1
00:00:05,297 --> 00:00:05,688
this is a test.

2
00:00:05,688 --> 00:00:07,688
>> good afternoon.

3
00:00:11,797 --> 00:00:15,172
I'm going to call the May 15

4
00:00:15,172 --> 00:00:17,572
budget workshop to order.

5
00:00:19,375 --> 00:00:21,775
please call the roll.

6
00:00:22,578 --> 00:00:24,578
>> supervisor kniss, cortese,

7
00:00:25,344 --> 00:00:27,470
wassermann, vice

8
00:00:27,470 --> 00:00:28,344
President Yeager, President

9
00:00:28,344 --> 00:00:31,250
Shirakawa, you have a quorum.

10
00:00:31,250 --> 00:00:33,650
>> ladies and gentlemen please

11
00:00:34,125 --> 00:00:35,281
stand and join in the

12
00:00:35,281 --> 00:00:35,891
pledge of allegiance.

13
00:00:35,891 --> 00:00:36,359
>> I pledge of allegiance, to

14
00:00:36,359 --> 00:00:36,953
the flag of the united

15
00:00:36,953 --> 00:00:37,594
states of america and to the

16
00:00:37,594 --> 00:00:38,219
republic for which stands, one

17
00:00:38,219 --> 00:00:40,234
nation under God, indivisible,

18
00:00:40,234 --> 00:00:43,234
with liberty and justice for

19
00:00:49,141 --> 00:00:51,000
all.

20
00:00:51,000 --> 00:00:51,531
>> thank you item three is

21
00:00:51,531 --> 00:00:53,531
public comment.

22
00:00:57,141 --> 00:00:57,344
I have two speakers at this

23
00:00:57,344 --> 00:00:59,344
time.

24
00:01:00,812 --> 00:01:02,281
linda kincaid and richard

25
00:01:02,281 --> 00:01:05,281
calhoun come on up please.

26
00:01:08,484 --> 00:01:09,562
Give you a couple minutes to

27
00:01:09,562 --> 00:01:10,940
speak.

28
00:01:10,940 --> 00:01:12,940
Good afternoon.

29
00:01:14,266 --> 00:01:17,828
Hold on a second, is the mic on?

30
00:01:17,828 --> 00:01:21,875
Let's make sure the mic is on.

31
00:01:21,875 --> 00:01:23,203
>> thank you, my name is linda

32
00:01:23,203 --> 00:01:25,203
kincaid.

33
00:01:30,672 --> 00:01:33,281
I'm speaking on behalf of

34
00:01:33,281 --> 00:01:34,453
jazell. Notice of rights and

35
00:01:34,453 --> 00:01:37,453
file states unless the court

36
00:01:39,188 --> 00:01:41,940
has limited or taken the right

37
00:01:41,940 --> 00:01:43,688
of way, the conservative keeps

38
00:01:43,688 --> 00:01:44,453
right to receive personal

39
00:01:44,453 --> 00:01:46,453
mail.

40
00:01:46,531 --> 00:01:49,703
The court has not taken away

41
00:01:49,703 --> 00:01:52,103
her right to visitation.

42
00:01:52,406 --> 00:01:54,806
However, the public guardian

43
00:01:56,406 --> 00:01:58,780
has violated that right

44
00:01:58,780 --> 00:01:58,281
since becoming conservator in

45
00:01:58,281 --> 00:02:00,470
2010.

46
00:02:00,470 --> 00:02:02,160
She was allowed to visit her

47
00:02:02,160 --> 00:02:03,609
son marcus for less than 2

48
00:02:03,609 --> 00:02:05,750
hours in the past two years.

49
00:02:05,750 --> 00:02:06,250
She is not allowed visitors

50
00:02:06,250 --> 00:02:08,780
from the community.

51
00:02:08,780 --> 00:02:09,750
She is not allowed phone calls

52
00:02:09,750 --> 00:02:10,891
and her mail is

53
00:02:10,891 --> 00:02:13,859
intercepted. She lost about a

54
00:02:13,859 --> 00:02:16,500
third of her body weight

55
00:02:16,500 --> 00:02:17,562
under the care of a public

56
00:02:17,562 --> 00:02:19,562
guardian.

57
00:02:19,625 --> 00:02:22,625
She needs new eye glasses.

58
00:02:25,297 --> 00:02:26,734
she is rarely allowed access to

59
00:02:26,734 --> 00:02:28,734
hearing aid.

60
00:02:29,938 --> 00:02:30,547
Her world is dark, silent and

61
00:02:30,547 --> 00:02:32,516
very lonely.

62
00:02:32,516 --> 00:02:32,953
She pray every night that God

63
00:02:32,953 --> 00:02:34,953
take her.

64
00:02:37,188 --> 00:02:38,719
I pray santa clara county will

65
00:02:38,719 --> 00:02:40,719
protect the public

66
00:02:42,359 --> 00:02:44,359
guardian.

67
00:02:48,620 --> 00:02:49,266
>> thank you richard calhoun.

68
00:02:49,266 --> 00:02:50,891
>> good afternoon.

69
00:02:50,891 --> 00:02:53,620
The public guardian spent about

70
00:02:53,620 --> 00:02:55,462
45 minutes on the phone

71
00:02:56,620 --> 00:02:58,234
with me regarding my

72
00:02:58,234 --> 00:02:58,406
mother-in-law elder abuse case

73
00:02:58,406 --> 00:02:58,844
in

74
00:02:58,844 --> 00:03:00,844
southern california.

75
00:03:01,406 --> 00:03:02,312
They assured me that abuse will

76
00:03:02,312 --> 00:03:03,812
not happen here in

77
00:03:03,812 --> 00:03:05,281
santa clara county.

78
00:03:05,281 --> 00:03:07,547
it's happening under his direct

79
00:03:07,547 --> 00:03:08,188
control at that time of

80
00:03:08,188 --> 00:03:09,984
the conversation.

81
00:03:09,984 --> 00:03:12,516
That abuse happening in this

82
00:03:12,516 --> 00:03:14,516
county is worse.

83
00:03:15,484 --> 00:03:16,984
The county despite selling our

84
00:03:16,984 --> 00:03:18,984
house for $350,000

85
00:03:21,500 --> 00:03:22,562
recently -- she has to use

86
00:03:22,562 --> 00:03:24,562
toilet paper.

87
00:03:26,406 --> 00:03:27,875
she has to use toilet paper.

88
00:03:27,875 --> 00:03:30,703
Kleenex is not that expensive.

89
00:03:30,703 --> 00:03:31,672
We walked across the street and

90
00:03:31,672 --> 00:03:33,672
bought three boxes.

91
00:03:37,875 --> 00:03:38,484
There's something wrong.

92
00:03:38,484 --> 00:03:39,578
The pastor of westgate church

93
00:03:39,578 --> 00:03:40,484
should be able to walk

94
00:03:40,484 --> 00:03:41,156
over and visit.

95
00:03:41,156 --> 00:03:42,844
He was denied.

96
00:03:42,844 --> 00:03:44,984
I was denied visits.

97
00:03:44,984 --> 00:03:47,984
Everybody has the right to

98
00:03:51,188 --> 00:03:53,588
visits, even prisoners have

99
00:03:53,766 --> 00:03:55,625
rights to visits.

100
00:03:55,625 --> 00:03:58,562
But yet the guardian is not

101
00:03:58,562 --> 00:03:59,672
letting me visit her.

102
00:03:59,672 --> 00:04:02,438
That takes time in southern

103
00:04:02,438 --> 00:04:04,838
california, we got no

104
00:04:06,938 --> 00:04:09,338
citation approved for months.

105
00:04:12,578 --> 00:04:13,109
then you probably heard about

106
00:04:13,109 --> 00:04:14,891
it, there was conviction

107
00:04:14,891 --> 00:04:16,750
of bribery down there.

108
00:04:16,750 --> 00:04:17,922
We already have four about

109
00:04:17,922 --> 00:04:18,422
dozen investigations under

110
00:04:18,422 --> 00:04:20,940
way.

111
00:04:20,940 --> 00:04:21,656
There's probably about five or

112
00:04:21,656 --> 00:04:23,500
six here in santa clara

113
00:04:23,500 --> 00:04:24,188
county happening under your

114
00:04:24,188 --> 00:04:27,940
public guardian and you guys

115
00:04:27,940 --> 00:04:28,625
need to wake up and pay

116
00:04:28,625 --> 00:04:28,859
attention and find out we

117
00:04:28,859 --> 00:04:29,906
cannot

118
00:04:29,906 --> 00:04:31,000
visit our elders when they're

119
00:04:31,000 --> 00:04:32,469
under the care of guardian.

120
00:04:32,469 --> 00:04:33,641
That is wrong and it's abusive

121
00:04:33,641 --> 00:04:36,312
and it's a human right

122
00:04:36,312 --> 00:04:37,406
the violation and we should not

123
00:04:37,406 --> 00:04:40,406
tolerate it in this county.

124
00:04:40,875 --> 00:04:42,781
Thank you for your time.

125
00:04:42,781 --> 00:04:43,188
>> be richard, we mentioned

126
00:04:43,188 --> 00:04:45,780
before.

127
00:04:45,780 --> 00:04:46,422
We cannot engage on issues on

128
00:04:46,422 --> 00:04:47,470
this agenda.

129
00:04:47,470 --> 00:04:47,891
I don't want to gauge back and

130
00:04:47,891 --> 00:04:49,891
forth.

131
00:04:50,516 --> 00:04:52,453
for the record, our public

132
00:04:52,453 --> 00:04:54,620
guardian office does great

133
00:04:54,620 --> 00:04:54,625
work protecting those most

134
00:04:54,625 --> 00:04:56,703
vulnerable in our community.

135
00:04:56,703 --> 00:04:58,940
I understand there's issues out

136
00:04:58,940 --> 00:04:58,469
there in some of those

137
00:04:58,469 --> 00:04:59,672
homes.

138
00:04:59,672 --> 00:05:01,703
We're on top of it.

139
00:05:01,703 --> 00:05:03,562
>> I will say, we brought this

140
00:05:03,562 --> 00:05:05,609
to your attention two

141
00:05:05,609 --> 00:05:06,438
weeks ago and nobody

142
00:05:06,438 --> 00:05:07,344
communicated in any shape or

143
00:05:07,344 --> 00:05:09,344
form.

144
00:05:09,406 --> 00:05:11,172
I did hear from Mr. Cortese and

145
00:05:11,172 --> 00:05:13,172
therefore it's not

146
00:05:13,812 --> 00:05:15,470
happening. I'm sorry,

147
00:05:15,470 --> 00:05:15,719
vacations doesn't take priority

148
00:05:15,719 --> 00:05:16,516
on

149
00:05:16,516 --> 00:05:17,547
someone personal right.

150
00:05:17,547 --> 00:05:18,812
>> I understand richard, you

151
00:05:18,812 --> 00:05:20,516
will be contacted by

152
00:05:20,516 --> 00:05:21,125
staff.

153
00:05:21,125 --> 00:05:22,781
Thank you.

154
00:05:22,781 --> 00:05:24,594
Next item -- anyone else want

155
00:05:24,594 --> 00:05:26,328
to address the board?

156
00:05:26,328 --> 00:05:29,928
I have cards on other issues.

157
00:05:30,125 --> 00:05:30,359
On this item on the opening

158
00:05:30,359 --> 00:05:31,940
session.

159
00:05:31,940 --> 00:05:34,694
i see none in the room.

160
00:05:35,109 --> 00:05:37,906
Moving on to item four, vivre

161
00:05:37,906 --> 00:05:38,234
view and county executive

162
00:05:38,234 --> 00:05:38,938
fy '13 budget.

163
00:05:38,938 --> 00:05:39,406
>> Mr. President, members of

164
00:05:39,406 --> 00:05:41,406
the board.

165
00:05:43,719 --> 00:05:45,875
I like to give a little

166
00:05:45,875 --> 00:05:48,275
introduction to the proposed

167
00:05:51,250 --> 00:05:54,850
budget that we are starting to

168
00:05:56,219 --> 00:05:58,219
evaluate today.

169
00:06:07,109 --> 00:06:09,109
First slide.

170
00:06:09,312 --> 00:06:11,578
We've been discussing a

171
00:06:11,578 --> 00:06:14,406
maintenance budget for a number

172
00:06:14,406 --> 00:06:16,609
of months now and I would like

173
00:06:16,609 --> 00:06:18,641
to clarify maintenance budget

174
00:06:18,641 --> 00:06:21,188
does not mean status quo.

175
00:06:21,188 --> 00:06:23,780
What we focused on in this

176
00:06:23,780 --> 00:06:25,478
budget as we've developed

177
00:06:26,359 --> 00:06:27,859
it, is trying to not only

178
00:06:27,859 --> 00:06:29,391
maintain the services that we

179
00:06:29,391 --> 00:06:31,266
are

180
00:06:31,266 --> 00:06:32,859
providing but also change the

181
00:06:32,859 --> 00:06:35,406
style and process with which

182
00:06:35,406 --> 00:06:37,234
we provide those in order to

183
00:06:37,234 --> 00:06:39,310
reduce the cost for unit

184
00:06:39,310 --> 00:06:40,620
service.

185
00:06:40,620 --> 00:06:41,469
Then fundamentally rebuild our

186
00:06:41,469 --> 00:06:43,469
foundation which

187
00:06:43,875 --> 00:06:44,906
includes rebuilding both the

188
00:06:44,906 --> 00:06:46,312
physical and financial

189
00:06:46,312 --> 00:06:47,984
infrastructure of the county so

190
00:06:47,984 --> 00:06:48,281
that we can prepare for the

191
00:06:48,281 --> 00:06:50,281
future.

192
00:06:51,609 --> 00:06:52,516
We know that this year's

193
00:06:52,516 --> 00:06:55,516
budget, fiscal year '13, will

194
00:06:55,516 --> 00:06:58,391
give us a bit of a break from

195
00:06:58,391 --> 00:06:59,297
the more than a decade of

196
00:06:59,297 --> 00:07:02,297
reduction that the board has

197
00:07:05,391 --> 00:07:07,791
been asked to take.

198
00:07:08,562 --> 00:07:10,266
However, that brief relief will

199
00:07:10,266 --> 00:07:11,641
not last forever.

200
00:07:11,641 --> 00:07:12,812
We're preparing the

201
00:07:12,812 --> 00:07:15,212
organization for the future.

202
00:07:16,172 --> 00:07:18,375
i like to point out that

203
00:07:18,375 --> 00:07:20,719
concessions from labor had an

204
00:07:20,719 --> 00:07:21,719
enormous part in helping to

205
00:07:21,719 --> 00:07:23,719
balance this budget.

206
00:07:24,484 --> 00:07:26,312
As you remember, last year, we

207
00:07:26,312 --> 00:07:28,312
asked labor for

208
00:07:29,391 --> 00:07:31,859
concessions in the general fund

209
00:07:31,859 --> 00:07:33,859
amounting to $75 million.

210
00:07:33,859 --> 00:07:34,859
They were very difficult

211
00:07:34,859 --> 00:07:36,859
negotiations but successful.

212
00:07:37,469 --> 00:07:38,438
our partners in labor and our

213
00:07:38,438 --> 00:07:40,438
employees take great

214
00:07:41,609 --> 00:07:45,109
credit or should take credit in

215
00:07:45,109 --> 00:07:47,344
great part for this budget.

216
00:07:47,344 --> 00:07:48,141
You'll notice as you go through

217
00:07:48,141 --> 00:07:50,344
the budget, you won't

218
00:07:50,344 --> 00:07:50,719
see a line item that says $75

219
00:07:50,719 --> 00:07:52,719
million.

220
00:07:54,780 --> 00:07:57,780
All of those concessions have

221
00:07:58,422 --> 00:08:00,422
been successful and

222
00:08:00,750 --> 00:08:03,750
they're built into the object

223
00:08:03,828 --> 00:08:06,828
one cost of each department.

224
00:08:06,859 --> 00:08:07,766
As we look forward, we're

225
00:08:07,766 --> 00:08:09,234
looking at a new normal.

226
00:08:09,234 --> 00:08:12,834
There's been a lot of talk

227
00:08:12,906 --> 00:08:14,703
about in the economy lately.

228
00:08:14,703 --> 00:08:17,780
But not a new normal just

229
00:08:17,780 --> 00:08:18,375
because we don't see an

230
00:08:18,375 --> 00:08:20,775
amazing number of jobs

231
00:08:20,938 --> 00:08:21,172
returning to the nation but

232
00:08:21,172 --> 00:08:23,172
because

233
00:08:24,516 --> 00:08:26,547
at a county level, we can no

234
00:08:26,547 --> 00:08:27,922
longer rely upon state and

235
00:08:27,922 --> 00:08:30,922
federal revenue to keep pace

236
00:08:32,188 --> 00:08:35,188
with the need for services.

237
00:08:35,828 --> 00:08:38,228
Also, with healthcare reform

238
00:08:41,438 --> 00:08:43,838
changes, our hospital and

239
00:08:47,266 --> 00:08:48,609
clinic system, santa clara

240
00:08:48,609 --> 00:08:51,609
valley medical system, where we

241
00:08:55,312 --> 00:08:58,312
can no longer rely on lump sum

242
00:08:58,312 --> 00:08:58,750
supplemental payments.

243
00:08:58,750 --> 00:09:00,750
Next slide.

244
00:09:04,484 --> 00:09:07,328
we do have a bit of respite

245
00:09:07,328 --> 00:09:09,728
from deficits because in

246
00:09:10,594 --> 00:09:11,656
2012 this board took the very

247
00:09:11,656 --> 00:09:14,560
thoughtful approach of only

248
00:09:14,620 --> 00:09:17,109
using one time moneys to solve

249
00:09:17,109 --> 00:09:18,562
one time problems and not

250
00:09:18,562 --> 00:09:20,962
putting them into ongoing

251
00:09:21,234 --> 00:09:22,109
deficits.

252
00:09:22,109 --> 00:09:24,406
That has stabilized our budget

253
00:09:24,406 --> 00:09:26,806
to great extent and

254
00:09:26,906 --> 00:09:28,470
we've also noticed some

255
00:09:28,470 --> 00:09:28,281
stabilization of the economy

256
00:09:28,281 --> 00:09:30,281
around

257
00:09:30,922 --> 00:09:31,750
us with some slight up tick in

258
00:09:31,750 --> 00:09:33,750
revenues.

259
00:09:35,160 --> 00:09:37,416
However those revenues are

260
00:09:37,750 --> 00:09:38,828
typically related to public

261
00:09:38,828 --> 00:09:40,828
safety realignment.

262
00:09:41,656 --> 00:09:42,125
we've had relief from

263
00:09:42,125 --> 00:09:44,125
reductions this year.

264
00:09:46,310 --> 00:09:46,703
As a matter of fact, you'll see

265
00:09:46,703 --> 00:09:48,703
in this proposed

266
00:09:49,266 --> 00:09:49,906
budget, we're actually adding

267
00:09:49,906 --> 00:09:51,203
positions.

268
00:09:51,203 --> 00:09:52,844
Total over 300 positions.

269
00:09:52,844 --> 00:09:54,000
I will point out many of those

270
00:09:54,000 --> 00:09:56,000
positions are funded

271
00:09:56,141 --> 00:09:59,141
from other sources than the

272
00:09:59,719 --> 00:10:02,719
general fund we've looked at

273
00:10:02,812 --> 00:10:04,859
each one closelily to make sure

274
00:10:04,859 --> 00:10:07,453
that next year, fiscal year

275
00:10:07,453 --> 00:10:09,594
'14, will not be faced with a

276
00:10:09,594 --> 00:10:11,994
situation of reducing those

277
00:10:12,859 --> 00:10:14,703
positions that we're now adding.

278
00:10:14,703 --> 00:10:16,438
We think they're all justified,

279
00:10:16,438 --> 00:10:16,938
we think they are all

280
00:10:16,938 --> 00:10:18,938
critical.

281
00:10:24,344 --> 00:10:28,375
we have utilized them to try to

282
00:10:28,375 --> 00:10:29,160
rebuild our foundation.

283
00:10:29,160 --> 00:10:30,375
However this brief respite will

284
00:10:30,375 --> 00:10:31,844
give us time to refocus

285
00:10:31,844 --> 00:10:34,609
our attention in the county on

286
00:10:34,609 --> 00:10:34,984
what our core mission and

287
00:10:34,984 --> 00:10:36,984
values are.

288
00:10:39,688 --> 00:10:41,156
The board of supervisors

289
00:10:41,156 --> 00:10:44,156
adopted this mission and value

290
00:10:45,922 --> 00:10:48,391
statement over two years ago.

291
00:10:48,391 --> 00:10:49,938
We have an opportunity now to

292
00:10:49,938 --> 00:10:51,310
make sure that it spreads

293
00:10:51,310 --> 00:10:52,172
throughout the organization and

294
00:10:52,172 --> 00:10:54,572
refocus the organization on

295
00:10:59,344 --> 00:11:00,938
the values that are critical to

296
00:11:00,938 --> 00:11:02,938
our future success.

297
00:11:06,719 --> 00:11:09,470
as I mentioned in the last

298
00:11:09,470 --> 00:11:10,828
decade, we have deferred

299
00:11:10,828 --> 00:11:12,160
many capital projects and much

300
00:11:12,160 --> 00:11:13,828
maintenance in order to

301
00:11:13,828 --> 00:11:15,620
continue provide services.

302
00:11:15,620 --> 00:11:17,422
This year we have the

303
00:11:17,422 --> 00:11:19,822
opportunity as the economy

304
00:11:21,203 --> 00:11:22,641
stabilizes to begin to rebuild

305
00:11:22,641 --> 00:11:24,766
and some of recommended

306
00:11:24,766 --> 00:11:25,938
budget invest in four key

307
00:11:25,938 --> 00:11:27,938
issues.

308
00:11:28,000 --> 00:11:31,000
Number one is the retiree

309
00:11:32,578 --> 00:11:32,984
medical benefits also called

310
00:11:32,984 --> 00:11:34,984
opeb.

311
00:11:36,422 --> 00:11:38,484
Gary will give you more

312
00:11:38,484 --> 00:11:40,391
detailed discussion on this

313
00:11:40,391 --> 00:11:41,547
budget.

314
00:11:41,547 --> 00:11:42,859
We also rebuilding our

315
00:11:42,859 --> 00:11:44,859
inspection technology systems

316
00:11:45,688 --> 00:11:46,859
putting some money into a few

317
00:11:46,859 --> 00:11:49,859
of the capital projects that

318
00:11:49,859 --> 00:11:51,266
have been on hold for a long

319
00:11:51,266 --> 00:11:53,310
time.

320
00:11:53,310 --> 00:11:55,310
We're recommending some

321
00:11:55,940 --> 00:11:56,562
reserves because of the

322
00:11:56,562 --> 00:11:59,562
question marks at the state

323
00:12:00,312 --> 00:12:02,469
level that have only gotten

324
00:12:02,469 --> 00:12:06,690
larger in the last day because

325
00:12:08,578 --> 00:12:09,781
of the May revise.

326
00:12:09,781 --> 00:12:12,391
Briefly, as I mentioned gary

327
00:12:12,391 --> 00:12:14,516
will give you more details

328
00:12:14,516 --> 00:12:16,188
later, but in recent years --

329
00:12:16,188 --> 00:12:18,588
>> President Shirakawa, can I

330
00:12:18,828 --> 00:12:20,891
ask a quick information

331
00:12:20,891 --> 00:12:22,891
question?

332
00:12:24,438 --> 00:12:25,672
Where you listed epic and the

333
00:12:25,672 --> 00:12:28,720
funding sources how they

334
00:12:28,562 --> 00:12:29,969
will be spent, within there

335
00:12:29,969 --> 00:12:32,969
somewhere is an incentive bonus.

336
00:12:35,281 --> 00:12:36,547
Are you going to mention that

337
00:12:36,547 --> 00:12:38,547
at some point?

338
00:12:40,188 --> 00:12:43,188
>> yes, we will mention that.

339
00:12:43,688 --> 00:12:46,880
>> is that another time?

340
00:12:47,188 --> 00:12:49,188
>> we'll get there.

341
00:12:49,719 --> 00:12:50,953
with regard to the retiree

342
00:12:50,953 --> 00:12:53,953
medical benefits, this is a

343
00:12:54,000 --> 00:12:56,000
very significant problem.

344
00:12:59,531 --> 00:13:03,131
A decade ago, this county was

345
00:13:03,375 --> 00:13:05,281
very forward-thinking and

346
00:13:05,281 --> 00:13:06,344
unfunded the light retiree

347
00:13:06,344 --> 00:13:08,344
health.

348
00:13:08,938 --> 00:13:12,538
over the decade of cuts of

349
00:13:12,750 --> 00:13:13,188
funding to that system has

350
00:13:13,188 --> 00:13:14,547
decreased.

351
00:13:14,547 --> 00:13:16,947
At this point we're

352
00:13:19,828 --> 00:13:22,228
recommending in this budget 75%

353
00:13:23,328 --> 00:13:23,797
funding to the normal cost for

354
00:13:23,797 --> 00:13:26,197
retiree health with a

355
00:13:29,940 --> 00:13:32,940
commitment to go up to 100%.

356
00:13:32,266 --> 00:13:34,172
Normal cost is a word used to

357
00:13:34,172 --> 00:13:36,172
describe essentially what

358
00:13:36,672 --> 00:13:39,281
would be equivalent to minimum

359
00:13:39,281 --> 00:13:42,281
payment on your credit card

360
00:13:42,812 --> 00:13:44,780
not really adequate to actually

361
00:13:44,780 --> 00:13:45,844
fund the unfunded liability

362
00:13:45,844 --> 00:13:47,984
in the long run.

363
00:13:47,984 --> 00:13:49,859
But certainly a minimum and we

364
00:13:49,859 --> 00:13:50,359
think you should commit

365
00:13:50,359 --> 00:13:52,125
to that.

366
00:13:52,125 --> 00:13:55,125
We need to develop further

367
00:13:57,000 --> 00:13:57,891
strategies in the future to

368
00:13:57,891 --> 00:13:59,594
deal with that.

369
00:13:59,594 --> 00:14:01,266
Information technology, we are

370
00:14:01,266 --> 00:14:02,828
recommending some

371
00:14:02,828 --> 00:14:04,828
significant investments in

372
00:14:05,234 --> 00:14:07,469
technology and as supervisor

373
00:14:07,469 --> 00:14:09,469
kniss pointed out, with regard

374
00:14:09,469 --> 00:14:12,469
to epic, one of the

375
00:14:12,484 --> 00:14:14,375
advantages that we have is that

376
00:14:14,375 --> 00:14:15,844
we are anticipating money

377
00:14:15,844 --> 00:14:17,422
from meaningful so called

378
00:14:17,422 --> 00:14:20,422
meaningful use which is federal

379
00:14:22,156 --> 00:14:25,756
money that will help defray the

380
00:14:26,000 --> 00:14:28,531
cost of revamping the entire

381
00:14:28,531 --> 00:14:30,931
core health information system.

382
00:14:33,672 --> 00:14:34,940
we have decided to issue debt,

383
00:14:34,940 --> 00:14:34,438
technology bond for

384
00:14:34,438 --> 00:14:36,234
$100 million.

385
00:14:36,234 --> 00:14:38,172
This is not a bond that needs

386
00:14:38,172 --> 00:14:41,772
to go to the voters, this

387
00:14:43,609 --> 00:14:46,953
is a bond we paid for based

388
00:14:46,953 --> 00:14:47,875
commitment from the meaningful

389
00:14:47,875 --> 00:14:49,875
use money.

390
00:14:50,422 --> 00:14:52,125
$70 million of that will go

391
00:14:52,125 --> 00:14:54,125
towards epic.

392
00:14:54,891 --> 00:14:55,859
$20 million will go towards

393
00:14:55,859 --> 00:14:58,859
general fund I.T. Project.

394
00:15:01,500 --> 00:15:02,310
$10 million for the cost of

395
00:15:02,310 --> 00:15:02,234
issuance and contingency

396
00:15:02,234 --> 00:15:04,234
fund.

397
00:15:04,234 --> 00:15:07,310
You can see that the total cost

398
00:15:07,310 --> 00:15:09,431
of epic that's budgeted

399
00:15:11,780 --> 00:15:13,172
at $68 million, most of that

400
00:15:13,172 --> 00:15:16,172
will be from bond proceeds.

401
00:15:17,344 --> 00:15:19,656
There also be will money from

402
00:15:19,656 --> 00:15:20,922
mental health services

403
00:15:20,922 --> 00:15:22,922
act.

404
00:15:23,516 --> 00:15:24,250
These are the list of the

405
00:15:24,250 --> 00:15:26,940
general fund I.T. Projects

406
00:15:26,940 --> 00:15:28,484
that we are recommending that

407
00:15:28,484 --> 00:15:30,484
you fund.

408
00:15:31,891 --> 00:15:32,297
You'll see that all of them are

409
00:15:32,297 --> 00:15:34,297
critical function.

410
00:15:34,391 --> 00:15:38,375
on the left are the ones we

411
00:15:38,375 --> 00:15:38,703
think we can fund with the

412
00:15:38,703 --> 00:15:40,578
bond proceeds.

413
00:15:40,578 --> 00:15:41,469
They are basic enterprise

414
00:15:41,469 --> 00:15:43,672
functions that are required

415
00:15:43,672 --> 00:15:46,672
for us to move forward.

416
00:15:48,160 --> 00:15:50,160
Things like public safety

417
00:15:50,160 --> 00:15:52,160
radios, sheriff's mobile

418
00:15:52,109 --> 00:15:54,109
computers, enterprise system

419
00:15:56,484 --> 00:15:57,656
called clarinet and our

420
00:15:57,656 --> 00:15:58,922
voiceover internet protocol

421
00:15:58,922 --> 00:15:59,484
system which helps with

422
00:15:59,484 --> 00:16:01,484
communications.

423
00:16:02,797 --> 00:16:07,500
We did not add all the I.T.

424
00:16:07,500 --> 00:16:09,500
System in here.

425
00:16:11,609 --> 00:16:12,141
These are just the ones that

426
00:16:12,141 --> 00:16:12,812
are absolutely necessary.

427
00:16:12,812 --> 00:16:15,812
Additional I.T. Projects which

428
00:16:16,547 --> 00:16:18,947
will not be funded

429
00:16:22,484 --> 00:16:25,484
through the bonds include the

430
00:16:25,688 --> 00:16:27,688
assessor system, modifications

431
00:16:29,297 --> 00:16:30,719
to kronus which is our time

432
00:16:30,719 --> 00:16:32,500
sheet keeping mechanism the

433
00:16:32,500 --> 00:16:36,100
cloud system and you can see

434
00:16:39,797 --> 00:16:41,875
also public safety radios.

435
00:16:41,875 --> 00:16:43,780
The next category that we're

436
00:16:43,780 --> 00:16:43,578
recommending for

437
00:16:43,578 --> 00:16:45,203
additional foundational

438
00:16:45,203 --> 00:16:47,603
investment is capital programs.

439
00:16:48,281 --> 00:16:49,703
I won't go through all of these

440
00:16:49,703 --> 00:16:51,780
capital programs.

441
00:16:51,780 --> 00:16:54,780
Again, these are actually small

442
00:16:55,470 --> 00:16:57,188
number of the programs

443
00:16:57,188 --> 00:16:57,484
-- projects that we need to

444
00:16:57,484 --> 00:16:58,891
accomplish.

445
00:16:58,891 --> 00:17:01,891
These are the most critical

446
00:17:04,562 --> 00:17:07,562
ones and totals up to

447
00:17:07,625 --> 00:17:09,625
$13.7 million.

448
00:17:13,203 --> 00:17:14,172
Terms of budgetary reserves, as

449
00:17:14,172 --> 00:17:15,672
always, your reserve

450
00:17:15,672 --> 00:17:16,906
we're keeping at 5% general

451
00:17:16,906 --> 00:17:18,906
fund revenues.

452
00:17:20,672 --> 00:17:22,844
We're recommending a funding

453
00:17:22,844 --> 00:17:24,141
$10 million for economic

454
00:17:24,141 --> 00:17:25,344
uncertainties from the state

455
00:17:25,344 --> 00:17:27,344
and fed.

456
00:17:27,688 --> 00:17:30,125
As I mentioned, the state

457
00:17:30,125 --> 00:17:31,781
proposal particularly the

458
00:17:31,781 --> 00:17:33,422
recent May revise has a lot of

459
00:17:33,422 --> 00:17:35,822
questions associated with it.

460
00:17:36,391 --> 00:17:37,531
At this point, we're doing

461
00:17:37,531 --> 00:17:39,125
analysis to try to decide

462
00:17:39,125 --> 00:17:39,391
exactly effect it will have on

463
00:17:39,391 --> 00:17:41,391
us.

464
00:17:42,766 --> 00:17:45,375
There are cuts recommended to

465
00:17:45,375 --> 00:17:46,609
medi-cal and safety net

466
00:17:46,609 --> 00:17:47,969
hospitals.

467
00:17:47,969 --> 00:17:50,438
Actually, it looks like to the

468
00:17:50,438 --> 00:17:53,438
best of our analysis at

469
00:17:55,312 --> 00:17:56,875
this point, those cuts will not

470
00:17:56,875 --> 00:17:58,453
have an effect upon us this

471
00:17:58,453 --> 00:18:01,719
year but it certainly will have

472
00:18:01,719 --> 00:18:01,922
effect upon us next fiscal

473
00:18:01,922 --> 00:18:03,688
year.

474
00:18:03,688 --> 00:18:05,310
However, don't hold me to that

475
00:18:05,310 --> 00:18:06,688
because there's still

476
00:18:06,688 --> 00:18:07,297
details we need to straighten

477
00:18:07,297 --> 00:18:09,297
out.

478
00:18:11,266 --> 00:18:12,203
As you watch the federal budget

479
00:18:12,203 --> 00:18:12,906
process, you remember

480
00:18:12,906 --> 00:18:15,306
that there automatic trigger

481
00:18:17,672 --> 00:18:20,641
cuts that are built into the

482
00:18:20,641 --> 00:18:22,844
federal process from last year

483
00:18:22,844 --> 00:18:24,516
so we're very concerned if

484
00:18:24,516 --> 00:18:26,916
congress and President Don't

485
00:18:27,484 --> 00:18:29,344
move ahead with effective

486
00:18:29,344 --> 00:18:32,344
budget or spending plan, we

487
00:18:32,859 --> 00:18:34,359
will end up with automatic

488
00:18:34,359 --> 00:18:36,359
reductions.

489
00:18:38,719 --> 00:18:39,500
We're also recommending a small

490
00:18:39,500 --> 00:18:39,734
set aside reserve for

491
00:18:39,734 --> 00:18:41,734
cash.

492
00:18:41,891 --> 00:18:42,656
This is not money we anticipate

493
00:18:42,656 --> 00:18:44,969
spending but this will

494
00:18:44,969 --> 00:18:46,531
actually help us with our cash

495
00:18:46,531 --> 00:18:49,531
flow issues which has been

496
00:18:50,609 --> 00:18:51,234
for the last two years, an

497
00:18:51,234 --> 00:18:52,844
issue.

498
00:18:52,844 --> 00:18:54,516
>> jeff, real quick.

499
00:18:54,516 --> 00:18:56,344
Last year we had extensive

500
00:18:56,344 --> 00:18:56,812
discussion on the

501
00:18:56,812 --> 00:18:58,812
contingency reserve.

502
00:18:59,719 --> 00:19:01,891
It's not all cash.

503
00:19:01,891 --> 00:19:03,594
just take 30 seconds to remind

504
00:19:03,594 --> 00:19:05,994
us again that the

505
00:19:06,828 --> 00:19:07,391
$96 million is not all cash.

506
00:19:07,391 --> 00:19:09,266
>> yes.

507
00:19:09,266 --> 00:19:11,156
>> we don't have to have the

508
00:19:11,156 --> 00:19:13,156
discussion again.

509
00:19:14,328 --> 00:19:16,728
>> the contingency is cash.

510
00:19:17,406 --> 00:19:18,310
It's an unspent allocation or

511
00:19:18,310 --> 00:19:19,266
appropriation.

512
00:19:19,266 --> 00:19:21,266
>> assets though?

513
00:19:23,344 --> 00:19:24,812
>> no, it's a budgeted

514
00:19:24,812 --> 00:19:26,812
allocation.

515
00:19:27,141 --> 00:19:28,312
It is equivalent to cash.

516
00:19:28,312 --> 00:19:29,953
>> what you're talking about is

517
00:19:29,953 --> 00:19:31,406
that we get the revenue

518
00:19:31,406 --> 00:19:32,780
over a period of time.

519
00:19:32,780 --> 00:19:33,984
We've allocated at the

520
00:19:33,984 --> 00:19:37,584
beginning of the year so we

521
00:19:37,781 --> 00:19:38,391
don't have a big lump sum

522
00:19:38,391 --> 00:19:40,391
instantaneously sitting there.

523
00:19:41,766 --> 00:19:44,500
>> how it was described to me --

524
00:19:44,500 --> 00:19:47,125
>> it's like buying on time.

525
00:19:47,125 --> 00:19:49,234
>> right, we also had some

526
00:19:49,234 --> 00:19:51,634
assets included in there.

527
00:19:52,266 --> 00:19:52,844
We had discussions about not

528
00:19:52,844 --> 00:19:53,234
being actual liquidable

529
00:19:53,234 --> 00:19:55,234
cash.

530
00:19:56,141 --> 00:19:57,000
I just want do make it clear

531
00:19:57,000 --> 00:19:59,400
because it's a different

532
00:20:02,141 --> 00:20:05,141
what we had last year.

533
00:20:06,891 --> 00:20:09,688
>> the fund balance is part of

534
00:20:09,688 --> 00:20:11,656
a fund balance.

535
00:20:11,656 --> 00:20:12,688
It's not 100% cash but it's

536
00:20:12,688 --> 00:20:13,859
tied into other assets

537
00:20:13,859 --> 00:20:17,459
which will convert to cash over

538
00:20:18,156 --> 00:20:18,969
a period of time.

539
00:20:18,969 --> 00:20:20,406
>> right.

540
00:20:20,406 --> 00:20:21,310
I guess that was my point.

541
00:20:21,310 --> 00:20:23,310
>> that's it.

542
00:20:25,109 --> 00:20:25,641
>> when you said asset, I was

543
00:20:25,641 --> 00:20:28,410
thinking you were talking

544
00:20:30,844 --> 00:20:32,812
about tangible assets as

545
00:20:32,812 --> 00:20:33,109
opposed to assets like

546
00:20:33,109 --> 00:20:35,109
receivable.

547
00:20:37,188 --> 00:20:38,125
>> the basic bottom line,

548
00:20:38,125 --> 00:20:39,359
there's not a lot of cash

549
00:20:39,359 --> 00:20:40,953
around.

550
00:20:40,953 --> 00:20:41,859
>> we had a long discussion

551
00:20:41,859 --> 00:20:43,859
last week.

552
00:20:45,297 --> 00:20:47,697
>> thank you Mr. President.

553
00:20:47,953 --> 00:20:51,553
May I ask one question page 7.

554
00:20:56,500 --> 00:20:57,812
On page 7, the debt issuance, I

555
00:20:57,812 --> 00:20:59,812
see the $70 million,

556
00:20:59,875 --> 00:21:00,344
the $20 million and $10

557
00:21:00,344 --> 00:21:00,781
million,ed needs for

558
00:21:00,781 --> 00:21:02,781
replacement of

559
00:21:03,438 --> 00:21:04,547
that debt, how is that

560
00:21:04,547 --> 00:21:06,406
happening?

561
00:21:06,406 --> 00:21:08,219
>> technology bond comes from

562
00:21:08,219 --> 00:21:10,619
the meaningful use money

563
00:21:11,125 --> 00:21:12,250
and it's also the general fund

564
00:21:12,250 --> 00:21:14,328
is committed to pay it back

565
00:21:14,328 --> 00:21:16,328
also.

566
00:21:18,266 --> 00:21:19,156
But it will come out of the 921

567
00:21:19,156 --> 00:21:21,156
budget.

568
00:21:21,156 --> 00:21:22,859
>> the $10 million jeff, where

569
00:21:22,859 --> 00:21:25,259
it says cost of

570
00:21:27,000 --> 00:21:27,938
issuance, I understand cost of

571
00:21:27,938 --> 00:21:29,797
issuance and contingency.

572
00:21:29,797 --> 00:21:30,266
What does that mean by

573
00:21:30,266 --> 00:21:32,266
contingency?

574
00:21:33,780 --> 00:21:35,844
>> it means basically that we

575
00:21:35,844 --> 00:21:38,244
have anticipated the cost

576
00:21:40,250 --> 00:21:42,250
of the infrastructure programs

577
00:21:42,250 --> 00:21:45,250
in a very rough way.

578
00:21:45,719 --> 00:21:46,219
We're not 100% sure those

579
00:21:46,219 --> 00:21:47,620
numbers are completely

580
00:21:47,620 --> 00:21:49,620
accurate.

581
00:21:49,766 --> 00:21:50,594
>> construction project, you

582
00:21:50,594 --> 00:21:51,156
got 10% contingency built

583
00:21:51,156 --> 00:21:53,156
in.

584
00:21:54,203 --> 00:21:55,000
Could end up with those moneys.

585
00:21:55,000 --> 00:21:57,000
Okay thank you.

586
00:21:59,500 --> 00:22:01,266
>> going back to page 11, a

587
00:22:01,266 --> 00:22:02,969
little bit about valley

588
00:22:02,969 --> 00:22:05,969
medical center and you'll hear

589
00:22:06,516 --> 00:22:07,344
a whole lot more later on in

590
00:22:07,344 --> 00:22:09,219
the day.

591
00:22:09,219 --> 00:22:11,344
You'll remember from mid-year,

592
00:22:11,344 --> 00:22:13,744
this year, this fiscal

593
00:22:14,922 --> 00:22:16,219
year, we anticipated about a

594
00:22:16,219 --> 00:22:18,219
$60 million current deficit.

595
00:22:20,656 --> 00:22:21,297
We look like we're on track to

596
00:22:21,297 --> 00:22:23,297
solve that deficit

597
00:22:23,391 --> 00:22:26,391
problem as was mentioned in

598
00:22:27,625 --> 00:22:29,000
health and hospital last week.

