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

that is. but as we move forward to continue to look at that. >> that is the idea. >> and a lot of the people that we see will be screened out in the european countries. >> that is an interesting, fact as well. and so those kind of backgrounds are helpful as well. >> i can't help but add. >> and tell us who you are. >> dr. evan. mysterious one alluded to. >> he was in the newspaper. >> and the, and again, and our evaluation is in the very early stages, but the numbers that we have, actually are rather comparable, to international numbers, and that have looked at satisfaction and quality of life, and after these surgeries. those systems are quite different than ours. but, i actually have the expectation that our out comes are going to be equally as positive as what is achievable

with those other populations. and i think that the peer navigation model that we are working with, along with the specialized professional care model in the mental health end and the surgery end are going to result in satisfaction and quality out comes, that are come parable or actually exceed what we have seen in some of the european countries, just the speculation, but i want to say that is what we are aiming for. >> thank you. >> commissioner singer? >> thank you. for this. and i am going to take the discussion in a little bit different direction. and the spirit of it, is as follows. and i think that as the city, we are super proud of this program. and we are committed to it. and so, the way that my brain works is as you said, that we

have, more demand than we can meet for our services. and i always try and figure out, okay, how can we meet the demand? and so, the nature of my question is going to be trying to at least push our collective thinking forward on that. and so, i guess the first questions is what is the demand? like what, what is steady state for this in our population, do you think? >> we get approximately ten new referrals a month without doing out reach. we don't know how many transgender people there are enrolled in public health in san francisco. because of what seth said before about the electronic health records and i mean it is also just about stigma and who we think that there is 2500 people enrolled in public health. who identify as transgender sexual or no one conning. not all of those people want or

need surgery, only a subset, do. it is actually kind of hard to estimate what it is other than we are thinking, you know, those numbers 140, 130, to 140 referrals a year is probably accurate. and do you think that a steady state or do you think there is some die ma'am i can because of our forward thinking policies that there is, and if you will, pent up demand that will then be at different basel rate. >> i think that is very possible. but we have not seen it yet. we have not seen it start to decrease yet. >> so, i mean this is obviously an area that is with the resource to make sure that we are planning appropriately for the future. and so, the first question is, how much more does it cost us to do things out of network? than to do them in network?

>> i don't actually know the numbers on that. i don't know, if that is an roland question? >> we can, it does not look like we have it right at this, and so we can track that. i mean, i think you know, we face these choices of, and in languages not usually reserved for this field, do we build the capacity or buy the capacity and i think that these two things are really related and it is worth thinking through, which depending on your view of the basel, rate, if you will, you may decide to be more aggressive in buying capacity on the outside, because you have enough capacity inside when you get to that basel rate. or you might decide the exact opposite, which is gosh we are spending 75 percent more on the outside. we are never going to be at our basel capacity. so, it makes a lot of sense and

it is worth a lot of resources for us in the long term to build to capacity here in the short term. and you come to, one comes to very different answers depending on your views of what the cost is, and inside out and i would really encourage as part of your work, to think through those things. because you may and we may end up in a space where we are five years from now, and we are not in the kind of environment that we are in today in terms of the city's resources. and we need to begin to make choices about programs. and the idea of trying to look as far forward to get the programs so that the dollar is allocated to the program, serve the most clients, doing that early, i think super important. so i would encourage you to think about the physics of that just as much as the physics of

how well are we providing the service. which you are spending a lot of time thinking about it and it is wonderful work. but if you and we do both, then we will be in a much better place. >> absolutely. and one of the things that we thought about early on, is that you know, if you are in the stock ton where do you go in and so, creating a program at say, san francisco general, to be able to provide this to all of california, for a while los angeles was thinking that they would send the people up to us and there is not this capacity and so the general hospital could be a center of excellence that does something that serves people all over the state of california. there is a huge need. >> and it is certainly true that roland would rather have more out of network patients than to

send more of our clients out of our network. >> and that is so true and this is also, a relationship that we have to develop with what you see and because part of the issue this into start it with when we didn't have our own surgeons in the budget, we put in a surgeon in with training. and also, being able to identify certi surgeons that have this expertise and so it is something and you can get those surgeons just towards the beginning of every physical year, and so we have to work them and we work closely with the first surgeon, and trying to kind of figure out, do we have enough capacity and sue, made a very, big commitment to us that she really wanted to see this as a center of excellence that we will provide for more than just san francisco understanding that there are no other expertise in the general area. and i selected that business plan that you are identifying i

think and also the commissioners are looking at how can we kind of look at our evaluation to kind of help us with that in terms of coming up with a police plan that we see to identify how we can bring more of those in network and knowing that it may be more affordable to have it out of network. >> exactly, because you have the short term and then your steady state and you would rather take them and spend them on the other parts of the program. >> and so, the last thing that i want to make is i would not presuppose, what the answer is. until you get the actual some sense of what your team believes that the steady state demand is. and more rigger around what are the costs between the innetwork and out of network. >> i go back to the fact that when the program started the idea was to have a center of excellence as sf general, be

that with the uc faculty or our own. and so i would encourage that, with the elements that you are talking about, it is not merely the steady state in san francisco, but what is the potential demand that i think that they need to look at from the business standpoint in which then, we would do, like you were saying, potentially, we would be accepting cases, for a center of excellence, which will be really, extraordinary for this city.

>> the way that our budget increases it is not the steady state for the decade and it was the past decade that ought to be the planning assumption, so getting our act in order now on these things is going to enable us to be a much better provider, to many more patients. and clients, in the future. and if we don't, we are, you know, you end up in these pen itani pinches and we have seen them in the city government, where no one wants to do things but you have to because it is the reality of the financial picture. >> commissioner pating? >> yes, regarding the scene and i am actually worried in terms of adverse demands and when you

build an excellent program people are going to come. is it true that it is a benefit?

