Good afternoon. Will the captioner please test when you're able?

Can

we please have test captions when you're able? Thank you.

We see the test captions. Thank you.

Good

afternoon. Welcome, everyone.

I'd

like to go ahead and call the Health and Hospital Committee meeting to order at this time. I am Supervisor Otteley, Chair of this committee, along with Vice Chair Supervisor Margaret Abicoga.

With

both of us present, we have a quorum. So moving to public comment period, this is for the members of the Public Justice Committee on items not on the agenda. Then you can go ahead and speak at this time.

If

you're in person, please go pull a card and submit it.

And

if you're on Zoom, please raise your hands.

I

have no request to speak on item two.

Okay.

All right. We'll move on to item three, which is approval of the Consent Calendar and Changes Committee agenda.

Let's see.

So

on this one, I would like to request to place item number six on consent, which is a report from the Valley Health Plan relating to marketing and communication outcome measurements.

And

Vice Chair, do you have anything else? Changes to it? No.

Happy

to make a motion with a change of adding number six to the consent calendar.

All

right. I'll second that.

Do

we have any public on that item?

No

request to speak on item three.

Okay. Let's close. Let's close that and take a vote.

Vice

Chairperson Abacoga?

Aye.

Chairperson Lee?

Aye

as well.

Thank

you.

Good.

Then moving to item four, to receiving report on EMS system design concepts.

I believe we have Nick Clea, Director -in -Chief of Santa Clara County Emergency Medical Services Agency.

Good

afternoon.

Good

afternoon, Chair Lee and Supervisor Abacoga. And I'm joined by Assistant Director -in -Chief Mike Cabano and our Program Manager, Tony Doe.

Great.

Thank you.

Would you like to talk about, present,

I

mean, we have seen the report already. Do you have anything to add?

I

would just, if I may, Supervisor Lee, highlight a few elements of the report. I'm certainly happy to answer any questions you may have. Go ahead. Do

you want to speak about the highlights?

Yes.

So I think one of the key things we want to highlight in this report is the verbiage of EMS system review or EMS system design versus the verbiage of RFP.

So

we really are looking at designing the EMS system. And RFP is a component of that, but it's a transactional component within that system design. So you'll hear us use those words sometimes interchangeably, but really are looking at the overall EMS system review.

The

goal today really is to help ensure that we are sharing concepts with you. We are drafting that solicitation that is mentioned, but really it's at a high level as a goal today

to

go through the concepts, receive any feedback you and Supervisor Abacoga may have, and then really there may be some draft language. We have already, but not really in a position to share any draft language today with you. And then certainly happy to answer any other questions you may have.

Good.

Thank you so much. Let's see. Any public would like to speak on this item? Jess?

Pause for Zoom. No. I have no request to speak on item four.

Yes,

by sure. Go ahead.

Thank you. Thank you very much for this report. Appreciate the update. I do have some questions, and I beg for your, your indulgence, Chair. We were able to do some outreach to some folks in our district, and so I'll just go by the subsections, and thank you for organizing it in a very organized way. Appreciate that. My pleasure. The first one is in dispatch and communications equipment. There is a question about the AVLs and integration with Marvelous. My understanding is that our partners, regional partners, are moving away from the system and towards the tablet command system. Is there a way to bridge the existing systems to work together, or would we be able to move

to a more regionally effective system for all EMS providers?

That's

a good question. Certainly integration is our goal as we move forward with system design.

There's

been quite a lot of work and sort of proven reliability with Marvelous today,

but

happy to explore other options to continue the integration. So I think that's a good question with both the providers and our stakeholders.

Great.

So you'll just have that ongoing conversation and come up with what would be the best system to work regionally on.

Great.

In regards to the, in the expanding access to healthcare and education section, there's mention of expanding access to nontraditional EMS services in a social service bridge program. Can you expand upon what that? Is, and what you're looking for in the RFP?

