tobacco, the department of public health and dpw are part of, and fee streamlining as a mitigation is going to be another tool i think this body needs to brainstorm. so please keep in mind, i'm going to be part of those meetings and i would love support. the first one is planned at the end of the month. we can talk offline about that. second thing, new business, i would like there to be more information about how to prepare merchant or merchant organizations for potential rfps for the city. there is going to revenue from the sugary beverage tax and we should try to support merchant organizations to get some of that money. if there is a tool or workshop we can do or presentation, that would be awesome. >> president adams: does that involve lbe?

no? >> commissioner zouzounis: they'll have to be registered nonprofit or entity of which then the merchant association could have a sponsor who takes the money, administrative -- fiscal agent. thank you. >> if i understand properly, you're suggesting that we have better outreach so that -- or enable merchants or small businesses to get a piece of this action? >> commissioner zouzounis: also merchant organizations. there are two examples i'm thinking of. the healthy retail program still has a pilot for fresh produce delivery model they want to develop. so it would be rfp for somebody already delivering to store. how do we outreach and make sure that is open to somebody already

doing that. and then -- >> just to be clear, anybody who -- any entity to receive money from the city needs to be registered with the city as a compliant supplier, vendor. bidder. and i think in this -- then they also have to be a registered entity and have a business registration. to have a business registration means for any of the merchants associations, then they need to have a 501 c-3. but they have to have some sort of business structure. so is maybe something that is also brought up with the council of district merchants. if you were thinking about merchant areas being able to access some of that money, then

to me that sort of seems like a good entity to help be a fiscal agent. >> right. we're having discussions about that. >> but i can -- we can ask the office of contract administration or the controller's office. and rick has done actually a phenomenal job working with our legacy businesses on putting together -- putting together a document on how to become registered with the city. and because we are now marketing in the legacy businesses as vendors that departments can do business with, because for those that become 12-b compliant, then the city can do business with them. so we're also -- rick is also going to be putting together over the next 2-3 months, a guide on how best to do business

with the city. so understanding how the payment process works, all of that. because it's very different than your traditional b to b. >> commissioner zouzounis: one last new business -- sorry, this should have been part of my report. i went to the reopening of the sav mor market on 3rd street and they also won their board of appeals for moving their license. so they are now viable in their new location. >> awesome. ok. any other new business items? >> this is not a new business item, i just wanted to add for the record, sonny made great points about district areas that are having problems with construction and you know, owning a bar and restaurant on

polk street and owning a bar and restaurant, i do a pop-up at may's oyster house. she's definitely onto something with the pop-ups to try to get some of these store fronts filled. i highly encourage anybody that wants to try a pop-up or something to that effect, that they -- you know, we give them a chance, because that's a great way to find out if they want to do small business in san francisco. >> great. i have one new business item. so it's my understanding that corporations can sponsor government activities, correct? is there a mechanism for corporations to sponsor things like the legacy business program? >> well, there is. there is a process of doing

accept and this happens with specific programs. >> the reason i ask is because one of the things that we could do to accelerate the legacy business program is to get more support on the onboarding side. we have one person who is not his sole responsible to onboard legacy business candidates. and so i think that if we wanted to reach out to a number of the large companies that have expressed interest in preserving small business in san francisco, like airbnb and square, they're making significant donations to activities in the merchant corridors to individual merchant associations as well, that we could outreach to them and

others if we had a specific ask. so for example, if we could fund a full-time position to assist with onboarding legacy businesses. i just think that program is such a hallmark of our commission and an area where we can have real significant impact, but it cost money and we're forever going to be budget constrained, and one of the best things we could do is have one or more sponsored positions. also internships. i was at square earlier this week, or last week, for a cdma meeting with square. and they had a number of interns in our meeting and i chatted with one of them who is a princeton student, she was about to go back, but she said my internship has been awesome and i've been tagging around with the government outreach team and

