>> 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 shared with the family members that was inconsistent. i spoke with joshua anderson and i asked a is few questions an specific with the activity

coordinator at st. lukes. she is so involved with our patients in a loving, caring, affectionate way, and i asked him if we can please have her since it's a nonunion position to be transferred with cpmc because basically she would be the only one there which the patients are comfortable with, and joshua mentioned they couldn't because she didn't have a degree, so the person they hired has a degree. so i said well carmen has 27 years experience with these patients, so unfortunately he said no. i wanted to read here a mission statement of cpmc. the mission statement states we are inspired by our northern california community and work tirelessly to deliver top-rated affordable,

health care doctors and employees are always looking for a new meaningful way to care for your loved ones. we believe that every moment matter when it comes to helping you live a longer life. >> thank you. so i have ton rivera and comer marshall. any other family members that would like to line up. >> thank you for taking your time to speak with us. my name is ton rivera. and my sister is a subacute patient. dr. warren browner is right with him says it's not about money. last year sutter health had

$893 million in profits after expenses. this is about choice they are making a choice to close down subacute the same way they made a choice to temporarily house subacute and they made a choice to find space at davies. thank you. >> i am comer marshall and i want to thank you for your support. my sister francesca is a patient at the hospital, st. lukes, she has been there for about six years. i want to support the family coalition the commitment they have made. my sister met with sutter and she is very disappointed because she was not clear of the timeline

specifically how they were going to handle my sister and as mentioned before we need continuity, and she is not clear about what that is going to be. the timeframe, i understand there are four rooms being prepared with 17 patients, what is the timeline getting those completed? i think we need clear on that, and the new subacute patients as we moved forward, we need to make sure that as we get new patients there is a plan in place to keep these people because they are not able to speak for themselves. we don't know what is going to happen tomorrow but i would request this be thought out very clearly so that we can move forward and keep your patients here in the city and county of sa san

francisco. >> do we have families of patients? do we have families of someone dells? swindells? if they would come up. i want to give them an opportunity to speak if that is okay with everyone else. >> my name is rick. my sister has been a patient there for seven years and i have a cold but i just want to say this i know the time is brief. i want to give you my experience. before laura was taken to st. lukes, they fractured her shoulder, they let her go early and we didn't want to bring her back so took her to ucsf. they

don't have a stepdown so we tried to get her into st. lukes but they weren't expecting anyone and they sent us to kent field across the bay, and they said they were concerned with laura and me not ever dealing with anybody with a trach and so she was only supposed to be there for two weeks, it turned out for me to be a three-month nightmare. her -- was dislodged and her abdomen filled with fluid and for three months i was going back and forth to the city from kentfield. kentfield whichs the golden gate bridge. people were telling me at work you don't look good you look tired

and thing. i would ask that the city do something for the future so no one experiences what i went through because i'm sure my case is just one of many. >> thank you. next speaker police. >> anne ludwig. my husband is 79 and has advanced alzheimer's and has lived at skilled nursing.age sutter healther decided to close this facility with 25 licensed beds and move the 17 residents remaining there. we have their proposal to move as many as 14 of them to alma via. this would be a great relief if it's developed, however, so far we have nothing

in writing to guarantee the subsidy for comparable services there where the space they will occupy is under renovation and unable to see, yet we feel pressed to make a decision to accept the proposal as soon as possible, but at least by june. if all goes well, our loved ones will have somewhere to live and receive care but they lose their devoted caregivers and the city loses the institutional know-how of this 20-year-old skilled nursing, there will be a 11 bed loss of care in san francisco, what about the need for more critical care beds for this frail population, which could include any of us. we think hospitals have a responsibility as nonprofits and a civic duty to partner with the city to provide skilled nursing and dementia care in our city and we call on your our elected

representatives to provide policies that will make that happen. >> thank you. next speaker please. >> linda rosario and my mom is at skilled nursing for almost three years she is going to be 104 in september. my main issue is the future families who have to look for memory care for their loved ones and to be able to pay for. i put my mom in irene swindell hoping to sell her home but that can't be done because i cannot evict my sister who is also a senior and disabled. struggling for funds managed to get subsidy grants

from irene swindell and from there it was medcal which doesn't pay for memory care and went through va because my mom is a widow of a veteran, so they managed to help pay half, and the other half would be her social security, and the remainder will be me, so right now i am holding three casual jobs trying to make end meet and i'm hoping in the future that there would be assistance to help family members find memory care which they could afford. thank you. >> thank you. next speaker please. >> my name is jeff tanaba, and

my father is a resident of swindell unit since 2016. his diagnosis was a devastating blow all we are fortunate enough to say that the smartest man we knew was also the kindest. i have won't discuss my father's wonderful life, instead i will discuss the effect this rushed closure is having on our family and although we must discuss the possibility of this for all of us, i won't discuss how this takes away our loved ones and leaves us emotionally, physically, and financially lost. i will discuss the implication of losing these beds on all of our futures. swindell has been home for all of us and this has been a huge life change for pau all of us and the rush h

