it's good for business and it's good for the community. [roll call] >> clerk: second item is the approval minutes from november 6. >> is there a second? >> so moved. >> any corrections to the minutes? seeing none, all those in favor, aye. opposed? approved. >> clerk: director's report. >> good afternoon. greg wagner, acting director. i will be brief because i know we're anxious to get to the heart of the agenda. as you know, beginning on november 8, there's the -- there were the wildfires in butte county, which had a significant impact on the city. the air quality was poor, as anybody who was here was aware,

for quite some time. we had a significant response to that. we distributed 19,502 masks. to city employees and homeless outreach team, for those that could not find indoor relief from the air. our call center activated through the holiday weekend and handled 864 calls, reached out to patients to ensure that they had adequate preparation. so that was part of our network response. and d.p.h. coordinated 20 healthcare professionals. so that was a significant response and we've learned from that, as we have in the past, and we'll continue to improve our protocols. on november 26, the department launched its truth or not campaign, which is youth

cannabis campaign in response to the state changing cannabis laws, making adult use cannabis legal. the campaign is really just to provide information to -- and facts to youth and dispel youths, so they can make well-informed decisions about cannabis and their health choices. we're entering a new phase in our electronic health records program, beginning yesterday actually, we're in the testing phase. we're still continuing on some of the build, but this is a big milestone as we're moving into actually testing out some of the functionality that we've been designing and building over the last several months, so the project continues to move along at full speed. the commission on accreditation surveyed the opioid treatment outpatient program and provided staff with an exit conference.

there were no recommendations for improvement. we'll take recommendations, but it's good not to have any. the feedback described what we do here as a best practice. so that's a positive result from that survey. on november 1, the health plan, the department of public health and delta dental, hosted a peri-natal roundtable protecting the health of san francisco pregnant women and their babies. 50 dental and medal providers attended and ensure early access to dental care and it included a number of leaders from the department of public health. and then lastly, the behavioral health during october 22-26, pharmacy and other key stake holders did a value stream mapping event, one of our tools to focus on performance

improvement and that event was a week-long event focused on mapping the current state and designing a future state map centered on improving services. so that's an important piece and a big step forward for behavioral health and their pharmacy program. with that, we can answer questions if you have them, or close the presentation and refer you to the documents available to the public. >> commissioners, i had one question concerning the fires and problem with the air. do we have any thoughts or focus on whether or not there were increases into the emergency rooms or how, you know -- you described us being able to help with some preventive measures. i wanted to know what were some in the emergency system and our hospitals. >> it's a great question.

i will ask dr. naveena bobbitt to come up and respond. >> yes, hi. so we did daily calls with the hospital system at that time and asked the e.d.s and asked at the capacity of in-patient beds. that means to that he were abiding by the advice and staying indoors and taking the appropriate precautions. >> yeah, commissioners, questions? commission sanchez? >> i would comment on the response that the department acted with the database and moved forward in a positive way. we were able to address many of these issues, especially when you looked at it every day and saw the memory go from 49 to 279 and you saw we're the worst city

in the world at this point in time, you get the feeling that maybe there is a problem. i would throw this out -- in apartments, homes, you really need to have the manager or whoever check your filters for the heaters, air, whatever you have. if you still drive a car in the city, which i happen to do, that's why i'm so late and i apologize, not only the roads and traffic, but if you drove during those periods, you better have your air filter checked and your in-filter checked in your car, even though they say it may not affect it, when they pulled it out, they're astounded to see how bad it is. some dealers are providing that as a free service. think of that, i'm sure muni is doing the same thing. so in a home, in an apartment,

where the air circulates. >> the mayor has asked us to update our response protocols for air quality issues. we'll go through that process and take that comment and any others that the commission has for us in that account as we go through that process. >> thank you. any other questions of the director? if not, we'll move on to our next item, please. >> clerk: item 4 is general public comment and there are several requests. >> right. i have several. dr. teresa palmer, marilyn morgan, and mark averni, i believe, could have mispronounced it. areni. okay. arenson? okay. anyway, mark. those are the three, please, for

