up to the time we moved that the unit on 1 east that we were going to be moving away. they had no places to put their patients. they were not afforded the courtesy of being notified ahead of time and now h.r. is scrambling to get doctors to move to mission bernal so they can fill those beds. in numerous meetings with cpmc over the weeks since this news came to light, the hospital should patients first and staff up during the transition period until the dust settles, however we staffed up for one woke and now we're going straight on regular ahead. it's been incredibly disruptive much it's unan fortunate occasion or lack of serious patient plan on the planning of cpmc. we urge the commissioners to discuss the important matters of patient safety that emerge in the hospital transitions.

before cpmc repeats the same mistake in the opening of van ness, sutter meets t needs to pd and anticipate the moves on the patients and staff. for an example,s we were told by h.r. there would be no impact of the move of our unit to mission bernal, however, now the nurses on 4 north and 5 north have a lower pay. they're loosing jobs by loosing shifts. let me see. i have a couple more comments --

>> experienced at st. luke's. we expect that cpmc would listen

to the nurses as you know suspend their practice of you will extra lean staffing for a generous period of time while they have adapted to the new hospital. which it's many layers of changes from our previous environment. instead, cpmc staffed up the new hospital for only one day or two before reverting to their usual pattern of canceling nurses. from our shifts at ever opportunity leaving those of us who worked short-handed and scrambling. more over, they sent permanent staff and obtained temporary traveling nurses. we've been scrambling for needed medical supplies and learning to utilize new technologies with frequent glitches all while struggling for patient assignments. this is unnecessary and unsafe and the results of nothing more than cpmc's grim obsession with

the bottom line coupled with dismally poor advanced planning. given cpmc's history of slashing needed services for aging and vulnerable patients, such as a recent closure of the hospital units at st. luke's it's cpmc presenting itself as the beating of care before the hearing, cpmc must do better for san francisco. thank you. >> thank you. next speaker, please. >> hi, my name is dr. teresa palmer. i work with the coalition for housing healthcare jobs and justice. in the 2017 report, sutter ignored its obligation to care for 1500 tenderloin patients on medical. also, in previous years, sutter provides numbers about charity care with inadequate breakdown

of the services provided and the population served. the aim of the deal was for sutter to care for lives into the tenderloin, not to just give isolated single services, sutter cpmc is non compliant with these services reporting requirements. the d.a. asked sut i remember to act in good faith to develop solutions for the sub acute sniff bed shortage in san francisco. specifically considering that sutter is shutting down to sub acute sniff unit at st. luke's left san francisco with no sub acute beds. the shut down with hospital base beds, many by sutter, has crowded long-term care patients out of town leading to a worsening critical shortage of nursing home beds all over san francisco. sutter's participation in the

post acute care study was supposed to have satisfied obligation to find solutions. it absolutely did not. the study examined how hospitals could avoid loosing money on difficult patients but did not address the crisis caused by the serial shut down of hospital-based sub acute sniff and sniff beds in san francisco. sutter is non compliant in its obligation to make a good-faith effort on the sub acute sniff shortage. there is room in the planned medical office buildings on both sides and the 30-bed shell at van ness to add post acute sniff and sub acute sniff care. however, sutter cpmc is only interested in getting rid of services that don't generate sufficient profit. they don't care what the people of san francisco need and they don't care what old people need. sutter is marketing the mission

burnal center of excellence while abandoning needed services for seniors in san francisco on all levels. this includes adult day healthcare, residential memory care, post acute sniff care and sub acute sniff care. sutter has no mechanism for sub ta tive input from the community. such as a grassroots community advisory board in the neighborhood surrounding st. luke's. their actions at open treat and there's no good way to giffin put to sut you are about what they need. >> my name is paul cartier.

