seeking they get them in a reasonable amount of time whether they're satisfied with those services it has been exemplary and I just wanna appreciate that. I also appreciate the willingness of the department to take on the hot potato of housing for people experiencing homelessness and the housing for health program I think will be, will, can help make a difference here in Santa Cruz County and we've seen in the response to COVID that we can move quickly when we need to and we're gonna have to continue to do that when this funding runs out but I think that the work that the department has done leading the focus strategies effort the report that we got at our last meeting about doing six month check-ins about the connections being made with other jurisdictions and people in the community we will yield the results that can make a difference in addressing this issue here in Santa Cruz County so thank you for that. You mentioned in your presentation about the role of economic development and you do because of your connection with the workforce investment board that has been really critical in these last couple of months. I know that Andy Stone has provided a great source of support when we've had constituents call in wanting to deal with the problems of dealing with the state unemployment insurance program. He's also done great work working with the small business development center and so has made a difference there and the idea that you've been able to hire over 130 people that's exemplary and really critical and when you have to move quick you need people who can do that quickly and as we think about that interesting conundrum of getting more money from the state on some things at times in which we are cutting back in other places having those slots that might be available is to move dedicated employees who through no fault of their own maybe losing their job because of budget cuts but there might be something else that they can move into would will be critical to the long-term success for the county family. So good timing on that and I hope you'll look very closely at that. On the issue of equity this has always been a longstanding concern and North Star for the Human Services Department. You mentioned your assistant director Emily Polly who's here today. She has played an incredibly important role I know in my district but at the county wide in dealing with immigration issues making sure that we are addressing to the full extent possible ways to support the immigrants in our community. She has been involved with the Justice and Gender Commission or Task Force Now Commission and didn't wait for recommendations to start changing the way in which those services were being operated to better meet the needs of women and their families and I just wanna extend my appreciation for that. Your staff has also been very critical to the success of the Live Oak Cradle to Career program. Leslie Goodfriend has taken a leadership role. She has great experience in lots of different things around healthcare, around community building and she has been a great leader in partnering with families most of whom are monolingual Spanish to create an infrastructure and a steering committee that is making a difference in the lives of so many people in Live Oak and I just wanna express my appreciation and both the financial support and the staffing support to sort of make that work. When we look at the statistics on data share for Live Oak and the Cradle to Career program you can see in empirical ways about the increase in testing scores increase in kids feeling safer and less depressed and dealing with their health issues in a much better way than they were before the start of the program. So thank you for that work. The last issue I just wanna talk about is food insecurity. This has always been a big issue. Can't get through the day without food and I know the department has worked very hard to increase the number of recipients of CalFresh and there have been great strides made over the last couple of years in terms of that outreach and hearing the numbers just in the last three months about the increases and stuff. That makes sense to me that there's a greater need but you have to have the infrastructure in place to be able to get those folks involved with the program. Today in the paper there was an op-ed about SNAP and the federal food program and the need to change the maximum benefits to increase the monthly minimum benefit and some time limit rules and changes there. Can you just take a moment and tell me how that's affecting folks here in Santa Cruz County? Having not read the op-ed but being aware of the current federal administration's approach to taxpayers' money going to low-income vulnerable people, I probably don't need to read it to understand what that's getting at. I wanna make a comment, broad comment before CalFresh specifically, you mentioned appreciations for newly enrolled and the need to outreach. I think human services departments throughout California in any state that accepted the Medicaid expansion under the Affordable Care Act went through an experience of outreaching to a constituent base that they were not used to working with before. In many people in communities have a stigma. I think when you get to the issue of immigration and whatnot, real legitimate fear, especially under the current federal administration, that there might be benefits to which people are eligible and they don't know about it or they're fearful of it or they have pride and stigma. So the experience of rolling out the Affordable Care Act, expanding Medicaid to people who'd never before thought of being eligible with the newly eligible sort of is something not lost on us. So I think it informs us in this new moment that there's gonna be people who never before have needed to rely on the safety net. And I think we can build upon that to outreach, specifically to Santa Cruz. I think I'll say a general comment and if I'm not answering specifically, I do wanna lean on, as you said in your comments, Emily who actually is the person who ran and built up in the last director of before she became deputy of our program that ran CalFresh. But I think that it's a combination of outreach and it's a very real issue of dealing with the stigma and fear a community like Santa Cruz has of having their name put in a database, even if California wants to protect it from the feds. How to navigate that is a very tricky issue. And I think we need to work with community ambassadors, with community-based organizations, people who are deeply connected to the community in order to be able to address that issue. And I'll just end, and you can tell me if I'm on point or getting to your point, because I think this is the same for healthcare. So much of what we do is driven by not only federal and state revenue, which we've talked about today in a budget hearing, but federal and state policy and regulation. So a lot of what we have to do is not only lead locally, but we have to lead in partnership with our lobbyists to make sure that there is a groundswell of work done, state is not so much an issue. I think their values are pretty much aligned with the values of this community, but the federal government usually dictates the terms and I'll just kind of end with the federal poverty level. You know, the federal poverty level is a number made by the feds. And that is from most analysis, usually somewhere in the ballpark of four times lower than what it actually takes to survive. So when you're living and you're operating a county program that provides safety net services, and you can only enroll people in a program you have like CalFresh, which was your specific question, but we'd add Medicaid and CalWorks that are also driven by the same federal policies with a federal poverty level that is deemed by most to be two, three, four times lower than it should be to really help people who really are in need. That is a challenge that requires lots of lobbying, lots of work and not to be political I'm a government at will employee here, but who has elected president and whether or not the Senate swings, those are all factors on whether or not policies might shift that help the safety net be better resourced and help people more in need. So I don't know, you can tell me if I'm on 20 or not. I mean, these are along the same issues that were brought up by food bank directors nationwide and it was an op-ed in today's Sentinel. And it may be that we need to bring something to the board on June 30th to do that lobbying to make sure that our federal representative understand the importance that food security plays in the lives of so many people here in Santa Cruz County. Related to that, the great place program is a huge success and hearing that almost 500 people are on that program. And some of these is, it's clearly a result of the hard work that you and the team put together to get those people. It's somewhat surprising also to me that there are 500 people who make below $75,000 and can't provide food for themselves. And we're already in a food assistance program. And I'm wondering what we're doing with that group who probably has other needs than only food security to enroll them in other programs. So the day that Great Plates ends that they still can get their needs met. Well, one of the great benefits of the FEMA funding we have, which is anything that's tied to COVID and FEMA were allowed to tie back to that 138 extra help. We've been able to resource ourselves by like a miniature case management unit. And we out the gate assumed that unit would be a group of people who would just do an eligibility screening and enroll them and then connect them to a food provider. That team through their chain of command it tells me it's actually also turned into a case management unit because not only are there sometimes glitches with the food delivery and questions and whatnot, but it's also your very question, which is trying to help people think about what's next. And that I think it's back to my previous comment about the health of the community-based organizations and our resources and one of the tensions is they might be eligible for CalFresh, but if they enroll in CalFresh, they have to disenroll from Great Plates. So having that conversation so people are empowered to make their choices as part of what we're doing. But we can do it because we have a couple of extra staff helping support those 500 people when they need it. Great. Well, the collaboration has always been the key of the department, collaboration with other departments and sounds like that is strong with health services. But I know it's also strong with the sheriff's office with public works. I mean, there's