>> as noted on the agenda the december 5th meeting did not have a quorum so there are no minutes but there are minutes from the november 21st meeting because they weren't approved december 5th. >> right so the minutes before you foray approval a motion is in order. >> i heard a motion and is there a second. >> second. >> ok, are there corrections to the minutes of november 21st? >> not seeing any we're prepared for the vote all those in favour , please a aye. >> aye. >> all those opposed. the mints have been approved. please next item. >> item 3 is the directour's report. >> as you know our mayor ed lee

passed away last tuesday morning at san francisco general hospital and we're really fortunate our hospital was a real important part of this process for the mayor and i also want you to know that we all focused on the work we have to do but also about his passing in grieving as you know, we have a new acting mayor and so we are continuing to do work we need to do and meeting with acting mayor yesterday and we're moving ahead on all of the initiatives that we started. i also just want you to know that i think the process of how the new mayor will be elected is still in play and all of you

will know as well in terms of that but today we have an acting mayor and we are working with herren sureing the health department continues to do its work. we are happy to announce today that the appointment of dr. bob as our deputy director of health and she actually will be replacing me at 3:00 because i have a department head meeting across the street so she'll be sitting in my heat. that is why we have deputy directors. [laughter] >> the president did sign a two- week top gap measure and we're still in the process of understanding exactly where the budget is going and also the agreement on the tax bill reconciliation will take another couple days due to conflict within the the senate roll so we'll hear about that shortly

and we will provide the commission update of what that means for us and on december 4tf supervisorors vote today approve our epi contract and that was really important for us and as you know we're spending $270 million on a new epi contract for our e.h.r. and we're very happy to move up forward ahead of implication of that new project and i'll leave the report at that if there's any other questions? >> on her report please. commissioner chung. >> thank you director. one question that i have in regarding the budget with the new development that it's still

kind of not completely verified about the words that like the -- they would not be able to use they would like to propose that budget so how would that effect our budget? >> did you see the words? >> yes. like the words and and ebc about the words they cannot use in the budgetary process so how would that effect our budget? >> we want to be clear so we haven't seen that in operations yet but one of those words that i know one is transgender so we

still have not our transgender community and how we would want to respond to that. >> interview: i appreciate that and also it's about how to communicate back to our con at this time -- constituents in the local level so maybe that can be something that we discuss in the next meeting. >> absolutely. we can also talk about the programs that we do have for transgender communities where i would think that might be the most impacted could be in our h.i.v. and aids work and as you know, we have millions of dollars we have back filled in general funds so if we have to transfer those activities that are specifically for populations being impacted by this language

and i believe we can do that so we will definitely bring that back to you and get more information as we have and it takes time for them to impact with us the changes and we have been fortunate to have enough general funds we can ensure to provide a continue to provide to the transgender community without the federalment involve ment in that. >> thank you. >> i took the director's comments in the care giving to the mayor during his time at general and it would be appropriate we send a letter of thanks for the service the hospital did provide during that very difficult period of time to the entire staff there for the

work they did. so, not seeing any objects i'll have our secretary present a letter to thank the staff fort care they gave to the mayor at that time. thank you and you can convey that to the staff. >> any other questions? we will move onto the next item lease. >> month public comments for that item, we can move on to item 4 general public comments i have not received any requests and we can move on to item 5, item 5 is the consent calender and if you recall at the beginning of the meeting i mentions the december 5th did not have a quorum and this was scheduled on that agenda so it was never approved and today you can do that. michelle rugels is here to answer any questions and i'll nighted the finance and committee did meet and discuss this and recommend all of the

items foray approval. >> do you want to report on the items you are presenting at the consent calender? >> so my apologies and i was out of the country when that meeting took place and the commissioners stepped in to chair the meeting. >> commissioner -- >> let me go and review there are six contracts or five contracts of very large dollar value but they've all been pre budgeted and um see one, two, three, four contracts for $9.9 million each these are contracts with the the deloitte consulting and nordic consulting for project manager related to

