San Francisco Government SmartTranscripts:

[Mark Morewitz, Executive Secretary, San Francisco Health Commission]: Oh, so we'll wait until oh, sure.

[Jonas P. Lobo, Commission Secretary, San Francisco Planning Commission]: Sure. Sure. She's walking right in the night right now. She's our problem child.

[Mark Morewitz, Executive Secretary, San Francisco Health Commission]: I know. The SFGovTV is gonna gonna unmirror it, but this is what we have now.

[Jonas P. Lobo, Commission Secretary, San Francisco Planning Commission]: I'm

[Mark Morewitz, Executive Secretary, San Francisco Health Commission]: sorry. Now we're good to go. I know it's mirrored. SFGov TV doesn't have access, so we're pulling from Webex and it mirrors it. When SFGOV TV shows it, it shows it it unmirrors it to the outside world, but inside the room we're going to be seeing it. Actually, I'll go ahead and announce that. Everyone, we're having a bit of a a small technical difficulty. And so in the room, the screen is gonna look like it's a mirror, but it's being shown to the world outside unmirrored.

[Tessie Guillermo, Vice President, San Francisco Health Commission]: Okay. Good morning and welcome everyone. Welcome to the joint committee meeting for the planning and health commissions for what's today? Thursday, May. Okay. And secretary Morris, can we call the roll?

[Mark Morewitz, Executive Secretary, San Francisco Health Commission]: Yes. I'll start with you, vice president Guillermo. Present. Commissioner Christian. Present. Commissioner Salgado. Present. Commissioner Chao. Present. Commissioner Guggenheim.

[Jonas P. Lobo, Commission Secretary, San Francisco Planning Commission]: Thank you.

[Lydia So, President, San Francisco Planning Commission]: We can't hear you with Jonas. My your mic is off.

[Jonas P. Lobo, Commission Secretary, San Francisco Planning Commission]: So at this time, I'd like to call roll for the planning commission. Commission president So?

[Lydia So, President, San Francisco Planning Commission]: Present.

[Jonas P. Lobo, Commission Secretary, San Francisco Planning Commission]: Commission vice president Moore? Here. Commissioner Braun? Here. Commissioner Campbell?

[Lydia So, President, San Francisco Planning Commission]: Here.

[Jonas P. Lobo, Commission Secretary, San Francisco Planning Commission]: Commissioner Imperial?

[Tessie Guillermo, Vice President, San Francisco Health Commission]: Here. Oh,

[Maxwell Guerra, Department of Public Health (DPH)]: I'm sorry. I used to be after you.

[Jonas P. Lobo, Commission Secretary, San Francisco Planning Commission]: And commissioner McGarry? Present. Thank you. We expect commissioner Williams to be absent today.

[Ittika Hussain, Chief Financial Officer, San Francisco Health Service System]: Sorry, please.

[Mark Morewitz, Executive Secretary, San Francisco Health Commission]: Commissioner Guggenheim, can you read the land acknowledgment? Oh, I'm I'm sorry. Commissioner Salgado will read the land acknowledgment.

[Commissioner Salgado, San Francisco Health Commission]: The San Francisco Health Commission acknowledges that we are on the unceded ancestral homeland of the Ramaytush Ohlone, who are the original inhabitants of the San Francisco Peninsula. As the indigenous stewards of this land and in accordance with their traditions, the Ramaytush Ohlone have never ceded, lost, nor forgotten their responsibilities as the caretakers of this place, as well as for all peoples who reside in this in their traditional territory. As guests, we recognize that we benefit from living and working on their traditional homeland. We wish to pay our respects by acknowledging the ancestors, elders, and relatives of the Ramaytush Ohlone community and by affirming their sovereign rights as first peoples.

[Mark Morewitz, Executive Secretary, San Francisco Health Commission]: Thank you. The the only item on the agenda today is case 2000Sixteen-four775 MCM, California Pacific Medical Center annual compliance statements. And this is a discussion only, informational only item.

