need to provide those service facilities. and then, a second or later project by the same program might be able to leverage program facilities that has been built in an earlier or nearby development. and then again, i just mentioned the challenges that many of these -- these -- these efficiencies face in terms of timing. so continuing to move forward with these discussions, our real focus right now from a funding and strategic approach is looking at the first five development projects, refining the estimated cost for those projects, and the potential availability of funds because

it's within those first five projects that we believe we should be able to complete the transition of all of our existing households that are eligible for transition opportunities. and making sure that we accomplish that goal, and then also, that would mean that there are no constraints on the market rate development posed by the existing housing stock. and then again, continuing to evaluate the potential for modular construction and to add that to be piloted onto existing treasure island projects. i think there may be the belief that two samples is really too small of a project set, and it would be by the third and fourth examples that the city would start to gauge best the

potential benefits of modular construction. perhaps our first project and perhaps our second project will still, like the industry, be learning quite a bit about the construction. but we expect that there will probably be more conversation about that after the june elections. and then, also, continuing to work with the mayor's office of housing and community development, participating in their developer meetings and working with one treasure island and our partners on our first two projects to explore all of the opportunities that i discussed. with that, i'll take any questions you may have. >> thank you. bob. i will point out any questions from the commissioners? >> thank you, bob. i really appreciate this

report, because this is the issue which i was very concerned about and had to -- started those conversations a year ago, and i'm glad that it's led to some more conversations about possible efficiencies. and i know that there's many; that the -- my hope is actually there can be really bold thinking be how we finance, develop and build affordable housing. we have the charge of building 2,000 units on treasure island, and unlike other sites in the city, we have the land already secured, so as long -- as soon as the infrastructure is done, these sites will then become available for the building of

affordable housing. and it is such a crisis in our city that having the ability to build 2,000 units is quite, you know, an incredible resource. there's other sites that have been looked at in the city recently, and in order to do an affordable housing project, some of that cost is approaching 1 million a unit because the land costs have gone up so incredibly. and then, in addition to that, the construction costs. and so i think if there's any chance at all for us to be able to even approach that production goal of 2,000 units of affordable housing which is, in fact, a promise to the city when we put together this master plan for treasure island, we have to find a way to look at it boldly and not to do it on sort of a piecemeal

way. there has to be by the city together with the mayor's office of housing, and by the political leaders to see this truly as a resource and to -- and if we're really serious about building those affordable units, we have to have the will and also the tools to do that with. and so, for instance, there is nothing to stop us from looking at the financing of these projects in a whole way and to put together a subsidy program. of course it's going to require resources by the city. that's not -- that's just a matter of political will -- to put together the resources so that these units could be fast-tracked, and that they can be built more quickly. i do know yes, of course, it's going to require partnerships

with the state and hopefully the federal, although the federal is almost out of the picture right now. the state is promising -- promising legislation that was being proposed. but i think the city can put together approval and subsidy dollars that they are promising to be able to do this project together. you know, we have an economy that is booming, that in terms of real estate value, in terms of economic growth, you know, it's over 1 trillion, actually, in the city. and it seems to me that the resources that we need to build housing is so very limited. and surely, there is the political will to do something that will allow us to build those 2,000 units. so i'm hoping that we can urge both the political leadership

in this city as well as the corporations who do business in the city and who also suffer from the fact that there's a lack of affordable housing, that there could be some will to see that this is a resource. we have the land to go ahead with the development, and could there not be a pool that is -- approval that is put together to allow those projects to go forward more quickly. i am glad that you are going through all the requirements now to do business in the city and to do development in the city. and many of those requirements are laudable. they're goals that we have to attain, but i think we need to look at the costs and if there

are better ways to solve those same issues, and it includes the ada requirements, the green building requirements, various hiring requirements. it's a good time to look at all of them to see how we might be able to meet those objectives also in a more stream lined way. so i'm glad that you have started that process with the mayor's office and with the various nonprofit housing developers that are going to be building this housing. let me say about marginal and prefab housing because my company has done a lot in this area -- and we're talking about not only marginal. there's also prefab factories that make, you know, systems which can be put together much more quickly. and i think that it's true that it's at a time when that whole

