and they are an important resource for keeping the adults in the community and out of institutional, long-term care. if this program were to close then it would result in a loss of services and would have a detrimental impact for residents in san francisco. and with that, that concludes my comments on this item? i'm happy to answer any questions. >> okay. and so what we will be doing is taking testimony on each of the items as we proceed. i -- and several people have asked to speak to each of the items, and some people have spoken to only asking for one. so -- but the public is encouraged, if they wish, to testify on each of the items as we go through each one. and trying to focus, then, on the subject of that item, which we believe will be the clearest.

following the presentation of the three, we will then have the overall discussion of the commission, hoping they have kept each of the three separately because that would then allow us to then ask the institutions what they want -- i mean, the understandings of how the institutions are seeing these moves in a strategic fashion, if that meets with your approval. so we'll go through each of the presentations, have the public testimony on each of the three items, and then, we'll have a commission discussion on each -- on 8, 9, and 10 together. the resolutions will be voted on after the usual period of time for further comment on the part of the public in august as is currently scheduled.

so i will call for those speakers who have first indicated that they would like to speak on item number 8, which is the licensure change. ken barnes please, is that correct? the medical foundation, that would be a different number. okay. we'll get that correct. then, kim tavanglion. >> national union of health care workers. i'm here once again to talk about and to support the resolution as put forth by the department. it is a travesty of justice that cpmc continues to close

programs affecting our seniors. this is one of the fastest growing segments of the population in san francisco. alzheimer's is devastating our communities. they are closing yet another program that affects these seniors and -- and u.h.w. cannot speak out strongly enough that this is just devastating. there are limited services in san francisco without having any proposed side -- site where this can go into, we know that the service is lost. we know that the rcfe's can't afford the land in san francisco. where are these programs going to go? the nonprofits are suffering from the real estate crisis in san francisco. we know that housing is expensive, but for these nonprofits to operate in san francisco, it's equally

expensive. and without this -- without a location where this can go, it's not going to automatically pop up. and cpmc is one more time deciding to hurt this population. you know, i see their commercials. it's like here, have a baby. here, i guess let grandma and grandpa have to go out of county. they have no problem shipping people to fresno, they have no problem telling people they have to leave the county. this is yet one more time where a very profitable organization is shirking their responsibility to every family in this county. and i hope that every commissioner will speak loudly about this, 'cause cpmc has had more prop q hearings in the past two years. i feel i know you all intimately because i've spoken so many times about this. you know, they are making tons of money. this isn't like a tiny community hospital.

millions, hundreds of millions of dollars, and they're sending these people -- they don't care. no referrals. other programs are impacted. where are these families going to find support for their loved ones, their seniors? the heads of their family, the way we would all want to take care of our grandparents or parents. this is not what san francisco's about, and i would encourage you all to vote yes on this resolution. thank you. >> thank you. the next speaker on this item is dr. teresa palmer. >> hi. i'm a san francisco geriatrician, and i work with kim at san francisco's for health care housing jobs and

justice. and i urge you to say that the closing of swindell's is detrimental to the people of san francisco. this was done purely to preserve revenue and not because these services are not needed. the swindell 1ed family founding this foundation, founded this with their foundation money, and unfortunately, now they're all dead, and so cpmc is closing it. and it's not acceptable, and it's just one of the many closures, including the subacute and the snf units at st. luke's. this is not because the people of san francisco don't need the services. the people of san francisco need the services, but cpmc wants to do the higher revenue acute short stay, and they don't really care what the people of san francisco need.

so please pass a resolution that this is detrimental. thank you. >> thank you. if there are no other speakers, did you place in -- i mean, that's fine. why don't you announce your name. >> i'm michael lyon. i'm also with the san franciscos for housing, health care, jobs, and justice. so kim had talked earlier about cpmc shirking its responsibilities for supplying a kind of health care to san francisco, although it make -- this nonprofit makes millions upon millions of dollars from getting rid of less reimbursed services such as swindell. i want to talk a little bit -- i want to shift the focus a

little bit on the question of shirking the focus of responsibility, because i think the focus really lies with you and the board of supervisors to not let this continue to happen again and again and again, of these services being closed. the -- the groups that are supposed to -- supposed to have been setup to deal with these programs, like the hospital council, that long-term care council, really is dominated by private hospitals, particularly cpmc. and it's no wonder that nothing has happened on these up to now. you have to reassert yourself. >> thank you. remember, the first item is on the licensure change. we'll now go onto the next item, which is on the potential closure. >> clerk: yes.

