into a pumpkin, okay so now we're just at the information items. my understanding is we don't have any discussion about these, but i am just n for the public. and then are there any board member reports? with that, we adjourn at 929. thanks, all. thank you. thanks, everyone. sfgovtv san francisco government

television.mç >> commissioner guillermo, present. commissioner chung commissioner salgado. commissioner chow, present. i note commissioner christian is on her way up from the garage. >> wonderful. we'll ask guillermo to read the land acknowledgment. >> the san francisco health commission

acknowledgest ancestral homeland of the ramaytush (rah-my-toosh) ohlone (o-lon-ee) who are the original inhabitants of the san francisco peni stewards of this land, and in accordance with their traditions, the ramaytush ohlone have never ceded, lost, nor forgotten thei this place, as well as for all peoples who reside in their traditional territory. as guests, we recognize that we benefit from living and working on their traditional homeland. we wish to pay our respects by acknowledging the ancestors, elders, tives of the ramaytush ohlone community and by affirming their sovereign rights as first peoples. >> thank you. the next item on approval of the minutes of the health commission meeting from july 16, 2024. commissioners you have before the minutes. if there are no additions or motion to approve. >> i motion. >> second. >> is there any public comment on this item? tely. any public comment in the room on the minutes? i don't hear any. before we begin i'll read a statement. for each item members of the public have a opportunity to comment up to three minutes. the public comment process is designed to provide input and feedback, however does not allow question answered or back and forth

conversation with commissioners. consider comments from the members of public discussing a itm and making request. please note each individual is allowed one opportunity to speak per item. individuals may not return more then read statements from individuals unable to attend.t3'@ health.commission.dph@sfdph.org. you may do so. 9r please note city policy along with federal state and local law prohibit discriminatory harassing conduct and be tolerated. alright. mr. shaw, you got three minutes. >> thank you. this is patrick sha!xw. my testimony included in this commission july 16, 2024 meeting minutes notes, there is a clear correlation and connection between increasing numbers of san franciscans discharged to out of county

facilities and the number of beds remaining in san francisco. it is unclear what 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 2022 california long-term care financial data table. >> how is this related to the minutes? this does not seem is applicable. shaw, i will repeat my question. the comments don't seem to relate to the minutes. the comments have to relate to the item you are on. we'll leave it there. we can do a roll call vote. because there is a member-- >> commissioner chow, how do you vote? yes.

commissioner guillermo, yes. commissioner chung, yes. commissioner green, yes. commissioner salgado, yes, the minutes are approved. >> the next item is general publ comment and believe there is information secretary morewitz. >> members may address items within the subject matter jurisdiction but not on the agenda. each member may address the commission up to three minutes and the same information i read about for non general public comment applies. we have several in the room motely. >> we'll start with the individuals in the room and the first on the topic is douglas. >> i have a timer when the timer goes off please know your time is up. >> thank you commissioners. honor to be before you. i am here on a matter not on your agenda, but a matter vital to the future of this commission.

as a former commissioner on the board appeals and planning commission, under three mayors for 15 years, the concept and operation of commissions in the city is dear to my heart. i was very up set when the ballot measure by san francisco ballot which abolishes this commission,22 other voter approved commissions in the charter and puts oved by the board of supervisors brie by the end of 2025. so not only the health commission, the library commission, commission on public works and status of women, human rights commission, they are all abolished from the charter, never to return unless a charter amendment if this passes. also as part of the charter

amendment gives the mayor additional appointments on each commission so he or she has a super majority and abolish compensation or benefits to any commissioner which this happened when on permit appeals i missed my $15 parking reimbursement i got every week. eliminate commission on status of women, historic preservation and so forth. it also removes any supervisor review of mayoral apointment moving forward and allow the mayor to appoint and replace the commissioners apointed the mayor without it puts on a limit on the number commissioners that could be in the city and charter to 65, when we have 130.am going around to different commissions having hearings because some haven't hurt about this

and don't really understand the seriousness of it. this is t together by those who remove theficiency of government in san francisco. i hope you and i know that commissions serve a really valuable role in allowing the public to be involved and to have citizens like yourself who are not full time government employees to have a say in city government. so, we are-there is a alternative. nobody will question the fact that commissions sometimes need to commissioners become redundant and that's why the board of supervisors is put in a alternate ballot measure on the ballot to have a study group study endations to the board and take it to the voters if necessary for an just like we did in 1996 for revisions to the city charter. this is absolutely the wrong way to do good government. cut everything out and force it to be replaced.

rather trumpian i think. so, we ask that you be aware of it. let your constituents know this on the ballot. i know some of you are restricted from making ballot argument s, but we are [indiscernible] to oppose this in the ballot arguments which are due august 19 so there may be people who believe in this commission that will sign a ballot argument and we are trying to as many commissions involved as possible. i thank you for your time and thank you for your service. >> thank you so much. next individual in the room i think mr. cline, are you for general public comment? 'you wrote here. >> good afternoon health comms. christopher cline. i was asked to put a power point presentation. i want to be cl health and director colfax did not assist

with the presentation and we know the answer. [indiscernible] john hopkins to illegally access san it was easy since medical eletes dont want to know the advance in healthcare and [indiscernible] if can send data [difficulty to patient from baltimore to san francisco with technology which is ju2800 miles away. page 4 refers apps that use voice and phone technology to to be positive healthoutcomes but can give negative outcomes.5 and 6 refer to how the interface works and [indiscernible] baltimore medical center became the man in the midd solutions and outcome. if it is apple and are told it is a orange, it is ss we have evidence to counter the facts giveren to us.w e negative facts to blur the facts.

[indiscernible] precursors for surveillance. page 9 +" configurations [indiscernible] page 10 brings to the geo fencing and person with higher frequency can control the man in the middle. page 11 shows how street lights and iscernible] used influence us. page 12 and 13 [indiscernible] compared to wireless networks today. anywhere your phone goes a signal can be sent to the person with a phone. page 14 martinng and 1967 talks about ai and computers. page 15 is how the [indiscernible] coming to san francisco to speak in 2019. page 16 is the drastic increase in overdose starting in 2019. page 17, the pier 45 large fire was a wear to get into the fire department and public safety and i want to be clear, if director colfax and

director from hsa do not contact the fbi today i will file misconduct charges and obstruction you. any other public comment in the room? remote? >> yes, we have one person. one second. mr. shaw, you got three minutes. thank you. i ooy6am speaking on the topic not on today's agenda item. long last the tommy tompson [indiscernible] certification status july 26, 2024 by san francisco superior court judge andrew chang. chang staff posted online july 26 granting the class certification and handed sa attorney david chui a loss in court. july 26, [indiscernible] chang order noted he took judicial notice of exhibit b.

lhh annual report. exhibit f, the settlement system improvement agreement between cms and lhh. exhibit h, analysis report dated december 1, 2022. exhibit ee, code of conduct 2018 version. exhibit jj, dph notice of dated march 15, 2019. exhibit qq, the transcript of the [indiscernible] troy williams presentation as cms quality conference april 10, 2024.á notably, page 5 of the order noted the evidence appears to be plaintiff allegation of governance failures ongoing in contributed to lhh decertification in april 2022. it is clear to me this health commission completel aggregated its responsibility to lhh patients. this commission deliberately or inadvertently let the problems

fester. the health commission governance failures as alleged in the [indiscernible] contributed to and exacerbated culture of [indiscernible] lead to a culture of neglect in 2020 and lead to decertification in 2022. hopefully health commissioners will sit up take notice the medicare recertification in june is not the end of the troubles. commissioner green should take note as president of the commission, body cullpability. it is likely in the future the health commission may have to go into another closed session approve multi-million settlement represented in the [indiscernible] it is clear the class action certification presents a threat to dph and health commission control of laguna honda hospital. it is a long overdue development anis justice denied saga.

