union notice regarding new employee orientation of new employees of that unit, at least ten business days prior to the orientation. they comply with that portion of the bill by providing all unions with an annual, central and typically, what we do, we sent out the annual schedule between november and december for the following year. in this particular case, for 2018, we sent our schedules between november and december. the second area at that the bill also covers, is employer to provide a union representing it's employees, with the name, job title, department, work location, home, work, and personal cellular telephones, personal e-mail addresses and that's been a coordination efforts between my respective hr department, and dhr for the city. that is just to give you a quick i -- highlight of the bill.

with the passing of this bill in concert and with working with commissioners, we have made some additional changes with respect to our communications with the labour union partners. regarding the following ways. we sent personal calendar invitations to the respected union organization who have members attending an eeo at each of the upcoming sessions with the wrist instructions on where to go, when to arrive and we also provided copies of the agenda and the roster which is the actual sign and seat. these invites typically go out 1-12 to a business days before n.e.o. is scheduled. to give you a context of how often we conduct n.e.o., we have a regular schedule of two n.e.o. a month at the training conference -- happens on the first day of the employee's work. during the summertime, we moved to scheduling it every week due to the high volume of employees

that we hire, and typically there in time. my staff are very busy at the moment. one of the request that was made was to further enhance our communications by implementing a new form which identifies employees a respective union organizations, contact information for the union representative, and a link so the employee can actually act on that information and become much more dictated about what being a represented employee means. this form will be on letterhead and will include the general manager's signature on it, and it will be disseminated at the beginning of every new employee orientation. we think commissioner courtney for working with us to enhance some of our communications. we indeed a partner with all of our respective labour organizations to make sure all employees are aware which unions

they belong to, and how we can continue to work with them in that partnership. at this time, i will take any questions you might have. >> thank you. public comment in this item? so i want to thank you for your work and your staff. i also want to note that this isn't just about the assembly bill, but the assembly bill, and that effort was really triggered by a national effort by those of you who don't know, supreme court decision that is inevitable coming down any day now that will really impact the way that labor unions an in the public sector do with their members and how the employer feels about their members. for a few years, i've been talking about as having some kind of an articulate -- articulate workforce development at our level so we know exactly how we deal with current employees, onboarding, recruitment, et cetera. i think this is, not just a positive step, i think it is

kind of step that, and i think we have to thank francesca and we need to thank the city thinky attorney's office too, about their assistance -- without their assistance, we would have wobbled more. there is a big difference between the kind of folks that work for the public utilities commission that work indoors and have college°. that are assigned workstations. we take these devices for granted. they are very expensive. expensive to upload. with my cable bill i cut that cable bill but with the folks that i come into contact with routinely, they are confronted with making decisions about whether or not to pay their auto insurance, or their cable or their internet or whatever it is. there is a big difference between a young man, a woman who is being brought on board at a much lower rate of pay, from a community that we identify as being a community that we want to go over and above for.

and so, providing them, and making sure they have that information, is probably one of the things that i hold most dearly to myself, in terms of taking care of our workforce. i do look forward, and this is an interesting game, because, you know, the chair man or chairwoman it sits in that seat for about a year. it is really, really hard to get anything done in a year. but that is how the game is played. so, i am moving this ball, and it's obvious, to everybody, i'm moving this ball because i expect a real thoughtful and deliberate approach to work force development in both the public and private sector, because the mayor, about a week ago, he also convened a group to anticipate the next economic downturn. the pressures that we were under 3-5 years ago, with respect to the community workforce, they are about to come back here. we will be ready for it. because i think, even though we don't always agree, i think we

are all thoughtful, and deliberate enough to work together, find a common ground, and get it through. my hope is that there is a little tweaking i see that i would like to talk to the general manager about, but i also want to thank the general manager and the city attorney, because at the end of the day, i want to be part of a conversation with all of us. i want to be part of a conversation that sets the gold standard for the city. i think the notification -- from the gm, and what we aim to do with this little onboarding piece, sets the gold standard and i think we should ask or other city departments have access to it. thank you for your efforts. >> thank you. >> thank you. >> now commissioner? >> thank you. >> commissioner courtney. public comments on this item? item seven f. please. >> seven f., i was going to

