the debate on this issue and like to say i don't take lightly what this bill seeks to accomplish. caution must be exercised when considering limitations to anyone's civil liberties which conservatorship entails. but the truth is that a small subset of our population faces profound challenges that inhibits their ability to engage in our existing services voluntarily. the highest users of our city services and the most vulnerable population, those who are chronically homeless, mentally ill, and dealing with substance abuse endure repeated crises day after day after day. and their self-care deteriorates. this causes them to spend more time on the streets and their health eventually fails. we cannot watch people languish like this. under current law we can't

intervene adequately. it has been increasingly frustrating to try and work specifically with people in my own district that we can't help. the current law written in the 1960s does not allow a court to consider the effects of psycho active substances other than alcohol. this limitation is completely insufficient to address the realities of substance abuse we see in our communities. today nearly half of all psychiatric emergency encounters in our city involve methamphetamine use, not alcohol. and we must change the status quo. our existing system is not working for those people. s.b.1045 would provide us the tools and the flexibility we need to change this. i would also like to say that this is legislation that was not

created in a vacuum. it was carefully and thoughtfully created by public health experts and agencies who also know the system is not working. the bill is supported by the departments who are frustrated every day with their inability to help those in dire need because of their limitations to the law. this includes the department of homelessness and supportive housing, the department of public health and the department of aging and adult services. the human services agency and the san francisco police department. our late mayor initiated this dialogue, mayor lee, and the department of public health has since worked to ensure that the eligibility criteria is narrow. that services are indeed available and do not detract from other people and that protections are in place to promote due process. individuals will still be assigned a public defender, and

can petition conservatorship status every 30 days. the city currently spends close to $300 million a year to address homeless issues. this includes efforts to provide supportive housing and voluntarily -- volunteer services. more funding alone will not solve this problem. we need more tools and flexibility to use our existing resources as we fight por more supportive housing and services. we cannot wait another day to start taking actions, as it is there will be a long process to implement this bill. if 1045 passes, the board will still need to adopt and implementation ordinance to actually opt in. this is where we should have robust conversations of what we want the process to look like.

what we have before us is an urging resolution. to support an effort that will give us more opportunities tho help those incapable of receiving services involuntarily, it will give us an opportunity to bring people indoors and help them get on the path of stability and recovery for the long-term. we have a moral imperative to act and to start these efforts now. colleagues, i also have one clean-up amendment to the resolution before you, copies i believe have been distributed. this amendment is on page three, line 23, which strikes the word or, and replaces it with and. so that it's clear that all of those things -- this change clarifies in order to be eligible to be considered for conservatorship an individual must be chronically homeless, suffering from serious mental

illness, and a substance abuse disorder. result in the individual unable to care for themselves, frequent visits to the emergency room, frequent detentions by police under 5150 hold, or psychiatric evaluation and treatment. colleagues, i would like to move that particular amendment and i hope i can count on your support with this resolution. >> thank you, president breed. i want to recognize supervisor yee next. >> supervisor yee: thank you. colleagues, i know all of us are deeply concerned regarding our ongoing homelessness crisis and impacts that it has on those individuals that are living on our streets. and the well-being of our neighborhoods.

s.b.1045 seeks to address a part of this problem by proposing a new process for the appointment of a conservator for a person who is chronically homeless and incapable of caring for their own health and well-being due to acute and severe mental illness and severe substance abuse disorder. while i agree that chronic homelessness due to mental health and substance dependency is a crisis -- is a crisis level problem for which we are not currently having a solution, i'm not ready to say that state senator wiener's bill is the right approach until we have heard from experts in the field and mental health as well as from the service providers in our city. homelessness is a complex tragedy that we need to address as quickly as possible, but we need to do so in a way that is effective, compassionate, and

that reflects our san francisco values. in the past few days i have heard from numerous service providers in the homelessness disability, senior, youths and other communities, who are extremely concerned that the bill loosens the standard for conservatorship, and could lead to civil right abuses that allow severely disabled individuals to lose their freedom without receiving access to the proper service and shelter in exchange. i am also concerned that this bill creates a mandate for providing expanded supportive housing and medical and mental health care without actually providing any funding from the state for us to do so. we do not need another top down unfunded mandate. i do not understand a reason to voting to support the bill without having an opportunity to fully hear from all

