other private hospitals in san francisco. we would work with cpmc -- >> and ucsf, kaiser, we all have responsibility. i want to have that shared responsibility including what cs doing. it's not fair for us to just pun cpmc. they have capacity outside of ts county and that's not going to r this situation that we're in to. >> we're talking about san fran. you said you would be -- maybe c would could work with st. mary'. >> not just cpmc. >> supervisor safai: you were lg the entire network of hospitals. i'm exite exit committed to worn that. we'll find the right level of sr subacute care here in san franc. mp thank you. >> supervisor safai: any other questions? if we do, we'll call you back u.

one -- all right. >> thank you. i have a couple of questions. you said we have 782 skilled nug beds at laguna honda. do we have any capacity there fa execute beds? and when we did laguna honda ann francisco general, why did we nt include subacute beds? it seems as though these are pre hospitals are owned hospital fas where we have an opportunity ase building and remodeling and sins has been a problem, why didn't d some? >> i believe it's the cost in tf the number ever bed of beds we f money. the psyche beds never went intoe building because of cost factor. i can take that responsibility s of the fact that we did not buit

for subacute beds within zuckerg general and some of that was ban the amount of space that we had between -- if you see where zucg is, it was a challenging new spr us to put a new hospital there e of the things have to stay behi. no, we did not plan for that ane did not have installers for that laguna honda. >> i know that -- when i first s appointed to the board, the thig i think i voted on was a parkind research facility at zuckerberg hospital. i'm wondering if we had -- if we any space, could we create one? if it wasn't -- i understand ths cost. there is a cost not to have the. >> absolutely. >> i think to put them on privae hospitals, you're right, it is o put it it all on cpmc, we shoule some responsibility as a city ay

to have some of the beds also. are we able to create at general hospital now any beds for acute? please stand by. do we have a number that all the hospitals that could have beds.

or to be relicensed to have beds or do we have a number or report about where we're at now and if any hospitals could be relicensed to have these beds. >> that is part of the extra edge tooic plan that we're doing and right now we're working on the short term plan with st. mary's, knowing they have sub-acute space today. >> ok. so, do you -- so you're preparing that report. you don't have those figures now. even not just with st. mary's, but for long range so we can get a larger picture of what we're dealing with here. that is part of your extra edge tooic plan? -- your extra edge tooic plan? -- your strategic plan? >> that's right. and one of the reasons we're building new buildings there like the search sfrr is because all the other buildings are very safe and so it's a host issue regarding building more sub-acute beds on the campus. but that would be a bond issue for us to discuss for the future in terms of how we do that, if we wanted to do that.

so, that's clearly another option. it would feel to me a little more expensive than trying to look at the other spaces that we have in the community. >> sure. i think that the whole way -- i think that we can also -- it's great that we're part of this hospital's council, quite frankly. but this is something that we should really be looking at. if the city is -- i mean, if he know that there is a shortage of sub-acute beds everywhere and that we hold the value that patients or families of sub-acute patients, we want them to be close to their loved ones, then i think that we should be looking at what that cost would be to -- to remodel or renovate, whatever, those older buildings so they could be sub-acute beds and how many beds could there be? there's also a shortage, i'm assuming -- i'm hearing now and i've heard before through this other presentation we've had before -- on skilled nursing facilities. and so could we do more

sub-acute and skilled nursing facilities at the hospital if we were to renovate some of those buildings? >> i think it would be very cost prohibitive from the research that i've done on this campus. as an example. it would be much more expensive to do that than other locations. >> let me finish. >> sure. >> would you have a nonprofit provider in the community who does have acreage and land that they're willing to use in these facilities. it's part of the plan and will include the department's responsibility as well. and i think if we can do that in the most affordable way, support some of the groups that -- the nonprofit groups that are willing to do that. we do have lands in laguna. there has been discussion about assisted living on that campus. that was one of the first plans that was not being -- we could not put that into the bond.

