>> thank you. i have the privilege of reading the land acknowledgment today. the san francisco commission acknowledges that we're in the unseeded homeland of the ramaytush ohlone who are the i object hab ants of the peninsula. they have never seeded nor lost nor forgotten their responsibilities as care takers of this place as well as for all people who reside in their traditional territory as guests, we recognize that we

benefit from work anding living in their traditional home lands. we wish to pay our respects by acknowledging the ramaytush o hlone. the next item in the agenda is approval of may 21, 2024. commissioners we have before you the minutes of the meetings, are there any additions or corrections? seeing none, we'll take, we'll take a vote? >> clerk: motion. >> motion to approve these minutes. >> speaker: so moved. >> is there any public comment on the items? any public comment on this item, item 2, there is a hand remotely, before we do that, i'll read a quick script, members of the public will have an opportunity to make public comment for up to three minutes. it's designed to provide

impacts from individuals. however the process does not allow process to be permitted in the meeting. the commissioner do consider comments when discussing items. individuals may not return to read statements from other members. the commission dphs we will first take public comment from individuals attending in-person and then we'll go to remotel folks. there is one remote person.

great thank you. you've got three minutes. >> caller: these minutes include my testimony during the april 10, quality conference that continuation of llccbi program is the key component of nine steps sustainability with cms regulations into the future. but l.a. change has not been presented a sustainability plan for the health commission review yet. why hasn't a sustainability so members of the public can see what the plan entails? why was that sustainability plan presented to a national conference of cms but not presented to this commission? for that matter why wasn't submitted for the review for the quality confidence? and was that sustainability

plan submitted prior to ending its contract that was scheduled to last until august 31, 2024. with them no longer, what happens to sustaining the ccbi program that they complained about? thank you. >> all right, that's the only comment on this item. >> all right we'll take a vote all in favor of approving the minutes, say aye. >> aye. >> thank you, the next agenda is general public comment and once again, secretary has a statement to read. >> the script is a little different for general public co. at this time members of the public may address the commission of items of interest to the public that are within the jurisdiction but not on this meeting agenda. and then the rest of the information, i already reviewed. is there anyone in the room? give me a second to pass out.

>> speaker: good afternoon, and thank you for allowing me to speak again. last meeting, i'm christopher klein, last meeting there was a presentation about ethic, ethic health so i did a little research and it runs parallel about the things that i've been talking about the last couple of months. 1400 people trained in san francisco that uses this system but there is 300 million health records that epic health owns. that's not just in san francisco california that's across the street and other countries. you're going to see university linked to ethics, university of san francisco and michigan

pennsylvania but there are other universities at our link. in san francisco there were more than two people that worked in san francisco. and when they left, they took everybody's whistle and one person went down to l.a., his name is mitchell katz used to be the director of public health here in san francisco and then took all the records from l.a. from l.a. to san francisco to new york. i don't want anybody in new york accessing my health records and dictating my health. that's one of the major concerns, so i'm going to put a power point presentation to explain this in very detailed information so everybody can understand, it's a lot of information and technical. but that's technically what happened, it's a cloud con paouted, they get your position from you about your health record.

so on, there is a lot of people working on this, i reached out to the department of defense, office of inspecting general, they're helping me guide me through this, it's not just happening here, it's happening everywhere. it's causing the protest because with it, you can send messages to protest and get them upset and riled up, so there is more to come, there is a lot of people working on this, and, right now, the best thing that we can do is just, ask questions. ask questions to director:fax within human services agency and we'll go from there and again i'll put that presentation together, i should have it within the next three weeks. thank you. >> thank you. >> let me check remotely, is there anyone that would like to make public remote public comment? i see no hands. >> thank you, the next item on the agenda is the director's

report. >> good afternoon, commissioners and members of the public, we have, i have an extensive reporter's report here. much of it very exciting. i'm going to go through the items and i'm happy to take any questions and i'll try to be both comprehensive and mindful of time. so there is a new san francisco program that uses night time tele health to provide immediate access to preparation medication to start recovering from opioid disorder. provieeding unhoused people with immediate medication preparation at night in a safe place to begin their recovery. under this pilot program, they're providing realtime connection with a doctor for those ready for treatment and other opioid use disorders.

medications from opioid use disorder highly affective and reduce the rick of dying by at least 50 percent. to use prescription is filled and medication is taken, the pilot provides a safe place to sleep at night. the caseworker is provided along with stabilization in certain cases. in the first 8 weeks, more than 55 people started medication for disorder residential treatment program under in night time program. in total 173 people, and 134 percent people prescription issued with 33 percent of the prescription filled. nearly 1,000 people entered treatment. the program is in partner with the community health center, the san francisco department for homeless and sub board nat

housing in four teams. the team which is out on the street from 7:00 p.m. to 3:00 p.m. was noticing and these were funding by dph were noticing that people were interested in starting treatment and we had very limited sevensers available at those times and of those pilot program we tested the hypothesis which is people protalked to a provider at night and offered a place to stay while they wait for the prescription to fill and you can see from the first data, we had a great number of people fill their description and start their recovery. so we look forward to reporting more on this program. again for the people out in the street at night in this area under this pilot, there is a truly treatment on demand, so i just want to emphasize that.

so item 2, city of san francisco encourages m pox and we want people to take care of their sexual health by vaccinating for m pox, which is also called monkeypox. we're continue to go encourage people at-risk for m pox to get two series vaccination. i have rio hond o personnel update. so laguna update remainses sustainable, surveyers from the centers for medicare and that should be medicare and medicaid were on side for a survey for the december 2023,

medicare certification in 2024 and preliminary findings indicate related to the medicare sert if --certification. laguna honda continues to work with regulators to report incidents and anonymous complaints. on may 30th, surveyers returned for one-day to resolve two plans of correction. we are pleased to share they exited with zero find fgz. laguna honda also was to announce--cherry brings a wealth of knowledge including most recently nurse manager and assistant director of san francisco, a general care a cute care hospital was a distinct nursing facility and

second in size only to laguna honda in san francisco. so we continue to our journey to certification as you can see we continue to bring in, leadership to, to help us continue with that journey. i have an additional department wide overdose response workup date in addition to the program that i started with to reduce fatal and non fatal overdoses with the focus on the black community and people living in permanent supportive housing. existing programs to create a database to reduce drug overdoses in san francisco. our coordinator response has made progress towards our goal of increation the accessibility and affective and treatment and strengthening engagement social support for people at-risk of overdose. they have partnered with department of supportive housing to implement a boxing

program at all housing sites and drafted is assembly bill that increases access to methadone by allowing clinics to dispense methadone for up to 72 hours, not that they're open for 72 hours, but they have 72-supply of methadone. create a new pages for over use disorder and distribute more than 50,000 cards described opioid services through the city and community programs. that's the last month in addition to the program that i talked about. moving on to the next item, very pleased to announce the new chief financial officer,

brings experience within the city and county of san francisco. from 2016, he has worked with dph finance and controller for the department. prior to dph worked with the controller's office. and initial prior will include financial planning through what is expected to be a challenging to maximize revenue and maintain financial stability for the department. next item with regard to the 46 annual carnival, the dph group was excited to announce that they successfully coordinated over 30 to support the carnival on saturday march 27th in the mission district. this is the second year that staff has come out to support this event and there was