stakeholders. this does not seem to be a responsible way to address such a serious issue. if there's a claim that we have adequate mental health services, i'm not sure then why during the budget committee hearing almost everybody that came up, department including, stated that we don't have enough money, enough mental health service, the resolution that is authored by supervisor cohen, chair of the budget committee, has a budget ask for the mayor to increase the budget for mental health services because it's inadequate and i agree with that. so for this reason i cannot support, allowing the resolution to move forward without the benefit of community hearing and i'm hoping that president breed, that you'll schedule a resolution for hearing at

committee and once again, i'm not saying i'm against this, but certainly would like to have a little more input from the community. >> madam clerk, at this time i want to recognize, i think president breed made a motion on the floor that was not seconded. >> that's correct. >> i would like to make a second to that motion. >> thank you. >> malia cohen. next speaker will be supervisor ronen. >> supervisor ronen: thank you. i also would love to have a complete hearing on this resolution. i actually don't know where i stand yet on s.b.1045. there are parts of it that i think make a lot of sense and there are parts of it that i have a lot of concern about.

i have been, since the beginning of the year, visiting all of our mental health system in san francisco. i've been to the psych emergency ward at general, i've been to the psych acute ward upstairs, i've been to the hummingbird step down navigation center to the door urgent care and inpatient treatment program, 360, behavioral court, conservator court, touring city services and asking everyone from doctors to our public defenders to our judges, to our conservator what is going so wrong, why are all of us seeing people in such dire straits in our streets. what could we do to fix this problem. and every single one of them has said one thing. and what they have said is that

we do not have enough beds in our system. we do not have enough treatment spots for people with substance abuse, addictions, we don't have enough treatment spots for people with acute mental illness, and when you stabilize someone in psych emergency, or even if you, you know, send them upstairs to the acute ward and you spend a lot of time with a lot of medical attention which is incredibly expensive, and you get them stable, when you release them back on to the streets of san francisco because they are homeless, they immediately deteriorate back to where we started. and that seems to be the crux of our issue in this city. and i'm not saying that parts of our conservatorship law don't need to be fixed, i do think there are parts that need to be fixed. but in my direct experience

working with a woman named alice in my district, living in front of the bart station, 16 street bart, you know what it took to get her inside, it took an intern in my office becoming her best friend and visiting her every single day. and developing trust and developing a friendship. it was intensive case management that convinced her to come inside. i -- that worked. and it took time and it took a lot of resources, but it worked. and we got her her own unit, her own apartment where she was inside and was not subject to the streets. and that is what eventually worked. she, unfortunately, passed away from stage four cancer but i believe would have successfully stayed in her housing unit had that tragedy not occurred. and the fact that so many of the

front line providers are saying this law doesn't -- isn't the fix that makes sense, concerns me. i feel we should at least have a robust discussion in committee. i have a ton of questions for director garcia who sent us a letter today saying that she supportive of this program, but i want to have a dialogue with her about the concerns that we are hearing from the community. so i am not yet ready to say i support or i oppose s.b.1045. but i am ready to say i would like to have a robust conversation and discuss these issues. so, i would prefer to send it back to committee and will do everything in my power to attend that committee hearing. >> colleagues, before we go on to the next speaker, an amendment on the floor made by president breed and the second has also been accepted.

if we can take that amendment and put it to a vote. >> can't we take that without objection? >> yes, we can. i need to call for that. so, we'll take that without objection. thank you. all right. thank you for your comments, supervisor ronen. supervisor fewer. >> supervisor fewer: thank you very much. i want to echo what my fellow colleagues just said, is that i don't really know enough about this proposal to be able to say whether i support it or oppose it. because i really don't know enough about the situation that we have here in san francisco around resources. so, i know the situation we have here around homelessness and people on the street with addiction issues and people who are very mentally ill. i think we have all seen our fair share and more of those individuals living on our streets, and some, you know, i have to say, in my neighborhood, you know, i worry about nadine

