Reports. To where commissioner joseph even mentioned about how inaccurate these reports are, and it weighs hujly gely on someones permit. Okay. And it weighs on sound. Since ive been on this commission, we were in cbd meetings with you. The neighbors wanted to work with you. They didnt file complaint against you because you said you would be working with them. I stopped going to those meetings, and you said you would work with these neighbors. If you see all those neighbors, theyre not here. Theres 30plus neighbors in the same building that im in, and theres no complaints. Thats what im going to ask. Events, clubs unrelated to this club, two commissions have said, its one complaint. We have one complainant here. Its mr. And mrs. Diamond. The diamonds have and i dont know what their motivation is. I dont know them. Ive never met them, ive never spoken to them, but its troubling to me that a mans livelyhood, depending on mr. And mrs. Diamond maybe theyre racist. Maybe they dont want black people there, but how come theyre the only people, the only people complaining. Okay. I do want to acknowledge that there is a letter from supervisor pen kinskins that the comment that a lot of the nonenglish speakers that did come in and made comments during the meeting e they, th afraid to return. I missed the word, im sorry. Theres a lot of seniors that live in the sros across the street, and theyre scared. Scared of what . Scared of complaining. So thats why the supervisors, sometimes they have to write a letter at the end of the day to work with their constituents. I would love okay. Lets just stop it here. Lets get us the data. Get everything that we think we need to protect yourself, to protect the neighbors, and to also protect the code. Can i work directly with you, commission, to give me specifics on what you guys need because last time i was here, you guys told me to come with a plan and what we have done, and you guys told me thats what you needed. Now youre telling me that i need data, and this is not its not complete. You told me i got an email from kevin. I got kind of a memorandum from ollie. Pretty detailed email from kevin. No, because he doesnt tell me what decibel he played the music on the inside. [ inaudible ] you guys ask for a plan hold on, hold on. Hold on. Can we have one speaker at a time. Commissioner lee, did you want to finish your question . I want going to say, we need the data. Its not complete. And if you want us to make a decision on this, its not correct. Mr. Montoyas correct. Last time we were here, you asked what was going on with the neighbors, 1k we responded. You said you need a plan, and 100 of the external doors are finished, complete, and theres an internal door thats 90 complete. Sir, if you want to watch the tape again, i specifically asked for data. Yes. So if you want to go and say i did not, its incorrect. And you can rewind the tape, and i asked for data, okay . Actual data. So telling me what i said is wrong. Weve got data. Youve got its not complete. Its not what you want. Thats why im asking for specifics. I would love to work with you guys, and i just need to know what exactly it is that you guys want so i can get that done. So a couple of things. One, i think its challenging where you come in and say well, theres a report but its not finished yet, and were doing soundproofing but its not finished yet. It would be helpful if you say heres a report, and its been finished, and we can take action. Its difficult for us to take action when the reports arent finished. And commissioner lee has been very consistent about his desire to see some of the data specifically around the noise. So i appreciate your frustration. Thats very clear, and we want you to be back in full operati operationas soon as possible. So i think finishing the reports that are in process, finishing and completing the work thats in process, and then, coming back is what were asking for, instead of coming in and saying things are almost done. Id also like to hear from other folks who are here to speak on this issue, as well. So are there any other final questions from the commissioners . I just want to add one note. It goes back to something that director weiland said. We are accustomed to a very specific set of data. Theyre reports that are easily obtainable online. Im sure the director has a number of these reports that we can share with you. Thats what were accustomed to getting. Its very kind of standard operating procedure. So when commissioner lee says he wants data, im thinking, and i could wrong, but its we want to see the data that we usually see with these complex reports that third parties put together. Copy that. So the report kevins report needs to be a different report under a different guideline, as far as the study goes. The data of the study, that needs to be complete. They take measurements of sound, and then, they analyze that. Today, weve already seen a couple. Can i say one thing . I respect your position and commissioner lee, as well. I understand its clear, and its clarity here. What happens when the data come in, and the diamonds say hey, still noisy here . I dont like it. My kids cant sleep. I dont like it. What happens . What do you do about him and her . Ill leave that as a rhetorical question. Yeah, it is. Its what we do all the time. Let me make it specific. What if that in fact happens . So can i just give it my opinion because ive been here on that side of the track before. Yes. If you do