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 Health San 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 confusing to many because we do think the 55 is where we need to be with the arf. We already have challenges with regard to managing 32 as regard to the citations. This is not about any one person or a judgment, it is just the fact the state has given us a number of citations. The plan was rather than leaving the excess capacity we would turn that into hummingbird. I understand there is disagreement about that. That was the plan. We are holding the idea of hummingbirds and fix to go to 55 for the arf. Again, to be really clear from what was that, that is what we put on hold at this point. As we are able to work that out and where those other beds go, i think that your note to us was quite explicit, to the public that we received and i am hoping people would understand that the department is trying to come up with what should be the areas that we are able to have to serve the public that will meet nose needs. It sounds that the department is not saying we dont need an arf capacity. The question is how to get to that and that there is perhaps not that the current way of trying, i think as director colfax was saying to meet part of our need while trying to get to the 55 was running into problems not only communication but implementation. People are being moved out of areas and at the same time while it sounded like we are going to just stop, you know, that particular level of service at this smaller level while we are also, but i think you are right. Technically you said you were not taking away the 55. We only wanted to put them in to try to deal with the current idea of using empty beds you would then have in order to fulfill a need that hummingbird also has, but that currently we are all saying how to work a hummingbird solution and possibly be able, also, to maintain a different configuration for arf, is that right . Yes. And that work is ongoing at this time with the offices across the street there, both the city hall board and the mayor to try to find a way in which the public will be properly served and that all i am doing is paraphrasing what you are saying, if that is correct. I am sure city hall does, too, the supervisor and mayor do not want to short other needed beds, simply to have a bed count under hummingbird or navigation or anything that we would try to see if we can accommodate all of this. This is nice if you could actually start coming to that accommodation within the third meeting. We might be able to look at a solution. It would seem to me at least that it would be very appropriate that the commission hear an overall broad plan as to the types of services felt to be needed in the city and how we cant reach all of them. Clearly the original intent of the building has sort of been changed by urgent needs otherwise in which we were supposed to be bringing back those who were housed outside on a chronic basis to San Francisco. The needs of the city that has been expressed hearsay if those people at the moment are there still, wherever they are, we cant bring them back because we cant solve our more immediate problems right now. That is the reason for the changes, i believe, at the Behavioral Health center to try to meet the immediate contingencies not forgetting that we have people outside. I think as an overall comprehensive look at the whole situation, we might want to see what happened to those people, too, and if anything could also be done for them in the future, but right now i think we are concentrating on the most immediate neats of the city, which are the urgent needs of people in crisis. Thats correct. That is a pretty fair summary. Commissioner green. I want to echo that. I am impressed by your honesty. He appreciate you educated us and your passion means a great deal and your wisdom means more. I guess the question is a request that i might have. I am confused how if we are embarking on this truly aspirational effort to identify the 4,000 homeless in San Francisco and concentration of 250 how when we find and identify them we can give them the best conveyor car best ce and service. We need to place them where they need to be placed. It seems that will not be successful that we havent analyzed the need. [please stand by] the first thing that i would say is that ive been mightily impressed how this department operates in crisis. I think that its been mentioned before how so many leading accomplishments across this country has been done by this department. And i witnessed how incredible this system has turned on a dime to respond to what is going on at the hospital. Every official has been there, and theyve been committed and thoughtful and proactive. And so given this leadership question that we have within this particular unit, im wondering who we can bring to the table, how we can marshall this skillset that is here within this department to try to act quickly, because i have seen leadership in action in this department and there is no better place to find it. But i want to understand what were going to do on that level to act quickly to give everyone, including the patients and the citizens, and the taxpayers, everyone has spoken here, a kind of reassurance and comfort that that we have the ability to move quickly on your concerns. So thank you for your questions, commissioner green. With the first one, have we analyzed what the needs are . So as you pointed out, the focus on the 237 and the 4,00,000, thy have done a lot of work to hone that population as the one to which we should focus. And as you can imagine the needs of that population will be varied depending where they are in their phase of illness or recovery and that goes the continuum from acute inpatient Psychiatric Care to p. E. S. To board and peers. So to on that end, we actually you remember a few weeks ago that the mayor announced the partnership with usff and tipping point. Part of that partnership is looking at the issue of care homes. Is there a way to begin to salvage