the e.h.r. they were put out for a public bid and we felt that the contracts were appropriate within scope and would defer on time with appropriate deliverable measurable outcomes and i think there were penalties if they weren't delivered in time. so that is part of the e.h.r. project and we had reviewed those and proved some. the one that came on up with golden gate neuro imaging it was a $1.85 million contract and my recollection was it was a single -source contract and this group has been offering monitor ing for neuro surgical procedures for quite a while it's a case-based rate and builds through medical and even though there was no out of way single source we felt that the staff had done due diligence in this contract. this contract also did not have

lbe to it but because they're the only game in town with regards to neuro imaging so this is -- and the last one enterprise content management that's an e.h.r. contract which i cannot remember the details, maybe margarie could come on up and talk about the contract. we talked about it. i remember the other one. >> michelle rugel, i don't remember either. [laughter] i know it was approved by the quorum. i don't have anymore details, sorry, to provide them than what is on here so if you are prefer ing to get more details before you make your decision i can go back down the call. >> i see greg in line but the nordic consulting is several companies that we'll use for

project management for the e.h. r. and -- >> ok, i remember it's the overflow contracts so in case anything cannot fit in to the deloitte contract in timely manner it set up providers that would come in on ad hoc contractual basis so mix the men 's program and implement any of the consulting needs that we have. >> that's exactly correct. the contracts here are we will use some of this authority but part of the approach is to give ourselves flexibility so that when we're in the midst of the project we will have the ability to hire resources quickly and we won't need to enter in to new contract processes which if we go that route that time could set us back on our schedule and end up costing us more in burnt resources so you are exactly correct there's a little bit of

a overflow capacity that gives us flexibility to adapt while we're in mid-flight on the project. >> thank you. if i can just ask in terms of all of the e.h.r. contracts, these are all within that framework and we have already i guess ageed or thought would be our costs. >> yes, absolutely, so we've got and we're going to look at it a little bit more this afternoon where we are in our current budgeting but we got a projection for what we expect to spend on a variety of third party software and consulting solutions that go along with epic and also on the project management category and so these contracts will give us the ability to bring resources on

but we're putting the process in place that we will manage the expenditures against the contract and the budget for the e.h.r. project so we'll have catagories of spending and controls around those catagories of spending that the project team along with my office will be managing to keep expenses within budget. >> ok, thank you. >> questions from the commission ? otherwise it is before us and on the consent calender. commissioner bernal was there so just to say one of us knew what we were doing. [laughter] >> ok,. >> you recovered that very well. >> i see no extractions so we'll proceed to vote and the contract report i guess was just a policy , is that right? >> that is being asked. >> right, well it needed to be

approved. we approved it at a committee level but there was no commission meeting last month so we needed to put it on. >> ok, so seeing no extractions all those in favor of the consent calender say aye. >> all those opposed. good. the consent calender has been approved and we'll move forward to the next item please. >> item 6 is a resolution horn of edwin mally. >> so item 6 is before you and the officers ask we placed a resolution in recognition of the work the mayor had actually done on behalf of this department as one who has actually served under a number of mayors i can personally say that this mayor had been probably the mayor who

had the most support for the departments of policys and the departments' direction as he looked at how it effected the residents of san francisco and i think as we went through the number of years while he was mayor our ability to work with the mayor's office and with our programs, with the director at the lead was one of the most productive that i have seen over 28 years. and i think that therefore the vice president and i have thought it would be fitting to bring a resolution to commend him and to recognize that this was true. the public ceremonys on sunday recognized his great skills in bringing the city together and in moving it forward and spoke of many of his accomplishments

