Transcripts For SFGTV Special Joint Planning Health Commission 12315 20151206

Soma, outser mission, very competitive marketplace with low unemployment rates are going to continue through the life of this agreement, but we think weve now really hit a stride with this excelsior, client town, southeast neighborhoods. Program the 40 goal was attained and that well continue this high rate. We are also very pleased to report that over 70 of those hires are august 14thjuly 2015. Coming from targeted neighborhoods the systems were filled with identified in the d. A. Our referrals. 74 of the 80 hires were from additional accomplishments from the Development Agreement as you the priority neighborhoods from the heard, weve not only initiated agreement and i just mentioned on the last slide. Community discussion at the saint lukes this is a vast improvement over the first year. At the end of the first year campus but weve had community they did a 13year deficit of a hiring engagement at all of our campuses. There are always going to be deficit down to 11. Members at im pleased to say so far this the community for what the expectation for that level of community is, year starting with october 2015, they certainly know how to reach us and that is a good thing. Weve been a part of which is these communities for over 150 over 70 and such that hiring years. We want this dialogue with them deficit is now eliminated which is a so we will continue that dialogue on good work all four on everyones behalf. Of our campuses. Its very important to us. We have hired additional full time staff to work on the one is a feature to highlight Transportation Management programs. To advance our efforts on training folks weve conducted assessments at and getting qualified each campus. Part of our process as candidates for cmpc paid 3 million by the san weve described to you previously is that we needed to hire this manager, francisco foundation. Focus or they needed to come and do some barrier removal and job training and i baseline data collection. Weve done that, weve listed conducted the employee commute at the end, there is six survey and we are currently reviewing the scope of our campus wide current grantees receiving funds through this shuttle program. Project. Faces sf, jewish vocational service, mission hiring hall, positive resource center, selfhelp for the with Construction Workforce hiring goals we have in vested 30 elderly and success center. Hopefully well see more system million, hires through these efforts. There is a goal for hiring and all of our 2015 commitments ultimately with compliance we have to look made ahead of schedule related to at good faith efforts. The numbers you see here. There was initial failings in so in conclusion, we are very terms of happy to the good faith efforts at the beginning have been found in compliance of the project. There is a failure to for calendar year 2014 on all enter level job notices until commitments and were even more pleased at december the progress we are making through 2013 and the hiring projections 2015 and didnt come until april 2014. Expect that well hope to find subsequent to that there have compliance when we get to the been some 2015 marked improvement. Reporting year. I have two more slides. We have each year on time the this is a current view taken yesterday from van ness and geary. Entry level hiring projections. The d. A. Offers every 6 months we are happy to report the and we closures on are in Constant Contact with van ness to do the work on the cmpc through meetings and conference tunnel underground, they are done. They were done without incident. Calls and trainings and paid we are very pleased and happy dividends and there has been rotating hiring about that. If you can see in the lower events what we call employer spot lights throughout the neighborhood and lefthand corner, that big hole, where the cmpc in our office have the medical Office Building is dedicated staff going to go, also. With that, i will finish my its well under way. Section and turn it over to colleen. If you havent been by the site, its worth seeing and very impressive as presenter thank you, good that steel comes out of the morning, ground and starting to take shape, we are commissioners. Colleen from glad to have you there. Department of Public Health. Next week we are having a topping out she will be here as soon as ceremony to raise that last shes able after that meeting is concluded. Steel beam. Equally as impressive is our so this is a summary of the saint lukes campus. This too was healthcare taken commitments that i will detail yesterday. The work here as has been noted in my portion of the report to you is all on schedule. We had our topping today. Out there 2 weeks ago. Baseline charity care, the new it was a wonderful celebration medical beneficiaries, Innovation Fund, integration of the medical between the workers our staff and the staff. Community benefits. Partnership, the agreements community and again we would be happy to with Chinese Hospital and culturally have you there. And its an equally impressive linguistically appropriate structure. Thank you very much. Services. So i will start with the baseline charity care. For the next few slides i will detail cmpcs compliance with the commissioners, before we healthcare elements in 2014. We recognize that we are well accept general Public Comment, we did into 2015 and there is progress to report allow on the four organized opposition a 2015 compliance status. But, to separate last years compliance which is the subject of this presentation 10minute presentation. With the progress towards compliance for the current year, i will address the details on the progress. For baseline charity care, there are four obligations. The goal of these four good morning, commissioners. Obligations is to make sure that everything my name is gordon mar and here else on healthcare of the development with san agreement were on top of what cmpc is franciscans healthcare housing jobs and justice and a member of the already doing. These four on the slides coalition. Thank you for holding this important are hearing which is a key part of meant to memorialize to keep in the public process to ensure that place the charity care that cmpc was sutter making at the time it entered into the cmpc is meeting all the Development Agreement. Important Community Commitments that it first on the unduplicated agreed to when it received approval for its patients served. Hospital Development Plan back there is a requirement for in 2013. For over 5 years our coalition has worked to ensure that cmpcs reconfiguration in San Francisco campus serve the interest of workers, 32,000, this neighbors and community as a number represents the last whole. We played a key role in shaping the terms of the Development Agreement medical patients served. And closely monitored the citys charity care is free care offered to low income people who are under and cmpcs mrems of implementation of the d. Insured who do not have the ability to a. We are here this morning to pay for those services. Medical are those with the offer our lowest income in our city making about assessment including neighborhood leaders and Community Activist and organizers. As detailed in our 16,000 coalitions two comment letters or less. Which the Development Agreement you have copies of. We have serious significant allows cmpc concerns about cmpcs failure to comply to make this up under a 2year with a number of key substantive areas of this rolling average provision. Development agreement which my it must be under 32445 that colleagues will address in their comments. I will focus first in our coalition strong procedural concerns about the city report. The coalition is deeply number is troubled by the insufficient to cover the short extensive delay and preparation fundamental it experienced in 2014. Therefore cmpc must makeup the in its posting which is 54 days later difference in 2015. At the end of the presentation specified in the d. A. And a i will discuss the efforts to makeup shortened time in the public to digest that difference. The second baseline charity care and respond. We had only 30 days element is Community Benefit rather spending. This is 8 million annually for than 60 days as required by the d. A. From when the city report was Community Benefits to the poor and under served. Released until this hearing. It was only yesterday afternoon cmpc exceeded this requirement that and missing lines from key pages of suspended 14. 6 million in 2014. The city report were reinserted and the third element of baseline charity care is the Hospital Charity published. Its hard not to care policy. Charity care policies outline interpret those failures as the city the income and asset limits for the asleep at the switch and in dialogue and hospital. The policies remain the same as full compliance. Before this citys report is a in the implementation significant step back from last year which Development Agreement. The final baseline charity care was elements is the Bayview Health completed on time, responded to issues by the coalition and did so a full 60 days before the joint hearing center. Cmpc has been a long supporter of the of commission. Bayview Child Health Center and moved to the south of market Health Center despite the coalitions track which is a nonprofit bayview record and the finding letter and clinic. Third Party Monitor to the board of support through a 325,000 supervisors last grant. They lead the former director through the end of 2015 to promote continuity of care. This years city report did they transferred all the assets of the center estimated at 91,000 to not participate in the dialogue. This is why it falls short and the south of Market Center at no cost and 1 million in tenant improvements the comments explicitly and and adequacy on the remain the health net partners cmpcs implementation and plan to provide hospital care. To do nothing to ensure that cmpc promises to secure jobs and the public on top of those 30445 baseline benefit to reach the communities intended to be served. Good morning, commissioners. Charity commitment is the commitment to continue to payment in medical managed care and to serve 5400 new running behind. Our coalition has attempted to ensure the cmpcs medical member beneficiaries. Cmpc new hospital to a Healthcare System continues to participate as a provider in the san in all people in San Francisco. Our Francisco Health plan, one of concern was under scored by 2011 report. The health plans providing medical in San Francisco. Prior to the agreement, cmpc the documented while cmpc is was the most responsible for 14,000 successful among all private beneficiaries. They are required to at 5400 to hospitals. We advocated for specific that for a total of 22,000 medical commitments to require cmpc to provide their fare share to Healthcare Systems to beneficiaries. Through its san franciscans. We learned that partnership cmpc has at medical northeast services failed to meet its obligation cmpc has for 2014. Accepted 16,000 new medical we understand that department of public beneficiaries, exceeding their health for providing diagnostic services to help reach their target. Its good to help reduce requirement by 10, 847. Waiting times new medical management and far sure providing for beneficiaries is to serve tenderloin uninsured patients. We ask to work with beneficiaries. With the 1500 is a new partnership with cmpc the provider should such a patients. It was encouraging that the provider exist. Saint during this time of reporting, anthonys clinic made a there was progress made on this commitment to partnership on the current year which i serve patients. Will deal with at the end of my it was disconcerting that it presentation. Was only in addition to the previously providing to very little healthcare commitments cmpc supported a Community Health Innovation Fund patients. Hemorrhoid at the held at the untapped Community Resources and ability to meet its commitment. The San Francisco foundation. The department of Public Health its 8. 