>> thank you. >> that's the only public comment. >> e next item is director's report. director colfax. afternoon commissioners. grant colfax, director of health. you have the director's reportyou awith links. we'll go over a few highlights director report given our full agenda today. just ally really excited to announce that laguna hondhospital resumed admission. this is a big step forward after two years as we successfully recertified in med now able to welcome people back and it is our first priority offering people transferred out of ç) laguna honda a opportunity to come back home and we

started admitting our first residents last week. really pleased that is moving forward at the time in celebration. it is a time to reflect on all the work the team did and moimportantly, a time where families and residents of laguna honda can celebrate laguna next item, dph and entertainme commission and drag artists are saving lives by getting up in the club. you will see a number of events that we are participating along with with partner with drag artist to increase overdysawareness and share how to respond to overdose to providing life saving naloxone training. [indiscernible] you will see a number ofpleased to partner to make sure we are addressing the

opiate overdose epidemic through multiple different interventions. to announce the behavioral health serv from the national association oz of county behavioral health service was recognized two awards granted. the office of coordinated care received an award as did bridge engagement services teamism both programs are recognized tanding government programs and services that improve access to behavioral health. just another example where san francisco is leading in the behavioral health field and a model for counties across the nation. i was going to say the state, but the nation. very competitive group. and then, just last item to mention in the report, i was really pleased to join many key staff at the 20th anniversary the avan center.

this is service provided on site at the campus really providing state of the art care, particularly with imaging and follow-up for breast health and just incredible to see what happened there in how our and meeting people where they are to make sure they recebest breast healthcare. it was really inspiring. this is a major program that reinforcing how committed and invested in before the center existed, there was ly challenging. there wasn't a centralized system making sure people had access to state of visioning and i was pleased to join the leadership group you see in the report to celebrate the

work that they have done. and there are other summaries in the director's report that i'll leave to your leisure to read if you haven't already and happy to take any questions. thank you. >> thank ch for the report and it is always wonderful to hear about the both the accoladeand the celebrations, especially laguna honda. is theroany dcomment on this item? >> we have remotely. any public commroom? 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 been "several admissions since several isn't a math value. since october 14, 2021 patient

census [indiscernible] 300 patients and 410 residents of july 22, 2024. how long does dr. colfax think it will taxke to restore [indiscernible] restricting the number of admissions to 5 patients per week take 60 weeks a year to ) admit two patients without factoring to conduct audit also missing in the presentation is mention if the waver is [indiscernible] 120 beds. as the director of cdph, aragon has authority 250 grant has that waver been submitted yet? the commission directing colfax and lhh to submit the waver immediately? lhh loses the 120beds, more patients will be jumped into out of town skilled nursing facilities due to the shorten of beds in san

thank you. comment for that item. >> any commissioner questions or comments? commissioner salgado. >> thank you. thank you director colfax for your report. i just have a quick question about dph and entertainment commission working during overdose week awareness. as someone that is in the night it would be nice to have maybe a link in our website that directs bars and restaurants where to get like say, narcan and ghwhat have you, because when we go and try to buy these items to have on-hand, you have like a hundred web sites and you don't know which one is the correct one, you ich you should get. i think as we go into august 'eo5 and bring awareness, i think maybe having

an ibusiness can go and purchase these ithave them on hand would be great. >> absolutely. i dont if we have something like that already, but i will make sure we follow-up with the behavioral health team, several who are here and we can take that back and make sure that we have links made available to people so they know where to go. thank you for the suggestion. issioner giraudo. >> thank you for your report dr. colfax.question about the pediatric allergy clinic. the presentation with the specialized education through the coit workers, et cetera, is there any outreach, semina the health clinics themselves?an advertised day more information about asthma and s versus having to go to 6m?

>> so, yes, i apprecthe question. i don't know if there is anyone remotely from the department that would be more a primary care clinic question. dr. [indiscernible] is a works at the clinic and not here now. we can get-- >> i'm on remotely. >> hi! >> hi. yes. thank you commissioner. the allergy clin what have been doing where as you said there was kind of this provided that consortium i would say after covid has dein grated for a bit. they still do outreach regionally through the bay area counties and i do all the clinics know 6m is a resocan refer patients who have asthma difficult to control so they can do the environmental assessment, but right now

are not available to hopefully in the future we can get it back up and running. >> okay, thank you doctor. i hope so, because as you well know, in the visit, often times a parent doesn't havef intime to ask questions about it or be really educated about partsuch a increase in it. i think if there were just education seminars in the outreach the clinics such as southeast, sunset, whatever, maybeare advertised i think it would be a service to a lot of the families. i encourage you to consider to see if it is in 2025. thank you. >> absolutel thank you. >> thank you commissioner. >> any other commissioner questints on the director's report? alright. seeing none, we'll go to

next agenda item, which is the overview of the dph program monitoring performance metrix and welcome jenny. >>af jenny louie, chief operating officer here to present the metric. the presentation has come up as a result primarily the finance committee members but thought it would be great to educate the entire commission. in the process i think there were questions as of the finance budget committee would be asked to approve very large contracts, multi-year contracts and the question is hoy do we know that this bram working? how do we know it is doing well? i'm here, again in the data driven world we are looking how do we know fwraum a data metric perfective

this is functioningism i have stripped down all the program monitoring we do. i know there have been ious presentations most commissioners have seen but [indiscernible] but just really there is a lot of information in terms of contracts, approval, monitoring, fiscal monitoring by the controller office and the role of this-purpose of the presentation is to really follow the metric just through the contracts procthe monitoring process so you really understand what the metric are.to be a full blown overview of rehash of what program monitoring and compliance all, but i there were questions that have popped up around we are happy a refresher. we sent a comprehensive precommission over 18 months ago as a refresher because there is a lot of context and it is trying to simplify this metric question, but there is obviously a lot that goes beyond these metrics that i'm presenting in the work we do

and program and financial monitoring contracts. with that will dive right in. has two parts. i will do a of program through the process and then i will go into deep dive how performance metric are developed and used. the metrics are developed by program staff office contract compliance but for ease and simplification of will present the information, but i'm the business office and behavioral health service and hiv health service should you have questions about the monitoring process or the metric developmen are available to answer questions as well. we'll hopefully do our best to answer your questions. next slide, please. for the first--you can skip--in termoffs the type of monitoring that the business office does two

types. the first is program monitoring and are that is when they look at individual programs of a agency and so as you know, we may have single agency that might have multiple contracts for different programs. the program monitoring focuses on the individual program and assess that program performance with objectives as contract. thsiness office of contracts compliance. in addition the city has fiscal monitoring and this is monitoring of the agency and looking at the financial stability and health of the organization and not looking necessarily the actual performance objectives and individual is overall healthch this is done in two different ways. the agencies with contracts with multiple city departments over a certain dollar threshold have its monitoring done and coordinated the city wide monitoring

process and those based on dph we will focus and e are done in conjunction with the controller's office. beyond these type of monitoring within dph that does compliance with monitor ing. our office of compliance and privacy affairs throughout the network and population health as well, but this is the area focused on monitoring in terms of contracts. as i mentioned, our focus is on the program monitoring side not on the fiscal side and then really again like drilling down of the metrics within that program monitoring.slide, please. so, in terms of the program monitoring the timelines can vary by section and monitoring take place for the pire completed year. the reports tend to use and submit nelatory entities to insure compliance which is through the department of helt care

services and [indiscernible] moving forward, we will that the commission is receiving the most completed report and quick spot check, sometimes members of the +á committee were receiving the summary, which didn't have the data. think we were braps trying to spare you the 8 patimes 10 contracts per committee, but i think the questions were there and so we will insure you're getting the full report which includes a full summary background on each of the 4 components that is being monitored. i will note there is some [indiscernible] if it is a new program, it will not a report completed. we have some non-direct services contracts that administrative in nature, not [indexceptions there is perhaps grant funded programs wre the requirements are so specific and [indiscernible] didn't seem necessary to layer

