everything that daniel and kelly just spoke of, and that is sort of the process that p.a.c.c. went through through most of 2017. daniel in his comments introduced the p.a.c.c. members that are here this afternoon. again, they met every month, lots of time and effort that was put into it, commissioners, and could not have done it without their incredible support. i don't know if they raised their hands, but hello. they're here. thank you, and so appreciate everything that they did. when we started this process, we couldn't have done it without two committed cochairs: kelly hiramoto and daniel arusz. they elevated the discussion at every step of the way. and when we provided updated to you, president chow and director garcia, you helped in that process, as well, so thank you very much. the first meeting of the san francisco section for this

calendar year, as daniel noted, the report was done around november of last year, and we had to do some tidying up. so our first meeting was in february of this year, this calendar year, and we had a full presentation and a formal adoption by the hospital council of the report. of course what's embedded in the report are what you have in front of you, the solutions, can we do something? and so we've begun a really robust dialogue around -- around -- particularly around solutions one and two, talking to nonprofit providers in the city. they're going to be meeting with us next week at our section meeting so we can get their thoughts on how we might implement some of these solutions because there's lots of getting into the weeding and mechanics of how you might go about contracting it, etcetera, etcetera. but there's a seriousness of purpose in this exploration, and so that is where we stand right now, and thank you.

>> commissioner chow: thank you. it commissioners, we do have public comments. we'll take those before we begin our own discussion. i'll call each of them. you can speak in any order that you wish. it will be ken barnes, mark aronson. looks like kim tavig-leon, melanie grossman, and vincent matic. each will have three minutes. speakers, i have an egg timer. when you start speaking, i start the timer. when the buzz buzzes, your time is up. dr. barnes, if you want to begin. >> my name is ken barnes, and i am a doctor who practiced at st. luke's for over 30 years,

and i worked in the sub acute unit for 15 years. i'm going to limit my comments to mostly the issue of sub acute. there's so much here that we could comment on. as you know, there is an acute shortage of sub acute beds in san francisco. at its peak, st. luke's had nearly 40 beds, and now it has 17. in 2012, sutter cpmc decided that only admissions from their hospitals could go into the sub acute unit. and then, in 2016, they decided that there would be no further admissions, so what's happened is that the number of patients have just been gradually falling. now, as i think was mentioned,

the plan that cpmc has now is to transfer the 17 patients remaining to the davies campus, and these beds that are being given to the sub acute are going to be placed in the skilled nursing facility, which has 38 beds now, and it'll go down to 21. and this is adding to another crisis that we have, and that is hospital-based snf beds, because the only snf beds that are hospital based in san francisco will be those 17 at davies. so what cpmc plans to do at davies is let the patients fade away by atrition, and this would mean at some point, there are no sub acute beds in san francisco. this is a vitally needed

service, and not having it would interfere with patient and family choice, about whether their loved one should live, and also be -- be nearby so that the families can visit them. the department of public health has estimated that at a minimum, there are -- there's a need for at least 70 sub acute beds in san francisco. dph 45z been working with ucsf, the st. mary's dignity and kentfield to discuss possibilities. as we understand it, noticeably absent from this discussion is cpmc, and what we're seeing is that cpmc sees itself as outside of this norm, much like the recent suit brought by the state of california. we are urge you to look at our proposal for a new sub acute unit and skilled nursing facility to be housed at the

new medical office building being projected to be at the new mission bernal campus. i have one sentence. >> commissioner chow: okay. one sentence. >> at this stage, floor or floors could be added to the building, and we urge you to strongly recommend that cpmc opened its current sub acute unit to new admissions and that they be part of the ongoing discussions with dph and other hospitals to find solutions to the sub acute and skilled nursing care crisis. >> thank you, dr. barnes, and you write very long last sentences. >> i did. >> please, next speaker, and if you'll all identify yourself. >> commissioners, i'm mark aronson. i'm an emeritus professor at uc hastings school of law. and i have been volunteering

