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 hands. the health commission is charged with the care of every san franciscan here. to say that closing this program would not be a detriment would be a crime. so i am going to urge the commission to vote that this would be detrimental to every san franciscan. thank you. >> thank you. >> commissioners, we're now open for discussion. and i would note that the printout, there is a packet that is with some revisions, but this one doesn't have one. i'd like to ask a clarification of one part of this. in the resolution, in the first resolved, could you explain where we are looking that the adult daycare services prolong

institutionization. >> sorry. can you repeat that question. >> it's in the first resolved. >> in the first -- >> and i'm just trying to clarify the wording. >> so prolong. >> this is resolution 18-3. >> i understand daycare services could provide respite to the caregivers. i'm wondering, do we really mean institutionization or for them to be able to stay at home? >> i think for them to be able to stay at home and avoid institutionalization. >> so we need to clarify that. it's to avoid institutionalization would perhaps be the better word? >> i think so. >> so commissioners, if we want to undertake the resolution, we may want to look at it as a revision. i'm just making comments right now, trying to clarify it, and so presumably, that actually

means to actually avoid rather than prolong. >> avoid. >> we can take that as ed editorial, unless the commissioners object. could you clarify, we were hoping that the services could be relocated. so at this point, what is the progress on that or do we want dr. browner to explain that, even though it's not his program. >> the last conversation i had with institute on ageing is that they are still working with multiple donors to try to secure a location to move this program to. they had been looking at a location in the presidio when they came to the commission on july 17. i think they are still trying to pursue that location and so there haven't been any real substantial updates since july 17. >> do they have any sort of timeline, in terms of how they would feel? because when is this scheduled to be closed? >> i don't believe that there's

an official close date, and dr. browner -- >> maybe dr. browner can tell us about the timeline for the closure of the adult day center program. >> i know that cpmc's california campus is slated to are closed in march of 2019, so i know this will have to lineup with that to some extent, but -- >> dr. browner, any -- >> march 2019. >> the landlords at the moment, we need you. >> dr. chow and commissioners. california campus closes its acute care hospital in march of 2019. there are some services that will continue this for a short period of time thereafter. i met with tom briody who's the head of the institute on ageing this week. he remains very optimistic

about finding another place. >> he is out from the state? >> yes. it's just any of you who are looking for space in san francisco know how competitive it is. they've identified really excellent space and are now looking to identify a donor who can help redevelop that space, and we're working with them on that. >> okay. thank you. so commissioners, we're still looking for space. questions now from the commission. dr. green, was that a question or you were just gesturing? yes, commissioner guillermo? >> i just want to clarify again. so giving the timing of the closure in march, and the optimistic but not concrete plans for a new facility, i want to be clear about what will happen if the stars don't align from a timing standpoint for the adult day health

program. >> in the worst of all possible world, the campus will close before the institute is able to find another location. i would say that's extremely unlikely, and a bridge we don't want to cross. >> and -- and then that means that the clients or the patients will not have a location to transfer to at that time. >> in that unlikely event, that is correct. but as i've said, many people are working hard to make sure that that does not happen. >> commissioner sanchez? >> yes, sir. once this facility becomes operational in the presidio, if, hopefully, that works out,

will there be shuttle transportation available, like the organization provides right now within the city or would they rely upon contractors like independent contractors using the vans which are in operation to provide or has there been any discussion on that? the reason why i'm saying that is because there are a couple of programs, including residentials for veterans that were assigned in the mission, and the presidio. one of the concerns was about transportation access to come back to different parts of the city, and that's been working out fine. so i wonder if this is going into the planning or is it everybody gets here on -- however you navigate? >> so i don't know the answer to that question 'cause this is an i.o.a. program, but i know that they're -- they have an extensive network of transportation to bring patients to their programs, and i imagine that will continue, but that's really a question better asked of the i.o.a.

