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tv   MTA Board of Directors 81815  SFGTV  August 23, 2015 3:00pm-6:01pm PDT

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>> (calling names). >> she'll be the last person to address you. >> good afternoon. i'm with the san francisco bicycle coalition representing the 10 thousand strong members throughout san francisco in supportive second street improvement project we've smimentsd nearly hundred personalized letters in a walk and a could say letters of support if businesses on second street second street is south of markets most important corridor people walk and take transit along second street a home to neighborhoods serving local shops and restaurants the only north's south bike route in the area and services a critical connection for people that work and live south of market and
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last built projects of sfmta corners we're excited to see this project as today as many of you may know as now is uncomfortable and safe people for public utility people driving through the neighborhood and they create dangers conditions and we've from the sea of traffic project hfa as proposed with the protected bike way and streetscapes give the visitors and on the complete street they deserve the project is a strong step towards the vision zero and as an agency of mta and has measurable impacts and lastly thank the staff as mta and the planning department in particular katrina 10 and others
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and countless community meetings thank you for supporting this critical project thank you. >> (calling names). >> and good afternoon. >> good afternoon. i'm pat valentino the president of the south bay admission prong peaceful is important it is a dangers mess i used to take a bike on it, it is an enormous risk every single certain times of day cars use this is a ramp up speed to get on the on ramp when no traffic and when there is zero respect for the
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pedestrians i wish they could go further but the changes will benefit obviously pedestrians first and transit and bikes as well i do count taxis as part of transit it is okay to have a street it isn't friendly to cars i think we know this by now stating the objectives it a unsustainable form of traffic to the merchants are numerous the benefits and nobody gets out of a car going thirty mile-per-hour to windows hop when there are plaza and walk and get out and bike and take transit people will more likely to get off their bike to walk by a store and it benefits the blood alcohol merchants for me who works and lives in the area this is
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stealing he needed from an emergency situation from the times i've almost been hit almost every single i walk through the area. >> thank you. >> last person to turn in a speaker card mary maguire. >> here we are i see your diagram now we've lost another kind of kind of bike stands we lost anothers cabstands give us a cab stands at the ball park between townsend and king on both sides so we can gets 0 in and out of there what are we supposed to side if we can't say make a left-hand turn go to market street if someone to pick up on second street how are we going to get them anywhere it's
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on a right turn on market street i mean this is nice but then once again, why not eliminate all cars on market street and put commercial cars i don't know what what floating is why on castro is a constant traffic jam nobody needs to park on it block a commercial zone on fulsome street maine i go to work on eight street you have to reinforce those a huge bike lane on fourth street i've seen people on the left-hand side i've mentioned the bike lane is on the one side how many minutes have you a huge lane why holdings up traffic it takes me
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to get to work sometimes an hour from rincon hill to the cab company and it takes 10 minutes to get home fulsome street is is a mess trying to get to the bay bridge you need to think this thing through better so thank you. >> members of board. >> director heinecke. >> i have two questions i'll direct to director reiskin if i could give us an anticipation of cars on second street quietly go i assume some anticipation of car reductions bus second street crease other options or frustrated by traffic and not drive a summary and the second question which maybe my discussion provoking question
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the way i look at this plan as implemented that street will be essentially undriveable allergy anyone in a private available you'll have a single lane of traffic in either directions at times subject to people making turns although the turn pockets will back up but more importantly a single lane of traffic with traffic lights and when busses stopped at their stops will block because one lane of traffic in each direction it is sounds market street why would anyone drive on this street i wonder why not take it the next level and do with second street like market street it is transit and taxis only free up that street for that sorts of vehicle traffic i think you solve the ball park if you
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have a dedicated taxi lane running flet south with with the subway train i'm sure someone thought about that i know we can't do this today given the environmental impact but to me it strikes me we should be long-term planning and to one of the public commenters if we create a north-south version of a transit only red carpet street that will, something that julie and her staff this should be considering if we're going to have a more transit friendly north-sou north-south artistry want to put more traffic those are big picture questions you'll probably wishing i didn't ask them but to me this proposal i appreciate the first step but i
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have an interesting reaction to it i have a reaction to you all can just it is two midly we leave the street and put in pedestrian or we go all the way but to me this proposal is going to make private car traffic untenable. >> we look forward and welcome comments from the boards i'ask christina and julie we didn't do angle analysis for a car free street the combarng between market market if have park it not a pattern for people were accustomed to and building to
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accommodate people pulling up to park so i think this is a little bit different than market many, many streets more of them north of market that are essentially gone lane in each direction for transit i think in terms of it being you can essentially a transit you know high quality transit facility the improvements will help transit but it is one lane in each direction interest will be plenty of people that be assessing second street and in their car it will be less attractive as a freeway approach but lots of businesses with small shops that folks will be coming by many memos to come back by so i'm not sure it is going to be a street that will
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accommodates a whole lot more muni volume the muni staff as a part's of planning and the services staff it did benefit from a lot of different input but the main issue of second street is a 2 flats a street in that part of town if you're on a bike that really works from the embarcadero to the etc. is the next and 5th center the to the west so as many hayne said a matter of trade offs for prioritizing the streets for not good alternatives from deriving from muni pained wlanz on third street that is a major corridor other alternatives for different
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modes we didn't study car free version of the plan something that is implemented we evaluate what the auto use is fill parking elimination will be problematic for folks and in terms of where the cars go christine r a or ellen can talk about that as part of the environmental impact for the project. >> christina if public works so to answer your questions as we all know street street not a direct route a lot of people uses it for a orientals but a big part of second street the revitalizing the streets for people w that live and work
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there and not an alternative route as director reiskin said one of the two-way streets in selma and as such we know that is a critical route for taxis to eye second street to and from and want to shift the vision of second street to leave it on for people trying to get to the small businesses around the grilled cheese company and hensleys spirits and the nail salon industries after south park but drive outside of the area so as far as what are other routes i've pulled up the map of selma the environmental impact studied 29 sgshgsz between market and king, first to third
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and we looks at 5th and bryant as one of the freeway on ramps so the additional routes it is articulating battery to first montgomery to new montgomery if you're on new montgomery make the resistance on howard, make the left on hawthorne and have the choice of fulsome or harrison if you are on second street southbound you would have to take howard to get to full name or harrison. >> i guess i said there are other ways to go really the balance there are currently a lot of cars on second street where will they go those routes you've described are in my experience are at cabinet. >> there are 11 intersections that have prestige level impacts 3 of them were able to be myth
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at southbound and harrison to provide a left-hand turn from left-hand turn all the time to take up the capacity and working with the waterfront to look at the improvements only beale and other streets on embarcadero to take some ever that need that demand. >> understood. >> well, i guess this remains something of an issue we should be discussing this is a major change in the way our city is moving our citizens around i certainly understand the need if not 92 just a unique corridors for bikes but if you walk up and down you'll see how many people will be living there in the future triple or quadruple
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judging but the cranes making the north south route decision and the ideas of a transit or enhanced transit lane i understand kantsz do that today not just muni but taxi or hof lane those are things in our disposal my fear we're going to have a calculated second street claw for the cars that made a bad decision and clog for the taxis i'm a little bit concerned about this proposal it is too much in the middle i think we should watch 19it i'm prepared to support it today but it is
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with some trepidation we'll have quick reluctance once it go in mines a timeline for implementation not very long; right? something we can do quickly. >> so the; correct contradiction will be at the end of 2016 and done by the middle of 2017. >> co-recordings to the subway by the way, maybe that will help alleviate. >> the creation of resistant pockets and the left-hand turn opportunities should help the traffic flow along second there will be congestion effects off of second but you know part of those designs was meant to keep the traffic and trachea flowing
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on second street. >> with respect to the taxi will it be two hours housing. >> what's before you is leging full-time. >> i'll stop i realize i've mop listed this director reiskin you'll not count on me for being precedence but i'll urge a second look at after a ball game and vegetation that are a lot of times we're using the corridors off traffic peak times if they can't make a left it will lead to larger microfilms money for passengers. >> the importance of second street it has a lot of small-scale businesses that a lot more local like
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grilled cheese and not fancy places people go they're 31 they have deliveries and people that get there sometimes by car and the majorities of their customer base it is for this street a place for people nostril pga through all studies have shown people that are consulting not our customers but people driving in that area because they want to be there so to insure people know this is under those circumstances not assess to the freeway and verbiage most people and peak hours are like on a daily basis the ones that discovered it the first and hopefully not make that mistake again and making sure that people i guess the only concern when the bus stops and making sure that we enforce the cars are not trying to go around the
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busy buses that stopped observing happens in corridors otherwise a great project second street is basically dead-ends in two spaces right king and embarcadero and market street has a ability to an calm down street friendliness and bike lanes i think this is a great approach and objective in the beginning in short will be absent more challenging in the beginning but once people get used to the patterns of what at the could and couldn't do it gets better of modifying on behalf of. >> i'm excited to support this this is not my neighborhoods but looking forward to another safeway to get through downtowns i have concerns that were
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previously voices i want to look at the taxi exemptions but approving it as it is now not prevent us from looking at it again that's all i have. >> thank you director heinecke for making me seem lake the mediator voice we can do something in the future if if it proves important awe applicable i know we've been hearing from a lot of people about masonic street if you can talk about what are we doing differently or lessons we've learned to apply to them this to keep us on schedule the. from our citizens i share is one of i am patience and as quickly as
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possible if we could talk about the timeline and how to keep it forward. >> one of our advantages on second street of one-half been an environmental impact for the past two years been cooperating with the other departments the public works and the mta so we have the project well independence the water and sewer the place will be repaved and as director borden said it ends at both ends up in a sense that is a little bit easier to deliver and federally funds we've be submitting our construction package to caltrain for approval in september they'll need to review it that's why we have a gap under our schedule and finish destine this winter and advertise but from a lot of
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projects like caesar chavez escape to complete a section or segment of the street before we demobilize and move on to streamlining from design to advertising and work hard the contract and trying to streamline construction as well. >> is that just to go back to this ma song we're hearing about that the masonic starts with the full board merging in dealing with outlet city agrees and improvements on timeline and delivery of projects and he guess i just want the public to have that confidence this project is more likely to stay on the timeline or being a city and dealing with city agencies yes something can always come up but to get us to
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the level of confidence. >> the schedule will stay as is we've been working on the project for several years we're at the tail ends and finishing the design and build it we have a lot of support if the communities and businesses not everybody is hundred percent confident that it has everything that everyone worksheets we have a lot of support going forward with the implementation of the project. >> thank you. >> thank you, chairman nolan my compliments to the staff sounds like a lot of hard work i couldn't be more excited about this i did looks like you've done a lot of thinking i appreciate supervisor kim for sending her staff and expressing her support
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i've clearly seen her out there and understand how urgent of a need there is more projects like this in the city as someone who goes and uses this corridor to get better from the ball park to the train station on a bike it is down right terrifying to ride a bike anywhere in south of market but this is the place to do it i would love to travel in the transmitted lanes everywhere at some point we should revisit this and it i feel that we need to do something soon i mean lives don't think it literally and great step forward to minimize the traffic and address the traffic issues i'll really encourage folks to consider how
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signage works to direct people do or into the best way to get to the freeway i've seen the signs to direct people to the freeway of a round about way people will get hip to it ever it is blocks away it is tremendously hopefully for people that are out of town that follows the flow of traffic and might ends up stuck i strongly encourage you folks to look at how to augment the mitigations by looking at the signage for a more a better route for all of us for them to be assessing the freeway signages is critical i think this is all i have to say i'll be obviously supporting the project and again want to - oh, yeah last thing i appreciate
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looking at the taxis i - i resent people make accusations we hate taxis we're having a juggle a lot of balls and taxis are important thank you all very much. >> i will be supportive i appreciate all the public outreach and community groups that came forward and the businesses and all of that i too burglary be interested in seeing the left-hand turn and the cab stand is there any way to replace that someplace and open to that as we get more and more information is under a motion. >> motion to approve. >> all in favor, say i. >> i. >> opposed? in the i's have it thank you staffer great job.
