contradict, not 50, not 60, not 70, not 80% but more than 80% of our prisoners, of our men and women happen to be high school drop-outs. over 80%. now, yes, it's true at this site we'll only look after 52 children, but all the data that we have, every single report we have read, those children, children from low income families who have access to early education programs will most likely graduate and continue on to college and graduate from college. that's our goal and with support from mayor breed, we'll make that a reality. in closing, i would like to acknowledge that this effort, our coalition and frc at this point is being introduced

because of two other organizations with mission neighborhood centers at the lead, good samaritan community resource center. (applause) is one of our partners. our second is mission economic association. (applause) so with that, i would like to thank the mayor's office of community housing -- mayor's office of housing and community development. they keep changing the name. my apologies. (laughter) thank you very much. so i would like to introduce our next speaker, a client of mission neighborhood centers, a parent, anna (spanish) (applause) we'll have translation services for those who can't speak spanish. thank you.

(voice of translator): hello good morning. i'm very grateful to be here to be here with everyone here at mission neighborhood centers. (speaking french) (speaking spanish) (voice of translator): my experience with missionary neighborhood centers is they have provided childcare for me and one of my daughters is there as well. (speaking spanish) (voice of translator): there's a lot of people here in our

community that don't know a lot about the services here in our community. (speaking spanish) (voice of translator): a lot of the barriers that our latino community here face is not being able to speak english and just being afraid because they don't speak english. (speaking spanish) (voice of translator): many times we are in fear so we don't seek services because we don't have our immigration status in order. (speaking spanish) (voice of translator): our community here needs houses and jobs. (speaking spanish)

(voice of translator): i think that if our community here was aware of more services, things would be a lot easier for us. (speaking spanish) (voice of translator): i hope that together here in this community of bayview, together we can all do more. (speaking spanish) (voice of translator): many times in my case i live here in the bayview district but have had to go to the mission district to get services.

(speaking spanish) (voice of translator): thank you for opening the center and for it being able to support me and to work together. (end of translation) (applause) >> so our san francisco latino parity and equity coalition consists of 21 member organizations and included in those 21, the executive director is joining us this morning and is the next speaker. (applause) >> good morning. today is a good day. like a few days recently, when we're able to come together and not only celebrate the opening and expansion of services to latino families in san francisco and immigrant families, like we

heard our mothers talk about how important it is to have access to services in your community and not have to travel, which is always difficult when you have children, especially if you're taking public transportation and this is a long time coming. the latino community has been part of the bayview district for decades and has been underserved and so this space creates an opportunity to build a community and black and brown and multicultural alliances, mainly with low income families in our cities. we're proud of the advocacy that resulted in additional resources granted by mayor lee so we could be here today expanding services to our children and families and make the best investment a city can make, in our children, youth and families. and we're happy to say justice is ruling in favor of our youth

once again and of what's right. san francisco has been a pillar in the nation and even internationally in terms of expanding protections for immigrant communities, making sure that our city is a city that affirms a value that we're a city for everyone. we know this ruling today will only lead us to a greater victory for the dreamers, because they are one of our city's, our nation's greatest assets. they're bilingual, they're bicultural. today we're investing in our most precious assets, our children, youth and families. congratulations and let the work continue. thank you mayor. (applause) >> thank you for the words. and also mayor london breed, thank you for being with us this morning. it is greatly appreciated.

and with those words, also thank all of you for joining us this morning and this press conference now is closed. thank you very much. thank you. (applause) ♪ ♪

