The providers because they were not covered in their networks. And with that, im going to turn it over to shenay who will talk to you about the feedback we received on the models. Good afternoon. As part of the engagement process, we presented five models of potential or possible Health Care Model options are or options that are hypothetical options that members were could potentially look for in the future. The first model during this presentation, members were able to share questions ask and share questions about the models, look at the models in detail to figure out what things were appealing and then also talk amongst themselves. Really to determine what models were appealing, what questions they had and what were priorities as they select future Health Care Benefits. The proposed models, there were five selected. The first one was the current plan offering. I wont go into too much detail about that. The second model that was presented was the plan offering third party navigation and advocacy support. For this model, support is considered to be any Third Party Service provider that is not at h. S. F. That is not the members employer and not the Health Care Provider or insurer that advocates for the members and supports them throughout navigation process of health care. The third proposed plan was a consolidated plan that included kaiser as well as one other Insurance Company. And that one Insurance Company provided will provide both an hmo and ppo. The fourth model that was offered was a system competition model. That model offered kaiser as well as three other fully integrated Health Care Providers and another ppo. The fifth model was the private Exchange Model and this was described to members as the cover california model. So you have a variety of insurance providers that offer multiple and various insurance plans at different price points and Different Services. That is created to offer a little bit of flexibility and choice around offerings, as well as price point for members. One thing that i should note, kaiser was available in each of those proposed models. Ill give you a little bit of feedback from each the models, the model one was the current offerings, i so wont go into detail. Model 2 is the current plan offerings with Third Party Support. When we think about or analyze the data, one of the Key Takeaways we got from the model, was there was mixed feedback around what Third Party Support services were. When they asked question, it was really around trust. Can you trust the Third Party Support provider . What is their level of expertise in the Health Care Profession and medical needs . Are they going to this Third Party Provider held accountable to the same hipaa standards and laws in the medical field. This was about trust and wondering the fidelity of the provider. One of the key questions that came from that was how Third Party Support impact complicate the overall experience of care. So while members were fairly interested in this, they had a lot of questions about trust fidelity and the bureaucracy that might come, or the complication that might come with the Third Party Support providers. Model 3 was the consolidated plans. That provides two options. The Key Takeaways around that was how does having three options for Health Care Benefits impact choice . Is it going to minimize the way that im able to select a provider . Is it going to minimize my selection for doctors . Will i lose different options around that . And similar with coverage. If we only have three health care options, how does that impact the way that i receive coverage . And the last one was around cost. Some people thought that having only three Insurance Options would either drive up costs, because with only three, that limits the competition. And others thought because more people might be under each plan, that could drive down costs. That was a big question around costs and there were varying sides of that. The fourth model is a system competition model. This included kaiser as well as three other fully integrated Health Care Insurance providers as well as another ppo. For those of you who arent clear about what an integrated Health Care System is, it is all of the care provided under unumbrella. Theyre provider, Insurance Company, et cetera. One of the questions was how will integrated systems impact ability to receive coverage outside of network . So by integrated systems having housing all of their services inhouse, how would that impact members in seeing specialists or getting second opinions. That was a big concern. And finally, the private Exchange Model, t this model rad a number of concerns. Some of the biggest questions were around how might the plan options and choices affect equity, quality and accessibility in relation to care. A lot of the insurance providers will provide Different Services at different price points and a lot of members wondered if i select a lower price point for my Health Insurance plan will that mean that im selecting a lower quality of care. So there were a lot of questions around there. There were things that came up around all of them. Third Party Support services were offered in three of the five models. And they wondered if Third Party Support, could that be offered in all of models . And another thing that came up again as i mentioned was the level of quality and accountability that the Third Party Provider would have. As we explore different, or as members explore the different options, everyone is worried about coverage, or a lot of people questioned how their coverage is impacted once they retire as they travel or for members independence who live out of