charity care we say this overall the second point it the general it continues to provide and likely continues to provide if the health care era the significant moumg of charity care and significant amount of expenditures 70 percent is the general number that we have notice over time and expect that to continue the third is maybe the most important point in the whole presentation that is to say that there is going to be a continued need for charity care programs and the safety net services in the studied the first thing the doctor and demand for charity sincere a testament to the ac a enrollments we're seeing over that time but also a significant pocket continue 35 and 40 thousand people in san francisco who will continue to remain uninsured and need charity care

services at the same time the decrease in demand for charity care loss give us an opportunity to think about medi-cal and charity care and community benefit all work together to maintain the safety net to the betterment of the health care system as a whole in the city and encourages us to think more effectively about the partnerships we have between dpw and the hospitals and others community partners and the partnerships can be maintained and improved and the last point has nothing to do with with the charity care patients as noted the decline in the number of patient was not significant for the charity care patients as for the healthy san francisco patients and the cinches over time don't really note a pattern that we can really rely on as noting the ac a impact for that

group we thought might happen with that group didn't they might not have as much access to the ac a insurance and the healthy san francisco the healthy san francisco programs is on model after the care the folks maybe more familiar with the kind of health insurance that be available to them in 2014 that might be playing a little bit of a role and the residential locations their speaking has been consistent over time i want to first thank the commissioners for the opportunity to present this information and the flexibility 2, 3, 4 combining the two years worth of data i also want to thank my colleagues in the office of health and planning colleen this would not have happened without her and lizzie

and all the hospital representatives that worked with me to complete this report and answered all my questions and made themselves available to complete this report many of them are in attendance in the audience as well. >> commissioners several public comments we'll take and go on to the discussions first of course want to thank you for the care that you've taken in this report with the response to the committee and questions and the ability to give us a real in favor of how the trend has gone frankly all the way back to a wonderful what? 2010 on. >> yes. thank you. >> we'll have further discussion and precede with public comment at this point i will first call 3 names if you will be prepared and after that

several others so we'll begin with yes, ma'am. >> please note when you are time is up. >> raise our microphone so everyone can hear. >> is that better. >> i'm emily webb the director of the health programs at camtc i want to speak about this ordinance it was passed 14 years ago and the first of its kind in collecting data like this we're happy to have provided data since the ordinance was passed several notices have schangdz

both state and federal government have the affordable health care act which ear experiencing a shift if medi-cal to medi-cal from charity care and healthy san francisco has been implemented so certainly c pmc to collecting data we can use and leverage the data that is provide he state and federal level to make changes for this population rather than continuing to collect data that is onerous for the hospitals and recorded in other areas we'll to ask the commission to have dpw work with the hospitals to a come up with an ordinance to make it more use full in

improving the health of this population thank you. >> thank you. >> good afternoon commissioner cut me off if i go past. >> you get 3. >> oh. >> kaiser permanente as many of you may know in the reports we're a volunteer reporter we're unique combination of health plan, medical group and hospitals we participate and have from the beginning we believe in the purpose of this as mabus stated to improve the coordination understanding and- but the most important part mabus highlighted about the affordable health care act it changed the entire landscape of how this activity is recorded it didn't just reduce the number of charity group patient addresses the expenditures that unified

something bigger than providing treatment for disease it emphasized community wellness this is the benefit and as we've talked about over the years charity care is in the middle and that's where i think this commission needs to focus what are the hospitals doing not only to provide care and treatment for the poor but prevent the need for that treatment to keep people healthy kaiser wants to join with the other hospitals and study over the next couple of months and coming up come back with a different way of reporting our community benefits thank you. >> thank you. >> good afternoon commissioners ash i didn't st. francis and one

of the original members of the charity care task force and so we've been at this for 15 years and had a hallmark report they're anticipating with the shift of charity care and some of it a large dose the medi-cal shortfalls the hospitals are experiencing the diagram was drawn casting charity care as one of the benefits but other programs that hospitals do to provide community benefits and it is our thinking at this point we do need to rethink charity care in the new world order and the public-private relationship for the care of san francisco we urge the commission to direct staff to really help us find a new way of doing this this is a

good time halfway through the assessment to informs the hospital master plan and the healthy plan and the community health improvement partnerships if we look at this as an opportunity with the community health partnership in play an important role i think our timing is spot on if he think about how we everything have the convergence of activity to help the san franciscans. >> thank you our next two speakers is mr. david caesar wall and barry from cedars. >> well president and honorable members i'm with the council of northern california san francisco office here to under the influence the points being made by the directors the experts to thank staff in