>> good afternoon. the health commission will now begin. >> i will call roll. [roll call] >> first item on the agenda is at approval of the minutes december 19, 2017. >> i move to approve. >> second. >> any deletions or corrections pertaining to the minutes? all in favor, aye? opposed? approved. >> director's report. >> good afternoon, commissioners. wanted to start my report with the issue of the flu. the flu season is off to an

early start nationwide and california department of public health reports widespread flu activity in the state. we encourage san franciscans to get the flu shot and take other steps. we have flu shots being given at the immune clinics, project homeless, and san franciscans can obtain flu shots at their doctors offices, primary care and pharmacies on a walk-in basis for a fee. in monitoring the flu activity, we've looked at our emergency medical service call volumes that have fallen to the normal range for this time of year. we reached out to hospitals, and while they're fairly full, they're managing to keep up with demand so far. to date, no reported deaths from flu of people under 65. and we have information on our website regarding this. on issues regarding the federal government and health, i just wanted to -- we're closely

monitoring three areas. one is the issue of the individual coverage mandate and the impact on those who will not have a mandate to have insurance and as well as the 340b savings cuts in 2019. and the children health insurance program. i hope to have some review of the three areas and impact and responses that we have for you in the coming meeting of the health commission. also just to let you know, we have been working with st. mary's and u.c. to open up 40 mental health beds. it's an exciting program. mid february will be the opening and we'll send you an invitation for that. that's the end of my report unless there are questions from the report itself. >> thank you. any questions regarding director

garcia's report? there's a lot of things on the radar coming up. next item, please. >> thank you. item 4 is general public comment. i'm noting that only members of the department here. so we'll move on to item 5. >> item 5, let's go. mr. pickens? >> >> good afternoon, commissioners. roland pickens, director of the san francisco health network. it's my pleasure to present to

you with the very first update on the network under our newly adopted strategic plan. this slide is one we use in all of our presentations to you and to show where the structure fits. in today's presentation, we'll review four things. first, i will provide you with a brief review of our journey to guide our strategic planning and performance improvement and daily management activities. next, i'll share with you our current, newly adopted strategic plan, which builds upon and refines the work of our previous plan that guided the journey over the last two fiscal years. third, i will describe how the network is with the greater department of health.

and, finally, i will share the status of our quarter one metrics and scorecard. this slide depicts the journey that started in 2012. and quickly spread to primary care in 2013 and then to the network in 2016, culminating in the adoption at the dph level in the third quarter of last year, 2017, with a dph strategic plan and an accompanying ex-matrix. the ex-matrix is that one-page document, which you have in your supporting information, that cross-references the key elements of our strategic plan. it shows the outcomes and

performance measures that we'll measure over the next few years. >> mr. pickens, if i may, and it has an x on the document, just so you know. >> yes. x-matrix, yes. thank you, mark. i wanted to show the evolution from our previous to our current strategic plan. you will remember when i've come up to present to you, we had nine various strategic, key initiatives. one of the things that we did when developing our new plan and i will talk about this later on, was that we narrowed our scope from nine down to only three strategic initiatives. the ehr readiness, in --

implementing that, and developing our people. and that's been drafted at the dph level and we adopted them at the network. we prioritize aligning care and finances and outcomes. really to recognize the shift in healthcare reimbursement from fee to service to fee for value. so, again, those are the three things that we'll focus on over the next two years. and that's also very complimentary with the work we're doing with the medicaid waiver and the whole person care. here's the multidisciplinary team that came together this past fall to develop our new network strategic plan. so we had representatives across

the network from laguna honda, maternal-child health and central dph, finance, hr and it. on this slide, we begin to see how we've begun to use the same standard tools like the x matrix, which you have seen before, and the sections throughout all of the visions through dph, with the goal of developing one common language and methodology. and particularly for those of you on laguna honda or jcc, you've begun to notice how we've been using that methodology. so that's across the network and

also other parts of the department. and so i put this slide together to show you just another picture of how we're beginning, as we matured over the last few years, we really started at the divisional level dph. now we've done that strategic plan. the sfg is about to do their strategic plan, and so is laguna. so we're beginning our cascading effect. and then for those divisions to take the priorities and figure out how to implement them. it's incorporating a top-down, and bottom-up approach to strategic planning.