since 2013 around cpmc issues but also broadly issues affecting housing, health care and jobs and justice in san francisco. dr. barnes is also appearing on behalf of this group. we have submitted to you a position paper and some proposals which complement and supplement what you were presented with today. i want to make two quick points. first is a process point, i want to emphasize the importance of having grassroots participation in these discussions with the department and with a group setup like the group that produced the p.a.c.c. report. we had a very constructive meeting from the coalition with zror garc drar garcia and her deputies on friday. we think grassroots involvement

is important from people achkd in the community and labor unions from these discussions particularly around the kind of facilities needed across the board is absolutely critical. the second point i want to make goes to both the short-term and midterm solution. one is to emphasize what dr. barnes said that cpmc has to be kept at the table. it should not be exiting from providing snf and sub acute care beds, and action has to be taken immediately. two proposals would be maintaining units at davies, and as dr. barnes suggested, using a new medical office building that's proposed on the mission bernal campus, to use some of those floors for snf and sub acute beds. that would be very important. and the second midterm to long-term solution that i would like to emphasize, we are all in favor of people coming

voluntarily together and reaching joint private-public kinds of solutions, but we also are very fearful, and my account is based on many years of experience working on behalf of community groups, but you also need some real teeth in the process, and we suggest, we urge that with the department, that we undertake a discussion and then coming up with legislative proposals that would provide greater certainty into meeting the kinds of needs we're talking about over the long run, in particular for sub acute care and also for some of the other kinds of facilities. just cooperative action is not likely to produce the kind of results we all want. we need some teeth, some legislative proposals, and i think it can be done at the local level as well as seeking federal and state help. thank you.

>> thank you. next speaker, and we also have received a request from gloria simpson. >> kim cataloni, national union of health care workers. i kind of feel like i got a report that says it's sunny outside today, and it's a beautiful day. these reports do nothing. it does nothing to add to the number of sub acute beds that are needed in this city today. their 17 filled beds that are declining rapidly. cpmc wishes nothing more than for these patients to go away. there are no more sub acute beds. this report doesn't add to that number. and essentially what it does it the hospital association essentially washes its hands clean of any responsibility for any future patients. there is no accounting for how many patients have been shipped out of the city. i personally believe that

somebody needs to bring a lawsuit against the hospital association because i think this is intentional discrimination against the elderly and disabled; that these folks are intentionally being shipped out of county and nobody has anywhere with all to stop it. and it's frightening, if that's the type of city that we want. it's frightening that nobody's standing up and saying, you know what hospital association? you know what, sutter? you're making millions of dollars off of our residents. you need to pony up. you need to put -- you need to keep these beds open. you need to have at least 40 other beds. whatever your market chair is, you've got to open up that many sub acute beds. not to mention you also need to pony up and start helping these

rcfe's stay open because all this says is like we have a problem placing people, and these facilities are disappearing. yes, there's a log jam, and until it reaches a crisis, nobody's going to do anything about it? the crisis is here. families have been tortured and torn apart, and nobody's speaking for them. i'm really appalled by the report that nothing is being done. it's like we're going to continue to study this until these patients die or just go away or they're shipped out of county. that's not an okay solution, and to accept a report like this is not fair to the families. it's not fair to the residents of san francisco, and the problem is going to get worse, and i think it -- we need something that says something like all the hospitals need to pony up. you need to do your fair share. you can't continue to ship these residents out of county, which is what they want to do, but they're all making profits.

they're all pocketing tons and tons of money. and they're even gouging. the a.g. says they're gouging. they need to come to the table and pony up the money. it's that simple. >> thank you. next speaker. >> hi. my name is medically grossman. and i am -- melanie grossman, and i'm a member of the older women's league. yeah, so i'm someone from the community. the older women's league advocates for older adults, but especially for older women. so i thought i agreed the report sounded extremely sunny, but in our experience, my experience, when a person needs to be discharged from the hospital, and i personally have been called for a friend to give her a ride home on christmas eve, and there's no

discharge plan, there's -- you know, no services that are going to be available over a long weekend, you know, we have a long way to go. it's easy to say improve discharge plans when the ones we have now really are inadequate. it's also easy to talk about an assessment tool, and there are human behavior, there are no tools to measure human behavior and human problems. and we certainly see them in our membership and in our neighborhoods. also, these wraparound teams, what are they exactly going to look like? supposedly that's for managing patients, but some of these behavioral problems are intractable, and they take weeks and months to work with, and these people are supposed to be managed at home? i don't think they're safe.