the country and out of the bay area. Im going to talk about the major themes of the asks that members had. We asked them if there were any other services they were looking for when they think of what hss provides to members. And some of these are going to be overlapping with what shenay said about the models. A key theme we heard was around Service Standards and accountability. What can hss do to extend more support for members to make sure that standards are met and make sure that patients are being served particularly around can we make sure that there are Mental Health providers available to us. Can we make sure that if the benefits say they cover alternative medicine, that the providers are there within network . And could we think about the Third Party Support . Because having support in the navigation and advocacy were something members were interested in if they believed it was going to be a high quality benefit they could trust. Members also, a lot of issues around communication. Again, support around the advocacy and problem solving, communicating in general about benefits. I know that hss does a lot of communicating, but there was still a lot of things we heard about from people, where members just werent aware that the service was available to them. So there was they were looking for better communication. And another area where they were looking for communication was around the transition to retirement. Would say in every single focus group we held, this question came up, either from people who are approaching retirement, people who recently retired, questions around what is this going to do to my benefits . How can i plan for this . What are the implications for me and my family . There were many, many questions that people had about that transition. Then the last theme that arose was meeting populationbased needs. I know that abbie mentioned we had some focus groups specific to particular populations we know have specific needs. Some of those are First Responders. Some are lgbtq members or members who live outside of the bay area. And there is work to be done to engage those subgroups and really make sure that were meeting the needs of those people. I want to note that there are some things that hss is already doing around those areas. That these acs are actions are under way. One is around the Service Standards and accountability. As h. S. S. Enters the renewal period, this is an opportunity to deepen the conversations. Abbie mentioned they were having conversations about access to providers, particularly Mental Health providers. As far as enhanced communication, there is an open position for a communications director. There is a search going on and when that person is brought on board, it is hoped they can promote hss Advocacy Services that do exist and make sure members are aware of when its appropriate to call hss. We heard mitchell talking about people calling during open enrollment, but one of the things we heard in the focus group, members didnt actually think to call the Health Service system when they had issues that arose. We might hear about challenges in finding providers, but very few of them called hss for the support that could have been provided. And lastly, around meeting populationbased needs, hss is working to develop strategies to monitor and enhance services to meet the needs of these groups and that is actually something that is part of the strategic plan. I want to talk a minute about just how the things we heard and the things that hss have opportunities to take action align with the strategic goals that have been outlined in the strategic plan. One of the things that members asked for was that hss continue to negotiate really hard for affordable comprehensive and high quality care. We heard a lot of appreciation that hss was doing that work and they want to see it continue. Another of your goals is reducing complexity and fragmentation. And one way in which hss can do that is supporting that transition to retirement. And also encouraging improved communication among providers. We heard from some members who felt like there was just a breakdown in the mune indication of their communication of their network and perhaps hss could advocate for better support around that. Engage and support. We heard from members who wanted more variety and more frequent communication around the plan materials. People access different access their information in a lot of different ways, so making sure its available to them early and in a variety of formats was asked for. We heard from a number of members who asked for greater Translation Services and support. For both support for open enrollment, but in other areas as well. There are lots of languages spoken by hss members. And, again, just increasing the awareness of the services that are offered by hss would be beneficial to members. Choice in flexibility. Advocating for improved and expanded access to providers, particularly those Mental Health providers, alternative medicine and the primary care. And as far as whole Person Health and wellbeing, ensuring the Wellness Programs are accessible to all, including shift workers. We also heard a request that maybe hss had a role to play in providing members with checklist of questions they could ask of their providers, or insurers to help them be better prepared for their own advocating. And we heard a lot of positive things about eap services and members were looking to have those continued and expanded. So i just want to go over big picture summary of what we heard, our Key Takeaways. Number one, the work we did, when we do this kind of conversation with community