decided with advanced a.l.s. he wants no more. so he went to the catholic church and went to a ceremony. it was very moving. the staff at st. luke's sub-acute was incredible. it's my opinion, and i can't prove this, because ombudsman and forensic nurse investigators that had they -- had the patients not moved out of st. luke's, into davies, there would be more alive today, because of continuity of staff, the incredible linchpin of carmen, the activity person. and when they moved into davies campus, it was a minor victory, not a major victory, because the staff did not follow the patients, the activity person did not follow the patients. they were merged into some more insidious skilled nursing care called post-acute care. [ please stand by ]

>> so you layer on that scarcity onto the disappearing 17 beds. we have a crisis in san francisco. again, my office is concerned not only about the quantity of beds that are disappearing, but also the quality of that care, as well. so what happened with the davies patients from st. luke's, the quality was affected. what happened is was you have people dying when maybe they would not have died, and i can't judge that, i don't have any forensic capabilities had they remained at st. luke's. our office looks at the whole -- i don't call it an environmental scam, i call it a supply matched up with the demand, which needs

better data, not only to subacute, but for care, long-term-care long-term care s.n.f. beds, for all the people aging in the very -- various supervisorial districts. this is a citywide issue. thank you very much. >> thank you. we will go ahead and open it up to public comment. i wanted to ask if there are any additional family members of any subacute patients. i know some are here. i will ask her to come up and speak first, but anyone else that would like to speak in public comment, they can line up on the right. you can start the timer over, please. is our translator here? >> he left about ten minutes ago i am trying to attack -- track him down. >> i think supervisor ronen can,

if you are able to. >> it is my new job as translator. [speaking spanish] >> i want to say thank you. it is very hard for me to come up and share, but thank you so much for the time you are taking for us. i'm here on behalf of my father. they translated him -- they transferred him to davies. my father is not the same. he smiled with us, and right now

he is always lying on the bed, doesn't open his eyes, they are not open like before. we can see he is not the same. they only have a new nurse. they don't have any relationship with my father. my father is fighting with them because he doesn't want anybody touching because they don't recognize him. i don't know nobody over there because they never show up. only the nurse. anything happens to my father, we have to deal with the nurse because there's no dr. around, only on the phone. that is why i am coming here to advocate because -- [indiscernible] -- my father still listens to us

he puts his head on my chest like, you know, don't worry. i am just coming to advocate for him and for everybody because the care that they provide to him is not okay. they don't have nobody taking care of them. today i want to the hospital with these photos. nobody is around. only two people who are talking. nobody is there. nobody is around -- [indiscernible] >> the speaker's time is completed. [speaking spanish] [speaking spanish]

>> next speaker, please. [reading names] anyone else would like to speak, please come forward. >> my name is sylvia. i was here two years ago for the same issue the same, what ever. i know the unit on the sixth floor, i work there. i have six to eight patients. i know how to take care of them a.m., p.m., night shift because i have been going around. i'm sorry, i have lack of sleep because i just finished working. i'm so dedicated to my patients and i want to be here. this is very crucial.

dr. browner, when they have a town hall meeting, because i just heard, i have been working for three people and i get paid for one. i said that two years ago when i was here. that is still an issue. now i am on my last limb. the patients are our bread and butter, that is how i feel, so we have to care for them. they peak, they poop 24 hours. you have to take care of them. they vomit, they are so sick, and they are cutting staffing after staffing after staffing. and at one point i have 50 patients for the whole pacific campus. until now, the same issue. it is a long stride at van ness

campus. my thing is, how about the patient ratio for a p.c.a. like me, who really care and are dedicated take care of patients. i don't care about the money, that's fine -- [indiscernible]. >> thank you. thank you for taking the time. next speaker, please. >> this is so obviously a product of capitalism. see bmc and other nonprofit and public hospitals have abandoned vital but low-paying care, not y for subacute staff but mental health and long-term care. the monopoly has a raise prices so much that the attorney general is even involved, and