[Tina Tam, San Francisco Planning Department]: Good morning, commissioners. I'm Tina Tam, planning department staff. The item before you is an informational presentation on the California Pacific Medical Center compliance with the development agreement. This is a hearing for the combined calendar years of 2022 and 2023, and it's the final hearing for this DA. I am joined by Ithaca Hussain of the San Francisco Health Service System, Lowell Reitz of the Mayor's Office of Economic and Workforce Development, and Maxwell Gere of Department of Public Health. Monitor, please. Here is today's agenda. We will provide an overview and dive into the details of three major topics, fee increase update, workforce development, health care commitments. Today's hearing is one part of the annual review process required by the DA. The DA requires CPMC to submit an annual report on compliance and for the city to evaluate their compliance and hold a public hearing. Following this hearing, the directors of planning and public health will determine whether CBMC has complied with their obligations for years 2022 and 2023. A third party monitor will then review the director's finding and inform the board of supervisors whether they agree with the director's determination. The DA require replacement of the St. Louis Hospital within two years of opening the Van Ness Hospital. Sutter Health has met this commitment with the opening of the Mission Bernal Campus Hospital in 2018 and the Van Ness Campus Hospital in 2019. The DA also required Sutter Health to make payments for a range of public benefits and improvements. They have completed their payments requirements under the DA with a total payments of over $73,000,000 For this combined reporting period, there are a number of action items up for compliance review. They include payments, hiring commitments, health care commitments, public improvements, and community outreach. My colleagues will go into many of these in greater details in today's hearing. Major DA obligations are as follows. Construction of the Van Ness Hospital and the associated medical office building completed. Payments completed. Construction of a new neurological care center and a permanent public plaza at Mission Berno are scheduled to start later this year. At this time, we'll hear from Ethika Houssain, the chief financial officer of the San Francisco Health System, and he will go over the fee increase updates.

[Ittika Hussain, Chief Financial Officer, San Francisco Health Service System]: Good morning. Some here report on the fee increase now. It's as we engage in outside the actuarial form, Millman, to do the review. They actually take a sample of claims during the effective period. And because we have claims in our self insured programs that are impacted by the rate increases, they quantify the impact of the rate increases of CPMC. So it is a cumbersome process, and it's done every year. It takes several months to do. And there's two years still open, the '22 and '23 open. All of the the work for all of the years is completed. There was one year in which there was a small payout, but CBMC is in compliance.

[Jonas P. Lobo, Commission Secretary, San Francisco Planning Commission]: Okay. Thank

[Ittika Hussain, Chief Financial Officer, San Francisco Health Service System]: you. And back to Tia.

[Tina Tam, San Francisco Planning Department]: Thank you. Up next, we'll have Lowell Rice, the manager of the First Source hiring program at the mayor's office of economic and workforce development. And he'll be presenting CPMC's workforce requirements.

[Lowell Rice, Office of Economic and Workforce Development (OEWD)]: Good morning, commissioners. My name is Lowell Rice. I've been with the Office of Economic Workforce Development for eleven years, and I've also been on this project for ten of those years. So the completion of the project is very exciting to me. The first slide you will see are are hiring goals, and I'm also the manager of nonconstruction. So we see that the construction goals were exceeded and will not be presented today. But the non construction goals, there were 40% of the entry level positions needed to be filled by people coming from our workforce referral network, which was a community based network of about a 100 different community based organizations. And 40% of those placements needed to be filled with those folks. And the 48% goal was the final goal for the ten years. Also, for year 10, the 48% goal was met August 2022 through July 2023. And in that last year of the DA, 78 of the 160 employees, that came from the workforce referral system were hired by CPMC. There were no deficit carryovers for those ten years either. During the course of this ten years, another goal that was exceeded by CPMC was that these folks were hired from what were called target neighborhoods, and the list of those target priority neighborhoods are listed there, Western Edition, Tenderloin, Mission SoMa, Outer Mission Excelsior, Chinatown, and Southeast neighborhoods. And another metric that was exceeded by an amazing way, I thought, because I've been doing workforce development for about fifteen years, I've never seen a retention rate of 77% of those folks that were hired by CPMC. 508 of those hires, 390 were retained over a hundred and eighty days. And then this last slide, I also did not have any participation in, but it was the CPMC workforce fund, and I'm here to present that to you today as well. The fund did target educational and nonprofit organizations that work in those priority targeted neighborhoods. It focused on barrier removal, job training, and other employment opportunities. As of 05/31/2020, the total remaining amount in the fund was $870,000 And these funds were distributed to the grantees, in program year 2021, 2122, and 2223. The grantees were the Jewish Vocational Services, which I believe does go by JVS now, Self Help for the Elderly, the Success Centers, and FACES San Francisco. And that concludes the presentation. If there are questions, I'm here to field those.

[Tina Tam, San Francisco Planning Department]: Thank you. And our last speaker is Maxwell Guerra from the Department of Public Health. And he'll be speaking on our health care commitments from CPMC.