599
00:22:29,000 --> 00:22:30,940
We also had to commit $30

600
00:22:30,940 --> 00:22:33,940
million from the general fund

601
00:22:34,703 --> 00:22:36,203
in order to deal with that.

602
00:22:36,203 --> 00:22:39,203
Now, as we've known and

603
00:22:41,160 --> 00:22:42,812
mentioned many times in the

604
00:22:42,812 --> 00:22:44,750
past, the 921 fund, the

605
00:22:44,750 --> 00:22:45,688
enterprise fund is a very

606
00:22:45,688 --> 00:22:47,688
difficult

607
00:22:51,828 --> 00:22:54,828
fund to project because it's

608
00:22:58,620 --> 00:22:59,672
contingent revenue.

609
00:22:59,672 --> 00:23:01,620
Contingent on visits and mix of

610
00:23:01,620 --> 00:23:01,906
patients and lot of

611
00:23:01,906 --> 00:23:03,906
other issue.

612
00:23:04,531 --> 00:23:05,344
We have many billing problems

613
00:23:05,344 --> 00:23:07,344
associated with that.

614
00:23:08,781 --> 00:23:11,780
even though we look like we're

615
00:23:11,780 --> 00:23:13,478
solving this problem, we

616
00:23:13,812 --> 00:23:16,516
do expect some bounces back and

617
00:23:16,516 --> 00:23:17,719
forth over the next couple

618
00:23:17,719 --> 00:23:19,719
of months.

619
00:23:20,312 --> 00:23:21,359
You might see in the financial

620
00:23:21,359 --> 00:23:23,297
things going up and down

621
00:23:23,297 --> 00:23:27,497
but we think that in the end,

622
00:23:28,125 --> 00:23:30,525
we'll end up balancing.

623
00:23:31,328 --> 00:23:33,620
the recommended budget for this

624
00:23:33,620 --> 00:23:35,620
coming year, for 2013,

625
00:23:35,562 --> 00:23:38,562
we looked at very carefully.

626
00:23:38,906 --> 00:23:41,875
You'll notice that it does

627
00:23:41,875 --> 00:23:43,875
include significant

628
00:23:44,672 --> 00:23:46,281
projections of new revenue.

629
00:23:46,281 --> 00:23:47,578
The county execs office and I

630
00:23:47,578 --> 00:23:50,578
know the board has been

631
00:23:50,922 --> 00:23:53,922
concerned about the past about

632
00:23:54,281 --> 00:23:54,828
projecting new revenue.

633
00:23:54,828 --> 00:23:55,453
However, it is a revenue

634
00:23:55,453 --> 00:23:57,853
generating enterprise fund and

635
00:23:58,891 --> 00:24:00,859
that's a critical component of

636
00:24:00,859 --> 00:24:03,310
the -- patient care revenue

637
00:24:03,310 --> 00:24:04,297
is a critical component for the

638
00:24:04,297 --> 00:24:05,672
overall picture.

639
00:24:05,672 --> 00:24:08,672
We had to project something.

640
00:24:10,812 --> 00:24:13,812
we looked very carefully trying

641
00:24:14,160 --> 00:24:15,109
to come up conservative

642
00:24:15,109 --> 00:24:15,781
projections based on experience

643
00:24:15,781 --> 00:24:17,780
in 2012.

644
00:24:17,780 --> 00:24:18,470
We think they are justifiable

645
00:24:18,470 --> 00:24:20,447
and reasonable and we

646
00:24:20,656 --> 00:24:23,125
think they will be obtained.

647
00:24:23,125 --> 00:24:24,594
We also focused on work

648
00:24:24,594 --> 00:24:25,891
process changes, schedule

649
00:24:25,891 --> 00:24:26,125
changes and patient access

650
00:24:26,125 --> 00:24:28,125
changes

651
00:24:29,625 --> 00:24:32,625
in order to increase revenue.

652
00:24:33,125 --> 00:24:36,725
then the final comment, if the

653
00:24:37,500 --> 00:24:38,766
projections end up not

654
00:24:38,766 --> 00:24:42,366
being accurate, we will have a

655
00:24:42,969 --> 00:24:45,734
plan b to you which will

656
00:24:45,734 --> 00:24:46,578
actually decrease expenditures

657
00:24:46,578 --> 00:24:48,578
significantly.

658
00:24:49,672 --> 00:24:51,812
We plan this year on watching

659
00:24:51,812 --> 00:24:54,812
the revenue in the county

660
00:24:55,156 --> 00:24:58,391
execs office on a monthly basis.

661
00:24:58,391 --> 00:24:59,328
We will keep close track of

662
00:24:59,328 --> 00:25:01,728
those revenues and any

663
00:25:05,891 --> 00:25:08,797
projections that look off, we

664
00:25:08,797 --> 00:25:10,703
will address immediately.

665
00:25:10,703 --> 00:25:13,703
Again, to reemphasize the risks

666
00:25:15,969 --> 00:25:17,500
that are associated

667
00:25:17,500 --> 00:25:18,281
with this budget, there are

668
00:25:18,281 --> 00:25:18,578
always risks associated with

669
00:25:18,578 --> 00:25:19,375
any

670
00:25:19,375 --> 00:25:21,375
budget.

671
00:25:21,375 --> 00:25:22,172
The budget is really projected

672
00:25:22,172 --> 00:25:22,688
spending plan and

673
00:25:22,688 --> 00:25:24,688
revenue plan.

674
00:25:25,844 --> 00:25:26,453
The projections are based on

675
00:25:26,453 --> 00:25:27,188
assumptions.

676
00:25:27,188 --> 00:25:29,588
Those assumptions can change.

677
00:25:30,688 --> 00:25:31,160
We need to let you know what

678
00:25:31,160 --> 00:25:33,160
the risks are.

679
00:25:33,156 --> 00:25:33,688
In terms of healthcare reform,

680
00:25:33,688 --> 00:25:36,880
you know that the

681
00:25:37,234 --> 00:25:39,359
supreme court is in the process

682
00:25:39,359 --> 00:25:39,672
of reviewing healthcare

683
00:25:39,672 --> 00:25:41,672
reform act.

684
00:25:41,797 --> 00:25:44,197
It's pretty much anybody's

685
00:25:44,797 --> 00:25:47,797
guess what they'll do if

686
00:25:49,281 --> 00:25:51,172
they were to reverse the act

687
00:25:51,172 --> 00:25:53,172
significantly, that would

688
00:25:53,219 --> 00:25:54,516
definitely cause chaos and make

689
00:25:54,516 --> 00:25:55,984
funding really unpredictable

690
00:25:55,984 --> 00:25:57,719
at the local level.

691
00:25:57,719 --> 00:26:01,319
We also have our own local

692
00:26:01,453 --> 00:26:03,125
problems, which I just went

693
00:26:03,125 --> 00:26:05,656
through at vmc that essentially

694
00:26:05,656 --> 00:26:08,620
boils down to turning the

695
00:26:08,620 --> 00:26:08,594
entire organization into a

696
00:26:08,594 --> 00:26:08,859
competitive organization

697
00:26:08,859 --> 00:26:10,859
compared

698
00:26:12,234 --> 00:26:15,938
to what has been in the past

699
00:26:15,938 --> 00:26:16,266
which relied upon lump sum

700
00:26:16,266 --> 00:26:18,266
revenues.

701
00:26:19,344 --> 00:26:19,703
Other local risks, I mentioned

702
00:26:19,703 --> 00:26:21,375
earlier on, the

703
00:26:21,375 --> 00:26:23,250
$35 million that's built into

704
00:26:23,250 --> 00:26:23,781
this budget for labor

705
00:26:23,781 --> 00:26:25,781
concession.

706
00:26:26,875 --> 00:26:29,750
Remember that this coming year,

707
00:26:29,750 --> 00:26:31,750
2013, is when the

708
00:26:32,922 --> 00:26:34,188
nurses, dsa and the district

709
00:26:34,188 --> 00:26:36,188
attorney investigators

710
00:26:37,656 --> 00:26:40,656
contracts open up and we

711
00:26:41,938 --> 00:26:42,859
programmed into this budget the

712
00:26:42,859 --> 00:26:44,594
expected concessions from those

713
00:26:44,594 --> 00:26:46,594
unions.

714
00:26:47,562 --> 00:26:48,172
If we are not successful in

715
00:26:48,172 --> 00:26:49,500
obtaining those concessions

716
00:26:49,500 --> 00:26:53,700
that will be a problem we would

717
00:26:55,406 --> 00:26:58,141
have to address with more

718
00:26:58,141 --> 00:26:59,812
reductions.

719
00:26:59,812 --> 00:27:02,391
We also are expecting increase

720
00:27:02,391 --> 00:27:03,312
retirement cost this

721
00:27:03,312 --> 00:27:05,312
coming year 2013.

722
00:27:07,940 --> 00:27:07,656
These retirement costs will

723
00:27:07,656 --> 00:27:07,953
come out of our general

724
00:27:07,953 --> 00:27:09,828
fund.

725
00:27:09,828 --> 00:27:12,594
We will not ask the employees

726
00:27:12,594 --> 00:27:13,656
to contribute to any of

727
00:27:13,656 --> 00:27:15,656
that.

728
00:27:15,906 --> 00:27:16,594
We will also have the risk of

729
00:27:16,594 --> 00:27:17,734
the retiree health which

730
00:27:17,734 --> 00:27:18,266
will be discussed in a little

731
00:27:18,266 --> 00:27:20,266
bit.

732
00:27:21,780 --> 00:27:21,812
I think I talked about state

733
00:27:21,812 --> 00:27:24,212
and federal issues enough

734
00:27:26,281 --> 00:27:27,438
so we can move on to the next

735
00:27:27,438 --> 00:27:28,453
page.

736
00:27:28,453 --> 00:27:28,906
>> supervisor kniss had a

737
00:27:28,906 --> 00:27:30,906
question.

738
00:27:35,156 --> 00:27:36,359
>> on this one in particular

739
00:27:36,359 --> 00:27:39,250
jeff, because, ken and i

740
00:27:39,250 --> 00:27:41,734
said on health and hospital.

741
00:27:41,734 --> 00:27:43,310
We spent substantial amount of

742
00:27:43,310 --> 00:27:43,531
time especially with

743
00:27:43,531 --> 00:27:44,734
washington consultants

744
00:27:44,734 --> 00:27:47,134
discussing the supreme court

745
00:27:47,969 --> 00:27:48,438
decision.

746
00:27:48,438 --> 00:27:50,438
You referenced chaos.

747
00:27:50,641 --> 00:27:50,969
I think more than chaos will

748
00:27:50,969 --> 00:27:52,969
ensue.

749
00:27:54,109 --> 00:27:55,281
I'm not sure that we need to do

750
00:27:55,281 --> 00:27:57,281
this right away.

751
00:28:02,160 --> 00:28:03,484
i think we should at least be

752
00:28:03,484 --> 00:28:04,281
very technical term,

753
00:28:04,281 --> 00:28:05,750
noodling what happens.

754
00:28:05,750 --> 00:28:07,156
It's a three part decision

755
00:28:07,156 --> 00:28:09,156
they're making.

756
00:28:09,422 --> 00:28:10,859
The first one would essentially

757
00:28:10,859 --> 00:28:13,259
not require states to

758
00:28:13,891 --> 00:28:15,891
have health insurance.

759
00:28:18,620 --> 00:28:18,359
That begins to alter the entire

760
00:28:18,359 --> 00:28:20,359
thing.

761
00:28:20,938 --> 00:28:22,469
That's one of the thing that we

762
00:28:22,469 --> 00:28:22,844
have been the most

763
00:28:22,844 --> 00:28:24,844
concerned about.

764
00:28:25,875 --> 00:28:27,203
Then as you know, the question

765
00:28:27,203 --> 00:28:29,344
will secondly be, can

766
00:28:29,344 --> 00:28:31,744
they separate different parts

767
00:28:33,922 --> 00:28:35,281
of the law and maintain other

768
00:28:35,281 --> 00:28:37,281
parts.

769
00:28:37,547 --> 00:28:39,250
I think you're right.

770
00:28:39,250 --> 00:28:40,828
It's a toss up at this point.

771
00:28:40,828 --> 00:28:43,828
It's probably up to one,

772
00:28:43,859 --> 00:28:44,859
believe it or not, probably up

773
00:28:44,859 --> 00:28:45,266
to one justice which is quite

774
00:28:45,266 --> 00:28:47,266
significant.

775
00:28:48,734 --> 00:28:51,297
I don't want us to lose the

776
00:28:51,297 --> 00:28:54,297
importance of that and that

777
00:28:54,438 --> 00:28:57,438
decision being made and also

778
00:28:57,906 --> 00:28:58,812
that there is a saying this is

779
00:28:58,812 --> 00:29:01,212
correctly as I can.

780
00:29:01,703 --> 00:29:03,750
There is a group in washington

781
00:29:03,750 --> 00:29:07,350
who very much had it as

782
00:29:07,922 --> 00:29:10,125
their goal to eliminate the new

783
00:29:10,125 --> 00:29:11,781
healthcare law should the

784
00:29:11,781 --> 00:29:12,797
administration change starting

785
00:29:12,797 --> 00:29:14,797
next year.

786
00:29:16,594 --> 00:29:20,194
Again, we can't be aware and

787
00:29:21,125 --> 00:29:21,469
ready for all

788
00:29:21,469 --> 00:29:23,266
contingencies.

789
00:29:23,266 --> 00:29:26,375
but at least, because I know

790
00:29:26,375 --> 00:29:27,500
that folks like gary are

791
00:29:27,500 --> 00:29:29,141
very good of kind of thinking

792
00:29:29,141 --> 00:29:31,812
ahead on this kind of issue.

793
00:29:31,812 --> 00:29:32,812
I hope that we're keeping that

794
00:29:32,812 --> 00:29:34,812
in mind.

795
00:29:36,344 --> 00:29:36,984
That will be a rather dramatic

796
00:29:36,984 --> 00:29:37,781
alteration for where we

797
00:29:37,781 --> 00:29:39,781
have been heading.

798
00:29:40,219 --> 00:29:41,453
It wipes out that meaningful

799
00:29:41,453 --> 00:29:44,453
use and dsrip whatever we

800
00:29:45,125 --> 00:29:46,484
will use for it.

801
00:29:46,484 --> 00:29:47,625
It's considerably alters that

802
00:29:47,625 --> 00:29:49,625
for the future

803
00:29:49,969 --> 00:29:51,969
>> yes, you're right.

804
00:29:52,734 --> 00:29:56,334
We have been noodling on it.

805
00:29:57,297 --> 00:30:00,312
Sort of standard logic in state

806
00:30:00,312 --> 00:30:02,712
of california has been

807
00:30:03,470 --> 00:30:04,781
that whatever the supreme court

808
00:30:04,781 --> 00:30:06,609
does, they won't invalidate

809
00:30:06,609 --> 00:30:09,844
the waiver and the waiver has

810
00:30:09,844 --> 00:30:10,547
been structured as a bridge to

811
00:30:10,547 --> 00:30:12,547
reform.

812
00:30:13,922 --> 00:30:15,859
However, we're seeing with the

813
00:30:15,859 --> 00:30:17,859
governor's proposal this

814
00:30:17,953 --> 00:30:21,553
year in the May revise, there's

815
00:30:21,688 --> 00:30:22,969
actually local effort to

816
00:30:22,969 --> 00:30:24,969
change the waiver.

817
00:30:27,297 --> 00:30:29,000
if the federal law changed,

818
00:30:29,000 --> 00:30:30,438
it's quite possible the

819
00:30:30,438 --> 00:30:32,531
state might change its mind too.

820
00:30:32,531 --> 00:30:33,109
>> as long as we're not caught

821
00:30:33,109 --> 00:30:34,844
off guard.

822
00:30:34,844 --> 00:30:36,160
I know you won't be.

823
00:30:36,160 --> 00:30:37,470
I think it's also important for

824
00:30:37,470 --> 00:30:38,344
us to say that in

825
00:30:38,344 --> 00:30:41,750
public and on the record that

826
00:30:41,750 --> 00:30:44,359
we are very aware of what

827
00:30:44,359 --> 00:30:47,959
those just what you call them

828
00:30:49,594 --> 00:30:51,156
risks and threats are that are

829
00:30:51,156 --> 00:30:53,156
out here.

830
00:30:53,594 --> 00:30:57,620
Cause us all kinds of heartache

831
00:30:57,620 --> 00:30:59,620
as a county.

832
00:31:02,297 --> 00:31:02,766
Of course, the $16 billion

833
00:31:02,766 --> 00:31:05,166
surprise I think it's

834
00:31:05,641 --> 00:31:06,547
sobering for all of us.

835
00:31:06,547 --> 00:31:08,547
Thanks george.

836
00:31:09,344 --> 00:31:11,344
>> okay.

837
00:31:11,547 --> 00:31:13,547
Page 13.

838
00:31:16,750 --> 00:31:18,188
We talked about restoration of

839
00:31:18,188 --> 00:31:20,188
personnel.

840
00:31:21,828 --> 00:31:22,328
There are issues having to do

841
00:31:22,328 --> 00:31:23,422
with bit rebuilding and

842
00:31:23,422 --> 00:31:25,125
financial infrastructure.

843
00:31:25,125 --> 00:31:25,688
You will see there are

844
00:31:25,688 --> 00:31:28,469
additions back to fleet and

845
00:31:28,469 --> 00:31:29,266
facility to deal with our

846
00:31:29,266 --> 00:31:30,734
increasing space.

847
00:31:30,734 --> 00:31:32,938
Additions back to employee

848
00:31:32,938 --> 00:31:35,906
services to deal with many

849
00:31:35,906 --> 00:31:36,938
of our workload issues and

850
00:31:36,938 --> 00:31:38,344
additions back to social

851
00:31:38,344 --> 00:31:40,344
services

852
00:31:40,812 --> 00:31:42,780
to deal with inhome supportive

853
00:31:42,780 --> 00:31:43,281
services and senior

854
00:31:43,281 --> 00:31:44,641
nutrition, which have not been

855
00:31:44,641 --> 00:31:47,641
performing as well as we

856
00:31:50,160 --> 00:31:50,281
would like without those

857
00:31:50,281 --> 00:31:52,281
resources.

858
00:31:52,453 --> 00:31:53,219
This is a summary of our one

859
00:31:53,219 --> 00:31:55,156
time funds.

860
00:31:55,156 --> 00:31:59,356
I won't go into it in detail

861
00:31:59,469 --> 00:32:02,940
but you can see basically

862
00:32:02,940 --> 00:32:02,734
that we're committing again to

863
00:32:02,734 --> 00:32:04,734
the 5% contingency.

864
00:32:06,672 --> 00:32:08,109
We have built in there the

865
00:32:08,109 --> 00:32:10,780
commitment to -- the

866
00:32:10,780 --> 00:32:12,160
repayment of loan from retiree

867
00:32:12,160 --> 00:32:14,516
health that was utilized to

868
00:32:14,516 --> 00:32:15,160
purchase the downtown clinic

869
00:32:15,160 --> 00:32:17,160
site.

870
00:32:19,984 --> 00:32:22,156
We built in here the sale of

871
00:32:22,156 --> 00:32:24,556
the children's shelter and

872
00:32:25,422 --> 00:32:26,828
we're spending that money on

873
00:32:26,828 --> 00:32:29,228
issues related to children.

874
00:32:33,940 --> 00:32:33,625
that will be on your agenda

875
00:32:33,625 --> 00:32:35,625
later on today.

876
00:32:35,797 --> 00:32:37,500
We'll give you much more detail

877
00:32:37,500 --> 00:32:38,344
about public safety

878
00:32:38,344 --> 00:32:40,703
realignment during the entire

879
00:32:40,703 --> 00:32:42,344
process but, I wanted to point

880
00:32:42,344 --> 00:32:45,484
out that santa clara county has

881
00:32:45,484 --> 00:32:47,750
been recognized across the

882
00:32:47,750 --> 00:32:49,312
state developing the most

883
00:32:49,312 --> 00:32:51,609
innovative ab109 plan available.

884
00:32:51,609 --> 00:32:54,609
we've been very successful in

885
00:32:56,125 --> 00:32:56,625
it at this point with

886
00:32:56,625 --> 00:32:58,625
reduced recidivism.

887
00:32:58,859 --> 00:33:00,719
We have not seen a dramatic

888
00:33:00,719 --> 00:33:02,719
increase, even significant

889
00:33:03,859 --> 00:33:05,940
increase in our jail population.

890
00:33:05,940 --> 00:33:06,310
Although there are mixed

891
00:33:06,310 --> 00:33:08,328
population and the population

892
00:33:08,328 --> 00:33:09,620
is changing a bit towards the

893
00:33:09,620 --> 00:33:11,620
more serious offenders.

894
00:33:11,844 --> 00:33:12,438
This budget assumes that our

895
00:33:12,438 --> 00:33:14,438
allocation will

896
00:33:14,547 --> 00:33:16,547
effectively be doubled.

897
00:33:17,470 --> 00:33:18,672
The formula has been in the

898
00:33:18,672 --> 00:33:20,672
works with negotiations

899
00:33:21,219 --> 00:33:22,781
between c sac and the state.

900
00:33:22,781 --> 00:33:23,781
We're seeing preliminary

901
00:33:23,781 --> 00:33:26,781
numbers which suggest that it

902
00:33:30,219 --> 00:33:32,562
will be at least doubled and

903
00:33:32,562 --> 00:33:34,962
we're therefore planning to

904
00:33:35,266 --> 00:33:38,266
spend on probation and public

905
00:33:38,703 --> 00:33:38,969
safety services commensurate

906
00:33:38,969 --> 00:33:40,969
with that.

907
00:33:41,672 --> 00:33:42,109
We're going to have a new

908
00:33:42,109 --> 00:33:43,375
population.

909
00:33:43,375 --> 00:33:45,375
We expect the state will

910
00:33:45,375 --> 00:33:47,775
continue with its commitment

911
00:33:49,780 --> 00:33:50,780
to fund our services to this

912
00:33:50,780 --> 00:33:52,780
new population.

913
00:33:52,141 --> 00:33:53,453
It is true that there is no

914
00:33:53,453 --> 00:33:55,853
guarantee at this point

915
00:33:56,250 --> 00:33:59,250
that this funding will come

916
00:34:01,656 --> 00:34:02,797
through without some more

917
00:34:02,797 --> 00:34:04,797
attached requirements.

918
00:34:05,656 --> 00:34:07,620
I wanted to highlight one part

919
00:34:07,620 --> 00:34:08,969
of the budget that we

920
00:34:08,969 --> 00:34:10,620
have relied upon for the last

921
00:34:10,620 --> 00:34:12,620
two years now.

922
00:34:13,531 --> 00:34:15,297
That is the center for

923
00:34:15,297 --> 00:34:16,375
leadership and transformation.

924
00:34:16,375 --> 00:34:18,281
We've focused on trying to

925
00:34:18,281 --> 00:34:20,172
change the way that we

926
00:34:20,172 --> 00:34:21,344
actually do business and we've

927
00:34:21,344 --> 00:34:22,578
had great success with

928
00:34:22,578 --> 00:34:24,978
empowering our employees to

929
00:34:25,578 --> 00:34:28,578
look at their jobs differently,

930
00:34:30,188 --> 00:34:31,547
to improve performance, to

931
00:34:31,547 --> 00:34:32,922
focus on customers and

932
00:34:32,922 --> 00:34:34,797
transforming the workforce so

933
00:34:34,797 --> 00:34:38,940
that people can lead from the

934
00:34:38,940 --> 00:34:39,734
middle as they say.

935
00:34:39,734 --> 00:34:40,938
So far, there are 39 teens

936
00:34:40,938 --> 00:34:42,531
currently working on

937
00:34:42,531 --> 00:34:45,531
projects which have saved us

938
00:34:45,703 --> 00:34:47,812
well over millions of dollars.

939
00:34:47,812 --> 00:34:51,412
You'll even see in your budget

940
00:34:51,906 --> 00:34:52,812
book, break out of all

941
00:34:52,812 --> 00:34:54,812
of those teams.

942
00:34:54,906 --> 00:34:57,906
these are the milestone dates

943
00:34:58,547 --> 00:35:00,947
for this budget process.

944
00:35:00,984 --> 00:35:02,125
We're currently starting the

945
00:35:02,125 --> 00:35:04,125
budget workshop.

946
00:35:04,922 --> 00:35:06,891
Last day for submission

947
00:35:06,891 --> 00:35:08,266
budgetary items will be the

948
00:35:08,266 --> 00:35:10,310
29th.

949
00:35:10,310 --> 00:35:11,625
We're starting our hearings on

950
00:35:11,625 --> 00:35:13,625
the 7th.

951
00:35:13,938 --> 00:35:17,109
We expect to be done by the 5th

952
00:35:17,109 --> 00:35:19,509
and then our final

953
00:35:19,812 --> 00:35:21,406
meeting after that to approve

954
00:35:21,406 --> 00:35:23,406
the entire process.

955
00:35:26,141 --> 00:35:29,741
I'm open to any questions that

956
00:35:30,312 --> 00:35:32,312
you might have.

957
00:35:32,484 --> 00:35:36,840
>> so, just on this one jeff,

958
00:35:37,531 --> 00:35:39,931
the center for leadership

959
00:35:43,797 --> 00:35:44,203
and transformation is

960
00:35:44,203 --> 00:35:46,203
transformative.

961
00:35:46,766 --> 00:35:47,875
I wonder if we have looked yet

962
00:35:47,875 --> 00:35:49,875
at finding ways.

963
00:35:50,109 --> 00:35:51,375
I know I seen it mentioned

964
00:35:51,375 --> 00:35:53,375
occasionally but finding

965
00:35:55,312 --> 00:35:57,312
ways to let the public know the

966
00:35:57,312 --> 00:35:57,578
kinds of differences we have

967
00:35:57,578 --> 00:35:59,453
made.

968
00:35:59,453 --> 00:36:02,470
some of you know, I was in

969
00:36:02,470 --> 00:36:04,922
pittsburgh at the end of

970
00:36:04,922 --> 00:36:08,620
last week and it was a

971
00:36:08,620 --> 00:36:08,250
conference put on in order to

972
00:36:08,250 --> 00:36:09,922
talk

973
00:36:09,922 --> 00:36:11,922
about transformation.

974
00:36:12,594 --> 00:36:13,734
It happen to concentrate on

975
00:36:13,734 --> 00:36:16,134
pittsburgh where we were.

976
00:36:16,391 --> 00:36:17,797
Pittsburgh as in pennsylvania

977
00:36:17,797 --> 00:36:18,766
and not california.

978
00:36:18,766 --> 00:36:20,620
the transformation that has

979
00:36:20,620 --> 00:36:23,620
taken place there and I

980
00:36:24,500 --> 00:36:25,344
never been there before, they

981
00:36:25,344 --> 00:36:28,344
certainly showed a great demo

982
00:36:29,780 --> 00:36:31,250
of what it used to look like.

983
00:36:31,250 --> 00:36:33,578
Many of you remember in the

984
00:36:33,578 --> 00:36:35,422
past, the three rivers

985
00:36:35,422 --> 00:36:36,516
there will catch on fire for

986
00:36:36,516 --> 00:36:36,859
the incredible amount of

987
00:36:36,859 --> 00:36:37,828
pollution.

988
00:36:37,828 --> 00:36:39,281
Transformation is so powerful

989
00:36:39,281 --> 00:36:41,484
that it really turning

990
00:36:41,484 --> 00:36:43,188
that city around.

991
00:36:43,188 --> 00:36:45,500
I think you can make an

992
00:36:45,500 --> 00:36:48,500
argument for this in this

993
00:36:48,594 --> 00:36:50,875
county and let our employees as

994
00:36:50,875 --> 00:36:54,475
well as those live in the

995
00:36:55,641 --> 00:36:58,844
county know that we have done

996
00:36:58,844 --> 00:37:00,984
this because, if I'm going to

997
00:37:00,984 --> 00:37:03,250
accept all that you say as

998
00:37:03,250 --> 00:37:03,609
gospel and so forth, it would

999
00:37:03,609 --> 00:37:05,609
be

1000
00:37:07,859 --> 00:37:09,470
great to see a series in the

1001
00:37:09,470 --> 00:37:11,940
murk that talks about what were

1002
00:37:11,940 --> 00:37:12,940
the differences that came about.

1003
00:37:12,940 --> 00:37:13,453
We made substantial investment

1004
00:37:13,453 --> 00:37:15,453
in this.

1005
00:37:16,940 --> 00:37:17,922
We involved stanford at a very

1006
00:37:17,922 --> 00:37:20,922
high level and I think

1007
00:37:21,828 --> 00:37:24,672
it's a wonderful opportunity to

1008
00:37:24,672 --> 00:37:26,109
show how we use county money

1009
00:37:26,109 --> 00:37:30,470
in different way to save a good

1010
00:37:30,470 --> 00:37:32,141
deal of money and also to

1011
00:37:32,141 --> 00:37:34,375
motivate and transform some of

1012
00:37:34,375 --> 00:37:36,375
our employees.

1013
00:37:37,160 --> 00:37:39,160
Just a thought.

1014
00:37:40,953 --> 00:37:42,940
>> well, in this year's budget

1015
00:37:42,940 --> 00:37:44,940
message, pages 9-18,

1016
00:37:44,297 --> 00:37:45,156
we've gone through all of the

1017
00:37:45,156 --> 00:37:46,620
current projects that are in

1018
00:37:46,620 --> 00:37:47,891
place.

1019
00:37:47,891 --> 00:37:48,828
You're right, it hasn't gotten

1020
00:37:48,828 --> 00:37:51,828
out as much to the

1021
00:37:54,940 --> 00:37:57,940
public as we would like.

1022
00:37:57,609 --> 00:37:58,906
We had a couple comments in the

1023
00:37:58,906 --> 00:38:01,234
newspaper but and we

1024
00:38:01,234 --> 00:38:04,438
put out a number of press

1025
00:38:04,438 --> 00:38:04,609
releases that don't typically

1026
00:38:04,609 --> 00:38:05,219
get

1027
00:38:05,219 --> 00:38:07,219
picked up.

1028
00:38:08,547 --> 00:38:09,953
We have this on our website

1029
00:38:09,953 --> 00:38:11,688
both our internal website

1030
00:38:11,688 --> 00:38:12,859
and our external website.

1031
00:38:12,859 --> 00:38:16,459
This year, will give us a

1032
00:38:16,828 --> 00:38:17,562
chance to refocus on getting

1033
00:38:17,562 --> 00:38:19,562
the message out.

1034
00:38:21,156 --> 00:38:21,797
>> a series was highlighted in

1035
00:38:21,797 --> 00:38:23,797
some departments.

1036
00:38:25,625 --> 00:38:28,310
some person putting a face on

1037
00:38:28,310 --> 00:38:29,531
it, can be very

1038
00:38:29,531 --> 00:38:31,531
influential.

1039
00:38:31,672 --> 00:38:32,703
Whenever I travel, there always

1040
00:38:32,703 --> 00:38:34,703
certain counties that

1041
00:38:35,984 --> 00:38:38,384
stick out including yours.

1042
00:38:40,484 --> 00:38:42,884
Fun to do that.

1043
00:38:46,391 --> 00:38:48,391
>> perfect.

1044
00:38:48,859 --> 00:38:50,859
>> supervisor cortese.

1045
00:38:52,766 --> 00:38:54,620
>> page 11 of the slides, you

1046
00:38:54,620 --> 00:38:56,297
went through this, that

1047
00:38:56,297 --> 00:38:59,940
page closes talking about a

1048
00:38:59,940 --> 00:39:02,940
plan b under development and

1049
00:39:04,266 --> 00:39:06,109
possibly revenue materialize as

1050
00:39:06,109 --> 00:39:06,812
planned.

1051
00:39:06,812 --> 00:39:09,212
Under development, can you

1052
00:39:10,281 --> 00:39:11,250
expand on that a little bit

1053
00:39:11,250 --> 00:39:13,250
more?

1054
00:39:13,344 --> 00:39:15,312
I don't know where is it at and

1055
00:39:15,312 --> 00:39:15,719
when will we hear more

1056
00:39:15,719 --> 00:39:17,719
about it?

1057
00:39:20,484 --> 00:39:21,953
Presumably if we were going to

1058
00:39:21,953 --> 00:39:23,594
have a contingency plan,

1059
00:39:23,594 --> 00:39:25,922
woe would have it ready before

1060
00:39:25,922 --> 00:39:26,125
the project develop and not

1061
00:39:26,125 --> 00:39:27,203
after.

1062
00:39:27,203 --> 00:39:27,891
I'm just wondering when is that

1063
00:39:27,891 --> 00:39:29,891
going to be

1064
00:39:32,469 --> 00:39:34,469
forthcoming.

1065
00:39:34,531 --> 00:39:35,438
I'm also wondering if any of

1066
00:39:35,438 --> 00:39:37,203
the thinking this board

1067
00:39:37,203 --> 00:39:38,906
asked to have looked at in

1068
00:39:38,906 --> 00:39:39,109
terms of areas where there can

1069
00:39:39,109 --> 00:39:41,109
be

1070
00:39:42,219 --> 00:39:44,516
a firewall between the general

1071
00:39:44,516 --> 00:39:46,516
fund and the enterprise fund.

1072
00:39:46,516 --> 00:39:47,719
i know we received some legal

1073
00:39:47,719 --> 00:39:50,516
advice as to where we

1074
00:39:50,516 --> 00:39:53,156
can't do that but we haven't

1075
00:39:53,156 --> 00:39:54,891
seen anything come forward

1076
00:39:54,891 --> 00:39:57,620
trying to make suggestions in

1077
00:39:57,620 --> 00:39:58,203
the areas where we can do

1078
00:39:58,203 --> 00:40:00,203
that.

1079
00:40:00,203 --> 00:40:02,469
>> let me try to take those two

1080
00:40:02,469 --> 00:40:02,797
questions one at a

1081
00:40:02,797 --> 00:40:04,797
time.

1082
00:40:06,203 --> 00:40:09,203
Number one, in terms of

1083
00:40:10,172 --> 00:40:11,203
developing a plan b, we don't

1084
00:40:11,203 --> 00:40:12,344
have that plan to the point

1085
00:40:12,344 --> 00:40:15,944
where we would be prepared to

1086
00:40:16,160 --> 00:40:19,616
put it out in the public.

1087
00:40:20,719 --> 00:40:23,156
The only other approach to

1088
00:40:23,156 --> 00:40:23,594
unrealized revenue is to

1089
00:40:23,594 --> 00:40:25,310
reduce expenditures.

1090
00:40:25,310 --> 00:40:26,562
There are a number of programs

1091
00:40:26,562 --> 00:40:28,962
in the health and

1092
00:40:29,266 --> 00:40:30,594
hospital system which are not

1093
00:40:30,594 --> 00:40:32,594
absolutely mandated.

1094
00:40:32,859 --> 00:40:35,859
Certainly not mandated to the

1095
00:40:36,703 --> 00:40:37,203
level that we provide

1096
00:40:37,203 --> 00:40:39,203
them.

1097
00:40:39,781 --> 00:40:41,641
If indeed we were unable to

1098
00:40:41,641 --> 00:40:44,641
meet revenues, we'd have to

1099
00:40:48,484 --> 00:40:51,484
start looking at those services.

1100
00:40:51,484 --> 00:40:53,453
They typically are specialty

1101
00:40:53,453 --> 00:40:55,853
type services and other

1102
00:40:56,891 --> 00:40:57,797
support services. That will be

1103
00:40:57,797 --> 00:40:58,828
in significant reductions.

1104
00:40:58,828 --> 00:40:59,531
Obviously, none of us want to

1105
00:40:59,531 --> 00:41:01,000
do that.

1106
00:41:01,000 --> 00:41:04,000
Therefore, we trying to project

1107
00:41:04,938 --> 00:41:05,469
a budget here we think

1108
00:41:05,469 --> 00:41:05,734
is very conservative and

1109
00:41:05,734 --> 00:41:07,734
rational.

1110
00:41:08,500 --> 00:41:10,703
In the midst of healthcare

1111
00:41:10,703 --> 00:41:13,750
reform, it is not the time

1112
00:41:13,750 --> 00:41:14,844
to be reducing services but as

1113
00:41:14,844 --> 00:41:18,444
you well know, the budget has

1114
00:41:21,781 --> 00:41:25,219
to balance one way or the other.

1115
00:41:25,219 --> 00:41:26,484
We are in contingency planning.

1116
00:41:26,484 --> 00:41:28,484
We will bring that forward when

1117
00:41:28,484 --> 00:41:29,531
we feel like it's ready

1118
00:41:29,531 --> 00:41:31,531
to be public.

1119
00:41:33,422 --> 00:41:36,328
in terms of the second answer

1120
00:41:36,328 --> 00:41:38,728
or second question about

1121
00:41:39,000 --> 00:41:42,600
a firewall, as you know, the

1122
00:41:43,906 --> 00:41:46,306
board does have constitutional

1123
00:41:46,641 --> 00:41:47,312
obligations under 17,000 to

1124
00:41:47,312 --> 00:41:47,906
provide healthcare for

1125
00:41:47,906 --> 00:41:49,780
medically

1126
00:41:49,780 --> 00:41:51,478
injured in the county.

1127
00:41:56,656 --> 00:41:59,125
we provide far more than that.

1128
00:41:59,125 --> 00:42:01,156
But, there is no legal

1129
00:42:01,156 --> 00:42:03,391
structural way to actually

1130
00:42:03,391 --> 00:42:04,859
prevent the expenditure of

1131
00:42:04,859 --> 00:42:07,259
money on that program.

1132
00:42:10,310 --> 00:42:11,203
It really boils down to setting

1133
00:42:11,203 --> 00:42:13,603
up systems -- policy

1134
00:42:15,906 --> 00:42:16,547
and commitments in the board

1135
00:42:16,547 --> 00:42:18,875
policy area that will restrict

1136
00:42:18,875 --> 00:42:20,812
how much money gets moved from

1137
00:42:20,812 --> 00:42:22,812
the general fund.

1138
00:42:22,844 --> 00:42:23,922
At this point, I know that

1139
00:42:23,922 --> 00:42:26,322
county council has been

1140
00:42:29,328 --> 00:42:32,531
working on some of those ideas.

1141
00:42:32,531 --> 00:42:36,131
we are targeting in this budget

1142
00:42:36,594 --> 00:42:38,859
trying to keep the

1143
00:42:38,859 --> 00:42:41,859
general fund subsidy below the

1144
00:42:41,906 --> 00:42:42,234
10% range of the entire

1145
00:42:42,234 --> 00:42:44,234
expenditure.

1146
00:42:44,578 --> 00:42:45,844
I think you'll see that we are

1147
00:42:45,844 --> 00:42:48,244
successful in that with

1148
00:42:48,344 --> 00:42:50,344
some leeway.

1149
00:42:50,938 --> 00:42:53,547
When I started 2.5 years ago,s

1150
00:42:53,547 --> 00:42:54,547
general fund subsidy was

1151
00:42:54,547 --> 00:42:56,547
about $220 million.

1152
00:42:57,688 --> 00:43:00,984
This budget envisions it to be

1153
00:43:00,984 --> 00:43:01,828
about $85.5 million.

1154
00:43:01,828 --> 00:43:03,219
That's a significant reduction

1155
00:43:03,219 --> 00:43:05,219
without significant

1156
00:43:05,766 --> 00:43:07,766
reduction in services.

1157
00:43:08,203 --> 00:43:08,859
I obviously can't take the

1158
00:43:08,859 --> 00:43:10,859
credit for that.

1159
00:43:10,969 --> 00:43:11,797
The hospital should take the

1160
00:43:11,797 --> 00:43:13,797
credit for that.

1161
00:43:15,620 --> 00:43:18,172
they done a fabulous job of

1162
00:43:18,172 --> 00:43:20,172
improving their efficiency

1163
00:43:20,906 --> 00:43:22,906
and effectiveness.

1164
00:43:24,875 --> 00:43:27,875
That's a good step forward

1165
00:43:27,984 --> 00:43:28,625
indicating that we are

1166
00:43:28,625 --> 00:43:30,625
making significant progress.

1167
00:43:31,470 --> 00:43:33,297
>> if you measure that by board

1168
00:43:33,297 --> 00:43:35,297
presidency, we've all

1169
00:43:35,719 --> 00:43:37,562
done well, President Shirakawa

1170
00:43:37,562 --> 00:43:38,500
you just have $85 million

1171
00:43:38,500 --> 00:43:40,500
more to go.

1172
00:43:43,469 --> 00:43:45,000
[Laughter] I want to get this

1173
00:43:45,000 --> 00:43:46,609
clear so it doesn't get

1174
00:43:46,609 --> 00:43:49,375
-- probably will anyway --

1175
00:43:49,375 --> 00:43:49,672
perhaps it doesn't get

1176
00:43:49,672 --> 00:43:51,516
misprinted

1177
00:43:51,516 --> 00:43:52,750
somewhere by some opinion

1178
00:43:52,750 --> 00:43:52,969
maker. I'm not suggesting nor

1179
00:43:52,969 --> 00:43:54,969
do

1180
00:43:56,160 --> 00:43:57,844
i hear the board suggest that

1181
00:43:57,844 --> 00:44:00,125
we do anything other than

1182
00:44:00,125 --> 00:44:00,750
guarantee the 17,000

1183
00:44:00,750 --> 00:44:02,750
commitments.

1184
00:44:04,891 --> 00:44:06,422
When you present it to us last

1185
00:44:06,422 --> 00:44:07,625
year, what the hospital

1186
00:44:07,625 --> 00:44:10,625
system was spending money on,

1187
00:44:14,172 --> 00:44:16,734
that piece of it is a less

1188
00:44:16,734 --> 00:44:16,969
than 10% of the total hospital

1189
00:44:16,969 --> 00:44:18,344
budget.

1190
00:44:18,344 --> 00:44:20,766
It seem to me we can guarantee

1191
00:44:20,766 --> 00:44:23,166
that piece and still

1192
00:44:23,375 --> 00:44:26,975
have awful lot of attitude in

1193
00:44:28,188 --> 00:44:28,844
term of where we prohibit

1194
00:44:28,844 --> 00:44:29,688
ourselves moving money back and

1195
00:44:29,688 --> 00:44:31,547
forth.

1196
00:44:31,547 --> 00:44:32,750
I'm only suggesting under this

1197
00:44:32,750 --> 00:44:34,750
plan b scenario.