general public comment. each has 3 minutes. >> clerk: and to remind everyone, i have an egg timer. when the timer goes off, please note it's your time and finish your sentence and move on. >> commissioners, going first alphabetically. >> i'm mark arenson, professor at hastings college of the law. i'm here for healthcare, housing, jobs and justice. specifically, i will be very brief. i want to request that the coalition be made part of the backup proceedings developing the healthcare services master plan, which is being done jointly with the planning department, which has been headed up. it's been in a hiatus and we would like to be part of that process, which establishes policies, goals, standards for

healthcare delivery in san francisco. the enforcement mechanism is in the review of land use requests for development by different hospitals and other healthcare institutions. so it very much is important in establishing some standards and opportunities for influencing healthcare decisions made by private and public parties in san francisco. so that is our formal request, to be made part of the workup of the healthcare for the healthcare services master plan revision that is currently being done. thank you so much. >> thank you. i apologize for not being able to read your writing better. >> i should apologize. >> hi. i'm marlaine morgan, coalition for healthcare.

the -- in 2013, is when we settled the development agreement with cpm and there were five major elements to that, which were housing, jobs, healthcare services, which we're talking about today, care and transportation. and my involvement here was around transportation, which as we know in the last five years since the construction of cpmc has started, transportation is worse, all over the city, all over the bay area. we have problems with public transit. we have problems with individual drivers, congestion, gridlock. we have problems with safety, issues on muni, bart, everyone's concerned. so we're struggling to see how we're delivering vehicles to these hospitals. van ness, which is what i'm focusing on today, has another issue, which is the b.r.t.,

which is supposed to open before the hospital opened to transport our 3,000 daily employees to that hospital is delayed for two years. transportation is a problem and it does affect staffing. and we'll talk more about this with the city and the planning department, just to get some updates. wanted to let you know. thank you. >> thank you very much. >> i worked at laguna honda for years. and i work with this coalition and my area of expertise is long-term care and i am working

on submitting keeping track of out-of-county discharges and transfers from hospitals and from nursing homes and post-acute care settings. and i ask for your support in this and i ask that this be placed on your agenda if at all possible. i'm not quite sure how it works, but i've sent you an article i wrote. it will be published in "the west side observer" sometime in the next week and it's about the fact that -- even the san francisco healthcare master plan in 2013, although it didn't halves much about long-term care, it did say, san francisco likely lacks sufficient long-term care capacity to accommodate its growing, aging population. and we know about -- we

testified here and we heard about the many closures of hospital-based, skilled nursing facilities, which then impact the long-term care that freestanding nursing facilities can give because the beds are used for post-hospital care and we're sending lots of people out of county. we did attempt to get the numbers, but not the hospitals. a number of hospitals with not cooperate in giving them to her voluntarily. and we can't plan for long-term care if we don't know who has been denied it. aging in place, if you can't age in place at home, you should be able to age in place in your community, where your friends, your support system is. and the most egregious example is sub-acute care. if you choose to live on a

ventilator with similar, complex care and you didn't be cared for at home, you now have to leave the county. there is none in-county. it's a form of long-term care. the smallest percentage of people embrace it. it's the most egregious example. i would like the health commission to support legislation that requires skilled nursing facilities to report out-of-county transfers in a way that's hippa-complaint. i'm sure it can be done. and i have an article that you have a copy of. thanks. >> thank you. that concludes general public comment that i have before me.

and we thank you for those issues. >> clerk: item 5 is the report back from today's found answer and planning committee. >> finance and planning committee met immediately before this meeting. during the meeting, we took a deep dive into the december contracts report, which took longer than anticipated. and we did approve the contracts for port and deferred six additional items to the december 18 population health committee for consideration and then to full commission. >> questions to commission er bernal on the finance report. seeing none, we'll move on to our next item. consent calendar is --

contract report brought to us by the committee and so we'll ask for any extractions, if not, we'll vote. all in favor, please say aye. those opposed? adopted. >> clerk: and theres with was no public comment request. item 7, proposition q hearing, cpmc license change of the alzheimer's day program from cpmc and institute on aging. >> good afternoon. i'm sneha patil. this is the third prop q hearing. as a reminder, proposition q requires hospitals in san francisco to provide public notice prior to closing an

