Relatively quickly. People with common names had been often will often take longer. You are saying the third floor is filled based upon your staffing right now and that the additional beds could not really be used until about two months from now when you have done all of the clearances . Yes, hopefully sooner than that. The Behavioral Health clinicians were made offers awhile ago. We hope background clearance comes soon. Sticking with the merf it sounds like the problem is staffing. Did we not at general improve the hiring process to move it along faster. Does that not apply for this . Is this a different process going on . We followed the process hr has for us. Nurses is one of the challenging positions to fillanticly psychiatric nurses. For the Behavioral Health we went through the process quick quickly. Getting to your question, the Human Resource department at San Francisco general also does the hiring for the Behavioral Health center. It is the same staff and tame lines applied to any position at San Francisco general. We are talking about looking at vacancies and beds in different areas right now, including the arf. This is all kinds of related to all of the capacity that we have and the problem of getting into the mrf. Is there not away that if we felt it important to staff up the beds to take patients waiting to get into the her of that we found a way into the merf. I want to make sure we are talking about the mrf on the third floor . The capacity. I am trying to understand the vacancies, what they are relating to. If we are freezing our configuration. Part of the point on the whole issue raised about the capacities within our Mental Healthsehealth system is how wee trying to be able to handle this. It is similar to trying to if one of the problems is filling the slots and we have problems filling the slots and part of the problem is bureaucracy, several years ago we went through that with general and improved the system. If we went back you would say six to nine months. It sounded like it would take a year to get somebody hired. If, in fact, we are having this Mental Health crisis in terms of extra beds that i am wondering if there are other ways of trying if the problem was staffing the issue would be how to handle the staffing. I will leave it there and move to the next question about the capacity and the reason for the arf beds we have spoken about and the information you have provided for us and to the public has been all of the different citations. We can read them in different ways. They are public. They do relate to staff but also as we understand from our citations, some are important and some arent. Certainly citation as are. Part of that related to staff. Where are we talking about . I heard two or three different stories on. There that freeze us from having additional beds beyond what we currently have at 32. At the current moment we would have to hire additional staff. We are about nine staff short to come to full census. Is that full capacity. That is full 55. We have enough for how many right now . If we take what we use for other parts of the building floats, we could open to somewhere around 41 or so. 41 or 42 . Depends on it. I mean just okay. What is needed or what can we afford between the different parts of the city . If you had an overall plan what should be the size of the arf . If you dont want to answer now, you can answer in the third hearing we are having because there is a lot of discussion we shouldnt be closing the arf. What that says is that we have a need for this level of service in our system. What is that level of service we need . Are we able to get to that answer in our presentation . I can answer that question. We would want to staff to the full license capacity of 55. That is what you feel the city really needs is the 55 . Absolutely. So if we are presenting a plan in several meetings, then the plan should be able to then describe what division is, right . The supervisor described a vision what they think would work and what Mental HealthSan Francisco or Something Like that. It would sound like the department should be able to be somewhat more specific what we think should be a plan or what we believe could be a plan, which maybe elements of theirs and elements of the city looking at Mental Health. Your belief is that orf should be arf should be 55. We have 32. We are nine short to get to 55 . Yes, nine staff short. So if we go to 55, so the answer is we need nine staff. We also need to have certain corrections and i think perhaps you might want to explain later how that might be, but that is working with the state again. We have done that in various elements all the way from the courts and jails many years ago to many other instances of working. If we are looking at that and it seems to me that this meeting two sessions from now should help us describe what we believe should be sort of the integrated system and what sorts of types of services are needed, right . That would include hummingbird. Commissioner, with regard to mr. Pickens comment around 55, one of the things that i think is part of the reason we are having this discussion now and i think you are right on the point here. The 32 to 55, we always intended to go back to expand the arf as we were able to build capacity and staffing but correct underlying performance issues with regard to saytations. In citations. In the interim have hummingbird have capacity to take care of the people as we solve for the 55. That is where it is confusing to many because we do think the 55 is where we need to be with the arf. We already have challenges with regard to managing 32 as regard to the citations. This is not about any one person or a judgment, it is just the fact the state has given us a number of citations. The plan was rather than leaving the excess capacity we would turn that into hummingbird. I understand there is disagreement about that. That was the plan. We are holding the idea of hummingbirds and fix to go to 55 for the