which this is implements and the fact that it's due to the almighty dollar is sobering to us all. the leaders among the swindell have fought for a suitable venue with affordable care, costability and the ability to move with new staff to a cpmc venue. we have been promised these results with the exception of the staff and we will miss the staff. we are hopeful that dad will be cared for as promised. we are less so for the future of elder care due to the implication of losing these 25 beds. i hope that our children will not have to face this difficult situation in the future. we are seeing aging populous and growing shortage of beds particularly in a city such

as ours. >> thank you. >> my father jack is also a resident of swindell. i will assume that this deal with swindell is a good deal, which we don't know that. we don't know anything about it. we haven't seen a written contract. let's assume it's a good deal. once our family believes alma via, dies, eventually that's going to happen they die or leave, the new residents will have to pay the going rate which is $10,000 for expenses. that is a lot of money. so the loss of swindell

will mean the loss of 25 beds of affordable care, memory care. alzheimer's and dementia is a fact of life and $10,000 would be an extreme burden for most families. my family is lucky because we do have this deal, but we don't know about the future. are the next generation families going to be as lucky as ours? we don't know that. >> thank you. can i call up theresa palmer, melanie. >> raymond holland, memory of the family council for swindell as well at the california street facility. a lot of what you have heard today is really on

the right issues. i hate to say it, but i think it's all part of the affordable housing crisis that you are focused on today it just has a few twists to it. 150 years ago your predecessors had a similar problem and that problem was they had too many cemeteries on the outside land and so they exhumed the bodies and shipped them to calma and lincoln park and all of those areas on the outside became populated and became used for things other than cemeteries. i think we are seeing today the tip of the iceberg in terms of skilled nursing and sub-acute care facilities that are affordable for housing and affordable for care. what is happening is it's all being pushed outside of san francisco

it's something that really should occupy your attention. i think the issue is when and to whom will there be an end to all of this so we can get back to business and do that. my wife passed away early last year unexpectedly and she spent a month over in the east bay in you wilultabates also owned by r healther. you are on the right issue. i applaud you. >> theresa palmer retired

geriatrician. what i wanted to ask about the sub-acuteth and skilled nursing crisis and i wanted to ask cpmc also if the state and city would cooperate with cpmc over issues of licensure, which i am sure they will because this is an emergency, what is the hurry about building medical office space when we should just stop, keep the subacute people at st. lukes even if the acute services move across the street there is no hurry to build medical office buildings. i'm not aware of sort tajes of medical office buildings in san francisco. for reasons of profit and plan to maximize

revenue wants to get out of the sub-acute business, at least wait until there are other options and it seems to me that this could maybe bedi bedeclarea public health emergency and we could ask the state and the city and the planning people and cpmc to all work together and keep the sub-acute unit open and work together on licensure for distributer subacute agencies in the future. >> michael lion with senior disability action. cpmc is the largest, richest and most powerful hospital group in california. the department of justice even says that cpmc they have such a strangle hold on

northern california hospital it is able to jack up the prices of all hospital care, so when the hospital council produces a document like the post-acute care council's report, you know that it's cpmc that's talking here and sutter healther health, and ssuttersutter healther heall care and they talk about -- so g thing of what cpmc's group is saying is still a regional care

forcing people out of the county. they talk about using existing facilities within san francisco like exploring unused space in hospitals medical office buildings. are they talking about the open floor in davies and empty med call medicl facilities. their main thing is trying to expand university based care. >> thank you. next speaker

please. >> my name is linda carter and i'm a retired nurse and i worked at st. looks for almost 50 years and i wanted to just talk a little bit about sub-acute patients and their needs. many of the patients come to our icu that need sub-acute care. sub-acute means they have ongoing issues and many of them are ventilator dependent, they are vital people and they are not just the ventilator and not just a body there, they are people. the aim is to get them out and back into the community, but the sub-acute is close to all ad admissions at st. lukes d

those patients that need those beds, it is really part on them sub-acute patients need a place that is home. many of them have been there for years and you can't dismiss that fact. that is home for them. some of them are able to get out on to the street a little bit on a mobile wheelchair with a ven ventilaton the back. they are needing to be part of the community. sending them out of the city the jus,when they are closed by attrition then we are minus more sub-acute beds and we are going to have to go out of county to get them. i hope that

st. maries is abl mariys marri - >> thank you. next speaker please. >> my name is elizabeth halifax visiting o ombudsman at st. luks i have witnesses first hand the anxiety this has generated for families and residents and i have been truly disappointed by the lack of -- shown by cpmc and their failure to develop trust and give reassurance to those

