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 lost and therefore

is not on behalf of the public. yet others here now have argued that perhaps that's not as important, and they would like to see that the contracts be in order and that there is no disruption of service, so that's sort of a different question. i recognize that there are two issues on here. >> just so that -- for the record, again, it's clarified, i think what my understanding is this is really representative of a health delivery model change that is sort of sweeping across us. and there is -- there is a range of services here that are very different from each other, and the administration of which we don't know whether, in fact, under the acute care setting versus the medical foundation setting, there is a detriment to the patients.

and i don't know whether over sight makes that difference. that's my point here. i would like to have heard from some patients? i would like to have heard from -- a little bit more of the practitioners currently serving the patients. that, to me, would make, i guess, a more all rounded sort of data set by which to understand better. i do understand the over sight issue, but because i'm new to over sight from a prop q standpoint, i can't, at this point, make a definitive determination. >> okay. commissioners, further discussion? there is no further discussion, there is a motion before us. there is the ability to to call for a deferral to a time certain, but that would require a motion at this point and vote on the part of the commission.

if there is no such motion and second, then we will proceed to a vote on the resolution. commissioner sanchez? >> i was going to see if our colleague has made that a motion? >> no, i didn't hear a motion. >> >> okay. >> would that be -- >> okay. a motion is in order to make a time certain and to defer to a time certain, and then, we can discuss that. >> would -- four months? >> it's up to you. you're making the motion. >> then i would say given that the transfer occurred this month, that you've got maybe three to four months of data that we should look at before making a determination, so i would put the outside, then, at four months. >> okay. so your motion is to defer this to a time certain four months. and is there a second to that? >> second. >> there's a second to that. okay. so the discussion is on the

motion for a deferral to a time certain which allows for a discussion. is there any discussion of that motion? >> commissioners, i would encourage you if you're looking at a deferral and possible be data to specify what you're looking for, to see if the foundation can honor that. they're in the room with you, and it might be a good reality check to see if what you're thinking about looking for would be something that they can provide for you. >> well, a deferral of time certain is a deferral of the commission. it doesn't require that the foundation or anybody else says when to have it. you then have it come back up, and if you don't have the information you want, you know, you can then take further action. this is not a question, i think, in terms of that, except in the minds of the author of the deferral. >> i think i've pointed out the kinds of information that i was -- >> and you believe four months will be an adequate time to

understand? >> yeah. >> okay. so it is four months at this point. so the vote on the motion for a time certain referral is before you. all those in favor of that, please say aye. all those opposed? we shall then defer the resolution for four months. thank you. >> i apologize, but i actually want to, like, add, you know, a specific questions because it actually says here that 7500 patients are affected, and i'd like to know, like, after the transfer four months from now, where do those 7500 patients go? it's just that simple. >> thank you. i think that the purpose of obtaining the information -- and i appreciate that. commissioners, if we bring that to the attention of our staff, then, that is the information that we will be expecting at our next hearing on this.

so what we have done is to postpone further discussion on this item pending further information that we are hoping to get in four months, and we will then give those thoughts to our staff and will then have the hearing on the resolution as you have voted in four months. thank you. >> thank you very much. and appreciate the public attending 1and we will move ono the next item. >> item 11 is other business. >> commissioners, do we have other business at this point, other topics for discussion? i don't believe we have -- you have the calendar before you, and a reminder, also, about the hearing for the joint planning and health commission on september 6, which is two days after our next health commission meeting. >> and the meeting will be from

10:00 to noon. it's very specification, it ends at noon every year. >> right. can we go onto the next item, please. >> sure. item 12 is a report back from the august 14 laguna honda joint meeting. >> commissioner sanchez? >> yeah. laguna honda joint cc meet on august 14. it was posted as a closed session regarding our reviews of the quality assurance programs and also medical certification. there was -- when we went to open session, there was nothing reported out other than what's already been approved for the -- excuse me -- the medical staff certification, which is

aboard here. any additional comments? >> no. >> i guess i was going to say there has been some additional discussion about shifts in time, but given the fact that we're in the middle of our operational year, we're going to keep the time for the laguna hont acommittee at the same time, 4:00, until -- just the fact that we're midstream at this point, but we will consider that next year if we serve on this committee. >> okay. all right. we will proceed. >> yes. item 13 is a consideration for closed session and there is no public comment request for this item. >> oh, we're having -- >> yes, a very brief closed session. >> is there a motion for a closed session? >> moved. >> second. you. >> all right. so we have come back into open session, and a motion to disclose or not disclose any of the items of the closed session

is in order. >> motion not to disclose the discussion in closed session. >> second. >> and all in favor of not disclosing, please say aye. all those opposed? we shall not disclose. are there any other items on the agenda? >> no, sir. >> seeing none other, then, a motion for adjournment is in order. >> move to adjourn. >> second. >> all those in favor, please say aye. this meeting is now adjourned. thank you.