Transcripts For SFGTV Health Commission 1516 20160110 : comp

Present. Commissioner. Present. Commissioner karshmer. Present. The second item on the agenda is approval of the minutes, one of december 3, 2015 and december 15, 2015 and i apologize commissioners i noted that commissioner pating was at the december 15 meeting so i will take that off the minutes. Okay thank you. Commissioners we will take each of the minutes separately. First the minutes of the joint meeting. A motion is in order for acceptance and is there a second . Are there any other corrections . Through the chair i would like to add one if i might on page four of the minutes. Page four of the minutes. Yeah, under my comments i guess number 3 mentioned that provided transportation et cetera. I also mentioned on lock and central latino to San Francisco and in that business for 40 years and thats a key program and vital to the services at st. Lukes so i want to make sure that is included. So you also want to include that agency . Yes, thank you. Okay. The only correction i had while i was formally present i was only present for some of the meeting. Commissioner, i noted you were there because the minutes noted you were there and i wanted them to be consistent. Okay. Right. You were there even though in the audience. Right. Okay. Okay. Any further corrections . If not then with that addition from commissioner sanchez all those in favor say aye. Aye. All those opposed and the minutes are approved and we will go on to the minutes of december 15 at laguna honda. A motion is in order to accept the minutes. So moved. Success. Are. Second. Are there any corrections or additions to the minutes . If not we will take a vote. All in favor say aye. Aye. All opposed . And the minutes are approved. Thank you commissioners. I will note fwl is no Public Comment for the item and we move it to the directors report. Happy new year commissioners. You will have a legislative update by the Planning Department and i wont go into that but we have a omnibus spending bill in december that president obama signed and during the presentation you will hear about the slightly increased overall budget compared to last year and many of the areas that we focus on had increases in the budget and that is good news for the budget. Covered california open enrollment ends january 31 for individuals to purchase insurance for covered california for 2016 and include the availability of adult dental services, increased of no cost Doctor Services at the brownz level and no cost for lab tests and specialty prescription tests and increases to 695 or 2. 5 for household and we want to make sure they get covered california and insurance in this next month. As you know the National Weather service predicted the weather phenomenon known as el nino and will be harsh in the area and we have been working with the Human Services agency and opening up they have the potential of opening up a thousand beds if necessary and there was a call to determine if we should open this week. It looks like were okay for this week and we have shelter openings but potentially in the coming weeks we could open additional shelters. I wanted to acknowledge the director here today and volunteered to be a shelter manager and i wanted to mention that and its a Important Role and part of the contribution back to the community but we had 65 individuals in the department that volunteered for the shelter support and theres lots of jobs they could do. We have 130 people employees of the city who have volunteered, so we will be really our hot team and roving teams of medical physicians and other medical staff are going to be wanting to make sure that people get into shelters and we take care of those especially in our streets, and the department the Directors Department there if there is any questions i am happy to answer. Commissioners any questions to the director at this time . If not then we will proceed onto the next item. Thank you director. And commissioners i will no there was no request for Public Comment for that item. We move to item 4 for general Public Comment and there is no request and we will move to item 5 which say report from the finance and Planning Committee today. Commissioner chung. Good afternoon commissioners. The finance and Planning Committee and Budget Committee met prior to the meetings and we have approved two items to be put on the Consent Agenda. The first one is the contract report with a slight amendment to the first contract which is the met Impact Health care system so instead of a 1. 5 Year Contract we cut that in half and make it a nine month contract and if they need more time we will consider that again in september when the time is up, and the other item for consideration on the Consent Agenda is adding a new locations for the richmond area multiservices and its a drop in site for their clients and its located near the civic center on market and you know the intersections of market and larkin. We had some discussions around you know, like the essentially ongoing discussions we have been having with contract review criteria, and also you know and we have pretty good discussions around contract to performances and outcomes, and that summed up the finance and Planning Committee meeting. Thank you. Thank you. Commissioners any questions to commissioner chung . May i ask a clarifying question . Of course. And the civic center and them moving the services for the wellness center. I want to applaud the city for opening the wellness centers. I think theyre a very good investment. Just an area the area theyre hoping to pull in. I saw the program is on Market Street and the richmond area is more in the Richmond District and i am wondering because of the intent of the population they intend to serve with the services. Would it be city wide . Let me give the opportunity to the executive director who is here and about the program and happy new year. Happy new year. Regards to the question would you like to introduce yourself for the record. Im the ceo of rams, richmond multiservices and the name of the organization and how it started in the Richmond District and palo alto district and its city wide. Its not a specific area. Were trying to connect with the clientele of the services and department of Public Health. Those are currently the clientele or the consumers of the services as well as those that could be the members so we can make the linkage for them so its city wide. Self referrals and other referrals through the providers. I like the location and youre able to access it. I am wondering on Market Street as city transports come and drop off people are there access issues regarding being able to make it to the front door with vans . So we actually looked very much in detail for looking for something accessible, central, easy to access and ground level entry without difficulty to get in and out so its one level, ground level, so there is very easy access comple available throughout the whole facility, and our intention is central for people to get to, but also for make it very welcoming and comfortable for people to come in and out. I am familiar with your services and congratulate you and wish you good luck with your new site. Thank you. Thank you. Any other questions commissioners or questions our guest here . . Well, commissioners i believe the finance and Planning Committee meeting had questions about the hours of service. The current hours are nine to five, the typical business hours, but we know the demand and interest may expand to evening hours and a possible Weekend Hours and we have a Community Advisory group of people who are advising us which are consumers and Community Members giving feedback about the demand and the interest, so were didnt want it to be ready and the hours are fixed and we wanted to be flexible and we are concerned about safety to the consumers and they have to get back to the home and to be nine to five and the demand is different hours and were looking at a weekend day and evening hours and we will pilot it and as the demand comes up we can adjust it. Okay. Further questions . If not thank you. Thank you. Shall we move on to item 6, the consent calendar . Yes please. Commissioners remember for the contracts report commissioner chung just mentioned the first item was modified to a nine item contract. Right. So the consent calendar is before you. Are there any extractions from the consent calendar . If not we will vote on the consent calendar as a whole. All in favor say aye. Aye. All opposed . The consent calendar has been accepted. Thank you commissioners. Item 7 is the security update. Mr. Price. That was merely a clarification that on our consent calendar the contracts was modified to nine months as reported by the chair, so we just want to make that clear. Thank you. Our next item mr. Price. Good evening. Happy new year commissioners. Director garcia, i am basil price for the department of Public Health. Im going to be giving a highlight of the report you received earlier in regards to the updates as far as the Security Program, so what i will be talking about this evening actually deals with the work that has been done at the dph clinics as well as laguna honda hospital and rehabilitation center, and then i will talk about the First Quarter performance of the Security Management plan for San Francisco General Hospital. So security assessments were completed for all of the dph facilities which included primary care clinics, Behavioral Health Services Health clinics and administrative buildings and Community Buildings where they house dph services. Each one of the facilities were given a risk level either high risk, low or medium or low risk based on the security vulnerabilityis identified during the assignment and minus security measures taking place and out of the 60 facilities determined that 13 were considered high risk. There were actually 50 considered moderate and 37 considered low risk. In addition to that we also did assessment as far as Electronic Security systems ensuring whether they were available and if theyre available if they were functional. There was a Security Staffing assessment which was done as well, and in addition to that we also did an assessment as far as employee knowledge making sure that employees had an understanding, a working knowledge, as far as responses based on the Security Response procedures. So based on the assessments the next steps is to begin developing a Security Program for the clinics as well as laguna honda which will implement this coming july. First part of the process will develop security operating procedures for those individual facilities. From there we will develop a Security Management plan which will include performance metrics to actually measure the effectiveness of that program. I have already started training in crisis intervention throughout the clinics and equip staff to defect early crisis to deescalate situations and as well as intervene to assist and addressing Risk Behavior working with hr in regards to a Threat Management process for the purpose of being able to proactively address work place violence weve addressed