i'm a resident of san francisco for 40 years now. i walk, bicycle, ride public transit and i drive. since we have an ongoing problem with traffic, i'm thankful that i have a variety of options on how to get around this city and beyond. i am very concerned about sutter health's lack of compliance with important transportation program. the main concern here is that sutter health is doing very little to increase the number of employees utilizing public transit, which they estimate from an online survey at 25%. as compared to 55% in single-occupant vehicles. they have two major muni transit corridors, notely the b.r.t.s. this is a paraphrase from

exhibit k in the development agreement. cpmc shall encourage all employees, new and existing, to enroll and purchase a clipper card as a part of its transportation demand management plan. as part of its normal t.d.m. activities, cpmc shall promote the use of the subsidy of the clipper card. undertaking additional outreach as necessary to drive up adoption and achieve the s.o.v. reduction goals. none of this is mentioned in the current compliance report. currently, sutter is passively promoting inserts in new hire packets. by actively promoting the advantages of using public transit, and regularly subsidizing the clipper card, sutter health could be a good corporate citizen. they can also be in com ployance with transit first and

environmental goals. more over, the clipper card program can track its actual use by it's participants and sutter health's progress in promoting this use, otherwise all we have is the phase out from a 777-450y of some portion of its busy employees. >> thank you. next speaker, please. >> good morning. i am a nursing assistant at cpmc davis campus. last year august 20 we have a hearing and the judgment lands on december or january of this year, it's because of the short

staffing that we get for the years. and part of this guideline during the compliance unit, i saw 51 the judgment of that is all the certificates of 51.50 it's not deductions of the floor staff but cpmc is not complying on the arbitration guidelines and they're out every time we have a theater on the floor and it's the short stopping and if you have the c.n. a. it's one c.n. a. on the floor every time we have a sitter because it's just more on the work for -- we still have the same patient. it's only with one instead of

three. we can have more work and you will have more and it's not safe for the patients or the staff. thank you. >> next speaker. i think i've called them. ruth, sylvia, kim. if i have not called your name but you want to speak, please come up. >> i work at cpmc campus. i'm going to show you a floor where i work. >> ma'am, you will need to speak into the microphone. >> sorry. >> sorry. >> ok. this is the hallway and we have three, four, five and six.

the total of the beds is 41. i handle sometimes when i work the night shift, we start at 28 patients. but i'm done with eight hour shift, sometimes i get 65 patients. some going to i.c.u. or die and i'm the one who is responsible to push the beds be open so e.r. can put more patients on the floor. i have to clean up the bed and go to the morgue on the second floor. i walk many miles and my friends, many staff, i'm sorry, many staff for eight hours on

each node two of the node 10,000 steps and 13,000 steps on node 6. it's a little bigger. i am on my last limb right now. i hurt this and i hurt my left

>> good morning. thank you so much for this hearing and i bring it for my father. he was at st. luke's hospital. so you know guys they are moving to davis. i guess coming over here because my father is suffering a lot because you know, the nurse, they are not prepared for those patients. my father when they suction to them most of the time he is always bleeding because they don't know how to do it. i talked with the nurse and i say can you please be more human. my father, you know, sometimes he cries and sometimes he closes his eyes and do like this because he cannot talk. i am his voice. that's why i come over here and i bring pictures of him. please help us. i wonder if you please go over there and davis and check the

nurse. when they come over here, all of them they talk very well. they say that the nurse they are capable to handle this but they're not. most of the nurses they do know what to do and when we ask them, can you please move my father it's lovely and human and you know, they are very upset when we ask for towels because we have to wash my father. next sunday they throw the towels on my sister's face. i report it with the nurse that is in charge of the floor. that is why i'm here right now. we're tired. my father is suffering a lot. so can the people. they can't come buzz they do speak english. they say how are we going to explain when we don't have no one in the floor. they're not talking in spanish. they're only english. they don't have anybody in

spanish. only two or throw people. they're not all the time over there. please help us. we need our language. my father needs someone to talk to him in spanish because he has been happy. we are suffering a lot. they do know their job. when we talk to them they say i'm sorry but they don't train us. we have only a few hours for training. and they throw into the floor to us. this is our job. we have to come over here. they are accepting that they do have enough training. please, help us and don't forget my father. don't forget all the people that is in subacute units and babies. thank you so much. god bless you. please don't forget them. thank you. >> thank you. next speaker, please. >> kim, san francisco labor

council. you have a choice today to speak and stand with the community or you can do the elmore fud thing and follow cpmc. those are the choices, right. the community has brought up issues that need to be addressed. the jobs' issue, the healthcare issues, what is happening on the subacute staffing issues that continue at campuses. all these issues should be setting up red flags. at the very least, abstain from the vote. don't give them a passing grade until they do better by the patients and the subacute. not to mention they also closed an alzheimer's unit at the cal campus. they have done enough atrocities in the year for you not to give them a passing grade.

