relationship. similarly it's their electric utility is a department of the city. same thing with santa clara, silicon valley power. so it varies. >> thank you. >> thank you very much, barbara. yes, with a municipal utility, it can be structured in a number of ways and depends on the size of the department, so some of them have their own commission that oversees them and others act more just like a city department. so one issue with a municipal object is how to acquire or construct the infrastructure that's needed to actually distribute power. and the options for that are fairly straightforward. you can construct your open. you could negotiate a sale or transfer with the owner of the infrastructure, in this case,

pg & e. or you could go through a condemnation process. it's worth noting while pg & e is under the jurisdiction of the bankruptcy court, the options may be limited entirely while they're looking to avoid loss of any assets. so briefly, in a municipal utility, the board of supervisors would be the one authorizing any eminent domain and for the district it would be the district's board of directors. >> so you say that it might be constrained or prohibited all together. that's completely within the decision-making power of the judge? >> right. once you're in the bankruptcy court, the bankruptcy court can prevent anyone from suing the subject of the bankruptcy. so since eminent demain and condemn authentication aration ,

that would be on pause until the bankruptcy was resolved. >> we don't know, a bankruptcy might allow that. >> that's right. i'm not a bankruptcy attorney. it's simply an observation that at this point in time, it may be difficult to acquire infrastructure from pg & e because those would be viewed as valuable assets in the bankruptcy process. so there are, of course, constitutional limits and statutory limits on eminent doe main, including facilities have to be used for a public use and pay just compensation. the governing body would have to make a resolution of necessity with very specific findings and that's a two-third's vote. some considerations just to keep in mind would be finding fair market value for -- energy infrastructure is difficult.

this is not something on the market so there's to the a clear market value. so valuation is possibly one of the more challenging things of this situation and the law does provide that you could go through a superior court process to determine the value of that property or you could go to the cpuc and the cpuc could take a role in valuing it. so that's a very brief overview of that area. if you have have any questions, let me know. >> any questions for miss culsa? >> are there any municipal utilities or districts that took a significant part of the grid or other aspects that allowed them to form through eminent domain? is that something that has happened before? do we have examples to look to toward that?

>> the municipal districts have the power of eminent domain. i don't know of any specific instances and, perhaps, barbara has antidotes but i know that power has been used in california to acquire infrastructure, as these new utilities were just being formed. >> anything of the scale we would be talking about, maybe? >> so this has happened over time in california. more recent times city of moreno valley municipalized and the irrigation district is about the middle of a process now, ongoing for a number of years. i would have to look at history to see if there's any in the more distant past that are of the size comparable to what we're talking about. i'd be happy to, through your

executive officer, you know, do that research and provide that information. >> that would be great. it sounds like there's some important legal questions, as well, in terms of whether the courts have found that for a purpose like this that would be something eminent domain is appropriate for. obviously there's public use there. >> and now you're getting more into the legal again so i'll step away. >> correct. i think that the good news is that acquisition of public utility's infrastructure has generally been considered a public use in making those finings and getting a two-third vote of the board to move forward that you would be looking at specifically whether or not you felt that it was for the overall public good. but historically, this has been done before and found to be of

public use. >> i was just wondering if manager hail could come back and describe the different rfps for the different studies the puc is undertaking, to my colleagues at the moment. >> so yes, the puc in response to the mayor's request for a report on what our options are, to preserve safe and affordable electric service here in san francisco, together with the city attorney's office, putting together some analysis and we are seeking the support of consultants as the city does to help us do that. the types of topics that we're addressing are the valuation, as miss culsa mentioned, valuation is an important component of this. and really looking at the

financial feasibility. it's a very important question for us to understand what the total costs of acquiring the system could be, what the ongoing operations and maintenance costs of the systems could be and what investments would need to be made to separate what would become the city's system from the pg & e system because it's inner interconnected today and you need to invest in infrastructure to do that. what the costs are for -- i lost my thought on what the last thought was but i'll keep going. another important component of the analysis is what the projected revenue stream is and taking together those overall costs and projected revenue stream, could the city provide safe, affordable, reliable

