we have conditions ranging from layers of asphalt to historic subbase structures for monuments dating back to 1888, so i'm here today to recommend -- i should say this is supported by the tennis coalition of san francisco, as well, so staff recommends amending the construction contract for the demolition and abatement to increase the contract amount by $339,000. and i'll just repeat the agenda wording, bringing the total not-to-exceed amount to $1,017,000, which is greater than 10% of the original budget. thank you. >> thank you. >> clerk: is there any public comment on this item? okay. being none, public comment is closed. >> commissioners? >> move to approve. >> second.

>> move to approve and seconded. all those in favor? okay. thank you. >> we are now on item 10. richmond playground -- >> i'm here for discussion and possible action to authorize the recreation and park department to enter into related agreements with the san francisco parks alliance under the let's play s.f. initiative for the renovation of stern grove playground and richmond playground. as we move through the initiative -- and i'll give you the presentation, but i wanted to pause and say that these are the last two related agreements of the initiative, so it's a really nice milestone to hit. so just for some quick background, as you know, let's play s.f. is a public private partnership initiated to renovate san francisco's 13

most deserving playgrounds. on november 13, 2016, the commission approved an agreement between the department and the parks alliance to accept up to $15 million for let's play s.f. and recommended that the board of supervisors approved the grant, and the board of supervisors gave that approval on february 1. also, on december 15, the commission approved an m.o.u. that defined the general working relationship between the department and the parks alliance, and that agreement called for the alliance to partner on each park that would receive funding under the agreement. both projects are tier two projects, which means that they will be largely privately

funded. the agreements are nearly identical and map out roles and responsibilities between the partners and identify city terms for design services commissioned on public land. completely coincidentally, the estimated budgets for both sites is $3,050,000. and i did also want to note that the landscape architects were selected by the parks alliance with support from the department after a thorough r.f.p. process, and the two landscape architects are m.i.g., who designed children's center -- children's corridor in golden gate park and is

now -- the firm is now working on hertz playground, and they'll design richmond playground, and jeff miller who's designed such playgrounds as lafayette playground will design stern grove. and i'm happy to answer some questions. i see we have some constituents in the audience. >> a row of ducks came in. >> does he want to speak? >> must have been something you said, lisa, go ahead. >> no, i'm finished. happy to answer any questions. >> thank you. >> clerk: is there any member of the public that would like to make comment on this item? oh, richard. >> he's stretching. it must be a long comment. >> i am. i was just looking at the occupational agreement and what comes up. you have it in the folder. i noticed one of them that --

we talked about it at committee, and there was the conflict of interest and now that might be bounced bang. if you do the consultation and the work, you can't do the bid. so i just hear that listed on that particular time is in contract. so of the bidders for different project, they also have the subcontractors. so of the issue, what happens--i'm trying to formulate a question -- a rhetorical question. what happens when the subcontractors are in a

conflict of interest? that's a very minor question because i'm already looking as they already have the question and been picked up by park alliance. >> thank you, richard. i think somewhere in there was a question. lisa? >> so just to clarify, these are just award of -- this allows us to enter into agreement with the parks alliance so the parks alliance can enter into contract with landscape architects, so it doesn't have anything to do with construction at this point. >> got it. >> and that the playgrounds will go through the full standard process, so this just allows us to start the participanto participatory process. >> and parks department enters into the contract with the

architect. >> correct. it conveys to the parks alliance what the city requirements are from the landscape architect so the parks alliance can make sure the architect meets the requirements of the city. >> thank you. commissioner mcdonald? >> just a quick question. it just seemed odd that both plans have the exact same budget and the exact same funding. >> to me, too. at this point, they're just estimates. they'll -- once the concept plan is more fully formed, there'll be a more detailed estimate, as well. but it is based on a professional cost estimate provided to the department.

