Transcripts For SFGTV Board Of Education 101315 20151022

Commissioner johns. Yes. Commissioner matsuda. Yes. Commissioner pearlman. Yes. Commissioner hyland. Yes. And commissioner president wolfram. Yes. So moved. That passes unanimously 60. That places you on case ten for 2015011315fed at 800 Chestnut Street San Francisco Art Institute. This is for your review and comment. Good afternoon commissioners. Shannon Ferguson Department staff. The item before you is a National Register for the San Francisco Art Institute and its capacity as a certified local government of the city is given the opportunity to comment to the nominations to the register. The San Francisco Art Institute is located on Chestnut Street and jones street and two buildings and the original was in the spanish colleenial style in 1926 and paused valid architectures styles and playful human and proportion. According to the summary the San Francisco Art Institute is nationally significant under criterion a events for the roll in development of american art and for contributions to Art Education in the United States. The identified period of significance is 1927 through 1980. This period begins with the construction date of the original buildings and ends with the significant contributions of faculty and students in the fields of photography, video and installation and body art. Because its less than 50 years old its under criterion g and significance in the last 50 years. The San Francisco Art Institute is not nominated under c Design Construction. The nomination notes that the building and addition were designed by prominent architects and examples of the styles. Staff agrees its significant however staff feels that the property should be nominated under criteria c and has high artistic value and the characteristics of this style. The additions considered one of the striking examples of the architecture in california. Both buildings were designed by master architects as well. Staff also suggests additional minor edits to the description and also including examples of art from the different art movements and the documentation section. Staff requests the Commission Review the nomination and provide comments on whether the San Francisco Art Institute meets the criteria of significance. The commission may recommend the nomination, want recommend the nomination or recommend the nomination to be revised to include significance under criterion c, Design Construction and minor clarifications mentioned previously. Comments maybe added to the resolution in the packet. The res will be forwarded to the office of Historic Preservation. This concludes my presentation. I am happy to answer any questions and the project sponser consultant is also available for questions. Thank you. Any questions . I do. Commissioner johns. You were showing photographs and the one to the next to the last page which you didnt show is a photo by stack pull. Its number 32. I would like to point out when talking about minor edits stack pull died in 1973, not 1873, and incidentally for those who are interested one of his sculptures out in the hallway of judge seawall that died and if you can attend to that i would appreciate it. I have a question, so i dont know whether you can answer this or the consultant. Why wasnt criterion c considered . I am hoping that the consultant can answer that. Good afternoon. I am with paige and turnbell. Were the consultant and awetorof the nomination of the project and happy to answer the question. We actually agree with the planning departments recommendation about it being nominated for criterion c. A little background on the project. We actually started this process with the client looking at landmark nomination and worked closely with Elaine Jackson with the National Park service to start that and they stressed that we focus only on criterion a for landmark nomination. Later the client choose to just focus on listing the buildings on the National Register and we spoke with them about how we would go through that process and updating the form for National Register nomination and we chose to stay the course and nominate under criterion a. Not to say that we dont agree we do agree it could be listed under c as well. Its just the approach that we took for this nomination. Thank you. Commissioner hyland. Did you have another question . [inaudible] so is the thought that if we push for criterion c it may compromise the actual eligibility or the success of it being listed . No. My understanding is that your comments will go back to the state Historic Preservation office and theyre hearing is next week i believe so they will take all of your comments into consideration and perhaps shannon can answer this better and its up to them which comments they take action on. If they agree on your criterion c suggestions then they would send it back to us to update the nomination and get pulled from the agenda. All right thank you. Does any member of the public wish to comment on this item . Seeing hearing none well bring it back to the commission and comments. I have a few minor comments but commissioner pearlman. Yeah, i would agree. I think everybody else on this commission that we should be looking at criterion c. The first time i came to San Francisco was after a summer that i spent at harvard walking by the Carpenter Center many times and i happened to stumble by the Art Institute that year and was astonished that there was this building there and then when i found out it was design and built in the late 60s which is only a few years after the Carpenter Center i just find it to be pretty remarkable and certainly one of the best buildings not just in california but the country and the existing the original building is also just a fantastic building and the way that the buildings are woven together to have this spanish classical building and the briewtdallist modern building is incredibly unique. I dont think of anything in the country that would have this kind of two pieces that are so desperate but worked together well and under design and architecture i think this is pretty fantastic so i highly encourage us to endorse thats its under criterion c. Commissioner hyland. I would agree with that as well and both buildings they still have a high level of integrity. Yeah absolutely. I would concur very strongly with the sentiment of my colleagues, and i think if its an extraordinary complex of buildings and i would like to i think on page seven im sorry, page 101 thing that might be added though under the integrity section which is a significant change and not mentioned and under the auditorium there has been anin fall and Significant Impact on that piece that was in filled later so i think its worth mentioning in that section because thats an alteration to undo at some point in the future. So do we have a motion . [inaudible] a resolution. I need a motion to adopt this resolution. Right. [inaudible] and that would be under criterion c with the minor edits. Second. Thank you commissioners. There is a motion that has been seconded to adopt the recommendation recommending to the state Historic Preservation officer that 800 Chestnut Street be modified with the other edits. [inaudible] yes. Thank you. As amended. On that motion commissioner hasz. Yes. Commissioner johns. Yes. Commissioner matsuda, commissioner pearlman. Yes. Commissioner hyland. Yes. Commissioner president wolfram. Yes. That passes unanimously 60. Commissioners that places you on item 11, the landmark designation work program. Good afternoon commissioners susan Park Department staff. This item is a quarterly update on the status of the landmark designation work program from july 1 to september 30 of this year. As usual i will go through the work program items that recently come before you in the coming months and update on the survey teams and projects and the Performance Measures that were fracking. In the first page two designations were initiated during the past quarter. Theyre for the [inaudible] building and cal house and one distribution sfrt University Mound ladies home was approved by the hpc and introduced at the board of supervisors. As for the other active designations these remain on hold and staff and community and agencies can reach an agreement on the Water Remediation at the plaza and [inaudible] and in place the project sponser plan to proceed with the landmark designation. The [inaudible] building is scheduled to come forward for a second read and staff expects to bring one more ingleside prosper tearian church and the mural by the end of the year and staff review at submitted applications. We received an application for 815825 tennessee street which was at the last hearing and work with the applicant for the woodward landmark district to finalize their report and during the past quarter we received one inquiry regarding a landmark designation for 1805 visadaro street but yet to receive a finalized application and during the last reporting quarter you reviewed an application for 2215 leavenworth street and not added to the work program. In addition to the landmark designation work Program Staff is Technical Support for the Historic Preservation committee and working with the hpc on the africanamerican context statement and finalized by