members, sometimes you hear big surprises. That wasnt the case. What we heard really affirmed a lot of things that staff is already aware of, both the positive and the negative, which is really valuable information to have. It raises some really important questions for hss around what are the barriers to prevent members from calling hss when they could . And how can this organization strengthen communications with members about plans and benefits . How can we better support members through the transition to retirement . What are additional ways hss can hold providers and insurers accountable for excellent care . And are there targeted approaches to improving outcomes for populations with specific needs. As i mentioned in many of these challenges are already being addressed in actions taken by the organization right now. With that, were happy to take questions. President breslin any questions . Commissioner follansbee i have a couple of questions. One, its impressive and i like the summary about this enhances a lot of the themes that weve already been discussing and helps us feel tuned into what the members are. Are you happy with the sample size . Was that what was your target . And number two, i was kind of curious about the response to the urgent care issue. Because urgent care has a broad weve been dealing with this to some extent over other issues. They have a broad it has to do with availability, location, shift workers, all sorts of things. And also without integrated care model, which we support some nonintegrated, urgent care has the specter of actually not bringing communication. So im just curious to know if you have enhanced first the question about the numbers and then about the urgent care issues and if you have a sense of what members thought that meant and what they wanted. So the first question, i think we were aiming for more. And i will also say we were happy with the turnout we got. Primarily because the representation was so diverse. We looked at so many different measures for where people worked, where they lived, what their educational background, languages, race, ethnicity, all these factors and plans. And we felt like we were hearing from the spectrum of members. I think we were aiming for more like 200 and in the end we got 117 focus group participants. And then additional close to 50 who provided surveys. So we got close to our number. And as i said, i felt like the representation was good. I also felt that there was a lot of consistency in what we heard which is useful to hear. You know, the things that people were happy with, the things that people were frustrated with, and the questions they had around the models. When you start hearing repeats of the themes again and again, then you know youre hitting a lot of what you want to hit. The question around urgent care. I should mention that there is a report that were finishing that has a lot more detail on all of these aspects, so youll be able to look at that when thats complete. But i would say its interesting that you bring up that point of the connection and coordination between urgent care and other care. Because one thing that people did say was that they liked urgent care particularly when it was available in association with the hospital, so not Free Standing urgent care clinic, but the urgent care aspect of their own network, because then they knew that the information would be communicated and if there was a problem that urgent care couldnt take care of, it could be escalated to an emergency room in their network. That said, there was a lot of appreciation for the Free Standing urgent care clinics. Especially those who cant make it to a doctor during the regular office hours. I would be interested, now that weve had this foray in terms of getting feedback from the director. And weve made a larger decision to defer, going out to the market, how were going to sort of keep this fresh to align with that action. Nice queue up for my Closing Remarks on this. Thank you very much. I didnt even pay him to do it [laughter]. I want to say that the recommendations concludes our findings are in alignment with goals. While there are areas identified as opportunities for improvements, the findings reflect a positive experience interacting with Health Care Providers. These findings are really qualitative in nature and confirm that the benefit design serves members through quality, sustainability and wellbeing, core facets of the mission of hss. And we are staying abreast of the Health Care Market place in an ongoing way. As we begin this renewal process for plan year 2021, we will in parallel continue the ongoing Market Assessment to determine what the right time to advance one of the new models for the health plans and restart the procurement process. So this is kind of a moving train which we, i think, have on reflection have really its been of great value thinking deeply about what it is were trying to accomplish and getting this input from experts and members that is complimentary. So i think that will all inform us. Ive asked my team to help put together what that parallel process would look like to sort of doubleteam an annual renewal process, while we fully prepare for a new procurement process. Just because of the length of time that it will take to do the full procurement process, we will have to do it in parallel. And i believe well be able to do that this year. The market is the market. The sutter decision i think will be very informative. The rollout of the canopy product that you see is going full force. So there are some major shifts occurring in the market. Anthem is making a play in town. So there is quite