and saturday workshops expose classes.d adults to photography ](■k >> commissioner green. commissioner guillermo, present. commissioner chung, present. commissioner salgado. commissioner chow, present. i note commissioner christian is on her way up from the garage. >> wonderful. we'll ask commissioner guillermo to read the lackn

>> the san francisco health commission acknowledges that we are on the unceded ancestral homeland of the ramaytush 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 this place, as wel f peoples who reside in their traditional territory. as guests, we recognize that we benefit from living and working on their traditional homeland. to pay our respects by acknowledging the ancestors, elders, and relatives of the ramaytush ohlone community and by affig rights as first peoples. >> thank you. the next item on the agenda is approval of the minutes of the health commissioning om july 16, 2024. commissioners you have before the mite if there are no additions or corrections, we'll ask for a motion to approve. >> i motion. >> is there a second? >> s >> is there any public comment on this item? >> yes, there is one remotely. any public comment in the room on the minutes? i don't hear any. before we begin i'll read a t. for each item members of the

public have a oppoun up to three minutes. the public comment process is designed to provide input and feedback, hower does not allow questions to be answered or baand forth conversation with commissioners. consider comments from the members of discussing a itm and making request. please note ea vidual is allowed one opportunity to speak per item. individuals not return more then once to read statements indidua. health.commission.dph@sfdph.org. if you wish to spell your name may do so. please note city policy along with ate and local law prohibit discriminatory harassing conduct and will not be tolerated. alright.

, u got three minutes. >> thank you. this is patrick shaw. my testimyin this commission july 16, 2024 meeting minutes notes, there a clear correlation and connection between increasing numbers of san discharged to out of county facilities and the number of beds remaining in francisco. it is unclear what action the commission is taking. after all, [indiscernible] rer of july 2, there were 983 standing beds remag o. 152 [indiscernible] provided freestanding bed data from the 2022 california long-term care data table. >> how is this related to the this does not seem it is mr. shaw, i will repeat my

question. s do't seem to relate to the minutes. the comments have to relate to the item yare on. we'll leave it there. we can do a roll call vote. because there is m >> commissioner chow. >> commissioner chow, how do you vote? yes. commissioner guillermo, yes. commissioner chung, yes. commissioner green, yes. commissioner salgado, yes, the minutes are approved. the next item is general public comment and believe there is information wi. >> members may address items subject matter jurisdiction but not on the agenda. each me the commission up to three minutes and the same information i read about for

non general public commenap we have several in the room and remotely. >> we'll start with the inid the room and the first on the topic ugla >> i have a timer when the timer goes up. please know your time >> thank you commissioners. honor to be before you. i am here on a matter not on your agenda, but a matter vital the future of this commission. as a former commissioner on the board appeals and planning cod three mayors for 15 years, the concept and operation of in the city is dear to my heart. ballot ery up set when the measure by san francisco qualified for the bawhich abolishes this commission, 22 other voter approved sis in the charter and puts a sunset on l the commissions

outside the charter if not reapproved by the survisors brie by the end of 2025. ,the health commission, the library commission, commis on public works and status of women, human righ are all abolished from the charter, return unless a charter amendment if this passes. also as part of the charter amendment, gives mayor additional oneach commission so he or she has a majority and abolish compensation or benefits to any commissioner which this happened when on permit appeals missed my $15 parking reimbursement i got every week. eliminate commission on status of women, historic preserva and so forth. it also removes any supervisor

revi of mayoral apointment moving forward and allow the mayor to and replace the commissioners apointed by the mayor without any review. itpuon the number commissioners that could be in the city and charter towhen we have 130. i am going around to different commissions having he because some haven't hurt about this and don't really rsta the seriousness of it. this is put together by those who remove theficiency of go francisco. i hope you and i know that commissions serve really valuable role in allowing the public to be involved and to have citizens like yourself who are not full time government 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 st group study commissions, make recommendations to the board and take it the voters if necessary for any changes. just like we indi1996 for revisions to the city charter. this issong way to do good government. you just cut everything out rc it to be replaced. rather trumpian i think. so, we ask that you be aware of it. let your constituents know this is on the ballot. i know some of you are restricted from making ballot but we are [indiscernible] to oppose this nts which are due august 19 so there may be people who

in this commission that will ballot argument and we are trying to et as many commissions possible. i thank you for your time and thank you for your service. >> thso much. next individual in room i think mr. cline, are you for general public i couldn't quite read what you wrote here. >> good afternoon health commissioners. christopher cline. i was asked to put a power presentation. i want to be clear, public health and director ad not assist with the knowswer.ion and we [indiscernible] john hopkins to illegally access san francisco public health and safety. was easy since medical eletes dont want to know the advance

healthcare nd data ■scernible] if we can hearing speaker] to patient from baltimore to n francisco with technology which is just 2800 miles away. page 4 refers to algorithms apps that use d phone technology to influence us what is supposed b positive health outcomes but ca negative outcomes. 5 and 6 refer to how interface works and [indiscernible] just baltimore medical center became the in the middle to control health solutions and outcome. apple and are told it is a orange, it is now a orange unless we have evidence to the facts giveren to us. [indiscernible] swapped the negative facts to blur the facts.

[indiscernible] precursors for surveillance. page 9 explains the configurations [indiscernible] page yj10 br to the geo fencing and person with higher frequency can control the man in the middle. page 11 shows street lights and [indiscernible] used influs. page 12 and 13 [indiscernible] compared reless networks today. anywhere your phone goes a signal can be sent to the pe a phone. page 14 martin luther king and 1967 t ai and computers. page 15 is the [indiscernible] coming to san francisco to speak in 2019. isthe drastic increase in overdose starting in 2019. page 17, the pier 45 large was a wear to get into the fire department and public safety and i to be clear, if director colfax and om hsa do not contact the fbi

misconduct charges and obstruction charges. thank you. >> thank you. in the room? what about on remote? >> yes havone 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 tommy tompson [indiscernible] awarded class certification status 26, 2024 by san fransco superior court anew chang. chang staff posted online july 26 granting certification and handed san francisco city attorney david chui a in court. july 26, [indiscernible] chang noted he took judicial notice

of exhibit b. lhh annual report. exhibit f, the settlement system improvement agreement between cms and lhh. exhibit h, hsh cause analysis report december 1, 2022. exhibit ee, of conduct 2018 version. exhibit jj, dph notice of data breach dated march19. exhibit qq, the transcript of e [indiscernible] troy williams presentation as the cms quality conference april 10, 2024. notably, page 5 of the order nod evidence appears to be consistent with plaintiff allegation of governance failures ongoing in 2020 and 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 in the [indiscernible] contributed to and exacerbated culture of [indiscernible] ad to a culture 2020 and lead to decertification in 2022. alth commissioners will sit up and take notice the medicare the end of the troubles. green should t note as president of 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 [indceis clear the class action certification

presents a threat to dph and health commission control of laguna honda hospital. it is a long overdue development and this stice denied saga. >> thank you. >> thaly public comment. >> the next item is director's report. director colfax. >> good afternoon commissioners. , dictor of health. you have the director's report in front of you awith links. few highlights of the director report given our agenda today. just really really excited to announce that laguna honda hospital resumed admission. ia big step forward after two years as successfully recertified in medicare and medicaid, we are

now able to people back and it is our first priority offering people of laguna honda a opportunity co back home and we started admitting our residents last week. really pleased that is moving forward at thme in celebration. it is a time to reflect on all the wo the team did and most importantly, a time where and residents of laguna honda can celebrate laguna honda is here to stay. dph and entertainment commission and drag artists are lives by getting up in the club. you will see number of events that we are participg along with entertainment commission with partner with drag artist to increase

to a respond to overdose to providing life saving naloxone training. [indiscernible] you will see a number of events we are pleased to partner to sure we are addressing the opiate overdose epidemic through different interventions. pleased to announce th behavioral health service team received awards from the association of county behavioral health erwas recognized two awards granted. the office of coordinated care received an award as did bridge and engagement services teamism ograms are recognized as outstanding government programs and services that improve access to behavioral health. just another example francisco is leading in the behavioral