when laguna honda was rebuilt. we don't exclude ourselves from the solution to the problem. and so we would be part of that solution in terms of that. but trying to do it in a costly and the most effective way possible, it would be the trajectory that i would put through. >> and do we have any relationship to the veterans hospital? >> we do not. and that's -- we're a difficult group because it is a federal hospital, but clearly we can work with them as well. >> because they also have a lot of land up there. >> yes. that's right. >> average 22 acres that is there. >> so, again, going back to this issue, though, it's always a short-term need that we have to have. we have somewhat of a focus on st. mary's. and then there's the longer term issue because if you ask me to build something today on the campus, it would take me five to seven years to get that completed plus million and millions of dollars for seismic

upgrades because there is historical buildings, which is why we did not rebuild those to build zuckerberg general. so i think there are more effective ways and more cost -- through the artists, costly to meet the same need. >> i just think that this is a population that will grow in our city and i think that it is a population, especially the skilled nursing beds also. sub-acute also, but skilled nursing beds and since there is a shortage already, and there is a shortage regionally and even statewide, sub-acute beds, i think that we're always going to have the need. and i think that as the city and county of san francisco, that we should be leading sort of the capacity for this because actually i would love to see the cost analysis of how many patients we pay for and -- >> [inaudible]. >> and the cost of at this time

and i just think that this is a problem. and i get that we're doing short-term. but actually i'd love to see long-term planning. because if we discussed this seven years ago and had a plan, we might not be in this situation now. i was actually a little disappointed to hear that with laguna honda, there wasn't any remodeling for sub-acute beds. what was the decision that these skilled nursing beds i know that we need, but no sub-acute bed interests at laguna honda? >> that is a question i wouldn't be able to answer because i wasn't during that period of time as the director. but that is something we can definitely explore. at one point, laguna honda went down to 780 beds because of the amount of money we had to rebuild laguna honda. so, the strategic plan -- the sxhition asking to do a seven

to 10-year plan and we are looking at the future of skilled nurses facilities as well. we have a short-term need, as you have outlined. but we also have a long-term need in terms of the future. >> ok. and so you are working with labor and community groups, as was mentioned, on this long-term and short-term plan. >> that's right. from the last supervisor hearing that you had, we were asked to have meetings with both labor and patients and we showed that in the slide today and then we've had continued conversations with some of the providers who are willing to do some of this work along with the supervisor's office to meet with the other providers interested in long-term projects. >> actually, i think what's really important in this plan -- if i may say so -- is it mandates a minimum number of beds that we should have in the city and county of san francisco, public and private.

just so that we know that what we can depend on, i think that when we hear this removal of sub-acute beds and then we're rushing, where are they going to go what a disruptions to the families. but if we have actually a minimum of what we're saying that we should have available in the city and county of san francisco, i think that helps us to prepare and plan and actually for families to plan, too. so that we know this is how many we have. but i also think, as i mentioned again, it is a shared responsibility and it isn't just with private hospitals, but also with uls, too. >> absoluteliful and we feel the same way. >> thank you. >> i don't think i have anymore questions for you right now. but thank you for all your hard work on this. we'll continue to work with your office to come up with a solutionage just to reiterate the hospital council has a whole host of different private hospitals that can be part of

this conversation. >> absolutely. we'll get back to the supervisor regarding the dollars that the department spends on subacute beds. as soon as possible. thank you. >> doctor, can you come back up just for a few more questions, please? >> thank you. i didn't realize until this slide was presented to me that there was even a subsection of sub-acute care. so short term and long-term. so, st. luke's is the only -- right now, licensed facility that's designated sub-acute skilled facility. not care, in the county. is that correct? >> yes. that's correct. it's probably easier, supervisor, if you think of elpacs which are called

long-term acute care, has really been more closely aligned with acute care hospitals. that's why it is so confusing and goes acute, long-term acute, sub-acute, chronic sub-acute. so, it is better to think of them as part of an acute care hospital. >> so i heard people wanting to call director garcia dr. garcia -- [laughter] i mean, she does have a ph.d.. but director garcia, you know she's made a commitment and we talked about st. mary's, but there is this general desire of this board and body and i know specifically i feel that way and i know supervisor ronan shares that. we would like to see all the private hospitals be part of the conversation. i don't know how we got here because i'm just becoming part of this conversation. but i don't see how we, as a county, can be the only county in the bay area without sub-acute care and you are the