>> thank you. >> yes, commissioner chung? >> commissioners, i want to actually make a motions because, like, all the discussions, like, from this point on, would be speculated until i.o.a. actually found a place, and -- you know, and present that time to us. it's difficult for us to, you know, like, make a resolution, you know, to determine how -- whether it's detrimental or not. so i -- i would like to make a motion to defer this resolution, you know, for -- for three months so that we can -- so, you know, like, we can revisit this, and hopefully, i.o.a. would have time to present to us. >> i second that. >> okay. there's been a motion and a second for the resolution to a time certain the approximately three months.

is there a debate on the question of the referral for three months? seeing none, then, we'll proceed to the vote. all those in favor, please say aye. all those opposed? so the resolution is deferred, time certain, to three months. thank you very much. we'll proceed to the next item, please. >> yes. item nine is also prop 2 hearing on the closure of cpmc's alzheimer's closure. this was also presented at the july 17, 2018 meeting, and approval is requested. >> hello again, commissioners. so this next item is related to the closure of cpmc's alzheimer's residential facility program, which is the 24 bed program located at cpmc's california campus. information was presented to you july 17 about this change. and while cpmc has made a great

effort to ensure the remaining residents who were left in swindell's were left with an alternative option to subsidize their cost at alma villa. we know this will result in a net loss of ten residential care beds for the elderly in the city. so there by, that will limit access to care for residents of san francisco, and so we do recommend that this will be a detrimental impact for health care services in the city. you have a draft resolution before you, 18-4, for your consideration. >> okay. again, i ask you to please look at the handout that we had to be sure that we have the final draft before us. we do have public comment, and i'll go through the names again. this is for item nine: mathy fano, dr. teresa palmer -- matthew fano, drrks teresa

palmer, and kim tavaglioni. please let me know if i've missed any, but this is for item nine. >> hi again. the nursing association agrees that this is detrimental. we agree with the department's finding, and we hope that you'll move to make that official. thank you. >> thank you. next, please. >> yeah. if you look at the research that mrs. patil did herself, you can see that all of the rcfe memory care units are full in the city. and this is, again, cpmc enhancing its own revenue at the expense of the people of san francisco. we've got an epidemic of alzheimer's going on, breaking waves of baby boomers going into it, and you've got them discontinuing services, not planning for services on its

very well endowed campuses, and a deficit of ten beds for the ones that are there now. so it's unquestionable that it's detrimental, and i urge you to vote that way. thank you. >> thank you. and our last speaker, please. >> kim tavaglioni. we wholeheartedly agree with the department's recommendation. the treatment of the patients who were moved to alma villa prior to us demanding that the board of supervisors have a hearing on this was just tragic. cpmc has routinely -- every time they've closed down something in the city, has really mistreated the patients and the families, make no doubt

about it. patients' families were told that it was closing. they had to find another service on their own. it was just tragic, and the last of the beds in san francisco, at this point where housing and homelessness is at an all time high just shows the callousness of cpmc, and we do hope that you will find that this is detrimental to san francisco. >> thank you. commissioners, comment and discussion. seeing none, is there a motion on the resolution? >> so moved. >> second. >> the resolution before you does say will, is that what you mean, commissioner? >> yes, it is. >> okay. any further discussion? there being none, all those in

favor, please say aye. all those opposed? the resolution is passed. thank you. >> thank you, commissioners. >> we'll proceed to the next item, please. >> yes. item 2 is also a prop q hearing for outpatient services being transferred from cpmc to the sutter pacific medical foundation. >> all right. so the final prop q item related to cpmc today is the management transfer of five outpatient departments from cpmc to sutter pacific medical foundation? these departments include the breast health mammography center at st. luke's pcampus, and outpatient psychiatry clinic at the -- its pacific campus. so commissioners, after the july 17 meeting, you all requested additional information about these changes which have been provided to you in a memo, and they are also summarized in the resolution