that as well. As far as Electronic Security systems i have been working with the capital Planning Committee, executive committee, working with them in regards to developing a five year phase approach to developing a security master plan. With that what we want to do its actually under way. Were first of way identifying costs for the project, and then in addition to that to start prioritizing from a phased approach enhancing the Security Systems from the first point of dealing with Access Control and then we want to start addressing alarm input and output alarms which deals with duress alarms and detection alarms as well as your high risk alarms and the security alarms and lastly we will address the c ct v or Video Surveillance so that sapart of the process to address a number of the issues identified in the security assessment for laguna honda as well as the clinics. The bottom line the objective is to actually have an effective Cost Effective Security Program again that we can standardize, and then integrate throughout the network, and then of course make sure its Customer Service driven as well so lastly to talk about the First Quarter performance for San Francisco general which i will cover the months of july through september. For the first year i have been in this role the primary focus has been at San Francisco General Hospital. We enhanced the systems there and the Security Program and make sure we have Standard Operating Procedures for the department. We revised the Security Management plan so its not just focused on one particular area but it actually addresses Hospital Security campus wide and that includes not only measuring the performance of our security provider, but also making sure that we measure the performance of the staff, and dealing with Security Response to facility response to security emergencies which you saw that in the report as well. Based on the report out of the nine performance metrics they were able to meet four which is expected being a new program, and were measuring things that hadnt been measured before, and so as we continue moving forward as far as again not only just testing and measuring the performance of the security provider, but the staff in order to develop this culture of Security Awareness. You have listed there the Performance Improvement plan which again the staffings, training and education with staff as far as being able to identify crisis at an early stage and makes us more effective to deescalate that. When is it appropriate and not appropriate to involve Law Enforcement in patient care incidents and to develop the Threat Management process to address work place violence at the early stage. All of this is to make sure were Incident Ready and the training of the Sheriffs Department in regard to care, experience and Crisis Development as well, so thats the security update. I am open for any questions at this time. Commissioners, questions . You submitted a very extensive document so i will start by asking within this then what priorities are you used . I mean sf general is a brand news building is one. Yes. And youre already putting in and the security cameras will be in operation when were ready to move in . Is that it . Yes, currently there is a system in place. Were doing additional security assessment for the new hospital. Just basedded on the design there are opportunities to address things there and alarms and looking at the entire staffing there to make sure that were secure in that building so the new hospital is definitely a priority. And for all the items that you put in here you actually have an adequate budget . Yes, yes. Thats part of what i am working with the Capital Planning executive committee on. Yes. The first step is to determine the cost for the Electronic Security system. Sure. Commissioner sanchez. I think its a very comprehensive report, and especially where in fact you did the initial surveys and not only that but physical visits to these areas that you have designated, and then you factored out those i think you said high risk and moderate. I guess my question is seeing there are so many different training modules that are being undertaken and seeing there are different resources being allegedly i am saying allegedly because i dont know and from different areas and whether Homeland Security or post training or collaboration between the departments and police or uc system. Theres a lot of interaction pertaining to serious incidents, et cetera, so i am wondering whether in fact a number of the San Francisco<\/a> and in that business for 40 years and thats a key program and vital to the services at st. Lukes so i want to make sure that is included. So you also want to include that agency . Yes, thank you. Okay. The only correction i had while i was formally present i was only present for some of the meeting. Commissioner, i noted you were there because the minutes noted you were there and i wanted them to be consistent. Okay. Right. You were there even though in the audience. Right. Okay. Okay. Any further corrections . If not then with that addition from commissioner sanchez all those in favor say aye. Aye. All those opposed and the minutes are approved and we will go on to the minutes of december 15 at laguna honda. A motion is in order to accept the minutes. So moved. Success. Are. Second. Are there any corrections or additions to the minutes . If not we will take a vote. All in favor say aye. Aye. All opposed . And the minutes are approved. Thank you commissioners. I will note fwl is no Public Comment<\/a> for the item and we move it to the directors report. Happy new year commissioners. You will have a legislative update by the Planning Department<\/a> and i wont go into that but we have a omnibus spending bill in december that president obama signed and during the presentation you will hear about the slightly increased overall budget compared to last year and many of the areas that we focus on had increases in the budget and that is good news for the budget. Covered california open enrollment ends january 31 for individuals to purchase insurance for covered california for 2016 and include the availability of adult dental services, increased of no cost Doctor Services<\/a> at the brownz level and no cost for lab tests and specialty prescription tests and increases to 695 or 2. 5 for household and we want to make sure they get covered california and insurance in this next month. As you know the National Weather<\/a> service predicted the weather phenomenon known as el nino and will be harsh in the area and we have been working with the Human Services<\/a> agency and opening up they have the potential of opening up a thousand beds if necessary and there was a call to determine if we should open this week. It looks like were okay for this week and we have shelter openings but potentially in the coming weeks we could open additional shelters. I wanted to acknowledge the director here today and volunteered to be a shelter manager and i wanted to mention that and its a Important Role<\/a> and part of the contribution back to the community but we had 65 individuals in the department that volunteered for the shelter support and theres lots of jobs they could do. We have 130 people employees of the city who have volunteered, so we will be really our hot team and roving teams of medical physicians and other medical staff are going to be wanting to make sure that people get into shelters and we take care of those especially in our streets, and the department the Directors Department<\/a> there if there is any questions i am happy to answer. Commissioners any questions to the director at this time . If not then we will proceed onto the next item. Thank you director. And commissioners i will no there was no request for Public Comment<\/a> for that item. We move to item 4 for general Public Comment<\/a> and there is no request and we will move to item 5 which say report from the finance and Planning Committee<\/a> today. Commissioner chung. Good afternoon commissioners. The finance and Planning Committee<\/a> and Budget Committee<\/a> met prior to the meetings and we have approved two items to be put on the Consent Agenda<\/a>. The first one is the contract report with a slight amendment to the first contract which is the met Impact Health<\/a> care system so instead of a 1. 5 Year Contract<\/a> we cut that in half and make it a nine month contract and if they need more time we will consider that again in september when the time is up, and the other item for consideration on the Consent Agenda<\/a> is adding a new locations for the richmond area multiservices and its a drop in site for their clients and its located near the civic center on market and you know the intersections of market and larkin. We had some discussions around you know, like the essentially ongoing discussions we have been having with contract review criteria, and also you know and we have pretty good discussions around contract to performances and outcomes, and that summed up the finance and Planning Committee<\/a> meeting. Thank you. Thank you. Commissioners any questions to commissioner chung . May i ask a clarifying question . Of course. And the civic center and them moving the services for the wellness center. I want to applaud the city for opening the wellness centers. I think theyre a very good investment. Just an area the area theyre hoping to pull in. I saw the program is on Market Street<\/a> and the richmond area is more in the Richmond District<\/a> and i am wondering because of the intent of the population they intend to serve with the services. Would it be city wide . Let me give the opportunity to the executive director who is here and about the program and happy new year. Happy new year. Regards to the question would you like to introduce yourself for the record. Im the ceo of rams, richmond multiservices and the name of the organization and how it started in the Richmond District<\/a> and palo alto district and its city wide. Its not a specific area. Were trying to connect with the clientele of the services and department of Public Health<\/a>. Those are currently the clientele or the consumers of the services as well as those that could be the members so we can make the linkage for them so its city wide. Self referrals and other referrals through the providers. I like the location and youre able to access it. I am wondering on Market Street<\/a> as city transports come and drop off people are there access issues regarding being able to make it to the front door with vans . So we actually looked very much in detail for looking for something accessible, central, easy to access and ground level entry without difficulty to get in and out so its one level, ground level, so there is very easy access comple available throughout the whole facility, and our intention is central for people to get to, but also for make it very welcoming and comfortable for people to come in and out. I am familiar with your services and congratulate you and wish you good luck with your new site. Thank you. Thank you. Any other questions commissioners or questions our guest here . . Well, commissioners