>> good morning, i'm colien, i'm the deputy director of the department of public health and dr. garcia can't be here. she has the flu that seems to be going around, so i'll sit in for her today. >> commissions, we have one item on your special calendar for case number 2012-043.w the medical center annual compliance statement. this is informational presentation. >> good morning, president chow and hillis, commissioners, i'm elizabeth pearl, planning department staff. the item before you today is an informational presentation on california pacific medical center compliance with the development agreement for the 2015 recording period. this is our third annual reporting period. today's presentation, you'll hear from city staff on compliance with key components of the da that are relevant for the 2015 reporting period and the updates on the projected compliance in 2016. following this hearing, the directors of planning and public health will determine whether ctmc is in compliance with their 2015 obligations and issue findings to that affect. a third party monitor will review the director's findings and inform the board of supervisors whether he agrees with their determinations. cpnc development agreement requires them to build two new hospitals and three new medical office buildings and public improvements. construction for both the cadral hill and homes are underway. cmnc is ahead of schedule with their commitment to open saint likes hospital. they open it been two years of opening the cathedral hill hospital and they're aware of that effort. for the 2015 reporting period, we're 11 main action items for compliance review as outlined here and these are in the areas of work force and hiring, of prevision of health care, payments and public improvements. my colleagues who are here today will go into these in greater detail. i would like to note that one reporting area, the first source hiring program has a reporting period that doesn't correspond to the calendar year from here today. that area of recording runs from mid-2015 to mid-2016. this is consistent with the way we have reported to this previously, so we're representing it with no data gaps and it will give you an update the picture of that area. and in 2015, cpnc had to make payments for $14 million, and they have paid up-to-date. and they're up-to-date for their payments of 2016. one additional area in the da that requires annual reporting is cpnc compliance with the requirement regarding pay increases for cpnc in its role and catherine dod is here to give you an update on that. >> thank you, catherine dunn. thank you elizabeth. there was -- key questions were identified on the spending engaged through exam 2015 health care cost and day the exchanges are occurring. and we will exam whether or not the health care cost increases exceeded the agreed upon amount. any questions? >> we may when it comes to commissioner comments, but we'll hear the presentation first and -- >> i have a finance committing meeting right now for my department which is a $790 million department, so i've been asked to rush back. >> sure. if there's questions directly for miss dunn at this point. >> i just have one question which was, whether that audit was or evaluation was supposed to be looking for possible fee increases in the future or what was the purpose of the 2014 that now was postponed to 2016? >> it goes for 7 years until 2020. and we didn't have -- we didn't have baseline data and baseline data changed so the audit will occur every year to see in fact the prices increased more than was agreed upon in the development agreement. >> it's a backwards look rather than looking at a potential fee increase for that particular service? >> exactly. and it's just for the cpmc facility and not for the other facilities. >> it's for cpmc or are you then isolating [inaudible] from that or are they using a uniformed fee schedule? >> i honestly don't know the answer to that question, but i can find out and get back to you. >> okay. >> thank you, dr. chow. >> thank you. >> i apologize for having to leave. >> thank you. any other questions? no, okay. >> thanks catherine. and could we have a document camera again. coming up next, ken nim from the work force development will present the results of the development agreement compliance with work force and hiring requirements. >> good morning, commissioners, ken nim administration services academy, and also local colleges and recruitment for college students for these jobs. the second item which is similar to the entry level position and these are more specifically working with contractors and employers that are seeking office type of work, and we are currently at 60%. so 22 to 37 candidates that we have referred are working on the project. and item number 3 is the first time goal for the construction at 50% of entry level apprentice filled out by city build academy -- we're at 30% and 78 out of the 258 possible opportunities were filled through the system referral and the challenges here for example is the iron workers, we have a lot of iron worker opportunities, but not enough residents able to do the work, and some other [inaudible] for example, they electrician and plumbers and you have to go through the protocol. so the list may have a local resident on there, and sometime they may not be local residents. >> great. >> and item number 4 is the minimum of 30% of the overall work hours performed by local residents, so as you see, we're currently at 29%. and all the contractors that are working on the project have been working -- working diligently and working through the system referral to get our residents so based on the apprentices and the challenges of the trades that we weren't able to fill, we're currently at 29%, but any opportunities that comes through our office, we've been able to refer. so for the next charge is a pie graph of the performance, so looking at the overall work hours, as you can see, it's 29% and for local residents. and apprentices is at 37%. and this is just a quick break down on the demographics. one of the key part of the dda is to target economic disadvantages of our community. in the chart, they can go inter mission -- visitation valley, and baby hunter's point is representing a majority of the work hours coming from local residents. and the next slide is just the local business enterprise goals. the contracting goal is 14%. and specifically we have broken it down by each of the projects, the gary [inaudible] campus. it's currently at 13% and van ness medical office which is just started coming up at 7% and saint luke campus is 20. and all other campus was 15% and we have generated over $81 million in revenue for local businesses. next i'll have lilly elison, our director of business offices talk about jobs. >> good morning, commissioners. my name is lilly elison, director of business service for work force development. under business services, we are task with the administration of the first source hiring program for non construction. our hiring goals were actually or are at least 40% of all entry level positions from our work force system each year. this is really a great turn around story. we started off at about 14%, and this year we're -- we've exceeded that. now if cpmc does not fill 40% of the entry level positions with our work force system referrals in a hiring year, the number of entry level positions constituting the hiring deficiency will roll over and they're added to the annual hiring target for the following hiring year. our priority neighborhoods were happy to report our western addition tinder loin, mission selma, outer center and china town and we've been hitting all those neighborhoods and we have detailed information we can provide to you at a later time. now, this year -- our first source hiring program for cpmc and this is our non construction. all of our non construction hiring goals have been exceeded. there's no deficits or carry overs. this program year is -- it's year three and that runs from august 2015 through july 2016. instead of the 40% goal, we're at 69%. now, how that works is that 176 employees were hired and out of those employees that were hired, 121 are from our work force system. so that's a great turnaround story. i will just add, and i don't have a lot of detail about this, but i will present to you that the first source hiring program for cpmc operations has a work force fund grant agreement. cpmc paid $3 million into a work force fund. that's administered by the san francisco foundation. the fund focuses on barrier removal and job training for the employment opportunities created by the project. now, these funds target educational institutions and nonprofit organizations with an existing track record of working in the priority neighborhoods and many of those are mentioned. our current grantees are jewish vocational service, mission hiring hall, mmh as we call it, positive resource center and self help for the elderly, success center and y cd, young community developers. commissioners, do you have any questions at this time? >> we may, but we're going to hold off until we hear from cpmc and public comment. >> thank you so much. and i'll turn it over to health care. >> thank you. >> good morning, commissioners, colien chavla and i'm here to talk about the health care developments of the health care agreement. this slide is a summary of the -- i won't discuss them here. so, first, the next several slides, i'll talk about the elements of the da in 2015. and of course we're now into 2017, and 2015 seems like a long time ago, but to separate what's happened its since, i'm going to talk specifically about the 2016 compliance in the slides and at the end, i'll have updates on what has happened since the 2015 annual report. so, with regard to baseline charity care, it includes four obligations and these positions were included to make sure that cpmc maintained the level of care to low income uninsured people in satisfy before they were doing before the da and everything else in the da was additive to the baseline charity care obligations. so, the first one is undupe bring catted served, they serve 1 -- this measure represents care to low income individuals who are uninsured or under unsured or have medical. the 30,445 figure represented the number of medical or charity care patients that cpmc served in the years prior to signing the development agreement. this and the other charity measures are included to make sure everything else in the da is additive to what cpmc was contributed to the community. in 2014, commissioners may remember that cpmc had a short fall of 8 -- they have a precision of a ruling -- allowed cpmc to make up for this short fall in a consecutive year, and so that meant that in 2015, cpmc had to serve 