This has been an enlightning and learning experience as we navigate ourselves through an ever changing complex, healthcare system, where the local and the state and the federal enter twine, i have been thankful to be part of the process, under Robert Garcia and her team, and my fellow commissioners in case people are wondering, i am, and i have been transferring back and forth, between valeo where the Stroke Center is, while i am in recovery that is the reason that i am no longer going to be. And although i have a local, business here in San Francisco, and i am committed to being in San Francisco and being a part of this community, i will continue to be a part of this community, and also i wanted to say that i wanted to make sure that as we move forward, with the work that we are doing here, at the Health Commission, that we take a serious look at how we can really look at the rate of healthcare disparities among african americans, in particular. It is an issue that is of serious concern to me. I would like to see us get to a point where we have Better Health out comes and as an advocate, i would like to be a part of that. And you will see me, continue to see me. The mayor understands my commitment to public service. And there will be something happening within the next week. I cannot say. But it is all good. And so i just wanted to thank everyone for their support, particularly as i have navigated my way through the healthcare challenges. So thank you. Thank you, commissioner taylormcghee. As we know, commissioner taylormcghee was during the Health Commission, four years ago, and has been an important contributor especially in advocating for the improved african, american health, initiative, that has been started by director garcia. And, and, for these numbers of year, we have certainly been trying to address that issue probably no more vigorously than we have in these last several years, which i attribute to the fact that commissioner taylormcghee has been with us and has been able to articulate the needs of that community so well. In her absence, we will continue to work on the initiatives, and bring it to a successful fruition and our thanks for the four years that you have spent with us, and given us your wise counsel. Thank you and we wish you well. Commissioners, item two, is the approval of the minutes of march first and to the right of your packets are the revised set of minutes that i sent you yesterday and they have a few extra comments from dr. Chow or comments that he asked me to put in, on page 8. And so commissioners the new minutes are before you and they were some additional explanations added to or as you will see from the underlining to note that we also had presented miss bear, a Public Health award, and in expansion. And i am hoping that these will be meeting with your approval, and so, the minutes are available now, for a motion for acceptance. So moved. Second. Second. There is a second. Oh, lets see, commissioners continue to look over the document to see if there are any other changes that they would like to propose. Seeing no further changes, we are prepared for the vote all of those in favor of the minutes as now written, and presented please say aye. All of those opposed and the minutes have been adopted. And the next item the directors report. Good evening, commissioner taylormcghee thank you for your service and it has been a Great Partnership and you and i have had and i respect your commitment to help equity. And so you have my commitment to keep work og that and thank you so much for your involvement and the encourage and you have attended. And thank you so much, and we look forward. And very excited to say that we just came from the board of supervisors, and about an hour or two ago. And we were approved. From a nine to two vote to seek the ability to negotiate with uc, for a new Electronic Health records. And so, we just want to give and i want to acknowledge all of the team and i do not see greg here but i do see bill kim and bill did a great job as well. Helping us with the board and really educating us, and you know he is really going to be leaving the ship for us, and he has the experience of implementation and he has been working on the Infrastructure Development and i think that he has been on the second day of the life of the new hospital. And things that are on green light, i understand, and working. So, that gives us an important step towards being prepared for the Electronic Health record. Our next steps, of course, is to allow for the mayor to sign this ordinance, so that we can then start having the conversations with uc. Bill and his team are working on the chart. And we will have two basic groups, one that will be working on the technical and implementation and the second group of the executives of the department at uc will be then and our lawyers who will be working on the contract itself. And as you know, within the ordinance, we do have the back up plan, that if we cant find our path through the uc, component, we do have a back up plan with another vendor. And so i wanted and greg just walked in and so i just want to make sure that he knows how proud we are for all of the work that he has done for the new Electronic Health record and the team and bill, shop and i think that we are moving ahead and as you know we have a lot of support from the uc leadership and the doctors in the department i want to thank them as well. We have and does not look like it today, but in the last couple of weeks we had bad weather. And the mayor lee, announced an expanded winter shelters and we will do that throughout the el nino storms and we are good at implementing these quickly. And what we continue to find the people who are not seeking healthcare but who really are in need of healthcare. And so our medical teams