i believe the finance and Planning Committee<\/a> meeting had questions about the hours of service. The current hours are nine to five, the typical business hours, but we know the demand and interest may expand to evening hours and a possible Weekend Hours<\/a> and we have a Community Advisory<\/a> group of people who are advising us which are consumers and Community Members<\/a> giving feedback about the demand and the interest, so were didnt want it to be ready and the hours are fixed and we wanted to be flexible and we are concerned about safety to the consumers and they have to get back to the home and to be nine to five and the demand is different hours and were looking at a weekend day and evening hours and we will pilot it and as the demand comes up we can adjust it. Okay. Further questions . If not thank you. Thank you. Shall we move on to item 6, the consent calendar . Yes please. Commissioners remember for the contracts report commissioner chung just mentioned the first item was modified to a nine item contract. Right. So the consent calendar is before you. Are there any extractions from the consent calendar . If not we will vote on the consent calendar as a whole. All in favor say aye. Aye. All opposed . The consent calendar has been accepted. Thank you commissioners. Item 7 is the security update. Mr. Price. That was merely a clarification that on our consent calendar the contracts was modified to nine months as reported by the chair, so we just want to make that clear. Thank you. Our next item mr. Price. Good evening. Happy new year commissioners. Director garcia, i am basil price for the department of Public Health<\/a>. Im going to be giving a highlight of the report you received earlier in regards to the updates as far as the Security Program<\/a>, so what i will be talking about this evening actually deals with the work that has been done at the dph clinics as well as laguna honda hospital and rehabilitation center, and then i will talk about the First Quarter<\/a> performance of the Security Management<\/a> plan for San Francisco<\/a> General Hospital<\/a>. So security assessments were completed for all of the dph facilities which included primary care clinics, Behavioral Health<\/a> Services Health<\/a> clinics and administrative buildings and Community Buildings<\/a> where they house dph services. Each one of the facilities were given a risk level either high risk, low or medium or low risk based on the security vulnerabilityis identified during the assignment and minus security measures taking place and out of the 60 facilities determined that 13 were considered high risk. There were actually 50 considered moderate and 37 considered low risk. In addition to that we also did assessment as far as Electronic Security<\/a> systems ensuring whether they were available and if theyre available if they were functional. There was a Security Staffing<\/a> assessment which was done as well, and in addition to that we also did an assessment as far as employee knowledge making sure that employees had an understanding, a working knowledge, as far as responses based on the Security Response<\/a> procedures. So based on the assessments the next steps is to begin developing a Security Program<\/a> for the clinics as well as laguna honda which will implement this coming july. First part of the process will develop security operating procedures for those individual facilities. From there we will develop a Security Management<\/a> plan which will include performance metrics to actually measure the effectiveness of that program. I have already started training in crisis intervention throughout the clinics and equip staff to defect early crisis to deescalate situations and as well as intervene to assist and addressing Risk Behavior<\/a> working with hr in regards to a Threat Management<\/a> process for the purpose of being able to proactively address work place violence weve addressed that as well. As far as Electronic Security<\/a> systems i have been working with the capital Planning Committee<\/a>, executive committee, working with them in regards to developing a five year phase approach to developing a security master plan. With that what we want to do its actually under way. Were first of way identifying costs for the project, and then in addition to that to start prioritizing from a phased approach enhancing the Security Systems<\/a> from the first point of dealing with Access Control<\/a> and then we want to start addressing alarm input and output alarms which deals with duress alarms and detection alarms as well as your high risk alarms and the security alarms and lastly we will address the c ct v or Video Surveillance<\/a> so that sapart of the process to address a number of the issues identified in the security assessment for laguna honda as well as the clinics. The bottom line the objective is to actually have an effective Cost Effective<\/a> Security Program<\/a> again that we can standardize, and then integrate throughout the network, and then of course make sure its Customer Service<\/a> driven as well so lastly to talk about the First Quarter<\/a> performance for San Francisco<\/a> general which i will cover the months of july through september. For the first year i have been in this role the primary focus has been at San Francisco<\/a> General Hospital<\/a>. We enhanced the systems there and the Security Program<\/a> and make sure we have Standard Operating Procedures<\/a> for the department. We revised the Security Management<\/a> plan so its not just focused on one particular area but it actually addresses Hospital Security<\/a> campus wide and that includes not only measuring the performance of our security provider, but also making sure that we measure the performance of the staff, and dealing with Security Response<\/a> to facility response to security emergencies which you saw that in the report as well. Based on the report out of the nine performance metrics they were able to meet four which is expected being a new program, and were measuring things that hadnt been measured before, and so as we continue moving forward as far as again not only just testing and measuring the performance of the security provider, but the staff in order to develop this culture of Security Awareness<\/a>. You have listed there the Performance Improvement<\/a> plan which again the staffings, training and education with staff as far as being able to identify crisis at an early stage and makes us more effective to deescalate that. When is it appropriate and not appropriate to involve Law Enforcement<\/a> in patient care incidents and to develop the Threat Management<\/a> process to address work place violence at the early stage. All of this is to make sure were Incident Ready<\/a> and the training of the Sheriffs Department<\/a> in regard to care, experience and Crisis Development<\/a> as well, so thats the security update. I am open for any questions at this time. Commissioners, questions . You submitted a very extensive document so i will start by asking within this then what priorities are you used . I mean sf general is a brand news building is one. Yes. And youre already putting in and the security cameras will be in operation when were ready to move in . Is that it . Yes, currently there is a system in place. Were doing additional security assessment for the new hospital. Just basedded on the design there are opportunities to address things there and alarms and looking at the entire staffing there to make sure that were secure in that building so the new hospital is definitely a priority. And for all the items that you put in here you actually have an adequate budget . Yes, yes. Thats part of what i am working with the Capital Planning<\/a> executive committee on. Yes. The first step is to determine the cost for the Electronic Security<\/a> system. Sure. Commissioner sanchez. I think its a very comprehensive report, and especially where in fact you did the initial surveys and not only that but physical visits to these areas that you have designated, and then you factored out those i think you said high risk and moderate. I guess my question is seeing there are so many different training modules that are being undertaken and seeing there are different resources being allegedly i am saying allegedly because i dont know and from different areas and whether Homeland Security<\/a> or post training or collaboration between the departments and police or uc system. Theres a lot of interaction pertaining to serious incidents, et cetera, so i am wondering whether in fact a number of the Training Programs<\/a> are because of this initial thrust or is this because theyre areas given youre background and experiences you feel that the data shows theyre high risk areas and you said there are four and you mentioned the other ones. I guess i am sort of going around but what i am trying to say theres been a lot of training you know, lets bring in more equipment, more teams, swat teams whatever and then we see Community Policing<\/a> is on the back burner here and integration of services because were still a Health Care System<\/a> in a Public Hospital<\/a> and a Public Hospital<\/a>. Yeah exactly. And there are so many unique things that could be done and hopefully used as a training module for some of the traditional institutions that really need to take a look at the unique cultures we have and the type of Outstanding Health<\/a> professionals and Security Professionals<\/a> that we have. It gives us an unique opportunity to develop new pathways and done by post and the feds and dea. Does that make sense . It does and commissioner you very good point. You hit the nail on the head in regard these are Health Care Facilities<\/a> and a lot of the training prior to that, while its good training, is geared towards Law Enforcement<\/a> is presented by Law Enforcement<\/a>, and within my first year one of the things i identified is the fact that our employees lack the confidence as well as the competence to actually address acting out behavior, recognizing it at its early stage so they default to Law Enforcement<\/a>, and often times what happens that you see in the document i presented in the First Quarter<\/a> 51 incidents of physical force and thats again where it shows the use of force against patients and a lot is driven by the fact you put Law Enforcement<\/a> in a situation that has escalateid and because the employees and nursing staff dont have the training to address the issues and theyre really patient care issues so this training focuses on that to give them the tools of deescalating. Excellent. Thank you. Commissioner karshmer. This is extensive hard to read. Very small print to read but it was worth wading through and the descrngz of creating a climate and sensitive to this is obviously important. I have a couple of questions though. Theres a lot of additional staffing that youre recommending here. Yeah. And how do the additional Security Staffing<\/a> interact with the sheriffs . That wasnt clear to me on that and how do you do the because its not todays staff. There is a bunch of new staff the next day and the next day and how do