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>> 12 prosecution for the transit economic study no people that have expressed an interest in addressing on this matter. >> this is the meat. >> that matters. >> we've waited all day this. >> for this. >> good afternoon decorations we're excited to bring you this information we as a city have looked the delay in a negative side of transit not actually tried to quantify the added value in the system whether or not i can't great system that brings the city this is our first attempt to have the dialogue and discussion so - >> increase in strategy plan you've approved under goal that
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the improve the quality of life in san francisco and objective 3.2 to increase the impact to the economy before we need to know that we need the bottom line this effort to study the baseline we hired. >> consulting firm economic planning system one the premium planning groups in the area to assist us in this effort so i have jason moody a exfoliate that works on this i'll pass it over to him and we're both here to answer questions. >> good afternoon mr. moody. >> thank you. i'm jason with the economics and planning wear a real estate consulting firm with offices in oakland and sacramento and los angeles to build on what was said the
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person of this analysis to look at transportation in a really big picture from a return on investment or cost benefit flafls to look at muni services it is kind of a surprisingly kind of transportation is looking at more and more those on the from the forehead level comparing the benefits to the costs the traditional formula for funding transportation in this study is in that vain vein of trying to look at the investments, if you will, be using a metrics in a field that is willing the metrics are getting better estimating the benefits and comparing the costs this is straightforward but the stems
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are a little bit more tricky next slide, please. >> in addition there is obviously the local context the city transportation infrastructure and the growth in the city that is pitting constraints this is a projection of growth we've experienced a lot of growth in san francisco in the last 5 or 10 years that will continue population growing 40 percent by 2040 and employment growing next slide, please. >> obviously going to put more and more pressure on transit and transportation infrastructure in general and obviously automobiles are not going to be able to solve that problem and basically the right-of-way and the capacity of the streets is already at capacity there muni is critical for meeting those
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targets that's a big picture context in terms of the methodology i alluded to it is anyone tiger's benefits and comparing them with cost and doing a cost benefit analysis you have the reports i think the detailed report part of the packet with the detailed analysis the calculations are transparency and we vetted the numbers and the model about the sfmta and the sf ct a with their transportation model and show the calculations we should a high and low rage for the estimates we provide i think the general kind of big picture assumptions this is why we're considering it we have to make a hypothetical assumption in some of the calculations what happens if muni didn't exist for
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parking demand and what happened to a whole host of things we had to do that in reality a content framework so it is a convert we made a hypothetical assumption you'll be able to continue to do things it will only be harder calculations as a result you know exclude a number of things value of foregone trips for example, if muni was there people would have to travel less there's a value we're not calculateing they include things for circling for parking and the costs they actually exclude the population employment growth this is a model based on the
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current circumstances now how much worse but the impacts will grow request population employment so we're going to look at as it is today preliminary skaegz we we looked at travel time savings phone call for muni drivers but automobile drivers they save times because muni reduces congestion and looked at the improved safety and the air quality issues and safety ones we didn't anyomonetize
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this services with the accessibility issues we didn't look at the last one i want to mention worker productivity next slide, please. >> obviously muni improves job assess and commute times it is for productivity the one we quantified the travel time how long it takes to get to work or commute, in fact, we looked that with the sfmta model and assumed a world in which muni was not there how much congestion and you put an seismic value on the cost of time and accompany with an economic estimate that is what that basis it go to the
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next slide we didn't monetize the productivity benefit from muni that essentially derives what you're able to get in different and people working next to each muni allows the urban formula that is really hard to game-changer we looked it but as a comparison type of analysis if you replaced - if you had to add more parking because muni didn't exist you'll have to replace 11 percent of the housing units and all the additional cars to be in the city car ownerships will go way up next slide, please. >> muni reduces travel costs has that's a straight up
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calculation and this is a pretty straightforward calculation a car obviously costs money to not only purpose but to maintain and operate muni costs money as well but on a per trip and per mile basis a set of facts for an automobile which you look at the costs biggest one is at our designation and look at that on a per mile basis that is significantly costs savings we committed that if the cost savings analysis okay muni reduces the needs to owner a car cars cost money we didn't through to be conservative not only to park at the designation
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but having a parish in our house car ownership in san francisco is less than 70 percent compared to 90 percent in the bay area this is largely for the transportation in muni the calculation we did as detailed basically. i'm sorry. >> that the car ownership rate will video to go up to san francisco the way we calculate up to percent and the calculations how many new parking spaces so have in other words, to do that and the cost of a parking space this is an illustration of interest because it shows you how space indoes he have for a overlay of candle stick park and
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if you think about the value the economic value combetsdz in the san francisco you get an idea of a space and other things related to car >> muni improves the environment this is obviously pretty intuitive basically the emissions per trip or per million people that use mini is less emissions we calculated that think a protocol on the cost of air reductions between the two modes and the volumes in this case and you come up with an economic estimate with that. >> safety is another one thing again on a per trip or per mile basis it is safer to travel from muffin travel relative to audit
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travel the analysis for all the muni travel what's the economic cost of the collision and again some standard methodology that put a price tag here's some of the findings that are pretty small we look at the annual impact and the fire chief earners back. >> no. it is easier in terms of of so obviously the amount of benefits far exceed the costs by depending on the high low on an annual $630 million to 1.5 billions of which is one thousand per residents and between 350 and $7 per trip when you look at in it in presents value that is the annual number and bringing it to a constant
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today's value the numbers are much more impressive on a per trip basis this is an overall cost benefit arbitrary this is technical between 2 and 3 which means for every dollar you invest our benefit is doibld to 3 times so overall muni is a strong investment relative to others investments out there in terms of next steps this is really more of kind of a you know feel good type of study (laughter) we do hope it improves the benefits of travel and understanding some of the discussion fitting for the day is about that there is a lot of
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decisions about cars versus transit and understanding the trade offs hopefully, will provide context we have a method dissolution for calculating a variety of metrics we can use going forward to update and understand the investments of - to potentially incorporate those metrics into the future budgeting decided and finally a lot of things we didn't look at bicycling and others services that sfmta provides and streetscape improvements complete streetscape sf was not evaluate there were other medics beyond the scope of this study we made this study directly to lead to with that, i'm available to answer any questions you may have. >> i have a question.
