>> >> >> >> >> roll call, please. >> commissioner green? >> commissioner cristian? present. >> land acknowledgment. >> ramaytush oholone land acknowledgement 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.

thank you. >> the next item on the agenda. 2) proposed action: approval of the minutes of the health commission meeting of may 7, 2024. *minutes of the meeting of may 7, 2024. so moved.. >> second. >> is there any public comment on the item? >> we are on the minutes. there is usually a person that comments on the minutes and wanted to make sure you are aware we are on item 2. i don't see any hands. >> all in favor say, "aye". >> aye. >> any opposed? wonderful.

thank you. >> the next item. general public comment. >> at this time members of the public may address the commission on items that are within the subject matter jurisdiction but not on the agenda. each public comment may have two minutes. each individual is allowed one opportunity to speak per agenda item. >> at this time, members of the public may address the commission on items of interest to the public that are within the subject matter jurisdiction of the commission that are not on this meeting agenda. with respect to agenda items, your opportunity to address the commission will be afforded when the item is reached in the meeting. each member of the public may address the commission for up to three minutes. the brown act forbids the commission from taking action or discussing any item not appearing on the posted agenda, including those items raised at public comment. please see page 6 of this agenda for information regarding instructions for making public comment. 4) for discussion: director's report (grant colfax md, dph, director

>> thank you. >> give me one second to pass something out. >> please begin your three minutes. public speaker: good afternoon, health commission. my name is chris. i have spoken here a few times. public health is going to be getting some great counselors on the 22nd. it's a great first start but there is a bigger issue that we talked about last week and hopefully will talk about the potential resolution. i just handed out a draft letter that we were requesting that all

politicians, commissioners, public health and safety department will sign off on it and we have been doing a lot of meetings, public speaking with the commission and 12 different commissioner meetings. i'm going to read it. the statement will be. will you invite the commission and on anyone giving access to public health, safety systems. >> false injuries, false illnesses, donations, illegal placing and altered for personal or religious reasons. we are going to be giving to the

board of supervisors and this is from all the systems that we have. there is an acceptable uses policy for all systems. this is pretty much in line. some of the wording is a little bit different and we'll leave that to the city attorney to sign off on the draft and everyone will sign off on it. and there are guidelines. you need to equal the subscription. if you take out abcd, that's information data, technology, the prescription is not going to work. that's what we are looking at. someone is using these systems to take out data and add data to include this. so you can be sitting on a

computer and cyber talking to someone and the person thinks that you are hearing these voices and that's concerning. they want to take more drugs, they want to drink more. that's what we are talking about. this is not public health, not public safety. they are trained to do their jobs. someone gave out these credentials to people who have no business doing public health, public safety. that's what we are talking about. thank you. have a great day. >> there is one remote public comment. a person who received accommodation. i'm going to unmute you now, sir. are you there? >> public speaker: i am. this is patrick. i am speaking on a topic that is not, repeat, not on today's agenda. so again, please don't cut me off. for testimony for today's health

commission meeting, i inadvertently stumbled on 511, i was totally flabbergasted reading it. don't apologize, don't explain, a social justice leader providing a $50 million foundation with guillermo. didn't mention guillermo's appointment in 2018. reported that the president for 15 years. guillermo screwed up badly. the article was substantiated when california attorney general baca announced this. superior court -- guillermo from director

officer for fiduciary for any california or other non-profit corporation for three years. april 2025. that stipulated judgment in resulting allegations that guillermo violated charitable trust laws was ironically announced seven days before it was to be certified. it barred guillermo from any charitable organizations for three years. how does she get to keep managing the operating budget as part of the judiciary governing body and for low-income and is a member of the health commission. why is guillermo still on the health commission. why is she still chair? has guillermo no shame? we should

expect. leaders like guillermo should take responsibility for their actions. she stead fastly refused to take responsibility for her actions. she apparently tried repeatedly to ask guillermo and she never apologized nor explained what was wrong. the san francisco hospital being sold by common spirit. didn't abstain from the health commission approval for ucst for the two hospitals. the case involved allegations and failed to file federal income forms. that's it for public comment on that item. >> thank you. >> next item on the agenda is director's report. director

colfax. thank you, and good afternoon commissioners. i will be going through a few items and happy to take any questions. the first item. matadorsey introduced legislation for opioid treatment. this will require san francisco pharmacy, one of the medications to treat opioid disorder. this legislation is by supervisors and will make it easier for individuals to have this life saving treatment when they need it. an important piece of legislation going forward in that regard. >> another item with regard to behavioral health is that mayor

breed announced plans to have an assisted living facility in the valley for more than 55 san francisco senior citizens. laguna street currently serves as a home and board and care facility. this facility will provide a home for providing 24 hour care for dealing with health necesseties. this is the building in the area that the city needs to purchase. i'm very excited about that. we are also highlighting several -- in regard to the calendar and may is mental health awareness month. and we are doing that in many

ways including social media campaign to highlight our diverse and culturally competent programs and recognizing asian and native american and hawaiian heritage month. and as an example of that, deputy director of health, joined mayor london breed at a reception ceremony for members who are in san francisco in the community for the past century. also recognized aanhpi community by hosting internal events and in training awareness for behavioral health services. last week, we celebrated nurses week which is nurses makes a

difference, which could not be true of la honda nurses and treated a period of restructuring laguna honda to be a model of skilled nursing facility. i was pleased to be able to join the laguna honda leadership team last friday morning during shift change to celebrate and greet the nurses in appreciation of skilled nursing appreciation week. it was really great to engage with the teams and visit many of the neighborhoods at laguna honda. and happy to see how excited people are about the improvements at laguna honda and how committed the staff are to continuing our journey for making la honda, the best it can be. in other news, i wanted to note

that one of our employees received the rookie of the year award. maurice de la cruz won the rookie of the year award which was presented at the 2024 emergency preparedness training workshop. this continues the journey to ensure that as we bring in our team and emergency response, that we bring in the very best and brightest and it says it all winning the rookie of the year in a statewide competition. that's really great. >> finally, just vsfg continues to focus on the department of equity that vsfg health and hosted its inaugural ceremony

and director addressed the full house of awardees and staff making it clear that equity continues to be our priority and you can see the number of awardees recognized there. just an exciting piece as we continue our journey recognizing equity in the department as well as of course our focus on health equity. that's my summary of the director's report. i'm happy to take any questions from the commissioners. thank you. >> thank you for that summary. and sharing the celebrations and honorees. it's wonderful to hear your report of great news and a lot of accolades for people who deserve it well. is there any public comment? >> is there any public comment in the room? is there any remote public comment? i see no hands. >> any commissioner questions or comments on the director's

report? okay. seeing none, i guess i had one. do we know when it comes to the pharmacies, do we have any idea how the public will learn where they can access. sometimes pharmacies keep closing in the city at such a great pace and if there is anything for example on the website or any of the emergency apps that might help people find it easily, know the pharmacy that have it and access it more rapidly? >> i appreciate the question, commissioner. i think the main thing is that it has to be prescribed by a provider. i think when they go on emancipation they are asked where they would like to go to pick up their medication. we

don't inadvertently prescribe it at one of the commercial pharmacies and we don't prescribe it to someone -- and if they are told that you have to go to another pharmacy and the provider has to find that out in someway or the patient has to be given this opportunity. it's really about making sure when someone is prescribed it they have to carry it across the city. we are focusing on awareness and we want to make sure that people understand. i think in the midst of our opioid epidemic and

deaths, of the narrative there is some sense of hopelessness and what can be done. i think we can lift up to ensure that through people telling their own stories and the use of methadone cut the death rate by 50% which is better than most medications advertised on tv. i think it's really important that we make it more accessible and we change the social norm about the importance and the value of these medications and make sure that as part of the society, they are available on all pharmacies like most meds should be. >> thank you. there were people that had to be to three pharmacies to get it at one time. do you know when it

will be available? >> i have not heard of a shortage. the day that san francisco has to ask for it, would be a good day. >> thank you. >> the next item on the agenda is laguna honda hospital and rehabilitation center and update. good to see you. >> thank you, good afternoon, commissioners. director and ceo of the san francisco health network and executive sponsor of laguna honda hospital and cms command. normally i'm joined by our ceo, but sandra stayed back to work on some items. she's working

hard. before i provide the update, i would like to provide a brief update to admissions to laguna honda hospital. since we announced the medicaid program, we discussed what this means for accepting new admissions. this is an excellent question because we know the role that laguna plays in the city with the healthcare system. this is also why we are working tirelessly for medicare certification. full certification means medicaid and medicare certification. we achieved medicaid from last year. laguna will resume admissions once we are certified in both programs. that means the medicare certification. we believe that is important because it will show the facility has a clear and definitive staff approval from

our cns federal regulators. nonetheless, while we are awaiting full cms recertification in the medicare program, we are going over all admissions, plans, processes with a fine tooth comb. you have seen those come through the commission in terms of revising policies. we have also reached out to all former residents who were transferred to other skilled facilities as part of the reface of the recertification. we are pleased to share that many of those who were still in nursing facilities have expressed an interest in returning to laguna honda. for those residents who still meet the criteria for skilled nursing care, those residents will be the first priority for new admissions to laguna when we

findly receive our medicare certification. once when laguna receives our medicare certification, we will make sure if there are any additional comments from cns regarding our process and then we will update our policies and procedures and they come back to the health commission. we will keep this commission updated on the staffing conditions and the medicaid recertification journey concludes in the future. moving on to our presentation, next slide. given everything i just mentioned in terms of the status of admissions, it's clear that laguna remains focused on our medicare recertification and sustaining many of the long-term

corrective actions that have been put in place over the last two years. recently, we have surveyors on laguna to different capacities, one april 18th through the 19 for a december recertification survey. in addition to being here for that december 2023 medicare recertificatation survey there were two previous plans of corrections related to fall and review one reported incident and 21 anonymous complaints. we are happy to report that there were zero deficiencies identified from that long awaited medicare december survey. and there were zero

deficiencies identified related to those two fall. so the team is very proud of that achievement and finalized that plan of correction to move forward with our medicare recertification process. we are at laguna again to review an official reported incident and anonymous complaints. you know in the world of skilled nursing facility, we do a tremendous amount of training with our staff in terms of making sure they are aware of their responsibilities as

mandated reporter's, particularly of abuse, and obviously the facility for laguna pretty much, we report things to our regulatory agencies a couple times a week. so it's not uncommon either that we have self reported or anonymous complaints and to make them aware of those complaints. our team was there april 29th through the third to review reported incidents from the month of march and april. we are happy to report that all of those instances were resolved without a deficiency. there was one deficiency received and again, that deficiency, the plan of correction is being worked on by the team today.

there are two plans of corrections that the team is working on with the goal of having those finalized and submitted back to cdph by close of business on thursday of this week. again our goal is to move this as quickly as possible so that we can assure cdp and cms that we are ready to take that final step towards recertification. as i mentioned that these facilities and reporting anonymous are important and that families and concerned citizens are heard. we take that process seriously

and train our staff for anyone that reports inappropriate or does not meet regulatory compliance because only when we are aware of problems that we are able to then correct them accordingly. so while it is definitely a challenge having surveyers at the facility on a monthly basis, we think it's a necessary part for transparency and residents in the community and makes the institution a better facility.

on discharging process, and for most of these residents is on a level of care that is a boarding care. we discharged a few patients and most of them went back home or home of a relative or supportive housing for wrap around services.

