Timing. This wasnt the only hospital being built at the time. Ucsf, mission bay was wrapping up, and ideally those residents and workers, everything was timed perfectly when mission bay would be completed. Those residents were transferred over to General Hospital and building the new trauma center, so after that was nearing completion, those workers were ideally going to move right over to van ness gary, and there was about a year hold up. A lot of the residence, apprentices and even in the office workers, even had to go somewhere else and work for that year, and then be transferred over later. They were a hiccup or two on the front end of the project starting on times on time, and that threw a wrench in moving people from hospital to hospital, but let me also say this is a very important sector in our city. The Healthcare Industry when it is not there, you notice. And sometimes certain things can be taken for granted. We typically see commercial buildings, residential, retail, and hospitals are a completely different type of building. They are so much more complex, they are so much more technical. We are not just installing simple every day features, theres different finishes, theres all kinds of machinery, technology, things need to be programmed, so it is just a feat that these projects to get finished and completed, and with the high numbers i am seeing on here, i am really impressed. I want to congratulate mr. Nam on his position and i feel really confident that he will be doing the right thing and getting all the right parties involved to sit down and get as many residents working on these jobs as we can. Thank you. Commissioner johnson . I just want to thank my fellow commissioners and thanks staff for this report. I just want to also echo that i think that the d. A. Agreements are so often both about what was discussed at the time of their forming, and also the goal and spirit of the agreement and really it should be focused on the evolving needs of the city and building a new and equitable and accessible relationship with all San Francisco residents. I am glad to see the report that came out this year did provide more detail. Especially i want to thank mr. Nam around helping us to understand what has been happening with the workforce and not only hiring an internship, but retention. That is where the rubber hits the road. It is great to see those numbers i would agree with commissioner greene that i think the rest of the report, particularly around community engagement, was extremely opaque and left some to be desired. I think there are some issues that were troubling last year that are still troubling this year. One is the issue of outreach to tenderloin patients. First choice, sure, people get to choose where they are go, but if theyre not choosing your hospital, you have a problem. Community outreach and Community Building is really about creating an ecosystem so that you are not just relying on one provider, but a myriad of organizations working together towards the goal of enrolment and retention of patients. Coming from a philanthropic background, that is how you do Community Back he outreach. You create and bolster an ecosystem. I am not seeing that ecosystem thriving. While i am hearing the efforts that have been done, and hope that next year there will be better outcomes, i think that theres more to do to shore up the organizations that you are working with, and working more closely with extremely competent organizations that are in the tenderloin that actually do know and have the skill of working with these populations and really keeping in touch with them, and making sure that they continue to engage. Along those lines, if you are not hiring social workers to support doctors and changing your culture to meet the needs of the community so that goes from everything from what your website looks like, to how people are welcomed, to very detailed plans around language and access to working with Community Members. We are also really concerned about, and still concerned about the issues related to the acute care beds. Our city desperately needs those beds and i would actually like to hear the end of my comments, what has happened with the patients over the last year . And what the plan is for that unit, and staffing. Im deeply concerned to hear again, this year, issues around lack of staffing, appropriate staffing. I absolutely agree with president woods that i think this is about equity and access and this is about making sure that your care is relevant, not just for the people who can pay for it, but for all san franciscans, and that will actually ultimately make your services viable in the long term being able to provide services for folks of all economic backgrounds, cultural backgrounds, and languages. That is the biggest challenge facing the healthcare sector as i see it, and i hope that you continue to be up for the challenge of really addressing those issues. Commissioner johnson, was that a question of the cpmc staff . Yes. Thank you. Good morning, commissioners. I am the Vice President of external affairs for sector. Commissioner johnson, we had a hearing last thursday, actually in the Public Safety committee of the board of supervisors to discuss this issue. Along with a presentation from staff around the work they are doing to address the citys larger problem, some of the information we shared last week around the issues of staffing and so forth, as you know, due to law and our concerns about privacy, theres only so much information that can be shared, but it is worth sharing that, first of all, the physician who spoke so ardently two years ago when there was pressure for us to transfer that unit from st. Lukes to davies has submitted a letter. We can share a copy with you giving his objective viewpoint of the care being provided in the unit. Staffing ratios are something that