and unfortunately, it didn't have the same recognition for the support he had given to us in the public-health department and i think that the resolution helps' numerous eight the number of things that he also supported which brought an increase quality of life to the residents here and continued to serve as a model for a moving towards responding to the disparitys some of our population were facing and so we have before you a resolution for your adoption and we would then forward to the family. is there a motion. >> i make a motion to accept this resolution as well as a motion if we could, either the director or maybe baba to read

this in to the record for members on television that may be watching. >> dr. chow i'm happy if you take that lead. >> surely. ok, if there's a second then we'll ask, ok, and the director wish to read that in to the record? >> ok. i will. we're ed lee was the first asian american to serve as mayor of san francisco he was the first appointed by the board of supervisorers in november 20, 2011 and re-elected twice and mayor lee was raised in public housing in washington and moved to the bay area to attend law school in berkley in 1978. where as, mayor lee devoted his early career to advocating for affordable housing, rights of immigrants, and rights of rent ers through his work at the san francisco asian law caucus. where as ed lee had a long and

productive career working for the city and county of san francisco including executive district or of the san francisco human rights commission and director of city purchasing, director of public works and the city administrator. where as mayor lee was strong supporter of the san francisco department of public-health, it's programs and its clients. he sought humane and lasting solutions to the issues at homelessness, untreated mental illness, and substance abuse in san francisco. he supported and funded the creation of the city's first behavior health navigation center at humming bird place on on the campus. and he was an avid supporter of the getting to zero initiative and backfield h.i.v. funding for the sfph programs. he launched an innovative program in 2016 to help san franciscoance afford health insurance through the san francisco covered m.r.a. under

the city options. he was a champion for the vision zero collective impact initiative which increases safety for pedestrians and bicycleists while reducing injuries and death. he supported the implementation of assisted out-patient treatment in san francisco giving families a chance at connection to treatment for loved ones suffering from mental illness. he put a generous amount of funds and reserve in the fiscal year 17-18 and 18-19 budget to protect the city against potential federal threats to the affordable care act and healthcare funding. he supported the san francisco department of public-health developments of an integrated electronic health record system through funding of the project and approved innovative funding mechanisms which the san francisco department of public-health could fund the initiative through safe revenue. he ushered in the rebuild of the

sucker burg san francisco general hospital and spent time with patients at the general hospital and laguna honda hospital in addition to visiting the sfdph heath centers where mayor lee created the department of homelessness in support of housing to focus efforts to prevent homelessness and assist those who are homeless. where as, mayor lee advocated for affordable housing and many ways including pledgeing to build and rehabilitate buildings intended for low-working and middle-class joining the board president david chew to reeight the housing preference program to assist tenants evicted through the ellis act sponsoring funding initiatives where mayor lee died december 12th, 2017 at san francisco general hospital and be it resolved the san francisco health commission acknowledges and honours mayor lee for his life-long commitment and dedication to improving the

lives of others through his invaluable public service. his enormous compassion for others and his effective and thoughtful leadership and be it further resolved that the san francisco health commission conveys its heartfelt condolences to his family, friends and colleagues. i hear by certify this san francisco health commission at its hearing at its meeting of december 19th, 2017 adopted the foregoing resolution. >> any comments on the resolution? otherwise we prepare for the vote. all those in favor the resolution please say aye. >> aye. >> all those opposed. resolution has been approved. >> thank you, i will make sure they get a copy of that resolution. item 7 is resolution in honor of colleen, i'll note this

resolution was read and presented at the december 5th information meeting and that today is the day foray approval. >> motion foray approval of the resolution for colleen is in order. >> all those in favor. >> second. >> ok. further discussion. if not all those in favor of the resolution, please a aye. >> aye. >> those opposed and the resolution has been approved. thank you. >> i will make sure that she gets a copy of the framed resolution. >> thank you. >> item 7 is resolution support of vision zero and automated speed enforcement and cindy will explain and the version you have in your packet has tracked changes because it is a version you all passed recently last year, i'm sorry, this year and this is a revised version. >> ok. please, thank you. >> good afternoon commissioners, here with the updated resolution for automated speed enforcement

