February 7 minutes. Motion. There is a motion for acceptance. Second. And a second. Are there any further corrections beyond those that have been made to the draft minutes that were sent out. And i will note there are no Public Comment requests for this item. And there are no Public Comment for this item. The major revisions are on the first page and page seven we gave dr. Patting the credit for his comments under section 11. If not there is a motion and a second. All those in favor of february 7 minutes please say aye. Aye. All those opposed . Those have been passed. A motion is in order for the meeting with the Planning Commission on february 9. So moved. Second. We have a motion and a second, and further discussion . Any edits . If not then the vote shall be taken. All those in favor of the minutes of february 9 please say aye. Aye. All those opposed . Those minutes are accepted. Through the chair just a question i wondered if the Planning Commission gets a copy of our minutes and do we get a copy of theirs . Commissioner, the two commissions have separate minutes but i send our version to their secretary. They dont know the comments but know the people that commented so its much more brief and i accept theirs as well and i just file it. Okay great. I just wondered. Yes. There is coordination between the two. Thank you for asking. Commissioner sanchez did you want to see a copy of their minutes. No. Thats fine. We heard everything. It was a very good meeting. Okay. All right. Move on to the next item commissioners. I am just thinking it wouldnt hurt to send a copy of the Planning Commission minutes out to the commissioners. Sure. It takes a few weeks to get the minutes. I think for the sake of completeness the point is well taken that we should understand how they all viewed it that would be helpful. Sure. I will do so as soon as i receive it. Thank you. Thank you. I wanted to thank the commissioners that were able to come to the meeting and it was a rich discussion and a far more positive discussion weve had in previous meetings so this bodes well i think for the future. All right. Next item please. Item 3 is the directors report. Director garcia please. Good afternoon commissioners. I want to welcome nursing students from San Francisco state and from their program to see how governance works so we want to welcome them and as you know we have a policy on immigration status and interrakz with immigration and Customs Enforcement agents and we did a policy internally with the emphasize of providing services to patients and clients regardless of immigration and documented status with dph facilities and comply with the San Francisco sanctuary City Ordinance which prohibits the use of city funds or resources to assist ice with the gathering or dissemination of information regarding the status release or personal confidential information of an individual unless warranted by federal law and state decision so we did that work internally. Many of you were at the signing of the lease for the Research Building at zuckerberg several years ago week weeks ago and happy with that and heroes with hearts happened and i know you attended with heroes and dr. Knudson, dean shrilling ger and other Community Members and i want to mention we have created a team of people going out to the encampments, a medical street team that is working on trying to get individuals into addiction medicine in terms of access to care and also providing bridges to our primary care centers and this also is involved with our the Homeless Departments Encampment Resolution Team so i will leave it there unless there are questions about anything in the report. I was looking at the section concerning the immigration status and interactions and noted that we dont actually have the link here for the website for those that might be interested in looking at it so if the secretary could provide that to us that would be yes, i will make sure you get that link. I think it would be useful to see that. Commissioners questions on the directors report today . Yeah, through the chair i would just make note first of all i want to thank as our director said we have students from sf state and there is one of our former commissioners who is being honored along with other distinguished social change agents i believe in the channel nine abc miniseries. Along with other leaders and served a distinguished rotation here on the Health Commission and made significant contributions and at sf state and your institution contributes along with all of us if you look at these individual challenges. The other thing i want to make is the heroes and hearts. I think thats special and this is the Largest Group weve ever had in the 12 year history now of heroes and other hads to raise money for San Francisco gh. There is another thing to note and noted by our chair at that point was that we had four mayors there. We would have a fifth. Gavin newsom always comes but all the mayors regardless of political affiliation or whatever are there to support the importance of this and department of Public Health and directors and staff and a major note the other thing i want to mention is the fact that knudson puggy, our professor of surgery has been there not just there for a few months but 32 years. She the second female surgeon hired at San Francisco general in the