essentially. so we lost a lot of our automated capabilities so there's the short-term issue of keeping the trains running and making our payments and making orders on time and reconciling systems and it's requiring extra staff and we've been work with the controller's office to understand the i.t. issue but we feel we'll need to create a new interface between the two systems to be able to automate it in the future. obviously we are not interested in doing manual reconciliation moving forward. so it's a one-time increase in the funding we have for a project we expect to use over the first 12 to 18 months of the next fiscal year and they're

continuing to create the modules. there's also other areas in terms of payments where we have manual reconciliation in part due to the conversion issues and we're reviewing the entries and making sure they're all appropriate. and want to make sure we have all the staff for a year-end close which happens in august, september and october of 2018. the budget proposes to create a pool of staffing and allows us to give support for our operations and also proposes for consulting for us as well as a work order through the

controller's office who can help implement better interfaces and modules for the financial system. then the last emerging need is related to the transfer emergency services for our department. as you know, we've been planning the transition for years and it became effective july 1. prior to the transition we did a study on the staffing and program and there were significant issues and there was an additional need for increased analysis and metrics, policies and procedures and proposing a pool of temp staffing to let us

do more discovery on what our operating needs are and then we'll evaluate the costs in the future. next in terms of solutions, we have a one-time revenue related to a 2009 claim for the mental health state plan amendment. this was an adjustment made to our claims and proposed around 2009. after several years it actually we were told to submit our claim and we expect payment. so we'd be pleased to recognize $8 million one time to help offset some of the proposed budget. the rest of the items are budget neutral and a few years ago we

pi pilot piloted a new treatment for hep c to cure patients and the revenues would be -- sore i have, the expenditures of this very expensive treatment which is about $90,000 course is offset by medicare dollars. the pilot has been very successful and laguna hondawood wish to double it from 11 patients for a total of 23 and our request is really just to increase our pharmacy budget offset by revenues. next is our environmental health fees. as you know, we bring our fees forward for your view every year. this year what we've actually added we've added additional positions for additional

inventory and our costs are not for new positions but they are for the work orders for tax collectors to implement a new online permitting system. it will have great impacts on our clients and the people we serve because it will obviously provide greater convenience. people don't have to bring their payments over. they have to come down in person. they can do all of it online. and then also just helps with our internal staff and reconciliation and it minimizes the the paper work on our side and an exciting change on the expenditure side. on the revenue side, we're projecting minor changes based on inventory and one significant change we did do was that last

year's budget we assumed some additional revenue in the food program based on sections relate to cannabis. in the current year the board of supervisors allowed to codify a new cannabis fee we're able to charge. i'm literally shifting the dollars in the program but it's net neutral overall. lastly, our initiative to expand our specialty pharmacy for the san francisco health network would allow our patients to access specialized medications including hepatitis b, oncology drugs at two additional locations. their expenditures would be the pharmaceutical expenditures

would be offset but it increases actions for patients and they've been trained to support our patients or give them a better outcome. so in terms of our overall balancing with last week's initiatives and new initiatives proposed, what you see is we've essentially corrected for the lopsidedness and we are about $700,000 to the good in terms of our budget proposal and fully meeting our revenue and reduction par gets. tash -- targets. there's been a lot of creative thinking on our part but we are pleased to say we're leading the proposed budget. with your approval today we'll submit our proposed budget to the controller's office and

mayor's office. where the mayor will review it and submit his proposed budget on june 1 and then it will go to the full board or budget and finance committee and full board. happy to answer any questions you might have. >> thank you. commissioners, questions at this time? >> my one question which i'll give to director garcia however, was that we had discussed the issue of the tuberculosis control the last budget hearing. >> and i'm still work on it. i was going to be working with our budget folks to try to complete that. >> this would assure with all the changes in both the feds and ourselves that we had adequate

resources for this important infectious program. thank you. commissioners. the budget is well explained and if there are no questions to ask, then we are prepared for a motion for acceptance and to move it to the mayor's office. >> i'll note there was no public comment requested. >> i'm sorry. is there public comment? oh, there was not. so moved. >> second. >> there's a motion to accept and move it forward to the mayor's office. and there's a second? is there a further discussion of the motion? if not we're prepared to vote. all those in favor please say aye. all opposed? and the budget has been accepted and will be moved to the mayor's office. thank you very much.

