cp >> good morning and welcome to the san francisco planning commission and health commission joint special meeting for september 6, 2018. i would like to remind the public the members of the commission do not tolerate any outbursts of any kind. please silence any electronic devices that may sound off during the proceedings. i'd like to take roll for the planning commission. [roll call] >> clerk: we expect

commissioners hillis and richards to be absent today and commissioner melgar to remind shortly. >> and i'll be taking roll for the health commission. [roll call] >> clerk: very good. commissioners, you have one item under your special calendar for case number 2012.0430w, this is the annual compliance statement. this is an informational item. >> good morning, president chow and commissioners. i'm elizabeth purl, planning department staff. the item before you is an informational presentation on california pacific medical center's compliance agreement for the fifth annual agreement. i'm joined by several people.

today's hearing is one part of the annual review process required by the development agreement: d.a. required cpmc to submit an annual report on compliance and for the department to evaluate their compliance and hold this hearing. following this hearing, the directors of planning and public health will determine whether cpmc is in compliance with the findings from last year. cpmc's development agreement allowed them to build a new hospital and medical office building at the vanness and geary campus with the requirement that they also build a new hospital to replace st. luke's. the development agreement requires that the replacement st. luke's hospital be opened within two years of the opening of the vanness hospital.

the d.a. also requires sutter to make payments for a range of public benefits and improvements. in 2017, sutter was required to make three payments for a total of 7.1 million, all of which were paid, and that completes their payments under the development agreement. sutter's total payments to date have been over $73 million. construction of the vanness hospital is now well underway. it's expected to open in 2019, and the associated medical office building will also open in 2019. cpmc regularly provides the required schedule updates through their website. future construction will include the new hospital at bernal, and the planned guerrero park upgrade, which is due in 2019 as well. for the 2017 reporting period, there are 11 main action items

up for review as shown here, including payments, hiring commitments, health care commitments, public improvements, and community outreach. my colleagues will go into many of these in greater detail. one particular area, the public area has a reporting period that does not correspond to the calendar year, so that means we'll be able to provide you with more recent information than other topics, and we'll be able to provide information on how cpmc's hiring record compares to roles under the d.a. >> good morning, commissioners, mitchell griggs. in late march of 2018, milman provided the evaluation indicating the analysis between calendar years 2014 and 2015 using data from january and

december of those years. cpmc was in compliance. peragreement, milman reported that cpmc had satisfied the annual rate increase commitment of the increase to be less than or equal to 5%, but no additional details were provided other than the methodology used for the analysis. cpmc and san francisco health service system has agreed to engage milman to conduct two separate analyses: evaluation comparing calendar year 2015 data to 2016 data and comparing 2016 data to 2017 to determine year to year rate increases. san francisco health is service system requested the claims data from united health care and from blue shield of california for 2016 and 2017. milman has received the claims data from u.h.c., and we are expecting those results in about eight weeks. thank you.

>> now we're going to turn it over to ken mann of workforce. >> good morning, commissioners. thank you for having me here. i manage the office program at the office of workforce development. first, before i start, i'd like to acknowledge emily chair and lowell rice in my office. they're the ones in the ground doing the work and getting people to jobs, and -- [inaudible] >> it wouldn't be successful of course for cpmc, so that's my acknowledgement. now, first, the first goal is hiring at least 50% of new entry level positions for new

nonunion administrative positions. we exceeded the goal, 32 out of 37, which is 86% of the applicable participants got on this jobs, and some of these are lead documenting coordinators, documenting clerk, project manager, and these were hired through our capsa program, and that stands for construction professional services academy. it's specifically focused on these administrative positions, so the project has exceeded the goals. moving onto the next, which is hiring interns, 56% of the interns were hired. we worked closely with the school district, san francisco state university, we focused on them to get these opportunities. and of the 29 interns, actually

ten were hired full-time, with a contractor on the project, so this was very successful in making sure that students graduating from our schools get the opportunity to work on the project. now, the next slide, and actually, the third and fourth slide are the challenges we've been experience, and this is specifically focused on construction. first the hiring goals for entry level union apprentices. the goal was 50%, and we've reached 30%. though it's below the 50%, both contractors really worked in our system, particularly our city build academy and our community based organizations that we recruit individuals to get into the industry to get them to work. to date, of the july 2018, we've had 168 resident apprentice construction workers that was placed on the project. and some of challenges we've been experiencing is actually getting available local residents interested in some of these higher skilled crafts.