in-patient or out-patient facility prior to the leasing or sale or change of management. first item, the licensing change of the day program from institute on aging. it was presented at the july 21 meeting. as a reminder, the day program operates at california's pacific medical center campus. there are 30 participants a day with mild or moderate dementia. currently, the institute on aging manages the program and cpmc provides space and support. with this change, the alzheimer's day program will be

independently licensed by institute on aging. this has reported that this change is related to the closure of the california campus in the spring of 2019. and we know that institute on aging has been searching for a new space to relocate the program. as of november, 2018, institute on aging has been reporting that there's been an agreement to hold property until january, 2019. they've been able to fundraise 50% of their gel and they're continuing to do so. so we know if a suitable location is ready prior to, there may not be a detrimental impact because i.o.a. has historically managed this program and there will be no gap of services for current participants. if i.o.a. is not able to secure a new location and the program were to close or reduce

services, we do believe that that would have a detrimental impact for healthcare services in the city. commissioners, i know you have a draft resolution before you. i would like to note that tom briodi is here and can provide any additional updates or answer any questions you might have. >> thank you. any further comments? >> yes. good afternoon. i'm tom briodi, institute on aging. we're making good progress relati relative. the engineering and architectural work is done. we're waiting on construction bids to come back to see if

there are any savings there. i remain guardedly optimistic that we'll proceed with the new site. >> guardedly optimistic or -- i mean, do you want to put a percent on it? >> no, i won't. [laughter] guardedly optimistic is positive in my regard. >> okay, thank you. appreciate that. commissioners, we have one public testimony, correct? before we take further questions, let me ask dr. palmer, who has asked for public testimony on this subject. >> the folks at the -- as you know, my mother attended that center before she ended up at the jewish home.

it will be closed down even though they tell me they've been told they will be closed in 2020. it's the same building, so i don't see the hurry, especially since i've never heard of new construction getting done in this time period in the presidio. it will get shut down and there will be a gap between the new place and cpmc kicking them out. it will be detrimental. these are patients with dem dementia. this is one of only two places in san francisco and it's very confusing for them to be moved

multiple times. they're routine-bound and stimulus-bound and they need continuity. my recommendation is to say it's detrimental because it's going to be and/or delay your judgment for another four months and see what i.o.a. and cpmc accomplishes. there is no reason to think that the building will be up, renovated and ready by the time cpmc is planning to kick out this program. >> thank you. there's no other public testimony at this point. i don't know if cpmc wishes to make any further comments. so we're prepared for further discussion. there is before you a revised

resolution, 18-3, which i believe has been distributed. and it's within the purview of the commission, but this is what is being placed before you at this point for review and potential acceptance. so did you want to describe the proposed resolution and its new version? >> yes. so the revised version you have before you, makes a few amendments to the language in the packet. so the statement that would be made is the resolution would be determining the impact of the

change in licenseure from cpmc to sole the institute on aging. and so additionally, language would be added to the bottom and the final further resolved statement, which says, the change in licenseure change to solely i.o.a. will have a detrimental impact open the healthcare services if i.o.a. is unable to secure a location and provider similar or expanded services to seniors. everything else within the resolution remains the same. >> commissioners, a proposed resolution is before you prepared by staff. we can open bisbee first placing that on the agenda and then making any modifications that

you would like. >> move to place it on the agenda. >> is there a second? >> second. >> there's a second. so the proposed resolution, which is our modified resolution is before you for discussion at this point. any comments? yes, commissioner sanchez, please? >> i was going to ask the -- because, again, the resolve, we state further resolve, i.o.a. is strongly encouraged to continue the program in similar or expanded capacity and update the health commission once the new location is confirmed. is that still on the radar? are we still moving on that? i know there were different comments made, but let me just -- i know that there have been some things that have been completed out there on time including v.a. program and meals, etc., for veterans out

there. and that was because there was a lot of discussion and input. so i would hope that, again, this is a real, you know, major effort to provide these critical services we need in the city and this could be a flagship program. everyone needs to work together to make sure that the quality of the programs are protected. as i said, there's a lot of concer concerns, but i remember the new director of the presidio out there is also served with us as an attorney to the health commission for many, many years and i know that she's always very much involved in the community input. would you like to comment on that? there was a moment of a date. i didn't see any date, that we provide these services. >> i would like to provide some