1198
00:44:34,781 --> 00:44:35,719
I'm coming into this process

1199
00:44:35,719 --> 00:44:38,119
more than willing to

1200
00:44:41,797 --> 00:44:45,397
support this plan at this point

1201
00:44:45,531 --> 00:44:47,531
of half revenue solution and

1202
00:44:47,531 --> 00:44:49,531
half subsidy solutions.

1203
00:44:51,969 --> 00:44:53,547
Currently plan b -- we all have

1204
00:44:53,547 --> 00:44:54,470
concern to have in

1205
00:44:54,470 --> 00:44:56,470
place.

1206
00:44:58,719 --> 00:44:59,953
i'm actually thanking you for

1207
00:44:59,953 --> 00:45:01,953
that.

1208
00:45:04,516 --> 00:45:05,594
>> you're correct on both parts.

1209
00:45:05,594 --> 00:45:06,453
We do have more flexibility

1210
00:45:06,453 --> 00:45:08,453
without reducing services

1211
00:45:10,453 --> 00:45:12,766
to reduce our costs.

1212
00:45:12,766 --> 00:45:15,166
We can actually increase

1213
00:45:16,203 --> 00:45:18,940
services and reduce our cost.

1214
00:45:18,940 --> 00:45:19,531
we're making progress there and

1215
00:45:19,531 --> 00:45:20,531
that will be our

1216
00:45:20,531 --> 00:45:22,531
directive.

1217
00:45:23,203 --> 00:45:25,172
Like you say, if we can't meet

1218
00:45:25,172 --> 00:45:26,781
it, we will then have to

1219
00:45:26,781 --> 00:45:27,141
start thinking about what we

1220
00:45:27,141 --> 00:45:29,141
can do without.

1221
00:45:31,250 --> 00:45:34,780
>> to the chair, again, not to

1222
00:45:34,780 --> 00:45:36,780
be misunderstood, I was

1223
00:45:36,780 --> 00:45:37,250
joking with regard to the

1224
00:45:37,250 --> 00:45:39,750
credit with the board President.

1225
00:45:39,750 --> 00:45:41,797
i do agree that employees are

1226
00:45:41,797 --> 00:45:42,188
the ones who have done

1227
00:45:42,188 --> 00:45:43,891
this.

1228
00:45:43,891 --> 00:45:45,656
There's no way five supervisors

1229
00:45:45,656 --> 00:45:47,969
or senior staff can go

1230
00:45:47,969 --> 00:45:51,569
out and manage an operation and

1231
00:45:52,906 --> 00:45:55,306
bring numbers into alignment

1232
00:45:57,234 --> 00:45:57,812
like that.

1233
00:45:57,812 --> 00:45:58,703
That's understood.

1234
00:45:58,703 --> 00:46:00,703
thank you.

1235
00:46:03,219 --> 00:46:04,547
>> anyone else on this section?

1236
00:46:04,547 --> 00:46:05,719
Thank you jeff.

1237
00:46:05,719 --> 00:46:07,719
Item five is overview of

1238
00:46:07,719 --> 00:46:10,719
funding status of the county

1239
00:46:11,620 --> 00:46:13,940
retiree medical benefit program.

1240
00:46:13,940 --> 00:46:13,953
>> george I'm taking my share

1241
00:46:13,953 --> 00:46:16,353
of time this year.

1242
00:46:19,891 --> 00:46:20,969
this is my last year.

1243
00:46:20,969 --> 00:46:22,297
I get special privileges.

1244
00:46:22,297 --> 00:46:25,297
I'm sitting here thinking that

1245
00:46:26,500 --> 00:46:27,938
when I first got here in

1246
00:46:27,938 --> 00:46:30,141
2001, the budget was quite

1247
00:46:30,141 --> 00:46:31,812
robust.

1248
00:46:31,812 --> 00:46:34,812
You remember gary, believe it

1249
00:46:35,641 --> 00:46:38,516
or not, they were called

1250
00:46:38,516 --> 00:46:40,625
funds supervisors had to offer

1251
00:46:40,625 --> 00:46:43,250
to their own district.

1252
00:46:43,891 --> 00:46:44,940
The next year that wasn't the

1253
00:46:44,940 --> 00:46:46,940
case.

1254
00:46:46,219 --> 00:46:47,500
By 2003 it was dismal.

1255
00:46:47,500 --> 00:46:48,391
It has been dismal for at least

1256
00:46:48,391 --> 00:46:50,469
nine or ten years.

1257
00:46:50,469 --> 00:46:53,940
It is amazing to be doing a

1258
00:46:53,940 --> 00:46:54,328
budget where we're not

1259
00:46:54,328 --> 00:46:55,500
discussing how awful it will

1260
00:46:55,500 --> 00:46:58,109
be, how terrible the year will

1261
00:46:58,109 --> 00:46:58,766
be, how many test we'll have to

1262
00:46:58,766 --> 00:47:00,766
make.

1263
00:47:04,844 --> 00:47:08,444
i think you're both to be

1264
00:47:08,688 --> 00:47:10,688
commended.

1265
00:47:12,250 --> 00:47:12,922
It seemed kind of jerky at

1266
00:47:12,922 --> 00:47:14,453
times.

1267
00:47:14,453 --> 00:47:15,125
Hard word, kind of a stop and

1268
00:47:15,125 --> 00:47:17,125
start.

1269
00:47:18,859 --> 00:47:20,500
Think we've gotten to an

1270
00:47:20,500 --> 00:47:22,900
unusually good spot given

1271
00:47:24,203 --> 00:47:26,500
where many other counties are.

1272
00:47:26,500 --> 00:47:27,172
Where much of california

1273
00:47:27,172 --> 00:47:29,572
doesn't enjoy the privilege

1274
00:47:30,375 --> 00:47:31,641
we're having this year of

1275
00:47:31,641 --> 00:47:32,469
looking at a budget that

1276
00:47:32,469 --> 00:47:34,469
doesn't

1277
00:47:34,906 --> 00:47:35,547
have as many challenges that it

1278
00:47:35,547 --> 00:47:37,375
has before.

1279
00:47:37,375 --> 00:47:38,406
I just don't -- it would not be

1280
00:47:38,406 --> 00:47:41,406
there if we didn't call

1281
00:47:41,609 --> 00:47:45,160
that out and say, good job.

1282
00:47:45,160 --> 00:47:45,594
i can look back over 11.5 years

1283
00:47:45,594 --> 00:47:47,594
at this point.

1284
00:47:50,620 --> 00:47:50,359
It's been a lot of those times

1285
00:47:50,359 --> 00:47:52,359
very rocky.

1286
00:47:52,625 --> 00:47:54,940
I thank you and I'm sure whole

1287
00:47:54,940 --> 00:47:54,766
board joins me in that.

1288
00:47:54,766 --> 00:47:56,203
>> thank you.

1289
00:47:56,203 --> 00:47:57,000
>> you better keep up the good

1290
00:47:57,000 --> 00:47:59,000
work.

1291
00:47:59,266 --> 00:48:00,875
>> well, we will.

1292
00:48:00,875 --> 00:48:03,344
It's only because of fabulous

1293
00:48:03,344 --> 00:48:05,609
employees and mary and

1294
00:48:05,609 --> 00:48:08,609
leslie and gary and department

1295
00:48:10,781 --> 00:48:12,281
heads who and all of their

1296
00:48:12,281 --> 00:48:13,922
finance people who do yohman's

1297
00:48:13,922 --> 00:48:15,391
job and they're here late

1298
00:48:15,391 --> 00:48:16,470
nights and making sure

1299
00:48:16,470 --> 00:48:16,922
everything adds up.

1300
00:48:16,922 --> 00:48:19,594
Thank you for recognizing that.

1301
00:48:19,594 --> 00:48:20,750
>> by the way, we are waiting

1302
00:48:20,750 --> 00:48:22,750
until January for

1303
00:48:26,766 --> 00:48:29,766
reinstated some of those funds

1304
00:48:34,141 --> 00:48:35,469
from the districts.

1305
00:48:35,469 --> 00:48:37,869
>> thank you Mr. President.

1306
00:48:38,312 --> 00:48:41,912
We wanted to provide you with

1307
00:48:43,875 --> 00:48:46,875
an overview of the issue

1308
00:49:05,969 --> 00:49:08,969
of the opeb retiree benefit.

1309
00:49:09,406 --> 00:49:10,875
First slide.

1310
00:49:10,875 --> 00:49:11,984
The second slide -- I'm going

1311
00:49:11,984 --> 00:49:14,384
to go through this

1312
00:49:19,125 --> 00:49:19,719
quickly because there's a lot of

1313
00:49:19,719 --> 00:49:21,470
contextual information.

1314
00:49:21,470 --> 00:49:22,688
The important thing about this

1315
00:49:22,688 --> 00:49:24,625
slide it outlines the

1316
00:49:24,625 --> 00:49:27,625
benefit we provide employees by

1317
00:49:28,688 --> 00:49:30,234
no means it's all retiree

1318
00:49:30,234 --> 00:49:31,391
medical benefit, the most

1319
00:49:31,391 --> 00:49:31,766
generous and no way that's the

1320
00:49:31,766 --> 00:49:33,766
case.

1321
00:49:34,875 --> 00:49:38,475
We only provide the benefit if

1322
00:49:39,234 --> 00:49:40,578
you retire from the

1323
00:49:40,578 --> 00:49:41,469
county, if you've met five up

1324
00:49:41,469 --> 00:49:42,938
to ten year continue of

1325
00:49:42,938 --> 00:49:43,484
service in order to get the

1326
00:49:43,484 --> 00:49:45,484
benefit.

1327
00:49:47,547 --> 00:49:47,922
also we only pay equal to the

1328
00:49:47,922 --> 00:49:49,922
geyser premium.

1329
00:49:50,578 --> 00:49:54,178
At the same time, that being

1330
00:49:55,250 --> 00:49:55,797
said, this is an expensive

1331
00:49:55,797 --> 00:49:56,891
benefit.

1332
00:49:56,891 --> 00:49:57,953
Next slide provide you with

1333
00:49:57,953 --> 00:50:00,353
some perspectives in terms

1334
00:50:02,266 --> 00:50:04,266
of how things have changed.

1335
00:50:04,266 --> 00:50:07,266
To give you some perspective,

1336
00:50:07,344 --> 00:50:09,344
the county began

1337
00:50:11,500 --> 00:50:13,900
prefunding this benefit in 1984.

1338
00:50:14,344 --> 00:50:15,780
We wanted very few organizes

1339
00:50:15,780 --> 00:50:16,672
that did studies to

1340
00:50:16,672 --> 00:50:18,375
determine what we needed to put

1341
00:50:18,375 --> 00:50:20,219
into this program in order

1342
00:50:20,219 --> 00:50:22,619
to fully fund it.

1343
00:50:25,188 --> 00:50:27,594
Since that time, there has been

1344
00:50:27,594 --> 00:50:29,297
a variety of changes.

1345
00:50:29,297 --> 00:50:31,297
2008, new requirements,

1346
00:50:34,969 --> 00:50:37,969
required the reporting of the

1347
00:50:41,141 --> 00:50:43,141
unfunded actuarial liability.

1348
00:50:44,609 --> 00:50:46,844
It requires dedicated assets to

1349
00:50:46,844 --> 00:50:48,219
be placed in

1350
00:50:48,219 --> 00:50:50,219
irrevokable trust.

1351
00:50:53,719 --> 00:50:56,470
The county did open a trust in

1352
00:50:56,470 --> 00:50:58,447
cal pers in indicate

1353
00:50:58,859 --> 00:51:00,859
2008.

1354
00:51:02,188 --> 00:51:04,500
The board approved those

1355
00:51:04,500 --> 00:51:05,125
funding. We ended up

1356
00:51:05,125 --> 00:51:07,125
suspended contributions in 2010

1357
00:51:08,734 --> 00:51:10,620
when we were really dealing

1358
00:51:10,620 --> 00:51:13,310
with our cash flow crisis.

1359
00:51:13,310 --> 00:51:16,203
That's the reason why in this

1360
00:51:16,203 --> 00:51:18,547
year, we are recommending

1361
00:51:18,547 --> 00:51:19,203
to increase our contribution to

1362
00:51:19,203 --> 00:51:21,203
this benefit program.

1363
00:51:21,953 --> 00:51:24,953
Also it's important to point

1364
00:51:26,922 --> 00:51:29,322
out that beginning in

1365
00:51:29,984 --> 00:51:30,562
2012, we did negotiate, some of

1366
00:51:30,562 --> 00:51:32,562
the employees contributing

1367
00:51:35,125 --> 00:51:35,359
directly to the cost of retiree

1368
00:51:35,359 --> 00:51:37,359
health.

1369
00:51:39,000 --> 00:51:39,562
Next slide provide you with

1370
00:51:39,562 --> 00:51:41,641
some definitions that might

1371
00:51:41,641 --> 00:51:43,109
be helpful for you in terms of

1372
00:51:43,109 --> 00:51:44,875
identifying how retiree

1373
00:51:44,875 --> 00:51:46,469
medical benefits are funded and

1374
00:51:46,469 --> 00:51:48,869
it gives a little

1375
00:51:49,844 --> 00:51:51,875
description, pay as you go.

1376
00:51:51,875 --> 00:51:54,875
Really only covers the current

1377
00:51:56,578 --> 00:51:57,922
period cost for current

1378
00:51:57,922 --> 00:51:59,780
retirees. The normal cost is

1379
00:51:59,780 --> 00:52:00,922
pay as you go.

1380
00:52:00,922 --> 00:52:02,562
Plus we're funding the cost of

1381
00:52:02,562 --> 00:52:03,359
benefits for future

1382
00:52:03,359 --> 00:52:05,359
retirees.

1383
00:52:07,469 --> 00:52:08,310
This is referred tos a partial

1384
00:52:08,310 --> 00:52:10,310
refunding, the arc,

1385
00:52:10,672 --> 00:52:12,703
which is the annual required

1386
00:52:12,703 --> 00:52:15,703
contribution is a normal cost

1387
00:52:16,310 --> 00:52:17,500
plus we're also making payments

1388
00:52:17,500 --> 00:52:19,900
on the unfunded liability.

1389
00:52:20,172 --> 00:52:20,703
This is substantial amount of

1390
00:52:20,703 --> 00:52:22,406
payments that ideally we

1391
00:52:22,406 --> 00:52:25,953
can reach but when you see the

1392
00:52:25,953 --> 00:52:27,812
figures, you can see what a

1393
00:52:27,812 --> 00:52:30,212
challenge that will be.

1394
00:52:30,781 --> 00:52:33,940
the next slide is a graphic

1395
00:52:33,940 --> 00:52:35,156
representation of the value

1396
00:52:35,156 --> 00:52:37,556
of these funding methodologies

1397
00:52:39,328 --> 00:52:43,310
and as you can see, the arc

1398
00:52:43,310 --> 00:52:43,906
currently is in the range of

1399
00:52:43,906 --> 00:52:46,306
around $170 million, which is

1400
00:52:47,531 --> 00:52:47,766
way above what we're currently

1401
00:52:47,766 --> 00:52:48,906
funding.

1402
00:52:48,906 --> 00:52:51,172
To the extent to which we do

1403
00:52:51,172 --> 00:52:53,609
not pay for the unfunded

1404
00:52:53,609 --> 00:52:55,750
liability, as you can see the

1405
00:52:55,750 --> 00:52:58,750
trend will increase over time.

1406
00:52:59,656 --> 00:53:01,719
These are annual costs.

1407
00:53:01,719 --> 00:53:02,812
The next slide gives you a

1408
00:53:02,812 --> 00:53:05,750
summary of where we are in

1409
00:53:05,750 --> 00:53:08,625
the funding of this program.

1410
00:53:08,625 --> 00:53:11,940
The amount that we have

1411
00:53:11,940 --> 00:53:13,494
contributed to the irrevokable

1412
00:53:13,672 --> 00:53:16,720
trust is $252 million opinion

1413
00:53:17,438 --> 00:53:18,266
we are still retaining in our

1414
00:53:18,266 --> 00:53:20,266
county funds $163 million.

1415
00:53:20,703 --> 00:53:23,375
These are funds that were

1416
00:53:23,375 --> 00:53:24,470
originally anticipated to be

1417
00:53:24,470 --> 00:53:24,516
transferred to their

1418
00:53:24,516 --> 00:53:26,516
irrevokable trust.

1419
00:53:26,844 --> 00:53:27,844
We've hold on to them base on

1420
00:53:27,844 --> 00:53:29,375
our concerns around cash

1421
00:53:29,375 --> 00:53:31,109
flow.

1422
00:53:31,109 --> 00:53:32,391
The retiree health trust fund

1423
00:53:32,391 --> 00:53:34,791
is a major source.

1424
00:53:36,328 --> 00:53:37,328
i think if you recall, we have

1425
00:53:37,328 --> 00:53:38,940
about $250 million worth

1426
00:53:38,940 --> 00:53:40,940
of play.

1427
00:53:42,940 --> 00:53:44,891
I got amount of 160 is retiree

1428
00:53:44,891 --> 00:53:46,891
health trust fund.

1429
00:53:46,906 --> 00:53:49,906
During the 2009, '10 time frame

1430
00:53:50,172 --> 00:53:51,641
when the economy was in

1431
00:53:51,641 --> 00:53:54,141
a chaotic state, we felt it was

1432
00:53:54,141 --> 00:53:56,541
very important to maintain

1433
00:53:57,109 --> 00:53:58,406
that flexibility in cash as was

1434
00:53:58,406 --> 00:54:00,806
discussed with the board.

1435
00:54:03,844 --> 00:54:04,656
As time has moved on, we're

1436
00:54:04,656 --> 00:54:06,656
feeling little more

1437
00:54:06,984 --> 00:54:09,384
comfortable in starting to

1438
00:54:10,359 --> 00:54:10,594
transfer funds out of the

1439
00:54:10,594 --> 00:54:11,828
retiree

1440
00:54:11,828 --> 00:54:12,625
health trust fund and that's

1441
00:54:12,625 --> 00:54:14,625
went recommendations we're

1442
00:54:14,969 --> 00:54:16,359
making in the current year.

1443
00:54:16,359 --> 00:54:18,859
Now the number that's startling

1444
00:54:18,859 --> 00:54:22,459
and of concern to us is

1445
00:54:23,703 --> 00:54:24,609
in fact our actuarial accrued

1446
00:54:24,609 --> 00:54:25,172
liability which is now

1447
00:54:25,172 --> 00:54:27,172
exceeding $2 billion.

1448
00:54:33,109 --> 00:54:33,953
Believe it or not, in 1999, the

1449
00:54:33,953 --> 00:54:35,219
actuarial accrueded

1450
00:54:35,219 --> 00:54:36,891
liability was $69 million.

1451
00:54:36,891 --> 00:54:37,422
So it increased substantially

1452
00:54:37,422 --> 00:54:40,422
based on a variety of

1453
00:54:40,453 --> 00:54:44,530
factors that I will touch on.

1454
00:54:44,359 --> 00:54:47,959
Again, the next slide gives you

1455
00:54:50,620 --> 00:54:50,672
a since of how the

1456
00:54:50,672 --> 00:54:52,672
unfunded actuarial accrueded

1457
00:54:53,000 --> 00:54:53,797
liability has changed over the

1458
00:54:53,797 --> 00:54:55,766
last 12 years.

1459
00:54:55,766 --> 00:54:56,500
That growth has been

1460
00:54:56,500 --> 00:54:57,812
significant as our

1461
00:54:57,812 --> 00:54:59,812
contributions

1462
00:55:00,470 --> 00:55:02,812
really have been limited again.

1463
00:55:02,812 --> 00:55:03,750
We did that in order to really

1464
00:55:03,750 --> 00:55:04,922
protect our services.

1465
00:55:04,922 --> 00:55:07,719
It's a decision that was

1466
00:55:07,719 --> 00:55:09,453
difficult but one that I think

1467
00:55:09,453 --> 00:55:11,853
we stand behind because

1468
00:55:12,453 --> 00:55:12,688
clearly, our mission is to

1469
00:55:12,688 --> 00:55:13,594
provide

1470
00:55:13,594 --> 00:55:15,594
service.

1471
00:55:15,688 --> 00:55:16,859
I think looking back, it was

1472
00:55:16,859 --> 00:55:19,859
the right thing to do.

1473
00:55:21,359 --> 00:55:23,641
The next slide provides you

1474
00:55:23,641 --> 00:55:25,406
with some more recent

1475
00:55:25,406 --> 00:55:26,310
information about our

1476
00:55:26,310 --> 00:55:28,310
contributions.

1477
00:55:29,109 --> 00:55:31,780
In 2008 and 2009, we

1478
00:55:31,780 --> 00:55:32,641
contributed 100% of our arc.

1479
00:55:32,641 --> 00:55:33,203
That was possible because we

1480
00:55:33,203 --> 00:55:34,438
utilized the retiree

1481
00:55:34,438 --> 00:55:37,188
health trust fund in addition

1482
00:55:37,188 --> 00:55:39,780
to what we budgeted to meet

1483
00:55:39,780 --> 00:55:41,470
100% of those costs.

1484
00:55:41,470 --> 00:55:42,391
As our deficits grew and we had

1485
00:55:42,391 --> 00:55:44,391
fewer and fewer

1486
00:55:46,828 --> 00:55:47,719
options, we made the decision

1487
00:55:47,719 --> 00:55:50,119
to reduce those expenditures

1488
00:55:52,328 --> 00:55:53,000
and as you can see, the amount

1489
00:55:53,000 --> 00:55:55,000
we contributed declined.

1490
00:55:55,531 --> 00:55:57,562
So, at this point in time, one

1491
00:55:57,562 --> 00:55:59,344
of the things that we're

1492
00:55:59,344 --> 00:56:02,344
recommending is to increase our

1493
00:56:02,500 --> 00:56:04,750
contribution in terms of our

1494
00:56:04,750 --> 00:56:07,750
ongoing funds from 50% of the

1495
00:56:07,906 --> 00:56:10,250
normal cost to 75% and then

1496
00:56:10,250 --> 00:56:11,844
make up that difference to get

1497
00:56:11,844 --> 00:56:14,244
to 100% gi beginning to

1498
00:56:14,688 --> 00:56:17,880
transfer from the retiree

1499
00:56:17,359 --> 00:56:17,984
health trust fun to the

1500
00:56:17,984 --> 00:56:19,188
irrevokable trust.

1501
00:56:19,188 --> 00:56:22,940
We begin drawing down reducing

1502
00:56:22,940 --> 00:56:24,494
the amount in the

1503
00:56:25,703 --> 00:56:26,859
retiree health trust fund by

1504
00:56:26,859 --> 00:56:28,859
relatively small amount.

1505
00:56:29,531 --> 00:56:31,203
We obviously will not go too

1506
00:56:31,203 --> 00:56:32,844
far too fast because we're

1507
00:56:32,844 --> 00:56:33,234
not 100% confident in the

1508
00:56:33,234 --> 00:56:35,234
economy.

1509
00:56:37,781 --> 00:56:39,172
The next slide provides you

1510
00:56:39,172 --> 00:56:41,572
with again, a graphical

1511
00:56:41,844 --> 00:56:42,875
representation about the

1512
00:56:42,875 --> 00:56:43,156
estimated future unfunded

1513
00:56:43,156 --> 00:56:45,156
liability

1514
00:56:45,719 --> 00:56:46,359
based on the three funding

1515
00:56:46,359 --> 00:56:48,359
mechanisms.

1516
00:56:49,281 --> 00:56:50,750
Our goal is to again, reach

1517
00:56:50,750 --> 00:56:52,766
that 100% of normal cost

1518
00:56:52,766 --> 00:56:55,469
and then as possible, try to

1519
00:56:55,469 --> 00:56:58,469
begin paying some of that

1520
00:57:00,562 --> 00:57:01,406
unfunded liability depending on

1521
00:57:01,406 --> 00:57:03,406
circumstances.

1522
00:57:03,500 --> 00:57:06,470
the next slide provides some

1523
00:57:06,470 --> 00:57:08,470
information regarding why

1524
00:57:09,875 --> 00:57:11,780
the unfunded liability has

1525
00:57:11,780 --> 00:57:11,672
grown so quickly. Retiree

1526
00:57:11,672 --> 00:57:13,672
health

1527
00:57:14,156 --> 00:57:14,984
is very sensitive to rise in

1528
00:57:14,984 --> 00:57:16,984
health insurance premiums.

1529
00:57:17,453 --> 00:57:18,984
That's a problem we face not

1530
00:57:18,984 --> 00:57:19,828
only here but of course in our

1531
00:57:19,828 --> 00:57:21,250
regular health premiums.

1532
00:57:21,250 --> 00:57:23,625
We see substantial growth and

1533
00:57:23,625 --> 00:57:24,266
even though they are not

1534
00:57:24,266 --> 00:57:26,266
in the double didn't range as

1535
00:57:26,266 --> 00:57:29,620
they had been in prior years,

1536
00:57:29,620 --> 00:57:29,391
they are still growing

1537
00:57:29,391 --> 00:57:31,141
significantly.

1538
00:57:31,141 --> 00:57:33,234
The increase number of

1539
00:57:33,234 --> 00:57:36,234
employees in retirees when we

1540
00:57:40,469 --> 00:57:41,781
look at this from a actuarial

1541
00:57:41,781 --> 00:57:43,109
perspective, has an impact on

1542
00:57:43,109 --> 00:57:45,109
that.

1543
00:57:45,141 --> 00:57:48,780
the funding strategy as I

1544
00:57:48,780 --> 00:57:51,780
mentioned, the more we put

1545
00:57:51,484 --> 00:57:52,188
into it, the limits the growth

1546
00:57:52,188 --> 00:57:53,953
of unfunded liability and

1547
00:57:53,953 --> 00:57:56,391
also the investment return rate.

1548
00:57:56,391 --> 00:57:57,531
All of those things have been

1549
00:57:57,531 --> 00:57:59,931
challenged by the economy

1550
00:58:02,703 --> 00:58:05,266
over the last several years.

1551
00:58:05,266 --> 00:58:07,609
the next slide provides some of

1552
00:58:07,609 --> 00:58:09,109
the things -- some of

1553
00:58:09,109 --> 00:58:10,781
the strategies that we're

1554
00:58:10,781 --> 00:58:10,969
thinking about and certainly

1555
00:58:10,969 --> 00:58:12,969
it's

1556
00:58:13,406 --> 00:58:14,906
important to note that these

1557
00:58:14,906 --> 00:58:15,609
are all subject to labor

1558
00:58:15,609 --> 00:58:17,609
contract negotiations.

1559
00:58:17,812 --> 00:58:19,953
These are not things that we

1560
00:58:19,953 --> 00:58:21,953
would implement.

1561
00:58:21,984 --> 00:58:23,188
Unilaterally but they will be

1562
00:58:23,188 --> 00:58:24,484
part of our contract

1563
00:58:24,484 --> 00:58:25,922
negotiations.

1564
00:58:25,922 --> 00:58:27,891
things that we can do for

1565
00:58:27,891 --> 00:58:28,953
instance would be to cap

1566
00:58:28,953 --> 00:58:30,953
county contributions.

1567
00:58:32,234 --> 00:58:33,672
We could reduce benefit

1568
00:58:33,672 --> 00:58:35,672
coverage levels.

1569
00:58:38,620 --> 00:58:38,969
Introduce a health saving

1570
00:58:38,969 --> 00:58:40,109
account option.

1571
00:58:40,109 --> 00:58:42,509
And on and on.

1572
00:58:43,703 --> 00:58:47,219
There are ways in which we can

1573
00:58:47,219 --> 00:58:49,219
address this obviously,

1574
00:58:52,922 --> 00:58:54,922
mistakes obvious --

1575
00:58:54,984 --> 00:58:55,328
this is something we have to

1576
00:58:55,328 --> 00:58:57,328
address.

1577
00:58:58,297 --> 00:59:00,297
The next step on the last

1578
00:59:00,297 --> 00:59:02,594
slide, what we are suggesting

1579
00:59:02,594 --> 00:59:03,940
we do is to create an

1580
00:59:03,940 --> 00:59:04,859
administrative steering

1581
00:59:04,859 --> 00:59:06,859
committee for

1582
00:59:08,000 --> 00:59:10,438
the retiree health benefit to

1583
00:59:10,438 --> 00:59:12,172
study best practices and to

1584
00:59:12,172 --> 00:59:14,172
develop options for

1585
00:59:15,875 --> 00:59:18,160
presentation to the board.

1586
00:59:18,160 --> 00:59:20,312
Obviously we want to obtain

1587
00:59:20,312 --> 00:59:22,344
input from our county and

1588
00:59:22,344 --> 00:59:24,312
labor organizations.

1589
00:59:24,312 --> 00:59:26,484
So that we can provide

1590
00:59:26,484 --> 00:59:29,453
information and get feedback in

1591
00:59:29,453 --> 00:59:31,219
terms of what this all means

1592
00:59:31,219 --> 00:59:34,219
and how best to proceed.

1593
00:59:36,328 --> 00:59:39,500
Our time frame is to study this

1594
00:59:39,500 --> 00:59:41,406
in the upcoming fiscal

1595
00:59:41,406 --> 00:59:43,109
year 2013 and to discuss with

1596
00:59:43,109 --> 00:59:44,703
the board probably through the

1597
00:59:44,703 --> 00:59:47,234
finance committee and the full

1598
00:59:47,234 --> 00:59:48,672
board as we look at the

1599
00:59:48,672 --> 00:59:50,547
budget for fiscal year 2014.

1600
00:59:50,547 --> 00:59:52,160
Once again, we're making a very

1601
00:59:52,160 --> 00:59:54,416
positive step this year

1602
00:59:55,484 --> 00:59:56,156
in terms of getting to 100%

1603
00:59:56,156 --> 00:59:58,156
normal cost.

1604
00:59:58,484 --> 01:00:01,156
Our goal will be to try to put

1605
01:00:01,156 --> 01:00:03,719
together a plan in terms

1606
01:00:03,719 --> 01:00:05,391
of how we can address and

1607
01:00:05,391 --> 01:00:05,688
approach these funding issues

1608
01:00:05,688 --> 01:00:06,734
as

1609
01:00:06,734 --> 01:00:08,734
we move forward.

1610
01:00:10,328 --> 01:00:11,620
with that, I would be happy to

1611
01:00:11,620 --> 01:00:13,620
answer any questions.

1612
01:00:13,406 --> 01:00:14,310
>> supervisor cortese and then

1613
01:00:14,310 --> 01:00:16,310
wasserman.

1614
01:00:17,438 --> 01:00:19,609
>> first of all, thank you very

1615
01:00:19,609 --> 01:00:21,781
much for including this

1616
01:00:21,781 --> 01:00:23,875
as a major component of the

1617
01:00:23,875 --> 01:00:24,984
study session.

1618
01:00:24,984 --> 01:00:27,188
It's helpful and it's probably

1619
01:00:27,188 --> 01:00:28,156
been on a lot of our

1620
01:00:28,156 --> 01:00:31,756
minds wherever we sit here in

1621
01:00:32,219 --> 01:00:33,922
the county in terms of roles

1622
01:00:33,922 --> 01:00:35,453
given the conversation that's

1623
01:00:35,453 --> 01:00:35,922
going on externally over the

1624
01:00:35,922 --> 01:00:37,922
years.

1625
01:00:44,203 --> 01:00:44,734
I know we were all aware of

1626
01:00:44,734 --> 01:00:45,469
abstaining the funding

1627
01:00:45,469 --> 01:00:47,469
effort.

1628
01:00:49,906 --> 01:00:52,609
one of the questions I have is

1629
01:00:52,609 --> 01:00:52,984
probably in the a real

1630
01:00:52,984 --> 01:00:54,984
question per se.

1631
01:00:56,780 --> 01:00:59,470
In the list of things that

1632
01:00:59,470 --> 01:00:59,750
could be negotiated, there

1633
01:00:59,750 --> 01:01:01,750
could be ideas.

1634
01:01:03,719 --> 01:01:06,620
To what extent can we as a

1635
01:01:06,620 --> 01:01:07,219
county given our capacities

1636
01:01:07,219 --> 01:01:07,688
connected to the healthcare

1637
01:01:07,688 --> 01:01:09,688
system?

1638
01:01:10,797 --> 01:01:14,397
at least attempt to bargain to

1639
01:01:14,406 --> 01:01:16,806
bring people into our

1640
01:01:18,438 --> 01:01:22,380
own health plans in order to

1641
01:01:23,547 --> 01:01:25,484
sort of mitigate what I would

1642
01:01:25,484 --> 01:01:26,484
call a victimization of local

1643
01:01:26,484 --> 01:01:27,750
governments by big insurance

1644
01:01:27,750 --> 01:01:28,780
companies that we have no

1645
01:01:28,780 --> 01:01:30,780
control over.

1646
01:01:32,219 --> 01:01:32,781
i'm wondering if it's worth

1647
01:01:32,781 --> 01:01:33,891
discussing?

1648
01:01:33,891 --> 01:01:34,281
I'm not trying to bargain from

1649
01:01:34,281 --> 01:01:36,281
here.

1650
01:01:37,297 --> 01:01:37,891
I need to see it up there as a

1651
01:01:37,891 --> 01:01:39,500
bullet point.

1652
01:01:39,500 --> 01:01:41,891
I didn't know if that's because

1653
01:01:41,891 --> 01:01:42,562
there's not much gained

1654
01:01:42,562 --> 01:01:44,531
or because it's a collective

1655
01:01:44,531 --> 01:01:46,531
bargaining issue.

1656
01:01:46,766 --> 01:01:50,578
>> I would speak -- one thing I

1657
01:01:50,578 --> 01:01:51,109
would say is there are

1658
01:01:51,109 --> 01:01:53,109
limitations.

1659
01:01:53,234 --> 01:01:54,312
i think that this is something

1660
01:01:54,312 --> 01:01:55,203
that's been looked at

1661
01:01:55,203 --> 01:01:57,203
before.

1662
01:01:57,344 --> 01:01:59,609
In fact, was challenged and so

1663
01:01:59,609 --> 01:02:02,900
there are limitations in

1664
01:02:03,125 --> 01:02:04,940
terms of to what extent we can

1665
01:02:04,940 --> 01:02:05,891
do that.

1666
01:02:05,891 --> 01:02:06,891
I think that's about all I

1667
01:02:06,891 --> 01:02:09,291
would say on it.

1668
01:02:09,625 --> 01:02:12,734
>> I would add a little bit.

1669
01:02:12,734 --> 01:02:16,310
last year we went forward with

1670
01:02:16,310 --> 01:02:18,431
trying to make our

1671
01:02:18,906 --> 01:02:20,672
internal system, vhp more

1672
01:02:20,672 --> 01:02:23,720
attractive by expanding the

1673
01:02:23,766 --> 01:02:24,875
network and making it a more

1674
01:02:24,875 --> 01:02:25,234
attractive product for our

1675
01:02:25,234 --> 01:02:26,516
employee.

1676
01:02:26,516 --> 01:02:27,641
There's still we need to do in

1677
01:02:27,641 --> 01:02:29,641
that respect.

1678
01:02:29,875 --> 01:02:30,984
Gary is right, we can't really

1679
01:02:30,984 --> 01:02:32,781
mandate that employees

1680
01:02:32,781 --> 01:02:36,250
take one system or another but

1681
01:02:36,250 --> 01:02:37,594
we can make it more

1682
01:02:37,594 --> 01:02:39,484
attractive.

1683
01:02:39,484 --> 01:02:39,922
We have seen significant

1684
01:02:39,922 --> 01:02:41,922
transfer.

1685
01:02:43,297 --> 01:02:46,897
I think it's up to 700 or 800

1686
01:02:48,672 --> 01:02:48,859
or something like that.

1687
01:02:48,859 --> 01:02:50,859
1100.

1688
01:02:54,109 --> 01:02:54,844
1100 of people transferred over.

1689
01:02:54,844 --> 01:02:56,172
That makes fairly significant

1690
01:02:56,172 --> 01:02:58,172
dent.

1691
01:02:59,172 --> 01:03:01,172
That helps us a lot because

1692
01:03:01,172 --> 01:03:04,172
every dollar that we pay

1693
01:03:04,484 --> 01:03:04,875
for health premiums it goes to

1694
01:03:04,875 --> 01:03:06,875
vhp.

1695
01:03:08,922 --> 01:03:10,328
Stays within the county system

1696
01:03:10,328 --> 01:03:13,156
and allows us to have

1697
01:03:13,156 --> 01:03:14,266
the flexibility to improve our

1698
01:03:14,266 --> 01:03:14,531
health system, delivery

1699
01:03:14,531 --> 01:03:16,531
system.

1700
01:03:16,922 --> 01:03:18,234
Whereas, every dollar that goes

1701
01:03:18,234 --> 01:03:19,594
to kaiser or health net

1702
01:03:19,594 --> 01:03:20,859
goes outside of the county and

1703
01:03:20,859 --> 01:03:22,500
helps them develop their

1704
01:03:22,500 --> 01:03:24,500
system.

1705
01:03:26,703 --> 01:03:29,703
>> it seems like that alone

1706
01:03:35,375 --> 01:03:36,219
would be in a dialogue, an

1707
01:03:36,219 --> 01:03:38,619
incentive or interest beyond

1708
01:03:39,391 --> 01:03:41,791
just the product itself.

1709
01:03:43,453 --> 01:03:46,562
In other words, if that's an

1710
01:03:46,562 --> 01:03:47,156
organization, it helps us

1711
01:03:47,156 --> 01:03:49,556
bring down accrued liability

1712
01:03:50,734 --> 01:03:52,203
that end up impacting employees

1713
01:03:52,203 --> 01:03:54,266
anyway. Trying to want if I

1714
01:03:54,266 --> 01:03:55,672
that a little bit more.

1715
01:03:55,672 --> 01:03:58,812
we're not asking people to take

1716
01:03:58,812 --> 01:04:00,172
a hit for the team so

1717
01:04:00,172 --> 01:04:01,906
to speak.

1718
01:04:01,906 --> 01:04:02,938
But to the extent that people

1719
01:04:02,938 --> 01:04:04,938
are attracted by the idea

1720
01:04:04,938 --> 01:04:08,538
that we can reach a certain

1721
01:04:08,656 --> 01:04:08,812
critical mass, it saves jobs,

1722
01:04:08,812 --> 01:04:10,812
it

1723
01:04:11,656 --> 01:04:13,470
freeze up dollars and wages and

1724
01:04:13,470 --> 01:04:14,940
other things.

1725
01:04:14,940 --> 01:04:14,781
I understand the collective

1726
01:04:14,781 --> 01:04:16,781
bargaining session.

1727
01:04:24,562 --> 01:04:27,328
i take note and other important

1728
01:04:27,328 --> 01:04:29,328
thing is willingness

1729
01:04:31,234 --> 01:04:33,234
convene early.

1730
01:04:34,375 --> 01:04:36,141
My experience has been in other

1731
01:04:36,141 --> 01:04:38,141
places, especially

1732
01:04:41,219 --> 01:04:44,819
prior to coming here, that the

1733
01:04:45,516 --> 01:04:47,719
lack or unwillingness of

1734
01:04:47,719 --> 01:04:49,719
management elected officials

1735
01:04:49,953 --> 01:04:53,553
and others to do that, really

1736
01:04:54,859 --> 01:04:56,531
help lead to a lot of conflict.

1737
01:04:56,531 --> 01:04:57,940
Like anything else, just like

1738
01:04:57,940 --> 01:04:59,940
any balanced discussion

1739
01:05:00,844 --> 01:05:01,375
with budget, there's a lot of

1740
01:05:01,375 --> 01:05:03,375
questions whether accrued

1741
01:05:03,844 --> 01:05:05,234
liability numbers are real.

1742
01:05:05,234 --> 01:05:06,234
Are those numbers really where

1743
01:05:06,234 --> 01:05:07,484
they should be.

1744
01:05:07,484 --> 01:05:08,672
I don't dispute them but people

1745
01:05:08,672 --> 01:05:11,720
need to understand that

1746
01:05:14,453 --> 01:05:16,125
before they make commitments

1747
01:05:16,125 --> 01:05:18,125
and secondly, what is the --

1748
01:05:18,125 --> 01:05:20,250
how sharp does the trajectory

1749
01:05:20,250 --> 01:05:21,484
need to be to get there from

1750
01:05:21,484 --> 01:05:23,484
here?

1751
01:05:25,391 --> 01:05:26,620
How much can we defer until we

1752
01:05:26,620 --> 01:05:28,391
see how the macro

1753
01:05:28,391 --> 01:05:29,266
economy changes and how

1754
01:05:29,266 --> 01:05:29,734
healthcare reform May change

1755
01:05:29,734 --> 01:05:31,734
things.

1756
01:05:32,620 --> 01:05:33,500
I think those discussions are

1757
01:05:33,500 --> 01:05:35,780
invaluable and maybe it's

1758
01:05:35,780 --> 01:05:37,234
during those discussions when a

1759
01:05:37,234 --> 01:05:39,634
little more sharing about

1760
01:05:41,875 --> 01:05:43,109
how internal -- how vhp and how

1761
01:05:43,109 --> 01:05:45,109
mechanisms internally might

1762
01:05:47,516 --> 01:05:49,859
be able to help the problem.

1763
01:05:49,859 --> 01:05:50,750
Sound like you're doing that?

1764
01:05:50,750 --> 01:05:52,750
>> absolutely.

1765
01:05:56,310 --> 01:05:58,969
The board action a few weeks

1766
01:05:58,969 --> 01:06:00,469
ago to direct this to look

1767
01:06:00,469 --> 01:06:00,969
carefully at a unified

1768
01:06:00,969 --> 01:06:01,266
healthcare strategy is

1769
01:06:01,266 --> 01:06:03,141
important

1770
01:06:03,141 --> 01:06:05,141
component of this.

1771
01:06:06,438 --> 01:06:08,578
It involves having a strategy

1772
01:06:08,578 --> 01:06:10,906
to expand the commercial

1773
01:06:10,906 --> 01:06:13,438
capacities of our local health

1774
01:06:13,438 --> 01:06:14,719
systems so that we can make a

1775
01:06:14,719 --> 01:06:16,312
much more attractive product

1776
01:06:16,312 --> 01:06:19,312
for employees and for that

1777
01:06:20,470 --> 01:06:22,328
matter, for employees of other

1778
01:06:22,328 --> 01:06:22,859
organizations.

