46. and press pound twice. at this point, you should be able to listen to the hearing live. wait for the item you're interested in speaking to and for public comment to be announced. to comment. you know, you need to press star three to raise your hand. and once you've raised your hand, you'll hear a prompt stating that you have raised your hand to ask a question. please wait to speak until the host calls on you. when you hear that you are muted. that is your indication to begin speaking for those joining via webex, please log in via the link. found on today's agenda and enter pass word. cpc 20 to 3 and use the raised hand

icon to ask a question best practices or to call from a quiet location and please mute the volume on your television or computer. for those persons attending in person. please line up on the screen side of the room to your right. please speak clearly and slowly and if you care to state your name for the record, finally i'll ask that we all silence any mobile devices that may sound off during these proceedings. and at this time, i'd like to take roll commission president tanner commission vice president more commissioner braun here commissioner diamond here. commissioner imperial here, commissioner couple here. and we expect commissioner ruiz to be absent today. commissioner bernal here, commissioner christian commissioner guillermo and commissioner chow thank you. thank you commissioners. um you have one item on your special calendar today. case number 2016. hyphen 004775 m. c m for

the california pacific medical center. annual compliance statements. this is an informational presentation. good morning, president personal and tanner and commissioners. i'm elizabeth pearl planning department staff. could i have the presentation, please? the item before you is an informational presentation on california pacific medical center is compliance with their development agreement for the 2021 reporting period. this is the ninth annual reporting period. i'm joined by iftikhar hussain of the health service system. lower rice and charlie paisley of the mayor's office of economic and workforce development. and max cara and davina baba at the department of public health. today's hearing is one part of the annual review process required by the development agreement. the d a requires see pmc to submit an annual report on compliance and for the city to evaluate their compliance and hold this public hearing. today's presentation, you'll hear updates for 2021, as

well as some updates on their projected compliance since that time. following this hearing, the directors of planning and public health will determine whether see pmc was in compliance for their obligations for that year. a third party monitor will review the director's findings and informed the board of supervisors whether he agrees with the directors determinations. cpm sees development agreement allowed them to build a new hospital and medical office building at van ness and gary with the requirement that they also build a new hospital to replace st lukes in the mission district. the development agreement required replacement of saint lukes within two years of opening the van ness hospital. southern methodist commitment with the opening of the mission bernal campus hospital in 2018 and the van ness hospital in 2019. both hospitals are now in operation. the d, a also required center to make payments for a range of public benefits and improvements. they have completed those payments under the development agreement with total payments of over $73 million. the main items up for

compliance review today include payments, hiring commitments, healthcare commitments, public improvements and community outreach. construction of the mission, bernal hospital and the van ness hospital and its associated medical office building are complete. future construction includes a new medical office building admission, vernal and some remaining improvements around that area in the mission district. one other obligation under the development agreement is the limit on fever service increases by cpm c in its role as a provider for the city's health service system, iftikhar hussain of the health service system will provide an update on that. good morning if the car is saying the cf for the health service system and happy report about the compliance with the fee increased requirements in the development agreement, it's a 10 year agreement, beginning with 2015 and the 2019 work by

the independent, um, actually has been completed. etcetera is in compliance. there was a $40,000 are difference in the findings. etcetera has paid us and the audit for 20 and 21 is in process expected to be completely run the august timeframe. thanks to home. okay? and now i'm going to introduce local rice of the o e w d workforce division. who's going to talk about the workforce requirements? thank you, elizabeth. and thank you commissioners. my name is little rice and with the office of economic workforce development. i've been working on this project for seven years as business services representative, and, uh, at the beginning of the pandemic. i was

promoted to the manager of first source hiring non construction. i regret that city bill director who is basically the director of our first source. construction side of the house can't come today because he's going to be a father soon, so we wish him all the best and can't wait to see when his baby is born. but this first slide is from him. the construction requirements as i understand or completed in july of 2019. and you can see in the bullets. the hiring goals did exceed the nine union, administrative and engineering candidates and the administrative and engineering internship candidates. the sutter contractors met requirements for the good faith efforts, as required by first source towards hiring goals for entry level union, apprentice candidates and journeymen and apprentices. and that last bullet is kind of obscured by

some some words there, but it says, i believe local business enterprise program. goals exceeded were exceeded during the construction period. next slide, please. okay so for first source hiring program, see pmc operations. as i said, i've been working on this project for seven years, helping see pmc fulfill their requirements. their requirement in the d a. is that they hire at least 40% of all their entry level positions come from our system referral network and, um those goals have have been exceeded. all non construction hiring goals have been exceeded. there are no deficit or carry overs as stipulated in the development agreement. as of july, the end of july 2022. it was a 47% goal that was accomplished, which meant that 48 hires were made for entry level positions out of

the 102 employees that were referred from the workforce network. next slide, please. um and then what this also means is that for those folks who were hired 67% of those entry level hires came from what are called the priority neighborhoods in the development agreement, and these priority neighborhoods include western addition, tenderloin mission south of market outer mission and excelsior chinatown in the southeast neighborhoods. ah, um . there has been, you know, over the years, uh, requests for retention data, which we now get regularly from c pmc. and for this time period, the retention rate of folks that were on the job for at least 90 days was 91. and with that equates to is that there were 430. first source

hires over these 99 years that met that retention goal. before we leave this slide. i just want to give you a preview since i'm working on the final year program 10 cpm c has, uh, continue to exceed their goal of 40% and we're looking at over 50 hires for this current program here. next slide, please. this slide is also contributed by another staff person that i work with charlie paisley. he's the director of sector programs for sector training programs, and he's more conversant with this slide. if you do have any questions, i'm just going to read read from the power point here. um it has to do with the c pmc workforce fund. first of all the fun targets educational and non profit organizations that work in those priority

neighborhoods i mentioned before , and it focuses on the barrier removal and job training for people to get employment opportunities with cp m. see um the current grantees are jvs self help for the elderly success center and faces as f and as of may 31st 2020. the remaining mount in the workforce development fund was $870,000. so that concludes my remarks. thank you very much. thanks lowell. and now max carreau from the department of public health is going to present the healthcare requirements and, um how cpm c has met those. good morning commissioners. my name is max. cara and i work at the department of public health. for this section of the

presentation. i'll provide an overview of compliance related to healthcare, healthcare commitments and the d a. for 2021. i received several questions from the commission prior to the to today's hearing, and i'll also be addressing these throughout the presentation. exhibit f of the development agreement provides multiple provisions related to healthcare, which are intended to ensure that cp m c continues to provide high quality care to all san franciscans, especially low income medical, uninsured and the city's diverse communities. this slide provides an overview of the da's healthcare commitments and these include five baseline commitments. to maintain the same level of care related to community benefit and charity care three provisions to increase care to medical beneficiaries and low income residents to provision on the innovation fund. this is a fun with a total of $8.6 million spread across four years to fund community based services and programs and note that these

provisions were completed in 2020, and therefore i won't be discussing today. there are also five healthcare provision in the da ranging from sub acute services to culturally and linguistically appropriate services to provisions related to the number and type of bed spaces. bed space available at the mission bertel on van ness hospitals and lastly, for provisions related to the number and type of bed space available. the mission bernal and banda's hospitals. um sorry. sorry for provisions to ensure specific services in programs at the mission bernal on campus and that these are provided so together these provisions help to assure seamless and accessible care to san franciscans and on the next slide, we'll provide more details on the healthcare provision that are still in progress and cpn cs 21 2021 compliance on each next slide, please. so before i dive in, i want to take a moment to acknowledge the impact that the

covid 19 pandemic had on the city's health care system, which started in 2020 and continued through 2021 during this time hospital citywide redirected resources to support covid surge planning there was a pause on non essential health care services and patients delayed seeking care due to stay at home orders. and we saw that patient volume significantly decreased in 2020 and also into 2021. c pmc reported that the pandemic impacted their performance for several provisions of the, uh several of the d a provision and i'll go into those throughout the presentation. so this slide provides details on each of the five baseline health care commitments c pmcs 2021 performance, and dph is determination of whether a c p m c is compliant on each cp m c has exceeded the d a requirement of caring for 30,345 charity care or medical patients. again charity care refers to health

care provided to those who cannot afford to pay and without expectation of reimbursement in 2021 c pmc cared for 30,779, un duplicated charity care and medical patients. the second provision is related to community benefits, which are unreimbursed cost incurred by cpm cd, improved community health and in 2021 c. pmc exceeded the $8 million requirements providing $16.5 million in community benefits through grants and sponsorships , cpm see supported initiatives and programming, aiming to improve the health and well being of residence. and examples of these partnerships include support for operation access. the lions i foundation, which provides screening and specialty procedures to uninsured patients and capital funding, as well as provided to health, right 3 60 clinic by the bay sf free clinic , which allowed them to canadian continue serving vulnerable san franciscans. the compliance for these first two provisions were

verified by deloitte as a third party audit. the next provision is related to charity care policies. it's c pmcs policy to provide full charity care to uninsured patients whose family income is at or below 400% of the federal poverty level for patients who have insurance family income at or below 400% of the f p l and whose medical expenses exceed 10% of their income. see pmc will ride off the patient responsibility amount. the last provision is for c p. m. c to continue to support the bayview child house center and since ownership has been transferred to the south of market health center, cpn t has provided an operations grant invested over $1 million transferred assets, and it's still the clinic specialty in hospital partner and this is all to ensure that comprehensive primary pediatric care is provided to bayview health residents or bayview. yeah neighborhood residents. um as part of c pmcs, ongoing five year commitment to support the center's general operations.