those, particularly the ones that announced their closure . So thats one of the things pursued right now. Are there some of these facilities that we can approach them before they sell to developers to see if theyre willing to sell to the City Partners to maintain those beds. So all of those activities are going on right now. And we will put together a Performance Improvement plan, for the Behavioral Health and rest assured that the management and the operation of that Behavioral Health center will be a significant component of that plan. I want to acknowledge and thank all who came to speak to us today and directed your comments about what is important for the population and the residents at San Francisco general hospital. And at the merf. And i want to acknowledge that the nurses from the Emergency Department were here today and we talk about the struggles they have in dealing with the issues of folk coming in on an emergency basis and being stuck there and theyre understaffed and their view of being understaffed. I think that its important to recognize that these divisions are interconnected and something happens at the emergency room or at the merv and inpatient, all is connected to these programs and that one of the things that well talk about here is whole person care. Thats what we need to be talking about. Thats what we need to address is whole person. Because the e. D. , the Behavioral Health, all of those units are connected and its important that we recognize that it is a department of Public Health and the public is out there. And the public demands a request of us and i want to assure you that this is not the end of the discussion and when we have the third reading in november, its not the end of the discussion. This is the departure point. We will work exclusively with the department and we will hear from and work with you as a community because if we dont do this together for solving problems and fin finding where e failures are, well have this discussion next were. We tede to ge need to get whereo be. So with that im ready to move to the next item. Mr. Chair yes, i think that after listening to commissioner green and im reminded that understanding the Component Parts and, yes, you know, people cant move through the system and our transitions process that this needs to be reviewed because some of it seems to be failures in the way that were hearing and if the thought here whether using the 4,000 as an example from the Mayors Office or otherwise is to say that were having a transparency with the number of beds available. Im not sure how well that by itself works because theres all kinds of things also kind of left out of this database. But on the other hand it would be fortunate understand how that program is going to be looking with what we are envisioning for our service programs. And a good part of our psychiatric floor is with nonacute patients who do need care. And theres another group of people who should be in a more proper place with a more an appropriate type of level of service. So im looking for a comprehensive review and i would suggest a transition to at least focus on the Mental Health part of the equation here. We now have transitioned all the way across for even our elderly and others who are chronically ill. But i specifically am talking about transitions in regards to this and the Mental Health program is a continuum of care. Absolutely. That will be part of you referenced the bed tracking system for residential Mental Health and substance use. So that is in phase one. And the plan is to roll out that bed inventory website to all of our levels of care in terms of i. T. And programming and the fact that we have data coming from multiple sources. But that is the goal is to have all of our level of care in a bed inventory that is transparent and can be seen. Two more quick comments. One has to do with the emergency room and the nurses were speaking and they were speaking about losing significant staff and managers and longterm employees. And theyre also talking about the trauma they experienced as nurses staff. So i hope that one of the things that were often seeing is that the nursing staff has the ability to access care for them as individuals and as a group. Because i think that is critical. And i think that its also true for the Behavioral Health part of our system. Theres trauma there, not only for the patients who come in, but theres no way that theres not some transference between the patients and the staff that work there is. So i want to make sure when were taking care of our patients we take care of the staff too who take care of the patients. Thank you, commissioner. Obviously, those of us who work in health care are particularly in the Public Sector are concerned with the effects of vicarious trauma. So i will make sure that i followup with all of thigh my t reports and leaders to make sure theyre making the reports available to staff. Thank you. Next item. So, commissioner, i have been asked you have been several items on the agenda and im asked by the president to mirror back to you to postpone those and the meeting but its up to you to do that. I cant make that decision for you. These items will be postponed to the next meeting or a future meeting. Are they here . The staff for items 8 and 9 are here. We should probably go ahead and do it because they sat here all of this time. Im sorry. 