you make this a viable ongoing proposal . And a little more about the cost of this. Are there some that are very effective and low Cost Solutions<\/a> and nice to have that are high Cost Solutions<\/a> . Very good point commissioner. In regards to staffing the only recommendations i would love to have support staff to actually help me provide service through dph and if it comes it comes, but the only additional staffing recommendations that have been made are to the new hospital at General Hospital<\/a> because of course you have an increased of Square Footage<\/a> there. The other costs associated with Electronic Security<\/a> systems and the thing about systems is when i look at what our current labor cost is to provide security under the Sheriffs Department<\/a> you actually theres a significant cost savings if we actually convert to more systems realizing that it is an increase up front but then over time there is a cost savings and the cost with labor at this point. That means electronic and save costs. Yes. And the recommendations is that say hire additional full time administrator thats for the electronics not for people . Thats for electronics and currently the way that dph is structured Electronic Security<\/a> systems is owned by facilities and you really need a security expert that deals with systems to focus on that to actually be able enhance the Security Program<\/a>. Throughout my assessment just you got the functionality of systems in place at some of the clinics but there is an issue how theyre maintained and things of that nature, so just having someone focus on systems from a security perspective is important. Is it part of an initiative and how to include the patients as part of the security . Is there any programming that you intend to help them be part of the solution . Im sorry . How patients can be part of the solution being mindful of security, being part of security . Yes actually if we had for example Emergency Security<\/a> phones. Right now theyre limited. Regardless of your physical security staff we need the eyes of employees and patients and everyone involved to respond. The majority of the incident when it comes down to preventing crime is not by the person doing patrol in uniform and from the information we receive and its what i talked about and developing a culture of Security Awareness<\/a>. When security is heightened at all levels that heightens the program. I think that is a great advice from the commissioners and we have Community Advisory<\/a> groups for each of the clinics and get them involved would be helpful. I have Community Advisory<\/a> members telling me things that happen in the back alley way all the time and its a great idea to think about those groups at the clinics to participate in a safety process so thank you. I think we could help him with that and a one man show and did a great job with San Francisco<\/a> General Hospital<\/a> and throughout the department. Commissioner singer. Thank you for the comprehensive report. I wanted to talk about a few things. I guess towards the end of the report you show some statistics for q1 of the 1415 year versus q1 of the 1516 year at the general, or i guess yeah, at the general, serious incident reporting, and i would have expected that with the incident that happened i think late 13 at the general, and they sort of spotlight on security there that we would have had at least a trend down in some of the serious incidents, so maybe you could give us a sense of the assessment of why that hasnt happened . The majority of the increase between 2014 and 2015 those incidents of either facility property which mainly of thefts, internal thefts, and then the other is batteries and the majority of the batteries are again patient on employee, and so the increase that were seeing and again when you dont have systems you got older buildings whose lock being mechanisms are easily defeated and as a result were putting in brandnew equipment, so that would explain why you have the increase of facility property thefts, and in the batteries again its just the ongoing Training Staff<\/a> as far as how to address and deescalate acting out behavior at the early stage. Continuing on this. On the back of that incident and sort of motivating you coming on board in many ways was kind of a reassessment of how the department and particularly sfgh is working with the Sheriffs Department<\/a> but thematically what happened at general is probably true of the department from my understanding and maybe you could give us a more acute assessment of where we are with the relationship with the Sheriffs Department<\/a> . Where you think the strengths are . Where you still have some concerns . I think its a Good Relationship<\/a> since i of there and been able to work with the leadership. I have a pretty good working relationship with them. When i came there they had a Good Relationship<\/a> with staff and that continues to be in place. I see an improvement in the Sheriffs Department<\/a>s performance in regards expressly the issue to at risk. The majority issue in the report the prevention and relocation of at risk patients that have that is 100 and that is pretty much contract to the search efforts contribute to the search efforts of the Sheriffs Department<\/a>. There are continued patrols and sweeps of the stairwell and things put in place as a result of the incident of the still working with the hospital culture as far as gaps to take ownership of their Security Program<\/a> as opposed to totally depending on the Sheriffs Department<\/a>, and so thats a role where i stepped in and started working with the staff and Sheriffs Department<\/a> as far as addressing those issues but again its been a culture in place for years, whether its just the ongoing of trying to raise Security Awareness<\/a> with employees opposed to the Sheriffs Department<\/a>. I think that is the biggest gap. Certainly things did you bring Law Enforcement<\/a> into a situation just by the nature of them being Law Enforcement<\/a> nay have a responsibility to act and we dont always like the outcomes of that situation, so again when you have Law Enforcement<\/a> as our security provider we need to really start training, educating staff when to bring them into a situation and when not to. So on theme i think it makes all the sense in the world to me that your initiatives to try and lower costs and increase security by replacing some of those Human Resources<\/a> with some of these systems. Exactly. Not only at the general but throughout the department, and i guess the kind of pointed question i have for you. If you look at your budget for the money that you spend hiring the Sheriffs Department<\/a> to provide security in your realm, and you could use that money in other ways to provide security, whether using other contractors or some of the system stuff as initiative. Could you increase the security for the same amount of dollars . Yeah definitely, definitely. Not only will you increase security but you will increase the quality of the Security Program<\/a> as well. Again with the systems you take out that Human Element<\/a> and then were able to assess right now for example where you have probably 90 of the staff on site is sworn deputies. You could actually reduce that probably half and have cadets who are trained to respond to some of the patient issues opposed to having Law Enforcement<\/a> in that situation. It would be interesting to hear a more specific plan because were you know, as director garcia and greg wagner constantly remind us were not always going to be in this current economic climate so i think it would be interesting while were still in it to hear from you more from a Strategic Policy<\/a> standpoint more aggressively okay if we really wanted to do this whats the ultimate vision for it . The second big topic i was curious about as i read through your report its detailed and super helpful. What i couldnt conclude and i am glad we have a chance to talk and in your mind what are the highest priorities in the department that you feel urgently about among all these things . I think its one building a security plan thats dph wide, standardizing it across the department, and Building Systems<\/a> Electronic Security<\/a> systems that can be integrated across the department. I think that would be the three. Okay. Thank you. Sure. Very helpful. Thank you. Commissioner. First of all i think the comments have been helpful. There is a macro level looking at security as a whole and i would like to focus on the interface issues and security and i have a comment and three short questions. I like the the plan. I thought that you covered everything including the clinics which we havent heard before which was really nice. I had very good experience with security folks at some of the clinicis. I just visited maxine hall clinic. The greeter is the sheriff officer at the front door. Very pleasant chatty but you felt at the same time provided security and from a client perspective and consumer perspective it was good and i want to commend you on that and the services youre providing already. I am interested in the interface. [inaudible] Security Budgets<\/a> i think are embedded in the department as sub items. I am wondering as we look at the master plan around security if we need to do a higher level just as a study what it looks like of the total security expenditure and see if some of the investments we want to make would pay off and because its embedded and part of this system and i am wondering if you have that . We have the full budget of the sheriff i am positive we can get that. Let me turn to the questions on the clinic. You mentioned 13 high risk areas. What are the 13 high risk and whats the clinical impact is . Can you give an example of the 13 are . Again the risk level is based on the security vulnerabilities. When i am doing the assessment you see the vulnerabilities as far as whether is Access Control<\/a>, functionality, whether there are systems in place . Whether they have Security Response<\/a> procedures in place. So i am looking the at vulnerabilityis and if they have security Counter Measures<\/a> such as system or sheriffs or cadet in place its to track the vulnerabilityis and how you determine the risk and its based on the number of serious incidents that occur and the risk of the population they serve as well so thats how the high, moderate or specific sites or issues that are high risk. Are there certain clinics or divisions that are high risk . I guess labeling them high risk will we address them with higher priority . Exactly. In the master plan the high risk are top priority. Okay. Maybe we dont need to get into the detail of which and 13 you felt were high risk . Yes. In regards to San Francisco<\/a> general and i will bring up laguna honda here. The interface of the clinical aspect and the secure officers and had 50 incidents that involved security of a significant event. Can i ask you were those reviewed between the clinical staff and the sheriffs staff as well . I know youre reviewing did we perform secure measures but there was a large proportion for example at San