sanchez to provide notice to one contractor that their contract will not be renewed. the board by a vote of five ayes, two noes, approved issuing notice that the contract of one director will not be renewed. the board by a vote of seven ayes issuing notice that two principal's contracts will not be renewed. the board, by a vote of seven ayes approved issuing notice that one assistant principal contract may not be renewed. that concludes tonight's meeting. section q is adjournment. this meeting is adjourned. [gavel]

>> the meeting will come to order. the secretary will call the ro roll. (roll call). >> at the next item is the approval of the minutes from february 19, 2019. >> the minutes are before you for approval. a motion is in order. >> so moved.

>> second. >> any corrections to the minute? i want to thank commissioner loyce for chairing in my absence. in favor aye. those opposed. the minutes have been approved. >> next item please. >> item three directors report. >> good afternoon, grant colfax director of health. i will give you a few highlighters from the report. they finalized the rule to govern title 10 family planning. this is a major policy change. the rules state the funds with not be -- recipients of title 10 funds would not be allowed to perform abortions or refer patients to abortion services. they are not to be used for abortions under previous rules. this extends that.

very concerning. in terms of the amount of title concerning the department receives it is about $234,000. it does serve alarming number of patients, over 6,000 patients are served through family planning programs in the department. we are doing an analysis. there is indication this rule could also put other funding at risk. you may be aware that a coalition of 20 states including colorado has announced -- california have announced lawsuits on monday when this was announced to block changes to the title 10 program. we are following the situation very closely. i am want to acknowledge on the sad passing of public defender, sudden and tragic as so many of you may have worked with him. i didn't know him directly but

certainly on his memorial yesterday at city hall was remarkable for the amount of community turnout and clearing the number of lives he has touched. we were privileged to play a role in terms of providing support services for staff, providing behavioral support and crisis counseling which the office appreciated. my condolences to the office and to the public defender's family. also in terms of services, we have been able to expand several services to improve health and wellness of those in need in san francisco. the health department received $3 million grant from the state to improve outreach to people suffering from mental health and substance abuse particularly homeless on the streets. that program is going to help

expand direct medical care, case management and navigation services to that population. in conjunction with that i am pleased to say we opened 14 new behavioral health beds at hummingbird place and are on track to meet the goal of 100 new behavioral health beds in san francisco for the people most in need by the end of the year. one of the key things we are doing is analyzing in addition to the 2000 behavioral health beds how many beds do we need in total to meet demand? we will have that number soon. >> finally, i asked the doctor to give you a brief update on breaking news with regard to a measles case that has just been reported in the city. he will give you the details here. >> good afternoon. i am the health officer of san

francisco. to give you context. you may have heard there are measles outbreaks in new york city, new york state and new jersey and in washington state there are 71 casings in clark county. san francisco several days ago in late february we have had our first measles case in the san francisco resident since 2013. this person, th adult was exposed on the international flight. it wasn't transmitted locally. it is the first case we have had as a resident. i want to put context. san francisco is very fortunate we have not had the types of outbreaks of vaccine preventable diseases you have seen in other areas. last year with the flu most parts of the country had a bad year we had a good year. one of the reasons is because of

in san francisco there are vaccination services and we have good vaccination rates. in canada the vac-- in california the vaccination rates are high for measles. you are not seeing in california what is in other parts of the country. that is the good news. thursday casthursday case went . they are looking out because of what is happening in this part of the country. overall things are good. any questions? >> doctor, was there some reason for the outbreaks in the other areas? was it simply under immunemization? >> they are under vaccinated because of different state laws. in california in 2013 we passed a law to remove the personal

belief exemptions which are religious exception around vaccine. we have a medical exception. it makings it more difficult for people to decide not to vaccinate their child. that is not the case in the states in the northwest. in the southeast, for example, mississippi the laws are similar to ours and they do not have a measles problem the way we are seeing in the northwest. >> any other questions on this issue? >> thank you. >> thank you very much. you are very clear. thank you. >> doctor did you complete your report? >> na was the summary of the report. if you require other details i am happy to bring them forward.

