number of things that make it unaffordable right now. that isn't necessarily true for seniors so i think we need more definition how we're going to be assured that a normal seniors today with their wrap around programs, and the part b big donut hole remaining not see this as an opportunity to reduce their costs. >> no. in fact seniors eligible under the expansion are otherwise eligible -- meet all of the other eligibility requirements so not eligible for the pubally subsidized health insurance and you need to be unemployed for that for healthy san francisco and that will be the case and anyone eligible for medicare will have medicare and not healthy san francisco. >> okay. i will assume that will be somewhere in your text

as we look at revised text. >> sure, absolutely. >> so we understand more. you're asking for an expansion of the senior and therefore -- i'm not against this but i want to know also along with the costs anticipated. how we protect and it's probably your statement that i just need -- >> absolutely we will make that more clear. >> -- review again. >> we will make that more clear. >> okay. there was a minor thing on the resolution and we can go over that later but i wanted to know because it's a "whereas" on the second page and there are so many "whereas's" and i understand when you want to make the argument of where we're going, so it's about the third whereas that talks about us conducting the analysis and recommendations

implemented before the 2016 open enrollment, so i'm not sure if that is related to the campus segment or that we the commission before 2015 to actually come up with these. >> both. it's related to the campos amendment. staff is supposed to bring by august 15 a plan to address affordability in time for implementation by the 2016 plan year. >> okay. so to avoid ambiguity i would separate those so it's clear to which ones we're talking about because we asked you to come in as you are now what to do for 2015, so i think -- just again i think i would with the resolves probably expand these items that you're doing, but i will take a look at it with you. >> okay. thank you. >> which ones we're actually implementing. okay. >> commissioners any other questions or feedback to staff here and you can continue to

give that by way of our director or even directly i think to colleen so she can accept those and be sure that we can integrate everything for a vote on october 7. if we don't make that we will be in some problem, right, because we have to let people know they're going to begin in the affordable care act november -- >> november 15. >> november 15. okay. we have a little time. thank you. >> thank you. >> director garcia any last comments on this? >> no. i think you covered all of the concerns and i want to thank you again for this consideration. >> >> it's been a long process to look at health care reform and continue to make sure people have health care. >> thank you. next item please. >> item 10 is the resolution to

support the availability of health care services to meet the needs of unaccompanied immigrant central american youth. >> okay. director are you going to introduce this? >> yes, i wanted to introduce the resolution to ensure those individuals coming to seek refugee issues in san francisco can access our services and we want to be welcoming to them as always to new comers in our community, and so we have been working from a city wide perspective on this with other agencies, and for ours it's much easier that we do have these services set up. we have to do a little bit of work -- like i said the legal services with maybe some home visiting and some social work support, but they're all within our resources that we have. i don't see this as increase in our general fund at all and i think there is

enough capacity for this. >> commissioner singer. it is within our budget -- that the proposal of this and the director and i agreed we thought should come before the commission was to affirm that our role is to be sure that these children get the care that they need. is there a motion -- oh is there any public comment first? >> i received no request for public comment on this item. >> okay. is in a motion for acceptance of the resolution. >> [inaudible] >> okay. a motion and a second. discussion? further discussion at this point? >> no, i would like to just state that i think the resolution is a reaffirmation of the city of san francisco and the department of public health and more importantly the city

itself pertaining to how we're a port city and there's always been room for families, seniors whatever, from whatever country -- at least in the history of san francisco, and i know that we mention the fact that during the 80's there -- this is where we declared it a sanctuary city but the fact of the matter is san francisco has always been a sanctuary city and i am glad to see this is a reaffirmation of this. the reason i say this there is a lot of concern nationally about the deportation of what we're doing, and the fact of the matter is this country and particularly california has always deported -- not california itself but the feds and others have deported many families whether they were citizens or not and our public