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>> questioned. >> can you apply it to methodology to others relationships actually, it is in someways to political to an individual i'm not sure if you're familiar with the federal level those are san francisco received money through that if i understand in motorbike they required a analysis and they select those projects bans which one has the history cost benefit and it is easy because you have more concrete information about the travel patterns and the streetscape about what is happening in some ways easy to do it at the local level this is challenging to try to go macro. >> did we plan to try to use
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this just because every time we have a lot of projects coming before us on a project based level this is even more relevance this is not the issue but on a project related basis this kind of stuff makes a difference. >> director that's the goal to be having a cost benefits analysis the system this is a starting point and hope to get more and more reif i understand but terrific to quantify for the public what the benefit cost of the individual projects so the first of a journey and hopefully, we're interested in making this a model of how we look at the world. >> i'd be rim if i didn't thank jason who is sitting in the audience thank you, jason.
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>> director borden brought up what i want to bring up this is a fantastic tool not only on a macro but a micro project by project i've not seen this come out of another traffic agency this is fantastic we're on the for the most part of calculate our benefits like director borden said we can point it to it this sort of an unusual thing. an agency >> i actually got the idea seeing that bart did it. >> seattle has done. >> bart's did to study to demonstrate bart to the region we were calculating how much we costs san franciscans when we have details so a small subtract from a unknown positive benefit that is why it is important to
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do this. >> i mean, i'm glad to see the awareness of the policymakers some of the information will be perfect to accepts to the assembly mentioning members that are working on the transportation funding infrastructure i think this is could possible help them with the laundering and framework to address that i'm looking forward to seeing how we're going to use that and expand it what benefit does that and what benefit if the pedestrian safety and bring this before the voters. >> thank you just quickly i really appreciate this is exciting i can't wait to do so the one on better management parking this is a premise ii think we all need more information available
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a few things i'd like to dig more deeply into the things you've listed as not being montana tied but the public health it is increasing more and more of a something we can address by way of our environment there is movement in the field of public health that is coming to light with the overall costs we live a more transportation lifestyle this is things for actively transportation i will encourage us to dig harder and figure out if it is not anyone tied maymon
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talk about it seems to me transit invaluable to people of lower-income and i know there is a tremendous cost savings that we allow people when they don't have to own a car and finding a way to be able to help put that into sound bite or a bullet point we can get out there will, tremendously helpful when we make the case for expanding the subway or putting in a light rail those are things that are associated with direct displacement or indirect displacement and pep people to understand how to get engaged in a project early enough enough but the long term benefits of some projects will be in terms
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of maintaining equity get to the real investment it is a wonderful thing i appreciate it. >> those points are right on we've seen what is happening for example, measuring the impacts the transportation system a lot of people working on quantifying that but the next iterations we'll quantify those i'm very optimistic we'll get there. >> thank you very much. >> well, thank you very much that's an excellent report any members of the public. >> herbert wiener now that we're alone. >> i support public transportation i came to this meeting on public transportation and leave the communities on public transportation i think this is necessary in light of
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the gridlock i couldn't agree more but observations i have you talk about travel time i ride the one california bus regularly there is a point of interest with the busses sometimes two to three buses that fellow each other and sometimes, we have to wait a long time for business and i always say when is the next bus going to come after we have weapons of mass destruction we talk about social equity you how about search and seizure and disabled having to walk to the bus and paratransit not a solution you have to reserve a day in advance and go four blocks on a paratransit vehicle is not okay when the muni
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forward is creating this inequity what i want to stress this is very important some people can't say not only drive in their 80s or 90s they create a danger to themselves and others i'll probably fall both that i'm 76 years of age but you'll have to give up my car sometime this is an important function that muni has your protecting the public and protecting individuals against potential injuries and accidents because of that you have to insure accessibility i wish this report would cover that those are my observations thank you. >> board members thank you, mr. moody fine report we have a quorum oh. >> mr. chairman item 13 is a vote for collection you have a
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member of the public. >> mr. pill pal is no longer here so. >> is there a motion? >> motion. >> second. >> all in favor, say i. >> i. >> how about a little break before we do the >> item 14 the mta met in clegs to talk about the local 25 a that matter that the case with the city attorney with the directors decided to close both and conducted the policy but the disclose or not disclose the information. >> not demolish. >> >> all in favor, say i.
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>> i. >> we're adjourned thank you very much, everybody.
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>> come to order and the skeet will call roll commissioner pating commissioner king commissioner chow
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commissioner chung commissioner sanchez commissioner karshmer the second is the approval of the minutes of august 4, 2015. >> before you guess for approval a motion is in order. >> so moved. >> are there corrections to the minutes. >> i think the only typo on item 10 it is obviously sf dph. >> my apologies that's the only one i found or saw sorry my other comments if not then the minutes are before you for approval>> all in favor, say i. >> i. >> nancy pelosi's the minutes are approved director's report. >> good afternoon, commissioners sitting in for
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director garcia on a well deserved vacation hair director's report the first is to talk about the first cohort of interns on august 3rd dpw human resources provided a orientation the year up a national program that provides a pipeline of threatened to 2 hundred and 50 partners by matching their needs for the communities that are loyal and trained the first cohort is 9 interns working with technology managers throughout the fields services and help desk function department supplied community health epidemiology known as arcs to have a surveillance report foyer it and online we highlight the disease from hiv
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are hepatitis b and c and sftv. >> con cable disease in san francisco we hope that provides a snapshot for the population health division august authenticating is international overdose warns heroin fatalities in san francisco have declined since 2000 from hundred 20 annually to 10 annually under 2010 to 2012 the change occurred in the community partner institutional listing drug treatment and making it available for drug users as a overdose antidote the population health division in collaboration with behavorial fund the drug overdose education project called dope to district this to folks if snow and the
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community organizations that serve them in the past six to eight weeks the staff observed an increase in the what is confirmed to be a drug the reports of over dozens have been record it is important to note despite the offer dozen referral it has not been known in san francisco the physician to providers noticing them of the recorded increase in the small occurrence that concludes the director's report i'm available to answer any questions. >> well, not to the director on the director's report. >> commissioner oh, okay
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so, yes. >> thank you commissioner karshmer. >> there has been numerous articles in the paper about the epidemic outbreak not sure for the use i want to have you embellish not clear what it is the paper as facts emily heart is here to talk about this topic. >> please. please welcome. >> i'm research correspondent and the center for public research so i've been working on our opiates overdose and familiar what is happening recently in terms of the new cottages you'll see a lot of sort the offer dozen emancipation proclamation demonic for the
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prescription inventing necessarily and on the east coast a lot of the recent senior citizen necessarily outbreak overdose a few differences we were able to get some of the product tests at sf dph we don't know if this is being produced or pharmaceutical we're trying to fourth that's the difference typically on the east coast we know there is a lot of alight drugs that is traveling there the east coast cities another thing we've seen in san francisco we are overt into this epidemic sort of the increase no over dozens most recently, we
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were informed through the dope and the syringe that is different and is really a positive carrot for san francisco's effort to decrease im- you see increases in the mortality and we're seeing you know the anecdotal reporting coming through the dope project and catching it from there is more taillights anecdotally we have gentlemen, yes one person we believe that died due to the drug so we've got age isolated incident the one thing we encourage we get as itch drugs
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into the community to prevent the mortality this is a highly sat down rated area sentinel requires for opiates we're encouraging people to use more than one dose if necessary. >> one question you were with dr. coveers information i wanted to thank you it was relevant to any clinic a drug abuse clinic that helps with the community with relevant to the oxycodone has the police department been trained and adapted the ox deny protocol. >> it is rolled out through the san francisco police department and i will say that that is wonderful and also encourage people in the community to have it at well, they're the people
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that are onsite they can be one step ahead of objection done. >> i assume it is the police department that policy another typo on the third paragraph; right? i was going to ask dr. katie it seems to me if hundred and 20 deaths annually to 10 deaths annually is really quite significant we were quite concerned about the deaths with the idea of having necessarily objection available to the public in the changed program for surface do you believe this is the success it is. >> yes. i've been in contact
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with dr. koffman in my cabinet and reviewed the research it is of the that the more question implement the longer than we implement necessarily objection a great co-raegs regulation and getting the news out but this is very fluid this is a wave that is not quite clear what the market analyze it would be easier to cut necessarily objection but the dealers can get more money it is driven by the dynamics and underground market i'm happy we have an excellent surveillance unit this is complicated the use patterns
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around civic center is different from cap street and the avenues so it is a micro compliment kind of issue with regards to where it is floating about but have an excellent surveillance and the word get necessarily objection on the streets and it saves lives. >> it is a very nice report for the awareness day it looks like we're certainly at least on the right track wear a national leader very is policy in conjunction with the state legislation that is national standard i'm not sure we're the first with the needle exchange and perhaps necessarily objection but this is really standard throughout the country so many great things that start here in san francisco with our
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department so - >> well, thank you. >> any further comments if not we'll proceeded to the next item. >> general public comment i've not received any general public comment requests so we'll move on from the community health community. >> this will be brief we heard today with dr. and leslie she's the director the response team known as b e f f e r and leslie the action committee for women in prison try care response team the bottom line we apartment the question we're thinking there are commissions will ask in terms of the emergency response are we prepared quantifyly we're
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prepared as evidenced by the response to the louisiana country and ebola the department route reviews capacities that are nationally required in terms of emergency response we're providing and meeting all of those and probably beyond when you look at what they're doing within the department with regards to training all the departments public health staff for the emergency response workers and working with the hospital counseled and assistance that is very much in presence today, the spearheaded approach to emergency prepares is through dim insurance through training and exercises and multiply scenarios that are continually going on are we
