Nobody is there. Nobody is around [indiscernible] the speakers time is completed. [speaking spanish] [speaking spanish] next speaker, please. [reading names] anyone else would like to speak, please come forward. My name is sylvia. I was here two years ago for the same issue the same, what ever. I know the unit on the sixth floor, i work there. I have six to eight patients. I know how to take care of them a. M. , p. M. , night shift because i have been going around. Im sorry, i have lack of sleep because i just finished working. Im so dedicated to my patients and i want to be here. This is very crucial. Dr. Browner, when they have a town hall meeting, because i just heard, i have been working for three people and i get paid for one. I said that two years ago when i was here. That is still an issue. Now i am on my last limb. The patients are our bread and butter, that is how i feel, so we have to care for them. They peak, they poop 24 hours. You have to take care of them. They vomit, they are so sick, and they are cutting staffing after staffing after staffing. And at one point i have 50 patients for the whole pacific campus. Until now, the same issue. It is a long stride at van ness campus. My thing is, how about the patient ratio for a p. C. A. Like me, who really care and are dedicated take care of patients. I dont care about the money, thats fine [indiscernible]. Thank you. Thank you for taking the time. Next speaker, please. This is so obviously a product of capitalism. See bmc and other nonprofit and Public Hospitals have abandoned vital but lowpaying care, not y for subacute staff but Mental Health and longterm care. The monopoly has a raise prices so much that the attorney general is even involved, and when forced by Community Uproar to continue caring for subacute patients, they are providing such poor care it is hard not to believe that they arent killing people off so that the space can be used more profitably. We demand, at minimum, 17 permanent subacute s. N. F. Spaces at davies with new admissions and safe staffing levels. We can and we must, and we will fight these shortterm battles for survival, but if we dont see this fight as a fight to get rid of capitalism altogether, then we will be fighting these fights again and again and again forever. Thank you. Next speaker. Hello, my name is teresa palmer. I have been working on the subacute issue and with the families for two to three years. One of the things i wanted to clarify is when the 17 patients were transferred from st. Lukes to davies, they committed to take care of them only until they died and then would return the beds to the 38 s. N. F. Beds that were previously there. It is a very the skill level needed to be a subacute nurse is very close to the level for an icu nurse, and the same for albion. To recruit sufficiently Skilled Staff for a temporary job is much harder. This is one of the bases of the request that they be pressured to make those 17 beds permanent so we can have permanent staff that is adequately skilled because what we are having is a lot of discount discontinuity of staff. When you have patients with very abnormal baseline to begin with, if you dont know them, it is hard to tell if they are doing worse. I want to point out that only two of the eight patients that died were comfort care, and the rest were candidates for ongoing lifesaving care. Thank you. You still have 25 seconds. I do . Okay. I wanted also to point out that the medical shortfall is a measure of how many medical patients we are serving and how much income they are making, and they have increased their revenue quite a bit like cutting subacute care. It is about money, it is about profit, it is not about what the people of San Francisco need. Thank you. Next speaker, please. Hello. I am with the San FranciscoLabour Council. I have been here many, many times. The fact that this unit, the subacute unit, and i know, i disagree with you on this, you are not here to beat up on them. Any unit that has over 50 death rate needs to be raked over the coals, sorry, that is just the way it is. Many of the supervisors have experienced long call buttons. Someone is choking, it only takes a few minutes for that person to die. A 20 minute wait for someone who is choking is an attorney tea, it is cruel, you dont want to break them over the coals, you need to. If these people were allowed to say things, they would still be alive. Im pretty sure most of them would still be alive today. Cpmc has neglected these patients, has ignored these patients. The staff, i feel really sorry for anyone who floats into this unit. Obviously they are not getting training, they are not being oriented to the unit. I saw this with my own eyes. I suggested it to an a nurse what button to push to make the alarm go off. I was there, i saw it all for my own eyes. This is not good care. This is not acceptable. We need to warn the residents of San Francisco that cpmc is unsafe. If they do this to the most vulnerable patients in the hospital, what else are they doing . We need to warn people that they need to take a look at who they are and i have seen the looks from some of these families were told they have to send their Family Members to los angeles. San franciscans deserve better. Thank you. Next speaker, please. Hello, supervisors. My name is tony rivera. I just want to thank you for coming to cpmc the other day for the tour. All the families really appreciate it. This will be short. I just want to say that if i was an executive working for cpmc, i would be questioning my values right now because i would be really ashamed of everything they are doing, you know, i dont understand how you can come here and defend these sorts of actions that are taking place and then go back to your family and to your kids and hold a different kind of set of values. I am calling all of them out right now that if they feel like what they are doing is right, they need to really take a look at themselves. Thank you. Thank you. Any other members of the public who wish to comment on this item please come forward. Seen none, Public Comment is