spent on these frequent flyers and problems on the street. so, good work, chief. it is certainly a difficult job every day that you and your paramedics and emt's having in responding to the city's homeless crisis. i noticed on page 17 that we actually inspect cryogenic fluids? so we have some fluid being held in our city. so, it gets around. i thought that was pretty interesting. you want to add to that? >> were you holding that for yourself? [laughter] >> president cleaveland: i had a question for our fire marshal. the percentage of notice of violations, how many notice of violations actually get corrected or -- and what percentage have to be referred

to the city attorney? >> good morning commissioners and chief. as far as the percentage goes, the vast majority are abated prior to the administrative hearing process. the administrative hearing process we implemented over a year ago has been very successful and where most in the past we carried on these violations and could be open-ended for sometimes years. and we would have to forward it to ace and get the city attorney involved and all that. this new process abates the majority. i don't have the number committed to memory. but the majority are abated prior to that. >> president cleaveland: are you currently conducting a routine inspection of city's warehouses to make sure there's no illegal squatting? >> xherl businesses -- ko

special businesses are not -- commercial are not part of us. >> president cleaveland: what is a crisp complaint? >> that would be a commercial -- that's an old -- in the past, the chief would know better. we used to inspect some commercial building and to my knowledge, the resources we had just wasn't actionable to maintain. so, we migrated over to focusing on r-2s. chief would be better background. >> president cleaveland: i see the report on page 18 and i saw it. >> commissioner covington: commercial residential inspection we did back in the day. it became resource exhaustive

for our companies to do. >> that would have been a complaint that come in for a warehouse or commercial business. in the past there was an active program for commercial inspections. but that's what this is referring to. >> president cleaveland: thank you. i was curious about that. again, i wanted to express my appreciation for the fact that lieutenant baxter had 475 people attend a community outreach in the month of march, which i think is fantastic. march 18th. 475 people. you are really doing a good job. you and the department is really doing a fantastic job in outreaching to the public and getting good attendance. these events where you discuss how to not have fires.

>> we average about 15 events a month. i think we had a high of almost 2,000 one month. >> president cleaveland: i really commend you on that, chief. >> chief, would you take the opportunity to acknowledge those that are out there, inspect fernando juarez and investigator janet brock. and they work under the direction of the fire marshal and in conjunction with lieutenant baxter to do the community outreach. >> president cleaveland: i think it would be great some time to have those individuals come to a commission meeting and put on a presentation that they do for the public so that we as a commission and the viewing public can see what is actually in that presentation. i think that would be very educational for all of us as commissioners and for the public. how often do you have to complete a tsa audit?

this is probably somebody else. chief gonzales? >> unfortunately, adc kyle lee is off today. but the tsa audit it is my understanding they can come around whenever they want to audit. they are not going to tell you. but i will take a look and find out from kyle lee. >> i believe it's annually at least. and like you said, at any time they can call for records and i believe we are -- according to chief who was at the meeting yesterday that i attended, we are in the process of getting those records together for the annual audit or inspection. >> president cleaveland: i just wondered what was involved with us as a fire department and tsa. >> they look mostly for us for the far 139 requirements as far as our training. and our response times.

>> president cleaveland: i notice we had 19 elevator rescues last month. maybe our fire marshal can tell us where those elevator rescue? were they downtown in some of those high-rise office building? >> they come from anywhere. my brother did one from truck 17. president breed was in an elevator. but they come anywhere. a lot of older elevators. they are standard operating procedures for our trucks. >> president cleaveland: my office used to be in an office building with an elevator that didn't work. >> i will find out about the tsa as well. the f.a.a. response times is the

f.a.r. response sometimes. but i will find out. >> president cleaveland: on the incidents by call type, i notice you had 2,081 medical incidents that were called i guess last month. that's quite a few. is that primarily your ems 911 calls? >> ma -- what page are you looking at? >> president cleaveland: after your last tab. you have got a couple of pages here talking about activities summary report and then incidents by call type. what's always curious to me is the medical incidents, 2,000 of them and that's 16% of all your calls. what was the primary cause of those medical incidents? heart attacks?

what? >> the incidents by call type, predominantly what we get is just medical incidents. that's when the reporting party either they don't make it clear to the call taker or the call taker puts it in to get it expedited. when we get on scene, they know what the call is. they don't necessarily transfer that back and then they change it to that. just because the call type comes in as this type, that's not necessarily what it ends up as. >> president cleaveland: that's how you categorize it. i was curious were they a majority heart attacks or what? >> we would have to look after documentation has been done to get that data back. >> president cleaveland: same thing for the overdoses. you had 224 and i wondered if they were primarily from heroin or what?