a lot of places that you interact with, but also you downplayed the significance in the role that your department plays with the core funding program. We haven't really talked about that much today. I'm sure we'll talk about it more in August, but that collaboration between our community-based organizations in Santa Cruz County has always been a hallmark of Santa Cruz. And I know it's trying for you as someone new to the community and this COVID pandemic to make all those relationships, but it's always been key to the success of our community. And I know you're committed to that. I thank you for your work. Wish you and us all to move to the marathon speed rather than the sprinting speed. I know exactly what you're talking about there. And thank you for the work of your staff and the incredible work that they do every day. Thank you. Supervisor McPherson. Thank you, Chair. I too just want to thank the staff of human services as we said to health services as well for carrying out, well, doing more work with less funding. And this tremendous uptick that we've had for need for public assistance. And as a result of the pandemic and the unemployment and CalFresh, I think my question's been answered. One of my questions has been answered, just how do we sustain this level of service that we're providing now? And what are the indicators you're watching for? I would guess it's FEMA and the federal government and well, federal and state government, but is there anything in particular and there's something we have as a board pushed and lobbying for continuance or increases in those programs? Is there anything that's needed at this time that you can see? That in two ways. Number one is there's a process here as in all counties to lift up to boards to formerly and endorse state or federal legislation. And I think we can continue to be very active in going through our process to ask for your board's consideration of endorsing. Cause sometimes our state associations work very hard to lobby for state and federal change, but having the power of a full board and or something to double up with that can be helpful. So Supervisor McPherson, we can continue to lift those things up that we see as critical as they play out over the next many months. I would say the one thing as a preview to we'll see what happens in the August hearing, but if indeed it lands that we end up getting significant allocation increases while we're having to deal with budget deficits, it will be a complicated narrative to explain how we want to add to our budgets because if we do not pull those allocations, we lose money in the future years while asking your board to deal with the difficult issues of accepting a budget involves furloughs and maybe even laughs. So I would just say as a preview, it might be that we're responsible to explain that very nuanced moment of having extra revenue one place and asking for your board's support of increasing staffing. And I think Supervisor Leopold named the art of this is we are already having conversations to make sure we do that as part of the County family if one department doesn't have the money that they could be transferred over into a new position we have, that's what we'll try to maximize. So I think that would be a practical ask of your board come August potentially. All right. And more specifically, are there key objectives of new programs that will have to wait until we have gotten out of this pandemic that you haven't in mind? We honestly haven't gone through that analysis. I think that those that would require general fund to resource something that was on the table to move forward is something we'll have to look long and hard at and be very transparent with your board and the community. If we have choices to make, whether or not we need to pause something to see if a fiscal year future is maybe we're in a better position. I think that that's the concept in mind but I don't have the specifics. Right. Okay. I understood. And I too, as I said with the health services too and your call for action, I really do appreciate your recognition of the equity issue that we really have to take a deeper dive into. I feel that we have addressed that somewhat but we're going to have to have a new closer look and a deeper dive into that. But thank you for your recognition of that. It's truly upon us and we need to address it. Thank you. Thank you, Mr. Chair. You're welcome. Supervisor Coonerty. Hi. Thank you Director Morris for your presentation. I agree it's going to be a marathon and your services are going to be critical, not only now, but going forward into the foreseeable future as the economy will continue to struggle. I guess the only addition I have, I appreciate your support of the Great Plates Program and Thrive by Three and all the CalFresh signups is if we do see a change in federal politics in November, having a plan that's ready to go to increase signups immediately, the economy will still no doubt be struggling in November, December, January, February. And so trying to get people signed up for benefits they're entitled to, even as they, even without the hopefully the fear that's coming from the federal government, I think will be really important. And I know you're going to have diminished staffing and a lot of different strains, but I think trying to get people the support they need as quickly as we can will be important. But thank you for your work. Recognized, yeah. I guess that leaves me, right? Okay. How many employees are there in human services? Just about 500. 500. And is that included? I should know the answer to this. That's not, is that, they're included in the 2400? Okay. That's a big section. It is. Yeah, it's about a fifth, yeah. Or fourth, right? Fourth. Correct. Okay.  And with, you know, budget cuts, normally if there's a critical area, you put more funding into it, and you hire more people to work on the problem. But you're facing the opposite as far as the number of employees. Are you going to have to cut a few or have early retirements or, you know, how are you going to make the budget work? Well, talking to a politician, I don't want to sound like a politician by being coy, but I think until the state budget settles, it's really hard to predict. I can tell you that we do not seem to be in a position today if the legislature and governor settle on something close to what the legislature put forward of something significant. We think we will be okay by just freezing vacant positions and not filling them as opposed to having, but I just, it would be premature to say until the state budget settles. So I think in August we'll be in a better position to be very official about what it's looking like. Yeah. And then when it comes to, yeah, thank you, you know, for everything you're doing. I know your funding is, the big part of it is state funding, right? But is there some, especially during the crisis we're in, you're probably depending upon what are you hoping for some federal funding and how does that look? Well, the budget's too complex to go sort of budget item and program by program, but I would say in general, the federal funding is almost half of our funding, but many of them are under what's called entitlements, like the federal government unless they change the policy, they're on the hook to keep their spigot open to keep 50 cents on the dollar flowing in general. And then the state matches that and then we have a local match. So I think it really depends the federal government, state government and the realignment funding is about 90, a little less than 90% of our budget. And I would say a large part of that is federal money. So it really depends. I think there are some programs that don't have federal funding that we would like to see the federal government step up. There are some programs as Supervisor Leopold mentioned earlier based on that editorial where the eligibility limits are very steep and strict and we'd like to see them lifted, but that would require an act of federal Congress and a president. So yes, what we do is heavily dictated by federal funding and federal policy. I think what's really impressing me is with the health department and also the human services department is how before the crisis and then going into the crisis and where we are now, both departments seem to have done this seamlessly and kind of just went right in and kept going and we have those words that you use and health services use, integrity, compassion, and quality and everything like that. I'm very impressed on how you guys are transitioning, especially with all these homeless shelters that your department is responsible for. I do want to recognize in partnership with the CAO's office, Elise and her staff, depending on which the program is, it's been a shared partnership and they deserve their credit as well. Yes. Okay. Well, I'll open it up for public hearing. Are there any questions from anybody here from the public in the chamber? Okay. And then that take nobody downstairs. There's nobody else. No one in the community room. What's that? No one in the community room. There is no public comment. Okay. Chair, I'd be ready to move the recommended actions for the human services department budget. Do we have a second? Don't care we have a second. Who was the second? Supervisor McPherson seconded. Great. I'll call the roll. Supervisor Leopold. Aye. Friend. Aye. Coonerty. Aye. Mr. McPherson. Aye. Chairperson Kepit. Aye. Passes unanimously. We do have closed session, right? Not today. Not today. Okay. So it'll be no closed session. The Board of Supervisors will now recess and reconvene as a Zone 7 Board of Directors at 7 p.m. That'll be online to conduct its regular meeting. And then after that at 7 30 will be budget hearings continuing this evening. Normally what we would do is have one meeting here during the day and then in the evening we'd be down in Watsonville. But tonight's meeting will be online, right? Okay. All word live. That is correct. Tonight's meeting, Watsonville session will be online. Watson City of Watsonville has not opened their council chambers as we have. So therefore we are abiding by their decision and keeping to a virtual meeting. Okay. But we'll be here tomorrow night. But we will be here tomorrow night because our board chambers have been open to the public. And we don't need to give out any information to the public on how to actually watch that or. Mr. Chair. Yes. The public will be able to comment via telephone and there is a telephone number provided with the agenda. And if you'd like I could read that. If well, maybe I'll have. It's. Christine, do you have that phone number? Christine will read the phone number for folks. I can also, it's up