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. we can answer anymore questions

from there if you'd like, but it continues to go on and on in how further we are embedding ourselves to make sure that a relationship only reflects the kind of excellence i think you'd expect. >> i'd like to thank the work that both the sheriff and i have done together and his staff, it has been a great partnership and we've been able to work through the problems we have and also to note that we have a lot of work to do in the future to strengthen our security systems within the department. i also want you to know there's another law enforcement on campus at any given time, ucsf police because they are responsible for some of their areas of particularly the labs and then our own san francisco police department who could be called to an incident regarding a 9-1-1 incident. we are still working on the 9-1-1 dispatch center issues and i think there's some progress going on that, but one

thing i wanted to let you know that one of the things we've been working on is how do we then now talk to our own staff about this and just to let you know we have tentative date, we're [inaudible] with the sheriff but we're bringing the sheriff and the ucsf chief along with us to discuss this and the integrated staff on the campus at san francisco general in the coming weeks. of the staff recognized we're all working together and have been working closely with the chief of ucsf police along with our own department staff. we'll be now coming to rogue that out to staff shortly in the coming weeks. i invited our president of commission to that session with us. >> if i can underscore one point. as it relates to our collective relationship with the department of emergency

management, whether you know it or not, we're no sprieding services directly for dispatcher communications dvss at department of emergency management because city charter really does not reflect and had not reflect the sheriff's department being part of the public safety family. so in essence we're a casualty of bag legacy in not really being [inaudible] into the common core of the dataly operations of what is provided for police and san francisco fire department. quite frankly we are an after thought and there was this sort of

kind of keyed to a lot of the communications because that was going to sort of what were potential security issues versus what were more traditional hospital type questions also. so as i understand it, and sheriff has described a bur rock say that we're going to have to walk through, is this something that we have a timeline on in terms of then creating a real 9-1-1. this was one of the issues that were discuss eded has not been

determined yet and so that's something we'll have to toll to follow up with the commissioners as soon as possible. >> questions from the commission. commissioner singer. >> thank you very much for coming. i have a couple questions for you, sheriff and then a couple for mr. pickens. i too share your admiration for director garcia and her staff and for your captain who you've assigned to the general hospital. i've had the pleasure of working with him on the join commission there and he's responsive and thoughtful and we appreciate that. i'm not sure i share your sense that we have lived up to our obligation to fix this problem urgently and let me expand on that. the obvious headline issue here

is that there's patient and staff safety issues. the equally important concern i think is there are accreditation issues related to the general and this is our safety net hospital for the city and county and we all have an obligation to work urgently to make sure we satisfy local state and federal requirements so we don't lose accreditation and so on those two things, i, as director knows, i am not personally satisfied that we've moved as you are jentsly as possible and i'll get to that in a minute. sort of the first question is it's probably likely that the next issue we have at the general, and it's a complicated place and it's big so there will be issues won't be a lost patient in the stairwell and so as you've had time to reflect

on just your personal fact finding and all the reports that have been done, what should we be thinking about? i mean, we're highly focused on the stairwells, but what other things are on your mind to really do this in a world class way that we need to be focused on. >> you're talking about systemic change. while that is initiated and carried through on a day-to-day level, with all due respect, this commission's not removed from that responsibility as well. i actually did my homework and looked backwards to eight years of records of health kwigss and i think only once had the sheriff's department ever come before this health commission, maybe twice at most to reflect on the relationship between both our departments so i think there is a reason for us to really retool the entire conversation of what takes place and leading up to, i think the kind of change that

should have happened we may agree to disagree, but in the last six months has been rocketing change compared to the previous eight years within, i think the construct of our relationship. and beyond that, on not just a highly regular event and tragic as somebody being stuck and dying in a stairwell, but on the day-to-day level of safety when any staff or visitors at sf general and the 24 acres that they may peruse, visit as sf general, nobody should ever feel unsafe and i think if there's ever been any gaps or holes in the policy or expectation of what a department has not responded to, that's what we're zeroing in on.

what might be not a crime per se because i've heard in the past that our sworn staff might be slow to respond to certain incidents, because no offense needing no crime has occurred we've looked hard at that and want to make sure if anybody feels at risk that our staff is not on the sidelines and i think that's important for all levels of staff and guests, visitors, patients who work and are at sf again. that's in your opinion one. number two is i think the alarm system so that there's continuity consistency and accountability for where there are obscure areas of the campus and more well traveled areas of the campus, both need to know and partners to both sheriff's department and sf general dph staff both need to know exactly with precision what is

occurring if alarms should go off. but if alarm doesn't go off when it should have, then that of course needed to be corrected too. as well as surveillance that didn't exist to the degree that it's going to xigs now and that feed of what is occurring on campus since again, pretragedy we only had four fixed posts and one roving deputy at a 24 acre campus proved insufficient all together so it's then our tentacles of making sure that we have just more thorough and wider coverage. that's the level of detail i'm talking about. >> and i appreciate that. and we'd love to have you back any time you're willing to come because i do think that the ability to sort of get through this urgent situation and then be able to take another look about okay, what did we miss, what did we learn, what's the next step would be helpful.

