You have the report in front of and you ill highlight a few items and take any questions. On june 13th, california lawmakers approved the 240. 8 billiondollar budget for fiscal year 20192020. And one of the most notable pieces of this budget is that it expands medical budget to 19 to 25, regardless of immigration status. So this is expected to provide full scope coverage to 90,000 undocumented in the first years across the state. So very excited about providing increased coverage to the population in need. And on june 4th the board of supervisors passed legislation to implement sb1045, sponsored at the state level by senator mark wiener and locally by mayor london breed and supervisor mandelman to provide care for San Franciscoians in need who have Severe Mental Health and Substance Abuse disorders. And its part of the mayors efforts to have response for those in need of treatment. And the mayor is including an investment in this years budget on including funding 100 new treatment beds. Last year as well as an additional 100 new beds as part of the budget this year. So a transformative change in terms of investing in Mental Health and treatment beds. Im also really happy i was able to attend this last previous thursday mayor breeds invincible women summit, and it had an outstanding turnout. It was a oneday event that inspires women to activate their personal power and collective strength, provide tangible takeaways and to have coalitions to create solutions to challenges. Among the many businesses and organizations that led sessions i was really pleased that the department of Public Health was there and promoted resources by featuring four exhibits, careers in health care and reproductive help and mindfulness in health and heart health. So really good Educational Opportunity as well and i have to say a recruiting opportunity for the departments. And also on june 7th, we had a challenging climate for three days and you may recall that we activated our emergency heat Response Plan and convene the Incident Management Team in response to the heat advisory that was placed by the National Weather service and it was three days of hotter than predicted extreme temperatures and staff worked 24 hours a day to serve populations under difficult circumstances and the work with our partners and staff implemented the new mrl mutual aid plan to successfully to have an increase for ambulances and to keep our system running and the Public Information was put out in messaging across the city including the populations and the warnings this year to remind people that heat with can remain elevated indoors even after the temperature cools and so forth. So the key thing is that the staff allowed engagement and to have wellness checks for populations that collaborate to work with other agencies and departments. And we did much better this year in terms of our response and we got the information out faster and had a quicker response in terms of ambulance availability on making sure that shelters, hospitals and our primary care clinics were providing cooling for our clients and that cooling centers were made available rapidly and people knew where they were. And that concludes my directors report and if you have any questions with regard to the items that i just went over and other items in the report that i didnt highlight, im available. Thank you. Commissioners . Commissioner chow. Yes. Thank you. And the question really relates to the heat and our own facilities. And the question, as a matter of fact we just happened to not hold a meeting up at laguna and we understand that the temperature up there was like in the high 80s or 9 is. Do we 90s. Do we have a plan internally about the routine services that were providing so that the staff itself could also then, of course, be also be assisting those that need other assistance, but not hold the routine meetings so to speak . Because it m might be that its high enough now that were getting these intense changes in weather and especially heat here what we dont necessarily have, you know, cooling or appropriate in certain of our workspaces that were able to also accommodate our staff along with helping the public. Yeah. So i think that the overall question is what is our plan moving forward for further events like this with regard to for our staff, right. Right. So we have we do have a plan moving forward. I think that we have the immediate plan which is to ensure that we have as many air conditioners and fans as possible to implement quickly and that people know where those are and that we have clear people responsible for buildings and something as mundane as having a clear understanding of who is taking the temperature and where and what time of day so we have a better sense of where things stand. Thats been vastly improved since my understanding from last year when we had serious heat waves. And the next step then is also in thinking and were working with our with our engineers on this and thinking what are the investments that we need to make in our infrastructure with regard to better cooling possibilities, because this heat event was three days and its early june so i think we need to think where wed be five or 10 years from now and when these events would last longer and occur even earlier and what are the cooling systems that we need to put in place to ensure that our patients are safe and our staff can do our work and so we have the Immediate Response which is what can we pull together now and how to ensure that plugin air conditioners isnt overwhelming the power grid in our systems which can occur. And what is our longer term infrastructure, what our longerterm infrastructure needs to build out cooling for what is going to be a profound Climate Change i think in the next in the next decade or so. Yeah, im just wondering if maybe in about 60 six months we could get a followup and we often have very