here on the yes, the agenda which is if people want to call in tonight, it's four, five, four, two, two, two, two. And the collaboration code is nine, one, zero, four, six, six, nine, one, zero, four, six, six. And that's also the calling code for the continued public hearing on the budget. So call four, five, four, 22, 22. And the collaboration code is nine, one, zero, four, six, six. Thank you. Thank you. We'll see you here from everybody tonight. Thank you. So yeah, go ahead. So Greg, this is a zone seven. So I'm happy with chairing this one. And then I'll hand it back over to you for the budget hearing at 730. Okay. Okay. All right, I'd like to call to order the zone seven board of directors meeting for June 22nd, 2020. We're doing this meeting remotely. If we could have a roll call, please. Director Leopold. Here. Coonerty. Here. Caput. Here. McPherson. Here. Bannister. Mary Bannister. Billusich. Here. Suri. By Dale Gonzalez. Chair Friend. Here. And I know we do. I'm sorry, go ahead. I think Mary Bannister is on the line. Is she there? Yeah, she is. Okay. Here. Welcome, Mary. So does everybody, if you could mute, if you're not. Thank you. If you could just mute if you're not speaking, that'd be great. We did the roll call. We'll now begin with the consideration of any additions or deletions to the Consent or Regular Agenda. Mr. Strudley, are there any changes to tonight's agenda? No, sure. There are not. Great. Now we'll move on to oral communications. It's an opportunity for either members of the community or for members of the board to address us on items that are not on tonight's agenda, but within the purview of zone seven. First, we'll begin with any members of the board. Does any member of the board of directors have anything that they'd like to discuss briefly? Seeing none. Is there, anybody on the phone that would like to address us during oral communications? If you would allow us, we're gonna give a little blurb instructions for people on the phone. To the public using call in option, if your caller ID is blocked, we will not be able to identify your call and will not be able to call upon you to speak. If you wish to speak, please unlock your number by hanging up and dialing star 82. And then the meeting number you originally called on and the same collaboration code. If you would like to address the board, dial star 41 on your phone.  The clerk will announce your name or phone number when it is your turn to speak. Please allow for a few second delay. You will have three minutes to address the board. After the three minutes, your call will be muted. When speaking, please do not have your phone on speaker. And if you are watching the meeting online, please mute your TV or computer.  This will lower your virtual hand. County staff that is joining us through teams, please keep your computer on mute unless you are talking to avoid disruptive audio feedback. And if you would allow this to be translated into Spanish, please. Para el público que desea llamar con sus comentarios, si tiene su identificación de llamadas bloqueado, no podremos recibir su llamada sin poder intensificar su número. Para quitarlo, cuelgue y marque estrella 82 y lego el mismo número que anotó. Si desea dirigir a la mesa directiva, marque estrella 41 en su teléfono. La secretaria anunciará su nombre o número cuando le tocó usted. Hay que esperar unos segundos para empezar y tendrá tres minutos para hablar. Favor de no tener la llamada en bocina alta y poner en silencio su televisión o computadora. Si siempre no desea hablar a la mesa directiva, favor de marcar estrella 42. All right, thank you. At this point, does anybody have their hand raised clerk that would be interested in participating in oral communications? Thank you, Chairman Friend. After all of that, we have no callers. That's okay. I appreciate that we're affording the opportunity for people to participate during oral communications. All right, we're gonna move on to item four, which is an approval of the zone seven board meeting minutes. Do any directors have any questions? Director Bilicic, you are muted, so you just need to unmute yourself, please. I promise we're not doing this to you, Director Bilicic.  Okay, no, I just wanted to approve the minutes. Okay, I'll come to you for a motion. Is, does anybody else have any comments on the minutes? Madam clerk, do you see anybody from the community that has their hand raised who would like to comment on the minutes? Okay, then we have a motion from Director Bilicic. Do we have a second? We have a second from Director Caput. We'll do a roll call vote, please. Director Leopold? Aye. Coonerty? Aye. Aye. Caput? You're muted, Greg. Director Caput? He said aye, but he's muted. Okay. McPherson? Aye. Bannister? I got muted. Aye. Bilicic? Aye. Chair Friend? I know. Aye. Do you want to go back to Director Caput? He's unmuted now. Yeah, you got me. Aye. Thank you. Perfect. Thank you. Yeah, it's okay, leave it alone. We're going to move on to the Consent Agenda, which are item six and seven. Does any Director wish to pull an item on consent or speak to an item on consent? Director Bilicic, any comments on consent? Comments. Yes, I'd like to say everything is so well spelled out. Everything, there's a lot of detail in there, and it's very impressive. The timeline, I thought it was a well done report. Thank you for those comments, Director Bilicic, Mr. Strudley, great work as always. Any other Director that would like to comment on consent? Madam Clerk, are there any member of the public that would like to comment on consent? Not at this time, thank you, Chair. Thank you. All right, we would. Chair, this is John Leopold. I'm prepared to move the Consent Agenda. Move by Director Leopold, a second from Director Bilicic. We'll do a roll call, please. Director Leopold. Aye. Coonerty. Aye. Caput. Aye. McPherson. Aye. Bannister. Aye. Bilicic. Aye. Chair Friend. Aye. That item passes unanimously. Chair Friend, can you tell me why Mary Bannister's going sideways? Yeah. Director Bannister, your photo is sideways. I was wondering the same thing. I say, why not? We're kind of living in that world right now, Director Bannister. Why not? It's kind of... Exactly. All right, we're gonna move on to the first item of the regular agenda, which is item eight, which is the Board of Directors of Zone Seven. This is a public hearing on Zone Seven assessment rates for the 2020-2021 fiscal year. We're gonna hear objections and protests, if any, and consider adoption of the resolution confirming the rate report as outlined in the memo of the district engineer, Mr. Strudley. Thank you, Chair Friend. Members of the Board, on March 10th of this year, the Board adopted a resolution confirming the previously approved increases in assessment rates for Zone Seven for the 2020-21 fiscal year. Those rates are attached to this item, and the Board set today as the public hearing date for those assessment rate report for Zone Seven. So in order to complete the assessment rate proceedings, the Board needs to open the public hearing, take testimony and consider objections and protests to the report, if any, and at the conclusion of the public hearing after considering the public, if there are any public objections to the report, Zone Seven asked the Board to consider adoption of the resolution. So with that, the recommended actions for this item are to open the public hearing and hear objections and protests, if any, to the proposed 2020-21 assessment rate report for Zone Seven and to close the public hearing. And upon the conclusion of the hearing, consider adoption of the resolution confirming the written report on assessment rates for the 2020-21 fiscal year. Thank you, Mr. Strudley. Are there any directors that have any questions on this item before we open up the public hearing on the rate assessment? Okay, seeing none, we will now open up the public hearing. Madam Clerk, is there anybody from the community that would like to address us in the public hearing? Again, if you're listening to this on the phone, it's star four one, if you would like to be added into the queue for this. Is anybody interested in joining us for the public hearing? Thank you, Chair Friend, but at this time, nobody is here. Thank you, Madam Clerk. Okay, we will close the public hearing and we're gonna bring it back to the board for action. Is there a motion, please? Make a motion to approve the assessment rates. Second. We have a motion from Director Bilicich for the recommended actions in a second from Director Coonerty. We'll go for a roll call, please. Director Leopold. Aye. Coonerty. Aye. Caput. Aye. McPherson. Aye. Bannister. Aye. Bilicich. Aye. Chair Friend. Aye. And that item passes unanimously. We'll move on to item nine, which is the Board of Directors of Zone Seven to consider the 2020-2021 proposed budget for Zone Seven is outlined in the reference budget documents and memo of the district engineer. Mr. Strudley, please. Thank you, Chair Friend, members of the board. In accordance with the rules and regulations for Zone Seven, a budget hearing is held during the district's June meeting in which the upcoming fiscal year's budget is approved. For your notes, the budget is also approved by the Watsonville City Council, which actually occurred this year at their June 9th meeting. And then the budget is brought before the Santa Cruz County Board of Supervisors, which is set to occur tomorrow on the 23rd. We are following the new procedures of the county in which the budget follows a two year cycle. And that budget is presented this year to the board includes revised information for fiscal years 2020 and 2021. So this is being submitted to you as for approval as year two under the new two year budget cycle. So attached to this board item are the overall expenditures and revenues for the district. This includes a capital improvement amount spending for $3,138,491 as well as overall expenditures of $4,207,000. We will have a beginning fund balance this year of $29,485 and we'll be expending all of our revenue for a zero fund balance at the end of the fiscal year. The attachments have line item detail on the budget down to specific projects and other elements. And I'm happy to answer any questions you may have about this budget. I would ask that you consider approval of this 2020-2021 proposed budget for zone seven flood control water conservation district. And you also accept and file the semi-annual levy inspection reports which are also attached to this board item for your information. Thank you, Mr. Strathley. Are there any directors that have questions? Mr. Strathley, I'll see Director Bill Sitch, please. I noticed that the projected budget is one thing and the