Good morning, my name is heavier and i am with Community Housing partnership and jobs with justice. We work with Supportive Housing residents who were formerly homeless and the people in our building have severe medical needs that require many trips to the hospital and lots of them that i have worked with have to go long distances to get their care. We have several buildings that are in very close proximity to the new van ness facility and i have heard of little to no enrolment in that facility, which would be a lot easier for our residents who are disabled. Also, as far as the outreach to the tenderloin residence, the people in our buildings and the tenderloin atlarge, as you know , a lot of their first languages are not english, and its almost impossible for them to be able to take that step without some really serious and intentional outreach on the part of cpmc. A lot of times, to keep people enrolled and to have them get the medical need that they deserve, we are relying they are relying on our residential case managers who are not familiar with the Health System, were having to scramble and figure out this paperwork that they are not familiar with, but they are the ones that are having to take on the job that cpmc should be doing as far as outreach and enrolling people. So i ask that the commission make the changes that are needed to hold cpmc accountable and to do what needs to be done. Thank you. Thank you. Next speaker, please. Hi, my name is sylvia. I work at van ness. I was here last year and i will say hi again. One of my patients told me to say hi for you because he had breast cancer. Once again, im talking about short staffing. Once again, we want arbitration and we will never go back in there. But i am here to give you a story, a reallife real life story of my experience on the floor. Right now, i am taking 13 patients because my doctor put me on modified. That is the only thing i take his 13 patients. Not 50, not above that because of my ankle that is really hurting. So i am working in pain, but one thing, the night shift is always short. Overall, it is short staffing, but what i do is check the patients, if they are breathing, and things like that. I walk around. If anybody wants to go to van ness, the tenth floor is too big i am the only one who has a short hallway, 13 patients. To make sure that when they arent drug, to make sure they are breathing and things like that. Our code blue, since we moved in there, is skyhigh, in my opinion , because i am grading them because they are grading me and i am grading them. I am doing 100 and 10 of my time to make sure my patient is safe and breathing because they are on drugs, heavy drugs, medication. If i dont do it, my legs will hurt. My patient will die. And it is so bad for my heart and my mind when my patient dies i see a lot of them in my years since 2003. Im asking again, i am crying here and asking again, we need more staffing on the floor. Thats it. Thank you. Thank you. Next speaker, please. Good morning, commissioners. I and the union rep and we represent workers at cpmcs davies, pacific, and van ness campuses. I heard a lot about talk about numbers, and it looked good from cpmcs account. They were doing everything on the up and up. I want to tell another side to that. They said they hired so many people. I would like to ask the question of where . Because i represent the tax, i represent the food service workers, i represent the p. C. A. , i represent pretty much everybody but the nurses and they are all shortstaffed, even Central Distribution departments that deliver cotton balls around nurses, nurses cant even get cotton balls because they dont have the stuff to actually delivered those. I wonder where are all of these people hired . Probably in management. The Food Service Department has like 12 managers just to manage one shift, the day shift in the kitchen on any given day. That is probably where all their hiring comes from. Speaking of the subacute, i would like i dont want to spoil anybodys hopes, but i dont think that they will ever have adequate staffing in the subacute because they dont have adequate staffing anywhere. Cpmc does not have any intention to actually comply. We have an open grievance right now because the contract, the cba obligates cpmc to keep an adequate level of casual per diem employees. We have an open agreement because they actually have none in most of the departments. Absolutely zero per diem employees, and as of recent, they may have hired probably about three, and i know because i watched the Staffing Levels there, so hold them accountable. I would like to speak about the spirit of this agreement. I would like for this commission to hold them accountable to that spirit as well as make sure that this is adequately staffed for the patients and workers alike. Thank you. Thank you. Next speaker, please. Good morning, my name is jennifer. I am one of the nurses from st. Anthony medical clinic. Im here to provide a few comments about the challenges our clinic has had in enrolling new patients. We welcome the partnership that we were invited to enter with San Francisco health to provide cpmc as one of those options for our patients. Since the other option was San Francisco general, when we presented just the options to our patients about which Service Provider they can choose, most of them were very familiar with San Francisco general. When we talked about cpmc, a lot of them did not know about cpmc or where places were located. So when we had to explain to them where they would have to go to the lab, xrays, specialists, it was very confusing for them. It was easier for them to choose somewhere like San Francisco general where things are centrally located and where