webster street because we don't have the capacity to follow them at sfgh. >> thank you. >> in terms of transportation, those patients who are currently coming to ward 17, this is the information in terms of how they get there currently as best as we know it. about 40 patients are using a van service. and about 12 come by private car. four have been from our behavior health center on the sfgh campus and so they come over for the dialysis service and then go back to the center. and you will see a vast majority are shown as using public transit. in terms of again, the issue of transportation and relocation from sfgh to laguna, one of the advantages that we see is that laguna is right there at the

forest hills station in terms of muni transport and that laguna has expanded their van service to the glen park station and i am looking at this is that still in place? do we know? okay. and so, that is actually still in a planning process. >> okay. >> and we have information from those that go to laguna honda and in terms of those patients on public transportation that might continue to choose to go via that method. in just a couple of slides in terms of how does the current sfgh center compare it other centers in san francisco and it is right at the top. we perform as good or better than most of the other sites and that is a testament to the staff.

at the center. some other related issues in terms of the current situation, at sfgh. we will remember that voters approved proposition 8 a rebuild san francisco general. that rebuild was only for the in-patient acute services at the hospital. and ideally we would have loved to have been able to put a new dialysis center in that building. but the bond measure did not include financing, nor did the designer of that building include that. and we have just a couple of statements from our david pierce, the physician over the renal service, and niel pope the chief of medicine that talk about there being no significant difference between sfgh community dialysis centers. >> supervisor mar? >> yeah, on the prop eight bond that i know a lot of people in

the audience supported, why didn't it include, critical services like this in the bond? >> yeah. my understanding at the time there was concern about the size of the bond measure. and that in order to keep that bond and measure at or the lowest cost possible, only the most essential services that are required by regulatory bodies for an acute care hospital. because remember the whole point of the seismic safety laws was for acute care hospitals to meet seismic standards for the patients who are not able to self-rescue or ambulate. so the decision was made in order to minimize the effect on the city taxpayers of that pond, only the essential things are going to move. for example the dietary service for that new hospital will actually remain in the old hospital because it was not essential, and required for regulatory purposes. >> who made that decision? >> that was at the highest ranks of the department of

public health and the mayor's office at the time. and the health commission >> the mayor and the department of public health? >> my understanding is that the appropriate and i was not part of the process. i know from what i have heard, whatever the process is for determining how bonds are put together for the city there was a back and forth. >> and why would not a dialysis renal service be essential service? >> well, it is essential but it is not for acute in-patients that new building is focused on acute-in-patient services. >> okay. >> and in terms of reasons for the rfp... >> before you do that, do i want to follow up on one of the slides because i want to understand, and make sure that i understand this live, and go back to page 7, and as a understand, the columns, where it says, miles to sfgh, that

column basically shows you the distance that folks and war in 17 and the community sites have to travel to sfgh, right? >> that is correct. >> and miles to lagno. a honda. >> and that shows the miles this they have to travel? >> that is right. >> kie get my math wrong but just based on this it looks of the 97 patients that you have, at ward 17, 92 are going to have to travel much father, to laguna honda than they do to sfgh. 92 of 97. >> that is correct. >> and then, if you look at the other column of 132 patients that are community sites, of the 132, 123 of going to have to travel a much longer distance to laguna honda. >> that is correct.

>> and in terms of reasons for the rfp, the city is, it is dedicated to making sure that we have a facility for our most vulnerable patient and in particular those that have been coming to sfgh for many years for their service and it is a matter of how we can consider to have the regulatory compliant and seismically safe space and in looking at all of our options because there is no space at sfgh. that laguna representing the benefits of the hospital have a lot of unused space that meets the requirements that we can relocate the service. getting back to the question about finances. and you will see the number at the bottom where you see the revenue of loss and gain, represents the actual operations of the unit in terms of expenses for labor, and

supplies, and verses, reimbursements, from the third party payers and it was just a slight loss and they actually do a great job considering the space constraints that they almost break even and in addition to that the $10,000 loss, under managed care, we have several patients because we don't have the chairs at sfgh, that have to receive our services in community sites and in the department of public health has to pay for that out of the payments so about $20,000 a month in out of network costs because we don't have the space to do it at the hospital. >> so am i correct in saying that money is not a big part of the consideration? >> no. >> it is very small. >> this is not about money, this is about we are on borrowed time, at any moment, cms will come in and they are already two years overdue for their inspection and when they come in we will not pass. and they have the option to shut us down.

>> okay. >> i think that we have talked about the time, well let's look at the time line in terms of... so our plan has been to hopefully have relocated to laguna honda by now and knowing that we were on this borrowed time because we are due for our cms survey, actually two years ago and so we are expecting them. but we have developed this rfp, the process started over a year ago. and the rfp was let by dph and it is actually going through the process now. >> was the rfp, ever presented to, or discussed or voted on by the health commission? >> yes it was. >> and i would just ask, the members of the public, you will have an opportunity to comment, if we could let you finish. could you tell me when that was considered? >> i don't have the right exact

date in front of me. we can certainly check with the secretary of the health commission, but it would have been around, i believe, april or may or june of last year. >> so they actually voted on this rfp, >> that is my recollection, correct. >> that concludes my formal presentation and i am happy to take questions. >> i have a number of questions for you, but i want to make sure that supervisor mar, do you want to? now you are moving the dialysis center from it because of the fact that you are not in a seismically safe building, and are you moving to a seismically safe building? >> yes, we are. and in addition to the seismically safe, it is also, a matter of expansion and we get to go from 13 chairs up to 30 chairs, and so that we can

