need commissioner. >> just to get the two departments that's fine. >> that's it that's it. >> the motion to have the board send a letter to public works and mta noting that there seems to be a conflict in the interpretation of the laws under the use of yellow zones and requesting that they work to clarify that law so in the future permit blnts for mobile food facilities looking to operating in yellow zones understand that law. >> that is such a good motion. >> such a good motion thank you. >> any public comment on that motion no public comment on that motion from commissioner swig to have the board send a letter commissioner fung. >> commissioner lazarus commissioner president honda and

commissioner wilson that motion carries. >> there's no further business. >> >>[gavel] >> i will note commissioner pating is here joyce singer and sanchez. yes there are four. commissioner pating just walk in. item 2 is the approval of the minutes of the health commission meeting of october 18, 2016. commissioners i apologize. is a common missing from item 2 on the minutes between the four and 26 injured i apologize for that. any

>> is there a motion to approve the minutes? >> moved and seconded. >> any comments or questions? no? >> second >> all those in favor say, aye >>[chorus of ayes] >> thank you. item 3 is the directors report >> i will left the directors report in front of you get a visit any questions for the directors report all try to insert the staff is also available for any answering. i just want to note we do have all of our news items media items attached to the directors report. so if there's any questions about any items, please try to answer them. >> any questions,

commissioners? no. i just had one and just curious about it a little more color on the easy to update >> yes our health officer [inaudible]. >> from my perspective, the report is actually very up to date up to now we've had 25 cases identified in san francisco. they have all been travelers could all the cases in california there's been 353 cases good all of them have been travelers. the only area there's been transmission in the us has been in miami. the only other thing that is news is that there has been longer

ongoing transmission in southeast asia. that is been known about but they the cdc has added health advisories to people traveling there. the last thing i want to mention is just something that can out recently that sort of interesting from a scientific perspective and that is that it looks like they micro [inaudible] seems to be more associated with a secret cases in brazil and we had seen less typepad defect in latin america. so it's perplexing as to why that is. the scientist or try to figure out what's going on in brazil that's causing the virus there to to cause the [inaudible] in newborns >> you may not be ready to comment on it but on that point, there have been several news stories about what might be the reason for that that had to do less with the etiology of the disease and more with standard public health practices >> yes. i just learned about this last week did i don't know

the details yet cured that's really it. >> thank you. >> no further questions? next agenda item >> item 4 is general public comment. i don't request any request for general public on we can move on to item 5 urges report from the financing planning committee commissioner singer >> okay. let me get the agenda here. we did a number of things probably the most relevant here are the month it was a very thin agenda but the month contacts report we got and we got a request for approval of the new contact and both those items i like to go through in some detail with the commissioners. so and mark, jumping if i do this wrong, but there were two contracts. one with university of pacific school of dentistry and the other with health right 360

which included no additional money from the general fund. it was either additional funds or reallocation of funds and i'd like to recommend-sorry-the finance committee recommended that we refer to the commission for approval of those two items. >> then also the new contracts. >> can i do that all at once? usds he was there is a new contact, which i like to describe an point out why this is sounds mundane but is actually important. it is a contract with guttural healthcare laundry and linen services for pounds of laundry i learned today that5.4 we generate at the zuckerberg san francisco general hospital in laguna honda hospital in a year. it should take care that in the finance committee also recommended to the full

commission that we approve this. the thing that is interesting about this and very encouraging, is an example of a consolidation of vendors could be of vendors for each of the hospitals separate contracts and through doing is there's a number of ways which it looks like we will be able to reduce what would have been the projected cost of laundry. so congratulations to the staff on that and hopefully it's the first of many contract consolidations that will come before us. so do we move approval for these? first asked if there's any questions >> offers as if there's any questions from the committee >> any public comment any questions from the committee >> >> to that change the rules on how we do [inaudible] >> it's an example of how they took through the normal process and decided to use one vendor instead of two. but it went through the normal procedural hoops that contract has to go through. >> thank you. >> a good question. >> question through the chair.

i just was looking at this this afternoon and just wondered these are significant dollars that as you said, evidently there's been integration consolidation which is about a three-year grant. i guess the question i have because i can't understand how, in fact, this operates because number one, before laguna honda and general both have their own laundry facilities. this quote was not effective, quote unquote to costly quote unquote etc. etc. then the con department contracted out and some of the hotel industries got the contractor so they were literally getting the laundry from general and tracking them down to monterey, monterey

peninsula and getting it done and when they came back they really had problems with the quality of the work. then there were other things being done. at the same time there were a number of small laundries in the city there were trying to consolidate especially minority communities that small laundry succumbing forbids and so one effort would always be why can we build hospitals which run higher local contractors and local workers etc. etc. do you know, then it seems like as i read through this, this is a large collaboration based in wayne pennsylvania and it's part of an international worldwide contract. wow. have we gone from our small neighborhood communities to try and encourage job opportunities and small businesses, etc. in order to provide jobs and keep families here for, what is

this. it's what are my? number of contacts [inaudible] the went to saudi arabia and china so forth and so on. i guess my question is, if in fact you look at the board of directors and it can go up to 30. i don't are these people all pleased here or are they based out of the home port in wayne pennsylvania? or are they part of the international corp. in who really is the international corp.? that's what i want to know and i assume our staff has reviewed it. >> we can certainly give you understand i understand your point of view we can surly give you more information about this particular project or you can also recognize that we also do have [inaudible] required to minority owned businesses as part are confident this just happens to not be one but is really born for us in terms of bulk costs and how do we-and we had very sizable purchasing power going on throughout the

department in fact that does not give his i think the end result of what we need to do is really try to use our purchasing power to build lower our cost. this is one of the ways we can try to do that. but i do understand a position but we are still required to follow lb fuels which we do for many of our services have minority owned contractors or providers. but this in particular one is one in which i really support to ensure we try to reduce our cost overall by using our purchasing power for large processes like we have to have. as you know, we've gone in out, in out in terms of the services. so this is also a nationwide for all public hospitals in which we are trying to purchase together and trying to reduce our overall cost. then, >> i understand >> i understand your position. >> it's a different protocol

as we don't look at your diligence and i mean it's the [inaudible] when we look at the building of the hospital were always so proud are hiring rate was above 20% even 28-29, 30% and look at the contractors should i mean laguna honda the same. something the department of public health was so proud of and whatever they could take a look at we are doing some great things but i guess as i said, normally long before we used everything on ethnic eight bracco and don't sometimes the directors came in from germany to tell us why they're bidding here when it's a german based company. we have special interviews on that. so i just wondered >> [inaudible] can also address this >> doctor sanchez thank you for asking that question in terms of our local business enterprises, one of the things as we are beginning to utilize these group purchasing contracts

that director garcia mentioned as a component where we can actually have our local business enterprises become members of that gpl. as we are bringing on these new larger were guys asians we are also working with her obe to give it got him on the same list we get the same pricing for those service. we are doing both at the same time. >> that's very helpful. thank you for clearing that. >> thank you. >> so opening up. okay. >> good >> thank you. we can move on to item 6 which is the consent calendar which you all can vote on. to approve good >> should we vote on the consent calendar? all those in favor say, aye >>[chorus of ayes] any objections? did i do that right? >> yes, thanks next agenda item >> item 7 is the healthcare accountability vinton this item was introduced at the last meeting and today you will be voting on this.

