to be at the point where everybody is pretty well trained except for new people. we're going to cut loose 100 trainers. we're going to keep the core trainers, but we're going to need them to get this launched on august 3. once that's done they can return to training the new staff. we asked them to get people into the orientations in august and july because there wouldn't be one in september. whether they anticipated this way back i'm not sure. it wouldn't have made sense to bring on those extra trainers. it was a dip in our hiring, but we will make that up. >> thank you. >> looking at that disciplinary table again, it makes me wonder what is the gender parity of our workfor

workforce, especially when there is no real way to know from these tables the size of our transgender workforce, you know, in d.p.h., transgender men and women. it's kind of like a -- yeah, i'm just like -- my head is filled with questions, like where -- how they placed in those city tables. >> so we just started tracking based on -- there was a directive six months ago or so or maybe earlier, they want to give us the option of tracking gender and transgender in all forms. we're starting to track that. we may be able to have that going forward. we're about 75% female and 25% male. something like that. it's been a while since i looked at those numbers. that's not unusual for a health

department. we can refine that. that's a good point. i will talk to d.h.r. this is their information, but i think it would be a good point to track that. >> i was disappointed to see that we don't have those data, especially given the department's work on sogi. we're asking it of the people that we serve, but we're not doing the work we need to inwardly as a reflection. certainly it's a priority to work to get this data that you're asking for. >> commissioners, other questions? thank you very much. >> all right. thank you. >> all right, everyone, we move on to item 9, which is the epic post go live update.

>> commissioners and directors. i am the chief information officer for d.p.h. i'd like to start by sharing a number with you. 8,800. more than 8,800 people have gained credentials and used epic since our go live on august 23, 2019. that includes over 1,500 of our clients. my take-home message for you this evening is we had a great go-live experience, everything from the support of your commission all the way down to all # 7,500 people who participated in classroom training and took proficiency

exam to be able to effectively use the new tools. it was across the board an outstanding effort. we had support from across the city. we had support from a number of vendors in addition to epic. and of course we had the support of all of our organization, as we know that it takes attacks on any company, any agency, to make a transformative change such as we have. all of our consumers as users of epic are getting accustomed to the system and day by day are getting proficient with its use. it takes a little bit of time and we're not even three months in yet. i do want to assure you that we have a systematic process in place, a good-governance program, so we can monitor and improve based on the information we glean from epic. what i mean by that is epic is not just a system we put things in, we're seeing a return on

information and not just in the form of reports, but information about how we're using epic, some of this in near-real time, so we can understand how we're making best use of this very large investment. so a handful of cocktail party starters. i maybe lead you to the fourth ring, next to the last on the right, and that 21 systems were consolidated that bring wave one of epic to life. that's important because that's a really large number of systems. it's also important because it speaks to our readiness in the coming year to decommission those systems, which has been part of our financing plan. so what did we implement? i think you have all sat through several briefings. across the top row of items is our traditional electronic charting infrastructure, the

support systems like lab, pharmacy, radiology, how we handle the revenue cycle, as well as scheduling. the first one on the bottom is health information exchange which may not have come to mind. that's the bi-directional sharing from and to our organizations and others. as a result of epic, we are now part of an industry consortium of two or three dozen other organizations that make electronic health records. we all agree we are able to share information with one another. i will show you some statistics for that in a few minutes. i also mentioned briefly that there's a lot of information we're getting out of epic, and it's beyond the standard analytical tools. it is striking the progress that electronic health record systems have made in my 20-plus years of working with them.

where we are today is that we are really starting to learn not just about how we can improve in real time by giving managers dashboards to use, but as i mentioned in my opening remarks, how we're actually using the software. it tells us how well we're doing and it provides areas where we can say focus enhanced training and other learning experiences to help our teams become as expert with epic as they can. i'll keep saying it, we've given access to our clients and patien patients access to their own health records. i'm glad to say we're off to a good start. where did we implement? no real surprises. i draw your attention to the lasting point and that we have gone mobile. we have gone into is is a new place with being able to access the capabilities that epic provides for us.

