>> commissioner green. commissioner guillermo, present. , present. commissioner salgado. commissioner chow, present. i note commher way up from the garage. >> wonderful.guillermo to read the land acknowledgment. >> the san francisco health co ancestral homeland of the ramaytush (rah-my-toosh) ohlone (o-lon-ee) who are the original inhabitants of the stewards of this land, and in accordance with their traditions, the ramaytush ohlone have never ceded,st, nor forgotten their responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory. as guests, that we benefit from living and working on their traditional homeland. we wish to pay our respects by acknowledging the ancestorves of the ramaytush ohlone community and by affirming their sovereign rights as first peoples. >> thank you. approval of the minutes of the health commission meeting from july 16, 2024.before

the minutes. if there are no motion to approve. >> >> second. >> is there any public comment on this >> yes, there is one remotely. any public comment in the room on the mi i don't hear any. before we begin i'll read a statement. t process is designed to provide input and feedback, however does not allow questions to be answered or back and forth conversation consider comments from the members of public discussing a itm making request. please note each individual is allowed one opportunity to sp individuals may not return moread statements from individuals unable to attend. health.corg. if you wish to spell your name you may do so.ase note city policy along with federal state and local

prohibit discriminatory harassing be tolerated. alright. mr. shaw, you got three minutes. this patrick shaw. my testimony included in this 2024 meeting minutes notes, there is a clear correlation and increasing numbers of san franciscans discharged to out of county of beds remaining in san francisco. d= itwhat action the commission is taking. after all, [indiscernible] reported as of july 2, there were 983 standing beds remaining in san francisco. 152 [indiscernible]provided freestanding bed data from the california long-term care financial data table. related to the minutes? this does not seem is applicable. shaw, i will repeat my ques the comments don't seem to relate to the minutes. to relate to the item you are on.

we'll leave it there. we can do a roll there is a member-- >> commissioner chow, how do yox9u vointe commissioner guillermo, yes. commissioner chung, yes commissioner green, yes. commissioner salgado, yes, the minutes are approved. >> the next item is general comment and believe there is information secretary morewitz. >> ems within the subject matter jurisdiction but on the agenda. each member may address the commission up toand the same information i read for non general public comment applies. we have several in tely. >> we'll start with the individuals in the room and the first on the topic is douglas. >> i have a timer when your time is up. >> thank you commissioners.before you. i am here on a matter not your agenda, but a matter vital to the

future of this commission. as a former commissioner on the board and planning commission, under three mayors for 15 concept and operation of commissions in the city is dear to i was very up the ballot measure by san francisco qualified for the ballot which abolishes this other voter approved commissions in the charter and a sunset on all the commissions outside if not reapproved by the board of supervisors brie so not only the health the library commission, commission on public works and s of women, human rights commission, they are all abolished from the charter, never to return unless a charter if this passes. also as pathe charter amendment gives the mayor additional appointments on each commission so he or she has a super majority and abolish d any commissioner which this happenedon permit

appeals i missed my $15 reimbursement i got every week. eliminate commission on status women, historic preservation and so it also any supervisor review of mayoral apointment mo forward and allow the mayor to appoint and replace the commissioners by the mayor without any review. it puts on a limit on the number in the city and charter to 65, when we have 13am going around to different commissions having hearings because some haven't hurt about this really understand the seriousness of it. this is put together by those who remove theficiency of government in san francisco. i hope you and know that commissions serve a really valuable role in to be involved and to have citizens like yourself time government employees to have a say in city gover

so, we are-there is a alternat0[p7e fact that commissions sometimes need be revised. commissioners become redundant and board of supervisors is put in a alternate ballot measure onhave a study group dations to the board and take it to the voters if just like we did in 1996 this is absolutely the wrong way to do nment. you just cut everything out and force it to be replaced. rather trumpian i think.ask that you be aware of it. let on the ballot. i know some of restricted from making ballot argument s, but we ar in the ballot arguments which are due august there may be people who believe in ishcommission that will sign a ballot argument and we are trying as many commissions involved as possible. i thank you for your time thank you for your service. >> thank you next individual in the room i you

for general public comment? i couldn't quite read what you wro >> good afternoon christopher cline. i was asked toa power point presentation. i want to health and director colfax did not assist we know the answer. [indiscernible] john hopkins to illegally accessn francisco public health and safety. it was easy since medical want to know the advance in healthcare and [ican send data [difficulty to patient from baltimore to san francisco with technology which 00 miles away. page 4 thms rs apps that use voice and phone technology influence us what is supposed to be positive outcomes but can give negative outcomes.and 6 refer to how

the interface works and ndbaltimore medical center became the man in the solutions and outcome. if it is apple and are told it is a or we have evidence to counter the facts giveren to us. [indiscernible] swapped the negative facts to blur .for surveillance. page 9 configurations [indiscernible] page 10 brings to the geo fencing and person frequency can control the man in the middle. page 11 shows how street lights and [indiscernible] used influence us. page 12 13 [indiscernible] compared to wireless networks today. anywhere you a signal can be sent to the person with a phone. and 1967 talks about ai and computers. gehow the [indiscernible] coming to san francisco page 16 is the drastic increase in overdose starting in 2019. page 17, pier 45 large fire

was a wear to get in department and public safety and i want to be clear, if dired director from hsa do not today i will file misconduct charges struction charges. thank you. >> thank you. any other public comment in the room?emote? >> yes, we have one person. one second. mr. shaw, you got three minutes. thank you. topic not on today's agenda item.the tommy tompson [indiscernibleawarded class certification status july 26, 2024 by francisco superior court judge andrew chang. sted online july 26 granting the class certification and ha attorney david chui a loss 26, [indiscernible] chang order noted he took judinotice of exhibit b. lhh annual report. exhibit f, the system

improvement agreement between lhh. analysis report dated december 1, 2022. exhibit ee, code of cond exhibit jj, dph notice data breach dated march 15, 2019. qq, the transcript of the [indiscernible] troy williams presentation cms quality conference april 10, 2024.of the order noted the evidence appears to be plaintiff allegation of governance failures ongoi contributed to lhh decertification in april 2022. it is clear to me this health aggregated its responsibility to lhh patients. this commission deliberately or inadvertently let the problems the health commission governance failures as the [indiscernible] contributed to and exaceculture of [indiscernible] lead to a culture of neglect in 2020 and lead to dein

2022. hopefully health commissioners will sit ke notice the medicare recertification in june is not ow of the troubles. commissioner green should president of the commission, body cullpability. it is likely in the future the into another closed fseto approve multi-million settlement represented in the [indiscernible] it is clear the certification presents a threat to dph and health commissionna honda hospital. it is a long overdue is justice denied saga. thank you. >> that's the only public comment. next item is director's report. director colfax. afternoon commissioners. grant colfax, director of health. you have the you awith links. we'll go over a few director report given our full agenda today.

