the first three come from the community health improvement plan and what i'm going to do is read those, i'm going to name the speakers all at once and then they'll come up one in a row. i won't come back and introduce them. so for the insurance, safe and healthy living environment, we'll have richard leaf, director of the environmental health branch, increase healthy eating and physical activity. we'll have tracy packer. under black african american health i will make a few comments under maternal, child and adolescent health. and then under health for people at risk in living with hiv, doctor susan phillip will make some comments. i'm going to go ahead and turn it over to richard lee for

environmental health. >> good afternoon. as acting director i'm pleased to present our work on phd strategic plan. we identified the need for safe and healthy living environments. we identified three headline indicators that you see that wu that we felt should be addressed. the first is clean air. san francisco has relatively clean air. our location along the coast helps us greatly. we're lucky we're not inland, but on page 17, the number of good air quality days average around 250 days per year. we'd like to increase that number to 365 days per year. we work with the bay area quality air management district staff to development the community risk reduction plan

and identify strategies to include air quality in san francisco. part of our plan will be support implementation to build va tee jik strategies. also we know that there are areas of san francisco where air quality [inaudible] most of those areas are along the main transportation routes like along the freeways or the busy streets like geary or van ness. we have been enforcing artd kl 58 to make sure residential buildings to install filters breathing in those particulates from the vehicles. we have process of improving article 38 through a new ordinance and amendment. chap is working with the school

district in metropolitan transportation authority to encourage safe walking and biking in the school program, which would then reduce air pollution. the second indicator is tobacco free living. as you can see on page 19, san francisco has been able to reduce the percent of smokers from 20 percent down to around 13% of the population, but that 13% has been fairly stable for the last two years and we'd like to reduce it even more. we've been working to make tobacco harder and more expensive to buy, make it harder to sell, reduce the number of locations where people can smoke and reduced opportunities to advertised. they provide smoking programs for those who want to quit smoking and they're partnering with community agencies to

advocate for smoke free housing. we were able to pass so that people -- when they try to rent a place they'll know if there are actually smoke free units or not. and we would actually like to ultimately pass a regulation to ban smoking in all dwellings, but there's going to be complications because some tenants think that people might actually get evicted if they pass that so there's issues with that regulation. it'll be a little more difficult. right now environmental health works with [inaudible] tobacco sales to minors. environmental health continues to recent ledge vags that allows us to regulate e cigarettes just like tobacco and we hope to reduce the number of smokers with these policies as we move into the future.

the last headline indicator is for ped safety. making aware from environmental health and [inaudible] from chap, i think just recently had a presentation for you in the last probably month or so. talking about vision [inaudible]. and that provision zero is to have zero pedestrian deaths by the year 2004. making [inaudible] important members of the [inaudible] task force which include members from sfmta, police department, walk first, county transportation and all other agencies. so analysis of entry data and interventions, the task force will assess the effectiveness of interventions to help determine the best use of resources in terms to reducing ped injuries and death. we hope to be getting more staff to conduct this analysis and we want to thank the health commission for your support for

[inaudible] initiative. and the three headline indicators. the first indicator is residents who do not have food security and they define food security as the resource to purchase food, having access to food and the consumption of healthy food. we're at about 34 pktd of low income adults who are able to afford enough food and this is the baseline says san francisco is doing better overall. in the second indicator which

is the percent of resident who is maintain a healthy weight, about 56 percent of adults who maintain a healthy weight were above the national. and third is indicator for physical activity, about 82 percent of san francisco adults report participation in physical activity. while we might be above the overall national average, we have very important health disparities in san francisco and we know that socioeconomic factors as well as environmental factors contribute to this. therefore, the work that the population health division is doing is structural in nature and environment al so we're trying to change the environment so it makes it easier to get healthy food and physical activity. we do this in three ways. we work with partners, working very closely with san francisco improvement partnership.

second, we work with community members. the food guardians are a group of bay view hunters point residents that are trained to mobilize and they work on healthy retail ensuring corner stores have healthy food and less tobacco and fewer alcohol products. and then finally we use evidence based approaches. the healthy retail example is another one of those and we're working with the mayor's office of economic and work force development to strengthen that program as well. thank you very much for you support. >> commissioners, we have a little bit of a scheduling issue. we've got the sheriff waiting and he did turn on time so he's been waiting in the second conference room. i wonder if we can move quickly into our security conversation and allow him to say his comments. i'm just a little concerned with how long this presentation's going and it could be until 5 o'clock that he would have to be waiting. >> yeah. i would think commissioners that this is an important

presentation for us. if we just stopped at this point and go on to the security ordinance and then come back -- then we could take the proper time for this also rather than to rush through. is that meeting with your approvals? >> mm-hm. >> okay. so why don't we reset this discussion because i don't want to short change the potential discussion of a very important document. >> thank you commissioners for being flexible with that. >> thank you. so we'll take up the next item then. well, it's not the next item. the item on our security update. >> yes, the next item will be the sf [inaudible]. >> okay. so today we were going to give you an update on our correction