>> we would have to go back and look at the epcr's to see what they were. and some of these sick calls, they could have been overdoses. >> president cleaveland: i think the public doesn't really know how many times and how many incidents we have every single day of overdoses and medical incidents. the traffic collisions. you had 438 that you responded to last month. 438 traffic incidents. that's huge. vehicle fires. in one month you had 40 vehicle fires. i'm going wow. you guys are busy. >> yes, sir. it is really impressive what our fire department does. >> president cleaveland: and most people never hear about it and never know what you and your department and your personnel do everybody day. so, thank you. >> thank you, mr. president. >> president cleaveland: madame secretary, would you call the

next -- did you have a comment? okay. would you call the next item. >> clerk: item five. commission report. report on commission activities since the last meeting on march 28, 2018. >> president cleaveland: any public comment on this item? seeing none, public comment is closed. commissioners, you have anything to report? >> commissioner hardeman: i would like to bring up a person that recently passed. the chief and i were at his funeral. probably don't want to hear this, but this is a very sad case. this fella, bernard, went by barney. as a matter of fact, commissioner veronese's mother sat next to me at the funeral, too. he was 94 years old.

and in the late '60s he lost three children and his wife to a fire. very tragic in san francisco. so, he became head of -- i don't think it was dpw. it was street sweeping department and he rose up to do that for many years and when he retired, he became head or director, chair of the city employee's credit union. if you wouldn't mind chief and us closing the meeting in memory of barney who was just the most wonderful person. and for that to happen to him was a terrible thing. fires hit everybody. >> what's barney's last name? >> commissioner hardeman: crotty. >> mr. crotty's son is a member of the san francisco fire department.

long time member of the recreation and parks. we hired him to be a firefighter. that's michael crotty. >> president cleaveland: thank you, commissioner hardeman. vice president nakajo. >> vice president nakajo: thank you very much president cleaveland and colleagues. i just wanted to report that i did extend an often to attend the gardens of city's next board meeting, which will be this coming saturday 8:30. a gesture of continuing communication and coordination with the guardians over the issues of the antique rigs. i also at this time wanted to invite you all to the first weekend of the cherry blossom festival in japan town. again, chief hayes-white has indicated we will be joining the parade on the 22nd. we would like to extend that invitation to you all as well. thank you, mr. president.

>> president cleaveland: thank you, mr. vice president. any additional commissioners comments? okay. commissioner veronese, your name popped up. >> commissioner alioto veronese: i could save this for the next item. >> president cleaveland: okay. madame secondary would you call the next item. >> clerk: item six. agenda for next and future fire commission meetings? >> president cleaveland: public comment on this item? seeing none, public comment is closed. commissioner veronese. >> commissioner alioto veronese: thank you, mr. president. so, several weeks ago i had been in discussions with the chief about -- and i talked openly about this particular issue the stress unit here in the department and how i would like this department to have a state-of-the-art stress unit that the rest of the nation can look at. i have proposed to the chief and

have been in discussions with the chief on a particular resolution that we -- that i'm asking the chief to take a look at to help me draft and redraft to make sure that it's consistent with what she thinks is best for the department as well. i have had a couple discussions with the chief. i'm not asking for this to be on the agenda for the next meeting because i think there's still a lot of work the chief and i need to work there and perhaps with the city attorney. but i wanted to mention it here because i don't -- what i don't want to do is drop this on the commission at the last minute. i would like to have the commission's input also on this and in the interest of public transparency. chief, i hope to -- that you and i can come up with a draft that we could perhaps present to the commission if not at the next commission in their materials but the one after that or the one after that so we get some

ideas from the commission before this is actually presented for a vote. i anticipate there's going to be a lot of changes still, chief. and from the discussions that we have currently had, but i would also like some opinions from the rest of the commission and it may be appropriate to -- the only appropriate way to do that is to give it to you guys. >> president cleaveland: you have shared it with all of us? >> commissioner alioto veronese: i have not shared it. that's my point in talking about it. the point so the public knows and the commission knows, this is a resolution where i'm asking the chief of the department to help me study or to study rather what the best practice is for a state-of-the-art stress unit would be. and so, i have set some guidelines in a resolution where the chief is in some time in a fashion set up over a timeline where the chief is to come up with -- to study this issue and come up with what we would