>> good afternoon to visit my name is patrick jane and secretary [inaudible] said we presented on this on alaska missions on happy to take any comments or questions you may have about its. >> mister chang, can you review the changes made so even though the commissioners of the package not necessarily everyone but maybe scuttled >> i apologize. thank you. >> whether any changes since the last meeting? >> there were no changes. no substantive changes. since the last meeting the draft resolution is just expanded to include include all 16 resolutions. the previous one had only the 14 number subject to change given that the full consensus of the workgroup. so this draft resolution includes all 16. as a rule is a resolution would >> thank you. there are several public comment request for this item. so our questions as commissioner, after those >> yes, sir. >> albright. the first person is greg brown. thank you for

taking the time to come talk to us. >> everyone is making public on. i've 3 min. on the egg timer. when the buzzer buzzes that means your time is up the was thank you for letting me come talk today about this. it's my first time serving on this group and it was probably of all the things i've ever done before the most interesting. it was a lot of different viewpoints and we went through every single point. i've never seen a more thorough review of anything before in my life. all viewpoints were discussed and we turned around and came to recommendations based on the needs of the business community as well as i represent labor could labor community, and nonprofit do we all just kind of sit here are our needs and we can up with our own proposal based on those needs. the proposal basically we do not go

to a basic sewer plan in order discovering that a lot of of our members are going through their own doctors for healthcare preventative but not for when they get sick. because that costs money. so they did not go. that defeats the purpose of having healthcare. now we are paying premiums in employer are paying premiums for deductibles and it's not being getting their money's worth out of it because people were not going to the doctor. we discovered this through our own workers. i've my own people tell me that. so yet, we can up with a solution of raising the deductible to $2000, raising the : insurance 270-30 and raising the top eight-top out-of-pocket 268-53 at having the hra hsa cover the first 2000 basically deductible. that weight should solve most of our members concerns, lower to keep the cost down for the employer and was kind of a win-win for

everybody. we all discussed it and we all happy we came up with something bounced everything up. met all of our needs could so actually was a very good consensus. we were able to find a win-win women all the way around for everybody and that was our recommendation based on meeting everybody's needs. i represent a group of women predominately women group several hundred members at the airport that are predominately-85% female. predominately minority. even though we are in a more progressive liberal city in the state most of the work still falls on the women, the wife, the mother and these women are working there as a full-time job . -i got an education that have by working with them and helping with her problems in i'm just amazed with these women can do. the working full-time and they go home and they take care of their kids make sure they go to school they take have some other in-laws with him there taken on their almost superwoman and they don't give up. just every day do what they have to do.

and they carry one massive work load to that quite a few single moms carrying the load all by themselves. they're paying rent $2600 month for a one-bedroom apartment that is green but not in the best neighborhood. so this helps them tremendously. thank you for pathos and keeps double they can stay healthy and ask for your support on this one. i think needs a lot of people's needs will help a lawful lot of people. >> thank you. and the gerald. the microphone is all yours. >> good afternoon commissioners. my name is emma gerald and i'm with seiu 1021 we represent city workers but we also represented by the thousand nonprofit workers in the city. i spoke here last week regarding our priorities around reducing the burden of the deductible and how that affects our members. it really

is a barrier to health care and that's why we work so hard to have the hra or the hsa cover that amount because we feel like that will have our members utilize the healthcare. i would like to read a statement from the labor council. all right. this is a statement from the executive director from the san francisco labor council. i want to be in rate fellow committee members recommendations to accept and implement the workgroups plan in updates the workgroups spend much time three multihour meetings in allies in data plans prices and trends in this ever-changing world of healthcare plans and premiums. we feel with consensus that we came up with changes that reflects the

intent of this historic legislation to provide the best healthcare for employees of vendors and contractors do business with the city and county of san francisco. in the era of obama care we need to be thoughtful about the values of our city and not just make decisions that appear to be simple bureaucratic fixes. that is what this workgroup accomplish. it should be noted that whoever is elected president next week is pledged to address healthcare in one way or another and we expect that our group under the guidance and facilitation of the great team that are dph will be meeting again with the adjustments that might be needed. on behalf of the 150 units 100,000 workers representing in san francisco i highly urge your adoption of the recommendations. >> thank you. karl cramer. >> karl cramer is san

francisco living wage coalition. the san francisco health department did a study this year that found that deductibles were one of the chief concerns of employees. also the metlife 14th annual us employees benefits trends study 2016 found that 55% of the employees reported that there were worse financial fears and worries included not having enough money to cover out-of-pocket medical costs that were not covered by their health insurance. the health department's study found that recent surveys indicate that nearly a quarter of adults with insurance are still unable to cover their deductible. the commonwealth fund provides a useful measure for underinsurance is having a planned the dockable that is higher than the 5% of income.

insured persons would plan deductibles greater than 5% of income are considered underinsured. which may lead to forgoing needed care. the current minimum wage under the minimum compensation ordinance which is a ordinance that we organize workers back in the late 90s to pass as well as a companion measure the healthcare accountability ordinance, under the minimum compensation ordinance which covers many of the same workers at the airport and on city service contracts, is currently $13.34 per hour. many of the workers at the airport are at that wage. the $1500 deductible that is currently in the minimum standards is 5.4% of their annual income. so according to the health determine study 40% of adults

with these kinds of deductibles that amount to 5% or more of income reported that because of their deductible they had not gone to the doctor when sick but did not get preventative care test, skipped a recommended follow-up test or did not get heated special scare. we heard reports that the meetings of workers on city funded service contracts not opting for insurance. instead using indigent care at the general. we know first our organization knows firsthand of workers who have health-who have health insurance instead of going to the emergency room at general and saying that they are unemployed. this shifts the cost burden of healthcare to the city while the city is also providing tax dollars to pay for the insurance company premiums. the aca requires that city departments confirm in writing that they included in their budget cost for nonprofits to comply with the

aca. so we reach this compromise and i think that this is one that does address high deductible plans. thank you. >> thank you. debbie lerman. >> good afternoon commissioners and debbie lerman from the san francisco human services network in i did also speak last time. i'm here just to reaffirm that the proposal before you does balance the needs of both lawyers and employees for affordable care am a affordable plans, and a wide choice of available plans and good access to healthcare for our workers and for all the workers on city contracts. from the employer perspective, over 50% of the plans that we studied on the small business market would be compliance

under these new proposed standards. under the old standards it was dipping below 30% which pushes everybody into the highest cost plants. as you know, nonprofits cannot raise our prices to pay for those plans but we would have to be knocking on the city's door to help us increase our cost to pay for them and even that would not completely cover the cost because we have many employees who also don't work on the contract. so it would put us in a real bind in force service cuts. so this proposal does represent the consensus of a very knowledgeable group of stakeholders from many different areas and most of us have been on this stakeholders group mobile times. so we have become experts at this and we do urge you to accept this current proposal. we will see what happens next with the affordable care act and 80 back before you next time around with some proposed changes.

