Transcripts For SFGTV BOS Budget And Finance Committee 22317 20170224

Enter their motion to excuse supervisor tang from attending todays meeting bs thank you. Width i will go ahead to make a motion to excuse supervisor tang that motion is taken without objection [gavel] item 1 except unexpended grant two under 30,000 from the California Department of Resources Recycling and recovery for the public purpose of increasing used motor Oil Recycling and household Hazardous Waste management for the period of april 1 20 3010 through june 30, 2018 thank you we have piero radius from the department of environment to present today good morning before you is a except unexpended for approximately 20 33,003 and 79. To support the departments Award Winning outreach effort to educate consumers around proper disposal of used motor oil in San Francisco. I just want to share with you just a couple of statistics in terms of our program that we have been running since several years now, since 1993. In 2015 San Francisco collected a total 42,000 103 counts of used oil from various collection points. 28,000 of them were from Certified Centers. We have 25 Certified Centers throughout San Francisco. The of to in supervisor norman yee district. We have five in supervisor melia cohens estate for example. We work very creatively throughout the city on our campaigns to educate consumers around both reduction on the need for oil as well as the proper disposal. So folks dont send it down our storm drains. Folks dont throw away in their trash. The people properly dispose of it. Weve done many different campaigns from working with Young Artists in the bayview for example on a mural to outreach events brought the city to educate folks. One little opportunity im going to take as a commercial is the state in San Francisco run a check your Numbers Campaign because many of us still believe that you need to change your oil every 3000 miles and you dont need to do that. So part of our campaign is to educate folks that there myths out there that are much more effective ways to reduce use of oil in the properly dispose of it. So we urge your support for this outreach grant that we have an welcome any questions you may have. Thank you thank you supervisor yee you have questions . Do you have a list of the centers queen yes. We do supervisor. I do email that over to your office. Appreciate it. Is that it . Okay. Thank you for the presentation mr. Rodriguez. Lets go ahead and note for the record that we do not have a delay report on this item so lets go ahead and go to public, through ladies and gentlemen if you like to comment on this particular item. Please conduct seeing none, Public Comment is closed. [gavel] the matter is in at the hands of this but is there a motion . With a positive recognition i will make a motion motion made with positive recommendation we take out without objection [gavel] next item item 2 approving a conduct amendment between westit to provide citywide Technical Assistance coaching training and relating services for serving low income children with special needs and increase the amount not to include [inaudible] okay. Without ms. Lisa lee from first five here to present this morning and before you present supervisor yee would like to say a few remarks. The thank you chairman cohen. Thank you chairman cohen. I just want to say im real proud to be the sponsor of this particular item. Its one of these things where people dont realize that how far ahead the curve we are in San Francisco when it comes to trying to improve the quality of our child develop an Early Education programs and even doing this for quite a long time. There is something we should need to continue to support as we see improvements in each improvement that we see means that many many of the Young Children are actually Getting Better quality Early Education and care than they would have otherwise and its really been a nice ride for us to see how we can know quantitatively that these centers are indeed, of high quality. So thats all i want to say. Thats all you want to say . Okay. Ms. Lee, the floor is yours thank you lisa lee first five children and families commission. The proposed resolution that we have before you today is to approve a six amendment to an existing contract between first five San Francisco and west ed. A Nonprofit Agency who has been providing for the last five years assessment Coaching Training Services for quality Rating System in San Francisco. First five is operated this contract for five years. And at the request of the office and partnership with the opposite Early Education, weve agreed to extend his contract through the fiscal year told thousand 1617 and thats exceeding the 10 million policy tenure the contract will exceed 10 nine. Therefore we are requesting this approval so that we can continue to maintain these essential services throughout the close of the fiscal year. One thing to remark, weve been working closely with the budget and legislative analyst and be totally agree with the recommendation to bid this contract and that process is actually taking place in march. Thats it . Thats it. Perfect thank you. We will go to Public Comment now. Excuse me , yes, please budget legislative analyst. Mdm. Chairman and supervisor yee, on page 3 of our reports we note that table 2 which is on page 4 of our report shows a total contract budget for fiscal year 1617 and that includes the increase of 880,911 and on page 4 we note the total fiscal year 1617 budget of 2 million 6003911 is three earned 50,000 or 50 more than the fiscal year 1516 budget of 2,000,280. On page 5 of our reports the west ed contract at a term of three years from july 1, 2000 wealth through june 30 2013 but did not specify the number of times about the contract could be extended. First five has extended the contract three times through june 30, 2017. So we given the existing contract between first five San Francisco and west ed does not specify the number of times the west ed contract would be extended, we make recommendations in which we show on page 6 of our reports specifically we recommend you amend the proposed resolution to specify first five San Francisco issue a competitive request for proposal provided by june 30, 2017 for a new contract to provide citywide Technical Assistance coaching training and services for publicly funded early care and Education Provider serving low income children and children with special needs. And any future contracts entered into by first five San Francisco for these Services Must specify the original term, the number of extension options on that term of each extension option and we recommend you approve this proposal resolution as amended youre happy to respond to any questions did the thank you i appreciate i recommendation. We will take it under advisement and at this point will give it and go back to Public Comment. Seeing none, Public Comment is closed. [gavel] supervisor yee yes. I have a question. In regards to the activity of the contract much of it is about assessments and i understand that the state is requiring or mandating some of these assessments of our title v programs. I dont knowto questions about that. When did that start happening . And then commit the states mandating it who is paying for that . The mandate for title v programs to participate in quality rating and Proven Systems began to years ago. And we still are at a point where first five is largely contribute in funds to pay for assessment services. If a stopgap measure to also, theres a very small amount that the state block grants of which only 200,000 is allotted for assessments. So the cost supervisor yee, is borne primarily by the county. Then when the governor made this a mandate was it specified that thethe funnypaper this was going to be tobacco money . No. It is not so what was he thinking . That you could just mandate and not fund it . Without objection no comment as to what the governor was thinking but we would clearly want to work with the Supervisors Office in advocating that the state provide more leadership and contribute to this mandate of making the system of qrs system, viable at the county level. I would love tomy office would love to work with your department on trying to sort of have the state mitigate this issue. Because this is the czar. That the state continues to create mandates, unfunded mandates, for a system that is so poorly funded anyways and to try to cripple it even further. So i think this outrage is in our local legislators at the state level should know about this. I will make sure they know about it. Thank you supervisor yee. We look forward to working with the thank you for being a watchdog on the supervisor yee. The members of the public that would like to speak . Seeing none, Public Comment is closed. [gavel] supervisor yeast would like to do . I will go ahead and make a recordation to accept the recommendations and to move the amended item forward with positive recommendation to the full board right. Thank you very much as amended this motion passes unanimously. The double thank you mdm. Clerk these call item 3 item number three accepting the Public Health to expend a grant in the approximately 137,000 from Public Health Foundation Enterprises to participate in a program entitled mac i can aids getting to zero for the period of july 1, 2016 through june 30 12,070. Hell take supervisor sheehy is a sponsor of this but today we got dr. Darden from the department of Public Health. To make a presentation to welcome. The morning thank you. This funding is in part of the getting 20 speed thank you new age of the deaths and zero hiv stigma by 2020. This is second year of this grant specifically this funding from the macaids foundation was allowed us to hire hiv care navigators or based at three dph clinics ward 86, [inaudible] Health Center in Pastoral Mission these navigators work with clinics in order to relink People Living with hiv have owned out of care and bring them back into care. We successfully relink under dating people and our first year of this program and we are continuing to provide these Services Within the community. As i mentioned this to the second and final year of this cramped in this funding will allow us to continue to operate what happens next year . We are seeking other options for funding through possibly two other grants as well sort of the alignments with existing services to see if these services could be provided within the system as it currently exists. So its kind of up in the year . Yes. Okay. Anymore comments . Just a question. Is this relatedduring last years budget process i rememberi thought i remember maybe it wasnt but its usually the city had funded this program. I think about 2 million. To support the program. Is this the same program . So as i understand the city have provided approximately 3 million getting 20 still changing getting to zero as all but the specific project, which is welinkage focus on relinkage to care and hiv navigation was solely funded through the mac eight foundation. Okay. With a 3 million allocated or if it does continue, could that 3 million absorb this . Currently that funding is targeted toward increasing prep update in the community preexposure prophylactic switches preventative for hiv. Its also focused on ensuring people who are newly diagnosed with hiv care are able to access care immediately. And there is somethen theres significant funding thats going to support increases in intensive Case Management as well as Employment Services and Food Services for People Living with hiv. So its nottheres no money thats directly allocated as part of that funding to this program although within the disease prevention and control branch of the Population Health division, we do have an existing infrastructure where we have a few navigators that arethat we can continue to support that are based within San Francisco city clinic. So we anticipate the ability to continue the services but the future of navigators being directly located within the clinics may need to change. Okay. I just wanted to remember because i remember that i was supervisor weiner that sponsor and icosponsored it after. So the same one. Yes. Its the same one thank you. Well will go to First Limited we have a bla . No. We do not. Thank you very much. We will go to Public Comment at this time. Public comment is open at this time. Seeing none, Public Comment is closed. [gavel] thank you the matter is now in the hands of the board. Is there a recommendation . Sure. I like to motion that we pass this to the committee with a positive recommendation all right. Without objection the motion passes [gavel] thank you mdm. Clerk item 4 please item 4 to accept an extended grant Public Health Foundation Enterprises to participate with the program entitled epidemic and Laboratory Capacity gonorrhea rapid attention response project for a period of august 1, 2016 through july 31, 2007 in the thank you again supervisor sheehy is the sponsor of this legislation can today to present from the department of Public Health is dr. Susan