this meeting will come to order. >> commission (roll call) >> the second item is the minutes of the meeting of february 20, 2018. >> the comments are ready for approval.

>> so moved. seconded. >> are there any corrections to the minutes? if not, then the minutes are before you for approval. all in favor please say "aye." all those opposed. the minutes have been approved. >> from was no comment comment. item three is director's report. >> good afternoon. yesterday we had a wonderful celebration, culmination of the last 8 months we have been work on the grand opening of the san francisco healing center. what this was is astute of mental disease, a locked facility for those greatly disabled. we are including people who also are incompetent to stand trial. we have many of our community members who are out-of-county facilities. part of it is bringing people back but also to build more

capacity. the services start march 12th. it is a 54 bed program. one of the most, i think, exciting parts of this was we are located at st. mary's. they had an empty store. we negotiated that with crestwood, our provider who has a great history of really providing a recovery based programming. we had a uc health provide us with $1 million for renovation as well as dignity. it is a $3 million renovation. it was a great opportunity to show that kind of partnerships with both the nonprofit sector of the city and a hospital as well. we had lloyd dean, the c.e.o. of dignity, the c.e.o. of uc health as well as the mayor and members who were excited about the

opening of the program. as we have been watching around the country and internationally, the issue of fentanyl and the poisoning of illicit drugs has been in san francisco, and this last couple weeks on february 27 we had three victims of fentanyl poisoning. this is important for us to be on top of and as you know in the last month or so the commission has supported a safe injection service really reaching out to this population. the four areas we have worked with are drug users, those who provide services are to have narcan and to be able to be trained in that. we have over the last 10 years provided and trained drug users themselves with narcannery versal. we try it first to make sure it works.

don't use drugs alone. stagger use in a group so someone is alert to help others. test the drugs with fentanyl with tester strips. we expanded our access to naloxone to the pharmacy walk ins. we are putting the narcan available in the needle exchange access points and different organizations are also doing this. we are trying to do outreach and engagement with drug users and trying to respond to issues that happen. we get a lot every response to the particular three deaths in february, including a lot of education to people in the shelter system and all of the programs that do provide care four drug users. as you have known on stealth, the cold and wet weather. we have been working with the department of health and human services and department of

emergency management to ensure that we are able to provide shelter beds for many individuals and so w we are working very closely to these entities to find additional types of temporary shelters for individuals. i think i am going to stop there. if there are any comments from other item this is the report, i will be happy to try to address those. >> commissioners, any questions to the director on her report. she was excited about the san francisco healing center that has a very large article on monday's paper if any of you have not seen that. commissioner lois. >> the comments sucked many years ago -- comments many years ago we didn't have the capacity

in san francisco for the patients needs i appreciate the work that they did in relationship to this. >> i failed to make sure that we give our staff member kelly here who is the designer and supporter of the program did a lot of the groundwork in working with entities including the state cdph and healthcare services to get take facility off the ground. as i said, in our opening she was the lead on this project. >> commissioner sanhugo chavez. commission -- commissioner sanchez. >> i think that st. mary's has done an exceptional job in this area. you can't help but think, sometimes the pendulum swings, a number of years ago proposition

q means we h2o the closer. we voted and had hearings from parents and everybody in city. no way. this is going to do an injustice to the quality of care for kids and families in this area. they went back and went back and came back and they salvaged it. they said we will continue to make a commitment. now look at it. we are getting other institutions involved in supporting these efforts to address these problems. i want to commend our leadership who is consistently focused on the needs of the total city to work together with a multitude of services and institutions and hospitals that before were in key competition to work together to support did he have for the r quality service in these times. >> i hope we can do as well on

the skilled i nursing in terms f cocollaboration. >> our director of the network is tag lead and having conversations about addressing that. >> thank you. >> i note no public comment on this item. >> mark, did you want to note the change in an agenda? >> i am not quite sure what it is going to be. i am not seeing the presenter. is doctor mark going to be here? i think commissioner that we might be best to move on and then see if mr. premo comes. then we can move on. great. would you like to announce? >> commissioners with your