i don't think the families will be safe. and then finally, i wanted to talk a little bit about the wraparound services. what exactly would that look like? it sounds so great, let's have some wraparound services that's all cozy and snuggly. but are pima sessed in their home before they're discharged? has anyone checked out, is there safety there? is there a refrigerator that is working so that they have access to food? how long is the waiting list for meals on wheels? last time i checked, it was six weeks. so what is the discharge plan? go get a sandwich at walgreens? so i think it's easy to talk about all of these lovely tools and implementations, but for older people really struggling, sometimes they need a place to stay where they're not going to

be pushed out, they need a place to stay where they can -- that they can depend on. some people just simply cannot be managed at home. thank you. >> thank you. >> next speaker, please. >> president chow, commissioners, barbara garcia, my name is benson aidel, and i'm the director of the long-term care ombudsman program. we're authorized by federal and state law to basically troubleshoot licensed facilities, and i have many comments from reading the report, but there is an error on the report on page 19 where it gives a rather large figure for hospital based snf beds, and my understanding is there are not that many hospital based snf beds anymore unless the writers of report meant dp-snf. i'm not quite sure, but i want to drill down on custodial care

in terms of the 117 from the october '17 snapshot. custodial care really implies disability and then contra to custodial care implies chronic disease management, and i think we need to not use custodial care anymore, but talk about individuals with disability returning to the community, either successfully or not so successfully. when they're combined with comorbidity, then, it becomes complicated. now in the dph memo, in ab-940, chapter in law as of january '18, we receive all the discharge notices. not the involuntary one from all the snf's to our office, and these include people on medicare, people on long-term care. we're starting to collect all these notices.

the first snf's to do a really good job were the city and county ones, laguna and general hospital, and the other community snf's have been kind of slow in giving us the reports. it must be the required notice of transfer with all the details in federal law. this report really does ignore some of the regulations for the snf's in its report. there may be barriers, but the ombudsman expect a person-centered care plan where goals and objectives are in the first few days of admission, including those on medicare. what we're finding in experience is the big meeting occurs a few days before discharge. most of our complaints from the various post acute snf's have to do with unsafe discharges, people going home with no coordinated care, where case managers are confused with social workers. the only facility that does a good job is laguna honda, but

they are working with a protracted period of planning because they're mostly on medi-cal, but when medicare has a short and very fast moving progression, there must be some subscribing to the cms requirements, and we're not finding that in practice as witnessed by some of the unsafe discharges. and finally, the rcp's need to be scaled in this report by large versus small. title 22 boarding care homes, where you have six beds to 15 beds do not require adequate fte's to handle some of the comorbidities. >> your time is up, sir. >> so this report needs additional input. >> thank you. >> thank you. >> thank you for your input. and lastly was miss simpson. if anyone else wishes to testify, if you'll submit a speaker card, that would be fine. this is the last one i had.

>> i'm gloria simpson. i'm with the family council at st. luke's hospital, and i'm speaking on behalf of the sub acute issues, especially with the transfer of the patients going to davies. we sent out several questions to cpmc to answer, and they refused to answer the questions, and we also asked them to come to one of our family council meeting does, a -- meetings, and what they did, they planned or they met with the families individually, so we don't know exactly what was said to each family member. we're expressing the -- the stress that -- in regards to the transfer trauma that may happen with the patients. they're not given giving any

incentive to the current staff to be transferred to cpmc. i requested to even have the activity person transfer, who is nonunion, and they refused. so this is a great concern of mine because these poor patients who's been with the same staff for several years, they go into some sort of anxiety or depression, which will cause death, which is a goal, i believe, with the pmc since from the beginning, they've been wanting to eliminate the sub acute. so we're asking, then, pleading, if you can please open 70 beds to the city and county of san francisco. thank you. >> thank you. there is no other public testimony. commissioners, we're prepared for questions to the presenters and/or dialogue.

any questions going for the -- yes, commissioner? >> i thank you for the report and thank you for spending the time to put this together. there are a couple of questions that i have. one is i don't really see the projections of the needs of the city in this report whatever. there's no predictions, you know, like how many of these, like, snf beds or sub acute beds that the city would need, you know, like, in five or ten years. we know that the baby boomers are getting older, right? and we know that the city is flaling, so we know that the need for this is rapidly increasing, so there's no --