6 million fund that is health cited a meeting as a beginning payments which are made to cmpc over a of a dialogue progress. There were 17 people at that meeting. That is not a 5year period. Funding decisions in the Innovation Fund will be expended will sustained dialogue. Our coalition is willing to be made by our group comprising help facilitate that process. Finally more general comment by san especially important to engage the Francisco Deputy department of community. Public health and one deposit with the commission of these two hospitals is what was initially was on time in 2014 and 2. 1 million proposed and influenced in part by the changes in the south market neighborhood. We understand for three different projects to improve Saint Lukes Hospital as stated in care coordination to reduce the board of supervisors meeting that is preventable hospitalizations and extended better the Progress Foundation grant to educated. As saint lukes continues to increase their Emergency Mental Health serve the services capacity. Population. Thank you. This slide details 5 other provision in the Development Agreement. The first is around the good morning. Any other my name is jane requirement to develop proposals to address sandoval. I have been a nurse at saint the need for subacute care in San Francisco. When saint lukes is rebuilt. Lukes. Thanks for the opportunity to be able to speak on behalf of the hospital. It is progressing well and the Health Department granted several weeks ago there was a reference and extension and i will talk about why that extension was granted. To the they are also required to make ceremony with all the bells and a good faith effort to integrate the whistles and fanfare medical staff among the hospitals to commemorating the promote continuity of care and access rebuild. This is very ironic considering cmpc had no among all hospitals. In addition, one medical Group Intention of was rebuilding saint lukes and many integrated, the pediatric were hospital list and it was previously not invited to the ceremony. Integrated. Moving forward, im thankful the third requirement here is for the the Community Benefits partnership organization. The Community Based rebuild. Its a reality and im hopeful organization, Health Department, uc san for the future but im concerned about francisco and promotes Better Health to the community cmpcs and participates on its track record for providing charity care. I see they say they are moving successor group to maintain healthy partnership. Forward but still fall short. They have continued to work in saint lukes has served the the manner of the previous community. Im concerned that their relationship. And required services culturally and appropriate services that meet ability to serve will be in jeopardy. Federal standards at all of their hospitals. They have policies and procedures and while they are compliant with cmpc has expressed the desire the Development Agreement, they to have wanting to attract the better remained at the steps and in insured and better educated. There is no plan for a pediatric unit at the new saint lukes unit compliance. I just finished the review of and will continue to travel to cathedral cmpcs compliance on healthcare obligations for 2014. I want to remind the site commissioners of which is difficult for families the issues of concern to you in who the need to travel and depend on 2015 review and talk about the public progress made in 2015 since the transportation. And the conclusion of the 2014 reporting year. Diabetes side addressed, the Spanish Speaking in 2013, to refresh your memory in your nurse review of that report, you were who was employed by sutter has concerned about the possible 2014 baseline commitment shortfall been displaced and replaced by a and nonspanish there was a short fall. Speaker nurse. I know anyone who have used the you were considered about a translator phone which is inept. Managed it will be a challenge for care to meet the tenderloin pregnant Spanish Speaking low income women to commitment. And were you concerned about access these services. Diabetes the and Services Offered by cmpc pregnancy is common in the particularly at the diabetes clinic based on lower income demographic south of market. Reports that came in from the community. Once again, i dont see any iron clad you were also concerned about plans for psychiatric beds, the reduction of the nursing care subacute or skilled nurse, nursing beds. I facility beds. While the program does not see there is on going assessments require any but we need some iron clad and thats facility beds provided by cmpc and was part of the under served demographics. Concerned about the nursing skilled facility beds after the two thank you. Public speaker my name is ken hospitals. Facility beds are one type. Barnes and doctor at saint lukes for many of these concerns were born out in the 2014 report that i just 32 years. I want to address two detailed. Im pleased to be able to report to you that progress has been made in 2015. On the baseline charity situations at saint lukes and diabetes shortfall, an i center. The Services Provided at the noted earlier, this cmpc fell new hospital and will they serve all that use the hospital. The Development Agreement of short by 2013 calling cmpc to establish 1549 patients. Excellence in because the overage wasnt health. Cmpcs limitation to centers. Enough, cmpc must make it up. When i think of centers of they met to discuss ways to improve excellence, services to medical patients i think of something grand and and something to improve the health existing partnerships with and quality of lives of significant number northeast of people. Something that medical services. Addresses health disparities. Cmpc and dph addressed a thank you, sir. Your groups time is up. Shortfall in a way to benefit their goal and clients who were on long waiting list for services. Can i take my own time and dph is San Franciscos health finish. Your group time was ended. Network. Had patient wait list as long as 9 months and to help with that is your personal opportunity to offer Public Comment. If you want to have somebody assisting to else finish your thoughts or submit meeting this obligation, they provide a what you process to refer 1400 patients have in writing, that would probably be best. That disappoints me. For two types of diagnostic. Opening up to public echo cardiogram and a comment. Measurement of the lungs. Cmpc provided these test to carney walsh . Public speaker my name is on there. My name is melanie grossman. About 3400 patients thus far. Its on track to meet the care i will get to the back of the commitment to include the 1849 line. Thats all right. Good morning, my name is lives to meet the shortfall from last melanie grossman, a licensed clinical year. Social despite this, cmpc continues to worker and the member of the Womens League of San Francisco. Meet those patients previously commitment the Womens League is very for services identified. Concerned about the healthcare needs of regarding the tenderloin managed care seniors lives, im pleased to report all over the city, but especially in to you that we launched a partnership the saint lukes community. Many of our members belong to to provide the pathway to meet this obligation. Those specifically nems, cmpcs existing partner added Saint Anthonys neighborhoods and we are Medical Clinic for which cmpc is the health partner. The creation to this Partnership Prior to december 31, 2015, ensures concerned that it would make acute care and transfer that medical access beneficiaries care difficult. Transportation is difficult for have access to cmpc for needed acute people as they age and shuttles are services. As of november 15, 2015. Very stressful for people who are disabled seven beneficiaries were and we feel that st. Lukes enrolled in this partnership. Cmpc is obligated to remain should provide care for their Community Members in the community. Open to this partnership for the remainder of so, with that said, i think we the agreement or referring up should have a special concern for our to 1500 participants, whichever is seniors who are in the st. Lukes area sooner. Beneficiaries may not be transferred to the new Partnership Without their consent and unless increased enrollment will be reliant on medical beneficiaries. The cmpc Innovation Fund has promoted this new partnership and enrollment and public speaker i would like will improve enhancement to to point Saint Anthonys to be strong partners out some facts. One is a slippage in the reporting and to medical beneficiary in the outreach around the reporting of the compliance of this compliance tenderloin. Saint anthony will have to hearing by the department staff. That does not indicate a build its billing requirements. This part is critical. Regarding culturally and linguistically department leaning forward involved in appropriate services, national participation. Which is a little bit stressful as has been stated class standards culturally and linguistically correctly, significant aspects of the appropriate Services Standards development are broad and cmpc is compliant agreement were due to the advocacy of with these the Community Based standards. As i mentioned the health and organizations, principally hs and j. J. Planning commission, they continue to have questions as to the cultural and linguistic and appropriate services at cmpc particularly at the saint lukes secondly it diabetes clinic. Seems odd that the staff is as a result of that input, director requested a two part interview. One was to look at the hospital alleging compliance and there is