a bit happening that were tuning into and paying attention that that is the rationale behind why we delayed in this last year. So it seems as though it were the right decision looking back on it. But it is something we have to look at in parallel with our responsibilities to have a solid renewal for the 21 year. I just want to thank the consultants because i think that the report shows number one, understanding of the issues that we are concerned about, and also from the responses that i heard, that the respondents who participated also were willing to respond in depth. And did not respond in a superficial or casual way. Thats something we should thank you and all the respondents who did participate by questionnaire or in person. I want to thank everyone. President breslin any Public Comment on this item . Seeing none. Item number 12. If i may, i would just like to add one thank you to natalie and letisha on the team that led the effort to engage our members. And it is a herculean effort. Its an area of growth that we have and the reason were bringing in a communications director, because we dont have the best way, clearly, yet, to communicate around these types of issues. The open enrollment messages are get through well, but we perhaps can learn from that and continue down that path to more readily engage members on asneeded basis. Item 12. Reports and updates from contracted health plan representatives. Good afternoon, Denise Rodriguez with Kaiser Permanente. Last time, i stood before you and you had many questions about the transportation benefit were adding january 1. I wanted to come back with more information. We were remiss in not providing an upsooner. So a update sooner than now. So my apologies. What i would do is start with defining the benefit. Commissioner scott asked what are we paying for. I want to explain the exclusions and what caused the exclusion of a particular benefit and what our plan is moving forward. The benefit and i also want to emphasize that the rates that youre charged for the benefit does not include the excluded benefit. Ill walk through that. So the benefit, if we cover up to 24 oneway trips i just woke up with a scratchy throat, so im sorry if im not clear. We cover up to 24 oneway trips, 50 miles per trip per calendar year. Its for nonmedical transportation. There is a few conditions that need to be met. Need to be going to a appointment for a covered benefit in the evidence of coverage of course. They have to use the vendor that we contract with. So pretty basic stuff in terms of that. This cost that a member would pay for the transportation is zero copay. So thats covered at 100 . There are nonmedical transportation exclusions. I think the one that was particularly of interest last time is transportation for members who require a gurney wheelchair van. That is excluded and i want to explain why. Let me emphasize though, if somebody is in the wheelchair and can make it to the curb, then the driver will assist them getting into the vehicle, store the wheelchair and get them out. And getting them in the wheelchair again on the way to the appointment. So when we rolled out and offered the benefit, it was with the idea it wasnt going to be fully implemented, that we were going to roll it out with what we could provide in a short time frame we had. We started discussing the benefit in may and june. Many of you commented, and from i think the audience as well, last time, there are many vendors that pride that service. That provide that service. That is correct. The challenge is we have to go through a regulatory process to contract with them and cms has requirements that we have to meet. And we have to get system changes done to track it internally. And that takes about a year. And so what we try to do to get this to go to market for january, was to look at what is a vendor that were already approved to use. And thats the vendor we use for the medical population. They dont have the same requirements for the gurney, were able to access other services to provide that benefit to the medical population, but because of cms requirements, were not able to that now until we contract with the new vendor. So thats the challenge that were faced with right now. I also want to emphasize that in no way are we trying to exclude anybody. That is certainly not our intention. Our intention was to try to meet the needs of what we heard from the medicare population with San FranciscoHealth Services system to provide a benefit that would benefit the majority of the population initially. I do also want to say this is the benefit that were only offering to San Francisco effective january 1. So its kind of special in that way were the only one were doing this with because you had so much passion around this. As we continue to fully implement the benefit, we expect to add the benefit going forward. I cant give you a time frame. If its going to happen 2021. But what i am committed to doing is having more check ins with you all. You can decide how frequent that can happen. I need to stay close to mitchell and abbie executive director yant, around how the implementation is going because this is a new benefit. And we want to make sure that any bumps in the road get addressed quickly and effectively and efficiently. So i will stop there and see if you have any questions or comments. Well, thank you for answering my preliminary questions. And from what you said, where you are at the beginning of january will not necessarily be where you are maybe mid year in terms of trying to contract with Wheelchair Services or get the appropriate clearances . And i think i heard you say youre trying