torques the majority of the staff here, i'm reaping that sometimes. but again, i have an investment to give the kids, what was given to me. as a former beacon student, i had many, many different staff members continue to invest their time in me, treat me like a little brother and even like a cousin. however they wanted to do me, but though, sometimes i was being rude, sometimes i was an obnoxious student, they still loved on me. and i decided that, ok, i have to go ahead and give back. i never thought i would be in this position i'm in now, but i'm honored to give them what was given to me. to hear we're going to be receiving $377 million over the next five years, to invest in our children, the youth and their families? it literally touches my heart. because now i know for a fact that san francisco is definitely invested in our young people. and want to see them grow. it's a beautiful -- into beautiful young adult. so again, i would love to give honor to everyone else in the rightful places and i thank you guys. me, myself, having two children, a son and daughter, i know that their futures are going to be very successful if they have a place like san francisco that cares for their children and families. thank you, guys. [applause] >> thank you dante. i want to acknowledge that our public defender just arrived. thank you. so that concludes our very exciting announcement. for our nonprofit agency ins -- agencies in the crowd and some behind me, we'll be releasing the reward announcement later, 1:00 today. so check your e-mails. and you'll be pleasantly surprised. thank you so much. >> secretary will call the roll. [roll call] actually, commissioner, please turn on your microphone. thank you. ok. great. [roll call] >> and i believe commissioner chow has an announcement. >> yes. as many of you may know, but others may not, i want to just acknowledge all the work that commissioner [inaudible]. he had resigned for personal reasons as of the beginning of this month. for that reason we have made adjustments until we have election of officers. as you know, he was vice president and with the concurrence of the commission, we will not vote for a new vice president until we reach march. and meanwhile, however, dr. pating's assignments, i would like to publicly make the following assignments in place of where he was. as he was chair of community and public health committee, i've appointed commissioner loyce to be chair of that committee. he is currently a member. and commissioner bernal will join him as a member of that committee. dr. pating was also on laguna honda and i will take his place on the laguna honda committee. so, those are the announcements for our committee assignments until we have our election. thank you. >> if i may, commissioners, commissioner chow was reappoint by the mayor's office. so, we have him for another four years which is cause for celebration. >> thank you. [applause] >> let's move on to item number two, which is approval of the minutes from january 16, 2018. >> minister, a motion is in order, please. >> second. >> ok. are there any corrections to the minutes? i want to thank dr. sanchez for actually helping chair that meeting. who did apparently a sterling job in having it adjourn in half an hour. so, thank you, dr. sanchez. if there are no corrections, we'll vote. all those in favour, please say aye. >> aye. >> all those opposed? the commission meeting of january 16 minutes are accepted. our next item, plea. >> item three is the director's report. >> good afternoon, commissioners. i want to, a knowledge that we have several members of the san francisco state university nursing programme in our audience today. just wanted to give them an acknowledgment for coming to the [inaudible] what happened. also we're tracking the issues as the federal government impacts us on our health care services and so just to let you know, we are following this issue as it is changing every moment. so we are following the cost of 340bs and some of the potential reductions of that and the impact of the mandate of the nonmandate and status of our family community, status of community health centres. we're also impacted by this and the fact that we do receive dollars from the federal government for our homeless services in the city and we recently had our deputy director with the san francisco clinic consortium in washington, d.c. to make their visits to advocate for the health centre funding and so we're tracking all of those three areas. i suspect by the end of next month, we can probably come in and do a financial update for you. just depending on where things are and we know that the potential of another closure of the federal government could happen and so we do really want to work closely for all of our providers who are dependent on federal funding and closely in communication with them. so that is the update for the federal government side. i want to let you know that we are focused on syringe disposal and so one of the policies that we've made internally is any out reach worker that is hired by the department's funding, at least for the next year or so, will have to have part of their work will be disposal. we recently hired six additional individuals who will do engagement in the community and one of their responsibilities will be syringe disposal. in your report today, it shows how we've collaborated with other city partners to place five disposal kiosks in this last year and we currently have 17 out door syringe disposal boxes and in your report, there is a map of all of their locations. i wanted to also let you know that we have received a $6 million grant for dental transfornight fight childhood tooth decay and