my second question relates to the following. we just came -- some of us just came from the finance committee here. >> that must have been fun. >> it's always a pleasure. and one of the things which is striking is both how well we do relative to other places in the country, for example, in treating our hiv population and how whoafully inadequate the funds are to do that compared to what staff would really like to do in a perfect world. therefore, while i congratulate you guys i'm getting another 1.8 million for security that in some ways we all wish we'd spend that on patient care and not on sheriff's deputies, not because we don't like them, but because we'd rather do that because that's central to our mission. one of the challenges we have as a commission is figuring out whether -- and i've gone back and read the debates that have

happened at the board over the best way to provide security at the general over the years, is whether this is the most cost effective way to do that for us, given our priority to spend both on public health measures and treatments. and so the question for you is, how should we think about whether this is over the long term the rational way to spend our security dollars. >> with the same level of excellence as we would fur patient care. it's an investment towards a county hospital that deserves our, i think immense support, never to be compromised in its ability to serve for all people, workers and people who -- patients and visitors to the

campus in that expectation that we are funding that level of care. we are leaders such as the hiv and aids response. let me tell you, in our jails we know something about that too so that's not something that we believe in short on but we've also been saying for quite some time that i believe in the investment of security and the investment of a better parter ship and infrastructure because we do have such an amazing, stellar county hospital. not to short trip that either, but i think we're heading in the right direction. >> thank you. i had a question for mr. pickens. >> just in response to death as well, one of the big pieces we saw was the world of law enforcement versus the bill of security. that's what we worked on in terms of reduction of costs.

what we were doing having sheriff's doing sheriff's activities. the cadets now at a much lower rate of pay. not to say equality, but the level of need in terms of a security role versus law enforcement. a: >> and the sheriff and i talked about that last time. sounds like you made a lot of progress and you delivered on it. i appreciate that. >> one distinction that's indirectly related to this is we put our first academy class of new deputies. we haven't had an academy class in five years. for the first time in the history of the department when they invented the cadet class is we incubated the cadets and harvested them into our deputy core so we're trying to create a better level of pipelining of

people we groom from the pipe level into that deputy level and that's exactly what we'll do much more of. and we have a large new field of deputies who former cadets and some of them may cut through teeth on very welding sf again and that's exactly the kind of [inaudible] that we should be encouraging in san francisco who gets that level of training and who wants to make the longevity be with our department. >> i'm wondering if we can hold the questions for mr. pickens until i can make sure that the commissioners have had the questions in deference to the sheriff and his time. you have none? okay. so thank you again, very much. you're certainly welcome to remain and potentially your own representatives could answer any other questions that may arise. i want to make sure you understand your own timing and that we respect that too and thank you for coming. >> thank you very much. >> thank you.

>> thank you. mr. pickens, there are questions and we'll start on my left here with commissioner karshmer please. >> thank you and thank you to the sheriff for the work that you obviously have worked very hard to address some of the issues. and my read of this -- these are a lot of really good ideas. the plan that you have, the meeting, the leadership, the training, the new cadets, the new security manager, frequently checks the tracking so all these process things you are implementing, what i'm looking for are the outcome metrics and how you have built them and how you intend to build them in. you did say there was the new protocol for at risk food plan and that has been activated. it would be helpful for two reasons, i think for the commission to know about those, one is that we would know that the action that you have put in place are having a positive impact. and the second part is it really speaks to what the

sheriff said is that we have not had a history of an ongoing commission, knowing what's happening around security so that kind of reporting would be useful. to finish this out, the whole new legal approach for the cadets to have an action with potential issues, limitations, i'd be really interested to know about that just so we are aware of the safety issues, but also then, the need for an ongoing evaluation plan for that. how many times is it activated, what's the impact, what's the disposition because i'm speaking to this idea of us being involved with the policy notions about that be so it doesn't just -- it's really asking about now that you've got these great ideas and really good plans in place, what are the positive impacts on the safety at the general.

>> absolutely. and both points are very well taken in terms of outcome measures, in terms of how often has the code green been implemented. we certainly have that data and can share it with you both at the full commission and the joint conference. >> and maybe at the joint commission is the appropriate place. and maybe getting that on a regular basis. >> i think the commission itself, as you've expressed, also wants to keep track of what's happening here so director garcia, we -- >> that will be a lot easier when we have somebody in charge of that, which will be the security manager of the whole department and that will be one of their biggest chores is to ensure that both the jcc and the health food commission gets updated reports on that. for right now though, i just want to acknowledge captain jung who's come up because she has taken that on and along with her other assignments and

has done an incredible job of working with us and ensuring the relationship with the captain from an infrastructure point of vie vuchl view. of view. >> we have a committee that meets once a month and the security report is done every month. we actually go over the data on every code green activation, every a wol or at risk patient we've been on the search for and we know the status of every one of those searchs. we debrief on each one of those -- well, we don't, but the committees that has been put together to look at all the at risk incidents, the debriefings and it's still evolving, we're still improving it, we're still training on it and of every incident we're finding new ways to improve it. we're looking at those metrics and reporting on that data.