hopefully, that would make it even better. in the meantime, it is-i do want to say it's late in the year. this process usually happens a bit earlier. so we are pushing up against the boundaries of employers needing to do their shopping for next year and hope you will move forward and approve this today and thank you for your consideration. >> thank you. any questions for-it's doctor chang,? it is now. >>[laughing] any questions bequest >> figure doctor chang >> >>[laughing] just calmly patrick >> was nice to see physical collective impact of labor and management working together as we try to find what affordable in the city. i think i mentioned last time you told me the reasons why couldn't we did not do this but i hope that affordable care act gets more

because of more stable product in an american economy that we will be able to meet even streamline this analysis hospital am really glad [inaudible]. my wish would be-i support this. at the end of this is that we actually might send the findings of this to cover california. i think the issues of affordability and city like san francisco both including our nonprofit partners and our public partners would be important for the state to hear. i just don't know if they're getting this information to us, the regional report you produce an affordability related to the -what was the other thing that scares security ordinance. i think is a really important information to share with the states. so just good work on this and thank you very much for pulling this together. >> thank you, commissioner. >> mission or sanchez

>> commissioner sanchez >> i just had to comment phenomena e commissioner pating's comments to justin bradford working group on taking disparate points of view that are often at odds on these very important issues good all from their own biological important perspective and coming to a working compromise. i think-i hope that in the future that as we look at these things we will also begin to think about how actually to do things to lower the cost, not just make sure that everyone is comfortable with how we share the cost of healthcare. i don't think we're that have a solution in san francisco were the countries can make much progress in less everyone is willing to kind of examined people's behavior from going to the emergency room to diet and

exercise good we are not to make much progress on that. this could take everyone working together like you guys have shown you can do. so in this second point is that i hope in the future when this comes up that as we talked about it that we have a better understanding of the code works and we talked about this last time the medical ward of san franciscans that this impact. which businesses does this impact? which employees? how many? i think that'll help us in context of this and many other policy decisions that we make as a group. so that something that would be helpful. that was it. under figures and more public comment so >> is there a motion to approve was bequest >> motion to approve >> all those in favor say, aye >>[chorus of ayes] opposed? congratulations. >> thank you, commissioner. >> open enrollment. >> commissioners item 8 is the san francisco health network update. mister pickens the was >> good afternoon again. >> hello.

>> commissioners in you are in front of you there is an updated couple of sheets that start pickens will review. your paper copies. >>sorry, commissioners.

>> i will be back. it person. he was maybe he was maybe expand your preamble. >>[laughing] >> first celebrity- >> mister pickens, hold on one second >> i've to these good one was in my packet that i got last week and the other one was presented today. which is the most recent document? if i want to fall you i want to fall you. >> sure. the two pager you got today represents updated slides

for the last two slides in the presentation. the packet you got last week is accurate up until the last two slides. >> okay. thank you very much. >> it is on the way but i suggest we move forward. [inaudible] >> so good afternoon commissioners. i'm roland pickens director of the san francisco health network and it's my pleasure to provide you with an update on the status of the health network today. today's presentation will be at the network level. that you see highlighted on the left side of the organizational chart for the department. in today's presentation we will review three things. first, where we are with our strategic plan and our progress utilizing lean methodology in the implementation of that land. second, we will review the

status of the nine strategic initiatives of the city to plan using the lien 8-3 team charter format. finally, we review the status of our true north metrics with our first report out at the network level on the status of those true north metrics. so on september 30 of this year to bring you up to date, the network and dph leaders can together for a one-day meeting your follow-up strategic planning retreat to our session back in march. your member back in march we stuck to very first tricky dick plan for the network using the methodology. at the session a few weeks ago in september, we received some foundational being education from our roanoke consultants about the value of visual management and monitoring the

status of lien improvement processes. in addition, at that september one-day session, we also spent time of we finding and bringing closer to completion of the unfinished a-three team charters for a five phase 1 strategic initiatives. the slide here shows a depiction of that lien visual management. what you see here is called a visibility room. this is a are a visibility room for the network which is located here in room 220 at 101 grove and some lien organizations this visibility room is referred to as the war room. this is where we have our regularly scheduled network leadership meetings went completely functioning this visibility while uca this is just our first initial stab at it. it will have our strategic

plan, the 83 team charters for nine initiatives and the true north metrics that only for the network but for the phd division and also for the dph. so this would be the one centralized place for all the improvement work across the departments comes together. you will recall when we est. the nine strategic initiatives we determined that five would have a focus in phase 1 which is this current fiscal year and the next. the other four we would focus on phase 2 in the following two fiscal years, 18, 19, and 19-20 when i reported to back in august of this year none of those five a-three team charters were complete. today i can report do that to of the five denoted by the green colors you see here under phase 1 write-in information anytime anywhere and stabilize finances are now complete and there in

the implementation monitoring phase good the other three denoted by the yellow color moving towards being completed. as i mentioned before, moving forward were being very intentional about how we are prioritizing our work using the lien framework and we are aligning and coordinating our efforts across the network given the varying degrees of lien support and resources and adoption across the various divisions of the network. as you can imagine, the work of these nine strategic initiatives is occurring along with and is complementary to many of the major initiatives of the department and the network including the implementation of a new electronic health record them to take a break.[pause]

>> mister pickens, if for some reason this is more than a minute about we go back to what we were doing. because it looks like- >> thank you. so picking up where i left off, as you can imagine, the work of these nine strategic initiatives is occurring along with many of the priorities of both the network and the departments. those priorities include the implementation of the new electronic health record that we will talk more about. the limitation of the state medi-cal 1115 waiver in its five individual programs being the prime program the global

payment program, the whole first year program, the drug medi-cal program. this is also going along with our work on the various workforce of element initiatives within the department cultural humility, collective impact in trauma informed systems. the of also got other initiatives like the replacement of the city's financial system also going on as we are doing our initiatives. for phase 1, we are committed to continuing to develop all five of the 8-3 team charters. with the understanding that completing that competing priorities are allowing us to really focus on the top to utilizing full lean methodology. we just don't have the support system and the resources to do a full lean implementation for all five but

it doesn't mean the work will go on for those other three. it will just be a more traditional performance improvement process. this slide shows our update on strategic initiative number one which is our number one priority. this was formerly known as implement and enterprise dhr. it's now titled, right information every time anywhere. the a-three team charter has been completed this initiative is now in the implementation and monitoring phase. some of the major highlights include that the work has been completed with ucsf medical center to inform a go-no go decision on epic with ucsf medical center. we expect that decision to be reached and communicated within the next week or two at the latest. the other highlights are

given that go-no go decisions are critical path risks have been identified and mitigation activities are underway depending upon that decision. but we are also establishing and dhr governance structure that will need irrespective of whatever system we go to and we are also standing up in project management office to help manage the project. this, our second strategic initiative, number two, underwent a major revision in the alignment changing its original focus from implement the medi-cal 1115 waiver to its new focus on aligning care finances and clinical operations for value-based payments. as we went through the process as honing and try to complete the a-three became clear as we

questions just what it was we were trying to focus on, it became clear that the focus really was and just incrementing the waiver. it's really preparing our struggle payments hence the changing in and naming and the direction of the a-three. that being the case, we would all the major revisions is not quite complete weeks that to have it completed within the next month and oust chen is the owner of that a-three and she will not rest until it started i can assure you. her and as she keeps us all up in night that it is not done. finally, here is the status of our other three a's one strategic initiatives. initiative-initiative number five stabilize finances. you see has a green dot. that

a--three chart is complete and much of that information was shared with you last month by greg wagner when he presented the five-year financial overview of the department and greg is the owner of that 8-3. for initiatives three and four with the yellow dots, due to changes in leadership and staffing for example you know [inaudible] left zuckerberg as the ceo. she was the co-owner of develop our people we also change in the coownership of the right place, right time with dennis mcintyre the un medical director at zuckerberg's now been replaced by guttural as the co-owner of that there are five and. we need one more workshop to finish development of those charters before they can move to the implementation and monitoring phase. commissioner [inaudible] asked about the two

new sheets. this world want to remind you that those sushi to receive today are updated versions for the last two slides could so please refer to those and this presentation today actually does have the one that's been displayed has the right information. as you know, there is an ever increasing focus on measurement and outcomes in health care. as a network, we are learning how to create a more integrated organization given her wide scope of services which is a strength but also a challenge when it comes to equitable measurements across our various clinical divisions which do different types of work. as we mentioned before, were using to north as our overarching unifying framework to create a culture of continuous data driven improvement. you can see the current status shows we have 55 total to north metrics across six dimensions. of those