Yeah,

absolutely. Thank you for that question. So the intent really, I think social services, we may be using that word a little loosely in the context of the county structure. So certainly not looking to replace a plant on social services as an entity of that engagement,

but

there are a lot of 911 calls or increasing volume of 911 calls that are low acuity and where folks don't know who else to call, so they call 911. And they may be for things that may be a connection to social service entities or social service networks. So the goal is really. Really to look at expanding and leaning into that proliferation of calls that are low acuity and making a connection point so that person may not need an ambulance transport or an ED visit but they may need pharmacy refills or access to food or whatever they may be. So it's just bridging that gap there.

Okay. So then what would you do if you had a call like that and you don't have to send transport, so you would divert them to nurse navigator or some of the other? Something

similar. In today's world. So the emergency environment supervisor, really when you call 911, it's the response of an engine or an ambulance and their only option really is to take you to the hospital, so it's trying to find ways to expand those options to reduce the burden on the emergency departments while also expanding their access to other non -traditional healthcare.

Okay. Great. In the innovations and enhancements section, you call out programs that address defining the needs of specific patient populations in a local community.

How would you address defined needs that are not supported by a published needs assessment? I know we have like the Latino assessment, the AAPI one, but the other groups of populations I'm thinking about is like geriatrics or youth or LGBTQ.

Certainly, supervisor. Thank you for that. I think certainly obviously we lean on the established reports. It's a wealth of knowledge for us to lean on. As those are non -established reports, there's certainly a, a number of metrics that both public health and our health and hospital systems do to gain information about those populations as well as direct outreach, reaching out to you and city leaders to figure out where are their gaps that they see with their communities and trying to find opportunities to bridge those. Great.

The integration of first response providers section talks about the agreements between the primary ambulance provider and each fire department. Okay. And in speaking with some of our community partners, there's a request to change that to make it into contracts with county EMS and that's so that we can preserve the ability to place resources and service if a response time by the contractor exceeds our targets in certain areas. So could we look at that change?

I

think what we're trying to do is we're envisioning there is basically a three -party agreement that includes the provider, the county and the local jurisdiction. One of the things that we've heard over the years on the part of the cities is a desire for compensation from the provider. That really has to be an agreement between the provider and the jurisdiction. And so that's a piece, that's a pretty significant piece here of what we're hoping to shift towards so that the provider is then, essentially, treating those jurisdictions in a more similar manner to the way that they currently treat the other ambulance providers that they surge into the system. But that has to be a contract

really between the provider and the local jurisdiction.

Can

we, as the one that grants the contract to the provider, make that a requirement? That they reach agreement with the?

Yeah, I mean, we can, that's why I said it would be a three -party arrangement because we would need to be involved and consent and be a piece of that. But that, you know, we don't want to be an intermediary in the financial transaction, right? So the, one of the facets of the current structure that I think has been somewhat challenging is, currently, the county, through the EMS Trust Fund, is a bit of an intermediary, fiscally, between the provider and the jurisdictions for certain of these items.

And we would like it to be a direct financial relationship.

Okay. Okay. And then, along those lines, I guess, I'm trying to envision how this would work and, you know, now that some of this is, you know, we're in the middle of, you know, cities have their own ambulances, in terms of, like, response time, how do we make sure that, right, the closest ambulance or the ambulance from that community where the call is coming from is the one, if it's available, the one that goes out? It seems like Marvelous or whatever system we use helps in that regard, but just, yeah, how do we make

sure that? I think we do. I do think it's critical that all the resources be visible to and centrally dispatched, which is a core facet, not only of what's described here, but actually prior actions the board has taken as a core piece of whatever the next RFP looks like.

Okay. Okay. Great. That's it for now. Thank you. Appreciate it. Thank you.

And, yeah, no, I actually do not have further, I'm certainly looking forward to the next, you know, next stage, so this is still very preliminary at this point, but certainly looking forward to the next stage when it comes back so we can have a much deeper dive onto the design, but thank you so much for the update for now. Yeah. And looking forward to see it.

Our pleasure. Thank you so much, and we'll continue to engage with all of our stakeholders as we go through this process and get their input as well. Great. So Vice Chair,

may I get a motion to accept the report?

