>> i know that you had to cut 8 positions. this was the last fiscal year. >> how many did you have your height. >> 35. >> we have been successful in getting a lot of grants. we have been able to get people on through grad-funded positions. >> there was reductions and

telephones. do you have that number as well? >> we can get the actual numbers to members of the committee. >> what are the priorities for our partners? i think we all know that everything that we find is important. if we want to make a real impact on certain areas, we have to leverage them with other priorities our partners are prioritizing with their dollars

as well if you want to have the highest outcome. one of them is graduating more students out of san francisco u.s. see. -- a san francisco usc. less than 50% of those that don't make it to ninth grade graduate from s.f.u.s.c. as much as we can leverage those dollars, it is really important. i would love to learn what you mean -- you touched briefly on this, what are you accounting for win prioritizing children's families.

what are the challenges putting you at risk of negative outcomes to for -- at risk for negative outcomes? more than looking at the restoration being a scalpel to how we make hats is looking at how we make them citywide, not just by department. some will hurt more within other departments. >> just a quick comment. i would like to say thank you to the members of the community who came out to speak. in the spirit of where we are trying to go with this budget in terms of transparency and having early feedback, this is one of those efforts to get us there. the mayor is talking about a

number of different priorities ahead of when this is amended. i think this is something that will be helpful. we get to know where the 10% contingency and apartments are coming from. we have an vicinity two-way and what we think needs to be evaluated. is there a way for us to share what their party should be. where would we want to prioritize those findings? do we not have a program that is finding it anywhere else? where are the cuts to state and federal that we should be looking at? to the extent that the members of the community have ideas for alternatives and to the extent

that members might think about how you would think about prioritizing different choices that we have to make, i think that that is exactly the kind of template that this committee needs and the mayor and knees before he crashed his budget. i would ask for your continued participation in that. >> [inaudible] >> it is it possible to get a reconsideration that includes a dollars from these other departments? that is not a good representation of what our city spends. this is what dcyf stands by age group. if we can hit one that shows what the city is spending by age group. >> we would be happy to work on

putting something like that together for you. >> thank you very much. if there are no other comments or questions, can we move to continue this item to the call of the chair? without objection. >> item number3, hearing to receive an update on the department of public health's budget for fiscal year 2011- 2012. >> thank you very much. we have barbara garcia. >> we appreciate all the work we have been doing trying to be as transparent as possible including all of our partners. i wanted to start off by showing -- creating a general

fund map which is one of the largest apartments with some of the largest general fund. just to go over a minute, our budget as a whole under the appropriations category. >> do you have any presentations? >> yes, we do. under the appropriations of the budget, 1.4 billion. our jarrell fund is up 108 million. -- our general fund. a total realignment with 545 million. revenue, which is one of the

important areas we have for with, 917 million. the 545 million, you will see how we leverage to that. this is a little bit of a public of detail that shows some of the public health areas. we're one of the few departments that provides housing >> just on this layout, what i am seeing, you have broken up the department's general sources of revenue overall. what i am seeing is that we have out of your 1.4 $6 billion budget, approximately 917

million comes from revenues and 408 comes from the general fund. realignment is 136. >> if you look, at laguna honda hospital as monody biggest recipients. that is for matching and leveraging those dollars. >> this is practically all general fund, really. >> that is a good point.

to get to the budget, we had a 69.6 million general fund reduction target, 34.8 in our base. we are very fortunate and you will see later, new dollars that really helped us balance the budget this year. our base budget balance without any service reductions, we were able to put revenue at against our base budget balance. we had to come up with $13 million in reductions proposed for the contingency. we are confident about that. this is still a deferred decision waiting for state approval. >> in order to meet the 20%

reduction target, you have currently met most of that with revenue. the portion would be 13 million out of the 70. >> we did receive $53.5 million $11.7 million. these are portend any aspects that we have to spend at least 38.5 million to meet some pretty aggressive standards from the federal government. we will only receive these funds if we meet certain milestones. there are fines if we don't meet those standards.

it does allow us to expand coverage of access to health services and requires us to be able to meet access to health services under a particular time frame. we have to be able to get individual appointments within 10 days for primary care and 15 days for specialty care. this will expand our primary care and specialty care capacity. as you can see, 53 million, we have on expanded to 30 and the rest of those, we feel that we can use for the budget balance due to the fact that particularly healthy san francisco which has gotten us further towards health care reform. shthere is a requirement to

invest in our i.t. technology. we are moving our system from a billing system to an electronic health record. we are moving to a chemical system and this requires a significant amount of i.t. investment. we understand that president chiu has an investment in this area and any questions of how we are efficient as possible, we have much more available information. >> the department it holds the stake holder meetings two or three times a year to bring our stakeholders including our department's staff along with our -- communities that we fund to talk about the budget and also to plan out how we will meet our targets. over the years, we have tried

numerous ways to reduce our budget. we have talked about looking across the board cuts but we also looked at some of the issues about non matched general funds. 2/3 of our general fund and realignment are used to draw down federal revenue. dph is a provider of last resort. this takes up about 100 million of general fund. but we cannot leverage those for revenue. there is a majority of remaining, about 70 million that is contract it. that basically leaves 70 million to prioritize our reduction. most of this is contacted

services and community programs. another part of that is that of the community programs, almost 2/3 is contract it out to the cbo. question as to clarification on the difference between the hundred million and a 70 million? >> this is 375. we spent 100 million in the areas of jail supportive housing. these are not matched, not not leverage. >> this is where he would not any finding anywhere else. >> for the individuals and the jails, for supportive services.