55, 16 are on target. 11 are off target and the vast majority of the other 28 are still in various stages of progress in terms of data validation. the timing and collection and reporting of that data. it prime example would be many of our care experience metrics are based upon staff experience and we currently do the staff expense survey biannually within the department. so the last one was done almost 2 years ago and we will be doing the current one now and be able to report on that once we get those results. and, again, i talked about some of the education we read we received from our roanoke consultants but the value of disability tools and here's

another one of those two. this is essentially are to north metrics on one sheet, green shows the metric on target. red are the ones that off and great are the ones that are still in development. so that is my overview in the former presentation and am happy to take comments and try to answer questions at this point. >> ever seen no public comment request for this item. >> thank you, market any questions, commissioners?they also to be thinking at the moment commissioner sanchez >> i just want to say it was a really well-documented pertaining to ali areas where involving and also those that we are successful in those that we are not at this point and those that are still ahead of us. i guess as we continue on though and there is going to be

more cost-cutting throughout teaching hospitals and they are looking for ways to save money and of course one way they are considering is it and the effects of-is that going to if in fact as does come to be whether it be the five teaching hospitals that in the uc system, with that affect our -would that be a potential limitation for us or an area that we are going to plan b and plan c and is that does come to fruition? if in fact we do move forward on the totals. i know that's a long questionable what i'm saying because i guess this laundry thing hit me earlier and am thinking about the departments [inaudible] sign centers are going to save money so the departments of radiology other radiology film went to india and was reviewed their was cheaper cost effective because many of the

radiologist seven trained board-certified and you see hospitals are stanford or some of the other ones. so my question is, are we going to as we move forward, do we see any limitations where this might limit our ability pertaining to tracking our patients, both at the general follow-up and laguna honda. i guess i should not ask a hypothetical question i get some speaking from-it's happened before different ways, as folks and institutions you try to cut and save over a five-year period and many times it's come back again and then they rehire it may retrain and they do whatever. does that make sense? >> i think so. from understand the question, please tomio, i think the question is, particularly with consolidation

of it amazed if we do that is mise means of saving cockpit would that somehow that affect our ability to do some of the changes we are planning to have a more financially viable long-term horizon? is that >> right. >> i will try to answer that. particularly if your are you referring particularly to the phr or just in general? >> no. yes. i'm just try to save protector share with us as you work through as we work through this this is going to be an ongoing variable because i know that a number of staff in some different disciplines are already being reassigned and/or illuminated. in order to save dollars because this is a very very expensive proposition for acting and teaching hospitals. and we are part of

that. the department of public health and we made major commitments and we will follow those commands but we want to make sure the quality control is here. i noticed there was a governance units that is going to be considered. so this way we can have which is great. that really shows some good creative thinking as far as how we are going to navigate this. so it seems like we are well upon it. i don't want to get into the nuts and bolts. i just think that as long as we are aware and i think we are, i think we could come in with some alternate plans if necessary. so we are not my you know, i can misty was absolutely should governance is definitely a consideration that i think will be part of the gold though go decision as it affects our long-term ability to really be self-sufficient and financially viable. >> thank you. >> commissioner pating

>> first of all thank you very much again for the overview. i really feel like be strategic planning that you have been doing particularly with plan together to north metrics and the r5 and regionally, together. it's good to see all the hard work and but also all the drivers that are monitoring can i just run want to commend you. kind of reminds me on their driven a starship or enterprise but they always have those buttons and there was into control the whole shift from one keyboard. >> is coming together not quite as fast as i like but it's coming. >> you are getting. you'll get work speed in no time. >> well it's kind of steering the starship enterprise in a new direction. which is kind of hard. big ship to steer. >> you are the captain, right? >>[laughing] captain roland pickens starship numbers start a number i can buy first question is in regards to the

second a-three on value-based implement, it seems to me the definition of value is changing. i guess the question is, are we going to make up the value were defining the whole person metrics based on our own view of that? they really haven't ruled out a cms in a conference of weight yet and i was wondering your thoughts on it. i like the direction this letter off i couldn't three but the definition of what valuable tool person care, i'm not sure what how that works >> my personal opinion on that. my opinion is the value is twofold. value one first of all is the value defined by cms because for the most part they are a major payer. so like it or not they get to assign the value. but also value comes from the point of the customer that can be either our patients

in terms of the care they are receiving or are they getting better are the outcomes better? the value is also from our workforce could our staff. are they in environments in which they are thriving and want to be here and then therefore able to give better service to our patients and hopefully will increase their understanding of the value we provide to so i think it's both. what are the external organizations that are driving and who are determined with the value is, based upon national benchmarks, measures, other things but i think it's too full. both of payer value and the value from the perspective of the customer. >> i feel like that's a good approach. we definitely need to follow cms's lead in areas that are not under cms's radar or that they are lagging we create our own measures in and we put forward her own in digby there's no reason we can't assert that we are providing our own measures to measure our sense of value and then just sell that to public payers or

private payers as being credible. i think the question of how we prove it and so i like your answer. >> that's one of the good things about the medi-cal 1115 waived the prime program. there are 67-59 measures that all the public hospitals in california are being held to and so these -not all of them are ones that are sponsored by cms. again, depending upon the agency were the body we are being measured prolifically and we just-we are under the gun to make sure we meet those pressures because it's now tied to our payment. so it's either meet them and

survive or if not we won't. >> i'm really glad you're on the ship and we sent it away team to explore the planets. >>[laughing] the second thing is about the scorecard good i'm not really sure whether we should go into too much detail but i just want to call out a couple of early progress indicators that i think are significant first of all i like the scorecard. i'm wondering whether at some point in the future if we get more handles on this we should call out we should maybe like we do with the audience report to a narrative on things that are really significant achievements or significant deficits so that maybe we can meet out the bulk of the report and look at the red and green but things that either want to highlight as just needs working or this needs-this is a big improvement i think a narrative on this would be useful in the future. although otherwise i'm a little worried you put data in front of commissioners is like me in front of dogs that will be all over this and may not leave

much of the bone left. but i would like to know that you didn't throw this need to us throat a couple things. one, really pleased black african urban health initiative i just really really proud that were making progress with hypertension on the equity any quality initiative i think that stands out is extremely significant in our first equity marker that is turning. i also like the idea that we are increasing revenue through timely documentation you i think revenue capture for public health systems is him they were not always as good as because were always thinking as i can know not fee for service but you are doing significantly better than your 40% goal and up to 73% is significant. the other one-i'm working from the back forward. that's under financial stewardship on page