to work that through to do that. So were starting that process. It takes about a year. Weve been focused on trying to get this up and running since january 1. Now that were there, theyre starting the process to add the benefit. Theyre working with the current vendor to see if they could add it. That would be an easy fix, but we also have to get the systems up to speed to meet the requirements of cms. So to answer your question, i dont know. Were working on it. I will answer to say were committed and working on it. I cant give you a time frame. But i will know more as the year goes on and will be happy to provide an update. I would be interested in at least a quarterly update in the area to track your progress. I recognize that licensing and vendor contracting in your organization, like in most large organizations, takes a bit of time. So, some kind of status would be helpful. Okay, then i plan to come back again in march, unless sooner. I appreciate the update. I think its quite i understand what the issues are and the hurdles that have to be met. Listen, in my own mind, i was distinguishing wheelchair to gurneys. Gurneys are a much bigger deal. I was not focused on people who need to be in a gurney. That is a bigger hurdle. I guess the question i do have, though, one question, one point, does the say someone is in a wheelchair and needs an attendant to help them get to the appointment, you know, a spouse, partner, whatever. Are those people transported as well, or do they need to then help their dependent into the van and then leave and come by a separate route . Because that would make a difference to me about the comfort level, about access. Okay. Im going to pause and ask one of my colleagues if they know that. If not, well have to come back. My gut tells me theyre included. So, yes, they can ride in the car with them. Commissioner follansbee good, because im much more comfortable with that. When we do revisit this, if he could have a sense of how many didnt qualify. So we have a sense of the volume. Because none of us want to make a big deal over an issue that really is, you know, can be handled another way. If we had some data on your access. And i think thats why the quarterly check kinz will be good. We have communication plan were working with abbie on right now to roll it out. The first month is going to be slow. The second month it will build. And the third month well see more. So well keep you apprised of what is going on through regular check ins. Commissioner follansbee one more question. So it covers the San Francisco facilities, mission bay and then the geary and french campuses, but doesnt cover south San Francisco or oakland or im a little confuse about the limitation . Its a benefit for your entire population, so depending on where they live, it would cover them up to 50 miles per trip. Commissioner follansbee thank you. That claver clarifies it. Thank you. Im going to give denises voice break and make our second couple of announcements here. So we do have a strike notice from nuhw, the National Union of Health Care Workers is that will begin the 16th of december and will last through the 21st of december. These are nonphysician Behavioral Health professionals. And so they will be going on strike. We do we are prepared for this. All facilities will remain open. Routine appointments may be rescheduled, but anyone who needs care will get care and were prepared for that. We also have received notice of a sympathy strike through the operating engineers local 39. And those are engineers for the facilities in northern california. So i wanted to make sure is that you were aware of that strike notice. The second announcement that i have is that we have chosen a new c. E. O. And this was many people have commented this was very quick. I think this speaks to the fact that weve done a lot of succession planning and Gregory Adams has been named the c. E. O. Of Kaiser Permanente. More than 30 years of appearance in the health care industry. A longtime Kaiser Permanente employee and really has worked closely with bernard overtime, so were exciteed as an organization to have a new c. E. O. And i wanted to share that with you. President breslin any Public Comment . Actually, not a Public Comment on that. Another vendor update. Go ahead. Im with aon, im not a health plan, but i do have update at the request of executive director yants over the medical. I did reach out to them and had a conversation. I wanted to give you an update on what the conversation was. So i pulled off at the top, ive included the link that i looked at, which is the one medical website under faqs. So the link is there. Its in regard to the annual membership fee we heard some membership complaints around to access their provider. And what i highlighted at the bottom of the first page is that payment of that annual membership fee is not a prerequisite for receiving medical care in one medical office. President breslin what does that fee give you . The way one medical described it to me. They think about it in two pieces. They provide the care in the office and then they have technology. So their app, making appointments online, virtual visits, senior Electronic MedicalRecord Online through the app, kind of that concierge piece. If you wanted to see a provider, dr. Smith at one medical, you can pick up the phone. You can call. You can make an appointment. You can see the provider, have the appointment. It will go through your insurance. And thats the end of it. There is no problem with that. If you want these Additional Technology services, you would pay that fee. In addition, at the bottom of this, it says for