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 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