[Maxwell Guerra, Department of Public Health (DPH)]: Good morning, commissioners. My name is Max Gara, and I work with, Department of Public Health. For this section of the presentation, I will be providing an overview of compliance related to the health care commitments under the DA. Exhibit F under of the development agreement specifies multiple health care focused provisions that are intended to ensure that CPMC provides high quality care to all San Franciscans, especially low income, Medi Cal, uninsured, and the city's diverse communities. This slide provides an overview of the DA's health commitments, and these include five baseline commitments to maintain the same level of community benefit and charity care, three, provisions to increase care to Medi Cal beneficiaries and low income residents two, provisions related to the number and type of bed space available at the Mission Bernal and Van Ness, Geary hospitals Four provisions to assure specific services and programs are provided at the Mission Bernal campus. And five additional, health care provisions in the DA ranging from community benefit partnerships to culturally and linguistically appropriate services. The provisions on the innovation fund were completed in 2020 and the obligation on subacute service was completed in 2016 and therefore, I won't be discussing these items. The next slides provide more details on the healthcare provisions that were in progress in 2022 and 2023 and some, CPMC's compliance on each. And a complete list of, the provisions can be found in the annual city report. So this slide provides details on each of the baseline health care commitments, CPMC's performance on each, for both, the review years and DPH's, determination of whether CPMC is compliant on each. CPMC exceeded the DA requirement of caring for 30,345 charity care or Medi Cal patients. Charity care refers to health care provided to those who cannot afford to pay and without expectation of reimbursement. In 2022 and 2023, CPMC cared for thirty thousand eight hundred and thirty six and thirty one thousand eight hundred and sixty five unduplicated charity care and Medi Cal patients respectively. The second provision is related to community benefits, which are unreimbursed costs incurred by CPMC to improve community health. CPMC exceeded the $8,000,000 requirement, providing about $15,000,000 in 2022 and $11,300,000 in 2023. The compliance for each of these two provisions, was verified by, were verified by Deloitte as a third party audit. The next provision is related to CPMC's charity care policies, which were found to comply with California law, And it is CPMC's, policy to provide full charity care to uninsured patients whose family income is at or below 400% of the federal poverty line. The last provision is for CPMC to continue the support of the Bayview Child Health Care Center, which provides comprehensive primary pediatric care to Bayview residents. And as part of CPMC's ongoing commitment to support the center's general operations, CPMC provided operation grants of about 240,000 in 2022 and January and 20 186,000 in 2023. The following three provisions in the DA focus on Medi Cal, which is an important form of public insurance for many low income San Franciscans. The first provision for the first provision, CPMC has continued to participate in the Medi Cal managed care program with the San Francisco health plan as required. Starting in 2014, CPMC met its obligation to assume responsibility for 5,400 new Medi Cal beneficiaries, and CPMC continued to meet this obligation. In 2022, CPMC had a total of over 43,000 medical managed care beneficiaries, which was an increase from 2021. And in 2023, CPMC had a total of about, over 41,000 medical managed care beneficiaries. Under the next provision of the DA, CPMC was required to partner with a new management service organization, or MSO, with a primary care provider base serving Tenderloin residents. In the event that there was no such, MSO, CPMC could then meet its commitment by contracting with an existing MSO. In 2022 and 2023, CPMC was a hospital partner for the NEMS MSO, which is the only MSO available in, with a primary care provider base in the tender line. CPMC was the hospital partner for, over four four thousand nine hundred unduplicated lives in the Tenderloin, in 2022 and '50 200, over 5,200 lives in 2023 through the NEMS MSO. The DA includes two provisions related to the number and type of bed space available at Mission Birtle and Van Ness Gary, hospitals. The first provision places conditions on the operation of 30 additional shelved bed spaces at the Van Ness Gary Hospital. CPMC may not build out or place into operation this bed space until after the Mission Bernal Campus Hospital has a daily census of at least 75% for a full fiscal year. This provision was not applicable in, either 2022 or 2023, as the Mission Bernal Campus Hospital census was not met for those years. The second provision requires CPMC to provide certain inpatient, urgent care, and outpatient services at the Mission Bernal campus. CPMC may adjust services at the Mission Bernal campus, but they are first required to give the city at least six months notice and then meet and confer with the city on the proposed changes. On 04/03/2024, CPMC provided notice of the permanent closure of labor and delivery services at the Mission Vernal Campus, which initiated the six month meet and confer process between CPMC and DPH as required by the DA. The DA also states that CPMC must comply with the city's Community Healthcare Planning Ordinance, also referred to Proposition Q or Prop Q, and Prop Q requires the Health Commission to hold a public hearing on the closure and for the Commission to make findings as to whether the change will have a detrimental impact on healthcare services in San Francisco. Two hearings were held in the 2024 where the health commission found that the closure will not have a detrimental impact on healthcare services in San Francisco, provided that CPMC takes certain recommended actions. These include continuing to fill, fill, CPMC's role in the