more information click here. One medical does have Financial Assistance and so if members wanted to call in to see if they are eligible for Financial Assistance, they can do that as well for the annual membership fee. It does appear they would potentially help with some of their outofpocket costs, no copays, but the other outofpocket costs. If we want more information, we should invite one medical back to speak with you. Does that help . President breslin yes. Thats makes it more clear. First you say they cant charge a fee. And then you say they can charge a fee, but so thinks the reason they can this is the reason they can charge the fee for extra technology. That makes sense. Correct. Commissioner follansbee im not sure i need to hear more from one medical. I do think that it does raise again the issue of the question i asked of our Outreach Survey about urgent care and all that, because obviously you know, to buy membership in one medical would be think being getting ongoing care. I mean, like, urgent care. In their own sense. And i dont think that our own networks, through any of our providers, actually, they belong to any of those networks. I think that would be something one medical . One medical. They do. Commissioner follansbee they do . They are . Yeah, they kind of i dont know for certain who all theyre connected with but i think its pretty much everybody. Commissioner follansbee maybe we do have them back, because the member who is a hill physician patient is seen there, is the lab and the encounter automatically transferred to some medical record . So there is continuity of care that we heard the members want . There are pieces about all of this that i still am a little bit confused. I can understand the ease of making an appointment online if youre getting your physician care at one medical, because theyre all over the city and i assume outside the city limits, but i dont know. Again, these are issues that we would need would want to know in terms of how to direct members in terms of what members want and need. This is not really a substitute if it doesnt meet certain criteria. They came on the market 15 years ago . And theyve been around a while and they were cutting edge when they came on market with all the technology. And theyve stayed focused on primary care and they have expanded. Im not aware that they do urgent care. No, not in the office, but they would have virtual urgent care. Yeah, so during regular business hours, that type of things, but they dont run any of the urgent care clinics that im aware of. Commissioner follansbee the question is, can people walk in and get care . Yes. I know they dont have 247 coverage. I have former colleagues who joined one medical as physicians and so there is nothing in my mind about the quality of care they deliver or the technology or anything, thats not the issue. The issue is really this wholistic approach to the delivery of health care, which i think is something that we as a board, we as a Health Service system, are really interested in promoting. Maybe we should ask them to come. President breslin any Public Comment on the item . Thank you very much. No Public Comment. Moving on. Item 13. Item 13, opportunity for the public to comment on matters within the boards jurisdiction. President breslin Public Comment . Clare . Good afternoon, commissioners. Im representing Dennis Kruger and firefighters. Dennis couldnt find parking. Found the garage overfilled. And so he sent me a text. He was very frustrated and he left. So theyre following up. They want to wish everybody happy holidays. By the way, we loved abbies, director yants message, it was nice to see. And that was pointed out at our retiree meeting yesterday when we had the party. So we are here to wish everyone happy holidays and also sorry, always to thank the staff. We have the best staff in the world. Im sorry, i get broken up about it. Health services workers, our staff is the best in the city and ive worked in a lot of different departments. I wont tell you stories, okay . But we have the best. They work hard for us all year. Open enrollment is a killer. And they make it easy for all of us. And all the services that they provide, you just need to know that all the retirees are grateful. And all of the associations, whether its retired fire or vpoa, or retirees, all of us are extremely grateful. Happy holidays and happy new year and see you next year. President breslin any other Public Comment . Seeing none. Item number 14. Item 14, opportunity to place items within the boards jurisdiction on future agendas . President breslin i think we have our work cut out for us. Any Public Comment . Were going to closed session and have to be closing the doors. Item 15, vote whether to hold a closed session for the Public Employee evaluation for hss executive director. This is presented by president. I need a motion i move that we vote to hold a closed session for the Public Employee performance evaluation. Ill second it. President breslin Public Comment . All right. All those in favor . Okay. Unanimous. We will now be going into closed session. President breslin were back. Item 17. Item 17, possible report on closed session regarding the employee evaluation presented by president breslin. I move that we not report on the action taken in closed session regarding an employee evaluation. President breslin thats 18. But i dont know what this 17 is. 17 is the action. Reporting of the action. I move that we not report on the action taken in closed section regarding employee evaluation. Second. All right. All those in favor . Opposed . Its unanimous. Item number 18. Item 18, vote for