area of marginal housing is in its infancy, but if you look at other countries that have adopted it, including scandinavian countries, including japan, almost 60 to 70 7 70% of housing incy den is marginal factory housing. in japan, i think it's close to 80%. i think it's something we need to look at here. and here, we have an incredible opportunity, because we have 2,000 units of housing we're going to build and look at ways in which we might adopt some of those new technologies to lower the cost as well as decrease the time it takes for construction. but it is at its infancy, and there are issues around it that perhaps we can solve, and that includes, for instance, the

insurance requirement, the subbonding requirement that often becomes an impediment for using the marginal factory processes. but the other thing that i'm concern about is that -- about is that now that construction prices have spiralled out of site is that construction developers are looking at modular processes. it's bidding up those limited pool and those limited factories, that they're able to also charge more, by then defeats the purpose of what we're trying to do in finding lower cost and better decisions. but in general, i'm glad that we're going in this direction, but i'm hoping that we will look at it to see if there's some bold moves that we can make to be able to finance and develop and build 2,000 units of housing, and so i look

forward to further conversation about it. >> thank you, commissioner. commissioner -- director beck? response? >> yeah -- well, no. the commissioner that sends commensends -- tsen's comments brought something to mind in my presentation, and this may be something that we need to address at the state level, which is we find ourselves in somewhat of a catch 22 in that many funding sources are looking to develop new affordable units. and although the existing community on treasure island was always a temporary use of naval housing, because we are proposing to transition residents from that temporary

use into permanent housing, the state doesn't view that as new units. even though the units that, you know, we're replacing were never intended to be permanent because we're transitioning, for instance, catholic charities residents from an existing unit to a new unit. that's not considered to be an additional or new unit, it's considered a replacement unit. and it just seems that this is a quandary that must be affecting other base reusery programs as well. so it's not something that's unique to treasure island, but the catch 22 that we find ourselves in, that we have to provide those transition units first, before we can get to 100% new buildings, those transition units act as a

barrier for us accessing certain streams of funding, and it seems there should be a solution that would acknowledge that although residents are being transition from former navy housing, that that was always a temporary use, and that we're moving them into new, permanent fortivsupportiv housing, and that that should be considered new. although it's not the same as a shelter, the existing navy housing is temporary housing, and it was never meant to be permanent for anyone. so that -- i just bring that up as a challenge that we're finding as we're trying to find funding for these first few projects, that there are certain streams of funding that we're barred from or do not compete well for because each building will include a

substantial number of transition units, and that's just another challenge for us on treasure island as we're moving forward. >> is that something -- we've got great stead led legislation -- state-led legislation there to represent san francisco. is that something we're having discussions on. >> it's something that's come up in the last month or so, so we're going to approach our lobbyists to see creative solutions to address that. >> thank you, bob, for this presentation. as those that are listening from remotely can see that this commission puts heavy emphasis on housing, on development on the island, affordable housing because we have the homeless population. we also have the transition housing matters that we are dealing with, and we also have the expertise on this

commission that can guide the city and all the stakeholders of the one thing that i have found that even the political leaders and city agencies need guidance, so i see this dialogue as a process from what we do here to be able to, you know, tran laslate and convey to be able to help them out, because on a global scale, it's not all that happening now. the city discussion seems to be segmented. you have the mayor's office of housing and all that, but at some point, ideas that people have should be conveyed across the board and we can take some leadership here. i would like for us to have on our calendar and maybe invite, we have expertise on modular here -- have a set of presentation on modular, and the technology, as commissioner tsen mentioned before, their

expertise and their countries, you know, outside of the united states that are really doing well. and i know we've been talking about that here as a solution. so let's bring in here and invite all the stakeholders and see what kind of ideas that we are having on this particular matter. on the shared efficiency discussion, i, again, would like for us to concentrate more on the financing. we know that we have the funding stopgap, you know, here. and in the boldness that we've been talking about, i said a long time ago that i loike to - these unions, these calpers and some of these organizations have capitals that no one has even tapped. i'm talking billions and

