[gavel] >> the meeting will come to order. welcome to the april 11 rescheduled meeting of the public safety and neighborhood services committee i sam supervisor jeff shea hee and to

my right is supervisor subbing in. the clerk is john carroll and i would like to thank s sfgovtv for staffing this meeting. >> clerk: please make sure to sigsilence all cell phones. aga item 1 is a hearing to discuss the closing of skilled nursing and subacute units at is the luke's hospital. >> supervisor: this is something we care about and i know we have had the hearings in the past and we have director garcia and her team and advocates from the community c2j2. i will keep my remarks

brief and this is something that we have pushed for and we were successful in working together to save the existing subacute beds, cpmc committed to transferring subacute beds to the davies campus and we are looking for an update on that today and then we want to have a general conversation on the state of sub-accuse i sub-acutey and what the plans are and we will ask the department of health to come up first and give their presentation. thank you. >> my name is nae and i'm with

the department of public health and office of planning. i want to provide you with an update on subacute healthcare an san francisco. so over all we know that given changing demographics health care financing trends, the high cost of doing business and the high cost of doing business that san francisco faces several challenges in meeting the needs for nursing care in the city. we have the number of seniors will increase from 14-21 percent of the population by 2030. we have a declining supply of skilled nursing facility beds and finally there are limited options for low and middle income residents who need long-term care and have behavioral health challenges. many skilled nursing facilities which are private for profit business limit add visions to --

patients due to low level of reimbursement. so optimally post acute care is provided in home and community base settings where possible and we know that aging adults prefer to age at home and several national, state, and local policies recognize the importance of this to maximize dependence and provide care in least restrictive setting. the majority of patients are sent home after a hospital stay. those who can't return home do rely on skilled nursing for post care. 85% of all hospital discharges are for patients that go home or home health and 95% arhalfa percent are for patiento

need sub-acute care. this slide provides overview of what skilled nursing facility services actually are. we have skilled nursing beds and sub-acute beds which are a skill set. both skilled nursing beds and sub-acute skilled nursing p beds provide 24/7 supervision, wound care, assistance with daily living such as bathing, eating. su subacute care is fr patients who require special care such as patients who are tube fed or use a ventilator. two hospitals have subacute nursing beds. we have 16 free

standing facilities that provide about half of the city's skilled nursing bed supply. i also just wanted to note that currently cpmc is licensed for 28 skilled nursing bids and 13 of those will be used for sub-acute beds in the short-terms. san francisco doesn't have any other subacute in the city and about 11% of the state's beds are located in the bay area while the majority are located in southern california. the department of public health has had conversations with key stakeholders to talk about their experiences in skilled nursing facilities. we have had four meetings with post acute care advocates, representatives and family members to talk about

their experiences and priorities, so we are still in the process of pulling together all of the findings from these meetings but i have on the slide key things that came across in each conversation. the first is that the availablabilit availabs challenging. we know there is a limited availability of skilled nursing care including sub-acute care and facility closures have limited the number of placement options and increased risk of displacement. a second theme and what we heard is that patients and families and caretakers often experience difficulties navigating the post-acute care system. families may lack the support they need to navigate this acute care and insurance systems and it's more different if families have limited english

proficiencies. the third thing we heard about is how important staff are in ensuring a resident's well-being. we know that changing personnel can limit staff connections to residents and make it more difficult for staff to know a resident's preferences and needs. finally, i think one theme that we heard, is just really the importance for skilled nursing residents and family members their desire to be treated with greater respect many felt it was a fundamental right that is not consistently honored across all facilities. the department is recommending a few multi-partner strategize, so this slide highlights some of the short-term strategize that we are currently working on. this is about looking at the need that we have here today and looking at potential unused

health care facility space that might provide opportunity for beds. we have been engaged in conversations with st. mary's hospital. we have had conversations about them expanding that service in st. mary's. -- has a skilled ce unit that is currently unlicensed and we are working with them on that process because we know that can take a full year. finally, we are also planning to initiate conversations with some of the free standing facilities in our community to see about other potential opportunities there. in the longer term.