on a monitoring report. on the right you can see rough timelines that we nfor different programs. these are aspirational. i think there is variation in terms of staffing and the number of contracts we have. overall goals and tend to align with the [indiscernible] shifted to align with the federal funding. next slide. getting into the components of the monitoring, there is four categories, which is program performance, which either standardized or individual objective performance metric. there is deliverable's, which is units of service, more outputs units of service, number clients served and client satisfaction measured by ed survey and then compliance. three of the four really have data components which is performance

deliverable and client satisfaction. compliance is a little-not quite this, but more a check box, like do you comply with ada standards and administrativeas well. this presentation will focus on those three boxes and we are not going to talk about the specific compliance components of the monitoring. the next slide just more into timeline is a sample and again, a aspirational timeframe how the metric are developed and are reported and are monitored and end up in the report. if we were looking at a program that was being monitored by fiscal year, we would work with the program managers to develop the metrics by may that and they submit the metrics for review. bocc takes are appropriate and measurable and and are then they

post the objectives on our website and notify the providers. through the over the course of the fiscal year, july to june, the cbo provider will perform submit the data, and they can submit it on the time they choose, but all the data must be submitted for the prior year by september after the close that year. basically three months after program time period. at which point, the business office of comes in. they conduct the monitoring visits. take analyze it and [indiscernible] compliance and distribute reports and necessary plans of needed based on the findings.+r the next slide just in terms of areas that are being monitored. i had a question from commissioners in terms of contract programs, we have476 that are cbo and 54 civil

service and this shows the areas that we are currently monitoring through the bocc. the next slide please. down more into the metric and the monitoring report. the metric are developed for by type of service and posted on the website. on the right side, this is a screen shot of 23/24 and so for behavioral health service adult and older adult, got a screen shot on the you'll see a set of metric for each of these areas. for behavioral health programs, they are required a standard set of metric. create exception rules that are noted and you will see that on the next slide, but they can also-discretion to create individual metrics as well and think in the case certain cases depending on the program they can also choose

similar but individualized metric depending on the service area and regulatory requirements. as mentioned before, data submissihout the area in the for claim receive a lot of output--volume datas more consistently. i will also 6÷note, during the pandemic we did collect the data, but we held off on scoring g a overall program score given the challenges cbo had for service service delivery and outputs. in fiscal year, 2021 there was a pause and 21-22, 22-23 s%particularly around [indiscernible] still heavily deployed at the time for covid purposes, we did not provide those sumerary scores, but

moving forward focus on that and have complete reports moving forward. this is a screen shot of what you find if you clicked on within of the links and so you will see performance indicator. the type of objective, the outcome as a process. client inclusion, this is where they may exclude or include programs depending on the type of service just to make sure we are collecting

--the overall work and all 4 areas. it also has category ratings broken down by the four components and there is subcategory below that. those are that you are seeing and again in the supplemental presentation i sent, there is a lot of detail how the scoring is done in terms of the ranges, what is 4 and 3 and how it is calculated. next going into the perf objective scoring, again there is two components to each of these sections. s one is going to be data statistical by a narrative report here as well. again, the developed by the system of care is and program managers and so you'll see the data here and then also e qualitative narrative detail just to give more tex ture ture if a program has

[indiscernible] that is what the purpose of the narrative section does. [difficulty hearing speaker] comments in terms of the data outputs provided there. similarly, with clients satisfaction, the calculation which includes submission, return ratio of the responses, and thenand the performance itself here and then you note in the narrative, they are trying to standardize these percentages, but they will actually note in the narrative report in this particular one that they had return rate of 90.3 percent. it provides the standardize way looking at it. next slide, please.

now that you received overview of the monitoring reports itself, i want to talk about how the metric are developed program staff and we'll dive into two areas. behavioral health service, which has probably the most contracts that members-the committee see as well as hiv health service which has significant amount of data. next slide, please. in terms of the drivers of behavioral health metrics, vast majority are driven by regulatory requirements [indiscernible] local health and contracts compliance requirements. also have continue improvement programs through ghcs and again can op for specific metric related e processing domentation such

as timely completion. compliance which is looking at program the timeliness of the referrals. completion of consent forms and outcome objectives. reduction in rehospitalization and [indiscernible] i know there is a lot of interest in the outcome metrics, i l wilprocess and compliance metrics are important to note because it gives more texture and flavor to get a of data quality. if a assessment isn't completed in a terms of data and accuracy, the ability to perhaps make-use for oses beyond like general population may not be as ac more timely manner, so while i understand there is a interest in the outcome metrics, all different type of metric help tell the metric story.terms of just a peak ahead, still very very early, know, we

did implemwe'll give them more time and focus on stabilization, but as we stabilize the system there is more to come what is possible but give them a mo catch their breath now. the next will focus just on [indiscernible] child and adolescent needs and strength data, a clinical assessment tool required by dhcs and facilitate the assessment process and individualized plans. an example of a process metric is 90 percent of new clients with open episode will have a assessment completed and submitted within will approve [indiscernible] i also note there is a similar tool

for adults called ansa. adult needs and strength assessment. moving to , in terms of the drivers and metric development, hiv health service standardize contract deliverables and are 18 service categories. the metric are primarily based on several hiv aids bureau. [indiscernible] recommendations and there is a joint we have to standardize the metric care and i will note a lot of our metrics that we started in san francisco were adopted by the federal counterparts en the first came out. in terms of the type of metrics used, there is direct service such as identifying clients as early as

ent as well as indirect is support and basic life needs, the clinical services. next slide, please. in terms of examples of the metrics used, viral suppression is a key indicator. part of getting to zero program, and they are updated yearly and we coupe keep moving the goal and lower based what we expect we can achieve. other examples include insuring medical visits for hiv health clients, at least 8 0 percent and [indiscernible] what is ahead for hiv 6m health services, the to look at different ways to look at metrics and tcomes as well as when we

look at the population, which is continuing to age and expected to be ove large majority being over 60 in the next 5 years. we expect perhaps additional services and support around disability and aging services as well. with that, looking at what is next, i will note, beyond the work we are doing in terms of stabilizing the programs and catching on [indiscernible] is new legislation in the city for non profit monitoring. it actually expands to controller audit responsibility beyond the regular financial stability to include operation and requires the controller to create city wide standards for contracting and corrective action. the controller's office is beginning a stakeholder process now to develop those updating policies by november. we'll with irk closely with the controller office. we believe we are doing most of ry

these things already and when the controller's office initially did a lot city wide monitoring took a lot a way for their monitoring, so but we'll work and watch and see how their work and collaborate with them to insure we are creating a consistent process across the entire city and will be a partner in that. with that, that was a lot of information. happy to answer any questions and joined by all the experts in the room materials for these slides, so there isét a lot of people and happy to answer questions you may have. >> first, you so much for the excellent presentation. you have a real talent ing unbelievably complicated information into a very understandable format, so we really appreciate that. i think as part of this, we also need to thank all these this obviously requires a tremendous amount of and detailed

analysis and we really appreciate the work. it obviously spans a huge number of topics, very complicated to gratitude to all you. i want to express our gratitude to fellow commissions, because commissioner chung, the chair, commissioner guillermo and commissioner chow have put also in tremendous amounts of work doing the really detailed nitty-gritty for us so we understand this better and again, it is all for wonderful outcomes as you pointed out. these programs are quite remarkable for the residents of san francisco, so again, great thanks. is there any public comment on the item? >> there is one remotely. is there anyone in the room that would like to comment?

mr. shaw, you have three mr. manette shaw, are you there? try one more time. public comment. >> we'll go to commissioner question and comments and start with commissioners not on the subcommittee and have the commissioners who make their comments and questions. any questions or comments? commissioner giraudo. >> i submitted a few qu really appreciate this presentation and since i'm not and i appreciate too that you this is a beginning deep dive into helping us further understand what the process is.nding and correct if i'm wrong, but in what you presented to us as well as the finance anas what the chromeer controller is doing new regulations, et cetera, will

help or have the checks and are baso a baker place does not happen again, am correct that this will really look at performance as well as things that did not woi guess is my question? >> i think a few goals of the legislation. part, the board of supervisors, we are required to bring foapproval of contracts over 10 million doll are seeing most of the contracts and very large contracts across the city and ñ experiencing similar sentiments members of the committee made as well as brought forward with the contrac i think that--overall in general, the number of contracts and non profit contracts in the city and continues to grow so i think this came out of concern overall.

