>> good morning and welcome to the san francisco planning commission and health commission special joint hearing for thursday, october 3rd, 2019. i will remember you that we do not tolerate disruptions or outbursts. please silence cell phones. please state your name for the record. i will take roll for the planning commission.

(roll call) we expect commissioners moore and richards to be absent today. >> i will take roll for the health commission. (roll call). >> commissioners, we have one item on the special calendar item one 2012-0403w. california pacific medical center annual compliance statement. this is an informational hearing. >> good morning, commissioners, i am planning department staff. the item before you is an informational presentation on the california pacific medical center's compliance with their development agreement for the 2018 reporting period. this is the sixth annual reporting period. i am joined by ken, marina from the health services service and the department of public health

and elizabeth pearl of the planning department. today's hearing is part of the annual review process required by the development agreement foresee see. for c.p.m.c. it requires a public hearing. following today's hearing the directors of planning and public health will derm whether c.p.m.c. is in compliance. a third-party monitor will inform the board of supervisors if they agree with the directors' determinations. c.p.m.c.'s development agreement allowed them to build a new hospital and medical office building at the vanness and geary campus with a requirement they build a new hospital to replace st. luke's. the development agreement

required replacement of st. luke's hospital within two years of opening the vanness hospital. they met this with the owning of the -- opening of the commission hospital. they required payments for range of public benefits and improvements. they completed the payment requirements with a total payment of over $73 million. for the 2018 reporting period there are 11 main actions up for compliance t.these include payments, hiring commitments, public improvement and community outreach. my colleagues will go into these. in one reporting area the local hiring period has a reporting period corresponding to the fiscal year rather than calendar year. that means for recent

information on hiring. ken will help explain how the c.p.m.c. overall hiring record compares to the goals of the overall development agreement. construction of the vanness hospital is complete, and the associated medical office building also opened this year. future construction includes the new medical office building omission and improve mends around the -- improvements around the mission area. one other obligation is the limit on fees for servicen creases by c.p.m.c. as the provider for the city health service system. annual increases must be no more than 5%. actual analysis finds they met the requirement through 2017. the most recent year for which this analysis has been complet

completed. they are working on the 2018 data now. with that we will turn to ken nem from the oawd work force division. >> welcome. >> thank you, good morning. i am the director of city build of the office of economic work force development. thank you for the hearing to give us the opportunity for feedback on the report and i would like to thank the public to serve the residents seeking employment for this great opportunity for the hospital. first, i would like to start with the construction. we are putting it as cumulative since it started in august of 2013. the first topic is hiring for internship. as you know, the majority of the construction work has ended.

st. luke's opened in august 2018. the vanness hospital opened in march this year. a lot of construction has been completed. when we generated these hours for the last program year, not a lot of hours were added. for example, for the 50% entry level positions for non-union administrative engineering candidates, new hires in the office we had requests for 38 of the new entry level positions. we filled 32 with folks out of our program. city build have the construction hands-on training and have the professional services so people coming through our program administrative type of professional training at city college. we work with contractors to get them into these administrative positions. 32 of those were from our

program and some include lead document, document coordinators, project administrators and project manager. from the next slide, which is very similar, but this is really focusing on the internship program. we work with the san francisco unified school district and san francisco state through the mesa program, mathematics, engineer and science achievement. they are disadvantaged residents. we got 30 interns on this project. goal was 50%. we achieved 57%. i spoke with the contractors. 10 of the hires are on the company working with projects outside of the hospital once it was completed. that is a good success.

we want retention and people sustaining to work. the next slide is our entry level positions for construction and most of these are focused on apprentice ship programs. city build we offer the academy which is 18 weeks. people who graduate from the program we pay for the initiation fees to get them in the union and to work. early are the challenges not having enough ironworkers. we have presented that in the past. one of the toughest trades to convince people to work in, and with that there was still a good amount of ironworkers. during one of the events a graduate spoke and highlighted success in working on the project. the last four years, we have experienced a big construction boom. in city build we manage other compliance programs, mandatory hire the city public works contract we increased for the

last year 3 million work hours. this has mandatory requirements. if the contractors do not meet that there are penalties. it is going to local residents on the projects but the other projects are taking them to avoid penalties. we had the opening of chase center. they increased the program year about 1.5 to 2 million work hours. they also had the office of community investment goals that was drags and pulling on local residents to work on those projects. some of the challenges we had difficulties in fulling. drywalllers during the chase center. sheet metal workers and operating engineers were some of the entry level positions we could not fill to get people working on the project. we had 175 apprentices on the project.