3. i don't see much in workforce and care experience of the we do have positive care experiences at san francisco general which i hope will continue with a new hospital. the last two real ones i want to just call out is that laguna honda and the health at home program reducing staff injuries in such a short time from 11.6 per month or per interval, i guess, to 2.8 on both of those is just really a wonderful reduction in i know where justin staff injuries at san francisco general as well. so as i look across this those are really great early successes. the only one that had a question around with the health at home and the quality measure division where we are-we went up on reducing emissions through improved discharge follow-up to 19.6 two 42.9. i'm

just wondering i'm not actually sure what we are measured are we measuring reducing hospital admissions or discharge follow-up? that would be the one that i would be interested if you did write narratives in the future. >> absolutely. >> great scorecards. >> scrabble can give you that answer. >> okay. >>good afternoon vice president and director garcia and health commissioners. we will be our two n. metrics that are direct conference committee for november 8 and will be explaining to our joint conference commissioners our green and red areas for our true north metrics. for the health at home metrics, as director dickens was saying, reviewing the data so that it

matches what we have in the matches what cms has has been a challenge for us. when we are looking at the data based on our patients that we look at on a monthly basis it is very-the numerator and denominator are very different than what is posted from our from cms. so we are currently rectifying that and we hope to have the right data for you >> [inaudible] >> yes for the readmissions. these are medicare patients who have good we are seeing and working we admitted back to the hospital within 30 days. >> thank you very much. colleagues am sorry sparrow i guess we do we are reviewing at the commerce committee's we

don't need to review it twice. maybe what we should do again in the narrative stakeout some of the summaries that were really at the joint conference and then that we can just highlight-i'm just thinking that a future to make it simple so we don't have to go through the whole report twice. >> yes. i love to get your feedback because if you're at the laguna honda for zuckerberg jcc you will see it but if you are not then it's how do i struggle hadley keep the other commissioners inform. i'm happy to take your suggestions on how to make that happen. >> we were suggesting that to roland may be highlighting several of these areas and going in deep that some of the other commissioners are not at the jcc for the zuckerberg area that may have the highest concern for you or overall in the network. he was sure. he was some of them might be quality bands around these numbers. like a standard deviation either plus or minus maybe those would be the ones

that you report out. the ones in the middle where you're working on, we will just- >> you are right. i think i make sense of the deadly as beginning answers make sense of the ones that are missing and i think we easier for the ones more important wants to float up to the top. >> thanks. >> thank you. commissioner hayes-white >> thank you much for your report. i guess the question i really has to do with having its more general question and deep dive question like you just got. that has to do with when you say it's in progress or for example the improved emergency overdose response, that's in front. to be determined and is also in progress. i think that following along commissioner pating another statement would be helpful to understand what that means. if you have a timeline than that would be helpful as well. i don't think it's necessary to do bottomless work on a but a sentence or two will help me understand and iron with the rest of the commission, but help me understand what that means.

because right now it could mean anything this old-time unassociated with it and i don't know whether this is an important issue for the work that you do but i would suggest that given the fact that it's being reported out it is very important to the work you do and that being the case, we need to lift up in a narrative form explanation of that. >> thank you for saying that and you should know we actually struggle with that. because when we first put this together we actually did the expiration of one by one and what we found it booked it was kind of gobbledygook because of basically for reasons. one was either either the key stakeholders still cannot come to consensus on a measure but agree with was not a national benchmark. second was just the ability to validate the data get as you know we have 16 67 different iis systems and some

of these have been required to in order to get the reporting you've got people from different systems. so much any apples to apples and oranges to oranges. then the other particularly the case of behavioral health because you know we been recruiting for new behavioral health director. so there just wasn't the cohesion there to really bring those together. so that's why you will see the more robust the more mature parts of the organization like laguna and zuckerberg we have more of their did the other parts of it are just coming onto their still struggling to really get up to that point >> given the variables you just described in terms of those between data points, it will be useful just at that distinction. there are too many data points which we have to pull together given an answer to this particular one we just say in progress were to be determined. but if you can say that exactly it would be very health. >> will do. >> thank you. i had a few

comments in question. the first is that i really want to congratulate the team here at sort of the network and at the institution adopting lean. this a very heavy lift. it requires a lot of training and you have quote your day jobs at the same junk so it really seems like we made a progress adopting that powerful management tool. the caution and maybe suggestion i have for you in reporting out to this group is that we know you are doing this already. we hear about it at the jcc's good we heard about it for years but we are interested in results. to the much later we can go on the process and the more time we can spend on these here are the areas that you're focused on. i think that would be more helpful to us to understand okay, how are we doing. and i will come back to that but i did

, in looking over the metrics i would just give you a sense of how i think about them. so when we want to reduce patient time in the er we just open a billion-dollar hospital with er much larger than we have and we talked about it this a lot and you guys are struggling with the changes in process and workflow for people but to see er times like this go out and for me to think, and i sit here and i look at this and i think, well if i took my cue to the er or if any one of the commissioners took their cue to the er or anybody's employed by the health department, took their wife or kids to the er, on their insurance plan and they had to wait this long they would blow their top. so i think that is the same lens and motivation with to think about the people who work spots for taking character likewise, i mean it is good progress duo from 44 days to 39 days on access to primary care but a

target of 14 days. we would also kick and scream about that and be frustrated. i think we've got to remember that at the end of these numbers we have a lot of our citizens and most honorable and they ought to expect to have the same sort of care that we get. sometimes these numbers i think are not ambitious enough. i know we are on a journey but i really want you to be ambitious which leads to my question. which is, you said before that you are frustrated that some things are not going fast enough. what exactly is not going fast enough? >> number one, just the development of visual strategic plan and the various a-. i think the command and control manager was trained to be would say all these things should be done. we should all 55 of these metric should either be read or green. in the old days, make it so. but as we are learning to be this learning

organization where we really try and define our problems, have multiple stakeholders involved in helping us number one identify with the real problem but also in terms of the countermeasures it takes time. you'll notice a lot of these a-three have various version to summer and version 10 summary version four. the fact that thousands a-three waiver to value-based it just takes more time so that's the part that's frustrated you i like to say, okay, everybody has this done next week but in order to be true to the process, i can't force that kind of thing. >> that is fair but only out. as you look at all these metric second got a couple i was first it would pick out a couple that you're critically frustrated with. he was number one, the ed one. >> number one that you won't

get i think we all hoped and expected with the opening of the new ed that the times would go down. that is one. the other would be increased to client satisfaction rates for health at hunter ideally you think would want off 100% client satisfaction. even though we are at 75% or rather at 72%, we actually went down from 75% but

you would think we would be able to have 100%. so whenever we have those kinds of gaps degree in terms of service delivery, that's frustrating because we think we are equipping our employees and staff to provide great service as a why aren't we seeing that reflected back in the responses from our patients. that's always frustrated. >> as a person in charge, like in the lean methodology, if you pick out a few things that you are just like among no, we have to fix this, what other tools do we have two kind of motivate so that you can get the results you are trying to have? >> so within the lean methodology to actually go to that process under review the process owners a great. here are your metrics which ones are green? which ones are red? once a red tommy what the issues are. what are the

barriers? can i help you resolve the barriers? that's go take a look and see what this is really about. but you and i take a field trip and you can to meet in the real place. >> so that in the er for example, what should be our expectations about the ability to hit a little under a is 3.5 hours waiting which is the goal at the end of year if we do a really well. what is your feel good about that? >> i feel good about that we have a process to get there. what i don't know is how quickly were going to get there. we are going to have to i think continue with the root cause analysis with the redefining of how they are using the three different pods within the er. that's the work they're doing out. how do they optimize pods one, two, and

three in terms of making sure we got the greatest patient flow. having said that, they also simultaneously need to then focus on the diversion rates good because all those things then applied affect how much time an individual patient spends with her within the ee. so it's really trying to having said that, it's where do we get the bang for our buck given the resources that we have. do we need to redeploy resources from somewhere else on another lean project to put them on on the ed in or to the big bang affect? that something we will also want to consider in order for us to speed up the time on. so those are the kinds of things we are going to have to do in order to really move the dial i think faster than it might normally go through this process. >> right. so if we walk away from this that thinking to under 10 min. er wait time is a goal by the end of your that's probably can be hard to hit?

