>> ready to develop your the harvey milk photo center focuses on and saturday workshops ex to photography classes. >> commissioner green. commissioner guillermo, present. commissioner chung commissioner salgado.chow, present. i note commissioner christian is on her way up from the garage. >> wonderful. we'll ask issioner guillermo to read the land acknowledgment.

>> the san francisco health commission acknowledges that we are on th unceded ancestral homeland of the ramaytush (rah-my-toosh) ohlone (o-lon-ee) who are the original inhabitants of the san franci indigenous stewards of this land, and in accordance with their traditions, the ramaytush ohlone have never ceded, lost, nor forgotten their responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory. as guests, we recognize that we benefit from living and working on their traditional homeland. we wish to pay our respects by acknowledging the ancestors, elders, by affirming their sovereign rights as first peoples. >> thank you. the next item on the agenda is approval of the minutes of the health commission meeting from july 16, 2024. comms you have before the minutes. if there are no additions or corrections, we'll ask for a motion to approve. >> i motion. a second? >> second. >> is there any public comment on this item? is one remotely. any public comment in the room on the minutes? 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 questions to be answered or back and forth conversation with commissioners. consider comments from the members of public discussing a itm and please note each individual is allowed one opportunity to speak per item. individuals may not return more then once to read statements from individuals unable to attend. health.commission.dph@sfdph.org. if you wish to spell your name you may do so. please notealong with federal state and local law prohibit discriminatory harassing conduct and will not be tolerated. alright. mr. shaw, you got three minutes. >> thank you. this is patrick shaw. my testimony included in this commission july 16, ing

minutes notes, there is a clear correlation and connection betweesan 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] freestanding bed data from the 22 financial data table. >> how is this related to the minutes? this does not seem is applicable. mr. shaw, i will repeat my question. the comments don't seem to relate to the minutes. the comments ha you are on.it there. we can do a roll call vote. because there is a member-- >> commissioner chow.

>> commissioner chow, how do you vote? commissioner guillermo, yes. commissioner chung, yes.een, yes. commissioner salgado, yes, the minutes are approved. >> the next item is general publis 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 same information i read abl public comment applies. we have several in the room and individuals in the room and the first on the topic is douglas. >> i have a timer when the timer 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 i was very up set the ballot measure by san francisco the ballot which abolishes this commission, 22 other voter approved commissions in the charter and puts all the commissions outside the charter 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 the charter, never to return unless a charter amendment this passes. also as part of 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 eliminate commission on status preservation and so forth. it also removes any supervisor review of mayoral apointment moving forward m 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 charter to 65, when we have 130. e some haven't hurt about this and don't really understand the seriousness of it. this is put 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 puvolved and to have citizens like yourself who are #< not ull 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 be revised. 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 commissions, recommendations to the board and take it to the voters if necessary for just like we did in 1996 for revisions to the city charter. this is absolutely the wrong way to do good government. you just cut everything out and force it to be replaced. rather trumpian i think. of it. let your constituents know this is on the ballot. i know some of you are restricted from making ballot argument s, but

we are is in the ballot arguments which are due august 19 so there may be people who believe in this sign a ballot argument and we are trying to 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? i couldn't qu you wrote here. >> good afternoon health commissioners. christopher cline. i was asked to put a power point presentation. i want to be clear, public health and director colfax did not assist with and we know the answer. [indiscernible] john hopkins to illegally access san francisco it was easy since medical

eletes dont want to know the advance in healthcare and [indiscernible] if we can send data [difficulty he to patient from baltimore to san francisco with technology which is just 2800 miles away. page 4 refers algorithms apps that use voice and phone technology to to be positive health outcomes but can give negative outcomes. 5 and 6 refer to how the interface works and [indiscernible] just baltimore medical center became the man in the middle health solutions and outcome. if it is apple and are told it is a orange, it is now a orange unless we have evidence to counter the facts giveren to us.the negative facts to blur the facts.

[indiscernibleprecursors for surveillance. page 9 explains the configurations [indiscernible] page 10 brings to the geo fencing and person higher frequency can control the man in the middle. page 11 shows how street lights and [indiscernible] used influence us. page 12 and compared to wireless networks today. anywhere your phone goes a signal can be sent to the person with a phone. page 14 martin luther king and 1967 talks about ai and computers. page 15 qgis 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 fireand i want to be clear, if director colfand director from hsa do not contact the fbi today i will file misconduct charges

and obstruct >> thank you. any other public comment in the room? >> yes, we have one person. one second. mr. shaw, you got three minutes. >> thank you. i am speaking on the topic not on today's agenda item. long last the tommy tompson [indiscernible] awarded class certification status july 26, 2024 by san urt judge andrew chang. chang staff posted online july 26 granting the class certification and handed san franccity attorney david chui a loss in court. july 26, [indiscernible] chang order noted he took judicial exhibit b.. exhibit f, the settlement system improvement agreement between

cms and lhh. exhibit h, cause analysis report dated december 1, 2022. exhibit ee, code of conduct 2018 exhibit jj, dph notice of data breach dated march 15, 2019. exhibit of the [indiscernible] troy williams presentation as the cms quality conference april 10, 2024. notably, page 5 of the order noted the evidence appears to be consistent with plaintiff allegation of governance failures ongoing in 2020 an contributed to lhh decertification in april 2022. it is clear to me this health commission completely aggregated its responsibility to lhh patients. this commission deliberately or inadvertently let the problems fester. the health commission governance failures as alleged the [indiscernible] contributed to and