Department Staff and needs to be posted to our website for public review and undergo some Community Outreach before it comes to you before adopt dop. The lgbt Historic Context statement was posted to the website last week for a two week public review period and scheduled to come before you on november 18 for adoption and staff is currently reviewing the korbin heights statement and landmark designation for the fump and one additional staff project has been the 201415clg grant for the store front survey draft of our finding was submitted to the ohp on september 30 and that should come before you for adoption in the spring and to track article 10 and 11 designations the following Performance Measures were established. First to prepare the report in 150 staff hours for this reporting quarter the only one that is over that threshold is [inaudible] hall and over it for the past three reporting quarters and article 10 and 11 designation application which was posted to the website in april 2015. Third to provide landmark designation applicants with comments regarding completeness or schedule of hearings for hpc with the last 30 days and has been met and staff reviewed the application for tennessee street and returned comments within two weeks and that was brought to you on october 7 and finally to maintain a quarterly report. The next update is expected to come before you january 20. Commissioners we discussed the active cases and projects. Once they move through the pipeline we can reprioritize the active cases. I am happy to answer any questions. Thank you. Any questions . No. Thank you very much. Does any member of the public wish to comment on this item . Seeing and hearing none we will come back to the commission. We will close Public Comment bring it back to the commission. Any comments on the work program . Very good thank you. Yeah, its very good. Thank you very much. Mr. Frye. Commissioners i just wanted to follow up with one comment and a bit of information that is not included in the report is just to remind you that we have that add back from supervisor mar for the Washington High School landmark designation and were anything to working with the committee to prepare that designation in the next few weeks we will have a kick off meeting and there is discussion about broadening that to include the Sunshine School which has been on the work program for some time and Roosevelt Middle School because its a [inaudible] building so let you know were trying to tackle other things as part of that. Great. Commissioner hyland. I want to say this is great work. We have been inquisitive and critical and definitely asked a lot of questions in the past and pleased with the progress. Great. Thank you very much. I think that was t final item. Is that correct . It was. Several of you have the opportunity [inaudible] hearing is adjourned. [gavel]. Hi, im ryan a prlth letting project manager with the sfpuc working at the sfpuc is a fastpaced environment the puc is American People eye person so breath and depth allows us to work on allows me to move across my career path. Fill the roadway. Our unique projects is the heritage puc Water Treatment longterm improvement plant its one of the largest projects ive managed and supervised to be successful as a project manager you have to be hard working and selfmotivated and being adaptable is important because the construction it is very fabulous that get me up in the morning youre going to be project solving and seeing the project go to me thats fun, i like coming to commissioner chow commissioner chung commissioner sanchez and commissioner pating the second item on the agenda is the approval of the minutes of october 6, 2015, and id like to note that commissioner pating requested on page 3 affirmative 3 underneath item 4 add the words state and federal they often dont match the needs you have a revised copy. I do. Just those two words state and federal. What page was that correction on. Page 3 under item 4 the third photograph the sentence is commissioner pating noted federal and state mandates dont match local needs. Fine i had further corrections two paragraphs further down it should say that commissioner chow commended dr. Arrest going gone rather commended the other explanation on page 5 for the inspection of the third paragraph on that page has to do with with the comments on how the counties organized their Emergency Services and the last comment on any part was that you the minutes note that the San Francisco dpw managed the Services Including ambulances and pharmacies i thought we should add this is transferred to the Fire Department many years ago following a national trend. I will make that change. Are any other corrections or additions . If not ill accept those as editorial clarifying statement of a motion for acceptance. Move for acceptance and a second any mother Public Comment. Ive not received requests. All in favor, say i. I. Opposed . And the minutes have been approved amazing. Item 3 the directors report. Good afternoon, commissioners i wanted to invite edwin buckle up tote pronounced edwin led our response to the valley fire id like him to give a quick report on our response. Good afternoon, commissioners the main thing i really want to start with just knowledge and give kudos to our dunst staff that really respond in overwhelming numbers on short response to the county wildfires you have in front of you the chronology a total of 4 staff during the first 40 civil certain volunteered to be advise for several days between september 17th and thirty and when they got deployed i was there for the first team they were very tuff in taking initiates for the fairgrounds they helped plan how to get the Mental Health services to be provided and also played an tuff roll in the advocating of the services of note was there precedent sending of the lines of communication the needs for Spanish Language workers there was a significant Spanish Language population in the area and till when we are there the needs of Spanish Language survivors were not attended to not Translation Services at the town hall meeting every night for the survivors so we step up to the plate and our Mental Health transactions provided translation for the survivors to this day we have responded to a request right now we have somebody my name is of Marietta Hicks he wants to come back on october 27th she currently at the local high school he signs the teachers there a violent had time off and their suffer the effects of you know the trauma of the fire he wants to come back on october 27th to provide emotional support for them we have other people lined for the two weeks to go there so the main thing i really want to say we have an excellent staff of individuals that care they want me to organize the response when i called wednesday evening on the first request by 9 oclock the following day 19 people ready to go so i really commend the staff ready to respond. I wanted to commend edwin he is our connection to the state on the mutual aid at the state level has the distinct response for Mental Health needs and many of the Mental Health is continuous need for post events so up to over a year depending on the incident from a Mutual Consent we have multiple languages and theyre prepared they also keeps us trained in response to discharges edwin is always ready at any time of the day or night to get our staff responses. Director are you done with that item r or are. There was a question if dr. Sanchez. I was going to commend everyone in the department not only responded as a colleague through the significant exchanges but more importantly what our core values are to recognize you know issues Public Health issues that effect those who dont have access to service the fact that was done in a crisis situations a significant number of families many were workers in the valley there and provided you know very critical support buses just about everything were not getting access to anything again, it shows the training and supervision in providing the support on the requests is really a outstanding when it comes to people in the district 2. Commend everyone on that a guarantee job well dawn i have one question you note you deployed a third request at this point doug that period of time then do we support our workers up there in terms of then providing them housing and so forth or does the county support that. Or the. The county is spotted to provide the support for lodging as well as meals sometimes in a disaster the communication lines and statistic doesnt operate for example, when i was with the first twaerm told there was lodging when i got there i asked where the lodging was i got a blanket stair so i had to scramble to find blankets from the red cross so weve since learned were more careful for the second and third deployments to make sure that the los gatos are well arranged for i dont blame the people in a disaster you have to be flexible so i notice the people are overwhelmed we dont expect to be treated like guests but supposed to help out. Thank you and thank you all. Ill continue on my directors report the San Francisco General Hospital Ribbon Cutting as our construction San Francisco general were preparing for the contribution and pleased to announce the Ribbon Cutting has been