closed. I want i did come down and experienced the conditions and the setting that these Family Members are living in, and experience it firsthand. I know that is very personal, and i tell you that it certainly had a major impact on my impression. I have the opposite experience of supervisor ronen because it was after supervisor ronen, so the Family Members shared with me that when we arrive, that was a level of care that they believed should be the baseline. I know that we have i definitely want to come back to the solutions and talk with the department of Public Health, but i think we have some current questions for cpmc. I know some of my colleagues had expressed that during this time while we have been listening. Is there a representative from cpmc here . If you can state your name for the record. Good afternoon. I am the Vice President of external affairs for starter health. Thank you for being here. I will start with a few questions and then i will i know supervisor ronen wanted to ask some questions. We visited the facility the other day. I think it was about last friday the nurses manager was on site, there were, i counted at least over a dozen nurses on the facility. One of the things that struck me , and i was actually taken aback by this, and i just want to ask if this is standard practice. There was a white board on the wall that showed the patients, and then when the patients were passed away, there were little exes where their slots where picket seemed seemed to me like a countdown. I just was a little bit stunned by that. Is that a practice that you normally have in your facilities , and what is the purpose of that . Im not certain of the board you are looking at and whether it was inclusive of all the beds that are in that unit. The s. N. F. Beds and the subacute beds, and what the exes were indicating. Let me describe it for you. I didnt want to take a picture, i didnt want to violate any of the patients privacy rights. It was a big white board that said subacute on it and it had all the different names of the individuals, and then the ones that had passed away, there were exes on their lines, and the ones that were still living, there were names and the room numbers. That took me aback. I just wanted to put that out there because i think it was important. I promised Family Members i would bring that up. Again, it was very emotional for them. That was one of the things but the level can you talk a little bit about the level of staffing . There were some people there that the Family Members said to west they had never seen these individuals. Talk about the rotation in and out and what that means. I think thats important to get on the record, and whats the level of training for each individual. Im not as familiar with the training, but are they people that are understanding in how to work with this type of patient . Yeah, thank you for giving us the opportunity to be here today and answer your questions. We also want to thank you for taking your time to visit the unit and learn firsthand. We welcome you to continue to come back and visit the unit. I especially want to say to you, your comments at the outset or on the onset of this hearing are appreciated about the sensitivity and incredibly emotional content that we are talking about. These are peoples lives. We know families are here today out of concern for their Family Members and we are concerned for them, as well. We cant, as you know, because of laws regulating privacy, share specific details about patient circumstances, but we do strive every day when we are in the unit to take the considerations of Family Members appropriately, and of course, inform them of Clinical Care decisions. We have state law that determines the ratios for staffing to patients. I think that is one of the situations that is probably becoming concerning to people, as the census in the unit has been reduced. For the eight patients remaining patients remaining in the unit, there are two r. N. And three p. C. A. , theres three registered nurses and two patient care assistants who are in the unit for the eight remaining patients those ratios of staffing are posted every day and they are submitted monthly because its a regulated ratio and weve consistently been in compliance with that. The staff that are in the unit are all trained, they are all trained and they are all qualified to treat even the most fragile and sensitive patient populations. We do also have ongoing dialogue with the California Department of Public Health who regulates this type of unit, and they were recently out doing a survey of the subacute unit. It was less than a month ago, and they determined that there were no findings there around the quality and safe care for these patients. Let me interrupt you for a moment. One of the things that i think were talking about and ive heard over and over again talking to the patients and their families, we did talk to one patient, is that there was a different type and level of care at st. Lukes. That is what i want you to talk about. There was an activities coordinator, there was someone who came in and did activities with the patients, that is no longer there. Supposedly that person had to have a certain level of education that was not transferable when you moved to the unit over. Yes, you might be needing the baseline, with the frustration here from the families is what was provided at st. Lukes is not provided here. I am sure you are meeting the baseline and you havent had any violations written up on that, but thats what we are talking about. Speak to that. And i dont want to let the countdown board go because i think that the minute to get out of the elevator, it is right in your face. So if you havent seen it, i would say go and look at it and maybe you guys can take another look at readjusting it, i dont know, but it really is offensive , i have to say. Okay. I think the difference between the unit at st. Lukes and the unit now is situation around the census. You had a larger unit at st. Lukes, and that warranted additional staffing including the activities coordinator. I cant