months we'll talk about the infrastructure with the plans we think the reality is not good enough to have been an rfp done we as an organization has to be ready otherwise we'll go through the money. >> commissioners we've already planned that you will get a quarterly update through our it director. >> thank you the entire scope. >> i would like an update on what t what incremental costs what the penalty range is likely to be for us and really encourage you to look at whether you should continue to hire on it given you're not sure what you need and may be able to contract out i think like this is very

skilled dependent i urge i urging you to hit the brakes but given what has happened that africans to me and we've started to make that transition i want to make one clarification the budget difference to what ucsf come back to our - where we are is not solid one hundred millions it is one hundred million dollars and ucsf has an incredible amount of pencil sharon if you recall originally the range is 70 to one hundred million dollars but i can imagine and shearling your pencil and have a low tolerance in terms of your conditioncy your risk all of a sudden gets very large so when we have a discussion one hundred a number and 70 is a number to you, we

working hard further questions if not we'll continue to get an update of our results but where we are and we've taken the questions and distributed those for example. >> commissioner singer asked for several issues commissioner singer asked questions regarding cost and also and the staff so we'll make sure. >> penalties and staff. >> i understand okay. great sorry i want to make sure we understood the questions. >> okay. thank you. >> all right. >> commissioners next item is other business. >> is there any business this the commissioners would like to

bring forgot otherwise on to the next item. >> the joint conference committee report and commissioner sanchez. >> commissioner sanchez. >> all right this is the lujd j.c. c of november 8th committee met in open session and heard the administrator's report that covered many of the achievements and activities of both our staff and the training and measured outcomes in a number of areas we look at health and safety and heard the reviews on that and

also the annual surveys and planning during the course that were submitted those were reviewed in details lastly we heard the true north goals and the staff training and the fact this is been going very well given the number of other activities we've been involved with with lonld and the committee reviewed the hospital wide programs and policies and then in closed session reviewed and approved the credentials report therefore i'll leave it up to i to approve and . >> no need this is an update if you've accepted the credentials report that's an informational. >> okay.

>> right at a time we didn't have the closed session equip. >> right. >> questions to commissioner sanchez just to remind people we'll be and a at the the lunld at the next meeting. >> while we're speaking of dates move on to item 12 the agenda setting on december 13th those of you on the j.c. c your meeting that day the second tuesday versus the fourth tuesday you know and also on february 9th some of you will be sitting in a joint commission meeting. >> right of course, owl commissioners are welcome on february 9th we took at least the minimum of people that are in town to making sure we didn't

have a quorum and meeting with the planning commission not embarrassed with a joint committee not have the quorum and make sure we have enough people about their early 2017 schedules to say that date was free we've committed with the planning commission with that. >> it in cement. >> very good. >> i have word from the goats to the sheep of lujd we have burden with san francisco general. >> is that an offer (laughter). >> that's a wvrm thing for me, i'm worried about that. >> (multiple voices). >> with that, now time for consideration of adjournment. >> motion for adjournment. >> move 1yr789. >> is there a second. >> absent objection this meeting is adjourned. >> thank you,

when a resident of san francisco is looking for health care, you look in your neighborhood first. what is closest to you? if you come to a neighborhood health center or a clinic, you then have access it a system of care in the community health network. we are a system of care that was probably based on the family practice model, but it was really clear that there are special populations with

special needs. the cole street clinic is a youth clinic in the heart of the haight ashbury and they target youth. tom woodell takes care of many of the central city residents and they have great expertise in providing services for many of the homeless. potrero hill and southeast health centers are health centers in those particular communities that are family health centers, so they provide health care to patients across the age span. . >> many of our clients are working poor. they pay their taxes. they may run into a rough patch now and then and what we're able to provide is a bridge towards getting them back on their feet. the center averages about 14,000 visits a year in the health clinic alone. one of the areas that we specialize in is family

medicine, but the additional focus of that is is to provide care to women and children. women find out they're pregnant, we talk to them about the importance of getting good prenatal care which takes many visits. we initially will see them for their full physical to determine their base line health, and then enroll them in prenatal care which occurs over the next 9 months. group prenatal care is designed to give women the opportunity to bond during their pregnancy with other women that have similar due dates. our doctors here are family doctors. they are able to help these women deliver their babies at the hospital, at general hospital. we also have the wic program, which is a program that provides food vouchers for our families after they have their children, up to age 5 they are able to receive food vouchers to get milk and cereal for their children.