generating this i'll have report it hieflts the crucial role that the note for profit hospitals play and highlights the need now we look back analysis how to better utilize this data and think about how to bring alignment with the goal of improving the equality of charity care, the reimbursement question and the on the challenges the hospital council will like to ask that the commission direct staff to deem it as you see fit and interested parties meeting with the hospitals and have that dialogue and report back to you whatever you deem 6 months operate or so thank you very much. >> good afternoon commissioner

i'm barry the director of community health clinics at as far as i am concerned in san francisco i want to thank mabus and colleen and lucy for the pleasure of working with them it is of the in the posted report we saw in the web site i want to add my voice you consider requesting us to work six months with the did you want to explore information that is already required as residents of the new emerging california requirements after the affordable health care act what mabus alluded to the identification of concern populations that have not made the transition in the affordable

health care act and what opportunities there would be for co-care management and chronic diseases and more collaboration referring to the doughnut for the charity care many years ago when you commissioners piloted and that's my point and thank you for hearing me today. >> can i ask a request about the ash pod requirements i know that medicare and medicaid. >> if you can describe the ash pod requirements but we'll go over that again. >> the actual requirements related to charity care and actually community benefit overlap in different ways two the local is state and federal

and the appendix but i will go over that and see the first hfa has nothing to do with to with the actual community benefits requirement which entities and where do they have to report their communities benefit requirement and they do that at the state legal of level that is ash pod and at the federal level as well. >> so it is state ash pod is collecting the data got it. >> yes. >> as opposed to the medicaid, medi-cal. >> ash pod is the extra agency that collects the benefit and charity care requirements in terms of the actual reporting of the actual charity care levels that happens here locally introduce our charity care ordinance and through federally through form 990 schedule h those requirements are new ones for the hospital and has to

report the actual levels of charity care provides there is differences between the federal government and what we require locally the local owners is a bit more robust in terms of breaking down services into in patient and outpatient and emergency and also the report at the federal level does not require hospitals to note the number of people that were served in the schirt care program the amount of people is optimal. >> that's the cms. >> i believe under the irs. >> the irs. >> form 990. >> yeah. part of government does talk about talk to the right maybe they do. >> and before we precede i thought that since also everybody has brought into the

conversation it would be good to recollect where this came in from thank you, again, for the report you highlighted this is a fine report the attachments are so valuable it helps to table for us and prepares prepares for any future dialogue what the landscape is in terms of the reporting for the various entities i want to thank staff for working it has to have been very difficult the ordinance is in there and this couldn't have been prepared without the help of the entire hospital council communities not only from the mandatory side that submits data but not anywhere as valuable without the benefit side as

complete a picture as the county can have the reason that charity care reports started from this commission and from the board of supervisors to be sure there is value to a nonprofit status that would have to be part of the work that would be done in terms of relooking what charity reporting is because the base was not just charity care with you and later nationally that has been a federal issue at the federal level of the value of nonprofits and what value there there is back to the community we heard thoughts not only to look at the value and took several years to get the even playing field what numbers complaisance we went through a lot of dialogue whether or not

the t ls look the same and use the same definition that was important to realize as the speakers have said charity care was much more important than just simply the dollars for awe execute care second year illsness and recognize at a community benefit at least the programs that hospitals were engaging in that were true community benefit could be highlighted within the report to have a broader implementation what were the dollar values if instead we were asking for operational versus emergency room care that's an added prospective to the reason why there is a segment trying to

sdrab all the facilities and what they're doing to the idea then of looking further for the last several years can do we do as the world has changed and clearly that demonstrates there were impacts upon charity care from the affordable health care act and the need to then refresh this and see what values i'm pleased i think all the speakers spoke to the needs to have value out of the report for something accountable it is accountable i believe also it is important then if we look at the core there is to remain as the data shows a block of patients that does not access the ac a programs and that question will

have an obligation to take care of so that cannot be forgotten within a prospective we should have our discussions as to what we ohio this is very much an ordinance that has been a very much part of trying to make it valuable and not just a trade off for property values from the contingency so i think after the commission standpoint historically can see how we would want to help to shape this to be more value able to the city ask the acting director if she has comments thank you for this report. >> i have like you, you

