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

behavioral health, women's health and sexual health. i want to point out that -- and in that roll i have been looking at this data now for almost 15 years and i can tell you we have a lot of work to do and what i want to emphasize now is the leadership that director garcia is -- she's put together an african american health initiative and we're actually going to focus in the area specifically in our healthcare system. we expend a huge amount of money and we need to within our system and some parts of or system are more than 50 percent of our population and we feel -- we can't turn the curve with a patient, the clients, the people whose lives we're touching, how can with go with communities so that's going to be a real important focus and i want to say that's what we're going to do. i want to end up with one little quote that my wife tells her first gradesers. she tells her first graders believe in yourself, work hard and dream big.

and that's what we're going to do. we're dreaming big. we think if we're very aligned and focused and we can make a difference with african american patients and what we learned we can and, per tease we can bring into the community. i'm going to turn it over to susan phillips. >> good afternoon commissioners, i'm marry as the director of maternal child and health sheer here in san francisco our mission is to promote the health and well being of women of childbearing age, infants, children adolescents and families in san francisco. we take a population based approach in our work and this way we support the effort to achieve health equity in

populations that are at greater risks for poorer health. we develop programs and interventions that focus on young children and young families because experiences early in life have an impact later in life. including the effect on health status. making positive change to the three head lieb indicators this you'll see on pages 47 through 53 will have important effects into the future and save resources that would have been required for more complicated interventions. we work in collaboration with partner organizations both within the city, family and in the community because the problems faced by san francisco families are complex. changing outcomes requires a thinking and efforts of many. work to change our third headline indicator on dedz line prohiv diagnosis in san

francisco and key strategies are going to be implementing newer strategies that can detect infections earlier as well as print or prep for communities and individuals that at increased risk for hiv. second, increasing the percent of newly diagnosed persons sfdph linked program which has specialists in linkage in support as well as other case management services in the city

and really trying to strategize around colocating services those people who are at risk for hef and those affected to provide the finally increasing the percentage of people living with hiv who have viral loads that are below the level of protection. that's a very key prevention stat ji that reduces the transmission risk for others to have a suppressed viral load. in doing this we feel that some key strategies will include supporting behavioral health often are interruptions to continued kaer and effective treatment and supporting clinicians both within our health network and throughout the city in the ability to provide care and treatment in order to get peop hiv to have very suppressed viral loads and

treatment. thank you very much. >> in closing today is election day and today we bring you a resolution to adopt our strategic plan it's fitting that we know that since this is something you need to review you will vote on at the next meeting we wanted to bring it to you today. it sends a message for us and the community and the public health accreditation board that you are standing behind the yafrs in which we are focusing on in our stat jis. this is just the beginning. i let you know next steps is for us to come together to look at our programs to see what works, what doesn't work and what we need to improve in order to make this strategic plan live in the community. we'll take your questions. >> i received no public comment requests. >> okay. we're prepared for questions. commissioner mal. >> yeah. yeah, i was wondering because i remember when we started with this plan we talked about -- i

thought violence was included in this somewhere and i don't see it anywhere so when i look at safe and healthy living environments i don't see street violence or domestic violence or children with trauma anywhere so i'm wondering where we -- >> focus area on child health around the maltreatment of children that talks about both violence, trauma, abuse, emotional, physical, the entire spectrum. >> i want to make sure it's included in there. yes, commissioner. >> i want to congratulate you and your staff on this. i enjoyed reading this. it gave me a sense not only of what you're doing, but a little bit the public health history of how these problems got started and how we're attacking them so congratulations to all

of you on this. i would like to point out that last meeting we got of the commission we were handed the california rankings of health factors and health outcomes, and san francisco county ranked fifth in health factors and those are areas where your efforts and your part of this department's efforts really have a quite a large impact and what was striking to me is that we were ranked so highly and we're a pretty complicated county in terms of these issues so i'll give you a sense of the counties that ranked ahead of us and they're much more ho moj nous on 14 different dimensions than us -- marin, san ma day owe and santa clara. that's a credit to this department's efforts and the

team's efforts. i get you're not satisfied, but we're doing okay. . >> we're number five in risk factors, but 22 in outcomes. >> that is true. >> we still have a lot to do with disparity. >> you have to give a little kudos where -- >> you can accept a little of it. >> yes, commissioner -- >> so congratulations. i think this is an exciting next step as part of the whole accreditation process. and what -- as i was reading this, what called to me is how to get this to the rest of the san francisco. you know, how these are tangible, tangible actions that are going to have an impact and the more we can get the rest of the san francisco community to understand tangible things are being done i think would be important.

so we're part of this so this is part of our contribution so doing collective impact we know we're not the only ones as we bring to the table as we work in partnership to really bring together but this is kind of our things that we bring to the dinner table. >> right. i just want to make sure everybody knows how much you're bringing. >> thank you. >> i'd like to add my congratulations to staff and to doctor aragon for the work you've put forth. i think this is monumental. it actual lyly brings tangible goals. and you've stated very clearly where we're trying to go and we're not satisfied with where we are and some of the most

important major things so my comments are -- and number two, that i think for particularly our african american friends and neighborhoods, we've now, again, been more clear about what we see as our need to move forward. there's been, as you have described, so many different approaches and initiatives, i think this is one that actually can be much more successful because we're taken some tangible areas that could have real outcomes and we're going to be trying to work on those and measure them. we're not trying to do the entire ballpark. i still remember when we went out there and we said we can't deal with health until we deal with security. well, we can't just wait and i think this is very commendable that we now have some

measurements that will start hopefully impacting upon the disparities. so talking about disparities then, recognizing that this is a a summary document, it's really important to be able to parse apart the fact that there are different levels here, the complexity commissioner singer has pointed out for or population that in contrast to marin in which most of the populations in the certain quadrant or actually almost majority, the high majority, we have an enormous diversity you've pointed out. so refinement to this would be really in some of the areas to point out where within -- aside from the african american initiative, that some of these are more disparate in certain populations than others and so that where we might look real good when we just aggregate

the data, then we focus on a particular population so that others wouldn't say well, in today's very limited resource, why are we chasing after item number two because item number two is already resolved. well, it isn't resolved for a particular population and i think you may find that you would be better if then that were described so that you are going to focus our activities upon those areas that you've already spoken to. within that, i just would also mention the one on obesity and i think you've touched on it somewhat, but the vmi issue within the east asian community at least and certainly actually the opposite and the pacific islander community really needs to be considered and those numbers could vary considerably

as our performance as a county and if you just aggregate it you probably will have more people within the group that needs to be addressed because we were using the current bmi measurements, you pointed out obesity is at 30 and the world health organization and things like our national programs and the diabetes coalition of the asian pacific islanders that i happen to have intimate knowledge of have pointed out in fact the epidemic is worse because we're using the wrong numbers for our asian population. >> yes, we're actually doing in death penalty work within community hoelt equity and promotion in that area and our focus right now has been around sugarly beverages. you may not be aware of this, they do have a different bmi calibration, but it turns out