3,200,294 patients and cpmc served 17,007 patients. this figure was verified by an independent third party auditor. cpmc reports the increases due to their -- due to the expansion of enrollment of their partnership with northeast -- the precision of diagnostic services and contributed for part fir ships with community clinics and the second element of the bay line care commitment is benefit spending and it requires cpmc to spend $8 million for community benefits to the poor and under served and this category, cpmc exceeded its commitment spending $14.5 million in 2015. the third element of the baseline charity care or its charity care policies, it required cpmc to not change its policy karat no cost to people who need it until the end of 2015. and no changes were made to cpmc charity policies at that time and the base charity commitment -- in 2015, they have continued to support the baby child health care center with their pre-commitment to the center. so on top of the 30,445 baseline charity commitments, it's the commitment to participate in medicare care and serve 545,000 -- these beneficiaries are meant to reflect the impact of the aca on san francisco. cpmc to be a provider with the san francisco health plan which is the larger of the two medical care plans in san francisco. prior to the development, cpmc had responsible for 14,000 medicare beneficiary and they had to add the total bringing -- and the 5400 were to be cared for at the cathedral campus. they serve beneficiaries at the saint like -- the saint luke campus. through the partnership with nims and through nims partnership with saint anthony clinic, in 2015, they accepted 15,008 -- this succeeded their requirement by more than 13,000. of the 5400 new beneficiaries they make sure the tinder loin and the campus was served by sutter. the new neighbor will serve tenderloin neighbors and the manage care partner nims entered into another contract at saint anthony to be that partner in the tinderloin. the partner is 125,000 medical beneficiaries. they have a choice of providers and can't be moved into this partnership. enrollment is as people choose the partnership. as they remain open to the partnership, they'll be in compliance even if they haven't received the 1500. to help grow the -- they had enhancements at saint anthonies and outreach at saint anthony's so saint anthony's was given funding to do outreach to their dining room guest to initiate discussions with saint francis to have a referral process, to do outreach and enrollment at hamilton -- to obtain access to eligibility workers to make them eligible for medical and participate in homeless connect events. >> in 2015, the innovation fund received $1.125 million into the fund. and a grants were awarded in the amount of $1.3 million. the grants awarded were to several community based organizations representing enhancements and care for behavioral health, senior health and the saint anthony infrastructure and outreach i mentioned a few minutes ago. this is a summary of the additional health care previsions that are required in the da. the first was around post to acute care, and the deadline for this obligation was extended to december 31, 2015. given reduction and skilled numbering services and sub acute karat cpmc homes, they asked for most -- we worked with san francisco hospitals to assess the acute -- the resulting report was presented -- was finalized in 2015 and presented to the health commission in february of 2016. and it included three key findings and seven short and long term recommendations, dph, the hospital council and other member homes including cpmc are continuing the work to address those recommendations under a task force obtained by the city council meeting which had their meeting in the last couple of weeks. cmpc has medical staff, the cross hospitals as directed by the da and to retain its membership in the san francisco health improvement partnership which is the successor -- for the term of this report, chinese hospital was in compliance or cpmc was in compliance. commissioners were called and dph received correspondence from chinese hospitals and it would have impacted cpmc compliance and commissioners have received communications from chinese hospital to independent date they were able to come to agreement and no longer assert non compliance with the da in 2016. regarding culture linguistic and eligible standards, it's cpmc policy to deliver services with these standards and they have provided a copy of their policy implementing the standards, but the health and planning commissions expressed both in 2013 and in 2014, that they still have questioning about the appropriateness of this services. the coalition for san franciscans addressed concerns at saint luke. cpmc had a task force to review their compliance status and opportunities for improvement and secured an outside expert to advise them. on september of 2015, they shared their class standards assessments and our own experts at dph reviewed the assessments and called attention to areas to benefit from focus and requested that cpmc address these issues in their 2015 annual compliance report which they have done. so, as i said at the beginning, i would summarize here to talk about your concerns in the past and what -- what accomplishments have been made since the 2015 report was filed. so in 2014, the commission may remember there were concerns about the 1500 medicare beneficiaries in the tenderloin. they're currently 125 members in this partnership, so still far below the 1500. but as we said -- i said also we've funded saint anthony's to do more outreach in education to increase enrollment and really there's no -- because patients have a choice in their providers, there's not a way to wholesale patients. it needs to be patient choice and we're continuing to fund saint anthony to educate individuals about that choice. regarding the cultural linguistic appropriate services, in addition to what we did in 2015, we continued to meet with cpmc in 2016 specifically related to the saint luke's diabetes clinic. that meeting resulted in recommendations and clarifications including adding additional spanish language -- spanish language classes should be offered at the clinic, that adding reception staff would improve the patient experience, and that the health first program provides positive connections for saint luke's diabetes patients, cpmc agreed to report on meeting these agreements as apart of their future compliance report beginning in 2016. i heard from cpmc that this month, they offered a position to a buy ring gal registered die significance, certified diabetes educator and they started classes at saint luke's and they have made improvements in patient satisfaction surveys, but when they filed their 2016, we'll learn more. and then finally with regard to community engagement, the commissions also had concerns about cpmc engagement with the community and it's my understanding that quarterly meetings took place with the focus on excellence in senior health. with that, that concludes the health care portion of the presentation. i'll turn it back over to elizabeth. >> thank you. >> thanks for your patience with this multi headed presentation and the complex details we have presented to you here. overall, noting the concerns that do lien and other of my colleagues have mentioned to you, staff believes that cpmc is in compliance with its commitments under the development agreement for the year 2015. they're up-to-date on their construction and payments and they're reading -- as you heard from colien and they have entered into partnership to meet the medical requirement and they're in compliance with the hiring goals. so -- i should note they have made up existing short falls noted last year. they're on track for compliance in 2015. staff believes as they're in compliance this year that we recommend the directors find them to be in compliance. that concludes our presentation. i'm going to turn it over to jim who is going to make a brief presentation on the project progress and they'll be time for your questions and public comment. >> thank you, ms. pearl. >> good morning, commissioners. >> good morning. >> director ram. i'm jim from cpmc and my colleagues and i are appreciative of your time today and staff's time today to report on our 2015 compliance. as -- as staff noted, a lot of this information in their reports, i'll be brief especially covering these 2015 key activities from our compliance report. we're proud to be found in compliance on all commitments. we've been working closely with our community partners and dph to make up the unduplicated short fall and you heard that from staff. remaining 12,000 lives over the managed medical target and the partnership with saint anthony's to serve tenderloins residents. the ongoing conversations we've had with dph in response to the diabetes center, we conducted the post acute care assessment and presented that to health commissioners of february of last year and we're proud of the operational and construction hiring goals and invested over $37 million into san francisco based contractors in 2015. our current priorities are things since this 2015 reporting period, some of which again you've heard mentioned by staff, but we are exceeded to share the replacement hospital at saint luke's is ahead of schedule by almost a year and scheduled to open of june of 2018. the tower crane is down. we would welcome bringing anyone on a tour of that facility. it's looking terrific. we're excited about that revised opening date. we are continuing ongoing meetings with members of the community and we have made great progress last year. we have opened lines of communication with various members of the community and are coming to kind of fruitful discussions and constantly trying to gather more people into that conversation to make sure that it's as open of a process as possible. we're proud of that activity and the progress with our community members, partners, neighbors, and friends. we did implement the public transportation subsidy this year in january of 2017 which had been a point of discussion in the past. we're pleased to report that 10% of our employees at this onsite have taken average of that. we have seen an increase in carpools and decrease in monthly parkers so we hope that when we see the results of our employee commute survey which should be at the end of the february, we should see that single occupancy vehicle number tick down. we're off to a good start with our transportation demand program. we will continue to support the partnership with them and saint anthony's to increase the amount of services being provided at tenderloin residents and as staff noted, we are implementing the recommendations from the class assessment