so what did we learn over the last two years within the network, as we implemented our first strategic plan when it comes to using lean as a roadmap. first, we need to have more focus on a fewer set of priorities and initiatives that are aligned with the more global dph plan, particularly giving our challenges with reliable data. secondly, we need to have more alignment across the different sections of the network, rather than having them focus on separate things. we felt it was important to end the other divisions and have some common items we're working on. for example, staff inquiries, and what they've chosen.

and, finally, we needed to have a real commitment to fidelity of the lean model. it gives you one of the tools for reporting, but if you don't put it in practice, you don't get the power of the process and not able to fully monitor and see your progress. one of the things we've done is we've reported a lean reporting calendar for the network and it shows which divisions will be reporting on their various true north and strategic plans. this shied provides a summary of our quarter 1 and our true north metrics. as you can see from the six sections of the network, maternal child health,

behavioral, jail health, laguna honda, and dph, we have 47 metrics, which are quality, safety, care experience, work force, financial stewardship and equity. in terms of quarter one data available at the time of this report, we show that nine of these 47 metrics are on target. 20 are off target. and for some that are off target, many of them are not off target by very much, just one or two points. you are either red or green. there is no yellow, so they ended up being red, being offtarget. and you also notice that 18 show data was still pending at the time of the report or data definitions and sources are still being developed. i wanted to talk more about this. while we've made great strides in improving our ability to capture and report timely and meaningful data, we still have

room to improve in this area. obviously, we believe that implementing epic will be one way we can improve our data recording capabilities, also bringing on behavioral health services into the lean process. it's probably the last big group within the department that we still need to spread lean and do education and training with that work force. as we continue to have more and more of our reimbursements based on performance measures and payments, it will provide incentive to develop more robust data reporting capabilities. so that's just a brief orientation to our new strategic plan and performance for this first quarter. when i come back to you in the next few months with quarter one

data, ideally we're on the right track, we'll have more data available. that's our overview. i am happy to take questions and comments. >> thank you very much for an outstanding presentation and look forward to your additional one and especially some of the variables that you mentioned that you need to look across rather than separate.

so well done and thank you very much. >> thank you. >> commissioner? >> i would like -- you're deciding as a network to use common language, it's making sense. finally sinking in better. thank you. >> if i may, commissioners, going back to the cascading lean slide. the one with the picture. there you go. just to note that we now have the full department under this model. and that we've opened up an office for dph that is working with the other groups. so now it's taken us over five years to catch up and be able to do the work we needed to do as a

department. so it's an ongoing process and big learning progress and i would like to thank the partnership that have helped us on the dph oversight of all the work. so now as we fund some of this, we look at how much can we do, particularly as we do the electronic health record. and then the public health side has their own process as well. everyone in the major divisions are working under the lean model, so i wanted to acknowledge that and thank all the leaders to help us from a department-wide perspective on this >> very good. thank you very much. any other questions or comments? thank you very much. next item, please? >> item 6 the sfdph security update. >> commissioners, this was supposed to come to you in october and it was bumped, due to that it was a very busy

meeting, so this report is a few months late. >> thank you. >> good evening, commissioners, director garcia -- >> excuse me. will you speak into the mike or move the mike over? thank you. >> so i will give an update as far as the development of the security program for dph the presentation will highlight the work that's been accomplished at zuckerberg and laguna hospital and the performance metrics as well as program effectiveness.