warm days in october. Yep. So these extreme days are apparently going to be more routine as the former Governor Brown even noted that its a new world. And i think that its important then that we take these measures that you are doing and then it would be good to have the followup. Im happy to bring that and to also bring the community and to inform people in the community and people on the street in terms of how to take care of themselves. And the heat levels will certainly include that. And i have asked the team, given the last this last week with what happened to come up with a plan with with a projection of what resources are necessary so that we can certainly bring that to the commission. Good. Thank you. Commissioners, any other questions . Seeing none. Clerk item 4 is general Public Comment. And for those of you who are making comment i will have a time theyre when it buzzes please know that is your cue to finish your sentence and let the next person come forward. Im going to call out a series of names and line up. And gloria simpson, and Raquel Rivera, and bruce palmer and mark argon. Please come up. Hello, commissioners. Were back with the same arguments, pleading to have a hospital base in San Francisco. These patients that have been diagnosed have been at st. Lukes for many as 10, 20, 30 years and then in less than 12 months theyre dead. Tell me honestly have you ever heard such a thing . Losing a patient almost every month, there was 17 and now theres 11. We mentioned last year that they did not have experience of acute staff. They hired r. N. S and trained them for a few weeks. When st. Lukes staff had over 50 Years Experience combined. If San Francisco had a permanent hospital base, then they would have been forced to keep proper staff and care for these patients but now theyre doing the bear minimum. How are six patients dead in less than 12 months . When is it going to matter when youre sick and when you cant breathe, i have photos here of my sister which we mentioned several times to have her in a walker and they did not. I told them that my sister was sick and they didnt believe me until i had to call the doctor. And she had pneumonia and was in i. C. U. And her foot, she fell because she didnt have a walker. And this is the type of care of minimum staff that we have at cpmc. If you could please have the Permanent Base of subacute before its too late for the other patients. Thank you. That was gloria systemson sie sister is a subacute patient. And my name is Teresa Palmer and im a retired geritrician and i used to work with the subacute families. And there were 23 you know, them wanting to close down subacute so anyone who needed this complex pharmacare would have to go out of county because the community and the families organized cpmc did offer to care for the 23 remaining out of the 40, and now theres 11 left. And during that time we were having talks with director garcia who did indicate that it was possible that deaths could be realized at st. Lukes. For a permanent subacute, a private Public Partnership of some kind. And this is critical. Its egregious that people this sick have to leave their families and their communities in order to survive. If you had copd and you ended up on a ventilator and your quality at life at home was good and you knew you could get off that ventilator but you needed some months to do it, to have to go to fresno or san jose is crazy. Its demoralizing. Theres a higher death rate. You need to be where your support system is, your psychological and support system is. And the other thing that is making the subacute families very frightened is that as the subacute patients die off that the staffing is less and less. The subacute patients have to be distinct from other patients so that the dedicated staff has up and left. Okay, thank you. Good afternoon, commissione commissioners. My name is Raquel Rivera and my sister, sandra, is one of the 17 patients that transferred to cpmcs davies campus late last year. Sorry, im trying to catch my breath. Last year we told the committee that these were the same that these very same 17 subacute patients rivered transfer trauma and as a result possible death based on the historical medical datas. In less than 12 months, six of the acute patients have died. Im here today because my sister almost died too from the neglect of cpmc. My sister had sustained injuries from a fall which caused severe bruising on her foot and ankle. Within one week from the fall after insisting that something was very wrong with my sisters health, she was admitted into i. C. U. For breathing complications. It turned out that she had pneumonia. My sister almost died. And if it werent for my familys regular checkups, cpmc would have let her die. Those six patients probably could have lived today if cpmc had kept permanent experienced staff. Instead, they hired nurses who have no specialized subacute experience. At st. Lukes, cpmc gave severance packages to those experienced subacute staff instead of transferring them with the patients. My sister would have died if this unit wasnt hospital based. Because she was suffocating and only had minutes for emergency treatment. Im scared for my sisters life and to wonder what will happen to the level of care when there are only a few subacute patients left. Im sorry, its time. I dont want my sister to die. We need to maintain hospital subacute care. We need experienced permanent staff. Commissioners, we need to reopen the discussion of subacute care in San Francisco. For the care of my sister and the rest of the patients, thank you. Thank you. Commissioners, i am mark ericsson, a professor of law at the university, and i work with our community, the Economic Development clinic and San Franciscoioans for housing and jobs and justice. And we ask to be distributed to you before the presentation today a position paper. Its the latest