schools have fought this and true among latin americans and asian americans and japanese americans as part of history and san francisco has played both sides of the waterfront so to speak and going to the late 90's and the anti-chinese and the irish versus the italian versus all of these. the reason i say this is because a lot of these things were addressed in particular in the 70's in this city, and at san francisco general hospital -- part of our department of public health there was a great concern because we had many, many children and families fleeing central america and other areas where there were earthquakes and tragedies and so there were so many students coming in during this point that a lot of our nonprofit organizations, the catholic council for spanish

speaking, central latino to san francisco, asian organizations were also involved and working together to how could we provide services to the children and families coming in? and as a result we had a department of pediatrics at san francisco general lead by dr. pelatasco and let's work together with the nonprofit institutions that are servicing these communities and let's listen to what they're saying and how could we provide services? as a result they developed what was called the latino receiving center with the department of pediatrics, central latino council for spanish speaking, the school district. they had replacement officers there and test the children and enroll the parents or grandparents. we had immigration there from the peds to come down and -- feds and

issue the federal forms required. we had the school of psychology and the dental school and the medical checkups and not just thursday or friday or whatever day it was open but on saturdays in buena vista elementary school and other schools in the area and the whole team going out and there was a whole unit set up at san francisco general hospital just before the refugee center was set up. i'm talking because this is part of the uniqueness and a lot of doctors today and those involves or learned or participated in some of the efforts in the 70's and 80's because what happened even though we were screening 400 to 600 children what happened happen many of the parents or guardians if in fact we didn't have the center would have to take time off because they took the muni bus to the immigration

center at the federal building on 135 van ness, out to the school. set up at the park and st. mary's or whatever and talking about them losing two or three days of work in order to provide these services to protect their kids so the social workers, psychiatric social workers, everyone got together as a team and had a comprehensive model and address the population and at san francisco general hospital had unbelievable services. wlawpd? prop 13 happened. the files were abandoned. everything closed down and that's when the city woke up and began dog darn it we're a sanctuary city and we're going to find resources. as i read through this today we have many nonprofits involved in these efforts. we're going to coordinate services with the

other agencies. hopefully the deptal school will come in again providing services. the law school at usf and the mother was involved and a refugee from latin america. a lot of the services could be provided voluntarily so instead of going to the federal building or the state building or the school or whatever we might have these rotating units that could provide the services where the kids are and the families and guardians don't have to worry about losing the job or missing a day of work or whatever. the fact that this addresses many of the efforts is commendable and i wanted to say it for the record because i think the city of san francisco has set the standards maintaining the importance of people in the city and immigration and diversity which is the spirit of san francisco and i am glad that i have a chance to vote on this as a formal resolution to reaffirm again the u uniqueness of the

city and the city of san francisco. end of comment. >> thank you doctor. i noticed that the health director is here and the lead person on this and as you recognize many children are facing trauma as they come to the united states so i thought the doctor could give us a kick update to the activities he's been involved in because he's coordinating with many of the agencies that are helpful and reflective of what dr. sanchez was talking about shirlee please. >> commissioners good afternoon. i can give you a quick update. a lot of is in the statement that you read under dir -- director garcia's leadership and it's remarkable and we met with san francisco

eligible and others and the mayor's office to develop a unified plan such as you talked about commissioner sanchez so it was good to hear the history of that and i think we're repeating history for the best efforts for these children. we know it's a humanitarian crisis and these children are faced unbelievable odds and circumstances as they have crossed the border so it's not just attending to them getting them to school and gets services but attending to the trauma they have experienced and i am glad to say that we have in the city a lot of trauma experts and under director garcia's leadership we have a informed system so we can attend to the childrens' needs as well as the staff's needs that are serving the children and youth and families coming into the system. i was also pleased to hear that superintendent carranza has identified the need in the schools and identified a lead social worker or a person who is

the coordinator for the schools so we will have a unified system cross. we are developing a template and not have many people visit the home with many questions but common set of questions that look at risk and trauma and legal issues so no matter who goes into the home we can have a common set of principles. our mission child and family director mr. mc quell is taken the lead in the system and organize our care so the treaters have a common principles and practices in terms of providing care so i think we have the begin of course a system of care. just the other day we met with primary care to talk about the fact that a lot of these youth will come first and foremost into the schools and primary care and making sure they have immediate access to services. >> thank you.

