>> >> welcome to the city and county of san francisco health commission meeting this afternoon at 4:00 pm., tuesday, february 6, 2024. secretary calling. >> commissioner chow here. >> oh, i'm sorry vice president guillermo present. >> president green and the commissioner christian and commissioner chung before we begin we'll to acknowledge and celebrate black history month and included activity in the director's report and in addition the health commission approved declaring anti black racism in san francisco several years ago. the resolution is

actually valuable on the health commission website i want to celebrate reappointed commissioners commissioner christian and commissioner chung was sworn in a few mingles and please read the land unceded ancestral homeland of the ramaytush (rah-my-toosh) ohlone (o-lon-ee) who are the original inhabitants of the san francisco peninsula. responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory.

ramaytush ohlone community and by affirming their sovereign rights as first peoples. >> thank you. >> the next item on the agenda is the. >> 2. approval of the minutes of the health commission finance and planning committee meeting of december 5, 2023. any additions or corrections? >> if i may before we do that i'd like this on the agenda as well the website the january um, 16 meeting not a quorum of commissioners so we held an information session as a courtesy to the public i have noetd notes provided but not in a leg read into the record of the meeting it was an informal one no action taken on the notes. >> thank you for the clarification secretary is there a motion to approve the minutes? >> i so moved. >> second. >> second. >> and any public comment on

this item any public comment on the - no, i will do a roll call. >> commissioner chow dhou i vote. >> yes. and everyone in the room as, yes. yes. >> the minutes are approved. >> the next is general public comment. >> we have actually no requests for for the public comment. but i apologize. okay. at this time the members of the public may address the commission with items note on the commission up to 2 minutes

afforded when the item is reached in the meeting. each member of the public may address the commission for up to three minutes. may be sent to the e-mail dot commission.org and if you wish to spell your name do so in the city hall is prohibited harassing comment against commissioners or the public will not be responder to and remind folks in koornsz with the mayors request the only january 16th for public comment will receive combhoomgsz for disability before the meeting today and two of those two folks have received accommodations we

didn't check for public comment on the minutes so i'll go back. is anyone in the room like to make general public comment? everyone limited to 3 minutes per speaker. >> thank you. >> um, so i have a general concern and i'll speak about that. so where ask the health commission and the department of health at the false dialysis and voice technology for personal religious and personal reasons on a january was noting not a meeting and the second one no quorum but several people within the county city and county of san francisco used technology called technology and it is cloud technology that the cities and counties do this and they place every person on the

commission i would investigate that and you know what i'm talking about dr. colfax and the contract city signed with the force and built a platform for every since on digital surveillance offer dose what they did they gave credentials for people like tire neighbors and families and friends it is frustrating that there is a commissioner of the - that they are authorizing software with that technology not the best way to spend money thank you. . thank you. >> anywhere else in the room like to make a general public comment? >> okay. let's see - a hand up remote. >> caller you're on the line please let us know you're there?

>> um, limited to 3 minutes per speaker. >> aa because my voice is so here's and not able to talk as a reasonable accommodation i'm using the microsoft to make sure it is reported in the automobile unfortunately, ami having troubles with windows because the window voice used is a standard of female. thank you. >> okay. >> shaw we heard the beginning but not the comments are you still there? >> okay. i'm going to stop that comment i'm sorry i'm not sure

what we had but that's the only hand up on general public comment. >> the >> the next. >> 4. request for approval of a new professional services agreement with san francisco aids foundation - stonewall project: low barrier counseling to reduce the harms caused by methamphetamine and other substance use among gay men and other men who have sex with men (g/msm) and 12%contingency for the term of 09/01/2023 through 02/28/2025 (1 year and 18months).(emily raganold, overdose prevention and contracts manager) a. thank you very much. >> commission. >> and for your approval for 22-25 on december and to accept the gift (unintelligible) $15,000 plus for the san francisco aids foundation. which will call the homeless people of san francisco and unfortunate delays and the san francisco

aids foundation and the department of health from 09/01/2023 through 02/28/2025. after the finding of this mou we welcome the city attorney (unintelligible) the distribution of the gift. i'll be happy to answer any questions you may have. >> regarding this (coughing). >> is there a motion to approve this resolution? >> so moved. >> second. >> hear any public comment on this item. >> anyone in the room i see one hand. >> do you have public comment on this item? >> all right. i don't think

i'm hearing anything we can move on to to a vote. >> commissioner chow. >> commissioner chung, yes. commissioner giraudo thank you. the resolution passes. >> thank you and we have a pending resolution which is january 14, 2029, (5 years).(nader hammoud, san francisco health network administrative director of support) i'm the manager for the laguna honda hospital has received a donation for $24,000 plus from the trust we are

gracious for the donation and will be for the ending of quality of life and the committee must authorize the department to accept and expend the donation provided with a resolution further that the department of health plans for those funds and are replacing ask for your approval. >> thank you. >> is there a motion to approve the resolution? >> move approval. >> a second. >> any public comment on this item. >> any public comment in the room on this item and remotely i see a hand. >> shaw are you there with public comment on this item? >> okay. thank you. >> no public comment so on to a vote commissioner chow, aye.

>> commissioner chung, yes. >> commissioner giraudo, yes. >> vice president guillermo and president green and commissioner chow. >> thank you the san francisco health department and the trust for your generosity thank you so much and the next item >> 3. monthly contracts report (dean goodwin, sfdph business office) *health commission february 2024 contracts report i'm a health plainer with the office of policy and planning and to present the annual report for effecting is registrar-recorder/county clerk by the administrator code and summary of the accomplishments

over the past fiscal year and incorporated feedback from the commissioners during our committee and public health committee and a thank you to the colleagues for their collective kwoms for this report next slide, please. the annual report opens the message and welcomes from the dr. grant colfax, dph director of health and formally (unintelligible) the expansion of the new health services the reopening of 3-d and the castle health center and the other center. and finally, for the laguna honda hospital revitalization and the directors message from the former commissioner and his message discuses the dph response for laguna honda hospital reverification and the reopening

of the three aforementioned clinics and both of the providers introduction for the departments activity discussed in the report and. next slide, please. the next set of sections provide an overview and the section started by introducing the department's two definitions and their roles no promptly the san franciscans health and the next section is the dph and the 6 pilars followed by the organizational charts a report present the demographic information on the health and leadership and will data will be presented in the data reporter each year and. next slide, please. the last introductory section this section provides an overview of the structure and the commission along with the

bios for each commissioner. next slide, please. the next section of the report is three features stories that highlight the highest effort by the department in the fiscal year. the first feature provides an overview of the dph community center nationally recognized and the feature describes dph respond to the impossible outbreak what disproportionately effecting gay men and other 0 individually on july 22nd san francisco announced a public health emergency and the response was a collective effort from across the departments of the public health and the messages during the pandemic the vaccine worked for equal distribution of vaccines and many have been administered within san francisco between the

may 31st and pa san francisco to to has one of the highest rates in the united states. and dph responses is almost community centered partnership with transand community organizations. and to be awareness for the education and direct responses and response for the community. next slide, please. the second feature is an overview of the behavorial health services of overdose efforts and as you know, we faced a dire overdose epidemic and established the office of overdose prevention the feature highlights the significant process made over the fiscal year to enhanced mental health resources services including