currently there are 36 who have a need and some that don't need the care and those that are in need of residential care under 65 years of age. we continue to work with all of our city agencies and other including working with the california department of health care services and our local medicaid managed health plans who now under a cal aim reform ensure that the residents have an appropriate level of care. we are really marching all of these key holders to find a placement for these individuals who are some of the most challenging. and it's been a year since

april 2023, we have discharged 20 residents. it's a testament of the tenacity and dedication of the staff to really work with residents to find particularly community-based care resources for them. so we will continue to provide this to the jc c in terms of finding appropriate care for those who no longer need skilled nursing. >> that concludes my presentation. last week was nurses week and there was a celebration at laguna honda. i want to shout out to our nurses who play such a key role at laguna. it's not just a hospital but

also their home. our nursing colleagues play a major role to make sure that whole environment is safe and regulatory compliant. at this point, i'm happy to take any questions or comments that you may have for the organization. >> thank you so much for the update. is there any public comment on this item? >> is there any public comment in the room? i see one remotely. >> public speaker: this is patrick. it is concerning that you have received more deficiencies. were they immediate citations again? members of the public deserve to be told just how

serious those deficiencies were. that's why there is an anonymous complaint with the result of deficiencies and that will affect their recertification timeline. admissions that have been halted for 25 months and to just 421 patients and medicare and revenue is at the fifth quarter of the 2023 financial report and whether it was under its own volition or chased out by local 21 nurses. has cms shown up for any site visits to address anonymous complaints. have they received more deficiencies in addition to the three deficiencies in april? the consultants suddenly leaving in the absence of having obtained full medicare recertification and with no date

to resume certification is very worrisome. supervised by hgsf to ensure they are ready and that will jeopardize recertification. the bedside nursing care to offer immediate coaching to correct deficient nursing care. williams, just presented at the conference on continuation of the remedy to be part of the nine steps sustainability plan to ensure substantial compliance for regulations. without this, what will happen with the cbi program that nurses are complaining about? if this

commission can deal with the curtailment of the strike? thank you. >> that is the only public comment for this item. >> are there any commissioner comments or questions? >> >> thank you very much for the update. can you walk us through the 2567. when does the public see it, and again if you can remind us because the timeline of what cph does and doesn't do to respond to corrections. and when there are holidays coming up. i wonder if you have an answer for the questions. >> thank you for the question. the reason sandra is there now

to get the pilot correction completed, we will submit that again with a goal by the end of day on thursday. typically, cdph has up to ten days before they are required to give a response. however, they have made it clear that they are aware of our need to really move forward with our cms recertification and has given us every indication that they will do a full review of the plan. i think we have gotten pretty good of that. the last time they did a correction, they accepted them without edits. that's one of the reasons why sandra is there now to try to do with these two plans of corrections. they will be submitted on thursday and cms has roughly 10 days where they will try to truncate and get it back to us

sooner and hopefully for approval. we have already started moving forward with some of the corrective actions that are required so that unless there are major changes which we don't anticipate are based on all the work that we have done so far. there will be a good place to turn around proof that we have successfully implemented the plan of correction so that the goal would be after that they give us approval of a plan of correction that they perhaps do what they did the last time which was actually accept the plan upon document review. we actually gave them a quite detailed information that showed we fulfilled all the components of the plan, the correction and until they were actually able to do a desktop review and approval and we are hoping that will be the case this time. i'm saying we are hoping because they all deserve the right to

come and do an investigation. we are hoping our documentation will be sufficient and that they will feel that is not necessary and will do a desktop review and approval. so, in order for us to get our medicare recertification which is the last thing that we need, we need those plans of corrections to be validated and completed by cdpa and cns. it is our understanding that once those are concluded, then cns is in a position to say whether or not they feel we have met all the requirements. from our perspective, we would have felt that we have met all of those and we have completed any outstanding plans, corrections, that have been completed and approved and are then just at the whim of cns to decide when

they are going to give us that recertification back. >> thank you for that. commissioner guillermo? >> given what we are waiting for since april have not yet been received. do you anticipate if there have been any fri's from may and in a survey that might also affect the timeline? >> so we have received the 25, the plan of corrections. >> yes. >> in terms of, we of course are always reporting and of course not aware of any anonymous

complaints. at this point we are not derailing anything from the timeline. again, it's out of our control to know about complaints prior to these investigations. which is why we are doing our best to minimize a window for something that might or might not occur. >> thank you. given that cdph, they must have stepped up their timelines for surveys for starting investigations and on anonymous complaints. do you anticipate that is going to, given there have been past tries that have not been investigated in years past, that this is a new method going forward?

>> yes. i do believe so this will be new going forward and as incidents occur that they will not allow before years and years to pile up. they will be there on weekly or biweekly basis to resolve any issues. >> that is beneficial to have those investigations started sooner because we could address any deficiencies or any concerns that come out of a survey or investigation sooner and make the corrections because we are set up to do that. >> that is correct. >> thank you. >> i wanted to also celebrate what they went through earlier with no findings and that is pretty much unprecedented so we know. just to reflect on that. as we move on our journey with medicare recertification, we

don't know what's going to happen, right? with regards to cdph and cms and surveyors can be on now. and for medicaid. and the team has been working really hard and there are possible scenarios going forward and some impossible scenarios that may go forward. i just want to make sure that there is a desire for certainty and that staff has worked so hard in an environment that is often shifting and where there are different dynamics change.

we would love to be able to provide the commission with a clear map and if you look at how laguna honda is performing, we are optimistic. >> this has been a roller coaster for the last two years. we can do our part but the regulators have the power and they control the timeline. >> thank you so much for the clarification and also for describing the new normal that hopefully it may in the long run do better. if anonymous complaints were addressed immediately and do hope there is a certain degree of trust and now they are becoming familiar with which may be reflected in the acceptance of the no deficiencies. and at the laguna meeting, when you look at all the other skilled nursing facilities across the country, it seems

like it's also normal that there are multiple deficiencies, multiple investigations and multiple needs for plans of corrections. and i suspect it will be worse, well, better for the quality, but also more likely given the current administration's interest in improving the care in skilled nursing facilities across the country. our hope will be that what we have done and how laguna has approached this which actually san francisco has been in many ways the example for other facilities across the nation to follow. as they face very similar issues that we face at laguna with smaller populations that are less complex than ours. we look forward to hopefully good news and appreciate your report. >> thank you. >> the next item is our coo which is our fy23/24 third

quarter financial report. thank you for being here because i know your teams are meeting a lot of deadlines right now. we thought we might have to flip the order of the agenda. so we are very happy that you are here. >> this is. this is important and happy to present the 3rd quarter financials reports and chief financial and financial officer of public health are here to present to you our latest projection based on our 3rd quarter findings. in the big picture, we are looking at a surplus of $120 million combined and $101 million revenue plus and $19 million of expenditure saving and $13.8 million is expected as part of our actions in response to the mayor's midyear

reductions. it's a portion that are even assumed and what you have left is about 89.9 of surplus remaining. once you take out those calculations. this 3rd quarter represents about a $22.7 million improvement compared to where we were in the 2nd quarter. on the revenue side, $12 million on improvement and revenue side, $10 million. going into it a little bit more detail. we have three more quarters to go and as mentioned the reflexes of the midyear reductions that we have made as well as the improvements that we've had. behavioral health revenue is $30 million higher than budget in part due to improvement as a result of better than expected

performance in behavioral health revenue as we were anticipating changes to payment reform and how we actually bill. we actually sort of had the conservative baseline for the year's budget and there were no adverse impacts and we were able to move forward, but obviously there is still a lot of work to be done and that's a portion of improvement and in addition about $13 million related to one time settlements that behavioral health has received. moving to the hospital for san francisco general's projecting to be $20 million higher but two-thirds of that is one year payment and delayed payments and the remaining is $31 million of ongoing revenues. in addition the hospital is projected to receive about $20 million of transfers from other areas of the departments to

off-site increased cost for inflationary and due to registry. laguna honda hospital, first, this is the first time we have made a projection in terms of the revenue impact for laguna honda and for the prior quarters, we have made an assumption that the revenues being baselined and for two reasons, one was for the recertification issues that you have just briefed on. so it's unclear on what to expect in terms of census. and we were waiting for an expected change for the facilities in their supplemental payments. now that we are in 3rd quarter, we have learned from the state that this payment will not be coming this current fiscal year and will not be

recognized. we do think this is significant and will be working with the mayor's office on what the impact would be one time should we get this payment because it would be retro active to january 2023. we are trying to understand the timing, but we understand that it will likely come. notification sometime in the 1st quarter of next year with end of payment the next calendar year. that's a guess. and given that we have any changes and certification will not have any material impact with the fact that we have been through 3/4 and we thought it was time to put that projection as part of our year-end as well. this $52 million is really a shortfall as it relates to

census with no expectation to our supplemental payments. in addition, laguna honda, the figures you see here reflect about a $20 million transfer due to recertification. we were not planning to have a recertification effort, but of course all the efforts -- and we are not taking anything for granted and those costs will continue. with this updated revenue, this will be scoping through the basis of what we are working on and working with the mayor's office in terms of our contingency projections and working in may which is a tough budget time and we'll be going over the ongoing revenue and we are getting a lot of new one

time settlements and some may not be recognized this year but expecting the following year and with that next supplemental will be coming in with 18 months of interactive payments and we expect this to be significant and working with the mayor's office in terms of what is appropriate and we hope to have an update on what we actually end up with in the mayor's budget. there is a question in terms of impacts around some of the incredible efforts that the hr team is doing with hiring as well as other hiring. in some cases, it's not really, we are just replacing our flavor of nursing from permanent nursing as opposed to p 103 nursing and over time and overall it doesn't net out to be significant but we know that laguna honda has projected a

lower utilization compared to the 2nd quarter and that is reflected in the financials. we will continue to look at the progress made in terms of our departments hiring over the course of the next quarter which we will know exactly what we hired and what we spent at year-end. >> just adding details for the $120 million, net patient revenues around $80 million of improvement, and $17.8 million related to the global payment program and medi-cal settlement. managed care supplemental is also $18 million. we are seeing a shortfall in capitation revenue due to out of network and collaborating with the health plan as well as cpg to really understand what are

some of the drivers of this out of network and understanding ways that we may be able to able to mitigate this moving forward. i think it's a complex issue that won't be solved immediately, but we are doing supplementary work and understanding where it can be mitigated and reuse our mitigation of this overall. >> can you explain cpg? >> does anyone know what cpg stand for? >> clinical practice, the medical group of the services. and then, for the graduate medical education program, about $19.8 million of one time. and we know we are expecting additional one time settlements to be coming for this program for prior years as well.

we also have a budget shortfall in the pharmacy revenue. this is a shortfall. we are experiencing because we are expecting to improve some of our pharmacy spending through a speciality contract. this contract was not set up in the current year, but we do expect it to be set up in time for the next fiscal year and we hope to not see this shortfall moving forward and these revenues as part of our budget ongoing. in terms of expenditures, salary and fringe benefits and our balance where although we are a little lopsided for $8 million and supplies due to census and

we have related to different departments in terms of worker's comp and process for dpw for toilet facilities on campus. so that is unbudgeted and will receive a shortfall and this $25 million shortfall follows the $20 million of transfers that we have made. >> for laguna honda hospital, $25 million expected in patient revenue and expenditures, a little bit of salary and fringe benefit savings by the non-personnel contract services of 5.6, and some minor variances and services of other departments. it's following transfers and $10 million to

offset that. this is the 30 million that i mentioned earlier on patient revenue and one time revenue. it's the drug medi-cal settlement as well as some minor adjustments around realignment, healthy workers, early childhood mental health services. i don't remember the exact acronym. but it's money -- from the school district for mental health services for students. expenditures about $10 million. $5.5 in terms of salaries. fringe benefits, $4.4 million of contracts. this includes a carry forward of dollars that we have moved forward for multiple years.