item nine is the potential closure of cpmc alzheimer's residential care facility. >> great. so the second change we are discussing today is the closure of swindell's residential care facility. this is a 24 bed residential care facility for the elderly, which is how it's licensed by the california department of social services that's located at california cpmc's campus. this campus provides 24-7 care and memory care services for patients living with moderate to severe dementia, including assistance with activities of daily living, such as eating, feeding, dressing or bathing. cpmc plans to close this facility by the end of 2018? and they have collaborated with elder kara lines, which is a nonprofit organization -- care alliance, which is a nonprofit organization. as a result of this collaboration, there will be 14 new beds available at

residential care case alliance's campus at alma villa. as i mentioned, they provide 24-7 supervision and assistance with activities of daily living. residents are typically private pay as this level of care is not reimbursed by health insurance? and some facilities offer what is called memory care, which is a special kind of care that's provided to adults with dementia or alzheimer's. memory care services can include activities to stimulate the memory of residents, security to prevent patients from wandering, which is common among those with more advanced stages of dementia, and these facilities typically have higher staffing ratios and staffing specifically trained to care for those patients. so given that our older adult population is growing, we know that our population 65 and older will grow from 14% of our

population to 20% by 2030, and the alzheimer's foundation has estimated that san francisco's population with alzheimers will grow by 69% by 2030. we know that residential facilities for the elderly are a critical level of care and long-term option of care for our residents? so how many do we have in san francisco? approximately we have about 66 facilities that provide 3,070 beds. unfortunately, there's not a good data source or publicly available information to learn more about these facilities, but we were able to determine that there are at least 13 facilities in san francisco that advertise memory care and they have designated around 322 beds for that type of service? i'll just note that this is likely an underestimate since we were only able to collect information on what we could

find. so a little bit about the residents who are currently at swindell. as of june 2018, cpmc reported that there were 15 residents remaining at swindells. at of july 2018 about 12 residents have moved to the eller care alliance alma villa, and another resident chose to move to a different facility, and two residents are planning to move to cpmc's coming home pos miss. cpmc wihas reported that about6 staff will be impacted by this change and that they will be placed in comparable positions within the system. and the graph on the right just provides a little bit of demograph demographic about the residents

who are at swindell's in june of 2018. so we know that our senior population and our population with dementia and alzheimer's is growing? and so whole cpmc has provided a viable and cost neutral solution for its current residents which will ensure that patients have families have a similar level of care with no additional costs, the closure of the facility will ultimately result in a loss of ten residential care facility beds for the elderly in san francisco which will potentially limit access to this type of care in the city, so for those reasons, we recommend that the closure of this facility will have a detrimental impact on health care services in the city. that concludes my presentation on this item. >> thank you. we have one testimony again, kim tavanglioni.

>> regarding the residential care facility, we do represent members who actually work in this -- on this unit. not everybody has been placed in a comparable position, i want to make that crystal clear. some people have wound up with reduced schedules, etcetera, so we are not completely happy with that. once again, cpmc is shirking its responsibility. the loss of these ten beds is detrimental to the entire community. alzheimer's, issues with ageing, it's a very specific

type of care that requires the workers to develop deep relationships with the clients, and closing the sliding scale service puts a lot of san franciscans out of county. san franciscans are being forced to find care outside of county. this makes it worse. cpmc is making enough to actually provide this level of care. they're choosing not to. they're choosing their own bonuses over the care of san franciscans, so i urge you to vote that this is detrimental to the community. thank you. >> you it. dr. conor, i also recognized that you had put yourself down for this item. are you okay with your prior

testimony? [inaudible] >> thank you. [inaudible] >> right. [inaudible] >> right. and commissioners, i recognize that the first two items actually do speak about swindell's and the residential care facility. the third item is actually quite separate which is the change from services from the hospital to the foundation. if it's okay with you, i think we should discuss the first two items first, and then, we'll go onto the third or the subjects may well get mixed up. so let's discuss swindell. first, a change of license and the closure. those are the two separate items that dr. bronner has presented. dr. bronner, thank you for