everything physically possible, provide us the data, spent the money on soundproofing, done Everything Possible by the book, the diamonds can file whatever they can file, but youre in compliance. As long as youre in compliance, youre not getting anymore tickets. This commission can only do so much. Youve answered my question. Thats all. Its not about i mean, other things can happen, but at the same time, when it comes to impacting neighbors and noise, which this is the issue right now, its done. Okay. That was my question, and youve i respect your answer. All right. So thank you. Is there are there other people here to comment on this . San Francisco Police department, are you here to comment on this . Do you have input on this decision . Welcome. Steve matthias, central station. I would respectfully request that i be able to speak on different issues if the hearing is going to be presented at a later date just so that the issues are fresh and can be presented at the same time. Yes, thats fine with us. Wed certainly like to have your input at the same time as everything else, but youre also welcome to make comments now, if youd like to. I think ill let the public have their time. I know that they have a lot to say, and but yeah, i think ill address the other things. I think it would just be a better package to be able to do that. Right. Great. Thank you. Thank you. Members of the public who would like to comment on this . Yes, please, come on up. Wed like to have three minutes perperson, if possible. Thank you very much, commissioners. My name is andrew diamond. Youve heard my name mentioned a lot this evening. I live at 2 roland street, which is across the alley from hue night club. I first moved there in 2007, before there was ever a night club at hue. I met bennett at some neighborhood meetings where he told me he was going to be a good neighbor. I was in support of the club. I love the community. Ive lived there now for 11 years. Ive heard some disparaging things about me said. I will just say, i will be the first to come in front of you and say when i dont have thump, thump, thump, coming through my walls at night. And even though you put the 12 00 restriction on, they still play music after midnight, so we still get that thump, thump, thump, coming until 1 30, 1 45 until they shut their music off. Thats all i care about. I know theres security issues. Broadways a tough place. Everybody talks about roland, and everybody talks im really concerned about the volume going up. At the back of the alley, its actually really very quiet. Its not like being out on the broadway the cars are going, so this bass music just cuts through everything. Ive spent over 10,000 soundproofi soundproofing and taking apart my walls, covering my windows that face roland street to try to decrease that issue. We bought our condo before we had kids. Wed like to live there forever. This is really a solvable issue. There are nights that hue is operating, and i dont have a problem. Its great and i love it. There are nights that they go overboard, and all im looking for is a solution to what i think can be solved. Weve had countless police officers, Entertainment Commissioners. Mr. Pauli, sean burke has been in my home. Dr. Matthias has been in my home. Abc has been in my home. Everybody can hear the music. You can come to the back of roland street at midnight and hear it. Its not like this is a mystery issue. Its there, and im really appreciative of everything the commission has done because its actually gotten better since last july. Things have started to get better, and if it could just get fixed, we would be in heaven. I wouldnt care what hue was doing because, you know, its just frustrating because theyve known about these issues for so many years. Bennett was in my living room eight years ago. Ive met with him many, marijuanmany times. This is an email. Weve bought our own sound meter, and this is inside our home where the sound just bounces about between 70 and 0, the bass hits; it just goes right up. And thats what im hoping can get solved, and i really want to thank everybody for their help on this. Thank you. Thank you. Next speaker. Good evening, commissioners. My name is garth smith. Im a homeowner and resident at 2 roland, as well, a neighbor to andrew diamond. Its a Pretty Simple issue here, it truly is, about a large part of noise and security. Both of which have improved dramatically since our meeting last june, where there were many people to express their concerns. As andrew indicated, weve met with mr. Bennett over the ten years hes been there. He has indicated he was there to be a good neighbor. He tends to be a procrastinor. For example, in june of last year, obviously, his operation permit was modified primarily because of noise. Its been six months now, and this insulation noise barrier has just been installed within a week. And the reports to show the improvements arent even put together yet. So the point is, all we want is the noise down to a reasonable level, and it hasnt been there. Its getting better, and we think it is a situation that can be solved. We just need somebody to put some effort into it, do what they say theyre going to do. And we have nothing against the operation. Its we know its broadway. We live there; we own property there. Its just an unusual or unreasonable condition at this point. Thank you for your time. Thank you. Good evening, commissioners. My name is dominick lamandre. Im the district manager for