these are individuals that did not be have experience or could not get an opportunity to work construction due to this project brought them on, started a career in construction and they are union members. that is the success of that. then the fourth compliance is the overall work hours. overall workout is 30%. the first three years we met the goal. with all of the construction happening and other projects, we have seen decline especially the last year the major work was the medical office building. a lot of exteriors were done. what caught us off guard a special interior modular system, prefab wall to use for that system in canada, and the carpenters that needed to do the work had to have special certification. we pulled in the contractors, we could not get it from the union because of the special

certification. we did not have people trained for that. even with that we were able to get some employment opportunities, not the bulk of the prefab work. that gave us a challenge in a drop in numbers. they did the best to work with us to hire folks outside of those specific classifications. we still convinced them to hire people from the community working in the cleanup work, laborers and whatever opportunity was available that didn't need the special certifications. to date we 432 -- 322 residents hired to meet the 30% goal. these are just some statistics. this is a piechart of where the hours went. we have reported roughly a little over 5.6 million work hours, of that 1.15 for

apprentices. 35% of those were local. these are new individuals coming into the system to help them retain them and successful journey level workers. now here is a demographic where the workers were coming from, from the different neighborhoods. these are the key neighborhoods that had the san francisco work hours. four biggest neighborhoods we were targeting and which the da put a special reference for. four of these neighborhoods represented 60% of the work hours. workers were coming from the neighborhoods we wanted to impact through the development agreement. now, i will focus on the lb eg egos. 14%. we have reached 16% of the dollars were going to l.b.e. that is equivalent to

$227 million to l.b.e.s. each of the bullets focused on the projects and where the money was coming from. the ti work was not significant compared to other major work. lower amount and we were able to reach 16% to the l.b.e. community. l.b.e. is monitored by the contractor monitoring division. they provided me that data. now, we are looking at the first source hiring. to focus first is the program year's goals. in addition to construction we have a business services team that works with c.p.m.c., the employer and they submit to us job notices. we work with the community to provide referrals. i convinced them to give opportunities for people coming

to the program. we have hospitality and healthcare that a lot of graduates go to the post construction work. the goal is 40% of the new hires entry level positions referred. in the program year we were able to hit 52%, 48 out of the 92 employees were referred through our system. we 432 -- 326 placements since the program started. i have statistics on the next slide. for the program year, i think a big question where are the individuals coming from? based on our analysis all of the qatathekey neighborhoods. 65% from the tenderloin, outer mission, chinatown and southeast neighborhoods. cumulative data we looked at since we started the program

with 81% retention rate. these are individuals hired that stayed for 180 days or more. we had 263 hires retained over 180 days. the last slide is just a work force fundings. those are provided to help fund the agencies doing the work in recruiting the neighborhoods, non-profits to do job training or employment opportunities. a lot did case management to make sure people are successful. life skills to prepare them before they come to our office for training. the current grantees this program year $375,000, and the agencies were jds, self-help for the elderly, success center, co-tenderloin is a new agency.

as of this may of 2019, there is $935,000 in the account. the program year they are looking at new scopes of work and what else needs to be done to prepare individuals for the post-construction and operation of the hospital and those are my updates. >> thank you very much. we may have questions. >> good morning. i am from the department of public health. for this section of the presentation i will provide an overview of compliance related to the healthcare commitments and the da. so first i would like to provide a summary of the healthcare commitments. there are multiple commitments to ensure that c.p.m.c. provides high-quality care to

all san franciscans, especially low income, uninsured. each contain multiple provisions. at the top five baseline commitments to maintain the same level of commitment. three to increase care to medical and low income individuals. two on the innovation fund for $8.6 million to fund community-based services and programs. the last two commitments are specific to the mission burnell campus in effect for the open of the new hospital in august of 2018. they are reported in the compliance review. these additional commitments include key provisions related to the number and type of bed space available and four provisions to ensure specific services and programs are