permission we want to be able to change the agenda for the presentation of the public and health and safety bond prior to the ucsf research presentation. because they follow in a certain order. if that is with the approval of the commission, we will make that change. we will put the medical staff by law revision as soon as also when doctor marks gets here. >> thank you, commissioner. >> let us proceed with the current position of our agenda. item five report back from the finance and planning committee from today. >> good afternoon, commissioners. the finance and planning committee met before this commission meeting earlier today, and we had put on the

consent calendar one contract report and five new contracts for your adaptation, and we also have a presentation by mr. wagner on the second quota of the financial report which he will present here as well. we also have had a great discussion about how we actually de term what outcome we have with the dollars in all different services in the city as the department of public health. i think that conversation will continue because personally i think that unit of service means different things in different time. the more that we can actually create a dashboard to look at how to measure those out comes just like what san francisco

general and they did with the dashboard, i think that gives us a better sense how the money has been spent and what return do we get out of it. that is an ongoing conversation. we welcome any input or questions or feedback that any commissioner might have. thank you. >> commissioner loyce. >> commissioner ch un g. in another life i am on a foundation board of directors. what we are talking about in terms of funding programs in the community is outcome objectives. we don't have an answer to the question in terms of outcome objectives. what we have done in terms of funding these programs, do what you need and tell us the outputs. we don't know the impacts of the

dollars. we are trying to figure that out what we fund in san francisco. i am looking forward to having discussions about outcome objectives. >> thank you, commissioner. >> further comments to commissioner chung? if not we will proceed to the next item. there is no public comment for item five. 6 is the consent calendar with the contracts report that commissioner chung just noted. >> the consent calendar is before you. are there any extractions from the consent calendar? we will vote on the consent calendar as a whole. the concept calendar has been adopted. we can move on to item 7 the 2016 public health and safety bond update.

>> mark primo. joining me is terry from zuckerberg. here is the presentation. the last time we were before you was in september. we tried to get in during the holidays, then the calendar was jammed. here we are in march. i am going to go over the financial part of it, then turn that over to terry to talk about the accomplishments in september followed by joe talking about the more details of each of the projects. this is just the recap of the first sale tha that we had in

january of 2017. remember this bond was one of three other agencies together with the support of housing and the fire department. this shows you our portion of that $350 million broken up between the zuckerberg campus with the majority of funds and the three clinics southeast, max inhall and caster mission. this shows a rate of spending. we should be about 25 to 30% spent. we are a little off just below 20%. that is due mostly to some of the reviews where they had to go back for an extra back-check and the bidding climate. we received bidding protests

which slowed things down in construction. we are spending okay but not as much as we thought. this then shows you how much for the campus and clinics, $23 million spent. 18 of that is actual money spent. the rest are contracts extra get epcumberred. on the -- encumbered. on the clinic side. i am turning this over to terry. >> this is like the smother brothers. accomplishments. he is talking about where we are at. it merges together. we thought we would do it together. looking bat at the come -- looking back at accomplishments. in october 2017 we went with the

rehabilitation departments. that got rejected due to a bid protest. if you look ahead at december, we rebid and were successful and we got a successful bidder. they are working on the award now. back in october the the the ina structure was 50%. retrofit going back and forth right where we are now, it is the peer review because we are meeting with the seismic work, not a state standard. we an regarded the office search space. that is coming along. we are close to issuing the ncp for that project. then the relocation review

continues. one thing on the office space it was under budget. that is tracking in the right direction as well as the rehabdepartment came in under budget. it is our job to keep it there. towards the end of the quarter urgent care clinic is finishing. that will be complete and we will move to phase two which is a group of groups like wound and fna to be develop. that is the zuckerberg and the public health lab in january went back. that is moving along as well. that completes the accomplishments. moving to inventory care accomplishments. i want to note none of the work accomplished has been due to

cathy j un g. she has done a lot of work with the project delivery. the managing efforts. back in september we started the -theo phase two of theory views. concept design and construction review. both received approval in the past quarter for the phase two design, and then we had phase one approval in january for southeast. we did have the advisory committee meeting. we received a lot of positive feedback from that committee meeting. then the last part of the quarter they were review for

historical reservation we got approval for caster hall and the mission is review. reviewed. >> good afternoon. joe chin public works manager. i will focus on the milestones and scheduleds and activities on the zuckerberg and community health center. to look at program wide we are still tracking well. we have encountered delays associated with extended review for plan checking as well as adverse bidding environment for the owner side. we have had issues that we are working through with planning department reviews for historical preservation. all clinics are fairly old in