is that a fair conclusion from what you just said? >> given we are in november now in the next two months come i think we are probably be difficult but i think we are >> you have until june on this bequest made. 16-7 and >> i thought you meant >> no. >> by then we've got-we've got enough eyes. the ed is the focal point for cfs g. all we've got other line lean implementation going to that's where the heart of the focus is. so every resource that they've got is being pulled into that place. and the loop [inaudible] staff are doing interested in doing the change. so i think we will definitely be closer to meeting that goal were mediated by the end of june. >> great. i think it's important for the public to appreciate the complexity of the problem you are trying to

solve. i spend a reasonable amount of time with a moment in the teeming er and it is sounds simple but it's a very complicated place. i think the more people appreciate that the more support you're going to have and i also think the more everyone when we remind ourselves about the urgency of solving that one issue. which requires a lot of other issues throughout the system to be solved. that's when we are going to get itself >> absolutely. >> any more questions, commissioners? >> thank you then much for this report. >> thank you and i will take your comments and try to hone this presentation better the next time. he was >> thank you commissioners i may remind you and mister pickett spoken comments when it comes back to you you're doing the best we can to meet your needs on that. item 9 is other

business. >> other business, commissioners you'd like to bring up to the commission? >> let's move on to item 10. commissioner sanchez can get the report back on the october 25 cfs g jcc meeting. >> this is identity jcc sfgh the committee reviewed the report approved of the environmental report sparrow care proxy and population for the annual meeting at on november 15. committee also heard an update on the transfer of the good on a hospital patients were cfs g is sparrow this was discussed with their and also at the jcc at laguna honda. the committee also reviewed the records were a report council minutes hospital

minutes [inaudible]. committee also approved the ob/gyn community service roles and regulated reviewed a modification to the permanent [inaudible] internal medicine inpatient units and revisions. vice the pulmonary privilege list and listed labs that are approved. in closed session the committee approved the credentials report and minutes. unless there's a new additions from our colleagues who were there-that is the jcc minutes >> great. thanks. >> item 11 is the committed agenda setting. you're the master calendar investors in a question >> any questions? >> a reminder to measure sanchez joyce you of the joint meeting with the planning commission on november 17. 10 am-noon >> what time? >> 10 am until noon

>> mister secretary are there any dates you worry about quorums? >> at this time there is not >> so we can move onto item 12 which is consideration of closed session at the receive any public comment for this item. you're welcome to vote >> will to go into closed session. all those in favor say, aye all those in favor say, aye >>[chorus of ayes] we will go into closed session and thank you everyone for attending. >> commissioners is no time to vote for not disclosing or disclosing could >> i move that we not disclose the item that was discussed in closed session. >> second >> all those in favor say, aye the course >> no consideration for a vote for a german >> move for adjournment. >> second >> all those in favor say, aye >>[chorus of ayes] >> thank you everyone.

>>[gavel] >>[adjournment] >> >> everyone. >> welcome and thank you all for coming this morning here my chief deputy city attorney and evan that has been working diligently on the investigation in this case and thank you for your efforts part of my responsibility as city attorney to protect san francisco residents and taxpayers from unfair or lawful business practices my office

filed a law enforcement over the tower the reason for the action is simply because of the facts in the case are so clear but not make them any less my office investigations shows the developer mission district, llc knew for a year before they began selling condominiums to the 58 story residential building was sinking faster than expected yet they went ahead and solid accumulated without telling the buyers about the situation we were legally required buyer be aware didn't cut it smol someone selling real estate must disclose that when construction of tower was completed in february 2008 it had already settled a lot of 6 inches 6 inches was a a maximum

amount of engineering appreciated it would sink it had reached the point a year again, the developer began selling the condominium by february of 2009 just before the condos went on the market the tower settled 8.3 inches more over the maximum amount predicted by the geotechnical engineer on may the developer had data showings the tower way continuing to settle at different rates in different parts of property that leads to the building tilting now the building has sunk 16 inches and news report say it is sinking at the base before they sold a single condominiums mission street development, llc knew they're building sunk more than it was supposed to and that was still

sinking yet doesn't dell the homeowners they're required under the law mission street, llc turned over 19 hundred packages of documents with the disclose information about the property as a result of the subpoena that my office issued in september these disclosures documents discussed everybody from color and marble to noting the size and types of of the plans in the common area change but they left out of most important detail no where is the city aware of mission street, llc disclose that the building settled faster than it was designed to do that's not just a bit of information perspective homeowners would like to know the information the developer is legally required to provide and at the heart of the case the homeowners have filed define the

transportation authority and the city and county of san francisco my office is bringing this lawsuit to a cross complaint against the mission street, llc they filed it today in a case of a number of millennium homeowners have sued the joint powers authority and the san francisco city center they're building a tower next to the site san francisco is one of the members of the authority the authority is a separate legal entity and our cross complaint we are seeking damages the court feels is appropriate in 2013 when it closed it's for sale millennium brought in what delighted quota massive 78 hundred there are no thousand dollars it was one $.8 million my office has a duty to protect the taxpayers of 70 spot sit by

and allow a developer to gunshot themselves by hiding information in their required by law to disclose that gave the developer in this case an unfair advantage and cheated the homeowners out of the information they needed to make an informed choice that's summarized the information and i'll be happy to answer any questions you may have. >> go in order. >> (inaudible). >> no do not. >> was there a choice to file a criminal complaint. >> this is a civil complaint i don't have the power under the law to file a criminal action this is a can i feel complaint we're not seeking reference nor have i made referral to the duo

district attorney or any other entities that makes that inquiry yeah. >> is the filing a cross complaint. >> that's correct. >> the homeowners that sued the transbay joint powers authority and the city and county of san francisco. >> well, it is depend on what the findings is in this case, the damages according to prove and in the event there was a finding against a city an indemnity against the developer since their the party at fault. >> (inaudible). >> monetary damages yeah. >> (inaudible). >> well, i think that that's

right what everybody - that should be the primary concern of everybody we're protecting life and safety i know there's a review going on by other city agencies to make sure that that the building is safe from everything i'm told the building is safe and would perform in an earthquake that's not the focus of my inquiry at this point but i know the city and the mayor and the department of building inspection and everybody has focused on assuring paycheck and safety. >> (inaudible).