the controller's office sets the policies and being able to allow us to carry dollars for no more than two years and understand the limitation and enough is enough and the expectation is that these one time dollars will be reprogrammed and we'll be using it for a capital facility. it shows up as savings here but shows up on the cost on the other side in terms of the budget and some minor variances around supplies and worker's comp. primary care, $10.8 million surpluses primarily driven by the quality improvement program and improvement in terms of having a report and ability to meet 100% of our points that we are very pleased. this is the outcome and the area that we'll be looking forward to looking at, but this is a

significant improvement compared to q 2, and some minor variances includes revenues in capitation and salary and fringes. >> jail house $2.5 million, contracted due primarily to registry and a little bit of savings from work from the departments. for health network services, technically on budget in terms of the revenues, but there is ups and downs between that and a little bit of patient revenues and shortfall on medi-cal and activities and we have not been able to recover since the pandemic of a million dollars and the fiscal revenues will be adjusted in the upcoming budget

and slight variances in the fee revenue as well as other revenues with the state of california program. and some variance, some large departments for salary and fringe. for population, $2.6 million surplus. it has a $3.2 million deficit patient revenue. this is related to another issue around medicare where we are seeking permission to bill for medicare services when we switch the public health lab to epic. it's my understanding we'll be ready to go july 1st and will not be seeing this shortfall in the next fiscal year. that is the plan in terms of getting that certification in place. the $1.7 million in permit fees

and licenses is lower than expected and billable units or claimable units regarding fees. and some light variation in the medi-cal activities as well. this is offset by expenditure savings by salary and fringe and contracts and one materials and supplies and as well as a one time liquidation project. last but not least in operations and activities and expenditures of $8.8 million include salaries and fringes of $1.3 million in contracts, and i wanted to separate out debt services. this is a one time debt service

payment that the office of finance has notified us that they will not be expecting us to incur this particular payment in the current year. so it will feel like one time savings that we have and we have next year's payment budgeted and that will shift that toll of the entire debt service and should show up as$6.1 million, and we are releasing $1 million in i.t. and work order with hr. that should complete all the divisions and update on the management reserve. there has been no change since 2nd quarter given this strong revenue news that we have. we will not necessitate any withdrawals. so the balance remains as is at

5% of our budget revenues at $130 million. that completes my presentation and happy to answer any questions that the commissioners may have. >> thank you for the detailed report. is there any public comment? >> public speaker: this is patrick, in my april 26th article regarding recertification and disaster, i updated my previous report to rescue hh and grown to $125 million. i was apparently premature not realizing that i was under reporting $25 million. operating officer, 3rd quarter

of 2023 to 2024 revenue expense report dated may 21 through march 31st. i learned i was off by $52 million suddenly announcing this and treating this exclusively by patient census and 2100 patients and following its decertification april 2, 2022. fy2023 to 2024 revenue shortfall may increase another $17.5 million during this fy4th quarter. as well, my previous estimate only included $23.2 million in revenue shortfalls in the first two quarters had officially

admitted to and not until the quarter of fy22 and the revenue shortfall in the 4th quarters of fy22 to fy23. this was also dropping steadily. so adding $52.5 million to the cost of $125 million brings up to $177.5 million in expenses to rescue and this is six years of quarters of budget shortfall and chosen to keep hidden. therefore costs to rescue lchlhh is under reported likely to $50 million and not as the patient census drop. when will this stop. when will the medicare cost stop evaporating and when are you going to stop disparaging public

funds? >> thank you. >> thank you. are there any director commission comments on this item? >> commissioner christian? >> thank you for that detailed report. you are clearly incredibly busy and it was very clear, and very detailed. thank you so much for your work. >> thank you, commissioners. >> director colfax? >> i would like to thank the team. i feel really went into this work and we are having a really challenging time across the city and this type of very close oversight and detail is so important for a department as complex as ours. thank you so much. >> thank you very much. get some rest.

i believe we have a statement? >> there is some new news that director colfax would like to share. >> yes, thank you, commissioners. i just wanted to read you a statement that has been released with regard to some tentative labor agreements. so just as an information item i wanted to read this. >> so, i will read it verbatim because it literally just came out. >> miscellaneous employees tentative agreement. the city and county of san francisco has reached a tentative agreement on 27 contracts with 33 unions on successor agreements after months of negotiations. members of the unions still to have ratify on these contracts and the board of supervisors need to vote to approve them. any employee strike is suspended

pending outcome of the ratification vote. this will include the work of our employees, prioritize employee safety and continue to deliver the quality of services to the residents and businesses of san francisco. a full detailed summary of all tentative agreements will be available in the coming days. some highlights of agreements include $25 hour minimum wage and improve and fill vacant positions, increase promoted opportunities, expanded training opportunities. a pilot contract review process for the city's two largest unions collectively representing 20,000 sf employees to collaborate for future use of

external contractors. nurses tentative agreement. the city and county of san francisco is promising to reach a fair and competitive contract for the hard work of our nurses and the 14 clinics, two public hospitals and other community-based programs will continue to provide high quality care well into the future. the union members at the local 1021 are needed to ratify this contract until it is officially adopted and the board of supervisors must also move this agreement. with this tentative agreement, any proposed strike is pending the outcome of the ratification vote. this agreement is including the valuable work of our nurses and employee safety and insures the safety can contain quality of healthcare services in the

businesses of san francisco. all the tentative agreement details will be available in the coming days. some highlights of the agreement include 17.5% wage increase over three years, dedicates 47 new positions of healthcare delivery system. improved employee safety measures to improve positions, and improve vacant positions, expanded city sponsored activities, provide reimbursement, allows employees to trade shifts. prioritizing scheduling permanent nurse staff and reemphasize nurse registry system. so i just wanted to share that very important breaking news and to express my deep appreciation for the hard work across dph, the leadership team, hr and the

team■k■ and hr who is part of t team. they were up clearly into the early morning hours to make sure that this got over the initial finished line. it again has to be ratified but also want to acknowledge and acknowledge our nurses in terms of all incredible work they do and obviously from the department's perspective were very pleased that a way forward is in view. so thank you so much. thank you for that wonderful information and thank you to the staff who worked so hard to get this to come to fruition. do we take public comment on this item? >> no, that's part of the director's report, an addendum. because it came in late, there

was no way it could have come in time. >> thank you very much. now we move to the next item which is information technology. our cio who always has a very enthusiastic and detailed report for us. >> good afternoon, commissioners. director colfax. it's a pleasure to provide an update on two exciting topics in the i.t. world. you are going to hear from me today on one of those topics, and you are going to hear the other topic from jeff, who is dph deputy chief information officer. here is where we are going. first, jeff will walk us through

the epic health boiler live and will go live tomorrow at 8:00 a.m. we feel quite confident that our partners across behavioral services are ready to go. your members asked a lot about artificial intelligence and i will provide more information about where dhs is in this ever evolving state that we are in. then i will address your questions. now we go to jeff. >> we are very excited to support behavioral health services and mental health services across this city in the current system to epic tomorrow morning. this project represents three years of detailed planning and

for 18 months, we have been driving what we would call 100 miles an hour as we work on this large process of transition. we have just about 1400 users. we have worked through in person classroom training as we prepared for this go live. we have also worked to improve our cbo partners and to return the new software. we are also working very hard to ensure that we incorporate the lessons of our transition in behavioral health over a decade ago. we had a lesson from epic go live on the physical health side in 2019 and learned about this

in the last five years and bring this all to bear tomorrow morning. we have over 100 technology specialist who support various modalities and different command styles and 25 individuals that we brought in with experience using epic who will be supporting all of our staff in transition and answering questions. with all of those lessons learned, we wanted to make sure our message is that it's a big day and big challenge but we are ready. our systems in i.t. have a purpose and we don't necessarily change them lightly and don't do it for fun. we provide information that we need to ensure that our city's resources are being used as

effectively as possible and extremely important area with challenges in san francisco. that is what we are looking forward to is increasing the level of information and the control we have over our data as we make those daily decisions. one example that resonates for me personally in terms of the changes that we are introducing is behavioral health access line. what we are looking to do this today and if someone calls and says i need help, we identify a clinic that can meet their needs and give them a contact to reach out to that clinic. and then we hope they call a second time. tomorrow, we are changing that model to ensure that when you call, the behavioral access line, you are able to hang up the phone with an appointment. know that you have that secured spot to talk to someone who can

help you. there is no need for that second call to reach out to ensure that you can engage the help that you are seeking. those are the types of changes that in the i.t. world, we are not the front lines, but our mission is still the same as the clinical staff and we do serve on the front lines with these changes and are what we do in terms of providing the support. with that, we have a lot of ahead of us and will be a long week for us but we are excited about it. we'll first learn to walk before we can run but excited to bring the number of positive changes forward for the behavioral health, mental health services in san francisco. i will turn it over to erik for more questions.

>> thank you, jeff. >> i think it would be really difficult for anyone in this room to deny that artificial intelligence has arrived in a very mainstream way. we are being flooded with it all across the news wires and also starting to see it everywhere. traditionally, changes in technology and healthcare lag about 10-20 years behind many other industries like manufacturing and finance, for example. that's for a good reason with a lot of regulations, and of course we are very invested to make sure that whatever decisions we make are provided for the providers and individuals we serve. artificial intelligence is frogging this lag and instead of a 10 year cycle is a 1-5 year cycle which is dramatically less and that is a testament to all the early work going on with

artificial intelligence that is behind-the-scenes. this is really sort of a break through moment that we are living through, much like when the internet became publicly available in the 1990s. but i would like to share with you this afternoon is that we have taken a really measured and deliberate approach to how dph is going to find ways to welcome ai solutions into our workplace. in a high level, i want to provide assurances that we have established a governance program for artificial intelligence in dph and drafted the first dph policy and principles for artificial intelligence in the department, and that is making its way to the final approval process and we are moving on swiftly to be sure we have a way to evaluate demand for ai, making sure that we can

prioritize it against a number of different factors. so a little bit more specifically about governance. i wanted to share a few points. first of all, is that where we stand today, dph is a buy organization instead of a build organization when it comes to software in general and that will be for artificial intelligence. as we evaluate different needs and requirements that will involve ai systems, will be mostly relying on relationships with vendor partners in order for them to be able to do the very heavy lift of supporting the ai technology. secondly, our investments are all going to link back to our strategic objective and measurable change, measurable

improvement, measurable process improvement, measurable outcomes for the people that we are serving, as well as for our healthcare provider community. we do this for our i.t. projects already and we are really just transferring that name into the ai space. we are also going to focus very carefully on all ai requests to make sure we understand not just what's going on with data that we may put into an ai system to generate some sort of objective or output or feedback, but also how are the partners that we'll use teaching their ai systems if you will. there is a lot of learning that goes on. the ai models that get created have to feed on data. so we will be paying very special attention to the sources that are feeding ai systems. we already have a little bit of experience with that with the

program that we have been collaborating on with ucsf with the general population and healthcare information from the general population is markedly different than the population we serve and that is reflected when you apply a robust technology like an artificial intelligence algorithm in this space. we'll be making sure it's kind of like having two sides to a coin. there is the data that feed the ai system and the data that you are using and how we are using that to generate the feedback that we are looking for that can hopefully amplify and support in a very complimentary fashion all of the outstanding services we provide. so, there are risks with ai. i think everyone has seen a self driving car stopped at an

intersection at some point here in the city and that's because it's learning. we are too going to be on a learning journey and we need to make sure that we do for all the information systems and technology that we evaluate pay very close attention to handful of areas. this is a list but the things that i think about and keep me up at night. first and foremost, is transparency, especially because we expect to be using partners in the vendor community to supply us with ai technology and understand how this model works. ai is a machine that is showing this capability to learn. but the ai model being used is explainable to be able to make sure that we address that ai

systems we make investments in will be explainable and intelligible to a lay person. you don't need to be an expert to understand what's going on. secondly, i think it goes without saying is we will apply the rigor to information security. one thing we don't see quite as much which is really important in the ai space is a continuation of ai cycle. since ai systems are learning, they are changing, and we need to make sure that if we evaluate a system and invest in it today that four or five years from now and make sure because all of the learning that the ai system is learning and it won't just be us but other healthcare organizations contributing to this information and that data

that is feeding may also change, we want to be sure there are no adverse biases that start creeping into the data set along the way. the only way to really deal with that is to have a holistic evaluation process that runs on some regular basis. that's a little bit different. we don't have the need to do a lot of that type of evaluation today because most of the information is just there. it's not changing, but it will change with ai especially because the feedback the ai systems will provide to us should actually get better over time. at least that's what we would expect. last but not least, is our workforce, all of us whether you are a leader in the organization or you are working hard in delivering value for the ph, most importantly for the people we serve, or if you are a technical person. we all are going to have to have some baseline learning that most of us, i'm included in that, have

not experienced yet because being able to harness ai is going to require certain amount of knowledge and skills that are new just like when somebody said, did you download the netscape browser in 1994 or 95 and people looked at you like what are you talking about? sometimes discussions about ai lead down those roads. we'll be working within our organization to find ways to get the right shot of brains, if you will, for everyone who is interested in learning more and getting more comfortable with what ai is and what ai isn't. the most important thing we need to do is get ai right. i'm going to borrow a quote from stuart russel who is at cal and a world renown ai expert,

publishing frequently and i think what you see on the top right of your screen is a really important axiom. it's coming as machines being the ai systems are beneficial to the extent that their actions can be expected to achieve our objectives. and at first glance you might say, of course, these systems have to be meeting our objectives, but actually a lot of ai systems don't. they meet the machine's objective. i need you to count how many times an improved rate of clicking on internet based advertisement. if that system is set up to only recognize clicking, you will start to see very similar things pop-up in your ads. this has happened and the root of the problem with that type of

ai work is that the system may not have even understood what a human being was. let that sink in for a moment because it has to be taught everything. it starts off with a blank slate. i share this idea with you that ai needs to understand human preferences. for instance, this crumpled car. i'm not making a dig at autonomous driving but a different example. imagine you are driving in a ride share that is an autonomous vehicle and a child runs out in front of the vehicle. the autonomous vehicle is making thousands and thousands of little decisions the whole time it's driving, but it has to in a split second make a decision that needs to reflect humanity.