bring up the award and i just want to say, i want to thank staff on to answer your question park we actually looked at last years and we talked to the ways we can improve it. a lot of those ideas came from you and from some of our atms and staff who have worked on the awards. what i think everyone felt in the little video was that people can actually have and show their families. people who couldn't attend. i thought it was a great touch as well. i'm just really proud, and i'm looking forward to getting some feedback, so that next year will be even better. if you guys, or any commissioner attended, if you can provide some feedback in ways that we can improve it, that would be great. and with that, that concludes my report.

>> any public comment on seven f.? >> at this point i would like to hear the tale of the origin of this but we will sa save that fr another time. >> bay area water supply and conservation agency update. welcome. >> thank you commissioners. can i have the projector, please? i will apologize for my low-tech version here. i had a failure of technology on my end. so donna assisted me when i started out today. i wanted to take my time today to talk to you about an effort that we've been working on for the last year. and we planned t plan to move fh it next year, regarding the governor's request to make water

conversation a way of life. the work that we have been doing for that... and only 2017, there were two pieces of legislation that were introduced in sacramento to support the governor's call for water conservation and this was conservation above and beyond the idea of a drought conservation. really speaking to long turn -- long-term conservation use. both of those have moved through the legislature and have made it out at the legislature as they are awaiting the governor's signature. what we did, in july 2017, as we initiated the development of our strategic plan to meet this. to really try to decide how to help our agencies meet this requirement, and how to do it best. we anticipated to have a role for that, and this was our weight to try to develop that.

so that strategic plan had three main components. the legislation is very specific. it has very detailed requirements about how to develop water targets, activities you have to do, highly data intensive and activity focused. so, in looking at it, the question was, we have to assess what it will take for 26 agencies, 26 water suppliers that are small, and large. cities, water districts, private utilities, how do they have this information and do they have it available to them? what does it take for them to get this information? what are the systems in place within their districts that will help them, you know, do this work? so that assessment of their capability is is a critical component of it. we also looked at the cost of that. not just what it would take for them to do it, but also trying to figure out what would it cost for them to do it?

part of this was figuring out how do we help them implement the most cost-effective way? and we use this information to also develop our position on the legislation. we were relatively quiet, we don't speak on active positions aren't bills but we do push in certain directions. we work closely with the association of california water agencies and other water utilities in the states and with your staff as well, to get certain changes made for the legislation so it can be more easily implemented and actually made sense this type of area. and that was successful. on the legislation currently reflects that. the other thing that's this information did is we developed a work plan. based upon what the assessment said, and what they needed to do and where we can identify some cost-effective opportunities, we put together a work plan. what we could do to help the agencies next year and what they

were going to do. this idea of working together which is consistent with how we implement conservation today in the service area. so, a couple of the key pieces of this legislation, the first is outdoor water use. and examining what kind of information our agencies had to look at our out -- outdoor water use. landscape area measurements is one of the big requirements of this new legislation. essentially coming up with a water budget on a per residential account basis based on actual measurement data out. if you can imagine, i know this is one of your issues and constraints you have had to, kind shows try to get that data is difficult. coming up with cost-effective ways to do that is important and how you deal with that amount of data. those types of analytical questions where the things we

looked at with our agencies. commercial and industrial water use is another major component, that to be totally honest, a somewhat undeveloped in the service area. is not the largest sector of water use, and it has been one that has not easily been responding to previous water conservation efforts. so now, looking at, you know, what kind of commercial audits can we do? which ones are successful? how do we all classify our commercial accounts? do we all do it the same? and how do we change that at what would that take? these type of questions all get into different departments, if you will in the city, you know, who does the billing, who does all the information. it is not a slamdunk and try to figure out the answers. and then, water loss is another major component of legislation. it was building on a previous bill that passed a few years before that. senate bill 555 that required agencies did you water loss evaluations, and then do

verifications after that, every year. the first set of evaluations were sent in last fall. and now he requires verification. this is done annually. again, these are areas where it is like, what worked? what didn't work? what kind of help do you need? i will say, we have worked mostly with chris nelson in your water supply and treatment division manager, and helping us with this. it certainly impacts, you know, the work that you do on your metres, and your launching of the metres on the verification and all those types of things. that will be an ongoing effort. that is not an easy one, but it will be necessary to make -- meet the requirements of this law. there's a reason why we don't do those things anymore. [laughter] so, last week, the board adopted the work plan for fiscal year