[Jonas P. Lobo, Commission Secretary, San Francisco Planning Commission]: city's, safety net system, maintain and or expand

[Maxwell Guerra, Department of Public Health (DPH)]: services at the Mission safety net system, maintain and or expand services at the Mission Bernal Women's Clinic, and communicate transportation options to patients of the Mission Bernal Women's Clinic. There are there are several other, obligations related to the Mission Bernal campus. The first provision on this slide requires CPMC to establish the Center of Excellence in Community Health at the Mission Bernal campus. The center, named Health First, serves patients in chronic disease management, and the center served 723 unique patients in 2022, which represented a 10% increase, from the previous year. And in 2023, the number of patients, also saw a slight increase. The second provision on this slide requires that CPMC, establish a center of excellence in, senior health to assist patients with or at risk of chronic illness and to provide improved inpatient and post hospitalization care. The center is made up of the acute care for the elderly unit or ACE unit and the hospital elder life program or health program, which is in a partnership, with the San Francisco Village. The ACE unit saw over a thousand patients or about a thousand patients in 2022 and over 1,100 patients in 2023, exceeding the DA goal of 600 patients, for both years.

[Jonas P. Lobo, Commission Secretary, San Francisco Planning Commission]: The third provision on this slide requires CPMC to submit a proposal for the development of the

[Maxwell Guerra, Department of Public Health (DPH)]: mission burnout medical office building within five years of the opening of the Mission Bernal Campus Hospital. And CPMC reported that this project has been approved by the Sutter West Bay Board and is fully funded, and they are o aiming for an opening of 2028. The remaining health care provisions in the DA are stand alone and cover multiple topics. For the first provision deep on this slide, CPMC has continued to participate in the San Francisco Health Improvement Partnership, SFHIP, which is a cross sector initiative with San Francisco nonprofit hospitals, DPH, UCSF, and community based organizations to improve the health and wellness of San Franciscans. The second provision on this slide requires CPMC to continue their partnership with Chinese hospital, and CPMC's contract with, with this hospital was renewed in early twenty twenty, which satisfies CPMC's compliance with this provision. And the last provision is on national, culturally, and linguistically appropriate service standards or class standards, and it is CPMC's policy to deliver services in accordance with the mandates of these national class standards. So most health care and all other DA commitments ended in 2023 with three health care obligations continuing into 2028. These include the maintenance of certain services at the Mission Bernal campus, the operation and maintenance of Mission Bernal campus's center of excellence in community health and senior health, and CPMC is required to continue submitting an annual health care compliance report detailing, its commitment to these provisions. DPH will continue to monitor and provide written updates on CPMC's compliance with these remaining obligations and which will be sent to, the Secretary to forward to the commissioners. Thank you, and this concludes, the health care portion of this presentation.

[Tina Tam, San Francisco Planning Department]: In summary, Southern Health is in in compliance with the requirements of the CPMC development agreement. Previous areas of con of concerns include labor and delivery service at Mission Bernal, provisions of culturally and linguistically appropriate services, and settler health increase in rates as a provider for the city's health service system. As you heard from Maxwell Guerra and Ithaca Hussain, these issues are no longer a concern for this DA. Staff's recommendation to the directors of public health and planning is to find CPMC in compliance for the 2022 and 2023 reporting years. While we have heard there are concerns about the lack of progress of the Guerrero Plaza at Mission Bernal, there are plans to begin construction later this year. This concludes my presentation. Happy to answer any questions. We also have members of MTA, DPW, and Sutter Health here to respond to any questions you may have. Thank you.

[Mark Morewitz, Executive Secretary, San Francisco Health Commission]: CPMC also has a presentation. Oh, no? Alright. I apologize. Alright. So, is there is there public comment in the room? And it is there any remote public comment? I see I see someone that's named me. Is that the person that is here? There's one person on, WebEx and I don't see a hand. I'm just, reconfirming that this is the time to make public comment on this item. Alright. There's no public comment. Commission, please

[Lydia So, President, San Francisco Planning Commission]: feel free. Well, good. Yeah.

[Jonas P. Lobo, Commission Secretary, San Francisco Planning Commission]: With that, we public comment is closed.

