existing grocery stores already existing, the average sales ffor all these groceries combined is about $887,000. which leaves by this report about 30% left of the market share to be filled by our grocery opportunity. with those sales amounts in their sales volumes based upon costs of average ticket sales trader joe's was voted the one to succeed. underneath that the 3 categories of groceries were health and organic- and by that term we look at examples of by right and whole foods. upscale mile and i am drawn at kos and over the next few years

by weakened by your are listed in this report. from the survey we have identified using those 3 types and categories 3 different sections of groceries to approach. trader joe's obviously is at the top.. now, each grocery has a specific model that they follow. square footage, democratics, parking and no parking. that sort of thing. so, we have been able to being in san francisco and being quite in the market for the scriptures we have been able to bend and mold groceries to see if we can help them to transgendered their models into no parking, transportation

only, smaller carts, maybe biweekly instead of just one trip per week. so, a question of how we do that in this space these are the type of tenants that are going to follow and going to be able to track. you will notice on this that we have the square footage is. our space is about one the largest level and about one or access space we have a fewspaces for advertising and on this you can see we have up scales such as molly stones etc. and then we have independent such as by wright and molly foods. the process of leasing and getting a grocery approved in the internal real estate

department is kind of a process. i hope the timeline you're presenting gives you an outlined idea of what we go through to get a grocery store to give us an analysis of this. obviously there are marketing towards. their multilayered processes. you have the real estate committee come out and tour. you have the operations committee come out and tour. do their trucks that? do they have to by smaller trucks to fit in their docs? then you get a little bit of time to negotiate with the landlord. once the lease is actually signed it is the permitting process. we all know about that. once the permits are received the landlord lord will build up his work and then they

will build up their space and that takes about hundred 50 days to build out thier and hopefully by the 3rd quarter in 2019 we can have a grocery store. any questions about the process? >>thank you. we are to take public comment. do we have any public speakers? >>there are no public speakers. >>do any members of the commission have any questions? >>you know commissioner bustos couldn't let it go. >>i know mr. felittes from his grocery store a long long time ago i don't know if it was

upstairs out of the then but now it is. the price point we have been approving a lot of affordable units in that whole area. sure you guys are considering that as well. trader joe's is a lot less expensive than whole foods are we taking that into consideration as far as the price point? >>absolutely. it depends on the model based upon the space that we have. >>so, trader joe's is at the top of the list? >>that is based upon our survey. my calls and research will obviously determine how they respond to our marketing efforts. we will be happy to come back report that to you. >>and also on the 17th and

ohara. >>the interesting thing about that is they have 75 spaces of parking and they don't use a 3rd of them. >>by wright is in san francisco. >>absolutely. >>okay thank you. >>any questions any questions commissioner singh? maybe this shows my ignorance because i a.m. a san franciscan and i want to go shop there just to try it out but where's harvest bourbon market? >>i believe it is one harrison and 7. i think i've got that right. >>harrison and 7th so it is not in the mission? gus' is in the

mission. >>don't they have another location on market street near castro. market and 15th or something. >>that is great. no, this is very thorough. thank you. we will follow this with great interest. the only thing i would add before i defer to commissioner singh is that this morning's paper announced to the new media that the -- >>it is a little bit more like

an tronic is. i'm trying to think. they have a lot more prepared foods. they've a really great grab and go section. >>grab and go versus a traditional? >>they have a great produce session. >>i believe they are considered high-end? >>they are. >>vectors to a price point position. >>or to a bank account. >>commissioner singh? >>is that going to be affordable for the people that live there. >>we will take that in consideration. >>okay anymore questions?

>>do we have any data from these current stores about how many people in what income levelare shopping at these stores? >>i know a lot of people of many different levels shop at trader joe's. we should take a food trip there. >>we call that retail experience. >>retail therapy. >>i have a question and you classified health/organic or as upscale. that would be great because i think that we should

push as much as we can for more organic food out in the communities and make organic more mainstream just for the health of our people. if there's anything that we can do to whoever was chosen to make sure that they stock up what healthy organic food or good service that we can do. we offer the people who live or shop in that area. >>absolutely. >>thank you. >>there was no vote on that so thank you. can you please call the next item. >>the next order of business is

5e.e) authorizing a 75-year air rights lease with t8 housing partners, l.p, a california limited partnership, for the construction of an 80 unit (including one manager's unit) very low-income affordable family rental housing development at transbay block 8 (250 fremont street), and adopting findings pursuant to the california environmental quality act; transbay redevelopment project area (discussion and action) (resolution no. 15 - 2016) mdm. director? >>commissioners as you've heard this is an air rights lease for transbay block 8 before they start construction this summer. you heard that in our previous presentation.- mr. sommer will provide a little bit of information on this presentation and will discuss it further with you.

>>good afternoon commissioners. and i apologize because you will hear some of the same information heard what trans bay 7 but i will keep this presentation as lively as possible.. >>good afternoon: commissioners and director bohee, i am here to discuss trans bay blockade affordable housing that is available for very low income families. as contemplated in the dda tthe developer is authorizing the ocii ttto enter into an air rights lease with one option of 8 additional years with the approval of an air rights lease wwith tp

housing patterns. and thetbc is the codevelopers for the site. it is am= project affordable project development and it is80 units including one manager's unit. there are 20 spaces includinga garage that contains 20 units. there are 2 midrise buildings. one is a tower and it is 65 feet and it contains 20 units.

there are 85 standalone podium buildings that contain 80 units. project manager shane heart and mr. anderson formally both showed that these are currently under construction. as you can see block 8 is under the future transit center. and this context mapplaces block 8 in unit one of the trans bay district. block 8 is under.havana and 1st streets. the blocks 6 affordable project

is 280 beale. that is due to open this fall. to the west is block 9 and existing developments or to the north and south of the here are aligned in red are the ground-floor perimeters of affordable projects in these buildings. these site meets with fleming and and clemtina. the red circle that you see on this slide will indicate the tower entrance to the units including the oci i sponsor midrise units that are attached to the tower. next i want to review the background of the trans-bay redevelopment project area that gretchen took you through earlier. it was adopted in

2005 for the purpose of developing 10 acres of property which are burned by the state of california. this is generally funded by the transbay housing authority and in conjunction with assembly 812 which assures 35% that are built in the project area are affordable to and occupied by very low, low, and moderate income households. the project area implementation agreement is another enforceable implementation to form these into development including affordable housing. the publicly and privately owned parcels in the transbay project area will all include over 3200

new residential units. they will have over 24 million development offices in over 200,000 of nretail space. and they will offer a new retail park. >>now an overview of previous approvals and milestones of the project. in november 2013 the former agency issued a request for proposals to re-development teams for design and redevelopment will block 8. in june 2014 the commission approved to enter into negotiations with related california and ttenderloin

neighborhood development corporation. in april of tenderloin neighborhood development corporation. in april 2015 the commission got approval of the block 8 dda and schematic design with a related tndc also last august commission approved the 16 million dollar permanent loan for agreement of this project and then last december the they developed a parcel for this product.