elect whether to disclose any or all of the discussion held regarding the employee evaluation in closed session. I move that we not disclose any or all of our discussion held in closed session. I second. President breslin all those in favor . Any opposed . Its unanimous. All right. So this is item number 19. This meeting is adjourned. Happy holidays. Happy holidays. Hi, im corn field and welcome to doing building San Francisco, we are doing a special series, called stay safe, how you can stay in your home safely and comfortable, and we know that an earthquake is coming and there are things that you can do to reduce the effects of the earthquake on your home. Lets take a look at that. Here at the spur urban center on Mission Street in San Francisco talking about staying in your home after an earthquake. I have guests today, pat buscavich and his dog, harvey and david, and both Structural Engineers and we want to talk about things that you might do before an earthquake to your home to make it more likely that your home will be ha bitable after an earthquake, what should we do . Both structural and maybe even important nonstructural things. You hear about how to prepare an earthquake kit and brace your book shelves and water tank and that is important. What you have to be careful is make sure that you are not going the easy things to make yourself feel better. If you have a bad structure, a bad building, then you need to be looking at that and everything that you do to keep your collectables in place is small and compared. If you have taken care of your structure, then there is a lot of stuff that you can do in your house that is nonstructural and your chimney and water tank. Lets talk about what the structural things might be. And he is exactly right. You dont want to make the deck chairs safe on the titanic, it is going down, you are going down, you have to make sure that your house is safe. There are basic things that you need to do including bracing the water heater, not just because of fire hazard but because of the water source and the damage, but basic things are installing anchor bolts, and adding plywood and strapping your beams to column and posts to footings and foundations are really easy things to do and most contractors can do the Building Department is set up to approve this work, and these are things that every home owner should do, and it is a little harder because you have to get a Building Permit and hire a contractor. But you want to be able to after a big earthquake to climb in bed that night and pull the covers up and say i dont have to worry about going to a government shelter. That is the main focus that it is great to have an earthquake kit to be able to bug out for 72 hours. Here is a better idea, stay in your own home and in order to do that you have to be make sure that your structure is okay. If you have a house, the easy things to do with the wood construction is feasible. If you have a renter or you live in a concrete building, you need to talk to the building own , and make sure they have done their Due Diligence and find out what the deficiencies are. When i have looked at damaged buildings,vy seen that a little bit of investment in time and money and structural work provides great dividends. Especially if it is the wood frame, typical house that you can do the things that i was talking about, the anchor and the plywood in the first garage area, you know if you refinanced in the last three years, get some of that savings and it is a really good investment. And the other thing that i try to tell people, earthquake insurance is not the solution to the shelter in place, if there is a big earthquake and your building is damaged, you are not in your house, you may be somewhere else, if you work in the city, it is going to be really hard to commute from sonoma, you want to do what is necessary so that your house is retrofitted and a couple of years of earthquake premium could get you to a level that you could be in the house after a significant earthquake and it may have damage and there is still a shelter in place where you are at home and you are not worried for the government taking care of you and you are living in a place where you can go to work and you want to have your wood frame house is really easy to get to that level. On top of the wood frame house, i mean every wood frame house in the west half of the city have a water tank and the water tank fall over because they are gas fired and start fires. And that is something that you could do for yourself, and for your neighbors and for the whole city is make sure that your water tank is braced. If you look at the studies that are predicting on fires, we are going to have a lot of fires and for every water tank that is braced there is a potential of one less fire that the Fire Department is going to have to fight and we dont want to have any more fires than we need to. So bracing the water heater is the first thing that you want to do. And so easy, and you go online and you google, earthquake, water and heater and you google the sites where you can find the details and you can put them out there on the Hardware Store and you can hire a small contract tore do that for you. That is a couple of hundred bucks, the best investment. If you are in other types of building it is complicated. If you are in a highrise building you just cant anchor your building down because there are no anchor bolts, but at that point, the tenant should be asking questions of the owners and the managers about earthquake preparedness and dont take the easy answer, oh, our building is safe it was designed to code. That is not the right