into a pumpkin, okay just at the information items.t have any discussion about these, but i am just noting that they are there for and then are there any board member reports? w, we adjourn all. thank you. thanks, everyone. sfgovtv san francisco government

>> commissioner green.er guillermo, present. commissioner chung, present.. commissioner ch i note commissioner christian is on her way up from the gara we'll ask commissioner guillermo to read >> the san francisco health commission acknowledges that we are on the unceded ancestral homeland h-my-toosh) ohlone (o-lon-ee) who are the original inhabitants of the san francisco peninsula. as the indigenous stewards of this land, and in traditions, the ramaytush ohlone have never ceded, lost, nor forgotten their responsibilities as the caretakers of who reside in their traditional territory. as guests, we recognize that we benefit from living and working on theirpects by acknowledging the ancestors, elders, and relatives of the ramaytush ohlone community and by oples. >> thank you. the next item on the agenda is approval of the minutes of the health. commissioners you have before tes. if there are no additions or

corrections, we'll ask for a motion to approve. >> i motion. >> is there a second? >> is there any public comment on this item? >> yes, there is one remotely.ent in the room on the minutes? i don't hear any.we begin i'll read for each item members of the public the public comment process is designed to provide input and feedba does not allow questions to be forth conversation with commissioners. consider comments from the a itm and making request. ead one opportunity to speak per item. individmore then once to read st individuals unable to attend. health.commission.dph@sfdph.org. if you wish to spell your name may do so. please note city policy along ññand local law discriminatory harassing conduct and will not be tolerated.

alright.shaw, you got three minutes. >> thank you. this is patrick shaw. in this commission july 16, 2024 meeting correlation and connection between increasing numbers of of county facilities and the number of beds remaining in it is unclear what action commission is taking. after all, [indiscern of july 2, there were 983 standing becernible] provided freestthe 2022 california long-term ca data table. >> how is this related to minutes? this does not seem it mr. shaw, i will repeat my question.to relate to the minutes. the comments have to relate to the item are on. we'll leave a roll call vote. because there member--

>> commissioner chow. >> commissioner chow, how do you vote? yes.mmissioner guillermo, yes. commissioner chung, yes. commissioner green, yes. commissioner salgado, yes, the minutes next item is general public comment and believe there is information etary morewitz. >> members may address items subject matter jurisdiction but not on the agenda. the commission up to three minutes and the same i read about for non general we have several in the room and remotely. >> we'll start on the douglas. >> i have a timer when the timer goes off please know your time up. >> thank you commissioners. honor to be before you. on a matter not on your agenda, but of this commission. as a formthe board appeals and for 15 years, the

concept and mmissions in the city is dear to my heart. i was very up set when ot measure by san francisco qualified for the which abolishes this commission, 22 other voter charter and puts a sunset on outside the charter if not reapproved by th by the end of 2025.only the health commission, the on public works and status of women, humaare all abolished from the return unless a charter amendment if p also as part of the charter amendment mayor additional on each commission so he or she has a majority and abolish compensation or benefits to any co which this happened when on permit missed my $15 parking reimbursement i got every week.ate commission on status of women, histso forth.

it also removes any supervisor of mayoral apointment moving forward and allow the mayor to and replace the commissioners apointed by ut any review.e number commissioners that could be in the city and we have 130. i am going aroufferent commissions having s because some haven't hurt about this and don't really nd the seriousness of it. this is put together by those who remove theficiency i hope you and i know that commissions serve role in allowing the public to be citizens like yourself who are not full employees to have a say in city government. so, we are-there is a alternative. nobody will question the that commissions sometimes need to be revised. commissioners become redundant and that's why the board of supervisors is put inalternate ballot measure on the ballot to have group study

commissions, make recommendations to the board and tato the voters if necessary for any changes. just like we in 1996 for revisions to the city charter. way to do good government. you just cut to be replaced.trumpian i think. so, we ask that you be let your constituents know this is on the i know some of you are restricted from nt s, but we are [indiscernible] to oppose this in ments which are due august 19 so there may be people who in this commission that will ment and we are trying to get as many i thank you for your time and thank you for your service. so much. nextthe room i think mr. cline, are you for genet? i couldn't quite read what yo wrote here. >> good afternoon health commissioners.. i was asked to put a power

i want to be clear, public health and colfax did not assist with the presentation and we answer. [indiscernible] johnins to illegally access san francisco public health and safety.easy since medical eletes dont want to know the healthcare and [indiscernible] if we can [difficulty hearing speaker] to patie san francisco with technology which is just 2800 miles page 4 refers to algorithms technology to influence us what is supposed be positive health outcomes but ;e+ negative outcomes. 5 and 6 refer to and [indiscernible] just baltimore medical center n in the middle to control health solutions and outcom it is apple and are told it is a orange, it is now a orange unless we the facts giveren to us. [indiscernible] swapped the negative facts to the facts.

[indiscernible] precursors for surveillanc page 9 explains the configurations to the geo fencing and person with higher frequency can control ththe middle. page 11lights and page 12 and 13 [indiscernible] anywhere your phone goes a signal can page 14 martin luther king and talks about ai and computers. page 15 is the [indiscernible] coming to san francisco to speak in 2019.the drastic increase in overdose starting in 2019.17, the pier 45 get into the fire department and public sa ty clear, if director colfax and director from hsa do not contact the fbi today i le misconduct charges and obstruction charges. thank you. >> the room? what about on remote? >> y

one second.got three minutes. >> thank you. i am speaking on the topic not today's agenda item. long last tommy tompson [indiscernible] awarded class 26, 2024 by san francisco superior court chang staff posted online july 26 certification and handed san francisco city attorney loss in court. july 26, order noted he took judicial notice of exhibit b. lhh annual report.f, the settlement system improvement agreement cms and lhh. exhibit h, hsh cause analysis dated december 1, 2022. of conduct 2018 version. exhibit jj, dph notice of data breach

exhibit qq, the transcript williams presentation as the cms quality 10, 2024. notably, page 5 of the order noted the evidence appears to be consistent with plof governance failures ongoing in 2020 and contributo lhh decertification in april 2022. it is clear to health commission completely aggregated its responsibility lhh patients. this commission inadvertently let the problems fester. the health commission governance failures as alleged in the [indiscernible] and exacerbated culture of to a culture of neglect in 2020 and lead to decertification in 2022.commissioners will sit up and take notice is not the end of the troublemmissioner green should take note as president the commission, governing body cullpability. in the future the health commission may have to go into closed session to ve a

multi-million settlement repres the class action certification presents a d health commission control of laguna honda hospital. long overdue development and this is justice denied saga. >> thpublic comment. >> the next item is director's director c >> good afternoon commissioners. grant colfax, director of health. you have the director's report in front of you awit we'll go over a few highlights of the director report agenda today. just really excited to that laguna honda hospital resumestep forward after two years we successfully recertified in medicare and medicaid, we are now able welcome people back and it is our first priority ofd out of laguna

honda a opportunity home and we started admitting ents last week. really pleased that is moving fo it is a time to reflect on all the work the team did and most importantly, a families and residents of laguna honda can celebrate laguna honda is here to stay.dph and entertainment commission and drag artists ing up in the club. you will see number of events that we are participating along with entertainment commission with with drag artist to increase and share how to respond to overdose providing life saving naloxone training.le] you will see a number of events we are pleased to we are addressing the opiate overdose epidemic through multiple different interventions.