billions. san francisco, for instance, low income teacher housing, low income housing and homeless housing. let's have a presentation provided, see the potential there. i really feel strongly on that. the precedent has already been set. decades ago, the union lent -- 100 million was lent to build a hotel. years ago, i know that mayor brown did that. with regards to the state level, we do have lemgislature, if we are lucky, new some get there's and we have all this funding. so we have all these new challenges, and let's know them, and then, we can present them. we can even invite the legislators every now and then

to our hearing because they talk about that all the time. we have all these opportunities, we have everyone right now that can help us to carry this ball, and the supervisors are, you know, very receptive. so i would like to have that in your presentation. i think it would be great if you can add, every time you make this presentation, to actually have those financing in there. i was looking at some of the materials that you have covered before. and at one point, in one of your presentation it was dedicated to financing. so when you have this, you can probably incorporate that in there, so we can all have, you know, one document, because you've done a lot of work on this particular matter. so i would like for them to be combined so, you know, we can have one document, and we can really present that. so the other thing -- also, i

did not see any mentioning about private sector financing. has that been explored before? i mean, what is the thinking on that? that we engage in the private sector for financing or public private partnership? i didn't see any. >> yeah. i think both catholic charities and mercy are looking at a portion of the development costs being private -- you know, a construction loan, and what the -- you know, the -- those financing costs are built into their current costs projections, as well. >> so mohcd has all the program efficiencies in parking, probably shared space. can they give us a list of models in san francisco already that we can even look at? i know even now and then they mention this project here and there.

can you go back to the mohcd and says, all these shared efficiencies that are currently in place in the city now, why don't you provide a list so we can tour the site, we can see and talk to the folks and whatever they are doing? so it would be great to have them list it in a project, you know, all over the city. i mean, i presume they're already doing that, right? >> yeah. no, and then, there are things already that mohcd is not -- typically are not including in new projects. for instance, elsewhere in the city, new projects are being built without any parking, new affordable buildings, but particularly, again, for our early buildings, although the island will be eventually heavily transit supported or served, our -- our existing residents that will be

transitioning are very used to having vehicles -- in some cases, multiple vehicles perhousehold. so there will be some parking in most of our early buildings. not one for one, probably more on the order of 1:3 or 1:5, so parking will be assigned via a lottery, but there will be some opportunity for parking. but that is something as we continue to develop additional sites and bringing new residents to the island, those -- those building will probably have no parking, which will, you know, help save on costs. >> yeah. so let's have the total picture because it's not one size fits all. some are going to have some limitations in parking, some will have -- and then, when we need from the mohcd all these models that are already without the shared, with the

efficiencies that are here that they are promoting, so we can see how they are there, the priorities and how visible. that would be great for them to provide -- you know, they have an obligation to tell us here, too, so i want to see the total picture of people now what they are talking about, because i know that they're the agency in charge of this affordable housing. so those are just some of the comments i have, but we need a presentation on modular housing if we can get all the experts and all the stakeholders to be out here so we know what the discussions are, and so we can better inform our leaders and, you know, take the front seat in helping mohcd and all the others involved. thank you. public comment? commissioners, any other comments? none? public comments, seeing none,

okay. >> clerk: item number seven, discussion of future agenda items by directors. >> well, i would like to see in the last tida meeting, when that temporary housing on the island, i think we need to bring that back for further discussion so we can understand the rules for engagement. we're going to have temporary housing on the island, what is the definition of temporary housing? that land in terms of geology, infrastructure, waste water, and what are the agreements? so we still need to, you know, have some dialogue in that. and of course, with the legal counsel, also. so you know -- and the top parties. so we're all trying to protect top parties and others can understand, you know, what our obligations are and all the parties before we get to the