>> can i ask a quick question? so in these conversations with st. mary's and -- hospital what would make it feasible for those hospitals to step up and provide this essential service, but sutter is somehow not able to do that? >> well, i mean we have been working with hospitals that we know are interested and want to provide this service. i think that all hospitals do have an obligation to provide these to their clients so we started with clients that have expressed an interest in working with us. >> supervisor ronen: i just find it interesting that we hear it's not financially feasible for sutter, but yet it looks like is the mary's and chinese hospital have stepped up to the plate and that is something i'm interested in hearing more from sutter

about. >> so some of the longer term strategies that we want to think about are how we can meet our post acute care needs more broadly, so thinking about residential care facilities and general skilled nursing beds, so one possibility that we have is exploring the expansion of residential care facility beds located at our behavioral health center that focuses on providing care for those with behavioral health needs. finally jewish home which is one of the largest community providers of skilled nursing beds in the city has several acres and have expressed interest of development there, but that is a longer term strategy around 5-10 years.

>> supervisor ronen: how long would that take. >> i would estimate one to two years to go through the regulatory processes. though our immediate need is about developing our current bed capacity in the city, we also know there is a need to look at a range of options that support people at home and also keep the capacity that we have here in the city and so a second strategy is really around looking at ways we can incentivize the facilities to preserve and create the beds that we have and includes office of workforc economic workforce d development. -- the third strategy is about examining ways to improve discharge planning so we make sure that patients who is need skilled nursing care can

get to skilled nursing care and patients who might be able to be supported in lower levels of care are placed appropriately. the fourth strategy is about aging in place, which is preserving an individual's ability to remain in their home with wrap around services and supports. the department of aging is already doing a lot of this great work and we want to make sure we support them as well as look at other options such as medical home waiver which allows those in nursing facilities to get that care in a home setting if they were possible. that concludes my presentation and i'm happy to answer any questions. >> i just wanted director garcia to come up because i have a few things that i would like to ask the department to do and it kind of builds on your presentation.

thank you director garcia. one of the things you mention in this report and st. mary's and chinese hospital, i think it would be helpful if your department could prepare a report to see all of the available space and hospitals in the city that could be utilized for sub-acute care so not just chinese hospital but all the available space in all the hospitals. >> director garcia: we did look at that. i will let you know which ones do not have availability. >> the other thing that would be really important because we have gotten this information, but it's really important that when you are doing this work in terms of coming up with short-term and long-term solutions that you're working with groups like c2j2 they have representatives from

nurses, they have representatives from uhw, they have representatives from community based organizations and labor. if you can work with them as you have been in this working group, that would be helpful in terms of looking at different solutions, and then the other thing that we got as we were preparing for this meeting is that people are being sent out of san francisco, so it would be really important for us to know how many people are being discharged out of the city and county of sarn to continue to access this care because i know that one of the individuals that was at st. lukes was sent out of the city and i know that's probably not the first time people are being sent out of san francisanfrancisco, so for the e five years if you could give us an understanding of the discharge data, not trying to

overburden you. >> barbara garcia, yes, ten years would be a longer request >> clerk carroll: maybe you should give us an appropriate and i will say the rest of my other comments. >> director garcia: remember that some of our clients are part of regional health systems and regional health systems will continue to have facilities outside of the county. i have am a kaiser patient and i would probably most likely go out of county for some services, so i want people to understand that some of the regional, larger entities have regional facilities and we want to service as many people of the city, the department would like to do that and that is why we are stepping up to add the

additional beds and negotiate those with our other partners, but i do believe that regional services are at times appropriate and i do want to make that statement. >> clerk carroll: i think that's important. the problem is when you're talking about subacute care, 24 hours around the clock, where family members have access to their family members. to be sent out of county is a burden on everybody. >> director garcia: absolutely. if the 17 beds leave san francisco, we do have an obligation to look at more in the city. >> clerk carroll: i keep saying c2j2, it's h2jt. sorry about that. my brain is not working this

morning, allergies. >> supervisor ronen: i wanted to ask you, so i'm surprised to hear and heartened and happy to here that you are talking to stl which the last couple we had indicated this wasn't the trend and sub-acute bed didn't fiscally or financially work out and then to hear that one of our main strategize to keep some in county was to talk to other hospitals who are much more willing to work with you on this, and it's frustrating. i just want to hear more from your perspective sort of st. marries an mary'shospital to meet this d

sutter's unwillingness to do the same. >> director garcia: the issue for the department would be the fact that these beds are necessary. we haven't talked about the fact that it's going to be a costly endeavor for us. one is that st. mary's is not providing the service. they will lease the space to us for a provider to provide that service, so it's a little different model. one of the strategize because we will be opening up our st. mary's be behavioral health beds shortly and that is the work that you have to do with all the other entity. because they had space variable we thought we would look at that a but it would be another provider, not st. mary,s so a quadruple partnership with uc. >> supervisor ronen: would the city be providing the services?

