home. >> people get hungry why not eat and give >> the health commission will please come to order. and the secretary will call the role. >> commissioner singer. >> i'm here. >> mcgee. >> present. >> malari. >> here. >> chou. >> present. >> sanchez. >> the commissioners and chung are out. the second item on the agenda is approval of the minutes of the health commission on may 2014. >> accept the commission. >> moved. >> there's a motion and second. any correction to the minutes. >> if not, we're prepared for the vote. all in favor please -- yes, please. >> i had one comment to director garcia. on the topic in your report about the beanie hauf generous

donation and the us f hospital down there, i was wondering if we can hear some point in the future on whether there's coordinations between what goes on at that hospital and the infrastructure being put in and the types services that are delivered now at san francisco general hospital which we all saw in the new york time is the best hospital for this kind of care in the country and just to have them within blocks of each other might be an opportunity to do something, you know, rationale partnership on things we're both good at. >> absolutely. and i know that our ceo of the general would be in favor of that. we'll incorporate that when we report to you about that. thank you commissioner. >> thank you, commissioner. there was only one typo which is under section 8 and it's in the third paragraph and that is mrs. robinson raet than robins. i'll make

that correction. >> we're prepared for the vote and all those in favor please say aye. >> aye. >> all opposed, the minutes are approved. >> next item -- >> next is the director's lot. >> good afternoon, commissioners. the may revision of the governor budget is out and i want to highlight some of the budget proposals. one is that an increase of $1.2 billion over the january budget is allocated to medical for 2014-15. it's to cover the cost of enrollment, it's an additional $1.2 and it stands at $11.5 million, that's why the increase in the medical as well because there's many more people taking advantage of

the medical system. the state continues to expect to recover in saving from counties $900 million and 80/85 realignment funds and as we reported to this, is that they were taking back our dollars for realignment to pay for those medical increases. and $187.2 million is allocated for medical manage care plan rate increases $191.2 million is allocated for increase mental health and substance use disordered available to medical and that's pushing the issue of parity between medical and behavior health, on the hiv and aids part , the funds are included for drugs for hepatitis c and this initiative

will increase initiative to hepatitis c medication for co-infected patients. and we -- you've been read nothing the paper. that's an expensive medication and a very effective one, so we're happy to see that. there's a $2 million is allocated to the place funding for county and administration cost related to the akd agreement and we're involved with that. just good news on the medical front. we don't have many cuts, but we do have take pack from the state regarding the may revision. and we're still working with the state on what that number is. and as commissioner singer just talked about, san francisco general was in the new york time regarding the stellar work in labor and deliver services and was featured in the new york times column on may 7th and the story is the

safest place in california to have a baby, so we want to acknowledge san francisco general. there was an article in the san francisco examiner, on may 11th that front page featured the story of garcia, he's not related, efforts to give back to san francisco general hospital. four years ago, trauma surgeons saved his life and garcia is organizing a run to race 30,000 to celebrate his health and show his gratitude back. i'll leave the report and answer any questions that the commissioners have. >> commissioners, any questions at this point in time? i think -- i have one or two. on the may revise of the governor's budget, they're

taking money from the county and that will be made up by the funds rendered. >> there's another part, those who do not select their health plan, we'll get 70 percent of those allocations from the health plan as individuals. if an individual does not select a health plan, 70 percent of those individuals will be given back to the county as part of the give back process. >> they know who hasn't joined the health plan and we're going to get that money back? >> it sounds like those that did not sign up for health plan, then the state will pay us back 70 percent? >> if an $70 percent? >> if an individual in the med-cal program does not select a provider and there's a pool of that, 70 will go to the -- >> i got it. >> those that did not make a selection, to the med-cal recipient will be assigned to the county.

speaker: yes. >> that was apart of the negotiation if taking back all of the dollars that there will be. that number is still influx. we'll get that to the commission as soon as we get them. >> the second question, actually related to the myron progress report, it follows the congressional hearing and my question was that, you've received summaries each of these funded projects that were occurring in the impacted neighborhoods so it seems to me and i was going to ask commissioner mcgee, is this something you're following to understand this. this is under the myron progress report. >> i don't think we've given an update to the committee, but we can do that. >> that would be nice.

