especially for the meals on wheels, they deliver two meals. so -- >> that would double, right. so, yeah. >> and sometimes caretakers are allowed to get home delivered meals if it makes it easier for the client to complete, to eat, so sometimes maybe three meals. >> right. >> i haven't thought about that one. the other question i want to ask is the national health care decision day is just one day. event, the whole week, or just one day? >> i think we are planning on the one day. we talked about both, the week and the day and at this point we are talking about most things happening that one day, which is april 16th. >> thank you. thank you very much. >> thank you. we will see you in two weeks. >> any public comment?

announcements? motion to adjourn. >> so moved. >> so moved. >> thank you.

>> my name is randy shaw and i'm a director of the tenderloin housing clinic appeared eight years ago, in january of 2011, i realized there was something really wrong with the tenderloin , that we don't have enough lights period people say they don't feel safe in the tenderloin at night, and it is because we don't have streetlights. just coincidentally with that, see pmc was planning on building a new hospital -- cpmc was planning on building a new hospital. and i thought the biggest impact would be all the cars driving up the street to get to the new hospital so that it was really important for the pedestrian safety of the tenderloin to have more streetlights, so i asked mark aronson, who happens to be

here today, a professor at hastings, if his class would do a study analysing the existing streetlights, and here on february 6th, 2011, they did this beautiful ten page study, which became the basis for our request. i also asked a member of the p.u.c., an engineer, for the per light cost, so i could -- took those numbers, and asked the then mayor, ed lee, if you could get us the money from cpmc. we figure the cost of adding lights would be $3 million. so i asked the mayor to ask for $3.5 million figuring there would be some bargaining. they would bargain with us, and i thought well, we asked for $3.5 million, we are pretty safe to get $3 million. if you know ed lee and how much he loved the tenderloin, he met

with cpmc, and he got us $4 million. a million more dollars than it we needed. he said randy, i want to make sure we have enough money. he was smart. so what happened was a board of supervisors approved at all in 2012, but then cpmc had to downsize the project, and it started again in 2014. in 2014, we had a little bit of a conflict with city officials. you see these beautiful teardrop lights qantas everyone like those lights while we are a historic district. we had engineers who said we are not putting in those lights. we are putting in the modern lights because they work better for lu d. we are having an argument on taylor street of august 2014. and i said to him, let me put it to you this way. mayor lee wants teardrop lights. do you want me to tell the mayor

you are not agreeing to what he wants? he did the same thing to mayor breach. you get mayors who really care about the tenderloin like them, in the city bureaucracy starts listening to the neighborhood. that is what happened. it took a very long time. i used to joke about harland kelley at the p.u.c. that whenever he saw me across the street, he knew i would harangue him about the delays. i have e-mails from the staff saying, randy, we are really sorry, but worse case scenario, it is finally going to open in the end of 2015. we finally thought it was going to open earlier in 2018, twice the wrong hardware was delivered , and barbara hale who is the assistant, since i don't know how this could happen. it is never happened before. twice they sent to the wrong fixtures, were finally, on

december 21st, they were installed, and they're all in all the north-south streets, and eddy street, and i think it is all really fitting in perfectly with mayor breed overall strategy for the tenderloin. from the first week she came into her job, she was here on a friday in the tenderloin. in the last 12 months, we have seen more police activity in the tenderloin then we have seen in years. we know it is a mayor who is paying attention. and the police are working hard to, but the mayor, as a team, i want to thank mayor breed for joining us today and for her support for the tenderloin. >> thank you randy. i am really excited to be here today. i know i have only been mayor for a short period of time. i think throughout the time, i have been in the tenderloin almost every single day. i came out here because first of

all, a lot of the folks that i grew up with live out here and spend a lot of time here, and they want their community to be safe too. we have to make sure that the resources that this community needs, so kids can get to school safely, so that folks who live here and especially our senior community, so they feel safe in their community, i want to see him clean streets in the tenderloin, i want to see safe streets and the tenderloin, and i want the people who live here, who spent time here to take care of the tenderloin too. this is an effort that is so critical to the success of this community, and i say yes, community, because there are so many people from so many parts of san francisco that live here, that enjoy this community. some amazing park space, and part of what our responsibility is is to make sure that the resources that this community needs, they get. that is why this opportunity for