pleased to behavioral health service team received awards association of county was recognized two awards granted. the office of award as did bridge and engagement ëh programs are recognized as outstanding government services that improve access to behavioral health. just francisco is leading in the behavioral heafor counties the nation. i was state, but the nation. very competit and then, just last item to mention in the report, i was really pleased to join many key staff 20th anniversary of the this is service provided on campus really providing state particularly with regard to for breast health and just incredible to see what happened there in 20 years.

how our approach to breast health and they are to make sure they receive the best breast healthcare. it was really inspiring. this a major program that reinfo invested in promoting health equity. beexisted, there was getting care people imaging mamo grams follow-up could there wasn't a making sure people had of the art visioning and i was pl you see in the report to celebrate the work that they have done. and there are in the director's report that i'll leave your leisure to read if you haven't questions. thank you. >> thank you so much for the report and it is about the both the accolades and the guna honda. is there any public comment on item? >> we have remotely. any public comment in the room? one person remotely. shaw, you got

three minutes. >> what is unstated in and lhh press have been readmitted to lhh. have been "several admissionssince june 20". several isn't a math value. please define several.since october 14, 2021 patient patients and 410 residents of how long think it will take to restore [indisce] estricting the number of admissions to 5 patients per week 60 weeks a year to admit two factoring to conduct audit between new admissions.so missing in the presentation the waver ndiscernible] 120 beds. as the director has authority 250 grant that waver. has that waver been submitted

yet? if not, why isn't the ting colfax and lhh to submit the wa if lhh loses the be jumped into out of town shorten of beds in san francisco.hank you. >> that's the only public comment for that item. >> any commissioner questions or comments?ner salgado. >> thank you. thank you director colfax for i just have a quick question about and entertainment commission working dose week awareness. as someone that is night life entertainment, it would be nice to maybe a link in our website that directs restaurants where to ke say, narcan and what have you, because when we go and uy these items to like a hundred web sites and you don't know correct one, you don't know which you should get. i think as we go into august

and brithink maybe having an idea where a small business can and purchase these items, so we have them >> absolutely. i dont know if we have something like that sure we follow-up with the behavioral we can take that back and make sure have links made available to people so they know where to go. thank yo for the suggestion. >> commissioner giraudo. you for your report dr. colfax. i have a question about the pediatric allergy clinic. the presentation ugh the community health workers, et cetera, is there any outreach, seminars et cetera, at any of clinics themselves? let's say on day more information and allergys versus having to go >> so, yes, i appreciate the question.anyone

remotely from the department that would be more a primary care clinic question.is a allergist and works the clinic and not here now. we can get--ely. >> hi! >> hi. thank the allergy clinic is dear to my heart.hat have been doing where as you kind of this education would say after covid has dein they still do outreach regionally through tarea counties and i do think all 6m is a resource where they can refer patients who have asthma difficult to control so they can do the environmental assessment, but right now the resources are not to continue that consortium as it was. get it back up and running. >> okay, i hope so, because as you s the primary care visit, often

times ask questions about it or be really educated about particularly asthma since there is such se in it. i think ifwere just education seminars in outreach in the clinics t, sunset, whatever, maybe once a year that are ve a lot of the fami i encourage you to consider see if it is possible in 2025. thank you. >> absolutely. thank you. >> thank you commissioner. any other commissioner questions or comments on the director's seeing none, we'll go to the next of the dph program monitoring performance metrix and welcome jenny. >> good afternoon commissioners. jenny louie, chief operating officer here present the metric. the presentation has come up a result primarily as the finance

committee meeducate the entire commthere were questions as members of the finance budget committee would be asked to approve large contracts, multi-year contracts and the we know that this bram is working? how do we know i'm here, again in the driven world we are looking how do we fwraum a data metric perfective this is functioningism i down all the program monitoring we do. i know have been previous presentations mostseen but [indiscernible] but information in terms of monitoring, fiscal monitoring by the controller office and the this-purpose of the presentation is to really metric just through the contracts process and the riu really understand what the metric are. it st. not intended to blown overview of rehash of what prcompliance all, but i know there were questions that up

around we are happy to do a refresher.comprehensive presentation given to the commission over months ago as a refresher because there is a lot of context and is trying to simplify this focusing on that metric obviously a lot that goes that i'm presenting in the work we do and program contracts. with that said, i will right in. for the agenda it has i will do a overview of monitoring and business--[indiscernible] walk through will go into deep dive how performance metric are developed and used. the metrics are developed by program staff not business office contract compliance but and simplification of the presentation i will present the information, but i'm joined by members of the office and behavioral health service and you have questions about the monitoring or the metric development they are

we'll hopefully do our beststions. next slide, please. for the first--you can skip--intype of monitoring that the business office does two types. the first is program monitoring and are that is when they look dividual programs of a agency and so as you know, we may that might have multiple contracts different programs. the program monitoring program and assess that program performance with objectives as outlined in their contract. this work is performed by the business officontracts compliance. in addition the city and this is monitoring of the agency financial stability and health of the organization and looking necessarily at the objectives and individual contract which healthch this is done in two different ways. the agencies with with multiple city departments over a certain dollar its monitoring done and coordinated through the city wide

process and those based on dph focus and manage that, but those are done controller's office. these type of monitoring there is areas within dph compliance with monitor ing. our office of compliance and privacy affairs and quality programs thpopulation health as well, but this is the area of contracts. as i mentioned, our focus is program monitoring side not on the fiscal side then really again like drilling down in terms of the within that program monitoring. next slide, please. so, in terms of monitoring the timelines can vary by section and place for the pire completed year. the to regulatory entities to insure compliance which is through the department of helt care se [indiscernible] moving forward, we will insure on is receiving the most completed report and

