because they can't go anywhere for about 15 minutes until everything clears out. in essence, i want to be positive because i am about the report and what we are doing, but i'm saying especially because you shared the equity part about listening to the community and their needs and a way to meet the needs by safety and for all our citizens not to just speed up transpor tation or the bikes or whatever, but we have to take a look at the human variable especially those who have lived in the city for many many years and our hand icapped and vets are having tough times now. i just hope we may look at that in the future and maybe after we goat our data for the next year we might have more insight on if there is a possibility we could meet some of the concerns

shared but not heard sometimes. >> i really hear you and the more we look at the data the more we see prioritizing seniors and people with disabilities is crilesh. the mayor issued a executive director on vision zero reaffirming our commit in august and the item that has a lead on is doing what you are describing for a deeper dive of analysis for seniors and people with disubltds and youth. we did a survey of organizations serving seniors, people with disabilities and youth this fall and we broke our survey account and had to subscribe because we had such a good response. we have over hundred responses. [inaudible] leads our safe streets for seniors program as well. ona i don't

know if you want to say anything about your workshops. >> would you like to come up and make your comments so we--thank you. and identify yourself. >> anna [inaudible] with the health department. we have done about 16 to 18 presentations at different seniors center across the city on high injury corridors including the ones mentioned in the mission, central latino and the one at mission neighborhood center and we heard that trade-off issue between wanting to be safe but also the issue about bus stop removal and funneling the nrfshz back to mta to incoperate seniors concerns. i doment want to add we heard from one of the seniorsenters it was a spanish

speaking only presentation where the seniors requested automated cameras in the mission and why we didn't have that and had to explain we don't have state approval so that is something we are also taking back to mta. >> thank you mpt commissioner chung. >> thank you for the presentation. there are two things i think it is new year so st. is fresh in my minds. every time when there is a new year there is always at least one fatality that is related to like driving under the influence so this year we know that somebody like lost their life to like the same reason. so, are we also tracking to see you know like, if like driving under the influence is one of the factors and the other one i think because there is state law that is

going into effect now that we cannot touch our cell phone in the car, so do you think that will have a huge impact to what vision zero? >> not in the top 5, driving under the influence is a leading factor and fortunate the state does provide a good amounts of funding for du i enforcement that the sfpd gets avenue year and they do a good job routinely implementing enforcement for du i and we also-the office of traffic safety grants are coming up this month and sf as a part of vision zero will aprive for a distracted driving enforcement campaign as well so think both of those things will be up included in the next strategy. >> thauj. >> did you have a question? >> kind of but i don't think-the other

one is i watch a lot of news. i dopt do any of those things, i don't touch my phone in the car. the other one is when someone having a medical crisis while they are driving and it seems this year we saw more incident that somebody was have agstroke or heart attack and cost a injury to pedestrian related injuries recollect so what kind of message can we give to that because that isn't something you can put a stop sign or like you know a yield sign to control that? >> i think that is a really good question, it is a challenging question i think for vision zero for me, it kind of fundamentally boils down to how fast is the person drivejug are you

driving. because two people walking and bumping into each other doesn't-we dopt have a report of fatalities that i know of. so, i think it is thinking about what alternatives in the city like san francisco where we have so many people on the streets and know walking has so many health benefit physically and mentally as well as cycling and the environmental impacts of driving, how can we better create better alternatives so more people are out of their vehicles and the consequences of a medical incident wouldn't necessarily be death. >> thank you. i had two questions, one was, from the information that you are getting from other jurisdictions and it is really sad the numbers continue to go up but that could be a number of factors. but are there factors there

that we should learn from and you could describe-you didn't bring any hear but you can bring it next time in terms of lesson learned. >> i would love to do that. the vision zeeree network i was looking today issued a great lesson learned from 2016 on the website what they learned from different jurisdictions. the importance of community engagement. i was encouraged and thij their themes are consistent with our action strategy. >> this was more a observation because we have so few like 31 deaths, is there a change in the composition of where these were? are they still in the high incident areas? >> we'll 234clude a full analysis of that otour 2016 year end