electric service consistent with our values and meet our financial metrics. that's really the big question that i think we've been asked to help the city answer and we're relying on some consulting services to help us do that. thank you. >> thank you. >> commissioner marr. >> manager hail, i actually had a few questions. i have been wondering natural gas fits into these planning effort, as we're kind of looking at municipalization of energy, services in san francisco, how does natural gas fit into that and for other utility districts, how is natural gas. >> so san francisco having a history of providing municipal electric service, we feel like we have a pretty good fit for scaling that operation up and

addressing this feasibility question of whether it's appropriate for the city to expand service to provide electric to all of san francisco. we are not looking at assumption of natural gas services. the other -- i think the other cities and jurisdictions have a mixed bag. some provide natural gas service along with electric service and other essential utility services and some don't. so as i say, it's a mixed bag. l.a. doesn't, alameda used to but they discontinued that natural gas service. to anand then the other part ofr question, i suppose, is how does natural gas fit into the supply

of an electric utility? our objective would be to continue to operate as we do today with a strong emphasis on greenhouse gas free and renewable gas services. our hedge utility serves our customers 150 megawatts of load with 100% greenhouse gas-free electricity. so we would strive for and would model the financial freeze feas, assuming any system expansion. and natural gas fire generation is definitely an important resource in the overall reliable operation of the electric system as it's configured today. thestthe efforts to decarbonizel help us get to further reduction

of reliance on the natural gas generation. >> thank you. >> commission sigh. >> are there ways in different target or goals can help with this? i believe mr. heims, i think it was you, brought it up at the last meeting that we need to acquire a bond or credit rating for the clean power sf program and is there a way to feed into the process of determining what is financially feasible and what is not some. >> so the two programs, municipal utility and a community-choice aggregation program are two offerings. the hedge program has a credit rating and using that credit rating to support its revenue bond financed capital program.

so we're already doing that as a municipal utility. the voters in june of 2018 supported an expansion of that or additional authority or a change in the authority, i should say, on how we use revenue bonds that allows us to utilize our credit rating for acquisition and construction of distribution systems and other supply, new supply. so we have the financial tools, if you will to move forward. you're right, the clean power sf program does not. we're the citwere the city to gh an acquisition and service to all of san francisco, we would

absorb the clean power sf program into the program and continue to serve those customer customers and the supply commitments that the clean sf program has made would help to serve the full complement of customers the city would be responsible for. >> thank you. >> thank you. are there any other questions for miss hail or miss culsa? lead open this up for public comment. any members of the public that would like to speak on item number 4? >> good afternoon, commissioners, eric brooks. just ducktailing off of that last question, it's very important for the lafco commissioners to understand and welcome to the new commissioners, by the way. it's great to see you on. if i had to pick two people be

would be the ones. it's important to understand that what miss hail was saying is that if we do a public power system, legally clean power sf ceases to exist. so instead of having a program that's o oriented on clean powe, the municipal utility which is a completely different animal. if you look ats los angelos, you can see some utilities are not aggressive on clean energy. if we go the route of a municipal ru utility, as we're supposed to have done as pg & e derailed us but building the last 15 wire wires, we would hae been a public utility already. but if we go that route, we have to make certain that everything that clean power sf is doing right now is baked into the

municipal utility and we have to make certain that we do the big renewable energy master plan, like the one in sydney, australia, three were wer that g with you all and make sure that's baked in. most importantly, we need a municipal district run by an elected board of directors, elected by the people of san francisco, not a bureaucratic agency. it's time -- if we do a public utility, we need it to be directly run and that will give us the power to make sure clean energy really happens and we don't go the route of l.a. which does not focus enough on clean energy. thanks. >> any other members that would like to speak on item 4? seeing none, public comment is now closed. madam clerk, would you please read item five?

