street please stand by for the san francisco health commission meeting of january 16, 2024. >> i have the privilege of reading the land acknowledgment. the san francisco health commission acknowledges that we are on the unceded ancestral homeland of the ramaytush (rah-my-toosh) ohlone (o-lon-ee) who are the original inhabitants of the san francisco peninsula. as the indigenous stewards of this land, and in accordance with their traditions, the ramaytush ohlone have never ceded, lost, nor forgotten their responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory. as guests, we recognize that we benefit from living and working on their traditional homeland. we wish to pay our respects by acknowledging the ancestors, elders, and relatives of the ramaytush ohlone community and by affirming their sovereign rights as first peoples. before

we get the year started i wanted to make an announcement. because of city budget constraints the staff needs to focus attention on critical priorities and service and the commission felt it was important to highlight those on the agenda in the coming year. with this in mind and input from dph leadership we identified four items we want to focus on during our agenda these meetings. the first being budget and contracting issues, the second being laguna haund hospital recertification and sustainability plan and two items of the four critical the mayor has identify, which is health equity and behavioral health which includes overdose prevention efforts as well. our goal is review the items and insure the public has a opportunity to both be informed and provide input, and of

course our meetings in the future will highlight other important public health topics such as the prop q hearings involving the sale of local dignity hospital to ucsf and other reports the dph staff feel are critical to having in the public record. i just wanted to make sure people knew, this year we really want to be focused and also make sure that we adequately cover those items greatest concern to the public and greatest concern to the dph and mayor's office, so i just wanted to begin the year framing it in that way. so, because we are in informational session, we'll skip approval of the minutes and the next item will be general public comment. is there any general public comment? >> yes, there are and i a few things to read. accordance with the mayor request the health commission announced at the december 19 meeting beginning this meeting january 16, 2024 remote public comment will only be made

available to individuals who receive accommodation for disability. individuals requesting accommodation for disability must submit requests via e-mail or phone by noon on the monday before health commission meetings. health commission agenda and website posting include information about the changes to remote public comment procedures and include instructions how to submit request for accommodation for disability. request to include written public comment up to maximum of 150 words and meeting minutes can be sent to health commission.dph@sfdph.org. members of the public may address the commission on items of interest to the public within the subject matter jurisdiction of the commission but not on this meeting agenda. each member of the public may address the commission up to three minutes. the brown act forbids the commission taking action or discussing a item not on the

posted agenda including in public comment. each individual is allowed one opportunity to speak per item, individuals may not return more then once to read statements from other individuals unable to attend the meeting. city policy prohibit discriminatory harassing conduct against city employees and others during public meetings and will not be tolerated. we'll take public comment from those in person and then take remote public comment from those who receive accommodation for disability. alright. i think there are a few folks in the room who would like to comment. you got three minutes on the clock. when the buzzer goes off please end your comments. sorry, the black bar is a speaker so please don't put papers on there because they will make a noise. >> good afternoon and thank you for allowing me to speak. before i get started i want to-everything that moves free to electricity and electricity creates raderation and raderation creates noise. that makes sense in a second.

public health is administered through algorithms through the public utilities and a lot don't know that because they want to keep that hush, hush. my name is christopher cline. i have 25 years of experience of investigation working with state, federal department of justice [indiscernible] miner in sociology and just recently went back to study public health because it impacts myself and others. a few weeks go i was talking about my cdc freedom of information request which showed no reportable diseases injury or illness which is problematic because in san francisco i was given false diagnosis. so, how many people in san francisco were impacted? a hundred, a thousand, maybe 75 thousand people have false diagnosis, including the people impacted by elizabeth holmes. why that is important when you have a illness or injury you get placed on public health

surveillance and that goes through public utilities with algorithms and sometimes people use that to influence people for politics and personal [indiscernible] increase business to come to the business. this is also done to place people including myself in mental health situational awareness that can change how you play softball. in the city and county of san francisco, they are using it illegally to alter softball games. that is not a way that public funds should be spent and i can prove that. again, public health surveillance sends message through the public utilities and i have public utilities request coming back with the information and i'll forward those to director colfax as well. this happened before in the country, 1918.

1947, 1957, 1976, 2019 and today and typically what happens is we have a pandemic and you basically everybody is placed on a wire tap because situational awareness to help get healthy and make sure we don't get sick, however people don't want to lose that ability when the pandemic is over and that is what we are seeing in san francisco. everybody wants to hold on to it and it is problematic because greed, personal agenda, you can cybersoft somebody, cause injury, illness. i reached out to director colfax and waiting to hear back. i'm very knowledgeable in the field. to date i have not heard back. i know it is very busy in isf. san francisco. i imagine it is happening behind closed doors. thank you. >> thank you. anyone else in the room that would like to make public comment? person in the blue shirt. yes. you have three minutes. >> thank you so much.

