we have in the goboc budget, or can we get that for the next meeting? >> do we normally request that, peg? if not, this would be -- >> i'm not aware that you have, but we have a current report on that all the time. so, yep. we can bring it. >> talking about adding audits and so forth using the goboc. >> that probably is appropriate as we approach the end of our fiscal year as you know, some, an item to say that, to show the data that mr. bush asked for. >> sure, yep. >> thank you. >> so there being no other business, we'll consider the meeting adjourned. >> so moved.

[ gavel ]. >> the health commission will now come to order. i will call roll. [ roll call. ] >> i'll note that commissioner sanchez, i believe, is on his way. welcome, everyone. the second item on the agenda is the minutes of the meeting of april 17, 2018. >> have my colleagues had a chance to read the minutes from the april 17 minute -- meeting? do we have a motion to approve? >> so moved. >> second? >> is there a second? >> second. >> all those in favor, signify

by saying aye. >> thank you. item three is the director's report. >> good afternoon, commissioners. just wanted to give a couple of updates, and then i will have an update from our deputy director on a labor issue in ucsf. the health department along with the mayor announced a -- an effort to basically get more hands, feet on the street, pick up needles. and as you know, the department gives out over 275,000 needles every month. that's how many we bring in, but we almost give out 4 million a year. and so because we bring in around 3 million, a little bit more than 3 million, we really want to be able to help with the cleaning of our streets, in particular getting ready needles. so we're adding an additional ten individuals on our team, and at any given time, we have about 30 people collecting needles in our needle exchange.

we also have put up kiosks in all of our pit stops. so that way, we can ensure that people have clean needles, and those needles are disposed of adequately. so i wanted to give you that update. that happened just this last week. also, the mayor honored 14 of our staff members and their work in puerto rico, and there's a little bit of an article on that. i will leave that and if you have any questions about the director's report, i'm going to ask the deputy director to come up and talk about our contingency plans regarding labor at ucsf. >> good afternoon, commissioners. so ucsf informed us of a strike that will involve three unions between may 7th, which is monday, through thursday, may 10th. so the three unions are the american federation of state and municipal county employees, the service members which are custodians food and hospital service members. there's also another branch of the afscme which are the

technical workers? and the technical workers are going to go to a sympathy strike at the same time, as well as cna. so this is expected to have significant impacts on both hospital campuses, so our ums agency is working closely with both of those hospitals. there may be some other strikes in the rest of the system as well. so we are planning to closely monitor the system and then activate if needed to support the hospital system. happy to answer any questions. >> do you think any patients will go on diversion from this? >> so in terms of e.d. diversion, yes. >> or even inpatient transfers. >> yes. so both of those are likely to happen at the parnassus and mission bay campuses. if they determine internally that they are not able to take patients, there is something in our ems policy codes that they

can go on disaster protocols to say that their hospital is unable to receive. >> other questions from commissioners? any other questions with regard to director garcia's report? thank you, director garcia. >> and i'll note there was no public comment requests for that item. we can move onto item four, which is the general public comment. i've not received any requests, and not seeing any, i can move onto item five, which is a report back from today's finance and planning committee meeting. >> good afternoon commissioners and director. the financial and planning committee met before the commission meeting today and we review contract report which had two contracts in it, and then four additional new contracts for approval, and it's all on the consent calendar that we recommended for the commission to approve. >> any questions with regard to

the finance committee report? do we need a second for that moval or does it come out of committee it's fine? >> no, we can go onto item six. so item six is the finance and planning calendar, i ayou all vote in one vote to approve, if you'd like. >> is there a motion to approve the consent calendar? >> so moved. >> a second? >> second. >> any comments or questions? all those in favor? motion carries. >> great. thank you. item seven is the sfdph nonhospital employee recognition awards. so what i'd like to do is let everyone know if your name is called or your group is called, please come up to that side of the stage and stand on the other side of commissioner bernal. if you wouldn't mind raising your hand so they know, and just stand as the paragraph is

read about you or your group, and then once that is done please move forward and shake all the commissioners' hands, and the commissioner will be waiting for you for your certificate on the side. we can begin, unless you have questions. >> i'll express my appreciation for all those getting an award. i'm getting a cold, so i'm not going to shake anyone's hands, but i'll do elbow bump. >> i'm also getting a cold, so i wouldn't shake anyone's hands. we will begin. commissioner bernal, would you read the first person or group? >> yes. can i ask "sunny" ho to come forward, please? hi, sunny. [applause]. >> i have to admit this is one of my favorite parts, getting