i think beyond baker place, there are other instances not relate dd to the department where there is the contract. i think one of the changes that was made as a result of baker place is that, which is really complex situation during the pandemic and i don't want to simplify it too much, abut i think we do our monitor programs but some things happen quickly, but one of the situ wrong, in that instance, previously with xpthe fiscal monitoring by the city wide process, if you had a number of sort of good liwe didn't want to put people through the ringer every year because it was a lot of work. commissioner green mentioned, we are doing a lot of work collecting information and all the information has to come from the providers themselves and so, i think initially th

thinking was, after a while they get a pass and go every otheand in the instance of baker place every other year of the pandemic and had lighter touch on the contracts and x.a lot happened financially during the pandemic. it will improve the monitoring overall and outcomes so the fiscal monitoring continues and expanding and making that nsistent across the entire city. >> i appreciate it and 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 7: that had fiscal monitoring issues and are through their department and have not still have not complied. i am also involved with oasis inn, where it has been a real so i know what you are doing and

department is light years ahead of many other departments to t. that's where i appreciated your presentation, because it really helped me further understand what the breath of what you where doing and i appreciate it. thank you. >> i realized you had a question about a few commissioners about what percentage of the programs we monitor considered---vast majority of them. we don't have a pass/fail.scale of 1-5 with aggregates. overall you will see as you receive the reports most ofthem have acceptable or above rating in terms of the past year performance. >> if they don't, you offer assistance to help them do whatever to liance and they do not

follow through with whyoe directions are--what happens? >> [difficulty hearing speaker] i believe the question is, if agencies do not comply with the financial standards do we offer assistance or try to help them out? >> if you offer assistance and they do not cooperate with the assistance or refuse the assistance. in all goodfaith you tried to help them with their monitoring and they did not accept it, what happens? >> so, i think kdis

multiple kind of like levels of flags if you want to call them in the fiscal monitoring. first, there's perhaps just findings which may or may not trigger providing them assist once step up, the findings keep being repeated or if there is big issue that brings them to el concern, that's when technical assistance is kind of mandatory. once they are on this level, the controller's office will them technical assistance. i believe if that's still did n't work or they are not cooperating with technical assistance or things are still not getting better, there is another level up called red flag status and this is kind of the highest red flag level level

the department actually gets the option toagency gets through the red flag status. i have been fiscal monitoring around 6 years now, i have only seen one agency go up to that level, so is a very rare occurrence. okay, that helps. >> there is variation for findings. is it not enough board members? there is different avenues depending on the situation. >> i appreciate that, but just wanted to understand the process on that part of fiscal monitoring, since there's in other city departments as well as throughout the city bit wayward in the process. >> [indiscernible] >> thank you.

>> commissioner christian. >> thank you president green. chief, good to see yo thank you so much for once again, a very info ative and clear presentation.about the fiscal monitoring you are talking about and so i understand that--i am not expe comprehensive answers, but i want to understand whether new legisl non profit monitoring includes operational requirements that are not state, man dates and fiscal responsibility because these are organizations that provide services to people in the city who are at risk and in need, and the employees of those places is very important that engaging with the residents and appropriately.

just like it is across the board in every organization. we and the mcity have hr requirements. certain trainings, that training you must do every year, and i'm wondering if you know or just broadly speaking, whether those types of requirements are also this space and whether if not, whether there is room a look at necessity whor cessary or useful to have certain kinds of trainings for people who are providing services through these organizations and also information-providing information to entities that work with the

organizations and being vague so i'll be specic, a lot of these organizations provide treatment and services to people who are referred through the criminal justice they are programs and they are meeting people needs and individuals are there providing those services meeting those needs. are those employees required to take training about non-harassment conduct and the kinds of things that most organizations require their employees to take? >> i don't have that information. we could find out, in terms of directs the controller's office to expand their monitoringthe financial that goes--specifically named operational performance and so this is still being developed and in process, but we can try to find out more

information for you on this, but we'll know more in november and is it dramatically different from what we do. what we currently track on the compliance side. on the other presentation which i sent very late this afternoon, so would not expect you to see it, but we can look into that. >> thank you. you mentioned the controller's office interacting with stakeholders, do we have a way to geof who those stakeholders are or ways to give input on the broadly speaking-the categories of stakeholders useful >> the controller's office has a city wide non a pretty extensive list at this point in terms of the cbo's they reach out to and they actually have set up outreach meetings specifically in august around this legislation to get stakeholder input as their updating policies in november and i

expect this to be a fairly iterative process as we get through to november. i don't have specific list serve, but this is about as the controller's gets the [indiscernible] have all the contract information [indiscernible] i would expect it to be comprehensive in terms of everyone who would be impacted by this legislation that way they would be able to outreach and include a invite to their stakeholder engagements. >> thank you. we'll probably won't be you, but someone coming to us to provide a presentation on what's evolving out of this extended monitoring? >> yeah, we can come back and report back. what updated requirements are and how different or not they are what we do as a department. this is directed city wide, not directed there are some departments that perhaps not not be ast as regulated as we are, and so i

think a part was bringing everyone up to the same curious to see in terms of what these policies do and how different they will be from our current monitoring policies. >> thank you so much. k 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 it is always really good to be able to hear as much and about the process and the responsiveness that you have had to the committees come up over the yenow and particularly, more recently. thank you for that. appreciate the it &4 detailed responses. mine is more a commentary then a question. i do ha

i always have to remind myself that san francisco--the department is responsibzúle for the city and county of san francisco, which is no di from i think what is structured in other counties or other cities and so the complexity and the scope with which this department has to monitor contracts makes it difficulty and complexity and responsiveness and i think rely so much on the non profit sector that which is--has varying levels of order to fulfill standards are the kind of things i think we need be reminded of. are looking at the responsibility the department, the bocc, the controller has and th aspirational goals to try and

standardize and monitor. but i think it is incumbent because are that complex to really get it right and to iterate over time how we s better, because ultimately we are trying to do the right thing and citizens of san francisco city and county, so i want to just acknowledge that it is not a easy thing and to bring people into the department willing to put the time and effort into again, as difficult i think as doing the work itself, so i wanted to acknowledge that. having said that, i do think that because it is complex, we get caught up in the bureaucracy a lot and sometimes u0 is hard to look outside that. one thing that i think i'm the most concerned about is we collect a lot of data and i think we do try to collect

real time as quickly as we can. it is processing and analyzing of the data that takes the the data is collected and when it is reported so we are responsive to what the data is telling us. [indiscernible] just wonderin difficult is it speaking the monitoring data that aspirationally try to collect in three months of program completion and when the report comes out so that the public, the commission and so on is able to respond to the data in a timely fashion to have a impact renewals, or new solicitations, or budget issues is that something that is a focus of what you are trying to improve within the department? >> there is always areas of

improvement and i think timelines, just because again like it is not just collecting ta and creating metrics it is work itself and evaluate. there is a site visit that convursations to cbo so that is why there is protracted timeline between the monitoring period ends and then the delay and actually getting tetoring report out and so, it's something that we are looking at and hoping to get staffed up so some of this can move more quickly but also getting significant number more increasing contracts, so also adds to delays and the be on insuring regulatory reporting these monitor reports are using but overall as we at ways to reduce the 1] bureaucracy and implement it and

overall want these to be faster. >> thank you. it is somethinthink in terms of the partnership and the department and then the onsibility we have to the funders as well as the citizens is something should really try to again, work on as much as possible. i think we have advantage in the controller's office is somebody who is very familiar with the kinds of things that need to happen internally to that objective and those goals so hopefully we'll be able to make that case to the extent that the controller's office has the right kind of incentives for us to continue or to reduce the bureaucracy as needed to be able to do that. again, i mostly want to acknowledge that i think that the fact we are ahead of the game in terms of most of ee do

is something that needs to be commended and acknowledged so thank you. >> thank you commissioners. >> commissioner chung. >> i just join all the commissioners in thanking you for the presentation. i think the evolution of the finance and planning committee has been quite extensive and to point, and i think most of are really excited to see what how this will transform the wwe make decisions and also like in of transparency and like open government, how we can better job in like helping everyone, not just us, but the public to understand you and how the funding was decided. i think that it is really --what's the word i'm looking for? not so much the bureaucratic part of it, but last thing i want to

say, we are doing is rubber ng everything. to break that mode, we start asking harder questions and i hope are helping us to go in the direction of like where it is going to take us to a even better performances. like commissioner guillermo said, the fact that we are ahead of like other departments, it is really a testimony of the great work that you all are doing, so sometimes you know, we might sound difficult. we have one share goal among the we very interested in how these investment change the health outcomes of every citizens in this particular city and count y that we love.