since this report, we've also developed a security management plan to include performance metrics as well as developing a safety and security committee for primary care and behavioral health clinics. so this slide and the next slide following calls out eight mile stoin accomplishments in the area of security services, training, education and electronic security systems. so in the area of at-risk response, they've exceeded target as far as at-risk patient

response. they had a return of 88%. customer satisfaction surveys are conducted to measure employee, patient and visitors satisfaction with security at both hospitals. 90% and 81% for the year. this year, we began doing surveys for laguna honda residents, just to receive input from them as far as to provide safety in their environments. so where there are electronic security systems, which is applicable in both facilities here, we want to ensure that they remain operational. on a quarterly basis, we inspect 100% of the system with a target of 98% functional. the overall functionality of a

system was 95% and 85%. based on this performance, one of the things we did, we were able to replace the systems vendor at zuckerberg, where we're getting more timely response in regards to any system malfunctions. we're holding laguna honda's vendor -- we're holding monthly meetings, so we hold them to task for functionality. we've added dedicated security system personnel to address functionality. on a monthly basis, 20 elements of the mou between dph and the sheriff's department are measured as far as compliance, so that reflects that in both hospitals for the entire year. the sheriff's department exceeded the target for

compliance with the mou. this chart reflects the crime stats for zuckerberg for three years. and so we have actually a 22% decrease in crime on campus. a lot of that is contributed to the collaboration that we have with the sheriff's department in regards to addressing staffing assignments, increasing visibility and implementation of a security awareness program that encourages employees to report suspicious persons and activity. increased at laguna honda in crime to 40% through no fault of their own. what we found out is that the data for grand theft of facility property included patients' personal property and that drove the numbers up, which we've addressed that moving forward.

the next slides will focus on use of force. 124 incidents where sheriff's deputies used some degree of force to affect an arrest or address risk behavior, risk behavior, that which is displaying a danger to themselves or others. we break it out. 119 were at zuckerberg and 5 at laguna honda. to give some context, the year prior to this, there were 173 incidents, so compared to 119, a decrease of 33% of use of force on campus and year-to-date, it's been only 58 of these incidents.

so on this chart, the chart on the left, you have the type of force, which was used, and you will see in most cases, 88% is what is called physical force. physical force being control, personal impact or physical takedowns. on the right side, you have the demographics as far as those individuals by demographics that the force was used upon. and then down at the bottom on the far right as far as locations, you actually have the highest being at zuckerberg with campus buildings and that consists of the outpatient buildings as well as the campus grounds outside of the hospital, followed by pes and emergency department. in regards to opportunities and

next steps, at both hospitals, there's a huge opportunity to change the culture in regards to calling law enforce kwchment toe no crime was committed. we had 4,000 calls for patient assist or stand-by or restraint. as a result of that, 40% of the use-of-force incidents were against patients. so we started to address this issue by implementing crisis intervention training for direct patient care. we completed the emergency department. this will assist staff in regards to building competence when it comes to de-escalating risk behavior at the early stage. in addition, also providing that same training for the sheriff's department to give them additional tools as far as how to react with risk behavior in a

hostile environment. other measures that the hospital has taken to address this issue include emergency department response plan, address risk behavior prior to law enforcement and a behavioral environment response team to provide the escalated support to the high-risk departments. this is an update of the security program. are there any questions? >> commissioners, if i may, those of you on the jcc know that security updates have been given at those committees as well. the hospitals are hearing their own data as needed. >> i just want to thank you. it's remarkable how much you've done in the years you've been doing this and to see this kind of responsiveness and this co collaborative work with the sheriff's department.

thank you. >> thank you. >> please turn on your microphone. [no audio] >> sorry. just want to say that we have really been impressed by your leadership and the ability to integrate the incidents and data to make a comprehensive review of the situation. if questions are asked, do we have people from inside the system or are they mostly latino or asian or from this area? all of these things could never really be answered in a comprehensive way because much of the data wasn't there and

you've been able to work with your colleagues on the team and all units, whether it be the general or laguna, to really provide us with comprehensive insight. as far as where the situations take place, the type, classificati classification, time, place, situation, so we want to thank you for really updating a system that was a couple of centuries back. thank you for a job well done. >> thank you. further comments? >> thank you very much. >> thank you. >> commissioners, this may be the quickest meeting i've ever attended. item 7, other business. >> do we have any other business? no. >> item 8, a report from january 9, 2018, jcc meeting.