>> commissioner loyce. >> vice president loyce: i have a simple question. you said you would bring on 100 new beds by the end of the year is that fiscal or calendar year? >> i believe the fiscal year. we can confirm that. >> thank you. >> i am getting confirmation from staff it is the figure thel year. >> in terms of hospital balance billing practices, where are we now regarding progress? >> as you know, we have put a hold on the billing practice. we will issue recommendations with regard to how to move forward on that issue after 30-days. right now what has happened is there has been a bill that has been introduced in the state

legislature to prohibit a balance billing for patients. it also has a second half which would essentially require that out of network hospitals do not bill insurance companies on any higher than they would for hospital care that is in network care. we are looking at that very carefully. we do have concerns about that. there is a supervisor hearing this week with regard to that bill, and we are in ongoing conversations with board members and mayor's office about possible implications for the bill for public and private hospitals that are in network. >> any other questions to the director, please? if not, thank you, director. we will move to the next item,

please. >> i will note there were no public comment. item four is general public comment. we have received one request. >> for everyone making public comment today i have a buzzer. when the buzz is buzzing, know that your time is up. >> you have three minutes. >> i won't take three minutes. i work at kaiser. i am studying health policy. i would like to advocate that the department of public health support medicare for all. >> that was your statement? >> okay. thank you very much. >> i have received two more requests.

>> karl kramer and aden sin. you each have three minutes. >> hello. i am aden sin a member of the living wage coalition and concerned citizen. basically what i am here to do is bring up an often overlooked section of the minimum compensation ordinance. it is section 12. p.3 point c. >> when preparing for supplemental appropriations for contract services, city departments that regularly enter into agreements for provisions of services by nonprofit corporations shall transmit with proposal a written confirmation

the department has considered in it's calculations the cost the nonprofit corporations calculate they will incur in complying with the ordinance. subject to budget provisions of the charter it shall be the policy of the city to ensure sufficient funding to prevent a reduction in the services to the community provided by nonprofit corporations and public entities. basically what steps are being taken to prepare written calculation the department that considered the costs for nonprofit corporations? how is the commission going to ensure this process is thoroughly completed in writing? also, i want to point out this is an annual process that needs completed with your nonprofit

contractors. every year we need written confirmation saying you went through the budget proposal. >> thank you. next speaker, please. >> karl cramer. san francisco living wage coalition. this is in the ordinance since we got amendments passed in 2008. for the last 10 years, the compensation ordinance has the rate for nonprofit workers has not risen. this last october we have gotten wage increases for nonprofit workers. their minimum wage is going up to $16.50 per hour as of july 1st with annual cost of living adjustments every july 1st. we want to see this process work. our opposition, the human

services network has been cynical about this whole thing. they said we don't see this as working because the relationship between departments and nonprofit contractors has not been very healthy and they are not going to be providing sufficient funding for these organizations so that they can increase the wage rates for the lowest paid workers. we would like to prove this motion to be wrong. so we are going to each department now and saying this is the responsibility on the department level for the department to be issuing a written statement saying they have considered what the -- to each of the nonprofit contractors the increase cost from the wage raises. this should be an annual process. thank you. >> thank you very much. the commission will be

commenting on general comment information. we will ask the director to review the item brought before our attention. >> item 5? >> yes. >> item 5 the report back from the finance and planning committee from earlier today. >> good afternoon. the finance and planning committee met before this commission meeting. i want to thank commissioner to step in and chair the first 10 minutes in my absence. thank you very much. now meeting today we have considered the contract report and had put that on to the consensus calendar. in the report on one of the items we had some questions for clarification, and i believe that, you know, it has been clarified and we are very

satisfied with the e explanation we did not change anything and recommend to move the entire contract report forward. we also have considered a new contract with cis for the trainings of the pertaining to the implementations of the electronic health records, and i can't find it right now. we had some robust discussions about that. one of the things we really want to note that is not necessarily to the training i was but to talk about the budget we have allocated for the whole process and to just like find out where we are in terms of the amount that we have spent with what we have located and hopefully it

will get additional clarification from mr. wagner moving forward. we also have a presentation from the san francisco option, city option. my apologies. names have changed so many times. i don't remember where it is. to talk about, you know, the new way of separating the city option updates to talk about how they are going to we categorize the contracts to separate the healthy san francisco plan from the medical reimbursement account and also the san francisco city option. we also have the really robust conversations, you know, like pretty much about how this has

been working out, you know, and also retention rate and also, you know, how it impacts equity. the amount of equity. we have that question for the contract report as well that we would really like to. this is ongoing conversation. we would like to find away forward for us to know how our investment creating the impact that we want to see for the city and county of san francisco. hopefully, there is a way to measure it moving forward. we are really excited that director colfax had mentioned he is leading that process and seeing him passionate about data, we are looking forward to the outcome, you know, that he is going to share with us somewhere down the line. we also have a presentation of

the drafted annual report and we had given some feedback and i believe that the draft will come back to us next meeting. >> it will be on april 16th. it is air few meetings away. >> it will come back for april 16th for approval. that concludes our meeting. >> questions? seeing none we will move to the next item which is the consent calendar. >> there was no public comment for item five. >> thank you. consent calendar is before you whicwhich is the contracts repot and the approval of the new contract with csi. is there any extraction from the consent calendar? seeing none, we will proceed with the vote on the consent calendar. those in favor police say aye.