next level. i think at this onset, we all need to formulate all these agreements before we get in there because at that department meeting, there will still be assessments and construction of that soil. again, geology applications, waste water, because if you're constructing temporary on an island that we know that the land, geologically, i know, we already have distributed -- we're still trying to develop the infrastructure. no matter where we are, it's not like a trailer. you are required to make sure that any structure can withstand earthquake. so that means even though it might be temporary in nature, it still has to conform to all the standards of building, and infrastructure and everything applications, so what are those implications for the development, you know, where we

do not have current infrastructure. again, i can just go on and on, but we need some understanding about what this is all about here before we will go into any depth, okay? >> and no, thank you. definitely heard in a from the directors last month -- or last week, and it was just a tight timeline to turn it around for discussion this week, but plan to bring that to the may itc. as a reminder, we won't be having an april itc due to conflicts with the artist selection process, but we'll be back in may, and i'll plan to put that on the may agenda. >> okay. thank you. commissioners? okay? >> clerk: adjourn. >> thank you. thank you. chow chow good

a. the commission will come to order. commissioner bernal. >> present. >> commissioner chung. >> present. >> commissioner san changed. >> present. >> item 2 of the aproven of the minutes. 2018. my apologies there are severalty possess on the copy of the again chasm tha agenda. that was corrected for what was posted onlyon so let's go to the approval of the minutes.

chow chow i'm sorry not the minutes. the agenda. >> so the minutes are open for approval. >> second. >> chow chow are there any oppose? all of those in favor. >> it's been adopted. thank you. >> item 3 the director's report. >> good amp, commissioners. it's a short director's report today but i thought we would be honoring northeast services for the leadership and tb prevention. we might want a report. so the health officer to give an update on that.

good afternoon commissioners and director garcia. i will add an aden gum to the report. and let you know about condemnation that happened in san francisco. you may have heard about this. we heard about a case in san francisco and over 700 students were exposed to that case of tuberculosis and we activated our command system to work with the school district to do mass tuberculosis screening and to give you an idea of the challenge. so during the investigation we identified about 400 students -- now these are middle school students and you can imagine what it's like to try to do a tuberculosis investigation with middle school students because we had to do blood draws and a skin test as well.

and we had to do -- not just a field investigation but set up a clinic sight. so we had to work with a network site that provided nurses and chairs and help to bring everything there and we had to do everything in two phases because we had to do that for those students initially and everybody who was negative then had to be repeated so we had to do everything twice over a period of two months and we are still in the final stages. currently it's a small number of persons that test positive and we are following up with the students and it's a great example how in public health we working to to prevent new cases so while there were a lot of people exposed we jumped tonight within a week of hearing about the case and went back and figured out all the people who were exposed. this person had actually -- had

been at other schools as well so it involved not just one main school but several schools. for us it was an incrediblebly valuable experience to work with the school distrig. we had a debriefing that included the school district as well and they were very grateful for having the experience working with us. and we committed as we move forward to work together on other issues and for example, with the school digit tricked thedistrict they were the wildfires and we will work ached specific preparedness issues for anything that happens in the future. so tube tutu berk low due -- tuberculosis is an area we are working on. and we will be honoring the services and city hall will be

it's going to be light up the world for tuberculosis. it will be lit red so we want to thank the director for supporting the tuberculosis clinic. because it's really important work and we couldn't do this work without your support and support the network side that mobilizes resources to support the activity. so thank you so much. >> thank you. mr. sanchez. >> thank you. i want to thank you and through the director. san francisco has always been -- well we are a port city. so we have always had cases of tb over the generations. and if it wasn't for the

generations, the brick building is still there. and the ones in matteo county when there was an overload read today. venezuela which had one of the best public health departments in the world because many were trained in cooperation with us, stanford, berkeley. now tuberculosis is an epidemic and families who have left to miami and other parts. the same thing happened -- we are a port city, so we are working collectively with the schools because the schools play a critical role. they have to be screened and what a great place to be collaborate. and more power to you and this commission will continue to support these great efforts. it's so critical for public health and i want to congratulate you for sharing that today. thank you.