>> it's for the city, not only our clinic, but the city. we have all our children in san francisco should have insurance now because if they are low income enough, they get medical. if they actually have a little more assets, a little more income, they can get happy family. we do have family who come outside of our neighborhood to come on our clinic. one thing i learn from our clients, no matter how old they are, no matter how little english they know, they know how to get to chinatown, meaning they know how to get to our clinic. 85 percent of our staff is bilingual because we are serving many monolingual chinese patients. they can be child care

providers so our clients can go out and work. >> we found more and more women of child bearing age come down with cancer and they have kids and the kids were having a horrible time and parents were having a horrible time. how do parents tell their kids they may not be here? what we do is provide a place and the material and support and then they figure out their own truth, what it means to them. i see the behavior change in front of my eyes. maybe they have never been able to go out of boundaries, their lives have been so rigid to sort of expressing that makes tremendous changes. because we did what we did, it is now sort of a nationwide model. >> i think you would be surprised if you come to these clinics. many of them i think would be your neighbors if you knew that. often times we just don't discuss that. we treat husband and wife and they bring in their kids or we treat the grandparents and then

the next generation. there are people who come in who need treatment for their heart disease or for their diabetes or their high blood pressure or their cholesterol or their hepatitis b. we actually provide group medical visits and group education classes and meeting people who have similar chronic illnesses as you do really helps you understand that you are not alone in dealing with this. and it validates the experiences that you have and so you learn from each other. >> i think it's very important to try to be in tune with the needs of the community and a lot of our patients have -- a lot of our patients are actually immigrants who have a lot of competing priorities, family issues, child care issues, maybe not being able to find work or finding work and not being insured and health care sometimes isn't the top priority for them. we need to understand that so

that we can help them take care of themselves physically and emotionally to deal with all these other things. they also have to be working through with people living longer and living with more chronic conditions i think we're going to see more patients coming through. >> starting next year, every day 10,000 people will hit the age of 60 until 2020. . >> the needs of the patients that we see at kerr senior center often have to do with the consequences of long standing substance abuse and mental illness, linked to their chronic diseases. heart failure, hypertension, diabetes, cancer, stroke, those kinds of chronic illnesses. when you get them in your 30's and 40's and you have them into

your aging process, you are not going to have a comfortable old age. you are also seeing in terms of epidemics, an increase in alzheimer's and it is going to increase as the population increases. there are quite a few seniors who have mental health problems but they are also, the majority of seniors, who are hard-working, who had minimum wage jobs their whole lives, who paid social security. think about living on $889 a month in the city of san francisco needing to buy medication, one meal a day, hopefully, and health care. if we could provide health care early on we might prevent (inaudible) and people would be less likely to end up in the emergency room with a drastic outcome. we could actually provide prevention and health care to

people who had no other way of getting health care, those without insurance, it might be more cost effective >> we love our parks, but we love... >> and the community who is really the core of it all, came together and said what we need is a place for our teenager to play, not just play grounds for the kids and soccer fields but we need a skate park that will keep the kids home in the neighborhood so they can play where they live. >> the children in the neighborhood and it will be a major boone. and we have generations, the youth generations that will be able to use this park in different places. >> the best park in san francisco right here.

>> creating place where people can be active and lead, active, healthy life styles that are going to just stay with them for life. ♪ i didn't o- >> sound familiar do you keep on getting up there's an easier way. >> of course there's

easier way get rid of of mosquito they breed whatever this is water no water no mosquito mosquito feed on good blood the eggs hatch and stay near the waters san francisco to breathe and the adult underlying mosquito waits on the as many until it's sexuality hardens water pools in any areas and creates places you'll not normally think of budget and any container that holds water and hidden in bushes or else were dump the water and do it over soil not into a drain the larva can continue growing in the pooled water is sewage disthe first of its kind the area if the sewage is two extreme have a

licensed plumber assist water pools in rain gutters and snaking and cleaning out the water when keep the water from pooling and keep in mind that mosquito breed in other waters like catch balgsz and construction barriers interest crawl spaces with clmg is an issue you may have is week to cause the water to collect this is an sour of mosquito so for buildings just fix the clean air act drains and catch basins can be mosquito ground it will eliminate it as a possible location keep shrubbery and growths estimated any water to can be seen and eliminated birdbath and fountains and uncovered hot tubs mosquito breed but it is difficult to

dump the water out of a hot top can't dump the water adding mosquito finish rids the source of mosquito there are also traditionally methods to protect you installing screens on windows and doors and using a mosquito net and politically aau planet take the time to do the things we've mentioned to eliminate standing water and make sure that mosquito are not a problem on your property remember no water no mosquito

good afternoon and welcome to the san francisco transportation authority meeting today. clerk please call the roll. >> >>supervisor john avalos: >>supervisor london breed: >>supervisor david campos: supervisor malia cohen: >>supervisor jane kim: absent, >>supervisor eric mar: is absent, >>supervisor katy tang: present, >>supervisor norman yee: present, >>supervisor eric mar: present. >> next item. item 2 approve the minutes. this is