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 burn rate we may push that out into the late second quarter. This is a breakout for zuckerberg, the spend. We are about 23 through the original first bond sale. A lot of our projects have not hit the construction mark yet. Once we do we expect to have that spending to increase. This is the community Health Center bond, theyre a little bit ahead of us on the spend, theyre at 42 . And, again, as they progress in the southeast they will get a new contractor on board theyll be proceeding and the next one we presented at last presentation and this is the breakout of each individual project and grouping them together in how were working with the budget. Right now we are overall in the black. And even though the political improvements are showing in the red. Overall were juggling the dollars around to make sure that all aspects of funded. And we have some savings in the lower end that are helping with the overages in the top end. And with the community Health Centers, again, theres some projects. This one has the benefit of funding from different sources other than the bond and theyre identified in the legend at the bottom. You can see how theyre applied by fund type in the chart above. So, again, this one is also in the black. Since we last met a lot of work has been done and ones that ill point out to you quickly for the billion five on zuckerberg, we moved with the i. T. Design, and with that, we have a study for 8090 and one that im excited about is the psych emergency study for the new location for psych emergency. As far as seismic, we have moved through phase one, were into the second half were finishing up the first half of phase bo one which is the removl of the sunshade horizontal elements and then the fiber wrapping. And below you can see the bottom you can see the phases of a fiber wrap. So on section one is the column and you go to number five and thats actually number four is the complete column that is fiber wrapped and strengthened. And number five is what it looks like from the outside. And the majority of care accomplishments, so we have them being seen over at the old urgent care since we vacated urgent care. And we have submitted 95 design drawings in august. And working to create a temp location. With that well pass the baton to joe chin to talk about the upcoming milestones. Thank you. Good evening, commissioners, joe chin, Program Manager for the Public Health and safety bond program. So moving to the first line, well focus this evening on the upcoming milestones and accomplishments for three components under the health and safety. Its a southeast Health Center component and on building five for the team advancing 15 of our core projects under this component. Not much has changed and we still have four projects in construction. One project is completed. And the remainder are in different phases of the planning, design, or plan review project life cycle. And so here on this slide 12, these are the two projects that are in construction, and we have the locations, and the rehab, and were anticipating finishing by the end of the year and then rehab were currently at 45 complete. And then looking at completion early part of 2020. And then just quickly on another project construction site sorry. On seismic retrofit, as terry mentioned were wrapping up the first part of phase one and moving to kind of the interior column strengthening scope and thats the new work that were doing and learning the process and how to best do the work with the occupy facility. And we have a project from planning to design and its the specialty services. So weve moved from plan to design right now and thats a new project that were tracking. And then on southeast Health Center, really theres two key areas that we focus on. We have completed design. We have the drawings submitted to d. P. I. For plan review for permitting. And the next milestone is to get this to bid document and get it bid and construction early part of 2020. Were looking to start bidding probably this month as our target to get this out on the street and start soliciting contractors. And then on community Health Centers, this is its a comprehensive scope and were doing work at two Health Centers, the maxine hall Health Center and maxine hall, i think that we talked about this earlier. And were having our groundbreaking ceremony tomorrow. Happy to report that this is the project where were able to kind of show that weve awarded a contract to a contractor and theres also photos on the slide that show the prefabricated trailers that are now have been assembled. Theyre being worked on in preparation for the staff to move from Maxine Mau Hall into e temporary clinics during the entire construction duration. So a lot of things are happening at maxine and its good to see this project moving. And the Health Center, weve received additional funding for this project from the Mayors Office and kind of focused on the City Initiative on global warming, climate change, and so the additional funding was to add air conditioning to this project. So because of that added scope we now had to push out the design and construction but its this is the best time to do it. The building is already vacated and its a good time to do a comprehensive improvement to the building. And then the last three slides is our typical i think that you have seen this before our high level schedule update on active projects that doesnt include all 19 projects but shows the more active projects. So i wont go through it, and i think that its pretty selfexplanatory. One thing that i do want to mention is on the schedule update for the Health Centers and based on what i mentioned earlier, maxine hall have been the updated schedule duration that shows it being issued for maxine and kind of the construction duration for that project as well as castro missions design and construction schedule being pushed out because of the added scope. So at this point im going to turn back to terry, and well talk about the research project. Just real quickly, this slide is a list of what has been going on to get to the points where were completing the documents to and targeting to have that closed and it will allow them to move forward with their plans. With that and were also working diligently with other city agencies to help the process along with approvals for drawings and as well as providing all of the documentation with the bureau of real estate. And an inventory of all of the space is one of the items that is on our part. And we will move on im moving on to item 9 which is the presentation. As of practice at the Health Commission these items are presented together and then you all ask questions and the public can make Public Comment during either of those at the end of the presentation. So were moving to iem9 which is the Academic Building update. Thank you, good evening, commissioners. My name is michael bidet, at uscf. We are nearing the end of the design phase for the Research Building and i will show you where the design is at later in the presentation to remind you of where it is on the b. C. Lot. We are, as i said, towards the end of design