accountable to our patients and our communities. please, help us protect our patients. >> thank you very much. next speaker >> good afternoon, my name is shurly [inaudible] i'm a nurse at california pacific medical center. i'm here fooask for your support for holding cpmc accountable for to the community and staut the [inaudible] the skilled nursing facility they shut down and had nurses scurrying around to fill positions that other campuses at the last minute t. was like they were holder their breath to get a job. i want to address the issue where cpmc said they are filling all these jobs and the jobs that they fill are clerical positions, but they failed to say they was outsourcing most of those jobs to another area code. trying to get services such from human resources or get your pay roll, anything that you need to get information about for yourself is like pulling teeth. these jobs are out sourceed to people that don't go the protocols with cpmc and it takes a act of god just to get your money back, get pay roll issues addressed and supervisors have called back people to talk to-it is just like you are-you call in for 2 to 3 weeks to get a issue resolved. the jobs are not given to the people here, so you need to look at the example they are setting right now and look for wherethey are going with this. these jobs are being out sourceed. they are not given to the people in the tenderloin district. when they say are giving these jobs to people in the area, we need to have cpmc be held accountable and keeping the jobs of the people they have here and making sure they get to be able to keep their time and have their issues addressed >> thank you, next speaker please. at this point i have one one card. any member of the public who has not spoken and would like to speak, please come up >> my name is choline phurenol and organizer for [inaudible] disappointed to hear yet again cpmc is [inaudible] similarly cpmc is failing to fulfill commitment to current employees. we are in contract negotiation right now and currently cpmc proposed high cost on the health inshirns to employees while failing to provide for what we consider a living wage to survive in san francisco. while it is important cpmc fulfills the promise to hire people from san francisco, they also need to provide these employees once they are hired with a actual decent living wage including affordable health care cost. i would like to let you know the next bogerning session is june 12 and the members committed if there is not a serious contract settled on june 12 that the employees will be on strike. thank you >> thank you very much. next speaker, please >> kim [inaudible] national union of health care workers. i said it at the last hearing which seens it was a few months ago regarding cpmc. it was like plague 3 card mont aey hear today. looking at this company they pulled a rab out of a hat but didn't look at all the other cuts they have done to the community. they took away 100 skilled nursing beds. the department of public health said that would be detrimental to the xhunty yet they did it anyway. they are not fulfilling the promises to workers or nurses so for every good thing they dothey do 3 or 4 bad things and it is a matter who is on the short list. you heard probably 100 people here today saying they are not doing what is right. people from the community and people not receiving money to sit here today. i saw one of our workers. they were offering to pay us today. do you realize your contract is tied and won't get a fair wage and threatening to cut your health insurance. they left. you have to look at the company where fr what it is. they lie and cheat and steel and it is suter and everyone elses wall lt. find a way to hold them accountable. do a collateral agreement. if they are doing everything right they shouldn't be squared of it but they are scared it and that is why they'll fight a collateral agreement >> thank you. next speakers >> my name is [inaudible] hearts. i came to support [inaudible] cpmc and c they were able to let me have a job. i was incarcerate frd the last 12 years and they have been a help to me. >> thank you for sharing your story with us. >> my name is michael [inaudible] and keeping score back there. 19 proand 32 against and 192 uteral. it seems to me cpmc needs at the very beginning a pr firm finding out what the community needed and going to the community and engage the community, but now it seems like they are having a pr night maer of going to the next steps. i would just suggest to them and hope maybe you can suggest they need to do better job with pr and do the fulfillment of agreements they had. i don't want to get into the the fegative because they already heard 32 speerks saying negative things about the cpmc, but i want to say i'm glad to see the voices of the neighborhood and community come out and speak what they believe is happening to them and has impact in their lives. again, i hope that the wisdom of the board will prevail and come to some-reach out to the community and help the community where their needs are not met >> thank you very much. i would like to ask any member of the public who hasn't spoken to come up? seeing none that concludes public comment for this item. i want to thank colleague frz holding on to questions until after pub lb comment. i have question and colleagues have question so mr. chairman >> let's close public comment and proceeds with questions >> thank you very much mr. chairman. i want to thank you first and formost all the community members who have come out and sat through this meeting to speak. i also want to thank the different government aensh who have presented and also want to thank cpmc for their work as well. in this caning about this, my question are focused on some of the issued raised by the community and the letter that was pernted by lieu jurado who was the third party monitor and mediator. i think that what mr. jur audi says in the letter essentially summarizer where i am, which is that i appreciate the areas where there has been a lot of work in that there has been compliance in those areas by cpmc. i think you have to recognize and give credit with wherethere is credit to be provided, that said, i think that i share what mr. jurado said, which is that there are many significant concerns in areas where there has to be improvement and where there has to be a response. with that i would like to focus on a couple and i know some of my colleagues have-in terms of the baseline charity care, if i may ask the department of public health or who ever is a good-mr. jurado notes cpmc did neat roirmts requirements for the 2013 calendar year, but the department is away they may not meet the requirement