to recognize staff here as part of my work, so i'm going to read a little bit about you, sunny, if that's okay. so kwok wau "sunny" ho is one of the unsung heros. in his role as porter, he supports every staff member and staff in the building. in his role, he must combine physical strength with strategy to determine how best to solve a particular problem. he is one of the vital employees at 101 grove that serv serves as a backbone so all other activities in the building can be conducted. when there is a shift in facilities and leadership management at 101 grove, sunny's knowledge of the building and its needs were very helpful during transition to a new supervisor. sunny provides hi knowledge of 101 grove street, but he does so with impeccable skills. he always has a 13450i8 to

greet everyone. he is incredibly hard working and dedicated to doing his job with integrity. "sunny" ho is a great asset to sfdph, and today we thank him for being an important member of our staff. [applause]. [ inaudible ] >> okay. can the prime team come forward.

[applause]. >> here we go. here we go. all right. so as all of you know, prime is the most ambitious paper performance service program that we have been involved with to date. rina gupta, patrick oh, senior analyst for strategic initiatives in three of our prime coordinators, karen chen, sally kelley, arcually scshley

scarborough, ellen chen, luke day, and rosalieferrer, lisa golden and ayana bennett, robert lynch, barb wismer, and joseph pace, anna delgado, i don't say chase and todd may, and david woods and david smith. winnie see, tina leigh, valerie chan, steve solman, and jackie haslan. as a result of their collected efforts, we have made significant strides on improve our data, and we have met 57 of 57 measures.

[applause]. >> earning 100% of the 34 million available for fiscal year 16-17. greg, what do you think of that? where is's greg, so thank you so much for all of your service and your fantastic work. [applause]. [ inaudible ]

[applause] >> before i recognize the next two honorees, let me apologize any advance for any harm that i do to your last name. the only one i'm sure about is my own, so having said that, here i go. the next nominee for dph 2017 award is douglas obana, a senior environmental health inspector. he was nominated by stephanie cushing, the director of environmental health. [applause]. >> douglas obana has been with dph since 2010. he has worked in many programs within the environmental health branch, such as refuse lane, food safety permitting and inspections, medical cannabis dispensary, permitting and inspections and nonpotable water check, permitting

inspections for the last two years as a senior inspector. doug has permitted 24 medical cannabis dispensaries and he also accepted and reviewed 26 nonpotable water applications and reviewed the accompany reengineering reports. doug has been rhea signed to the new cannabis program and environmental health. he is a valuable asset regarding all information regarding cannabis applications, processing, permitting of the medical cannabis dispensaries and the recent adult use retail permitting and medical cannabis dispensaries. probably should have smoked some before i said all that. he keeps up to date of the medical cannabis regulations. doug works well with the regulating community and spends time to explain current processes regarding cannabis. doug is hard working, does not complain and is willing to do whatever is necessary to protect the public health.

i give you douglas obana. [applause]. >> thank you. [applause]. >> i have a second awardee. would the group from the medical and sobering center please come up. [applause]. >> and the two people who are named in this group is alice m mug -- moughamian and the

medical respite and sobering center is comprised of two medical clinical programs. they provide postoperative care. the sobering center provides a clean safe place for intoxicated people to rest, sober up and also be introduced to other health services. both programs are largely nurse ran and staffed. units will provide compassionate patient centered services to high risk individuals. with the effective collaboration with an investment community partners, the mrsc successfully expanded into a new adjoining building this year and is now functioning at maximum capacity which is 75 respite and 11 sobering beds. with a vision of home care for

people without a home, medical respite was founded as a place for homeless people to recuperate after surgery or hospit hospitalization. nutrition and compassionate care are needed in order to make a full recovery. suck duker burg san francisco compassionate hospital is over 30% homeless, having a safe place to which homeless people can be discharged is essential to patient flow at csfg, especially to minimize the number of patients who remain in hospital care but are lower level care. and thus, not requiring an acute hospital bed. this helps ensure that we have beds available for acutely ill

individuals. the staff of the medical respite and sobering center epitomize compassionate care and promote and protect the health of all san franciscans. they care for our most vulnerable and high risk individuals, and play an essential role in the continuum of our integrated health care system. despite the challenges of continuing care of people during a complicated expansion project, they did so and successfully expanded from 56 to 87 beds in the two programs combined. thank you very much. [applause]. >> thank you.