for your consideration. the original resolution was passed in may of 2016 for vision zero and automated speed enforcement and i want to give you background on the automated speed enforcement and why we're asking for your consideration for an updated version so the version original version was passed in may of 2016 and fortunately that year we were unable to get an automated speed enforcement bill introduced but fortunately in february of 2017, the general hospital with assembly member chew mayor ed lee and the mayor from san jose, the streets act of 2017 was introduced and this bill would allow for both san francisco and san jose to have a five-year pilot pharoah program of automated see enforcement. and the bill after it was

introduced it was double referred so it was referred both to the privacy committee and to the transportation committee the bill passed through the priv' committee and when it got to the transportation committee. they thought it was best to turn it to a two-year bill was we weren't sure we had the votes for it to move forward and the department of public-health has been working closely with the m. t.a. for the past nine months trying to gather support and do more out reach and education not only automated speed enforcement but our vision zero initiative in san francisco. the bill is schedule for the transportation committee hearing on january 9th and we are seeking for commissions and constituencys that supported this bill to renew their support as we go in to this transportation committee meeting in the againing of next year -- beginning of next year.

so the resolution is very similar to the original resolution that was passed and there were a couple updates and the most notable the national transportation board came out with a study that really sum enter theed correlation between speed and fatalities, traffic fatalities and also recommended that all states removed barriers of having for automated and this was a really necessary tool to achieve our vision zero goals. i'm happy to answer questions but our vision zero team is on vacation for the holidays but i can try to answer questions or get back to you with information thank you. >> thank you. >> if not the resolution -- a

motion before us. >> i want to make one comment in the last year i've noticed on the buses the adds about speed and the vision zero desk i find them effective. i slowed down and people around me are slowing down so i wholeheartedly support any campaign to get us there, thank you, very much. >> yes, please, commissioner. >> hi, how are you. >> quick question about a a assemblyman chew, it creates a pilot program for those two jurisdictions san jose and san francisco that with the intention of it bringing results that would then help create a state-wide program?

>> that's correct. there was pretty wide opposition throughout the state and so having the two pilot projects that have local support we thought it would be more effective trying to introduce this new technology and move it forward. >> thank you. further discussion. if not we're prepared for the vote. all those in favor. please say aye. >> aye. >> all those opposed. so good luck. >> thank you, very much. >> commissioners item 9 is the s fph budget. there's a long presentation from mr. wagner. very informative and interesting presentation. >> get some coffee. [laughter] >> as we go in to this we normally would have a less format setting for the ability to have a dialogue around the subject that we have at hand as

in our past planning sessions. however, so for today, we are going to try to do something that would allow everyone to have input and make their thoughts known and prepare for the future by going through each of the sections and stopping at each of the sections for commission and other comments that may come from staff and then proceed onto the next session knowing barbara has to go to a department meeting during part of this if there are questions we wanted to reserve for her we'll wait for her to return. and we'll set those aside. you can make the comment and we would then present those to her when she got back to put them back in to the context.

it's not totally ideal as a set up but i think what those of us who plan this one to do is to begin top layout just before we go in to the budget for the coming year and this may be even more important with the potential transition and changes of leadership and government, where we stand in terms of our resources and how we are planning for the future. so this is a background a year ago we went in to a good part of it where we got in to the details of parts of the pools of funding and hopefully then today one can look at and see how those actually effect programs and what one with do about programs that are related to our budget. and so we will ask for -- is

there any public comment on this topic first? >> i received no request for public comment. >> ok, so, from this point on then we'll have accepted there were no public comments and dialogue will be between therefore the department and the commission and certainly if staff members also have something they want to weigh in on that could help they just sort of raise their hands because this is not really a roundtable and we'll call on them in order to add to the dialogue. i would encourage that we'll need to try this format for right now. so with that, mr. wagner. >> thank you dr. chow. i think the overview and the context he gave is exactly right