>> thank you. that doesn't quite reconcile it to me, but okay. >> it has to do with cost and existing site conditions and topography. >> why don't we write the contracts ourselves? >> because these are private landscape architects. so the parks alliance is privately funding the hiring of private landscape architects. >> so they're contracting with architects. >> landscape architects, that's right. >> and ultimately, we will contract with the people doing the work. >> exactly. we'll -- the department,

through the full standard construction process, will contract with construction contractors, that's right. >> so we normally do not contract with landscape architects? >> no, we normally do not. >> we have our own? >> that's right. >> and in this case, why are we not doing that? >> why are we not using our own? >> yes. >> so for let's play s.f., it's been a mix from the public works department and privately hired landscape architects, and that's always been the intent of this project because there are private funds available to vary how the contracts were awarded. >> but that was part of the let's play initiative? >> right. >> okay. thank you. seeing no other questions, i would entertain a mometion. >> so moved. >> second. >> it's been moved and

seconded. all in favor? >> clerk: we are now on-si it 11. >> the item before you today is discussion and possible action to award a contract to miller company landscape architects in the amount of $152,920 for the buena vista park needs assessment and cost analysis project. this project honors the department's strategic focus in the project.

the san francisco recreation and park department is undertaking a study to assess the needs and associated costs of improvements to buena vista park. the scope of services includes cost estimation, concept planning, forest management planning, and community engagement. buena vista park is a densely forested urban park in the northern central section of san francisco. the park wide needs assessment and cost analysis project seeks to build upon an existing 2015 project. the project will incorporate the capital improvement plan, community needs and maintenance needs while considering the circulation and hardscape, emotion control and water management issues and forest management. key stakeholder in this project is the buena vista park

neighborhood association, bvna. they have provided a grant to assist the department with undertaking this work. the two organizations will be working in partnership on this project, and the consultant will be required to meet jointly with the department and bvna members as a focused working group. regarding the selection process, a request for proposals was advertised on march 15 of 2019, and the department received proposals from five consultant teams. a selection committee approved by the contract monitoring division was composed of two department staff and two members of bvna. a review of the proposals by the selection committee yielded a short list of three consultant teams which were advanced to interviews on may

2, 2019. following these interviews, miller companies landscape architects received the highest score as determined by the selection committee and approved by the contract monitoring division. the project will receive -- or will feature multiple opportunities for opportunity input and engagement. there will be three community meetings cohosted by the department and bvna to discuss the needs assessment and to provide feedback through the iterative process. community park walk, led by the consultant team, is also planned to provide field observation and discussion of existing park features. the project was also presented to the haight-ashbury neighborhood council on thursday, july 11, 2019, to encourage additional attendance at the upcoming community meetings. the project is fully funded, and the funding sources are as follows. a grant from the buena vista park neighborhood association in the amount of $50,000.

a budgetary add back from district 8 in the amount of 50,000, and recreation and park bond funding in the amount of $162,560. it's expected that construction will commence in august 2019, and be complete in 2020. a letter of support from the buena vista park neighborhood association is attached to the staff report, and one item that i'd like to clarify for the record is the d-8 support that we received actually referred to the previous supervisor. we have not received notice yet from the current d-8 supervisor. i apologize for that error. staff recommends that the commission award a contract to miller company landscape architects in the amount of

$152,920 for the buena vista park needs assessment and cost analysis project. i'd be happy to answer any questions. >> thank you. >> clerk: is there any public comment on this item? seeing none, public comment is closed. >> commissioner low? >> once the report's prepared, what's the strategy -- what do we do with the report once the needs assessment is completed? >> the need is to identify the areas of the park that are in greatest need of improvement and investment. it's to assist with future planning for construction projects that may occur in the park. >> so the needs assessment is required first before future planning can be conducted? >> it provides detailed scoping and cost estimation to understand the funding that would be required for improvements and could assist

with determining future projects. >> thank you. >> commissioner anderson? >> um, can you tell me if a needs assessment and cost analysis is done because we think there's a good chance that we will go on and take action based on the report? >> yes, that's the intent, is that the needs assessment and cost analysis will determine where investment is -- should be prioritized. knowing that that park is in need of substantial amount of work, and there is significant community interest in making those investments in the future. >> do you know what the possible timeline would be before such a project might begin? >> no, i don't know the timeline.