lighting, and i know people are thinking, well what is the big deal about lighting? it is a big deal. every community in this city, they want pedestrian lighting. they want teardrop lighting. lighting fixtures that look this beautiful. the tenderloin, we have made it a priority so that this community knows it is a priority , that we are going to continue to make sure that the resources are brought to this community on a regular basis. i want to thank cpmc for their community benefit package that includes funding for not only pedestrian safety like these lights, buffer housing opportunity, for job opportunities, they are a part of the tenderloin community and so they have invested in the tenderloin community. in addition to all of that, there will be free services and care at the package to take care of the residents of this community. it is absolutely amazing. is a true testament to a real

partnership between cpmc and the city and county of san francisco i can't wait to be there in march when we cut the ribbon to open the new hospital on van ness avenue. i also want to thank harland kelly and the guys and gals at p.u.c. for your work. thank you so much for finally getting this job done, because a randy, not only did he harass the mayor at the time, he harassed every mayor of the board of supervisors, and that is why we finally have got it done, and yes, in less bureaucracy years than typical. i also want to thank the san francisco police department. thank you for so much for the officers who continue to walk the beach and develop relationships with the community on a regular basis. it definitely means a lot to have community policing so that members of our community feel

safe when they are walking the streets. thank you to so many folks who are a part of really the driving force. they are the reasons why we, as a city, pay a lot of attention to providing resources to the community, starting with randy shot in the tenderloin housing community clinic, essential safety s.r.o. collaborative, thank you so much. [cheers and applause] >> u.c. hastings, and unite here local two. incredible partners. people who are fighting and advocating for the tenderloin. i have made a commitment as i have said to you all before that we will continue to invest, invest, invest in resources. in fact, many of you heard about the significant amount of money that we actually came into recently. it is a one-time fund, and my proposal with conversations with so many people here today includes a significant investment, especially in the

tenderloin community. make sure that you pick up the phone and call your supervisor and other supervisors to let them know that the tenderloin will get its fair share of resources, and will not be forgotten. we will make it clean and safe for all of the residents and visitors alike. thank you all so much for being here today. [applause] >> thank you, mayor breed. as the mayor pointed out, the reason we have lights, the money came from cpmc, and one of the interesting things about the experience, there was a whole big narrative about how difficult it was for cpmc to work with certain people in the city, but their representative, from the very first time i met him, he said of course, we want to do streetlights pick whatever it costs, we want to do it. that is a fact. that is what he said to. it may get him into trouble forgiving us so much money, but he said cpmc wants to increase lighting in the tenderloin. it wasn't like the pole or the

fighting, it was great. let me introduce -- i want to make sure i get your name right. pamela kentucky -- kanaki. >> we indeed want to have safer streets in the tenderloin. so as you heard, i am the chief operating officer at cpmc. we have been part of san francisco neighborhoods for over 150 years. we are very excited, as mayor breed said to be opening our new hospital and our new campus just around the corner from here, on march 2nd, less than two months. as a not-for-profit organization , centre health believes in getting -- giving back to the communities. and these lights that everyone is talking about are one of the ways that we are working with our neighbors, the city, to make our communities better, safer and healthier.

in fact, a couple days ago, last friday, i was going to dinner in the tenderloin and i noticed the lights. i mentioned to my husband how beautiful the lights, how bright and beautiful they were, and so we are very pleased and proud to be part of the city, and the tenderloin. thank you very much. [applause] >> our last speaker, there is the empire market right across the way, which is benefiting from all these lights, and they have been a running that market for decades. she would like to explain what the lights mean to her. bora? [cheers and applause] >> thank you very much. good evening everyone. my husband and i own empire market right across the street. my family, which includes my children who live in the tenderloin for many years.