>> just for the record, on item number four, no action was taken. >> thank you. >> executive officer's report, labor study update, an expenditure update. >> good afternoon. welcome and excited to have you here. i just have a few brief items today. as you know, we issued a request for proposals for our labor survey on on-demand workers on january 18 and right now, what we're working on is really trying to narrow the best way to obtain a good sampling frame for the survey and we're working with the treasurer's office to gain access to business license information, both historical information and information on current gig workers. some of the potential bidders want to make sure before they submit a proposal, they will be

able to get a good sampling frame, names and addresses of folks to reach them. and that is something that i have been working on and hopefully will be successful at getting that information. secondly, on the labor study, i spoke to a class of usf graduate studented this month. as you know, they're taking on a key segment of our study for their method's course. leah troe, our former intern joined me. it was a great time. the students were very engaged and right now they're in the process of finalizing their research questions and again, they will be making a presentation before this body at our meeting in may. and then finally, i've included if your packet, an update on expenditures through january 31. everything is pretty much on target and with that i'll submit. >> colleagues, any questions?

seeing none, let's open this up for a public comment. any members of the public that would wish to comment on item 5? seeing none, public comment is closed. there is no action taken on this item. madam clerk, could you read item 6? >> general public comment. >> are there any members of the public that would wish to speak on public comment? >> yes. eric brooks again. this time i'm speaking on behalf of the local grass root's organization, our city, san francisco. anand the san franciscogreen pa. i want to direct this to all but especially the commissioner, we recent -- a coalition of my group and green action and some others working on the bayview hunter's point and treasure

island crises have met with your aide and it's important what we do on treasure island, the same contractor did almost all of the clean-up work since the mid90s and probably falsified a lot of that work, where there's radio active contamination right now that people are exposed to, where there's chemical contamination like dioxins that people are being exposed to, we need to halt the development program on treasure island, the same way the program in bayview hunters' point has been halted. part of the process is that, frankly, chida, treasure island development authority is bought and paid for by the developers and has been, basically, lying to the board of supervisors,

pretending that tetra had nothing to do with the clean-up on treasure island, which is totally false but trying to make it appear that's the case. there are other problems along those lines that we've had this whole time and this is the local agency formation commission. that's a local agency. it would be very interesting to possibly have the hearing at the lafco, depending on what the legal council might say about that. but just wanted to throw that out as a possibility. >> thank you, mr. brooks. any other members of the public that would like to speak now. seeing none, public comment is closed. madam clerk, would you read item number 7. >> future agenda items.

>> colleagues, any future agenda items to note seeing none, we'll open up this for public comments. >> mr. brooks? >> yes, california for energy choice, san francisco clean energy advocates. so the good news is that i've got is that as of late last year an early in this year, we've been meeting with especially the chair of this commission, miss furer and also the people in the mayor's office, workforce development and the mayor's environmental adviser to talk about whether we do public power or stay with clean power sf. under either scenario, right now we're not building clean energy in san francisco. since the beginning of this process that i got involved in 15 years ago and others got involved in this, even longer

time ago, we've been asking for a city-wide, county-wide, clean energy build-out plan that's spectaculasimilar to the sydneya plan. it's an amazing plan. the only problem was that it was developed before battery storiage became competitive and it relies on bio mass and bio gas and that's not a good panel. so i'll send it with that disclaimer that says energy disclaimer, bio gas, not mass. when we talked, they expressed interest in doing the city-wide master plan. we and lafco have been talking about it and tyrone expressed

interest -- i won't commit him to anything -- but expressed interest in lafco leading for the plan. so that is something very important that we would need to get on an agenda soon so that we can get that rolling. especially with all of this pg & e stuff. >> are there any other members of the public that would like to speak? >> my name is hunter stern, we represent the pg & e workers in northern and central california and then a number of utilities in northern nevada. so under the heading of any time i can agree with eric brooks, i will stand up and do so. the points that eric just made about the build-out of local generation, renewable