>> in all of the surgeries only 20 of them were healthy san

francisco, and early on, and in 2015, only 20 were healthy san francisco and the rest is the san francisco health plan. >> could you get closer to the microphone? >> i guess that my question is we are looking at access to, you know, the treatment, surgery, and follow up, and difficulties, and health concerns and etc., presented. but, i would like to, sort of find out if, if the, if the

health providers themselves, if in fact if there is any movement to certification, pertaining to this pathway, based on patient need demand and etc. etc. you mentioned that, some people go and some of the doctors there are stanford and some are ucsf and you can go he to philadelphia, and other programs medical schools, and maybe that have the different pathways, involved. and but i don't know. i have not looked at and yet there is a movement towards, board certification, within the department of surgery, so this will be an especially in the future. would it involve obgyn and etc. etc. it takes time. that is why sort of get, i don't want to get confused, but i get

frustrated when the people make a statement surrounding statements about we are going to have a center of excellence and it is going to happen like this. centers of excellence don't happen like that. unless we have providers who are board certificated, for these unique challenges or you have an integrated program, with a multitude of disciplines and this is ongoing and it is ongoing and ongoing. and so, all that i am thinking about is you know, we have really made a unique step forward in saying this is, our population here in san francisco, and we are addressing this as best as we can. but we have limitations. and in order to do this, we are going to have to have, you know, some interaction and dialogue, and some leadership, within these medical boards and the department of surgeries and the surgeons, and you name it and it takes time and they have specific, training programs and they have, you know, what we

talk about accreditation and visitation and etc., and the board certification and follow up and all of these things are part of the pathway and until we see some collective movement, i mean, uc has five medical schools, you know, the la program is great, and our program is great, and there are other, and you know, chapel hill and etc. and there are a number of programs and it seems to me that, the battle to be fought within our department of public health. or our affiliation with one campus or one, you know, one, or what we also need a national dialogue, with those who really have the professional expertise in order to say, you know, we want to bring this before the board and we want to have it approved and go through a trust file and we want to make sure that we have the special ways to address this in the future. and i think that that would really be a major contribution, and i can't think of any place in the nation that perhaps, some

of that dialogue could not start right here because you have stanford and ucsf and you have the collar ration, and you know, as we have the links going through, the others and we have excellent programs. but, that is another area i think that could help us you know, as a health department and as we have shown that here is the unique need and we want to address us in a comprehensive and confident way with the most qualified providers. and hopefully that will get the movement and dialogue in the future, does that make sense? >> yeah. some of them are gynecology. and if you are doing faloplasty you need to have an neuro surgeon and, this is complicated and there is no training, there is no place, there is no place that does this.

there are well, in character there is a cadaver lab that is about to happen to train the people how to do these surgeries. it is sort of piece meal. i also am a part of the world organization and part of what we have taken on recently is certifying people and we are developing the programs f for, therapists and we are at the beginning of creating it, to certificate people because we need competent people. because there are people who are just starting to do because they see that there is money in it and they are not properly trained. >> i like it, that is helpful. >> just briefly, that there are a handful of medical schools and university of miami is one of them that have started looking at certain, training programs for obgyn programs, for example or other kinds of surgical residents that are coming

through. and a lot of interest in the medical community to take a hard look at how we incorporate this kind of education into our curriculum. >> to lead to a national certification through surgery or whatever discipline it is from. that gives them a validation to the effort. which i think enhances the quality of our programs that have been started here. >> and dr., thank you for those comments, because when we first started this, and it was the transgender, law center, and it really took this on, around the benefit issue. and we could have not and we not be able to continue the level of need if we had, if they had not, fought for the rights of the benefits for transgender people, and so like i do think that we are in relationship with them in terms of the work that they are doing. and so i really want to acknowledge the staff that i know, and one of the things that we wanted to do, and this was the assignment to barry was to really bring and because we had the transgender tuesday for 20

years. but tom health center when i started we had started that. but it was not very organized. but we had pieces all over the system. and so, bringing it altogether and making sure that we provide comprehensive services and remember that the transgender individual if they did not have dollars, there was no way for a surgery to happen. it is a very large spectrum of what the people would like to do

in their lives. i want to acknowledge your work and i think that we are doing fantastic work for our community members and i get a lot of pressure about how fast we are not going. so that helps me also, to help to keep focused and to make sure that the staff is focused. and we have a lot of eyes on us in terms of our community wanting to make sure that we do the right thing >> i think that it is exceptional finding in the fact that we are able to respond and this is where we go. i am thinking, you know, hey, changes takes a long time.

those that it work, regarding certification and follow up and it is going to take the time and so what we are saying is it was started here and we have the excellent, and you know that is great. but i was, thinking of the long haul because it is going to take, you know, everybody together to institute and then to sustain it. and it takes a long time. >> and you, and along with some of the other commissioners have really given us some really important direction in terms of that, particularly to as to what the business plan, considering that we have the ability to do this right now. and we have to be smart, and so we take that direction and we will do a lot more work on this to make sure that we take those into consideration, but i do want to thank the staff and barry for the leadership

>> to provide the necessary support, you know, that our clients need. and the question, the first question, that i have is, so what type of like, insurance that we take in right now, other than the uninsured?

what we need to be, to become the providers of choice, because like for those specific patients, they actually do have the choice. they can just access some of these certify gons. and if they can take medical themselves they can access them, if they have medicare it is a similar situation. they might have to go through, you know, like the irp process. but, it is still, possible for them, you know, to like, access

that without, you know, going through our system; is that correct? ? >> so, if the people have the san francisco health plan, they have to go through our system. are you coming here? >> medicare and medical, and so for the medical and medicare patients, if they do not have the san francisco health plan, they are stuck. >> so their question becomes, you know, if they have medical or medicare, what makes them decide to have the san francisco health plan. verses going to another health center or clinic? >> actually the san francisco, health has been wonderful. they have, they have provided that, and pardon? >> they have provided access, to procedures that other medicals don't cover. because they recognize that the people need to have these procedures, and that are medically necessary. and so i think that is a big piece of this.