i mentioned that over 1,500 of our clients are now using the mychart application. if any of you are getting your health care in the bay area, you are likely using epic mychart. that is the same tools our clients are using. for the providers, they can chart on a mobile device using hayku. for business partners and many others, you can log into epic and share in the care experience that we're providing. we're letting a lot of business partners in to have and to share in the experience that we have launched. we have, for a number of years, have been able to do the same thing the other way. so i mentioned how we know how we're doing. i wanted to just take one moment to share a slide with you.

the numbers in the slide aren't terribly important at this time. this was a first cut at an epic leader dashboard. this one is for primary care, but i wanted to share with you that we don't have to do anything special to create a dashboard like this. it's something that we get more or less out of the box, and all we have to do is tune it to our needs. in the past we've had to make a significant investment to deploy a dashboard like this. the nice thing about epic is that there are about five or six dozens of these dashboards that are available for us to use. they are very straightforward, and we are able to customize them to an extent to reflect the kinds of outcome measures and key performance indicators that are relevant to us to represent our true north strategic goals. nothing is perfect. going live with an electronic

health record that is now in use by more than -- well, nearly 9,000 people, there are going be issues. we have closed thousands of them since august 3. where we are now is dealing with some of our more complex concerns. they deal a little bit more with software, but we really deal more with workflow, people, process, technology, that intersection. as an example, we've always been spending a lot of time at sgfg tackling the topic of patient movement. how do they move from the emergency department to the intensive care department. in the past we had people and process and the technology didn't tell us much. today the technology can tell us a lot. epic can share a lot of information about what's going on and how to effectively manage that transition from one venue to another. when we first saw it, and i'm in

this camp too, i didn't really believe what i was looking at. for the last month or so, there's been a really intense effort to understand how we can get utilize the information that the information system gives back to us to inform our process and a lot of strides have been made there. there's a handful of other workflow examples where we're diving in deep. it's not about epic, but epic is forcing us to have the conversations and focus on problem solving. the second issue that we're having, and this was more or less expected, is our ability to deliver against many types of reports and outcomes measures that we have for regulatory purposes that are in support of value-based care. when you move from one information system to another, you are reporting all the way up to the last day that you had that tool. when you start in a new

information system such as we did on august 3, we didn't go into it with a fully populated database. we did it with a mostly new database. so we prepared how we would begin to use the new data as folks come in our doors after august 3. but we have to go through a validation process in order to ensure what we're looking at and that all of the pre-work we did to produce all of these measures is going to be valid and stand up to our data integrity checklist. we are close. hoping in the next 30 to 60 days to be completely back on course. it was expected that we would have a delay, and we had a bit of a delay. i want to be up front about that. the nice thing is epic is friendly about us taking the data out. that has been a real struggle with our electronic platforms, and that's not the case with

what we have today. we've talked about benefits realizations before. i mentioned decommissions systems. that work is beginning in earnest at the beginning of the calendar year and will take us to july, where we expect to spin down, which is something i.t. people don't like to do. we like to keep old systems on as heaters. but we plan to demission our legacy health record system by the end of the fiscal year. the great news about that is we don't need them anymore. the second piece of good news is we won't be paying for them anymore. that's been part of the budget and financial plan for epic since the beginning. i'd like to take a few moments, and i know we're getting towards the end of our time today, to talk about the our in our records, patient record exchange, something i mentioned at the beginning. since august 3 up through

october 1, we have exchanged health information with 215 other healthcare organizations across the united states. it's possible there are some international ones in there. i didn't dive deep enough to double-check. if you look on the bottom left, you will see who our highest-volume information exchange partners are. i don't think there are any surprises there. what's really powerful is in basically just shy of two months of being live with epic, 43,000 of our clients have had their records appended by healthcare information from other healthcare organizations. this is pretty powerful stuff. in addition to that, nearly 14,000 of our patients, their information has been requested and sent across this trust framework that i mentioned before with this industry consortium that epic is a member of to augment the records of our clients in other places. so really very powerful.

we don't have to do anything special for this to happen, it just happens. so our epic journey, we spent a number of years in what i would call a get-ready phase. we're definitely past that. we're coming up to the tail end of our get-going phase, where there's been a strong focus on having a really good governance program for epic, for having a great go live, which we did. now we're in this period of time which we call stabilization and we'll be there for the next few months. during this time of stabilization is where we process people, process, and technology, the couple of examples i shared with you before. what's really exciting is as we march into the new calendar year, we're getting ready to get better. getting better means tuning our governance process even more so we can do two activities in parallel. one of them is beginning the optimization of the epic environment so it can do things it's not doing today.