really excited to announce that laguna hospital resumed admission. this is a big step forward years as we successfully recertified in now able to welcome people back and it ñty offering people transferred out of laguna honda a opportunity to come back home we started admitting our first residents last week.ased that is moving forward at the time in celebration. it is a time the work the team did dzportantly, a time where families and can celebrguna honda is here to stay. next item, dph and commission and drag artists are saving lives by getting up you will see a number of events that we are participating along with with partner with drag artiease

overdysawareness and share how tospond to overdose to providinlife saving naloxone training. [indiscernible] you will see a pleased to partner to make sure we through multiple diffrvento announce the behavior ice team received awards from the national association of county behavioral health service was the office of coordinated care received an award as did engagement services teamism both programs are recognized nding government programs and services that improve just another example where san francisco is leading the behavioral health field and a model for counties across i was going to say the state, but th very competitive group. and then, just last item to was really

pleased to aff at the 20th anniversary of the avan center. this is service site at the campus realdi of the art care, particularly with imaging and follow-up for incredible to see what happened there how our approach to breast health and meeting people where they are to make sure theye the best breast healthcare. g. this is a major program that reinforcing how committed and invested before the center existed, care for people llow-up could be really challenging.ere wasn't a centralized system making sure people had access to state of sioning and i was pleased to join the leadership group you see report to celebrate the

work that they have done.ere are other summaries in thto m ur leisure to read if you haven't already and happy to take any questions. thank you. for the report and it is always wonderful to hear about the both and the celebrations, especially laguna honda. comment on this item? >> we have remotely. om? we have one mr. shaw, you got three minutes. thank you. what is unstated in the director's report today and lhh press release is how patients have been readmitted to lhh. all mentioned is there have "several admissions since several isn't a math value. since october 14, 2021 patient census [indiscernible] 300 patients d 410 residents of july 22, 2024. how long does dr. colfax think

it will to restore [indiscernible] restricting the number of admissions per week take 60 weeks a patients without factoring to conduct audit between new admissions. also missing in presentation is mention if the waver is [indiscernible] 120 beds.director of cdph, aragon has authority has that waver been submitted yet?the commission directing colfax and oto submit the waver immediately?h loses the 120beds, more patients will be jumped out of town skilled nursing facilities due to the shorten of beds in thank you. comment for that item. >> any commissioner questions commissioner salgado. >> thank you. thank you director colfax for your report. i just have a ick question about dph and commission working during overdose week awareness.

as someone that is in the would be nice to have maybe a link in our that directs bars and restaurants where to get like say, narcan what have you, because when we go and try to buy these items have on-hand, you have like a hundreyou don't know which one is the correct one, h you should get. i think as we go and bring awareness, i think maybe having ansiness can go and purchase e items, so we have them on hand would be great. >> absolutely.if we have something like that already, but i will make sure we followthe behavioral health team, several who are here and we can take that back re that we have links made available thank you for the suggestion. ssioner giraudo. >> thank you for your report . colfax. i have a question about the

pediatric the presentation with the specialized education through the workers, et cetera, is there any of the health clinics themselves? let's say on an advertised day more information about asthma versus having to go to 6m? >> so, yes, i the question. i don't know if there is anyone remotely re a primary care inic question. dr. [indiscernible] is a allergist and works at the clinic and not we can get-- >> i'm on remotely. >> hi. yes.you commissioner. what said there was kind of this education provided that consortium i

would say covid has dein grated for a bit. they still do outreach regionally through the bay area counties all the clinics know 6m is n refer patients who have asthma difficul the environmental assessment, but righ are not available to that consortium as it was. hopefully in the future we can get it back up and ru >> okay, thank you doctor.i hope so, because as you well know, in visit, often times a parent doesn't havef intime to ask really educaabout particularly asthma since there is such a increase in it. i think if there were t education seminars in the outreach the clinics such as southeast, sunset, whatare advertised i think it would be a service to a lot the families. i enurage consider to

see if possible in 2025. thank you. thank you. >> thank you commissioner. >> any other commissioner s on the director's report? alright. seeing none, we'l next agenda item, which is the overview of dph program ni metrix and welcome jenny. jenny chief operating officer here to present the metric. the presentation has come up as a result the finance committee members but thought it would be great to entire commission. in the process i think there were of the finance budget committee would be approve very large contracts, contracts and the question is hoy do we know that this working? how do we know it is doing well? i'm here, again in the data how do we know raa data metric perfective

functioningism i have stripped down all the program monitoring i know there have been ous presentations most commissioners have seen but [indiscernible] but just really there is a lot of information in terms of contracts, approval, monitoring, d the role of this-purpose of the really follow the metric just through the monitoring process so you really understand what th it st. not intended to be a full blown overview rehash of what program monitoring and compliance all, there were questions that have popped up around we a refresher. we sent a compmmission over 18 months ago as a refresher be lot of context and it is trying to sithis focusing on that metric question, but there is obviously a lot that goes beyond these metrics that i'm presenting in the wo and program and financial monitoring contracts. with thwill dive

right in.has two parts. i will do of program monitoring and business--[indiscernible] walk through the process and then i will go into ve how performance metric are developed and used. the metrics are developed by program staff office contract compliance but for ease and simplifi will present the information, but i'm the business office and behe alth0r and hiv health service should you have quesabout the monitoring process or the are available to answer questions as well.'ll hopefully do our best to answer your questions. next slide, please. for the first--you can skip--in termoffs the type of monitoring two types. the first is program monitoring that is when they look at individual programs of a agency and you know, we may have single agency that have multiple contracts

for different programs. the program monitoring focuses on the individual program that program performance with objectives as r contract. this work is performed by the business office of contracts compliance. in addition the city has fiscal monitoring and this is of the agency and looking at the financial stability the organization and not looking nethe actual performance objectives is overall healthch this is done in two different ways.th contracts with multiple city over a certain dollar threshold have its monitoring done and coordinated the city wide monitoring those based on dph we will focus are done in conjunction with the xbd! beyond these type of moniwithin dph that does compliance with monitor ing. our office of compliance and privacy and quality programs throughout the network and population

health as the area focused on monitoring in terms of contracts.mentioned, our focus is on the program monitoring side not the fiscal side and then really again like of the metrics within that program monitoring next slide, please. ñn so, in terms of the program monitoring the timelines can vary by section and monitoring take place for pire completed year. the reports tend to use and submit tory entities to insure compliance which is through the department of services and [indiscernible] moving forward, we withat the commission is receiving the mod report and quick spot check, sometimes members of the mmreceiving the summary, which didn't have the data. i think we were braps trying to spare you the 8 times 10 contracts per committee, but i e and so we will insure you're getting the full which includes a full summary as well as background on each of 4

components that is being monitored. i will note some [indiscele a new program, it will not a report we have some non-direct services contracts that b7 administrative in na[indiscernible] for a few exceptions there is perhaps grant funded the requirements are so specific and didn't seem necessary to layer on a monitoring report. on the right you can see rough timelines that for different programs. these are aspirational. th terms of staffing and the number of contracts we ha overall goals and tend to alwith the [indiscernible] shifted to align the federal funding. next slide. getting into the components of the monitoring, there categories, which is program performance, which either standardized or individual ob there is deliverable's, which is units of service, more outputs units