only as a whole and second to look more compliance because of the rolling two year closely at the saint lukes diabetes averages. This is noncompliance. Clinic, in compliance means we did not response to these concerns cmpc comply looked this year but we promise to for an opportunity for comply next year. That is in every case except improvement and secured advisement and they will share that assessment. Employment. Employment there has been increases on dph put the peer review on hold the citys side and cmpc side for which to determine its own assessment. We are more than happy. We are gratified to realize that strong on december 30th, cmpc shared advocacy by our member organizations the has produced that which leads assessment and reviewed it. Me to my conclusion. There is a as a result of their findings, requirement it the director of health sent a seems to me in the history of letter requesting additional this project in building in information for future reports for the hospital wide assessment and indicating her institutionally Community Involvement and that is available to you by amending desire to proceed with the peer review with the the Development Agreement to include saint lukes diabetes clinic. Collateral agreements with and a organizations like our coalition to ensure around the critical letter which we have not issues of received. With regard to the post acute healthcare and healthcare care in the project, as i noted in planning in april, the continued advances and Development Agreement requires cms employment that Community Voices and advocates are heard which seems to me are cmpc with dph to provide pretty clear of the driving force of all the services and benefits of this Development Information to the san agreement. Thank you. Francisco. This information was required in a good afternoon, related request by the Health Commissioners. Commission to look at the need my name is leila with city san for Skilled Nursing facility beds in response to closures at cmpc franciscans for housing jobs and justice. Im going to address my time and dignity health. In august 2015, dph, cms and for the progress workforce commitments. As you heard from oew d earlier dignity launched the post acute care project to address the Health Commissions from hiring, cmpc hired 6 candidates concerns regarding the out of 47 which is a total of 13 availability of nurses in San Francisco. Grossly short of the 40 of the goal. And subacute which is a type of so hiring your two after significant Skilled Nursing care. The project is defined as public advocacy from our coalition and other subacute care for San Francisco patients parties hiring greatly improved. 80 out of 196 candidates were discharged from the hospital to the community. Including resources to support hired and the design, research and design and Community Engagement for this oewd began hiring monitoring project. The project identified three primary goals to summarize relevant skill nursing data and future need and future demand. And hiring to identify Community Based improved. We are glad to see alternatives to Skilled Nursing this. Facility care and to develop furthermore we are glad to see a strong recommendations to the Health Higher from october to this commission to review. The work of the progress is year and from the shortfalls from past currently wrapping up and the final work is held year. At the earliest opportunity no one is happier for these which will rely on the report for february. Commitments for the prior 2 years. We hope finally, i want to comment on this level of oversight can be the hospitals. All issues raised july 23rd and applied to healthcare commitments. We are november 24th of this year why concerned that there are a key addressed in the memo i sent to target neighborhoods that are under the commission before thanksgiving. Hired from one additional point highlighted including tenderloin, chinatown related to and valley and soma. The public dialogue to cmpc. Hires include less than 20 of in the 2013 compliance statement the hires and this is critical in these planning director and director under served communities. Of finally we are concerned about retention rates and we health covered the programs encourage stronger work to attain the surrounding the hospitals and helped shape level of the agenda for the august 31st workers for their communities. Meeting and committed to a future meeting in 69 months. Dph continues to build good morning commissioners. The coalition has pointed out a trust. Number dph continues to build dialogue. Of deficits and im definitely concerned about all of those. I that concludes my report. I will turn it over to pamela urge you to say that cmpc has not been in compliance because of these significant levine. Areas. Charity kaeshgs care shortfall, the tenderloin has been under served. That means 2 years of lack of pamela levine, Deputy Director, health services. I want to healthcare there and with point out that Catherine Department dod serious needs. The lack of hiring for both construction and nonconstruction people, the shortfalls there was called to a meeting on specific group on health that aids the city in and the lack of getting actuary determining health rates and Health Benefits for the city. Services fee increases. Much work has been done by the Development Agreement cmpc, but please do not certify this, do provided for not pass this until their completion of all of these matters. An actuarial assessment which thank you. Was delayed. In 2015 hsf works to identify key questions for an independent public speaker hello, marlene auditor to answer by examining the hosh morgan for health and justice. I would pod data. Like to thank mr. Mac sued for his we request that cmpc suggest actuaries to review and agree upon. Comments and the construction manager, an thank you. Outstanding organization. We have had great Construction Management just to wrap up. Thank you very much for your at Cathedral Hill and also great details of Community Engagement. What i would like most about the compliance. The Construction Management specifically above all noted by agreement about the work around safely my colleagues and culturally and demolishing around the hospitals. Is they have a commitment to linguistically appropriate services and shuttling and getting their employees, all of their workers into a congested the dph commission knows they area throughout driving in their are being personal cars. That is a big accomplishment addressed. It will be to consider those in for the construction workers and one that is missing for the rest of the compliance. 6,000 with that im going to employees employed by cmpc, at the time when we started this introduce to you for his presentation and conversation in 2005, the biggest private then well be available for Public Comment. Employer in San Francisco. Thank you. So from all the conversations from many many years, the community has strongly said that we need to have forms of transportation to come to work to cmpc presenter good morning because they cant drive their commissioners. Cars and park. One of the things that my name is jim sui. Cmpc did commit to in the Development Agreement was to do the transportation all of our hard work going Management Program and however there has towards this Development Agreement results been an interpretation recent lau that from it assessment from staff finding doesnt have to apply until 2020 us in compliant for 2014 and the foresight of the creators of the development. As we can see, when we started agreement to include the in 2005, rolling metric on some of the more complicated aspects of the d. A. Has proven to be employees lived in San Francisco, now its 45 . We are going to get down to wise this year to make sure we are doing maybe 70 the work we are asked to do. Or 80 of these people by the and in that spirit, what i time this would like hospital is hospital that are to show you here today is some of the commuting detail about the work thats from outer suburbs. We have to get people out of been going on in 2015. You have heard some their cars. Of this Cathedral Hill is an urban information in the staffs presentation, but we think its hospital, important to go through. Generates over 20,000 trips a day, over 3,000 employees. There is no employee parking. Regarding healthcare commitments, weve we must urge cmpc to be a good been working very hard. This central commitment of Corporate Citizen and put in baseline the Transportation Demand program healthcare is very important to us. The shortfall that we expected now. To have i would love to see them step in 2014 we reported to you in up and do that job now with the 13 and in an update hearing in 14 and we construction did in management and help out with fact have that shortfall so the Transportation Management for their weve been working very hard against current and future employees affected today. Making up that commitment and as you thank you. Heard staff describe in 2015, we put programs in place, the diagnostic services at San Francisco general, the ancillary services in partnership with nems and then weve also been providing services through events at project public speaker good morning, homeless connect. We very much are committed to commissioners. I was part of the Advisory Committee in 2008 when making this aspect of compliance be this conversation began and it was something really about at least from our that we do not have a shortfall perspective of our part of town was about on in any given year and very proud of the work in 2015 so weve been able to makeup the gap from 14. Rebuilding st. Lukes hospital about the services that were going to serve our also, as was mentioned working part of town. With i would like to echo some of nems, we are 12,000 lives over the things the that the nurses said. Managed care enrollment commitment and there has been a partnership its really really important as a developed father, as someone who has between nems, Saint Anthonys Young Children and i know many of you Medical Clinic to serve the tenderloin have children, the idea of moving the pediatrics inpatient from st. Patients. If you know emily web, her help lukes to Cathedral Hill is anxiety with provoking and burden to those families. Its our work with Health Partners has been not a key and why we are able to keeping to the spirit of what provide we these outstanding results to discussed in the agreements over the last few years. You today. The idea that you would fiore as was mentioned too, we have Spanish Speaking nurse or clerks in the started our comprehensive audit of diabetes units when there is a Class Services at cmpc and we share lot of families dealing with pediatric that information with the department and diabetes, this is a serious concern for members of our community. One of the other things that a lot of of Public Health and as we go primary and care for seniors, the outer through the next process and next phases of mission, that area of the city has a lot of elderly aging in place. Our program that is done to meet a lot of them cant rely on the expectation in the spirit of the family members to come drive them Development Agreement and across town. So they rely on public expectations for the department of Public Health. As mentioned we funded the transportation. So they get from, just to give healthcare Innovation Fund with 4. 