and the specific review with dph of the saint like's diabetes center. through this time, we've invested over $100 million into san francisco based contractors so that's a jump from the numbers you saw reported in the 2015 compliance report. we continue to support our local businesses and the hiring year is -- is on a slightly different schedule than some of the other commitments for da year 2015 and 16, 74% of san francisco hires has come from the da targeted neighborhoods. this is a current view of van ness and gary and it doesn't mean real time view, although with the weather we've been having, i don't -- i think we'd be able to pull that one off. this is two views of the van ness and gary hospital. the top view is the corner of geary and van ness looking west. the bottom is a view of franklin and post looking east down post street. this is a current view of saint luke's. those are both -- that first view is cedar chavez facing east, and the second is standing on the north corner of cedar chavez and valencia looking back at the hospital. and that is our report. and we're welcome to answer any questions that you might have. thank you so much. >> thank you, very much. i'm sure we will have questions. at this point, now that the staff presentation is complete, we would like to open it up for public comment. you'll have three minute to address the commission and we have a couple of dozen speaker cards. if i call your name, you can speak at any order. alice, mary paton and zeek and perez, maria, vaquez, tido, gloria dixon, and bruce garon. if you can line up on the screen side on the room. that would help keep the door clear, and again, speaking in any order if your name has been called. >> good morning, commissioners, my name is zeek and i'm the clinic director at saint anthony medical clinic where you're a manage care provider as you heard. challenge at saint anthony, you might think 110 lives, why is that? we have a very complex patient population, homeless. chronic care is one of our diagnosis of the practice, but just on that tone, i would like to share with you where we have been. we were -- we've been a san francisco help plan provider for almost five years and we have in that line of business, 817 lives. on an average we hold 15 members. to put this in context, our nims, cpmc relationship has 100 -- to be exact, 121 lives and that's on average of 8 lives. so i would like to share that with you. it's not an easy task to be a provider in the tend did -- in the tenderloin and i brought one of our patients who have lived in the tenderloin since 2014. it wasn't until 2015 when we were doing outreach enrollment in the [inaudible] room, that i met him. he had not been directly participating in taking care of his health care. he is missing a limb, but never had anyone to treat him with a compassion to seek services. and as a result of our partnership in the dollars allocated from cpmc to saint anthony's, this work is being done. and we continue our work day in and day out, challenges with aca, the enrollment of our patients in the queue right now, we have 220 patients that we're waiting for med-cal to assign a designation, and as we know, our patients have a choice which network they'll choose, but subsequently our responsible is to get them into the medi-cal management care of business. i would like to thank cpmc and you for your time this morning and we're grateful with the partnership with cpmc and all they do in the tenderloin to support us. >> thank you. next speaker, please. >> i like to thank the committee board and cpmc because i'm a latino. i'm a proud latino. i used to work for the city of north new jersey. i used to do the checks for recreation and parks, sanitation, and for the police department. i never thought i would come and lose a limb or i was too young when i got my job, and i never thought i would be homeless. i never thought that people would treat me in the way that they treated me. myself esteem -- my self-esteem went down. i became homeless and i lost my family. if it wasn't for you and the board and if it wasn't for zeek because i'd never -- you know, i worked all day of my life. i always paid for my own medi-care, but when i became homeless, i never thought about applying for health insurance or nothing like that. and i felt real bad. i lost my arm. i didn't take care of my hygiene or nothing, and now i'm proud. i'm glad of zeek. when he met me i was dirty and never shaved, never had a nice haircut like this. i have an arm and i wanted to show it to you, what you did for me. i got an arm, but it took me a hard time trying to put it on so i left it home, but i just like to thank you for what you're doing for the community, and [inaudible] and it helps my self-esteem and makes me feel like a person again. and what you're doing for the people, i think it's good. i think the clinic that i attend in the tenderloin at 150 golden gate is the best thing you ever had and i like to thank san francisco general for just making me a person again. thank you. >> thank you very much. next speaker, please. >> good morning, my name is elise and i'm a social work at the saint anthony's medical clinic and my role was created over the past year to help families that are trying to gain access to health karat saint anthony's and helping them enroll in insurance and connecting them to the resources they need. we find a lot of -- or i find the families i work with have been in similar situations to mr. price and they never expected to be homeless or worry about where their next meal is coming from. my work has been supporting the family so they get their basic needs can be met so they have the capacity and ability to focus their attention in care to their health care and needs, and to -- for the gain of more comprehensive care for their family and so part of that has been making it as easy as possible for them enroll in health insurance and gain access to our clinic and we have worked on a bunch of outreach program and working with the family resource centers and letting their members know we have ability in our clinic and are always open to new patients and really focused not only on the physical health of the families, but the well-being and mental health and a lot of my job is working with them, and addressing the cycle of social needs and stressors they may have in their life. thank you. >> thank you, mrs. casey. next speaker, please. >> good morning, my name is mary and i'm a nurse practitioner at saint anthony's clinic. i would like to speak to our outreach attempt in the tenderloin community. we face many challenges given that a lot of the families we work are not permanent residents and so dealing with medi-cal to get their insurance transferred to san francisco county takes months. so we're excited about the continuing opportunity to the outreach in our community. we got them enrolled in this partnership with nims >> thank you, ms. paton. next speaker. >> hello, my name is bruce and i have the privilege of leading a construction company called gms. back in 2012, i believe it was or 2013 when this project was approved. we were given an opportunity to help start the construction -- on the construction office that's presently occupied at van ness and post. i know it was a test to see if we can do half of what we said that what we could do. that was our chance to become involved with a larger project when it began. we started with a small work force at its peak about 4 people and we started that task and invited back again in 2015. a small work force, but it has led to continuous work from 2015 to today. and it has been with a number of growths from the initial path that we were given of being one small part of the overall activities there to, i think, about 7 separate work packages. some of them have been directly with hararra or trade partners at hararra bolt. i believe those growth were apart of our -- by demonstrating each and every single time we were given an opportunity to prove we were worthy of the opportunity they had given us to work out there. i am indebted to the leadership of herrara bolt forgiving me the opportunity to show what we can do. i think that it's not only at the leadership level where we enjoy this relationship, but it made it down throughout the organization to the folks we work with everyday. the superintendent and the foreman and the people that made sure this project gets done. and we have demonstrated time and time again we've earned the right to be out there. it hasn't been smooth the entire way. we've had our challenges, but i believe we have met them and grown from them. one of the many keys of effectiveness that i place upon myself is not having people become employed and go off employed. my goal is to provide an environment where there's continuous employment because you don't get to develop and invest in people unless it moves beyond entry level, and while i've had other projects and pretty good opportunities with the city of san francisco, with the airport, dpw, puc and rec and park, this opportunity has given me stability. and i think that what it has done is given my company the ability to be able to stand competitive to be -- >> thank you, sir. thank you. next speaker, please. >> good morning, my name is maria mortonson, born and raise resident here in san francisco. a recent graduate of city build academy. after graduating, i was hired onto work with the saint luke's project, and i just want to say that i think the programs and the opportunities affiliated to the project going on for residents are very grateful and i think they're great. thank you. >> thank you, mrs. martinson. next speaker, please. >> good morning, commissioners. my name is it tido and i have been here 20 years and i live in -- i graduate city build, cycle 24 last year. as far as the opportunity that city builder has given me, it's a great company. i'm a medical worker. i work at the van ness gary campus hospital project. as far as some of the things -- one of the offer that was really good is that if i - when i leave work, if i were to drive to work, it only takes me 12 minutes, but taking public transit, it takes 40 minutes. there have an incentive program, if you take public transit or carpool, they give you some things that you can get points every month. one of the other things, that's what cpmc does. what the southland district does and i was surprised when i started working with them, they encourage you to take public transit. they pay for your public transit, and that's the thing that surprised me when i worked with them. this is the first time i have worked for a construction company. i found myself unemployed a year ago. when i went to the unemployment office, i found out about city build and after that, i've been there