i work at our store at night so my family is happy to have additional lights that will improve safety on sidewalks. during the daytime, a business owner and resident, we walk through sidewalks all the time. we are faced every day with safety issues, however, i am glad to know that new lights will offer a much safer situation. we will be able to know what is going on the sidewalk outside of our family business neighborhoods. thank you very much. [cheers and applause] >> it turns out that the lights actually got on before jane kim

left office, within a few days. jane kim by unexpectedly, so she would like to say a few words. [cheers and applause] >> so it really is incredible that these lights have come on. just a couple of days before my turn was ending, only because this was one of the first projects i worked on when i came into office in 2011. it only took a little over eight years, but this did really begin in the community first, when the negotiations with cpmc began about the move of their hospital to the van ness core door, and has a lot of questions about the impact that this hospital would have in terms of traffic to the neighborhood, in terms of economy, and many other things. it was groups like central city s.r.o. collaborative who had been working collaboratively on passages to increase adult presence on the streets as kids walk and back doors walk back

and forth between school and afterschool programs, and i see many of our partners are here today. and randy, who talked about a study of how this neighborhood had the least number of streetlights at night of any neighborhood here in san francisco. so this, along with the pedestrian safety improvement really became the priority at the community and how cpu josie beat -- and how cpmc could make this neighborhood safer and stronger. there are many steps along the pathway to get here, of which they were not the major obstacle because they committed to this program so early on. i can't mention how many neighborhood studies and community processes that our offices worked with so many of the community leaders here over the last eight years to make that happen. i want to give a huge shout out to the public utilities commission. i know the general manager is here. [cheers and applause] >> the staff really did a tremendous amount of work to move this money that has been

committed to, which i should note, also went to the tenderloin museum that was standing behind here today, and we actually had to repurpose other city funds to come to help fund with cpmc originally, which is a street lighting funding program, and the p.u.c. made that happen. and whether the challenges we are getting, we need to connect it to our infrastructure, to so many other design challenges, and then different wants from the community. the p.u.c. really came out, along with the mayor's office of economic development, working alongside our community leaders to make sure that this happened within eight years. so i just want to wish everyone a big round of congratulations. our neighborhood really does work together to make this community safer, and i want to thank our mayor for her strong commitment to making sure that the tenderloin continues to be invested in heavily and strongly , and prioritized over her time as mayor. thank you very much. [cheers and applause]

>> and matt haney is out of town or else he would be here, our new supervisor. thank you all. if you have any questions or anything important to ask to folks, enjoy the lights. the darker it gets, the brighter they are. thank you all. [♪] today we are going to talk about fire safety. we are here at the urban center on mission street in san francisco. it's a wonderful display. a little house in the

urban center exhibition center that shows what it's like in a home in san francisco after an earthquake. one of the major issues that we are going to face after earthquakes are fire hazard. we are happy to have the fire marshall join us today. >> thank you. my pleasure. >> we talk about the san francisco earthquake that was a fire that mostly devastated the city. how do we avoid that kind of problem. how can we reduce fire hazard? >> the construction was a lot different. we don't expect what we had then. we want to make sure with the gas heaters that the gas is shut off. >> if you shut it off you are going to have no hot water or heat. be careful not to shut it

off unless you smell gas. >> absolutely because once you do shut it off you should have the utility company come in and turn it back on. here is a mock up of a gas hear the on a house. where would we find the gas meter? >> it should be in your garage. everyone should be familiar with where the gas meter is. >> one of the tools is a wrench, a crescent wrench. >> yes. the crescent wrench is good and this is a perfect example of how to have it so you can loosen it up and use it when you need it. >> okay. let's go inside to talk about fire safety.

