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 feeling is that cpmc is noncompliant and having a centre of excellence in senior care. They have an acute Hospital Unit , but theyre planned for discharge is sponging off nonprofits and volunteer organizations, and not doing any Real Community outreach or discharge planning on their own. Their primary goal seems to be saving payroll, not having their own dedicated employees, and getting people out of the hospital as quickly as possible so they can make a profit on the medicare dollars. This is pretty much the same with subacute. The d. P. H. Has estimated that we have a dearth of 50 to 80 subacute beds in the subacute unit. We have none for the surviving patients at cpmc. Davies, who are rapidly dying. The least cpmc could do is make the 17 retrofitted beds at davies into permanent subacute beds so we could get permanent staff because you cant this is a very high level of skill and it is very difficult to recruit the Skilled Staff for temporary jobs as these patients die, and which may be one of the explanations of the high death rate. In general, cpmcs approach to tenderloin it lives, to everything, has been passive. Blaming st. Anthonys for not doing enough to get patients to them is ironic and ridiculous. Cpmc should be doing what it needs to do to make these patients welcome and to recruit these patients and even to case manage these patients. This is the same with the center of excellence in geriatric. To not have a hospitalbased Skilled Nursing facility to send these patients to after a complex at geriatric patient has a stake, is ridiculous. The medical Staff Office Building at st. Lukes or the 30 shelf beds at davies could be used for subacute or hospitalbased care. It is all about revenue, it is all about profit, even though this is a Nonprofit Organization that isnt paying taxes. Thank you. Thank you. Next speaker, please. 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 pa