motion to send the item forward with recommendations with the conditions established by the public. supervisor chu: thank you. there is a motion to send the item forward with recommendations. without objection. thank you very much, inspector. item six, please. >> items 6, or events amending the san francisco administrative code by amending section 21.40 to authorize the department of public health to contract for behavioral health services to children in foster care system under jurisdiction of the city and county of san francisco and located outside of san francisco, utilizing contracts -- contract language and form as mandated by the state of california under california welfare and institutions code under section 5777.7. supervisor chu: thank you very much. we have ann from the department

of public health. >> thank you. the department is requesting that we use the state contract low of the city boilerplate, and this will put us in compliance with sb 785. this legislation, in regards to delivery of specialty mental health services for foster care children, and it mandates the use of standardized contracts statewide, so this would be for children that are placed out of county, and i have our director of children, youth, and families for the system of care for community behavioral health services. thank you. >> supervisors, this should give you an idea about the extent of the need. 534 children in foster care are facing -- are placed in san francisco. with the largest percentage placed in alameda county and san

mateo counties. the reason they are placed in those counties is because half of them are placed with relatives, and the remaining in foster homes. they all actually have a right and need to access and services when they have the need. right now, it is not easy to enter contracts for services with them, so the change is to create more timing access for the children living with relatives outside of san francisco. supervisor chu: could you explain a little but why you think the california state code would be better than using our san francisco code? what is it that we would be changing? >> it is the contract thing language that all counties are expected to comply with, and also a sense of time line in

terms of authorization timeline and also a timeline for setting up payment schedules so that it has statewide application. supervisor chu: from a statewide perspective and the use of those funds, is it a requirement of san francisco? >> it is in our contract with the state department of health services. supervisor chu: are there any members of the public who wish to speak on item 6? seeing none, public comment is closed. questions from the committee? we have a motion to approve and send this item forward with recommendation. thank you very much. madam clerk, are there any other items before us? >> no, madam chair. supervisor chu: thank you. we are adjourned.

captioned by the national captioning institute --www.ncicap.org-- supervisor maxwell: welcome to land use. we will be joined by our other member and president of the board, david ichiu. lisa, thank you very much. i would like to thank the folks and live. madam clerk has some

announcement. >> please be sure to turn off all cell phones and pagers. completed files should be submitted to the clerk. items acted upon today should be submitted to the september 21 board of supervisors agenda. supervisor maxwell: first item, please. >> ordinance amending the san francisco health code by amending sections to eliminate grocery stores and big box the sale of tobacco products in pharmacies. supervisor maxwell: our director of health, are you here for this item? sorry, erik? supervisor chiu: i think that dr. katz will testify the san francisco has been a leader in limiting the harm of smoking to the public. in 2008 the tobacco free coalition and the department of

public health passed a measure that limited the selling of tobacco products in a number of types of stores. this ordinance eliminates an exemption that was made a bad time for big box stores and general grocery stores. this will prevent all pharmacies from across the board, in an even-handed way, and prohibit them from selling tobacco products. in the tobacco free coalition literature and advocacy, we always say that cigarettes and pharmacies do not mix. we are not trying to bar cigarettes, but we are trying to change social norms and to be even-handed in that as well. pharmacies should be about promoting healing. people go there to purchase products that kill them, they should not be able to purchase

tobacco, which is the number one cause of preventable death items that harms our health. so, the policy is strengthening our anti-smoking efforts in san francisco. good for the public health. we have a number of health experts and community-based organizations testifying in support of this. i would like to thank bob gordon and many other organizations that have been long working on this issue ended is my honor to introduce the doctor mitch katz, the doctor of public health. >> thank you very much, chairman. thank you for holding this hearing. thank you for introducing this legislation. as the supervisor said, in 2008 as board of supervisors made history, san francisco became the first locality anywhere in the united states to ban the sale of tobacco at pharmacies.

but we were not the only ones, people follow our example. the entire city of boston immediately made themselves another city that does not allow the sale of tobacco at pharmacies. along with other towns in massachusetts. there is legislation across the nation. there were bills introduced in both the state house in new york and massachusetts that would have done it for the whole state. those bills did not pass, but that does not mean that they will not. these movements that have to start somewhere to gain strength. i am so proud to work for this board of supervisors, who has taken such a courageous action. one other update that i thought you would be interested in, there were concerns about how this would affect businesses at the time. so, we have checked the count

and in 2008, there were 64 commercial pharmacies in san francisco, now there are 65. not only did no pharmacies close, we got one extra commercial pharmacy. the number of independent commercial pharmacies has stayed stable. 39 in 2008 in 2010. the argument is, whether or not if you close the rates at the time, people were concerned not only for tobacco sales, but that people would not come into these stores, but it has not borne out. meanwhile i am proud to say that when our own family goes to a commercial pharmacy to pick up the asthma medicine for my daughter, you know that they do not see, as we walked in, big sales for tobacco. what i want from a social norm for them to think of is that a pharmacy is a place to go to get