we have a straightforward implementation and without violating our principles of sticking to that, we can still make it better. so we're going to begin that process. in parallel, we will be locking in the scope and schedule for wave two and three of epic. when we're done with that in a few years, we'll be in a continuous improvement environment, where we will bank on everything that we learned and all of the good governance that's in place so we can keep getting better. so epic is both hard and it has been very rewarding. i just want to share with you the message that we're sharing with all of our staff because not every day is a great day with epic. it's okay to feel frustrated. this is the first message that we're sharing with our staff because we have really changed a lot. more than a thousand changes were made in order to get ready and learn epic. sometimes you look at the screen

and you're like i'm not sure i remember how to do this, which is a reminder that we're all in this together. when i go in front of epic, i look at the screen and i'm befuddl befuddl befuddled. the good information is we continue to help and train and build tip sheets which are in the epic user's first pane when you log in. you go to a place called "my learning home." that's where you go when you log into epic. we are an organization of helpers. i think during go live this was really evident and a lot of people could see how well everyone reached out and was supporting everyone, and that's the environment that we need to continue to maintain as we move forward with more change in epic. so we've asked staff to be there for one another because some day you're going to need some

support as well. with that, i'm happy to take your questions. >> i have not received public comment request for this item. >> my question is -- i'm an epic user and a frustrated epic user at times -- >> we're all in this together. >> yes. what is your i.t. or your help line for an epic provider? what is the response time for someone to be on the line to be able to help one walk through whatever the issue is? i mean, is it five minutes? is it ten minutes? i mean -- and what is -- do you have the adequate staff to be able to help those that are a bit befuddled, especially with epic going live? >> so we have a lot of support

across the board. a program that we set up for the go live was to establish a super user program, where we could have people much closer to where the value is being generated and the work is being done who are actually super users. we have team of infomaticists who can dive in. with regard to actually calling on the phone, when you call on the phone to our service desk, you're calling the general i.t. service desk, and the pickup times are less than two minutes now to get you in there and get your issue noted. many of the items that are coming in are being redirected to analysts on my team who are resolving these items in just a day or two. that's not all of the items, but we've reached that point where the number of items coming into

our service during the day and the number of items we're resolving, we've worked down a significant amount of the go live backlog. >> okay. thank you. >> thank you. >> thank you so much. i don't think we can overstate the significance of this accomplishment, having been through the same epic process, and the potential to improve patient compliance and care coordination. i've had about six patients almost that i've shared with doctors of the county and at u.c. and being able to reach into these records and really do a much better job for the patient, it's astonishing, how having these systems that used to be siloed and vulcanized be all one. it makes such a difference in a great outcome. i want to congratulate everyone involved and say as the few epic

go lives that i've seen have been -- your team is spectacular and awesome. i think there's a show where there's a gold buzzer or something -- i think you deserve a gold buzzer. >> thank you. i'll happily try and accept that comment, having only been here myself only 90 or 100 days. but it's obvious what a full court press there was by every part of this organization to be ready for epic and it totally paid off. >> if i may add to that, i do think it's important that we recognize the people who aren't in the room and worked on this for many years and no longer with d.p.h. i want to acknowledge director garcia's leadership. alice chen who was committed to this and made a lot of this happen. and also wynona medolovich who

was acting c.e.o. for many months. i think it's important that as we move forward and go into the next stage that was spoken about, that we recognize the reason we're at this point today is the incredibly hard work of literally hundreds, i think in some cases thousands of people to make this work. it was really that leadership, including the leaders i just mentioned, that helped us get to where we are today. >> thank you [ indiscernible ] -- >> my question was from the patient perspective, when patients come in and they're told they are able to access their records on their mobile device, for example, is there any kind of orientation offered to them or a guide they might receive, or are they more figuring it out on their own? >> i can't totally answer your

question. i'm not sure if anyone is out in the audience who may be able to assist. doctor, i think you can address this better than i can. >> in terms of signing up for the patient portal, we have information support for the patients to get into the portal. once they get onto the portal and they have access navigating through the site or submitting a quarterback with he have a contract with an outside vendor that specializing in providing the first-tier support. obviously if they need to ask about lab results, that would be routed back to our desk. >> is it an in-app chat function or a phone call? >> it is a phone call to the service, person to person. they would help the patient navigate real time because they know how to access the portal.