frz the 2014 calendar yeerb. if you can tell pus exactly the specifics of what that looks like. you are working with cpmc-i know there was reference about some of the things that you are planning to do, but how below are they and & do you see that the obligations is met? >> so, the obligation is to serve 30.445 unduplicated lives, low income folks, charity or medi-cal patients in a year. in any one year cpmc falls short they haveajacent year to make it up. if they had done more in the year previous the average of the 2 years as long as it is 30.445 they have sth falling to make it up so the average is 30, 445. in the fall of last year we were advised they would between 12 and 1500 people short of meeting the 30, 445. we began a dialogue in december to try to insure that they met the commitment that they had made and also to help the patients in the system to reduce wait lists. for the criteria i described previously, we decided diagnostics is the best methed to do that. we had wait lists for diagnostic services and it helps our helthd care providers expudt care to the patients so we decided on echo and pulmonary function tests and they will be perform 1400 in total of those 2 tests. presumably the rest is made up in care they provide in other arrangements or through patients come in 34 existing medi-cal or charity care avenues >> i know as we go through the naishation one of the concerns at that time is relative to other institutions cpmc was not doing enough from the perspective of a lot of us in terms of charity care. do you have a sense of plan in terms of on going monitoring to make sure that the goals laid out in the da are met and in there is ongoing monitoring? can you talk about what you are thinking of doing going forward? >> as the supervisors likely aware there is a annual reporting requirement which is the end of may of every year for the year proir. we have regular meetings with cpmc cl is why we know in the fall of last year they would fall short so we are in regular dialogue with them to make sure things go to plan >> i think it is helpful if you continue to update as you continue the conversations. update the bord and also incommunity >> i also have regular meet wgz the coalition for health care housing and jobs and justice where we discuss these issues >> i know supervisor mar has questions about the tenderloin and other things, but want to talk more about what happens with saint lukes and something that was issue and where you see this going from here. >> so as i mentioned, we had suggested to cpmc department of public health do a peer review to level peer review with class standards. at one level it is hospital wide to look in the high level at the class standards and policy and procedures they imp limited in the extent to training and monitoring of the implementation of the standards was done hospital wide and then we proposed a second level more targeted to the saint lukes diabetes clinic. it was more in depth and performed by bilingual staff at our own diabetes clinic that includes in clinic time monitoring patient interaction and going through data and patient records in compliance with patient privacy requirements. cpmc responded and will hire a outside consultant to review compliance with class standards and agreed to give additional nrfckz to do our own review as well. the report that cpmc has committed to will be done in 120 days from now from may and we anticipate our own staff will review the documentation and data in that report as well as data they neme necessary to class standsards >> in termoffs what happens once the report is presented and reviewed by the department, what do you expect would be the next step following that >> ? >> it is likely our own health commission would like to review that report and our own staff with would look at the report and cultural comp tent staff would take a look at the report as well as the data they provided >> something else we discussed is having a process public discussion for the service at saint lukes which is a key concern underlying the development agreement of course, so can you talk about what that process will look like and what you plan to do >> this is something important to director garcia also. they strongly urged cpmc to engage in community dialogue with neighborhoods around the community. director garcia and i met with cpmc staff to talk about plans for committee engagement, made recommendation about how to go about doing that . plan for a broader community pleating. i meeting. that group gave good and strong and honest feedback to cpmc about the history they had with the community and input the community wants going forwards and the proper acnobbling of the communities role in discussion related to saint lukes and so my understanding is that cpmc designs a meeting around that >> if you continue to keep my office and i have speaken to director garcia and sthais priority for her and us and want to continue to work with you ask the community around that process . i have one more question for the department and then wanted to ask cpmc as well and give them a opportunity to come up and turn it over to supervisor mar and supervisor christensen or anyone else who wants to speak or raise questions. on the transportation piece i wundser if i can speak-i don't know who is the best department to address that? maybe planning. i center to say that i strongly agree with the coalition reading of the development agreement around this and i indicated to cpmc this is a area i feel there is a opportunity to make really strong showing and so i wonder if you can tell us where that is and what you see happening around this issue of transportation and specifically what is happening with the clipper card and subsidies >> the department and sfmta strongly agree this is not a requirement that was required in 2013. it is a requirement that kick said in between 2 and 5 of the agreement. spirfckly because it was about new people coming to van ness and geary. it is a way to improve as i mentioned the fact there is going to be a parking deficiency and green house gas, all those components [inaudible] that is in terms of strict compliance that is our position. it is my understanding cpmc is working on this and trying to figure a way to implement this sooner than they center to. i would defer to cpmc to chimeen in on that piece. we are supportive if they would like to roll this out earlier, but they are in compliance with 2013 obligation >> i could like to give cpmc a chance to respond at least around by egz quz of saint lukes, the clinic and the transportation piece. i also want to acknowledge mike cohp hill who is here and played a variety important role in the process and we certaintyly appreciate his leadership. doctor browner, the floor is yours again >> i do want to correct a couple misimpression about the saint lukes diabetes clinic and also our role in engaging with the medical staff. i meet with the medical staff monthly. i will meet with them at the conclusion of this meeting and sure we'll talk about the diabetes clinic. 