do about it and that led to pretty high-level meetings with the sheriff's department including chief butler and the watch commander over san francisco general to try to work some of these things out. at that time the sheriff's department would only respond in instances for patient safety management if there was a 5150 in place and visible on the chart. we got through discussions with the sheriff's department counsel and we got them to move a little bit to include 520's and l.t. conservatorships and that's only been in the last four months that we have been able to come that far. the sheriff's department's stance is unless they see a violent behavior enacted, they will not respond. that means that staff and patients have to demonstrate the violent behavior before they can even act. that being the case, we have had several instances of physicians -- i have two sitting right here

-- who have been injured or kicked along with nurses because that is the trigger for action. so there is a large groundswell of support for this on the frontline staff. >> how would that trigger be any different for an on site nonpolice officer security guard who would then have to then call it into san francisco police department to effectuate the same response? the same law applies as it would for the deputy sheriffs. >> actually, it wouldn't. private contracted security would be guided by hospital policy, number one, and in the r.f.p. we could actually indicate that we would want them to have powers to detain. the reason why certain facilities don't do that is because they actually don't have a place to detain individuals. we do. we had previously an m.o.u. with the san francisco police department which is what we would do again in order to

detain and arrest. >> so power to detain based on what charge? >> it is not a legal issue. when we are talking about patient who is by the virtue of the medical condition do not have control over their mental faculties and able to make appropriate decisions, behaving erratically, that is not a legal issue. that is when you want to intervene. you don't want to wait until there is an assault and wait until a patient has removed catheters and lines and oxygen nay need and become more acutely ill. you want to intervene before they strike out. we need folks to help us deliver the care they need. >> but you are saying to me that this issue was only just reconciled in part because of the enhancement of having the sheriff's respond to in the last four months. why did that take so long to do it within the last four months

then? >> again, a confluence of things happened all at the same time. so because of the pullback of the sheriff's department, we had a very inconsistent response because the mix at san francisco general are partial sheriffs who come to us from 850 bryant and we also have the remnants, for lack of a better word, of institutional mrpolice officer who have been at san francisco general and many of whoem over the last, i don't know, two to three years have retired and moved on and are now under the auspices of leaving us with a very small group of i.p.o.'s who are under the auspices of the sheriff's sheriff's department who can no longer respond the way they did in the past. todd is right that a lot of us have to do with medical issues but still the added value is that contracted security would be able to detain for illegal

behavior but they would also be able to assist us in delivering medical care in instances that would require hands-on presence which is what the sheriff's department can't give us. >> walk me through this a second. contracted security is able to detain because they are employee of the hospital. how long are they able to -- how long are you able to detain? >> it depends on what the term detain means. in terms of in a medical condition based on their medical condition. if you are talking about someone who breaks the law within the grounds of san francisco general, they can be detained until the san francisco police department comes and arrests them and takes them away. >> then the police would have to require citizen arrest because if they didn't see it on site, who is relaying that citizen arrest? and is it the hospital administration or is it the security guard?

>> it's the security. >> so it's the same exact scenario as it would be another 830.1 of the peace officer in standards and training. whether it's a police officer or sheriff, they would still have to be required to see a citizen's arrest through security in order to then respond. how is that any different? >> i want to make sure we're talking about the same thing here. i think that hospital has it own policies about what is restraint and those are very specific policies and they have their own limitations but the conditions under which a person can be restrained physically and/or who are on medication and there are hospital policies around restraint. and a contracted security organization working with the department can conform to those policies on restraint. so a person who is agitated or is pulling out lines or is

trying to leave against his own personal safety or is somehow endangering the safety of others but is not breaking the law can be restrained. that is so the restraint issue is something the sheriff's deputy cans not do that these people can follow hospital policy. when you get to the issue of doing something that requires detention and arrest, we go back to the exact some model we had eight years ago when we managed our own security force. when we had institutional police and security guards at san francisco general that were our employees and this was a long time ago, a program we abandoned. and they did not have by themselves the ability to detain or arrest. but that ability was conferred on them through on m.o.u. with the police department and gave them limited powers to detain and hold until they arrived. now obviously whether -- and then the police would take custody of the person and take