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

comment. >> the next item is director's report.fax. >> good afternoon commissioners. grant colfax, director of health. you have the director's report in front of you awith links. we'll go over a few highlights of the director report given our full agenda today. just realfreally excited to announce that laguna honda med admission. this is a big step forward after two as we successfully recertified in medicare and medicaid, are now able to welcome people back and it is first priority offering people transferred out of opportunity to come back home and ting 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 most importantly, a time where families and residents of laguna honda can celebrate laguna honda is here to stay. next item, dph and entertainment commission and drag artists are saving lives by getting up in the club.a number of events that we are participating along with rtainment commission with partner with drag artist to increase overdysawareness and share how to respond to overdose to providing life [indiscernible] you will see a number of events we partner to make sure we are addressing the opiate overdose epidemic through multiple different interventions. pleased to announce the behavioral health service team received

awards from the national association of county behavioral health service was recognized two awards granted.coordinated care received an award as did bridge x@4and engagement services teamism both programs are recognized as outstanding 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 jostaff at the 20th anniversary of the avan center. this is service provided on site at the campus really providing state of the art care, particularly with regard to

imaging and follow-up for breast health and just incredible to see what happened there in 20 years. how our approach ñto breast health and meeting people where they are to make sure they receive best breast healthcare. it was really inspiring. this is a major fvprogram that reinforcing how committed and invested in promoting health equity. before the center existed, there was getting care for people imaging mamo grams follow-up could be really challenging. there centralized system had access to state of the art 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

leave to your leisure to re haven't already and happy to take any questions. thank you. >> thank you always wonderful to hear about the both the accolades and the celebrations, especially laguna honda. is there any public comment on this item? >> we have remotely. any public comment inthe room? we have one mr. shaw, you got three minutes. >> thank you. what is unstated in the director's report today and release is how patients have been all mentioned is there have "several admissions since several isn't a math value.eral. since october 14, patient census [indiscernible] 300 patients and 410 residents of july 22, 2024.does dr. colfax think

it will to restore [indiscernible] restricting the number of admissions to 5 patients per week take 60 weeks a year to wo patients without factoring to conduct audit between new admissions. also missing in the presentation is mention if the waver is [indiscernible] 120 beds. as the director of cdph, aragon has authority 250 grant th[ has that waver been submitted yet? if not, why isn't the commission directing colfax and lhh to the waver immediately? if lhh 120beds, more patients will be jumped into( out of town skilled nursing facilities due to the shorten of beds in san francisco. thank you. >> that's the only public 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 about dph and entertainment during overdose week awareness. as someone that is in the night life entertainment, it would be nice to have maybe a link in our that directs bars and restaurants where to get like say, narcan and we go and try to buy these items to have on-hand, you have like a hundred web siteand you don't know which one is the correct one, you don't know which you should get. i think as we go into august and bring awareness, i think maybe having an idea and purchase these items, so we have them on hand would be great. >> absolutely. i dont know if we have something like that already, but i will make sure we follow-up with

health team, several who are here and we can take that back and make sure that we have links made available to people so know where to go. thank you for the suggestion. commissioner giraudo. >> thank you for your report dr. colfax.a question about the pediatric allergy clinic.with the specialized education through the community health workers, et cetera, is there any outreach, seminars et cetera, at any of the health clinics themselves?'s say on an advertised day on about asthma and allergys versus having to go to 6m? >> so, yes, i appreciate the 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 allergist and works at the clinic and not here now.an get-- >> i'm on remotely. >> hi! >> hi. yes. thank you commissioner. the allergy clin my heart. 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 through the bay area counties and i do ththe clinics know 6m is a resource e ey can refer patients who have asthma difficult to control so they can do the environmental assessment, but right now the resources are not available to continue that consortium as it was. hopefully in the future we can get it back up and running. thank you doctor.

i hope so, because as you well know, in the primary care visit, often times a parent doesn't havef intime to ask questiont gdor be really educated about particulnce there is such a increase in it. i think if there were just education seminars in the outreach such as southeast, sunset, whatever, maybe once a year that are advertised i think it would be a service to a lot the families. i encourage ])consider to see if it is in 2025. thank you. >> absolutely. thank you commissioner. >> any other commissioner questions or comments on the director's report? alright. seeing none, we'll go to th next agenda item, which is the overview of the dph program monitoring

performance metrix and welcome jenny. >> good afternoon commissioners. jenny louie, chief operating officer here to present the metric. the presentation has come up as a result primarily ittee members but thought it would be great to educate the entire commission. in the process i think there were questions as members of the finance budget committee would be asked to approve very large contracts, multi-year the question is hoy do we know that this bram is 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.know there have been previous 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 process and the monitoring process so you really understand what the metric are.st. not intended to be a full blown overview of rehash of what program monitoring and compliance all, but i know there were questions that have popped up around we are happy do a refresher. we sent a comprehensive presentiothe commission over 18 months ago as a refresher because there is lot of context and it is trying to simplify this focusing on that metric question, but there is obviously a lot that goes beyond these metrics that i'm presenting in the work we doand financial monitoring contracts. with that i will dive

right in. for the it has two parts. i will do a overview of program monitoring and business--[indiscernible] walk through the process and then i will go into deep dive how performance metric are developed and used. program staff nobusiness office contract compliance but for ease and simplification of the presentation i will present the information, but i'm of the business office and behavioral health service and hiv health service should you have questions about the monitoring process or the metric developmen 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 does two types. the first is program monitoring

and are that is when they look at individual programs of a agency and so as 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 outlined in their contract. this wo business 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.agencies with contracts with multiple city departments over a certain dollar threshold have its monitoring done and coordinated wide monitoring process and

those based on dph we will focus and manage that, but those are done in conjunction with the cont beyond these type of monitoring there is areas within dph that does compliance with monitor ing.compliance and privacy affairs and quality programs throughout the network and population health as well, but 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 in terms of the metrics within that program monitoring. next slide, please. so, in terms of the program monitoring the timelines section and monitoring take place for 4tdthe pire completed year. the reports tend to use and submit regulatory entities to insure compliance which is through the department of helt care

services and [indiscernible] moving forward, we will insure that the commission is receiving the most completed quick spot check, sometimes members of the committee werereceiving the summary, which didn't have the data.braps trying to spare you the 8 page report times 10 contracts per committee, but i were there and so we will insure you're getting the full report which includes a full summary as well as 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 [indiscernible] for a few exceptions there is perhaps grant funded programs wherex the requirements are so specific and