the only okay to do that is to make sure that a system understand what our preferences are. so the car will have to decide do i just slam on the brakes and hope for the best, or do take this action knowing what the impact is like and if i swerve, hit the light pole. realizing these preferences where ai is making all the decision-making is an easy example to make but really important for us to think going forward. the good news is that the ai that we are going to be investing in are much more complimentary in how they work. they are going to help us. they are going to be in the words of the tool that actually microsoft is making. they are going to be our copilots in helping us to make the very best decisions we can, helping us confirm all sorts of

different information as we go through all the different experiences whether it's typing an email, or evaluating a clinical diagnostic image. so, the promise of ai is huge. it took 190 years for the gross domestic product of it. everywhere on planet earth to expand 10 fold. what if, instead of it taking 190 years, it just took 20, and the only thing we changed was adding general purpose ai systems across the board, across the planet, and had them help us out. anything from a robot butler in your home to all of the very fascinating clinical adjunct that we are going to see and start evaluating now for use in

our healthcare organization. i'm not saying that it's going to happen in 20 years, but what i am saying is that as ai moves in and takes residence in our lives because it's already doing in our personal lives, there are some upside advantages and i can't tell you what all of them are and i don't think anybody can yet. and where we are aheading and what i would like to think about in opening the doors and preparing to evaluate and bring more ai is how are we going to improve quality of life if it's just in healthcare or how we are working with social services, education, other types of industries where in the past may have been really difficult

to bring the data together and have a meaningful multiparty analysis and plans and decisions and actions, ai is going to help us because it will know all sorts of information that it would take us years and years to compile, but it will simply consume it and be ready to assist us. from an innovation perspective, innovation is going to change a little bit in my opinion. so when we think about healthcare information and art artificial intelligence and changing to where we are headed and sometimes restricted to what we believe is deemed impossible but ai systems are not deemed impossible and because ai systems can process so much more information than any one of oh you are brain as a single unit can handle at any one time,

there are larger more potential future states that have never been positive before for this to happen than ai is allowed to think and learn and then we as humans are alongside it to take advantage of things that we may never have been able to conjure ourselves. lastly where ai is headed around sustainability and protecting our planet from where we know to be certainly adverse impacts as climate changes. to wrap things up, i wanted to be sure that your commission is aware that we are using ai in dph today, and it's in a handful of different areas and we are starting to see a demand on the operational side and research side. i can tell you that the way that

our cybersecurity tools work, they work by correlating events, millions and millions of events per year. it actually takes a fair amount of attention by human beings to figure out if we see an odd behavior say on our computer network to see if that's really linked to a vulnerability or passing little glitch. now ai systems are evaluating all behaviors that our computers do when they speak and talk on our networks and as a result, they can immediately, the ai system can immediately link that back to known vulnerabilities and give us an immediate warning if there is something we need to block or isolate so that we don't have a cybersecurity issue turn into a cybersecurity problem. we have also been working in collaboration with ucsf

initially on predictive modeling for care facts for readmission rates for patients diagnosed with heart failure and we are getting ready hopefully in the coming months to be able to introduce a readmission risk score that will be produced using a large language model for ai systems that you see constructed. it is being trained on our data. one of those times when we looked at the national data sources and determined that they weren't going to provide the right type of feedback that we need. so instead, we are using the dph sources which align obviously because they are the people that we care for today. thirdly, we are using support for the confirmation of stroke diagnosis using a diagnostic

radiology rapid system providing confirmation, not initial diagnosis for strokes, but it is the first radiology cal tool we are using based on images, not text. so much is based on text, but this is assessing ct scans. fourth, you may have seen this in your own e-mails, but if you haven't, you are going to start seeing your sentences are going to start getting completed by the ai system. because it knows what you typed. it knows pretty much much once you start a sentence, what you might finish it with. i see it all the time and it spooks me each time but i realize it's exactly what i was going to type and i just hit thebutton and move on. we all get too much email. i wish there was a way to find out there is less email instead

of making me write to more email. finally we are all composed to free versions of ai products whether it's chatgpt or what ucsf has created. you are able to use a chatgpt used just for this community. we are really excited about what's coming, but we also as i mentioned, are putting the governance model in place to do right type of evaluation to know exactly what the ai system is going to be doing and how we are going benefit. how will the people we serve be a benefit from that investment

in that system. with that i have one more slide and now to answer your questions. >> thank you. you always finish your presentations with very interesting quotes. thank you. is there any public comment on this item? >> yes. public speaker: great presentation. thank you. good luck tomorrow with that. a lot of people watching to make sure it's going to work and everything is go to go right and i'm sure it will after listening to both of you. a comment that almost 400 people have been trained on epic and if you are not trained, you don't have access. that's perfect. another is epic in uc sf using

ai systems and what we found is that sherlock is developed by the university of san diego and want to be sure that all of your partners are using that same standard. if they are not trained, they don't get access, they are not sharing their credentials with somebody else. good luck tomorrow with the launch. there are a lot of people looking forward to the success. that's all i have, thank you. >> that's the only public comment. >> how about commissioner questions and comments? >> thank you both for your presentation. i'm excited as well to see a successful launch of the epic and behavioral health system. good luck. the other one is mostly a

common. what you noted in terms of the use of ai with dph and this modeling and to use our data or at least national data or supplement, i don't know how it works, but i think that is going to be really beneficial overall because of the populations that we care for and the kinds of information and data that those patients are going to improve with the objectives whether it's a machine or other thing that humans don't understand. i'm actually quite excited to know that we are sorting taking charge in leading in terms of being able to make sure that the

purposes of the ai system and the partners that we are going to be partnering with are really oriented towards what can be beneficial for san francisco. i don't know whether we are the only county that is being sort of as in front of ai integration, but i would imagine that whatever san francisco does is going to be emulated in terms of making sure that ai's uses and governance are really benefitting the population that it serves, and is willing to share that across all uses. for the future. that is a positive comment. obviously there is a lot of risks and a lot of concerns as we need to choose the right

partners and the right roles in governance. i just wanted to make that comment. >> commissioner christian? >> thank you for the presentation. a couple of questions, you talked about earlier in the presentation about policies being developed. who is going to authorize those policies? >> so the way we have established governance for artificial intelligence is within our information governance function. so we have an information governance steering committee which comprises representation from across dph and we created a subcommittee to that group which is just focused on artificial intelligence and has broad representation across dph. that group drafted a policy and we brought the policy to the

information governance steering committee that will go across dph for any new policies. >> policies and principals? >> the principals are in the policy as well as for allowable procedures on what we'll do and what not. >> will that document be brought to the commission for its approval? >> absolutely. >> and dedicate a serious meeting for the policies to understand it. >> what's your timeline estimated for getting through these three steps of the ai page? >> weeks. >> so in a couple weeks you expect to bring something to the commission? >> i think in a few weeks, we hope to wrap up the ratification internally and then be able to

set a time that works for all of you. >> that is fast. thank you. >> ai is faster. >> on the key take away page, the third paragraph talks about evaluations and the need to evaluate holistically to ensure it's biases are mitigated to ensure the validity and accuracy. so testing, it sound like for somebody that doesn't know anything about this, it's somewhat of an iterative process. there could be adverse biases that occur, could there be adverse biases that occur and occur and okay, this is happening. so what happens to prevent these adverse biases from impacting

individuals before there is a recognition that they exist? >> there are actually some tests that you can play, technical kind of tests which i imagine we will research. stanford university has this built, this whole environment where you can consume tools and they built a bit of a community as well specifically focused on this just one really important area. but the idea would be you can't just do this type of evaluation once. you just have to find a good cadence and make sure that you are doing it on a regular cycle. >> so, obviously we are all concerned especially those of us with disability among us and all of us concerned about transmitting our biases into this systematic, particularly

those that control this don't control the bias. how do we deal with that? >> at first that will be a lot of very deep conversations with vendor partners that we are considering. ai is not magic. we can be told what the data is that it's feeding the ai system, and we can see by the way the ai system is getting from input a to output b, how it got there. but we can't see it if we haven't developed it. we have to be sure that business partners that we may acquire technology from can explain that process to us and that can be done. i have already observed in some cases where companies are a little reticent about having that discussion but we will

press that very hard. >> we have so many biases embedded in our systems particularly in the public health area and medical area. they are biologically physically life threatening, not just, you know, emotionally and psychically. so, it's obviously a concern to all of us, and i'm just articulating this concern now about that, and the transmission of those biased outcomes from the human element to the data machine realm. i'm just really deeply concerned about how we interrupt that. that's just a comment. >> appreciate it. as are we. it can help to once you understand the input and output of say we are testing something, we had an evaluation and see

what it did and look back at all of our actual records and see the deviations off the path of that bias. we think that might be one strategy that we use just to make sure that it's tracking the way that the company that wants to sell us that item is telling us it should track. >> so one of the other key parts, hi, i'm anita. in that role, in the ai subcommittee. one of the key things also that we have included in our plans for a policies and procedures is really detail the evaluation plan of not just the model, but how are we going to use the models, how are we going to measure the outcomes stratified by the key measures. and if you are concerned about heart failure and readmission to really important to not just look overall but also to look for the outcomes as we always do

stratified by the key educators and the data and make sure that we are not leaving people behind in the intent to apply this ai model. that is one of the key things we really learned in the work that we have been doing with our colleagues. i think that's going to be a key part of this as well and we need to make sure that all of our performance improvement and plans and projects have key methods before we track and look for unanticipated outcomes that we were not thinking of and we need to include this data internally in those processes as well. >> thank you. >> i have two questions. i'm curious to know what subset of dph will prioritize items

like chs verses other algorithms and protocols and some of this may be off the >> and all the issues we are interested in getting more data on especially equity issues, what would we do to prioritize first. now, it didn't seem like it took that long for kaiser to get hooked onto epic and now one of the leading in hospital. now will there be certain companies that will lead in these initial areas of ai. the last thing i was wondering is what functions that ai can perform that you think will be layered first? will it be describes or searching for clinical information like chatgpt. do you have any sense for this and this is such a burgeoning

area and where access to medical care and research and functions performed. and curious to see what you think and in terms of privacy and policy you think will be noted first. i was telling you earlier and talking to one of the leaders and ucf said they can operationalize in april but didn't start until august. i don't think we are getting anything getting this traction really quickly and only what scribes do exist but they are often humans. and what you think what happens first, and whether there is a time line. lastly the cost and do you think ai will create efficiencies whether it's physicians and providers being able to see more patients? where do you think the balance will be in terms of cost benefit

to both quality of care and cost of care? >> back to the evaluation, we are going to use the governance framework that we have to do as mentioned, a really deep dive deeper with anything we have done with any other technology essential since i have been here to make sure we understand where is the link to improvement and outcomes and also to address commissioner crest an, your points about bias. they are all incorporated into this evaluation process that we are going to undertake. we have not quite finalized it. so i can't give you any statistics on it yet. that's how we'll roll this evaluation first.