Yes. I'm happy to make a motion to accept the report.

And I'll second that. Let's take a vote.

Vice Chairperson Abacoga?

Aye. Chairperson Lee? Aye as

well. Thank you. Thank you. Thank you.

Moving

to item five, which is receiving a report from the Santa Clara Valley Healthcare Integrative Medicine, and we have our CEO of our SCVH, Paul Rents.

Thank you, Chair Lee, Supervisor Abacoga. Joining us today is Super, excuse me, our CMO, Fong Nguyen, and Dr. Jenny Biller, who's leading this program.

Good

afternoon, Supervisor and the Board. Absolutely. You have our written report. And we are happy to answer any questions. Good.

Let me see if there's any public who would like to speak on this item.

I am pausing for a moment. This is item five, Integrative Medicine. Right now I have two requests.

Let's do two minutes each.

Okay. Our first speaker is in chambers, Mike Rogers.

Please approach the podium.

Good afternoon.

Can you hear me okay? Yes. I'd like to thank the county leadership for really, you know, embracing this and moving forward especially the supervisors are being driving forces I'm the chair of the Health Advisory Commission we've been investigating this and helping continue to work with these guys we brought in Eric Chen I've had several discussions with Eric directly we brought in dr. Chris Magrida recently which was phenomenal long meeting with the task force directly about his model in North Carolina successful both of these are large successful Medicaid programs for large safety net populations kind of here's my advisory positions I'd like to see the next expansion to be a broad based syndromes like for example

metabolic syndrome we've got women's health we've got pediatrics doing more integration and stuff hey these are the types of things that are safety net population diverse ethnicities more than 90 % of people in the county that was supported by the system suffer from these conditions secondly grant grants are really important for systems like this to get off the ground Chris Magrida dr. Chen their first help was having a little bit of breathing room to be able to work on organizational boundaries right in fact dr. Chen said hey I had a supervisor basically tell the Alameda Foundation give them a grant to get food for medicine off the ground now it's the it's a stellar program

for the whole state right and we're continuing to look at how do we they're even offering us potential services etc the other thing is it's challenging because there's silos in SCVH right we have to figure out what Chris Magrida works great across his organizational boundaries they're tuned across disciplines right and they support even when they don't have the funding somebody doesn't have coverage they have the ability to say the right thing to do is treat this patient same with dr. Chen because he has some flexibility because of the grants right and then finally I'd like to see a roadmap for how the expansion rolls out how to supervisor Abacogas request how do these services become

generally available thank you thank

you our

next speaker is Ken Horowitz on zoom we'll open your microphone you'll

have two minutes the timer will start when you begin speaking

yes

yeah doctor

would you mind try to readjusting the mic it's very um garbled you're going to start over again yeah thank you

okay i'll try it i'm i'm not i'm that possible make it clear um we talked to a proposal of four years ago

it's time to put the boots on the ground

the cost of care is going up and up and up and we'll never reach the point where we can finance after so let's try things differently than we do i hope you put uh forward a recommendation because the climate will be forward so that integrative medicine can become a culture i think the strategies that are being proposed are good but they'll only work if they're actually worked um don't do enough actually so let's put the boots on the ground now let's get it started thank you for your time

just a note from the clerk that mr horace did also submit written post comments that you can refer

to very good thank you okay

let's close the public speaking part on this one yes i share you have any questions on this one thank

you uh chair and thank you for continuing this conversation i know chair and i are very interested in integrative medicine i think you've heard us over and over say that so i appreciate that we're continuing to pursue this as mentioned by our health advisory commissioner um i too am interested in uh maybe a more detailed concrete road back on how to um move the i am forward um so i uh would ask like what are some concrete steps that we can take in the next year to increase the adoption of im practices within our provider with it beyond the provider education that we're doing so