1779
01:06:22,859 --> 01:06:24,859
>> supervisor wassermann.

1780
01:06:26,422 --> 01:06:28,359
>> I wanted to thank staff and

1781
01:06:28,359 --> 01:06:30,297
all of employees for

1782
01:06:30,297 --> 01:06:30,734
being direct, being

1783
01:06:30,734 --> 01:06:31,620
transparent, being

1784
01:06:31,620 --> 01:06:32,328
collaborative.

1785
01:06:32,328 --> 01:06:32,969
We're all working on this

1786
01:06:32,969 --> 01:06:34,766
problem together.

1787
01:06:34,766 --> 01:06:38,366
What I wanted to state here

1788
01:06:39,578 --> 01:06:41,469
with something I stated in

1789
01:06:41,469 --> 01:06:45,690
ledge committee,ly say it again

1790
01:06:45,609 --> 01:06:46,281
now, at some point, I think

1791
01:06:46,281 --> 01:06:48,281
somebody somewhere organization

1792
01:06:48,688 --> 01:06:51,880
some individual needs to

1793
01:06:51,953 --> 01:06:52,625
hold the medical industry

1794
01:06:52,625 --> 01:06:53,859
accountable.

1795
01:06:53,859 --> 01:06:54,656
When cost, supervisor cortese

1796
01:06:54,656 --> 01:06:56,656
mentioned cost of

1797
01:06:59,156 --> 01:07:00,125
insurance going up and up, they

1798
01:07:00,125 --> 01:07:03,125
talk about premiums going up

1799
01:07:03,672 --> 01:07:06,797
because the cost of the medical

1800
01:07:06,797 --> 01:07:08,375
care is going up and up.

1801
01:07:08,375 --> 01:07:11,375
I know I seen premiums.

1802
01:07:12,470 --> 01:07:14,250
I seen in medical care.

1803
01:07:14,250 --> 01:07:14,750
I'm just hoping somewhere

1804
01:07:14,750 --> 01:07:16,750
washington, sacramento,

1805
01:07:17,719 --> 01:07:19,844
somewhere somebody says why is

1806
01:07:19,844 --> 01:07:22,244
medical costs going up 10

1807
01:07:23,578 --> 01:07:24,859
times the cpi when we as

1808
01:07:24,859 --> 01:07:25,160
employees are happy here when

1809
01:07:25,160 --> 01:07:27,160
our

1810
01:07:27,922 --> 01:07:30,322
salaries don't go down.

1811
01:07:30,531 --> 01:07:32,620
The comcast go up couple 3%

1812
01:07:32,620 --> 01:07:34,620
each year.

1813
01:07:38,906 --> 01:07:40,562
The medical cost goes up 10 time

1814
01:07:40,562 --> 01:07:42,562
s cip.

1815
01:07:43,469 --> 01:07:46,109
it was double digit increases.

1816
01:07:46,109 --> 01:07:49,219
When your cost of medical care

1817
01:07:49,219 --> 01:07:51,619
or coverage insurance or

1818
01:07:52,953 --> 01:07:55,353
whatever is estimating 10 and

1819
01:07:55,391 --> 01:07:57,391
20 percent and we're

1820
01:07:57,453 --> 01:07:58,750
scrambling to try and find to

1821
01:07:58,750 --> 01:08:01,266
be more efficient so we can

1822
01:08:01,266 --> 01:08:02,625
set aside for money to pay for

1823
01:08:02,625 --> 01:08:05,250
the insurance coverage of

1824
01:08:05,797 --> 01:08:07,500
retiring employees, you got to

1825
01:08:07,500 --> 01:08:09,859
ask at some point, why these

1826
01:08:09,859 --> 01:08:11,375
costs are going this way?

1827
01:08:11,375 --> 01:08:11,969
I appreciate the respect and

1828
01:08:11,969 --> 01:08:13,969
collaborative efforts and

1829
01:08:14,312 --> 01:08:15,906
between the administration and

1830
01:08:15,906 --> 01:08:18,906
employees to figure out how

1831
01:08:19,609 --> 01:08:23,209
we will pay for these expenses.

1832
01:08:25,453 --> 01:08:27,156
sooner or later, we got to say

1833
01:08:27,156 --> 01:08:27,359
these expenses are

1834
01:08:27,359 --> 01:08:29,359
wrong.

1835
01:08:29,453 --> 01:08:29,828
I don't know if we can throw

1836
01:08:29,828 --> 01:08:30,125
out for further

1837
01:08:30,125 --> 01:08:32,125
discussion.

1838
01:08:34,156 --> 01:08:35,125
Gary if we have the right for

1839
01:08:35,125 --> 01:08:35,828
justification of

1840
01:08:35,828 --> 01:08:37,828
insurance premiums.

1841
01:08:38,828 --> 01:08:39,328
I know there's a state

1842
01:08:39,328 --> 01:08:41,328
insurance commissioner.

1843
01:08:42,266 --> 01:08:42,875
I don't know who regulates the

1844
01:08:42,875 --> 01:08:44,141
cost and what they

1845
01:08:44,141 --> 01:08:46,500
charge for medical care.

1846
01:08:46,500 --> 01:08:47,938
it's hard to be playing catchup

1847
01:08:47,938 --> 01:08:50,750
all the time and you

1848
01:08:50,750 --> 01:08:52,141
got this run away horse and

1849
01:08:52,141 --> 01:08:54,344
somehow pull the reigns back.

1850
01:08:54,344 --> 01:08:58,544
No matter what we do no matter

1851
01:08:59,625 --> 01:09:01,281
with the epic, no matter

1852
01:09:01,281 --> 01:09:03,156
with more efficient methods, we

1853
01:09:03,156 --> 01:09:05,556
cannot keep up with

1854
01:09:07,234 --> 01:09:09,634
escalating medical cost and

1855
01:09:10,156 --> 01:09:10,562
premiums that are double digit

1856
01:09:10,562 --> 01:09:12,562
each year.

1857
01:09:13,328 --> 01:09:15,234
It's not a question of if or

1858
01:09:15,234 --> 01:09:17,234
when.

1859
01:09:19,469 --> 01:09:20,312
>> I think jeff and I can maybe

1860
01:09:20,312 --> 01:09:22,780
both reflect on this.

1861
01:09:22,780 --> 01:09:23,672
There was a time when medicine

1862
01:09:23,672 --> 01:09:26,720
was not a business.

1863
01:09:26,875 --> 01:09:27,281
it was looked at quite

1864
01:09:27,281 --> 01:09:29,281
differently.

1865
01:09:31,312 --> 01:09:32,922
It was a -- I don't mean to get

1866
01:09:32,922 --> 01:09:33,516
carried away -- it was

1867
01:09:33,516 --> 01:09:35,516
a laudable calling.

1868
01:09:37,297 --> 01:09:37,719
Most of you know I have a

1869
01:09:37,719 --> 01:09:39,719
nursing background.

1870
01:09:40,940 --> 01:09:41,797
At that time, when people went

1871
01:09:41,797 --> 01:09:43,266
into the hospital, there

1872
01:09:43,266 --> 01:09:45,666
was insurance coverage but

1873
01:09:47,641 --> 01:09:47,797
medicine was not the business

1874
01:09:47,797 --> 01:09:48,203
it

1875
01:09:48,203 --> 01:09:49,641
is today.

1876
01:09:49,641 --> 01:09:50,469
There are, learning about this

1877
01:09:50,469 --> 01:09:52,375
in pittsburgh, there are

1878
01:09:52,375 --> 01:09:53,750
whole cities in the south that

1879
01:09:53,750 --> 01:09:55,406
are devoted to healthcare.

1880
01:09:55,406 --> 01:09:55,875
That's how people make their

1881
01:09:55,875 --> 01:09:57,875
living.

1882
01:09:58,312 --> 01:09:59,656
There's one city devoted just

1883
01:09:59,656 --> 01:10:01,656
to dialysis.

1884
01:10:02,812 --> 01:10:04,470
Dialysis is a very lucrative

1885
01:10:04,470 --> 01:10:05,625
business.

1886
01:10:05,625 --> 01:10:06,484
I hesitate saying things out

1887
01:10:06,484 --> 01:10:08,156
loud but the more

1888
01:10:08,156 --> 01:10:09,891
developed we have become in the

1889
01:10:09,891 --> 01:10:12,291
healthcare field, the more

1890
01:10:13,656 --> 01:10:17,000
ways there are to save people,

1891
01:10:17,000 --> 01:10:19,297
to maintain them sometimes

1892
01:10:19,297 --> 01:10:22,234
long after the quality has

1893
01:10:22,234 --> 01:10:22,547
disappeared, the more expensive

1894
01:10:22,547 --> 01:10:24,547
it becomes.

1895
01:10:26,344 --> 01:10:28,375
That is one of the reasons in

1896
01:10:28,375 --> 01:10:31,375
the aca there was a

1897
01:10:31,453 --> 01:10:33,750
discussion initially which had

1898
01:10:33,750 --> 01:10:36,453
a great dealed feedback about

1899
01:10:36,453 --> 01:10:38,328
it about the dreaded word, what

1900
01:10:38,328 --> 01:10:41,422
do I call that word instead

1901
01:10:41,422 --> 01:10:41,797
of what it is.

1902
01:10:41,797 --> 01:10:43,797
Call it options.

1903
01:10:44,469 --> 01:10:45,203
Whether or not you discuss with

1904
01:10:45,203 --> 01:10:46,859
people what they want

1905
01:10:46,859 --> 01:10:51,590
the quality of life to be for

1906
01:10:51,875 --> 01:10:54,875
them or for their family.

1907
01:10:57,906 --> 01:10:58,812
I realize, I'm opining somewhat

1908
01:10:58,812 --> 01:11:00,578
on this.

1909
01:11:00,578 --> 01:11:03,422
We have become a very

1910
01:11:03,422 --> 01:11:04,125
complicated country as far as

1911
01:11:04,125 --> 01:11:06,125
healthcare goes.

1912
01:11:06,859 --> 01:11:07,859
As we used to say, still do, no

1913
01:11:07,859 --> 01:11:08,391
one every dies in

1914
01:11:08,391 --> 01:11:10,391
surgery.

1915
01:11:11,125 --> 01:11:14,125
they only die later because

1916
01:11:15,297 --> 01:11:18,562
there is no way you can do

1917
01:11:18,562 --> 01:11:20,438
that.

1918
01:11:20,438 --> 01:11:22,438
Again, I am so sympathetic for

1919
01:11:22,438 --> 01:11:23,500
families who lost

1920
01:11:23,500 --> 01:11:25,969
someone who had that grief.

1921
01:11:25,969 --> 01:11:27,906
There's also grief in families

1922
01:11:27,906 --> 01:11:30,172
where someone lives far

1923
01:11:30,172 --> 01:11:30,938
longer and as one of the women

1924
01:11:30,938 --> 01:11:32,609
said earlier today, somebody

1925
01:11:32,609 --> 01:11:34,219
who goes to bed praying,

1926
01:11:34,219 --> 01:11:36,719
they'll be dead in the morning

1927
01:11:36,719 --> 01:11:37,578
because it is so hard to

1928
01:11:37,578 --> 01:11:39,578
maintain your life.

1929
01:11:41,250 --> 01:11:42,594
It's a long answer mike but I

1930
01:11:42,594 --> 01:11:43,391
really think the

1931
01:11:43,391 --> 01:11:45,791
transformation that has taken

1932
01:11:46,656 --> 01:11:48,297
place in healthcare and the

1933
01:11:48,297 --> 01:11:48,594
time I reserved it is pretty

1934
01:11:48,594 --> 01:11:50,594
dramatic.

1935
01:11:51,125 --> 01:11:52,797
Probably why the aca did pass

1936
01:11:52,797 --> 01:11:53,141
and even though it has

1937
01:11:53,141 --> 01:11:55,109
its fault.

1938
01:11:55,109 --> 01:11:57,906
I think there are a number of

1939
01:11:57,906 --> 01:11:58,172
really good provisions in

1940
01:11:58,172 --> 01:11:59,375
it.

1941
01:11:59,375 --> 01:12:02,375
Longer answer than you you

1942
01:12:03,719 --> 01:12:05,547
wanted but it has troubled

1943
01:12:05,547 --> 01:12:08,547
me for years how insurance

1944
01:12:10,594 --> 01:12:11,719
company have become such big

1945
01:12:11,719 --> 01:12:13,719
business.

1946
01:12:14,750 --> 01:12:15,359
their executives are paid

1947
01:12:15,359 --> 01:12:17,625
extremely well and from time

1948
01:12:17,625 --> 01:12:19,940
to time the system is misused.

1949
01:12:19,940 --> 01:12:20,328
I don't know if you want to

1950
01:12:20,328 --> 01:12:22,728
comment jeff or not.

1951
01:12:25,500 --> 01:12:28,312
We have one nurse and one

1952
01:12:28,312 --> 01:12:28,703
doctor on a board throughout

1953
01:12:28,703 --> 01:12:30,703
california.

1954
01:12:31,672 --> 01:12:34,672
Jeff you maybe the only

1955
01:12:36,160 --> 01:12:37,875
physician ceo.

1956
01:12:37,875 --> 01:12:41,475
I did carry on didn't I?

1957
01:12:42,391 --> 01:12:42,828
>> I guess the question was who

1958
01:12:42,828 --> 01:12:44,828
regulates this and

1959
01:12:45,188 --> 01:12:46,891
there is some regulatory

1960
01:12:46,891 --> 01:12:48,391
capacity that the insurance

1961
01:12:48,391 --> 01:12:48,891
commissioner has but not

1962
01:12:48,891 --> 01:12:50,891
complete.

1963
01:12:52,266 --> 01:12:54,172
There also is regulatory

1964
01:12:54,172 --> 01:12:56,572
capacity that the department

1965
01:12:56,766 --> 01:12:57,797
of managed healthcare has.

1966
01:12:57,797 --> 01:12:59,797
Again, not complete.

1967
01:13:01,780 --> 01:13:03,641
I guess the fundamental issue

1968
01:13:03,641 --> 01:13:06,410
is as supervisor kniss

1969
01:13:07,344 --> 01:13:08,312
pointed out that in a for

1970
01:13:08,312 --> 01:13:08,688
profit structure, somebody has

1971
01:13:08,688 --> 01:13:10,688
to

1972
01:13:15,516 --> 01:13:19,116
win and somebody has to lose.

1973
01:13:19,953 --> 01:13:23,125
That's the way it no, our

1974
01:13:23,125 --> 01:13:25,125
country today.

1975
01:13:27,734 --> 01:13:29,672
>> to be perfectly clear so I'm

1976
01:13:29,672 --> 01:13:31,234
not misunderstood or

1977
01:13:31,234 --> 01:13:33,266
misquoted, I'm perfectly happy

1978
01:13:33,266 --> 01:13:34,875
with each and every

1979
01:13:34,875 --> 01:13:36,812
individual and organization

1980
01:13:36,812 --> 01:13:39,212
making profitings. I don't

1981
01:13:39,547 --> 01:13:42,375
begrudge that and it's the

1982
01:13:42,375 --> 01:13:44,344
american dream.

1983
01:13:44,344 --> 01:13:45,219
What I'm saying, I'm not just

1984
01:13:45,219 --> 01:13:46,940
lobbying for government

1985
01:13:46,940 --> 01:13:46,781
here.

1986
01:13:46,781 --> 01:13:48,359
How government employees

1987
01:13:48,359 --> 01:13:50,453
suppose to keep up with the

1988
01:13:50,453 --> 01:13:51,422
cost.

1989
01:13:51,422 --> 01:13:52,828
Private sector too.

1990
01:13:52,828 --> 01:13:53,297
I was self-employed for 30

1991
01:13:53,297 --> 01:13:54,891
years.

1992
01:13:54,891 --> 01:13:55,422
Can't keep up with the

1993
01:13:55,422 --> 01:13:56,828
escalating cost.

1994
01:13:56,828 --> 01:13:58,328
We're in government now.

1995
01:13:58,328 --> 01:13:59,000
I'm in government now, we're

1996
01:13:59,000 --> 01:14:01,400
all in government, can't

1997
01:14:11,906 --> 01:14:14,906
keep up with the cost.

1998
01:14:15,470 --> 01:14:15,578
Something got to move more in

1999
01:14:15,578 --> 01:14:17,578
parallel.

2000
01:14:18,312 --> 01:14:19,859
i hope something somewhere

2001
01:14:19,859 --> 01:14:20,594
happens at some point.

2002
01:14:20,594 --> 01:14:22,891
Last couple years has been

2003
01:14:22,891 --> 01:14:24,531
great.

2004
01:14:24,531 --> 01:14:25,125
You brought that $220 million

2005
01:14:25,125 --> 01:14:27,525
down to $80 million or

2006
01:14:27,891 --> 01:14:28,156
whatever the number is, that's

2007
01:14:28,156 --> 01:14:30,156
all great.

2008
01:14:33,562 --> 01:14:34,844
But if cost go like this, and

2009
01:14:34,844 --> 01:14:37,244
revenues go like this,

2010
01:14:39,203 --> 01:14:39,578
like I said, it's a question

2011
01:14:39,578 --> 01:14:41,578
when you break.

2012
01:14:42,375 --> 01:14:42,609
Z

2013
01:14:42,609 --> 01:14:44,609
break

2014
01:14:45,656 --> 01:14:46,188
>> thank you supervisors.

2015
01:14:46,188 --> 01:14:47,812
Anything else?

2016
01:14:47,812 --> 01:14:50,812
Thank you gary and jeff.

2017
01:14:52,125 --> 01:14:55,125
Item six is a recommendation

2018
01:14:57,310 --> 01:14:57,500
relating to the sale of

2019
01:14:57,500 --> 01:14:59,391
real property.

2020
01:14:59,391 --> 01:15:01,203
Jeff I have one speaker.

2021
01:15:01,203 --> 01:15:04,203
I think it's a question.

2022
01:15:06,703 --> 01:15:10,303
Let me have her ask the

2023
01:15:12,938 --> 01:15:14,172
question.

2024
01:15:14,172 --> 01:15:17,772
Why don't you ask the question

2025
01:15:18,922 --> 01:15:21,322
as presentation goes on.

2026
01:15:23,828 --> 01:15:24,750
>> good afternoon lynn bradley

2027
01:15:24,750 --> 01:15:26,750
from seiu.

2028
01:15:28,156 --> 01:15:29,156
It talked about the shelter or

2029
01:15:29,156 --> 01:15:31,156
receiving center where

2030
01:15:32,531 --> 01:15:34,531
children will go.

2031
01:15:34,797 --> 01:15:36,141
We have never been told in

2032
01:15:36,141 --> 01:15:38,141
social services agency.

2033
01:15:38,672 --> 01:15:39,234
we're curious where it will be

2034
01:15:39,234 --> 01:15:39,906
moving one.

2035
01:15:39,906 --> 01:15:41,234
>> staff?

2036
01:15:41,234 --> 01:15:43,250
>> thank you Mr. President,

2037
01:15:43,250 --> 01:15:45,650
members of the board.

2038
01:15:46,141 --> 01:15:47,188
With me today, this is a

2039
01:15:47,188 --> 01:15:48,375
familiar face, he's the

2040
01:15:48,375 --> 01:15:49,609
interim acting director of the

2041
01:15:49,609 --> 01:15:52,900
social services agency and

2042
01:15:52,719 --> 01:15:53,656
responsible for the operation

2043
01:15:53,656 --> 01:15:56,656
of a relocation assessment and

2044
01:15:56,688 --> 01:15:58,688
intake assessment center.

2045
01:16:03,469 --> 01:16:05,125
david and nancy weiner who is

2046
01:16:05,125 --> 01:16:06,375
the founding and director

2047
01:16:06,375 --> 01:16:08,328
of the silicone valley children

2048
01:16:08,328 --> 01:16:10,328
fund.

2049
01:16:13,000 --> 01:16:15,438
In the audience we have sharon

2050
01:16:15,438 --> 01:16:17,438
pick assistant business

2051
01:16:18,719 --> 01:16:20,484
manager for harker school.

2052
01:16:20,484 --> 01:16:21,109
in conforming with the

2053
01:16:21,109 --> 01:16:23,109
government code following

2054
01:16:25,219 --> 01:16:26,453
direction on January 24th when

2055
01:16:26,453 --> 01:16:28,297
you adopt resolution for

2056
01:16:28,297 --> 01:16:30,359
offering to sale the former

2057
01:16:30,359 --> 01:16:32,266
children's shelter.

2058
01:16:32,266 --> 01:16:32,734
We subsequently opening sealed

2059
01:16:32,734 --> 01:16:33,562
written bids on

2060
01:16:33,562 --> 01:16:35,562
March 1st.

2061
01:16:36,000 --> 01:16:37,000
We received four written bids,

2062
01:16:37,000 --> 01:16:38,203
three at the minimum

2063
01:16:38,203 --> 01:16:40,203
qualifying requirements.

2064
01:16:40,766 --> 01:16:43,766
there was a subsequent oral

2065
01:16:44,172 --> 01:16:46,172
bidding process at the

2066
01:16:46,172 --> 01:16:49,172
closed of which harker school

2067
01:16:49,641 --> 01:16:52,641
made the highest remaining bid

2068
01:16:56,470 --> 01:16:57,719
of $25,505,000.

2069
01:16:57,719 --> 01:17:00,119
Before recommend action to

2070
01:17:00,484 --> 01:17:01,719
adopt the resolution accept

2071
01:17:01,719 --> 01:17:03,422
highest bid approving purchase

2072
01:17:03,422 --> 01:17:05,328
of sale agreement.

2073
01:17:05,328 --> 01:17:08,328
It provides for 150 day due

2074
01:17:08,828 --> 01:17:10,297
diligence period and a

2075
01:17:10,297 --> 01:17:11,906
30-day close escrow period.

2076
01:17:11,906 --> 01:17:14,172
Following a successful close of

2077
01:17:14,172 --> 01:17:16,172
escrow, the county

2078
01:17:16,969 --> 01:17:18,470
would realize one time proceeds

2079
01:17:18,470 --> 01:17:21,470
of $10.7 million and in the

2080
01:17:21,609 --> 01:17:23,141
proposed budget there'sal a one

2081
01:17:23,141 --> 01:17:25,470
time allocation of

2082
01:17:25,470 --> 01:17:27,470
$3.5 million toward relocation

2083
01:17:27,391 --> 01:17:28,156
of the intake and assessment

2084
01:17:28,156 --> 01:17:30,156
center.

2085
01:17:32,250 --> 01:17:35,310
But I think that those are the

2086
01:17:35,310 --> 01:17:37,310
stark details.

2087
01:17:37,500 --> 01:17:38,297
This really is a 20 year

2088
01:17:38,297 --> 01:17:40,297
collaboration.

2089
01:17:51,609 --> 01:17:54,609
there's been much cash --

2090
01:17:58,625 --> 01:18:00,625
cachet.

2091
01:18:01,160 --> 01:18:02,250
What we now see is prospect of

2092
01:18:02,250 --> 01:18:04,250
beautiful facility

2093
01:18:06,359 --> 01:18:06,953
entering new phase devoted to

2094
01:18:06,953 --> 01:18:08,953
children.

2095
01:18:11,625 --> 01:18:14,625
This partnership started out as

2096
01:18:15,375 --> 01:18:17,375
a 50/50 joint venture

2097
01:18:19,172 --> 01:18:21,578
between the private sector and

2098
01:18:21,578 --> 01:18:24,344
the county and it ended up

2099
01:18:24,344 --> 01:18:27,344
with 50% of the proceeds from

2100
01:18:28,922 --> 01:18:31,922
the sale with the property

2101
01:18:32,688 --> 01:18:35,880
being satisfied. Proceeds are

2102
01:18:35,484 --> 01:18:36,625
split 50/50 with silicone

2103
01:18:36,625 --> 01:18:38,620
valley children's fund.

2104
01:18:38,620 --> 01:18:39,859
This afternoon I was also

2105
01:18:39,859 --> 01:18:42,734
informed that city council of

2106
01:18:42,734 --> 01:18:45,797
san jose played their part and

2107
01:18:45,797 --> 01:18:48,000
took action to provide a

2108
01:18:48,000 --> 01:18:49,312
process for lifting the

2109
01:18:49,312 --> 01:18:49,500
affordable housing restrictions

2110
01:18:49,500 --> 01:18:50,844
that

2111
01:18:50,844 --> 01:18:54,444
were placed on the property at

2112
01:18:56,109 --> 01:18:58,312
the beginning of the project.

2113
01:18:58,312 --> 01:19:00,712
With that, Mr. Mavis.

2114
01:19:02,891 --> 01:19:04,594
Anything you like to say on

2115
01:19:04,594 --> 01:19:06,656
behalf of the fund?

2116
01:19:06,656 --> 01:19:07,359
>> we would like to thank mike

2117
01:19:07,359 --> 01:19:09,759
wasserman and his staff

2118
01:19:09,766 --> 01:19:12,620
and also bruce for helping us

2119
01:19:12,620 --> 01:19:14,462
navigate through this process.

2120
01:19:18,266 --> 01:19:20,666
We're looking forward to

2121
01:19:22,578 --> 01:19:24,578
wrapping it up.

2122
01:19:29,375 --> 01:19:31,109
so thank you.

2123
01:19:31,109 --> 01:19:32,453
>> I appreciate the opportunity

2124
01:19:32,453 --> 01:19:34,922
to just make a few

2125
01:19:34,922 --> 01:19:36,688
comments to all of you.

2126
01:19:36,688 --> 01:19:38,484
Some of the familiar faces.

2127
01:19:38,484 --> 01:19:40,156
I only want to correct one

2128
01:19:40,156 --> 01:19:42,556
thing that bruce said.

2129
01:19:42,891 --> 01:19:44,359
I was actually a 39 year

2130
01:19:44,359 --> 01:19:46,531
employee of santa clara county

2131
01:19:46,531 --> 01:19:49,938
and it was in that capacity

2132
01:19:49,938 --> 01:19:50,797
that we formed the fund and

2133
01:19:50,797 --> 01:19:51,906
developed this very unique

2134
01:19:51,906 --> 01:19:53,906
partnership.

2135
01:19:54,969 --> 01:19:57,812
Many of you know it was a model

2136
01:19:57,812 --> 01:19:59,812
throughout the state

2137
01:20:01,844 --> 01:20:04,244
for its community participation

2138
01:20:11,620 --> 01:20:12,391
and for thed the model it set.

2139
01:20:12,391 --> 01:20:12,922
I had opportunity to create

2140
01:20:12,922 --> 01:20:14,922
this partnership.

2141
01:20:19,328 --> 01:20:21,703
This gives me a chance to say a

2142
01:20:21,703 --> 01:20:22,734
special thanks to

2143
01:20:22,734 --> 01:20:25,109
supervisor diane mckenna who

2144
01:20:25,109 --> 01:20:27,609
really did an amazing job

2145
01:20:27,609 --> 01:20:27,875
with the cheerleader of this

2146
01:20:27,875 --> 01:20:29,875
project.

2147
01:20:30,812 --> 01:20:33,750
i think we ought to take a

2148
01:20:33,750 --> 01:20:36,750
moment and thank the staff

2149
01:20:38,125 --> 01:20:39,160
and our county supervisors and

2150
01:20:39,160 --> 01:20:40,250
our county administration for

2151
01:20:40,250 --> 01:20:41,953
the tremendous work that was

2152
01:20:41,953 --> 01:20:44,310
done at the children shelter

2153
01:20:44,310 --> 01:20:46,766
during all of these years.

2154
01:20:46,766 --> 01:20:48,828
I am particularly appreciative

2155
01:20:48,828 --> 01:20:51,228
of the very thoughtful

2156
01:20:52,859 --> 01:20:54,328
process that has gone on at

2157
01:20:54,328 --> 01:20:56,728
this point in time.

2158
01:20:57,234 --> 01:20:58,344
I greatly appreciate the fact

2159
01:20:58,344 --> 01:21:01,281
that bruce has been able

2160
01:21:01,281 --> 01:21:02,141
and the county executive has

2161
01:21:02,141 --> 01:21:05,141
been able to spearhead this

2162
01:21:08,422 --> 01:21:09,781
project to place it in the

2163
01:21:09,781 --> 01:21:11,453
good hands of harker who by the

2164
01:21:11,453 --> 01:21:13,859
way contributed to this project.

2165
01:21:13,859 --> 01:21:16,656
A group of kids from harker.

2166
01:21:16,656 --> 01:21:17,359
That's a fun thing to note.

2167
01:21:17,359 --> 01:21:19,359
I'm particularly appreciative

2168
01:21:19,922 --> 01:21:22,156
that the fund will be

2169
01:21:22,156 --> 01:21:25,375
able to use the donations that

2170
01:21:25,375 --> 01:21:28,531
were given to this project to

2171
01:21:28,531 --> 01:21:29,375
further the work because the

2172
01:21:29,375 --> 01:21:31,781
real focus these continue to be

2173
01:21:31,781 --> 01:21:33,406
to support and help the abused

2174
01:21:33,406 --> 01:21:33,844
and neglected children of our

2175
01:21:33,844 --> 01:21:35,719
county.

2176
01:21:35,719 --> 01:21:37,109
I am very grateful for that and

2177
01:21:37,109 --> 01:21:38,750
I thank all of you for

2178
01:21:38,750 --> 01:21:41,150
the work you've done.

2179
01:21:41,312 --> 01:21:43,160
I thank bruce for the work that

2180
01:21:43,160 --> 01:21:43,359
he's done in carrying

2181
01:21:43,359 --> 01:21:45,359
that forward.

2182
01:21:45,484 --> 01:21:46,625
Thank you.

2183
01:21:46,625 --> 01:21:48,625
>> thank you.

2184
01:21:50,625 --> 01:21:51,266
>> Mr. President, I like to

2185
01:21:51,266 --> 01:21:52,940
respond to lynn bradley's

2186
01:21:52,940 --> 01:21:55,940
comment and question about what

2187
01:21:57,500 --> 01:21:58,375
is the future of the center

2188
01:21:58,375 --> 01:22:00,775
for social services agency.

2189
01:22:01,109 --> 01:22:03,469
Comment that the employees have

2190
01:22:03,469 --> 01:22:05,469
not been informed.

2191
01:22:09,844 --> 01:22:10,516
I think the new shelter sale,

2192
01:22:10,516 --> 01:22:11,578
pending sale is common

2193
01:22:11,578 --> 01:22:12,516
knowledge as has been reported

2194
01:22:12,516 --> 01:22:14,516
in the paper.

2195
01:22:15,828 --> 01:22:16,422
The agencies continue to be

2196
01:22:16,422 --> 01:22:18,422
seeking for alternate

2197
01:22:23,125 --> 01:22:24,203
location for their scaled down

2198
01:22:24,203 --> 01:22:25,625
operation.

2199
01:22:25,625 --> 01:22:28,141
They received children for no

2200
01:22:28,141 --> 01:22:30,541
more than 24 hours. We

2201
01:22:30,562 --> 01:22:34,162
are in the process of looking

2202
01:22:34,812 --> 01:22:37,438
for possibilities and we will

2203
01:22:37,438 --> 01:22:38,470
definitely confer and consult

2204
01:22:38,470 --> 01:22:39,875
our employee organization in

2205
01:22:39,875 --> 01:22:41,219
the future of where the

2206
01:22:41,219 --> 01:22:43,219
location is.

2207
01:22:44,844 --> 01:22:45,688
There are other county partners

2208
01:22:45,688 --> 01:22:47,453
whether it's pediatric

2209
01:22:47,453 --> 01:22:48,125
center of vmc and mental health

2210
01:22:48,125 --> 01:22:49,391
department and other

2211
01:22:49,391 --> 01:22:51,791
department of social services

2212
01:22:52,297 --> 01:22:55,297
agency that we will be

2213
01:22:59,734 --> 01:23:02,134
consulting and conferring for

2214
01:23:02,703 --> 01:23:04,500
either temporary location

2215
01:23:04,500 --> 01:23:06,900
>> thank you, anything else?

2216
01:23:07,969 --> 01:23:09,203
Thank you to all of you.

2217
01:23:09,203 --> 01:23:09,438
Let me recognize supervisor

2218
01:23:09,438 --> 01:23:11,438
yeager.

2219
01:23:14,688 --> 01:23:15,281
>> I know all of this,

2220
01:23:15,281 --> 01:23:17,160
appreciate all the work

2221
01:23:17,160 --> 01:23:17,547
everybody has done to make this

2222
01:23:17,547 --> 01:23:19,547
happen.

2223
01:23:20,828 --> 01:23:22,953
For those of us following this

2224
01:23:22,953 --> 01:23:23,766
very closely like I was.

2225
01:23:23,766 --> 01:23:26,422
There was no guarantee we were

2226
01:23:26,422 --> 01:23:29,562
going to be where we are

2227
01:23:29,562 --> 01:23:30,359
this afternoon with everybody

2228
01:23:30,359 --> 01:23:32,359
saying thank you.

2229
01:23:32,969 --> 01:23:33,297
Having an agreement that works

2230
01:23:33,297 --> 01:23:35,297
for everybody.

2231
01:23:37,406 --> 01:23:38,203
this was very complicated from

2232
01:23:38,203 --> 01:23:40,203
the very beginning.

2233
01:23:54,297 --> 01:23:55,156
It took a lot of excellently of

2234
01:23:55,156 --> 01:23:56,766
-- flexibility.

2235
01:23:56,766 --> 01:23:57,500
i was excited that harker was

2236
01:23:57,500 --> 01:23:59,500
the top bidder.

2237
01:23:59,938 --> 01:24:03,538
It's going to fit very well

2238
01:24:04,469 --> 01:24:04,797
with the surrounding

2239
01:24:04,797 --> 01:24:06,734
neighborhoods.

2240
01:24:06,734 --> 01:24:07,609
If I had to sort of choose

2241
01:24:07,609 --> 01:24:09,812
where I would want public

2242
01:24:09,812 --> 01:24:11,375
land to be used for school

2243
01:24:11,375 --> 01:24:11,547
would certainly be at the top

2244
01:24:11,547 --> 01:24:11,781
of

2245
01:24:11,781 --> 01:24:13,781
my list.

2246
01:24:17,780 --> 01:24:17,547
it was good to hear little bit

2247
01:24:17,547 --> 01:24:19,391
about the history.

2248
01:24:19,391 --> 01:24:20,953
We did have an obligation to

2249
01:24:20,953 --> 01:24:23,953
make sure some of the

2250
01:24:25,797 --> 01:24:26,953
proceeds did go to abused and

2251
01:24:26,953 --> 01:24:28,620
neglected children.

2252
01:24:28,620 --> 01:24:28,656
Nancy appreciate you giving a

2253
01:24:28,656 --> 01:24:31,656
little bit of history and

2254
01:24:31,703 --> 01:24:33,000
all the people involved in that.

2255
01:24:33,000 --> 01:24:35,310
It was a magnificent project.

2256
01:24:35,310 --> 01:24:36,620
When it started it look a lot

2257
01:24:36,620 --> 01:24:37,620
of collaboration and lot

2258
01:24:37,620 --> 01:24:40,620
of support and dollars and

2259
01:24:41,609 --> 01:24:44,609
leadership to make it happen.

2260
01:24:45,281 --> 01:24:47,109
Times changed and we all need

2261
01:24:47,109 --> 01:24:49,509
to change with them.

2262
01:24:50,160 --> 01:24:52,891
We did all of that obligation

2263
01:24:52,891 --> 01:24:54,516
to the children that

2264
01:24:54,516 --> 01:24:54,922
using that property to begin

2265
01:24:54,922 --> 01:24:56,922
with.

2266
01:24:57,453 --> 01:24:59,297
with thatly make a motion that

2267
01:24:59,297 --> 01:25:01,297
we adopt this

2268
01:25:02,234 --> 01:25:04,234
resolution.

2269
01:25:05,266 --> 01:25:05,859
>> motion by yeager and

2270
01:25:05,859 --> 01:25:07,859
seconded by wassermann.

2271
01:25:09,906 --> 01:25:10,172
Supervisor yeager thank you for

2272
01:25:10,172 --> 01:25:11,766
your work.

2273
01:25:11,766 --> 01:25:12,203
Bruce of course you and your

2274
01:25:12,203 --> 01:25:14,203
staff.

2275
01:25:16,672 --> 01:25:19,672
Anything else on this board?

2276
01:25:22,609 --> 01:25:25,900
please vote by light.

2277
01:25:25,625 --> 01:25:27,625
That carries unanimously.

2278
01:25:28,422 --> 01:25:28,797
Thank you everyone,

2279
01:25:28,797 --> 01:25:30,797
congratulations.

2280
01:25:31,453 --> 01:25:31,859
I think there's nothing before

2281
01:25:31,859 --> 01:25:34,259
us for this item.

2282
01:25:34,359 --> 01:25:35,438
We will move on to item seven.

2283
01:25:35,438 --> 01:25:36,938
Supervisor cortese we are

2284
01:25:36,938 --> 01:25:38,562
starting children family

2285
01:25:38,562 --> 01:25:40,562
seniors committee.

2286
01:25:40,672 --> 01:25:41,266
As a chair, I want to afford

2287
01:25:41,266 --> 01:25:43,666
opportunities, if you want

2288
01:25:46,000 --> 01:25:48,109
to say any word before we start

2289
01:25:48,109 --> 01:25:49,484
with the child support

2290
01:25:49,484 --> 01:25:51,160
services. Did want to say

2291
01:25:51,160 --> 01:25:53,160
anything prior?

2292
01:25:54,109 --> 01:25:57,109
>> only that we've taken a

2293
01:25:58,940 --> 01:26:00,494
preliminary look at the

2294
01:26:00,797 --> 01:26:02,797
committee.

2295
01:26:03,828 --> 01:26:06,203
The budget items -- still

2296
01:26:06,203 --> 01:26:07,000
opportunity for that to

2297
01:26:07,000 --> 01:26:09,000
happen.

2298
01:26:09,500 --> 01:26:11,900
Looking forward to the

2299
01:26:18,780 --> 01:26:18,672
engagement of the full board on

2300
01:26:18,672 --> 01:26:20,672
respite process.

2301
01:26:21,160 --> 01:26:24,616
>> item seven is review of the

2302
01:26:25,656 --> 01:26:27,625
department of child

2303
01:26:27,625 --> 01:26:28,160
services.

2304
01:26:28,160 --> 01:26:29,188
>> good afternoon.

2305
01:26:29,188 --> 01:26:31,588
Adele hunter with the

2306
01:26:31,797 --> 01:26:33,688
department of child support

2307
01:26:33,688 --> 01:26:34,266
services filling in for ralph

2308
01:26:34,266 --> 01:26:34,531
miller who has family

2309
01:26:34,531 --> 01:26:36,531
emergency.

2310
01:26:41,297 --> 01:26:42,000
i want to give you update of

2311
01:26:42,000 --> 01:26:43,938
these department budgets

2312
01:26:43,938 --> 01:26:45,297
since the recommended budget

2313
01:26:45,297 --> 01:26:46,969
was published. Yesterday on

2314
01:26:46,969 --> 01:26:49,969
the conference call from the

2315
01:26:50,160 --> 01:26:53,160
state department of the child

2316
01:26:53,578 --> 01:26:54,344
support services, it was

2317
01:26:54,344 --> 01:26:55,470
announced there will be a

2318
01:26:55,470 --> 01:26:57,470
reduction.

2319
01:26:57,609 --> 01:26:59,219
At this point, the state is

2320
01:26:59,219 --> 01:27:02,219
looking at options for ways

2321
01:27:03,625 --> 01:27:04,859
to reduce that funding.

2322
01:27:04,859 --> 01:27:06,453
We have no additional

2323
01:27:06,453 --> 01:27:07,828
information and what the impact

2324
01:27:07,828 --> 01:27:11,428
would be on santa clara county

2325
01:27:11,500 --> 01:27:14,000
at this time is unknown.

2326
01:27:14,000 --> 01:27:15,531
Once impact is known, and what

2327
01:27:15,531 --> 01:27:17,931
our reductions are, we

2328
01:27:18,141 --> 01:27:20,234
will be working oba to

2329
01:27:20,234 --> 01:27:20,469
determine how to balance our

2330
01:27:20,469 --> 01:27:22,469
budget

2331
01:27:23,672 --> 01:27:26,344
and during the budget process,

2332
01:27:26,344 --> 01:27:27,953
we will have more information

2333
01:27:27,953 --> 01:27:30,891
for the board of supervisors.

2334
01:27:30,891 --> 01:27:33,594
I'm available for any questions

2335
01:27:33,594 --> 01:27:35,594
>> questions from the board?

2336
01:27:35,594 --> 01:27:37,656
>> when you talk about the

2337
01:27:37,656 --> 01:27:38,500
call, you referring to the

2338
01:27:38,500 --> 01:27:40,000
May revise?

2339
01:27:40,000 --> 01:27:41,125
There was a conference call

2340
01:27:41,125 --> 01:27:42,328
dealing with the may

2341
01:27:42,328 --> 01:27:43,620
revise.

2342
01:27:43,620 --> 01:27:46,620
I just wanted to understand

2343
01:27:46,172 --> 01:27:46,766
whether or not these are

2344
01:27:46,766 --> 01:27:47,672
just additional proposals or

2345
01:27:47,672 --> 01:27:49,203
something cemented?

2346
01:27:49,203 --> 01:27:49,766
>> these are results of the May

2347
01:27:49,766 --> 01:27:51,766
revise.

2348
01:27:51,844 --> 01:27:52,906
>> so it's still up in the air

2349
01:27:52,906 --> 01:27:54,906
at least.

2350
01:27:56,547 --> 01:27:57,719
>> all right, thank you.

2351
01:27:57,719 --> 01:27:59,719
>> anyone else?

2352
01:28:01,516 --> 01:28:03,916
Jeff any other comments?

2353
01:28:04,156 --> 01:28:06,556
thank you, appreciate it.

2354
01:28:08,828 --> 01:28:11,310
Item number ability is inhome

2355
01:28:11,310 --> 01:28:13,310
support services.

2356
01:28:14,938 --> 01:28:16,938
Luke?

2357
01:28:21,469 --> 01:28:23,869
Item eight now, ihss.

2358
01:28:25,438 --> 01:28:25,844
>> sorry Mr. President, I was

2359
01:28:25,844 --> 01:28:27,281
providing further

2360
01:28:27,281 --> 01:28:29,281
explanation to --

2361
01:28:33,484 --> 01:28:36,484
>> I know you were working.