quick s members of the committee were receiving didn't have the data. i think we were u the 8 page report times 10 committee, but i think the questions were there and so we will insure you're getting the full report a full summary as well as nd on each of the 4 components that is i will note there is?some [indiscernible] if it is a new program, ita report completed. we have some non-direct services contracts that are more administrative in nature, not [indiscernible] for a few experhaps grant funded programs where the requirements are ic and [indiscernible] didn't seem necessary to layer on the right side, you can that we have for different progra i think there is variation in terms of number of contracts we have. these are overall goals to align with

shifted to align with the federal funding. next slide. getting into the monitoring, there is four categories, which which is either standardized individual objective performance metric. is units of service, more outputs units of service, number of clients served and measured by standardized survey and then compliance. three of the four really ts which is program performance wclient satisfaction. compliance is a little-not quite th but more a check box, like do you standards and administrative binder as well. this present those three boxes and we are not going to talk about compliance components of the monitoring.slide just going more again, a aspirational timeframe how the and

are reported and are monitored and end up in the report. program that was being monitored by fiscal would work with the program managers to by may that year and they metrics for review. bocc takes that and insure they are appropriate and measurable and timely and data is available and post the objectives on notify the providers. through the of the fiscal year, july to provider will perform the service, submit must be submitted for r year by september after the close that year. basically three months after their program time period.business office of contract compliance comes in. they conduct take the data, [indiscernible] compliance with objectives anbute reports and necessary plans of correction

needed based the findings. st in terms of areas that are being monitored.om commissioners in terms cowe have 476 that are cbo and this shows the areas that we are currently monitoring through the bocc. slide please. just drilling down more the metric and the monitoring report. metric are developed for by type of on the right side, this is a screen shot of 23/24 and so for behavioral health servand older adult, if you click on the link and i got a the next slide, set of metric for each of these areas. for behavioral health programs, they are required a set of metric. they can create exception rules that on the next slide, but also-discretion to create individual metrics as ll and think in

the case in certain cases the program they can also choose to have similar but individualized metric area and regulatory requirements. ta submissions happens throughout the the for claiming and billing where we receive a of output--volume more consistently. i will also note, during the collect the data, but we held off on scoring and providing a the challenges cbo use and 21-22, 22-23 particularly around [indiscernible] deployed at the time we did not provide those sumerary scwe are hoping focus have complete reports

moving forward. this is a screen shot of what you find if thin of the links and so you will the type of objective, the outcome client inclusion, this is where they may exclude depending on the type of service just to make sure we are collecting appropriate metrics. --the overall wall 4 areas. it also category ratings broken down by the four components and low that. those are the summary sheets that you are seeing and agthe supplemental presentation i detail how the scoring is done in terms of the ranges,

what is 4 and 3 and how it next slide, please.the performance objective scoring, again there is two these sections. one is be data statistical section and accompanied by a again, these measures are developed by is and program managers and so you'll see the d then also see l just to give more tex ture ture if a what the purpose of the narrative section does. [difficulty hearing speaker] comments in terms of and outputs e. clients satisfaction, you'll see the calculatpercentage

on suurn ratio of the responses, and then the program e performance itself here and then you note in the narrative, they are to standardize these percentages, but they will actually note in the this particular one that they had return rate of it provides the data and standardize way looking next slide, please. now that you received overview monitoring reports itself, i want to talk about how metric are developed by program staff and we'll dive behavioral health service, which has probably the contracts that members-the committee see as hiv health service which has significant amount of data.slide, please. in terms of the drivers of behavioral health metrics, vast are driven by regulatory ernible] local health plans and also have continue quality improvement ghcs and also again specif metric

related to individual programs as well. the type of do use are different in nature. some are processing documentation such as timely completion. compliance which is looking at 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 will note the process compliance metrics are important to note because it gives and flavor to get a sense of data quality.nt isn't completed in a timely manner, in data and accuracy, the ability to if you got it in a nner, so while i understand there is a interest in metrics, all different type of metric the metric story. in terms of just still very very early, but as you

know, implement epic. we'll give them motime and focus on stabilizatibut as we stabilize the system there is mopossible but give them a moment to catch their breath now. the next slide will [indiscernible] child and adolescent needs an

of the metric development, hiv health has 180 standardize contract delivera 18 service categories. the metric are primarily based on several hiv aids bureau.d there is a joint process we have to i will note a lot of our metrics francisco were adopted federal counterparts as well when the first came out.in terms of the type of used, there is direct identifying clients as early asuble pa. linkage and retention to as viral load and indirect is support service and basic needs, housing [indiscernible] beyond just the next slide, please.of the metrics used, virala

key indicator. part of getting toey are updated yearly and we ep moving the goal post to get lower and lower based expect we can achieve. other examples include insuring medical for hiv positive health clients, percent and [indiscernible] what is y health services, the long lasting injectibles require to look at differlook at metrics and outcomes as well as when we look population, which is continuing to age be over 60 large majority being over 60 in years. we expect perhaps additional support around disability and aging next slide, please. with that, looking at what is next, i we are doing in terms of stabilizing the programs catching on [indiscernible] there is new legislation in non

profit monitoring. it actually expands responsibility beyond the regular financial stabilprogram andficiency and requires the to create city wide standards for contracting anrrective action. the controller's office is beginning a sta develop those updating policies by we'll with irk closely with the controller office. of these things already and wher's office initially did a lot of its city wide monitoring a lot of our templates as a way for their monitoring, so but we'll work and their work and collaborate with them to creating a consistent process across be a partner in that. with that, that was happy to answer any questions and join that helped me develop the for these slides, so there is a lot of people and ha questions you may have. >> first, thank you so much for the you have a talent

distilling unbelievably complicated information format, so we really appreciate that. i think as part of all these teams, because this obviously a tremendous amount of collaboration and analysis and we really appreciate the work. it obviously spans a huge number of icated to gratitude to all you. i want gratitude to fellow commissions, because chair, mmguillermo commissioner chow have put also in tremenwork doing all the really for us so we understand this all for wonderful outcomes as you pointeare quite remarkable for the residents of san great thanks. is there any public comment on the >> there is one remotely. is there anyone in the room that would like to comment?