when forced by community uproar to continue caring for subacute patients, they are providing such poor care it is hard not to believe that they aren't killing people off so that the space can be used more profitably. we demand, at minimum, 17 permanent subacute s.n.f. spaces at davies with new admissions and safe staffing levels. we can and we must, and we will fight these short-term battles for survival, but if we don't see this fight as a fight to get rid of capitalism altogether, then we will be fighting these fights again and again and again forever. >> thank you. next speaker. >> hello, my name is teresa palmer. i have been working on the

subacute issue and with the families for two to three years. one of the things i wanted to clarify is when the 17 patients were transferred from st. luke's to davies, they committed to take care of them only until they died and then would return the beds to the 38 s.n.f. beds that were previously there. it is a very -- the skill level needed to be a subacute nurse is very close to the level for an icu nurse, and the same for albion. to recruit sufficiently skilled staff for a temporary job is much harder. this is one of the bases of the request that they be pressured to make those 17 beds permanent so we can have permanent staff

that is adequately skilled because what we are having is a lot of discount -- discontinuity of staff. when you have patients with very abnormal baseline to begin with, if you don't know them, it is hard to tell if they are doing worse. i want to point out that only two of the eight patients that died were comfort care, and the rest were candidates for ongoing lifesaving care. thank you. >> you still have 25 seconds. >> i do? okay. i wanted also to point out that the medi-cal shortfall is a measure of how many medi-cal patients we are serving and how much income they are making, and they have increased their revenue quite a bit like cutting subacute care. it is about money, it is about profit, it is not about what the people of san francisco need. >> thank you. next speaker, please.

>> hello. i am with the san francisco labour council. i have been here many, many times. the fact that this unit, the subacute unit, and i know, i disagree with you on this, you are not here to beat up on them. any unit that has over 50% death rate needs to be raked over the coals, sorry, that is just the way it is. many of the supervisors have experienced long call buttons. someone is choking, it only takes a few minutes for that person to die. a 20 minute wait for someone who is choking is an attorney tea, it is cruel, you don't want to break them over the coals, you need to. if these people were allowed to

say things, they would still be alive. i'm pretty sure most of them would still be alive today. cpmc has neglected these patients, has ignored these patients. the staff, i feel really sorry for anyone who floats into this unit. obviously they are not getting training, they are not being oriented to the unit. i saw this with my own eyes. i suggested it to an a nurse what button to push to make the alarm go off. i was there, i saw it all for my own eyes. this is not good care. this is not acceptable. we need to warn the residents of san francisco that cpmc is unsafe. if they do this to the most vulnerable patients in the hospital, what else are they doing? we need to warn people that they need to take a look at who they are and i have seen the looks

from some of these families were told they have to send their family members to los angeles. san franciscans deserve better. >> thank you. next speaker, please. >> hello, supervisors. my name is tony rivera. i just want to thank you for coming to cpmc the other day for the tour. all the families really appreciate it. this will be short. i just want to say that if i was an executive working for cpmc, i would be questioning my values right now because i would be really ashamed of everything they are doing, you know, i don't understand how you can come here and defend these sorts of actions that are taking place and then go back to your family and to your kids and hold a different kind of set of values. i am calling all of them out

right now that if they feel like what they are doing is right, they need to really take a look at themselves. thank you. >> thank you. any other members of the public who wish to comment on this item please come forward. seen none, public comment is closed. i want -- i did come down and experienced the conditions and the setting that these family members are living in, and experience it firsthand. i know that is very personal, and i tell you that it certainly had a major impact on my impression. i have the opposite experience of supervisor ronen because it was after supervisor ronen, so the family members shared with me that when we arrive, that was

a level of care that they believed should be the baseline. i know that we have -- i definitely want to come back to the solutions and talk with the department of public health, but i think we have some current questions for cpmc. i know some of my colleagues had expressed that during this time while we have been listening. is there a representative from cpmc here? if you can state your name for the record. >> good afternoon. i am the vice president of external affairs for starter health. >> thank you for being here. i will start with a few questions and then i will -- i know supervisor ronen wanted to ask some questions.