only facility right now, you are the only facility that has that care that's licensed. so i imagine the reason why you can't move some of the patients tomorrow is because you have to do certain things to make it -- and then the state will come in and authorize you to have license it seems like you are going through a tremendous amount -- and we really appreciate that. but what i heard director garcia say is that we want cpmc to be part of the conversation and solution for a permanent sub-acute care in the city. can you talk to that? can you commit to that and can you what that would mean for your hospital. and if you can't, why can't you? >> let me just begin by saying, i want to thank the supervisors for havinging this incredibly thoughtful discussion about a very important issue and really addressing it the way we need to do as a city that takes pride in providing care for the

people who live and work here. you asked how we got to this place and i think the supervisor hit the nail on the head. we have not been doing the work we should be doing to anticipate the future needs. direct to garcia is absolutely correct. right now the limiting factories for -- [coughing] just has to do with available space. i would remind the supervisors that sub-acute beds are actually a sub-part, sub-license of snf facilities and we shouldn't eliminate the possibility that these facilities in the city could also take on sub-acute responsibility. even among those that aren't attached to hospitals. does that answer your question? >> yeah. but -- you just made a good point because you said your current facility at davies is currently s.n.f. facility.

so we'll go through that trouble, why not then make that a permanent part of your delivery there? >> because it solves one problem, potentially, while exacerbating another which is we also need those beds as ordinary s.n.f. beds to take care of patients who are dischargeded from the hospital and snead s.n.f. but not sub-acute care. it is a very thorny problem and it is probably a more difficult problem that we can solve right here and right now. but certainly the hospital sill, which represents public and private hospitals, including the v.a., includinging laguna honda, including the jewish home, we're absolutely commited to working on this because the reality is, although this is a problem for the board of supervisors when you hold hearing it is a problem for those of us who take care of patients every single day. >> how many beds are you going to have at the new hospital at

cathedral hill? >> we will not have any s.n.f. beds at either new facilities. they're being built as acute care facilities. the licensing requirements and probably more importantly, as director garcia was implying, the seismic requirements for acute care beds are much higher than they are for s.n.f. beds for sub-acute beds, for lpc beds or psychiatric beds. >> higher on those end? >> greater for acute care. require stronger buildings, more service,etc. >> so, you'll have acute care in the short-term, in and out. >> yes. acute care. where in your network ofment hos, do you have any s.n.f.? >> we currently have them on campus and a few at st. luke's and then we, like almost every other hospital in san francisco and throughout country contract

with s.n.f. providers in the community to provide beds for patients when they're discharged from the hospital. >> [inaudible] seems like most hospitals are now contracting out into the community that level of service. >> it's probably appropriate. s.n.f.s care is probably best provided in designated units and facilities. >> ok. so, i just -- just -- i understand it could be thorny and part of your overall number of bedsful we're not asking you to take on that entire burden of 70 or 40, but you have an existing facility. you could -- potentially you have an existing, like say building that you either could convert into office space -- because the seismic requirements are different for sub-acute versus an entire hospital. >> that is correct. and we are -- our current plans

are to keep the unit on 1 south as a combined s.n.f. and sub-acute facility. those are our current plans. >> where? >> at davies, at 1 south. >> at existing st. luke's building. >> i'll remind the supervisor that once we move the acute care patients into the new hospital across the way, that building actually will be taken down. >> being torn down. >> yes. >> and you are going to build a new building there. >> that -- that acute care hospital requires additional medical office sfies take care of other needs that people in san francisco have. >> could you consider being part of the solution? >> i think we already are part of the solution and i will absolutely commit to being part of the solution. as i was saying, this is an incredibly difficult problem. the health commission has been struggling with it for years. i know that director garcia has been working on it diligently and if there was an easy, ready

solution, i would be more than happy to offer it today but there isn't. >> ok. thank you. do any of my colleagues have any questions? >> hi, doctor. so sorry. i probably need further explanation. so, at the -- at the existing st. luke's, clearing everybody out and rebuild that whole building and mraeen to rebuild that building without any skilled nursing beds, is that correct? just acute care and medical offices. >> so i'm -- there are two -- there is a building going up on the campus fou that i'm happy to take you through that will be just for acute care. that is the 120-bed acute care hospital that we committed to build during the discussions back in 2013 with the supervisors. >> sure. >> until part of that plan -- part of our plan for that campus involves building a medical office building where the current hospital is located.