health field and a model for counties across the nation. i was g say the state, but the nation. very competitive group. enjust last item to mention in the report, i was pleased to join many key staff at the anniversary of the avan center. this is service provided on site the campus really providing state of the ç"care, particularly wit regard to imaginfollow-up for breast health and just incredible to see what happened there in 20 years. how our approach to breast health and meeting people they are to make sure they receive the best breast healthcare. it was really inspiring. this is a major program that

reinforcing how committed and invested in promoting health equity. before the center existed, there was getting care fopeople imaging mamo grams follow-up could be really challe there wasn't a centralizeem making sure people had access to state of the art visioning and i was pleased to join adership group you see in the report to celebrate the rk they have done. and there are other summaries in the director's report that i'll leave to your leisure to read if you haven't already and happy to any questions. thank you. >> thank you so much for the report and it is alwahear about the both the accolades and the honda. is there any public comment on this

item? we have remotely. any public comment in the room? we have one person remotely. u got three minutes. >> thank y what is unstated in the director's day and lhh press release is how tihave been readmitted to lhh. all mentioned is there have been "several admissions since june 20". several isn't a math value. please define several. e october 14, 2021 patient census [inscpatients and 410 residents of july how long lfx think it will take to restore [indiscernible] restricting the of admissions to 5 patients per week take

weeks a year to admit two patients withouri to conduct audit between new also missing in the the waver is is [indiscernible] 120 beds. as the director cdph, aragon has authority 250 grant that waver. waver been submitted yet? if not, why isn't the commission dicolfax and lhh to submit the waver immediately? if lhh loses the 120beds, more ll be jumped into out of town skilled nursing facito the shorten of beds in san francisco. thank you. >> that's the only public comment for that item. mmsioner questions or comments? commine thank you director colfax for your report.

have a quick question about and entertainment commission working during overdose week awareness. as someone that is in thnight life entertainment, it would be nice to have main our website that directs bars and reau where to get say, narcan and what have you, buy these en we go and try to items to have on-hand, you like a hundred web sites and you don't know which one correct one, you don't know which you should get. i thinwe go into august and bring awareness, i think maybe having an idea where a small business can go purchase these items, so we have them on hand would be gat >> absolutely. i dont know if we have something like that already, but i make

sure we follow-up with the behavioral health team, several whan we can take that back and make sure that have links made available to people so they know where to go. thank you the suggestion. >> commissioner giraudo. >> thank for your report dr. colfax. i have a question about the pediatric allergy clinic. the presentation with the education through the community health workers, et cetera, is there any outreach, seminars et cetera, at any of the health emselves? let's say on an day, more information about asthma and allergys versus having to go to 6m?

>> so, yes, i appreciate the question. i don't knowis anyone remotely from the department that would be more a primary care clinic question. dr. [indiscernibis a allergist and works at the clinic and not here now. we can get-- >> on remotely. >> hi! >> hi. yes. thank you commissioner. the allergy clinic is dear to my heart. what have been doing where as you said there was of this education provided that consortium woulsa after covid has dein grated for they still do outreach regionally through the bay area counties and i do think all the know 6m is a resource where they can refer who have asthma difficult to

control so they can do environmental assessment, but right now the resources are not available to continue that consortium as it was. hopefully in the future we get it back up and running. >> okay, thank . i hope so, because as you well know, in the primary care visit, often times a parent sntime to ask questions about it or be really educated about particularly asthma since there is such a inse in it. i think if there were just education seminars in the outreach in the clinics such southeast, sunset, whatever, maybe once a year that are advertised i think ita service to a lot of the families. i encourage you to consider to

see if tnk you. sible in 2025. >> absolutely. thank you. >> thank you commissioner. any other commissioner questions or comments on the director's report? gh seeing none, we'll go to the next agenda item, which is overview of the dph program monitoring performance metrix welcome jenny. >> good afternoon commissioners. louie, chief operating officer here present the metric. the presentation has come up as a result primarily as the finance committee members but thought it wobe great to educate the en commission. in thk there were questions as members of the budget committee would be asked to approve very ge contracts, multi-year contracts and the question is hoy we know that this

bram is working? how do we know it is i'm here, again in the data driven kn ld we are looking how do we fwraum data metric perfective this is functioningism i have stripped the program monitoring we do. i know therprevious presentations most seen but [indiscernible] but just really t of information in terms of ntapproval, monitoring, fiscal monitoring by the controller office and the of this-purpose of the presentation is to really follow the metricjust through the contracts process and the really ing process so understand what the metric are. it st. not intended to be a fu■blown overview of rehash of what program monitoring and compliance all, but i

know there were questions that popped up around we are happy to do a refresher. nt a comprehensive presentation given to the commission over 18 ago as a refresher because there is a lot of context and it trying to simplify this focusing on that metric question, but there obviously a lot that goes beyond these that i'm presenting in the work we do and nitoring nd final contracts. with that said, i will dive right in. for the agenda 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. the metrics are developed by program staff not business office contract compliance but foase and simplification of the

presentation i will present the informon but i'm joined by members of the business office and behavioral health service and hiv health service o you have questions about the monitoring or the metric development they are well.ble to answer queson answer opefully do our best to your questions. next slide, please. for the first--you can skip--in termoffs the type of monitoring that the business office does two types. is program monitoring and are that is when they look at as you know, we may have single that might have multiple contracts different programs. the program monitoring focuses individual program and assess that program peth objectives as outlined in their contract.

this work is performed by the business office ntracts compliance. in addition, the city has fiscring and this is monitoring of the agency and looking at financial stability and health of the organization and not looking necessarily at the actual performance objectives and individual contract which is overall healch is done in two different ways. the agencies with contracts with multiple city departments over a certain dollar threshold its monitoring done and coordinated through the city wide monitoring process and those based on dph wewill focus and manage that, but those are done in conjunctionthe controller's office. beyond type of monitoring there is areas within dph that does a.

our office of compliance and privacy affairs and quality programs throughout the and population health as well, but this is the area focused on interms of contracts. as i mentioned, our focus is on the program monitoring side not on the fiscal side and en really again like drilling down in terms of the metrics that program monitoring. next slide, please. so, in terms of the progra monitoring, the timelines can vary by section and ke place for the pire completed year. the reports tend to use submit to regulatory entities to insure compliance which the department of helt care services and [indiscernible] moving forward, we will insure that the co receiving the most completed report and quick times members of the committee were receiving the

which didn't have the data. i think we were braps trying spare you the 8 page report times 10 contracts per committee, but i think the questions were there and so insure you're getting the full report which includes a full summary as well as on each of the 4 components that is being i will note there is? some [indiscernible] if it is a new program, it will noa report completed. we have non-direct services contracts that are more administrative in nature, not [indiscernible] for a few exceptions there perhaps grant funded programs where the requirements are so specific and [indiscernible] didn't seem necessary to layer on a mo on the right side, you can see

melines that we have for different programs. these are aspirational. i think there is variation in terms of staffing and the contracts we have. these are overall goals and align with thle] shifted to align with the federal funding. next slide. getting into the components of the monitoring, there is four categories, which is prh is either standardized or individual objective performance metric. there is deliverable's, which u of service, more outputs units of service, number of clients served and tion measured by standardized survey and then compliance. three of the four really data components which is program

performance deliverable and client satisfaction. compliance is a little-not but more a check box, like do you comply with ada standards and administrative binder as well. this presentation will fous those three boxes and we are not going to talk about the specific compliance components of the monitoring. the next slide just going more into timeline sample and again, aspirational timeframe how the metric are ed and are monitored and end up in the report. if we were looking atprogram that was being monitored by fiscal r would work with the program managers to develop the by may that year and they subt e metrics for review. bocc takes that and insure they

are appropriate and measurable and timely and data is available and are post the objectives on our an notify the providers. through the over e course of the fiscal year, july to june, cbo provider will perform the service, submit thand they can submit it on the time they choose, but all the must be submitted for t year by september after the close that year. basically three months after their program time period. atic business office of contract compliance comes in. they conduct the visits. take the data, analyze and [indiscernible] compliance with objectives and distribu reports and necessary plans of correction needed based on the findings.