we visited the facility the other day. i think it was about last friday the nurse's manager was on site, there were, i counted at least over a dozen nurses on the facility. one of the things that struck me , and i was actually taken aback by this, and i just want to ask if this is standard practice. there was a white board on the wall that showed the patients, and then when the patients were passed away, there were little exes where their slots where picket seemed seemed to me like a countdown. i just was a little bit stunned by that. is that a practice that you normally have in your facilities , and what is the purpose of that? >> i'm not certain of the board you are looking at and whether it was inclusive of all the beds that are in that unit. the s.n.f. beds and the subacute

beds, and what the exes were indicating. >> let me describe it for you. i didn't want to take a picture, i didn't want to violate any of the patients' privacy rights. it was a big white board that said subacute on it and it had all the different names of the individuals, and then the ones that had passed away, there were exes on their lines, and the ones that were still living, there were names and the room numbers. that took me aback. i just wanted to put that out there because i think it was important. i promised family members i would bring that up. again, it was very emotional for them. that was one of the things -- but the level -- can you talk a little bit about the level of staffing? there were some people there that the family members said to west they had never seen these individuals. talk about the rotation in and out and what that means. i think that's important to get on the record, and what's the

level of training for each individual. i'm not as familiar with the training, but are they people that are understanding in how to work with this type of patient? >> yeah, thank you for giving us the opportunity to be here today and answer your questions. we also want to thank you for taking your time to visit the unit and learn first-hand. we welcome you to continue to come back and visit the unit. i especially want to say to you, your comments at the outset or on the onset of this hearing are appreciated about the sensitivity and incredibly emotional content that we are talking about. these are people's lives. we know families are here today out of concern for their family members and we are concerned for them, as well.

we can't, as you know, because of laws regulating privacy, share specific details about patient circumstances, but we do strive every day when we are in the unit to take the considerations of family members appropriately, and of course, inform them of clinical care decisions. we have state law that determines the ratios for staffing to patients. i think that is one of the situations that is probably becoming concerning to people, as the census in the unit has been reduced. for the eight patients remaining patients remaining in the unit, there are two r.n. and three p.c.a., there's three registered

nurses and two patient care assistants who are in the unit for the eight remaining patients those ratios of staffing are posted every day and they are submitted monthly because it's a regulated ratio and we've consistently been in compliance with that. the staff that are in the unit are all trained, they are all trained and they are all qualified to treat even the most fragile and sensitive patient populations. we do also have ongoing dialogue with the california department of public health who regulates this type of unit, and they were recently out doing a survey of the subacute unit. it was less than a month ago,

and they determined that there were no findings there around the quality and safe care for these patients. >> let me interrupt you for a moment. one of the things that i think we're talking about and i've heard over and over again talking to the patients and their families, we did talk to one patient, is that there was a different type and level of care at st. luke's. that is what i want you to talk about. there was an activities coordinator, there was someone who came in and did activities with the patients, that is no longer there. supposedly that person had to have a certain level of education that was not transferable when you moved to the unit over. yes, you might be needing the baseline, with the frustration here from the families is what was provided at st. luke's is not provided here. i am sure you are meeting the baseline and you haven't had any violations written up on that, but that's what we are talking

about. speak to that. and i don't want to let the countdown board go because i think that the minute to get out of the elevator, it is right in your face. so if you haven't seen it, i would say go and look at it and maybe you guys can take another look at readjusting it, i don't know, but it really is offensive , i have to say. >> okay. i think the difference between the unit at st. luke's and the unit now is situation around the census. you had a larger unit at st. luke's, and that warranted additional staffing including the activities coordinator. i can't speak to the human resources situation around anyone employee, and when the unit moved from st. luke's to davies, but because of ratios and because of the size of the unit now, you have things like