>> we'll do that and calendar thatment -- we'll do that. >> that would be great. >> thank you commissioner. any public comment on the director's report. >> i haven't received request for the public comment. >> next item is general public comment and we have three folks who have made requests. if i can quickly say our normal projector system is down today accident and how that's going to effect public comment , i'm going to hold a timer, so when it buzzes please stop talking and move on, please. >> okay. moody, please, first. >> mr. president, commissioners, please let me first address some feedback i received on may 6th. it was suggested to me that my

comments were taking as bashing the health department. i want to be clear that such outcome was never my intent. let me reiterate my specific comment. i want to end can you -- i want to encourage the health department and all of its part necessities to develop and implement a broad program of specific intervention of africans. there's a response from the health department and the community. i suggest as i did two weeks ago that we continue in that vane. on monday may 12th, i attended the west coast kickoff of president obama "my brother's keeper initiative". i was in oakland at the endowment and we were linked to a similar gathering in los angeles. my brother's keeper is a federal inter agency effort to improve

measurablely the expected educational and life outcomes for and address the persistent opportunity gaps faced by boys and young men of color. 20 separate federal agencies or officers are membered of the task force established by the member random. but this is less than adequate. programs and a recommendation to search out evidence based inat the vengs and partner with the private sector to insure sustain, i'm not sure of what is less than robust. good but not good enough given the crisis situation we face with african american boys. i was encouraged at this meeting by the announcement that 11 foundations in california would

publish to call action dealing with this issue and no content was revealed, i'm hopeful they'll be more concrete recommendations to address the growing need of african american boys across all sectors of our society. i was encouraged that the initiative task force is seeking input from a variety of community sources to provide a more workable framework for actual change. the days to clinging to government and non profit speak and hoping things will change must end. so let me once again encourage the commission to support the efforts of leadership at d -- d ph and encourage the health and well-beings of african as a whole and african american boys

specifically and have our existing plan against it. in many areas, he with may lead in others we may lag behind. but its inclusion in our discussion and planning is crucial as the inclusion of whatever my brothers keeper initiative is able to build on a national level. we must now be the measure routed that millions of hours of work invested in improving the condition for african americans could not bring. thank you. >> thank you mr. moody. your time is up, we appreciate your continued support. >> the next speaker is bob ivery, please. >> you also have placed yourself on the agenda for a second item. >> i can cover it here. >> cover both. >> i have something --

>> with the same three minutes. >> i can do it. >> thank you. >> you all heard our testimony in the prior meeting. >> could you speak up. >> you heard testimony of the nurses from san francisco general. i've been at a nurse at san francisco general for 30 years. you've heard our concerns about staffing and patient safety. you will see on the news tonight that the nurses held a demonstration in city hall in front the mayor's door to call upon the mayor to fill the unfilled nurses scrubs that we presented to him so that we can provide the kind of care that we all want to give to the basis of san francisco. i'm giving to you a white paper position prior to our release and get to the press tomorrow. this is our best interpretation of the data that we have of the problems with staffing at san francisco general. whatever the right number is, we do know that the hospital is under

budgeted for the kind of staffing that we need to provide legal, safe and excellent care to our patients. whatever the number is, we know that it's going to take some doing to get there. right now i am authorized to buy my bargaining team as we are in bargaining to tell you that the nurses are ready and willing to take a strike authorization vote in order to gain the staffing that we believe that we need to keep our patients safe. why would we do such an extraordinary step? because we believe we did not get here with 90 short f d's short of the budget which may not be the correct budget for providing that care. we did not get here because of the hiring pace of the hr nor by the income bans of civil service. they were