phillips. Thank you and good morning. Im susan felt director of disease prevention and control in the Population Health division of the San Francisco department of Public Health. Im coming to speed you today about a collaborative competitive grant that sfdph and the California Department of Public Health applied for and was awarded from the centers of Disease Control and prevention. This grant is really focused on resistance and gonorrhea cdc identified as the top three antibiotic resistant rats among organisms of Public Health importance. In california, there has the highest number of gonorrhea cases of any state in San Francisco has the highest rate per population of gonorrhea of any area within california. So for those reasons this is an important project for us to undertake. The purpose of able to really have new ways of identifying potentially resistant on a real in San Francisco and also devise Public Health ways to respond to protect Public Health, to detect and promote health in this area. Is that it . Could you kind of opine on my the rates are so high year . Of gonorrhea rates . Wide . Yes. In San Francisco and in california, the rates are generally high. Some of this is just due todue to changes in the way people are choosing to have sex and a lot of the advances they may of heard about with getting 20 with hiv have to do with a very very effective biomedical hiv prevention including preexposure prophylactics or prep and also treatment which is great for the individual Persons Health but also prevents transmission of hiv. There have been some documented decreases in condom use associate with both of those strategies over time and so that then does not protect against std transmissions with some increases over time could San Francisco has historically had high rates of stds and other areas as well. Predating the impact of Biomedical Agency prevention. Thank you. Lets go to Public Comment. We dont have a budget legislative and also report on this so we will open it up. Any members of the public to speak on this item . Public comment is closed. [gavel] the matter is in our hands. Lets make a motion to send it to the full board i make a motion to pass it out of committee with positive recommendation all right. That motion passes unanimously. The devil next item, please item 5 Real Property lease to extend the lease for continuous seas by the sheriff the permit for approximately 882,000 in the initial year with 3 annual increases with 120 14th st. As landlord for the lease lease extension term for july 1 june 30, 2022 all right. On one unlike welcome from the department of real estate shall be presented on this item. Welcome good morning mdm. Chairman and supervisor yee. Were your consideration and review today is a proposed Resolution Resolution regarding the second five year options to renew an existing lease for 1744 120 14th st. Approximately 18,000 squarefoot building plus, if you Parking Spaces used by the San Francisco Sheriffs Department for its training units and background unit Field Support Services Unit and also can serve as the Operations Center or doctoring in emergency. The current extension expires june 30 of this year and this option an extension would go through 2022. The underlying lease requires the renewal and 95 of the fair market rental rate for comparable spaces within annual 3 increase during the renewal period. In appraisal independent appraisal was conducted which 50 per swear food arriving at 47. 50 per square foot for 95 or, 74 74,667 per month. The appraisal was reviewed by the director and accepted good the city transaction agent was able to also negotiate an additional 3 concession for the rest of 2017 calendar year to exist with the sheriffs current budget. So for the rest of 2017 the Monthly Price goes down for a bit then it goes up to 4750 per square foot. The agent did look for other spaces for lease or purchase for the Sheriffs Department but nothing was available at this time that met the sheriffs current and future needs. In addition the city did approach the owner regarding selling the property but the owner was not interested and we do have a right of first refusal in the underlying lease so should the owner put it up for sale during the next five years we would have the right to refuse first. We believe this extension in the terms are in the cities and charts to the permits best interest knowing that the Sheriffs Department should begin its fiveyear planning now we ask that you approve this resolution to the full board good if you have any questions i am of the sheriff storm and the cfo are here to answer anything could thank you i do not have any questions but lets hear from the budget legislative analyst. Yes mdm. Chairman, supervisor yee, on page 9 of our report we note the sheriffs determine existing annual rent this is at 120 14th st. And 1617 is 550,003 and a 90 but thats equal to 29. 18 per square foot. For 18,862 square foot under the proposed lease extension, the rent would increase to an annual rate of 4608 for the First Six Months and then 4750 for the second six months. The total rent will increase from 550,000 392 in 1617 to 85. 5 161719 an increase of 332. 158 or 60. 4 . However, we also note that as the department has just testified from the proposed annual rent of 47. 50 per square foot represents 95 of the current fair market value established by an independent appraisal. As shown on table 2 on page 10 of our report over the fiveyear term of the lease extension, the total rent by the Sheriffs Department is 4 million and the total cost for utilities is estimated 20,001 191 resulting in a total cost of 4 million 943. 727 for the proposed fiveyear lease extension good we do recommend you approve this resolution. Thank you. Appreciate your analysis. Thank you. We will go to Public Comment. Public comment is opened seeing none, Public Comment is closed. [gavel] supervisor yee any comments or ideas you want to share . Ill make a motion i will take it. Passes out with a positive recognition to the full board all right. Without objection the motion passes. [gavel] next mdm. Clerk we no other business ladies and gentlemen this meeting is adjourned. Thank you. [gavel] [adjournment] listen, your story line, it makes for incredible tv drama. Thing is, your drug use is too adult for the kids, so im going to have to block you. Oh, man. Yeah. [inhales] well, have a good one. Youre a nice lady. Good afternoon everybody. The commission will please come to order and the secretary will call the roll. Commissioner commissioner pating. Present. Commissioner chow. Present. Commissioner loyce. Present. Commissioner. Present. The first item is the approval of the minutes and i apologize which ares i made some errors on the february 7 minutes and plear minor but three administrative issues. Okay. We will take the sets of administra minutes straightly and ask for a motion and ask for corrections to the february 7 minutes. Motion. There is a motion for acceptance. Second. And a second. Are there any further corrections beyond those that have been made to the draft minutes that were sent out. And i will note there are no Public Comment requests for this item. And there are no Public Comment for this item. The major revisions are on the first page and page seven we gave dr. Patting the credit for his comments under section 11. If not there is a motion and a second. All those in favor of february 7 minutes please say aye. Aye. All those opposed . Those have been passed. A motion is in order for the meeting with the Planning Commission on february 9. So moved. Second. We have a motion and a second, and further discussion . Any edits . If not then the vote shall be taken. All those in favor of the minutes of february 9 please say aye. Aye. All those opposed . Those minutes are accepted. Through the chair just a question i wondered if the Planning Commission gets a copy of our minutes and do we get a copy of theirs . Commissioner, the two commissions have separate minutes but i send our version to their secretary. They dont know the comments but know the people that commented so its much more brief and i accept theirs as well and i just file it. Okay great. I just wondered. Yes. There is coordination between the two. Thank you for asking. Commissioner sanchez did you want to see a copy of their minutes. No. Thats fine. We heard everything. It was a very good meeting. Okay. All right. Move on to the next item commissioners. I am just thinking it wouldnt hurt to send a copy of the Planning Commission minutes out to the commissioners. Sure. It takes a few weeks to get the minutes. I think for the sake of completeness the point is well taken that we should understand how they all viewed it that would be helpful. Sure. I will do so as soon as i receive it. Thank you. Thank you. I wanted to thank the commissioners that were able to come to the meeting and it was a rich discussion and a far more positive discussion weve had in previous meetings so this bodes well i think for the future. All right. Next item please. Item 3 is the directors report. Director garcia please. Good afternoon commissioners. I want to welcome nursing students from San Francisco state and from their program to see how governance works so we want to welcome them and as you know we have a policy on immigration status and interrakz with immigration and Customs Enforcement agents and we did a policy internally with the emphasize of providing services to patients and clients regardless of immigration and documented status with dph facilities and comply with the San Francisco sanctuary City Ordinance which prohibits the use of city funds or resources to assist ice with the gathering or dissemination of information regarding the status release or personal confidential information of an individual unless warranted by federal law and state decision so we did that work internally. Many of you were at the signing of the lease for the Research Building at zuckerberg several years ago week weeks ago and happy with that and heroes with hearts happened and i know you attended with heroes and dr. Knudson, dean shrilling ger and other Community Members and i want to mention we have created a team of people going out to the encampments, a medical street team that is working on trying to get individuals into addiction medicine in terms of access to care and also providing bridges to our primary care centers and this also is involved with our the Homeless Departments Encampment Resolution Team so i will leave it there unless there are questions about anything in the report. I was looking at the section concerning the immigration status and interactions and noted that we dont actually have the link here for the website for those that might be interested in looking at it so if the secretary could provide that to us that would be yes, i will make sure you get that link. I think it would be useful to see that. Commissioners questions on the directors report today . Yeah, through the chair i would just make note first of all i want to thank as our director said we have students from sf state and there is one of our former commissioners who is being honored along with other distinguished social change agents i believe in the channel nine abc miniseries. Along with other leaders and served a distinguished rotation here on the Health Commission and made significant contributions and at sf state and your institution contributes along with all of us if you look at these individual challenges. The other thing i want to make is the heroes and hearts. I think thats special and this is the Largest Group weve ever had in the 12 year history now of heroes and other hads to raise money for San Francisco gh. There is another thing to note and noted by our chair at that point was that we had four mayors there. We would have a fifth. Gavin newsom always comes but all the mayors regardless of political affiliation or whatever are there to support the importance of this and department of Public Health and directors and staff and a major note the other thing i want to mention is the fact that knudson puggy, our professor of surgery has been there not just there for a few months but 32 years. She the second female surgeon hired at San Francisco general in the history and faculty member and mary steel was there in the 60s and 70s and one of the mentors and youre there at general for the compation and commitment and with the department of Public Health and gives insight into reference to there is a link with the department of Public Health, with our institutions, with our faculty and our directors and justed just wanted to note that for the records and congratulate those that participated inlet events. I want to congratulate commissioner sanchez for the work hes doing as the representative on the foundation and also for your attendance also at the heroes and hearts. I am sorry i couldnt get there as i was out of town. David was sounds like it was extremely successful. An event after hours. They did. This is not one that participated in but dr. Patting may have. I participated