report. we find the high injury network is still quite predictive of where we see severe and fatal injuries but we are thank tooz the work that [inaudible] epidemiologists is doing thinking the police and hospital data we will update the high injury network and better understanding are there corridors dropping off. are there hot spot said coming up and doing more work to understand that. >> maybe you can sort of [inaudible] at the next meeting. the last was simply a observation that i had made also similar to what commissioner shan chez had. on the streets that are wide are there [inaudible] people can stop at? it is not always clear that you could or should stop at those between the lights. embarcadero is one that very often you cant make all the way across as you rush to the ferry

building. it is not really always clear the median stream is the comfortable spot you are supposed to stop at and i would imagine van ness is similar and some of the others, so having put in some of the streets even a median stop, i'm wondering if that is part of the education that could go on and think this also impacts seniors and all who walk slower. it isn't necessarily to try to make the end of the next street but you might just get partly through and wait for the next one. that may be part of education. those stops be made more clear as somewhere you could really be pedestrian friendly stopping at. i think that can be a part where there is feeling you should get all the way across the street. so,

that was just a observation and whether that was something other places have fond or we could be clearer. now that we take the effort of putting the- >> the medians are seen as important to service that #23u7ckz. function. >> i think those are good ideas to tell people you don't have to rush across, you can't in most cases. otherwise i think we will look for wrd to your presentation of the strategies you have at our next meetding and we will take up the resolution that you will be proposing. >> thank you so much. >> sorry, commissioner loyce. >> yes, you mentioned in your report you do not count suicide as a part of your vision zero. i'm wondering sp there data collected on suicide in relationship to the traffic and where is that data deposited and it will be helpful for monetal health sunch services we look at that as a

issue. you dont have to have a answer today. when you said that it struck me that it doesn't make sense to add it here but it needs to be somewhere. >> i think that is a good point and something that we have discussed with respect to institutionalizing the protocol and getting more into detailoffs the fatalities raised other issues. >> thank you. >> thank you very much. >> thank you. >> our next item, >> item 8 is assisted out 237 patient treatment. aot. >> thank you. let me know if you need help getting there. >> i think i'm okay, thank you. >> good afternoon and happy new year. angelica [inaudible] director of outpatient treatment and pleasure to give you a update. i want to

start out the conversation by reoriented to what assisted out 37 patient treatment is. it is outpatient treatment aot and not something new to the united states. the first program was 1972 in washington dc and 44 states currently have existing aot laws, but they do vary greatly from state to state. in california aot became part of our law as assembly bill 1421 passing in california in 2002 becoming part of our welfare and institution code. it was a recommendation of mayor lee's task force and adopt bide the board of supervisor july 2014. at that point a implementitation committee was convened of diverse group of stakeholder tooz talk how to implement aot in san francisco which we'll talk about in more detail moment airly. my

primarily responsibility of the director up to implementation is insure our community is aware how we implemented aot and conduct strake holder training. i conducted 63 stakeholder trainings to hospital, the jail, peer organizations, peer advocacy groups, patient rights, family groups and anyone interested knowing more about aot. we implemented the program in november 2, 2015. assistant outpatient in california is rirfed to as laura's law based only laura wilcox. what is unique about the law is adopted by each county and not a mandate to adopt. it is a new tool in the tool belt to support and assist individuals with severe melthal ilmss and families and communities where they live. what it is is the goal of getting ahead of a criseish and

supporting individuals with severe melthal illness not engaged in treatment, have a history of treatment non compliance and on a downward spiral. what the law allows in certain circs is allow the individual to participate in the treatment and utilize the black robe effect by the court to leverage someone in the care. in the case of aot, this is civil court order and if somebody 12349 compliant wa#2r50e789 plan they are not held in contempt or arrested and not sent to the hospital unless they meet the 5150. a long term goal is reduce negative outcomes such as reducing hospitalization, incourseeration and victimization. these are counties that have aot programs or adopted programs in the planning implementation in california. i would like to note san francisco has besxh a leader in the conversation as aot and

convened and hold a conference call quartly to discuss challenges we are facing, tools for engagement and successes to learn from other counties. the substance abuse and mental health service adminlstration named aot as a evidence based practice provided feedback for a study on aot and support other counties adopting. how is san francisco different and how we implemented aot? while this is required by law to offer multiple opportunities to engage someone in voluntary services recollect san francisco took it step further to make it is a part of our health safety so allow 30 days of engagement before filing a court putension but on achberage allow longer than that around 60 day squz that shows the

