concerned about that. >> it's about thirty something out there that's risky. you know, disliked by someone torn apart and that's the whole point of what we're drying to do >> you never take this for granted you make sure it is the best if you can. >> ♪ ♪ ♪ ♪ ♪

>>[gavel] >> the meeting will come to order and the secretary will call the rolex >> pating, present. singer, present. kalb be present chung, present. sanchez breslin karshmer, present. >> before we go on to the meeting itself i'd like to welcome our new commissioner commissioner jimmy royce. he is no stranger to the this department having worked here a full 20 years before retiring as deputy director back in 2007. we are happy to welcome him back and to assist us in developing the policy for the department that he worked for. so, welcome on board commissioner.

>> think you commissioner kalb >> next item please >> yes. item 2 is the approval of the minutes of mission meeting of august 2, 2016 >> the minutes are before you for approval. is there a motion for acceptance? >> moved and seconded. >> other corrections or additions to the minutes? if not we are prepared for the boat. all those in favor say, aye >>[chorus of ayes] opposed? the minutes have been approved >> item 3, directors report >> good afternoon commissioners and welcome to make commissioner royce. i wanted to just get a couple eight could i do about items on the agenda on the report in your welcome to ask any questions. one in particular with the health apartment investigating eight bible incident that second 19 people. was candy that was at a mission district on august 6 and was suspected and we believe to to be edible marijuana that [inaudible] found thc. the main

psychoactive ingredient in marijuana in addition the lab work for 12 hospitalized patients was tested positive for thc. the most recent part of this was all of the 19 patients that were impacted by taking to the hospital on saturday, august 6 and were discharged by the following monday. but many of them were male, nine were female 13 of the patients were 18 or younger. the san francisco office of california poison control center has been working closely with hospital reading these patients were treated patients collected information on patient laboratory results. i do want to say the san francisco police department is also conducting an investigation. our health officer is here if there's questions but luckily, all of the patients were discharged and this ongoing investigation. a quick update on 12 san francisco residence of those impossible for zika residence as august 12 contacted the

patient will traveling in countries with zika viruses circulating. there's no risk to the public and zika is not circulating in this area with al lawyer incompetent the department of public health informed the san francisco of the bombing of positive test results in the council california continues to update public weekly tally of the numbers of cases by county and provide pregnancy information can as you might have seen in the paper recently, the entire area when rico is right now impacted by the zika virus. so, we keep our eyes on this. we know that mosquitoes are not as prevalent in san francisco but we have this year added another vector control personnel to make sure that people know how to manage mosquitoes in the san francisco entered so people get concerned about mosquitoes and wicked i know we have a long agenda tonight and if there's any questions on here >> i'm just wondering if dr. aragon wants to give us an update on this-the edible

marijuana? >> good afternoon. so, around 930 on saturday evening this was i believe august 6, at a teasing you in the mission district several children became ill. 19 people were hospitalized. 13 of them were actually minors. fortunately, for us, the people the patients were covered relatively quickly and what we do know is that they consumed a gummy ring that contained cannabis. so, we were able to identify both through the urine toxicology screen in the hospital. were positive for thc. we were also able to identify in the gummy rings was also positive for thc. we were

able to trace back and identify how that made it to the-because of the police investigation were not saying anything else because there are are still questioning people to figure out exactly what happened. i got involved on the next day which was sunday, and we made sure that what occurred there and what occurred that night would not happen again. of course, arrest witnesses are concerned we have around cannabis edibles becoming available to children and we know that around the world there's actually products actually treated in a way that are there's cookies and brownies and candy, so they're attracted to children get in san francisco, any edibles they have to be packaged in that hope a package that is not look at all like candy. the other thing that's happening in san francisco do we do have a task force that's been working on preparing if the proposition

passes to legalize recreational use, that we are-these are the kinds of issues that are going to be addressed to make sure that, if cannabis is legalized, that we ensure product safety. >> in the experience of other states that have legalized marijuana, has there been such incidences? >> there has. so colorado come i think has captured most of the experience around children eating edibles. fortunately, adverse outcomes like death is very very rare. so, these when these patients become sick they require supportive care in a healthcare facility. but, it is-yes, this has been an issue. i believe, probably this maybe actually the biggest outbreak that we know of involving that number of people could 19 people want on is pretty big. >> actually can i want to give a big shout out to the ucsf

