i want to welcome everyone back to the budget and finance committee. i'm supervisor cohen, i want to recognize mendoza and jesse assisting with the broadcast. thank you for your assistance, sfgovtv. what i'd like to do is call the airport items first.

let me see here. it's 9 through 14. >> resolution approval a food and beverage concession lease for a term of 10 years and minimum annual guarantee of 365,000 for the first year of the lease. item 10, approving food and concession beverage lease for 10 years with one two-year option to extend annual guarantee for the first years of the lease. item 11, concession lease and the city for a term of ten years with one two-year option and $475,000 for the first year of the lease. item 12, resolution approving lease between sfo for a term of 10 years with one two year option to extend and minimum

guarantee of $600,000 for the first year of the lease. item 13, lease between on the fly and the city for a term of ten years, one-year option to extend and minimum of $310,000 for the lease. item 14, food and beverage lease between the food group and the city, for ten years, with minimum annual of $85,000 for the first year of the lease. >> president cohen: we have the airport presenting. deanna, items 9 through 14, are concession leases. for food and beverage, all were competitively bid. what percentage are locally owned? >> 64% of those sales are by local owners. so, thank you, for hearing this item. we have six terminal concession leases. you have bun me llc, a local

business started off of fillmore in california. the little chihuahua. amy's drive-thru. star bird. we expect the total minimum annual guarantees for these six leases to be $2.5 million in the first year. first year sales should be $22.6 million we estimate. 64% are by local owners. we made effort to make sure we were connecting the large companies with the small businesses to give them that opportunity to put a foothold they airport. all of the sales we're anticipating, 33% will be owned by acdb businesses and our initial vote -- >> president cohen: what do the acronyms stand for?

>> airport disadvantaged business enterprise program. it's operated on a federal level that recognizes disadvantaged businesses so we can identify those geographical businesses that are coming from disadvantaged communities. >> president cohen: thank you. colleagues, any questions? seeing none, we'll go to the budget legislative analyst. >> good morning. severin campbell. just to repeat, these were six leases selected for term al one concession leases. we summarize the lease terms in table 2, page 29 of the report. each lease has minimum guaranteed rent. the initial term is for ten years with options to renew for additional two years. we estimate base revenue for the

airport over the initial 10-year term would be $22.8 million. if the two-year option to extend is added in, it would about $27.8 million, but there is an expectation these leases would get percentage rent rather than the minimum annual guarantee. we recommend approval of all six. >> president cohen: thank you very much. we appreciate the recommendation. any member of the public who would like to comment on items 9 through 14? seeing none, public comments is closed. make a motion to send this to the full board. without recommendation. positive recommendation, unanimous. omar cortez, are you here? i'd like to take 15-17. is the sponsor here for 15-17?

seeing none, we'll go back to 1. >> resolution authorizing the direct tefr of the property to exercise a lease extension approval a first amendment for the real located. >> president cohen: the new executive director of. the floor is yours. >> good morning. thank you for having me here this morning. on behalf of the police department, i'm seeking positive recommendation for the lease entered into originally in july of 2008. if approved this extension would be for slightly less than ten years and commence upon the board of supervisors' and mayor's approval. they're currently used by the san francisco police department tactical company. the current uses are office,

operational support and warehouse. and these uses will continue. the current rent is approximately $200,000 per month. the new rent will be $256,000. or 3,075, $373 per year. the original lease term expired in november, 2018, and we're in a holdover period. the lease extension expires on november 2, 2028. and is time to mark the 10-year anniversary of the original lease. that's why this lease extension is about 6-8 weeks shy of ten years. to take into account the holdover period that was necessary to get this legislative process through. increases or year over year at cpi bracketed at 2%, and 5%. that's no lower than 2%, no

greater than 5%. the cost to the city includes, in addition to the rent, the payment of the utilities averaging $150,000 per year, as well as services which average $125,000 per year. the fair market price was based upon appraisal by collier's which came in $59 per square foot. the city and the landlord have negotiated some extensive repairs and improvements to the air handling, hvac and generator located at the premises. these improvements will be done at the landlord's expense, improving the premises for the police department. i wanted to point out at this time that there are two type graph cal errors. the first modification is page