were highlighted in the chronicle just the other day, and so we are proud and i see barry, and along from the dr. , seven who is in the odd ens today and he has done a great job of leading that group. And another big, structure, structural decision for the department, of course, is the fact that the mayor and for the public and safety bond to the june, 2016 ballot and this will be for 272 million for the department. And 222, for the health, or for building five, and where we are going to integrate, many of our outpatient programming, prohe vied a much better space for dialysis patients and along with the urgent care. And then we will have 30 million for the building of an integrated Mental Health program, with primary care at south east. And then the 20 million because over the years we have had a prioritized process of identifying some of our clinics who need it and ada improvements and flow improvement and privacy, improvement and especially as we move towards Behavior Health integration, within our Primary Care Clinic and we will 20 million, and we will hear more about some of our updates on the capitol today as well. I do want to acknowledge that we do have a change in our environMental Health department, kusihing is the new director, richard was honored by the board this last week, and also on wednesday, march 9th, a group of staff crowded into the Health Officers office to cheer him on as he clicked the submission, and documentation box of the Public Health accreditation, on the computer, and signalled the completing of step there in the board process. The search for the written evidence of the work and so this will, and this was also, reported out today in one of our joint, conference committees. And i will end it there and if this is a long, director report this time and if there are any questions, i am happy to try to answer, thank you commissioners. Questions to the director . And the commissioner . Thank you, for the excellent, report. Regarding the california special legislative special on health, with the date now of the attempted suicide and end of life options now, solidified as june, 9, 2016, i would assume that at both the general and laguna honda or both, we need to look at policy issues and i just like to ask that one of the jccs that we will be able to review how we might be implementing that and looking at the policies that. I got to request that we have it here because it is a jcc. We start here, with that conversation, and then, the jcc can kind of refine some of those so that they are all talking together. As a whole, commissioner and i am sure that some of the other commissioners who are not sitting on the hospital, committees will really like to hear and i believe that our Deputy Director would be ready to provide for some of that. That will be fine, i think that this hearing will be nice. Absolutely. I would agree with the issue that did come before the commission, and certainly, the entire commission would benefit from understanding how we will be implementing it and also be informing the public that way. Okay. The second question is the two tobacco bills and one is at the city level and the tobacco 21 and now the state, i think that the state, copied us. We were first, and so what is the implication now of having two ordinances that may do, some what of the same thing, does that supercede our ordinance . Our directive policy will try to address that. And the details of that. Actually, i think that it is a little bit different and we will have to coordinate the two. I believe that the state level, legislation, prohibits smoking. By ages 21, ours prohibits purchase of tobacco and so we will have to look at how to make sure that the ordinance reflects what has been passed at the state level chl thank you very much. Sure. Would it be possible then to get a follow up on that at our next meeting in terms of the clarification . And providing that the governor is on the bill. The governor has 12 days to sign the legislation and there is no indication and we just had a call with the director of the Healthcare Services and there is no indication by them, whether he will or wont sign it. And so we will up date you as soon as we know. Thank you. Any further questions . No that is it. Questions from and i did want to note that the department has been certainly doing a lot of work and particularly, i think passing the number of the surveys, should be commended because those are really key and they were of concern as to whether or not knowing state surveyors and licensing that they would not find and are very complex and new building, with the new technology. That they would not have been even mo even, issues so to everyone that were involved. There should be or continue to be congratulated if the only real issue is that we have to have the dialysis unit up for 30 days and that i, and i would believe that it is not a real problem. We have our chief Operations Officer here. Sure. Tell us directly doctor. Why dont you. You can come up here. The commission and the rest of the commission that everything is going in order. Maybe maybe you can come and just give us a two minute up date on where we are. It is worthy because this is such an accomplishment and because those of us who have gone to, even the routine, hospital surveys have real problems, and this is not routine, the opening up a brand new, and highly Technology Cal facility. So take some credit and tell us how you did it. Thank you. And i believe that i get to share a rebuild in transition up date later in the agenda. You are right i have never done this before, many of us who work at the hospital have never done this before. And i work with a remarkable team. And that just pulled it together from a clinical standpoint. And under the leadership of jeff smith, and terri salt, from the