thank you. >> commissioner sanchez? >> i would just like to thank everybody for coming out this morning, and sharing with us, your dialogue and your concerns and pertaining to this unique collaboration. which is now been under way and which has some unique challenges, which were brought out by our staff and also, emphasized and highlighted by a number of you, representing various parts of the challenge here. it is large, and that is a given, not only the building of the hospitals and the retrofitting of the hospitals and the quality, and the patients that are brought in all over the world, etc., etc.,

but, you know, the competition among the various campuses, whether it be cpmc, or whether it be the old catholic hospital west or kiaser or ucsf, one of the major things that it was brought in many, many years ago, was sort of an incentive to have the staff and our post docs and our medical students, and our health science students at ucsf, use the old bart ways, or shuttles, or anything to not impact the campuses and the cars, etc., etc..

it is something that should not be on the radar and it should be a given and let's move forward on it. and the part that really, you know, it is still, you know, it is still, and again, it has been highlighted again, and how do we have, still and the fact, that, and in our department, the health department and in the presentation, that was excellent, and we need to find a way, there was an effort because of this intervention, to have to see if they can develop a comprehensive program to provide the services. the same time that we heard from them saying that they have been working with cpmc in doing a great many things, including collaboration now, and the

public health and etc.. and i think that we need more discussion and dialogue on how in fact we are going to collaborate to insure that and to provide and open up services in the tender loin and here we are still not done, it seems to me that they have a unique challenge and a great opportunity. and i think that the comprehensive services are provided for the unique community and shifting over to the mission, and saint lukes, and my gosh we had our chair of our commission and others and, we had the doctor hernandez at

that time and serving on the supervisors and serving on a joint committee, to work on the saint lukes issue, and it was a positive program, and we talked about out comes and quality care >> and it was first and the to develop the family practice, program, along with

san francisco general and ucsf. and sort of to eliminate this as we are going to rebuild and to continue to build to saint lukes and when of course, this is now, this is being navigated as a latino cultural center, and this is, something that you are really need to think about, and i mean that i think that this is a very important area that you need to think about pertaining to how we are go to provide the services and going to continue that we have done for years and years and years. and this is something that we will be discussing for the health commission, and out comes and etc.. all that i am saying is that i really think that we are not voting on anything today and i was informed before we came, but i really think that this was a fantastic opportunity to

listen and say, you know, it reminds me and saying, that we stand with the pride and we view it with alarm and we have a few challenges that we are going to work on and we are going to navigate them to make sure that patients and san franciscan and the quality care is a flag ship of excellent pertaining to the collaborations that are under way. and we have some reservations that we are building, in the high and sf general and we are pertaining to the particularly the workforce and it will see that we have ak celled in the reference to all of the areas that we were asked to comply with. it was not built in one year and it takes and as we heard today it was sand there instead of rock and well that adds to the thing and then you need the certain jobs, that you have to be trained and retrained, and we saw it here as the community, and as the high

school years ago. it takes a collaborativive and a community to provide these excellent service and so at this point i would say that i feel that we made some major headway and i think that we are in it together and communicating, and i really look forward to next year's reporting. and the out comes but it is going to take the unique work and the area which is a fantastic place and that did not happen, and so we will work and we will provide what is second best and this protocol that we can agree to and we will provide the unique options for san franciscans. and so, again, thank you very much for par participating, in this

that go -- that is not a flip remark. there is a value of dollars. that's fine. you have to figure out how you cover it and there is a value of integrity and there is the value of social and economic and health equity. i think it's exactly that particular different set of values where we are having some major issues. i would agree with large number of the health commissioners observations that we have health equity concerns and issues that are resurfacing right out of the heated battles i sat in for i don't know how many years here and

the same issues are resurfacing and there would be a proactive effort to move forward and really shine because the negotiations were painful enough considering what effort everybody put into this and i'm unhappy but i'm also on the flip side confident that there is enough common ground and enough stick in the development agreement to see a better or more stellar performance in the next year. those issues are in the area of proactive attitudes towards medical short falls in the tenderloin, the issue with saint luke and particularly with diabetes center and staffing

and health care for culture and linguistic activity and there would be 18 -- increase in personnel particularly to what we are trying to do and the generations of people being born in this country. there should be a large number of people who are not only capable of two languages but bilingual in health care and those particular areas particularly for mothers and diabetic and there is an extra level of sensitivity that go beyond translating. i myself refuse to go to an office where somebody else has to stand by to translate what my personal issues are. going to the doctors is an issue itself. i'm glad that we do not have to vote compliance but i am looking inform -- for an

increased level and from the planning department etc to really work more closely on compliance and the issues in between. again, as always i'm sitting here as an english second language person. the accuracy of what we say and what we do when we say that we do and when we do what we say and doing it are extremely important particularly to get back to my initial point, the number of people which came together to craft this development agreement commas the most diverse backgrounds and the largest number of different objectives of what needed to be done. it is now in the follow through and by the extra energy that everybody spends to make the next year the most successful reporting period in front of these commissions.