for five months. what city build has done for me was it gave me the opportunity to work in the construction field. we have people from southland supervisors to visit our school to demonstrate for us and other trades went and visited and happened to choose sheath metal. if city build was not there, i know i would never have had the opportunity to work in the construction industry and in the field of my choice. i appreciate everything that this city build and the office of economic development has done for me and my family. thank you very much. >> thank you. next speaker, please. >> hi, i'm vaquez, i'm a project engineer of the gary campus. i work for herald bolt. i've been a san francisco resident for 12 years, and i did my high school year here. i did my undergrad at san francisco state university. i got my current position thanks to the herald bolt inter ship program that was represented as a state. as soon as i graduated, i became a project engineer for the structural team and i got hired on as a full time project engineer for the medical equipment team, and i just will like to thank cpmc for the he opportunity to further my career and everyday i learn more about construction and along with a great team. thank you. >> i'll call additional names. nox, melody grossman, kim barns and sand sal, and james. >> good morning. my name is gloria dixon. i'm a native of san francisco. i had the privilege of becoming a graduate of a capsule program. i started as an intern at the saint luke's hospital and from that point, i was promoted three times. i'm working at the van ness project, and i thank you. >> thank you, mrs. dixon. next speaker, please. >> good morning, commissioners, my name is abigail and i'm with -- running an employment -- finding pathways to good jobs is extremely difficult. as i'm sure you know, we have the highest rates of poverty of previous incarceration, substance use, mental health and we have doubled the homeless population of nine other districts combined and i'm here in support of cpmc because they've been extremely dedicated to our community. kevin train have come on and they have dedicated literately hours to interviewing every single one of our job seekers. after the interview event, they ran out of time and had to go back to the office. but instead they sat down with me and they went over feedback on every single one of our job seekers. some of our job seekers were referred from employment and it transformed their lives. one of the women they hired is a single mom with three children. since working for xhm, she's been able to find permanent house and change her children's lives. for the folks who are not referred for hire like i said, progna gave us feedbacks -- on behalf of hospitality house and the nine -- we're grateful for our partnership with cpmc and i can't advocate enough for support of them. thank you. >> thank you, next speaker, please. >> good morning, commissioners. my name is christian martin. i'm the executive director of the lower pope district. i would like to echo the comments of previous speakers and thanking cpmc for their community outreach. their generosity allowed us to directly employ people that have -- and providing cleaning and maintenance services to the district which in calendar year, 2016 removed over 50 tons of trash, feces, needles from the neighborhood. and indirectly, their presence has supported small businesses, and i would like to thank them publicly and encourage the commission to support them. thank you. >> thank you, mr. martin. next speaker, please. >> good morning, commissioners, my name is escamine and i'm the director of the economic clinic which -- jobs and justice, the community labor coalition that so tenaciously pressed for the meaningful community benefits that we've been hearing about today. and a coalition that has consistently participated in the da compliance review process. in the public comments that follow mine, you'll hear from individual members of the coalition speaking on a number of specific issues. but i've been asked to make three overarching points. and the first is that it really shouldn't have been this hard and it should not have required so much effort from this coalition to push the city to insist that sutter cpmc fully comply with all of its obligations and the second point is the coalition is disappointed that the city has not used this review process to cat allies a forward discussion and looming conversations that need to be address to explore whether all the essential promises of the da are being fulfilled. instead, this review process has evolved into a formalistic bureaucratic backward looking box checking exercise. at the end of every may, cpmc reports that it has met each and every obligation of the da. in june or july, the coalition submits lengthy written comments of where cpmc has not fully complied in areas where more information or dialogue would be helpful. we literately suggest the areas that the city report should discuss. then in the fall, the city report typically ignores most of the coalition efforts to catalyze discussion and discuss whether all the ordinary lives of the san franciscans lives are being -- it appears to many coalition members that the rules of this review game are that cpmc must never be scrutinized too closely and given a passing grade, and if it can't be given a passing grade, the previsions of the da that is violated or ignored or they're reinterpreted or this joint hearing is postponed until cpmc can be given that passing grade. thank you. >> thank you. next speaker, please. >> good morning, commissioners, my name is osney and i work at community housing partnership. we help homeless people secure house and help them become self sufficient. last year we served over 1400 residents throughout the city. most of them in the tenderloin. i think it's great to see other partners in the tenderloin line saint anthony's and hospitality house. we deal with residents every single day. we have heard about compliance verses non compliance. i want to talk about this from our residents perspective because they live in the tenderloin. we work there, but they live there everyday. i think we're starting to form a partnership that's great with the different nonprofit and non community -- in august, we hosted a community event and while turn out was low, we did ascertain we need to collaborate better and we can do better for our residents. they've stated if there is the ability for cpmc to provide transportation for tenderloin residents to access other cpmc facilities until the cpmc office opens -- additional they stated that a navigator to help support access to services was available, and that would be helpful for them as well as other low income residents. last but not least, working with homeless residents and formal homeless residents, i think it would be great to collaborate with the department of public works and cph to see how we can provide access to care for those coming out of encampments and get them when they enter the system, to make sure they have the opportunity to have access -- equitable access to care in the tenderloin. thank you. >> thank you. next speaker, please. >> hello, my name is melanie grossman and i'm a member of the older women's league. and i would like to address the low enrollment of the tenderloin residents to the cpmc manage care program. i have experienced a recruiting community members in the mission, the bay view, visitation valley, and oakland to research programs at the institute for health and aging. and although i congratulate saint anthony's on their work, i'm here to suggest that there really are ways to successfully recruit community hard to reach community members, and we were successful in our over efforts. the first thing that we did was to get community input. what are their barriers, what are their motivations. what would help people join? the second thing that we did was just showing up in the community and i'm not suggesting that people aren't showing up in community, but just thinking outside the box. showing up at the churches, going to the beauty parlor, going to the barber shops. there's lots of interesting places to meet community members and to recruit them. the third issue is the advantages of enrollment have to be immediate and they have to be clear. we learn that people want to stay in their own community, and that means that if they have to leave their community for, let's say, consultations or procedures at other cpmc city campuses, we suggest providing navigateers so they can feel more comfortable and they have to be user friendly and welcoming. i think using these techniques that the enrollment goals can be reached realistically. thank you. >> thank you, mrs. grossman. next speaker, please. >> good morning, my name is matt and i'm with the california nurse's association. we would like to see sutter cpmc and city reports more fully discussed why there has been so many volume volume tilt. we would like to see a break down by campus to -- by patient zip code and three, how many diagnosis services at cpmc has done to relieve backlogs at san francisco general? finally we would like to know why the city thinks that a random sampling of 25 patients out of more than 30,000 is a sufficient sample size. on its face, this number is inadequate. thank you for your time. >> thank you. next speaker, please. >> good morning. my name is jane, thank you for having us here this morning, commissioners. i'm a 30-year nurse at saint luke's hospital and i work in the emergency department, and i have been down this hearing road almost 8 to 10 years now with trying to ensure that cpmc rebuilds saint luke's the right way. san franciscans support the health director's efforts to -- appropriately services compliance at cpmcs hospitals, however, we want cpmc to end act best practices and that's providing services that promote the health and well-being of all patients, particularly spanish speaking patients. we have in the past asked the health commission to folk house the diabetes centers at saint luke's hospital assessing for demolition of services. the reason for this focus was the abrupt termination of almost 3 years ago of two spanish speaking diabetes educator, one by cultural and the spanish speaking buy cultural administrative assistant who were working at the diabetes center for 12 to 18 years. at that time almost three years ago, 70% of the center's patients were spanish speaking whereas today the number is 51%. thus we see a 20% drop in the number of spanish speaking patients served probably reflecting in large part the [inaudible] spanish speaking workers at the center. at a meeting on april of 2016, cpmc met to discuss the diabetes saint $2016, cpmc met to discuss the diabetes saint luke's