consider as a department a state-of-the-art stress unit that the rest of the nation could look at and model. so, anticipating that this is a discussion that will take some time, i started it first with the chief and now i would like to introduce it after we have got at least a working draft that the chief thinks she could work with to get it to the commission. if it won't be at this next meeting, it will be at the meeting after that. but i wanted you to know this is something i'm working on for a future commission meeting. i think it is an issue that nationwide is becoming a topic of -- centralized topic of conversation in many departments. not just police departments, not just fire. but it is also police and i would also like to lump into that group of first responders, the dispatchers, acknowledging this week is national dispatcher week. this is on the issue of ptsd and

stress. so, that being said at the next meeting or the meeting after that, i would like to present a copy of the resolution that the chief and i have gone over and i will present it to local 798 and the city attorney. >> president cleaveland: thank you commissioner veronese. i would imagine this would also have some budget implications so we would need some input from mr. corso. >> commissioner alioto veronese: it would have some budget implications. but as i have set it out, i specifically anticipated that this is -- starting a state-of-the-art stress unit is not something you do over night. it is something that will take time given the budgetary constraints. hopefully when you get it, it will answer a lot of questions. i have asked the chief to determine, for example, what she believes the ratio of stress unit members, actual members

that are in the stress unit to firefighters or members of the fire department. there's also a call for a clinical director that is an expert in this particular topic that is not necessarily a member of the department. but perhaps as i studied this, some of the departments nationwide are using consultants to a much cheaper rate to give them ideas on how to address this particular issue within the department. so, we broke it up. yes, there are going to be some budgetary issues but the way i broke it up is we wanted to project this over the next three or four years so we can be responsible with the budget and make sure the mayor's office and the other departments have enough time to budget these things in. but as it currently stands, we have two people, right, chief, that are in that unit? >> correct. >> commissioner alioto veronese: we also have members of the department that have some sort

of stress unit training. we have a grant we're currently using to train members of the department. as you may recall, commissioners, i think there was a general order that went over in the last -- over the line in the last month or two that asked for people to be -- what wanted to be a part of that particular training so that we could use the grant funding. so, we're already -- the chief is already doing some of the work that is anticipated here without this resolution. but my point of doing the resolution was so that we could project this as you mentioned going forward and make sure we have the budgetary requests in our future budgets to make sure that we have the state-of-the-art stress unit. not something that is going to happen overnight and i anticipate that this is -- the resolution will anticipate the amount of time that it will take to get there. >> president cleaveland: certainly a laudable goal, commissioner veronese.

vice president nakajo. >> vice president nakajo: thank you very much president cleaveland. on the subject matter of agenda items in the future, is that what we are currently on? >> president cleaveland: yes. >> vice president nakajo: at some point at your discretion, chief hayes-white, we never had an opportunity to hear and have chief cochran and his presence to report up on his enormous responsibility. and i thought that at some occasion when it is appropriate that both chief cochran could come up and do an information session in terms of the commission as to what is going on within his particular area. i just wanted to note that as well. i also wanted to reinforce the president's suggestion of the group that does the community outreach information. we talked about them coming and doing a presentation as to what

they do. i think that's real important as well. so, that's the two items, mr. president, chief hayes-white, colleagues, thank you. >> president cleaveland: thank you, mr. vice president. sure. >> sorry about the confusion on the last one about the airport, tsa. the f.a.a. is one i'm you rememberly most concerned about. but the tsa audit is either for badges or access. some of our stations have access for the firefighters to get in. but they checked all of our firefighters' badges to make sure they were up to date and nobody has a badge that shouldn't have a badge or lost badges, et cetera. >> president cleaveland: thank you so much. all right. i guess that's it. madame secretary, next item.

>> clerk: item 7. public comment on item eight. all matters pertaining to item eight below including public comment on whether to hold item 8b in closed session? >> president cleaveland: is there any public comment going into closed session? seeing none, public comment is closed. commissioners, what's your pleasure? >> vice president nakajo: motion to close. >> president cleaveland: that would be good. all in favor of going into closed >> president cleaveland: we are back in open session. do we wish to report on any action taken in this matter? i don't believe so. council? no. okay. do i have a motion to disclose

or not to disclose the contents of our private discussions in closed session? >> commissioner covington: i move that the contents not be disclosed. >> second. >> president cleaveland: i have a second from commissioner veronese. all in favor of keeping the conversations confidential say aye. [ayes]. >> president cleaveland: thank you very much. i would like to adjourn this meeting in honor of barney crotty and this meeting is adjourned. [meeting adjourned]

[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