6 you a cross street. Mission and silver to cathedral million. Hill. That is over an hour plus regarding operational hiring, travel in public transportation. Its not you also heard this information from realistic. Its not meeting the spirit of what we talked about in our staff, but, again, we are very excited to Development Agreement. I urge you today not to certify share this information with you today. This and force them to do more work to meet there are significant the demands of the community, Community Based organizations and be more culturally competent sir, again, when your organization request to speak as a group, you cant speak both under organized option and as a member of the public. I have information that i think is very important for the commission to hear. You can submit that in writing. I would like to state it here. I would like to say this to the community. I think in the future you would be better off to not speak as an organized group so you will be able to speak for three minutes. 3 minutes. So somebody doesnt eat up your time. Im now speaking as a resident and person who uses st. Lukes. I would like to make some brief comments about the Diabetes Center. Commissioner Kathrin Moore sir, it is possible for the commissioner to call you become to express your thoughts. That is a possibility that still remains. After Public Comment finishes, we are going to open to commissioner questions, deliberation and comments, and at that time a commissioner may or may not call on anyone upon the public to offer comment, clarify somethingcious we can do the same with staff. Its an equity issue, sir. If we recognize you, we have to allow anyone else who spoke in your group to come up and be provided more minutes. Please ask me to come up and speak. Public speaker good morning commissioners, im the new Public Policy director. Our hope is to lead our tennants to self sufficiency. Last year we served 1500 people, many seniors, people with disabilities, families and other folks who need access to quality affordable healthcare. We believe that good healthcare. This includes proximity access to healthcare commitments. Lets start to dialogue with the community. Healthcare to residents in tenderloin is important. Lets provide this healthcare to the community. Thank you. Public speaker good morning. A member of the san franciscans for healthcare and housing and jobs. As a community of Healthcare Organization we are committed to serving the community we are in and engaging the work we do. Several issues have been raised about the lack of Community Engagement moving forward through the Development Agreement. Primarily to begin with, as you heard procedurally the lateness and short Response Time severely limited the ability of the community to respond to the Development Agreement. But more specifically, around the issues that have been raised around cultural competency in the mix of Services Within the hospitals that are being developed. As you heard getting rid of Spanish Speaking nurses, being replaced by diminishing services through a translator phone that might fit some abstract listing of what cultural competency might be. But far less than what was being provided as is. But more troubling is the lack of Community Engagement in developing that mix in both of the hospitals. As one of the speakers said before moving pediatric care from one part of the southeast San Francisco to the north is very trupelling. What i want to do is just reiterate what speakers have said so far, we ask that you not certify this report. We ask you to carefully review the comments and take those into consideration before any certification. Is there anymore Public Comment . Any additional Public Comment . Public comment is closed and opening up to commissioners. Commissioners antonini . Commissioner michael j. Antonini i have some questions. I would like a rep to answer some of the questions. My first question is i believe the d. A. Does allow for a rolling compliance. It was already put into the Development Agreement, is that correct . Thank you. You may want to come to the microphone because i have a couple of questions. This should not come as a surprise and its very realistic. I want to ask a question first. The next question has to do with i think i heard from the report that the Saint Anthonys clinic and the tenderloin outreach will be a report by the end of this calendar year, is that correct . Yes. That will clearly be addressed in next years report . Thats correct. Okay. That was a question raised. The other thing, people are talking about senior care and pediatric care. I believe they both will take place at st. Lukes . Thats correct. But the hospitalization particularly pediatric will probably be centered in the Cathedral Hill hospital . Thats correct. Pediatric for everyone else including all people that come from throughout San Francisco and population outside of San Francisco. Its the same for everybody . Thats correct. This is hospitalization. Its a big difference. I also understand you have a specialty area focusing on liver care at st. Lukes and you will continue to have that . Correct. I have a patient who is a physician involved with that and that is where you are sent particularly for liver related problems and diseases . Yes. Okay. And then the same with i think those are most of my questions. Thank you. I have a few comments. It looks as if all the goals as well as most of the charitable goals are either satisfied by the end of 2014 or have been reached or exceeded to date in 2015. Thats what we want to see. There is a need to have the 2015 report at an earlier time and part of this might be something because we have to talk to the city about and make sure that it comes out of a more realistic time like midyear. There is apparently a time that we are supposed to have a report and we are a little late and that will be helpful for next year. As a pointed out before one of the reasons the client does have to be rolling on some of these things is hiring people for acute situations in a hospital takes training first. Even with the best of intentions, you have to have special training to be able to serve in certain capacities as a permanent employee in an acute hospital. I can see where it takes a year or two to get up to speed and an acquaint people that need training to be able to work effectively in these situations. So i noticed that st. Lukes topped off first to see that its finished its steel work even before Cathedral Hill. I think its great to see this hospital has lots of excellence and attracts people not just from San Francisco but from outside San Francisco. I have a number of dental patients that live in marin county and almost without fail when they had children, the children were born at cal pacific. I think more people from marin have more people born in marin and this is because of their excellence. San francisco has been a center from which people come from throughout the bay area because of the excellence of hospitals we have in San Francisco and this continues. In terms of where you go for care, im a kaiser member and i have to go to places like redwood city and San Francisco and marin to deliver services. Those are just outpatient services. For hospitalization, the same thing would apply, there is a difference between the two and it would be nice, its probably not the most effective thing to have all services having hospitalization in three different hospitals when you can put all of your staff together and deliver the highest standard of care particularly for people with needs that require them to be hospitalized either senior or pediatric. I think pediatric care should remain in the hospitals and easily accessible to neighborhoods. I understand you are going to have the subacute Skilled Nursing questions raised by the end of this year or certainly part of the 2015 because that was another thing. I think all in all, its very impressive, the goals that have been reached to date. Commissioner, moore . I would like to ask dr. Barnes to finish his point because i do believe in order to have a balanced presentation that his comments as a former physician at st. Lukes would be very important for us to hear. Thank you very much. Public speaker as most of you know in 2014, cmpc announced the sudden lay offs of three longstanding employees who were full time, two educators, one bilingual and by cultural and spanish and bicultural spanish administrative assistant. Twothirds of the patients were and continue to be to this day Spanish Speaking or spanish as a preferred language. At a recent hearing, stated that two bilingual bicultural educators that the problems were being addressed and failed to say the educators were bilingual, bicultural filipinos. As of tuesday, there was one bilingual educator who works one 1 2 days at the center. There is daily and intensive use of translators but this is hardly providing the quality of services that bilingual educators can provide. What im led to conclude that cmpc does not care about the quality Services Provided to the Spanish Speaking patients. This is not serving minority population with Certain Health disparities. We urge the Health Commission conduct a peer review of the Diabetic Center and not accept the review by cmpc. Thank you very much for allowing me to speak. Thank you. And i do thank the Planning Commission for offering the joint meeting to be held here. Our commissioners are probably not as aware as to how to push some of the low buttons. We are going to use our tradition to ask if you wish to make comments or ask questions please recognize and i will recognize that. Who wanted to speak at this point . That was me. I was one question because the question came up about the types of services. One question about the maternity services. At what level would you continue those and would they in answer be turned over to Cathedral Hill . All of those services will continue at st. Lukes. Which is at what level . Its comprehensive maternity care, including some of our alternative methods of delivery. If there are pediatric complications coming from the newborn, that would then be transferred to the new hospital . Yes. Is that what we are doing now . Yes. Thank you very much. My fellow commissioners . First of all i want to thank cmpc for the large commitment investment they are making in the