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prepared and ho do we know we'll hear a more fully presentation on the boards level in october and they promise to give us that respond in a more descent way but quantifyly we feel there is great depth and the exactly part of the presentation was in regard to the patient under care in the network occurring an emergency can we take care of patients in the health network and direct response providers the answer is one/26 into 3 parts looking at the preparation of the san francisco general and laguna honda that is not put in this but preparedness in the ambulatory there shutting down a clinic and okay do we know where all the patients are and coming into staff that day and
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practicing those disaster scenarios we have the structure and processes that are being implemented in terms of the question are we prepared their planning on coming back in the october meeting to answer that more fully so again at the community level we've felt there was good progress and satisfied with those citywide preparedness and health wise preparedness. >> any questions. >> i have one in the sense that in a citywide emergency question would be whether our clinics are prepared not just for our own network but for others. >> we can ask dr. babe babe to speak those are part of the scenario training and i'd like to underscore the department of
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training all the department of public health staff to be ready both for citywide emergencies and a health network emergency we're at 50 percent the ducht has been trained hopefully to hundred percent so a full system capacity to deal with both levels i'm going to turn it over to dr. bubba. >> i was going to everybody else all the health care partners understand they can train anyone actual one the cabinets it the medical sunday morning for the entire community not only in the ambulatory network but garner all their resources to be able to serve whatever the disaster is. >> is that part of where your review going to go in terms of your review. >> we're trying to look at the
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community health care we're looking at the health network and the citywide capacities we'll hear both those in the october meeting; is that correct. >> it would be up to the commission which parts of the meeting to highlight you'll get information on all the services provided within the population and bans that information choose to highlight ones for the october meeting. >> okay. it so you would if we are having it prepared this is what you're talking about also that if that became part of an expansion and the area so we can understand how the precipitation program is coordinated here does that make sense and there are two levels one is taking care of our own patients part of our
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network your responsibility and taking care of the citywide folks the way i think the way the department has designed the flexibility of the staff to address both is really amazing not there yet i think we're still training 50 percent more of the staff but the goal is there. >> any further questions. >> okay. thank you very much and i've not received public comment for this item. >> yes. please. i have an urgent comment can i - >> does that relate to the item we're on. >> what. >> does it relate to the item we're on. >> no, it would be general public comment and oh, sure you just got here are we finished with this particular item why not take here comment at this
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point. >> i hope you'll find is ms. cross i'll put 3 minutes on the buzzer. >> do i have a half minute warning and i will do that. >> my name is are last name is nancy cross anybody that reports what is going in the city that might be an emergency takes a risk the grand jury said no whistle law for reporting things that need to be recorded but i am as a a resident of a shelter which is subject to not good health environment in terms of noise and smoking it violates the law to smoking and also i was hard of hearing all day today because having to listen
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to a leaf blower sound all night long churning air into the blast you know, we have all the hotness we have it night and day because people think that is a nice game to play on women residents in the first floor they hear it we have no benefit of anybody evaluating what's going on all day long i've had problems that leaf blower was running all night long and continued now the person responsible it the episcopal services community and within a week as i remember in the carpenter examiner to showed two sros he is the - they were found
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dead bodies most in those hotels and what was his response? he shrugged his shoulders things happen i think we need an overview of things health related in relation to this health and not other primary urgent care and hospitals for patients that get sick and ill and abused by non-overview of the environmental conditions including the loud noise of the leaf blower all night and day long for a week or 10 days >> you have ten seconds. >> i hope you can do something about it. >> our department will take into account that we've had interests in the serves of the
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sros. >> thank you for allowing me to speak. >> thank you. >> item 67 commissioners is the fiscal year 2013-2014 charity report. >> good afternoon commissioners deputy director i'm mabus i'm the new assistant director for the department of public health i'm pleased pleased to present the 2013-2014 charity care report as many of you may know the 2013 information has been detailed cue to staff changes in the office but the decisions to
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combine the information from 2013-2014 to present post analyze and we believe it made for a better report first thank you all 234reb89 we'll discuss the presentation will take 3 parts the first 20 to go over the charity ordinance i'll provide brief information and the second part will go into the charity landscape with the affordable health care act and the third part of the presentation the part we'll spend most of the time based on the finding of that track fiscal year 2013-2014 report and so first, the charity care owners it's been here since 2001 the first of its kind in the in addition the purpose to provide transparency around the charity care levels that we are seeing in the city and county and to
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allow the did you want and the community partners including the hospital to plan for different charity care needs we're noticing through the report it is defined charity care emergency in and outpatient medical care for those who can't afford to pay along those lines to requirements the first having to do specifically with the hospital and the second a joint requirement between the department of public health and the hospitals themselves so the first requirement has to do with with maurnt patients to be notified and they do so first verbally and also a requirement to have notifications in various areas of the hospital novelist the parnlt of the eligibility requirements for them
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the second requirement has nothing to do with with reporting every year the hospitals in san francisco provide charity care data to us and the department of public health then in turn analysiss the data with a report for the charity care trends reporting purposes 78 reporting hospitals for the charity care ordinance and they fall into 2 main categories mandatory health 360 are required by ordinance to provide information to the department of public health and volunteer hospitals those would do so volunteering on the slide the volunteer hospitals are notified after kaiser and sf g h and another one providing the analysis for the charity care report oh, and one important thing to
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note all the hospitals whether mandatory of volunteer provide the same information no difference between the information and the mandatory volunteer is simply for reporting the next thing that is important to know the actual charity care reports that the hospitals have within tare buildings so as you can see the state law delineated by the red line the hospitals provide information below 50 percent of the hospitals the hospitals meet or exceed this requirement against it back drop we've talked about the charity care ordinance and the reporting hospitals i wanted to also all the main findings that will go go depth we're talking about the first has nothing to do with with the decline in the number of charity care patients the
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next healthy san francisco and traditional paperwork the next findings with the variations among the reporting hospital the next has nothing to do with with the medi-cal shawls with the city and county and the last has to do with charity care paperwork and the residential partners that remain thinking chaunld i changed from 2013-2014. >> this slide notes the number of charity patient from fiscal year 2009 to 20142009 was the first year the data was separated from healthy san francisco patients and traditional charity care patients just to be clear the healthy san francisco patients are within the program whereas the charity patients back in the charity care programs run by the hospitals themselves as you can
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see that with and an there's in the healthy san francisco patient the blue line a decrease in the charity patients that soifz a shift between traditional care and healthy san francisco as the healthy san francisco we're gaining momentum and popularity among the insured's the number of patients seeking the care increased over time the timeline you notice has nothing to do with with ac a related information as you may know the ac a was signed into law in 2010 so 2013 san francisco engaged in a rigorous effort to enroll as many folks as possible into the new health care programs as possible as you
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can see the circle delineates the shift from 2013 to 2014 and with the healthy san francisco patients the blue line as you can see a significant decrease the first time in the history of the report if 61 thousand to 51 thousand 10 thousand less patients for the traditional charity skewer patients the decrease is much less significant 3 thousand patient and the decrease was note before the affordable health care act taken together ann and overall a decrease in the total number of schirt care patient if 2013-2014 from hundred 10 charity care painter in fiscal year all in favor? > i. > to 97 thousand in fiscal year 2014 that prediction that the city and county had for the successful enrollment to
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decrease the demand for charity care actually rang true this graph shows fiscal year 2009 to 2014 but it tracks the actual expenditures and so for the blue line the healthy san francisco patient as you can see that the expenditures kind of track the number of patients we've been noticing over time with an increase in the fabulous number of patient a steady increase in the expenditures associated with that group if 2013 to 2014 a shafrp decline this san francisco patient a sharp decline in the expenditures associated with that group that's what you'll expect to happen as many uninsured patients frathd i anything congratulated away from 2013 we
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saw a co-responding interests in the amateur expenditures the history is not clear if you'll notice in the previous slide in terms of the number charity care patients the overall number was decreasing over time the impact of the ac a on the charity group is less attributable to the affordable health care act as you can see here the expenditures as commissioner chow rightly appointment have remained flat over time the considers in the amount of expenditures in 2014 and an increase in 2014 but the increase button them compatible to previous years it is unclear with the trends actually represents at first, we thought perhaps the understated line with regards to expenditures along with the decrease if the
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number of patients said something about the patient less health needs or status worsened commissioner chow asked us to understand the relationship with between the expenditures and patient no evidence that alluded to the health status worsening or their health needs more complex more information is needed to understand what the trends are but the future charity care reports will note that now we've talked about a little bit about the overall charity care patients and he expenditures i thought i'll provide information about the actual patients themselves as you can see in terms of the expenditures for charity care patients adjusting for inflation the charity patients has
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remained flat and decreased in fiscal year 2012 to 2014 and in terms of the charity care patients how their assessing the charity care system as you can see the overwhelming number of patients assess the system throw out patient services emergency care patients have a sixth role to play as you might expect charity care reports outlines the data across 3 points the first is the overall what was the experience for 2013-2014 overall and the next data point has nothing to do with with healthy san francisco and traditional charity care and then the last has nothing to do with with the hospital specific trends that we saw after analyzing the data provided to us what we saw there was really