>> thank you. >> thank you. i'm just going to ask if presumably the app is better than the ucsf? [ laughter ]. >> that app is really a problem. [ overlapping speakers ] -- >> is there a language capability? >> yeah, that's a great question. right now it is limited in terms of other languages. so no to answer your question. >> that could be one of the -- whether they -- in wave two, three, four, or five, in this community it would be useful with the diverse languages we have. >> no doubt, as well as other epic communities where they serve large communities of multiple languages. that certainly is a push that

all of these epic users is going to be pushing. especially with my chart and the patient portal piece of the technology is being so readily available and enabling to the patient and client, we have to push that. there's no ifs, ands, or buts about that. >> no, you're correct. it's a nation-wide issue that really would make sense for epic. more towards our own problems and within the time frame and i forget on schedules -- could you remind us because you've done a great job getting this all together and having the basic epic work. now in terms of the optimization so to speak, we know that laguna is a challenge. do you have some time frame upon which you would be able to i guess enhance it and optimize

laguna's use on a long-term basis, trying to close the chart out -- when they talk about in terms of years versus days, right. secondly, our mental health programs and avatar and the timing in terms of trying to unify those records. >> maybe i'll go backwards. we'll start with the behavioural health. so behavioural health is slated for wave three which is -- i don't want to commit to a firm schedule. it's after wave two which will likely go live in 2021. so it's in late 2022 or 2023 before we're fully in place with the replacement to the community behavioural health function -- i mean the electronic health record. to your first question about

optimizations for laguna honda, part of the process is to be inclusive. we had a domain structure presented several months ago. the idea with that domain structure is it's a place that has almost no i.t. people engaged, which is probably a great thing, and it's all about the line of business being able to bring items together that can be prioritized that are based on how do we not just get better against our performance outcomes, how are we getting better for how folks are engaging in the system. that is the process that we've been using so far. i'd be happy to take more information about the laguna honda concerns and make sure that we get that roped into our governance process, so that as we approach making epic better for all of us, that we can address those. >> yeah, the thing i raise there

is mostly because it is sort of different from most epic acute care, that there seems to be an issue of having it flow in as seamlessly as it does at the hospital. i don't know where all the priorities are. i do think laguna or its joint conference should understand what is happening there so we can understand the challenges staff had in terms of trying to optimize the use of an electronic record over there. >> sure. laguna honda is the largest long-term care facility in epic's customer base. sonch >> so i think a report back to there would be quite useful. >> commissioners, other questions? thank you very much. congratulations again.

>> thank you. >> commissioners, item 10 is other business and we have several public comment requests for this item. just so you know making comments, i have a timer. when the buzz -- buzz ergos off that's time for you to end your sentence. >> good evening, commissioners. my name is nathan dang, this is holly and kyle. we have pharmacy students from san francisco joined by some of

our classmates in the back. we are here to bring attention to a current pharmacy related issue, pertaining to reimbursement rates authorized by the 2013 california senate bill 493. so the services affect patients all over california, but especially in san francisco. so sb-419 had expanded the practice for pharmacists that authorized them to perform additional services such as nicotine replacement therapy, as well as participating with other providers in the evaluation and management of various disease states. this bill, however, didn't address payment or reimbursement for these services. >> my name is kyle merchant. really what we're just advocating for is support in implementing additional codes so that pharmacists can be reimbursed appropriately for services, because not every

patient is as straightforward as come in, let's have a discussion, and here is what you're looking for. sometimes we have more complex situations and medical histories that need to be taken, discussions that need to be had with patients. i think this will be especially important as we move towards the implementation of prep being made available in pharmacies. >> so as you know, people [ indiscernible ] -- this is to expand the ability for pharmacists to furnish prep which is proflax sis for h.i.v. we can give a 60-day supply in our practice. in the spirit of getting zero, i believe -- i also have -- >> we'll give you a 30-second extension. >> thank you so much.