>>h here we have thepopulation and most of the housing will be a 50% ami of affordable housing for that year. they will meet the ami and market the particular units within the preference holder. one will be with certificate of preference holders and next would be with the ellis act and then the next would be for san francisco workers or residents and then for the general public. >>i want to give you the highlights for the transbay developer project. again the service is shown again on this

slide and in the next are to provide loan documents with the air rights lease.furthermore prior to the applicant lottery that developer is required to submit to the oci i staff that defines how they complied with the cop outreach obligation and the housing holders prior to our reach lottery. the trans bay proposals had one in 4 residential units in the affordable project. this will provide access to clement tina street. it will reserve 20 spaces for the affordable project. the projects limited parking is in line with the city's transit policy and the

transbay district is a transit rich area.my point about the area having multiple transit options showing close proximity to the site this shows all of the things that are accessible within a half mile range of the project. the park is located within at least 4 blocks of the site. it provides access to this safeway and trader joe's supermarkets. block 8 site includes approximately 1700 ft.2 of retail space. the dda obligated related to pursue a grocery store as one of the retail tenants. this is 1200 ft.2 reserved for grocery

stores. related has not yet secured a grocery store tenant for these options. 5 related has not yet secured a grocery store tenant for these options. 5000 of the square feet will be filled by a neighborhood retailers. expanding on retail amenities. the transbay district shows aproffer of all of these. this shows a post office at ymca gym, now to the terms of their rights least. at this time staff is requesting authorization of their rights lease. the lease enables the developers to construct a project within the air rights partial of the blockade site. they were designated by the responsible units. ocii will retain these upon construction and once this

is completed they will retain this to the mayor's office of housing and community development. that is a 99 year term lease with the initial term at 75 years with a 24 year option. the annual rent is sent at 10% of the fair market value of the property. the annual rent has 2 components. 1st, a base rent of $50,000 which comes out the projects in operating expenses. and accrues if not paid. and 2nd a residual rent which is due on the residual basis of class flow. and this will not defer any decidual project for the 1st 55 years of the project.

their rights lease and ask certain restrictions such as certain affordability levels and contracting policies and marketing requirements. i also wanted to give you an update on the affordable party professional service consultants. they have 57% sbe, 18%mbe and 9% wbe and the mba is potentially all san francisco firms. here is the biographical info on the architects. they are both san franciscan firms. the trans bay citizens advisory committee

approved this can mattock design of the entire block 8 site in april of last year and it continues to support the project on the design. here, we have a few renderings of the affordable project. the 1st picture is a view on the east amongst fremont street. the reddish-brown color represents this building's brick veneer. this isnortheast view. this is from the southern side of folsom street. you can see the great clad 65 feet affordable housing that connects to the tower. this will connect the paseo to the 85 foot affordable housing building. from this view we are looking directly down. that bisects the block. here

we have a view from clemtina that overlooks the townhouses that overlook paseo. finally we have a view from full some and 1st street this shows you how the tower meets the street as well as its relationship to the adjoining or affordable podium building. the last information that i want to cover before wrapping it up is the remaining reactions of the construction of the affordable projects air rate disposition and bond issuance that will in june the development team must

submit the early outreach and marketing plan the following month. construction of the product is anticipated to take a little over 2 years and resident movants will begin in the fall of 2018. >>that concludes my presentation the representatives of related californiaand tnc from tnbc we have katie malan from the office of housing development.we have click low and associates and web core the general contractor. and we also have sbes general consultant monica wilson is also available. >>thank you. do we have spear cards? we do not have speaker

card? questions? commissioner singh? >>once we have 4 residential units, who can get that space? >>is the question how is that space design? >>the question is how are you going to go about one space and 4 units. >>so the initial parking area is satisfied in the proposals that were initially approved by staff. the space as per the parking ratio are available. we are happy to have 20 spaces rather than 0. >>who gets those spaces in all of those units? is that a lottery system or how do you do that? >>typically there is a lottery system where those parking spaces are designed but i can

turn to the developer and they can provide more insight into that. >>okay thank you. >>hi, hi macovy i am representing california. the answer is the parking spaces will be- designed we haven't talked to the staff and come up with a system but once we design a system we will make sure that once they are available they will be full. we will work out a system with the staff and make sure they get a sign. we are going to guarantee that the spaces will be available for the affordable

component. >>commissioner pimentel? >>commissioner pimentel? i can imagine and with this design you have 2 kids, groceries, and you don't have a park? what do you do? >>i will do my best to find out those answers. make sure that they are designed effectively. >>how many people have you talked to me people submitted applications? >> gretchen i think that there

are some housing agencies with the agency of community and development and somehow the development team will be responsible for working with those agencies. i think we heard loud and clear that commissioner bustos recommendation about working loud and clear with more of those agencies.as far as your question as to how we will document, i don't want to go so far as to say that we've identified a complete plan. we can definitely document this information as we go forward and make sure that we b back to y'all. >>i'm i would appreciate if you would because i know there are people that have careers and families aren't able to attend the meeting but they would be interested in they need that affordable housing as well.