ve three minutes.u there? try one more time. mr. shaw. there is no public comment. >> we'll go to commissioner question and comments and start with commissioners not on ve the commissioners who are make their comments and questionsns or comments? >> i submitted a few questions and i really appreciate m noon that committee you said this is a beginning deep dive helping us further understand what the my understanding and correct if i'm what you presented to us as well as the and planning committee, as well as what the chroer is doing and new regulet cetera, will help or and are balances, so a baker place again, am i

correct that really look atas well d not work out as well i my question? >> i think there are a few of the legislation. i think in part, the board of supeto bring contracts for approval of contracts ov dollars so you are seeing mo and very large contracts across the experiencing similar sentiments members of the committee made well as brought forward with the contracts. i think general, the number of contracts and non profit in the city has grown and continues to grow so out of concern overall. i think beyond baker plances not relate d is financial instability in the contract.the changes that was made as a baker place is that, which is really complex situation during the pandemic and i don't

want to much, but i think we do our best to monitor things happen quickly, but one kf situations and correct me if i'm wrong, instpreviously with the fiscal monitoring by city wide process, if you had a number of good compliance years, we didn't want ringer every year because it was a lot of work.ned, we are doing a lot of work collecting from the providers and so, i think initially the thinking was, after a while they get pass and go every other year and in the instancey other year was the middle of the pandemic and the contracts and a lot happened financially during it will improve the monitoringoutcomes so the fiscal monitoring at work consistent across the >> i appreciate it and i assumed so in presented, but there

are not other non profits that serve the that had fiscal monitoring issues and been given assistance their department and have not still have not complied. i am also involved with oasis been a real issue, so i know what you ar your department is light years ahead to say the least.where i appreciated your presentation, because it helped me further understand what breath of what you where doing and i appreciate it. than>> i realized you had a question about a few commabout what percentage of we monitor considered-ve a pass/fail. it is on the scale of . p average. overall you receive the reports most of them have acceptable or above rating terms of the

past year pe they don't, you offer assistance to help them do be in compliance and they follow through h what you're are--what happens? /g >>[difficulty hearing speaker] i believe the agencies do not comply with the financial standards do we offer assistance or try to help >> if you offeand they do not cooperate assistance or in all good faith you them with their monitoring and they did it, then what happens? think there is

multiple kind like levels of flags if you want the fiscal monitoring.perhaps just findings which may or may providing them assistance, then there is once step e findings keep being repeated or if there is big issue that them to elevated concern, that's when is once they are on this level, controller's office will try to provide i believe if that's still did n't work or they are not cooperating with technical are still not getting better, there is led red flag status andof the highest l and with that level the option to defund a agency if the agency gets flag status. i have been doing fiscal

monitoring around 6 yes i have only seen one agency go to that level, so it is a very >> thank you. okay, that helps. >> variation for findings. it not enough board members? there is different avenues depending on the situation. >> i but just wanted to the process on that part nce there's always a few in otthroughout the city that have gone a bit wayward the process. >> [indiscernible] >> >> commissioner christian. >> thank chief, good to see you and thank you so much a very inform ative and clear presentati my questions are about the fiscal i understand that--i expecting comprehensive answers, but i want understand whether new legislation for

non profit includes anymore operational requirements not state, local, federal man dates and fiscal responsibilnizations that provide services to who are at risk in need, and oyees of those places is very they are engaging with the the clients appropriately. just board in the city have hr requirements. certain trainings, that training you must do year, and i'm wondering if you know or broadly speaking, whether those types requirements are also present in space and whether if not, whether room for a look at necessity whether or not it is necessary or useful

certain kinds of trainings fopeople who are providing services ugh these on to ties that work with the tions and being vague so i'll be specific, a lot of these treatment and services to people who rred through the criminal justice system and they are programs and they meeting people needs and individuals those services meeting those needs. are those employees required to take training about non-harassment conduct and the kinds things that most organizations require their employees >> i don't have that we could find out, but i think in terms of the legislation directs the controller's their monitoring beyond just the goes--spechically

named operational performance and so this is still being develope process, but we can try to find out more information for you but we'll know more in november and is what we do. we have a list of what we currently track on the other presentation which i sent afternoon, so would not expect you to see it, but can look into that. >> thank you. you the controller's office interacting with stakeholders, do we have a way to get a sense of who those stto give input on the broadly speaking-the categories to consider? >>fice has a city wide non profit monitoring group and a pretty extethis point in terms of the cbo's they reach and they actually have set up outreach mein august around this legislation to get stakethey develop their updating polia fairly iterative process as we

have a specific list serve, but this is about as the controller's gets have all the ntract information [indiscernible] i would expect it to be comprehenswould be impacted by this legislation that to outreach and include a invite to >> thank you. we'll probably won't but someone coming to us to provide presentation on what's evolving out of extended monitoring? >> yeah, we can come back and gthe updated requirements are and how differen do as a department. this is directed city directed just at dph. there are some department perhaps not not be as far along not as regulated and so i think a part was bringing everyothe same level, but curious to see in terms of d how different they will be from our current h. >> i think we need to hear about that.

other commissioner comme >> thank you for ishz. presentation. i sit on the fi committee,b it is always really good to be able to hearmuch and often about and the responsiveness that you have committees concerns and questions that have come up over the years now and more recently. thank you for that. it mine is more a commentary then a question. have one specific question. i always have that san francisco--the department is responsible for the city and san francisco, which is no different from i think what is other counties or other cities and so the complexscope with which this department has monitor

cont multiples of difficulty and i think because we rely so much e non profit sector that makes, which is--ha levels of competency and resources in order to fulfill standards are think we need to be when we are looking at the department, the bocc, the controller has and the aspirational goals to try and standardize and monitor. but i think because we are that complex to ht and to how we can get things better, because ultimately we right thing for the residents and citizens of i want 0[ just acknowledge that it is not a easy thing and tointo the department willing to put the time and effort into that is again, as difficult i think as doing itself, so i

wanted to ac having said that, i do is complex, we get caught up in bureaucracy a lot and sometimes it is hard to look outside that. one thing that i think i'm the collect a lot of data and i think we do collect real time as it is processing and analyzing of the data the time gap between when the data is collected and it is reported so we are responsive to what the is telling us. [indiscernible] wondering, how difficult is speaking specifically to the monitoring data that aspirationally try to of program completion and when the report comes out so that the commission and so on is able to respond to the data in a timely fashion to have a impact on

renewals, or ne issues and so on. is that a focus of what you are trying to improve the department? >> there is always areas of ent and i think our timelines, just because again like it is just collecting data ics it is around compliance and work itself and evaluate. that is involved. convursations to cbo so that is why timeline between the ng period ends and then the delay and getting completed monitoring report out and so, we are looking at and hoping to get staffed up so memove more quickly but we are also getting significant nu more increasing contracts, so also the focus will be on porting these monitor reports are using but overall as we look at ways to reduce ] the bureaucracy and implement it

and overall want these to be faster. >> thank it is something that would i think in between the committee, the commission and the department an responsibility we have to the funders as well as the citizens is something we should really try to as much as possible. i think we have advantage in the mebody who is very familiar with the kinds of happen internally to get to thgoals so hopefully we'll be able to extent that the controller's office has the right kind of incentives for us to reduce the bureaucracy as needed to be able to do that. again, i mostly want to acknowledge that think that the fact we are ahead of the game the other departments in doing that twee do is be commended and acknowledged so thank you. >> you commissioners. >> >> i just want to join all the