the top of broadway cbd. Its good to see you. This is the third time im going to submit a comment on this issue. What i will say is that it seems that benity came here today to ask you to make a decision based on incomplete information. We brought this issue to the Entertainment Commission back in june 2017, and then subsequently went to the appeals board on june 20, 2017, and there were some stipulations laid out in that ruling that bennett has to follow in order for his case to be reviewed. So he comes to you with 90 of it done, and my question is, this has been an issue that weve been dealing with since february 2016, and he comes to you today to make a decision based on work that has yet to be completed within that twoyear time span and asks you to bank that extra time on his good word and on his good faith. And at this point, bennett hasnt shown any good faith in the neighborhood. Ive been trying to have a constructive dialogue for over two years now. Only recently hes started responded to my emails, and its a one way dialogue that doesnt promote conversation when only one party responds. Nothing else to say except i would be very worried about taking bennett at his word. Ive tried to cash that in many times, and i have yet to see any results. So thank you. Thank you. Is there any other Public Comment . All right. Then Public Comment is closed. Commissioners . Well, obviously, you know, we should continue this, but maybe with maggie showing some samples of sound studies that we usually look at, get all the soundproofing and everything all done, all done to the best you think to your ability and then bring sean out there and do the check, you know, like we normally would do, but id like to you may want to stipulate that in terms of you want sean to do a new sound test, and if so i think he kind of wants to work with sean and all this, but i want to make sure cause were not anybodys personal sound person. We want to get it resolved, but i want to make sure that the the place holder has all everything done, have those those things for the door in, everything done, have jordans paperwork all done, all the data ready to come to us so we can finally make a decision. And i guess at the time i want to know whats seans findings are. Im happy to send sean ought ought out to do monitoring. Its a little bit out of the ordinary, but you want him there as theyre doing testing . In my opinion, i think its better that seans with them with their people so that theyre saying that hes taking readings at different times than they take readings. I mean sorry to interject. I dont want to be contrary, but i think i think it would be necessary to send me out if what we were talking about is an increase in their internal sound limit or an adjustment to what ambient is, and i think thats maybe not whats on the table here. I think whats on the table is they need to well, theyre saying that theyre in complains. Neighbors say theyre still having problems skbl they have have they have an opportunity to fight the ticket that was issued thats not true. Actually, the ticket has been paid, but they still an opportunity to appeal that. I think right now theyre asking some guidance. Happy to do that. So before they come back to us, we want all of their data complete, and maggie can show them they dont have to go so extensive, but give us some points of when they took the data, at what time, where they were at; a little bit more detail than a paragraph or a report. I want all their witnesses to be here, kevin, and everybody whos going to testify for them to be available for us to ask questions. And you say their standards when they take their sound check and your sound check, and if you say its different than what they have, then, we can bring that up, too, i guess. Okay. Sorry. I dont want to go on too long here, but i want to make sure that this is this is clear. Youre stipulating that i have a role in them id like to verify the process prior to them id like you to verify what theyre claiming that theyre in compliance, okay . Like, i want you to take the same reading is it possible to take the same reading . I think that might encourage a situation in which theres a difference of opinion actively onsite in the moment, and i think maybe thats not the best course. Yeah. I dont. I think inspector burkes job should be to offer guidance and to help them to provide the data that were requiring with director weiland. I would personally not assign or try to assign him to something way outside of his help them out, let them get all their data. Well, to me, its a very legitimate concern theyre bringing up. You want something. Help me to tell me what it is, and i think between inspector weiland and director burke, theyll be able to do it. Do what you guys got to do, what you guys think youre in compliance, and inspector burke will take his own readings, as he would do with any other poe. But thats the thing we need to clarify, commissioner lee, because if were sending sean out to be doing readings, what are the parameters for that . Seans role for going out and doing readings are to a, set a limit or b, ensure the readings are within the limit. Hes not going out and doing 24 hours of data or information that youre used to seeing. Thats separate. If you want him to skbrust go out and oversee the process, have a lending advice on whats going on, that might be a separate thing. Yes. And i dont know speaking for myself, i do not think setting the limits is the way