erftd to engage in voluntary services and utilize the court order and petition process as a last re-sort. san francisco insured we had a care team which is multidisciplinary melthal health team that consists of a director which is psychologist and myself, peer specialist and family leize on. these are unique to san francisco but many other counties in california followed suit and what we do is embody the principles of recovery and wellness and insure the services are commune tee based individualized and strength based. move toog discussion of what we saw in the first year of implementation. again, we started the program november 2, 2015 so this covers november 2, 2015 to november 1, 20s 16. we had 214 goals one 06 chs

information only where a individual wanted to know about what aot is and 108 were referrals. 53 of the individuals we had contact with. we'll discuss in more detail but as we discussed the program is based on a law so many individuals do not meet the strict eligibility requirements, however all the contacts were able to talk to the poren and provide support and provide information about resource squz the best pathway for treatment. this gives a ovview of the number of referrals we receive each mupth. the first month of impmentation we had 30 referrals which is not surprising. most were from family members and family members are a long proponent adopting aot in san francisco. since that time it leveled off and on

achberage we have 9 referrals a month. looking at the number of court orders in total in the first year of implementation we filed 7 core petitions. two of which were extensions of existing core putensions so only 5 individuals that we putensioned the court to order into treatment. the result of those are three resulted in a settlement akbrument where the individual agrud to work with us, three court ordered to participate in outpatient service and one withdrawn because we were unable to contact the individual. in total 60 percent of the individuals we had contact with accepted voluntary sunchss. the number of core petitions filed is lower than in other counties and speak tooz the uniqueness of our program and care team outreaching kwl engage individuals in voluntary services. looking at who made

referrals, as you can see family members and treatment providers counted for most referrals made and total account for 8 seven percent of the referrals. we also received furts from adults libing with the individual and parole agent. we had 8 referrals made by [inaudible] only certain individuals with report to the program but in all the circumstances we were able to work with incaller to figure another person in the individuals life who is qualified requesting party and can make the referral so there wasn't anyone that missed out on the opportunities offered by aot. in regard to the location of refrlts, most originated from san francisco county accounting for 74 percent of referrals and neighboring counties. one thing we didn't anticipate is we had a lot of referrals out of state and made by family member jz aconted for 9 percent of the referrals. these were

family members contacting us who luchbed ones traveled to san francisco who had severe mental illness. mubing to demo graphics who we were working with, orient avenue wn to the graph you are seeing, the top graph which is total referrals we received. the orange graph is who we saw in the program and the teal graph is individuals court ordered. across the board for individuals referred recollect seen and core petition was filed we saw predominantly male. age of referrals for individuals referred and seen, the age group is between 26 and 45, however we saw a sligetly higher skew for individuals with core petition filed and that fsh 36 to 45. in terms of ethnicity, you can see that we had a diverse group of individuals referred to us, however, for individuals

referred, seen and core petitions filed were predominantly caication and african american. wanted to take a couple minutes to talk about reliminary outcomes from the first year. the average length of time we worked with each individual is 124 days or 4 months with a average number of two contacts a week, but this fsh as frequently as 5 contacts a week dependent on the needs of the individuals we are working with. again, i think it speak tooz the level of intensity och the individuals we work and even if somebody agrews to vaulden volunteer services it takes time to stabilize them and continue in long term care. 40 percent of individuals reported a history of homelessness and 36 month prior to aot contact and at the time of discharge we had 65 percent of individuals

housed. again, 60 percent of individuals accepted voluntary services and time of discharge 62 percent of individuals connected to long term case management service. part the requirement for aot is provide a annual report to state department of minuteal health and that is a may each year. i believe you have a copy of that report see the first report delivered to the state may 2016 and there was a small period implemented, the data in the report is primarily qualmitative, however, 2 gabe gave a great opportunity to provide information from participants as well as family members and other support persons and how we can improve our program. happy to report 100 percent of participants surveyed reported feeling hopeple hopeful about their

future and respected by the case manager and staff is trying to support and engage in volunteer services. feedback from family members reported increase awareness of resources and service in san francisco, however, not surprisingly did report frustration in the limited amount oaf information we could share with them due to confudenchality laws and not able to require someone to traik psychiatric medicine. i had a opportunity to do data analysis due to negative outcome. commissioner chow, i know you wond ered about the 36 month prior so have data regarding the year prior. the reason we use 36 month is that is what the state department of healthal health requires. psychiatric