2018-2019. it essentially took all of this information and put it into an action plan. we did a lot of case studies with this analysis and try to look at other water utilities throughout the state and elsewhere to say, how did they meet these requirements? what are different ways to implement these programs? we brought that into what we are going to do. the first one is a residential indoor, outdoor water use study. the legislation requires a certain residential efficiency, and then we have to do the outdoor efficiency. we, in our region, have not done a study that provides a breakdown of what is an indoor use on a per account basis or a type of residential customer basis and an outdoor use. we will go through that process to understand what is the base start in the service area for residential water use so we can understand, what do we need to tackle to meet the requirements of the law? the other thing we are going to do is implement a pilot audit

program on a regional basis. we will look at a couple of different options to see what might work and come up with the best alternative to me to the needs an exhaustive -- cost-effective way for the agencies. the other piece is what we call our water loss management program. and bringing on someone to do multiple parts of this water loss investigation. it is highly analytical and there's very specific requirements. and unfortunately it is kind of like any other audit we have one person that does the analysis and you have to have a third party verification and then you also have education about it. what we have found is some agencies want help with the water loss and they will do the verifications and some want to do the verification without the loss. it is a combination of activities, but overall, getting them to get these things done and getting them completed, so we can all meet the requirements of the state legislation. i'm really excited. i think it was a bold step for

us to take this on a year ago. really, it is building on what has been our historic activity for water conservation, and what has worked in the service area, and in recognizing the differences between our agencies, and how we can help their needs. i was very excited with the support we go off and the board the other night and i look forward to seeing that what the results are. just to kind of, in my comments, so, as we continue to keep track of water use in the service area for last march, about a month and a half ago, i guess, use was 28% less than it was in march 2018. this is where it is interesting. this is total water use. all support -- all supplies of the area. social water use has been reduced by 21%.

the interesting thing, is for the san francisco supply, it was only reduced by, now i can't find my numbers. four%. so, this is something we know happened. agencies have multiple supply sources are using something different. and in this incidents, it is likely. another wholesaler in the issues have a treatment issue in their plants. they asked some of their agencies to take more san francisco supply. the presumption is it will balance itself out. it was certainly things we have done in the flip side, but it is an interesting thing to track. if you look at one supply, you missed the picture. this is something we will continue to keep track of as we move through that season and we see what the long-term implications are. with that, i will conclude my comments. >> thank you. commissioners?

thank you very much. is there any public comment? we will move to the consent count. madam secretary? >> all matters constitute the consent calendar are considered to be retained by the san francisco public utilities commission and will be acted upon by single vote of the commission. there will be no discussion. in which event the matter will be removed from the calendar and considered a separate item. >> the request to remove items from the consent calendar? >> commissioners? or public? no discussion, the public comment, do we have a motion to approve? all in favour? opposed? approved. item number 10.

>> item number 10, improvement number 1, customer and administrative services for community choice aggregation programs with energy solutions, and authorize the general manager to bring and this amendment and increase it by 14 million and extend th extentm of the agreement by three years. >> discussion, commissioners? >> any public comment on item ten. do i have a motion to approve? all in favour? opposed? item 11, please. >> item 11, approve correction to an error of scheduled... adopted by the commissioner on april 10th 2018 by resolution number 18 to include a monthly service charge for nonresidential customers at the wastewater enterprise. >> any discussion?