clarification. there is no new construction under way. it's an existing building. it is being renovated. timelines have been given to us by three construction firms. so based on the timeline we're looking at right now, renovations would be complete bid june or july. we're looking at this property coming to fruition, we can double the size of individuals we're able to serve there. so this is highly orchestrated. it's very much in sync with the presidio. presidio leadership is behind this. >> thank you. >> so if -- are you saying that there would not be a loss of continuity if this all went in accordance to your guarded optimism? >> yes. we're working very much in sync with cpmc, so there's a coordination of when that transfer would happen. if we're delayed a month, we're

not going to exit the california campus for a month. it's well synchronized. >> thank you. thank you for the input. commissioner bernal? >> i would like to offer a similar amendment to the last whereas clause to add, "without interruption." >> is there a second to that, please? >> second. >> okay. further discussion on the motion. i think it's quite clear why we're asking for that. if there's no further discussion, a vote on the amendment, we will take at this point. all those in favor of the amendment, please say aye. opposed? the amendment is added to the motion. we're back at discussing the motion. and i'm glad commissioner sanchez pointed out that we were

commending the program in the first resolve. being very important. second resolve says that if i.o.a. is unable to continue this program, then it will be detrimental. and clearly the commission would encourage that the i.o.a. continue this program, which is what we would -- all desire to find, therefore, very positive for the city, especially as they're talking about also expanding the service. thank you. okay. commissioners, any further comments, discussion? if not, we're prepared for the vote. all those in favor of this resolution, please say aye. opposed? resolution is now passed. thank you very much. >> thank you, commissioners. item 8 is a proposition q hearing cpmc change of management of patient departments to the sutter pacific medical foundation. >> ms. patil?

>> the second item is for the transfer of management from five outpatient services from cpmc to sutter pacific medical foundation. again, information about this change was reported to you during the july and august health commission meetings. there are five departments impacted by this change the first three services have transferred management in august of this year and that includes the breast health mammography center at st. luke's, diabetes center at st. luke's and noninvasive cardiology at st. luke's. two of the five services have not transferred. that includes outpatient psychiatry and diabetes center at the california campus. so during previous hearings, the health commission raised concerns regarding the need for the medical foundation to enter

into plans similar to the contracts held by cpmc in order to ensure that there is continuity of care for the patients impacted. since the last hearing, cpmc has reported on the volume of patients that have been seen at the three services that have transferred and provided an update on the progress with health plan negotiations. so this information is in the memo you have before you. what is reported that the sutter pacific medical foundation has a plan in place. if a contract is not in place with the plan, they will work on developing letters of agreement with the health plan to ensure that there is continuity of care. while it is our policy to develop letters of agreement, we do know that there were staff

training issues identified. so some patients may experience a disruption to their services. however, sutter pacific medical foundation is working to assess the impact of this and be sure that the staff training issue is accounted for and corrected for. so at this time -- additionally, cpmc has reported that due to a staffing issue, some patients at st. luke's were unable to see a nongestational diabetes center at st. luke's. patients were able to access this educator at the california campus. so it did involve some commuting for patients. those are the main updates that we have at this time. we believe that change in management will have a detrimental impact if the foundation is unable to secure a contract or ensure that letters of agreement are stated.

however, if it's not the case there, would not be a detrimental impact. commissioners, i know how of a draft resolution before you. warren browner, c.e.o. of cpmc is here and can answer any additional questions. >> dr. browner, would you like to make some comments? or your staff will? >> i will make some comments. >> dr. browner has been referred to an appropriate person. >> it's been transferred to me. i'm happy to see you again to let you know that we've secured the letters of agreement with hill physicians and as the pay for performance measures, we reach out to those who have not

had their mammograms, pap spears, we've sent out letters to all who are due for their mammograms, so people we've served before who may have gotten caught in the shuffle. we've sent out letters in english and spanish. that's working well. we've continued to grow our diabetes program. we have an educator at the other campus so people won't have to commute. those that did have to commute, we offered them transportation. so i would say that having done many, many moves in many places, it went well and i have to commend, yes, my staff, karen, operations director, who has done a really human job to make this work well for our patients. as we spoke before, as you know, patient care is really moving outside. most diabetes care is done outside of the hospital. it's less expensive.