this will allow us to target high-value care, improving access, utilization performance measures and to also increase the use of preventive dental services for children. and to prevent and treat more early childhood carries and increased continuity of care for children. this is an important fund for us and we have several partners in the community. as you know, we've seen some of those reports previously in front of the commission. that is the end of my report, commissioners. if there are any questions, i'll certainly try to answer those. >> commissioners, any questions from the directors report that you would like to ask? >> director, i only would ask if you could just speak on the dental transformation in which it seems to be under a medi-cal programme. is that it we would then -- we've had an initiative over the last several years. how will this co-ordinate with that initiative? >> it is a part of that whole coalition. it's a waiver -- dental care waiver that we applied for. >> oh, great. >> so all of the partners that both you and i have [inaudible] in their events are part of this whole coalition on dental care for children. so they're participating and some have been funded through this process. >> commissioners, if there are no other questions, then we'll proceed to our next item. >> item four is general public comment and i received many requests, but the requests are all specific to item seven. i just want to make sure that there is no one else that would like to speak to general public comment, which is about items not on the agenda. ok. we can move on from item five. which is a report from the finance committee from earlier today. >> commissioner chung. >> good afternoon, commissioners. the planning and finance committee met today before the commission meeting at 2:00 p.m. and our agenda is nothing but contract approval a. you'll find the consent calendars with the new contract as well as the contract report that we would like to vote on. >> commissioner chung, i'm just noting that there was one change, probably the other commissioners didn't notice, but you corrected the -- >> oh, yeah. >> the term? >> yes. there was one slight adjustment with the contract terms. so, what happened is there is -- there are about four to five contracts for substance abuse services and, you know, behavioral health. one, they are supposed to, like, have the same contract term, but one of them has a misprint so we've asked them to correct that to reflect the consistency of other contract. it's supposed to be from august 18 to -- >> 2022. >> yeah. 2022. >> thank you, commissioner chung. commissioners, any questions in regards to the finance committee report, on either any of the items or anything else you would like the ask? if not, then we will move forward to the consent calendar. the consent calendar is the items before you. are there any extractions from the consent calendar? might note that three new contracts are related to the i.t. system and we'll have a report on the i.t. system later on this afternoon. seeing none, we're prepared for vote on the consent calendar. all those in favour, the consent calendar, please say aye? >> aye. >> all those opposed? the consent calendar has been adopted. we'll go on to our next item, please. >> item seven is a resolution evening dorsing the san francisco safe injection services task force final report and recommendations. this was presented to you -- the topic of the task force recommendations, what's presented to you on november 7, 2017 and you requested a resolution to be brought back to you and this is the resolution. >> right. commissioner, this is at a request that there be a resolution, but may endorse the task force final report and recommendation. so, it is now before you and will be presented by ms. logren. >> my name is eileen logren and i work in the department of community health. thank you for your time and the opportunity to come back here today, to follow up on the presentation from november 7. it's the safe injection task force recommendations that were presented. i'm here to follow up specifically on the request and the resolution to support the recommendations and the operation of safe injection services in san francisco. you have a copy of the resolution in your packet, which outlines the process of the task force, the information that was presented last -- in november and the recommendations. you may have seen also that in other cities, similar conversations are happening. just last week, nsdad, a national hepatitis organization came out with a statement called "a call to action." and it is a call to action to acknowledge safe injection services and for other cities to consider this as a mechanism to meet the needs. this is a motion put before all of you to endorse, ask for the health commission to endorse safe injection services in san francisco and for supporting ab-186 and to support the implementation of safe injection services. as i said, you have the resolution before you. and i'm happy to answer any questions that you may have. about the resolution or presentation from november. >> thank you. commissioners, we do have public testimony, which i'd like to call before then, we ask staff for clarification or recommendations as you may wish. and then we cans review the resolutions. i will call five names in succession. the secretary will actually time the two-minute testimony per person. >> and when the beeper goes off, please just know that means your time is up. >> ok. so, first would be the following, dr. alan cooper, holly bradford, kyle, top dollar and biscud and that could be in any order, please. >> hi. i'm dr. alan cooper. member of d.s.a., which is taking an