history and faculty member and mary steel was there in the 60s and 70s and one of the mentors and youre there at general for the compation and commitment and with the department of Public Health and gives insight into reference to there is a link with the department of Public Health, with our institutions, with our faculty and our directors and justed just wanted to note that for the records and congratulate those that participated inlet events. I want to congratulate commissioner sanchez for the work hes doing as the representative on the foundation and also for your attendance also at the heroes and hearts. I am sorry i couldnt get there as i was out of town. David was sounds like it was extremely successful. An event after hours. They did. This is not one that participated in but dr. Patting may have. I participated in the past and this first year they didnt have an after hours event and the day time was wonderful and i ate your desert and pleased. Okay. Thank you. Anyway Excellent Program and we certainly continue to commend and thank the foundation for the work that they do and how well this has been built. Its grown out of the union square tents they used to have; right . Its now at the Giants Stadium and i guess you cant get much bigger than that; right . Okay. Thank you. Anything further comments . Any Public Comment on this . No Public Comment requests for this item. Okay. Then we will forward to the next item please. Item 4 is general Public Comment and i have not received any general Public Comment requests as of yet so we can move to item 5 which is a report back from the todays Community Health meeting. Commissioner pating. Today we heard two reports on General Health services with the center of innovation and learning in the Population Health division so dr. Pratt has been on the job as our director of jail House Services slightly less than a year and its been a very good year for us indeed. I dont know if people realize that the jail House Services sees 12,500 unique individuals through the jail every year and i think the strengths are in the our leadership and growing linkage to the health network. We heard a report on the true metrics and quality and Service Scores looking at the implementation of nar can in the jails and linkage for patients with hiv or detected with hiv in the jails and then doing additional assurances to make sure that we have effective transfers from hospital to the jails. Regarding the network we heard a lot about how we are screening for gc and chlamydia and have good Md Communications so i think this is an example these metrics are examples how the jail has become not just an isolated entity where people go into the jail but really a point of preventive screening and evaluation and then linkage back to the primary care clinics. We focused a lot on the linkage and the main Quality Improvement component the jails are taken under the system and using warm hand off techniques to make sure that patients are met, linked up to the primary care and behavioral Health Services and we hope to see gradual improvement of people leaving jail and connecting with services. We of really impressed with the relationship with the new leadership and the sheriffs and how theyre handling conversations with regards to collaboration. Working with a multisystem center like the jails were always having to do with Court Appearances as well as health appearances and getting the two schedules in line, and we have very Good Communications going on. It was really impossible to say anything bad is happening at that point in Jail Services and in fact we were impressed how well theyre absorbing some of the patients from the ab 109 release and getting them through. There has been an overall decrease in the patients going through the jail Health Services representing a longer trend Butt Department seems to be keeping up well and providing good quality so we gave them a seal of approval and hear from them in six months and more information hopefully on the qa process and look at cases in the review. The next report that we heard was the center of learning and innovation. This is the division that does Capacity Building and inform with trauma informed care, doings and continuous impact and improvement and we heard examples of training for Young College students going into Public Health. We heard about training and Capacity Building for preterm birth in the community and training for hiv prevention in the community as well and this unit is one of four units that we have across the division. We have a Training Division in zuckerberg and in laguna honda and in the network and they all Work Together with the center for learning and innovation. In fact were one of the other cities in the country that has a center for learning and innovation bringing new procedures and policies to Public Health in the country so were very fortunate to have these four centers working together as one moving across our division to again help build new capacities like lean trainings, trauma formed care, hiv care. These are things we have to make comp tendency across the whole system to raise the overall quality and dr. Fulks unit is key to all of that. Any questions on the reports . On the true north quality that they showed could you explain and maybe thats why six months they will give a better answer on