70 percent of those patients seft identify at english as the language, 30 percent is spanish. of the 3 providers 2 are bilingual [inaudible] of the visiting providers they are about 70 percent bilingual and spanish so it is not true we are not providing bilingual services to patients who need them and it is true the quality of the care we provide is first rate and invite you to come down and see that first hand. we are extremely proud of how we are doing to help patient manage gestational and other forms of dediabetes. we knhimented to look at cultural and lick wisticly appropriate services. as i think you real aiz, those standards are not as spinge as many of the other standards hospitals live up to and hofep by engaging in nationally recognized expercent figure how to do better. in this city which is one of the most diverse cities in the u.s., it is our oubigation to take the lead >> i would simply say i agree with i think how lieu jurado kwibeed the issue in the letter and hope that we can continue to work on this together on this. >> any other questions for me? >> on the-going beyond the diabetes in termoffs a process around the mix at saint lukes if you can talk about that >> as you know the commitment and development agreement and the full intention is to provide a full service hospital at saint lukes at the campus with 120 beds. it will be vibrant part of cpmc and suter health. we graint graitded many medical services provided at the other campuses at saint lukes. recently for example, the an sthees aulgist and path omgist and emergency room doctors and inturnest are working at all the campus squz will expand those services. it will be a integral part of cpmc that we will all know and love in san francisco. we are very proud that that building is going up and on schedule and look forward to be with your for the ribbon cutting and think you'll be delighted for the services provided there >> i appreciate that and still have a year and a half left >> we are not going to rush the construction that much >> can we talk a little about the transportation piece? i know there is a difference of opinion in terms how people read the development agreement, but i do think this is one area where i'm hoping we can work together to expedite that. >> i'm not sure-we participated in writing the development agreement and was intend today be a response to the new hospital we are building at van ness and geary. we engaged a expertd in the process on the staff of reviewing all aspects not just the clipper card, fwut parking and shuttle and free ride services and bikes and pretax. she is developing a plan. i will review that plan and implement it and hope by 2017 we will be compliant. we want to do thisen a respectful way so we can manage the transportation demand in a effective way and not rush to something simply because it is expedient >> the last point i would make and i know that supervisor mar and christensen have questions is on the hiring. i know as mr. jur ardo noted you did meet the obligation arounds construction and want to say that i'm appreciative of that and appreciative of the people that came and spoke. it is owl owl moving spaens when it challenges of the folks that are hired have and have to say for me especially the challenges for previous incarcerated folks, the challenges that come with that experience--i'm very appreciative of the courage people have when they share about that background. i think it is great we have done what we done and hope we can do more because i think the is a lot more of a need in that area. in terms of beyond construction, some of the other objectives where i know that the start was not what i think we all wanted but think we are moving in the right direction and just hope that we can do oo lot more. the thing about san francisco right now is that even though there is a great deal of wealth and prosperity for some communities they are not sharing so thipg this project provides a opportunity to do that so i want to continue to work with you on that >> i couldn't grew mow. i think the success we had in construction and hiring is no accident, it reflects programs that were put in place long before we started our project. the difficulty we had in meeting the 40 percent goal i think has been resolved. we actually-i want everyone to understand, we are hiring more san francisco residence than we get credit for because we only get credit for those that come through first source and it tooks a while working with first source and hr to work out all the kinks. you started to hear the kinks are recent hiring numbererize first rate and confident we will not only meet the 40 percent goal, we'll also make up the deficit and will be a example and one i would challenge other employers including some in the room to meet. we worked really hard to meet that goal and we are very proceed of the work we are doing >> thank you doctor browner. i'll turn it over to chair mar or sproovisor christensen >> i dide did want to thank you for being up here and follow up on what some of supervisor camp pose missioned. many in the audience question the good faith efforts in the jobs we were talking about. i think they showed in the first year there was only 13 percent of hiring and i know that was a concern of lieu jurado. 13 percent in the first year, the target was 40 percent. you are saying you will make up quickly-as quickly as possible to get tupe 40 percent plus the deficit and that is the pattern you see? smin the audience said it is suspicious that up to jan the numbers are dismal but since the time they are improving but you are saig it is a strong good faith commitment to make up that large deficit? >> absolutely. i would reiterate the commitment to first source and working with first source and hiring san franciscans for entry level jobs is that strong as the commitment we made around construction and the difference was one was a well oiled machine that we were fortunate to participate in and the other is a new process. when we discussed the agreement before we negotiated and signed the dwument agreement tfs a concern whether we would have the ability working with the city agency tooz get this up to speed quickly and the answer is we didn't and acknowledge that, but it is now and you will see much better results going forward >> i know for the fixed target neighborhood with the