thank you. >> i see no other comments or questions, we are so lucky to be associated with this amazing commissioners who have done such diligence and work with you i know to bring things along and of course, once again, gratitude to the teams and everyoreally bringing this to a new level and handling amazing amount of complexity and stakeholders so we appreciate very much appreciate the work and look forward hearing in particular how the new legislation will effect the work and-- commissioner chow:i didn't see your hand. please, close the conversation. >> i associate myself with all the comments that have been made and i think that what we are seeing and really appreciate from the department is being part of a evolutionary process so that it isn't merely looking at a contract and seeing whether all

the i's are dotted and t's are crossed.are concerned about the outcomes and that ways of outcomes and process, but the fiscal side and so i think over these years, there been really a continued evolution to try to find what might be the right mix and i think we are still trying to balance the amount of data that we are now learning the department really collects, both on a performance side, and on the financial side, so the presentation was helpful and very clear there are so many different processes going on to really look at the performance of a contractor.

as we know, things seem to fall through the cracks, and i think that over time the committee has been trying to balance too much work--trying to exclude extra work on the part of the department and yet being able to answer those key questions you know, what are we doing with this contract? and has it been al is it of value? so, i think in the coming years or coming months hopefully, we'll continue to have a opportunity to fine-tune this.e looking at going back to 30 so ago where we receive the contract package and had 5 or 6 inchcontracts to look through and the attempt to try

to streamline it by way of reducing the amount of paperwork needed for renewals of contracts that are before me similar services as previous in the materic. i must say, the print is very very small. it has been a good summary and i think again, trying to look at how we present new contracts is another part of the evolution that tries to du amount of data that we get to the key arneed to look at. thank the working staff here, level, and at our performance levels particularly those who are handling all these contracts to really commend them for what i 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 feds require. it is there and it wasn't that we were not looking at these things, at we worked out a way in which the commissioners would get the information. it a privilege to me anstand the contracts much better and when recommendations are made from the committee to the commission that the mfortable that the committee understood what we was happening with these contracts and could take the recommendations in confidence that it had been reviewed appropriately. i really do want to thank--i think the enormous work that so many areas of the department do in order to insure us that we are getting the best we

can from our contracts looking at the best and also being fiscally responsible, so thank you. >> thank you. >> thank s. again, i'm standing up here talking about but these are the people side as well as business office and contracts compliance and so, i thank them and i feel honored and lucky that they are on our team and helping us navigate. >> director colfax. >> i just wanted to thank jenny and team for this. jenny is relatively new to the new coo and had quite a challenging budget process to go through with the team and at the same time this was priority of the commission so want to appreciate the work that went into the presentation that was clear and concise, but somebody said, if i had more time i would write a shorter letter. this is instilling complex things

into easily understood concepts, so i want to thank you and your team for doing this and look forward to ongoing progress in a very important area that would be an ongoing priority for the commission. thanks. >> thank you. we'll go to the next item on the agenda, which is the current research epidemiology of the center on substance use and health and dr. [indiscernible] nice to see you in person. last few times it has been remote. was in person last year. >> great. nice to see everybody. good afternoon. i have the [indiscernible] and we are directly--[indiscernible] how do i move forward? so, we are in the research arm of the population health division. you can go to the )next slide.

we are fully all mo federally funded with nihcdc draft with my time and [indiscernible] all the work we do. next slide. our goal is really focused around substance trying to create ve 30 staff and little under-staffed. some grants have ended and-go to the next slide. i will spend time on this slide and go right to the left and tell you about a few projects we have. the top is reboot study. this was behavioral intervention for opioid overdose prevention. we just wrapped up the full trial and adapted to the new of fentanyl and ran both in san francisco and

boston. the final data are still under analysis so i cant give the zwfinal update on the study yet. it was a use our tools to prevent overdose as effective as they used to be. chow is our more a programmatic project we d for over a decade where we conduct academic detailing which is a one one behavioral change goal intervention, educational work with providers that has been used for about 40 years. used to be called counter detailing to counter [indiscernible] this is more a evidence based public elth focus efforts using similar pharmaceutical companies would. we demonstrated through the

project changes that happened to the national opioid guidelines to recognize how challenging working with people who are already on opioids is very very different from not starting opioids new on somebody. we played a key part in shifting the federal policy so that we ho stopped or at least slowed the rate people were forced off opioids resulting in a lot of suicide and overdose death and unfortunate outcomes.ect is in close collaboration with dhs and doing local detailing specifically nd managing opioid use disorder.

prescribing [indiscernible] and how to manage stimulate use in primary care practice. we have working with dph clinics and expanding to other clinics 2 throughout the city and individual providers to give this and help them become u( better managing opioids and stimulates.2 study is a national trial to test two different kaons, tending release [indiscernible] j in combination for cocaine use disorder. this was a citing stu study of general population for cocaine and which is effects in particular a lot of the black and african american people with substance use disorder have cocaine use disorder so this is a population we hadn't reached before with our other trial jz it has been satisfying. i dont know if the mecations

work. we won't know until the we had many participants through the trial ask for graduation ceremonies and it has been really impactful. we ack and tell us they managed to remain cocaine and i a lot of intervention for people who use cocaine in san francisco. it hasn't been a focus and this is a moving for this population. this is a study of iscernible] study of medication for helping people with alcohol it is a herb. if you know may have seen [indiscernible] show use disorder and should have data on that soon. on the left wein the methamphetamine work, m3 is a trial of

phase 1 trial where we are looking for interaction between [indiscernible] and meth. [indiscernible] a medication that actually dr. colfax or director initial ly started working on about 20years ago to reduce methuse and it did and we ran a larger study that showed yes it did and effects had dur ability and then the next phase for the fda for phase trial large multisite trial they wanted to look drug interactions. we did that in ation with ucsf and 15 people were generous enough to time in the hospital to go through [indiscernible] titration and small dose methemphetamine use disorder and not interested in stopping, so very challengbut we succeeded and should have it data soon. to see issues and that

will allow movement to trials. prime is a s adherence intervention for daily prep use among people who use methamphetamine and that's >> could you define prep so you are not--re. prime. prep. my apologies. pre-exposure i say while this is ongoing we had injected prep intervention and another study listed here that is looking at how we get injectible prep to people who use methamphetamine. there is monthly and 6 monthly recently released. excited movement but realallenges around logistics of implementing injectible prep.study of oral for people who

use methemphetamine and ongoing study. snap is a that looked we did after several studies where we studies of people prescribed and we followed them over time and as they lost acsess to opioids we want today see what happened and many went to street opioid use and some went to stimiants to manage pain d strange because i want taught stimulate increase [indiscernible] what we found in the data was tof the people using stimiants used to manage pain. this is well established phenomenon that has data and neuro transmitter

system that respxoon to cocaine and reduce pain particularly we followed up with a study where we look at people with hiv related neuropathic pain and report methemphetamine helped manage pain. wree follow over 6 months with intensive studies to track and figure really and how does it and how are they using it. l end up prescribing methamphetamine for pain, but it might change how we manage the situation when people themphetamine. this might be good group for prescribed [indiscernible] that help them avoid methemphetamine and manage pain. i dont know, but exciting study driven by patients and frankly patients that usually nobody listens to. job is when you are able to do work that attends to people not otherwise attendeded to.