the consent calendar is adopted. next item. >> item 7-up date of the public health and safety bond update. i believe mark primeau will explain. >> good afternoon. we thought we would do what we did in october. that is to do 7 and 8 and reserve questions for both me and the representative from ucsf. >> we will proceed with both items 7 and 8. then we will receive questions regarding both items. proceed. >> thank you. just a little bit every cap for the new director. on the bond strategy that we embarked on in 2015 which became a bond of the voters of 79% in

2016. the cap was political. we went from a bond in early 2015 of $535 million and then a few months after that dropped to $450 million. ended up at zero and came back with shared bond at 350 split between dph, fire and supporting housing. it was very unlike the 2008 rebuild bond where we spent almost a year studying it and pretty much figured out the program and cost. as backdrop i wanted to put that out there. joining me on item 7 is the facilities director and then joe chen from public works. item 8 is michael bade, choice

chancellor. this shows the allocation for dph only. 272. then the other columns show the breakdown when you subtract out the finance cost and the financing cost to produce the bonds. then the comments of the current appropriation was some free bond front money we used to study that got reimbursed when the first sale happened in januar january 2017. then you can see the last column showing the $150 million. this is a recap of the slide at a higher level. first bond was in 2017. we are spending around 3%. we are in 26 weeks. we are about 75% in time. we should be spending a little

bit more, but we only have -- i will show you the next slide. only five projects in some phase of construction. one is complete the urgent care. that is where the bigger dollars are spent. you will see these numbers, the first row purchase construction. mobilization is going to grow pretty high over the next quarter and next report. just going back over here to show you that. of the total measuring against the total bond of $350 million. we are at about 15%. when you look at community centers total amount $50 million split between $30 million for southeast and $20 million primarily for castro mission and maxine and some work at chinatown. we are 20% spent. i will turn this piece over to

terry. >> good afternoon, commissioners. i am looking back at what we accomplished in the past quarter. as you can see from the slide, we have gotten our project approval for both public health laboratory and dialysis relocation. that is a big step forward. we had the drawings before we start construction. we have a few efforts ahead of that. we are going to time the application for the permit accordingly. the surge space is an office suite. we surge into it to move people around. we create an office space advanced design. we are preparing to submit that.

seismic retrofitter was awarded. now we are in phase one. it was awarded to the builders. if you look at the pictures on the lower right-hand side, we actually separated the structural elements. you can see where we separated horizontal from very cal to allow ex -- vertical for expansion. next is south side of the building to get out of the way of the ucsf project. the cmgc contract, joe will talk about that. we got that started and published in january. then, of course, we had a great opening in february of the urgent care clinic. it was a grand opening, ribbon-cutting. the mayor came and participated in and the urgent care's move has turned out to be a great win

for the organization. next slide. this is a look at the am blatory care. what happened here is that southeast health center we had artists selected. we are moving ahead with the arts program for that scope of work. the seismic activities and assessments are going on at silver avenue and ocean park and the city clinic. they are continuing through that protest to determine the strategy for seismic retrofits for those. we awarded a contract to build group in february. we arranged for a temporary location during the construction. that was touch and go for a while. castro mission. we completed 50% design in

january, and we will be relocating them temporarily to zuckerberg sometime in july. the last thing is we are completing the seismic assessment of china town. with that i will pass the looking forward to to joe in the department of public works. >> thank you. good afternoon, commissioners. joe chen, public works program manager for the 2016 public health and safety bond program. i will provide an update on the upcoming milestone activities on the bond program. let me first talk about building 5. overall the team has been working hard to progress the 19 core projects that are part of

the building 5 component. we have 15 that are active in various phases of completion, design, plan review and so forth. the team is working hard to move that. the last health commission we have progressed one project which is the seismic retrofit phase one from bidding to construction. i will spend more time talking about that during my presentation today. first let me jump to the search space a project well underway. we are approximately 70% complete in overall construction completion. right now you can tell from the photos on the slide. the contract is in the phase one called rebuilding, demolition completed.