them down and book them or whatever they would decide to do. in the long run whether this -- what affect this might have ultimately on prosecution or conviction there would be witnesses to what happened who could testify. there would be the report given by the members that were there and whatever other behavior was exhibited by that person throughout the process of the arrest. but in the long run, i think you're asking a question about whether a security guard can detain somebody and what the value of that is. the value is that it stops the violent act, it takes the person out of the -- takes everybody out of harm's way, holds that person in our holding cell that we have, that we have always had, that the institution used to use, until police arrive and take them away. what part of this am i missing? >> first of all, don't be so defensive. i am asking some questions to get to the bottom of this.

>> okay. >> that is not what i just said. what i am asking for is i want to understand what this process is about because if, in fact, the security guard is waiting for the police to hand that person off as you just said, that would be the exact scenario with the sheriff's department, too. they would still hand them off as well, too. >> i think we have to separate the issues here between the legal and the word detained sounds like a legal connotation. if that is a criminal act, we detain a person. that would be very similar whether it's the sheriff's department or security guard. that is the procedure. that is not where the gap and the concern is. the concern is where there is not a legal hold. and it is about patients and patient safety. that is where the security firm can bridge the gap. that is where for legal reasons

the sheriff's department has to be hands off and cause harm to themselves and to others who leave the hospital without potentially life-saving treatment. that is where we have the gap and that is what this is all about. not the criminal aspect. it's about patientses and that is where we're having trouble. >> and it's not just about patient safety but employee safety, too. my questions are still not being answered. the question i asked, i find it strange that the response was about contracting out, which is why i asked. what is your why there is concern and nobody responds with the question of all the comments i am hearing is about employee and patient safety and there seems to be a distinction in the interpretation of the plan that this potentially exacerbateses the ability to be able to protect employees, staff, and

patien patients. that is what i am trying to understand more not about the issue to have legality so much but i think that liability will definitely be a questions th ths not resolved. then the question of being able to uphold patient safety and staff safety is what i am trying to get to the bottom of so i can understand how, in fact, a security guard is more enabled to provide that level of safety where somebody else is not. especially if it's then deemed as criminalized behavior because it is not a security guard who is able to cite for 5150 unless you know something i don't. that it would require efrptually after de-- eventually after detention a 5150 citation would have to be issued and that can only be issued by whom? police or sheriff, right? or can police issue a 5150? >> can you speak into the microphone? >> members of the medical staff

can do that from the department of psychiatry. they can cite someone to 5150. >> but they would be required on site to do that or the security guards once again that would be required to testify to that? >> no. we have ip houn-house psychiatr that would be called to the scene. what we need security for is help us restrain, contain, and keep patients and staff safe in the event of this violent type of behavior. that is where the sheriff's department can't help us. they can't be part of that integrated team that goes in to deal with these type of patient problems. >> so they have never written 5150's before? >> sheriff's department? >> no. >> psychiatry, yes. >> it would be great to get some idea how much they have cited. >> but the key here and dr.

leery can probably talk to you about it, they have to meet certain criteria for 5150. >> absolutely. that is what i want to hear. what is the tally of the 5150's that the department is actually issuing? how many, for example, say last year? do we know? >> i would be happy to address that. we at the hospital we see annually about 4,500 patients who are on 5150 holds. and i want to etch size that patients who are on 5150 holds are not the safety concern that we have because in those situations the sheriff's deputies are able to intervene and hold them in the hospital for their safety and other people's safety. it is the patients as dr. may was mepgsi in mentioning, the patients who don't meet 5150 and are delirious because of a drug intoxication or other medical

cause that don't meet that 5150 but meet the legal requirement for emergency medical treatment. the problem is that sheriff's deputies can't intervene in that situation. it puts our saf staff at safety risk and the patients at safety risk if they were to leave the hospital. and the level of concern about staff at the hospital and people in general. and i did talk to a colleague at john george at the psychiatric facility and this is the director of their psychiatric emergency service athey have ha a private security firm and explained that the firm and staff were able to work in an integrated way with the psychiatric team to increase the