[Lydia So, President, San Francisco Planning Commission]: Thank you. Thank you everyone to be here today, and hello my fellow commissioners and hello my health commissioners. On behalf of our planning commission, I am saying our deep appreciation on CPMC's continued commitment to enhance our public health and uphold our development agreement standard and agreement. And I'm personally very happy to hear that you have either met or exceed what we agreed to do throughout these years. And it's like a marathon, and thank you for doing this. I notice life change and career might have changed, but overall, our goal and commitment to providing excellent health care for all of San Franciscan, including those who have limited resources, are your mission. And thank you for continue to keep us safe. And I personally had many of my friends and their babies are born in CPMC. I'm really happy for your commitment to continue our agreement. And thank you for all the department staff, OEWD, finance department, planning staff, and also, I think I need to shout out on SFMTA, right? You guys are here. Thank you for continuing to collaborate and in partnership with our major healthcare anchor for our city. I'd like to open up my floor to all my fellow commissioners. If any one of you like to have questions or come in. And, in respect to our history of our commission, I would like to applaud our vice president, Commissioner Moore. You probably had seen through the inception of this project and throughout the whole process. And I'm pretty sure you will have a few sage words you'd like to share with us. May you like to start? Thank you.

[Kathrin Moore, Vice President, San Francisco Planning Commission]: This has been a long rodeo, and I'm glad it's coming to an end. I'm delighted to see that there are not long lines of people opposing. I very, very vividly remember the nurses unions being very, very strong on what isn't working, holding up really a balanced discussion to keep us on our toes. We had strong neighborhood and community activists commenting on traffic and transportation performance, including the use of the Clipper card, which mysteriously has disappeared. I talked with some of those members out of memory lane yesterday, and they thought that they did not have any more questions. So hopefully, that has resolved itself, a difficult thing to track as the entire transportation situation has greatly changed during COVID. And the obligation for those of my fellow commissioners, it was that CPMC would actively pursue ClipperCard, for nurses and staff in order to diminish the parking pressures that exist around the CPMC, campus along Venice Avenue. But that must have subsided, and I'm glad to hear that. Overall, I am delighted for this to calming down and seeing a hospital that is functioning, visually quite pleasant because Venice Avenue overall has become a fun street actually. Taking the bus down Van Ness and coming to City Hall is actually a very pleasant experience, and I think CPMC was a pivotal point in justifying the addition of the rapid bus service on the street, together with some visual enhancements regarding the sculptural enhancement of the stop in front of the hospital, which I enjoyed driving up for Ness and always having a little landmark. Here are my little yellow orange balloons that I need to see. Overall, I'm delighted. The question that I do have to ask is, why is the Guevara Plaza Mission Bernal project late? If somebody could just give us a brief update on that, I would be happy to hear it because the hospital itself is strongly reliant on those additional nearby services. And this is ten years later, and while you have assured us that it would be starting, I would like, if possible, somebody to speak to that with a little bit more detail. Thank you.

[Khalil Hennessy, San Francisco Public Works]: Good morning, commissioners. My name is Khalil Hennessy. I'm with Public Works, Task Force project, and, we are working with our development partners to get this project over the finish line. We have been working closely with them over the past few years to finalize the design and also to walk through the maintenance to make sure that it will be maintained at a highest level as would be would be required by this commission and by the neighborhood association. So all those elements take a little bit of negotiation. We are at the final stages. We just need to work out one final waterline design element. Once that's completed, you know, the project should be able to complete their design, and then task force and public works is ready to issue a construction permit so that we do wanna get this contract out as quickly as possible because we know it has been lingering. And, again, we wanna follow through with our commitment to get the contract on the street as quickly as possible.

[Kathrin Moore, Vice President, San Francisco Planning Commission]: Thank you for filling us in on that.

[Khalil Hennessy, San Francisco Public Works]: No problem.

[Kathrin Moore, Vice President, San Francisco Planning Commission]: I have one additional question, and I'm going to direct that question to my fellow health commissioners. Just the last day or two, I read that California is thinking of decreasing medical support for particular vulnerable people in the state of California. And I am concerned, among other health care cost difficulties we already all have, of how that manifests itself in how you see the delivery of health care service in an equitable manner across the city.

[Tessie Guillermo, Vice President, San Francisco Health Commission]: Thank you, commissioner Moore, for that question. And, you know, as you can imagine, we all have the same concern because the need is only growing as opposed to lessening. And the proposed cuts to Medicaid both at the state level as well as the federal level are gonna bring more pressure to a city like San Francisco that is a sanctuary to many who depend on public assistance. And so it is something that until the budgets are passed and until the policies associated with that budget are put into place, or, more firmed up, it would be difficult, I think, for us at this point, to, to speculate on the impact, or the specific impact, but we do know that we will depend on the continued efforts of our core hospital providers, ZSFG, CPMC, UCSF, and and others, to work with us, and and to work with the department and, you know, the, all of the different departments that have a responsibility and a mission, to protect the health and well-being of the residents of San Francisco. And we hope to be able to work with you, towards that goal. I don't know if other com commissioners would like to comment, but I know there's also general comment on the presentation from CPMC, but I appreciate that question very much.