of seclients served and client satisfaction measured survey and ththree of the four really have data components which performance deliverable and client satisfaction. mpillian quite this, but more a checbox, like do you comply with ada standards and well. this presentation will focus on those three boxes are not going to talk about the specific compliance components the monitoring. the next slide just nv7more into timeline is a sample and a aspirational timeframe how the metric are developed and are reported and are monitored in the report. if we were looking at a program that monitored by fiscal year, we would work with ram managers to develop the metrics by may that and they submit the metrics fo

bocc take are appropriate and measurable and timely and data is available and are then they st the objectives on our website and notify through the over the course of thto june, the cbo provider will do submit the data, and they they choose, but all the data must be submitted for the prior year by september after the e that year. basically three months program time period. at which point, the business office comes in. they conduct the monitoring visits. take analyze it and [indiscernible] compliance and distribute reports and necessary plans of needed based on the finding the next slide just in terms of areas are being monitored. i had a question from commissioners in terms of contract programs, we that are cbo and 54 civil

service and this vcnsshows the areas that we are currently monitoring through the bocc. the next slid just drilling down more into the metric and the monitoring report. the metric by type of service and posted on the website. on the right s[is a screen shot of 23/24 and behavioral health service adult and older adul]t, got a screen shot on next slide, you'll see a set of metreach of these areas.programs, they are required a standard set of metric.create exception rules that are noted and you will see that on next slide, but they can also-discret1éiodual metrics as well and think in the case certain cases depending on the program they can also to have similar but individualized metric depending on the service area

and regulatory requirements. as mentioned before, data ut the area in the for receive a lot datas more consistently. i note, during the pandemic we did collect data, but we held off on a overall program score given the lenges cbo had for delivery and outputs. in a and 21-22, 22-23 particularly around [indiscernible] still heavily deployed at time for covid purposes, we did not e those sumerary scores, but moving forward focus on that and have moving forward. this is a screen shot of what you find if you clicked on within of the

links anso you will see performance indicator. the ctive, the outcome as a process. client inclusion, this ] may exclude or include programs depending on to make sure we ar÷s appropriate metrics. --the overall work and all 4 areas. it also has category ratings broken the four components and there is subcategory below that. that you are seeing and again in the supplemental presentation i sent, there is a lot of detail hob+ of the ranges, what is 4 and 3 and how it is calculated.

slide, please. going into the objective scoring, again there is two components to each of these sections. going to be data statby a narrative report here as well. developed by the system of care is program managers and so you'll see the data here and then see qualitative narrative detail just to give ture if a program has [indiscernible] that is what the narrative section does. [difficulty hearing speaker] comments in terms of the data outputs provided there. similarly, with clients the calculation which includes

submission, return ratio of the responses, ogram and the performance itself here annote in the narrative, they are trying to but they will actually note in the narrative report in this particular one they had return rate of 90.3 percent. it standardize way looking at it. next slide, please. now that you received overview of the monitoring reports it want to talk about how the metric are ogram staff and we'll dive into two areas.service, which has probably the most members-the committee see as well as hiv health significant amount of data. next rms of the drivers of behavioral health metrics, vast majority by regulatory requirements [indiscernible] local health and contracts compliance requirements. also have improvement programs through ghcs

again can op for specific metric the type of metric they do are different in nature. some are prmentation such as timely completion. compliance which is looking at program the timeliness completid outc reduction in rehospitalization and [indiscernii now the outcome metrics, i will note the process and compliance metrics are important to note because it gives more texture and flavor to get of data quality. if a assessment isn't completed interms of data to perhaps make-use for other purposes beyond like general population may not be curate as if you got it in a more timely manner, so while i undeis a interest in the outcome type of metric help tell the metric story.terms of

just a peak ahead, still jrvery ve know, we did 'll give them more time and focus on stabilization, but as stabilize the system there is more to come what is possible but give them catch their breath now. the will focus just on [indiscernible] adolescent needs and strength data, a clinical assessment tool required by dhcs and cilitate the assessment process and individualized plans. an example of a is 90 percent of new clients with oa assessment completed and of the episode and then example of outcome v a similar tool for adults

called ansa.and strength assessment. moving to in terms of the drivers and verables and are 18 service categories. the metric are primarily on several hiv [indiscernible] recommendations and there is a joint we have to standardize the metric care and i will note a of our metrics that we started in san adopted by the federal counterparts as well when the first came out. in terms of the metrics used, there is direct service such as identifying clients as possible. linkage and retention to care and getting treatment as well direct is and basic life needs, housing [indiscernible] beyond just the

clinical services. next ide, please. in terms of examples of the metrics used, viral suppression is a tor. part of getting to zero program, and they we coupe keep moving the and lower based what we expect we achieve. other examples includinsuring medical visits for health clients, at least 8 0 pat is ahead for hiv the long lasting injectibles require to look at different ways to look at metrics omes as well as when we look at the population, which continuing to age and expected to be large majority being over 60 in the next 5 years. we expect perhaps additional services and support ar and aging services as well.%[ next slide, please.

with that, looking what is next, i will note, beyond the work we ar in terms of stabilizing the programs and catching on is new legislation in the city for non profit ni it actually expands to controller audit responsibility the regular financial stability to include operation and requires the controller to create ty wide standards for contracting and corrective action.roller's office is beginning a stakeholder process now to develop those updating policies by november. we'll with irk with the controller office. we believe we are doing most when the controller's office initiacity wide monitoring took a lot of our templates as a way for their monitori we'll work and watch and see how their work them to insure we are ess across the entire city and will be a with that, that was a lot of information.

any questions and joined by all the experts in the room that helped me develop the materials for these slides, is a lot of people and happy to answer questions you may have. you so much for the excellent presentation. real g unbelievably complicated information into a very understandable format, so i think as part of this, we also need to thank althis obviously requires a tremendous amount collaboration and detailed analysis y appreciate the work. it obviously spans number of topics, very complicated to i want to express our gratitude to fellow commissions, because commissioner chung, the commissioner guillermo and commissioner chow have put also in tremendous amounts of work the really detailed nitty-gritty for understand this better and again, it is

all outcomes as you pointed out. these programs are quof san francisco, so again, ic grcomment on the item? >> there is one remotely. is there anyone in the room that would like mr. shaw, you have mr. manette shaw, are you there? try one more time. public comment. >> we'll go to comm quents and start with commissioners not on the subcommittee and have the commissioners make their comments and questions. any questions or comments? commissioner giraudo. >> i submitted really appreciate this presentation and since i'm not and i appreciate too that you said this is a beginnindeep dive into helping us rstand what the process is.ing and correct if

i'm wrong, but in what as well as the finance as what the chromeer controller is doing and new regulations, et will help or have the checks and are so a baker place does not happen again, correct that this will performance as things that did ot work out as well i guess is my question? >> there are a few goals of the legislation.part, the board of supervisors, we are required to bring contracts for approval of contracts over 10 million are seeing most of the contracts and contracts across the city and mmittee made as well as brought forward with contracts. i think that--overall in general, the number of contracts and non profit contracts in