>> okay. thanks. >> commissioner mcdonald. >> thank you. i guess picking up on commissioner anderson's question, i'll presume that not knowing a timeline is because you don't know the scale and scope and what will be required. are there resources already identified at some level that post assessment you'll have some identified sources? >> post assessment, i'm not aware of any identified sources? >> so basically, we have two strategies for making investments in parks and tackling deferred maintenance. one is through our park program, which is a mix of bonds and grants and phil philanthropy. what we will use this for is we

make significant investments every year through the general funding that we receive as a result of proposition b, so we have -- work there is ongoing, but it is a very significant park both in terms of its size, its topography, and its history. it's something we need to continue to pay attention to and think about how we're going to make even more significant investments there. so the analysis is a guide that we will use to use our ongoing maintenance investments. there's going to be a big figure number of work that's going to be done at buena

vista, and we're going to have to figure out over time how to get there. >> thank you. one more question, different point. i just want to make sure i understood your clarification around district 8 support. so we don't know one way or another whether supervisor mandelman supports it or not. >> we requested a position, and we have not received a response. >> thank you. >> thank you. the chair would request a motion and second. >> so moved. >> second. >> all in favor? so moved. thank you. >> clerk: we are now on item 12, general public comment continued. if there is anyone here that would like to make general public comment that did not on item 4, please come forward now. okay. being none, this item is closed. we are now on item 13, closed session. is there anyone who would like to make public comment on closed session?

being none, public comment is closed. commissioners, we need a motion and a vote on whether to go into closed yeah. >> okay. we are coming back into open session. commissioners, item e is a possible report on actions taken in closed session. you would need a motion on whether to disclose the action, and then, if you do want to disclose it, and then, item f, two separate motions, is to vote on whether to disclose any or all discussions held in closed session. so for item e? >> i would move that we do disclose the action taken. >> second. >> moved and seconded. all those in favor? >> clerk: and commissioner

buell, will you please comment on the action taken. >> the action taken is to retain the director of the commission, ashley summers. >> clerk: and then, item 13 is a vote to disclose any or all discussion held in closed session. i need a motion and a second. >> i would move that we not disclose any of the conversation taken. >> seconded. >> moved and seconded. all those in favor? so moved. >> clerk: okay. we are now under item 14, which are commissioner's matters. are there any commissioner's matters? >> i just wanted to clarify, it's all right, i wanted to clarify discussing jackson park? >> we had discussed that in a bond presentation for you. jackson is one of many parks

and many park communities that are interested in investment, so i think we can provide a general overview for you. >> and that will be next meeting? >> i think we had it slated for september. >> september? okay. thank you. >> i don't see any other comments. >> clerk: is there any public comment on this item? seeing none, public comment is closed. item 15 is new business agenda setting. commissioners, public comment? no public comment. this item is closed. communications, is there any public comment? seeing none, this item is closed, and item 17 is -- oh, i'm sorry. >> no, i'm moving slow, so it wasn't you at all. >> i'll talk to him offline. >> clerk: are you sure? >> yes. go. >> clerk: and item 17 is adjournment, and commissioner buell, you requested that we

adjourn in memory of dan carlin. >> yes, and i would like that motion and second. >> so moved. >> second. >> move that we adjourn in memory of dan carlin. all those in favor? so moved. okay.

>> 7 and a half million renovation is part of the clean and safe neighbor's park fund which was on the ballot four years ago and look at how that public investment has transformed our neighborhood. >> the playground is unique in that it serves a number of age groups, unlike many of the other properties, it serves small children with the children's play grounds and clubhouses that has basketball courts, it has an outdoor soccer field and so there were a lot of people that came to the table that had their wish list and we did our best to make sure that we kind of divided up spaces and made sure that we kept the old features of the playground but we were able to enhance all of those features.