8 and 9 are here . Yes . All right, so, sorry, everyone. Item 8 is the 2016 Public Health and safety bond update. Thank you all who came for item 7 and well move to the next item. The bond and item not marked mark primo is not here tonight. He offers apologies, hes suffering adverse reaction to a flu shot that he had yesterday. So he begged off. And so im going to try to do justice on his slides. Weve moved right into it and youre familiar with this slide, this is the scope and the budget of the d. P. H. Portion of the Public Health and safety bond. This one is the first bond sale of the 149 million and were working all the way through. As you can tell im moving at a quick pace through this presentation. And by the way, back to introductions and i skipped over that, im from zuckerberg capital programs and im joined with joe chin from the department of public works. Our city project manager on the bond program. And michael bidai the associate chancellor capital program. And so this is the previous bond breakout was on the first bond sale. We were planning we are planning on a second bond sale. We were shooting for early 2020, but right now because of the current burn rate we may push that out into the late second quarter. This is a breakout for zuckerberg, the spend. We are about 23 through the original first bond sale. A lot of our projects have not hit the construction mark yet. Once we do we expect to have that spending to increase. This is the community Health Center bond, theyre a little bit ahead of us on the spend, theyre at 42 . And, again, as they progress in the southeast they will get a new contractor on board theyll be proceeding and the next one we presented at last presentation and this is the breakout of each individual project and grouping them together in how were working with the budget. Right now we are overall in the black. And even though the political improvements are showing in the red. Overall were juggling the dollars around to make sure that all aspects of funded. And we have some savings in the lower end that are helping with the overages in the top end. And with the community Health Centers, again, theres some projects. This one has the benefit of funding from different sources other than the bond and theyre identified in the legend at the bottom. You can see how theyre applied by fund type in the chart above. So, again, this one is also in the black. Since we last met a lot of work has been done and ones that ill point out to you quickly for the billion five on zuckerberg, we moved with the i. T. Design, and with that, we have a study for 8090 and one that im excited about is the psych emergency study for the new location for psych emergency. As far as seismic, we have moved through phase one, were into the second half were finishing up the first half of phase bo one which is the removl of the sunshade horizontal elements and then the fiber wrapping. And below you can see the bottom you can see the phases of a fiber wrap. So on section one is the column and you go to number five and thats actually number four is the complete column that is fiber wrapped and strengthened. And number five is what it looks like from the outside. And the majority of care accomplishments, so we have them being seen over at the old urgent care since we vacated urgent care. And we have submitted 95 design drawings in august. And working to create a temp location. With that well pass the baton to joe chin to talk about the upcoming milestones. Thank you. Good evening, commissioners, joe chin, Program Manager for the Public Health and safety bond program. So moving to the first line, well focus this evening on the upcoming milestones and accomplishments for three components under the health and safety. Its a southeast Health Center component and on building five for the team advancing 15 of our core projects under this component. Not much has changed and we still have four projects in construction. One project is completed. And the remainder are in different phases of the planning, design, or plan review project life cycle. And so here on this slide 12, these are the two projects that are in construction, and we have the locations, and the rehab, and were anticipating finishing by the end of the year and then rehab were currently at 45 complete. And then looking at completion early part of 2020. And then just quickly on another project construction site sorry. On seismic retrofit, as terry mentioned were wrapping up the first part of phase one and moving to kind of the interior column strengthening scope and thats the new work that were doing and learning the process and how to best do the work with the occupy facility. And we have a project from planning to design and its the specialty services. So weve moved from plan to design right now and thats a new project that were tracking. And then on southeast Health Center, really theres two key areas that we focus on. We have completed design. We have the drawings submitted to d. P. I. For plan review for permitting. And the next milestone is to get this to bid document and get it bid and construction early part of 2020. Were looking to start bidding probably this month as our target to get this out on the street and start soliciting contractors. And then on community Health Centers, this is its a comprehensive scope and were doing work at two Health Centers, the maxine hall Health Center and maxine hall, i think that we talked about this earlier. And were having our groundbreaking ceremony tomorrow. Happy to report that this is the project where were able to kind of show that weve awarded a contract to a contractor and theres also photos on the slide that show the prefabricated trailers that are now have been assembled. Theyre being worked on in preparation for the staff to move from Maxine Mau Hall into e temporary clinics during the entire construction duration. So a lot of things are happening at maxine and its good to see this project moving. And the Health Center, weve received additional funding for this project from the Mayors Office and kind of focused on the City Initiative on global warming, climate change, and so the additional funding was to add air conditioning to this project. So because of that added scope we now had to push out the design and construction but its this is the best time to do it. The building is already vacated and its a good time to do a comprehensive improvement to the building. And then the last three slides is our typical i think that you have seen this before our high level schedule update on active projects that doesnt include all 19 projects but shows the more active projects. So i wont go through it, and i think that its pretty selfexplanatory. One thing that i do