for example, the drywall, ironworkers, sheet metal workers, brick layers, operating engineers. it was very difficult to fill these positions. we get employer requests for these workers and working with the unions and the trades and these community based organizations, we were able to get some workers in there, but it still wasn't enough to reach the 50% goal. i'll address a little bit more of the details of why on the next slide, which is our fourth goal, reaching a 30% overall hours for journey men and apprentices would be performed by san francisco residents. as of july 2018, we've reached 25%. of the 5 million plus hours, 1.2 million were performed by local residents, the problem is san francisco we've had a booming construction. city build had been involved with all the major construction

work, and in the last several years, there was unprecedented demand for local construction labor across the region, and this impacted cpmc's contractors to achieve the minimum 30% goal, and compared to this same reporting period as last year, we've actually increased 1.8 million work hours, which is about 36% of increase and keeping it at 25%, which is -- to our end was very successful in working with the contractors to make sure that they fulfilled their commitment. and also, at the same time period, city build had been working with the chase build to build this other major infrastructure. a lot of hours were added into those work, and they were pulling local residents to make sure they had their own local requirement that they had to meet, they were competing against each other for our workers. but still we've had more than 309 resident construction workers placed on this workforce project alone. and some of the things that

city build have been doing to meet the demands of the industry. last year, we increased from our regular two cycles of regular city build training, we added three cycles. this year we've already increased to five specialized trainings just this year alone to meet the demands, and one of those examples was the chase training center. training center graduated last week. 32 out of 32 participants graduated last week and are aligned to work on the construction of the chase arena. in addition to that, we have the glenn eagles training program, and all of this effort to make sure we don't leave anyone behind. even though we have 2.1% unemployment rate, we want to make sure that the communities that are still challenged with unemployment to get the residents to work on not just this construction projects but across the -- san francisco. all right. and these are just some

additional informations for your reference. these are the demographics and pie chart whereas you can see with the work hours and how many of that is apprentice compared to the rest of the work hours. and now, we break it down by demographics of the neighborhood it represents. and one of the neighborhoods that we really target with the bayview-hunters point, ingleside, mission-excelsior. now, in addition to our workforce development, i'm here also to speak on behalf of the c.m.d., contract monitoring division. the contract goals have been met, so the main goal was the l.b.e. participation was at least 14% of the contractors working on the project are local business enterprises, and some of the specific -- the

success, vanness had 15%. the current medical office building had 12%. the st. lukes which just celebrated its grand opening had 21%, and all three projects combined is 16.4%, and as of july 2018, something like 22.5 million have been generated for local businesses. and specifically outside of construction, we also have opportunities to work on the operations of the hospital, so this is entry level positions. it could be medical, clerks, and working in the -- in the hospital's operations for the food industry, so a lot of those jobs are entry level, which our goal is 40%, and i'm happy to report that it's exceeded. and these are some of the target areas that we worked with, so western addition, chinatown, outer mission.

and they currently were at 54%, so 35 of the 65 employees were hired through the workforce system. and in addition to the workforce hiring, there's also investment fund grants that was provided? cpmc paid over $3 million fund to workforce through san francisco administration and also in partnership with the office of economic and workforce development. it focused on the area movable job training and economic opportunities, so our office worked with local community based organizations to make sure they get the funding that they need to provide the services to get residents to get through some of the barriers to work on the project. and it also targeted educational institutions and nonprofit organizations that in priority neighborhoods. some of the current grantees are faces sf, jewish vocational

community, success for help and young developers. that concludes my portion, and i'll be around to answer questions. thank you. >> thank you, commissioners. my name is sneha patil. so this slide provides a summary of the health care commitments within the development agreements. there are multiple provisions related to health care which are intended to insure that cpmc continues to provide high quality care to san franciscans, especially those who are low-income, medi-cal or uninsured. so as i mentioned, this slide is a summary of this commitment. the first three provisions from multiple commitments, so there

are five baseline commitments to maintain the same baseline of charity care, three provisions to increase care to medi-cal beneficiaries and low-income individuals. there were two provisions on the innovation fund, which totalled 8.6 million to fund community based services andum practices, and finally, there are an additional five health care provisions that range on various topics around subacute care to culturally and linguistically appropriate services, so the next slides will provide more details on these commitments. so this slide shows each of the five baseline health care commitments. cpmc's 2017 performance, and a determination of whether cpmc is compliant on each. so starting at the top, in the past few years, the cpmc has exceeded the development agreement requirement of caring for 30,345 charity care or