>> the playground and the soccer field and the tennis fields and it is such a key part of this neighborhood. >> we want kids to be here. we want families to be here and we want people to have athletic opportunities. >> we are given a real responsibility to insure that the public's money is used appropriately and that something really special comes of these projects. we generally have about an opportunity every 50 years to redo these spaces. and it is really, really rewarding to see children and families benefit, you know, from the change of culture, at

each one of these properties >> and as a result of, what you see behind us, more kids are playing on our soccer fields than ever before. we have more girls playing sports than we have ever had before. [ applause ] fp >> and we are sending a strong message that san francisco families are welcome and we want you to stay. >> this park is open.

>> here we are responsible to oversee the drinking water distribution system. in san francisco changes in the fire code required anyone doing representtro fit to the home to get a new fire service this caused the need for new water services to spike. we used to do 200 a year. now we are up to 600. >> if you are building a new house you need fire protection. you have to make application to the water department for that. if you go through the process we come out and install the new line and the new fire line. >> the project got kicked off by two of our a gms, steve and eric. they recognized the need for improving this process. they pulled together the project

and selected the team members and asked me to lead the effort. >> on c cd there is permit and no parking signs and installing the service, having water caught at the check off and pave. >> it is a lengthy application process with manual tracking. for construction because we communicate with ccd we have to stay in touch with ccd to inform the customer for updates. >> at one time there was three separate visits to activate the fire service. water quality and gate manment and then gate man would go back. now the gate man goes one-time, one visit and it is done. >> we dissected the process and looked for ways to streamline the process and use technology to make the experience smoother

and what we are building is an online portal for customers to apply without coming downtown and they can get updates. >> with the online application everything is there. it is built in condition logic with tracking to communicate with the customer without having to take notes. >> we want to tell you these are 10 steps and you are on step three or four. >> we streamlined the process. we knocked it down to 65 days. the goal is half of that. from the time you make application to put the check on the table to the time we pave the street, we want it down to 30-days. >> i am proud of the team for the work to get together to understand each other's work and come up with solutions. i really wanted the rest of the team to understand the time and

deliberation and thought so they could get the recognition that they deserve. >> i call the health commission meeting to order. >> a commissioner chow. >> present. >> a commissioner green. >> a present. >> the second item on the agenda is approval of the june 18, 2019 minutes. commissioner, the minutes are in your hand. if you have any corrections, edits, or additions, please say so now. >> move to approve. >> we have a motion. do we have a second? >> a second. >> an all those in favor signify by saying aye.

>> thank you, commissioners. there is no public comment request for that item. and if anyone does have public comment request, i am the person to see. hand me the forms. item 3 is the director's report. >> good afternoon, commissioners. grant colfax, director of health. you have your director's report in front of you. i wanted to highlight a few issue, and i think the major issue that i wanted to highlight today was, as you know, we have had major patient care incidents at laguna honda hospital, and june 18 i was joined by my yor breed and the president of the board of supervisors yee to report directly to the public and to the community about patient abuses -- about patient abuse issues involving 23 laguna honda residents. this misconduct does not represent who we are as the health department and as the san francisco health network, and it will not be tolerated. laguna honda has had a positive

effect on the live of generation of san franciscans and continues to be a good place for our residents. d.p.h. leadership has taken immediate steps to correct problems including notification of all patients and family and caregivers, wellness checks for all laguna honda residents, all staff training on preventing and reporting patient abuse, and improvements in drug dispensing and monitoring policies, separation of six staff members involved and changes in hospital leadership. the c.e.o. of the hospital, the prior c.e.o. of the hospital has resigned. we immediately notified the california department of public health and san francisco police department, and each agency is investigating. acting c.e.o. maggie rakowsky is in place to lead the way forward, and they present a turn around plan to the commission, mayor, and the board of supervisors by september 1. and president loyce, i know you

wanted to add to the comments, so i will defer to you. we are deeply saddened by what has occurred and this misconddo not represent who we are as a health care system. we contact all the appropriate places as soon as we learned what happened. d.p.h. leadership has taken immediate steps to correct the problem, and i am confident that with the terrible circumstance comes the opportunity to make meaningful changes and will ensure the safety of patients at laguna honda hospital and the provision of quality care going forward. there are many wonderful staff and workers at laguna honda. it is an invaluable institution that has had positive effect on the lives of generation of san franciscans. laguna honda continues to be a good place for our residents, and we are taking steps to ensure that and then build upon its strong foundation. >> thank you.