[ inaudible ] >> -- and all the beds that have been closed so far. >> i can address the need. i think when we think about the need for long-term care or skilled nursing care, there are several ways we can think about it. we can think about it in terms of ageing demographics, two, utilizing, and three looking at it with the current population of beds that we have right now. we know we have 20 beds per-1,000 adults 65 and older. but in terms of making a projection going forward, i think that that's a very difficult thing to assess, and we've reviewed literature that's out there, and we're not able to find, you know, a magic

number in terms of how many beds the city needs. but we do know variation across counties, and we can compare us to other counties. >> you have no projections of like, the graying of the city in five to ten years and what the median age -- >> when we did this, we brought it to you at the first report, and i believe that sneha -- i believe these are projections, and the thing about projections is as soon as we say the number, you're going to be asking me when we're going to fill those numbers, so i want to be real clear about projections because part of the way we're trying to make sure -- and i would want to comment on the fact that we do have -- you just heard a whole person care report about a very vulnerable population that probably wouldn't meet the guidelines in terms of a skilled nursing facility. so i do want to acknowledge that some people do need more intensive report. that's why in our report directly from the department, you saw two reports, one from

the hospital, one from the department where we are trying to identify where we need those numbers. we're going to give you the number that we projected, but i wanted to understand it's projections, and part of our goal is to try to get ahead of that to ensure that people age in place as much as possible. and as you remember, commissioners, we were brought under the homestead act as well as the other suit that we had to ensure that people were not institutionalized, so that's the balances that we're going to do. so sneha, why don't you talk a little bit about the numbers. >> yeah. to the projection that we had made previously, it was based on a ratio. so as i mentioned, we had 20 beds based on 1,000 people. based on our ageing population, if we wanted to maintain that same bed rate of 20 beds per-1,000 adults, we would need about 1600 beds by 2030, and that's again based on the

assumption that what we have right now is an ideal number, and we're only able to do that based on our current ageing population and the current bed supply we have now, so there's no current literature we would need based on the needs of older adults. there are also national statistics that say that 37% of adults over 65 are likely to need care in a residential care facility or skilled nursing facility at some point in their lives. >> if you were to look at the report that we did, we show you at least for today in the next five years what we think we could put on-line, and that does not reflect -- comes close to those numbers, and so i want to make sure we understand that this is going to be a big lift for us for the next decade. and i do think that all the hospitals, we all have to come together to try to figure this out. and also, the private sector

who -- how can we make it more attractive for them to come back to san francisco, considering the cost of doing business in san francisco and also availability of space and building. so we're trying to insert our ability to look at how can we make it in our master health plan in terms of permit streamlining and how -- and that's why we are engaged with some of the providers today who are providing skilled nursing facilities and see if we can really help in terms of providing those benefits to ensure that we keep the beds that we have, and how do we build more -- and whose responsibility is that? and i think it's a joint responsibility of all of us. and we are trying to lead the way in terms of the planning process and what the city's responsibility is to try to insert its power over trying to make sure that as we're doing affordable housing, we're also

looking at residential care facilities and skilled nursing facility beds, but as you can see, depending on where the federal government goes with reimbursements, it's how people are deciding whether to keep their beds in hospitals or not. and so there could be lots of different ways of looking at this and so we're doing our best in trying to identify at least for the next three to four years what we can do in terms of inserting our power to make it affordable and also attractive to bring people back into san francisco. we heard one of our labor member leaders talk about the fact that out of county is the only location we have for many of our transfers, so we do need to build upon that in terms of how do we build more capacity in the city. the department's committed to that, and we're trying to look at our own abilities, and so that's why we're trying to partner with ucsf to look at skilled nursing and acute beds,

and you can see that in our report, but we're going to have a lot more to do as a city as a whole. >> thank you. i think it is important for us to also then refer back to our previous reports on previous data. i think on also skilled nursing and as we're looking at numbers, there is that whole question of short-term skilled nursing versus long-term skilled nursing which is really important. and short-term skilled nursing and maybe that's more the hospital level responsibility than the long-term skilled nursing kind of gets into this whole issue of ageing in place and ageing where and what type of facilities. i think that also is part of our confusion when we look at gross numbers without looking at that type of division, and then, places may get all concerned about all of a sudden the undifferentiating numbers

