Any comments, commissioner . I would move that on page 10, under comments on section six, i would just add that the statement that i have there would seem to sound like ucsf is the only other provider for the Cardiovascular Surgery, and thats not correct. I think my question was who were the other providers, and i think we heard that cpnc and kaiser. I will go back to the recording and clarify that. It sounds odd. Thank you for the clarification, commissioner. Other comments from commissioners . Motion to adopt . So moved. Second . Is there a second . Second. All those in favor, signify by saying aye. Thank you, everyone. Item three is the directors report. Good afternoon, commissioners, brian colfax, director of health with the directors report for august 6. So the big news is we are at the go live. We went live at 2 00 a. M. On saturday, august 3 . So far, all systems are running well, and i just really want to thank the incredible team. Literally hundreds of people, thousands of hours, millions of dollars to make this all work, but so far, so good, and while there certainly have been some issues brought forward as expected, the problem solving has acted at every level across the organization and the support for the clinicians, and i think most importantly our patients are continuing to receive the best care possible is really key. And youll remember this was literally the go live for zuckerberg hospital, laguna honda, and our clinics really connecting the data as never before. Just to give you a perspective, many of us were at zuckerberg hospital for go lives. We were walking the hauls of zuckerberg general and same then for laguna honda, looking for that change. And yesterday was the big live because yesterday was our first full business day. There was some issues in terms of data expected to show up that didnt show up, but those things are being worked on as much as possible and then triaged by the great support teams. Just to give you the numbers, zero patient harm events, so thats a good first step. 4700plus Service Tickets opened, and the majority of those have been resolved, so thats a really key thing. And then, i think in terms of service desk calls, so far, theres been a less than sevensecond twotime wait call for that, so really good data there. Going down stairs to tom lidell clinic, i was talking to some providers, and literally, i turned to talk to someone else, and there was a person helping them, solve problems. Keeping it real, i think there are some frustrations and challenges, but i think overall, were expecting what is to come in the system change. And finally, i just wanted to state in meeting with the ambulatory care leadership in the trailer at zuckerberg general. One person had gotten a low potassium on a patient that had come into the care clinics. And because of our generalized data, they were able to determine the person was at the Sobering Center and able to make sure that persons potassium was being corrected. Before, we wouldnt even know where that person was. Had to track down that patient, and this was a very clear example of how in the first few hours, we were making patient care better. Im confident that there are hundreds, if not thousands of examples of that going forward. Very excited and will provide more detail to you at our next commission meeting. I also wanted to mention on a few other pieces of our report, we are continuing to cooperate with the California Department of Public Department with regard to the laguna honda investigation, and we received a formal statement of deficiencies from cdph on july 3. We filed a response on august 2. It describes how were implementing standards to establish standards set by our regulatory partners. I also wanted to remind the commission that we continue our Operations Center in response to the increases that weve been seeing in congenital silvsilv syphil syphilis. Im actually serving as Incident Commander for the month of august, so its great to support an amazing team thats working on this and more focused on collaborating across the departments and communities so we reduce the incidents of congenital syphilis going forward. So you can read the rest of the report and i stand ready to answer any questions or comments. Thank you, director. I did have a question on the go live. Is there anything youre especially hypervigilant, especially things that might still be coming up. Even though things have gone incredibly well too much to expect. Well, i think the things were most hypervigilant about is making sure that the data thats there when a patient is coming in so that the provider can prepare the best care possible . Also with a mapping from older systems to the new epic system that there have been occasions in the system where the mapping didnt go to where we thought it would go, so correcting for that quickly and effectively. I think also because of the workload that continues to be in the clinics and in the hospitals, that were ensuring that providers have the support that they need in order to continue to provide the level of care and services . And then i think finally that were provide the work necessary so theyre not workarounds that could harm our system, so making sure that people arent going outside of the established protocols that are necessary for the whole system to function . And i think whats really key, and i just want to acknowledge this because it cant be said enough is that the super users in that persontoperson support, and when you look at epic and the implementation, its about making sure we just had a discussion at the finance committee, that theres robust numbers to help people problem solve is really key. Thank you. Any questions or comments from commission . Commissioner . Yeah. I had two. One was on