center. this meeting result in series of clarifications and recommendations. number one, the first recommendation was that additional language, spanish language capacity is warranted. as of tuesday this week, cpmc hired a four day per week spanish speaking dietitian. given the 20% drop in the number of spanish speaking center going to the sent e we urge cpmc to do outreach to the latino community advising them of the increase of the capacity to serve them. a related issue is a use of interpreters and patients state they don't like interpreters as continue invasion of their privacy and they have different conversations with an interpreter present as opposed to a spanish speaking provider. cpmc best practice goal should be to have every spanish speaking patient be seen as a spanish speaking provider. we use an interpreter phone which cold and there is something lost in the translation there and the patients do not like that. i see that. thank you. >> thank you, mr. sanderval. >> my name is ruin. i work for the california nurse's association. the second recommendation of the joint cmpc meeting was spanish meeting education that should be offered at the saint luke's. it was understood at this meeting there was a plan for this classes in the future. this has never happened. but three weeks ago, classes for english speaking -- ready for this hearing. spanish is spoken by 51% of the patients, someone will think the spanish speaking language will be your best practice, but that hasn't happened. the third recommendation with the reception staff will improve patient experience. there was a full time aa who's door was open at the center at all times. and since she left, the room has been empty except when it's used by an educator. there's no reception area except for the hallway and the chairs. and those chairs are [inaudible] location when you want to see them wait. when patients call a number for an appointment, there are directed to room 230 which is a prior administrative room which is closed and has a sign on it telling the patients to find their provider with whom they have an appointment. to make matters worse, and more absurd, the patients are not given the name of the provider so when they're looking for an appointment, so often times they wander the hall looking for someone to ask the name of their provider and they start working on doors all over the place. to this day, there's no aa room or staff. we have here cpmc have no plans or intentions to add [inaudible] for this office with the capacity to make appointments and direct people to their providers. i'm pleased, this situation is getting worse when we compare to the diabetes center, that center has 2 full time aa as well as american assistance. and this person is the one that's directing and making the appointments. thank you very much. >> thank you. next speaker, please, and i'll call additional names. bob, michael lion, gordon mar, and david elliot lewis. thanks. >> hi name is ken barnes and i was at saint luke's for over 32 years. adding to what the prior speaker says, i invite you to visit the saint luke's diabetes center yourself and see the condition of the year. i have no idea as to whether the new diabetes center is going to be moved to the new hospital although i kind of doubt it. if it doesn't, in my opinion, the space itself and the organization of the space is at best disrespectful to patients. the fourth recommendation of the joint meeting of dph and cpmc had -- it's prevention in education serving patients for chronic diseases including diabetes. it's supposed to coordinate care with the diabetes senter and primary care providers in the saint luke's community. to provide comprehensive services to patients with diabetes which in fact is only sporadic with sharing in coordination of care and not consistent. in the april 2016 meeting. the group discussed the possibility of including patients and staff from health first on the saint luke's diabetes center advisory council. a council was mandated by both the american association of diabetes educator and the centers for medical and medi-cad services. saint luke's diabetes center doesn't have an adviser council how committee. the adviser council to the diabetes center -- the main diabetes center is located. as far as we know, staff nor patients of the saint luke's diabetes center city advisory council and the members are from the california campus only. given the differences in patient composition and location, we believe that the saint luke's diabetes center should have its own council comprised of patients and staff of the saint luke's center. what we described is disturbing to say the least. the fact that it took cpmc three years to hire a spanish speaking -- to serve spanish speaking patients who prefer or must use spanish in their patient visits. and it speaks to the gross -- in general towards spanish speaking patients showing respect to -- finally, there's a question as to whether cpmc is out of compliance with the diabetes educator as it pertains to an advisory council. cpmc must do better than this. and we call on you, the health and planning commissions to hold them accountable. thank you. >> thank you. next speaker, please. >> hello, commissioners, i see we have some new commissioners since we last testified. my name is bob. i have been involved with the coalition since its inception. i want to address one thing first today and talk about the latest developments at the centers of excellence and senior health and community health and i want to acknowledge jim nick on and ebone web and their colleagues at cpmc. they talked about working with a coalition. to date, we have focused on the center of excellence for senior health in part because we wanted to learn how to get it right before we expand it to the more comprehensive area. there's a great deal of support for the work we're trying to do at saint luke's for the center of senior health, but it has been hard to get people from a lot of nonprofit agencies to participate in a planning, but i think we have an agreement with the folks at cpmc that will work on that together. it's going take time. and it's going to become more difficult because people overwhelmed in their work is going to have a harder time over the next several years so we're going to work on that together. i think -- where there's a principle we have accomplished that cpmc who -- which wants to keep seniors out of the hospitals to the extent possible, it's a goal we share, must have relationship with the community based organizations that help seniors and other aspects of their daily living, you know, meals, programs, transportation, recreation and things of that sort. and i think that's one of our challenges to how to make that part of the advisory group that works with cpmc. i want to say, i think the center of excellence health is going to be a challenge because if there's no accountability to community, saint luke -- i'm reminded about the new saint luke's homes serving a new demographics of people who are better educated and employed. saint luke's hospital must serve of course, the new demographic in the neighborhood, but it must be under the nearly 150 year mission of saint luke's hospital that served immigrations -- the last thing i - this is stepping out the bounds of this, but given the changes that we might be seeing, there are so many different assumptions we made when this development agreement was corrected. i am ' -- i implore the commissioners to think about it. if -- i'm running out of time. damn it. the last thing -- given the assault that's going to happen on public institutions, i hope we can work with private providers to help deal with the consequences from whatever repeal of obama care takes. >> thank you mr. prentis. next speaker, please. >> michael lion. i lived in [inaudible] heights for 40 years and i worked 15 years at san francisco general. it seemed like that whole time was a struggle to get saint luke's viable, and to keep it serving the community that's poor, so called minority and grossly medically underserved. when the california nurse's association began their medical red lining campaign on the poor communities of color that hospitals mostly avoided and the stresses on the few hospitals that did serve those communities, southeast san francisco and saint luke's were almost the first target. and viable saint luke's was the back up when the san francisco general emergency department was on ambulance diverse which was an unconscionable amount of time. we remember that when the first setter health foundation of saunt luke's ended up with trying -- it meant the required five years was up. and we cannot -- we cannot ignore my co-hills neighborhood about wanting to serve the community. if we think we had problems providing medical for those in the past, imagine what it would be like when the medi-cad expansion is appealed. any plans that san francisco comes up with to deal with this emergency needs to include saint luke's as an intra cal part and that means supervision or saint luke's. the blue ribbon commission and the hj 2 commission and other groups have been the guardians of saint luke's and health care in san francisco and especially in the san francisco's health care, h 2 j 2 is a labor organization -- they need to have a formal role in ensuring that cpmc adheres to its development agreement, that they so reluctantly sign, but that he bare the burden for health care for all of -- such many hotel projects that are in the pipeline, the shopping mall at candle stick and the warriors arena for example. so this includes key previsions in the -- such as the 40% for source hiring goal which key previsions which are unique to the cpmc agreement and the $4 million investment for cpmc and the hiring monitor system that cpmc have created and also the partnership with our coalition of community advocates, so all of these unique components of the cpmc work force agreement can and should be included in other development agreements to expand on the success of the work force component thus far and maximum employment opportunities for disadvantaged residents. thank you. >> thank you. next speaker, please. >> good morning, commissioners, kim with the national union of health care workers, we're part of the coalition for housing health care and jobs. one of the things that we wanted to say -- talk about today was the local hiring. we have continually asked the mayor's office -- there's some jobs where you're hired for three months and out of door, a new body comes in. and we want to make sure that the people who are coming in are -- it's leading to a permanent job, a permanent few -- pertinent future of jobs and not a roll over of jobs. we would like to see a tracking. health care, as you know, people are