excess of four or five years. this is triggering historical preservation review. that approval delayed the projects. let's go to zuckerberg sf general. the teams are focused on to party one projects. we are all doing fairly well. we will be in construction next week. ntps will be march 12th. that is when the contract will go to board with demolition in building five followed by rehab department project probably in the second quarter of 2018 when we anticipate construction starting. to put it in perspective, once we start construction next week, there is ongoing construction activities significant activities for the next few years. this is just the first of a

series of bond projects to keep us going for a long time. the remainder of the projects are still in plan review or in the final phase of design. at this point we anticipate approval for all of these party one projects by the end of the year. then segway to construction starting in 2019. moving on to the next slide. in past presentations, i have talked a lot about the zsfg building five project. i want to spend a few minutes to talk about this project. it is going to be one of the largest and most challenging projects in building five. it is one of those projects that

requires coordination, communication between the dph and contractor as well as with the design team. in this slide what i want to point out is kind of the all all strength of the scheme. focus on four scopes. we are talking about cutting out existing concrete sun shades or creating or cutting the concrete slabs to create a wider seismic joint. we have fiber reinforce meant to make the columns or slabs stronger to resist earthquakes. we have demolition of existing concrete sun shades and also building new beams and columns to support some of the slabs as well as new foundation that is the overall scheme. to look at further is this project itself is going to have

a direct impact of 206 room this is the entire building. that is fairly significant. the room impacts or direct impact ranges from eight rooms on the ground floor to 31 rooms in the upper floors. on top of that indirect impacts to the adjacent spaces. this is one of the projects we are working closely with dph staff, terry and his team and the dph health and safety to make sure we understand the issues and dealt with them during design and not run into an issue during construction. this next slide takes a more detailed look at one floor on this level. it is fourth floor 31 rooms

impacted. i won't go through all of the issues. the message is very clear that there is going to be a lot of impact, a lot of coordination and communication that we will tip to do with the dp staff. the areas are highlighted in color that represent the direct and indirect impacts on "the space" during all of construction work. obviously it is a project where we need to do in phases to work out the logistics of moving people out, doing the work and moving people back in. that is one of our challenges on the project. then just one of the strategies of the team has been looking at is doing a mockup of the area i circled in red. that is the current proposed location that we want to hire a contract or to help us further assess out the potential impacts

and sound issues and become better mitigation measures to think this through before we jump into the larger project to avoid identifying issues during construction. moving to the southeast health center, the team has been focus on design for the project. design is currently scheduled to finish first part of 2019. civic design review went well. january we are planning to go back to civic design review for phase two review with them. it is the second quarter of 2018. it is coming up fairly soon. the next slide i want to share some of the recent rendering presented to design review. as terry mentioned, it was well

received by the community as well as by the civic design commissioners. as a matter of fact, i have a quote from one of the commissioners. i will read that to you right now. southeast health center is one of the more thoughtful projects out of public works. extremely well presented. this is great accomplishments for our team. also i want to recognize the partners and that including cathy jung and lisa who guided this to where we are today. it is a team effort to work on the successful presentations for this project. then moving to community health center, the work is focused on two community health center is

maxine hall health center and castro. they are both in design. we are working toward completing design by the third quarter of 2018 with hopefully construction starting toward the end of 2018 or 2019. i mentioned earlier one of the delays we had was the extended process in going through historical review with the planning department. we have gotten approval for maxine hall that is a big win for the team. i expect feedback for the castro mission on the historical review hopefully by the end of march. that we are tracking as a risk item right now. so the last slide is overall program schedule. i don't want to spend too much

time on this. i talked a lot about this earlier. this is a summary format. one item i want to mention we are working with dph as well as the rest of the team to really further haven't out the schedule for zuckerberg hospital. 19 core projects. currently it shows only project one. we are trying to make it more meaningful to track the 19 core projects. back to mark so he can finish. >> thanks, joe. you recall the mayor signed the lddh for the research facility last year in february. we executed it in october so what we are focusing in now is closing the escrow. there is a number of documents listed here that we are working on together.