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not a clear hospital specific trend in 2013 to 2014 that applies to all the hospitals non-uniform changes from fiscal year 2013-2014 i had a hospital meeting with many of the hospital representatives in attendance today it was noted the city and county excuse me. very unique transition period that transition period and how unique for every hospital b will lead to the results we're seeing some of the factors that might lead to the result would be the geographic location of the hospital, patient migration patterns and the various insurance enrollment programs that each hospital has one of the measures that we looked at was expenditures by hospital as you can see you know this tracks from fiscal year
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2010 to 2014 as you can see before the arching a a slight variance for hospitals in terms of their actual expenditures from 2013 to 20145 hospitals got a st. luke's oar st. francis and as far as i am concerned and sf g h kaiser and chinese and ucsf actually experienced increases in charity care expenditures that is the kind of various in the data and one thing to note we've decided in the community meeting worth noting the hospital reporting periods are not uniform some hospitals report to us on a fiscal year from july to june and some hospitals report on a calendar year into january to december as you can see in the slide the hospitals with the asterisk they
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denote the actual hospitals that are reporting on a fiscal year so the hospital timelines in terms of the fiscal year years don't exactly match up as you can see within that group the calendar hospitals at the top and the fiscal year hospitals at the bottom there is variance variation as well could lead to that is not necessarily the reporting period but the specific hospital characters that will effect the type of charity care expenditures that a hospital might see from year to year. >> this graph shows the actual medi-cal shortfall and the charity care expenditures one thing that is very important for all the hospitals in the city and county are medi-cal shortfalls maine the difference between the cost of providing a particular service for a
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medi-cal patient and the actual reimbursement as you can see there is also variation in terms of the hospitals experiences the report as requested by commissioner king details from 2010 to 2014 but for read ability purposes cutdown it down for 2013-2014 for that substantive so you can see the trends taken together across the 8 hospitals as you can see that there was a decrease in the amount of charity care expenditures to the tune of about $21 million but an increase in the medi-cal shortfall over that by about 3 times 63 million dollars looking back in time those changes were the most significant we've seen in the data. >> is that for all the calendar year for suffusions over and over the bryan graph. >> i'm sorry, i should have
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denoted the fiscal year the four hospitals on the bottom are reporting fiscal year sorry about that. >> the charity care owners requires the hospitals to provide zip code information an important measure it allows us to track the traditional charity care trends over time and what we saw in looking at the information the residential patterns of the traditional charity care patient doesn't change 6, 9, 10 and 11 contribute to the landscape in the city and county and those districts are areas we might focus our efforts with regards to the uninsured and loovktd the data we found the traditional charity care pool may consist of in the new health era new san
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franciscans 20 percent to 76 in 2014 a disinterests performers of out of the county due to other counties robust ac a enrollments efforts as well less of out of community residents and a consistent population of homeless 10 to 12 percent and out of state 12 percent consistent over time so taken together in terms of the data analysis we had looked at 0 for the charity report a few conclusions and important points stand out the first one the a. ac a has an important change with the great success in intraoral folks in covered california the proposition of the uninsured has decreased we
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expect a less of a demand in charity care we say this overall the second point it the general it continues to provide and likely continues to provide if the health care era the significant moumg of charity care and significant amount of expenditures 70 percent is the general number that we have notice over time and expect that to continue the third is maybe the most important point in the whole presentation that is to say that there is going to be a continued need for charity care programs and the safety net services in the studied the first thing the doctor and demand for charity sincere a testament to the ac a enrollments we're seeing over that time but also a significant pocket continue 35 and 40 thousand people in san francisco who will continue to remain
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uninsured and need charity care services at the same time the decrease in demand for charity care loss give us an opportunity to think about medi-cal and charity care and community benefit all work together to maintain the safety net to the betterment of the health care system as a whole in the city and encourages us to think more effectively about the partnerships we have between dpw and the hospitals and others community partners and the partnerships can be maintained and improved and the last point has nothing to do with with the charity care patients as noted the decline in the number of patient was not significant for the charity care patients as for the healthy san francisco patients and the cinches over time don't really note a pattern that we can really rely on as
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noting the ac a impact for that group we thought might happen with that group didn't they might not have as much access to the ac a insurance and the healthy san francisco the healthy san francisco programs is on model after the care the folks maybe more familiar with the kind of health insurance that be available to them in 2014 that might be playing a little bit of a role and the residential locations their speaking has been consistent over time i want to first thank the commissioners for the opportunity to present this information and the flexibility 2, 3, 4 combining the two years worth of data i also want to thank my colleagues in the office of health and planning
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colleen this would not have happened without her and lizzie and all the hospital representatives that worked with me to complete this report and answered all my questions and made themselves available to complete this report many of them are in attendance in the audience as well. >> commissioners several public comments we'll take and go on to the discussions first of course want to thank you for the care that you've taken in this report with the response to the committee and questions and the ability to give us a real in favor of how the trend has gone frankly all the way back to a wonderful what? 2010 on. >> yes. thank you. >> we'll have further discussion and precede with public comment at this point i will first call 3 names if you
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will be prepared and after that several others so we'll begin with yes, ma'am. >> please note when you are time is up. >> raise our microphone so everyone can hear. >> is that better. >> i'm emily webb the director of the health programs at camtc i want to speak about this ordinance it was passed 14 years ago and the first of its kind in collecting data like this we're happy to have provided data since the ordinance was passed several notices have schangdz
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both state and federal government have the affordable health care act which ear experiencing a shift if medi-cal to medi-cal from charity care and healthy san francisco has been implemented so certainly c pmc to collecting data we can use and leverage the data that is provide he state and federal level to make changes for this population rather than continuing to collect data that is onerous for the hospitals and recorded in other areas we'll to ask the commission to have dpw work with the hospitals to a come up with an ordinance to make it more use full in
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improving the health of this population thank you. >> thank you. >> good afternoon commissioner cut me off if i go past. >> you get 3. >> oh. >> kaiser permanente as many of you may know in the reports we're a volunteer reporter we're unique combination of health plan, medical group and hospitals we participate and have from the beginning we believe in the purpose of this as mabus stated to improve the coordination understanding and- but the most important part mabus highlighted about the affordable health care act it changed the entire landscape of how this activity is recorded it didn't just reduce the number of charity group patient addresses
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the expenditures that unified something bigger than providing treatment for disease it emphasized community wellness this is the benefit and as we've talked about over the years charity care is in the middle and that's where i think this commission needs to focus what are the hospitals doing not only to provide care and treatment for the poor but prevent the need for that treatment to keep people healthy kaiser wants to join with the other hospitals and study over the next couple of months and coming up come back with a different way of reporting our community benefits thank you. >> thank you. >> good afternoon commissioners ash i didn't st. francis and one
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of the original members of the charity care task force and so we've been at this for 15 years and had a hallmark report they're anticipating with the shift of charity care and some of it a large dose the medi-cal shortfalls the hospitals are experiencing the diagram was drawn casting charity care as one of the benefits but other programs that hospitals do to provide community benefits and it is our thinking at this point we do need to rethink charity care in the new world order and the public-private relationship for the care of san francisco we urge the commission to direct staff to really help us find a
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new way of doing this this is a good time halfway through the assessment to informs the hospital master plan and the healthy plan and the community health improvement partnerships if we look at this as an opportunity with the community health partnership in play an important role i think our timing is spot on if he think about how we everything have the convergence of activity to help the san franciscans. >> thank you our next two speakers is mr. david caesar wall and barry from cedars. >> well president and honorable members i'm with the council of northern california san francisco office here to under the influence the points being made by the directors the
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experts to thank staff in generating this i'll have report it hieflts the crucial role that the note for profit hospitals play and highlights the need now we look back analysis how to better utilize this data and think about how to bring alignment with the goal of improving the equality of charity care, the reimbursement question and the on the challenges the hospital council will like to ask that the commission direct staff to deem it as you see fit and interested parties meeting with the hospitals and have that dialogue and report back to you whatever you deem 6 months operate or so
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thank you very much. >> good afternoon commissioner i'm barry the director of community health clinics at as far as i am concerned in san francisco i want to thank mabus and colleen and lucy for the pleasure of working with them it is of the in the posted report we saw in the web site i want to add my voice you consider requesting us to work six months with the did you want to explore information that is already required as residents of the new emerging california requirements after the affordable health care act what mabus alluded to the identification of concern
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populations that have not made the transition in the affordable health care act and what opportunities there would be for co-care management and chronic diseases and more collaboration referring to the doughnut for the charity care many years ago when you commissioners piloted and that's my point and thank you for hearing me today. >> can i ask a request about the ash pod requirements i know that medicare and medicaid. >> if you can describe the ash pod requirements but we'll go over that again. >> the actual requirements related to charity care and actually community benefit overlap in different ways two
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the local is state and federal and the appendix but i will go over that and see the first hfa has nothing to do with to with the actual community benefits requirement which entities and where do they have to report their communities benefit requirement and they do that at the state legal of level that is ash pod and at the federal level as well. >> so it is state ash pod is collecting the data got it. >> yes. >> as opposed to the medicaid, medi-cal. >> ash pod is the extra agency that collects the benefit and charity care requirements in terms of the actual reporting of the actual charity care levels that happens here locally introduce our charity care ordinance and through federally through form 990 schedule h those requirements are new ones for the hospital and has to
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report the actual levels of charity care provides there is differences between the federal government and what we require locally the local owners is a bit more robust in terms of breaking down services into in patient and outpatient and emergency and also the report at the federal level does not require hospitals to note the number of people that were served in the schirt care program the amount of people is optimal. >> that's the cms. >> i believe under the irs. >> the irs. >> form 990. >> yeah. part of government does talk about talk to the right maybe they do. >> and before we precede i thought that since also