um we i have been meeting with uh people other physicians from different departments as you know integrated medicine it's about collaboration between specialties and um so very we're very fortunate to have a life healthy lifestyle program in pediatrics department and so we're going to the adult medicine side is trying to collaborate with the pediatric side to create a similar program we have written up a proposal for healthy lifestyle and metabolic syndrome management program you know of course the proposal is done but we still need to work out the details about how to go about implementing this program which will be similar to the medical bariatrics program but it's very different in that we'll um we'll

put everybody from you know we'll have nutritionists social worker and hopefully psychologists all work together to really focus carrying the patients who have very complex metabolic syndrome like complex diabetes poorly controlled high blood pressure kidney disease and those are the you know

it's not going to be easy and fast i'm not going to be able to promise you oh by the end of this year you're going to see this outcome but i can tell you we are actively working together with various departments including the office of sustainability and resilience i understand they're working on a food management system yes and uh we've been working on that as well so we'll working with her and Dr. Steven Chen from Alameda County to set up our own medicine, a food as medicine program. And as you know, that's gonna take a few years again. But you know, it's just great because we have a lot of people in our hospital system,

health care system, who have different areas of expertise. And I think right now we're starting slow because we're still exploring, you know, what's possible without spending a whole bunch of money to hire new people.

You know, kind of, we're

trying to build bridges between different departments so that we can all collaborate and work together.

So sorry,

I don't have a really good, like, concrete roadmap, but I do have a five -year plan that is forever changing every few weeks.

It's

a different five -year plan. But I can, I'm happy to send it to you.

It's

completely a draft.

It's

not, you know, it's not ready for prime time.

Yeah,

that would be really helpful.

Just,

and I very much understand it's iterative.

So,

but to have that,

and

even, you know, if you can share that in our updates, so at some frequent frequency, that would be helpful just to see it evolving and moving forward. So I would, my other question was that what are the primary operational and cultural barriers that are preventing the broader integration of IM?

The

barriers we have in our healthcare system are very similar to all conventional healthcare system. We are very, we treat patients as diseases,

so

if you have a kidney disease you go to the kidney doctor

if

you have eye disease you go to the eye doctor

although

we have a primary care physician but the primary care physicians usually just send people off

you

we did a referral

and

they you don't really communicate with the other doctors

so

I think there's a the biggest barrier is really our American medical system with our culture is such that we because we are fee -for -service

you

provide a particular service you get pay so the

it's

not our systems that set up as though we can collaborate easily

we

have different call centers

like

the nutritionist who was who are working with the bariatric clinic

they're

under nutrition department

they're

not part of the

bariatrics

program you know it's just even the call center you

know

all those things

I

don't think we can solve that problem quickly but I think we can definitely reimagine a different way of delivery our health care

I

really think we have a lot we're very fortunate in our County we have a lot of resources

not

just money but also people

right

and I I think that's the problem is people don't

we

don't know what the other person is doing

you

have very happy that I'm working with the public health health department and I'm working with the office of sustainability and resilience you really learn what they're doing

how

what they do you can help the health care system as a whole

but

that's going to take time

sure

yes

I

know there it's easy to be in silos

and

this is really about breaking down those silos

and

I do understand it'll take time but we just have to keep working together it's important to do that we can't take time we have to be flexible at it right so so i know that one of the challenges um is reimbursement

um but

i also i keep i do hear about alameda and that they've been successful in this and are there some best practices or lessons learned that learned that we can gain from alameda is doing

um

the the main thing with the alameda program is the food is medicine program

okay

dr um chan was able to pull all the small farmers together and create a workflow to implement so that we can actually deliver medically tailored

medically

prescribed meals to patients

yeah

so that's what we are trying to do for some of our most vulnerable patients

and

the reason we're trying to do that it's because you know food insecurity is a big problem right now right so we're trying to

instead

of just telling patients you have to eat healthy you know you're trying to create a system where we can actually provide healthy food and so that's the main part of alameda county where we're folk um we're kind of learning from

okay and

uh the best practices honestly

um

we're still doing visit like fee for service

we are

fqhc sites

so

each time the patient come we bill based on their medical problems okay you know based on their visit

but

um i think what we are trying to understand is the alternative things like acupuncture chiropractor and how will dose be reimbursed and um as of right now