city and opportunities for jobs and growth and growth in healthcare opportunities in general. I find on the Positive Side Community Benefit funds and San Francisco to exceeding by 14 million is for me quite significant. I also like the idea that you continue to support the Bayview Health clinic and your overall managed care, i think these are really great strengths of the efforts and hopefully continued commitment to the larger Community Health needs in San Francisco. With regards to again the compliance itself that we were addressed with the report, i want to applaud you. I think this years report is a greater improvement than last year. So applaud that. The baseline, 2year rolling average, i understand the efforts that you are making to increase services and i really like that collaboration thats happening with the department to bring in the Health Network patients that are backlogged and receiving services. On our sides we need to keep failure to keep rates and your commitment is appreciated. Im hopeful for the partnership for the tenderloin and Saint Anthonys. Van ness is a big street. Im afraid to cross it. Im worried about how many people are afraid to cross it even though you are in the neighborhood. So im going to leave it with one last thing and this is where i would like to focus. The issues of cultural competence at st. Lukes continues. I would like to ask two questions if i could. With regards to the cultural competence issues at st. Lukes because thats where i see the most concerns are and they are the same magnitude of last year even though i know there has been an audit. With regards to the audit, my understanding is that the department of Public Health sent you a follow up letter november 17th and we havent heard a response yet. I would like to know your specific intent to respond to director garcias inquiry about your evaluation at st. Lukes in both in terms of timeline and what your intent to respond to and also maybe if we can even hear it at the Health Commission, i dont think there is a reason to wait a whole year to be hearing about your follow up plans. I have another question after this. Certainly, we had hoped to have that response to director garcia prior to this hearing with the thanksgiving holiday we werent able to coordinate all the internal resources and voices that we wanted to have in that response, but we expect to have that potentially sometime next week. Well have that response to director garcia and then well be continuing to work on that class work that includes all our campuses, not just st. Lukes. Maybe i might ask our Health Commission president and commissioner garcia can we hear it at the next hearing . Absolutely. We requested a peer review and we would like to continue that. The second issue then really relates to the community. It does seem the community and sf hhjj has had persistent concerns about the quality of conversations and having the concerns addressed. I know there was one meeting i understand from st. Lukes and the community. Can i ask what your plan is for a further meeting and perhaps even why do you feel the concerns keep arising and how might you address this. Because i think having good relationships with the st. Lukes neighboring community and participants of the coalition would really be part of your success and something to be proud of. I would encourage you to do that and ask you to think out loud, why do you think thats happening and what would you do to address the concerns and relationship . We share your perspective. I think thats why prior to the actual meeting at the end of august we had a premeeting from some of the members from the coalition because we wanted to make sure the Public Meeting we held would meet some kind of for lack of a better description, agreed upon expectation that we would not just use that form in some open ending way that was going off in a bunch of different directions. We wanted it to be a productive dialogue. Thats why we held kind of that preconversation to try and determine what were the things we wanted to talk about. So we created an agenda for that meeting and i think to answer your question, its to continue that type of approach. And hopefully as we continue that dialogue, we might better meet the expectations that we are hearing. So that meeting was in august. There are further meetings already been planned . We talked about having an additional follow up meeting in the next 9 months. We did get to one. We suggested the topic of that next conversation be focused. It seems a lot of the conversation kept coming back around the transportation issue about how some of the populations, you heard some of the comments today might have better access or understanding of how care might be coordinated. So we had talked very generally that it might be the topic of the next meeting and we would certainly ask all the appropriate parties, not just from cmpc or the coalition but from across the city who might weigh in on that topic. Maybe bring in coparticipants to help coagendaize this meeting to help facilitate the proceedings. Great. Overall, i think you have made great progress and i hope you will continue to look at these issues with the community and hope to hear more about it in the next coming months. Commissioners, any others . Mr. Sanchez . I just want to say it has provided us a unique service to this area. This has been a challenge. I think overall, i think weve made some significant head way even linking with Saint Anthonys over the years and others change. Santsdz st. Anthonys and others. I want to bring up other issues brought up. In reference to the workforce, i remember we discussed this before about lets take a look at the different populations with the city and what we can do to provide the city jobs and i remember the fact that there used to be a really great native American Program and the Vocational School in the mission in the 60s which provided job training for the industry. As i read the report and saw there are a number of fantastic options developed through numerous jobs filled. I think we can even spread the net even wider because there are services and programs and unions and Training Programs especially as they try to regear both to provide Services Including training to have many in the mission and in the southeast area. The other part that hit home was seniors for transportation which is a bigger factor. What can we provide for our seniors who live not maybe in the inner mission per say. Mission has changed. Before it was from Caesar Chavez all the way down to divisadero. All of it has changed. But the quality of service, the linguistically and culturally competent is full circle. Lets spread the umbrella wider. There are Transportation Services now with some nonprofits many Spanish Speaking, many serving not only latino population, but filipino population and in Service People and folks inhouse and part of that would be a central latino to San Francisco which has been in operation for over 45 years which is now by the projects which have now been rebuilt again and they have transportation bans and working quietly into the radar and providing services and it would be off 30 streets. Many of the patients there and there is other programs for seniors in the excelsior and we work with Filipino Centers in the south of market, and with va and so forth and so on to work at so if there are any seniors that if they need something to go to the Caesar Chavez program, lets get something done. I was glad when our colleague asked dr. Barnes to finish his comments. He was one of our first graduates from the Community Medicine of Family Practice and uc sf almost 40 years ago and volunteered to go to st. Lukes and help set up a program with uc sf to develop the Community Medicine program which you are very much still active with which you presented again today. Congratulations on 32 years of Excellent Services and st. Lukes. What we are seeing is we have the concept of a center for excellence. What does that really mean . Well, the populations have changed over time and we are going to need a real Outstanding Center of excellence for our seniors and gerontology. Remember all medical centers are not required to train and provide elective programs for our upcoming challenges and programs for seniors. What a great opportunity for st. Lukes to expand the network and utilize the partnerships with the multitude of these programs serving seniors and use this as a real real seed to develop a center of excellence at st. Lukes and you can carry on for another 50 years. Remember the library is right there on your campus which at university of california was founding right there. There is a little brick stone there. You look at it now, look, my gosh. Look at it now. People are going to look at it in the next two or 3year generations. I can go on. The quality is critical, the training is critical, the Due Diligence is critical. Remember we have parts with the San Francisco foundation is good but we need communication pertaining to Due Diligence. Is there a way to expand the networks. We have a core of the funds already spent roughly 2. 1 million. We need to expand to ensure that nonprofits programs and services are provided. As we looked at the data of San Francisco general which will be completing our new hospital there. It was interesting because we spent over 16 million in local Small Businesses. And we can identify those businesses and the ethnicity and background and gender etc of these Small Businesses and these are unique opportunities. The trainings are also the same. My question is there any continuity where we can utilize and look at how these Small Businesses can be provided to help build st. Lukes whether it be the artwork, plumbing, carpeting, whatever. The Little Stores and the models in the flagship of your Sister Campaign for San Francisco general because the two of us, st. Lukes and San Francisco again are general are the only two that are still the flagship. We want to main tain that model. A dialogue is two ways. And to take it and discuss it and lets move forward. The coalition did bring a number of these Critical Issues to a mandate for both our commissions and thats why we are here again and again and again. So i know its a lot of extreme work. Thank you very much for the work that you have done. We have other work to do but it can be done in a positive and constructive way. Thank you. Commissioner Kathrin Moore im concerned about the projects. One ahead of time. The positive comments regarding Construction Management which is crucial to all of the discussions we had about impact. Those with eir as well as the preliminary hearing where there was lack of clarity and lack of pace of construction that would suit the community and the neighborhoods. Im happy to hear positive comments about Construction Management that interface with