active interest in this. i practiced liver disease for over 40 years, mostly at stanford. more recently at health right. i've taken care of hundreds of patients with hepatitis c. a few facts you may not be aware of. about 10% of people with hepatitis c have no known risk factors. why is that important? hepatitis c is a slowly progressive disease, usually 20 years after the infw*ex no symptoms. they show up at a liver clinic, very sick, with cirrhosis, needing a transplant. how did they get it? as i said, they had no risk factors. these were basically if people going about normal life. they could be your children. your grand children. people who might have gotten stuck at a playground, in a sandbox. could be an adult cleaning up outside their house who got an inadvertent needle stick, didn't notice it and 20 years later show up needing a liver transplant. hepatitis c costs about $80,000 to treat. liver transplant, depenting on who your insurer is, $500,000, plus or minus. and then you have a shortened life span. taking immuno suppressive drugs for the rest of your life at great cost and considerable risk. getting these needles off the street is imperative. a programme like the safe injection sites will help. probably won't help thousands of people in the year, but one or two innocent people, like your children, or your grandchildren, may be protected by a programme like this. thank you. >> thank you. next, please. and you can actually all line up within the aisle so it will be a little easier. >> like being at the airport back there. hi, i'm holly bradford. san francisco drug use union. we talk about should we come here or not shz because we pretty much know how you're all going to vote. but we wanted to come here from the drug users union out of respect for you guys to say thank you for your bravery, for your willingness to care about the health and drug users in the city of san francisco. so i don't want to take up a lot of your time. i'm here out of respect and out of gratitude and that is why i came today. our friends in denver created these little safe injection booths and i'm going to leave one for each of you on this table. i don't know if it is appropriate. i hope it is. >> it's ok. [laughter] >> now it's done. [laughter] so san francisco might be the first city to have a supervised injection space, but you would be the first health commissioners to have your own personal supervised injection booth. [laughter] and, again, thank you very much. thank you. >> thank you. next, please. >> my name is kyle barker. my colleagues, first off, want to thank you very much for listening to us. it's not very often that we as addicts and people feel like we get that. and to not only be heard, but to be heard on a level where something is going to be implemented that will save a lot of lives. improve and give a lot of second chances. that means the world to us. it allows us to have a shot to improve ourselves to have someone else and to maybe prevent someone from going down a certain road. so, from a guy who grew up in the midwest where i still, you know, have friends and are calling me and surprised that this is actually a real thing. and it is a beautiful thing. you know, it's the reason i came to this city. it's progressive. it actually cares and your actions are speaking massively on that. really honestly, thank you, guys, in the both of my heart and my daughter would thank you, too, to give me a chance to do something to save myself and turn my life around. thank you, guys. >> thank you. next, please. >> yes. my name is -- >> and following those would be biscuit, tommy, billy and aaron. please. >> i would like to thank you guys for allowing us to be here and realise that there is something that can be done. and i just hope we get to it. thank you. >> thank you. afternoon. my ?aim kevin. for the record, biscuit is what people call me. [laughter] i just want to thank each and every one of you all for giving us the opportunity to speak with you previously. i'm a street musician. that is what i do. and i'm thinking no biggy to get up and talk for a couple of minutes. and the last time i said about three sentences and i couldn't think of anything else to say. but i mean, you know, it really is -- means a lot to us. we've been working with holly, the drug user's union, the last couple of years from picking up dirty syringes on the street to passing out information. helping to educate people regarding drug addiction and its effect on our society today and living in the place in gives us opportunity to do something positive and act of positive change regarding this, as opposed to sweeping up more underneath the carpet and keeping it -- and just putting it on side when it is really reaches the problem -- the problem has evolved into and it can just as easily be maintained and be something that is -- uses education tool for not only parents, for children, because -- and plus it will take a lot of the negativity that is associated with drug use. you know, like -- well, really myself. the big catch 22 that i see that i failed to mention last time is, you know, the overdose deal where naloxone is ready available and will save people from overdose and it has to be administered within so many minutes of someone having an overdose. if it's applied properly, there is no side effects and saves a person and it is a wonderful thing. the education factor of making it readily available to everybody out there as a member of the public, to -- you know, there's people that -- >> time. >> that in that situation. >> thank you. >> sorry. thank you. i'm long wind. thank you so much for listening to us and thank you on behalf of all the drug users in