[Jonas P. Lobo, Commission Secretary, San Francisco Planning Commission]: Thank you.

[Commissioner Christian, San Francisco Health Commission]: So, thank you for the question. I certainly appreciate and support everything that vice president Guillermo has said. I think we also all, understand and are concerned about the basic fact that we are all connected no matter where we come from and who we are and what our financial status is. So public health is, connected. No one's health is safe if everyone's health is not safe. And so that is a deep concern, I'm sure, for all of us, and, and certainly the governor knows that as well. And I'm eager to understand the the administration's plan for protecting public health overall if this, provision goes through. I'm, confident that there will be a plan because I can't believe that the governor would, knowingly endanger public health overall. So I am confident confident that there will be a, a solution, but it is concerning.

[Kathrin Moore, Vice President, San Francisco Planning Commission]: Those were my questions. Thank you.

[Lydia So, President, San Francisco Planning Commission]: Thank you for sharing your perspective, and it's very important to hear from you at this time of what we have right now. And I would like to ask, commissioner Braun, you might like to have some comments?

[Derek W. Braun, Commissioner, San Francisco Planning Commission]: Yes. I just kind of following on vice president Moore's, question about the Guerrero Plaza update. First of all, I'm really glad to see that plaza coming to fruition soon. I'm really happy to hear that the kinks have been worked out. It was something that I was asking about last time we had a hearing on the DA. It's also a place I walk through multiple times a week, so I have to admit I have a personal interest in it. The other I'm just curious. This is not necessarily connected to the DA, but since we might have the right people in the room, that design of the plaza surely took into account that I believe there's a stoplight intended to be installed at 28th And Guerrero, where today there is a just a pedestrian crosswalk on Guerrero Street. So you can imagine, what that's like. So I'm I'm curious if anyone happens to, know more about coordination of potentially that, intersection being improved and its connection to the the Guerrero Park.

[Victoria Chung, San Francisco Municipal Transportation Agency (SFMTA)]: Yes. I'm Victoria Chung. I'm with the SFMTA in our transportation and development integration team. So there is a signal planned, and it's planned to be activated in 2027. And with Cohal's group, we've been coordinating design review for the crosswalks, the curb ramps, and everything. So that coordination is ongoing.

[Derek W. Braun, Commissioner, San Francisco Planning Commission]: Okay. Thank you very much. That's good to hear. It's a very scary place to cross the street. My other question I have also deals with the Mission Bernal campus. So one of the items that was completed in a previous report was the I think I'm thinking about the same thing. It's referred to as the Lower Plaza at the Mission Bernal campus. And I assume that's the plaza that opened with the new hospital building. That plaza has recently been completely removed, it seems, as part of construction staging for the medical office building. It was a little surprising. It was a really, really nice plaza with very high quality design and a lot of, landscaping and trees. So I just wanna verify if I could just find out. I mean, the what is the plan for reinstalling that plaza? And, you know, I think I saw the medical office building plans, but I'd like to hear a little more about, kind of the the timing on that and what the plan is.

[Valharam Masahian, Sutter Health/CPMC]: Good morning, commissioners. Valharam Masahian with Sutter, CPMC. You are correct. The SWA designed lower plaza that was built after we put in the tanks under the plaza to support the hospital. We we we put in, the plaza with the intention of it being in place and operational until we had funding and could move forward with the, the neurosciences care complex building, which is, slated to break ground next month. So once once that project is completed, the lower plaza will be reinstalled, and connect to the the upper plaza, and there's the, the connection across the plaza from the care complex neuroscience care complex building to the hospital, so unifying, it all. Since we didn't know how long we would, be in a position of in between projects, we built the plaza with the intention of activating it, which we did. And it'll be coming back. 2028 is the target, somewhere in that time frame.

[Jonas P. Lobo, Commission Secretary, San Francisco Planning Commission]: Okay.

[Derek W. Braun, Commissioner, San Francisco Planning Commission]: Thank you. That's great to hear. Mhmm. And I agree it's it was nicer to have that plaza there for two or three years rather than just a fence. So I appreciate that it was fulfilled before and that it it will be back in the future. So thank you. You know, so it's great to hear how many of the milestones are being hit on the development agreement. I'm really appreciating seeing the update. The other one thing I'll mention is, I do hope with the transportation demand management measures that we can continue to increase or decrease the single occupancy vehicle numbers. It was good to see, despite some struggles post pandemic, that there was a decline in single occupancy vehicle trips as of the 2023 report. So hopefully there can continue to be progress there. Thank you. Those are my questions.