>> ok. can you give me an example? i'm so sorry. there's all these terms and, you know, i've only spaent short time in a hospital myself, goodness. just wanted to know, like what kind of patients are we talking about when we talk 120 acute beds. >> so, acute care beds are used, for example, for patients with pneumonia, patients who have undergone surgery, women who have delivered babies, patients in intensive care units. what we call medical, surgical and o.b. patients for the most part. >> and at the facility, what kind of beds do you have there? >> at the van ness facility -- >> yeah. >> we have 274 acute care beds. again the same kinds of beds. medical-surgical bed, i.c.u. beds, labor and delivery beds and that hospital also has a

pediatrics unit. >> and you don't have any skilled nursing beds planned for the new cpmc? >> no, as i mentioned to supervisor safai, the seismic requirements for acute care beds are so high that it is just not fiscally possible to build sub-acute or s.n.f. beds within an acute care facility. that is the reason. none of the new hospitals being built around the state will include any of those facilities. >> ok. is it the cost? >> yes. >> so it's the cost. >> essentially, yes. to do -- for example, the building we're building on the st. luke's campus is a $600 million building for 120 beds. so when director garcia was talking about the costs of including or renovating buildings to accommodate

s.n.f. sub-acute bedses she is talking rather large numbers. >> and then just because it's so confusing to me, the new cpmc on van ness is going to be 274 acute care beds and then you are also going to be having pediatrics there? >> yes. pediatrics acute care. kids get sick as well. and are you having medical offices there, too? >> not in the hospital, no. >> ok. and so -- so it is the cost that prevents you from having skilled nursing beds. >> i'll answer on behalf of all the hospitals, including the public hospitals and say, yes. the cost of acute care beds to build them to be seismickically safe and to be compliant with all regulations, it's prohibitive to also include s.n.f. beds in that kind of a structure. >> ok.

so, i mean, so we made -- there is acute beds, there's sub-acute. there's skilled nursing. so you're saying to me that the only ones that are affordable, not even affordable, i get the price tag, that you are able to because of finances are acute beds. you are not aable to put any skilleding beds in these facilities because the seismic upgrade for a skilled nursing bed would be cost prohibitive, is that correct? >> all of the new hospitals, whether it's cpmc, ucsf, san francisco general or the new facilities that eventually dignity and kaiser will have to build will include acute care beds but not sub-acute, s.n.f. or psychiatric beds because of the seismic requirements, yes. >> ok. so then from what you're telling me, you're telling me that it is impossible to build those things in san francisco. >> no, i'm not saying that at all. i'm saying that they should be

built in either distinct facilities that are just for s. n.f.s that don't need to meet the state's new requirements for seismic. they can be built within existing facilities. for example, we have at davies in our 1 south tower, or they can be entirely new facilities that are just built for the purposes of taking care of s.n.f. or sub-acute patients. >> is it your opinion, doctor, if these facilities are best stand-alone facilities, what i'm hearing, specifically just for those patients, and your own facilities, it's cost prohibitive to do it and it is cost prohibitive kaiser and all the other ones, do you think, though, then it is because you're not able to offer that in your own facilities that you have a financial responsibility to help pay for some of these facilities that are stand-alone.

since your hospital and other hospitals that you're telling me is pretty cost prohibitive unless they're stand alone. so, do you think that the hospital council and the members of the council -- hospital council as a solution to this are fiscally responsible for some of the costs to build these facilities since your hospital and all these other hospitals -- and correct me if i'm wrong -- are not able to, but see that there is a high need and you see that we have a lack of them in san francisco. do you think it is the responsibility of the hospital council to help pay for some of these -- the building of some of these facilities? >> let me clarify this. the hospital council doesn't have any funding. so -- >> i mean the individual -- i mean the individual corporations that are hospitals, quite frankly. do you think that they -- the members themselves -- i didn't mean that the hospital council, but i meant the members of the hospital council, including the city and county of san francisco, do you think we have