they are much more familiar with the services. One of the other challenges that we had was that last year in 2018, we lost three of our primary care providers. Two of them moved out of the area and one of them retired. Since then, we have had staffing challenges and have had different per diem staff coming in and out of the clinic, and with different schedules. We have been trying to maintain the panel of patients that we have and provide care to them, which doesnt always allow for new patients to join because of our access. In terms of recruitment, we have been trying to recruit new permanent care providers and we are also contending with Different Centers and organizations that can maybe offer more bonuses or bigger salaries then we can, unfortunately offer them. We still strive to provide the level of care that we always have, but we have been faced with a few challenges in the last couple of years. Thats all i have to say. Thank you. Next speaker, please. Kim tell villani, San Francisco labor council. I am deeply saddened. I feel like this is the greatest issue of all time. I dont even know where to begin one, cpmc has not fulfilled its obligations, and despite the boxes that you all check off. I work one block away. My old office looks out at cpmc van ness. When i pull my car out or in of the garage, there is a tent city right there exactly one block. In fact, the smokers from cpmc smoke in the same alley. There is a tent city. Theres lives that could be taken care of cpmc a block away. There is no excuse why they cant be taking on more. We have been here, we have testified. They can hire navigators, they can partner with Community Housing partnerships who have residents in their hotels. Tenderloin housing, for example. But cpmc chooses not to do any of its because they really dont want to do it. They are perfectly fine sending more and more people to San Francisco general on a taxpayer dime and it limits the capacity of San Francisco general. I need the commissioners to really holistically look at the Health System and make the private hospital, cpmc, do more. This is a sad, sad day. When you walk out of here, there are people without health insurance. That is not an excuse. They need to do more. They can do more, they are choosing not to, and we are letting them get away with it. These are the options. They are fairly simple options. Either you are for the people or you are with cpmc. Cpmc has failed. We have seen the deaths that have occurred in the subacute unit. They really dont care about patients and we really need to hold them obligated to do more in the city. It is disgusting and we should not allow them to continue to do their Business Model this way. A look at st. Francis, they do weigh more and they are just a few blocks away. You have the ability to make them do more, the question is, will you . Thank you. Any other Public Comment on this item . Okay. Public comment is closed. I will defer to my copresident as many of these issues are healthrelated, and then we will provide comments. It is now in the hands of the health commission. The commit are there commissioners who wish to speak on this item that have questions yes, first of all, thank you to the staff of the Planning Department and also the department of Public Health for your excellent presentations as well as for everyone who stood up for Public Comment today. I would like to dive a little deeper into the question of providing services in the tenderloin, the medical services. I know we are looking at this presentation and it is looking very similar to what we saw last year. Some of the numbers are confusing, so i would like to give the opportunity to clarify it because going back to what corey said about the spirit and the goals of this, it is not really just about the numbers, it is about the people, it is about the lives. Particularly when you are looking at the tenderloin, it is lifting up and bolstering services that are available in the tenderloin with the organizations that already exist in the neighborhood. When you look at some of this data challenges, which, of course, are legitimate challenges, these are things that could have been anticipated if you are looking at patient choice, that is something where you could do more outreach to the communities of people are more aware of the services that are available from cpmc. You are looking echolocation of services that make it more complicated for people to take advantage of whats available at cpmc. There are ways to address that as well. And then of course, staffing challenges for some of our nonprofit partners. That is something that can be anticipated as well when youre looking at the cost of living, the cost of housing, and the cost of soaring rent of nonprofits were trying to serve people in our community. I would just like to ask and also applaud them for stepping up and taking on some responsibility, but this looks very similar to the presentation we saw last year, and while we hear there are plans to put together a path to sustainability, we really want to ask more pointed questions about what those plans are and what has come from those discussions, so i dont know who is best suited to answer those questions, but those are ones that i think we would like to hear addressed. Thank you, good morning, commissioners. Im emily webb and director for Community Health for the bay area. I appreciate the question an opportunity to clarify. This is an example where i think cpmc has made some efforts towards the spirit of the agreement. The letter of the agreement said if there was not an mso with the tenderloin serving base by december 31st, 2015, then cpmc was to meet the obligation for additional lines through our existing