Of management. They have been languishing in jail. When their public defender got fed up and said this is ridiculous, i cant get answers, i am going to sub the department of Public Health. All eight are in beds out of jail. Some lang winninged for 8 months. This is a scandal of the highest proportion. People are waiting in jail so desperately i ll we cant find a bed for nine months until they come to Court Everything i am angry. This is the most humane i have seen. All i have seenence i called the mayors office. We it is by our plan. We have staffing issues and blame the workers. It is not good enough. We have got to do something to get those beds up and running. We are talking about hiring 12 more workers. In two years the department of Public Health doesnt have that capacity so that mentality i ll people can get the care they need. Is that the department we are running in the city these days . I have brought copiesna i introduced when this was happening. Directs the department of Public Health to open beds. Directs the department of Human Resources to take over management of the arf and provide some professional management and staff hires to get this facility up and running and serving the people dying in jails and on the streets every day. I implore you to act with the urgency the workers have and i somewhere on the board of supervisors that most of my colleagues that is lacking the vision and leadership to take care of the crisis on the street. Join us and act with that level of urgency. It is morality and an issue of life and death. Thank you. applause . Before the Department Responds to the repor. Reporter we will have from the speaker, would you add here to the timer it would be helpful to folks behind you and gives us an opportunity to hear from everybody who wants to speak. I thank you in advance a apologize for anybodys name i ruin. I will start with first five. Patrish an shaallen, patricia, jennifer, doctor palmer, janette cooling, i believe. I cant read the writing. I stay at the arf facility. I dont think they should close it down. That is my place of living. I have been there for five years along with my other clients there. I feel that the arf shouldnt be closed down. Thank you. Thank you, ms. Allen. Good afternoon. I am a Mental Health worker at the facility also known as arf. I want to thank you. Thank you so much. I dont have anything to say because supervisor ronen said everything i will agree with what he is saying. I is agree with her. I came to the arf to the Mental Health and living en independeny in the community. It is in the hopes of enabling them to get back into the community. Some clients are able to move to lesser care. Unfortunately, a majority of clients are in need of Constant Care and attention. The ones that need the most care received eviction on august 19. We have an established program serving the needs of San Francisco adult Mental Health population for the last 14 years. Instead of building on the program and increasing beds, the program has been losing beds. Not because of the care we are provides. I ask you to consider the individuals you are affecting before making changes. That will have a negative impact on the more helpless clients. Displacing the Mental Health and taking their home are not the solution to the homeless issues. Lets address the facility issues and Work Together to solve them so we can all retain our beds and continue to serve the members of the community. Thank you so much. [applause. ] thank you. I am Theresa Palmer a long time san franciscan. Usually i talk about longterm care. This whole thing is extremely upsetting, and my hope is the department of Public Health can improve from the fallout of this fiasco. Keeping longterm care beds empty because of what amounts to dphs lack of will to fill them is unacceptable. I cant help having the paranoid thoughts the mayor wanted to gain political points by keeping beds empty to say she could offer navigation beds then in the coverup. I may be off on that but that is what it looks like. This disregard for the mentally ill is chilling. I hope this thought is not the case. There is no easy solution to the long and short term beds in San Francisco. Surely we can do a better job by working together. Please work with and not at odds with those in City Government in San Francisco who really care. Dont close down arf beds, staff them and reopen them. Work with supervisors haney and ronen who are looking at ways to fix this. Thank you. Marcus i cant read it. Houseman, i believe. Janette cooling. Vivian and amy. I am marcus heisman, a resident at the arf off and on since 2009. All i got to say is, is this discrimination against gay people like myself secretly, and i think 10 times before you kick people out on the streets. It is not safe out on the streets. Thank you. I am janette connelly, and i live in the reseptive Behavioral Health center for more than 15 years. I went from there and i worked in the acute care psychiatric area, and i see that you keeping beds empty at the Behavioral Health center when there is an ample amount of people ready to go from acute care and in the medical area of San