set for saturday november 21st the mayor to cut the ribbon and a celebration of the new Hospital Building we unveil the San Francisco General Hospital campus in recognition by dr. And Mark Zuckerberg the executive director at sfgh foundation is here and shell be talking about this through the commission meeting. This year in our budget we provided for San Francisco department of Public Health physicians that will be provided a membership to the selfmedical society as you may know our San Francisco medical society were proud theyre one of the most progressive in the country so is including next year our own San Francisco health net will be contributing a regular column in the San Francisco magazine bimonthly publication that has a print 2000 online so we proud well offering that if you want to opt out but San Francisco employees will have automatic membership what to talk about the primary care clinics at the at San Francisco General Hospital Health Center and the chinatown Health Center you mean half the commission provided a resolution for the Health Improvement partnering childrens or health this is part of our 2 year strategic plan. Also wanted to let all you know many of you may know johnnys now become not here today but appoint as the cfo at laguna proud of john hes played a major leader in the Health Center as the deputy care were excited and i know that laguna honda is excited ill stop there commissioners, if there is any other questions or comments id like to answer questions. Commissioners any comments if not then do you have. I wanted to thank the director for supporting the physician mileperhour and the medical society an important form for the physicians to be involved in the policymaking with regards to the communication of the Public Health issues the relationship relatively has been equally been beneficial i want to share i had several copies of doctor chius wonderful article on asian bli of 23 well be discussing that later on it broke in the medical Society Journal i had the honor of then enterprising the medicine so youll find additional quite well spread 2 thousand members that goes statewide in sacramento and gives San Francisco a very good vehicle to share the good work were doing in our universe and rep our Public Health work. Thank you i just wanted to make a comment the alisa miller floral vicarious id like to commend the department in february we had noticed that chinatown has the most impact on well, the worse record in dental health normally any experience takes a while before we go anything but the clinic is taking action so i do want to commend the speed weve respond to this so thank you. Thank you. Shall i move on to item 44. General Public Comment we have currently one request. Public comment from mr. Vaughn edmond abraham; is that correct . Yes. And just for everyone Public Comment is 3 minutes i have a timer when the buzzer goes off your time is up. Do you have a 3 minute. Well, thank you this is age taimentd so pardon me if i constitutional im not used to speaking before an audience naked i dont know about the halfnaked the thing to advocate and to beg for services for an overlooked population psych population for long survivors of aids in the two years ive been researching on my own ive found none including the ah p when above and beyond a couple years ago took aids out of their name so i feel im in kind of a first man on the moonwalk on this surface in many ways i know what im talking about and in some ways on the provider side i have no experience ive never provided a psychiatrical service it didnt have to cost a lot of money or some money it can be provided by welltrained professionals or a professional but im clear of the benefits and of the what it takes for a human being to get out of bed each day when Certain Services are not provided i beg you at this point to please do one thing everyday and there are a thousand things to do but one would be nice everyday to forward this so that we who have survived this holocaust have a place where we can meet and discuss our unique problems we shouldnt be tloel thrown in with generally population people who are just discovering they have aids or want or looking at taking the cocktail weve done that we have a fierce ability to stay alive to put it mildly i was diagnosed in 1985 and im still here it is in the pretty anymore it is very difficult some days and other days it is a complete lark but we need your help and commitment and we need our compassion more than anything to motivate you to do the right thing for us were being overlooked in every which way thank you. Thank you. That is the only Public Comment request. Okay. Well proceeded to the next item, please. Item 5 is the outpatient treatment program. Good afternoon, commissioners that is a pleasure to be here my name is angela a psychologist with the department of Public Health and the director for the assistant 30ush9 program to talk about the implementation of the sawdust poushl treatment in San Francisco as or as you may know the treatment is a new tool well have in our tool belt to support people with with millions give you a little bit of background about the assisted outpatient treatment in the passed Assembly Bill in 2002 and ultimate became part of institutions code in 2014 m task force recommended adaptation of the assisted poushlt treatment and ultimately paced by the board of supervisors in july of 2014 a couple of things to highlight the deposition of the outpatient is our supervisors had to make a determination that through would not be a reduction or cut of services this is funded though the Mental Health services the other piece in implementing in San Francisco your board of supervisors wanted to share that like all our programs within the system this is a Program Based on recovery and wellness tomato misses patient treatment ill highlight those ones adopted by the board of supervisors and Implementation Committee was convened a Different Group of people including consumers Mental Health providers and attorneys and, of course, so on i came on board in march of this year as a director and work towards the prelims in providing this to centered and starting the programs on november 2nd of this year a week and a half so moving on this is commonly lauras law because of laura wilcox in 2001 what is unique it has to be adopted by and i a county not a marketrate it was adopted in San Francisco last year that ultimately allows for a Court Ordered treatment for individuals with a known millions of mentally ill the goal to get heads of crisis we have wonderful emergency Psych Services that is necessary how to fill the gap it we dont let people get worse before they get better a common discrepancy it allows forced treatment i want to talk about the difference of forced treatment and Court Ordered treatment allowed under the law forced treatment is involuntary treatment as i mentioned involuntary psych working are an important part of system under the law for those cases a possibilities of involuntary medication and or restraint Court Ordered treatment ultimately is using a symbolic weight of the court to leverage someone into care arrest or someone that is likely to be compliant and that is commonly referred to as as black robe effect that is held in civil court if respond is not compliant with the treatment theyll not be held in contempt not a bench warrant issued or our involuntary hospitalization it is relying on the symbolic weight it comes with the law so in our board of supervisors adopted the program they decided we should have called a care team or a mobile disciplinary Mental Health team that is consists of a Health Director a specialist or an individual that is a consumer Mental Health services and a family liaison someone that is a Family Member with mijdz those family liaison are unique to San Francisco were excited about them for many reasons this is embodied of the recovery and because we want to maximize the volunteer participation in the services and San Francisco at the forefront or utilizing this services we know those position are vitality we think will help us to engage the individuals before we get to a Court Process this is an overview of the process for amt well talk about this in detail the first a referral from a qualified requesting party by law and we try to make that is a assessable to accept some referrals be it a town hall free number a website that launches that has information about the assisted treatment as well as other resources from the community it will have a referral form that can be implemented and emailed to the care team so qualified party it one of the individuals an adult that lives with the individual a Family Member a care or sibling or spouse the director of a Mental Health facility treatment where the individuals lives the director of a hospital a licensed Mental Health provider to provide treatment to the individual or supervisor their attempt and finally presiding officer or to who is assigned to the caseload another common misconception Police Officers can refer to this this is carrying a caseload our Police Officers dont carry caseloads theyre not qualified parties moving to the session is it so overseen by myself i want to highlight this is a program signed to get ahead of crisis