to go on this. I think its compliance. Ensuring compliance. They can supposedly legally work out of that. If they say theyre hitting that same limit, but theyre still hearing it in the back, then, theres got to be something wrong. I think the sound study will just be interesting and curious to see what are the levels that were hearing in the alleyway based on the soundproofing theyve done. All right. So are you guys okay with just the data . And to have that the final piece of the soundproofing put in place before the next meeting, that small little check box of their okay. So im waiting im not going to be having him set any kind of a new limit. No. Especially because its that at ambient right now. I think id prefer to hold off on that. Okay. So he will just be, like, an Expert Witness to help out. Is that so mr. Bloom, so you understand, before you come back, please have your compliant have everything ready to present, and they will give you the guidance of what theyre looking for. We can just talk about there might be other issues, but lets get the sound thing out of the way so we dont disturb a neighbor that obviously doesnt want the business to go down, but lets establish a kind of mutual understanding. Thats okay, no, no, no. No worried. No worries. All right. So i have a motion to continue. Motion to continue. With all the data complete data from whoever experts they have, and all their witnesses here. And if you cant make it, then skip skip the hearing where especially the sound people can be here. So are you asking for a motion to continue it and when theyre ready, theyre contact our director and ask to be calendared then . Yes. February 6th. Okay. Yep. All right. So thats a motion. Ill second it. And a second. So just for claritys sake, within that motion, are we also cause you didnt list within your motion that you wanted a recommendation from an expert that includes data. And you also had mentioned that you wanted or commissioner bleiman had mentioned that you wanted the soundproofing to complete. So are those two motions to continue . Yeah. Yes. All right. And then a vote. [ roll call. ] all right. Thank you, everyone. And thank you for your patience on this item. Our final item is commissioner comments and questions. Yes . Just one thing. I think a lot of us down here understand what the tones mean when people come up and talk, but sometimes people that dont come down to city hall much dont understand that theres two tones, so when we talk to them, maybe we can kind remind them, youll hear the two tones, 15 seconds left. Thats the only thing. I hear people starting to get uncomfortable and starting to hurry up. Yes. Thank you. Useful to remind me of these things. Any other comments or questions from the commissioners . Are we doing the rdr changes of the the lighting . My bad. I mean data. We dont have to keep repeating it. I still think skbl is that somethi that is that something that you guys want to have in another offline group. I think we should discuss that in our yearly retreat, just so everybody can get a little more informed on the kind of questions we can ask. We can make the changes in that kind of a setting. I would love to have an rdr crash course. When did we have our last retreat . March. In march . Yeah. Okay. Let me get through the summit, and then we can go to a retreat. We can go to napa and do some wine tasting or something. I just want to acknowledge the staff for throwing an amazing holiday party. Yeah, thank you. And a belated happy birthday to steven rice. Happy birthday. All right. Thank you all for sticking with us for this meeting. No final comments . Meetings adjourned. Good afternoon. The Health Commission will now begin. I will call roll. [roll call] first item on the agenda is at approval of the minutes december 19, 2017. I move to approve. Second. Any deletions or corrections pertaining to the minutes . All in favor, aye . Opposed . Approved. Directors report. Good afternoon, commissioners. Wanted to start my report with the issue of the flu. The flu season is off to an early start nationwide and California Department of Public Health reports widespread flu activity in the state. We encourage san franciscans to get the flu shot and take other steps. We have flu shots being given at the immune clinics, project homeless, and san franciscans can obtain flu shots at their doctors offices, primary care and pharmacies on a walkin basis for a fee. In monitoring the flu activity, weve looked at our Emergency Medical Service call volumes that have fallen to the normal range for this time of year. We reached out to hospitals, and while theyre fairly full, theyre managing to keep up with demand so far. To date, no reported deaths from flu of people under 65. And we have information on our website regarding this. On issues regarding the federal government and health, i just wanted to were closely monitoring three areas. One is the issue of the individual coverage mandate and the impact on those who will not have a mandate to have insurance and as well as the 340b savings cuts in 2019. And the Children Health insurance program. I hope to have some review of the three areas and impact and responses that we have for you in the coming meeting of the Health Commission. Also just to let you know, we have been working with st. Marys and u. C. To open up 40 Mental Health beds. Its an exciting program. Mid february will be the opening and well send you an invitation for that. Thats the end of my