also, there is some key milestones. you can see this is the presentation, doctor car lime is -- doctor carlisle is here. we are meeting as a team between dph and ucsf every three weeks. michael and i meet every month to see if there are any roadblocks the team has. we have an effective organized method of approaching this important project alongside the work we are doing on campus. we could take questions on our presentation or i can ask michael to come up and reserve questions after he presents. >> commissioners, why don't we proceed to get a full picture by having our presentation on the ucsf. >> thanks, commissioner.

michael. >> for the public this is item 8. it is the zsfg research general hospital and trauma center. >> good afternoon, commissioners. i want to get to my presentation. good afternoon. i am glad to be here. this is our first opportunity to talk a little bit about our process. just to remind everyone, we are going to build on the indicated site on the bc lot and we have

been doing a lot of site investigation recently of the site and we are also starting the procurement of our project team, which in our case is going to be a design build team that works under a best value arrangement with ucsf, and it is a transparent design process. it is more what is called integrated project delivery than the traditional design build, but it does make the team responsible for the delivery of the project within the funds available. it does not preclude design excellence or high performing

building. mark's team is involved with us on this. they are sitting on our selection committee and will be observing our process as we go forward. to remind you, this is where the project is going to be. as mark said, at this point the ldda is approved and signed by both the city and university. we are mostly done with our site investigation activity and our project criteria document. we are in the process of procuring the design and construction team, which will be done in june. the design is scheduled to start in july, early july which is why it is labeled q3. that sounds late. actually it is the middle of the

summer, and this schematic design is to be june, july, august, september, october. a four month period. then in november, we will be working to finish as many if not all of the escrow documents. governing bodies, of course, need to approve. the regents need to approve the design and budget. the parking relief plan needs to be approved by the board. then we can start closing escrow and also i should note the believe permits are also -- the building permits are required for escrow to close. we typically because uc permits

its open construction, i have a building department that reports to me. we work on deferred approvevals mostly. we will issue foundation permits to get us started on the site. that will be the permit issuance for construction. our design approval by the region and the permit by the city for the road and the site are the other permit issuance that pertain to escrow. road improvements and rebuilding construction periods are noted and then we are targeting a move in in early 2022. any questions on the overall schedule? >> commissioners we should

probably take questions in total. i appreciate your presentation at this point. we will have comments as we go along. >> that is it for now. we don't have the nice pictures to show you yet. we will come back with those. don't worry about that. >> okay. i note that you had mentioned the integration. let me first make sure how that is working between the two teams then i will take commissioner sanchez's question. >> we have all of the team members, terry's group, joe's group and we meet every three weeks and go through a whole detailed checklist, actually michael's staff and we are going to join them. we are trying to tie in all of the action items into the ldda

to satisfy the legal document and at the same time we satisfy all of the technical issues with building a project like this. then michael and i step above that at 30,000 feet and look at the landscape to see if there are any things to stop us from moving the way that we think we should into the future and getting this project done as soon as we can. it has been highly successful. there are a lot of logistical things as you can imagine being on a tight campus, how trucks could in and dust and dirt and how we handle that and the communication and messaging. all of that together is being consider. >> thank you. commissioner sanchez. >> i just want to thank both of you for the update and especially the unique efforts to collaborate. as you are underway on this

transpaper see and based on our -- transparency and working together as the health commission and the regions of the university of the california separate by the state how it is a very, very positive effort t ensure that we maintain the highest quality faculty and training programs in the nation at sf general based with ucsf. as far as healthcare, it is to us one of the top priorities. i know there is going to be clinical trials sometime. we are dealing with two agencies. i am glad we are working together that is bart of it. we -- that is part of it. we have to focus on the end result. that is why we are all involved. it is a great effort, gentleman and staff. we are pleased with what you guys are doing. >> thank you.