wong, chronically homeless and find her a place and she refuses to go. and as an older chinese woman myself i can relate to her as an older woman being cold and hungry and just living marginally, and i have great empathy for her and if we were to have her under a, you know, conservatorship, i would not want her to be incarcerated. i would want her actually to be in a place where she's getting some service. and i think that i don't know also the budgetary implications of this. i have heard again through all the testimony exactly what supervisor ronen said, we don't have enough resources, we don't have enough beds, we don't have enough shelters, don't have enough supportive housing and this is what the individuals need. i think that i understand about

the problem, i get it, i think that something has to be done. i'm just saying i don't know enough. and so i also welcome more of a conversation about this, but especially because senate bill 1045 does not have any resources attached to it. it's very, very concerning that where are these services going to come from, how are they going to be funded, will the state throw down some money for us. what services are being provided for those who are currently conserved, what are the outcomes for them, will we have to reduce services for others in order to accommodate new conservatorships, i think these are all questions i would like to have answered and i'm not saying i oppose this, i'm not saying i support it, i am saying that i would like to find out more about this and have a really robust discussion on if this were to pass, what would it take to implement something like this. i would like to ask director

garcia what type of resources do you think this might require of us, and since we are going through the budget season right now, i think is really appropriate to have that conversation. thank you. >> thank you. supervisor sheehy. >> supervisor sheehy: thank you, and also, i want to thank president breed for her outstanding description of this bill and for her leadership here. the reality is, is that we are spinning resources already. budget committee director garcia describes an individual 5250, 72 hour psychiatric hold, more than 100 times. that to me is, does not make any sense. i mean, that person is being traumatized by doing in and taken involuntarily to the hospital, it's costing us hundreds of thousands of dollars. i mean, when i go to my district

and i see people who i've seen actually taken to the hospital who then come back, it doesn't make any sense. and that's why i introduced legislation, once we get someone off the streets and into mental health or substance use treatment we can continue to care once their period either in general or at walden house or another mental health facility ends they don't end up back on the streets but i think we have gotten to the points where somehow it seems humane to let someone, and there are three categories, three boxes that have to be checked. homeless, mental health issues, and substance use issues. are we doing anyone a favor by living, letting them be on, you know, leaving them on the street to slowly die? that's compassion?

it -- i just don't understand why we don't make choices and make decisions that, to really try to address this. i've heard from folks with, who have been in leadership to not build a new jail who are supportive of this because where do these individuals end up? they end up in jail. they end up in jail. it's not like people with severe mental illness who are homeless, substance using, are just having a normal life on the street. and the other thing is, once we get people into treatment, it does not mean we are incarcerating them, we are starting them on a path of careless and less restrictive. but i think we tend to look at

the best case scenario and say well, it's going to be that individual. that individual and i know individuals, you know, a kid i talk to at least once a week. this is not going to apply to that kid who is service resistant, as they call it. he's probably not going to go in until he gets a situation that he likes. but he's not mentally ill, he's, he may be, i think he's probably using substances, but he doesn't check all those boxes. what we are talking about are people who are clearly slowly dying because, i talk to mothers of these kids. you know, who tell me we got to do something, and it's so hard to get action taken. and i guess that's where i always come back to on these issues, is i look and i say if this was my daughter, heaven forbid, if this was my daughter, would i think it was her civil right, would i think it was

compassionate for this city to allow her in the state of mental distress, living on the street that i don't think we have an obligation, a responsibility to do something for her? so, that's why i support this bill, and i think as president breed said, this is just the first stage. getting this through the legislature is an important first step. and we talk about resources, but we are spinning the resources already, spinning at san francisco general, spinning at county jail, we are spinning at, d.p.w, d.p.h., we are spinning resources already on this problem already. and at least let's try to actually help people. >> thank you, supervisor sheehy. president breed. >> president breed: i want to also add that this is an opt in program. so, still a policy that has be

agreed to here at the board of supervisors, it's not any sort of un -- it's an unfunded mandate. it's not necessarily a dollar amount attached to it. i appreciate the comments from my colleagues about this particular issue. and this is putting us on record as board of supervisors to support the legislation and would still need to come back to our legislative body in order to implement it, and i think it's the right direction, the right thing to do, so i would hope you consider supporting it. >> supervisor ronen: thank you. just in response to supervisor sheehy. there are things that i agree with need could be changed about the conservatorship laws. for example, the issue that it allows people suffering from severe alcoholism, a harm to themselves or others to be