poison control center. they were phenomenal. they've been really helpful in these types of events in the collaboration with ucsf and us and our being there at the zuckerberg san francisco general hospital and then join following up on the test results they were really good. they have fellows following up to make on the clinical outcomes of the patient as well as the toxicology results and then their lab was involved in actually the testing of the gummy rings. i just want to say they were very good. >> if i may, our team internally in the department works really i think really well together and also informed the family, informed the family members, so i think another test to our emergency response

could i think we did the job of making sure the public understood but more poorly the people that attended the-as you know kids will take that kind of candy and take it home so we really did work closely with the families that >> commissioner singer >> i had a question relates not to the issue of cannabis into candy, but more our response as a city and what observations that we had and learnings we had in this incident and in particular, the question it seems to me that like with infections in these outbreaks, the issue of when like a seminal event is like a normal course event in an er and when someone in an er or doctor's office across, there could be more of this and this is so nonstandard that i need to notify someone in public health so that someone here can say, oh god i got for calls from four different institutions. how fast, how did that work in this situation and how satisfied are you with that we have god, those notes out there sniffing if you will?

>> so, for my perspective this is interesting for my perspective oftentimes we learn about outbreaks they often are associated with for example a restaurant were usually clinical site that's being in the case we hear. in this one it was really the ems system been alerted from the ems perspective they called a mass casual incident because they had several people that one time need to be transported to multiple hospitals. at the moment that we hear about something like this, is that we can consider it an outbreak because it's more of a-it's more pieces of the sewing somewhat unusual than for a place and time. an at that moment, we think about how to find out the source. is this a type of the iceberg? are there more cases? if there circulated product out there that me getting more people becoming ill? if we go down-we don't know what happen we go down that route which is really an outraged investigation should it's about mobilizing a team of investigators to help

through that investigation. we are really-we were very fortunate that we were able to figure this out relatively quickly, especially when the urine toxicology screen cannot positive we are able to identify the candidate able to trace back how it got in there. so, i was, by sunday afternoon, we felt very confident that we figured out what happened and it was did not spread further. but those are sort of the two different paths that things can happen. we just had a deep reef yesterday just reviewing everything because it involved us, the hospital, environmental hazmat was initially called out, so it involved a lot of different agencies and the police became involved as well. >> fax. >> any further questions at this point either to dr. airey on what to the director on her report? if not, thank you. and i think that you are commendation to the poison control center shows a number

of years ago we talked about whether or not we were able to continue to be able to fund or have a poison control center did i think this is just another very fine example of why it's really important for a major city to have one. thank you. >> thank you. >> next item commissioners >> yes next item please >> item for general public, good about received any request. i think we have one. okay. >> commissioners my name is double i usually tend up >>: for one second opportunity minutes on the clock for you. >> mr. duffy, correct? okay, 3 min. >> hon. dr. chow. an honorable 10/sanchez and commissioners i normally can attend because i

go to the board but on vacation for the month oh here it is august. i am on the tom o'dell advisory board. press sometime we can do a more formal presentation because there's a lot of work and on patient advisory councils as part of the medi-cal and affordable care act. there's been a quite a bit of energy put into it and am pleased because were getting all of our support that we've got in recent years. a few years ago we got eight kind of an administrative hub because the center directors were eliminated in 2003. the minister backfilled at and we are getting a brand within a meet the new one. this is our second one, now. but enemy dumb on thursday. the kind of things that we can provide input on, the patient dr. interface and the human factors being, is smooth. those are the kinds of things that position can help with. a lot. i am very

interested in the prime campaign and see what score to come out with that and how medi-cal is can be optimized. mr. kaczynski here, also down because of interested in seeing how for example the hakim is going to fit in. i know they have a clinic and there's been some talk that the hot clinic by combined with that, without urban healthcare urgent care clinic downstairs. i don't know what happened with that. so i'm kind of interested in that as well. about two years ago there was a retreat and it turns out that your commission at a retreat. it turns out because of the open meeting laws of the public had to be invited. so, i happened-i happen to be there. that's how i got. i noticed the meeting here i thought i'll go to the meeting and, i'm not the fastest person to catch up on things and think about things. a delayed reaction sometimes and it was a lot of talk. someone came and presented on the it situation. the servers and the whether it should be an

e-mail servers and all the upgrades were going on. he mentioned how things were in a bit of this array any mention there's even a server sitting on a desk in an office somewhere. as if that was a negative thing and i just thought about it a long time and kind of the thing i do is look at things that other people miss. it seems to me that we can't rebuild or renew our it infrastructure every single 2-3, four yet it is got to be a work in progress. in fact the fact there is a server sitting somewhere unused is actually a sign that were not heard back of transition which the technology were always going to be a proactive transition. that's the ideal state it is the ideal state we can be in. something i noticed retreat to years ago i thought i might mention two years late. they do. >> thank you. item 5 is the report that from the community and public health committee meeting from this afternoon. >> who is presenting that?

