the prohibition of selling of drugs in the city if the manufacturer was not in compliance with drug disposal programs. line 2323. removing from the ordinance the confusion, meaning only manufacturers and importers covered in the ordinance. however, if we find that this is not sufficient in time, reasserting drug wholesalers, illustrated in deletion on the following lines. page four, line 18 to 19, age 11, 19, 12, 5, and the term the elimination of " section. clarifying the definition of producer, manufacturers and importers, page five, line 17.

with page 893 and packaging separated from disposal, clarifying an existing, i would motion that we take those amendments. i very much appreciate the comments from the supervisors that want to strike cautioned with regards to was proceeding. when we brought forward the documents that provided the deliberations in other states in

the pharmaceutical industry asking for those states to not go forward, those arguments are incredibly similar to the arguments we have heard here. those of us waiting for state government to come forward with legislation that uniformly tries to to morton made municipalities throughout california, that would be like waiting for the gedout. it's not going happen. there may be some glimmer of hope, as i had opened in my remarks in the beginning of this deliberation, we were heartened to see the obama administration moving forward and advancing this level of interest. but that level of interest has not been assigned to state and local governments get. this is where the doors open to other levels of government to

take up the initiative spirited through the obama administration. there is nothing that says that any of those laws, federally speaking, the state to local governments are precluded from moving forward. san francisco is no stranger from initiating a law that is then followed by state and federal government. this is not something that we are stranger to. if we are able to investigate what i think would be seen as a pilot program for other municipalities, so be it. if the challenge is to align the municipalities, i see that as a welcome problem. but the absence of any law whatsoever in the state of california should be considered unacceptable. in the discussions with the city attorney during the orchestration of this particular law, there is no unintended consequence with regards to the concerns articulated by the

representatives of the manufacturers. lip balm and toothpaste would not be included in this particular law. there would be a more defined segregation to make sure that that would not be an unintended capture. with regards to take back programs, we hear very differently on mandatory take back programs in canada, as well as europe, completely. the 1998 study that was mentioned about germany, germany is actually one of the leaders in europe right now on the question of recapturing pharmaceuticals from getting into the waste stream. it has been well updated by the parliament of germany that focuses on manufacturer responsibility. the difference is that a lot of the same manufacturers that might come to the united states to debate at the level of the state or even local levels in preventing us from enacting such laws are being reined in in

europe and other places for compliance and enforcement. i think that this is the slow trend that will hopefully come to a head. we are a state government now sees the writing on the wall, having a law that is meaningful and shows efficacy for producer responsibility will alleviate local governments from having to go this direction. let's hope that they do. but it is not on the radar any time soon. i ask that we move forward in san francisco. supervisor chiu: from my perspective, i have been thinking about this for a bit. first, i would like to thank supervisor mirkarimi for accepting the riding of the amendments that he did that were proposed by the industry to make this legislation more effective. i do think that this is an issue that we have all known. the industry, the public has

been aware that the lack of places to dispose of medicine has engendered health and safety issues around the country, including here in san francisco. my understanding is that the city attorney does not opine that that is the case. localities have a constitutional right to address health and safety concerns within our borders. that is what i believe this legislation is doing. i do think, i do believe that the good faith efforts and comments made by the industry and business community that they wish to address this on a voluntary basis. that being said, that has not happened yet. if there are other, smarter ways to do this, now is the time to propose it. i think a number of us are open to hearing that, but it has not happened yet.

i appreciate the fact that the obama administration has addressed this general area and i have received a copy of this from industry representatives earlier today. interestingly, specifically they provide encourage the attorney general to promulgate regulations in this area that specifically states that such regulations may not require any entity to establish or operate a delivery program, which at the end of the day is why it is appropriate for us in san francisco to consider moving forward and proposing a program that hopefully will be efficient and respectful of the needs and issues within the pharmaceutical industry that accomplish the goals that we want to accomplish. i will be supporting this legislation today. that being said, i know that there are still questions and concerns. my office is absolutely willing to meet and hear from various

representatives of various stakeholders that need something address. but of the many amendments that have been adopted today, this goes a long way towards addressing those concerns. if there are any additional discussions? let's call the roll. can we adopted this? let's call a role. >> on the motion to refer this item to the full board? supervisor elsbernd? no. supervisor mirkarimi? aye. supervisor chiu? aye. two ayes, one no. supervisor chiu: with that, madam clerk, is there any more business in front of this board? >> no, supervisor chiu: mr. chairmanchiu thank you -- no,

mr. chairman. supervisor chiu: thank you, at this time this meeting is adjourned. when a resident of san francisco is looking for health care, you look in your neighborhood first. what is closest to you? if you come to a neighborhood health center or a clinic, you then have access it a system of care in the community health network. we are a system of care that was probably based on the family practice model, but it was really clear that there are special populations with

special needs. the cole street clinic is a youth clinic in the heart of the haight ashbury and they target youth. tom woodell takes care of many of the central city residents and they have great expertise in providing services for many of the homeless. potrero hill and southeast health centers are health centers in those particular communities that are family health centers, so they provide health care to patients across the age span. . >> many of our clients are working poor. they pay their taxes. they may run into a rough patch now and then and what we're able to provide is a bridge towards getting them back on their feet. the center averages about 14,000 visits a year in the health clinic alone. one of the areas that we specialize in is family

medicine, but the additional focus of that is is to provide care to women and children. women find out they're pregnant, we talk to them about the importance of getting good prenatal care which takes many visits. we initially will see them for their full physical to determine their base line health, and then enroll them in prenatal care which occurs over the next 9 months. group prenatal care is designed to give women the opportunity to bond during their pregnancy with other women that have similar due dates. our doctors here are family doctors. they are able to help these women deliver their babies at the hospital, at general hospital. we also have the wic program, which is a program that provides food vouchers for our families after they have their children, up to age 5 they are able to receive food vouchers to get milk and cereal for their children.