opening an additional 70 residential - and xavndz our intact and treatment and delivering morphine to clients and housing facilities and treating hundreds of folks and the hospital across the city seen more one md and 35 doses. next slide, please. the last feature discuses how capital hill reopened three clinics in the fiscal year and the 17 helped people in the to network system assuring high quality care to address the diverse community dph is making necessary health and safety updates to the network facility and first dph opened the family health center a thriving

thousand foot clinic for pc for the behavorial health services and trader to the diverse health needs of hunters point community and understand the southeast opened the door of the stand alone clinic in 1979 and the existing heat center among the buzz and rely on the health care center and opened a castro within the cities first pc clinic has provided castro commission for the past 57 calibers and serves 4000 patients and 51 patient from the latino community and eat 50 if lgbtq plus and the center or o s

m in december 2022 was a benefit access clinic for urgent care one of the two urgent care clinics that you provide 15 thousand visit a year of people experiencing homelessness and it has increased by more than 25 percent and the clinic welcomes one hundred patients per day next slide, please. and showcasing the san francisco health network the highlights speak to the tremendous work across the departments with the healthcare serviced and behavorial health health at equity and administration as well as laguna honda and san francisco general hospital. we have incorporated the feedback

from last year to add more data points in order to serve those individuals for the programs. next slide, please. the next section of the report focuses on the data the data provides expenditures programs and major investments. next slide, please. the next data highlights the data think visits demographics and other systems the section highlights how the network provides a wide array of services and unique data is provide for each of the service areas pc and behavorial health and integrated care and mental health and pro health and urgent care and diagnose ethnic care

and nursing are included for laguna honda. further this as ethnicity and gender and in addition the data shows of the sources at laguna honda is included as well as the entire pc and integrated care. next slide, please. and the report end with an overview of the services and contractors include in the section (clapping.) are dph and behavorial health sites updated to reflect the changes and a list of community contractors is provided. additionally each of the health resolutions deposited in 2022 and 2023 are included 78 and lastly, the report included dph resources for how to find information where to get the

coverage. next slide, please. i'd like to thank the staff at dph for the alcoholic work on the reporter and streamline the report as well as provide more programmatic data for the scale of the programs and services at this time i'll be happy to answer any questions you may have. >> thank you for your time. >> thank you so much any public comment on this item? >> any public comment in the room on this item please come on up. >> and remembered three minutes on the timer. >> thank you indulge heart and soul commissioners i wanted to mention dph all the work you all did with the crisis all the community voices is part of a that conversation to make sure our community is centered and in a way in a what you that allows

the people to assess the vaccination with the crisis and highlight that part of this effort um, the work that was done at the community-based organizations we really incredible in terms of reaching the a positive recommendation that were at risk and the infrastructure in terms of public health to do do work this requires that from spreading and cut to the community-based organizations would not have undermined our structure and not respond i want to lift that up in the conversation particularlyly around the things mentioned in the presentation. thank you.

>> i see none on line 90 in any questions or comments. >> thank you for the report and incorporating your city feedback and just so the other commissioners know that our community feedback needs more data for the next report. and so we have the numbers that is served, etc. so comments that the next report will reflect that and appreciate that you will incorporate that information so, thank you. >> thank you very much. we appreciate that. >> any other commissioners questions? >> comments? >> well, thank you so much i think that and this report really identifies the breath and

depth of the department and summarized how convict q and a /* exemplar and across the commission we have had challenges i think that reports in particular outlines how hard everyone worked and um, the incredible um, and, of course, leading the nation and on behalf of the commissions at the each one for the dph work and the report shows how hard we work and how caring you are and in the leadership up here i see assistant director bob and dr. colfax our soon to be fell greg wagner a wonderful leader and we're appreciable so a comment

from commissioner. >> i think um, said enough the uniqueness of san francisco in the city and county of san francisco as well as? a department that has oversight and in charge of hospitals pc it didn't get spoken to enough how complex the modification of all the things that happen in the department and, you know, really the - i think celebration of being able to contain all of that under a single administration is really important to understand and as much a lot more to do and a lot we can try to be a lot better

and pointing to the uniqueness of city and county of san francisco having the responsibility for both sets up a range of services the city and county has and being able to remind people that san francisco that the department has charge of the hospital on the clinic and all the other things that the public health has congratulations and thanks again. >> thank you very much. >> thank you. and wonderful. >> so i guess we go to the next agenda item and that is the second hearing on the 2024-2025 and 2025-2026 budget our chief

financial officer. >> i'm truly grateful she's present the documents and as you recall our first hearing we've done a biggest overview and provide the context for the introduction and with the detail proposals back we for the requesting of your approval for the controller's office on february 21st and didn't meet our contingency tatter for the mayor's office at this time next slide, please. so our work

will continue beyond today's hearing and the proposals are required and required more challenging a reduction and significant problem from a to b the city the governor has the state budget we are grateful no significant adverse impacts to to the areas of health. there are other areas of the proposed state budget could is have an adverse impact and they need to be adjusted in the forecast and currently the city attorney is working on a 6 month report and the preliminary numbers show no significant improvement in the projection we're all and do have the labor negotiations. and. next slide, please.

with all of that news our approach for balancing this budget is to leverage the revenues we have in the general fund for we have incredibly impressive function that with we are um, project by project and including our first line of defense in terms of a general fund restriction and we are working in the reductions and expenditures savings that really we're trying to minimize of the services and to conclude adjusting just budget to tills and finding operation efficiency and taking positions were for the impacted because would not effective currently serve levels we are able to see how we

provide security contracts with our security. next slide, please. in terms of proposals before you i'm as you recall the general fund our first defense is $93 million and we also have additional revenue about 16 and $30 million are assumed as part of the controller's office forecast offset the inflationary costs we can't double count that open our side of leverage and the controllers side we have works the mayor office close to $8 million and we'll receive credit for those with the usual target to our goal for today to reach the first (unintelligible) at one hundred and 2 and

$20 million and speaking i'm going back to the assert revenue functions putting forward $72 million and one hundred and 2 in the second year and the balance of expenditure savings 21 and $25 million over this finish line have got a down payment of $25 million and leaning towards our contingency targeted will remain about $47 million annually again 9 three over the two years and $90 million to go with that, i'm going to turn it over to ms. gibbs to talk about the initiatives themselves and i'll be happy to talk about the next

steps. >> thank you good evening, commissioners and deputy finance officer for dph and. next slide, please. and to our initiative we are looking at the a package because of that 80 percent the initiative targeting with revenue this is the last 20 percent is with the expenditure and the headquarters of our revenue is our updates in the baseline revenue for the health network and for zuckerberg san francisco general hospital will net us $25 million and in 2025-2026 reflecting a number of things with the pole year-end for fy2022-23 and the good news

that was in that as well taking a look at where we are in the current year with the revenue we're earning. so a mix of (unintelligible) by looking at the fiscal year current level of service that we're providing so good news there and a lot of that it bans the revenue target and put that towards of offering projects and the next is a change at the state level with the program. the supplemental program one directed by the state through the management of their plans and a discussion pending with the final medi-cal and medicare and likely will button if or that in the proposal in 24, 25 and

