to hit that number at san francisco general hospital you have savings in the first year and cost in the second so big picture and now i'm moving through this at a curry level it comes down to as you can see the balancing picture here revenue increases costs and savings all add up to $19.3 million at the bottom right on this slide that's the balance that is available and we're programming that balance again towards our it program and we'll in a couple of minutes later in the agenda have more details from bill kim about the programs but that's our commitment to the electronic records project we'll be

providing for information over time on what that looks like i've got a come up of slides i'm not going to go into extreme detail this is one of the requests we've had if the commission is to give a little bit more of a sense of how the budget is changing by division and so we've got 3 slides one for combuchz one for revenue and a calculated fund support this is the changes in expenditures by divisions within the department you have the 14 and 17th century budget the current year budget and you have in the second column the number that which is adapted in the base budget when we did our two year budget last year and the third climate the proposed changes and the budget before you today and

the last column the bottom line proposed budget will be so again about $1.98 billion is the total as you can see as you can see the variances but division based on the initiative we're assuming there's a lot buried in those numbers that is sometimes a little bit hard to pick out the true matt haney i'm happy to talk you to for example san francisco general hospital you'll see a negative 1.5 this is largely the result of this f x dollars being 3wuk9d in the past not budget going forward we're ramping up staffing as we move into the new hospital there's a net decrease in the total expenditures but as you can see relating consistent with

the few exemptions between one and 3 percent growth rate in the expenditures a lot of that is due to the programmed salary and benefit cost increases those are driven by the labor mous and adjusts as we put new initiatives in place it changes a number 6 ftes or the total expenditures so again on expenditures similar picture to prior years as you can see san francisco general hospital is our largest division has been for some time 43 percent of the budget and followed by public health and that includes our housing and a lot of our other programs

in addition to our core population how it function mental health and laguna honda similar chart for revenues and i will not go into this in great detail just to point out a few of the out liars san francisco general shows a negative that is the loss of the revenue from debt we issued or issuing to fund the furniture fixtures and equipment that is booked out if you look at purely operating costs you'll see an increase year after year of san francisco general hospital as we move to the new hospital operations another out liar here a couple of out liars mlk and primary care mental health revenues that

includes m h s and the realignment dollars and primary care a small amount based on on our actual and lastly in terms of where the general fund support it within the department as you can see in the second to the last column in terms of general fund support it will be about $625 million of our $1.98 billion budget so a significant expenses to the city again that number is declining prominently because of the sf and e there's growth although wife tried to make an effort to restrain the growth in our general fund programs and try to

allocate the savings toward our it program so again i'll be happy to answer any questions that you have about those items if not i will kind of i'm going to turn it over to a little bit of a productive from bill kim from the it budget. >> all right. i building that at this time we'll do as we've spoken before a good natural break the presentation of it following the discussion on our item 8 and then take up 7 and 9 together with the it explanations and then questions from the commission. >> if the public wishes to comment on the budget this is available to them by submitting a form for that discussion but at this time we'll go back and call again our item.

>> oh, yes. >> item 8. >> sure the massage establishment in san francisco and the state law amendments for the san francisco health code and resolution. >> okay. good afternoon xhiksdz i'm sorry i couldn't accommodate the immediate q request for the stakeholders who had to listen thought presentation again i'm cindy work on planning and policy in the environmental health and to talk about the change to the mass acknowledge i'm sure you're aware of the environmental health branch provides the oversight on the natural built investment and the regulation as

it pertains to health we have 14 regular tell you programs making sure that hotels are held to certain sanction and taxicabs are in regulations aimed at protecting public health and we're tasked with regulating the mass acknowledge establishment it conducts recital making sure establishment are clean and free of con donate and well vent laid and using proper commit we review and improve new construction and issue permits and licenses i'll hear to talk about the changes in the proposed new ordinances that

will codify the state law and amend the health code we're hoping to accomplish conform local to styling and improve the regulation of massage establishment and support healthy community we're asking for your support to it legislation with the legislation you have in front of you so this slide shows on overview of what i'm going to talk about i'm going to get a background on the massage legislation and talk about the protective how it impacts health and what's the current health of the massage legislation and talk about the specific changes being proposed and also how to offer more health services so in order to understand the

need for legislative changes you'll talk about the background the massage legislation in on a 4 the massage as to his was regulated by the police department it was shifted to the which recollects the adult entertainers to create a system that regulated the theory pubic services and one that compared it to the adult entertainment many of the aspects including the reduction of high pressure and the reduction of stress in 2006, the it health department started issuing health and a permits and licenses in order to open a massage business in san francisco i have to get a permit