and continues to grow so i think this came out of i think beyond baker place, there are other instances not relate d to the department where there e contract. i think one of s made as a result of baker place is that, which is really complex situation the pandemic and i don't want to simplify it too much, but i think we do our monitor programs but some things of the situations and correct me if i'm wrong, in that instance, previously with the fiscal monitoring by the city wide had a number of sort of goodwe didn't want to put people through the ringer every a lot of work. commissioner green mentioned, we arwork collecting information and all the information has to come providers themselves and so, i think initially thinking was, after a while they get a pass and

go every and in the instance of baker place every other year the pandemic and had lighter touch on the contracts and lot happened financially during the pandemic. it will improve the monitoring overall and fiscal monitoring continues and expanding and making that work consistent across the entire city. >> i appreciaand i assumed so in what you presented, but are not within dph, but other non profits that have been especially that serve homeless population, et cetera itoring issues and are been given assistance through their department r#and not still have not complied. also involved with oasis inn, where it has been a re so i know what you are doing and z2 department is light years ahead of many other departments that's where i taonapbecause it really

helped me further understand what the breath of what you where doing appreciate it. thank you. >> i realized had a question about a few commissioners percentage of the programs we monitor considered---vast majority of them. we don't have a pa it is on the scale of 1-5 with aggregates. p average. overall you will see as you receive the reports mothem have acceptable or above rating in terms of past year performance. >> if you offer assistance do whatever to ance and they do not follow through with you're directions are--what happens? ]z>> [difficulthe

question is, if agencies do not comply with the financial standards we offer assistance or try to help them out? >> if you offer assistance and do not cooperate with the refuse the assistance. faith you tried to help them monitoring and they did not accept it, then what happens? >> so, i think is multiple kind of like levels of flags if you want to call them in the first, there's pemay not trigger providing them assistance, then there is once step up, the findings keep repeated or if there is big issue that brings them to concern, that's when technical assistance is

kind of mandatory. once they are level, the contro them technical assistance. i believe if that's still did n't work or they not cooperating with technical assistance or things are still not getting there is another level up called red flag status and this is kind 0cthe highest red flag level level the department actually gets the the agency gets through the red flag status. i have been fiscal monitoring around 6 years now, i ly seen one agency go up to that level, is a very rare occurrence. okay, at >> there is variation for findings. is it not enough board members? there is different avenues

depending on >> i appreciate that, but just wa to understand that part of fiscal monitoring, since in other city departments as well as throughout th9ty that have gone a bit wayward in the process. >> [indiscernible] >> thank you. >> commissioner christian. >> thank you president green. ch thank you so much for once again, a very ative and clear presentation.about the fiscal monitoring you are talking about and so am not comprehensive answers, but i want to understand whether new non profit monitoring includes operational requirements that are not man and fiscal responsibility because these are organizations provide services to people in the city who at risk and in need, and the employees

of thosvery important that engaging with the residents and propriately. just like it is across the every organization. we and e city have hr requirements. certain trainings, that you must do every year, and i'm if you know or just broadly speathose types of requirements are this space and whether there is a look at nece not it is necessary or useful to have certain kind trainings for people who are services through organizations and also information-providing information

entities t with the organizations and being vague so i'll, a lot of these organizations provide treatment people who are referred through the they are programs and they are and individuals are there providing services meeting those needs. are those employees required to take training about conduct and the kinds of things that st organizations require their employees to take? >> have that information. we could find ou in terms rects the controller's office to expand r k=ust the financial that gonamed operational performance and so is still being developed and in process, but nd out more information for you on this, but we'll r and is it dramatically different from what we dowhat we currently track on the compliance side.

i sent very late this afteoon, somz would not expect you to see it, but we can look into that. >> you mentioned office interacting with stakeholders, do we of who those stakeholders are or ways give input on speaking-the categories of stakeholders useful to consider? >> the controller's office has a city n profit monitoring group and a pretty extensive list at this erms of the cbo's they reach out to and they up outreach meetings specifically this legislation to get stakeholder input as their updating policies in november and i expect this to be ative process as we get through to november. i don't a specific list serve, but this as the controller's gets the [indiscernible] have all the contract information to be comprehensive in terms of everyone who wlegislation

that way they would be able to invite to their stakeholder engagements. >> thank you. we'll probably won't be you, but coming to us to provide a presentationevolving out of this extended monitoring? back and report back. what dated requirements are and how different or not they are what we do is directed city wide, not just at dph. there are some departments that perhaps not not be as far along not as regulated as we are, and so i think a part was bringing everyone up to the same rious to see in terms of what these policies do and our current monitoring policies. >> thank you so much. we need to hear when you know something about that. other commissioner comments? commissioner guillermo. thank you for the prezen taishz. presentation. i sit on the finance and

program committee,b good to be able to hear as much and qabout the process and the responsiveness that you have had to the concerns and questions that have come up ovrnow and particularly, more recently.for that. appreciate the it detailed responses. mineç is a question. i do i always have to remind myself that san francisco--the de for the city and county of san francisco, which is no from i think what is structured in other counties or so the complexity and the sc has to monitor ; contracts makes it multiples of difficulty and complexity and responsiveness because we rely so much on the

sector that which is--has varying levels of order to fulfill standards are the kind of things i think we edbe reminded of. when we are looking at the responsibility the the bocc, the controller has and aspirational goals to standardize and monitor. but i think it is incumbent are that complex to really get it right and to iterate over time we can get things better, because ultimately we are trying to do thing for the residents and citizens of san francisco city and county, ti want to just acknowledge that it is not a easy thing and to bring people into the time and effort into again, as difficult i think as doing the work it v÷to acknowledge that. having said that, i do think

that because it is complex, we get caught up in the bureaucracy a lot an hard to look outside that. that i think i'm the most concerned about is we collect a think we do try to real time as quickly as we can. is processing and analyzing of the data that time gap between when the data is collected and when it is reporewe are responsive to what the data is telling us. [indiscernible] just wondering, how difficult is it the monitoring data that aspirationally try to collect in three mo completion and when the report comes out so that the public, the commission and so respond to the a timely fashion to have a impact renewals, or new solicitations, or budget iss is that something that is

focus of what you are trying to improve within partment? >> there is always areas of improvement and i timelines, just because again like it is not just and creating metrics rk itself and evaluate. there is a site visit r÷ convursations to cbo so that is why there is protracted timeline between the monitoring period ends the delay and actually tioring report out and so, it's something that we are looking hoping to get staffed up so some of this can move more quickly but we are also getting significant number more increasing contracts, so also adds to delays insuring regulatory these monitor reports are using but overall as at ways to reduce the

bureaucracy and implement it and be faster. >> thank you. ink in terms of the partners between the committee, the commission and the department and then the sibility we have to the funders as well as the citizens is should really try to again, work on as much we have advantage in the controller's office is somebody very familiar with the kinds of things that need to hapthat objective and those zh hopefully we'll be able to make that case to extent that the the right kind for us to continue or to reduce to be able to do that. agai i dge that i ink that the fact we are ahead of the game in terms of most of the other departments in doing that twee do is something that needs commended and acknowledged so thank you. >> thank