any public comment in item 11? i have a motion to approve. all in favour? opposed? please read the closed session items. >> item 14, existing litigation. a proposed partia propose partif action as to property damage. numerous plaintiffs are remaining in litigation. a settlement amount of 28,000. item 15 as existing litigation. a proposed settlement of action with the plaintiffs release of all actions of the city. the plaintiff amount of hundred 99,000. as a president mentioned at the beginning of the meeting, item 16-21 will not be heard today. >> it's or any public comment on matters to be addressed during

closing? do i have a motion to assert the attorney-client privilege regarding the mitre -- items below? all appro light for our city an

streets o light for our city an illuminating our ideas and values starting in 2016 the san francisco public utilities commission is xhoefl that light with new led with the did i audits for better light for streets and pedestrian and they're even better for this

vitally lasting longer and consuming up to 50 percent less energy upgrading takes thirty minutes remove the old street light and repeat 18 thousand 5 hundred times while our street lights will be improving the clean energy will remain the same every san francisco street light is powder by 100 percent godfathers hetch hetchy power in one simple word serious as day turns >> all right. so good morning, everyone. thank you for joining us today. you know, for the past four months, as mayor of the city of san francisco, i have from

reside residents across our entire city up and down the ladder about the streets of san francisco. our streets are filled with trash and debris, and it is unacceptable, and i've said from day one the cleanliness of our streets is going to be one of my biggest priorities as mayor of the city of san francisco. san francisco residents are fed up with the conditions, and i am the first to say that i feel their pain, and we are doing something about it. so last week, along with a number of people who are here behind me, we announced a comprehensive budget proposal that we're going to move forward with to aggressively cleanup our streets here in san francisco. we are no -- we know that our conditions on our streets exist across our city. it's not confined to one neighborhood. every single neighborhood is feeling this pain, including right here in the castro district. so this plan that we announced last week includes 44 new

street cleaners throughout the city of san francisco, four in each supervisorial district that will have material impact in the conditions of our neighborhoods, in particular our commercial corridors. we're adding five new pit stops to address the feces and urination issues that we are seeing in many different neighborhoods here in san francisco. and also talked about and announced a dedicated team to picking up syringes and needles across the entire city of san francisco. family members and individuals should not have to step over needles on the way to school, on the way to work. it simply doesn't need to be part of our landscape here in san francisco. and we are also growing our fix it team, sandra, who runs or fix it team, and does such an amazing job. how about a round of applause for her. [applause] >> the hon. mark farrell: we are expanding it to ten new districts in san francisco. because they do such an amazing job in san francisco.

when there are areas to be picked up, when there is anything that needs to be done, they are there doing it, doing such an incredible job. but we need to do more. we need to put our foot on the gas pedal, and as mayor, until i leave office, i am going to do it, and street cleanliness is something i am going to address. we have a big effort to cleanup our streets. san francisco residents do, as well, and now today we're going to have some bigbellys to help us with that effort. and sorry, i had to go there with that line. so today, we are announcing five new bigbelly trash receptacle here in the castro district and 15 others in different neighborhoods throughout san francisco. now these bigbelly trash cans, as you will see, there's going to be a demonstration at the end, are different than your normal trash cans. they have automatic compactors inside, allowing them to hold

five times the amount of waste of any normal garbage can. they tick recycling, compost, and trash, and they're outfitted with wireless technology, real-time technology that alerts those when these are full to come pick them up and empty them. that means no more wasted trips to pick up half full garbage cans. you know, we are the technology capital of the world. we should not be afraid, and you know i believe as mayor, we should embrace technology to benefit the daily lives of our residents, and we are doing that today. we are making this investment now in partnership with our small business leaders. our community benefits districts are the ones that really do the work on the

ground. i want to thank andre who is here today for all of your work in the castro, and we are partnering with them to install these new bigbelly trash receptacles, but also to maintain them going forward. we are going to cleanup our city here in san francisco. we made a number of announcements last week. today is just another step in that direction, and i want to make sure to reaffirm my commitment to the residents of san francisco that cleaning up our streets is going to be one of my biggest priorities, and we will not stop again until the day that i leave office. i look forward to seeing these trash cans across the city of san francisco. we are going to swallow up the trash with our bigbelly garbage cans, once again. so with that, i want to thank everyone for being here. we have a number of speakers, and i would like to introduce and bring up supervisor jeff sheehy, who's right behind me. and i want to make a quick comment about supervisor sheehy. there has been no one, since i have become mayor, who has been more forceful in his advocacy of cleaning up the streets of