san francisco. thank you. >> thank you. >> hi. i just wanted to thank few approving a safe injection site. thank you. >> hi, my name is aaron. i think a safe injection site would be a great thing because a lot of people feel like they have to go and hide and that is when they usually o.d. and they die, you know? i just want to say thank you. >> thank you. and just before the next speaker, let me call laura thomas, alex and michael diskapola or -- i'm sorry about that. michael from the san francisco aids foundation. [laughter] >> please. my name is william from the drug users union. i wanted to say thank you again for letting us speak here. i think it is important that education out there, there's a lot of stigma against us. and that's what has us all on the ground and it's not going get any better if we don't know what's going on, you know? so i think more information that is out there is better and it is a great thing that is going on. thank you. >> thank you. >> good afternoon. alex, task force member on the supervised injection site. task force that london breed had and i was fortunate to speak with y'all a couple of months ago as well. as you know, i'm an epidemiologist, i've been doing research around injection drug use in san francisco since 1993. our group are the ones that first provided the research in jama, that needle exchange helps people reduce sharing syringes. subsequently we had papers that compared sitings that had one for one exchange to exchanges that provided a need-based distribution, which in those papers showed us that you're also reducing sharing by having a need-based distribution while not increasing any needles on the streets by doing that. after that, we -- we're the first researchers to look at and examine take-home naloxone here in san francisco, which has been adopted as well and here we are looking at supervised consumption sites. obviously we publish the papers on that regarding both the cost savings, $3.5 million a year to san francisco with just one site, if it were to have more than one site, that would be more savings obviously. and really seeing that this really would help not just the people who are using drugs, but it would really help the overall community because we would reduce public injection, it would reduce needles on the streets, issues i think are near and dear to every san franciscan's hearts. thank you for listening and taking into consideration this important issue. and hopefully you will be all voting yes. >> thank you. >> good afternoon, commissioners. i'm laurie thomas, the interstate director for the drug policy alliance. and we also think that supervised [inaudible] a member of the san francisco h.i.v. planning council. and i'm really delighted to be here talking to you today. it's one of those days when i'm really proud to be a san franciscan. so, seeing the very nice write-up in the chronicle this morning really puts this day off to a very good start so i want to say thank you to the commissioners and to the department of public health and a huge fan of this department in large part for being willing to take these kinds of action, whether it is around syringe access or supervising services. [inaudible] worked on all the bills at the state level to authorize injection programmes usually with the san francisco aids foundation and we're very proud of create ago legal framework for that. we're also now working on creating a legal framework for supervised injection services from the state level with eb-186. but i'm so glad that san francisco is willing to move forward in the meantime. i know that you have legally now a system with the city attorney which i read with some interest. i appreciate their use of access in the needle exchange programmes to make an analogy. i think it's a very daily bread food -- analogy which is now adult use cannabis programmes that puts department of public health and city employees directly in the role of regulating and administering a programme that deals with scheduling a controlled substance. obviously san francisco has voted repeatedly to allow those programmes to exist as well as the people of the state of california. we think that is the analogy to look at when you are looking at the legal issues, rather than safe access programmes, which again don't involve direct use of the substance. but the same way that we provide on-site consumption permits for cannabis, we can do this as well. thank you for your courage and i'm happy to stand with you and partner with you and support you. thank you. >> thank you very much. >> good afternoon. i'd like to [inaudible]. director of behavioral health services there. some of my responsibilities include outpatient substance use and syringe access services and i'm a member of the task force and i sit on the h.i.v. and care community planning group as well with laura thomas and others. as laura said, this is a happy day for me to see us moving forward with recommendations of the task force. i look forward to an affirmative vote from the health commission and thank all the commissioners for your support of this important next steps for public health for the city and county of san francisco. i wanted to be on record in support of the recommendations since i sit on the task force. but i also just wanted to make a couple of statements also about, you know, the bottom line of all of this is about a message to drug users that their lives matter. and that we actually, as a city and county of san francisco are taking a stand and we are saying that we love drug users, we love our family members and community members who use drugs and we have the courages to walk with them and be with them where they are on their