see, pmc has provided an operational grant of $227,000 in 2021. so the following three provisions in the d a focus on medical, which is a public insurance for many low income san franciscans medical his historically and continues to be an important insurance for option for san francisco residents for the first provisions c. pmc has continued to participate in the medical managed care and medical managed care with the san francisco health plan, as required. starting in 2014 c. pmc met its obligation to assume responsibility for 5400 new medical beneficiaries, and cp m. c continues to meet this obligation in 2021. c p. m. c had a total of 40,182 medical managed care beneficiaries, which was an increase from 2020. um under the next provisions of the d a. c p. m c is required to participate in a medical managed care partnership with a tenderloin primary care

provider. in june 2020 the rams, msl opened a primary care clinic at 6 50 pork street, and there is now one available episode with a primary care provider based in the tenderloin cpm see reports that is the hospital partner for 4593 duplicated lives in the tenderloin throughout through the names mso during 2021. so with regards to the question that i received from the health commission on the names patients see pmc indicated that they could not provide data on the on how many of the names patients residing in the tenderloin are new patients in time for today's hearing, um, and for historical context provided to prior to june 2020. there was no available msl with a primary care provider based in the tenderloin. and despite efforts by cpm c to support the creation of one it was deemed financially unfeasible by clinic partners and in 2015 c. p. m. c. had initiated a partnership with names msl and saint anthony's

medical clinic, primary care clinic and the tenderloin to have st anthony's joined the names msl as a pathway for cp m c to meet this commitment, and cp m c has reported that they recently restarted conversations that to develop some kind of some form of partnership over the coming year. next slide, please. so the d a. i includes two provisions related to the number and type of bed space available at the mission, um, mission bernal and venice hospitals. the first provision places conditions on the operation of 30 additional shell beds at the venice hospital. c p. m c. may not build out or placed into operation this shelf space until after the mission. burl campus has a hospital has a daily census of 75% for a full fiscal year. and this provision is not yet applicable. um the second provision requires see pmc to provide certain impatient urgent care and outpatient services at the mission. brittle campus c p. m c may adjust

reduced, move or eliminate the specified services at the mission borough campus, but first they're required to get the city at least six months prior notice for that reduction and also meet and confer with the city on on the proposed changes. so in 2020 impatient labor and delivery services at the mission, bernal campus were temporarily temporarily relocated to the vaness campus in order to use the space as a potential covid 19 surge unit. c p. m. c did not provide the city with prior notice of these changes, and it was therefore found non compliant with this provision and 2019 2020. annual compliance findings. see pmc indicated that this non compliance was a result of the pandemic. uh in 2021, labor and delivery services remain closed under the california department of public health covid waiver and recently see, pmc has reported that they plan to restore labor and delivery services at the mission borough campus, but a timeline has not yet been provided. alright note

that patients have continued to receive prenatal care at the women's clinic at the mission borough campus and are informed that their labor and delivery will be performed at venice campus and with regards to the commission's questioned regarding the 2021 compliance finding so further 20 to 1 2021 review dph didn't find see pmc noncompliant. for their lack of prior notice for the closure, as they had already been found to be non compliant in the previous years. review uh when this action took place, dph has identified the temporary closure of labor and delivery as an item of concern and continues to monitor the closure to ascertain when services may resume during this period. dph is also sought to understand the impact that the temporary closure on cpm see the temporary closure has had on cpm see patients and how pregnant person sins are receiving care at both campuses. dph will continue to monitor and follow up with cpm see on this issue. so the first provisions

on this slide requires a cpm see to establish a center for excellence and community health. at the mission. bernal campus. the center named health first serves patients in chronic disease management by integrating community health workers into a multidisciplinary care team. health first served 652 unique patients in 2021, which was below the annual target of approximately 800 patients as fourth by the d. a. see pmc reported that covid 19 pandemic or the pandemic presented challenges in terms of patient hesitancy for coming in for services. and even when services were offered virtually um also due to the pandemic. the community advisory board did not meet in 2021 was replaced by series of phone interviews with providers and patients. so with the stabilization of covid cpm c expects patients to come back to health first and see pmc has indicated that health first will conduct additional outreach to community providers to increase referrals. dph staff will

continue to monitor and follow up with cp m c to ensure that appropriate measures are taken to increase their patients served by this program. the second provision on this slide requires cpm see to establish a center for excellence and senior health to assist patients with or at risk of chronic illness and to provide improved, impatient post hospitalization care to seniors center is made up of the acute care for the elderly unit, the hospital elder life program and a pilot partnership with the san francisco village. the ace unit was established at the mission bernal campus with 34 beds, providing in addition to play interdisciplinary care to order adult patients. um a song. the ace units are 1149 patients in 2021, exceeding the goal of in the set out in the d a of 600 patients and further 27 patients were referred to the sf village, 11 of whom were enrolled. the third provision on this slide requires see pmc at to submit a proposal for the development of

the mission brunel campus medical office building within five years of the opening of the campus. um see, pmc reported that the site permit for the medical office building is pending approval by the city. next slide, please. so the remaining healthcare provision in the d a r, stand alone and cover multiple topics, so the first provisions on this slide requires see pmc to develop a specific proposals for providing sub acute care services. and just as a background this is a form of sub acute or this is a form of skilled nursing, but for patients that require a higher level of service, such as ventilator care or tracheotomy care. and to present these proposals to the health commission. this obligation was completed in 2016. and this is the only provision in the d a. that addresses sub acute services. dph has been working to support the development of new sub acute beds and san francisco and in 2021 convene meetings with the san francisco community hospitals. to explore options to support opening sniff

and sub acute beds in the city. see pmc participated in these meetings and has continued to engage with the dph through 2022. uh and commissioner with regards to the question on sub acute beds at chinese hospital. currently chinese hospital has a 23 bed unit in the process of sniff and sub acute certification. chinese hospital was also awarded awarded a $5 million.05 million dollars from the state to support renovating a unit to provide sub acute care . this will add up to an additional 30 beds and this unit will go through the licensing certification as well. but on a different timeline from the 23 bed unit that i mentioned cpm c is not committed to participation or financial support for these projects, and dph is continuing discussions for with san francisco hospitals around partnership for sub acute beds. for the second provisions c pmc continued to participate participate in the san francisco health improvement partnership across sector initiative with san francisco. nonprofit hospitals, dph, ucsf and

community based organizations to improve the health and wellness of san franciscans. cpm c is required as well to continue depart their partnership with chinese hospital and see pmcs contract with chinese hospital was renewed in early 2020. which satisfies see pmcs compliance with this provision. the last provision is on the national, culturally and linguistically appropriate services or class standards at sea pmcs policy to deliver services in accordance with the mandates of these standards, and those cpm c is compliant with this provision. commissioners and community members have expressed concern and past hearings regarding the cultural and linguistic appropriateness of cp emc services. in a previous joint hearing, the health commission requested see pmc to provide supplemental information for venice and mission hospitals to help the city have a better understanding of the cpm sees compliance with class standards and also to demonstrate that these new hospitals are truly serving the communities that

they're located in. ah at the commission's request. see pmc provided data for 2021 on patient preferred language, patient and staff, race, ethnicity and the number of proportion of services for which interpreters are requested. information was also provided on the process. see pmc uses to incorporate patient perspective into its class standards and continuous improvement efforts, and this supplemental information was provided in the annual report for your consideration. so thank you. and this concludes my section of the presentation. thanks, max. so sutter health is generally in compliance with the requirements of the development agreement. ongoing areas of concern include labor and delivery services admission, bernal. patient enrollment in the centers of excellence and community health care. the provision of culturally and linguistically

appropriate services and setters increase in rates in its role as a provider for the city's health service system. staff's recommendation to the directors of public health and planning is defined. see pmc in compliance for the 2021 reporting year. representatives are health do not plan to make a presentation today, but they are available for questions as a staff and that concludes our staff presentation. very good. if that concludes presentation and having no presentation from cpm, see, we should open up public comment. members of the public. this is your opportunity to address the commissions on this matter. and if you're in the chambers, please come forward. if you're calling in remotely you need to press star three or raise your hand via webex. hello, commissioners. my name is billy jean wall and i'm here representing the setters. cpm see clients who are no longer