the next just in terms of areas that are being monitored. haquestion from commissioners in terms of contract programs, we have 476 that are cbo and 54 civil service and this shows the areas that we ar currently monitoring through the bocc. the next slide please. just drilling down more into md the metric and the monitoring report. the metric are developed for by type of website.and posted on on the right side, this is a screen shot of 23/24 and so for behavioral health service adult older adult, if you click on the link and i got a screen shot the next slide, you'll see a t of metric for each of these areas. for behavioral health programs, they are required a standard set of

metric. they can create exception rules that are noted and you e that on the next slide, but they can also-discretion to create individual metrics as wellthink in the case in certain cases depending onch have similar but individualized metric depending rvice area and regulatory requirements. as mentioned data submissions happens throughout the in the for claiming and billing where we receive a lot of output--volume datas more consistently. i will also note, during the pandemic collect the data, but we held off on scoring and providing a overall progscgiven the challenges cbo had for service service

delivery and outputs. fiscal year, 2021 there was a pause 21-22, 22-23 particular around [indiscernible] il deployed at the time for rpes, we did not provide those sumerary scores, but movingwe are hoping focus on that have complete reports moving forward. this is a screen shot of what you find if you kewithin of the links and so you will see performance. the type of objective, the outcome as a client inclusion, this is where they may exclude or include programs depending on the type of service just to make sure we are collecting

appropriate metrics. --the overall work and l 4 areas. it also has category ratings broken down by the four components and there isategory below that. those are the summary sheets that you are seeing and again the supplemental presentation i sent, there lot of detail how t scoring is done in terms of the raes, what is 4 and 3 and how it is cal

next slide, please. goto the performance objective scoring, again there is two components chof these sections. one is going be data statistical section and accompanied by a narrative poas well. again, these measures are developed by the system of care is and program managers and so you'll see the data hethen also see qualitative najust to give more tex ture ture if a program ha[indce the purpose of the narrative section does. [difficulty hearing speaker] comments in terms of the data

and outputs provided there. th clients satisfaction, you'll see the calculation includes percentage on submission, returtiof the responses, and then the program and perfmance itself here and then you note in the narrative, they are to standardize these percentages, but they will actually note in the narrative inthis particular one that they had return rate of it provides the data and standardize way looking at it. next slide, please. now that you received overview of the monitoring reports itself, i want to talk about how the metric are developed by program staff and we'll dive o areas. behavioral health service, which has probably the most contracts

that members-the committee see as as hiv health service which has significant amount of data. next slide, please. in terms of the versof behavioral health metrics, vast are driven by regulatory ndiscernible] local health plans and contracts complianceents. also have continue quality improvement programs ghcs and also again can op for specific metric related to individual programs as well. the type of metric they do use are different in nature. some are processing documentation such as timely completion. compliance which is looking at program the timeliness of the referrals. completion of consent forms and

outcome objectives. reduction in rehospitalization and [indiscernible] i know there is a lot of interest in the outcome metrics, i compliance he process an metrics are important to note because it gives xture and flavor to get a sense of data quality. assessment isn't completed in a timely manner, in rms of data and accuracy, the ability to perhaps makeother purposes beyond like as accurate as if you got it in a more r, so while i understand there is a interest in the metrics, all different type of metric help the metric story. in terms of just pe ahead, still very very early, but as you know, we did implement epic. we'll give them more and

focus on stabilization, but as we stabilize the system there is more to come possible but give them a moment to catch their breath now. the next slide will just on [indiscernible] child and adolescent needs and strength da, a clinical assessment tool required by dhcs and facilitate the assessment process and indu. an example of a process metric is 90 percent of w clients with open episode will have a sessment completed and submitted within 60 days of the episode and then example outcome metric, 80 percent of clients will approve [indiscern also note there is a similar ool lled ansa.

adult needs and strength assessment. moving to hiv health services, in terms of the and metric development, hiv health service has 180 standardize contract deliverables and are 18 service categories. the metric primarily based on several hiv aids bureau. [indiscbltis and there is a joint process we have to standardizca and i will note a lot of our metrics that started in san francisco were adopted by the federal counterparts as well when the first came out. rms of the type of metrics used, there is direct service as identifying clients as early

asuble pa. possible. linkage and retention to care and eatment as well as viral load and indirect is support service and basic life needs, housing [indiscernible] beyond just the clinical services. next slide, please. in terms ofof the metrics used, viral n is a key indicator. part of getting to zero program, and they are updated yearly and we coupe keep moving the goal post to get lower and lower based what we ex we can achieve. examples include insuring medical for hiv positive health clients, at least 8 0 percent and [indiscernible] what is ahead

hiv health services, the long lasting injectibles require to look at different ways to at metrics and outcomes as well as when we look at the population, which is continuing to age and expected be over 60 large majority being over 60 in the next 5 years. we expect perhaps additional services and support around disability and aging services as well. next slide, please. , looking at what is next, i will note, beyond we are doing in terms of stabilizing the programs and catching on [indiscernible] there is new legislation in the it for non profit monitoring. it actually expands controller audit responsibility beyond the regular financial stability to in operation program andficiency

and requires the controller to create city wide standards for contracting and ctn. the controller's office is beginning a stakeholder process to develop those updating policies by november. we'll with irk closely with the controller office. we believe wedoing most of these things already and when th controller's office initially did a lot of its city wide monitoring took lot of our templates as a way for their monitoring, so but we'll work and watch and their work and collaborate with them to insure creating a consistent process across ente city and will be a partner in that. with that, that was a t information. happy to answer any questions and joined by alexperts in the room that helped me develop the materials for these slides, so there is a

lot of people and happy to westions you may have. >> first, thank you so much for the excellent you have a real talent distilling unbelievably complicated information into a format, so we really appreciate that. i think as part of this, we ed to thank all these teams, because this obviously requires tremendous amount of collaboration and detail analysis and we really appreciate the work. it obviously spans a huge number of picomplicated to gratitude to all you. i want to press our gratitude to fellow commissions, because comm the chair, commissioner guilran commissioner chow have put also in tremendous amounts work doing all the

really detailed itty for us so we understand this better and is all for wonderful outcomes as you ese programs are quite remarkable for the residents of san so again, great thanks. is there any public comment on the item? >> there is one remotely. is there anyone in the room that would like to comment? mr. shaw, yohave three minutes. mr. manette shaw, are you there? try one more time. mr. shaw. there is no public comment. go to commissioner question and comments and start with commissioners not on the subcommittd have the commission are make any questions or comments?ns.