i

we actually i actually found out a couple of our primary care physicians just got their acupuncturist license okay so it's it's what one of those things once again if we didn't ask we didn't know right

so

now i'm like oh okay we have people like that then we can probably start exploring different um reimbursement models

and

um we do need to talk to the health plan about the budget they have for food is medicine

uh

-huh

yeah yeah okay well

great

thank

you so much appreciate it

thank

you chair

good

paul

thank

you uh supervisor lee

supervisor

abe koga i think to your request about a further defined roadmap

that's

something that we can work with dr biller and dr nguyen on and bring back in future reports

that'd

be great i appreciate that i i like to have timelines and you know goals and just see where we're headed

um and

so having something like that to to just check in on would be really helpful

thank

you

thank

you

well

on on that note regarding you mentioned acupuncture and chiropractic services uh california's one of the few states that recognize

you

know acupuncture

and

i would love to learn more about the reimbursement side of it on the revenue since we are so tight on with the money side and how we could enhance that

reimbursement

because we know it works

uh it's

a something that um like you said

they don't

necessarily teach that in medical school but that doesn't mean it's not something that's useful

and

in this case that's what integrative medicine is

a

lot of these things they don't teach you in medical school turns out to be something that's very uh you know

i

always tell people you know what's that clinical studies do you have acupuncture

well

we only have 5 000 years of it so i think i think it was proven

so

for that matter i i really think we we need to uh uh encourage

more

uh usage of it and and not make it look like a kind of a cult like weird studies and oh my god all these needles

like

there's a lot of people are not exposed to it would have that initial feelings

uh but

you know we've of course

seen

many uh very beneficial uh uh practices and as we all know a lot of our

drug addiction problem we have

it's

on what i call irresponsible pain management you know you know providing people with these very highly addictive uh painkillers for the past decades and these are so -called you know proven medical practices and acceptable fda approved medications and and now we have a huge uh a bunch of addictive problems we're dealing with so i think these type of alternative ways to deal with pain that does not lead to these type of addiction is truly uh necessary so i just want to mention why i think it's so important that we adopt these practices sooner and you know a lot of times you know i understand people you know have medical degrees or practice for a long

time

uh

but understanding some of these alternative practices is is truly important and so i just want to uh thank you for for coming here and uh discussing what you're working on yeah looking forward to the the world the roadmap that you have ahead

uh

and certainly want to make sure that if you can reimburse for any or all of it

that

would be uh amazing

yeah

okay

thank you so much for the report

truly

excited

we're

moving forward and looking forward to future reports to work on the now incorporated fully uh uh throughout the hospital system uh in the future

all

right

do

i have a motion to receive report please

yes thank you vice

chairperson abacoga

aye chairperson

lee

aye

as well

thank

you

thank

you

all right moving

on to item seven which is receiving a report relating to efforts to establish a mobile medical unit on the anza college campus

thank

you chair lee

i'm very

pleased to to share with this committee and of course the community that we will be launching the mobile medical unit at the anza college campus on may 6 and it will be there every wednesday

and

we will continue to monitor the utilization and adjust our schedule as needed to serve that community

so

with that being said i'm very pleased to to share that and happy to be here thank you to take any questions

from

from this committee

and

also uh celine ho our primary care director is also with us who has been wonderful in bringing us about

great all

right

do

if any public likes to speak on the sim

I have

no request to speak on item seven

yes

vice chair

any

questions

thank you chair um just really a big thank you to paul and celine and your entire team for making this happen and that is the intent of this meeting and we are very thankful to the committee for this BEING JUST OVER A YEAR INTO THIS ROLE, YOU KNOW, GOVERNMENT DOESN'T ALWAYS WORK SLOWLY.

THIS

IS QUITE AN ACCOMPLISHMENT

AND

I REALLY APPRECIATE THE HARD WORK THAT YOU PUT INTO MAKING THIS HAPPEN.