my name is luke [indiscernible] community organizer and advocate for streets and transportation in san francisco. as i'm sure you know, our city faces a roadway safety crisis, which dph partly oversees in terms of our vision zero program. i recently started a campaign for imlmenting and approving a city wide no turn on red policy, so prohibiting turns at red lights throughout the city al signalized intersections and nearly a thousand people supported that campaign and the board of supervisors unanimously passed resolution in support of that and the mayor disability council, youth commission [indiscernible] cac and so i'm here today hoping that in the future meetings you all can support a similar city wide no turn on red policy. some background for you, sfmta implemented a no turn on red policy at 50 intersections throughout the tenderloin after

supervisor haney urged them to do that in 2021. sfmta later studied the tenderloin at those intersections and found that 92 percent of drivers complied with the no turn on red policy despite as you probably know, traffic enforcement being at historic lows in san francisco, so a common thought is no one will follow the rules because the laws are not being enforced, but sfmta data backs that up. it also found that close calls or near miss decrease by 80 percent as a result of turn on red policy or signs installed there and finally, cars blocking intersections or cross walks trying to make a turn decreased by 72 percent. really phenomenal results from that instillation in the tenderloin so this is a effort to expand that throughout the city. there are studies throughout

the past decades that show one side allowing turn on red increasing crashes, collisions, injury and death and the other side when no turn on red policies are implemented crashing collisions, injuries decrease so it also makes it easier safer more comfortable to cross the street as well, especially for children, seniors and people with disabilities. new york city instituted a no turn on red policy throughout the city in the 1930's and then in recent years came across [indiscernible] washington dc and seattle all approved city wide policies, so there is a lot of support throughout san francisco including people who primarily drive some have told me they like this because they don't feel they have to turn on red when someone is behind them inching up behind them. currently the sfmta board and mayor breed haven't publicly taken action on this and they

are the two most needed. thank you so much. >> thank you. next. >> hi, there commissioners. my name is andy stone, with the hiv advocacy network a grass route activist across san francisco with hundreds of members and i want to speak to you about the budget projections and upcoming budget cuts to sfdph and reiterate folks who are in our community often times some of the most vulnerable and marginalized in the city. we have come a long way reducing transmission but there is a still a long way to go. we also have some of the highest burdens in terms of folks experiencing homelessness and being unstablely housed and as you know, there are lot of complicated and nuanced health needs these communities face, so i really want to urge you to

insure that these communities have the resources we need in order to be able to address for the long-term the implications of some of these public health crisis we are facing, including hiv, including things like sti increases we are seeing as well as the overdose crisis and people experiencing substance use disorder so i hope you will take that into consideration as you are reviewing any potential cuts to the department of public health. thank you. >> thank you. i believe that's the last person in the room for general public comment. can we unmute the one caller we have remotely and i have only given accommodation to one person. >> that's me, dr. palmer ww. i think this is appropriate for this part of the meeting. it is about the content of the

first and third tuesdays. mr. morewitz implied in the communication to us that comprehensive report of about laguna honda is limited to the second tuesday, the laguna honda jcc, but given how active laguna honda has been, i urge you--we deserve a update on recertification and a chance to get our questions answered on every health commission meeting on the first and third tuesday. there is too much going on and we need to know what is going on and we need full transparency. i am really worried that one of the ways we got into this mess, which is a 20 year old mess is by trying to save money on the budget and that has been very expensive mistake we do not want to repeat, and i would

like as much transparency as pabl possible and weekly reports on the first three tuesdays on laguna honda. thank you very much. >> thank you. >> thank you all for sharing your concerns and opinions. we appreciate it. the next item on our agenda again for discussion is our first hearing for the fiscal year 2024 to 5 and 25 to 26 budget and jen louie our chief financial officer will be presenting. >> [indiscernible] chief financial officer for department of public health. here to present our first hearing on the budget. in the hearing we will do a overview of our budget so you have the context for some proposals moving forward, include the base budget and then as required by admin code 3.3 we will also update you on

projected salary spending as well. we will have then provide you the context across the city of your financial projection and then talk about our approach to this upcoming budget as well as next steps. next slide, please. and then this slide after that. jump nothing to the budget overview, the base budget is $3.2 billion. we have the city's rthis chart our break-out by size as well as full time equivalent fte overall. san francisco general is the largest division we have, about $1.2 billion. behavioral health $690 million fallowed by laguna honda hospital at $347 million and then we have ambulatory care functions and [indiscernible] $175 million and dph operations which is all hrit finance

contracts compliance, support staff which supports the entire department is just under $200 million. you see the fte counts there as well. next slide, please. and, one of the important context to make when we are looking at a budget and financial forecast is one we are looking at now is really important to look forward and always important to look back and in terms of the context, our budget has grown significantly over the past decade and the blue bar represents the total budget overall in terms of growth and our portion of general fund support. proportionally the budget all most doubled since 2013, the general fund support moved in proportion to that, it has not increased as a result so we remained very disciplined about

leveraging revenue and financial stewardship, so we are not out-pacing our growth and increasing our request for general fund support, which is what our targets are placed on and so, it is the general fund support that is the portion that our instructions are based on and we are better positioned as we kept our [indiscernible] consistent as a percentage overall department budget. next slide, please. speaking of general fund support, this shows basically how general fund support is layered across all our divisions. as you know, we get significant rates from and support primarily from medi-cal and medicare, but also draw down significant grant and fee revenue from population health as well as other areas within