>> thank you. >> i thank commissioner sanchez. noted we have always been a sanctuary city but that's not true. back in the 1870's and on in fact our own general hospital did not take certain categories of people including the chinese. this resolution i think speaks to the fact as a commission and as a department we welcome with open arms these people to get their care. it's an unmistakable statement that says we are here. please don't be afraid to come because that's what immigrant children and others who feel that they can't have access because maybe they don't belong here. we're seeing everybody who was here belongs to get care so i hope the commission will unanimously approve this resolution.

>> we're actually good at the coordination with the schools here. we're probably want perfect but we're probably better than anywhere else in the united states because this is so important to our values, and one way we can have an impact i think is making sure that people know what we're doing, so other municipalities kind of step up and have the kind of courage that our department and our city has shown. i know you don't need more to do on your to do list director garcia but these are the sorts of things we should be proud of and ambitious enough to say to other cities "hey you guys ought to be doing this". >> yes, sir. you wish to add to -- >> relative to the question there is a regional initiative so the mental illness directors regionally have done what you

said. >> that's great. it figures. >> yes commissioner. >> two thumbs up. >> two thumbs up. okay. we will make that a visual comment. any other comments please? if not are we prepared for the vote? all in favor say aye. >> aye. >> all those opposed? the resolution is accepted. thank you. next item please. >> item 11 is the san francisco general hospital institutional master plan and the accompanying resolution. as you recall this item was introduced to you august 5 and today you will vote on it. >> good afternoon commissioners. roleand pictins director of the san francisco

health network and it's my pleasure to deliver this presentation on behalf of my colleagues and administrator of facilities and service at sfgh and planning advisor to dph. this came to you at the first meeting in august. it was then remanded to the sfgh jjc and presented last week and i am bringing it back to you today. just for some of the background section 3 04.5 of the city planning code has a statutory requirement that all medical and post secondary educational institutions in the city and county of san francisco file a current institutional master plan with the planning department. with the last one for sfgh and dph being filed in 2008. it's important to point

out that the institutional master plan is differentiated from the sfgh campus master plan in that the institutional master plan is a high level document which provides a context for capital development on the campus and as part of that calls for a future revision to the sfgh campus master plan that will be done through an inclusive and collaborative process including user groups as has been done in the past. it's anticipated that the planning of the sfgh campus master plan and those user groups, the planning process should begin in the second quarter of this fiscal year, that's october, november, december time frame. again more background particularly related related to the campus master plan is that the master plan goes into more detail than the

institutional master plan, the campus master plan does, and it will go into the details of space use on the sfgh campus after the new hospital construction is completed. the campus master plan will call for programming of the existing hospital building five and will begin once bonding has been confirmed about the city's capital planning committee and city hall and the date of that proposed bond has still not been solidified but anticipated to be either 2015 or 2016. the program planning process when it does move forward for the sfgh campus master plan will use the prior assumptions again that were developed through user input as a spring board to updating that plan when it

begins in the second quarter of the fiscal year. just setting the stage for the 2014 update to the 2008 sfgh institutional master plan in september of 2012 director garcia convened a dph planing retreat and included representatives from all divisions of the department, laguna honda, a population health, ambulatory care, sfgh central growth, central administration, mental illness and substance abuse programs and maternal and child health. during that retreat there were over 50 attendees and participants and we established the overall dph base and planning needs as they were envisioned in 2012. that retreat also established

priorities for future dph development efforts. for example, like the dph public health lab located in this building which will need to be relocated and we discussed the needs like the building in 80 and 90 -- ambulatory clinics on the campus needing to be relocated. a little more in terms of setting the stage for the 2014 master plan. in general the planning efforts that were established at the 2012 retreat globally addressed the seismic retrofit of the existing sfgh building five that would allow for an expanded ambulatory care site in the building once the new hospital opens. that 2012 retreat also acknowledged and recommended proceeding with the development