>> thank you, i'm going to ask a few questions and then ask dr. chow to please give some closing remarks. so on the issue of workforce, i have some questions, i assume for either miss simmons or another member of staff. the specific period that this report covers is the 2013 period, but we received some numbers that came through into 2014 i believe that's correct. so i understand there is this 2-year rolling period that gives us the ability of finding an average but we have the jobs going into 2013. what i want to understand is are there specific number of jobs with no. 13 that we need to catch up or i forgot, the 13 rolled over, what time period does that cover. i want to get a sense when we see it neck -- next

year what was the 2-year time period. >> because i don't want to miss speak, i'm going to refer to my staff for more details than i do on specifics. >> okay. thank you. >> so, the hiring year is actually from the beginning of the d. a. so it's 1 year from august 10th. that is the hiring year. the compliance report that cpmc is on the calendar year. what they were reporting was not a full calendar year. what we were reporting in the report was through the year and the hiring year was not over, now that the hiring year is over they are now at six jobs. the 13 jobs from the shortfall from the first hiring years, those have rolled over to this hiring year. >> we have 10 reports total for this process. every year we hear

from the number of jobs from august to august? >> yes, just to date for an update since the second hiring year has started we have 5 new hires. there are two additional hires in november and december and 5 offers made. two residents since the end of october. so we are seeing a positive trend in terms of the number of residents hired into cpmc jobs. >> okay. thank you. i heard a number of concerns today from staff on a number of different topics, i think it would be helpful, staff, i don't know if you want to at the end summarize them and let me know if i heard more or overstated any. clearly the catch catch up on the entry level and the

cultural competency of staff with language interpretation, the tenderloin medi-cal provision and the charity care commitment. all right. so i will leave my comments there and ask. i think actually, so commissioner taylor thank you. in the interest of time i will be brief. i want to testify today. the both are instructive and informative. thanks for that. it seems that a lot of what i'm hearing boil down to a social justice issue particularly when we think about jobs and hiring, it's

important to all communities. it doesn't seem to me that it's something that is so out of whack that we can't fix it. in light of that i would like to put that on the table that i would really like to have more thought given to how we meet the goals in a city like san francisco. i would like to ask from the director, he mentioned barriers removed, i want to know what those barriers are whether they are perceived or real. >> for employment based on what we see because we are seeing folks coming and they are not moving up, there is a more reality to it. so maybe not when you apply for cpmc they look at your minimum qualifications and sort of the next level is i don't want to say preferred, i forget what the acronym is what they used but to make

sure the resume really brings out all of your experience is one thing. so how your resume is worded, how you interview. we've gotten a lot more information from cpmc and what they are looking for for the positions that we have seen. making sure that because it's a process, it's not like you interview and you get an immediate call. there is a couple steps. to make sure there are steps like that. i think i hear what you are saying about the perception and the reality. we've had discussions with the community too about making sure that the, for lack of better way of saying it, the blame why someone isn't hired isn't solely the job seekers fault because that becomes the perception and that becomes the folks reality, but to not make that the reality but to really talk about skills and experience and

compatibility for the positions. so it's a win win for the job seeker and the employer and to make sure that balance is there. we've done a lot of work and the funds that are going out from sf foundation are going to be to support that and over the last several months we've sort of done a road show in partnership with cpmc to train on organizations on what the employer is looking for, how you want to prepare your clients and we've done that before, so for us, that's important. and conversely cpmc has received a lot of education around sort of our cbo's and how they prepare clients for opportunities not just theirs but broader type of training and skill development. i feel like we've gotten

stronger but i have heard comments around trust and perception and cultural competency and obviously that's a big part of the work that we want to do moving forward and the funds that we have to focus on. >> thank you very much. the counseling medical center also has the responsibility to ensure those structural barriers are removed. when we heard from the three gentlemen who had three interviews and no feedback and you have the community to ensure that we have the people in the community who get the job and they are discouraged, that's a problem. so we need to fix that. >> yeah, we hear it. >> thank you. >> thank you. commissioner richards? >> just quickly, those kinds of things we are talking about happen everywhere. the company i just came from apply and they have an interview and it takes forever and they