Francisco general. It is just almost criminal. We have huge amounts of people getting acute Care Services that really need to be on a lower level of care and they are unable to move because there is empty beds not being filled. To change them and the bhc that it is now called is just i dont know. I think you need to find a better solution to find the Navigation Center or shelter to open them up in the city. Bhc is doing a good job of caring for the patients in the facility. A lot of people work well there, there is need for it. If you close down the needs met there now, what is going to happen to people that are in the jails, in the medical area, and in the psychiatric area that need to go to a lower level. If you eliminate a lower level area you are going to have a bottleneck. You will have the psychiatric areas in the acute areas of general bottlenecked and you will create a big problem, in my opinion. Thank you. Amy wonk, vivveon, jennifer. I am amy wonk. I am a Mental Health specialist on the third floor of the Mental Health center. I have been working there 20 years. What i have seen over the time and time again is the lack of transparency of the management. The lack of the transparency i just heard thank you. He mentioned a couple things that stood out that i have to mention. He mentioned the 14 beds. There are 13 beds now. One bed was made for or attempted to be made to a washer and drier room. The other one is noncompliant with the state regulation. One to two years to correct the problem. I have spoken to several colleagues. That has not happened. Where is the transparency. If transparency. The people impacted and the residents who lived at the arf. Because when they are not being transparent that is under mining the actual good work that the staff had been doing for the past 10 or 20 years that i have been there. They have been doing a phenomenal job, and so by under mining the clinical work of the staff, it compromises the care of the residents. I am very concerned the residents will suffer trauma, deterioration from the poor decision of suspending the arf beds. The members of the health commission, we are demanding to really to rescend this notice and open up the arf beds. I am vivian, a staff representative for local 21. We represent some workers at the bhc. I am here on behalf of staff who requested i make some corrections on doctor pickens presentation. Here are some corrections as follows. Doctor pickens gave incorrect statistics in his presentation. None of the bhc staff has been terminated. Number two, the number of citations he sited is incorrect and in addition to that the state determination of noncompliance is related to a death which occurred on the sfgh campus. As representative of the staff i am here to say dph has got to stand by the staff and not be throwing them under the bus. In addition, i would like to mention especially ms. Kelly. We would love it if you would Say Something good about the people who make dph run. Stop insulting staff, stop insulting workers in public. Without these workers and staff you would have no bhc, no arf, no dph. Thank you so much. Jeff esten, michelle, sarah larson, robert rogers. Police say your name. Good afternoon, i am vivrian. I have been a Mental Health advocate for over 40 years including working in the field for over 20. Decades an go we fought to have the Mental Health residential facility built. We expected that it always would be fully utilized. Recently there was a plan to switch some beds to Navigation Center beds. This essentially pitted one group of people needing services against another. The community revolted. Before the publico speak, San Francisco in an incentive action sent formal notices to vacate to some residents an the the adult residential facility. Getting that frightening notice can really set them back. Evicting Mental Health clients to get positive press about homelessness is a shameful political strategy. Then the plot thickens. A number of beds at the facility are empty. Why . People wait for months stuck in inappropriate levels of care when, in fact, there are empty beds . At first the county claimed the state forbid them from filling the beds. The state quickly denied this and followed a perplexing periods of excuses for not filling beds. We read there was trouble fills staff positions. Then the story shifted again. They were aware of staff negligence and error so they left beds empty rather than expose new admission to say that. What about existing residents. Identifying staff negligence and error at not correcting it is, in fact, negligence and error. They didnt provide services for people needing care. They deemed the staff incapable of doing so properly. This must not go on. People are waiting for services. Thank you. Commissioners, secretary, thank you all for having this hearing today. I see appreciate the time. Everyone in the audience, i appreciate you coming out. The system is broken. Thithis is a symptom. There are 30 beds to close on december 1st. Six beds on november 18th, 18 beds on the 17th of this month. That is 54 beds between today and december 1st. We do not have capacity to place 54 people. Rye