and there are folks that, and so for instance, they will cover the people with medicare, and anthem is not doing that. the same thing with facial electron sis, and the facial hair removal, people can get that through the san francisco health plan. medical does not cover that generally. so the san francisco health plan, covers things that medical does not reimburse them for. because it is medically necessary. and it is ultimately reduces costs in the long run because it decreases people's gender dysphoria. >> and i wanted to bring that up because that is the standard that now that the california correctional, you know, like the facilities are using, that they have to provide the electron sis, like before, you know, they would provide, the reassignment surgeries to know, you to the, inmates and so are we doing something right and that is what i am trying to, and that is like, the go around in the

circles to get to that point. and i think that is also, really important, to really recognize something that i think most people would take for granted is that we talk about genital surgery it is not just the surgeries that you stitch something together. you know there is the aesthetics of it and that is the functionality of it. and the community, of a very educated you know. like in the abilities of the different surgeons. and you know, but, they really want or see themselves to have, and i think that is the other piece of the conversation that needs to be incorporate into this. and so it is not just one surgeon, it is what is available out there. and also, the other thing i think to this, is if it is great to be measuring the quality of life, for me. personally, you know, i know how my life changed, you know, after

my surgery. and how i took better care of my own health. and --. >> we are looking at preand post surgery comparisons. and i believe that because we are so advanced and you know, pretty soon, we are going to have other, gender, information, surgeries that we, that we will

be looking into covering. and are we, ready, you know, like for, to make those available? i am not even going to name the surgeries. >> so it is coming, it is. >> and thank you, for it, and the facial is coming and because that is important, and it is a big piece of what happens around the safety, you know that the people are assaulted and harassed and harmed because they are perceived to be an again ter other than they are, and so it

matters. and we are going to figure out how to make that work for folks. >> so -- yeah. >> and it is not just about, rearranging the face. and thank you for doing all of the work that you do. and so how can the commission help to support this to, like, continue to let it grow and develop into --. >> i think that you have asked us some really important questions, tonight. and so, that is, i think, really, informative for us, and for some of the direction to really think about the business plan. and particularly as we see, we have a window of opportunity, to really think about this. and also, to really get the evaluation to maybe, embrace some of this data that we will need. in terms of determining what the is it more affordable to bring in health surgeries.

or is it more costly, to have them out of the network? and i think that is a big question that we have to answer, and that is something that has, some difficulty because of the issue of one, just being able to give the data on the transgender individuals in our system, and looking at the pent up demand as we move forward with the managing that pent up demand. and so i think that, and what you have done tonight and in this discussion, i think that it is helpful for us for the network development and also, i think that they have dealt, very clearly, some of the needs and continual needs that they have, and one being a location, and which i am trying to work on, because you know, they really need to have a focused area in the hospital, area, because that is where many of patients are, and so we are making sure, that they will be part of the whole move that we have in the hospital, so, he has his eyes on that as well. >> so director, within that framework, that i think that you have described, well, the

discussion that has occurred today, where, or would we then have the next opportunity to look at this? i mean that this is, and of course an important program but a very small part of the over all budget. >> and it often does not come. but as a topic, and certainly, as a potential, center of excellence, and for our community, it is a very important topic. and so, what would you suggest? >> at the minimum on the annual basis, i think that we should bring this forward, between now and in a year from now, if there is something important as an example we can come up with some projected business plan, with uc, to think about for next year's budget. >> yes. >> that not the one coming but the one after. i think that will be a very important time for us to come forward and so i would say, probably you know, december of next, and less than nine months so that we can have a little time to figure out how, the next >> and it might be within the

presentation of the coming budget, next year. that this could be also, called out to say that this is where we are at this point. >> i think that it will be fair. >> okay. >> was there any public. >> i have not received any public comment requests for this item. >> i don't know, and sthurly. i was just going to say if the commissioners had questions. >> it is sort of along the lines of what the commissioner, singer talked about. one of the questions is how do you incentivize, providers to do this work and to provide more care, where do you get them since you have a lack of pro-he vieders, how do you get them coming in? obviously there is a need. how do you ensentivize them to do that snchlt >> that is a complicated question. so, one of the surgeons that we work with is actively training people, he is actively training other surgeons, because the needs is so great and that is a big piece of what we need, is that we need the people who recognize the need, and want to

specialize in this. it is a very small number of, i can count the surgeons that do the faloplasty on one hand in this country. it is a very small number of providers. and we are really lucky that we have one of them. there needs to be training in medical schools. >> i think that it is a complicated question because it is not only incentivizing providers and surgeons, to be interested in this field, but, to be interested in this field in the public sector, we have found is really, something that is i think there is, and i think that the people are out there and i think that they want to do this. and it is fascinating work, and the people want to be, on the cutting edge of it. i think that is saying, this is great work, and we want to you do it in this highly diverse,

setting in a setting where the people have many challenges. this is, this is, where we are really in the cheerleading mode. and saying, you know, i can't think of anything that i would rather do. but, how do i express that to colleagues? how do i express that to others? >> so, it is, and it really is, and it is explaining as i do when i am talking to primary care providers, this type of work is the most fun that i have all in my week. i do a lot of fun things. some people don't necessarily look at it that way. but this is something that is truly fulfilling and sas identifying, and though this is going to, really, be something that is fulfilling. and that is, the message that we

have got to get out there and to be aible to recruit and retain the new staff who need to be here to do that. >> thank you. >> i would also love to add that with every year that goes by, with, the enhanced visibility and love, that we provide, to the younger generation of transyouth, that they have an opportunity to grow up and access resources that generations before them, just did not think that they could ever access. because of such stigma and discrimination and as we support the next generation of transyouth, i can already share that there are a number of my peers that are going into medical school for the purpose of being the next primary care provider or to be the next surgeon who will take care of their community. and so it is a wonderful thing to witness. and i think that, i don't think that it is unreasonable to suggest in the next decade to the next generation, we will see the transyouth of today becoming the providers of tomorrow. >> thank you.