and we anticipate construction to start in early 2020, once the final approvals are completed. And we are here at the Health Commission today and then in november on the 13th and we will go to the board of regents for the design and final budget approval. Which constitutes the approvals needed to build. And and were on schedule. This is a section through the building. Showing the way that the Program Components are distributed on the dry research floor, so that would be four or five. And this is the design that has been by the Arts Commission and this is what we are presenting to the board of regents. This is a view from the 23rd street entrance, looking up from the west to the east. And the glass corner is the sort of internal kitchen and the breakroom and conference area. With vertical transportation, and the glass lobby at the ground floor is the main entrance to the building. And you can see building five behind it. And the building is clad in terra cotta which is very much like brick in its texture and color. And this is a view of the looking due east, showing the main entrance and one of the connecting stairs going up. And the relationship to building five. I think that is the last picture in the presentation. Can i answer any questions . Clerk i have not received any Public Comment or requests for this item. Commissioner . I have a fairly naive question. So it looks like theres more green lines ahead of red and a few times ago when you presented it seems that youre doing well with keeping to time lines and what im confused about is how do you link, you know, kind of your expected expenditures to timelines . Like if youre ahead or behind, how do you analyze the expenditures compared to where you are and how often do you do it . And how important is it to look at when youre going through the bonding and how you make those decisions. And then my second question is there room for us in this building . Just a Little Office . Just a little one . Please . As far as the budget analysis, we are constantly, joe, myself and mark constantly greg were constantly going over the budget on this. The key milestones that are keying us to where were at are estimates. So we do estimates at the design completion and the project 50 design and 100 design and we estimate on the executive management team. And so we will constantly estimate the jobs. But it didnt get real until we have a contract and we have a bidder and a signed contract. And thats where we get to true up the budget and true up the timeline and match it to our projections. Thats really where it happens. And once were in construction phase it becomes just a regular part of the construction process and tracking the budget and the spend and making sure that we dont have cost overruns. Anyone else . Any other questions, commissioners . So it looks like were kind of slipping in time on the p. E. S. And all. Is that is that, you know, good . Its not good but to be expected. So if you recall the p. S. Program has changed and before we were going to try to do a 10phase project in the same location that was going to be it turned out to be a budget buster and we couldnt do it. So we identified a place adjacent to that that was vacant and we took it over. And so we started the clock on that but were still keeping the same baseline. So once we get to that process where we go through the design process and then we try to get a contract, then well reset all of those milestones. Okay. So youre rethinking the original . Yeah, and its a good move. All right. Absolutely. Thats the only question. Other questions, commissioners . Hearing none. Thank you. Thank you for staying and we appreciate it. I know that its late. So commissioners, item 10 is the person is no longer here, item 11 is other business and i will note that some of you are going to be at the joint hearing with the Planning Commission on the cpm agreement on thursday at 10 00 a. M. And then shall we do the item 12 . The update itheres people here. The report back from the september 24, 2019, zsfg jcc meeting. They discussed reports, including the regulatory fares and the c. E. O. Report and Human Resources report. And also discussed the epic related salary variance issues. And it will be continuing to track the epic program as it moves into its new phases. And at the medical staff report we reviewed the process for the affiliated staff form and approved that. And the registered nurse Standard Practice was a Standard Practice was created for administration of flu vaccines by registered nurses in the hospital. In closed session the committee then approved the credentials report and the minutes. And that ends my report. Thank you. Questions . Commissioners . Clerk theres no public request for that comment so were at the consideration of adjournment, commissioners. So moved. All those in favor . Aye. Aye. Thank you, everyone. The new friday farmer his market is in the u. N. Plaza. It features the best of San Francisco. Grab fresh foods and veggies from the heart of the farmers market. Shop from marker local vendors. Engage in free diy craft sessions and grab lunch representing cuisine from around the world. [ ] we offer 60 varieties of organic fruit and 30 varieties of conventional. One of our best sellers so sellers is our manager in. It is super sweet. We sell 600 pounds a week. One of the things they like about the market as i get to see my regulars on a weekly basis. I get to meet their families and kids and it is really good to be here. San francisco won my heart. One of our vegetables that is very popular is kale. A lot of people go for dino kale our mission is to make sure we have access for everybody to get organic foods, no matter your financial status. We make greeting cards, invitations, enamel pins, and we do workshops. I am participating in this market because it is a great opportunity for local makers to sell to a really Diverse Community of people in San Francisco. They partnered with the market here and invited us to come out and reach out to the public. We are going to do a full event of workshops where you get to arrange your own bouquet. We will teach you all the tricks and techniques and you will be able to take home a bouquet of your own. You. [ ] we really are wanting to bring opportunities to the community to introduce these local makers to a larger audience. This is my own pakistani recipe. It goes with rice, chicken, lamb we have a very delicious drink. We have a lots of variety of foods. [ ] we do lots of different curries. We do three different types of wontons. Spring rolls, too. Thats right. It is really great they are bringing out local artists from around the city to participate and really help us making our business more successful. [roll call] at this time we ask that you silence also phones and sound producing devices. Thank you. May i have a motion to approve the agenda . So moved. Second. Any discussion . All in favor . Aye. The motion carries. May i have a motion to approve the august 7th, 2019 Meeting Minutes . So moved. Second. Any comments or changes . All in favor . Aye. The motion carries. Item four, directors report
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