bring those patients back, who are scattered throughout the city, buzz you have to realize that there is also a burden on the physicians rather than being located in one spot, they have to get in the car and go and drive here and there as opposed to having more comprehensive care in caring for those patients in the facility. >> i have heard from folks who said that you are moving the center to an unsafe seismically unsafe site. and so, as far as dph is concerned that is incorrect. >> that is incorrect. and the architects and the building experts, have all evaluated the building. and it meets the seismic standards. >> okay. >> i am really bothered by the earlier number that i talked about in your presentation. and i am really bothered by the fact that it is, that it is 132

patients that 123 of them are going to have to travel much longer distance. of the 97 that 92 are going to have to travel a much longer distance. and so can you walk me through the steps of you know, how, did you explore the possibility of staying at sfgeneral and sort-what did that exploration look like? >> absolutely. so, if we had it within our power the facility will remain at sfgh, meaning that if we had the space to put it and i know that both of you have been to sfgh and done tours, and we are definitely landlocked so some have said, well when the new hospital opens why not move the center into part of the old hospital? which is a valid question. and which, could probably work. however it is going to be a matter of timing, the new hospital is set to begin operations in december of 2015.

with people moving out of the current hospital at the beginning of 2015. so about a eleven to 12 month process to move the people out and then there has to be renovations, and configurations of a space to accommodate. and there also has to be the funding to pay for that. and as you also know, dph, there is a plan to make that old building an amblatory facility similar to dialysis in terms of moving other clinics on the campus into that building. but at this point, it would probably take another 3 to four years before the plans could be done, the funding could be found to actually reconfigure the space in the owed hospital to accommodate the unit. >> why would it take so long? is it an issue of funding? because you said that it could probably be done and it could

probably work? and so, if the funding is available, what would... >> having the funding would definitely make the process go a lot faster. and how much are we talking about? >> the cost to build it out at laguna is 5 billion and we will have to run the numbers to see if it will be any more or less at sfgh. >> you are going to spend $5 million moving it? >> no the contractor will bare the cost of doing the renovation and not the city. >> did you guys consider doing an rfp where the contractor would bear the cost of doing what needs to be done to allow the center to stay at sfgeneral

and go in the existing hospital space? >> that was not one of the options we looked at. >> why is that? >> well, this is the current plans for the old building, include moving of the other clinics from the older brick buildings on campus so that we can have one big ambalatory care center like most hospitals do. >> so all the space has been planned for other essential services like dialysis that occur in the other parts of the building like the clinics in ward 86 and 85 and family health centers and specialty and those are planned to move into the old building. >> and did you consider any other options in terms of staying within the vicinity. did you study any other options? >> yeah, we actually had real estate... were there options to us to lease the space in? there were not any that met the

requirements to really expand beyond the 13 chairs, >> and is this from the real estate here that can talk about that? >> no we just have dph. >> do you have a report from the real estate on that? >> no i don't. we will have to go back and look for that. >> okay. >> supervisor mar? >> yeah, i just had a couple of questions, i know that the space and meeting the cms codes are critical, but i am going back to the slide that supervisor campos it seems to have the 97 people from building 100 or 132 from the community sites to have to travel so much longer, if they were healthy, just normally healthy people, that to me would maybe be a little bit of

an inconvenience, but these are people with kidney failure, and i know that there is a van and a private car or a vehicle processed, but it just seems, if you bottom lined the whole thing and cost benefit analysis and consolidating in one spot and you could save a lot of money, but it seems to me there is going to be tremendous suffering for this 97 and 132 people, especially if you are from the inner mission, out of missioner and where the lion share of people are coming from. do you factor in these human factors of suffering when you do the bottom line analysis like you have done. >> absolutely. we are in the healthcare business and we are here to take care of patients. and i agree with you, i think that there is a burden of increased travel distance. and i think that it is incumbent upon us to take whatever mitigation factors that we can perhaps in terms of shuttle service, or from sfgh

to laguna so that the folks are not having on their own to provide the support that they need to get from the current location to the new one. >> and then it is my understanding that people that use the dialysis unit may use other services at sfgeneral as a place where there is a lot of other types of health services, is there similar services at laguna hon do. laguna has began to increase the number of especially clinics that they offer on site. and so right now many of the specialists actually have the clinics and i think that is something that we can look at going forward to see if that can help with that process. >> good morning, supervisors. from laguna hospital. >> could you speak up please? >> yes, i will. >> thank you very much. >> 2010, laguna honda moved to

this new hospital and we have a clinic space that has... we have 13 exam rooms and we have special care clinics that roland has spoken about and these are ucsf physicians that come from san francisco general, orthopedics and plastic surgery. and trauma, and plastic surgery, dermatology and we have got, about 23 different clinics and cardology is the latest. and the latest additions that the physicians come to the hospital. and in addition, in terms of proximity, we do work with ucsf and the renal service at san francisco general, and it is run by the su. csf renal service, and we are more in proximity with the ucsf with the medical center and who they work with in terms of referring

to potential transplants also and so that, different benefit in terms of proximity. >> did you survey any of the 132, or patients did you talk to any of them about this option or proposal. we have not. we have had discussions with staff and presentations at the joint conference but in terms of surveying patients. no, we did not. >> why would you not do that? obviously staff is going to be impacted and it is good that you spoke to them. but why would you not talk to the 132 people that are ultimately are going to be the ones that are most impacted by this move? >> i think that in hindsight we should have done that, and that is a mistake that we made. >> i mean the