>> internationally it's been a big issue. you don't hear about this but we've had to do cases of tuberculosis and home intervention and people homeless and mentally ill. so it's been everybody working together to be able to work with all of those patients. >> thank you. >> president chow: thank you very much for reporting on the tuberculosis (e)s and the fact you werable to do this contact. our contact program -- what were the results? were there additional cases found? or in fact, were you able to pick up additional cases or what? >> there was a small number, less than 15 that were positive. but some of those actually were people who probably were infected long ago that had not been treated so now they are,

log through the data to find out how many may have been effected. the truth is even if we identified specific people who were "conversions" we don't know for certain whether it was that exposure but certainly everybody who is turning out to be positive everyone somebody treated so i would say in general we were a little surprised. we were expecting more positive because there's a large latino population so the numbers were smaller than we would have expect bud that's okay. so one thing is for certain, if there was transmission there was very little of it. there wasn't a lot if there was any. >> president chow: any other questions for the health officer. thank you for your report. director, do you want to complete your report? >> i think that's the end of my report unless you have any questions regarding any of the other items. >> president chow: i was interested in the program that you had that the department, in

fact, trained state and other local health departments. in hiv prevention. >> right. the center of innovation received a grant about two years ago and they've been going out to multiple departments across the country. and training regarding our surveillance and also our work within communities. and so they've been doing this work for a while now in terms of working with other communities around hiv and aids prevention. >> president chow: very good. well it's nice to be remindedded that that was happening. thank you. any questions to the director at this point? san san we have move on to item 5 which is a report back to the community and public health

committee from today. >> good a, commissioners. we had two reports. with regard to health, there is specific data i would like to lift up for all of us. 86% of people in jail have no sentence. they operate with a budget of $330 and there's an overrepresentation. people of color and -- in the jails, particularly latinos and americans. although the data is somewhat flawed because the data is derived from what the police put down when they arrest someone. so if person may not identify with the ethnic group that is here so we need to look at how we can collect more data with

respect to the population that is in jail. 59% of the people in jail spend less than seven days in jail and about 6% of that population spend more than a year. it has been an access point for us to get people into public health service services and particularly in relationship to a and c. and that's the jail part of it. if my colleagues have any comments they would like to make about, that i would like to hear it, and i'm going to the next report. >> sure. why don't you go on to the next report and then we can go back. >> and the next report has to do with the artist program. and it's timely that it follows the report from dr. argan from director. it functions for tuberculosis control and prevention is to improve case detection and management. to do public health surveillance on tuberculosis patients and followup on active cases which

he talked about. outbreak management and contact investigations and reporting and this helps them make decisions that manage tuberculosis in san francisco. and it's important to recognize that, and to recognize what the doctor was reporting as well. so those are the two reports that we received at the committee. my colleagues are open to questions or comments. >> president chow: any questions on the report? further comments? if not, then thank you very much, and we will move on to the next item, please. >> there was no public comment request for that item. item 6 is the officer elections.

>> president chow: in accordance to the rules and regulation the time for the election of new officers is the second meeting of every month, which is today. so we are now open for accepting nominations for the president of the commission. >> i would like to nominate commissioner. >> president chow: achow. >> because commissioner chow has spent four years in office. i would like to say that the president and vice president shall not serve for more than four consecutive years. for one years. the reason for this suspension of the rule is due to recent turnover of the mayoral upcoming new mayor in the summer and commissioner carson has resigned effective april and we expect two new health commissioners to be appointed in the next month. the health commissioner will

benefit for one more year under the effective leadership of dr. chow. >> president chow: so commissioner, we would need to take your motion for suspension of the rules prior to receiving the nomination because otherwise the nomination comes as a violation of the rules. >> i second the motion. >> president chow: you've seconded that motion so we will take up the question as a suspension of the rules on that particular rule in regard to four consecutive years. it is debatable. so is there debate? >> just for clarifications. bun-year suspension we will return to the rules as described and the rules and regulations after this one year. >> president chow: you're trying to make the case this is not china where we have abolished

terms. thank you. and actually if i were to accept this nomination i also would insist that we maintain the current rules. further discussion. if not all of those in favor of suspending the rules. say aye. >> aye. >> president chow: we will record that suspension in the minutes. thank you. we will now proceed with the nomination again. i will accept your nomination at this point, then. and the second. is there further nominations? yes, commissioner -- >> yes, i move that the nominations for president be closed. >> second. >> president chow: see nothing further nominations we will vote on closing the nominations. all of those in favor, say aye.

