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 because the it doesn't necessarily mean fatal overdoses. and a lot of people overdose. thank got they don't fatally. if we had supervised consumption services it would reduce those fatal and non-fatal. >> commissioner chow: we have norman tanner, shawn laura and dr. alex crowell. >> hi, i'm clara nichols. i'm a pharmacy student at ucsf. i have a comment and then question. my first is my comment. i wanted to thank everyone for coming up today and sharing their story. it gave me a more humanistic perspective on the need for injection sites which is different than the perspective i walked in here with today. the task force recommended an integrated model with staffing.

they mentioned differences with behavioral health and also recommended community engagement and education. my question is what role do you see pharmacists playing within health care services and are going to be offered and also what role do you see health care providers playing with the education piece of it as well. >> commissioner chow: thank you. next, please. >> hi, my name is alexi and i'm also a ucsf pharmacy student and i wanted to voice my support for everything previously brought up in terms of the safe space injection and would like to advocate for safe needle disposal specifically. a potential to keep in mind for the future is the vending machine needle dispensers used in europe and las vegas and more

ease of location placement and the benefit of the safe needle disposal as well as clean needle use. thank you. >> commissioner chow: thank you. >> good evening, commissioner. i'm norman tanner. i'm a community activist. the city and county of san francisco's fault because these people who use the drugs on the street do it pause they don't have no place to live. it cost too much for them to have a place to live. i don't like seeing them use on the street. you have to think about the kids, the elderly. i support them having a place they can come and use safely and get the service they need. but the housing here it's the biggest reason why we got homeless people. the reason why they're using

drugs on the street. we need to take a look at that. thank you. >> thank you. >> next, please. >> good evening, commissioners. it's great to see you here. i want to thank the leadership from the department of public health with barbara garcia and others folks in the department who have taken the lead and thank you for that. i encourage the health department and city and county of san francisco to be bold on this. we know what works and saves lives and it's a supervised consumption services. in canada, for example, they've gone from one to over 25 this year and they've done that because they had a change in their federal government and a change of approach and change of

political will and it's become essentially non-controversial there and i look forward to when that happens here. i think it is incumbent on san francisco to lead the way. you heard earlier we don't have the overdose and opioid crisis they do in other parts of the country but that's a matter of time and a matter of fentanyl making its way to the drug supply as it has in other parts of the country. we need to step up and provide these services and increase access to treatment before it's too late rather than after. from the drug policy alliance perspective, we're delighted to continue to partner with the department of public health and support you and help figure out how to make this happen in san francisco as well as across the state and country. that includes bill 186 and we

hope to have the full support of the health department. this is an intervention that's been supported by the american medical association, the california society of addiction medicine, the san francisco moran health society and it's a public health intervention and thank you for taking the lead on this. >> commissioner chow: following the next speaker will be elaine chan, tiffany tron, annie park and grace leh. >> i'm alex carl. i'm an epidemiologist and work here in san francisco. i've been conducting regarding people injecting drugs in san francisco since 1993. i want to thank you all for the time and thank you the department of public health. i was a task force member and it

was a well-run task force and productive as well. half a million americans have died of overdose since 2000. that's 500,000. it's really ridiculous, 500,000 people. we're in the situation here where we are in a crisis. what we need is innovative solutions. here's one that the been shown to work throughout the world. all over europe, australia, canada. the research is very clear on this. you reduce overdose deaths and reduce hiv and hepatitis c and you link people into drug treatment. we have a tonne of research that's shown all of these things and the other side it helps the community. you reduce the number of discarded needles and crime and violence around the sites and

public perception increase once you institute them. in sydney, the site there they were concerned about in the neighbourhood and then they had a model and asked a year after that and public perception in the neighbourhood was higher than before about these sites. it's something that's a good part of community practice in general. the research is clear on it. the research shown here a lot of our research it would save $3.5 million a year. that's beyond the cost of running these and that's probably an under estimate. we're going to save money along the way. that's all i have to say. i hope you approve these as soon as possible. thank you very much. >> good evening, health commissioners. i'm elaine chan on behalf of