>>understood. >>my comment is this project design qualifies for the wow factor, is that right? >>[laughing]. >>the architectural team can you please stand up. all of you that are responsible for this wonderful thing. i think we commented on it but we saw the design. it's very pretty, it's very nice. also because we haven't talked a lot about the sbe program i see there is quite a lot of diversity in the team as well. not just geographic but racial and gender diversity as well. we like to see that in a team.

i have a question and that is on the schedule. that says in june 2016 the construction is going to start and that is around the corner. do we have a sense of if mr. lee is still here? if not we can tell what the developer. does the construction subcontractors in our spe program compliant? what does that look like on the construction site? >>it is aggressive. they the contractors have to look at web core and we've been in touch with web core so we can align more that process. >>earlier? >>i wouldn't say earlier. i would say we are right around that time. >>i think if i recall that my own comment is that if we have trans bay and we look at the 3

project areas him without assigning a letter grade in public you know trail mission bay hunters pointe or hunters pointe in terms of small business and minority business participation so we want people to see those numbers on the construction side. >>correct, and quite honestly is a challenge. with respect to large towers and construction. we are in very close communication to the general contractor and they are present here as well. i'm not sure if the developer would like to say something with that as well? >>please. >>yeah, we've been working closely with raymond and george bridges to do as much as we can to up the percentages. it is challenges. is aggressive as raymond pointed out. but our goal is to involve as many sbes as we can. we have been

following the process of solicitations of bids and reviewing the mean of them and interviewing the particular subcontractors in our goal is to push it and to push the involvement as much as we can. >>right, thank you. okay. those are my questions. any other questions or comments or missions? >>i move. >>a move by commissioner bustos. >>2nd. >>okay commissioner singh. commissioner pimentel we will defer. >>can you please call the roll.

>>[call the roll] >>mme. chair we have 4 eyes and one absent >>can you please call the next item? >>f) authorizing a seventh amendment to the legal services contract with shute, mihaly & weinberger llp, a limited liability partnership, to increase the contract amount by $450,000, for a total aggregate amount not to exceed $2,400,000, to provide specialized legal services related to public trust and state park issues for the candlestick point and hunters point shipyard phase 2 project; hunters point shipyard and bayview hunters point redevelopment project areas (discussion and action) (resolution no. 16 - 2016)

>>mdm. director? >>commissioners, as you know the scope and scale of the hunters point shipyard project is rather large. is over many many years. there are many interlocking agreements. they require specialized services. this contract before you is for specialized legal services with the firm of shute mihaly and weinberger. mme. chair we will walk you through what this. >>in preparing the disposition and development agreement for canister point in the shipyard phase 2 which was approved in

2010 that agency obtained the shtuz, mihaly and weinberger to obtain the acquisition of the state park lands and acquisition of these lands to make a more appropriate scale for open space and the appropriate development for public housing and so that the trust lands were configured in a more appropriate way. those agreements with the state lands commission and the state parks department are embedded in the dda for the shipyard at canister point. in those

agreements where the agency may acquire or reconfigure or authorize or appropriate develop an in these sites are all perfect indications of implementing dda. shoots and weinberger have specialized expertise on the public trust issues on the state park and issues both legally and in terms of relationships with the state bureaucracy that handles these matters they have satisfactorily performed services for the agency for a number of years. if you go back to the original item on the calendar in this meeting for candlestick point your remember there was a requirement for this for

candlestick point and this'll be part of these main lands for dda as part of this agreement that you have helped us to approve so the implementation of this requires that for most of the phases for all the phases really of the shipyard as well as most of the sub phases that there would be this acquisition and this mapping and this transfer of lands into either state parks jurisdiction or conveying public trust on certain lands or providing that public trust lands be transferred to the private developer for private development. so, in the long run we hope to assume some of these specialized services in-house but i assume at the moment we're still a legal staff

of one and we hope to expand that very soon. in the interim we need the assistance ofshute and mihaly and because of their relationship and their expertise i would urge you to approve this and also from shut mihaly and weinburger is our trust and also tam's and drew is the senior project manager for the shipyard at canister point.in case there's any questions that i cannot handle. with that i am available for your questions. >>do we have any speaker cards?

>>we do not have a spear card. >>any questions or comments? >>commissioner singh is looking. i don't know if you have question but i will ask one question 1st. are there any subcontractors or subconsultants under this contract? >>not that i'm aware of but we have put in the 7th amendment an sbu requirement so if there are any subcontractors they have to contract me or the compliance of the agency to see how to reach out to small business consultants. just in case there's ever a conflict with shute and mihaly

because i know you do wonderful work but if ever this firm you've a conflict with those assisting us. >>as conflicts arise we will revisit that again. at the moment we do not have someone in the waiting to use but we will carefully look at the situation that may arise and determine what services are needed. for the shipyard. we also use this as an attorney's office to some extent and as i said we hope to have in-house counsel someday further assisting everybody. >>were you referring to your department is a department of one where you including yourself and that number? >>i am. >>commissioner singh?

>>i just want to know how you figured out the computation? >>it's based on the past level of work and an estimate of the work basically for approximately a calendar year and so there are a number of agreements and a number of permits and a number of issues that need to be addressed in the next year or so and so we asked the firm to put together a budget, i reviewed it with project management and that is how we arrived at it. it is an estimate obviously. it is a budget and if we don't need to use it all- it is as needed. >>okay, i am willing to make a motion.? it has been motion by chair it's been 2nd and by

commissioner bustos. >>commission members please announce your vote when i call your name. commissioner pimentel, commissioner bustos, commissioner singh, commissioner mondejar is absent. i have met him chair 4 ayes one absent. >>motion approved. next item please? >>the next order of business is

item 7 report of the chair. >>5 nothing to report >>please call the next item. >>the next order of business is item 8. report of the executive director. >>is there any public comment on the executive director's report. >>seeing none. please call the next iteem. >>next order businesses item 9 commissioners question and matters. mme. chair? >>does any member of the board have any questions for executive director? no? >> >>next order businesses item 10 closed session. >>okay the commission will go

into close session to conduct the

>> pilaties. it's a creation, an old regimen of exercise. really based on core engagement and core structure and core development. we do a lot of