terms to help them improve their lives. i'm really pleased that we'll be moving forward with some of this and i want to remind us that we cannot roll back some of those services that we have currently with syringe access and dissuppose sal. -- disposal. those services are evidence-based services that have helped prevent overdose. they have helped us prevent h.i.v. and s.t.d. infections and transactions and those services along with supervised consumption services allow us to move forward and make more progress towards improved health and wellness for all san franciscans including those who use and/or misuse drugs and alcohol. thank you very much for your support. >> thank you. there are actually no other slips for public speaking. if anybody still wishs to make comments, you may come up. we are looking to place the resolution before us. i should say, though, first are there any questions to staff that presented ?r seeing none, then a motion for the resolution is in order. >> so moved. >> second. >> so a motion and second has been heard. are there any discussions? the resolution is very extensive in terms of the where as and the reasons and ends with several resolves, including endorsing the safe injection services task force recommendations, supporting assembly bill 186 and supporting the implementation of safe injection services. that is before you at this point. commissioner sanchez? >> yes. well, i -- i just want to state that when this was first brought up, the task force was under way and i just think the quality of the work that has been done, from federal to state or whatever is -- was really a horrendous task. as i read through this, the very last further resolve that the health commission supportses safe injection service. i was thinking that really this was done with continued integrity and due diligence. and i would just like to perhaps consider adding those two words at the end of the health commission and further resolve -- this is on page eight of nine -- the health commission supports the implementation of safe injection services with continued integrity and due diligence. that really is what this whole product has been. and i just want to mention that -- not mention that, but actually stamp it as our confidence in the ability of this great community to pull together this new pathway that we will be looking at. both the positive [inaudible], but i think it might be -- again, it is a confirmation of what we validate in this effort. >> do i hear an amendment? is there a ?ekds >> second. >> there is a second for that. is there further discussion of the amendment? mr. morris, do you want to repeat the amendment? >> sure. it's the last further resolve that the health commission supports the implementation of safe injection services with continued integrity and due diligence. >> ok. commissioners? further comments on the amendment. otherwise, we're prepared to vote on the amendment. commissioner loyce, you look like you wish to make a comment on the amendment. >> i do not. >> all right. sorry. ok. we're prepared for the vote. all those in favour of the amendment to the resolution, please say aye? all those opposed? we're now back to the resolution with the amendment. are there any further comments? commissioner loyce? >> yes. i want to commend the staff and director garcia for her commentses in the chronicle this morning that reflex this commission's view of what safe injection drug sites should look like and i am pleased to be a part of a commission in a city that takes proactive action in support of all of our citizens and support of the health of all of our citizens. i go back to the early days of h.i.v. and aids and also looking at the importance of san francisco operating from a place ofs if commission. we're going to do something as opposed to omission, being afraid to do something. we've done the right thing. we continue to do the right thing. i'm very happy to be part of this process. thank you all from the community and most importantly as well you are a staff who have done the heavy lifting on this. >> thank you. any further comments regarding the resolution? yes. commissioner chung? >> thank you, commissioner chow. first of all, i want to congratulate every single advocate who has been work on this so diligently for a long time to make this happen. and i know that, you know, that through all your hard work, sweat, tears, blood that you are able to get the supervisors to move on this. and to give san francisco the opportunity to lead. on this again. just like we did with the syringe access programme before it was even accepted. ments in california. i think that it is also really important to remind ourselves that we're making this decisions is because we're not judging anyone whos have to access these sites. we are not endorsing drugs, but what we are doing here as a commission is to reflect to the public and let them know that we think this is a sound and good public health decision. and for that, i think that -- and for that, i think that we have a lot to be proud of. but more importantly, to really help with the effort that we have worked so hard on as well. to reduce further the h.i.v. prevalence in the city. right now we're sitting at around 2% general. so, that is a big dip already from 4%. so, hopefully, youfn, with these new sort of radical policies, we can move the doubt even further and be the first city to get to zero. >> thank you. commissioner, did you wish to -- >> yes. first of all, i wanted to acknowledge everyone in the community who has been here and at pra*ef you meeting, i think it is really filled us as commissioners with a sense of purpose in helping to play a role in getting