generation, this has been promised to people, and i'm a san francisco resident, as well, this has been promised to people in the city for 15 years. we met actively with leadership at the sfpuc, i think five or six years ago. they have identified 20 different projects they can build that have not moved forward in at least ten years. i shouldn't say for all 20. there's a list the puc has identified. this is something we can do. people voted and there was a ballot measure talking about clean energy projects and infrastructure that we in sanfrancisco approved. you have to push this forward. it's something that is incumbent on a city that is clean, clean, clean and doesn't own or invest in clean energy projects. thank you. >> thank you. >> just as an action item, can

you send commissioner hainy and marr a list of the report? thank you. i see no action is to be taken on this matter. madam clerk -- oh, public comment is closed first and no action to be taken on this matter. madam clerk, any other business for today? >> that concludes or business for today. >> no further business, we are adjourned.

>> when i open up the paper every day i'm just amazed at how many different environmental issues keep popping up. when i think about the planet i want to leave for my children and other generation, i think of what contribution i can make on a personal level to the environment. ♪ clean power sf is san francisco's key way of fighting climate change by renewable energy and offering it to san francisco customers. i'm from the san francisco public utilities commission. the program came about with state wide legislation in 2002 to enable people to take more control over supplies. i first heard of the program when the organization was

advocating to launch clean power sf. what i'm most excited about, it's going to bring 100% renewable energy to my home and reinvest into renewable energy infrastructure and jobs. i had gone to a lot of street fairs and heard from the staff at the san francisco public utilities commission to sign up for clean power sf even before it launched. >> we learned about clean power sf because our sustainability team is always looking for clean operations. linkedin is the largest online network. there are about 530 million members using our site. in this san francisco office there's about 1400 employees working in roughly 400,000

square feet. >> after signing up for the program we heard about the san francisco program and learned they had commercial rates and signed up for that. i'm the co-owner of the new wheel electric bike shop. we opened this store in 2012 and the new wheel sells and services electric bikes. 11 people work here in san francisco and our store is about 2,000 square feet. electric bikes are fantastic for transportation in the city, they're clean and green and you get places faster than any other form of transportation. it amplifies the power, it doesn't replace it. it makes it easier to get places by bicycle and it's so enjoyable and environmentally friendly way to go and more convenient in san francisco. >> clean power sf requires two products, green, 40% renewable and competitively priced with pg

and e. for those who want to fight climate change more, 100% renewable at $0.02 per kilawatt. >> i decided to go with the super greens, after finding it only to cost about $5 more a month to have super green, that's a no-brainer, i can do that. >> we were pleased that clean power sf offers the super green 100% for commercial entities like ours and residents for the city of san francisco. we were pleased with the package of services for linkedin and now encouraging our employees who have a residence in san francisco to sign on as well. >> clean power sf buys its power from renewable plants that feed

the energy directly into the grid. >> there's a commitment to sustainability throughout the entire organization and this clean power opportunity reflects that. >> one of the wind farms we use is the shilo wind farm and that is large enough to be able to provide energy for up to 200,000 homes. >> our mission is sustainability, even though our bikes are minimal energy use, it still matters where the energy comes from and part of our mission in sustainability is how we run everything -- run our business. having the lights come on with clean energy is very important. >> the sunset reservoir has solar panels that take up about four city blocks covering the reservoir and the solar power generates energy for city resources and clean power sf for

residents participating in the program. >> it was easy to sign up for the program, i went online to cleanpowersf.org and i started getting pieces in the mail letting me know i was going to be switched over and it just happened. when i pay my bill, i still go to pg and e and i don't see any difference between now and a year ago. >> sign up online, just have your account number ready and it takes about two minutes and there's nothing to install. no lines are getting connected to your home. all the power goes through the existed power grid. >> we haven't had any problems with the switch over to clean power. >> it's super easy to sign up. our book keeper signed up online, it took about 15 minutes. nothing changed but now we have cleaner energy. >> we see clean power sf as a