political decisions to hold nursing wrecks and that will continue when the ink is dry on our contract. to summarize, we want a permanent solution to this problem of staffing. we're trying to achieve it through bargaining, and with we would like to continue to give reports and to dialogue with the members of the health commission through our labor monitoring committee co-chairs. so my ask on the agenda item is that we gain the right to be part of the team and so that nurses with best experience don't have to come here as the public and we can talk to you and you can talk to us and we can maybe solve some problems. thank you very much. >> thank you, mr. ivery. do we have any other general public comments? okay. >> we can go to the next item,

please. >> next item is the lot back on the community public health committee but the committee was cancelled due to a lack of quorum, and item 6 is a consent item so we have item number 7 which is the resolution. >> good afternoon, commissioners. lonnie with the may's office. it's nice to be back. so since we were -- we were here two weeks ago talking about the outcomes of the task force which to remind you of our acronym, care, and success and insure success, a group we ran over the last two months to look at, behavioral health and service gaps and what we can do to address those service gaps. we had presented you with a laundry list of recommendations that came out of this task force and you asked us to go back and prioritize them and we have done so since then and

that's what you're going to find in this resolution today, so what we have here is a priority to address some of the issues that came up with family member involvement and support. one of the things that we were able to do, we were able to add a family specialist to current services so that family members are getting the support in their homes that they need when they're also in crisis because of their loved ones illness. we're able to add pier specialist. specifically we've been able to add five peer specialist to work in the psychiatric hospital and it will be staffed with peer specialist, so they'll be a hybrid approach and a place for folks to get off the street and access care in a timely manner.

creating new and existing programs, so we're able to increase the number of case managers working in the full partnerships so those intensive case managers have a smaller case load, so they can do more intense work with the individuals so we're able to add two new fte's there. we're going to expand the community independent placement project, so this is something dph has done and it provides the individual to remain living in the community while receiving their needed services. it includes mandated medication compliance. so right now that program, it has been successful. it's offered through san francisco general and one of the priorities that we've pulled out of this in the last two weeks

per your question request -- per your request, we're going to expand it so those leaving jail and reentering the community can access these -- we can work through that -- we can work with those individuals to provide these services. what else do we have here? we're also able to add a transition ag specialist, so similar to addressing the concerns of individual family members whose loved ones are in crisis. we can provide a specialist, so transitional age list and getting the service needs that they need with someone who understands their unique challenges. the final item that we are going to work on is health information sharing and collaborations, so one of the aggravations i think

you had when we were talking about this a few weeks ago, how do you know who the population is? and that's hard given our data. i got an e-mail in my inbox, our fire department and d ph was able to meet with us. i don't have the data to share, but this is an ongoing dialogue and we want to continue that dialogue and finding a solution so wee sharing information and we're populate this in a meaningful way and we can measure the outcomes through the population and meaningful way. our data systems aren't allowing us to do that. so work still in progress. there's many more recommendations that came out of this. i believe in your memo, you have a description of

all of them. all of them we can't tackle right away, but these are the -- these are our priorities in the short term. and i just wanted to, i think you had some questions so i'm here to answer questions. >> thank you. was there any public many -- any public comment? >> i didn't receive any public comment. >> commissioner singer. >> i had a question for the chair which is, this is super important work and they've come a long way in prioritizing it from a long list of important stuff to a list of more urgent stuff. as a matter of how this place works, if we pass this resolution without any sense of what the financial burden on the department is going to be, do we put them in a box? how does that work? >> so these are -- these were

items that our department has reviewed and felt was priority and we'll ask director garcia. >> we not only prioritize, but we funded them them the nha dollars and we had dollars and also as an example, the peer program has been funded the year before and we're implementing that now. so we did not put -- we put most of the things on priorities and have already allocated funding towards those, so the last piece that we don't have is the hie which is an ongoing issue for us and the health information and sharing collaboration at city wide effort that we have been working on for eight, nine years already. so we have any of the areas that you talked about and i believe this is true lonnie that we did already look at the budget and allocated that through our msa. these are items we're fully behind and allocated.