i think it's about time people stood up to cpmc. they have the resources to fix all these problems. they chose not to. they rob from peter and give to paul. right. they short staff some units, clearly they did not do the training. the health commissioners are aware of this. we've been telling them that cpmc refused to train their davis staff. it wasn't until after the patient started moving that they decided to put some programs together, some shadow program together. cpmc is capable. they need to do better. you are the ones that can make them do better. so i'm going to urge you today not to give them a passing grade. i'm not saying why have expectations you would say they're not meeting the requirements but at the least don't give them a thumbs up

because that will be a sad day for the community. that is a sad day for all san franciscans and i think the commissioners need to stand up to cpmc and say, we know you can do better, now is the time to do better. we'll come back to you whether or not you are meeting the requirements after you fix these issues. but please, stand up for these patients. they need your help and it's not until you, if he was your family member in this getting towels thrown in their face, would you give them a passing grade? i don't think so. but why does it have to come to that? why does it have to wait until it gets personal. stand up for those folks. that's all we're asking for today. >> thank you. >> thank you. any other public speakers? with that, public comment is closed. we will go with the planning commissioners comments and

questions first and then we'll turn it over to the health commission. >> thank you. >> fellow commissioners. >> commissioner moore. >> may i ask that we hear the health commission first. that is their expertise. we are attentive listeners and watchers and i think their comments for me personally, are far more waitful at the moment than our own questions. >> if that's ok with the heath commission. >> if that is the wish of the commissioners, we can start on our side. >> we're not used to all this hi-tech. commissioners you flagged you would like to either ask questions at this point of any of the speakers or to be able to

make comments in regards to today's testimony. as you recall, we will not be actually making a decision. the decision is that of the two directors of the departments who will be in fact writing a report to the supervisors which will be reviewed by mr. derardo prior it it going to the supervisors. the input coming from the commissions will be taken into consideration by the directours and also these are public issues that therefore, if the commission, each of our commissions have instructions they would like to recommend to our own departments to look into in order to enhance the development agreement, then those are also issues that we can bring up today and present to our director.

any of our commissioners want to start? commissioner sanchez. >> i think you are supposed to push the motorcycl microphone o. >> it's really hi-tech. >> is that off or on? it's on. >> well, first of all, i just want to say that i want to thank the departments and both of our commissions for, again, listening to a very formalized report pertaining to the different areas that cpmc has endeavored to bring a number of facilities and patient care up to the standards that we in san francisco feel must be

maintained and increased as we see even more shifts in our population. at the same time, i also want to comment on the fact i really think that many of the speakers, in particular, who have been here, some of them have been here for the duration of the inquiry going back 10 years, to even discuss the fact that st. luke's would remain in the mission and there would be an effort to provide the same type of services, including developing centers of excellence for different populations and different areas. i really thought one of the most significant outcomes that we heard today, at least in reference to part of the health shifting here in san francisco

is our growing number of elderly and how this is being addressed, both by charity care, et cetera in the tenderloin and our own mission district, let's say. i really think the concepts pertaining to the center of excellence that could really anchor down a significant new pathway to provide services for st. luke's, bernal height mission hospital, could really provide some unique dialogue and some new showcases pertaining to, if it's based on the recommendations and dialogue that both u.s. hastings and dr. barnes and others have been talking about, and some of our other physicians and patients who have been talking about it for years. i think the department, our

department in particular, they really have a unique hunt to shore in on this and to make sure that these areas are in fact developed and part of the out coming contribution of this particular effort. the other thing that, as we looked at and heard, some of the i do a log pertaining to job training, job training, where they come from. i was taken back, there's a small number that are from san francisco, significant but small number. others are from bay area or east bay. at the same time, let's look at programs in the schools. the mesa program, which is a flagship program for minority students in our public schools. why aren't we reaching more kids?