his district than jeff sheehy. you can clap. it's great. we have gone on neighborhood walks. we have walked this commercial corridor right here with our department of public works. there's no supervisor more focused on cleaning up the streets of his neighborhood than supervisor sheehy. and with that, i'd like to hear from him. supervisor jeff sheehy. >> supervisor sheehy: thank you, mayor farrell. thank you for those kind words, and i really want to thank you deeply for your leadership on this issue. it's been a challenge, but the inno-nateti innovation that you're bringing to this, the resources, it's making a difference, and i know the people in my district, we're grateful. i also want to thank the department of public works because they have been so steadfast, so diligent in cleaning up this neighborhood, in cleaning up the district. it's a struggle because we know that this is an ongoing

problem, and i think your new initial initiatives are going to help us turn the corner on this. we are moving forward on this. i want to thank the community benefits in the castro for their leadership. these things are great. compacts, signals when the trash is full. and i do want to note that recology is here. recology is doing a great job. this is allow them to be enormously more efficient, so as the mayor said you're not emptiying half empty trash cans, you empty them when they're full. we've seen the problem. we have the open trash cans, people rummage in them. they overflow, and sometimes that creates a mess. so andre, thank you for your partnership with recology, with the mayor. i'm going to address you, but

sandra zuniga, i can't say enough about you. she comes in, she solves problems, she works so closely with the community to identify problem areas and find solutions. she was telling me, for instance at glen park park, we have a little flower stall that was graffitied up. and you know, she just went and painted it herself. that's the type of attitude she brings towards san francisco. that's how much she cares about this city, so i am honored to introduce sandra zuniga, who's director of the mayor's fix it team. >> good morning, everybody. thank you for that introduction and thank you to both mayor farrell and supervisor sheehy for their leadership in this city. special thank you to mayor farrell for giving me this assignment. being able to work on these bigbellys has been fun. so fix it, i run the fix it

team, and what we do z we work closely with communities, talking to residents, listening to residents to find out what concerns they have, and we want to act quickly and effectively to help address those. in the castro, we've been working here about two years, and we've seen improvements, a lot of great improvements to the castro. one of things that's a great concern is litter and the amount of litter we see around our city, especially trash cans, when they've been rummaged through or overflow especially when the wind blows and blows them away. so we're happy today to show you not just an efficient can but a very pretty tran ca-- trh can in the castro that we hope will bring new life, new energy to people who are shopping here, passing through here to use the handing, throw their

cigarette butt or bottle away in the right place. today's announcement is part of a larger strategy that fix it has to make improvements in neighborhoods based on what we hear about from residents, so we plan to implement new strategies in neighborhoods across the city, and find out what works and when something works, we can replicate it in other neighborhoods with confidence. i really would like to thank all of the community benefit districts who are working with me on this project. of course f andre aiello with the community benefit district, and several others who will see their bigbellys this summer, and a special shout out of course to public works, recology, economic and workforce development and kevin from bigbelly, who will give you all a demonstration soon. so with that, i would just like to introduce a wonderful partner in this who has been

tremendously hard working and really fast at turning around a lot of giving us, you know, ideas, information, feedback, andre aiello, for getting the -- from the castro c.i.d. for getting the first big belly on the ground. >> thank you for that. the castro community benefit district is so excited to be the first neighborhood that will be getting these bigbellys in a special program that has been sponsored by mayor farrell, and i want to thank the mayor so much for his dedication to keeping the neighborhoods clean, not only just downtown but the neighborhoods. and we are -- we'll be working with the city to develop metrics on how do we evaluate and measure these to make sure they're effective.

