they actually came in and did an on site review at sfgh. then mayor lee thought it was important to have an external review and asked the university of california of san francisco medical center to come in and do a review of security systems at the hospital. and then finally director garcia had her staff, and i was a part of that, develop a corrective action plan that we delivered to the sheriff and he graciously accepted and has been a partner as we've gone through trying to put together that action plan. the summary i'm going to share with you is a couple four mayor areas. those are leadership, patient safety, contractor services and facility improvements. you can follow -- you'll see the legend actually at the top. it shows the organization that made the finding and/or recommendation and so those are cms for the medicaid federal survey, ucsf from the medical centers review and those items in the corrective action plan, the cap for the sheriff's department. in terms of leadership, the general theme was insufficient oversight of a contract

and i took a captain and literally grounded the captain there at sfgh. there had never been a captain there before because i wanted boots on the ground and somebody that i had qualified to be my go to person on the ground to literally shake it up and help us almost restart what we needed to do maybe many years earlier than that. born out of that process and then the communicative process, which frankly i don't think existed or well existed in the past. second motion strings of communication, which i don't believe is just ad hoc because of a tragedy, but now become more of a permanent establishment of how two departments should work together and a captain that's not reporting to a chief deputy, but now who are erased all sort of chain where he reports directly to me so we have the ability to make swift and deliberate decisions which we have. so i want to share what some of those are that i think help result since 2002, 2003 when it happened, has there been any kind of infusion like that, so what that gives us is to inject in depths at a level we've never

department of emergency management and serves as a practicing physician in the emergency department at sfgh. >> chief, what i am trying to understand is when i look at this chart on page 13 of the report, the city verses private ambulance response from 2007 to 2013, beginning in 2007, we were at about 98 percent of the response calls, and not only were we at a higher percentage of the response calls, there were a lot more, there were 83,000 calls at that time, compared that to 2013, we are at 73,000, so about ten,000 less calls, but we are only at 73 percent in terms of response and so i am trying to understand. this chart gives me a clear understanding that something has happened, because we have begin to decline in terms of the percentage of calls that we have responded to but i don't understand specifically what has happened to the department and within the department, that has led to this decline and so can you give me insight to that? >> sure, because of that period of time that i just described, between 2008 and 12, it became an open system where the privates were able to come in and

occurred with dph and i think that was a testament recently to a town hall meeting, if you will at sfgh, with their staff, and with ucsf president who has also been a strong assistance to us, and everybody, i think is feeling good about the direction that we are going. >> and there is a work order between dph, and the sheriff's department, for the services. and i don't have that entire department before you, but do you happen to know offhand what that is. >> i know what was budgeted was upwards to 3 let me ask. >> and i can get that for you. if you would like? afterwards? >> i think that there was a policy recommendation? that we have been in the budget analyst report that was about reducing that work order? and i just want to make sure that is in this report or not? i hear from the legislative aid, but i wonder if there is any room to, i know that we made the program and plans in place and we have had the issues of security and i have visited the hospital and learned about the security issues that there are and i wonder if there is any recommended cost savings based on the budget analy

occurred with dph and i think that was a testament recently to a town hall meeting, if you will at sfgh, with their staff, and with ucsf president who has also been a strong assistance to us, and everybody, i think is feeling good about the direction that we are going.