coming, and would you like to make some comments, please. and if there is someone who would like to make some comments from the institute of ageing, that would also help us to understand what the i.o.a. is considering in regards to these two topics. >> so good afternoon, commissioners, and that's tom briode from the institute on ageing who will make comments after i conclude mine. i'm warren bronner. i'm the c.e.o. from cpmc, and i'm happy to answer any questions that you have with regard to the swindell's residential care program. we expect no negative impacts from the change in licenseure. we're working with the agency

to secure an alternate location for the program in san francisco. i want to point out that i.o.a. already manages the program in its entirety and have been a spectacular job. we simply been providing space on the cal campus, and when the cal campus close is by necessarily, the program will thrive at its new home. in terms of the residential closure, that provides 24-7 care for patients with severe category anitive dysfunction, and while we understand and appreciate the staff recommendations, i would like to emphasize how pleased we are and i believe the families with the residents are with the solution that we've developed with elder care alliance to create 14 more beds in san francisco so they can move into a brand-new assisted living

facility at alma villa which is in parkmerced. i would like to say that almost all of our patients have transferred and that the swindell's residential facility is actually already officially closed. you have already heard that we've arranged for the residents at swindell's to pay the current rates that they pay us. this solution allows the residents to stay together in san francisco and not worry about any increase in costs. we think this is about as good of a solution as we could possibly come up with. we're also supporting the alzheimer's free community. finally, i want to add prop q hearings are about all the locations we're closing, but i

would like the opportunity sometime during this hearing to tell you all the new things that we're doing with alzheimer's and geriatric patients here in san francisco. and we support ageing in place here in san francisco. tom, you want to say a few words? >> good afternoon, commissioners. i'm tom briode, c.e.o. of the foundation. we've had a wonderful partnership with cpmc, and we are very invested in continuing this program into the future. cpmc gave us a significant advanced notice of the closure of the california campus, but as you can well appreciate in this wonderful community of ours, finding alternative space is a significant challenge. finding space is a problem, and then being able to afford it is a second year problem, so we have been in the market for almost two years, looking for

appropriate space to transition that day program. i am happy to say that there is a glimmer of hope. we have found a wonderful piece of property in the presidio. it is a freestanding building, about 7,000 square feet. it will allow us to double the number of people that we're able to serve in that program. and in fact, we're looking at building a much more robust ecosystem around families and individuals with dementia. the challenge continues to be how do we pay for it? the presidio property is class a priced space, and for the last 16 years, cpmc has allowed us to operate on their property on california without any rent charges, so we are going from a rent-free operation to one where we're paying premium rent. we are -- so that comes out to somewhere in the neighborhood of $450,000 a year, year one.

we are currently in dialogue with some major donors to help us to fund that rent. we're doing -- the presidio is very interested in having us. they've come up with some creative ways for us to be able to fund that rent obligation from an up front payment from a donor, so that is not a fait accompli. we should know or have some decision from the donor that we're speaking to by the end of august. so we are aggressively marketing the donor opportunity to multiple people, but there's one donor that's in front of that line, and so we are working very diligently. we're committed to serving the families and individuals with dementia. it's a part of our core work in serving older adults and adults with disability. we serve about 20,000 people every year through the institute here in san francisco, san mateo, santa

clara, marin, and now in southern california as of january of this year. so serving this population is our sole purpose for existing. i'd be happy to answer any questions. >> thank you. commissioners, questions to any of our presenters and to our guests? commission commissioner bernal? >> hi. specifically with your comments with regards to the presidio, are there protocols in place, and in addition, would something -- would occupying a space there require any kind of build out, seismic upgrades, etcetera? >> i'm happy to say that all of those issues have been resolved. the architectural drawings have been approved by the historic preservation staff at the

presidio. there's parking available, so easy access for family. there's a transportation within the park for employees to get to our site. it really meets all of our requirements. if we can come up with the rent, we'll be doing quite well, for all of our families and being able to serve a much larger population. >> i'm familiar with the systems. so there's the presidio go system. are you saying you'd be utilizing that specific system in the presidio for the families. >> four our employees. we provide all of the transportation for our clients. >> commissioner sanchez? >> yeah. yeah, hi. i wondered if -- cpmc has been involved in a multitude of explorations, and i didn't realize that you've been linked with them since 2002. this is the same program that

