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 wondering if you have the basic level of security we need at this point to make sure we have safe for our patients and staff >> sure. one of my recommendations what i would like to ideally see once you have a general hospital with the state-of-the-art center. to use that for the dph wide for the entire department so emergency calls panic button is coming into that center and looking at further opportunitieses to put -- if we

don't have sheriff's department or security assigned to a fa tillty at least have them in the field within the jurisdiction to be able to response to security emergencies until that time i'm working with each one of the clinics as far as coming up with a security plan that involves contacting the local police and also their response to the issues as well. >> okay. director garcia maybe to the events that occur through the sub committee whatever you -- and the chair might feel is appropriate make us all aware of the strategities to improve or address. >> absolutely one of theish issues we have begun with the mou one we need to know there is an event and we have worked with

a sheriff's office with basil and others to know they're informed we do have policy department to report those up and so we do get those on a probably weekly beltway -- basis so we can debrief on those as they happen >> is there a system wide management team that works in terms of different things coming up >> we have critical responder and those as an example we're broader than just a department commissioners we respond to depths after our housing facility we have guests go out to every team on violence they will come and debrief with staff

sometimes we debrief with school with children who are impacted so we have used that same effort we have done externally to the community as large as we reflect it ininternally as well there is work to do still like some organizations like our two hospitals have a richer system because of their requirements and also because their larger campuses and that's what basil's goal is to work on each of these in terms of any event of the department that impacts the staff member we get this team out they're out there within the hour of any issue >> i'm happy to hear you and mr. price being an employmenty of the health system part of being safe and healthy when things get unsafe it's hard to be healthy i think this is a commitment to our patients and

employees >> mr. sanchez >> i think you have done an excellent job of listening and observing and looking at different path way and subcultures that have operating within the network and laguna honda. i was interested in some of the comments in particular many years ago there used to be a police special team assigned to sfgh to deal with special tra maw psych attic situations available 24 hours a day and between the sheriffs back and forth. the fact of the matter is the sfpd trains with the units and they're critical training in response as you move forward in your planning i know you will you have a unique opportunity to identify with spesht teams whether it's the police or fire

department has exceptional teams brought into the hospital given krim cal brace etc. there say network out there, that is above and beyond the individual klture of the sf police department or f sheriffs or fire department now that we have a director as one person that coordinatings it gives you a unique opportunity -- buys into that model it's not going to fly. so when you do have a crisis if the internal unit doesn't know how or what you will have more of a crisis you name it you can think of it. over the years many years ago there was special training activities both in the public schools r here in the city and in the hospitals pertaining to

various crisis that might happen in all coordination is done at that point from some really comprehensive work that goes back many many years all of these things were laws in prop 613 and everybody cut all of these things the need is there you identified it here are some unique resources we can integrate within our operational model whether it be laguna honda or gang task force whatever with those institutions that are working with paeshlts and where the kid's families are coming from that way it integrates the quality of patient care in community response in that way we haven't had that we did many years ago we had shootings where our physicians were shot that say different world then we're way passed that but there is still navigation problems i was

glad to hear you and the director garcia to talk about yeah here's a whole other area we can listen to work with input and develop an operational model where we know exactly here's path way one here's path way two here's condition one and condition four. we bought into it. and we train we supervisor we train we supervise. real good report i'm glad you are aboard. >> thank you. >> thank you. commissioners if there are not further comments it appears that this is a very important topic to us called into question for our leadership so i thank the memorandum has been in existence for about a month it would be appropriate to have a follow up on some of the questionses we brought up and the issue of expanding your eval indication

and reach into other yeahs perhaps a six month report would be appropriate. >> that is fine. >> thank you very much. >> thank you commissioners >> next item is item 11 other business. >> thank you. under the business i realized as we had accepted the report from mr. wagner of how much support we were getting from the mayor's office that the first comments that the director gave us which i made hope be reflected under the budget statement that the commission is extremely encouraged by the support the mayor has given for the health department and the health of the city and that we encourage and the board of supervisor accept those initiatives as being for the health of the city. so i hope that would be put in