>> if i could, commissioners, just to acknowledge their hard work on this and to the staff who tried to maintain the initiatives this year so we can continue to manage our budgets. >> yes. and definitely and we had comment on the clearing of the budget. i think the department and the finance people particularly took next issue of the lopsidedness of the budgets and also refined it so it is now an acceptable budget. thank you. >> commissioners, item 7 is an update from the gender health program and evaluation. >> thank you. >> if you have any problems let me know and i'll come over.

>> i am a math person. >> okay, everyone. we're having technical difficulties today. >> good afternoon, commissioners and director garcia. i'm julie graham the director of gender health sf. this is dr. seth pardo. he's our evaluator and we'll be sharing this presentation. i'm very grateful to be back in front of you to discuss the

incredible work of our program so we'll start with -- maybe we won't. >> so our program began with you all in 2012, the health commission approved the development of a program for people to be able to access surgeries relate to their gender identity. in 2013 my program was established. we called it transgender health services and subsequently changed the name to gender health sf. in 2013 medical lifted the

discriminatory exclusions that had been in place that prevented people from accessing care and we got a location and became a for real program people could walk in and meet with their navigators. so what we do -- so we're the first program in the nation to do this, to provide navigation and access to these surgeries. we're just going to click on this on the side. we're the first program in the nation to do this for public health. we provide access to surgery and navigation and education.

we're under i'm a gender specialist and nationally known expert in gender health. our medical director is also a nationally known expert in gender health and we now have a very part-time nurse practitioner which is very exciting to us. as i said, our evaluator is under quality management. we had a patient care coordinator and two vacant positions we're hoping to fill and the bottom line is our core staff. so behavioral health clinician and karen aguilar our hearts and heroes award winner, tamika godwin who is a peer patient

navigator. how that's important because that's our model. the people who work at our program, by and large, identify as transgender or transgender binary and many of us have had the patients our having and so we're experts in that way and in experts in terms of knowledge. the people doing surgeries for us are at zuckerberg and people we contract with because there's so few gender surgeons in the united states and we're lucky to have a few in the bay area.

our referrals have now -- they've started to get steady and moving back up is what they're seem like but i'll let you talk about that. >> i can demonstrate this and it's a pleasure to present for you. the numbers are increasing annually and though the orange bar which are the surgeries completed are less over time a lot of is because the program takes great care to make sure the patients are prepared for surgery so everybody goes through the education preparation program and through a rigorous assessment of their medical records to make sure they're stable and ready especially in a vulnerable public health population. what is of note is over the

years amongst all patients the number of surgeries completed is essentially hanging steady with this green bar in the middle. these are the number of patients who have discontinued or not been eligible. in the data some of the predominant reasons for eneligibility has been changing of insurance, mainly people get jobs, they get better insurance, they're no longer on the health care and that's a good thing or change providers so they're no longer in that work so it's not bad they're not eligible for this but moved out of the main service category. for all surgeries completed so far for gender health sf

>, most the surgeries completed have been in network another really great thing. most have been for transwomen. you can see the blue and purple side of the pie chart represent both breast surgeries so mem -- feminizing mammoplasties and the vaginalplasties. most surgery covered by the san francisco health plan. 70% of the surgery covered by the san francisco health plan and 10% for healthy sf. out of network surgeries as julie mentioned, we are competing with a worldwide population who are in need of these surgeries and we have a concentration of the most skilled surgeons here in the bay area.

regarding the program flow and evaluation, julie can speak to the flow of the patient through the program if you care to have -- if you're interested in that flow. for this slide i wanted to draw your attention to the items on the left in the purple box. those are where the evaluation are and we do a baseline of where patient in their quality of life and body address and substance abuse and other concerns in the evaluation. we says how the patient satisfaction in the preparation and education program and the support groups that are run by the near navigators and we follow-up after surgery to see how well the patients are doing after surgery and to see how well gender health sf is supporting the patient. in brief, the primary outcomes for the evaluation are surgery readiness, timely access,

patient satisfaction and quality of life indicators and we hope to see annual relative improvement in surgery readiness where patients feel they're ready for surgery following the preparation and education program add gender health sf and able to access them in a timely fashion and hope with advocacy they can continue to access the surgeries sooner and sooner so they're not waiting as many as a year to two to access some of the surgeries for such a vulnerable population as has been waiting decades. for patient satisfaction we hope to see a minimum of 80% of our patients satisfied. that's a standard threshold. we aim higher than that and finally for quality of life we hope to see relative improvement to baseline for quality of life indicators, psycho, social,

