>> good afternoon, the commissioner will please come to order and the secretary please call the roll. >> present. >> present. >> commissioner chow. >> present. >> chung. >> present. >> sanchez. >> present. >> the second item on the agenda is the minutes and approval of minutes of october 172,017th. >> motion is in order for the approval of the minutes. second. >> so moved. >> it's been a motion second are there any corrections to the minutes? if not all those in favor of the minutes please a aye. >> all opposed the minutes have been approved. >> thank you. >> next item. >> 3 the director's report. >> good afternoon commissioners i want to welcome the ucsf pharmacist students, lift your hands so we can wave at you.

also our members of our drug usage union are here today to testify so i want to acknowledge all of you. and many advocates from the community so we'll have a very great commission meeting today. and just on that note, we'll let you know president trump announced he is helping human services agency to declare a opioid crisis a public-health emergency. this does not provide us new dollars. there are a couple of things i think are worth noting, one is that there may be flexibility about the regulations of certain medications considering being able to pay for tele medicine for many rural communities who do do not have access, this would be a real important part. also naloxone, trying to reduce cost to that and also there is some concern from h.i.v. advocates in the way they've allowed for thinking about flexibility to shift resources from h.i.v. and a.i.d.s. to this issue but i think over all,

knowing that it's a public-health emergency i think is from a symbolic message i think is very important. as you know, we have been discussing this for the last month or so. we have had a epidemic, i mean an outbreak in hepatitis a in san diego and santa cruz. it's in san diego and in santa cruz, not in san francisco. but we are doing a lot of preventative vaccinations and to date we've already vaccinated 3,000 individuals at risk and those include homeless individuals and drug users. and we believe we're trying to do this in a preventative way and we believe we have enough ak vaccines in stock and this is a really important part of the work that we're doing in terms of prevention and there's over

500 individuals in san diego that had hepatitis with almost 30 people that have passed because of it. so, a lot of this is being part of ensuring that people have access to water and being able to use rest rooms and wash their hands so as you know, we've had many pit stops in the community and we've done a lot of that infrastructure that many of those cities are now having to look at as part of this. so i'm proud of the staff, we've opened up our disaster operations center to do this and i want to particularly note that our emergency preparedness staff have been involved, all of our clinical staff and many of the groups from our executive staff have also been involved. also, during the d.p.h. has responded to north bay fire victims over 115d.p.h. staff and contractor staff have answered the call to go to the many shelters up north. many of these individuals were

spanish-speaking and they've done i think an incredible job of responding, we were the largest response group in the area that provided support helping many of the neighbors in the north bay. i will end my report there unless there are questions to the report. thank you, commissioners. >> thank you, commissioner. any questions? >> i don't think your microphone is on. >> i thought we might try to have a report on the reduction subsidiaries as they now affect us. >> before we ask our deputy director to come up, let me make an announcement i think is one that is really great and another that is a big loss for us and that is colleen chala will be the alameda health director in the next couple months. we're proud of her and also of

course it's a big loss for the department so you may want to take advantage of her in the next meeting so she can report on the policy issues. in alameda she's done a lot more than policy and i want to acknowledge that she's done a lot of work around many of the things you will hear today on your agenda and it's a great honor to work with colleen so we want her to come up and we can give her a hand of applause as well. >> right, congratulations. [applause] >> we wish you well but hopefully you can give us a good report. >> interview: thank you, i appreciate those kind comments and it's really a difficult decision to leave. i've been here for nearly 13 years and i've learned a lot since i've been here and i really love my job and it's prepared me well for the one in alameda county so i'm looking forward to that. i'm sorry that i won't be here to talk you through all of these interesting policy issues like safe injection and other things

and the future but i'll still be watching from across bay. but i can answer your question about cost-sharing reductions, the cost sharing subsidiaries, california anticipated that the cost-sharing subsidiaries for people 138% and 2 50% of the federal pottery level might go away and they enacted law that essentially allowed insureers to instead get their subsidiaries from another pot of federal money so it shifts from the cost -sharing subsidiaries to the tax credits and it will have little impact on policy holders through covered california, not zero impact but minimal impact. so we're fortunate to be in a state that thought ahead for that policy issue. >> very good. do you know if recovery california is making it well-known to the public? >> interview: they are, they are mostly the reason that it's effecting a particular plan so