>> director garcia: we will hire a contract provider. it is uc and ourselves that are coming together to look at that. >> supervisor ronen: what about with chinese hospital. >> director garcia it's most likely going to be chinese hospital. we are at the beginning stages. to get to 23 beds they have to have some renovations done in their ki kitchen. we are at the beginning stages and i believe that is an important conversation to have with chinese hospital. i've asked cpmc what it would take to keep those beds open. there are times for us to get the beds that we need we have to pay an additional dollar for some providers to ensure that we can

get our clients into a bed as an example, so i sub-acute pays ber than a s.n.f. bed. each has the direction they are going and i would need to have cpsm discuss their own issue. we are looking at one with chinese and one with dignity as well. we are more than willing to work with cpmc as well. >> i was wondering about kaiser >> director garcia: we will address with kaiser. we took who was willing to come to us quickly on that and they are on our list as well. they have lots of facility it is across the county and i believe

they could be responsive to if they have patients in san francisco. the population most impacted is our medic health population and the department feels responsible for many of those patients in terms of their ongoing care. we also believe that all hospital systems have that same responsibility but they also have that commitment because they are serving medical populations. every health system has their own plans and we are hoping all of us can come together to achieve the same goal. >> seems like a larger need in terms of health care and a gap that we have identified the niv beds ths.n.f. beds, the subacut

how does this align with the care that hospitals have to obtain to keep their nonprofit status, required charitable provision of services, charity services that they have to do in order to maintain that status or is that left to each individual hospital group to do independently regardless of the needs of the city and the community they are supposed to serve. >> director garcia: they have a responsibility to the state to report those, but we do our own reporting in the city to look at how charitable care is done and we also have lots of our organizations come together around needs assessments so many of the hospital systems are part of that and they do focus in on some of those areas of need.

many work together on charitable work but they all have their own ways of contributes. >> supervisor peskin: maybe we can have a conversation at some point about alignment with the needs of the city, which i i think you are best placed to determine where the needs are and the provision of that care so we can serve the city needs more efficiently and in a strategic way. >> director garcia: happy to do that in the future. thank you. >> supervisor sheehy: , we will call up dr. brown at cpmc. he can give us an update. we would like to hear from you. >> good morning supervisors. i

am please to share we have made transitions and answer your questions. we are working with the families and patients in our subacute unit to ensure a safe trant mission of all 17 patients to the unit at davies. the meetings are held privately with each patient or their designated family representative. at our most recent meetings in march they met with patients, physicians, nurses, as well as respiratory therapists. coordinating with amr for medical transport which includes a critical care nurse and the team has developed a efficient

mode of travel and the patient needs. construction of davies is on track to convert nursing room into subacute beds under the skilled nursing room license. this involves certification by three state licensing agencies, the office of statewide development, the office of public health and the department of healthcare services dhcs. we anticipate approval by -- in june and dhs will visit to complete their process and we anticipate this will occur in time for patients to move by the end of june con tin gent about dhcs capacity. the current employees have all been into new positions or they have selected or enhanced

severance package. i appreciate your ongoing interest in this issue and in the well-being of our patients and their families we share that interest, our top priority remains the quality of care that we provide to our patients at cpmc. . >> some of the questions that we have gotten are concerns about the existing care right now in st. lukes because people that have been working with the patients have familiarity and have relationships with the patients are either done severance or moved on and it's a big concern for the family members. what do you have to say to that? >> i am pleased that we just had ha licensing survey and no significant issues were identified. >> is there a barrier to have

these nurses moved to the davies campus or the caregivers in general. >> all of the staff including the nurses have made decisions about what they want to do. some are moving to our -- and are going to be acute care nurses and others have elected severance. thos >> supervisor peskin: it's 17 now, the number was higher before? >> some of the patients were s.n.f. patients and some have moved to day vies and some have passed away. >> supervisor peskin: so down by seven. how many have moved out of county. >> two. >> supervisor peskin: how many have moved to davies?