I

KNOW THE COMMUNITY HAS BEEN ASKING WHEN IS THIS GOING TO OPEN

SO

NOW WE CAN TELL THEM WHEN IT'S OPENING. I REALLY APPRECIATE THE COUNTY WORKING WITH DE ANZA COLLEGE IN THAT PARTNERSHIP I THINK IS VERY VALUABLE.

SO

JUST A QUESTION IN TERMS OF WHAT

SERVICES

YOU EXPECT TO HAVE AVAILABLE IN THEM.

WON'T YOU COME UP AND RESPOND?

ALTHOUGH

I CAN, I THINK GIVEN ALL THE WORK YOU 'VE PUT IN.

GOOD

AFTERNOON, SUPERVISOR. YES, WE'RE PROVIDING PRIMARY CARE SERVICES AND SO ROUTINE CHECKUPS, SICK VISITS, VACCINATIONS,

LAB

TESTING, AND THEN OBVIOUSLY REFERRAL TO A MEDICAL HOME WITHIN OUR PRIMARY CARE NETWORK IF THEY DON'T ARGUE WITH THAT. SO WE ALREADY HAVE ONE.

THANK YOU.

AND

THEN IN TERMS OF

PROMOTING

THE MMU, WHAT ARE SOME OF OUR PLANS TO PR AND MAYBE THAT WAS ITEM SIX THAT WE PUT ON THE SUBMIT. HOW ARE WE GOING TO PROMOTE USAGE?

SO NOW THAT WE HAVE A LAUNCH DATE, WE 'VE BEEN WORKING WITH OUR MARKETING DEPARTMENT TO CREATE SOME OUTREACH MATERIALS. OUR TEAM IS GOING TO BE ON SITE AT DE ANZA COLLEGE. WE'RE GOING TO DO SOME OUTREACH MATERIALS AS WELL TO LET THE FOLKS KNOW WHERE OUR MMU IS GOING TO BE PARKED AND THE HOURS.

OF

COURSE, IT'S ALSO FOR OUR SURROUNDING COMMUNITY AS WELL. SO WE'RE GOING TO TRY TO DO SOME GRASSROOTS OUTREACH, POSTING IN SOCIAL MEDIA,

ALSO

PROVIDING IT AT COMMUNITY CENTERS IN AND AROUND THE AREA AS WELL.

GREAT. THANK YOU. AND WE'RE HAPPY OUR OFFICE TO HELP PUSH IT OUT TOO THROUGH OUR CHANNELS.

I

KNOW THERE'S A GRAND OPENING LAND. SO THANK YOU. THANK YOU AGAIN. REALLY APPRECIATE ALL OF THE WORK. THANK YOU, CHAIR.

HEY,

THANK YOU. SO THIS PILOT PROGRAM IS SCHEDULED TO LAST ONE YEAR. AND THE MMU WILL BE OPEN ONCE A WEEK ON WEDNESDAY. SO IS THAT THE EXPECTED LENGTH OF PILOTS ONE YEAR?

YEAH, WE'RE STARTING OUT WITH ONE DAY A WEEK. WE WANT TO SEE WHAT THE VOLUME LOOKS LIKE AND WHAT THE SERVICE NEEDS ARE. AND WE 'LL SEE IF WE NEED TO ADJUST. ONCE WE LAUNCH AND SEE.

WELL, EXACTLY. SO IF IT TURNS OUT THAT SERVICE SEEMS TO BE VERY POPULAR, IT WOULD BE POSSIBLE TO INCREASE IT TO TWICE A WEEK. LET'S SAY IF WE STARTED WEDNESDAY, MAYBE WEDNESDAY AND FRIDAYS, TWICE A WEEK IN ORDER TO MEET SOME OF THESE. BECAUSE I KNOW FOR STUDENTS, IF I RECALL THE DAYS OF STUDENTS, FRIDAY TENDS TO BE THE DAY OF THE LEAST CLASSES, FOR EXAMPLE, RIGHT? SO THAT MIGHT BE EASIER FOR STUDENTS TO ACCESS THIS SERVICE. SO IS THIS SOMETHING THAT COULD BE DONE, LET'S SAY, AFTER THREE MONTHS IF IT TURNS OUT TO BE SO POPULAR?