1, line 3, it says resolution retro actively. obviously this is not retroactive in this lease extension will not commence until approved by the board. >> president cohen: what is the language you're changing? >> line 3 should delete the word retro actively. >> president cohen: do you have these written down? >> i do. >> president cohen: we'll need a copy of that. >> the second change, page 2, line 6, it reads director of public health and the city attorney. that should read, chief of police and the city attorney. i'll get those changes to the board. at this time, i'd like to thank the bla for their hard work on this item. and their positive

recommendation. with that, that concludes my presentation. and i'm available to answer any questions you may have. >> president cohen: supervisor fewer has a question. >> supervisor fewer: thank you for your presentation. i have a couple of questions. why wasn't this department included in the new police department public safety building? >> i believe that the police are happy with this location and prefer to extend this location as opposed to going to the public safety building. >> supervisor fewer: really? because actually, this rent is very, very high. why would they prefer to have it in this building versus the new public safety building that is brand new? >> president cohen: this is a tactical unit. it's been there for at least 10 years, if i'm not mistaken. it's ongoing. it's more cost effective to keep them where they are. and there is no space in the

headquarters. this is a fairly large space. i think it makes sense to accept what the department is proposing. >> and thank you, supervisor, to that point, this is 52,000 square feet of rentable space. i don't know the actual available space that the public safety building, but i do not believe it could accommodate this unit. >> supervisor fewer: okay. my next question is, we spend a lot of money on rent, frankly, city departments. do we have a long-term planning process to look at this? i don't think this is covered actually by our capital planning either. >> that is an excellent, supervisor, and thank you for raising it. i also noted in the bla report, they point out the fact that we do not have a long-term plan for transitioning our departments from lease space to city-owned

space, which is our desire and our goal. and we are working on that. but it is -- it's an evolution, because what happens as a practical matter is that we have the leases that come due, that are expiring and they don't always sync up with buying opportunities or the funding to make the purchases. what i personally believe is the long-term goal is for the city to develop and own swing space, so that the -- when these leases expire, we have a place to park the departments until a buying opportunity comes along. and we're not forced in this, you've got six months to decide whether you want to buy something or lease something. >> supervisor fewer: absolutely. so where is that in the plans? >> that is on a very long list of things for me to work on, supervisor.

>> supervisor fewer: it seems without a long-term plan, we get stuck when we need to prove a lease extension. please stand by.

>> i would love to see a long-term plan because we've had the leases approved again and again without knowing what relief we can have or be proactively. >> thank you. >> supervisor: we'll go to the budget satellitive analyst and hear their thoughts. >> in response to what he said, this is a 10 year lease the company has been at the location since 2008. they had an option to renew at the market rate and an appraisal was done and table 1 of our report the estimated cost to the

city would range from $37 million to $42 million depending on the c.p.i. adjust whether it's 2% or 5% or in between. and i want to point out because supervisor fewer pointed out that at the time many city leases were function weren't going to go away and being renewed in a highly competitive and expensive market at a high rate at general fund cost. at that time we recommended there needs to be a long-term planning process. this has not been the purview of the committee to look at least space and alternatives and glad to hear there's discussion and we recommend approval of the resolution. >> supervisor: you appreciate that. we'll go to public comment on item 1. seeing none, public comment is closed. recommendation is made to

accept. >> i'd like to make a motion to accept with a positive recommendation. >> first we need to accept the recommendation. do you have that language or a copy? now that we have the language we'll have a motion to accept. >> as amended. right. >> chair, would you like to send this as a committee report? >> yes. we're going to approve as amended a positive recommendation. item two, please. >> clerk: resolution approving number 5 services, with kennedy/jenks consultants, for continued engineering design and engineering services during construction for the regional groundwater storage and recovery project and the san francisco groundwater supply project; and authorizing the general manager to execute this amendment increasing the

i. >> supervisor: this is for the regional ground water supply project. we heard it in the committee. the lease started in 2007 and the contract is through 2022. for a to the of $22 million, is that right? >> yes, total contract value. the amendment is $3.5 million. >> supervisor: we have dan wade from the public utilities commission to present. >> dan wade, water capital programs. you summarized the contract background so i won't dwell on this, but suffice to say the contract has been used for half a billion dollars work of projects in the improvement program. we've had four amendments. the amendments are listed here. two of them were for the harry tracy water treatment project a large project of $300 million. we had an earthquake quality