benefiting from the. community aquatics exercise program. a program. the hospital continued for almost three decades. all of the class members are suffering since access to the warm water has been denied. the warm water really does this a lot of good at loosens our muscles and our nerves and we can actually work out and it's you know, prevention of further things. that could go wrong. um it is the best medicine for allowing most of us to move. the warm water, so it's believes them to keep the program going. they had it for 30 years. i don't know why they can't continue with it. um. the i from what i understand

center as represented that this has been a drop in recreation. program without structure. the opposite is the truth. the application process requires a form for the patient to fill out a form from the doctor, including why you would benefit from the program. then you were notified by phone that your application had been received and accepted. and then you had to wait until i use but became available in one of the classes. um. we had physical therapists as our instructors. there were five classes at davies. with a different instructor every day, and they were part of the physical therapy program at the

hospital. however i do want to say that there was a program at the pacific campus as well. the same thing. there were five classes. uh per week monday through friday, and so hmm. that got ended prior to um the program at davies. um. there were strict rules in place that we could not enter the water until our instructor arrived. i know that i am here to discuss the program it davies. but i did feel compelled to tell you about the program at pacific campus on clay street. thank you, ma'am. that is your time. okay. thank you. seeing no other members of

the public in the chambers coming forward. we'll go to our remote callers. hi can you hear me? yes, we can. hi. this is dr teresa palmer and um, i, um uh, what's the longtime doctor at st lukes and, um i feel that, um. that you need to, as you have an opportunity to do under the developed agreement to extend the monitoring. see pmc performance with public participation for another 10 years. there's an ongoing pattern. when you see pmc of maximizing profitable short stay acute care. while shorting less lucrative services that benefit the underserved population and carriage gone. i feel that in terms of health care services,

your committee has stood on its head defined cpm c compliant. ah even when there's obvious patterns of authentication and non compliance. princess with the care for attendance by live b p. m. c just adopted the patients at, uh, north east medical standard, er and most of them aren't new. um they divested st luke's clinic and the other low cost clinic with the five year paying off. they have stopped, they have overtly violated the development agreement by stopping labor and delivery at saint lukes have given no notice have continued. you know it was undercover of covid, but it's continued. there's no justification for this. and it's a gross violation. with the davis warm cool. they lied to the city attorney about its youth. for

low cost groups therapy to avoid a proposition to hearing and has has discontinued to flow cost used. this is absolutely agree gis. pretty scary disabled in any people, and we need a proposition. huge hearing on what they've done what they used warm pool low cost services in terms of the sub, acute skilled nursing. they are not participating in financial support of a new sub acute bed and due to, um uh, transitional problems from st louis to davis with the patients that did, um, remain in their care due to low quality of care and stabbing issues there with a 50% off of these patients. and one patient is remains and eventually native state due to debilitation, poor care. and, um um what happened

to her in the transition between saint lukes and davies? um bariatric center of excellence discharge you care is joke. referring 27 patients in a rolling 11 and you, ma'am, that is your time. go ahead caller. hi this is money in is gloria rivera's since then. um. we have been fighting for the hospital. they acute beds here in san francisco in 2017 me ask you this question . have you ever been in a position where you don't have a choice? how did that make you feel? have you ever been in a position where your life depended on it? have you ever

had to make a decision of leaving your family and not knowing when you will see them again? this is how many families been going through with no permanent hospital based sub acute san francisco? these are franciscans. we live here in the city of san francisco, where we were born in the city where we put our sweat into raised. our family paid our taxes. as long as we are functional is what we matter is this how it is here in substance. cisco do we not deserve better than this? not only are we faced of getting old but now we are scared that we have no need of. there's no subject. acute care bed, permanent hearing stuff, francisco we have, uh, we have to go to another county. what we can't see our family. how is it

? how is it that you can't house thousands of homeless people in san francisco, but we cannot provide 75 hospitalized. something cute bags permanent bed for these permanently ill people in san francisco. cp m c is continuing eliminating programs from the san francisco skin. how many more programs are they going to eliminate again? we have been fighting distance 2017. commissioner what steps are you taking to help ensure that is vital care remains available in san francisco. thank you. no not really grows. the women ma'am, you're gonna need to turn

off the volume on your computer or television. a lot of feedback. oh, hello. this is melanie grossman. okay that's much better. go ahead. yes. go ahead, man. yes. thank you for, um helping me out here. i wanted to talk about, um the closure of services. through this other and at, um see pmc over the years. and the. one more to pull and just waited in a number of clothing. that um, since i've been involved, uh there's been a closure of an alzheimer's humid , which was residential units, culture snip bags. and cpl. see is not the only person who is

guilty of this most of the hospital. san francisco are also guilty of this, but, um, that we are in trouble in this city because there are no place no places for our um people in need of bands, especially our seniors , most of them women, just no place for them to go. and our continuous closure and the closers and the reduction in services is just is just done. pauling and, um, continuation of the trench. and i'd like to know when will they start? thank you. this is antonio rivera. um so i

wanted to agree with the first color harry palmer instead in that she it was that there should be a 10 year convention into the development agreement. i think there should also be a 10 year extension. and to add to that um, it was stated somewhere the frequency with nine compliance with the development agreement due to the labor and delivery reduction services. not notifying um that's a government hmm. it appears that there's no penalties than i don't like there needs to be revisions. what the development agreement because in this case, it seems like not just the pmc, but like any hospital could reduce services without penalty. so if there's no penalty, like what's even the point of the development agreement. you know whoever abide by that agreement to do whatever they want. thank you.

i believe this next caller's already spoke. but when we go ahead and then mute them just to confirm hello, ma'am. have you already spoken? this is gloria did did you hear me earlier? we did hear you earlier, ma'am. alright thank you. thank you. that's quite alright. okay last call for public comment again. if you're in the chambers, please come forward. if you're calling and remotely you need to press star three or raise your hand via webex. saying no requests to speak at this time commissioners public communist closed and this informational item is now before you. great thank you. stop for the presentation. and to all those

who called in, um just asked commissioners were there from the health commissioner planning if you have any questions or comments that you'd like to make just use your button, and we'll call on you. chair bernal. yes thank you, president tanner and thank you to members of the planning commission. we have not met in person on this topic. for many years. we did have one virtual meeting over the course of the pandemic. thank you. also to dph and planning staff and other city staff for your presentations. today my question focuses on the tenderloin and the requirements to under the new medical beneficiaries commitment. um it notes in the presentation that, um, see pmc was unable to provide data on how many new patients, new medical patients were enrolled through their partnership. um either through names or through the st anthony's clinic in advance of this meeting. my question is, what is the plan

for providing that data and determining how many of those i believe more than 4000 patients that are being served? there are indeed new patients. and if that they do not meet that 1500 patient requirement. what are the plans to get to that? requirement. anyone from staff or see bmc available to answer the question. thank you, commissioner bernal. we'll continue to follow up with cp m c to try and ascertain that data as well. but also i'll note that , um now have them hope deferred to see pnc in terms of kind of their compliance with the actual provisions regarding whether or not the patients have to be un duplicated as well. and then just as a quick follow up. also i note that it notes that the saint anthony's clinic has become a part of the nms network . does that mean that indeed, there are two clinics operated both 6 50 polk street and as

well as st anthony's, because the development agreement requires partnering with two clinics. um, um esos yeah, i didn't mean to add to the confusion about their partnership, so, um and i can have them. i'll defer to see pmc in terms of the status but currently see pmcs indicated that they don't have a current partnership with st anthony's, but they are looking to re engage with them this following year to establish, so i don't know of the nature of that partnership between names and saint anthony's. if that continues to exist, but see, pmc has indicated that they would like to participate or partner with the st anthony's clinic. and of course with the history, i think, as you well know that there's been a series of leadership changes, and that's been cpm sees rationale for the kind of on and off nature of their partnership with st anthony's thank you. did you want to hear from cpm? see on the topic? yes, please.