i also wanted to highlight some other departmental wide issues. one is announcing our new chief information officer eric raffin. i think he's here. eric joined the health department on july 8, and he comes from d.p.h. most recently from san mateo health where he was c.i.o. as six years. eric has many accomplishments including creating a health information technology governance program, establishing a program in project management office and implementing a health information exchange. so he is the right person at the right place at the right time for the health department. prior to working in local government, eric spent nearly 17 years with the department of veterans affairs and several executive leadership roles including overseeing major transformations in health care and health care technology for a broad and vast v.a. system. so we're really excited to have

eric on board. i think you will see during his tenure, his vision moving forward. we are just thrilled to have him. please welcome eric. >> welcome. >> u i am also really pleased to announce that the san francisco health network has signed the first commercial contract, and this is with canopy health. the contract was sign july 1 and will allow ucf to access obstetrics services at family health center at san francisco general hospital t only 24/7 midwife program in san francisco. and starting july 15, ucf canopy patients receiving care at mount zion mission bay and interested in the midwife assisted delivery will be given the option to select this as their birthing hospital and place to receive outpatient obstetric care related to the delivery. this was a lot of work on behalf of the contracts and hospital

team, i want to acknowledge that work and greg wagner and his team in particular in terms of putting forward this first commercial contract. so very exciting three years in the making. in terms of epic, we are only a few short weeks away from what will be one of the most pivotal moments in the history of the health department, the implementation of the epic electronic health record, and we will see how it goes on august 3. i will say the team is working very hard. all hands on deck in terms of being ready at all levels. and we are confident -- i am confident that we are as prepared as we possibly can be to make august 3 launches a success and then also to emphasize to the commission and to the rest of the department, this is not just a one day, everything turns on and then we're done. this is a major cultural work flow change and information exchange going forward. so the team and the culture of the department is ready for

that. i rook forward on how that is going the next time we meet. i have some exciting news with regard to surpassing our true north goal for hypertension equity for black, african-american patients. equity continuing to be a major goal of the department, you'll recall, and we did exceed our true north equity goal for the 2018-2019 fiscal year in the metric focussing on percentage of black african-american patients with hypertension whose last blood pressure was controlled in the past year. so from january of 2015 to june 2019, hypertension and blood pressure control for black african-american patients has improved from 53% to 67% and the disparity gap between theover all population to black african-american -- the disparity gap between the overall population compares to black-african-american population is decreased from 3% to 8%. this is a significant step in reducing health disparities in

our city, and again, proof of concept that it can be done, although we have still quite a ways to go. and finally, i just want to acknowledge the health department marching during sf pride. we had quite a contingent joined by the president of the health commission. commissioner loyce, thank you. we marched together at the sf pride parade and had one of the largest contingents ever with almost 150 people in our group. patients from positive health care -- from positive health program also participated in the parade as they do each year. and obviously we never miss an opportunity to educate the public on public health, and we passed out condoms and materials supporting access to pre-exposure prophalaxys to prevent h.i.v. infection and lots of different people including the health department and the public health foundation. within the departments, the public health foundation, bridge h.i.v., and community equity,

and promotion and laguna honda hospital, and vsfg. and a really exciting time that i was really pleased to see the public's reaction to the health department and the value they have for the department that was an inspiring event. it shows we remain deeply committed in the values of san francisco and in the work that we do. so very exciting afternoon for marching and promoting health equity in san francisco. thank you, commissioners. >> thank you, dr. colfax. we will go to public comment and come back to answer other questions. >> we have dr. derrick carr. >> good afternoon, commissioners and director colfax. i'm dr. derrick kerr. there are several intriguing features about the recent removal of laguna honda's c.e.o. and quality director. the 23 patients reportedly abused at laguna honda were