this done. one thing that i think has been so remarkable of this process is the way that -- that the task force and others have really taken seriously the need to anticipate and address concerns that people may have from all of the communities, from people who would be taking advantage of these services, to the various neighbourhoods, etc. so, i think we can all be really proud of the process that not only the department, but also the task force and others have undertaken and the way that's really embraced the community. the various communitis that are served and impaxed. so, just wanted to associate myself with the remarks of my colleagues around the commission and thank everyone. >> thank you. >> i wanted to add my thanks to department and in particular to the director for the work thats in the final document on the safe injection services task force. it's one of the best pieces of work that i've read in regards to a policy decision and implementation from our department. i see that the privilege that i have been given to continue to work with the department also reflects not so much my work, but the work of this health department and this remains an affirmation that the city needs to continue to move forward and this is another, i think, very important example that people matter and that we consider people as our product, as our responsibility. that is what our charter says. we are responsible for the health of the city. we need the people of the city and i believe this resolution, as is crafted, actually speaks to that. this is a part of our people. and we are going to suggest how we feel we should take care of these people. so, i was agreing with my colleagues that i also believe that this resolution reflects our desire to move forward in order to assist the residents of san francisco and i will then, if there are no further comments, we'll call for the vote. all those in favour of this resolution, please say aye. >> aye. >> all those opposed? this resolution has been passed unanimously. thank you. [applause] [cheering] thank you very much. and we hope we'll get same affirmation as we move through the processes. [laughter] and some of you are -- please do not congregate outside the door because it becomes quite loud. so, celebrate down the hallway and cheer, if you would please. it's exciting, folks. it will be great. [laughter] >> you don't take this personally, do you? >> i thought this crowd was here for me. [laughter] >> just hit exit, greg. yeah. >> all right. our budget manager jenny is on her way up so i'm looking to see if she is coming against the flow in the door. all right. just a couple of kinda introductory comments and then i'll pass it off to jenny when she comes. but just to put this in context, the way we presented this budget is a little different than we sometimes have in the past. as we're kind of looking at the package of initiatives that we're putting in front of you today and that will add as we go into the second hearing next week, you'll notice those of you that have been around for multiple budgets, that the list is smaller than you often see. there is often a much longer list of initiatives. and i think the reason for that is just we're reflecting where we are in terms of our financial approach and our operating priorities is there are not a lot of new initiatives because we only show you incremental change, but you're seeing a huge amount of work and major initiatives that the department is focused on. they just happen to be things that we have funded in our budget over the past two to four years. so underneath the list of initiatives is in front of you. we have the e.h.r. promise, the lean -- thon going adoption of the lien which we discussed in our finance committee today. we have a number of major changes in our behavioral health and transitions programming that we're working through. we have a number of initiatives under way to provide development opportunities for our staff. so, the budget -- the list of initiatives that you see in front of you, i think, doesn't kind of do justice to what is really included in the body of this larger budget. and the budget does reflect our big priorities and continued direction of what we're working on as a department. so i just wanded to kind of give you that context as you're looking through this. the other piece of this is, givesen the instructions from the mayor's office, we've been asked not to add f.t.e.s and do everything that we're doing and still meet our target and we have achieved both of those goals. so we have tried to limit ourselves in taking on new initiatives both for that reason but also because we have a lot in our hands as it is. and the departments to-do list will be very full over the next two years that we're going to talk about. so, with that, i'll hand it over to jenny to go through the presentation and initiatives that are in front of you. >> good evening, commissioners. d.p.h. budgets manager. it's my pleasure to present to you the first part of our 1820 budget, proposed budgets for next year. for this first hearing, we just wanted to give a base budgets and review to give you the contexts for our larger budget and then show sort of initial set of budget initiatives that we'd like to move forward for fiscal year 18-'20. we'd love to bring forward budgets for your actual approval. so, just the context. for the budget. big picture, g.p.h.s has a $2.2 billion budget. you might have seen a similar slide in the past, but what i'm actually pleased to show you here is our slightly new budget structure that reflects our organization as a result of the implementation of the controller's new financial system project. it looks fairly