conserved but not someone taking another substance, like drugs of some sort. that does not make any sense to me and should be changed. but there are other parts of s.b.1045, that a sheriff is making medical calls and i don't understand why that's included in the bill. overall, and again, i think maybe with tweaks i would be on board with the law. but just on record right now and saying i'm totally on board, especially without being able to question the experts, both in the community and in the city about my concerns, it doesn't make, i'm not comfortable with that yet. but it is an absolute mistake to think that just by broadening the criteria under which we can conserve people suffering from severe mental illness in our street is going to solve the

problem that we all agree absolutely needs to be solved. to solve that problem we have to have beds available when people are released from jails, or from our behavioral health court or in the conservatorship program, or from emergency psych ward or from the acute ward. and right now, there are no beds to release people to. they are released, either held in the acute ward at general, by far the most expensive way and the most restrictive way to serve these people, or released to the streets where they deteriorate almost immediately. so, to pretend that s.b.1045 is going to solve the problem in our street is just going to set our residents up for disappointment. that is not the debate we are having on this.

the debate we are having is whether or not our criteria to conserve someone is not fitting the reality of our times or not fitting the reality of the situation on the streets in san francisco. and that's a debate we should be having, and as i said, i do think there should be some changes, but i'm just not convinced that going on record 100% supporting a bill that we have not vetted in committee makes sense. >> supervisor peskin: thank you, madam president. this is obviously a very complicated body of policy and whether or not the bill in question is the right public policy approach or not. i actually am viewing this from a slightly different lens, which is how we as a body take positions on legislation that is pending either in the state legislature or the united states congress and there are some things where all 11 of us are on

the same page and it's on the adoption without committee reference calendar. there was an item earlier, a.b.2989 and no brainer and stuck it on the calendar. there are more controversial things like assembly bill 827, we had a split vote but it was after a committee hearing where we heard from the people and we heard from experts. and when i see folks from the drug policy alliance come up here and other folks and i get a letter from our respected director of public health but not here because she's in sacramento and i want to ask miss garcia questions but i can't do that, i feel this would benefit from a public hearing and i want to agree with supervisor sheehy which is we have to do something, and as supervisor ronen said, our current system, it's either

acute or the street, is not ok, and conservatorship has proven effective in many ways. the woman that we heard testify about her mother was extremely moving and important to me. having said that, i guess i have really one question and i don't know if president breed can answer this. is really the timing of when a hearing, a committee hearing in sacramento is going to take place on this bill because for instance, with s.b.827, we knew a hearing was going to take place and needed a position before the hearing and we, you know, managed to have a committee hearing so we could hear from everybody and have a full board vote on it prior thereto. my understanding is this bill is significantly amended or really just started to take form in the last few weeks. does anybody know when it's going to have a committee

hearing? >> president breed: they were at the committee today, so it's already happening. >> supervisor peskin: in committee today, it does not sound like there's any urgency to be voted on if it went before a committee today, maybe we can get this into a committee at the board next week and then back to this body on may 8. that's my suggestion. i would vote for sending it to committee and bringing it back here. >> seeing no names on the roster, on the item as amended, madam clerk, please call the roll. [roll call vote taken] >> supervisor kim: whether or not to vote this item up or down as amended. >> i thought there was a motion to refer this to committee. >> there was no motion to refer to committee. this is just a motion to amend? >> the motion --

>> already approved. >> i would like to make a motion to send this to committee, on the theory that it comes back here quickly and benefits from the kind of -- >> i apologize, are we out of order and having this discussion? >> when an item is under debate, item to refer to committee does not take precedent -- i should say it does take precedence over the vote. so, supervisor peskin is making a motion to send it to committee. takes precedence over voting on the item itself. >> point of clarification. >> supervisor cohen: i thought we were discussing and getting ready to vote and supervisor kim interjected in the conversation and then supervisor peskin interjected with a motion. i believe the motion that was already underway for the vote would take precedence. >> through the pres to supervisor cohen, the president did ask the roll call to be