so well utilize some of the Wonderful Services we have in our robust system of care move on to the criteria for someone to be meeting all the criteria it includes the individual is 18 years or older a residents of San Francisco has a severe effect to imagining or the individual will unlikely survive without supervision and a lack of participation in the statement either their he imagining to two or more incarcerations they receive Mental Health treatment within 6 months are 3 years and attempts or acts of violence between the period of time a caveat is the hospitalization or incarceration immediately preceded the referral or was a catalyst that would go towards meeting this i actually think this is thoughtful the idea we dont want to order someone into treatment as a reaction of a crisis but as a system we had many opportunities to try to engage the individuals and weve been unsuccessful in doing so other criteria theyve been offered an opportunity to participate in the have arey services and part of responsibility we can we thats been done and offer them voluntary services on a going on base they have to be substantially deteriorating and the least restrictive option a ot to prevent relapse in great harm of extensively or others it reduced the livelihood of incarceration and finally, the individual will benefit from a ot what is a National Statistic one in 20 need this weve anticipating fewer hundred people meet this criteria we accept more often than not an individual will offer them volunteer services but it is voluntary at that point in time. Now owner movein on from the conditions are met well start the referral well do on in depth survey to gain the information about the persons history and i think we ask other important questions including what with be strengthens any i interests or strengthens as can way to engage with them well be outreaching them if anyone agitating them and similarly anything that interests them a thorough review the records for the fortunes of treatment and write a treatment plan i want to highlight this is a very preliminary treatment plan that has to take into account any directives in place and changes dramatically as we get to know the individual we want an initial idea of who we recommend when we outreach an individual well be transparent why were there and provide them with a lot of information including document about the patients rights the Public Defenders Office who will be representing asa these and put together a document for Legal Services and all of those documents will be provided in a preferred language we would ask the individual content to conduct on assessment new, of course, a couple of things can happen if they consent to an assessment and regardless of whether or not they meet the criteria well offer them voluntary services if necessary meet the criteria and well connect them to care well restart the investigation at any time during the First Six Months of treatment from the individual disgadgets if treatment i should not with other Things County have few cases have a Court Process so solemnly swear today information from relocating they have one thousand phone calls will information about the program only 8 cases went to court so again, a small number of cases we hope well see something similar in San Francisco engaging many people in voluntary services but as individuals refuses the assessment or the assessment of refuses any level of care well go through an engagement period by law we have to engage the person before we file a Court Petition every county is different San Francisco has a thirty day we attempt to engage the person before filing a court order so if an individual continues to refuse the volunteery services and meets the criteria and deteriorating well move forward with a Court Petition filed within 10 days of the last assessment of the individual it includes an affidavit assessed the person how they met the criteria as well as an updated treatment with all the information at that point in time part of the caregivers is to give the person a copy of the petition filed in court the Public Defenders Office gets a copy any treatment provider gets a copy we meet with the individual and ask if there are any relevant persons in they life that needs a copy we again ask the individual to engage in individual services that is an effect that is unique in San Francisco offering treatment along the process in Orange County there are 8 cases a petition was filed and 7 individuals expecting the attempt that is a Settlement Agreement it as court order the Court Monitored them but a degree of care now if an individual didnt enter into a she means to well get a Court Hearing within 5 Business Days an individual can enter into a settlement but the judge can he determine if wench meet the policy and this is Outpatient Services or decide we dont meet the threshold by law an update to the court every 60 days we anticipate more frequently based on other counties we have a hearing of noninclines we will continue to outreach them and engage them and monitor them closely for 5150 criteria as well again moving on along with the treatment looks like the treatment is a individualized affordability take into account the preferences and their unique needs and level of care it is flexible as a remind not involving involuntary reducing the hospitalization and victimization and a our law is like new york there is some mixed data out of new york next year the day was reviewed so again talking about the services that will be offered services are field based people well meet them where their confront and includes a full partnering an expansion the usf Service Partnership theyll say have an organization ot that is specialized to work with the population we have a small ratio of staff member to clients well be monitoring 245i calista caseload and, of course, there is a goal of linking to individual to longterm care well talk about the steps for the next services those are some things that services are that may include support services are diverse and common forms of ada compliance to highlight a couple of things were lucky to be implementing this in a robust system of care it includes access to medication and helping assistance that is emergency short time or long term housing, Family Support and San Francisco taking that a step forward to identify people as Family Members and under the law the person were outreaching has custody of a child we maintain that custody or ultimately not custody but we support them in supporting them necessary so the goal of reducing isolation and evidences based practices just to name a few an important question how do we know if this is working in San Francisco we have to provide an annual report to the state department that is quantify and qualitative quantify data how many individual we outreach and are connected to services Court Petitions filed etc. Qualify active is their support systems their provider and again, our board of directors board of supervisors has taken it a step further to do a in depth 3 Year Analysis and it is required we use an external consultant to make sure that the reports are objective and, of course, we have not starred the record no data to show you up to this point in time but look forward to coming back and speaking with you, of course, im available to answer any questions you might have any Public Comment. Ive not received Public Comment requests for this item. Commissioners. I have 4 items. Commissioner pating. Thank you very much this wonderful presentation im glad after a long time the preparation and many, many meetings. Its happening. You were all looking forward to it. So four questions so im aware the nevada data not aware this was a best practices it is encouraging but with regards to nevada i think 80 percent of people were this is involuntary treatment theyre willing to be voluntary this is encouraging is there anything about San Francisco you will think that makes us unique we might have different outcomes or need to consider other unique vanishes. It is difficult planning San Francisco is so unique to the other counties that have implemented that up to this point in time but as i mentioned in San Francisco is at the forefront of Consumer Services and outreaching to the individuals were implementing this in a different way this is robust so im very hope the array of services well offer people will help us in connecting with individuals and care. With regards to the consumer reception across the state a lot of consumer opposition i havent heard of opposition in our city i assume because youve done a great job how is it consumer with the experience have. Received feedback and concerns that youre still trying to address. Well commissioner, i appreciate the confidence in my ability we have made a very skertdz effort to do those including the customer run organization and, of course, there are concerns in how it is implemented and insuring that it is done so recovery and oriented fashion what i have consistently heard individuals think this is an intervention and tool rather than a cohers thats what we want to maximize participation and services, of course, ongoing conversation and an open dialogue with other organizations to insure that continues throughout the prelims i