level of safety and found they were very responsive and i have a lot of confidence in his description of that and his experience with that. but nonetheless, i think it will be a huge transition for our staff. it will take some getting used to. people will have to realize that this is a different way of doing things that can work and has worked. but it's understandable that people would be concerned about the experience with that particular way of doing things. >> is there any data that helps us understand where the gaps are and the ability to be able to attend to these needs for intervention but was made inadequate because of the limitations i am hearing of the current structure? is there any data like this at all that's made available? >> i'm sorry? >> incident data. >> we may very well be able to

provide you with risk management data. >> i appreciate the anecdotal experience but absent any information, you can understand that you're suggesting to us that there have been incidences when there has been a failure to respond because of the limited authority or desire or what have you or policy or what have you, i understand that, but this is anecdotal and i am trying to understand, give me something m empirical to work with to explain the situation. you have gone through in the last eight years the third iteration of a different security service if we were to approve this. and that's not common, to be honest with you. i don't think it's too common. even in the days of contracting out. >> i appreciate the need for

data and that would be helpful. i can tell you this type of occurrence happens on a daily basis if that gives you some sense. it is not once every six months but a daily occurrence whether the patient is violent or unable to cooperate with care. >> talking about at general. >> i work at san francisco general, so that is what i am speaking to specifically. >> i don't have direct experience at laguna and this returns to us next week, it would be helpful to have something more to look at. thanks, appreciate it. >> actually, many of my

questions were asked and throughout the state and the country with an understanding of how it's done in other hospitals. and i totally get the difference between the types of security we might need at the hospital. so i do want to focus on the types of security that are not with mental health. stories that i sometimes hear because general is our trauma hospital, we often have people that come in that are both victims and participants of violent crime. and sometimes that can be an issue when friends and family are at the hospital together and there are concerns about that and a plethora of why people are at general hospital and when it is not a mental health or a patient safety issue and there are some valid security concerns

for friends and family and the employees for a variety of reasons, just some of your thoughts on that. >> sure, from an operations standpoint, we have had numerous instances due to gang violence and general urban violence when we have had to ask for additional assets to be deployed. it's all dependent on what the sheriff's deputy cans do in that moment. we believe that moving to a system like this would augment our ability to deploy the assets when they are needed and in whatever form that is required. right now i would have to call the watch commander who called 850 bryant to see if there are additional resources that can be deployed. there are instances where members of different gangs end up on the same medical unit and we don't have the resources

currently with the sheriff's department to be able to increase the surveillance necessarily of those units or to station patrols there that would increase security. and we have to be innovative in where we place the patients and where they go and who comes to the unit and it's labor intensive and doesn't make anybody feel safer. >> are there concerns by not having uniform ed officers on site? >> what i am hearing from the staff is as long as we can insure that the security is armed and that they are well trained in the use of those armses and that they can detain those type of individuals and get them out of the clinical area if necessary, that is their ultimate concern. >> and again, in terms of making a final decision, what would be most helpful is seeing what other county hospitals do in terms of security and hospitals

who contract out for private security and what that has been like for those hospitals. >> thank you. >> just to reiterate what we will bring, we have documentation regarding the legal issues that they were trying to get clarity around and the risk reports we have as well as the survey. >> and naturally cost savings is probably a bottom line to all this, so what are we looking at in cost savings exactly? >> i believe it's $2 million in savings. >> $20 -- $2 million for six months. and $4 million at the department of public health plus the savings at the sheriff's department. >> as you know, the controller's office is required to certify when a proposal to contract out is presented to certify that it

is indeed less expensive to perform the service by contract than it was under the civil service. and we have done this analysis and we find that based on the current staffing model the savings on the annual basis would be between 4.2 and 4.8 million dollars op an annual basis. now the budget that's before you has a contracting out proposal for six months and therefore, the savings in the first year would be about half the amount. also, though, important as was stated yesterday by the sheriff's office, the sheriff is assuming that the deputy sheriffs who are currently deployed would revert back to the sheriff's department to staff a small jail that would be