myself and my partners. we're health care professionals and want to express our support for safe injection facilities in san francisco. s -- as you are aware there's a growing movement across the united states for the services in seattle, new york, baltimore and new mexico. we believe now is the time for us to be bold and to be trailblazers. let's bring safe injection facilities and services to the city. be the first city to demonstrate the success of the model in the united states. >> commissioner chow: thank you. next are varsha, pandi, angie and dr. christie warn are --

warner and lauren kohn. >> i'm dr. christie waters. i'm a member of the california society of addiction medicine. we have over 400 physician wrong to the group in california. they don't all live in the san francisco but we all support this idea. we're all working hard to support ab-186. we appreciate your hard work and would urge you to push on. thank you. >> commissioner chow: thank you very much. >> good afternoon, commissioners. i'm a third-year farm d candidate at uc fresno. my question is on how the city of san francisco can be more proactive. the act ab-182 was to increase education on opioid and heroin. trump's attempt launched a prevention campaign to educate the public about the dangers of

opioid. my question is why we can't do both. warn of the dangers and informing the vulnerable and already addicted individuals who take opioids on the services available to them. there's an excellent presentation on what is already being done and how they're doing a good job getting naloxone out there but i think there needs to be more information on follow-up and ensuring these people are seeing health care professions to -- professionals and taking steps to become clean. and i want to thank the brave people who shared their stories because it's impactful and increases my drive and passion to act on the issue. thank you very much. >> commissioner chow: thank you. >> hello. my name is rasha pandi. i hoped to speak during the public comment section but i was called now so is it okay if i

share something alternative. >> commissioner chow: we're sorry. >> i'm here to advocate for the family pact programme established in 1996 to provide reproductive services to low-income families with an income of 200% or less of the federal poverty limit and ensure optimal reproductive health but it doesn't include lgbtqi individuals because it's only accessible for those for a medical need for reproductive services. what we know is sti screening is essential for ensuring optimal reproductive health because chlamydia and gonorrhea can cause infertility and gay men are at greater risk than heterosexual men and i'm bringing this issue forth. i know it's poor timing, i

apologise. i'm bringing it forth so it can be addressed in the future and the disparity can be addressed. >> commissioner chow: thank you. before we proceed to the next speaker let me call several other names. polly gray, scott steiger and otto duffy. >> i'm lauren kohn from health way 360. we provide treatment and services to over 300 people from san francisco annually and we were happy to have the opportunity to contribute to the task force in part by serving the people in early recovery in our programs to find out what they thought about safe injection sites. it occurred to us maybe they would not be in favour of the idea of allowing people to

continue use and one of the responses we received is if it saves lives it's good for everyone. also i wanted to pick up on the id idea that people who use outside are pariahs. if people are feeling they're rejected from society, it absolutely drives them further away from seeking help and treatment. it's really important to consider safe injection sites not only for the dignity they provide and as an important way to come into substance abuse treatment. >> thank you. my name is pauly. i'm reduction work for almost two decades and been on the other side of it before that. a lot of the things that have been said are things i was going

to say and want to echo them. sometimes things are repeated because they're true and i want to say quickly, four things. one is this is not a radical idea. this is just common sense. it makes common sense economically and financially and medically and as far as us being human beings. it's a matter of stigma. if you believe in god we're all equal and we can agree on that. second is numbers from 2016 showed if you add all the deaths called by speed, heroin, crack, all of it together, they don't equal 18% of the death caused by alcohol. they have safe injection spaces for people who drink, they're called bars. it's common sense we need a place -- if you don't want people to shoot up on the street give them a place. i've been to montreal and it works. san francisco and california,

i've been here 35 years and people say those whacky californians and on the they do the same thing and i know someone who was infected with hiv. if people aren't chaotically using and terrified in the situation where it's dirty they make decisions they wouldn't normally make. in a safe injection facility you have options. on the street it's survival only. no one needs to live a life survival only because they do less harmful drugs than drinking. >> next, please. >> good afternoon. i'm the director of the behavioral health services in the stonewall project with the san francisco aids foundation and oversee our substance programme and i'm here to