now the contractor is rebuilding the wall framing and stones and installing sheetrock followed by the mechanical ductwork, piping, utilities to be installed and at some point that will be followed by finish work painting and flooring and ceiling insulation. that is 6h. the location started construction last summer of 2018. overall progress we are approximately 25% complete. as you can see, the contractors hazard abatement is continuing with the wall demolition in the same space. at the same time they are working on laying out new walls

and plumbing fixtures in 3b and 3g. i included photos to show before and after. you can tell the significant work in building 5. this is probably the first time since the building was built in the 1970s when we embark on the extensive construction in building 5. a lot of the major projects in the bond program are taking the space back to the building structure and rebuilding for new programs or new patient services. i think a picture is worth a thousand words. you can see the extent. the space in 3g. 3m used to be surgical suite now it will re-purposed for the rehab department. moving on to the next project. phase one.

just a quick summary of the scope. this is a smaller phase of the larger project which includes 206 locations. we are tackling 40 discrete locations. cutting of concrete within the building. we saw photos earlier. we are also doing removal of some of the concrete in the building and some structural fiber, strengthening of the columns and enlargement of columns. that is some of the work in phase one. at this point we have completed the one space and we are moving on to the interior abatement on the south side of building 5. when that is completed that will allow us to start the retrofit of the exterior on the building of on the south side. at this point we are looking at starting that toward the end of

march to early april. those are the three projects in construction. there is a fourth one, roof replacement. that is on hold due to weather issues. moving to the contract. public works did advertise in january proposals for general contractor to partner with public works to deliver the next eight major capital projects under the bond program. we did get four back from four qualified contractors. those are currently under review by a panel convened. we are in the process every viewing and scoring proposals. the other projects i won't go into. the last 11 projects follow the same typical strategy.

when we finish programming it will allow the project design then bidding and then construction. now futuring to the -- moving to the southeast health center. the team is completing the design to allow construction by the end of 2019. the public arts program is an integral part of theject. the two artists have submitted preliminary concept which is imagings on the right-hand side of the powerpoint. so the two artists could include tapestry sculpture in the front lobby of the clinic and some digital image to be incorporated to the glass on the second floor

waiting room. it will be a personal touch in the clinic. key milestones. we focus on finishing design that is currently targeted to complete by about second quarter of 2019. that will allow the plan review to start with the building inspection and then the goal is to start bidding in the summer which would allow construction to start before the end of 2019. thathat is the southeast. looking at the next component community health center. the bond program has two locations that we are focused on. maxine hall health center and castro mission health center. maxine hall is ahead. we are in the process of awarding a construction contract with anticipated start date

summer of 2019. on the parallel path we are finalizing the temporary clinic procurement of trailer space to be used to allow the clinical services to be relocated from maxine hall during the building renovation. moving to castro health center, we are in the design phase. we are planning to finish in the first quarter of 2019 and also with plan review and bidding and then construction to follow that and with construction to start by the end of summer of 2019. the next three slides i will go to each project on the schedule, i can give you a orientation how to look at the schedule format. this is the same format i used at the last commission meeting back in october. it really provides a graph cal

representation of the schedule. the three colors on the graph cal side of the schedule, red is the baseline, yellow represents the schedule presented at the last commission meeting. green is what we look at as the current or forecast based on information from the contractor or what has been in the construction documents. i can give you an example how to look at the schedule. look at the second project from the top. looking at the sub activity of construction. you can see right now it shows the green bar which is beyond the yellow and red. what that tells us on the project side there has been delays on the search base. a lot of those delays are given by unforeseen issues.