for the establishment and also to practice massage in 2008 sb 7731 shifted the massage therapist to therapist council i'll refer to as the m t c unfortunately 2, 3, 4 creating the statewide standards for massage theorist that rejected the local zone in san francisco in a nutshell the legislation if a month ago age place employed certified people you're exempt in local permitting you don't have to get a permit in the department of public health which insures the safety and sanction and not go through the

zoning code so many establishments have opened in the pretense of the presumptions and this corporation of those establishment with the oversight this insured safety and sanitary a lot of the places are associated with illegal activity i was able to find 1/3rd of the exempt establishments associated with illegal activities including information about seblgs sex all services most people modestly might see that harm less but it's part of the sex trafficking it is hard to quality that i want to talk about one task force inspection with the fire department and the building inspection we visited an establishment in the outer

sunset that was formally permitted and switched to the exemption site numerous complaint when the sites but not permanent we were not doing routine spikdz it which is 10:00 p.m. at night two massage practitioners that offered a decoy they don't have permits for the massage therapist and were living in the establishment one person had 7 cell phones and tens of thousands of dollars in cash no location and very little english and bans the owners both the police department and health department thought that was a case i have human trafficking i'm happy to report the two uncertified trafshgz were kicked outside and pouting put into a

safe place and we closed the establishment this place would not have been able to get a she didn't have permit this establishment had minimum overlook oversight and not overseen and lengthy process to close down we see the proposed legislation will prevent places like this from opening and close places down and support a robust permitting and listening program for all massage programs that allow them to flourish so there are a few parts to the local legislation amendment to the health and considered as a separate item at this or a future hearing. code i'll speak about the amendments to the health code but also will be happy to answer questions 3 things that the health code is

trying to do conform state law to local law that allows the local jurisdictions to regulate and permit all massage establishment and adding additional requirements for the currency and legislation recommended working would go outreach workers so next i'm going to talk about massage regulation and the match to health it is seen as the positive health the regulatory programs has created healthy and save community i spoke about the loopholes that created a high density for the unregulated businesses they don't have the same permitting to share like proper hygiene of equipment and

proper sanction and ventilation and while we recognize many, many establishment are legitimate and you'll hear from some of the great businesses today unfortunately, some are not we estimate to 45 are illegal and hubs for human trafficking i mean human trafficking is the faster crime growing in the word and 43 percent of all trafficking cases in california are in the bay area because plan use left lanes loopholes there is no process to those businesses opening in neighborhoods so i know many of us go to spaces and get massage your concerns are a wide variety of the visions we see during the

massage inspections often the interior doors are locked and the establishments have window covering and video cameras that or uninviting and have negative impacts on the neighborhood fabric we see the conditions with improper equipment that comes directly 0 into cannot with people and people live in those establishments people living in the marge massage places are an indication of him trafficking they range from high product of infliction and severe mlk that includes discrepancy and drug and alcohol depends and hiv issues so moving forward this slide

show us the escaping he know of 146 that are permitted and 90 there the cac exemption we've had a couple of dozen places close and on those figures are fluent many of the exempt places that are opening are not regulating with the health department or the other department we don't have an accurate picture we have 28 plummet establishment on in san francisco in the last year 15 of the establishment used to be permitted by she didn't have and over 2/3rd's have a violation as you can see there are certain neighborhoods that have a higher concentration about 70 percent of the mass acknowledge establishment in 7 neighborhoods

the uttering sunset and the financial district and chinatown and western edition unintended consequences of sb 71 has created approximately 40 powers of our mass acknowledge places in san francisco unregulated so what do you mean by unregulated those are the c mc exemption sites this is the difference between public health and c mc regulations the department of public health permits an enforcement we're permits and licenses are subject to cost recovery fees i'll the permits are subject to local land use and zoning control and have to be compliant with the laws in the human trafficking training i know our last meeting at the subcommittee meeting we had a discussion partner this

and wanted to reiterate that is closer in the state mandate doesn't focus on massage establishment this is to restaurant and alcohol and airport and truck and bus stopped and forearm labor we have to permit our urgent care centers and e.r. centers in 2013 we passed amendments that allowed the health department to have standards of health care at outline establishment but we lacked permitting authority and the ability to cost recovery fees so in general massage regulation has been problematic in san francisco over 50 percent of the establishment have at least one violation and 14 percent have 10 or more since 2008 we'vey revoked over