represent the aid foundation in a statement about the fact we have as an aid foundation have looked at the evidence and believe in this model of care. we will sit at the table with the san francisco department of public health if you decide that's the direction we'll be going. as a provider, i've been doing this work over 20 years. i can repeat what people said before me but what i want to say is we have to think about this, what if this is your brother, father, sister, mother, lover, many of us have lost people to drug use and drug overdose. there's systems of care that do not accept people where they are. now's the time to make a statement in san francisco the lives of drug users matter.

the statement goes further than you can imagine. just saying we're willing to open it tells our drug users they matter and we have hope for a better life for them. we have hope they can improve their conditions. whether they stop using or not. the time is now. we're at the table with you to partner with you and others are as well. this is definitely a state of emergency, public health emergency in san francisco. we can lead the nation and we must. thank you. >> commissioner chow: thank you. next speaker, please. then i'll call the final names, curtis bradford, jennifer kiff, ann colmes, paul harkin and

lydia branston. thank you. if you're name was not called -- and one more -- terry morris. >> i'm a physician and i work at the out-patient programme at fresno general and a primary care doctor. i wanted to echo the 360 folks that the community is in favor of this. i just got back from the association of medical educators and research on substance abuse conference in washington, d.c. and i can tell you that organization has endorsed this effort as well. it's through the ab-186 bill. opioid overdose should be a

never event whether it's in the hospital or or outside the hospital. the reason is we have the antidote. people are overdosing and don't have access to the antidote or not around other people, that's how you end up with a fatal overdose. the second treatment point is we don't have great treatments for all drugs people use. that's something we don't like to acknowledge but is true. so how do you get people to change their behavior? well, you keep them alive long enough they figure it out on their own or you get them hooked into treatment that becomes available that aren't necessarily here right now. they're ten years from now. maybe there will be a more effective treatment for methamphetamine disorder. how do we keep people alive long

enough? we let them use it in a secret way. from a treatment perspective we're up favor of supervised drug consumption services. the last point i'll make is from my business end, we're ready for patients. they are more likely to end up in care if they are alive and more likely to end up in care if they use publicly sponsored services. >> i'm involved in a large number of organizations in pemberline. i'll start bringing my issues with federal policy from now on and work them in substance users often use the toilet down stairs to use their drugs because if they overdose which occasionally happens it's a facility.

sorry, you probably shouldn't have said that. i don't want to advertise that. there's broad support for this among activists like myself and it extends to service providers as well. we want it see this work to lower addiction rates and whatever law enforcement is involved it will improve it. it's not counter to it. i have an application my organization put in for a $2000 grant to help with volunteer street cleaning we do. $2,000 is the amount of money your department consumes in the speech i'm making even if it's brief. the things you run into street cleaning one isn't needles. when we started the needle

exchange maybe this is the ultimate outcome of that. thank you. i hope you support this. >> thank you. >> next speaker, please. >> hi, commissioners. thank you for your time. i'm curtis bradford. i am a bord -- board number and for the masses coalition and tendline people's board. i list them because each and every one of to the organizations i mentioned has seen a presentation and had a meeting specifically on this topic in the last year. i can honestly say without exception every person i've spoken to supports you. as you can see there's no opposition. it's clearly the right choice to make. and why?