[Lydia So, President, San Francisco Planning Commission]: Thank you, Commissioner Braun. Commissioner Chao?

[Edward A. Chow, M.D., Commissioner, San Francisco Health Commission]: Yes, thank you. Like vice president Moore, I think we have lived through this entire process of the DA. Some of us actually worked even before the DA to get the CBMC project on track. And it is nice, as she said, not to see a line of people here pointing out issues that were important to address and that CPMC, in fact, has addressed all of them. And the documentation, regrettably, we didn't have an interval year. We're missing one year. But the report of the two years shows, I think, a great deal of progress. And substantial compliance in almost everything. I do think that and I do want to commend CPMC especially on an area that I had previously discussed which had to deal with the CLOS standards and that the new reports over the last two years are much more detailed and are actually showing, at least in progress, a structure in which we're trying to address this. And I hope that CPMC will continue this, in spite of the environment that we have today federally. These are very important standards for betterment of care and, it's not related politically and I'm I'm, hopeful that CPMC will continue the work they're doing now. And I think if we were doing a fifteen year program here, we would then be asking that, we would see the outcomes of all this work that's now being done. But since, the DA doesn't call for that, we, will just, go on, faith that, CPMC will continue, the fine work that they are describing here and coming out with good outcomes. I think along that line, because this will be our last formal meeting under the D. A, it's important to note that there are several health issues that still remain. Obviously, Vice President Moore has brought up the big elephant in the room in terms of now the announcement about the undocumented care. And I can't address that, nor I guess can our committee or meeting today address it. But I think as Vice President Guillermo pointed out, our department will certainly be at the forefront for the city in trying to respond to a great need that we all know that we'll have to address and that we'll just have to understand the mill year, the environment, what both the federal and the state budgets allow, and obviously our city budget. So, we will, be very vigilant about that. I think there are several issues, though, that come out of the DA that I believe that it would be important that our department keep track of and gets regular, perhaps annual reports on. And those are the outstanding programs that are still, slated under, Bernal Heights for continuation at least, to 2028. I think it's important to understand as, we are caring for all these people And the CA the Bernal Heights campus has actually stepped up and even perhaps enhanced what the DA has asked, that we understand what's gonna happen during the course of the next three years there, which way the programs will go, what type of public input continues to be able to inform CPMC what the community does need, what the community finds is very helpful. And so I would ask that DPH agenda for us, a regular reporting back on, the three obligations, that are health related that, are still, needing to be fulfilled. Along that line, I believe that the same type of reporting needs to come from our resolution in regards to the closing of the maternity unit at Bernal Heights. I mean, there were very good scientific reasons for this, and CPMC has made certain, or we have asked for CPMC to make certain commitments to be sure that the public there in the mission are aware of how to navigate the services. And we'd like to then also see at, say, on an annual basis, how accepted that has been. The data from CPMC was very positive up to, at least at the time that we had our commission meeting, that the deliveries went very smoothly. And we'd like to see that that continue and ask that CPMC return with a report back to us as to, the four items that we have in our resolution, which I believe was named, earlier. Lastly, and this has been something that goes back beyond the D. A, is the whole issue of subacute care. The city lost its only available beds when CPMC and St. Luke's closed their unit. And understanding that was also then a limited unit, it still by itself did not address, but was at least there to assist the, residents of the city to be able to have subacute care in San Francisco today. There is no subacute unit in the city. As part of the D. A. Agreement, and it came about, of course, because CPMC was closing their unit, we asked that CPMC take a leading role in assisting us at the city in responding to the problem of subacute care. And while there have been meetings called and the department, of course, has been working on it with the organization, I believe that they're now at a point where we would like to hear that CPMC is an active participant. We understand that other hospitals have been in terms of looking at how the city can afford to have a subacute unit. Subacute units are not really, by themselves, money making. And this does require support. I believe that the city is willing to add to that support, but it needs the help of all of our hospital systems who then can assist in having, their patients also be part of the subacute unit, or else we cannot have a subacute unit in the city. And so I think that, while, again, outside the DA, the whole spirit of the creation of the DA was related also to the fact that since CPMC is closing a subacute unit, they should be playing a very leading role, not merely having meetings, which is what's written, but in the spirit of the DA and for the city, continue to be active and also look at how they can help support a subacute unit. We've noted that Chinese has offered to provide a site and is currently in the process of getting that certified. But again, the issues and we're back to talking about finances here to a great extent. But if CPMC can become a partner with other hospitals and the city to fund a subacute unit, I think then we'll have that or we can have it fulfilled. It was our underlying hope, those of us who were here at the beginning of the DA, that the work that CPMC would be doing in leading the discussions or being a substantial part of it would then lead us to a subacute unit. We are fairly close to one. But we do need the cooperation then of CPMC, etcetera, for this. And I would ask then that the department also then keeps the commission abreast of the progress on the subacute unit. I think with that, again, I'm grateful that after ten years and I really didn't think I was going to sit here for ten years in order to see the conclusion of this DEA in such a fine way, We have a rebuilt and a very important facility in the Mission that we almost lost, and that came from the And, and we have a world class hospital over on Venice Avenue, along with all the street improvements, of course. So, I think those were, the objectives of the DA to maintain hospital services here, to be able to serve the city along with the region. So, I'm very pleased to be able to have gone through the ten years with you all. And, I look forward to also the next several years in which, we can then have, CPMC as even a greater partner in, the needs, to address healthcare in San Francisco. Thank you.