commissioner. thank you for having us. my name is kate weiland. i'm the manager of community health for cp m. c um, so this provision has been kind of confusing over the years. um and there has not been an available new mso in the tenderloin throughout the history of the d a. so um, the closet da actually says that if no new mso becomes available prior to 2015. then there's not really anything that we can do about it. we have been working with st anthony and names over the years and we've always been a long time partner of names in the tenderloin and not in the tenderloin. so that isn't a mess so that we've been a partner for a long time. we see over 30,000 patients in that partnership in general that 4500 patients in the tenderloin from names they let me know that about 8% of those were new in 2020. um so that's about you know, 300 or so new patients that were new medical enrollees in the tenderloin? um, the 1500 new medical enroll years. we were

not able to meet that because no new mso was available prior to 2015. so at the time, we had worked with st anthony's and other providers to try to create an mso, and that was just not deemed. financially viable by the partners, so they didn't want to create it. st anthony's does serve patients in the tenderloin. they are partners with m s with names. i actually spoke to them yesterday, and they didn't have a great sense of how many patients that really working on together with names, but we are in talks with them. they have a new medical director and indeed director of the organization, so we are committed to serving patients in the tenderloin. we have other ways that we partner with organizations and tenderloin through grants, which is wound up being kind of more viable, given that no new mso was created, and that the partners there didn't want to create one. so, um i'm happy to share more about this other partnerships as well. with those other partnerships result in meeting the requirement of 1500 new medical patients and what would be the planet for doing so. so not necessarily. i think we partner with san francisco

community health center, which sees patients in the tenderloin and we're also the hospital partner for them, but we have not been able to enroll 1500 new medical anomalies in the tenderloin, and that isn't really us. that's that. there's no new mso in the tenderloin, too. enroll 1500 patients they're just never has been. so excellent. did you have any other questions or comments? great thank you. vice president christian. you elevated me? i'm a commissioner. oh, looking at not correctly at my notes. i apologize, but i appreciate that . uh so thank you, president tanner and members of the planning commission. it's my pleasure to be with you for the first time today in this joint hearing. my comment. my first question and comment was initially raised by president bernal, but i do have additional questions. and if miss weiland

could come back to the podium that would be appreciated. thank you. so um, i'm new to this. and so i asked for your, uh understanding. um. so since 20 since before 2015, you said, because there was no mso so first just for the record and to make for me to make sure i'm understanding what you're saying. is that a medical service organization? yes manage services organization. okay thanks. and so you if i'm remembering correctly, you said that you were not able to, um document this because before 2015 there were no new organizations, right, so we, the clause in the development agreement basically says. we should work to try and create a new mso in the tenderloin. that means working with, you know, primary care providers who are

based in the tenderloin, if no and if we create one, then we need to see 1500 new medical enrollees within that new mso. um the development agreement says if no new mso is able to be created prior to 2015, then you know that clause kind of expires . we continue to be asked about it continues to come up just because, of course, there's a dire need in the tenderloin for primary care and we have done everything. we've done a lot to try to work with providers in the tenderloin to provide grant funding to work with names. um we did, um we're contracted with one mso, which is names in the tenderloin, but they were supposed to be another one in the d a, if that was able to be created, but the clinic partners didn't want to create it because it was not deemed financially feasible. so that's kind of where it stands. so under the terms of the d a. you were not required. to attempt to do anything after 2015 right. we were in compliance because there was no new msl prior to 2015

that being said, we have continued to try to talk to st anthony's over the years. um and they've had a lot of leadership changes, but we are back in touch with them. and so it's possible that they are going to be interested in creating a new mso. but at the time that wasn't um, deemed visible, so there wasn't really anything we were able to do to force the creation of one again. we do have this longstanding partnership with names. they've opened a new clinic in the tenderloin. they're continuing to do outreach to see more patients. so we're hopeful that we get more. you know, medical enrollees from the tenderloin through that partnership as time goes on. thank you, so i'll rely on the city attorney to let us know the legal interpretation of that. i'm not going to go to try to do that. because i can't. yes sure. but i also just want to encourage you to do all you can to create. the services. i know that you are saying that you've done uh, a lot and that you continue to but obviously as you just recognized san francisco overall, but especially in the tenderloin, we have a dire and the kind of lethal need for more

services. and so this is obviously an all hands on deck problem in the city that could not have been anticipated. before when this when this, uh, d a was created, and so you know, i just want to join the community and as the commissioner on the health commission ask you to do everything that you can to in whatever ways that you can to create those new services and to document them. i think we do need to know what has been done. and it seems, um um kind of odd and unacceptable that there's no way to count. the number of new . individuals and duplicated individuals in the tenderloin. and so, um, you know, i appreciate all the work that you've done, and i know it's you know. it can be impossible but still asking you to try to try to do it. and since you're here at this, my comments and questions were directed towards

you. so if you don't mind, i'll just you know. go go ahead with it. so starting with the pool so it's my understanding and correct me if i'm wrong that uh, it's. see pmcs position that because the pool was not designated as a treatment facility. there's no obligation to keep it open or report why it's closed. actually going to defer to a colleague on this one, um, i'm gonna bring up the white to talk about the pool. but i appreciate your comments about the tenderloin and thank you very much. thank you. high commissioners melissa white. thanks for having me on the pool . the pool has not closed indefinitely. the pool was closed during the pandemic reopened, and then we closed it again because the pump is broken and the lift is broken. so we are currently fixing fixing those issues. we imagine that that will probably be open end of august early september, so i think there's some misunderstanding. so the pool is

reopened, will is will be remains open will reopen after those items get fixed. um and it is for 1 to 1 therapy patients, so you have to have a doctor's order. and you know, i'm not a medical person. and so if you can, uh, help me with that so i . does that? what is it true that it? was not designated as a treatment facility. and that is one of the reasons that that see pmc relied on or is that just a misunderstanding? well i think it and i probably asked our legal folks, but i think it has to do with the license, right? i mean, it's not. i think the difference was a community pool to a therapy pool. so community pool is like what we all you know, i people can go to it. they can jump. you know they can take classes. this is a therapy poll that was designated for, um you had to have a doctor's order or a note to be able to come

into the pool. um and prior to the pandemic, there were smaller classes that were done. maybe 2 to 3 people in a class after the pandemic when it reopened, it was we trying to make it a smaller situation we did went back to 1 to 1 therapy. so that doesn't mean though, that we can't have a conversation and if a doctor prescribes a note, we can look at going back to those 2 to 3 people classes, but that's where we are right now. when we reopened, it was more about let's make it smaller. make it safer, and we went to the 1 to 1. and as soon as the devices. you need to reopen the pool. uh you will reopen it. oh, yeah. yeah. no we imagine that those things will be fixed by the end of august. early september is what our facilities folks are saying. thank you. that's great news. um and a collar mentioned that the pacific campus also had a pool and is also in that pool is also not open. what is the status of

that? so that pool was closed years ago. i mean, years ago. i mean, obviously, you guys know that the pac campus moved over to the van s campus. so i'm going to say that that the pact campus closed maybe six or seven years ago. um so that was a process. well, well before me. okay that's really helpful. thank you for your explanations . i have a question about the sub acute beds. i don't know whether that's something for you or not going to get it back up here, okay? give me here. bye hi . thanks. and so with the sub acute beds, you know again, it's just looking at the fact that we are in this emergency multiyear emergency. that's not going to go away. it's probably sadly going to get worse if we don't throughout the city throughout the and you know you're here and so i'll just say throughout your network. that more beds are not . if more beds don't come online

. people in your network are going to get the treatment that they need and certainly in the city. uh others. you know your colleagues outside of your network if they don't do it as well across the city, we're going to continue to have this lethal dearth of facilities and , uh, individuals in your network. obviously, we'll have to go out of the city to maintain to have a bed if it's necessary, and so just if i don't know if there's anything that you want to add about c pmcs efforts to create these sub acute beds. i mean, i will say you're right. you know, there's a crisis both of sub acute and sniff beds. i would say, i think, um, we have been working with the city. um you know, it's been a while actually, since they've reached out to us, but we are open to conversations about the best way to support the creation of new sub acute beds in san francisco. um and how we can be a part of that process along with our other

hospital partners. um you know, i think it's something that to your point has to be kind of a city wide solution, and that's sort of where we've come on board and, um you know, we have been compliant with sharing all of our data on sub acute discharges. and how many of those folks are going out of state? i don't have those out of you know the area. i don't have those numbers in front of me. um but we are always open to conversations and trying to figure out a solution to both the sub acute and sniff bed issue in san francisco. thank you for adding the sniff to that, and i'll just say that as a as a san francisco and as a health commissioner i would urge you to use more of your resources to make this happen more quickly, and even if it's on, you know, kind of a triage basis to the extent that that makes sense in reality to just to, you know, do all all that you can to get this going even as a small as it has to be just to add more resources to, uh keep people alive in the city and to keep them housed san franciscans to be able to stay in the city and not be sent out

of the city if they if they need that bad. and so i think those are my comments and just thank you for your work. but please do more. if you can. thank you. thank you, commissioner cameron. thank you. and uh, along with my fellow commissioners, you appreciate the opportunity to be here together with members of the planning commission. uh to hear the report and to, uh i guess, um make sure that we are doing our duty. uh is it relates to the residents and citizens of san francisco, uh, in the dire need for health care and expanded healthcare in san francisco. my questions have to do with the emission bernal. ah labor and delivery. um concerns . um there have been a number of comments that we've heard at the health commission and i think throughout the city around the need and the concern ah around

labor and delivery services. it was noted in the report that there is an intent by cpm c, uh to restart or to relocate. and open the labor and delivery services. but no timeline has been sent. could you please? um share with us why, uh, the delay or and what the process is going to be for setting a timeline in actually bringing those labor and delivery services back. to the, uh areas of san francisco that are needed. we understand that the transportation issues for patients having to go to van s, as opposed to being able to maintain, uh, a local, a local uh, services for them is, um burdensome to say the least. and so the sooner we know and they know ah, that there is going to be local services or nearby