>> so thank the presenters for bringing forecast the work that you are all doing. we are pleased with where you are going. i think that you have heard of where the commission and the department is interested in the future with you all. and we will look forward to that report. so, if there are no further questions, we move on, with our request for presenters. >> thank you. >> item 8, is the zuckerberg san francisco, general rebuild up date. >> building, 25. >> that is the new building.

>> so -- are you following a

different set? >> we had updated the, okay. >> the first, slide, to, and there was a typo and so we corrected that. and but i am not sure why -- they are not showing up. >> i am happy to go ahead and you all have the document? >> yeah. >> and i think just for the billing and there it goes. >> it is broken down by going from top to bottom, and we hit those.

in order to launch the survey on february 22nd, and we have the deliverables for operating safe, patient care and those, facility construction, related issues are going to take us out into about, may 15th. and may, 13th. and to make this in the processing is the right size and it it is installing all of the appropriate, way of signage and so there is a list of about 45 items and we are working through those. and the next chunk of the 5 lines, relate to it tracks. and all of those are on, on track, except for slightly over on to facilities. and that is related to our real time location services. and our arrow scout, implementation. and i have been assured by bill kim that we will make-up lost

time, and be fine with that. implementation. >> let me go back one second to orient those who are not in the j. cc and because i know that the commissioner singer chow and sanchez are familiar with this document. the gray bottom line, is our base line and our green line is current status. and so, we it is at a glance you should feel really good that we are, we are on time, and on target, for a may, 21 move in. the next item is hr staffing. and we added 119 positions to building, 25, operations and those have been hired for. and the work flow design and validation is, and it is on track, the workplace organization on track, and i am going to say more, in a moment, about orientation training, licensing and our patient moves.

>> so, our more detail around the elements that keep us on track for a may, 21 move in, includes the board of pharmacy survey, which we had last week. and we had a successful, board of pharmacy, survey. the licensing validation is going to, and we requested for the week of may, second, and we anticipate, our california, department of public health, license to be issued, by may 6th. and several weeks before our move in and our actual, patient move, and some of the activities related to that include, the move orientation. and where all of our staff, who are part of that, particularly leadership capacities, gathering on march 30th. and we will have a mock move simulation on april, 9th to test out our flows. and to test out elements like, when we take a patient over, and

in a bed, and the move date is may, 21 and we are going to participate in the activities around the census reduction and so making sure that any patient that is lower, level that we can find appropriate placement for them. and any elective surgeries that will be, anticipated to stay after surgery, we would not

schedule those, and those are referred to as a come and stay, and any type of an he cannive or a schedule, and i should say a schedule c-section or a schedule labor, induction and we will not schedule those during the time and so those are the activities during the census reduction week. >> tomorrow is going to be our first full day in the life activity and this is where the department interact with each other, to similar you late a patient experience.

and so a patient, coming into the emergency department, needing to go to the operating room, and then, being taken to critical care. and so those are the flows that we are going to practice tomorrow. and then, again on april, 20th. and so we did a lot of preparation to have as the successful of a licensing sur fa that we had, and we did a truncated day in the life in early, february and then we, did have a mock, survey, where our consultants and fdi, acted just as if they were cdph, survey ors and prepared us for, the actual licensing week of february, 22nd. and you all heard this already. i am just going to briefly say that, we had two findings, one was the failure of not having the board of pharmacy come out and that has been taken care of. and we anticipate, our license from the board of pharmacy, by march 28th. and then this issue of having, 30 days of water, quality

control, data for our dialysis, machine. and we anticipate that being taken care of by the end of april. >> so, that is the current state of our new acute care and trauma center. i am super excited that we are on track and i am happy to field any questions. mark is here to go over the construction budget, really? >> this is complexity on complexity on complexity and so congratulations. >> it was just commenting that

we don't clap very much at health commissioners and i wanted to clap for the last presentation, thank you. >> thank you. >> and i mid ask, why, you need 216, infusion, pumps don't we already have them. >> so this was actually, interesting, and i should say more about this. there were two items that the pharmacist survey ors from the california department of public health observed, in addition to the lack of a stocked medication, because we didn't have the pharmacy, license yet. and we can't have the crash carts in two places taking care of the population and so we have to double up and so that was a good catch that she shed the light on and the second issue is that we have the different types of pumps in building, 25 than we currently have and they operate on a wireless system and so, she is requiring us to have those

installed, and tested, and ready and waiting for the patients and so that, again was a really good, catch and we are working on that. >> we have the pumps and we need to install them. is that what it is. >> so we are getting nem from baxteare, and that has been a miracle that they are delivering them and we are going to have them, soon. and that is going to allow us time for implementation and then testing because they are on the wireless platform. thank you. >> you want to proceed, with the you are going to do the --. >> no i want mark to come up. >> right here. >> so the budget is pretty straight forward and there are about, 24 million dollars that are still being held back and mostly payments for the general contractor. but we really then, have been very lucky to hold this program, so precisely to the budget, and

i think that that is just the tribute to the terri, and the ron and the everyone on the team that really have focus on this program. >> andp there were four where we planned on five and we cut that back and so any of the savings that come from the reduction of the sale, will be put back into the program, there is also about, 12 million, and 12.2, million in interest, earnings that we have to go to the board. and to apply against the project. and any questions? >> mark it would be good to talk about the final process that we are going to for the closure. of all of it, and for you the contractor. and what happened. there is a final negotiation. >> ofttimes, on some of the larger and particularly on the

larger projects, you get into, the situation where the subcontractors usually that are under the general contractor, see this as the last chance to sort of ask for money, whether they deserve it or not, or if there is a merit around it, this happens on just about every project, and dr. chow remembered the soar project and we had a similar situation, where the subcontractor because the building was occupied, and thought that they were owed more money than we thought. and so we kind of go through that negotiation. and barber is right, we still need to go through that. and we anticipate, that probably there will be, some subs asking for additional money. that most of the larger projects tend to do that and we tend to go through that process, over the next two or three months.