>> well, i'll disagree as a matter of fact the department of building department dbi didn't have information about the current settlement until the past july so that's something that will be discussed in litigation. >> (inaudible) you've already said in some litigation the homeowners waited too late to file their filing against the city you said they've known about it since 2015 and should have settled sooner you want the - now your intervening that goes sg against the millennium developer and then he going against the developer and they don't have any money they're out out of

luck your public health they're wrongly suing the city and on the other hand, you're saying it is millenniums fault. >> the as a matter of fact jackson i think what you're referring to a lawsuit that was filed against the city we filed and refiled today but we've been clear the vocal point of this needs to be on the responsible party that's the developer because if you accounted a lot the claim before us and the complaint against the city it is basically for a condemnation and the claim of the value it because what has occurred there was a loss of value not an adequate disclose made to the purchasesers by the developer at the time of the arbitration it was completed that's what cause

the loss in value has occurred from my perspective the vocal point is on the responsible party the developer who has known about this all along and not disclose the information that was required to disclose to their purposeers or pro seismic purchasers. >> i'm sorry. i'll come back to you. >> certainly i do absolutely i think that you know this is every homeowners worst nightmare a lot of people go through this they know what happens when the investment it is to go and purchase a home or condominium sometimes you have people's entire savings they put forward to purchase something that's why this is egregious and the

california raw is to district and expensive whaven when it comes you must throwers for the purposeers the reason for the law in this area is to that people don't get ripped off and they're protected and in our view what makes that egregious when you look at all the disclosures and the marble eloquently goes to the heart of what one considers had making an transaction yet i have compassionate for the folks that's why we're stepping in to make sure the developer that the city is making sure that the responsible party here is paying for their misdeeds. >> you have a question. >> (inaudible). >> it is it is. >> (inaudible).

>> okay this gentleman here. >> (inaudible). >> i'm sorry (inaudible). >> we received 19 hundred pages of documents in respond to a subpoena we issued in september. >> oh, okay. >> (inaudible) 2011. >> yeah. >> do you think that although it is millenniums responsibility aren't you you embarrassed the agencies didn't bother to tell nobody that the city's job for safety obviously they can step in a do the right thing in 2009 including those are by all measures the presented measure of settlement is he watched and the city knows the millennium is not telling you it is readily

apparent or the. >> at least be careful with the words the gentleman asked about criminal activity i'm not sure anyone is committing a crime no doubt that dbi knew about settlement in 2009 but it wasn't until this past july dbi had additional information about the continuing settlement accordance of differential settlement they didn't have all the information number one but number two the second part of our question you - who's the one that is dealing with the purchaser the city is not in a position of knowing what the developer is disclosing to pro seismic purchasers we're not in a contract the city didn't

interjefferson county themselves into all transactions we don't know what in their disclosing to the purchasers it was as a result of our subpoena that we preserved the disclose and went to the purchasers and saw what was and not disclosed if we followed the logic the as a matter of fact of the matter the city being sure on all home purpose in san francisco stepping in and trying to monitor and interjefferson county themselves in that to see in profits are made or not made its simply - >> your city is a aware of the position and let them get away with it and actually nobody recorded a crime so nobody recorded it. >> we didn't release or know that millennium was not living

up to its obligations the second we got the information we were not aware they were living up to their obligation we taken steps to address that so i'll say you know we operate laws are on the book people expect their live up to the obligations we become aware they're not we'll take action and be aggressive about that that's what we're doing today and (inaudible). >> i'm sorry in my office i have a code compliant office division. >> (inaudible). >> somebody from city building look at this and you start talking about you have this building we talk about the fact that may not be seen - a big earthquake was a threat i mean the city just walked away under

the table. >> as dbi has gotten information the department of building inspection that's who i presume you're asking about they're involved and making sure that the building is safe and i don't think that anyone is walking away and trying to say it is not anyone's problem the city is aggressive in the health and safety and the terms of discloses to make sure that millennium their obligation is up and that's what we're talking about today. >> (inaudible). >> i can't speak to that that's something the department of building inspection will be continuously working with the developer as it processes and not anything i can speak to - yes. >> (inaudible) to fix the problem and what you know what

is the next step that building is still - >> i can't speak to a criminal inquiry that is something for the district attorney or something else i have - we're unaware of at this time but if we become aware nushgs we thought darned a criminal inquiry we'll make that referral but i don't have any indication. >> yes. it is about monetary damage; correct. >> no according to prove the courts democrats as we go through the case. >> (inaudible) that are it is urban precedent have you not necessary developer. >> we sue people and entities all the time. >> this is obviously i don't think - this is obviously a very, very serious case and a big case in a high-profile case

but you yufgs one case is more important than at a homeowner feels their safety is threatened even though this is not a high profile this is a big case and a big development this is unprecedented case (inaudible). >> (inaudible). >> i can't will you at this point. >> (inaudible). >> well, we obviously directing your attention of this litigation looking at everything obviously we'll have to in terms of handling this case. >> part of our toufbz about the disclosure (inaudible)

part of our objectives we should be more scrutiny and will be scrutinizing this and the developers be wander and i'll not is that actually, i think that here in california basis there are such robust and protective disclosure laws i'll find in most incidents in purchases of hopes and development there is a lot of disclosure a lot of disclosure because buyers are sophisticated and sellers are they know what the law requires that's what makes this particular egging gregarious you have a very, very sophisticated developer but be assure if someone is not living up to their legal responsibility we'd like investigate and take

action where appropriate i'll not say this is sending a message i think that most sophisticated developers and purchasers are aware of their legal responsibility and live up to it. >> yeah. >> (inaudible) the stores you've done can you talk a little bit about more about the development. >> that's the developer of an affiliate that was wraeshl for the sale of the condos in the beginning of the marketing of that. >> (inaudible). >> an affiliate, an affiliate. >> take two more questions aj has not had a chance. >> (inaudible) we thought that was the best deal for the case and knew we had to file an answer and

orderly in a case like this if you going to file an answer you have a cross claim choose to go to this group two more questions. >> obviously in terms of our case the millennium will be i should - just to be clear mission street development will be served and with the complaint and they'll have an opportunity to respond file an answer and we'll see where that goes. >> (inaudible). >> said an obligation to disclose. >> yep. >> (inaudible) i'm kind of confused those guys profited millions of dollars for failing to disclose a serious problem and walk away with the money that is why isn't this a crime and there - when you file

a criminal action i know that makes for a sexy sounds like bidded owl crimes very specific elements and as we reviewed this to date we are obviously i'm not a criminal lawyer but reviewing this and we see a violation of civil lay in the event we thought this was an element to the crime we referred it but does see any element of criminal activity we filed an action of a lawsuit i don't throw the word out criminal crime willy-nilly without having evidence i don't have any evidence if i did i'll make the information to the

appropriate party. >> okay - >> (inaudible). >> no, that's - we're going to have to see where this goes if there is liability we found a contribution or who is held responsible for the payment of damages - >> we'll have to see where things go in this case at this time it is premature to talk about that. >> but - >> but if you think about damages yeah. i don't know what a mechanism would be because of the early stages of the litigation thank very

>> welcome to "culturewire." today we are at recology. they are celebrate 20 years of one of the most incredibly unique artist residency programs. we are here to learn more from one of the resident artists. welcome to the show, deborah. tell us how this program began 20 years ago. >> the program began 20 years

ago. our founder was an environmentalist and an activist and an artist in the 1970's. she started these street sweeping campaigns in the city. she started with kids. they had an exhibition at city hall. city officials heard about her efforts and they invited her to this facility. we thought it would coincide with our efforts to get folks to recycle, it is a great educational tool. since then, we have had 95 professional artists come through. >> how has the program changed over the years? how has the program -- what can the public has an artist engage with? >> for the most part, we worked with metal and wood, what you would expect from a program like ours. over the years, we tried to include artists and all types of mediums.