if you get there first, and if you are inundated with a lot of asks. we will others an evaluation system that is very much focused on improvement and outcomes in order to drive which systems are going to be most beneficial to the people that we serve. >> as far as the future state of ai systems is going to be the wild west and there will be a lot of others merging with other ones and what we have already seen is companies like epic are really seizing the opportunity to put a number of artificial intelligence options into the development queue and actually some of them are already out of the development queue.

so as an example to project that we already know we are going to be working on, use the first one, very simple process using generative ai through epic in their partnership with microsoft to be able to to have the ai system respond or shouldn't say respond, draft a response to my chart messages to patients and their providers. so instead of provider at the end of the busy day going in to finish off and looking into their basket and have ten messages that i need to start from scratch and write a response to, epic is going to draft a response to those and then the provider will have the choice to either edit it or move it on and send that message back to the patient. that will

probably be the first significant change we make and that's good for the patient. one of the qualities of these messages and already doctors already using this. the messages use very empathic language and just like anyone at the end of the day, i'm a lot more empathic at the beginning of the day than the end of the day except for now the engine is on 100%. that's for generative ai case and not a lot different if you were to go to chatgpt now and say this is my patient, please write a response to the question. of course the big difference is we can't use chapter for that because we can't put any protective health information into the chatgpt framework but when epic comes to us, it will

offer all the safety features and we'll be able to use those platforms effectively. i know of another pipeline that will be involving a third party in addition to epic and that is to be able to to use ambient notes. meaning you can be in an examination room or treatment room with your patient or client and epic can absorb the conversation that you have. it's listening and can draft a clinical documentation for you by the time your visit is up. that takes a little bit more technology in the room itself, and that will cost us more for sure to implement. but we don't know all of those costs yet and we are just at the beginning of that process. but the dividends from that, to your point, commissioner green about creating an inefficiency or creating a burden as we know

with the health record platform with every time a regulation changes we end up putting more documentation into the system and ai can help us do that more effectively by giving us a lot of the initial scaffolding and framing for documentation and allow the provider instead of even if there is a template, there is a lot of entry to make, this is really going to lean more towards a complete item of documentation that just needs to be reviewed. jeff, did you have a couple of things or not? >> we can keep going on cases that are coming if you like but we want to be cognizant of time. i think he mentioned the cost and our aim of these projects is to improve the efficiency of our team so they can spend more time focusing on what they need to do and what we have going live next week which is optical care

recognition which takes a picture of your insurance card to bring that information of the insurance card into the system to support the billing process. it's less time you spend at the front desk. we also know that that's not exactly an equitable approach if that's the only way in which we offer interacting with our system. in no way do we want to remove the front desk or individuals from serving patients in that scenario. we want to take more time for them to hold the hand of the folks who need it most. ai and smartphones work great for some people. it doesn't work great for others. our focus is to control cost by creating and using that time to focus on those who need it most. >> thank you. >> director colfax. >> thank you. just would like to thank the team. that focus on ai is really important, and i also want to

say that they straddle the antiquated systems that we have and with cutting edge technology. i think it's important to realize they are sort of, i don't know how far back, but they go further back. maybe not quite back to 1985, but maybe, yeah. so, from 85. and they are striving to improve, and i think it's really great to see both what the potential ai has, but also concerning about what some of the risk are. we'll continue on that journey of discovery but also being rigorous about if and how and when the technology gets adopted so that we can make sure that our true equity can be realized as much as possible. with regard to epic as an epic user myself, i'm really excited to see mental health go in and finally this is more on policy

but i think one of the things that is still challenging in our system is as we try to union fee in the system, the federal law that prohibits the sharing of substance abuse disorder information into a general medical record without some very specific consents and agreements. where we still have an area of our medical care system that is walled off from the rest, and we can debate the pros and cons of that and for epic and the whole services. >> thank you for bringing this up and really wonderful answers to the questions. we really appreciate them and we look forward to hearing how you develop the policies and governance and priorities of this incredibly exciting potential that we have. thank you so much.

i look forward to your next visit with us. >> the next item on the agenda is joint commerce committee and other committee reports and with commissioner chow being absent today. i will give the report. on may 15 we reviewed the report presented today, fairly same content and discussed resources and regulatory report and listed the policies and recommended for full approval to the full commission which will be on next agenda item, and they did answer all of our questions and with satisfaction and in closed session, we reviewed the reports. any public comments on the item. >> let me make sure the person on the line knows we are on item

8. this is the chance to do public comment. no public comment. >> any commissioners -- >> i'm sorry, a hand went up. okay, you have three minutes, mr. bradshaw. public speaker: this is patrick. the committee report, commissioner green omitted the report on may 10 and later with an expanded same report without announcing to members of the

public. the extended report massively increased the anonymous complaints dating back to 2019 and anonymous complaints, 54 were certification on april 22, 2022. and 110 following certification including 25 and 2024 not reported april 9th. the underlying data in the revised regulatory affairs report doesn't make sense. pages 9-10 report 150 total deficiencies between anonymous complaints, but approximately 29.27 received documented received 250 deficiencies. putting aside for a minute how the anonymous complaints did you get to 110 complaints for certification. how could that be that i as a private citizen have been tracking this and has been flat

since 2019 patients sexual abuse scandal and cross potentially 29.7 and quality management department are reporting to this to lajcc and received only 151 deficiencies between facility reported incidents voluntarily reported to dph and sustained on the 164 anonymous complaints of the department has received since 2019? ultimately changes queue on the department of total reporting on the number of deficiencies received since 2019 for the 100 of the deficiencies. what is this? magical math coming out of the lchlhh department. something kelly might be proud

of. information commissioner guillermo along with dr. colfax don't want the public to remember. the report back all but reporting today the report that the lhh reports on insufficiency and anonymous complaints may threaten the recertification. how many more anonymous complaints do you anticipate lhh receiving? thank you. >> we will move to the consent calendar and you have a list of the policies recommended for approval by the entire commission. is there a motion to approve? >> so moved.. >> second. >> there is no public comment. >> all in favor say, "aye". >> aye. >> any opposed?

>> the next item is community and public health committee update. >> the first update is juvenile hall with no plan to close and redesign for the internal part of the center. on-site is medical, dental, behavioral education. priority identified by the presenter was cal aim services for justice involved youth. the most important was intensive behavioral services which will replace a high aim higher and currently there are 29 use in that program. things have altered at juvenile hall where it now serves young adults up to age 24 for long-term treatment. the average age of youth is

25.5, and they have increasing complex behavioral health. one of the new trends that they are currently addressing is opioid withdrawal symptoms and that is being managed as well by the medical director there. our second presentation with whole person integrated care and overdose prevention strategies, and again just to remind everybody it focus on people experiencing homelessness, and where does whole person integrated care operate. it's street based, there is care permanent and also in permanent supportive housing and shelters in the hub of a whole person integrated care is maria martinez health resource center which it is indeed the hub.

the expansion services going forward are with cal aim are care management. a managed alcohol program, permanent housing, clinical services, and in the street overdose, the poet team, the post overdose engagement team which is new and very exciting. in 2023, through whole person care, there are 9,000 individuals that were served in 47731 encounters which is amazing. their budget is $38 million for this mainly in salary and fringe benefits. the overdose prevention presentation was very interesting. and it focused on the increase availability of medications for opioid

treatment, and again the evening telehealth that dr. colfax mentioned and that operates from 8-12 in the evening with the tenderloin navigator group. for the first four weeks of the project, 173 people were served. the other program which is extremely important is the civic bridge program brought out of the mayor's office innovation which is coordinating all the service providers within the city government to serve those with overdoses and pretty new

and served people within those services for the program. that's our update. >> thank you. any public comment? >> no public comment. >> any commissioner comments or questions? all right, seeing none. the next thing is other business. is there any other business? is there any public comment in other business >> the next item is adjournment. we'll take a motion to adjourn. >> so moved.. >> second. >> all in favor say, "aye". >> aye. >> any opposed? thank you, everybody. >> thank you sf.gov. >> [ end of realtime captioning ] >>

>> (clapping.) >> in san francisco the medical examiner performs the function of investigating medical and legal that occurs with the city and county of san francisco from a variety of circumstances in san francisco there is approximately 5 thousand deaths annually i'm christopher director for the chief mr. chairman the chief my best testimony a at the hall of justice on 870 drooint street that is dramatically updated and

not sufficient for the medical chairman facility i've charles program manager public works should a earthquake of a major are proportion occurs we'll not continue to perform the services or otherwise inhabit the building before the earthquake. >> we're in a facility that was designs for a department that functions and in the mid 60s and friends scientific has significantly changed we've had significant problems with storage capacity for evidence items of property and also personal protective if you're doing a job on a daily basis current little storage for prirjs are frirnlsz we're in an aging facility the total project cost forever ever commercial is $65 million the funding was

brought by a vote of go bond approved by the voters and the locations is in the neighborhood the awarded contract in 2013 and the i'm the executive director we broke ground in november 2015 and that started with the demolition of existing facility we moved into the foundation and january so pile foundation and then with second construction of the new facility. >> one of the ways that we keep our project on time on budget and we're having quality to have regular meeting and the variety of meetings with construction process meeting as well as cost of control meeting and i'm a project manager for public works the office of chief

commercial we want walk the project site when we sign up and also with a contractor insinuates for a change over we need to verify what or what was instead of. >> the building is 42 feet tall so it is two stories and 46 thousand square feet roughly we're that's a greaquestion to be on time and budget have the roof complete a the exterior moving with the site work. >> and as you can see we've got a lot of the interior finishes installed. >> in an effort of an differentiate the facility that designed to work for 72 hours. >> not taking into account there was a lot of structural updates made into this building not seen in other construction throughout san francisco or other barriers we have friday morning examiners from 8 to one public comment monday to friday

because of air circulation we literally have to shut the doors and so the autopsy is done without staffing being able to come and go or exit the space and literally lock down the autopsy in the new facility we have bio build one door opens and closed behind you you can gown up and go through a second seizures of doors that has its own independent air supply and now in the exterior opt space having that middle space have greater flexibility of staff as they move in and out of the area. >> in the current facility investigative unit has small tiny, tiny place in the area of the new facility is almost

doubled in all divisions from the current facility and the new facility. >> the planning we have here gives them the opportunity to have the pool needs to complete theirs jobs in a much more streamlined fashion. >> we're looking forward to have secured parking to minimize the egress of you know visiting and the members of the public but really to minimize the investigators remaining remains from our advancing and so the facility. >> we have a new visitors area we're building that is a little bit more friendly to families. >> one thing you may notice in the room no windows there is no natural light not good for most autopsy but in the new facility at new hall we made that an

objective they want to insure we were able to look up in the middle of exam and see the sky and see natural lights. >> that's one of the things the architect did to draw in as much light as possible. >> we have staff here onsite we insure the design of the new design enables the investigators and other investigators skiefksz to consider to house on site this meant we needed to design and plan for locker room facilities and shower rooms the ability to sleep. >> third of the construction going into the building has been by contributions of small businesses. >> part of the project is also inclusive to the sidewalk have all new sidewalks and new curve cuts and landscaping around the

building we'll have a syrup in front of the building and rain guardian. >> the medical examiner's office has been a several if in their contributions of the understanding the exception and needs. >> it's a building that the chief medical examiner has been looking forward to quite a few of the. >> it is extremely valuable contribution to the, neighborhood address san francisco as a whole. >> the building will allow is to have greater very much and serve the city and county of san francisco and the neighboring

my name is doctor ellen moffett, i am an assistant medical examiner for the city and county of san francisco. i perform autopsy, review medical records and write reports. also integrate other sorts of testing data to determine cause and manner of death. i have been here at this facility since i moved here in

november, and previous to that at the old facility. i was worried when we moved here that because this building is so much larger that i wouldn't see people every day. i would miss my personal interactions with the other employees, but that hasn't been the case. this building is very nice. we have lovely autopsy tables and i do get to go upstairs and down stairs several times a day to see everyone else i work with. we have a bond like any other group of employees that work for a specific agency in san francisco. we work closely on each case to determine the best cause of death, and we also interact with family members of the diseased. that brings us closer together also. >> i am an investigator two at the office of the chief until examiner in san francisco. as an investigator here i investigate all manners of death that come through our