>> commissioner chung. >>join all the commissioners in thanking you for i think the evolution of the finance and planning committee has been quite get to this point, and i think most of are really excited to see what how this will make decisions and also like in of transparency and like open government, how we better job in like helping evernot public to understand you know, like the nature of the work and how the funding was decided.ink that it is really --what's the word i'm looking for? not so much the bureaucratic part of to say, we are doing is rubber ping everything. to break at , we start asking harder questions and i hope these harder questions are helping us

to go in the direction of like where it is going to to a even like commissioner guillermo said, the fact that we are ahead of like other departments, it is really a of the great work that you all are doing, so sometimes you know, we might sound difficult. we have one share goal amwe very interested in how these health outcomes of particular city and count y love. thank you. >> i see ther comments or questions, we are so lucky to be associated with thiswho have done such diligence and work with you i know to brig course, once again, gratitude to the teams really bringing this to a new level and amazing amount of complexity and stakeholders eciate the presentation and very much appreciate the work

and look forward hearing in particular ho new legislation will effect the work and-- commissioner chow:i didn't see your hand. please, close the conversation. >> i associateall the comments that have been made an think that what we are seeing and really apthe department is being part of a evolutionary process so that it isn't merely looking at a and seeing whetherall the i's are dotted and e concerned about the outcomes and but the so i think over these years, there been really a continued evolution to ght be the right mix and i think we are trying to balance the

amoare now learning the department ects, both on a on the side, so the presentation helpful and very clear there are so many diff really look at the performance ctor. as we know, there are times when things seem to fall through the cracki think that over time committee has been balance too much exclude extra work on the part of the department and those key questiu doing with this contract? 3 what has-been the outcome and has been fiscally responsible and is it of value? so, i think in the coming ea or coming months hopefully, we'll

continue to opportunity to fine-tune this.are looking at going back to 30 some odd years ago where we receive entire contract package and had 5 or contracts to look through and the attempt to try to by way of reducing the needed for renewals of contracts that me similar as previous has been helpful in the materic. i must say, the print very very small. it has been a good and i think again, trying to look at how we present new contracts is of the evolution that tries to amount of data that we get to the ed to look at. really want to thank the working staff at the finance level, and at our particularly

those who are handling s to really commend them for before we saw some of the performance reports we were unaware as to the detail that it actually was being carried out in and what the state requires and the feds require. it is there and we were not looking at these things, we worked out a way in which the commissioners would rmation. a privilege to and see the revolution and understand the contracts much better and when recommendations are made from the committee to the commission commission feels comfortable that the committee understood was happening with these contracts and could take the recommendationsce that it had i really do want to thank--i think the enormous work that so many

areas the department do in order to insure us that we are getting the can from our contracts looking at the and also being >> thank you. again, i'm standing up here talking about but these are people doing the work on the program side as well as business office and contracts and so, i thank them and i feel honored and lucky that they are on and helping us >> director colfax. >> i just wanted to thank jenny team for this. jenny is relatively new to being the new coo and had quita challenging budget process to go through with the team and at the same time was priority of the commission so want to appreciate the work thatthe presentation that was clear and concise, bu more time i would write a shor this is instilling compthings into easily understood concepts, so

i want to thank you and your doing this and look forward to ongoing prry important area that would be an ongoing priority for the co >> thank you. on the agenda, which is the center on substance use and health see you in person. last few times it has been . >> i was in person last year. >> thank you for having me. nice to see everybody. i have the [indiscernible] and we are directly--[indiscernible] how do move forward? so, we are in the research arm of the population health division. you can go to the next slide. we are fully fully federally with nihcdc draft with my time d

next slide. our goal is really focused around substance trying to better outcomes, we have 30 staff and little some grants have ended to the next slide. i will spend time on this slide to the left and tell you about a projects we have. the is reboot study. is was behavioral intervention for opioid overdose prevention. we just wrapped up the full trial and adapted to th fentanyl and ran both in san francisco and boston. the under analysis so i cant give the on the study yet. it was a exciting project because our tools to prevent overdose not as effective as they used to be. chow is our more a programmatr over a decade where we

a one one behavioral change goal with providers that has been used 40 years. used to be called counter detailing to counter e] this is more a evidence based public h s efforts using simila pharmaceutical companies would. we demonstrated through the guidelines to my challenging working with people who already on opioids is very very different from not starting opioids on somebody. we played a key part shifting the federal policy so that

stopped or at least slowed the rate forced off opioids resulting in a lot of and overdose death and un outcomes. now that project is in close ation with dhs and doing local detailing specifically around managing opioid use disorder. prescribing [indiscernible] and how manage stimulate use in primary care practice. we rking with dph clinics and expanding r the city and individual providers give them education on this and help them become better managing the curb 2 study is national trial to test two s, tending release [indiscernible] j in inatio cocaine use disorder. this was a exciting study, our first study of general population for use disorder and which is

effects in particular a lot of the black people with substance use disorder have a population we hadn't reached before with our other it has been satisfying. i dont know the medications work. we won't know until data is analyzed but we had many participants through the ask for graduation ceremonies and it has been really impak and tell us they managed to cocaine and a lot of intervention for people use cocaine in san francisco. it hasn't been a focus and this moving experience to provide this for this population. below that is harness. this is a study ofcernible] study of medication for helping it is a herb. if you know the southeast you may have

seen [indiscernible] benefit in alcohol use disorder and should have data on that soon.get in the methamphetamine work, m3 buisa trial of phase 1 trial where we are for interaction between [indiscernible] and meth. [indiscernible] a medication that actually dr. colfax or director ly started working on about 20years ago to reduce methuse and it did and we ran a largstudy that showed yes it did and effects had dur then the next phase for the fda trial large multisite trial drug interactions. we did tion with ucsf and 15 people were generous give up two weeks of their time in the l to go through [indiscernible] titrationsmall e disorder and not interested in stopping, so but

we succeeded and should have it to see issues and that will allow movement to larger trials. prime is a study of a adherence intervention for daily prep use among who use methamphetamine and that's >> could you define prep so you . prime. prep. my apologies. pre-exposure [indiscernible] ongoing study. i say while this is ongoingwe had injected prep intervention and another study listed here is looking at how we get to people who use methamphetamine.and 6 ntly released. excited movement but real challenges around logistics of implemen hint is a study of oral for who use methemph ongoing

study. snap isef that looked we did after several studies studies of people prescribed opioids and we followed them over time and as they lost acsess to opioids we want today see and many went to street opioid use and some went to stimiants to manage painstrange because i want stimulate increase [indiscernible] what we found in the was that most of people using stimiants used this is well phenomenon that has data neuro transmitter to cocaine and reduce pain particularly neuropathic pain. we followed up with a study where we look atpeople with hiv related and report