action plan. the sheriff did want to come and speak to the commission and he should be coming in shortly. i wanted to also let you know that we've done, i think a really tremendous job of working together. kathy with san francisco general hospital has worked closely with the captain in coming up with a new security structure. we may not be fully prepared to give you all the positions today, it depends on what the sheriff is going to present, but i can tell you that our security manager is in the budget. it's effective as of july 1 so we're actively beginning the recruitment of that process for that position. we also have worked -- there have been two structures in terms of security for the hospital and this is -- the security manager is not just going to be for san francisco general. this is a security manager for the entire department, but we are focused of course on san francisco general. the big change that -- i hopefully [inaudible] sheriff

today is the fact that we are looking at adding a security component to our legal component of security law enforcement so if you want to acknowledge the sheriffs and also the work he's done, roland's going to give a little introduction and then we'll turn over to the sheriff. >> thank you and thank you for coming. >> thank you director garcia. roland, director of san francisco health network and i'm joined by kathy jung who is the lead agent for security and is overseeing security efforts at sf [inaudible] and then the primary lee liaison for the past few years. i want to share with you the summary of key findings and

recommendations and also share some improvements related to hospital safety and security. as you know, there was an unfortunate indent involving the death of patient lynn spalding at sfgh and that incident shook the core of the staff and community at sfgh. as a result of that, several key activities ensued shortly thereafter and they were done by three different organizations. one was the federal centers for medicaid and medicare services, cms. they actually came in and did an on site review at sfgh. then mayor lee thought it was important to have an external review and asked the university of california of san francisco medical center to come in and do a review of security systems at the hospital. and then finally director

garcia had her staff, and i was a part of that, develop a corrective action plan that we delivered to the sheriff and he graciously accepted and has been a partner as we've gone through trying to put together that action plan. the summary i'm going to share with you is a couple four mayor areas. those are leadership, patient safety, contractor services and facility improvements. you can follow -- you'll see the legend actually at the top. it shows the organization that made the finding and/or recommendation and so those are cms for the medicaid federal survey, ucsf from the medical centers review and those items in the corrective action plan, the cap for the sheriff's department. in terms of leadership, the

general theme was insufficient oversight of a contracted service, be it security, both on the part of the hospital leadership and governing body. and insufficient communication between the major partners responsible for security at sfgh, be it the hospital administration, department of health and sheriff's department. there were two key recommendations, first was chief executive oversight. both chief executive of the department, robert garcia and the ceo, sue kern. in terms of the corrective action, director garcia meets on a monthly bay sigs sis with the sheriff and they involve key staff to ensure there's appropriate oversight of security operations. and then on a more ground level, sfgh ceo, sue kern, meets with the sheriff captain and key staff

assigned at afgh on a weekly basis to ensure appropriate oversight and remove any barriers to effect tiff security and safety operations. the second operation was the development of a contract performance monitoring plan. that monitoring plan was initiated and is ongoing and for those of you as members of the sfgh jcc, i know that you have been kept up to date i believe on that progress, but if not, as we go through the presentation, we're happy to entertain any questions you might have. in terms of patient safety, the general theme of deciding was there was a lack of comprehensive security plan that is actually a requirement of the accreditation body. it's the only commission that a credits san francisco general. special recommendations included the development of a comprehensive security plan,

the appointment of a full-time security program manager that would help to promote a culture of safety throughout this association organization and that that security program manager should have responsibility for developing that comprehensive plan. so in terms of an update on where we are with those, the dph security manager position has been put into the dph budget for 14, 15, and due to the critical nature of this position, we've requested an exception to the city annual salary ordinance to allow us to recruit for that position now rather than wait for july 1. that is going forward through our process and requires board of supervisors approval and is in that pipeline. another finding was a lack of

staff training and awareness and confidence and security. a lot of work is being done by the sheriff's staff and in promoting a safer environment. all sheriff staff assigned at sfgh have gone through orientation and smart training and they have an effective program to ensure that any sheriff staff assigned to sfgh complete that process. another finding was there was a lack of a coordinated search plan for missing persons. the recommendation was to develop a missing persons search policy and standardize the steps taken by the sheriff department to search for at risk patients. in terms of an update on where that process is, the sheriff's department and the hospital created what we call a code

green, which is a policy that deals with at risk patients who go missing or absent from their units. that program was initiated in november and completed in january and the code green process is ongoing at sfgh and has been triggered from time to time and the appropriate response has been given by all parties involved. another key finding was the involvement of the sheriff's department staff in assisting staff at sfgh who were trying to prevent at risk patients from leaving. much progress has been made collaboratively by the staff and sheriff's department and

the legal counsel for both the sheriff and department of public health worked together to come up with legally sufficient and defendable processes that have allowed for the sheriff's department to actively assist staff at the hospital for at risk patients and staff indicate they are quite satisfied with that involvement. under the area of contracted services, the finding was that the memorandum of understanding between the department of public health and the sheriff's department did not outline specific expectations of the security providers performance and knowledge. and it also indicated that transparency, communication and coordination of staffing was not sufficient and resulted in