voted on, and all due respect to supervisor kim, unless the board wants to override the roll call vote with another vote, the president's call on the roll call does take precedence. >> apologize, i thought i heard supervisor yee to make a motion to move it to committee. i thought that's what -- why have we been discussing sending this to committee then. i thought it was clearly what we were debating whether to send it to committee, not whether we supported the bill or not. an o only one motion on the floor, articulated and seconded. >> at this time, madam clerk, a step back. supervisor peskin has made a motion to send it to committee. is there a second? seconded by supervisor yee and i want to say i'm not going to be supporting the motion to send it to committee. i think that i continue this

item one week to continue to allow discussion to give people an opportunity to talk about this particular issue. it is not completely decided and won't be until if it passes on the state level, it will come back to the board at that time. it's an unfunded mandate, so many of the concerns brought here today are not necessarily things that are relevant to this particular bill. i think it's necessary, i would like to move it forward. i think it's clear in terms of what it's proposing to do. and so with that i won't be supporting the motion to move this item to committee. please call the roll on the motion to move this item to committee. [roll call vote taken]

there are five aye and six no, with supervis-- >> the motion fails. >> and because i had to leave because of family matter last tuesday, i would have made that motion last tuesday, so i'm -- anyway, i'm sorry i was not here for the vote last tuesday. >> understood. on the item as amended, madam clerk, please call the roll. [roll call vote taken]

there are six aye and five no with kim, peskin, ronen, yee and fewer in the dissent. >> the resolution fails. read the in -- >> adjourned in memory of the following beloved individual on behalf of supervisor peskin for the late mr. danny neeson. >> thank you. any other items before us today? >> that concludes our business for today. >> thank you, we are adjourned.

being here today as we celebrate the individuals that i just had a chance to meet here right behind us. and today is really an amazing day for the city of san francisco. we're showing that once again our city employees, our residents, but our city employees are stepping up to the task. and want to welcome, i know there are 14 individuals that came from our department of public health that went to puerto rico to help the victims of hurricane maria and really dedicated their time and effort to helping those that are in need. as the city of san francisco, these are the values that we embrace as a city. we've had our own incidents, whether it's earthquake in particular, where we're the beneficiaries of other cities

and jurisdictions coming to our help and participating in the rescue efforts here in the city of san francisco. and now we're paying it forward and replicating it in kind. i want to thank all of you personally for representing the city the way that you did. the doctors, nurses, mental health professionals, they are representing our city on the international stage and showing what our city is all about. it's an honor to be here to recognize them for their efforts, for their volunteerism, and really, barbara, to thank you, because i think this is about the testimony of the department that you have created as well. and that you are supporting. we're so lucky to have barbara garcia running our department of health here in san francisco and the values that we are part of our dna here in san francisco, that we own as a city government, as city employees, are represented here in your department. i'm going to turn it over to you, but as mayor of the city of

san francisco, i am so proud today to be here to recognize these individuals. i know we have certificates of honor. i was able to do this the other day, but we have a unique thing called the heart of the city pins, that we're going to give each of these individuals, that did the heroic work in puerto rico. i want to say thank you to each and every one of you for what you did and know how proud we are as a city, but as mayor, proud you represented us so well. congratulations. [applause] we'll give them their gift in a minute, but i want to turn it over to barbara garcia who runs our department of health. [applause] >> thank you, good morning. and thank you, mr. mayor. we should be proud of all our staff and we're really proud of the support that the city has given our staff to be able to go to puerto rico. you know, we depend on the

electricity and water every day. and the people in puerto rico still cannot depend on these fundamental services. the impact of hurricane maria had a detrimental effect on the people and the medical assistance in puerto rico. this is one of the main reasons we sent our 14-member health team to provide support to one of the community clinic organizations. in the northwestern part of puerto rico. the response to emergencies is one of the core responsibilities of any health department and san francisco health department has had decades of experience, so we felt obligated to assist the puerto rican people and their communities medical providers. you'll hear more from the staff, they supported the clinical staff and continued to provide care to thousands, the clinics in puerto rico. our staff crossed rivers and climbed mountains with local clinic staff to provide medical