>> so i believe it's my turn to read the next awardee, and would kelly hiramoto please step up. [ inaudible ] >> okay. so this is for the public health accreditation team, and karen pierce is the had he had with isela for the record, cora hoover, melissa ta, karen cohn,

karen yu, marise rodriguez, janine young, and veronica shepard. so on march 7, 2016, the san francisco department of public health achieved the arduous work of becoming a fully accredited public health department by the national public health accreditation board. [applause]. >> the accreditation is for conducting high quality continuous improving core public health services. nod in addition to the strategic plan, the community health assessment and the community health improvement plan, using standards and erbmas, we must demonstrate organizational competencies in 12 public health domains: community assessments, field

investigations, health education and information dissemination, community engagement, policy development and planning, legal enforcement, ensuring access to health services, workforce development, continuous quality improvement, research and evidence based practice, administration and management and governance. the public health accreditation team led by karen pierce reviewed thousands of documents and have selected and meticulously prepared over 500 documents for review by the public health accreditation board. this has been a huge undertaking, and the staff took on this work in addition to their regular responsibilities. these staff have demonstrated tremendous dedication and commitment to public health service. thank you so much.

[applause]. >> i can't even say the metrics, and you filled them. >> yes. i was just informed that kelly is not -- is unable to join us and accepting on her behalf will be roland pickens. in her tradition of the role of receiving -- [ inaudible ] >> -- and clients who no longer require acute intensive services but cannot -- cannot

return home or to their previous place of residence of care. find appropriate placements in community based and/or residential care facilities at the lowest and least restrictive level of care. kelly not only provides these services to the department of public health, she also serves as a resource to other delivery systems in the city as they, too, battle to advocate and provide placements for these vulnerable populations. in the most recent efforts to aimed at providing services to citizens suffering from mental health or recurring substance abuse conditions, kelly oversaw the implementation of two vanguard programs. first is the humming bird navigation center at the san francisco health center located at 22nd street and potrero avenue. the program first opened in 2015 as a daytime only service and then expanded to 24 hours

operations in 2017. offers psychiatric respite, clinical and pier counseling, hot meals, showers -- hot meals, not not meals, showers, and overnight accommodations to help clients regroup and find their footing after a crisis episode. the second one is the san francisco healing center, located at st. mary's medical center added 54 new conserveator mental health beds. these locked psychiatric beds serve a critical need for clients who are placed on conservatorship and are too ill to live independently but do not require respite care. it has significantly improved the county's capacity to serve people with serious mental illness. kelly is acknowledged as one of

the experts for mental health in the city and county of san francisco because of this, so a huge thanks to kelly. [applause]. >> one more round of plaapplau for everyone. [applause]. >> thank you all. so i'll note there was no public request for comment on that item, so i'll move onto

eight. [agenda item read]. >> okay great. we will take a moment break. >> through the chair, may i make a comment? >> yes. >> yeah, thank you, please. yeah. i apologize for being late. i didn't hear the director's report, and i really apologize for that, but it's just taking longer to get even from 16th and -- and the mission to here. and now, it takes 28 minutes. i usually can do it in 15, and i apologize for being late. but i did want to comment, because after these awards, we've heard so many of these outstanding achievements. i mean, take a look at what our group has done. and the comment has always been, in addition to. i mean, in addition to your day-to-day operations and oversight and duties, this is always above and beyond. and when you look at people who nominate part of that team,

hali hammer, to me, having been a part of these teams, we would always get a number of volunteers, and it was sort of like a search-air rescue going down or a wing and a prayer, and you'd get a coalition, and you'd go down and do something for a very -- week period of time. this was actually organized. we had a cohort of people, people who are busy, busy, busy, busy, making a pledge to go above and beyond. the bottom line is when they came back, we had a diversity of different professions there, including professor emeritus of psychology. spent 34 years -- i could name over half that. just the staffing, and they

came back, and they have now provide links, so this way, we can make sure that anyone within the network and without the network can use our public health foundation to provide services, medical supplies, whatever it is, in a valid channel, so this way, we can sustain what in fact was discovered there. and i have to tell you what was discovered there because you know how our -- our puerto rican colleagues, along with other latin americans are being treated today, especially along the border. i'm sorry i missed it. i know that congress woman pelosi was helping work with this, and all of the services that were record, but -- invol. it's going to get even a lot worse as things go on, but i just wanted to thank our