key strategy to meet renewable energy goal, we have a goal of 50% renewable energy by 2020. currently we have enrolled about 86,000 customers across the city. about 20% of what we hope to serve in the future and in the next two years we'll offer service to all san francisco electricity customers. >> an easy way to align your environmental responsibilities and goals around climate change and it's so easy that it's hard to not want to do it and it doesn't really add anything to the bill. >> joining clean power sf is one of the easiest ways to fight climate change, receiving cleaner energy at low and stable rates, you're helping to support a not for profit that helps influence the energy grid and produce more production. >> i would encourage any

business to seriously convert to the clean sf service. it's good for environment, business and the community. >> you can sign up online our call and the great thing is, you'll have the peace of mind that you're doing your part in your household to help the environment. ♪ ♪ >> (speaking foreign language.) >> shop and dine in the 49 promotes local biz and challenges the san franciscans to do their shop and dine in the 49 within the by supporting the services we help san francisco remain unique and successful and

vibrant so where will you shop and dine in the 49 san francisco owes itch of the charm to the many neighborhoods people coma greet and meet it has an personality these neighborhoods are economic engine seeing the changes is a big deal to me especially being a san francisco native and it is important to support the local businesses but also a lot to over here it is nice not to have to go downtown i think that is very important 0 for us to circulate our dollars the community before we bring them outside of the community for the time we have one dollars in the community is the better off we are it is about economic

empowerment by apron ingress the businesses that are here. >> shopping local cuts down the cyber foot you'll find cookies and being transported the world where everything is manufactured and put on the assembly line having something local is meaning more the more we support our local businesses the more i can walk down to where i need to be. >> bridges contingency bye like west portal it is about city and san francisco may have a big name but a small city and a lot

of small communities shop and dine in the 49 highlighted that and reminded people come outburst and i love that about this city i'll always be a ♪ >> welcome to hamilton recreation and aquatics center. it is the only facility that has an integrated swimming pool and recreation center combined. we have to pools, the city's water slide, for little kids and those of you that are more daring and want to try the rockslide, we have a drop slide. >> exercises for everybody. hi have a great time.

the ladies and guys that come, it is for the community and we really make it fun. people think it is only for those that play basketball or swim. >> i have been coming to the pool for a long time now. it is nice, they are sweet. >> in the aquatics center, they are very committed to combining for people in san francisco. and also ensuring that they have public safety. >> there are a lot of different personalities that come through here and it makes it very exciting all the time. they, their family or teach their kids have a swim.

>> of the gem is fantastic, there is an incredible program going on there, both of my girls have learned to swim there. it is a fantastic place, check it out. it is an incredible indication of what bonn dollars can do with our hearts and facilities. it is as good as anything you will find out why mca. parents come from all over. >> there are not too many pools that are still around, and this is one-stop shopping for kids. you can bring your kid here and have a cool summer. >> if you want to see some of the youth and young men throughout san francisco play

some great pickup games, come wednesday night for midnight basketball. on saturdays, we have a senior lyons dance that has a great time getting exercise and a movement. we have all the music going, the generally have a good time. whether it is awkward camp or junior guard. >> from more information, visit >> i am so excited to be here to stand in this waiting room of this beautiful new urgent care center that will serve thousands of patients here at s.f. general. as our population continues to grow, it is more important now,

more than ever to make sure our public health facilities are now up-to-date in the latest in technology and programming, but also, resilient and strong, and in the event of a major earthquake, or any other disaster that may come our way. that is why i'm grateful to the voters who passed the 2016 public health and safety bond that funded not only the expansion of the urgent care facility act which served more than 20,000 people in 2018, but also the funding for the seismically -- for seismically retrofitting this entire building that we are standing in today. one of the key things we are doing with retrofitting this entire building is bringing everyone back under one roof. by recentralizing services into this building, we can improve services and coordination by our staff. this is key to better deliver