now at the arf and rcfe there are 46 empty beds. I talked to the Deputy Director today and he informed me the state licensing body told him if people are not placed from the bed that is going to close the home to close this month, they will be sent to the emergency room at San Francisco general hospital. This is unacceptable. How much more do we have to spend if 18 people show up at the emergency room with no emergent need except for housing, which we have been providing for a number of years for them . We have open beds right now sitting vacant we could have put them into a mop ago when we month an go. It is because of the neglect from leadership to the people we contracted with. Even the contractors are mistreated and decided a 35 a day rate is not enough. The same kind of care we see given to the staff has been given to the contractors and given to the clients. It is not okay. Time. Sarah larson. Hello i am sarah larson, Mental HealthTreatment Specialist working since 1986 at ph. D. We are so isolated we have had to be on the edge of closing to have a voice. It has taken 20 years to get attention to mismanagement. We are a microcosm of what is wrong. I met to get clarity on where this is going. We found them to be defensive, rude and hogs tile rather on hostile rather than the permanent beds management has the right to make decisions and file grievance. They are suspended arf because of errors and staff conflicts. No conflict management, no team building. It looks like i ca looks like it leadership. New staff are to learn on the job. No clerks and little staff support. The arf would be a great facility if we invested with leadership with a plan to run it. We have been in a crisis of leadership for beds. This is a political decision, not a necessity. We are not on the verge of losing the license. Management is trying to outsource the workers making a living wage with underpaid nonprofit staff. In the meantime our contract with transitions expires in less than six months. Neither row land pickens or the resource representatives admit to the knowledge of the contract. It was signed by pickens and hiramoto. We deserve better, our clients deserve better and the citizens of San Francisco deserve better. Dph has got to change. Robert rogers, judith crane,roma guy and jennifer. You can come up in any order. Whoever gets here first gets to speak. Good afternoon, commissioners. I am judith claim. As a past employee with over 30 years working with the city, i get how difficult it is to institute change. As a mother with a son with schizophrenia currently lives at the arf we cant afford not to. My son entered with the jails after being beaten by eight police officers. He was moved seven times during the first year of treatment. Now you are telling me that it is unsafe for him to be at the arf where he has been for two years . He has finally found some stability. I dont believe he is unsafe. While it is needing major reforms, it provides low barrier longterm care for severe Mental Illness that is rapidly disappearing. He was moved from hummingbirds. It does not provide longterm care for people with severe Mental Illness. Keep the beds open at the arf, that Service Improvements be helped to move them to independence. Schizophrenia is a painful condition. I have witnessed my son suffer. Not only suffering from his condition. He is suffering from our system of care. Please dont reduce the needed resource. Thank you. Good afternoon. Roma guy from taxpayers for Public Safety. We attacks payers for public taxpayers for Public Safety want to and our support. We want to thank you for having this meeting finally and bringing your leadership and listening ears to problem solve not only be this issue but many as many speakers have said to other issues that are in cries cease in this modern era. The arf, from our point of view, is just another mishap in plugging holes in a leaky old barrel. We must change the Healthcare Systems approach at the leadership level, Management Level and at the practice level if we want to meet the challenges of this era. We did it with h. I. V. , and some of you were part of it. I know you are sitting here. We did it with healthy San Francisco. We are doing it with pedestrian safety. Why not Behavioral Health . We are behind other jurisdictions and there are many lessons to learn as well as the ones i have sited in our own county and city. We are not problem solving, we are fighting, not helpful to the people we want to solve problems for e. We have chosen positions we must take them on. Be visible, transparent and accountable in the modern era. Thank you. I am michelle. I think you called my name. I will speak for robert rogers. He left. I am a social worker and i work as a conservator. I am speaking on behalf of private citizens. I think it should be obvious at this point be this is not a good idea. There are enough people saying the same thing over and over again. Front line people in the system every day, and a sign of good leadership is when you recognize that may be you have made a mistake and deciding to not make that mistake if you are getting a lot of feedback from the people