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 i was staff reviewing the general hospital institutional master plan i would consider consider it for incentive because we serve a large number already to dr. chow's point -- no, maybe it was commissioner singer's point and how many people we serve already and the population we serve already and we're looking to expand the services we provide to the under served population so as a critical safety net population it does what the master plan prioritizes and expands care to low income people and hospital services to low income people so it's

definitely consistent and high number of health disparitys. >> doesn't make sense to make it explicit that we are building on our own policies. >> and if the bond passes that's something we could do. >> and then we want incentives; right? >> [inaudible] >> commissioner chung. >> so actually i just whisperd that question to commissioner chow earlier. this has been a conversation we had for a while i believe, and so within this master plan you have to propose like capital improvement plan, the garage as well as the research building and one of the things i think during my conversation anyway was how would the neighborhood receive these like additional constructions? like we just finished building a hospital and i think that might be something

that we have to interact with. >> absolutely. there's always -- in addition to the user groups at the facility itself there is always a community input involvement in the process so that would definitely be a part of it and also getting back to your question commissioner singer the good thing about the code it's not proscriptive in terms how often we do this. we could do it every year if we wanted to and of course most institutions don't because it's a huge under taking. you usually bring in consultants. you have your community meeting process. i live through ucsf and they're going through that now and i get the notifications but given the journey with health care reform it makes sense to look more often than we have in the past. >> thank you. >> any further comments? we're prepared for a -- there is a

resolution before us? >> yes. it should be in the packet. >> so we need a motion for the resolution. >> so moved. >> second. >> any further discussion? if not we're prepared for the vote. all in favor say aye. >> aye. >> all those opposed? the resolution has been passed. thank you. >> i and will note i received no public comment comments for that before you voted. item 12 is the vote for the sfdph for the sexual orientation guidelines. this was brought been the finance and planning committee and the first time you are hearing it but you will be voting today. >> okay. please proceed. >> good afternoon commissioners. i am maria martinez and i work here in

administration of public health. today i am talk about the sexual orientation guidelines, it is principles for coding and reporting sexual identity of sexual orientation and i am here as a folks in the department with casper and looking at data, integrity of the data and i co-chair with dr. airgone and with me today i want to make note of staff that is here today and jenna. jenna is here. randy is here. they had a lot to do with developing the guidelines and today i am presenting this to you so you can adopt the principles that i'm going to put forward to it and basically would charge the department to try to implementlet principles, implement the methodology and any new systems that the

department purchases, it systems would need to be accommodated with these. the purpose of these -- as you know we have been before you with sex and gender as well as ethnicity guidelines. this is the third in a series. because it matters in terms how we design services and look at health out comes and look at conditions that impact those out comes. this is an exhaustive process and started in 2012 for sexual orientation. we are engaged all of the thinkers thinkersin the demeanor. w and worked with university of san francisco and came back to the committee about a month ago. had great input

and you will see the incorporated input. casper identifies -- addresses identity indicators. as i mentioned we did ethnicity and sex and gender and did did it because we found over time there was no standardized way of identifying coding or reporting sexual orientation if it's asked at all in our systems. we looked at not only the dph systems but interagency. did this department ask it? did the department of children and families et cetera if we recognize it as a concept the services we provide and [inaudible] experiences and health out comes. we also recognized in our guidelines that we're not the only ones considering this to be important to ask. healthy people 2020 outlines indicators the 2012 institute of medicine report on

lgbt measures and research gaps reported it. the department of mental illness and there are federal -- the affordable care act notations that it's important to ask. the definition that we landed on after a lot of conversation was that sexual orientation is an identity that typically indicates the genders of people of an individual who is sexually or romantically attacked and may change over time. this is not a medical condition. it's an identity. and it is an important marker of health differs but should not be assumed to be the source of the health differences. in terms of what the differences are in our research we identified there were a number of surveys and peer review research that compared lgb individuals and their health out comes and behaviors against the their straight heterosexual peers and found more likely to avoid or

delay medical care, smoke cigarettes and engage in self harming behaviors and in sites that required treatment than the straight counter parts. the goal of the -- excuse me, of the sexual orientation guidelines is have a method for identifying the person's sexual orientation and the reason for that is we want to own able lesbian gas and bisexual individuals to see and identify themselves with accurate and positive terminology. to minimize the confusion by the larger straight population which we serve a large number of people. when we ask them the sexual identity they need not to be confused by it. limit the answers so it's meaningful. not confuse sexual identity with behavior or activity. be able to get