Francisco<\/a> general that had Mental Health<\/a> components and i am interested in whether the cases also received Quality Assurance<\/a> review to make sure there was good collaboration and we were providing not only good security but good care within those incidents . Currently there has been patient and employee security and Safety Committee<\/a> to do exactly what you are referring it to actually begin to start assessing. That committee actually started probably about three months now, and so the Sheriffs Department<\/a> theyre a part of that committee as well to start having some Quality Control<\/a> over reviewing the particular incidents. We started tracking use of force incidents beginning in july, and so that 51 is over a three month period. Okay. So my similar question would shifting frames perhaps to laguna honda. Is there a similar conversations at laguna honda . One of the areas we have been looking at on the clinical side at laguna honda and you maybe the first or last person since security often is called in those situations. Yeah. What kind of interaction between security and the clinical teams occur perhaps around that . And violence issues are less common in the laguna honda environment. Current the Sheriffs Department<\/a> is involved in the elopement activity. As we develop the program for laguna honda we will have an opportunity to capture those incidents. At this point not a lot of the security related incidents at the current laguna honda are documented by the Sheriffs Department<\/a>, and being able to capture those so we could see what the activity entails and coming out with action plans of it and part of the development of that program. So just as a commissioner karshmer was asking that we might look at consumer panels with our Security Officers<\/a> i am interested when you have future reports and at the clinics and the hospitals and the clinical and our security staff conversations so again we can follow up on the events and learn from them, and really work as a team to integrate security as part of our best practices and providing good Clinical Care<\/a> as well and my understanding when you come from two different cultures sometimes they dont mesh so this is a Good Opportunity<\/a> around the events for everyone to get on board what are good priorities and how to handle the Critical Incidents<\/a>. Right. At General Hospital<\/a> where the security Leadership Meeting<\/a> we have on a weekly basis were implementing that at laguna honda and we will do it for the clinics as well and sweasing the security active as you mentioned. Thank you very much. If i may commissioner chow. Yes. And the process of staff coming in and focusing and houses at San Francisco<\/a> general is important for the time period and being able to spread the security role out and thats what you see today in the assessment so were at the beginning of the assessment for the system and also to note we have a new sheriff in town and we will be meeting with her shortly and bas he will there and he is diminishing his role and we made it clear he was representing the department in the oversight of their role and it was a new position and they realized that and appreciate that but i do want to recognize that wasnt totally you know, a recognized role so it was a new role that we had to ensure that the sheriff understood and the sheriff in charge particularly of San Francisco<\/a> General Hospital<\/a> understood the role of the oversight and never able to get this kind of data of the kinds of and basil meet and look at that and i am concerned with Law Enforcement<\/a> versus our patient behavior happens and so were really focused on that. I wanted to address commissioner singers comment which is important which is a part of how do we get a better Cost Effective<\/a> role here, so there have been conversations about cadets. There are some classification issues but with the new sheriff coming on its one of the conversations we want to have with her and how can we really ged maybe hrps and improve on the cadet role to have the interaction with patients and right now there are restrictions but i dont think its a boorier to be in the way and ensure we have Law Enforcement<\/a> where we need it and other levels of security where that is not needed but this interaction of ensuring the staff not just having to turn to Law Enforcement<\/a> and begin thinking how they really work with clients, and as i think he is focused on and bringing the culture of security with the staff and providing the training that they need and in the last process of the budget with the sheriff i tried to support the sheriffs getting training around debriefing as well so i really upon to recognize the work being done and also greg and i are focused on this need of the change process that we have been going through around security, and we have more work to do, so i really appreciated your report and i think we will keep you all updated on our progress on this. I would actually like to reiterate that accommodation. Last year was a hard year for all of us in regards to security and rolling out of the events at San Francisco<\/a> general and you handled it well and i am excited were able to use the skill set to look at the broader system so i want to frame my questions within that context and this is exciting stuff and very optimistic and give you our deepest gratitude. Thanks. And director garcia i think you deserve commendation trying to work and optimize the relationship with the Sheriffs Department<\/a> for the benefit of the patients at our institutions, but i would feel remiss if i didnt emphasize that wasnt my point. The point i was making was not whether we could do better within the current relationships with the Sheriffs Department<\/a> which is we all know is unique in the city and county of San Francisco<\/a> compared to how Hospital Security<\/a> is done most other places in the country. My point was not that were about doing good work within that relationship. My point was a view that says we ought to look with much broader lens at how we spend our security dollars and challenge ourselves and the city to say you know this really there is i dont know if there is the conclusion so i dont want to prejudge. I just want to ask the question whether there is a possibility to ask the question for the money that were spending with the sheriffs for security at our facilities there is a much more Cost Effective<\/a>, much more high quality way to do that without spending the money at that department. I realize theres a whole lot of consequences to that question and action but i believe that is the role of the Commission Like<\/a> ours to challenge from the outside perspective and some of the procedures that the department is making and deployment of resources and lets look broader and maybe theres a better way to do this and what i heard specifically from mr. Price thats probably worth looking at. I could have misinterpreted it but thats what i heard. I am not disagreeing with you commissioner. We tried that numerous times to do that because youre asking for a contracting out of our security and the department has tried that four times in my history here and we were not successful at the board and doesnt mean we dont try again. I appreciate that. I have gone back and as you know i read the testimony and drama from the board of supervisors. Its a matter of doing it again. I think its the right thing to do. I dont think there is disagreement and the department has did that four times at least in my career here. Yes. And i would say where we are now is actually working with the reality of the situation in San Francisco<\/a> that says at this point and time we are not going to be in a contract position. We tried that when the issue particularly was one of finance again, and evening that didnt play out. It doesnt mean its still not on the table but in taking the Current Situation<\/a> were trying to make better and more effective use of the Sheriffs Department<\/a> and putting them into a role where then we will have a better understanding of their role, possibly bolstering as mr. Price said our role and our employees in the management of these incidents which are not felonious themselves but quick become a matter of assault or battery and he has presented possibilities in which the manpower in the Sheriffs Office<\/a> would be less by certain types of Electronic Devices<\/a> and other ways of monitoring security, so that we would make the best of what we can with the Current Situation<\/a> while looking at possibilities of others. I think they should be commended for that part which i know you have done. I agree, but maybe someone could explain to me in this public forum why we have to accept for the patients in our system this security construct, and why we dont think we can be successful in spending our money more efficiently as a Security Professionals<\/a> suggest we might be able to . I just dont understand it. That would be a question for the board of supervisors commissioner because we did try to do that several times and we werent allowed to by the vote of the board. Now if the Board Changes<\/a> one action if you would like us you could ask us to explore that how to do that. Just to note we tried that and i dont have to work through the Mayors Office<\/a> for the possibility of that. There is a transition piece to think about and we havent done planning around that. Im not opposed to doing that. I just want you to know that others are. Just as one commissioner i would love to see that flan. We will work on a plan then. I think the best opportunity is still within the construct how we most efficiently manage our department as you pointed out and i think were moving in that direction by just mr. Prices approach to this which may get us to the ultimate end also and having a more efficient system at a lower cost. Right. The principle here is that all the for me the principle is that i have been completely impressed what every single commissioners questioning and field of expertise on various subjects kind of imploring different people at the department to examine the way theyre doing things in a world that is changing very quickly and to think about ways to bring outside practices and learn in whether its commissioner karshmer and her area expertise or everyone else up here today so if we ask people to do that we awenot to make security an exception and like everyone else we really encourage you to teach us how to do this in a world class way and think about it without being anchored in the current practices and the historical practices that San Francisco<\/a> has used to get us to where we are today because otherwise you never ever affect real change and its incremental change and we will have the same conversation like two years ago when we had a disastrous security problem and we havent been free of problems with the Sheriffs Department<\/a> in our institution. I dont have anything against our sheriffs but there is a security professional telling us these arent your words. Its my interpretation. There might be a better way to do this. Just to note in order to contract