18-5, which are -- which is here for your consideration. i'll just quickly highlight a couple of the pieces of information that we're -- that was provided by cpmc. so cpmc reported that ofs 7,5 -- off the 7,500 patients that were affected by the transition to sutter medical foundation, 17% were medi-cal, 48% for commercially insured, and 43% were either medicare or self-pay or other. sutter pacific medical foundation has expressed its commitment to continue care for patients who are served at each outpatient department that cpmc operates today, and sutter pacific medical foundation has expressed its intent to accept new patients that are undergoing transfer. there's additional information provided in your packet, 18-5, for your consideration. >> and commissioners, the responses to some of your

questions are also in a packet in the pile of paper that i gave to you. >> right. and thank you very much 'cause they were also provided to us over the weekend, so -- and thanks, cpmc, for submitting those to our staff. we have public testimony. dr. barnes, this is the right resolution? and mark aaronson, matthew fano, kim tavaglioni, and dr. palmer. please. in any order would be fine. >> okay. thank you. thank you, mr. chairman, commissioners. i'm mark aaronson. i'm a professor emeritus at u.c. hastings college of the law and associated with our community development clinic which provides legal counsel to san franciscans for health care, housing, jobs, and

justice. i am speaking on behalf of the coalition. we ask you to find contrary to the recommendation of the director that these transfer of services overall will have a detrimental impact on san francisco. the reason is -- one of the reasons is that the transfer may result in a loss of proposition q oversight, what you are doing today. proposition q clearly covers hospitals. it is not as clear in terms of its coverage of the sutter pacific medical foundation, which is an arm of sutter health. this loss of public oversight would have a detrimental

impact. the proposition q hearings do not result in follow up enforcement action, but they do serve a very important function in bringing to the attention of the public, to the attention of the department, to the attention of the commission, to the attention of others in san francisco city government, what is happening with respect to the delivery of health care in san francisco. witness last year, your decision to find that the closing of the st. luke's subacute care unit would have a detrimental impact was a critical factor in cpmc eventually deciding, at least temporarily, to keep that clinic open. more still needs to be done, but at least we've got an important postponement. so we very much think, for procedural reasons, as well as

the substantive reasons my colleagues will address that this is have a detrimental impact on the community. thank you. >> thank you. next speaker, please. >> my name is ken barnes, and i'm a physician who worked at st. luke's for over 30 years and also am working with san franciscans for health care housing, jobs, and justice. i have talked to you before about the diabetic center at st. luke's, which underwent an up heavial two years ago when all of its bilingual staff were fired with no notices.

this was despite the fact that most of the clients served by the center were monolingual spanish speaking clients. burying the center in the bowels of this megafoundation, cpmc says the move of the foundation is the way of the future. there's less accountability, direction of the future, how is cpmc going to make such accountability? well, what we need, moving forward, is more, not less, transparent public accountability on the part of cpmc. this is true not only of the --

within the foundation but of all the services provided by cpmc. sutter is a nonprofit, receives huge tax breaks, and as such, should be held accountable. looking to the future, the development agreement calls for the creation of a center of excellence in senior health and a center of excellence in community health. for example, the center for senior health which should work to keep people in their residences in their community, it is essential that there be direct and strong links to programs and services provided by their communities. it would best benefit cpmc to accept recommendations about the needs is in the community. in new york each hospital has a community advisory board which was significant input in each patient's and each hospital's decision making process. the community advisory boards are made up of people from the

community and work with the hospitals in the decision making process. they also function in bringing information back to the community so that this communication is facilitated between the hospital and the community. cpmc says it has one community board for all of its hospitals. in our opinion, this is not adequate. there needs to be mechanisms of accountability at each hospital where the people served are different and have different needs. the patients at vanness will have different needs than the patients at mission bernal. i urge you to find the transfer of services to these sutter pacific medical foundation detrimental, and that the only way it could be beneficial would be for the creation of mechanisms for accountability that truly represent the will of the people of san francisco. thank you.