>> commissioner singer. >> i hat a couple questions, roland. the first is -- i would encourage all of you, if you haven't, to read the ucsf report. when i read that it sort of screamed to me in very diplomatic language was someone needs to be in charge of security at the general and no one was in charge. when i read your action list and director garcia, thanks for your urgency in moving that up in terms of recruiting priorities from our last meeting over at the general. i think that's just terrific. and it can happen sooner, that'd be even better. your description of that person is to create a culture of security and safety, i imagine, which is hard to argue with, but i've read that report and

it basically said somebody needs to be in charge and able to control the place and make sure it was staffed when it was appropriate. are you interpreting it differently than i am? >> i don't think so. i think probably -- i think there's a separation of duties in terms of the latter, in terms of the person who's in charge of the day-to-day. that's what the captain does for us in ways that we never had before we didn't have the services of a captain. i see the security manager as the person who does promote that culture, who initiates the policies and procedures, who initiates and oversees the training related to safety and security and then who become a partner with the captain and then with kathy as the lead administrator for security, the three of them become those who

create the safety from an operational point of view. >> with all due respect, that's a disrespect from how i read the report. what the report said is that they don't know another hospital that does security in this sort of distributed fashion. and maybe it's the right thing to come back to the joint commission, but i really think we have to look at that recommendation because this solution to me does not follow the reck ommendation of the experts. in fact, sounds a lot like where we've been in terms of not having a person with the resources responsible for security, who is a hospital employee. that's what the report said to me. so my second question, and this is sort of what can we do to help you, which is which areas do you feel are not moving fast enough when you prioritize patient and staff safety in

terms of things you need to change. what would you like to see go faster? >> i think probably, and the one we have least control over, which is the facility, both major capital improvements that will require perhaps state level approval to do major changes in terms of walls and building that larger security operation center, but having said that, we're also looking at every opportunity to be innovative in terms of how we can still move forward in advance of those barriers like that that we know exist, but i think it's the ones that are out of our control that give me the most worry. >> thank you. commissioner melara. >> i have none.

>> i do think having read the report, there are other organizations that do have the challenge of the separate responsibilities of hospital security versus -- what -- legal and appropriate response on a potential criminal thing, but i do agree that we should at the joint con explore that further to ensure that we are on the right track because obviously your point i think is well taken, there has to be one person who's response ible or at least we need to understand if it's more than one person, who's responsible for what. >> we will work on that from a staff level. there's this issue of a safety officers on the campus that's responsible and there's a safety manager that's looking at all those issues. i think that level that commissioner singer identified

was a potential [inaudible] in this process we've developed so we'll take aerolook at that and ensure at the next jcc we address that. >> i think beneed to answer that question to ensure that it's clear that we understand what's being divided and who then become responsible for each. if it has to be collaborative or not. i think you are correct that we should bring this to the joint conference for further working out. >> the ucsf report actually criticized us for this collaborative distributed responsibility and i think implicit in what i heard from the sheriff's remarks earlier it made his job and his predecessor's job super tricky. so he inherited a situation, but the ucsf report -- it was in the first paragraph and,

like, no one is in charge. >> sure. >> and i think we need to see if the solutions coming up to answer that and answer it to the satisfaction of the commission. so we'll look forward to that. i think the other items we have put forward is trying to -- because i see another area which i think we've spoken to, which is the 9-1-1 communications, which is the trigger to everything and we need some sort of a timeframe upon which this is going to happen and we need to be part of the advocacy for that, then we should. and lastly, it would be a future report r because this is going to be a model upon which we are going to try to have security at our other points of service including laguna and our clinics, how is that going to roll out? obviously we have to have some sort of answers here before that can move on. but i see those as at least

three areas that we should continue to have. i agree with that a report does come back to the commission even though first vetted during conference to be sure that outcomes reports are being looked at at least for some period of time. >> i'd like to remind the commission that we are looking at safety throughout the department. of course san francisco general is our first priority right now. >> yeah, thank you. so if there are no further areas that commissioners would like to be sure, thank you commissioner melara. >> just a suggestion that we've had so much wealth of information here today that i would suggest that this be taken at the join conference committee in that periodic report from the joint conference committee come to the full commission. >> yes, we will see that. this remains on the commission calendar and we'll try to do

our work during conference to bring you the best answers