>> i have that. >> commissioner pating >> were honored at the community and population health subcommittee. to have our new commissioner dr. jimmy royce join us and commissioner chung. we are to reports. one from ms. mary ann zell was the director of the maternal child and adolescent health division. the maternal and child adolescent health division has 25,000 individual clients under care of which 82% are under medi-cal. we reviewed the metrics for this division. two of the tumor metrics i'd like to share with you were the desire to increase prenatal home visits and the desire to increase fluoride varnish so the department has set as its true north quality metric increasing home visits for families and mothers that are at risk for preterm or had preterm labors. this would be

include african-american women, the first term pregnancies and particularly, those that made would be living in public housing and at risk for preterm labor. the department outlines three approaches that they're using good one is visiting nurse family partnership's with user nursing that's pacific we work with high-risk moms to both before and during and after the pregnancy. there's also a field public health nursing program and finally, a specific spell out program and were pleased to see the breath of these services as well as the focus that these national best practice models of care brought to their disparate populations in african-american and latino communities. also, we heard at this commission around fluoride varnish. this was elected again as another true north metric. currently, 30% of 3-5-year-olds

of color have cavities which cavities as young youth set you up for poor dentures as adult. the department has achieved 80% of kids receiving fluoride varnish and so they're making good progress on fluoride varnish. so we are going to be hearing from the maternal child adolescent health division quite broadly. we think tumor metrics which would been reviewing with that the subcommittee level and at this commission level, were enlightened with the department's goals and so we supported them in their efforts for these two initiatives. the second thing we heard was the rivera talked about the move from the san francisco health improvement assessment which we heard two sessions ago to the development of the san francisco health improvement

plan.. we talked about the three things that made the planned war that will tentatively-we discussed and presented to us in the plan in the following month in the fall. i'm not going to go into two great detail but access to care which includes oral health, and decreasing hospitalizations for chronic diseases, healthy eating and physical activity which will be measured by making sure that there is food adequacy during pregnancy. food adequacy for seniors that are on home deliveries and exercise and fitness programs for six and seventh graders and behavioral health treatment be adequate. these will be things that we emphasized in the upcoming health improvement plan but again this is the first draft. we were just raising questions to be able to help them focus the report. what we liked about this and what we will hope the commission will focus on is

particular emphasis on disparities and inequities in the plan. this is a new approach to the community health planning that we did not have before. before we look at citywide metrics for example for dental care, for return labor. and at this point what we are looking at is more of the inequities and moving in those subpopulations with regards to access, eating and physical activity and behavioral health. so, that ends my report and if you make questions of the glad to answer them. >> questions commissioners? my only one was you mentioned that they were now at an 80% fluoride rate? i mean, that's fairly high from where it was before could probably talk about just the people that maternal health is taking care of or were talking about the whole city? >> is mishandled here? note?

>> i can follow up on that commissioners and get that answer >> yesterday when you clarify with the 80%. >> the matrix we were trying to reach was to move from 73% of identified children to 78% of identified children needing fluoride treatment and they said they were at 80. so, i assumed is the population under sample and those needing and the number that was reported out recollected was 8%. so,- >> okay >> does that help out? >> not exactly because i was looking more since were talking about disparities that we are the biggest problems were and how they actually got to those. they were moving from 73 to 78? >> i'm sorry. the increase percent risk of children ages

six months-six years of multi-risk for developing cavities receive fluoride punish application will go from 71.5% to 76.5% and a reporting at the meeting it was that 80%. so that it looked like we were meeting the target. i don't have that-this was broken up by demographics or by disparate populations which as you and i have discussed asian population has very- >> that was critically when i was actually looking at. is that closing of the gap related to the some targeted interventions were not. we could probably find out. >> i'll work on that make sure you get that. >> yes. commissioner singer >> commissioner pating, i sort of a question which is kind of in contrast to some of the numbers that you just gave us where we really have defined targets for patient care. i was interested and look at the true north metrics that were presented to the committee and

two in particular struck me as just sort of scratch my head on them. one was financial stewardship and one was care experience. the metrics that we were going after in each of those for financial stewardship among it was the percent of staff who completed medi-cal time study. for the care experience it was to increase the percentage of patients who filled out a survey. it wasn't with the survey told us about the care experience. >> we actually only heard the last three of the true north metrics. the diagram on page 5 that you are referring to we heard about quality workforce and equity and we reserved for future discussions with the maternal child adolescent health division will be doing on the first three slides. we can ask the question to the staff. >> commissioner i heard what you said we can pass that along to when they do the report they address those two issues.