recommended is another and the recommended is more money. So the projected budget was the budget that originally appeared when the two-year budget cycle was initiated by the county and the district followed that model. So the 2020-2021 projected numbers are the numbers that were originally developed in the two-year budget roughly two years ago. The recommended amount are the revised amounts for those budget items. So they are updated now that we have more current information. Oh, thank you. And then you're the levy district where you went and did all of the inspections. The conditions, is that part of this too? Yes, so we typically include our semi-annual inspection report which our drainage crews developed for us based on their regular inspections as well as derived from their annual inspections with the Army Corps of Engineers. I have to say, I thought that was very comprehensive. A really good report and it looks like we're in great shape. Thank you. Thank you very much. Thank you for that question, Director Bill Sitch. Are there any other questions on this item? Can I move to approve? I will open it up for public comment before we do the motion. So Star 4-1, is there anybody from the community, Madam Clerk, that's interested in participating on this item? Again, thank you, but no one has called in yet. Thank you. All right, so we'll move it back. Director Bill Sitch. Yes, I moved to approve the, let's see, the proposed budget has outlined and the memorandum of the district engineer with all of the attachments. We have a motion for the, all right, we have a motion from Director Bill Sitch and a second from Director Leopold. It will do a roll call vote, please. Director Leopold. Aye. Coonerty. Aye. Caput. Aye. McPherson. Aye. Bannister. Aye. Bill Sitch. Aye. And Chair Friend. Aye. And that item passes unanimously. We move on to item 10, which is the Board of Directors of Zone 7 to consider a status report on the Pahoa River Flood Risk Management Project and consider the design agreement and associated certifications to authorize the chair to sign the certification regarding lobbying on the district's behalf, authorize the chair to sign the design agreement, consider the memorandum of understanding between the department of the army and the joint non-federal sponsors, authorize the chair to sign the MOU on the district's behalf, consider the terms of the generic model funding agreement between the state of California department of water resources and the joint non-federal sponsors under the flood control subventions program and authorize the district engineer for flood control program manager to sign the agreement and adopt a local public agency authorizing resolution as outlined in the memo of the district engineer. I don't know, Mr. Strudley, I don't know that there's a memo that's needed after that title, but we will move on to it anyway. So Mr. Strudley, please. Thank you, Chair Friend, members of the board. Yeah, there's an awful lot going on with the levy reconstruction project, and this is a pretty important piece before you with a number of agreements and MOUs for you to consider and provide authorization for us to move forward. As you know, on December 12th of last year, we secured the director's report from the Army Corps of Engineers, which gave us the authorization to move into the design phase. And then in January, we received $1.8 million in appropriations to start the design phase. And ever since that time, we've been working through the initial stages of preparing for this design agreement to be brought before you as well as the other non-federal sponsor, Monterey County Water Resources Agency. And so right now, in order to proceed into the design phase and to get the Army Corps to embark on design of the first prioritized reach, we need to come to agreement on the terms of the design agreement, which is attached for your review. It describes the financial commitment of the federal government as well as the non-federal sponsors and describes the cost share allocation as we move into design. You may recall from feasibility, our cost share arrangement with the Army Corps was a 50-50 split, 50 federal funds, 50 non-federal funds. For design and construction, that shifts to a 65, 35% cost share split, 65 falling to the federal, part of the equation and 35 falling to the non-federal. So this agreement describes a contract for design of the first prioritized reach. So this is not all of design. It is the first component of design. And as described in this agreement, that's $7.1 million worth of effort for design. So that equates to a $4.615 million federal commitment and a non-federal commitment of $2.485 million, which will be shared with the both non-federal sponsors. The agreement allows us to accelerate provision of funds if we want to. I don't think we're in a position to do that right now. I would not make that recommendation at this point, but it does allow that. This can be useful if the core falls back and we want to spring ahead of them. So it allows us some flexibility. Also allows us to provide work in kind. So to get credit for existing work or work that we make arrangements to do with the Army Corps. So also included with this item is an MOU that allows for crediting. So this is similar to work in kind, but it just allows more flexibility for us to receive the credit for work that we arranged to do that the Corps would normally be doing themselves. So this can become useful again, if we want to speed things up or if we want to capture a little more control over the process as long as the Army Corps is comfortable with doing that. So both these agreements will be brought in front of Monterey County Water Resources Agency Board of Directors, as well as they're the Board of Supervisors. The dates in this Board memo are actually not accurate any longer. The June 15th Board date for the Water Resources Agency, that is accurate, but it looks like the Board of Supervisors on the Monterey County side will be considering this item sometime in early to mid-July. I just wanted to add on the federal side that the Army Corps has already put together a proposed appropriation for next federal fiscal year of $2.915 million. That would be the second federal component of this $7.1 million initial design effort. And at that point in time, we will have another funds request being made to non-federal sponsors. On the state side of the equation, we are moving forward still with our Subventions Authorization. In order to do that, we need to sign a funding agreement with the state as well as get a resolution adopted by this Board. So the resolution attached to this item is for your consideration and adoption, which will be an exhibit to the funding agreement with the State Department of Water Resources. The Subventions Agreement that is attached to this item is not specific to our project, but what I was seeking was your concurrence and approval on the basic terms of the agreement. All the details in terms of the actual funding source, our project name, as well as the exhibits, will come from the Army Corps once they develop their project management plan, which they are doing so right at this second. And we hope to have that done sometime in July. So with your consideration of this, the terms of this model funding agreement, you can authorize the District Engineer or the Flood Control Program to sign that agreement when those exhibits are completed and provided by the Army Corps of Engineers. We are still going through the CEQA process. We still plan to have a administrative draft document sometime this fall, and we are taking this summer to develop our impact analysis as well as to address comments that were received during the scoping period. Most important potentially along with the agreements that are attached to this Board item is the finance strategy. The coronavirus has really called into question our ability to bring a benefit assessment district formation vote, a Prop 218 compliant vote before the public, which we had initially anticipated doing perhaps in spring of 2000, or excuse me, in fall of this year. That is no longer a reality because of the economic downturn. And we are unclear at this point whether or not we will be able to do that at some point during next calendar year, but we are making our plans right now to develop a new cash flow analysis as well as finance strategy to address this issue and to identify how we can move forward efficiently without hindering the progress that's being made on the federal side. With that, I would like to hand the mic over to Matt Machado who's gonna give you an update on our governance formation process. Thank you, Mark, and good evening, Chair and members of the Board, Matt Machado, your district engineer. And so while financing the project remains the most important item moving forward, we still continue to work on the JPA, the establishment of the JPA to support the project. It is crucial to form the new agency for multiple reasons. We've listed some of those in the Board report and I'll quickly go through them. First off, a JPA will align and focus all of our purposes with our partners. Secondly, state and federal partners certainly prefer a single project sponsor, which the JPA would give us. Additionally, the JPA could be considered a part of the revolutionized Army Corps initiative which is important to our federal partner. And lastly, the JPA would certainly simplify our benefit assessment district vote. And so we are pursuing this effort, yet the finances is taking a bit of a lead at this point and COVID has put in a bit of a slow on our meeting schedule. Our governance and finance committee meetings have been, we're temporarily postponed until today. Mr. Strudley sent out an email today to set our next meeting for July 9th from three to 5 p.m. It will be an online meeting through Webex and we're looking forward to getting the group back together and providing updates on the project and moving forward with our JPA strategy. With that, I'm gonna turn it back to Mark and he will finish out our report. Thank you. Thank you, Matt. Yeah, so I just wanted to finish with a repeat of the recommended actions and then answer any questions you may have. So our recommended actions are to accept and file the status report on the Power River Flavors Management Project to consider the design agreement and the associated certification regarding lobbying between the Department of Army and the federal sponsors, authorize the chair to sign the certification regarding the lobbying on the district's behalf and authorize the chair to sign the design agreement upon final concurrence with the Army Corps legal counsel. To also consider the memorandum of