also think that having the pier prospective will sure we discuss that on a day to day basis. With regards to our care team whats the total budget and we have hundred clients what is your anticipated cost per person your imagining. Right. So the care team is the 3 individuals and then in terms of an estimated costs bans the services that are provided were estimating 30,000 a year per person but, of course, that is to be determined your so the services theyll receive comes out of this budget not the general Mental Health. It is funded through the Mental Health services act. So stand alone maybe it uses Others Services the fund is there t sma. Were able to be reimbursed partially from medical and other benefits but ultimate we be providing those services under h m a are s a you i know were starting two or three years i think weve definitely wanted to see quality of life carts as your reporting and i think very much in terms of felt Economic Feasibility for the potential savings i guess the dollars back phil that have less bottom line impact savings as soon as possible to costs. Thats important to consider while that more nonprofit analysis in 3 years, of course, well be connecting daylight and that annual report is due may first of every year to additional data. So the next question this is i was on the do the Emergency Services sunset at all. Okay inaudible . Thats great. So this is somewhat of a well, not a free program but a Great Potential to do Great Services with dollars. Again those are individuals that meets melanie it theyre our clients well work with them throughout the program and hopefully long term and other services. Do the clients mostly clients that have housing already or embed in the families networks or Homeless Population or populations that are not reaching because their insured any thousands on the demographics. Orange county it has implemented the program is very different than San Francisco theyre similar to the counties that have implement their primary refers is something that families have been very eager to have implemented throughout california so in anticipation of the rivers from the individuals that may include their living with family but the second highest referrals in Orange County was the forensic setting well not see individuals coming out of jail that meets the criteria well be engaging that may require housing assistance. Thank you very much. Thank you. Commissioner sanchez do you have a question. I thought that was an excellent report and we look forward. Thank you very much. Thank you. Like to make a comment commissioner chow first id like to acknowledge the great director shes she has a history in forensic and worked in our jail system so a great selection and won the things you might not have caught in 4 hundred people call for services 4 hundred people will be connected to service this is an important outreach for the department and Mental Health for many families whether they called county give information will be the child but helps never before it is an opportunity for us to serve for clients in the Community Even if they dba dont meet the criteria the department is engaging with those individuals to get them health. I want to go on the record thanking dr. Robison i know i see you youve been instrumental in moving this issue along thank you very much. I have 1 or 2 questions which was certainly thank you because laura has been sufficiently a controversy with no people that need to protest what youre or even comment on the place is a credit to how you have trartd this into the needs of San Francisco but so im kind of curious youve said if, in fact, it became a treatment plan by law and from the recipient of this plan then choose not to follow there is noting no ultimate consequence; is that correct. Thats correct. Is there this a process work with the client and trying to have them feel that there is a possible oversight from someone else watching that wouldnt you rather work with us voluntary and absolutely it is the effect of the report and as i mentioned while no formally consequences this is a group or population we feel at risk for hospitalization and incarceration in order to meet the criteria for the program and well be monitoring them closely with the volunteery hospitalization criteria to get the services should they meet the criteria. So the involuntary level. And outreaching them at the hospital. So it is interesting youve pointed out the experience we went through the other experience to so the annual report our anticipating if youre starting in october this would be next year that you would have some data. Right we have had 6 months of data for the may report and again, were using the external consultant went through an revenue process work with us to insure our data for the initial report and providing an item place of residence for the ongoing years. It seems reasonable to get an interim report that as an issue with the county to see how it is being used in our Public Health committee. And well have it before that goes out to sacramento to the state Vice President the final report will not be sent before we go through the commission and and owe interim focusing on concerns and efforts to address those concerns i dont think youll have data but structural information. Very good well again, thank you for putting together this fine program. Well, thank you very much and as i mentioned the Implementation Committee was easy to slide into and work within so i appreciate all our support and being here today. Okay. Thank you. Thank you. Well look forward to youre next report. Thank you very much. The next 6 is a resolution for the type 2 diabetes and asianamerican adults residents this resolution will be voted on today. Dr. Argon. Good afternoon, commissioners. My comments if weve received slips for testimony if anyone else wishes to comment following the presentation from the public please fill out a speaker form and bring to say the secretary. Before dr. Argon begins to our right a slightly revised version of the resolution with red lines language and the public has that at the front table that is clear what the represents changes. So thank you, dr. Argon please. Good afternoon, commissioners good afternoon. Director garcia im the Health Officer of San Francisco and also the director the Populations Division today id like give a brief overview of body mass screening for asianamericans in the u. S. And its relevant to the resolution and then after i speak dr. Ben a medical director of the chinese Health Center will pub u talk about the network i want to give special knowledge to the type 2 diabetes the Asian Pacific islander positions and dr. Chow for collecting being a champion of this important issue and bringing National Attention to the criteria so thank you. Let me actually put my presentation up. Do you need assistance dr. No ill be fine. Thank you. Maybe i do need assistance here. Is that full screen mode; is that correct . Yes. Im going to run and get it support. Make sure of one thing here. There it is. Its working and yep. Yeah. Okay so im going to briefly give an overview and background and go the reliable for why bli screening should be reduced and recognized from some of the body that support this recommendation the first one i wanted to point out we know that diabetes is a growing problem in the United States and this reminds us first of all, the vast majority of diabetes is type 2 diabetes we know that over 46 persons are downloading every year and thirty million americans have doing the best we can and thirty million will have prediabetes perms are diabetes go on to have heart attacks and kidney failure and being responsible follow disease and amputation being responsible for lower is sxreement amputation the cost of california is 7,800 every year and medical costs are estimated to be over 27 whether they wouldnt say problems of diabetes has increased in the United States while around 1990 the previous lens was 8. 8 and 12 it is now 12. 12 percent an important thing to float about doing the best we can we are interested in the total burden diabetes were interested not only in the those who are downloading but undownloading this is a critical point to Pay Attention to as i go through this so for example, if you looked at the 14. 3 percent of deceasing 13 percent of the us is undiagnosed youll see this is much higher for asians and based on the data 38 percent have prediabetes this is a huge problem the next slide is from the ed haynes data to emphasize the association between weight and diabetes you see on the graph at normal weight a to over weight to obese a prevalence is increasing as you move from left to right because the obese epidemic when you look at this data an example of type 2 diabetes in california when you look at this graph youll see Asian Pacific islanders are 6. 2 percent so it equivalency gives the misimpression not a problem population i wanted to get to the point what matters is the total diagonal burden of diabetes well show you in a second the National Data if you just were to focus on this youll be missing an important part of problem so the u. S. Census independence aligns as person from china and monocombol and Southeast Asia and philippines and china and vietnam additional singapore and other countrys the india continent in 2011 more than twothirds were foreignborn in the u. S. When i focus on the asianamerican population currently 4 millions are chinese and 3 that is 4 filipino and 3. 