we did this last year for the first time and the item was as the city goes through its five- year financial outlook we've tried to kind of piggy back on that process and look within the department of public-health and see where we fit in to that broader outlook to try to give ourselves some background and some context for the budget that we're going to enter in to for the next two years but then also to start thinking beyond that and imagine what the next four to five years will look like in types of decisions that we have to be thinking about now in order to impact our trajectory over the next five years. so as dr. chow said, we've got five sections, i do want to try to kind of plow through this but i do want to make this useful to all of you so i'll let the

discussion and questions to the extent that you have them guide where we spend time. so, first section is just to go through where we are in terms of the city's financial picture and the instructions from the mayor 's office as you know, this year, this time each year we get the official projection from the mayor's office which is sort of a kickoff of the formal departmental budget process and the mayor's office working with the other city stakeholders as a projection of revenues and expenditures for the general fund and uses that to develop policy instructions for the departments to guide the submission of the budget to the mayor's office and in february. so the slides that i'm walking through right now are borrowed from the mayor's office presentation to us so i'll just

recap what that presentation looks like and we'll dive in to more d.p.h.-specific numbers. so there are two things going on , the short term and the medium to longer term and in the short term, the fiscal picture is close to last year. there's a deficit but not what we experienced in the years following the recession and so the deficit is not huge but it is significant and it is going to require some financial restraint to get threw this two- year budget and in the medium and longer term the picture looks different and there are slowing of revenue growth compared to what we've seen in the last five or six kind of super charged years of economic growth and we're still

growth but not at the rates we have been and expenditures are growing faster than revenues, a couple of those areas are employee costs which is always a factor for city budgets and our budget and there are state policy changes including a big one one on ihss in home support services which is shifting a significant portion of that program onto the countys from the state and we have voter approved baseline set asides which are carving outgrowing share of general fund dollars dedicating those dollars to a specific mandated services approved by the voters. we also of course are doing this in the context of what is happening at the federal level so that is something that is area of uncertainty and of course the economic climate is something that is perpetually worth watching. so the high level snapshot of

the approach on the budget is to continue to do financial planning with an eye towards the future of building reserves and limiting the growth in our on going costs and being strategic about where the money goes so that when we have dollars we're putting them towards investments that will payoff over many years and so those are all things that are very well aligned with our approach at d.p.h. and a lot of our focus for the last two years and our financial planning. the instructions to city departments are to reduce our level of general fund support by 2.5% in the first year and 2.5% in the next year so it's relatively similar to last year and last year it was 3% and another 3% so we're on the same order of magnitude. just we'll get to if a little bit more later but the dollar

value of those changes is about 16 and $32 million in each of the two years of the budget for us and in addition to covering all of our other new costs. the other significant instructions and we'll see, i'll explain to you the reasoning for this but again no new f.t.e.s that was an instruction last year we're expected to accommodate our needs and operating new to the budget. so, the mayor's office financial projection again for the update from the five-year financial plan covering four years and it looks at the revenue growth and again the economy is still strong and in certain areas the rate of growth is slowing so we're getting back to a normal, stable rate of growth as you remember during those few years

after the recession ended in the city started a recovering and we're really seeing astronomical rates of growth by historical standards in the city economy and jobs started coming back and property values escalated business taxes, hotel taxes were all coming in at highlights of growth and salary and benefits of course are continued cost growth but projection assumes we have inflationary increases in those rates and some other calculated rates for benefits and pensions and then other city wide costs. so here is the high level picture from the financial projection, these are millions of dollars by the fiscal years of the projection so you can see at the top total sources that's the growth in the revenues for the city and then below is the