i think it's paramount that we include reimbursement for the pharmacist counselling because the adherence to these medications is critical and the only way this will be happening is counselling in the scope of the community. >> thank you. hello, my name is manuel and i'm a pharmacist student as well. this is my first time at this hearing. thank you for this opportunity. i just want to start by addressing that i know we're trying to understand and address mental health issues, specifically those that may be untreated, it's dr. hammer and ms. martinez mentioned in the presentation a while back. i want to bring to light the implicit biases in the government and also officials, the sfpd as well as local security guards, their attitudes they may have towards a subset

of our population and those afflicted with mental health conditions. i'm wondering what kind of steps the condition plans to take in order to mold the attitudes of our city to humanize attitudes to be more empathetic when interacting with the subset of homeless individuals, perhaps less likely to incarcerate them and more so aiding them and escorting them to hospitals, social support systems, as well as shelters. if we start with the city employees, we can expand on that towards the population of our residents. so they will no longer see someone on the streets and think they are crazy, because that's really not the case. but it's just that they're not intentionally being disruptive. it's just some underlying mental

illness that's not been resolved. >> thank you. >> hello. my name is jane. i'm also a pharmacy student from ucsf. currently i also intern at the santa clara hospital down in south bay. i have a lot of counselling sessions with the patients there. a lot of them are homeless and they end up being discharged back to the streets. beyond the counselling sessions, we also talk about -- go on tangents and about their personal lives. what i hear from patients they're struggling to access public washroom facilities, they're not clean or not accessible. a lot of them travel around the city as well. this is something i wanted to bring up because i wanted to bring attention to how feasible it is to increase access public

washrooms in the city, that we're helping the homeless population to improve their health hygiene, but also to increase the cleanliness. i wanted to bring it up and see if it is feasible in the city budget. >> good evening, commissioners. my name is franceska okala and i am also a second-year pharmacy student at ucsf but also expressing some of my concerns. there was a bill signed into law that allows h.i.v. post-exposure

proflax sis and pre-exposure proflax sis to be in pharmacies. my comment today is this access to medication is extremely important to several of the vulnerable populations we've been discussing all throughout the session today, including homeless patients who might be using injectable drugs of abuse. my concern i wanted to bring up to the commission is how exactly the department of public health wants to implement these services in the coming year and how it's going to be advertised to these vulnerable populations to make sure they get access to these resources. >> good evening, commissioners. i am also a second-year pharmacy student at ucsf and a pharmacy intern. i am also here representing just my own self and concerns and beliefs. as was just mentioned the bill

was recently passed, but beyond promoting this new accessibility of two of the most vulnerable populations, i also wanted to ask the commissioners to explore potential ways to help promote training for our pharmacists as well. under sb-159 in order to make pre-exposure and post-exposure proflax sis available, pharmacists are meant to attend training. i would ask that we provide this training in san francisco department of health as well as make resources available to ensure that we have enough resources for that. thank you. >> seeing no other new business, do we have a motion to adjourn? >> i had one quick comment.

>> are you sure? do we have a motion to adjourn? >> so moved. >> do we have a second. >> second. >> all in favour. >> aye. >> we're adjourned. [♪]

>> welcome everyone. [applause.] we are pleased this afternoon to get started on this big project in front of us. we are going to be having some seismic upgrades, a new elevator, we have a two story building wit out an elevator. we will have that for patients and staff. we are happy to have the mayor, supervisor, director of health, director of primary care, finance guy. you can't do things without the finance. we are happy he is here. our patient advisory committee is here. of course, several members of maxine hall's family are with us today. this work honors who she was in

this community, a leader and we want to keep that work going caring for the people in the community. we are excited about the project and i want to welcome mayor breed, who grew up in this neighborhood. please join us. [applause.] >> mayor breed: thank you. first of all, hello, hello. this is somebody taped the microphone. i am going to hold it like this to make sure everybody can hear me. you grew up in the neighborhood. in fact i spent a lot of time at ben franklin middle school where that is when i was a handful. i turned out okay. all is good. just remember when any of you are working with the young kids that are a handful, you never know what is going to happen. it could be someone who just