because it's the compassionate and humane thing to do and the right choice because it's the best thing to do from a public health standpoint and makes sense from a financial standpoint. i would encourage you to pass this. also as a former iv drug user myself, i would like to advocate and say strongly i support a decentralized version where services are provided already. as a drug user i wouldn't have traveled more than a couple blocks to use a safe injection site. just being honest. i would have found an alley in

between and that's how my mind worked when i was using. if there was a place within reach i would have used it. so if i can get it at a place i'm already getting for services i would is used it. i urge you to move it forward with some urgency. thank you. >> i'm from the st. francis foundation. together with st. francis hospital lead the health improvement partnership. we met with the commission last september and spoke openly the need for safe injection. it was one of the first forum to discuss the potential to significantly impact the health in a positive way and i think the commissioners for their curiosity and willingness to

explore further what the benefits are to those who use drugs and the community as a whole. in exploring the issue with tenderloin stakeholders we all learned from a multi-sector engagement. including representatives from public and private and drug users themselves. we went from how we looked at it to the stigma and disrespect shown to them as members of our community. if we want to reduce usability and mitigate needles we must offer a place to do so safely and be treated with dignity and respect and get access to services. our stakeholders have moved to operating plans for safe

injection services. we fully support the recommendations. at the recent hearing at the board of supervisors we asked to declare a state of emergency to allow the necessary services to our community. there's over 50 members of the community that testified at the board of supervisors hearing. as a funder of st. francis challenges to provide operational funding as part of a spectrum of harm reduction services. we believe this is a safe injection facility will cause intervention to have a profound impact and the health of the community and individual drug user health. thank you. >> commissioner chow: thank you very much. next speaker, please. >> thank you. i appreciate you guys here and i

want to thank supervisor garcia for the leadership. it seems weird to me we think of this as a controversial step. if anybody has read this report, it's emphatic that this is an evidence-based intervention and there's not a down side [inaudible] the diseases that will be prevented the connection to services. it's not just about coming up and having the act of injection and it's about folks that have been criminalized and stigmatized and i worked and

lived in the tender line and the program director for glides centers and i consider myself to be quite the expert. for me the controversy is why we're not doing this. i've seen so many people overdose in carports and bathrooms and this is going on and on for a long time. yet this intervention's been around over 30 years. san francisco was once a pioneer in harm reduction and interventions and we need to get that mojo back. while we're sitting here debating this, there's going to be overdoses and abscesses and people have toxic encounters with trauma and we'll see people dying on the streets. not only are people injecting on the streets put dying and we have an intervention.

if you google it you can see it's a highly efficacious intervention and let's do it and allow provisions for folks to do it in the community so they have legal cover. >> commissioner chow: next speaker, please. >> my name is terry morris. i want to thank you for hearing us today. i work with a harm reduction center and program and i started doing harm reduction work as a volunteer 18 years ago in atlanta, georgia where there's incidents. when you hand somebody a clean syringe in georgia, it's an act of civil obedience. when you want it make changes you have to be willing to engage the community and people in

atlanta, a lot of people in atlanta at that time needle exchange sounded outrageous and crazy and harmful and i think in san france conversations need to happen. we work with a lot of other community organizations that are willing to have those community organizers with folks with our businesses and people who need to talk the issue and we'll approach them humbly and respectfully and we've had 100 interviews with people who inject publicly. we sat in a small room with people and listened. people said they were injecting indoor ways, garages, busses, bart trains, in bart stations, in alleys, in tents, in the public rest rams -- rest rooms

of nonprofits. injecting affects every san franciscan and it would give law enforcement a place to refer people and give social service providers a place to send people where they'd be safe. it would prevent firefighters with a place to refer to and change and save lives. thank you. >> commissioner chow: next speaker, please. >> good evening. i'm lydia branson representing st. anthony foundation. i'm the dining room manager and on the task force. we heard a lot of powerful voices today. this is a really intense topic and one that st. anthonys has

had a very strict policy of abstinence and zero tolerance for drugs on our property for many years of the 67 years we have been part of the community. it's been a long learning process for us. to be able to stop and listen and look at what's happening in the community. we're at a time now where we have learned a lot and listened to the same voices you have heard today. what we have learned is that you can't [inaudible] you can't

detox the dead. so how do you stop people from [inaudible]. it's not by saying no. it's by saying, yes, please come in. you're welcome. you're part of us. you're one of us. how can we help you. safe injection sites will provide an opportunity to make those connects. -- connections. thank you. >> commissioner chow: thank you. next speaker, please. >> thank you for listening to our comments. my name is hannah. i've worked in this field for almost ten years. every day i work alongside people in need of this service