out these kinds of services we have to get authority from the board. Right. I understand that but i dont think we can get board of supervisors approval for it until we go to them with a plan. Now we might be rejected but our job is go with the best plan we can. Commissioner sanchez. I would just state that i really think the presentation when youre asked about the three priorities you were right there. Youre asking for a top staff person but not a deputy chief in charge of weapons and or response and or Critical Incidents<\/a> to bring in a swat team or another unit. Youre talking about surveillance. Youre talking about a computer systems. Youre talking about developing a uniform policy that could link with all of the above, and the questions that were raised here are valid questions, but over the years, and over the centuries things have changed pertaining to security at the hospital and even with Law Enforcement<\/a> and 40 years ago we had patrol specials and monitoring by the Police Department<\/a> and because at this point administration, the mayors and supervisors felt police shouldnt be working secondary employment. If so we had problems and we had to get post certification in incidents and had patrol specialists and they were required to live in the city if they wanted to to be a captain or deputy or chief of police and the sheriff was all over the water so to speak and came in over time and what i am saying it shifted again. Police officer secondary you know theyre working in a multitude of areas whether because of Film Industry<\/a> or athletic vent or the super bowl. You name it. It doesnt just happen here but up and down the peninsula but that is because the supervisors over time and the mayors and commissions agreed this is the way theyre going to operate in the future, so again were in a totally different system. We have a totally new Health Care Program<\/a> and for the first time we have a uniform department of Public Health<\/a> pertaining how were all in fact in the same ship and crew so therefore we need to have valid information. We need to have administrators who think creatively, and we have been able to hire some of the best and brightest here and were moving towards that, but again its not going to happen unless the leadership at city hall and the supervisors and whatever field there needs to be a restructuring and the commission will hear some dialogue and you will hear a number of things going on but there will be the the pendulum will swing back and forth how in fact we provide services for our patients and for our Community Clinics<\/a> and incidentally for many of our programs in the schools, and we have a wide range right now. You go to some schools back east and you have four, five Sworn Police Officers<\/a> within the school. You have to go through the whole protocol. We dont have that here, but at the same time we have a unique population and we have been able to keep abreast and thank god we have creative leadership, both in our flagship institutions within laguna honda and San Francisco<\/a> General Hospital<\/a> and the clinics and leadership here and were going to come out with the best Program Available<\/a> to provide safety of staff and hospitals and clinics and facilities, but its going to be an ongoing process but it can happen but i said things have shifted within the last 40 years to one side to the other and back and forth and here we are. Were still discuss the same thing. How do we maintain quality of Service Given<\/a> the nature of the world which has changed 360degrees . We have moved considerably and this report demonstrates that due a number of circumstances but commissioner chung. I almost feels like this has been a discussion when we were meeting for the Community Health<\/a> master plan around you know around safety in clinics and hospitals, and this is as i recall some of discussion is what that uniform represents like to our patients. You know a lot might have history of criminal justice and incarceration so when you have police or sheriff being stationed there you know they dont see that as a welcoming environment and see them as threats so this is what i remember so i might be making this up or hallucinating. Im not sure but on that note i think thats really worth like some of these explorations and ask the question why is the Sheriffs Department<\/a> and not the police . Why did we decide to go with one and not the other . And when we know that the Police Department<\/a> actually have more trainings around deescalations and handling patients with Mental Health<\/a> issues versus the Sheriffs Department<\/a>. So i know the commission cant take action today because its not an item on the agenda but were coming into the budget season. This is a decision you have to make as a commission. I am happy to take that recommendation. I heard it from one commissioner and others and its a matter of planning it and processing it. Theres a lofng history around the sheriffs. I dont know all of it but we also explored police but you do need to agendize it so we can have action on it because i couldnt at this point go to the board and ask for that but package it within the budget process. Yes director garcia is correct and that and historically of course the peace officers used to be under the department of health and that was another issue in terms of appropriate training and so forth, so we used to actually control our own Police Officers<\/a> here and they were under us so there is a whole history of this and i think its important as were looking at this and looking at the new opportunities that you have brought to us that were able to reexplore some of the options and come you know, either yes or no or that maybe were not quite ready that are for that yet but its appropriate time because of the budget setting forward if we want to look at some areas of savings. Commissioner pating. Thank you very much. Maybe just to help us get through this. It seems i would conclude you provided an excellent Needs Assessment<\/a> and what are the needs in the department and what is the best vendor for it . And we have the sheriff right now. I have no Major Concerns<\/a> with them but i think the issue its complicated. Its not just economic. Its political and also services and in terms of the recent environment now which is prop 47 or ab 109 release i wouldnt want to make in a financial decision because the systems are overlapping now with changes in demographics. Most important we have a new sheriff in town and we need to give this an opportunity. That phrase doesnt have what cliche and carbshay in the meaning and maybe if you want to represent us and meeting with the new sheriff and what the plans would be and whether there are changes and see if she will be able to comply with our needs are and start from there, but to me its a complicated decision. I dont think we rush it or forget what commissioner singer is saying and accountable here and do it in a step wise holistic manner and start with conversations with the new sheriff in town and see where it takes us and with commissioner singers concerns fully on the plate. Can you offer us this at a reasonable price and give the services we are needing and wanting and maybe we will get the holiday discount and at the negotiating table. So what we will do is follow the offer that director garcia has made in terms of bringing a the dialogue well, you need to take an action as a commission to do that so its a decision you need to make and we need time to develop a plan and what it looks like, because we have done it before and we have experience and rfp transition but we have to get through a proposition j hearing in order to do that. All right. Just to switch the topic a little and talk about the outcome performances that while you developed a series of metrics at sf general and one of the urgent areas in order to get to that and since were broadening this i assume in the next iteration you would be bringing similar performance metrics fitting the particular facilities but some are the same and we have metrics for general but not for laguna or the clinics and you have under the title performance outcomes sort of different topics so i think in the idea of uniformity for the entire department we should look at the type of outcomes we are expecting and which are the right ones obviously within your expertise. Yes, that will be the next step. So i suggest that since security report also is an important item that the commission is to have the responsibility for that we have another report i guess in six months or so on this and then on the other topic as the director finds the appropriate time for us to take up the topic again of the Vendor Services<\/a> offered by the Sheriffs Office<\/a>. Okay. Okay. Is there any further discussion at this point . Is there any Public Comment<\/a> . There are no requests for Public Comment<\/a>. Okay. Then we can move on and thank you very much for this great progress that were moving forward on and we wouldnt be able to have this type of a topic and discussion without this background. Thank you commissioners. Commissioners the next item on the agenda is item 8 the dph general gift report. Ms. Okubo. Good afternoon. Anne okubo. The item before you is the report of gifts raft in 1415 and three different at this times and its the San Francisco<\/a> general foundation and the laguna honda hospital and the public foundation. For San Francisco<\/a> General Hospital<\/a> we received a number of gifts to support programs. They total 5. 5 million dollars. On the part of the City Capital Campaign<\/a> which i am sure youre familiar with there is a significant amount of gifts there. 99. 2 million. For laguna honda the dont aitiondzs to the hospital are 448,213. There were in kind donations of 109939 and the Public Health<\/a> foundation received 4. 