contract with the institute on aging for the provision of the community living fund program to include a pilot for the administration of the public guardian housing fund. currently, we provide the services using a two-prong approach of coordinated case management and purchases of goods and services. it serves san francisco residents 18 and older with incomes of 300% of the federal poverty level. they must be able to live in the community with appropriate support and have demonstrated need with service or resource to prevent institutionalization. the modification we are requesting today for the provision of the monthly subsidies and move-related costs for public guardian and conservators. under the department of aging and adult services the office

serves at the court-appointed conservator of vulnerable individuals and estates. due to declining health, some of these individuals are marginally housed for prolonged periods of time while waiting for appropriate housing option. this funding will be used to help them attain or be placed in a safe and stable home such as assisted living, supported housing or similar housing. those served must meet the c.l.f.and pg criteria. we will provide administration while the p.g.office is program support including case management, in person visits, monthly approval of the housing subsidies and other activities to ensure the equitable access

and appropriate use of the funds. the p.g.office will prioritize access based on the conserveties need and the amount will be set okays by case base -- on the case-by-case basis. the subsidy will range depending on the client's need, functional and financial. 30 to 50% of their income while others may be subsidized up to 100% due to lack of income or resources available. based on the current need the p.g.has identified for this funding, the fund can cover up to 10 conserveties annually. it will include monthly subsidies and move-related cost and security deposits, moving

boxes, packing and transportation for the move and furniture and other similar items. at this time i would be happy to answer questions from commissioners. >> i have one question. from the time the process begins for the individual until it is approved and the individual begins to get services, how much time does that normally take? >> depending on where they are, we have entered into agreements with the facilities or supportive housing. if that is in place it could be very quick, within, i would say, less than a month. i would say two to four weeks. then additional time may be required if vendor agreements haven't been set yet. >> thank you. any other comments? >> a question on the operating expense details. the consultants, line 21.

appendix page b-1, page 3, line 21. the contractor. >> yes, at this time because this is a pilot program, c.l.f.may need to pull in a temporary staff to get this up and running. there is some funding allocated to allow that. then as you can see on the next year, it is blank because by then we participate there will be an actual staff. >> over the page, the purchase of service detail. $304,348 each year. what are they?

>> that is the actual subsidy, the funding for the subsidies and the move-related costs. >> thank you. >> i have two questions. >> first should i consider the c.l.f. similar to purchases services and case management. are those similar in nature like a pace program. should i think of c.l.f.like a pace program? >> i think it would be similar. of course, pace has something other. >> i think there are elements, the purchase of service dollars. other than that, no, this is intensive case management to help people who are at risk of institutionalization to come out and live in the community, the

community can mean in this case assisted living, but generally living in the community in san francisco. we have found that the intensive case management is often what people need to stay at home safely. >> i want to add i it is the pay or of last resort. >> any other comments or questions from the commission? any comments or questions from the public. hearing none, may i have a motion to approve. >> so moved. >> second. >> further comment? all in favor? any opposed. thank you the motion carries. >> item j2019 through june 30,

2021 an additional amount of $200,000 plus 10% continuing been see for a total amount not to exceed $1 million. >> this item before you was an ad back. it is $100,000 per year ongoing with the idea of supporting cantonese language capacity in advocacy services around the skilled nursing facilities and assisted living facilities. we are going to do that in cooperation with the ombudsman who are going to use this funding to hire a contonies speaking staff person to focus on that. ombudsmen provide services. they are known for responding to

complaints by residents. they do a number of other things, providing consultations to facilities, families, residents, letting them know about their rights and things like that. wit to any advance healthcare directives completed in a sniff. that is a legal requirements. also including legislative hearings and changes in regulations and practices in this area. this is going to focus on skilled nurses facilities. much of the work is with clients. they will also focus time on outreach and educational presentations within the facilities and within the target population to try to increase awareness and accessing of

ombudsman services. beyond the cantonese capacity that will be increased here, the program itself has a pretty good language capacity including mandarin, spanish and french and japanese. >> thank you very much. any questions or comments? >> a quick one. within all of this on page 7 of 8. there is the designated community focal point. is that where it is advertised. if you go there, people would hear about it and be able to know? >> the focal points are age and disability resource centers. california department of aging wants to make sure that when we do our big area plan we designate community focal points. these are places where hubs

where information can be given out about the variety of services available. the california department of aging wants us to make sure we identify those focal points in our contract documents with every contract that involves cda funding. the idea is here and it will be clear that the ombudsman program will say these people are out there. yes, first the ombudsman can reach out to be sure they are aware of the services. we are also making sure the agencies are aware of the ombudsman service should someone come into that site needing assistance related to the facility. the idea is that the sites would know about that. >> they are informed and could helped. >> thank you.

yes on the subcontractors 9 and 10. chinese mandarin specialists. the other one is another dialect. why is there a difference of $28,000 versus $16,000? is that because of the number of hours or what? >> yes, the number of hours. what this represents back here is that the ombudsman program is doing whatever they can to get language capacity and get qualified people working for them. sometimes there are people excellent ombudsman staff who have other things going on not looking for a full-time job. benson has done well to work with those folks to keep them in his stable of staff out there in the community so that is the difference there. >> thank you. >> any other comments or questions? any comments or questions from

the public? hearing none may i have a motion to approve. >> so moved. >> second. >> any further comments or questions? hearing none, call the question. all in favor. a. thank you the motion carrieds. next is to >> all right. item 8. a motion regarding whether to disclose the discussions during closed session pursuant to san francisco administrative code section 67.12a. do i have a motion for discussion purposes to disclose? >> so moved. >> second. >> the motion is whether we should or should not disclose. if you are in favor of disclosure please indicate. those opposed to disclosure.

all in favor of not disclosing. a. >> any opposed thank you. the motion is not to disclose the items that were discussed in the closed session. any public comment on that particular motion? thank you. any general public comment? >> good morning, commissioners and executive director. i am the director of the richmond senior center. i am not sure if this is the time to come in or if i should have come in at the beginning of the meeting. we look to invite you to an event we are hosting on october 19th. the richmond senior center in partnership with the round table, a coalition of senior agencies are going to be hosting

one hard thing. that is an event we started with our village to recruit neighborhood volunteers to send them in pairs of two or three to the homes of seniors who have requested help with one hard thing. we did it twice a year at the start and the end of daylight savings time. it started with setting back clocks. then additionally doing something like flipping a mattress or cleaning out behind the fridge or changing the smoke detector battery, those things that help people remain in their homes. it is so popular we do it quarterly. we wanted to host an event this october that encouraged leadership of agencies that serve seniors so they could see some of the great work other agencies are doing and meet the senior in the community. i did send an insight and you

should get an e-mail. we would love you to join us to see the good work that is happening out there. >> thank you very much. any other announcements? may i have a motion to adjourn. >> motion. >> second. >> we are adjourned. thank you all.

>> 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