>> >> >> >> >> 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 and hr who is part of this 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 ] >> >>

pen. >> well to edge own little square we are a new culture "accelerating sf government performance - taking accountability and transparency to the next level." the artist and culture of chinatown. as an immigrant giveaway we tell the stories of chinatown the people that are here and the culture and history our presence and future through arts and culture. it is a 35 community. there is so many to see come come in and buy certify increases and ongoing exhibitions here t t t

(gavel) (gavel) county transportation authority meeting this morning at 10:00 am., tuesday, may 21, 2024. i'm chair mandelman serve as chair and our vice chair is commissioner melgar and thank you, sfgovtv and our clerk clerk yvette lopez-jessop madam clerk, call the roll. >> absolutely commissioner chan absent. >> commissioner dorsey presents. >> commissioner engardio present. >> chair mandelman present. >> commissioner melgar absent. >> commissioner peskin present. >> commissioner preston present. >> commissioner ronen absent. >>