people who fall within certain income brackets are being navigateed towards that level plan so that the impact is least felt. >> interview: very good, thank you. and i guess you do have an update in regards to the new bell that is going through, i mean, what is the staff us righf the bipartiasan bill? has it changed in the last two days or three days? >> are you talking about the budget bill? >> the congressional budget on the bipartiasan retention of the subsidiaries? >> interview: i haven't heard anything different than what is reported there. >> ok. >> thank you. >> commissioners any further questions? >> yes. i'm sorry,ers first. >> thank you for all your good

service and we will miss you. i hope things workout and you will decide to come back at some point later on too. with regards to the aca and the lack of advertising, that has been supported nationally as the city and county had to fill in with any incrows advertising for a.c.a. enrollment and or has the state been picking up that. >> the state cover california has invested in more advertising and in fact california's open enrollment is longer than the federal open enrollment so the state has invested more in advertising and it's open enrollment is longer so we won't see same challenges faced in other states that rely on the federal exchange. >> do you know if we'll take any measures locally just to monitor or make sure that the communities that need to be reached are being reached? >> i believe that the san francisco health plan is working on that as well as a lot of the c.b.o.s we work with. >> thank you, very much.

>> commissioner sanchez. >> hi, i would just like to -- first of all, again, with comments just even an exception al colleague staff executive officer chief, whatever, and alameda is up there and we're glad you will assume the helm there and you will make an exceptional chief over there. but one question i want to ask with all of our, the work we know and the work we do both here and alameda county together , about immunizations and these problems coming in san diego area, you know, i still am still so frustrated over the fact that i talked to some colleagues today that there are still major, major areas in puerto rico that are still not even in communication even with the ship out there and even with others, you know, and they're going to need all of these

supplies and i hoped with you across the bay we have old navy basis with the port of san francisco is the port of oakland the fourth largest port until the world, hopefully we can think of some ways where public-health department can provide new path ways so when our u.s. citizens in puerto rico and these areas have been begging and asking and still don't have the supplies, perhaps we can find a new pathway, that's all i'm saying, think creatively. what i'm trying to say is as we look at within our own areas, you know, we've always been listen to go other parts of the world, especially where they are u.s. citizens and they are it's just a little frustrating, that's all i'm saying so hopefully we can keep those areas on the radar and hopefully we can get some answers.

>> i share your frustration and i've been in touch with nancy pelosi's office as well and some international disaster relief groups so we aren't looking at it's going to be working with commissioner banel and pelosi and it might be a way to get our foot in the door. we have staff from puerto rico who are from many different areas and we're exploreing the idea of can we send a medical team to one of their homes and use that as a base and maybe get a creditability and i'm kind of waiting to see and make sure they're not a burden on on the local community and so we may have tried veteran's administration first and then look at some other opportunities but there are many disaster groups that are trying to work with a couple of national disaster groups through the national hispanic alliance and working one of them is the next mayor in puerto rico so it's a

very big frustration and i understand your frustration and as soon as we can we will respond just wondering if maybe commissioner banel has comments to that as well? >> thank you. >> so currently the veteran's administration they're accepting volunteers deployed within their own resources and clinics and other places so i don't know that they are really capability to bring in outside groups that would operate outside of the v.a. system but we can make another inquiry with them and if i can add, colleen you've been a tremendous resource to san francisco and a fantastic partner to your counterparts of the state and the federal level and we've enjoyed looking with you and our loss is alameda's gain and thank you very much and we'll miss you. >> thank you. >> a com days coming from you in december so we don't have it today but we will cap a special one for her next month.

>> let me add my voice too, others who have spoken up, i've known colleen, she worked for me in los angeles and i watched her come here and watched her growth and development as a professional and you know we often times talk about the students exceeding the teacher's skill set, colleen has done that in relationship to me and i appreciate the work she's done here but at the los angeles state and federal level so you will be missed but i still have lunch with you. thank you. [laughter] >> thank you. >> colleen, thank you. i can't believe it's been 13 years. we've been working together and it will be a pleasure that we can access you and alameda. >> any time? >> thank you. >> >> item 4 general public comment and we have two requests. >> yes.