it's less difficult for patients and we're pleaseded to offer that to the citizens of san francisco. thank you. any questions for me today? >> thank you. >> i think there's a question on the end. >> yes. >> thank you for your update. did you say with the letters of agreement that the health plans have agreed to the letters of agreement? >> yes. >> with all the patients? >> yes. >> so there is no disruption? >> there was a brief disruption -- >> no continued disruption? >> no. and we've outreached to all patients that we cared for before that are due for their mammograms. >> did you have a question, commissioner? >> hill's physician group -- >> we're working on the contract

with them. in the meantime, we have a letter of agreement. >> there are public comment requests for this item. >> waiting for our presenters and our guests to complete their presentations for us. >> we will then proceed with the public testimony. dr. diedel, dr. barnes, michael lions, and lydia montono. each has 3 minutes, please. >> good afternoon. i'm karen diedel, primary care physician at 899 valencia. i speak spanish. i would not say that the transition from the st. luke's diabetes center -- >> could you speak a little louder into -- or maybe raise the micro phone up, so everybody can hear you in the room? thank you. >> good afternoon. i'm karen diedel.

i'm a primary care physician at 899 valencia. i speak spanish. i do not think the transition in the st. luke's diabetes center has gone well. previously the st. luke wes diabetes had 3.6 full-time positions between nurses and nutritionists. now there's a 1.4 f.t.e. there. that's more than a 50% reduction. before there was .1 f.t.e. medical social worker. that bit of time now is at the cal campus. i knew nothing about any transportation for patients to get to cal campus the diabetic r.n. mainly sees

pregnant patients. all other diabetic patients, nonpregnant patients, to see a diabetic r.n. have to go all the way to the cal campus in the richmond, which is way too far and it simply does not happen. previously, the -- there was a diabetic r.n., spanish speaking, who could see patients on the in-patient side, and then help them to transition to the outpatient side, right there at st. luke's. she only has one day a week way over at the cal campus for the outpatient teaching. she's out sick currently and there's no coverage for her and that's the only spanish-speaking r.n. she was a critical bridge for patients because you can imagine if they saw her in the hospital, they were much more likely to see her on the outpatient side

right there at st. luke's. if they have to go to the c cal campus in the richmond, it doesn't happen. many of my patients are older, don't speak english. they depend on family members that may be working two jobs to get them to the californ campus it doesn't happen. i feel like the diabetics south of market have been abandoned, particularly the ones that are most vulnerable, the ones with the most difficult time getting transportation all the way to the cal campus in the richmond. they simply don't go. and so i have many diabetics right now who are out of control, being hospitalized. i would ask the question -- >> time. >> you can complete your sentence. >> i would ask the question -- is this to fill st. luke's hospital with sick diabetics so

van ness hospital can be filled? >> thank you. next, please. >> my name is kevin barnes and i work with the san francisco annes for housing and justice. i feel frustrated coming to you again about the diabetes center at st. luke's. it leaves a very bad taste in my mouth. sutter says the number of hours of diabetic education at st. luke's is the same as before, but that's not true. as dr. diedel said, in the past, there were 3.6 f.t.e.s and now

there are 1.4. you heard several months ago from cpmc that they were hiring more educators at st. luke's and now the number is down again. this is deceitful, disappointing and unprofessional and it hurts the care of patients at the st. luke's center. at valencia, there's an r.n. educator three days a week, doesn't speak spanish, and mainly sees pregnant diabetics. they use the phone service. they have interpreters sometimes. yes, it means the class standards, but it isn't the most beneficial way to deliver care, particularly to mono lingual patients and those who are less educated. in fairness, this coming january, there is supposed to be another diabetic educator, a nutritionist, not an r.n. at valencia. it's not clear how much time he or she will have. we're told that he or she knows

basic spanish. it's not enough to meet sutter's policy of being certified to conduct appointments in a language other than english. in room 802 where the new center is located, there are no diabetic education classes. when it was located in the second floor of the hospital, there were classes. the only possible space for classes is the waiting room at 802 and it's impossible. the sweet success diabetes center for pregnant women were maternal fetal is located is modern and spacious compared to the 802 room. sweet success is not lost on me. juxtapose that with 802 in the top floor.