again, the community brought this up. why aren't we reaching more kids and more people in the areas? we are providing basically the zip codes. we're talking about where the kids are coming from. why did they drop out? why did we have programs where you spend $8 million or $3 million and then $8 million on the others, for a number of these job training programs and then the san francisco foundation ad administered the grants and some why not renewed in the mission district. why weren't they renewed? do we need additional training? is there something we should look at. you have john owe con he will highigh school andthey're dealis with the computers, et cetera, and here is an area that could certainly be looked at in reference to new pathways and we

have a society for native americans and they have been active for years and many would love to have around opportunity to be involved in things like this so as a department looking at where is our pool coming from and are we really providing access and about what about the retention? what happens to those who are -- there were programs for the san francisco public schools and the community college and the focus on native americans because of vote culturally and whatever else they had a high altitude

prevalence to deal with the type of thing. it worked for a year and two years and they were going to develop more programs in the san francisco public schools and then they were eliminated because the new machines had been in the basement of one of the schools and allegedly been put down as these programs were operational for the native american schools students and yet when the due diligence people went out to review these programs, these arc welders, machines, were still in the crates in the basement of one of the schools. so, it wasn't even operational. what i'm saying is, that's why we have these commissions to look at what are we looking at pertaining to outcome and retention. are we providing the highest level of care for our patients.

i mean, we have been told, and many times, that there was exceptional community staff planning within the hospital to provide the transition between the whole hospital and the new ones and you hear the department that has given two week's notice pertaining to moving patients and units in the new wing. what i'm saying is i really think we need to take a look at how have we been providing this? are there areas we can shore up to ensure that patients safety and patient quality care and staffing is adequate to ensure that these services are maintained. do we need additional training? do we need additional oversight? whose responsibility is it? we find things these out when we have hearings like this and listen both to our staff and those who are involved in the work of building hospitals and facilities and our communities

who are involved both within the hospital as patients and staff to find out what in fact should we be doing. so again, i'm saying that this was a real excellent opportunity to, again hear, but not only hear, there's a lot of data we need to take a look at pertaining to are we really making the most significant contributions we can to ensure that all san franciscans will have the highest quality of patient care in institutions that are accessible, that provide unique models of excellence, and that we have ultimate opportunity for all to participate in jobs and training and retention. this is a really important meeting. those would be my questions that our staff could certainly look at as we go to end our proposition 2 hearings over at the department within the next couple of weeks.

>> thank you. commissioner green. >> i wanted to thank the staff for their remarkable reporting and the in sight from the community comments. they were very helpful. i am concerned about chinese hospital and the chinese community health plan. i'm an obstetrician at cpmc and work with the physicians who deliver patients there. i know there's data about cost of care on orb pod that corroborates with the contracts so i think it would be helpful to get concrete information from you about the details of what is going on. we're very committed to see the pediatric as well as the obstetric services remain robust and the best care possible for the chinese community. i also am concerned about

transition of someone who will be participating in the transition. the woman that mentioned about this st. luke's situation, we actually found out about it in a meeting when our chair of gynecology had no idea the patients we admit after surgery would no longer be able to stay on this particular unit. she spoke of and that's just one person's experience but i do think we need a little more detail and a little help on the transition. i certainly couldn't say anything more eloquently than commission sanchez about our commitment to the quality of care and the availability of care and touch we really care and appreciate effort of the community members and staff at cpmc which whom i work with and i have the highest regard for your commitment to patient care and all you bring to this community. our nursing staff is absolutely incredible and we're here to

support you. >> thank you to the community to the hospital and to all those who spoke today. i have a couple comments and a question. one of the comments is last year in this room we spoke to staff from city side and staff from cpmc. i asked very specifically, what is the retention data for the population of folk that you employ. we don't have that data now but we will begin the process of collecting that data. today the presentation did not have that data. i have difficulty understand how we don't retention data. one of the things that i'm aware of is when you talk about communities of color and vulnerable communities, access to work leads to access to healthcare. and if you have those two things together, you improve the mental health and psycho social health