4 asian india and 1. 7 coroner and on that are japanese that population represents 5. 1 percent of u. S. Population by 2016 that will go up to 8. 2 percent among the faster growing population in the u. S. So this next slide is an important slide when you looked at that previous slide we are that looking downloading diabetes were looking is the difference continue the blue bar and the green bar the blue bar is total diabetes burden it is those that are diagnosed with diabetes and those are undiagnosed with diabetes so typically when you are looking at the data only the difference between the top of blue bar and the top of green bar if you only look at that the asian category would be smaller the difference is the green bar for asians more than 50 percent of total burn of diabetes more than 50 percent of it is undiagnosed so its a large proposition we dont know youll see for hispanic and asians that is much larger undiagnosed Pay Attention to that that explains why it you only look at part of data you miss of important part of picture and when you dont pickup this you will be surprised ill show you data in a couple of months out of the Community Health assessment we looked at recently, we question happened to beginning to think about is reasons for this so you if you look at this slide this is not published that will come out in the Health Status report look at the diabetes from 2007 to 2012 there is a dramatic increase in youll ethic groups of diabetes and different from the other data youll see the asians that are highest this is an example where asians youre not following the burden of deceased disease and here it is catching to us this is part of the reason changing the screening criteria is important we need to be able to cast those undiagnosed portion of persons with doing the best we can the importance of catching them is helping us in primary preservation and weight loss so what we used right now is body mass index a way of looking at adjustment for height additional Heart Disease and increased cholesterol and the problem with bmi it is weight adjusted for height it includes muscle mass, bone mass as well as the amount of fat that is in the body so it turns out for asians if you take two an asian and nonasian that has the same bmi the asian will have a higher promotion of fat it is distributed around the visa are as opposed to the fat you can see we call it sub cutaneous fat around the owners is call vice rally fat that is predicted of causing diabetes a so anyone on the outside may look to have normal weight but actually have more vice rally fat than someone else that is turning ought to be true for the asian population begins to explain why the b m index in terms of the cut off is not visible for the asian population what about changing the cut off one thing to realize the way bmi used have a category of normal over reject e weight and obese categories this screening is focused on not changing the category designations but really improving the screening of diabetes diabetes improving the screening for diabetes this is an important thing to mention so with the category that is currently this will continue to exist but the emphasis ero on changing the cut off to diagonal diabetes for example, the current cut of 25 the sensitivity of a b any m i have 25 is 64 percent it means 36 percent of asianamerican with diabetes by dropping the cut off youll see here the arrow on overweight by dropping the cut off to if you increase the sensitivity to 80 plus it works with the different asian groups a different cut off for the asian groups and vice chair an sensitive screening is better than for this type of screening. So i want to acknowledge that knowledge about this is really existing i existed since the mid 1990s they published an article in 2004 recognizing the difference in the population this is 10 years later a Long Time Coming countries walk china and india and japan h have changed theyre cut off the 2014 has a draft that is consistent with the current guidelines of screening for persons at higher risk is didnt mention the cut off of 23 will be consistent with what were recommending the strongest establishment from 9 America Diabetes Association and what we say ill read it quickly test this be considered in all deputies over weighed and this means b mississippi m i or 23 for asianamerican and other reflex factors like africanamerican or hispanic or ailing that is consistent with what the resolution is promoting so what im going to do is ichlz to dr. Benefit louie to give us information about the network. Thank you. Hi good afternoon, commissioners and good afternoon director Barbara Garcia i hope i dont have difficulties technical. Ill try to see if this. Excellence and okay. So im ben lou why a a are International Medicine he serve and a another china Health Center thank you for having me to speak about the screening at the bmi for asianamerican and the impacts on the network before i do that i want to quickly recognizing the oral disparity for the children in the community and recognizing our staff for implementing thats a lot more that needs to be done and well do it we realize that so first of all, talking about our Health Network that is primary care which is the third column this is 72 thousand patients represents the patients served in primary care this is richly diverse population evidenced by the breakdown the pie chart here the published question is our asianamerican population 25 percent of our network that represents 18 thousand patient and im going to talk about china Public Health center use to those numbers to come to estimates and thees trappings for the screening of 23 patients china Public Health is a primary care Health Center that currently serves 55 hundred active patients over 95 percent of asianamericans represent 27 percent of Health Network of asianamerican patients given this population the 90 percent asianamerican the estimates that ill be talking about will be helpful to estimate the impacts of bmi for obese on the network we currently have 8 hundred and 72 patients are diabetes this which is 16 percent of our population 15 hundred 60 patients have prediabetes which is about 29 percent and well come back to our stems and the following the bmi breakdown to 59 percent of the bmi are equal to 23 ill measure that 90 percent asianamericans and for bmi if you take the difference the 22 percent of patient is 12 hundred representing with the patients of bmi with 23 and 25 this is impacted by the new screening guidelines and again use this percentages in the next couple of slides this slide is you give us a sense of the bmi breakdown of the diabetics and prediabetics 8 hundred 70 diabetes patients 29 have the bmi between 23 and 25 for the 15 hundred plus patients 27 percent have a bmi between 23 and 25 this is the sense of the magnitude of the patient who have the bmi profile for the diabetics and prebeefbz using those numbers the impacts the screening for the health in effect the number of asians in our need not is 18 thousand so using the t p percentage of 22 percent having a bmi between 23 and 25 it deals with over 4 thousand paternity additionally screening at the bmi 23 for diabetes and estimating the number of prediabetes dialyses we picked a number of sxreenz and using the 29 prebeacon hill at chinatown over 90 percent are asianamericans and using that we estimate about 11 hundred and plus diagnosis so using the chinatown our experience munld by the number of patients screens we have 6 hundred and 40 additional diabetes so this really speaks to what doctor argon talked about what was undiagnosed cases really is that the blue and the dwrr and well be decreasing the gap and be able to diagnose is otherwise undiagnosed cases okay. And in terms of the cost analysis the benefits are many the primary care and intervention that allows us to do that and prevents costly complication and hospitalization the complications as mentioned include heart attacks, loss of vision and limb and it will lower the loss of prosperity among our patient as for cost hair relatively small because of the simple screening blood tests and hemming global and by and far lowcost human exercise and some of the medications like the generic those are all relatively lowcost intervention so at china Public Health we screen the asianamerican in april of 2015 and the three because the mounting evidence for the evidence based benefit of doing so we find out the benefit already for those patient who diagnoses with prediabetes with the local ymca doing the preprogram that is implement across the country 16 session of life coach and ymca working with patients on Lifestyle Changes and well be able to do that and really taking that into a diagnosis to the intervention we talked about and having a class with the emphasis oneself any Public Comment it is important for the patient that live with diabetes and prediabetes every single day id like to make a comment on the tremendous under the circumstances that exist to publish the opportunities like this right here in front of the us