>> probably one or two more just to close this out. >> i think that probably close to the opening. of the move and so that we can give you an up date on how well we are doing. and i think that probably, we have to go to may. i would probably say that we might want to do the first week and the second week of may. and to be able to really get crisp in terms of where we are. and then the post review. and as we did with laguna and we looked at the beginning and the post process of what happened, as the move happens and how well we are settling into the new building. >> yeah. and any, and i think that it would be good that we were able to say with confidence that as this shows that we are not only, well within the budget, we are delivering the essentially, what was promised. >> absolutely.

>> thank you. >> further questions from the commission on the presentation? was there any public comment? >> i have not received the requests for that item. >> okay. so, if not, then we can go on to the next item. >> the next item is the 2016, public health and safety bond up date and i am locating it. >> mark is going to present also. >> all right. >> thank you. >> so, this is the report that was done earlier on march first, to the budget and finance committee. and that would be appropriate to bring it to the full commission. keep in mind, that over the last two years, bar bra, and greg and i have seen the scope and the budget v this thing, change five different times starting out in 2014, at 535 million. and covering about, 7 buildings, and some additional buildings on

campus, and then getting cut back by 100 million, and going all the way down to zero. and we were told that we were not going to get anything. and then, becoming the bond that it is today, and at 350 million dollars, shared. between the fire department and hsa. and with the budgets that you see here, and the 222, and that barber mentioned earlier for building, five and existing hospital and the 50 million for the clinics and that split, between the south east, for 30 million and then 20, for a number of clinics from the system. and then, you will see the 58, for the fire. and 20 for the hsa. these are some of the things that we will be able to achieve with the money that we are going to be doing the selective seismic improvements and the hospital and consolidating some of the urgent care severings out of the building, 8090, and increasing the dialysis from 13,

and the chairs and relocating out of the building 100 and moving the public, lab that is above us, and out of this building. and to the building five and so it is a safer building. and also, a lot of the improvements that we will be making on the seismic side meet the requirements for the ucsf, region policy. here is our schedule which is aggressive and we took advantage of something ha we started back in 2008 was to get the prebond, fund and then when that first sale will happen, those proceeds will then pay for the money that were up front and so we have got about 12 million dollars. and we have been working on a lot of the design and programming now. and that is why we are able to get in the construction and the seismic work so quickly. and 2017. i talked to logan about the health centers and the south east and it will be, and doing

two things, there. and one renovating the existing facility and the patient, flow, and making it work well, and better, and locations, and more privacy, and also, it will be adding, to the south, and on the city property, a new approximately, 20,000, square foot facility to bring in the mental health service component which is something that the director garcia has been focused on, mirroring the primary care, and the substance abuse, and the k dentistry and etc. here is just a map of the ten basic clinics throughout the city. and then, here and here is their schedule, and a little bit later, starting, and then, ending, wrapping up, between 2019, and 2020. this is just for your information, and this is the fire component, and the ambulance, appointment, and which is the 44 million, and there is some fistations

throughout the city, and the homeless service sites to get 20 million to do into the bond. and then here their schedule and so the next steps, we have been through the bond committee that prepares what the voters get, and the february, 29th. we are going through the ballot arguments right now, and so the mayor will be doing them and several commissioners will be doing them, and the fire chief, and they will be happening between the 17th, through the 22nd and we have got one, official endorsement and so far from the san francisco chamber board, and directors voted to approve the bond. and on saturday, director garcia and i in the campaign, staff went through harvey, mill, and alex, and the central democratic committee and that will be happening every saturday between now and the end of may. and we only have 84 days between now and june 7th. and so there is a lot to do.

out there, and on the campaign trail. >> questions? >> all right. >> questions? >> on the bond issues? >> i guess that part of the question, might be that in different areas or different organizations, or even, different communities, we are not even going to say too much except for the south east it sounds like. what could we say about the health centers? because they do carry, you know, ai fairly good geographic area, and so some of them are within, certain districts like either, so is there any idea, that or what, what are we going to be able to help inform the public? i would think that one of the things that told the extremely high was both the seismic and they did the polling and as well as, doing improvements city wide

through the clinics. and when we originally started the bond, program, we did not have that component and so i think that having this component, into the bond is actually going to help us, and i think that some of the things that we will probably do, is we will probably suppliment the castro, mission project and we have had the additional fund money to do that project right. and to look at the second floor, and to make sure that we are doing sort of the whole, family at risk, individuals, and family, and being able to treat them with that integrated care, that the director garcia wants and also we will revisit, the maxine hall and suppliment that project and probably look, possibly to the west side or even into the china town, at those clinics and we are actually studying that right now, we had a meeting last week, to look at all of those ten clinics to see where the money and the funding would make best

sense. >> yeah, because it would be nice to be able to, inform people that you know, let's just say that china town, we are going to do seismic here and over there. and not that, you could do it for, everybody, and some of the clinics already have had their up grades as you have pointed out. >> correct. >> and it would be nice to be aible to then, bring it back down to the people, if we are able to get some of the further information. without getting real specific. but, saying that this is our intent and it goes out to, 2021, any way. >> but, that these will be, you know, it is like the library ponds, right? >> exactly. >> one of the constraints that we had, commissioner chow is that we could not, because of the 20 million was added so late in the process, like 2 weeks before we went to the board on february, 23rd. and in order to put projects on the ballot, with he have to have clearance and the clearance from