>> thank you, dr. barnes. next, please. >> once again, california nurses association stands with our community partners. we believe that this action, proposed action be detrimental to the community of san francisco and ask you to vote that it will be. thank you. >> thank you. next, please. >> kim taglioni, nphw. cpmc really hasn't agreed to do anything special here. they're required by the development agreement to do more medi-cal, to do more charity care. for them to say, like, yes, we will continue to accept medi-cal patients, it's a crock, right?

moving these services on their foundation, they specifically do not want you all to make any decisions on discontinuation of their services. they do not like being here, they do not like the prop q hearings, and this is why they're doing it, solely because they do not want anyone to know what they're doing, and they want a disconnect for their patients. there is no other real value here in moving these services under the foundation. they just want less public scrutiny, and of all the organizations in the city, cpmc requires much public scrutiny for the way they've treated their patients. not that long ago, i just met with a lovely asian family who's needed subacute services, you know, and they were given a

list, and they were told you can send your mother to fresno or you can send your mother to los angeles. like, that's cpmc. that's the care that they give. not that we're going to find that -- and it wasn't until, like, a bunch of us started jumping in and started talking them to this family, letting them know their rights, letting them know how to deal with cpmc, that they actually got a resolution for their family member. you know, they need scrutiny, and there are a lot of san franciscans who don't know what their rights are, who don't know that they need to fight back against cpmc to ensure that their loved ones are cared for. this is an example of this. we are the guardians of health care of san francisco and i'm going to urge you to vote that this is detrimental. do not allow cpmc to get away with less public scrutiny.

thank you. >> thank you. >> dr. palmer. one of the things that's disturbing to me is that in the new st. luke's campus, cpmc is using the center of excellent as a big marketing draw but has done nothing to involve the community on a grassroots level to begin getting information for what the community really needs in a center of excellence. this includes both the center of excellence for senior services and the center of excellence for community services. perthe terms of the development agreement, this doesn't have to start until they open the new hospital, which will be august 25. so if you're -- you feel there's not enough information to judge this detrimental at this time, it might be a good idea to defer your vote on this for another three months. my guess is that cpmc's aim is

to maximize attracting to the new st. luke's privileged, english speaking patients with major medical insurance, minimize its exposure to medicare except for short stay acute care in its geriatrics unit. there's no incentive to create a center of services that would meet the needs of the community in that part of town. so i think the diabetic center, the mammography and noninvasive cardiology is all going to be less accessible to the most vulnerable populations that need it the most, and that will be more evident in three months after the hospital opens and we

see that cpmc hasn't gone around to senior centers, hasn't gone around to community groups, has no idea about how to do the wraparound care that a true center of excellence needs. and this move to the medical foundation is a further lack of integration of inpatient and outpatient services into a true center of excellence. so if you can't see your way clear to vote it detrimental today, defer it for three months and see what happens. >> thank you. commissioners, that was the end of public testimony, and so we are open for discussion at this time. i would have you recognize that a number of items in the resolution has changed based

upon the conversations in the past. and i'd start the discussion first with asking because of the last public comment spoke about deferral, but is there a time on here that these services will be changed? by now, i've forgotten, so miss patil, or maybe dr. browner can tell us for sure if we're not certain. >> one second. no. on the -- i don't know if you have copies in front of you, but in the memo that was provided to you on july 17, on

page seven of that memo, so for the breast health and mammo graphy center at st. luke's, the expected transfer was august 5. the noninvasive cardiology at st. luke's, the expected transfer was august 5. the diabetes center at st. luke's and california campuses was -- actually for st. luke's, the expected transfer was august 19. in terms of the california campus, the transfer date was still to be determined as they had not found a location for that program. and then, the outpatient psychiatry clinic at the pacific campus, the expected transfer date was no earlier than may 1, 2019, but the transfer date is still to be determined. >> okay. so do we know that those transfers have occurred already? dr. browner or staff is nodding