learning how this company is interacting with the city. it occurred to me, how could would it to be a get an internship at airbnb and you were to help legacy businesses? i think we should look into how could we facilitate these companies helping at a level making donations to san francisco city and county, and you know, all the p.r. benefits that come from that. especially with our program which is really, i think, shaping up, especially as we're finishing our branding program and start to roll that out. it will become a lot more visible. i know that the legacy business is grateful for the support they receive getting through the process. if nothing else, there is the gratification of documented your history which you've never taken the time to do. not only for yourselves but for

your children and grandchildren. there is nothing but feel-good out of that exercise. so the more of that we can do, beyond rent mitigation, all the potential financial benefits, but the mere benefit of going through the process of getting on the legacy business registry, i think is a beneficial one and one that we should try to do more than we do. because right now i feel like we're in a little bit of a reactive mode. again, that's part of your new supervisor orientation. here we are and one of the best things you can do is nominate legacy businesses, that gives them an opportunity to meet the businesses. a lot of times those owners are the most active in their districts because they've been there a long time, and they've been fighting the good fight. those are the people the supervisors need to know any way, so it's a reason for them

and their staff to outreach to them and say, hey, you're not on the legacy business registry, how can we make that happen? >> is 365 a legacy business? >> good question. >> commissioner dwigh >> commissioner dwight: look, i went to the opening of the terminal and closing of gumps this weekend. and it's just proof that even the most longstanding of institutions, whether it's fao schwartz, you name it, they come and go. and we all have to remember as small business owners and business owners in general, we're the first line of defense for our companies. we have to fight for ourselves. and you know, whether it's the internet or amazon or a formula retailer or the city doing things that are kind of counter

to our business interest. at the end the day, if we don't fight for ourself, we're going to go out of business. we can provide support. but even the most venerable businesses are vulnerable if they don't keep up with the times. and gump's admittedly didn't keep up with the times. whether they survive bankruptcy or not is to be seen, but there is a lot we can do to support businesses. >> can i ask a question of rick? >> commissioner dwight: sure. >> i'm the third or fourth owner of may's oyster house, it's the second oldest bar and restaurant in san francisco. would i qualify for a legacy business? or you know, for the fact that i kept the name and kept the seafood going, et cetera, et

cetera? >> there are three business criteria on the application process we look at. the business has to be 30 years old or older. there is exception for 20 years if they're at risk for displacement. they have to have added to the community or the city and then the third thing is have maintained their business model. so we look at all three of those. >> change of ownership is not a disqualification. >> that's what i'm asking, i'm sorry. >> change of location is fine. those don't affect the criteria. >> commissioner dwight: the answer is yes. >> i probably will do that with a blue light cafe, too, there is another one. interesting. >> and so, commissioner dwight, we have met with both new supervisors' offices, we did

meet with the aides of supervisor brown and i think one of their questions is always what is the outreach that you're doing? and at this point we're none, because we can't facilitate it. so i think to your point is, even the ability to take on new applications and help with that, but also the process of outreaching, and educating businesses of this opportunity, i think that's a good point to bring. and i think to your point of engaging the private sector, i don't know if commissioner corvi wasn't on the commission at the time, but when the discussion of the creation of the legacy business was created, professor giles from usf had talked about engaging, especially with the

larger legacy businesses to help support because we do have some very small businesses that, you know, probably would love to be on the legacy business registry. and especially those where english is not the first language, so the challenge of writing the application can be a challenge. so getting more support in that area to also bring on those -- >> you don't have to be writer to write a book, you just need to talk to someone who is a writer. so i think if we could fund again this onboarding and also to your point, outreach, we could fund more outreach efforts, especially as we have our tool kit with all the branding. it would be much easier for us to really show, here's the package, here's the extra little bit of gloss you get to put on your business related to legacy business. that is helpful. but we should talk about how we