2362
01:28:38,797 --> 01:28:39,620
>> this is a my ihss support

2363
01:28:39,620 --> 01:28:40,953
services.

2364
01:28:40,953 --> 01:28:41,859
If you can confer with me, this

2365
01:28:41,859 --> 01:28:43,859
is transferring the

2366
01:28:48,266 --> 01:28:49,938
function to social services on

2367
01:28:49,938 --> 01:28:50,938
the administrative portion?

2368
01:28:50,938 --> 01:28:51,641
>> the transfer tax and

2369
01:28:51,641 --> 01:28:53,641
responsibility will be

2370
01:28:57,203 --> 01:28:58,438
transferred to social services

2371
01:28:58,438 --> 01:29:00,838
on an administrative level.

2372
01:29:02,844 --> 01:29:03,547
>> this has been historically

2373
01:29:03,547 --> 01:29:04,219
been administered under

2374
01:29:04,219 --> 01:29:06,619
the county executive office

2375
01:29:12,188 --> 01:29:15,188
ever since the public authority

2376
01:29:15,422 --> 01:29:17,422
was formed.

2377
01:29:21,375 --> 01:29:23,775
>> questions from the board?

2378
01:29:26,203 --> 01:29:27,406
>> I'll just point out that the

2379
01:29:27,406 --> 01:29:28,406
governors May revise

2380
01:29:28,406 --> 01:29:30,470
suggest more cuts when we know

2381
01:29:30,470 --> 01:29:32,547
what's going on with that, we

2382
01:29:32,547 --> 01:29:35,375
will come back to the board

2383
01:29:35,375 --> 01:29:37,375
with modifications.

2384
01:29:38,250 --> 01:29:40,250
>> okay.

2385
01:29:40,328 --> 01:29:42,797
I'm thinking, it was difference

2386
01:29:42,797 --> 01:29:44,500
you spoke of 11 years

2387
01:29:44,500 --> 01:29:46,625
ago today and last years today

2388
01:29:46,625 --> 01:29:48,203
it's a little different.

2389
01:29:48,203 --> 01:29:50,172
I'm sorry I'm shell shocked and

2390
01:29:50,172 --> 01:29:52,203
we had more discussions

2391
01:29:52,203 --> 01:29:53,406
on some items.

2392
01:29:53,406 --> 01:29:54,641
>> [Inaudible]

2393
01:29:54,641 --> 01:29:55,172
>> thank you supervisor.

2394
01:29:55,172 --> 01:29:57,172
Thank you luke.

2395
01:29:58,734 --> 01:30:01,109
We will move on to item number

2396
01:30:01,109 --> 01:30:03,109
nine.

2397
01:30:08,953 --> 01:30:09,719
item nine is review of custody

2398
01:30:09,719 --> 01:30:11,719
health services.

2399
01:30:13,620 --> 01:30:16,000
>> I'll just make some very

2400
01:30:16,000 --> 01:30:18,125
brief momentos keep with

2401
01:30:18,125 --> 01:30:19,391
tradition, I guess.

2402
01:30:19,391 --> 01:30:21,791
Thank you Mr. President

2403
01:30:21,906 --> 01:30:23,406
shirakawa and honorable

2404
01:30:23,406 --> 01:30:25,406
supervisors.

2405
01:30:27,938 --> 01:30:28,438
at both Dr. Smith and gary

2406
01:30:28,438 --> 01:30:29,938
described, the proposed

2407
01:30:29,938 --> 01:30:32,609
budget for our health and

2408
01:30:32,609 --> 01:30:32,984
hospital system fiscal year

2409
01:30:32,984 --> 01:30:34,984
2013

2410
01:30:37,875 --> 01:30:39,344
reflects the direction to stay

2411
01:30:39,344 --> 01:30:41,344
with maintenance level.

2412
01:30:42,281 --> 01:30:44,681
It reconfirms commitment from

2413
01:30:47,484 --> 01:30:49,484
the county mission.

2414
01:30:50,828 --> 01:30:51,500
it continues and some cases

2415
01:30:51,500 --> 01:30:53,500
accelerates the necessary

2416
01:30:53,828 --> 01:30:54,297
changes to respond to the

2417
01:30:54,297 --> 01:30:56,297
increasing challenges.

2418
01:30:58,266 --> 01:30:58,844
As many of you noted, earlier

2419
01:30:58,844 --> 01:31:00,844
discussion related to

2420
01:31:01,375 --> 01:31:02,469
healthcare reform as well as

2421
01:31:02,469 --> 01:31:04,469
the economic uncertainties.

2422
01:31:04,516 --> 01:31:06,219
It's that purpose and with the

2423
01:31:06,219 --> 01:31:08,619
county mission as well

2424
01:31:09,422 --> 01:31:11,470
as our values in mind our

2425
01:31:11,470 --> 01:31:11,344
executive leadership for

2426
01:31:11,344 --> 01:31:12,891
adopting

2427
01:31:12,891 --> 01:31:13,984
the following five major

2428
01:31:13,984 --> 01:31:15,984
strategic priorities.

2429
01:31:15,984 --> 01:31:17,940
First and foremost as you know,

2430
01:31:17,940 --> 01:31:19,494
since this has been

2431
01:31:20,625 --> 01:31:23,156
part of the strategic framework

2432
01:31:23,156 --> 01:31:24,625
from the a&m work.

2433
01:31:24,625 --> 01:31:25,938
The culture of accountability

2434
01:31:25,938 --> 01:31:28,938
is very important for us.

2435
01:31:30,780 --> 01:31:32,141
we can happens the monitoring

2436
01:31:32,141 --> 01:31:34,781
of our system and also

2437
01:31:34,781 --> 01:31:35,703
the manage performance of our

2438
01:31:35,703 --> 01:31:36,844
health and particularly

2439
01:31:36,844 --> 01:31:37,781
hospital system.

2440
01:31:37,781 --> 01:31:39,781
System integration important

2441
01:31:40,453 --> 01:31:44,578
for us as well in term of

2442
01:31:44,578 --> 01:31:46,978
delivering better quality care

2443
01:31:47,391 --> 01:31:49,391
and lowering cost.

2444
01:31:49,719 --> 01:31:52,119
Position alignment is better

2445
01:31:52,297 --> 01:31:54,766
for provision of care and

2446
01:31:54,766 --> 01:31:55,703
strategic and decision-making

2447
01:31:55,703 --> 01:31:57,703
process.

2448
01:31:58,672 --> 01:31:59,266
Unified managed care in terms

2449
01:31:59,266 --> 01:32:01,266
of happening reliability

2450
01:32:02,406 --> 01:32:03,310
of safety net in more

2451
01:32:03,310 --> 01:32:03,203
competitive marketplace as well

2452
01:32:03,203 --> 01:32:05,172
as

2453
01:32:05,172 --> 01:32:05,812
deliver the better and still

2454
01:32:05,812 --> 01:32:08,212
support the critical functions

2455
01:32:09,109 --> 01:32:11,509
of our health system.

2456
01:32:13,844 --> 01:32:14,453
we added a tiff which is

2457
01:32:14,453 --> 01:32:16,453
transforming communities.

2458
01:32:17,281 --> 01:32:19,125
It's a challenge but also even

2459
01:32:19,125 --> 01:32:21,525
more important to be

2460
01:32:21,828 --> 01:32:22,766
within participations of both

2461
01:32:22,766 --> 01:32:25,766
patients as well as community

2462
01:32:28,672 --> 01:32:30,406
so we can continuously continue

2463
01:32:30,406 --> 01:32:32,406
the health status.

2464
01:32:32,703 --> 01:32:33,969
we think combining all of these

2465
01:32:33,969 --> 01:32:34,469
five major strategic

2466
01:32:34,469 --> 01:32:35,344
priority will position

2467
01:32:35,344 --> 01:32:36,438
ourselves in a much better

2468
01:32:36,438 --> 01:32:38,109
place in

2469
01:32:38,109 --> 01:32:39,703
terms of reform.

2470
01:32:39,703 --> 01:32:40,609
As you mentioned, our employees

2471
01:32:40,609 --> 01:32:43,900
have done tremendous in

2472
01:32:46,953 --> 01:32:49,470
terms of day in and day out,

2473
01:32:49,470 --> 01:32:51,447
7/24, 365 days out of year.

2474
01:32:51,922 --> 01:32:53,328
Doing what we need to do to

2475
01:32:53,328 --> 01:32:55,328
fulfill our mission.

2476
01:32:55,453 --> 01:32:56,234
We want to make sure that we

2477
01:32:56,234 --> 01:32:58,310
continue to protect and

2478
01:32:58,310 --> 01:33:00,562
promote the health of residents

2479
01:33:00,562 --> 01:33:01,500
in our communities.

2480
01:33:01,500 --> 01:33:03,172
That includes all 1.8 million

2481
01:33:03,172 --> 01:33:04,000
residents, that's part of

2482
01:33:04,000 --> 01:33:04,469
our public health

2483
01:33:04,469 --> 01:33:06,780
responsibility.

2484
01:33:06,780 --> 01:33:08,470
Mental health will continue to

2485
01:33:08,470 --> 01:33:10,109
treat and care the

2486
01:33:10,109 --> 01:33:12,172
seriously mental ill in our

2487
01:33:12,172 --> 01:33:12,984
communities on behalf of all of

2488
01:33:12,984 --> 01:33:14,984
us.

2489
01:33:17,780 --> 01:33:18,750
Custody health will serve

2490
01:33:18,750 --> 01:33:20,594
incarcerated adult or youth.

2491
01:33:20,594 --> 01:33:21,453
Drug and alcohol services

2492
01:33:21,453 --> 01:33:23,853
department, will continue to

2493
01:33:24,250 --> 01:33:24,953
serve youth and adults

2494
01:33:24,953 --> 01:33:26,359
afflicted by addiction.

2495
01:33:26,359 --> 01:33:28,759
Our community health services

2496
01:33:28,828 --> 01:33:31,228
will continue to treat

2497
01:33:31,391 --> 01:33:34,391
people with illnesses, that are

2498
01:33:38,312 --> 01:33:41,234
risk to themselves as well

2499
01:33:41,234 --> 01:33:42,844
as others. Certainly our santa

2500
01:33:42,844 --> 01:33:45,244
clara valley medical center,

2501
01:33:45,250 --> 01:33:47,470
we continue to provide care and

2502
01:33:47,470 --> 01:33:47,875
treatment at your hospitals

2503
01:33:47,875 --> 01:33:49,625
and clinics.

2504
01:33:49,625 --> 01:33:50,984
Each of our department heads

2505
01:33:50,984 --> 01:33:52,391
will now present very

2506
01:33:52,391 --> 01:33:54,791
briefly the major highlights

2507
01:33:54,828 --> 01:33:57,828
offer budget proposals and I

2508
01:34:02,438 --> 01:34:02,969
will turn it over to mary yan.

2509
01:34:02,969 --> 01:34:04,672
Maryann.

2510
01:34:04,672 --> 01:34:07,672
>> let me recognize the chair.

2511
01:34:07,906 --> 01:34:10,203
Let the chair say a couple

2512
01:34:10,203 --> 01:34:12,203
words.

2513
01:34:16,547 --> 01:34:18,422
>> just to say in general,

2514
01:34:18,422 --> 01:34:21,422
welcome renee first of all.

2515
01:34:22,547 --> 01:34:25,547
It's good to have you.

2516
01:34:26,688 --> 01:34:28,422
Secondly, I'm not always sure

2517
01:34:28,422 --> 01:34:29,859
that everyone understands

2518
01:34:29,859 --> 01:34:32,125
what it takes to upgrade the

2519
01:34:32,125 --> 01:34:35,125
health system in this county.

2520
01:34:35,172 --> 01:34:35,500
Unless I'm wrong, we're usually

2521
01:34:35,500 --> 01:34:36,203
running about

2522
01:34:36,203 --> 01:34:38,203
$1.5 billion.

2523
01:34:42,969 --> 01:34:44,844
Have we changed any this year?

2524
01:34:44,844 --> 01:34:47,244
We upped it to 1.7.

2525
01:34:48,641 --> 01:34:49,688
That is a third overall as we

2526
01:34:49,688 --> 01:34:50,422
look at our $4 billion

2527
01:34:50,422 --> 01:34:52,822
budget. It's very important

2528
01:34:52,984 --> 01:34:55,384
service that we provide.

2529
01:34:56,156 --> 01:34:57,219
i truly believe and I often say

2530
01:34:57,219 --> 01:34:59,156
to people, this county

2531
01:34:59,156 --> 01:34:59,797
has universal healthcare

2532
01:34:59,797 --> 01:35:00,297
regardless what you might have

2533
01:35:00,297 --> 01:35:00,719
in '

2534
01:35:00,719 --> 01:35:02,719
county.

2535
01:35:03,969 --> 01:35:06,203
We really do have that.

2536
01:35:06,203 --> 01:35:07,438
There is absolutely no way that

2537
01:35:07,438 --> 01:35:08,766
you could not get

2538
01:35:08,766 --> 01:35:09,828
service in this county if you

2539
01:35:09,828 --> 01:35:12,228
wish to get it.

2540
01:35:14,172 --> 01:35:16,672
You can go to one of our

2541
01:35:16,672 --> 01:35:18,578
clinics or partnership clinic.

2542
01:35:18,578 --> 01:35:19,781
You can access our urgent care.

2543
01:35:19,781 --> 01:35:21,578
You can access -- there are

2544
01:35:21,578 --> 01:35:24,844
number of ways that you can

2545
01:35:24,844 --> 01:35:26,281
get treatment in this county.

2546
01:35:26,281 --> 01:35:27,391
We have had support from that

2547
01:35:27,391 --> 01:35:30,125
from the public for a

2548
01:35:30,125 --> 01:35:32,797
very long period of time.

2549
01:35:32,797 --> 01:35:34,797
Right now, we're under way with

2550
01:35:34,797 --> 01:35:37,940
a new building which I

2551
01:35:37,940 --> 01:35:38,859
think still is on target for

2552
01:35:38,859 --> 01:35:40,875
2013, which is going to be

2553
01:35:40,875 --> 01:35:43,500
certainly state of the art.

2554
01:35:43,500 --> 01:35:45,672
Having said all of that, we

2555
01:35:45,672 --> 01:35:48,720
really have struggled over

2556
01:35:50,250 --> 01:35:52,688
the last few years, ken equal

2557
01:35:52,688 --> 01:35:55,391
credit and I, to really put

2558
01:35:55,391 --> 01:35:55,984
the hospital on a different

2559
01:35:55,984 --> 01:35:57,984
track.

2560
01:35:59,160 --> 01:36:01,391
because just as mike mentioned

2561
01:36:01,391 --> 01:36:02,940
earlier that the rise in

2562
01:36:02,940 --> 01:36:04,940
healthcare is phenomenal.

2563
01:36:04,828 --> 01:36:08,428
It is also difficult when we

2564
01:36:09,672 --> 01:36:11,266
now have so many issues so

2565
01:36:11,266 --> 01:36:13,000
many new diagnostic test.

2566
01:36:13,000 --> 01:36:14,266
So much is new particularly for

2567
01:36:14,266 --> 01:36:14,797
patients not ask for

2568
01:36:14,797 --> 01:36:16,609
those.

2569
01:36:16,609 --> 01:36:19,375
If you go in with broken leg

2570
01:36:19,375 --> 01:36:20,984
now rather than simply

2571
01:36:20,984 --> 01:36:24,584
have an x-ray, someone will say

2572
01:36:24,609 --> 01:36:25,516
you need an mri and ct scan.

2573
01:36:25,516 --> 01:36:28,516
There's a lot of explanation

2574
01:36:29,780 --> 01:36:30,781
that must go on between

2575
01:36:30,781 --> 01:36:32,984
the provider and the user.

2576
01:36:32,984 --> 01:36:34,125
It's become a far more

2577
01:36:34,125 --> 01:36:36,797
complicated system that we use

2578
01:36:36,797 --> 01:36:38,891
in order to provide healthcare.

2579
01:36:38,891 --> 01:36:39,797
one that I think we have to be

2580
01:36:39,797 --> 01:36:41,703
explaining to the public

2581
01:36:41,703 --> 01:36:43,562
a great deal of time.

2582
01:36:43,562 --> 01:36:46,500
Having said that, we still got

2583
01:36:46,500 --> 01:36:48,234
great support in '08 for

2584
01:36:48,234 --> 01:36:50,875
the bond putting up the new

2585
01:36:50,875 --> 01:36:51,470
building. When we have gone

2586
01:36:51,470 --> 01:36:53,470
out

2587
01:36:53,109 --> 01:36:54,470
for public support particularly

2588
01:36:54,470 --> 01:36:57,470
for kids areas, trauma and

2589
01:36:57,844 --> 01:36:58,422
so forth, we've gotten that as

2590
01:36:58,422 --> 01:37:00,422
well.

2591
01:37:00,422 --> 01:37:04,220
i think the public truly does

2592
01:37:05,531 --> 01:37:07,931
value this service that

2593
01:37:13,172 --> 01:37:13,531
we provide in exemplary way in

2594
01:37:13,531 --> 01:37:15,531
this county.

2595
01:37:17,969 --> 01:37:19,203
This is not a whole new area

2596
01:37:19,203 --> 01:37:21,172
for you but a different

2597
01:37:21,172 --> 01:37:23,572
way to deliver healthcare.

2598
01:37:25,250 --> 01:37:27,375
I really like to say thanks to

2599
01:37:27,375 --> 01:37:29,812
ken because this is --

2600
01:37:29,812 --> 01:37:30,922
these are long meetings that we

2601
01:37:30,922 --> 01:37:32,750
have.

2602
01:37:32,750 --> 01:37:34,719
We've spend a great deal of

2603
01:37:34,719 --> 01:37:36,719
time.

2604
01:37:37,484 --> 01:37:39,562
I spend a lot of time talking

2605
01:37:39,562 --> 01:37:41,962
to jeff and linda

2606
01:37:42,766 --> 01:37:44,672
particularly with gays and cfo.

2607
01:37:44,672 --> 01:37:47,672
We are working with diligence

2608
01:37:48,438 --> 01:37:50,609
to try to keep the cost

2609
01:37:50,609 --> 01:37:52,780
down of that most expensive of

2610
01:37:52,780 --> 01:37:53,812
our department.

2611
01:37:53,812 --> 01:37:55,547
I really want the public as

2612
01:37:55,547 --> 01:37:57,947
well as employees know

2613
01:38:03,156 --> 01:38:05,780
that, I think we have had a

2614
01:38:05,780 --> 01:38:06,219
concentrate effort in order to

2615
01:38:06,219 --> 01:38:07,859
understand more completely

2616
01:38:07,859 --> 01:38:08,940
exactly how the healthcare

2617
01:38:08,940 --> 01:38:08,719
dollar

2618
01:38:08,719 --> 01:38:10,719
is spent.

2619
01:38:11,797 --> 01:38:12,125
I think we're making some

2620
01:38:12,125 --> 01:38:14,125
progress.

2621
01:38:14,891 --> 01:38:16,891
I'm going to turn this over to

2622
01:38:16,891 --> 01:38:18,859
ken next year and lord

2623
01:38:18,859 --> 01:38:20,266
knows he May save a whole lot

2624
01:38:20,266 --> 01:38:21,234
more than we've been able to

2625
01:38:21,234 --> 01:38:22,641
together.

2626
01:38:22,641 --> 01:38:24,203
i really do want to show

2627
01:38:24,203 --> 01:38:24,844
everyone that we have worked

2628
01:38:24,844 --> 01:38:26,844
hard on this.

2629
01:38:28,470 --> 01:38:30,641
It good to see you renee.

2630
01:38:30,641 --> 01:38:32,375
You will be over seeing our

2631
01:38:32,375 --> 01:38:32,719
umbrella of healthcare

2632
01:38:32,719 --> 01:38:34,719
services.

2633
01:38:38,453 --> 01:38:39,625
For all the other thing that we

2634
01:38:39,625 --> 01:38:40,828
provide, we deliver

2635
01:38:40,828 --> 01:38:42,562
kind of a sober message.

2636
01:38:42,562 --> 01:38:44,531
if you don't have your

2637
01:38:44,531 --> 01:38:46,891
healthcare and you don't have a

2638
01:38:46,891 --> 01:38:50,491
way to get healthcare to help

2639
01:38:50,906 --> 01:38:53,906
you through the problem to

2640
01:38:54,406 --> 01:38:56,806
hopefully get better, there's

2641
01:38:57,672 --> 01:38:59,672
no other option.

2642
01:39:02,906 --> 01:39:03,609
many other things we can do

2643
01:39:03,609 --> 01:39:05,609
without.

2644
01:39:05,781 --> 01:39:06,719
When one's health is

2645
01:39:06,719 --> 01:39:07,688
threatened, it changes your

2646
01:39:07,688 --> 01:39:08,160
whole

2647
01:39:08,160 --> 01:39:10,160
life.

2648
01:39:10,219 --> 01:39:11,219
We're in a life saving business

2649
01:39:11,219 --> 01:39:13,219
and hopefully we're

2650
01:39:13,531 --> 01:39:16,328
also in a prevention business,

2651
01:39:16,328 --> 01:39:18,359
which has been one of the

2652
01:39:18,359 --> 01:39:19,359
areas that both ken and I have

2653
01:39:19,359 --> 01:39:21,359
concentrated on through

2654
01:39:22,000 --> 01:39:26,200
public health as we look at our

2655
01:39:29,312 --> 01:39:32,312
great great grants come in.

2656
01:39:32,719 --> 01:39:35,484
A rather long speech but I feel

2657
01:39:35,484 --> 01:39:37,484
fairly passionately

2658
01:39:38,780 --> 01:39:40,250
about this whole area and it

2659
01:39:40,250 --> 01:39:42,650
certainly has been a

2660
01:39:42,719 --> 01:39:43,750
challenging but very rewarding

2661
01:39:43,750 --> 01:39:47,350
area to work with while I've

2662
01:39:48,891 --> 01:39:49,188
been here at the county.

2663
01:39:49,188 --> 01:39:50,156
Thanks.

2664
01:39:50,156 --> 01:39:51,156
>> thank you very much

2665
01:39:51,156 --> 01:39:52,734
supervisor kniss.

2666
01:39:52,734 --> 01:39:54,641
You did ask a question in there

2667
01:39:54,641 --> 01:39:55,310
that I feel compelled

2668
01:39:55,310 --> 01:39:57,310
to answer.

2669
01:39:59,310 --> 01:40:01,160
>> I'm trying to think where I

2670
01:40:01,160 --> 01:40:01,312
asked the question

2671
01:40:01,312 --> 01:40:02,375
[Laughter].

2672
01:40:02,375 --> 01:40:03,547
>> you asked whether we're

2673
01:40:03,547 --> 01:40:04,470
still on schedule for that

2674
01:40:04,470 --> 01:40:05,953
building.

2675
01:40:05,953 --> 01:40:09,553
the answer to that is no.

2676
01:40:12,625 --> 01:40:16,225
With changes in terms of our

2677
01:40:18,940 --> 01:40:20,494
interaction with osh pod

2678
01:40:26,562 --> 01:40:27,172
as well as we modify our

2679
01:40:27,172 --> 01:40:29,172
strategic planning.

2680
01:40:29,375 --> 01:40:30,297
In addition, there's some

2681
01:40:30,297 --> 01:40:32,697
issues around the design

2682
01:40:33,906 --> 01:40:34,281
build and the relationship with

2683
01:40:34,281 --> 01:40:36,470
the contractor.

2684
01:40:36,470 --> 01:40:38,470
We are behind schedule and at

2685
01:40:38,470 --> 01:40:40,719
this point, I can't give

2686
01:40:40,719 --> 01:40:44,160
you an exact number but it's

2687
01:40:44,160 --> 01:40:47,160
probably in the year range.

2688
01:40:49,359 --> 01:40:52,531
i would not expect to be ready

2689
01:40:52,531 --> 01:40:54,359
to open in 2013.

2690
01:40:54,359 --> 01:40:56,562
>> heading at least to 2014?

2691
01:40:56,562 --> 01:40:58,962
>> with our fingers crossed.

2692
01:41:00,969 --> 01:41:01,938
>> one other thing I would say

2693
01:41:01,938 --> 01:41:04,338
george, I think we've

2694
01:41:04,375 --> 01:41:05,969
become much more realistic in

2695
01:41:05,969 --> 01:41:08,369
our prediction of numbers.

2696
01:41:09,578 --> 01:41:09,781
you're going to see that in

2697
01:41:09,781 --> 01:41:11,781
here.

2698
01:41:12,312 --> 01:41:14,953
Ken and I both follow an daily

2699
01:41:14,953 --> 01:41:17,353
basis what the consensus

2700
01:41:17,359 --> 01:41:18,453
is on the hospital.

2701
01:41:18,453 --> 01:41:19,453
Almost no stone has been

2702
01:41:19,453 --> 01:41:22,453
unturned if we track this.

2703
01:41:24,594 --> 01:41:25,500
As you look at this here, you

2704
01:41:25,500 --> 01:41:27,328
have noticed we have

2705
01:41:27,328 --> 01:41:28,766
become far more realistic in

2706
01:41:28,766 --> 01:41:29,969
our prediction which allow us

2707
01:41:29,969 --> 01:41:32,969
to become much more realistic

2708
01:41:33,734 --> 01:41:35,672
as we go through our budgeting

2709
01:41:35,672 --> 01:41:37,672
session.

2710
01:41:41,672 --> 01:41:42,844
That -- we haven't hit our

2711
01:41:42,844 --> 01:41:44,844
target.

2712
01:41:45,344 --> 01:41:48,547
I think it's more realistic and

2713
01:41:48,547 --> 01:41:49,859
i think we have seen a

2714
01:41:49,859 --> 01:41:52,259
number of improvements lately

2715
01:41:54,797 --> 01:41:57,328
as far as getting toward that

2716
01:41:57,328 --> 01:41:58,469
those actual numbers we

2717
01:41:58,469 --> 01:42:00,469
allocated last year.

2718
01:42:00,828 --> 01:42:01,469
>> thank you supervisor. Jeff

2719
01:42:01,469 --> 01:42:03,469
anything else?

2720
01:42:05,375 --> 01:42:06,172
Thank you renee and let's go to

2721
01:42:06,172 --> 01:42:08,469
the unit form 14 grant.

2722
01:42:08,469 --> 01:42:11,484
it was a long way to get to you.

2723
01:42:11,484 --> 01:42:12,906
>> I'm happy to wait.

2724
01:42:12,906 --> 01:42:13,484
Custody health services. From

2725
01:42:13,484 --> 01:42:15,484
the highlights

2726
01:42:15,844 --> 01:42:18,844
identified above, just like to

2727
01:42:19,891 --> 01:42:20,484
quickly point out two of the

2728
01:42:20,484 --> 01:42:22,156
highlights.

2729
01:42:22,156 --> 01:42:24,422
The first the second bullet

2730
01:42:24,422 --> 01:42:26,422
where we finalized

2731
01:42:27,859 --> 01:42:30,125
agreement with the social

2732
01:42:30,125 --> 01:42:32,125
security administration.

2733
01:42:34,172 --> 01:42:35,438
This is really a critical

2734
01:42:35,438 --> 01:42:37,438
piece, success reentry

2735
01:42:38,609 --> 01:42:40,906
efforts for inmates back into

2736
01:42:40,906 --> 01:42:43,141
our community I'm sure board

2737
01:42:43,141 --> 01:42:43,781
members are aware May lose

2738
01:42:43,781 --> 01:42:45,781
benefits upon incarceration and

2739
01:42:45,781 --> 01:42:47,109
when they are released from the

2740
01:42:47,109 --> 01:42:49,922
jail, it takes them three,

2741
01:42:49,922 --> 01:42:51,891
six and more months to obtain

2742
01:42:51,891 --> 01:42:54,291
benefits. This agreement will

2743
01:42:55,828 --> 01:42:56,656
allow us to start the process

2744
01:42:56,656 --> 01:42:58,000
three months prior to the

2745
01:42:58,000 --> 01:42:59,620
release and the benefits will

2746
01:42:59,620 --> 01:43:01,562
be available to them hopefully

2747
01:43:01,562 --> 01:43:04,940
on the day of their release.

2748
01:43:04,940 --> 01:43:05,828
We will be able to provide

2749
01:43:05,828 --> 01:43:07,828
appropriate housing and

2750
01:43:10,266 --> 01:43:11,672
other benefits for them.

2751
01:43:11,672 --> 01:43:15,272
The last bullet I will point

2752
01:43:15,438 --> 01:43:17,838
out 62% of our inmates

2753
01:43:18,719 --> 01:43:19,781
receive medicare and equates

2754
01:43:19,781 --> 01:43:21,781
about 2200 inmates. 22%

2755
01:43:21,781 --> 01:43:24,181
receive mental health services

2756
01:43:27,656 --> 01:43:29,500
and approximately a thousand

2757
01:43:29,500 --> 01:43:32,620
inmates. As far as our request

2758
01:43:32,620 --> 01:43:34,462
for funding, for fiscal

2759
01:43:34,797 --> 01:43:35,797
year, the request is six

2760
01:43:35,797 --> 01:43:37,531
positions.

2761
01:43:37,531 --> 01:43:39,931
These positions are direct

2762
01:43:50,688 --> 01:43:52,688
service care providers.

2763
01:43:53,281 --> 01:43:53,953
i would be happy to answer any

2764
01:43:53,953 --> 01:43:56,353
questions you might have

2765
01:43:58,891 --> 01:44:01,291
>> maybe question and comment.

2766
01:44:03,297 --> 01:44:05,697
We had discussions with

2767
01:44:06,828 --> 01:44:09,641
possibly medical and that whole

2768
01:44:09,641 --> 01:44:11,641
model.

2769
01:44:15,672 --> 01:44:16,969
i think it was on page 463, the

2770
01:44:16,969 --> 01:44:19,369
four positions and it

2771
01:44:19,484 --> 01:44:23,840
mentions focus of care will be

2772
01:44:24,984 --> 01:44:25,625
on primary prevention and

2773
01:44:25,625 --> 01:44:27,625
chronic disease management.

2774
01:44:27,953 --> 01:44:30,328
Certainly a good plan that

2775
01:44:30,328 --> 01:44:30,828
rotate maybe one out of the

2776
01:44:30,828 --> 01:44:33,359
six doctors and ga the

2777
01:44:33,359 --> 01:44:36,359
community to do that treatment

2778
01:44:37,594 --> 01:44:39,938
possibly and I've always

2779
01:44:39,938 --> 01:44:40,141
advocated that the -- can you

2780
01:44:40,141 --> 01:44:42,141
talk

2781
01:44:42,172 --> 01:44:44,172
about discussions?

2782
01:44:46,844 --> 01:44:49,812
>> the plan is that setting and

2783
01:44:49,812 --> 01:44:51,780
primary care clinic at

2784
01:44:51,780 --> 01:44:53,780
the reentry center.

2785
01:44:58,312 --> 01:44:58,781
we want it to be a transition

2786
01:44:58,781 --> 01:45:00,781
al center.

2787
01:45:01,297 --> 01:45:03,891
We will be providing services

2788
01:45:03,891 --> 01:45:04,734
until we can get them

2789
01:45:04,734 --> 01:45:06,310
reestablished within the

2790
01:45:06,310 --> 01:45:06,234
community with their primary

2791
01:45:06,234 --> 01:45:07,625
care

2792
01:45:07,625 --> 01:45:09,625
provider.

2793
01:45:10,531 --> 01:45:10,906
>> we'll hear that five year

2794
01:45:10,906 --> 01:45:12,906
plan.

2795
01:45:13,469 --> 01:45:17,690
I'm sure you'll be there too.

2796
01:45:17,875 --> 01:45:20,275
other questions from the

2797
01:45:22,781 --> 01:45:24,719
committee?

2798
01:45:24,719 --> 01:45:27,719
>> on page 460, on the right

2799
01:45:28,922 --> 01:45:31,922
hand side three down, it

2800
01:45:32,328 --> 01:45:34,328
says unfunded codes.

2801
01:45:35,125 --> 01:45:37,234
i understand it cost center and

2802
01:45:37,234 --> 01:45:38,531
it list 24 ftes.

2803
01:45:38,531 --> 01:45:40,310
Can you explain what those are?

2804
01:45:40,310 --> 01:45:44,620
Are they in the body of this

2805
01:45:44,620 --> 01:45:46,797
and I didn't see it?

2806
01:45:46,797 --> 01:45:48,797
>> the unfunded codes

2807
01:45:50,609 --> 01:45:51,938
historically had a number up

2808
01:45:51,938 --> 01:45:53,672
funded codes as I believe

2809
01:45:53,672 --> 01:45:54,250
valley medical center had

2810
01:45:54,250 --> 01:45:56,470
unfunded

2811
01:45:56,470 --> 01:45:57,109
codes.

2812
01:45:57,109 --> 01:45:59,780
Primary focus of those codes is

2813
01:45:59,780 --> 01:46:01,250
they are all clinical

2814
01:46:01,250 --> 01:46:03,250
positions. For-instances, we

2815
01:46:07,625 --> 01:46:09,469
have clinical nurse position,

2816
01:46:09,469 --> 01:46:11,469
nurse practitioner.

2817
01:46:11,625 --> 01:46:12,500
They are used on individuals on

2818
01:46:12,500 --> 01:46:14,900
a long term leave

2819
01:46:16,797 --> 01:46:18,844
>> those are sort of like

2820
01:46:18,844 --> 01:46:20,844
temporary health help?

2821
01:46:22,844 --> 01:46:24,780
>> they are not temporary help.

2822
01:46:24,780 --> 01:46:25,750
>> temporary contracts maybe?

2823
01:46:25,750 --> 01:46:27,750
>> they would be.

2824
01:46:32,160 --> 01:46:34,470
If we fill the position, it

2825
01:46:34,470 --> 01:46:37,470
will be a coded position.

2826
01:46:37,625 --> 01:46:38,484
it's a vacant position but it's

2827
01:46:38,484 --> 01:46:40,484
unfunded.

2828
01:46:42,922 --> 01:46:43,594
Funding will come from the

2829
01:46:43,594 --> 01:46:47,194
position that -- let me see

2830
01:46:48,500 --> 01:46:50,641
if I can back up.

2831
01:46:50,641 --> 01:46:51,875
I can't remember when we last

2832
01:46:51,875 --> 01:46:53,344
use them.

2833
01:46:53,344 --> 01:46:55,344
We use it on in situations

2834
01:46:55,344 --> 01:46:56,703
where we have a critical

2835
01:46:56,703 --> 01:46:58,484
position within the

2836
01:46:58,484 --> 01:46:59,375
organization to provide

2837
01:46:59,375 --> 01:47:01,375
clinical care

2838
01:47:02,484 --> 01:47:05,160
and we don't have the capacity

2839
01:47:05,160 --> 01:47:06,125
to fill the position because

2840
01:47:06,125 --> 01:47:07,453
people are on long term

2841
01:47:07,453 --> 01:47:09,620
extended leave and we need to

2842
01:47:09,620 --> 01:47:12,620
continue to provide the service.

2843
01:47:12,766 --> 01:47:15,391
We would seek permission to use

2844
01:47:15,391 --> 01:47:17,391
unfunded code.

2845
01:47:17,625 --> 01:47:18,328
Let's say a nurse practitioner,

2846
01:47:18,328 --> 01:47:20,141
we will seek

2847
01:47:20,141 --> 01:47:22,375
opportunity to use unfunded

2848
01:47:22,375 --> 01:47:24,141
code, hire someone under the

2849
01:47:24,141 --> 01:47:25,312
code and they will be a coded

2850
01:47:25,312 --> 01:47:27,312
employee.

2851
01:47:29,375 --> 01:47:32,375
>> what jure saying, these are

2852
01:47:32,609 --> 01:47:32,984
sort of your kinds of

2853
01:47:32,984 --> 01:47:34,984
provided codes?

2854
01:47:35,391 --> 01:47:38,991
You seldom use them but you

2855
01:47:39,219 --> 01:47:39,750
need them in a just in case

2856
01:47:39,750 --> 01:47:40,922
situation?

2857
01:47:40,922 --> 01:47:42,891
>> that it correct.

2858
01:47:42,891 --> 01:47:44,940
>> you you're saying you seldom

2859
01:47:44,940 --> 01:47:46,940
use them?

2860
01:47:46,922 --> 01:47:48,438
>> very seldom.

2861
01:47:48,438 --> 01:47:52,380
I have to check with finance.

2862
01:47:53,875 --> 01:47:58,750
I know we haven't used them in

2863
01:48:00,703 --> 01:48:02,703
many years.

2864
01:48:04,641 --> 01:48:07,410
>> employees on long term

2865
01:48:08,391 --> 01:48:09,688
leave, we do not need

2866
01:48:09,688 --> 01:48:11,484
unfunded codes. Historically,

2867
01:48:11,484 --> 01:48:14,484
the unfunded codes in custody

2868
01:48:15,188 --> 01:48:17,310
health as well as elsewhere in

2869
01:48:17,310 --> 01:48:20,310
the hospital as mentioned are

2870
01:48:20,797 --> 01:48:22,562
clinical positions.

2871
01:48:22,562 --> 01:48:22,797
They mostly for the patient

2872
01:48:22,797 --> 01:48:24,797
census.

2873
01:48:27,734 --> 01:48:28,266
We build to the number of

2874
01:48:28,266 --> 01:48:30,266
positions that maximumly

2875
01:48:31,344 --> 01:48:32,812
going to be used. At times, we

2876
01:48:32,812 --> 01:48:35,109
look at those unfunded codes

2877
01:48:35,109 --> 01:48:38,484
to see if we continue to

2878
01:48:38,484 --> 01:48:41,484
reflect that in the budget.

2879
01:48:41,922 --> 01:48:44,322
>> anything else on that?

2880
01:48:47,620 --> 01:48:49,797
>> I think you can understand

2881
01:48:49,797 --> 01:48:51,969
why I was somewhat

2882
01:48:51,969 --> 01:48:53,266
puzzled by those.

2883
01:48:53,266 --> 01:48:54,234
I almost call them extremist if

2884
01:48:54,234 --> 01:48:54,594
you need to pull on

2885
01:48:54,594 --> 01:48:56,594
those.

2886
01:48:57,531 --> 01:48:59,141
It's just a lot of codes.

2887
01:48:59,141 --> 01:49:01,541
That what seemed unusual.

2888
01:49:04,109 --> 01:49:04,578
thanks george.

2889
01:49:04,578 --> 01:49:06,578
>> supervisor cortese?

2890
01:49:06,719 --> 01:49:09,781
>> this is kind of a general

2891
01:49:09,781 --> 01:49:10,781
question about the fte

2892
01:49:10,781 --> 01:49:13,156
that will be seen throughout

2893
01:49:13,156 --> 01:49:15,984
the budget in terms of ab109

2894
01:49:15,984 --> 01:49:17,859
and the add ons.

2895
01:49:17,859 --> 01:49:20,259
I'm not really clear.

2896
01:49:21,620 --> 01:49:23,203
I didn't catch it in the

2897
01:49:23,203 --> 01:49:26,203
overview or anything yet, as

2898
01:49:26,469 --> 01:49:28,297
to what the bigger picture is.

2899
01:49:28,297 --> 01:49:29,734
Obviously, the reentry program

2900
01:49:29,734 --> 01:49:30,609
started in this current

2901
01:49:30,609 --> 01:49:32,609
fiscal year.

2902
01:49:34,781 --> 01:49:35,281
It started in prior calendar

2903
01:49:35,281 --> 01:49:37,281
year.

2904
01:49:38,780 --> 01:49:41,678
I don't recall how we factored

2905
01:49:42,188 --> 01:49:42,391
in covering the cost of

2906
01:49:42,391 --> 01:49:43,312
that.

2907
01:49:43,312 --> 01:49:45,656
Obviously reimburses from the

2908
01:49:45,656 --> 01:49:47,656
state.

2909
01:49:48,453 --> 01:49:50,594
How we factored in terms of fte.

2910
01:49:50,594 --> 01:49:52,469
How we getting by.

2911
01:49:52,469 --> 01:49:55,469
There must be some strategy

2912
01:49:55,969 --> 01:49:59,234
beneath all of this is is

2913
01:49:59,234 --> 01:49:59,703
ramping up with the program to

2914
01:49:59,703 --> 01:50:01,703
add fte.

2915
01:50:01,844 --> 01:50:02,469
I do see the revenue coming in

2916
01:50:02,469 --> 01:50:04,869
the documents I don't

2917
01:50:08,470 --> 01:50:10,547
know what the methods to to

2918
01:50:10,547 --> 01:50:12,547
the madness is.

2919
01:50:12,719 --> 01:50:16,319
The way we receive it it's

2920
01:50:19,656 --> 01:50:20,891
pieced in unit byunit.

2921
01:50:20,891 --> 01:50:22,922
Maybe for the benefit for the

2922
01:50:22,922 --> 01:50:25,310
rest of us, you can tell

2923
01:50:25,310 --> 01:50:25,328
us how does that ramping

2924
01:50:25,328 --> 01:50:27,125
working?

2925
01:50:27,125 --> 01:50:28,672
I didn't really want to put

2926
01:50:28,672 --> 01:50:31,672
that on one unit here.

2927
01:50:32,406 --> 01:50:35,406
>> in the front of the

2928
01:50:36,938 --> 01:50:39,938
document, there's a section on

2929
01:50:55,734 --> 01:50:57,594
ab109 that 109 attempts.

2930
01:50:57,594 --> 01:50:58,656
The department created a plan

2931
01:50:58,656 --> 01:51:01,656
to how we approach this.

2932
01:51:02,500 --> 01:51:03,438
The key factor is to recognize

2933
01:51:03,438 --> 01:51:06,438
the fact since this was

2934
01:51:07,172 --> 01:51:08,703
a major change, a change in a

2935
01:51:08,703 --> 01:51:11,703
that we recognized there would

2936
01:51:13,219 --> 01:51:13,906
be things happening where we

2937
01:51:13,906 --> 01:51:14,781
have to adjust.

2938
01:51:14,781 --> 01:51:15,984
It's a flexible plan.

2939
01:51:15,984 --> 01:51:17,250
Over the course since October

2940
01:51:17,250 --> 01:51:19,781
1, we come back to the

2941
01:51:19,781 --> 01:51:21,160
board on two different

2942
01:51:21,160 --> 01:51:23,416
occasions to make modifications

2943
01:51:24,940 --> 01:51:26,494
already to the plan.