understanding between the Department of Army and the joint non-federal sponsors for work provided or performed prior to execution of a project partnership agreement and authorize the chair to sign the MOU on the district's behalf. And lastly, to consider the terms of the generic model funding agreement between the state of California Department of Water Resources and the joint non-federal sponsors under the flood control subventions program, authorize the district engineer or flood control program to sign the agreement upon state identification of funds and completion of exhibits A, B, C, and H and adopt a local public agency authorizing resolution which is exhibit E of the agreement. Happy to answer any questions you may have. Thank you, Mr. Strathley for that presentation. Director Bilicich? You know, the state right now, obviously their budget is not in very good shape. How's the funding gonna come from the state? So right now, our recent discussions with Subventions staff indicate that the funds would be coming from Prop 84 grants. So Prop 84 was passed by the voters many years ago and so it is a stable and secure funding source. I have been speaking with other agency partners such as at PV Water who have very recently signed agreements with the Department of Water Resources. So I don't see any hindrances to signing an agreement with EWR for Subventions, hopefully sometime during the month of July. And I don't see any issues with securing funds for support of those reimbursements against the initial phases of design. I should point out that every time we step into a new contract with the Army Corps, so for example, two years from now when we expect to go into a project partnership agreement under construction with the Army Corps, we would then sign a new funding agreement under the Subventions program. At that point in time, it may be a different funding source, but at this point in time, DWR has identified Prop 84 as our funding source. Thank you. I also wanna say this is a very comprehensive report. Appreciate that. Thank you. Thank you, Director Bills, Instructor Caput. Thank you about, thanks, Chairman Friend. Yeah, with the funding and everything we're doing, will some of them expire if we don't keep moving forward? Which, you know, the money for the design phase and all that, those are things that have deadlines. They have, you know, paperwork that has to be done.  Yeah, so the $1.8 million that have been appropriated from the federal government, it will require the design agreement being signed to actually exercise those funds and put them to use. There technically isn't an expiration on any of this, especially once we sign an agreement until we terminate an agreement. We certainly don't wanna be in the position of sending funds back either to a federal source or a state source. And we're also not in the position of contemplating having to do that either. What coronavirus has done really was called into question the support that will be needed from the public, the financial support needed from the community for this project. And we've always been in pursuit of trying to minimize that requirement on the community, but there will be a non-zero commitment required unless we're somehow able to secure a really fantastic grant source from the state. So the delay to that revenue stream has put a little bit of tightening on our cash flow situation, but what's also very important to that cash flow is our subventions because as we make appropriations to the federal government, 70% of those appropriations will be reimbursable under the subventions agreement. So part of our cash flow problem is getting the subventions agreement signed and in effect so that we can start exercising it and getting reimbursed back from some of these initial costs. Right. Okay. Thank you. Thank you, Director Caput. Are there any other board members that are interested in asking a question on this? Okay, again, star four one, if you're a member of the community and you would like to add input on this, Madam Clerk, is there anybody from the community that would like to participate? Good evening, Chair. Yes, we do have one speaker. One moment, please. Speaker identified as unavailable, you may now speak, you have three minutes. Speaker identified as unavailable, you may now speak, you have three minutes. I just want to say, I hope you all are making myself fortunate and you are to have a lot of struggling to be in this department. It's still a project, the process, the progress over the past year that has happened in the past six years. Thank you, Carol. Did you have anything else that you wanted to add on that item? We're doing an okay job. I'll take okay is better than terrible. So in my line of work, we consider that an approval. So I'll say that the approval rating of this board just went up a tick. Thank you, Ms. Shirley, for those comments. And thank you also for your advocacy, continued advocacy on behalf of Pajaro Dunes and the entire Pajaro River system. Is there any other member of the community that'd like to address us, Madam Clerk? That was all, thank you, Chair. Thank you. Okay, we'll bring it back to the board for action. Director Bilsich. Yes, I'd like to make a motion to approve and just thank Mark for all of his hard work. This is amazing how much detail is in this report. Second, Coonerty. All right, we have a motion for the recommended actions from Director Bilsich and a second from Director Coonerty. We'll go to a roll call, please. Director Leopold. Aye. Coonerty. Aye. Caput. Aye. McPherson. Aye. Bannister. Aye. Bilsich. Aye. And Chair Friend. Aye. And that item passes unanimously. Thank you, Mr. Stradley. Thank you, Mr. Machado for all of your work on these items and everybody else within the public works crew. That'll adjourn this meeting, but we will move on to, for those that are on the Board of Supervisors anyway, to the evening budget hearings and I'll turn it over to Chair Caput and Mr. Plosios. Okay, yes. This, I'm not looking right at the time, it's 7.30, right? Yes, we can go ahead and proceed. So we're okay. We're not jumping the gun here. Continued public hearing on 2020-2021 proposed county budget. We have time here for opening remarks and public comment from any person may address the Board during its public comment period. Speakers not to exceed three minutes. And they can speak only once during public comment. All public comments must be directed to an item listed on today's consent agenda, closed session agenda, yet to be heard on regular agenda. Or topic not on the agenda that is in our jurisdiction. That pretty much covers everything, right? Okay. Okay.  Yes, so I am going to make some brief remarks and then I'll turn it over to Assistant County Administrative Officer, Nicole Coburn, and then we'll open it up to public comments. So we're gonna share the screen and we're gonna show the PowerPoint. There we go. And so go ahead and go to the third slide, there, Christine. I will say that this has been, for the entire County family, a very difficult year. We have been working very, very hard on the pandemic response. And now we are faced with a budget deficit. And so the good thing to report is that we started the year with a very strong financial position. We had tripled our reserves. We had reserves of $56 million and tripled them over the last number of years. We have also improved our credit rating. We have a very strong financial position, actually having triple A, a bond rating, which is the highest rating you can get. So that says a lot about the board's fiscal stewardship over the last number of years to put us in such a strong financial position as we entered into this crisis. The board had also reduced pension obligations, passing a second tier of retirement benefits. And then the state followed with the third tier of retirement benefits, which lowered our unfunded liability. And we also have controlled our employee growth. In fact, today, we have less employees than we did a decade ago. And so even though we have reduced the number of employees, County employees, we actually are doing many, many more things. And we've done that through becoming more efficient with technology, and it's just a great thing to see how our County employees have been able to provide more services even though we have less employees. And we've also started working on our deferred maintenance. Go ahead and go to the next slide, Christine. This is just a illustration of our reserves. You can see that in 2014, we had about $30 million of reserves and we're now in 2020 at $56 million of reserves. The reason that we are showing a decrease in the reserves in fiscal year 21 that's next year is because we currently face a $20 million deficit in this current year fiscal budget. And that's due to the impact of the pandemic on our revenues starting in this March. And so the good thing is that we are not forced with having to make immediate budget cuts. This, the reserves we have will allow us to soften the blow and absorb those cuts through the reuse of reserves in this fiscal year. Go ahead and go to the next slide. I mentioned that we have had many successes over the last number of years. In behavioral health, we just opened up a new behavioral health building at our freedom campus. We also have remodeled and expanded our health clinic and we provided a brand new genetic clinic also at our freedom campus. Those are significant services offered to Watsonville. I know this budget meeting meeting is centered on Watsonville. So I wanted to mention those as examples of the county's commitment to South County. We also have expanded CalFresh, CalWorks and our MediCal services as well. It's important to note that even though South County and the Watsonville area represent about 20% of the county's population, South County actually has about 50% of the clients of our safety net programs. So these programs are of critical importance to South County. And I'm very proud to say that we've been able to expand all of those services over the last decade. We've also increased the number of parks that we've offered. And we had some wonderful successes this year in opening up Chanakler Park, Leos Haven, other parks as well, Heart of Soquel. And it's just a great success that the county has had including the new park out at our Felton library. We've also started addressing our deferred maintenance. We have a lot of county buildings that need repair and we've started that work, had some good successes in doing that. And we've also spent millions of dollars repairing our roads and storm drains after the storm event 16th of the 16th of the 17th. So we've had great successes and part of that has to do with the fact that we