>> it's from the ucsf pharmacy and it has noname so the issue of roll back birth control. >> yes, please. you are invited up to the podium so your comments are public comments so they need to be made to the public. >> just for everyone my name is mark and i'm the executive secretary to the commission and there's a lot of public comment that's going to happen today and each you is going to have two minutes and i have a timeer with two minutes and when the beep goes off it means time for you to finish your sentence and walk away from the podium and the commissioners will likely not engage with you in conversation because their job right now is to hear your comment and if they have something to offer they may direct comments to the director next to me to follow-up so we're all on the same page about that.

i'll start the timeer. >> thank you. proceed please. >> ok, hi, my name is shirley and i am from ucsf school of pharmacy and if it is about roll back for birth control it's -- i mean i think we just wanted to know what your current standpoint is and if there are proposed actions against women in san francisco or on a federal level for the people that can no longer afford birth control because of this. thank you. >> thank you. that is a question and we'll move that over to our director of health. and you can actually get that answer back from the director or colleen that can tell you the department's position at this point. ok. thank you. we have one more public comment.

>> i can say 30 seconds. >> thank you. >> hello, my name is michael pet relis and i'm a long-time person with aids and accountability activist and i'm here today because i'm very concerned that there was no public discussion as far as i was aware of a pointing nancy pelosi's chief-of-staff to this public body. specifically, i'm talking about dan personal. my concern about the appointment of dan bernal to this board needs a lot more scrutiny. specifically we need to know why dan bernal has never held a town hall meeting. he has so much time on his hands as nancy pelosi's chief-of-staff he can serve on this panel.

he has also served as a board member of the san francisco aids foundation. he is also currently serving on the board of the national aids memorial. annually, he goes on the aids ride. clearly this chief-of-staff has a lot of time on his hands but not for weekly town hall business. we cannot accept business as usual from the former speaker of the house. our congressional representative is quite busy but her chief-of-staff needs to start holding town hall meetings now. thank you very much. we need town town hall meetings so that dan bernal hearse from us and conveys our concerns to his boss. one big concern that mrs. pelosi does not represent me or my husband on is she is against single-payer health.

you have appointed the chief-of-staff for the congressional representative from san francisco who does not support single-payer health for all. that is one of the issues we need to address when dan starts holding town hall meetings, thank you. >> thank you. >> and just for everyone to note that's how this works. public comments. [laughter] >> we'll proceed onto the next item please. >> item 5 is a report back from the finance and planning committee from today. >> commission. >> good afternoon, commissioners the finance and timing committee met before this commission meetings and we have focused on mainly two items, one is the contract report which you will see on the consent calender which for contract under the

report for your approval and the other discussions that we have is on the draft annual report which will also come in front of the commissions in january for final adoption and we actually also have a follow-up conversation about the format of the contract reports and i think that's going to be like a continuing conversations that we have because like for a long time you know, we've been trying to bring how to reflect outcomes and impacts on the dollars that we invest and as the department of public-health and we have to look at how we format the contract report so we know what we're comparing that to when it comes in front of our desk and so that is it so i hope that you

all have a chance to look at the four contracts in the contract reports. thank you. >> no questions and we'll move onto the next item. >> item 6 is the consent calender and it's noted on your agenda there's only one contract , the contracts report. >> so the contracts report was also afforded to you in the packet and has been moved by the committee. are there any extractions from the contracts report the commissioners wish. >> it's not what we'll proceed to the vote on the contracts report? all those in favor of the report please say aye. >> aye. >> all those opposed recommendations have ban proved. thank you. >> item 7 is the safe injection facility task force

recommendation. >> hello commissioners, i am really excited to be here today and have the opportunity to present the task force recommendations. >> introduce yourself. >> my name is irene lockrin and i work with the community health equity and promotion brands of the department of public-health and i was fortunate enough to partner and work on the safe injection task force with colleen, patrick chang, israeli and 15 task force members and the direction of the director garcia. before i start presenting, i

want to just acknowledge supervise or london breed who really supported this and for her leadership for convening the task force and to explore just innovative and creative interventions to address the issues that is happening on our streets and i also want to acknowledge board of supervisor 's public safety committee which was really in full support of us? >> ok, sorry. >> it was in full support of the recommendations and so moving forward, i'm going to present the recommendations and if there's any questions we can ask them at the end. i also before i began want to acknowledge the task force members we had 15 task force members that gave their time and commitment and just a lot of enthusiasm and thoughtful discussion for us to be able to