the department and basically what happened is general fund for the most part sort of [indiscernible] for whatever our revenues don't match so we don't have general--in certain cases we have special revenue funds, but it isn't either or, but it does create a challenge when we are looking reducing general fund because we do leverage so much and what we don't want to do is minimize the impact to the revenues we have. but we are continuing--have 70 percent of our cost maintained with revenue. next slide, please. and then pursuant to admin code 3.3, our operating budget has $1.4 billion of salary and fringe and we are on track right now to have $25 million in surplus. this is about 1.8 percent of our total salary savings. there is a few areas where some

is expected and isn't. we have about $2 million mid-year attrition savings as requested by the mayor office. 4.5 is elimination of 55fte and part of the midyear process, $3.1 million is one time shift to general fund salaries to grants and population health and then the remainder, about $15 million is for continued vacancies as we continue to fill new positions in part for the positions we added over the last few years and i also note hr has been doing a lot of work in terms of filling those positions, but we are seeing on the back end also is people leaving as we fill and so it isn't so much--there are some delays getting the new positions filled, but it is also the turn [indiscernible] not only us but other city departments and other healthcare agencies are seeing,

particularly post-pandemic and so, but we are better positioned just looking at some of the preliminary data. i believe overall our permanent positions have increased in this current year by about 150, 200 fte. still a significant gap to go but we are making progress towards that goal. i note the continued efforts i mentioned before, a lot hiring, a lot of focus, prioritization filling positions quickly could impact these numbers as we move forward with the remaining 6 months of the fiscal year and as you know, we will be providing these quarterly updates to the health commission as part of our financial statements we present to the commission. next slide, please. moving to the mayor's budget instructions, the economic realty remains challenging. there is reduced revenue

expectations as well as increased cost out-pacing the revenue growth. 9 percent employee healthcare rate growth as well as multiyear inflationary growth on contracts and other inflationary growth on dph cost of services, and because they are out-pacing it, we are looking at a fairly significant gap in in terms of our 5 year projection, but i note this isn't a recession scenario and believe the next slide will actually show--thank you kenya. i think this a incredible helpful graph to visualize what the deficit and what is driving it. that first orange bar you see is projection of expenditure growth across the city. as you can see, it continues to be--grow, a steeper rate then the blue revenue bar down below

it. recession is considered when the revenues dip-the economy shrinks and we are not at that recession moment. they are flat to neutral in the projection and so this is the worst case scenario we are looking at. as you can see, the flattening revenue and continued growth and that is the financial situation the mayor's is facing and city is facing now. should there be no action taken over the next 4 years we are looking at a $1.4 billion deficit by the 4th year of this projection. to be clear, this is not something the city can fix in the single year and so but i think it is important that this is flagged. the mayor office has been taking steps in the mid-year to curb some spending and i think that this will be a multiyear process to really turn the needle around over the next 4

years but the goal is obviously close the two year budget and have a balanced budget for the city, but also with the eye towards the 4th year to try to move the needle on that. it is a lot easier to do that with two years of planning, versus two months of planning. next slide, please. as a result, our targets is 10 percent general fund reduction target which is based off general fund support and not off the $3.2 billion overall budget and then any of ongoing savings that was included as part of midyear reduction count towards those targets. and then given some of the uncertainty the city is facing around revenue projections we see as well as our challenges, the mayor office would only take if necessary an additional 5 percent contingency target.

next slide, please. specifically what these targets look like is about $93.4 million is 10 percent general fund reduction target. in addition as part of that deficit, some of that revenue, the blue bar assumed 16.7 and $34 million of growth in zuckerberg san francisco general. it shows as a negative here because we are trying to show the negative. this is the general fund savings and gaps to show overall targets, but i know we had a question from commissioner green and understandably so. our revenues are not shrinking but a portion is already assumed but you think $16-34 million on all inflationary cost for cost of doing business for cbo, for affiliation agreement we get annually adjustment for pharmacy to keep pace with a lot of our medical costs as well as all the mou

driven costs for all our labor as well as benefits. it far exceeds $34 million, so a good deal that i'm willing to take. it is portion of revenues are [indiscernible] anything above and beyond that is then we get credit for, but it just sort of is a way of just doing the math so not double counting what is already assumed which closes the deficit. but we are still looking at significant target of 110 and $128 million over the two year budget and then we have about $8 million of mid-year savings we can get credit for so looking 102 and $120 million in terms of the gap and i note this is prior to our 5 percent contingency, so we add 5 contingency you see $150

million, $167 million remaining towards our target. next slide, please. in addition to just general fund reduction targets, we have been instructed not to create new positions and repurpose positions where we can to meet the new needs and review vacant positions. we are asked to focus on core department operation and services. reduce our cost in non essential discretionary ways and the mayor's office also is convening city departments to identify solutions and strategies that may overlap across cities so really working on this multiple levels. of course, we should continue work on the mayor's priorities which is public safety, street conditions, economic vitality, reducing homelessness and transforming how we deliver mental health service and