are mandated by the state and we are in constant compliance with those. They are posted weekly, they are submitted monthly, we also are regulated by the California Department of Public Health who have recently come through and done an audit of the unit and found there to be no concerns with the care being delivered there. Can you give a little bit more detail about what is going to happen with acute care beds and what has happened with the patients . I cant speak to whats happened with any particular patient. I think staff probably could, if kelly was here, could give a broader understanding of the type of patient who requires subacute care and what that means for their condition and level of fragility as a patient. Our intention, is agreed to with the supervisors and others last year, was that we would continue caring for that population that was with us at st. Lukes over at the davies campus and that is what we are continuing to do. Thank you. Commissioner fung . This is my first meeting on not only cpmc and the development agreement, but with some of the issues that have been brought forth. We have seen, and it is primarily technical analysis, i understand, some of the issues that are relatively new to me. It appears that i will need to study this pretty extensively if i am able to proceed in a thoughtful manner on future meetings. Just from looking at what was primarily on the planning side, it would be not as challenging as from the healthcare side. At this point, i will be studying it further. Thank you, commissioners. I agree with all of my fellow commissioner comments. Thank you so much. I did want to press a couple of issues and ask him questions. I agree with the font. [laughter] and i dont wear glasses for close reading, but it is a little bit challenging. I see that the patient demographic that was provided are for all campuses, and in thinking back to previous hearings, you know, especially as we heard about the issue of Language Access to the diabetic unit, i am wondering if we could have a more detailed, by Campus Demographic data, especially as, you know, folks when we rebuild st. Lukes were very worried about access within the eastern side of the city to cpmcs services, so i just wanted to see how that was in terms of the demographics as we know. We know the demographics are a big concern in the city and it tends to be different then in the cpmc main campus. So that is one, and then the other thing i wanted to ask was about hiring and resource hiring totals because i see that we are in compliance and doing well. I am wondering what this looks like in terms of race. So you provided data in terms of neighborhood and zip code, so we know that africanamericans have a much higher rates of unemployment in San Francisco, and this is an opportunity for folks, especially young people, to get skills to get in the door for this one project, but then those skills can be applied to other projects, and during an era where we have an extreme shortage of construction workers in San Francisco. We cannot meet the demand. So can you talk to a little bit about what the demographics look like . Thank you, commissioner. I am with city build. I knew that question would come up. Specifically for city build, our program has a 35 africanamerican demographic that graduates from the program. Is over 1400 since we started 14 years ago. Overall for construction, i did not procure the Demographic Data , but i provide a supplemental to provide that information for the commissioners, and then this specifically, that is what i was asking for from our office for the nd use post construction work for the operation. That is the other data i will be getting for the referrals and the placements that we have made for the operation of the various hospitals. Thank you. I would appreciate that data when we do this again. I think it is important. Thank you. Thank you. In my last question, that is for cpmc staff as it relates to the partnership with saint anthonys. I think that part of what commissioner johnson very distinctly said, always, is my worry, also, about creating an ecosystem by which people are attracted, but also once they walk in the door, there are culturally appropriate and welcoming services so that folks can be hooked on as patients. Im wondering what the plan is going forward. I understand that numbs was the partner who could fulfil the d. A. Requirement, but im wondering in terms of outreach to the Tenderloin Community specifically where they are not based, what the plans are for making that connection to the community and providing access and culturally appropriate access to folks. Thank you, commissioner. Emily webb again, director of Community Benefit for the bay area. We do work outside of just providing Healthcare Services in the tenderloin. For example, our Child DevelopmentChild Development centre on van ness, which provides Multidisciplinary Care to children with developmental and Behavioural Health delays is providing services at saint anthonys. We are also at schools in the neighborhood. We fund and work with dozens of communitybased organizations in the neighborhood, so through our Community Benefit investment, we do go outside of the walls of the hospital to try to make sure that we are meeting the needs of the community in the neighborhood. In terms of the services on campus, the data, which im happy to send you in a larger format, shows you that we try to recruit a workforce that is reflective of our patient population. That is really the number one thing from a healthcare perspective that helps with cultural, linguistic access to services. In addition, in the packet you will see we did an assessment of all of the cultural and linguistic access standards, and in the packet theres a detailed document that outlines what the consultant found, recommendations, and how we are working to address them. Theres