medi-cal parents. charity care refers to health care provided to those who can't afford to pay without expectation of reimbursement. second provision is related to community benefit, which is unreimbursed costs that cpmc incurs to improve community health. in 2017, cpmc exceeded the $8 million community benefit requirement and provided about 12.5 million. cpmc has -- provides -- met this requirement by providing grants, including community health programming and community outreach. i just want to note that these first two requirements are also verified by deloitte as a third party provision. the third provision was in effect until 2017, which was that cpmc was to maintain their current charity care policies.

that obligation was met by the end of 2015. the fourth provision was that cpmc maintained charity care policies that are compliant with the state law, and that is the case as of 2017, cpmc's charity care policy was the same as it was in 2015. the last provision is for cpmc to continue to support bayview child center. since the ownership has transferred to the south of market health center, cpmc has provided an operations grant for five years, invested over $1 million, transfer assets, and is still serving as the clinic specialty and hospital partner. so the next three provisions focus on medi-cal, which is public insurance for low-income san franciscans. so the first provision, cpmc has continued to participate in medi-cal managed care with the san francisco health plan.

the next provision requires cpmc to assume responsibility for 5,400 new medicare beneficiaries, and this obligation was met in 2014 and cpmc continues to meet this obligation. in 2017, they had a total of 29,739 beneficiaries. the third requirement is that cpmc serve 1,500 of new medi-cal beneficiaries through a partnership with a tenderloin care provider. currently there is no such provider. to meet this obligation, cpmc has partnered with northeast medical services to bring in st. anthony's clinic as a primary care provider in the tenderloin. cpmc has reported that they are continuing to work with st. anthony's leadership toward a path for sustainability and outreach efforts.

a grant of $35,000 was awarded to st. anthony's through the innovation fund to help increase capacity to do outreach. there are two provisions in the development agreement that pertain to the innovation fund. the first that cpmc is to make payments between 2013 and 2017 totaling $8.6 million. the total payment was made in 2017, and this completes their obligation to the innovation fund. the second provision describes how the funds will be used, and they're administered by the san francisco foundation. cpmc along with the department of public health and the san francisco foundation sit on a committee to grand awards that support community clinics, behavioral health, and other community based services and programs that ultimately support the health of san franciscans. in 2017, the committee granted awards totaling near 27,000 to

six different organizations. so the remaining health care provisions in the d.a. are stand-alone and again span a range of topics. the first provision on should lied requires cpmc provides specific proposals for providing subacute skill nursing services in which patients require a higher level of care than your average person in the s.n.f., and so the requirement was that cpmc present these proposals to the health commission. this obligation was completed in 2016 through a presentation of the post acute care project report to the commission. the second provision is around the integration of staff across cpmc campuses. in 2016, cpmc completed this integration of st. luke's medical staff into a single integrated staff at all four campuses with the completion of the new hospital campus, cpmc

also plants to integrate that staff. [please stand by]

>> from out patient services from cpmc to sutter pacific medical foundation through the proposition q process, they have informed the commission of plans to transfer management of out patient clinics including the saint lukes diabetes center so the health commission held a hearing on this and will deliberate in a sesquicentennial and have an impact on continuity for patients. >> th this was discussed at previous hearings and i wanted to provide update. sub acute squarely is skilled nursing care for medically

fragile individuals and in 2016, cpmc announced they were closing saint luke's and skilled nursing units so that unit did close in 2018, it was the opening of the mission bernal campus which is a 68% reduction in over all beds and cpmc, however, following hearings in the health commission in 2017, cpmc did commit to continue to care for the remaining sub acute patients. as of august 18th, the remaining patients have been transferred to the davies campus. that concludes this portion of the presentation. >> as heard from my colleagues, they are in comply with the development of the cpmc agreement although there are concern that include enrollment with the managed care providers,

appropriate services and construction hiring of the union journey men and apprentices and the information we've received so far for 2018 is continuing compliance. staff's recommendation in health and planning is to find cpmc in compliance for the 2017 reporting year. staff will be available for questions and we will have a presentation briefly. >> good morning commissioners. i'm from external affairs group. thank you for having us here this morning. i'm joined by colleagues who can serve as subject matter experts when i'm sure we get into question and answer portion of the morning's hearings and we're