$16 million in 2025-2026 and the health service revenue in 24, 25 and grows to $4 million in 2025-2026 with the alignment (unintelligible) and four is commission recognizing our ability to lurch and with the administrative costs as well as staffing costs (unintelligible) those are existing expenditures that are within the grant we get to shift over to the grant revenue and recognizing that clinic in our project and savings about $3.5 million. next slide, please. we got and we get to enhance the services and there the revenue

the zuckerberg san francisco general hospital and able to have the operating room capability for $5 million a year and that is on increasing our staffing and right now we have been 5 (unintelligible) with the staffing we're going to add about seven hundred and 12 hours for the facility and based on that (unintelligible) the main factor we'll be able to have more operating procedures and generating more revenue. the next couple of notifies in our package are mutual generating enough revenue those are increases to our special pharmacy programs as well as

equipment and critical departments services, and have an additional appropriation for our pc and returning more in the - snechz and a 12 step program with the pilot for medi-cal revenue and we'll be able to bring that in the budget services and the hospital is $51 million for $10 million in the second year and additional revenue other set for the general fund and this is the - (unintelligible) the first of these is the savings for healthy

san francisco with the equity with the extension of medi-cal and single it out we'll have the enrollment in healthy san francisco dropped and the good news for our patients and good news for the providers getting this encouragement. and then on our side we'll reduce the administrative costs and the providers for the super patients. so we're seeing those savings at $2.4 million and 3.7 in 25. next slide, please. here we are russ our ongoing budget vaccination costs that is this is in recognition we have seen decreasing numbers of our patient and community members

and turning to the pharmacy for vaccinations and using this over time so we're going to reduce our budget accordingly and still need about one million dollars for vaccinations. (unintelligible). >> these four on the next slide, please. this one is a shift (unintelligible) so mental health service app that a 10 percent tax on incomes over one million dollars and some revenue growth there. we are also, we. next slide, please. we are also um, anticipating some potential changes to that measure march 24th ballot

proposition one redirects that funding within the mental health service act to prioritize housing and other initiatives so located the changes as well as growth in the revenue projection we are recommending shifting about $2.6 million in the existing housing program and less than $8 million fund by the general fund on to the health services act and generated about four and a half million dollars saving a year to the general fund. >> and. next slide, please. this recognizes a data strategies with the operating budget at dph so proposing

working with parking in 2425 and part of the 60 mission and some of the offices in the building and then we will ultimately have a lease savings of one half a million dollars a year and anticipate moving into a building has security resources and saving for security as well. we are also reflecting this initiative to belt-tightening by the it department one million dollars and one-half in cost savings. >> and. next slide, please.

so we ask folks to reduce the emissions and the initiative included 75 full-time and vacant positions a variety of different strategies across the departments. and if was cleaning anti partial position have a full-time position but fill it reducing by that .2 and reflecting on the position and eliminating the positions from the co-funding for operational responsibility and eliminating did the filled possessions to be minute missed. >> and. next slide, please. the last two initiatives are a reduction in the university of

california san francisco affiliation agreement costs $.6 million a year and looked at it their inflation and recognizes the savings there and the last one is about looking at krarlt out for the security services this is kind of our ongoing effort to work with the security team there and the departments to find the right strategies for staffing security at our hospitals and at our clinics. this is one initial proposal will work with the stakeholders and additional levels of approvals and the board working with this direct commission with an initial outline that changes from public

to private security and (unintelligible). >> hospital care but that - and also a little bit of some vacant positions on the campuses not filled and combination and they'll explore the i wanted to put that out there and the total savings here are about 21 and a half million dollars in 24, 25 and gross to $24 million in 26. next slide, please. brings up our remembered that total we got to get a little bit more than the general fund reduction in the proposal and a

couple of more on contingencies and my colleague to talk about the next steps how we're thinking about the result next slide, please. >> and so while we don't have a proposal we wanted to be transparent but looking at the next 4 to 5 percent in the prior years and not had to use the contingencies but likely lead us to proposals and working closely in terms of the next steps and match our some - cross city departmental working groups we are prasht in conversation around secretary as mentioned

and response for the children and youth the idea there's a lot of difference between the multiple departments a way to combine them in terms of how we see services and some will continue to the spring and in addition at an initiative around contracts that don't lurch the outside funding and as you can see the revenues are very important to um, either financial stewardship and challenging at times taking a look at the reduction of contracts and lurch the revenue this is the area we'll be looking at we're not in a situation have is to cut one dollar to achieve $2 and looking

at areas where it maybe that appropriate to contract out the services we're able to maintain service levels without a budget delivered in a more comprehensive manner and continue to look at the hiring and develop a plan and position the authority for the upcoming to your budget and see what we can accurately fill over the next two years and continue to look at revenue while we look at it in revenue options and still waiting more information around medi-cal applications and laguna honda and been silent on those revenues but looking to laguna honda to get more information and a change to the existing partnership for the financial

staff all this local health departments and information was hoping for an update potentially this spring and that will also can be factored in and last but not least looking at medi-cal and under cal theme there is an second year the budget around populations and jail health and to see if there is an intelligent to leverage revenue for a jail for services for when in our jails and related to that entry services and focused on - not a lot of - some initial details not head on we need a

requirement (unintelligible). next slide, please. in addition to those general fund savings ideas continue to work with the mayors office on two, that are for the general funds but our home and in the prior years working with them throughout the spring and chauvinists in those revenues and we'll work with them to sustain a long term plan for spending we have. and in addition the settlement fund new for the current year an opportunity to revenue the proposed spending plan we have now any opportunities to um, improve our plan for our current state. next slide, please. and then in terms of next steps

i'll cover the 21 and march and may continue to collaborate on this and build a contingency and work with the mayors office and keep the commission update in the terms of timing and then at june the mayors will go to the board for consideration for june and july. >> thank you we appreciate this report it is helpful for us to better read and the understand the context items and several commissioners wanted to make a public comment and i have your card and we appreciate want to hear from our fellow san

franciscans so i'll call your name and secretary will say you are limited to 3 minutes per speaker and will be watching the clock i apologize if i mispronounce your name welcome. >> good afternoon, commissioners. my name is stephen. s t e ph e n and i'm a voter in san francisco since 2008 and i've been living with hiv since 2012 had a whole thing prepared but i'm unnerved by the general funds sorry 2007 and 2008 with the healthcare act. and we've been good using that money for general funds and a

lot of this going my colleagues and i have to say sometimes, it feels like we are holding the city together with our two hands and the kit to the bone. so a few years ago our aaron shelters and others are still killed by this virus it looks like with the trauma and mental health and looks like overdose dedicates are much higher than than the vaccinations in the city and we can't afford to make cuts to our reduction programs and mental health programs and very

essential services. i urge you you to not make kits to the essential services. thank you very much. >> thank you very much. and next is megan green for the seiu 1021. >> hi there. i am a non-my name is megan i respectable on the hiv panel and oncology unit i want to give you guys a number my unit alone on february 22nd from fall to october we - and 5 hundred and 11 (unintelligible). >> there were 2000 delivers

and went to arbitration and every single was fulfilled we were filled are travelers. and no sbes we're at add and one hundred and $69 million plus how much anyone has been used in registering staff that money is from last summer one hundred million dollars for this for more registers and was working last christmas with a nurse in a swing shift she was working two and they go back to their city and invest in their city and two

wrongful terminates and many hours of overtime and i am a .9 employee i worked one hundred and 18 thousand units and take that that is one hundred and 9 people. and so i'm not sure where this text comes from it is very concerning and the city data from neighboring hospitals can't retain staff we hired they get their training and go to, you know. and kaiser permanente and may tax dollars and everyone's tax dollars goes to

training those nurses. so there are some things i want people to think about and 7 b the unit 9 of their staff including the managers (unintelligible) i think that is really important to think long and hard about cutting this program. and i pressed the emergency button more time than i called. >> we should have three people come as once to have more time for comment this next three people will be oliva, paul, and david piles if you want to come up we'll start with alicia.