over there. is that right, according to that, the schedule that we have? okay. thank you. all right. that's for your facts. commissioner green? >> yeah. i'm a little confused, and i just want to make sure i understand this fully. so it says here that the spmf plans to contract with payers, including managed and straight medi-cal with the exact same contracts that cpmc currently holds. does the sutter pacific medical foundation actually accept the reimbursement rates of state medi-cal and will they accept the straight reimbursement rates that cpmc currently accepts for the same services? i just want to make sure i understand same contract really means the foundation for these services will actually accept the reimbursements are currently straight medi-cal

reimbursements. >> thanks, dr. green. you're exactly correct. >> what was exactly right? >> next question. >> sutter will accept the same -- >> excuse me, dr. browner, could you speak a little louder. >> sutter will accept the same rates at cpmc accepted, assuming that the plans actually will provide them. as you know, contracts are two-way streets, so we can't dictate -- or spmf can't dictate to the plans that they would offer the same rates, but if they do, spmf will accept. >> could i just follow that up

for a moment, commissioner green, because it seems to me that if some of these transfers have already occurred, are you -- >> correct. >> so what's happening to those people at this point or have you already negotiated with plans or you finished with that? what is happening to those people? >> hi. good evening. i can speak to that. so my name is karen jaffrey. i'm with sutter pacific medical foundation. the three programs that have already transitioned, the breast center on august 5, the cardiac echo lab on august 5, and the st. luke's diabetes program transferred on august 19. so far, it is business as usual, and we have not had any contracting issues since the go live dates. and in any situation where we need to request continuity of care, or policy is for those

patients that are impacted, we will try to get an agreement with the health plans. and if the health plans agree, we will continue their service. if the health plan does not agree, it is their responsibility to identify alternative areas of service. >> commissioner sanchez? >> yeah. we've all spent a lot of time together, many of us here from different segments of the community both internally, externally, etc. and the bottom line to me has always been astounding. it's not about the quality of care, because we had families come from all over the bay area who would come and visit their brother, uncle, cousin because they were concerned about the quality of care that they've always had at st. luke's and

all of these programs, and now they're going to be dismantled and put in other places. we've heard people talk about the diabetes programs, where we have a multitude of spanish speaking people involved, and, etc. and it's -- as i said, it's never really been about, you know, the quality of care st. luke's has provided in the community it terrible, no, it's been about -- is terrible, no. it's been about why if we have services that are accessible, that are multilingual, that are sensitive to the community and culture of this area that we've been service are for over 125 years, why do we have to use, number one, forget public transportation. you have a very good shuttle service, but you now have 45,000 additional cars coming into the area every day who

pick up people, call ubers and whatever. and things that would take you five and ten minutes could take you as much as 35 to 40 minutes to get to cpmc. i mean, but why would you leave these services and this really positive community feeling that has been going on for generation and generation by saying we're going to move you to this big new facility which is going up, and it'll be a flagship, but st. luke's -- we have the option, and some of us have the option to attend to your new hospital. that's a fantastic new facility that you're building there, and we had a chance to you can with a through it, all the way from -- walk-through it, all the way from the top floor to the senior beds in the new unit. we went back to the old hospital where many of us have been over the years and remember where the diabetes education programs were, and it's right there, in this

beautiful all wooden building that has been services communities for all different years, and a little chapel that you do sort of stop by and say thank you. it has made a significant difference for years and years and years. all i'm saying is my gosh, why leave, a certain part of this where these programs -- you now, where these programs have been based, to say now, we're going to move in the other way? all i'm saying is this: things change, communities change, but at the same time, you have parents, grarnt parent parents, great grandparents, grandparents, you have a number of people, they came to testify, not blasting

you, but saying, what a fantastic program you're running and please don't -- don't move it, and -- and that's true with the diabetes and a multitude of other programs. you have a pharmacy there. you have all these other activities going on, and all i'm saying is, it just is interesting seeing how we're discussing, you know, a -- a fantastic new operation, but it's being moved and will open up where you're going to have to have transportation and time to get in, time to get out, and wait. and if you can't find a facility there, you're going to miss your appointment, you're going to wait to go back to the mission or other parts of the community, the st. luke's and the new bernal mission campus is providing. all i'm saying is that i just hope that as these programs have been moved -- and you're saying that some already have been moved, that maybe you sort of reflect on, in about three months or six months, i think,