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everybody has brought into the conversation it would be good to recollect where this came in from thank you, again, for the report you highlighted this is a fine report the attachments are so valuable it helps to table for us and prepares prepares for any future dialogue what the landscape is in terms of the reporting for the various entities i want to thank staff for working it has to have been very difficult the ordinance is in there and this couldn't have been prepared without the help of the entire hospital council communities not only from the mandatory side that submits data but not anywhere as valuable
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without the benefit side as complete a picture as the county can have the reason that charity care reports started from this commission and from the board of supervisors to be sure there is value to a nonprofit status that would have to be part of the work that would be done in terms of relooking what charity reporting is because the base was not just charity care with you and later nationally that has been a federal issue at the federal level of the value of nonprofits and what value there there is back to the community we heard thoughts not only to look at the value and took several years to get the even playing field what numbers complaisance we went through a
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lot of dialogue whether or not the t ls look the same and use the same definition that was important to realize as the speakers have said charity care was much more important than just simply the dollars for awe execute care second year illsness and recognize at a community benefit at least the programs that hospitals were engaging in that were true community benefit could be highlighted within the report to have a broader implementation what were the dollar values if instead we were asking for operational versus emergency room care that's an added prospective to the reason why
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there is a segment trying to sdrab all the facilities and what they're doing to the idea then of looking further for the last several years can do we do as the world has changed and clearly that demonstrates there were impacts upon charity care from the affordable health care act and the need to then refresh this and see what values i'm pleased i think all the speakers spoke to the needs to have value out of the report for something accountable it is accountable i believe also it is important then if we look at the core there is to remain as the data shows a block of patients that does not access the ac a
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programs and that question will have an obligation to take care of so that cannot be forgotten within a prospective we should have our discussions as to what we ohio this is very much an ordinance that has been a very much part of trying to make it valuable and not just a trade off for property values from the contingency so i think after the commission standpoint historically can see how we would want to help to shape this to be more value able to the city ask the acting director if she has comments thank you for
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this report. >> i have like you, you commissioner chow one of the pictures first people to work on this it has gone through a lot of evolution as mabus noted in the report a significant impact the ac a has had with charity care it provided a good opportunities to talk more holistically about the community benefit how we can best use hospital resources, community benefit resources, dpw resources to better the health of the population that is the intent of the sf hip to look at the intersection all our missions to fourth how to improve the populations health this dialogue can happen. >> commissioners comments. >> commissioner pating. >> i want to say first thanks
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to the department and ma vice and others and lucy for a wonderful diagram good job. >> thank our hospitals for the hundred and $80 million less than $2 million last year is not a small amount the contributions to the hospitals that are making to the communities is both good and necessary and when i look across how refund our healthy san francisco initiative we just basically gave a stamp of approval at the last meeting a large part if not the bulk based on charity care to make that system work our hopeless systems in providing this charity is really providing good service to this with that said, parts of reports the second part not quite sure though to evaluate a
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number of patients the zip coaxes code and what we're looking at in this report effectiveness certain it's decreased i'm interested in a global approach to the community health and benefits with the charity contributions is it adequate to meet the needs of the community is it fair and equal is the reporting confusing to the hospital constituents i think we should look at making it expedite i'll be in favor of a task force or director has suggested might be feasible to look at a framework of reporting, look at a system of
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goals for this reporting i like interfacing the goals we know that charity will meet the population health goals we want and coming back and perhaps 6 months and giving us some recommendations rather than changing the ordinance study it for right now under the changes and realizing this is important i think reporting is a mechanic thing simplifying it and make sure that charity care is virtually and effective. >> those are my comments. >> commissioner. >> thank you for this this is dense a lot of information i have a lot of questions you've done more thinking about this this issue it is the same - so about the same number of people that receive the care from the 5 years ago as today; is that correct so the numbers have been
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flat and the locations is the same. >> right. >> so that per police vehicles me this in fact the comment about the impact we're having if we're consistently okay. we have more people they're the number of people coming from the same location praepz perhaps they need to been this public-private partnership and think about not just the amount of care not just the dollars and the number we serve but what do we do to look at the outcomes because that seems to be perplexing to me. >> you're correct in stating that over time we've had some fluctuations in the number of patients and the expenditures you you know the same 4 districts over time have transcribed most to the charity
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care landscape in the city and you know the attachment for the awe preparation at the ends has neighborhood profiles which give position about the different neighborhoods within each district and the mediums household income for the district we're seeing the multiple charity care responds to the lowest medium household income over time because those districts are continuingly representing the areas in the community i think it is try that the those same districts contribute the most no matter how the patients are fluctuated over time that will continue to be i think is good way for us to understand from a strategic parking space stand point where we modestly might focus to
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change the dynamics to lift those district out of the situations they're in that led to the continuous representation. >> it is almost like a stable population from those continued areas. >> we think about are we looking at this with the efforts to really looking at how do we have new path not impact overall but there. >> very good thank you. >> so i think i want to follow what commissioner karshmer just mentioned you know like if we just like play that through you know if this is really where you know some of the most poverty stricken contingency that supposed to be our responsibility we need a different kind of plan i think
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that through all our partners they also have you know mentioned similar suggestions about you know trying to taking into account what it means as we move forward with the charity care i think this is y where f it gets interesting so if they're really you know like assessing they resource full to assess the services but but at the same time, they self-sign up for you know like our haeblth plan and didn't like enroll in medi-cal extensions so that question is the big question for me you know why and why not and interested in the language barrier is it you know like other factors in place and then the last thing that appears i think that assessing the charity
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care episode preventable have we done anything to like help them to improve their health so that they could watch for signs and good to a clinic rather than you know getting them to a hospital you know i don't think that i have the answer i don't think that any of us have the answers keep asking those questions that goes to goes beyond the charity care what was created for i think this is time to put up a task force i'm not sure a six months task force would be adequate to come up with that but i think you know added assessment that we need to do so i don't have a clear solution i think that you know in the
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interest of like looking for that pattern i recommend at least doing the current reporting for another year by then we'll have another enrollment period and you know we'll have a better sense of last week two is left behind. >> right. >> commissioner sanchez. >> yes. thank you. i will just like to say it was an exceptional presentation and a communities inclusive presentation roughly 13 or 14 years ago the dialogue was my turf your turf my data your data the first couple of years ago it was sort of a shake down crew with exchange of information
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what were the outcomes and the penalties and not and here we sit and listen to those report and look at the data presented it is exceptional the fact that there is a safety net in the city that involves the totally o totality of our institutions and many of the colleagues in the hospitals are as frustrated as anyone when our involved in health care you're involved with the quality of care the treatment and diagnoses a follow-up and so many oversight and everybody is reporting on everyone and we want this data this year and not that data next year you have the accreditation and licensing and you name it the state and federal and everybody is asking
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for information i think everything is asking today after 15 years or 14 years we could have even additional discussions and sort of a review of are interest factors here that are common we can save dpupgs e to integrate the data it focuses on the mission of this ordinance i really know that people could do it i mean you've done it this far it could make a difference the other thing there are so many variables but all of us know there is so many changes today in the zip code areas that report then, now and 5 years from now we're going to have a center the excellence of
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germantology at st. luke's we look at the senior population in the city significant pockets everywhere and cuts in services and increases and transportation is more limited therefore you know is - are the participants the same cohort or other variants when this was started many, many families moved into those areas that utilized the services and programs yet today newer families in many newer with young children whatever and caregivers that are taking care of households with the community from the east bay and can't afford to live in the city or get services from the programs alls variables are ongoing in the city and this group her is an oufrn group twenty-four hours
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a day and for those who work here he think that this body and our colleagues here could really make a unique tricks a greater contribution if we look at the day wow. sf sustainability that is the only service goes back many, many years but other times many institutions that stand above where st. luke's or attorneys or ucsf based the needs the population is shifting all over the city more delancey streets more on the waterfront are in the excelsior with different populations so it's exciting change is exciting we have a responsibility and believe me the group that worked
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on this and the leadership has provided an excellent, excellent dialogue and trust trust and excellence in professionalism in; right? and listening and coming together to create those pathways i look forward to further discussion and the time factors are months or six months but ongoing i look forward to creative paychecks where we can insure the charity cares or whatever the definition provides quality health care and you name it to the ending time with the respect for all the patients whether the folks at laguna honda or c pmc thank you all for hanging in there and making a
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unique difference if the quality of life in the city carry on. >> commissioner singer. >> yeah. thank you for the report it's a pleasure to hear it again in this broader setting thank you to the community and all organizations that have been involved it is super important what the first few sentences of the first ordinance it is our responsibility to deliver this care and understand that. >> i'm sensitive to the report issue that has come up the hospitals make a reasonable case as commissioner sanchez just noted in terms of the myriad perplex rules they have to live by and obtain i want - we have to put the horse before the cart
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on this i apologize if i have a myopics view it is important for charity care for san franciscans and that comes from me before reporting and so i think the first issue for the department to sort out before you yes, ma'am panel any group to fourth how to do that fourth wasn't data you need to make good judgements how health care is delivered what will end up in a large group you'll get busted what is easier and more convenient not our mission our mission to get the data under this origin to get the right data to make the best policy
