with the controller's planned expenditure audits? i so move. >> second. >> all in favor? [voting] >> good. any other public comment relating to any matters? seeing none, meeting is adjourned.

>> 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 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