[indiscernible] didn't seem necessary to layer on a monitoring report. on the right side, you can see rough timelines that we for different programs. these are aspirational. i think in terms of staffing and the number of contracts we have. these are 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 categories, which is program performance, which is either standardized or individual objective performance metric. there is deliverable's, which is units of service, units of service, number of clients served and client satisfaction measured by standardized survey and then compliance. three of the four really have

data components which is program performance deliverable and client satisfaction. compliance is a little-not quite this, but more a check you comply with ada standards and administrative binder as 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 g more into timeline is a sample and again, a aspirationalmethe metric are developed and are reported and are monitored and end up 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 yepj!par and they submit the metrics for review. bocc takes insure they are appropriate and measurable and

timely and data is available and are then they post the objectives on our website and notify the providerthe over the course of the fiscal year, july to june, the cbo provider will perform rvice, 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 basically three months after their program time period. at which point, the business office of contract compliance comes in. they conduct the monitoring visits. take e data, analyze it and [indiscernible] compliance with objectives and distribute reports and necessary plans of correction needed based on the findings. the next slide just in terms of areas that ÷xare being monitored. i had a question from

commissioners in terms of contract programs, we that are cbo and 54 civil service and this shows that we are currently monitoring the bocc. the next slide please. just drilling 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 a screen shot of 23/24 and r behavioral health service adult and older adult, if i got a screen shot on the next slide, you'll see a set of metric for each of these areas. r behavioral health programs, they are required a standard set of metric. they can create exception rules that are noted and you will see that on the next slide, but they can also-discretion to

individual metrics as well and think in the case certain cases depending on the program they can also chooshave similar but individualized metric depending on the service area and regulatory requirements. as mentioned before, data submission happens throughout the area in the for claiming and billing where we receive a lot of output--volume datas more consistently. i will also note, during the pandemic we did collect the held off on scoring and providing a overall program score given the challenges cbo had for service service delivery and outputs. in fiscal year, 2021 there was a pause ç and 21-22, 22-23 particularly

around [indiscernible] still heavily deployed at the for covid purposes, we did not provide those sumerary scores, but moving forward we are hoping focus on that and have complete s this is a screen shot of what you find if you clicked on within of the links and will see performance indicator. the %-pe of objective, the outcome as a process. client inclusion, this is they may exclude or include programs depending on the service just to make sure we are collecting --the

overall work and all 4 areas.)= it also has category ratings broken down by there is subcategory below that. those are ;9the y sheets 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 it is calculated. next slide, please. going into the performancis two components to each of these sections. one is going to be data statistical ion and accompanied by a narrative report here as well. again, thr3ese measures are developed by the system of care is and you'll see the data here and then also see qualitative narrative detail just to give

more tex ture if a program has [indiscernible] that is what the purpose the narrative section does. [difficulty hearing speaker] comments in terms of the data and outputs provided there. t') similarly, with clients satisfaction, you'll see the calculation which includes submission, return ratio of the responses, and then program and the performance itself here and then you no 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 ta and standardize way looking at it. next slide, please. now that you received overview of the monitoring reports itself, i how the metric are developed dive into two areas. behavioral health service, which has probably the most contracts that members-the committee see as well as hiv health service whh has significant amount of data. next in terms of the drivers of behavivast majority are dren by regulatory requirements [indiscernible] local health plans and contracts compliance requirements. also have continue quality improvement programs through ghcs and also again can op for specific metric related to ll. the type of metric they do use x different in nature. some are processing documentation such

as timely completion.g at program the timeliness of the referrals. completion of consent forms and outcome obj reduction in rehospitalization and [indiscernible] i know there is a lot of interest in the outcome metrics, i will note the process and compliance metrics are important to note es more texture and flavor to get a sense of data quality. if a assessment isn't completed in a timely manner, in terms of data and accuracy, thto perhaps make-use for purposes beyond like general population may not be as more timely manner, so while i understand theroe the outcome metrics, all different type of metric help tell the metric story. in terms of just a peak ahead, still very very early, you know, we

did we'll give them more time and stabilization, but as wee is more to come what is possible but give them a moment to catch their breath now. the next slide will focus just on [indiscernible] and adolescent needs and strength data, a clinical required by dhcs and facilitate the assessment process and individualized plans. an example of a process percent of new clients with open episode will have a assessment completed and submitted within days of the episode and then example of outcome metric, 80 percent of clients will approve [indiscernible] i also note there is a similar tool for adults

called ansa. adult needs and strength assessment. moving to hiv health services, in terms of the drivers and metric development, hiv health service has 180 standardize contract deliverables and are 18 service categories.metric are primarily based on several hiv aids bureau. [indiscernible] recommendations and there is a joint process we have to standardize the metric care and i will note a lot of our metrics that we started in san re adopted by the federal counterparts well when the first came out. in terms of the type of metrics used, is direct service such as identifying clients as early asuble pa. possible. linkage and retention to care and getting treatment as well as

viral load and indirect is support e and basic life needs, housing [indiscernible] beyond just the clinical services. next in terms of examples of the metrics used, viral suppression is a key indicator. part of getting to zero program, and they are yearly and we coupe keep moving the goal lower and lower based what we expect we can achieve. other examples include 8 0 percent and [indiscernible] what is ahead for hiv the injectibles require to look at different ways to look at metrics and

at the population, which is age and expected to be over 60 large majority being over 60 in the next 5 years. we expect perhaps additional services and support around 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] there 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 u0syandficiency 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 a]policies by november. we'll with irk osely with the controller office. we believe we are doing most of

these things already and when the controller's office initially did a lot city wide monitoring took a lot as a way for their monitoring, so but work and watch and see how their work and 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 ther people and happy to answer questions you may have. >> first, thank you so much for the excellent presentation. you have a real talent distilling unbelievably complicated information into a very understandable format, so we really apprecia i think as part of this, we also need to thank all these teams, because this obviously requires a tremendous amount of collaboration and detailed

analysis and we it obviously spans a huge topics, very complicated to gratitude all you. i want to express our gratitude to fellow commissions, because commissioner chung, the chair, commissioner guillermo and commissioner chow have put also tremendous amounts of work doing all the really detailed nitty-gritty for us we understand this better and again, it is all for wonderful outcomes as you pointed out. these programs are quite remark the residents of san francisco, so again, great thanks.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 th mr. manette shaw, are you there?