accountability and equity in services and spending. next slide, please. the slide after that. so, in terms of what we will do. knowing this was going to be a more challenging year, we wanted to get feedback. we had internal and external stakeholder meetings and we also created a suggestion box that is monitored regularly to get ideas in terms of areas where we might achieve savings. first and for most is leverage revenue either increasing, continuing stable revenue or cost shifting where feasible. this is a area we will always look to, but just given the magnitudes of targets, i'm not sure if we can close the entire gap which is revenues alone. we want to focus on core services and we have--a lot of the work is we have is cogent

to the department of public health, but this is where we need to double down on our mission and services and pause new programs and services where we can and appropriate--that in some ways is easier to pause a program as opposed to reduce service levels of a existing program. we will continue to focus on the implementation of new initiatives we do have that are prioritized and limit the growth of new expenditures and then we'll coordinate with the mayor's office on some of the city wide work that will be in progress throughout the spring. next slide, please. in terms of next steps, just a note, we already had two stakeholder meetings internal and external. the weeks after receiving our budget instructions in early december and we are now at our first meeting where we are

providing details on the mayor instruction and approach and at the next health commission meeting we will bring forward our full proposal for consideration and approval by that commission and should it be necessary, we will have subsequent hearings as well. the full budget proposal is due to the mayor office february 21, at which point it shifts over to the mayor and then june 1 the mayor [indiscernible] to the board for consideration in july and june and july. next slide, please. in terms of the very next steps we will bring forward a detailed balancing plan and request approval with additional hearings as necessary and as mentioned before, the submission is due february 21. also received a few commission questions. as part of the q4 financial's we did note behavioral health

had $18.3 million revenue surplus. this is general fund surplus that was a result of prior year close-outs and so one time in nature. one thing we do see is we have a lot of multiyear one time and i know this is work we have been analyzing to determine to get a estimate how much one time revenue we might expect on a ongoing basis if that makes any sense, and it is a little unpredictable. so much depends on a lot of other reconciliation, adjudication by other state and federal entities and so we are never quite sure, but it is one area we will look at to say, but we always know in general that there is upside risk as we say in terms of one time and we do have the management reserve as well so i think it a

important data point that we will look at in terms of forecasting our revenues moving forward. a question around our approach to cbo contracts and deliverables. i think overall we will be looking at the core services again with cbo and civil service and the question around just in terms of the deliverable's, we do a lot of work in terms of financial and contractual and compliance monitoring and i think we are just starting that process in terms of more productivity and performance monitoring. i think that is a multiyear--we don't quite have all of that data available and want to make sure we do it consistently but we appropriate we will look in those areas as well. and then last, i had a question about the our city our home proposition c funds, and given that it is a non general fund

source so not included in the target, it isn't included in the deficit either, but one thing we have seen with proposition c, which is funded with a single source is that we are showing a short-fall. we had persistent shortfall in the revenues. first we thought it was a blip and slow recovery but we are starting to see a trend and overall the revenues in that fund are perhaps about 40 percent lower then the city wide spending plan overall. the good news for dph is that because of some of the release of prior year dollars as we waited for the lawsuit to settle as well as one time delay in implementing programs, we are sitting on significant one time funds we are hoping to use for site acquisition, but

we do have some one time funding to help us ride out the few rough budget years as we work with the mayor's office to develop a long-term plan for this and this is something the mayor's a watching closely and we are waiting for their instruction on how to move forward with this. as commissioners may recall the proposition c budget process trails the department general fund budget process and so expect to have additional updates over the course of the spring in terms of what the mayor's office actions may be, but the commissioners--we have one time surplus available. we have used in prior years and likely use to cover in the current year as well. i believe that concludes my presentation and happy to answer any questions

commissioners may have. >> thank you as always for your concise and understandable presentation on a body of work that is complex and voluminous so very much appreciate it and i also want to mention that emily gibbs, the deputy financial officer wrote our memo that was absolutely spectacular. i encourage anyone who is really in a muddle understanding not only what we are faces but the city in general is facing, this is a wonderful memo and it is on our website. thank you so much. it is absolutely terrific. i know director colfax wanted to say words as well. >> thank you president green. also want to thank [indiscernible] and emily gibbs and their team with the work that they have done and will continue to do. this is going to be a really challenging year. i think it is important to remember we will be needing to make really significant

reductions and at the same time we are not in a recession so sometimes that is missed in the conversations is the fact is revenues are not keeping up with the growth and you have seen how much the department has grown over the past two years. hard choices to make and we look to you to help guide us in those decisions. the other piece i wanted to reinforce and mentioned this earlier as well, but we have if gauged stakeholders in this conversation early. we had a meeting, remote meeting with our contractors to make sure that they understood the instructions and context and timeline and timing of the various meetings that we are already shown to you but wanted to make sure we got the message out early and they understood it will be challenging and communication and partnership

is going to be very important as we move forward. that was also fallowed with a meeting with the human service network with many stakeholders who provide services and care and that was also well attended. just to inform you that we are doing our due diligence to make sure that we communicate when we communicate the dynamics that jenny just went through. it was productive meeting. people had good questions and we wanted to make sure they also understood the future timeline for them to continue to provide input around any questions or concerns that they might have as we go through a fiscally challenging year we haven't had for a while. just reemphasize that context. >> thank you. is there any public comment? >> public comment in the room? just reminder, everyone has three minutes and when the