speak to the Human Resources situation around anyone employee, and when the unit moved from st. Lukes to davies, but because of ratios and because of the size of the unit now, you have things like the activities coordinator being shared between that unit and the s. N. F. Unit. I have one more question that i will handed over to supervisor ronen. One of the things that also caught my attention was the idea that, i dont want to use the word encouraged, but at some point, people were being asked, are you okay enough to go back to your home or go back into the community, whatever the residential setting, and then if they fall back into need of subacute care, thats it, they cant come back. Can you talk about that a little bit . It seems to me as though if somebody was either encouraged or they made the decision that they wanted to go, one of the patients brought that up to us. They said that, im sorry, the patients sister was speaking to us on that day and she said, they are asking us if maybe my sister is okay to go home now, but im worried that if she then falls back into the need for subacute care, the door will be closed to me. Can you speak to that . I understand what you are saying. I cant speak to any individual patients. Im not talking about the individual patient, just the scenario. If someone made the decision to leave, and then within a month or two needed to come back, what happens in a scenario like that . The unit is not accepting new patients, but i cant confirm for you what a timeframe is if the second they are discharged the patient becomes termed a new patient. I cannot answer that. That one we will put to the side. If i could also share, you know, along with the daily engagement that the staff has and is available for the families, every quarter, there is interdisciplinary meetings scheduled with every family and their physician, and our staff and our ethical staff to address concerns that Family Members may have. Those are scheduled quarterly with every family. It is another opportunity for a dialogue with the families around the care being received and for their loved one. I wanted to share, especially given some of the comments you dont need to read that letter for the record. Okay. We have it. We have all been given a copy of that record. Supervisor ronen . Thank you. A few questions. So 17 patients moved from the subacute unit at st. Lukes to this campus. Today there are eight patients that remain. Do those other nine patients have pass away . Again, i cant speak to the specifics of any of those patients. It is such a small census that, you know, there could be an understanding of identifiable patient information. Okay, so we know a large portion of this. Let me ask you another question. Do you have aggregate data for the death rates at st. Lukes for the years prior to it closing . Im sure that information could be gathered, though i think much like you heard with the millman presentation, the discharge order and depending upon where any patient may have been before they are discharged, whatever the discharge position, it makes that data cloudy to look at. I think i understand your intention trying to compare, is there a rate historically and a rate now that are different. Correct . That is exactly right. And the statistics right now are alarming. I would like to compare those two, you know, what was happening at st. Lukes. Let me say this. The family of the patients loved the care they were receiving at st. Lukes. They felt supported by the staff he knew their family, who was there for the long term, knew how to read, you know, facial signs of their Family Members when they couldnt talk because they couldnt breathe, because they had that type of medical provider patient relationship. They love to the activities coordinator who would call the Family Members several times a day just to give updates on how their Family Member was doing. The quality of care that those patients were receiving at st. Lukes was something to brag about, and something to be very proud of. And thats the type of care that we would expect a hospital of the calibre like cpmc to be providing the patients. That is not happening today at davies. Pretty much any member of the families will tell you the same thing. They have come and they have testified here. The day i went to visit, as i explained earlier, was terrifying. There were not two patient care assistance and three nurses there, i guarantee it. I walked the small halls. We couldnt even when the alarm went off, we couldnt even find a staffer to ask what it was and what was going on. The absence of the activities coordinator, you can imagine, these are patients that never leave their bed without help, and so to just be stuck in a bed all day and have nothing to do and nobody keeping their spirits up, how crushing that could be, and that first rate care they were getting at st. Lukes is not happening at davies. It is very troubling and it is especially troubling that that is coupled with an alarming death rate. Im trying to confirm with you, but i cant get that confirmation from you, but that is what we have heard from the Family Members, a 50 death rate in a one year period is alarming i would like to be able to compare that what happened at st. Lukes when everyone agrees the patients were getting top rate care. So this is something thats very troubling and we would expect, you know, unfortunately my conversations with doctor were not very comforting because according to him, everything is going as it should go. And when i was there, it was horrendous care, as far as im concerned. When we finally got someone to deal with that alarm, and thank you for reminding me about that, it all came back. It was kim from the Labour Council that had to figure out how to turn off the alarm because the rehab worker, who was the only one there that we could find to help, had no idea what the alarm was, how to turn it off, what to do. I mean, that is not the type of care i think that cpmc would be proud of. It was really, really bad. We want some answers in terms of what is going on and why these high d