try one more time. mr. shaw. there is no public comment. >> we'll go to commissioner question and comme commissioners not on the subcommittee and have the commissioners who are make their comments and questions. any questions or comments? commissioner giraudo. >> i submitted a few questions and i really appreciate this presentation and since i'm not on that committee and i appreciate too that you this is a beginning deep dive into helping us further understand what the process is. my understanding and correct if i'm wrong, but in what you nted to us as well as the finance and mmittee, as well as what the chromeer controller is doing and new regulations, et cetera, or

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

i think beyond baker place, there are other instances not relate d to the department where there is financial instability in the contract. i think one of the was made as a result of baker place is is really complex situation during want to simplify it too much, but i think we do our best to monitor programs but some things happen one of the situations and correct me if i'm wrong, in that instance, previously with by the city wide process, if you had a number of sort of good compliance want to put people through the ringer every year because it was a lot of work. commissioner green mentioned, we are doing a of work collecting information and all the information has to come the providers themselves and so, i think initially the a while

they get a pass and go every other year the instance of baker place every other year was the miand had lighter touch on the contracts and lot happened financially during the pandemic. it will improve the monitoring overall and outcomes the fiscal monitoring continues and expanding and making that work consistent across the entire city. >> i appreciate it assumed so in what you presented, but ther within dph, but other non profits that have been especially that serve the homeless population, et cetera that fiscal monitoring issues and are been given assistance through their department and have not still have not complied. i am also involved with oasis inn, where it has been a real you are doing and your department is light years ahead

of many other departments to say the least. that's where i appreciated presentation, because it really helped me further understand what the breath of what you where doing and i thank you. >> i realized you a few commissioners about what percentage of the programs we monitor considered---vast majority of them. we don't have a pass/fail. it is on the scale of 1-5 with aggregates. p average. overall you will see as you receive the reports most of them have acceptable or above rating in terms of the year performance. >> if they don't, you offer assistance to help them do whatever to be in compliance and they do not follow throwith what you're

directions >> [difficulty hearing speaker] i believe the question is, if agencies comply with the financial standards do we try to help them out? >> if you offer assistance and they do not cooperate with the assistance or refuse the assistance. in all good faith you tried to help them with their monitoring and they did not accept it, what happens? >> so, i think th of like levels of flags if you want to call them in the fiscal

monitoring. first, there's perhaps just findiny or may not trigger providing them assistance, then there is once step up, the findings keep being repeated or if there is big issue that brings them to elevated concern, that's when technical assistance is kind of mandatory. once they are on this level, the controller's office will try to provide them technical assistance. i that's still did n't work or they are with technical assistance or things are still not getting better, there is another level up called and this is kind of the highest red flag level andlevel the department actually gets the option to defund a agency if the agency gets through the red flag status.

i have been doing fiscal monitoring around 6 years now, i have go up to that level, so it is a very rare occurrence. thank you. 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 press on that part of fiscal monitoring, since there's always a few 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 you and thank you so much for once again, a very inform ative and clear presentation. my questions are about the fiscal monitoring you are talking about and so i understand that--i am not expecting comprehe want to understand whether new legislation for non profit monitoring includes that are not state, local, federal man dates and fiscal responsibility because these are organizations that mñprovide services to people in the city who are at risk and in need, the employees of those places is very important that are the residents and clients appropriately. just like it is across the

board every organization. we and the city hr requirements. certain trainings, that training must do every year, and i'm wondering if you know or just broadly speaking, whether those types of requirements are also present in this space and whether if not, whether there is room for a look at necessity whether or not it is necessary 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 specific, (a lot of these

organizations provide treatment and services to people who are referred through the criminal justice 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 conds of things that most organizations require their employees to take? >> i don't that information. we could find out, but i think in terms of the legislation directs the controller's office to expand their monitoring beyond just the financial that goes--specifically ennamed operational performance and so this is still being developed and in process, but we can try to on this, but we'll know more inis it

dramatically different from what we do. we have a list of what we currently track on the compliance side.h i sent very late this afternoon, so would noit, but we can look into that. >> thank you. you mentioned the contstakeholders, do we have a way to get a sense of who those stakeholders are or ways to give input on the broadly speaking-the categories of stakeholders useful to consider? >> the controller's office has a city wide non profia 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 they 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 a specific list

serve, but this is about as the controller's gets the [indiscernible] have all the contract information [indiscernible] i comprehensive in terms of everyone who would be impaby this legislation that way they would be able to outreach sand a invite to their stakeholder engagements. >> thank you. we'll probably won't be you, but someone provide a presentation on what's evolving out of this extended monitoring? >> yeah, we can come back and report back. what the updated requirements are and how different or not they are what we do as a department. this is directed city wide, not directed just at dph.jt 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 level, but

of what these policies do and how different they will be from our current monitoring policies. >> thank you so much. >> i think 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 rely good to be able to hear as much and about the process and responsiveness that you have had to the committees concerns and questions that have come up over the years and particularly, more recently. thank you appreciate the it detailed responses. mine is more a ry then a question. i do have one specific que i always have to remind myself

that san francisco--the department is responsible for city and county of san francisco, which is no different 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 ltiples of difficulty and complexity and responsiveness and i think because we rely so much on the non profit that makes, which is--has varying levels of competency and resources in order to fulfill standards are the kind of things i think we need to be reminded of.hen we are looking at the responsibility the department, the bocc, the controller has and the aspirational goals to try and

standardize and monitor. but i think it is incumbent because we are that complex to really get it right and to iterate over time how we can get things better, because ultimately we are trying to do the right thing residents and citizens of san francisco city and county, so want to just acknowledge that a easy thing and to bring people into the department willing to put the rt into that is again, as difficult i think as doing the work itself, so i wanted to acknowledge that. ving said that, i do think that because it is get caught up in the bureaucracy a lot and sometimes it is hard to look outside that. the most concerned about is we collect a lot of data an try to collect real time as quickly as we can.