come up with the document to share today and most importantly , the direction of director garcia in sharing the task force. >> we know that there are an estimated 22,500 injection drug users in san francisco what is happening on our streets is the same thing happening nationally there's an opioid epidemic and out on our streets, people are injecting primarily people who inject drugs are in the tender loin south of market the mission and bay view hunters point and injection drug users are often male 41 to 60 years of age and often have multiple health shoes and they're at risk for h.i.v. and hepatitis c and as well as

chronic health conditions. as well as overdoses. so we are continually seeing -- i'm sorry, i'm spacing out. i apologize if i get nervous or ahead of myself. i'm very enthusiastic about this topic. so we're continually seeing overdoses on our streets and from heroine and methamphetamine and also with the drug supply just being poisoned contaminated with fentanyl and we do a really great job in san francisco with getting naloxone in to the hands of people who use drugs or syringe programs have been ahead of the curve in that and that's why we've been pretty stable with our overdose since 2006 and there's a range of 160 to 200

overdoses per year fortunately we have not seen the spikes in deaths that are happening nationally and again that's because wore getting naloxone in to the hands of drug users and the communities it's most important they have. so prime reduction is the philosophy our public-health programs and basically harm reduction is a philosophy that we meet people where they're at and recognize everyone is an the the same place and it's important for us to recognize we have to work with people until they're at a place to make changes and that includes meeting people with respect and dignity and kindness and helping people move along and that might mean abstinence for some people it might not but we know it's a

really difficult challenging group to work with for many reasons people challenges and relationships with the health-care system and it's really important that we step back and meet people where they're at and in san francisco we've been doing this for a decade and the way that we would see safe injection services it's just another piece of our harm reduction model in our system of care and in san francisco, we have a very comprehensive harm reduction program right which includes our syringe access and disposal programs and naloxone distribution and medicateed addiction treatment and such adds methadone, our sobering center and the task force really sees this as kind of another tool in our continuum of services and our spectrum of

care. so safe injection services is nothing new and it's evidence- based intervention and they are -- there's none in the u.s. there are programs national ly, internationally in over 100 countries and the wave that safe injection services work that people go to the service with their pre obtained drugs and they go and are able to inject in a clean safe space where other services are available and there's opportunities to link and connect people to services such as substance use and treatments, mental health services, et cetera. so there's several different types, there's the ingrateed model which is basically it's

looked at just another piece of the comprehensive services available and specialized something more of a stand alone sort of sight and then there would be linkages available to services and what we do now is that safe injection services promotes safer injection practices and are an opportunity to pull people to get people connected to services. people who who are hard is reach and have challenging relationships with the health-care system. one of the things of safe injection services is we know

that this would probably reduce the number of outdoor injection that is happening on our streets and we'll also just create a cleaner and safer environment by perhaps reducing the syringe litter that we see on the streets. the next few slides are pictures of different types of safe injection services that are international and we felt it would be a good idea to show these

>> the community because there's already that trust. there's already that and we're moving people along. the next recommendation was just the task force felt strongly there had to be a strong engagement and education component to a safe injection services. and that includes engaging several levels. the public which includes residents and business owners

and neighbourhood groups, law enforcement because if the services are going to set up in neighbourhoods we need the strong relationship and partnership to ensure there's sustainability and that we're all on the same page of what we're doing and how this is operating as a partnership and city agencies and community organizations that may already be providing services or already dealing with the same issues out on the streets. we recognize this is not a stand alone issue that falls within one department or one organization. it has to be a collaboration to be really effective. the education has to happen and the one thing that's not up here is the importance of it also

engaging people who use drugs into the conversation. that's just a given to have a strong effective programme is there needs to be that level of dialogue as we move forward. finally the last recommendation is to identify populations that are at risk for health disparities and just to ensure a place is welcoming to everyone and it came up, well, will i be comfortable there and people of colour, women, lgbtqi we have to consider en our programming and that's important.