patients at the st. luke's diabetes center are seen as second class and forcing them to go to the california campus for their care emphasizes that attitude. because the dietician and r.n. are not paid for phone calls with patients, they're not using this method of follow-up. patients miss appointments and educators have a hard time calling to reschedule. because they're not reimbursed much for visits, it appears that -- >> time. >> directing of visits to a shorter time and the visits are too short. education takes time and more so with mono lingual patients. one last thing, my wife and i are moving to miami in one week, where we'll be closer to our daughter and three

grandchildren, as well as our other grandchildren in nashville, chicago and upstate new york. i want to thank you for your kind attention over the years and to tell you how much i've appreciated your hard work. if you know of any healthcare issues in miami that need to be kept honest, please let me know. thank you, again. >> thank you, dr. barnes. and i envy you moving. thank you. >> i really can't add anything more to what the two doctors have said. it's obvious there's huge, huge cultural competency issues involved in this transfer and particularly the issues of the

diabetes care at st. luke's points it out in glaring detail. most of the programs were developed very locally to meet local needs and to transfer them over to the -- to transfer the management over to the california -- the northern california-wide sutter program would completely eliminate all the work that had gone into develop these local programs. and in addition, prop q's powers have no enforcement. at least they have oversight and for that -- to allow clinical programs to be removed from your oversight would allow them to get away with more of what you've been hearing about up to

now. >> thank you. >> hi. i am with senior disability action coalition. right now my heart is pounding really hard. as a person that had her family impacted by diabetes. all i see in this program is very classist and racist move from a hospital. i say it this way because it's not something that you don't know about what the gentrification has done to the

mission. and so now these people, latinos are at high risk for diabetes and many of us have diabetes. so how can you remove a program that is helping the community? and not put in place something else? and expecting the people already affected by a chronic problem to travel across the city. we know that now because of uber and lyft and because of many, many other issues in the city, commuting time is so hard. you think that older adults will be having the time to do that? i don't think so.

so, please, think about your decisions and think about who will be affected. thank you. >> thank you. that ends the public testimony, as i have before me. we'll then proceed to commissioners' questions and discussion. commissioners, you will note the revised resolution, which is immediately under and it's 18-5, the prior revision. are there questions from the commission or would the commission like to place the resolution before us for discussion? >> i'm sorry, this actually pertains to what we're discussing today, again, it's

still hard to conceptualize that st. luke's is no longer the st. luke's three and four generations of san franciscans knew. and i know we have the new mission campus. we had an opportunity to visit it. to see the new facilities, etc., etc. but the quality and spirit of st. luke's remains there, folks. the astounding part to me is, within three blocks, you have the hub of what's left of the latino community in the mission district. and it represents the industry part. but on mission street between 24th and st. luke's, there is program for spanish-speaking elderly, mission cultural center, which was an old

warehouse, and now it provides all sorts of cultural program for children all over the city. it provides free nutritional. it provides educational programs. and across the street, you have our mental health services, which used to be a funeral parlor. for the last 20 years, it's been providing mental health services for spanish-speaking families. but folks in the mission had the great pride of, which is st. luke's. if you wanted someone to find out about what programs are available in the mission, you knew somebody at st. luke's. it's still that way. one of my sons was born at st. luke's. you say, wait, what's going on here? to me, instead of making it part of the new facility, st. luke's

lamp is going smaller and smaller and smaller. i mean, you put -- we have -- your foundation is on valencia street, 20th almost. nice place. you always see people stop in there. people stop to read, to pick up coffee. couldn't you have diabetes classes there in spanish? i don't know. i've never been in there. isn't there some way creatively we can think about providing these f.t.e.s and have -- a lot of the foundations in the mission would even help out, i'm sure. everybody is going through the changes, but there's still -- what i'm saying is, the spirit of st. luke's, the light -- it's like the general. the general has been there for years and years and years. one other comment. dr. ken barnes, i knew him when he was a resident and i was

faculty at san francisco general and ken was a resident and he wanted to go to st. luke's and set up a collaboration to provide comprehensive services for minorities and spanish-speaking communities and he went there and he provided the leadership and the collaboration to focus on the unique needs. this is the first time -- pardon me, dr. barnes, i've heard you are leaving, going with your family and god bless you. but this is somebody who really lit the candle to make sure that the programs would expand and the quality would be there. right after that, it was a young pediatrician, richard sanchez, who sat on this commission, one of the first ones, at st. luke's and they provided multiple