>> three. >> supervisor ronen: thank you for being here dr. bre brenner.i appreciate you responded to our concerns about keeping the families in your network and not forcing them to find another provider, so i do want to appreciate that t but one of my ongoing concerns is that with s.n.f. beds so in need to know that these 17 of the s.n.f. beds that are currently in davies campus vies will bdavieswill be, what happens when that no longer need this care? >> they are currently licensed

s.n.f. beds. some will become subacute beds as they become available again in the future because patients some of them get better and get to go home with their families, which is of course is what we all want to see happen and they will get converted back to s.n.f. beds. >> supervisor ronen: so the subacute beds are only temporary. >> temporary is a relative word, some of the patients are with us for a very long time, yes. >> supervisor ronen: there is no possibility of working a permanent s.n.f. unit into if davies. >> it is at the davies campus. >> supervisor peskin: i meant subacute. >> the needs in the city for s.n.f. beds and our needs as a hospital are substantially greater than our need for subacute beds. i think the

supervisor remembers an earlier version of our agreement that included keeping 100 operating beds. we negotiated with the mayor's office i think in the process of going through the development agreement hearings with the board of supervisors the decision was made that it was more important to downsize and up size the hospital at st. lukes and the 100 beds were no lon longer going to be avail that was a decision made through a public process and we and the department of public health were very knowledgeable about the

need for s.n.f. beds and now we are beginning to see how sometimes in the heat of the moment if political process doesn't always make the best sessions. >> supervisor ronen: what would it take to maintain a subacute unit at davies. >> you said something earlier that it was a financial issue and it's not a financial issue. you heard that the payments for subacute are somewhat better, but it has to do with space. >> supervisor ronen: there is no space that can accommodate and nowhere else in your system? >> correct. you may well remember a substantially downsized the new hospital building in van ness. >> supervisor ronen: so it's a space and not a financial.

>> i have said that all along. >> supervisor sheehy: i have not heard that before and that was one of the reasons i asked dr. garcia to do a survey of existing space in the hospitals because it would be helpful to have independent analysis of what you're saying that you don't have space. >> no comments from the crowd please. we will have public comment in a minute, but it's very impolite to interrupt a speaker and sorry dr. browner. >> i am pleased to talk about what's happened. the north

tower of davy's campus is where the north tower was retrofitted and where we have acute patients and south tower is where we had a larger s.n.f. and we currently operate one on the upper floor and the other two are being converted to behavioral health, both in and outpatient and that is another important need that we have in the city. >> i hope that you would be open to working with the department to have public health to have a look at what space is variable. if chinese hospital and st. ma st. mary's are open to coming up with a strategy, i would hoping that sutter would be open to a creative strategy. >> we actually initiated the

conversations with sutter and we have had discussions with seaton and the hospital council discusses this every month and d all the hospitals are interested in a city-wide solution. >> supervisor sheehy: but you have more space than anyone in the city and county. >> i would respectfully disagree. >> supervisor sheehy: you don't have more hospital space than anyone in the city. >> no we don't. uc is the largest hospital in the city. >> supervisor sheehy: thank you >> supervisor ronen: i had a couple of questions from concerns of the families of the remaining 17 patients. one of the concerns of the families is, i guess that the standards for staffing go down if there are 15 patients. will there be a reduction in staffing? >> so, as i'm sure you are aware

we follow very strict staffing standards and we will continue to meet them. we are committed to doing that. >> supervisor ronen: will they go down if it goes from 17 to 15 patients? >> i don't know where the changes happen, but if you have three patients on a unit you need less than 30. >> supervisor ronen: but the ratio? >> i can't answer the question you would have to ask someone from the staffing requirements from the state. we may have somebody. i don't know if mary or josh wants to comment but they are regulated by the state and we absolutely will meet them. >> supervisor ronen: no, i would just love a ratio for the families. >> what is the specific

question. >> supervisor ronen: the staffing ratio for 17 patients is that different than the staffing ratio for 15 patients. >> the staff ratio for 17 is graduated based on the number of patients but the ratio of caregivers to patient remains the same, and if we get to a point where the number of patients is lower but we wouldn't be able to keep to the ratio then we are staffing with more staff. the subacute ratio is higher than the s.n.f. ratio and we do keep those separate. we have historically always been above what was required and we trend in that direction all the time. it's been commented on when we have surveys. >> supervisor ronen: okay, thank you. >> that was mary by the way.

>> sorry. >> supervisor ronen: right now at st. lukes there is about two or three beds in each room and our understanding, let me know if it's a correct understanding is that there will be separate rooms which is nice for privacy but families are worried about isolation of their family members. >> again, i will ask mary to be more specific but most of the rooms on the new unit are semiprivate, two patients per room, sometimes you have to have one patient per room and you can't have male and female in the same room by legislation. >> supervisor ronen: those were the questions i had. thank you >> supervisor sheehy: the next person i would like to bring up is rachel rivera from the st. luke's council.