on the front line like myself, the staff, the doctors, psychiatrist, every Single Person working in the system thinks this is a bad idea. We should stop doing that. Also, i work on the third floor. I work on the psychiatric facility. You cant tell you how many meetings i have sat in and had to look my client in the eye to tell them that even though they worked through their care, they did everything i asked them. They took medications, went to groups, took showers, they did everything and they are ready to go to a lower level of care and i have to sit in the meeting and tell them there is nowhere to go. We have those meetings month after month, and then to learn there were beds below us they could have gone to. I cant tell you how angry that makes me and how sad it makes me for our system, and if i was my client, i wouldnt trust me after that. How can we have a therapeutic relationship when they do everything i ask them to do, and those are very difficult things, then i cant give them the thing they have earned which is to come out of a locked facility and be able to walk out on the street. Thank you. I have one more. I am jennifer. I work at the locked facility on the third floor of the Behavioral Health center, i am a social worker there. I work with San Francisco residents there involuntarily hospitalized for treatment knowing they are going to work through. Like mitchell is saying, go home and they cant go home for months. There are people there for over a year who cant get out, similar to jail. They cant get out. They need a home like the arf. Two points. One safety concerns put out by dph do not hold water. In the last year from 2017 to 2018 there is one substantiated citation and three at the rcfe one floor up is held open. Going to fill to capacity according to this plan. Also, the staff that are blamed for the citations are floating up. They work upstairs. The plan is to have them go upstairs. They are already going upstairs. The staff work down stairs. That is happening. This argument that one floor is not safe while the other is doesnt hold water. The citations upstairs are about events leading to a clients death. The humming bird extension is not doing harm. It is doing harm. They are locked and cant go home. There are 41 people that need somewhere to go. There is a reason the whole community of the San Francisco front line workers are coming out. They are getting good care. Thithis is a good place. We beg you to hear the word of the public and weigh it against the messaging of d. P. A. To look at what is going on here. Thank you for taking time to hear us out today. Thank you. Kim, San Francisco labor council. I agree with just about all of the public testimony that has gone on here, and i think dph is in a pathetic state. I was here testifying before this Commission Many years ago when laguna honda ceased receiving medicare because of the 700 violations. We are talking 10 violations over a four year period. Dph is not telling the truth. The people who are supposed to be telling the truth are lying. I think it is pathetic. We have called the state to ask them about the status of the arf, and they have assured us. It is on the website the arf is no no way in jeopardy of closing. Why they are perpetrating that is beyond me. This department is playing politics with peoples lives. Their sole job is to care for the folks and they would rather play politics . They need to be ashamed of themselves. If we need to clean house, start at the top. It is time to start caring for the people who come to us when they are most needed. I have been talking to taxpayer groups who should sue the department over there. I was there when Behavioral Health system when this center was built. It was to be a long term Behavioral Health center, and that is what the taxpayers paid for. The fact you changed it without discussing it with anybody . I think you all should be sued. It is pathetic, sad, and dph needs to do better. Thank you. Any more public testimony . Please come up. I am ei am ed de steal. I have a long history of depression and anxiety. This spring it got bad. I ended up in the hospital. I am in the kaiser system. I went to the emergency room. From my personal experience i was able to move from the emergency room to the hospital fairly quickly within six to eight hours. Other patients with me were in the emergency room two or three or four days before they could get a bed. There were patients with me in the facility waiting on longer term beds they couldnt get in. They were in the short term facility when they needed to be in the longterm facility blocking the bed for someone in the emergency room. This is what is going on at arf. If people arent able to get in the system, people are going to die, od, to selfmedicate. I will say to leave beds empty during an acute Mental Health crisis is the same as withholding future in a famine, keeping water from people in a drought. You are making money. It is not right. Open those beds and make more beds for people so we can deal with the Mental Health crisis on our streets every day. Thank you very much. Good afternoon, i am with Community Housing partnership