report unless there are questions from the report itself. Thank you. Any questions regarding director garcias report . Theres a lot of things on the radar coming up. Next item, please. Thank you. Item 4 is general Public Comment. Im noting that only members of the department here. So well move on to item 5. Item 5, lets go. Mr. Pickens . Good afternoon, commissioners. Roland pickens, director of the San Francisco health network. Its my pleasure to present to you with the very first update on the network under our newly adopted Strategic Plan. This slide is one we use in all of our presentations to you and to show where the structure fits. In todays presentation, well review four things. First, i will provide you with a brief review of our journey to guide our Strategic Planning and Performance Improvement and daily management activities. Next, ill share with you our current, newly adopted Strategic Plan, which builds upon and refines the work of our previous plan that guided the journey over the last two fiscal years. Third, i will describe how the network is with the greater department of health. And, finally, i will share the status of our quarter one metrics and scorecard. This slide depicts the journey that started in 2012. And quickly spread to primary care in 2013 and then to the network in 2016, culminating in the adoption at the dph level in the Third Quarter of last year, 2017, with a dph Strategic Plan and an accompanying exmatrix. The exmatrix is that onepage document, which you have in your supporting information, that crossreferences the key elements of our Strategic Plan. It shows the outcomes and Performance Measures that well measure over the next few years. Mr. Pickens, if i may, and it has an x on the document, just so you know. Yes. Xmatrix, yes. Thank you, mark. I wanted to show the evolution from our previous to our current Strategic Plan. You will remember when ive come up to present to you, we had nine various strategic, key initiatives. One of the things that we did when developing our new plan and i will talk about this later on, was that we narrowed our scope from nine down to only three strategic initiatives. The ehr readiness, in implementing that, and developing our people. And thats been drafted at the dph level and we adopted them at the network. We prioritize aligning care and finances and outcomes. Really to recognize the shift in Healthcare Reimbursement from fee to service to fee for value. So, again, those are the three things that well focus on over the next two years. And thats also very complimentary with the work were doing with the medicaid waiver and the whole person care. Heres the Multidisciplinary Team that came together this past fall to develop our new network Strategic Plan. So we had representatives across the network from laguna honda, Maternalchild Health and central dph, finance, hr and it. On this slide, we begin to see how weve begun to use the same standard tools like the x matrix, which you have seen before, and the sections throughout all of the visions through dph, with the goal of developing one common language and methodology. And particularly for those of you on laguna honda or jcc, youve begun to notice how weve been using that methodology. So thats across the network and also other parts of the department. And so i put this slide together to show you just another picture of how were beginning, as we matured over the last few years, we really started at the divisional level dph. Now weve done that Strategic Plan. The sfg is about to do their Strategic Plan, and so is laguna. So were beginning our cascading effect. And then for those divisions to take the priorities and figure out how to implement them. Its incorporating a topdown, and bottomup approach to Strategic Planning. So what did we learn over the last two years within the network, as we implemented our first Strategic Plan when it comes to using lean as a roadmap. First, we need to have more focus on a fewer set of priorities and initiatives that are aligned with the more global dph plan, particularly giving our challenges with reliable data. Secondly, we need to have more alignment across the different sections of the network, rather than having them focus on separate things. We felt it was important to end the other divisions and have some common items were working on. For example, staff inquiries, and what theyve chosen. And, finally, we needed to have a real commitment to fidelity of the lean model. It gives you one of the tools for reporting, but if you dont put it in practice, you dont get the power of the process and not able to fully monitor and see your progress. One of the things weve done is weve reported a lean reporting calendar for the network and it shows which divisions will be reporting on their various true north and Strategic Plans. This shied provides a summary of our quarter 1 and our true north metrics. As you can see from the six sections of the network, maternal child health, behavioral, jail health, laguna honda, and dph, we have 47 metrics, which are quality, safety, care experience, work force, financial stewardship and equity. In terms of quarter one Data Available at the time of this report, we show that nine of these 47 metrics are on target. 