of those communities and it's important that cpmc at least help me to understand that's one of the roles you are taking on. and at this point, i don't understand that to be true. it's imperative that when we have this hearing again, that you come back and tell me that there are or tell us, that there are in fact a way of retaining folks and and where they go if they leave the system. because, this is a bottom-line issue. healthcare and we have an obligation to make sure that happens. >> commissioner bernal. >> i'd like to associate my comments on the colleagues and thank you to the staff for preparing this presentation and

the members of the community who stepped up. in particular with regard to hiring when it comes to the construction trades. seeing there is a shortage of workforce in san francisco, i would be interested to know what efforts are being made to expand outreach into communities of people who are under represented in the construction trades. for example, i didn't see a mention of whether or not there's an effort to increase the number of women who are working in the construction trade either within any of the data that we've seen or the grants being provided and the organizations being engage to train and hire folks. that would be something is i would be interested to no. are there under represented communities that we're just not getting into that could help increase the preportion of not only the construction workers but the entry level workers who are both hired and retained. that would be my additional comment to my colleagues. thank you. >> thank you. actually, if i could piggy back

on that question in terms of construction, which is a little outside of our healthcare field, but is an issue of the workforce. i mean there was a pi chart in temperatures of the percentages from different neighborhoods. i wonder if staff could help us understand why one, we didn't get the retention information in regards to jobs and number two, also, in terms of the targets and the pis, while you demonstrated how many were coming from different neighborhoods, what were the targets for those neighborhoods? for example, in chinatown it says 3% were hired from that community. was that the goal? did we do adequate outreach, which i think kind of piggy backs on the question from commission bernal. i don't know if anyone from staff today could actually

answer that. particularly, i think answer the question from commission why we did not have retention data that have requested last year by our joint commissions. anyone from staff willing to answer that? >> in the mic, please. >> good afternoon. ken with oewd and we have our office that works and he will describe about the retention. >> good afternoon, commissioners. so, i have been working with cpmc for about five years. on compliance, looking at their hiring from first source hiring in particular, and this past late spring, we were provided retention data so i am on here

to provide that to you today. there were 277 hires over the five-year period. 128 of those hires were terminated and 73 of those 128 were retained for 180 days. now, 180 days is a metric that is used in the workforce development field. six months obviously people don't and they come and go and there's a certain amount of turn but 180 days is considered a good metric for retention. so given that there's 80% retention towards the 180 day

mark. >> there was a target per neighborhood or you just took the listing of the neighborhood from the development agreement and just added up where they came from? >> so for the operations hiring of the first source, there are target neighborhoods and we don't have the percentages and where the hires came from. the specific occupations that people were hired for. we do not have a goal of like 40% need to come from the targeted neighborhoods or anything like that provided in the development agreement. i do have the breakdown for all the targeted neighborhoods, if you are interested. >> we have the numbers targeted. >> that was for construction and i have it for operations as well. from the targeted neighborhoods,

i track all the referrals that are made from the community and 57% of all the referrals that were given to cpmc come from the targeted neighborhoods. >> surely. commission bernal. >> perhaps some of the numbers were misstated because by my calculation only 36% were attained for 80 days or 180 dies versus i believe you said more than 80% and 46% of hires were terminated. >> as i said, 73 were retained over the 180 days out of the 128. >> 277? >> that is the total number of hires over the five years. >> thank you. i did have several questions which d don't relate to hiring.