there as we complimenting our own staff to work with the mayor's office i know director garcia has looked at different initiatives that they have had and carry out on behalf of the administration i wanted that on there. the papers recently have an article on the variety soda initiative tell uses on the board of supervisors i wasn't sure if our director was quoted appropriately that would seem to lead the department to be essential essentially not concerned and i may have been miss reading the article -- >> yeah i think that was the intent i did not quote with rachel kagen on our behalf we're waiting for the supervisors to pass it just to let you know our

staff is very involved in this effort we're part of several committees in the community about this now we're waiting for legislation for the next step. >> i think that part was fine and the information we were being very neutral on the subject not on the specific bills i think was the problem which of course is that of an author calling you to just brief us also with the work we're doing with the subject at hand >> certainly good afternoon commissioners we have been working closely with supervisor weiner's office on his particular legislation there are three pieces of legislation introduced as a package on mar coage and weiner that would ban the sell of sugars on city property the other other would

ban sugar suite and beverage and the third one a ban on beverage suite and advertisements that third one had a very broad definition of advertisement it had a couple of challenges to implement it. certainly we have long supports the reduction of consumption of sweets and we have worked with them to create something that is enforceable. anything that had an advertisement needed to have a warning label on it. from a soda can to a bus shelter to the billboard to the shirt of the delivery person so we wanted to work with the supervisor's office to create something that is enforceable they taken the amendmentses on monday. so now the new legislation has other side guidelines and

addressed some other concerns we had about ads the previous version said ads that were mraeed before the implementation date for the warning requirement which made it difficult for inspectors to determine what is older and what is newer so anything is subject to the requirement to say we were not involved is not accurate as the regulating agency this is an instance our health department has several roles to play around something that is sugar sweet and beverage consumption as a health advocate we have been working on this on a language time and we have the ability to enforce it as well. >> thank you. commissioners any other topics you want to bring under this aye snem >> actually chair chow i want to ask a question it would akly be

helpful to make a formal acknowledgment to thank the mayor and encourage the supplement whether it adds value at all personally when you take the items in total they add up to more than the parts i like the emphasis on the volume nar rabble -- vulnerable population if i was to ask nine out of ten people on the street i ask they would be high priority areas they want you to be involved in an i was wondering i will refer to you with a formal recognition or vote or motion without that add any weight to recognizing the budget supplementses >> it would seem that the mayor's proposal is actually moving towards the board we could write a note to the mayor's office thanking him for

his initiatives here's putting forth to the board and the support for the department. this would not require any beyond if that was the sense of the commission we're be doing that >> thank you very much. >> is that the consensus from the commission? then that way formally -- it like we when send over our annual report we write a note to the recipient in this case we received quite a series of initiative along with support of our own departments' own initiative i would think the sense of our commission is to let him know we're grateful for that. >> one other thing i wanted to note is we have public comment last week sometimes we get public comment we're not allowed to respond immediately i'm sure

members of the public want to know their comments are being heard i wanted to acknowledge we also had this example of public bathrooms in front of us that was a source of some energy last time. specifically the availability to use the restrooms in the fire stations. so thank you distributing that it's clear you guys are listening to the public and their concerns. is this something that is new and the person who came and spoke to us didn't know about or were they referring to something else? >> no i think they were aware but i think they needed to seethe it in paper but also this is the beginning of an initiative to get access to public facility and i want thank the chief of pyre who opened up

here doors torque do this we also have the pit stop program that is roaming facilities for individuals and more to come as our city grows public has been a challenge for us as an example in our facility downstairs, we traded a model in the library we have a monitor in there because of behavior downstairs the sheriff asking to close the bather i said no we will have a monotore just like the library. that will help with skaefty concerns and activities happening without supervision in public path room that's why some public bathrooms get closed because of behavior we have a successful program at the library a hot team with peers that are supervisored that work

with the facility to make sure they're using them aappropriately >> i know from my specific experience in the men's room on the first floor i have seen all sorts of crazy stuff in there and never one felt my safety was it. >> that is create. with the -- >> that is great. i have had communities from others who have felt unsafe but i think having bathrooms is important we will do whatever we need to do to make sure people have access. >> thank you for the point that was made. >> commissioner chung? >> speaking of public comment that is a public comment made in the last meeting but the meeting before about the discontinuati