never hear back. specifically the feedback to why the candidate didn't get the job or you should hear within 6 weeks would help them build their confidence and help them build that skill set for the next interview. >> again, on behalf of the health commission and the planning commission we thank the public and we thank our staff which has produced a report from a very complex d. a. that i think simplifies sufficiently that we were able to have meaningful dialogue on the key issues that have a risen. i think commissioner moore has already spoken and discussed on where the issues lie and we have very specific issues that our directors will need to weigh as to whether we are not is compliant or not or a c grade or d or f or even an a. we have nine

more years to go and those of us who probably lived as commissioner moore and i and commissioner have instructed. as we are speaking of and as we are looking for the rights that our citizens and residents should be experiencing under the benefits, the economic benefits related to the development of these projects, i think we did and i believe that our commissioners were very pleased to hear that we handle off sight what these projects are for. these projects are not to create jobs only. they are not only to have

gleaming structures in neighborhoods. they are really to deliver the care that we then and i commend my planning colleagues for recognizing that the issues of cultural competency, the issues of the need to reach out and be sure that our indigent and our most needy are going to be cared for is what this project is about. it maintains us definitely as a world class center and i have supported that san francisco is not only a world class center but with the addition of the strengthening of cpmc and even stronger world class medical center. but we can't ignore therefore what this is about. cpmc in its

own motto, we plus you. the you is us. the you is not only pacific heights and not only mission bay, the you has to be and that's what we are today focusing on, the you has to be our tenderloin also. our mission district, our chinatown, all of us need to benefit, all of us need to be able to participate. and i think that's what we've all spoken about. in that relationship and without numerating the issues certainly that the health department feel are in question and can be strengthened. we have an opportunity as so many have spoken up here from supervisor campos to commissioner moore to bring this, to continue to bring it together so this is not just some sort of grading opportunity, but that we move it to a

more proactive type of relationship so that we actually can answer the questions for which these issues were framed and while they then came out to be more mundane about $3 million here and a clinic over there, what our bottom line is as i said before, how do we deliver that care to these people all the way from cultural competency to a process in which we can make sure that those living within the shadow of van ness actually feel they can get added care than what they are getting today. we don't have all the solution, but what i'm going to be asking our department and our director is that we are not just going to simply follow a time line of the d. a., but we are going back to where we had a collaboration, way back several years ago under the resolution that

was created with our institutional master plan. and ask that our department work with and use our resources along with your resources at cpmc and within the rest of the city to try to answer the needs that have been spoken to so that the next time we come back, we will be celebrating that there is no question. this is an a report card rather than us trying to decide did you meet 8 out of 10 simply on compliance. we recognize as a timeframe if we were merely to only look at waiting for a report and then finding the problem really leaves us years behind. we need to actually work on it today. so within that i'm looking forward to our colleagues at cpmc to once again -- reengage during

the d. a. process we allow that to happen because it needed to get worked out, but i think it's time for our department and you heard from our commissioners said it's time to step up and make sure that we come to answers and that we will work together to make those answers. we will be looking forward in the coming year before our next meeting here to actually get continued reports from our department and we'll be asking our department how we can help so we can have like i say class a answers to all these questions in a year from now. so, once again, i thank the public. >> absolutely i want to go ahead and move forward with the director. >> thank you very much. i just want to add my thanks to everyone who came out and to both commissions.

as you know garcia and i prepared the report based on the hearings to the board of supervisors to provide feedback whether on the compliance issues with the development agreement. if i may, i just, it appears to me what i heard from both commissions today that regardless of technically whether they are in compliance with each provision per say in the code that there are several issues that need to be addressed. i think it's fair to say that we will highlight those with the board and i think president wu highlighted those and in my note there were four issues that were highlighted that both commissions mentioned and one is the entry level issue jobs and the competencity with language and the overall issue of charity care and fourth the issue of tenderloin and how we get at that issue whether it's through a partnership with the clinic

as proposed from the d. a. so what i propose is we address all of those four issues and not only are they issues to be addressed but as much as we know about how to be addressed in the cottage year -- coming year in the coming reporting period and we'll get back to you in the coming weeks. >> your concerns, state your point about saint luke and include the discussion about the structure of the diabetes center. i heard the majority of commissioners on both commissions agreed that is a concern. >> i believe from the appropriate concerns around the diabetes center. >> why that was mentioned it

would help. >> thank you, director. >> i look forward to working with director ram and i want to thank the commissioners because i worked with you during this process and will is the community along with cpmc. the department of course has the development agreement and we have the responsibility to provide this overall health in our city for example with the ebola response we worked very closely with the hospital and made site visits to make sure they were prepared. we are obligated to ensure that when we hear things like diabetes and cultural competency i think we can work closely with cpmc and a stronger way to ensure that they are culturally competent. i don't see why i can't work with them closely to ensuring them. also the mso issue in the tenderloin, i think we can