physical building side of things. I cant say enough about max under the facilities because he has a web corp that has pulled back on the staff and has had to step up and so then, you know the surveyors, were truly, amazed by the joy of our staff. And in talking with our front line nurses and our super users, around how excited they are, the pleasure that they are going to have in delivering care to our patients in such a remarkable building. So, i have been through many cdph licensing surveys. Obviously not for opening a building. But, the energy that we got from the Licensing Team from cdph like you could feel that they new the value of zucherburg San Francisco general and wanted us to succeed and i think that they were super pleased that we didnt let them down and i will share more with you later. Surely. I just thought that it was important to call out how amazing that the survey process went so far for us. And that you and your team all of these are the credit that you are, and that you are justly getting. Thank you. Thank you. Any further questions on the directors report . Or any of the other items that you may wish to address the director of . Otherwise, oh, i did want to commend that, i think that the work on the homeless, injure work that you have continued to carry out on the pier 80 and all, are beginning to be reflected in the public testimony that is coming out. The last thing that the work, just that was, was it yesterday or today . That was, just so important, showing we have medical services at fury and how important those are. And so, thank you very much. Thank you. We are going to go to the next item, please. The next item is four and general Public Comment. And i have not received any requests, so he we should move back on to the report back from the Public Health committee from today and commissioner, and chairs that committee. Okay, the commissioner . Yes, and we, and on the xh itty, and the Public Health, and the committee we heard two reports and one on the accreditation project and i think that you heard from the directors report that on march 11th, dr. Aragon pushed the button and submitted the documents for the Public Health accreditation, on board, this, we saw a small portion of this document which is about 500 pages of about 50 of the sections, so this is about 1,000 or so pages electronic document and i just need to commend the team for the compiling of the data which was very broad scale across the Public Health department. The good news is that the expectation is by the end of this year, we will be accredited. There will be a mock survey, done by our own consultant. And in june and then, by october the expectation is the reviewers will come through, and we have asked that the full commission receive an interim report in july, after the mock, survey. But in terms of our subcommittee looking at the status of things, and there was a lot of optimism and there were, in our own sort of preliminary surveys no major gaps. And the documentation gaps that were there, have been filled. And i think that it is just a lot of optimism and a lot of hard work and sweat that has gone to get us to this point and so it was an momentus moment and having pushed that button and now it is on the way and up to the board to start the process of review and then come back to us, and we mreef believe that t date was in october. So we will hear before that site visit and we can ask more questions from the full commission. The second item that we heard is the first of the Behavior Health reviews. We are now in a process of trying to review the Health Network revisions twice a year and so we heard the Substance Abuse today. And so with have about 7500 clients and the Substance Abuse treatment, and about 3800 of them are receiving methadone and 7500 are unduplicated and it does not include the people that go in and out of the can enter and the hot team, and so we have asked for a drill down on what services that 7500, people actually received and what is the dollar amount for those services, and to begin to understand our Substance Abuse services in more detail. In the interim, the 1115 waiver has been approved by the state which guaranteed or which mandates an expansion of the Substance Abuse services for medical as part of a demonstrati demonstration. And this means that there will be, more requirement for about 75 percent of our Substance Use disorder patients who received, medical, under the expansion for enhanced services which have greater accountability, attached to them so the department will be looking at in more detail what services our cbos will be providing, these clients, receiving these new, 1115, waiver moneys and are they receiving evidence pf based treatment and this will also help us, as they get the information from the cbos to then be more accountable us as a commission, about again, what are the 7500 people receiving, are they getting good out comes and how is the dollars can be spent. So we are going to give them 6 months to compile that and hopefully we will have more information on the report to the commission. So right now, we are just getting oriented and to be led with the 15 wave as the first step and so those are the two reports and if my fellow commissioners have anything to add, we will welcome that. Yes, commissioner singer . Do we have an idea, we have 7500 unduplicated Substance Abuse . I think what was brought out today is that the numbers are not correct that we are calculating. And so, because we have people in different systems, that are also, Substance Abuse, clients, in our Sobering Center which is in another division, we want to do a little bit more guiding into the data, commissioner singer because i dont believe when i ran Substance Abuse, we were at 20,000 clients and so i just dont think that the data is ri