the fairly simple question of hiv positive patients given discharge packets to which it sounds like the goal is 80 . Theyre at 26 . I mean so if you actually look youre looking at page 13 well, it would be 13 , right. The jail service true metrics and look at the bar graph and if you look at well, dont look at the line graph. Look at the bar graph. Its hard to do interventions when people stay less than 24 hours and between 24 and sfo hours theres a lot going and the metric is those that stay more than 72 hours and detected with hiv positive based on the Screening Test on admission. You will see that 37 of them have been followed up with primary care. The goal is get up to 80 and so we have a 60 group and those that stayed over 72 hours and thats where we hopefully be seeing the improvement. The department is using warm hand off techniques so caseworkers are meeting people, giving information and telling them where to go. I think we need to see how it works out but there is a problem with 80 is a high goal. Its its an important goal and getting to zero plan but when theyre here less than 24 hours its really hard to make the diagnosis, the blood test, do the linkage. I assume on most of those the blood tests comes in after the person is released. I see. Okay. So you are following i mean that is being followed . Great. Right. Commissioners any further questions . Again i want to commend you for being able to help to go over the work that the committee is reviewing in the course of the year including the jail House Services. Thank you. There being no further questions lets go to the next item please. Sure. And i will no there was no Public Comment for that item number 5. Number 6 is the sfdph fiscal year 1718 budget update. Mr. Wagner. Good evening dr. Chow. I understand on this item we will take a vote. I wasnt quite clear. There will be a motion at the end. Correct. Its a motion to accept the Budget Proposal to be submitted to the Mayors Office. And the proposal is the memorandum. Yes, basically the budget as presented in the memorandum. Okay. Yes. Yes. Good afternoon commissioners. Greg wagner chief financial officer. So we are here today asking for your approval for the proposed budget in front of you. Your approval would be essentially to forward this document to the Mayors Office as the Health Commission proposed budget for the upcoming two year budget cycle. Theres the memorandum included in your packet. In addition there are theres a table summarizing the proposed changes in the budget and the individual written and more detailed interpretation of each of those budget initiatives included in your packet. We will be going through this in summary form. I will turn it over to our budget manager jenn louie shortly. Where we are today is as you recall at our last hearing we talked in kind of policy level about the budget instruction and approach to the budget. This is our second hearing and we have the initiatives proposed for submission to the Mayors Office in front of you. The proposal that is in the packet that came to you does meet the mayors instructions including covering the target from the Mayors Office of 3 and additional 3 in the second year and it also covers the revenues assumed in the citys five year financial forecast so the proposal does comply with the budget instructions and also funds some of the priority initiatives that we have identified over the past year. If the Commission Approves this budget and sends it forward to the Mayors Office the next step in the process would be that from now until june 1 the department will work with the Mayors Office as they review our budget subcommission and make amendments. There are items that we discussed at last Commission Hearing and we will touch on briefly again that are still in discussion and likely to be incorporated in some form in the mayors budget submission and would be in that phase and there are changes to the budget and i will turn it over to jenny. Good afternoon. I am the budget manager so as mr. Wagner said we are here to walk you through our 1719 Budget Proposal. We will have our regular revenue initiatives, revenue newt tral as well as key Strategic Initiatives that we will go into detail but before i do i wanted to give the context for the changes were proposing so what you see before you is the 1718 approved budget. This is the budget as we do two year budgeting this is the 1718 budget that was approved from last year and the base is 2. 1 billion dollars the significant division we have is San Francisco general at 858 million and behind that our second largest dwitionzs are Mental Health as well as laguna honda hospital. In terms base expenditures this slide shows the expenditures by expenditure type overall and this is how we spend the 2 billion and again most significantly more than 50 of our budget goes towards salaries and benefits and then followed by non Personnel Services also known as contracts. Revenues continue to play a significant role in dphs budget. The blue line that you see on each of these bars represent the revenue that each division is generating and included in the budget and that orange bar you see thats stacked up on top represents the general fund support that you see and with this budget were leveraging a lot of revenue in the services and where our revenues dont quite meet the exp