those immediately adjoining neighbors. What is still puzzling and a little bit difficult to me is the krebld credibility of the coalition is the no doubt, the driving force of why we are sitting here and commenting on the timeliness of the reporting concept. There is almost a clash of culture and potentially grass roots and in the trenches. When i hear lack of Community Engagement which i will call timely communication, lateness in submitting of report, council competency and services where it is needed, im saying there is still something not quite in sync because its in everyones interest, particularly in our interest to have two groups in sync challenging each other in a timely manner that we do not have to sit here and say how am i going to be weighing the pros and the cons. I feel like im sitting on an unbalanced balance beam. Thats the best way i can describe it. As i recall the permission involving support for particular issues, i go back to cultural competency and as a woman who required services, although im bilingual, im empathize with this. If you do not have somebody who fully understand you. There is no translation which doesnt. You have to be able to speak a language with full language competency. Im a bilingual person and i know what it means, otherwise i wouldnt be sitting here. Im making a strong supportive comment that bilingual competency, not translation is what is needed in medical care and in provisional services particularly women related diabetes and personal issues. The other thing that we have been taking a very strong position on is the support for st. Lukes. I would like to add a question about st. Lukes which generally is positive and lacks on the issue of mixed services and issue of cultural competency and that is the interaction or the interface between the medical Office Building and the commitment that that is a part, integral part of rebuilding st. Lukes. I would like to ask a request that is not exactly in the agenda but doing the approval of the medical Service Building on advance valencia street. This particular commission asked for a clearer position on how having a large medical office on valencia street would subtract from the commitment that cmpc was to make in rebuilding the medical Office Building at st. Lukes campus. That wasnt entertained, but i think it goes to the core question about the mix of services and accessibility of services in a reasonable radius to where services are needed. That was a question regarding rebuilding st. Lukes and how to distribute services throughout the city and the integral part of that. Those are my comments at the moment. Commissioner wu . With vicepresident cindy wu i have a question for staff. On the timeline of the report, i read that the reason that this handout was because of a printing error, but there are substantial changes in the report. So, can staff talk about the timeline for next year and if there might be the report to come out in full earlier . The changes that were made visible following the error have to do with the information already in the cmpc Compliance Report and some you heard in updates and you will hear more next year. In regard to the timing of the report, the hearing is identical to last year. We had hoped to compress that time but coordination of the is is services did not make that practical this year. With regard to the review period, the d. A. Includes requirements for 60 days notice for this hearing which is to consider the cmpc report and we did provide that notice. So, do you see room in the timeline for next year to expedite what is it of course the 60 days is important and you need the time to review. Where is the room to look at getting here sooner . Yeah. One of the things that constraints us is the d. A. Allows cmpc i believe its 150 days. Its about half the year following the end of that reporting period, the calendar year to submit that report and they do have that short time in the d. A. And there is a number of steps that involve coordination of assessment of their report by the city departments and collecting those assessments into a single report. We do see some opportunities to vet that a little bit and get to the cycle earlier next time. As we were reporting last year next to the next calendar year reporting. What i would like to see is what were issues in the 2013 period and 2014 period. It really seems they are the same issues and if we come back to see the same issues, that is very challenging to say that everything is in compliance. I have some specific questions about the tenderloin partnership between nems and the st. Anthonys clinic. Who is responsible for doing outreach to find the new patients and how are they resourced . The partnership is between nems and st. Anthonys Medical Clinic. Nems has the partnership. The outreach should come from the partnership and nems together and thats why the fund has money to do the outreach and education. Also its helpful to not have a whole bolus of patients to come up because they need the ability to serve and in a way that is compliant with state regulations. Okay, that makes sense, but it was reported that it was only 17 or 14 new patients. What is your expectation for the coming year. It was between august and november. Medical patients can change their provider at any time. Existing members can be a priced ce apprised of the new partnership and change anytime they would like. Thank you. On the question of the mixed services for st. Lukes and van ness hospital, is that part of a larger discussion in terms of whats available. I heard cmpc residents talk about transportation which is linked to that because its harder to access services. Would that be discussed in your upcoming meetings and is there the possibility to do more frequent meetings, lets say quarterly meetings with the community in there is certainly the possibility to do more meetings. The line of discussion about trying to develop a service mix with in that Community Dialogue is not something that we are pursuing. Thats a complicated conversation that goes across all four of our campuses. While we are able to discuss with the community about informed decisions we might be making, it seems challenging if bordering on unproductive in those, for those decisions for our administration to be making in that manner. But you had mentioned earlier that you may talk about transportation and what do you think of the link between the transportation and access to services . Again, we absolutely would like to be part of the solution for transportation in terms of where either expand that not to be just transportation but the topic of care coordination and make sure that dialogue and as we make decisions about Different Services again that we are kind of meeting the healthcare needs of the community. Okay. Thank you. Commissioner, richards . Last year was my first year hearing this. It was the first year that it came before us. I think there were a lot of issues with the start up of the agreement of getting things in place. I completely understand that. It looks like there was more not in compliance and i talked about that last year. I agree with commissioner wu. I would love to see progress year to year in a table. I know you have several boxes that you checked and if you can maybe do this visually if you have noncompliance, a red do t and yellow dot and green dot and you can see over time the progress very easily and visually. A question on the transit subsidy an issue on the letter about five years from the5 years from the transit subsidy. Can you explain why you want to wait 5 years to employees . Sure. We have subject Matter Experts here with us today. This is janis hamilton who is our manager for all of our tdm work. Good morning, janis hamilton, tdm manager for cmpc. I came on board in april. Its important to note that we are committed to the transit subsidy beginning in 2017. The reason for that is, there are a sequence of tasks that we need to do between now and the beginning of 2017 to make sure that transit subsidy is accepted and utilized. We just completed our employee commute survey. Our drawing baseline is 48 , our transit use is 23 . So what we want to do is we want to look at if you are looking at a scale in tdm parking is an integral part. We want to be able to shape from driving alone to commuting alternatives. We want to be able to have so longer disincentives for driving when we implement the transit subsidy. We are in process of this. Parking operations, parking management. In parking operations there is a lot of process in improving that. We have a lot in place so when we come to 2017, that subsidy will be accepted and utilized. Thank you. Youre welcome. Commissioner, isnt it also because the 5year date was simply when the new hospitals opened. I think that was the reason for the actual reason. That was why there was a 5year allowance for the transit subsidy. I was coming from a place where they studied this. Studies say it takes 3 5 years to see a shift in a commute behavior, right . We certainly have a lot of work to do and we are certainly on board to make that happen. We look forward to make that offering. You sound like you know what you are doing. Thank you. A couple other thoughts. I dont want anybody to think that im taking away from all the good things because i highlighted the ones that were over achieved and significant progress. There was a lot of good work here. We dont have a lot of time. I just want to harm harp on things. The st. Lukes Diabetes Center. I remember someone saying my husband is a nurse, hes in renal care and needed to have a translator and the costefficient sea efficiency to having two nurses in a room when my husband doesnt speak english. It seems to be an easy fix if twothirds of your patients dont speak the language, why not have them come back and treat the patients . Its better in the end of care and efficiency sake. Do you have any comments for that this year. I think i raised that issue last year . So we are again completing, we started the audit of our Cultural Linguistic Services across all of our campuses and the operational component of that which includes staffing and bilingual speaking will have a full report on what our metrics are across the campus and weve got that information about the st. Lukes Diabetes Center. We presented some of that previously earlier this year in a follow up that we are preparing for director garcia. We have also the latest information about the Staffing Levels that at st. Lukes and Diabetes Center to director garcia next week. Things could change as a result of your audit . Yes. I would like to understand that as well. Thank you. One more question. I saw in the visioning on page 8, it looks like you are doing well there. Have you ever had or thought of having a st. Lukes visioning . There was Community Engagement before the Development