>> hi, my name is alicia and i have been in public health and work in the foundation i've been here long you have in what those resources do for the community and working in an under serving community if you cut the programs you cut their services for the mental health and making the situations harder than they have to be and cit the programs effect the people living with hiv. cutting those programs and more people are struggling as well as the struggle with mental health and drug use and things

of that nature i think a lot of this have survived in the bay and so if you cut those budget will make a negative impact. um, i guess you don't i don't know what to say i'm very emotionally and see how grateful people are and how much joy and i'm sad to see the cuts in the budget. >> thank you. >> thank you. mr. aguilar. >> good afternoon, commissioners. and dr. colfax

i'm paula q u l ar and i'm a generation - and here to advocate for the mental health services survivors for hiv and aids, aye. >> the love of my life just end his life had a heart attack and i found myself homeless and before any 18 birthday in 1981 and 6 months - not through that rainy period but the programs

funding by the isolation by long term survivors and it is critical over and over again. cutting any funding for those mental health services or programs is just servicing the community and only traumatize the community. in the community. >> like to point out cutting any service programs in the city negatively impacting the city's ability to - thank you for your time. >> mr. pile. >> good afternoon. i'm david pile. i have lived in this city

for guarantees over thirty years here in the 80's when aids what scary to love people died and friends and family. (clearing throat) since then we've come a long way with medication and preventing people from hiv positive or people healthy who have contracted aids keeps them healthy and relatively living a normal life you can't imagine how that effects killing us like saying 10 percent of people he went over the budget and most people will not get the services they need and i'm here to ask that you - thank you. >>. thank you. >> so the next three is

laura thomas and robert mitchell. >> and start with laura thomas and good afternoon, commissioners laura thomas the director of the policy and san francisco aids foundation and first of all, i want to say thank you for all of the work this department has done. pushing need to push for approaches and get over this crisis (unintelligible) this is a public significant public health crisis and in particular one of the items mentioned in the presentation over a settlement fund, you know, millions of dollars coming to

the clinic in san francisco not, however, been any sense as to our community input around how three money is spent and hoping for this commission and the health commission to look at how, how the dollars are spent the things i know can be effective and getting over the crisis and overdose and encouraging mental health services we know what really the department has come up with (unintelligible) and knowing what works and what gets people in treatment and what is substantive treatment consists of about the values and what

gets people in treatment and to continue to lift up as evidenced as mentioned and continue to self-confident on the things we know works with prevention centers and includes expanding methadone and change the regulations and providing funding for mebt methadone what works and thank you and (unintelligible). >> all right. >> hi there my name is leila and i'm here to implore the commission not to cut the community-based organizations that provide essential services sophomore san franciscans we're coming out of an unprecedented

pandemic and cit back the services many of the residents relay on this at a time we're on the cusp of poverty. and we're working with the nonprofits for over 10 years and seen shifts in individuals having access to city fund programs and speaker card i'm reminded of one of my clients experiencing homelessness and dph able to connect with services and get pc and supporting the management has not - individuals like that like the rest of us deserve to have healthy life and when someone needs management those are long term costs in terms of

chronic long term hospital care. we as a city on the productivity history we need this lifeline and wanted to say many of the members sponsoring spoken here i admire the survivors of hiv and we have a history of supporting those in terms of mental health and a legacy i'd like to see to continue. thank you for your time today. >> thank you. >> robert mitchell. >> good afternoon. >> my name is robert mitchell i represent the group pause which is a grassroots group that knows the effect of hiv. and (unintelligible) and also, we are under the umbrella of san

francisco very good work they attempted to do and i'm just a volunteer i don't have any particular reports of statistics to share by people in crisis and take a look at one example i believe the number is something like that 800 and 60 people died last year of overdose. what would have been more if not for the people coming together to train (unintelligible) and services are available another example cutting down the transition of hiv. and very well but we should - still in epidemic propositions we'll

continue to have more. so i suggesting and hope i shutter to think the services will be cut. and should be done soon and hiv in particular i wanted to stress that a concerted effort that i very much appreciate what you've done with the efforts of commissioners and churches willing to serve the needs and volunteer to to be on the ground - makes a huge difference and if cut i'm afraid we're see more transitioned and lives lost. i feel that is just taking a look at this and look at this example

far and wide you never know but if this is allowed to walk up again, it will effect you and even if it didn't effect individuals i'm sure - said to make that make my statement known as a person and like to (unintelligible) services and i hope you continue to help others. thank you very much. >> thank you so much. >> our next that are jessie and david count and andy stone. >> good afternoon commissioners i'm jessie and felt repetitive and have the

privilege of representing our 12 hundred members that work at the laguna honda hospital their registered nurses and nursing assistants just about every job in the hospital. and as the city and the department of public health are looking at those difficult budget decisions i think the thing i said to raise today to your attention and scrutiny on it the use of contracting out with the agencies and agencies because we believe that the department is over the relying on those kinds of services and what that means is that one is that osgood city

jobs don't go to the workers in our community and instead going to, you know, travelers and for temporary jobs stable positions with the city and impacts patient care because the lack of continuity of care is permanent in house staff that know the residents and know the patients the providers all of that the department uses um, temporary staff only here for an are short term contracts and not short term work that is permanent it is permanent work. i have the privilege of greeting all of the new hires at their employee orientation and at laguna honda and a lot of them tell you they

first were hired as a temporary agency or traveler. and i refer they refer to themselves and because that was the first opportunity to work and then months later if they're lucky get a call from the city to get a temporary position or idly a position in the city that is the city to be recruiting and paying people to starts who come in the door as legal service workers and i had one example also that i can share from laguna honda a big a radiology department the hospital has made the decision to. okay - all right. thank you for your time. >> thank you. >> mr. kent.

