i think the issue of how we distribute resources is a huge issue like i said a very very challenging one what we're trying to do to get alignment within the various committees about priorities and then make sure that we all work towards that common goal and realign the resources it didn't mean taking resources away from groups but we may if not successful the commitment of groups to common agenda we have to be sure we are heading in the right direction that's how to get to be sure we're all on the same page we won't if everybody is doing they're on thing or what they think is the most

successful we started with those 3 initiatives by the way wes we needed to know things we have a measurable impact and set tasks to get to those ends points and measure the end points to see how well, we're doing. >> it seems to me the one of the key to success is the allocate resources completely unequally because the initiatives have unequal benefits and so i still want to go a level deeper how well, do we do that as a department. >> i can take a stab at that one of the things we can do we fund a majority of those funding it is not the 1.1 over thirty something million dollars so one of the things we'll be looking at rfping out according to need and rereflecting what the new need is as we really out new

rfps we'll have to look at go where the targeted pongsz and how do we get money back to them and this is what the federal government did they look at the country and that's why we don't get as much money we may have to do the same as we move into this direction we control the dollars and have to figure out how to do this without new people at the table i don't continue to win the game so to speak i think we have the ability to shift the dollars where it is needed it will take time this is the first step we're looking at how to have those communications in the community about reorganizing the way we do our rfps it is not just the hiv dollars we're talking about mental health and dollars to make sure we are

aligned not only in this but you brought up the african-american health initiatives right there that community is being impacted and put more resources the fact that this is one of the smallest is community in the community we should be able to have an impact and share the resources it will be a rae alignment of the dollars you're right on the mark. >> and i'm asking the question i think that is really imtalking about this in various things that is so important that we have the courage to be disciplined about this so that we get the most health for the resources we have to deploy or the most preservation or whatever that's kind of not easy for a public service local government organization to do so is is it is unequal but educate

people so we get what we all want. >> i will say the department has been doing that for a number of years there were a realignment uaw from the large counseling preambles and counting the number of people you service h serve to what we do to link people to care and get them on meds and virtually suppressed find a way to increase the the president but not the size but repurposing the ways people not providing services need to provide the services around the care. >> prep is so important in reducing the risk of hiv infections at high-risk individuals that you reduce our costs so even though there is an

initial expense to the system and the individuals it is so not reduce to zero but - >> that's where we say synergy he know the treatment is much more than that highly effective without side effects so if we work at hiv positive and incline with that the people negative and at risks we think we can get synergy. >> for the first time we're not growing like india but actually turning the curve and going downward with the next innovation in 3 to 5 years we'll need more wind to get to the zero but the innovation is moving in that direction. >> i want to acknowledge the doctor she's the researcher in

hiv group and she brings in million dollars from the federal government to and there's a beautiful clinic she brought in go $11 million at 25 van ness and utilizes the 6 floor that's the trial clinic she's brought in volunteers towards the future of new innovations i want to acknowledge her for her work. >> we're the only hunt this supports this kind of forever we have a public health approach wetlands. >> one last approach people coming into san francisco four for our wonderful sunshine and weather people not born here is that part of the statistic.

>> we have susan it is a challenging thing a lot of the numbers that i show you are the people that are newly diagnosed in san francisco numbers for retention and the number of new diagnose i didn't see the way that the susan i don't know if you want to come up or not the way to measure this in the past once we have a case we follow that case and get other information on other people living in san francisco who are in care but that information is less complete. >> so most of the information that she presented are residents of san francisco but we do have a lot of people that receive care that have been dgdz elsewhere and tracking that. >> are dgdz elsewhere and show up here like new york and others places come in. >> that's what makes it

challenging to get to zero that's why we've reached out to oakland and having a similar initiative we cannot do this as to be routine by the planning commission, and may be acted upon by a single roll call vote island but it is true we get people coming in that have goggles enacted who get diagnosed here and included in those numbers. >> and glad you clarified that this is getting confusing clearly this is an initiative do you have an idea when our roles are to try to reach zero i mean that is - obviously it is a continue goal but some sort of finite thought. >> our goal to get to 90 percent in 2020 like 2013 it is going to be daunting let's see

where is the hiring we we want to take those 2013 numbers and bring them down to 2020 and we've got as you've pointed out we have to turn those kifshz carton drift darned we so to downward and use did resources to get there our focus on the whatnot the whom we've got to focus on. >> so clearly deaths are something you can measure but in terms of the the hiv diagnose that is dependent on the number of people being tested how do you reach it determination i can get to 90 by stopping.