and psychological support in people's homes. we want to continue to support these clinics and we encourage catastrophens to help us. -- san franciscans to help us. we set up a fund at our public health foundation and all the dollars go to the clinics to continue their efforts. i'm so proud today. and i had my own experience of running a community clinic in a middle of a disaster. i know how important it is to get the support we provided to these clinics, so i want to ask the staff to come up and talk about their experience. the first one is ramona. she'll give opening remarks. [applause] >> hello, everyone. my name is ramona, i'm registered further at the family health center. i work in the complex care management team at zuckerberg general hospital. i would like to thank everyone who had a hand in putting this together. this was a wonderful medical

relief mission. and i speak for everyone when i say this was truly an amazing experience, we feel so blessed to work the staff. the community offers primary care and home care services to patients at risk in the surrounding area. and it's truly serving its community in a time of need. i'm hopeful that the relationships we made there will continue to grow. our time in puerto rico was spent working alongside our brothers and sisters, providing care to patients in their homes. these home visits were in remote mountain areas. our team of nurses, doctors, mental health professionals, pharmacists, outreach team and community leaders would travel up to two hours every morning along hazardous roads, trying to outreach these vulnerable residents. it's been 217 days since hurricane maria hit. and the people we visit still

have no electricity. some no water. and many still have the blue temporary tarps as roofs. these people are still struggling. what i found especially tragic, in these remote areas, many of the patients were elderly. as a result, many of these seniors are taking care of their geriatric parents. from a nursing perspective, patients in need of skin care, wound care, a lot of foot care, nail-trimming, reconciliation. much needed teaching and education around chronic disease management, these were some of the prevalent diseases. these diseases are made much worse by the stress, anxiety and fear related to this hurricane. we visited a gentleman in his 70s dealing with the stress of the hurricane maria aftermath,

no electricity, his hypertension and diabetes and he's the primary caregiver for his mother in her 90s. upon entering the home, our physician recognized that his elderly mother was not well. she had the signs and symptoms of sepsis, it's complicated because of delayed medical attention. we jumped into action, recognizing the signs of this complicated infection and the possible risk of death. the team facilitated medical attention and intervention. everyone working together to improve the outcome of this family. this is just one of many of the success stories we brought back with us. the most healing intervention we provided was our presence, our time. we provided a sense of humanity, it reminded us them that puerto rico has not been forgotten,

seven months after hurricane maria, we still care and wanted to help. puerto rico. [applause] >> good morning. so i'm ricardo, i work for comprehensive crisis services here at the department of public health and feel fortunate to assist in the disaster relief as a senior psychologist. one of the things that happens is that you have the honor of hearing people's pain.seamlessl. and became a topnotch primary care clinic on the road that included behavioral health and we found some very chronic conditions. a lot of anxiety. a lot of depression that existed before the hurricane, but

exacerbated because of the lack of water, lack of electricity. one of the behavioral health interventions was to get a generator started. a woman could not pull the generator. that is the only way to get electricity. she's by herself. lost her husband 11 years ago. depressed by herself. children don't visit and there was nobody there to pull her generator. so two of us did. a younger guy than me, he was able to pull it, make it happen. [laughter] so that was our behavioral intervention for her, but we were left with lots of different thoughts about follow-up. one of the beautiful things, the agency responsible for that community took our recommendations and will follow-up, so hopefully this

woman will do care. i was in the middle of doing a panic attack treatment when they say, sorry, we got to hospitalize your mom. so he needed medical attention. he got treated for that. and the mother, yeah, she was really in grave situation. and had this agency not been there, this team, or the other team that was serving them, a number of those people might have died because they just really needed that attention. so i think, i want to support this effort and any other further efforts to continue to do that. we do that at crisis. we respond to disasters, we do the fires up north. i got deployed to katrina and rita and that's the kind of think we do in the city and

county of san francisco and we're able to do it. the fact that we're able to spare the staff helped them and gave us the psychological boost. they taught us a great deal on how to be humble, responsive, responsible, ethical. and i'm glad that we in the city and county of san francisco were able to do that. thank you so much. [applause] >> i want to introduce dr. hammer, i asked her to find a group, identify the group and to lead the group. i'm really proud she did that and she did that with so much pride and also i think, i'm really proud of the work and her leadership. doctor? [applause] >> thank you. thank you for sharing your stories. and to the other members of our amazing team for your service to the department of public health and the people of puerto rico. and sincere gratitude to the