>> you're welcome to submit your public comment after the statements. >> hi, good afternoon health commission i'm a queer san francisco resident and work with the san francisco aids foundation and part of advocacy network i know that is important for the organization supporting people living with hiv and at risk of hiv roadway given the ongoing challenges. i want to specifically mention as a critical component to address the emerging health crisis ongoing overdose crisis a community organization are important part of this reaching the vulnerable population and long term survivors can face critical challenges from the out break of crisis and subsequent pandemic with covid and that

transpired this at the onset of hiv crisis and issues dealing with the individual aids and context of issues at people are trying to self met indicate and face the challenges. and this is a crisis for high suicides and mental disorders and similarly advances hiv aids and die from the come indications on unhoused it is incredibly challenging and truly effective mentioned for hiv and cutting the funding for organizations serving our community including funding for the core groups and mental health counseling and this will be devastating. i want to

elevate this you've heard; right? not just numbers we're talking about cutting from organizations those are people with real lives and faking challenges. without the funding and um, those organizations that service the community members will not access many - the consequences are dire. we need your support to assure community access the services and we urge to maintain the funding for the services and programs those are life and death issues for our community thank you for listening. >> and hi, i'm david hartley been here for thirty years and been a u of drugs and i have

utilized public health programs both in terms of dealing with those issues and in terms of mental health and harm reduction i am a survivor of suicidal ideas and drug eye that founded on public services and department of public health programs. so that's my experience i also am a citizen and i hand out harm reduction slides and supplies forget about that and what i want to echo and the you - also want to thank up front what you did in terms of advocating for policies during this covid crisis and seeing the political push back. but you

stood firm and unpopular policy i think this is another time i hope you reject any costs for management policies any policies that goes to public safety community funding. we are on boots on the ground; right? and we know we're not just here for numbers we know and we know you know so dollars are not going in one place and we're advocating for (unintelligible) and one other thing i want to leave you was that this was - we wouldn't be having this definition you about people of color and reminded was walking down the

street and there was people who are helped by funding from the department of health were there when their pregnant advocating and getting to the point where they bleed on themselves. so take away the dollars from the programs that forget this carbon monoxides and thank you for your consideration tlangz for having us here. >> the next wilson and i'm sorry. >> good afternoon dr. colfax thank you for allowing public time i'll been brief. i want to for the most part say thinking

about the many people i have the honor of serving in public health nonprofits next month and i want to point out a few things i know you are observing in our foundations and duties when i think of potential cuts i'm concerned about the emotional, practical and financial support. and whole personal care. san francisco as you can see the city by the bay. the city of st. francis and transformative service is a city of protest. but thank you for your service. but it is note just good enough and appreciate the speakers that spoke about the tasks of mental

health and transitional services. and continuity of care that is the key function here and at the commission and the director dr. colfax i know you are once again in a tough fiscal year policy i'm very - i don't envy you but it is my duty as a citizen and someone that cares about the citizens. that i will take the time to think about the people. who would be affected by this and i won't assume you may know have had or continue it is see lives effected. i just ask could i you have you happened to

serve policymaking body and ask you all take the time to figure out how you can avoid this drastic cut and few keep increment of our cut will cost and i think that the city deserves our leadership and care and stewardship to get things done throughout the covid crisis and lastly, i think that the administration are - it's for me not about a job but care. >> your time is up. >> thank you. >> matt korman. >> good afternoon. commissioners dr. colfax and i'm

the new executive director for did panel and thank you and you're procedures and thank you for the public health challenges with including hiv and lift up this agency and commission working with you at (unintelligible) as evidenced and want to express in any sympathy for the departments i know you're going through to make cuts and want to say evidenced based on san francisco mold of dealing with hiv and aids is a worldwide thing and every single medic you can measure the hiv treatment and care and you name it so far

ahead of the other cities and far ahead of the world and we are a crown jewel. but it is crown jewel and your honor, you to make the cuts but support of effort and sustain those efforts. thank you. >> thank you. >> mr. paul. >> good afternoon, commissioners i'm paul and - this thing you're budget i know three things one is that your budget reduction (unintelligible) causing the staffing reducing the staffing vacancies and providing the services and for the police services by the members here and those positions a lack of

candidates. it is too long for them to hire why you can't hire people you want but focus solely on staffing a better solution and look at the second point that i'm going to make cutting the services they are not the best incentive for the services providing in the community and the last point i want to make on the budget reduction pride for san francisco and in conclusion, i'd like to say in order to make the future brighter for san francisco as us heard from megan

we get overworked and burn out. and contracting out if you look at the budget for the 2025-2026 this costs us double contractor don't care about services they don't care. you should do that a better solution we need more people that live in san francisco rather than contractors i received 10 to 15 public service contractors. okay. (unintelligible) try to do that in conclusion, like for you to consider to the vacancies for reduction in the burn out and vacancies and double for the years 2025-2026 doesn't make sense. and with the budget and

(unintelligible) out here so let's not use this solution but let people know that the critical services are cut in the community that lets address those by hiring people and not lean on the solution of hiring contractors they're not reducing the costs. thank you. >> that was the last paper i had anyone else in the room wishing to speak? >> money on the public comment line. >> we have two hands and thank you, you have an accommodation from me by yesterday at noon to speak remotely and ask i for the two letter code for accommodations. >> caller are you there? >> yes. this is dr. palmer can

you hear me? >> yes. >> i support jessica of 1021 and a nursing home residents need care and having temporary workers will be ongoing problems at laguna honda and the loss of certification and not getting it back. the people of san francisco can't afford that majority for the scope of laguna honda and the need permanent staff (unintelligible) for nursing home cases. also many patients at laguna honda who do not need nursing home care are for the safely discharged to the community because adequate care wrap around services is not

available and so these other types of care need to be fully funding or laguna honda cannot be used in the most efficient way and so i don't see defunding staff and services for the department of public health and all and any discussion? of that (background noise.) really very frightening. thank you. >> thank you. and one more. >> caller please let us know you're there and with the code. >> i don't have a code. >> i don't need a medical commendation. thank you. >> to one is able to make a remote public comment that's the last one. >> first of all, thank you for being here. and coming forward with our info active and passionate comments and also for

those of you who shared your personal stories and moving and important and part of the public record we are appreciative and hope you let the board know and we'll hear from you so we'll few move to the commissioners questions or comments commissioner giraudo. >> i want to thank you for the great demo i read that before the presentation because that really does help us to understand what is behind us so i highly encourage to continue that practice that um, ms. laura has done and most helpful in time of (unintelligible) that

you, your captiontion is helpful and lair tell the board how they can find the memo and we need more information. >> number one, if you haven't got one and watching few or in the future the health commission page on u.s. and the health commission is a tag and see that at the bottom of this page. >> and we're having more grandular information. >> commissioner christian. >> thaupgz for to the budget people for making this very clear to our folks for naming them and the proposed cuts that helps us to helps make it really

visual for us to understand what those cuts mean not just we're getting rid of one million dollars but incrediblely important and it makes it potential for us to do our work. >> thank you commissioner giraudo. >> thank you i want to as endorse the comments by the fellow commissioners. >> thank you for the presentations for the work that's done and i think this is probable the most difficult budget i've seen since on the commission i want not to understate the appreciation and this work in the time of the changes in the department and coming off the difficult issues with laguna honda and some other

things we know recently this made us use every single penny from the general funds so other source of funding and i know that the additional contingency budget will cause a lot of pain and not to things that have been both well established as well as the things we want to initiative in regard to to keep san francisco a model a place for needs and encourage, you know, all those involved to listen to the testimony and able to come as well as we know exist in our neighborhoods and throughout the city has the same issues and more dire ones and people are

not able to come and testify to the extent the commission can do anything to evaluate for the difficult decisions that have to be made, you know, this is our job in terms of wanting to provide that for us as well as for those in san francisco and again as a a native san franciscan i've seen a lot that the city has to go through and many so i think all the people you've employed will be note looking any more of those and support for all of those that came here today and those that represent really i mean it hits home and hits the hardest to. thank you very much.