commissioner chow one of the pictures first people to work on this it has gone through a lot of evolution as mabus noted in the report a significant impact the ac a has had with charity care it provided a good opportunities to talk more holistically about the community benefit how we can best use hospital resources, community benefit resources, dpw resources to better the health of the population that is the intent of the sf hip to look at the intersection all our missions to fourth how to improve the populations health this dialogue can happen. >> commissioners comments. >> commissioner pating. >> i want to say first thanks

to the department and ma vice and others and lucy for a wonderful diagram good job. >> thank our hospitals for the hundred and $80 million less than $2 million last year is not a small amount the contributions to the hospitals that are making to the communities is both good and necessary and when i look across how refund our healthy san francisco initiative we just basically gave a stamp of approval at the last meeting a large part if not the bulk based on charity care to make that system work our hopeless systems in providing this charity is really providing good service to this with that said, parts of reports the second part not quite sure though to evaluate a

number of patients the zip coaxes code and what we're looking at in this report effectiveness certain it's decreased i'm interested in a global approach to the community health and benefits with the charity contributions is it adequate to meet the needs of the community is it fair and equal is the reporting confusing to the hospital constituents i think we should look at making it expedite i'll be in favor of a task force or director has suggested might be feasible to look at a framework of reporting, look at a system of goals for this reporting i like

interfacing the goals we know that charity will meet the population health goals we want and coming back and perhaps 6 months and giving us some recommendations rather than changing the ordinance study it for right now under the changes and realizing this is important i think reporting is a mechanic thing simplifying it and make sure that charity care is virtually and effective. >> those are my comments. >> commissioner. >> thank you for this this is dense a lot of information i have a lot of questions you've done more thinking about this this issue it is the same - so about the same number of people that receive the care from the 5 years ago as today; is that correct so the numbers have been flat and the locations is the

same. >> right. >> so that per police vehicles me this in fact the comment about the impact we're having if we're consistently okay. we have more people they're the number of people coming from the same location praepz perhaps they need to been this public-private partnership and think about not just the amount of care not just the dollars and the number we serve but what do we do to look at the outcomes because that seems to be perplexing to me. >> you're correct in stating that over time we've had some fluctuations in the number of patients and the expenditures you you know the same 4 districts over time have transcribed most to the charity care landscape in the city and you know the attachment for the

awe preparation at the ends has neighborhood profiles which give position about the different neighborhoods within each district and the mediums household income for the district we're seeing the multiple charity care responds to the lowest medium household income over time because those districts are continuingly representing the areas in the community i think it is try that the those same districts contribute the most no matter how the patients are fluctuated over time that will continue to be i think is good way for us to understand from a strategic parking space stand point where we modestly might focus to change the dynamics to lift

those district out of the situations they're in that led to the continuous representation. >> it is almost like a stable population from those continued areas. >> we think about are we looking at this with the efforts to really looking at how do we have new path not impact overall but there. >> very good thank you. >> so i think i want to follow what commissioner karshmer just mentioned you know like if we just like play that through you know if this is really where you know some of the most poverty stricken contingency that supposed to be our responsibility we need a different kind of plan i think that through all our partners

they also have you know mentioned similar suggestions about you know trying to taking into account what it means as we move forward with the charity care i think this is y where f it gets interesting so if they're really you know like assessing they resource full to assess the services but but at the same time, they self-sign up for you know like our haeblth plan and didn't like enroll in medi-cal extensions so that question is the big question for me you know why and why not and interested in the language barrier is it you know like other factors in place and then the last thing that appears i think that assessing the charity

care episode preventable have we done anything to like help them to improve their health so that they could watch for signs and good to a clinic rather than you know getting them to a hospital you know i don't think that i have the answer i don't think that any of us have the answers keep asking those questions that goes to goes beyond the charity care what was created for i think this is time to put up a task force i'm not sure a six months task force would be adequate to come up with that but i think you know added assessment that we need to do so i don't have a clear solution i think that you know in the interest of like looking for

that pattern i recommend at least doing the current reporting for another year by then we'll have another enrollment period and you know we'll have a better sense of last week two is left behind. >> right. >> commissioner sanchez. >> yes. thank you. i will just like to say it was an exceptional presentation and a communities inclusive presentation roughly 13 or 14 years ago the dialogue was my turf your turf my data your data the first couple of years ago it was sort of a shake down crew with exchange of information what were the outcomes and the