in which they themselves may have a limited responsibility as a post acute care type of service. and i know that where you have been discussing with a number of other facilities, that's certainly in your mind. certain places are not. looking at long-term or short-term, and so i think that's important to continue to did differentiate. i think the other point i'll just make and we'll get onto other discussions, it's important to also have an understanding of the sub acute area. i do have one question, which in fact -- and i forgot which presenter had said that somebody was here from cpmc that might be able to answer the question that was raised in terms of if the sub acute patients are being placed into the davies does that reduce or current snf beds as -- or in fact maybe they were never used, and therefore it's open

space. so is there somebody from cpmc to explain to us how this transition is? and i know for our new commissioners, the sub acute issue at st. luke's was an enormous subject over our past several hearings, and we would like to also understand how this is -- and the cpmc responded by being able to keep these sub acute patients within the city and moving them to davies. now we'd like to understand the implications of that upon the snf beds that you may have had over there. >> good evening, commissioners. i'm emily webb. i'm the community director for bayview center health. we had 38 snf beds at our davies campus. those are the last beds in san francisco. in order to change our plans and keep the existing sub acute

patients that are kushl at the st. luke's campus within the cpmc system, we need to convert 17 of the existing 38 snf beds to sub acute, which would leave us with 17 sub acute beds at the davies campus and 21 snf beds. you'll recall we came back to the commission and made that commitment to our existing patients, and also shared that as the sub acute beds are no longer needed, we would move those back into skilled nursing beds. so over time, the mix of sub acute and snf would shift based on patient needs. >> okay. so thank you. and i think the question there might be as you've described it, about whether or not that actually might create a prop q hearing. and i don't know legally, but

it sounds like if you're reducing one of the services, that that is in existence, i'd only ask staff to assist you in understanding if approximate a prop q hearing is needed or not. i don't need more hearings. >> yeah. i'd be happy to talk to staff about that. i'd say sub acute is a designation under the snf license. there's not a license change, there's a designate through the department of health care services, so i would think that's a legal question for us to talk to the city attorney. >> right. i wouldn't want you to be in violation -- >> we will follow up with cpmc on that. >> thank you. >> commissioner, i don't think there's any -- i don't know if there's anymore questions, but i just wanted to emphasize that commissioner chung brought up, and that was what we were grounded in was the predecessor

documents that informed us about data of the need and sort of p.a.c.c. took it from there. just one final comment, and this is sort of speaking as a former deputy city attorney, the employee for 14 years. to imply the motivation of p.a.c.c. members, people like daniel, kelly, margaret, austin, ruth, elizabeth, everyone here is -- is i don't think an accurate characterization of how we went about our business. i'll just leave it at that. >> i do want to note, though, that we should take the information gathered because that was one of the issues that we did talk about, the importance of getting other members' voices in the community, and so we would like to have their reflection as an addendum to this report, 'cause i do think that's 30r7b. >> thank you, director.

>> thank you chow right. and thank you, and of course in public testimony, we are receiving everyone's opinion, and i appreciate it. and i think we have already noted and staff has noted the importance of the cooperation that has brought about the report and also, obviously, the staff work that is creating a work plan for us. mr. marens, public testimony is currently over. thank you -- unless it's a point of clarification, which would accept. >> this issue of the reduction in skilled nursing -- nursing facility beds at the cpmc is a very serious one. we had in san francisco hundreds of hospital based snf beds, and we're going to be done to 21.