want to mention is on the schedule update for the Health Centers and based on what i mentioned earlier, maxine hall have been the updated schedule duration that shows it being issued for maxine and kind of the construction duration for that project as well as castro missions design and construction schedule being pushed out because of the added scope. So at this point im going to turn back to terry, and well talk about the research project. Just real quickly, this slide is a list of what has been going on to get to the points where were completing the documents to and targeting to have that closed and it will allow them to move forward with their plans. With that and were also working diligently with other city agencies to help the process along with approvals for drawings and as well as providing all of the documentation with the bureau of real estate. And an inventory of all of the space is one of the items that is on our part. And we will move on im moving on to item 9 which is the presentation. As of practice at the Health Commission these items are presented together and then you all ask questions and the public can make Public Comment during either of those at the end of the presentation. So were moving to item 9 which is the Academic Building update. Thank you, good evening, commissioners. My name is michael bidet, at uscf. We are nearing the end of the design phase for the Research Building and i will show you where the design is at later in the presentation to remind you of where it is on the b. C. Lot. We are, as i said, towards the end of design and we anticipate construction to start in early 2020, once the final approvals are completed. And we are here at the Health Commission today and then in november on the 13th and we will go to the board of regents for the design and final budget approval. Which constitutes the approvals needed to build. And and were on schedule. This is a section through the building. Showing the way that the Program Components are distributed on the dry research floor, so that would be four or five. And this is the design that has been by the Arts Commission and this is what we are presenting to the board of regents. This is a view from the 23rd street entrance, looking up from the west to the east. And the glass corner is the sort of internal kitchen and the breakroom and conference area. With vertical transportation, and the glass lobby at the ground floor is the main entrance to the building. And you can see building five behind it. And the building is clad in terra cotta which is very much like brick in its texture and color. And this is a view of the looking due east, showing the main entrance and one of the connecting stairs going up. And the relationship to building five. I think that is the last picture in the presentation. Can i answer any questions . Clerk i have not received any Public Comment or requests for this item. Commissioner . I have a fairly naive question. So it looks like theres more green lines ahead of red and a few times ago when you presented it seems that youre doing well with keeping to time lines and what im confused about is how do you link, you know, kind of your expected expenditures to timelines . Like if youre ahead or behind, how do you analyze the expenditures compared to where you are and how often do you do it . And how important is it to look at when youre going through the bonding and how you make those decisions. And then my second question is there room for us in this building . Just a Little Office . Just a little one . Please . As far as the budget analysis, we are constantly, joe, myself and mark constantly greg were constantly going over the budget on this. The key milestones that are keying us to where were at are estimates. So we do estimates at the design completion and the project 50 design and 100 design and we estimate on the executive management team. And so we will constantly estimate the jobs. But it didnt get real until we have a contract and we have a bidder and a signed contract. And thats where we get to true up the budget and true up the timeline and match it to our projections. Thats really where it happens. And once were in construction phase it becomes just a regular part of the construction process and tracking the budget and the spend and making sure that we dont have cost overruns. Anyone else . Any other questions, commissioners . So it looks like were kind of slipping in time on the p. E. S. And all. Is that is that, you know, good . Its not good but to be expected. So if you recall the p. S. Program has changed and before we were going to try to do a 10phase project in the same location that was going to be it turned out to be a budget buster and we couldnt do it. So we identified a place adjacent to that that was vacant and we took it over. And so we started the clock on that but were still keeping the same baseline. So once we get to that process where we go through the design process and then we try to get a contract, then well reset all of those milestones. Okay. So youre rethinking the original . Yeah, and its a good move. All right. Absolutely. Thats the only question. Other questions, commissioners . Hearing none. Thank you. Thank you for staying and we appreciate it. I know that its late. So commissioners, item 10 is the person is no longer here, item 11 is other business and i will note that some of you are going to be at the joint hearing with the Planning Commission on the cpm agreement on thursday at 10 00 a. M. And then shall we do the item 12 . The update itheres people here. The report back from the september 24, 2019, zsfg jcc meeting. They discussed reports, including the regulatory fares and the c. E. O. Report and Human Resources report. And also discussed the epic related salary variance issues. And it will be continuing to track the epic program as it moves into its new phases. And at the medical staff report we reviewed the process for the affiliated staff form and approved that. And the registered nurse standard
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