can start outreaching. what is our ask to these businesses, corporations, who want to and have a stated goal of supporting small business? i think that there -- there is a huge demand for the ability to say we are putting our money where our mouth is to support small business, whether it's buying employee lunches from local restaurants to funding programs like this one. and this is low-hanging fruit if you're in the government affairs department of any of these companies to be supporting legacy business programs in san francisco. as unique as it is as well. and to be shouting that out to not only within san francisco, but beyond where all of your others say, hey, look what we're doing in san francisco. we're not unique in the fact

that small business is an endangered species in our city. every major city throughout the united states is experiencing gentrification and the displacement of small businesses. all the same reasons that we are. anyway, let's see how we can go reach into the pockets of our generous local businesses and have them support a very specific program. it's a lot different than saying we're going to levy a tax on you to pay for general things, or already heavily funded things like homelessness. big problem, you kind of hard to get your arms around that. you're throwing money into an awfully big pot there. but when you're donating money and you can donate a smaller pot highly directed and really see the results, that's where you can get powerful -- it's a real powerful story and ability to sell that. enough said.

>> but i think your point is, we could specifically reach out to the city attorney, so that you fully understand what we can do, what kind of ability to allow for the visual identity of the association of those that are contributing the money in terms of joint marketing. >> what i want staff to do is talk to the city attorney and any other departments that have to weigh in on this. what can we offer corporate san francisco to support the legacy business program specifically? because then we'll have -- here's what we're asking for. we want this to do this. we want this money to do this. and i think it would be onboarding and advocacy, two major things, there may be others. let's find out. and does that mean can we fund a position? what are the -- i'm sure there

are always kinds of issue with that, because there is the pension program. but it has to be sustainable. but then there are some things that don't have to be as sustainable. funding outreach programs, you can turn them on and off. you either buy the ads or you don't. if we could fund a stable position and then also fund p.r. efforts, that would be tremendous. and i think we could round up the funds to do that. so that's my -- that's what i'm gauging as i'm floating that idea with a few of the government affairs people. staff can report back to us. if we have no other new business, commissioners, i'll put it out to public comment. any public comment? seeing none, public comment is closed. >> sf gov tv please show the slide. >> it is our custom to end with a reminder that the off thes of

small businesses is the only place to start your small business in san francisco and the best way to get answers to questions about small business in san francisco. the office of small business should be where you go next. the small business commission is the public forum to voice your opinions and concerns about policies that affect the vitality of small businesses in san francisco. if you are a small business start here. item 8, adjournment. >> all in favor? >> aye. so be it. motion passes 4-0. meeting is adjourned the 6:53 p.m.

>> this is one place you can always count on to give you what you had before and remind you of what your san francisco history used to be. >> we hear that all the time, people bring their kids here

and their grandparents brought them here and down the line. >> even though people move away, whenever they come back to the city, they make it here. and they tell us that. >> you're going to get something made fresh, made by hand and made with quality products and something that's very, very good. ♪ >> the legacy bars and restaurants was something that was begun by san francisco simply to recognize and draw attention to the establishments. it really provides for san francisco's unique character. ♪ >> and that morphed into a request that we work with the city to develop a legacy business registration.

>> i'm michael cirocco and the owner of an area bakery. ♪ the bakery started in 191. my grandfather came over from italy and opened it up then. it is a small operation. it's not big. so everything is kind of quality that way. so i see every piece and cut every piece that comes in and out of that oven. >> i'm leslie cirocco-mitchell, a fourth generation baker here with my family. ♪ so we get up pretty early in the morning. i usually start baking around 5:00. and then you just start doing rounds of dough. loaves. >> my mom and sister basically handle the front and then i have my nephew james helps and then my two daughters and my wife come in and we actually do the baking. after that, my mom and my sister stay and sell the

product, retail it. ♪ you know, i don't really think about it. but then when i -- sometimes when i go places and i look and see places put up, oh this is our 50th anniversary and everything and we've been over 100 and that is when it kind of hits me. you know, that geez, we've been here a long time. [applause] ♪ >> a lot of people might ask why our legacy business is important. we all have our own stories to tell about our ancestry. our lineage and i'll use one example of tommy's joint. tommy's joint is a place that my husband went to as a child and he's a fourth generation san franciscan. it's a place we can still go to today with our children or grandchildren and share the stories of what was san

