when i was first diagnosed my environmental load was at a - i'm now at 850 and my environmental load is at 71. so thank you. >> thank you very much next speaker. >> good afternoon i'm here on behalf of we feelness center. for years we have been a anchor in the community not only providing wrap around services

but also providing much needed hiv health education services and linkages to general care. in the past two years the tenderloin center have gotten 16 clients to healthy conditions. i've contributed 1/3rd of our clients come from the tenderloin with the highest community of environmental load 20 percent are currently living with hiv. i've contributed the - i believe

in the philosophy of about creating our system designed to educate we've been able to lesson the hiv - we're serving some of san francisco most vulnerable people with the greatest needs. people have traveled across the state to get those services. our community are investing in the health and we ask that you continue to invest in their health as well >> thank you. next speaker >> my name is dave and i'm a case client. i've been living with hiv since

1984 living with this has been tragic for me. i lost my job because i couldn't get out of my place. but i became homeless. two years ago, i got all the help you neat mental health care, food and the community. it was about my medical attention that allowed me to move forward. because i had - too years ago later my viral load is undid he

technically. i'm thinking about trying to doing all that by myself is like a 5 hundred pound weight prergz down on me. if i don't get those services i'm in trouble. 60 percent of my friends including me have a greater success and my story is not over i've still got a lot of things to do. please continue to invest in our health too. thank you >> thank you very much. next speaker >> i'm juan and i've been living with hiv since 2003. i was gainfully employed before this.

i started to use drugs and eventually i lost my jobs. then 2007 i find a case manager and find a social community. but because of my drug use i - my doctor said that i needed to be treated for my drug addiction. so in 2011 things got worse i asked my staff manager to help me going get into rehab. i was able to get on hiv medication and i've been clean for over two years and my t cell

counts have increased dramatically. san francisco's safety net saved me when everyone gave up on me. what will happen to all others in san francisco if this safety net is taken away. we're all 87 today to take responsibility for our health please invest in us. thank you very much >> thank you for your consideration and support. i'm bill, i serve as the director of the aids panel. for years we've provided help for people with aids we help people live and die with dignity. we're a small agency we have 7 staff attorneys but we have over

seven hundred attorneys who serve on our panel. the investment that the city makes an incredible amount of services. there are many competing needs and we need our support. thank you >> thank you very much. next speaker. >> thank you for having this opportunity for being here today. i'm here to talk about the programs that catholic charity ceo provided for the hiv community. we have two communities. peter and lee lane are people

who care for the services. the ryan white funding provides salaries for our certified nursing. which means we wouldn't be able to provide mid management and 24 hour new year's and escorts to appointments. we've got residents who have been alive for 19 years and without this services those residents wouldn't be able to adhere to these messages. together our 3 programs house a hundred and 74 previously homeless individuals.

i hope we can reconsidering funding the ryan white program >> thank you very much. next speaker >> good afternoon. three years ago, i came to san francisco to die. i had $1,500 in my hand and i was going to pay for my cremation. had i not access to services in san francisco i wouldn't be here before you i wouldn't be an active member in the community. i have worked with the aids foundations and i have heard of the pain people had are effected with hiv. if we cut back on the services that gave me life it will take

away from lives that are effected by hiv. i'm here to speak on behalf of the latinos because of their inability to speak and be heard. if you cut back on the information or education any kit backs that are made on the steps of progress we'll have to regress back to the 1980s and 90s and start seeing people die again. i'm here to plead and ask for your help. without those services i would not be here before i and be of service to the community i'm a

fighter for civil rights and i seriously hope you'll reconsider and take this is to the mayor >> thank you very much. next speaker >> thank you. i moved to this area in 2011. july 13th of of 2012 i had a heart attack. when i moved here from tennessee my viral load was high. thanks to ward 86 and this project i hope they restore the cuts and i hope you ail will

help us. thank you >> thank you. next speaker. >> i'm ann i'm a social worker's. i wanted to bring some residents here today but they are not feeling well. i want to about our facility where we rely heavy on ryan whites fund to fund our y n a salaries without whom we couldn't stay licenses. we serve people with mental health issues and extremely complicated medical issues. i believe we save the city money

because of our triage. we're able to observe medication and prevent a lot of infections hospital shuns not to mention possibly institutional costs since we get a lot of folks from the la begin hospital. so i'm urging you all to backfill the cuts and also looking forward to advocate with mayor lee for restored funding. thank you >> thank you. next speaker. >> hi thank you for the opportunity to speak. i'm a program manager at the health aids project. we provided health services you