a lot of Different Things that go into that, but it is in the Compliance Report that we submitted in may of this year thank you. Any other comments or questions . Okay. We are not taking action on this item, but thank you all for coming and we will see you again next year. It had been rain for several days. At 12 30 there was a notice of large amount of input into the reservoir. We opened up the incident command and started working the incident to make sure employees and the public were kept were safe there is what we call Diversion Dam upstream of moccasin. The water floods the Drinking Water reservoir. We couldnt leave work. If the dam fails what is going to happen. We had three objectives. Evacuate and keep the community and employees safe. Second was to monitor the dam. Third objective was to activate Emergency Action plan and call the agencies that needed contacted. The time was implement failure of the dam. We needed to set up for an extended incident. We got people evacuated downstream. They came back to say it is clear downstream, start issuing problems and create work orders as problems come in. Powerhouse was flooded. Water was so high it came through the basement floor plate, mud and debris were there. It was a survey where are we . What are we going to do to get the Drinking Water back in. We have had several emergencies. With each incident we all ways operate withins dent command open. Process works without headache. When we do it right it makes it easier for the next one. We may experience working as a team in the different format. Always the team comes together. They work together. Our staff i feel does take a lot of pride of ownership of the projects that they work on for the city. We are a Small Organization that helps to service the water for 2. 7 million people. The diversity of the group makes us successful. The best description we are a big family. It is an honor to have my team recognized. I consider my team as a small part of what we do here, but it makes you proud to see people come together in a disaster. Safety is number one through the whole city of San Francisco. We want people to go home at the end of the day to see their loved ones. We dont want them hurt. We want them back the next day to do their work. There is a lot of responsibility the team members take on. They word very they work hard. They are proud of what they do. I am proud they are recognized. My name is doctor ellen moffett, i am an assistant medical examiner for the city and county of San Francisco. I perform autopsy, review medical records and write reports. Also integrate other sorts of testing data to determine cause and manner of death. I have been here at this facility since i moved here in november, and previous to that at the old facility. I was worried when we moved here that because this building is so much larger that i wouldnt see people every day. I would miss my personal interactions with the other employees, but that hasnt been the case. This building is very nice. We have lovely autopsy tables and i do get to go upstairs and down stairs several times a day to see everyone else i work with. We have a bond like any other group of employees that work for a specific agency in San Francisco. We work closely on each case to determine the best cause of death, and we also interact with family members of the diseased. That brings us closer together also. I am an investigator two at the office of the chief until examiner in San Francisco. As an investigator here i investigate all manners of death that come through our jurisdiction. I go to the field Interview Police officers, detectives, family members, physicians, anyone who might be involved with the death. Additionally i take any property with the deceased individual and take care and custody of that. I maintain the chain and custody for court purposes if that becomes an issue later and notify next of kin and make any additional follow up phone callsness with that particular death. I am dealing with people at the worst possible time in their lives delivering the worst news they could get. I work with the family to help them through the grieving process. I am ricky moore, a clerk at the San Francisco medical examiners office. I assist the pathology and toxicology and Investigative Team around work close with the families, loved ones and funeral establishment. I started at the old facility. The building was old, vintage. We had issues with plumbing and things like that. I had a tiny desk. I feet very happy to be here in the new digs where i actually have room to do my work. I am sue pairing, the toxicologist supervisor. We test for alcohol, drugs and poisons and biological substances. I oversee all of the lab operations. The forensic operation here we perform the toxicology testing for the Human Performance and the case in the city of San Francisco. We collect evidence at the scene. A woman was killed after a robbery homicide, and the dna collected from the zip ties she was bound with ended up being a cold hit to the suspect. That was the only investigative link collecting the scene to the suspect. It is nice to get the feedback. We do a lot of work and you dont hear the result. Once in a while you heard it had an impact on somebody. You can bring justice to what happened. We are able to take what we due to the next level. Many of our counterparts in other states, cities or countries dont have the resources and dont have the beautiful building and the equipmentness to really advance what we are doing. Sometimes we go to court. Whoever is on call may be called out of the office to go to various portions of the city to investigate suspicious deaths. We do whatever we can to get our job done. When we think that a case has a natural cause of death and it turns out to be another natural cause of death. Unexpected findings are fun. I have a prior backgroun