cost and mroimentd deficiencies. in terms of [inaudible] there are many. some of key ones include the development of a new memorandum of understanding between the department and sheriff's department. at this point in time, both the city attorney for the sheriff and the city attorney for the department are actively working on new language for that mou that's more specific outlines service expectations and requirements. and we'll be sharing more about that with you as that mou is developed. and also the dph budget office is working with the sheriff's cfo on staffing. you're going to hear more about that from the sheriff at the conclusion of this presentation. the fourth and final key finding area was in facility

improvements. the finding was that the designated security communications office, or soc it's also referred to was inadequate in terms of space and functionality of the technology. invested security equipment and hardware did not meet the needs of the unique clientele served by sfgh. recommendations and corrective actions include the establishment of an appropriate hospital security operating center that's equipped to handle 24/7 requests for skusht and safety services. in terms of activities to date, a larger space has been identified to house the security on the first floor of the hospital and we're working with our facility folks now to begin to transition that from

the current space into the new space. the other part of the finding was that the technology was insufficient. part of the review from the ucsf medical center included a comprehensive assessment from an outside vendor by the name of kroll. they outlined the numerous information system electronic lock systems that are required in order to bring sfgh up to the standards that are required for effective security system. the costs for those items have been included in our dph budget that's been presented to you previously. and that is a quick review of the summary findings and i'm happy to take questions now or after the sheriff.

however you'd like to do that. >> perhaps we can have the sheriff make his presentation so that it would complete our picture. and we thank the sheriff for being present here. >> thank you honorable commissioners, greatly appreciate the opportunity to be before you today and our staff from the sheriff's department . first, i really want to give praise to the department of public health, san francisco general hospital, and its wide network of staff. before i was sheriff, as many of you know, i was a member of the board of supervisors. seven year i spent on the budget committee so that gives you an intimate window of how departments work together, well together and how they do not. and considering the challenges

that i think confronted the city overall, i'm impressed with the level of cooperation and collaboration, agility, responsiveness and how we were able to come together very quickly and with the snapshot that troy had just shared with you and others, how we were able to scale both structural and bureaucratic hurdles that had been in place years before i was sheriff and years before barbara garcia was head of dph. i really want to acknowledge the hard working staff of the upper leadership throughout dph and how they work with our staff and the [inaudible] -- the discussions were not always easy because history would come up that we all inherited that really tried to make sense of how we got to the place we did, spotlighted by tragedy that of course nobody wanted and we were all just stunned by, but

yet, determined to really turn this around and that's why we're here before you today. so i just want to say, i think overall for the city, not just our relevant departments, it's an important milestone of why we're here to report. these are highlights. the detail is much more in depth and i'm more than happy to go into that detail with you per our responses of the issue hearings identified by troy and ucsf audit which we greatly appreciate in our collaboration with them too and our internal assessments as well. as you recall when i was before you months ago i did something out of convention as sheriff with our department that is a very much chain of commands type of military institution,

like all local law enforcement. and i took a captain and literally grounded the captain there at sfgh. there had never been a captain there before because i wanted boots on the ground and somebody that i had qualified to be my go to person on the ground to literally shake it up and help us almost restart what we needed to do maybe many years earlier than that. born out of that process and then the communicative process, which frankly i don't think existed or well existed in the past. second motion strings of communication, which i don't believe is just ad hoc because of a tragedy, but now become more of a permanent establishment of how two departments should work together and a captain that's not reporting to a chief deputy, but now who are erased all sort of chain where he

reports directly to me so we have the ability to make swift and deliberate decisions which we have. so i want to share what some of those are that i think help result since 2002, 2003 when it

happened, has there been any kind of infusion like that, so what that gives us is to inject in depths at a level we've never been able to inject before. they cost less than deputies but we'll train them with a level of specialization so there are an ungraded version of i think what your normal private security might be in concert with the level of training and field training that never have been in place before up and down our chain

there captain to the cadet level. also, when we had instituted, naturally we wanted to speak to the stairwells, so there are daily stairwell checks. when one would shrug shoulders and think why hadn't there been, there just hadn't been and the protocol had never required that in the past. and us required to have the training that the second largest law enforcement agency now were allowed to rise to the stat stat chur of what our jay agent is. we have a lieutenant seven days a week which we did not have before, and then moving forward for the anticipated budget which we agreed on is increased vehicle patrol at buildings 1, 10, 20, 30, 40 and 9 and 24/7

building cough raj, a typical control of campus by our sworn deputy stf. our presence of security at the urgent care clinic, something we care very much about, an added presence that is from 7:00 am to 11:00 pm seven days per week and security presence added at our substance abuse clinics, 7:00 am to 3:00 pm seven days a week where there had not been before. and communication dispatch which is koir to the structural deficiencies that occurred over the years past leading up to not that distant past that are now rectified by people who were signed and must be really the leaders that represent our interests at these key meetings.