As reported the foundation has maintained several of the recommendations and added a receptionist. In past hearings the commission encouraged easy the easy to proe Additional Information regarding staff standards such as demographics. C. P. M. C. Provided a summary which you received last week. We will continue to Work Together to gain a deeper understanding of compliance and will include more information in future hearings and compliance reports. This concludes this portion of the presentation. Thank you. Setter health is in compliance with the requirements of the c. P. M. C. Development agreement. They met hiring and local contracting goals. Areas of concern include enrollment with the tender highway loin medcal provider and hiring of journeymen and add prentices. For 2019 it indicates continued compliance. Staffs recommendation is to find that c. P. M. C. Is in compliance for the 2018 reporting year. That concludes staff presentation. We will be available for questions. Sutter health is also available for comments. Does Sutter Health wish to make a presentation as well . We are good. I have a few speaker cards. Catcrachel, gloria. There is an organized opposition. Okay. Good morning, commissioners. I am a professor of law at university of California Hastings College of law. I am here to present the comments today of the San Francisco for healthcare, housing and jobs and justice, a coalition which is an organization active for the last 10 years, more than 10 years. They were instrumental in if Community Benefit package that is part of the Development Agreement. We are not a party to the agreement but actively involved in the drafting by participating in public proceedings, and it also has been monitoring the agreements, and implementation. We presentd written comments back in june and those are at the end of your package. There are two statements, one on the Development Agreement overall and also a statement on the subacute care issues in San Francisco. A lot of time is invested in this process, and it is important time. It is an opportunity to review the c. P. M. C. And city reports. It is also an opportunity to look at the c. P. M. C. As the largest fee for Service Private provider of Hospital Services in california as it relates to the needs of sa san san franciscansr healthcare and civic concerns. It is an opportunity to look seriously not just at the Development Agreement compliance but at the c. P. M. C. Performance overall. Today orally i want to make two points. First, to say that the Development Agreement even when it addresses specific actions does not prohibit or limit c. P. M. C. From doing more than what is specifically stated. Second, there is ren is recent a that indicates c. P. M. C. Is doing less to meet the healthcare needs of lower income san franciscans than in 2017. I will look at not the overall benefit of the community but looking at the actual patients being served by c. P. M. C. With respect to the first point, c. P. M. C. Repeatedly mentioned the da for not taking sufficient action to address an identified problem. This has particularly come up with respect to the demise of subacute care Skilled Nursing facilities in San Francisco. The da states c. P. M. C. Tha c. P. Ml work in good faith to develop specific proposals to provide subacute Care Services in San Francisco. Now, it does indicate an Expiration Date for that provision but that is not the end of the matter. It explicitly states c. P. M. C. Is not obligated to expands funds or resources. These provisions do not mean that c. P. M. C. Is prohibited from committing and spending funds or resources. It is just not mandated by the Development Agreement. Nothing in the d. A. Limits the city from suppressing c. P. M. C. From doing more than it is now regarding the need for quality subacute care units in San Francisco. Nothing prohibits them from fully participating. Subacute care is the most intensive form of postacute care. It is for patients who cant survive on their own, as was referenced previously, like those who need a ventilator. Because of the expense most longterm subacute patients receive medcal. Hospitals regard it too low to meet cost and medcal recipien recipients. C. P. M. C. Agreed almost two years ago to transfer existing patients from st. Lukes hospital subacute care unit to a new unit at davies campus. At that time in late 2017, there were 23 patients in the st. Lukes unit with no new patients having been accepted since 2016. In august of 2018, patients in the saint looks unit st. Lukes unit excuse me. In august of 2018, when st. Lukes was closed and the new hospital opened, there were 17 patients transferred to the davies campus. As of now there are eight remaining patients. When they die, c. P. M. C. Will close the unit and there be no subacute beds in San Francisco. This is a crisis now. C. P. M. C. Must be part of the solution whether it provides space and staffing at davies, at the proposed new medical Office Building on the mission burnell campus as part of the undevelopment space in the vanness campus or in support of Chinese Hospital interest in having subacute care unit. Another area where c. P. M. C. Needs to step up more than set out in the d. A. Is meeting the spirit and letter of the commitment to serve 1500 new medcal or healthy San Francisco patients in the tenderloin. With the opening of the vanness campus in march this year, an important geographic proximatity issue is now eliminated. As of may of 2019, as