growth in the uses if you look at fiscal year '21, '22 you have revenue growth but then compare that to what you see in the uses which is $1.1 billion of expenditure growth and you can see how that imbalances growing overtime to the point where the four-year outlook shows $709 million deficit which is a very sizable deficit now that of course is projection that says if we just let present trends continue doing nothing about it, that is what will happen but of course, we're not going to do nothing about it we're going to do lots of things about it and that is what subject of the financial work we're doing now. one other item to note on this slide in particular is if you look at the salary and benefits

line in fiscal year '21-'22 that number is $559 million of growth and that number alone is greater than the growth in the total revenues. so all of that projected revenue growth is being consumed by the rate of growth in our employee costs. that is the reason for the instruction about no new f.g.e. s the city is historic high in the number as the health department and so the idea here is because of the rate of that growth every time you add new f. f.d.e.s you compound that cost to the future and it's exacerbateing the gap between expenditure and revenues so there's a strong instruction for us to limit our f.d.e. growth for that reason. here is a high level break down of how the cost increases shake out so half of them again are

salaries and benefits we're half the salaries and benefits and then other operating costs and growth and baselines and set aside as i mentioned earlier. on personnel, the number of factors that are pushing on those personnel costs upward, pension is a big one, the picture on the amount the city needs to contribute to the pension costs has changed for the worse for a number of reasons over the last couple of years and it was expected the contributions the pension fund would decline at this point in time but a number of things including a loves a lawsuit, the level of returns on the pension fund's investment and demographic of retire res has changed and pushed the forecast of those costs upwards and it has a big impact on ours in the

city's total expenditures. we of course have continuing growth in wages which is reflection of the labor market and the economic climate in the region and then our health costs for employees are also continuing to grow at a faster rate than the economy. this is another illustration of the effect of our employee costs on the bottom line for the department and for the city and this is a history since 2007- 2008 of the rate of the growth and employee costs versus normal inflation so the bottom green line is normal inflation and the economy and the consumer price index and the top line is the rate of growth in our employee costs so you can see that our employee costs are going much faster than you would have normal inflation in the economy and that's i couldn't see those costs really pushing the gap between expenditures and

revenues and driving the deficit and again the reason for the no f.t.e. instruction. i will pass on that slide and move to the next one. the same concept which the mayor 's office and controllers' office always use to remind us and i find a helpful reminder but these are the bars is the length of the time between recessions so if you have a period of one year of recessions it's a bar graph of one so each year shows the starting point of an economic expansion so you can see that in 1991 for example, we began a period of economic expansions so no recessions consecutive periods of growth that lasted about ten years and

the dark blue-line which is the third from the right is the current economic expansion that we're experiencing so that's been going on since 2009 and we're at a little over eight years and that tells us that if we go through this upcoming two- year budget cycle, without experiencing a recession we will then be in the longest continuous period of economic expansion since we really have reliable economics data so the city is not forecasting a recession but you keep this context in mind it's a helpful reminder we should keep at the front of the mind it's certainly possible from the historical perspective that we can have an economic change in the economic cycle within our planning horizon and we should start to act in ways that create cushion for ourselves if that's the case another kind of caution on the

horizon is when you look at the way that the city has balanced its budget and how we're using different sources to pay for our operating costs, this graph those you a couple of big one- time revenue sources that had been used to balance the budget and first this fund balance that is the dollars and the surplus we end the year with and spend forward coming the two year budget and the blue at the top is the property transfer tax and the property transfer tax is when a property changes hands it comes in to the city's general fund you can see how it has grown dramatically over the period of the economic expansion that's due to the rise in property values and you can see also kind of what happens to that revenue in prior periods of downturns. it's susceptible to the economy

so a lot of city's financial projections and our current budget is balanceed on the assumptions that we will be able to continue to see that high rate of revenue from property transfer taxes if there's a change in the economy that significantly effects property values that can drop significantly it's a risk to the city's budget. >> so looking forward i won't go in to these in detail but risks from the federal you are familiar with most of the number of different area were policy changes that could effect income to the city the biggest and there was to be a change to the medicate funding have been proposed earlier in the year in congress that did not go through and it's something we need to be mindful of that could have a significant change to our financial outlook.