to do that and we have our Electronic Medical records and to be able to leverage that and to continue to develop our data airbnb lyrics and register and try to collaborate with our public colleagues there to take it from the level of the data to tell you intervention to better outpatients and we need to be able to build the strategy and i believe there is a gap in resources to be able to take the data and consecutively have the coordination to pick the data to outpatients to benefit them that exists there. Thank you very much. Thank you, dr. Louie. Dr. Argon are you done. Yes. That concludes my presentation. Thank you very much. We have a number of public testifiers and ill call 3 at that point to be prepared to come forward. Dr. Dexter louie and dr. Hoe tran the first 3 please. Our secretary will be keeping the time. Yes. Thank you, commissioners for this opportunity i wish to speak in favor of the resolution 15 dash 13 enforcing the screening for type 2 diabetes im a physician a full physician here in San Francisco. Would you move our microphone doctor louie thank you. Im department of education take care an ems e emt information for 40 years my office in chinatown is navigate is two fwlokz from the hospital i was born that 4 blocks from Mire Elementary School and 6 blocks from where i live on north beach so im a really native here im also the chair of the National Council of asian physicians leading the effort in make our communities and physicians aware the need to use a bmi of 23 for asianamericans the national organize of physicians was one efforts lead organizations in the asian Diabetes Coalition with the American Diabetes and joslyn asian clinic so that is a strong leadership there and Strong Movement to support that forego several years the Asian Coalition is focused to screen asianamerican for diabetes at bmi 23 as dr. Argon and dr. Louie said the standard is a bmi of 25 but not holding for asianamericans the lower b mississippi example i have if a a better measure with regards to number 3 as a senior resolution this is a Health Care Disparities that needs to be addressed and it is to raise awareness in our communities to screen asianamericans at the bmi of 23 that is consistent with the nationals constitutes of health, World Health Organization and the American Diabetes resolution it is data based and includes years of research by harvard and the diabetes chaplain that is forwardlooking and just plain good medicine the resolution is indian with the focus on prevent care dr. Louie mentioned as Population Health that is upstream medicine in the 21st century we need to take care of our patients and upstream not down stream when theyre sick i strongly urge to you vote in favor of the resolution. Next speaker dr. Yeah. Im larry im a pediatrician and director the chineseamerican society ive been in practice for 44 years now and the last 20 years of or so i actually have been seeing increasing number of my patients with type 2 diabetes and actually a lot of prediabetics so much so ive seen their bmi going up im screening all teenagers for diabetes and i would say close to 2 or 3 percent of them are prediabetic i picked up before 4 two or three diabetes patients so i definitely endorse the screening at bmi of 23 im sure that will benefit the Adult Population since it benefits even the teenager patients of mine thank you. Thank you. Dr. Tran. Good afternoon, commissioners i very much appreciate our times im here to talk about the 323 an issue of quality about time to understand the operation and screen according to their body mass index and the second one it goes up as presented practitioners it is based on that 50 percent of our asianamerican population and not been diagnosed and the first one is the Cost Containment it prevents complicates from the disease and touch on issues at an early stage last but not least a patient i had diabetes i was diagnosed with hundred and 35 as my glue close level i reduced my bmi to 23 i offer came. Thank you our next 3 is dr. Roxanne, ms. Jessica and dr. Eric. Hi im roxanne balancing tissue the director for the Asian Pacific islander an organization endorses and supports the campaign thank you to the commissioners listening to us i wanted to share that we know asianamericans are unrecognized as as an at risk population for diabetes it is common in our communities as 21 percent the higher there is among the diabetes previous lansz in india and chinese and filipinos and koreans the data that was shared it is important they to share we worked with them on an asian sample 80 so by the serving much large groups of asians we were abdominal able to provide data to the data is really amazing to share around having 51 percent that asianamerican have diabetes a National Status so it is important with this resolution and this campaign asianamericans that have diabetes and prediabetes needs to be tested for type 2 diabetes and needs more education about this to be tefdz for type 2 diabetes asians are at risk of they dont reach the bmi of 23 is a redirection of obesity but to get checked by the doctors by screening every 16 thousand asianamerican with diabetes that will revealed and treatment and management of diabetes can begin earlier before complications arise thank you very much. Next thank you. Good afternoon commissioners and discharging im jessica representative for the medical society represent 18 hundred physicians in training here in San Francisco id like to on behalf of our organization put in our support for this resolution obesity and the many negative Health Consequence it is a worsening problem among asianamericans figures and others clinicians need training tools to address this issue amongst their patient and have a smaller bmi needs to reflect the thrown we join Public Health experts in endorsing the bmi at 23 and we have the issue of our journal we have on your counters with the consequence a cantonese the article that commissioner pating referenced earlier that was coauthored by edward chow on pageant 24 thank you so much for this important issue. Thank you very much. We have two other speakers. Good afternoon Health Commissioners my name is dr. Ink i eric im the Vice President of the chinese Community Health Care Association and nonprofit associations of physicians serving the Chinese Community in San Francisco over thirty years. Im speaking in support of the skwooen for bmi 23 initiative as we all know that asianamericans consist of 34 percent of the population in the city and county of San Francisco morph asianamericans are thirty percent more likely to develop diabetes than our white counterparts in south asia hawaii and Asian Pacific islanders the percentage of the developing diabetes is even higher morph asianamericans are more likely to develop diabetes at a lower bmi as evidenced by studies by jocelyn clinic Washington University and usc b the presents conference o convention recommended e recommends the screen at bmi 25 because at 25 the chances of developing diabetes has theres, however, if one uses this recommendation it will miss approximately 35 percent of diabetes in asianamericans population and it will even miss for cases of prediabetics in this population and National Institute of health says that over 50 percent of the diabetes cases in asianamericans remain undiagnosed and unrecognized this means their missed opportunities for treatment and prevention. As a Community Eye doctor ive been seeing a good number of patients who are awe systematic the back the retina already shows damages by the diabetes and this damage is in the back the eye it correlates well with complications in kidney micro circulations in the extremities the the heart and in the brain matt haney that these stages of the diseases are high i recommend highly to screen for diabetes at bmi 23 thank you thank you. The next calling names . Good afternoon, commissioners and all the leaders in attendance im diane with the Asian Health Institute at ac sf im glad im here to be able to talk about this a little bit i want to thank dr. Thomas excuse me. My voice is cracking up for the wonderful presentation with the strong evidence for the bmi 23 bmi is certainly within the things we get a remedy from patients although i personally because of the reserve are more in favor of raising this didnt come bill so in lieu of the bmi the certainly strongest and easy number to come by physicians and clinicians to be a potential diabetes patients so i speak strongly in favor of the resolution and i xels especially want to echo all the previous speakers and two of the most important points are the Health Equality that the bmi bring and the under diagnoses problem if we stop there is still under diagnoses but hopefully with the b mississippi m i screening that will be less in the largest number of immigrants coming to San Francisco are chinese immigrants and china has also a very similar rate of diabetes as we have in the United States at 12 percent but 12 percent the population has almost 1 hundred and 14 millions of people that is a worse problem but more the people coming over here some of the problems are going back to be burdensome to the problems 90 in San Francisco thank you very much. Thank you. Doctor i may have mispronounced our name in so, so give that