dave badigar has been involved it. >> dave is my predecessor. >> i'm sorry. i haven't kept up on the shift of personnel, etcetera. >> okay. >> the second question -- okay. as -- okay. because it's all interrelated, there is a crisis pertaining to providing the quality of care, number one, with actual physicians available or part of the protocols. and then, secondly, the fact that part of the st. luke's effort, and we're still looking at that, is that there would be a senior center of excellence there to provide multitude of service -- at least this is part of the hearings we heard many years ago, etcetera, and we still hear it. and yet my question is, and

some of the community, how come all of the senior projects or programs are not really being looked at areas around st. luke's whereby we have a number of -- of projects for housing, even for seniors, which they want to put eight stories, ten stories, and seniors don't want that. they would like, maybe four stories at the most, along with certain specialty units. some are being done in los angeles, seattle, etcetera, but somehow it's not happening around this fantastic facility that is going to be opened up next month, and we're still looking for some of these programs to house patients such as you have been working with. and i guess i'm sort of wondering, like, right across the street, and this is going to come up again, but it's interrelated. they just built new huge condos

on valencia where the chevron station used to be on -- whatever. those are going from 1 million to 3 million. two blocks down, you have the foundation, which cpmc now -- i don't know if they own, rent, whatever, but that's there. and a number of folks are trying to say, you know, as we take a look at this growing need for seniors -- and you take a look at the data, who are we serving? they're saying about how families moving out, a lot of the families are not only being moved out, they're being picked up and sent out, not only within the counties, but back to -- back to countries that they came 40 years ago under agreements with the u.s. so all i'm saying is all these things are happening today, and -- and when you take a look at the data of who's being served in a multitude of these

programs, i didn't see one native american or latino family in a number of these programs. at the same time, many of these services have a high number of veterans who are native american and latino, and they're asking and being serviced now in the mission district. and yet, we're not getting any creative thinking even though we have these new facilities. the presidio is fine, but nobody, or very few families could even afford to go to the hotels there, veterans -- $600 a night, or to rent out a space? don't get me wrong. the presidio is a great space, but all of a sudden, there's a big differential pertaining to costs, and as you said. 7,000 square feet, $450,000? more power to you. if we could find money like

that, but to sustain you, but look at other parts of the city which the institute on ageing has access to, and instead of sending people out to santa clara or whatever, let's do some creative thinking which would reflect the contributions of cpmc, institute on ageing and others, which you've been providing for a number of years. that's all i'm asking. it's a real challenge, and it gets more frustrating as we see more fragmentation and alienation -- not alienation, but -- yeah, alienation of services because of -- of some of the particular political focus that looks at immigrants again and immigrants that have, quote, owned this land in the 1840's, and families are still

being deported, and that includes some from even the city and county of san francisco. so what i'm saying is all of these movements pertaining to moving families out, and again respect for the elderly in many cultures. and having folks some their families be cast out or saying there's no way we can afford to put you in these places because it's too expensive really does a disserve to what these institutions and these places have been to the city over the years. maybe it's type to think what is our mission here in the city of st. francis? we still need the quality -- the quality of care and dignity, respect that these elderlies and families have that have helped built this city and this nation. end of comment. >> just a comment relative to

the day program. that's the only thing i can address. but the location in the presidio is ideal because the catchman area of the program the people it's currently serving is right there. for us to move the location would mean the timeline would be too long, and the clients that we normally serve, we wouldn't be able to serve. so yes, the presidio is an expensive location. that wouldn't necessarily be moved to the people we continue to serve, but it's near our current location. also in our bigger concept that we're putting forth, we need other day programs, dementia specific in the city. we need to identify where can we place other centers to serve other neighborhoods, and that is part of the discussion we're

having with our donor, that we're talking about a citywide approach to this, not just a one center. so -- >> that's good. >> and we serve a significant number of veterans in approximate our existing program right now, funded through the v.a. >> thank you. commissioner green? you mentioned that you're working in other geographies in the area and in the state. i'm a little confused what the relationship is with cpmc in particular. you mentioned free space, but if i understand the employees were cpmc employees, so can you explain the relationship in a little more detail and also whether you plan on sending those employees back when you open in the presidio. >> so our formal relationship with the cpmc is limited to the swindell's day program and all of the employees are i.o.a. employees. the employees that we

referenced previously those are in the special aspects of swindell's. so those are distinctly different areas of the program. so -- yes? >> i mean, yes what? i'm sorry. you're saying there are two different groups of programs, there's the swindell estate. >> there's residential. >> there's residential, and the day program, and the day program is under cpmc employment? >> it's under i.o.a. the day program has been operated since the very beginning under the institution. >> under the i.o.a. it's the swindell residential that's under cpmc. >> right. >> and that's where cpmc has been helping to adjust those, also? no, no, that has to do with the foundation. sorry.