really surprises you and becomes all you ever dreamed they could be. that is the spirit of today and the spirit of maxine hall. i am excited to be here. we have incredible community treasures that are forgotten. the work we have to do to make sure this clinical was prioritized in the 2016 bond to help address disparities in communities around clinics and healthcare and support was a lot of work. to arrive at this occasion, and i can think about, you know, so many amazing leaders in the community who photo help take care of our kids, seniors to provide resources and services, and maxine hall represented that. that was the work she did her entire life for this community. why it is be fitting her legacy

carries on through the health clinic supporting those vulnerable in the community. we want to know why it is called maxine hall in the first place but more important the lady behind what made it is a community. thank you again. yes, this is happening. this is happening no more moving up the stairs real slow, no more helping to carry people who can't walk up the stairs. we are finally going to get an elevator in this place. let me tell you. an elevator may not sound like much to some people. when you don't have one and don't have one that works right like we did at the cultural center before we redid the elevator when people got stuck

in there. an elevator is everything. today we break ground on really what will be an incredible facility. thinking about the needs of the patients that this clinic supports, thinking about the fact that, yes, there are people that have challenges with behavioral health and need a safe place to go to in the community with people who they trust that they could talk to. i see a lot of the staff on the sidelines of people who work to keep this place running every single day. thank you so much for your dedication to the community, for your compassion and work and your patience as we provide the important services that our city needs. we also need to have the important conversations around getting rid of the stigma attached to seeking out help for those who are mentally ill. people suffering with depression

and sometimes dementia and not sure what to do, and making sure we have places family members can access to get people help and support and treatment they need. this has been an amazing facility, and people here have made do with what they have, but now it is time to get something better. better exam rooms to meet the needs of the patients, nicer bathrooms with new fixtures and water that works. making sure the little things and how people feel about walking in the facility changes because it is going to be a new facility, but it is important people understand this is about the people that access this facility every day, whether they work here or they use the facility for various things or they come by to pick up healthy fruits and vegetables and the great things and programs that

maxine hall has offered for so many years. protecting and supporting this vital community resource is critical to the success of the future of the city. i am happy to be here today. all is not lost, when this facility closes to be done on time and on budget, we have a temporary location near the community center. we will make sure that folks in this community know that is the case. just because a facility is shut down doesn't mean the business can't continue. the business of the people in serving this community has to continue. i want to thank the staff for their flexibility and the community for their patience. i want to introduce your supervisor brown who worked as ad for me when we were fighting for the fight that places in our

community especially maxine hall need priority and in city bureaucracy years from 2016 2016 passing the bond and preparing and getting the project ready to 2019 breaking ground, not bad in city bureaucracy years. [applause.] >> ladies and gentlemen, your supervisor vallie brown. >> commissioner brown: thank you for coming. i want to thank a few people. department of public health, thank you for pushing to make sure this happened in a way that cares about the community. i want to thank the san francisco health network, department of public works. i recorded when you said, yes, ma'am, we will have that done. i will keep playing the recording to you.

mayor's office of disability. reverend brown and the naacp was very instrumental and the community center and of course our mayor london breed. [applause.] you know, when i first started really getting involved in the neighborhood, it was over 20 years ago as a neighborhood activist. i remember someone telling me the story, and this is maybe 12, 13 years ago. about maxine hall. they said you need to know this story if you are going to be an activist. when i heard the story and the kind of woman she was and the kind of fighter for the community. it gave me that kind of passion to do more. when i found out her tragic how she tragically died and how the

community said we are never going to forget her and making sure that she was never forgotten in the work she did. she was vessel less. i'm sure her family will have stories to tell you about how selfless she was. she was a community organizer and activist. for me that gave me a path forward of how i should push forward, how i should never take no for an answer. it also is personal for me. with the center opening, you grew up in utah. half native-american, on and off reservations my whole life growing up. we never had healthcare, ever. if i ripped open my knee i went to the vet to get it sewed up because it was cheaper. when i was 14 and my mother turned 40 she passed away with

undiagnosed diabetes. she had no idea. i think if we had a maxine hall is along the path of our journey she could have gotten a checkup. she never got a check up. she could have had that checkup and that she would have probably, you know, lived on. her life was cut short at 40 years old. when i think about healthcare and i think about healthcare for all and justice, i feel that this is something that i fight for every day because it is personal to me. i want to thank doctor james for all of the work you do because i know it is not easy. [applause.] and your amazing staff. i have a quick story. when we were looking for a space to spring some trailers so maxine hall would not close down, there was one area we were looking at. i won't tell you where.