emergency contactss, each individual had a average number of 7 contacts and the 36 mujt leading up >> student sth contract with us. since that time we how shown a reduction in pef contacts. we look at the year prior individuals had a average of 4 contacts and that is less than 1 currently since 6789 what we did for the comparison for the statistical analysis and compared the daily average so we look at everything on the same scale. so, the significant reduction is on the.05 level, hourfbl, however, when we look at the year proir and post it is more significant at the.o1 level. related to psychiatric hospitalization, individuals had a average of 3 sake atric hospitalizations totaling 24 days on inpatient unit in a 36 months prior to aot. we haven't shown

significant changes we are hopeful that with ongoing data collection we can show significant chaisk in this point as well. related to incourseeration, individuals had a average of two contacts totaling 44 days incourseerated. we also don't have statistically differences hereby but have have a trend. for this analysis it is.o8 and hopeful with additional time and data analysis we will be able to show positive outdcomes. we can't say aot is the cause of the outcomes. there is lot that has change in someones life but look forwardworking to look at more data analysis and efficacy of the program. in terms of next steps, we look forward to hiring a 293 twoe senior behavioral

health. we think this is invaluable to support the outreach and engagement and will continue to provide our annual report to state department 06 minutem health which includes quantitative and qualitative data and go to the state may 2017 and posted on the website soon after. the board of spl vise rbs adopting aot require that we do more in-depth and robust analysis and that will look at the efficacy of the program as well as cost savings realized and working with hard earned company to support in the evaluation. we are happy to have positive outcomes to report and hope because of success och engaging individuals who have not successfully been engaged previously we can have best practice and implement across the system of care so better prepared to support our

population. of course happy to answer questions and look forward to continuing to come back to provide updates on aot. >> can you talk about the 800 line and is that the major way people are refered? >> we try to make refirms as easily as possible and meeting people where they are at so there is a tol free number and local 415 number and have a referral form on the website in the languages completed and e-mailed to us. >> very good. was there public comment? >> i didn't receive public comment request. >> commissioner singer. >> thanks for that comprehensive report and documents that supported it, super helpful. a couple questions. one, how do you-what is your expectation how many more lives we will touch

with this program in the next few years? >> that is a great question. it is hard to say since we only have a year under the belt to know the impact but haven't seen reduction in the referrals so imagine it is comparable to year 1 so 100 to 150 referrals avenue year. >> so it isn't growing at a expotential rate? >> correct, not at thiss time. >> what are the resources we are putting gans this? >> we are fortunate to be funded by mhsa so have a lot of flexible money to spend. we have a team atu csf case management to provide case management to those involved in the court process. we have to have a staff to client ratio of 10 clients to one staff member so a really small case load. part of that is also providing

housing money so contract with a local sro to provide housing. we also have flexible responding that we use to engage individuals. some individuals feel more comfort togging at a coffee shop or going out and getting close or whatever is needed so it gives us a tunlt opportunities to meet people where they are. >> can you put a dollar figure on that >> i would have to double check. i believe between the two programs and flexible spending it is probably arounds a million. >> the one area of this program that was pushed for [inaudible] didn't have a way to engage our system for their children or loved ones. that seems to be still the major group that

is giving you referrals, but yet they are also frustrated you can't giv details of their issue so i think that was the balancing act #23r5u78 the state is insure-many 06 these individuals could live at home with them. why not talk about who is qualified and who isn't qualified to provide the referral? >> having a family leize on is helpful. we still get calls from family members how people are doing long after we close their case. there are 6 parties that can make referral tooz the program. it is a family member identifieds a parent, sibling, spouse or a#2cu89 chide. the director of a treatment facility where the individual is housed, the dreblther director of a hospital, parole or probation officer and a treatment provider.