the city planning and we were able to do that on building five and 8090. and south east. because we started so early, and when they added the 20 million for the clinics, program wide, we could not mention, specifics. otherwise we could not put them into the bond and so, that would now be a con trant that we had. >> thank you. >> questions? >> dr. chow, we have done a lot of, and we have done a lot of planning around our capital needs, for our clinics. and so, we have a list who we have already been working on many of those. so, we can prioritize, the clinics pretty well in terms of what clinic comes up next and what kind of areas. so we can't do that directly but yet, but we will. >> thank you. >> commissioner pating? >> first i have no comments on the safety bond, very much in support of the initiative. and just very happy that we have this leeway in our, and i g he

is in our over all that we can propose a bond like this. and so thank you, for forwarding this. >> my question is actually to director garcia. assuming on are if this bond were to pass, and there would be money to improve the clinics, would there be the opportunity for the commission to review the plans. for improvements for the clinics and are those already have been i guess preestablished or preread in. >> there is no magic to it, it is just the process of what we have done before and with we are going. and so, examples could be elevators. and to familiar that they are counseling rooms and the flow is different now in terms of looking at tbased services. and so those are the things that the primary care also is prioritizing and so we go from, the way to redo it, and that the user of the facility, really helps to drive the direction

that we are going >> and the improvements that improve the patient, satisfaction and over all wellness and welcoming of our clinics. >> and our primary care providers have all of that in the process, and so we have to think about and help to transform to the clinics for sure. >> we will add an extra zero to that. >> i wish that i could. >> we don't have the machines in the back there. >> but, also. keep in mind that you were in the ten year capitol plan, we are also back in six years, and in 2022. and with an additional amount, for the clinics, and so there is another, bite out of the apple. down the road a little bit.

>> and that is how we have done most of our clinic operations, prior to bonds, it is really, trying to look at incremental support. for our clinics in terms of all of those things that you have talked about that will make us competitive in the future. but, it is just a limited amount and so we have to prioritize, the sieismic safety and move frm there. >> i think that we did heard that you said that there is the issue of safety and flow that will be one of the priorities for clinic, upgrading. >> is that right? >> yes. >> is there any public comment? >> i have not received any requests for public comment for this item. >> okay. >> if not, then, thank you for the presentation. >> thank you. >> and we will look forward to more information. >> we will move on to other business.

item ten. >> commission? there would be the opportunity to bring up other topics. and again, probably noting that we are going to have our planning session the second meeting of april. >> yes. >> so. >> 2 to 6:00 p.m. and all of you have given that okay for your calendar. >> right. >> thank you. >> does anyone wish to add anything to other business right now? >> if not, with he will move on to the next sit em. >> 11, is a joint, conference, committee report, back and we are looking at the march, 2016, lhh jcc meeting. >> reporting on the joint commission, i think that the conference committee, we discussed the report, and the health at home report, and a very important review of the general acute care hospital,

licensing survey, up date and regarding that item, i would like to say that we were very satisfied that the staff, appears quite ready for the general election and the survey which is coming on up and it should be in the next three months and anticipating the survey and they have been running the mock surveys already. and assured me that they feel prepared. >> we also looked at hospital wide policies, and some standardized protocols for the assessment and the management of the acute patients. and the privileges. and so that is what we covered and then there was a closed session afterwards. >> okay. >> anyone want to add further comments to it? or ask the questions? >> if not, we can proceed to the next item. >> item 12 is the community, setting and you have already gone over that. and but, we are happy to hear more. >> right, and i think that we added more today. and so, great.

>> great. so you are there there for the adjournment. >> we are prepared for adjournment and the motion is in order. >> motion, and yeah. >> and the motion and second have left hand heard, all in favor, please say aye. >> all opposed. >> this meeting is now adjourned. thank you. >> and quiet counsel

all right i want to go ahead and call the meeting excuse me. hello human resources that works really well, i'll to call to order the as a matter of law ms. bloomer

director brinkman director borden director heinecke director ramos directors please be advised director nolan and cristina rubke will be convictions devices. any person responsible for disruption may be asked to leave the room. cell phones set on vibrate can cause interference with the microphones, we respectfully ask they be turned off. item 4 approval of the minutes from the march one regular meeting. >> do i have a motion to approve second >> all in favor, say i. >> i. >> minutes pass communications i see we have supervisor avalos here ask him to come forward. >> thank you directors having me here on short notice

most first of all, thank you for are we looking at the auto return contract and the administration fee for towing that's a huge change to make is it easier for working families in san francisco we all make mistakes and making a mistakes for a person barley on being able to pay for rent and food and towing that sets them back forever maybe have to leave san francisco thank you for are we looking at that and you don't know i don't think we gave you much choice so thank you i think we need to look at revenue and reimbursement reinforcement i know metering is controversial looks at at our transit goals of being a transit first aide we don't provide that

subsidize on sunldz i don't know why that day is important but 21st century we should be doing with constraints on the foundz for transit leaking overall parking maybe night or sunday parking will be something would be worth studying for the mta that is only for reinforce i want to get funding for mta through the sustainability fee last friday was my birthday i got for my birthday present a veto of an increase to the fee and think that was poor planning on behalf of the city that we wouldn't look at how we can make developers who developments have a huge back impact on the transportation pay a little bit more not socking to 9 taxpayers

or the riders with the analysis of transportation sustainability fee we can increase the fee on large commercial buildings by $4 those projects will be flaebl we raised it $2 and not taking away when it was rejected by the mayor's office a new version asking for a new version of tsf for funds from the tsf for operations at some level of operation i believe the mta needs nor flexibility the budget to handle operation needs the capital is spur important to be able to have revenue to make investments in we have 2030 process we're 20 or $30 million short of covering

deferred makes sense be that as it may we have operational needs with the sustainability fee that helps when last minute decided with made on the budget for the mta i want to make sure you have the flexibility we want to reopen this is a heads-up i was intending to do and most of all when we make the decisions we can be responsible coming up with ways to help you find resolutions to the abrupt issues as they come up thank you. >> thank you very much supervisor and happy belated birthday thank you for your continued support. >> madam chair please be advised no decision of the anticipated litigation in closed session today item 6 introduction or unfinished business but with board members. >> director's report.