services and a complete set of services for them is going to be important. so if you could explain that, thank you. thank you. for that question. i'll introduce myself. hamblen county kemah, interim ceo of c p. m. c and, uh, commissioner christian , this is my first time here too. so ah! and so thank you for the question. we will reopen r o b department inpatient department at mr and burn all we would like to meet with dph to discuss the details for a safe return. we have continued outpatient services on that campus for women and obvious services both and department. you know, frequent checks that you have to go see a doctor. uh for prenatal care. it is only the episode of delivery that was consolidated at the one location. which you heard from max. talking about the primary goal was to convert those beds have them available for a surge

in the city, as we had reported to the department, public health over and over again on that particular topic to be ready to serve san franciscans. thank you . i appreciate your intent to do that is there? um again, uh, sense of the timeline. and are you waiting for the dph to approach you or are you initially will we will. after this hearing, we will set up a meeting with dph talk about the details for a safe return. we're not waiting for them. we will call them. great and we would appreciate as soon as there is meaningful progress to be notified of that meaningful progress. and so again, the patients that are in need of the services will be able to be assured that i understand that the prenatal services are available, but as as we know, at the time of labor and delivery to have to transit worry about being transported, uh to a place

that is unfamiliar at the time of critical need, uh, is something that is more than just sort of a physical burden. on the patient. and so the sooner that we can hear that those, uh, services have been or on their way to being reinstated. that would be great. i had absolutely small question about the, uh, the center of excellence at the , um at the campus, and i don't know if that's something that you can quickly. it's just, uh quickly, it said the community advisory board meetings were replaced with, uh, stakeholder interviews are is that community advisory board being reinstated on a physical meeting basis and when, when will that occur? i'm going to have to defer to my expert. yes they are back in person. we actually just had a meeting last month with a number of patients and providers, so those are back in person now and

will be done at least twice a year. great and then one other minor question. well, not minor, but, uh um, the staffing, it said it was includes two languages could you share with us with those languages are and is there a, uh a and intend to expand those languages there? just spanish and english right now, um, the majority of patients seen there are spanish speakers. is there an intent to expand the number of languages of made available? uh given the population of san francisco, even though the majority of the patients are spanish, speaking we all know that proportionately . there are many other languages that are going to show up, if not already showing up. sure interpreter services are always available for all patients right now the community health workers that are embedded at the center for excellence are spanish and english speakers. um but of course, you know, staffing changes, as needs. you know, present themselves in the community, so i'm sure there is the possibility of that. i don't think right now that has been identified as a huge need, but of course, it's something that

we're to your point aware of that. this is a you know, multicultural city with a lot of different languages, and we do try to meet those needs. thank you appreciate your answers to the questions, uh and i would encourage you to not wait until uh, particularly on the language services. uh problem presents itself with regard to the need to proactively. uh um collect the data or do the work that is necessary to see whether there are proactively language. other languages that are required. thank you. thank you. the end of my questions. great thank you so much. commissioner couple. yeah. thanks for all the staff involvement today, great to see some of our familiar health commissioners and new faces just for your reference, uh, all kind of just make some comments on the construction compliance. i'm still a dues paying member of electrical workers local six. so i've been tracking this project since day one. i remember when it was a huge block wide hole in the ground. really really,

really deep. i was looking for a picture of it. i don't have it, but that's how far this project has come. i've been working into really integral e with ken um and chase torres throughout the process, making sure that more women in disadvantaged residents from 941 to 4 neighborhoods have had a chance to work with and through city build feeding into the building trades apprenticeship programs, which many of her here located in san francisco in these kind of jobs employ a lot of, um, construction workers on the job sites as well as apprentices and also city bill graduates in the office is working for the contractors doing a lot of the paperwork, too. so couldn't have been happier that jobs like these wish there were more of them. um but throughout the process with the labor and construction and completing the build out, i couldn't have found the pmc in more compliance. so thanks again. thank you very

much. commissioner brown. yes, um. yeah, that's great to be here with the members of the health commission appreciate the opportunity of this hearing together and also thanks to all the members of the various departments in the within the city of the city staff who have worked on this as well as um, cpm. see, i have uh, kind of two issues. i want to just ask some questions about so one item. relates to the build out of, um , improvements that the guerrero and san jose plaza um, that was part of the development agreement. and from what i read. my understanding is that those improvements were supposed to be completed the time of the opening of the plaza adjacent to the mission bernal campus, which i assume that means the plaza and cesar chavez and that is now open and it's gorgeous. um but i'm just wondering what the state you know this is the 2021 report. um, the deposit hasn't been built out at all yet, um, today in 2023. so what's the state? the status of that right

now? yeah the my understanding is that the plaza is either recently completed or just about to be completed the one at the hospital, and that is the benchmark set in the in the development agreement for completion of guru plaza. we've had a pretty lengthy process of design and permitting. it's a although it's a small location that grew up plaza. it's a complex one it you know it impacts a public street, the site itself as a public right of way. um so they need a major encouragement permit to create that park and also, um, it's gonna affect driveways and drainage inlets and so on, so there has been a lengthy planning process. um we've also over the course of the development agreement seen a number of changes in what the city wants and what is feasible to build in the entire surrounding area. and so we went through a process twice now of, um substituting as the development agreement allows us to do some improvements that either have already been built through other means, or that we've determined were not needed after all, and that allows see pmc to take those funds that

were originally earmarked for those improvements. and move them over to the plaza. i'm happy to say that we have just completed the second substitution agreement that we're going to be able to substantially increase the funding that's needed to build group plaza and that we anticipate the cpm already submitted a permit application for the major encouragement permit and for the improvements they need that that permit is in process. but we expect the approval now to be able to take place relatively quickly and for the plaza to be under construction. we hope this year i don't know if, uh, representative from center have anything to add to that since third one is actually pursuing the permit. did you want to hear from the health system on the permit prior progress? no i think that that answers the question. i appreciate the answer. um certainly stood out to me as given that the you know the timing of the that opening was supposed to be linked to the timing of the hospitals plaza opening, so it's good to hear this progress on that. i understand it could be complex as well because i think there's

also intersection improvements that are happening at that. there's section, possibly this year. um, so i do appreciate that. um my other question is around. we received some comments about the transportation demand management measures and specifically the clipper cards or or encouraging employees to shift away from the single occupancy vehicles through transit measures. um you know, i'm wondering if, uh first of all. are there any updates? you know? i saw in this report that 80% of the employees were enrolled in the transit subsidy program. um and that's the transit fare was expected to resume in 2022. what's what sort of happened since the 2021. period for this report. um in terms of what's happened since 2021 i do you want to? do you want to say something? okay. come on. this is very messy in from center health. thank you. elizabeth varmus, etienne,

etcetera, um so the transit fares were we were hoping to start in the fourth quarter of 2022. but the covid, uh, order was lifted thereafter. so we are going to be having four transit fares one at each of our campuses. ah hopefully, we're targeting november of this year , we might have a second transit fare also at our venice and gary campus, since over 50% of our employees work in that transit rich intersection. so that's that's our that's what we're aiming for. we're beefed up our internet homepage. we have a dedicated space where employees can get information about transit, not only transit, but about other ways of getting to work. um, and the resources and benefits that we offer to allow for that. um i think within c

pmc and outside of cpm see within the center, other center affiliates, everybody. uh, can you patterns have changed drastically and where we've fallen behind in terms of our transit ridership? and it's gonna be a number of years. we project before we get back to a level. um you know, pre pandemic goal setting, but we're, um i think we have measures in place where we're trying to get to those get to those levels. um thank you for that. yeah, i don't have any follow up questions, but just to say i mean, yes, certainly the world has changed quite a bit since the development agreement was signed in terms of how our getting around and where folks are going, but um, i think that that's just a challenge to be met. and it makes the tdm measures all the more important and the need for a really robust implementation of them. all the more important, uh, including,

you know, making this as easy as possible the choice as easy as possible for employees to decide to take transit or walker biker carpool. um, now that we're out of the public health emergency, so i would just encourage that. all those efforts resume and, um are we doubled at this point, but thank you very much appreciate that. thank you. well, we have one that topic. i just curious or if you have any insight into imagine there's been not only changes in commute patterns that changes and who works at the facilities as i think a number of organizations have experienced just turnover during the pandemic, and certainly health systems among them. do you have onboarding for new staff that informs of them the transit and kind of non kind of uh, s o v ways to get to work kind of building on commission. ron's question about how we're making it really easy and you know sometimes, if folks are new learning to navigate a new transit system to a new location , a new job site could be comes in as a burden and hopping in the car could be easier. could