wellness and decreases in body disphoria and for the outcomes we're mostly on target. 80% of the patients served by gender health sf felt very or completely ready. we asked how ready do you think you were before the surgery which is a testament to the preparation the staff are doing for the patients. over time, the wait times have increased for out of net-work surgeries and medical is now funding them and we're now compete a global market and 69% were satisfied with their surgery experience. some of the room for improvement is through the patient and education program to accommodate the unrealistic expectations. people have an idealized outcome for the surgeries and there say

high complication rate upwards of 50%, 75% and when i'm waiting my whole life to access something that i've needed or wanted to have an amazing quality of life, it's easy from a psychological place to think this won't happen to me but it does. and we're working on making sure our patients are prepared for that and with the surgery experience there are active engagements with staff across gender health sf to increase sensitivity training to make sure the patient experience increases over time and we have seen outcomes for psychological and social wellness and connectedness and decreases in body discomfort and gender disphoria as we expected.

>> one of the other issues about people being satisfied with the outcomes is there's so much misinformation out there it's part of why we do what we do. there's so much misinformation many people are disappointed they don't have body parts that are exactly the same as people who were born with penises or vaginas or vulvas and that's a piece of the dissatisfaction is the surgery can't replicate that yet. >> for those who would like to see pictures like me, this a data visualization and so the needle doesn't move a lot down people are experiencing they're

ready for surgery after the fact and this is a graph that shows timely access and you see the genital surgery and the wait times are four times higher than for in-network surgery. >> i just want to talk about a couple key accomplishments in the last year. so up 2016 we started to be able to do evaluations. so that hasn't been very long it's been a serious effort to evaluate ourselves and what's happening. all of our program navigation staff are peers. they're people from the community who have accessed these surgeries or have accessed medical intervention. we have accessed information. we can do more pre-surgery information and preparation for

patients. we have peer-led support groups. smoking is a huge issue and interferes with good surgical outcomes so we're able to address that with people prior to surgery. we have people talking about nutrition and gender disphoria and managing it while waiting for surgery. we're able to talk about hiv and prep with our patients. we have post-surgery support groups and we talk about sexuality post surgery and we have done a number of in-service training including the lgbtq sensitive trainings for the staff. and as i said, we secured a program location and that was huge. most do an intake and if you do

intake with us you'll learn something. we'll do information on the procedures so you know what you're getting into. we do surgery, education and preparation and we've been bringing the surgeons who do these in to do this for us. everybody is able to have a peer navigator go to appointments with them and walk them through the process. we have a nurse practitioner to assist with those worried and are having complications and they're not comfortable talking to their surgeon and we have a nurse practitioner with them and so someone who has a significant mental health issue or medical issue that's interfering with access to care we can keep them moving forward. we do monthly patient education and preparation groups both in

english and spanish. about 26% -- i think 26% of our population are spanish speaking. so it's critical that we have spanish education. we do it's a real goal for us to develop our peer staff. and we were able to money from nhsa hire patient navigators who are peers and using the program through the department of h.r., that was huge. we now have staff who are civil service employees which i fundamentally believe is critical. these are folks who are going to be here for the long term for our patients.

we have increased coordination with surgeons and primary care providers because the surgeons don't necessarily talk to the primary care providers. everything is still very siloed. part of our role is to decrease that siloed experience for folks. we have developed a protocol for under age 18 to begin accessing surgical intervention and developed a relationship with speech pathology at zuckerberg and ucsf which is thrilling because these are things very important to people. let me see if i can make this go up. challenges. so many of the challenges that we face are the same as the last time i was here. one of the big ones is at the bottom, misinformation in the patient and provider community. house is a nightmare in san francisco as we all know. after care, surgery, housing for

people is very critical. coordination among providers i feel is improving and part of our patient navigator and care coordinator. it's hard to take care of people in other counties. people have trouble having follow-up care if they have to go across the bridge to san rafael. the network capacity is -- we don't have what we need and so it does mean people are wait very long time to access surgeries. the fact that we have an overweight population and population that smoke are issues we're actively trying to address in our program. substance abuse continues to be an issue and we work with people abusing substance to move them forward. there's not a lot of facts in this so we're trying to develop

an evidence-base that doesn't exist anywhere. we were trying to get people to open hand for nutrition. people are struggling with minority stress in their life and the impact of that on surgery. many of the vast majority of our patient trauma survivors so there are behavioral health issues and people report they lack a place to be and congregate and we can't offer that. we're too small. neurodiversity there's a number of transgender and transgender binary system in the autism spectrum and that brings up its own challenges in providing care. one of the other challenges that isn't here is our need for elec

trick -- hair removal. i've resigned so we have to replace me. we have to stabilize our staff. so get a new director and fill the clinical director position and get the trainer. we've been missing those key roles and we need to get those filled. we're going to -- once we have that we'll do more training for mental health primary care and the community people think surgery is like what they see on television and it's nothing like that in terms of recovery. many of the primary care doctors have one patient who is transgender so they don't know what the aftercare's supposed to be.