[Kathrin Moore, Vice President, San Francisco Planning Commission]: I wanna say something.

[Lydia So, President, San Francisco Planning Commission]: Thank you. Commissioner Vice President Moore?

[Kathrin Moore, Vice President, San Francisco Planning Commission]: If I may, ten years is a long time, and it has been incredible, fruitful, and really deepening experience working with the health commission. I have always asked this year, can we can we meet more often? We haven't met for two years, and I do ask all of you, including the planning department, to facilitate that we at least miss one once a year. We have many, many overarching issues that we need to inform each other and support each other on. So I'd like to thank you personally, and hope that we can build on what we have started. Thank you.

[Lydia So, President, San Francisco Planning Commission]: Thank you. Those are really thoughtful comments, and, thank you, commissioners, sharing in-depth about what you work on so tirelessly on this project and also delivering quality healthcare for San Francisco. I do echo with my fellow commissioners here, there are certainly clearly some outstanding items that we should be continuing to track. And in light of Commissioner Chao mentioned about the reporting directly back to the health commissions. May I suggest that for the remaining commitments that are ongoing till 2028, let's have our staff send us a report. If it's, like, twelve to eighteen months time frame till this make sure that the Mission Bernal campus maintenance, operation, and maintenance aspect of Mission Bernal Campus, as well as the community health and senior health campus, and the Guerrero Park Plaza of completion of its, to its final glory state of the design by SWA landscape architect. These are the things and also collaboration with, DPW and SFMTA, these are the things that, our planning commission will be interested to, if nothing else, to see if we can be helpful to keep us update on the process. I would like to see commissioner Braun and myself be able to walk across the Guerrero Street on 28th with a safe traffic signal sooner than later. Thank you. And I really appreciate, I got to learn a lot about from my fellow health commissioners about the health care aspect of the importance of the existence of CPMC being one of the largest health care providers in the region, certainly providing continue to partner with our other hospitals that are very good at culturally appropriately treat our San Franciscans, especially bringing back a subacute care unit that will no longer exist. This is something that I am personally really interested to follow-up. So if there's anything we can be helpful, please, we're just literally one wall away from you. Thank you.

[Tessie Guillermo, Vice President, San Francisco Health Commission]: If I may, I would, also just just to emphasize the the leadership role that commissioners Moore and Chao have played throughout this process is we talk about ten years, but we know that they were in the fight way before that and will continue to be so as you have both been the leaders and the historians in many ways on this project. And we know that whatever tenure you continue to have on our commissions, that you will be also still pushing for continued improvements in all the kinds of things that San Franciscans need to be represented on as we all collectively continue to represent the needs and the wishes and the improvements for the residents of San Francisco now and in the future. So I wanna again, commend Commissioners Chow and Moore for being here throughout and leading us through the process, and hope that we can continue in your shoes to represent the kinds of things that you've shown us. It can be done with partnership both from private sector partners and with government that people think doesn't work anymore in San Francisco. It does. It takes a while. But, but we can continue, I think, to, to represent the interests of those in need in San Francisco as we work together, which I would, I think if I can, speak on behalf of President Green, Doctor. Green, that, she would, probably endorse some, ability to continue the commissions to, collaborate, communicate, together, in the future. Do we need a motion to no? Okay. I guess meeting adjourned. Congratulations. Thank you. Thank you. Thank you.