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. 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