methemphetamine helped manage wree follow over 6 months with intensive studies to track ally and how does it and how are they using it. not suggesting we'll end up prescribing for pain, but it might change how we manage the situation when people are using methemphetamine. this might good group for prescribed [indiscernat help them avoid methemphetamine and 9vmanaknow, but exciting study driven patients that usually nobody listens to. a nice part of the job is when you are able to work that attends to people not other lasso is a exciting study. not a trial, this study of people deaths attributed by medical examiner to stimulate toxility. it is domain a real struggle because we focus so on opioids and rightly so. fentanyl is the elephant in

but the stimulants play a role in a deaths and primary drug labeled for about 120 acute deaths each year.n we don't understand stimulants result in death. it isn't like opioids where we have a opioids make you stop breather and your heart stops and pass away. stimulants probably effect through [indiscernible] most already have vas ural disease. next slide. this is example study of acute toxicity and th56 they came to san francisco from midwestern family and the found family used a lot of drugs, particularly methamphetamine and as they many friends passed

away or stopped using drugs young people came to the community and didn't they developed congestive heart fail and lung #couldn't get down the hall to the room to visit them and just stuck in their room and found after not seen over a week deceased and there was methemphetamine in the blood stream. this is the classic type h we see, particularly with many drugs but with stimulants. when i read about this is and thought it sounded much more like elder who's didn't have family around to care them and friends passed away. it sounded like elder death and i started thinking for some of these deaths should we tap more into a care model in order to try to them or improve the fact of decades of substance

and homelessness accelerate aging so we lot of people who are 50 years old on paper, 75 or older bi they have been through in their life. the way me things around because fentanyl responds more to the terventions, but not necessarily tapping into other isve about chronic disease and less about acute toxicity next slide. of the stimulant death in the last study which when we look at the stimulant only not involved opioids 94 percent of cardio vasural disease. that is profound. everyone dying from cardiovascular disease. a lot of most of the ekg's had prolonged which is

an interval pu1wts k of arrhyth mia that could be fatal. for me as a clinician in my practice i do a ekg on peopdo meth or cocaine get a sense of the baem and tell them about that risk and also may modify medications i prescribe them given effect the qtc interval as well. pacts for me so far and it is driven some of work with clinicians to help design better ways to manage stimulant use thinking a chronic disease and prevention as a prim staten as for prevention.. looking now we also a the deaths re opioid stimulant death but think fundamentally opiate death and stimulants are along for stimulants raise threshold

people on the street result this. as cliniciane what they say. can use more fentanyl safely and that is true on a one-off, but if the reality, when you use the r you jack up the fentanyl use higher and to so overdose tends to be higher. the delot more like opioid death. when we look at the ':ca see and comorbidities in people l who die from opioids stimulants die [indiscernible] they look like opioids. stimulant death is much more higher rate of comormidities. another complicated slide. sorry, we dove into the caseexcited about them, because we wanted to understand what is going on why can't we éjprent all by handing out naloxone.

fentanyl deaths, we sure they are. stimulant only is something different. stmajority are happening in private and 52 percent of the people nobody was there when they days to weeks before they were found.population that a f: ervention is going to dent frankly. we have to look at ot on top that. the stimulpant only death are more likely to that makes sense because is cardio vas urhigher mortality rate. [indiscernible] naloxone isn't going to do anything and out of hospital mortality for ou hospital cardiac arrest is around 8 opse to reverse. go to the we dove into the detail and the witness cases that involve fentanyl were by

opioid use and what look respiratory arrest and delayed resuscitation. not unwitnessed deaths for percent had evidence of drug use at the scen for stimulant deaths, only one of the witnessed deaths had stimulant use before the death. this wasn't really an acute it was frankly chronic disease. they mostly cardiac events. grabbiabout palpitations only 71 percent had evidence of drug use at the scene the event. much lower then 94 percent. overall, this supported our belief these are stimulant deaths are deaths of chronic disease and fentanyl deaths . our general epidemiology involves last year we and will

continue this year. have the data soon.ok not just at acute toxicity death but all deaths. in green at the bottom is all drug related deaths. it is actually pretty flat. it drops in the late en remains flat. i don't know but sometimes i think as the denominator of people at risk, maybe.x might correspond to that. the light blue line in the middle is acute . a very small nuv the blue is acute toxicity deaths and as lbsee, that eted in 2019 and unfortunately in 23 atwent up again. next next slide.we are finalizing those data, but have a total of acute toxicity deaths from opioids really

big increase, and with 697-i think that was readjudicated to 696 involving opioids so a big increase from the unfortunately. it is also all most entirely fentanyl. the opioid deaths are attributed to fentanyl. heroin and prescription opioids have this is a model of where you based on the proportion of the deaths attributed to fentanyl and the top line is without using naloxone and bottom line is .,aggressive comprehensive naloxone program. we were doing really well through we had a blip in 2020 where we were up to the isolation involved with covid. then in 2023, we had more due to fentanyl so expected increase, but that ease was higher then we expected for reasons that i state for sure. next slide.

what we are doing is we are = to do mostly federally fund re into finding medications, particular ly for simulates and alalcohol there is ongoing work around opioids, general consensus in the country, we medications for opioid use disorder and it is difficult to get on other agents so we foat don't have approved the we found through the work [indiscernible] fentanyl does account for overdose on tof the city with fentof the changes we see. i want to note one more>÷thing, in 2023, increase we saw was all most black african american and latinx individuals in the city, it really hit the

non-white é5crease for first time among asians individuals non-white individuals in the city very hard in 2023. stimulant deaths are t like opioid deaths, they armore similar to alcohol deaths. the way we manage them much more managing chronic disease and premature aging. thank you. >> first of all, thank you so much for this really clear presentation and your because this is probably the most challenging public hethe city now and people like you are important critical to try to find some solutions a problem that is and san francisco in particular so thank you so much. any public comment? there is one person. mr. manette shaw, you have mr. manette shaw. one more time, are you there? we don't have public comment

for >> commissioner comments or questions? commissioner guillermo. taking all that in, an amazing prntation.finding or research about the non-stimulant deaths is something i nder are other counties or othe observing the same thing or are we sort of is research or this look? >> ar >> yes. >> this is pioneering stuff. everyone focused on opioids obvious reasons, it is most of the deaths, but the--i thinthem with stimulants creates a because there are acute stimulant toxicity deaths and rare. .when someone has a cardio vascular condition or people

that traffic drugs in their body, which means that young deaths are very rare it is a much more of older population. understanding that and disaggregate the deaths is really important. i submit a lot of on methemphetamine and great to show skyrocketing but feel disingenuous because think is fentanyl and i--so feels disingenuous and for me part of larger effort to figure how to best use drive the public health activities.is case, if we just accept as acute assume [indiscernible] we'll go down the wrong road in efforts to prevent deaths. understanding it is really important to developing the right interventions. >> really look forward to more of the data and i guess conclusions, outcomes from the research you are able to goes along.