accurate information from the populations that we serve and normalize the questions. so our question is how do you describe your sexual orientation or sexual identity? check one, straight -- we have all these choices. the two options that we weighed for a long time. one was queer and the other one was fluid and so we decided to not put those into it and as we can watch and monitor over time and look at the text written to see if it begins presented there. as i mentioned it's important not to conflate this with sexual activity and if that's what you're looking for in terms of risk that should be asked and

not an identity indicator but identity is important because there is stigma associated with the identity. the principles are it should be self identified. should be shouldn't say you shouldn't ascribe to a identity by looking at how you dress or talk and should be voluntary and collected for all adults 18 and over and if appropriate in a clinical interaction if the youth are alone with the clinician that it's asked of individuals between age 12-18 and when it's asked and when entered into the record it's beholden to the minor consent policy and then we should consider how to keep this up-to-date because i mentioned it's fluid and changes over time, and it should allow us to not only collect information that's helpful but also there are time when is it's dictated how we need to ask the questions

so we can't -- so the policy recommendations that we incorporate the recommendations into the data collection and reporting as feasible that we develop materials in terms of implementing it. that we look at training, technical assistance in helping individuals implement it, and that each data system articulate how the questions are asked and how they're asked and by whom. i am happy to answer any questions. >> is there any public comment? >> i received no requests for public comment? . >> okay. commissioners. commissioner chow. >> just one comment to say i really appreciate how thorough you have gone into these policy guidelines especially like with -- we had that discussion -- you know during the guidelines and

about the magical number when do we think -- like when we were young at what age did we develop our sexual orientation and our gender identity and i am glad to see that like you -- the group has decided to choose the age of 12 which is the age they can actually get an hiv test without parental consent and i think that is a huge step forward and i want to say we have been ahead of the curve in data collections, and as far as i know at this moment community policy makers in riverside counties are waiting for us to approve this so they can actually show the county how they can start collecting data on lesbian gay, transgender

patients that they serve so congratulations and thank you for all the work that you and your team have put into this. >> thank you. >> any other -- commissioner. >> i just have a thank you too for all this work and the next step how it's going to get deployed for non department of public health providers out there and part of their lexicon that it's important to ask because it has an impact on health care. i know the sex and gender when we address the transgender was asked by the interdepartment city wide transgender, and then this was adopted as well for the homeless count, so other than that i'm not quite sure how far my reach would be. probably a good question to have this there so educators, providers start having this as part of the way they teach as well as what is expected, what becomes the norm. >> associations are really important in that process and

we're will work on the health associations that we all belong too but it's great if you have other -- >> [inaudible] >> absolutely. i want to thank maria. i watched this go on for years and diligent. >> 10 years. >> fantastic job on this so thank you. >> thank you. >> yeah, i also want to thank you for the clear presentation that discusses the subject that is at hand which is to have a motion to adopt the principles for collecting, coding and reporting identity data for the sexual orientation guidelines that are before us. >> so moved. >> is there a second? >> second. >> is there further discussion? we're prepared for the vote. all in favor say aye. >> aye. >> all those opposed? the guidelines have been adopted. thank you. >> thank you commissioners.

the next item is item 13 other business and there is a public comment. >> [inaudible] >> okay. mr. goodman please. you have three minutes. >> okay. i'm a little -- president, dr. chow, honorable commissioners, director garcia i am riewk rub an goodman and have been dual diagnosed and i would like to see some effort on part of the commission and the mental health department in trying to bring about more sensitivity on the part of some of the social workers that work in clinics so there's less of us versus them mentality. i would like to first say that the mission act

which i attend i recommend the highest possible accommodation for my psychiatric social worker, nancy a baro. i have been working with her for years and she's excellent. also i recommend the highest accommodation for the director galileo and in my dealings with him he makes me feel at ease and equal to him. there's no superiority complex. also a counselor named donovan but unfortunately there are some social workers that seem to have a us versus them mentality, and this can lead to situations that i call blaming the victim. recently i went through a manic episode and rather than looking at the symptoms, rather than the

social workers consummitting dsm4 and mr. goodman is going through these symptoms which he described right here there was a tendency on part some of the social workers who i was and my personality and wanting to try to check me and blame the victim. i won't go into any specifics but i commend galileo, the director and my social worker nancy and donovan especially in tune with the clients. thank you very much. >> thank you for your comments. commissioners any other business you wish to present? if not we will move on to the next item. >> yes. item 14 say report back from the san francisco general hospital meeting from august 26 that commissioner singer chairs. >> we had a meeting. let me summarize the salient points.