it is processing and of the data that takes the time gap when the data is collected and when it is reported so we are responsive to what the data is telling us. [indiscernible] just wondering, how difficult is it speaking specifically the monitoring data that aspirationally try to collect in three months of program completion and when ort comes out so that the public, the commission and so on is able to rethe data in a timely fashion to have a impact on renewals, or new solicitations, or budget issues and so on. is that something that is a focus of are trying to improve within the department? always areas of improvement and i think ougain like it is not

just collecting data and creating metrics it is around compliance and work itself and evaluate. there is a site visit that is involved. convursations to cbo sois why there is protracted timeline between the monitoring period ends and then y and actually getting completed and so, it's something that we are looking at and so some of this can move more quickly but we also getting significant number more increasing contracts, so also adds to delays and the will be on insuring regulatory reporting these monitor reports are using but overall as we look reduce the cracy and implement it and overall want these to be faster. >> thank you. it is something that :would i 4t think in

terms of the partnership between the committee, the commission and the department and then the responsibility to the funders as well as the citizens is something we should really try to again, work on as much as possible. i think we have advantage in the controller's office is somebody of things that need to happen internally to get to that objective and those goals so hopefully we'll be able to make that case to the extent that controller's office has the right kind of incentives 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 fawe are ahead of the game in terms of most of the twee do is something that needs to be d so thank you. >> thank you commissioners.

>> commissioner chung. >> i just want to the commissioners in thanking you for the presentation. i think the evolution of the finance and planning committee has been quite extensive and to get to this point, and i think most of us are excited to see what how this will transform the way decisions and also like in terms of transparency and like open government, how we can do a better job in like helping everyone, not just us, but the public to understand you know, like the nature of the work and how the funding was decided. i think that it is really --what's the word i'm looking for?much the bureaucratic part of it, but last thing i doing is rubber stamping everything. to break that mode, start

asking harder questions and i hope these harder questions are helping us to :=go in thewhere it is going to take us to a even better like commissioner guillermo said, the fact that we are ahead of like other departments, it is really a testimony of the great woall are doing, so you know, we might sound difficult. we have one share goal among the commissioners 'pis 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 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 everyone whis really bringing this to a new level and handling this amazing amount of complexity and stakeholders so we appreciate thtion and very much appreciate the work and look forward hearing in particular how the new legislation 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 thinkwe are seeing and really appreciate from partment is being part of a evolutionary process so that it isn't merely looking at a contract and seeing whether the i's are dotted and t's are crossed. we are concerned about the

outcomes and that there are ways of monitoring bjust outcomes and process, but the fiscal side and so over these years, there has been really a continued evolution to try to find mix and i think we are still trying to balance the amount ta that we are now learning the department really collects, both on a performance side, and the financial side, so the presentation was helpful and very clear there are so many different processes going on at the performance ofa contractor. as we know, there ar when things seem to fall through the cracks, and i think that over time the committee has

been trying to too much work--trying to exclude extra work on the part of the department and yet being able to 5:answer those key questions you know, what are we doing with this contract? what has-been the outcome and has it been fiscally respons8ible and is it of value? so, i think in the coming years coming months hopefully, we'll continue to have a opportunity to fine-tune this. don't think we are looking at going back to 30 some odd years ago where we receive the entire contract package and had 5 or 6 inches of 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 has been nk helpful in the materic. i must say, the print is very hkl. it has been a good summary and again, trying to look at how we present new contracts is another part of the evolution that tries to reduce the amount of data that we get to the key areas that we need to look at. really want to thank the working staff here, both finance level, and at our performance levels and ling all these ## contracts to really commend them for what i think 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

th requires and the feds require. it is there and it wasn't that we at these things, but that we worked out a way in which the commissioners would get it really is a privilege to me and see the revolution and understand the contracts much better and when recommendations are made from the committee to the commission that the feels comfortable that the committee understood what we with these contracts and could take the recommendations confidence that it had been reviewed appropriately. i really do want to thank--i think the work that so many areas of the department do in order to insure us that we are getting the best we acts looking at the best outcomes and also being

fiscally responsible, so thank you. >> thank you. >> thank you commissioners. again, i'm standing up here talking about but these are the people doing the work on the program side as well as business office and contracts compliance and so, i and i feel honored and lucky that they are on our team anhelping us navigate. g7 >> director colfax. >> i just wanted to thank jenny and the team for this. jenny is relatively new to being the new coo and had quite a challenginto go through with the team and at the same time this was co want to appreciate the work that went into clear and concise, but somebody said, if i hai would write a shorter letter.instilling complex things into easily understood concepts, so i want to thank you and your team for doing wh this and look forward to

ongoing progress in a very important area that would be an ongoing priority for the commission. thank you. we'll go to the next item 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. >> i 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 5next slide. we are fully all most fully

federally draft with my time and [indiscernible] all the work wedo next slide. our goal really focused around substance trying to create better outcomes, we have 30 staff and little under-staffed.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 opiocw overdose prevention. we just wrapped up the full trial and adapted to the new world of fentanyl and ran both in san francisco and boston. the final data are under analysis so i cant give the final up on the study yet. it was a ex

