it's marked specifically for pedestrians only or kids and they don't stop or whatever and you have a lot of families using that park every day from seven in the morning throughout. this say major concern of course the bottom line is i hear this from a number of places again the senior areas are concerned about this state-wide also is that even where we have four way stop signs oftentimes it isn't the car who maybe be the one who doesn't stop it may be a couple of bikes riding through or go from the street hop on the curb and shoot the other way go through lights and knocking over a few folks there is a real real concern about that. all i'm saying is it gives us a unique opportunity to come up with positive thinking for safety for quote all folks whether it's for kids in the

baby carriage walking your dog grandma whatever we need to be conscious of everybody in the city it's not just for the cars we have a lot of folks using the sidewalks that are congested especially around the bar areas or bus transfers in san francisco what have you maybe we can have a discussion on that at a point later this year >> absolutely mr. sanchez that is very important. megan on our staff is working closely on 0 we have lots of visions on 0 i went to one of the meetings the police and mtr are sitting at the table our staff is giving them the data of what you just said the types of injuries where they're occurring and through that gate they're targeting areas for different kinds of enforcement

and structural changes to the transporation areas so we're very involves and certainly we can report we can certainly bring that to the commission with the board to get that done. >> thank you. >> also i have the funding for uc on this sheet is a small part of a city-wide initiative there say significant more funding with mta to work on this effort >> thank you. >> any further comments to mr. wagner? thank you very much for bringing in additional information on our budget positive information for this coming year we look forward to your continued work with the board so it will continue to be positive. thank you. >> commissioners next item is improvements made to sfdph hospital safety and security.

bassil >> good evening commissioners my name is basil price sfdph director of security. i will bring you updates as par as the security program and the key improvement in the areas of leadership as well as patient safety contract security then facility improvements part of this process what i have done is actually done a security risk assessment in general hospital as well as laguna honda and 21

of the department facility clinics throughout the city based on that i have identified 16 different opportunities for improvement as well as 23 different recommendations so what you are going to hear this the evening is about 21 key improvements most have been at san francisco general hospital based on my time in this role that has been the primary focus however tlshgs is still the writings and procedures assessment throughout the entire department that is an on-going process the only thing you won't hear i can answer questions is in regards to the security plan for the new hospital i'm scheduled to present that in september again if you do have any questions regarding that i'm happy to answer those as well. so in the area of leadership

there is actually three key improvements 1 of those being a monthly security performance survey. this actually is a tool which is used to validate the performance of the sheriff's department in the area of mou which i will get into when we talk about contract security on monthly basis we score them as identified in the mou and in regards to their performance value indicate dating they're in compliance with the mou expectationses in addition to that there is a committee that has been formed that deals with commission and staff security and safety a sub committee of the violence prevention group this group will perform functions such as over sight in the sheriff's

department addressing in regards to reports of clant in regards to miss conduct. the group will be myself as well the executive leadership nurse executive leadership over they will be on that as well. they will investigate respond s to perceived miss conduct and use of force at the general hospital. we also established 18 different standard operating proceediers in regards to the entire security program from this from a dph point of view detail what is the expectation as far as what the sheriff's department to

various incidence. again this is part of the process of developing that governess as well of leadership in this area again three key improvements the maernlt of our work has been in the area of patient safety. again i have done a security risk assessment for general hospital laguna honda and 21 other clinics from there identify security as a rule nar rablt which will be addressed in the 2015-16 management plan that will address those specific issues about security program dph wide. in addition to that we are pursuant for an ongoing development of security aware rns that will include as far as

facility wide drills addressing at risk patients as well as the patient infant abduction also in addition to that the security alerts and communications on a monthly basis there say communication that goes out in regards to security on-site as well as the personal security as well as work place security. then increasing staff and training education we see opportunities for increased opportunities as far as emergency responses pr the staff in addition to that providing training in the process of developing this month emergency department specialized training crisis intervention to assist them as par as how to deescalate situations and recognize crisis

and being able to intervene in addition to that today i have provided crisis training for 600 dph employees throughout the department and we're also in the process of revamping the violence prevention to it's more proactive dealing with case management as well as being able to develop security plans, to address the acting out behavior. one of the things i'm proud of is the child care security at this point at the hospital the maternal child is now a secure unit which is in compliance with with the health center for missing children. that being a secured unit there is 24 security on the unit for cart reader badge access we have

enhanced and ub grade it there. there is a kiosk to screen visiting as well as issues passed with photo id you have an example on the slide there in addition to that there is also a kiosk for emergency department for control after hours for visitors control we recognize an opportunity to identify visiting physicians and medical students as well as employees that didn't have id badges we have a process with the temporary id badge process. under contract services the mou between dph and sheriff's department is signed on april 29th i trust you all

received a copy of that as well. just in my efforts to continue the relationship with the sheriff's department it's been collaborative efforts in regards to security staff assessment dph wide addressing the clinics areas we don't have any security and start looking at opportunities to provide protection for them as well with the standard operating procedure that develop that also included the sheriff's departments we want to make sure they married our procedures and their expectations are not outside of the scope of their services. under facility improvement what you have here is a before and after as far as security operation center. the one on the left before is about 85 square feet.