the Hunters PointShipyard Building 606, which was the police department, how are they accepting the report and how are we working with them . It was a great report that they are not now in danger. Have they received that in a positive fashion or is there still dialogue with them because this was a huge yes, yes. So dr. Aragon will provide some details of that, and thank you for pointing out. I did skip that item in the report in the interests of time, but dr. Aragon has more details. Good afternoon. Is the question about building 606 or is it about parcel a . Building 606 because thats all the report is on. It says that weve come to a weve come to a report saying that there was no problem. Correct. So they did extensive testing both they did a radio logical scan looking to make sure there was no exposure . They also did dusting, and they also did dust testing for asbestos. So all the testing that has been done over the years has been negative. The only problem they did find was early on, there is some lead levels in the water, so theyve been providing bottled water for that site for years, so no ones had any exposure from the lead to the water. So thats same accepted are they still occupying the building . Yes, the building is still being used, and the building is completely safe. Okay. And since the late 1990s, weve had an industrial hygienist from d. P. H. Based at the building to provide not only testing but also address concerns over the years that has come up. No, thats helpful. As you know, public reports have sort of portrayed it otherwise. Yeah. Most of the reporting has been primarily about parcel apartment where they have apartment buildings. I know people confuse them. Thats why i brought it up, because thats the perception people have. Thank you. Yeah. My other question was in regards to the supplemental budget. Administratively, we had some decreases in the recommended budg budget which were not going to affect your administrative capacity. But then, with the new proposed programs, is it that we are going to be able to put those in feis in the budget year that were talking about . Or were they already there and were now just getting more funding for it or whatnot . So i can get you more information on that that specific one . Oh hello. I will let our budget director respond to those questions. Yeah. Commissioners, jennie lui, d. P. H. Budget director. They are ambitious. Most notably is the 2 million you see for residential treatment for youth. The parentheses you see, it means we have two years of funding for it . So we can spend that allocation over two years. I expect it will be a new program, so were going to have to identify, so its not started up at this point today, but we will work with identifying an available c. B. O. Through appropriate contract to get the services started, and then, we have the ability to Carry Forward the funds into the second year. And some of these are potentially continuing projects and some that are new. So we will work with contracts and michelle rugals staff over the course of the fiscal year. Okay. Thank you. Any other questions . Next item, please. Theres no Public Comment request for that item. Item four is general Public Comment. Ive not received any requests. Im not seeing any now, so we can move on to todays report on the budget and finance Planning Committee. The budget and finance Planning Committee met immediately before this meeting. We reviewed a few separate contracts. There are four separate contracts to provide pharmacy Registry Services through december 31, 2021. Two of them are existing existing contractors and two of them are new contractors. So as well be considering in the next item, the consent calendar, theres a caveat on those two new vendors, we will receive to the board to review, and the secretary, mark, will be getting those. The reason that we need of course these pharmacy registration temporary Personnel Services is to cover vacation times, times when theres high vacation activity, and times when persons are being trained on epic. We have additional contracts with regard to network and Security Support Services as well as epic go live activation and adoption plan. And then, we have three different contracts relates to healthy related to healthy sf and kid is in particular. I would like to say that while healthy sf is being sunseted because kids are being moved on to medicaid, that is everything that is on the consent calendar. Commissioners, questions . Comments . We can move on to item six, which is the consent calendar, and as commissioner bernal stated, the Committee Approved the report with the understanding that i would receive the board of directors from the two new vendors with the understanding that i could forward them all to any questions that you have about that. Thank you. Were going to call for a vote. So all those in favor. Of accepting and adopting the finance committee report. All right. And ill note that theres no Public Comment request for that item. Item seven items seven and eight are going to be presented together. Item seven is the closure of st. Marys cardiovascular center, and the other is st. Marys spine program. I wish to recuse myself for these two items. And commissioners, dr. Kol f dr. Colfax, and i am recusing myself. Oh, and commissioners, and im sorry, for the public, these items were introduced at the last meeting, and today, you will vote on them. All right. Good afternoon, commissioners. Im here today for the second of two scheduled proposition q hearings on closures at st. Marys Medical Center, and the first hearing took place on july 16 at the last meeting. As a reminder on april 29 of 2019, st. Marys notified the Health Department of two closures. The closure of the Cardiovascular Surgery