20 are off target. And for some that are off target, many of them are not off target by very much, just one or two points. You are either red or green. There is no yellow, so they ended up being red, being offtarget. And you also notice that 18 show data was still pending at the time of the report or data definitions and sources are still being developed. I wanted to talk more about this. While weve made Great Strides in improving our ability to capture and report timely and meaningful data, we still have room to improve in this area. Obviously, we believe that implementing epic will be one way we can improve our data recording capabilities, also bringing on Behavioral Health services into the lean process. Its probably the last big group within the department that we still need to spread lean and do education and training with that work force. As we continue to have more and more of our reimbursements based on Performance Measures and payments, it will provide incentive to develop more robust data reporting capabilities. So thats just a brief orientation to our new Strategic Plan and performance for this first quarter. When i come back to you in the next few months with quarter one data, ideally were on the right track, well have more Data Available. Thats our overview. I am happy to take questions and comments. Thank you very much for an outstanding presentation and look forward to your additional one and especially some of the variables that you mentioned that you need to look across rather than separate. So well done and thank you very much. Thank you. Commissioner . I would like youre deciding as a network to use common language, its making sense. Finally sinking in better. Thank you. If i may, commissioners, going back to the cascading lean slide. The one with the picture. There you go. Just to note that we now have the full department under this model. And that weve opened up an office for dph that is working with the other groups. So now its taken us over five years to catch up and be able to do the work we needed to do as a department. So its an ongoing process and big learning progress and i would like to thank the partnership that have helped us on the dph oversight of all the work. So now as we fund some of this, we look at how much can we do, particularly as we do the Electronic Health record. And then the Public Health side has their own process as well. Everyone in the major divisions are working under the lean model, so i wanted to acknowledge that and thank all the leaders to help us from a departmentwide perspective on this very good. Thank you very much. Any other questions or comments . Thank you very much. Next item, please . Item 6 the sfdph security update. Commissioners, this was supposed to come to you in october and it was bumped, due to that it was a very busy meeting, so this report is a few months late. Thank you. Good evening, commissioners, director garcia excuse me. Will you speak into the mike or move the mike over . Thank you. So i will give an update as far as the development of the Security Program for dph the presentation will highlight the work thats been accomplished at zuckerberg and laguna hospital and the performance metrics as well as program effectiveness. Since this report, weve also developed a Security Management plan to include performance metrics as well as developing a safety and Security Committee for primary care and Behavioral Health clinics. So this slide and the next slide following calls out eight mile stoin accomplishments in the area of security services, training, education and Electronic Security systems. So in the area of atrisk response, theyve exceeded target as far as atrisk patient response. They had a return of 88 . Customer satisfaction surveys are conducted to measure employee, patient and visitors satisfaction with security at both hospitals. 90 and 81 for the year. This year, we began doing surveys for laguna honda residents, just to receive input from them as far as to provide safety in their environments. So where there are Electronic Security systems, which is applicable in both facilities here, we want to ensure that they remain operational. On a quarterly basis, we inspect 100 of the system with a target of 98 functional. The overall functionality of a system was 95 and 85 . Based on this performance, one of the things we did, we were able to replace the systems vendor at zuckerberg, where were getting more timely response in regards to any system malfunctions. Were holding laguna hondas vendor were holding monthly meetings, so we hold them to task for functionality. Weve added dedicated Security System personnel to address functionality. On a monthly basis, 20 elements of the mou between dph and the Sheriffs Department are measured as far as compliance, so that reflects that in both hospitals for the entire year. The Sheriffs Department exceeded the target for compliance with the mou. This chart reflects the crime stats for zuckerberg for three years. And so we have actually a 22 decrease in crime on campus. A lot of that is contributed to the collaboration that we have with the Sheriffs Department in regards to addressing staffing assignments, increasing visibility and implementation of a Security Awareness program that encourages employees to report suspicious persons and activity. Increased at laguna honda in crime to 40 through no fault of their own. What we found out is that the data for grand theft of facility property included patients personal property and that drove the numbers up, which weve addressed that moving forward. The next slides will focus on use of force. 