with the dispatching stations there from that to a 500 square foot space with a cons frens room you have about four disbatching stations there at this point we're operating both while transition there is still some work that needs done with the sheriff's department to make sure they have radio communication inside the building outside of the field. other improvements include surveillance cameras all of the existing cameras in the hospitals are being ungraded to high definition cameras and an additional 50 cameras will be intalled as well that will be on the doors and elevator lobbies

and contact alarms on each of the doors and stairwells what will happen is any time someone opens a door it sends an alarm to the operation center not only do they have an alarm they have camera feed with the activity that happened with that particular doo with initiateuate a response from the sheriff's department again the exterior doors elevator lobbies as well and all security sensitive areas. then here on the right side here this particular area here is the hospital's loading dock at general hospital. i have the arrow there pointed at a card reader additional control access to the emergency department as well as each of the elevators this particular at the loading dock prior to a week ago anyone could come to vermont

street gain assess to the loading dock call elevator and emergency management storeroom as well as inventory that is at any point of the day. so we have corrected that with the badge reader you need a badge to actually control the elevators in addition to that. there's been enhancement as far as departments to bring them to health care security standards as well as management and nutritional services to the cash counting areas that is my report is there any questions? >> commissioner chung? >> thank you for the report. i have questions about the temporary id badge do you need an actual government issued id to get the badge? >> yes.

the temporary badges are stored in the sheriff's operation center. again any employee or physician or student without picture id pr their institution will be brought down to the operations center by their supervisors at that point they have vouched for that individual will issue them a temporary badge they will give us the government id that is collateral to ensure we will get the badge back. >> do you anticipate any challenges you know like when somebody cannot produce a government issued id might be visiting a friend in the in-patient units >> in our procedures we actually did consider that as well. so in the event that is the case if we get approval from general hospital administrator on duty

if they vouch for them at that point based on their recommendation will issue the temporary badge in the process there say form they fill out so we can account for that temporary badge as well. >> what about putting all the scenarios, i'm familiar with what about if someone for instance who had just transitioned have not changed id documents but have a different preferred name how would you handle that >> usually what will happen anyone that is here for the medical center for any business reason for sponsored or received by someone in authority at the hospital. so we're going based on the authority of either the provider or again the administrator on duty they're the ones coming down to vouch for that

individual and that's how that badge is presented in most cases we're talking about the level of people we're trying to identify they either have id or don't we have someone that can vouch for them. >> i think in follow up what about visitors? how and when do you implement this badge? who is enforcing it? >> sure with the visitors pass kiosk the cadets are there 24/7 -- anybody that requires after hours tlshgs is a screening process upon approval they will be issued the visitor's pass in most cases where the person does have government issue id you swipe it through the kiosk it

prints the person's information as well as the face on the id in the visitors pass in the case visitors don't have id the kiosk is equippeded with cameras so the cadet will manually enter the information and take a picture. >> commissioner karshmer >> let me get this rite every time somebody opens a door there is an alarm to the -- >> operation center >> okay because we want to encourage people to take the stairs it's a good thing. >> it is a good thing at the same time given the history we also want to be alert to the random patrolses in the stairwell operation center we want to be alert any time the stairwell doors are opened then given certain times of the day

those alarms are able to be programmed we realized during business hour they're constant alarms what we're more concerns about is the stairwells to be closed when they come through >> this is not alarm that most people hear? >> no it goes to the operation center. >> commissioner singer? >> thanks for that report as i think you know when we had the consultanting firm come on after the unfortunate spaulding incident the first recommendation was you need to put one person in charge of this whole thing which we didn't have before so it good to have you stuck to this challenge i appreciate that. i have three questions. one is a cost issue versus what we get so we pay the sheriff let's assume we're on budget

which is sheriff's department more than 12-and-a-half million dollars that is without any more surprises in the hospital. if we were to spend that money getting private security for the hospital which many institutions like ours do the general system would we get less more security for our dollar? >> you definitely get more security for your dollar it comes down to the issue of the quality of security. in my experience being on both sides working with private security hospitals as well as law enforcement i think we're in an advance of having law enforcement resources available and accessible to us i think more of it is we may not need as many so it's an opportunity to look at the level of securities