>> i submitted a few questions and i really appreciate this esention since i'm not on that committee and appreciate too that you said this a beginning deep dive into lpi us further understand what the es my understanding and correct if i'm in what you presented to us as well as the finance and planning committee, as well as what the chromeer controller is doing and new regulations, et cetera, will help or have the chec and are balances, so a baker place does no again, am i correct that this will really look at mance as well s

that did not work out as well i guess is question? >> i think there are a few goals th legislation. i think in part, the board of supervisors, we are to bring contracts for approval of contracts over 10 million dollars so you are seeing most of contracts and very large contracts across the and experiencing similar sentiments members of the committee made as we as brought forward with the contracts. i think that--overall general, the number of contracts and non profit contracts in the city has grown and is came s to grow so i thin out of concern overall. i think beyond baker place, other instances not relate d to department where there is financial instability in the contract. i think on the changes that was made as a result of place

is that, which is ally complex situation during the pandemic and i don't want to simplifymuch, but i think we do our best to monitor programs things happen quickly, but one situations and correct me if i'm wrong, in that instance, prio with the fiscal monitoring by the city wide process, if you had a number of sort good compliance years, we didn't want to put peoe ringer every year because it was a lot of work. commissioner green mentioned, we are doing a lot of work collecting information and all thrmatn has to come from the providers themselves and i think initially the thinking was, after a while they get a a go every other year and in the instance

of baker other year was the middle of the pandemic and had lighteonthe contracts and a lot happened financially during the it will improve the monitoring overall and outcomes so the fiscal monitoring continues and expanding making that work consistent across the entire city. >> i appreciate it and i assumed so in what youd, but there are not within dph, but other non profits that have been at serve the homeless population that had fiscal monitoring issues and are been given assistance through their department and have not still have complied. i am also involved with oasis inn, wherbeen a real issue, so i know what you are doing

your department is light years ahead other departments to say the least. that's where i appreciated your helped ation, because it really me further understand what the of what you where doing and i appreciate it. thank you. i alized you had a question about a few commissioners about what percentage of the rogrs we monitor considered---vast majority of th we don't have a pass/fail. it is on the scale of 1-5 with aggregates. p average. overall you will see as receive the reports most of them have acceptable or above rating in of the past year performance. >> if they don't, assistance to help them do whatever to be

in compliance and they not follow through with what you're directions are--what happens? >> [difficulty hearing speaker] i believe the question if agencies do not comply with e financial standards do we offer assistance or try to help them out? >> if you offer assistance d they do not cooperate the assistance or refuse the assistan in all good faith you tried to help them with their monitoring and they did

not accept it, then at happens? >> sothink there is multiple kind like levels of flags if you want to call them the fiscal monitoring. first, erperhaps just findings, which may or may not trigger providing them assistance, then there is once step up, the s keep being repeated or if there is big issue that brings em to elevated concern, that's when technical is kind of ma once they are on this level, the controller's office will try to provide them technical assistance. i believe if that's still did are not cooperating with technical assistance or things still not getting better, there

is another level upred flag status and this is kind of the highest flag level and with that level the department actually getsthe 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 only seen one agency go upto that level, so it is a very reccurrence. >> thank you. okay, that helps. >> there variation for findings. is itenough board members? there is different s depending on the situation. >> i appriabut just

wanted to undetand the process on that part of fiscal monitoring, since there's always a few in other city well as throughout the city that have gone a bit wayward in the process. >> [indiscernible] >> thank you. >> commissioner christian. >> thank you presid chief, good to see you and thank you so much for agin, a very inform ative and clear presentation. my questions are about the fiscal monitoring you are talking d so i understand that--i am not expecting comprehensive answers, but i want to whether new legislation for non profit monitoring includes anymore operational requirements that n state, local, federal man dates

and fiscal responsibility because these ar organizations that provide services to people in the city who are at risk and in need, and the of those places is very important they are engaging with the residents the clients appropriately. just like it acro the board in every organization. and the city have hr cetain trainings, that training you must do every wondering if you know or broadly speaking, whether those types of requirements are also present in this space and whether if not, whether there is room

for a at necessity whether or not it is necessary or useful to have ain kinds of trainings for who are providing services through these organizations and also info information to entities that work with the organizations anue so i'll be specific, a lot of these organizations provide treatment and services to people who are ed through the criminal justice system and they are programs and they are meeting people needs and individuals are there w providing those services meeting those needs. are those employees required to take trainiabout non-harassment

conduct and the kinds of that most organizations require their employees toe? >> i don't have 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 al that goes--specifically named operational so this is still being developed and process, but we can try to find out more information for you on but we'll know more in november and is it drrent from what we do. we have a list of what we currently track on the co on the other presentation which i sent very te this afternoon, so would not expect you to see it, but we caok that. >> thank you. you mentioned the controller's

office interacting with stakeholders, do we have a way to get a sense of who those stakeholders are orto give input on the broadly speaking-the categories ers useful to consider? >> the controller's office hawi group and a pretty extensive list at th 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 they develop their updating policies in november and i to be a fairly iterative process as we get through to november. i don't have a specific li , bu this is about as the controller's gets the [indiscniall contract information [indiscernible] i would expect it to be

comprehensive in terms who would be impacted by this legislation that way ab a invite to their stakeholgagents >> thank you. we'll probably won't be you, someone coming to us to provide a presentation on what's evolving out of exteed monitoring? >> yeah, we can come back and report what the updated requirements are and how different or not they what we do as a department. this is directed city not directed just at dph. there are some departments that not not be as far along not as regulated as we are,soi think a part was bringing everyone up to same level, but curious to see in terms of what these and how different they will be from our current monitoring policies. yoso much. >> i think we need to hear when

you w something about that. other commissioner comments? commissioner guillermo. >> thank you for the prezen presentation. i sit on the finance and committee,b it is always really good to be able to hear much and often about the process and the responsiveness that you have had to the committees concerns and questions that have come over the years now and particularly, more recently. thank you for that. appreciate the it ilsponses. mine is more a commentary then a question. i do have one specific question. i always have remind myself

that san francisco--the department is responsible for the city and county of whicis no different other counties or other cities and so the complexity and the scope with which this department has to monitor contracts makes it multiples of difficulty and co responsiveness and i think because we rely so much on the non profit sector that makes, which is--has ar levels of competency and resources in order to fulfill standards are of things i think we need to be reminded when we are looking at the responsibiitdepartment, the bocc, the controller has and the aspirational goals to try and

standardize and monitor. but i think it is in because we are that complex to really get it right and to iterate er time how we can get things better, because ultimately we are tr do the right thing for the residents and citizens of cio city and county, so i want to e that it is not a easy thing and to bring people the department willing to put the time and effort into that is again, as difficult i think as doing work itself, so i wanted to acknowledge that. having said that, i do think th use it is complex, we get caught up in the bua lot and sometimes it is hard to look outside that. one thing that i think i'm the

most concerneabwe collect a lot of data and i think we do try to collect real time as quickly as we can. it is processing and analyzing of the data 9íthat takes the time gap between when the data is collected and when it is reported so we are responsive to what the telling us. [indiscernible] just wondering, how difficult is it speaking specifically to the monitoring data that aspirationally try to collect t months of program completion and when the report comes ouso that the public, the and so on is able to respond to the data in a timely fashion to have a impact on renewals,

or new solicitati budget issues and so on. is that is a focus of what you are trying to improve the department? >> there is always areas of improvemenour timelines, just because again like it is not just collecting data metrics it is around compliance and work itself and evaluate. there is a siis that is involved. convursations to cbo so that is why eris protracted timeline between the monitoring ends and then the delay and actually getting completed monitoring report out and so, it's we are looking at and hoping to get staffed up so some of can move more quickly b we are also getting significant number more increasing contracts, so also

adds to and the focus will be o 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 terms the partnership between the committee, the commission and the department and then e responsibility we have to the funders as well tizens is something we should really try to again, wo much as possible. i think we have advantage in the cool somebody who is very familiar with the kinds of things to happen internally to get to that objective d goals so hopefully we'll be able to make ase to the extent that the

controller's office has the right kind of incentives for us to continue to or reduce the bureaucracy as needed to be able to do that. again, i mostly want to acknowledge that i think that the fact we are ahead of the game in terms of the other departments in doing that twee do is t needs to be commended and acknowledged so thank you. >> thank you commissioners. >> commissioner chung. >> i just want to join all the commissioninu for the presentation. i think the evolution of finance and planning committee has quite extensive and to get to this point, and i us are really excited to see what how ll transform the way we make decisions and also like in

terms of transparency and like government, how we can do a better job in helping everyone, not just us, but the understand you know, like the nature of the work and how the dided. i think that it is real --what's the word i'm not so much the buau part of it, but last thing i want to say, we are doing rubber stamping everything. to break that mode, we start asking harder questions and i these harder questions are helping us to go in the direction of like where it is to take us to a even