lasso is a exciting study. not a trial, this is a study of people who died from deaths attributed by medical examiner to ac stimulate toxility. it is domain of work that-been a real struggle because we focus so much on and rightly so. fentanyl is the elephant in the room, but the stimulants play a role in a lot of deaths and primary drug labeled for about 120 acute deaths each year. we don't understand how stimulants result in death. it isn't like opioids where we have a clear mechanism.stop breather and your heart stops and pass away. stimulants probably effect through

cardio [indiscernible] most already have cardio vas ural disease. next slide. this is a example from our study of acute toxicity and this individual died add 56 of ac they came to san francisco astranged from midwestern family and the found family used a lot of drugs, particularly methamphetamine and as they aged many or stopped using drugs and young people came to the community and didn't connect with the young people. they developed congestive heart fail and lung disease and couldn't get down the hall to the friends room to visit them and just stuck in their room and

found after not being a week deceased and there was methemphetamine in the blood stream. this is the classic type of death we see, particularly with many drugs but particularly with stimulants. when i read about this is and saw this, ll i thought it sounded much more like an elder who's didn't have family around to care for them and friends passed away. it sounded like a elder death and i started thinking for some gdof these deaths should we tap more into a care model in order to try to prevent them or improve the fact of the mattesvr decades of substance and homelessness accelerate aging so we have a lot of people who are 50 years old on paper, but or older

biologically, because of everything they have been through in their life. the way that some things around overdosebecause fentanyl responds more to the interventions,but not necessarily tapping into other issues we have disease and less about acute toxicity moment. next slide. so, give a example stimulant death in the last study which was all of t when we look at the stimulant only not involved opioids 94 percent had evidence of cardio vasural disease. everyone dystimulants has cardiovascular disease. a lot of most of the ekg's had prolonged qtc interval which is an interval that puts you isk

of arrhyth mia that could be fatal. for me as a clinician in my practice i do a ekg on people who do meth or cocaine get a sense of the baseline qtc and talk to them and tell them about that risk and also may modify the othe medications i prescribe them given other medications effect the qtc interval as well. the studies has profound impacts for me so far and it is driven some of the work with clinicians to help design better ways to manage stimulant use thinking about it as ñhdisease and prevention as a primary issue. staten as for prevention. next slide. looking now we also a lot of the deaths are opioid stimulant death but think fundamentally opiate death and

stimulants are along for the ride. stimulants raise threshold for overdose. people on the street result this. as clinicians we often ore what they say. i use meth can use more fentanyl safely and that is true on a one-off, but if the reality, when you use the two together you up the fentanyl use higher and tend to have more chaotic use so overdose tends to be higher. the deaths look a lot more like opioid death. when we look at the cause of see and comorbidities in people from opioids and ndiscernible] they look like opioids.t death is much more higher rate of additional comormidities. another complicated slide. sorry, we dove into the case narratives excited about them,

because we wanted to understand what is going on with why can't we prevent all by handing fentanyl deaths, we are pretty sure they are. stimulant only is something different. most of the dmajority are happening in private spaces and 52 percent of the people nobody was there when they died and haven't been seen for days to weeks before they were found. this isn't a population that a bystander response intervention to dent frankly. we have to look at other strategies on top that. the stimulpant only death are more likely to be witnessed. that makes sense because it is cardio vas ural event that has higher mortality rate. [indiscernible] naloxone isn't

going to do anything for stimulant event hospital mortality for out of hospital cardiac arrest is around 8 opercent, so a tough disease to reverse. go to the next slide. we dove into the witness cases in detail and the witness cases that involve fentanyl were preceded look like respiratory arrest and delayed resuscitation. not very many of those. unwitnessed deaths for fentanyl, 94 percent had evidence of drug use at the scene. for stimulant deaths, only one of the witnessed deaths had stimulant use before the death. this wasn't really an acute event, it was frankly chronic disease.

they mostly look cardiac events. grabbing chest.about palpitations before collapses, those kind of things. only 71 percent had evidence of drug use at the scene of the event. much lower then 94 percent. overall, this supported our belief that these are stimulant deaths are deaths of chronic disease and fentanyl deaths are much more ss. next slide. our general epidemiology involves last year we started and will continue this year. have the data soon. to loacute toxicity death but all drug related deaths. in green at the bottom is all drug related deaths. it is actually pretty flat. it drops in the late teens kyand remains flat. i don't know but sometimes i think about this as the denominator of people at risk, maybe.pond to that.

the light blue line in the middle is acute toxicity death that don't involve stimulants or opioids. we don't pay much attention to that. a very small number of events. the blue is acute toxicity deaths and as you see, that sky-rocketed in 2019 and unfortunately in 23 that went up next slide, pleas slide. so, in we are finalizing those data, but have a total of 800 acute toxicity deaths from opioids and stimulants soreally big increase, think that was readjudicated to 696 involving opioids so a big increase from the prior year unfortunately. it is also all most entirely fentanyl. 96 percent of the opioid deaths are attributed to fentanyl.

next slide. heroin and prescription opioids have been rare in this is a model of where you would r) expect deaths to be based on the proportion of the deaths attributed to fentanyl and the top line is without using naloxone and bottom line is a really aggressive comprehensive naloxone program. we were doing really well through the years. we had a blip in 2020 where we were up higher and attributed that to the isolation involved with covid. then in 2023, we had more due to fentanyl so expected increase, but that increase expected for asons that i state for su next slide. l what we are doing is we are continuing to do mostly federally fund

research into finding medications, particular ly for simulates and also ongoing work around opioids, but the the country, we have the medications for opioid use disorder and it is difficult to get movement on other agents so we focused more on stimulants that don't have approved therapy. we found through [indiscernible] fentanyl does account for overdose mortaltion tof the city with fentanyl has acof the changes we see. i want to note one more increase we saw was all most exclusively among black erican and latinx individuals in the city, so it really hit the non-white and there was also increase for

first time among asians individuals so hitd non-white individuals in the city very hard in 2023. stimulant deaths are not like opioid deaths, they are more to alcohol deaths. the way we manage them is much more like managing chronic disease and premature aging. thank you. k you so much for this really clear presentation and your dedication to this work, because this is probably the most challenging public health problem we face the city now and people like you are so nd some solutions to probably a problem that is confronting the world and san francisco in particular so thank you so much. any public comment? >> there is one person. mr. manette shaw, you have three minutes.

mr. manette shaw. one more time, are you there? we don't have public comment for this item. or questions? commissioner guillermo. st taking all that in, an amazing presentation. this finding or research about the non-stimulant deaths is something i wo other health departments observing the same thing or are we sort of pioneering this research or this look? >> around the stimulant deaths? >> yes. >> this is everyone focused on opioids for obvious reasons, it is most of the deaths, but the--i think lumping them with stimulants creates a problem, because there are acute ulant

toxicity deaths and rare. . they are when someone has a cardio vascular condition or people that traffic drugs in their body, but they are rare, and which means that young deaths are very rare and it is a much more of the understanding that and able to ?c disaggregate the deaths is really important. i submit a lot of grants on methemphetamine and great to show is skyrocketing but feel disingenuous because of the think is fentanyl and i--so it feels disingenuous and for me a part of larger effort to figure how to best use mortality data to drive the public health activities. this case, if we just accept the statement as acute toxicity and

assume [indiscernible] we'll go down the wrong road in the efforts to prevent deaths. understanding it is really important to developing the right interventions. >> really look forward to more nd i guess conclusions, outcomes from the research you are able to share as this goes along. >> commissioner christian. >> thank you. i join commissioner guillermo's comments and just want to thank you for your work and this is something that is completely new to me, because we do-those of us not in the profession, medical profession especially, we are laser focused on fentanyl fentanyl fentanyl and hardly talk about meth anymoreucating me and the work you do and your happy demeanor is an amazing thing

and i hope you are continuing to do things that enable you to keep it, so thank you so much. >> commissioner chow. >> yes. thank you for such work you are doing. i found especially that your discussion of the stimulants and these may [indiscernible] in acting like the patient is older and maybe--do you think that then there should be medical interventions, secondary or tertiary type of intervention on this population to then reduce the incidents the medical complication? >> that is a great question commissioner chow, thank you very much. from this work, a couple things

have emerged. one in collaboration with dr. patting and dr. man who departed and psychiatric emergency service chill pack or methemphetamine e we give small number of doses of [indiscernible] low dose to patients who have psychiatric toxicity from methemphetamine at psych emergency service and found they have 30 percent fewer psych emergency visits at and working developing a clinical trial that inte that is one thing we do around psychiatric toxicity which is major concern in lxsan francisco around vasular toxicdeveloped a protocol for people o use methemphetamine.