>> it's for the city, not only our clinic, but the city. we have all our children in san francisco should have insurance now because if they are low income enough, they get medical. if they actually have a little more assets, a little more income, they can get happy family. we do have family who come outside of our neighborhood to come on our clinic. one thing i learn from our clients, no matter how old they are, no matter how little english they know, they know how to get to chinatown, meaning they know how to get to our clinic. 85 percent of our staff is bilingual because we are serving many monolingual chinese patients. they can be child care

providers so our clients can go out and work. >> we found more and more women of child bearing age come down with cancer and they have kids and the kids were having a horrible time and parents were having a horrible time. how do parents tell their kids they may not be here? what we do is provide a place and the material and support and then they figure out their own truth, what it means to them. i see the behavior change in front of my eyes. maybe they have never been able to go out of boundaries, their lives have been so rigid to sort of expressing that makes tremendous changes. because we did what we did, it is now sort of a nationwide model. >> i think you would be surprised if you come to these clinics. many of them i think would be your neighbors if you knew that. often times we just don't discuss that. we treat husband and wife and they bring in their kids or we treat the grandparents and then the next generation.

there are people who come in who need treatment for their heart disease or for their diabetes or their high blood pressure or their cholesterol or their hepatitis b. we actually provide group medical visits and group education classes and meeting people who have similar chronic illnesses as you do really helps you understand that you are not alone in dealing with this. and it validates the experiences that you have and so you learn from each other. >> i think it's very important to try to be in tune with the needs of the community and a lot of our patients have -- a lot of our patients are actually immigrants who have a lot of competing priorities, family issues, child care issues, maybe not being able to find work or finding work and not being insured and health care sometimes isn't the top priority for them. we need to understand that so

that we can help them take care of themselves physically and emotionally to deal with all these other things. they also have to be working through with people living longer and living with more chronic conditions i think we're going to see more patients coming through. >> starting next year, every day 10,000 people will hit the age of 60 until 2020. . >> the needs of the patients that we see at kerr senior center often have to do with the consequences of long standing substance abuse and mental illness, linked to their chronic diseases. heart failure, hypertension, diabetes, cancer, stroke, those kinds of chronic illnesses. when you get them in your 30's and 40's and you have them into your aging process, you are not

going to have a comfortable old age. you are also seeing in terms of epidemics, an increase in alzheimer's and it is going to increase as the population increases. there are quite a few seniors who have mental health problems but they are also, the majority of seniors, who are hard-working, who had minimum wage jobs their whole lives, who paid social security. think about living on $889 a month in the city of san francisco needing to buy medication, one meal a day, hopefully, and health care. if we could provide health care early on we might prevent (inaudible) and people would be less likely to end up in the emergency room with a drastic outcome. we could actually provide prevention and health care to

people who had no other way of getting health care, those without insurance, it might be more cost effectiti >> ed lee was kind enough to accept my request that he continue as a city administrator in san francisco. his term now officially will be longer than mine, regardless of my win for the lieutenant borders race or not. ed lee is one of the best and brightest in city government. since he took the helm as city administrator, he led our efforts to create the 10-year capital plan. he has led our efforts in organizing and reinvigorating our birds the prepared this recovery plans. he has been a great steward in

these times of economic constraints, helping us become more efficient in terms of the governments of this city. he has been on the forefront of our efforts to reduce our vehicle fleet, green our vehicle fleet. he has proven remarkably adept at working with everyone in city government regardless of their political ideologies, political backgrounds or agendas. he has great support of the community and broad support in the private sector as well. i cannot imagine anyone better, anyone more deserving than ed lee to continue on in this role as city administrator. that is the formal announcement today. >> the most important thing that i know of when i come into this job is to make sure we carry on the promises that we may, at the executive and legislative level. if we cannot do that in a smart

way, do so in an efficient way, knowing that we are serving all the communities in san francisco. my job is clearly defined. i have been challenged by this mayor, with all of the new programs he has introduced to the city. even today, the announcement of this program. we are capable of implementing these programs, not only because fear healthy financially, but it is my job to keep that financial help in this of the city going by getting work done. thank you. this is a fantastic opportunity. this is the greatest city in the world. i personally have my house here, my life is here. that makes it personal for me to do the best job i can. thank you. >> you got it. i will be locked out soon. i am counting on ed.

i have been working with him for 15 years, since i have been in local government. there are few people who have earned more respect from so many people and ed lee. he is the right person. the charter of the city, the city administrator position is an extraordinarily powerful position. if we come across a transition, i think his role will be significantly elevated. if we do not, nonetheless, he will be a big part of the future of the city and in partnership with the next mayor. i say this as the future ex- mayor, as someone who lives in san francisco. i want to see it run and govern respectfully. ed lee is the person to do that.