for the presentation. i think the evolution and planning committee has nsive and to get to this point, and us are really excited to see what this will transform the way we make decisions and also terms of transparency and like government, how we can do a better job g everyone, not just us, but the you know, like the nature of the work and how the i think that really --what's the g for? not so much part of it, but last thing i want to say, we are doing bber stamping everything. that mode, we start asking harder questions and these harder questions are helping go in the direction of like where to

take us to a better performances. like commissioner guillermo said, the ahead of like other departments, it imony of the great work that you all are sometimes you know, sound difficult. we have onshare goal among the commissioners is we very interested in how these investment change the health every citizens in this particular city and count that we love. thank you. no other comments or questions, we are so lucky to associated with this amazing commissioners who have done such diligence and work with know to bring things along and of course, once again, grateams and everyone who is really bringing this to handling this amazing amount of comple so we appreciate the presentation and very much appreciate the work and lothe new legislation will effect the work and-- commissioner chow:i didn't see your hand.

the conversation. i associate myself with all the comments that have been d i think that what we are from the department is being part process so that it isn't merely at a contract ther all the i's and t's are crossed. we are concerned about comes and that there are monitoring both not just outcomes and process, de and so i think over these years, there has been really continued evolution to try to find what might be the right mix and i still trying to amount of data that we are now learning ally collects, botside, and on the financial the presentation was helpful and very clear there are so

different processes going on to really look ormance of a contractor. asthere are times when things seem to fall and i think that over time the committee has trying to balance work--trying to exclude extra work on the part tment and yet being able to answer those questions you know, what are we doing what has-been the outcome and it been fiscally responsible and is it of value? so, i think in coming years or coming months hopefuhave a i don't think we are looking back to 30 some odd years ago wherthe entire contract age and had 5 or 6 inches of contracts to look through and the attempt try

to streamline it by ucing the amount of paperwork needed for ntracts that are before me services as previous has been helpful in the materic.is very very small. it has been a good summary and i think again, trying to look how we present s is another part of the ies to reduce the amount of data that we the key areas that we need to look at. really want to thank here, both at the finance level,at our performance levels and particularly those who are handling all these contracts to for what i think before we saw some of unaware as to the detail it actually was rr the state requires and the feds require. e and it wasn't that we were

not looking at these things, but that we worked out a way in oners would get the information. it really is a privil me and see the revolution and understand the contracts much better from the committee to the that the commission feels comfortable committee understood what we was happening with and could in confidence that it been reviewed appropriately. i really do think the enormous work that so of the department do in order to that we are getting the best we can from our contracts looking at the best outcomes and also being fiscally responsible, so thank you. >> >> thank you commissioners. again, i'm standing up hethe people doing the work on the program side as well as compliance and so, i thank them and i feel honored lucky that they are on

our team and helping us navigate. >> director colfax. thank jenny and the team for this. being the new coo e a challenging budget process to go through with the team anthis was priority of the commission so want to iate the work that went into the presentation that was and concise, but somebody said, if i had more time i write a shorter letter. this is instilling complex things d concepts, so i wantteam for doing this and look forward ogre in a very important area that would be oing priority for the commission. thanks. >> we'll go to the next item on the agendathe current research epidemiology of the center on substance health and dr. [indiscernible] nice to see you in person. remote. >> i was in person last year. >> great. >> thank you for having me.

nice to see good afternoon. i have the [indiscernib do i move forward? so, we are of the population health division. you to the next slide. we are fully all most fully federally funded with nihcdc draft thtime and [indiscernible] all the work we do. our goal is really to create better outcomes, we have 30 staff and little under-staffed. some grants have and-go to the next slide. i will this slide and go right to the left and tell you a few projects we have.top right, is reboot study. this was

intervention for opioid overdose prevention. we just wrapped up trial and adapted to the new world of fentanyl and ran both in san the final data are still under the final update on the study yet. it was a exciting project because our tools to as not as effective as they to be. chow is oua programmatic project we had going for over a decade conduct academic detailing which is a on one behavioral intervention, educational work with for about 40 years. used to be counter detailing to counter [indiscernible] this is more a public elth focus efforts similar tactics pharmaceutical companies would. project that [indiscernible]

happened to the national idelines to recognize how challenging working with people already on opioids is very very different from new on somebody. we played ey part in shifting the federal that we hopefully stopped or at least slowed rate people were forced off opioids resulting in a suicide and overdose unfortunate outcomes. now that project is in collaboration with dhs and do detailing specifically around managing opioid use disorder. in how to manage stimulate use in primary we have been working with dph to other clinics throughout the city to give them education on

this and better managing opioids and stimulates. the curb 2 is a national trial to two different medications, tending rele combination for people with cocaine use disorder. a exciting study, our first study of gene cocaine use disorder and which is effects in particular a lot of the and african american people with substance cocaine use disorder so this is a population we other trial jz it has been satisfying.if the medications work.the data is analyzed but we had participants through the trial ask for graduation ceremonies and it been really impactful. we had people come back and tell us they remain off cocaine and i think it's--we haven't had a lot of who use cocaine in san francisco. is a

moving experience to provide this for this population. below that is harness.is a study of [indiscernible] helping people with alcohol use disorder. it if you know the southeast you may have seen [indiscernible] show benefit in alcohol use disorder and shou data on that soon. on the left we get in methamphetamine work, m3 is a trial of phase 1 we are looking for interaction between meth. [indiscernible] a medication that actually dr. lfinitial ly started working on about 20years ago to reduce methuse and and we ran a larger study that showed yes it did efhad dur ability and then the next phase fda for phase 3 trial trial they wanted to look for drug interactions. we that in collaboration

with ucsf enough to give up two weeks of their time in the hospital to go [indiscernible] titration and very small dose methemphetamine use disorder and not so very challenging study to run, but it data soon. i don't expect to see issues and ment to larger trials. is a study of a adherence intervention for daily among people who use that's still ongoing- >> could you define you are not-- >> sure. prime. prep. [indiscernible] ongoing study. i say while is ongoing we had injected prep intervention another study listed here that is looking at we get injectible prep to people there is monthly and monthly

recently released. real challenges around logiof implementing injectible prep. hint is a oral for people who use methemphetamine and snap is a fun small study that looked where we did several studies opioids and we fo over time and as they lost ids we want today see what happened and many went to street opioid uand some went to stimiants manage pain which seemed strange because i taught stimulate increase [indiscernible] what we found in the data was that most the stimiants used to manage pain. this is well established

phenomenon and system that responds to coparticularly neuropathic pain. we followed up 4ra study where we look at people with hiv related neuropathic pain themphetamine helped manage pain. wree follow over 6 monttrack and figure out does it really and how does it and not suggesting we'll end methamphetamine for pain, but it might change how we manage situation when people are using methemphetamine.might be a good prescribed [indiscernible] that might help and manage pain. i dont know, but driven by patients and frankly patients that usually nobody a nice part of the job is when you are work that attends people not otherwise attendeded to. lasso is a exciting study. not a trial, this is a people

who died from deaths attributed by meto acute stimulate toxility.of work that-been a real strug much on opioids and rightly so. fentanyl is the elephant in the room, but the stimulants play a role in a lot of deaths and primary for about ar. we don't how stimulants result in death. it isn't like opioids where we have a clear mechanism. opioids make you stop breather art stops and pass away. stimulants through cardio [indiscernible] cardio vas ural disease. next slide.a from our study of acuticity and this individual died add 5of acute meth.