penalties and not and here we sit and listen to those report and look at the data presented it is exceptional the fact that there is a safety net in the city that involves the totally o totality of our institutions and many of the colleagues in the hospitals are as frustrated as anyone when our involved in health care you're involved with the quality of care the treatment and diagnoses a follow-up and so many oversight and everybody is reporting on everyone and we want this data this year and not that data next year you have the accreditation and licensing and you name it the state and federal and everybody is asking

for information i think everything is asking today after 15 years or 14 years we could have even additional discussions and sort of a review of are interest factors here that are common we can save dpupgs e to integrate the data it focuses on the mission of this ordinance i really know that people could do it i mean you've done it this far it could make a difference the other thing there are so many variables but all of us know there is so many changes today in the zip code areas that report then, now and 5 years from now we're going to have a center the excellence of germantology at st. luke's we

look at the senior population in the city significant pockets everywhere and cuts in services and increases and transportation is more limited therefore you know is - are the participants the same cohort or other variants when this was started many, many families moved into those areas that utilized the services and programs yet today newer families in many newer with young children whatever and caregivers that are taking care of households with the community from the east bay and can't afford to live in the city or get services from the programs alls variables are ongoing in the city and this group her is an oufrn group twenty-four hours

a day and for those who work here he think that this body and our colleagues here could really make a unique tricks a greater contribution if we look at the day wow. sf sustainability that is the only service goes back many, many years but other times many institutions that stand above where st. luke's or attorneys or ucsf based the needs the population is shifting all over the city more delancey streets more on the waterfront are in the excelsior with different populations so it's exciting change is exciting we have a responsibility and believe me the group that worked on this and the leadership has

provided an excellent, excellent dialogue and trust trust and excellence in professionalism in; right? and listening and coming together to create those pathways i look forward to further discussion and the time factors are months or six months but ongoing i look forward to creative paychecks where we can insure the charity cares or whatever the definition provides quality health care and you name it to the ending time with the respect for all the patients whether the folks at laguna honda or c pmc thank you all for hanging in there and making a

unique difference if the quality of life in the city carry on. >> commissioner singer. >> yeah. thank you for the report it's a pleasure to hear it again in this broader setting thank you to the community and all organizations that have been involved it is super important what the first few sentences of the first ordinance it is our responsibility to deliver this care and understand that. >> i'm sensitive to the report issue that has come up the hospitals make a reasonable case as commissioner sanchez just noted in terms of the myriad perplex rules they have to live by and obtain i want - we have to put the horse before the cart

on this i apologize if i have a myopics view it is important for charity care for san franciscans and that comes from me before reporting and so i think the first issue for the department to sort out before you yes, ma'am panel any group to fourth how to do that fourth wasn't data you need to make good judgements how health care is delivered what will end up in a large group you'll get busted what is easier and more convenient not our mission our mission to get the data under this origin to get the right data to make the best policy decisions and once the department has that then it is

really appropriate to sit down with all the stakeholders and go eject in a perfect world this is the data we want and what data can you provide. >> what works and then work on compromises i'd like to hear a presentation this is the data to improve upon the dictated we've learned over 15 years some of the stuff we've gotten is not relevant but this is relevant because as i read this report i can't come to any of the conclusions that the report comes to personally the data is not- this is big deal been massive changes in what's going on in health care and overlaying that are magnificent changes in the fabric of the city you also have institutions

moving neighborhoods in the coming years and i have different time periods you compare in the middle of this fluctuation fluke so we have to be careful about the conclusions until we get normalized more material that is more relevant i'll give you an example tends we talk about the time periods but at the end you have the district profiles in 2012 so let's say it was 2011 since this data it was probably 2010 so the idea that the population of the mid market area is the same is going to be the same in 2015 and 9025 and we know that will change we're struggling

with the implications but it has changed unless our department understands the changes and builds on top of them the system is not treating people where we are for the realties of the future the first thing to figure out what we want to measure and fourth okay. what's the easier way to do it if there is one. >> that's an important point making sure the data wear relying on is something we can rely on in the future and the policies we're making now we'll have to live with in the future to have an opportunity to make sure our policies are catching i'm sensitive to that and