>> coming back to the the resource question for a second. >> absolutely. >> so, steady state you think this costs about $20 thousand a year per client touched, is that the way the map is? >> i trust you for doing the math, i would have to double check it. but that being said i think given the positive ruments results we are seeing cost savings for emergency services. >> i assume as you are longer in the tooth in the program you will weigh the cost. if you look at the results to date and it is early but statistically significant in one place and trnd and dont really know in the other and the other is inconclusive is a nice way to say it, if you look at the 3 metrics

where programs existed before, are those the results that tend to persist over time or do you have different expectations? >> i think given what we have seen from orebt programs as well as other conties i think we are in a great place. i'm impressed we have statistically significant results so have no doubt we will see positive results. >> your expectation is each category we will see statistically significant improvements? >> that is correct. >> commissioner pating. >> #245u7ck for the prezen station mpt on the funding u is there problems drawing it down from the state and is itfunded in advance or have to bill the state for funding? >> we have that in advance and there haven't been problems krauing down the dollar said and when possible

city wide case management bills medi-cal so able to recoup some of the costs. >> i like the results, i think you have similar results when nevada did the pilot. i think your rate of hopefulness around the services is higher than in nevada county. have you presented this to nan nami and client organizations and how the clients felt? >> i haven't presented the data anywhere else but when i did the stakeholder trainings they are important to do. what other count aiz have done is 1 to 5 trainings for the whole county and we did 63 before implementation so it made for a smoother implementation in san francisco and i think peer groups part

of the implementation process so hopeful of the intervention aot could offer and supportive of us as a team. >> are we linking to peer services too kr >> we give information to meet with them and support them in peer activities. many we cobelthed to peer wellness and orelt peer oceans in organizations in san francisco. >> that is great. >> arounds nev ada nev they have seen results but san francisco a more service rich county so the fact we see significant results here is more significant. >> nevada county likes to brag but we can brag too. the last question is operational issues, referrals from the court, how does it work and what does the judge need to do or what cases do the judges make referrals on and lastly, once somebody is in the

system, how do we determine when cases can be terminated or closed? when are people done with aot if they are evench done? >> we don't receive referrals directly from the court but had several with pending charges referred to us and support them being refer today the appropriate court for them. many individuals participated in behavioral health court. three of our first clients we worked with successfully graduated from health court in november and when somebody is done the beauty of the program is when they are ready so able to continue working with them. we work average 4 months and support them in the linkage to services and engagement before we close their case because we want to insure once they are in voluntary service they continue on the path to recovery. >> thank you very much. >> commissioner chung

>> you mentioned the average treatment is 4 months and way beyond the scope of treatment laura's law had suggested and that fs like one month, right? >> for the engagement period, correct. >> my question here is i appreciate when you mentioned that you know like it all depends on how well the person is before you graduate that person from treatment, but in general, like because we have such a complex safety-net and so much different types of mental health and behavioral service like city wide community focus and also you know like at the more acute like case management services, are there any

overlaps to transition them into a different funding stream and continue to retain some of them in services? that's is my first question. the second question is, do you think it is more unique for san francisco because of the safety-net we have that they are able to see better result than somewhere that may have less resources towards behavioral health service and also the sigma for the family, do we see any changes in terms how they talk about it and how they perceive the family member who are receiving services? one more-- sorry. >> you may have to remind me. >> i will remind you. the last one i have is, do we see less

opposition from civil liberties advocate around the laura's law implementation for our program? >> work backwards, i think for opposition, as i mentioned, i think we worked hard to insure peers were part of our implementitation process and discussion how aot is implemented in san francisco. the one thing i heard consistently is they felt we embodied recovery and wellness so dont think we had the opposition. not that there isn't concern about aot and think it is important to revisit how we work with individuals but we had a successful relationship with peer advocacy groups. family members, we have haven't assess how they talk about the loved one. i appreciate you bringing up the stig am

piece because i think is it is important. the family lias onis trained by nami and utilizing that and it is something we try to educate family members to provide what mental helths needs are and support #24e78 so they are better equip to support the lubed one. remind me, i know there are two others. i apologize. >> one of them is is san francisco unique because we have so many different safety 46 -net services in place and makeathize transition easier? >> i #24i7ck implementing aot in a robust system of care is a privilege and when i talk to other counties they are very jealous for me being able to work in san francisco. i think it makes a transition easier because the system is based in recovery and wellness and out#r50e67ing