a shared responsibility, the members of the hospital council to help to pay for these facilities? >> so, just to clarify, supervisor. we do contract the facilities to make sure that our patients can get access to care. and it is important to recognize that different kinds of patients have their health care paid for from different kinds of sources. so, until we get to a situation where all health care in this country is paid for from a single source, i.e.: single payer, it is hard to determine who should be paying for which can aspects of what needs to be done for what patients at what point in their history. so, it's a long way of saying that hospitals, like cpmc or dignity, are responsible for providing health care for patients who are in our facilities. we technically don't have financial responsibility for those patients once they're no longer in our care. we do have a moral responsibility to make sure that they receive safe care.

and we follow that by contracting with other providers in the community to provide that care. >> but you're seeing the problem that we have here. >> i absolutely understand the problem -- >> and also might i say -- >> and it is a difficult one. >> i know it's difficult and i think you said is it thorny or something -- >> thorny were my exact words, yeah. >> but i also get that it's very costly and i also get that there is great need and i get that we're at a crisis situation right now in san francisco. and hearinging from director garcia, these places that we would like to look at are very costly to redo. i actually feel as though, because i think a hospital in san francisco -- kaiser included, i'm a kaiser patient -- has a moral responsibility to serve those people who are in great need that you would normally serve, except you can't do it. and it's almost like contracting out to have a

financial responsibility to help pay for some of these resources. so, i guess my question was just -- we don't have to answer this. i guess it is just an opinion or a question, floating out there, that is it the responsibility of the members of the hospital council to help fund some of these things since they're rebuilding facilities or remodeling facilities -- i know kaiser has done huge remodeling -- but not serving these patients. but there are patients out there. because hospitals, quite frankly, in my opinion, they're built to serve people who are sick and who need care. and i get that acute beds are less expensive. but what we have is a situation here in san francisco that i think, you know, city and county of san francisco, we heard took responsibility for it. it takes everyone who's in the health care industry and in

particular hospitals to help pay for some of this and what it is going to cost. simply because hospitals themselves couldn't do it. but collectively many hospitals could come together to help build stand-alone facilities that would serve the aging and the ill of san francisco. and actually we think about money, we think about bonds and we're thinking about the people of san francisco and the future generations of san francisco to pay for these bonds. in the meantime, i don't -- i think that if you were to wait for single payer, like, people will die. and so i just think that -- if we're saying it is too expensive, it is a collective moral responsibility and this is not a question. i just sort of feel that it is a collective moral responsibility to take it -- for everyone to pitch in and if you're not able to have these

beds at their own facilities or even kaiser or any other hospital, then maybe there is a financial responsibility, collectively the council to help us build these stand-alone facilities so people will have that care. because -- just because we don't have it doesn't mean that people will not need that care. because we don't have it, they can't get that care. they will still be in need and i actually think that we have -- we're not even close to meeting this need. and i know hospitals -- i know it is expensive, but i know hospitals make a lot of money, too. the kaiser included. i'm a kaiser patient. so, i just think it is going to take all of us and it is not just sitting around and saying, gee, we have this problem, let's get a plan. but what is the financial responsibility and moral responsibility of people in the health care to help us provide this if you can't -- if

stand-alone hospitals can't provide it. but collectively maybe we can. >> i appreciate that. i could stand an education on this. absolutely that my knowledge is not as deep as yours or as broad. i appreciate the offer. >> i will follow up. >> thank you dr. brown, i don't have any other questions at this time. reiterate for the record, we're

going to work with director garcia in the hospital council of labor and other community labors to advance this conversation about a permanent solution for subacute care. we hope that you would commit to being a part of a permanent solution. i know you've mailed a big step. i wanted to review the timeline. in five months, we started out the answer was no on june 20th in 2017 when we had our hearing in terms of could we keep these folks in county. here we are five months later and cpmc now has committed to keeping those patients in their hospital network in san francisco. that's a big victory but we have more work do and we have a lot more work to finalize this and i appreciate director garcia saying that this is something that needs both a shor short ted long term solution and i disi ay