and we need to continue the legal analysis exploring the laws. having conversation with the city attorney. advocating for ab186 which will reappear in january of 2018. investigating potential partnerships and service sites and thinking through very thoughtfully how we can do this. the importance of having a very comprehensive work plan is so that we can do this right and just really meet the needs of the community. that's an overview of the task force recommendations. again, i wanted to acknowledge the great work of the task force, the leadership, the director garcia in chairing the group and happy to answer any

questions you may have. >> we have public testimony and we'll accept that first before asking staff questions. if not we'll proceed to public testimony. >> as commissioner chow called calls your name i'll have two minutes on the timer and when the buzzer goes off please know your time is up. >> i will call approximately five or six names as a time. you do not have to stay in the same order but this is to allow you to prepare to be in the centre aisle so we can all receive your testimony and not have gaps between. also, following the two-minute

timer you are allowed to complete your sentence and then please exit. the first five will be holly jess, johnny sevin. police. please. i understood some of you would like to be in a certain order and that's perfectly fine. for this is holly first, jeff, johnny and sevin. thank you. >> i'm holly bradford. i work at the san francisco drug users union. first i want to thank you for being here and for listening to us today. i want to beg you to please let this happen in san francisco. a supervised injection facility is so needed. there's such a street-based

using population. i've traveled all offer the world and lived in cambodia. i've never seen close to what we have in america like we have in san francisco. it benefits the drug users and the population that lives in san francisco. the population doesn't want to see people in the street injecting drugs and needles and the drug users won't want to be seen injecting in the streets and it saves the city money because we get them health care. what i want to say is behind me for the first time i know had are injection drug users from the streets of san francisco here to tell you why they feel sup supervised injection services are important and it takes a lot of guts. you're a hidden population and to come out and put themselves in front of you guys, i ask you

listen to them with open hearts and please pass this on to the mayor. thank you for listening to us today. thank you. >> hi, my name is jeff. every day i pick up needles if the streets because i feel, first, they have to get picked up some way. i feel if we have a facility then there would be less in the street, obviously. [inaudible] i feel we need these facilities and definitely need more than one.

i mean, it's going to save lives. it's going to save my life. i'm putting myself at more risk by picking up these needles in the streets and keeping them off the streets and by people using the facilities. it's a win-win. i had it all planned out and as soon as i got up here i lost everything. thank you. >> commissioner chow: thank you. you did great. next, please. >> my name is kevin. when i use drugs in public i'm afraid i will be seen by children who have enough things to deal with today's day and

able with you name it. it's the last thing kids need to worry about being distracted as far as what they need to be focussed on the things they must be focussed on a daily basis like their school work. just being a kid, you know. 'cause i remember growing up in louisiana and georgia there's fog -- nothing like what we have here in san francisco. i think i speak for most of us when if it was a socially acceptable thing, yeah, but it's obviously not. we don't want to be the bad guys here. with this kind of facility i think it will allow all of us to do that. thank you. >> commissioner chow: following

the testimony is kyle, tommy and ian and nona. >> my name's johnny. i'd also like to speak -- i don't like using it in public. i don't like to offend other people. i think it benefits children so they don't have to get stuck by needles and stuff if the street. i think it would help to have these sites. it would help a lot. thank you. >> commissioner chow: thank you. next, please. >> good afternoon. my name is sevin. i'd like to thank you for letting us speak and the work you're doing and from a personal standpoint it's important when i

inject in public it's stressful. i see the faces of judgment and the looks of disgust and comments as people walk i. -- by. i live outside. i had a home and would go in my room and do my thing. eve everything i do is in public. injecting drugs is one of them. given this opportunity, a place, a clean environment in which so inject would benefit the community at large in general because san francisco's always been ahead of the curve. you were ahead of the curve on needle access and didn't obey the rules on a federal level you figured out a way to get it done because it's necessary. this is necessary. this is an epidemic. we have lots of people injecting. in the eight years i've been using i've noticed it more and more. piles and piles of needles. it's unacceptable.