okay. i see. but the residential program is the one that actually is being closed? >> as i mentioned, the residential program is actually closed. the state came out and officially closed it. all the residents who had been living there are now -- >> oh, they have moved. >> it is closed. >> e oh, it is closed. and those people are either at another location, the hospice, and -- >> for the most part, alma villa. two patients were hospice eligible, and one private paying patient close to go elsewhere. >> okay. thank you. >> you're welcome. >> commissioner chung? >> so i have questions, 'cause, like, that's already a done deal. so -- and we really appreciate

you giving us the courtesy notice to come in. and since we're looking at the impact, and you mentioned that there are some, like, newer technologies and treatment for alzheimer's, and can you share that with us. >> well, actually, i don't think i did mention that, but i'm happy to share that with you. no, no, we have a very active program based at davies that specializes in diagnosing and treating patients with cognitive programs and dementia. remember, i said prop q is the programs that are either closing or transferring ownership. i wish we had the opportunity to come before you and tell you about all the new things we're doing. so i'll take advantage of commissioner sanchez brought up, what are we doing for the elderly at the new mission bernal campus, and we're delighted that we're opening a new ace unit, acute care of the elderly, specifically designed

to take care of older patients. i will tell you when it was first proposed, the definition of older was 65 and older, which was a little too close to home for me, so we moved it up a few years. we're also going to have special geriatric beds in our emergency department because we often see elderly patients in the e.d. who become confused, and we think if we have a special place to take care of them at mission bernal, we can reduce the likelihood that they need to be admitted. we're also delighted that patients on the ace unit, when it comes time to discharge, if they're safe to be discharged out, they will be discharged to the san francisco village, which is a wonderful organization that we've been helping so that he can help us when patients go home after a medical stay or surgical illness, that they have the ability to continue to thrive in their homes.

sbie -- [please stand by]

>> given what was said about the difficulty of availability, of the patients, could you share with us where those residents, those patients might have gone. >> no, because it's just one patient and that would be too close to violating their confidentiality. i will say, for private-paying patients, as many of the patients a. >> the second question then would be the staff impact for caregivers for the facility that is closed? they have all been placed in similar or equitable positions. >> the facility just closed. in fact, we're still in the

process of and we will find jobs for those looking for a job. they were all working until the transition happened as of last week. we're still working with them. >> that means that some employees have lost their positions. >> just to clarify, they will all need to change positions because ac as i mentioned, theyl worked in the unit and the unit is closed. we have other opportunities for them within such a large organization. >> thank you. >> and my next question is regarding the potential location in the presidio and you mentioned the expansion of services. you will then not only need funding for the build out and the rent of the facility but if you are going to expand

programs, which is great, would you also then need to be able to hire additional staff to serve the additional -- they're not patients. they're clients, yeah. that will be now able to come to the larger and expanded facility? >> if we receive the gift that we are asking for, that would be sufficient to launch a major expansion and so there would be employees involved in that. this is a visionary concept at this point. it's not like a very d delineatd approach. we're attempting to get the interested donor in the concept specifics on the presidio is black and white. the rest of a build out of an expanded program would be a conversation with that particular donor as to how it would be rolled out over many

years. yes, there would be the expansion would result in employment and other pro ten shall centers and all depending on the gift. >> thank you. >> first of all, i know that discussions around such a generous gift are sensitive. they have to be treated as such. i was wondering if you had a sense of the timing? if that would happen -- if perhaps that would all be settled before the closure of it? >> timing is critical. an open parcel in the presidio is in high demand. it's giving us latitude with time but i don't control the donor's timeline. we'll have some indication by the end of august. >> and the existing program will close when?

>> i will not say that the existing program is scheduled to close at all. because the program is being relocated. we don't have the new location. we have until next spring to make that relox. >> the timeline is feasible to prevent an interruption and service. >> we will make it happen. it's not a choice. >> so i'm just trying to get clarity. the alzheimer's is closed but the facility isn't yet or is? >> the facility is closed but they have stuff that needs to be packed up. >> staff will do that. >> thank you for clarifying

that. where are the day program? >> the day program is still open. they're two separate programs and two separate locations and they just happen to be on the california campus. >> ok -- the program is closed and that location on the cal campus is no longer being used, right? >> correct. >> the program there is the day program wouldn't continue when the campus closes? >> it wouldn't continue at the campus. >> ok. >> all right. >> so physically you would have to move and that is what you are looking for and presidio at the moment is your best hope?