similar but the changes that i'd like to point out is first you'll see a division h.b.h. behavioral health. we've actually combined mental health and substance use into one division, which allows our managers and leadership to further sbeg rate the programmes. we have low-level details that actually tracks separately the mental health costs, for the mental health cost reports. but this enables of bigger picture of behavioral health because they are interrelated and allows the managers to sort of control the budgets more freely. separately in the opposite direction, what we have seen in previous years, it was a very large public health division budget and that was always a little bit confusing because it was a mixture of three different things that we've separated out here. the first is population health division. and its budget is actually closer to about $100 million and it separates the work that we do for population health. the second division that we created is san francisco health network, which is basically the services that you are not seeing elsewhere. basically in the nonhospital services, nonprimary care but you're seeing the transitions programme, the office of managed care, maternal child health and network-wide initiatives such as the call centre and our nurse advice line. and then last but -- oh, and i should also note that under the health network budget, we have a $93 million i.g.t. payment, intergovernmenttal transfer payment used to offset revenues at san francisco general. it sort of looks like a large piece of the pie in terms of the actual expenditures for services, it's actually only about half of that size. and then lastly in the public health admin sdwition where you have the central services that support all of these other divisions. so, it's h.r., i.t., finance, policy and planning, security and facilities that aren't related to the hospitals themselves. anyway, i'm pretty excited to actually be showing you a budget that aligns our organization. i think there is going to be some more refinement as we move forward with this new system and figure out what's available but moving forward this is how you will be seeing our budget initiatives. salaries continue to be the largest portion of our expend chures in our budgets followed by nonpersonnel services. and i'm pleased to say that d.p.h. continues the work, its work to leverage revenues to offset our general sense of support and what you're seeing here is a chart by our new divisions that shows the blue bar, which the blue section is a bar, which is the revenues that we're leveraging and i'm pleased to say it far exceeds the general sections that are layered on top of all the revenues that we get. for those who like a good table like me, just sort of summarizing the last couple of slides that we have here, just so you can see the revenue expenditures and the general fund subsidy for each division and note that, you know, we're approximately 34% funded by the general fund, which is definitely not a majority of our expend chures. at the same time, we're still receiving $. 770 million worth of general fund support from the city, which is obviously not insignificant. so as mr. wagner mentioned earlier, our focus for 1820, what you're not seeing in these new initiatives, but are continuing doing, is many of the strategic initiatives that have been adopted in prior years, you won't be seeing many new initiatives just so we're able to focus and continue the work, that we started. yeah. be rest assured we're still continuing those initiatives, although we may not be calling them out specifically in this presentation. some of these initiatives that we're work on is consistent with our lien to north, health record and implementation and developing our people. really just investing in our workforce. and leveraging our most important resource within the department. in addition, we continue to look at whole person health care. we will be add agnew behavioral health engagement team that will be discussing shortly. a drug medi-cal organized delivery system, which continues the expansion of the drug medi-cal waiver which we'll start shortly. we hope to be opening additional beds via st. maris's and crestwood. we continue our focus on equity as we continue our bahi initiative and we also look forward to the renovation of the southeast health centre. and we will continue our financial stewardship initiatives where we're focusing on reserves, we'll be back in core population health services, maintaining coverage for our patients, maximizing value-based payments as we move progressively toward more waivers in a value-based payment world and revenue cycle planning is part of the implementation of the new electronic health records. going nichest specifically to the initiatives that we're bringing forward for your approval, the first set are revenues. as you can see, we have some baseline revenue growth at san francisco general, laguna honda and within revenue projection. these are based on projections by our financial officers in these divisions ands are basically the baseline growth expected. what offsets some of that good news is the loss of federal and state funding for population health in the areas of s.t.d. and t.b. emergency preparedness, sansa grant and h.i.v. set aside funding and -- there's one more, it escapes me now -- oh. hepatitis c. and so these are grants that funded core services within population health and these are services that, again, does a lot of prevention and support for our population and not an area where we would want to lose those services. so we're back filling them. all in all, we're seeing about $50 million of additional revenue that we