in the past and this first year they didnt have an after hours event and the day time was wonderful and i ate your desert and pleased. Okay. Thank you. Anyway Excellent Program and we certainly continue to commend and thank the foundation for the work that they do and how well this has been built. Its grown out of the union square tents they used to have; right . Its now at the Giants Stadium and i guess you cant get much bigger than that; right . Okay. Thank you. Anything further comments . Any Public Comment on this . No Public Comment requests for this item. Okay. Then we will forward to the next item please. Item 4 is general Public Comment and i have not received any general Public Comment requests as of yet so we can move to item 5 which is a report back from the todays Community Health meeting. Commissioner pating. Today we heard two reports on General Health services with the center of innovation and learning in the Population Health division so dr. Pratt has been on the job as our director of jail House Services slightly less than a year and its been a very good year for us indeed. I dont know if people realize that the jail House Services sees 12,500 unique individuals through the jail every year and i think the strengths are in the our leadership and growing linkage to the health network. We heard a report on the true metrics and quality and Service Scores looking at the implementation of nar can in the jails and linkage for patients with hiv or detected with hiv in the jails and then doing additional assurances to make sure that we have effective transfers from hospital to the jails. Regarding the network we heard a lot about how we are screening for gc and chlamydia and have good Md Communications so i think this is an example these metrics are examples how the jail has become not just an isolated entity where people go into the jail but really a point of preventive screening and evaluation and then linkage back to the primary care clinics. We focused a lot on the linkage and the main Quality Improvement component the jails are taken under the system and using warm hand off techniques to make sure that patients are met, linked up to the primary care and behavioral Health Services and we hope to see gradual improvement of people leaving jail and connecting with services. We of really impressed with the relationship with the new leadership and the sheriffs and how theyre handling conversations with regards to collaboration. Working with a multisystem center like the jails were always having to do with Court Appearances as well as health appearances and getting the two schedules in line, and we have very Good Communications going on. It was really impossible to say anything bad is happening at that point in Jail Services and in fact we were impressed how well theyre absorbing some of the patients from the ab 109 release and getting them through. There has been an overall decrease in the patients going through the jail Health Services representing a longer trend Butt Department seems to be keeping up well and providing good quality so we gave them a seal of approval and hear from them in six months and more information hopefully on the qa process and look at cases in the review. The next report that we heard was the center of learning and innovation. This is the division that does Capacity Building and inform with trauma informed care, doings and continuous impact and improvement and we heard examples of training for Young College students going into Public Health. We heard about training and Capacity Building for preterm birth in the community and training for hiv prevention in the community as well and this unit is one of four units that we have across the division. We have a Training Division in zuckerberg and in laguna honda and in the network and they all Work Together with the center for learning and innovation. In fact were one of the other cities in the country that has a center for learning and innovation bringing new procedures and policies to Public Health in the country so were very fortunate to have these four centers working together as one moving across our division to again help build new capacities like lean trainings, trauma formed care, hiv care. These are things we have to make comp tendency across the whole system to raise the overall quality and dr. Fulks unit is key to all of that. Any questions on the reports . On the true north quality that they showed could you explain and maybe thats why six months they will give a better answer on the fairly simple question of hiv positive patients given discharge packets to which it sounds like the goal is 80 . Theyre at 26 . I mean so if you actually look youre looking at page 13 well, it would be 13 , right. The jail service true metrics and look at the bar graph and if good afternoon everybody. The commission will please come to order and the secretary will call the roll. Commissioner commissioner pating. Present. Commissioner chow. Present. Commissioner loyce. Present. Commissioner. Present. The first item is the approval of the minutes and i apologize which ares i made some errors on the february 7 minutes and plear minor but three administrative issues. Okay. We will take the sets of administra minutes straightly and ask for a motion and ask for corrections to the february 7 minutes. Motion. There is a motion for acceptance. Second. And a second. Are there any further corrections beyond those that have been made to the draft minutes that were sent out. And i will note there are no Public Comment requests for this item. And there are no Public Comment for this item. The major revisions are on the first page and page seven we gave dr. Patting the credit for his comments under section 11. If not there is a motion and a second. All those in favor of february 7 minutes please say aye. Aye. All those opposed . Those have been passed. A motion is in order for the meeting with the Planning Commission on february 9. So moved. Second. We have a motion and a second, and further discussion . Any edits . If not then the vote shall be taken. All those in favor of the minutes of february 9 please say aye. Aye. All those opposed . Those minutes are accepted. Through the chair just a question i wondered if the Planning Commission gets a copy of our minutes and do we get a copy of theirs . Commissioner, the two commissions have separate minutes but i send our version to their secretary. They dont know the comments but know the people that commented so its much more brief and i accept theirs as well and i just file it. Okay great. I just wondered. Yes. There is coordination between the two. Thank you for asking. Commissioner sanchez did you want to see a copy of their minutes. No. Thats fine. We heard everything. It was a very good meeting. Okay. All right. Move on to the next item commissioners. I am just thinking it wouldnt hurt to send a copy of the Planning Commission minutes out to the commissioners. Sure. It takes a few weeks to get the minutes. I think for the sake of completeness the point is well taken that we should understand how they all viewed it that would be helpful. Sure. I will do so as soon as i receive it. Thank you. Thank you. I wanted to thank the commissioners that were able to come to the meeting and it was a rich discussion and a far more positive discussion weve had in previous meetings so this bodes well i think for the future. All right. Next item please. Item 3 is the directors report. Director garcia please. Good afternoon commissioners. I want to welcome nursing students from San Francisco state and from their program to see how governance works so we want to welcome them and as you know we have a policy on immigration status and interrakz with immigration and Customs Enforcement agents and we did a policy internally with the emphasize of providing services to patients and clients regardless of immigration and documented status with dph facilities and comply with the San Francisco sanctuary City Ordinance which prohibits the use of city funds or resources to assist ice with the gathering or dissemination of information regarding the status release or personal confidential information of an individual unless warranted by federal law and state decision so we did that work internally. Many of you were at the signing of the lease for the Research Building at zuckerberg several years ago week weeks ago and happy with that and heroes with hearts happened and i know you attended with heroes and dr. Knudson, dean shrilling ger and other Community Members and i want to mention we have created a team of people going out to the encampments, a medical street team that is working on trying to get individuals into addiction medicine in terms of access to care and also providing bridges to our primary care centers and this also is involved with our the Homeless Departments Encampment Resolution Team so i will leave it there unless there are questions about anything in the report. I was looking at the section concerning the immigration status and interactions and noted that we dont actually have the link here for the website for those that might be interested in looking at it so if the secretary could provide that to us that would be yes, i will make sure you get that link. I think it would be useful to see that. Commissioners questions on the directors report today . Yeah, through the chair i would just make note first of all i want to thank as our director said we have students from sf state and there is one of our former commissioners who is being honored along with other distinguished social change agents i believe in the channel nine abc miniseries. Along with other leaders and served a distinguished rotation here on the Health Commission and made significant contributions and at sf state and your institution contributes along with all of us if you look at these individual challenges. The other thing i want to make is the heroes and hearts. I think thats special and this is the Largest Group weve ever had in the 12 year history now of heroes and other hads to raise money for San Francisco gh. There is another thing to note and noted by our chair at that point was that we had four mayors there. We would have a fifth. Gavin newsom always comes but all the mayors regardless of political affiliation or whatever are there to support the importance of this and department of Public Health and directors and staff and a major note the other thing i want to mention is the fact that knudson puggy, our professor of surgery has been there not just there for a few months but 32 years. She the second female surgeon hired at San Francisco general in the history and faculty member and mary steel was there in the 60s and 70s and one of the mentors and youre there at general for the compation and commitment and with the department of Public Health and gives insight into reference to there is a link with the department of Public Health, with our institutions, with our faculty and our directors and justed just wanted to note that for the records and congratulate those that participated inlet events. I want to congratulate commissioner sanchez for the work hes doing as the representative on the foundation and also for your attendance also at the heroes and hearts. I am sorry i couldnt get there as i was out of town. David was sounds like it was extremely successful. An event after hours. They did. This is not one that participated in but dr. Patting may have. I participated in the past and this first year they didnt have an after hours event and the day time was wonderful and i ate your desert and pleased. Okay. Thank you. Anyway Excellent Program and we certainly continue to commend and thank the foundation for the work that they do and how well this has been built. Its grown out of the union square tents they used to have; right . Its now at the Giants Stadium and i guess you cant get much bigger than that; right . Okay. Thank you. Anything further comments . Any Public Comment on this . No Public Comment requests for this item. Okay. Then we will forward to the next item please. Item 4 is general Public Comment and i have not received any general Public Comment requests as of yet so we can move to item 5 which is a report back from the todays Community Health meeting. Commissioner pating. Today we heard two reports on General Health services with the center of innovation and learning in the Population Health division so dr. Pratt has been on the job as our director of jail House Services slightly less than a year and its been a very good year for us indeed. I dont know if people realize that the jail House Services sees 12,500 unique individuals through the jail every year and i think the strengths are in the our leadership and growing linkage to the health network. We heard a report on the true metrics and quality and Service Scores looking at the implementation of nar can in the jails and linkage for patients with hiv or detected with hiv in the jails and then doing additional assurances to make sure that we have effective transfers from hospital to the