exercise in developing that and think about lengthening of the spine and our muscles. if you're a runner, if you're into kayaking, martial arts, cycling pilates are for you. >> programs are variety year around at various locations and to learn more come to the >> the office of controllers whistle blower program is how city employees and recipient sound the alarm an fraud address wait in city government charitable complaints results in investigation that improves the efficiency of city government that. >> you can below the what if anything, by assess though the

club program website arrest call 4147 or 311 and stating you wishing to file and complaint point controller's office the charitable program also accepts complaints by e-mail or 0 folk you can file a complaint or provide contact information seen by whistle blower investigates some examples of issues to be recorded to the whistle blower program face of misuse of city government money equipment supplies or materials exposure activities by city clez deficiencies the quality and delivery of city government services waste and inefficient government practices when you submit a complaint to the charitable online complaint

form you'll receive a unique tracking number that inturgz to detector or determine in investigators need additional information by law the city employee that provide information to the whistle blower program are protected and an employer may not retaliate against an employee that is a whistle blower any employee that retaliates against another that employee is subjected up to including submittal employees that retaliate will personal be liable please visit the sf ethics.org and information on reporting retaliation that when fraud is loudly to continue it jeopardizes the level of service that city government can provide in you hear or see any dishelicopter behavior boy an employee please

report it to say whistle blower program more information and the whistle blower protections please seek www. chun >> good afternoon, the commission will please come to order. and the secretary will call the roll. >> commissioner pating? >> present. commissioner taylor-mcghee. >> present. >> singer in >> here. >> chow. >> here. >> singer. >> here. karshmer. >> present. >> approval of the minutes, i am sorry. >> before we begin, though, with the approval of the minutes, commissioner taylor-mcghee, has asked to be able to say a few wor words. >> thank you very much. president. and i just want to say that effective today, that this is my last day as a health commissioner. my term expire as of today. this has been an enlightning and

learning experience as we navigate ourselves through an ever changing complex, healthcare system, where the local and the state and the federal enter twine, i have been thankful to be part of the process, under robert garcia and her team, and my fellow commissioners in case people are wondering, i am, and i have been transferring back and forth, between valeo where the stroke center is, while i am in recovery that is the reason that i am no longer going to be. and although i have a local, business here in san francisco, and i am committed to being in san francisco and being a part of this community, i will continue to be a part of this community, and also i wanted to say that i wanted to make sure

that as we move forward, with the work that we are doing here, at the health commission, that we take a serious look at how we can really look at the rate of healthcare disparities among african americans, in particular. it is an issue that is of serious concern to me. i would like to see us get to a point where we have better health out comes and as an advocate, i would like to be a part of that. and you will see me, continue to see me. the mayor understands my commitment to public service. and there will be something happening within the next week. i cannot say. but it is all good. and so i just wanted to thank everyone for their support, particularly as i have navigated my way through the healthcare challenges. so thank you. >> thank you, commissioner taylor-mcghee. as we know, commissioner taylor-mcghee was during the health commission, four years ago, and has been an important

contributor especially in advocating for the improved african, american health, initiative, that has been started by director garcia. and, and, for these numbers of year, we have certainly been trying to address that issue probably no more vigorously than we have in these last several years, which i attribute to the fact that commissioner taylor-mcghee has been with us and has been able to articulate the needs of that community so well. in her absence, we will continue to work on the initiatives, and bring it to a successful fruition and our thanks for the four years that you have spent with us, and given us your wise counsel. thank you and we wish you well. >> commissioners, item two, is

the approval of the minutes of march first and to the right of your packets are the revised set of minutes that i sent you yesterday and they have a few extra comments from dr. chow or comments that he asked me to put in, on page 8. >> and so commissioners the new minutes are before you and they were some additional explanations added to or as you will see from the underlining to note that we also had presented miss bear, a public health award, and in expansion. and i am hoping that these will be meeting with your approval, and so, the minutes are available now, for a motion for acceptance.

>> so moved. >> second. >> second. >> there is a second. oh, let's see, commissioners continue to look over the document to see if there are any other changes that they would like to propose. >> seeing no further changes, we are prepared for the vote all of those in favor of the minutes as now written, and presented please say aye. all of those opposed and the minutes have been adopted. and the next item >> the director's report. >> good evening, commissioner taylor-mcghee thank you for your service and it has been a great partnership and you and i have had and i respect your commitment to help equity. and so you have my commitment to keep work og that and thank you so much for your involvement and the encourage and you have attended.

and thank you so much, and we look forward. and very excited to say that we just came from the board of supervisors, and about an hour or two ago. and we were approved. from a nine to two vote to seek the ability to negotiate with uc, for a new electronic health records. and so, we just want to give -- and i want to acknowledge all of the team and i do not see greg here but i do see bill kim and bill did a great job as well. helping us with the board and really educating us, and you know he is really going to be leaving the ship for us, and he has the experience of implementation and he has been working on the infrastructure development and i think that he has been on the second day of the life of the new hospital. and things that are on green light, i understand, and working. so, that gives us an important step towards being prepared for the electronic health record.

our next steps, of course, is to allow for the mayor to sign this ordinance, so that we can then start having the conversations with uc. bill and his team are working on the chart. and we will have two basic groups, one that will be working on the technical and implementation and the second group of the executives of the department at uc will be then and our lawyers who will be working on the contract itself. and as you know, within the ordinance, we do have the back up plan, that if we can't find our path through the uc, component, we do have back up plan with another vendor. and so i wanted and greg just walked in and so i just want to make sure that he knows how proud we are for all of the work that he has done for the new electronic health record and the team and bill, shop and i think that we are moving ahead and as you know we have a lot of support from the uc leadership and the doctors in the department i want to thank them as well. we have and does not look like

it today, but in the last couple of weeks we had bad weather. and the mayor lee, announced an expanded winter shelters and we will do that throughout the el nino storms and we are good at implementing these quickly. and what we continue to find the people who are not seeking healthcare but who really are in need of healthcare. and so our medical teams were highlighted in the chronicle just the other day, and so we are proud and i see barry, and along from the dr., seven who is in the odd ens today and he has done a great job of leading that group. and another big, structure, structural decision for the department, of course, is the fact that the mayor and for the public and safety bond to the june, 2016 ballot and this will be for 272 million for the department. and 222, for the health, or for building five, and where we are going to integrate, many of our