they came to francisco astranged from midwestern family and lot of drugs, paey aged many friends passed away or ing drugs and young people came to the didn't connect with the young people. they developed congestive heart fail disease and couldn't get friends room to visit them and just stuck in their not being seen over a week and there was methemphetamine in the blood stream.is the classic type of death we see, particularl drugs but particularly with stimulanis is and saw this, i thought it sounded much like an elder who's for them and passed away. it sounded like a elder death an started thinking for some of these deaths should we tap more a elder

care model in order to to prevent them or improve the fact the matter is, decades of use and homelessness acceleratehave a lot of people who are 50 old on paper, but 75 orolder biologically, because of everything they have been through in their life.the way that some things around overdose prevention because fe interventions, but not necessarily tapping into issues we have about chronic disease and leacute toxicity moment. so, give a example of the stimulstudy which was all of them. when we look stimulant only not involvt had evidence disease. that is profound. everyone dying from stimulants has cardiovascular disease. a lot of most of the ekg's prolonged

qtc interval which interval that puts you at risk of arrhyth 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 the baseline qtc and talk to them and tell them about atmay modify the other medications i other medications can effect the qtc the studies has profound impacts for me the work with clinicians design better ways to manage ant use thinking about it as a chronic disease a primary issue. staten as for prevention. next slide.lot of the are opioid stimulant death but think fundamentally opiate death and s are along for the ride.

for overdose. people on the street result as clinicians we often ignore what they say. i use methemphetamine because i can use more fentanel on a one-off, but reality, when you use the two together you jack up the fentuse higher and tend to have more chaotic use so overdose te the deaths look a lot more look at the cause of death you see and who die from and stimulants die [indiscernible] look like opioids. stimulant death is much er rate of additional comormidities. another complicated slide. sothe case narratives and got excited about them, becausing on with these deaths. why can't prevent all by handing out naloxone. fentanyl deaths, we are pretty

sure they are.thing different. most of the deaths, majority are happening in e and 52 percent of en they died and haven't been seen for days to this isn't a population a bystander response intervention is going to dent frankly.ve to look at other strategies on top that. the stimulpant only death are to be witnessed. that makes sense because it is ural event that has mortality rate. [indiscernible] naloxone isn't goinanything for stimulant event and out of for out of hospital cardiac arrest around 8 opercent, so a tough disease to reverse. go to next slide.the witness cases in detail and the cases that involve anyl were preceded by opioid use and what look like

respiratory arrest and de not very many of those.for fentanyl, 94 percent had evidence of drug the scene. for st of the witnessed deaths had t use before the death. this wasn't really event, it was they mostly look like cardiac events. grabbing chest. complaining about before collapses, those kind of things. only evidence of drug use at the scene of the event. much then 94 percent.orted our belief that these are stimulan deaths of chronic l deaths are much more a acute process. next slide. our ar we started and will continue this year. data soon. to look not just at acute all drug

related deaths. in green at the bottom is drug related deaths. it is actually pretty flat.the late teens and remains flat. ink about this as the denominator it might correspond to that. the light blue line in the midd acute toxicity death that don't ants or opioids. we don't pay much attention to that.very small number of events. the blue is as you sky-rocketed in 2019 and unfortunately in 23 that went up again. next slide, please. next slide. so, in 2023, we are finalizing those total of 800 acute toxicity deathsopioids and stimulants so a and with 697-i think readjudicated to 696 involving opioincrease from the

prior year unfortunately. it is also all fentanyl. 96 percent of the opioid deaths are next slide. heroin have been rare in our city. this is a model of would expect deaths to be based on attributed to fentanyltop line is without using naloxone and bottom is a really aggressive comprehensive naloxone y well through the years. we had a blip in 2020 wher higher and attributed that to the isolation then in more due to fentanyl so expected increase, but that increase was higher then we expected reasons that i state re. what we continuing to do mostly research into finding medications, partly for simulates and also alcohol there is work around opioids,

but the general consensus in the y, we have the medications for opioid use to get movement on other agents focused more on stimulants that don't have oved therapy. we found through the work [indiscernible] fentanyl does accounoverdose mortality and saturation tof the city fentanyl has accounts for most of the changes we see.more thing, in 2023, increase we saw was all most exclusively among black african american and latinx individue city, so it really the non-white and there was also increase for time among individuals so hitd non-white individuals in the city very stimulant deaths are not like deaths, they are more similar

to alcohol deaths.we manage them is much more like managing chronic premature aging. thank you. >> first of all, thank you so much for and your dedication to this work, because this is probably the health problem we face in the city now are so important critical to try to find some solutions to probably a problem is confronting the world and san francisco in particular so thank you so much.ic comment? >> there is mr. manette shaw, you three minutes. one more time, are you there? we don't have public comment for this item. >> commissioner comments or questions? commissioner guillermo. >> yeah, just taking in, an amazing presentation. this finding or about the non-stimulant deaths is i

wonder are other counties or other health departments observing the same thing sort of pioneering this research or this look? >> around the stimulant deaths? >> yes. >> is pioneering stuff.for obvious reasons, it is most of the think lumping them with creates a problem, because are acute stimulant toxicity deaths and rare. . they are when someone vascular condition or people but they are rare, and which means rare and it is a much more of the older population. understanding that able to disaggregate the deaths is really important.of grants on show it is skyrocketing but of the skyrocketing i think is it fedisingenuous and for

me a part of larger effort to figure how to use mortality data to drive the blic health activities. in this case, if just accept the statement as toxicity and assume [indin the efforts to prevent deaths. understanding it is the right interventions. >> really to more of the data and conclusions, outcomes from the research you are able share as this goes along. >> thank you. i join thank you for your work and completely new to me, we do-those of us not in the profession, especially, we are laser focused on fentanyl fentanyl fentanyl and about meth anymore so thank you for educating me and the work do and your is an amazing