opening up. above and beyond the cost of the contract that the savings is al indicated in the overtime in the sheriff's department. we have worked closely with both the sheriff's department and the health department and the mayor's office and we are accounted for about $3.2 million that would be required if this prop j were not approved for a six-month period. >> thank you. so just to be clear, the number you have is about an annual savings worth $4.2 to $4.8 million across both departments? >> plus the cost of overtime that would be required. what we did here is only compared the health department's cost but above and beyond that there would be an additional cost from the sheriff's department if they had to use overtime or hire additional

deputy sheriffs for the increased census they are anticipating. >> to be clear, the number you are looking at is roughly a saving of $4.2 to $4.8 at the department of health and does not include the oftime savings cost at the sheriff's department and anything tos that what you are saying is that it's worth about $3.2 million for the six-month period of time. >> that is correct. >> and that $3.2 million, is that only d.p.h. or sheriff as well? >> that includes both departments. >> another $700,000 -- >> that does include the sheriff's department and the $3.2 is the value that would be required, the additional general funds that would be required should this contracting out proposal be rejected by the board. >> right. but that is for both departments. >> both the sheriff and the health department. >> and about of the $3.2 is $2

to $2.4 million is d.p.h.? >> actually, i think if i could explain, it sounds like the difference is just whether it's a half year or full year and the controller's office is saying for the department of public health alone a full year is savings for this project would be worth $4.2 to $4.8. however, if you want to look at what the reversal would be for this year a six-month period of time, the value and plus whatever the sheriff is involved. >> that would be the annualized savings and if we were at 4.2 to 4.8 and half a year is 2.1 to 2.4 and the difference between that is the sheriff -- trying to figure out what the sheriff portion is. >> it is the overtime difference, correct. >> about $800,000 or $1 million

for a six-month period? >> the $3.2 is broken out $2 million for the health department and $1.2 million for the sheriff. that is the six-month amount. to translate it for a year. and going forward after this year, we are talking about assuming this would happen year after year and $6.5 million line item for the general fund. >> that would be the cost, yes. and this contract has been how many years out? >> the r.f.p.? >> we probably go for five years. >> thank you. i believe they do have some amendments to that legislation, correct?

>> the original legislation that was submitted had to be re-amended because of savings was adjusted from the original amount by a couple hundred thousand and then also we are requesting to add a section in the resolution that states that the mayor's determined state of the city's budget has created an emergency situation to be able to award a contract security services. >> is this pretty typical language generally? >> correct. >> an i know the department is not yet in agreement with the budget analyst recommendations and there are outstanding issues not least of which is providing information to regards to the proposal and i would like to ask the department to come back next week after we have had some discussions and in addition to that, colleagues, if it would be

fine, item number three is the prop j documentation that the controller's office has recommended we amend to reflect the correct amount for savings as well as making sure that we are congruent with the language we consistently use for prop j's, so we're not asking on the actual prop j and we have to hear public comment on it tomorrow and make decisions, but if we can make those amendments, can we do that without objection? okay. we'll accept the amendments without objection. thank you very much. we'll see the department next week. >> thank you. >> and now the other department and final one is the human services agency. >> good afternoon, supervisors. director of the human services agency. i have with me the department of aging and adult services ann hinton.

h.s.a. is comprised of two departments, human services as well as aging and adult services and we merged in 2004 to form the human services agency. just the high level look at the budget that's before you today, with $683 million budget of which about $30.5 million representses general fund and that is across the whole agency, both departments. the d.h.s. shares about $443 million and the d.o.s. shares about $163. $87 million is ascribed to both department as administrative and other support to both. as you know, i was here in april presenting my budget as well. given the need to reduce our general fund expenditures or fund revenue, we developed some budget principles and these are the prips proposals we use -- these are the principles we used over the last couple of year. and really sort of developed

given the lean fiscal years that we're dealing with. and that is the principles are as follows. the first of arching is to preserve programs and services that meet basic human's needs with housing or shelter and access to health care and access to income support and protection and safety prips principally of children and vulnerable adults. the second principal is to focus on 2/3 of our budget is revenue is from the federal or the state government. and the third is to focus on our mandates to preserve services that meet the mandates. the fourth is to look at efficiencies within the internal operations and the fifth is to have our decisions being guided by program effectivend either internally or externally. followin