healthcare to the people of san francisco, we have to be -- we have to do more coordination and be more efficient in that process. it is a major reason why i created the position of director of mental health reform so that we have one person whose job it is to bring everyone together to help coordinate all of the efforts around mental health in the city. when we coordinate, we centralize services, we get better outcomes for the people that we are here to serve. san francisco general has long been a hub for our safety's disaster response. it has been a real leader, and i have spent days, particularly in this location in the emergency room for those who unfortunately have fell victim in some way to -- somewhere in our city. whether it is during the 1906 earthquake when the hospital serve not only as a place where people could seek treatment for

injuries, but also as a place for refuge and shelter or a 1983 when the hospital led the nation by those impacted by the aids epidemic or throughout the years as san francisco general, and the staff, and the incredible people who work here have always been at the forefront of groundbreaking research and cutting edge innovation and in the medical industry. the hospital's values reflect those of san francisco, inclusion, diversity, and most important, compassion. i know many of you here today are on the front lines of providing that compassionate care for residents, and i want to thank many of the people who work here at san francisco general, every single day, thank you so much for your hard work, and for your patience, and for your compassion in serving so many residents of san francisco. it really means a lot.

especially to those who are experiencing homelessness or suffering from mental health or substance use disorder, i have seen firsthand the patient's that you provide in caring for those individuals, and it means a lot. your city supports you in these efforts, and the important work you do every single day, and i am committed to working with the department of public health, our health commissioners, and all of you to tackle the public health issues that we face in our city, and to make it easier for you to do more. thank you so much to everyone that is here today for this new facility. i can't stop looking at the florist, because i don't know about you, but the walls are white, not yellow. the ceiling even, and the furniture, it is blowing me away , and i'm not always -- are not only happy for the patients that you are serving, i am

excited for the people who are working in the facility every day. you deserve the kind of conditions that help you to better do your job, especially under the most challenging of circumstances. at this time, i would like to introduce mr roland pickens. >> thank you. [applause] >> thank you very much, mayor breed for your ongoing support in making this project, and many others happen here. to the school of medicine, the c.e.o., acting director waggoner, thank you for your support in making this happen. he says change is the only constant in life. this statement highlights the need for all of us to always plan for and be ready for change

in every aspect of our lives. i say that because having been a long tenured person here, i have seen the changes that urgent care over the years. when i first started 18 years ago, urgent care was on the sixth floor of the hospital, then it moved to the fourth floor of the hospital, that it moved across the street to building 80, and out is going back home to this one-stop coordinated care spot. so to the staff who have been part of the change over the last 18 years, congratulations, into the patients who made that journey, they are to be commended. this urgent care center is a vital hub for our san francisco health network. if you are a patient at maxine hall in the western addition, or southeast health centre, when you can't get into your appointment, this is a place you can come for service. so to our medical director, we thank you for your years of service, and look forward to the great work that will go on in

this new facility. thank you all. [applause] >> my boss just reminded me, i am going to introduce dr ron, our medical director. >> thank you, roland. hello, everyone, may agree -- mayor breed, distinguished guests, i am glad to welcome all of you to the new adult urgent care center. we are very excited that starting next week, we can continue to provide quality healthcare now in this state-of-the-art facility where our clinic staff deserve to work , and where the citizens of san francisco deserve to receive the urgent medical care they need. we are grateful to the voters of san francisco who approved the bond measure that made this possible, and in doing so, recognize the value that our public health facilities provide our community. let me take a couple of minutes

to share with you more about our clinic, who we are, and what we do, and what it means to move into this new space. the adult arts and care center started in january of 1999 as was mentioned upstairs on the sixth floor. wiring for rooms on the children's health center. last month marked our 20 year anniversary, and throughout these 20 years, the clinic has played a vital role in providing care for patients for urgent, nonemergency medical needs. we offload our emergency department by caring for patients that don't require emergency level services. we provide urgent medical care for primary care services, and we care for other san franciscans who don't have primary care, don't have insurance, and don't have access to urgent care anywhere else. and for these patients especially, our clinic is a portal of entry into the san francisco health network, where they have access to a range of services to get them healthy, and keep them healthy.