2944
01:51:26,531 --> 01:51:27,562
we attempting to -- what we

2945
01:51:27,562 --> 01:51:29,962
seeing we given forecast.

2946
01:51:31,656 --> 01:51:33,469
As we implement the programs we

2947
01:51:33,469 --> 01:51:34,620
are adjusting based on

2948
01:51:34,620 --> 01:51:36,620
the actual experience.

2949
01:51:36,109 --> 01:51:38,844
It's not as if it's a hard and

2950
01:51:38,844 --> 01:51:40,234
fast plan because we're

2951
01:51:40,234 --> 01:51:42,469
trying to be flexible.

2952
01:51:42,469 --> 01:51:44,438
As jeff mentioned in the

2953
01:51:44,438 --> 01:51:46,838
introduction, we plan for

2954
01:51:48,109 --> 01:51:49,780
basic. Getting a doubling of

2955
01:51:49,780 --> 01:51:52,547
our resource and so what's in

2956
01:51:52,547 --> 01:51:53,656
front of you in terms of the

2957
01:51:53,656 --> 01:51:53,891
recommended budget, reflects

2958
01:51:53,891 --> 01:51:55,891
that.

2959
01:51:57,453 --> 01:52:01,653
There are an impact in terms of

2960
01:52:02,438 --> 01:52:04,203
ftes in each the

2961
01:52:04,203 --> 01:52:05,297
area, collection, probation and

2962
01:52:05,297 --> 01:52:06,234
custody health.

2963
01:52:06,234 --> 01:52:07,406
There's impacts more service

2964
01:52:07,406 --> 01:52:09,172
and contract related drug

2965
01:52:09,172 --> 01:52:11,172
and alcohol and mental health

2966
01:52:11,172 --> 01:52:11,906
type of services. It's a

2967
01:52:11,906 --> 01:52:13,906
combination.

2968
01:52:14,844 --> 01:52:16,250
What we're trying to reflect is

2969
01:52:16,250 --> 01:52:17,375
our actual experience

2970
01:52:17,375 --> 01:52:19,547
in the area that is

2971
01:52:19,547 --> 01:52:19,812
particularly clear to us as

2972
01:52:19,812 --> 01:52:21,812
probation.

2973
01:52:22,922 --> 01:52:25,250
We trying to keep a 1 to 30

2974
01:52:25,250 --> 01:52:28,828
case load to make sure the

2975
01:52:28,828 --> 01:52:29,984
over sight is very intense.

2976
01:52:29,984 --> 01:52:30,656
Corrections is a little bit

2977
01:52:30,656 --> 01:52:32,656
more difficult because

2978
01:52:39,906 --> 01:52:42,000
we're changing the nature of

2979
01:52:42,000 --> 01:52:42,531
our collection system.

2980
01:52:42,531 --> 01:52:43,500
Previously, we rarely had

2981
01:52:43,500 --> 01:52:45,203
people here only a year.

2982
01:52:45,203 --> 01:52:47,375
We have to look at how we're

2983
01:52:47,375 --> 01:52:48,281
going to manage that

2984
01:52:48,281 --> 01:52:50,681
change in the geopopulation.

2985
01:52:51,375 --> 01:52:52,578
>> is it fair to say we're

2986
01:52:52,578 --> 01:52:54,344
extrapolating growth based

2987
01:52:54,344 --> 01:52:55,516
on our immediate past

2988
01:52:55,516 --> 01:52:57,625
experience, which only been

2989
01:52:57,625 --> 01:52:59,160
about 6

2990
01:52:59,160 --> 01:53:01,160
offer 8 months?

2991
01:53:02,125 --> 01:53:05,725
In the formula over all seems

2992
01:53:06,766 --> 01:53:08,438
to be a doubling of

2993
01:53:08,438 --> 01:53:10,438
resources?

2994
01:53:10,531 --> 01:53:11,906
sounds like there's nuances in

2995
01:53:11,906 --> 01:53:13,906
each unit?

2996
01:53:14,780 --> 01:53:14,812
>> their ramping up as we see

2997
01:53:14,812 --> 01:53:16,672
more individuals coming

2998
01:53:16,672 --> 01:53:20,172
out of state prison, we become

2999
01:53:20,172 --> 01:53:20,641
more responsible for in terms

3000
01:53:20,641 --> 01:53:22,641
of parole/probation.

3001
01:53:22,844 --> 01:53:24,780
We also seeing increase in the

3002
01:53:24,780 --> 01:53:25,516
number of individuals

3003
01:53:25,516 --> 01:53:27,470
coming into our local jail

3004
01:53:27,470 --> 01:53:29,470
system.

3005
01:53:29,391 --> 01:53:30,188
these are known the 117hs that

3006
01:53:30,188 --> 01:53:30,688
would have gone to

3007
01:53:30,688 --> 01:53:32,688
state prison.

3008
01:53:32,688 --> 01:53:33,719
You end up with this increase

3009
01:53:33,719 --> 01:53:36,719
and then people start to

3010
01:53:37,594 --> 01:53:38,828
be released and you end up with

3011
01:53:38,828 --> 01:53:40,562
sort of a plateau effect.

3012
01:53:40,562 --> 01:53:41,594
We have projections from the

3013
01:53:41,594 --> 01:53:43,141
state in terms of the

3014
01:53:43,141 --> 01:53:44,672
numbers of people we're getting

3015
01:53:44,672 --> 01:53:47,672
out of the state prison

3016
01:53:48,469 --> 01:53:49,109
system that would have normally

3017
01:53:49,109 --> 01:53:51,509
gone to state parole.

3018
01:53:53,172 --> 01:53:53,906
we know the individual that are

3019
01:53:53,906 --> 01:53:55,906
being sentenced.

3020
01:54:00,219 --> 01:54:01,625
I'm getting more detail here.

3021
01:54:01,625 --> 01:54:02,828
There's changes in the way

3022
01:54:02,828 --> 01:54:05,228
inmates are sentenced. Some

3023
01:54:05,328 --> 01:54:07,500
are sentenced without any

3024
01:54:07,500 --> 01:54:07,922
probation and some are split

3025
01:54:07,922 --> 01:54:09,922
sentences.

3026
01:54:10,859 --> 01:54:13,672
we have to take all of those

3027
01:54:13,672 --> 01:54:14,969
factors into account to

3028
01:54:14,969 --> 01:54:16,203
determine what's the

3029
01:54:16,203 --> 01:54:18,203
appropriate level.

3030
01:54:18,203 --> 01:54:19,203
We have the spillover in terms

3031
01:54:19,203 --> 01:54:21,203
of custody health as

3032
01:54:21,203 --> 01:54:24,203
more people are sicker and

3033
01:54:24,984 --> 01:54:27,470
trying to manage all of that in

3034
01:54:27,470 --> 01:54:27,375
terms of how we're allocating

3035
01:54:27,375 --> 01:54:29,780
our resources.

3036
01:54:29,780 --> 01:54:30,625
The other focus is making sure

3037
01:54:30,625 --> 01:54:33,250
these people have the

3038
01:54:37,922 --> 01:54:39,266
services that they need to avoid

3039
01:54:39,266 --> 01:54:41,266
recidivating

3040
01:54:42,859 --> 01:54:45,259
>> that's been a helpful

3041
01:54:45,328 --> 01:54:47,328
overview.

3042
01:54:47,703 --> 01:54:50,703
I heard bits and pieces

3043
01:54:53,470 --> 01:54:56,172
depending on who office I was

3044
01:54:56,172 --> 01:54:57,160
sitting on.

3045
01:54:57,160 --> 01:54:58,160
I understand all that was put

3046
01:54:58,160 --> 01:54:59,422
together by the teams

3047
01:54:59,422 --> 01:55:03,220
that have been working on this

3048
01:55:03,891 --> 01:55:04,359
and you brought it back down

3049
01:55:04,359 --> 01:55:05,781
unit by unit.

3050
01:55:05,781 --> 01:55:08,181
The board of supervisors

3051
01:55:09,940 --> 01:55:10,766
ultimate question is, having

3052
01:55:10,766 --> 01:55:13,797
done that, you then match those

3053
01:55:13,797 --> 01:55:14,940
unit numbers up with the

3054
01:55:14,940 --> 01:55:16,940
revenue.

3055
01:55:18,906 --> 01:55:20,438
I don't want to call it new

3056
01:55:20,438 --> 01:55:21,266
money.

3057
01:55:21,266 --> 01:55:21,672
There's in general fund

3058
01:55:21,672 --> 01:55:22,844
encroachment.

3059
01:55:22,844 --> 01:55:23,969
I don't what keep asking that

3060
01:55:23,969 --> 01:55:24,938
question.

3061
01:55:24,938 --> 01:55:25,641
That's what I'm really after

3062
01:55:25,641 --> 01:55:27,641
here.

3063
01:55:29,109 --> 01:55:32,109
I need it understand the

3064
01:55:39,359 --> 01:55:41,859
process, any time we see these

3065
01:55:41,859 --> 01:55:44,156
ab109 ft es ramping up, that's

3066
01:55:44,156 --> 01:55:44,891
going to come from the unit

3067
01:55:44,891 --> 01:55:45,656
of that state.

3068
01:55:45,656 --> 01:55:47,656
It's a wash.

3069
01:55:48,859 --> 01:55:50,328
>> the dollars allocated for

3070
01:55:50,328 --> 01:55:52,728
the ab109 expenses are

3071
01:55:52,734 --> 01:55:55,134
100% coming from the state.

3072
01:55:58,344 --> 01:55:59,250
we tie them directly.

3073
01:55:59,250 --> 01:56:00,719
There's no discretionary

3074
01:56:00,719 --> 01:56:02,719
general fund impact.

3075
01:56:02,781 --> 01:56:04,781
So far.

3076
01:56:07,250 --> 01:56:09,650
>> thank you very much.

3077
01:56:11,156 --> 01:56:14,756
That was one of the concerns

3078
01:56:16,391 --> 01:56:17,734
that part $15 billion

3079
01:56:17,734 --> 01:56:19,266
balancing act might pull the

3080
01:56:19,266 --> 01:56:20,000
rug out from under us.

3081
01:56:20,000 --> 01:56:22,400
I appreciate the explanation.

3082
01:56:24,234 --> 01:56:26,812
I was just worried that these

3083
01:56:26,812 --> 01:56:29,438
fte May not have been

3084
01:56:29,438 --> 01:56:29,781
unit by unit balance against

3085
01:56:29,781 --> 01:56:31,281
the revenue.

3086
01:56:31,281 --> 01:56:36,810
If I was in the unit, I would

3087
01:56:47,562 --> 01:56:49,562
say this is what I need.

3088
01:56:49,562 --> 01:56:51,469
>> we're really managing the

3089
01:56:51,469 --> 01:56:52,828
funding allocations from

3090
01:56:52,828 --> 01:56:55,228
the county executive's office

3091
01:56:56,734 --> 01:56:58,469
working closely with the ccp.

3092
01:56:58,469 --> 01:57:01,344
The thing that is really

3093
01:57:01,344 --> 01:57:02,470
interesting is that -- one of

3094
01:57:02,470 --> 01:57:04,688
the things we will be talking

3095
01:57:04,688 --> 01:57:05,953
about is that the preliminary

3096
01:57:05,953 --> 01:57:08,312
formula or funding allocation

3097
01:57:08,312 --> 01:57:11,312
looks like it's going to

3098
01:57:12,953 --> 01:57:14,359
allocate more than we assumed.

3099
01:57:14,359 --> 01:57:15,250
Recognizing the concerns that

3100
01:57:15,250 --> 01:57:16,656
everyone rightly has with

3101
01:57:16,656 --> 01:57:19,656
the state deficit increasing, I

3102
01:57:19,734 --> 01:57:21,203
think it's going to give us

3103
01:57:21,203 --> 01:57:22,859
an opportunity to reserve

3104
01:57:22,859 --> 01:57:25,859
significant portion and hold it

3105
01:57:26,109 --> 01:57:27,234
until we have more confidence

3106
01:57:27,234 --> 01:57:28,375
that those allocations are

3107
01:57:28,375 --> 01:57:30,672
going to be stable.

3108
01:57:30,672 --> 01:57:31,438
Of course, one of the issues is

3109
01:57:31,438 --> 01:57:31,875
going to be what

3110
01:57:31,875 --> 01:57:32,812
happens in November.

3111
01:57:32,812 --> 01:57:35,672
There is a funding guarantee

3112
01:57:35,672 --> 01:57:39,272
that will be on the ballot

3113
01:57:39,656 --> 01:57:40,780
for the ab109, the public

3114
01:57:40,780 --> 01:57:42,780
safety realignment.

3115
01:57:43,547 --> 01:57:44,719
>> we'll talk more about that

3116
01:57:44,719 --> 01:57:45,797
on thursday.

3117
01:57:45,797 --> 01:57:47,297
Supervisor wassermann.

3118
01:57:47,297 --> 01:57:49,697
>> very quickly, I really

3119
01:57:50,620 --> 01:57:51,391
appreciate the point

3120
01:57:51,391 --> 01:57:52,766
supervisor cortese brought up.

3121
01:57:52,766 --> 01:57:55,310
President Shirakawa you made

3122
01:57:55,310 --> 01:57:56,172
about the rug coming out

3123
01:57:56,172 --> 01:57:58,172
from under us.

3124
01:58:03,578 --> 01:58:04,470
the reason if hasn't happened,

3125
01:58:04,470 --> 01:58:04,375
they jumped to three

3126
01:58:04,375 --> 01:58:06,375
days ago.

3127
01:58:07,375 --> 01:58:08,984
The question I had was on page

3128
01:58:08,984 --> 01:58:10,984
four, talking about

3129
01:58:11,344 --> 01:58:13,344
custody health services

3130
01:58:13,781 --> 01:58:16,781
highlight to fiscal year '12.

3131
01:58:17,940 --> 01:58:19,219
it talks about two out of three

3132
01:58:19,219 --> 01:58:20,797
inmate receive medical

3133
01:58:20,797 --> 01:58:21,688
services daily.

3134
01:58:21,688 --> 01:58:22,156
That's an astounding number to

3135
01:58:22,156 --> 01:58:24,156
me.

3136
01:58:24,359 --> 01:58:27,959
I learn more every single day

3137
01:58:29,297 --> 01:58:31,310
while I'm in office.

3138
01:58:31,310 --> 01:58:31,875
With the transitions taking

3139
01:58:31,875 --> 01:58:33,672
place with those being

3140
01:58:33,672 --> 01:58:36,141
transferred from the state to

3141
01:58:36,141 --> 01:58:36,609
county, I imagine it's about

3142
01:58:36,609 --> 01:58:38,609
the same.

3143
01:58:38,984 --> 01:58:40,344
because of the nature of the

3144
01:58:40,344 --> 01:58:42,744
individuals that were the

3145
01:58:44,844 --> 01:58:47,244
state prison, I understand

3146
01:58:49,125 --> 01:58:51,391
there's severity seriousness of

3147
01:58:51,391 --> 01:58:52,531
crimes committed are the

3148
01:58:52,531 --> 01:58:54,531
make-up the prisoners?

3149
01:58:57,594 --> 01:58:59,172
I think it changes over time.

3150
01:58:59,172 --> 01:59:00,297
will the medical needs increase

3151
01:59:00,297 --> 01:59:02,297
greater still with

3152
01:59:02,703 --> 01:59:05,103
those being transferred over?

3153
01:59:05,938 --> 01:59:06,641
>> let me make a point of

3154
01:59:06,641 --> 01:59:09,410
clarification, the inmate who

3155
01:59:10,438 --> 01:59:13,438
within the jail system, the

3156
01:59:14,547 --> 01:59:16,219
ab109 inmates, we are familiar

3157
01:59:16,219 --> 01:59:17,250
with them because they've been

3158
01:59:17,250 --> 01:59:18,953
incarcerated and gone through

3159
01:59:18,953 --> 01:59:20,891
trial and they are sentenced.

3160
01:59:20,891 --> 01:59:21,156
we believe in providing care to

3161
01:59:21,156 --> 01:59:23,156
them.

3162
01:59:25,188 --> 01:59:28,391
They now just in a new bucket.

3163
01:59:28,391 --> 01:59:29,828
Now they are ab109 inmay notes.

3164
01:59:29,828 --> 01:59:31,875
The inmates from the prison

3165
01:59:31,875 --> 01:59:33,562
system who being released

3166
01:59:33,562 --> 01:59:36,234
from the prison, we do not

3167
01:59:36,234 --> 01:59:37,266
provide services to them within

3168
01:59:37,266 --> 01:59:39,266
the jail.

3169
01:59:42,641 --> 01:59:44,641
>> they're all probationary?

3170
01:59:45,281 --> 01:59:46,891
>> yes.

3171
01:59:46,891 --> 01:59:49,291
We would establish primary

3172
01:59:50,281 --> 01:59:52,681
clinic center. We would

3173
01:59:54,250 --> 01:59:55,719
have the doors open to them.

3174
01:59:55,719 --> 01:59:56,531
>> thank you for that

3175
01:59:56,531 --> 01:59:58,940
clarification.

3176
01:59:58,940 --> 01:59:59,266
>> with respect do we

3177
01:59:59,266 --> 02:00:00,562
anticipate that the healthcare

3178
02:00:00,562 --> 02:00:02,962
needs essentially going to

3179
02:00:06,734 --> 02:00:08,375
change this population, we do.

3180
02:00:08,375 --> 02:00:09,812
In the past, although many May

3181
02:00:09,812 --> 02:00:12,812
stay with us many years

3182
02:00:13,250 --> 02:00:15,780
while they going through their

3183
02:00:15,780 --> 02:00:17,478
trial, generally, period of

3184
02:00:18,609 --> 02:00:20,470
time within the jail maybe 150

3185
02:00:20,470 --> 02:00:22,447
average length of stay.

3186
02:00:23,828 --> 02:00:24,219
we didn't necessarily need to

3187
02:00:24,219 --> 02:00:26,219
provide services.

3188
02:00:27,310 --> 02:00:29,391
For instance someone had a

3189
02:00:29,391 --> 02:00:31,234
minor hernia, we would not

3190
02:00:31,234 --> 02:00:33,000
support having that hernia

3191
02:00:33,000 --> 02:00:33,297
repaired while they were in

3192
02:00:33,297 --> 02:00:35,297
custody.

3193
02:00:36,297 --> 02:00:36,906
It would be taken care when

3194
02:00:36,906 --> 02:00:38,172
they were released.

3195
02:00:38,172 --> 02:00:40,141
Now that they are going to be

3196
02:00:40,141 --> 02:00:41,469
sentenced to the jail, we

3197
02:00:41,469 --> 02:00:42,375
need to provide those services

3198
02:00:42,375 --> 02:00:44,375
for them.

3199
02:00:48,375 --> 02:00:49,656
In fact, we need to provide

3200
02:00:49,656 --> 02:00:50,578
preventive healthcare

3201
02:00:50,578 --> 02:00:51,859
services because they are going

3202
02:00:51,859 --> 02:00:52,656
to be with us year after

3203
02:00:52,656 --> 02:00:54,656
year.

3204
02:00:55,688 --> 02:00:56,940
We do anticipate there will be

3205
02:00:56,940 --> 02:00:56,328
very significant

3206
02:00:56,328 --> 02:00:58,328
changes.

3207
02:00:59,453 --> 02:01:00,562
>> I like to expand on that a

3208
02:01:00,562 --> 02:01:02,562
little bit.

3209
02:01:05,310 --> 02:01:06,500
it is also true that the

3210
02:01:06,500 --> 02:01:09,500
inmates who classically are in

3211
02:01:10,438 --> 02:01:14,380
prison or has been in prison

3212
02:01:14,109 --> 02:01:15,406
tend to be less healthy than

3213
02:01:15,406 --> 02:01:15,609
what has classically been in

3214
02:01:15,609 --> 02:01:17,609
jail.

3215
02:01:18,780 --> 02:01:21,375
That has to do with a lot of

3216
02:01:21,375 --> 02:01:22,547
factors but when you

3217
02:01:22,547 --> 02:01:24,547
figure that the vast majority

3218
02:01:24,547 --> 02:01:25,719
of the crimes that are

3219
02:01:25,719 --> 02:01:28,625
committed that result in people

3220
02:01:28,625 --> 02:01:30,594
being in jail are drug

3221
02:01:30,594 --> 02:01:32,859
related and violence related

3222
02:01:32,859 --> 02:01:35,259
and people typically also

3223
02:01:37,172 --> 02:01:39,572
taking their own drugs.

3224
02:01:39,641 --> 02:01:41,562
We are much more able to keep

3225
02:01:41,562 --> 02:01:42,375
people alive for longer

3226
02:01:42,375 --> 02:01:44,375
periods of time.

3227
02:01:46,234 --> 02:01:48,109
lots of people with chronic

3228
02:01:48,109 --> 02:01:49,516
heart disease, chronic lung

3229
02:01:49,516 --> 02:01:51,516
disease, chronic kidney

3230
02:01:53,160 --> 02:01:54,781
disease, diabetes, all kinds of

3231
02:01:54,781 --> 02:01:57,781
other issues infection, tb, hiv

3232
02:01:58,781 --> 02:02:00,859
and various sort of things.

3233
02:02:00,859 --> 02:02:01,625
As maryann brings out, now that

3234
02:02:01,625 --> 02:02:02,453
we're going to be

3235
02:02:02,453 --> 02:02:04,853
responsible for these people

3236
02:02:06,203 --> 02:02:08,594
for a longer period of time,

3237
02:02:08,594 --> 02:02:11,594
we're going to be responsible

3238
02:02:12,969 --> 02:02:15,369
for things like transplants,

3239
02:02:15,438 --> 02:02:16,875
dialysis, lots of very

3240
02:02:16,875 --> 02:02:18,469
expensive procedures.

3241
02:02:18,469 --> 02:02:20,172
>> you're saying they let

3242
02:02:20,172 --> 02:02:22,172
health insurance lapse?

3243
02:02:24,470 --> 02:02:25,484
>> we don't --

3244
02:02:25,484 --> 02:02:26,953
>> I'm kidding.

3245
02:02:26,953 --> 02:02:28,312
>> the question you are getting

3246
02:02:28,312 --> 02:02:30,712
at, they're going to

3247
02:02:31,453 --> 02:02:34,453
get more extensive and the

3248
02:02:35,219 --> 02:02:38,219
answer is question yes, lot

3249
02:02:58,812 --> 02:03:00,812
more.

3250
02:03:04,391 --> 02:03:07,500
>> I wanted to ask board of

3251
02:03:07,500 --> 02:03:09,500
supervisors so extend

3252
02:03:10,656 --> 02:03:13,560
services to juvenile hall.

3253
02:03:15,531 --> 02:03:19,731
They get visit one day a week.

3254
02:03:20,969 --> 02:03:21,438
With 60% of the kids, have

3255
02:03:21,438 --> 02:03:23,438
serious dental issues.

3256
02:03:25,281 --> 02:03:25,906
It was also noted in the last

3257
02:03:25,906 --> 02:03:27,906
juvenile justice report

3258
02:03:29,250 --> 02:03:31,650
several grievances were filed

3259
02:03:32,312 --> 02:03:33,219
by you because dental payments

3260
02:03:33,219 --> 02:03:35,219
were delayed.

3261
02:03:35,859 --> 02:03:36,688
We all know how much dental

3262
02:03:36,688 --> 02:03:39,880
pain interferes with your

3263
02:03:42,625 --> 02:03:45,625
ability to learn and behave.

3264
02:03:45,969 --> 02:03:47,310
I know san diego is a much

3265
02:03:47,310 --> 02:03:47,906
larger system but they have

3266
02:03:47,906 --> 02:03:50,306
two full time dentist.

3267
02:03:51,781 --> 02:03:52,469
We need to figure out how to do

3268
02:03:52,469 --> 02:03:54,869
this because these kids

3269
02:03:56,547 --> 02:03:59,375
-- they have so many issues

3270
02:03:59,375 --> 02:03:59,922
with them.

3271
02:03:59,922 --> 02:04:01,922
Thank you.

3272
02:04:02,312 --> 02:04:04,594
>> any other questions on this

3273
02:04:04,594 --> 02:04:06,594
unit?

3274
02:04:10,422 --> 02:04:13,422
i see none, thank you.

3275
02:04:32,516 --> 02:04:34,516
next unit is 417.

3276
02:04:34,516 --> 02:04:36,916
>> good afternoon President And

3277
02:04:37,484 --> 02:04:38,922
board members.

3278
02:04:38,922 --> 02:04:40,922
I'm bruce copeley.

3279
02:04:41,000 --> 02:04:42,531
I'm here to review our

3280
02:04:42,531 --> 02:04:44,531
recommended budget.

3281
02:04:46,310 --> 02:04:47,328
I would draw your attention to

3282
02:04:47,328 --> 02:04:49,328
two elements.

3283
02:04:52,734 --> 02:04:55,734
the first is a recommendation

3284
02:04:56,172 --> 02:04:58,172
for authorization for

3285
02:04:58,609 --> 02:05:00,250
$311,000 for two psychiatric

3286
02:05:00,250 --> 02:05:02,650
social workers and a

3287
02:05:02,875 --> 02:05:03,719
replacement of dollars lost for

3288
02:05:03,719 --> 02:05:04,312
half time psychiatric social

3289
02:05:04,312 --> 02:05:06,312
worker.

3290
02:05:07,625 --> 02:05:10,625
These are individuals that are

3291
02:05:10,750 --> 02:05:13,310
working at the park and

3292
02:05:13,310 --> 02:05:14,266
adopted at the clinic to

3293
02:05:14,266 --> 02:05:14,594
provide additional medical

3294
02:05:14,594 --> 02:05:16,594
services.

3295
02:05:17,891 --> 02:05:19,359
They will be providing

3296
02:05:19,359 --> 02:05:21,531
screenings, consultation to the

3297
02:05:21,531 --> 02:05:23,906
primary care doctors and

3298
02:05:23,906 --> 02:05:25,906
treatment.

3299
02:05:30,780 --> 02:05:32,470
The second is $401,000 that is

3300
02:05:32,470 --> 02:05:33,344
for augmentation and

3301
02:05:33,344 --> 02:05:34,375
enrollment of clients into the

3302
02:05:34,375 --> 02:05:36,188
valley care.

3303
02:05:36,188 --> 02:05:36,719
These are fees previously

3304
02:05:36,719 --> 02:05:38,453
collected both from the

3305
02:05:38,453 --> 02:05:41,188
county department as well as

3306
02:05:41,188 --> 02:05:43,484
from our contract agencies.

3307
02:05:43,484 --> 02:05:44,531
With enrollment of valley care

3308
02:05:44,531 --> 02:05:45,797
that is eliminated to

3309
02:05:45,797 --> 02:05:47,391
continue the capacity necessary

3310
02:05:47,391 --> 02:05:49,791
to serve these individuals

3311
02:05:55,203 --> 02:05:56,109
and to bring in enrollment in

3312
02:05:56,109 --> 02:05:57,000
anticipation medi-cal

3313
02:05:57,000 --> 02:05:58,344
qualification.

3314
02:05:58,344 --> 02:05:59,812
We're recommending these

3315
02:05:59,812 --> 02:06:01,812
dollars be added.

3316
02:06:02,672 --> 02:06:03,344
The final good news is,

3317
02:06:03,344 --> 02:06:05,344
approximately $2 million of

3318
02:06:05,578 --> 02:06:07,922
additional 109 moneys that are

3319
02:06:07,922 --> 02:06:09,891
recommended to be brought

3320
02:06:09,891 --> 02:06:11,188
into the department to stand

3321
02:06:11,188 --> 02:06:11,719
both outpatient services and

3322
02:06:11,719 --> 02:06:13,719
residential services.

3323
02:06:15,484 --> 02:06:16,859
currently we have a waiting

3324
02:06:16,859 --> 02:06:18,266
list from ab109.

3325
02:06:18,266 --> 02:06:19,328
It will substantially reduce

3326
02:06:19,328 --> 02:06:20,391
that waiting list and

3327
02:06:20,391 --> 02:06:23,391
allow us to serve the

3328
02:06:24,234 --> 02:06:24,500
individuals that are now coming

3329
02:06:24,500 --> 02:06:25,172
for

3330
02:06:25,172 --> 02:06:27,310
into ab109 process.

3331
02:06:27,310 --> 02:06:28,141
With that I'll take any

3332
02:06:28,141 --> 02:06:30,541
questions or clarifications you

3333
02:06:32,344 --> 02:06:34,744
would like from me.

3334
02:06:35,672 --> 02:06:37,547
>> let me just start by saying

3335
02:06:37,547 --> 02:06:39,547
thank you.

3336
02:06:40,484 --> 02:06:41,547
Last year we talked about the

3337
02:06:41,547 --> 02:06:43,547
gateway program.

3338
02:06:44,470 --> 02:06:46,359
We all know people are ready to

3339
02:06:46,359 --> 02:06:48,594
make that change and so

3340
02:06:48,594 --> 02:06:49,328
appreciate that effort.

3341
02:06:49,328 --> 02:06:51,728
You mentioned the $2 million.

3342
02:06:52,828 --> 02:06:54,766
Hopefully it will free up this

3343
02:06:54,766 --> 02:06:56,641
$2 million more services

3344
02:06:56,641 --> 02:06:57,562
for others.

3345
02:06:57,562 --> 02:06:58,109
That's a good thing.

3346
02:06:58,109 --> 02:07:00,109
Supervisor wassermann?

3347
02:07:00,844 --> 02:07:01,734
>> just a quick question, one

3348
02:07:01,734 --> 02:07:03,780
way or another, how long

3349
02:07:03,780 --> 02:07:06,678
have you been with the county?

3350
02:07:08,641 --> 02:07:11,410
>> 24 years in another month.

3351
02:07:11,547 --> 02:07:11,984
14 years with dad and 10 years

3352
02:07:11,984 --> 02:07:13,984
with mental health.

3353
02:07:14,812 --> 02:07:16,828
>> it's probably a good time to

3354
02:07:16,828 --> 02:07:19,228
think about, I know

3355
02:07:21,234 --> 02:07:23,634
folks have talked previewed

3356
02:07:24,266 --> 02:07:26,859
some kind of behavior health

3357
02:07:26,859 --> 02:07:29,297
department from a dads merger.

3358
02:07:29,297 --> 02:07:30,469
I know others out there talked

3359
02:07:30,469 --> 02:07:32,469
about it.

3360
02:07:34,438 --> 02:07:36,344
I'm just throwing that out

3361
02:07:36,344 --> 02:07:38,744
there as a comment.

3362
02:07:38,812 --> 02:07:41,109
>> I know that the issue has

3363
02:07:41,109 --> 02:07:43,109
been discussed.

3364
02:07:43,516 --> 02:07:44,156
I just met this morning with

3365
02:07:44,156 --> 02:07:45,859
bruce.

3366
02:07:45,859 --> 02:07:48,859
He's getting up to speed.

3367
02:07:49,156 --> 02:07:52,594
We're looking at all of our

3368
02:07:52,594 --> 02:07:53,688
options at to point and

3369
02:07:53,688 --> 02:07:55,828
pluses and minuses to no matter

3370
02:07:55,828 --> 02:07:57,297
what you do and nothing will

3371
02:07:57,297 --> 02:07:58,940
be done without stakeholderrer

3372
02:07:58,940 --> 02:07:59,828
input.

3373
02:07:59,828 --> 02:08:00,609
>> it doesn't hurt to have the

3374
02:08:00,609 --> 02:08:02,609
discussion for sure.

3375
02:08:02,672 --> 02:08:03,172
That's all I'm saying.

3376
02:08:03,172 --> 02:08:05,172
>> I understand.

3377
02:08:06,780 --> 02:08:06,938
>> I don't have any other

3378
02:08:06,938 --> 02:08:09,338
lights on thank you.

3379
02:08:11,312 --> 02:08:14,912
We'll move on to the next

3380
02:08:15,844 --> 02:08:17,844
section, unit 418, community

3381
02:08:25,188 --> 02:08:27,188
health services.

3382
02:08:31,000 --> 02:08:32,266
>> dave wright, directors of

3383
02:08:32,266 --> 02:08:34,266
ambulatory care services.

3384
02:08:35,609 --> 02:08:38,900
Our community health services

3385
02:08:41,672 --> 02:08:44,720
is composed of two

3386
02:08:44,953 --> 02:08:46,953
community health clinics.

3387
02:08:48,156 --> 02:08:49,484
They also receive the unit and

3388
02:08:49,484 --> 02:08:51,884
diversity award by the

3389
02:08:53,625 --> 02:08:55,625
board of supervisors.

3390
02:08:59,203 --> 02:09:02,203
our tb clinic and refugee

3391
02:09:03,000 --> 02:09:05,969
clinic, they have the liest

3392
02:09:05,969 --> 02:09:07,438
numbers coming from iran,

3393
02:09:07,438 --> 02:09:09,838
burma, iraq and china.

3394
02:09:14,672 --> 02:09:17,672
No budget changes are proposed

3395
02:09:22,156 --> 02:09:24,156
for fy '13.

3396
02:09:24,156 --> 02:09:27,359
>> I don't have any lights on.

3397
02:09:27,359 --> 02:09:29,759
You're off the hook.

3398
02:09:30,391 --> 02:09:32,391
Good job dave.

3399
02:09:35,703 --> 02:09:37,703
Item 12, unit 725.

3400
02:09:40,141 --> 02:09:42,141
valley health plan.

3401
02:09:45,160 --> 02:09:45,750
>> hello.

3402
02:09:45,750 --> 02:09:47,406
Greg price.

3403
02:09:47,406 --> 02:09:48,375
Valley health plan has a

3404
02:09:48,375 --> 02:09:50,375
commercial plan.

3405
02:09:50,516 --> 02:09:52,125
We had a very successful year

3406
02:09:52,125 --> 02:09:53,594
this year.

3407
02:09:53,594 --> 02:09:55,156
We approach being 15,000

3408
02:09:55,156 --> 02:09:57,156
commercial members.

3409
02:09:58,620 --> 02:10:00,188
We also manage medi-cal,

3410
02:10:00,188 --> 02:10:01,328
healthy kids healthy families

3411
02:10:01,328 --> 02:10:03,728
for valley medical center.

3412
02:10:03,859 --> 02:10:06,359
We're getting on to about

3413
02:10:06,359 --> 02:10:07,375
90,000 new lives and we're

3414
02:10:07,375 --> 02:10:08,500
forecasting about 184 million

3415
02:10:08,500 --> 02:10:10,900
next year in revenue.

3416
02:10:14,109 --> 02:10:15,312
All of our positions for fy '12

3417
02:10:15,312 --> 02:10:17,160
were paid for.

3418
02:10:17,160 --> 02:10:18,312
We're in the asking for any new

3419
02:10:18,312 --> 02:10:19,547
money.

3420
02:10:19,547 --> 02:10:22,219
any questions about the budget?

3421
02:10:22,219 --> 02:10:22,922
>> I don't have any lights.

3422
02:10:22,922 --> 02:10:24,922
No, thank you.

3423
02:10:27,922 --> 02:10:29,922
>> always a pleasure.

3424
02:10:31,620 --> 02:10:32,391
Thanks.

3425
02:10:32,391 --> 02:10:33,391
>> we still --

3426
02:10:33,391 --> 02:10:34,422
>> we should mention at health

3427
02:10:34,422 --> 02:10:36,422
and hospital committee,

3428
02:10:37,310 --> 02:10:39,375
we discussed all of these.

3429
02:10:39,375 --> 02:10:41,438
>> as a case with all the

3430
02:10:41,438 --> 02:10:43,438
sections and committees

3431
02:10:44,734 --> 02:10:45,203
either have or will have

3432
02:10:45,203 --> 02:10:45,812
detailed discussions.

3433
02:10:45,812 --> 02:10:46,344
Thank you.

3434
02:10:46,344 --> 02:10:48,344
Supervisor wassermann.

3435
02:10:49,484 --> 02:10:52,719
>> I want to mention that it's

3436
02:10:52,719 --> 02:10:54,156
a pleasure spending

3437
02:10:54,156 --> 02:10:55,578
hours going over these binders

3438
02:10:55,578 --> 02:10:58,578
with staff and discussing and

3439
02:10:58,891 --> 02:10:59,484
at the end hearing no new

3440
02:10:59,484 --> 02:10:59,750
changes, status quo that kind

3441
02:10:59,750 --> 02:11:00,422
of

3442
02:11:00,422 --> 02:11:02,125
thing.

3443
02:11:02,125 --> 02:11:05,125
Think you're all doing great

3444
02:11:05,734 --> 02:11:06,703
work.

3445
02:11:06,703 --> 02:11:07,859
>> thank you.

3446
02:11:07,859 --> 02:11:09,620
Item 410.

3447
02:11:09,620 --> 02:11:12,620
>> we'll start by going through

3448
02:11:14,234 --> 02:11:14,438
our highlights for the

3449
02:11:14,438 --> 02:11:16,438
year.

3450
02:11:18,780 --> 02:11:18,906
Really a huge thanks to our

3451
02:11:18,906 --> 02:11:21,306
board of supervisors for

3452
02:11:22,470 --> 02:11:23,422
being progressive in adopting a

3453
02:11:23,422 --> 02:11:24,344
number of health related

3454
02:11:24,344 --> 02:11:26,219
policies. Just a quick

3455
02:11:26,219 --> 02:11:27,250
refresher over this list.

3456
02:11:27,250 --> 02:11:27,859
We adopted a comprehensive food

3457
02:11:27,859 --> 02:11:29,859
and nutritional

3458
02:11:31,250 --> 02:11:31,688
policies which a lot of folks

3459
02:11:31,688 --> 02:11:33,688
worked on.

3460
02:11:34,310 --> 02:11:37,469
Both the city and county passed

3461
02:11:37,469 --> 02:11:39,869
a number of outdoor

3462
02:11:40,797 --> 02:11:42,797
smoke prevention policy

3463
02:11:45,266 --> 02:11:45,531
including tobacco retail

3464
02:11:45,531 --> 02:11:47,531
licensing.

3465
02:11:47,766 --> 02:11:49,109
We're in the line of to do the

3466
02:11:49,109 --> 02:11:51,109
latino health assessment

3467
02:11:57,160 --> 02:11:58,125
in the fall of 2012.

3468
02:11:58,125 --> 02:11:58,984
The vietnamese community it in

3469
02:11:58,984 --> 02:12:00,922
the bay area and become

3470
02:12:00,922 --> 02:12:02,922
state and nationally recognized.

3471
02:12:02,922 --> 02:12:05,688
as you will recall this time

3472
02:12:05,688 --> 02:12:07,531
ast year, we were talking

3473
02:12:07,531 --> 02:12:10,125
about a potential new vendor

3474
02:12:10,125 --> 02:12:12,500
for our ems system.

3475
02:12:12,500 --> 02:12:13,141
I'm pleased metro has been

3476
02:12:13,141 --> 02:12:14,266
performing good or better

3477
02:12:14,266 --> 02:12:16,109
than prior vendor.

3478
02:12:16,109 --> 02:12:16,797
The response time is slightly

3479
02:12:16,797 --> 02:12:18,172
better.

3480
02:12:18,172 --> 02:12:21,172
All in all slight improvement

3481
02:12:22,344 --> 02:12:23,250
in the system and kept

3482
02:12:23,250 --> 02:12:24,750
the system affordable.

3483
02:12:24,750 --> 02:12:26,750
now budget highlights.

3484
02:12:27,109 --> 02:12:28,953
Much like my other colleagues

3485
02:12:28,953 --> 02:12:30,344
our budget is essentially

3486
02:12:30,344 --> 02:12:31,391
level budget for this next

3487
02:12:31,391 --> 02:12:33,156
fiscal year.

3488
02:12:33,156 --> 02:12:34,160
No additional county general

3489
02:12:34,160 --> 02:12:35,922
fund augmentation request.

3490
02:12:35,922 --> 02:12:37,310
I will quickly run you through

3491
02:12:37,310 --> 02:12:39,431
where we're moving some

3492
02:12:39,656 --> 02:12:41,656
money.

3493
02:12:45,438 --> 02:12:46,406
we're moving essentially

3494
02:12:46,406 --> 02:12:48,406
$247,000 from federal fund.

3495
02:12:49,000 --> 02:12:50,672
I will start with accreditation.

3496
02:12:50,672 --> 02:12:51,812
As I mentioned before,

3497
02:12:51,812 --> 02:12:52,375
accreditation is a additional

3498
02:12:52,375 --> 02:12:54,375
public health effort.

3499
02:12:55,160 --> 02:12:56,641
We're going to be moving about

3500
02:12:56,641 --> 02:12:57,672
$95,000 into that

3501
02:12:57,672 --> 02:12:58,719
particular effort.

3502
02:12:58,719 --> 02:13:01,119
The latino health assessment

3503
02:13:03,656 --> 02:13:04,812
actually will cost us

3504
02:13:04,812 --> 02:13:06,812
around $250,000 to $300,000.

3505
02:13:08,188 --> 02:13:08,750
we need to move additional

3506
02:13:08,750 --> 02:13:09,859
$75,000 essentially out of

3507
02:13:09,859 --> 02:13:12,259
the administration in other

3508
02:13:12,500 --> 02:13:14,391
areas and back fill that.

3509
02:13:14,391 --> 02:13:16,969
Incidentally, we went out for

3510
02:13:16,969 --> 02:13:18,000
bids to do the community

3511
02:13:18,000 --> 02:13:18,703
neighborhood assessment for the

3512
02:13:18,703 --> 02:13:20,438
latino health assessment.

3513
02:13:20,438 --> 02:13:21,375
We got quotes as high as a

3514
02:13:21,375 --> 02:13:22,969
million dollars.

3515
02:13:22,969 --> 02:13:25,969
The fact that we're actually

3516
02:13:27,281 --> 02:13:28,172
able to deliver hopefully,

3517
02:13:28,172 --> 02:13:29,750
deliver an assessment during

3518
02:13:29,750 --> 02:13:30,844
financial health week, it's

3519
02:13:30,844 --> 02:13:31,609
quite an accomplishment for the

3520
02:13:31,609 --> 02:13:31,953
amount of money we're

3521
02:13:31,953 --> 02:13:33,953
working with.

3522
02:13:37,984 --> 02:13:42,184
We like to propose to move about

3523
02:13:43,297 --> 02:13:44,922
$30,000 into help

3524
02:13:44,922 --> 02:13:46,922
promotion media.