you saw in the report you just heard, only 174 such patients are receiving services from c. P. M. C. A number which is actually two patients lower than in may of 2018. C. P. M. C. Has to be an active parties pant i participant in reaching out to serve the tenderloin in three respects. First in insuring that the vanness hospital is culturally and linguistically welcoming to lower income individuals from diverse family. Second, aggressive efforts to encourage tenderloin residents to use st. Anthonys as primary care clinic. Third, providing financial and technological support in whatever ways are most needed to facilitate highquality primary care providers in the tenderloin to referpatients to c. P. M. C. For specialty and Hospital Services. With respect to the second point i want to call your attention to the San Francisco charity care report for 2017. The latest report available. This report provides data and information from all San Francisco hospitals on traditional charity care which covers only nonmedcal patients who are uninsured or who are healthy San Francisco beneficiaries. Though the definition for the charity care for this report does not include individuals on medcal, the report does inclu e relevant data on the medcal shortfall. That is the difference between what hospitals set as the fee rates for specific services which are much higher than private Health Insurance reimbursement and not the same as the actual cost of those services and what medcalorie im buses for the beneficiaries. Reimburses for the beneficiaries. Since obamacare, the cost of charity care patients, not medcal patients have gone down. Generally speaking, this correspondses with the number of individuals with private insurance through california exchanges over the expanded medcal coverage. One major result is reported medcal dollar amounts for most San Francisco hospitals. I have a minute left. That is your time, 10 minutes. I still have 10 minutes . That is your time, sir. Let me emphasize for most Hospitals Charity care costs have gone down, but at the same time the medcal shortfall amounts have gone up sometimes two or three times that amount because Previous Charity care patients are now receiving medcal. The one anthe is c. P. M. C. That a decline in charity care and medcal shortfall costs. Something is not addressed by the measures and procedures used with respect to the Development Agreement. Thank you so much. Thank you. So we will now open it up for Public Comment. I have Theresa Palmer and gloria. Anyone else who wishes to provide Public Comment, please line up on my left. Good morning, thank you for the opportunity to speak today. I am the director of programs and administration at northeast medical services. C. P. M. C. And nems have a partnership s. We serve 32000 medcal patients. We provide Specialty Care and care coordination. While c. P. M. C. Serves as the Hospital Partner and provides diagnostic services. We have worked together to serve the tenderloin in our contract with st. Anthonys but through contracts with three independent providers in the tenderloin area. C. P. M. C. Is the partner for all four providers as well as the clinic on ellis street. In total we serve a little over 2600 in the area. We will Work Together to serve our patients and residents of the tenderloin. Thank you. Next speaker, please. If you could line up on the left, we wont lose time between speakers. Please come up. Thank you. [please stand by] they want to refrain from the longterm commitment and caring for these fragile patients. The inexperience and unfamiliar staff, inattentiveness, lack of stimulation, are always to ensure they dont last. This is why we need the subacute unit reopened. These rooms have already been specifically retrofitted for 17 subacute patients. In the best interest for cpmcs current patients and the community, cpmc should maintain and admit new patients so that there is an adequate level of staffing and continuity of care at all times. My sister, sandy, as well as the other patients, do not deserve to be treated so inhumanely. They deserve to live as long as they showed with the best entitlement of care. The only way that this will happen is to commit cpmc to reopen the subacute unit and accept new patients in order to maintain an adequate level of experienced staff at all times. Thank you. Thank you. Next speaker, please. Im very sorry. We just lost one of our members of planning. Can we keep going . Unfortunately not. We should pause. We will give a couple minutes pause. I think it is a bio break and we didnt realize. Thank you. Okay, welcome back to the San FranciscoPlanning Commission and Health Commission joint hearing for thursday october 3 rd, 2019. We left off under Public Comment if any member of the public wishes to submit their testimony , please. I wouldnt i am so sorry to have interrupt you to have interrupted you. I am one of the patients in subacute. Cpmc speaks about adequate staffing of the unit, but let me say this. It shouldnt take a patient to use her cell phone to call the front desk to ask for assistance it shouldnt take a patient to have the call light on and wait for an hour for assistance. It shouldnt take that when i went to go see my sister and i saw something was wrong with her , and the socalled experienced nurse stated, theres nothing wrong with your sister, gloria, she is fine. So i went and got the doctor myself. After he evaluated sandy, he rushed her to icu immediately. She was in icu for