better performances. like commissioner guillermo said, the fact that are ahead of like other departments, it really a testimony of the great work that you all are doingsometimes you know, we mi sound difficult. we have one regoal among the commissioners is we very interested in how these investment change the health outcomes of every citizens in this particular city and count y that we love. thank you. >> i see no other comments or questions, we are so lucky to be edwith this amazing commissioners who have done such diligence and work with you i to bring things along and of course, once again, gratitude to the teams and everyone who is really bringing this to a new veand handling this amazing amount of complexity

stakeholders so we appreciate the presentation and very much appreciate the work and look forwd particular how the new legislation will effect the work and-- commissioner chow:i didn't see your hand. please, sethe conversation. >> i associate myself with all the comments that have been de and i think that what we are seeing d really appreciate from the department is being part of a evolutionary process so that it isn't merely lookina contract all the i's are dotte and t's are crossed. we are concerned about outcomes and that there are ways of monitoring both not just outcomes and process,

fiscal side and so i think over these rshas been really a ntued evolu find what might be the right mix and i think we arstill trying to balance the amunt of data that we are now department really collects, both a performance side, and on the financial side, so presentation was helpful and very clear there are so many different processes going on to really look at the performance of a contractor. as we know, there are times when things seem to fall ug cracks, and i think that time the committee has been trying to balance too

work--trying to exclude extra work on the part of thdepartment and yet being able to answer those key questions you know, what are we doing with this contract? what has-been the outcome and has it been fiscally responsible and is it value? so, i think in the coming years or coming months hopefully, we'll continue have a opportunity to is. i don't think we are looking at go ck to 30 some odd years ago where we e entire contract package and or 6 inches of cont to look through and the attempt to to streamline it by way of ing the amount of paperwork needed for

of contracts that are before me services as previous has been helpful in the materic. the print is very very small. it has been a good summary and i think again, trying to look at we present ne another part of the evolution that tries to reduce the amount of data that we get the key areas that we need to look at. rking staff to thank the here, both at the finance level, and our performance levels and particularly those who are handling e contracts to really commend for what i think before we saw some of the performance reportwe were unaware as

to the detail that it actually was being carried out inwhat the state requires and the feds require. it is there and it wasn't that we were not looking at these but that we worked out a way in which thers e would get the information. it really is a privilege to me and see the revolution and understand the contracts much better and when the committee to the commission that the commission feels comfortable that the committee understood what we was happening with these and cont could take the recommendations in confidence that it had been reviewed appropriately. i really do waank--i think the

enormous work that so ma areas of the department do in order to insure us e getting the best we can from our contracts looking at the best outcomes and also being fiscally responsible, so thank you. >> th >> thank you commissioners. again, i'm standing up here talking e the people doing the work on the program side as well as business office ancontracts compliance and so, i thank them and i feel honored and lucky they are on our team and helping us navigate. >> director colfax. >> i just wantank jenny and the team for this. jey w to being the new coo and quite a challenging budget process to go through with the team and at the same time this was priority of the commission so want to appreciate the wothat went into the

presentation that was clear concise, but somebody said, if i had more time i wo ula shorter letter. this is instilling complex things easily understood concepts, so i want to thank you and team for doing this and look forward to ongoing progress in a very important area that r the be an ongoing commission. thanks. >> thank you. we'll go to the next item on the agenda, which is 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. >> thank you for having me. nice to see everybody. good afternoon. i have the [indiscernible] d

we are re how do i move forward? so, we are e search arm of the population health division. you can go next slide. e fly all most fully federally funded with nihcdc draft with time and [indiscernible] all the work we do.. our goal is really focused substance trying to create better outcomes, we have 30 staff d little under-staffed. some grants have ended and-go to the next slide. right to the left and tell you about a few projects we have.

top right, is reboot study. this was behavioral intervention for opioid overdose prevention. we just wrapped up the full d adapted to the new world of fentanyl and ran both in san francisco and on. the final data are still under analysis so i give the final update on the study yet. it was a exciting project because our tools to proverdose as not as effective as they used to be. chow is our more had going for where we conduct academic detailing which is a one on one behavioral change goal intervention, educational work with

providers that used for about 40 years. used to be called counter to counter [indiscernible] this is more a evidencebpublic elth focus efforts similar tactics pharmaceutical companies would. we demonstrated throug project that [indiscernible] changes happened to the national opioid guidelines to recognize how challenging working with people who are already on opioids is very very different from not startingopioids new on somebody.

we played a key part in shifting the federal policy so we hopefully stopped or at least slowed rate people were forced off opioids resulting in a lot suicide and overdose death unfortunate outcomes. now that project is in close collaboration with dhs and doing local li specifically aro managing use disorder. prescribing [indiscernw ible]to manage stimulate use in primary care practice. we have been working with dph ind expanding to other clinics throughout the city and providers to give them education on this and help them become naging opioids and stimulates. the curb 2 study is a national

trial to test two different medications, tending release [indiscernible] j combination for people with cocaine use disorder. this was a exciting study, our first study of general population cocaine use disorder and wh effects in particular a lot of the blac and african american people with substance use disorder cocaine use disorder so this is a population we hadn't reacour other trial jz it has been satisfying. i dont know if the medications work. we won't until the data is analyzed but we had many through the trial ask for graduation ceremonies and it has n really impactful. we had people come back and tell us they managed to remain off cocaine and

i think it's--we haven't had a lot of interventionpeople who use cocaine in san francisco. it hasn't beend this is a moving experience to provide this for dz ion. below that is harness. this a study of [indiscernible] study of medication helping people with alcohol use disorder. it is if you know the southeast you may have [indiscernible] show benefit in alcohol use disorder and should have daton. on the left we get in the work trial of phase 1 trial weare looking for interaction between nd meth. [indiscernible] a medication that actually dr. colfax or di

initial ly started working on about 20years ago to reduce methuse and it did d a larger study that showed yes it did and effects hadur ability and then the next phase for fda for phase 3 trial large trial they wanted to look for drug interactions. we that in collaboration with ucsf and 15 le were generous enough to give up two weeks of their time in the hospital to go through ble] titration and very small dose methemphetamine use disorder and not interested in so very challenging study to run, but we succdhave it data soon. i don't expect to see issues and that alvement to larger trials. prime is a study of a adherence

intervention for daily prep use among people who use methamphetamine that's still ongoing- >> could you define prep so you are not-- >> sure. prime. prep. my apologies. pre-expour [indiscernible] ongoing study. i say while this ongoing we had injected prep intervention and udy listed here that is looking at how we get injectible prep to people who there is monthly and 6 monthly recently released. excited movement but real challenges around logistics of implementing injectible prep. hint is a study of for

people who use methemphetamine and ongoing study. snap is a fun small study that looked we did ral studies where we did several studies of prescribed opioids and we followed them over time and they lost acsess to opioids wentwhat happened and many went to street opioid use some went to stimiants to manage pain which seemed strange because i n taught stimulate increase [indiscernible] what we found in data was that most of the people usinstimiants used to ma. this is well established

phenomenon transmitter a and o system that responds to cocaine and pain particularly neuropathic pain. we followed up with a study we look at people with hiv reed neuropathic pain and reportamin pain. wree follow over 6 months with nsdoes it really and how does it and how are they not suggesting we'll end prescribing methamphetamine for pain, but it might change how we manage the situation people are using methemphetamine. this mightbe a good group for prescribed [indiscernible] that might help them avoid methem and manage pain. i dont know, but exciting ud driven

by patients and frankly patients that usually nobody stens to. a nice part of the job is when you are able todo work that attends to not otherwise attendeded to. 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 that-been a real struggle because we focus so much on opioids and rightly so. fent ephant in the room, but the stimulants play a role in a lot of deaths and primary drug labeled for about 120 acutea 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 opass away. stimulants probably effect through cardio [indiscernible] most already have cardio vas ural disease. next slide. this is a example from our study of acute and this individual died add 56 of acute meth. they came to sfrancisco astranged from midwestern family and the unily ed a lot of drugs, particularly methamphetamine as they aged many friends passed away or stopped using ádrgs and young