because our tools to prevent overdose as as effective as they used to be. chow is our more a programmatic project we had goina decade where we conduct academic detailing which is a one on one behavioral change goal intervention, educational work with providers that has been used for about 40 years. used to be called counter detailing to [indiscernible] a evidence based public elth focus efforts using similar tactics pharmaceutical companies would. we demonstrated through the project that [indisce changes

that happened to the national opioid guidelines to cognize how challenging working with people who are already on opioids is very very different from not starting opioids new . we played a key part in shifting the federal policy so that we hopefully slowed the rate people were forced off opioids resulting in a lot of icide and overdose death and unfortunate outcomes. now that project is in close collaboration with dhs and doing local detailing specifically around managing opioid use disorder. prescribing [indiscernible] and how to manage stimulate use in primary care practice. we have been working with dph

clinics and expanding to other clinics throj7ughout the city and individual providers to give them on this and help them become managing opioids and stimulates. the curb 2 study is a national trial to test two different medications, tending release [indiscernible] j in combination for people with cocaine use disorder. this was a exciting study, first study of general population for cocaine use disorder and which is effects in particular a lot of the black and african american 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 medications work. we won't know until the dataed but we had many

participants through the trial ask graduation ceremonies and it has been really impactful. we had people come back they managed to remain i think ithaven't had a lot of intervention for people who use cocaine it hasn't been a focus and this is a moving experience to provide this for this population. below that is harness. this is a study of [indiscernible] study of medication for helping people with alcohol use disorder. it is a herb. if you know t you may have seen [indiscernible] show alcohol use disorder and should have data on that soon. on the left we get in the methamphetamine work, m3 is of phase 1 trial where we are log for

interaction between [indiscernible] and meth. [indiscernible] a medication that actually dr. colfax or director initial ly started on about 20years ago to reduce methuse and it did and we ran a larger study that showdid and effects had dur ability and then the next phase for the fda for phase 3 trial large multisite trial they wanted to look for drug interactions. we did that in collaboration with ucsf and 15 people were generous enough to give up two weeks of their time in the hospital go through [indiscernible] titration and very small dose methemphetamine use disorder and not interested in stopping, so very challenging study to run, but we succeeded and should have it data soon. i don't expect to see issues and that

will allow movement to larger trials. prime is a study of a intervention for daily prep use among people who use methamphetamine and that's ill you define prep so you are not-- >> sure. prime. prep. my apologies. pre-exposure sc study. 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. monthly and 6 monthl recently released. excited movement but real challenges around logistics of implementing injectible prep. study of oral for people

use methemphetamine and ongoing study. snap is a fun small study that looked we did after several studies where we did several studies of people prescribed and we followed them over time and as they lost acsess to opioids we want today see what happened street opioid use and some to manage pain which seemed strange because i want taught stimulate inible] what we found in the data was that most of the people using stimiants used to manage pain.well established phenomenon that has data and neuro transmitter system that responds to cocaine

and reduce pain particularly neuropathic pain. we followed up with a study where we look at hiv related neuropathic pain and report methemphetamine helped manage pain.months with intensive studies to track and figure does it really and how does it and how are they using it. not suggestingwe'll end up prescribing methamphetamine for pain, but ge how we manage the situation when people are using methemphetamine. this might be a group for prescribed [indiscernible] that might hem avoid methemphetamine and manage pain. i dont know, but exciting study driven by patients and fran patients that usually nobody listens to. a nice part of the 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 acute stimulate toxility. it is domain of work a real struggle because we focus so much on opioids and rightly so. fentanyl is the elephant in the room, but the stimulants play a role in a lot of d 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. opioids make you stop breather and your heart stops and pass away.z> 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 add56 of acute meth. they came to san francisco 9%tranged from midwestern family and the found family used a lot ofdrugs, particularly methamphetamine and as they aged many friends passed away or stopped using drugs and young people came to the community and didn't connect with the young people. fail and lung disease d couldn't get down the hall to the friends room to them and just stuck in their room and found after not being seen over 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, i thought it sounded much more like 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 ould we tap more into a eldetry to prevent them or improve the fact of the matter is, h)decades of substance use 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 their life. the way that some things around

overdose n because fentanyl responds more to the interventions, but not necessarily tapping into other issues we have ronic disease and less about acute toxicity moment. next slide. so, give a example of the stimulant death in the last study which was all of them.kñ when we look at the stimulant only not involved opioids 94 percent had evidence of cardio vasural disease. that is profound. everyone dying stimulants has cardiovasc a lot of most of the ekg's had prolonged qtc interval which is an interval that puts you at risk arrhyth mia that could be fatal.

for me as practice i do a ekg on people who do meth or cocaine get a sense of the baseline qtc and talkout that risk and also may modify the other medications i prescribe them given other medications can 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 a chronic disease 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 e death and stimulants are along for the ride. stimulants raise threshold for

overdose. people on the street result this. as clinicians we often i use methemphetamine becsause i can use more fentanyl safely and that is true on a one-off, but if the reality, when you use the two together you jack up the fentanyl use higher and tend have more chaotic use so overdose tends to be higher. the deaths look a more like opioid death. when we look at the cause of h you see and comorbidities in people who die from opioids and st [indiscernible] they look like opioids. stimulant death is much more higher rate of additional comormidities. another complicated slide. sorry, we dove into the case narratives and got excited about them, because we wanted to understand what is

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

and out of hospital mortality for out of hospital cardiac arrest is around 8 opercent, so a tough go to the next slide. we dove into the witness cases in detail and the witness cases that involve fentanyl were preceded by opioid use and what look like respiratand 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. thly an acute event, frankly chronic disease.

they mostly look ke grabbing chest. complaining about palpitations before collapses, those kind of 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 ese are stimulant deaths are disease and fentanyl deaths are much more a acute process. next slide. our general epidemiology involves last year we started and will continue this year. have the data soon. to look not jusqt at acute toxicity death but all drug related deatbottom is all drug related deaths. it is actually pretty flat. it drops in the late teens i don't know but sometimes i think about this as the denominator of people at risk, maybe. it correspond to that.