widespread where they, volunteered and engaged in community in participating with the event and made people aware of our health and wellness service sxz that we're open for care for every one. next item is vsfg received a baby friendly did he go designation and received a friendly designation after a rigorous progress conducted by baby u.s.a. provieeding that supports breast feeding of all birthing people that make decisions for themselves and families and this is just another indication of what strong program for maternal health they have. cfg department and emergency

nurses recognized during medical services week which was may 19th through 25th. the city celebrated all the great partners in emergency medicine and other professionals save lives everyday. during the award ceremony which i was able to and happy to attend, we recognized the emergency teresa sandwhole who was awarded the hospital provider award in recognition of her incredible contributions. there is a lot of detail to call out staff who worked for many years including, dr. earl recognizing jenny trend, who

served dph for 35 years, that's 35 years. and richard find people's clinic and other clinics across the hospital. and recognized teresa del rio, i'm sorry, delian a physician leader who--and she is an experienced leader and chief of service of family medicine. i can say she is an outstanding leader. next item, the population health division has been closely monitoring avian influenza a, h-5n1 and there is a full review of the local developments. i will just go through the san francisco update and happy to answer any other questions but

that specifically in may of 2024, dph was informed about a positive h5 avian flu test result on two a systematic chickens and a live bird market in san francisco. this testing was conducted as part of food and agriculture testing program of live markets. dph responded to protect the health of market employees and completed the health of employees who are in close contact with the live chickens. the employees monitor did not report any symptoms, no members of the public were exposed and the market has safely reopened. the infectious across the uflt states has recently begun waste water at the timing for h11n1

due to the live bird market detection in may, waste water scanned their new avian flu in san francisco waste water and fragments of the material were detected. we're the only municipality with a avian flu detection. multiple other jurisdictions across the country did have detections. more resent testing conducted in the latter part of 2024 did not detect the waste water. it is possible that the genetic fragments originate from the birds or other animals through the san francisco sewer system that collects storm water in the same network of pipes. still remains a low risk to general public, there have been no detection of avian flu among

patients investments that have been poured to a laboratory. dph is working to increase the number of patient respiratory specimens for a lab for testing. we continue to work closer to their partners to monitor h5 a 1 activity and update public if there is any action taken to protect health. budget update there is an attached memo that i'm happy to respond to any questions in regards to the budget and then you have the covid-19 update report and i'll stop there and see if commissioners have any questions, thank you. >> first of all, thank you for the report and of course our dph and population of division is all over following this avian flu issue and we really appreciate that, and it's always so wonderful to hear about the recognition that work in the department, you see this

and besides the people in this room are so so talented. testament to leaders and lead so well. i know there will be a lot of questions because we covered so many different top ixz on the direct's's report but we'll start with public comment. >> all right, is there any public comment in the room? all right, i see one hand remotely. if you're unmuted, let us know that you're there mr. menshaw. >> speaker: i am but it says i'm muted. >> you are unmuted, i'm speaking to you right now. you have three minutes. >> speaker: this is patrick. first i would like to offer my

con --congratulations. i met ms. grados when i was admitted for meeting hospitalization for cancer mass on my right cheek. the jewish home before i was allowed to return home. i had some intersections and found her to be responsive to patience's concerns and had a terrific bedside manner. sadly with the consultant company saag no longer around, it's troubling that they had to return to l.a. change to correct two of the plans correction that resulted in two severity actual harm citation. having read the details on the form 25-67 it's worrisome that without consultants, had

trouble preparing the trouble of correction and had the return op site to pocs, this director reported the surveyor survey revisit on may 30th will not lead to another delay looking to delay to see if there are actual findings from that survey. will that contribute to more delay? thank you. >> that's the only public comment to this item. >> are there any commissioner questions or comments? okay, i just had two very quick ones then. one is is there a, it sounds so encouraging the night time tele health and accomplishments to date. is there an end date? and if so, what would be the next steps? it sounds like it's going to be very successful?

>> dr. just arrived, and we'll be providing a behavior update. i just went through the highlight program. president green was asking if there is an end date. there is no end date, we're actually looking to see if we should expand it. we can come back and report, they can give you a few pointers about a few keep points about how we're working to expand the program in the future. >> thank you, and i can see other things and this is both for my identification and the public, do we know if people that have gotten their two m

pox vaccine how long immunity will last? do we have any ideas? people lose their immunity to other viruses, i'm wondering if there is any update. >> i snuck up upon you commissioners. that's a great question, right now cdc and i are aligned that people if have received both of their doses no matter if it was in the first year or just recently, they are considered fully vaccinated for the purposes of m pox protection. we donough that people can still get infected but the evidence is suggesting that it causes a more milder disease and we think that is good. so if people have received two doses, they are fine and our--please get a second dose. >> thank you, thank you for

clarifying that. because with the shingles vaccine, if you don't get it within six months, you need to reboot. great. thank you. >> thank you. >> any other questions or comments? oh, commissioner girando. >> i'm hoping, i read an alcohol about the alcohol reduction program which i thought was a good article too, you know, on yes, it's harm reduction but it's all working and it was positive. if in fact, dph's media folks, i know i'm always on the soap box, but good parents, night time tele health and overdose response work together and get it on the local news and in sf

gate, because this i think is such positive work and we need more information out there. >> yes, i appreciate that and there have been a couple of pieces that have received coverage so we can call the commission attention to that as well. and you're reference to u.s.a., what is in sf gates. so it was today. that won through the data and science, with regard to the manage program and the staff that by our estimates it's saving the taxpayers 1 and a half million dollars a year in terms of costs and keeping people off the streets and emphasizing that no taxpayer

money is being paid for by alcohol. >> thank you, and i may be incorrect it may be the u.s.a. today article but it was in the san francisco foundation paul rose's blurp. >> thank you. >> thank you, the next four items volve resolution to see recommend to the authorization of dpa to accept and expand a series of gifpts from the foundation and we'll take them one by one but greg will present each one and we'll see if there is any questions in both reach. >> thank you very much,? in discussion with the board, board of supervisors. so in discussion wz the controller's office, the

coerl's office has asked about amendment be made to line nine of the health commission 23-14, with the line accept to expand a gift of cash to department and donations to better reflect the nature of the gift. we ask the commission to approve this amendment. >> so, let me get, we have the resolutions numbered here, is this resolution 24-07? the one-14. >> okay. >> with the previous resolution approved bit health commission.

and when we turn to the controller office, they want us to show that it was a donation of cash and in kind donations to the department. so that is o7. >> thank you, thank you for the clarification. and i'll let commissioners to look that over. >> i so move to approve 24-07. >> is there a second. >> there is no public comment in the room, is there public comment remotely on this item? no hand. >> everybody in favor of approving number 24-07, please say aye. >> aye. >> aye. >> okay, now we'll move 24-08.