jails. Regarding the network we heard a lot about how we are screening for gc and chlamydia and have good Md Communications so i think this is an example these metrics are examples how the jail has become not just an isolated entity where people go into the jail but really a point of preventive screening and evaluation and then linkage back to the primary care clinics. We focused a lot on the linkage and the main Quality Improvement component the jails are taken under the system and using warm hand off techniques to make sure that patients are met, linked up to the primary care and behavioral Health Services and we hope to see gradual improvement of people leaving jail and connecting with services. We of really impressed with the relationship with the new leadership and the sheriffs and how theyre handling conversations with regards to collaboration. Working with a multisystem center like the jails were always having to do with Court Appearances as well as health appearances and getting the two schedules in line, and we have very Good Communications going on. It was really impossible to say anything bad is happening at that point in Jail Services and in fact we were impressed how well theyre absorbing some of the patients from the ab 109 release and getting them through. There has been an overall decrease in the patients going through the jail Health Services representing a longer trend Butt Department seems to be keeping up well and providing good quality so we gave them a seal of approval and hear from them in six months and more information hopefully on the qa process and look at cases in the review. The next report that we heard was the center of learning and innovation. This is the division that does Capacity Building and inform with trauma informed care, doings and continuous impact and improvement and we heard examples of training for Young College students going into Public Health. We heard about training and Capacity Building for preterm birth in the community and training for hiv prevention in the community as well and this unit is one of four units that we have across the division. We have a Training Division in zuckerberg and in laguna honda and in the network and they all Work Together with the center for learning and innovation. In fact were one of the other cities in the country that has a center for learning and innovation bringing new procedures and policies to Public Health in the country so were very fortunate to have these four centers working together as one moving across our division to again help build new capacities like lean trainings, trauma formed care, hiv care. These are things we have to make comp tendency across the whole system to raise the overall quality and dr. Fulks unit is key to all of that. Any questions on the reports . On the true north quality that they showed could you explain and maybe thats why six months they will give a better answer on the fairly simple question of hiv positive patients given discharge packets to which it sounds like the goal is 80 . Theyre at 26 . I mean so if you actually look youre looking at page 13 well, it would be 13 , right. The jail service true metrics and look at the bar graph and if you look at well, dont look at the line graph. Look at the bar graph. Its hard to do interventions when people stay less than 24 hours and between 24 and sfo hours theres a lot going and the metric is those that stay more than 72 hours and detected with hiv positive based on the Screening Test on admission. You will see that 37 of them have been followed up with primary care. The goal is get up to 80 and so we have a 60 group and those that stayed over 72 hours and thats where we hopefully be seeing the improvement. The department is using warm hand off techniques so caseworkers are meeting people, giving information and telling them where to go. I think we need to see how it works out but there is a problem with 80 is a high goal. Its its an important goal and getting to zero plan but when theyre here less than 24 hours its really hard to make the diagnosis, the blood test, do the linkage. I assume on most of those the blood tests comes in after the person is released. I see. Okay. So you are following i mean that is being followed . Great. Right. Commissioners any further questions . Again i want to commend you for being able to help to go over the work that the committee is reviewing in the course of the year including the jail House Services. Thank you. There being no further questions lets go to the next item please. Sure. And i will no there was no Public Comment for that item number 5. Number 6 is the sfdph fiscal year 1718 budget update. Mr. Wagner. Good evening dr. Chow. I understand on this item we will take a vote. I wasnt quite clear. There will be a motion at the end. Correct. Its a motion to accept the Budget Proposal to be submitted to the Mayors Office. And the proposal is the memorandum. Yes, basically the budget as presented in the memorandum. Okay. Yes. Yes. Good afternoon commissioners. Greg wagner chief financial officer. So we are here today asking for your approval for the proposed budget in front of you. Your approval would be essentially to forward this document to the Mayors Office as the Health Commission proposed budget for the upcoming two year budget cycle. Theres the memorandum included in your packet. In addition there are theres a table summarizing the proposed changes in the budget and the individual written and more detailed interpretation of each of those budget initiatives included in your packet. We will be going through this in summary form. I will turn it over to our budget manager jenn louie shortly. Where we are today is as you recall at our last hearing we talked in kind of policy level about the budget instruction and approach to the budget. This is our second hearing and we have the initiatives proposed for submission to the Mayors Office in front of you. The proposal that is in the packet that came to you does meet the mayors instructions including covering the target from the Mayors Office of 3 and additional 3 in the second year and it also covers the revenues assumed in the citys five year financial forecast so the proposal does comply with the budget instructions and also funds some of the priority initiatives that we have identified over the past year. If the Commission Approves this budget and sends it forward to the Mayors Office the next step in the process would be that from now until june 1 the department will work with the Mayors Office as they review our budget subcommission and make amendments. There are items that we discussed at last Commission Hearing and we will touch on briefly again that are still in discussion and likely to be incorporated in some form in the mayors budget submission and would be in that phase and there are changes to the budget and i will turn it over to jenny. Good afternoon. I am the budget manager so as mr. Wagner said we are here to walk you through our 1719 Budget Proposal. We will have our regular revenue initiatives, revenue newt tral as well as key Strategic Initiatives that we will go into detail but before i do i wanted to give the context for the changes were proposing so what you see before you is the 1718 approved budget. This is the budget as we do two year budgeting this is the 1718 budget that was approved from last year and the base is 2. 1 billion dollars the significant division we have is San Francisco general at 858 million and behind that our second largest dwitionzs are Mental Health as well as laguna honda hospital. In terms base expenditures this slide shows the expenditures by expenditure type overall and this is how we spend the 2 billion and again most significantly more than 50 of our budget goes towards salaries and benefits and then followed by non Personnel Services also known as contracts. Revenues continue to play a significant role in dphs budget. The blue line that you see on each of these bars represent the revenue that each division is generating and included in the budget and that orange bar you see thats stacked up on top represents the general fund support that you see and with this budget were leveraging a lot of revenue in the services and where our revenues dont quite meet the expenditure gap thats where the general fund flows in and you will see it in the orange bars. In between the changes that weve already proposed just important to note that our 1718 base budget already grows by 43 million and these were the changes that were approved last year and i will just note that laguna honda hospital while it shows a negative growth that reduction is really related to the loss of a one time expenditure related to the laguna honda Remodel Program and actually not a reduction in the actual operations or services. In terms of position growth the department had previously requested changes that represent about 60. 72 fte in its base budget and you will see that right now prior to any proposed chairchs that dph is operating positions is at 6867 fte. Moving specifically into the detailed initiatives that we have first we will start with revenues and again to remind you about the figures sort of negative numbers show general fund savings so even though its an increase in revenues what were trying to calculate is whether the general fund impact so whenever you see a negative you will see general fund savings and a positive it means increase in general fund and increase in expenditure requests so first the significantly zuckerberg San Francisco general is projecting revenues its baseline Revenue Growth of about 16 and 13 million annually in this budget and then in addition thats also budgeted in its at San Francisco general are the gpp and prime revenues and the new medical waivers and 36 projecting this new growth and with the baseline revenues sources in medical waiver sources represents 49 million and dops to 41 in year two and laguna honda is projecting revenue increases due to midyear good news of increased in their current rates and so this rate change net overall represents 6. 8 million in year one and increases to almost 9 million in year two. Finally we are trueing up the primary case line revenues to the actuallies and increase of 2. 4 million we can achieve over the next two years. Moving to the budget neutral initiatives. EnvironMental Health is proposing neutral changes as it does every year. Its proposing some modest increases in its staffing to really supports it operations and all of these changes are offset by projected increases in revenue due to increases in their essentially their inventory. Theyre expecting increases in the number of fee applications and the like. We also included in some areas just a modest Cost Recovery for fees to just cost recover some of our inflationary costs. In addition the Population Health program had identified several grant expired grant funded positions that were using to offset the new fte increase so overall theres no change in the ftes as a result of this initiative. Childrens Mental Health is continuing a prior Year Initiative to meet some of the state regulatory requirements. In prior years the state expanded mental Health Services for foster care and which required them to provide two programs intensive case coordination as well as intensive home base services. In addition what it did last year was say well expanded the target population from foster children to basically all children who are covered under epstd childrens medical and then on top of that this year theyre expanding a new program introducing therapeutic foster care where medical certified agencies are allowed to bill for their services and training foster care parents to provide services to their kids. Theyre asking for 1. 