outpatient programming, pro-he vied a much better space for dialysis patients and along with the urgent care. and then we will have 30 million for the building of an integrated mental health program, with primary care at south east. and then the 20 million because over the years we have had a prioritized process of identifying some of our clinics who need it and ada improvements and flow improvement and privacy, improvement and especially as we move towards behavior health integration, within our primary care clinic and we will have $20 million, and we will hear more about some of our updates on the capitol today as well. i do want to acknowledge that we do have a change in our environmental health department, kusihing is the new director, richard was honored by the board

this last week, and also on wednesday, march 9th, a group of staff crowded into the health officer's office to cheer him on as he clicked the submission, and documentation box of the public health accreditation, on the computer, and signalled the completing of step there in the board process. the search for the written evidence of the work and so this will, and this was also, reported out today in one of our joint, conference committees. and i will end it there and if this is a long, director report this time and if there are any questions, i am happy to try to answer, thank you commissioners. questions to the director? and the commissioner? >> thank you, for the excellent, report. regarding the california special legislative special on health,

with the date now of the attempted suicide and end of life options now, solidified as june, 9, 2016, i would assume that at both the general and laguna honda or both, we need to look at policy issues and i just like to ask that one of the jccs that we will be able to review how we might be implementing that and looking at the policies that. >> i got to request that we have it here because it is a jcc. we start here, with that conversation, and then, the jcc can kind of refine some of those so that they are all talking together. as a whole, commissioner and i am sure that some of the other commissioners who are not sitting on the hospital, committees will really like to hear and i believe that our deputy director would be ready to provide for some of that. >> that will be fine, i think that this hearing will be nice. >> absolutely. >> i would agree with the issue that did come before the commission, and certainly, the

entire commission would benefit from understanding how we will be implementing it and also be informing the public that way. >> okay. >> the second question is the two tobacco bills and one is at the city level and the tobacco 21 and now the state, i think that the state, copied us. we were first, and so what is the implication now of having two ordinances that may do, some what of the same thing, does that supercede our ordinance? >> our directive policy will try to address that. >> and the details of that. >> actually, i think that it is a little bit different and we will have to coordinate the two. i believe that the state level, legislation, prohibits smoking. by ages 21, ours prohibits purchase of tobacco and so we will have to look at how to make sure that the ordinance reflects what has been passed at the state level chl >> thank you very much. >> sure. >> would it be possible then to get a follow up on that at our

next meeting in terms of the clarification? and providing that the governor is on the bill. >> the governor has 12 days to sign the legislation and there is no indication and we just had a call with the director of the healthcare services and there is no indication by them, whether he will or won't sign it. and so we will up date you as soon as we know. >> thank you. >> any further questions? >> no that is it. >> questions from -- and i did want to note that the department has been certainly doing a lot of work and particularly, i think passing the number of the surveys, should be commended because those are really key and they were of concern as to whether or not knowing state surveyors and licensing that they would not find and are very complex and new building, with the new technology. that they would not have been even mo

even, issues so to everyone that were involved. there should be or continue to be congratulated if the only real issue is that we have to have the dialysis unit up for 30 days and that i, and i would believe that it is not a real problem. >> we have our chief operation's officer here. >> sure. >> tell us directly doctor. >> why don't you. >> you can come up here. >> the commission and the rest of the commission that everything is going in order. >> maybe -- >> maybe you can come and just give us a two minute up date on where we are. >> it is worthy because this is such an accomplishment and because those of us who have gone to, even the routine, hospital surveys have real problems, and this is not routine, the opening up a brand new, and highly technology cal facility. so take some credit and tell us how you did it. >> thank you. >> and i believe that i get to

share a rebuild in transition up date later in the agenda. you are right i have never done this before, many of us who work at the hospital have never done this before. and i work with a remarkable team. and that just pulled it together from a clinical standpoint. and under the leadership of jeff smith, and terri salt, from the physical building side of things. i can't say enough about max under the facilities because he has a web corp that has pulled back on the staff and has had to step up and so then, you know the surveyors, were truly, amazed by the joy of our staff. and in talking with our front line nurses and our super users, around how excited they are, the pleasure that they are going to have in delivering care to our patients in such a remarkable building. so, i have been through many

cdph licensing surveys. obviously not for opening a building. but, the energy that we got from the licensing team from cdph like you could feel that they new the value of zucherburg san francisco general and wanted us to succeed and i think that they were super pleased that we didn't let them down and i will share more with you later. >> surely. i just thought that it was important to call out how amazing that the survey process went so far for us. and that you and your team all of these are the credit that you are, and that you are justly getting. >> thank you. >> thank you. >> any further questions on the director's report? or any of the other items that you may wish to address the director of? otherwise, oh, i did want to commend that, i think that the work on the homeless, injure work that you have continued to

carry out on the pier 80 and all, are beginning to be reflected in the public testimony that is coming out. the last thing that the work, just that was, was it yesterday or today? that was, just so important, showing we have medical services at fury and how important those are. and so, tha you very much. >> thank you. >> we are going to go to the next item, please. >> the next item is four and general public comment. and i have not received any requests, so he we should move back on to the report back from the public health committee from today and commissioner, and chairs that committee. >> okay, the commissioner? >> yes, and we, and on the xh itty, and the public health, and the committee we heard two reports and one on the accreditation project and i think that you heard from the director's report that on march 11th, dr. aragon pushed the button and submitted the documents for the public health accreditation, on board, this,

we saw a small portion of this document which is about 500 pages of about 50 of the sections, so this is about 1,000 or so pages electronic document and i just need to commend the team for the compiling of the data which was very broad scale across the public health department. the good news is that the expectation is by the end of this year, we will be accredited. there will be a mock survey, done by our own consultant. and in june and then, by october the expectation is the reviewers will come through, and we have asked that the full commission receive an interim report in july, after the mock, survey. but in terms of our subcommittee looking at the status of things, and there was a lot of optimism and there were, in our own sort of preliminary surveys no major gaps. and the documentation gaps that were there, have been filled. and i think that it is just a lot of optimism and a lot of