i have been work on this project for 10 years. you haven't met we. i have been working with sue carlisle and her staff for that long. mark and i have been working together for about seven. >> again, i would say that underneath the building we are going to be redoing now, building five, that was the old general hospital, our first office there in the late 1960s. we have seen the new hospital then. the one we are going to retro fit. then we have the new zuckerberg. it is a continuum. the beauty is there is more inclusiveness and openness and collaboration pertaining to ucsf and department of public health than ever before in the many years i remember. i know doctor chow feels the

same way. we want to maintain that and we would be glad to do that. keep up the fine work. >> commissioner loyce. >> unlike my colleagues i don't know what all this means. what is ldda? >> lease disposition and development agreement. what that does is governs how the building gets designed and permits. after escrow closes we sound a ground lease with the city and that governs how the city as landlord over the next 99 years interacts with uc. >> thank you very much. >> in terms of trying to integrate this because it would appear as i also look at our

presentation under ourselves as we are building -- working on building five which is immediately adjacent to the new site, there should be a way of integrating the presentations that we get in terms of progress reports and obviously there is a different level of responsibility which i understand, of course, goes to uc and ourselves. we are all working on the same pieces of property and using the same roadways, what i think i am asking is to see if there was an integration in which we could receive both reports together or certainly references back to the other reports, and i am assuming uc is working with you all on

the project because you could bring in all kinds of things to upset whatever they are doing, right? >> that is a good idea. we should condense the presentation as collaborative presentation. we meet -- the meeting where the entire team comes we are working on a conceptual site logistics plan to look at the movement including our work, their work, how pedestrians travel through the ada parking. when we get that graphic complete, that will appear in in the presentation to show you all of the thought that has gone into coordinating the site. >> as you could be your program schedule which needs more lines to show where we are versus

where we anticipated our responsibility. at the same time we appreciate that from the university side. we understand where we are standing with you even though your responsibilitity is to the regents in having this. if we could then be able to look at that and measure the progress and obviously on our side we have the presentations on the other copy of work we have and many more projects. for our signed as you are going to to main projects within our building. you have a whole list of priority one and two. i think those have to be flushed out so we understand. you have now told us the urgent care center is ready. that is great and that is a milestone and should be marked off. we arwe have done that.

we need to understand the priority ones and twos and which ones are pulling behind. is renal dialysis coming in? it is important for more detail from you. we need to get the understanding where they are with their project and how that is tracked and integrated with ours. >> i don't want you to present your presentations for us in terms of our projects. >> you are absolutely right. we are in some ways ahead of uc because we got approve for moneys from 2015 and 2016. we are in pieces of tractions where they are putting the team together and don't have egypes approval. we could show progress from the previous meeting so you can game

where we are. if we lose on one project we gain on another. that is the intention. joe from dpw got the scheduling consultants on board last month. these are the same people that helped with the new hospital. they will do cost verification and scheduling. that will be produced at the next meeting. >> commissioners does that meet with your approval also? i do have several questions -- i don't have any on uc except we are here that we do get presentations on the basis it would be certainly no less than we receive presentations from ourselves to understand how the progress is moving. does that make some sense? >> sure. >> right now it is o on the

calendar quarterly. >> yes. what i did want to ask just out of curiosity. to mr. primeau. the seismic at chinatown, i assume they can continue to operate and we don't have a real problem and this is preventative or there is as much a problem as we have here? it is over a tunnel. >> one of the things we are doing is looking at all of the sites and looking at geotech any cal information which really isn't current except for the new building we built on campus as well as two of the clinics. we are stepping back to do the dew diligence we need to understand the seismic

vulnerabilities. you start with the soil and capacity of that soil when you put a foundation in. we are stepping back to do that because until we development to bond we didn't have funding for that is we are analyzing them and coming up with a seismic hazard rating. we want to rank all of buildings and clinic. this is one of the worst. the worst is city hall across the street. we are going through that process right now. >> we will hear that. i don't want to hear the clinic is closing tomorrow. >> we are struggling. i want that clear as to what if and how do we do this? we do not want to close. we know the complications of that. we are stepping back to give

options to make sure we do not stop service that is a big disruption and the number one key issue on the community sites. we have a logistical process which we are going through to look at are there other options for us? can we stay in the building? do we have to work different hours or serve different hours to allow for the seismic upgrades. we let you know i don't have that information myself. i asked the staff to dig into that literally and figuratively. >> i appreciate the assurance of all of our clinics. we want to be sure we suddenly don't have a disruption of service as we do our due diligence. >> thank you, director. on a quarterly basis we expect to receive a report from both i

think the university's progress and of course our own more detailed report on the work on our bond issue. >> absolutely. thank you. >> no public commit. comment. thank you very much. congratulations to the university on getting its approvals for the well needed knowledge. you have been working on it 10 years. some of us discussed it for longer. we are gratified that this is finally coming to fruition. thank you. >> item 9 is the bylaw revision. to note this was discussed early in a robust discussion at it was approved at the october 24, 2017 meeting.