>> we greatly appreciate it. >> well, the commission wants the program to continue, so i think you have -- >> to i.o.a., do you have a plan b? >> yes, all eggs are not in this basket. there are multiple donors we're talking about relative to the presidio and then we have have a real estate people continuing to look for alternative properties. >> an understanding that this is one-time dollars for a donor that could go multiple years, are you having a strategic financial plan how to -- because you are bee facing this same question in four or five years. >> the model that we're using would be a pre payment for 20 years of half the rent. the operation of the program would be responsible for paying the other half?

so the donor would essentially be preparing the rent. >> that's your plan? >> that's the plan. >> that's the way it works for that parcel. >> yeah. >> i would go beyond most of the memories of this commission. commissioners, are there more questions on the swindle residential care facility and or the when there is a day program. there are two separate things happening here. hearing no further questions, why don't we move forward to our next item. >> item 10 is change of management of the following out patient department to sutter. pacific medical location. breast health, mammography

center. non evasive center and the specific campus out patient psychiatry. >> and my third and final prop q item for today is the change in management to sutter pacific medical foundation. so, they will transfer five out patient department services listed on this slide to sutter pacific medical foundation, which is sutter health foundation in san francisco, marin and sanoma. they have over 240 doctors that provide primary and special professional services throughout clinic. the first is a breast help ma'am omammography center. it's august 5th. the clinic will be located at the medical office on saint luke's campus. and all this detailed information is in your memo. the second change is for the n n

evasive cardiology. the expected transfer date is august 5th and the clinic at saint luke's campus. the third and fourth change is the diabetes center at saint luke's and california campuses. the saint luke's diabetes center will be located at the medical office at saint luke's campus. and they are still determining where the california diabetes center will be located. the fourth change is the out patient psychiatry clinic at its campus. this expected transfer date is still to be determined but will not happen before may first of 2019. and the clinic will be moved to ctmc davies. in terms of impact, cpmc has reported that 7,497 patients will be effected by this

management transfer. the majority of those patients would be saint luke's patients. about 15 staff will also be impacted. and at this time, ctmc has reported no changes to services, accepted payment sources or staffing models. we did receive a couple of additional questions from you regarding this change which we have shared with ctmc who might be able to speak to those today. so, at this time, while cpmc has reported there's no changes for patients, as a result of this management transfer, additional information might be necessary to determine what the impact will be. information such as the new location of the california campus diabetes center as well as sutter help ability and commitment to retain these future services in the future. things that need to be considered before making a determination. that concludes the information i

have on this item. >> thank you, very much. we have three requests for testimony. dr. kim barnes, dr. theresa palmer and kim leoney. dr. barnes. >> my name is ken barnes and i was -- i am a physician and i worked at saint luke's for 30 years. i also work with san franciscans for housing health jobs and justice. i want to talk to you about the proposed transfer of the hospital-based diabetes center at saint lukes to the sutter pacific medical foundation, which i find somewhat problematic. with such a transfer it appears the diabetes oversight by the

department of health, would no longer be operative. they're employees of the foundation not the hospital. hiring and firing would be located in the foundation and there's nothing stopping the foundation from putting the educators into individual office practices. how will there be accountability in terms of spanish language capacity in serving latino patients that make up a large part of the patient's going to the diabetes center? foundation practices have been known to limit medical patients through percentage caps or designating certain days they will see them. if this is true, does this mean that less spanish-speaking patients would be part of the foundation?

a medical foundation practice of objecobject stick tricks, what happens to those with the costly diabetes type one and type two. where will they be served. this possibility brings to mind fears of the influence of gentrification. will a foundation serve this new demographic at the expense of the current users of the hospital? it's unclear if the medical foundation has a obligation to provide community benefits. as does the hospital. the diabetes centers have always contributed to cpmc's community benefit program with free classes, outreach, support groups and exercise programs.