>> (multiple voices). >> i'm curious how you will keep up how do we keep up the awareness; right? of the need to test and the need for testing so we don't miss the opportunity because with an of the reasons we're testing to find a case. >> right. exactly. and. >> there's been a tremendous testing since 2009, 2010? reflecting despite more testing we're undercover people that were diagnosed long ago we're driving down numbers we also track a calculated number of infections we don't know how many infections are happening but dr. sheer can explain we vw have a session on focusing on

the testing but there is a greater lag time and pretty wide confidence when we go back and said there were 3 hundred and 71 new diagnose i didn't see 365 what did estimated number that probably isn't right but we're very close in what we estimate as the incident. >> so very good let me pick a new tag on the question of retention and aside from the fact you've identified the areas which have been identified also in the std world that whole challenge of a new population too that may feel less vulnerable anymore and have less risky habits what i'm curious about is not only the

group has perhaps less retention but 3 we also have a thirty percent average loss of cases that were there so are we also working on that it seems to me once we've been able to capture somebody this seems like a lost opportunity for thirty out of 70 people. >> yes. so we have - there's a big part of the cdc initiative to get this thing called data to care we're using the data and a on who we're losing we've been doing that linkage before but we need a broader effort we're starting with the city that the 3 city clinics that have the highest burden and the most vulnerable populations with hiv but the goal is also we've got a lot of community-based

organizations that serve vulnerable people and we're working with the archer group to have this mechanism to find the people hopefully, we can predict bra they are really out of care anybody that is missing an appointment and go after people aggressively we're trying to work across the programs as a member of the storm mentioned at kaiser it is if a person misses an appointment they assume he'll contact them before the affordable health care act there themselves a turn of where the people's medical homes are and making sure that people get to their medical homes and kept in the medical homes and if their get whatever support of services are needed and data to find those people. >> very good thank you i think clearly this is

enormously important issue we should see an annual report that would be useful and looked at it as a community health so we continue to track and for those areas in which you feel we can be of support and have an opportunity to let us know. >> and appreciate the questions they stimulate the kind of work. >> thank you for your we have work. >> i'll note no public comment and dr. bucking finder comments to present hiv ass on worlds aids day i'll make sure it is calendared. >> we look forward to the presentations that you bring to us after you present it to the world. >> thank you. >> so moving on to item 8 the

update on the dpw budget for 2014 through 2017. >> it turns out you do present it here and slightly different. >> try the finance committee was asked and spent time and commissioners we'll have the update as mr. wagner has for the commission and the commission has the background details okay. and to clarify this is on the development of fiscal year 2015-2016. >> oh our new budget autopsy you covered the financial statement so, yeah it is a brief update only the process on where we are are on the project for the coming two fiscal years that is in process i'm sure you're aware of every year the mayor 134i789s balances budget to the board of

supervisors the budget that was submitted we discussed it at this commission at the last hearing board of supervisors during the most month of june reviewed the mayors budget and makes amendments the way that process works their bucket and budget analyst comics through the departments budget and finds proposals for where we can trim the savings and makes those savings available to the board of supervisors to reallocate for the priorities in the bunt process so at the end of june we went through that process with the board of supervisors and board committee passed out of committee budget that includes should reductions to our budget and then some additions back into it so we wanted to quickly cover what those changes were that happened in the board so

i'll talk through a little bit about the reductions. >> mr. wagner i'm not sure you're talking into the microphone. >> and director barbara garcia b will talk 0 through the add back as every year we work with the boards budget analyst to identify places they can trim and look at it things such as positions that have not been filled for an extend period of time or pots of money not stepped up to the plate on a prior fiscal year and put those reductions and we negotiate with them based on what we can accept so we did to agreement with them on the list of items that is in front of you, we don't each year any of those are going to have a intunlt service impact for us they're reasonable

there are are about $1.2 million worth of one time reduction but the board may put that into the top section those are the recommendation of a position to a later start data or some are close out of one-on-one one time dollars there are $1.5 million on the ongoing reductions and as you can see from the table here the bulk of those is in positions that have been recommended for elimination those are all vacant positions they're all positions that we think we can manage through again without a significant disruption so the total reductions to the budget by the board of supervisors were about $4.3 million this is fairly continent with what we generally give off in the process and as we give a little bit of

money into the pot we tend to get some of that back so i'll i'm going to turn it over to director barbara garcia. >> okay. >> some of those nichtsz are for cb o and xoirldz i'll go quickly for the safety streets or vision zero that were in pusht the next 3 are homeless directed services one of the things that we're looking at it the supervisors wanted specific outreach workers in their districts mid-market because their citywide if you have a big issue you have to contend to in the park or having staff removed from one part of the city we do that with business for district 2 and 10 and support of the youth alliance in the community that provides the needle distribution