there on a regular basis and they care more about the patients, they care more about the community, if they're there by three months and somebody comes and takes that job over, you know, it doesn't lead to great health care, so we're urging people to ask more questions about the local hire at the mayor's office, what jobs are permanent and which are not and going into the future, what that will mean for the residents of san francisco. thank you. >> thank you. >> good morning, i'm david lewis and addition to serving on the mental health board, i'm active in tenderloin including -- the community congress of the tenderloin, and i have community housing partnership. i live in one of their buildings and i serve on their board. and i'm also on a community advisory board for a local clinic in the tenderloin. a san francisco health care network clinic, and so i have spoken to the director and others about the -- to try and find out, how everyone heard of sutter health, has anyone heard anything about outreach? and while it's true, a community housing partnership has done outreach and referred people and they have had little success in seeing the people they referred has been accepted as patients, and outside of them, i'm telling you, of all my other tenderloin contacts and i have a lot and i'm well-connected in the tenderloin community and, i'm not seeing the outreach. i applaud cpmc stated intention to do outreach to the tenderloin, but i think there's a gap between what they say they're doing and what's happening on the ground -- back from the ground. i would ask you commissioners to continue to pressure cpmc and let tenderloin residents they have a -- we have medicare and medi-cal and there's vulnerable people who could use this service. they're over subscribed and burden and they could use the assistance of an additional health care provider like cpmc so please, they need to do a lot more. i think they have so much to offer our community, but they're not quite offering it yet and the community is mostly in the dark that it even exist or it's coming. thank you for your consideration to my comments. >> thank you, mr. lewis. next speaker, please. >> commissioners, thank you so much for your attention, and your hard work on these matters. i'm mark erinson and i'm a former director of our community economic development clinic. i have brief comments. one, i want to convey comments of another member of our coalition, marlene morgan who is active in the cathedral hill neighborhood's association. she would have been here, but she has bronchis and she would have directed her comments on the transportation. i'll be brief. we're relieved the -- it has been implemented by cpmc as of january 1st. and that the participation already has 10% of its employees. this is a major benefit in terms of dealing with transportation issues and encouraging employees of cpmc to take public transportation. i'm sad that its taken three years more than i think the specific terms of the development agreement required for the implementation of this program. but we have it, and we look forward to other progressive measures in this area. second, i want to just address what is a constant theme of our work and that is the kind of contribution that community groups, that group experts can make to develop programs that are truly responsive to the needs of san franciscans especially its poor residents. this is very important. it's always very important whether it's at the advocacy stage or in the monitoring stage, and we appreciate the cooperation with the city officials that we've had to date. we appreciate what appears to be a change in the perspective and actions of cpmc. but it's not enough. and it is particularly not enough for several of my colleagues have indicated. previously in light of what is now going on nationally. we are in such a difficult period. in my own mind, and i also have a substantial background in political science, this is a political crisis unmatched in this century. it is important that there be real creativity and outreach to community groups as we continue this process and it shouldn't have to come with us pushing so hard for it. we invite you asking us for help and we will be forth coming in ways that i think will be more responsive to the need that there are now. thank you so much. >> thank you, very much. i have no other speakers cards, but if there's other members of the public that would like to speak on this item, you can come forward now. no -- seeing none. we'll close public comment. thank you for the testimony and open it up to both commissions to ask questions. commissioner koppel. >> yeah, thanks, everyone. and the other fellow commissioners for hearing the item today. i followed the -- both hospitals process through the health commission through planning and i'm glad to -- and privileged to be here speaking with you guys here today about the project. i've worked in hospitals for a number of years and i don't underestimate the work that the doctors and nurses and all the staffing do to keep these places running and hopefully us being in san francisco, we won't necessarily need our hospitals as much, you know, pertaining to natural disasters and what not. but as a city, we're prepared for these occurrences if they happen. i want to commend the team work, the seamless team work i'm seeing with cpmc, herrara vault as the contractor with office of work force development and city build program. not only are they giving job opportunities to san francisco residents on the job sites, but they're putting them to work in the offices too. so, forever example, the van ness and gary project, besides the actual construction part of that project, there's a large amount of work being done across the street in the offices with the contractors on computers designing the building and there's a lot of people being put to work that way. don't forget about people on the job sites and off the job sites that are being employed. also i'm impressed with the fact that the -- these groups are encouraging local business enterprises to be on the job, like sub contractors and people in these offices that have you know, locations here in san francisco. it's going to be more sustainable practices if these contractors are employed on these jobs instead of out of town contractors and i'm excited to see that the projects are not just on schedule, but ahead of schedule, one year ahead of schedule. that's pretty much unheard of. so please, everyone realize that's a really big deal. i'm not impressed to see the neighborhood break out too between all owe own just the san francisco residents, but the neighborhood break outs also, and i'm glad to see that bay view hunter's point is leading the way for residents on these jobs. i also many glad to see that public transportation and carpooling is being encouraged. these jobs are in locations where public transportation of muni can access workers through the job, and would like to see this more so in the future. i have a clipper card myself and i'm familiar with public transit and it's once again encouraging, less cars on the road, happier employees that are getting these benefits and these little things like happier employees that are going to lead to improvement in production and result in these ahead of schedule timelines, so i commend all the groups involved. thanks. >> thank you. i want to -- any questions -- i did have one question to the presenter from cpmc. if you would, in regards to describing the meetings that you are having both at the cpmc cathedral hill and the saint luke's campus from a community's standpoint, the adviser committees that you're having -- >> so we've got a couple of different -- down at saint luke's, the meetings we have been holding have been focused on our senior center of excellence and the type of services that will be offered at the new hospital there. we also have a forum at saint luke's and at cathedral hill through our construction partners whereby all members of the community are invited engage in conversations about the projects themselves. to talk about issues related to noise and parking and materials, loading and unloading. at our pacific heights campus, we have meeting at our neighborhood-- we have various forums at different campuses >> can you address the question raised to an advisory committee specifically for the saint luke's diabetes center or is it an overall diabetes center for three campuses you have centralized? >> we have one diabetes program that is administered at different campuses so the administrative function supports the program no matter where patients seek access to care. >> sure. and on that advisory board, are their representative from saint luke's. >> i don't know the answer for that. i'll find the information and get back to you. >> thank you. i know commissioner karshmer had questions. >> so i'm heartened by the testimony from the partners that found there's clear signs of progress and i - particularly around the process and the employment and the transportation, i am -- you urge cpmc to continue to listen to the community partners from the neighborhood in the saint luke's particularly that it doesn't take -- that doing that extra effort makes all the difference and doing the extra effort around services, i know it sounds like you're doing some important work around the process, but the services -- because the perception of the understanding and the commitment is as important in many ways as is the process, so thank you. >> thank you. commissioner melgar. >> thank you. i wanted to highlight the local hiring and small business numbers, i think that's impressive. and i would also encourage us to look at keeping track of things like one of the commenters asked about jobs. it does make a difference. i have a couple of questions for the cpmc representative. particularly to saint luke's and the level of spanish speaking personnel going forward. so, you know, we've seen a migration of the latino population from the mission although we have not seen a decrease overall in the latino population in this city. and so what i've seen in terms of the distribution is latino population is increasing in the south eastern neighborhood so outer mission, the valley, baby hunter's point, and saint luke's -- besides general, the only hospital on that side of town and it's accessible from all those neighborhoods so saint luke is important to the valley and the outer mission and bay view. so i'm wondering going forward in the new hospital, what plans do you have for -- are you okay? >> yes. >> for the -- you know, for the spanish speaking personnel and my other question was i really was happy to hear about the ongoing relationship with nims and saint anthony and what that has provided and i'm wondering if