>> this is similar issue at the controller's office looked through this motion that was approved which was 23-09, and said that, they would like to amend the line which says the public has been a gift of cash to department to accept a gift of incline donation instead, if there is donations for supplies that was given to the clinic, we humbly ask to approve the amendment of this resolution. >> all right, once again, we'll take a few seconds to look at 24-08. is there a motion to approve. >> is so move to approve. >> second. >> any public comment on this item? >> is there public comment on this item remotely? there is nothing in the room. i see no hands. >> all right, all in favor of approving 24-08 please say aye. >> aye. >> aye. no. wonderful. 24-09 and please speak up,

enunciate. >> they're donating to the public health food in the amount of 367,187 thousand of food to go support the food pharmacies at dph clinics to address nutrition and security. we humbly ask the committee to approve this resolution. >> thank you, that sounds wonderful. is there a motion to approve. >> can i ask motion first. >> public comment. >> sorry. >> is there a second? >> second. >> we'll take public comment. >> public comment on this item remotely? no hands. >> okay, now commissioner comments, commissioner girando,

sorry. how many food pharmacies? >> unfortunately, >> this is gregory can you all hear me? >> yes, is it possible to turn your camera on, dr. gregory? >> yes. >> did you hear the question? >> ye, i'm the director of primary care. and thank you for your question. so i don't want to tell you the exact number without knowing that i have it right. we do not have to you shall every one of our clinics but we have them at a handful so if it's okay, i would like to give the specific number as a follow-up, it's less than half a dozen. >> thank you. is there any thought even with this funding of adding anymore? >> yeah, we are very motivated

to expand the program it's been really successful and well received by patients. we're in the process right now of doing a deep dive into the model using a lien to analyze it and figure out how we can optimize it. we just want to make sure that we get the model right and understand the best delivery possible before we spread it to other locations. >> thank you, any other commissioner questions or comments? okay, we'll take a vote, please says aye. >> aye. >> aye. >> and our final resolution is 24-10. >> this is going for the fiscal

year 2025. the health foundation is donating to the health gift 368,000 for the food. and previous resolution goes to support food pharmacies and dph clinics to address nutrition and security and provide patients with healthy food. i humbly ask that we approve this resolution. >> all right, is there resolution to approve resolution? >> so moved. >> is there a second? and is there any public comment on this item? >> is there any public comment on this item? we're on item 6. no hand. >> commissioner comments and questions? >> yes, thank you mr. wong. did you say that this is for 2025? >> yes, fiscal year 2025. >> which would begin in july. >> it will be beginning in

july, i'm sorry i didn't explain that, the resolution could be for the 23-24 which is coming to a close but we're trying to get this resolution approved so we can get it. >> because like in the resolution itself, it didn't have any references that year. so, so that's why. thank you. >> all right, seeing no other questions or comments, all in favor of approving resolution, please say aye. >> aye. >> aye. >> thank you very much. appreciate it. the next -- ~>> actually commissioner if we may, director colfax asked me if he's able to read part of the budget memo from the director's report, he feels it's important. so we'll do that. >> absolutely. >> thank you, commissioners and i just thought to read into the record, i know the budget was

pretty challenging this year, i want to thank louie and emily gibbs that were here earlier and seriously across with many people across the department to provide the mayor's office with the mayor's asked for in terms of putting her budget out which will go to the board of supervisors. so i wanted to read the introduction to the memo, that the mayor introduced for the fiscal year and 2025-26 on may 31, overall proposal by about 47 million dollars or 1.5 percent to over 3.2 billion and includes similar funding. the budget fund contribution declines from the community year to about 135 million before increasing fiscal year.

includes update made during labor negotiations aligned projected, we anticipate some of these changes in reduction to some dph programs can examine in that regard, there is a hearing scheduled before the board of supervisors on june 25th at 3:00 p.m., so you'll have other numbers and other details in the memo but i just wanted to read this into the record. thank you. >> thank you so much. >> we can go back to the item. we welcome our dph director, and she is going to give us a behavioral health services update. thank you.

>> hi, everybody, good afternoon, commissioners, i'm really happy to be here, next five. and thank you also for your questions in advance. so for today's update, i wanted to just remind us about phs mission and vision speak about prop one the recently passed state law is in epic migration update and update on the office of coordinated care, cultural green care residential care and treatment and finally overdose response, so this is a little bit of a hudge pudge that we wanted to make sure that you were all aware of. next slide.

as missioners know, well being and participate meaningfully and across life spans and generations and to accomplish this vision our mission is to provide questionity and substance and promote behavioral health and wellness among san franciscans. you can see our key tactic below our mission and vision to improve access to care and increase, awareness of where and how to get help. and i believe the presentation you'll see will focus on these areas. next slide. i wanted to update on proposition 1, the state

proposition 1 was approved by california voters in march of this year. prop 1 changeses a number of different things. first, it substantially revised the services act. this was an act passed by california voters in 2004 and the focus of the changes has or will be on how many under this act can be or should be allocated by the counties. the act is also changing the name. this includes substance use related care and what is allowable. so, a part of proposition 1 is to allocate money in particular ways.

right now it's not in align with proposition 1 future allocation. that by the way does not need to go into affect until july of 2026. so we have and we begin embarking now is a planning period in order to fully understand what is and isn't an alignment and how we get to be an alignment. i should also say that the full guidance from the state about what is allowable in each of the categories, has not been started yet. so we're waiting for guidance on what counts for each of the services, behavioral house supports and housing.

i think the other has been and likely continue to be volatile. it's based on tax collections that happen at the state level and it goes up and down and anticipated to have some declines in the coming years. comprises about 13 percent. the other pieces important pieces of prop one is that it approves a 6.4 billion dollars bond that is state wide money. from what we understand is that the state will allocate applications the request for funding, we expect to be coming out in july and then, we apparently have until november to apply for the money and then it will be awarded next spring.

so we are awaiting what will be eligible and what will be applied for and we'll make an application. the last change is changing and integrating the way behavioral health has to report up to the state right now, as i think i've related to you all, we report, we have many reports and many things we do and it's divided by mhs a by substance use, mental health, health plan and many have multiple parts. so it's a lot of reporting which takes a lot of staff time and energy and we are hoping although again, no guidance, is in our hands yet that this will rationalize and streamline some of our reporting, hopefully, next slide.

this is a state issue slide with a full go slide in july of 2026, next slide. epic migration has launched last week as of may or two weeks ago, may 22, we and behavioral health on our mental health services side joined the san francisco health network on health records, you can see, on the picture in front of you, is max rocha, marco lopez, imo

momo our vhs leaders, marla simmons is here in the audience about to present, this was and is still herculean, preparing for the day, the many many behavioral health staff who learned the electronic health record coaching staff to change workload to change the way we're doing business. every one is very excited and op mus tick and also experiencing the very real challenges of this kind of enormity of change.