provided at the mission burnell campus. there are five additional healthcare provisions that range various topics. sub-acute services. these provisions help to ensure seamless and accessible care to those in san francisco. over the next several lieds i will provide more details on the healthcare provisions and the compliance on each. this slide provides details on each of the five baseline healthcare commitments. the c.p.m.c. compliance and if they are compliant. c.p.m.c. exceeded the requirement of caring for the charity care patients. it is for those without expectation of reimbursement.

they cared for 38,210 charity patients. second is community benefit unreimbursed costs to provide or improve community health. in 2018, c.p.m.c. exceeded the $8 million community benefit requirement providing $15.1 million. they met this by providing grants, community health programs and community outreach. it is important to note that the first two provisions on the slide are verified as part of a third-party audit. third and fourth are related to charity care policies. third required easy to maintain the charity policies through 2015 which they met. it requires charity care policies compliant with state law. that is the case. as of 2018, c.p.m.c., charity care was the same as 2015.

the last provision i is for the easy to support the bayview child care center. they have provided an operations grant for five years, invested over $1 million, transferred assets, is still the specialty and hospital partner. so the next three provisions focus on medical. the first provision, c.p.m.c. continued to participate with the san francisco health plan. next requires easy to assume responsibility for 5400 new beneficiaries. this was met in 2014. in 2018, c.p.m.c. had.

they are required to serve the new medical beneficiaries through a partnership with the tenderloin serving provider. currently there is no such provider. to meet this c.p.m.c. partnered with northeast medical services to bring st. anthony's clinic as primary care provider in tenderloin. they are accepting enrollees. in may 2019 there were 174 members in the partnership. they have reported several barriers to increasing enrollment. if you include patient choice. new enrollees can choose which hospital to go to for specialty referrals. these may be more familiar with the csfg and opt for that instepped of c.p.m.c. another barrier is follow up

with potential enrollees. they may have unstable housing or have outdated contact information. clinic staff have been unable to reach them to complete enrollment. another barrier is staffing challenges. they have experienced staff turnover. c.p.m.c. has reported that it is partnership with three-inch dependent primary care providers. they collectively serve 2600 tenderloin residents. c.p.m.c. continues to work with the st. anthonys for outreach efforts. the next two provisions pertain to innovation fund. c.p.m.c. is required to make payments between 2013 to 2017

totaling $8.6 million. the final payment of $1.25 million was made in 2017 and completed the payment obligation to the innovation fund. this describes how they are used administered by the san francisco foundation. c.p.m.c. and the public health and foundation it is on a committee to support community clinics and community based programs. these awards will support community based programs for african-american and pacifi pacc island communities, healthy living and services for seniors.

so the da includes two provisions related to the number and type of bed space available. the first provision on this slide requires the mission be 120 beds general acute care with comprehensive emergency services, must open within 24 months of the vanness hospital. they have opened the hospital as described in august 2018 abearlier this year opened the vanness hospital in march of 2019. this second provision is conditions on the operation of 30 additional shell bed spaces at the vanness hospital. c.p.m.c. may not build out or place into operation this shelled space until after the mission burnell is open and has a 75% for a full fiscal year as

in the compliance report. this provision is not yet applicable but subject to the mission burnell campus hospitalization utilization. the follows four provisions ensure c.p.m.c. provides specific programs at the campus. they require comprehensive inpatient and out patient and urgent care services. c.p.m.c. is compliant offering all services outlined in the development agreement. for the second and third. c.p.m.c. is established to establish and maintain a center of excellence in senior health. this center is named health

first at the mission bernel campus and integrates community health workers to the healthcare team. c.p.m.c. reported the following in 2018. it provided care to 717 unique patients and over 1400 encounters. staffing includes three bilingual community health workers bilingual in stannish and english and the program is fully staffed adding patients regularly. they require easy to create a community advisory board to provide input to the operation of the center. c.p.m.c. convened the first board meeting in october 2018. in review we noted the advisory board could have additional membership. we recommend c.p.m.c. recruit and engage additional community organizations into the body. next is center of excellence in