so again, instructions from the mayor's office on going reduction of 2.5% and another 2.5% in the second year and don't grow budgeted f.t.e.s we need to submit a budget to the controllers' office by february 21st could combine with those instructions and our numbers are 16 and a half million in '18-'19 growing to 33.1 in '19 and '20 so those are numbers that are big numbers but they are within the range of instructions that we have met in the past. so that is a summary of what the mayor's office presented to us and i'll take a moment and see if there are any questions or conversations on it. >> questions from any commission ers?

>> see how clear you were. >> we'll troy to keep the streak going. >> what is our total budget now? >> our total budget is a little over $2 billion. >> ok. >> so we're putting the 16 million-dollar in to that context? >> yeah and so the $16 million, the $16 million is not total reduction to our budget but it will be after you take going from the current year to next year you build in all those increases that we know will happen so pension costs and labor contracts, inflation an our pharmaceutical that's will push our budget up and we're being asked to reduce that higher number by $16.5 million so in actuality the mayor's budget instructions is really not a cut to us and this is been the case in the past several years where essentially it's saying you are going to grow but

please restrain the rate at which you are growing so we can keep expenditure growth closer in mind with revenues and so why want to get the impression it's like a nominal like you have to reduce your budget compared to the current year so we'll grow and trim back on that growth. so next -- >> commissioner. >> i just wanted to thank you, this is -- it's an excellent protocol of what happened and it all changes even the last week the votes with congress our mayor and it's interesting when you look at it and you shared it especially the draft from 1945 we had this period of growth compared to where we are now and you think about what happened

from 45 on and you think built investment i.e. in hospitals and education and rebuilding this station and building schools that's institutions of higher learning and the g.i. bill providing all of these services so we can make quote really what the nation is all about and we take a look at where we are within the last whatever and you think about west longest war ever 16 years and you look at the industrial military complex and how many billions were spent and our schools are, everything else that was built before were education was free and we invested in education and all of our people and now it's astounding it's like we're two different world's and the other variable where there's a shift even locally in administration i cannot remember closely when

they were killed and dianne came in and george had his own way and we are going to zero base budgeting and all of a sudden we had it revised and our staff went through a whole top see topsy-turvy and we've had outstanding input and we were able to track the best of the best and you folks have been fantastic but again all these variables are -- it's like really watching two nations that are totally different and what we're about and thank god for the city but i mean, we're going to be hit as we all know i mean, the variables brings us back to there was a out beat client but i think about the leadership over the years and as our president has said our mayor was such an exceptional person and

there was a thing called men to match our mountains and they looked at yo sem tee and so fourth and you think about we had a mayor that not only match people went through mountains building those railroads, building access here and all those clinical trials that went through and look what he went over the mound and his commitment to what our institutions were, what our democracy was is unparallel and then here we are in this other world dismantleing everything, we all know it's every day and you think where are we as a nation but thank god we're still here in the city county still navigateing that we have a lot of challenges but you staff have been through so many challenges

and whatever and there's going to be more challenges coming in but as was mentioned in the services, they wanted to thank all the staff city and county who have really pulled together to go through where we are now and why we have the ability to do some things and some things will be challenged on but it's a team effort and anyway, the leadership you just had will feel never get again and restore dignity to public service, to what our mission is and what our values are as the city and hopefully as a nation at one point. i'm sorry, but again this budget was a budget designed by this crew. the crew and the mayor's crew and that may shift and we'll hold stead fast. thank you. >> and i will say to one of

mayor lee's legacy is investment where maybe not everybody was stepping up but the city stepping up to make those investments and public infrastructure going back to a city administrator he was one of the authors of the first capital plan and the first new version of the capitol plan and it included the rebuild of san francisco general hospital and it included the bonds that were currently spending on and it included parks a lot of that infrastructure and so i think that has been one of the f. we look at the world that we're in right now that's a big piece of that context is where we have had resources locally and we have made an effort over the last many years to invest those is in public infrastructure that hopefully will payoff over many years to come. >> thank you.