francisco like back in the 1950s. >> i'm the general manager at tommy's joint. people mostly recognize tommy's joint for its murals on the outside of the building. very bright blue. you drive down and see what it is. they know the building. tommy's is a san francisco hoffa, which is a german-style presenting food. we have five different carved meats and we carve it by hand at the station. you prefer it to be carved whether you like your brisket fatty or want it lean. you want your pastrami to be very lean. you can say i want that piece of corn beef and want it cut, you know, very thick and i want it with some sauerkraut.

tell the guys how you want to prepare it and they will do it right in front of you. san francisco's a place that's changing restaurants, except for tommy's joint. tommy's joint has been the same since it opened and that is important. san francisco in general that we don't lose a grip of what san francisco's came from. tommy's is a place that you'll always recognize whenever you lock in the door. you'll see the same staff, the same bartender and have the same meal and that is great. that's important. ♪ >> the service that san francisco heritage offers to the legacy businesses is to help them with that application process, to make sure that they

really recognize about them what it is that makes them so special here in san francisco. ♪ so we'll help them with that application process if, in fact, the board of supervisors does recognize them as a legacy business, then that does entitle them to certain financial benefits from the city of san francisco. but i say really, more importantly, it really brings them public recognition that this is a business in san francisco that has history and that is unique to san francisco. >> it started in june of 1953. ♪ and we make everything from scratch. everything. we started a you -- we started a off with 12 flavors and

mango fruits from the philippines and then started trying them one by one and the family had a whole new clientele. the business really boomed after that. >> i think that the flavors we make reflect the diversity of san francisco. we were really surprised about the legacy project but we were thrilled to be a part of it. businesses come and go in the city. pretty tough for businesss to stay here because it is so expensive and there's so much competition. so for us who have been here all these years and still be popular and to be recognized by the city has been really a huge honor. >> we got a phone call from a woman who was 91 and she wanted to know if the mitchells still owned it and she was so happy

that we were still involved, still the owners. she was our customer in 1953. and she still comes in. but she was just making sure that we were still around and it just makes us feel, you know, very proud that we're carrying on our father's legacy. and that we mean so much to so many people. ♪ >> it provides a perspective. and i think if you only looked at it in the here and now, you're missing the context. for me, legacy businesses, legacy bars and restaurants are really about setting the context for how we come to be where we are today. >> i just think it's part of san francisco. people like to see familiar stuff. at least i know i do. >> in the 1950s, you could see a picture of tommy's joint and looks exactly the same. we haven't change add thing.

>> i remember one lady saying, you know, i've been eating this ice cream since before i was born. and i thought, wow! we have, too. ♪ sustainability mission, even though the bikes are very minimal energy use. it still matters where the energy comes from and also part of the mission in sustainability is how we run everything, run our business. so having the lights come on with clean energy is important to us as well. we heard about cleanpowersf and learned they had commercial rates and signed up for that. it was super easy to sign up. our bookkeeper signed up online,

it was like 15 minutes. nothing has changed, except now we have cleaner energy. it's an easy way to align your environmental proclivities and goals around climate change and it's so easy that it's hard to not want to do it, and it doesn't really add anything to the bill. >> will call the roll. [roll call] >> clerk: the second item on the agenda is the minuting of the meeting of august 7, 2018. >> so the minutes are before you. a motion is in order. >> so moved. >> and is there a second for acceptance? >> second. >> are there any corrections to the minutes? seeing none, we're prepared for the vote. all those in favor of the

minutes, please say aye. all those opposed. the minutes have been approved. >> thank you, commissioners. i'll note there is no request for public comment for that item. director's report. >> hello, commissioners. greg wagner. chief financial officer. since i am filling in, i'm not going to go into the substance of the director's report, but it's available for the public on the stand. you have that in front of you if you have any questions, we're happy to respond with the appropriate staff. >> commissioners, questions on the director's report at this point? fine. thank you. and we recognize that the director's not available today, so mr. wagner's with us, and -- >> was there any public comment? >> no public comment. >> we can proceed to item 4.