for thousands of patients over the last 20 years, the first step to getting primary care was a visit to the adult urgent care center where we met their immediate medical needs and help them get health coverage and establish care and a primary care medical home. it is our of ensuring that our patients get the right care in the right place at the right time. that is crucial to the success of any healthcare system, and that is why we are also taking this opportunity to educate patients about urgent care, and how it differs from emergency care and primary care. that knowledge gives patients the power to navigate our healthcare system to their advantage so that when they have an urgent medical need, they know the right place to go for care. after the ribbon-cutting, i invite you to stay a bit and take a look around. our beautiful and newly renovated space is larger, has more rooms, it is more centrally located on the hospital campus. this will make the clinic more

accessible, efficient, and patient-friendly, and result in a better care experience. finally, i am thankful that our new facility will enhance the hard work of our clinic staff, to every day provide quality urgent health care with a respectful caring attitude, and a compassionate heart. for the last 12 years, i've had the privilege of working side-by-side with these extraordinary colleagues, their perseverance and dedication to our patients continues to inspire me every day to do my best as a physician and a medical director. in this grand opening celebration, it is a perfect opportunity to express our appreciation for our staff. unfortunately, most of them weren't able to make it because many of them are working right now across the campus. so in closing, i need your help. please join me in showing our appreciation for our staff and the outstanding care they provide our patients every day. let's all give them a big round

of applause, so loud, so loud that they will be able to hear it all the way across the campus. [applause] >> all right. i think it is time to cut a ribbon. >> i need some company over here are we ready? their ego. five, four, three, two, one. [applause] [♪][music]

>> san francisco city clinic provides a broad range of sexual health services from stephanie tran medical director at san francisco city clinic. we are here to provide easy access to conference of low-cost culturally sensitive sexual health services and to everyone who walks through our door. so we providestd checkups, diagnosis and treatment. we also provide hiv screening we provide hiv treatment for people living with hiv and are uninsured and then we hope them health benefits and rage into conference of primary care. we also provide both pre-nd post exposure prophylactics for hiv prevention we also provide a range of women's reproductive

health services including contraception, emergency contraception. sometimes known as plan b. pap smears and [inaudible]. we are was entirely [inaudible]people will come as soon as were open even a little before opening. weight buries a lip it could be the first person here at your in and out within a few minutes. there are some days we do have a pretty considerable weight. in general, people can just walk right in and register with her front desk seen that day. >> my name is yvonne piper on the nurse practitioner here at sf city clinic. he was the first time i came to city clinic was a little intimidated. the first time i got treated for [inaudible]. i walked up to the redline and was greeted with a warm welcome i'm chad redden and anna client of city clinic >> even has had an std clinic since all the way back to 1911. at that time, the clinic was founded to provide std

diagnosis treatment for sex workers. there's been a big increase in std rates after the earthquake and the fire a lot of people were homeless and there were more sex work and were homeless sex workers. there were some public health experts who are pretty progressive for their time thought that by providing std diagnosis and treatmentsex workers that we might be able to get a handle on std rates in san francisco. >> when you're at the clinic you're going to wait with whoever else is able to register at the front desk first. after you register your seat in the waiting room and wait to be seen. after you are called you come to the back and meet with a healthcare provider can we determine what kind of testing to do, what samples to collect what medication somebody might need. plus prophylactics is an hiv prevention method highly effective it involves folks taking a daily pill to prevent hiv. recommended both by the cdc, center for disease control and prevention, as well as fight

sf dph, two individuals clients were elevated risk for hiv. >> i actually was in the project here when i first started here it was in trials. i'm currently on prep. i do prep through city clinic. you know i get my tests read here regularly and i highly recommend prep >> a lot of patients inclined to think that there's no way they could afford to pay for prep. we really encourage people to come in and talk to one of our prep navigators. we find that we can help almost everyone find a way to access prep so it's affordable for them. >> if you times we do have opponents would be on thursday morning. we have two different clinics going on at that time. when is women's health services. people can make an appointment either by calling them a dropping in or emailing us for that. we also have an hiv care clinic that happens on that morning as well also by appointment only. he was city clinic has been like home to me. i been coming here since