identified during construction and had necessary changes. the ground water projects had an amendment in 2016 for $2 million. the projects are ongoing. they'll be the last projects completed in the water system improvement program which is 87 projects worth $4.8 billion. the project on the peninsula is called the regional ground water storage and recovery project. phase one is in the construction phase including 13 wells. it produces what we call in lieu water supply when we have excess water during wet years, we are able to provide that to the wholesale customers on the peninsula and create an underground reservoir for later production during brought and san francisco ground water is in two phases, both in the construction phase. the reasons for the recent cost and duration increases are listed here. i'd be happy to go into them but

i don't want to dwell on them if you don't have questions. and we do have a listing of the scope of work that's planned for this amendment. so our request again is to increase the contract by $3 billion, increase the duringati duringation -- duration by three years and allow to us complete the project successfully. >> supervisor: thank you for your presentation. supervisor fewer has a question. >> >> supervisor fewer: i wanted to know how much did the coordination with pg&e set the time line back? >> you're talking about the ongoing negotiations? i wouldn't say that's had a major impact on the projects. we have interconnections needed for the well stations. that has taken some time. but that hasn't been the critical path. >> supervisor: we'll pivot to

the budget legislative analyst to hear her thoughts. >> as a follow-up to mr. wade's report it's a total 15-year contract with kennedy jenks for engineering services to the program and increase the contract amount from $18.5 million to $22 million. we summarize that on page 8, table two of our report. a couple points we raised here is one, is that given the extension of the contract and total of 15 years and the increase of $22 million, we did ask and agreed it would not be efficient to look at a new contracting process at this point because the project is so close to completion. and when we do summarize on pages 9 and 10 of our report, some issues around the ground water storage project that have caused the contract to be extended but we do at this point

recommend approval. >> supervisor: thank you for that recommendation. we'll go to public comment. any member of the public to comment on item 2. seeing none, public comment is closed. thank you. i'll make a motion to approval and send to the full board with a positive recommendation and please send as a committee record. can we take that without objection? without objection? without objection. thank you, without objection. item 3. >> clerk: the agreement between health rights 360 or intermediary service for the amount of $16.2 million not to exceed $79 million and an agreement of january 1, 2014 through december 31, 2023. >> it's providing intermediary services through 2023.

colleagues, you may remember we heard a similar item back in october for intermediary service for adults an older adults. thank you for coming back to explain this to you. my question to you is why does this need to be a different contract? >> i think that the contract we may have brought last time was for check writing. so this contract and in the future they probably could be it's a different mechanism and it's more common other contract paid per check. i think it's $3 or something per check and so this is continuing a service and allows us to pay for things which are difficult to pay for using the normal process. so it allows that ability. >> supervisor: thank you.

is there any other cliff fiction -- clarification you'd like to offer? it's straightforward. supervisor fewer. >> supervisor fewer: it was chezzen for a it was chosen for a one-year contract without amendments. this doesn't seem like a good practice. can you respond on that? >> based on -- >> supervisor fewer: we continue with amendment after amendment. >> the solicitation allows for a 10-year contract. it has an initial contract and then options to extend the contract. if we're happy with the contract and this is true for almost all the contracts and specifically speaking for behavioral health services, we have many long-time vendors and so not per se, exactly this, but we have

long-term vendors and so if they're doing a good job and we're happy with them, we do annual monitoring. so typically we'll exercise the option because when we do go out to bid and we just finished 20 solicitations in behavioral health services, there's not a lot change -- a significant amount of change among the vendors interested in doing business with us. so we make adjustments. if there's under spending we'll move money around. it's not that a vendor has the exact same contract through the duration but for business purpose, we tend not to go out to bid unless there's a need to and we're still within the allowable time period. >> sure, so i think my question is also, so we never had a contract before with health 360? >> the contract before that had

been awarded to asian american recovery services and we merged and went out to bid again and hr360 got it and that's how it's continued. >> supervisor fewer: are you saying to me after a 10-year period because you said we have an option to renew within a 10-year period we'd be looking at a new contract for longer than one year so we wouldn't have continual amendment to keep on contracting with health right 360? >> we're exercising more options to extend it. if approved it maximizes the 10-year period for whatever the solicitation period was and then we gout to bid and select a vendor. it may or may not be this ver vernd -- vendor and go into contract and return to the board. >> supervisor: let's go to the