many of the issues here relate to fire, for example, we have a little smoke detector and i see you brought one here, a carbon monoxide smoke detector. >> this is a combination of smoke and carbon monoxide detector. they are required in single homes now and in apartment buildings. if gas appliance is not burning properly this will alert you before the fumes buildup and will affect you negatively. >> this is a battery powered? >> this is a battery powered and it has a 10 year battery life. a lot of times you may have one or the other. if you put in just a carbon monoxide detector, it's important to

have one of these too. every house should have a fire extinguisher, yes. >> one thing people expect to do when the power goes out after an earthquake about using candles. what would you recommend? >> if you have a battery operated candle would be better to use. this kind of a candle, you wouldn't want it in an area where it can cause a fire or aftershock that it doesn't rollover. you definitely want to have this in a non-combustible surface. >> now, here we have our stove. after a significant earthquake we expect that we may have gas disrupted and so without gas in your home, how are you going to

cook? >> well, i wouldn't recommend cooking inside of the house. you have to go outside and use a portable stove or something else. >> so it wouldn't be safe to use your fireplace to cook? >> not at first. you should check it by a professional first. >> outside should be a safe place to cook as long as you stay away from buildings and doors and windows. >> yes. that will be fine. >> here we have some alternative cooking areas. >> you can barbecue and if you have a regular propane bark could barbecue.

>> thank you for joining us. and thanks for this terrific space that you have in this exhibition space and thanks for helping san francisco stay safe. >> san francisco is surrounded on three sides by water. the fireboat station is integral to maritime rescue and preparedness not only for san francisco but for all of the bay area. >> fire station 35 was built in 1915, so it's over 100 years old. and behind it, we're going to

build fireboat station 35. >> so the city's capital planning committee, i think about three years ago, issued a guidance that all city facilities must resist sea level rise. >> fireboat station number 35, construction costs are approximately $30 million, and the construction is over complicated because the float, it's being fabricated in china and will be brought to treasure island where the building -- the actual fire station will be constructed on top of it, and then brought to pier 22 1/2 for installation. >> we are looking at late 2020 for completion of the fireboat float. the historic fire house will remain on the embarcadero. we will still respond out of the firehouse with our fire

engine and respond to medical calls and other incidents raratin the district. >> the if a sill has to incorpora incorporate five to 6 feet of sea level rise. it's built on a float that can move up and down as the water level rises, and so it's on four fixed guide piles, so as the seas go up, it wican move and down with the bay. it does have a full range of travel from low tide to high tide of about 16 feet. so that allows for current tidal movements as well as several extra feet for sea level rise in the coming decades. >> the fireboat station float will also incorporate a ramp for ambulance deployment and access. >> the access ramp is rigidly connected to the land side or

more of a pivot or hinge connection, and then, it's sliding over the top of the float. so then that way, the ramp can, you know, flex up and down like a hinge but also allow for a slight -- a few inches of lateral motion of the float. both the access ramps, of which there's two, and the utilities, need flexible connections when connecting from the float and back to the building. so interesting power, water, sewage, it all has flexible connections to the float. >> fireboat station 35 will provide room for three boats and one fire boot. >> we would like to establish a dedicated marine unit that would be able to respond to multiple incidents. looking into the future, we have not only at&t park, we have a lot of kayakers, but we

also have a lot of developments on the southeast side, including the warriors stadium, and we want to have the ability to respond to any marine or maritime incidents along all of these new developments. >> there's very few design references for people actually sleeping on the water. what we really looked to were cruise ships, which are, you know, larger structures, several times the size of station 35 but have a lot of people -- a lot of sleeping, but they're really the only good reference point. and so we looked to the cruise ship industry that has kind of an index for, you know, how ma many -- how much acceleration they can accommodate. >> it's very unique. i don't know about any other fire station built on the water in the united states. >> the fireboat's a regional asset that can not only be used for water rescue and stin wishment of fires, but we also do environmental cleanup. we have a special rigging that

we carrie that will contain oil spills -- carry that will contain oil spills until viermsal can come out. this is not a job, it is -- environmental can come out. this is not a job, it's a lifestyle, a community, and we're willing to help people

>> this is a reminder to silence all electronic devices. fire commission regular meeting wednesday, january 23rd, 2019 in the time is 5:02. roll call. president stephen nakajo. vice president franc francee covington. commissioner michael hardeman. ken cleveland is excused.