people came to the community and connect with the young people. they developed congestive heart fail and lung disease and couldn't get down thto the friends room to visit 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 death we see, particularly with many s b particularly with stimulants. wh this is and saw this, i thought it sounded much more like an elder who's didn't have family to care for them and friends passed it sounded like a elder death and i kingfor some of these deaths should we tap more into

care model in order to tryto prevent them or improve the fact of the matter is, decades of substance use and homelessness accelerate aging so have a lot of people who are 50 years old paper, but 75 or der biologically, because of everything they have been through in their life.e wa that some things around overdose prevention because fentanyl responds more tothe interventions, but not necessarily tapping into other issues we have about chronic disease and less about acute toxicity moment. next slide. so, give a example of the stimulant death in the study which was all of them. when we look at stimulant

only not involved opioids percent had evidence of vasural disease. that is profound. everyone dying from stimulants has cardiovascular disease. a lot of most the ekg's had prolonged qtc interval which interval that puts you at risk of arrhyth mia that could be for me as a clinician in my practice i do a on people who do meth or cocaine get a sense of the baseline qtc and talk to them and tell them about that risk and y modify the other given tions i prescribe them other medications can effect the qtc interval as well. the studies has profound

impacts for me so far and it of the work with clinicians to help gnter ways to manage stimulan thinking about it as a chronic disease and prevention staten as for prevention. next slide. a lot of the deaths are opioid stimulant death but think fundamentally opiate death and stimulants arg for the ride. stimulants raise threshold for overdose. people on the street result this. as clinicians we often ignore what they say. i use methemphetamine because i can use more fentanyl safely and that is on a one-off, but if the u use the two together you jack up

the fentanyl er and tend to have more chaotic use so overdose tends to be higher. the deaths look a lot more like opioid death. when we look at the cause of death you see and comorbidities in who die from and stimulants die [indiscernible] they look opioids. stimulant death is much more hiere of additional comormidities. another complicated slide. sorry, we dove the case narratives and got excited about them, because we wanted to understand going on with these deaths. why can't we prevent all by handing out fentanyl deaths, we are pretty sure they are.

stimulan different. most of the deaths, majority are happening in ivate spaces and 52 percent of the people nobody when they died and haven't been seen for days to weeks before they r found. this isn't a population that bystander response intervention is going to dent frankly. we have to loat other strategies on the stimulpant only death are more keto be witnessed. that makes sense because it is cardio s ural event that has hi. [indiscernible] naloxone isn't going to do anytfor stimulant event and out of hospital morta for out of ound 8 l cardiac arrest is opercent, so a tough disease to reverse.

go to e next slide. we dointo the witness cases in detail and the cases that involve fentanyl were preceded by opioid use and what look like respiratory arrest and delayed resuscitation. unwitnessed for fentanyl, 94 percent had evidence of drug use the scene. for stimulant deathsone of the witnessed deaths had stimulant before the death. this wasn't really an acute event, it was frankly chronic disease. they mostly look like cardiac events. grabbing chest. complaining about palpitations

before collapses, those kind of things. only 71 percent had evidence of use at the scene of the event. much lower th94 percent. overall, this belief that these are stimulant deaths are q deaths of chronic disease d fentanyl deaths are much more a acute process. next slide. our general epidemiology year we started and will continue this year. have the oon. to look not just at acute toxicity death but all drug related deaths. in green at the bottom is all d related deaths. it is actually pretty flat. the late teens and remains flat. i don't know but somem think about this as the denominator of people ybe. it might correspond t.

the light blue line in the middle is acute toxicity death that don't involve ds. we don't pay much attention to that. a ry small number of events. aths and is acute to as you see, that sky-rocketed in 2019 and unfoun3 that went up again. next slide, please. next slide. so, in 2023, we are finalizing those data, but have a total of 800 acute toxicity deaths from opioids and stimulants so a really big increase and with 697-i think readjudicated to 696 involving opioids so a big eafr the prior year unfortunately. it is also all most entirely

96 percent of the opioid deaths are attributed to fentanyl. next slide. heroin and prescription ioids have been rare in our city. this is a model of where you would expect deaths to be based on the proportion of deaths attributed to fentanyl and the toline is without using naloxone and bottom line a really aggressive comprehensive naloxone program. we were doinll through the years. we had a blip in 2020 where we were higher and attributed that to the isolation involved id. then in 2023, we more due to fentanyl inease, but that increase was higher then we expected for reasons that i state for next slide.

what we are doing are continuing to do mostly federally und research into finding medications, particular ly foand also alcohol there is ongoing work ios, but the general consensus in the coy have the medications for opioid use disorder and it is to get movement on other agents so we focused more on stimulants that don't have approved therapy. we found through ■kgthe work [indiscernible] fentanyl does overdose mortality and saturation tof the city fentanyl has

accounts for most of the changes we see. no one more thing, in 2023, increase we saw was all most exclusively among black african american and latinx individuals in the it really non-white and there was also increase for time among individuals so hitd non-white individuals in the city very hard in 20. stimulant deaths are not like opioid they are more similar to alcohol deaths. the way we them is much more like managing chronic disease premature aging. thank you. >> first of all, thank you so much for this really clear pr and your dedication to this work, because this is probably the most public health problem we face in the city now and people li you are so

important critical to try to find solutions to probably a problem that is confronting the world and san francisco in particular so thank you so much. any nt? >> there is one person. mr. manette shaw, you have three minutes. aw. one more time, are you there? we don't hacomment for this item. >> commissioner comments or questions? mmissioner guillermo. >> yeah, just taking all that in, an amazing presentation. this finding or research about the non-stimulant deaths is something 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 pioneering stuff. everyone focused ■á■onopioids f obvious reasons, it is most of the deathb the--i think lumping them with stimulants creates a problem, because there stimulant toxicity deaths and rare. . they are when someone has rdio vascular condition or people that traffic drugs dy, but they are rare, and which means that deaths are very rare and it is a much more of the older population. understanding that and able to disaggregate the deaths is really important. i submit a lo grants on

methemphetamine and great to show it is skyrocketing but feel because of the skyrocketing i think is fentanyl and --soit feels disingenuous anme a part of larger effort to figure how to best use mortality data to drive the alth activities. in this case, if we just accept the statement as toxicity and assume [indiscernible] we'll go down rg road in the efforts to prevent deaths. understanding it is really important developing the right interventions. >> really look forward to of the data and i guess conclusions, outcomes from the research you are able to share as this goes along. >> commissioner christian. >> thank you.

i join commissioner guillermo'j you for your work and this is something that is completely new to me, because dohose of us not in the profession, medical profession es we are laser focused on fentanyl fentanyl fentanyl and hardly talk about meth anymore so thank you for educating me and the work u do and your happy deanis an amazing thing and i hope you to do things that enable you to keep it, so thank you so much. >> commissioner chow. >> yes. for such work you are doing. i found especially that your discussion of the stimulants and these may

become [indiscernible] in acting like patient is older and mayb--do you think that there should be medical interventions, or tertiary type of intervention on this population to thenreduce the incidents of the omplation? >> that is a great question very much.er chow,an from this work, a couple things have emerged. one in collaboration with dr. and dr. goldman who paed and psychiatric emergency service we started a chill pack or methemphetamine assist pack program where we give small number ofdoses of