budget legislative analyst. item 3. >> the original contract was for $9.7 million and extended from 2014 to 2018 by previous resolution of the board and increase the contract amount to $62.8 million. i want to point out because i don't think it came up in the discussion the original r.f.p. was for 10 years and the contract was set up. what's previously been approved is the five years with the five-one-year extensions. this would exercise all the contract option to extend through 2023 and increase the amount by $16.3 million from $62 million to $79 million. there's one other issue in the contract the cost of living adjustment that has not -- it would have to be subject to board of supervisors' approval but the number is in the contract and we do recommend

approval. >> supervisor: thank you for the recommendation. public comment. no public comment. public comment is closed. i think we got what we need. i'll make a motion to approve and seems the full board with a positive recommendation and send it as a committee record. we'll see this on tuesday's agenda. thank you. without objection. madame clerk, item 4. >> the resolution approving the amendment to increase the agreement amount by approximately $84.9 million not to exceed approximately $94.5 million from july 1, 2018 through december 31, 2022. >> we have the department of

health. >> it's an example of a contract long-term 20-plus years. we bid under two solicitations. one for the residential treatment and one for the out patient treatment in their housing co-op environment. we brought this into a contract. we are now coming back. we did an initial shorter term negotiating the changes we needed and they wanted to discuss what to put in place. so now we're proposing this contract until december 31, 2022 at which time we'd return to exercise options assuming everything is going okay. >> supervisor: is this a new provider to san francisco? >> no, it's a long term called

progress foundation. they've been doing the job 35 years. they're an important part of the behavioral health system of care. they have 133 residential treatment beds they provide with range from acute diversion units to longer term residential treatment and run an acute care respite instead of having go into psych emergency services can come to the door to stabilize and then be referred to acute diversion unit or residential treatment. it's a very key part of our system of care and has been for years. >> supervisor: how many people do they serve? >> i don't know. they have 133 residential treatment beds and i think the

rotation -- here's our person from the director of adult system of care who can speak to that. >> hi, i'm the director for adult behavioral health services. and in terms of the number of people served, our residential treatment episodes run anywhere from three, six, to nine months. on average the turnover would be 1.5 or so. so 1.5 times the numbers of beds would be the estimated number of clients. >> supervisor: okay. old -- hold on, 1.5 times the number of beds. >> 1.9 is my rough in the moment estimation. >> supervisor: you're supposed to be presenting information to me. >> the number of beds i think is 131 beds.

-- 190 beds. -- 133 beds. >> supervisor: interesting i ask a simple question about how many people you serve and i can't get a straightforward answer. >> i can get the answer. >> supervisor: great. what do you look when you evaluate whether to extend a new contract like this one? i don't know if you want to -- what due to -- do you look to and what are your qualifiers when you're extend new contract similar to this? >> well, there's a lot of indicators that are included in the solicitation. they get selected through the solicitation process. the reason this one we would want to extend, well, first of all, they have to be doing okay in their annual monitoring and meeting all the compliance

measures that we have but they have a 133 residential treatment beds which is a significant part of our system. it's not they're licensed in all those facilities so it would not be easy to replace that capacity and we rely on that capacity. they also have a very robust system of co-ops and supportive housing locations where clients are placed and they provide the wrap-around service to ensure their stability. so what we're looking for in extending them is the knowledge that they're meeting all the requirements both county and state they're meeting their performance objectives, which they are. >> supervisor: performance objectives such as what? can you give an example? >> such as we keep track of

residdivism rates, 30 days from when someone leaves, recidivism rates and discharge and treatment and there's also a tool that's used to measure a client's stability and remeasured to compare how they're improving in their own stability. and ability to manage their day-to-day functioning. there's different measures that measure both the individual client improvement as well as the agency's ability to how they're doing and if the recidivism is high maybe the client was discharged before they were stable and there's a number of compliance items that we measure as well. >> supervisor: all right. i'm going back to my original question, how many people do you serve?