have a board that has been very fiscally prudent, but at the same time dedicated to expanding services community and South County has benefited greatly over the last decade with new services at our freedom campus. With that, I'm gonna turn it over to Nicole Coburn, Assistant County Administrative Officer. She's gonna talk about our strategic plan. Thank you, Carlos. So good evening to our cap and members of the board. So I'm Nicole Coburn, Assistant County Administrative Officer and I'm here to give you some brief updates on our operational plan. I'll go ahead to the next slide, Christine. So as you can see here, we have four major county initiatives that lay the foundation for achieving the county's vision and mission in 2018, the board adopted the county's first strategic plan. It provides the why for the county, why we exist and serves as our North Star. We also have an operational plan, a two-year operational plan covering the years 2019 to 2021 that describes how we are going to achieve our strategic plan. It is our action plan and it says exactly what we're going to do. We also have Primo Santa Cruz, which is our continuous process improvement initiative and it describes helps us to get an idea of what we're doing to get better each day. Finally, we have our performance measurement initiative and this is trying to measure whether our work is having an impact and how we can tell. Go ahead to the next slide, Christine. So here again, you can see the vision and the mission for the county's strategic plan. I mentioned that it serves as our North Star. After the turbulence behind us and the new role to come, this North Star is getting more and more important to guiding our work and our priorities. The vision, mission and values represent the voices of our community, our service partners, our clients and our employees. Go ahead and fast forward. So the operational plan is only a two-year action plan. In December of this past December of 2019, we were looking pretty good. Halfway through our plan, however, we've been knocked off course. Both the department strategic plans and the county operational plan have guided departments through the ongoing revised budget process as well as responding to the COVID-19 pandemic. These plans provide foundations for staff. They focus on the major initiatives and goals for improving our mandatory services. The objectives in the operational plan are measurable. So in some cases, we will be able to see directly the impact of the pandemic in a way we would not have been able to in the absence of the plan. So the charts before you, if you're looking at the purple and amended slices or bar graphs, those represent the COVID-19 impacted objectives. The pies and the bar graphs in green represent completed and in progress time of the COVID-19 impacted objectives. About 60% of our work is expected to finish on time or is already complete. June 2020, the completion date has had the biggest impact. Almost two thirds of our objectives have been impacted. However, about 50% of these impacted objectives are expected to be complete by December of 2020. We're still trying to quantify the full impact of COVID-19 on our operational plan and we'll be returning to the board with some further information. We have an operational plan website that's been updated and you can view it at our main site at www.sccvision.us. Christine, I don't know if you're able to go there, but if you are, we can take a look at it. So this is the website. The ISD and Sven Stafford in my office have been working very hard on updating the information shown here. We now have a way to display the COVID-impacted objectives for the public and the county. So if you go here, you can take a look at those objectives. You can see that we have our 180 objectives and 61 of those have been impacted by COVID. We're gonna be adding some additional features to the site so that we're able to search by the COVID-impacted objectives so that someone who might be interested in just seeing those, we have a number of other search functions available currently. So if you go to the sort by department, you can see specifically what objectives are either been completed or in progress or have been impacted by COVID. So if you go back to the PowerPoint presentation, Christine, and fast forward one. So our plan for fiscal year 2020-21 is that in December, this upcoming December, we will be providing the board with our third progress report on the operational plan. We're gonna be working with departments to understand the full impact of COVID-19, including from the public health standpoint, the county, state and federal budget landscape, our local economy and just the impact in general on the county, how we work as a county. We're going to be breaking down the 61 COVID-impacted objectives to show whether they've been completed, if they're on progress in progress and back on track, if they've been amended and are back on track but with some delays or if they've been discontinued and some work may have to be abandoned either because of budget impacts or what changes to how we're working. We're also gonna be training staff on measurement. We are currently using a smart framework for objectives. And we're planning to provide staff with some additional training on performance measurement and our results-based accountability framework. We're gonna be working with departments on getting better at measuring impact and that training will help us do that. We're also planning a one-year resiliency addendum to our operational plan. The original operational plan called for a new two-year plan for the years 2021 through 2023 and due to the public health pandemic and the economic uncertainty, we feel that creating a new two-year operational plan is not practical at this time. And we would like to work with departments on a resiliency addendum to the current operational plan that will help us through this period of time. It will enable planning flexibility. It will also help us build on our training effort, our Primo Santa Cruz initiative and performance measurement and it will allow departments to think about the key management challenges necessary to adjust to what we're facing currently. And so with that, I will turn it back over to Carlos to close the presentation. Thank you, Nicole. And if we could go to the next slide, Christine. So here's what we are facing both to get through this fiscal year and for next fiscal year with regard to the impacts that the COVID-19 pandemic have had on our county finances. Like all the rest of the community and many of our businesses, we are having a very difficult time with big impacts to our revenues. So in 2019-20, that's the fiscal year we are currently in which will end on June 30th. We are facing as I mentioned earlier, a $20 million deficit. This is approximately 12% of our general fund net county cost. To deal with this, I have implemented a spending and hiring freeze on all non-essential expenditures and any positions that we are able to freeze. We have been doing that. We are also recommending to the board that you use our reserves to get through this fiscal year. So that would mean that we will use approximately one third of our reserves. We have $56 million in our general fund reserve. We will use up to 20 million of those reserves to get through this fiscal year. That will leave us at approximately 7% for our reserves, approximately $36 million. I will not be recommending the further use of our reserves below the 7% and there's a number of reasons for that. One is that we have to be prepared for potential for additional emergencies. This year is predicted to be a very difficult fire season and we know that we have fire risk in our county and therefore we need those reserves in the event of an emergency. Also the pandemic may come back in a way in the fall or a winner that requires us to spend additional funds. So therefore we need to keep the remaining reserves ready in case we have a further emergency. Next fiscal year, we are facing potentially up to $40 million a deficit. That's potentially 23rd of our net county cost. Just to give you a sense of our magnitude, that's more than double of the deficit that we faced in the great recession in 2008, 2009. So it's very significant. So to get through that year, I have recommended that departments are going to submit budget submittals with pets of up to 20% of net county costs. We are trying to protect as much as we can public safety and our health and human services budgets by recommending that they cut up to 10% of their budgets. The reason for that is that we know that those safety net programs that are health and human service budgets are so essential to the community, especially during a recession. And therefore it would be the wrong time to cut those budgets. And I know the board has expressed their values in doing the strategic planning. So we're developing the budget, trying to backfill the losses in health and human services to keep them to only having to make up to a 10% cut. We also are going to be recommending furloughs, our employees and the great recession gave up to 7.5% furloughs. We are going to be using some one-time funds in some of our trust funds and some of our other departmental funds. Normally we wouldn't recommend that, but given that our economy is fundamentally sound, even though we are facing this pandemic, we're hoping that the economy will recover after one year. And so we know that the second year will also be, and the second year out will also be difficult over hoping that we start recovering and that we'll be able to get by with using some one-time funds. In addition, we are hoping for state and federal assistance. I know the state budget was signed today by the governor. We're still looking at the details. We don't know about that yet. And we also hope for federal relief as well. And we know that in our meetings with our hosts representatives and our senators that they've all expressed strong support for relief for state and local government. And so at the present time, we know that legislation is before the house stuck in the Senate, but we're hopeful that federal aid will come in the future. Can go to the next slide, Christine. So the good news, there is a little bit of good news that the state budget that the legislature passed had some additional relief for state and local government, including a CARES Act funding of $28 million. Unfortunately, much of that funding is very restricted and can only be spent on new costs incurred because of the pandemic. It can't be used to backfill some of our lost revenues, but nevertheless, it's helpful. And we think that some of that money can be used for the match that we were going