joe alioto ve. >> members of the public may address the commission for up to three minutes on any matter within the commission's jurisdiction and does not appear on the agenda. speakers shall address their remarks to the individual as a whole and not to individual commissioners. commissioners are not to enter into debate or discuss with the a speaker. the lack of a response by the commissioners or department personnel does not necessarily constitute agreement with or support of statements made during public comment. >> anybody wishes to give public comment at this time? are there any questions, discussions for the commissioners at this time? seeing none. public comment is closed. >> >> clerk: approval of the minutes, item 3. discussion and possible action to approve meeting minutes from

a special meeting on january 4th, 2019. >> at this point, is there any public comment on the special meeting minutes of january 4th, 2019? are there any questions or discussions from the commissioners at this time? commissioner vice president covington? >> thank you, mr. president. yes, i did share with the commission secretary some minor adjustments. nothing of great importance. i. >> this is for the special meeting. >> the special meeting? >> clerk: yes on january 4th. >> we're doing them one by one. >> sorry. >> ok no problem. i'd like mont move the item. >> do we have a second? >> call for the question, all in favor say aye.

>> aye. >> any opposed. none. thank you. >> clerk: an approval of the min es from a special meetig on january 8th, 2019. >> at this time is there any public comment on this special meeting on january 8th, 2019? any questions, discussions from the commissioners at this time? >> i'd like to move the item. >> thank you, vice president covington. i need a second please. >> >> second. >> call for the question all in favor say aye. >> aye. >> any opposed? none. motion passes. >> clerk: minutes from the regular meeting on january 9th, 2019. >> the regular meeting january 9th, is there any public comment at this time? >> commissioner vice president covington, any questions, discussions from the commission at this point? >> as previously mentioned, i'd like to move this item as well. >> thank you, very much.

is there a motion to approve? commissioner vice president covington has moved and i need a second, please. >> second. >> commissioner. all in favor say aye. >> aye. >> approved. madam secretary. >> item 4. five department operating budget fiscal years 2019-2020 and 2020-2021. presentation from mark corso on the fire department operating budget for commission review and discussion. >> at this particular time, is there any public comment on this item of operating budget fiscal year 2019-2020? hearing none. public comment is closed. director corso. >> thank you, president. good evening. here to give a brief update and start the discussion on our

19-20-20-220 and 20-21 update. it's an overview of time lines and instructions. things we've touched on in previous meetings. look at budget to date. some of the updates in the current year as well as some of the discussion that's we've had so far regarding priorities and challenges. as always, open up for any discussions or questions that you may have. as i mentioned at the last meeting, we received our budget discussions along with all other city departments in december. the city is projecting $271 million deficit over the next two fiscal years. and those deficits are anticipated to increase. that is detailed in the city's five-year financial plan update. they're looking at a 644 million-dollar deficit and fiscal year 2024. so all city departments have been requested to make reductions to the support that

they receive from the general fund to the extent of 2% in both years. they would be on going. that would be a 4% reduction in the second year and in addiction, they would -- the departments are being requested to submit a 1% contingency reduction. 2% is $1.4 million and 4% is $2.7 million. over all timeframe, we have a discussion at the meeting today and then potentially further discussion obviously in potential approval at the next next meeting. budget submissions are due to the mayor's office on february 21st and over the next few months the departments work with the mayor's office to submit a city budget that would be on may 31st do the board. and june and july are budget hearings at the board as well as budget being considered at the board. last year, we're in a two-year budget process. last year's budget process

supplied a second year. as part of the budget last year, some with month indications our budgbudget has approved. all known fringe rates, the results of the m.o.u.s are incorporated into our base budget. one time expenditures are taken out and equipment is usually extracted and target reduction requests are measured against the department's general fund support. taking our expenditures from the general fund, offsetting revenue that this general funds is contributing to our budget after consideration, that's from which our target reductions are based off of. so here is kind of a historic budget overview. so our budget over all, the blue you will see is the total department budget. the red or orange is the general fund department budget. as we discussed previously last