can put up towards our initiatives and also to meet the mayor's general fund reduction target. a budget neutral-initiative that we're moving forward is a behavioral health team that we're implementing to increase our street presence out on the street and it is a small team and we'll start to pilot it to see if it's work or not. but there's been a need for increased behavioral health presence on the street and this is how we'd like to respond to that. we're going to leverage additional whole person care payments that we believe we can draw down as a result of increased co-ordinated efforts. for emerging need, we'll be continuing the liberty system. some of you remember in the school year '17, we put forward an initiative where we would organize the delivery system. we thought we would implement in fiscal year 15-16, but due to delays on the stateside to approve rates and finalize whole process for approval, they actually did not implement it until this year. but we have the information now. we have the rates. we've been working with our providers to become medi-cal drug certified and we'll slowly roll out this programme year by year. which you are not seeing on this slide, but will in your package that overall what we're proposing is a $3.3 million increase in our contracts for our providers to provide improved quality of service with improved coordination. and it's off set by about $2.2 million of revenue and you see that net general fund impact of about $1 million. but the goal is that we're actually going to be providing better quality services that's actually billable for our clients. next is our sensing and staffing initiative for laguna honda hospitals and there are two related things going on here. first in the current year, what we're seeing at san francisco general is their census is actually exceeding our budgeted staffing. we budget for about 285 beds annually and we're seeing an average of about 302 beds being filled on a daily basis. and so what this is causing in the current year is an expenditure overaverage that we don't have budget authority for. on the flipside, we're also receiving revenues on the fee for service side that we haven't seen before. technically those two, you know, factors offset each other. and so what we'd like the do to move forward, as we continue to review the census is create a $6.6 million pool of expenditures that san francisco general could tap into when its census goes above its budgets and gives it the expend -- expenditures and we would see the revenues associatesed with it. in addition laxer guana honda hospital has been seeing in their patient population an increased need for one-on-one patient coaches for their residence and this is because of an increase population that we're seeing in the last few years related to residence who need one-on-one coaches because they could be considered a danger to themselves or others and so what they're required to do is actually have a patient coach be watching them for most of the day. so, therefore, these coachs are not part of their regular staffing model and so what we're doing is making a correction to dress the additional need of patient coaches. this correction will alow laguna honda to continue its level of admissions at san francisco general hospital which will help keep the admissions level at the current level that it iss in at san francisco general. and then lastly, we are going to be increasing our contract with the ucsf under the affiliation graement. as you know, these are services we get for providers and other clinical services at zuckerberg san francisco general. we've been contractually obligated to pay for the cost of those services. in the last few years, under the a.c.a., they have been enjoying increased pro-fee billing that has actually enabled them to capture some revenues and, as a part of an effort to help us with our implementation in the electronic health record, they had an agreement to hold flat their costs for the affiliation agreement through 2021. but, however recently when they sort of reprojected those revenues, it turned out that they don't believe they can continue that agreement. so what we're proposing here is to increase affiliation agreement first in year one by using $ million of reserve grant funding from the san francisco health plan and it will off set $4 million of additional costs for u.c. in year two, we would increase that to a total of $4 million. and this would actually -- $3.8 million has already been assumed as part of the city's financial projections. but the remaining $10.3, we need to look at our electronic health records project to see how -- what impact it might have if we were to transfer the funding to u.c. but overall, these are services that we need to continue at san francisco general because they are so integral to its operations. >> you really mean the title is not correct, right? it's really 18-19 to 19-20. >> yes. i apologize. the first column is supposed to be 18-19z and the second column is 19-20. for inflationary, this is similar to what you've seen in the past. our pharmaceutical costs are the bulk of these costs that continue to grow. last year, our pharmacist dave woods projecting a 10% increase overall. he's lessened it a little bit and is now projecting 8% and this is just the cost of, you know, sort of keeping up with -- of doing business and keeping up with those increases in health expenditure costs. these costs were assumed by the mayors in the five-year financial projection and so it would not affect our target. in terms of big picture to summarize, there is 3% reduction on target is $16 million and grew to increase of $13 million in year two and there's also