2 million increase in professional services to support the cbos who would support the services and the increase is offset by 50 federal financial participation as well as 600,000 of 2011 realignment dollars that we expect from the state. Moving on to our emerging needs again we have four initiatives that were looking at supporting our core services. The first one is related to additional operating costs related to zuckerberg San Francisco general. As you know we opened the hospital seven months ago and now with seven months of operating under our belt we so reevaluated our operations and budget and the proposal used before you is realigning our budget to make sure its matching where operations are. The details are in front of you but significantly were putting more resources into our Emergency Department which did have expanded number of beds, additions psyche Emergency Services and were also looking at our imaging, our radiology departments want second were investing in de dphs Human Resources and the second and final year were completing a transition of a pilot where we increased our hr staffing to meet our needs and again as a reminder over the last five fiscal years dph added close to a thousand positions but havent kept up with the hr staffing to support them so if you think about every Civil Service hire and every separation we you know, its a drain on our hr staff and so what were doing here were proposing permanent positions to allow us to continue some of the services that have been provided overall and this would allow us to maintain our current staffing. Third, were stake a Department Wide lean strategy so were looking forward to be efficient and improving the quality of services we have were developing a centralized promotions officer of a Lean Management Office and then this office will be created through the reorganization of sort of two key programs we have. We have ambulatory Quality Improvement as well as some of our Mental Health work force and training and so through the reorganization of these two programs were going to move that into a centralized office that will actually provide lean support for the entire department. As many of the commissioners know we have been doing lean sort of in different areas and significantly at San Francisco general and laguna honda and primary care and other divisions and we want to establish a Central Office that will focus on dph wide needs as well as coordinated efforts among the various lean initiatives that we have. I will pause before i go into Electronic Health records and i have a detailed slide that follows but quickly on the inflationary side again theyre inflationary increases. The 5. 5 million is almost all pharmaceuticals and based on projections by dave woods our pharmacy director. Right now at this point were assuming 10 inflation on pharmacy and thats really just based on where we see the market going, and we will continue to watch this, but what we had a 6 increase for proposed 1718 already proposed, but he believes by 1819 the increase will be at the level of close to 10 . Going back to Electronic Health records basically as you remember this is this represents a multiYear Initiative we have to fund this major it project so what you see here the first line is what we believe the what we project the implementation costs will be over the next three years. This is based on a consultant study. Its not tied to a specific system, but overall what they believe they think we need to spend and then if you see down below the cumulative totals by 1819 they believe we would spend about 152 million. On the second half what you will see is what their existing planned appropriations so its a walk down memory line to remind you over the last several years we have been investing heavily in this project so in 1516 we had 12. 7 million and last year we had 11. 4 ongoing and in the last fiscal year we had 31 million as a one time infusion base the on one time project close outs so what we proposing for this year increase the budget by another 15 million ongoing. In addition we have also received two revenue transfers in this current fiscal year as well as the prior fiscal year and those and all of these sources together represent about 143 million. The difference between what were projecting what we have currently have or proposed is about 8. 3 million so again its still a gap, but we have some time to work on it and again we still dont have a vendor selected. We dont have a final Implementation Plan and over the next years we will continue to look at what the projections look like and then see what other resources we could put into it, but at this point we actually believe that with this last 15 million its a strong infusion and well positioned financially for a success completion of this project. So then to recap in terms of overall budget balancing again the mayors reduction targets were 3 each year and 18 and 36 million and in addition they assumed some of our Revenue Growth in the budget and again this Revenue Growth im sorry, they assumed it in the deficit so this Revenue Growth is used to offset increases in our salaries and colas and including the one you saw for inflationary. And then the total of our proposals you will see that were proposing 59 and 52 of revenue and offset by increases of 11. 6 and 26. Nine of increases and costs. Net, net overall what this does we are actually a little lopsided in terms of balancing but if you look at the two year total we have met the two year reduction target working with the Mayors Office on this proposal and this is an acceptable one to them so and their eyes we have met the mayors instructions. And then moving to show you the changes in the positions where you will see the divisions with a negatives where they repurposed positions and where you will see the increases but overall were proposing no net new fte. In addition to the initiatives that we put before you were still working with a few initiatives and the Mayors Office that mr. Wagner mentioned. The first are the mismurphy beds, the misdemeanor competent for trial bed and were seeking out so we dont have details on that yet. In addition were working to transform hummingbird into Behavioral Health Navigation Center and a significant programmatic change and working with kelly yometo to understand what that would look like and the transfer of Emergency Management services this was a proposal put into last years department, this transfer of the services to the Population Health division is effective july 1 to [inaudible] and christine have been planning for this. Its a significant responsibility and were going to need to understand programmatically what it will take to make sure that we support it adequately so theres sort of more to come on these initiatives. Finally to address the questions regarding ongoing Financial Planning we continue to prepare for some of the uncertainties that might happen and as mr. Wagner mentioned the Previous Commission meeting we have a controllers management reserve against potential state and federal issues and have a balance of 107 million. Again as a matter of sort of technical matter we have general ledger reserves where we sort of hold back a little bit of revenue to protect against cost findings, disallowances and negative reconciliations against the cost reports and our expected billings and then finally the ehr funds that we discussed earlier they are put into separate continuing project so the project funds will continue to be available and continue to roll forward until the time theyre needed and then we will continue to work on the Financial Strategies that we have identified in the fall limiting costs growth and increasing revenue capabilities so with your approval with this budget submission today will complete the Department Phase of the budget and move forward and work with the Mayors Office on the proposed initiatives as well as initiatives that are still outstanding and by june 1 the Mayors Office will make their proposed balance budget submission and in june go through board approval with final approval in july. Thats all i have for you but i am happy to answer any questions that you may have. [inaudible] [off mic] dr. Chow pointed out. Commissioners one note that dr. Chow identified in our write up on Electronic Health records project. There is a date in the writeup that says implementation i have lost my page and i am opening it up. It says that page 25. No. There we go. It says that in the writeup that we have a goal of implementing the new system by the summer of 2019. I want to clarify that date is the go live for phase one of the project and then the second phase two would have a go live date of six months later than that, so i mentioned that because the dates are a little different than what we had shown you in january but thats the reason for the error and the dates have not changed since the presentation we gave you in january. Thank you. Is there any Public Comment . I have not received any requests for this item. Okay. So commissioners i think before you is a rather extensive distillation of 2. 1 billion dollars budget but with the clarity that i think each year goes by and it becomes much easier to see where the dollars and the personnel are moving, so our request today is to forward a budget to the Mayors Office as we were requested as every department in the city is requested so that the Mayors Office then continues to work on the budgets that they will submit in june as noted in the next steps and i want to thank the department for making the presentation so clear so that discussion can be really quite pointed with the information that we have before you. The format continues to i think meet our needs. There is the spreadsheet that goes through each of the items as divided into the segments that we have here and then there is also the Detail Program change requests which really goes further into the specific details in each of the areas that they speak of. I think they clarified to us the issue of no further hiring as was are ordered and yet on top of that we have permission to add to the staffing as required particularly the new general came online so i think with that clarity we are now open for questions from the commission in regards to the budget. So commissioners questions or comments concerning the budget . Yes, through the chair i just want to change again our staff and all the units that have been involved really. This has been ongoing and its still ongoing. Its a continuum of how we meet the unique challenges and needs that we face in the city and those that are projected and still maintain like as an example i will just deviate a little bit because our mayor did make really excellent comments at the hearts function again talking about the importance of our department of Public Health and research and innovation and how we treat all people regardless of what nation they come here and we will awdle maintain that standard and i think even though we have a 3 cut, boom, boom in the next three years were still seen with the uniqueness of collaboration the fact that we are still steadfast pertaining to maintaining and assuring that we will try to maintain the quality of services and excellence for all of our people within our divisions and i think its really a testimony to the leadership and to the mayor and our staff who have been able to prepare this excellent document at this point again knowing there will be more revisions but again they know where we are and where the city is and we just want to wish you folks as they continue the excellence work and i know its a lot of exceptional work but the presentations have been just outstanding and made such a difference when you take a look how were reviewing it today versus many years ago, so just want to commend everybody for that so yeah i will be quiet tpt. Thank you. No, sir. Commissioner pating. Thank you very much. Mr. Wagner can you tell me whether two new items did they come with funds and the Behavioral Health Navigation Center at hummingbird. My understanding [inaudible] and hummingbird is the third of five of them . Is that correct . Yes. That is correct. And when four and five come online and i dont know if theyre planned theyre under the Homeless Department so this is the only one that is a joint work with the department that is leading the hummingbird location. Oh okay. But they will come with its own funds . Thats why its under the mayors line in terms of consideration for funding. Okay. And the second thing with the ems transfer to our department will we be looking at their budget before they transfer i guess at this point they transfer well, their budget transferred into our budget already last year so now were adding staff because in the analysis we did with the new consultant that came in we added seven additional positions to ensure to have enough staff to run the division. With regards to the 3 then its across the whole department and not the division. Thats correct and again those services were cut, no staff laid off. This is the ability we had revenue to offset that request. And by saying youre adding staff to ems are we expanding ems then with the transfer . Right now there is four staff coming with ems and we believe we need 12. We dont get the call center. No. Ems is the regulatory body that provides oversight of the Ambulance Services and the Emergency Services. Okay. Thats dr. Browns position. Dr. Brown is the medical director of ems and we have another position were recruiting this year for the ems director. [inaudible] so we certify all of the paramedics and investigate bad outcome from ambulance delivery to a hospital and protocols within the ambulances and type of services and level of service we provide is included in that ems role but we dont do the 911 call center. Got it and the last question goes to the balance summary. I think it was back three slides. That one, yes. So i understand the 3 so we have a net savings next year of 23 million and then the next year we are a little over so theyre going to call it a wash but we meet the two year goal of 3 . 