the activities coordinator being shared between that unit and the s.n.f. unit. >> i have one more question that i will handed over to supervisor ronen. one of the things that also caught my attention was the idea that, i don't want to use the word encouraged, but at some point, people were being asked, are you okay enough to go back to your home or go back into the community, whatever the residential setting, and then if they fall back into need of subacute care, that's it, they can't come back. can you talk about that a little bit? it seems to me as though if somebody was either encouraged or they made the decision that they wanted to go, one of the patients brought that up to us. they said that, i'm sorry, the patient's sister was speaking to us on that day and she said, they are asking us if maybe my sister is okay to go home now,

but i'm worried that if she then falls back into the need for subacute care, the door will be closed to me. can you speak to that? >> i understand what you are saying. i can't speak to any individual patients. >> i'm not talking about the individual patient, just the scenario. if someone made the decision to leave, and then within a month or two needed to come back, what happens in a scenario like that? >> the unit is not accepting new patients, but i can't confirm for you what a timeframe is if the second they are discharged the patient becomes termed a new patient. i cannot answer that. >> that one we will put to the side. >> if i could also share, you know, along with the daily engagement that the staff has and is available for the families, every quarter, there is interdisciplinary meetings

scheduled with every family and their physician, and our staff and our ethical staff to address concerns that family members may have. those are scheduled quarterly with every family. it is another opportunity for a dialogue with the families around the care being received and for their loved one. i wanted to share, especially given some of the comments -- >> you don't need to read that letter for the record. >> okay. >> we have it. we have all been given a copy of that record. supervisor ronen? >> thank you. a few questions. so 17 patients moved from the subacute unit at st. luke's to this campus. today there are eight patients that remain.

do those other nine patients have -- pass away? >> again, i can't speak to the specifics of any of those patients. it is such a small census that, you know, there could be an understanding of identifiable patient information. >> okay, so we know a large portion of this. let me ask you another question. do you have aggregate data for the death rates at st. luke's for the years prior to it closing? >> i'm sure that information could be gathered, though i think much like you heard with the millman presentation, the

discharge order and depending upon where any patient may have been before they are discharged, whatever the discharge position, it makes that data cloudy to look at. i think i understand your intention trying to compare, is there a rate historically and a rate now that are different. correct? >> that is exactly right. and the statistics right now are alarming. i would like to compare those two, you know, what was happening at st. luke's. let me say this. the family of the patients loved the care they were receiving at st. luke's. they felt supported by the staff he knew their family, who was there for the long term, knew how to read, you know, facial signs of their family members

when they couldn't talk because they couldn't breathe, because they had that type of medical provider patient relationship. they love to the activities coordinator who would call the family members several times a day just to give updates on how their family member was doing. the quality of care that those patients were receiving at st. luke's was something to brag about, and something to be very proud of. and that's the type of care that we would expect a hospital of the calibre like cpmc to be providing the patients. that is not happening today at davies. pretty much any member of the families will tell you the same thing. they have come and they have testified here. the day i went to visit, as i explained earlier, was terrifying. there were not two patient care assistance and three nurses there, i guarantee it. i walked the small halls. we couldn't even -- when the alarm went off, we couldn't even

find a staffer to ask what it was and what was going on. the absence of the activities coordinator, you can imagine, these are patients that never leave their bed without help, and so to just be stuck in a bed all day and have nothing to do and nobody keeping their spirits up, how crushing that could be, and that first rate care they were getting at st. luke's is not happening at davies. it is very troubling and it is especially troubling that that is coupled with an alarming death rate. i'm trying to confirm with you, but i can't get that confirmation from you, but that is what we have heard from the family members, a 50% death rate in a one year period is alarming i would like to be able to compare that what happened at st. luke's when everyone agrees the patients were getting top rate care.

so this is something that's very troubling and we would expect, you know, unfortunately my conversations with doctor were not very comforting because according to him, everything is going as it should go. and when i was there, it was horrendous care, as far as i'm concerned. when we finally got someone to deal with that alarm, and thank you for reminding me about that, it all came back. it was kim from the labour council that had to figure out how to turn off the alarm because the rehab worker, who was the only one there that we could find to help, had no idea what the alarm was, how to turn it off, what to do. i mean, that is not the type of care i think that cpmc would be proud of. it was really, really bad.