buzzer goes off please know your time is up. >> thank you. hello commissioners. my name is debbie [indiscernible] san francisco human services network and we are a public policy association 25 years old of health and human service non profits. most of our members contract with the city to provide services and as community service providers who also work not only with government but with corporate and philanthropic sectors, we do bring a unique perspective and many many decades of experience to city policy debates. particularly on topics that effect our organizations and the people we serve. i wanted to come here today because we have a short paper on budget priorities and guidelines that we originally

drafted way back in the dot com bust and sadly had to bring it back today. we already shared this paper with the department and we thank dr. colfax and mr. wagoner and other staff for meeting with us. we also shared it with the mayor's budget director, with the board of supervisors and other major departments and universally all told us they found it helpful approach. the paper identifies a framework for implementing these difficult budget decisions and put forth 8 priorities and i wanted to share with the commissioners as well, because it gives a way of looking at these decisions and some of the things that you may not have thought about when you see proposals that come from the department. for example, some of the priorities and we have seen some of them in the presentation today, emphasize

the basic human needs. what is life or death? shelter, food, healthcare, the most basic core services need to be prioritized. the most vulnerable people need to be prioritized. we want to look avoiding cuts to things that leverage outside funding because we lose more that way. we want to look what can be ramped down and up again as opposed to things we will lose forever if we cut, something like a residential treatment facility owned by a non profit. if it is cut we might lose it and never get it back. we want to look at disparities. we don't want to exacerbate existing inequities. we want to look at prevention if it saves the city money opposed to institutionalization and incarceration or higher cost service. those are the factors we want

to look at. we also have guiding principals in the paper. for example prioritizing community based approaches. >> your time is up. is it possible to get a copy ramification of that? >> i have a few copies so i'll e-mail this to you tomorrow. >> thank you very much. anyone else in the room who would like to comment on this item? i see one hand. one remote public comment. please unmute the caller. >> hi. it is dr. palmer again. i just downtown don't see how you can save money on direct caregivers like nurses, non licensed caregivers and social workers without totally getting into trouble. my area of expertise is nursing homes and i know what happens when there is under-staffing

and under-training and laguna honda will be watched closely. cant afford to cut corners there and i hope reinstitution of admissions isn't going to be delayed because the budget isn't letting you hire people. that's really nightmarish. we will be sending fragile people out of county and--but i'm sure the same is true at san francisco general and the out-patient setting. it is just really scary. we can't cut and we have to actually continue to aggressively hire and give a living wage. thank you. >> thank you. that was the last public comment. commissioner giraudo. >> thank you.

again, thank you. seconded about your report. i always read these first before i look at the slides, so i better understand. one of my questions, and you basically you answered it to a certain extent, but when you noted 55 vacant positions and then my understanding is with one of our priorities, which is behavioral health, there are a number of vacant positions within behavioral health and i don't know if part of the 55 is there and whether or not those positions are covered by prop c or whatever, but i guess just trying to further understand it. >> great question. i don't have the detail in front of me, but when we looked at that first pass at 55 fte, there is no service impacts.

many have been vacant quite some time. some are hard to fill positions, some of them were little fragments of positions that kind of were just more cleaning up the system, rather then--but none of them were filled and we do not believe it will impact services and i think part of the approach as we look at vacants instructed by the mayor office is what can we reasonably do and fill and it is important--these positions obviously are--[indiscernible] let's just what can we truly spend and if you think about our growth, we will continue to grow. that is just a question at what pace and how do we perhaps ride this economic bump through and then perhaps it is more a pause

and then revisit it in future years. >> with behavioral health open positions because i know there's--they are very difficult to fill, but within this budget will there be--will they be put on hold, or will those be prioritized by dr. cumins? i'm just concerned within that area with behavioral health and what's going on. >> understood. yeah, it is concern shared by many. behavioral health is one of the mayor and department priorities. we are not slowing down hiring despite we are asked to put 55 positions on hold. just for context, we have all

most 8,000 fte so when you think context of 55, 55 feels like a large number, but spread across the department we are talking about 2 or 3 per division, so we will continue to look at it and really think about service--what impacts if any as we move forward with savings proposal but the first 55 is part of the mid-year reduction. we do not believe there would be any changes [indiscernible] as a result of the reduction proposed. >> so, within behavioral health because i think they got an enormous number of behavioral health positions open, those will continue to be recruited? >> yes, we will still continue to fill the positions and there will be--we are not implementing any delays as a result of these instructions. i think once we have our proposals and if there are

additional positions that we choose to pause for whatever reason, those will not be done, but if you think about just the larger context of our projected salary savings and vacancies we still have significant room to grow and that issue around workforce turnover, even if we did actually completely close the gap in terms of salary projections we still need to continue to hire just to make sure we are maintaining keeping pace with the workforce and we have to monitor it more closely to make sure we stay within our budget propeations and work with the mayor's office in that situation, but at this time there is prioritization being done, but i don't have details to share now, but i think the services would be provided. we are continuing to do it and rest assured. >> thank you. it was just one of my concerns as we are facing all this, so