3 is that correct . Thats correct. And this often happens and our practice and going over the two years. Balancing over the cycle. Exactly and balancing to the bottom line and what you see here. My concern is if the 3 stays in place and i guess were at 23 million over in 1819 i know you have taken a peek and years three and four any thoughts about that and does there need to be further tightening . Can you look that far ahead and will we run over budget . Sure. There are a couple of levels that we look at this so what were looking at today is the two year budget and so by definition under the city charter the board takes legal action to appropriate funds for exactly two years and thats what were approving. Also under the charter is the requirement that the city adopt a five year Financial Plan and that plan is is a plan. Its not legally appropriating funds, but its a process where we look out beyond the two year budget horizon and this is developed over a few years. It was as recently as six years ago the city had a one year budget and no Financial Plan and so the planning cycle and the thinking about the longterm financial situation for the city and our department has evolved significantly. There is the Mayors Office Financial Plan that projects the larger deficits in the out years and then as you know weve done our own internal finance planning that goes beyond this two year horizon, so we are going to have to as we see what the mayors financial budget looks like is go back and reconcile what we had kind of talked about as our five year Financial Plan with what has come in and out of our budget and look to see where we are. I think this is fairly consistent with what we anticipated our goal in that five year Financial Planning session was to look to increase revenues in a number of areas which this budget does, and also to limit the addition of growth in spending on new programs and expansion of programs so those are the two core categories of strategies and weve done that so i think what we should probably do as we have the mayors budget we will go back and do an update to those projections that we talked about at the Planning Session and review where we are and we will have to sort out the things added from the Mayors Office which will have an impact on the out year Financial Planning and other items such as one time expense capital end and that sorts. What i am hearing we did well with the revenue for the last two years and keep an eye on year three. Absolutely. I think thats what i am hearing. Absolutely. We are very conscious what happens beyond this budget cycle and that is driven partially by the decisions we make in each budget and partially by the economic climate in the city but yes absolutely we never stop looking at year two and we are very conscious of what our ongoing level of general fund support is and the focus of the five year planning. Great. Thank you very much. Yes. Commissioner loyce. I want to thank you for this indepth and clear budget presentation and documents and i am particularly pleased to read the Program Change requests because in there i get a clear understanding exactly where the dollar value is now and where its going to be and again thank you very much for that. Great. I do think that the brevity of discussion for a 2. 1 billion dollars budget is really amazing but i think it does reflect the great work that the department has come up with and mr. Wagner particularly in terms of the years as you have taken what was the development of this to this level and of course its particularly helpful that while we didnt add we werent subtract ftes and programs and we could be here more hours as commissioners know and the take backs that occur. I think the process e the evolved at the city level and look at two year budgets. Those that remember the one year budget remember how that became almost a constant yearly battle all the way through. Its like running for office throughout the whole year. We were running for the budget throughout the whole year and the fact we were able and you were all able in the past to have you know corrected the infrastructure problems at sf general was another part of this budget problem that we constantly faced so i think its really a credit to that. I believe were also beginning to look at forward planning as a commission and that as a follow up on our Planning Session theres a section in here about how we will then be looking at areas they will see and already put into place i am sure but theres a lot more to be done as we remember the projections you were showing that at some point the Economic Conditions change and of course we have the uncertainties from the federal government at that point so i would believe that as we move into that we will find a correct time that one of the issues for the Planning Session may well be to look at this as we get more information and look at the opportune time to place a Planning Session that would understand where were moving in the next five years as soon as some of the clarity comes from both economic and particularly the political world at that point. What i like about this budget i want to give credit to the director and mr. Wagner. This really keeps us despite the mayors request for the 3 budget cut fully staffed with regard to services. The reason that is important because youre in the middle of many quality initiatives and its very hard to do quality initiatives when youre having talent escape the back door because of down siding or layoffs or what reasons there are changes in staffing and i think keeps a very steady ship for the next two years and allows us to grow in the ways you have been innovating throughout with lean and Electronic Health records so its really excellent. Year three may be a different story but hopefully by then markets will fall and bounce back and back on it. Thank you. I will say that over the last couple of years as we formed the network and reorganized the Public Health division we went through a lot of changes how we approach our Strategic Planning and Financial Planning as a department and the approach on this really has been driven by working closely with rolan and his team, thomas and his team and everybody pitching in to figure out how can we meet those targets and without having to Impact Services and try to maintain the initiatives so we have been pushing forward so its really a good collaboration. Its still in evolution but a great collaboration between the finance team and the programs trying to make this thing work. You balanced our budget with revenues. Can i ask how much of that improved revenue collection . Does that play any role in u us the amount of income with services . Yeah, if you look at the initiatives so some is pure rate increases where we are getting paid more for the existing amount of services, but there is a big portion of this as you will recall one of our strategies that we discussed at the commission Planning Session was on the waiver, the 1115 waiver and gpp and prime and at that point were forecasting we would receive a certain percentage of the revenues that are available to us to draw down under that waiver. Were actually on track to draw down a higher proprorkz even at that Planning Session and a significant amount of our revenues included in these initiatives is a projection that we will do better than we initially anticipate and drawing down the waiver funds and that is all based on really a changing our operations to meet the metrics and the outcomes that are embedded in those waiver programs so that has been a big effort. Its a big part of the true north planning on the network side so thats one of the areas they think we have been successful, but theres a lot more, and revenue capture issue is going to be a big focus over the next three years as we lead up into the planning phase and the implementation of the ehr and gives us i guess an opportunity is one way but it very much compels us to redesign our Revenue Cycle processes and were going to take that opportunity and use it in conjunction with the lean process to make sure that we are pulling every dollar into the system that we are entitled to. I remember you had several recent contracts, right, in order to do the studies . Yes, absolutely. And passed last time. Thats correct. Just to add i want to thank greg wag ner and jenny louie and the staff has been incredible working together as the cfo said and we are concerned about year three and four. You cant open up the newspaper today and cant think about and particularly under Health Care Changes so were working with our executive staff to keep our planning processes going so were prepared for any changes as the Health Care Environment changes, but we are very fortunate as greg said and in that area and better with Revenue Generation and as changes happen in the future for us so were fortunate to have a city that and mayor that is very responsive to this and you see were having growth particularly in the Mental Health area and Substance Abuse areas so we really are appreciative of that because we know theyre very needed so with those two just programs plus our 30 beds for medical respite were finishing up in construction now we will be close to 100 beds in the s and fortunate for that and the people that we are serving need that and we want thank the staff and the commissioners for the support of the budget. I will add my thanks to jenny. She is without match in the city and managing the budget process and our team. We have an Incredible Group of people on the finance team throughout the department that are you dont seem them up here but theyre doing a huge amount of incredible work for the departments and i want to acknowledge our finance team and thank them for their work. Thank you. I think this shows the wisdom of having centralized our finance department. Historically those will remember we had a decentralized and four different finance departments and trying to work between all of those and looking at a budget would not allow us to be quite as sanguine about the budget as today so commissioners if there are no further comments we are prepared for a motion to move this budget to the Mayors Office. Moved. Second. Okay. A motion for approval and recommendation to the Mayors Office. All those further comments . If not were prepared for the vote. All those in favor of submitting the budget please say aye. Aye. All those opposed . It has been passed unanimously and thanks the staff and the department of. Thank you. Thank you. Commissioners item 7 is the 2016 Public Safety and bond safety update and i provided you an update of the presentation and it didnt print properly i will pass it out. We centralized the reports to the commissioners and important to understand the dynamic bond work that is being done but todays report we want to take a minute to really get all the commissioners to understand the bond process and so were going to take a little time today for you to know that and then as we come to report we will give you more understanding of the programmatic pieces but today were focusing on the big large timeline, all the multiple projects. Its different than what we did before and we had one hospital. This is multiple projects going on so there are multiple people working on the projects so we have a little bit more coordination were trying to do but centralizing it to the commission in one location is helpful for everyone to understand. Right. I also think it is important to note that this is a bond issue that covers as the director said the entire department. In the past even at the Commission Level we heard the progress at [inaudible] for both laguna honda and general but each was a specific bond issue, so this is i think probably unique for many years we havent had a general bond issue so i think hopefully will be the beginning of also that kind of a project that we will be tracking to be able to be the over oversight the improvement of all of our assets, so we will then hear the presentation. Thank you. Good afternoon. Mark primo capital oversight director garcia and joined me is terry satz and project manager chin. So director garcia wanted me just to briefly kind of go over the major Financial Instruments that the city used to fund capital so the 2008 bond, the laguna honda bond and the june bond that just passed are all go bonds that need to get voter approval of 66 and 2 3. Theyre usually a 20 year term and the debt service is general fund which comes from property taxes and probably the biggest use. The second biggest use of Capital Investments are Revenue Bonds and you see those from the airport, Enterprise Department ofs, puc. Those are things like the sewer charge and paid back through both fees and also some combination of general fund. The third instrument is called cops. Theyre c certificates of participation. The courthouse at mc clatster used that method and the san bruno jail used that financial instrument and the last one with the least desirable from the Mayors Office to fund is actually with cash, general fund, and the instance of both the 2008 and the 2016 bond we got what they call prebond funding which it allowed us to gain a lot of time so after we passed the o zero for the new hospital we were in the 08 in the ground seven months later and similarly we started a small project with general and doing work at the southeast Health Center and because of the probond money. However there is limits on the amount of debit that the city can issue so they tie how much they can issue and how much they retire to a formula that is constrained by property taxes at 2006 rate so even though you will see annual incremental increases for indexing you wont see these large jumps because theyre retiring bonds in a way that when they issue them it doesnt bump up against that curve. The city also has a charter constraint which is the debt service it has to be below the 3. 