the distribution of that patient population is representative of the tenderloin and if you're keeping track of that? >> um, so to your first question about our commitment to providing culturally and -- it's a focus and it's something we have discussed through the development compliance and something we're working on everyday, we're continuing to build our program at cpmc for all the services we provide which includes the activity at saint luke's hospital and certainly the activity within the diabetes center. i think -- i would like to share that, for that patient population, they do make appointments and when they make that appointment, they're given an opportunity to express it that they like to receive in-language care. we pay attention to that. we track it and we try to meet that need absolutely as much as we possibly can. i'm sorry, your question about nims and the tenderloin residents. >> yes, whether you know if the population that's being served through that collaboration that represents the demographic distribution in the tenderloin. are you tracking that? >> i'm sure we have reports that can be zip coded and identified so we can understand what neighborhoods that population is coming from. >> my question was more specific and not of zip code, but social economic, race, you know, the -- >> i'm not aware that we're keeping that type of demographic information. i'm not certain if nems is tracking that information, but we could find out and get back to you. >> thank you. >> yes. commissioner sanchez. >> yes, just -- just a few comments. i think -- this is -- this meeting has changed since the first time we had a meeting regarding these two efforts including a task force and oversight and commitments and as i listened, again today, let me just say that there really has been some significant headway in what has happened and in the coalition, and in the bottom line where we have hospital sites that are finished, but are staffed by quality incompetent see, and i want to commend the city agencies and our contractors who have been providing new opportunities for the work force because if we weren't doing it here, as we did with the build at laguna honda and ghgh and we're doing that -- doing the proposed research for -- if it wasn't for the health karen -- the health care industry, a lot of these jobs and skills won't be here anymore. as you look at the data and the compliance and the oversight and the opportunities, you see wow, this is really making some significant headway. the critical variable is can we sustain -- can we sustain these opportunities because think about it, folks, when the old otis elevator company used to do so many old facilities, federal state, the old general hospital, whatever, these companies were trained skilled jobs, and they're no longer operational and everything is computerized and it takes six months to a year to get repairs in the facilities and that's why we're rebuilding these hospitals and facilities to make sure we could keep up with the quality assurance that can provide safety for our patients and our health staff and our community. so what i'm saying is that even though there are shifts in job skills, there are shifts in the quality and service on what we need to provide and sustain, so you know, cpmc is, i believe, to be commended for the fact that they have committed and have fulfilled up to this point in time charity ability contributions and we have people who have been here for years, former institutions that says we need to look at what the radar is showing as we move forward. it bring back a thought that you know, in the 60s, we had the old war and poverty and that gave dollars to then schools. san francisco had kindergarten to a community college all in one district. they were training our art -- with native americans because they were fantastic skilled people and they could make these fantastic jobs and we had all these other programs and the airport industry. all these things disappeared. so who is doing it today? health care. hospitals. rebuilding, restructuring and transportation, park, you name it. as we have lost people, there's been a change in definition pertaining to how we provide these services. one more example, and i know i'm -- local 261 was very active in the 60s to form a training school, to train immigrants to work in the skill building industry, construction workers, okay. they started a school called a mission language and vocation school, and that school is still operational, but the curriculum doesn't provide for the jobs, but it has been providing training for health care. interpreters working as specialist, people have been hired by u.s. and kaiser, et cetera, et cetera, bilingual, not only in spanish, but other schools. that school is still there. i mentioned that in two of our hearings before saying we need to look at the community, what are the resources and can we link with some of these programs that's ongoing? and ovs is on 19th street. it has been there a few blocks from general hospital, a ten minute walk up to saint luke's, the mission neighborhood health center, you name it, they're there, but many of their trainees go to other parts, you know, what i'm saying is we need to take a look at these internal resources in this community as was noted by some of our speakers later on. the other thing is the elderly. take a look. where are they? are there any organizations that has been in there. we have mentioned these also. latino, the san francisco has been involved for 40 years -- and they have provided services and they're on 15th street. they have worked with veterans, all these services provided along with [inaudible] which is on the side. all these community organizations would be tremendous resources to provide onsite training for diagnosis and treatment and having a specialty clinic or visiting nurse or nutritionist and come in and present these programs. they have been there and they'll continue to be there, but at some point, hopefully the next round, they might be linked so we can provide some of these preventive programs, but there's a lot on your plate. u drshgs -- uc has been using them to rebuild san francisco general. they know because they've been there for a long time. saint luke's needs to also take a look at some of these organizations that have been here for a multitude -- for over 40 year and are still servicing people today including expanding their programs for up to seven days. what i'm saying, we have a multitude of other organizations, again, in the mission, that have been here, but they work under the radar, they work quietly and they provide service and have measured outcomes and they're doing an effective job. as we move forward to the next stage, i hope we could link and talk about how we are not only going to expand unique services and have a fantastic center of excellence that maybe has a unique model known to no other, or are we going to continue and maintain a different approach pertaining to the -- not only integration of health care, but the services we must provide when you have the population of kids change from 95,000 in 1968 to 51,000 in public schools today, and we still have families coming in. we still have kids coming in. we have many kids coming in from other communities, believe it or not because the families are afraid of the new laws for immigration and undocumented workers, but the kids are here because the workers are here, and the grandparents are here, and we need to think these new models as we take a look at our patient population in our community we serve. and i want to say, as a native san franciscan, when my family goes back four generations including two generations in the mission, saint luke's has made significant headway since we started this dialogue before, and i hope we open dialogue. i feel there are -- there could be great changes even greater changes as we complete these new facilities. facilities need trained confident, health providers and staff related to the culture and the dignity and respect of everyone that we see who are involved in this great network. congratulations for the work well done and there's an old navy saying we have, we stand with pride and view [inaudible]. well done, though. and we could do a little bit more, a lot more and we'll have due diligence. end of comment. >> thank you commissioner sanchez. commissioner richards. >> i'm surprised that so much has been made up in the last year. this question i have for staff before i go on. i know you've answered this question twice before. the gap between the end of the year, reporting year and today seems very wide. companies can report results and a quarter million dollars of transitions in days, why the gap? >> apart of the gap is the development agreement. and after the -- at the end of the each calendar year, cpmc has 150 days to produce the report and the city has 45 days to report its own and we have a 60 day notice hearing for this period. there's many calendar year. with that said, this past year, we did taking on board comments from the commissions last year, we worked diligently to tighten up that period and we produced a city report a full three months earlier this year than last. you may recall this hearing was scheduled for november and unfortunately there was a quorum issue that caused us to postpone it to this. date cpmc, i'm happy to say has been a great partner with us in compressing all these timelines and being diligent in getting answers that we need so we can provide a report quickly and we hope to be here confusingly quickly for 2016. >> i appreciate that. i forgot this was scheduled before. the makeup -- the year before i was suspicious of how are we going to make up these deficits and development agreements and it seems like there's so much wiggle room to drive a truck through, however, it looks like it was structured where -- and here we are now with a lot of green dots, virtually no red dots and just a few yellow dots, meaning on target, almost at target and far behind target, so i really like the tone of the discussion. i like the fact that we've had so much progress. in fact, at first part way through the first portion of the public comment, i was like wow, am i in the right room because they were contentious and we had issues and it seemed like we were really far apart. i guess the question i have for the gentleman who represented the coalition about the process, just a little -- i have a couple of questions for you. i get the role of the coalition is to hold cpmc's feet to the fire, right, and we started with these big issues and we're down to what seems like issues that's easily overcome. is it the process that you have issues with, maybe are there trust issues there, or is it cpmc it stem that there's trust issues