pleased to be here today. as you've heard, we've opened the new mission bernal campus on the 25th of august and you are looking at baby isabella who is the first baby born at the new mission bernal campus. everything there, with patient census appears to be steadily increasing and satisfaction from staff and patients alike. we're happy to have a successful opening under way. this is photos of the vaness campus which will open march 2n. it's when we'll transfer patients from the campuses to that new location. we have been awarded approval to staff and stock so we're getting our training schedule ready and a little later on in this fall, we'll begin training at the new vaness facility. these are photos.

m.o.b. which went up much quicker than the hospital across the street. even still, with some tenant improvements going on, it looks like the m.o.b. might open just a bit later than the hospital. maybe the end of march. maybe if we can squeeze that schedule in the next six months, it will open at the same time. right on schedule. we showed this last year, just to make an over-arching view of the major transitions that we see. we're counting this as four major transitions and with the opening of mission bernal, we have accomplished one of those. which is to move services from saint lukes and a few from pack and cal to the new mission bernal hospital. as i said in march, number two will be opening van ness number three will be the van ness m.o.b. and four will be once that situation has settled,

we'll resort a few programs and service that's have had to move to tem temporary locations whie construction was finished and that will take us to 2020. something we've talked a lot about in these hearings in the past is community engagement. last year, we wanted to make sure we showed the broad range of community engagement that we're involved in, not just certain specific conversations, we wanted to continue shares that view with you here today. there's a couple things specifically i'd like to call out because we actually have not included them in the past. one is that first point. in 2015, we established a buy-local program in the lower

polk neighborhood. we've talked a lot about the neighborhoods and activities around the mission bernal campus, not so much around our new van ness campus. this is a program we're very proud of. we've worked with our partners on and it's been on going since 2015. we wanted to make sure to include it here today. i also would like to point out sunday streets program, if any of you are familiar with that. this will be our fourth year of participation with sunday streets. throughout the entire year in 10 neighborhoods across the city, we're there talking to the people coming to the events, getting their input, answering their questions. it's a very grassroots level of community engagement that we've had on going for years, across the city. and we wanted to make sure we pointed that out to you today. it was mentioned the gurerro

park community help design what that park would look like. the last thing would be to just note that we had a very lively, exciting, public block party the week before the new hospital opened. we had more than 500 community members come out to kind of kick the tires, if you will, on the new mission bernal hospital and take a tour. it was a terrific event. this is also a slide that you've seen before. this is a running total. where we are now through july 2018, the total impact to san francisco from this effort has crossed the 300 million-dollar mark. it's something we're proud of and something we hope that the

commissioners and writers of the development agreement also take pride in seeing this investment into our community. 2018 accomplishment and 2018 key priorities of course were happy to be founding compliance on all commitments. i wanted to note a few things here, rather than run through this entire list. we continue to work in good faith and have exceeded the operational workforce hiring goals. that is a tremendous amount of effort in conjunction with oewd and others and we do have subject matter experts here from our team who can answer a specific questions about all the outreach they're doing and the commitment to those goals. we are continuing to promote that. it's just one piece of our

commitment to reducing our single occupancy rate. we're increasing by at least two-fold the amount of on campus transportation fairs that we hold. we have many partners there. again, the subsidy is just one part of the options that encompass our transportation demand management program and again, we have subject matter experts here rigald who can take you through the amazing activity going on there. lastly we hope to stay on track for the march hoping of the medical office building. i think i will just proactively say, as i assume it will be a question coming from staff's key health issues for us to follow-up on or watch. the transfer of service of the

saint luck's diabetes foundation to the medical foundation, the benefit that that brings is that there's a receptionist so the first healthcare priority that was noted has actually already been solved. that receptionist speaks spanish. the secretary in the office who sits right behind that receptionist speaks spanish and the m.a. in the program speaks spanish and is in the midst of getting her spanish certification. healthcare items 1 and 2, as noted by staff, the transfer of that service to the medical foundation, has already accomplished some improvements that we've been talking about for a couple of years. and that concludes our comments and again, we're here to answer any questions you might have.