there are additional code issues that are impacting the work itself and the scope as well. at this point we are anticipating finishing 6h in july of 2021. on the same hand, looking at the project below that department relocation. you can see all three bars are in alignment, green, yellow, red. that tells us the project is on schedule based on the baseline and what was reported at the last meeting. at this point that concludes my presentation. i will turn it back to mr. primeau. thank you. >> thank you. the first several bullets are the background on the ordinance. we are currently involved with the closing of the escrow which allows the state to deliver to

ucsf and we are landlords for the next 99 years. some of the things w we are working on between real estate and legal teams. we are clearing the title which we anticipate at the end of march. then we will move to the other items that michael can go into centered around the research facility design and permits. the key milestones, i will let michael have slides to depict what those are. >> the target for construction of the roadway and the building is the first quarter of 2020. working back from that date, we have to finish and permit both permits for the roadway through the -- through the roadway

through ucsf. i can actually better talk from my own slide, if we can move it forward. >> as you can see, the blue box in the lower right hand corner is where the building will be situated. the roadway between the new building and believe five and connect to vermont street with a ramp. the accessible parking that is currently in the bc lot is replicated on the roadway and on

the building five side. all of those spaces are going to remain on the site in front of the new urgent care clinic entrance. we had a little bit of delay in procurement. our procurement process was more challenging than we had thought, but we have a really good team on board. the general contractor, architects and structural engineer are all working now. the general contractor selected is de bolt company. you may remember them from the recently completed center health facility at geary and vanness. we got core members of the team we know well and are very pleased to have. the architect is skid more from the san francisco office, a

top-notch firm. they are working in a large big room setting with the contractor. what we do is we get everybody working on the project to work in one office and not scattered to their own offices. that has started quite well. the structural engineer and the point in the design process they are at. they are just now starting to understand the complexity of the client. every one of our medical academic medical departments is represented in this project. that is 37 departments. they were given a program that described every space in the building but no clues to organize it. that is their first problem. they are talking with our staff,

the doctors and the support staff, to figure out what the best way to organize the interior of the building is. they have also been working with the contractor and the engineers to start to look at the different kinds of exterior envelope systems that could be used with the understanding they will have to square the circle with the historic fabric of the older buildings at san francisco general. this is a problem that everybody knew they were going to have to solve. the city of san francisco will do this quite well. they know how to fit a building into the urban context. we are just getting to the point where we need to start to talk to mark about how to engage with

the right people in the different city agencies so that we can build the consensus around exterior envelope systems to procure the contractors who are going to build them so we have the right systems and have a good idea how we are going to build then have the people who build be part of the design process. there are several different strategies to do that. the team is refining those strategies. we are about to talk to mark and get his advice to start the engagement process with the people in the city at planning, at d.b.i. and at historic preservation and the art commission here in the department who the architects will need to talk about this with so that we can arrive at a design we both are really proud

of. the procurement delay has actually allowed us to be thoughtful and we are hitting the ground running. we are moving out some of the interim dates. the general contractor has spent a great deal of time working on the scheduled dates that you see here. they are keeping the mid 2022 in point and they are confident they will be able to keep it. i will pause for questions, if you wish. >> we have no public comment requests. questions can be for presentations of both items. >> in terms of what you were describing as terms of parking. we are going to be able to take

the amount of parking subsequently on that site and maintain it within the area and not look for additional? >> ucsf is providing displacement parking at the mission bay campus so the sum total of spaces around 130 or so is plus the 30 or so accessible spaces is around 160. that amount will remain to be available for the community. ucsf is reserving 130 spaces at mission bay and will provide the shultz service to move people -- the shuttle service to move people from the parking to the campus. >> commissioner.

>> i would like to add that at zuckerberg general we leased a space within a mile of the campus to house 134 vehicles during the construction we plan to move the -- during the roadwork construction we will move the ada parking to the parking structure and expand the parking we have been working with sf m.t.a. once that work is done first within six to nine months of the start of construction we will reinstate the ada on building five. there is a multiple step plan to address parking. not only 130 stalls but 134 at 16th street and reconfiguring the garage to be patient centered and reserve two floors for patient parking. we put a lot of thought into

that. it is now in like the second phase of that effort. >> it requires then as we talked about expanding the parking structure? >> not at this time. >> commissioner. >> i had a question about the bond sale. that has not yet been scheduled or do we have any sense of timing? what are the conditions in terms of starting that? >> we sold first bond in 2017, january. the second one we are still holding off and will probably anticipate selling in september. we will sell the remaining balance of 140 plus million dollars. >> you don't anticipate any issues with this holding the sale until september? >> no. in fact, it is actually better

that we do that. if we are not spending as much as we should they will stop us from selling anyhow. we are trying to work within the other departments to see when we can pigtail on them and do a combined sale which will reduce costs across the departments or do we go alone and sell the 140? >> thank you. >> yes, commissioner. >> any additional approvals required through the board of supervisors or is that taken care of? >> for the city work? >> yes. >> the city work has the approvals. we work independently or jointly to get approvals for building five and some with the local jurisdiction and campus improvements. >> great.