year marked the first year we eclipsed the 400 million-dollar threshold for department budget. that's anticipated to increase as you will see on the next slide in the coming years. as a result of that, the general fund, the non general fund is things like the airport and previously the port and other funds that aren't paid by general fund moneys so as i mentioned it's a 21% increase over this time. majority of that is due not to expansion of scope of services but to some extent for sure but it's salary and benefit increases. so here is a look at our current budget as compared to -- our base budget compared to our current and extended year budget. as i mentioned, we're looking at $400 million budget. and 413 the year after that. the reason that is lower, is because a lot of the one-time

equipment and capital expenditures are scrape scrippe. that will reduce the budget until those allocations are approved. $269 million is our general fund support. after revenue, after offsetting funds from other expenditures like the airport, that's how much the general fund is allocated for the department. so that's what the base -- after prop f staffing considering are removed, that's the amount from which the budget reductions are based off of. so current year, there were some changes that were approved last year. there was the addition of a grand writer. that position has not been filled but the announcement closes later on this week. we're looking forward to filling that. we had funding for q.r.v. vehicles, which is staffed and e.m.s. 6 which established a administrative position. there were changes to overtime and federal labor standards act. there were some impacts to the

department. there were changes city wide and impacts with the department as well. the on going hiring and equipment plans were in the process of procurement and a number of apparatus and the next academy starting up next week, the fire academy. fire prevention. we've expanded the scope of work along with city initiatives such as a.d.u.s and other plans and construction projects. we brought on additional staff supported by revenues to manage that workload and provide the bureau additional resources. there were other staffing include. airport increased some training staff and infrastructure staff as well as bike medic staff and there's marine equipment allocation added back as part of the budget process that covers marine equipment as well as the match for our dive boat that was allocated from a federal grant. so to date, last meeting we discussed our capital and i.t. requests. those were approved by the commission and submitted to the

respective committees by januare deadline. there were a couple of changes to those due to some changes in the program. i'll detail those at our next meeting. we continued to work with division heads on budget issues and needs assessments. we've reconvened the budget committee to discuss the needs of the department and prioritization of those needs. i have included some of the materials that were incorporated in your packets as well. we'll update staffing models as well as revenue and feed projections for the next two years. as far as over all departmental priorities, both the department effective may 2012 established under mayor lee's leadership, public safety hiring plan. that has continued through 2020. in addition in may of 2016, mayor lee established a public safety or fire department equipment and apparatus replacement plan and so from a

departmental perspective, it's very important we continue thost we can but enhance those to future years. that is an ongoing and in addition, we are discussion, along with the budget committee and labor departmental priorities and e.m.s. staff and cyst assistance and in addition to just over all staffing for increasing in calls as well as support for restoring funding for incident sports specialists so those discussions are on going with the budget committee. challenges, i think we've discussed the budget committee level, the large challenge is to submit a budget that would be in

response to budget reductions but also have the department deal with increased call volume and increased demand for services. so not just front line calls but in addition the scope of services that the department provides and has increased over the recent years such as public education and outreach and those kinds of services as well. so there's a very much a lack of budget flexibility that we have given the staffing requirements that we have and the number of initiatives we have. the consensus among the budget committee is that we are the department should not submit reductions to its budget. we have been proposed to the commission previously so it's up for discussion. that's been the message from the discussions at the budget committee level is due to the needs of the department, the department shouldn't be submitting any budget reductions. we're still looking if there's any revenue opportunities to offset some of that, currently that's been the discussions so

far at the budget committee level. just going over the documentation that you had in your packets, just a very, very high level overview outlining the department's costs, revenues as well as expenditures. there's a little packet on page five that outlines the different types of revenues that the department has. by project. on page 8, outlines the total expenditures by type. salaries, benefits, materials and supplies, et cetera for general fund and not general fund and then on page 10, or on page 12, it outlines the 14 it outlines the type of expenditure by division or project type. for example, sports services prevention, administration, et cetera. as you can see in all cases the budget rolls up to the