124 incidents where sheriffs deputies used some degree of force to affect an arrest or address Risk Behavior, Risk Behavior, that which is displaying a danger to themselves or others. We break it out. 119 were at zuckerberg and 5 at laguna honda. To give some context, the year prior to this, there were 173 incidents, so compared to 119, a decrease of 33 of use of force on campus and yeartodate, its been only 58 of these incidents. So on this chart, the chart on the left, you have the type of force, which was used, and you will see in most cases, 88 is what is called physical force. Physical force being control, personal impact or physical takedowns. On the right side, you have the demographics as far as those individuals by demographics that the force was used upon. And then down at the bottom on the far right as far as locations, you actually have the highest being at zuckerberg with campus buildings and that consists of the outpatient buildings as well as the campus grounds outside of the hospital, followed by pes and Emergency Department. In regards to opportunities and next steps, at both hospitals, theres a huge opportunity to change the culture in regards to calling law enforce kwchment toe no crime was committed. We had 4,000 calls for patient assist or standby or restraint. As a result of that, 40 of the useofforce incidents were against patients. So we started to address this issue by implementing crisis intervention training for direct patient care. We completed the Emergency Department. This will assist staff in regards to building competence when it comes to deescalating Risk Behavior at the early stage. In addition, also providing that same training for the Sheriffs Department to give them additional tools as far as how to react with Risk Behavior in a hostile environment. Other measures that the hospital has taken to address this issue include Emergency Department response plan, address Risk Behavior prior to Law Enforcement and a behavioral Environment Response Team to provide the escalated support to the highrisk departments. This is an update of the Security Program. Are there any questions . Commissioners, if i may, those of you on the jcc know that security updates have been given at those committees as well. The hospitals are hearing their own data as needed. I just want to thank you. Its remarkable how much youve done in the years youve been doing this and to see this kind of responsiveness and this Co Collaborative work with the Sheriffs Department. Thank you. Thank you. Please turn on your microphone. [no audio] sorry. Just want to say that we have really been impressed by your leadership and the ability to integrate the incidents and data to make a comprehensive review of the situation. If questions are asked, do we have people from inside the system or are they mostly latino or asian or from this area . All of these things could never really be answered in a comprehensive way because much of the data wasnt there and youve been able to work with your colleagues on the team and all units, whether it be the general or laguna, to really provide us with comprehensive insight. As far as where the situations take place, the type, classificati classification, time, place, situation, so we want to thank you for really updating a system that was a couple of centuries back. Thank you for a job well done. Thank you. Further comments . Thank you very much. Thank you. Commissioners, this may be the quickest meeting ive ever attended. Item 7, other business. Do we have any other business . No. Item 8, a report from january 9, 2018, jcc meeting. Theres a summary sheet in front of you. Okay. A report that in essence the jcc at laguna honda pertaining to members brought before us. It was an excellent presentation, staff training, etc. , and we had a comprehensive review of director price and security at laguna honda, but more importantly, as was shared today, how, in fact, its linked to our other facilities and institutions, as we take a look at security for patients and staff and our citizens in San Francisco. We also went into closed session pertaining to medical certification and approvals, hires, terminations, etc. That was for december. My colleagues, if you would like to add anything to that. If not, that concludes the joint Conference Committee for this commission meeting. Next item . Item 9, agenda calendar. On february 6 and 20, there will be two budget hearings. Please let me know you will not be attending, for quorum issues and who needs to be updated on the side. Thats all i have for the calendar, but its before you if you have any questions. Otherwise, its adjournment. Just one thing. I want to see if we can add an item to get an update on insured in San Francisco, because theres new articles that just came out and said that last year there were actually an addition of 3 Million People added in the united states. If were ahead of the curve, i would like to know how ahead we are. Well incorporate that into the mandate. Thank you. Yes. Before we adjourn, i would like to recommend that the commission adjourn in memory of dr. Matilda crim, who passed away today. She did tremendous work along with Elizabeth Taylor and others in research and advocacy at the early days of the aids epidemic. She did so much to address stigma in communities of color and she was a hero. Second . All in favor, aye. Were adjourned in her memory. Any further discussion or comments . Welcome back, everybody. Happy new year. Is there a motion for adjournment . So moved. Second. All in favor, aye. Opposed . Commission is hereby adjourned