recognizing doing the assessment appropriately, not assuming everyone who uses has use disorder and are trying to figure the benefits people get from stimulants have functional benefits. some people use them to stay alive on the street and recognizing the functional benefit is important to address their use. and then, making sure they have the package of preventative therapys that anyone who use drugs which is i work in ward 86 so similar to hiv care in the sense of vaccines and making sure they have nalin the research with the soems overdose program we found that 44 percent of the confirmed opioid overdose deny opioid use. significant portion of the overdose people using

stimulants and picked up the wrong things like that. we have done interviews with them =and found there is a real population and very heavily african american as well. people who dont intend to use fentanyl and die from fentanyl overdose. making sure they have naloxone even though they are not intending to use opioids. we also start up soon a trial of injectible opioid blocker that lasts for nth to see if we can reduce opioid overdose events starting in the new year. around the cardiovarsural side, we have a domain of what to do to slow xicities of methemphetamine use among people who are not dpoeing to stop using and are i personally offer everyone at staten at this point.

we have increasing data people who don't have indication for a staten t a staten when to start a staten. they are not a risk know they are risk disease and we don't incorporate into our care. we are trying that by encouraging statens, lower threshold to start a staten on somebody. statens also have data that they actually prevent the neuro logic disease.people who use ñ [difficulty hearing speaker] braef dementia is slowed by staten use and animals at least, the neuro toxicities for methemphetamine are well prevented by statens, so to me that is enough. if i need to continue to use methemphetamine i want to take

a staten and find most my patients feel the same and usually go from saying yes, aten to safely use methemphetami i want to prevent these things so should probably reduce use. what were the medications you had? it has been a real turnmy own medical practice. >> thank you very much and r your work. >> thank you. you for your enthusiasm and all this information. very interesting. do you think there is adequate funding especially on the grant side for the work you do and collaboration across the country because there are pockets of drug use of other places in the country where the politics may not be as open-minded so i wonder your perspective especially if administrations change and grant funding. >> there was a lot of grant

funding gislation several years ago but that funding is starting to dry up. we are runginto a drought like many other professions in funding so it has gotten the--but it is still mostly works. ound the country on many different projects. obviously, stimulants sometimes take a back seat to fentanyl for good reasons. we hahorrible national crisis from concerns arou >> thank you very much. director-- >> i this is nihfunded research cdc money and dr. kaufman is being too subtle. the cut off rates for the grants are extremely competitive. this is a case where the health department goall the leading university and i say we are usually if not the only health department that draws nih dollars independent of other universities, so just to--mention that they

collaborate nationally, but there are a number national trial networks dr. kaufman is a part of, so really important there. but there most important is to understand that the research that his group does translates quickly to be on the ground and i to the commission i'm [indiscernible] but also the fact we çz interventions on the ground and one of the more recent examples is ich the health department pioneered researching controversial contiskancy management not using certain drugs or doing posit taking hiv meds and that is very controversial years and now [indiscernible] and we just saw something called a cashrolled out across the city and 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 there and embraced by many different communities and it is really a key piece of started at dph and now expanded to the very communities that this work was being done to serve, so just really proud of the work dr. kaufman and his team continue to do. >> thank you so much for adding that and again, thank you so much for the presentation and for all the work you are doing. the next item on the agenda and thank you patience we have director of security who will the dph security update. >> good evening commissioners. basal price, director of security for dph. i will give a update wito the progress made on the an and the areas

of security equity as well as continual work of [indiscernible] and also the security staffing training next slide. and next slide. thank you. in fiscal year 22-23, we have reported that the 11.4 of the deputy sheriff fte had been reduced and to provide a update that sheriff office continues on qí a weekly basis provide with progress on hiand recruiting status, however they continue to face challenges with regards to filling the 21 remaining fte's. we also report in the program was fully implemented, however due to turnover and hiring barriers, the result in 11.8 vacant positions.

this year fiscal year 23-24, bert out of the 11.8 vacancies they were able to fill 8.4 of those vacancies and even with the 3.4 remaining fte's, bert intervention increased by 92 percent and rounding consultations increase nearly from 2800 to over 3,000. next slide. each phase of the bert bram was implented in 22-23, this was actually the first year full year of the emergency department bert program and again, despite the 3.4 vacancies, bert provided over 6,000 patient ed

patient interventions had nearly 2800 more inteoffice. next slide. reported in 22-23, that the sheriff office was unable to hire and train cadet for the ambassador program. the previous fiscal year, the sheriff cadets training as as the hiring actually on weekly open hours that equates to 1.5 vacant fte's, opposed to there being where every was at least four vacancies per shift. private security continues to provide service ambassador service at each of the hospital entrances, in addition, they also received their required training with dph required

training. the compliance training as well as the training with regards to the crisis prevention and intervention training. they expanded their services to include providing visibility safety escorts in each of the they also provide support to [indiscernible] fte well as again, just increase of throughout the campus. next slide. at laguna honda, private security officers provide service there to clainical staff with regards to eliminating sources of contra band. ban. they too completed the cms training and thtraining and expanded their services there too to include supporting nursing

staff on the units with resident standby and resident assistance and participating in resident prevention and that is reported and last fiscal year those three bert fte's continue to provide support for the nursing units. next slide. ' 22-23 we reported that the safety ambass community clinics was delayed as a result of the approval and the rfp process as of april 1, three have the safety ambassadors in place and we expect to have the fourth one at silver avenue staff come september 1. based on the performance surveys, the three where we started have actually

ambassador bram exceptional, so glad for that success.coming, but now wie are in the process moving forward with that program with success starting next slide. with regard to the current state over the past four years, use of force decreased by 52 percent. deputies assisting with restraining patients continues to be the driver behind law enforcement use of force. within that same four year period, use of force is actually in all race ethnicities. 20-24, force were the highest at 36 percent. in the 9 years we have been monitoring use of force against our patients, this is the first year that black african americans were not the highest subject to law enforcement use of force

in the hospital. some of the contributing factors for that have to do with one of course, the services, but in addition to that, nt staff and their standard work with regards to responding to risk behavioral and what they call code 50 and also the sheriff office they have taken a different approach as far as how they address the issues using more time distance an[cd verbal de-escalation to actually avoid any type of physical force. each one of the areas contribute to success of this reduction both in race and ethnicity and overall reduction of use of force in hospitals against as mentioned under security equity, during 23-24 fiscal year, the bert providenearly 800 moreq=-8,000

more intervention in sheriff os. office. 87 percent were t law enforcement. the emergency department bert program accounted for over 6500 bert interventions or patient interventions and increased over 53 peb!rcent when it first started in 22-23. when it comes down to security equity and how we sheriff office or law enforcement, we monitor based onuous use of force by race. with bert, we by race support to prevent patients from escalating. what we see in the chart here, the emergency department bert supported by race and ethnicity was nearly equal between black african americans and

caucasian patie that support was for black african americans, 32 percent was for caucasian patients. next slide. the update for 2024. turn it back over to commission secretary. positive news.the [indiscernible] outcomes volume of work and outcome from the bert teams and you ask your team are to be congratulated. as commissioner guillermo says this is a model for the nation and this program is so effective and really has positive data very quickly and we really commend you came together to develop that program and now show is there any public comment? >> i want to say thank you work but your time and going through the presentation i like to stand up and

>> comment on the presentation? commissioner salgado. >> thank you for your presentation. just have a quick question when obtaining the data on :lrace, do you ask the person their race or do you do by i think this person is, xyz? >> we gather data from the actual report use force report, and the race ethnicity is the report and usually that is obtam9ined by the california id or some type of government document that is where the information comes. >> the reason i ask, being latina we can fall in all most any category, so i just want to make sure that the numbers are represented correctly. >> thank you for that. >> thank you. >> i'll bring that back and follow up with the sheriff office as well. >> yeah, we know that.