under the direct care of nurses, yet the chief nursing officer was not held accountable. instead, the quality director, a person who does not govern clinical practice and to whom nurses do not report, was removed. what was the rationale? now, troy williams t quality director for san francisco general hospital, is taking over laguna honda's quality management, yet on his watch, general hospital has been cited by state inspectors for its impermissible policy on reporting patient abuse. in fact, general hospital was threatened with a fine and the loss of payments in part for this policy that allowed

underreporting of patient abuses since 2016. lastly, the d.p.h. compliance officer was appointed acting c.e.o. of laguna honda. if she maintains this dual role as the compliance overseer and laguna honda c.e.o., it could create a conflict of interest. suppose somebody reports a violation involving laguna honda. would ms. rakowsky be defending against it as well as as the laguna honda c.e.o.? in short, the compliance office should be independent from hospital administration. thank you. >> thank you, dr. kerr.

next speaker. colon gomez. >> good afternoon, commissioners. >> speak into the microphone please. >> good afternoon, commissioners and dr. colfax. i am also referring to the events at laguna honda hospital that was reported to the press on june 28. i will say my concerns in brief. 23 residents were subjected to privacy violations over a period of three years, and yet today the director of privacy is in charge of laguna honda? and there is no mention that the privacy at laguna honda and direct subordinate of this director is being held accountable for the privacy violations. secondly a quick check with state shows at least 27 reports were made by the quality department for alleged abuses over a period of two years.

15 of which amounted to deficiencies. such reporting was the responsibility of the quality director and i was never concerned that there was a wall of silence here. however, this quality director has been removed and replaced by the quality director of zuckerberg. another quick check with the head shows that zuckerberg has one deficiency in the same category as laguna honda. that deficiency is for failure to report allegations of abuse. this is the same quality director that had two negligent deaths in two consecutive months while in charge. they have a 30-bed nursing skilled care facility that did not pass the annual recertification survey not once but twice. this director is now in charge of laguna honda with 769 beds. on june 28, dr. colfax stated

that the misconduct of six employees happened in just two neighborhoods at laguna honda. such misconduct is not effort throughout the facility, yet there is no mention or everyday that any of the supervisors, manager, or the department head of these two neighborhoods were held accountable for the six employees and their actions. and yet the c.e.o. and quality director have been removed. if the removal of the c.e.o. and quality director consolidation services and i am concerned with the choices being made. and i wonder what may have breed so profoundly hurtful, offensive, and heart breaking will be equally as concerning for the decisions being made. in closing, i would like to submit to the commissioners cop piste of the notice of the two negligences and the notify of

diefficiencies for failing to report abuse and the deficiencies at both properties and a brief summary of my statement. thank you very much. >> thank you, mr. gomez. >> is there further public comment? hearing none, the director's report is now with the commission for comments or questions. dr. chow? >> i want to go back to the first item of the report that you actually did not verbalize, and this is in regards to the governor's budget. how does the governor's budget affect our budget at this point? >> so thank you, dr. chow. so at this point we have not

been in detailed discussions with the state given this change in terms of the budget. but we're having ongoing conversations and this is basically just recently passed so how it gets implemented will be a little bit unclear to us. but i think particularly around the medical expansion that we would anticipate just as we saw with implementation of the broader a.c.a. that coverage for people who currently are either without coverage or in healthy san francisco would transfer over to this coverage program in particular. and we are working on the details and conversation with the state about that. >> i understand since it's a recent passage, and it would seem to me it would be appropriate to have that reported to the finance committee just to bring us up to date. >> we can certainly do that. yes, absolutely. >> thank you very much. >> commissioners?