affected in many many, many yeas working as a nurse, i have never witnessed this degree of lack of compassion. >> i had stated in the beginning that i have to leave at 12:30. i have another something that i have to leave and prepare for. i appreciate department of public health and director gar sey for preparing the report. we talked about the possibilities whether or not cpmc sutter healther were going to continue their subacute care and we came to the agreement along with h2j2 that it is a priority for the city of san francisco. we will continue to work with you. i have personally met with chinese hospital. i know that you have

been working really har hard. e need to bring in kaiser and ucsf and continue to work with dr. browner and see if there is a way to find additional space -- i want to thank h2j2 for coming out today and advocating on behalf of proper level of care. it saddens us to think that people of these economic means that indigent would be treated in this way and this is not a criticism of anyone in particular, but it's being caught up in a transition of our city's history where this has not been a priority and we need to make it a priority again. we have to have this level of care

when you look at this report presented today to see how los angeles has over 2,000 sub-acute beds and we have 17. that is crazy. all over the bay area there is sub-acute care and san francisco is not. i understand it's a cost and a space and there is all different kind of things that come up, but we need to work with the community based organizations, labor and the department of public health and my colleagues to come up with the right solutions. i know there are proposals for legislation and we will aggressively look into those. we will continue this conversation and continue to push. i think we will have an additional hearing because we want to come back and have a discussion when the patients are getting ready to be transferred and we will continue to work with -- on the plan for subacute

care. sorry i have to leave now. >> thank you for supervisor asophe. we will go back to public comment. >> under title 42, the patients have appeal rights against involuntary transfer. this right is included to notices given to each family and patient member. what happens when a patient appeals is that an administrative hearing officer will hold a hearing at st. lukes and preparations made of the patient to a new location. each patient had the right to appeal if they feel that the new location may not adequately provide the care that they need the ombudsman program will

advovat for each patient's right for good care. >> any other persons interested in testifying before public comment closes? seeing none, public comment is now closed. [gavel] >> supervisor ronen: i want to thank every for coming out today and especially families who are going through such a difficult time. every time we have a hearing on these topics, i just feel a little bit heart broken that we don't have a single payer health system because to put families financial jeopardy and ruin when they are trying to care for a loved one is just so deeply wrong and to not have a medical care system that is built around the needs of patients, rather than a profit motive is so deeply wrong, and i

am hopeful that in my lifetime we will see a single payer health plan in our state anded in our country. it just can't come soon enough. having said that, i will also be continuing to watch this issue very closely. i would ask cpmc to continue to consider what it would take to continue a subacute unit in your system in san francisco. i know space is an issue, and it's a legitimate issue, but if we partnered with you, the city, the state, what could make it possible if we had a yes attitude? i am certainly willing to be involved and give it my all and fight within the city to make it happen and to make a similar partnership like the city is exploring with st. mary's

possible with you. i also just wonder for all of the systems, i know we are focused on cpmc and sutter but for all of the systems you see kaiser. these are your patients that need these services and to put those on another entity doesn't make sense and it's not fair, and certainly the city is ready and willing as director garcia has shown to work with any system of care who is willing to step up and partner with the city to serve this essential need of our residents. i will just put that out there that i would love to continue to work with you on this issue and to partner to address this need. in terms of the other eight suggestions of the commune and h2j2, did i get

that right? we will consider looking at these ustio suggestions. i wily like in so many arenas it's frustrating at the local level when we are preempted on acts on some of these more prescriptive pieces of legislation. i wish we had more power than we have, but we will continue to look at these and take these suggestions very seriously, so i want to thank everyone for coming out today and we will continue to pay close attention to this issue. will that, i will make a motion to continue this item to call of the share when supervisor sheehy is read. >> supervisor sheehy: we do need single payer and we need it yesterday. i will comment the city and director garcia on the work and identifying twocyte for

subacute beds so we can start to address this capacity that we are using. i want to thank everyone for coming out today. i think we need to stay on top of this issue and rationalize this system so we can meet those needs within the city. the issue of alzheimer's memory care was brought up today and i think all of us that are getting older had that on our mind and i would like to add that to the list of issues as we prepare for health care for san francis cans. i would like to encourage cpmc to take that large step with the arrangements they are taking with the swindell patients. sounds like there is something positive that's moving forward and if that work can get done and i know it will leave the angzies orelieve theanxiety of g

gone with my father who had alzheimers all the way to the end, but when you have something of this magnitude being a i believable toresolve that and ge peace of mind, the sooner that can happen the better. i will take your motion to continue to the call of the chair. the motion passes and mr. clerk any other business before this body >> >>clerk: there is no further business. >> supervisor sheehy: then we are adjourned. thank you.

>> okay. good afternoon. thank you, everyone, for waiting. want to welcome you to the san francisco public utilities commission meeting for today, tuesday, april 10th, and i want to make a couple of announcements as we start first, again thank you for your patient. we're going to have a revised order on the items that we're covering today. first, there will be no closed session, and we're going to go through