there are people, and i -- from my own practice, people who are discharged from the hospital with heart failure, with pneumonia, with an acute stroke. putting them into a community based snf is a recipe for disaster. and what's happening already is that people who are discharged into the community based snf's are being sent back to the hospital. and because the hospitals don't want to readmit them because it interferes with their medicare reimbursement, so what they're doing is hospitals have now created an observation, and so people are kept in the emergency room for up to three days. >> dr. barnes, i asked you for a point of clarification. >> this is a clarification. >> i appreciate your interpretation; however, the chair will rule that that is

not a clarification. thank you. we'll proceed -- >> and if i could -- chair. >> yeah. >> i do think that we have to work very hard to look at this issue and this need, and i just want the public to know that they have the commitment of the department to really do that. and i also think that, you know, we do need to work with our other partners. ucsf is willing to do this. i've asked cpmc what would it take to keep those 17 beds open because i think we need to ask that question, because we're losing ground on this. as we move more beds, then we need to figure out how do we stop more beds leaving? so i've asked that question, and i'm very -- you want to look at that. i also think that if following the direction of our proposal that we've put in front of you, we are going to submit that to the board of supervisors in terms of, you know, we have an incredible provider sitting here with us of jewish homes

and services and she's very interested in looking at how to expand, but it's not going to happen over night. it's going to take some time to develop this. maybe the criticism for us is we didn't start this fast enough, and as federal changes how, who, what they pay for, and this is the driver of some of the closing of these beds, that's what we have to look at as well. what do we need to look at, a critical conflict in the ways of what the federal government has decided they're going to pay for and what they're not. i do think we have a responsibility as the health department to look at this, including what our commissioner asked about data, and we also have a responsibility to ensure that people can age in place, and when they do need that next level of care, it's there.

i do want to say that we have not closed snf on san francisco general and we do not plan on doing that, and i think that's an important program to continue. and we have over 700 beds of skilled nursing at laguna honda, so i believe that the department has really been a leader in this, and we do need all of our other health care systems to also continue with this. and maybe it might not look the same for them, but we do have to continue to work together in trying to meet this overall need. >> all right. commissioner? >> i think funny in these conversations, my concerns are less about those using the county's resources or the uninsured. these are more issues about the working poor who might have a very minimal kind of insurance plan but had high medical costs, and this would be

additional burden. and when we're talking about this, i think that we have to be really careful. i'm not saying that we're not, but -- but there are a couple of considerations here. are we creating an environment that's not conducive for the working family to stay and i think that the answer is yes, and i think that's something that we have to looking deeper than just how many snf beds, but we have to start the conversation, because this is a crisis in the making, and it just didn't happen today. i still remember how many times we had to listen to closing of snf beds in the hospitals and have the same conversation. it's really concerning to me that this is happening, and i'm not saying that anyone has intention to avoid responsibilities, but it's a clear issue, it has a bigger picture to consider, and i just want us to take a step back and

look at what that impact would be. >> commissioner chow: thank you. any other comments from our commissioners in regards to this? i do think that the department has put forward the next steps that we were taking as we have as a commission asked the department. i'm going to ask that they quantify what they are intending to do for us in a resolution for consideration at the next meeting. i think the issues have been brought up by -- by the public are very important, and should be part of the resolution that's in the resolution in terms of at least responding to those areas of concern that have been raised. and that the department has put thoughtfully, what, three,

four, four items here which are parts of the next -- which then follow with next steps, but it does allow us, then, to move the next step because we have resolved that the p.a.c.c. was continuing. they have produced their report, they have indicated their areas that create parts of the solution the department has then expanded on, which we have asked for. i would ask the department to then present to us a resolution that we can then review and vote on in terms of our next steps as we do try to respond to not just snf beds, as commissioner chung had pointed out, and need to be sure that we are addressing everyone's needs, and i think beginning with the principle of supporting ageing in place that brings this whole work as to what is needed and where, and that probably will also change

some of the projections. those projections, as you know are based essentially okay, the population keeps going that way, and we have a certain ratio. it doesn't take into consideration this change which we actually -- a change has been occurring over at least 30 years when even the blue ribbon committee at laguna honda looked at how many beds were actually needed. and the issue there was more understanding than are there different approaches to here, and taking into consideration if there are different approaches to care, how can those be funded, because that is a real problem? that's not institutionalized right now. i mean, the idea of the residential care if a ilt is has is -- facility has no backing, they would get a reimbursement that allows that to happen. and the idea that we need to