thank you very much. >> i don't see other commissioner questions or comments. great. commissioner chow. >> certainly appreciate again the finance department and a wonderful explanation from both emily and [indiscernible] it is always concerning and i'm not sure and maybe dr. colfax can respond better on this, our work with particularly the cbo is always a problematic when it comes to cuts. everyone feels that they are doing an essential job that is within the core of what they

are doing and of course [difficulty hearing speaker] there's always a feeling that [indiscernible] i recall also that i guess you haven't had a remote meeting and then ask people to respond by way of it sounds like e-mail into a particular mail-box. [indiscernible] if you are working with any of the core providers that you identified to see how these might work and how do you balance very large organizations with [indiscernible] set up because they are people who can touch

the very special group that are not really in a large majority, but [indiscernible] i remember that when we were talking about cuts in the past, that is a fairly good example that says, well, they are a very small group, they don't have a lot of people, the impact is far less then if we took [indiscernible] and they take their 10 times the people and we have to keep that flowing and there was a question of what the balance was between very small groups and very large. i guess my questions are one, are we doing more then just passively having a meeting? are we working so when you bring your proposals to us that you have been able to actually

give dialogue on a one to one basis perhaps with the large proposals you are presenting to us and how do we balance large populations versus the specialty populations and their needs and it may not only be racial, but it may be related to disease types and so forth. >> so, thank you dr. chow and i'll start and don't know if jenny will have more to share. i just want to make sure it is clear. these are not passive meetings. we reach directly and engage in --the contractors come to the meeting and emphasize the importance of the issue so there was definitely an effort on our part to be actively engaging with the different

providers. i will say the human service network reached out to us and asked for the meeting as well and think we had good dialogue on that and it was also very clear that if people had--it wasn't just e-mail us if you have questions, there were lots of ability for people to connect with different staff at dph to share their concerns, ask for follow-up, ask for more specifics and detail so i want to make it clear this was not sort of a--i dont know how you define passive but not just a slide set presentation and here we go. there was very much a effort made to be active in the engaging in people in the conversation. the mayor has been very clear about her priorities and think we have grown tremendously over the past decade and certainly since last recession, so i think to your point, there is going to be a balance.

we are and jenny has done a great job finding--estimating new revenue sources. i think that is a really important component. the vacant positions right now there is proposals to reduce certain number of vacant positions and we can do that without effecting current services and quite frankly in some areas some of the positions are just not part of our core mission or they would not be filled, so we think that is a very important piece and then get down to the nitty-gritty looking at areas where the duplication of services across the system not only dph but potentially across other city agencies so looking at that as well and looking at areas, it is a significant public health effort is essential to the public health effort.

the most important core to our mission and so those are going to be the places where we need to look at things like efficiency, effectiveness, uptake of services and balancing that across the system of care we have and taking into account certainly the special populations you brought up as well. it is a extremely complex process, but i think that given the conversations we had with our stakeholders , the process we articulated for them to give input, the availability of staff to answer questions and engage with stakeholders i'm optimistic it won't be easy but optimistic we will get there in a way people understand the path by which we get to the final proposal that we submit to the mayor's office. >> i would echo everything dr. colfax said and also note this is our stakeholder meetings beginning of the conversation and dialogue and i'm not

involved with directly as involved with the program but i understand also program [indiscernible] working more directly with providers and make them aware of impacts if any as well, so the conversation does continue beyond just our initial meetings. >> so am i to understand if for example you're looking at--we looked at large programs in the finance committee meetings this afternoon. [indiscernible] your staff is in conversation in terms of where you might make changes or might not make changes and get their input so that when you are coming forth to us we would have a idea that there has been discussions especially on key

issues. they don't have to be in agreement. there have been dialogue about that? >> i think the timing of the conversation is going to be dependent on the process we described. there is that process by which the reductions are proposed that the health commission hears those, that there is opportunity for input in the conversations and as you know dr. chow there is a process that unfolds at the board of supervisors and mayor office as well so i don't know we can speculate on any specific conversations with any-with a specific organization or given their size or scale, but i think we will continue to go through the dialogue with the organizations and certainly if they have questions we will do everything we can to respond to them and be as transparent as

possible. >> yes, and thank you dr. colfax. unfortunately went through the cuts we had to make in previous decades and that is where i'm coming from in terms of being able to be sure that--it sounds like you are making a --certainly being open that the department is available for people who have questions and that it may be that we would have some questions about them, so in the timing of that and in order to make the mayor's deadline [indiscernible] we could complete a recommendation on the 20th if the proposal is for the 21?