>> commissioner christian. i join commissioner guillermo's comments and just want to you for your work and this is something that is new to me, because we do-those of us not in the profession, medical profession especially, we laser focused on fentanyl fe fentanyl and hardly talk about ating me and the work you your happy demeanor gan amazing thing and i hope you are continuing to do that enable you to keep it, so thank you so much. commissioner chow. thank you are doing. i found especially that your discussion of the stimulants and these may become [indiscernible] in acting like the patiolder and maybe

you think that then there should be medical interventions, secondary or ia/ry type of intervention on this population to then reduce incidents of the medical complication? a great question commissioner chow, thank you very much. from this work, a couple things one in collaboration with dr. patting and n who departed and chill pack oremphetamine assist pack program where we give small number of of [indiscernible] low dose to patients who have psychiatric toxicity from methemphetamine at psych emergency service and found 30 percent fewer psych emergcy vi and working developing a clinical trl that intervention for next year. that is one thing we do around psychiatric toxicity which is

major concern in san francisco around developed a protocol for people who use methemphetamine. recognizing doing the assessment appropriately, not assuming yone who uses has use disorder and are trying to figure the people get frohave functional benefits. some people use them to on the street and recognizing the important to address their use. and then, making hpackage of preventative therapys that anyone drugs should have, which is i work in ward 86 so similar to hiv care in the sense of vaccines and making sure thoxone because we found in the research with ems overdose program percent of the confirmed opioid overdose deny opioid use.

significant portion of the overdo from fentanyl are by people using stimulants and picked pipe or wrong drug, things like that. we have done found there is a real population an very heavily african american as well.dont intend to use fentanyl and die from e. making sure they have naloxone even thoughare not intending to use opioids. soon a of injectible opioid blocker that lasts h to see if we opioid overdose events starting in the new year. around the cardiovarsural side, a domain of what to do to slow the toxicities of methemphetamine use among people who ng to stop using and are i personally offer everyone at staten at this point. we have who don't have indication for a staten

benefit from a stand is [indiscernible] when to start a staten. a risk father but we know they are risk factor for cardiovascular disease and we don't incorporate into outhat by er threshold to start a staten on somebody.data that they actually prevent the neuro logic we know people who use [difficulty hearing speaker] braef dementia is slowed by stat animals at least, the neuro for methemphetamine are well prevented by statens, so to is enough. if i need toto use methemphetamine i want to take and find most my patients feel the same and usually go i'll take the staten to i want to prevent these things so should

the medications you had? it has been a return-around in my own medical practice. >> thank you much and thank you for your work. >> thank you. yeah, thank you again and thank you for your enthusiasm formation. very interesting. do you think there on the grant side for the work you do across the country because there are pockets of drug use in other places in the country politics may not be as open-minded so i wonder pective especially if administrations change and grant funding. >> there was a lot of grant slation several years ago but that funding is starting to dryinto a drought like many other professions in funding so it has gottharder and the--but it is still mostly works. we do collaborate with people around the country on many different proj

obviously, stimulants sometimes take seat to fentanyl for good reasons.horrible national crisis from concerns around fentanyl. >> thank you very much. director-- want to reinforce, this is nihfunded researalong with cdc money and dr. kaufman o subtle. the cut off rates for the extremely competitive. this is a case where the all the leading university and i say we are usually if not the only health department that draws down nih dollars independent of other univtit to--mention that they collaborate nationally, but there arr national trial networks dr. kaufman is of, so really important there. to understand that the research that his group his team does translates quickly to be on the ground i talk to the commission i'm [indiscernible] but also we translate quickly and get interventions on the ground and

one of more recent examples contingency management, which the health partment pioneered contiskancy management not using certain drugs or doinlépositive like taking hiv meds and that is =a controversial years ago is and now we just saw something called a sh not drugs that is rolled out across th people are coming to me and saying have you heard of contingency management and impressed by the fact it is good because it is out thand embraced by many different communities and it is really a piece of started at dph expanded to the very communities that this work was being really proud of the work dr. kaufman and >> thank you so much for adding that and again, thank you so much for esentation and for all the work you g. the next item on the agenda and thank yofor your patience we have

director will give us the dph security update. >> good evening commissioners. security for dph. i will a update with regards to the progress made on the security management plan and the areas ñ2 well as continual work of [indiscernible] and the security staffing ne lide.ank you. in fiscal year 22-2we have reported that the 11.4 of deputy sheriff fte had been reduced and a update that sheriff a weekly basis provide with progress on and recruiting status, however they continue face

challenges with regards to filling the 21 remaining fte's. we also report the 22-23 that the program was fully implemto turnover and hiring barriers, the in 11.8 vacant positions.year fiscal out of the 11.8 vacancies they able to fill 8.4 of those vacancies even with the 4 remaining fte's, bert intervention increased by percent and rounding increase nearly from 2800 to over 3,000. next slide. of the bert bram was ted in 22-23, this was actually the first year the emergency department bert

program the 3.4 vacancies, rtover 6,000 patient patient interventions and had nearly 2800 e intervention in the sheriff office. to hire and cadet s for the ambassador prog that report in the previous fiscal year, the training as well as the hiring improved significantly based on weekly open that equates to vacant fte's, opposed to there being where every shift there was at least four vacancies per shift. private security continues to service ambassador service at each of the hospital entrances, in

addition, they also received their required training dph required training. as the training with regaisis prevention and intervention training. they also have expanded their services to incluvisibility and personal safety escorts in each of the hospitals parking areas. they also provide support to [indiscernible] fte well as again, throughout the campus. at honda, private security officers provide service there include collaboration with clainical staff with regards to eliminating sources of contra band. they too completed the cms training and expanded their services there to include supporting nursing staff on the units with standby and

resident assistance and in resident prevention and that is reported and fiscal year those three bert fte's provide support for the nursing units. next slide. 22-23 we reported that safety ambassador program for community clinics was delayed as a result of the the rfp process as l of the clinics now have the safety amplace and we expect to have the fourth at silver avenue staff come based on the performance the program directors at the three where we started have rated the ambassador bram exceptional, so a long time coming, but now wie are in th that program with success starting

next slide. with regard to the current the past four years, use of force by 52 percent. with restraining patients continues to be the drlaw enforcement use of force. ur year period, use of force is sed ally in all race ethnicities. 20-24, use of force against caucasians were the highest at 36 percent. in thhave been monitoring use of force is the first year that black african subject to law enforcement use of force in hospital. some of the contributing factors for that have to do with one of course, the services, but in addition to that, the emergency department staff and their standard work with responding to risk behavioral and what they call code 50 an sheriff office they have taken a different approach as far z address the

issues using more verbal de-escalation to actually avoid any tyof physical force. each one of the areas cont success of this reduction both in race and ethnicity and raof use of force in hospitals against our patients. under security

based onuous of force by race. with bert, we measure by race support to prevent patients from escalating. what we see in the chart here, emergency department bert supported by race and ethnicity nearly equal between black african americans patients, 31 percent that support was for black percent was for caucasian patients. next slide. r(tthe update for 2024. turn it back over to commis >> thank you for the positive . those on the [indiscernible] outcomes and outcome from the bert teams and you ask your team ar congratulated. as commissionerilo says this is a model for the nation and this program is so effective and really has such positive data very quickly and we really command everyone