conceptual artists, at installation, photographers, videographers. >> that has really expanded the program out. it is becoming so dynamic right now with your vision of interesting artists in gauging here. why would an artist when to come here? >> mainly, access to the materials. we also give them a lot of support. when they start, it is an empty studio. they go out to the public area and -- we call it the big store. they go out shopping, take the materials that, and get to work. it is kind of like a reprieve, so they can really focus on their body of work. >> when you are talking about recology, do you have the only sculpture garden at the top? >> it is based on work that was done many years ago in new york. it is the only kind of

structured, artist program. weit is beautiful. a lot of the plants you see were pulled out of the garbage, and we use our compost to transplant them. the pathway is lined with rubble from the earthquake from the freeways we tour about 5000 people a year to our facility, adults and children. we talk about recycling and conservation. they can meet the artists. >> fantastic. let's go meet some of your current artists. here we are with lauren. can you tell us how long have been here so far and what you're working on? >> we started our residency on june 1, so we came into the studio then and spent most of the first couple weeks just digging around in the trash. i am continuing my body of work,

kind of making these hand- embroidered objects from our day-to-day life. >> can you describe some of the things you have been making here? this is amazing. >> i think i started a lot of my work about the qualities of light is in the weight. i have been thinking a lot about things floating through the air. it is also very windy down here. there is a piece of sheet music up there that i have embroidered third. there is a pamphlet about hearing dea -- nearing death. this is a dead rabbit. this is what i am working on now. this is a greeting card that i found, making it embroidered. it is for a very special friend. >> while we were looking at this, i glanced down and this is amazing, and it is on top of a book, it is ridiculous and

amazing. >> i am interested in the serendipity of these still life compositions. when he got to the garbage and to see the arrangement of objects that is completely spontaneous. it is probably one of the least thought of compositions. people are getting rid of this stuff. it holds no real value to them, because they're disposing of it. >> we're here in another recology studio with abel. what attracted you to apply for this special program? >> who would not want to come to the dump? but is the first question. for me, being in a situation that you're not comfortable in has always been the best. >> what materials were you immediately attracted to when you started and so what was available here? >> there are a lot of books. that is one of the thing that hits me the most. books are good for understanding, language, and art

in general. also being a graphic designer, going straight to the magazines and seeing all this printed material being discarded has also been part of my work. of course, always wood or any kind of plastic form or anything like that. >> job mr. some of the pieces you have made while you have been here. -- taught me through some of the pieces you have made while you have been here. >> the first thing that attracted me to this was the printed surface. it was actually a poster. it was a silk screen watercolor, about 8 feet long. in terms of the flatwork, i work with a lot of cloddish. so being able to cut into it come at into it, removed parts, it is part of the process of negotiating the final form. >> how do you jump from the two dimensional work that you create to the three-dimensional? maybe going back from the 3f to

2d. >> everything is in the process of becoming. things are never said or settled. the sculptures are being made while i am doing the collages, and vice versa. it becomes a part of something else. there's always this figuring out of where things belong or where they could parapets something else. at the end goal is to possibly see one of these collage plans be built out and create a structure that reflects back into the flat work. >> thank you so much for allowing "culturewire" to visit this amazing facility and to learn more about the artists in residence program. is there anything you like our viewers to know? >> we have art exhibitions every four months, and a win by the public to come out. everybody is welcome to come out. we have food. sometimes we have gains and bands. it is great time. from june to september, we

accept applications from bay area artists. we encouraged artists from all mediums to apply. we want as many artists from the bay area out here so they can have the same experience. >> how many artists to do your host here? >> 6 artist a year, and we receive about 108 applications. very competitive. >> but everyone should be encouraged to apply. thank you again for hosting us. >> thank you for including us in "culturewire." ♪ (clapping.) the airport it where i know to mind visions of traffic romance and excitement and gourmet can you limousine we're at san francisco inspirational airport to discover the award-winning concession that conspiracies us around the world.

sfo serves are more 40 million travelers a year and a lot of the them are hungry there's many restaurant and nearly all are restaurant and cafe that's right even the airport is a diane designation. so tell me a little bit the food program at sfo and what makes this so special >> well, we have a we have food and beverage program at sfo we trivia important the sustainable organic produce and our objective to be a nonterminal and bring in the best food of san francisco for our passengers. >> i like this it's is (inaudible) i thank my parents for bringing me here.

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our great operators. >> ♪ ♪ ♪ ♪ the food option in san francisco airport are phenomenal that's if it a lot of the airports >> yeah. >> you don't have the choice. >> some airports are all about food this is not many and this particular airport are amazing especially at the tirnl indicating and corey is my favorite i come one or two hours before my flight this is the life. >> we definitely try to use as many local grirnts as we can we use the goat cheese and we also

use local vendors we use greenly produce they summarize the local soured products and the last one had 97 percent open that. >> wow. >> have you taken up anything unique or odd here. >> i've picked up a few things in napa valley i love checking chocolates there's a lot of types of chocolate and caramel corn. >> now this is a given right there. >> i'm curious about the customer externals and how people are richmond to this collection of cities you've put together not only of san francisco food in san francisco but food across the bay area. >> this type of market with the

local savors the high-end products is great. >> i know people can't believe they're in an airport i really joy people picking up things for their friends and family and wait i don't have to be shopping now we want people take the opportunity at our location. >> how long has this been operating in san francisco and the late 18 hours it is one of the best places to get it coffee. >> we have intrrnl consumers that know of this original outlet here and come here for

the coffee. >> so let's talk sandwiches. >> uh-huh. >> can you tell me how you came about naming our sandwiches from the katrero hills or 27 years i thought okay neighborhood and how do you keep it fresh you can answer that mia anyway you want. >> our broadened is we're going not irving preserves or packaged goods we take the time to incubate our jogger art if scratch people appreciate our work here. >> so you feel like out of

captured the airport atmosphere. >> this is its own the city the airline crews and the bag handlers and the frequent travels travelers and we've established relationships it feels good. >> when i get lunch or come to eat the food i feel like i'm not city. i was kind of under the assumption you want to be done with our gifts you are down one time not true >> we have a lot of regulars we didn't think we'd find that here at the airport. >> people come in at least one a week for that the food and service and the atmosphere. >> the food is great in san francisco it's a coffee and i

took an e calorie home every couple of weeks. >> i'm impressed i might come here on my own without a trip, you know, we have kids we could get a babysitter and have diner at the airport. >> this is a little bit of things for everybody there's plenty of restaurant to grab something and go otherwise in you want to sit you can enjoy the experience of local food. >> tell me about the future food. >> we're hoping to bring newer concepts out in san francisco and what our passengers want. >> i look forward to see what your cooking up

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considering a career with the city and county of san francisc >> good afternoon, everyone and welcome to the board of supervisors of monday, november 1, 2016, madam clerk call the roll. >> supervisor avalos supervisor president london breed supervisor campos supervisor cowen supervisor farrell supervisor kim supervisor mar supervisor peskin supervisor tang supervisor wiener no