next slide, and i'm going to try to answer questions as we go. so thank you, both commissioner je ra do and green, so will health record be available everywhere. so the answer is yes, when the patient is available when the healthcare providers who are providing care to the patient when the health record is shared as you all know. it occurs by an electronic change. under care with the client's consent, so it's really exciting and will change meaningfully how healthcare can be coordinated. commissioner green you had a complex section about disorder

and mental health issues and as commissioners know, we elected at this time to not move our sud services with the federal confidential law, that has implications about high low that we're continuing to work on, what that means and there is many different, different implications when a person may be getting care in primarily care, it's not concerted 42 protected information so it can be shared in the record. if a patient discloses to a non 42cfr covered entity and that entity like me as a primarily

doctor puts it in a medical record can be shared as epic in the routine. but it's providing are providing care in outpatient clinic that those records will not be part of the routine epic record. and again maybe this is too detailed but it's because of la protections and you can probably deduce my point there. so this is a bift a busy slide about the office of coordinated care.

this office has done extraordinary care. i'll acknowledge marla's image for whom this was a brain child before mia rival, we in the city did not have capacity to really have properly and follow people from setting to setting where and when needed. and our care coordination function that is the ability to not only get people in the front door but to move with them across sites when they are at high-risk for not making it to the next level of care or service.

what we're start to go do and have been able to do is track data, that office did launch an epic to they were early doctors and have shown up some of the things that is doable and epic. so you can see, we've been,

through april of this year, and to business had gotten steady by november of 2023. the next slide depickets what we're following as teams. to make it an appointment or housing appointment or something else that they need. the green is our best neighborhoods team, these are

the street base teams specifically working on people who may be encountered in the street. they get refers from other teams from neighbors, from from coming in from 311, with the hot team, the homeless out reach team. and these are folks that follow people, longitude overtime to try to connect them to further service. and then finally, we have a team focused on the shelter and providing and supporting shelter behavioral health working very very closely. and you can see that there is steady large number of referrals dating since november.

and we'll continue to come back to you. i know one of you had a question about the percent of referral meaning of people who we hear about or know about, how often are we able to connect and make some forward nation. we will come back to, i think that's exactly where we want to head in terms of data. i think that's where we want to go in addition to how things happen to folks. and retain gear which is ultimately about trying to improve their health.

okay, next slide. we will come back with more specific updates, part of what we're focused on behavior health is trying to deliver appropriate care as we have come to term congruent care to specific folks. we have one program for black african-american communities. these programs are now implemented in four of our our own dph clinics, they're using, both practices that have been

adapted to the black african-american using techniques like storytelling and management and therapeutic intervention. this is one of the programs that has been funded under mental services act as part of the project that we're very eager to see live on. maternal mental health trying to tie together mental healthcare and that will soon be implemented. next slide. so switching gear again, a very important part of the system as i've spoken to a number of you

is what is happening in our residential care and treatment programming. and i wanted to these slides are actually drawn from an update that we provided to the board of supervisors and wanted to make sure that you were all aware of these as well. next slide. so this fiscal year, we have access to 25 residential care and treatment beds. why is this an estimate? this is an estimate because in some cases, we own the beds, we run the bed, it is only for san franciscans or if it's somebody else is there, by permission or special case. we also contract that is we're in an arrangement with an

organization that does not reserve the bed for san franciscans but is available for us to place the patient and we might assess the person and say, call up a particular providers will you accept this client or not? there may be and reasons that they may accept or not, that include space importantly and competing over space resources. and i'm about to tell but substance abuse care because they're regulated differently. we separate even though a lot of what is happening does volve the other diagnosis or the other challenge. so on the mental health side, we have 114 beds.

with most being in county and they offer range of treatment plans intensity of care.

for kunzed of new beds that we believe we still need. we believe we need between 55 and 95, what are called sub acute or mental rehabilitation center beds.

the next slide.

the really higher medical complexity beds that we don't really have access to in san francisco and we're working on strategies to figure that out. we also need more sud residential step down beds. these are beds that are not specifically treatment beds but these are sometimes called recovery housing. transitional recovering housing or sober living.

including a good analysis by brand institute that confirms that we know people waiting but we don't have the data to analyze flow and inside, next slide.

some of the difficult beds. we're anxious to see this happen and anxious to have a time line. i also know that you heard from dr. leaer' from pdf, and he raised some of the challenges around shelter which we obviously don't control and that the coninfluence of housing needs with behavioral health issues is together a city problem. but the shelter problem is not under dph. i don't have specific numbers around what levels of care, of folks need coming out of pef, i will say that tr*, in my conversation with dr. leaer' with whom i worked very closely, there was an awareness that a lot of what is needed is connecting people and helping them to get into care is a mainl or part of what we have been working on together including with the particular

office coordinated care. one more section, moving on to overdose. when i come before you to talk about overdose and you heard from dr. coalfax about our program with tele health. we as awe department i think you know, are really aiming to strengthen our efforts, laser focus on fatal and non fatal overdoses and to reduce overdose death disparities in san francisco. we're aiming to do these five things align and coordinate existing and new approaches to maximize our impact.

we're really focusing on equity and reducing racial disparities. particularly analyzing assessing gaps and existing intervention sxz who we are not reaching. we are working closely with community partners, we are also really pushing on local state and federal policy and i'll circle back to that and then strengthening our data capacity. next slide. are key objective are on the slide in front of you and i'll talk specifically about the first key objective, we're aiming to improve access to and retention in medication treatment for opioid use disorder and the evening tele health gets at that issue, if we can get to people in the moment that they want help and this is the bedrock of what it means to have treatment on demand and get people into care

in the time that they're ready and this is what that pilot program represents. we also know that it's one challenge in the city and in the country, is it that methadone treatment and i think i will get there, which is highly regulated makes it more difficult to have the kind of flexibility patient centered that we know is ideal so that is why the policy work is very important to take advantage of any flexibility that is available. our next key objective is around community engagement and in particular we're focused on building and supporting capacity of black african lead organizations to address overdose in the communities that they serve. and then, secondly, we know that over death deaths are over represented and we are working really aggressively with the

providers and shs to find way to see expand access to treatment and overdose prevention. we are also want to go raise awareness, helping people identify resources when and where they need it. so i'm going to speak briefly about methadone and share can you three data slides. we, the landscape for methadone treatment in the city is as follows. we fund and provide methadone by a six clinics and one mobile van, you can see them in front of you. the o top award 93otop van services run out of zuckerberg, the remaining program in the case of ford help and bart are national methadone programs that are part of a large for profit system.

dave view hunter's point and black serving methadone program and non for profit. and each in the situations, there needs to be different approaches in order to expand access like intake, like retention and care like flexible services. i'll just point out and we've talked about a lot about staffing shortages and workforce, and in some cases, workforce really impacts the hours of operation for new patients, their ability to do and see as many new patients as we would like and they would like. so this is an on going project for all of us. i want to share three data slides, next slide. and just again, make sure that you all are aware of the data that we now are able to follow

and be able to share with the public to track how we are doing. what we know on the last is the annual numbers those come out from the office of chief medical examiner and i'm just showing the finalized numbers in front of the screen. we do make available monthly fatal overdose and i think you all know we're doing monthly press conferences after the ocme releases the monthly data. on the right, what this slide does, is compare since january the month to month vaie aiblt.