>> okay. >> i think that would be good. >> so i think the commission and the subcommittee seven hearing the true north metrics presented in multiple ways and i think the department is trying them out to make sure that we are in agreement with the general direction and these will be refined over iterations. with only did three of the metrics today. >> good. further questions? if not, then we will move on to the next item. thank you very much for the summary >> although there's no public comment for that request. the move on to item 6 which is update on the transfer of sf dph program addressing homelessness to the apartment of homelessness and supportive housing and commissioners, i just passed out to you a document director may prefer to an out run and open up the slide. >> i will be making the first presentation. it's an honor to be here with our new director jeff kazan's feet of the san francisco department of homelessness and supportive

housing and a provide an update as well to the developers of the department. the commissioners have asked for an update on what we transferred to the new department and we gave you both things which was a financial which is $42.5 million of services and also the fact that we are still involved with those who are homeless and we'll talk about that a little bit about that before introduce the new director to come up. so, 42 million, 8.9 was $9 million, is the san francisco was a reaching and there's only six civil service that are part of that. there's over i believe almost 70 individuals who are the outreach team. those are from a contractor so they would not be listed here under civil

service could housing and urban health, 32 million, and that is the attachment we gave you with all of the housing units that housing areas that we transferred to the community departments. under the community programs area, we can't conduct with homeless prenatal would almost 300,000 and many of you know what about labor projects is project homeless connect, which is a real opportunity opportunities to get involved in our own lives connect and daily connect it happens and that's $1.1 million. as you know, the department serves homeless individuals every day and our job and i'm really proud of the fact that what the director of the new department will be doing is leveraging all of that housing route the city and we

were not the only department to provide a transfer to human services. did as well. they are the top two departments that did that. so, the housing component i think will be well taken care of. also, leveraged with all the other departments. our job will continue to be clinical and to support the individuals in those housing units and to work closely with the new director to ensure that the clinical needs of the clients in housing, those who are homeless, those without breach teams are continued to provide care. mental services and primary care services. also, at times having to be in our hospital system. so, we will continue to be partner with our new director and i want to see if there's any questions or the transfer of these funds and that we can ask the new director jeff kaczynski to come up and give his presentation. >> commissioners, questions? the first presentation on the financial transfer. on the building where you're also talking about that >> these are the buildings attached to the 30 million transfer. >> so, the back page it looks like it might've been cut off

but it says ambassador and has little numbers. >> okay. we can get that updated. it doesn't look like it came through >> which i think is a fairly sizable hotel. so, >> we can give you another update of that >> thank you. >> i will send that to you. i can print that out. presentation is going on. >> okay. that is fine. any other questions at the moment in terms of the financials and the transverse? if not, we can proceed with the >> i just want to say this is done gone very smoothly. the new director can tell you exactly where they are in the process. but many of the staffers still where they are digitally in 101 as new opportunities form make space for the new department. we also are providing some of the personnel support and as the apartment ramps up its role we will be able to then go back to the role we play but right now we are trying to provide the services as much as possible to the existing services. so it's

a smooth transition and i think they're going to be opt up and running very soon, though. >> thank you. >> salon by dr. jeff kaczynski. our new director of the san francisco department of homelessness and supportive housing. >> welcome. >> thank you dir. garcia and commissioners thank you for having me here today i has to give a brief presentation on the new departments did not just give you some topline information and be happy to answer any questions that you might have. just a little bit about the problems that were trying to address and is currently 6700 people experiencing homelessness in san francisco. although that number has been relatively flat during the past five years, we have seen an increase in the number until third homeless individuals we currently have 3500 people approximately living on our streets. the mayor along with dir. garcia and try and work on the human services agency, determined that would make sense to put all homeless pearl jam's under one department in order to

better coordinate the city's response to homelessness. the dph and ages they have done some very extraordinary work during the many years and providing services to the homeless population it i think most notable is that since 2000 2004 week of 23,000 people exit homelessness. i should also point out that some of the nationally recognized programs, actually internationally recognized programs, on how to address homelessness best practices used around the country were developed right here in san francisco. frankly, many of them were developed in your department. so you all should be proud of your roles in developing some model revamps including the direct access to housing program which is really seen as a gold standard for how to address the intersection between health issues and homelessness. project homeless connect, re