healthy. you would never expect to see tobacco being sold. that is not what a pharmacy as for. with my tremendous thanks to this board of supervisors, i come before you, asking that you extend it to eliminate the exemption. it will only now affect 14 businesses. before your initial lot affected 60, so this is a much smaller edition and in that the supervisor has well said, it evens the playing field. anyone who has a pharmacy is not allowed to sell tobacco. with the addition it would be approximately 74 businesses -- supervisor maxwell: with the addition it would be approximately 74 businesses? >> correct. supervisor maxwell: how many in total? >> obviously many of the independent pharmacies no

longer sell tobacco. if you put them all together, it is 118 businesses. >> 74 would be affected by this legislation? >> right, many of them were not selling any ways. supervisor maxwell: since 2008 there were 39, in 2010 there are still 39? >> correct. thank you. supervisor chiu: do we have any speaker cards? supervisor maxwell: do you want to open it up to the public? supervisor chiu: are there any questions from my colleagues? >> i would just -- supervisor maxwell: i would like to be added at this point. supervisor chiu: that is great, thank you. i have a number of speaker cards. i will just start calling. supervisor maxwell:, as you hear

your name. -- come up as you hear your name. supervisor chiu: [reads names] thank you. three minutes? thank you. >> hello, i am a professor of clinical pharmacy at the university of california, san francisco. i am also a smoking cessation counselor and practicing pharmacist. i am here today to express my full support of this ban. i would also like to submit this white paper that we prepared back in 2008, the previous ban. this white paper clearly shows that the profession of pharmacy indeed supports a ban of tobacco products. weast -- we respectfully submit our position that it is in the

best interest of the health of the people of the city and county of san francisco that pharmacies be prohibited from selling tobacco products. fewer than 2% of licensed pharmacists in california are in favor of tobacco sales in pharmacies. the vast majority of independently owned pharmacies do not sell any tobacco products, indicating that pharmacists may have the choice to sell or not to sell or choose not to sell. i would like to share the results of a small study that we conducted since the ban in san francisco by myself and other faculty members as well as five senior pharmacy students to gather the opinions of san francisco residents regarding this band. earlier this year, we surveyed approximately 200 san francisco residents, smokers and non- smokers, on the sidewalk near the chain pharmacies in town. the majority of people surveyed

were in favor of the van and not surprisingly, while smokers were less in favor, almost one-third were in favor of the ban. to conclude, speaking as a pharmacist, i feel that there is a strong conflict of interest for an establishment that contains a pharmacy where health care is provided to also profit from the sale of tobacco products that are known to cause heart, lung diseases and also cancer. san francisco has already taken the bold leap, nationally, with that the current ban and continues to lead by banning the sale of products that pharmacy locations throughout the city. when i travel nationally i am proud to say that san francisco did ban the sale of tobacco products in pharmacy and that they are all looking to us to leave.

supervisor chiu: i am just going to call a couple of more names. [reid's names] >> thank you, a supervisor, for introducing legislature around banning selling tobacco in pharmacies. the proposed ordinance would affect all pharmacies, including ones in grocery stores and big box stores, creating a level playing field. to reiterate what the supervisor has already said, since pharmacies are already a trusted source of health care information for the public, it is a direct conflict of interest to sell tobacco, the number one cause of preventable death in an establishment where people are going to improve their health and get treatment for diseases that are caused by smoking. thank you for your time.

thank you. >> good afternoon. i want to thank you profusely for bringing this legislation. it is god's wish that you do that and save lives. my husband happened to have been a pharmacist. he never carried cigarettes in his store because he was a principled man. he never believe that that should be done. he said to his customers that if he wanted cigarettes he would send his man out to buy them for you, but he would not sell them. there are other ways of making money my father was a smoker and lived in north carolina, he died of smoking at the age of 41. with three children left behind.

he had two heart attacks. then he got ammonia. -- pneumonia. his lungs could not fight the disease. it is still happening today. my younger brother smoked. i told him that his father died of it. i pleaded with him. he would not listen. he smoked, it was so addictive because they spiked it with chemicals, now it is harder to withdraw than heroin. can you picture that? my younger brother stopped smoking for five years, then went back on it. at his funeral at 72 he had a headache and he went to the doctor and they found that the cancer started in his lungs and went to his brain. in one week he was gone. at the funeral the told me that. i cannot say enough that

tobacco is the worst foison ever and it should be condemned across the board, not just pharmacies. i thank you profusely for it and i wish that more people would do would you are doing. thank you. >> good afternoon. i am an american heart association volunteer, here to support the proposed amendment to delete these exemptions for general grocery stores and big box stores to sell tobacco products. smoking is a major risk factor for cardiovascular disease. in fact, heart disease is the nation's number one killer. smokers are four times more likely to develop coronary heart disease and three times more likely to die from it.