so we're not seeing an increase in the way that we did in 2023 it is still far too high. but we are i guess hopeful that some of the work that we and others are doing are beginning are flattening the curve this year. we're tracking the number of people receivinging methadone and morphine in the city, most affective forms of treatment to prevent overdose. so in the slide that you see in front of you, we're able to see a number of san franciscans at a city level, that we have received morphine and i hope by next presentation, we'll be able to receive nepanophine,

this data come from the state with a very long, as you can see, lag time. and next slide. and finally, we're able to track a number of people receiving methadone in the city. what you can see in front of you is, a loss from 20 to 21, very similar to the rest of healthcare, followed into 2022 with an up stick in 2023 and what you're seeing is 2024 is the first three months of the year. so we're expecting and hopeful that we will see a big increase ideal, because of our many efforts and as we attract and hopefully retain more people in methadone treatment. okay. i'm going to stop there. >> thank you so much for a really wonderful and very

extensive presentation and of a thought and analysis that has gone into this, as you said the night program has been innovative idea and it will be a wonderful addition to trying to address this huge problem, is there any public comment on this item? >> there is no public comment, i suspect going to be some commission. >> thank you so much for answering most of any questions, and this one i did not write down but i'm going to throw it out anyhow. in the presentation about the beds and it's all adult, and i totally understand that, but i'm also wondering, and i know, i believe it's next year that at csfg there will be another 14 beds available for adolescents. for kids who are not in that

age range, there is only four beds available at edge wood that are crisis beds. is there any thought of expanding that number. i experienced this out yesterday with a ten-year-old figuring out and my best bet was in the east bay. i don't know if that's my question is. >> let me, i would like to bring up part of the team and i always appreciate you bringing up kids. and i know we spend a lot of time speaking about adults. for everybody what commissioner girando is referring to is a very large stake grant that we received to set up in patient

unit for adolescent at zuckerberg which goes in enormous way to see filling out a big gap in the city while not perfect. let me bring that back to to the team for the below adolescent population. as you know, regulations about who and how, different age group can be treated and had aing and manage that and i appreciate that question.

i'm still concerned with the under 12. >> under 12. thank you. >> thank you. >> commissioner christian. >> thank you, president green. it is thank you for this presentation, very rich and helpful as always. in the slide behavioral health residential needs and you spoke about, prim --preliminary recommendations, can you talk about the 9 percent does it include people who are higher needs? how do you balance that out? >> so i knew as i was reading that that that was, it was a statistical maneuver. the average wait night and

waiting to go below zero. so inclusive of the difficult. i don't know what the term, the most complex folks, because we don't want a situation where we're mostly placing every one except what we see already some very long stairs and i know you're aware of those folks. we want to build services that will take that, that we're not finding as it is sometimes now, the most difficult place. so the 95% was really for statistical and i appreciate what you're asking. >> thank you, i knew you would. and so of course, as you know better than i do, the people who are, have a more difficult time finding appropriate places for, is that in part because of

the unusual nature or the not usual nature of a residential facility having the expertise for let's say forensic clients who have a series history of violence in the community? >> yeah. so first, let me also say that this is not a san francisco, exclusive san francisco problem. and if you read, the rand rater that i referenced, be really it described the same situation that we are challenged by. and i think it is that residential care, the majority, the many residential care providers are not always staffed or willing to take on some of the challenges that

turns out many california counties are sending. i think there is a well intentionally, our well intention finding care placement for as many people as can be in your, as you're asking diverted from forensic karsral settings which every one is on board with and having the mix match expectation that's there is homes in behavioral treatment for them and i think what this really highlights is cultivating whether it's new providers, new services, building it together, with a potential provider to try to solve for this.

people are not left behind or left out. >> thank you, and when you, speak to the powers that and the funders at all levels, is this something that would profitably be emphasized to them? >> meaning? >> that there is a need, everybody in your situation knows there is specific needs always, but this specific need is one of them that is crucial for a lot of when we're having this conversation this is part of what we're saying and negotiating and conversing with

providers about. >> as much as you think that it is useful i think it would be helpful for that to be emed a public way when you talk about these beds and these facilities, you know, again to the extent that you fill it could be useful. >> absolutely. you noted in some of our comments that we had the pleasure of having dr. at the jcc meeting and he and dr. jarlet noted that there is about two shelters that are, focused or able or willing to take people who have behavioral health needs. talk about whether it takes any

sense for dph for the city, for the state to have department health having shelter beds that are specifically for people with behavioral health needs, not just one or two that may take. they obviously have some that's like two beds or something like that. >> yeah. >> commissioner, just to clarify, those are two beds for all the hospital for everybody, they're not specific to behavioral health, two shelter beds in all the hospitals in the system for 24-hour period. >> okay, thank you for that clarification, i appreciate that. even worse. so does it make any sense for there to be any move towards creating specific more specific facilities or beds under the supervisor of whatever entity is appropriate, whether it be public health department or the

hsa or whoever does it. >> i know that the issue of shelter in san francisco is so, you know, obviously for shelter is needed than we have. and i think that the design i'll just offer the design of the program and what really is a, the right model, the wrong model, i would just sort of offer the faith as we're hearing two shelter beds, across the system beinger it's hard to even go where you would like to go which is really what is the right design of a particular shelter when we are still work withing very few beds. i will say differently from what you're describing, one success in the last couple of years, has been the opening of what we have been calling

psychiatric beds coming from valencia that is a discharge destination. i know we have spoken about sometime discharge destination for street teams and i would frame it as morality na tiff to emergency department. we are obviously, and you all know working on a crisis what we have been calling the stabilization unit which will be alternative destination to the department. so i think where behavioral health has been really working is thinking about some of the lower barriers sites that both can stabilize people in lieu of emergency department and also offer psychiatric res pid. >> thank you for bringing that up and thank you for this very

meaty yet clear presentation on a lot of amazing work that you've been doing. thank you. >> can i just ask doctor, i think we're also for the 24-hour, for the night time treatment program, we're essentially proving the hypothesis that if you give people a place to go they will most likely go on treatment. this is related to the conversation. >> so as part of the evening tele health pilot that we implemented, we have identified some hotel rooms that we can tie medication with hotel room. we find when there is a hotel room with next day follow-up with a navigator folks have a pretty high rate of filling a

prescription continuing with the prescription and with their medication and we've been able to provide hotel rooms for 7 days, 7 nights while we're working on next placement and next steps. so i think this is a really good example as dr. colfax just mentioned and thanks for reminding me to prepare the shelter with the health intervention. >> that is a fantastic idea that is now a reality, so thank you. >> team. >> not surprised. >> so i guess, and thank you so much for this. can you clarify one thing, you got the slide that talks about shelter behavioral health. how does that correlate with what we're talking about with shelter beds?

because you've so well explained that entry and moments of engagement is critical and that's part of what this night time tele health is going to do. but just curious to know how that relates to this challenge of two beds for the city per night. >> so the shelter behavioral health team which is part of our office coordinated care is the team working with, within dph with our physical shelter team to work with people in shelter who have been identified as having behavioral health needs. sometimes that work is around coaching the housing case manager, sometimes it's meeting with staff, the problem solve, it's somebody that needs care or maybe somebody just having disruptive behavior.

and to try to work with either the client or the shelter team to problem solve and get the person the care into the care they need. so this is not about navigating people into the shelter, this is where people already in shelter.