colleen is as well district profile we tried to find information that of more current that identified the information by district with you the the recent information we found organized was from 2012 i am self-evident is that it is an important point colleen and i are committed p to work together to make sure that the information we provide pow to you is relevant not only for us but the entire city. >> it is completely fair yogi bear said prediction is hard especially about the future it is difficult but you have the courage to give it a try and definitely. >> i think in the conversation which as far i've been able to

glean you are commission will like to make that a relevant exercise and beyond an exercise that is accountabtionablactiona. really the kind of overshadow by this fact a definite change in the pattern the reports showed that essentially the number of people under the definition of charity care remains fairly stable over the 5 years whether there's in lieutenant governor san francisco or not when you add it up it move forward 10 thousand count that's all there's a block of people and this block seems it is in the geographic areas even though the geographic areas some of them may change but i think

commissioner singers point with the right data remembered we were still doing programs for communities that are no longer there and spending a lot of forecast when, in fact, new needs arising that issue of trying to begin as yourselves have said is we're not quite sure of who is in the block it seems stable but commissioner karshmer and commissioner chow somehow those people are still in the areas and not all of them are changing and the prospective you've added is a nice 5 years we have to know about that group and what do we do about that group the report shows that the people are still living there and still uninsured whether there are in healthy san francisco or not we know the

whole block of people that couldn't afford the insurance or insurance and ac a is helping at least we're playing out the scenario for another year the way it is while we're doing the study not dropping it we don't want to as imperfect as it is what is pertinent data and now the hospitals are coming together with the needs assessment we combine with our hip program and that's a prospective to say where could we go as commissioner sanchez said for the future and take into consideration certain areas are changing certain things are constant and we're still spending this amount of money

with this block of patients with charity care it is good money we're getting and it is values we find from your hospital communities both volunteer and no non-volunteer but now we want to also see where else we should be going but inside the right data whether we want to ultimately have a broader conversation i do think we need the departments to first get the information together and bring it back to us what a plan might be and not charging off with the plan as far as we again continuing to use your uphill relationships or expand it for this particular period with an objective to look at a new vision for both charity care and community benefits that

benefit our community but, of course, based on data and so is isn't the data is going away we can only draw gross conclusions if so hard to go to the hospitals and find out what is down i appreciate st. luke's they said they dropped and this was the ends of charity care that was a shame we lost a substitute unit but that will probably planning explain a large amount of money that is the problem with this data is is very hard it beyond the gross things we can't draw so i'd like to hear the departments reaction was it might think and the timeframe

and have a game plan >> i have a quick question it sounds like you were saying let's keep the same system for this year. >> we've got to- we only have half the years reporting. >> i imagine. >> it maybe greater. >> i can see we end up doing both if you study it this year you'll not change the tire in mid-year but keep this year the same and the departments comes back we all want the same thing for the bitter quality of care i have questions b around fairness and equality but i don't know if as well as effective contributions i hope those can be added in so am i hearing you

correcting task force are you president this to go away and come back with a house they'll handle it at the next meeting. >> question have to keep the same to finish off the half year we lived have half year of ac a influence and to have the data we have good historical data this will allow us to continue and same thing continue - it will take a while to come up your analogy if we have no tires to the tires poor as they may be get us further information while we're working on the new client. >> buying the new car. >> we all need all the hospitals to be on board and we can't just you know suddenly

have a hiatus so to understand it would be a shame to suddenly have a whole limit essential this is only a half year influence on the ac a on some of the facilities so - >> we're looking for 2016 implementation and, yes, that is true like all the mr. larkin and the it work we have to build the infrastructure before you brown before we go out and have the program so. >> to answer our question to staff how would we estate this. >> you know it is your touts would it be reasonable to come back with the plan in two or three months to try to you know remodel this to our new needs. >> certainly we heard the comments of the commission here and the desire for the

commission we can come back with a plan in 3 months how we would devise a plan what data is useful and why we think it is useful and what kinds of changes to do that other thing i would say i agree with you should continue the reports as we do this we can do those things krurlg and not have a gap. >> we're under the obligation of the ordinance to do that until we can explain how we can fit it in a different role for the ordinance we have to foreperson follow through with the ordinances passed by the city. >> what's the next step when you said the direction you want to go. >> i heard some commissioners