is that sort the table you are looking at? >> so, our goal is to bring forward a full proposal february 6, but should a third meeting be necessary we can calendar it for the third tuesday as needed. >> okay. and that would make the mayor's deadline also, right? >> correct. we would still be in compliance of the administrative code. >> okay, there is a period that would allow that if questions arose or suggestions came up on the 6th that we would have time in order to be able to review that? i recognize this is very difficult for all of you and i will be looking forward

to--when do you think those will come before us to study before the commission meeting or are you just going to present them at the 5th? >> we will do our regular posting more work with mr. morewitz on that. the budget documents are tricky getting details right and mr. morewitz has been very helpful in letting--allowing us as much time as possible. we will with mr. morewitz to determine a schedule and update, but i would ask for as much time as possible given the complexity of the work to take place this year. recognizing as well it is important to give you the policy makers sufficient time to contemplate the proposal that would be put forward. >> commissioner chow, it is likely the final documents with detailed proposals won't be in your hands until friday before the tuesday meeting, but i will

be working with jen and if there is possibility of getting overview or ball park summary we'll do that, but i know from working with jen 15 years, everyone has to review it, comes down to the last minutes usually. >> no, i understand the great detail you all do and the very clear explanations are really helpful. this was making sure that we wouldn't be surprised on the 6th that you present a document at that time because i know how much work that has to be done now, especially since the department has grown so much and has been able to provide so much back to the public. it becomes a greater challenge then over a decade ago when we were closer to core and certainly have expanded as we have our services to so many different populations. i recognize it as a real

challenge and it is one that i don't envy our department in trying to meet that challenge and i'm sure [indiscernible] the needs and really take -counts on you to give the principals of which you have made these decisions and really recognize the hard work that has to go into doing this. thank you very much and i would imagine that if the--i leave to the [indiscernible] to agenda that particular meeting and then this certainly is one of the [indiscernible] president breed mentioned was going to be our focus and i think if we are pushing for this budget by the

21 that we should have adequate time on our agenda in order to have a discussion and allow the public to weigh in. >> agenda is clear on february 6 commissioner chow for that exact reason. >> okay. thank you. >> first of all, thank you for clarifying further all the steps you have taken with there community. that was very very helpful to us and i just want to acknowledge as commissioner chow said, we recognize what a difficult year this is and we appreciate the diligence and care the dph and also your division in particular put forth to try to get through this and try to cover all the bases and continue to offer the service s we know are so critical to the health of san francisco so we are truly grateful for the work and want to acknowledge the challenge you face as well and we look

forward hearing more february 6 so thank you so much. >> thank you commissioners. i want to echo the comments about mrs. gibbs and the documents. she prepared all of it. it has been heavenly to have her on staff and looking forward having her expertise. she has been doing budget for human service agency over a decade and look forward having her expertise moving forward. >> thank you. thank you. the next item is director's report. director colfax. >> thank you president green and good afternoon commissioners. grant colfax, health director with january 16 director's report. first item, i read with great congratulations and also sad to see him likely be leaving the department, but as you know and city knows, the mayor london breed recently appointed greg wagoner to be the next city

controller. congratulations mr. wagoner. the appointment is pending conformation by the board and as you all know, greg is the chief operating officer of dph and has over 16 years of high level executive experience working with the city and just want to congratulate him in the incredsable work he's done here, most recently as coo where he help weed the city through covid response. integral to laguna honda work and the overall expansion of rebuilding and improvement of our public health infrastructure in particular. greg has other roles as well in the city. he was the mayor budget director under two mayors where he lead another long budget series of budget processes and while we are very sad he will

be leaving the department, we are absolutely thrilled and delighted he has been nominated as city controller and wish him every success because his success and the controller office success is a success for dph so greg, congratulations. moving on, you got the budget update so will not focus on that item. i do have other information that i did want to review quickly though. going back to public health, specifically we are continuing to be in the middle of the respiratory virus surge with regard to flu covid-19 and rsv, so we are continuing to get the message out that people should get vaccinated, stay home if they have active symptoms, and also get treatment if-see the healthcare provider and get

treatmented if recommended. a important piece there. we have so far been able as a community to manage the covid-19 surge that we continue to experience after the holiday. we did report our first flu death last week. again, sadly people do die of the flu, which is one of the--key reason we recommend and ask people to stay up to date on all of their respiratory virus vaccinations. finally just another piece i wanted to call out. i was really delighted on january 8 to join dr. susan [indiscernible] of zuckerberg san francisco hospital and san francisco general at the ferry building where more then 20 sculptures were [indiscernible] 2024 hearts in san francisco gala that supports zuckerberg

san francisco general and it was wnderful to meet the artist and hear about the work and the hearts are beautiful this year and encourage you to go to the website and see those and help generate interest in having people acquire one of those wonderful pieces of art and support the hospital. so, that is my director's report and happy to answer any questions. thank you. >> thank you. is there any public comment? >> none in the room. folks, we are on item 6, the director's report if you like to--actually, the one person who has accomitation, if you like to comment press star 3. i see no hands for this item. >> i will take chair prerogative here and say to mr. wagoner everything director colfax feel we have been so wonderful and so kind to all of us when we came on the

commission like deer in the headlights and barely add 2 and 2 most of us and you and your team and team you developed and leaving behind is so superb and that has a lot to do with your leadership and you step in when needed. you have been the ultimate utility player and now we have a friend on the inside which is even better. we really value you so highly and congratulate you. i know-i see commissioner chow's hand. commissioner chow. >> yes. thank you. i certainly want to join you in congratulating mr. wagoner. also [indiscernible] during the time that we were searching for dr. colfax. it looked--this is another case in which we continue to lose talent to higher offices, so