in as - >>. thank you. >> the next item on the agenda is calaim medi-cal and have our sponsor and bernadette our sponsor. >> hello, everyone good afternoon. i'm marlo for the bus transit district services been a while since i've been here we're going to have a presentation and joined by the

director for the behavorial health network and we're happy to be here to do a presentation very briefly our next item. very briefly we're going to give a brief remainder and talk about the leadership role in the medi-cal san francisco and share data about the impacts we're seen so far. and next slide. so calaim as a remainder for the commissioners is really a significant um, transformation by year transformation of medi-cal system in california and huge deal one to three california on the medi-cal system in san francisco about 200 and twrief thousand people

that eligible for medi-cal and a speaking overall goal is outlined four about looking at people more holistically from trying to bring in a more comprehensive set of services and improving the quality of services trying to address some disparities to be more efficient. and seamless and they're doing this through a number of components and really overall feasibility study introducing new benefits and found gaps in available services and streamlining and improving the coordination and non-traditional support and help to address the health barriers providing incentive funding to really drive a lot of change and help the systems have the

possibility of overall increasing strategies to um, rile help folks enrolled and can benefit from medi-cal in all of this. next slide, please. so the um, calaim has a lot of components. we don't have to do a presentation we think of - but wanted to i'll talk about the behavorial health transformation work and all of the initiatives and multiple things happening and a couple of things i want to highlight on this slide one is the wheel to the right here really highlights a how many county level partners are involved and justice departments

and institutions and community-based organizations, and level of coordination happening is really unprecedented and calaim pulling the partners in many cases in the city of fresno this is very helpful i wanted to give an example of one of the initiatives the justice involved work that is happening and obviously a high priority population what calaim is doing it is among striving screening for folks they come into the jail and supporting them to get enrolled and paying for services 90 days and doing a lot of things on the discharge and really mandated connections and into the community care and ben

detective will talk about what those services look like but an example of one of the initiatives happening. and. next slide, please. one thing it is focused on medi-cal managed care and so in san francisco we have three medi-cal and san francisco and blue cross blue shield and next as you all also probably remember the dph operates two spltsz medi-cal any member of the public wish to speak on this item care and the mental health and the drug medi-cal operations and so this slide is showing the research from the dph into the managed care plan and ultimately for providers san francisco health net is a big procedure if mix as well as dph and other of

our dph contractors providers and then ultimately serving the members and another thing just on the managed care fund prior to calaim were about thirty percent in the medi-cal numbers were not enrolled in and now approaching the high 90s a model of care and what was? >> yeah. i made the point and a lot of the fund going to the medi-cal managed care plans and so we are working closely with them to make sure the services are 2k3wr5g9d in the dph systems and next slide, please. so again, i won't go into all the details on the slide but calaim tries to provide services for populations

that are focused and it is, you know, the same population the dph has tried to prioritize populations that we know have a lot of different health disparities and district access to care and not having the same outcomes we want everyone to achieve and calaim benefits all calaim and people in the system really falls out to specific individuals you've hear that from ben detectives comments. next slide, please. and i'm just given time not going to i want to highlight which talks about someone is ongoing challenges 51/50 households and have treatments and in this situation paid for

with the intent happened to someone from our office in cal management and the services allow times for people to engage not having treatment but build relationship in this situation and, of course, over time will build the trust and up more stable and for the emergency services and. next slide, please. hand to over to ben detective and back in a couple of slides. >> thank you i'm bernadette and i'm here with my executive sponsor. next slide, please. and excited to share with you about the way that pedestrians impacts dph you but the city and county of san francisco and residents of san francisco and

currently 5 vacancies across the city and county of san francisco. who are leading the inches and san francisco is leading the way an example dph has provided the critical infrastructure and contracting fenton street for two city agencies and hsh. to be able to provide enhanced care management and community support and as well as leveraging their network so the stark contrast to be able to having their own infrastructure for the contracting and direct operational management for them and examples of the hsh and being able to give me with

calaim the efforts are provided coordination for clients for laguna honda hospital with our relationship and workload of hsa and calaim supports that foundation for hsh to be able to scale their support. additionally, we have our dph jailhouse services team leading this initiative i understand that is two folks were here sharing an overview and since this is close cooperation with our sheriff's department and hsa and many other agencies and community-based organizations and care plan, our special programs is leading the planning for we believe reentry for laguna honda and that's, of course, with the initiatives and

two additional city agencies operation and ihss are leading the application systems for the initiative. and in general our partnering and our cbos leading to cross agencies and data sharing and design and implication and scaling the medi-cal enforcement and re-entry services. next slide, please. some additional examples of cross coordination is calaim helps to streamline the workload and help with the experiences and one example a community support modification. community support of programs that has been defined are cost effective such as entering room or

hospitalization and so considered. >> community support example of home modifications are like you see in the photo so that plans throughout this in the background setting have a feature set up for the mobility and risk of - and as we been preparing to luncheon with the community support we understood that an exercise are all providing services consistent with the modifications and so we brought our key stakeholders into the room to discuss what it is and just by getting stakeholders into a room together we learned there were significant duplication and by

diving into the current states we have the place of streamlining to resonate the processes and especially important increases the team members experiences next slide, please. and a little bit about the hsa so really focused on the role of b h s with the mental health plan and has a number of initiatives over multiple years and on the top highlights two of biggest shifts happened in the system first is the adoption for mental health. and what this is done to the healthcare system modernized and streamline how we get to this getting us away from the

healthcare and moving towards health risks and working to support our providers to spend a lot of time with the clients and less time with the charge and things are complicated to this has been a welcomed change you can only imagine a huge lift for uses of care and services about the changes. and payment reform is another significant change ongoing and really had is happened over the reform the state is paying is some different - and moved to services model and then that trickles down and will change how we pay our providers but moving our providers over the next couple of years to service structures and i know a lot of it is happening change will really roll out and one managed

care plans color together with a speciality so now about the collective use with the same training tool to identify the specialities services for they belong with the non- specialities with the mental health services and shared way we're um, using the transition to share that information and we are also implementing the health care management and benefits of the programs that bernadette talked about and have expanded management which is really the only evidenced treatment available for meth men and one

last a huge lifting for us, we currently have two contracts with the state and those contracted have separate reporting and those we go separate audits and over the next couple of years and coming together we'll have like top one is mental health services access and behavorial health services and have one integrated health plan in san francisco and the state ultimate goal so have all the managed care plans work together a ways away for us but a lot of change happening next slide. >> so we have the benefits of care coordination talked about that quite a bit this afternoon and talked about the healthcare

management for the team through this calaim benefit. so enhanced care management is a medi-cal benefit under the managed care system and what it is a - it is really a high attach person-centered program whereby a client is soifrnd a case management and community health working with the clients experiences and can be a registered nurse and social worker and that meets the needs and functions within the environment with a collaborative approach and with a air traffic controller how to help them have a successful um, and under calaim in 2021 a new function

for the staff we identified courage care equipment team were perhaps in the general fund and providing services that were aligned and converted to the medi-cal requirements. and we are also able to add our organization and develop new teams examples for the medicine team and the brand new discharge team that are be lodged this summer and our teams are embedded into the health systems of care and community so a our led case management are in hospital and taking emergencies and primary care in our housing department and shelters in the neighborhood to might the clients and opportunity for our