director, 'cause she was -- was the prime mover along with others and all of our people who volunteered for this effort. this is part of the awards ceremony, in addition to, we are so proud you -- our department and -- which is our people really makeup just an exceptional cohort of outstanding professions dedicated to why we're a department of public health second to none. thank you very much. [applause]. >> and if i could -- we do have dr. hammer here, so maybe she could standup and we'll give her a round of applause. [applause]. >> i didn't see her. [applause]. >> good afternoon, commissioners. i'm here to update you on our work on cannabis and the transition from article 33 to article 16. so i'll give you an overview of the legislative history. i'll give you a little bit about the work we're doing in partnership with the office of cannabis to transition. the office of cannabis

permitting process, and then, the new department of public health cannabis consumption permit. so all of us know brownie mary volunteer general, hospital working with perrone around hiv and aids and really illegally giving our patients brownies. and that's -- and she helped champion the compassionate care act, proposition 215 in 1996. we move on nine years later, and we pass article 33. what's important here that you know is all we did was permit the dispensary. we did nothing else. fast forward 22 years later, and we see california laws that really promote both medical and adult use. the thing that we need to know is that the industry is very sophisticated. this is no longer your grandma's brownie, and so it's important to know now we are catching up as they are catching up, as well.

so in 2017, we passed a series of laws. first, we created the office of cannabis. we also passed a planning code amendments to allow for adult use, as well as multiple cannabis business regulations. this is an overview of what you'll see dph -- today, i'm going 230 focus on the left side. -- going to focus on the left side. what you see is up in the blue. before, what you never saw was below that line. the other questions that people had was about kmund education. we'll come back and talk about that another day and substance abuse programming. people have questions about the tax, and if we do a tax in november . i split this slide in half because both things are happening side by side, so what you have is us continuing to

issue article 33 permits, inspect them, continue to do our work, but we also have to authorize adult use in partnership with the office of cannabis and police. so on the other side, you'll see what the office of cannabis does, and on the left side you'll see how we authorize the adult use. simultaneously, like i told you earlier, nothing else was permitted. so we needed to create some minimum standards, what we call safety standards or life safety standards to make sure we protect both the people working in the site as well as people around them because a lot of these businesses were not completely completely up to code. so we needed to make sure they have minimum standards that they -- we can make sure that the employees and the population around them are safe while permitting and keeping this industry alive. so we -- we assembled a team of people doing sanitation,

pesticide, hazardous materials. we developed some documentations. if they weren't up to par, we let them know what they needed to do to come up to par. we also have to draft regulations. no regulations are there. the team spent a long time looking at the state regulations and the local codes and making recommendation as to how do we proceed. the other thing that's going to happen this year is that we're going to start permitting all the businesses. what you need to know as the health commission is we no longer are going to be the permitee. the permitee is going to be the office of cannabis. what we will do is plan check the business model, make sure it's up to code, make sure everything is up to par, and we will do the annual inspections. go below the line, and you will see other things we do that are currently the laws that have nothing to do with cannabis.

so looking at their point of sales scales -- i mean, their point of sail register, their scales, looking at the labelling, all of those things we do in the health and safety code. they will not go away. we'll continue to do our work there. i wanted to give you an overview of how much regulation is going to happen. we have three state agencies that also have to issue licenses. then, you have the office of cannabis, the new sheriff in town, if you will. and then, you'll see the department of public health environmental health programs all depends on the business model, so if you don't use hazardous material, they won't go in there. if you do use hazardous material to store them, they will register you and work request you. we were required to do a fact sheet. i think you have it before you. the law required us to do that. that actually is provided to every individual every time they purchase cannabis, whether it's adult use or medicinal

use. it's in the five threshold languages and can be found on both websites of the office of cannabis as well as dph. what's new? we have permits that the department of public health will be issuing. there are three types of permits that were approved by the board of supervisors and signed by the mayor. the first i'll describe so that you won't have to read. i gave you all the information. think, you have information, you buy your products, there's no preparation. you go to your little table, you open up your brownie, maybe you open up water, and you're sitting there, eating it. that's permit a. there is no smoking in that location. permit b is limited food prep. it's the same thing. think this time you're warming up the brownie. you can't cook. this is not a bakery. it's not a restaurant. let's not misstate that.