hard work and sweat that has gone to get us to this point and so it was an momentus moment and having pushed that button and now it is on the way and up to the board to start the process of review and then come back to us, and we mreef believe that t date was in october. so we will hear before that site visit and we can ask more questions from the full commission. >> the second item that we heard is the first of the behavior health reviews. we are now in a process of trying to review the health network revisions twice a year and so we heard the substance abuse today. and so with have about 7500 clients and the substance abuse treatment, and about 3800 of them are receiving methadone and 7500 are unduplicated and it does not include the people that go in and out of the can enter and the hot team, and so we have

asked for a drill down on what services that 7500, people actually received and what is the dollar amount for those services, and to begin to understand our substance abuse services in more detail. in the interim, the 1115 waiver has been approved by the state which guaranteed or which mandates an expansion of the substance abuse services for medical as part of a demonstrati demonstration. and this means that there will be, more requirement for about 75 percent of our substance use disorder patients who received, medical, under the expansion for enhanced services which have greater accountability, attached to them so the department will be looking at in more detail what services our cbos will be providing, these clients, receiving these new, 1115,

waiver moneys and are they receiving evidence pf based treatment and this will also help us, as they get the information from the cbos to then be more accountable us as a commission, about again, what are the 7500 people receiving, are they getting good out comes and how is the dollars can be spent. so we are going to give them 6 months to compile that and hopefully we will have more information on the report to the commission. so right now, we are just getting oriented and to be led with the 15 wave as the first step and so those are the two reports and if my fellow commissioners have anything to add, we will welcome that. >> yes, commissioner singer? >> do we have an idea, we have 7500 unduplicated substance abuse? >> i think what was brought out today is that the numbers are

not correct that we are calculating. and so, because we have people in different systems, that are also, substance abuse, clients, in our sobering center which is in another division, we want to do a little bit more guiding into the data, commissioner singer because i don't believe when i ran substance abuse, we were at 20,000 clients and so i just don't think that the data is right. >> that was the nature of my question, and so i will ask it and you will come back to it later, it is kind of two other pieces of data, and one is what is the need, so, how many people do we have in this city who could take advantage of those services? and the second question, is, and i think that this is a smaller number, than that. if we had more capacity, how many people would avail themselves of it and so trying to figure out, are we, and where are we in meeting a demand of

the population? >> and i think that we do really well in the methadone programs and we have on demand, and in the primary clinics the opiates i would say that the residential programming and the outpatient, programming but we can definitely look at the wait list that we have and the demand and we have a lot of work and i spoke to our cfo after the committee meeting today that we will need to get some of our analysts to really support our substance abuse side of the house, to see if we can get a better picture of the need. and also the cost. >> yeah, that would be great. and look forward to getting the data. i think that it is worth mentioning that actually getting precise numbers is not trivial on this. >> absolutely. >> yeah. >> thank you. >> thank you. >> so, commissioner i also had a

question about the demonstration waiver and it is titled drug medical and so i am trying to pdz, is this related to getting the medicine to them? because the discussion sounds like we are delivering the care in ted and so maybe the title is misnamed or, i don't think that i am understanding totally, and as the 1115, waiver and you could help me out, practice pz and the rest of us, and it is just that another way that we are able now,o use funding and why is it called drug medical? >> i am going to, and it is the way that medical, designates the services and the services and i am going to turn this over, to her and see if she can give you a lesson, and how those are divided. >> yeah. >> maybe i am the only one. >> it is in fact, the unfortunate way that medical refers to substance use, disorder coverage, it is called drug million dollaedical and to

comprehensive like we have for the mentally ill that we have. more coverage for the services that are not covered now, and a greater rigger in the provision of the services now that medical is covering them. >> okay, so in fact it is not related to how one obtains drugs, but the delivery of the services that are -- in the benefit. >> no, it is really about the coverage of the substance abuse disorder of treatment by medical. >> right. >> but i do think that it is reflection of how we have looked at and i worked for samsa and why it is so important to have the parity in the systems of care and san francisco leaps and bounds ahead of many other counties and even, states.

in really trying, and we really try to put some humanity into those programs to our harm reduction approach and accepting people because there is so much stigma, like we have seen in the mental health system and sometimes, even more, and in fact, the most recently, we passed proposition, 47, where the people with addiction were being arrested and put in jail. and so, i do think that this is an opportune time to main stream and also increase the medical services which have been care driven and really medicalized a lot of those services through the medical detox to our programs for opiates under the methadone. and so i do think that this is a great opportunity to be able to create some revenue, increase the accountability, of many of our providers, and also, improve their services to the clients.

and i think that some of the questions that the commissioners have asked for is really important and we need to really be right about our direction on this. and so we will be working and because this is 90 percent, almost, 95 percent, contracted out to cbos it is really working what those contractors to insure that they are meeting the compliance and training them and getting them and the helping them with the staffing that they are going to need to draw down, these new federal dollars. >> all right. just trying to close part of the loop of where you had indicated for example, in regards to that workforce that our former commissioner, and you were heading, and will this then be of help to that, so that we would therefore have access to facilities and therefore, not have to have those jails? >> yeah, i think that it will be another tool, it will not be that the entire solution. because remember when someone is in jail, they don't have

medical. and it is until they are able to get discharged that they will be aible to take advantage of those. which is another, policy i would like us to take on, is you know, the facts that the people in jail don't have medical, therefore, you know we are not able to really create a revenue source for many of them. and that is why in every city and county, the jail service is very different, depending on how much that county, can really support their jailed inmates. but it will be a tool and many of the clients can benefit from the services and that jail, committee i think, just to let you know, that we had that first meeting last weekend and i think that we started off very good and we have 40 members of it and lots of enthusiasm and i think that a very broad spectrum of representation and so the first meeting went really good, but this medical program, i know will be another tool to help us and improve those services for those meetings and jail and keeping the people out of jail. >> wonderful.