Agreement was approved and signed and there was a conversation about having services not just at st. Lukes but both campuses but what were remaining at the two campuses. There was dialogue about that before it being approved. Would you want to establish at st. Lukes . You mean the cal campus . Right. That is specifically in relation to kind of the evolution of the development of that campus once its no longer part of our actual operation. So thats why its going through kind of that focused acute vision process. St. Lukes is a base. Its going to be there . Exactly. One other thing. It seems weve had somewhat of this adverse aryary correlation. We hear you want to be a part of this, what are your thoughts on that to joining forces and coming back more powerful and are not at odds with things . I think this is something we talked about and maybe goes along the lines of the earlier question you asked, but its the development of formal kind of on going Community Advisory councils for all of cmpc. I think pursuing actions along those lines might serve us well. The coalition will be a part of that . Correct. I want to piggy back when we heard 800 valencia street, one of the other cmpc folks, i think Melissa White was here as well. On the medical population, there was a part they werent going to pursue, i would encourage that because it would help these numbers a lot greater. It would. To answer the question, cmpcs perspective of the valencia development is viewed as additive to the medical care we feel is needed for the support for the work done at the new hospital at st. Lukes. Thanks. One last question for mr. Welch. Commissioners, if i can interrupt one second. I wonder if i can ask you to speak more closely into the mic. They are not getting a lot of the dialogue. Im sorry. Mr. Welch, i asked the question about the future role of the coalition. You mentioned something about working together. Right. Can you comment on what i heard . Thank you very much for your question and thank you for asking me to comment on it. The history has not been good. The dialogue that happened before the Development Agreement was ended by cmpc. Cmpc felt it was not productive to continue these conversations on uses of the two campuses at that time. Why . I have no idea. The people that were involved in that process are no longer employed by cmpc. The reality is that what weve been offered at st. Lukes is basically a powerpoint. A Powerpoint Presentation which is not quite what we have in mind. There is a long history of members of the coalition involved in keeping st. Lukes open, and keeping it open and a viable healthcare facility. There is a lot of that dialogue and that is not what cmpc wants to do. They really dont want to talk about what kinds of uses, what kinds of services should be offered at st. Lukes because its very complex and we agree and understand that but its what we are looking at. A Committee Advisory . That would be great. But its the history of the communal Advisory Committees in this city is not outstanding. What we would love and have asked for consistently is a formal agreement with the city departments, with the Health Department and with the planning department. Thats where it seems to me cmpc and the Development Agreement gives the authority to actually recommend compliance. If cmpc were more than happy to meet with cmpc in a meaningful way. But what i heard today was that they are not interested in that kind of a conversation. I would hope, i heard the exact opposite that they are interested in having that conversation. So i guess the most fruitful way to have that conversation is with the Health Commissioners and with the Planning Commission because cmpc is not interested in having that conversation with us. Thank you. Cmpc raised your hand. I would love to have a response to mr. Welch. Just to remind you of the services are listed in the Development Agreement. They have been in there since it was approved. Okay. I will look forward next time to the hearing of this advisory. I think something can happen when you actually sit down and talk to each other. Thank you. Commissioner . Just a quick comment. I know we are out of time. But this whole issue of information and information sharing and timeliness of it, i think its important to be on going and just periodic. The people of the coalition or the commission have on going updates. Maybe its not the analysis, on going updates of whats happening and not happening and use that as a forum for the advisory and for the community to have conversation not just yearly but on going could go a long way to address some of these issues. Commissioner, antonini . Commissioner michael j. Antonini for the gentlemen from cal pacific one more question to clarify things because i know there is a certain amount of confusion. From what i know you are going to have medical offices and st. Lukes and van ness cathedral. Right. And probably one at davies. I would expect a broad range of services. Outpatient services are available at all of those facilities . Correct. So people with ambulatory is social services go there. If there is neurological problems, they will probably be at davies and its safe to say they are not going to be at all hospitals. Correct. I believe that is specified in the Development Agreement. Yeah, i remember reading all of those Different Services. It sounds like its moving in the right direction and the concerns about the transportation. The hospitalized patients are not traveling very far, i mean visitors would have to come from another area but the hospitalized patients stay there until they are released. Correct. And parents and grandchildren. You will have services at st. Lukes for even care of mothers and children afterbirth for whatever period of time they stay in the hospital. Correct. Thank you. Yes. From the Health Commission side i believe you heard that we have concerns in regards to areas that are shared with the Planning Commission. Clearly, we have moved forward from last year. There was some outstanding issues regrettably remain. I would like to commend cmpc for taking on the subacute and creating that committee that we have looked for for several years and look forward for the commission to understanding a possible solution for this city and for this community and perhaps the region in regards to both subacute and sniff issues. I would like to thank cmpc for taking that initiative as we hoped it would take at our lasts meeting here. Likewise, the work they have done in regards to coming into compliance and regards to units of service and the levels certainly have come into the agreement parameters and beyond. And the ability to work with our San Francisco Health Network and work with the Safety Net Services are all positive from the Community Benefit that we are getting strong from cmpc and st. Lukes. I think the areas we remain very concerned about are quite well outlined by dr. Garcia and they are not just simply for a compliance issue in clause. Definitely what you have submitted to us will pass a joint commission. But that isnt what we are about. What we are about whether or not that really passes the measure of helping our patients. Thats what class is and you have heard from both commissions a real concern that weve got to be sure that there is cultural and linguistic opportunities that are afforded to both our patients and for our delivery service. I think that is a very important issue. Its been pending now for at least two years because its taken us another year to get to this point in the report and i would hope like our fellow commissioners have said that we are able to put a green light on that one and there is truly a cultural and Linguistic Program that is meaningful and not merely one that meets certain standards of participation, but that it really is and has that monitor from both from outside source looking to see whether the program that has been developed makes sense and particularly where patients and those who are using it can tell us that it is of use. I really think thats where our letter went for that understanding. I believe that the same as a subnote relates to the entire issue of which the st. Lukes diabetes clinic is merely a symptom, and that its not just the st. Lukes clinic we are worried about but other clinics that the Cathedral Hill campus would have the ability to respond to that. Its taken way too long unfortunately as we are trying to help with our patient care even today and not waiting for new hospital to understand how cultural competency and the ability to answer those issues and i believe that as director garcia said we would like to see that report coming to the commission before we even need to have another joint Conference Meeting here. So, i think those are areas in which the commission will continue to work. In partnership, its been i think a Productive Partnership kind of year. I believe the staff has felt that it was important to highlight what was happening even outside of the official agreement report here which ends a year previous, but that youve been able to show the progress that has been made in this year particularly and if we continue that assent both in employment and with the community and answer issues of competency and services, i would imagine by next year this time, i think we expect to see green on all of our points. So, i thank the parties for actually being able to continue to work through this process in the coming year and i really encourage that even more progress be made so that we will have a first class facility, a First Class Service that adds to the enormous wealth of services that well be able to offer our residents. Thank you. Commissioner, richards . No. I would love to see a copy of the audit when its done. Thank you. If i may commissioners, director garcia of the Health Department. The one concern and piece of advice i would give to cmpc, is in this new world of competitiveness of patients to be able to make decisions of where they are going, its important to have an open ear to the community. As someone told what to do by the community everyday, many times i get great ideas from the community and patient input. It makes us a stronger department, it makes us a more culturally Relevant Department and makes us also a quality improved organize. So its really important as you work with community and coalitions who are very strong in San Francisco. You are not in any kansas, you are in San Francisco. And San Francisco has a very Strong Community input. So i would really advise you for the future to just listen, acknowledge. People know they cant direct the corporation to where they are going, but its very important for you to listen, to hear them and i guarantee you that you will have better ideas to be more patient centereded and improved quality of care. I would encourage you to do that more