senior health to provide care to approximately 600 seniors over 70 to live successfully in the community and reduce unnecessary hospitalizations. it is comprised of three programs. the first is acute care for elderly or ace, it is a 34 bed unit at the mission bernal campus providing care to older adults. physical and occupational therapy and rehabilitation and group activities to encourage socialization. second is the hospital elder life which develops personal care to help each patient stay mobile and social and prevent functional decline. third is the san francisco village partnership, which is a nonprofits that provides a care navigator to access needed community services to ease

transition from hospital to home. c.p.m.c. reported 70 patients each month and has conducted outreach to community partners to promote as a potential resource. for the last provision on the slide, c.p.m.c. has a proposal for the office building within five years of opening the new hospital. they are within the five year window. they have until august 2023 to submit a proposal. so the remaining healthcare divisions are stand a stand alo. the first requires easy to develop specific for sub-acute care services. it is skilled nurses in which patients require a higher level of care such as ventilator care.

the requirement was to present the health commission. this was completed in 2016 through presentation of the post-acute care to the health commission. c.p.m.c. is currently engaged in the project to a assess and develop strategies in the city. second is integration of staff across the c.p.m.c. campuses. in 2016 they completed integration of st. luke's to a single integrated staff. they have maintained this with opening of the new mission bernal hospital. the third provision requires the participation in a community benefits partnership. they continued to participate in the san francisco health improvement partnership which is a nonprofit hospital and community-based organizations to

improve the health and wellness of san franciscans. the next commitment i is for the easy to continue partnership. they maintained the current agreement during 2018. there are concerns regarding the agreements. c.p.m.c. and chinese hospital are negotiating contracts. we will provide update next year in the compliance report. so for the last provision, the last provision touches on national culturally appropriate services or class standards. c.p.m.c. has reported it is their policy to deliver in accordance with mandates with the national standards. they are compliant be with this provision. commissioners and community members expressed concerns regarding the cultural appropriateness of the services.

particularly, around the st. luke's diabetes center. they met in april 2016 and the meeting resulted in specific recommendations to increase spanish speaking staff, provide spanish group positive, hire reception staff. it is important to note as of april 2018 they transferred diabetes center. they did provide updates. as reported the foundation has maintained several of the recommendations and added a receptionist. in past hearings the commission encouraged easy the easy to proe additional information regarding staff standards such as

demographics. c.p.m.c. provided a summary which you received last week. we will continue to work together to gain a deeper understanding of compliance and will include more information in future hearings and compliance reports. this concludes this portion of the presentation. >> thank you. setter health is in compliance with the requirements of the c.p.m.c. development agreement. they met hiring and local contracting goals. areas of concern include enrollment with the tender highway loin med-cal provider and hiring of journeymen and add prentices.

for 2019 it indicates continued compliance. staff's recommendation is to find that c.p.m.c. is in compliance for the 2018 reporting year. that concludes staff presentation. we will be available for questions. sutter health is also available for comments. >> does sutter health wish to make a presentation as well? >> we are good. >> i have a few speaker cards. catcrachel, gloria. >> there is an organized opposition. >> okay. >> good morning, commissioners. i am a professor of law at

university of california hastings college of law. i am here to present the comments today of the san francisco for healthcare, housing and jobs and justice, a coalition which is an organization active for the last 10 years, more than 10 years. they were instrumental in if community benefit package that is part of the development agreement. we are not a party to the agreement but actively involved in the drafting by participating in public proceedings, and it also has been monitoring the agreements, and implementation. we presented written comments back in june and those are at the end of your package. there are two statements, one on the development agreement overall and also a statement on the sub-acute care issues in san

francisco. a lot of time is invested in this process, and it is important time. it is an opportunity to review the c.p.m.c. and city reports. it is also an opportunity to look at the c.p.m.c. as the largest fee for service private provider of hospital services in california as it relates to the needs of sa san san franciscansr healthcare and civic concerns. it is an opportunity to look seriously not just at the development agreement compliance but at the c.p.m.c. performance overall. today orally i want to make two points. first, to say that the development agreement even when it addresses specific actions

does not prohibit or limit c.p.m.c. from doing more than what is specifically stated. second, there is ren is recent a that indicates c.p.m.c. is doing less to meet the healthcare needs of lower income san franciscans than in 2017. i will look at not the overall benefit of the community but looking at the actual patients being served by c.p.m.c. with respect to the first point, c.p.m.c. repeatedly mentioned the da for not taking sufficient action to address an identified problem. this has particularly come up with respect to the demise of sub-acute care skilled nursing facilities in san francisco.