>> ga good morning. thank you r your time on this continuing matter. the family council would like to provide the following update. since our february 6 letter that was sent to cpmc by the family council, cpmc left many unanswered questions and contradicted their responses to others which caused frustration with the june deadline approaching. after hearing family members concerns, the family council invited cpmc to a family council meeting so that family members could ask questions regarding the transfer process and everyone could receive the same information at the same time, but cpmc instead ignored our request. cpmc

created their own individual meetings and upon feedback from family members the information provided was inconsistent. this has brought a lot of distrust between the families and cpmc. the families are not confident that the mu to davies campus is safe wascpmc has not provided a written detailed plan and they feel it is rushed and this rushed move will impact the patients and cause transfer trauma. as of the beginning of april only four rooms at davies campus are under construction. the activities rooms h has not been updated. there is only one oxygen cook u hooked up and cury used as break room and storage.

there were also no activity or patients at the time of the visit. the quality of care concerns are a main co ongoing issue still occurring at st. lukes. family members have had numerous complaints in regards to hygiene, patient rotation and sections. the new staff are unfamiliar with the patient's needs. the families are dealing with this issue at st. lukes where there are still staff members familiar with the patients and can provide guidance to the new staff. what's going to happen once they move to davie davies where theya completely new staff? this issue is creating many doubts and anxiety for the family on transferring their loved ones to davies given the lack of information and

transparency from cpmc. in regards to the transport to the critical care team hired by cpmc, they said the transport will not include a family member or a nurse from the subacute unit familiar with the patient despite this being a specific request by the families. due to the lack of information provided by cpmc and the inattentive care of quality concerns we feel this is a strategic move to dump the patients at davies and then for get about them. these patients will no longer have a voice since the nurses who are not unionized will fear to speak up for fear of retaliation from cpmc, so the patients and their families through the family council request that the

following conditions b be met prior to the transfer to davies first we request that the hospital subacute beds be a permanent part of care provided at sutter cpmc with ongoing admissions which will address the quality of care concerns. that they commit to training a staff with subacute training and experience, that they commit to maintaining current staff ratios and that they are responsive and transparent in its dealings with the famil families and the famiy council and actses in good faith. thank you. >> supervisor sheehy: thank you now i would like to bring up representatives from h2j2 ken barns and each one of these

folks has two minutes. ken barns, kim mar. >> my name is ken barns and i'm a physician who worked at st. lukes for 30 years including sub-acute unit for 15 years. there is a health emergency, subacute care which includes people requiring the chronic use of ventilators to breathe and people with long-term medically complex physicians is to be phased out by cpmc. as testeddage plans to let the unit die of attrition which would leave them without any subacute bed. patients would be separated out of the county. dps estimated at least 17 beds are needed. dph has convened a

group of hospitals to wrestle with this problem. cpmc up to now has been resistant to participate thinking they have made their contribution already cpmc wants to get out of the sub-acute business and witness their plan for attrition at davies. cpmc has a responsibility to be part of the solution and one way they can do this is admit new patients to the sub unit at davies until solutions can be found. -- building a new subacute facility into the buildings. we applause and support the efforts by dph to look at st. maries as an option. finally one last

comment, sub-acute beds are not be in free standing facilities. they must be adjacent or in hospitals because of patient fragility and frequent transfers to the icu. thank you. >> you are now going into public comment. >> no c2j2 and then we will. sorry gordon, please. >> is it okay for one of the nurses to speak from st. luke to speak before myself? >> supervisor sheehy: sure. we are also going to open it up for public comment as well.

>> my name is jane sanderval. i have worked at st. lukes for -- years. our concern as future nurses and the health and well-being. as a result of the advocacy of nurses the h2j2 collision of which we are a part and the families of our patients at st. lukes make a commitment last fall to provide care to our remaining subacute patients however we are here today to state in no uncertain terms that this commission beige does not gdoes not go farenough to addree services in the city and county

of san francisco. cpmc and must commit to accept new subacute patients and make permanent commitment. shamefully, cpmc has rejected this idea and has only outlined the plan to disrupt the remaining subacute patients by transferring them to beds on a skilled nursing unit on davies campus this summer. subacute nurses do not wish to transfer their employment to davies campus. nurses there do not belong to the unit. st. lukes nurses that transfer there immediately lose the -- union nurses speak out publicly as i am today in the interest of