the light blue ne middle is acute toxicity death that don't involve stimulants or opioids. we don't pay that. a very small number of events.acute toxicity deaths and as you see, that sky-rocketed in 2019 and unfortunately in 23 that went up again. next slide, please. next slide. so, in 2023, those data, but have a total of 800 xicity deaths from opioids and stimulants so a really big increase, with 697-i 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 our city. where you would 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. 2020 where we were up higher and attributed that to the isolation involved with covid. then in 2023, we had more due fentanyl so expected increase, but that increase was higher then we expected for reasons that i state for sure. next slide. what we are doing is we are continufederally fund research into finding medications, particular ly for simulates and also alcohol

there is ongoing work around opioids, but the ensus in the country, we have the mediycations for opioid use disorder and it is difficult to get movement so we focused more on stimulants that don't have approved therapy. we found through the work [indiscernible]es account for overdose mortality and saturation tof the city with fentanyl has accounts for most of the changes we see. i want to note one more thing, in 2023, increase we saw was all most exclusively among black african american and latinx individuals in the city, so really hit the non-white and there was also increase for

first time among asians individuals ry hard in 2023. stimulant deaths not like opioid deaths, they are more similar to alcohol deaths. the way we manage them is much more like disease and premature aging. thank you. >> first of all, thank you so much for this really clear presentation and your dedication to is work, because this is probably the most challenging public health problem we face in and people like you are so important cr find some solutions to probably a problem that is confronting the world and san ank 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. >> commissioner comments or questions? commissioner guillermo. >> yeah, just taking all that in, an amazing presentation. this finding or research about the non-stimulant deaths is something i wonder are other counties or 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 pioneering stuff. everyone focused on opioids for obvious reasons, it is st deaths, but the--i think lumping them with stimulants creates a problem, because there are acute stimulant .

they are has a cardio vascular condition that traffic drugs in their body, but they re,that young deaths are very rare and it is more of the older population. understanding that and able to ally important. i submit a lot of grants on methemphetamine and great to show it feel disingenuous because of the skyrocketing think is fentanyl and i--so it feels disingenuous and for me a part oeffort to figure how to best use mortality data to drive th public health activities. in this case, 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 ons.

>> really look forward to more of the data and i guess lconcsearch 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 ofor your work and this is something that is completely new to me, because we do-those of us not in profession, medical profession especially, we are laser /focused on fentanyl fentanyl fentanyl and hardly talk about meth anymore so thank you for educating 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 tothank you so much. >> commissioner chow.

>> yes. thank you for such work you are doing. i found especially x:that your discussion of the stimulants and hthese may become [indiscernible] in acting like the patient is older and maybe--do think that then there should be medical interventions, secondary or tertiary type of intervention this population to then reduce the incidents of the medical complication? >> that is a great question commissioner chow, thank you very much. from this work, uple things have emerged. with dr. patting and dr. golddeparted and psychiatric emergency service we started a pack or

methemphetamine assist pack zprogram where we give small number of doses of ible] low dose to patients who have psychiatric toxicity from methemphetaminrqe at psych emergency service and found they hapercent fewer psych emergency visits so we published developing a clinical trial that intervention for next year. that is one thing we do around psychiatric toxicity which is major concern in san francisco around vasular toxicity we developed a protocol for people who ine. recognizing doing the assessment appropriately, not assuming everyone who uses and are trying to figure the benefits get from stimulants have functional

benefits. some people use them to stay alive and recognizing the functional benefit is important to address their use. and then, making sure they have the whole preventative therapys that anyone who use drugs should have, which is i work in ward 86 so similar to hiv sense of vaccines and making sure they have naloxone because wel found in the research with the sort ems overdose program we found that 44 percent of the confirmed opioid overdose deny opioid use. significant portion of the overdose from fentanyl are by people using stimulants and picked up the wrong pipe drug, 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 trial of injectible opioid blocker that lasts for a month 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 the toxicities 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 n't have indication for a staten benefit from a staten and is [indiscernible] when to start a staten. they are not a risk father but

we know they are risk factor cardiovascular disease and we don't incorporate into our care. we are trying to change that by encouraging statens, lower threshold to start a staten on somebody. statens also have they actually prevent the neuro logic disease. we knpeople who use [difficulty hearing speaker] braef dementia is slowed by staten use and 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 the same and usually go from saying yes, i'll take the staten to safely use methemphetamine and saying i prevent these things so should

probably reduce use. what were th had? it has been a real turn-around in my own medical practice. >> thank you very much and thank you for your work. >> thank you. yeah, thank you again and ank you for your enthusiasm and all this information. very interesting. do you think there is adequate funding especially for the work you do and collaboration across the country because there are pockets of drug use of all kinds in 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 through opioid legislation several years ago but that funding is starting to dry up. we are running into a drought like many other professions in funding so

it has gotten harder and the--but it is still mostly works. we do collaborate with people around the country on many different projects. obviously, stimulants sometimes take a back seat to fentanyl for good reasons. we have a national crisis from concerns around fentanyl. director-- >> i want to reinforce, this is nihfunded research along with 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 goes in against all the leading university and i say we are usually if h department that draws down of other universities, so just ion that they collaborate nationally, but there are a number national trial networks dr. kaufman is

a part of, so important there. but there most important thing is that the research that his group his team slates quickly to be on the ground and i talk to the commission i'm [indiscernible] but also the fact we translate quickly and get interventions on the ground and one of the more recent examples is v# contingency management, which the health department pioneered researching controversial contiskancy management not using certain drugs or doing positive like taking hiv meds and that is very controversial years ago is and now [indiscernible] and we just saw something called a cash not drugh0 is rolled out across the city and people are 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