[indiscernible] low dose to patients who have psychiatric ty om methemphetami at psych emergeseund they have 30 percent fewer yc emergency visits so we published that and working developing a trial that intervention for next year. that is one thing we do around psychiatric toxicity which is r concern in san francisco around vasular toxicity we developed a protocol for people who use methemphetamine. recognizing doing the assessment appropriately, n assuming everyone who uses has use disorder and are trying to figure thbenefits people get from stimulants have

functional benefits. on the street recognizing the functional benefit is important to address their use. and then, making sure they have the whole package of preventative therapys who use drugs should have, which is i work in so similar to hiv care in the sense of vaccines they have naloxone because we found in the research with sort ems overdoser we found that 44 percent the confirmed opioid overdose deny opioid use. significant portion of the overdose from fentanyl are by people usinnts d picked up the wrong pipe or wrong drug, things like that. ve done interviews with them and found there is a population and

very heavily african american as well. people who dont intend to use fentanyl and difentanyl overdose. making sure they have naloen though they are not intending to use opiods we also start up soon a trial of injectible opioid blocker that lasts for a month to see if we can reduce opioid overdose events starting in the new r. around rsur side, we have a domain of what to do toslow the toxicities of methemphetamine uspele who are not dpoeing to stop using and are i personally ofevefer yone at staten at thi point. have increasing data people who don't have indication for a staten benefit from a staten and is

[indiscernible] when to start s. they are not a risk father but we know they are risk factor for cardiovascular disease and we don't our care. we are trying to change that by encouraging statens, lower threshold to start a staten on sobo statens also have data that they actually prevent neuro loc disease. we know people who use [difficulty hearing speaker] braef dementia is slstaten use and animals at least, the neuro toxicities for methemphetamine are well prevented stens, so to me that ifi need to continue to use

methemphetamine i want to take a staten and find most my patients feel the same and usually from saying yes, i'll take the staten to safely use methemphetamine and saying i want to prevent these things soshould probably reduce use. what were the medications you had? it haa real turn-around in my own medical prac >> thank you very much and thank you for your work. thank you. yeah, thank you again and thank you for yosmand all this information. very interesting. do you think is adequate funding especially on the grant side for the work do and collaboration across the country because there are pockets e 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 ndin. >> there was a lot of funding through opioid legislation several years ago but that funding is to dry up. we are running into a drought like many other infunding so it has gotten harder and the--but it is still mostly works. we do collaborate with people around the country on many projects. obviously, stim take a reasons.t to fentanyl for we have a horrible natiocsis fr concerns around fentanyl. >> thank you very much. >> i want to reinforce, this is cdc money and dr. n is being too subtle. the cut off rates for grants are extremely competitive.

this is a caseagainst all the leading university and i say we are usually if not the only health departmet draws down nih dollars independent of other universities, so just to--mention that they collaborate nationally, buare a number national trial networks dr. kaufman a part of, so really important there. but there most important thing is to understand that the research hi group his team does translates quickly to be ground and i talk to the commission i'm [indiscerniblet the fact we translate quickly and get interventions on the ground and the more recent examples +,is contingency management, which the department pioneered researching controversial contiskancy management not using

certain drugs doing positive like taking hiv meds and that is very controversial years ago is now [indiscernible] and we just saw a cash not drugs that is rolled out across the city and people are coming to me and saying have heard of contingency management and impressed by the fact it is good because it is outhere and embraced by many different communities and it is rea key piece of started at dph and now expanded to the very communities that this work was done to serve, so just really proud of the work dr. kaufman and his team continue to do. >> thank you so much for adding that and again, thank you so muchthe presentation and for all the workyo are doing. appreciated. thank xt item on the agenda an dictor your patience, we ha

of security who will give us the dph security update. >> good evening commiser basal price, director of security for will give a update with regards to the progress th security management plan and the areas of security equity as well as continual work of [indiscernible] an also the security staffing training plan. next slide. and next slide. thank you. in s22-23, we have reported that the 11.4 ofthe deputy sheriff fte

had beenanto provide a update that sheriff office continues on a weekly basis provide with progress on hiring and recruiting status, however continue to face challenges with regards to filling the 21 remaining fte's. we also report in the 22-23 that the program was implemented, however due to turnover and hiring barriers, in 11.8 vacant positions. this past year year 23-24, bert out of the 11.8 vacancies they were able to fill 8.4 of those vacancs and even with the 3.4 remaining fte's, bert intervention increase92 percent and roconsultations

increase nearly from 2800 to over 3,000. next slide. each phase of the bert bram was implemented in 22-23, this was actualt year full year of the emergency department bert program and again, despite the 3.4 bert provided over 6,000 patient ed patient interventions and had nearly mo intervention in the sheriff office. next slide. reported in 22-23, that the sheriff office was unable to hire

train program.for the that report in the previous fiscal year, e sheriff cadets training as well as the hiring actually improved significantly based on weekl hours that equates to 1.5 vacant fte's, opposed to there beinwhere every shift there was at least four vacancipeshift. private security continues to provide service ambassador service at each of thspans, in addition, they also received their required ing with dph required training. the compliance training as well as the training with regards to the crisis prevention and intervention training. they also have expanded their services toproviding visibility

and personal safety escorts in each of e hospitals parking areas. they also support to [indiscernible] fte as well as again, just increase of visibility throughout the campus. next slide. at laguna honda, private security officers provide vie to include collaboration with clainical staff with to eliminating sources of contra band. ban. they too completed the training and healthcare security training and too to d their services there include supporting nursing staff on the units with resident standby and resident assistance and

participating in resident prevention and that is and last fiscal year those three bertcontinue 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 approval and the rfp process as of april 1, three of the clinics now have the tyambassadors in place and we expect to have four one at silver avenue stfme september 1. based on the ance surveys, the program directors at the three where we sta actually rated the ambassador bram exceptional, glad

for that success. a long time coming, but now wie the process moving forward with that program with succstarting in april. next slide. with regard to ent state over the past four years, use of forc decreased by 52 percent. deputies assisting with restraining driver s continues to be behind law enforcement use of force. within that same four year period, use of force actually decreased in all race ethnicities. 20-24, use of against caucasians were the highest at 36 percent. th9 years we have been monitoring use of against our patients, this is the first year that black americans were not the highest

subject in the enforcement use of hospital. some of the contributing factors for that have to do with onof course, the th, the , but in addition emergency department staff and their standard work regards to responding to risk behavioral and what they call code 5d also the sheriff office they have taken a different approach asfas how they address the issues using time distance and verbal de-escalation to actually avoid any type of physical force. each one of the areas bute to success of this reduction both in race and ethnicity and overall reduction of use of force in hospitals our patients. as mentioned under security equity, during 23-24 fiscal year, the

ber provided nearly 800 more-8,000 more inteenos. office. 87 percent were without law enforcement. the emergency department bert f intervensor patient interventions and increased over 53 percent when it first started in 22-23. when it comes down curity equity and how we measure the sheriff office enforcement, we monitor based of force by race. with bert, we measure by race support to prevent patients from escalating. what we see in the chart here, the

emergency department bert supported by race and was nearly equal between black african americans and caucasian patients, 31 percent that support was for black african ucasian s, 32 percent was for patients. that concludes update for 2024. turn it back over to coission secretary. >> thank you for the tive news. volume of work and outcome from the bert teams and you ask be congratulated. as sioner guillermo says this is a model for the nation and this program is so effective really has such positive data very quickly and allycommend you and everyone that came together to develop that and now show the efficacy.