jurisdiction. i go to the field interview police officers, detectives, family members, physicians, anyone who might be involved with the death. additionally i take any property with the deceased individual and take care and custody of that. i maintain the chain and custody for court purposes if that becomes an issue later and notify next of kin and make any additional follow up phone callsness with that particular death. i am dealing with people at the worst possible time in their lives delivering the worst news they could get. i work with the family to help them through the grieving process. >> i am ricky moore, a clerk at the san francisco medical examiner's office. i assist the pathology and toxicology and investigative team around work close with the families, loved ones and funeral

establishment. >> i started at the old facility. the building was old, vintage. we had issues with plumbing and things like that. i had a tiny desk. i feet very happy to be here in the new digs where i actually have room to do my work. >> i am sue pairing, the toxicologist supervisor. we test for alcohol, drugs and poisons and biological substances. i oversee all of the lab operations. the forensic operation here we perform the toxicology testing for the human performance and the case in the city of san francisco. we collect evidence at the scene. a woman was killed after a robbery homicide, and the dna collected from the zip ties she

was bound with ended up being a cold hit to the suspect. that was the only investigative link collecting the scene to the suspect. it is nice to get the feedback. we do a lot of work and you don't hear the result. once in a while you heard it had an impact on somebody. you can bring justice to what happened. we are able to take what we due to the next level. many of our counterparts in other states, cities or countries don't have the resources and don't have the beautiful building and the equipmentness to really advance what we are doing. >> sometimes we go to court. whoever is on call may be called out of the office to go to various portions of the city to investigate suspicious deaths. we do whatever we can to get our job done. >> when we think that a case has

a natural cause of death and it turns out to be another natural cause of death. unexpected findings are fun. >> i have a prior background in law enforcement. i was a police officer for 8 years. i handled homicides and suicides. i had been around death investigation type scenes. as a police officer we only handled minimal components then it was turned over to the coroner or the detective division. i am intrigued with those types of calls. i wondered why someone died. i have an extremely supportive family. older children say, mom, how was your day. i can give minor details and i have an amazing spouse always willing to listen to any and all details of my day. without that it would be really

hard to deal with the negative components of this job. >> being i am a native of san francisco and grew up in the community. i come across that a lot where i may know a loved one coming from the back way or a loved one seeking answers for their deceased. there are a lot of cases where i may feel affected by it. if from is a child involved or things like that. i try to not bring it home and not let it affect me. when i tell people i work at the medical examiners office. what do you do? the autopsy? i deal with the enough and -- with the administrative and the families. >> most of the time work here is very enjoyable. >> after i started working with dead people, i had just gotten

married and one night i woke up in a cold sweat. i thought there was somebody dead? my bed. i rolled over and poked the body. sure enough, it was my husband who grumbled and went back to sleep. this job does have lingering effects. in terms of why did you want to go into this? i loved science growing up but i didn't want to be a doctor and didn't want to be a pharmacist. the more i learned about forensics how interested i was of the perfect combination between applied science and criminal justice. if you are interested in finding out the facts and truth seeking to find out what happened, anybody interested in that has a place in this field. >> being a woman we just need to go for it and don't let anyone

fail you, you can't be. >> with regard to this position in comparison to crime dramas out there, i would say there might be some minor correlations. let's face it, we aren't hollywood, we are real world. yes we collect evidence. we want to preserve that. we are not scanning fingerprints in the field like a hollywood television show. >> families say thank you for what you do, for me that is extremely fulfilling. somebody has to do my job. if i can make a situation that is really negative for someone more positive, then i feel like i am doing the right thing for the city of san francisco. [♪♪♪]

>> my family's starts in mexico in a small town. my parents are from a very, very small town. so small, that my dad's brother is married to one of my mom's

sisters. it's that small. a lot of folks from that town are here in the city. like most immigrant families, my parents wanted a better life for us. my dad came out here first. i think i was almost two-years-old when he sent for us. my mom and myself came out here. we moved to san francisco early on. in the mission district and moved out to daily city and bounced back to san francisco. we lived across the street from the ups building. for me, when my earliest memories were the big brown trucks driving up and down the street keeping us awake at night. when i was seven-years-old and i'm in charge of making sure we get on the bus on time to get to school. i have to make sure that we do our homework. it's a lot of responsibility for a kid. the weekends were always for family. we used to get together and whether we used to go watch a movie at the new mission theater and then afterwards going to

kentucky fried chicken. that was big for us. we get kentucky fried chicken on sunday. whoa! go crazy! so for me, home is having something where you are all together. whether it's just together for dinner or whether it's together for breakfast or sharing a special moment at the holidays. whether it's thanksgiving or christmas or birthdays. that is home. being so close to berkley and oakland and san francisco, there's a line. here you don't see a line. even though you see someone that's different from you, they're equal. you've always seen that. a rainbow of colors, a ryan bow of personalities. when you think about it you are supposed to be protecting the kids. they have dreams. they have aspirations. they have goals.

and you are take that away from them. right now, the price is a hard fight. they're determined. i mean, these kids, you have to applaud them. their heart is in the right place. there's hope. i mean, out here with the things changing everyday, you just hope the next administration makes a change that makes things right. right now there's a lot of changes on a lot of different levels. the only thing you hope for is for the future of these young kids and young folks that are getting into politics to make the right move and for the folks who can't speak. >> dy mind motion. >> even though we have a lot of fighters, there's a lot of voice less folks and their voiceless because they're scared.

>> everyone loves a good sunset, but in san francisco we take to a new level. i'm city supervisor engardio and i represent an entire part of the city called the sunset. it stretches 30 glorious avenues. welcome to district 4! the sunset is a collide scope of people culture and experiences for residents of all ages. we are a beach town, we are a chinatown, and not a town at all. the sunset is home to 80 thousand people and we love our dogs. we live in neat row houses, homes with yards, story book homes and every quirk in between. the sunset used to be sand

dunes all the way to the ocean. when the city needed to grow, san francisco's future ran through the sunset. we built rows and rows of housing for a great irish population and welcomed a great chinese population. today home to a gowing number of families from all backgrounds and the future starts here. >> we chose sunset knauz we love san francisco but during the pandemic we needed more space and more family focused, so that is where we found the sunset. how walkable it is. we live along iving street along where diana's school is our son's day care is. >> our kids and all the kids we knee in the neighborhood are really the future here and we are really excited to live in the neighborhood. we love it so much. >> nina and alex are expecting their first baby and it first leaders

of the newly formed sunset community band which bring together musicians of all ages at special events. >> we are about to have our first kid and met so many younger people and so many moving into the neighborhood. exciting to raising our family here because this community is awesome. >> bringing the community together and making it stronger i think a band can help with that. it is a matter of civic pride and coming together and doing something as a community that really makes like us from a collection of people into a neighborhood. >> sundays in the sunset are for worship, farmer's market and live music at the ocean. if the sunset had a town square, it would be this magical area that

appears every sunday on 37 avenue. the sunset farmer market isn't just a place to get good food and produce, it is where community gathers live music from local musicians and cultural celebrations and [indiscernible] share ideas to shape our city. it really is the place the community comes together to celebrate the best of the sunset. >> something about it had sunset chinese cultural district is there a lot of opportunities to uplift the chinese voice and chinese people. when you look at the sunset, a lot of think of trees and single family homets and the schools, but there isn't a lot of very iconic locations that people can look at and know they are in the sunset. one thing we are working on is to unveil a new mural in the park by community and as we do more work in the sunset and uplift the unique qualities of the community, we want to do

more mural s and spaces that are iconic so the sunset gets a piece of being unique and identifiable. >> a supermarket for everything you need for chinese home cooking and [indiscernible] the rice noodles are so good they are featured in catherine moss latest novel, [indiscernible] takes place in the sunset. there is a old school menu at the ond mandarin islamic restaurant and a item so spicy they have to warn customers. maybe bobo can neutralize the spice. the sunset has plenty options. try the bars at the beach. we also have the sunset reservoir brewing company and o'briens irish pub. cuisine in the sunset spans the world. [indiscernible]

>> travel and work in [indiscernible] we have our own restaurant. and then, it was my turn to follow her to her country, so that's why we opened in her neighborhood. >> we are looking for more a local gentleman gem. we traveled around the world and what we highly value, a place for the community to gather. a local hang-out spot. that is why this isn't a restaurant, it is cafe, you can order a coffee, you can have a fuel full meal but it is place to connect. whether parents kids friends is why we decide to go qulose close to the beach, a neighborhood i am familiar with. i run into people all the time. i live in a big city but why i chose district 4 outer sunset. it has a small town feel. i love our neighbors.

>> the sunset has everything from footwear to hardware. here is great wall hardware, 3500 square feet of retail space. we carry about 22 thousand items and counting. it never stops because i have a thing. when a customer says don't you have this and i don't have it, it bothers me. i want to have it,s so it is just of those things about owner a hardware store, people expect you to have everything and you to fulfill that need. i like to serve my neighborhood. most businesses you want to buy this or that or eat this or buy the widget. a hardware store is different. people come in and have a problem and need a solution and they are looking for you to navigate them through that problem and offer them products that help them get to where they need to go. people are great. i love this neighborhood. there is different ethnicities here, different cultures here.

we all intermingle and mix together and we get along fine and i always like that about this neighborhood. it is just a nice place to be. it is near the beach, it is beautiful and near the zoo and near golden gate park, stern grove. great schools, great parks. whats there not to like? we also love pizza from hole in the wall to [indiscernible] hottest restaurants in the sunset tunching vietnamese food [indiscernible] ice cream [indiscernible] this is great highway park. a great place to burn calories on the weekend. i'm here every sunday doing a long run and start with 5 miles and with this ocean view, if it motivates me i try for 10. the new york times named great highway park one of 52 places to change the world.

it is that amazing and the gem of the sunset and people are finding new ways to activate the space. in halloween it turns into the great haunt way. >> we imagine a future from the part time road close toor to a park to welcome people all ages and activities to our coast. >> since we had [indiscernible] always looking for ways to sort of improve what is already good around us. the neighborhood is great. it will be even better with a park here. >> sunset turn to put a new sign up on our coast. open for all. >> this is the treasure of san francisco and this hasn't been discovered yet. homes are still relatively affordable, there is decent schools and a place for kids to have a feeling they can run and play and take part in things. what i'm happy the great

highway has become a park for the weekend. i'm glad we share what we have with the rest of the city and people come from outside the city. i'm sure people come from the east bay, and i just feel like, seeing the people out here enjoying this represents the hope for the future. >> imagine the potential of an emerald necklace in the sunset for safe biking and recreation along the green belt of sunset boulevard which connects lake merced with golden gate park and great highway park. quality of life matters and we know how to take care of each other. sunset youth service helps teenagers find purpose and self-help for the elderly let's seniors shine. local artists capture the sunset experience and work is on display in cafes like java beach and black bird books. the art of conversation happens

at this new barber shop called the avenue. the owner calls it a barber lounge because he wants to create a space for the community to gather beyond hair cuts. this corner is a hent of the future. you see new housing built for new generations and it is over a community space that everyone loves. the sunset is a place full of potential. >> the possibility is here, anything. you can start something here and people will get behind and the community finds there is a need for it and people support it. >> i always look around the corner, the next thing we can do to crank it up more and make it safer, make it more enjoyable. bring in new business, support them. >> i really hope we bring just joy, because ultimately music helps bring joy to the community. >> this is where people are at. this is where people want to be, so it gives me a lot of positive energy. >> my office created the first sunset night market on iring street

where i'm standing. more then 10 thousand people showed up. nobody has seen that many on--[indiscernible] here it celebrate all the fun things in life, food music and art. our beautiful sunset always amazed. the sunset experience is pure joy. the sunset is where we will create our best san francisco. join us.