you elaborate a little on that? yeah we, um you know, are hiring numbers have picked up since the since the pandemic and we have new employee orientation that employees need to go through, and a big part of that is providing them with information on their not only their commute options, but the benefits that are afforded to them. um through , um we use wage works in terms of making it as easy as possible or seamless to do. to pay for the transit. and then we have our our subsidy program. um we also provide them with information about the pre tax benefits associated with that. um we have emergency right hope programs. we have a shuttle program to get folks from barton, caltrans. um. i think i think challenges also, um, uh, challenge of perception of security as well. um we have three shifts of employees who come to the hospitals and, um

and particularly during the evenings and later on. it's it's harder to try and, um. i think i think it's a partnership with the with the city and with the transit agencies to try and create an environment which is, uh, where people feel safe as they can to write on transit. great. thank you very much. commissioner diamond. thank you . i too want to express my appreciation for the joint hearing. i learned a great deal from the questions asked by the health commissioners, as i always do from the questions asked by my fellow planning commissioners, there are two substantive issues that have already been raised by the commissioners, one related to the timing of the labor and delivery services at the mission bernal hospital and the other related to the tdm measures that

i share the concern raised by both of them, and i want to dive a little deeper with staff in the city attorney as to what the legal requirement is, um like, uh many other mothers in the city. i have benefited from the wonderful labor and delivery services that were provided and are provided it. she pmc having had three children at their facilities. i also understand how absolutely critical it is. especially for new time moms to have those services nearby. and so i'd like to understand whether we are relying on the good graces of cpm see, open up , reopened labor and delivery at mission bernal or whether or not there's actually a d a requirement to do that. and i don't know whether staff or the city attorney can weigh in because while i am understanding us to why they shut it down without giving the 60 day

notices during the covid emergency, i don't really understand the lack of a timing commitment that was provided in response to the question that was asked. and so i'd like to dive a little deeper and understand whether or not it's actually an obligation. or whether or not they can choose to do this, um or not do this, so if you could weigh in a little bit as to the nature of the obligation and the consequences if there is an obligation, i would appreciate it. yes thank you. commissioner diamond. so under the d a. c p. m c is required to provide a set of services at mission bernal, uh, and that they can adjust or reduce or move or eliminate these specified services, but they have to provide prior notice to the city and this, um, and they have to at least provide. i believe six months prior notice, which they did not provide. right in 2020 and which we found them noncompliant for and so under the d a. if they

provide that prior notice, then they meet and confer with the city to discuss, um those services and there's latitude within the d a, um, i forget the exact criteria for them to decide whether or not to continue providing those services so there is a requirement that they provide notice, but then they can reduce those services if they meet that certain criteria, but there's also other provisions that they would have to kind of abide for possibly a prop. q hearing or the ordinance, sir. what's allowed under that ordinance? i'm not sure if you're familiar with that, but no. could you explain that, please? so let me actually provided the specific language. um so property you as a voter approved ordinance that requires private hospitals to provide public notice prior to closing hospital, inpatient outpatient facility or eliminating or reducing the level of services services provided prior to leasing, selling or transferring of management and the health commission can decide whether or not to hold a hearing to determine whether that proposed

act action is detrimental to the community. and historically, dph provides a presentation on the impact analysis of that proposed action. at which point then the commission can decide whether or not that action is detrimental to the community. um and so in terms of labor and delivery, um um, what we can i guess that in terms of like why we found them compliant. this for 2021. is that the action that of not providing notice had occurred in 2019 and 2020. but if there's continues to we're, of course, happy to kind of revisit that finding as well to see him and kind of follow up the city attorney regarding that finding as well. yeah. sorry. i remain confused, and obviously this is a dph issue and not one for the planning department. um although i will say it's confusing in terms of the legal obligation under the development agreement , which does fall within our purview. so they didn't provide

the notice. they didn't have the meet and confer. um but now they're in compliance because it's past that time period. i'm just having a hard time getting my head around. what the city what the city can do about that at this point in time. obviously the prop q hearing that's within your purview as health commissioners. i just trying to understand. an issue that was raised by one of the commenters as well to as to consequences and next step, so i'm i'm looking at the city attorney to see if they want to weigh in as to where this stands. i'm sure. um, and thank you, commissioner diamond. i believe this health commission secretary and wanted to add something. thank you. really quick comment. commissioner diamond. the prop q hearing does not give authority to the health commission to do to decide on whether something should close or not. it's simply determination of whether it's detrimental. i want to make sure that's clear so they can't make changes to what's been decided by a hospital. and like like

yourself. i've learned quite a bit at this hearing. um this d a was adopted before. um my time advising this commission, so i'm not intimately familiar with all of the details and their obligations and to the extent that some of your questions relate to um, health services that are required and not truly land. use questions. i'd have to defer to my colleague who advises dph who they're not here today, but i'm certainly able to follow up about this question and circle back with you and any other commissioner who would be interested. okay i really would appreciate that. and uh, as i said, it feels like this is more within the purview of the health commission and our commission. it's just troubling to me. that's not have received an answer. really as to the timing on. i mean, delighted to hear it's going to reopen but concerned about the timing, so i'll just leave that. you know, as a question love to hear back from the city attorney and, you

know, raised that with the health commission for them to follow up on my second question had to do with the tdm measures , which is within our jurisdiction is land use issue. and i noticed it wasn't covered by staff when they were going through the analysis as to whether or not they were in compliance, erratic compliance, so i'm curious about the nature of the obligation. and the d a, uh, and the requirement the actual requirements under tdm, and they are they simply goals. um or as maybe you could just delve a little deeper into the nature of the obligation given where they are sure, the fundamental obligation is that, um c p. m c has to reduce their um, single vehicle up 50 trips by 15% relative to the condition at the time the development agreement came into effect in 2013. um and to that end, they have, um, you know, in addition to the programs that you've heard about the transit subsidies and various other

measures to encourage transit use and to discourage driving and parking, they have done a survey and analysis every year that the development agreement has been in effect, um, to see, uh how effective um, in the interim. um there measures have been in reaching that goal. um i do want to point out that they are not obligated under the d a to achieve that goal until 2024. clearly the pandemic because it's encouraged people to drive in single occupancy vehicles has impeded their ability as you've heard, um, to continue to reduce the number of those trips. um there are still some measures available to them that in addition to the ones that they already have in place that could further reduce them their their trip generation. um they have again another couple of years to do that. and this again is a snapshot from 2021. what we know about 2022 is not particularly

encouraging. it continued kind of a pandemic pattern of commuting. so you know, obviously this is something that we're that we're watching closely and that that s f m to is working with c pmc on to make sure that they continue the measures that they've already have in place and to consider whether additional measures are needed to meet that goal, okay, and the goal is an actual obligation. it's an actual obligation, 24. so what happens if they don't hit that goal? but if they don't need that gold, and they need to take even further measures, and some of those are outlined in the development agreement, specifically others are available, you know, ongoing td at you know, as we learn more about the effectiveness of tdm measures in general over time, there are additional technologies that could put in place or measures they can take. because i, you know, i'm very understanding of the disruptive consequence or the consequences of the disruptive event of the pandemic and that i'm just wondering whether or not the

2024 date needs to be amended in order for them to actually achieve that, if that's the case , what's the process for changing that date or or or do you consider changing the goal? and i'm trying to figure out how you deal with that disruptive event in terms of non compliance with the actual terms of the d a. yeah you know, we could. certainly by that time, be in a position where we would have to make a finding that they're not compliant or, you know, assess whether there's a realistic prospect of compliance within that time period as to changing the da or what or what d obligations continue after that time, i think it's more question for the city attorney's and we'd probably have to get back to you on that. not sure, deputy city attorney austin yang any amendment to the d a will most likely require approval by the board of supervisors. um so i, you know that would be there's a process for that, and there's typically a process outlined in

the development agreement. um, for considering, um, an amendment. i'm not sure if this would be considered a major amendment or minor modifications that there are depends on what specifically proposed. okay i just wanted to raise the issue, which is clearly not in compliance at the moment. there's you know, an explanation for why they're not. but, um i want to just leave it hanging out there because it feels especially given that 2022 numbers that you referenced that sort of what do we do about that? because i am concerned about having obligations that aren't mad. and what are the consequences? and i would say that at this point, it certainly is a concern that they are not trending toward compliance and again, largely due to the pandemic and the change in commute patterns due to that the tdm obligations go on indefinitely. they do not end with the d a. so they will still be required to, um, to maintain those measures and to community work toward the goals. indefinitely and sfm ta will

continue to monitor how they meet those goals indefinitely. i think i'll leave it at that moment. thank you. well certainly there's some more room to keep working on the tdm. since that continues on, uh, commissioner chow. oh, there. there we go. yeah. is that okay? thank you. and i do want to thank my fellow planning and health commissioners again for allowing us to meet in person. and that, uh, the pandemic certainly has thrown off many of the you know, presumed obligations or being able to meet that. so so i understand that and the first thing in to take up commissioner diamonds point i do think that our department needs to understand better. were the prop q stands for the issue of o b. i mean,