individual soze have that in plaiss. in terms of overlap, there are periods of time with ovlap with the new caiss manager to support the individual to get to the appointments to make it the community based. >> that is all the questions i have. i'm interested continuing to follow this, especially like when we can have participants maybe come and testify. >> absolutely. >> pause positive impact for them. i think it is a great program to have. thank you. >> thank you. >> commissioner loyce. >> thank you for your report. it was very informative. i have a couple questions having to do with incourseeration and reduction in jail time. that means to me that there is a relationship between sheriffs department, jail medical and

psychiatric services and police department who are the people who take people to jail, so do you have a relationship with them and have they been trained and how do we have the trends twhords reduction since the police department makes the decision who goes to jail? >> i worked with sergeant kelly groo kruger and appreciate your bringing that up. we have a trend towards significance for reduction in jail contact and where that lies is not that people are diverted from jail which is a important discussion to have, but we are able to support them so there are not behaviors that lead to contact with the police department in the first place. >> and the sheriffs department and jail and medical psychiatric services, when they are incourse- >> they have been trained. i was fortunate to work with jail fwhavioral health observe i came to this position so have a close relationship

with them and the courts. >> thank you. >> commissioner sanchez. >> excellent report. many many years ago i wish we had this program because there were many many #c458gs challenges for a number of families and they didn't know what to do and some are aware of this and think that it is a great opportunity that wasn't available before and wished it was available many years ago but glad [inaudible] well done and look forward for the reports. >> thank you. >> commissioner sanchez said what i was going to in the sense that this has been controversial and yet i think this report really shows it is a opportunity we have for our clients. i'm wondering on the part of trying to relate to families is there not a way or maybe you aurd already do it where clients can give permission to allow you to lias onwith the family?

>> of course. and we request that frequently when there is a family member involved. i have to say in many situations where family members don't [inaudible] are doing the best so it is unfortunate we couldn't share that information. i think that the annual report also helped a lot of family members to see data even though they didn't know specifics about their loved ones , they could see the impact the program was having. >> that you brought up the annual report i was going to bring this up because your report is due in may, right? >> correct. >> i think the update the commission appreciated especially since you took november to november, it is off cycle, so what would be the best that we get on cycle to receive the annual

report and work going on and perhaps what we should do is get a submission in may and start in may on the annual basis getting updates on this. would that make sense? >> i am happy to come at any point in time and make sure you receive the annual report but if it makes more sense to have two full years of data and can come back. >> i think we get to your may cycle, we could receive the annual report in may and begin the may to may-does that make sense? y whauv the commission prefers, i'm happy to come when sneeded. need. >> we'll get another update. >> i think that is a great idea and do every may as the report is done and be on track. >> right, and start with the may report because this will be fresh. we

got a good track record going and like to hear it continues to be successful and do it on a annual basis on the time you do your annually report. >> thank you. >> we had a successful implementation of the laura's law. >> thank you so much, always a pleasure. >> our next item. >> #50i89m 9 is the dph annual report for the year 2015 to 16. >> there is in your paper that i left for you a e-mail containing information which will highlight some of the presentation today. >> good evening commissioners.

kristin putell, a planner in the office of policy and planning and i want to thank you for the opportunity today to prept our annual report for fiscal year 2015-2016. as you know, the report is mandated by city administrative code and provides general summary of the departments activities for the #23isical year. overall, the report follows our mission and also there are efforts to make the report consistent from previous fiscal years, so the look and feel is very consistent. also, there were efforts to make sure the report was visual and there was less text. just as a remindser, the report was presented to finance and planings committee december 6 and afterwards the comments and feedback were incorporated ipthe vision along with a few

other design changes as well. in this presentation i will go through major sections of the report and just to give you more context. the report begins with a message from our director barbara garcia. this roids a introduction to the rorlt and highlights two major accomplishments that are featured later in the report as well. these are the first plxment the opening of new hospital building which is in the works for the past few year jz the second is community health needs assessment which is completed triannually by the population health division in collaboration with community partners and it is a important tool to inform decision makers about the health status of san francisco and better understand of disparities and inequities that exist and i'll talk more about that in the

future stories later on. moving forward, similarly the message from dr. chow also provides a introduction to our annual report. dr. chow's letter covers the opening of the new hospitalbleding similar to drickter garcia and talks about the public health accreditation process and electronic health record preparation happening. overall these two letters provide our leetdership introduction to department highlight moving forward. in order to provide the reader with more context this section provides a ovview of the two divisions, the population health division and san francisco health network and the roles protect ing and promoting the health of san franciscans. it provides a ovpch view of functions and services, so for the san francisco health network focus on clinical suvls while population