3525
02:13:47,703 --> 02:13:48,406
we were fortunate to have a

3526
02:13:48,406 --> 02:13:50,406
full time position.

3527
02:13:52,531 --> 02:13:53,141
We don't have a single dollar

3528
02:13:53,141 --> 02:13:54,672
behind her code this is

3529
02:13:54,672 --> 02:13:58,272
to recognize a small amount of

3530
02:13:58,906 --> 02:14:00,160
money for that type of work.

3531
02:14:00,160 --> 02:14:01,219
Public health preparedded, is

3532
02:14:01,219 --> 02:14:03,219
an interesting idea.

3533
02:14:04,578 --> 02:14:07,156
We never had any dedicated

3534
02:14:07,156 --> 02:14:07,750
staff.

3535
02:14:07,750 --> 02:14:09,281
This amount money coming from

3536
02:14:09,281 --> 02:14:10,297
internal resources which

3537
02:14:10,297 --> 02:14:12,391
fund a half time code.

3538
02:14:12,391 --> 02:14:15,188
We'd initially hope to work

3539
02:14:15,188 --> 02:14:16,328
with oes and faf to fund a

3540
02:14:16,328 --> 02:14:17,469
full time position and we could

3541
02:14:17,469 --> 02:14:17,969
have contributed half of

3542
02:14:17,969 --> 02:14:19,969
that.

3543
02:14:23,469 --> 02:14:26,109
We were not able to do this in

3544
02:14:26,109 --> 02:14:28,109
this budget cycle.

3545
02:14:29,469 --> 02:14:30,344
we have roughly $4 million in

3546
02:14:30,344 --> 02:14:30,672
inventory in the

3547
02:14:30,672 --> 02:14:32,672
warehouse.

3548
02:14:33,780 --> 02:14:35,656
By the time full lease payment

3549
02:14:35,656 --> 02:14:36,953
will be made, the county

3550
02:14:36,953 --> 02:14:37,188
well invested well over $10

3551
02:14:37,188 --> 02:14:38,188
million.

3552
02:14:38,188 --> 02:14:39,470
This particular code and the

3553
02:14:39,470 --> 02:14:41,447
reason I'm talking a

3554
02:14:41,453 --> 02:14:42,828
little bit more about this one,

3555
02:14:42,828 --> 02:14:45,219
is that this would be the

3556
02:14:45,219 --> 02:14:46,969
one and only individual

3557
02:14:46,969 --> 02:14:49,297
dedicated to nation sure that

3558
02:14:49,297 --> 02:14:50,938
warehouse is on a ready-go

3559
02:14:50,938 --> 02:14:53,940
status at all time.

3560
02:14:53,940 --> 02:14:54,703
It's able to both receive and

3561
02:14:54,703 --> 02:14:56,375
deploy goods in rain out

3562
02:14:56,375 --> 02:14:58,469
of the warehouse in a disaster

3563
02:14:58,469 --> 02:15:00,469
situation.

3564
02:15:01,203 --> 02:15:01,812
The next item is interesting

3565
02:15:01,812 --> 02:15:03,812
one immunization clinic

3566
02:15:04,719 --> 02:15:06,719
staffing.

3567
02:15:06,750 --> 02:15:09,219
We have 1.5 vacant codes in

3568
02:15:09,219 --> 02:15:12,219
that particular code and we

3569
02:15:15,625 --> 02:15:15,891
will be adding 1.5 1.5 vacant

3570
02:15:15,891 --> 02:15:17,891
code.

3571
02:15:18,594 --> 02:15:22,194
We're going to be deleting a

3572
02:15:23,938 --> 02:15:25,938
vacant office specialist

3573
02:15:26,766 --> 02:15:30,366
and a vacant clinical nurse and

3574
02:15:31,703 --> 02:15:32,875
adding a full time office

3575
02:15:32,875 --> 02:15:33,780
specialist specializing in data

3576
02:15:33,780 --> 02:15:34,750
entry.

3577
02:15:34,750 --> 02:15:37,281
Then the childhood led poison

3578
02:15:37,281 --> 02:15:40,281
program, we are losing a

3579
02:15:40,312 --> 02:15:41,160
state grant of just under

3580
02:15:41,160 --> 02:15:43,160
$94,000.

3581
02:15:45,953 --> 02:15:47,953
Therefore we're going to let

3582
02:15:47,953 --> 02:15:49,328
go of a vacant position.

3583
02:15:49,328 --> 02:15:51,297
This is cleanup from last

3584
02:15:51,297 --> 02:15:53,297
budget year.

3585
02:15:55,000 --> 02:15:55,203
We had lost grant last budget

3586
02:15:55,203 --> 02:15:56,641
cycle.

3587
02:15:56,641 --> 02:15:58,438
This is actually a cleanup that

3588
02:15:58,438 --> 02:15:59,438
is to say that the

3589
02:15:59,438 --> 02:16:01,844
services have not been provided

3590
02:16:01,844 --> 02:16:04,141
for the full fiscal year.

3591
02:16:04,141 --> 02:16:04,875
The child, health and

3592
02:16:04,875 --> 02:16:06,875
disability prevention, we're

3593
02:16:09,578 --> 02:16:12,470
going to be deleting a vacant

3594
02:16:12,470 --> 02:16:12,719
public health nurse three

3595
02:16:12,719 --> 02:16:14,719
code.

3596
02:16:16,828 --> 02:16:17,391
That's due to the fact we're

3597
02:16:17,391 --> 02:16:18,940
losing $110,000 state

3598
02:16:18,940 --> 02:16:20,940
grant.

3599
02:16:20,453 --> 02:16:22,853
That particular line item

3600
02:16:28,562 --> 02:16:30,109
allows us to move $22,000 to

3601
02:16:30,109 --> 02:16:32,109
general fund.

3602
02:16:33,266 --> 02:16:33,812
we ask pharmacy to be very

3603
02:16:33,812 --> 02:16:34,609
aggressive on object two

3604
02:16:34,609 --> 02:16:36,609
cost.

3605
02:16:38,406 --> 02:16:39,781
Really bringing down the cost

3606
02:16:39,781 --> 02:16:41,781
of pharmaceuticals, we're

3607
02:16:42,156 --> 02:16:45,156
able to move about $2000 of

3608
02:16:47,422 --> 02:16:49,822
what's county general fund.

3609
02:16:50,422 --> 02:16:51,453
Any questions?

3610
02:16:51,453 --> 02:16:53,453
>> supervisor kniss?

3611
02:16:54,562 --> 02:16:54,969
>> just some comments and a

3612
02:16:54,969 --> 02:16:56,969
couple questions.

3613
02:16:57,828 --> 02:16:59,469
One of the thing I like to call

3614
02:16:59,469 --> 02:17:02,797
out is that with all of

3615
02:17:02,797 --> 02:17:05,797
our employees, we happen to

3616
02:17:06,780 --> 02:17:08,470
work particularly closely with

3617
02:17:08,470 --> 02:17:10,470
dan peddycord.

3618
02:17:11,188 --> 02:17:11,781
We came to me the other night

3619
02:17:11,781 --> 02:17:13,781
with comprehensive plan.

3620
02:17:15,953 --> 02:17:18,953
it was a challenging meeting.

3621
02:17:21,620 --> 02:17:23,462
He handled it well.

3622
02:17:26,620 --> 02:17:26,594
I want to call out that also on

3623
02:17:26,594 --> 02:17:28,994
a national level, we

3624
02:17:29,406 --> 02:17:33,606
have nose who play a major role

3625
02:17:33,844 --> 02:17:37,281
and dan you're one of those.

3626
02:17:37,281 --> 02:17:37,781
That would lead me into talking

3627
02:17:37,781 --> 02:17:39,781
about the prevention

3628
02:17:42,984 --> 02:17:46,547
fund which is part of the aca.

3629
02:17:46,547 --> 02:17:47,484
One that naco and c-sac worked

3630
02:17:47,484 --> 02:17:49,484
hard to protect.

3631
02:17:50,250 --> 02:17:50,750
I had the health steering

3632
02:17:50,750 --> 02:17:52,750
committee for naco.

3633
02:17:53,766 --> 02:17:54,156
that is one of our top

3634
02:17:54,156 --> 02:17:55,359
priorities.

3635
02:17:55,359 --> 02:17:58,359
The reason that's so important

3636
02:17:58,938 --> 02:18:00,406
that is where we have

3637
02:18:00,406 --> 02:18:02,141
applied some time grants do

3638
02:18:02,141 --> 02:18:02,297
come from other places. That

3639
02:18:02,297 --> 02:18:04,297
is

3640
02:18:05,297 --> 02:18:07,310
place where we can get grants.

3641
02:18:07,310 --> 02:18:08,469
That is where some money can

3642
02:18:08,469 --> 02:18:11,578
come in for just the kind

3643
02:18:11,578 --> 02:18:12,516
of thing we talk about, led

3644
02:18:12,516 --> 02:18:13,547
poisoning and so forth.

3645
02:18:13,547 --> 02:18:14,688
There are issues that are

3646
02:18:14,688 --> 02:18:16,312
looking for thousands of

3647
02:18:16,312 --> 02:18:19,312
dollars and not for millions.

3648
02:18:19,359 --> 02:18:19,625
They make a big difference in

3649
02:18:19,625 --> 02:18:21,625
counties.

3650
02:18:23,250 --> 02:18:24,688
It is a fund that is constantly

3651
02:18:24,688 --> 02:18:26,688
in jeopardy that

3652
02:18:27,422 --> 02:18:29,828
congress looks at it like it's

3653
02:18:29,828 --> 02:18:31,266
a flush fund.

3654
02:18:31,266 --> 02:18:33,438
Prevention doesn't have any

3655
02:18:33,438 --> 02:18:34,469
great payback as far as

3656
02:18:34,469 --> 02:18:36,469
they are concerned.

3657
02:18:38,141 --> 02:18:38,672
It's a lot easier also if we

3658
02:18:38,672 --> 02:18:40,547
put money into acute care

3659
02:18:40,547 --> 02:18:41,160
and than it is to put into

3660
02:18:41,160 --> 02:18:43,160
expression.

3661
02:18:44,906 --> 02:18:46,484
It's one of areas public health

3662
02:18:46,484 --> 02:18:47,641
keeps working hard.

3663
02:18:47,641 --> 02:18:48,188
Marty is part of the national

3664
02:18:48,188 --> 02:18:50,188
group as well.

3665
02:18:51,516 --> 02:18:54,160
I just want to say out loud

3666
02:18:54,160 --> 02:18:56,297
both marty and for dan, i

3667
02:18:56,297 --> 02:18:58,697
so appreciate your service

3668
02:18:59,359 --> 02:18:59,734
because we do get heard around

3669
02:18:59,734 --> 02:19:01,734
the country.

3670
02:19:02,859 --> 02:19:05,141
We are recognized being a

3671
02:19:05,141 --> 02:19:07,620
county that really does do

3672
02:19:07,620 --> 02:19:07,641
excellent work in the

3673
02:19:07,641 --> 02:19:09,641
healthcare field.

3674
02:19:11,172 --> 02:19:12,312
>> thank you very much

3675
02:19:12,312 --> 02:19:14,312
supervisor kniss.

3676
02:19:14,547 --> 02:19:15,406
By 2014 that fund is suppose to

3677
02:19:15,406 --> 02:19:16,160
be about $2 billion on

3678
02:19:16,160 --> 02:19:17,250
a national level.

3679
02:19:17,250 --> 02:19:19,641
It represents the first time

3680
02:19:19,641 --> 02:19:20,453
the federal government put

3681
02:19:20,453 --> 02:19:21,422
some real financial backbone

3682
02:19:21,422 --> 02:19:23,422
into prevention.

3683
02:19:23,422 --> 02:19:25,822
We were the fortunate

3684
02:19:25,828 --> 02:19:26,940
recipients through the

3685
02:19:26,940 --> 02:19:27,625
community

3686
02:19:27,625 --> 02:19:29,391
prevention work money for

3687
02:19:29,391 --> 02:19:31,391
obesity that is reflected this

3688
02:19:31,391 --> 02:19:33,391
that fund.

3689
02:19:34,531 --> 02:19:36,734
Those funds seeming to come to

3690
02:19:36,734 --> 02:19:36,969
an end here in our

3691
02:19:36,969 --> 02:19:38,141
county.

3692
02:19:38,141 --> 02:19:41,141
>> thank you having said that,

3693
02:19:41,734 --> 02:19:42,609
we have a couple

3694
02:19:42,609 --> 02:19:44,609
questions.

3695
02:19:45,609 --> 02:19:46,172
We just talked about emergency

3696
02:19:46,172 --> 02:19:47,344
warehouse position.

3697
02:19:47,344 --> 02:19:50,944
Do we have any other department

3698
02:19:51,812 --> 02:19:54,470
in the county that has

3699
02:19:54,470 --> 02:19:57,470
any role in that warehouse?

3700
02:19:57,922 --> 02:19:59,359
i only visited it once.

3701
02:19:59,359 --> 02:20:00,297
>> we have a small presence

3702
02:20:00,297 --> 02:20:01,531
there.

3703
02:20:01,531 --> 02:20:02,125
The sheriff's office has a

3704
02:20:02,125 --> 02:20:04,125
small presence there.

3705
02:20:04,531 --> 02:20:06,969
We try to work with those

3706
02:20:06,969 --> 02:20:08,859
partners to fill out the

3707
02:20:08,859 --> 02:20:11,310
other half of the fte that full

3708
02:20:11,310 --> 02:20:14,310
time code was justified for

3709
02:20:14,766 --> 02:20:15,470
the amount of assets in that

3710
02:20:15,470 --> 02:20:17,470
warehouse.

3711
02:20:17,109 --> 02:20:18,281
they were not able to fund that

3712
02:20:18,281 --> 02:20:19,672
particular request.

3713
02:20:19,672 --> 02:20:20,203
Our proposal was to go forward

3714
02:20:20,203 --> 02:20:20,609
at least with the half

3715
02:20:20,609 --> 02:20:22,609
time code.

3716
02:20:23,219 --> 02:20:25,578
>> thank you, I appreciate that.

3717
02:20:25,578 --> 02:20:28,578
The other one regards the

3718
02:20:28,812 --> 02:20:29,312
ongoing money for the phd

3719
02:20:29,312 --> 02:20:29,750
accreditation, prep and

3720
02:20:29,750 --> 02:20:31,750
application.

3721
02:20:32,453 --> 02:20:32,828
Does it need to be ongoing

3722
02:20:32,828 --> 02:20:34,828
situation?

3723
02:20:39,310 --> 02:20:39,734
is that one to be a downside to

3724
02:20:39,734 --> 02:20:41,172
one time money?

3725
02:20:41,172 --> 02:20:42,297
>> we're looking at that level

3726
02:20:42,297 --> 02:20:43,297
of commitment on ongoing

3727
02:20:43,297 --> 02:20:44,734
basis.

3728
02:20:44,734 --> 02:20:47,734
Once we reached point of

3729
02:20:48,734 --> 02:20:49,578
applying, we will need to send

3730
02:20:49,578 --> 02:20:51,672
in about $55,000 check. This

3731
02:20:51,672 --> 02:20:53,172
that's good for five years.

3732
02:20:53,172 --> 02:20:56,172
However, most department of our

3733
02:20:57,656 --> 02:20:59,484
size are looking a the

3734
02:20:59,484 --> 02:21:02,160
staffing 1-3 fte full time

3735
02:21:02,160 --> 02:21:03,656
dedicated accreditation.

3736
02:21:03,656 --> 02:21:05,656
What accreditation is

3737
02:21:05,859 --> 02:21:06,940
instilling high level of

3738
02:21:06,940 --> 02:21:06,562
quality

3739
02:21:06,562 --> 02:21:07,156
insurance performance

3740
02:21:07,156 --> 02:21:08,266
improvement across an entire

3741
02:21:08,266 --> 02:21:10,234
organization.

3742
02:21:10,234 --> 02:21:11,620
That takes small investment of

3743
02:21:11,620 --> 02:21:13,620
human resources.

3744
02:21:13,703 --> 02:21:15,703
>> so, I guess my question

3745
02:21:15,703 --> 02:21:17,109
would be, because once we've

3746
02:21:17,109 --> 02:21:20,709
gotten into ongoing, we tend to

3747
02:21:21,547 --> 02:21:21,906
not look at it again as you

3748
02:21:21,906 --> 02:21:23,906
know.

3749
02:21:25,672 --> 02:21:26,406
You feel that's justified and

3750
02:21:26,406 --> 02:21:27,641
something that we should

3751
02:21:27,641 --> 02:21:29,844
include over the next several

3752
02:21:29,844 --> 02:21:31,844
years?

3753
02:21:32,625 --> 02:21:33,719
>> yes, I would very much

3754
02:21:33,719 --> 02:21:35,719
supervisor kniss.

3755
02:21:38,766 --> 02:21:39,297
We are moving other fte within

3756
02:21:39,297 --> 02:21:39,734
the department to back

3757
02:21:39,734 --> 02:21:41,620
our resource need.

3758
02:21:41,620 --> 02:21:44,662
Rather than coming to you and

3759
02:21:44,938 --> 02:21:46,297
asking for a financial

3760
02:21:46,297 --> 02:21:49,297
augmentation for fte, we felt

3761
02:21:50,203 --> 02:21:52,603
$95,000 if it stays relatively

3762
02:21:53,344 --> 02:21:55,203
level should afford reasonable

3763
02:21:55,203 --> 02:21:56,641
level of resource to sustain

3764
02:21:56,641 --> 02:21:58,109
journey to accreditation.

3765
02:21:58,109 --> 02:21:58,844
>> okay, thanks.

3766
02:21:58,844 --> 02:22:00,844
>> besides supervisor the

3767
02:22:01,250 --> 02:22:02,188
president announced on the

3768
02:22:02,188 --> 02:22:04,588
state of the county.

3769
02:22:04,984 --> 02:22:05,328
>> you know, george, you said

3770
02:22:05,328 --> 02:22:06,484
it.

3771
02:22:06,484 --> 02:22:09,484
It's got to be true.

3772
02:22:22,172 --> 02:22:23,938
>> dan, just a couple things.

3773
02:22:23,938 --> 02:22:25,109
When it comes to trauma and

3774
02:22:25,109 --> 02:22:26,672
violence and injury and all

3775
02:22:26,672 --> 02:22:27,484
of those issues, you guys are

3776
02:22:27,484 --> 02:22:29,884
the experts I'm not.

3777
02:22:32,453 --> 02:22:33,281
I can tell you, you come from a

3778
02:22:33,281 --> 02:22:36,281
community of me -- I

3779
02:22:36,328 --> 02:22:37,688
don't need to study, I don't

3780
02:22:37,688 --> 02:22:38,160
need experts tell us the impact

3781
02:22:38,160 --> 02:22:40,160
it has.

3782
02:22:45,000 --> 02:22:49,200
we all know the impact of those

3783
02:22:50,310 --> 02:22:50,234
-- obviously smoking

3784
02:22:50,234 --> 02:22:50,641
thing.

3785
02:22:50,641 --> 02:22:52,310
Interinterrelated.

3786
02:22:52,310 --> 02:22:53,844
I want to thank you for your

3787
02:22:53,844 --> 02:22:56,844
work and I know the

3788
02:22:57,938 --> 02:22:58,250
committee will continue to have

3789
02:22:58,250 --> 02:23:00,250
discussions.

3790
02:23:01,780 --> 02:23:02,453
I think it was a one man

3791
02:23:02,453 --> 02:23:04,219
discussion last time.

3792
02:23:04,219 --> 02:23:06,125
I appreciate your efforts for

3793
02:23:06,125 --> 02:23:09,125
sure and you can expect

3794
02:23:09,250 --> 02:23:10,797
memo from supervisor kniss and

3795
02:23:10,797 --> 02:23:12,797
I here shortly.

3796
02:23:13,156 --> 02:23:15,328
Certainly finding someone to

3797
02:23:15,328 --> 02:23:17,728
help coordinate some of

3798
02:23:24,438 --> 02:23:26,312
those efforts.

3799
02:23:26,312 --> 02:23:29,203
I just want to say that and

3800
02:23:29,203 --> 02:23:31,375
thank you at this time and

3801
02:23:31,375 --> 02:23:32,875
of course, some of the staff

3802
02:23:32,875 --> 02:23:34,141
offline will ask you a few

3803
02:23:34,141 --> 02:23:34,844
things to bring back in the

3804
02:23:34,844 --> 02:23:36,844
future.

3805
02:23:38,188 --> 02:23:38,859
Anything else on this item

3806
02:23:38,859 --> 02:23:40,859
before the board?

3807
02:23:42,922 --> 02:23:45,922
See none, thank you again.

3808
02:23:46,156 --> 02:23:49,756
we're down to our last, before

3809
02:23:52,375 --> 02:23:54,775
we recess, last unit,

3810
02:23:54,797 --> 02:23:56,797
412, mental health department.

3811
02:24:06,844 --> 02:24:08,625
i see Dr. Pena making a way up.

3812
02:24:08,625 --> 02:24:09,250
>> good afternoon.

3813
02:24:09,250 --> 02:24:10,953
President Shirakawa and board

3814
02:24:10,953 --> 02:24:12,625
of supervisors, nancy

3815
02:24:12,625 --> 02:24:15,250
pena, mental health director.

3816
02:24:16,422 --> 02:24:18,234
I am going to briefly talk

3817
02:24:18,234 --> 02:24:19,891
about our highlights from

3818
02:24:19,891 --> 02:24:21,891
this past year.

3819
02:24:22,940 --> 02:24:24,141
We've been extremely busy.

3820
02:24:24,141 --> 02:24:26,969
Thanks to really the support of

3821
02:24:26,969 --> 02:24:29,369
the full board, mental

3822
02:24:29,547 --> 02:24:32,547
health has been extremely busy

3823
02:24:33,109 --> 02:24:35,578
and a very happy with our

3824
02:24:35,578 --> 02:24:36,750
activities.

3825
02:24:36,750 --> 02:24:38,750
School link services

3826
02:24:38,812 --> 02:24:38,984
initiative, we are getting for

3827
02:24:38,984 --> 02:24:40,984
the

3828
02:24:41,160 --> 02:24:43,656
launch in fiscal year '13.

3829
02:24:43,656 --> 02:24:44,719
Our older adult summit is also

3830
02:24:44,719 --> 02:24:45,797
creating some

3831
02:24:45,797 --> 02:24:46,828
implementation planning that we

3832
02:24:46,828 --> 02:24:49,562
will also bring forward as

3833
02:24:49,562 --> 02:24:51,000
we go into the next year.

3834
02:24:51,000 --> 02:24:53,359
Certainly our partnership with

3835
02:24:53,359 --> 02:24:55,469
ab109 and the ccp and

3836
02:24:55,469 --> 02:24:57,766
all of the county departments

3837
02:24:57,766 --> 02:24:58,766
that are participating in that

3838
02:24:58,766 --> 02:25:01,166
has been extremely rewarding

3839
02:25:01,469 --> 02:25:04,750
and we really look forward to

3840
02:25:04,750 --> 02:25:06,219
the next year as we go forward.

3841
02:25:06,219 --> 02:25:09,160
then as we do continue our work

3842
02:25:09,160 --> 02:25:11,416
with the mental health

3843
02:25:11,891 --> 02:25:13,922
services act and our interface

3844
02:25:13,922 --> 02:25:15,328
with various innovations

3845
02:25:15,328 --> 02:25:17,728
projects as well as

3846
02:25:18,940 --> 02:25:18,594
partnership, we're extremely

3847
02:25:18,594 --> 02:25:18,797
busy right

3848
02:25:18,797 --> 02:25:20,797
now.

3849
02:25:21,891 --> 02:25:23,734
One of the things I did want to

3850
02:25:23,734 --> 02:25:25,620
note that isn't on the

3851
02:25:25,620 --> 02:25:25,906
slides, it relates to the

3852
02:25:25,906 --> 02:25:28,109
mental health services acts.

3853
02:25:28,109 --> 02:25:29,469
This is an item that will be

3854
02:25:29,469 --> 02:25:30,609
coming forward to the

3855
02:25:30,609 --> 02:25:32,609
board.

3856
02:25:33,234 --> 02:25:33,703
Probably in August once you

3857
02:25:33,703 --> 02:25:35,250
return from the break.

3858
02:25:35,250 --> 02:25:38,250
That's just because the timing

3859
02:25:38,250 --> 02:25:40,484
for the mental health

3860
02:25:40,484 --> 02:25:41,470
services act annual report and

3861
02:25:41,470 --> 02:25:43,156
30 day posting that to the

3862
02:25:43,156 --> 02:25:44,953
public and then the hearing

3863
02:25:44,953 --> 02:25:45,312
that we have to have through

3864
02:25:45,312 --> 02:25:46,828
our

3865
02:25:46,828 --> 02:25:48,859
mental health board won't

3866
02:25:48,859 --> 02:25:51,620
happen until July probably.

3867
02:25:51,620 --> 02:25:52,328
That means that we now have to

3868
02:25:52,328 --> 02:25:55,310
come forward to you with

3869
02:25:55,310 --> 02:25:57,328
our full plan for the mental

3870
02:25:57,328 --> 02:25:59,906
health services act in August.

3871
02:25:59,906 --> 02:26:02,203
There will be some items on

3872
02:26:02,203 --> 02:26:05,203
there that we will be

3873
02:26:05,844 --> 02:26:07,312
requesting in terms of ftes or

3874
02:26:07,312 --> 02:26:08,484
funding for programs that

3875
02:26:08,484 --> 02:26:10,547
you will see at that time.

3876
02:26:10,547 --> 02:26:12,484
I just wanted to make sure that

3877
02:26:12,484 --> 02:26:14,884
are aware of that.

3878
02:26:15,422 --> 02:26:16,781
We are expecting with mental

3879
02:26:16,781 --> 02:26:19,181
health services act to

3880
02:26:22,156 --> 02:26:22,562
have about a 20% increase for

3881
02:26:22,562 --> 02:26:23,891
fiscal year '13.

3882
02:26:23,891 --> 02:26:25,828
That will pretty much pay for

3883
02:26:25,828 --> 02:26:28,310
most of the items that we

3884
02:26:28,310 --> 02:26:29,906
have funded with one time funds.

3885
02:26:29,906 --> 02:26:32,310
we'll be bringing that forward

3886
02:26:32,310 --> 02:26:33,734
and our budget for the

3887
02:26:33,734 --> 02:26:36,609
mental health services act next

3888
02:26:36,609 --> 02:26:37,234
year will be approximately

3889
02:26:37,234 --> 02:26:38,734
$53 million.

3890
02:26:38,734 --> 02:26:39,578
So it's a significant amount in

3891
02:26:39,578 --> 02:26:39,875
the mental health

3892
02:26:39,875 --> 02:26:41,875
department.

3893
02:26:42,516 --> 02:26:46,716
Going on to the items that we

3894
02:26:46,719 --> 02:26:48,219
have.

3895
02:26:48,219 --> 02:26:50,188
The first item should be in the

3896
02:26:50,188 --> 02:26:52,188
emerging issues.

3897
02:26:53,359 --> 02:26:54,953
We are exploring the

3898
02:26:54,953 --> 02:26:57,353
possibility of operating our

3899
02:26:58,969 --> 02:27:00,940
emergency site services as a

3900
02:27:00,940 --> 02:27:00,531
separate distinct stabilization

3901
02:27:00,531 --> 02:27:02,531
program.

3902
02:27:04,969 --> 02:27:05,469
You can operate these programs,

3903
02:27:05,469 --> 02:27:07,375
these emergency psychs

3904
02:27:07,375 --> 02:27:09,775
in two different ways.

3905
02:27:10,938 --> 02:27:12,516
one is attached to a hospitals

3906
02:27:12,516 --> 02:27:15,922
a an psych er the other

3907
02:27:15,922 --> 02:27:17,344
one is a free standing crisis

3908
02:27:17,344 --> 02:27:19,344
stabilization service.

3909
02:27:20,125 --> 02:27:21,922
Both of them would be locked

3910
02:27:21,922 --> 02:27:23,562
and contained and pretty

3911
02:27:23,562 --> 02:27:26,562
much in compliance with title 9.

3912
02:27:27,500 --> 02:27:28,828
We are really in the

3913
02:27:28,828 --> 02:27:30,828
exploratory phases.

3914
02:27:34,940 --> 02:27:34,703
we determine whether or not we

3915
02:27:34,703 --> 02:27:36,703
will be feasible.

3916
02:27:37,109 --> 02:27:38,703
If it is feasible, we will come

3917
02:27:38,703 --> 02:27:41,703
back to you later in

3918
02:27:42,938 --> 02:27:45,938
the fall with a proposal.

3919
02:27:47,750 --> 02:27:51,350
I wanted to make sure people

3920
02:27:52,859 --> 02:27:54,328
are seeing that we are

3921
02:27:54,328 --> 02:27:55,688
operating off the vmc license.

3922
02:27:55,688 --> 02:27:56,828
That is in the next fiscal

3923
02:27:56,828 --> 02:27:58,297
year, we'll be coming

3924
02:27:58,297 --> 02:28:01,297
forward with some plan about

3925
02:28:01,766 --> 02:28:02,391
that or at least some reports

3926
02:28:02,391 --> 02:28:04,391
on it.

3927
02:28:06,766 --> 02:28:09,766
The second item relates to

3928
02:28:10,906 --> 02:28:11,844
changes in the lives relates

3929
02:28:11,844 --> 02:28:12,703
to special education.

3930
02:28:12,703 --> 02:28:13,203
As aware the responsibility

3931
02:28:13,203 --> 02:28:15,603
that the mental health

3932
02:28:16,906 --> 02:28:19,344
department had and the counties

3933
02:28:19,344 --> 02:28:21,281
had has changed this fiscal

3934
02:28:21,281 --> 02:28:23,188
year.

3935
02:28:23,188 --> 02:28:24,391
This fiscal year '12 to fiscal

3936
02:28:24,391 --> 02:28:26,791
year '13 when the

3937
02:28:27,984 --> 02:28:30,384
schools will be solely

3938
02:28:38,531 --> 02:28:38,797
responsible for providing iep

3939
02:28:38,797 --> 02:28:39,797
related

3940
02:28:39,797 --> 02:28:41,797
service.

3941
02:28:43,203 --> 02:28:46,172
We will continue to be involved

3942
02:28:46,172 --> 02:28:48,172
as medi-cal

3943
02:28:51,547 --> 02:28:52,578
beneficiaries are served

3944
02:28:52,578 --> 02:28:53,250
through the health system he

3945
02:28:53,250 --> 02:28:54,219
will

3946
02:28:54,219 --> 02:28:55,780
no longer be the administrator

3947
02:28:55,780 --> 02:28:57,780
of the program.

3948
02:28:58,828 --> 02:28:59,484
Basically what this item, we're

3949
02:28:59,484 --> 02:29:00,594
downsizing somewhat the

3950
02:29:00,594 --> 02:29:03,500
budget that we have dedicated

3951
02:29:03,500 --> 02:29:06,500
to that in general fund.

3952
02:29:07,969 --> 02:29:09,359
Actually what we gend to do is

3953
02:29:09,359 --> 02:29:11,359
redirect equivalent

3954
02:29:13,310 --> 02:29:15,431
amount of two schooling

3955
02:29:16,406 --> 02:29:17,000
services to help support our

3956
02:29:17,000 --> 02:29:18,734
new

3957
02:29:18,734 --> 02:29:20,734
schooling services effort.

3958
02:29:22,516 --> 02:29:23,453
The next item really relates,

3959
02:29:23,453 --> 02:29:25,141
we talked to you about

3960
02:29:25,141 --> 02:29:26,922
this a little bit in this

3961
02:29:26,922 --> 02:29:29,125
fiscal year, programs were

3962
02:29:29,125 --> 02:29:32,125
transferred from dads to mental

3963
02:29:33,688 --> 02:29:35,688
health.

3964
02:29:40,266 --> 02:29:41,859
for the calworks treatment

3965
02:29:41,859 --> 02:29:42,500
services. This basically

3966
02:29:42,500 --> 02:29:44,900
moving the three administrative

3967
02:29:45,141 --> 02:29:46,906
staff who are connected to

3968
02:29:46,906 --> 02:29:48,641
those services from dads into

3969
02:29:48,641 --> 02:29:51,410
the mental health department.

3970
02:29:51,469 --> 02:29:53,172
The next item really is a no

3971
02:29:53,172 --> 02:29:55,906
cost item but it does

3972
02:29:55,906 --> 02:29:56,453
relate to priority of the board

3973
02:29:56,453 --> 02:29:58,853
and certainly the county

3974
02:29:59,422 --> 02:30:02,453
exec that we take a look at the

3975
02:30:02,453 --> 02:30:03,620
high users in our county

3976
02:30:03,620 --> 02:30:05,620
across departmentally.

3977
02:30:08,000 --> 02:30:09,620
Particularly those who are

3978
02:30:09,620 --> 02:30:09,703
homeless and chronically

3979
02:30:09,703 --> 02:30:13,203
homeless as well as those who

3980
02:30:13,203 --> 02:30:15,531
are involved in the criminal

3981
02:30:15,531 --> 02:30:16,672
justice system and the health

3982
02:30:16,672 --> 02:30:18,406
system.

3983
02:30:18,406 --> 02:30:20,469
Those we consider most frequent

3984
02:30:20,469 --> 02:30:21,470
users.

3985
02:30:21,470 --> 02:30:23,447
And really looking at

3986
02:30:23,516 --> 02:30:23,672
assessment of that population

3987
02:30:23,672 --> 02:30:25,438
to

3988
02:30:25,438 --> 02:30:26,719
see what we can do improve the

3989
02:30:26,719 --> 02:30:29,141
services that we offer as a

3990
02:30:29,141 --> 02:30:30,516
safety net for these

3991
02:30:30,516 --> 02:30:32,516
populations.

3992
02:30:32,984 --> 02:30:33,922
We also had some grant

3993
02:30:33,922 --> 02:30:36,322
terminations ending of grants.

3994
02:30:37,359 --> 02:30:40,625
we are picking those up in our

3995
02:30:40,625 --> 02:30:42,625
medi-cal program or

3996
02:30:43,469 --> 02:30:45,869
lihp, low income program.

3997
02:30:50,641 --> 02:30:54,241
We do have 4.5ftes that we

3998
02:30:59,160 --> 02:31:01,416
requested through the ab

3999
02:31:07,188 --> 02:31:09,188
ab109 program.

4000
02:31:10,422 --> 02:31:12,656
We also have a proposal here

4001
02:31:12,656 --> 02:31:13,922
that really is done in

4002
02:31:13,922 --> 02:31:15,359
collaboration with dads

4003
02:31:15,359 --> 02:31:15,969
regarding the low income health

4004
02:31:15,969 --> 02:31:17,969
plan

4005
02:31:19,906 --> 02:31:22,906
and our continuing to move

4006
02:31:22,906 --> 02:31:25,306
towards an expanded medi-cal

4007
02:31:25,609 --> 02:31:27,469
program and benefits beginning

4008
02:31:27,469 --> 02:31:29,469
in 2014.

4009
02:31:30,812 --> 02:31:31,250
In will add some qi staff and

4010
02:31:31,250 --> 02:31:32,812
health services

4011
02:31:32,812 --> 02:31:35,212
representative staff to mental

4012
02:31:35,891 --> 02:31:36,312
health that will be dedicated

4013
02:31:36,312 --> 02:31:38,312
to dads.

4014
02:31:39,156 --> 02:31:40,219
for the development more of a

4015
02:31:40,219 --> 02:31:41,766
managed care

4016
02:31:41,766 --> 02:31:43,766
infrastructure, getting ready

4017
02:31:44,625 --> 02:31:46,594
for the future when there will

4018
02:31:46,594 --> 02:31:48,994
be more individuals with

4019
02:31:50,375 --> 02:31:50,938
medi-cal benefit who will be

4020
02:31:50,938 --> 02:31:53,338
entitled to substance abuse

4021
02:31:53,469 --> 02:31:55,172
treatment as well as mental

4022
02:31:55,172 --> 02:31:57,172
health benefits.

4023
02:31:57,938 --> 02:31:59,172
Finally, the last item is three

4024
02:31:59,172 --> 02:32:01,172
contract staff.

4025
02:32:01,641 --> 02:32:04,188
These would all be be paid

4026
02:32:04,188 --> 02:32:06,188
through funding.

4027
02:32:07,719 --> 02:32:08,312
We came to you earlier through

4028
02:32:08,312 --> 02:32:09,891
the mental health

4029
02:32:09,891 --> 02:32:12,291
hospital for these positions.

4030
02:32:12,594 --> 02:32:14,297
These positions are desperately

4031
02:32:14,297 --> 02:32:17,297
needed a we move into

4032
02:32:19,938 --> 02:32:22,000
really processing close to 500

4033
02:32:22,000 --> 02:32:24,000
either contract, rfps,

4034
02:32:24,406 --> 02:32:27,438
mous we expect many for coming

4035
02:32:27,438 --> 02:32:29,438
with school link services

4036
02:32:29,438 --> 02:32:31,375
as we enter into agreements and

4037
02:32:31,375 --> 02:32:32,172
our provides across the

4038
02:32:32,172 --> 02:32:34,109
county to articulate services

4039
02:32:34,109 --> 02:32:36,109
that we'll be delivering.

4040
02:32:36,109 --> 02:32:38,859
These three staff are basic in

4041
02:32:38,859 --> 02:32:41,259
our contract units to

4042
02:32:41,281 --> 02:32:43,681
support the contracting process.

4043
02:32:45,940 --> 02:32:48,469
With that, I will welcome any

4044
02:32:48,469 --> 02:32:49,797
questions.

4045
02:32:49,797 --> 02:32:51,797
>> any questions.

4046
02:32:56,438 --> 02:32:58,838
I have one speaker.

4047
02:33:01,470 --> 02:33:02,781
sparky, good afternoon.

4048
02:33:02,781 --> 02:33:04,781
>> good afternoon.

4049
02:33:08,812 --> 02:33:11,516
I wasn't sure if this belonged

4050
02:33:11,516 --> 02:33:12,922
to you but it has to do

4051
02:33:12,922 --> 02:33:13,188
with my concern with rap

4052
02:33:13,188 --> 02:33:15,188
services.

4053
02:33:20,625 --> 02:33:21,203
the reduction of services that

4054
02:33:21,203 --> 02:33:21,625
emq and rebecca would

4055
02:33:21,625 --> 02:33:23,625
have.

4056
02:33:24,940 --> 02:33:24,672
If you've going to change

4057
02:33:24,672 --> 02:33:27,720
providers, that's fine with

4058
02:33:27,297 --> 02:33:29,703
me but I'm really concerned as

4059
02:33:29,703 --> 02:33:31,344
you're putting this stuff out

4060
02:33:31,344 --> 02:33:31,969
to bid, how you're going to

4061
02:33:31,969 --> 02:33:33,969
transfer clients over?

4062
02:33:35,470 --> 02:33:37,750
I know when I lost a grant that

4063
02:33:37,750 --> 02:33:39,516
we had for 25 years

4064
02:33:39,516 --> 02:33:40,844
with iop independent living

4065
02:33:40,844 --> 02:33:42,578
program, the kids were suppose

4066
02:33:42,578 --> 02:33:43,250
to transfer over and they did

4067
02:33:43,250 --> 02:33:44,719
not.

4068
02:33:44,719 --> 02:33:45,922
Because it was so tied to

4069
02:33:45,922 --> 02:33:48,422
provider, they really did not

4070
02:33:48,422 --> 02:33:48,922
want to transfer over to a new

4071
02:33:48,922 --> 02:33:50,562
provider.

4072
02:33:50,562 --> 02:33:52,531
Even though we tried really

4073
02:33:52,531 --> 02:33:54,234
hard to do that.

4074
02:33:54,234 --> 02:33:57,172
So my concern is that you

4075
02:33:57,172 --> 02:34:00,172
really look at how those

4076
02:34:00,734 --> 02:34:02,500
clients are going to transfer

4077
02:34:02,500 --> 02:34:05,160
over sense they are most

4078
02:34:05,160 --> 02:34:06,484
serious mentally ill clients

4079
02:34:06,484 --> 02:34:09,750
and look attrition fund to give

4080
02:34:09,750 --> 02:34:10,281
them time to transition out of

4081
02:34:10,281 --> 02:34:11,984
emq.

4082
02:34:11,984 --> 02:34:13,984
Another thought I have is

4083
02:34:13,984 --> 02:34:15,125
something I know county

4084
02:34:15,125 --> 02:34:16,470
department, how about

4085
02:34:16,470 --> 02:34:17,219
encouraging new providers to

4086
02:34:17,219 --> 02:34:17,859
hire

4087
02:34:17,859 --> 02:34:18,160
those people that will be laid

4088
02:34:18,160 --> 02:34:20,160
off.

4089
02:34:20,391 --> 02:34:20,828
I can tell you right now what's

4090
02:34:20,828 --> 02:34:22,828
happening.

4091
02:34:24,203 --> 02:34:25,594
there's a lot of movement in

4092
02:34:25,594 --> 02:34:27,406
nonprofit sector with

4093
02:34:27,406 --> 02:34:29,806
everybody is changing jobs.

4094
02:34:32,109 --> 02:34:35,109
We're all getting new contracts.

4095
02:34:37,312 --> 02:34:40,312
We're all hiring each other

4096
02:34:52,156 --> 02:34:53,234
staff.

4097
02:34:53,234 --> 02:34:56,234
>> any questions from the board

4098
02:34:57,828 --> 02:34:58,531
before we recess to

4099
02:34:58,531 --> 02:34:58,734
6:30?

4100
02:34:58,734 --> 02:35:00,734
Jeff?

4101
02:35:01,641 --> 02:35:04,312
Members of the boards, we will

4102
02:35:04,312 --> 02:35:04,875
recess until 6:30

4103
02:35:04,875 --> 02:35:06,875
exactly.

4104
02:59:41,359 --> 02:59:44,959
>> we have our hands full at

4105
02:59:45,328 --> 02:59:46,719
this time we do not have the

4106
02:59:46,719 --> 02:59:49,119
financial expertise to handle

4107
02:59:50,000 --> 02:59:52,672
these tasks at this time.