if, in fact, we are servicing and providing the quality that we've had a strong tradition of in this city, not only in reference to our community, our patients, but also in reference to places like san francisco general and others who you've always been a partner with us whenever there's a crisis, and we'll work together. you know, all i'm saying is i would certainly take a look at is there any way we could, you know, not change, but perhaps -- you talked about a continuum of care and continuum of access. let's think about it, and the quality your institution has provided in the city for all these years. i would hope you would increase that quality and community involvement and think about these things as you get underway in your new flagship. >> so commissioner, thank you for the comment. i want to make sure none of the other commissioners are laboring under that

misimpression. these programs are not physically moving anywhere, they are simply moving from under the egis of cpmc to the egis of spmf. the program we were talking about at st. luke's now at mission bernal campus, remain there. the mammography remains there. it's sichly a different administration of who is providing the service. the location has not changed by a sonometer. >> thank you for that clarification. >> i actually have some questions in that. >> it was actually commissioner bernal first. >> please. >> i have two questions, and they have to do with a little bit more specificity and an update on some of the information that you provided. the first has to do with the

contracts with the plans. i would imagine that at this point, especially since you've already transferred the administration of the services from cpmc to the medical foundation, that you actually have a much better sense of what will be covered and the rates at which the services will be covered by the plans than you might have shared with us to this point. if you can update more specifically what -- what the status is of the coverage of these services under the foundation versus the cpmc, what may be at risk, and what might not be at risk. that's the first question. the second question has to do with your commitment to do more to increase met cal outreach and acceptance of medi-cal at your outpatient facilities, and if you can give us a little more specificity of how you are actually attempting to do that.

>> so at this stage, like i said earlier, we don't know of any -- >> are you actively just passively waiting for problems to come up or are you proactively -- >> we tried to proactively tried to address any problems in the contracts between cpmc and spmf, and those contracts we have consistency on, we shouldn't have any problems on, and those are the lion's share of the contracts. there may be a few that may be on a case by case basis once the patient presents themselves, and like i said we are going to try to get letter of agreements with the health plans, and if the health plans a approve, we will continue the service. if the health plans do not approve, they will have to find

alternative service. >> and medi-cal? can you describe the processes by which -- >> commissioner, you may not be aware we have a requirement to see a minimum number of medi-cal patients at cpmc and we have exceeded that number some years by as much as 15,000 patients. we've had extensive outreach to make sure, especially nems, to make sure that patients have access to their care. we'd be happy to review that. i think we actually have a meeting on the development agreement coming up soon, and we'll be presenting data from the previous area, and we can go over that in much more detail then. >> commissioner chung.

>> so i have questions and then a comment. so- so i want to just get this clear. so the pacific and california campuses are closing, and then, the services would move to the vanness. >> so just to clarify, the california campus will be closing in its entirety. the pacific campus will continue to operate as an ambulatory care campus. it will no longer be licensed as an acute care hospital as a result of the seismic standards. all of the current programs the pacific and california campuses will move to one of the new campuses, either davies or the vanness campus when it opens. >> so where would the patients

of ski, which -- outpatients of psychiatry, where would they go to? >> we are in the process of building a new outpatient unit on our davies campus, and we are in the process of building outpatient facilities on the davies campus. when those are complete, then, the clinics will physically move. >> i -- yeah. so my comment to that is, you know, i don't doubt that, you know, like, cpmc has tried to, like, provide, you know, as much services to the community as possible, but i just wonder where the mistrust has come from because this is not the first time we've heard the same testimonies. >> no. and i would appreciate at some point to come back and give my version of what i've heard because i would caution much of what you're hearing is not mist