and it continues to drive a rate of homelessness. so many community members need a place to go to exist even for a minute. not just to use drugs but clean, safe private place to use the restroom and maintain hygiene and maintain peace and solitude. it's something that can be taken for granted and considered a human right. as a service provider we'd be a critical first point of contact for a rare opportunity for the city's highest need community members to connect with support, referrals and linkage to other services. as many can attest, people must have their most basic needs met before other life changes can be possible. i also want to bring attention briefly to the benefit of supervised consumption site would have on nonprofit

organizations and public spaces. those who operate these spaces are face with the dilemma of having to deny services or face the reality drug use will happen next door and lack the capacity, staff and training and tools for it to happen in a safe and responsible, practical way. one of the most heartbreaking conversation i've had is no, you can't use our facility and there's nowhere else you can go. that puts them in a position to either choose to break the rules or lose services or face injecting between parked cars.

>> commissioner chow: thank you. are there any other speakers? if not we will proceed to discussion within the commission. the commission placed this on the agenda as we wanted to receive the report that the board of supervisors has asked our director to help lead and it bring that for us for our information. we really thank the public for bringing your information to us so we can see the best way in which this commission could assist in this public issue and public need. so i ask my fellow commissioners now to either ask further questions from staff and give us suggestions as to where our next process will be. this is our first hearing on the

report and we've seen the recommendations as we could then review and go on record an endorsement of this or continue to work with our director on this. so i ask our director first to makes comments. >> you heard drug users' lives do matter and we need to work diligently and quickly in finding ways to open these types of facilities. we have some legal issues but i don't want to use that as a barrier. i'm going to work closely with the supervisor asking us to be as quick as we can and i'm having conversations with the city attorney.

there are already organizations in this room willing to do this today. we need to help them develop those. i think our role will be to help develop protocols and policies for them and also give some structures. there's plenty of organizations doing this around the world i don't think that's going to be a big problem but this is really important for me personally. so i do want your support to allow me to continue. >> commissioner chow: commissioners, comments, questions to staff. who would like to start? commissioner karshmer. >> thank you for the work you've been doing. it sounds like white a remarkable and -- quite a remarkable and fast process.

thank you for that. i also want to thank you for coming and testifying today. it makes it a real and incredible concern and i can feel how anxious you are. i get it. and i think we all echo director garcia's belief in something we need to move forward rapidly. >> commissioner chow: commissioner. >> first, thank you for your presentation on the topic. thanks to everybody who came out, particularly jeff and kevin and kyle and tom and others who shared your experiences. one of you said to make it a survivable moment. people have difficult challenges at any moment so it's a good philosophy to go by as we look at this. my question involves the safety

and vulnerability of those who avail themselves of these sites either in your observation or what is done to protect those at the sites being preyed upon or take their vulnerable situation. >> i've been to vancouver so i was a witness to the services. the organizations provide the safety. also the police are very supportive the service. in fact we walked with some of the police officers as well through the neighborhood and it's safer because the facility is there. i think there was in vancouver they had people who volunteered at the program and also worked at the local bank. they were able to use this

facility as not only an opportunity to improve people's health but the community is very important. the safety issue is where people are having to hide or shoot up in our bathroom downstairs. so i think the issues of when we go into a neighborhood with already-existing organizations there could be concerns of the neighbors about the safety and we'll have to look at that in terms of security. there have been concerns and we heard positives today but we heard some neighborhoods who spoke about bringing dealers close to the facility. drug dealers are probably two blocks from here now. i think the facilities do protect the individual coming

in. can't protect them once they walk down the stress but once they're in the facility i think they'll be protected. >> commissioner chow: commissioner loyce. >> thank you to eileen and members of the task force and those who took the risk to speak publicly to speak what it means to them to be in harm's way from the law anniversary -- enforcement side and people took exception to the pariah and if i feel like one i will do things pariahs do. it's a feeling and needs to be acknowledged and people need to recognize and be helpful in terms of that. for those who have been involved in the recovery of those folks who have a variety of medical