saying they like us to take into account what data elements are necessary we can take a deeper look within dpw to see what the provided at the federal level and state level and what is provided here and what data to plan moving forward and we can have that conversation with the hospitals and come back with a timeline does that sound reasonable. >> commissioner do you have a comment. >> my comment to really ask the hospital partners to have the patience with that extra work in order to you know get the data for the report i think in the long run i'm pretty optimistic we have now multiple sets of data that can go back to the a.k.a. so if we have another set of data it will help us you know to help a full and more complete

story how the charity care of the city has changed only other thing i want to add the data is one element of the conversation the data is just what is recorded to the charity care but queer having a larger conversation i heard the commission chiming in a larger conversation about the community benefits and the overall value that the nonprofit hospitals provide for the community so that has to be part of the conversation. >> yes. absolutely any further questions. >> i was wondering going on officially thinking those are tricks like the contribution we received at the san francisco general so we're getting care for - in exchange for many other

things but a community contribution. >> we i believe expressed our thanks and first of all, our understanding at least the gross data and our thanks that is an important participation on the part of all that the hospitals play for us i think we've said that before the public-private partnership and the delivery of care in this city is absolutely necessary the city can't do it alone we're grateful for the contribution and the participation of the hospitals in p the development programs thank you to the hospitals and thank you to our staff. >> thank you. >> thank you. >> other comments no other public comments more this. >> can we go on to the next item we thank all the hospital

personnel for coming here. >> the next is the ebola update. >> all right. good evening 0 i'm the director the emergency precipitation branch i want to start out with a brief overview i'll talk about the ebola the partners in general is presenting for the precipitation efforts i'll be joined by dr. carla the director for the prevention and has done most of her unit has done the monitoring

we'll start with the precipitation and go to the actions around ebola. >> so this slide denot the outbreak situation in west afghanistan we have to countries from both the countries are over 17 thousand liberia in a cyst category about may had no case of ebola for a couple of months i'd like they were going to contrary and unfortunately towards the mid june one case that ended up having 5 contacts so unfortunately, a couple of deaths back up not having widespread transition but overall they've had over 10 thousand cases and reporting one

thirds of the total cases have an outbreak this is a graphic to visualize what the outbreak looks like this was so much reporting and continues to be the visual the virtual of the out break as you can see you know mark 23472014 there was the first notification for ebola but really the caseload starred to increase towards august and september and paekdz accept in fairly known in the december times and as we move out into the spring the outbreak containment has worked in those countries both improved infrastructure in the countries as well as cdc and the international community providing some of their

capacities to the 3 different countries the rest the graphic is about cd cs resistance internationally but how does that effect obvious locally well in november when the - well, actually tends of november cd c turned to monitoring for all people coming from the effected countries and there is still travel not a band but travel issues with the recognition to avoid non-essential travel all the people are going to 5 airports wear getting screened pea what this first started again, this was in reaction to what happened in dallas that was a lot of panicking around the missteps talking about e pe the cases spread to local nurses in that hospital and because of all

that i think that our health care system and the public health care system has to ramp up the process to make sure we're protecting health issues as well as providing family care it gets lost the real dowel is any returning travelers they got care and presented with a disease that had had more symptoms so this was kind of where we activated at the height of the activation as you can see this was all for planning the actual monitoring happened i think in mid-november when it was initially kwaftsd the response for the response so we activated our entire cd c and in light of the planned sections

they're responsible for collecting the data as well as forecasting the needs and forecasting the objectives in the pink is the operation section they did all the planning the people that do in the response metrological ice cream section they get the it staff the p p d the personal precipitation equipment there was their responsibility and they basically monitored the resident. >> and this comes out of a framework by the cd c because emergency precipitation didn't have tends to be unique events it is difficult to plan for a hypothetical so cd c and synthesis coyote with 9 health preparedness side and the hospital precipitation program 8

capacities as a system we need to base this new disaster that faces us we're able to respondent those are broad-based capabilities to work with the vulnerable population how to treat them and make sure their health is maintained in a disaster and so forth so for this response we basically and unfortunately, the community preparedness, i.e., looked at the expects we had to put both reaction and this was the response and pressure and sensitivity was a great way to test the system. >> the other they know with ebola was there was a lot of

partnerships and work at the local and communities level but at the state level we closely worked with the dpw we're the lead agency in san francisco that meant any kind of ebola the questions came to us we acted as despite if sfo and animal care controls all those eligibility were engaged or asked by us to be engaged in they're planning we were involved in a number of protocols i have to highlight here vicky wells our health leader in that section did an extraordinarily amount of work working with the agency to make sure their protective equipment was okay within the department