thank you. >> is that it for staff presentations? >> the coalition of housing has asked to address the commission. >> we can do that as part of public comment. >> that concludes the staff presentation. we'll be available for questions afterwards. >> with that i open it up for public comment. i have some speaker cards. julie, joan yang, larly lou and thomas kravik. >> my understanding was an arrangement was made -- >> we have organized them 10

minutes as organized opposition. >> good morning commissioners and directours. i am a professor at uc hastings college of the law. and director of the community economic development clinic which represents san franciscans for healthcare, housing, jobs and justice. the community labor coalition that pushed the city to insist on all of the community benefits that we're hearing about today. for the fifth year in a row, the coalition submitted written comments on cpmc self assessment and my understanding is that staff have included those comments as the last item in your packet. the coalition continues to urge the commissions and directors to use this compliance review process, not simply as a yes-no

box checking exercise, to bestow the passing grade on cpmc we all know cpmc will be awarded. rather, we encourage you to use this public process to insist that cpmc and city departments answer some important questions outlined in the coalition's written comments, which i will summarize momentarily and coalition members will expand upon in their public comments. for some of these issues, we ask you to look more closely for others we ask you to take a broader look. and of course, coalition members and i are happy to respond to any questions that you have after public comment. so let me just preview the seven areas we would like you to look further at. the first has to do with charity

care patients. here we're asking you to take a closer look. yes, cpmc is exceeding the numbers of patients that its committed to. there's been a great deal of volatility from year to year. we think it would be helpful to ask why that volatility. it would be also informative if we knew a little bit more granular details on charity care patients. at which campuses are they being seen? what zip codes do they come from? how many are receiving full services? how many are just one-time diagnostic appointments? in an era of electronic record keeping, those are not difficult questions to answer. the second issue has to do with the saint luke's diabetes center, which the health department has noted as one of its key healthcare issues. and the key question there, after cpmc fired its

bilingual-buy cultural staff, four years ago, has there been a dim using in ak at th in accesse population it served? cpmc has not provided the city with information to answer that question. we don't know how many mono lingual spanish speakers were being served in 2014, how many are being served now. that's a question that the public deserves an answer to. the third issue we would like you to take a broader look at, is cpmc serving frail and elderly patients the way we in san francisco would expect a well-resourced state of the art

healthcare organization to do. the health commission has heard about the actions at saint lukes with a swim at swindles and we encourage you to use this as an opportunity to get an understanding of whether cpmc really believes that its treatment of frail and elderly patients is the best that it can do. the fourth issue has to do with an center for excellence in senior care. on that point, i will distribute a written statement from dr. ken barnes, that outlines the coalition's expectations for what a center of excellence should look like. the fifth issue, also identified by the health department, has to do with the commitment to serve 1500 residents of the tenderloin on medical-managed healthcare to provide specialty and hospital

care to those patients. in the city reported indicated that only 180 tenderloin residents have signed up. today's presentation said it's only 170. for several years, saint anthony's has been given funds from the innovation funds to do recruitment. the coalition has suggested on a number of times there are additional steps the city's public-health department can take and cpmc could take in order to publicist the availability of those services, perhaps to provide transportation if that is the impediment leading people not to chose the saint anthony's managed service organizations. the sixth issue is in the realm of entry level operations hiring. where it is entirely correct more than 40% of the hires are

coming from the first force hiring program. but the way more important closer look that we would urge you to take, is why have the total numbers of entry level hires plummet from 220 in 2015 to 57 in the city report. now 65 in the presentation today. why does cpmc project that it would hire three times as many entry-level operations hires? perhaps even most importantly, what are the retention rates of the people that are being hired through the first source hiring programs? these seem like really reasonable questions to ask but neither cpmc has provided the information nor have the city apparently requested it.

and then finally, the seventh and last question that we asked you to inquire about is what is cpmc doing to promote the subsidy program to its employees? to get more than 18% of its employees to take that public transit subsidy when 43% of its workforce live in san francisco. with the commissioners and directors' permission, i'd like to handout a summary of those questions and the coalition's written suggestions for what a center for excellence and senior care would look like. >> thank you, very much for your comments. >> we also have a number of speaker cards to submit. >> folks, if you want to make comments on this, please come up. the names that i've already

called. if have not turned in a speaker card, lineup near the wall on my left. thank you. come up, please. first speaker, come up. good morning, commissioners. chinese hospital is small non-profit community hospital located in chinatown offering wide range of medical services to a multi cultural community for over 100 years. our clients are low income asian immigrants. many of them are monolingual speakers. 90% are medicine' care, medicine' calmedicare and medics