health focus on population wide activities. this section has the organizational chart, which is the most current includesing the directors and sections within the divisions. next we have a ovview of the health commission, which includes the structure, the function, the committee and a few ort information. the commissioner bio's and photo's are included to help the reader understand who sits on the health commission and as a note commissioner tail r mu gee was added back after the committee meeting per our discussion just to give all-to have all the commissioners who served on the fiscal year. this section is our last introductory section for the annual report because brf we go into two major sections on the highlight jz also the numbers. on the slide there are two snap shots from the annual

report which are two feature stories. these highlight two major accomplishments for the fiscal year that go back to dr. chow's letter and drecktder garcia. big move, can had is the new hospital building focus on the opening of the new space and also the efforts to move the 200 patients from the old building to the new space. this involves countless hours of planning and also over a thousand clinicians and staff. the second feature story, the chna is the key piece for ourpublic health accreditation. the population health staff worked in collaboration with san francisco health improvement partnership and community partners as well. this identifies key helthd needs for san francisco and will help inform the community health improvement plan to address the health needs for the city. the continuing with the

highlights, the next section provides stories and includes 18 shorter highlights that show case the commitment to the commission. the highlights were collected from all divisions and sections within dph and these show case the activities for fy 15, 16. there are nigh highlights which includes vision zeer so and zika preparedness and plaque african american health andteneder loin helths and building infrashuck struicture which are lean and med i-cal. [inaudible] this was added to focus on administration and infrastructure. the next major section of the annual report focus on the numbers and data. we start the section off with the dph budget. this includes our

expenditures, revenue and key investment made for fiscal year 15-16 which some included the $26.8 million for operating cost for the new building and $12.8 million in it investment. following the budget, we have dat spanning our two division so san francisco health network and population health division. starting with san francisco health network we include encounters on different visit types and patient demo graphics across the hospitals and clinics. per the commissioners request add finance and planning this was verified by the business intelliance unit as dph and followed the data definition when possible. the next section is on the population health actiskties so this focus on the 6 areas of the strategic plan and have key highlights

within each. lastly, in this section we have our health commission resolutions for fy 15-16. these highlight the major actions taken by the commission ovthe fiscal year and this section or this page was moved to the section per the commissioners request as the finance and planning committee as well. the last piece of the annual report focuses on dph services sites and our contractors. the service sites are shown on the map as such and showcase locations for civil sunchss primary care and behavioral sites. we didn't include all the contracted sites because we have over wn 15 and couldn't showcase it on the map. lastly, we ends with community contractors to acknowledge the contributions

to the work at dph. there is a limited number of copies printed at no cost to the city and will be provided to the commissioners and also the board of supervisors and will post the final version afterwards on our dph website. thank you again and want to acknowledge commissioner chow had a question about the dph budget section and included a write up for the budget director and have [inaudible] in case there are questions on the budget. thank you again. >> thank you very much. commissioners you have sth annual report before you. >> there are no requests for public comment on this item. >> comments from the commission? >> we look at this at the finance committee and looked even better in the final. >> thank you. >> public health and think putting meaningful data there. >> yes, we collected more data from the

population health division and they suggested those were the key highlights for this fiscal year. >> good. >> i wonder whether we may be able to consider one amendment. you wrote a important message to the public about the san francisco's commitment to maintaining peoples insurance in our environment going forward. while this document is ret rospective on the mission page it is wonderful to see part of your statement there representing our full commissioners efforts of maintaining full insurance for our-not sure where that-for our san francisco population. only because this is out there, maybe a place people look about what we are about and think it is a statement about saying what we are about going forward in the next 2 or 3-years that is important even though this is ret row spect

#6b. >> we have been on that journey many years. i think we can do something like that. it isn't on the final final yet, right? >> no. >> i see on the mission page you have a gab- gap. >> that is good. >> maybe a letter to the mublic. the directors memo-i don't remember the words. basically don't worry btd your benefits, wree got you covered. >> that is a great idea. thank you. >> i see what you talking about trying to fill in here insurance to the public. >> that is the message we sent to the public regarding continueic to come to seek care. >> perhaps there could be a box of some sort. >> we'll figure that out. >> on the mission page 6789 >> okay. >> we are open for business maybe - >> that is a good point.