>> item 4 is general public comment, and i'm going to hand commissioner chow one public request. >> thank you. so we have one -- well, actually, we have three speakers. i guess -- is it david? >> the speaker's about the jail. >> this is staffing in the jail, and there's apparently a series of names, rather than individual -- four names. >> we decided to save some paper. we put all the names on one form. >> david cohen, elaine samuels, and jessica inoue from the s.c. i-10:1. >> okay. each of you have three minutes, and we'll hear your general

comment. >> and if i may, when the buzz ergos off, it means time is up. >> all right. you're not going to cut me off. >> i will say time, and that is your time. >> my name is david cohen. i'm the director of san francisco seiu 10:1. we're here to talk to you about short staffing in the jails primarily at c.j.-2, but not just at c.j.-2. we have seven r.n. examine l.p.n. vacancies that have yet to be filled, leaving folks experiencing mandated over time. manning staff are being mandated over time.

employee staff are work with no breaks, heavy workload, facing increased risk of med hours and near misses as a result which put both the patients and staff's licenses at risk. we've had an increase in the jail population at jailhouse two with no additional increase in staffing. and i'll just give you a synopsis of the history at c.j.-2, that historically on the day shift, we used to have six l.v.n.'s and two r.n.'s. now we only have four l.v.n.'s and two r.n.'s, leaving us short. we are having six l.v.n.'s be assigned at least on the day shift on the swing shift, previously historically, we had four l.v.n.'s assigned and

three r.n.'s. we are requesting at least five l.v.n.'s to staff that shift. on the night shift we are requesting one l.v.n. at c.j.-4 and 5. and apparently, there's a plan to remove the r.n.'s on the night shift, and we're telling you to do that because that will increase the problems i'm highlighting here. we've also been called that the inouye population has increased. two months ago there were 289, now there were over 420. we are short staffed, and ron, i appreciate you just gave me a document, ron wagner, that you're trying to fill the vacancies, but we still need additional staffing at c.j.-2. we've had a population of 20 elderly patients that were moved over that have more severe and complicated needs, medical needs at c.j.-2, adding to the additional stress that the employees are facing.

so we're asking for d.p.h. to sit down with us and come up with a real plan to address the staffing at c.j.-2, primarily on a long-term basis, not this ad hoc basis that we have right now. >> time. >> thank you. >> thank you. >> good evening. my name is delphina hardy. i'm a licensed occasional nurse. i work out of 425 7th street

where the medical department is on the second floor. i wanted to speak -- we're asking to add six l.v.n.'s in the morning shift, which is 6:30 to 2:30, and we're asking to add five l.v.n.'s from 5:30 to 10:30 at night. the reason why is the population has increased, and they're sending inmates from san bruno to downtown, and in the last two months, we had 60 elderly inmates come, and they're located in a-pod. you can do things, you still move, but you don't need as much care if you were in c-pod, where we change your ostomy

bags, colostomy bags. the elderly gentleman in a, you don't need that. also, we cannot provide the patient care as we need in c-pod, where they have more ill patients that are, like, maybe on the end stage for hiv, and they send them back from san francisco general. we have to look at them and take care of them for two or three days, send them back out, so we need more help there. we're getting mandated three to five times a week. we're getting no lunches. in the packet that i gave you, you will find people, employees that have signed where they're getting no lunch, and management's decision to say okay, just continue to not have your lunch and eat. i work side by side with my nurses, and these nurses are

falling out. we have to do health care on them. we have to cover the shift for them because we can't go home because we're so short because with the state of california you are abandoning your post under your license, and this is not what we signed up for. we need more staffing, we need help. we do have r.n.'s, and they are also in the same position as we are. they're saying the minimum is two r.n.'s on these shifts. but we have a population, maybe of -- for the whole county jails, a population of maybe 1300 inmates, and we don't have the proper r.n.'s in there as well as l.v.n.'s, so we need help. we are asking to add additional representation so we have staffing. we are asking for additional positions where there's four l.v.n. positions, six r.n. positions that we can fill. we are asking for nor requisitions to fill the staffing that we need.