and member of the treatment on demand coul coalition. These were written by david lewis. He served two terms. He had first hand chance to observe the citys Behavioral Health system of care as well as client receiving services. This was at a time when treatment on demand was much more reality. Oneonone conversations with barbara garcia. Providing the treatment in locked facilities was not priority. It was detrimental to recovery. The number of treatment beds were reduced under the leadership of the Behavioral Health services. It may result in under capacity at the San FranciscoBehavioral Health center. The demands off of often resulting from addiction, domestic problems created need for the intensive level of care provided in the facility. De prioritize this facility or reallocate beds for Navigation Center purposes leaves a psychiatric medical need unmet. There will be a percentage of patients that need this level of care. Rather than further reducing we need to provide a comprehensive system of Behavioral Healthcare. We needed this yesterday. We need it more today. Thank you for your consideration. Is there any more Public Comment . I just want to say the arf is anything but unsafe. The staff deserve consideration for their jobs. Thank you. I am a gay man that i hate. I will put this in the hands of the commission. Mr. Pickens will you come back up, before we get into the commissions questions and comments i would like to give doctor colfax an opportunity to respond to the things he has heard. We will come back to you during the course of the dialogue up here. Thank you. I want to thank everybody for coming out today and expressing your opinion. It is incredibly important. I apologize on the part of the department for not getting input earlier and hearing your concerns. I do think that we also need to be clear that with regard to people who turned out today the residents, front line staff, members of the public, that you hold a collective wisdom that as director of health i am committed to getting your input as we make decisions Going Forward. It is very important that the department has a shared accountability for the problems of arf and having visited with some of the staff here today i want to assure you while i do think there is severe problems with the arf and the history of the past five years, that i also recognize and i think the leadership recognizes the incredible work that people do every day at the arf and a cross the dph facilities. I want to express my perspective your work is valued by me. I think when i visited many of you described the members of family and some of you have worked there for 19 years. Not to say there are not issues and concerns. When you see problems consistently in the arf, i want it not to be either other. You can have good staff caring for patients kept safely and providing good care and there can be some problems and those need to be a shared responsibility across the leadership and management and front line staff. To express that Going Forward. Whether the arf stays at 32 beds, whatever hatches i am committed to fix happens i am committed that we can fix these problems together. Thank you. It is in the hands of the commission. Commissioners. Thank you, doctor pickens and supervisor ronen. I wrote down names but there are too many to mention. Thank you for turning out to show how much you care about the Services Provided at the a rf and caring for those in need. I did have a question if you refer to i am not sure if the pages are numbered. Actions taken for Resident Safety where you discussed staffing concerns. There were weekly meetings with hr since 2017 to look at the staffing shortages and how those might be addressed. I believe supervisor ronen said there are 12 positions currently unfilled. I am not sure i if that is the number. What are the barriers to filling those positions if there are weekly meetings and why havent beds been addressed . As i said in the presentation, we got down to three vacancies at the arf but we still continue to have the operational issues and concerns that were affecting the unit. Therefore because we were already on heightened alert from the state, we felt in the best interest of care we could not bring additional patients into the system until we figured out what was going on and try to correct those to open up the beds in a safe manner. Follow up. The Unfilled Positions at the current level of 32 . No there are more vacancies. I think there are actually i dont have it in front of me. At least nine vacancies if not more. What are the barriers to filling those . Hr continues to work towards those. We are filling positions on the third floor. There are no barriers to filling positions for the arf other than the plan to use that space for the hummingbirds program. That is why we are in a pause situation. If the decision is to reopen the arf beds we will have to bring hr to the table and work full steam ahead to fill those vacancies. Thank you for your History Lesson on the Behavioral Health center and thanks to everyon everyoneluso passionately has spoken on behalf of the residents of a rf, the staff and the care and wellbeing