thing and i you are continuing to do things that enable you to keep it, so thank >> commissioner chow. >> yes.for such work you i found especially that your the stimulants and these may become [indiscernible] in actin patient is --do you there should be interve tertiary type of intervention on this populatioce the incidents of the medical complication? >> that is a great w, thank you very much. from this work, a couple things have emerged. one in collaboration with and dr. goldman who and psychiatric emergency service we started a chill

methemphetamine assist pack program where we give small of doses of [indiscernible] low who have psychiatric toxicity from methemphetamine at psych found they have 30 emergency visits so we published that and working ial that intervention for next year. that is one thindo around psychiatric toxicity which major concern in san vasular toxicity we developed a protocol for people who use methemphetamine. recognizing doing the assessment pr everyone who uses has use disorder and are trying the benefits people get from stimulants have functionople use them to stay alive on the street recognizing the functional benefit is important to address their use. sure they have the whole package of who use drugs

should have, which is i work ward 86 so similar to hiv care in the sense of making sure they have naloxone because we found in the the sort we found that 44 percent e confirmed opioid opioid use. significanthe overdose from fentanyl are by using stimulants and picked up the wrong pipe or wrong drug, things we have done interviews with them and found there population and very heavily african american as well. people who dont intend to usfentanyl overdose. making sure they are not intending opioids. we also start up soon a trial of injectible opioid blocker for a month to we can reduce opioid overdose events starting

we have a domain of what to to slow the toxicities of use among people who are not dpoeing to stop using and are i everyone at staten at this point.we have increasing data people who don't have indi%z staten benefit from staten and is [indiscernible] when to start a staten. they are not a risk father but we know they factor for cardiovascular disease and incorporate into our care. we are trying to change encouraging statens, lower threshold to start a statens also have data that disease. we know people [difficulty hearing speaker] brby staten use and animals at least,neuro toxicities for methemphetamine are wellme that

is enough.continue to use methemphetamine i take a staten and find most my patients feel the same go from saying yes, i'll take the staten safely use methemphetamine and saying i want to prevent should probably reduce use. what were the medications you had?real turn-around in my own ank you very much and thank you for your work. >> thank you. yeah, thank you again and thank you your enthusiasm and all this information. very interesting. there is adequate funding especially on the grant side for the wordo and collaboration across the country because of all kinds in other places in e the politics may not be as open-minded so i your perspective especially if administrations grant funding. >> there was a grant funding through opioid legislation several years ago but to dry up. we are running into a drought

like so it harder and the--but it mostly works. we do collaborate with people around the co different projects.metimes take a back seat to fentanyl reasons. we have a horrible from concerns around fentanyl. >> thank you very much. >> i want to reinforce, is nihfunded research along with cdc money kaufman is being too subtle. the cut off the grants are extremely competitive.the health department goes in against all the say we are usually if not the only headraws down nih dollars of other universities, so just to--mention that they nationally, but there are a number national trial networksis a part of, so really but there most important thing is to understand thhis

group his team does transland i talk to the commission i'm [indiscernible] but also the fact we translate quickly and get interventions on the and one of the more recent is contingency management, which health department pioneered researching controversial contiskancy management not using positive like taking hiv meds and very controversial years ago is and now [indiscernible] and we just saw something called a cash not drugs that is rolled the city and people are coming to meheard of contingency management and impressed by the fact it there and embraced by many different communities and it iskey piece of started and now expanded to the very rk was being done to serve, so just really proud of the work dr. his team continue to do. >> thank you so much for adding for the

presentation and for all the are doing. appreciated. the next item on you for your of security who will give us the dph security update. >> good basal price, director of security for dph.give a update with regards to the progre security management plan and areas of security equity as well as continual cernible] and also the security staffing training plan. xt slide. and next slide. thank you. in we have reported that the 11.4 of the deputy had been reduced and to provide a sheriff office continues on a weekly basis provide

hiring and recruiting status, inue to face challenges with regards to 21 remaining fte's. in the 22-23 that the program was fully implemented, however due to turnover and hiring rs, the result in 11.8 this past year year 23-24, bert out of the 11.8 were able to fill 8.4 of even with 3.4 remaining fte's, bert inteincreased by 92 percent and rounding consultations increase from 2800 to next slide. each phase of the bert bram was implemented in 22-23, this was ally the first year full year of the

program and again, despite the 3.4 bert provided over ed patient interventions and had 2800 more intervention in the sheriff office. next slide. reported in 22-23, that the sheriff office was unable train cadet s for that report in the previous fiscal sheri cadets training as well as the hiring actually improved significantly based on weekly open hours that eq1.5 vacant fte's, opposed to where every shift there was at least . priv provide service ambassador service at each of the hospital entrances, in addition, they also received required training with dph required training.

the compliance training as well as the regards to the crisis prevention and they also have expanded their providing visibility and personal safety escorts in eac hospitals parking areas. also provide support te as well as again, just increase of visibility throughout the campus. next slide. laguna honda, private officers provide service there to include collaboration with clainical regards to eliminating ban. they too cms training and healthcare security training and expandeto include supporting nursing staff on the standby and resident assistanand participating in resident preventio is reported and last fiscal year

those bert fte's continue to provide support for 22-23 we reported that the safety ambassador program for community clinics was delayed as approval and the rfp pras of april 1, three of the clinics now have the safety ambassadors in place and we expect fourth one at silver avecome september 1. based surveys, the program directors at the three started have actually rated the exceptional, so glad for that success. a long time coming, are in the process moving forward with that starting in april. next slide. with state over the past four years, use of force decreased by 52 percent. deputies assisting with

re the driver behind law enforcement use of force. within that same four year period, use of force actually decreased in all 20-24, use of against caucasians were the . in the 9 years we have been ut mouse of force against our patients, this is the first year th african americans were not the highest subject to law enforc in the hospital. some of the contributing factors for of course, the servicesthe emergency department staff and theandard work with regards to responding to risk behavioral and what thcode 50 and also the sheriff office they have taken a far as how they address the re time distance and verbal de-escalation to pe of physical force. each one of ribute to success of this reduction both in and ethnicity and overall reduction of use of force in against our

patients. as mentioned under security equity, during 23-24 fiscal year, the provided -8,000 intervention in sheriff os. office. 87 percent were without law enforcement. the em program accounted for over 6500 or patient interventions over 53 percent when it first in 22-23. when itto security equity and how we measure the sheriff office or law enforcement, we onuous use of force by race.we measure by race support patients from escalating. what we see in the the emergency department bert supported by race and ethnicity was nearly equal

between black african americans and caucasian patients, 31 percent that black african americans, 32 percent was fo caucasian patients. that concludes update for 2024. turn it back over to secretary. >> thank you for the positive news. those on the outcomes volume of work and outcome from the your team are to be congratulated.issioner guillermo says this is a model for the nation and this program really has such positive data very quickly you and everyone that came together to develop that program and now show the efficacy. is there any t? >> i want to say thank you for your incredible work and going through the presentation i like to stand up and applaud. >> comment on e presentation?