no, county jail two do not have as much staff as county jail five, but our accruity is please higher, so we're asking that you consider our proposal that you're also seeing there to help us. thank you. >> thank you. >> good evening, everyone. my name is elaine samuels. i'm an l.v.n. at c.j.-2, and i've been an l.v.n. for 40 years. we deal with clients with multiple medical problems, psych problems. we deal with clients with psycho social problems, so we have the whole gamut. in addition to homelessness, we start i.v.'s, we tell man downs, which are seizure

precautions. we get clients in from the streets that get sent to us that may be having seizures, may be having multiple substance abuse, and we have to deal with them right on the spot. we do not have enough staff to cover these clients. we have clients that are suicidal, homicidal, and we have clients that have been, what you call held hostage? we have clients with sexual problems, female and meale problems, we have gender problems in a unit. we deal with all sorts of care that we have to give to the clients. we -- our clients' age group is from 18 to 65, so we're dealing with that group. one patient might be on 20 pills, in addition to being injections, in addition to being diabetics, in addition to being -- having no medical care at all, having no interaction

with people that really can communicate with them, so we have to find out where those clients are mentally, physically, before we even interact with them. a lot of the staff are not trained to do that, and we need help. our senses -- i'm at -- i float. i'm a float nurse, and i'm also a psych nurse. a lot of our clients are on psych meds, and they're paranoid, they're delusional, and we have to deal with them. we put them in restraints chairs. we have to monitor them. they're in safety cells. so we might have about four to five man downs, which means medical emergency, which means safety cell placements, which means -- and they have to be monitored. when they're in a safety cell, they have to be checked q-15 managed times four, in addition to giving meds to them.

and if they are -- if they're hurting themselves, we have to monitor that. we have to interact with the psych department, we have to document on these clients to protect the clients and protect ourselves. and on my unit i worked today, we had maybe inmates of 50 with two nurses. two nurses. if somebody in dorm a is hanging themselves, we can't monitor them. we're catching them on the fluke. that's very dangerous. and also, if you giving on a daily basis, i might give 150 pills -- >> time. >> your time is up, please. >> -- and we need help. thank you. >> thank you. >> this could be our family. >> good afternoon, commissioners. my name is jessica inouye, and

i have the privilege of representing our nursing staff, l.v.n.'s and r.n.'s, and the rest of the miscellaneous staff in the jails and, you know, in speaking with our members, i know that one of the primary concerns that they have and as a unit that we share is the impact that the staffing crisis has on patient care. and these patients who are locked up on the jails and who rely on the nursing staff to have the kind of safe care that they need and that the city is meant to provide for them. you know, we want to acknowledge that the executive labor and executive team, i know they've been working on trying to resolve things, but it simply hasn't been enough

right now to resolve what we see is a really -- is an urgent crisis. the low morale, the exhaustion, the heavy and dangerous workloads that the nursing staff in the jails are facing are a real threat for the safety of these patients, and that is -- that is one of our primary concerns. and i know that our nurses speak to me about that on a regular basis. in particular at c.j.-2, there are a lot of problems, and that has -- there have been a lot of problems for many years, and we want to work with the department to resolve things, but it has to be in a way that respects the dignity of the patients who our members are on

the front lines of caring for? and it has to be in a way that respects the rights and the dignity of the staff as well, and that is that things are resolved in a way that is transparent and respectful of the relationship between -- between the union and the department, and that's something that we're committed to. we want to continue to do that, and we really want your help and your support in urging the executive and leadership of d.p.h. to work with us and work with our members to try to come to some improvement and to make real change in the jails for the staff and for the patients, as well. thank you. >> thank you. i've ever received any other requests. >> okay. so -- so we do thank the members of the jail force to