flourishes through the years with over 50,000 birth recorded. and i have a display that shows you in 1998, limited by only being able to provide level one labor and delivery services, chinese hospital partnered with cpmc and relocated its labor and delivery services along with its nurses to cpmc. to provide a community direct access to both primary o.b. care. cpmc agreed to charge the chinese hospital and its affiliates reasonable market rates. we respectfully ask the commissioners to help facilitate that reasonable market rates. which are consistent with the cpmc development agreement for chinese hospitals and its a fil

it's a and maffiliates. >> next speaker, please. >> good morning, my name is julie. i have a few papers that can be handed to everyone. i want to thank you for letting me speak today. i just want to read a letter that was written for us. i am a licensed vocational nurse at cpmc. i work postpartum labor and delivery the last 14 years and have been an employee for 26 years of cpmc. on february 16th, 2011, i received a letter after we were beginning negotiations that said dear julie, during last year's collective bargaining sessions with seiu, uhw, we discussed cpmc's plans to rebuild our facilities in san francisco. the union representatives

recognized the importance of those plans but they were concerned about what might happen to your jobs when the new facility opens. we understand those concerns and agreed to a strong employment security language in your contract. i am writing you today because there's some confusion exactly about quotation, employment security means. it is simple, all seiu representative regular employees, who are employed on the date of your contract was ratified march 18th, 2010, will continue to have jobs at cpmc when the the new facility weres built. so if you worked at cpmc in march and working for us when the new facility opened, you are guaranteed employment with the same or greater pay than you will be earning then and number two, you will have no reduction in hours unless you ask for a change. also, cpmc has no intention to interfere with your right and union representation. thank you for your hard work and

dedication. warner browner, md, mph c.e.o. i am here because as of august 29th, i was asked to go no a conference room with management and basically stated that lvns will not have jobs across the board as working on the unit. i have dedicated our time as speaking before all lvms. four of us who work postpartum, we are excellent nurses. although we do not carry certain job engagements of the r.n.s, we are able to give great care to our employees and patients. we are great colleagues, we have worked very hard in our profession. we deliver the highest care given. in the second and third page, i have letters from management.

i have letters from a patient which i can give more of. also a survey that was done by 3,003,000 hospitals stating i'm proud this is the second time you've been recognized as a top performer in the healthcare systems and i'm grateful for your dedication and partnership. >> thank you, your time is up. >> thank you, very much for listening to us today. >> thank you. we appreciate your comments. next speaker, please. >> good morning commissioners and directors. my name is dina. i am the current and new c.e.o. of chinese community health plan. a.k.a.ccph. ccpm administered contracts on behalf of chinese hospitals. thank you for the opportunity to address the joint planning commission and health commission. per the cpmc development agreement, cpmc was supposed to provide services in a manner consistent with exiting services

agreements of chinese hospitals and its affiliate. i find it difficult to accept that cpmc/sutter is providing services in a manner generally consistent, quote-unquote, when chinese hospital has experienced rate increases since 2013 as my colleague larry lou will attest. my apologies to both the tempt of public-health and the commissioners our contract and rate issues were shared with the department of public-health. chinese hospital and its affiliates encourage the commissions to request that sutter health corporate act in a spirit of the d.a. and engage in upcoming 2019 rate negotiations that result in reasonable market rates for chinese hospital and its affiliates. we request this in the spirit of cooperation amongst local providers. the only stand-alone community hospital in san francisco and the only onish of two remaining san francisco-based commercial

health plans in serving san francisco ans. thank you for your time and attention. >> next speaker, please. >> i'm the c.o.o. of chinese community health plans. i was born at chinese hospital. c they provide manage care patients for chinese hospital. the spirit of the development agreement and the past relationships with cpmc and chinese hospital were collaborative. cpmc provides hospital services for the community which are not available for chinese hospitals such as labor and delivery or pediatric beds. in mid 2014, just a few months after the development agreement was concluded, sutter notified us they were determine innating all of our existing contracts with cpmc, saint luke's and its doctors and demanding much higher rates. during our most recent contract