we want some answers in terms of what is going on and why these high death rates, and why the two patient care system and three registered nurses were not there the day that i visited. what is going on here? >> again, i understand your concern, and you are right. we wouldn't be proud of that type of care, and we know there is an ongoing desire for the current unit to be just like the unit was at st. luke's, and that , you know, we know it is a different unit, and a death rate with a declining population is always going to be higher. i think that's why i've tried to share with you our available engagement with the families on

a daily and a scheduled quarterly basis to discuss these things with them. it's why i'm sharing the information that's posted and mandated by the state regarding staffing, and the reviews, and it is why i thought that dr. birnbaum's letter was important. she is an objective physician working with the patients in the unit who was a strong advocate for moving the patients from ste quality of care they would receive and now she is still advocating for those patients and giving his perspective for the quality of care that is being delivered at the unit.

>> are the two patient care assistance and three registered nurses supposed to be staffing 24 hours a day? >> yes. >> so that is a 24 hours a day staffing. >> yes. i'm not aware that an overnight shift has a different staffing ratio then the day. >> do they leave the unit often? we just couldn't find anyone on the floor when the alarm went off except for the one rehab worker. it just wasn't what i saw. we were looking for staff. >> i understand. it is why i welcome you to come back to the unit and continue to see maybe a different day, a different time of day experience a different situation then you did in that moment. >> but normally they can't leave the floor. so if the minimum staffing requirements are three r.n.s and

two patient care assistance at all times, 24 hours a day, we should expect then that those five individuals will be on the floor. >> yes, and a break room or somewhere. >> twenty-four hours a day the whole time. >> correct. >> that just wasn't the case. we were a huge group of people. we all witnessed the exact same thing, and we were actively going into the different rooms because we were worried about the alarm, as you can imagine. i just don't know what to say to that. we have family members saying that is always the case. i just don't know what to say to that. i will stop in unannounced to check because it is not what i saw the day that i was there. so we heard from mcmillan that they are in conversations and chinese hospital, dignity health

and kentfield to talk about potentially opening subacute units in those different hospital facilities or with interesting collaborations and partnership. what is cpmc doing to help with the citywide crisis? because in the d.a., there is a specific commitment that you will be actively helping the city resolve for this crisis. it does go back to the d.a. and what types of beds we will have in which of our campuses. that is how we got to the agreement where cpmc would not have subacute beds, and i think the need to that the city has shared if you think back to the slide for the millman report for when someone is discharged from an acute setting, what are those

different levels of need that you have. we are continuing to do our share by having the sealed nursing beds in our acute care setting, which the department of public health has identified as a greater need, so we are both in compliance with the agreement that was made in the d.a. around not having subacute beds, but we are still doing our part in helping the city with a larger postacute crisis by increasing the number of s.n.f. beds that will be available we will continue to work with the department department of public health and others through this process, as there are sure to be additional answers and solutions developed. >> i don't have a copy, unfortunately. do any of my colleagues have a copy of the d.a.? i'm sorry i don't have that with

me. my bad. my memory of the language on the d.a. on this, it is true, it does not require -- thank you. [please stand by]

>> i think we are trying to do our part in the larger crisis, supervisor. >> that is one of the pieces i

wanted to come back to to talk about short and long-term solutions. we have a couple other supervisors that want to ask questions. >> i have a last question. this is my last question. are different staff members floating in and out at different timeses that don't have regular contact with the patient? >> i don't have a complete accounting for you over the period of time since patients have been there how many nurses are f.t.e. versus floating from one unit to another, i am sure

that has ebbed and flowed over the course of the year and without speaking to any specific human resource situation, it is true that nurses in our employ on their own accord make decisions to work in other units so again, whoever is there is qualified and trained, and i understand the situation of when new staff are there they are meeting patients and families the first time. that is not as familiar. i understand the concern raised. >> supervisor stephanie, to underscore 1.1 thing that would be helpful and this is your