>> good afternoon madam chair and members and members of the public and staff a number of items to touch on today and first and most tragically i guess i'll say we're off to a bad start this year in terms of safety on the streets streets of san francisco sadly a gentleman was hit and killed imply a hit and run driver by the broadway tunnel a at the intersection of broadway and powell on the same day something hit on sunset boulevard i believe there was two additional hit and run incidents on saturday we stale obviously those are fresh and not a lot of information about those but as with ever serious and fate

collision in their tragic and preventable your thoughts and prayers and condolences to the friends and families of those who have been involved with this i guess i'll say this underscores of work we're doing at your doing on the board and across the city with the coalition and the impervious of marking our streets safer as supervisor avalos said maybe folks shouldn't get can charged a hefty fee for charges of the subject to be sorrowful hurt or killed by somebody making a mistake in our streets so as you know, we've been working hard and committed to 24 high priority projects in this

months got thirty done with the 2015 with another $13 million no 2016 by the end of this year we've improved hundreds of the highest needs intersection with the high visibility and crosswalks and red zones at broadway. >> powell there is a project you've previously approved that is set to start construction this summer that improves the intersection that greatly and will help with - we will be going out potentially as soon as this week and putting in interim improvements that could come back to you by retroactively approval that might make that intersection safer we might do that i want to give you a heads

up we'll continue to redesign the streets but, of course not about design it is there behavioral issues that play here we'll continue to work on education, supporting the police department and enforcement and really need everyone the city to be careful and mindful and to slow down and pay attention we have i don't know what the number is right now this year but more people that have been killed in the first 2 1/2 months than at that point the last few years this is not where we want to be in terms of vision zero we were named by the vision zero network as one of the 10 focused cities we'll be cooperating and sharing best practices and anything from the cities but i just it is a sobering reminder that there is work we need to do i think you'll see things on the

agenda that are reflective of that work but a long road ahead to get to that zero and sadly we're not on the path for that today. >> on to some better news were with regard to ceqa the california environmental quality act i know you know this just to refresh when sp 743 was passed by the state senator senate a couple of years ago for criteria for the significance of transportation impacts and sufficiently they require the career is with the green house gas emissions and the development of multiple transportation and diversity that land you know the old measure sometimes drove us the option direction the great news

a couple of weeks the planning commission unanimously implemented the standards for, thank you to the vice chair for speaking in support as were a number of folks that understand the matt haney of this in terms of making the transportation system better and safer so with that, decision we became the first city in california to adopt the levels of serves as a measure that is congestion will be replaced by vehicle miles traveled as the threshold for ceqa viral determinations going forward the old standards essentially protective of the car and don't think the transportation system suggests as remedies like wildly the streets things we can't do in san francisco wanted to do in san francisco but this modernized approach will be a better way for us and the urban design that public to evaluate the impacts of transportation

projects and building development projects that allows us to better get to solutions efficiently get to solutions that prioritized walking and parking and thank you to the planning department for that achievement wanted to also let you know that walk to workday it is thursday april 7th at participation takes on this 15 minutes of walking at the beginning or end of the bike transcript or car trip i think we can do more than 15 minutes of walking folks leaving from different places around the city i urge you to meet you up with the city supervisors and others as folks make their walk to city hall that is a critical part of i guess an important mode of transportation the city that is

the cleanest and one that ever trip begins and ends with and the more we promote and make our streets safer and the better for our residents and better for our city so look forward to seeing everyone on april 6th for walk to work and the season starts april 10th the mission run for typical from april to november generally one a month sfmta is proud to be city the main aide sponsor of this program and looking forward to engaging with the naked that the event will come to in this event to kickoff the season in april a number of staff working will be there to share the projects and update to promote biking and walking and transit hope for a sunny day on

april 10th a couple of other quick things the work in the sunset tunnel continues this past week was off because st. patrick's day there are 3 scopes of work did replacement of the rails themselves and overhead wires by the emergency communication system and the new radio system so we've got two more we understand shutdowns we'll need more in april this is not necessarily a exist stuff not like new buses e.r. red transit lanes but critically important for the safety work we need to do so we apologize in advance for the invention and they have done well, we have a few more ahead and get the work done

i wanted to give you an update on the 7 hate project that was nearly a year ago in june of last year you approved a variety of parking and changes on laguna to improve pedestrian safety and the liability lower hate portion of the corridor is under construction as part of a public works repaving contract and the construction it expected to last to another 12 to 18 months the upper hate construction ♪ 2017 we're working with the stakeholder the area ta to accommodate the festivals the efforts in the hate over the summer this project i think as you may know the lower hate reverberation was delayed because of contractor that was the reason for the motor coach

as opposed to a other coach but we'll continue to work with the public works to expedite in a way they can to get the projects done and restore the service and get the benefit the transit and pedestrian safety benefits when you approved this item in june you asked for the support back on the progress made to fund the pedestrian scale lighting as part of the upper hate as you may know jeopardy support for the project one thing people didn't like it didn't include the pedestrian scale lighting the funding sources we have are transportation funds generally are not appropriate for non-transportation purposes but we have been working with public works additional public utilities commission staff as well as the district 5 presidents office to get other

is sources for the 3w4r06 ground lighting we have install the underground conduit and hopefully, this will identified and we'll identify the remaining fund for to light the lights when the project is complete and sorry for the long report the last one i wanted to let you you know in case you've not heard this past weekend san francisco and sfmta was one of the finalist in the united states department of transportation of transportation for the smarter project through the program the that i have are partner offers $50 million to the winning city and it is two this was a challenge that was put out to midsized cities we made it under the cap the purpose for the

forward thinking plan to hanger technology and reimagine how people move we'll have a lot of temp that enables the services that come to our city witch largo have been racking to this is an opportunity to work with the neighborhood to proactively help to define how we want that to look rather than those things coming at us a lot more technology is that will be coming to us via vehicles and connected vehicles our feeling if we proactively work with san franciscans to help frame and shape how that comes to san francisco we'll get much better results 0 so as one of the winning cities they give us a one thousand dollars for to the grant two months to do it as sprint if we are successful then we would be in line for the