>> all right. and commissioner chow. >> thank you. >> i also want to echo to my fellow commissioners. >> could you stipulate councilmember morgan you're faint. >> well, i'll fix the vacuum volume and thank my fellow commissioners and appreciation to the employees and the departments for the very fine work and very difficult situation. to be able to come up with a proposal that has really minimal service to be able to be initiative innovative with the ability under the expenditure proposals to make it so that

they actually have a man and woman and have there costs i believe (microphone feedback). >> improvements in the services of the potentially by actually for example, emerging with the enhance themselves and in which we've be able - (microphone feedback) drastic cuts that (background noise.) . so no question that if we are needing to do our additional 5 percent contingency everyone will need to figure what is the potential if their community organization no limit to what we

have to be able to do but that is where our department is going to (background noise.) working with our key players to deliver those important services (background noise.) and um, we would be a very sympathetic president indicated (background noise.) unfortunately, if the city revenues continue february in the (background noise) (microphone feedback) there are will need to be same way and minimize the impacts upon the public health of our city. so i again want to commend the department for cleaning up

with this first budget (background noise.) and in the community or (background noise.) retail service cuts and look forward to the fact they will be working with our (unintelligible) in order to make (microphone feedback) likely a difficult task so. thank you very much. >> thank you and dr. colfax has come. >> thank you president i want to thank emily with regards to preparing this budget and a good job was challenging to come up with a reduction and come up with the ideas but i think that is really incumbent we minimize the reductions on the needs with

the available outcomes and thank you commissioners for you're support and comments and thank you for public speakers for what you brought today and you're heard by the department. thank you. >> thank you very much. we then should entertain a motion to approve the budget is there a motion to do so. >> i so move and second. >> i'll second. >> now roll call. >> commissioner chow, aye. >> commissioner chung, aye. >> >> dmorgz, aye. >> commissioner christian, aye. >> commissioner giraudo. >> the budget pass. >> thank you for the comments were so elegant and to the point i appreciate all you've done. >> thank you for being here. >> the next item is the director's report. >> dr. colfax.

>> good afternoon dr. colfax. >> dr. grant colfax, dph director of health with the director's report. >> i'll go through fairly quickly and didn't just want to present a verbal update by own january 9th the california department of public health updated the isolation and the? guidance from 5 days of solicitation for 24 hours without medication symptoms and isolation has changed and the depth reviewed that with the california department of health and non-healthcare congress and transition outbreak can be changed and more protective than the - we have the updates on our covid web page as well and in

terms of written report a highlight i'll delighted to announce the director of primary care and in her positions will provide 14 primary care centers and in the podiums will supervise the support and shift to the dental services and provided oversight of primary care services and in the robert roster that dr. gregory is well-qualified in the position. and about sb the bill 43 that

modernize the laws went into effect for those eligible for the cover forship and co-chaired by the public health and aging and adult services as a part of implementation the department of aging have provided healthcare for the professionals and february 21st trained many employees and this has involuntary - and develop the implementation of tracking and closely improve the controls and with the covering forship that is appropriate and next item

with regards to the laguna honda hospital update. laguna honda hospital submitted plans and corrections for the recertification survey. the fire portion was submitted on saturday, january 13th and the health monitoring on wednesday january - for medi-cal services and at this time laguna honda with full approval for the corrections and then dlemgs into the program and as mentioned the at the beginning of meeting and continue to celebrate black history month and kicked off with the black celebration for staff on the center at february 1st and the event had remarks from dr. butler

associate director of the health initiative and dr. green and myself. and a performance by the black history month and to confirm the strong commitment for the services and reducing the barriers for high quality healthcare. another piece i have wanted to highlight laguna honda hospital posted secretary services and last week the secretary for uk. and staff at the uk f - on the campus had important conversation with regards to reproductive health and nationwide that is g team were

able to share their firm commitment and leadership and their stories around training providing for a portion of care and other respect healthcare services not only own jurisdictions zuckerberg san francisco general hospital to anyone regardless of their emergency but they continue to support the training of professionals to do this work in other communities and what we've seen across the country where we - essential healthcare productive healthcare and abortion services are no longer provided and the update afternoon the test covid positive is 8 percent and people from with covid in the hospitals

and 20 percent of sf residents are are fully up to date on their covid vaccinations i'll be happy to answer any questions you may have. >> thank you and welcome credit gregory. >> thank you for highlighting the reproductive services at the general and especially the secretary. >> any public comment. >> wonderful. >> so, thank you. >> well directors love that. >> i want to introduce myself and say hello and thrilled to take on this role of primary care it is important with the wellness and those who are vulnerable in the city so of with the amazing primary care and grow especially in the areas

access to care and working closely with you. thank you. >> thank you. dr. gregory congratulations. >> any public comment. >> please feel free to continue. >> this is. >> (multiple voices.) >> go back to work. >> and public comment. >> let me - first on the line please let us know you're there. >> as of january 22nd laguna honda hospital failed 4 hundred and 46 residents and seven hundred and 10 residents on october 14th and 2021 are four hundred and 50 people. the health commission was told on

january 16, '28 residents no longer have - so the 48 from 4 hundred and 50 only had (unintelligible) nursing care will transparent 4 percent from the seven hundred plus residents (microphone feedback). >> immediately work with the patterns to resume the admissions and now process 57 residents face mandatory discharge. and mandatory for 2022 (background noise.) 20 died from trauma and - we

need to contact the 45 residents two did not die enormous have skilled nursing and (background noise.) - the comments is completed? >> all right. i'm taking that as a yes. thank you very much. >> one more. >> hi caller let us know you're there. >> hi that's dr. palm eerie wanted to ask the people in san francisco gets their questions answered about laguna honda on the first and third tuesday of

health commission and tell laguna honda to stay and so i'd like those questions answered how many of the 48 people waiting as of january have been discharged and what and where are their what is the timeframe we need to know as much as possible about saving the approvals for the plan of correction. um, are there negotiations we need to know more. >> it is so - dependent on a transition plan i heard that was the reason the data (background noise.) belated timeframe but those of us who need nursing health bed at laguna honda wait

indefinitely or transfer away from our our family or how will laguna honda reach out to the families and to them they can prioritize them for admission please advise us. thank you. >> at the. >> that's the last public comment. >> and there are any commissioners questions or comments from the director's report. >> ? >> commissioner miller thank you, dr. colfax and a conversation with the secretary viewed or recorded or comments we can read to see what the back and forth was that's a great question. and . >> we'll follow-up with you to provide the access to the public documents. >> i image that was recorded

but for future engagement like this and recorded and made available to the public comment. >> we'll try to do that we have the services. >> thank you. >> and other questions or comments so the next item is the finance and planning committee update. >> good afternoon commissioners. >> the finance and planning committee met right before this meeting. and there were quite a few items had been discussed first of all, you know, you look at our contract report earlier we are going to extract four contracts from the contract report that includes the study center, the um, seneca and the

contract from the - because some tipis and information and we're not comfortable with that. and also the other things i want to mention, you know, with the san francisco aids foundation contract were an error in the amount in the total revenue um, the total revenues. under the ongoing years. the amount under the total revenue should read one million dollars $50,660,000 and not $2 million 5 hundred and plus million dollars so some of the other questions we actually

have discussed to make sure that we got enough of information to measure the services, you know, not with breaking down how much goes to there we really are imploring the whole staff of like the contracts the more diligent in putting that in the report so we can go ahead and move that forward i believe some additional questions that commissioner giraudo has with - which outside services. and richmond area and that the going