>> we have no reductions in children's services, prevention services, hiv health services, long-term care services, and medication support. we did try to preserve some of the services that we felt where our highest priorities. >> this is the 13 million contingency. why would we accept the efficiency measures? >> one is the reallocation of -- to ada housing. we do have new housing pipelines coming in. this was a way to relocate some of these clients into what i believe is better housing. we also have several housing --

several hundred stabilization beds. we will provide permanent housing as a way to save $1 million which includes a couple of full-time equivalents. >> these are not necessarily administrative efficiencies. >> these are program efficiencies. >> we have done a number of the program efficiencies. last year, as you can recall, we cut several hundred clerical positions. we have reduced our administration clinic directors, primary care directors and we also created a business office last fiscal year that reduced administrators as well.

this gives more detail to the reductions and efficiency measures. under our behavior services, we are cutting 4.1. important to talk about the difference between non match fund and percentage of the total funding. in our substance-abuse area that is also an area that does not have a lot of leveraging. when you think about those community-based organizations, some of them may have more general fund than others. those that will get a non matched general fund. the total category i 2.1%. something not leverage dollars. that could be a real cat.

-- some to not leverage dollars. that could be a real cut. >> this is 2% of the investment? >> this is 2% of the modality of contracts. that represents 16% of the unmatched funds. these contracts represent a 15 and a half percent of these non matched funds which is about 1% of the total funding. >> the total of those cuts are 4.38. >> we have also included civil service reductions of about 10 positions representing about 1.1 million.

residential treatment reduction is probably one of the hardest ones i had to put on this list. we have a very strong residential treatment system of care. we don't get a full complement of leveraged dollars. this represents a 10% cut for the programs. we will have to work with each organization very closely. those are somewhat more difficultdo not have to close ee systems, entire modalities. and then the transfer of the boat 125 clients. that represents a service reduction.

the next slide, we will talk about security, but just to make a couple of comments. security, we are not an organization that manages security. we are in organization that provides health-care services, so this has become a debacle a process for us -- we are an organization that provides health-care services, so this has become a difficult process for us. more civil service cuts. i will let our cfo talk about this in more detail to you, and then any questions, i can come right back up. >> good afternoon, supervisors.

i am cfo for the health department. just to introduce this a little bit more, obviously, our priority in trying to balance our budget begins with trying to do everything we can to improve revenues, he thereby improving our collections or by trying -- improve revenues, either by improving our collections or by trying something else. we managed to meet most of our targets with the approach. and we look less costly ways of doing what we do, so we have only service cuts remaining. the purpose of this is really to minimize the negative impact of further cuts to services, because that is really the only other option we can identify right now that remains for us,

so we are resubmitting a proposal that we have submitted in the past to contract out security services that are two hospitals, san francisco general and the laguna honda hospital. this is with ongoing work of the sheriff's department and is also an alternative to an initiative that was approved last year to try to move to a civil source security work force. -- a civil service security work force. we are committed to a no-lay off way of doing this. we want to return all of our sheriff's deputies to the sheriff's department so that they can return to work either in the jails or in other locations that the sheriff identifies where their priorities are calm -- are, and

there is a likely increase in the jail population with some of the state proposals. it creates an increasing need for those deputies to be available to supplement their staffing. that will help them reduce their overtimed and theoretically reduce their expenses. -- reduce their overtime. there are officers that are currently in the sheriff's department budget that would move back to the health department budget, and we would deploy the institutional please at our clinics and at our minister of locations, -- we would deploy the institutional police at our clinics and at our

and ministerial locations -- our ministerial locations -- our administerial locations. we brought over a chief deputy, and we have been paying that 100% to help us move forward with the civil service option, and what we have learned, number one, first, it is more costly than what was included in the budget. the budget did not include any of the costs of recruiting, training, background checks, or, and most importantly, backfill. if we had a civil service security force in place at our hospitals, we would have to backfill for our paid time off, schedules, and unscheduled time off for all of the civil service workers, .-- paid time off, scheduled and unscheduled time

off for all of the civil service workers. it assumed we would be fully converted to a civil service work force by january 1, last january 1, and in six months, on july 1, we would have done all of the work, the hiring, and we would have it in place within the six-month time frame. the reality is it will take us much, much longer to make that large a change ups -- at our hospitals. we would be moving into the following year before we could complete convert san francisco general hospital, so it would be a long process, and during that time, we would be incurring expenses of the current high

cost. the other issue that we became aware of as we look at this is that we fear that if we were to create a security guard work force of the hospitals, the most capable and best qualified would note -- note create a security guard work force out of hospitals, the most cable and as qualified would be -- the most capable and qualified would be moving out to better positions. certainly, you would not want to stay in the way of somebody getting a promotion and getting a higher paid position, but there would be a revolving door on the continued recruiting, training, a background check,

deployment, and turn around process but -- trading, background check, deployment, and turn-around process. we know from our own experience. several years ago, we did manage our own security force, and we did not do a good job at it but we do not have the infrastructure to provide the command and control structure that would need to be there. we are not skilled in managing police, and what we found was we were incurring really excessive overtime and a very high level of inefficiency with that work group when we were trying to manage it ourselves. our motivation moving it to the sheriff was specifically because we felt we could not do a good job of this. so our analysis, essentially,

suggests that we would save $3 million in this coming budget year, assuming that we could get this program implemented november, december, and get the work force in place at the hospitals, and then in the following year, with a full year of implementation, which would save under $7 million for the 2012-2013 year. on the one hand, we have a savings of $3 million, $6 million later. if we did not go forward with the civil service plan, we would have to ask for an augmentation in the budget for what is not in there, the additional work force costs and the higher costs of the civil service work force that really was not built into that plan, so it is really a choice of spending more or saving money, and in either case, looking at a deeper and more painful cuts.