this is just limited food prep. you also cannot smoke cannabis at this location. the third one is a smoking type of cannabis consumption. what we said was you have to have a separate designated smoking room, not in the retail location. you have to meet ventratiilati standards, smoke standards, noise, depending on how -- what kind of material you use, all the standards that we have. this permit will allow for either(a) or(b), and you should know they get costly. so one is 800, the other one gets to 1,000, the other one gets to 1200. so if you get 1200, you get to chose smoking,(a) or(b). there are locations that are going to be allowed to do smoking as is. they have been smoking for many

years. they meet the ventilation standards. the thing that you should know about those nine is if you sell your business or move, you lose it. smoking is lost. they were just grandfathered in because they currently were allowed by the planning code and health department to allow for smoking, and we let that transition happen. that business model has been in operation. our goal is to release our rules and regulations in application sometime this spring. we're working hard to try to align it with the business application being issued by the office of cannabis so that you're not doing things twice, and you're not reviewing plans twice, you're not developing diagrams twice. we're trying to be very business focused and very lean in thinking in terms of how we issue this application. the important thing you should also note is we will not give them the application if they do not first get a permit from the office of cannabis, permission, and a license from the state.

no plan issuing a permit to smoke when we're not even sure if you're going to open. there's also information on -- consumer information on the office of cannabis website providing cannabis for medical use where you can buy, how much you can have. all of that information is on the office of cannabis. we know a lot of people wanted to know that information. and i just actually have to thank this partnership with the office of cannabis as well as the team you see. the people involved here, i just want to let you know, all of this has been done in less than four months. okay. they got together middecember, really hudled with the building department, with the fire, made the minimum requirements, get out there. they went out there, twice a day, wrote their reports in the afternoon. reviewed their rules and regulations, sent them to me, met the next day, hudled the next day, and all of this work happened in four months.

so i want to thank them today, and two of them are here today, and i think we should give them a round. [applause] >> questions? >> before we go to questions, is there public comment? >> i have not received any public comment requests for this item. >> okay. and colleagues, if you want to indulge me for a moment, i'd like to go to director garcia to see if she has any comments. >> no. i'd like to comment that this is a whole different business model. if you can look back at all the areas that we are responsible for related to dph program. so for many of you who shop, you will note that weights and measures is an area that we do. so we visit anyplace that is weighing, and so all of these areas below the line are things that we already do. and this is incorporated, this business model has now incorporated many of the areas that environmental health already does.

and so without a lot of expansion, we've been able to really keep up with the business models that have been -- and the businesses who have been applying for these new permits. so i do want to acknowledge israel and dr. aragon who have been working hard getting this business model off the ground. also transitioning to another department in the city who has taken some responsibility, so we've had to figure out which responsibilities each of us was going to keep. we are keeping regulatory oversight of these businesses, and so we wanted to separate that out from the group that -- the office of cannabis. so if one of the businesses does not meet the code, whether their weights and measures are off, or if they're also finding that they're doing things that are illegal, like having underaged individuals in the business, that's an area that also could shut their businesses.

but i do think that we've done a really good job in a short period of time. i just wanted to echo what israel has been stating today, and also to acknowledge himself as somebody who's really been working really hard on ensuring that the new office of cannabis is able to do their work. and they give me complimented every time, all the time they see me, so this is a good way of acknowledging his work, as well. any questions, we're happy to answer. >> colleagues? commissioner chen. >> thank you for the presentations. it's really educational. like yeah, this is the first time i actually realized how many, like, licenses, have to, like, get, in order to be a dispensary? but with that said, i think this is great because a lot of my friends in the hiv community have benefited from medical cannabis. i don't -- i don't -- that's the part that i -- i'm having some trouble understanding is who regulate the strains of

these, like, cannabis that being put in storefronts? >> so there's a tremendous track and trace system being developed by the state. one of the things you should know in order to ensure people didn't cut and run and all go to adult use, there are only two permit types -- main permit types. you are either remain medicinal or you must do both adult and medicinal. you cannot just decide in san francisco. that's a san francisco model. that's not the way it's being done other places. it is quite expensive because you're getting the local one that's a and m, and then you've got to get both the state a and the m, and you've got to be approved for all three, so something to watch as we're getting a little bit of push back on that. but we're keeping whole to that, and we're going to keep that model moving before making any changes to ensure that patients get -- so the track and trace system, very easy to