our patients because the union and solidarity of our patients gives us the ability to do so. union membership guarantees us job security and prevention of layoffs. for example, once cpmc closes the subacute unit after the last patient passes on, nurses will have no contractual guarantee of job units. subacute nurses who would work at davies campus would face extreme job insecurity. to avoid this cpmc must accept new sub say cute patients and nurses must have the protection of a subacute crat.subacute contracts

will not receive their current level of excellent care. as it stands the only registered nurses who meet this description are those working in the st. luke's subacute unit. in fact these are the only nurses who know these long-term patients and can give the highest level of care to these patients. by refusing new patients admissions to subacute units patients requiring this level of care must remain in acute care icu beds while case care seek out of -- often in nonhospital subacute beds. unless cpmc a i degrees to provide subacute unit -- using qualified and acut rns they wiln

jeopardy. >> thank you so much for your attention to these important issues through today's hearing as well as the previous ones last year. as is clear, we face a city-wide crisis in access to long-term and post acute care for seniors and people with disabilities with most severe impact on patients who are predominantly people of color. who need income health care services to proventing the lost of the subacute units. the h2j2 coalition has shared with your solutions to the city to the

complex crisis, and we really focus on the need for the times of levels of care most? jeopardy. given the focus of today's hearing on cpmc's proposed closure of subacute units. the city needs to use all power available to stop the cpmc proposed stopping of the unit. this is critical for the quality of care for those 17 patients and critical to address the interests o nurses who are h taking positions at davieses. beyond the issue of their

obligation to do it's part by keeping the subacute unit open, there is also a need for broader solutions so again i would refer you to the proposals for action that h2j2 has shared with the supervisors and on number eight we had proposals for framework for city policy and lesion that could prevent situations like what is happening from the st. luke's subacute unit from happening. >> i have that and i did discuss that with the group when we met in advance to talk about the opportunity to propose legislation and i will talk about that at the end. >> i am one of the nurses. >> supervisor sheehy: i understand. we are going to open up the public comment.

okay, that is fine. go ahead. >> good morning i am a registered nurse at st. lukes been working there 42 years and am also the chairperson of the st. luke's -- we deal with safety and concerns and we meet once a month. indiscernible. becausagbecausewhile case managr

placement they are kept in icu waiting for placement. the wait can be long. because of this in some instances we were able to accept more -- indiscernible. this led trecently in our ten be care for patient awaiting lung transplant and the most appropriate unit to care for this patient is sub-acute but this request from nurse case managers refused to allow this patient to move to the empty sub-acute bed. downstairs to e patient was held in icu for close to a year even with sub

sub-acute beds empty on the floor. as one of the nurse case managers - -- we are committed o do everything in our powers to provide shar -- indiscernible. as nurses we need to be able to care for patients at the appropriate time. thank you. >> thank you. are we ready for public comment? >> so for members of the public that wish to testify, speakers

will have two minutes please state your first name and last name clearly and speak into the microphone. those with written statements are encouraged to leave a copy with the city clerk. no booing. speakers are encouraged to avoid repetition of previous statements. i think kim then theresa palmer. >> good morning supervisors kim with the national union of health care workers. i have just find it hilarious that there is no care in sutter health and this is another example that we are here again. i think it's ironic that the hospital association continues to talk about the need for

sub-acute beds but won't poney up and come up with a solution. that is laying it your hand to force a solution. i think it's a travesty that cpmc will not continue to admit subacute patients. it puts the current patients in complete danger. furthermore, they say there is a plan but there is not a plan. they have not notitied -- of the new subacute patientnew subacute patients that the nurses will need training and they have not if there is a plan in place they have not met with us or inferred

with us so clearly they do not intend to do a whole lot with these patients. the way they have treated the family councils is a travesty. cpmc needs to do better. they have the ability to do better, and i am tired of hearing excuses that oh, space is more important than patients. they clearly have patients with needs, but their space is more important than the needs of their patients. the irony of that is i don't know, go into real estate, do not be in health care. >> next speaker please. >> trying to have a hearing here. if you guys wanted to organize

this, it would be helpful, so i did call one, two, okay, then i will try to dig through here and figure out which ones are from the family council. >> just come forward. . >> my name is gloria simpson. i am concerned with cpmc and delivering their messages to us. as my sister mentioned earlier, we requested to have a group meeting so we can all hear the same thing and that didn't happen, so here we are coming with a message to cpmc in regards to the information that they sharedh