there's a summary sheet in front of you. >> okay. a report that in essence the jcc at laguna honda pertaining to members brought before us. it was an excellent presentation, staff training, etc., and we had a comprehensive review of director price and security at laguna honda, but more importantly, as was shared today, how, in fact, it's linked to our other facilities and institutions, as we take a look at security for patients and staff and our citizens in san francisco. we also went into closed session pertaining to medical certification and approvals, hires, terminations, etc. that was for december. my colleagues, if you would like to add anything to that. if not, that concludes the joint conference committee for this

commission meeting. next item? >> item 9, agenda calendar. on february 6 and 20, there will be two budget hearings. please let me know you will not be attending, for quorum issues and who needs to be updated on the side. that's all i have for the calendar, but it's before you if you have any questions. otherwise, it's adjournment. >> just one thing. i want to see if we can add an item to get an update on insured in san francisco, because there's new articles that just came out and said that last year there were actually an addition of 3 million people added in the

united states. if we're ahead of the curve, i would like to know how ahead we are. >> we'll incorporate that into the mandate. >> thank you. >> yes. >> before we adjourn, i would like to recommend that the commission adjourn in memory of dr. matilda crim, who passed away today. she did tremendous work along with elizabeth taylor and others in research and advocacy at the early days of the aids epidemic. she did so much to address stigma in communities of color and she was a hero. >> second? all in favor, aye. we're adjourned in her memory. any further discussion or

comments? welcome back, everybody. happy new year. is there a motion for adjournment? >> so moved. >> second. >> all in favor, aye. >> opposed? commission is hereby adjourned. ] >> san francisco city clinic provides a broad range of sexual health services from

stephanie tran medical director at san francisco city clinic. we are here to provide easy access to conference of low-cost culturally sensitive sexual health services and to everyone who walks through our door. so we providestd checkups, diagnosis and treatment. we also provide hiv screening we provide hiv treatment for people living with hiv and are uninsured and then we hope them health benefits and rage into conference of primary care. we also provide both pre-nd post exposure prophylactics for hiv prevention we also provide a range of women's reproductive health services including contraception, emergency contraception. sometimes known as plan b. pap smears and [inaudible]. we are was entirely [inaudible]people will

come as soon as were open even a little before opening. weight buries a lip it could be the first person here at your in and out within a few minutes. there are some days we do have a pretty considerable weight. in general, people can just walk right in and register with her front desk seen that day. >> my name is yvonne piper on the nurse practitioner here at sf city clinic. he was the first time i came to city clinic was a little intimidated. the first time i got treated for [inaudible]. i walked up to the redline and was greeted with a warm welcome i'm chad redden and anna client of city clinic >> even has had an std clinic since all the way back to 1911. at that time, the clinic was founded to provide std diagnosis treatment for sex workers. there's been a big increase in std rates after the earthquake and the fire a lot of people were homeless and there were more sex work and were homeless sex workers. there were some public health experts who are pretty progressive for their time thought that by providing std

diagnosis and treatmentsex workers that we might be able to get a handle on std rates in san francisco. >> when you're at the clinic you're going to wait with whoever else is able to register at the front desk first. after you register your seat in the waiting room and wait to be seen. after you are called you come to the back and meet with a healthcare provider can we determine what kind of testing to do, what samples to collect what medication somebody might need. plus prophylactics is an hiv prevention method highly effective it involves folks taking a daily pill to prevent hiv. recommended both by the cdc, center for disease control and prevention, as well as fight sf dph, two individuals clients were elevated risk for hiv. >> i actually was in the project here when i first started here it was in trials. i'm currently on prep. i do prep through city clinic. you know i get my tests read here