$50 million grant 40 from the federal government and $10 million from the private sector the strategy is led by the new office innovation and was telling him that hesitates that office that spearheaded 24 application done with the with the transportation authority with the mayor's office and will continue to work with them and others to develop that proposal so hope at some .3 months director fried will is a good news that concludes my report. >> thank you director reiskin and action packed d ot report on the ceqa changes that was director borden's former commission i want to thank the planning department and others for the anti climate, etc. there should have been balloons and

confetti but we'll do great things and continue to as we know with the hit-and-runs we have tlooekd so hope that helps us move towards that and congratulations to the smart city grant that will be fascinating to side how that happens and decorations anything on the director's report no director. >> i want to say i'm deeply disturbed by the amount of pedestrian injuries and collisions we've had i certainly don't take that lightly i'll work for ways to expedite the work and/or maybe changing things so that the way we're going about doing things but looking forward to topics the future to how we can really address this this is something

that you know pedestrian safety is something we all need to be healthy as a city the economy is better for that and communities are better for that everybody is better for it we need to get a handle on a few years ago an all-day workshop i talked about lower the slightly around the city i want to make sure invokes folks know that is not sitting easily with us and looking forward to expediting the efforts to resolving this and getting us closer to vision zero faster. >> thank you that is a good thing to bring up i was the vision zero conferee in new york city and the sfpd was recommended a lot of stuff that came out i was reminded the of

national highway transportation thirty percent of the cashiers in some manner of distraction not that easy for the police to subpoena the records of cell phones of the drivers director reiskin we're working on a lot of things around vision zero can that be involved for our court to look at that to work with the city hall or the state to change that. >> how about when we come back i think we at our request we were bringing you quarterly updates or so with regards to vision zero maybe at the next one we'll be able to address the speed limit reductions i don't know if if so a leg or procedural issue i know that anecdotally i know when i'm

standing on the corner i see a lot of folks that are looking at their phones it is horrifying this is a real large go a automobile or truck they're not paying attention we'll make sure to get this as part of our next report. >> thank you very much madam chair you have one member of the public that want to address an addresses director reiskin addressed. >> casket. >> thank you good afternoon directors i'm kathy the policy and program manager with walk sf and i'm here to express our extreme questionnaires for the rash of pedestrian fatalities that director reiskin and some of you mentioned on friday as director reiskin mentioned mr. sun was killed at broadway and powell a high injury location on saturday a gentleman was killed at leavenworth and ellis another

one an february 12th ms. lange was killed one block away from the high injury and sue was killed on market and 7 a high injury location as far 7 pedestrians have died in traffic crashes our grandparents and coworkers and friends we need to step up and do something to keep san franciscans save and the city is making great process on doing this the projects are faster the environmental review reform will be fantastic but i think there is something this body can do to help you can be vision zero leaders and not let the projects that the city staff bring to you get water counsel they have great recommendation the original proposal for pedestrian safety features it because of the push back back and other

projects are water down you, say no room for compromise on pedestrian safety do that that now and every week that you meet so i encourage you to do that and be the vision zero leaders the city needs thank you. >> thank you. any other speakers? >> wait one more. >> that's okay. please come up to the microphone. >> i'm diana having attend the planning department open house on the el carville i don't know what was said is entirely what happened i understand the passion of recuse fatalities there are many things that can be done but parking is not what that community meeting was mainly about i'll urge you to do the simple fler things rather than concentrate stops and call

that delusion with the community that has concerns that are not just parking but has to do with with people living there i respect the passion about this i'll you go suggest you not only listen but hear with the community is saying how they would reduce the facilities thank you. >> thank you very much. >> any other speakers. >> yes. >> items that ed reiskin discuss. >> in continuing on el terryville and sorry mr. ed reiskin didn't talk about that. >> pedestrian safety the you mean tuesday we don't want to have boarding islands we want more parking the same kind of thing not if you have enough to give us us parking around the corner we have a tight street to

move traffic no matter what this is crazy i'll have to say looking at another the time relevant to this when we set up the mta we collected signatures we could not get enough and the supervisors put it on the ballot and it essentially says transit first a tremendous vote of people every time you. could to a neighborhood transit first is good for the city we have an interest the neighborhood you guys don't need that you have to move transit and now hey here we are we're up to 4 it will break our record for killing people this is a boarding island harlan kelly this will be good for transit but the supervisors knew they couldn't stand up to people

that wanted parking they give you to you guys you have to do the work because you can't keep watering down those things so each we'll deal with many important issues but every time you have to hold firm and accommodate them a little bit we'll talk about but making people safer and moving traffic ticket faster and better when the transit moves better, more people use it if their driving and all that kind of stuff thank you very much. >> the director's report items discussed by ed reiskin not by commenting. >> according. >> state your name for the record. >> patricia i disagree with howard i think that you should have pedestrian safety but i'm sure about some of the other things my question on this

is the fact it the transit first policy says that the department must address he had a safety and quality of life and equal viability in san francisco in san francisco and what i'm seeing is oh, we'll put it altogether and i'm seeing the department push issues low that are going to be causing all over the city more pedestrian accidents and i i did not think that the department is doing proper studies every single section of this city has their own presenter or personality and their own issues and by pushing through and pushing it through

aggressively our eliminating people that are not just in wheelchairs but eliminating the people that have other health issues and safety issues now at the hot corners like those mentioned particularly market and mission that is where you should be working hard and safety you should be working hard on the garages that are having break-ins and assaults like wall to the safety of people there will be murders pretty soon i'll guarantee you must look at the broad picture. >> thank you very much i see mr. wiener approaching the podium. >> herbert wiener one comment about pedestrian safety