we're working to create a smoke cessation program at the gender center at ucsf and at castro mission. we're working to try and create a gynecology specific care for transgender people. both trans men -- we have a problem with trans men going to the women's clinic at zuckerberg. that's a disaster. we have men that won't go because it's called the women's clinic and we have folks who really need to have a gynecologist to follow them through the process. we want to work on developing that. we're going to formalize a consultation practice for the department of public health so whenever doctors have questions, they really know to call us whenever mental health providers have questions they know to call us. and we can walk them through how to think about the clients they're caring for. last, this is for the staff of

gender health. we have an incredible just hard-working excellent staff they want to thank for all their incredible work. i also want to thank role and -- rolland. he sat through weeks of meetings and we wouldn't be here without him. so that's our presentation and i'm happy to answer any questions. >> thank you very much. commissioners, questions? >> i couple questions. one, is a patient who's identified as having a substance abuse issue preclude from having the surgery if they're deemed an appropriate candidate though

they abuse substance. >> the answer is no. if somebody is actively using a substance that will interfere with their surgical outcome, an example, methamphetamine, it brings you up, sedation in surgery brings you down. those folks are likely to have peri-operative awareness and that's a bad outcome. we work to get people at least sober for a period of time if they're using those chemicals. there's not great research on this and i feel this is something we'll able to contribute to the field because we're paying attention but it doesn't preclude folks. if people use marijuana. you can't smoke cigarettes and you can't smoke marijuana. we work with them to switch to edibles and tinctures. we're trying to figure out to give people what they want because they're self-medicating often for gender disphoria.

[please stand by] .

. >> so maybe that's the worry. not so much what we're doing here, but that there aren't enough providers to respond to the -- we've got a bottle neck, and that has really been a concern from the beginning. >> thank you. >> yes, commissioners. >> i have a question. well, actually, it pertains to actually the education in preparation within the various disciplines. 'cause you mentioned that we have a very highly trained, talented group of surgeons, and the fact that we have an increase in surgeries, and the increase is decided by our colleague here, i guess the thought that sort of flashed to

me is that the different specialties that are certified by san francisco general, we have, iklike urology, which haa number of specialties in it that participate in numerous, i assume, surgeries here, and they have the residency program where they have a major cohort, and their subspecialties, where they have outstanding training programs, and the list to rotate through the general has grown substantially. but my -- not concern but sort of something that we may face is that once we are certified in these new disciplines where

their discipline, they're board certified in urology, but all these sub areas that are involved in all this, a number of them are going to other places, especially southern california, chicago, etcetera. there's a big recruitment going on quietly. i've heard this from a number of those who have completed programs, and patients who were upset because maybe there's no longer a spanish speaking urologist who was a key person there or someone else, and i wondered if, in fact -- if, in fact, you are projecting that there will be even more demand for us to maintain the highest quality of physicians which we have at the general, as we see -- it's going to be a question of how do we retain

them afterwards, even though who are in the bay area and could rotate through there when the competition in other parts of the nation is on the radar? i wonder if you had any thoughts about that, and the challenges? >> so something i think is true, is san francisco is san francisco, and we are doing things here that are not happening other places. we're light years ahead in many things. one of the goals for this program that wasn't on that slide, and i'm not sure why i didn't have it there -- was, you know, over time, over the next five years, we really want to develop more of a training program, official training program with ucsf and with zuckerberg, and that's all really exciting, and i think people do really want to be a part of it. and so yeah, we have to figure out how to keep that momentum going, and i think that's true across all of the specialties that are doing this work. it is -- there's only a handful

of people that are specialists, and they are wanted every where else, and we have to keep them. >> a data point of comment that amongst the eight to ten in service training that gender has for staff throughout public health, average provider was ten, so over the course of 2016, they've trained over 100 providers over competence, sensitivity trains, and in their feedback in their evaluations, they agreed or strongly agreed that they felt better that they were able to take care of their transgender patients, especially with regards to their up coming surgeries, that they wanted more of these training and education sessions; that they hoped following the training to use the information gained from the training to create safer