YES.

WE WILL DEFINITELY TAKE A LOOK AT THE SCHEDULES

AND

SEE IF WE NEED TO ADJUST.

OKAY. GOOD. YEAH. WHEN DO YOU THINK YOU 'LL COME BACK TO GIVE US A QUICK OVERVIEW OF HOW THINGS ARE GOING AFTER IT STARTED? ABOUT A QUARTER LATER OR SIX MONTHS? YEAH.

WE CAN PROBABLY DO A QUARTERLY UPDATE WITH INITIAL LAUNCH AND SEE IF THERE'S ANY ADJUSTMENTS THAT WE NEED TO MAKE.

OKAY. SO YOU'RE STARTING AROUND APRIL TIME FRAME, Q2, RIGHT? RIGHT. SO MAYBE AROUND JUNE OR JULY. WELL, JULY IS OUR BREAK. STARTING IN JULY I THINK WOULD WORK.

YEAH. JULY THERE'S NO BOARD MEETING, RIGHT? RIGHT. SO AUGUST.

AUGUST. SO MAYBE THE UPDATE COULD BE AUGUST TIME FRAME. IF YOU COME BACK TO US THE NEXT RECESSION MEETING THAT WOULD BE GREAT. YEAH. PERFECT? YEAH. ALL RIGHT. THAT'S ALL THE QUESTIONS I HAVE. ALL THE QUESTIONS I HAVE. MAY I HAVE A MOTION?

YES. I 'LL GIVE THE REPORT. YES.

SO THE REPORT AS WELL. I'M NOT GOING TO ADD A MOTION BUT LOOKING FORWARD TO THE PILOT, THE PRELIMINARY RESULTS BY AUGUST. THANK YOU SO MUCH. LET'S TAKE A VOTE.

VICE CHAIRPERSON ABBACOGA? AYE. CHAIRPERSON

LEE? AYE AS WELL.

THANK YOU. THANK YOU.

MOVING TO ITEM EIGHT, WHICH

IS OUR, LET'S SEE, YEP,

SO THE REPORT OUT FROM OUR COUNTY HEALTH SYSTEM. I THINK, PAUL, YOU WERE FIRST ON THIS ONE. DO YOU HAVE ANYTHING ELSE TO ADD? JUST A

FEW ITEMS. OBVIOUSLY YOU HAVE OUR WRITTEN REPORT, BUT I DID WANT TO POINT OUT A FEW THINGS. FIRST, AS YOU WELL KNOW, THAT OUR SOUTH COUNTY CHILDREN'S ADVOCACY CENTER BROKE GROUND OR STARTED CONSTRUCTION. SO WE'RE VERY PLEASED WITH THAT. AND AS YOU KNOW, IT'S MODELED AFTER THE CAC IN SAN JOSE, WHICH HAS BEEN VERY SUCCESSFUL. AND IT WILL DELIVER TRAUMA INFORMED MEDICAL EVALUATION, FORENSIC INTERVIEWS, INVESTIGATIVE SERVICES, AND FAMILY SUPPORT SERVICES TO THESE IN ONE LOCATION FOR OUR SOUTH COUNTY RESIDENTS. AND OBVIOUSLY THIS HAS COME ABOUT BECAUSE OF A VERY DEEP PARTNERSHIP WITH THE D .A.'S OFFICE AND MULTIPLE OTHER COMMUNITY -BASED ORGANIZATIONS IN OUR COMMUNITY. SO WE'RE VERY PLEASED THAT THAT PROJECT IS MOVING FORWARD.

I THINK THIS IS ALSO AN IMPORTANT NOTE THAT IS INCLUDED IN THE REPORT. THE BREAST CENTER AT VALLEY MEDICAL CENTER HAS EXPANDED OUR CAPACITY. WE 'VE SEEN A 51 % INCREASE IN OUR VISIT VOLUME IN OUR HEALTH SYSTEM SINCE WE 'VE ADDED THE SECOND SURGEON.