>> commissioner chow. >> i just wanted to thank mr. price for the excellent presentation the fact over the several years we really have shown you can bring down the use of force and in increase the quality of the work being done and your current data when really thank you for the work that you have done and the conversion from a law enforcement to a trained individual as ambassadors seems to be working so thank you very much. it is wonderful to see success. >> thank you commissioner. >> director colfax. >> i mr. price for his work and acknowledge that he has a very busy job of try

triangulating different groups of people or connecting different groups of people to make sure that patients and as safe as possible and works very closely with the department and built stwraung relationships there. you have seen the data. we talk about the bert work at zuckerberg and appropriately so and i want to acknowledge the work mr. price does across our system of care, including the primary care clinics. just to share specifically, there have been real safety concerns in the last year and the staff was very concerned and also reporting patients were not coming to the clinic because they were concerned about outside the clinic there were

situation and things are much better thof the work he does and the fact he has a very broad scope of-broad charge across the department and service delivery systems and more to make sure that we can do our work safely and importantly, keep our patients who come to get services as safe as as well, so thank you mr. price for your work. >> >> commissioner christian. >> quickly, thank you so much for this wo. it is so incredible. i remember when you were first coming to us about the issue and how to address it and to see where you are now is astounding and i just want-we all acknowledge that. i want to say that and particularly dr. colfax said, the context of a healthcare facility where op people are coming in distress and there is a lot of violence as a result that can result from that and then

we have staff who are trying to help people and you are to keep people safe while being able to do their jobs and not over g law enforcement to do that. for it and thank you for continuing it. if you remind me, what is the end game here for us? what is our goal? is it to completely move law enforcement from these--never hundred percent, but to completely remove law enforcement from these situations from staffing for safety, or what is it? >> thank you for that commissioner and thank you for your comments as well. i would say end goal is not to ement, but to make sure that we have the apprplace so we are not bringing law

enforcement into patient care situations. again, i thank you for the question because what i started doing is studying incidents where law enforcement was called into these ns and i still recognize opportunity even with bert. we celebrate their success that they provided these services without sheriff deputies or law enforcement, 87 percent of the time. interested in the percent and what are those issues 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 law enforcement pace care situation especially when it is isn't criminal. >> thank you so much, we appreciate you. >> thank you. >> thank you. i see no questions or comments so go to is the joint

conference committee report from the zsfgjcc of july 23, commissioner chow. >> thank you. the committee at the meeting reviewed our standard reports, including the ceo report and we are now getting monthly reports from the bert opportunities that we just about this afternoon. we also looked at the regulatory reports and the hiring and vacancy report. we are very pleased to see under the hiring and vacancy that we have low vacancy rate of of the categories it was like a or minus 1 percent vacancies. we also commended the zsfg continuing to perform well in the regulatory surveys, along with as i said earlier, being very pleased how human resources has really

stepped up to the plate and reduced the mber of vacancies across all our clinical needs. during the medical staff report, the committee reviewed and recommended that the full commission approve the neuro surgery rules and regulations, the pediatric [indiscernible] ssion the committee approved the [indiscernible] >> thank you. >> that's my report. >>any pu cblic comment. >> any commissioner questions or comments? thank you commissioner chow. the next report the finance planning committee update from commissioner guillermo. >> was going to be absent today so commissioner guillermo. >> we look alike.

so, the finance planning commission met right before this commission meeting and we reviewed the ract report andquite a few new contracts.three--six--five new contracts. i went to ask if they were able to give you the updated ver >> yes. you asked amfor the monitoring report and updated document and i received both of these via e-so of- >> so we can >> yes. >> great. some the change in what porting, so we still have time to understand the process. the level of effort that

we will be hearing a lot and that's the change in the way that they calculate the the units. yeah, so that's one that rd worth mentioning. >> if i can jump in to gi context. it is the new cal aim requirement. instead of paying for service they divide the contract by the amount of units and be a standard, now it is the position and different levels of payment depending on of time but more complicated and more real and that is coming in the next month. not >> so and that concludes my update. >> thank you. any public comment? . one public comment. mr. manette shaw would you like me to share the slide now or consent calendar? >> iit consent

calendar. >> okay. you got three micínutes. are you speaking on this item too? this is finance planning committee report-back? >> no, just on the consent i item 11. >> alright. thank you, sir. i'll talk to you in a minute. there is no public comment. >> any commissioner questions or comments from this report? alright. hearing none, we will go to the consent calendar and ask secretary morewitz to walk us through the steps and how we should approve or not approve because seg regate out items. >> commissioner salgado has something. >> i need to recuse mysewith contracts involving ucsf for conflict of interest. >> what we'll do after we hear public comment is, split the vote into two sections and i'll lead through this. the first section everyone can vote and extract and say all uc contracts are removed, you will vote on that and

everyone but commissioner salgado will vote on the uc contracts. in the mean time, there is public comment. mr. shaw, i will pull up the thing right now. >> isa presentation on this? >> no. >> alright. should i start? yes, you have three minutes. [difficulty hearing recording] why not know what they are doing running skilled nursing faci million annual expense? instead of issuing the $10 million contract which is astronomical, hire experience staff who know what they are doing running a skilled nursing facility.

does the commission believe management and staff need to be monitored for [indiscernible] across the past month, lhh awarded two contracts totaling $15.2 million. my chart shows cost r external consultant since may 1, 2022 after lhh decertified in april 2022 and through the next 5 years to 2029 raised $53.6 million. commission is apparently okay to [indiscernible] to see

if external over sight might help rather then hiring competent staff. it is disgusting to me [indiscernible] full board of supervisors are going along with the scam. paofthe health commission failure is lhh governing body. this commission is not performing sufficient fiduciary restraints needless $53 million in contract expenses. mmission is boardering on neglect and fiduciary malfeasance. these costs could have been avoided all along had lhh hired folks who knew what they were doing before decertified. [indiscernible] just $1 shy of triggering the full board approval for contracts exceeding $10 millio supervisor open public hearing. thank you. >> that is the only public comment. i believe we can go on to--i'm going to say something, i can't make the

motion, so if someone would parrot what i say. please make a motion for everyone to vote. please make to vote on the consent calendar items, minus the three uc contracts. >> is there a motion? >> i'll move. >> second. >> then i will do a roll call. [roll call] the next vote is minus commissioner salgado will not vote and this is for the three uc contracts on the consent calendar. >> i move. >> second. [roll call]

thank you. >> thank you so much that secretary morewitz. much appreciated. we are ready for the next item which is othebusiness is there any other business? i think atible] >> yes. >> alright. other business? >> no. >> then we need to entertain a motion to go into closed session. >> so move. >> second. [roll call on closed session] great. if you can give me 30 seconds to go into please know you will not be able to is going on, >> disclose or not disclose the contents of closed session.

>> i move not to disclose. >> second. >> roll call vote. [roll call] >> next is motion to adjourn. >> second. >> al

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>> good afternoon and welcome to the mayor's disability council this friday, 21, 2024. this is in person and virtual this to the public on sfgovtv. it