>> i am filipino, i was born in the fill philippines and immigrated here. it is just more then a means of transportation. it holds a special place in the hearts of filipino s representing their resilience. [indiscernible] a symbol of the rich cultural heritage of the philippines and are a part of the country national identity. being asian american is about embracing ones heritage. happy aapi month, san francisco.

>>ime i half chinese and half thai and born in thailand. this is his majesty, a picture of my late king. his majesty, he pass away in 2016. the reason why i still have his portrait is to remind me of the amazing thing he has done for thailand. how he ruled the country with love and lead with passion. his legacy and philosophy in life is one i want to live by. when i moved to america, i became exposed to many more cultures. something else--[indiscernible] with chinese thai. i enjoy making connections with

other people. happy aapi heritage month, san francisco. asian pride. >> i was born and raised --our tradition is [indiscernible] the weather is very extremely cold in the winter, and extremely hot in the summer, so this one garment is designed for the winter time. it keeps the heat within the body. it is designed specifically also comfortable for during the summer time too. modern day also design change to more simplified and easy to wear every day.

to me, being asian american means [indiscernible] of heritage with others in america. happy aapi heritage month, san francisco. >> come shop dine and play. taraval street is open for business. >> this is joey smith at barber lounge. one of the coowners at 19th and taraval and sunset. this establishment came about when me and my brother andy, coowner barber decided to it was time to take a step up in the barber industry.

our business is community that shows their true artistic side of the barber indust rae. we are involved in taraval bingo so please stop by, get a haircut and when you do you get the barber sticker made for us. i say in three words, we are community, artsests and here to help. visit at barber louvl, 901 taraval and find on-[indiscernible] >> a new community game supporting small businesses, anyone can participate, it is easy, collect stickers on a gameboard and enter raffle event for a chance to win awesome prizes. for more, >> are you looking for a rewarding career and eager to acquire skills that can unlock new job opportunities? what if quou can receive

training for free? exciting prospects are waiting for you. offering through economgic workforce development, the hospitality initiative prepares participants in hospitality. no experience is necessary. explore training and services in the restaurant industry for food and beverage careers including chefs, line cooks, bartenders andber easters and [indiscernible] service industry careers [indiscernible] housekeeper maintenance manager security guard and more. class are taught in english, spanish,s cantonese and mandarin. connect to job opportunities throughout the city. elevate your skills. ignite your passion and embark on a journey of growth. to get started, visit

>> i think we'll get started. thank you for joining us today in this incredibly glorious east cut transbay day. thank you mayor for bringing the sunshine. i'm executive director of community investment and infrastructure, known as ocii. my name is [indiscernible] i'm excited and honored to be here with you today to celebrate this groundbreaking for these two affordable housing projects here on transbay block 2. can we get applause for that? [applause] the vibrancy of downtown is better showcase then development of these two new spectacular affordable housinging. we are surrounding by nearby fronts and waterfront and best in class

transit at intersection of entire san francisco bay area local regional water rail and bus services. these two projects, east and west are community vision to develop a mixed income neighborhood for all san franciscans. the fact we are standing here today is a testament here to mayor london breed's steadfast commitment to delivering high quality affordable housing to this east cut community in the thriving neighborhood for the great city of san francisco. also grateful to supervisor dorsey for his leadership and east cut neighbors and advocates for collaboration and support of these dynamic developments. in addition to mayor breed, and supervisor dorsey, today we have other key partners in this strong public private partnership. i want to acknowledge the hard workic team at ocii, [indiscernible]

fruit of dedication is evident in today's major milestone achievement. i want to also thank our especially hard working commission, chair bracket, vice chair [indiscernible] as well as commissioners [indiscernible] and now, it is my honor great pleasure to introduce our first speaker, san francisco housing champion, our great mayor, mayor london breed. [applause] >> alright! i don't know about you, but building housing gets me really excited! and feel like opera, you get a home. the reason we are so excited to be here in the east cut because it is a long time coming. when i announced by 30 by 30 plan, that is to bring 30 thousand residents to

and students to the downtown by 2030, it had everything to do with plans that were already in process, but also opportunities to make it easier to get to yes to build more housing, and to turn downtown from the 9 to 5 financial district it has been in the past, to a place where people work, live and play. what is so great about being here in the east cut is, it represents all of those things. people who live here now, folks who play here, sometimes pickleball and a few other things in this east cut open space, but also a place for people to live, of all economic levels. when these 335 units are completed in the next couple years, they will represent an opportunity for so many of our seniors and families and people who represent different income

levels and represent a opportunity for them to call downtown home too. why is that important? well, san francisco our downtown is very dense, and it is a density populated neighborhood, but also a place where people want to be here. who can imagine the sun can shine in downtown? who would think you need sunglasses? in this part of east cut you need sunglasses and need to bring the energy and excitement of what this entails. when these 335 units are completed, we anticipate that anywhere between 7 to 800 people will be living in these units and we are excited to welcome them. but building housing just isn't the final thing. we also have to make sure that our transportation network is in tact, so we are excited last week we were with speaker pelosi announced $3.4

billion investment in our transbay terminal that will allow 11 different regional transportation options come to this transportation hub, including caltrain at 4th and king and our future high speed rail! can you imagine kids wanting to take a trip to los angeles and getting on the high speed rail and walking from their new unit? folks visiting san francisco catching the different modes of transportation? people working here. this is a game changer for the future of san francisco so it all starts with housing and transportation is a important part that. we are so grateful to everyone who made this possible. these various-people think that groundbreakings and ribbon cuttings are just ceremonial events, but the fact is, they represent a lot of

hard work. they represent a lot of collaboration and a lot of money and let me just say that we could n't have a better partner in the work then governor gavin newsom, but the person he put in charge helping make sure the right resources financially get to the right projjects and i want to thank gustauvo vulas cz being the partner and in this project over $41 millions, was going to say billion, but so used to getting that money from the feds. we'll take the $41 million and make every last dollar stretch to get this job done on time and on budget. i want to thank our non profit developers who continue to insure that this is done right and that folks from the community are a part of

this development from start to finish. thank you to malcolm young from chinatown community development and doug shoemaker from mercy housing for the extraordinary work you do. [applause] i also want to thank lynn min ic from bank of a america because all the people you see here, we do a lot of groundbreakings and can't do without the extraordinary partnership both public and private secter. a really proud to be working with a extraordinary supervisor who believes in building housing in san francisco and again, this neighborhood, the east cut, thank you for continuing to partner with the city so that we can move forward on the vision of what downtown can be for the residents and

the people who call san francisco home. thank you all so much for being here. [applause] >> thank you madam mayor. one more time for mayor london breed, please? as the mc i am introducing folks and i'll introduce somebody to this community probably needs no introduction but i want to bring up supervisor matt dorsey who has been a champion for affordable housing and housing at all levels. >> thank you so much. it is so exciting to see the transbay plan coming together and i'm just grateful for the opportunity to do my part to realize a vision that is underway for a lot of years. with something like this, you always have to give credit to people who have been working on this for many

years as it is coming together. it is just remarkable we get to see a neighborhood that we can all celebrate. this is such an example of what authenticly progressive 21 century urbanism should be and this is a neighborhood i have the honor representing and coming here to celebrate cultural events and this is it the neighborhood backyard where we watch the super bowl and have a great time together. i want to thank mayor breed for her leadership and just being a visionary on 21 century urbanism for you leadership on building housing. i know it is important to you, because when i first met to ask the mayor for the job and i had a bunch of ideas on recovery , mayor breed wanted to know where i am on housing. we are in lock step for affordable housing and make sure we live up to the commitments we have made in the housing

element. i want to thank thor and his team at ocii for the remarkable work they have been doing many years. thanks to east cut community and cbd andrew and his team. when you talk about the east cut community, you can't leave out the all powerful pickleball lobby. wie see you, we hear. mercy housing is no stranger to district 6 and operates a few in my district include aing a couple who are neighbors of mine. i'm excited to see the chinatown community development having expanded presence in district 6. now they got a few facilities, one we just opened recently, maseo

may and edwin lee apartments and 544 mission bay. there is another one also in mission bay. what i love about malcolm young and his team is, malcolm is one of my favorite community mc's. always having a lot-like having malcolm at events because he is a lot of fun. as the speaker who after me knows, san francisco has some ambitious housing element goals to facilitate the production of 82 thousand units of housing by 2030, and the projects we are here to talk about and celebrate the opening of today gets us closer to that. what we are doing here isn't just building communities. in many ways we are creating a blue print what 21 century will be in san francisco. what we are accomplishing in district 6 is what san francisco will look like a lot more like in a hundred

years so i value the partnerships of community partners, partners at the state level, non profit partners and city leaders who are a part of this. this is really about fulfilling the promise of the city of saint francis and all that means for 21 century urbanism in terms of being a city, it is more inclusive, more diverse, more equitable, more affordable, livable and sustainable with bike lanes and pickleball for all, so thank you so much everybody. [applause] >> thank you supervisor dorsey. did you have to plug the pickleball folks? the mayor, [indiscernible] gustauvo believes california deparm of housing community development their programs are creating affordable housing and communities of opportunity throughout the state and on this project they

awarded a $28 million plone to fund the block 2 east portion through the affordable housing and sustainable community program. our next speaker, give a big round of applause, gustauvo >> thank you, good morning. it is a pleasure to be here. beautiful morning. really glad i have the sun behind me. it is remarkable. i have been coming to san francisco a lot lately, which is a testament of the incredible that mayor breed, her team and ecosystem. the affordable housing ecosystem in the city, which is one of the best in the state of california and one of the best in the countries with organizations like mercy housing and chinatown community development and all contributing to this project. just a great ecosystem and

great partnership, but it is local elected leadership. that is going to drive these projects to fruition and we are at the state in sacramento only holding hands kwr helping facilitate what the city of san francisco can do for itself and again, just the fact i'm here many many times in the last two years is a testament of many many great things happening in the city. i come here a lot actually. i have often meetings with our federal counterparts. you will never believe that there is so much affordable housing here. i was talking to doug shoemaker about the affordable housing we have here and you are right, there will be a new building here behind you. of course this 200 unit that is already being built behind me. it is just a momentum is

incredible. we know there is a lot more affordable housing that needs to be built in city of san francisco, but that is why again these partnerships are so important and the leadership the mayor and the board of supervisors can provide. the affordable housing and sustainable communities program, it is funded through cap and trade proceeds. it is a exactly the type of program we want to see replicated time and time again. this is the intersection of creating more affordable housing, infrastructure, climate friendly goals, transportation t. is about connective. the mayor made reference to 600, 700 households, all will be low and with moderate income households and

the outcome connectivity produces by walking to their jobs or biking or close proximity to all the services they need, that is incredible improvement, not just the home they are living in but the connectivity. that is what the affordal housing and sustainable program is about. this program invested $3.3 billion since inception across the state of california, and today with this project, we mark for the city and county of san francisco $350 million that of all that volume of investment, which is-which is the first time we see a city and county reaching more then 10 percent for the entire state of california, all the funds.

why is that? because projects like this just fit so well the criteria governor newsom is so focused on, that the state legislature is focused on in investment. helt outcome, connectivity, transportation, compleen housing and transportation and ultimately it is centered by people agenda that i know everybody here is so focused on. again, thank you so much for making the state part of this investment. we appreciate everybody that is involved, especially let's give a big hand to the people who actually make this project possible, construction contractors. [applause] all the folks that will be intimately involveped getting the project to fruition and seeing the families soon here. thank you so much.