to spend some. >> yes. yes- >> (multiple voices). >> two things one i'd like to of it's. okay. i clarify and four contacts taken off and put on february 20th if necessary receive the information that may come to you and i have number one, the committee heard more detail about the contract and i believe they commissioner pulcini we of the comfortable moving and we have the information like to do that before you vote during the meeting i can pass it out right now. >> any public comment on this item. >> i want to ask about the agreement in the agreement it stated um, interpreted that was

for the first initial year and subsequent years with the minimum is 45 so i think that that is something that is three 2 - and then, you know, like they also account for the staffing hours. so that that it is clearer. and each year like what the initial years is one million dollars so subsequent years is $1.5 million so i building that we are going to get similar contractor agreements and the other organizations that we have um, contracted with. >> and just another note on the contract with internal health had that 48 is the minimum and you have the list of services that the services are

wrap around and the seeing the folks not just for pregnancies but for several years and that is determined with the impacts or for children and i'll let the commissioners speak about that. >> that is pretty self comparison explanatory. >> i appreciate the photocopy but i'm with this by in the contracts we need more information. that is part of wrap around services how many people are they intending to serve? >> and i assume this is over years. in the future with should

some of those contract with the community-based organizations when they have said written in the contract that there is feedback to the engagement on how many were actually served for example, be targeting, you know, 48 but if at the serve 29, then we'll ask for a renewal of contract or whatever i think that if the future with the data same way we need to know some um, i mean - i know other commissioner require that so that's all i'm worried about. >> commissioner at i advocated for that and i did mention it

like we have quite a few children and families services contracted that i'm pretty sure the commissioners and (laughter) like i hope we can catch those data like you said we have to measure the impacts otherwise we're throwing money in the wind. >> that's fine. thank you. >> one of the things that was clarified for me at least one of the things the potential of contact, you know, it does seem like a lot of money for relatively small population but a difficult and vulnerable population and was clear a lot of the salaries to deal with the critical staff that is really

requiring the full range of wrap around services we talked about how hard particularly in the community organizations i think that is an important clarification or important piece of information in addition to the need to break down the number of hours that in the contract for this and breakdown that would a range of services that is more drips active - we the kind of outcomes that are inspired that is helpful and think that, you know, it is the kind of thing we said and hoping

wouldn't have to cut. yep. >> commissioner christian. >> i testify i was here and looking at commissioner thompson o commissioner giraudo and you commissioner chung asked so hoping in the future why not require this is necessary for us to do our job i don't understand. >> i know, i know you are but i'm going to say that is difficult for someone for the like an accountant and understand but we shouldn't have to ask those questions should be provided. >> (multiple voices.) >> and contract to be considered. >> yeah. >> and we also have highlighted like why it was - so clear what is provided how many

hours up and coming so that 0 the dollars were accounted for and especially in this time we have stone mindful of budget we have things to ask and absolutely so mr. horowitz will play the bad koch and put forward additional (unintelligible) and i believe the person next to me has a little bit more authority. >> i i don't want to burn the ceo those for things not - but a way to show them how to do what we need to do - what they need to do for us not before we go forward on this. >> commissioner chow.

>> yes. thank you. and i agree with all the comments that my fellow commissioners made on the committee and observations. i want to add a respective we are looking at either the contractor older existing (unintelligible) it is often we don't see the within what the um, whole context is for those contractors and actually comes from a solicitation out of state for a project on equity based internally housed and approved for black african-american and tried to explain we didn't have

that when we were looking at the documents but turned out they live with partners and you might have seen the entire concept and each of those programs come and where the others come but for the memory enough for the d c m and the homeless children network coming in and understand where those programs are headed they are part of the (unintelligible) we're participating in so see the types of services and programs and actually be helpful in this very vulnerable consolation and we understand where the contractors coming in to our overall picture of our

initiative in various health things. we need the that when we were implementing we created an entire picture of what ethics should look like and able to contract (background noise.) part of that and while that is a different type of contract i think we were able to see the over arching of objectives and it was he helpful for the contractors respectfully. >> so that's my comment i think once they had the contract it makes a lot of sense but putting it into where we are actually as part of the the program helped. >> thank you. >> dr. colfax and thank you,

commissioners i appreciate the comments and the perspectives that were shared and assure you the department will respond honoring those concerns he and errors that came up earlier today with the contracts and acknowledge that will for the continue and hearing two other areas one is understand how the contractors fit into the work we've done and with the contracts more quantitative think outside the box executive session of outcomes that are required by the contractor agreements that is appropriate and back to staff. and we will come and work with the secretary to make sure there is a process by which the feedback is provided to respond to your concerns. >> i think the um, matrix of

discrepancies with the quantification and looking at them, you know, out of context in each so i think that is what has helped to provide along with the button so we know it it takes time to put all of this, you know, in the types of format well-thought-out creating, you know, whole new set of procedures and context that, you know, over time will happen. but it is much for incumbent on the period of time with up and coming the difficult financial situation we're only not just the departments but contractors. commissioner chung. >> yeah. the appreciate that is bold and within testify and

qualitative we've been discussing that important a link time not the outcomes like if we don't know the outcomes how do we know if we sunshine continue doing that. it is a thing to say the overall fatality we'll be interested in knowing this and the services and prevention and do well with like tracking. i think we can could that as well for the other types of programs. >> and again, following up with commissioner chung i agree you're being very nice not only necessary to know we think we hear about the beautiful work

done and um, but what have we learned in the past throughout the places as well as the beautiful work we thought was getting this um, isn't working we need to do something different so we have t&e have to have the um, generated but at some point, when the grant they come and outcomes at that point so far we can get them or come back and report on the outcomes i did so we need it fight i'm sure anyone has done that already. >> we have in meetings. >> and i guess those comments are amenity i've wonder like many things with maternal health and

with the sad outcomes and goals and said and maybe i'm concerned about maybe you can give us feedback what is realization and the vacancies and set forth but may we don't have toy vent this work so we can immediately contact the best practices and evaluated and other jurisdictions and so we can then have something to go by. >> my last comment the directors i've told him he loves when i state it like we can come up with some type of like analysis to all those services we have are funding. >> i second that comment.