>> aye. >> president chow: we will proceed. all of those in favor of the nomination please say aye. >> aye. all of those opposed. thank you, colleagues and i promise you only one more year. thank you. the office of vice president is now open for nomination. commissioner bernal. >> commissioner bernal: i nature commissioner james loyce. >> i accept the nomination. >> president chow: any further nominations? >> i recommend the nominations be closed. >> president chow: all of those in favor say aye. all of those opposed -- well there's nobody to oppose. we will proceed to the vote. all of those in favor of the nomination of commissioner loyce to vice president, please say aye. >> aye. >> president chow: all of those opposed. commissioner loyce, congratulations you're a new

vice president. >> thank you. >> congratulations to both of you. item 7 -- no public request for item 7. it's an action item. the annual gift report. >> president chow: thank you. >> good afternoon, commissioners. deputy financial officer. i'm pleased to preaccept the annual gift received in fiscal year 16/17. you can see that there was 7.8 million in gifts received in 16/17. of that amount, san francisco foundation had 5.4 many in gifts to hospital programs and they also had 1.2 million which were the remainder of the members for the capital campaign for a total of 6.7 million. the magunda hospital had -- from

the gift fund. from in-kind gifts from the gifts of the hospital and employee development fund. and then the public health foundation had 813,058 in gifts. on page 2 and 3 itlies the gifts that -- the donations that were over 25,000 it. lists the donor names for each of the organizations. on page 4 and 5, that's the expenditures that these organizes made during 16/17. they don't correspond to the gifts they received. they get them on a rolling basis and in the fiscal year they expand funds from that year as well as the prior year. and then on the last -- on page

6 and 7 it's the board of directors for the organization. so if there's any questions? >> president chow: commissioners any questions on the gifts report? >> no public comments on this item. >> president chow: thank you. >> president chow: so the expenditures are on a fiscal year, did you say? >> yes, the expenditures are reported on a fiscal year. so that's what the organization spent that year. and the source of the funds was from that year as well as the prior year. because it's a rolling basis. you know if they received a donation in december then they would probably extend the fund the following year. so that's yet dollar a.m.s for donations don't tie to the expenditures because the

expenditures are just kind of a rolling basis. does that make sense? >> president chow: yes, i think so. commissioners a motion for acceptance is in order. so moved. >> second. >> president chow: any further discussion? >> i would like to kate that a member on the public health foundation. >> thank you. >> president chow: okay. we will add that to -- you will add that to the record? would you like me to rewrite this? update it or you will just note it in the minutes? >> a question through the

chair. some of the fiscal reports that end june 30th. some of the members listed here were rotated off. and then new ones were reported. otherwise you might have a few more changes. >> that's true because -- you know i weapon back and forth on that because one of the organizes sent me the flames for the board members for 16/17. and i went through the web sites and updated for the current members so that's a bit confusing. >> i just wanted to clarify. if it ended in june 30 you would have board members who's term ended and then new ones were appointed. >> that is a good point. >> for the health foundation, colleen -- they submitted it as a board member but when i looked at the new board, it was

different. i don't know. i wasn't sure how to do that. >> president chow: if this is an annual report 2016, 2017. maybe we should use the fiscal year that we are talking about. >> and you were on? 16/17. >> president chow: 16/17. okay. so that would be after this fiscal year. >> 17/18. >> president chow: just to use you as an example. >> i will make a note of that for next year. >> president chow: i will make a note of it. the board of directors should be 16/17. >> i will make a note of. that because this report is delayed because it takes a while north organizes to provide it. so that's part of the problem.