thank you. >> the board will be the last actor in the signing of the ground lease, which will allow construction to proceed for both the roadway and the ucsf research building. >> you didn't know this yet, but we figured out -- got agreement from the city attorney's office we do not have to go back to the board of supervisors because they approved the ground lease as part of an ordinance. there was a school of thought that we had to go back. once we examined it we know longer have to go back. it saves quite a bit of time. >> very good. >> i am looking at the schedule. you are pushing out the completion of the research

building. do we know how that actually affects our own thoughts of moving the department or parts of the department aside from the public health lab into or on to the campus? >> as michael, he did say they are holding that q2 until 2022. we have seen that as the move in date. i think he did have some procurement delays at the front end. we have been working towards that date, working with his real estate department, our real estate department and all of the departments at the hospital and we are still targeting the thing that we saw as the target a year and a half ago. that is a very good question. the exhibit that was missing was an exhibit that looked at

the 3,000 or 3200 spaces they currently occupy in the nine old buildings. we are going through those as part of the exhibit and identifying the work that has to be done once they go. very, very detailed. >> okay. in the schedule it shows that several of these projects we are talking back in building five have shown that we do have delays, right? all the way from dialysis unit to -- well the whole series have moved from what the original thought was. is that because we were slower in doing it or, you know, it may well have been because of the surges needed? does that increase our cost because we are delayed in doing it? >> i will try to first respond.

when we were developing the bond, we had to produce a schedule. not knowing any of the detail we currently have. we produced the baseline schedule to give us some idea on which to build. that is the first scheduled bar that you see. as we got into the detail and produced the design and figured out there were over 200 enabling projects to support the major -- support the major projects. then we saw the interconnections. we want to be transparent about the schedule. once we get a contract or on board, they buy the schedule as they have in the case of the research building. they are sticking to the end date. some of the things we are doing to mitigate any kind of cost increases as joe mentioned bundling four or five projects

together so there will be one contractor doing a number of projects instead of 5, 6, 7 contractors running around. the other thing would we are doing. we are systematically going through the seismic project elevation by elevation to take what we are learning on the components and apply to the next. our exposure to the stakes we will know more as we move along the building. those are some of the things we are doing. >> i think that is a very good answer and makes some sense. what i would say here is that as the project progresses, we probably should be looking at how we are doing financially in terms of staying on track.

obviously we are are a very small spend at this point so you don't have a lot of over ages unless you have had a lot of change orders and so forth. i am looking at this from the standpoint for our commission in terms of our experience as some of us who walked through the changes and then actually what was learned when we did the sf general rebuild we stayed very much on target and were able to follow at the commission level. this bond issue is significant and that we try at the right time as we start having more expenditures to come in and be sure that we are able to work with you and understand that we are on track. [please stand by]

that included getting back from different departments, along with members of the community, multi lingual, you name it, and going out and meeting with them. whether it's in the mission,

whether it's in the tenderloin, et cetera. to really talk about, this is your hospital and we really work together. i'm saying that because, he had documents and you wouldn't think ranging out from all different departments depending on whatever. some of our top women surgeons were out there meeting, talking about the importance of this. to not only sfgh but to the whole city, ok. i'm bringing that up now because, this isn't a new hospital. this is a research space where ucsf on built property built in an area that's been a very active area pertaining to the quality of care and rights of passage and due diligence and who was responsible for what. we get that even in this meetings here. so i'll sharing with you, as you navigate further on this,

remember, ucsf is a partner with us but we're talking about research space, et cetera, and access, you mentioned 160 park and all of these things may come back at some point and i'm sure that from both sides of the aisle and from -- i know sfgh and others, that there will be, you know, some common mission. so this way they can really highlight. today we have docks at the general that reflect the totality of this community. they would be used in a fantastic cell saying the importance of this facility to ensure we maintain the highest level of quality care. i just want to put that on your radar as we proceed on. this isn't a new hospital. it is providing, you know, the quality of research with

outcomes pertaining throughout the general and the world. we're a partnership and we can't lose that as we move forward to ensure that this new center is on target. >> thank you. >> we understand that very clearly. i work closely with dr. carlyle and our team will be continuing to engage in her meetings with the department and the surrounding community as we move forward. i think your point is really well taken. the burden is on us to communicate these values and let people know that this is, still, the way it always has been. >> thank you. >> thank you, commissioner. i have no