>> and i guess one other comment. and i thank president loyce for the comments made on laguna honda. i do think as a member of the commission that i fully support the actions on the part of the leadership, the president, and the director himself for our actions as we must make the corrective actions needed. and i'm hoping that the public will be tolerant of some time in order for us to be able to make these changes. >> president: thank you, commissioner chow. no further comments or questions from the commission, next item please. >> item four is general public comment. i have not received any requests for this item. just double checking. okay. so we can move on to i a tem five, which is report back from today's community and public

health committee meeting. >> yes. thank you. community and public health meeting that met immediately before this meeting today. during the meeting we had two presentations. the first from jen from the environmental health branch regarding the tobacco and smoking program including a retail tobacco rules and regulations. the rules that govern the tobacco permitting process here in san francisco and also presentation about the density of tobacco permits broken down by supervisory district and the tools that are available to retailer who is either hold or are seeking permits. we also learned about the flavored tobacco ban roll out in some of the success that the department has had in both education and outreach compliance and inspections and enforcement. and in that roll out. and seems to have been very successful and then a brief update on the e-cigarette ban. we also received an update from dr. jonathan fukes from the center for learning and innovation about developing our

people locally and nationally. the focus of the presentation was on internal workforce development where our priority training areas are including racial humility issues, project management, and sexual orientation and gender identity guidelines. in addition, we had a presentation about some of the external capacity building assistance being offer bid the department through a grant from the c.d.c. and some of the success that has come about from their consulting, for example, in florida with very high increases in the uptake of prep, in the time that the department had been consulting with florida department of public health through the c.d.c. grant. we also had a presentation about the summer h.i.v.-aids research program in which the department provides mentorship opportunities for undergraduates students in h.i.v.-aids research. and there is a great class in place right now and i believe

there were 90 applications for six slots that were available. and we will be having their final presentations on, i believe, august 9. and we will have some of the commissioners participating then. >> thank you, commissioner. commissioners, questions, comments? shall we move on? >> all right. i will note there is no public comment requests for that item. item six is a discussion item, prop q hearing for the closure of st. mary's cardiovascular program, and i will note that item 7 is another prop q hearing for the closure of st. mary's spine center. the two will be presented separately, but they are related. and i will note to the public that this item will be voted on at the august 6 meeting, not today. and i would add to that that the commission will not be making any responses to public comment today. >> just a reminder to the commission that i have conflicts on both of these, so i will excuse myself and dr. baba will

sit in as acting director. >> all right. hello and good afternoon. i'm claire lindsey, a senior health planner in the office of policy and planning with the health department. i am here for the first of two proposition q hearings on two closures at st. mary's medical center. on april 29, 2019, st. mary's notified the health department of the two closures. the first being the closure of the cardiovascular surgery program. and the second being the closure of the spine center which is a licensed hospital outpatient clinic. so you all received a memo with more detailed information on the closures and today i am just going to be providing a brief summary of the information that was given to me by st. mary's. i will begin with an overview of

proposition q and the first agenda item is the closure of the cardiovascular program. i want to note that dr. david cline, president of st. mary's medical center and saint francis memorial hospital is here along with the vice president of philanthropy and external relations and a former health commission member. they are both here to speak on behalf of st. mary's if you have any questions. so in november of 1988, the city of san francisco passed proposition q which requires private hospitals in san francisco to provide public notice to the health commission prior to closing a hospital inpatient or outpatient facility, eliminating or reducing any level of services provided, or prior to the leasing, selling, or transfer of management. so the proposition q hearings allow the health commission to make a determination about whether any of the reported changes will or will not have a detrimental impact on the

community of san francisco. in recent years the health commission has reviewed five proposition q closures. so st. mary's notified the health commission on april 29 of these two anticipated changes that are going to be taking place by july 31. and first, st. mary's will be closing the cardiovascular surgery program and second closing the spine center which, like i said s a licensed hospital outpatient clinic that is co-operated by the sf spine group which is a single physician group. today is the first proposition q hearing on these closures and the second one is scheduled for august 6. today i will begin with the closure of the cardiovascular surgery program. st. mary's medical center currently offers a full service cardiac care at the campus and that includes a fully digital card catheterization lab and a

designated steme center which designates a hospital specially equipped to treat significant heart attacks caused by a major coronary artery blockage. with the closure, cardiovascular surgery is the only aspect of cardiac care that will no longer be offered. the other services listed on the side, they will continue to be provided. so the chart to the right of the slide shows the annual cardiovascular surgery volume by san francisco hospitals from 2014-2017. as you can see, st. mary's has over time had the lowest surgical volume compared to other area hospitals with an average case of cardiovascular surgeries of about 30 to 35 cardiovascular surgeries. then the other san francisco area hospitals that offer this type of surgery range between 200 and 600 surgeries annually. so of the cases seen at st.