how will the closing of the center impact the neighborhood women's center, also housed at montego. that practice serves many, if not a majority of medical recipients and uses the current diabetes center extensively. where will those medi-cal patients be served? my sense is this changes up a fire wall between the community. the effect of being the lessening of accountability. two of the simple questions, is this the direction you want to see this process unfold? thank you. >> thank you. >> dr. palmer. >> the out patient psychiatry moving to davies, is probably to go on the third floor of the

north tower, which was, could be a skilled nursing facility. which cpmc is shut down. having wonderful care for the elderly unit at saint lukes doesn't justify shutting down chronic care services like sub acute and skilled nursing care. the third floor of the north tower at saint davies could be used for sniff or sub acute care, which needs to be reopened, and these are services that cpmc has withdrawn from the community, at the community's did hdetriment to increase its n revenue. >> kim tafagloni, please. >> cbmc has done everything they

can to shed any long-term commitment to any san francisco resident. some of these changes, like this proposal, i believe it will be detrimental. moving people's healthcare around becomes a thing of habit, right. like the diabetes center. i know where it's at when you changed someone's habit, they're likely to fall off. and i would need to see a map to see how the flow would happen. i think moving things under the foundation is a way of keeping things out of the public eye, which is very much the m.o. for cpmc. in the previous issues, cpmc didn't tell you that all their

plans or all their new programs are all short term programs. there's not a single long-term program. which if someone needs a nea a r more of care, cbmc, we're out of that business. we don't want you. you go to the next place. the supplements that they provided. those are gone. so, i am highly suspect of anything cpmc does because they really are not into to long-term care for any san francisco an and i want you to be aware of that. it's always a double-edged sword. so i am highly suspect of this proposal. and i'm really thinking public accountability is needed where cpmc is because they will never do the right thing by anybody. thank you. >> thank you.

>> do you want to indicate the reason for this management transfer and if in fact a representative of the foundation were here? how the foundation fill the gaps of what happens as you transfer these programs. >> thank you, very much. this is dr. elizabeth bellardo the chief executive officer of the medical foundations and she will comment as well. let me just start by reminding everybody here that contrary to what you just heard, we have a tremendous long-term commitment every single person in san francisco. has manifest by the fact we will soon be opening two hospitals to serve the people of san francisco for at least the next 50 years. it's deeply disturbing to me that people don't recognize that. as to the specifics about these

transfers, let me just remind you that we know reduction in services as a result of these changes. this is a transfer in who is operating the various clinics. these programs psychiatry, non invasive cardiology, breast health and diabetes will be continuing to be offered here in san francisco, same patient. instead of being operate bid the hospital, they'll be operated by our medical foundation partners as are the vast majority of out patient services that sutter health and most other health systems provide. in fact that's a national trend i'm sure those familiar with on the panel aware of. with two new hospitals opening and two new ones closing, now is the time for us to advance as practices as they relate to our operations concluding the management of our out patient programs. as you know, sutter health operates hospitals in northern california and hundreds of

related clinics, offices and services and it's common practice to have hospital programs managed by hospitals and out patient programs managed by the physician foundations. sutter pacific medical foundation is our partner in providing comprehensive healthcare across the continuum here in san francisco and they will continue to assure access for patients through these and really many, many, many of the programs that we're proud to offer. >> thank you. >> nice to meet you all. i'm an internist, a practice physician and as well as the c.e.o. of the bay area foundation which includes both san francisco foundation, the east bay foundation and the medical foundation. the north part of the cpsd foundation in santa rosa. i always start with -- we believe and our quality metrics show that patients are best cared for in a system of care. in a system of care is not a

hospital centric care center. the system of care means out patient and inpatient care many of frankly, most diabetic patients are diagnosed as pre diabetic as out patients and they're cared for best in the out patient setting long-term. they can get pre diabetes care to prevent them from becoming diabetics. they can get care for diabetes. we do both gestational diabetes care and care of the elderly and as you may know there's a new study that came out which just shows that patients in systems of care do better in their diabetes measures, there's less negative outcome and less more bid tee and mortality. we have provided diabetes out patient education for 1.4 million patients it's been

around for years and i'm committed to my patients and their care. they will get language appropriate and ethnicity appropriate counseling on their diet. certainly the diet and the cultural appropriateness of has panic family is different from the south asian and different from chinese. we believe that it's very important to give culturally appropriate care to our patients and we have information. i'm very excited about this opportunity to expand our services in the health of the patients in the community. i'm very pleased with that. >> thank you. commissioner green. >> yes, i am a little confused about spmf and the health plans you take. because i know that cpmc, for