and throughout the city. >> to switch d oc it activated over a hundred people between october and february of last year to this year and that alone offers a wonderful training opportunity people started to realize how the command structure was done and the training was utility and starting to work with a problem we didn't have a lot of plans around to highlight some of the things that occurred the information graph puts out information for ebola a large amount of work providing the accuse for the community and making sure they got translated and working with the communities organizations that had questions he even doing some work around cigarette ma people coming out

of west african they also the medical part of the information grants was responsible for putting out health advisory and the health branch provides information the branch is where the work. >>was not just planning but implementation so developing of protocols and implemented in mid-november as soon as people came back into the country that was part of the isolation and quadrant thank you has to occur potential we need an isolation team environmental health that was a while back but what to do with this we're hearing cities are spending millions of getting contractor and they worked closely within the city to

insure that the public contracts are if place and the check list to make sure that is okay. if is cases come here we get it under control and finally, the medical branch did a lot of work with the hospitals the hospitals faced as enormous task they do this on a regular basis but a completely different scenario with a scomplaktd personal protective equipment so i'll training all the front line staff to do what ebola once you get a positive screen with something not only the out patients they have fever or they have to at an you'll talk about it in a later slide and so that was i know where the

bulk of the response analytic we're still preparing for ebola and ronald to ebola still travelers that we're monitoring and the doctor will talk about that but we've cut down a smaller team to insure that my ongoing objectives are pushed forward and we're making process we've discuss monitoring issues and identify the gaps and the biggest thing we're prepared to activate we've not had any ebola cases in san francisco but if we're suspicious we have to activate it is important that most is of the people that are working on ebola have returned to their normal day to day work second thing we're trying to do is develop a process anytime you have a disaster or emergency it

ends up being a complex case because of the agencies and partners involved to really now that we're a few months out of the need of the responses we not to step back internally so we're all think the on the same page we review okay. we think this is what should happen i've been everything that you think happen explicit but working from the same framework helps we continue to update our partners on the ongoing working group which are part of the hospital providers and we continue to work closely with the hospitals i want to segue into the work we've done p with hospitals ebola has a 3 tier system a basic front line hospital, there's an assessment and treatment hospital

san francisco does have a treatment it is ucsf mount zion and it was visited in the early part of informative to do a thorough plan for the treatments process they continue to practice they are respond sibd our health care partner that couldn't be here unfortunately did a lot of work with the other hospitals gone out to how's hospitals and assess it and i read back the question is when i say assure if they have identified gaps it's been difficult to fill she's made sure that the public health whether communication issues e.r. ems issues whatever we can come together as a team to make sure that everybody is able to respond in a capacity so all the

hospitals were involved including the san francisco va they adhere to different standards and but they've been a wonderful partner and always wanted to be included as part of the hospital family in san francisco i'm actually i am sorry to dr. here on behalf of the project sponsor to talk about some of the ground work that is happening in san francisco >> thank you so i'm dr. co-sponsor are the director of customable diseases it is my pleased to talk about the monitoring work since october i realized it is a year we've been monitoring the travelers it is amazing when he started the incorporating we had to ramp up it was announced by cds c and we had to get started done in the context of the cd c but since then we've rolled the

monitoring into the day to day work of the comparable it is done by line staff it is appropriate part of the ongoing work at this point so we've at the time those slides were pit together we have monitored a.d. travelers from ebola effected countries again we've received notification we do an in take to assess their level of risk the rapport that is done by phone and daily monitoring that takes place for a 21 day period the incubation periods for ebola done by phone number or whatever the person's risk levels at this time it is done by the public health their speaking with the travelers

daily and have great rapport with them something to note as was mentioned really non-essential travel to those areas the folks we're monitoring have gone interest for work in many cases to serve a abate people or work for the state department that type of thing and very value the work they do and feel we want to support it by doing the monitoring so for all of us it has meaning and so really the goal of monitoring as mentioned to make sure that if someone does develop symptoms that potentially be symptoms of ebola they'll receive evaluation in a controlled and safeway we're in touch with them we'll catch it

earlier and they'll get in touch with us early none the transfers to california you know hundreds of travelers to this state and nun have been diagnosed with ebola you'll know that but this work continues to happen 7 days a week and you know we're available to deal with any concerns that may come up twenty-four hours a day. >> this is the final slide of the presentation just some take home points if the ebola response and kind of i guess you could say our ongoing work in relations to this threat that seems to be awe boyd the cased continue to occur but monitoring

has you know not yet been appropriate to relax the moshts that is going around we remain rea ready to activate and really i think the key point is that our precipitation and response activities over the last month's have really helped us to build capacity and identify areas for future communicable disease most if not all of what we've learned is you know the lessons are translateable and been helpful i'll stop here and i'll be happy to answer any questions. >> commissioners. >> was there any public comment. >> no public comment requests for this item. >> commissioners. >> commissioner singer.