and county is complitted t commp up. mr. benson nadal, you have five minutes. thank you, sir. >> supervisor fewer, supervisor ronen, and supervisor safai, thank you for the opportunity to make some comments about the future needs of all the residents who may need subacute care coming from all the hospitals in san francisco.ç while i was waiting, i googled the per diem rate under medi-cal for subacute, there were two separate rates. $933.31, or $822.48 paid for by medi-cal for subacute long-term care. that is significantly higher if subacute care is in a hospital rather than in a free-standing

or community licensed skilled nursing facility. that is background. i want to ask a rhetorical question -- >> and that is per day. >> per day. i want to ask a rhetorical question. i'm on the long-term care coordinating council planningç for the future for long-term care mostly emphasizing community and home-based care. i've been on the dementia expert panel workforce appointed by the previous mayor and long time ago, the discharge planning task force. i've been doing this for a fair number of years and my hair might be white, but my brain isç gray and full of ideas still. one thing i'd like to ask the board of supervisors is to request hospitals do data on

post discharge to whatever location for patients that are sent out so that we have an accurate reading of trajectories, longevity and not just metrics for return to emergency rooms or rehospitalizations. within 30 days hospitals can be penalized for return to hospitalization for being discharged to the community. i'd also like to say that assault and battery cute as many said before today, and previously, is a medi-cal benefit and long-term care benefit. it represents the choices and options that patients and families make to continue to live their life, usually cognitively intact but hooked up to machinery with computer

monitoring. i have know another question embed in my points in the transmitted document is that the [inaudible] group be allowed to monitor the tooling of the davies-smith campus to see that all the documents for approval for subacute are approved by department of healthcare services and that they be allowed to review the on-going process of retooling that rather small s.n.f. unit. will that be a case-next unit with rehabilitation staffing, and will it also include subacute which is the long-term care of medi-cal benefit? because with case mix s.n.f. units, it gets complicated with ferms of staffing, training, supervision and monitoring by

computers. i have comments in my written statement which i will defer until maybe next time around the whole dilemma of post-acute care. we've heard a lot about post-acute care. that is a medicare-drich worlddd where many complaints about it. i have a list of complaints to move subacute individuals into a post-acute environment is detrimental to doing harm to them, i guarantee you because of the complaints that come from the post-acute patients to our office in terms of poor discharge planning, lack of involvement in the person centered care and integrated model as we used to find in the hospital bed facilities. post-acute care is full of

risks. dr. browner and cpmc is not responsible for what happens after a person leaves their care. my argument is bothç morally ad ethically and as well as improved data collection for all the hospitals, there is a responsibility. and i think it's fair for the city and county to ask for the data collection and bear a moral and ethical load in getting a permanent subacute peunt for all individuals. whatever the hospital, whatever the district and hospital who elect to choose to live their life depending on machinery and advancing around the clock care. >> supervisor safai: before you leave, i have a couple of questions on what your role is so the audience and board understands. on a day-to-day basis, what do you do as an o ombudsman?

>> the program was created by the federal government through a visiting advocacy program to monitor actions or inactions or decisions that may adversely affect the welfare and rights of the residents in a skilled nursing facility. that jurisdiction was expanded by the feds to assisted living residential care homes. in california, we get reports ever abuse and neglect if those persons are abused and neglected in licensed facilities. we're like an abuse investigator. our involvement with st. luke's has been since its inception, we visited the 40 bed unit, the hospitals are allowed to admit the individuals with subacute scare. we value st. luke's as a really,

truly community-based hospital taking people who are poor and indigent open arms like st. luke's picture in the hallway indicates. we value st. luke's serving the important districts of mission, bayview, oceanside and we value st. luke's as a key player in san francisco. look, there were some antitrust business with sutter taking over st. luke's. we know about that. i put the links in my electron electronically france mission, the argument was that the geographical region did not win the arguments of the plaintiff. however, we live in a district-by-district bay with a area to transport people from

one home from hospital to another ambulance endangers their health. there is no information. we had a case where someone was supposed t to go to general hospital and wound up at cpmc, they didn't know the guy so they called the ombudsman office. we have the localized use of healthcare. st. luke's has been historically an amazing hospital for serving people. the reimbursement rate for subacute when it started was enough to offset any losses as long as the acute care hospital was diverted. medicare people didn't have to go to webster and buchanan, they could have stayed in st. luke's where the medicare payment could have offset some of the losses. that's an old historical argument but it's valid in terms of sutter cpmc corporate behavior. >> supervisor safai: thank you