motivated by a respect for what really happened but is much more politically motivated. i would say, for example, that someone previously said that we told the residents in the alzheimer's units to simply go find their own places. that's simply not true. helped rhenvate space for them, arrange for them to move, and they're very happily moved into a new place. >> commissioner chung? >> yeah. i'm still having some problems with that because, you know, like, with what i heard so far, i also heard that, you know, like, that the nurses, like, losing jobs. like, i think that in the beginning, like, of the process, of the vanness geary campus, we were expecting, you know, a net increase in workforce and not a decrease. but now, i'm not sure whether, you know, at the end what would come out of it.

>> so again, this is probably best covered at the hearings on the development agreement, but to be clear, the rebuild of cpmc was not going to result in a larger medical center. that was the discussions we had over the course of many years with the planning commission, the health commission, and the board of supervisors. the total number of inpatient beds at cpmc when the new vanness campus opens will be less than the current number of beds we currently operate. despite that, we have assured employees at cpmc that no one will lose their job as a result of the transition. so i'm not sure where the impression came that we were building a larger medical center. that simply is not correct. >> commissioner green? >> another point of clarification. so does sutter pacific medical foundation accept straight medi-cal for all service lines?

>> no, it does not. >> pardon? >> no, it does not. >> can you elaborate a little more so we can understand the totality? >> i'd have to go down the rules of contracting here. you do understand sutter pacific medical foundation is a separate corporation, so our contracts are deictated by ter agreements that we make with health plans. we do see medi-cal patients in primary care and in specialty services, but it is a case by case basis. >> commissionthis is a questio department. what authority, if any, will we have to hold a prop q hearing if the foundation determines that it needs to make some movement around its services at

the hospitals? is the foundation exempt from the prop q, which is -- was implied here today by some of the public testimony and if it is, i'd like to know that, and if it's not, i'd like to know that, as well. >> the prop q process will not relate to the foundation because it's not covered as an acute care hospital. it's a separate organization, and so the jurisdiction that you have under the prop q process would not apply to a foundation. >> thank you. [inaudible] >> that is correct, and that actually was a point that we were going to make within a whereas, and i see that it didn't actually make it into the packet here. so if we were to move on this resolution, i would put back in the whereas, that, in fact, the

authority to understand changes from the hospital will no longer -- well, that the -- by moving it to the foundation, then, the public scrutiny of hospital services, these hospital services would no longer be available to the public. >> so commissioner -- [inaudible] >> i would suggest that for a couple of reasons, one being that the transition of patients from an acute care administration to a medical foundation administration is still relative, particularly this large of a population and with so many different services, it's still something that i think is not at common, although it's -- i guarantee it's going to become more common, not just with cpmc but probably throughout the whole health care delivery system. there's little enough known at this point in terms of what the

impacts have been, beneficial or nonbeneficial. and then also, because we're at this point, i think still unclear about the potential for the coverages for all of these services and where their status might be since you've indicated that it's on a case by case basis or you haven't yet heard whether there are cases of denial, that we might want to wait a while to really make a determination of the detriment or the -- or lack of before passing a resolution. >> okay. that's -- that's also within a range of discussion in which we're aware that some of these transfers are still occurring, and that there are opportunities to continue to try to bridge the gaps, and

that would be one question. i think the question of public scrutiny does remain, but that would be part of the discussion in the future. commissioner chung? >> so thank you, president. i think that, you know, for me, i think that it's kind of detrimental. i'm not saying that because, you know, like i -- you know, that i listened to all the testimonies. you know, but, like, we went from the opportunity to, like, apply public scrutiny to the services to, like, losing that oversight, that means that we, like, would not be able to -- we can't be accountable to those people who are going to continue these services. so, like, it's our job, you know -- you know, as an oversight body to really look at the worst case scenario. so in the worst case scenario, i think that it's more than