and there's some towards the bottom. but we could show the allocations to each of those and those we didn't have allocations for. >> as a practical matter whether the commission passes this resolution or not, you're doing all these things? >> yes, we're working on those. when a -- when a commission would pass something that may not have a funding source to that, what it does is help us prioritize those in the upcoming budget years. >> which one these things do you not have money to do? >> we can more about this in another report, but right now i would probably say the issue of health and commission share sg the piece and the hie is the areas we have to continue to work on and that's apart of our overall it process. >> this higher level point i'm trying to understand is that we never hear at the commission things

which aren't or we very rarely hear ideas that aren't super important and effecting a population our citizens that we want to effect positively, but unless you have the whole picture, i want to make sure we're not putting the department in a position where they have to reprioritize things in a certain way because we passed a resolution in just the velocity of the business that we didn't think through, okay, that means we're not going to do x because we don't live in an environment of infinite funding. >> i appreciate that commissioner. when we sat with the staff and the leadership of the care council, it was very -- i think it felt like it's fit to the direction we're going already. and so

what i'd like to do is maybe bring this back again with the funding aspects of it so you can see the full picture of this and the implementation. i appreciate that and we would work with the commission on any resolution that i felt was not obtainable in terms of a funding issue, so we commit to that and we always do that and if there -- the commission has been thoughtful of putting resolutions that don't have that ability to implement so i appreciate your comment. >> thanks. >> i'm sorry. >> i want to add to what barbara said. that was our priority. we want to make sure this conversation is looking at current programming, not just trying to layer new programming. but what are we currently doing, and how can we shift things and reprioritize so we're more effective. the image of funding is -- it's state funding so there's no local general dollars going to this. so

that's my personal priority too. i don't want to throw money at things if we're not -- if it's not plugged into the larger strategy of the department. so -- >> yeah. you've been great about that in talking to us before. but i think the reality of how these things unfold is we all feel that way and we end up, you know, looking at it and saying we're committed to do all these things and we can't deliver on that. it's our responsibility to make sure we don't get too far ahead of ourselves speaker: your correct. we do work with staff to make sure these aren't unreasonable question and outside of our strategic plans and one reason for the resolution is to say these were reasonable, strategic goals that we should then be needing so i think your points are well taken and that's what

resolutions are about, to try to do that. i have commissioner sanchez and mcgee. >> i understand, you know, the comment made by commissioner singer. i interpret this differently. i felt as i reread it and the unique changes that were made in dialogue, that in essence, we were being asked to reaffirm this integration of staff from disciplines in the work they've been undertaking and still as an example, it's very specifically states that we need to collect valid, adequate data and discuss that. that's a -- that's apart of the studies we did. they mentioned three areas. seattle accident san diego, and san mateo county. they went through

similar protocols relates to money goes to gates. and it's going to part of the missions in san mateo, but this was after the re-- i interpreted it as a reaffirmation and the work being done. we don't have all the answers but we're going to look at different pathways, and i was ready onto support the concept and have additional comment in the future pertaining to where we're at right now and data that all of this have shun. that's why we have a commission. >> commissioner taylor and mcgee, please. >> thank you for the lot of the update. i'm curious on page 4 when you look at your graphic. i

mean, you basically said this is a hard to quantify population for various reasons, not withstanding substance abuse and the fact that i think you've already identified them as adults who can take care of themselves. however, it looks like -- with the graphic, i have the sense that you've quantified it in some way because you have the large area and then the smaller, can you tell me, you know , what are you talking about in terms of the numbers or how have you identified that if you can't quantify it? >> we've identified the population, but we're not able to put numbers into those boxes so, you know, there's 30,000 people and san francisco behavior system system at any given time. most of those individuals are -- they are -- they've successfully engaged treatment and they go into recovery.

what we were try to go get out with this population, it seems often times as individuals, the different indicators for everyone, it's different. if some people, it's confounded by homelessness, lack of family connections there's a lot of different things that we can try to quantify. but what we were try to go do is conceptually capture this group of people that typically do not get treatment until they hit what is referred to as a 51/50 until their disease grows to a great disability and they lose their civil liberties and taken to psychiatric emergency. what we're try to go say, who are these folks that are just almost there, so we're doing good at prevention on the front end and we're helping