negotiations, sutter again insisted on rates that were more significantly higher than our own costs and the market as a whole. just to put that in perspective, the cost of a normal delivery at cpmc is two and a half times than it was in 2013. company we hope they will hold e collaboration we had prior to 2013 and return to more reasonable and fair market rates for their services. we believe this will help us fulfill our mission to provide quality, affordable care to the communities that we serve. with that, i would like to thank you for the opportunity for

giving your comments and thank you for your important work. >> thank you, mr. lou. next speaker, please. >> good morning commissioners, thank you. my name is dr. tom cravis. i live with my family here in san francisco, less than 20 minutes walk to chinese hospital. our son has selected his own personal physician, who is on the staff of chinese hospital and although he receives many of his services there, he is referred for certainly specialized care at cpmc. for an office worker in his 20s, the cost of care at cpmc, including the out-of-pocket co payments and deductibles is high. his needs are a microcosm of the problems of our elderly face because they have multiple chronic conditions, which often require specialized services at sutter, where the cost of care is high and certainly

considerably higher than chinese hospital. studies published by ucsf and other sources over the past several years, have shown that the cost per hospital admission is higher by about 113% when the care is provided in large systems such as sutter. let me be clear, we acknowledge that the care at sutter is medically appropriate and of high-quality. however, let's ask ourselves this, how many of our thousands of members that average 74 years of age, were aware that a simple agreement entered into years ago, about o.b. care and care for babies could have such an adverse impact on the cost of their care and that today that same or similar care at sutter may cost them considerably more than a chinese hospital. we remain committed in having our member, just as we would our families, to receive the highest

quality care. however, let us see how we can work together going forward to make this care more affordable. we respectfully request that there must be a thoughtful, consideration of the intent of the agreement with sutter and the significant financial burden on on families today. thank you. >> thank you dr. kravis. next speaker, please. >> goo good morning, commission. i am the chief financial officer for chinese hospital. i've only taken that position, i am honored to be able to work with such a vital part of the san francisco community. as mentioned by previous speakers, the relationship with cpmc is longstanding and integral part of the its continued mission to provide high-quality affordal healthcare. maintenance was central to the cpmc development agreement. unfortunately, the rates paid to

cpmc under that relationship have not, in any meaningful definition of the sense, been generally consistent. we find them today at an increasingly high level that is far beyond the market rates paid to other providers in the market. consequently, we are in a position of not being ability to sustain that level of payment to them. we ask the commissioners to help us in upcoming negotiations to restore that generally consistent premise that was originally intended under the development agreement. thank you. >> thank you mr. forny. bob prentice, mike lion, melanie grossman, james sandoval and mary mickoluchi. next speaker, please. >> good morning, commissioners. i work with community housing

partnership and i'm also a representative of the good jobs for all coalition. i want to first acknowledge that sutter cpmc has been having success in hiring economically disadvantaged workers by the city's first source hiring program for entry-level positions. we would like to know, however, that sutter cpmc and echo what has been noted before it's had a glaringly decreasing its over all entry level hiring. we urge the commissioners to explore the reasons behind this slow down. as what was noted before, we urge the commissioners to ask how many of the entry level operations his ove hires have bn retained. we think this is very important, there were six targeted neighborhoods in the development agreement. if those targeted neighborhoods are not being reached, we should have them be identified so that this can be addressed. although progress has been made, such an extreme shortfall from

over all predictions warrants a deeper explanation. >> thank you, next speaker, please. >> my name is colleen. i'm the executiver for housing healthcare and justice. so, as we have spoken here, when we look at development in this city, and especially cpmc, one of the biggest promises, right, has been jobs. jobs for the members and residents of our city. i think that the promise is not been fulfilled. when we look at operational workforce hiring goals were exceeded, well, if we side step that, it's not operational but it's construction. those goals have not been met. where the target was 50% of city referred applicants only 30%. that's a clearly a goal that we need to reach. and still fulfill. in what javier mentioned when we

look at jobs deliver to the people who need it most in our city, we're falling short. so, in cpmc's own 2016 compliance statement, there was a projection of 173 entry-level jobs. that is far short of what actually happened in 2017. when we look at that, 33 of the jobs were city referred of the entry level and that actually, if we think of 173 entry-level jobs we were hoping for, 40% of that target would be about 69 jobs so in terms of the actual number of jobs that came through, 33, it's about fair. you can check my math on the paper. when we dig into this a little bit more, there's a lot of work that we need to do. i hope that the commissioners can really inquire what is the reason between