>> i have a list of all the programs and the numbers served by programs it will take me a minute to add them all up. >> supervisor: okay. supervisor fewer has a general question. >> supervisor fewer: the contract states over 10 years or over $10 million goes to the supervisor for approval what if it take over 10 years? >> deputy city attorney, john gibner. the 10-year question whether the $10 million question is whether the city anticipates the contract will cost $10 million over its term.

your question about a five-year contract with multiple extensions, if there are extensions built into the contract when it's first signed and the term is going to be over 10 years, that contract comes to the board for approval. if there's a five-year contract without extensions or options to extend built in goes to the board but if it extends by two years and in year nine wants another two-year extension the department must come to the board that the point to approve because that's when it goes over 10 years. >> supervisor: okay. thank you very much. >> the target numbers and it comes out to 1,300 clients for the beds. >> supervisor: thank you. so my question is just to pivot

off this, are we increasing our reach or meeting 1300 this year, how many last year and how many the year before? i'm trying to understand more a little bit more clearly how we're reaching our target. >> i understand. the beds are used very much. they're part of our step-downs from the psychiatric and patient hospitals and some are stabilization units and we make use of the beds. >> supervisor: i want to ask the budget legislative analyst about bed utilization. in your analysis, dit , does it capture the dollars we're spending are a good return on our investment? >> for this type of analysis we look to see what they have been spending and how the contract -- in this case it was a new

contract so we look at the process to see that the process was legitimate. it was a competitive and open process and the contract itself reflects what the r.f.p. says and doesn't have different terms from what was publicly advertised and don't look at make sure it corresponds to the contract for an amendment we look at see what happened in the original or prior amendments or the original contract to see where they were with that. i would like to say in terms of a deeper look at it we completed and had a hearing and audit report looking at behavioral services an progress foundation was a contract we looked at as part of the audit. so in that purview we did actually did look more closely at the performance and utilization. >> supervisor: what did that audit yield?

>> we had several findings. we had an audit yesterday on it. we looked at how we took samples of behavior health contracts and looked at the performance indicators and how it had consistently been looked at and we focus on the performance indicators that were about client utilization and client outcomes because we were concerned to see how each of the nonprofits and the city civil service clinics were dealing with patients an progress foundation was one of the non-profit contractors we looked at and we looked at city wide utilization and looked at the behavioral health needs and utilization. >> supervisor: and your recommendation is to auto -- is to approve this? if there's any members of the public to comment come up.

seeing none, public comment is closed and i'll accept the recommendation and send it to the board with a positive recommendation and send it as a committee report. can i take it without objection? without objection. please, item 5. >> clerk: reading item 5. >> supervisor: so we've got item 5 is a contract amendment between the department of public health and toyon associates for medicaid and medical. can you tell me what is toyon associates? what kind of a business is this?

>> reimbursement services in general. >> supervisor: welcome. >> it's a medicare, medical reimbursement private company that have files medicare and medicaid cost reports to both federal and state regulatory agencies in order to recoup any uncompensated funds from the programs. >> supervisor: is toyon played a flat fee or the a money they recover? >> both. in certain instances they're paid for a fee-for-service where an hourly rate is paid and for appeal services they perform. >> supervisor: describe to me the instances where they are paid when they recoup? >> generally speaking, there are instance where's regulation is

passed down from a federal perspective or from federal regulators that counties or counties who are operating hospitals disagree with and instances where multiple hospitals have a similar issue or take on a similar case, what's created is called group appeals where the zuckerberg general hospital or hospitals in san francisco are able to participate as a group on an appeal case taken to the administrators and for those cases, it's difficult or the practice that it will receive a percentage for successful appeals. >> >> supervisor: thank you. mr. mario marino, please make your presentation. >> good morning, supervisors. first of all, i'd like to acknowledge the contract is

brought to you late due to a staff absence during the time the contract was to have been continued. we've since then addressed staff fully primarily my hire. the proposed resolution would approve a second amendment to the contract to provide regulatory reporting and reimbursement maximization of medicare and medical programs. the proposed resolution increases the contract amount by $5,555,360. we're exercising the option to extend the term for four years due to the solicitation process as described was the structure and the basis of toyon's

services. it's essentially supporting reimbursement services for san francisco general hospital and laguna hospital and health home agency to review and file required regulatory documents with federal and state agencies to maximize revenue to the city.