because your language can be changed a bit to make the community feel understood and heard. And you would do really well by just being a little bit more open to hearing them and trying to make this divide a little bit smaller in terms of really understanding the needs of the community. I think cmpc and sutter would do so much better in this process. Weve been here now going on many years and i have started my career with this Development Agreement and i think i would continue with it throughout my career. So i just really encourage you to a little bit more humility and humbleness in terms of how you approach community input. Thats my advice for you today. Okay. If nothing further, this meeting is adjourned. The regular Planning Commission meeting will resume in about 45 minutes. [ meeting is adjourned ] to address these concerns, i have made a series of amendments to the resolution that capture the spirit of the policy but would allow continued conversation with the task force and other stakeholders about how we do metering. I believe strongly that the city needs to start developing toes to help create Affordable Housing. In our Housing Element alone, we talk about building a 60 affordable, but we are currently not doing that. It is important to start the discussion about creating tools of measuring our Affordable Housing and creating tools to enforce that. I grew up in new york city, one to my parents who had immigrated here to the u. S. Actually, i started really becoming active in working with the community when i was in high school. Came out to california for college, went to stanford. I was always politically involved. When i was a college student, i worked on the initiative to get rid of affirmative action in our public government system. Currently, we have 3 legislative items that are pending. The first is going to be coming to a final vote on tuesday, our midmarket uptown Tenderloin Task exemption legislation. It is basically an incentive to encourage businesses to come to midmarket. In particular, where we have the highest commercial vacancy. And then when i graduated, moved out to San Francisco about 12 years ago. I always loved Sanford Cisco in college, and i just wanted to try it out. I started working in Economic Development policy. I was a Community Organizer for six years. I worked with young people, parents, and families around issues that concern our neighborhoods, whether it was improving muni lines, Affordable Housing, public schools, or just Planning Issues in neighborhoods. We just had a hearing last week, and we are trying to do some work around bedbug enforcement, which is a major issue in the tenderloin and of hill and 63. A hearing will actually be on thursday, april 7, 10 30. Were doing our first hearing on pedestrian safety. I think Public Safety is a huge concern. It ranges from both lowlevel crimes to pedestrian safety, and so that is a really important issue to me. We are probably more than double what every other district has. And that are preventable. And we can do better. District 6 is one home to one of the most diverse constituencies. We have the poorest residents in San Francisco. We have lgbt. We have immigrants, people of color, youth, and a high proportion of seniors in the city as well. We heard that people want to see more jobs, want to see access to more jobs for our residents. We want to see more preventive instead of just reactive. We want to see afterschool programs versus the Police Picking them up because they are out on the street, which i think our chief agrees with. I actually ran for the board of education in San Francisco and got to serve a term on our school board. What really surprised me was how much i enjoyed it. I loved it. I love meeting with families, meeting with youth, meeting with teachers, visiting schools, and getting a deeper understanding of what it means to make our system work better. The one thing i really enjoyed was i got to run within a district instead of citywide, was that i really got to know voters and residents. I actually enjoy campaigning more because i had time to knock on doors and the voters individually. Id love it. I actually really enjoyed being out on the field. So i spent a lot of time doing it because i got to really get a deeper understanding of what people care about and what peoples concerns are and also what people loved about the district and the city. I was talking with the mayor yesterday. He was very interested in seeing how the good work with our office how he could work with our office. I would love to see how we could support Small Businesses because they are the heart at San Francisco. They provide 60 07 of the jobs in Sanford Cisco, and they provide it locally, and they are not going to offshore their jobs any time. I am not an opponent of cleaning up the tenderloin. I love the tenderloin. I love what is right now. I recognize we have a diversity of books that live there and people do not want to see open drug dealing. I do not have a problem with people lit think people out on the street socializing. I think that is good. That to me is more you know, it is part of the character of the neighborhood. I get to represent one of the most exciting and dynamic districts in the city. It is where change is happening, so i think it is exciting in terms of how we can model what it means to be a smart growth neighborhood, how we can use transit and housing effectively to serve our city and also to do a lot of the new green policies that we have developed over the last 10 years. Id like to call this meager to order madam chair rosales has postponed me to chair this meeting in her absent good afternoon. The time is one 08 the this is the regularly scheduled meeting of the on Community Investment and infrastructure the Successor Agency to the Redevelopment Agency for tuesday, december 1, 2015, welcome to the public those that are here and listening secretary of defense. Thank you commissioner bustos the the first order of business is item one roll call commissioners, please respond when your name is called commissioner mondejar commissioner pen commissioner singh commissioner bustos. Here. And commissioner rosales is absent madam chair rosales absent and all other members of the commission is presence the next order of business announcements the next this is the regularly scheduled meeting of the will be held at one p. M. City hall room 116 and please be advised the ringing of and use of cell phones, of cell phones, Electronic Devices are prohibited at this meeting. Please be advised that the chair may order the removal from the meeting room meeting room meeting room responsible for the ringing or use of a cell phone, pager, or other similar soundproducing Electronic Devices. C announcement of time for Public Comment please be advised a member of the public has up to 3 minutes to address the commission unless the Commission Adopts a shorter period on any item. It is strongly recommended that any member of the public any member of the public wishes to address the commission fill out a speaker card and submit it to the commission secretary. The the next order of business is item 3 report on action taken at a previously closed session meeting if any no reportable action the the next order of business is item 4 matters of Unfinished Business no matter of Unfinished Business the next order of business item 5 matters of new business consisting of consent and other agenda 5 a approval of the minutes of october 6, 2015. Do we have any comments from the public regarding item 5 a. I did not all right. So hearing none and no request ill Public Comment is closed. And turn to any fellow commissioners for their questions or comments on this item. Motion . I move to approve. The consent agenda. I had the how much the comments above weve not had the protection election of the officer first 2013 when president johnson was elected and commissioner mondejar and the Vice President and upon i understand it should be elections every year and we didnt have elections in 2014 and now the 2015 and now the 2016 the first meeting in december we are the election of officer and i think we should you know the bylaws it should be done. Through the chair commissioner singer the election of officers are for youre next meeting. Oh, okay. Great so we have a motion to approve do we have a second. Second maam, commissioners, please respond when your name is called commissioner pen commissioner mondejar commissioner singh commissioner bustos madam chair rosales is absent i have 4 is and one absent. Great, thank you madam secretary next the next order of business is regular agenda 5 b authorizing the executive director to enter into a memorandum of understanding with the city and county of San Francisco Mayors Office of housing and Community Development for tracking reporting and administering the Community Block grant income discussion and action resolution number 752015 madam director. Good afternoon, commissioners and good afternoon to the members of the public thank you for joining us commissioners next item. Before you for your consideration is the result of. Hud audit of mohcd who serves as the cb g administrator with the hud regulations and the proposed mou before you really codifies the existing practice that the formation ocii had with respect to c e g program fund with that, id like to ask the Deputy Director of finance and administration for ocii to walk you through the proposed terms. A little bit shorter than that im brea the Capital Punishment of dinging i financing and administration to propose a mou with mohcd with tracking the cb g tracking fund to give you a little bit of background on the item that the sf rda acquired property with federal dollars and those dollars are restricted by hud that any income purchased yes, i did. By properties purchased with those dollars is referred to as cb g program it must be used according to hud they be used for Economic Development within the project area itself the Mayors Office of housing and Community Development has the executive director said is responsible for reporting and tracking on the use of those dollars to hud and in particular were looking hud came to San Francisco in 2014 and did think audit of 40 properties 3 of them workplace why not go to the budget Analyst Report gardener and marriott and other streets that were chosen by hud through smaller properties you can think of those 3 properties make up the group and Hunters Point coopt as 345 food coall of those properties pending the approval the Property Management plan will ultimately be transferred to the city the y b g and 345 williams that are r be transferred for future activities the good news the hud audit no vnsz everything was clean and hud confirms were using all the cb g income and tracking it correctly in in accordance with hud regulations they requested we codify our