of a ucff research building at sfgh and that processed includes an expanded sfgh garage tied to the research building on the campus. so some of the objectives of the 2014 sfgh institutional master plan. the objectives are to provide an viewover view of the projects completed from sfgh since the last plan was submitted in 2008. as you know the new hospital building is in process and on target for completion in 2015. also we are i believe halfway through with the modernization of the elevators in main building five and 80 and 90 and there are

considerable ada compliance projects going on. some projects that were in the 2008 plan were completed and the carlyle learning center of boot current library of the merge generator replacement at sfgh. update of the radiology and biplane equipment and significant service seismic upgrades that bring the service building into compliance. just a few more objectives of the 2014 institutional master plan.

the current proposed scope of -- either 2015 or 2016 general obligation bond includes funding proposed for the building five seismic retrofitting, and also critical building system replacements that are desperately needed now. for example, the chiller replacement coolingly towers, supply fans, a new roof, and other facility rated issues, and also some improvements and fire, life, safety upgrades as required by osh pod. the current 2014imp also includes the proposed construction of the sfgh research building which will be financed by ucsf and not the city and the proposed expansion

of the garage and funded by a sfmta revenue bond. so in more broad terms the 2014 sfgh institutional master plan has a primary obilitydive of reaffirming that the future development plans for san francisco general campus are consistent with the findings and plans from the 2008 report, and that the 2014 plan provides guidelines for development of a more detailed campus master planning document which again is based on user input and considering the needs and resources of both sfgh and the department of public health space needs overall. so contingent upon health commission endorsement of the imp and adoption of the proposed

resolution the imp would be submitted to the city planning department. it's then anticipated that would be calendared for the planning commission in october and just to let you know that the imp is a non actionable item by the planning commission. they simply need to receive it, so that concludes my presentation. i am happy to answer any questions that you may have. >> commissioners questions? commissioner singer. >> we reviewed this in some detail at the recent sfgh general hospital and i think it's a super thoughtful plan. one thing i think we should keep in mind as pointed out this is consistent with the 2008 piece of work which on the one hand is terrific and that's what we expect, and on the other hand you kind of scratch your head

2008 small changes in health care in the united states, small changes in our city since then. how relevant is it to when the buildings under the plan are going to be built, probably a decade later best case, so i think it's something you struggled with in health care, and particularly as we struggled with capital resources from the city that investments required way ahead of when the capacity is needed, and making sure that we have the courage to make those cases and make the subtle changes in plans which is going to allow us to make the most sense from today going forward, but maybe a little bit different than everyone got set on in 08 and there are certainly things in this plan in terms of buildings and prioritization that i am sure given the advantage years we're going to have the opportunity to look back and say "you know maybe this should be higher on the stack" and i think it's work

if we don't do and take a hold of as a commission we will end up with a narristic -- a nakistic set of buildings and how we deliver care to the people of the city. >> so joint conference reviewed this -- >> we reviewed this and -- >> i want to say that we came together about that and if we did it today we would have other possibilities and you're right and every two years rethink about issues. as an example would we have small clinics in the community or have larger ones and those issues were already brought up and we struggled with how could we do that but i think that is the future of what we have to think about is how we have the facilities in the community because now we does the major

institutions and the it's the small community clinics that were never developed to be clinics that we revised and remodeled and put in elevators and new ada laws and you're right and this has to be a continuous improvement process in terms of looking at facilities. >> commissioner karshmer. >> thank you. i just have one question and maybe a red herring but how does our master plan deal with the constituency determination? don't we have to subject ourselves to ourselves? >> [inaudible] >> and i guess my continued thought based on the discussion and director garcia and commissioner singer is that a way to make sure that we do this in a ongoing way opposed to "x" number of years? >> so if