just because they did not come in, and 2019 and 2020 and were found not to be in compliance. they still haven't come in. and when does that clock actually tick now because prosecutor was designed to be prior to an action. and now that action has already occurred. um and in in in that case it prosecute doesn't apply. what really does apply because something has closed. and even if it were to open, um then at what time or when do we get those reports? so i'm not asking max for you to, you know, answer at this point, but to bring that problem back to legal and the city attorney for us to understand, uh because it propped cues. intent was to allow the public to understand that something was going to be changed. and give the public a

chance to talk about that and give the institution a chance to explain why that would be important, um, then are finding while um you know, advisory only is to be able to look at whether or not this is original, not an action detrimental. or how it may or may not be detrimental. uh, so the public understands what is being changed. so to get back to that question, and not to just stand on the legal issue . how then do we come to an understanding as to what to do about the fact that old closed at saint lukes for two years. we didn't hear any more. we understand that. obviously all institutions were asked to provide adequate space for intended surges. we're very fortunate in the city with all the public health, uh, that that we put in place. that we didn't

need it. uh and now that today the pandemic has ended, uh, emergency wise. i mean, obviously, the, um viruses still around. ah then then it's time to understand. how do we get back to the intent of prop q, which was to understand what is happening. or if we can't do that. what's the timeline then? that we have to put this service either back in place or not in place. and i, you know and understand from my fellow commissioners and commissioner diamond. um the desire to have delivery services as close as possible. but this brings back to my memory number of years ago when chinese face the same problem. and we had a small unit there. and we then had to

safeguard the patients by making sure that we classified either high risk or low risk delivery. and high risk delivery would not be done in our facility because we didn't have the appropriate neonatal intensive care. and low risk could be. but if you consider a low risk, but then changed to high risk and ultimately the hospital and our medical staff decided. patients first and patients, including the newborn needed to be somewhere where there was not a transport issue. for that emergency even those 10 minutes. uh because the standard in san francisco today is much higher than that. that is facilities that have the services. and as we know, several other hospitals have actually not resume their obese services. and this goes back. of course. um, almost a generation. so i do think that

we've had the opportunity for three years to understand what happened to the population. how they were impacted and whether or not looking again from a patient's standpoint and for that newborn sandpoint what is best but then the questions don't comes, uh we've got avoidance service. ah. will the institution put this back? and will that be safe for patients? or maybe they choose not to. i note that in the city we are having a, you know, uh, reduction in the number of cases that are, you know, being delivered, especially in our private hospitals. and, uh, does this affect us? because um, again. that was another factor at chinese. ah the requirement recommendation by a cog that you know one that institutions

should deliver at least 1000 babies in order to have adequate trained staff. then there's also the question of can one find train staff were having trouble that general finding adequate trained staff. all of that may go into the equation as to starting up again, a service remembering that whatever they decide on it's really important to decide on the basis of what is best for the patient and for that newborn, so that's just sort of my comment about obi, which i know is something that for many years here we have discussed and um was accentuated when the unit was closed because of covid. but i think one needs to step back then and take the opportunity to say okay, what is really best for patients today? and if the d a allows for a change in services, they need to

go through a regular process to do that. and where does then the public get to here with the intent to prop q in mind, so, um , i leave that for, um our staff and for c pmc to consider, and i do want to welcome our new um, um yeah, i ceo to, uh um to the city. uh, the whole, um, remembering, uh, commissioner couples comments i remember before building with dr bradman and dr cat sitting across the street from your venice building and really holding a public information session concerning the building of cpm see? so i think following this process over these 10 years, um it shows that i think both the city and

sutter chose wisely that san francisco should be a major, another major medical center here, and i think we're all working out the way that that major medical center then serves us in the community. so my short , brief comments about the rest of this is that it goes back to our centers of excellence at saint lukes are burnell mission or mission? bruno i forget which way it goes, but, um i do think, and we've talked about that for several meetings here. that community input is really helpful. and to hold advisory meetings once a year or with the pandemic. at least there was a verbal meeting but understanding that there are, you know, just sort of brief reports. it sounds like if you're only going to do it once a year meeting you don't really have follow up on information that's coming to you. i think both of those

centers of excellence could as again benefit from having the community. uh speak with you about understanding what they would like to see and how to meet their needs, because that that when the centers of excellence were put in. they were specifically for the community. and so i think that at our next hearing, it would be nice to hear what that was. ah a compliment to in terms of the class report, which is the cultural competency report. um. the information that you have provided that cp m c has provided has been excellent this time. it has shown the effort going into the class standards, not just simply quoting them as we had in the past, but actually demonstrating the work that you're doing, uh, the fact that you also gave us demographic semi guards the breakdown of the

language requests and how you've met those so i want to thank you . this, uh all of us, i think thank you for demonstrating the work you're doing. i think all we're asking for is show us what you're doing, and not just merely quote the line and say we are in compliance, and i think that's an excellent example of the work that you've been doing. and i commend you for that. ah! less so on the sub acute beds. uh and i would join my fellow commissioners in really encouraging that see pmc work with the city continue to work with the city. uh you know that . um uh and we know and appreciate that the study done in 2016 was with the sponsorship of c p. m. c. ah! now is the time as the city is working itself. um uh, with with with

funding on its side to try to create sub acute services for the county's patients. that it's an opportunity for all san francisco hospitals to see how they can keep their san francisco patients in san francisco and therefore there really is an opportunity today to actually have a solution that would work for all hospitals. sutter is one of our largest systems and i would encourage then that center take, uh, consider a more active role with the city. um and not wait for the city to call you on this one either, but to reach out to the city and find out how they can also assure that there can be sub acute beds are valuable to residents of san francisco who are patients have sutter uh, and the c p and c campus when there

is a need for sub acute services, so um that actually, i believe includes the comments i had. i'm really appreciative of also the summary that was put together. i think those concerns remain, um, on the technical side. i think commissioner ah! um commissioner diamond has brought up the, uh, complexity that how do we find this particular item on page 43 compliance when we still don't have the maternity program there ? i mean, that's just a technical thing. it looks sort of odd that for two years were saying they weren't in compliance, and that this year they are, but there was no change in the status. so i'd ask the director of health to consider that, um, that might be , uh, um, marked in a different manner because i think we're still working on what is the

best solution for delivery at ah, mission, burnell. burnout. omission. sorry. so thank you. those are my comments, and i appreciate the opportunity to be able to make them great. thank you. so much for those commissioner more dr chao's comments are a hard act to follow. not only the wisdom no, don't use the worst time of having participated in this forum for his allows 10 years, basically from day one on but also have councils the depths of the struggle that surrounded the planning and building of this project. and again, i think my own fellow commissioners for why is comments particular mr koppel , reflecting on the building of the project was was difficult. but i want to pick up not repeating all the comments that you have all made but look forward to the responsibility, he said. well west with you a little bit longer than with us.

uh the development agreement for most of its provisions is effective for 10 years. and i think for our group together for us, it is the last time that we are part of this of this cycle to speak to each other. and while i agree with all the positive things that have been achieved, um. the letters we received, particularly the planning side. we mind me of a number of things that are never done. never finished because of vote to success is always under construction. commissioner brown spoke of policy transportation management plan. we received a very strong, detailed letter from the cathedral hill neighbors. who originally was the strongest opponents of the project, given that they are directly affected being next to what is a residential neighborhood. they act for the last 10 years participated in each review, making their comments and the comments. are

slightly changed because they acknowledge compliance, but they continue to remind us that rents the transportation management plan is not the project is a beginning and an end. that's basically how we after covid have to look at all transportation management, particularly the eu. some more intense use of public transportation and see avails of clipper card etcetera to do better than we did before. and i think it is hard to measure after three years of nothing to all of a sudden figure out of how to properly measure it. but it has been pointed out in the past and it it's being pointed out again. that particularly used the absence of data on encouraging the use of clipper cards. uh needs to be pursued by everybody. and again, we know that parking is easier and safer and i don't have an answer. i just want to we emphasize the

collective need. of looking at that. the other thing is, um one second. i am delighted about the bus rapid transit on vaness. it makes a huge difference of how we use it and see pmc. was a major participant for that to be studied properly and implemented. however. i write from the clay street station, uh , all the way down to city hall. and i hardly ever it's a difficult thing to admit. see people get out at sea pmc stop! and that such says to me that the participation of patients as well as personnel is at least not on that line. i just want to say that the clip of cards requests that is being posed to us needs to be more intensely studied. i want to shift to

something. that's a little bit harder to speak about, but was clearly reflected in many comments that i heard today. as you all know, this commission. two years ago, committed to social and racial equity being one of the strongest elements that shapes and forms of what we do as a planning commission. and from the very beginning, as you may recall, particularly dr child will be called we had the . francisco disenfranchise iskan for health, housing, jobs and justice to be a very, very forceful voice and literally everything we did. and they were minded us. not only in the preliminary still proving the project, but while it's a process in the 10 years that this has now been hood by both commissions. that's the attention to proper support for