i want to say thank you for your incredible work but your time through the presentation i like to stand up and applaud. >> comment on entaon? commissioner salgado. >> thank yor your presentation. just have a quick question when obtaining the data on race, do you ask the person their race or do you visual? i think this person is, xyz? >> we gather data from actual report use of force report, and the race ethnicity is included in the report and usually that is obtained by

the california id or some of government document that is where the information comes. >> the reason ask, being latina we can fall in all most any just want to make sure that the numbers e reesented correctly. >> thank you for that. >> thank you. follow up ing that with the sheriff office as well. >> yeah, we know that. thank you. >> comm >> i just wanted to thank mr. the excellent presentation and the fact over the several we really have shown you can bring down the use of force and in fact increase the quality of the rk being done and particular ly of your current data when really thank you for the work that you have and the conversion from a

law enforcement to a tra individual as ambassadors seems tobeorking so thank you very much. it is wonderful to cce. >> thank you commissioner. >> dire c >> i want to also thank mr. price for his anacknowledge that he has a very busy job of try triangulating different groups people or connecting different groups of people to make sure patients and staff are kept as safe as possible very closely with the sheriff department and built stwraung la you have seen the data. we talk about the bert work at zuckerberg and appropriately so and i want to acknowledge the worpric does across our system of care, including the clinics. just to share specifically,

there have beenreal safety conc tom ladell clinic in the last year and the staff was very concerned and al repor patients were not coming to the clinic because they were concerned about outside the clinic there real issues and mr. price took a hold that, worked very quickly across our system with the sheriff office to rectify the situation and this are much better there, so just an example of the work dothe fact he has a very broad scope of-broad charge across the department and service delivery system can do our work safely and importantly, keep our patients who come services as safe as we can as well, so

thank you mr. price for your wo >> thank you. >> commissioner christian. >> klso much for this work. it is so incredible. i remember when you were first coming to us about the issue and how to address it and to see where you are now is astounding and st want-we all acknowledge that. i want to say th particularly dr. colfax said, the context of healthcare facility where people many people are coming in distress and there is a lot of violence as a result can result from that and then we have staff who are trying to help people and you are working to keep people while being able to do their jobs and not over using law enforcement to ■c that. it is astounding so thank you so much for it and thank you

continuing it. if you could just remind me, what the end game here for us? what is our goal? to completely remove law enforcement from these--never hundred percent, but remove law enforcement from these situiofrom these areas in staffing for what is it? >> thank you for that commissioner and thank you for your comments well i would say end goal is not to remove law enforcement, but to make sure that we have the appropriate alternatives in place so we are not bringing enforcement into patient care situations. anyou for the question because what i started doing is studying incidents where law enforcement was llinto

these situations and i still recognize ev with bert. we celebrate their success that provided these services without sheriff deputies or law enforcement, 87 percent of the time. interested in the 13, 14 percent and what are issues that escalate where bert escalates to enforcement and what tools they need, what other alternative needs to be in place so we n'law enforcement into pace care situation especially when it is imal. >> this is brilliantly done so thank you so much, we ou. >> thank you. >> thank you. i see no questions comments so go to the next item, which is the conference committee report from the zsfgjcc of july 23,

commissioner chow. >> thank you. reviewed ttee at the meeting our standard reports, including the ceo report and we are now getting monthly reports from the opportunities that we just talked about this we also looked at the regulatory reports and the hiring and vacancy report. we are very pleased to e under the hiring and vacancy that we low vacancy rate of i think in one of the categories it was like a 0 or minus percent vacancies. we also had also commended the continuing to perform well in the regulatory surv as i said earlier, being very pleased how hun resources has r stepped up to the plate and reduced the

number of vacancies across all our clinical needs. during the medical staff report, the committee reviewed and recommended that the full commission approve the neuro surgery rules and regulati the pediatric [indiscernible] in closed session the committee approved the [indiscernible] >> thank you. >> that's my report. >> any public comment? >> no public comment. isoner questions or comments? thank you commissioner chow. the next report is the finance planning committee from commissioner guillermo. >> i thought commissioner chung was going to be absent todai

put commissioner guillermo. >> we l so, the finance planning ion t right before this commission meeting and we reviewed the contract report and [indiscernible] quite a few new contracts. one, two, three--six--five ne contracts. i went to ask if they were able you the updated version? >> yes. you asked for the monitoring report and updated document and both of these via e-mail so in terms of- >> so we can move forward? >> yes. >> great. something worth mentioning is

the change in what reporting, so we still have to understand the process. it is the level of effort that be hearing a lot and that's the change in the that they calculate the rate or the units. yeah, so that's one that is worth mentioning. >> if i jump in to give context. it is the new cal aim requirement. instead of paying for service they divide the contract by the amount of and be a standard, it is the position and different leve of payment depending on the amount but more complicated and more real and that is coming in the next month. not there yet. >> so and that concludes my

update. >> th any public comment? >> there is. one public comment. mr. manette shaw would you like me to share the slide now ornsent calendar? >> i guess on it consent calend. >> okay. you got three minutes. are you speaking on this item too? this is finance planning committee report-back? >> no, just on the consent i guess for item 11. >> alright. thank you, sir. i'll talk to you in a minute. there is no public comment. isoner questions or comments from this report? alright. hearing none, we will go to the consent nd and ask secretary morewitz to walk us through the steps and how we prove or not approve because we have to seg regate out items. >> commissioner salgado has something. >> i to recuse myself with

contracts involving r conflict of interest. >> what we'll do after we hear comment is, split the vote into two sections and i'll lead through the first section everyone can vote and extract and y all uc contracts are removed, you will vote on that and everyone but on the uc contract. in the mean time, public comment. mr. shaw, i will pull up the thing right now. >> is there not a presentation on this? >> no. >> alright. should i start? yes, you have three minutes.

[difficulty hearing recording] why not just hire staff who know what they are donni skilled nursing facilities and save the $2 million annual expense? instead of issuing the $10 million rwhich is astronomical, hire experience stafkn what they are doing running a skilled nursing facility. does the commission believe management and staff tobe monitored for [indiscernible] across the past

month, lhh awarded two contracts totaling $15.2 million. my chart shows cost for external consultant since may 2022 just after lhh decertified in april 2022 and next 5 years to 2029 raised $53.6 million. the health commission is apparently ■: okay to [indiscernible] to see if exte t might help rather then hiring competent staff. it is distto me [indiscernible] full board of supervisors are going along the scam. part of the criticism of the health commission failure governing body. this commission is not performin sufficient fiduciary restraints expenses.$53 million

as fiduciaries this commission boardering on neglect and fiduciary malfeasance. these costs could been avoided all along had lhh folks who knew what they were ing before decertified. [indiscernible] just $1 shy of triggering the contract must receive contracts approval exceeding $10 million during a board of supervisor open public hearing. thonly public comment. i believe we on to--i'm going to say something, i can't make the motionif someone would parrot w i please make a motion for everyone to vote. plmake a motion for to vote on the consent calendar items, minus the three

uc contracts. >> is there a motion? >> i'll move. >> second. >> then i will do roll call. [roll call] the next vote is minus commissioner salgado will not vote and this is for the three uc contracts on the calendar. >> i move. >> second. u. >> thank you so much for doing that secr much appreciated. we are ready the next item which is other business. is there any hebusiness?

think that was [indiscernible] >> yes. >> alright. no public comment on other business? >> >> then we need to entertain a motion to go into closed session. >> >> second. call on closed session] great. if you can give me 30 seconds go into closed session. please know you will not be able to see >> disclose or not disclose the contents of closed session. not to disclose. >> second. >> roll call vote.

[roll call] >> next is motion to adjourn. >> second. >> alright. ank you everyone. [meeting adjourned] what's th?

i will have nile firefighter friends bring me a bench to the. joy want to see. >> this is cool marbles up here. a, appliance and hose ts is a y >> why? >> why is it called a y, that's a great question this . is a y. you see it looks like ay. we use it for yellow in fight we use it to take 2 different hoses from one that way in a big building like a high rise, and w a large piece of hose connect here, we are able to te two more hoses in different directions to help put a fire in a floor that is well above the street level. >> okay. >> fire engines 4 firefighters and firefighter paramedics.

firefighters should not considered strangers. firefighters are your friends. >> uh-huh. >> you aref help you need to make sure it is okay to go up to the firefighter. firefighters utilize many of the tools wecu in the a fire engine. such as a fire extingu >> what's that for. >> they can be used to put out fires thesize. a waste basket and squirts ter. >> oh , >> that is cool. >> yea! >> we have other t chain saw. they help us get through the many obstacles we encounter while we are trialing to put out a fire somebody's life. >> nice >> that is cool if you see a refiter like this in a fire the firefighters are friends and this firefighter will save your life. it is okay to go to the firefighter. >> to know. [music]■y ♪♪

wednesday august 21. egul meeting of abatement appeal's board. firstavez. >> here. >> commonalexander-tut. >> here. >> commissioner shaddix. >> commissioner sommer. >> here >>mi