>> so president green to respond to your comment dph has a book that mandates that contractors use you have not seen them but you've been monitoring and any part of the document but they have been a requirement and did contracts a year ago and that's something we're going to request and commissioner christian the incorporated point dph side is separated out a separate goal and it is important but the outcomes with a group of people and the city is requesting they put it together and work on that and definitely will be measured just not getting that information. >> perfect. >> thank you for that will be helpful to see that

maybe more specifics by other best practices especially for programs beginning so very helpful. to have. >> great. so we'll do the community report from the i can't think meeting and with the consent calendar commissioner chung can make the motion and go to the report. >> commissioner chow. >> thank you on january if we heard reports from the staff from the department of medication and turn out out and knew that but the department within the medical staff has a connection administrative chart

of administration and multiple services that it offers and well worth reading to understand what the department really does and appreciate and said to comment on that and also wonderful work being done by the department of zoology and the fact they're making progress and the next to do staff training. context problem. on your consent calendar the department of - congratulations staff updates on

the previous meetings and the department rebsz and sustained decided the features rooemdz that you approve on the consent calendar and in a closed session we approved the - as (background noise.) i'll be happy to answer any questions you may have. >> thank you, any public comment. >> folks on the line i thought there was bus no public comment. >> commissioners questioning egging questions or comments. >> seeing none, go to the consent calendar and commissioner chung. >> thank you president green i think the consent calendar we'd

like to respect the february 24th, report to make sure we are only approving the contract the dph region have three contracts in the report and we are seeing the other reports with updates and hoping e hopping next commissioner meeting in two weeks. >> if i may clarify the admission to approve the including as is cb tracking the contract seneca to the contract and the sf study center in the february contracts reports everything else is okay. and

voting on the contract amounts and we'll take that a motion. >> do i have a second? >> second. >> no comments so i guess we vote. >> commissioner chow, aye. >> commissioner chung, aye. >> commissioner giraudo, aye. >> president green, aye. >> president green and vice president guillermo. >> the consent calendar passes and next other business. any other business? >> any public comment on other business and i don't see hands and wearing on that item as well no hands. >> motion to adjourn. >> mo. >> second. >> roll call vote. >> commissioner chow, aye. >> commissioner giraudo, aye. >> commissioner christian, aye. >> president green, aye. >> councilmember colliver and

commissioner chung. thank you very much. [meeting adjourned] >> item 50 is resolution calling on department of public health to provide medically necessary transition related care for transgender related people and remove restrictions. >> in 2012 gender health sf was born out of advocacy from community stakeholders and local leaders. really as response to providing quality, accessible jnder aaffirming care for the most

under-served. (indiscernible) the way i see it, there is two ways of folks we serve at our program. the first wave of folks who never imagined surgery access was accessible to them. many folks who had to save money or par ticipate in underground economy to access the surgery outside the country. (indiscernible) really to make something real in terms of being able to connect with the gender identity and external (indiscernible) and so transform so many lives of many of trans folks who never imagined it was accessible to them. now we are in the different era and time where transrights is in the social political and general (indiscernible) and now we are serving young folks to support them and making sure their gender identity is connected to who they are, so providing a space

to support transfolks to live authentically and that is the goal to provide the level of care trans folks deserve. >> when it comes to access to healthcare, while we all believe in cost control and make sure we deliver healthcare in a cost effective manner, i dont think that cost is a reason or legitinate rational to exclude people from healthcare (indiscernible) colleagues i ask for your support. >> thank you supervisor wiener. colleagues on this item can we do this without role call? same house same call, without objection the resolution is adopted. [applause] [music] hi.

i'm san francisco mayor london breed i want to congratulate sfgovtv on 30 years of dedicated service as a broadcast channel for our vibrant city. you played a critical role during the pan dem and i can worked keep residents informed. adapted to changing situations that allowed our residents to engage and participate in government. thank you for 3 decades of informing and inspiring and connect the people of san francisco as the voice that ♪♪ >> san francisco! ♪♪

>> this is an exhibition across departments highlighting different artworks from our collection. gender is an important part of the dialogue. in many ways, this exhibition is contemporary. all of this artwork is from the 9th century and spans all the way to the 21st century. the exhibition is organized into seven different groupings or themes such as activities, symbolism, transformation and others. it's not by culture or time period, but different affinities between the artwork. activities, for example, looks at the role of gender and how certain activities are placed as feminine or masculine.

we have a print by uharo that looks at different activities that derisionly performed by men. it's looking at the theme of music. we have three women playing traditional japanese instruments that would otherwise be played by men at that time. we have pairings so that is looking within the context of gender in relationships. also with how people are questioning the whole idea of pairing in the first place. we have three from three different cultures, tibet, china and japan. this is sell vanity stot relevar has been fluid in different time periods in cultures. sometimes being female in china but often male and evoking

features associated with gender binaries and sometimes in between. it's a lovely way of tying all the themes together in this collection. gender and sexuality, speaking from my culture specifically, is something at that hasn't been recently widely discussed. this exhibition shows that it's gender and sexuality are actually have been considered and complicated by dialogue through the work of artists and thinking specifically, a sculpture we have of the hindu deities because it's half pee male and half male. it turns into a different theme in a way and is a beautiful representation of how gender hasn't been seen as one thing or a binary. we see that it isn't a modest

concept. in a way, i feel we have a lot of historical references and touch points throughout all the ages and in asian cultures. i believe san francisco has close to 40% asian. it's a huge representation here in the bay area. it's important that we awk abouk about this and open up the discussion around gender. what we've learned from organizing this exhibition at the museum is that gender has been something that has come up in all of these cultures through all the time periods as something that is important and relevant. especially here in the san francisco bay area we feel that it's relevant to the conversations that people are having today. we hope that people can carry that outside of the museum into their daily lives.

>> the bicycle coalition was giving away 33 bicycles so i applied. i was happy to receive one of them. >> the community bike build program is the san francisco coalition's way of spreading the

joy of biking and freedom of biking to residents who may not have access to affordable transportation. the city has an ordinance that we worked with them on back in 2014 that requires city agency goes to give organizations like the san francisco bicycle organization a chance to take bicycles abandoned and put them to good use or find new homes for them. the partnerships with organizations generally with organizations that are working with low income individuals or families or people who are transportation dependent. we ask them to identify individuals who would greatly benefit from a bicycle. we make a list of people and their heights to match them to a bicycle that would suit their lifestyle and age and height. >> bicycle i received has impacted my life so greatly.

it is not only a form of recreation. it is also a means of getting connected with the community through bike rides and it is also just a feeling of freedom. i really appreciate it. i am very thankful. >> we teach a class. they have to attend a one hour class. things like how to change lanes, how to make a left turn, right turn, how to ride around cars. after that class, then we would give everyone a test chance -- chance to test ride. >> we are giving them as a way to get around the city. >> just the joy of like seeing people test drive the bicycles in the small area, there is no real word.

i guess enjoyable is a word i could use. that doesn't describe the kind of warm feelings you feel in your heart giving someone that sense of freedom and maybe they haven't ridden a bike in years. these folks are older than the normal crowd of people we give bicycles away to. take my picture on my bike. that was a great experience. there were smiles all around. the recipients, myself, supervisor, everyone was happy to be a part of this joyous occasion. at the end we normally do a group ride to see people ride off with these huge smiles on their faces is a great experience. >> if someone is interested in volunteering, we have a special section on the website sf

bike.org/volunteer you can sign up for both events. we have given away 855 bicycles, 376 last year. we are growing each and every year. i hope to top that 376 this year. we frequently do events in bayview. the spaces are for people to come and work on their own bikes or learn skills and give them access to something that they may not have had access to. >> for me this is a fun way to get outside and be active. most of the time the kids will be in the house. this is a fun way to do something. >> you get fresh air and you don't just stay in the house all day. it is a good way to exercise. >> the bicycle coalition has a bicycle program for every community in san francisco. it is connecting the young,

older community. it is a wonderful outlet for the community to come together to have some good clean fun. it has opened to many doors to the young people that will usually might not have a bicycle. i have seen them and they are thankful and i am thankful for this program.

states of america and to the republic for which it stands. one nation under god, indivisible, with liberty and justice for all. oh yeah. oh, yeah. yes. oh president lyons, i'd like to take roll. please do . commissioner walker here. commissioner benedicto