this will eliminate some of. -- some of that. we'll still be the pariahs but we don't have to be the visible pariahs. it's bad enough being homeless but to be an injector as well it's not necessary when we can inject cleanly. we're rushing our shots because we're afraid of police or people seeing us. it's for everyone's benefit and i really strongly recommend you vote for it. >> commissioner chow: thank you very much. next speaker. >> hello, my name is kyle. i'd like to all very much. it's near and dear to me. i was born and raised in indiana. it's still a felony to be caught with a needle and nine month in prison for it. when i came here and i was blown away by as they said there's

still a lot of problems and injection facilities helps so many things. first off, i find it with great disgust when i see piles of needles and the blood and objects around the street. with safe injection facilities it allows san francisco to put rules back in place where law enforcement can give tickets back to those caught loitering because if you're not doing it where you're supposed to you can get ticketed and puts responsibility to the actions and responsibility for our own waste. i never leave my stuff. i have a 10-year-old driver. unfortunately my drug addiction cost me but i still see the other ones. i don't want to be the one that sees somebody inject drugs. it rips me apart in side. why should you guys have to deal with this. my demons are mine. not yours. you don't want you to deal with

it but i also don't want to be judge or the vicious cycle of judgment. it continues inside of me. it's not good. these things would give me access to the resources to get clean, to get healthy to all the things i don't see any more. if someone says hey, man, we have something for boxing maybe i'd be more likely to go towards it because i'd feel more comfortable talking to that person. this say win-win for everybody in my opinion. and like the guy before me said, you guys do the best thing that needed to happen for san francisco. i've always loved that about this place but it's beginning to take a lot people across the country and you have the chance to set the bar for it and a hope you do. thank you for your time. >> commissioner chow: thank you very much. next speaker, please.

>> my name's tom. i worry about when i shoot up in the street the children will see me and i'll be judged by others. i believe a safe injection facility will do good for all of us. i have brain cancer and i'm dying and the reason i'm using these drugs. i believe a safe clean place would be a great thing for san francisco. thank you. >> commissioner chow: thank you. next speaker. >> hello. i work at the san francisco drug users union and work with holly and these lovely people you just met. i just want to make two quick points. i guess three, the first is it's also tommy's birthday. but i echo the point that everyone's making about syringe letter. our job is considered front-line work and there's not a day that goes by where i don't hear all

my participants abhor the amount of syringes they see if the street. we at the union and other organizations, a lot of the people in the audience today are out almost every day of the week picking up syringes and it's still not enough because you hear lots of complaints. and for reasons you heard about today is why people leave syringes out in the street. i wanted to echo the point a site would diminish the amount we see in the street. two, the thing i see all the time is wound care. i see so many abscesses that get really infected and sometimes cripplingly so because they've had horrible experiences getting help at clinics and hospitals. as much as they'll wait as long as possible to the point where

they can't even walk before they experience that situation again. and i'm not saying all clinics and doctors are horrible people. it only takes one nurse or slip up or i can tell you inject face to not want to do that again. i think this would end that and have humane treatment for my people that would be stigma free and that would be amazing. >> commissioner chow: thank you very much. following the last speaker is aly and michael, one anonymous from ucsf that wishes to discuss the availability of nanoxone.

>> yeah, shooting up is a high-risk activity the one i'd want my kids, my friends, the people i care about i'd want whatever evidence-based practices we can put into play to make this a survivable condition or moment in someone's life. whatever we can do to make that possible. whatever we do let's bring that into play. >> commissioner chow: thank you very much. >> hi, i'm in the street harm reduction centre and i have been

an injection drug user in my life. i'm here to beg you to go through with this. as someone who moved between both of those worlds, drug use, street drug use and now i'm sitting here talking to a bunch of important people. there's a lot of tale of two cities. i think a safe injection space sends a message they're not forgotten and we don't just assume. so many people assume. i'm struck by how many people

talked about not wanting to shoot up in front of kids and the shame. this is our most sensitive population. >> commissioner chow: thank you. next, please. >> good afternoon. my name is michael seaver. many have heard me testify many times and i'm a psychologist whose specialty who is working with people with additions and i'm a drug user. i want to talk about the importance of supervised injection facilities or consumption services. it gets called several things. primarily it's about the health and wellness of the people who inject drugs. that's the most important part. this will go to having supervised injection facilities and services will do a lot of

for particularly homeless people. the streets are not sterile environments to do anything. it's very hard and a lot of the reasons people get sick is because they don't have a sterile place to inject their drugs. having supervised injections facilities would reduce abscesses and we're fortunate in the city because of having naloxone available and we don't have a huge number of overdose deaths like is happening in the rest of the country. and overdose is a bit strange in english