>> okay. thank you. if there are any other questions, we will move on. >> item six is a health commission election. >> yes. commissioners your preference and we had in the past deferred our elections until to hold the election into march. so that we could understand any of the, well, i should say, the appointment of commissioners because all of these got changed with the now, older charter. that allowed only a 90-day stay for those whos appointments expired and so we wanted to be sure that we could, have a commission that has known who the health commission members were before we elected officers. and so we put it to the second

meeting of march. and this near and coincided exactly with the end of the term. of commissioner taylor-mcghee. and in fact we didn't know that taylor-mcghee was going to or be staying on the commission and therefore eligible for an officer ship or not. and therefore, we have placed on to the agenda that we would entertain the idea of delaying the election until there are a few changing. and of course we don't have a name replacement either for commissioner taylor-mcghee. but, that does not necessarily negate, and so it is the desire of the commission where to hold the election or to postpone it for until the next meeting? and it would be your pleasure. we will have it at the next meeting if the commission so agrees, or if the commission wishes to move forward. so i guess that it would be best

to see if there is a motion to postpone the election until the next meeting? how do you feel that we should proceed. and if the commission wishes to proceed with the election, at this meeting and then we can proceed. >> okay, so the item is the election. and there are two officers opened for election, the president and the vice president. we will open the nominations for the presidency at this time. commissioner chung? >> i would like to nominate dr. chow to serve another term as our president of the commission. >> any other nominations? >> i will second that. that is the way that we do it. >> i don't know. >> yes, thank you, you are correct. if there are any other nominations, i move that the nomination be closed.

>> is there a second to that? all of those in favor? say aye? all of those opposed. we will take up the vote. >> all of those in favor? i did read that in the sunshine act, if it is unanimous or by numbers and i do that and so i thank you for your vote of confidence and i hope to be able to continue to be worthy of that in the coming year. nomination for the vice president is in order. commissioner chung? >> i nominate, commissioner singer, to serve another term as the vice president. >> and your reception to that? >> second. >> and i heard a second. okay, are there further

nominations. there are not further nominations and the motion for the nomination to be closed. >> i move that the nomination be closed. >> is there a second to that. >> second. >> all of those in favors of closing the nominations please say aye. >> aye. >> all of those opposed? >> the nominations are closed and the vote is on the motion to have commissioner singer serve as vice president for another term, all of those in favor of that, please say aye, all of those opposed. and are there any abstaining? >> if not, commissioner singer congratulations on a second term as vice president. >> thank you. >> that was a surprise. i didn't realize that was going to happen today, congratulations everyone. item 7, is a transgender health services evaluation up date.

>> thanks, who is presenting? # # # # # # good afternoon, i am the director of the transgender health service and this is dr. seth pardo our evaluator and we are here to give you an up date about the transgender health services and talk about our evaluation plan. some of you may remember that in november of 2012, the health commission made a historic decision and decided to cover surgery medically necessary

general, gender surgery for transagain ter people. this is something that did not exist in this way anywhere else in the u.s. and then, director garcia appointed evans to create a program. the only models is in european countries where there is socialized medicine, it did not exist, if the people wanted these, they had to pay out of pocket which meant that they are out of reach. in 2013, the department of managed healthcare, removed the discrimination exclusions that insures that medical will cover, gender related care. this is primarily for your reference, and this is transgender health services, the direction that we are headed. so we are under community

behavior health services. and in truth i just want to give you a shout out to joe robinson, because without joe, i think that we would not have nearly what we have, around transgender, sensitivity, and services in san francisco. so, i am the director and funded by the mental health service act. we currently have some vacant positions of a health worker three, and a social worker. for 17, 18, we have proposed positions for health worker and for another social worker. what we currently have is we have a peer care coordinator and we have the patient access navigator who is half time mhsa person and we are currently hiring two patient, navigators, that will be peer providers, to navigate the people through this

very complex system of care. this is again, for your reference. and this is the budget that we have moving forward. and i am going to jump to what i think is more interesting. to me, at least. so, in 2013, we started in august, and we got 78 referrals into this program. and we were able to provide, 7 surgeries in 2013. and in 2014, we had 148 referrals into the program, and provided 36 surgeries. 2015, 60 surgeries and 135 referrals, the referrals went down, because we put an hyadus on putting on the public out reach because we did not have the staff that we needed to at that point in time. so if you look at the whole they think, we have had 361 referrals

by the end of 2015, and we have provided 133 surgeries and you might notice that there is a discrepancy between the number of referrals and the surgeries what that has to do with is the people who want the access to genital care we have to refer them out of network. and there is a 9 month wait list and a three year, wait list for one of the other s. the surgeries that we are able to provide at this point in time in that work are hysterectomys and then an mascectomy, and the removals of the testes. and that all happens in network. what happens out of network are

vaginoplastys and the falo plasty and the creation of it is basically the lengthing of the clitoris and permitting people to stand to pee, and if you look at this, 32 out of network and 68 in network. and if i look at our list of people who are in the cue waiting to have access to care, over 55 percent of them, are waiting for out of network surgeries. our population, we are a public health population, and we have, we have transgender, and sexual and non-buyary people, who are staying the stigma on a daily basis, we have the people that were kicked out of homes and living in sro and people are homeless in neighborhoods that are unsafe and we have a lot of

people on disability and the people that are struggling with poverty, and the distress, and we know, already that there is already, healthcare, disparity, for gay and lesbian, and transgender people and people on public insurance, and the people who are socially isolated and people who are, in poverty for people of color, the people with behavior helialth issues and so our population, stigmaize, that interferes with the people being able to be set up for good outcomes.