to have to provide some of the information we're receiving and that way help the general fund. I also know that the state legislature had a realignment backfill. This is some of the funding that's used to help fund our safety net programs. And we're hopeful that some of that funding is still in the budget that the governor signed today, although we don't have all the information we need to know that yet. We are going to continue to rely on our community partners to help us with our county programs. This is many of our nonprofit partners. We are also going to continue as a county to rely on telework and using remote work that we've had to rely on as we're doing this meeting. So there is some good news and we're hoping that the budget that we had projected $4 million will actually be somewhat smaller. We're hoping that we can get that deficit down to about $30 million before we have to start making all of the cuts due to some of the federal aid and some of the state aid. But it's going to be very difficult nevertheless and we are still looking at the impacts that are much greater than we've faced in the great recession that we had in 2008, 2009. With that, I'll close my remarks, Chair Caput and turn it back to you. I know now you'll be open for public questions or comments. Thank you. Thank you, Carlos. Yeah, we'll open it up for public comment. Should I read it again? I read it earlier right before your report. So any, I'll do it, abbreviate it. Any person may address the board during public comment period up to three minutes. Please don't exceed that. And then you can only speak once during public comment and the comments must be directed to an item listed on today's consent agenda, closed session agenda, which we don't have today. Yet to be heard on regular agenda or a topic not on the agenda that is within our jurisdiction of the Board of Supervisors. So we are open to a public comment and I will take a pause here and wait and see if we have somebody ready to comment. Chair Caput, we have nobody that wishes to comment at this time. Nobody. Okay, I'll bring it back to the board then. Any comments from board members? Any questions from board members? I don't hear any. Okay, we'll move on then. Do we have anything else to report? We'll just be adjourning. We'll just be continuing the public hearing to tomorrow at nine o'clock, the board chambers. And that will be, some of us will be there live in Santa Cruz at the Ocean Street County Building and others will be online. So we'll close the meeting and we'll see everybody tomorrow at nine a.m. Thank you. Meeting adjourned.


A hundred and fifty. Sixth, number forty. Yeah, half CC, but run a little bit. Get the scope. Good evening, Dr. O'Donnell. Oh, she is dead. Now her striving body that brought her life into the world is cold and empty. Now her blood that was bringing heat and life to them is turning from red to purple. A well-developed white female of thirty. There was no indication of cardiac trouble during labor. Following a spontaneous delivery, her pulse became rapid and her blood pressure dropped suddenly. Cause of death is certified to have been acute heart failure. Contributing cause, mitral stenosis and pregnancy. But there were seven of us. Was there one balanced second when we could have held the life flowing from her? Maybe the record was filled in in advance. She was born and lived and created a life.  But when? At what sudden signal did the complex organism of her life start to fail? Maybe there's a design. An eye for an eye. A tooth for a tooth.  Perhaps there's a design. Eye for an eye. Tooth for a tooth.  Perhaps there is a design, but we don't know it. We stumble and search and sometimes think we see light. Then it's dark again. As biologists, we know that death is not the inevitable consequence of life. The stuff of life has never died since it began. Now that's cold comfort to a husband in a waiting room or a child who has lost the love of flesh and blood.  But I know this. That we cannot learn too much about the business of bringing life into the world. The night that you lost a patient, perhaps she could have been saved. Perhaps she couldn't. Of all, Aisman's heart disease is the one that blows out the candle most often. But if you want to learn and if you want to be sure, there's nothing in all medicine and surgery that requires broader knowledge than obstetrics. Too many have thought too long that having children is a normal process. It should be. In modern times it isn't. Of course, among insects, it's normal for the female to die after reproduction.  Floods and erosion are normal in nature. Perhaps human erosion is normal. Too many still think so. The damnable thing is, where are you youngsters to learn? Right now, for all these grand clinics, 90% of our babies are brought by men with 5% training. We don't open up our science to enough men. Only four out of 50 of your class will get a residency in a hospital. There is a place for Donald. There in the slums, where two young doctors are bringing modern science to the poor women of the city. If you want to start over and work as you've never worked before, if you want to learn and teach as you learn, there is a place. Trinity Center. Has she had a baby or is she having a baby? Please. Moran. M-O-R-A-N. Your address please. 4056 Fulton. Has your wife been coming to the center? Fine. Is she having pains? When did the pain start? How often are they coming? Has she had any children before? Now you collect some newspapers, stacks of newspapers. Get two clean kettles and put some water on to boil. Be sure the kettles have covers. Do you have any oil cloth in the house? All of oil? Now don't you worry, the doctor will be right over. It's south of Lincoln Park, doctor. Trinity Center. Trinity Center. Has she had a baby or is she having a baby? What is the name please? Address? 1251 Monroe Avenue. Is your wife having pains? How often are the pains coming? Has she had any children before? Now you collect some newspapers, stacks of newspapers. Get two clean kettles and put some water on to boil. Has there been any sickness in your family? Yes. Any cancer? No. What floor? Do you have a telephone? What is the name of your closest relative? About how many months pregnant would you say she is, doctor? About seven months. Could you hear the baby's heart beats? Teeth, throat, heart, lungs, blood pressure 140 over 90. Mrs. Olson has been having headaches every day. Almost every morning. Is your husband working, Mrs. Olson? Two days a week. Have you someone to help you with the housework? My sister comes in once in a while, but it's hard for her to get away.  No, sir. You can dress now. We're ready in here now, Dr. Hansen. Coming right away. I'm glad you called me. You were right. I thought you'd want to see her below. Mark and Red Ink, patient is toxic. And to watch for preeclampsia. Make sure that she comes in once a week for a blood pressure. If she doesn't come in, send for her. Now, Doctor, what were her symptoms? She was a few pounds overweight. Her test showed a slight trace of albumin. She had a rise in blood pressure. She had a sudden rise in blood pressure. And then there were the headaches. But, Doctor, wouldn't that mean just as well that she might have kidney trouble, a bad diet, or that she might be a hypothyroid? If it were kidney trouble, she likely would have had high blood pressure from the very beginning. If she were a hypothyroid, we would find many symptoms besides high blood pressure. We don't know much about these toxin mires of pregnancy, Doctor. We know that men don't have eclampsia and that women who aren't pregnant never have it.  And they could be saved. If we didn't heed the danger signals we found, at any time our patient might have an eclaptic seizure, stabs of light before the eyes, convulsions, and then it's a little late for diagnosis. Here is one of the three killers. Remember them. Eclampsia, infection, hemorrhage. Do you notice anything unusual in this case? Her blood pressure is normal. She has no cardiac trouble. She complains of shortness of breath. Note that she's to come in every two weeks for a checkup. Hemoglobin, 50%. Count 3,200,000 red blood cells. Our patient is anemic. Probably overworked and undefeated. We'll give her 60 grains of iron pills daily. Try to get her some fresh vegetables. You must watch this patient carefully. Remember your Bible, doctor. The blood is the life. Hemorrhage in these cases often proves fatal. Purity center. Maternity center. Oh yes, Dr. Craig. Dr. Buller is busy right now. I'll give him the message. Yes, Dr. Hansen is busy too. You came to the maternity center, tree. Because you wish to learn more about obstetrics. Your experience for the most part has been limited to a few months' training in a general hospital. But even in that short time, you've seen tragic accidents resulting in death or injury to mothers and babies. You know some of them could have been avoided. And that's why many of you are here. We have two objectives here at the center. To bring modern obstetrical care to the poor women of the city. And to teach you the art and science of obstetrics as practiced by the best institutions in the country. As doctors, we have to face this fact.  With all the new science and medicine we have in this country, we lose more human lives from childbearing than we do from cancer. The deaths of mothers and infants under one month rank second only to heart disease in the total mortality figures.  Eclampsia, infection, hemorrhage. And of these, childbed fever, infection at birth, is still the chief killer. 35 out of 100 women who die, die from infection. And most of them could have been saved. All right, Dan. This washing and scrubbing up may seem like old stuff to you. But we're fanatics here on the subject. Remember, infection most always comes from outside. A clean pair of hands is your guard against invisible death. When you arrive at your home, keep everything above table level at least. Newspapers are the cleanest coverings we find in these poor houses. Spread them on the kitchen table and on chairs. You're carrying those bags and wearing your clothes from home to home. And you must guard against carrying infection with you. Put the large bag on the right and the small one on the left. Get used to making every operation systematic. You may have to find those bags in the dark some night. In a hurry. Here we don't have sterile sheets and sterile surgical tables and the white aseptic looking furnishings of a hospital room. They too often make a doctor careless because he feels secure. You can see the dirt where you're going. Only the insides of the basins, the instruments, your hands and the obstetrical area are sterile. You scrub carefully for 10 minutes, but there's still danger of contamination. Your gloves are specially folded so they can be slipped on without the outside of the glove ever touching the skin. You wear two pairs of gloves at the beginning of delivery. The outer pair is removed following the preparation of the patient.  