>> absolutely. >> we haven't pushed the button to send out the final report so we can do that >> commissioners any objection to that adding that to the report? i don't see any then we will work to add a such statement. >> great. >> any further comments? we probably have enough-the document that i really thank staff for producing and didn't need as extensive as it is and put into context because it showed under the budget line a series of items that we had particularly highlighted or targeted and just wanted to be sure we understood what that meant because if the public asked you what was the 22 $22 million or 26 $26 million

we highlighted in these 5 items you could have a backgrounds for that. and because they are not really related exactly to the budget numbers because our support for sf jenroom is far greater than the $26 million but the fact we are also putting in $1.2 million >> student the zeer ofep zeer oaf initiative is there so you have some backgrown on that so asked to give context so the commission could understand where those numbers came from. and you have that before you for your reference. if there are no further discussions on this once we added the reassurance to the public we are still open for business- >> i believe commissioner xhung has a comment. >> we will sends this to the board of

supervisors with a cov letter as we normally do. >> the mayor's office as wrel. >> and the mayor pfss office. >> the other commissioners reviewed the bio graphic information, but if i have a update-- >> sends to colleen. >> she wim send it to me and i'll pass that on. >> we will place that in and thank you. updates are definitely welcome. anybody else wish to update that? that will update our website also? >> yes. >> yes. >> should we move to the next item? >> we will send this forward to the board of supervisors and mayor's office with the connections or additions we just talked about. thank you. >> next item then, please. >> item 10, other business. >> hearing none, item 11 is the

joint conference knhity committee report and commissioner singers has a report back. >> i have december 12. >> december 13th i apologize for the typo. >> we met december 13? >> that is sf general? >> yes. sf general. >> that is right because it wasn't listed as sf general. >> open session the committee reviewed the quaultd manlagement regulatory fairs report, the hospital admip strairtd report and patient service report and hiring a vac aenss report. those are stanered reports. the only thing i say to everyone about what is going on over there is that there really is quite a attempt to

take advantage of the new facility to redo many processes and get the performance metrix that i think susan expects, susan [inaudible] ceo expects of her staff and that is very encouraging what is going on, but it is long process and has a long way to go. there is a lot of inurshia in the way staff does things and that combined with a new physical plan is a recipe for hard management situation, but they are attacking it and hope in the future we will see the benefits. they attack through the lean process and we had a briefing on that as well. in particular we had-probably the most visible issue in that area is the rate of diversion and time the er is on diversion and that is a substantial amount of time that has gone up

significantly and i think we are all hopeful there is a lot of work in progress to start to bring that down to something that is within the realm of palletable for avenue everyone about there is a lot of work going on there. we did defer the neurology clinical rules and regulations report and the logic is we did not have anyone with a md among the commissioners at that meeting and felt it was appropriate commissioner shan chez and i to wait to approve changes in the medical rules to have a doctor ovsee that. the closed session we apruchbed the credential and tips minutes. commissioner sanchez anything i missed? >> [inaudible] >> any questions? thank you very much for the report.

>> the next item is committee agenda setting and you have the calendar in front of you. >> the calendar is before you. any comments on the calendar? >> the february 9 is the joint commission meeting. >> yes. >> february 9 of the planning-with the planning department is a joint meeting as a additional meeting to our calendar. >> [inaudible] >> i believe it is 10 o'clock. 10 o'clock at city hall. >> 10 to noon february 9th. >> yes. i was informed actually from the director that the budget submissions will be coming as instructions

issued as ayou know ast month in the coming months to the commission. i don't see that actually calendared here. >> we are working on that now. >> thank you. are there any other comments from the calendar or areas you wanted to add? we are looking at a potential of our community meeting in-and that is under process with mr. morewitz now working with the department in terms of what is the appropriate time for community meeting and we are at the moment projecting the bayview. no other comments on the committee agenda thaen we are ready to accept a motion for adjournment. >> motion to adjourn. >> is there a second? >> second 6789 >> all in favor please say aye.

opposed? the meeting is adjourned, thank you. [meeting adjourned]