>> good afternoon, commissioners. i am chief of the until staff bringing to the commission revision of our medical staff by laws and rules and regulations which were last revised in 14-15. as mark mentioned these are developed by the bylaws committee over a -- committee over a six-month period. they were approved by our joint conference committee. they are extensive revisions as you can see from the 8 pages for the bylaws and another page for the rules and regulars. rather than going into detail i will be happy to answer any questions you might have. >> commissioners questions about the presentation or in regards to any of the changes that are

being proposed? you do have before you a spreadsheet of all of the different changes. the one that the joint conference had taken up and was clarifies is in regards to article sixty page -- article six that is on page 3. the commissioner asked about this. i believe that we have received satisfaction in regards to the statement that does not impact upon the prerogatives of the medical staff or hospital, but relates to the actions that might be taken as the individual may be an employed position of either the county or the university. is that a fair statement?

>> yes. >> that is on the corrective action. this is new and allows and always was present that an employer could take action on their own employee. >> yes. >> commissioner sanchez, please. >> i would just like to note because we are in a full commission meeting that this medical staff revision has been going on for a significant block of time with due diligence. why did the joint conference committee at zsfgh. there is few discussion and review. it is not something we are just get anything the last month. it is something that is really been an excellent reaffirmation and definition of the rules and

procedures pertaining to this critical area. i wanted to thank both members of the jcc who have been in that but more importantly our staff and directors who have been involved in making sure that it does reflect both the values and mission of zsfgh. that my only comment. this is an ongoing presentation with due diligence and oversight and revision and coming back and forth again. it is here for full recommendation. >> with respect to that, commissioner sanchez. it wasn't just back and forth with in the bylaws committee and the jcc but also with the city attorney's office in the sections that you specifically referred to commissioner chow. >> thank you so much for this work. i just have a question.

i don't know the answer. that has to do with i understand the importance of staff by laws, medical staff by laws as it relates to the institution itself. when the accreditation folks come to review do they look at the by laws as well? are they critical to that review? >> they look about the governing body by laws as well as the medical staff by laws. there are specific things they are look for in the bylaws, self governance and peer review. how the medical staff engages to improve quality. it may appear technical in response to regulatory requirements including joint commission. >> approval is requested

commissioners for the document. >> approval is question, a motion for approval is in order. >> so moved. >> second. >> are there further commissioners to make comments? >> we are prepared for the vote. all those in favor of the medical staff by laws revisions police saplease police say i. i want to thank doctor marks for his work here and as chief of staff for the many years. >> i would like to add diligence and patience as well. thank you. >> thank you, commissioners. this is chief of medical staff history. the only one who has brought the bylaws on two separate occasions to the commission for approval. >> thank you. you are a brave man. >> there was no public comment

requested. we can move to item 10. the financial report. mr. wagner presented the same >> reporter: at the finance and planning committee. he is going to do a summary of that presentation today. >> mr. wagner. . >> good evening, commissioner, greg wagner, chief financial officer. as mark said, we agreed about a year ago that for the quarterly financial reports the schedule would be that for the first and third quarter we will present only at the committee, second and fourth we will present a more in depth discussion at the committee and summarize at the full commission and so that is what we are doing today. i won't go through this in a ton of detail. you have the report and i am happy to answer questions.

i will stick to the high level. we are projected to end with 22.8 left side surplus at the end of the year. that is good news. revenues $30 million over budget projected. expenditures over by $7 million. you can see there is some variance across the divisions. the largest variance are at san francisco general hospital, which is usually the case. there are a few things going on there. significantly we have patient census higher throughout the year than the budget. because of that we have a combination of expenditures required to meet the mandated staffing and additional revenues that come four billing for the

services provided. because of the $7 million expenditure over age, we don't have appropriation authority for those dollars. we have to take corrective action to bring that back into line. we have a number of actions that are in place to deal with that. we are putting additional layers every view on hiring for vacant positions. we are looking at making sure that we appropriately charge those salary costs to our projects including the hr and capital projects. that is where they belong, and some other steps. we are asking for supplemental appropriation for a limited portion of this e expenditure or rage. at zuckerberg we have