industry, but i would say to have a main point of contact for the remaining eight families there. ththe family members had not mt the person. they had not met that person before ever. these sisters and brothers come up to visit their sister all of the time. my only suggestion would be i understand you are rotating nurses and pcas. i think they would like consistency. if you could have one point of contact, that would be really helpful. then if staffing drops at a

particular moment they are able to call someone. that seems to be something that is missing in this conversation. >> we will make sure the manager has direct contact with the families and there is a clear line of communications. >> that would be very helpful. >> supervisor stefani: i have what is basic and naive questions. my mom got her nursing degree at st. luke's hospital, where i was born. my sister is a labor and delivery nurse at uc davis and another sister is a therapist in georgia. i grew up with a ma'am who was a -- mom who was a psychiatric nurse. you grew up in a family that had a lot of points with hospitals and healthcare, and for me i am looking at the need.

i was there on friday, and my mom and sisters went into healthcare because they care about people and they want to help people. i am wondering, and i look at all of the people that make up the hospital, the nurses, doctors to care for those people, and when we see the need for that sub acute care and see those people laying in the beds suffering and the family members suffering because of everything they are going through, i am wondering basic why wouldn't the hospital want to provide sub-acute care if the hospital knows sub-acute care is needed for their patients? >> i think the answer goes back to some planning during the negotiations around the development agreement. we only have a certain number of licensed beds across all

campuses to manage the general medical surgical beds, to manage the labor and delivery preand postpartum beds, to manage sub acute beds and the other types of different regulated beds, and at that time, based on our need and the needs that were negotiated with the city, have g more skilled nursing beds was the agreement versus having sub-acute beds. >> i understand the agreement. it is concerning to me, and this is to all hospitals, the fact that we have a shortage of sub-acute care beds in northern california and we have nowhere to send these people. for me, i went into law and politics because i care about people. as policymaker, i want be to

know how to get you and the other hospitals to provide sub-acute beds so we don't have to send people out-of-county. >> there was a conversation on these lines a year or so ago as we talked about the transference of the st. luke's unit to davies. i want to know you want to have the larger discussion from the city, but the preference for sub-acute care is not to be in an acute setting. i know there are differences of opinion, but that is the opinion we hold and the department of public health holds. >> that is all. thank you. >> supervisor fewer, thank you for waiting. >> supervisor fewer: thank you very much. one question on staffing. about the backfilling of staff.

you said staff are on break, aren't you required to have backfilling on staff with the critically ill patients? >> backfilling on staff, meani meaning? >> during bake times. >> i think it is during restroom breaks or other types of breaks. i don't think there is a requirement if someone is on break that there are three active duty rns on the floor or in the patient rooms. >> okay. i just want to say we have heard a lot today, i think, about the care that people feel like they are receiving at davies, but i think what is most pressing of all is the conversation about the 17 beds and that you are

transitioning them to skilled nursing beds after people pass. the idea that the city and county of san francisco is so short on sub-acute beds and i think the sub-acute care needs on page 21 of the presentation shows the wait times vary from 30 to 45 days with extreme cases 500 plus days wait times. two of six hospitals reported they have nothing to successfully place any sub-acute care patients in the last year. i understand there was a development agreement, and, quite frankly, i think that development agreement is a little ridiculous. it was before i came in, but the idea the agreement was silent on skilled nursing beds, it left it up to the goodwill or the hospital's sense of humanity

to actually continue to help us with the sub acute problem, these things should not be negotiated in a development deal, quite frankly. when we are looking at actually we re-zoned 88, i think, zoning differences so that you could actually create your new hospital, i think with some underground tunnel and the other stuff, i feel like really? we have eight sub-acute beds in san francisco, and you used to supply 17. i think we can look at other hospitals to help us, but, quite frankly, cpmc, i think it is within your means to keep these beds at 17 sub acute beds. i don't know how we do that and look at development agreement

again, bring back the terms how we can do it. we are not going to let them fall by the wayside, we are not going to desetter them. they have to move to la. i understand this is a corporation. even though a nonprofit corporation. quite frankly, this is not about money over human life. this is really about prioritizing the need for this type of care in san francisco. quite frankly, i also think that we are behind the game on this with the department of public health. now you have eight and we are in desperate need. i don't think this is even saying this report is even saying that we have a need for this. i think it is a critical need.