5 million. On the next pages you will see the list of donors for the three entities. The next section shows the expenditures that were made from the gift funds of 1415. However those funds were probably received in a prior year so the timing when they received time and spent the funds are not necessarily linked and the lasted page includes the board of recs for directors for that and if you have any questions let me know. Commissioners any questions for the gift report . I guess my only question is laguna honda lists in kind support but not listed by any other agency of ours . Thats correct. Im not sure of the reason why. I know historically thats the way laguna honda presented it. I dont know if the San Francisco<\/a> general Foundation Receives<\/a> in kind or not. Its something i can inquiry about. Yeah, we need to understand and there is a dollar amount and not hours and exact dollar. I think what they do on the in kind is value the donation. If its staff or equipment. Okay. So if you can give us explanation i think that would be helpful to understand because sometimes in kind might be that apple gives a computer. Right. That has value and i think thats different from volunteer in kind and i think we just need to clarify. [inaudible] of hard goods. I think its the former and not the latter but i will pass it on to mr. Morewitz. Which is the former . Meaning i think theyre items given rather than apple brought staff into work at laguna. There were some item with value. They bring products in or donated a car or something. Oh okay. We will get an explanation right now. Happy new year president chow and Vice President<\/a> singer and commissioners. I can answer the in kind contributions. Many Community Members<\/a> in San Francisco<\/a> and past volunteers have actually past retired employees bring back to us items such as crocheted blankets and underwear and clothing and listed on page three in terms of books and magazines and subscriptions and drop it off at the Volunteers Office<\/a> or administration and i send them acknowledging the receipt of the items and we send them a thank you note and we do acknowledge through the items that they provide. Oftentimes also they will bring to us provide supplies through the clothing room, gently used clothes for residents, and very expensive that medical shaly wont pay for are electric wheelchairs and they bring it to laguna honda and we have it reviewed by Occupational Therapy<\/a> staff and we have it for residents and medical denies that approval so i hope that explains what the in kind contributions have been from the public. Well, its a very nice listing. I am still somewhat confused because musical performances seem different from equipment, so it sounds like a mix of both people donating their time for doing something and others that have brought in hard goods or something. I am just trying to understand the category versus a direct donation. Maybe i am missing the musical donations and i am reading in kind donations. I am reading page three and four and under page four im sorry. If i can clarify. For the in client donations they clothing and Household Items<\/a> and the miiveg cal performance is under friends of laguna honda so those are funds 501 c 3 of laguna honda and pay for musical performances for patients for holiday shows. This is a small point. Its a different classification and i think were mixing up the in kind and took the total and placed it there. [inaudible] and thats okay. Well clarify. Its just thank you. I am just trying to clarify that youre trying to get to the donations of items like a goodwill and you get a slip for and the remainder should have a different category then because its not in kind. Yes commissioner chung. I have questions and for instance San Francisco<\/a> health plan showed up four times on the list and says multiple. I dont know oh yes. They must have given several separate giftis. Thats what i assume the multiple means that they made separate gifts and all fell within the 100,000 to 500,000 range. So its the incident they gave . Im sorry . Its the incident and not the amount. Youre right. Seems there is a typo and its on twice. I dont know. This is the way i got the info and obviously i missed the point but i think the multiple means they gave more than one gift. I can confirm that. Thats what i assume. Okay. Thats where it got complicated a little bit. For instance you have [inaudible] Research Institute<\/a> and multiple and why say that youre right. I see that. Okay. Im not sure. That looks maybe it was a duplicate entry. I think the multiple in parenthesis implies more than one gift but that looks like a typo and on my part. I think that is something yeah, okay. That stood out for me. Okay. I think its worth noting as we get this clear in our heads how amazing the generosity one the generosity of the supporters in the community are for the institutions inlet health department. This is incredible. Its incredible. Its a lot of resources that people are wanting to donate, and the second thing it just didnt happened and theyre dedicated people who are fans and working hard to solicit these gifts. Obviouslylet San Francisco<\/a> foundation is one and you know other groups and we should take a moment and recognize those folks for the generosity and hard work cultivating that. And the campaign is impressive. When i was putting together the report i was astonished. Yeah. I think we send a note to each of the organizations having received the report and thanking them for the outstanding support of the community. Thank you. With a picture of dr. Chow. You dont need my picture, but with the consent of the commission we will do that. Thats a great idea. I will do that. Without my picture. Without. You can use my picture if you like. Was there any Public Comment<\/a> . There is no Public Comment<\/a>. Then move on to the next item. Item 9 is the 2016 federal and state legislative plans. Good afternoon commissioners. Director garcia. Aneeka chaudhry with the office of policy and planning and i would like to talk about the 2016 federal and state legislative plans so in the packet you received a background memo as well as the narrative of the plans so i wont go into a lot of detail of that and we will do an overview. As you know the Department Plans<\/a> two each year, one for state legislation and one for federal legislation. These plans are guided by and promote the dph priorities and mission. However because individual city departments dont take positions on legislation the plans are incorporated into the plans. The state plan goes through the mayors state Legislation Committee<\/a> which is composed of representatives from the Mayors Office<\/a>, several city agencies as well as the board of supervisors, and the advantages being incorporated into the city wide plans it gives us flexibility and advocacy and track being and monitoring as we go throughout the year so i will note that generally the Health Commission<\/a> approves the legislative plans before they go to the Mayors Office<\/a>. However, due to a scheduling conflict in december the state plan was presented to the state Legislation Committee<\/a>, so any changes that the commission might request will be presented to the state legislative committee again as an amendment. So the plans internally serve as a guide for monitoring and Advocacy Development<\/a> for the offices of policy and planning and the office of equity and improvement in the Health Division<\/a> as well as for our various staff who work on policy issues throughout the department. Externally the Mayors Office<\/a> shares them with the citys contract lobbyist as well as other partners who help us flag issues as well as build advocacy platforms. The plans are developed with input from sfdph content experts and happens throughout the year as we review legislative proposals or as new issues are flagged by experts working on different issues so this year we solicitid input from Department Wide<\/a> staff in september and october and then the plans were developed and presented to the Integration Steering Committee<\/a> and they the leadership was asked to once again disseminate the plans to get feedback and the versions include all of the feedback we covered and lastly the plans cover a broad range of issues important to dph and because they touch so many facets of health and issues that arise during the year but we dont specifically include every single issue like a specific bill or a specific like we wont call out ab whatever but write it broadly to address the issues as they arise, so a little bit of background on 2015 legislative tracking for bills. We tracked 160 bills relative to the department. More than half failed to make it through the legislature. 50 made it to the governors desk and signed and another 50 were vetoed. However because were in the second year of the legislation at the state level any of the bills that didnt make it can be amended or revived to cover issues. Again as i mentioned because the department doesnt take official positions we request that the city take positions on issues and we recommended 11 bills for official city positions and issues related to Tobacco Control<\/a> notably ecigs and weights and measures and increasing immigrant access to health care and Sexual Health<\/a> education in the schools. I would like to note a few high profile policy issues that happened in 2015 so medical eligibility was extended to undocument children under the governors budget and slated to happen in may 2016. Governor called a special session on health to address a potentially 1 billion hole in the Medicaid Budget<\/a> from the tax. However the special session runs along side the regular session and can include other bills and so theres several introduced related to tobacco and tobacco tax so we will watch that closely. The medicaid renewable was a big issue on the state and federal side and the waiver special terms and knows were signed on december 31 so in the next months will be details coming out in terms of additional attachments to be completed so this is something we expect to follow because there might be additional legislation. The medical Delivery System<\/a> and puts the medicaid Delivery System<\/a> in a managed care format and rolled out this year and San Francisco<\/a> is in the first cohort of counties to participate. You maybe aware there were bills to regulate medical cannabis state wide and San Francisco<\/a> has a role in that currently so this is something were following closely also and finally but not least the federal budget we have a fy 16 budget enacted as and director garcia mentioned earlier it was good news for the department and health and Human Services<\/a> in general because the cuts under sequestration were lifted and most Health Programs<\/a> stayed flat or increased slightly. So for 2016 the California Legislature<\/a> resumed yesterday. Congress will resume next week and the governor is expected to release his budget later this week, so were back and again its the second year of the session, so the dph legislative plan if you recall from last year they dont they havent changed too much. However there are basic themes that we follow and those are supporting on going aca implementation at the state and federal levels and they have sufficient funding and support. Preserving and increasing funding for our core Public Health<\/a> functions, disease prevention, Emergency Preparedness<\/a> and increasing access to Health Care Services<\/a> for all populations and increasing services for Housing Services<\/a> so the state legislative plan falls into several broad categories and i wont go into all of them but we follow closely medical and as i noted in the bills we expect to follow those in 2016. Similarly the special session on health care is ongoing and follow that closely and we anticipate there are bills provided to provider rate increases as well as increased eligibility and access for more populations for med cal and on the Mental Health<\/a> we expect activity around the mental Health Services<\/a> act and San Francisco<\/a> receives 2 of the states funding and a big program with the formula it doesnt account for Services Provided<\/a> to homeless populations so there are Senate Budget<\/a> proposals under way to try to address this and we will follow those closely. Proposition 47 was passed in 2014 and essentially it will make more money available for local