we mentioned there were key heath care issues that were related to the fact that as i think our staff had pointed out, there was a recent hearing in regards to the changes where services would be provided. perhaps the best example was the diabetes center in which this was no longer a hospital based service but now would be moved over to the foundation and the foundation itself was going to be the deliverer of those services. we heard, if i recall from cpmc telling us that now in the foundation, when you go over to the foundation, we have language-specific types of people and so therefore this is

better. the problem that the commission is reviewing and looking at is whether or not this moves those services from hospital to a private organization that they would remain under the scrutiny of the city. they don't because then it would move over obviously into a private organization so if you were wondering why that was of some concern, i just wanted to clarify for your information one of the key healthcare issues that we were struggling with now, it doesn't mean it won't be better or that there would be more enhancement but definitely the city would have far less influences over the service and whether they would be provided to the population that historically the hospitals have served. and so, while outside of

development agreement, it is a movement that is occurring. it might be symptomatic along with the discussion that's i think our staff pointed out in which while and to cpmc's credit, they are now caring for the subacute that were being displaced by the closure of subacute is absolutely true as was pointed out by the staff and other speakers that there are no new beds that are being created in the situation. and that while technically, and we can check more, that cpmc was greatly instrumental in assisting in this subacute studies that we still need to continue to respond to the need of the city to have subacute

services and we want to encourage that cpmc participate in that. because they completed the study, i don't believe that while technically to be considered in compliance that that should be the end of the relationship in terms of any further looking at a subacute solution for the city. we do recognize that it isn't one is that cpmc itself has to come up with. they should be a part of this solution and that just assisting us with the first level of study in regards to understanding the problem does not absolve either cpmc from having to continue to participate. i believe that we are continuing to have dialogue with cpmc on this and i don't want to say

they just walked away and out of the poor but i'd like to have continued i do a log in that and also in regards to resolving the sniff. as they have closed the sniff, there have been no added beds as also been pointed out by the public in regards to the sniff. so, we have kind of a conundrum here. yes, they have complied with the development agreement but there are a lot of areas while complying we are loosing services that ar are and if we e the opportunity to be able to continue encourage that in the development agreement, we could continue to help influence and

work together with this and i'll have some final comments and later after we conclude everybody's discussion, what we would hope from our department that we would be able to do to continue to service the people of san francisco. and in collaboration with cpmc. i think at this point, we should hear from our planning colleagues. >> thank you. >> commissioner fong. >> i thought the planning commission was complex. you guys certainly have a complex job and i appreciate it. i just wanted to ask, after hearing all the public comment or the community input, it's cpmc had some responses to some of them maybe in particular the subacute care f. there was any reaction to that or things that are in the works that are addressing some of the community

comments. >> specifically to the subacute care, as commissioner chow described, those patients have been transferred to the davies campus in a new unit there. the staff are credentialed and trained to handle those patients. in introduced some of the other schematic things that were brought up, we've got retention numbers here. i'm sorry for the oversight if that was not included in the submission packet. i think the notion of transitioning to these new hospitals, everyone can appreciate is a complex and fluid process. one of the examples and came up

around orth a speed i can is a good example of understanding how physician decided that that moment to move cases to a new location. services that support that work also need to follow. we would have loved to have had that decision happen a year ago, six months ago, four months ago, maybe not exactly when it did. but that is when it happened. our commitment to safe, patient care, especially through these transitions, is the first priority. thousands of hours of training and preparation have gone into this. while i understand there are always going to be differences of opinion or concerns that happen when you get into that acute moment around the

transition, our commitment is to absolutely quality, safe care, transitioning these patients from one hospital to another. we do have people here who can talk about some of the h.r. issues. we have someone here who can talk about all the work that's going on to promote the transportation subsidy. scheme atticly those were the things i heard. >> from the planning commission side, if you don't mind just someone addressing about the transportation and the network system how that might play out.

>> i'd like to give you background. i'm a san franciscoan for 50 years and i've worked for cpmc for 41 years. i'm proud to have worked there and continued to work. i have a tremendous amount of colleagues that are committed to cpmc. one of the areas that is complicated and dr. grown knows very well about it is parking. what we have done since last year in january when we started the subsidy, we had put that information out to employees ever month. on their paycheck there's a by weekly letter that goes on the internet. we hold four transportation a year. this year we're having 12, which four were already completed last month and the next one will be