am to help those individuals to truly so the highest clinical issues. next slide, please. . and so in regards to our case manages to meet people where they're at this is a in his visible to show you where our clients are extremely located in san francisco next slide, please. as you can see the d c m enrollment is bigger than 2022 our method for increasing enforcement includes expanding the care team and workloads and close partnership with the management plan our d c m enforcement is 50 percent compared to the average of 25

percent we are very proud of our enforcement rate and attribute it to having community health workers that have exercise and supporting the enrollment and into our demographics is more details we can really understand the disparities and our methods were about outcomes and so we're starting to understand what is the age range of our clients and what is the reason as is clients we're serving and we're planning to significantly dive deeper into this work. by better finding the breakdown of the processes we outreached and enroll persons with the disparities and looking

ethnicitys and. next slide, please. and another one of the calaim initiatives community support we found to provide a foundation to allocate because of prior steps by the care programs we found we launched 4 community supports are supporting hsh and the today and the medi-cal billing and adoption and reporting requirements into our existing program. and some of the programs have become calaim support includes centers this is you see here. and both are care and respite and the programs and

our housing navigation and transition and we found those practices providers and leaders are required to follow up are including the data driven and linkages to care and providing an ongoing data revenue source. next slide, please. another initiatives within calaim a large umbrella is the population of the management initiatives and medi-cal is requiring a plan for the population of management initiatives and concentrated in the holistic approach to improve the um, of the individuals and predominately through the data storing to provide services to provide members with the right

services and support in the population. we have either begun the implementation of the two key initiatives under the population health management umbrella and one of them is called population needs assessment our population division is leading those efforts and leading those efforts whereby the management care plans now under calaim are required in our community health and holistic assessment and so for several months our population health division with the network representation and our three managed care plans for san francisco come together to look at data sharing, and what the goals of the population health management and our addressing one shared goal over

the next several years those goals is to improve the percent of children to - decrease disparities and - this work will continue over the next years and one additional initiative over time indeed so we have talked about providing medi-cal coverage and about disparities that claims the frustrations. and so i want to share some data how medi-cal coverage is provided to the clients in incarceration and so prior to calaim individuals who became incarcerated lost their medi-cal status so under calaim not only is there a requirement to scale

up insurance screening with the pedestrians application support but clients no longer are incarcerated actually get their medi-cal and soft their incarceration they get released the majority of them do and have gaps if health insurance and hsa does the medi-cal conform and data sharing about the release that medi-cal conform will be unsuspended and have access again in the community. so, so currently our plans to the county jail are screened in the past that was objective question so uniform more reliable - and for the support clients uninsured in their time for medi-cal scaling up and then um,

we talked about this suspension and unsuspension i wanted to respond to one question that i received that i didn't have enough data on this morning but this average with our partner with ihss and questions about the juvenile health since are leading the applications in juvenile hall and shared with me is that the applications they received for medi-cal the vast majority finds the plans they have medi-cal so up stream that is not recognized earlier think in the process but that results is that seem to agree and the plans not having medi-cal um, are special programs for the team and agencies team shared

that unfortunate they're finding that the plans that the parents are not responding very much to their efforts to help the client get on medi-cal. so - i'll also share that, you know, this work is that set up to provide the entry services in juvenile hall and the jails to have the outcomes. and jail health together with the sheriff's department plans to go live to the services and help in 2025 and the juvenile health will go live in fourdz twooif and 26 and touch on how the calaim is helping to offset the federal funds by bringing in medi-cal revenue. (clearing throat) there are multiple calaim

initiatives two i have currently launched the revenues generating community supports the enhanced care management and launched this justice that will bring in medi-cal and as you can see since our beginning of calaim have gotten close to $8 million for the services provided d c m and additionally building on what the opportunities for calaim d h c s offers opportunity to leverage from the state through the management care plans and through those planning opportunity we have brought in addition $7 million to direct to dph like providing the work with the access to conclude the care coordination or the entire tiers on the

neighborhood team and we also supported the other cities agencies and their ability to drive down those funding tints as well as and service million dollars next slide, please. and so finally to share some highlights moving forward we we move from the third year the medi-cal have 2 and a half more years. we are currently planning a citywide calaim strategy violation goal of strategies so like other cities one way a strong coordinated effort and engaging in the studies that are finding the hospitalization that help the programs we will have this by many factors and take that data to improve on the programs to address and improve the whole

that person health in a manner and finally, continue to launch the additional initiatives required and shared as a screen shot we'll be engaging the services and monitoring the initiatives and other things in 2025 and health initiatives that. >> no public comment all right. commissioner questions or comments start on that end vice president guillermo. >> thank you for the presentation it is informative and exciting to learn about what happened to date and what the more challenging but i think - i sense a lot of optimism. in our comments and presentations and hope was not just for us to hear

but truthful. thank you very much. and i did have one quick question about the team. as can you describe for what type of workforce in those teams and for the case managers the level of training that is required? >> so the fun part one has been difficulty in completing those teams and then expanding them as is programs continue on successfully? >> thank you for that. >> so d c m works with the three services social workers and behavorial health clinicians and the health workers don't need to be licensed and, of course, the other other three the case managers need to be licensed the health workers have

that team supervisory model that is a licensed background and directive for unalso staff providing the d c m services and in terms of - again a strong supervisor model for services. the case managers the essential team managing this and in terms of like how our workforce is functioning and what that expansion in the summer of if we had about 70 percent staff vacancies across the team and has improved so determined this improvements in our hiring and probably our retention i can look at that as well. such this,

of course, helps with the enrollment we're trying to meet our goal that is 80 percent of capacity across all teams and then expanding to additional care teams with the d c m team and identified more teams and we need to make sure we have central progressing skills available. that's really great improvements indeed you mentioned that are the reasons for the gap from 70 to 23 percent vacancy has to do with with more efficiency progressing on the h.r. side is that a big part of it. we are leading one with the hiring and the team leading the efforts i'm not sure yet i haven't gone to better

understand like exactly what the options about that but and something we have to top of the mind to bring our minds together with a higher percent. >> to note just we're aware how difficult it is to bring people to work - to the workforce particularly in this area of work in the san francisco and retain them and so the more efficiency we can retain them over time. the programs will be so again, huh? . thank you very much. ferry the work and, you know, it is a monumental effort to consider an offer hall, you know, the medi-cal program and it appears we have took advantage of the infrastructure that we have and the knowledge about the

inefficiencies and how to be addressed across the departments and have the collaboration and the um, all the administrative work has to happen behind us. thank you. >> thank you. >> commissioner giraudo. >> i want to thank you for answering all the questions and we can process it was super helpful and especially the data that your able to present. i wanted to say thank you for that presentation but you dig into the questions so - thank you. >> thank you for reading through that and providing the questions. >> (laughter.) >> appreciate it (laughter). >> commissioner christian. >> commissioner giraudo helps us thank you. i'm a beginner about calaim and medi-cal. and so here is a question that