programs. don't lose that. don't wipe that -- i mean, in front of st. luke's is still the plot of the library, oldest in california. now it's over at berkeley and has all of these things going on. but st. luke's is still there, and people in four and five generations -- we don't want to go back to all the hearings we've heard. we've seen families come from all over the bay area, saying they would be driving night and day to take care of the elderly there or young brother or sister being treated with dignity and respect and quality of care because of st. luke's. when you had the nursing school, st. luke's was tops. think of it creatively. diabetes is one of our major illnesses in the latino population and others.

let's address this. even with the kids. we could be doing it from the schools, right down from you, another two blocks, early childhood education program. named after the first puerto rican woman administrator because of her commitment to women, refugees and health of kids. she died of diabetes. what i'm saying is -- and the school was named after her afterwards. everybody says, we need more education. where? you folks are right down the street. the kids could walk there. let's think of -- we're not saying, you know, the ship's dead. we're saying, let's revisit and think about, you know, the unique families and immigrants we have coming to our unique city and let's provide them with

the highest level of care. hill's is a good start. they have a number of spanish-speaking physicians. all these things could be combined and could really provide -- you could be the flagship of what could be divided in communities like the commission district, campus of san francisco. but st. luke's will still be there. i encourage you to think creatively and think about what that hospital meant and continues to meet to many of our families, immigrant families, who come from san francisco and those who have been here for four, five, six generations. it makes a big difference. >> thank you. commissioners, perhaps we can get a clarification from the foundation because under the report that we are being given here, it says that the st.

luke's diabetes center will resume to the same level as under cpmc management. do you want to elaborate on that? >> good afternoon. st. luke's campus diabetes program, we took over august 5. and we provide the same level of services. we -- there were some comments made about staffing. we have tried to pair the staffing and we're hiring full-time additional educator that speaks spanish as well to join in january. so we'll be adding more staff to the diabetic program. and we're offering more -- we'll have more opportunities to do some cross training when the cal diabetes program transitions. so we'll have a broader team to

support the populations. >> okay. >> do you have any solutions -- >> i want to say thank you for your idea about having classes at the center. i think that's a great idea. if there's opportunity there, that's great. certainly we're always looking for places to have classes and to have outreach. and i would just say that my father died very young of diabetes, 59. and i did not grow up with a silver spoon in my mouth. i started military, worked as an l.b.n. and then r.n. and worked and went to college. so i understand that it takes a lot to get ahead and move forward. so i do resonate with the concerns. >> thank you. commissioner loyce? >> i have a couple of questions.

one is, if the statement by dr. leidel is accurate that went from staff of 3.6 f.t.e. to 1.4 and now you are suggesting you will hire another one, the numbers don't match-up for me. can you help me understand the numbers? and the other thing that you have indicated is that there is transportation available. how is it made no en-- known to the patients? >> thank you. there are 1.6 f.t.e. that are currently at the mission campus supporting the diabetic program. we cooperate and collaborate with the cpmc cal diabetes program and try to do some cross-coverage with staff until we can get the whole team together integrated under the

foundation model. we're adding 1.0 additional f.t.e., so it will be 2.6 f.t.e., january 7, with the addition of another educator coming from the cal campus. >> so there was not 3.6, as indicated? >> no. there's the two individuals that are supporting the outpatient, primarily based at mission and have remained there. and we have hired them at spmf. i'm not sure where the 3.6 is coming from. >> and the other, transportation that's made available? >> we have over the course -- since taking over, we had a few patients that could not -- that were nonpregnant diabetic patients and we offered them

lyft rides to get there for the services. >> is that universally known to the population? is it specializes between a provider and the patient only and not broadcast? >> it's not broadcast. we've done it over the last 2 1/2 months. >> thank you. >> any other questions? if not, i think you will have ms. patil explain the revise resolution. >> so the revised resolution 18-5 that you have before you, the title reads, "determining the impact of the change in management of five outpatient departments from california pacific medical center to sutter pacific medical foundation." the other edits are on -- begin on the 3rd pagef