that came together to develop that program ow the efficacy. is there any public comment? >> i wafor your incredible work but your time and going to stand up >> comment on the presentati commissioner salgado. >> thank you for have a quick question when you ask the person their race or do you do b)by a visual? i think this is, xyz? >> we gather data from the use of force report, and is included in the report and usually thatobtained by the california id or some type is where the information comes. >> the reason i as being latina we can fall in all most any

category, so i ?a sure that the numbers are re >> thank you for that. >> thank you. >> i'll bring that back and foiff office as well. >> yeah, we r ; the fact over the several years really have shown you can bring down the use of in fact increase the quality of the done and particular ly of your current u for the work that you have done 2óand the conversion from law enforcement to a trained individual as ambassadors seems to be workingu very much. it is wonderful to see success. ank you commissioner. >> director colfax. want to also thank mr. price for his work and achas a very busy of try

triangulating different groups of connecting different groups of people to make sure thatd staff are kept as safe as possible and works very the sheriff department and built stwraung relationships there. we talk about the bert work and appropriately so and i want to acknowledge the work mr. prof care, including the primary care just to share specifically, there have been real safety concerns mfémat tom ladell clinic in the last staff was very concerned and also porto the clinic because they were erned about outside the clinic there were real issues and mr. price took hold that, worked very quickly across our system sheriff office to rectify the situation and things are better there, so just an example of the work he does and the has a

very across the department and service delivery systems and mormake sure that we can do our work safely and importantly, keep our patients who come to ices as safe as we can as well, so thank you mr. price for your work. ñthank you. >> commissioner christian. >> quickly, thank you ess it and to see where you are now is astounding and i ju want-we all acknowledge that. i want to say that and dr. colfax said, the context of a th people many people are is a lot of violence as a result that can result from that and then we have staff who are trying to hel people and you are working to keep people safe while their jobs and using law enforcement

to do it is astounding so thank you so much for it and thank you for you could just remind me, what is what is our goal? is it ove law enforcement from these--never hundred percent, but to completely remove law enforcement from these situations from these areas in staffing for safety, or >> thank you for that commissioner and thank you as i would say end goal is not to remove law enforcement, but to make sure that we appropriate alternatives in place so we are not bringing law patient care situations. again, i thank tion because what i started doing ng incidents where law enforcement was called s and i still recognize opportunity even we celebrate their success that they provided these services without

sheriff deputies law enforcement, 87 percent of the time.the 13, 14 percent and what are thoseissues that escalate where bert escalates to law enforcement and what tools they need, what other alternative needs to be in place so we don't bring w enforcement into pace care situation especially when it is isn't criminal. >> this is brilliantly done so thank you so much, we appreciate you. >> thank you. i see no questions or the next item, which is the joint report from e 23, commissioner chow. >> thank you. the committee at the meeting standard reports, including the ceo report and we are now hly reports from the bert talked about this afternoon.r+the regulatory reports and the ncy report. we are very pleased to see der the

hiring and vacancy that we vacancy rate of i think in one of the categories it was like a 0 or minus 1 had also commended the zsfg the regulatory surveys, along with as i said earlier, being very pleased how huhas really stepped up to the plate and reduced the number of vacancies across all our clinical needs. during the medical staff reviewed and recommended that the full commission approve the neuro surgery rules and regulations, the pediatric [indiscernible]in closed session the committee the [indiscernible] >> thank you. >> that's my report. any public comment?

>> no public comment. >> any commis or comments? thank you commissioner chow. next report is the finance planning committee update from commissioner guillermo. >> i thought commissioner chung was going to be absent today so i put commissioner guillermo. >> we look alike. so, the finance planning commission commission meeting and we reviewed the contract report and [indiscernible] quite a contracts. one, two, three--six--five i went to ask if they were able to give you the updated version? >> yes. you asked for the monitoring report and updated document and i rece these via e-mail so in terms of- >> so we can move forward?

>> yes. >> great. something worth mentioning is the change in rting, so we still have timunderstand the process. it is the level of effort that we will be hearing a lot and that's the change in the way at they calculate the rate or the units.that is worth mentioning. >> if i can context. it is the new cal aim requirement. instead of paying for service they divide the contract by the amount of unit; be a standard, now it is the position and different levels pending on the amount of timemore real and that is coming in the next month. nothere yet. >> so ganthat concludes my update. >> thank you. any public comment? >> there is.

one public comment. mr. manette shaw would you like me to share the slide now or >> i guess on it consent calendar. three minutes. are you speaking on this item too?planning committee report-back? >> no, just on the consent i guess for item 11. >> alright. thank you, sir. in a minute. there is no public comment. >> any or comments from this report? alright.to the consent calendarwitz to walk us through the steps and how we shou we have to seg regate out items. >> commissioner salgado has something. >> i need recuse myself with contracts involving ucsf for conflict of interest. >> what we'll do after we hear publ vote into two sections and i'll lead through this. vote and extract and contracts are removed, you will vote on and

everyone but salgado will vote on the uc contracts. in the mean time, there public comment. mr. shaw, i will pull up the thing right now. there not a presentation on this? >> alright. i start? yes, you have three minutes. [difficulty just hire staff who know what they are doing nlities and save the $2 million annual expense? instead of issuing the $10 million contract which is astronomical, hire experience staff whwhat they are doing running a skilled nursing facility. does the commission believe management and staff need tobe le] across the

past two contracts totaling $15.2 million. chart shows cost for external consultant since may just after lhh decertified in april 2022 and through e years to 3.6 million. the health commission is apparently auto see if external over simight help rather then hiring competent staff. it is disgusting to me [indiscernible] full board of supervisors are going along wi part of the criticism of the health commission failure is body.

this commission is not performing fiduciary restraints needless $53 million in contract expenses. as fiduciaries this commission is ardering on neglect and fiduciary malfeasance. these costs could ha avoided all along had lhh hirefolks who knew what they were dobefore decertified. [indiscernible] just $1 triggering the contract must receive full board approval for million during a board of supervisor open thank you. >> that is the only public comment. i believe we to--i'm going to say something, i can't make the motion, o boif someone would parrot what i please make a motion for everyone to vote. please a motion for to vote on the consent calendar items, minus the ee uc contracts. >> is there a motion? ll move.

>> second. >> then i will do the is minus commissioner salgado will not vote and this is for the three uc contracts on the consent >> i move. >> second. [roll ca thank you. >> thank you so much for doing that secretary morewitz. much appreciated. we are ready next item which is other business. is there any othe that was [indiscernible] >> yes. >> alright. no public comment on other business? >> no. motion to go into closed session. >> so move. [rolsrcall on closed session]

great. if you can give me 30 seconds closed session. please know you will not be able to see or hear what is going on, or not disclose the contents of closed session. >> i mose. >> second. >> roll call vote. [ [roll call] >> next is motion to adjourn. >> second. >> alright. [roll call]

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