we have in place and an opportunity to enhance the role of the cadets to be more of the first responder in a lot of these issues of disruptive behavior that are not really criminal issues to answer your question yeah you are definitely getting more. >> so if you can get the best of worth worlds the power of having law officer there. what i heard from you more appropriate staffing levels by them. is there a chance you can manage this cost down? >> yeah i'm engaged right now in an ongoing effort to reduce cost. that has been part of my staffing assessment not just in general but dph wide to look for opportunities to reduce the cost >> thanks my second question brought up there are huge

advantages to having law officer but there are certain disadvantages we found out which relates to nurse safety which is a concern to all of us the sheriff assured us nine months ago when he was here i forgot the date they had made grate progress in finnessing that in a way for the sher sif and deputies officers to intervun without queering their role as law officer peace officers how is that going? >> i would definitely say there has been improvement with law enforcement and all of the staff i think the sheriff's lacks training in crisis intervention.

with crisis intervention they would have an opportunitying that some acting out behavior is mental illness or other affect r tors which they don't have that training. san francisco police department doesn't have that training my understanding is that has not been available to them: that is one of the keys when they're called to be able to approach the situation from an intervention standpoint as opposed to criminal element a number of time they're not being called to criminal incidence they're service incidence they end up handling it as if it's a criminal or jail situation >> keep us posted on that one. >> my last question relates to a more national theme if you are awake in america today you realize we have in our cities

racial tensions between law officers and in the black community in particular if you read the local paper you would see some of the things about the jail although not judging there is concern about that issue as it relates to the sheriff's department in the jail i'm wondering how comfortable are you that we have those issues under control in our health care center given we have those deputies there. >> i would say it's a work in progress not just at general hospital but as you mentioned nationwide whether you have a law enforcement or private security there has been an increase of accessive force on patients by whoever that

security is. that is because lots of times the medical lacking the competence to call in them for patient care and service issues >> that's an important issue we have to keep on top of just in closing i would say if the sheriff's department does not have the funding to train their officers in the things that mr. price is suggesting are necessary to have the kind of performance of the safety of the nurses and to make sure we treat everyone with the dignity that is their due given they're not criminalses in our institutions. that we got to really find the money to do that and do it soon

because it would be nice if it were only their problem in reality i think it's all of ours to work on so i encourage you to work on that >> yes i agree we had talking to the sheriff's department about that to incorporate that into our training that may cost more money but it's an important part they're a team working together we see that as one of the initiatives we should do the sheriff es are aware of that i'm aware of that that is one of the thoughts we have had moving forward on this incorporate them into our own crt training critical response training. >> mr. price thank you for the presentation i would like to ask about the third leg of our security needs i will trust that our committees have looked at san francisco general and laguna

honor ka and will continue discussing those i'm concerned about the outpatient and maternity care position when you did our audit were there any concerns? how will further conversations go forward in terms of any issues and what role would there be any over site with commission in regards to ambulatory regarding outpatient issues >> of the 21 facility assessments i have done including the outpatient settings so that is 600 employees have gone through the training includes those employees as well part of the assessment and the volume --

vulnerable vulnerables there how to address acting out behavior how do deal with evacuation just overall security. the management plan will not just be for one facility but also include dphw and break out the facility what the need is on a quarterly basis we want to make sure we're testing as well as drilling them as far as security management developing a plan specific to that clinic or particular area then from there monitoring the success of the management plan and how to respond >> are officers from the chef ir's department are they assigned to individual clinic? >> some are some are not >> are some clinics more at risk

than others? >> commissioner pating just to be clear basil is the director security in the entire department he had to focus on san francisco first and spreading out to other clinic we do have sheriffs at other clinics and looking ot now we have ones that are not clinical focus like one on one growth we have a sheriff here 56 buildings he just went out to sunny dale to work with an outpatient area one of the wellness centers we talked about part of his role we sits on san francisco because that is where most of the reports but he sits on corrin as a way to look at entire department next year you will see additional support once his

assessment is completed i want to acknowledge his incredible work on getting a handle on the entire security department for security and access issues i have personally taken his training i think it's really good in terms of our own personal culture of being safe and making sure we take care of ourselves in those areas and surrounding areas >> thank you very much. one last question. with regards to ambulatory care crisis response something comes up a client that is violent ha behavioral issue or outright criminal activity what is the response how do we work with the sheriffs to get a rapid response how is the system alarms triggered i know you are working on these things, i'm wonderin