i think considering how the city and county of san francisco has bent over backwards to accommodate your development on vanness avenue, i just think it is not asking too much to keep those as sub-acute beds in san francisco. they have been switching to what the report tells us, we have thousands of skilled nursing beds, not that we don't need them, but we have only eight sub-acute beds. i get you are just the representative and we don' don't to beat up the messenger. i think what you heard today from the supervisors is that this is serious to us and that we expect the corporation like cpmc setter health to step up to the plate to help us.

17 sub-acute beds is not too much to ask, quite frankly. considering the accommodations we have given you as city and county of san francisco in this development deal agreement which i think it is ridiculous. silent on skilled nursing beds, how could we do that as city and county? we are disappointing the people in san francisco that we are silent on skilled nursing beds when we agreed to this development agreement? this is just ridiculous. the language is so soft on sub-acute beds. i just think it is time, actually, for setter health to come together with us and put your best foot forward and your good faith commitment of keeping the 17 beds as sub-acute beds. when we look at other hospitals that we could have, the chinese

hospital, the independent hospital in the nation have 23 available beds and you can't do 17? you are like a big corporation. i am sorry, i don't think it is too much to ask. i have been at multiple hearings. we should have another hearing on skilled nursing beds. it is they are sending people to sub-acute beds to replace those with skilled nursing beds at davies hospital, i think it is wrong. i think it is morally wrong, and i don't want to second guess what the morals may be of setter health, but i am telling you

what i heard loud and clear is that my colleagues agree it is morally wrong, if you don't keep these beds as sub-acute beds, it is wrong with the city and county of san francisco and the families that need the care to keep their loved ones alive. thank you very much. >> thank you, supervisor fewer. >> chairman mandelman. >> i was not here when this blew up over a year ago. i have a narrow point or question and a larger point or question for the other hospitals. on the narrow point, my colleagues expressed concerns of various things we have seen and heard about the current operations of the sub-acute

floor. the one piece that is striking me as troubling -- many of them are troubling. the piece that is sticking with me is this idea if patients who are currently there agree to try out a less restrictive alternative, more independent alternative and they are encouraged, i'm sure, to do that. within a very short period of time of that happening, it turns out that wasn't the right move for them, and they did need to be in sub-acute nursing facility the door would be closed on returning back to davies. it seems pen me wise and pound foolish for cpmc as actor in the san francisco environment. it would seem to me that as long as that facility is there or at

least for some reasonable period of time after which discharge happens it shouldn't be a got ya. i heard that several months ago. i think that was raised at the health commission when this come up, and it would be great to know whether or not that is what is going on and whether or not people who agree, sure a family agrees to try out something different then finds out that something different is not enough is barred from coming back to davies. i would not love that if that were the case. >> i understand you. let me get information and guidance on how much and what level of specificity we are allowed to share, and we will get back to you. >> the second thing relates to the development agreement. the development agreement was, i know, hard fought, and dealt with the particulars of the

facility on vanness and st. luke's and what expectations the city had in exchange for cpmc moving forward with those. i recognize that the da did not impose, you know, stringent new obligations on cpmc about sub-acute beds. i don't think that means cpmc's obligations to the city or any hospital's obligations to the city are forever met going forward. looking beyond the development agreement, our hospitals are an important part of our healthcare ecosystem. san francisco has tremendous health care needs right now. for the sub acute beds and for hummingbird placements and for our assisted living crisis. we are going to look to our

hospital partners who, frankly, are showing, you know, significant revenue in san francisco, most of them, to be part of solving these problems. even if it is not in the da, and i know the mayor reached out to the hospitals and asked for help around beds that she was looking for, and i think it is incumbent upon the hospital community to step up to be solutions to this plethora of issues which sub-acute is part of it those are my points as a newcomer to this conversation. >> i think that is a good point. i want to say one thing i thought about in this conversation, it always struck me and i am glad she i