program, and the closure of the spine center, which is a licensed hospital outpatient clinic. You all received a memo that had detailed information about the closures . And for todays hearing, you received a memo that contained Additional Information based on the information that was requested during the last hearing. So for todays hearing, im just going to be briefly sharing points that are addressed in the fullout memo. I do want to note that dr. David cline, director of st. Marys Medical Center are here to represent st. Marys and answer any questions about this brief presentation. All right. So as a follow up to the Health Commission hearing on july 16, st. Marys provided data on the number of plans versus emergent cardiovascular procedures. To look at this chart, there are four types of surgical patients . Elective, meaning, the patient waits at home or the surgery is scheduled far in advance. The next is urgent. Next is emergent, meaning the patient is very sick and it is not safe to wait for surgery. And then finally, its emergent salvage, which means that the patient has no pulse. And so based on st. Marys data, the percent of total cardiovascular surgeries that are nonelective vary from three to year, but from 2013 to 2018, about 30 of nonelected cardiovascular surgeries. It should be pointed out that since 2011, st. Marys hasnt had any emergent salvage procedures. So upon the closure, its the nonelective cases that will likely have to be medically transported through van nuys or parnassis as those are the closest hospitals to st. Marys that officer Cardiovascular Surgery. So then, looking back at the 2018 data, that would account for approximately eight Cardiovascular Surgery case thats would have needed to be medically transferred. So a few questions raised in the hearing were about surgical and nonsurgery card know vascular patients. With the closure, theyre going to be referred out if surgery becomes necessary. So regarding the ability of physicians to follow their patients who are referred out of st. Marys, st. Marys has stated that theyre fully supportive of their cardiologists practicing as other hospitals and realize that some of their cardiologists already do practice at other hospitals. So while saint marys dont have a comprehensive list where their cardiologists provide active duty care, they did provide a roster of their cardio laskar care and the location of their offices . So some have offices located at cpmc pacific, van nuys, stanford Medical Center, ucsf parnassis, and at al Alta Bates Summit Center in oakland. St. Marys cardiovascular surgeons are also credentialed at other San Francisco hospitals . And that includes cpmc, ucsf, and kaiser. All right. Also during a last hearings, there was a few questions about transfers . The map shows the locations that offer cardiovascular procedures that are comparable to the Services Provided at st. Marys. So for San Francisco, this includes ucsf parnassis. And then, for other cardiac care services, cpmc, ucsf, and kaiser all have cardiac catheterization labs, and those hospital locations are designated stemi centers, which means that theyre equipped to treat emergent coronary heart attacks. So for any cases that need to be medically transferred from st. Marys, patients will go to cpmc vanness or ucsf parnassis. So regarding a network of care through a review of the accepted insurance plans that st. Marquiss accepts, all but one plan is accepted by cpmc and ucsf . Both especially medicare, medical, and chai accept medicare, medical, and Chinese Community health plan. Went too fast. So another question was also raised about Hospital Capacity and the current ability of San Francisco hospitals to take on the average of 30 patients that are seen at st. Mar hess annually for Cardiovascular Surgery . And st. Marys has stated theyve had conversations with cpmc and ucsf, and theyre knowledgeable about the case log and theyre prepared to take on these patients. It should be noted that cpmc and ucsf have higher volumes of hard yo la cardiovascular patients than st. Marys. And then, finally, as a part of the formal transfer protocol that i spoke about at the last hearing, both were spoke about during that transfer protocol with st. Marys. Okay. So to close, id just like to restate the conclusion that was presented during the july 16 hearing . In that despite st. Marys low surgical volume in the general advancements in minimally available surgical technology, San Francisco does have a growing older Adult Population and card low Vascular Surgery services are going to become increasingly important . That the closing of the Cardiovascular Surgery unit may also have impacts on the level of care provided and the complexity of patients that may be able to be seen . And that finally there will be an average of 30 patients annually who can no longer receive Surgical Services at st. Marys. So the closure is a reduction in services, and for that reasons, and the reason spoken before, the closure will have a detrimental impact on the community. So i just want to note that on page seven of the packet, the memo follow up, you will find an amended resolution, 1911 for the closure of the Cardiovascular Surgery unit . And the regulation in your packet includes red lines, based on the discussion and feedback that took place at the july 16 hearing . And then specifically as suggested by commissioner chow, i added statements about the history of st. Marys and their impact on the field of Cardiovascular Surgery. And so that concludes my statements about the cardiovascular closing, and im happy to take questions, and the staff from st. Marys is happy to take questions. Im dr. David cline, the president of st. Marys and also st. Francis. I know there is a question regarding q