>> thank you you guys for your effort when you don't get a case none writes about it in the newspapers that's fine but i want to thank you. i think everyone up here feels the same way i hope if continues. >> commissioner karshmer. >> thank you for all the work and to date it is timely they're not not recorded my mother cases of ebola you know that like terrific and i'm curious you know like what we can learner if in terms of like how they continue to get to this point. >> yeah. >> so you know it is interesting but in many ways it

is not - there are not foreign concepts for all of us in many areas i think what has allowed the epidemic to come through control actively a kind of grassroots plan work in rigorous isolation of exploded people of exposed people who the contacts are and if their contacted and ill they're identified as well as obviously you know investments in the immediate and then kind of more i don't know what you say investments in the health care but i actually a lot of it you know seems to be

public health i've noticed over the most and partly it is a little bit more controlable you can you know get a better sense of what is going on you hear there are such and such many contacts under monitoring you know this conducted their monitoring periods there's an a growing ability to provide the health interventions some of the cultural practices spread ebola such as the way their bodies are handled in funeral practices that type of thing and also been some you know fear and you know caution around you know government health personnel it

is really diligent work around that that has helped. >> commissioner pating. >> well, actually if people want to say something i want to ask dr. bubba to conclude with size 7 with a prelude to what it becomes to be pubically prepared this ebola case is a test of our precipitation but the extent of the precipitation is the 15 dimensions of the public health and hospitals if you could spends two more minutes on this this is what we discussed on the community health committee and it goes to a large question what does it take to prepare while we have the slide up. >> just to give you a little

bit of background what preparedness first started in public health focused on diseases that was around pandemic and flus and is 9/11 attacks and all disasters have a health element we couldn't was it on disaster to disaster but a bigger framework to demonstrate the capacities around the placement that is harder there is no evidence so take a lot of disasters and see what happens in health many is is intuitive and we actually building after seeing the disasters and hurricanes there is something that came up as a need it will be a capability but it expands the spectrum or public health for example, number 14 on safety

and pthd to make sure our frrnz if interest is something out there, there is dangers whether it is a toxic chemical or come building disease when 9/11 went down none thought about it when the oil spill in louisiana none thought about those health workers this is leaning forward part of the difficulty your preparing sometimes for the unknown and can't say predict what recordings will face and the communities about face that's why we have those capacities it goes much deeper i know each other was has a function the book is hundred and 50 pages in terms of deaths and the capacities but i think where

we try to improve our precipitation is during the responses like this tested the plans and find out our gaps once you have to have a disaster you sit back and the group that responds well, it went well, what do we need to improve on next time in the system. >> thank you. i have one question which was when the protocols you were doing hospital calls weekly and at some point you'll not do it weekly like putting the surveillance into the system when do you start reducing this and what lets you do that so then i know this kind of goes back into a precipitation mode

rather than- you can't keep having a crisis and make calls when nobody wants to pay attention anywhere; right? >> a great question when you allow people to do do normal day to day work part of that the way - why we end up activating the needs out strip the resources if comparabmunicable diseases the protocols were in place has been tested for a few weeks and starts to go back we have monthly calls with air partners once they say stop calling in we realize this is less of an issue and on the monthly calls we check in and see we're doing well and they don't need our

support but the open lines of communication we have a strong relationship with the hospitals their you know i'm very open about communicating there are issues that people otherwise will talk about. >> thank you. >> and thank you for the presentation. >> shall we go on to the next item. >> no public comment. >> item 8 is other business. >> commissioners any other items you want to bring up on other business if not next item. >> no public comment requests for that. >> item 9 is a joint venture report and commissioner sanchez will report think outside the box that from yesterday. >> the laguna honda meeting was held yesterday as 4 o'clock within lodging that was a