reflects that can you kind of give an overview of the my understanding that the difference between our medi-cal in san francisco and here speaking specifically to the jail situation and clients in the jail if someone is as often the day in custody in san francisco and they have medi-cal outside of san francisco. and we're trying to get them services how much of that can - i know you're working on it - how much of that falls under calaim. >> that's a great question. >> a lot of conundrums and calaim so if we find that a client has out of the county while they're experiencing characterization hsa sends over an assessment needed to the

other county um, a goal to make sure they're medi-cal is active and upon their release and, you know, for sure the client will be residing in san francisco that on their release rather than the original county and an escalation process for the residents they can get the aide in san francisco medi-cal. >> but how long does that if they're any support for the state to shorten the times? >> and um, what i do know is that to - it is the actual out of the county i don't know. >> i don't know if the jail (unintelligible) about three months with an emergency

transfer and a large population is a big issue that the state and they're aware of share that (unintelligible) shared this a few times and the things they're going going to tackle. >> well, i'm sure not but anything anyone can evaluate for that timeline for shortened and objective so many things you can - we can help you with please let us know. >> and with the data sharing to get someone on the phone we're getting there. thank you. >> thank you for your work. >> dr. colfax. >> i wanted to thank you for this incredibly challenging work. in transient to shift it's

been um, really amazing when it gets down to u v and not and i think we're starting so see transformative changes for people in the room and many people in the department working towards or now starting so thank you, both and for your executive sponsorship and with the entire department that is um, ushering health network and dph presenting together in this an indication how things are coming together and changing. >> thank you so much. and we all are soshtd ourselves with all comments made by our presentation. thank you very much. >> thank you very much. all

right. next other committee reports i'll start with the report from the jcc a wonderful presentation and about the psychiatric entering services and just expanded day room by 3 hundred percent and also adding clear kit entrances and exits will be for patients and staff and then heard the usual reports the vacancy report and other reports and um, in ceo we continue to get great news the people from the health team are so important to workplace violence and psychiatric and emergency room and report in the closed session and then the day

after that commissioner christian and dr. colfax had the privilege of representing the department at the annual staff meeting of zsfg with the major residents honored the most it's been a long time coming. and with specialities and then the rops is imprisoning to the clinician that has contribute the moose and went to mark berry and incredible pictures when he was in diapers and i got year before and jeff got it and the diapers working i don't know eleanor know she's the person until they went 6 slides into it is inspirational and makes you confident the next generation of

individuals will take care of us will be clinicians and leaders so that is about one of the best parts of being part of j.c. c and does much in support of the work and a shot in the arsenal for healthcare and all the frustrations and things you hear about in the meetings and hear about those individuals and just kickoff renews the optimism that is my report and i ask for public comment. >> no public comment. >> and any commissioners questions or comments. >> great. and move on to the next report it is commissioner chung with the finance updates. >> thank you, president green so the finance committee metabolic commission meeting and

it was a short meeting so exciting so the contract we worked with and one new contract with the san francisco aids foundation and also list of providers. so i want to go to first contract report first and those are actually contracts approved in 2022 by the city attorney's office is asking the department to really separate the contracts by contract team authority. so because of that like the original contracts were three programs it is breakdown into separate two. the first one is so both through the agencies

so the first one is the um, community youth center of san francisco and it is - the amount of con city is $9 million $9 million plus dollars so this amount will will energy the contracts to um, continue though the entire term. um, and the other two programs um, being have drafted a new agreement and

that is contracts authority that is different from the other one they all continuing. and um, then have the san francisco aids foundation contract and it today is the day we are doing everything we can around behavorial health and so this is for the overdose prevention welcome to the distribution at high risk of overdose so pretty promising program as well so great work and then last but not least on the consent agenda the new providers that um, we do this to approve there is one

small change um, for the contractor for the - fort health mission it is bryan instead of for the health mission is closed other than that - no other changes. >> may i interject i received an e-mail from michelle for minor changes and something she's not imagination in the meeting she moved the indian contractor continuation potential they'll be and added the has to not current contractor maybe in the upcoming year two, that minor changes will show up on the final list.

>> so both on the list already just different; is that right? >> the second one is not on the list at all the sierra vista hospital. >> oh, that's a new one that i'm not sure. >> she said they've been a vendor but a long time ago and provide the chemical adolescent and that is a service they may need have not future we used that before but assuming a source in the upcoming year put it on for safety. >> okay. i kind of not comfortable weighing not. >> reviewed that - >> reviewed that that. >> (multiple voices.) >> in the subcommittee and i think that and two don't have an existing contract maybe this can

be separating and in our next meeting. >> is the indian-americans - >> (multiple voices.) >> okay. thank you. >> and apologize excuse me - and so that's the changes. >> any public comment? >> no public comment. >> any questions or comments. okay. so we're at level of clean energy the next item i'm going to ask if you can make a motion to approve but extract that one sierra. >> what is for the on the current list. >> (multiple voices.) >> so no need to mention perfect. >> all right. a motion to approve the consent calendar? >> so moved. >> and no public comment. >> no public comment.

>> all in favor, say "aye." >> aye. >> wonderful and any other business? >> anyone wanted to adjourn this meeting. >> (laughter.) >> (multiple voices.) >> move to adjourn the meeting. >> (laughter.) >> sorry. >> a second from someone. >> all in favor, say "aye." >> aye. >> thanks everyone. >> and happy pride month everyone

>> item 50 is resolution calling on department of public health to provide medically necessary transition related care for transgender related people and remove restrictions. >> in 2012 gender health sf was born out of advocacy from community stakeholders and local leaders. really as response to providing quality, accessible jnder aaffirming care for the most under-served. (indiscernible) the way i see it, there is two ways of folks we serve at our program. the first wave of folks who never imagined surgery access was accessible to them. many folks who had to save money or par ticipate in

underground economy to access the surgery outside the country. (indiscernible) really to make something real in terms of being able to connect with the gender identity and external (indiscernible) and so transform so many lives of many of trans folks who never imagined it was accessible to them. now we are in the different era and time where transrights is in the social political and general (indiscernible) and now we are serving young folks to support them and making sure their gender identity is connected to who they are, so providing a space to support transfolks to live authentically and that is the goal to provide the level of care trans folks deserve. >> when it comes to access to healthcare, while we all believe in cost control and make sure we deliver healthcare in a cost effective manner, i

dont think that cost is a reason or legitinate rational to exclude people from healthcare (indiscernible) colleagues i ask for your support. >> thank you supervisor wiener. colleagues on this item can we do this without role call? same house same call, without objection the resolution is adopted. [applause]

okay good morning. the meeting will come to order. welcome to the june 14th, 2024 meeting of the budget and appropriation committee. i'm supervisor connie chan, chair of the committee. i'm joined by vice chair raphael mandelman, supervisors mariano melgar and shamann walton. today, supervisor ronen will be sitting in for president aaron peskin shortly, our clerk is john carroll, and i would like to thank, corwin cooley from sfgovtv for broadcasting this meeting. mr. clerk, do you have any announcement? yes. thank you , madam chair. a quick reminder to those in attendance today in the chamber. please ensure that you've silenced your cell phones and other electronic devices to prevent interruptions to today's proceedings. if you have any documents to be include as part of the file, you