with? what's with the coalition terms of how they view cpmc in the process? i'm really interested in that. >> i think there's a correct perception with the relationship between cpmc and the coalition and they have improved after stern warnings or stern admonitions. i think part of it is the coalitions expectation is that -- the coalition worked very hard to get all of the community benefits into this agreement. it pushed the mayor. there was a first version of a deal that was not deemed sufficiently significant enough benefits for the community and with a lot of pressure, a better da was struck. our expectation is that every single promise that cpmc makes will be fulfilled. we don't need to express our gratitude for cpmc doing what it committed to do. there was an arm's length bargain offer what benefits cpmc would give to the community in return for authorization to operate the project. so we tend to focus on what hasn't been done and in terms of the lag, we are deeply troubled that three years after the coalition indicated, there's a serious problem at the diabetes center, we have the response that cpmc in may of 2017 will tell us what it did after a meeting in april 2016 with the department of public health. >> let me ask you this question. we're down to what i think are doing the scope of where we started, and you acknowledge a lot of progress has been made. issues, i think are easily -- it's sur mounted. the diabetes center. these are important issues, but given the scope of the da and cpmc's resources, if you were cpmc, why wouldn't you just say, here, here's the resources we need to do, next area going to come back and sing -- and everybody is happy. where's the gap in your mind? >> i can't speak for cpmc. i'm not quite sure i'm following your question. >> i'll ask the cpmc representative as well. i appreciate your response. i understand your role. what's your name, i'm sorry? >> mr. premelly. >> the cpmc rep, i get there's a lot of issues and here we are with a lot of progress being made. now we're down to -- it appears to be something within your resources that you can just maybe get done quickly. what's the -- what's remaining hurdles? >> we totally agree. it's why we have been working so diligently with the dph and have a -- addressed all the recommendations we've had from the meeting. we want culturally linguistic services and it's challenging in our specialty to find the competent employees who are culturally and linguistically able to handle that. we're going as fast as we can. we're addressing all of the specific items that were addressed, but we completely also agree with your perspective that, you know, its scope of the da is this, and we're down to these few items. we should be able to find a way to get those items off the table. >> regarding the culturally linguistic -- people were relieved in year's past for doing what they needed to do and it created the gap and we have this time period go by and we have one other person. why not call these people back and say -- >> it wasn't that people were relieved of their duties. the program was consolidated across our entire enterprise and the fte load, particularly in certain aspects of the program did not need to be as high as it had been when there were separate programs across the campuses, so those fte were offered other roles at other places and i'm not sure if they've ended up and they're working at u.c. and i believe they're not working with us at cpmc, so we can't ask them to come back -- >> i got it. i think commissioner karshmer's comment about -- there's things to overcome, but the perception is sometimes bigger than what reality should be, so i completely agree, so great progress. i like forward to seeing kumbaya next time. we've heard the spirit of the agreement is as important as the components of our compliance, so we know. thank you. >> thank you. >> thank you very much. >> commissioner loyce >> good afternoon, ladies and gentlemen. i have a couple of comments. one of them has to do with -- i can remember years ago when we were having discussion about saving saint luke's as to improving the quality of services and relationship to the community. the concern that i've always express and it may not be valid because this is my first hearing, i hope of many, that have, in my mind's eye been positive and constructive in terms of the presentation from staff and from the community. and so i want to be clear that when we look at the burden of disease in the latina and african-american and asian-american communities, when the cpmc and the health department do outreach to bring board members that we do deep into the community and we don't align ourselves with the historic nonprofit, will you look at those outside the nonprofit community, so that we can gain insight from those who are receiving service and from those who have a voice in the community that isn't heard via the traditional model of acquiring and recruitment of people to join community based organizations as representatives from people of colored community and from the southeast sector, and certainly from the mission district. i've watched this activity because i've been a 25-year resident of st. mary's park which is less than a mile away from saint luke's, so i've watched this happen and grow and develop into, from what it was when we were saving saint luke's to what it is today, and granted, i think there's always going to be room for improvement. there's always going to be apart of the community and they're less and satisfied with the responses, but kudos to those who worked hard from the community perspective and from cpmc and from local government. thank you. >> sorry. i also want to thank all the participants for the great progress that is being made over these several years. and a number of us have been sitting here and it is better to be really looking at the fact that the major component parts are moving forward. and where we are now is where our comments have been made regarding how we can actually enhance where we are going to go so that the health care facilities that are being built here will serve the entire population and the public. and that includes clearly the residents who are around the new cathedral and the residents of saint luke's and the greater city, we aren't that large that we don't really have [inaudible] of san francisco. and clearly a number of steps have been taken, but they do appear to take an awful long time to get there. even if we ignore the fact that this is a 2015 report because we did get an update on the current priorities and -- in 2016, we're hoping to hear better information, but the fact that after all the discussion, that saint luke's is just an example. it has taken almost three years in order to bring about -- one additional bilingual staff member. and was apparently some question that there is community input. so i believe that from at least the health standpoint, we certainly are on point with most of the agreement. i do think that -- i'm somewhat concerned from director dod's first comment that we didn't have the fee assessment within time, but we had agreed to have an assessment and i would ask staff that those points that are in compliance or within the compliance, but clearly if we're behind in that, then the issue of the cost of our health care for city employees may in fact be overstated, if in fact the study shows that there were problems. so i think that needs to move forward. it's a small point, but so many are on our city plan. i would think that -- i don't have all the details on how that audit was supposed to work, but if it's supposed to be sure that the rates are appropriate, then we need to be sure about that a lot earlier or perhaps it's within the time schedule. i'm not sure. but i do think we need to understand that a little better. i think the other broader things that i would also like to echo is that i think that going beyond the letter of the agreement is the spirit. and the spirit does say that we involve those who actually are in need of the care from our communities and may be able to benefit and even better, to be able to enhance the services that may well be provided and our commissioner spoke about other organizations within each of the communities that may well be a synergy to the work owe open advisory board comes up about how formal and how informal, but to have the community input. it's what we do at the department of public health. we actually hold all these hearings and involve -- we must have three, four dozen advisory boards so that we understand what the communities -- what our target populations need and therefore we can also have them as partners as we move forward to the goals that we have for our own organizations and i would say that where -- you have two campuses in two great areas to make that impact on our communities, working with the communities really is going to make an even better agreement and a better health care system for all of us. so i would encourage that, and lastly, i would encourage we not only look at the letter of whether or not we are meeting cultural competence, but it's really an issue of are we actually creating a better environment for health care decision making, which is what it's all about. so it's not merely complying with the very pretty picture of 15 standards and where we have all the people in place to do it. that's a progress and a process, but that we understand the outcomes. you have that on your interpreters but i encourage as we look at this and the class standards, and they're not there to be checked off, but to be there to be sure and it's not easy. we have made a difference by having appropriate class standards and not just the numbers that we have. from our standpoint, i commend our own department staff for the work they have done in responding to this. thank you for cpmc for filling out all these forms and >> thank you to the health commission and thank you to city staff. this is a ton of work and especially to the coalition that have been a driving force in get this agreement done and implementing it. so that's all. do you want -- >> indeed it is. i believe the commission will break before our regular hearing for 30 minutes. >> yes, if you're here for the 12:00 planning commission hearing, we're going to take a break. we're finishing up our 10:00 meeting and we'll be back here at 12:45. thank you. >> the office of controllers whistle blower program is how city employees and recipient sound the alarm an fraud address wait in city government charitable complaints results in investigation that improves the efficiency of city government that. >> you can below the what if anything, by assess though the club program website arrest call 4147 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