416 million-dollar base budget number that we were discussing previously so i'm happy to answer any questions. when we get towards budget approval detail and submission budget book information will be provided to the commission in advance. and then on the last page of the packet provided, there's three pages here. it's an overview of the items needs that were identified both from different divisions as well as the budget committee and were currently up for discussion. we've met a few times and we'll send out communications for prioritization of these needs and we anticipate meeting either the end of next week or early in the week after to discuss and formally prioritize. just because the budget is submitted in february doesn't mean that our conversations with the mayor's office stops, they just quite frankly begin and many as facts so it will condition to discuss our needs and provide our data and justification for a lot of them over the next few months up until the mayor's budget release

in may. with that i'm happy to answer any questions you may have. >> thank you, very much, director corso. vice president covington, did you want -- >> i called for public comments. at this point, commissioners. >> >> thank you, mr. corso. you are doing god's work and we all appreciate it. >> thank you. >> i had a question. last year the issue of $100 million of fees that were uncollected and i believe those were ambulance related. is that in here? >> yes. so if you look on page 6, top

line. >> so on page 5 and 6. on page 6, the top line, ambulance billings that shows the estimate total number of charges that we would be billing for. actually the previous line on page 5, the last line on the bottom shows essentially the write offic offs for that and te anticipated revenue for that department. >> there's $135 million billed and there is $106 million that are written off. what does that mean written off? are you just not collecting that? is that something every year we just -- what is that exactly? >> it's a combination. it's for bills that aren't paid but it's also mainly based on the demographics, we run a lot of medicine' car medicare and me do not collect anything beyond

for what they approve. if we have a $2,000 ambulance bill and the patient has medi-cal insurance, they will reimburse us $125 on that and that remaining balance is then considered written off. there's no collecting ability on the department's behalf for that. same with medicare where it's $450 there's a big bill we're not able to collect. >> let's say that i need a ride to the hospital and i use an ambulance and it cost me a thousand dollars. my insurance covers 75% of that and i'm left with $250 bill for that. >> as a copay or something along those lines, right. >> i have to pay the department that money? >> correct. it would depend on the structure of your insurance but in most cases, a lot of insurance have a copay where the insurance will pay 75, 85% and there's a

remaining balance, be it $50 or a few hundred dollars that would go to the patient. or to the patient's secondary insurance. >> what if i don't have any insurance at all which i imagine is the case for many of the people using our system? >> correct. so we run people through the medi-cal and medicare to see if they're eligible for benefits and then we have an outreach that the billing company works with. if people do not have insurance, we have financial hardship program that allows for department's ability to write off bills if your income is below 300% of the federal poverty level where that bill would be waived. >> ok.

>> it seems like in the system we've created for ourself, the system we've created people are being billio billed differentlye same ride to the hospital? >> they're billed the same it just depends on the insurance they have. depending on private or medicare or medical, the charges are the same. it just depends on the insurance or the individual's ability to pay that fee where the account goes. >> in the three scenarios that you just mentioned, the ininsured, medicare, i'm the only one that pays in that circumstance? >> correct. >> everything else is written off? >> correct. >> ok. and so, over the last 10 years, by way of example. this number has been hovering at

about $100 million. >> correct. >> we've written off a billion dollars in these fees over the last 10 years? >> correct. if you add that up. if you look at when we do a fee increase, or costs over the years, costs of services may increase for the department and in turn our fees may go up and they go up by medical c.p.i. every year. that doesn't change the amount of reimbursement we're receiving from medicare or the amount of reimbursement we receive from medi-cal. it would extend the write offs with the structure of the insurance. >> you mentioned the general allocates, how much was that? $320 million? where is that number? >> i believe it's on the side. after accounting for our funds and our revenues it's about

$270 million. >> $270 million? >> correct. after our revenues that we received. >> it's twice the money we should be receiving in ambulance billings. the ambulance billings are $135 million. >> yes, that's an issue in jurisdictions with demographics we have, there's very low reimbursement. it's not very unique issue for us per se. >> who does the collections on the ambulance billing? >> we have a contractor that does our ambulance billing. we work with them to find better

communications with hospitals and incorporating patient data and getting patient data. for example, when we pick up our patient, our crews may not collect the data on that patient before dropping them off at an emergency room. we work with our billing company to set up with relationships to hospitals to get additional patient information from them for billing purposes. >> has anybody ever run the number as to how much of that 180 or $106 million a year that we are writing-off as homeless-related? >> i do not believe so. >> is there a way we can do that? now that we're tracking it, we've tracked that information for a year, we should be able to go to the mayor's office and say hey, madam mayor, 40% of our calls are homeless related. that's going to be a really low number because you know that more than 40% of our homeless population is using our ambulance services.