>> president chow: otherwise will you have to go around correcting a few more things. it would be better as a consist simple this is a report of 16/17. these are the board of directors at that period of time. >> thank you. i will make a note. >> president chow: thank you, commissioner sanchez for pointing that out. so a motion is still before us for acceptance of the report. all of those in favor say aye. >> aye. >> president chow: the report has been accepted. thank you very much. the ssg governing body bylaws. now commissioners you may vote on this today. if you have comments and questions that need to be answered before you vote, this can also be delayed because this has not yet gone to the jcc. >> president chow: thank you. >> thank you. mark. >> good afternoon. i'm sandra with the general hospital and i'm here today to

be a resource for you regarding the governing body bylaws and i wanted to just give you -- and i'm joined by my colleague here. troy williams and from the city attorney's office who worked very hard on these businesses didlaws as well. i'm going to give you a little context as to why it is you are approving these bylaws and we can go to questions. we have a number of examples. so for example, the commission, 2022, the centre for medicaid services and these governing bodies require that we have a highly effective governing body and that they are utterly accountable for the safety, quality and care and treatment that happen at the hospital. the governing body bylaw for the hospital describe in writing the responsibilities that you as a

commission have to carry out whether a happens at the hospital. so for example, these responsibilities include but not limited to adopts bylaws for the staff with the appropriate officers and bylaws of their own which you recently approved and appointment and reappointment of the medical staff and purchase alps and improvement of the national safety program and the budget and providing for the services we provide to our patients. when the licensing and accreditation bylaws come to the office, they look at the bylaws and they want to see evidence that you and your commission are purchasing in accordance with the bylaws so it's very important that we have up to date bylaws that not only select the correct name of the institution abou but the current mission values and all of our practices.

so that is what these bylaws updated about. we've been working on this for quite a long time now. although we got through our join commission renewal without current bylaws we would very much like to have current bylaws in place so the next time the governing body comes to assess what we are doing that they reflect our current practices, and your practice as the governing body at the hospital. the changes are very hopefully summerrize sum summarized on the table. and then on the next document that you have. so that is the context, the summary, and i or my colleagues are happy to respond to any of your questions. >> president chow: recognizing that this is the first time you have seen it, i think that context is important.

in as much as -- particularly the joint commission and as surveyors are looking for the authority line and making sure that the hospital board is taking full responsibility for the work of the hospital. so this spells out current practicing. and is one that has been reviewed with the city attorney. i believe that -- some of the comments in the bylaws were in response to the survey. could you describe what the surveyors were looking for -- more specifically how the duties of the governing body. the health commission as the

governing body work within a city context here in which we have a separate administration also responsibility that is dough rifled from the charter. >> i will let troy williams respond to what came up in the survey that actually advise bad we put inted what we put into the bylaws. >> from a survey perspective it was just updating the bylaws. it still had -- it didn't recognize the health network we currently have now in terms of an integrated care system. being a part of an integrated care system there. wasn't anything specific that needed to be added in terms of the actual role (n) governing body but it was more making sure we had an updated document to show them when they come. >> i would say one other things that was a really important change to our practice with respect to quality was the re-do

of the pips committee. so that division between quality council which was meant to be the nonmedical staff part of our quality program and the pips committee. we combine those two. it's been an incredibly effective body to help govern our quality improvement program. and that's another thing that is reflected here in the changes to the bylaws. >> president chow: if i may note the commissioner bernal met when the committee and is also chair at the hospital. >> right, i would say the main substance of change is the fact that we had to put in -- or should have formalized the pips committee which was ordered over the past year. and brought together two different committees.

one administrative committee and one medical staff committee. and then that made it a single committee that was reviewing the quality of work and allowed for a lot more interaction and positive feedback for all party involved and turned out to be actually an effective tool for review of quality. and your committee does review. and certainly that needed to be institutionalized if anybody was going to be reviewing us in the future. commissioner sanchez has been there quite a while. do you have comments on this? and your feelings about the changes in the governing body bylaws? >> commissioner sanchez: i agree. i think there have been various details or sectors, et cetera and i think this rea