perhaps change some of our planning codes in order to encourage that, to ask whether organizations would like to add those areas or their mission. i think that's where the department is going on this, and i believe that that, then, even though it may be a little late right now, looks to see whether or not we cannot then continue this not just dialogue and not just a report but to get to responding to the need and in a thoughtful way as a comprehensive solution. so i know i haven't forgotten the fact that we all want the sub acute beds to be addressed in this, and then to address also what i think the department has noted as helping with some of the impediments that prevent some of the other solutions to be available to the public. does that make some sense to

the commission? and if so, then, we will ask for a resolution to be drawn up for our next step. if there's no other comments, we will then proceed onto the next item, and i really thank the public, thank the -- our committee. i thank the hospital council for the continued dialogue, and we are going to move towards a solution. >> commissioners, item nine is other business, and you have the calendar before you. i will note that i'll be contacting all of you to get your schedules probably for late -- late summer to schedule a -- the community session, and then also possibly a planning session in the fall, so that will be coming up probably as i contact you. otherwise, any questions about the calendar on here? all right. so commissioners, also, as is our tradition, especially for

our new commissioners, once a year we will have a meeting off-site in a neighborhood so that we will give an opportunity for the community for input also and for us to understand the neighborhood's needs, and currently we are considering the outer richmond, but we'll have to see if we can actually work that or not. so previously, we had asked for suggestions, so we've taken those, and with that, move forward with a designation. if our new commissioners have some other ideas, they can let me know, and possibly, hawaii is not an option. >> the outer richmond, that's my neighborhood. >> all right. once again, we welcome our new commissioners. we would like to understand your interest as we then set new assignments for our commissioners in the coming year. so i'd appreciate that, and we'll try to get that

information before our next meeting so we'll put that on the schedule for the new members of the committee. next item, please. >> item ten is report back from the march 27 vfg meeting, and i believe commissioner thousand will end up doing that. >> commissioner chow: yes, we received the regulatory report. the hospital continues to undergo a number of surveys, which are routine for hospitals today, and they are doing quite well in all of the surveys that were experienced over that past month. we also reviewed the hospital's 2018-2019 strategic plan presented by dr. aaron, and the hospital's administrative report, the patient care report, the hr report in which our hiring is actually on

target at the moment, and the medical staff report. following the medical staff report, we did approve the family community medicine rules and the rn standard practices in our closed session. we approved the credentials report and the report of the pifs committee and and that's the performance improvement committee work. if there aren't any question, thank you. >> and the next item is consideration of adjournment. >> so there are no items for other business. a motion for adjournment is in order. >> move. >> okay. and a second? all in favor, please say aye. this meeting is now adjourned. thank you. [music]

>> san francisco city clinic provides a broad range of sexual health services from stephanie tran medical director at san francisco city clinic. we are here to provide easy access to conference of low-cost culturally sensitive sexual health services and to

everyone who walks through our door. so we providestd checkups, diagnosis and treatment. we also provide hiv screening we provide hiv treatment for people living with hiv and are uninsured and then we hope them health benefits and rage into conference of primary care. we also provide both pre-nd post exposure prophylactics for hiv prevention we also provide a range of women's reproductive health services including contraception, emergency contraception. sometimes known as plan b. pap smears and [inaudible]. we are was entirely [inaudible]people will come as soon as were open even a little before opening. weight buries a lip it could be the first person here at your in and out within a few minutes. there are some days we do have a pretty considerable weight. in general, people can just walk right in and register with her front desk seen that day. >> my name is yvonne piper on the nurse practitioner here at sf city clinic. he was the

first time i came to city clinic was a little intimidated. the first time i got treated for [inaudible]. i walked up to the redline and was greeted with a warm welcome i'm chad redden and anna client of city clinic >> even has had an std clinic since all the way back to 1911. at that time, the clinic was founded to provide std diagnosis treatment for sex workers. there's been a big increase in std rates after the earthquake and the fire a lot of people were homeless and there were more sex work and were homeless sex workers. there were some public health experts who are pretty progressive for their time thought that by providing std diagnosis and treatmentsex workers that we might be able to get a handle on std rates in san francisco. >> when you're at the clinic you're going to wait with whoever else is able to register at the front desk first. after you register your seat in the waiting room and wait to be seen. after you are called you come to the back and meet with a healthcare provider