we got a huge push back from the community. i said why? this is amazing. we got a push back. they didn't want it. i worked with mayor breed and we said let's take it right in the community of maxine hall? we went to the ellie hill hutch community around there and i have to tell you everyone was excited and said, yes, bring the trailers here so services will continue. i want to thank the community for being open when we need those kind of direction to make sure that everyone gets service. thank you everyone for coming on this lovely day. [applause.] >> we want the teens coming over, especially rowdy ones.

bring them along. we want to acknowledge james. we learned a lot from him. roland pickens who helped us as well. [applause.] >> i want to welcome grant colfax to the stage. doctor colfax was a resident at maxine hall. i want to say one of our loungest serving staff member is tanya thompson. she has been here for 30 years. she started at the age of four. (laughter). >> she was one of the people who welcomed doctor colfax when he came as a resident. she had him seeing patients from the get-go. thank you for being here. >> good afternoon, thank you for

being here for this exciting day. mayor breed i would like to thank you and your leadership for making this help, supervisor brown thank you, muhammad you are crucial. i want to thank roland pickens and the team and staff at the clinic who do the work every day. i came back a couple weeks ago. i was here as a resident in 19 1994. the remarkable dedication that everybody has to the community and, most importantly, to the patients that get the care they need. the work around integrating mental health with physical healthcare, the fact there is a methadone clinic add join -- add

joining this clinic. i think tha that is the legacy f maxine hall and this click. now we will turn the -- the clinic hasn't changed in terms of the physical piece. where you get care and what it looks like. healthy environments, positive spaces improve mental health. help peak struggling with substance abuse. decreased stress. i am excited to see what we can do here in 14 months on time and budget. let's get going. thank you. (applause). >> i think we have the director

who is going to say a few words. >> thank you to the health department. we have developed a very great long-standing partnership. we have delivered many projects together. of course, the biggest one we have projects in the southeast, south center coming up, renovations. we are excited on this project. we are doing pretty much everything. the project management, construction management, architecture is all going to be done by the public works staff. we are excited to work on that. the funding as you heard the mayor say came from the 2016 public health and safety bond, which is very important. i want to thank the voters for making that funding available to

us. i think some of the key elements you heard about having an elevator makes a huge difference. we will get a new elevator and make the building seismically safe. in the event of an earthquake or disaster the building will be operational for 72 hours or more. new consultation rooms when people come to use the facility, larger exam rooms, everything with the funding we are excited about. i would like to thank our project team and all of the staff from public works for working so hard to get us here and the contractors working on. the engineers are going to make sure we deliver the project in the 14 months. that would be winter of 2020.

i am excited and i hope it gets done on time and on budget. thank you very much. [applause.] >> we want to hear from one of our patients. our patient advisers are a group of people who bring wisdom to us. we are grateful for their work. we want to hear from them. this is a pamphlet for patients to best access their care. it was thoughtfully done. we give this to all patients. thank you for being our patient today. >> thank you, doctor james. i have been a patient here good years.

i receive the best care. i have been to a number of other clinics. this is above all of them by far. i work with the central city which may or bleed knows about. i have been there for about 10 years, i am a housing peer counselor. i am also on the gourd for the pack committee and new member of the city-wide pack team. also, i have been on the sro task force for six years. the clinic, remodel is something that we have desperately needed.

inches i have been on the board for the past two years. every meeting is about the remodel work. we are glad to see it finally coming together. thank you. >> we have to have the raffle. marty made all of this come together. her mother is a talented artist who put together the pieces for us. ms. charlene hill, who is maxine's daughter. [applause.] >> this is rosalyn frazier. [applause.]

we grew up together. >> matthew rothschild. (applause). >> one question for people. what is 1181 golden gate. who can tell me what that is? >> the new location for the clinic. >> that is where we will be for the next 14 months. visit us there as well. we are counting on our patients to be with us. we will have you back in 14 months and two days for