2011. my name iskim troy, client of city clinic. when i first learned i was hiv positive i do not know what it was. i felt my life would be just ending there but all the support they gave me and all the information i need to know was very helpful. so i [inaudible] hiv care with their health >> about a quarter of our patients are women. the rest, 75% are men and about half of the men who come here are gay men or other men who have sex with men. a small percent about 1% of our clients, identify as transgender. >> we ask at the front for $25 fee for services but we don't turn anyone away for funds. we also work with outside it's going out so any amount people can pay we will be happy to accept. >> i get casted for a pap smear and i also informed the

contraceptive method. accessibility to the clinic was very easy. you can just walk in and talk to a registration staff. i feel i'm taken care of and i'm been supportive. >> all the information were collecting here is kept confidential. so this means we can't release your information without your explicit permission get a lot of folks are concerned especially come to a sexual health clinic unless you have signed a document that told us exactly who can receive your information, we can give it to anybody outside of our clinic. >> trance men and women face really significant levels of discrimination and stigma in their daily lives. and in healthcare. hiv and std rates in san francisco are particularly and strikingly high were trans women. so we really try to make city clinic

a place that strands-friendly trance competent and trans-welcoming >> everyone from the front desk to behind our amazement there are completely knowledgeable. they are friendly good for me being a sex worker, i've gone through a lot of difficult different different medical practice and sometimes they weren't competent and were not friendly good they kind of made me feel like they slapped me on the hands but living the sex life that i do. i have been coming here for seven years. when i come here i know they my services are going to be met. to be confidential but i don't have to worry about anyone looking at me or making me feel less >> a visit with a clinician come take anywhere from 10 minutes if you have a straightforward concern, to over an hour if something goes on that needs a little bit more help. we have some testing with you on site. so all of our samples we collect here. including blood draws. we sent to the lab from here so people will need to go elsewhere to

get their specimens collect. then we have a few test we do run on site. so those would be pregnancy test, hiv rapid test, and hepatitis b rapid test. people get those results the same day of their visit. >> i think it's important for transgender, gender neutral people to understand this is the most confidence, the most comfortable and the most knowledgeable place that you can come to. >> on-site we have condoms as well as depo-provera which is also known as [inaudible] shot. we can prescribe other forms of contraception. pills, a patch and rain. we provide pap smears to women who are uninsured in san francisco residents or, to women who are enrolled in a state-funded program called family pack. pap smears are the recommendation-recommended screening test for monitoring for early signs of cervical cancer. we do have a fair amount of our own stuff the day

of his we can try to get answers for folks while they are here. whenever we have that as an option we like to do that obviously to get some diagnosed and treated on the same day as we can. >> in terms of how many people were able to see in a day, we say roughly 100 people.if people are very brief and straightforward visits, we can sternly see 100, maybe a little more. we might be understaffed that they would have a little complicated visits we might not see as many folks. so if we reach our target number of 100 patients early in the day we may close our doors early for droppings. to my best advice to be senior is get here early.we do have a website but it's sf city clinic.working there's a wealth of information on the website but our hours and our location. as well as a kind of kind of information about stds, hiv,there's a lot of information for providers on our list as well. >> patients are always welcome to call the clinic for there's a lot of information for providers on our list as well. >> patients are always welcome to call the clinic for 15, 40 75500. the phones answered during hours for clients to questions. >>

>> [roll call] director, please be advised that director chiu will be absfrenlts today's meeting. please be advised that the ringing of cell phone, pagers and other