in the hate and the rapid program to develop a community kitchen and the fatherhood program working with the mayor's office for targeting families to work towards getting out of poverty into health and what had we identified was the fact that some of the families do not have the father's in the home and so we can work with the father's program and so we'll be working fiscal year an father fatherhood programs targeted for the african-american fathers we're also working within our housing areas to really do the pier training for piers to get trained in health care jobs they'll be working at several sites throughout the community some of the streets i don't know if you joy enjoy the sunny street but that supporting the ambulance on call for that and

human trafficking we shared that from our area of massage work in looking out those businesses making sure they're not doing human trafficking and hire a health working to secure the issues this is a work order to their program an security those so those initiatives will come into the program and many will be contracted out. >> so just the last step in the budget process the budget goes to the further be it resolved for two hearings in late july generally the usual if possible there will be changes at that phase but usually not and no changes by the mayor at the beginning of august so overall the budget is likely to remain

essentially in this form it is a great form we've had an incredible amount of support and i think pretty much universally the priorities we've identified going to the budget process we've come out of the budget process with something to show for it we're pleased with the budget in the form it is going to the full board. >> thank you great deal from our staff to be sure that the message is received by the mayor and the board and thank you for that work. >> we'll pass that along. >> commissioners questions or comments. >> mr. wagner we're slightly above $2 $2.02 billion that that is the bottom number. >> that's correct that's correct it went down slightly

between the last version and is one but it is down by $2 billion. >> any further questions if not any public comment. >> we're ref public comment requests. >> thank you thank you very much. >> thank you, commissioners next item is the youpt on san francisco general hospital transition. >> good afternoon. i'm terry san francisco general hospital rebuild director i'm joined here with any usual cohorts ron from the department of public works and william our transition director we're to go talk about our rebuild project as soon as i find the presentation right there. >> my comment those

commissioners that have not seen the facility please make arrangements with mark to be able to tour the facilities those of us produce prior to the joint conference committee came away with an expressive building. >> i'd like to mention it was my pleasure to show you the building i'm excited and proud and feel lucky to be part of the process to echo director barbara garcia words we're on to deliver a new hospital to our staff and san franciscans so this is a great project for part of i want to talk about the highlights of this report but we're going to talk about the impacts 0 our timeline and the milestones we have to meet to

meet an adjusted patient date with that talking about the building looking like a hospital exterior and exterior some of the pictures show the rooftop looking at the hospital one of the my favorite pieces of the artwork we've partnered with the art commission to populate the building with public arts that's a stained glass window wall that portrays potrero hill and the pictures of the organization r and i cu room the other buildings are coming along nicely our enterprise and our local hiring goals we continue to meet and steady the thresholds that are met 5 percent for local enterprise and 20 percent threshold for local

hires and because of the towards the end of the project we've been successful throughout the entire time to meet those goals to let you see snapshot a story for our project our f f and e program we're $91 million we've placed equipment and have x-ray equipment on the first floor and this month an magnet and mri are insult and other cts are arriving this continues to progress we're on target to meet our hundred and $70 million goal and the information technology is well under a way with the purchasing of equipment and the room readiness to support of it configuration. >> with that, i'm willing to

pass it on to ron to talk about the schedule and examinations. >> thanks terry the schedule has moved forward along a familiar slides you've been looking for the better part of 8 years as time went bay by the various streams of activities have gone off the charter we're at that moment in time the generate our project is winding down at the administrative close out stage up in sacramento and we are moving towards what we call staff and stock for the construction and this is the moment in time where our pod allows us to introduce shock and staffing towards moving towards transition and licensing into the building the last bar of activity the short bar at the bottom in

future we'll develop a little bit more grand last year schedule we're not trying to span over 8 years of multiple activities it is a key moment in time i call it the center of gravity shifting from the state ash pod delivery of the building to the center of gravity or focus on the state health department or the transition lillian will be putting forward so having emphasized that where we are right now some key challenges that we spoke of at the joint commission is those 6 line items that were kind of major challenges to achieve clearance from ash pod since we've met last we've

achieved 4 out of the 6 line items we're aggressively pursuing stair previoustion and the air balance report to the compliance officer and we're aggressively moving that forward and then from staff and stock on the construction side we're continuing to round out the exceptions o exceptions that represent the difference between staff and stock and full occupancy and the green light targeted licensing with that i'm going to turn it over to lillian. >> i'm on my tiptoes sorry this chart detects the timeline work stream as you heard from ron and terry

thank you transition begins when a lot of the construction and the equipment of the hospital can occur so we can begin the training and orientation of the 54 hundred individuals that comprise the physicians and nurses and technicians there are major milestones we need to achieve to get us to hospital licensing and starts with that staff and stock occupancy clearance that ron spoke of that is that first red line and what it give us the opportunity to go into the new building with our staff and be able to play on the new equipment and the work flows that are being designed right now and see they work for patients care second major milestone is the one the submittal red line it isn't targeted for around the end