the da states c.p.m.c.tha c.p.ml work in good faith to develop specific proposals to provide sub-acute care services in san francisco. now, it does indicate an expiration date for that provision but that is not the end of the matter. it explicitly states c.p.m.c. is not obligated to expands funds or resources. these provisions do not mean that c.p.m.c. is prohibited from committing and spending funds or resources. it is just not mandated by the development agreement. nothing in the d.a.limits the city from suppressing c.p.m.c. from doing more than it is now

regarding the need for quality sub-acute care units in san francisco. nothing prohibits them from fully participating. sub-acute care is the most intensive form of post-acute care. it is for patients who can't survive on their own, as was referenced previously, like those who need a ventilator. because of the expense most long-term sub-acute patients receive med-cal. hospitals regard it too low to meet cost and med-cal recipien recipients. c.p.m.c. agreed almost two years ago to transfer existing patients from st. luke's hospital sub-acute care unit to a new unit at davies campus. at that time in late 2017, there

were 23 patients in the st. luke's unit with no new patients having been accepted since 2016. in august of 2018, patients in the saint looks unit -- st. luke's unit -- excuse me. in august of 2018, when st. luke's was closed and the new hospital opened, there were 17 patients transferred to the davies campus. as of now there are eight remaining patients. when they die, c.p.m.c. will close the unit and there be no sub-acute beds in san francisco. this is a crisis now. c.p.m.c. must be part of the solution whether it provides space and staffing at davies, at

the proposed new medical office building on the mission burnell campus as part of the undevelopment space in the vanness campus or in support of chinese hospital interest in having sub-acute care unit. another area where c.p.m.c. needs to step up more than set out in the d.a.is meeting the spirit and letter of the commitment to serve 1500 new med-cal or healthy san francisco patients in the tenderloin. with the opening of the vanness campus in march this year, an important geographic proximatity issue is now eliminated. as of may of 2019, as you saw in the report you just heard, only

174 such patients are receiving services from c.p.m.c. a number which is actually two patients lower than in may of 2018. c.p.m.c. has to be an active parties pant i -- participant in reaching out to serve the tenderloin in three respects. first in insuring that the vanness hospital is culturally and linguistically welcoming to lower income individuals from diverse family. second, aggressive efforts to encourage tenderloin residents to use st. anthonys as primary care clinic. third, providing financial and technological support in whatever ways are most needed to facilitate high-quality primary

care providers in the tenderloin to referpatients to c.p.m.c. for specialty and hospital services. with respect to the second point i want to call your attention to the san francisco charity care report for 2017. the latest report available. this report provides data and information from all san francisco hospitals on traditional charity care which covers only non-med-cal patients who are uninsured or who are healthy san francisco beneficiaries. though the definition for the charity care for this report does not include individuals on med-cal, the report does inclu e

relevant data on the med-cal shortfall. that is the difference between what hospitals set as the fee rates for specific services which are much higher than private health insurance reimbursement and not the same as the actual cost of those services and what med-calorie im buses for the beneficiaries. -- reimburses for the beneficiaries. since obamacare, the cost of charity care patients, not med-cal patients have gone down. generally speaking, this correspondses with the number of individuals with private insurance through california exchanges over the expanded med-cal coverage. one major result is reported med-cal dollar amounts for most san francisco hospitals. i have a minute left.