assume that it's half that. let's call it 50%, which i think is still low. $50 million should be an added cost to homelessness to san francisco. i just think that this type of information should be the information we're discussing with the mayor's office when we're doing budget analyzes. so when we're asking for -- when we're up at the mayor's office asking for -- just by way of example. a department electrician that cost $161,000. if you look at total of the asks on page 17, 18 and 19, that comes out to 29 million or $30 million. right. so, if we ask, for example, the homeless department, the department of homelessness to

pay for the $50 million in homeless ambulance rides, we can get every little thing that is on that list on page 17 and 18 and 19 and have $10 million to spare. i think these are the types of conversations we should be having since we're in a homeless crisis in san francisco. these are the situations we should be having with the other departments in this city since we're the ones that are picking up the slack on an issue that is technically not just our issue. our mission is to respond to 9-1-1 calls and make sure that people are getting emergency care. it seems like we're giving a large part of our budget to homeless people rides to the hospital -- given they need those rides in a lot of those cases and some cases they don't

need the rides. it's cold outside and they know as the ms6 will tell you and some of the other people out in the engines other tell you, they know the right buzz words. they say the right buzz words and wore going to show up and give you a ride to the hospital. that's probably a part of what is going on here. i think that we, the department should recoup some of those funds because they would pay for everything on our asking list plus another $10 million. i'm just talking to you because you are the guy bringing the news. it's not your fault, but it's something that the department could be better at, given that we're taking up a lot of the slack. i know the police department budget is $450 million when i was on the commission eight years ago. it's probably $500 million by this time and they don't have

revenue sources like we do. their general fund pool is closer to their budget. we're the ones that are pulling in the revenue and pulling a lot of the slack for some of the other departments. i just think that we need to do a better job of trying to get that stuff paid for. >> understood. those discussions are on going. i think that homelessness is being treated as a steed wide problem. to the extent that we have been able to insert ourselves in those conversations in general. we're trying to advocate for the department's position. >> let's try and figure out, if we could, i know jesus does magic work. if we can him to tie that number in an accurate way, the write-off number to homelessness, perhaps it's something we can ask out of the homeless budget. it's something that is happening. >> we can definitely look at that. >> great. thank you mr. corso, i appreciate the hard work you do.

>> thank you, very much, commissioner alioto-veronese. at this point, commissioner hardeman. >> thank you, mr. president. thank you for the clear speaking. your voice carried very good. probably always does. i just noticed how crisp and vibrant your voice was carrying. i just sat back and could hear very good. >> thank you. >> it's interesting, one of the reasons why graphs and charts and just information where you can view it is, you look at the base overview and you go back five years and you look at how it's grown. you look at how the department and the population have grown. that's a very modest growth in

the budget. iin my opinion. i think we're holding the line very good. if you just grasp it, the reality isn't the city. if the city would just hold its own and not growing any in population or in workforce, for this department, you would expect anyway. doing this under the circumstances of growth and the 40% that no addresses. is there a collection of any money for the 40%? or we don't even try to collect that. >> we do. we bill, in some cases, those people have medi-cal or medicare insurance. they just don't have an address. we'll take a closer look at it. we do bill and to the extent

that we have information on individuals to see if they have insurance, we look at that as well. >> some of that is collected? >> i'm sorry? >> are funds collected. >> i would imagine for some of them, yes. >> another thing, like i say, i like the written information. the revenue summary, the expense by type, ex pensio expense by dd the needs and review how you indicated everything. thank you. very good. i appreciate that. i might be sitting in on a budget meeting here. i really like to have this stuff in my mind before that happens. thank you. >> thank you. >> thank you, very much, commissioner hardeman. chief hayes-white. >> thank you, president nakajo. thank you to director corso. i would say that it might be