partnership with northeast medical services. We hear the communitys concerns about wanting additional primary care options in the tenderloin with a pathway to hospital and Specialty Services at cpmc, hence we forged the contract with Saint Anthonys to provide that option to patients. As has been stated, we also have a clinic and three other independent primary care providers that contract with cpmc as the in network hospital. Although this challenges that have prevented the Saint Anthonys number from growing to 1500, despite actually quite a bit of funding and inkind effort on my behalf and my stuff s behalf, we have worked with the community and a whole host of partners to provide access to cpmc with primary care choice in the neighborhood. I think it is important to note that while there are acknowledge challenges that you heard from Saint Anthonys, we are working with multiple providers in the tenderloin to be the Hospital Partner and to serve about 2600 residents that have home zip codes in and around the tenderloin. Just a quick followup, when youre talking about path to sustainability and efforts that are happening now, what are you anticipating you can accomplish in the next year to fully meet the spirit and the goal of the agreement . Yeah, the effort with Saint Anthonys, i think our perspective is because we have multiple primary care providers, that can refer patients to cpmc, we are meeting the letter of the agreement and the spirit of the agreement, which is to allow tenderloin residents to have access to the hospital that is newly in their neighborhood. What we have done with Saint Anthonys is we have done quite a bit of work with them. They used to be a free clinic. They now accept reimbursement and we have funded them to get access to federal dollars for the health care for homeless grant to join the San FranciscoCommunity Clinic consortium and to begin to contract with medical. That did not exist prior to our building this relationship with them. We funded them towards that effort, as well as provided Technical Support and guidance. We have also funded them for outreach efforts pick we believe that them having people in their dining room and out in the neighborhood and they have quite a few programs around staff recruitment, they have a wonderful Security GuardTraining Program in the neighborhood, that those staff are better suited to engage with the neighborhood. We funded them towards that effort. Those are just some examples of the things we have done, and they also have had a leadership challenge and staffing challenge which plays into the ability to grow the partnership. With respect to the acknowledgement of the great work that is done by the folks at Saint Anthonys, the next time we get a report back we would like to see the results of some of these efforts and see that even more enhanced with Saint Anthonys and organizations in the community. Okay, thank you. Thank you. Commissioner child . Thank you. I have reviewed the document and its easier to review them as we sit here in these years, but it also becomes, i think now a real opportunity now that both hospitals have gone into operation. And we look for the future, and as i think much of our apostate public testimony spoke of, we then to need we then need to see how these hospitals actually meet the needs, not only of the Business Needs of cpmc and their desires to be more than just simply local and Community Hospital, but as the opportunity , as a city, to take to make use of these as providers for the residents. So most of my comments really, at this point, dont relate so much to how well you have come to check the boxes over the past , but what we would look forward to in the future. That is, for both hospitals. So as i am reading, i am reading the smaller one first, and we think cpmc for coming and stepping up to the issue of providing additional and patent inpatient and Outpatient Services for that district, which were, if it were not there , would certainly have overwhelmed general even more. That was a Real Community need. But as we see that the hospital is a Community Hospital in that sense, i think some of the areas that were in the d. A. , that really should then be those which the communities able to access, and that was one reason it was put in there. I believe that it appears that we have gone quite well in terms of moving a Diabetes Program. And i am somewhat concerned, but i think the d. A. Might be able to cover that even though it has been transferred out of the hospital, and no longer really within the realm of the Health Commissions purview as a service from the hospital, it still does, i believe, remain under our d. A. , and that we should be able to take comfort in the coming year as to what the Diabetes Program has been. So i would look forward that staff would be able to provide that to us in an x youre working with cpmc as to now a mature Diabetes Program with at the new hospital. I think the last speaker also brought up the question of the senior programs, and the senior excellence with both the ace unit and with outpatient programs. I think its our opportunity for the coming year to then ask that as part of the report, it is not checking off the box that you have those, but that the commissions be able to understand what has actually occurred, how many people are being taken care of, how many were from that community, and, in other words, to understand not just a quantity, which would be nice to know, but also the quality of the work that is going on. I would say that i am looking forward to a coming year and we could see the fruition of the reason these buildings were built. They are not built there just to be buildings, they are not built to just become Tertiary