and we'll call you back up if we have more questions. that was it for rightfké now. we're going to go ahead and take public comment, before i do that, in my -- as part of this overall opening questioning and also presentation, i just want to give a special thanks to kim from for the work she's done and katie rose and their coalition of people at cpa and galore why you simpson and her husband and brother. and lalia montano, they've been involved in this conversation and push the board of supervisors and informed us and leading this conversation with us and so we know they are part of the solution. that's why we asked the department of public health to include them in the overall

along with teresa palmer and a host of people leading this conversation. we thank you for that. we're going to go ahead and open it up to public comment. folks, please stand up to the right or you can wait until i call you. each member of the public will have two minutes to speak. and please clearly state your name for the microphone. if you have any information, you can leave it with the clerk. i'm going to call patrick shaw. next is charles minister, sherrie groper and linda osario. >> thank you supe super visors. thank you for holding this. i'm patrick shaw. the dire lack of subacute facilities must be solved. we don't know how many 3,081 san

franciscans discharged out of county already wound up in s.n.f. level of care rather than in a county or out of county subacute facility. they presented data last fall since 2003 we've lost over a thousandç3me s.n.f. beds in te city. 900 or so were hospital-based facility. dph informed the commission that san francisco faces the shortage of 1,745 s.n.f. beds 13 years from now. that was before we heard about the potential loss of st. luke's s.n.f. units. it's my testimony that 1381 patients dumped out of the county is preliminary because stst. mary's, st. francis and

kaiser haven't responded to the dph survey. my testimony requests that this committee prioritize development of a o "certify for preference program" for those patients discharged out of the county assault and battery cute and s.n.f. units. there is a tracking system to return them to the community is what they've recommended. finally in my testimony, your budget and legislative analyst noapted in july of -- noapted in july of 2016 that a -- noted in july of 2016 informed that -- >> supervisor safai: thank you, sir. thank you. next speaker.

>> supervisors charles minister, a member of senior disability action and a resident of district one. cpmc is part of the sutter healthcare octopus which is located in sacramento and tentacles reach out to northern california and central california. they suck up hospitals that are not pemmin performing and decidf they're going to run them for them. they try to make money so they can feed the head in sacramento. this city,. find places for sutter -- i mean for lyft and uber to park their cars and build condos but can't find space to put subacute patients up for care. that's pretty sad.

sad commentary on this city. it's a problem all over the country. as i see, the only way we can solve the health problem in this country is if we nationalize healthcare, without compensation under workers' control. that's it. all other reforms are great, but it's not going to solve the recommend that we as we get older and more and more problem as rise. it's not going to solve it. it's going to take up more time in hearings. healthcare is a right. we're not going to get this by reforms. it's going to take a social resolution to do it. >> supervisor safai: thank you, sir. >> thank you for opportunity to speak on behalf of the

swindlecommunity. i'm a member of th swindel comm. he died but i want to keep it alive. they can accommodate 24 patients. cpmc wants to shut counsel the facility.  do close so swindells. first is the well-being much the loved ones currently at swin, swindels. the first interest served by staying at place at 3698 california street which is the home of the swindel program. the council informe informed thf

this. dear dr. browrn and rob, we believe that swindels should remain open at the full and much-needed capacity and we heard cpmc say they intend to close swindels. we want you to know our intentions, given the nature of patient's disease, irreparable harm will come to the patients if they're removed from their surrounds. they should remain there. thank you for this opportunity. >> supervisor safai: thank you, next speaker.