spaces and to use what they've learned to be more sensitive, to be more competent, and really, the bottom line was they just wanted more, so there is the demand out there. >> very good. thank you. >> thank you. i remember when the commission first approved the development of this program and whether it would also be at general, and it's nice to see after five years, the fruition of this, and you and your staff are to be complimented. >> thank you. >> thank you. >> thank you so much. thank you for caring about this and being interested in it and supporting it because it matters. thank you. >> thank you very much. >> thank you, commissioners. i'll note that there were no public comment requests for that item. we can move onto item 8, which is the sfjph technological

report, and i believe the same issues are going to be with us for theph technological report, and i believe the same issues are going to be with us for tgph technological report, and i believe the same issues are going to be with us for the presentation. >> good evening, commissioners, director garcia. office of policy and planning, and i'm here presenting rdp's annual report for our fisking year '16-'17. overall our annual report provides a general summary of the accomplishments and highlights across dph in the past fiscal year and is required by our san francisco administrative code. the design in look and feel is pretty similar to previous years reports, and we have incorporated some of the new branding for the san francisco health net work, as well. if you recall, draft report was presented to the finance and planning committee back in november of 2017, and the version that you've received now, your feedback has been incorporated into that.

so our report begins with two messages. one from director garcia and one from our health commission president, dr. chow. the two letters provides our leaderships introductions to the report and provide an introduction to our three feature stories that are introduced later on, which is the progress on the electronic health record, dph becoming accredited public health department, and the whole person care pilot. there's also language in these messages around how our programs help address the social determinants of health and dph's commitment for all san franciscans in the face of uncertainty with the aca. the next section, which is about dph, we introduced the two division: the san francisco health net work and the population health division, and their roles in our commission to protect and promote the

health of san franciscans. we've also included our 2017 organizational chart in this section, and overall, the information provides an overview of the functions and services across dph. our last intro ductory section in the report is the overview of the health section. we also include bios for the commissioners that were serving in that fiscal year. following the health and finance committee feedback, we've incorporated the changes into this section. the bulk of our annual report focuses on the programatic highlights, and these start with three highlights across dph in fiscal year '17-'17, the first being our public health

accreditation. we were awarded accreditation on march 9, 2017. at that time we were one of nine health departments in california to hold that crediting, and that demonstrates our -- to the community. the next story is around the whole person care pilot. so the city was awarded additional funds for a total of 161 million for whole person care, which is a medi-cal waiver for california. the pilot for dph is a collaborative interagency effort, with an aim to establish a human centered and seamless system of care for our homeless san franciscans. and the last feature story that we've included this focuses on our enterprise for an electronic health record. our ehrrfp was issued, and it

will not an essential tool to continuously improving our patient experience and ensuring the highest quality of care for all san franciscans. then, moving forward past those three major accomplishments, we also have included 27 shorter highlights this year, showcasing dph's commitment to our mission. there are nine highlights around promoting health, which include our bayview health zone, sf quits. there are 12 on protecting health, including reenvisioning jail replacement, vision zero, and we've included six on our infant structure and ourlene,lene being the key priority for the department. highlights were collected across our services, our programs, and they showcase our key programmatic work across our division. so following the highlights, we do include a major part of the report on data and numbers.

first we have our dph budget. we include the revenue, expenditures, and we highlight investments that were made for fiscal year '16-'17, including the 2.8 million that we invested in specialty mental health services for youth, and the 1.5 in ongoing human resources efforts for the department. the next is our san francisco health net work data. it incorporates encounters across different visits and patient demographics across our hospitals, primary care of mental health, substance abuse and jail health. there's been a lot of effort this year across the network to create a standard data methodology to ensure more accurate, clean data moving forward and the aalignment with sfgph's annual report as well. the next report is the public health data. it focuses on the six areas of the strategic plan with key

programmatic activities and impact metrics within each. we've also included an additional metric on black african american health based on the feedbacks from the commissioners in planning. that was based on hypertension control. and lastly, we include the 13 health resolutions to showcase the major policy actions of the commission, as well. the last section of the report, you'll notice, includes our service sites and our contractors. the maps that we've included for service sites have been updated, and they follow our new branding for the san francisco health net work. we've included one on primary care, and one for our city's behavioral health site, and we've included a note now that all of our contracted sites for behavioral health couldn't be included due to the number. we then end with our community contractors to acknowledge their contributions to the work that we do here at dph.