revision of our position paper that has additional Background Information and on the last page it lists proposals. Were here today to urge you and we have met previously with director colfax and met with Deputy Director patel on this issue and they have been receptive. But given the the number of priorities that are around we are here today to urge you to make subacute care a very number one priority. Now our paper addresses in detail background and some of our concerns. I want to highlight today just one very important point that has to do with cpmc and it is relevant to the 2017 charity care report that you just had submitted to you at a previous meeting. I apologize for us not being there at that time. One of the striking facts that comes out in that report is that since the Affordable Care act has been administered, not surprisingly, the number of people on traditional charity care is down with the amounts of money spent by hospitals on traditional charity care is up. This is mainly because of people getting private insurance through the exchanges and the expansion in medical eligibility. Whats gone along with that for every hospital in San Francisco except the cpmc hospitals, is that the medical shortfall, the difference between what they say they charge for their services and what they get reimbursed, has gone dramatically up, sometimes two or three times at other places and at cpmc, time has gone down. This is very suggestive that cpmc is not doing its fair share of meeting the poor, the health care need. Time. Thank you so much. I have extra copies of this report if needed. Thank you. I have three more names here. Ken kom, and paul cartier and latia montana. Latia montana. Many of us know that from our experience with our elders, a real impact and risk when you move people away from their supports and their loved ones and family, that is actually detrimental to their health and actually puts them at risk of passing away. And so i think you know from our own experience, this is a real fact in our lives. This is the impact of whats happening. And so i saw call on cpmc especially as the largest, as the most profitable, private hospital chain in San Francisco. I think a unique responsibility that we need, both from all of our health plan throughout the city, but especially with cpmc. Especially with them to provide the care that our Community Needs and deserves. Thank you. Good afternoon. My name is paul cartier. And im a citizen of San Francisco. I have been for 40 years. I made my home here. I have a we bought a house here, my wife is here, my daughters right here at the moment are here. And im very concerned about the moving of any kind of subacute sniff services out of the county. This would create a if i was in that position, and i can easily imagine a situation as a cyclist, as a driver in the city, where i might be put into a situation where i would have to be taken care of in that kind of facility, to be moved to somewhere tollly out of the region, not just out of county, would be an extreme hardship on my family. And would be a hardship on anyones family frankly. And it would be hard on me as well, because has been cited the survival rate is not good for people who are outofcounty, who do not have, you know, regular access from their families. I believe that cpmcs decision is basically unethical, its immoral and inhumane. And it kind of defies modern reality is youre in the city. Thank you. Thank you. Hi. Im with senior and disability action. And also the coalition. And i every time we come here here at city hall, i i feel really bad about the city where we live in, its a city that doesnt really value human life and allows well, maybe the whole country actually, it allows really forprofits, hospitals to run as nonprofits. And allows them to do the bare minimum and get more profit. So i dont know what kind of power the commissioner and the director have. But i i beg you to really see how you can make this hospital accountable. Its not its not easy to hear that in 11, 12 months this vision that weve been fighting along with has died. And these families have to face this loss. And the hospital is not accountable. And what is going to happen to the rest of the people that need this kind of support. So, please, if you have any power over them, use it. And make them accountable. Thank you. The last speaker i have up here is michael lion. Yeah. Im michael lion. I lived in heights for 40 years. We fought like hell to keep st. Lukes open. Cpmc and sutter did everything they could to try to close it. It only stayed open because somebody on the inside revealed that, in spite of cpmcs promises that nothing would let them close st. Lukes, they actually intended to do it all along. And at that point all hell broke loose and they had to keep the st. Lukes hospital open. However, the level of services that have happened since then have gone way down. Were going to be talking about that later this afternoon. But its so perfectly obvious that the deaths that have occurred on the subacute unit, the death that happened all over the city back of the lack of continuum care for old people, comes only from the profit and the profit mode. And it comes from the fact that the hospital cpmc dont get reimbursed as much for subacute or sniff care. But their obligation their obligation to provide that care remains. This is such a demonstration that capitalism kills. Thank you. Thats the list for Public Comment on this item. Yes. And if i may, commissioners, just a note to the public that the standard for city commissions, with receiving Public Comment, is that they dont comment on the Public Comment. And theres not interaction between the body and you all. So just i wanted to make sure that everyone understood that. Item 5 is the committee and Public Health committee. Report back. Good afternoon, commissioners. The community and Public Health