. i have nothing to add, except we have senior staff here to answer any questions. significant increase in the sense of --

>> president cohen: great, i have a question then. the contract is dated through june 2018 for added staff at san francisco general hospital. hello, i guess that's the general hospital staff behind you. it's good to see you all, thank you for joining us. really, this has been an ongoing situation with labor. for the last eight years that i've been on the board, people have been declassified, there's been understaffing in certain segment segments of the hospital. my question is, what's the plan to bring in permanent staff to bring up the staffing levels as patient census continues to increase? welcome. >> thank you. i'm terry dantonio, the chef nursing officer at san francisco general. we have a budgeted census of 285. we have been running a census of

313, and so it's seasonal. we're still trying to regulate our budget with census, and so we've moved into the new building, building 25, in may of 2016. during that time, we have notic noticed fluctuations in staffing, and those are not positions we're going to fill until we're secure of what is our actual census going to be. >> president cohen: yes, with all due respect, we've had this problem before you moved into the new building. you had it in the old building. it's an ongoing problem. when you talk to many employees and union leaders, i've done a walk in your shoes day, you know, i've seen some things that are concerning. so you know, with this new information, how do you increase the staffing levels? >> so, staffing levels -- >> president cohen: i'm not talking about descaling or classifications. >> we are filling all of our permanent budgeted positions. these are patients that come in

that are beyond staffing, and so we are trying to regulate just as an example, critical care patient requires 1 to 1 or 1 to 2 nursing, so i would need twice as many nurses if it's critical care. if it's a med surge patient it's 1:4. if it's a cna for extra patients that need coaching, so we are filling budgeted positions. these are beyond our budget, and so -- >> president cohen: how many budget positions do you have? >> we have 285 beds that are budgeted for. >> president cohen: how many are filled out of the 285? >> of the beds? these are beds, these are not positions. >> president cohen: i'm focused on positions. i'm not worried about beds. >> i couldn't give you that information now, but i can get that for you. but we do meet with the health commission every month. we go over our budgeted census

and we go over our budgeted f.t.e.s. we do have vacancies, they are all being filled. in our med surge unit, we had 24.6 va ccancies, we filled 24. so we are filling our vacancies when they come up. >> president cohen: we have unmet need, we need more positions, right, this committee, we give them more positions, they go to the board of supervisors, and now what is disconcerting is how slow the process is to fill a position. now, with that said, we had a hearing almost two weeks ago about discrimination and racial profiling when it comes to promotion retention and hiring. now, it's no secret the department of public health has some challenges when it comes to hiring a diverse -- ethnically

diverse, i'm talking about, ethnically diverse set, particularly in the nurses, and i think there's nurses aide, several different types of classifications. now, this may not necessarily be under your purview, but since you're at the mike, i might as well address you. >> thank you. >> president cohen: susan, right? >> terry. >> president cohen: terry, my apologies. terry. what i'm trying to understand a little bit is to -- what is the plan? i haven't really heard a plan to bring permanent staffing, bring these levels up to meet the demand. >> so right now we are filling our budgeted -- these are -- i guess i may not be explaining it correctly. >> president cohen: maybe my question isn't clear. i know you're filling them. >> we're filling our vacancies. this is about overcensus. we're filling our budgeted f.t.e.s, they are being filled. >> president cohen: when i say plan, first quarter of the year we're going to have 60%, second quarter we're going to have the remaining balance, so by the end of the year or end of the fiscal year, we're at capacity.

we're at, you know, have all f.t.e.s filled. that's what i'm trying to understand. >> correct. this does not -- this generally does not have to do with unfilled f.t.e.s. this goes towards overbudgeted census. so we have a total number of f.t.e.s that are for our budgeted census. we do have a few vacancies there, and we do have staff that fill that. these, the registry, is to get us and bridge us over our seasonal increase in census, which has been running about 33 over our budgeted census. >> president cohen: so is that 33%, 33 persons? >> 33 patients above our budgeted census. so we are budgeted for 285 and we're running about 313. so we have staff for as much as we're budgeted for. >> president cohen: right. >> and then beyond that, we need to staff those beds. does that make it clear?