so moving forward, we'll finalize the report after your -- if you have any additional feedback, and then, the final report will be posted on our website, and you will all get copies -- printed copies, funding provided by the public health foundation, and with that, i'll conclude. i thank you all, and if you have any questions or feedback, i'd be happy to take it. >> commissioners, questions. the staff has taken the comments very well and has i think produced a marvelous report which balances the enormous work that this department has done via -- i didn't count the number of highlights, but you said 27. >> there are 27 and then three major additional ones, for 30 total. >> for those who want to read about the programs and those who are more data driven, can

see the numbers, so it's a very fine balance of both, and i think within the highlights, there are also numbers, those of us who like to know how many people are really touched by these programs. and i think the staff has done a marvelous job in presenting a report that demonstrates that our $2 billion organization's done. although it suddenly dawned on me, we probably didn't actually discuss any of our research this time, did we, in this? >> i don't think there's too much on that. >> and a portion that this department does -- and maybe that is for the future in terms of adding that as a component because that certainly is a very important part of what we do. and i think you've captures,d,

think, both the programmat particulprogrammatic problems and individuals in our entire city, and i think maybe research is what we're missing. >> sure. >> but i -- and the reason i gave this comment was that i needed to have found a copy of this to read within the past hour and are i was overwhelmed within that period of time that you could just feel the energy that you put into and that the department does. just know it's out there, almost every second of every day, doing something in some part of the city, and for somebody. that was the impression i got just reading the document this

morning. >> thank you. >> so commissioner cavekarshme? >> yeah. i just wanted to thank you for the work. it's pretty impressive? >> yes. >> im want to thank you for yor work on this report. i agree with my colleagues. this is very easy to read. sometimes these things are hard to read, and it's laborius, you put it beside your bed, on your night stand, but not this. >> you look at this, whole section by the numbers. how many things -- [ inaudible ] -- there it is. where are the sights? what's our mission? and you've done it. our staff -- it's really a useful document. i mean, it isn't just something to look at and say oh, wow, it

really shares the heart and soul of what we're doing, and our partners that are involved in this total process of public health in san francisco. well done. thank you. >> thank you. >> and i'm wondering, as you're finishing a draft and just to, you know, go back to that thought of research, you think we should put maybe one page, and the amount of research that we are doing, and then, we could expand that next year a little bit more? 'cause this does go to the mayor and the supervisors, and it would be really nice to be able to have them understand that not only are we also delivering services and keeping the health of the city in check here and improving it, but that we're also creating research and informing the world. >> i -- dr. aragon is probably the person you could work with for his section. >> i don't want to delay much

more when we need to move it forward. >> i think we can do that very easy, yes. >> and then, as we have in the past, we can forward this with a letter to each of our board of supervisors and the mayor's office. does that sound reasonable, that we could perhaps add one more page, and then, we would expand on that in the following year? >> i can work on that. >> okay. thank you very much. >> thank you. >> was there any other public comment? >> no public comment requests for this item. >> okay. thank you. >> item nine, commissioners, is other public business. and you have the calendar before you. there's nothing noted in terms of special meeting notes, as we move forward. >> were there any items from the prior year that we had not completely covered or -- ain

calendar. >> i took the past two years' calendar and forwarded all the items that we had calendared in the previous years, and any items that we haven't done, i put it forth on this calendar, so right now, the answer would be no. there's nothing undone from the previous years. >> so we begin with a clean slate. >> at least trying to. >> okay. thank you. commissioners, any items you would like to place on the calendar at this point? i think we already placed one, which was the food program. >> right. >> i should say food security, right? >> which i think will probably go in the fall after director garcia -- there's more work to be done on that in the department before that comes forth. >> right. >> shall we move onto item ten, the jcc report back? >> okay. item ten, and i've lost my agenda. >> commissioner sanchez? commissioner sanchez? a report back on the jcc meeting from february 13th?

>> yes, commissioner sanchez? >> the joint conference committee for laguna honda met on february 6th. we approved the minutes of the previous meetings. it was primarily closed session, reviewing both the quality reports and the medical credentialing reports, so that ends our meeting for -- on that. any additional comments? >> okay. our next item, then. >> a consideration for adjournment. >> so a motion for adjournment is in order. >> so moved. >> and a second? >> second. >> all in favor, please say aye. this meeting is now adjourned. thank you.

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