have brought this to our attention. we'll ask our director -- and in this case, mr. wagner, to please look into this, and then, to submit a report back. >> we will do so. >> thank you. >> all right. item five is a report back from today's finance and planning committee meeting. commissioner chung? >> yeah, commissioner chung. >> good afternoon, commissioners. the finance and planning committee met prior to the commission meeting today, and we have recommended one contract report and three new contracts. it's all on the consent calendar for the commission to approve. >> commissioners, the consent calendar -- any questions to the finance and planning committee chair regarding any of the items or else we will move forward onto the next s e

item, which is the consend calendar. seeing no questions, we will move onto the consent calendar, please. the consent calendar is before you as listed. are there any extractions? there being no extractions, then, we'll proceed to the vote for the consent calendar. all those in favor, please say aye. all right. all those opposed? the consent calendar has been approved. thank you. >> item seven is an action item for the revisions to the sfgh medical staff bylaws and rules and regulations. oh, i'll note that the sgc recommended these to be approved by you at the june 26 meeting this year. >> good morning, commissioners. i'm clare horton, deputy chief of staff at san francisco general. there are two things to bring to your attention.

one is the sfgc bylaws, and it specifically doles with the granting of emergency privileges in the case that we have a clinical need that's urgent in terms of the life or, you know, severe medical condition of one of our patients in that we do not have someone who's currently privileged on staff that can perform that procedure? and it specifically sets up a situation where the chief of staff can review the situation and grant emergency privileges to someone at ucsf to come over and perform that service at the hospital. this -- a good example of this might be ecmo, which is a heart-lung machine for infants. we don't have someone at sfg, but there are qualified people at the university, and we would want to have some mechanism for them coming over and approving and performing those services.

so that's one item. the other item is in the rules and regulations? we just wanted to clarify, you know, there's been a lot of focus on making sure that we get notes locked in a timely manner, and some notes, there's even more of a time urgency fofor than others. we wanted to clarify, if anyone's got this in front of them, that on page six, in the case of operative reports, we do need those to be written immediately and that's really because the patient is about to be transferred to another location, and so although the official signing, other parts need to go into the note or the note might need to be finalized, the note might be signed within five days, we do need that written immediately because the staff that are taking care of them on the floor need to be able to see what happened to them in o.r.

so i'm happy to answer any questions about these two items. >> dr. horton, thank you for coming, and congratulations for being our new chief of staff. >> thank you. >> and the first time, i believe, as such, that you are appearing before us. >> that's true. >> i did want to have the commission understand that under your 5.4, emergency situations, you see for emergency services in terms of certain specialties that might be needed, that there is also another area in the bylaws that allowed for any qualified professional to be also recognized in the case of some sort of massive emergency, right? >> yes, that's correct. so in fact what exists in the bylaws now is you'll see part a of that emergency privileges and that deals with the situation of someone who is part of our medical staff and is privileged in certain items, if there is sort of a life

threatening situation is able -- and they have had, you know, adequate levels of training to perform that procedure, that they are able to go ahead and do that in order to save the patient's life or health. it also kind of spells out that as soon as the person who has the privileges can arrive on the scene, that they would hand over the care. but occasionally, these things do aarrive, and we wanted to make sure it was codified in the bylaws before we asked for acceptance from you. >> commissioners, any questions before the acceptance of the recommendations? any further questions? seeing none, is there any need to bifurcate the question between the rules, regulations, and the bylaws? seeing not, then, we'll vote on the entire question before us. all those in favor of both the