>> [inaudible] rosario, reverend hope. >> i'm linda rosario. my mother is at swindel. she just turned 103 yearsç old. since she's been there three years ago, she's adjusted to life there and happier and eating well and connects with the workers there. i was told that they're closing and my first thing is, okay, where do i place my mom and how will i go about paying for it since i'm struggling now trying to pay for her care by applying for medi-cal and v.a. and is. s.i. and to this day, i've had

no reply. so i'm i paying out of my pocket to care for her. but what i'm saying is i would like for my mom to stay at swindel because if there is any displuptiodisruption in her lift think she'll last at another facility with the care of the workers. and -- where was i -- so i feel that since the new hospital is being opened, we were told we're going to be part of the new hospital that we'll be moving in and found out that no, we were not. and at that time, we just didn't know where we're at now. so, i need some assistance from

all of you to help us keep swindel open and to have our family remain together if we're going to another facility -- >> supervisor safai: thank you. you can follow up with my staff and we'll follow up with you. thank you. reverend hope. >> i'm 81 years old a 47 year homeowner in district 11 and i speak on behalf of myself and elders i work with. i have three chronic life-threatening conditions which can occur and do at any moment without much warning. i'm not alone among elders with this kind of situation. i've been hospitalized a number

of times. i've not yet needed s.n.f. or subacute care unit, but many of my former parishioners and many of my friends and neighbors have. it's important to keep these close to us. so that i can speak personally so that the clergy of a person's particular tradition can be there to comfort them and encourage them as well as their families at this time. percently on another issue, i know that my healthcare insurance does not allow me to have any procedure at any sutter facility. that's because they charge more than anybody else. so when i hear them dancing around the financial responsibility concern, i have to just shake my head about that. so, please keep us -- keep our

facility available. my last thing speaking as a clergy woman, i know the holy rit of jewish an christian traditions as well as other enduring faiths enjoin us to care for the ill and elderly among us. thank you for doing this. you're taking on a divine mandate in pushing this issue. >> supervisor safai: thank you, remped hope. you -- rercht reverend open. tess and gloria and dr. palmer. ma'am, did you submit a card? sorry. go ahead. >> good afternoon supervisors. thank you for this hearing. i'm tess mulborn, i've been one of the general public that followed cpmd for a number of

years. we thought why not serve the southwest/southeast part of san francisco? they were not interested. i think that suggests that some of their patients may not be coming from san francisco. and that3me might be somethingo look into in the future. st. luke's -- pardon me,çç cpc provides as little as 3% medicare/medi-cal patient care compared to ucsf approximately 30%. i raise this because they talk about the cost of things and they say they can't do stuff. they should be in the case of the s.n.f. and subacute care units, they should be taking the 40 units at st. luke's now and filling them. then they should be adding the 40 units at davies, not

subtracting 40. we should be getting 80 out of this. we should think of additional ways that we can deal with corporations like sutter. for example, they have office buildings they want to build. there maybe some negotiating room there. we should also look at their patient statistics and services much more regularly, the reporting and make sure that they're serving san francisco. thank you. >> supervisor safai: thank you. gloria simpson. dr. teresat( palmer, lillio montano. dr. palmer, would you like to go? >> my name is teresa palmer, i've been in practice 30 years

in san francisco and working with san franciscans for healthcare, housing, jobs and justice. i want to thank dr. browner for clarifying why acute hospitals are refusing to provide subacute and skilled nursing care on their campuses. but what we have is an on-going shell game where acute hospitals are sending their hospital discharges to community facilities who then are not providing long-term care. they're just providing post hospital care and they're not doing it well. according to the ombudsman, there are many, many complaints because the community facilities do not have the skilled teams to do the rehabilitation that hospitals do. and so, basically, the corporate hospitals are saving money and

making more money by having a narrow focus on short-stay acute care and everybody else is getting screwed including the subacute. this is not business as usual. we should not be conducting business as usual. now, this is a crisis. we have no subacute beds slated for san francisco. a shortagal of skilled nursing beds because hospitals have refused to provide post hospital rehab. the -- i'm sure there is room -- now they're moving subacute patients to davies and subtracting s.n.f. beds so 20 patients will be moved to davies and 23 s.n.f. beds will be removed. i'm sure there is room at davies on another floor. if not, why not use --

>> supervisor safai: thank you. thank you, dr. palmer.ç >> [off mic] >> supervisor safai: thank you. liham montano. >> i want to thank you for having this hearing and soing your support in this issue. sometimes when i get here, i don't really know what to say because i get so overwhelmed, i cannot believe that we are in this rich city with so many resources and a corporation like sutter