25. Thats assessed values and so theyre actually probably a percent below that already just for to get better ratings on the bonds et cetera but thats a charter requirement as well. This is a little looking into the future. I mean we if you look at bites out of the apple possibly laguna honda was the first with the go in 99 and in 2008 was the second and third is the june bond so we have another bond as a place holder as you see in november 2022 and a number that was approved at without detail but a place holder to develop what that scope is, where the money is spent and we actually had a second retreat with 40, 50 people to strategically lays out what happens at general with the clinics and the laguna as we move forward with the next bond so in june theres a 350 million bond passed with the voters and 79 . This is probably the first time we have shared a bond with other agencies, and it didnt start off like that. This is actually the fifth version of this bond. We started with 535 million which was as you recall was actually do 101 grove as well as building 8090 and other projects. That got cut back because of other High Priorities like the Affordable Housing bond. Sfmta came in with a bond and further constrained us we cut it back to 435. I think it was zero at one point which doesnt make sense and up to 311 and approved finally at 350 and partial political road map to get to where we at but out of the 350 we have the 272 and the homeless and Supportive Housing has 20 and the Fire Department has 58. This is just an allocation of the bond authorization broken down by each building. We probably will drop off since this is the first presentation we will drop off the other two agencies from any subsequent presentations so we just focus on dph, and so this shows the current appropriation. The current appropriation is the free bond money i talked about which a us to accelerate some of the projects. I will skip over this terry will do the slide i skipped over. The bonds were rated high and double a plus and Interest Rate below 3 . Weve spent to date end of january about 10. 6. This number 9. 9 is from the end of december and again thats the prebond money that we got that allowed us to do what were doing now. The budget line item even though the bond was 173 million some to the Fire Department and other departments so were tracking the 146 million that is our piece of the pie. Terry do you want to go over the highlights . Good afternoon commissioners. Director garcia. This is an exciting time. We have the bond projects getting under way and i would be remiss without acknowledging director garcia and leadership and guidance and mark primo and tireless work on getting the bonds moving for us so we have a west portal avenue between uloa street and vicente Capital Program and we had prebond money to get the work done and the slide shows some of the progress we have done last quarter in getting a lot of stuff done. As mark mentioned the south east Health Center is ready to move forward into a construction phase. Weve actually broke that up into two phases and to were kind in a mode to conserve as much bond dollars as possible to get as much scope possible and the southeast Health Center is under way shortly. A contractor was just awarded that scope. Maxine hall and Castro Mission have been advanced through a conceptual design and Structural Design so those are moving forward. We are looking forward to maxine hall to Start Construction in the Second Quarter of 2018 and Castro Mission in april 2018. The rest is about zfg so i will advance to the next slide. Which is advance . This slide that talks the work were doing at zsfg and in the upper corner on the side of the new rebuild project there is the existing 1970s era main Hospital Building were familiar with. We will be doing a seismic retrofit of that building which will entail scaffolding all around the exterior of the building to remove the horizontal elements exposing the columns and fieker wrapping the columns to strengthen the building and improve the performance. That work is scheduled to start in september of 2017 and weve also got our physical therapy project which is it will be [inaudible] last fall and were in the permitting process right now. I want to mention with the permitting process with the seismic work and called a collaborative process and going back and forth with them and working with them and not simple submitted the drawings and get reviewed. Its a back and forth and hone in and get the permits shaped for the project. Weve continued with the Public Health lab and dialysis projects, the relocation projects. We are at 100 Design Development on both projects of the were planning on construction start dates for the health lab in 2018 and the dialysis lab in 2018 and with the tb clinic and work flow studies and work space so the work happening with the seismic around the perimeter of the building and expansion that joins the wing with the rest of the hospital there will be disruption in the hospital for offices and spaces and creating space within the building to move offices during the construction and thats what the surge space project inn tails september 2017 start date. We also are in construction phase with the urgept care project and thats proceeding and plan on having a complete by August August 2017. And in the midst of this were planning for it infrastructure and building it up and were going to have not only the ehr coming this way and have a larger footprint and building that up and thats the work at zsfg. With that i will introduce our health care and action display. [laughter] professor chin from dpw who has the responsibility of managing the bond throughout the departments. Thank you. Good afternoon commissioners. Joe chin public works, program manager. I am here to give everyone an update on the other two components of the Public Health and safety program. These are the smaller yet so important programs within the Public Health network. Its the Health Centers, community Health Centers so one of the larger component is the southeast Health Center and as mentioned earlier there are two phases, phase one and phase two and phase one is focused on renovating the existing space with a focus on the dental suite and some of the lobby space and that project as a matter of fact delays updates we issued so construction has started officially on february 10 so thats great news based on the prebond dollars allocated to these projects and what is coming up next for the next few months is obviously the current target is complete construction of phase one Second Quarter of 2017 and then also to complete the Schematic Design phase for the phase two which is the addition of new multistory building adjacent to the existing facility and kind of looking at the overall budget theres about 30 million that has been allocated for phase two im sorry 25 million for phase two and 5 million for the renovation project. And then the other components what we call the various other community Health Centers and the focus has been on three community Health Centers, Castro Mission and maxine hall so i will focus on those two Health Centers first. We completed a Structural Assessment of the two facilities and found that there are some structural needs that need to be addressed as part of the design process and two of the upcoming activities is complete design. We have done a lot of design work with the prebond dollars and by july of this year we anticipate finishing the 100 cd and segue into bidding award and construction for cast troo mission and the other Health Center is maxine hall and a little bit behind but tracking for 50 Design Development drawings by march 2017 with construction anticipated to start Fourth Quarter of 2017 and the third Health Center that we have been working with Public Health on with staff is chinatown Public Health. We started the planning process or the development of the scope and doing project development and programming for that Health Center. Amount anticipating to finish in bring 2017 so the next slide is to give overview of the construction budget for the components. The first slide is focused on all the projects at zuckerberg, sfg as mentioned earlier there is 222 million allocated to the zuckerberg project costs. The next column we call encumbrances and the end of 2016 and the reason the numbers are fairly low is the focus has been on design side so thats what is being tracked under project control and really the only project in construction is urgent care which reflected by the 102,000 for the Construction Side so as we progress to design and construction the dollars towards the construction will obviously be ramping up. And then the next slide is very similar to what you saw now for the zuckerberg piece but this table is showing the budget for all the community Health Center which includes both southeast as well as the other community Health Centers so total budget were track being 50 million for all project costs both construction and soft costs which is generally what we look at as Design Management and any other specialty tasks and support to deliver the construction of projects and this one is data as of end of 2016 which is the reason why it doesnt show the actual Construction Costs for southeast phase one. And then the last slide i have today is what we call the Program Schedule summary and this just high level schedule that shows all the projects within the zuckerberg southeast and community Health Center and everything up to three line items design, construction and close out, and you know one thing i want to point out as you can see design is going to continue from or at least for zuckerberg the design has started in 2015 with the prebond dollars and pretty much going to extend through 2018 and you can see there is overlap of construction because a lot of the projects are going to be awarded while design is continued for other projects and thats why there is overlap and likewise for the southeast Health Center there is a similar pattern because of the fact that design is continuing while construction proceeds and last is the community Health Center so it shows basically Design Construction again and that concludes our presentation for today. If you have any questions. So my first question actually under the construction budgets you have the column called project control which seems to be a fairly considerable portion of the total so what is in project control versus construction purchase and mobilization in the budgets. Thank you for the question commissioner. In general the project controls is what is support services are needed to deliver the project. Construction is hard construction dollars. That is a contract awarded to a contractor to build the work but in order to start there is a lot of support from the architect, engineers which is not as large as the Construction Side, but theres also the project management side, Construction Management during construction to provide Quality Assurance and quality control. Some of the projects are by jurisdiction so therefore theres a need for representatives that are certified by the state to provide onsite management and inspection during the project so hopefully i answered your question. So that includes the architects, the designs and all of that before you begin and the top number is the actually construction . Thats correct. And does any of that include equipment . Probably not huh . No. No furniture. And included in these projects. It includes items that are fixed to the building and not sfne. These projects have we also accounted for furniture and supplies somewhere in somebodys budget . Greg can answer that. Okay. And yes we have. Yes commissioner. So we have projections for were still working through the furniture and fixtures process where we get into the detailed work on precisely what were going to purchase but we have high level estimates. We have included those in the five year Financial Plan of the city and have funded allocated beginning in next fiscal year 1718 for some of the dollars. As we experienced with the rebuild and the laguna honda bond theres always a lot of work to do to pin that number down and theres always more need than is available to be funded, so theres a lot of priority decisions to be made and also conversations where we might see additional funding outside of the general Fund Allocation given to us so that is proceeding. Were working on it. Working on its on a separate track and its not a bond eligible expense unless as joe