answer, ask the tough questions and see if you can get a report that has been given to you. What is the right question . Will i be able to stay in my home after the expected earthquake . Is that a good question to ask . Yeah, you may be more specific if you talk to the owner, if it is not a recent building, if it is ten or 20 years old see if they had an inspection done and there you will have a written before that will tell you all about the structure. Thanks, pat. Thanks, harvey. And thanks david for joining us and thank you for joining us on San Francisco, 911, whats the emergency . San francisco 911, police, fire and medical. The tenderloin. Suspect with a six inch knife. He was trying to get into his car and was hit by a car. San francisco 911 whats the exact location of your emergency . Welcome to the San Francisco department of emergency management. My name is shannon bond and im the lead instructor for our dispatch add academy. I want to tell you about what we do here. This is San Francisco 911. Do you need police, fire or medical . San francisco police, dispatcher 82, how can i help you . Youre helping people in their what may be their most vulnerable moment ever in life. So be able to provide them immediate help right then and there, its really rewarding. Our agency is a very combined agency. We answer emergency and nonemergency calls and we also do dispatching for fire, for medical and we also do dispatching for police. We staff multiple call taking positions. As well as positions for police and fire dispatch. We have a priority 221. I wanted to become a dispatcher so i could help people. I really like people. I enjoy talking to people. This is a way that i thought that i could be involved with people every day. As a 911 dispatcher i am the first first responder. Even though i never go on seen scene im the first one answering the phone call to calm the victim down and give them instruction. The information allows us to coordinate a response. Police officers, firefighters, ambulances or any other agency. It is a great feeling when everyone gets to go home safely at the end of the day knowing that youve also saved a citizens life. Our department operates 24 hours a day, 7 days a week, 365 days a year. This is shift work. That means we work nights, weekends and holidays and can involve over time and sometimes thats mandatory. This is a high stress career so its important to have a good balance between work and life. We have Resources Available like wellness and peer support groups. Our dispatchers of the month are recognized for their outstanding performance and unique and ever changing circumstances. I received an accommodation and then i received dispatcher of the month, which was really nice because i was just released from the phones. So for them to, you know, recognize me for that i appreciated it. I was surprised to even get it. At the end of the day i was just doing my job. A typical dispatch shift includes call taking and dispatching. It takes a large dedicated group of fifrst responders to make ths department run and in turn keep the city safe. When you work here you dont work alone, you work as part of a team. You may start off as initial phone call or contact but everyone around you participating in the whole process. I was born and raised in San Francisco so its really rewarding to me to be able to help the community and know that i have a part in you know, even if its behind the scenes kind of helping the city flow and helping people out that live here. The Training Program begins with our sevenweek academy followed by on the job training. This means youre actually taking calls or dispatching responders. You can walk in with a high school diploma, you dont need to have a college degree. We will train you and we will teach you how to do this job. We just need you to come with an open mind that we can train you and make you a good dispatcher. If its too dangerous to see and you think that you can get away and call us from somewhere safe. Good. Thats right. From the start of the academy to being released as a solo dispatcher can take nine months to a year. Training is a little over a year and may change in time. The training is intense. Very intense. Whats the number one thing that kills people in this country . So were going to assume that its a heart attack, right . Dont forget that. As a new hire we require you to be flexible. You will be required to work all shifts that include midnights, some call graveyard, days and swings. You have to be willing to work at different times, work during the holidays, you have to work during the weekends, midnight, 6 00 in the morning, 3 00 in the afternoon. Thats like the toughest part of this job. We need every person thats in here and when it comes down to it, we can come together and we make a really great team and do our best to keep the city flowing and safe. This is a big job and an honorable career. We appreciate your interest in joining our team. We hope you decide to join us here as the first First Responders to the city and county of San Francisco. For more information on the job and how to apply follow the links below. Please call roll call. [roll call] this is the recreation and Parks Commission meeting of december 19th, 2019. Welcome to everyone here today. Remind you to turn off Electronic Devices during the meeting and take any secondary conversations outside in order for the meeting to proceed as efficiently as possible. If you like to speak on any item , we request but do not require that you complete a blue card. Each person will have three minutes for Public Comment on each item. Please address your commentso