several weeks with pneumonia and every other breathing issue. Cpmc is giving the minimum care of the subacute patients and this is why i feel that there is a reduction of these patients left, and i also feel that if the rate goes on this way, in december we will probably just have two patients left. We need a permanent subacute in San Francisco so there can be adequate staffing to protect these patients. You think about if something happened to your family member, your loved ones, your son, your daughter, and they needed subacute care, how would you feel sending them out of county to los angeles or sacramento . Please help us protect our san franciscans who pay taxes and voted for everyone here. Please take care of our family in San Francisco. Thank you. Thank you. Next speaker, please. Good morning. I am the executive director of jobs with justice and Labor Organization in San Francisco. I want to talk a bit about this hearing, which is that its not just a discussion of the Development Agreement, it really comes back to the goals of why we even have this Development Agreement, and that is to remind cpmc of their obligation to our communities around jobs, around healthcare, and thank you to the families for fighting, literally for the family members in the hospital. So we can come to this agreement and hearing, we are not just trying to check a box. When we say tenderloin lies, it literally is a lie. So on the subacute, we can look at this report in terms of specific proposals for providing subacute Care Services in San Francisco and presented to the Health Commission. It says the obligation is completed on 2016. This obligation is not completed we need to subacute. This is a crisis. Another piece that i think this hearing actually has been helpful, when i came here last year, and thank you to oewd for presenting this information, there was a question on retention and promotion. Not only was there not enough jobs coming up for people coming from the communities, and there was a decrease in the total number of jobs, which means that percentage was very low overall, but also the question of retention and promotion. I remember the commissioners raising that. I see the improvement from last year to this year. Based on your actions as a commission, and investigating this question of retention and promotion so people who get in the door actually stay in their jobs. I just want to lift that up as an example of how this hearing can make a difference and ask that you, as commissioners, hold cpmc and, not just to the Development Agreement, but to the goal and the spirit of the Development Agreement. Thank you. Next speaker, please. Hello. I am a Community Organizer with Community Housing partnership. We provide affordable housing, Supportive Housing for over 1500 folks in the central city. Our clientele have many traumatic barriers from experiencing homelessness, and i want to call attention to something that i heard today, which is kind of interesting. We have a goal of serving 1500 people on medical, and it sounds like we have backslid over the six years that i have been aware of cpmc. We backslid from not even reaching 200. I heard today that the reason is because folks are unable to reach out to people because their phone number isnt working or their address may have slipped. As a Community Organizer, if i just gave up on everybody that didnt have an address or a phone number in my community, then i wouldnt be doing anything. So im going to ask you guys to dig deeper and do better. Thank you. Thank you. Next speaker, please. Hello, my name is Melanie Grossman and im with the coalition. I am a retired social worker and i am especially interested in the center of excellence for senior care, and we have a small group which has worked with that center to make sure that its more than a centre of excellence in name only. The center is charged with making sure that people stay in the community, live in the community, and to reduce hospitalizations. In order to do that, the center has to know the community, know the resources that are there, and work with the community. So the ace unit is a fairly selfcontained unit. It is run by dr. Zachary who has been extremely helpful to us in welcoming, and also welcoming of the community, but we have to do a lot of the work for her because she doesnt have the staff, she doesnt have a social worker, she doesnt have people who can do this outreach for her , and that is especially important. Same with discharge. I had a neighbor who was hospitalized on the unit and i asked a dr. Zachary to make sure that my husband and i were called before she was discharged , and again, it is not dr. Zacharys job to set up discharge, but my neighbor was sent home over the 4th of july weekend. We were never called, even though her number was plastered all over her room. She called me and told me she was going home. We were out of town. I had to set up a ride for her to get home, call the home care agency, make sure they were there to greet her, get her keys to her. My neighbor didnt even have her keys. And to make sure that that transition went smoothly, which it did. The unit did give her a referral for home health care, and they didnt call her until the middle of next week. I dont consider that a smooth transition to home. Thank you. Next speaker, please. Hello, my name is teresa palmer, im a geriatrician. I work with senior and disability action at san franciscans for housing, healthcare, jobs and justice. My