mayor and director garcia and everyone at dph for giving us the opportunity to represent the city and county of san francisco on this important mission. our team spent seven days in puerto rico, working alongside colleagues, a group of four federally qualified health centers based in the northwest part of the island. they're sister clinics to us in many ways. the clinics in san francisco are federally qualified health centers with a mission to serve the most vulnerable members of the community. we each came back from our time with so many stories and images. houses and cars washed down mountainsides, broken bridges and roads. dark living rooms, empty fish tanks. but i think and hope that our most lasting memories are the incredible resilience and sense

of hope we encountered. speaking for the clinicians, this mission was a natural extension of our mission in the dph. each of us is called to service. and to a person, we were deeply honored to have the honor to serve in puerto rico. we rode vans deep into the forest, where we stopped in tiny communities and attended to people in their homes. all of us were left of a renewed connection of what brought us to the healing profession in the first place. our ambassador of hope, as i like to think of them, were the puerto rican partners at csm. they are health care professionals working tirelessly since the hurricane seven months ago to do anything in their power to help their community. ever since the storm passed, their teams have traveled every day to find people in need and bring them whatever they can. food, water, medicine,

generators, or just a healing presence. we feel honored to work alongside them. we learned from their example. many people have asked us what they can do to support puerto rico's recovery effort? first and foremost, we should remember puerto rico and visit there. it's alive, but suffering, and definitely recovering. it's a beautiful and great place to live and work. also, we encourage san franciscans who want to support the relief effort to donate to the clinics we worked with on our trip. you can do that through the san francisco public health foundation. we handed out this flyer. the public health foundation has set up an account to support the clinics and the outreach efforts. please take one of the flyers with you in you want -- if you want to get information how to donate. one of the most enduring memory from our time in puerto rico is

families welcoming us into their home, so grateful for the care, medicine, water and food we provided. thank you for coming, these beautiful elders would say to us as they gave us coffee. thank you for not forgetting us. and they expressed their gratitude not just to us, but the people of san francisco. it was a great honor to represent the department and the people of san francisco. it's also an honor for us to bring back a certificate of honor from the executive director of csm to present to mayor farrell and gift to present to director garcia. [applause] >> this is a certificate of recognition dedicated to the honorable mark farrell, for your initiative of sending aid with

health professionals from the city of san francisco to assist those affected by hurricane maria in puerto rico. thanks for your support. it is signed by the executive director of csm. thank you. [applause] beautiful neck and we bring a gift for director garcia. we acknowledge and appreciated your support everywhere we went when we were in puerto rico. you were the spark that made this happen, so thank you so much for giving us this opportunity and a necklace for you from csm. [applause]

ellen davis. [applause] ricardo. [applause] richard santana. [applause]

ann daleman. [applause] ramona. [applause] steven delgado. [applause]

vita mullins. [applause] jody scottniss. [applause] kenneth pilon. [applause] jesus pestano.

[applause] last but not least, halle hammer. [applause] we're going to do a picture, but how about one more round of applause for everyone here? [applause]

i see that vivian is here. and she was our connection to puerto rico. and so i really want to thank her, she also worked for the health center in california. thank you, vivian. [applause] and this ends the program.

- working for the city and county of san francisco will immerse you in a vibrant and dynamic city that's on the forefront of economic growth, the arts, and social change. our city has always been on the edge of progress and innovation. after all, we're at the meeting of land and sea. - our city is famous for its iconic scenery, historic designs, and world- class style.

it's the birthplace of blue jeans, and where "the rock" holds court over the largest natural harbor on the west coast. - the city's information technology professionals work on revolutionary projects, like providing free wifi to residents and visitors, developing new programs to keep sfo humming, and ensuring patient safety at san francisco general. our it professionals make government accessible through award-winning mobile apps, and support vital infrastructure projects like the hetch hetchy regional water system. - our employees enjoy competitive salaries, as well as generous benefits programs. but most importantly, working for the city and county of san francisco gives employees an opportunity to contribute their ideas, energy, and commitment to shape the city's future. - thank you for considering a career with the city and county of san francisco.

good afternoon, everyone. this meeting will come to order. welcome to the april 25, 2018, meeting of the rules committee. my name is commissioner safai, to my left is supervisor catherine stefani and to my right norman yee. our clerk today is alisa.