of the San Francisco residents. Being a native san franciscan and whose immediate family has had to deal with many Mental Health problems described here, i want to assure you that at least from my sense of my colleagues that we do want to work very, very closely to correct the concerns and to put it into larger context of the lack of facilities and the decreasing lack of facilities that we have to deal within San Francisco and in the bay area for what is actually a growing problem and more complex set of problems that if we can find a way to Work Together in a larger context and systematically, it wont happen quickly but maybe it will happen in the right way. I wanted to ask about the humming bird place expansion. There was a suggestion by one of the speakers, and i apologize i dont remember which one, that one of the things that dph could do is think about the expansion of hummingbirds not necessarily by taking beds away from arf but in other locations and to other facilities within San Francisco. Is that something that the department has looked into . What is the status of that . Thank you for the question. You are absolutely right. I was at a hearing of the board of supervisors last week. I believe it was supervisor fewer who said it shouldnt beep one or the other, it should be and. The department is actively pursuing opening hummingbirds sites around the city. Those investigations are Going Forward and we hope to have those facilities online. I just want to ask mr. Pickens several questions to clarify the presentation. When you say that our changes at the Behavioral Health center are on hold, what is hold . Which scenario are we holding at. We are holding on moving patients in the arf up to the rcfe. Holding on opening a new hummingbird at the bhc building. So those numbers in terms of the additional 14 that would have occurred becoming part of hummingbirds does not happen at this point . No, that happened over a year ago. That happened already . Over a year ago. We are talking about current number at the arf . The current number at the arf will remain. The proposal was only 14. That is on hold. Exactly how many then are at the arf right now . I believe it is 32. So at the moment at the arf we have 32 . At the merf, we have a capacity for a number 50 something . On the third floor . Yes. Yes. There are vacancies there at this point . Yes, i think there are two vacancies. It could be more. We will get you that data. We are not going to fill those either at this point . That is the departments plan right now. Which ones are you referring to . On the third floor . No, we are filling vacancies on the fired floor. That has never been at question. The third floor is the locked ward. It is the second floor the rcfe and first floor is the arf. So the patients from arf are going to the second floor and not third floor, is that correct . Yes. So what the vacancy on the second floor in the residential area . The r. C. F. E. . Kelly, can you help me out . 36. 34 bed vacancy . Lets wait. I am trying to find what the landscape really is when we talk about holding. Where are we then . I am kelly hiramoto, manager of special projects. We now have a census of 36, capacity for 59. How many . 36, capacity for 59. We have 36 out of 59 at the moment. Yes. At the arf we have . 32. Capacity of 55. The capacity still at 55. Then upstairs we have what . On the third floor currently 36. Capacity of 47. Okay. To get back to understanding what we are holding. This is what we are holding . What we are on target for is consolidating the second and first floor. Our plan was to take clients from the first floor to the second floor, 18 clients, 11 of whom are older adults. We will leave 14 as residents of the arf so we can bring the census to 59. We will be four short, but we would be bringing people in from new referals when we got the staffing completed. On the third floor, the locked floor, the reason the census is down is because we had two nurses retire, and we have two senior Behavioral Health clinicians that left, and we are trying to fill all of those vacancies. Our census can only go up when we have those positions filled. We have two Behavioral Health clinicians going through the hiring process currently. We recently finished interviews for the nurses. The third flourish shoes of vacancies flouris floor has b vacancies. We would take those who qualify for locked facility at that point. Until that you dont have the staffing to do it . Thats correct. You anticipate staffing to be filled in what period of time are we talking about now . It sounds like they are through the hiring process. For the Behavioral Health, with the beginning of the process for nurses. Next is background check clearance. That is variable. For some people it can take several months. For others it can happen relatively quickly. People with common names had been often will often take longer. You are saying the third floor is filled based upon your staffing right now and that the additional beds could not really be used until about two months from now when you have done all of the clearances . Yes, hopefully sooner than that. The Behavioral Health