conditions on the recovery and treatment side, i recognize this is a very challenging issue and we'll not answer the question today. but we need to take the opportunity to recognize this. san francisco is on the cutting edge. i was here when everybody in the world says it's illegal, you're going to bring drug dealers to the community. we were already there. you're going to bring more drug abusers. they were already there. you're not bringing new people to the party, so to speak. what we need to do is continue our risk-taking behavior. i'd rather be on the side of commission than omission. commission means we save lives and omissions means we contribute to the deaths of many san franciscans. because somebody smokes, shoots does something doesn't mean they're not valuable.

i will support the next steps because i think it's critical and essential. the legal analysis and ab-186 and the potential partnerships on service sites and a work plan. but i strongly support this notion. we'll take risks in san francisco. we have and will continue to do so. when i go around the country and say i'm from the independent republic of san francisco. we're housed in california but we're san franciscans but we do what's necessary to take care of the health and welfare of our community. thank you for the insightful statements. >> i want to thank the speakers who have come up to speak on the issue especially those who are drug users who have been courageous enough to go through

the process and be part of the presentations. i believe every step of the way it's unprecedented and it gives me so much hope to see we have become a city that would be willing to stop and listen and give the dignity back to those who need it most. so i speak in favor of moving forward to the next step because i think like many of you have said we have always been on the cutting edge and i believe this not the only city we're considering having the supervised injection sites. there's other cities including chicago and new york. of course we are better than chicago and new york and there's that friendly competition as well. for us, as a commission, it sounds like we're ready to move to the next step and empower the

director and give her the directions to move forward. i would encourage commissioners to join me to support the director and the task force to work with the city to find the best means and ways to make this a reality. >> commissioner? >> i was moved by our friends struggling on the streets every day. i want to share my personal struggle with this issue. i work with addicts and alcoholics every day but i've not heard these stories before. four years ago we began discussing this at the california addiction society. my friends wanted to put this in

san francisco as the place to try this first. i read all the articles and looked at the evidence and i said, you know, the evidence is there but i can give you any conference and tell you about evidence of things that work and don't work. i was at a stand still. i said it work but do we want it to work in our neighborhood. it wasn't until we looked at the alternatives at the civic center and saw the difficulty of all the individuals using in front of bill graham daily walking past going to bart. today even listening not as clients -- i don't want to think of them as clients. this is family and friends who came up here and didn't have to come up to tell us their story and what they told me and the

question i've always had is the evidence says this is work but if we build this, will you use it? if you use it and go then why not. if you go and you'll be respectful to the neighbors and kids, which is what i heard, and get the support of the neighbors and the kids and the agency in the neighborhood, so much the better which we heard. i feel the discussions could be an indication of the conversations we have to have across the city. this is a slam dunk and no-brainer. at this point we're not offering any other real or positive solution. and we have methadone and needle exchange. i think this is the voice of our friends and families who are addicts and alcoholics and just telling us this is what we need and what we'll use. one thing i did find in the evidence i was reading was

there's other things that i think people are learning. i'd like to put this in there as well. we want clean washers and dryers to do laundry. i want a place where i can take a shower. i want a place with maybe i can get a little bit of a cup of coffee so i don't have to go out in the street hungry because my next street isn't until 7:00 in the morning. we need to think about this in a comprehensive way to not only provide a safe injection site but a place to rest. i like to travel up and down i-5 a lot and i'm a connoisseur of truck stops. i can tell you the difference between a pilot and an okay, you know, corral 6 and they're good places to get a clean shower and warm meal and i hope the safe