>> that is your time, 10 minutes. >> i still have 10 minutes? >> that is your time, sir. >> let me emphasize for most hospitals charity care costs have gone down, but at the same time the med-cal shortfall amounts have gone up sometimes two or three times that amount because previous charity care patients are now receiving med-cal. the one anthe is c.p.m.c. that a decline in charity care and med-cal shortfall costs. something is not addressed by the measures and procedures used with respect to the development agreement. thank you so much. >> thank you.

so we will now open it up for public comment. i have theresa palmer and gloria. anyone else who wishes to provide public comment, please line up on my left. >> good morning, thank you for the opportunity to speak today. i am the director of programs and administration at northeast medical services. c.p.m.c. and nems have a partnership s.we serve 32000 med-cal patients. we provide specialty care and care coordination. while c.p.m.c. serves as the

hospital partner and provides diagnostic services. we have worked together to serve the tenderloin in our contract with st. anthonys but through contracts with three independent providers in the tenderloin area. c.p.m.c. is the partner for all four providers as well as the clinic on ellis street. in total we serve a little over 2600 in the area. we will work together to serve our patients and residents of the tenderloin. thank you. >> next speaker, please. if you could line up on the left, we won't lose time between speakers. please come up. thank you. [please stand by]

>> they want to refrain from the long-term commitment and caring for these fragile patients. the inexperience and unfamiliar staff, inattentiveness, lack of stimulation, are always to ensure they don't last. this is why we need the subacute unit reopened. these rooms have already been specifically retrofitted for 17 subacute patients. in the best interest for cpmc's current patients and the community, cpmc should maintain and admit new patients so that there is an adequate level of staffing and continuity of care at all times. my sister, sandy, as well as the other patients, do not deserve to be treated so inhumanely. they deserve to live as long as they showed with the best entitlement of care. the only way that this will happen is to commit cpmc to

reopen the subacute unit and accept new patients in order to maintain an adequate level of experienced staff at all times. thank you. >> thank you. next speaker, please. i'm very sorry. we just lost one of our members of planning. can we keep going? >> unfortunately not. we should pause. >> we will give a couple minutes pause. i think it is a bio break and we didn't realize. thank you. >> okay, welcome back to the san francisco planning commission and health commission joint hearing for thursday october 3 rd, 2019. we left off under public comment

if any member of the public wishes to submit their testimony , please. >> i wouldn't -- i am so sorry to have interrupt you -- to have interrupted you. >> i am one of the patients in subacute. cpmc speaks about adequate staffing of the unit, but let me say this. it shouldn't take a patient to use her cell phone to call the front desk to ask for assistance it shouldn't take a patient to have the call light on and wait for an hour for assistance. it shouldn't take that when i went to go see my sister and i saw something was wrong with her , and the so-called experienced nurse stated, there's nothing wrong with your sister, gloria, she is fine. so i went and got the doctor myself. after he evaluated sandy, he

rushed her to icu immediately. she was in icu for several weeks with pneumonia and every other breathing issue. cpmc is giving the minimum care of the subacute patients and this is why i feel that there is a reduction of these patients left, and i also feel that if the rate goes on this way, in december we will probably just have two patients left. we need a permanent subacute in san francisco so there can be adequate staffing to protect these patients. you think about if something happened to your family member, your loved ones, your son, your daughter, and they needed subacute care, how would you feel sending them out of county to los angeles or sacramento? please help us protect our san franciscans who pay taxes and voted for everyone here. please take care of our family

in san francisco. thank you. >> thank you. next speaker, please. >> good morning. i am the executive director of jobs with justice and labor organization in san francisco. i want to talk a bit about this hearing, which is that it's not just a discussion of the development agreement, it really comes back to the goals of why we even have this development agreement, and that is to remind cpmc of their obligation to our communities around jobs, around healthcare, and thank you to the families for fighting, literally for the family members in the hospital. so we can come to this agreement and hearing, we are not just trying to check a box. when we say tenderloin lies, it literally is a lie. so on the subacute, we can look at this report in terms of specific proposals for providing subacute care services in san