4108
02:59:52,672 --> 02:59:55,562
Nor do we feel that the cross

4109
02:59:55,562 --> 02:59:56,469
training is sustainable in the

4110
02:59:56,469 --> 02:59:58,469
long run.

4111
03:00:07,750 --> 03:00:09,750
And this will also relate to

4112
03:00:09,750 --> 03:00:10,470
policies and procedures for the

4113
03:00:10,470 --> 03:00:12,470
tasks.

4114
03:00:12,953 --> 03:00:14,953
Thank you for your time, only

4115
03:00:14,953 --> 03:00:15,687
financial experts can provide

4116
03:00:15,687 --> 03:00:17,687
financial expertise.

4117
03:00:23,359 --> 03:00:25,359
>> thank you.

4118
03:00:27,875 --> 03:00:28,703
>> I am brett russell, and an

4119
03:00:28,703 --> 03:00:31,172
am state administrator, and I

4120
03:00:31,172 --> 03:00:34,609
have been worked in the office

4121
03:00:34,609 --> 03:00:35,640
for 25 years and came in as an

4122
03:00:35,640 --> 03:00:37,640
entry level position.

4123
03:00:39,187 --> 03:00:40,719
I have worked myself up to the

4124
03:00:40,719 --> 03:00:42,719
state administrator position.

4125
03:00:46,781 --> 03:00:48,250
I was hired shortly after the

4126
03:00:48,250 --> 03:00:51,250
grand injury admin strargz that

4127
03:00:51,266 --> 03:00:52,390
held for the model was

4128
03:00:52,390 --> 03:00:54,790
insufficient to protect our

4129
03:01:00,109 --> 03:01:02,509
clients and the county

4130
03:06:28,875 --> 03:06:30,875
incompetence and waste.

4131
03:06:36,656 --> 03:06:38,656
>> good evening.

4132
03:06:40,562 --> 03:06:41,703
So first highlights from fiscal

4133
03:06:41,703 --> 03:06:43,703
year 12.

4134
03:06:44,500 --> 03:06:46,797
We have increased hours of

4135
03:06:46,797 --> 03:06:49,797
service at valley health center.

4136
03:06:50,812 --> 03:06:51,640
we have reduced our diversion

4137
03:06:51,640 --> 03:06:53,640
hours by 60%.

4138
03:06:55,312 --> 03:06:56,375
Meaning that we are open to

4139
03:06:56,375 --> 03:06:58,375
more ambulances arriving

4140
03:06:58,406 --> 03:07:00,406
serving our community.

4141
03:07:03,390 --> 03:07:05,484
We achieved our disrepresent

4142
03:07:05,484 --> 03:07:07,160
milestones for the year, and

4143
03:07:07,160 --> 03:07:10,160
collecting all revenue we could.

4144
03:07:10,422 --> 03:07:12,969
And we have begun installation

4145
03:07:12,969 --> 03:07:15,969
of the electronic record and

4146
03:07:16,172 --> 03:07:19,772
scheduled to go live on that.

4147
03:07:19,937 --> 03:07:22,937
We have formed a partnership

4148
03:07:23,780 --> 03:07:23,547
for fciu to help in health care

4149
03:07:23,547 --> 03:07:25,547
reform.

4150
03:07:25,906 --> 03:07:27,375
We have seen increase in

4151
03:07:27,375 --> 03:07:29,453
satisfaction over the last

4152
03:07:29,453 --> 03:07:31,453
three quarters.

4153
03:07:31,516 --> 03:07:32,750
And finally credited by the

4154
03:07:32,750 --> 03:07:33,281
american college surgeons for

4155
03:07:33,281 --> 03:07:35,281
burn care.

4156
03:07:35,625 --> 03:07:39,225
Those are the highlights of our

4157
03:07:39,797 --> 03:07:41,797
current fiscal year.

4158
03:07:45,594 --> 03:07:46,437
We have 15 budget proposals for

4159
03:07:46,437 --> 03:07:48,437
next fiscal year.

4160
03:07:51,203 --> 03:07:52,875
We started with a deficit of 84

4161
03:07:52,875 --> 03:07:54,437
million, once we based our

4162
03:07:54,437 --> 03:07:57,437
revenue and the experience of

4163
03:08:01,160 --> 03:08:03,416
the current fiscal year.

4164
03:08:03,812 --> 03:08:06,578
The item that genders the most

4165
03:08:06,578 --> 03:08:06,812
conversation is the clinic care

4166
03:08:06,812 --> 03:08:08,281
volume.

4167
03:08:08,281 --> 03:08:11,281
Some comments about where we

4168
03:08:14,000 --> 03:08:16,625
are with that in this year.

4169
03:08:16,625 --> 03:08:19,625
The projection for next fiscal

4170
03:08:24,437 --> 03:08:28,370
year is a 15% -- 14% drop from

4171
03:08:30,547 --> 03:08:33,547
the kurpt -- current year.

4172
03:08:33,719 --> 03:08:35,953
we believe this is an

4173
03:08:35,953 --> 03:08:37,953
achievable number.

4174
03:08:38,547 --> 03:08:40,890
This is a sustainable number.

4175
03:08:40,890 --> 03:08:41,359
We reduced our unused

4176
03:08:41,359 --> 03:08:43,359
appointment slots.

4177
03:08:45,625 --> 03:08:47,422
We have in our current clinic

4178
03:08:47,422 --> 03:08:49,822
scheduling system the capacity

4179
03:08:50,469 --> 03:08:52,869
to achieve this number.

4180
03:08:54,703 --> 03:08:55,640
and it's managed to fill every

4181
03:08:55,640 --> 03:08:57,000
appointment slot.

4182
03:08:57,000 --> 03:08:58,906
Which we have many strategies

4183
03:08:58,906 --> 03:09:00,516
to do.

4184
03:09:00,516 --> 03:09:02,916
The inpatient volume increase

4185
03:09:03,750 --> 03:09:05,250
is a result of down stream

4186
03:09:05,250 --> 03:09:07,650
revenue from increased primary

4187
03:09:07,719 --> 03:09:09,719
care volume.

4188
03:09:10,359 --> 03:09:11,922
And increase enrollment in our

4189
03:09:11,922 --> 03:09:14,922
low-income health plan that is

4190
03:09:15,297 --> 03:09:17,697
a later budget proposal.

4191
03:09:18,266 --> 03:09:19,625
It's simply a calculation.

4192
03:09:19,625 --> 03:09:21,625
Revenue cycle redesign.

4193
03:09:21,625 --> 03:09:24,625
We have four strategies to

4194
03:09:25,797 --> 03:09:26,172
bring in that additional $21

4195
03:09:26,172 --> 03:09:28,172
million.

4196
03:09:29,234 --> 03:09:31,812
And as the board is aware that

4197
03:09:31,812 --> 03:09:32,781
we brought in revenue

4198
03:09:32,781 --> 03:09:34,781
collection.

4199
03:09:36,719 --> 03:09:39,719
we are renegotiating some of

4200
03:09:40,844 --> 03:09:42,625
our surance -- insurance

4201
03:09:42,625 --> 03:09:45,250
contracts and working on

4202
03:09:47,310 --> 03:09:47,719
collections of lab and dialysis

4203
03:09:47,719 --> 03:09:49,719
centers.

4204
03:09:50,310 --> 03:09:51,969
Reduction of vacant positions,

4205
03:09:51,969 --> 03:09:53,359
these are positions that are

4206
03:09:53,359 --> 03:09:55,359
not currently filled.

4207
03:09:57,297 --> 03:10:00,897
that we don't intend to fill,

4208
03:10:03,906 --> 03:10:06,578
for which we are not use are

4209
03:10:06,578 --> 03:10:08,344
over time or extra help to get

4210
03:10:08,344 --> 03:10:11,944
the work done and believe we

4211
03:10:13,859 --> 03:10:14,250
can do without those 33

4212
03:10:14,250 --> 03:10:16,250
positions.

4213
03:10:17,516 --> 03:10:18,310
icpp-10 was delayed by cms by

4214
03:10:18,310 --> 03:10:20,310
one year.

4215
03:10:20,734 --> 03:10:21,828
But for the preparation of

4216
03:10:21,828 --> 03:10:24,228
implementation, we will have

4217
03:10:25,562 --> 03:10:29,162
some costs in the next fiscal

4218
03:10:35,516 --> 03:10:37,516
year, approximately 2.8 million.

4219
03:10:38,470 --> 03:10:40,375
Our core project for the

4220
03:10:40,375 --> 03:10:42,687
medical record, we figure

4221
03:10:42,687 --> 03:10:44,780
that's about 68 million, and I

4222
03:10:44,780 --> 03:10:46,281
believe that jeff covered that

4223
03:10:46,281 --> 03:10:47,160
earlier in the budget.

4224
03:10:47,160 --> 03:10:49,160
Covered by technology.

4225
03:10:49,531 --> 03:10:50,390
Is that correct?

4226
03:10:50,390 --> 03:10:51,656
Okay.

4227
03:10:51,656 --> 03:10:54,000
The cms incentive program.

4228
03:10:54,000 --> 03:10:55,500
As I mentioned earlier, one of

4229
03:10:55,500 --> 03:10:57,828
our highlights this fiscal year

4230
03:10:57,828 --> 03:10:59,500
is that we achieved all of

4231
03:10:59,500 --> 03:11:01,469
those revenues and goals as

4232
03:11:01,469 --> 03:11:03,869
required in that program.

4233
03:11:04,203 --> 03:11:06,547
We went back and looked at the

4234
03:11:06,547 --> 03:11:08,947
possibility for next year.

4235
03:11:11,780 --> 03:11:12,687
And we believe there is an

4236
03:11:12,687 --> 03:11:14,516
additional $5 million we can go

4237
03:11:14,516 --> 03:11:16,516
after and achieve.

4238
03:11:19,516 --> 03:11:22,516
our managed care contract this

4239
03:11:22,562 --> 03:11:24,962
is a renegotiation between

4240
03:11:30,875 --> 03:11:33,275
santa clara health care.

4241
03:11:34,780 --> 03:11:36,140
We have a different way of

4242
03:11:36,140 --> 03:11:38,540
calculating valley health plan

4243
03:11:39,750 --> 03:11:42,219
with transferring risk over to

4244
03:11:42,219 --> 03:11:42,750
them that dmc has had in the

4245
03:11:42,750 --> 03:11:44,750
past.

4246
03:11:44,875 --> 03:11:48,187
But had no control of that risk.

4247
03:11:48,187 --> 03:11:49,625
So this is more of an

4248
03:11:49,625 --> 03:11:51,890
accounting transaction to move

4249
03:11:51,890 --> 03:11:55,490
the revenue and expense to the

4250
03:11:55,562 --> 03:11:57,962
appropriate place in valley

4251
03:12:02,562 --> 03:12:04,562
health plan.

4252
03:12:05,310 --> 03:12:06,969
Cap conversion.

4253
03:12:06,969 --> 03:12:10,569
In the health plan, we started

4254
03:12:11,750 --> 03:12:14,150
the year with 8,000 enrollies.

4255
03:12:14,516 --> 03:12:16,687
And have a goal of 12,000

4256
03:12:16,687 --> 03:12:20,780
enrollies by the end of the

4257
03:12:20,780 --> 03:12:20,625
fiscal year, we are rapidly

4258
03:12:20,625 --> 03:12:22,547
approaching 10,000.

4259
03:12:22,547 --> 03:12:25,547
we believe this is achievable

4260
03:12:28,328 --> 03:12:30,625
to bump that enrollment up.

4261
03:12:30,625 --> 03:12:32,437
And our managed care contract

4262
03:12:32,437 --> 03:12:34,328
featured service.

4263
03:12:34,328 --> 03:12:35,766
A renegotiation of our future

4264
03:12:35,766 --> 03:12:36,562
service, santa clara health

4265
03:12:36,562 --> 03:12:38,562
plan contract.

4266
03:12:42,516 --> 03:12:46,116
and thal bring -- that will

4267
03:12:54,656 --> 03:12:57,560
bring an additional 7 million.

4268
03:13:03,594 --> 03:13:05,994
we are currently in

4269
03:13:06,469 --> 03:13:09,469
negotiations and we May be

4270
03:13:10,734 --> 03:13:13,134
reforced to reduce our

4271
03:13:15,780 --> 03:13:15,984
enicologists by 3.5 ftes.

4272
03:13:15,984 --> 03:13:18,384
The contract position budget,

4273
03:13:20,812 --> 03:13:25,120
in the past we used an outside

4274
03:13:30,562 --> 03:13:33,125
firm care and we brought our

4275
03:13:33,125 --> 03:13:36,125
physicians in and putting ftes

4276
03:13:37,640 --> 03:13:41,840
back in the budget and this is

4277
03:13:48,109 --> 03:13:50,470
cost neutral.

4278
03:13:50,470 --> 03:13:51,219
We have assistance in opening

4279
03:13:51,219 --> 03:13:53,219
the downtown location.

4280
03:14:05,266 --> 03:14:05,500
they did not get guarantee this

4281
03:14:05,500 --> 03:14:07,500
amount.

4282
03:14:13,266 --> 03:14:16,866
We are bringing this next area

4283
03:14:17,780 --> 03:14:17,375
in the custody health

4284
03:14:17,375 --> 03:14:19,375
discussion.

4285
03:14:28,390 --> 03:14:30,281
so questions?

4286
03:14:30,281 --> 03:14:32,281
>> with information about

4287
03:14:32,719 --> 03:14:34,328
gardener, I know at the hcc

4288
03:14:34,328 --> 03:14:36,620
meeting I asked questions and

4289
03:14:36,620 --> 03:14:38,462
didn't quite get clarification.

4290
03:14:38,969 --> 03:14:42,172
I knew we had given the 550,000

4291
03:14:42,172 --> 03:14:43,500
that we thought would cover the

4292
03:14:43,500 --> 03:14:45,500
expense.

4293
03:14:47,470 --> 03:14:48,000
but because they didn't get the

4294
03:14:48,000 --> 03:14:49,937
additional dollars.

4295
03:14:49,937 --> 03:14:52,844
Therefore we are covering it

4296
03:14:52,844 --> 03:14:53,140
and it wasn't covered by the

4297
03:14:53,140 --> 03:14:55,140
550,000?

4298
03:14:58,250 --> 03:15:00,219
>> I see that gary is reaching

4299
03:15:00,219 --> 03:15:01,625
for the microphone phone.

4300
03:15:01,625 --> 03:15:03,531
>> gardener's projection is

4301
03:15:03,531 --> 03:15:06,328
that in the first year of

4302
03:15:06,328 --> 03:15:07,734
operation, they require a

4303
03:15:07,734 --> 03:15:09,734
550,000 subsidy.

4304
03:15:10,310 --> 03:15:13,310
The second year of the

4305
03:15:13,172 --> 03:15:14,310
contract, they require a

4306
03:15:14,310 --> 03:15:15,640
$300,000 subsidy.

4307
03:15:15,640 --> 03:15:18,312
What happened here, we are

4308
03:15:18,312 --> 03:15:19,875
being a little conservative.

4309
03:15:19,875 --> 03:15:21,812
Because the original plan was

4310
03:15:21,812 --> 03:15:23,578
for gardener to open earlier.

4311
03:15:23,578 --> 03:15:25,906
So really what is happening,

4312
03:15:25,906 --> 03:15:27,281
right now we are hoping that

4313
03:15:27,281 --> 03:15:28,470
the downtown clinic will open

4314
03:15:28,470 --> 03:15:30,470
on June 1.

4315
03:15:30,390 --> 03:15:31,594
If we look at this on a

4316
03:15:31,594 --> 03:15:33,594
calendar basis.

4317
03:15:39,969 --> 03:15:42,369
Basically we are allocating

4318
03:15:46,297 --> 03:15:47,437
330,000 that is the amount for

4319
03:15:47,437 --> 03:15:48,937
2013 to 2014.

4320
03:15:48,937 --> 03:15:52,281
The timing is a little skewed.

4321
03:15:52,281 --> 03:15:53,672
But at this point in time the

4322
03:15:53,672 --> 03:15:56,672
expectation is that what we

4323
03:15:57,781 --> 03:15:59,953
were funding is a two-year

4324
03:15:59,953 --> 03:16:01,953
program effect.

4325
03:16:02,219 --> 03:16:03,922
And so the 550 is the first

4326
03:16:03,922 --> 03:16:04,250
year and 300 for the second

4327
03:16:04,250 --> 03:16:06,250
year.

4328
03:16:11,531 --> 03:16:15,731
over two years it's a title of

4329
03:16:15,969 --> 03:16:17,969
850,000 subdiddys are --

4330
03:16:18,000 --> 03:16:20,400
subsidy because they weren't

4331
03:16:20,469 --> 03:16:20,844
able to acquire the federal

4332
03:16:20,844 --> 03:16:22,844
funds.

4333
03:16:24,281 --> 03:16:27,281
>> but we anticipated that they

4334
03:16:27,719 --> 03:16:30,719
would and added that extra.

4335
03:16:30,750 --> 03:16:32,750
>> adding the 850,000, our hope

4336
03:16:32,750 --> 03:16:36,350
is that the amount they needed

4337
03:16:39,219 --> 03:16:40,297
to open -- operate on a

4338
03:16:40,297 --> 03:16:42,297
break-even basis.

4339
03:16:42,328 --> 03:16:45,328
And with the clients and

4340
03:16:46,297 --> 03:16:47,703
expenses results in a need for

4341
03:16:47,703 --> 03:16:48,437
a 550,000 requirement in the

4342
03:16:48,437 --> 03:16:50,437
first year.

4343
03:16:51,203 --> 03:16:54,780
And because of a ramping up and

4344
03:16:54,780 --> 03:16:56,375
seeing more clients, that

4345
03:16:56,375 --> 03:16:56,609
requirement will decline to

4346
03:16:56,609 --> 03:16:57,969
300,000.

4347
03:16:57,969 --> 03:16:59,812
Again this is based on forecast

4348
03:16:59,812 --> 03:17:01,281
and we will be working with

4349
03:17:01,281 --> 03:17:02,640
closely with them to see what

4350
03:17:02,640 --> 03:17:04,640
their needs are.

4351
03:17:06,750 --> 03:17:07,281
That at this point is what is

4352
03:17:07,281 --> 03:17:09,281
funded.

4353
03:17:09,953 --> 03:17:11,125
by allocating this 300,000, we

4354
03:17:11,125 --> 03:17:11,328
will have funded them for two

4355
03:17:11,328 --> 03:17:13,328
years.

4356
03:17:15,620 --> 03:17:17,156
>> and we are anticipating

4357
03:17:17,156 --> 03:17:18,672
gardener not receiving other

4358
03:17:18,672 --> 03:17:20,940
grants that they were expecting

4359
03:17:20,940 --> 03:17:22,672
and we would have to cover?

4360
03:17:22,672 --> 03:17:24,531
>> at this point this is the

4361
03:17:24,531 --> 03:17:24,969
maximum we expect to have to

4362
03:17:24,969 --> 03:17:26,969
fund.

4363
03:17:27,234 --> 03:17:28,734
>> okay, and also at our

4364
03:17:28,734 --> 03:17:31,937
meeting, I had asked a couple

4365
03:17:31,937 --> 03:17:32,984
of questions about the unused

4366
03:17:32,984 --> 03:17:34,875
appointment rate.

4367
03:17:34,875 --> 03:17:35,750
And maybe get a little more

4368
03:17:35,750 --> 03:17:37,750
understanding about that.

4369
03:17:41,359 --> 03:17:42,484
I know that the no-shows and

4370
03:17:42,484 --> 03:17:44,531
the unused appointment rate.

4371
03:17:44,531 --> 03:17:45,797
And maybe if you can talk a

4372
03:17:45,797 --> 03:17:48,422
little about both of those.

4373
03:17:48,422 --> 03:17:50,703
Where we have, I know we are

4374
03:17:50,703 --> 03:17:53,703
trying to increase the number

4375
03:17:54,766 --> 03:17:55,906
of patients that the dollars

4376
03:17:55,906 --> 03:17:57,906
-- doctors see.

4377
03:17:58,766 --> 03:18:00,312
And I assume that's the unused

4378
03:18:00,312 --> 03:18:01,703
appointment rate, trying to get

4379
03:18:01,703 --> 03:18:03,703
more patients in.

4380
03:18:04,109 --> 03:18:06,516
And making sure, in a way you

4381
03:18:06,516 --> 03:18:07,281
overbook, just in case you have

4382
03:18:07,281 --> 03:18:08,890
the no-show.

4383
03:18:08,890 --> 03:18:11,547
And can you talk about that.

4384
03:18:11,547 --> 03:18:13,984
and as we look at that and

4385
03:18:13,984 --> 03:18:15,531
reduce that, is that savings or

4386
03:18:15,531 --> 03:18:17,859
additional revenue and how that

4387
03:18:17,859 --> 03:18:19,766
will help the overall budget?

4388
03:18:19,766 --> 03:18:21,594
>> sure.

4389
03:18:21,594 --> 03:18:23,994
The unused appointment rate

4390
03:18:27,437 --> 03:18:27,703
that we used in the budget is

4391
03:18:27,703 --> 03:18:29,703
6.25%.

4392
03:18:30,312 --> 03:18:31,734
That's [Inaudible] Class is

4393
03:18:31,734 --> 03:18:33,578
zero.

4394
03:18:33,578 --> 03:18:35,978
There are physician practices

4395
03:18:40,719 --> 03:18:41,719
out there that fill every

4396
03:18:41,719 --> 03:18:43,719
appointment everyday.

4397
03:18:47,531 --> 03:18:48,719
And we get an unused

4398
03:18:48,719 --> 03:18:50,719
appointment rate daily.

4399
03:18:56,875 --> 03:18:59,875
and since we have studied

4400
03:19:01,766 --> 03:19:03,281
that, reduced our appointments.

4401
03:19:03,281 --> 03:19:06,281
And appointments go unused for

4402
03:19:07,953 --> 03:19:10,353
a variety of reasons.

4403
03:19:13,156 --> 03:19:15,125
we don't include the no-snow

4404
03:19:15,125 --> 03:19:18,725
-- no-show rate in the report.

4405
03:19:20,500 --> 03:19:22,940
That's a different piece of it.

4406
03:19:22,940 --> 03:19:24,594
An unused appointment is an

4407
03:19:24,594 --> 03:19:26,994
appointment where the patient

4408
03:19:31,437 --> 03:19:32,969
canceled in less than 24

4409
03:19:32,969 --> 03:19:33,937
hours and we weren't able to

4410
03:19:33,937 --> 03:19:35,937
fill that.

4411
03:19:36,470 --> 03:19:38,219
Or it's a case where the

4412
03:19:38,219 --> 03:19:40,516
patient demand wasn't there.

4413
03:19:40,516 --> 03:19:42,890
Or the appointments we had

4414
03:19:42,890 --> 03:19:45,219
availability for patient demand

4415
03:19:45,219 --> 03:19:46,359
didn't match the type that the

4416
03:19:46,359 --> 03:19:48,359
patient needed.

4417
03:19:50,297 --> 03:19:50,859
Maybe we had three return

4418
03:19:50,859 --> 03:19:52,500
appointment slots available.

4419
03:19:52,500 --> 03:19:55,940
And this was a new patient.

4420
03:19:55,940 --> 03:19:57,172
and we didn't have an

4421
03:19:57,172 --> 03:19:57,437
appointment slot for them that

4422
03:19:57,437 --> 03:19:59,437
day.

4423
03:20:04,000 --> 03:20:07,000
So there is a tremendous

4424
03:20:07,469 --> 03:20:08,672
science between managing of the

4425
03:20:08,672 --> 03:20:10,140
appointment schedule system so

4426
03:20:10,140 --> 03:20:12,540
every slot is filled.

4427
03:20:12,984 --> 03:20:15,470
What I can tell about the

4428
03:20:15,470 --> 03:20:18,470
budget, as compared to prior

4429
03:20:21,719 --> 03:20:23,953
years, this year's clinic

4430
03:20:23,953 --> 03:20:24,687
volume is based on what is in

4431
03:20:24,687 --> 03:20:26,687
the scheduling system.

4432
03:20:27,266 --> 03:20:30,266
We have a means electronically

4433
03:20:30,562 --> 03:20:34,140
and by schedule to achieve it.

4434
03:20:34,140 --> 03:20:37,266
And now it's as much about

4435
03:20:37,266 --> 03:20:37,640
massaging the types of

4436
03:20:37,640 --> 03:20:39,640
appointments.

4437
03:20:40,109 --> 03:20:42,844
And you know making sure that

4438
03:20:42,844 --> 03:20:45,312
there are very few unused

4439
03:20:45,312 --> 03:20:45,516
appointment slots on a daily

4440
03:20:45,516 --> 03:20:47,109
basis.

4441
03:20:47,109 --> 03:20:49,160
>> yeah, I know this is a one

4442
03:20:49,160 --> 03:20:51,828
part of a big puzzle we are

4443
03:20:51,828 --> 03:20:52,890
trying to work with, trying to

4444
03:20:52,890 --> 03:20:54,828
coordinate so many things in

4445
03:20:54,828 --> 03:20:56,219
the hospital that we haven't

4446
03:20:56,219 --> 03:20:58,187
been doing in the past.

4447
03:20:58,187 --> 03:21:00,000
And my congratulations to focus

4448
03:21:00,000 --> 03:21:02,000
in on that.

4449
03:21:02,437 --> 03:21:04,140
And because so much revenue May

4450
03:21:04,140 --> 03:21:05,500
be earned in addition, I am

4451
03:21:05,500 --> 03:21:06,609
glad that everyone is focusing

4452
03:21:06,609 --> 03:21:08,140
on that.

4453
03:21:08,140 --> 03:21:11,140
And trying to tweak that

4454
03:21:12,672 --> 03:21:13,140
schedule as ach -- as much as

4455
03:21:13,140 --> 03:21:15,140
they can.

4456
03:21:15,219 --> 03:21:17,547
>> thank you for the report.

4457
03:21:17,547 --> 03:21:19,470
on your first page of

4458
03:21:19,470 --> 03:21:19,250
highlights, I enjoyed seeing

4459
03:21:19,250 --> 03:21:21,250
that.

4460
03:21:22,625 --> 03:21:25,328
Second bullet from the end

4461
03:21:25,328 --> 03:21:27,187
talked about patients

4462
03:21:27,187 --> 03:21:29,587
increasing what would recommend

4463
03:21:29,625 --> 03:21:29,922
the facility to friends and

4464
03:21:29,922 --> 03:21:31,922
family.

4465
03:21:35,172 --> 03:21:37,140
A couple of weeks ago I saw

4466
03:21:37,140 --> 03:21:39,540
several graphs that recommend

4467
03:21:40,266 --> 03:21:40,703
them to noise at night and

4468
03:21:40,703 --> 03:21:42,140
cleanliness.

4469
03:21:42,140 --> 03:21:43,000
And not thrilled where it

4470
03:21:43,000 --> 03:21:45,000
showed that.

4471
03:21:48,453 --> 03:21:51,453
But I am thrilled improvement

4472
03:21:51,812 --> 03:21:54,219
of something, and when months

4473
03:21:54,219 --> 03:21:55,940
go by and when you have

4474
03:21:55,940 --> 03:21:57,940
measurements.

4475
03:21:59,859 --> 03:22:00,594
i would appreciate receiving a

4476
03:22:00,594 --> 03:22:02,594
copy of that.

4477
03:22:02,797 --> 03:22:06,997
And where we are with our peers.

4478
03:22:08,562 --> 03:22:10,406
I did this last year and I will

4479
03:22:10,406 --> 03:22:13,406
continue it this year, thank

4480
03:22:14,969 --> 03:22:15,844
you for taking a look at that

4481
03:22:15,844 --> 03:22:17,844
funded vacant positions, and

4482
03:22:17,844 --> 03:22:19,453
how necessary to keep them on

4483
03:22:19,453 --> 03:22:21,453
the books.

4484
03:22:23,187 --> 03:22:25,587
You eliminated 33 pots --

4485
03:22:26,160 --> 03:22:26,250
spots and that equated to 43

4486
03:22:26,250 --> 03:22:27,281
million.

4487
03:22:27,281 --> 03:22:28,890
Thank you for looking at that.

4488
03:22:28,890 --> 03:22:32,266
I don't know what the numbers

4489
03:22:32,266 --> 03:22:33,266
are, still in the 700 range of

4490
03:22:33,266 --> 03:22:34,594
funded vacant positions

4491
03:22:34,594 --> 03:22:36,594
throughout the county.

4492
03:22:37,266 --> 03:22:40,866
For a variety of reasons, some

4493
03:22:42,906 --> 03:22:45,109
are brand-new and summon --

4494
03:22:45,109 --> 03:22:47,509
someone leaves and retires.

4495
03:22:49,470 --> 03:22:52,470
But when a department head

4496
03:22:55,953 --> 03:23:00,153
takes a hot -- shot at this

4497
03:23:02,250 --> 03:23:02,562
and it's instant savings to the

4498
03:23:02,562 --> 03:23:04,562
country.

4499
03:23:11,906 --> 03:23:13,906
>> probably the fluctuating

4500
03:23:14,969 --> 03:23:16,578
to the department and this is

4501
03:23:16,578 --> 03:23:18,969
an hour by hour science that

4502
03:23:18,969 --> 03:23:19,547
goes on at the hospitals and

4503
03:23:19,547 --> 03:23:21,547
clinics.

4504
03:23:24,109 --> 03:23:25,687
>> siappreciate -- I

4505
03:23:25,687 --> 03:23:27,109
appreciate that and every bit

4506
03:23:27,109 --> 03:23:28,922
helpss and that's a big thing,

4507
03:23:28,922 --> 03:23:31,322
thank you for that.

4508
03:23:31,390 --> 03:23:32,719
>> thank you.

4509
03:23:32,719 --> 03:23:34,719
Supervisor kniss.

4510
03:23:35,890 --> 03:23:38,687
>> so I thought perhaps I would

4511
03:23:38,687 --> 03:23:42,287
get a lot less grandular, even

4512
03:23:44,266 --> 03:23:45,000
those are the things that made

4513
03:23:45,000 --> 03:23:47,000
enormous difference.

4514
03:23:48,000 --> 03:23:49,609
And I agree with ken asking

4515
03:23:49,609 --> 03:23:50,140
about the clinics and unfunded

4516
03:23:50,140 --> 03:23:51,703
positions.

4517
03:23:51,703 --> 03:23:54,547
Those are what make the

4518
03:23:54,547 --> 03:23:55,875
differences over the long run.

4519
03:23:55,875 --> 03:23:57,609
But jeff, because I talked

4520
03:23:57,609 --> 03:23:57,875
about this a little this

4521
03:23:57,875 --> 03:23:59,875
afternoon.

4522
03:24:00,125 --> 03:24:01,687
I thought maybe this time you

4523
03:24:01,687 --> 03:24:03,687
could restate this.

4524
03:24:05,359 --> 03:24:07,940
But I think in three years,

4525
03:24:07,940 --> 03:24:08,890
while we haven't solved the

4526
03:24:08,890 --> 03:24:10,922
problem, we have at least

4527
03:24:10,922 --> 03:24:12,703
identified it.

4528
03:24:12,703 --> 03:24:15,103
We have worked pretty

4529
03:24:17,620 --> 03:24:19,875
successfully I think with the

4530
03:24:19,875 --> 03:24:21,812
anm group that came in.

4531
03:24:21,812 --> 03:24:25,781
And so I want to talk a little

4532
03:24:25,781 --> 03:24:28,219
about what I think are some

4533
03:24:28,219 --> 03:24:30,453
really good strides we made.

4534
03:24:30,453 --> 03:24:31,656
And one might be far less

4535
03:24:31,656 --> 03:24:32,578
subsidy than we have done in

4536
03:24:32,578 --> 03:24:34,219
the past.

4537
03:24:34,219 --> 03:24:36,328
And another might be far more

4538
03:24:36,328 --> 03:24:38,728
attention to the numbers.

4539
03:24:38,922 --> 03:24:40,531
As I mentioned before, I get

4540
03:24:40,531 --> 03:24:42,859
the daily flash, I know what

4541
03:24:42,859 --> 03:24:43,437
the numbers are all over the

4542
03:24:43,437 --> 03:24:44,594
place.

4543
03:24:44,594 --> 03:24:46,594
Which really helps.

4544
03:24:47,406 --> 03:24:51,606
And you know, I think maybe you

4545
03:24:51,875 --> 03:24:52,109
could toot your horn for a

4546
03:24:52,109 --> 03:24:53,875
minute.

4547
03:24:53,875 --> 03:24:55,437
It wouldn't be all bad.

4548
03:24:55,437 --> 03:24:57,437
>> not my horn.

4549
03:24:58,160 --> 03:25:01,160
>> it's been a tough two years

4550
03:25:01,160 --> 03:25:02,516
to come in and make major

4551
03:25:02,516 --> 03:25:02,890
changes in the health care

4552
03:25:02,890 --> 03:25:04,890
system.

4553
03:25:06,422 --> 03:25:08,822
>> it's not my horn.

4554
03:25:10,594 --> 03:25:12,940
>> you can do gabrielle it is

4555
03:25:12,940 --> 03:25:14,000
or anyonacy, just a horn.

4556
03:25:14,000 --> 03:25:17,000
>> just like any other health

4557
03:25:18,940 --> 03:25:20,406
system in the nation, vmc was

4558
03:25:20,406 --> 03:25:22,344
faced with a total

4559
03:25:22,344 --> 03:25:23,734
transformation in a short

4560
03:25:23,734 --> 03:25:25,734
period of time.

4561
03:25:28,672 --> 03:25:31,140
Going from a system that relied

4562
03:25:31,140 --> 03:25:34,422
on med cal funding, that is one

4563
03:25:34,422 --> 03:25:37,187
way of funding a system, to a

4564
03:25:37,187 --> 03:25:40,594
system in the future that will

4565
03:25:40,594 --> 03:25:42,994
rely on performance payment.

4566
03:25:44,620 --> 03:25:45,766
and that's an enormous change

4567
03:25:45,766 --> 03:25:46,310
in infrastructure and cultural

4568
03:25:46,310 --> 03:25:48,310
approach.

4569
03:25:48,172 --> 03:25:50,437
It means a lot of changes.

4570
03:25:50,437 --> 03:25:52,344
And the team has done a

4571
03:25:52,344 --> 03:25:54,844
fabulous job in the last years.

4572
03:25:54,844 --> 03:25:55,734
Working towards that change.

4573
03:25:55,734 --> 03:25:57,469
It's very difficult

4574
03:25:57,469 --> 03:26:00,250
particularly at the same time

4575
03:26:00,250 --> 03:26:02,906
that they are preparing for

4576
03:26:02,906 --> 03:26:04,906
health care reform.

4577
03:26:09,484 --> 03:26:10,422
and dealing with lip and

4578
03:26:10,422 --> 03:26:12,822
medical expansion, everyone has

4579
03:26:13,594 --> 03:26:14,453
a lot on their plate at vmc and

4580
03:26:14,453 --> 03:26:16,453
health and hospital.

4581
03:26:18,310 --> 03:26:21,266
And it's true, that in the

4582
03:26:21,266 --> 03:26:24,266
past, we've removed little too

4583
03:26:24,375 --> 03:26:24,875
much from the administratorive

4584
03:26:24,875 --> 03:26:26,875
support.

4585
03:26:27,344 --> 03:26:28,812
people are running around from

4586
03:26:28,812 --> 03:26:32,412
one crisis to another at same

4587
03:26:33,750 --> 03:26:34,875
time they are planning a

4588
03:26:34,875 --> 03:26:36,687
long-term strategy.

4589
03:26:36,687 --> 03:26:39,250
It makes it difficult to do and

4590
03:26:39,250 --> 03:26:41,187
they have done an excellent job.

4591
03:26:41,187 --> 03:26:44,187
The clinicians and nurses and

4592
03:26:44,453 --> 03:26:46,853
doctors and technicians and

4593
03:26:47,562 --> 03:26:48,620
everyone continue to do very

4594
03:26:48,620 --> 03:26:49,890
high-quality work.

4595
03:26:49,890 --> 03:26:52,562
And they are very proud of the

4596
03:26:52,562 --> 03:26:54,562
work they do.

4597
03:26:55,531 --> 03:26:58,780
And our job and the systems job

4598
03:26:58,780 --> 03:27:00,109
is to get patients connected

4599
03:27:00,109 --> 03:27:02,109
with the clinicians.

4600
03:27:02,375 --> 03:27:04,109
In the riept time, in the right

4601
03:27:04,109 --> 03:27:06,281
place and the right level of

4602
03:27:06,281 --> 03:27:06,812
service and the right type of

4603
03:27:06,812 --> 03:27:08,453
care.

4604
03:27:08,453 --> 03:27:09,953
And we have proven that can be

4605
03:27:09,953 --> 03:27:12,687
done and we are doing a good

4606
03:27:12,687 --> 03:27:13,828
job of it.

4607
03:27:13,828 --> 03:27:15,156
That all being sides.

4608
03:27:15,156 --> 03:27:16,890
>> you still have a way to go.

4609
03:27:16,890 --> 03:27:20,940
>> we have a ways to go.

4610
03:27:20,940 --> 03:27:22,494
You don't change an

4611
03:27:23,766 --> 03:27:26,297
organization of this size in a

4612
03:27:26,297 --> 03:27:28,697
rapid period of time.

4613
03:27:29,109 --> 03:27:32,109
particularly when the risk of

4614
03:27:32,312 --> 03:27:34,750
rapid change is life and

4615
03:27:34,750 --> 03:27:36,750
welfare of patients.

4616
03:27:37,719 --> 03:27:38,844
You know, at any time it's

4617
03:27:38,844 --> 03:27:41,156
certainly the highest priority

4618
03:27:41,156 --> 03:27:44,756
to make sure that the patients

4619
03:27:44,890 --> 03:27:45,219
are safe and cared for

4620
03:27:45,219 --> 03:27:47,219
appropriately.

4621
03:27:48,359 --> 03:27:48,656
and so change is not super

4622
03:27:48,656 --> 03:27:49,828
rapid.

4623
03:27:49,828 --> 03:27:51,828
But it's happening.

4624
03:27:52,969 --> 03:27:57,769
And I am very proud of the team.

4625
03:27:58,562 --> 03:28:00,531
And they are doing a great job.

4626
03:28:00,531 --> 03:28:02,531
And individuals and the

4627
03:28:02,531 --> 03:28:04,609
employees in the health and

4628
03:28:04,609 --> 03:28:06,375
hospital system and the

4629
03:28:06,375 --> 03:28:08,219
hospital system are truly

4630
03:28:08,219 --> 03:28:09,953
committed to make sure they

4631
03:28:09,953 --> 03:28:11,781
provide the best care possible.

4632
03:28:11,781 --> 03:28:12,156
And they are all struggling

4633
03:28:12,156 --> 03:28:13,844
with change.

4634
03:28:13,844 --> 03:28:15,219
But they are doing a good job

4635
03:28:15,219 --> 03:28:16,922
of it.

4636
03:28:16,922 --> 03:28:19,125
>> I appreciate saying that.

4637
03:28:19,125 --> 03:28:21,594
Because I think going from one

4638
03:28:21,594 --> 03:28:23,687
system to another, as you said,

4639
03:28:23,687 --> 03:28:27,287
from the dish and the system

4640
03:28:28,797 --> 03:28:29,640
where money was really given to

4641
03:28:29,640 --> 03:28:31,437
us.

4642
03:28:31,437 --> 03:28:31,875
Without any measurable outcomes

4643
03:28:31,875 --> 03:28:33,875
required.

4644
03:28:34,734 --> 03:28:35,312
And that's a huge difference

4645
03:28:35,312 --> 03:28:36,734
now.

4646
03:28:36,734 --> 03:28:37,780
As measurable outcomes are

4647
03:28:37,780 --> 03:28:38,703
required.

4648
03:28:38,703 --> 03:28:39,812
And without them you will not

4649
03:28:39,812 --> 03:28:41,812
get your money.

4650
03:28:42,187 --> 03:28:44,484
And we will not get our money.

4651
03:28:44,484 --> 03:28:45,812
We will not be able to continue

4652
03:28:45,812 --> 03:28:48,212
to provide those services.

4653
03:28:48,484 --> 03:28:49,625
And the one thing you didn't

4654
03:28:49,625 --> 03:28:52,250
mention, jeff, the substantial

4655
03:28:52,422 --> 03:28:55,422
decrease in the amount of

4656
03:28:55,625 --> 03:28:57,859
essentially subsidy or general

4657
03:28:57,859 --> 03:29:00,328
fund money we are using.

4658
03:29:00,328 --> 03:29:02,140
It's down depending on how you

4659
03:29:02,140 --> 03:29:03,562
look at it.

4660
03:29:03,562 --> 03:29:05,297
Certainly 50% or more.

4661
03:29:05,297 --> 03:29:06,172
And that's making a big

4662
03:29:06,172 --> 03:29:08,172
difference as well.

4663
03:29:09,281 --> 03:29:12,281
I think it's important, you

4664
03:29:17,609 --> 03:29:18,859
know, we usually are saying far

4665
03:29:18,859 --> 03:29:20,219
more inquisittive types of

4666
03:29:20,219 --> 03:29:22,719
things, but it's good to hear

4667
03:29:22,719 --> 03:29:22,984
that we are making good

4668
03:29:22,984 --> 03:29:24,984
progress.

4669
03:29:25,828 --> 03:29:29,359
And that we are not only doing

4670
03:29:29,359 --> 03:29:31,172
that but paying great attention

4671
03:29:31,172 --> 03:29:32,859
to how that progress can be

4672
03:29:32,859 --> 03:29:33,203
made and reach those

4673
03:29:33,203 --> 03:29:34,531
measurements.

4674
03:29:34,531 --> 03:29:34,969
So far, so good.

4675
03:29:34,969 --> 03:29:36,969
Thanks.

4676
03:29:37,000 --> 03:29:38,937
>> thank you.

4677
03:29:38,937 --> 03:29:40,203
Any other supervisors?

4678
03:29:40,203 --> 03:29:42,203
I see none.

4679
03:29:44,875 --> 03:29:47,275
>> thank you, Mr. President.

4680
03:29:47,781 --> 03:29:47,984
>>> jeff, anything?

4681
03:29:47,984 --> 03:29:49,984
Okay.

4682
03:29:50,484 --> 03:29:53,160
Board we will recess until

4683
03:29:53,160 --> 03:29:55,160
tomorrow afternoon at 1:30.