can we determine what kind of testing to do, what samples to collect what medication somebody might need. plus prophylactics is an hiv prevention method highly effective it involves folks taking a daily pill to prevent hiv. recommended both by the cdc, center for disease control and prevention, as well as fight sf dph, two individuals clients were elevated risk for hiv. >> i actually was in the project here when i first started here it was in trials. i'm currently on prep. i do prep through city clinic. you know i get my tests read here regularly and i highly recommend prep >> a lot of patients inclined to think that there's no way they could afford to pay for prep. we really encourage people to come in and talk to one of our prep navigators. we find that we can help almost everyone find a way to access

prep so it's affordable for them. >> if you times we do have opponents would be on thursday morning. we have two different clinics going on at that time. when is women's health services. people can make an appointment either by calling them a dropping in or emailing us for that. we also have an hiv care clinic that happens on that morning as well also by appointment only. he was city clinic has been like home to me. i been coming here since 2011. my name iskim troy, client of city clinic. when i first learned i was hiv positive i do not know what it was. i felt my life would be just ending there but all the support they gave me and all the information i need to know was very helpful. so i

[inaudible] hiv care with their health >> about a quarter of our patients are women. the rest, 75% are men and about half of the men who come here are gay men or other men who have sex with men. a small percent about 1% of our clients, identify as transgender. >> we ask at the front for $25 fee for services but we don't turn anyone away for funds. we also work with outside it's going out so any amount people can pay we will be happy to accept. >> i get casted for a pap smear and i also informed the contraceptive method. accessibility to the clinic was very easy. you can just walk in and talk to a registration staff. i feel i'm taken care of and i'm been supportive. >> all the information were collecting here is kept confidential. so this means we can't release your information without your explicit permission get a lot of folks are concerned especially come to a sexual health clinic unless you have signed a document that told us exactly

who can receive your information, we can give it to anybody outside of our clinic. >> trance men and women face really significant levels of discrimination and stigma in their daily lives. and in healthcare. hiv and std rates in san francisco are particularly and strikingly high were trans women. so we really try to make city clinic a place that strands-friendly trance competent and trans-welcoming >> everyone from the front desk to behind our amazement there are completely knowledgeable. they are friendly good for me being a sex worker, i've gone through a lot of difficult different different medical practice and sometimes they weren't competent and were not friendly good they kind of made me feel like they slapped me on the hands but living the sex life that i do. i have been coming here for seven years. when i come here i know they my services are going to be met. to be confidential but i don't have to worry about anyone

looking at me or making me feel less >> a visit with a clinician come take anywhere from 10 minutes if you have a straightforward concern, to over an hour if something goes on that needs a little bit more help. we have some testing with you on site. so all of our samples we collect here. including blood draws. we sent to the lab from here so people will need to go elsewhere to get their specimens collect. then we have a few test we do run on site. so those would be pregnancy test, hiv rapid test, and hepatitis b rapid test. people get those results the same day of their visit. >> i think it's important for transgender, gender neutral people to understand this is the most confidence, the most comfortable and the most knowledgeable place that you can come to. >> on-site we have condoms as well as depo-provera which is also known as [inaudible] shot. we can prescribe other forms of

contraception. pills, a patch and rain. we provide pap smears to women who are uninsured in san francisco residents or, to women who are enrolled in a state-funded program called family pack. pap smears are the recommendation-recommended screening test for monitoring for early signs of cervical cancer. we do have a fair amount of our own stuff the day of his we can try to get answers for folks while they are here. whenever we have that as an option we like to do that obviously to get some diagnosed and treated on the same day as we can. >> in terms of how many people were able to see in a day, we say roughly 100 people.if people are very brief and straightforward visits, we can sternly see 100, maybe a little more. we might be understaffed that they would have a little complicated visits we might not see as many folks. so if we reach our target number of 100 patients early in the day we may close our doors early for droppings. to my best advice to be senior is get here early.we

do have a website but it's sf city clinic.working there's a wealth of information on the website but our hours and our location. as well as a kind of kind of information about stds, hiv,there's a lot of information for providers on our list as well. >> patients are always welcome to call the clinic for there's a lot of information for providers on our list as well. >> patients are always welcome to call the clinic for 15, 40 75500. the phones answered during hours for clients to questions. >> >>