also, as you know, non-smokers are impacted by secondhand smoke, including children and young people. we often forget that aspect. the heart association advocates banning tobacco sales in health care institutions, including pharmacies. reduced access to invisibility of smoking and cigarette may lower the rate at which current non-smokers experiment with and become addicted to smoking. current studies indicate that limiting access is a key component to limiting tobacco use. we highly recommend that tobacco products not be sold in all pharmacies. personally, i agree with dr. katz. i am a mother to two teenagers, shopping at the store they are observant and impressionable and i would like to limit their exposure to the selling of

tobacco products in these stores with pharmacies. it just does not make sense. in conclusion, the heart association believes the banning the sale will save lives and we urge you to adopt these amendments. supervisor chiu: [unintelligible] >> thank you, my name is david jesup. i am a san francisco resident and a member of the american cancer society. i strongly -- support the proposed legislation. the ordinance will end the current situation where our city still allows remaining stores with pharmacies to sell medicines and cigarettes, the most deadly product on the marketplace. it is time for our cities to protect the health of their residence, taking further action to make sure that we will no longer find legal and addictive

tobacco products for sale in any store that is authorized to dispense medicines. we now know with certainty that tobacco smoke causes along list of diseases. the stay well solution web site at safeway discusses many of these. 90% of new smokers are children and teenagers. we give our children absolutely the wrong message when we allow pharmacies, places of health and healing, to sell tobacco products, which are instruments of disease, disability, and death. in recent years i have seen the business community's growing commitment to protect and improve the health of their customers. aho customers that support healthy living should comply willingly with this ordinance. i think that the great majority

of san franciscans hope and expect that these companies would decide to get ahead of the curve and end the sale of tobacco products by an all of their stores, including those that do not have pharmacists. thank you very much. >> hello. my family owns the charlie drug store in the western addition. when this legislation first came about in may of 2008, i received word from the mayor's office that this legislation had nothing to do with mom-and-pop stores. that they were going after chain stores. that they were not in the business of putting mom-and-pop stores out of business. i was later told that that was what the mayor's office said, i could take it to the bank.

i had to go to the appeals court to get my license. my family has service the community for 23 years. we put in the pharmacy because we did not want to beat another corner store to benefit the community. i also have a liquor license. do not get me wrong, we are not open from 6:00 a.m. until 2:00 a.m., but my pharmacy itself operates at a loss. we provide a great service to the community. my customers are 90% low-income and senior citizen. what other pharmacy allows paying what they can? we do. losing tobacco sales would cripple my business. people will not make a special trip to my store if they can purchase everything that they can or want at another location. i am one single business and not a chain store. we have been a part of this

community through the good times and the bad times. by business does what it can to help with senior serb -- my business does what it can to help. i have crunched the numbers and there is no way to continue to operate with store profits to support the pharmacy, the seniors depend on it. i see where you are coming from with this legislation and you probably did not think it would affect the small businesses, but it is going to. we have eliminated all -- almost all of the advertising in the store for tobacco. this is something -- i have been offered by a chain store to sell my pharmacy, but how do i tell my senior citizens that they have to go across the street, wait half an hour for the 22 to take it to the walgreen's. within three blocks i have several senior buildings, each

consisting of over 200 residents. how do i tell them that i can no longer fill their prescriptions? is not fair to them. if money were the issue, i could have sold out, kept my store running, no problem. but the issue is the people of my community. i cannot put them in the face and sell them out, i will not do that. thank you for your time. >> thank you. good afternoon, supervisors. my name is fred mayer, a practicing pharmacist for 55 years. i speak to you as past owner of a pharmacy for 35 years and as education share of the

california pharmacists association, the academy of employee pharmacists, and as president of the pharmacy services. we are nonprofit, public health consumer pharmacy education organization. as a pharmacist first and foremost i care about the health of the patient. i think that every pharmacist does. i think that every pharmacist should be a place of health to deliver health care. pharmacies that sell health care cancer treatment and cigarettes at the same time, this tobacco free pharmacy policy of 2008, san francisco used it to take a bold step to committed health. walgreen's has been tobacco free under the influence, as have the independently owned pharmacies in this city. however, now is the time to

expand the ordinance by including every pharmacy in the city. if it includes safeway, costco, lucky, and any independent pharmacies. with my recollection, none of the in of an -- none of the independent ones sell the ordinance. cigarettes are deadly and addictive. the only product on the market with no safe use. keeping all pharmacies as a place of health, no exception. in all of europe, which i just returned from, no pharmacies sell cigarettes. in canada, there are no pharmacies that sell cigarettes. they have been outlawed. thank you so much for your consideration. i will answer any questions you

might have. supervisor chiu: thank you. mr. gordon? >> thank you, dr. katz, for your leadership with this issue. my name is bob gordon. i am a member of the san francisco tobacco free coalition. after saying just a few words i would like to deliver to you several letters from pharmacists in san francisco. they would like to see all pharmacies, licensed, her becoming tobacco free. i would like to read a typical comment, both of these pharmacists were not able to leave their stores to make it to the hearing. the first is from gerald of a los. "der supervisors, pharmacies dispense medication and health information to promote and maintain the good health of our

patients. to this end, case has not carried tobacco products for 11 years. i am writing to urge support of the ordinance, banning the sale of tobacco products in all stores and pharmacies. -- pharmacies." another pharmacist here from the castro, "time for san francisco to step up, joined the california pharmacists association and california medical association, setting the standard in the united states. he finished by saying that he commanded the supervisor for taking action. thank you, i have copies of these and other letters from the pharmacists for you. thank you.