they go through a number of checks, with the providers and with the administrative, staff, and across the department, to see what do they need in order to be ready to be referred to actual surgerie assuming all things go well and the documentation is submitted as necessary, they get a referral to the san francisco health plan, or their insurance provider to cover them for whatever surgery is being

petitioned. and they will go through the surgery authorization process and then at the bottom, 6:00 here on this graphic, they will get referred to a surgeon and all of this in the first 12 months and then they get a referral to have a con sult with a surgeon that could happen between the first year and as long as it could be as long as a year and a half. and then they have a schedule date for surgery, which can be as long as two, two and a half or three years later. now in this theory, if anyone goes well as planned and the patient is prepared for surgery and completes the surgery, they go through the cycle more than once, and they have to get an approval for each surgery, and then in theory, we are providing the providers in the san francisco health network to have care provisions for the patients and hopefully in theory this should lead to the success and

the increased quality of life and improve social, and decrease substance use and ultimately the creation of the best practices. for the purpose of the evaluation and information that i am going to share with you today. i am going to share with you phase one, the first phase is going to look at client outcomes. now, in quite a complex evaluation plan that i have that is really technical, these are the nuts and bolts of the most important parts of what is relevant vapt to what i am talking about today, there are activities that i will be going over and doing the interviews with the clients and provide the reports to the staff and clinical staff. and part of those outputs that i will be sharing are information about readiness, access, and spasht satisfaction in the out come and the quality of care. information that we can gather on quality of life changes. we would like to see improved

health, quality of life, restored trust in the public health system. >> so here is some of the sprefk indicators that i will be looking at as the evaluator for the services for the four basic areas that we are looking at with regard to the output, surgical readiness we hope to achieve a ten percent relative improvement in the patients who are ready for surgery. hopefully through the education program we should see relative to the year before, increase in those number of patients that say that they felt ready for surgery and i will show you the data that we have. timely access and the same thing, and relative ten percent and improvement based on the year before. patient satisfaction and we would like to maintain if not exceed the 80 percent bench mark, 80 percent of patients being satisfied and the quality of care and improvement in

quality of life at the indicators before you here is some of the data and i just started and today we have the interviews that were conducted between 6 and 12 months after a surgery was completed. it could have included, and with regard to the general regards of the readiness, 26 percent said that they felt, completely ready for surgery.

on average, over all, in the network services is the most of the tests services are picking about 25 weeks, from enrollment to their date of surgery, and about, 53 weeks for general

surgies and those these are on average and how they split, for those who enrolled, verses those who actually had a consult for surgery. for the patients satisfaction over all we had 3 quarters and more than half of the majority of patients who reported being completely satisfied with the surgery out come. they said well, that feels pretty low. there were additional 13 percent of people who reported mixed satisfaction. so they were satisfied, but, or happy with the services but -- they were okay with the out come but. so i didn't include those in the complete satisfaction indicators here. but know that the additional 30 percent of each of the out come and mixed additional satisfaction and among those who provided information regarding quality of life, a majority of them reported improvements.

for example, things like you know i never thought that i would have access to this, this totally changed my life, and i may have had complications but i have been waiting my whole life and this is the best thing that happened to me. even though they had serious complications. access to surgery and those who actually landed the consult with the surgeon and then you can see that there is a disparity and there was a difference. and the out of network, and verses those that happened in network and just taking way too long, for those that are seeking general surgeries, to access those services and just some of them i don't have the exact numbers right now, but working on that, and some of them are relapsing or having the housing issues or the other things that are getting in the way of being

stable enough to access services when in theory, having access would stabilize them. and so it could be a catch 22. and we are trying to assess that out. i separated this by year to show you that over time, as transgender health services gets a handle on how to provide the services and though they need the services. >> so these are the challenges or some of the challenges that we are confronting.

so our network does not have the capacity that it needs to have. we have surgeries happening in burliggame and when you think about a person who lives in an sro and on public health in the city getting to the follow up care this is not or does not work well. and they said that our need for genital surgeries is increasing. so the network capacity in the location of surgeries is a significant issue. many of the patients that we see have trauma issues. so they smoke. smoke is highly connected to trauma. more smoke, because it is a barrier to surgery and good outcomes. the same issue with obesity. we are in substance use. so those things we really need to address. people don't have a safe place

to recover in, so after care housing is a significant issue. after care fa some of these surgeries is, and it is somebody has an falo plasty for three months they are going to be recovering and need assistance for a vaginoplaty is less, the people have a dilation protocol, if you don't have a safe place to live you can't do that. if you are living in an sro with a shared bathroom you cannot do the after care you need in order to have a good out come. we talked about nutrition, and we had to get people food.

because people have to wait so long, we have to do again, a presurgery three months before surgery to see if the person is still stable and the health insurance requires that as well. we are working with san francisco general hospital to create a gynecology clinic, so that the post surgery people don't have to go to green bra. we are working with dr. hammer to do better medical and health coordination across dph and we started to do training for youth providers. because we do have young people who are in need of support around their gender identity. we are going to restart a lot of things that we began and then had to put down for a bit because we have way too much to do for the people we have right now. some things that are cool is we are going to have a residents. so much of what we do is very

heavy and intense and so doing something that gives people a chance to tell their stories. and we are doing, community ride education and we have to fix the data base that is where we are headed. i am the director, seth is our evaluator and dr. evan is here and candy is next to him. >> how do you close the gap between the wait time for innetwork and contract care. >> so they are a specialized

surgery. there are not tons of surgeons who do that and it is a struggle across the u.s. in new york they send people to philadelphia. we need to train people and it is my understanding that it is a provider issue. >> it is a huge provider issue. >> how do we envelope more surgeons. >> i can have row land come and respond to that.

roland is doing the business plan on that and looking at how many people do we have seeking the services. >> we knew that you would ask that question and it has been a pleasure to work with the group from the beginning in 2013. and to see where the program has come from and where it is going. so, as julie mentioned. we have already, worked with our colleagues at ucsf, and to actually put together, what will it take to begin to.

as we prepare to move into a new hospital we will have three additional operating rooms. and so it is also going to record, additional surgeons. >> thank you for the presentation, i just have a question because i don't know,

so i am asking. this data around satisfaction and timely access, quality of life. do we have national data to bench mark against? >> no, we are so far ahead, that we don't have it that is public health and international there is some data. >> it would be helpful as we gauge to have the highest standard, is that we can look at how we are doing with the public health groups >> it would be on the international level. >> well, i will say that, we have a unique poll you lags that is one of the first to be investigated at a public health level.

and one of the samples that have the data on the patient satisfaction or out come or the time to surgery are based on private clinic or university, clinics and so yes we have a unique population and that being said we do have a sister health department in boston, and new york that are tarting to engage in that kind of evaluation and we have the challenges with doing this, and namely that the public health record does not really track, gender identity for transpeople very well. if we don't know how many people we are talking about, it is hard to gauge some of these what is the constitution of the sample and how does it compare in san francisco. >> i appreciate the sensitive and how, you know, how unique