just detrimental because it's not just losing services in an acute hospital, it's about, like, you know, we don't know how the business model would go with -- no offense, with the foundation. >> so commissioners -- >> i would recommend that we find it detrimental. >> -- so we actually need a motion on -- on the will of the commission, so commissioner chung, is that a motion? >> yes. i'd like to make motions that we -- we -- we adopt the resolutions as detrimental, and with the amendment to the resolutions to add the actual prop q losing -- >> right, i ran some similar,

if that's what you're trying to move, whereas the transfer of hospital services to a foundation will remove these services from public scrutiny under proposition q. >> so moved. >> that would be added to the -- your motion. >> yes. >> okay. is there a second? >> i'll second. >> okay. so the motion has been moved and seconded. this also includes three different resolves. one that -- in this case, it would then say this change in management will be detrimental is what you are motioning. that the commission does strongly urge the foundation to make every effort to contract with all current providers and health plans, and to resolve that, then, the foundation please report back to the

commission to indicate the impact of the service transfers in six months. it's possible to split the resolves, if you wish. if not, then, i don't see anybody wishing to divide the question on the resolves. we'll then have further discussion. if not, we'll then proceed to the vote. commissioner green? >> i just have a question. if we were to defer this, would that mean we'd get return information about how things are unfolding apropos with what commissioner green was asking? if it's detrimental, would that lead to a less rich import in the future? i'm new to this, and i'm a little confused. i'm interested in the information, and if deferring would lead to a richer discussion, more information from spmf, i'd be interested in deferring as opposed to declaring it detrimental now. >> okay. commissioner chung? >> i don't know.

that's why i'm asking. >> yeah. i mean, i think i interpret it a little bit differently, like, because once you pass -- you know, you change management, you know, you change the business, we've lost the oversight. so whether they come back in three months or not, you know, it's really not binding at this point. >> commissioner guillermo? >> yeah. again, being new to this, i also am interested in the information. i don't -- i can't yet be sure about -- and i understand the lack of oversight on its surface or the change in oversight from a public oversight to an internal oversight, essentially, may or may not result in a detriment to the patients. i just don't know enough information -- have enough information to feel a strongly enough about the detrimental

effect of a move from a public oversight to a -- to not having the oversight. i'm -- actually, the issues that i'm most concerned about, i think, are different than what you're raising, commissioner chung. >> okay. commissioners, so the question that you've all raised is whether to actually allow more time before voting on this because you're concerned -- u your concern that you're expressing is you're not certain it is actually detrimental to move services oversight from prop q, and you would like to know if, in fact, they were able to contract for services that tloherefore allo

for contract of services. commissioner loyce? >> well, in fact, the breast health, mammography, and others have moved already, we've lost our oversight already, and that's troublesome that we don't have the public oversight. whatever vote we take today, since they've already made the move, it doesn't matter what we say. that, to me, is a bill troubling. i have stronger language, but i'm troubled, i will say. so i'm not sure what to do with this. >> from the prop q, we are required to come to understand they have told us that they are moving services from a hospital, and many months ago, they actually told us, for example, they were moving the reasonab

reasonable -- renal dying sis dialysis to another location. that's what prop q requires, certain hospitals report termination of services or changes of services. and then, these services then move to wherever they go, of course, and when there are issues that rise during the course of that movement, like, i believe has happened already in terms of, for example, the subacute care and whatnot, of certain issues that have arisen in the public are then acted upon by the administration, and they become less onerous or they become more positive for patient care at that point, but then, that's sort of the end of the question. so the proposition, the prop q is actually meant to surface

these issues for the public and thin allow the public input, and there is no other authority on it. it's not like the health accountability where we actually set the parameters. so we also have no authority to compel them to return. we can hold the hearing and -- on the issue, so we always have that power, but we don't have the power to say return at a certain time. we'll hold a hearing. if they don't return, then we can draw our own conclusions, but those are the powers we have. we have the power of inquiry, of the hearings, if you want to put, the public approach towards health care services. so that's -- so it's been argued here that that -- that it will be