arf. Again, to be really clear from what was that, that is what we put on hold at this point. As we are able to work that out and where those other beds go, i think that your note to us was quite explicit, to the public that we received and i am hoping people would understand that the department is trying to come up with what should be the areas that we are able to have to serve the public that will meet nose needs. It sounds that the department is not saying we dont need an arf capacity. The question is how to get to that and that there is perhaps not that the current way of trying, i think as director colfax was saying to meet part of our need while trying to get to the 55 was running into problems not only communication but implementation. People are being moved out of areas and at the same time while it sounded like we are going to just stop, you know, that particular level of service at this smaller level while we are also, but i think you are right. Technically you said you were not taking away the 55. We only wanted to put them in to try to deal with the current idea of using empty beds you would then have in order to fulfill a need that hummingbird also has, but that currently we are all saying how to work a hummingbird solution and possibly be able, also, to maintain a different configuration for arf, is that right . Yes. And that work is ongoing at this time with the offices across the street there, both the city hall board and the mayor to try to find a way in which the public will be properly served and that all i am doing is paraphrasing what you are saying, if that is correct. I am sure city hall does, too, the supervisor and mayor do not want to short other needed beds, simply to have a bed count under hummingbird or navigation or anything that we would try to see if we can accommodate all of this. This is nice if you could actually start coming to that accommodation within the third meeting. We might be able to look at a solution. It would seem to me at least that it would be very appropriate that the commission hear an overall broad plan as to the types of services felt to be needed in the city and how we cant reach all of them. Clearly the original intent of the building has sort of been changed by urgent needs otherwise in which we were supposed to be bringing back those who were housed outside on a chronic basis to San Francisco. The needs of the city that has been expressed hearsay if those people at the moment are there still, wherever they are, we cant bring them back because we cant solve our more immediate problems right now. That is the reason for the changes, i believe, at the Behavioral Health center to try to meet the immediate contingencies not forgetting that we have people outside. I think as an overall comprehensive look at the whole situation, we might want to see what happened to those people, too, and if anything could also be done for them in the future, but right now i think we are concentrating on the most immediate neats of the city, which are the urgent needs of people in crisis. Thats correct. That is a pretty fair summary. Commissioner green. I want to echo that. I am impressed by your honesty. He appreciate you educated us and your passion means a great deal and your wisdom means more. I guess the question is a request that i might have. I am confused how if we are embarking on this truly aspirational effort to identify the 4,000 homeless in San Francisco and concentration of 250 how when we find and identify them we can give them the best conveyor car best ce and service. We need to place them where they need to be placed. It seems that will not be successful that we havent analyzed the need. [please stand by] the first thing that i would say is that ive been mightily impressed how this department operates in crisis. I think that its been mentioned before how so many leading accomplishments across this country has been done by this department. And i witnessed how incredible this system has turned on a dime to respond to what is going on at the hospital. Every official has been there, and theyve been committed and thoughtful and proactive. And so given this leadership question that we have within this particular unit, im wondering who we can bring to the table, how we can marshall this skillset that is here within this department to try to act quickly, because i have seen leadership in action in this department and there is no better place to find it. But i want to understand what were going to do on that level to act quickly to give everyone, including the patients and the citizens, and the taxpayers, everyone has spoken here, a kind of reassurance and comfort that that we have the ability to move quickly on your concerns. So thank you for your questions, commissioner green. With the first one, have we analyzed what the needs are . So as you pointed out, the focus on the 237 and the 4,00,000, thy have done a lot of work to hone that population as the one to which we should focus. And as you can imagine the needs of that population will be varied depending where they are in their phase of illness or recovery and that goes the continuum from acute inpatient Psychiatric Care to p. E. S. To board and peers. So to on that end, we actually you remember a few weeks ago that the mayor announced the partnership with usff and tipping point. Part of that partnership is looking at the issue of care homes. Is there a way to begin to salvage those, particularly the ones that announced their closure . So thats one of the things pursued right now. Are there some of these facilities that we can approach them before they sell to developers to see if theyre willing to sell to the City Partners to maintain those beds. So all of those activities are going on right now. And we will put together a Performance Improvement plan, for the Behavioral Health and rest assured that the management and the operation of that Behavioral Health center will be a significant component of that plan. I want to acknowledge and