ranging from acute orders and we keep our clients housed. the demand for our services remains as high as every. we saw 1 hundred 1 hundred and 35 people had hiv. 1 thousand and 1 hundred 68 of those persons had low incomes. 1 hundred and 67 person for psy psych - people receive - we do

our best to connect people in order to prevent any lower level of existing. that means a hundred or more persons who are resulting in hospitalization and decline in overall educational functioning. we are here to ask for your help >> thank you very much. is there any additional public comment? okay seeing none may we close

public comment? and i want to thank everyone who came out today and also the public health and the community based toeshgsz was very useful presentation at the beginning. we're earlier in our budget and we'll continue to work and advocate to do everything we can to backfill the anticipated federal cuts. so mr. chairman if there are no additional comments? >> just some brief condemns i want to thank you for your comments that we put the hiv context of our entire safety nets. san francisco is known as a

compassionate city and we've been strong in taking care of the hiv community and i'm committed to backfill the cut. and the choices we make as a city i've been talking about the city in terms of how we support the america's cup and it con trains our ability to look at our safety net but i want to make sure we're moving in the side to support our hiv services. i think what we saw we've been making a strong commitment over the years especially the big dip in 2006, 2345078 we were able to backfill the cuts.

thank you for bringing this forward and i'll make sure that jul july 1st, we'll look at those services >> thank you. i wanted to thank supervisors wiener and campos for bringing this forward and explaining how our model in san francisco is really one that the whole nation should be looking at and explain house the data from the national speck but the most important thing is you've done a tremendous job to

humanize the day that we've heard. and i know we ail work together to backfill as much as he. thank you >> and lastly thank you inform the members of the hiv provider network and thank you for coming in my office the other day and talking about it. i think the fact we're a parish national city i want to thank you for coming and spending the time. we're going to work together and find a way through this >> thank you so if colleagues if there's no additional comments i move we continue the items of the chair. >> so moved. mr. clerk could you, please call items 2 and 3 together.

>> item 2 to receive an update and focus year 2013 and fourteen. >> out of 4 thousand deficit the plan. >> thank you very much mr. clerk. i call these items a few weeks ago after our 6 week report came out but we are going to see some structural issues moving forward and i'm sure it's going to be a topic of the committee for weeks to come. i want to thank mr. wagner and invite barb garcia

>> first thank you for hearing the hearing today, we're going to be challenged this year but also internal and external deficits. so after the first 6 years the department faced large deficits that included both on costs of doing business for the department. for the majority of those proomz we were able to cover some costs and the board of supervisors have continued to be incredible supporters. but we still carry a deficit that was driven by labor costs. during this time we faced reductions and eliminations of programs. so to provide you with a few

details for it does cost the department the one 20 and $30 million just to stay the same and those costs are due to pharmacy and medical supplies. those historical deficits prancing from 15 million has been consistently accounts for federal cuts. as we enter into health care reform and this has already started and we began that with seniors and people with disabilities. we will be paid for outcomes and performs and no longer for the number of invests. all of those are coming to a

head this year and we're completing the opening of a new hospital and that's outside the bond we have to be able to pay for future and we're requesting money in the city. we need to make some different decisions and to ensure safety nets. for the last two years we have moved 10 thousand people who are dp h patients and have been transitioned into a health care plan and this would be based on performs rather than a number of business. as we're moving our department

towards the patients needs and reimbursing hospital admissions and readmissions we recognize that during the depressions we can't provided the same amount of services with less money. our department has never been shy from trying to meet our obligation from the city and we work hard with our decisions we plan a lot of before we make those and as we have in the past while we work with the boards committee we'll did so to help balance the budget you while we're seeking the services from the department. so i'll leave it to greg our which kind of operating office to give details and thank you.

>> thank you. i'll go through a couple of things today. i want to talk a little bit about our deficit and what's underlying our financial condition but i'll go through it in a little bit more details and talk about the implementations for our two year budget process. just by context as a reminder about the department of health budget we are about a $1.7 billion operation including san francisco general hospital and laguna hospital and extensive networks of primary care and substance abuse

services. of our 1 had the $7 billion about 4 hundred and 50 million is city general fund subsidy for the 2013 focus year and the other is state and federal revenue. so as barbara said we have a large counter year deficit in the controls 6 month report it is $14.9 million and i'll let you know we've been working hard since the six months report to bring that number down and we've brought that down somewhat although your financial position is we're a significant draw on

the city's if you believed just to support our operations in the current year. in terms of what's causing the deficit there's a number of things by the 4 categories we've got a instructional we face rapid cost inflammation that drives our costs up and we're facing continued state and federal revenue reductions and as part of our general operations weakness in the growth of our partial revenues throughout the system. again from the controllers 6 month report we have a 49 point something millions and some in the