[applause] >> thank you gustauvo. it is so great to hear the head of hcd make the business case for affordable housing and community investment in san francisco. we as san franciscans believe that that's the case and it is good to hear a state leader recognize that and it really benefits all of san francisco and the whole entire san francisco bay area and the entire state, so thank you gustauvo. the next speaker is leader in affordable, quite some time. doug shoemaker, he leads mercy california and they are the project developers for block 2 east. the 184 family project here. i want to bring up mr. doug shoemaker. [applause] >> it is never a good sign when your friends say he has been around for a while.

i'm good. i'm the old man of affordable housing as malcolm just told me. anyway, it is great to be here. obviously mercy housing super excited to be developer another building here in the east cut where we had such a good experience. happy to be talking to residents of mercy housing properties and others around the neighborhood and has become such a vibrant neighborhood and impressed to be down here and see the association and neighbors have been able to make out of this and looking forward to it development of the park and as mayor breed said, excited about caltrain and some day high speed rail. all that sounds fantastic. what i really excited about though is just inclusivity of the neighborhood, the degree to which we have incredible expensive high rises behind us and now thanks to partnership with ocii and chinatown cdc and others, an

additional slug of affordable housing to make the community that much more inclusive. i will go through names. mercy housing side, sean and [indiscernible] mike kaplan, randy, john and eric [indiscernible] many other said. malcolm and i have been friends a very long time. glad to know he is your favorite developer. i will punch up jokes for supervisor dorsey to get props next time. but, it was fun to actually do something together. malcolm and i have done a ton of advocacy for years. wonderful to do work together and are thank the folks at chinatown for all the work that are doing to make the combined project possible. it is exciting to build something together. on the ocii, there are a ton of

folks to thank. i won't name them all, but in addition obviously providing both with this opportunity, incredible staffing that goes into making sure the projects move forward and availing to funding sources [calling out names] a few folks listed on the sheet, so gustauvo, wonderful to have you here. we want you here every week and go from 10 percent to 20 percent. where did he go? he is just moving around so i don't raise the bar. also, the same for liz and the rest of the bank of america team. huge partners of mercy housing and chinatown. we do a lot of work in these public private partnerships and when you assemble this many people and complicated funding sources it is really wonderful to know you are in good hanz hands and that is how we feel with the team of carrie and jennifer and brandon over there.

our general contractor, wonderful to see the folks. patrick. shellby, rubin from rubicon. great to be here. and then i saw serena and owen and [indiscernible] ya studios [indiscernible] fantastic buildings behind us. preef [applause] i don't think stokes is here but they will be a fantastic service provider to residents and want to thank andrew and other folks from the community benefit district for making this community such a vibrant place and we look forward to opening a new building with new neighbors for you really soon. with that, i'll turn it back to you, thor. thanks a lot. [applause] >> thank you doug. i did not mean to imply you have been around a long time. you are just a expert. people look to you for advise and those kind of things. i have the great pleasure introducing the best developer mc, bar none

in the east cut main corridor, malcolm young. malcolm is the executive director of ccdc. cdcd. enhance the quality of life for san francisco residents. profound. it is legit stuff. i know that is what they do. malcolm will come talk about that. malcolm, come up. [applause] >> good afternoon everybody. i had a scripted speech but because of supervisor dorsey remark i am throwing that out the door and have to be funny or something like that. i want to start with tradition and hopefully a tradition we can bring to east cut and all district 6. i want to--everyone to take a look to your left and then take a look to the person on your right and tell them you're beautiful. now we are a community.

we are done and built community, i can leave. first off, i want to say, it really is amazing to be here. i know these past 4 or 5 years have been incredibly challenging for san francisco, but i also know affordable housing production is one of the bright spots in the city. in many ways we help to keep the economy going, we help keep jobs going, and investment going but that doesn't happen without intentionality, without focus and towards that end, i think we really have to acknowledge the leadership of our mayor, madam london breed and our supervisor, supervisor matt dorsey. [applause] that intentionality has to extend to city agencies and state agency partners. gustauvo at housing community development, thor at ocii and i have to mention they got the shoe game

going. i thought i would look cool, their shoes are way better then mine. thank you. no one laugh s at my jokes, what is wrong with you guys? only supervisor dorsey. come on! i also want to thank our bankers, b of a, you guys cut the checks, thank you very much, keep them going, don't stop that. thank swinerten and rubicon for building. it is cool to be partnering. first time partnering with swinerten and architects and designers, you guys are building the environment that will create community so thank you for your focus and dedication and attention to that. that's where you applaud. [applause] i also just want to acknowledge our partners at mercy housing. you know, it is something-doug is right, this is the first time our organizations partnered together. doug and i have known each other a long time and when we were exploring this potential partnership, my team

over at chinatown cdc got really excited not because they wanted to work you doug, sorry, it is because they recognize mercy team is the gold standard in project management, not only in san francisco but throughout the country and they were super excited to learn from the pros and doug, we will be stealing some of your secrets. doug said, keep your hands off his staff and vice versa. last but not least, i really want to acknowledge the chinatown cdc team. i see kim here, joanna, i see [indiscernible] julia ling and matthew who helped put the event on along with mercy staff. it is challenging to develop in this environment. i think we know that. the challenges faced by the market rate folks have the same challenges we had to face and yet we all have been able to overcome time and time and

time again and while it isn't a solo efforts i want to acknowledge the hard work that goes into getting the projeths projects where they are. to the chinatown cdc team, i want to give a big round of applause. thank you. i'll end with this, we in chinatown know what it is to build complete communities. we know what it is to have a place where you can live and work and play and eat and love and-not love, sorry. that might be inappropriate. eat and play and we also know that in times of crisis, that is where you resiliency comes from. we know that as a neighborhood, we were able to survive the pandemic and come out of it stronger because of the completeness, because of the ecosystem, because we are not a neighborhood that is a one trick pony or one neighborhood because of the diversity, so

i'm really exseated chinatown cdc can contribute to creating the diverse economy, diverse community that will be the east cut and frankly, that will lead the way in san francisco's recovery in restoring the vibrancy of the city moving forward because we are world leader in so many ways and the neighborhood is at the for front and i'm excited to be a part of it, so thank you everybody and hand it back to thor. [applause] >> i always forkbet to thank monica yang in the back who does all this work for us. she helps prepare the events and writes my own notes. thank you for your hard work. [applause] >> great. thank you. maybe you can help with our notes. marie in our office did all my writing so thank you marie. our next speaker, malcolm

suggested it is maybe a given, but better not left unsaid, the money. i want to bring up liz. liz from bank of america. they are providing financing for 2 developments. liz, please come up. thank you. [applause] >> thank you so much thor. it is honor to be with you all today on this beautiful beautiful day as we break ground at this wonderful development. bank of america is proud to partner with the bring the 335 new affordable housing units to our city. bank of america commitment to community development is vast and deep. last year we invested all most $8 billion across the united states creating 13 thousand units and

that commitment starts in san francisco as well. i will continue to thank but go fast because we are san franciscans and we melt in the sun. bank of america and behalf of bank of america i like to thank ocii, mayor office housing community development, city san francisco, mercy housing and amazing teammates at bank of america. thank you so much. [applause] >> thank you liz and thank you for your partnership and confidence in investment in ocii and san francisco as a whole. the next speaker is cutina johnson, community organizer for nearly 14 years. she is a member of the transbay citizen advisory committee and strong advocate for affordable housing include ing block 2 development here. catina, can you come up? thank you.

[applause] >> alright. good morning. thank you. i'm here to speak on behalf of the ocii transbay citizen advise ray committee. my name is catina johnson. i say i specifically chose this area when i moved here in 2009 because san francisco is a city of neighborhoods. every neighborhood has its own vibe and flavor and a city as historic of san francisco you don't get the chance to play a role in the formation and early stages and development of a neighborhood so that excited me moveic to rin can hill and east cut. august of 2009, the old terminal building was a few months away becoming rubble. there was nothing going on on

the weekend so wasn't much a vibe. today in 2024 there is color, there is vibrancy, there are families, there are children, there are older/middle age single people like me, and yes, this is downtown, but also a neighborhood and most importantly, there are things going on on the weekends. building a neighborhood and getting to this point has not been an easy task. among many challenges i'm sure the developers had to endure, sometimes took a grilling when it came to cac meetings but they took it in stride and great about addressing committees concerned learned based on the lessens we learned about living in affordable housing in a expensive area. the ocii staff continues to work miracles to move things forward with each new obstacle and surprise that comes at them.

i want to say thank you to every person who worked so hard to make this happen and the soon to be residents of transbay block 2, welcome to east cut neighborhood. [applause] >> thank you catina. did i hear catina right, she said it is a vibe. east cut is a vibe. you hear that andrew? thank you. can our next speaker will talk about the community, the community building going on, andrew robinson of the east cut community a benefit district has been the director there since 2015. he has been leading them and contributing to advance the development in this area, including a building sense of place and cultivating the east cut quality of life for all san franciscans and visitors alike. he loves pickleball and about to tell you about it and also loves soccer and a good laugh so andrew, come on up. preef [applause] >> >> thank you very much thor.

i am the last speaker, so i apologize. the sun always shines in east cut and the mayor did mention every house comes with spf50. it is an amazing time to be part of the naerbd neighborhood. the last week building a tunnel to 4th and king to transit sentser but that is a small piece of the story and maybe here today touched oen it. i believe this neighborhood is at the forefront of what koun downtown will look like. it is mix of housing across the economic spectrum. retail, walkable streets, it has jobs, bringing more jobs through this project and others in the pipeline. this block is a microcosm of what is happening in this neighborhood. the civic pop up recreation space behind you is a community hub for us. it is creating the social infrastructure we need to

create neighborhood bonds and the housing project behind us that deliver over 300 affordable housing units is essential to how we create a vibrant naerbd neighborhood that is a tapestry representative of what we love about the city and together these two projects are a small storey of the neighborhood. these 335 housing units will add to the over 8 thousand housing units in the neighborhood. believe it or not, we have housing here and we are building our community vitality as well. we are helping san francisco meet ambitious housing goals; but we also only as good as the spaces we build around these buildings, so the retail that comes here, the child care facility that is part of this is essential to having families thrive in this neighborhood, and we have to deliver the long promised permanent park space in the neighborhood that connect the neighborhood and bring people together and provide that space we all need to thrive. the east cut community benefit

dist rth of course is committed to work wg all the partners here today and i couldn't be more grateful to welcome. thank you to the state for investment, bank of--all you here today make this possible. with that, i want to thank everybody and say the evidence is strong san francisco will recover and downtown will be a place of vibrancy, safety, community, all the things you want to see in your neighborhood. thank you everyone. [applause] >> thank you andrew. we are coming to the merciful end. i want to thank everybody. there is refreshments and lunch but i want to make sure we didn't miss everybody. i want to thank you can start doing the long round of applause, mercy,

cdcd, swinerten, rubicon, [indiscernible] child care, [indiscernible] [applause] department of building inspection, patrick oreardon, have to make sure the permits are right. i thank monica from mercy. iulia julia ling, [indiscernible] [calling out names] go get something to drink, go get something to eat. thank you, have a good day. [music]

>> [music] what's this for? i will have nile firefighter friends bring me a bench to explain the cool things. joy want to see. >> this is cool marbles up here. a, appliance and hose and this is a y >> why? >> why is it called a y, that's a great question this . is a y. you see it looks like a y. we use it for yellow in the fight we use it to take 2 different hoses from one hose. that way in a big building like a high rise, and we have a large piece of hose connect here, we are able to take two more hoses

in different directions to help put a fire out in a floor that is well above the street level. >> okay. >> fire engines carry 4 firefighters and firefighter paramedics. firefighters should not be considered strangers. firefighters are your friends. >> uh-huh. >> you are in need of help you need to make sure it is okay to go up to the firefighter. firefighters utilize many of the tools we discuss in the a fire engine. such as a fire extinguisher >> what's that for. >> they can be used to put out fires the size. a waste basket and squirts water. >> oh , >> that is cool. >> yea! >> we have other tools a chain saw. they help us get through the many obstacles we encounter while we are trialing to put out a fire or save somebody's life. >> nice >> that is cool if you see a firefighter like this in a fire

the firefighters are friends and this firefighter will save your life. it is okay to go to the firefighter. >> hum. good to know. [music] ♪♪

if you. okay. good evening and welcome to the may 29th, 2024 meeting of the san francisco board of appeals. president jose lopez will be the presiding officer tonight. he's joined by vice president alex lundberg, commissioner rick swig, commissioner john trevena and commissioner j.r. epler also present is deputy city attorney john huber, who will provide the board with any needed legal advice at the controls. the board's legal assistant, alex long. and i'm julie rosenberg, the board's executive director. we will also be joined by representatives from the city departments that will be presenting before the board this evening. up front is cory teague, the zoning administrator representing the planning