injection sites will serve as the same respite for friends and family using. i'd rather they be there then in front of bill graham or on the streets. you've convinced me. it's with that i would like to ask to make a motion, if i can, before our colleagues. i think we're going to be requested for some action to at least at this point support the final report or support the recommendation. i think there's a lot of work that has to happen. ab-186 is like bouncing back and forth there's a lot in the work plan, how many will use it, what's the cost, how many facilities, how many washing machines and do you put quarters in or is it free. that has to be worked out. as a place to start, i think the

report as a basic recommendation, if people are willing today or do it next time i'd like to make a motion we consider it as a commitment to >> such a motion is out of order because it's not slated as an action item because we wanted to first receive the report. with the sentiment that's been discussed we will move forward to create a resolution that can be voted on working with staff to determine what would be the best way to be supportive as not only merely supporting a report but what will help move this forward is the sentiment i'm getting put forward into a resolution.

it will be before you within the appropriate time frame. if that meets with the commissioner's pleasure, we will create that resolution for discussion and acceptance at our next meeting. >> thank you very much. we thank the public again for bringing to us the reality of what this report is and all who have taken your time to be with us tonight. thank you. >> i am sorry, commissioner sanchez. >> apologize. >> i agree with my colleagues. i think this is a unique hearing because for the first time i can remember, we had all parts of the equation, the patient, the nonprofits involved in matching the two worlds and are providers, physicians, students,

etcetera and all focussed on could we all look at our patients as human beings and could we look at them with dignity and respect. it's sort of like what the st. anthony's clinics and nonprofits have been doing for years. dignity , respect, hello, how's it going today instead of -- you name it. our presenters -- i've seen some of our colleagues would presented today in different parts of the city in different circumstances and to see them here today and share and stand before us in a formal commission is astounding. the fact that many did it because your all here. you're all part of this equation. you're all part of the staff's recommendation. i think the past recommendations

are unbelievable, fiscal models, etcetera, limitations -- it's an excellent comprehensive document and asks us to continue to work out these critical areas that will affect the quality of services that we could provide as a model not only for san francisco but other parts of the nation. i agree with my colleagues we're fortunate to have exceptional task force members, our director, to follow through on the request. i look forward next week is fine. i'm sure it will be unanimous. there were so many doubts that a number of people have had prior but the presentations tonight really i think blew everybody away. everybody was here at the table and we all listened.

we thank you very much for sharing that story with us and continue on with fine work. >> thank you, commissioner, sanchez. so you are not opposed to my summary. i apologize. it is up contrast to commissioner loyce the hearing to when we were speaking about injection drug use and in contrast, today's filling of the auditorium here was in opposition to that. the ability to bring together so many factions and neighborhoods and people and having this type of consensus demonstrates a complete change in how the city is viewing this and we will move forward with that resolution having it available for the

commission. our next item has been -- we have asked with the commission's permission to defer because it should have a longer hearing as our time is coming close to you are later hour and give sufficient due consideration we're asking the permission of the commission to defer that to an appropriate meeting. i can assure you there's adequate safety. i hear no objection so we'll move to the following item, please. >> the next item is other business. >> the other business is just a reminder of the next several

meetings. the november 21 meeting will be at zuckerberg general -- and december 5 at laguna honda and december 19 the special planning. >> december 19 is the special planning committee. >> in room 220 here. the next item which is the joint conference committee reports. >> i was going to ask you if you wanted to have that. >> you can give a brief report. you can read the minutes on it. the committee did meet on october 24 and received the regulatory affairs report which was excellent because our hospital has been performing exceptionally in these surveys.

we also received the hospital administrators and care report. more importantly, we also ten looked at for our consideration at our next meeting, the various policies and the annual report which you will receive at the next meeting. approval of the orthopedic rules and regulations to standardize protocols was also approved in closed session we approved the credentials report and pips minutes and their work. i encourage you to read the minutes for more detail. >> item 11 is commission agenda setting. >> i think i completed it. we're prepared for a motion for adjournment. all up favor say aye. >> aye. >> this meeting is now adjourned.

thank you. [music] >> san francisco city clinic provides a broad range of sexual health services from stephanie tran medical director at san francisco city clinic.