the city controller's office will benefit and we will need to find another replacement. i did want to express my personal thanks, because i remember when he first came on and we needed to have continued financial [indiscernible] to also negotiate challenges and i must say that greg is wonderful as a controller and it certainly wish him well. i have a question on the report about the [difficulty hearing speaker] the result of the work that is being done to try to overcome [indiscernible] do we have people in the city who are

short of medications or has that [indiscernible] the work done to overcome that. >> you are talking about the sftb clinic? >> yeah, right. >> i believe dr. phillips is on the line. sorry commissioner, just trying to get you the best answer. i'm going to turn-hello dr. phillip. i'll turn to dr. phillip to provide details there. thank you. >> thank you dr. colfax and good afternoon commissioner. well, it is the work of the tb program and our nurse manager [indiscernible] who really has been working with the state to make sure there is backup supply, so the short answer to the question is that, patients in san francisco are able to get the tb medications they need but it is increasingly difficult and takes ingenuity

and collaboration and leadership at the state level shown by the leaders in our tb program to insure that continues to happen and we continue to have access to the medications needed. but for now, we are in okay shape, it is difficult situation across the country. >> thank you very much. >> thank you. >> commissioner giraudo. >> i just want to thank mr. wagoner and also congratulate you. in going forward, the next chapter. i totally agree with commissioner green in my very first meeting here as well, it was really baptism of fire and i appreciated your understanding as well as mentoring some of us through the process, so congratulations to you and to your family as

well in your next chapter. >> thank you. i guess we'll skip the finance planning committee update. >> the finance planning did have a information session because they do not quorum so the information from the session will be chaired by commissioner chow at the february 6 full commission meeting. >> we'll move to the other committee reports and because commissioner guillermo is out today, commissioner chow will give the summary of the laguna honda hospital jcc meeting of january 9. >> thank you. the january 9 jcc meeting was highlighted giving a verbal update on the recertification effort. laguna honda receives the 2567 for the health monitoring portion of the cms

recertification survey january 2 and received the similar document on the fire life safety and emergency preparedness portion on january 3. these documents show improvement from the prior cms monitoring surveys with findings of lower scope and severity so very pleased with that. the plan to correction for [indiscernible] submitted saturday january 14 and the plan of correction for the health monitoring survey we [indiscernible] january 17. [audio cutting in and out] plan of correction proposed. subsequentially, after the approval of the plan of

correction, cdph must validate the successful completion of the plan of correction. once cdph validates it they will inform cms. cms will then make a determination of laguna honda recertification into the medicare program. we are really pleased and noted that the hospital has made significant improvements throughout the recertification process and there has been a great deal of positive change in operations and in leadership over some [indiscernible] it is critical these improvements are sustained so we will never again have to deal with this situation and he wants to be sure that we can insure there is excellent and regulatory

compliant care for every resident in every interaction today and in the future. to help achieve this laguna honda will resume admission only when leaders are confident the changes and improvements made are sustained over the long-term. it is likely that when admission resume they will start slowly. the dch and laguna honda leaders know the key role laguna plays in san francisco and the need for high quality skilled nursing care and they are working hard to resume regular operations. we will continue to be receiving reports as the jcc and the whole health commission from this leadership even after we are fully recertified and there will be a sharing of the

plans to sustain these improvements and the return to regular operations during these reports. in addition to having received recertification update, the jcc discussed the regulatory reports for november and december and recommended laguna honda policies on the consent calendar, which will be before the commission at the next meeting. the jcc members received responses to the questions that were asked and in closed session we approved the credential report and the [indiscernible] and that ends my report on behalf of chairman guillermo. >> thank you. thank you for standing in commissioner chow. is there any public comment? >> there is and i will--please unmute dr. palmer.

one hand up. >> hi. the plan of correction the final plan of correction is due to be submitted tomorrow. has it been submitted? and when will we be able to see the sustainability transition plan? i hear it is still being written, but it--the public does need to see that. i would also like to be regularly updated on any ball park dates for resumption of admissions. my other question is, since people who were evicted still need nursing home care who are still alive, priority to return to laguna honda, how will laguna honda reach out to them to let them and their families know about this?

thank you very much. >> thank you. that's the only public comment to the item. >> any commissioner questions or comments on the report? okay. next item on the agenda is other business. is there any other business? commissioner guillermo. >> i'll chime in. i just-the san francisco general hospital foundation gala and dr. colfax alluded to the looking at the hearts and hearts reception in january, but the gala is on february 8, and i think it's important that all of you know about it and hopefully can participate. the invitations are online. it is not snail mail anymore, so if anyone is able to

participate it would be wonderful. thas that's my only comment. >> thank you. public comment? >> i see no hands for this item. >> great. thank you. we look forward seeing that invitation. the next item is motion to adjourn. >> you can't take a motion to adjourn because you can't take action so we can thank everyone. >> then we'll adjourn. >> thank you all. [meeting adjourned]

[music]