we approved the council minutes and requested regulatory issues and they now have quite a good framework for updating us on the myriad of regulatory issues. we reviewed and talking about the proposed institutional master plan which we saw here and talked about the lean update. lean is the program they have a very comprehensive and cohesive team approach to making their work more efficient and the care better, and that's particularly . >> >> important now because they're dealing with the prospect of moving the hospital next year so they have to be tighten than they have been and it goes correctly and feels like they're embracing that with unthese yasm and rises to the level of hard to fathom but it's

terrific. we got a new version of the vacation report we use and we approved a new sheet for surgery and we approved the full commission approved the bylaws which the chief of medicine and his staff -- including the predecessor, put an incredible amount of time on it. mark, do we need to move on that now? >> that's coming before you october 7. >> great. we got an update on the head of security which you all know and are interested in was one of the main things that came out of the review of the unfurniture incident at the beginning of last year -- end of the prior year i guess and we're making good progress on that and that felt good, but as part of that i would say that we have a lot better appreciation for the

hiring process that the department operates under that is sort of given to it by the city, and that's something they think bears a lot more work. in any circumstance it's important to identify and hire good people quickly in the kind of competitive environment that we face in san francisco today. it is almost unconference i believe that we -- conconscious i believe that we ask them to deal with that and in the steep competition for great people. >> >> so it's something we should in counsel with director garcia try to understand it because it will be a huge cost to us in the coming years if we don't figure out a way around it and in closed session we got a report,

the credentials report and the pips report and we approved those. >> questions commissioners? if not thank you for the comprehensive report. next -- any other joint conference meetings? >> no. and i also received no public comment requests for that item. . . the next item is committee agenda setting. >> so commissioners we had gone through our planning session so based on that we're working on what might be some topics that we could take up and how we would do that probably in some sort of format that allows for further discussion in a less formal fashion as one of our sessions, but commissioner chung today the possibility that we would vet some of the subjects first in a similar type session within our own subcommittees,

so that the topics then would be already matured in order for us to look at what we might consider like many planning sessions for certain large topics, like either the ehr or the system -- the aca so while we're getting these important reports we could digest that and also look at where we're going in the future, so that's on the horizon working on the director how we're going to do that, and so i just want to report that as part of our committee agenda setting for the future. you may have wondered where our off site meeting will be and that actually was put into the mix or first quarter of next year because the calendar was very tight and takes a little bit of logistics to locate the outside site and to set those up, so we

have put that off until the first quarter of next year. commissioners have any other announcements to make regarding committee agenda setting? if not then an item on number 16 says adjournment. a motion is in order. >> so moved. >> second. >> and there is a motion and a second. all in favor say aye. >> yes. >> all opposed? this meeting is adjourned. thank you. [gavel]

(music)

>> herb theatre,open rehearsal. listen to the rehearsal. i think it is fun for them, they see our work process, our discussions, the decisions we make. it is good for us. we kind of behavior little bit when we have people in the audience. msk (music) >> we are rehearsing for our most expensive tour; plus two concerts here. we are proud that the growth of the orchestra, and how it is expanded and it is being accepted. my ambition when i came on as music director here -- it was evident we needed

absolutely excellent work. also evident to me that i thought everyone should know that. this was my purpose. and after we opened, which was a spectacular opening concert about five weeks after that the economy completely crashed. my plan -- and i'm absolutely dogmatic about my plans --were delayed slightly. i would say that in this very difficult timefor the arts and everyone, especially the arts, it's phenomenal how new century has grown where many unfortunate organizations have stopped. during this period we got ourselves on national radio presence; we started touring, releasing cds, a dvd.

we continue to tour. reputation grows and grows and grows and it has never stopped going forward. msk(music) >> the bay area knows the orchestra. you maybe take things for granted a little bit. that is simply not the case will go on the road. the audiences go crazy. they don't see vitality like this on stage. we are capable of conveying joy when we play. msk(music) >> any performance that we do, that a program, that will be something on the program that you haven't heard before. string orchestra repertoire is pretty small. i used to be boxed into small repertoire.

i kept constantly looking for new repertoire and commissioning new arrangements. if you look at the first of the program you have very early, young vibrant mendelson; fabulous opener and then you have this fabulous concerto written for us in the orchestra. is our gift. msk(music) >> and then you have strauss, extraordinary piece. the most challenging of all. string orchestra work. 23 solo instrument, no violin section, now viola section; everybody is responsible for their part in this piece.

the challenge is something that i felt not only that we could do , absolutely could do, but i wanted to show off. i can't tell you how aware i am of the audience. not only what i hear but their vibes, so strong. i have been doing this for a long time. i kind of make them feel what i want them to feel. there is nobody in that audience or anywhere that is not going to know that particular song by the fourth note. and that is our encore on tour. by the way.

i am proud to play it, we are from san francisco. we are going to play that piece no matter where we are.