said its affixed to the building. So if its not in the bond its also not in our budget that we just passed; right . Its a capital expenditure. So in the base budget and last year budget fiscal year 1617 and 1718 there is allocation of 6 million in fiscal year 1718 so thats in the base and another 5 million that is in the five year Financial Plan which will have talking with the Mayors Office over the next three months about whether that will get added into year two of the actual budget so there are some dollars that are part of the citys general Fund Planning process but again it wont be enough to cover everything that we need so there will be ongoing discussions how we fund that. Thank you. Commissioner pating. Thank you very much for this review of the bond. The dollars are large and certainly i think that our clinics do need modernizing. I think the spaces dont really reflect the Excellent Services that people receive in the spaces so i am glad were bringing spaces into the 20th century. With that said i actually would like to see the plans. I think it easier for me to be able to connect the dollars and the values that are being applied to the various reconstructions if we could see what the plans look like. I have seen the southeast Health Center plan and i really like the concepts that were involved. For example i think youre going to include a big courtyard which seen also as a Gathering Center and a Wellness Center and i would be interested looking at the other ones whether the concepts are extended to other ones. Theyre coming. We gave the first initial review today and well get deeper into this with the designs and weve had lotses of hours of staffs input into the designs as well. Great. So we wanted today to make sure you understood how the bonds work, the financial oversight of those and some high level on each of those and we will get deeper into the projects as we go along. Very good. I think we were looking at zuckerberg area and trying to be more concrete in each of the other yeah, more concrete in terms what does 50 million buy in regards to a clinic . And what i like about the southeast clinic and i wont get too far ahead but i like that you moved from the idea that providing care is just an office visit to providing care is a place where communities can come and do more to both prevent health, discuss about health and really enjoy their health in a very open and positive way and i thought that was really a move towards the future rather than you know bunch of offices in 20 years looks like another concrete building. Absolutely. Well, we can give that credit to all of the staff that contributed to that and also thank you for acknowledging the fact that we really want to and as you can see we have to go ahead of ourselves as well as really trying to look at the departments truk and all of t infrastructure and the buildings on campus that we own and make sure that the lynn clinics get dollars as well and over the last five to ten years added general fund dollars to some of the clinics and we have been able to get some of the dollars from the city to again bring up as an example we have put elevators in the clinics so two floors are able to be used and one was maxine hall as an example and this is where i first started by work with mark almost 20 years ago trying to look how we will going to develop and keep maintenance of effort of the great facilities in the community and theyre from the 1970s so they need a lot of work. And with the clinics we need to think of the future and probably not remodeling [inaudible] and Team Approaches is the theme and taken the work and many have lean processes along with it so thats why in one example of why i supported the lean process because it does gives us for example the Public Health lab did a lot of work and one of the important labs in the city and serves the entire city for Infectious Disease we being have and outbreak and want to make that lab as efficient as possible. Its on the fourth floor if you would like to take a tour i would like to show you. Its not an efficient lab and we have been adding on in this not seismic safe facility. Is that part of this bond. Yes and on the fourth floor. Moving into zuckerberg. All right. We will move keeping into it and any other comments so through mark and make sure the staff gets that and we have plans to show you the plans and the details. Back to the financial questions at the interface of the bond budgets and what is not in the bond budgets which maybe a television that wasnt planned or a chair or stool or a staff i guess how do those things get worked out . What is in the bond and what is not in the bond . And what if theyre under run or over runs how do the dollars get worked out . We dont allowed over runs sir. [inaudible] [off mic] how do we manage the risks around the budget since were talking about budget . Surely wont be a television set; right . Yeah, right. So we can go into as much detail you would like but we have a pretty good process that we practiced in 2008 bond which had a very large and ebs Extensive Program and we have high level of magnitude and we literally have a process where we bring in outside consultant that develops a data base of every piece of equipment that is going to be purchased or that we would like to be purchased for the facility. Then we go through the process of prioritizing and trimming that down. Its an iterative process. I think when we started with the 2008 bond the new hospital we at one point had a list of well over 200 million we ended upbringing down to 170 including all of these things and it and equipment so we will go through the process. Furniture im sorry, furniture, fixture and equipment and it needs so we have a good process in place and at the end of the day we are going to have a budget that we have to work from and then were going to have to go through and work with the project team and the operations to determine whats a must have and whats a would like to have. The must haves will have to work around the budget. The like to haves we will draw the line at budgeting and we also have an ongoing process of having things that are in at day one and things that will be at day two so i think we have a got good process in place. Terry satz manage the process for the 2008 bond and we have a process how to manage that. Thank you very much. Commissioner loyce. Thank you for the presentation along with your colleagues. I have what i think are simple questions and probably will get simple answers but i would like to know what the go Oversight Committee fee is . What do we get for that . And whats the formula for arriving at that and at the same time what the controller auditor fee and i am wondering what we get for it . Theyre voter approved measures that the controllers Office Office worked closely to develop the costs. The audit fee is something that the controller uses to go into and look at a project that contractors and subcontractors are not over charging the city through the rates or labor rates or a special problem we want them to look at and they looked at one of the projects related to the ucsf Research Facility and the expandablity of the garage and used some of the funds from the controller that goes into that pot of money. Let go Bok Committee was approved by voters to review the dollars spent to make sure theyre being spent in line with what the voters approved so thats their mission and i think thats a quarterly meeting joe . Its a quarterly meeting that we go up there, present much of the same things youre seeing today and then we get their comments back in terms of individual members. Thank you. Thank you. Commissioner sanchez. Now i just want to thank all of you for this excellent presentation. I mean we have been involved in various parts of it like sfgh before, laguna honda, southeast clinic, close the dialysis, dont close it tb and all of them are in the radar and you forget about them and we are focusing on different issues and see you in the years focusing on one project but this the first time i can recall all of a sudden its presented pertaining to the totality of what were in the process of doing and i think you gave an excellent understanding of the different funding methods between the different bonds and the fact that some of the mayors have expedited that knowing that weve had lag time before so why not like for the berg bargaining hospital and use general fund to move on but this took time and effort but this is the first time we had oversight pertaining to all of these above and with the time factors and whatever. It blows your mind saying wow. All of a sudden we have a much wider picture and we will be looking at them as we proceed on because i mean i was so glad to see the tb units and all of these things are still on the raider we forgot and all of a sudden its here again and chartered and where the funds come from and the time factor but part of the overall vision so i just want to thank everybody and the director in particular for saying you know lets integrate this and bring it together so we have a complete radar of what in fact were doing in the department of Public Health with funds generated through the different processes and doing the Quality Assurance et cetera. This gives a comprehensive understanding so i want to thank all of you and i know it takes a lot of time and youre involved in many segments of it and it brings it together for us. We look forward to a future presentations. This it takes a lot of time but keeps us in whichd and we thank you for that. So director garcia since this is new and looking at a total bond issue rather than previously trying to get the go dollars to do it im going to ask how we should be able to track this because its actually multiple projects and the project schedule is here. Were going to come to you quarterly and what we will probably do is take one project at a time and thats something we will work with you but i wanted to acknowledge commissioner sanchezs comments and we take this seriously. Theyre from voters to give us dollars and we are responsible to use them responsibly so we added layers of oversight in the department that everyone is accountable to the voters so i want to acknowledge terry and his team and others in the room and mark primo that lead us around the bond process. Dpw plays an Important Partnership with us and we have to figure out what we will give up to make the dollar work and thats what we did with the hospital and i think we had to do to make sure were responsible to the voters and get the project done and it may be different at the end and you dont know when you pull out a wall in the older buildings if you have done renovations but i want to acknowledge the fact that greg and i sit on a team and we do oversight. We asked dr. Eric to be the project manager oversight for building five and shes doing that and so we have layers of oversight to ensure were meeting the goals but it starts with our staff. They have to give us input how it should work so we spend a lot of time on the front end and allowing staff to give input with the designers. I dont design the clinics. The staff does. It doesnt work unless you have their input so i think we do that pretty well and getting good at it and so but it is important for us to meet the voters goals and also be responsible for the dollars. We feel really responsible for that and i think the staff do as well because they know we may not get another bond if were not doing these right. The voters gave us their support for this and so we feel obligated that we meet those goals but i want to acknowledge mark primo who has done a wonderful job for us. And has been doing a wonderful job for us for years. Since this is the first piece we will try to put a calendar for the process and get the full picture and look at it from the design and construction and close out since thats the way it is and get deep into it and ask questions and if we dont do enough do the next time and the input to feel comfortable about the process. Excellent. I think this a new area that were now moving into allow us to follow the project here or projects. Thank you very much. Thank you. Thank everyone for the work that they have done. Shall we go was there any Public Comment . No Public Comment requests for this item. Can we go on to the next item . Sure item 8 is other business. Commissioners other items that you may wish to bring up at this point and time . If not i would just note and i know we sometimes merge this but on our calendar we were looking at the Community Programs and the director and i were suggesting that we actually consider going to the sunnyvale who had a Wellness Project and programs out in that area. Oh sure. So we are open to your suggestions also but thats what were looking at at this point and trying to find the right timing and we have a site out there already. Wonderful, and commissioner i was waiting for the elections to occur as to once that happens to deal with the president and Vice President on dates and trying to hone that down but i will