clinicians were made offers awhile ago. We hope background clearance comes soon. Sticking with the merf it sounds like the problem is staffing. Did we not at general improve the hiring process to move it along faster. Does that not apply for this . Is this a different process going on . We followed the process hr has for us. Nurses is one of the challenging positions to fillanticly psychiatric nurses. For the Behavioral Health we went through the process quick quickly. Getting to your question, the Human Resource department at San Francisco general also does the hiring for the Behavioral Health center. It is the same staff and tame lines applied to any position at San Francisco general. We are talking about looking at vacancies and beds in different areas right now, including the arf. This is all kinds of related to all of the capacity that we have and the problem of getting into the mrf. Is there not away that if we felt it important to staff up the beds to take patients waiting to get into the her of that we found a way into the merf. I want to make sure we are talking about the mrf on the third floor . The capacity. I am trying to understand the vacancies, what they are relating to. If we are freezing our configuration. Part of the point on the whole issue raised about the capacities within our Mental Healthsehealth system is how wee trying to be able to handle this. It is similar to trying to if one of the problems is filling the slots and we have problems filling the slots and part of the problem is bureaucracy, several years ago we went through that with general and improved the system. If we went back you would say six to nine months. It sounded like it would take a year to get somebody hired. If, in fact, we are having this Mental Health crisis in terms of extra beds that i am wondering if there are other ways of trying if the problem was staffing the issue would be how to handle the staffing. I will leave it there and move to the next question about the capacity and the reason for the arf beds we have spoken about and the information you have provided for us and to the public has been all of the different citations. We can read them in different ways. They are public. They do relate to staff but also as we understand from our citations, some are important and some arent. Certainly citation as are. Part of that related to staff. Where are we talking about . I heard two or three different stories on. There that freeze us from having additional beds beyond what we currently have at 32. At the current moment we would have to hire additional staff. We are about nine staff short to come to full census. Is that full capacity. That is full 55. We have enough for how many right now . If we take what we use for other parts of the building floats, we could open to somewhere around 41 or so. 41 or 42 . Depends on it. I mean just okay. What is needed or what can we afford between the different parts of the city . If you had an overall plan what should be the size of the arf . If you dont want to answer now, you can answer in the third hearing we are having because there is a lot of discussion we shouldnt be closing the arf. What that says is that we have a need for this level of service in our system. What is that level of service we need . Are we able to get to that answer in our presentation . I can answer that question. We would want to staff to the full license capacity of 55. That is what you feel the city really needs is the 55 . Absolutely. So if we are presenting a plan in several meetings, then the plan should be able to then describe what division is, right . The supervisor described a vision what they think would work and what Mental HealthSan Francisco or Something Like that. It would sound like the department should be able to be somewhat more specific what we think should be a plan or what we believe could be a plan, which maybe elements of theirs and elements of the city looking at Mental Health. Your belief is that orf should be arf should be 55. We have 32. We are nine short to get to 55 . Yes, nine staff short. So if we go to 55, so the answer is we need nine staff. We also need to have certain corrections and i think perhaps you might want to explain later how that might be, but that is working with the state again. We have done that in various elements all the way from the courts and jails many years ago to many other instances of working. If we are looking at that and it seems to me that this meeting two sessions from now should help us describe what we believe should be sort of the integrated system and what sorts of types of services are needed, right . That would include hummingbird. Commissioner, with regard to mr. Pickens comment around 55, one of the things that i think is part of the reason we are having this discussion now and i think you are right on the point here. The 32 to 55, we always intended to go back to expand the arf as we were able to build capacity and staffing but correct underlying performance issues with regard to saytations. In citations. In the interim have hummingbird have capacity to take care of the people as we solve for the 55. That is where it is