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decisions and once the department has that then it is really appropriate to sit down with all the stakeholders and go eject in a perfect world this is the data we want and what data can you provide. >> what works and then work on compromises i'd like to hear a presentation this is the data to improve upon the dictated we've learned over 15 years some of the stuff we've gotten is not relevant but this is relevant because as i read this report i can't come to any of the conclusions that the report comes to personally the data is not- this is big deal been massive changes in what's going on in health care and overlaying that are magnificent changes in the fabric of the city
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you also have institutions moving neighborhoods in the coming years and i have different time periods you compare in the middle of this fluctuation fluke so we have to be careful about the conclusions until we get normalized more material that is more relevant i'll give you an example tends we talk about the time periods but at the end you have the district profiles in 2012 so let's say it was 2011 since this data it was probably 2010 so the idea that the population of the mid market area is the same is going to be the same in 2015 and 9025 and we know that
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will change we're struggling with the implications but it has changed unless our department understands the changes and builds on top of them the system is not treating people where we are for the realties of the future the first thing to figure out what we want to measure and fourth okay. what's the easier way to do it if there is one. >> that's an important point making sure the data wear relying on is something we can rely on in the future and the policies we're making now we'll have to live with in the future to have an opportunity to make sure our policies are catching
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i'm sensitive to that and colleen is as well district profile we tried to find information that of more current that identified the information by district with you the the recent information we found organized was from 2012 i am self-evident is that it is an important point colleen and i are committed p to work together to make sure that the information we provide pow to you is relevant not only for us but the entire city. >> it is completely fair yogi bear said prediction is hard especially about the future it is difficult but you have the courage to give it a try and definitely. >> i think in the conversation which as far i've been able to
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glean you are commission will like to make that a relevant exercise and beyond an exercise that is accountabtionablactiona. really the kind of overshadow by this fact a definite change in the pattern the reports showed that essentially the number of people under the definition of charity care remains fairly stable over the 5 years whether there's in lieutenant governor san francisco or not when you add it up it move forward 10 thousand count that's all there's a block of people and this block seems it is in the geographic areas even though the geographic areas some of them may change but i think
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commissioner singers point with the right data remembered we were still doing programs for communities that are no longer there and spending a lot of forecast when, in fact, new needs arising that issue of trying to begin as yourselves have said is we're not quite sure of who is in the block it seems stable but commissioner karshmer and commissioner chow somehow those people are still in the areas and not all of them are changing and the prospective you've added is a nice 5 years we have to know about that group and what do we do about that group the report shows that the people are still living there and still uninsured whether there are in healthy san
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francisco or not we know the whole block of people that couldn't afford the insurance or insurance and ac a is helping at least we're playing out the scenario for another year the way it is while we're doing the study not dropping it we don't want to as imperfect as it is what is pertinent data and now the hospitals are coming together with the needs assessment we combine with our hip program and that's a prospective to say where could we go as commissioner sanchez said for the future and take into consideration certain areas are changing certain things are constant and we're still
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spending this amount of money with this block of patients with charity care it is good money we're getting and it is values we find from your hospital communities both volunteer and no non-volunteer but now we want to also see where else we should be going but inside the right data whether we want to ultimately have a broader conversation i do think we need the departments to first get the information together and bring it back to us what a plan might be and not charging off with the plan as far as we again continuing to use your uphill relationships or expand it for this particular period with an objective to look at a new vision for both charity
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care and community benefits that benefit our community but, of course, based on data and so is isn't the data is going away we can only draw gross conclusions if so hard to go to the hospitals and find out what is down i appreciate st. luke's they said they dropped and this was the ends of charity care that was a shame we lost a substitute unit but that will probably planning explain a large amount of money that is the problem with this data is is very hard it beyond the gross things we can't draw so i'd like to hear the departments reaction was it
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might think and the timeframe and have a game plan >> i have a quick question it sounds like you were saying let's keep the same system for this year. >> we've got to- we only have half the years reporting. >> i imagine. >> it maybe greater. >> i can see we end up doing both if you study it this year you'll not change the tire in mid-year but keep this year the same and the departments comes back we all want the same thing for the bitter quality of care i have questions b around fairness and equality but i don't know if as well as effective contributions i hope those can
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be added in so am i hearing you correcting task force are you president this to go away and come back with a house they'll handle it at the next meeting. >> question have to keep the same to finish off the half year we lived have half year of ac a influence and to have the data we have good historical data this will allow us to continue and same thing continue - it will take a while to come up your analogy if we have no tires to the tires poor as they may be get us further information while we're working on the new client. >> buying the new car. >> we all need all the hospitals to be on board and we
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can't just you know suddenly have a hiatus so to understand it would be a shame to suddenly have a whole limit essential this is only a half year influence on the ac a on some of the facilities so - >> we're looking for 2016 implementation and, yes, that is true like all the mr. larkin and the it work we have to build the infrastructure before you brown before we go out and have the program so. >> to answer our question to staff how would we estate this. >> you know it is your touts would it be reasonable to come back with the plan in two or three months to try to you know remodel this to our new needs. >> certainly we heard the comments of the commission here
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and the desire for the commission we can come back with a plan in 3 months how we would devise a plan what data is useful and why we think it is useful and what kinds of changes to do that other thing i would say i agree with you should continue the reports as we do this we can do those things krurlg and not have a gap. >> we're under the obligation of the ordinance to do that until we can explain how we can fit it in a different role for the ordinance we have to foreperson follow through with the ordinances passed by the city. >> what's the next step when you said the direction you want to go. >> i heard some commissioners
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saying they like us to take into account what data elements are necessary we can take a deeper look within dpw to see what the provided at the federal level and state level and what is provided here and what data to plan moving forward and we can have that conversation with the hospitals and come back with a timeline does that sound reasonable. >> commissioner do you have a comment. >> my comment to really ask the hospital partners to have the patience with that extra work in order to you know get the data for the report i think in the long run i'm pretty optimistic we have now multiple sets of data that can go back to the a.k.a. so if we have another set of data it will help us you know
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to help a full and more complete story how the charity care of the city has changed only other thing i want to add the data is one element of the conversation the data is just what is recorded to the charity care but queer having a larger conversation i heard the commission chiming in a larger conversation about the community benefits and the overall value that the nonprofit hospitals provide for the community so that has to be part of the conversation. >> yes. absolutely any further questions. >> i was wondering going on officially thinking those are tricks like the contribution we received at the san francisco general so we're getting care
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for - in exchange for many other things but a community contribution. >> we i believe expressed our thanks and first of all, our understanding at least the gross data and our thanks that is an important participation on the part of all that the hospitals play for us i think we've said that before the public-private partnership and the delivery of care in this city is absolutely necessary the city can't do it alone we're grateful for the contribution and the participation of the hospitals in p the development programs thank you to the hospitals and thank you to our staff. >> thank you. >> thank you. >> other comments no other public comments more this. >> can we go on to the next
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item we thank all the hospital personnel for coming here. >> the next is the ebola update. >> all right. good evening 0 i'm the director the emergency precipitation branch i want to start out with a brief overview i'll talk about the ebola the partners in general is presenting for the precipitation efforts i'll be joined by dr. carla the director for the prevention and has done most of
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her unit has done the monitoring we'll start with the precipitation and go to the actions around ebola. >> so this slide denot the outbreak situation in west afghanistan we have to countries from both the countries are over 17 thousand liberia in a cyst category about may had no case of ebola for a couple of months i'd like they were going to contrary and unfortunately towards the mid june one case that ended up having 5 contacts so unfortunately, a couple of deaths back up not having widespread transition but overall they've had over 10
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thousand cases and reporting one thirds of the total cases have an outbreak this is a graphic to visualize what the outbreak looks like this was so much reporting and continues to be the visual the virtual of the out break as you can see you know mark 23472014 there was the first notification for ebola but really the caseload starred to increase towards august and september and paekdz accept in fairly known in the december times and as we move out into the spring the outbreak containment has worked in those countries both improved infrastructure in the countries as well as cdc and the international community
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providing some of their capacities to the 3 different countries the rest the graphic is about cd cs resistance internationally but how does that effect obvious locally well in november when the - well, actually tends of november cd c turned to monitoring for all people coming from the effected countries and there is still travel not a band but travel issues with the recognition to avoid non-essential travel all the people are going to 5 airports wear getting screened pea what this first started again, this was in reaction to what happened in dallas that was a lot of panicking around the missteps talking about e pe the cases spread to local nurses in
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that hospital and because of all that i think that our health care system and the public health care system has to ramp up the process to make sure we're protecting health issues as well as providing family care it gets lost the real dowel is any returning travelers they got care and presented with a disease that had had more symptoms so this was kind of where we activated at the height of the activation as you can see this was all for planning the actual monitoring happened i think in mid-november when it was initially kwaftsd the response for the response so we activated our entire cd c and in
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light of the planned sections they're responsible for collecting the data as well as forecasting the needs and forecasting the objectives in the pink is the operation section they did all the planning the people that do in the response metrological ice cream section they get the it staff the p p d the personal precipitation equipment there was their responsibility and they basically monitored the resident. >> and this comes out of a framework by the cd c because emergency precipitation didn't have tends to be unique events it is difficult to plan for a hypothetical so cd c and synthesis coyote with 9 health preparedness side and the