health care and the tenderloin. each year fell short of the compliance. it just did. i understand it is extremely difficult. i understand all of it. however that does not diminish the obligation was com, which comes with the d a. and i think i want to. perhaps quote. one sentence that professor abramson aaronson, who was now emeritus of you see, uh, law school, wrote in his last sentence to us. and i'm not gonna read what he says. they're not doing but i think he is asking us. uh, that's the highest order for us is to meeting the healthcare needs of low income san francisco individuals and families, not just under the d a. but also as a nonprofit entity that receives substantial tax relief for which expectation is that its services

will be fully and proudly available. that goes beyond what we do here and looking at compliance that goes to encouraging a shift of attitude. and that has been at least in my presence here. repeated each year when we look at compliance, and they won't leave us with that. thank you, commissioner. more commissioner imperial thank you. and i think for all my fellow commissioners, both in department, public health and planning with all of the questions, um i share many of the sentiments of other public health commissioners and also the planning. um and overview for me. um uh and with all the comments from the public and the commissioners, there seems to be , um yes, there are in compliance in terms of the piece there are, you know, compliance in terms of the them, you know

the other services that can provide, but at the same time, it's still falling short and what the community actually really needs or what the city really needs. um so i'm trying to, um, figure out as well or from my understanding. this is the last joint hearing. for this development agreement. is it or i want? perhaps that's a clarification. i need to ask. is this the last joint public hearing? yeah it's a little confusing. the development agreement expires in august of this year, although, as i mentioned some obligations do go on after that, um because of the annual review cycle, we expect to have a 2022 review for last year, and that report is due soon, and that process starts very soon and then also for the portion of 2023, for which the da is still in effect. we're still discussing internally whether there'll be one more hearing or two more hearings, but there will be at least one.

thank you. that's a good relief , at least for me. um because in terms of i mean, one for the planning commission side is the tdm requirement, and it looks like and thank you, um, you know, gave us a lot of information in terms of sfm ta monitoring this um, in terms of the tdm compliance, and i would like to hear as well as from from the sfm to side in terms of the tdm and whether they should increase their fees to the cities if they are not actually reaching their goal by 2024. so would you like to comment on that? i don't think i can address that question directly. i just want to point out that we do have an sfm to staff member who's available online for questions if necessary. um forest chamberlain from sfm ta is waiting on webex. are they available? i don't think can you check? janice do see. so if you have questions for sfm to he is

there. good to know. thank you literally just fell off. i saw another promoted. he's promoted was okay. mr. chamberlain are you there? could you address commission imperial question? i do have a question in terms of s, f f m d, a monitoring on the annual basis and whether it determines for any kinds of additional feasted city. um can you hear me? yes. um, that that has not come up at least on this on this last review. um see pmcs paid all its fees for the d a to the city. they've been completed that, um it's something i can look into. and i can follow up with you. however, that would be helpful. yeah um, thank you for that answer. i just would like to emphasize in terms of again the tdm compliance that if it's not reach they, you know by 2024 . it sounds like that's the

deadline that perhaps that is the time to reevaluate those, um, agreements as well. or that agreement. that particular agreement. um so thank you and i would share also the other sentiments that in terms of reporting to us, um i think it's better as well not to just say that you're in compliance, but what's actually being, um, doing more as what is commissioner christian has mentioned before? we would like to hear rich actually being done. um, in terms of i'm also interested in what i know this is in the purview of the public health. in terms of the, um, the in the tenderloin. um what are its actually the barriers of the partners in the community? why um what is the barriers in there? and why is it officially financially viable. i think we also need to understand that. um and also i do not want to blame the they, you know, blamed the

do the blame you on the on the committee partners side, but sometimes community partners also have a lot of struggles as well. and we need to understand that. and how can really what is the hospital is doing pmc is doing to support that. um so i think we need more information, not just what is being compliance. um, so i share with, um you know, in terms of this kind of hearings because we've had this kind of hearing before between, um with the tenderloin and other clothes, shirts of the programs, and until now, um, it's still like the same information we've been having. so um, so that's what i'm looking forward in the next hearing, and i'm glad to hear that. this is not the last hearing. thanks for you said great. thank you very much. make a few comments and i do see commissioner christian and president donald have their hands up. i do see a few hands up from commissioners that i think are from your prior speaking. so if you do want to

speak again, let me know, but i only see two additional lights. um certainly been a very robust hearing. thank you all for your expertise and the questions that you bring and then planning commissioners for the expertise you bring, and i which is not add much because i think we've covered all the topics. but just to say there's clearly a lot of progress, a lot of great things that happened a lot of elements in the d a. r in compliance and really have realized the very hard negotiated and thought out requests from community and city and the multiple stakeholders who brought the dea into existence and then have carried it forward to what will i guess our penultimate hearing, perhaps, and we have one more next year. but it's just to note the areas concerned that we have all asked questions about that. we heard, um folks call in, or perhaps writing into us about just to continue to make sure we can be working on those that there's really good communication. um happy to hear that there will be outreach to the department of public health about the labor and delivery services and certainly wanted to be a very thoughtful about what is best for patients in that

context and making sure that um , whatever happened is happening in a way that the public can understand what time happened and that there can be really just a clear clarity around that. certainly we understand things happening and changing for the pandemic, and i think it behooves cpm c two, then really make sure that we are being transparent, with the public going forward and trying to explain what's happening or why certain things can or can't happen, um, that the public may be expecting. um and again. i just really want to thank everybody for their time and attention today, and with that, i'll call on commissioner christian thank you, president tanner, and i'll be brief and, uh, regards to the time. first though i do want to say that i've learned so much just in the short time from the planning commission, and i'm really grateful for this opportunity to sit with you. and also i want to say that, uh, one of the things i love about being on the health commission is attending meetings with commissioner child i learned so much about the history of everything in this city, but particularly with

respect to the history of history of our obligations, and today as well as you know, with respect to yours. i wanted to ask regarding commissioner koppel's comment about the labor force. uh uh, issue. are you referring to city billed as being, uh on page five slide. 10, the major source of labor under the hiring goals. you mentioned that city build was? yeah okay. and i wonder if there's a breakdown of the neighborhoods for the neighborhoods of where the hires come from. is it in the materials or it would be interesting to know if we could have that at some point. it doesn't have to, you know, happen today. yeah we have presented that information in the past and because construction ended in 2019. we didn't include that kind of detail in the presentation in the interest of just keeping it

more streamlined, but i would be happy to provide that to you immediately following the hearing, it was available. that would be great. thank you so much. and also i wanted to appreciate commissioner bronze comments that that yes, we have these barriers, but it is a challenge to be met. and going back to the things that we've all pointed out. um, we are. you know, this is all of this, and particularly in the wake of the pandemic. you know, this is an all hands on deck where so much more is required of all of us than we ever imagined. and so you know, regarding the pool. it's been closed a long time. uh legally, it's probably not under the d a agreement, but we have heard consistently from the community. about what what unnecessary health resource it has been for some very vulnerable people, and i wonder it's been closed a long time. and construction can be difficult and you're talking about it being open reopened in august. that's three months away, and it's already been closed a long time, and i wonder

if it's i wonder if there are barriers that could be removed a little, uh, to make it a little quicker for people to be able to get back in, or whether there has has been any effort to find. alternatives for people. to use while these two pools are not in operation. i don't need any comment on that right now. but if you could respond later and let us know about that that would be great. and, um and commissioner town, noting that q . there's the intent to give the city and the community. uh information in advance and the need for a regular process. i really do hope that there's a way for the information that we have requested and don't have to get to us very quickly. and for this not to continue to be, uh, an operating procedure that, uh, anyone but. with respect to this meeting that cp m c operates

under going forward. we need the advance. notice and engagement. uh not to hear things later. so thank you so much for all of your work and your time and i will stop thank you, commissioner for comments and i will give our illustrious president of the health commission the last word today. thank you. first of all, i'd like to associate myself with commissioner christians. comments about commissioner ed chow, who has served on the commission for about as long as it has existed. so thank you for your service and for being an example to all of us. thank you. also to president tanner for hosting us again, i agree with what commissioner diamond said that every time we meet, we learn something from our planning commission. associates so thank you for that. um even though the city attorney is indicated that c pmc is in compliance with the development agreement, um c p. m c has also acknowledged the spirit of that agreement, and i joined my fellow commissioners and encouraging see pmc to continue

to lean into that spirit, including some of the obligations. that are either time limited or technically have been met. there are still some very serious critical needs in our city in terms of the health crisis we see in the tenderloin every day. the shortage of skilled nursing, um and sub acute beds, the need for labor and delivery services throughout the city, as well as increasing linguistic capacity and competence. um this calls on all of us to do more so again, i just encourage see pmc to continue to leaning into the spirit of the agreement, even if some of those obligations have technically been met, and thanks to my fellow commissioners for your time and for your very thoughtful questions. great thank you. well health commissioners planning commissioners. i think that concludes our hearing for today and we are adjourned. you.