Of course, we don't recommend the complete return to deliveries in the home. The isolated, well-equipped maternity hospital is the ideal place for a mother to have a baby. But we're not dealing with ideal conditions. The facts are that over half the women who had babies last year had them at home. A quarter of a million of them had only a midwife to attend them. And thousands of mothers went to hospitals where there was inadequate equipment for men without obstrical training. We want to give you a technique that will enable you to go into a hospital or into private practice, able to meet any condition you may find there. You have one broad plan on a case to bring a live baby to a live, uninjured mother. You have created an island of safety against death from infection. You will remain with your patient until at least two hours after the baby is born and until you've filled in carefully a complete record of your case. In three years, our doctors and students here delivered 9,000 mothers without losing one from infection. You have to maintain that high standard. Since we've been in this room, two mothers have had babies somewhere in this country and died. One of them might have been saved. Remember, gentlemen, it is not only pathological knowledge and a skill with your hands which makes the great obstetrician. It is vigilance, vigilance, eternal vigilance. One that does not let you forget for one tragic moment that during pregnancy and labor you have in your hands the lives of two people. Dismissed. I had a call from Dr. Craig. I think I'd better get over there right away. Fine. Doctor, I can't understand why you don't include standards low reserve kidney in your toxemia classification. I'd like to have seen that cesarean you did with Dr. Johnson. We were out on a case. I'll try to remember to call you next time. Coming upstairs or down? No, I think I've got a couple of calls. Finished with your books, eh, Doctor? Yeah. We'll see. Eternity Center. Eternity Center. Has she had a baby or is she having a baby? What is your name, please? Mendez and BND. Address, please. Is she having pains? When did the pain start? How often are they coming? Have you had any children before? Now, you collect some newspapers, stacks of newspapers. Get two clean kettles and put some water on the boil. Be sure the kettles have covers. Do you have any olive oil in the house? Olive oil? Now, don't you worry. The doctor will be right over. It's 127 East Jay Street. The entrance is in the rear, Doctor. Now, Doctor, do you have your stethoscope? Yes, sir. Record? Yes, sir. Flashlight? Yes, sir. All right. Let's go. I have a little pain.  Have any members of your family been sick? Give her a physical examination. Yes, sir. 124 over 80. They are 150. The plan of delivery here is simple, Doctor. We have a normal pelvis, but her pains are weak, so we may have to help her. She shouldn't have any trouble. Fill out the record. Yes, sir. Comfortable, Mother? Yes, I am. Maternity Center. Maternity Center. Yes, Doctor O'Donnell. Fetal heart beat, 150. Station minus one. Pain's moderate, every 10 minutes. Maternity Center. Maternity Center. Has she had a baby or is she having a baby? Maternity Center. Maternity Center. Has she had a baby or is she having a baby? Maternity Center. Maternity Center. Has she had a baby or is she having a baby? Maternity Center. Maternity Center. Bay Toxemia. We'll have to watch her kidneys closely. Yes, sir. Why do we bring them into the world? They were clean, decent people. Did you notice the flower boxes they had? That was a fine baby, but what will happen to him now? We can bring their babies safely, but how can they keep them well? We tell our mothers, give them plenty of milk to drink. We say, feed them cod liver oil and orange juice and green vegetables. We say, keep them clean and dress them warmly to fight off influenza and pneumonia. We teach them, the sun will make them strong against rickets and help fight TB. But where do we tell them to go for the green vegetables? Where do we tell them to move for the sunshine? We say, guard against measles and hopping cough and scarlet fever and diphtheria. We tell them, there is science to keep your children from being deaf or blind or crippled for life. But where can we tell them to go for the doctors in the science? The house in America. All our great cities from the hills and fields to build their machines and roll their steel and left them in these shacks. There are ruined teeth and tainted blood and infected lungs. Here are damaged kidneys and cracked hearts and twisted legs. But here are men who want decent clothes and homes and medical care for their women and children. How can they keep alive in these places? These markets and warehouses are millions of pounds of surplus food. Yet there are children in this city who never in their lifetime have eaten a decent meal. We tell them, eat liver and mark anemia on the record. We tell them, rest in bed and mark cardiac trouble on the record. We tell them, eat fresh vegetables and mark malnutrition on the record. Why don't we just mark on the record? They're hungry. It's a time of sadness and trouble. Of worn-out ideas and weary people to heal the sick wherever and however he found them.  Attorney's Center, Avenue A and 90th Street. Yes, Mrs. Arturo Tannetti, T-O-N-E-T-T-I. Yes, officer. We'll send a doctor over right away, officer. There's an emergency call. Bring the emergency kit, O'Donnell. It's a police call. It just came in. The officer says she's losing her eyesight. Is the car back? Yes. You're not up. Do you want to come? Sure. Buy the steel mills, doctor. Attorney's Center. Yes, Dr. Balloon. Hypertension. You're hospitalizing her at Memorial. Yes, I'll have Dr. Hanson with you there. Yes, sir. Dr. Balloon's case. Yes, Mrs. Tannetti. Puzzle's name. Arturo. Andreas. Avenue A and 90th Street. And who is paying for her doctor? She's on relief. It's a maternity center case.  No, sir. How long have you felt sick? I just felt awfully sick today. Then tonight my eyes went bad.  Yes, sir. Have you been to see a doctor at all during the last few months? No, sir. Take these specimens to the lab at once. I've already telephoned. Life or death, written in the chemistry of her blood, is in the hands of 10,000 ghosts. Here she is neither rich nor poor, young nor old. Here she inherits a legacy freely given. All the knowledge of the legions of unknown men of science. In a basement room running a routine test. But he's not alone. He's working with Domson and Minkowski. Failing and bright. Bold heart and far. Benedict and Van Slyke. Working with the unbroken line of men against death. Who's labored to make life sureer and easier. And now Newman II plus. She's got Hyland and granular casts. We want you to rest and not worry. We're going to keep you here for a little while so that you can be quiet. There's no reason why we shouldn't have a fine baby. Thank you, doctor. Good night. Good night. Here's what we're up against when we have no prenatal record of our patient. There's no way for us to tell how suddenly that blood pressure hit the ceiling. Until we got those tests, there's no way to tell whether she's in a true pre-eclantic state. Or whether she was nephritic due to a past sickness that damaged her kidneys. Which we found to be the case. Suppose she'd been in a true pre-eclactic condition. Well then she'd have been really blinded. Or threatening convulsions by the time we got there. These are the orders from Mrs. Tornetti. She must be kept quiet. No visitors. Restrict her fluids to 800 cc. Put her on a salt-free diet and record intake and output. Get a quantitative albumin daily. And take a blood pressure every four hours. What have we got? Nephritic. Please notify me of any change in her condition. I'll be in in the morning to see her. Yes, doctor. She's pretty sick. But we're going to carry her for a while and I think she'll be all right. She's afraid she's going to lose her baby when I saw the call. You two look all in. How about a cup of coffee? Yeah, I could use one. You can drop me a Presbyterian. There's a post-partum patient there I'm worried about. Almost midwinter. We had shrimps for supper, I remember. My husband said they came from New Orleans. They fly them in now, he said. He told me the second one would be easier. But she seemed harder than Daniel. Perhaps girls are harder. Maybe we'll have a boy this time. We always have a picture full. I forgot tonight. He went to Detroit two weeks ago. He said there was work there. Things have changed since my day. A man was home at a time like this. Too much sugar just makes your heart again, my husband says. You raised your children in a house where there was room. Is there more work, do you think? He said it was better in Detroit. I think it's better. We don't know, we haven't much time to find out what's going on. I didn't bring one for him. He's sound asleep, isn't he? He studies when he's not out on the case. That's why it's so sleepy. They're quiet tonight. Careful with those hands. Remember, the island of safety. What's going on in here? Just a woman having a baby. Eight pounds. I was off a quarter of a pound. You can take him in now. Now, we checked our seven points. Yes, sir. Baby in good condition. Mother uninjured. Blood pressure 110 over 70. Temperature 98.4. All's normal. That's fine. You see, our plan of delivery was very simple here, doctor. Our patient is a young woman. She'd already had two children. She has a normal pelvis. The position of the baby was normal. We had a spontaneous delivery. Now you can fill out the birth certificate. Yes, sir. You want anything? No, I'm fine. Petuitron. The center immediately. Rush this specimen over to the blood bank. Yes, sir. Hurry. Collect all the jars and bottles in the place. Put lots of water on the boil. Yes, sir. I will, yeah, doctor. Downstairs at once. This is on his way over. Give me the blood bank. This is the maternity center. We have a patient in shock. A Dr. Harris is on his way with blood specimen now. Thank you. What have we got? Pembridge. Or Donald case. What about blood? Harris is on his way now. Let's go. 60. Blood pressure 60 over zero. Fix the operating setup. What have you done? I've given up. Petuitron. Irgant. Morphean. Adjusted minister to gentlemen. Massager.  Have the glucose and saline. Maternity center. Maternity center. Oh, I am glad, doctor.