mary's medical center, about 69% are xeshl commercially insured. 29% have medicare and only 2% or med-i-cal patients. 85% of the cardiovascular surgery patients are over the age of 60, and then 47% are asian, which is proportionally much higher than the asian population for the city of san francisco, which is 35.9%. then final note, i just want to say that 81% of cardiovascular surgery patients seen at st. mary's are san francisco residents. to provide a proper assessment of the impact that this closure will have, i want to provide the background in context. this is one form of treatment used for cardiovascular disease and most specifically heart failure and coronary heart disease. cardiovascular disease is largely preventible, yet it is still the leading cause of death

for men and women in the united states and more locally, four out of the top 20 leading causes of deaths in san francisco are also cardiovascular diseases, and they account for about 25% of all san francisco resident death. cardiovascular disease in pedestrian also disproportionately impacts vulnerable populations. for example, hospitalizations and emergency room visits for cardiovascular diseases in san francisco are highest among residents in the southeast half of the city, and among those who live in households earning less than 30 # o% of the federal poverty level. the neighborhoods with the highest hospitalizations and emergency room visit rates for hypertension and chronic heart failure are in the tenderloin, the south of market, bayview-hunters point, and treasure island neighborhoods. there is a few other important considerations in assessing the impact of this closure.

one of them is the relationship between surgery volume and patient outcomes. so reporting on cardiovascular operative volume indicate that low volume can impact the proficiency of the surgical team as it reduces the number of hours that are spent refining and maintaining surgical skill with the team. studies have shown that high volume cardiovascular hospitals have low arer mortality rates and lower incidents of complications compared to lower volume hospitals like st. mary's. but that being said, after a cursory review of outcome metrics for cardiovascular surgeries in san francisco area hospitals, so things like mortality and 30-day re-admission, st. mary's outcomes are the same as other san francisco hospitals, in that they are average. secondly, because of significant technological improvements, minimally invasive surgery procedures have become more common, and more efficient

without risking the safety of patients, even the most vulnerable, but despite this trend, most hospitals in san francisco that offer cardiovascular surgery have shown to have steady surgical volume. so these surgical invasive surgical procedures are still very much needed in san francisco. then another trend that impacts cardiovascular surgery volume is there is an anticipated shortage of cardiothoracic surgeons due to a declining enrollment in cardiovascular specialties by medical t students. with the decrease in the number of providers and number of locations for receiving cardiovascular surgery, this may impact the ability of individuals to receive the needed surgical services in a timely manner. finally as i previously noted when looking at st. mary's demographic information, cardiovascular surgery is a procedure that most often effects individuals over the age of 60. and as san francisco anticipates the greatest population growth

to be within the older adult age group, there may be an increase in the present of cardiovascular surgeries and the number of cardiovascular procedures that are required of the population. st. mary's reported multiple efforts to try and bolster the cardiovascular surgery volume by working with other hospitals that offer cardiovascular surgery. but due to the failed attempts to increase the surgical volume, st. mary's does not expect the surgical volume to increase to a degree that would make a difference in their ability to operate from both a financial and clinical safety perspective. so this slide currently shows the remaining cardiovascular surgery programs in both san francisco and in the greater bay area.

so briefly mentioned, st. mary's will continue to provide cardiac care at the campus. however, there will be an average of at least 30 cardiovascular surgery patients annually who will be impacted by the closing of the cardiovascular surgery program. the the closure could have residual impacts on other patients with heart conditions who currently see cardiologists at st. mary's in the event they need a surgical procedure. the closure may limit the ability of current cardiologists to treat complex patients when surge vi no longer an option at the hospital. once the closure of the surgery program is complete, cardiologists will be referring patients to facilities listed on the prior slide because all of them are within 50 miles of st. mary's hospital. then st. mary's has also adopted a safe protocol and go to ecsf as other closer hospitals.