revisions of the rules, regulations, and staff bylaws, please say aye. all those opposed? these have been approved. thank you very much. >> thank you very much. >> dr. horton. >> and i'll note there was no public comment for that item. item 8 is a prop q item. i'll note there's a clerical error on my part with the text. this is actually an item -- action item that approval is requested. it was introduced at the july 17, 2018 meeting. >> good afternoon, commissioners. sneha patil with the office of policy and planning here. so on july 17, you heard three separate changes that cpmc is planning to make in 2018. so today, you'll be taking action on each of those items. so the first item that we will be talking about today is the change in licensesure from cpmc

and the institute on ageing to solely the institute on ageing to the alzheimer's day campus. this is currently located at the the california campus, and provides care for people with mild to moderate if dementia. you heard that they are working with multiple donors to secure a location for this program? at this time, we do not have any further updates about their progression with the donor, and we're unable to predict when a decision will be made. so you have a draft resolution, 18-3, before you, for your consideration. i'll also note that dr. warren browner, director of c.p.m.c. is here, and can answer any questions you might have on this item. >> okay. commissioners, we'll be taking each of these items separately,

so the discussion will be on each separate resolution, and this one is on the alzheimer day program. >> and there are several public comment requests for this item. >> let me see. this is item eight, right? >> yes. >> yes. because several people had asked to speak on different items. we'll call you each time, those that have listed more than one. but first, we'll go to the public for item 8. mark aaronson, ken barnes, teresa palmer, matthew fano, and that's all i have for item eight right now. please. so we're speaking to item eight. >> yeah. i'm mark aaronson. i made a mistake. i meant to speak on item 10. >> item 10? okay. thank you.

next, please. does anybody wish to speak on -- dr. barnes, did you wish to speak on item eight? okay. number 10. >> dr. palmer. >> dr. palmer? you're going to speak on item eight? >> yeah. >> okay. >> greetings. i wanted to talk about the adhc. i have personal experience with it. my mother went to that adhc. in 2016, i.o.a. transferred a number of patients from arguello and geary to that site, so it's a very large adhc. it -- it's -- it helps people who have dementia, and it's a very labor intensive thing to keep these people stimulated and awake during the day to help their families keep them at home so they're not up all

night. and it actually delayed my mother's entry into a nursing home. she's 101, and she was 99 at the time. i think it's undoubtedly detrimental, and i urge you to say this, that these services are being discontinued. this is a program that does not just serve the pacific heights area, we live near the panhandle. it serves the haight area, the western addition, the inner sunset, and there's a -- the dementia related -- the adhc's that are specialized to care for demented people, there's not enough of them, and there's -- having some idea that they might have a site out in the presidio where frail, old people will have to ride a van forever isn't adequate. there is going to be a decrease

in services to the community when -- when this site is shutdown, and it's a community that needs more services and not less. so please, i urge you to vote this as detrimental. it's a withdrawal of services from a community in dire these of these services. thanks a lot. >> thank you. >> there's one additional, commissioner chow. >> there was matthew fano, and kim taglioni. >> are you mathy fano? >> i am. i'm matthew fano, and i'm with the california nurses association. i'm here with our job housing and jobs justice coalition to speak out again not only item

eight, but also items nine and 10. we believe these actions will be detrimental to the community of san francisco, so we ask you to recognize that finding. i'll keep it brief. we echo all the points that these doctors will be bringing up. we thank you for your time. >> thank you. and. >> kim cavaloni, national unit of health care workers. any gap in the delivery of service for senior care is detrimental. it's our job to speak for the patients, it's your job to speak for the patients. if my family member was in this program, and i was told that it was closing, it would be detrimental. if your family member was in this program, it would be detrimental. there's no place to open these

types of services. san francisco is perhaps in the -- one of the worst housing and homeless crisis, and this is not going to make it better. this would be a crime against san franciscans. it absolutely would be detrimental. the fact that cpmc can walk away, a heath care corporation -- and it is a corporation that makes millions of dollars is just walking away, wiping its hands clean and saying good luck, find a program on your own, yeah. i.o.a.'s got to go find funding. that's not acceptable. they -- they are not guardians of health care, they're profiteers. they're carpet baggers. they want to make money, and this they can't, they want to wash their