regularly and i highly recommend prep >> a lot of patients inclined to think that there's no way they could afford to pay for prep. we really encourage people to come in and talk to one of our prep navigators. we find that we can help almost everyone find a way to access prep so it's affordable for them. >> if you times we do have opponents would be on thursday morning. we have two different clinics going on at that time. when is women's health services. people can make an appointment either by calling them a dropping in or emailing us for that. we also have an hiv care clinic that happens on that morning as well also by appointment only. he was city clinic has been like home to me. i been coming here since 2011. my name iskim troy, client of city clinic. when i first learned i was hiv positive i do not know what it was. i felt my life would be

just ending there but all the support they gave me and all the information i need to know was very helpful. so i [inaudible] hiv care with their health >> about a quarter of our patients are women. the rest, 75% are men and about half of the men who come here are gay men or other men who have sex with men. a small percent about 1% of our clients, identify as transgender. >> we ask at the front for $25 fee for services but we don't turn anyone away for funds. we also work with outside it's going out so any amount people can pay we will be happy to accept. >> i get casted for a pap smear and i also informed the contraceptive method. accessibility to the clinic was very easy. you can just walk in and talk to a registration staff. i feel i'm taken care of

and i'm been supportive. >> all the information were collecting here is kept confidential. so this means we can't release your information without your explicit permission get a lot of folks are concerned especially come to a sexual health clinic unless you have signed a document that told us exactly who can receive your information, we can give it to anybody outside of our clinic. >> trance men and women face really significant levels of discrimination and stigma in their daily lives. and in healthcare. hiv and std rates in san francisco are particularly and strikingly high were trans women. so we really try to make city clinic a place that strands-friendly trance competent and trans-welcoming >> everyone from the front desk to behind our amazement there are completely knowledgeable. they are friendly good for me being a sex worker, i've gone through a lot of difficult different

different medical practice and sometimes they weren't competent and were not friendly good they kind of made me feel like they slapped me on the hands but living the sex life that i do. i have been coming here for seven years. when i come here i know they my services are going to be met. to be confidential but i don't have to worry about anyone looking at me or making me feel less >> a visit with a clinician come take anywhere from 10 minutes if you have a straightforward concern, to over an hour if something goes on that needs a little bit more help. we have some testing with you on site. so all of our samples we collect here. including blood draws. we sent to the lab from here so people will need to go elsewhere to get their specimens collect. then we have a few test we do run on site. so those would be pregnancy test, hiv rapid test, and hepatitis b rapid test. people get those results the same day of their visit. >> i think it's important for transgender, gender neutral

people to understand this is the most confidence, the most comfortable and the most knowledgeable place that you can come to. >> on-site we have condoms as well as depo-provera which is also known as [inaudible] shot. we can prescribe other forms of contraception. pills, a patch and rain. we provide pap smears to women who are uninsured in san francisco residents or, to women who are enrolled in a state-funded program called family pack. pap smears are the recommendation-recommended screening test for monitoring for early signs of cervical cancer. we do have a fair amount of our own stuff the day of his we can try to get answers for folks while they are here. whenever we have that as an option we like to do that obviously to get some diagnosed and treated on the same day as we can. >> in terms of how many people were able to see in a day, we say roughly 100 people.if people are very brief and

straightforward visits, we can sternly see 100, maybe a little more. we might be understaffed that they would have a little complicated visits we might not see as many folks. so if we reach our target number of 100 patients early in the day we may close our doors early for droppings. to my best advice to be senior is get here early.we do have a website but it's sf city clinic.working there's a wealth of information on the website but our hours and our location. as well as a kind of kind of information about stds, hiv,there's a lot of information for providers on our list as well. >> patients are always welcome to call the clinic for there's a lot of information for providers on our list as well. >> patients are always welcome to call the clinic for 15, 40 75500. the phones answered during hours for clients to questions. >>

>>

>> good afternoon and welcome to the regular scheduled meeting for the ethics commission for january of 2018. i'm going to call the roll. we have excused absences on the part of vice-chairperson chiu and commissioner lee. commissioner renne? >> present. >> we'll proceed with