governments to do for Mental Health<\/a> programs and Substance Abuse<\/a> programs and other activities that would keep people out of the incarceration, so the savings will be provided as grants to counties so were monitoring closely how the grant process develops and we will have implementation as well and we will follow that and increased access to Supportive Housing<\/a> is tied into a lot of the other proposals and Mental Health<\/a> and the medicaid waiver. On the Population Health<\/a> side we anticipate following legislation for tobacco and ecigarettes. Ecigarettes have been a big topic because we support regulating them as regular Tobacco Products<\/a> and so this is something thats been introduced both in the special session and regular session. Medical cannabis powered alcohol is a new substance that is not available for sale in california or the United States<\/a> yet. However, a lot of the Population Health<\/a> officials are concerned about its marketablity to children as well as just not knowing what the Health Effects<\/a> of the substance are or any of its potency. We would like to continue advocating for Emergency Preparedness<\/a> and response funding and working with the vision zero fans in the city to advocate for the use of automated Speed Enforcement<\/a> and cameras that will reduce speeding. On the children, youth and families and were monitoring the children system and providing care to low income children and families so the state has a couple of pilots to move this into managed care but that might not be the best way forward for all counties so were following that closely. There were several bills related to children in foster youth and we anticipate activity around that and of course anything we can do to increase Longterm Services<\/a> and support and Community Based<\/a> alternatives to institutional and on the federal side we would like to continue supporting the Affordable Care<\/a> act and local funding as well and an example this the Community Centers<\/a> health fund and approved in the aca but not appropriated so last we preer advocated for that and this includes that. Of course through the budget we would like to preserve and increase budget for the Health Programs<\/a> ryan white programs and hospital programs and Emergency Preparedness<\/a> response and a few other issues to work with and coalitions is a Social Security<\/a> disability for severe Mental Illness<\/a> so San Francisco<\/a> was part of a pilot, so if you had a diagnosis of schizophrenia you were eligible for Social Security<\/a> disability and you could get payment without waiting for the whole process. The pilot results are not available yet and we want push for that and continuelet pilot. We are interested in removing barriers to data sharing and there is a issue of Substance Abuse<\/a> data held to a higher standard than other health protected information so this is something were interested in pursuing because the state and federal governments Going Forward<\/a> want to see integrated care and we see this as a barrier to that and of course theres been several opportunities for promoting access to lgbt health and health care this past year with cms reversing their ban on transgender on gender reassignment surgery so currently theyre doing a determination to see if they can issue a National Coverage<\/a> determination on exactly what should be covered as part of this surgery and we think we have a lot to offer as a Pioneering Health<\/a> department in that sense, so i will leave it at that and i am happy to answer questions. Okay. Commissioners we received the report and approval will be needed for this from us. Commissioners commissioner pating. I would just like make comments regarding Mental Health<\/a> and Substance Abuse<\/a> policies. First i want to commend you on this. I went through this closely and in detail and you guys are on right side of the right issue and makes us a forward thinking Health System<\/a> and it starts with good policy so i want to commend you and commend director garcia and our assistant director for really excellent policy positions, so if you wouldnt mind giving me a little with the Mental Health<\/a> expertise and turn to the page the one on the desk is the new one; right . Yes. I attached the wrong attachment so thats the complete version. Second page, mental Health Services<\/a> act prop 63. I think were getting a disproportionately funds in the last two years. I think we got 33 million or something small for the services that we ne and anything that can change the formula. Although its not in legislation as you know and done at the Department Level<\/a> so i wish you luck and i am willing to help out if i can. You might want to consider if there are policies with housing funds that come up. I think San Francisco<\/a> has been a positive beneficiary over all through housing funds. We have built more projects and my discussion there might be set asides for housing and lord knows we could use more Homeless Housing<\/a> in the city so just a parentheses you might want to consider adding that. The second thing on prop 47 i want to make an addendum on the second and third line where you say you will Prioritize Services<\/a> and mental Health Services<\/a> and Housing Services<\/a> and no where i think you need to show the context and reduce recidivism and thats what its for and anyone reading the record were not increasing Overall Services<\/a> and just implementing 47. Sure. Next item and ab48. I know this bill very well and having dr. Judy martin to represent us and the medical cannabis issue would be great and i like our leadership as a committee as a county on the two issues so those are great. The last thing is omission. I dont have anything with lauras law and i dont know if anything is coming up and i think were on track with it and i like where were going and i noticed the omission and i dont know if there needs to be a policy on that. There is no issue right now. And the last issue because its a pet issue which is prouded alcohol. There is no reason to put koolaids poweredded alcohol for children or adults to slip into foot ball games and city hall or anywhere and put water in you get a vodka smoothie and make sure that doesnt happen and most states are takes positions to prohibit it and i am glad it made the agenda here and this is excellent and thank you for all the great work that you do. Thank you. I apologize for the detailed comments. Commissioners any other . I think i have two questions. First sequestration was then eliminated in the budget. I am trying to get the fineness of your statement. It didnt clearly tell me it was no longer there. Its still there, but per the agreement that congress and the president came to was that for the fy 16fy 17 budget years the caps will be lifted. Oh. So the law that puts sequestration into place is still there however they increased the caps by 2 . So they put it aside for the fiscal year. Right. Okay. And i believe that the version you gave me or gave us i should say had omitted under provider rates the restoration of the rates which i will you put in the new version but you didnt put the yellow in for the support legislative efforts to restore the cuts. Those are the provider cuts; right . Yes. There is the claw back which would apply to laguna honda and [inaudible] and the provider rates are just in january. We have a 10 reduction in medical and that is covered by the clause that you have at the the phrase at the end that was not in the version that you sent us . Yes. Is that right . Yes. So that was my only addition i was going to make sure because year after year we seem to be very comprehensive in how we look at Health Issues<\/a> in both the state and federal level and i think its a matter of adding here more than if there were omissions that the commission feels important rather than taking anything off the table that we would see was not important for us. So director garcia i think the issue i want to be sure that dr. Patings point was sufficiently taken. Does the wording currently because you do speak about adjustments of allocation formulas for homelessness and what not, or do we have to add housing into it for the suggestion . It doesnt hurt to add housing. Its a long standing issue we were trying to get. As an example in the drug medical they dont pay for room and board. So any approval on our part we could as an addition suggest that housing be added under the Mental Health<\/a> . Okay and the second one is the clarification under 47 and the services were to reduce recidivism. And that is for clarity and if we move approval and part of that. If you want to be generous we could say no to powered alcohol. Im not sure. Its already on there. Its a little open ended but its okay. I know director garcia will do the right thing. It says take positions where appropriate. The appropriate is a no. [laughter] okay. So we dont have to put that in . No, im fine with it. All right. Just do the right thing. No Public Comment<\/a> . There are no Public Comment<\/a> requests for this item. Okay. We are prepared to have a motion for acceptance with the suggestions. Motion to approve. Second. Is there a second . Second. And these are with the additions we discussed. Okay. Any further discussion . If not all in favor say aye. Aye. All those opposed . And the motion has been approved unanimously. Thank you. Thank you commissioners. Thank you very much. Item 10 is other business. Commissioners are there any items to bring up under other business . If not then we will move on to the next item. We will skip item 11 because there were no joint conference meetings since this session and we move to item 12 which is the Committee Agenda<\/a> setting. Okay. Any items for committee or Agenda Setting<\/a> . I believe that the consent calendar calendar has been released. Yes and were working to fill in the committees. And were trying to fill in the Committee Assignments<\/a> especially under Public Health<\/a>. And now were at consideration for adjournment. A motion for adjournment is in order. So moved. Second. No further discussion. All favor in adjournment all in favor say aye. Aye. All opposed . [gavel] this meeting is adjourned. Welcome to the regular meeting of the for wednesday, january 6, 2016, happy new year id like to call roll at this time. Commissioner hasz commissioner hyland commissioner hasz commissioner johnck commissioner johns commissioner matsuda and commissioner pearlman commissioners, the first item on your agenda is general Public Comment<\/a> at this time, members of the public may address the commission on items of interest to the public that are within the subject matter jurisdiction","publisher":{"@type":"Organization","name":"archive.org","logo":{"@type":"ImageObject","width":"800","height":"600","url":"\/\/ia801307.us.archive.org\/9\/items\/SFGTV_20160110_011500_Health_Commission_1516\/SFGTV_20160110_011500_Health_Commission_1516.thumbs\/SFGTV_20160110_011500_Health_Commission_1516_000001.jpg"}},"autauthor":{"@type":"Organization"},"author":{"sameAs":"archive.org","name":"archive.org"}}],"coverageEndTime":"20240623T12:35:10+00:00"}