francisco and presented to the health commission. it says the obligation is completed on 2016. this obligation is not completed we need to subacute. this is a crisis. another piece that i think this hearing actually has been helpful, when i came here last year, and thank you to oewd for presenting this information, there was a question on retention and promotion. not only was there not enough jobs coming up for people coming from the communities, and there was a decrease in the total number of jobs, which means that percentage was very low overall, but also the question of retention and promotion. i remember the commissioners raising that. i see the improvement from last year to this year. based on your actions as a commission, and investigating this question of retention and promotion so people who get in the door actually stay in their jobs. i just want to lift that up as an example of how this hearing can make a difference and ask that you, as commissioners, hold

cpmc and, not just to the development agreement, but to the goal and the spirit of the development agreement. >> thank you. next speaker, please. >> hello. i am a community organizer with community housing partnership. we provide affordable housing, supportive housing for over 1500 folks in the central city. our clientele have many traumatic barriers from experiencing homelessness, and i want to call attention to something that i heard today, which is kind of interesting. we have a goal of serving 1500 people on medi-cal, and it sounds like we have backslid over the six years that i have been aware of cpmc. we backslid from not even reaching 200. i heard today that the reason is because folks are unable to reach out to people because

their phone number isn't working or their address may have slipped. as a community organizer, if i just gave up on everybody that didn't have an address or a phone number in my community, then i wouldn't be doing anything. so i'm going to ask you guys to dig deeper and do better. thank you. >> thank you. next speaker, please. >> hello, my name is melanie grossman and i'm with the coalition. i am a retired social worker and i am especially interested in the center of excellence for senior care, and we have a small group which has worked with that center to make sure that it's more than a centre of excellence in name only. the center is charged with

making sure that people stay in the community, live in the community, and to reduce hospitalizations. in order to do that, the center has to know the community, know the resources that are there, and work with the community. so the ace unit is a fairly self-contained unit. it is run by dr. zachary who has been extremely helpful to us in welcoming, and also welcoming of the community, but we have to do a lot of the work for her because she doesn't have the staff, she doesn't have a social worker, she doesn't have people who can do this outreach for her , and that is especially important. same with discharge. i had a neighbor who was hospitalized on the unit and i asked a dr. zachary to make sure

that my husband and i were called before she was discharged , and again, it is not dr. zachary's job to set up discharge, but my neighbor was sent home over the 4th of july weekend. we were never called, even though her number was plastered all over her room. she called me and told me she was going home. we were out of town. i had to set up a ride for her to get home, call the home care agency, make sure they were there to greet her, get her keys to her. my neighbor didn't even have her keys. and to make sure that that transition went smoothly, which it did. the unit did give her a referral for home health care, and they didn't call her until the middle

of next week. i don't consider that a smooth transition to home. >> thank you. next speaker, please. >> hello, my name is teresa palmer, i'm a geriatrician. i work with senior and disability action at san franciscans for housing, healthcare, jobs and justice. my feeling is that cpmc is noncompliant and having a centre of excellence in senior care. they have an acute hospital unit , but they're planned for discharge is sponging off nonprofits and volunteer organizations, and not doing any real community outreach or discharge planning on their own. their primary goal seems to be saving payroll, not having their own dedicated employees, and

getting people out of the hospital as quickly as possible so they can make a profit on the medicare dollars. this is pretty much the same with subacute. the d.p.h. has estimated that we have a dearth of 50 to 80 subacute beds in the subacute unit. we have none for the surviving patients at cpmc. davies, who are rapidly dying. the least cpmc could do is make the 17 retrofitted beds at davies into permanent subacute beds so we could get permanent staff because you can't -- this is a very high level of skill and it is very difficult to recruit the skilled staff for temporary jobs as these patients die, and which may be one of the explanations of the high death rate. in general, cpmc's approach to tenderloin it lives, to

everything, has been passive. blaming st. anthony's for not doing enough to get patients to them is ironic and ridiculous. cpmc should be doing what it needs to do to make these patients welcome and to recruit these patients and even to case manage these patients. this is the same with the center of excellence in geriatric. to not have a hospital-based skilled nursing facility to send these patients to after a complex at geriatric patient has a stake, is ridiculous. the medical staff office building at st. luke's or the 30 shelf beds at davies could be used for subacute or hospital-based care. it is all about revenue, it is all about profit, even though this is a nonprofit organization that isn't paying taxes. thank you. >> thank you. next speaker, please.