>> thank you. commissioners, any other comments on this and we appreciate the perspective commissioner sanchez put us in to in terms of these aren't just mayors' instructions. we'll move forward to the next item getting more directly in to our general fund. >> all right. so i am included here as the request of president chow and others a slide we did at last year's presentation for some context and clarity on the general fund because as you know the general fund and the level of general fund support is what really driving our budget process is what we're balancing to throughout the process and there are a couple of words that we get tripped up on often times in our financial and planning committee and other contacts which is the general fund and

our level of general fund support which is what we're balancing to so the general fund is an accounting fund in the city and i think i've got some old lingo up there since we've changed our accounting system but it's app accounting fund and it contains a lot of things and it contains general tax revenues and it also contains revenues that come from the state and federal and it contains fee revenues and it's used to pay for a lot of different things in the city and a lot of different departments including d.p.h. so within the general fund, which is an accounting fund, there is concept called general fund support and within the general fund there's a pool of tax dollars that comes in their local tax dollar and those local tax dollars are available to be allocated by policy decisions

from the board of supervisorors and the mayor's office so you can see i have a graphic here showing there's the general fund within it and there's a pool of unallocated general fund dollars that can be spread around to diffuses at the discretion of our elected officials so d.p.h. received dollars and general supports those are the dollars that are between our revenues and our expenditures and we also receive dollars that are federal grants and we earned federal and state and commercial revenue through a services that they provide to patients throughout the network and we have a significant portion of our budget which comes from that un allocate general fund dollars and it's our general fund support so the graphic up here say little convoluted and i'm happy to dive in to it if it's

useful to refresh the ideas is there's that general fund un allocated dollars those have to be spread around to fund a whole bunch of city and county services and police department, fire department, rec and park department, health department, human services department the whole range of services and so in a sense we are competing with all of those other departments maybe competition is the wrong word but they're competing demands on that pool of un allocated general fund dollars from those important services that the mayor and board need to weigh each year to balance the budget and because the demands on that pool of funds is larger than the available funds every year, that's why we're asked to take actions that restrain our rate of growth and our draw on those funds. so just to give you a little bit of a sense of perspective on how we fit in to that picture, this

is a table from the city's approved budget our adopted budget you can see for example on fiscal year '17 and '18 each department and it shows how many revenues is generating and how much allocated general fund support it is receiving so that column is important and that is the amount that they're receiving from the mayor and the board of supervisors through the budget process through that pool of local tax dollars and then they're total sources and so you can see how the dollars flow for example and there's the police department in this first section which earns $128 million per year in revenue but it receives a subsidy $460 million from the city's general fund and so on and so fourth. the department of public-health is highlighted in blue.

we earn 1.5 billion in revenues from sources but we receive 715 so we draw the pool of local tax dollars that gets allocated for us for our services. the total in the box is $4.2 billion so we receive a substantial amount of that but not the per ponderance when you look closer however, there are a lot of constraints on the discretion over the funds with the mayor and the board of supervisors have to make decisions and this is an example from fiscal year '17 and '18 so of that $4.2 billion that is legally available for the mayor and board to allocate out to city departments there's about

three quarters of a billion of that amount that is locked in and mandates so for example, the voter say we're going to require in the charter that x dollars gets to this specific service those dollars must be allocated and the mayor and the board have no discretion to allocate them otherwise and there is about a billion of that 4.2 that goes to pay for general city responsibilities which is things like retiree health subsidiaries , health service administration costs and those dollars that we must spend keep city services running and we're obligated do not have a policy choice to make to reduce them without other action and that leaves about $2.5 billion that is available that is truly a matter of policy addition correction so in that light our