in october and the point of one will be december. our push is to remind employees that the city first is to reduce the s.o.v. when we got the survey returns, a lot of the employees' comments were that they, why they didn't take public transportation. some of them claimed that they work at night and they come on weekends and public transportation is not available for them. amount of the responses were a lot of especially with mothers, they would have to pick up their kids right after work so their time was consumed. it was necessary to go from one place to the other. we have made tremendous progress from last year, i believe we're now about 850 employees that take the subsidy. we're committed to get the goal much higher. another item that came to concern was that bart and itself

is a scary for them to take that and muni was a concern. i know that the city is doing quite a bit of work to resolve those issues. again, we're committed. any other questions? >> thank you, very much. >> thank you. >> thank you. >> commissioner johnson. >> thank you so much. first i wanted to thank city staff, cpmc, members of the community for coming out to share your perspective and my fellow commissioners, i have just learned so much from you already. like my fellow commission or fong just said, this is a great introduction into your world. [laughter] >> first, it's great to see a

community agreement played out in real time and i'm grateful for this opportunity to be able to have a community conversation on what is happening so we can see what is working and what's not and what we can do to make sure we achieve our ultimate goals of providing excellent care to all san franciscans. i wanted to touch on health disparity which is a issue i'm passionate about in relation to the report out on culturally and linguistically appropriate care. this is in the news and several fronts. yesterday president cohen announced a duel a care program to protect mothers, particularly women of color and their children. in this city black babies are 5% of birth but 23% of infant deaths and 13% of black mothers, 10% of pacific islanders mother and 9.1% have pre term rates which is 50% to 70% higher than white women in this city and that coverage has received

national coverage. specific to san francisco and so when we talk about culturally appropriate care, we need to be talking about racism, stress, systemic health inequality and equity as part of those conversations. making sure that people can get care in their community and it's affordable, and you are working specifically not just in making sure that those populations get care but that we're working on reducing bias both in the hiring and staffing processes and our fork worse, which is also diverse and also combating bias in the industry. i know the cpmc foundation was part of that duela care effort, which is awesome. i love to see other efforts that you are combining with your work force investments to really reduce bias in the industry. we know that it goes from hiring to how the care is actually delivered. on workforce development, another issue i'm passion at

about. it's not enough to get people in the door. as my fellow commissioners have said, you have to create the conditions to help them thrive in that requires tracking retention, creating programs and support. so, you know, when we hear that number of 277 folks hired over five years, the number of 128 folks being terminated, that begs to question of someone would worked in workforce development what is happening with training and support for those workers. i have just looked up the average turnover in healthcare and it's about 26%. those numbers don't mirror that. i know it's a different population but i want to know the average in relation of the workers in relation to the retention of those workers. it's been disheartening to hear about the lvn and rn and cna staff talking about their working continues. this population of the workforce tends to be diverse. they're also vulnerable and

crucial to providing quality holistic care. and so, you know, i echo the concerns of the community. we want to better understand kind of what, how you are supporting those workers and that staff and then also, i wanted to address charity care patients. which i hope we can come up with a different phrase for that. really tracking where people are coming from in different zip codes and their ultimate outcomes and whether they're moving the needle on their outcome. that's what we're trying to get to. if we're not slicing that data by race, location, it's hard to achieve goals if you are not measuring for that data. i grow with commissioner sanchez that i think that going to a deeper level of bet understanding of the data will provide all of us with an important opportunity to make sure that we're having impact, which is our ultimate goal. even perhaps inform the city

about what is happening in our workforce pool and what are the best practices on retaining this type of workforce and ultimate ultimately. >> it's convincing, however, the public testimony, including the questions that i associate was from the health commission themselves, seems to not fully substantiate the highest success rate of the data as been

presented. and then comes the public voice which raises issues and anything with can communicate and that is where i feel my primary questions are. i like to basically stand with the san francisco for healthcare housing and jobs and justice questions raised about the seven issues. you have those issues in front of you. i do not want to spend time going over them but each and all of them individually and together. the matter and require further and in-depth examinations including the strong infusion of the the human voices which testify to the fact that there is a big gap between the words and the deeds. the other points that i was raising is and i'm reading them off as i take