commissiyou for your presentation. just have a quick obtaining the data on race, do you ask the person their race or by a visual? i think person is, xyz? >> we gather data al report use of force and the race ethnicity is included in the that is obtained by the california id or type of government document that is where the information comes. ask, being latina we can fall in all to make sure that the ectly. >> thank you for that. >> thank you. ing that back and follow up with the sheriff office as well. know that. thank you. >>oner chow. >> i just wanted to r the excellent presentation and the fact over the we really have shown you can bring down the and in fact increase the ing done and

particular ly of data when really thank you for the work that done and the conversion a law en individual as ambassadors se so thank you very much. it is wonderful to see success. >> thank you commissioner. >> director colfax. >> i want to also thank mr. work and acknowledge that he has a job of try triangule or connecting different groups of people to make and staff are kept as safe as ible and works very closely with the sheriff department and ung relationships there. you have seen the data. we talk about the bert work at zuckerberg and appropriately so and i want to mr. price does across our system of care, includ clinics. just to share real safety concernat

tom ladell clinic in e last year and the staff was very concerned also reporting patients were not coming to the clinic because they concerned about outside the real issues a hold that, worked very quickly with the sheriff office to rectify the he does and the fact he has a very broad scope of-broad charge across the department and ore to make sure that we can our work safely and importantly, keep services as safe as we can as well, so thank e for your work. >> thank you. >> commissioner c >> quickly, thank you so much for this work. it i remember when you were first coming the issue and how to address it and are now is astounding want-we all acknowledge that.

i want to that and particularly dr. colfax said, the context a healthcare facility where people many people coming in distress and there is a lot of viol can result from that and then we have staff who help people and you are working to keep people to do their jobs noover using law enforcement do that. it is astounding so thank you so much for it anyou for continuing it. if you could just remind the end game here for us? what is our goal?to completely remove law from these--never hundred remove law enforcement from situations from these areas in staffing for safety, or what is it? >> thank you for that commissionerfor your comments well. i would say end goal is remove law enforcement, but to make sure that have the appropriate

alternatives in place so we are not bringing law enforcement into patient . again, i thank you for the question because what i started is studying incidents where law enforcement into these situations and i still recognizen with bert. we celebrate their success provided these services without sheriff or law enforcement, 87 percent of the time. interested in the 13, 14 percent and are those issues that escalate wher enforcement and what tools they need, what other alternative needs to belaw enforcement into pace care situatio >> this is brilliantly done so thank appreciate you. >> thank you. >> thank you. questions or comments so go to the next item, which is joint conference committee report from the zsfgjcc of july 23, >> thank you.

the committee at our standard reports, including the ceo report and we now getting monthly reports from bert opportunities that we just talked about afternoon. we also looked at the regulatorhiring and vacancy report. we are very pleased under the hiring and low vacancy rate of i think in one of the categories it was like a 0 or 1 percent vacancies. we also had also commended fg continuing to perform well in as i said earlier, being very plearesources has really stepped up to the ittee reviewed and recommended that the full the neuro surgery rules and

the in closed session the commapproved the [indiscernible] >> thank you. t. >> any public comment? >> no public comment >> any commissioner questions or comments? the next report is the finance planning from >> i thought commissioner chung was going be absent today so i put commissioner guillermlook alike. so, the finance commission met right before this commission meeting and we reviewed contract report and [indiscernible] quite few new contracts. one, two, three--six--five new contracts. i went to give

you the updated version? >> yes. you asked for the monitoring ),port and updated document and i received both of these via e-mail so in terms of- >> so can move forward? >> yes. >> great. something worth mentioning is the change inwhat reporting, so we still have to understand the process. it is the level of be hearing a lot and that's the that they the rate or yeah, so that's one that is i can jump in to give context. it is the instead of paying for service they divide the contract by be a standard, now it the different levels of payment depending on the amount of time but more complicated and more real and that is coming in the next not there yet. and that concludes

my update. any public comment? >> there is. you like me to share the or consent calendar? >> i guess on calendar. >> okay. you got three minutes. are you speaking on this is finance planning committee report-back? >> noon the consent i guess for item 11. >> alright. talk to you in a minute. there is no public comment. questions or comments from this report? alright. hearing none, we will go to ent calendar and ask secretary morewitz to walk us through the st should approve or not approve because we have to regate out items. >> commissioner salgado to recuse myself with conflict of interest. >> what we'll do after public comment is, split the vote into two sections and through this. the first section everyone can vote and extract say all uc

contracts are removed, you that and everyone but er salgado will vote on the uc contracts. public comment. mr. shaw, i will up the thing right now. >> is there not a presen >> no. should i start? yes, three minutes. [difficulhearing recording] why not just hire staff who know whatdoing running skilled nursing facilities and save the $2 annual expense? instead of issuing the $1which is astrwhat they are doing running a skilrsing facility. does the commission believ and staff need to be monitored

for [indiscernible] across past month, lhh awarded two contracts totaling million my chart shows cost for external consultant since just after lhh decertified next 5 years 2029 raised $53.6 million. the health commission is okay to [indiscernible] to see sight might help rather then hiring competent staff.to me [indiscernible] full board of supervisors scam. part of the criticism of the health failure is lhh governing body. this commission is not performing sufficient fiduciary restraints

needless $53 in contract expenses. as fiduciaries this commission boardering on neglect and fiduciary avoided all folks who knew what they were doing before decertified.rnible] just $1 shy of triggering the contract must receive full board for contracts exceeding $10 million during a board of public hearing. >> that is the only public comment. on to--i'm going to say something, i can't make if someone would parrot what say. please make a motion for everyone to te please make a motion for to the consent calendar items, three uc contracts. >> is there >> i'll move. >> second. roll call. [roll call] e next vote is minus

commissioner is for the three uc contracts calendar. >> i move. >> second. [roll call] thank you. >> thank you so much for doing y morewitz. much appreciated. we are ready the next item which is other business. is there any ss? that was [indiscernible] >> yes. >> alright. no public comment on >> no. >> then we need to entertain a motion to go into closed sesmove. >> second. call on great. if

you can give me 30 seconds to go into closed session. please know you will not be able to see or hear what going on, >> disclose or not disclose the contnot to disclose. >> second. >> roll ca [roll call] >> next is motion >> second. >> alright. you everyone. [meeting adjourned] ;s

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