way -- so if you grow, and that's going to be the last thing that's going to be done, or you're going to sell plant for smoking, that has to get tested to be sure that it makes all the qualifications. if you sell it to a manufacturer, that's cultivating it or making it into an oil. that end product, too, must be tested to see what happened during that process. now if you're another manufacturer, and you're making brownies, to say you have to make your brownie, send a batch. that also gets tested for additional things like salmonella and other things that may have occurred in the making of the product. and that's all tracked through the track and trace system at the state level, and we will have access to that information. so that's how the chain of custody -- now there is one business model that is a microbusiness, where you can do cultivation, distribution, manufacturing, and selling all under one license. little bit more expensive, but instead of making you get four, you can get one -- one license,

and there are currently four temporary operating in san francisco. >> so i have follow up questions. so because this is still a very new territories in so many ways, and we are adopting a new business models to regulate these -- the industry it efl is, how do we ensure medical marijuana -- like, the pricing of medical marijuana with all these, like, additional, like, regulations continue to be affordable and accessible for the patients who need them? >> degree question. we -- great question. we contemplated that question in writing the compassion program. that's still in development at the office of cannabis. you're right. this is tax, tax, tax, tax, and we put a local tax, people fare all of a sudden people will go back to the illicit market that's not tested. so we have to figure out a compassion program that we can

then allow people to get free or low cost cannabis, but that's in progress. >> so i'm looking forward to, like, an update on that, because i think that that's the next level of discussions for, you know, the community, you know, who needs that, especially those who are, like, using that as their primary pain management source. >> yeah. we're also going to see an increase in people getting the medical card. that's the only thing that allows us allows you to get a tax cut so you don't have to pay local tax. >> okay. thank you. >> commissioners? i have a comment and question, and thank you very much. and the question has to do with should i drive, if i consume cannabis products. and i recognize in this department, we are a harm reduction model, and that that statement looks like a harm reduction model statement, and i'm all for that, but when you -- i'm going to drive

across the bay bridge tonight, and there's a big, blinking sign that says buzzed driving is drunk driving. so i know that we don't want to be the chp, but we need to let folks know that you probably shouldn't be driving if you're going to use cannabis or we need to just make a clear statement, this is a health department statement, it is not a chp or a law enforcement statement. >> we agree. we agree, and it's also troubling that one of the things we have to educate people are on edibles. they can take 12 to 32 hours to kick in. you can get in the car and oh, i am good, and then all of a sudden, oh, i'm not good. there will be a lot of education, and that is on the rise when we look at our community health education, we do have currently a campaign being developed in partnership with 510 media and tracey packer and her team will come back to you. we want to come back to you with information.

they're collecting the focus group information, so what were the messages, what are the findings, that's what they'll come back to you. >> thank you. >> okay. >> thank you very much for your well thought out report. >> thank you. and i did hear your request for a follow up, commissioner chung. we'll figure that out. all right. there were no public comment requests to the item. we can move onto other business, item nine. commissioners, i'll note on the calendar that you all have told me that august 7th, i believe -- the 9th or 7th, august 7th, you're all available, so that is the date of the community meeting, and i will get back to you as we figure out details of the location, so just please keep that on your calendar. any other questions about the calendar or any other business items? okay. we can move onto item ten, which is a report back from the april 24e csfg shall jcc meeting. commissioner sanchez?

>> the csfg/jcc met april 24. our new member came on board, dr. green, and she was introduced to staff and to our jcc committee and welcomed herrin put. the reports in essence included are the open session included the regulatory affairs, our excellent hospital administrator's report, our patient care service report, human resources report, which also announced the promotions of two of the key staff who have been working there, and they'll still be assigned but over part of the whole area pertaining to hr, but they've done an exceptional job pertaining to many of the critical areas that we've been under staffed. we also have the medical staff report. the committee has very

extensive discussion on presentations on the -- [ inaudible ] >> -- from there we moved to closed session. the committee discussed the credentials report and pips minutes, and that really ends our jcc. is there anything to add, dr. green, to the committee? >> it's an incredibly impressive institution. >> if not, then that's it for the joint conference. >> and unless there are comments, a consideration for adjournment is in order. >> motion to adjourn. all those in favor, signify by saying aye? meeting is adjourned. thank you all. [music]

>> 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. >>

>> clerk: commissioner seriñá. commissioner lang and commissioner loo is excused and commissioner pappas. commissioner jeremy wallenberg. and please note that the executive director is present. >> thank you. we have amendments to the agenda. items k, l, m, n will not be discussed today and we're making the agenda shorter, please. and item b is the approval of the fiscal year 2018-2019, and area plan update, not 2017-2018. with those two amendments may i have a motion to approve the agenda. >> so moved. >> a second? >> second. >> thank you. any comments or questions? all in favor?