youre from the american Diabetes Association. Absolutely good afternoon. Im dr. Melina uncapher Corin Jackson the associate director for the American Diabetes im standard here in place of my director michael that county be here we want to come and applaud San Francisco and the department of Public Health for nicht this resolution and adapting the screen it is our desire to prevent and cure diabetes and help those of the folks and one of the ways to it had i serve 9 counties in our office im the director of programs im out hosting and finding partners to collaborate with you and host in face and communities based organizations we conduct free to the public Diabetes Education and selfmanagement with or we have looking forward to collaborating with you in this fight against diabetes we applaud you were coming out to the National Diabetes month please look at our doing the best we can website and thank you so much for having us. Thank you. That will ends Public Comment unless someone didnt turn in a form and wants to speak okay. Good commissioners we need commissioner chung back to continue, however, we can continue our business but we will require doctor katie tang if you discuss what time commissioners we do have a proposed resolution brother you i do want to thank staff for theyre very hard work in putting this together and the revision ive suggested as part of populated resolution mirrors the discussion of testing for diabetes to clarify to some who had asked why they were looking at the resolution whether this was a mandate clearly not a mandate a recommendation that endorses the standards that are from the America Diabetes Association, in fact, do so as read out to us by dr. Argon the testing it be considered and so to help clarify not a mandates we are asking to do you want and therefore, if you fall short some kind of punishment this is what we wanted clear in the resolution that it is accept and therefore mirror the language used but is american Diabetes Association so i hope that my colleagues here would feel that that would be an acceptable substitute if respond wants to move the resolution. Id like to the go ahead and move the resolution. Second. And a second. Okay. Good is there further discussion by the commissioners . I skill want to thank you, dr. Chow for bringing this forward and playing a role in the communities for making us aware certainly you made me aware of this and helped to get it both the journal and thank you all members on the Asian Community for speaking for the resolution. Okay commissioner chung. I have a question for the director actually so as we move forward with this recommendation will there is like a screen for diabetes when an asian patient comes as we implement the new h. R. That will be able to catch them earlier on. Well, i think as you saw with dr. Ben he kind of outlined what theyre doing within the Chinatown Health Clinic and so as we precede that with this we already have an e m r theyre able to use sometimes registry this is included and assessments and the fact their murray is different will cause as we go through the body mass assessment that is a common assessment all doctors do within a department this bring attentions is that and insure were doing a greater assessment of that. Commissioner sanchez. No, i would just make a statement i think that this an outstanding recommendations it shows a real unique oust into the population of the city i want to thank you all particularly many of you come came from the practices i thought that today weve heard everything from internal medication theyve coasted the waterfront and the resources and collaboration and so forth was a really great great deal of trust and in both all of you and in the department in bringing to death a new benchmark to look at the diagnosis and treatment in a exceptional population that transcribed in the countries and overlooked this was really a great learning curve for after all us to look at how we clarify and measure and diagnose and treat in a comprehensive holistic way that is a fantastic effort thank you to the colleagues on the commission who spends a great deal of time for representing our endorsements today. Thank you commissioner sanchez any further comment i will make one since we have been talking about personally here and personally in bra for 40 some odd years and noted the rising numbers of diabetics both in any own practice within the plans that we were administering through the programs at the communities led to really evaluating why this was happening and then clear that we might the no have known but the rest of the world in asia we are florida were under diagnosing and got this i know that in the health plan i was working at one of the most devastating chronic diseases what renatural disease relative to the fact everyone what was diabetic so this is one of the common disease like the eye complications in our population we dont see has much vascular but we kept words the merger Diabetes Association a decade ago said you dont have any greater diabetic prevalence than the rest of the communities but it seems to me to be enabling weve been watching the rise in diabetes but to then understand that we were missing the diagnoses as our study come out in regards through the bmi led to the fact we should be doing something and very important to not just this communities but to the entire country that once the recommendations came out that had been verified through the american Diabetes Association we take that opportunity and have the opportunities to as the first city in the United States here to actually campaign for the identification of diabetes in our large asian population so i really thank staff here for the work theyve put together but more importantly also and really thank many of whom have testified today who really worked working very hard over the last several years to get the measurements regarding what is true incidence of diabetes in the asian communities which was published in our following the convention in 2011 that n cap helped with the coalition and from there working hard to work with the Diabetes Association to look at the evidence again that the rest of the world was using and this shouldnt we also be using that that in america he hope to follow my fellow commissioners b will join necessary me in voting for in the first supply city in america to recognize this on behalf of our communities are we prepared for the vote. If so. All in favor, say i. I. Of resolution 15 dash 13 i opposed . The resolution has passed unanimously thank you to the public for coming clapping. thank you, commissioners that he move on to item 7 a resolution recommending the board of supervisors accept a gift of 5 million it from the San Francisco General Hospital and approve naming of various locations of planning and Mark Zuckerberg and trauma building in recognition of a film profit donation good afternoon, commissioners im rollands director the San Francisco Health Network and also the intern chief executive director of San Francisco General Hospital youve begun laughter . United states of america the San Francisco signal foundation embarked upon an ambitious Capital Campaign to raise few minutes as sf fixtures and furniture and equipment those essential items needed to operate the new Central Nervous system that was burger to be paid for by the 8 hundred and 87 general fund bonds youll recall that you back on march 3rd of this year approved a resolution recommending that the board of supervisors accept and an initial gift of 25 million from the Selfreliance Foundation for this effort we are here today and you have before you a resolution asking our approval and recommendation to the board of supervisors that they accept now a gift of 5 million and also recommend the approval of various donor naming recognize opportunities in the New Buildings that are outlined in our resolution im joined by amanda executive director of the sfgh foundation we also have deputy City Attorney julie to help answer questions we are presenting this resolution for your consideration and approval and i object to entertain any questions you might have. Do we have any speakers no speakers. . Im asking. Yes. Yep. Ill note commissioner sanchez i guess lemon found out are you going to be presenting future this or is this . Perhaps the executive director could thats the extent of my presentation but if something else. Commissioner sanchez question. First of all, i want to say again to the intern executive director has been a hard working of the foundation along with our new director but i do want to state this the board of trustees has been working diligently and passionately and quietly in order to identify a cohort of philanthropists in this city many of whom didnt want to, announced because they were either the whole family or new family everything was represented this was done with a great deal of over the last couple of years it is outstanding to think here we are a Public Hospital where we had voter approval unbelievably in the 80 percent bracket and built with public funds in order to maintain and provided the best equipment and the best environment we had philanthropist all over the waterfront speaks for itself come into and present dollars were raised i want to mention two