thank all who came to speak to us today and directed your comments about what is important for the population and the residents at San Francisco general hospital. And at the merf. And i want to acknowledge that the nurses from the Emergency Department were here today and we talk about the struggles they have in dealing with the issues of folk coming in on an emergency basis and being stuck there and theyre understaffed and their view of being understaffed. I think that its important to recognize that these divisions are interconnected and something happens at the emergency room or at the merv and inpatient, all is connected to these programs and that one of the things that well talk about here is whole person care. Thats what we need to be talking about. Thats what we need to address is whole person. Because the e. D. , the Behavioral Health, all of those units are connected and its important that we recognize that it is a department of Public Health and the public is out there. And the public demands a request of us and i want to assure you that this is not the end of the discussion and when we have the third reading in november, its not the end of the discussion. This is the departure point. We will work exclusively with the department and we will hear from and work with you as a community because if we dont do this together for solving problems and fin finding where e failures are, well have this discussion next were. We tede to ge need to get whereo be. So with that im ready to move to the next item. Mr. Chair yes, i think that after listening to commissioner green and im reminded that understanding the Component Parts and, yes, you know, people cant move through the system and our transitions process that this needs to be reviewed because some of it seems to be failures in the way that were hearing and if the thought here whether using the 4,000 as an example from the Mayors Office or otherwise is to say that were having a transparency with the number of beds available. Im not sure how well that by itself works because theres all kinds of things also kind of left out of this database. But on the other hand it would be fortunate understand how that program is going to be looking with what we are envisioning for our service programs. And a good part of our psychiatric floor is with nonacute patients who do need care. And theres another group of people who should be in a more proper place with a more an appropriate type of level of service. So im looking for a comprehensive review and i would suggest a transition to at least focus on the Mental Health part of the equation here. We now have transitioned all the way across for even our elderly and others who are chronically ill. But i specifically am talking about transitions in regards to this and the Mental Health program is a continuum of care. Absolutely. That will be part of you referenced the bed tracking system for residential Mental Health and substance use. So that is in phase one. And the plan is to roll out that bed inventory website to all of our levels of care in terms of i. T. And programming and the fact that we have data coming from multiple sources. But that is the goal is to have all of our level of care in a bed inventory that is transparent and can be seen. Two more quick comments. One has to do with the emergency room and the nurses were speaking and they were speaking about losing significant staff and managers and longterm employees. And theyre also talking about the trauma they experienced as nurses staff. So i hope that one of the things that were often seeing is that the nursing staff has the ability to access care for them as individuals and as a group. Because i think that is critical. And i think that its also true for the Behavioral Health part of our system. Theres trauma there, not only for the patients who come in, but theres no way that theres not some transference between the patients and the staff that work there is. So i want to make sure when were taking care of our patients we take care of the staff too who take care of the patients. Thank you, commissioner. Obviously, those of us who work in health care are particularly in the Public Sector are concerned with the effects of vicarious trauma. So i will make sure that i followup with all of thigh my t reports and leaders to make sure theyre making the reports available to staff. Thank you. Next item. So, commissioner, i have been asked you have been several items on the agenda and im asked by the president to mirror back to you to postpone those and the meeting but its up to you to do that. I cant make that decision for you. These items will be postponed to the next meeting or a future meeting. Are they here . The staff for items 8 and 9 are here. We should probably go ahead and do it because they sat here all of this time. Im sorry. 8 and 9 are here . Yes . All right, so, sorry, everyone. Item 8 is the 2016 Public Health and safety bond update. Thank you all who came for item 7 and well move to the next item. The bond and item not marked mark primo is not here tonight. He offers apologies, hes suffering adverse reaction to a flu shot that he had yesterday. So he begged off. And so im going to try to do justice on his slides. Weve moved right into it and youre familiar with this slide, this is the scope and the budget of the d. P. H. Portion of the Public Health and safety bond. This one is the first bond sale of the 149 million and were working all the way through. As you can tell im moving at a quick pace through this presentation. And by the way, back to introductions and i skipped over that, im from zuckerberg capital programs and im joined with joe chin from the department of public works. Our city project manager on the bond program. And michael bidai the associate chancellor capital program. And so this is the previous bond breakout was on the first bond sale. We were planning we are planning on a second bond sale. We were shooting for early 2020, but right now because of the current bur