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hospital precipitation program 8 capacities as a system we need to base this new disaster that faces us we're able to respondent those are broad-based capabilities to work with the vulnerable population how to treat them and make sure their health is maintained in a disaster and so forth so for this response we basically and unfortunately, the community preparedness, i.e., looked at the expects we had to put both reaction and this was the response and pressure and sensitivity was a great way to test the system. >> the other they know with ebola was there was a lot of
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partnerships and work at the local and communities level but at the state level we closely worked with the dpw we're the lead agency in san francisco that meant any kind of ebola the questions came to us we acted as despite if sfo and animal care controls all those eligibility were engaged or asked by us to be engaged in they're planning we were involved in a number of protocols i have to highlight here vicky wells our health leader in that section did an extraordinarily amount of work working with the agency to make sure their protective equipment was okay within the department
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and throughout the city. >> to switch d oc it activated over a hundred people between october and february of last year to this year and that alone offers a wonderful training opportunity people started to realize how the command structure was done and the training was utility and starting to work with a problem we didn't have a lot of plans around to highlight some of the things that occurred the information graph puts out information for ebola a large amount of work providing the accuse for the community and making sure they got translated and working with the communities organizations that had questions he even doing some work around
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cigarette ma people coming out of west african they also the medical part of the information grants was responsible for putting out health advisory and the health branch provides information the branch is where the work. >>was not just planning but implementation so developing of protocols and implemented in mid-november as soon as people came back into the country that was part of the isolation and quadrant thank you has to occur potential we need an isolation team environmental health that was a while back but what to do with this we're hearing cities are spending millions of getting
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contractor and they worked closely within the city to insure that the public contracts are if place and the check list to make sure that is okay. if is cases come here we get it under control and finally, the medical branch did a lot of work with the hospitals the hospitals faced as enormous task they do this on a regular basis but a completely different scenario with a scomplaktd personal protective equipment so i'll training all the front line staff to do what ebola once you get a positive screen with something not only the out patients they have fever or they have to at an you'll talk about it in a later slide and so that was i know where the
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bulk of the response analytic we're still preparing for ebola and ronald to ebola still travelers that we're monitoring and the doctor will talk about that but we've cut down a smaller team to insure that my ongoing objectives are pushed forward and we're making process we've discuss monitoring issues and identify the gaps and the biggest thing we're prepared to activate we've not had any ebola cases in san francisco but if we're suspicious we have to activate it is important that most is of the people that are working on ebola have returned to their normal day to day work second thing we're trying to do is develop a process anytime you have a disaster or emergency it
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ends up being a complex case because of the agencies and partners involved to really now that we're a few months out of the need of the responses we not to step back internally so we're all think the on the same page we review okay. we think this is what should happen i've been everything that you think happen explicit but working from the same framework helps we continue to update our partners on the ongoing working group which are part of the hospital providers and we continue to work closely with the hospitals i want to segue into the work we've done p with hospitals ebola has a 3 tier system a basic front line hospital, there's an assessment
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and treatment hospital san francisco does have a treatment it is ucsf mount zion and it was visited in the early part of informative to do a thorough plan for the treatments process they continue to practice they are respond sibd our health care partner that couldn't be here unfortunately did a lot of work with the other hospitals gone out to how's hospitals and assess it and i read back the question is when i say assure if they have identified gaps it's been difficult to fill she's made sure that the public health whether communication issues e.r. ems issues whatever we can come together as a team to make sure that everybody is able to
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respond in a capacity so all the hospitals were involved including the san francisco va they adhere to different standards and but they've been a wonderful partner and always wanted to be included as part of the hospital family in san francisco i'm actually i am sorry to dr. here on behalf of the project sponsor to talk about some of the ground work that is happening in san francisco >> thank you so i'm dr. co-sponsor are the director of customable diseases it is my pleased to talk about the monitoring work since october i realized it is a year we've been monitoring the travelers it is amazing when he started the incorporating we had to ramp up it was announced by cds c and we had to get started done in the context of the cd c
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but since then we've rolled the monitoring into the day to day work of the comparable it is done by line staff it is appropriate part of the ongoing work at this point so we've at the time those slides were pit together we have monitored a.d. travelers from ebola effected countries again we've received notification we do an in take to assess their level of risk the rapport that is done by phone and daily monitoring that takes place for a 21 day period the incubation periods for ebola done by phone number or whatever the person's risk levels at this time it is done by the public health their
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speaking with the travelers daily and have great rapport with them something to note as was mentioned really non-essential travel to those areas the folks we're monitoring have gone interest for work in many cases to serve a abate people or work for the state department that type of thing and very value the work they do and feel we want to support it by doing the monitoring so for all of us it has meaning and so really the goal of monitoring as mentioned to make sure that if someone does develop symptoms that potentially be symptoms of ebola they'll receive evaluation in a controlled and safeway we're in
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touch with them we'll catch it earlier and they'll get in touch with us early none the transfers to california you know hundreds of travelers to this state and nun have been diagnosed with ebola you'll know that but this work continues to happen 7 days a week and you know we're available to deal with any concerns that may come up twenty-four hours a day. >> this is the final slide of the presentation just some take home points if the ebola response and kind of i guess you could say our ongoing work in relations to this threat that seems to be awe boyd the cased
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continue to occur but monitoring has you know not yet been appropriate to relax the moshts that is going around we remain rea ready to activate and really i think the key point is that our precipitation and response activities over the last month's have really helped us to build capacity and identify areas for future communicable disease most if not all of what we've learned is you know the lessons are translateable and been helpful i'll stop here and i'll be happy to answer any questions. >> commissioners. >> was there any public comment. >> no public comment requests for this item. >> commissioners.
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>> commissioner singer. >> thank you you guys for your effort when you don't get a case none writes about it in the newspapers that's fine but i want to thank you. i think everyone up here feels the same way i hope if continues. >> commissioner karshmer. >> thank you for all the work and to date it is timely they're not not recorded my mother cases of ebola you know that like terrific and i'm curious you know like what we can learner if in terms of like how they continue to get to this point. >> yeah. >> so you know it is
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interesting but in many ways it is not - there are not foreign concepts for all of us in many areas i think what has allowed the epidemic to come through control actively a kind of grassroots plan work in rigorous isolation of exploded people of exposed people who the contacts are and if their contacted and ill they're identified as well as obviously you know investments in the immediate and then kind of more i don't know what you say investments in the health care but i actually a lot of it you know seems to be
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public health i've noticed over the most and partly it is a little bit more controlable you can you know get a better sense of what is going on you hear there are such and such many contacts under monitoring you know this conducted their monitoring periods there's an a growing ability to provide the health interventions some of the cultural practices spread ebola such as the way their bodies are handled in funeral practices that type of thing and also been some you know fear and you know caution around you know
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government health personnel it is really diligent work around that that has helped. >> commissioner pating. >> well, actually if people want to say something i want to ask dr. bubba to conclude with size 7 with a prelude to what it becomes to be pubically prepared this ebola case is a test of our precipitation but the extent of the precipitation is the 15 dimensions of the public health and hospitals if you could spends two more minutes on this this is what we discussed on the community health committee and it goes to a large question what does it take to prepare while we have the slide up.
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>> just to give you a little bit of background what preparedness first started in public health focused on diseases that was around pandemic and flus and is 9/11 attacks and all disasters have a health element we couldn't was it on disaster to disaster but a bigger framework to demonstrate the capacities around the placement that is harder there is no evidence so take a lot of disasters and see what happens in health many is is intuitive and we actually building after seeing the disasters and hurricanes there is something that came up as a need it will be a capability but it expands the spectrum or public health
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for example, number 14 on safety and pthd to make sure our frrnz if interest is something out there, there is dangers whether it is a toxic chemical or come building disease when 9/11 went down none thought about it when the oil spill in louisiana none thought about those health workers this is leaning forward part of the difficulty your preparing sometimes for the unknown and can't say predict what recordings will face and the communities about face that's why we have those capacities it goes much deeper i know each other was has a function the book is hundred and 50 pages in terms of deaths and the capacities but i think where
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we try to improve our precipitation is during the responses like this tested the plans and find out our gaps once you have to have a disaster you sit back and the group that responds well, it went well, what do we need to improve on next time in the system. >> thank you. i have one question which was when the protocols you were doing hospital calls weekly and at some point you'll not do it weekly like putting the surveillance into the system when do you start reducing this and what lets you do that so then i know this kind of goes
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back into a precipitation mode rather than- you can't keep having a crisis and make calls when nobody wants to pay attention anywhere; right? >> a great question when you allow people to do do normal day to day work part of that the way - why we end up activating the needs out strip the resources if comparabmunicable diseases the protocols were in place has been tested for a few weeks and starts to go back we have monthly calls with air partners once they say stop calling in we realize this is less of an issue and on the monthly calls we check in and see we're doing
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well and they don't need our support but the open lines of communication we have a strong relationship with the hospitals their you know i'm very open about communicating there are issues that people otherwise will talk about. >> thank you. >> and thank you for the presentation. >> shall we go on to the next item. >> no public comment. >> item 8 is other business. >> commissioners any other items you want to bring up on other business if not next item. >> no public comment requests for that. >> item 9 is a joint venture report and commissioner sanchez will report think outside the box that from yesterday. >> the laguna honda meeting was held yesterday as 4 o'clock


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