80 massage permits and many are opening under a different name or opener be 50 percent of them that close reopen this includes strerlg the enforcement and this slide shows the violations and the access of the establishment that have been claims and the establishment that open and closed multi times unfortunately ways we have the two tiered regulatory system it is impossible to see the difference of regulated we've seen 39 high rent violations at the c mc again we're not doing r0u7b9 inspections and it's complaint driven so within the last year closing businesses have proved to the adapting and expensive

for the department we've had found many of the establishments regardless of type of licenses massage certifications indicating that consumer protection is filing complaint and endorsing disciplinary action with all the challenges that self-san francisco is facing and this is not unique to san francisco there are many cities around california that are fyi the same issue the department of public health and the mayor's office and supervisor tang's office work with state representatives to reform the state laws and it was signed by goefrn in september it took steps to decrease the human trafficking and provide a fair and even regulatory environment by 5 things which included running land use authority to

local government and fees and regulations can't be imposed by the establishment and improve the regulation of c mc and now on the board we're required to have a public health official and someone from an anti human trafficking organization it changed or changed the massage theorist requirement state law makers saw the complagsdz with the c mc exemption and made the laud passed passage of this bill made it clear that that c mc regulated the theorist and the city and county regulates the industry through the land use we're proposing the following amendments to the health code we

want to delete the exemption urging to c mc now previously exempt establishments need a permit and pay cost recovery fees this will 11/help weed out bad actresses and help to utilizing the fields practitioners we're adapting the state we're adding language this qualifies anyone that is holding a theorist license and to eliminate dual fraud we're requiring that pragsdz get background checks that is what is caused we're raising the educational level for pragsdz to match the state law so in addition to codifying ab 11 we've updated some of the

language within the ordinance to increase transparent and enforcement, of course, we updated the language around the permitting authority with the update to make the language similar to the permitting authority and this is a legal contact we've removed language not consisted with the administrative process for example, doing fingertips it is now written into allowing law and transparent around deadlines we've added additional language around the revocation for example, added that the rest indication and extension of any height permit in 12 months could be grounds for denial of a permit we're considering step up to the plate this based on the feedback in the mass acknowledge industry and human trafficking is grounds for denial of a permit and additionally we're

addressing the ability to revoke a permit that is operated in the same place for 12 months this is something we're looking at extending the deadline from the massage industry we've received. >> one more amendment i'll talk about it is not included many the licensing and permitting program i want to quickly talk about the fiscal impact so the regulatory program our goal to recover one hundred percent of the cost of the program those legislative amendment will be covered and the fiscal impact is $100,000 and no impact to the scombrfd the funding for the program employees two health employees an administrator i know many people in the massage industry have spoken about the cost of the regulation

i want to insure you we're in line with the other regulations such as restaurant and tattoo establishment i definitely under the influence with the massage industry about the costs it is expenditure in san francisco to have a bits and live in san francisco i want to know even though this is out the pressure view of the legislation with the health branch we're looking at ways optimize and make our permitting and licensing programs more efficient we'll be going through this training in the next couple of weeks to update technology i've spent time outside of work with organizations and think tanks how to make government work better we're all committed to make this process as easy as

possible for the businesses to be regulated we're committed to improvements we can't provide exemplification that endanger health this is lastly protecting the health of the vulnerable population within the legislation a represents for a health outreach eric to work with the health inspection team our environmental inspectors are experts in providing assistance to meet the public health and safety requirement we'll work with the community and promotion branch around public health issues the public health workers build cultural trust and provides the resources and referrals through a team based approach many employees are not

aware of the labor laws and available health services and increased risk for streets and psychological abuse and extradition the branch have an a a in this case opportunity for the victims and human trafficking and other workers in need of assistance this is for the focus in the area of increasing the linkage to the quality and care services this slide community colleges the legislative amendment i want to note we've been working with supervisor tang's office and stakeholders which we will be meeting with tomorrow there are several legislative amendments we're going to work on i want to note them quickly one of the things suggested to us whether the background checks from

construction mc can be a substitute from the ones the police department oh, they ask to add language to the ordinance at the validity at the massage progression and for directors hearing when applying for permits we've been working with the planning department what within the establishment permitting program we offer a permit for solo imagine as establishment that if aura sole proprietor and the permitting and licensing is half the cost to remove the conditional use permit so easier for small businesses to enter into san francisco other issues that were bring your attention are existing legislation that are beyond the scope