>> president cohen: yes, it does. thank you. >> thank you. >> president cohen: supervisor fewer. >> supervisor fewer: sure. i just want to echo what president cohen has said, because i also think there's an overreliance on the registry. i think that, you know, my question is the same, why aren't these permanent full-time positions? when we look at registering nurses, they are per diem, and that we should be actually working -- if we are consistently over, then this is something actually i think should be addressed during the budget process, but to have a reliance on this registry, we are looking for actually two secure more full-time, you know, employees that are actually employees of the city and county of san francisco rather than on this relying on this registry. and, you know, the fact that these nurses are paid per diem and are full-time nursing staff or adequately compensated, i just think that there is a big

difference in the discrepancy and, you know, who we pay and how much we pay and what benefits we have, and if they are a permanent part of our staff. and i think that this is something actually during the budget process that we should be exploring, but we shouldn't be in overreliance on this registry. and i concur with what she has said, because i think that, you know, i get your explanation, but i think if we are consistently over our census budgeted beds, our people or whatever, then we should take into account during the budget process. but what i am also hearing from d.p.h., from people, nurses, registered nurses at d.p.h., is they are unable to take extended maternity leave. they are unable to do these type of things, because there isn't enough staff to take their place. and so it just brings up a concern to me about this reliance on the registry. i see that you need it, but

actually, i think that if we have nurses that we consistently rely on this registry for certain number of nurses that we need to take a really hard look at whether or not we should be increasing our permanent full-time staff for nurses, because it is not right that they work alongside other nurses that are paid per diem and then some are actually paid, you know, what we consider through collective bargaining a living wage here in san francisco. >> thank you. >> president cohen: is there any more to your presentation? >> not unless you have more questions. >> president cohen: like a girl group over there. backups. okay, just teasing. good to see you. all right. ms. campbell, what do you have for us? what are your recommendations on item 6? are we off base with our questions, or are we -- >> no, i actually think the question about permanent nursing staff as opposed to registry staff is a very important one. >> president cohen: it's an

ongoing question, or dilemma, i should say. >> i will say this increase in the context, $9.8 million to $27.7 million is mostly due, from our understanding and talking to the department, is mostly due to the increase in the average patient census, the budgeted census is $285 per day, our report says 317 per day, so they need to actually add staff to -- to staff, you know, prepare for those patients. i would say, though, if this were an ongoing increase in census, it is something that needs to be looked at in the budget in '19-'20. to summarize on page 25 of our report, the increase in the contract. it does not extend the terms of this contract, it does expire in june 2019, and we recommend approval. >> president cohen: all right, we appreciate the recommendation. any last words? >> no. >> president cohen: okay, great. we'll go to public comment at this time. any member of the public? please come on down, item 6.

>> part of department of public health, $700,000 of misappropriations of funds that was spent and misabused by that former executive director by the name of barbara garcia. she embezzled $100,000 a year, year after year, for seven years straight. then you turn around and let her retire and keep her pension plan when she should be prosecuted for tax evasion, money laundering, bank fraud, and misappropriations of funds. so that $700,000 that she failed to report on that 700 form, which is supposed to be reported on income that's coming to her

household, should be used, and as an example to reduce that amount of money by approximately $700,000. and quit being so damn lenient to people who are in violation of the rights and deprive them money and treat them like they are a good person. how come the city attorney is not prosecuting her, getting that money back? how come the city and district attorney is not prosecuting her for criminal law, tax evasion, money laundering, and bank fraud? and by the same response, over $217 billion worth of tax-free money is not being collected from the high-tech companies such as twitter. with the tax cuts that's coming from the president of the united states, they have gotten over $350 billion worth of tax-free money, but you want to tax everybody else in the city and county in san francisco. and not help the most vulnerable people in the city. then you turn around and give

salary increases and the bus drivers as an example how you can't even afford to live in the city. then you give salary increases acting like you're helping people afford to live in the city, while you sit there on your tail end all day. i can tell you one place you weren't sitting at -- >> president cohen: any other speakers? any other speakers? none? public comment's closed. all right. let's take up this matter, supervisors. all right, we'll take this item without objection. make a motion to approve and send to the full board with a positive recommendation as a committee report. thank you. all right, next item, item 7, please. >> clerk: item 7 retroactively authorizing the port of san francisco to accept and expend a grant award in the amount of $5 million from the california natural resources agency bonds and grants office to support the port's san francisco seawall earthquake