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 l-:zmuch for adding that and again, thank you so much for the presentation and for all ence we have director of security who will give us the dph security update. >> good evening commissioners. basal price, director of security for dph. i will give a update with regards to the progress made on the security ma the areas of security equity as well as continual

work of [indiscernible] and also the security staffing training plan. next slide. and next slide. thank 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 provide with progress on hiring status, however they continue to face challenges with filling the 21 remaining fte's. we also report in the 22-23 the was fully implemented, however due to turnover and hiring barriers, the result in 11.8 vacant positions. this past year fiscal year 23-24, bert out of the 11.8 vacancies they

were able to fill 8.4 of those vacancies and even ewith the 3.4 remaining fte's, bert intervention increased by 92 percent and rounding consultations increase nearly from 2800 to over 3,000.ps ch phase of the bert bram was implemented in 22-23, this was actually the first year full year of emergency department bert program and again, despite 3.4 vacancies, bert provided over 6,000 patient ed patient interventions and had nearly 2800 more intervention in the sheriff

office. next slide. reported in 22-23, that the sheriff office e to hire and train cadet s for the ambassador program. that report in year, the sheriff cadets training as well as the hiring actually improved significantly based on weekly open hours that equates to 1.5 vacato there being where every shift there 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 training with regards to the crisis prevention and intervention training. they also have ex services to include providing visibility and personal safety escorts in each of the hospitals parking areas. they also provide suppoto e] fte as well as again, just increase of visibility throughout the campus. next slide. at laguna honda, private security officers provide service there to include collaboration with clainical staff with regards to sources of contra band. ban. they too completed the cms training and healthcare security training and expanded their services there too to include supporting nursing

units with resident standby 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 ambassador program for community clinics was delayed as a result of the approval and the rfp process as of april 1, three of the clinics now have the safety ambassadors in place and we expect to have the fourth one avenue staff come september 1.on the performance surveys, the program directors at the three where we started have actually rated the

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

to law enforcement use of force in the hospital. some of the that have to do with one of course, the services, but in addition to that, the em standard work withto 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 and verbal de-escalation to actually avoid any type of physical force. each one of the areas contribute to success of this reduction both and ethnicity and overall reduction of force in hospitals against as mentioned security equity, during 23-24 fiscal year, bert provided 800 more intervention in sheriff os.

87 percent were without law enforcement. the emergency department bert program accounted for 6500 bert interventions or patient and increased over 53 percent when it started in 22-23.wn to security equity and how we measure or law enforcement, based onuous use of force by race. with bert, we measure by race t to prevent patients from escalating. what we see chart here, the emergency depa race and ethnicity was nearly equal americans and caucasian patients, 31 percent for black african americans, 32 percenwas for caucasian patients. next slide. that concludes the update for 2024.commission secretary. >> thank you for the positive news.

ndiscernible] outcomes volume of work and outcome 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 is so effective and really has such and we really commend you and everyone that program and now show the efficacy.ic comment? >> i want to say thank you for your time and going through the presentation i like to stand and applaud. >> comment on @the presentation? >> thank you for your presentation. just have a question when obtaining the data on race, do you ask or do you do by a visual?this person is, xyz? from the actual report use of and

the race ethnicity is included usually that is obtained by li$fornia id or some type of government document that is whmes. >> the reason i ask, being latina we can famost any category, so i just want to make sure numbers are represented correctly. >> thank you for that. ll bring that back and follow up with the sheriff office as well. ah, we know that. thancommissioner chow. >> i to thank mr. price for the excellent presentation and the the several thing right now. >> is there not >> no. >> alright. should i start? you have three minutes. hearing recording] why not just hire stdoing running

skilled nursing facilities and save the llion annual expense? instead of issuing $10 million contract which ical, hire experience staff who know what they are doing runninnursing facility. nt and staff need to be monitored for [indiscernible]past month, lhh awarded two my chart shows cost for extermay 1, 2022 just after april 2022 and through the next 5 2029 raised $53.6 million. the health okay to [indiscernible] to see external

over sight might help rather then hiring compe it is disgusting to me [indiscernible] full bo going along with the scam. part of the criticism of thfailure is lhh governing body. this commission is performing sufficient fiduciary restraints in contract expenses. as fiduciaries this is boardering on neglect and ary malfeasance. these costs could have been avoided all along had lhh hired folks who knew what they were doing before decertified.ndiscernible] just $1 shy of triggering the contract must receive for contracts exceeding $10 million during a n public hearing. thank you. >> that is the only i believe we can go on to--i'm going to motion, so if someosay. please make a motion please make a motion the

consent calendar the three uc contracts. a motion? >> i'll move. >> secon then i will do a roll call. [roll call] the next vote is minus is for the three uc on the consent calendar. >> i move. >> se [roll call] thank you. much for doin secretary morewitz. much appreciated. for the next item which is other business. is therother business? i think that was [indiscernible] >> yes. >> alright. no public commen >> no. >> then we need to entertain a motion to go >> so move.

>> second. woll call on closed session] if you can seconds to go into closed session. please know you will not be able to see going on, >> disclose or not disclose the of closed session. >> i move not to disclose. >> second. >> roll >> next >> second. >> alright. [roll call] thank you everyone. [meeting adjourned]

>> what's this for? i willghter

friends bring me a bench to explo see. >> this is cool up here. a, appliance and hose y >> why? >> why is it called a his . is a y. you see it looks like a it for yellow in the take 2 different hoses from one hose. building like a high rise and we havenect here we are able to more hoses in different directions to help put a fire out floor that is well above the street okay. >> fire engines carryfighters and firefighter paramedics. firefighters should not bghters are your friends. >> uh-huh. >> you are in need need to make sure it is okay to go up firefighter. firefighters utilize many of the tools we d such as a e other tools help us get t a fi fire the firefighters are friends and

this firefighter wilr go to the firefighter. >> hum. good [music]♪ this is the fire commission regular meeting. august 14, 9:00 am. held in person at public public