and as everyone has been describing, the bigbellys work because once you put the trash in, you can't take the trash out, and that includes limiting and preventing overflowing trash cans, which i think we've all seen all over the city. the wind is blowing, and the wind takes the paper or the cup out of the trash can, and there's a mess all the way down the sidewalk, and it blows it all the way down the sidewalk. so we're really excited that this is going to help keep the benefit district really clean. the castro neighborhood benefit district works tirelessly to keep the neighborhood clean, keep it vibrant. we have a lot of different strategies around cleanliness, around safety, economic vitality, greening. we have live performances in the jane warner plaza? the summer every weekend.

everything fits together in a puzzle to encourage more people and more pedestrian traffic in the neighborhoods and in an urban environment. cleanliness is probably the first thing because nobody wants to walk around a neighborhood where there's trash and other things, and worse than just trash in a neighborhood. it's community benefit districts working collaboratively with public works who has been absolutely fantastic as a partner and recology all working together to pitch in and keep san francisco clean -- or cleaner, and a great city. so i want to thank everybody and thampg the city family. they have vust been absolutely great. we've pushed through this contract in like a month, so that's unheard of. so thank everybody. i want to thank the mayor for hez creativity and initiative on this. and now, i think we're going to have kevin give a demonstration on how these wonderful things work. take care. >> one, two, three, go!

[inaudible] - 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.

>> i want to welcome you here to the civic center hotel. my name is gale dill man, the c.e.o. of community housing partnership. in 2015, this was the second navigation center to open its doors and welcome over 92 individuals living inen ca encampments in the street. this announcement will ensure that before individuals have the opportunity to enter shelter and navigation centers, they can receive vital services and treatments that they so much need and deserve. and on an on going basis. on behalf of all of community housing partnerships, and the 91

navigation center individuals here at this site, we are so excited and honored to introduce our mayor mark farrell. [applause] >> thank you, gale. good morning, everyone. i want to thank you all for joining us here today. as we all know, san francisco and the rest of our country, and cities around our country, are dealing with an opioid crisis hitting our streets. it's unfolding in our neighborhoods and in our sidewalks in front of our very eyes. fighting this fight means that we not only have to use existing programs but if we're really going to solve the issue and make a dent, we have to be creative. we have to come forward with new policies and new programs that will make a difference on our streets. and that is why we're here today. to announce a significant investment in a new, addiction treatment program with our

street medicine team. the street medicine team has long been a part of how san francisco seeks to deal with the health of individuals on our sidewalks and in the streets of san francisco. the street medicine team is on the front lines every single day here in san francisco. bringing service and treatment to those who need it here in san francisco. the small but vital team works every single day to care for those were in a traditional clinic or hospital, it's simply not the answer and it's not working. their work is rooted in compassion and acceptance and meeting people where they are. including streets, our shelters and our navigation centers here in san francisco. with this new investment of over $3 million a year, we are adding 10 new staff and increasing resources to focus on the drug

addiction on our streets of san francisco. and to address the opioid epidemic, right here on the streets of san francisco, the team will be expanding the work that they started with the pilot that started last year and expanding this program across the entire city. i am proud that san francisco is going to be the first city in the nation to take this approach. san francisco is a leader in so many areas and once again, we are stepping up with professionals that know how to get job run right. leaders willing to take bold approaches to address the issues confronting san francisco residents and those that need our help on our streets. by providing this medicine out of a traditional clinic setting, we're expanding our outreach capacity and taking every

opportunity to help those individuals that are on our streets suffering from drug addiction. the program, which sometimes i have trouble saying, is an important part of our larger strategy here in san francisco and with our department of public-health, to address those struckelling with addiction. which includes detox to residential treatment services. this investment, let me be very clear about this. this investment will ultimately help save lives. and it will improve the conditions on the streets of san francisco. i want to thank a number of people who have brought this program to light today. first of all, director barbara garcia from our department of public-health. [applause] >> dr. sven for his leadership and ingenuity. we knew he would get the loudest

applause and he deserves it. our department of homelessness and their partnership in leadership as well. and all the other providers and healthcare leaders that are behind me here today that are working so hard every single day in san francisco. to get those that are on our streets with the help that they need. whether it's homelessness or drug addiction or the other issues plaguing those on our streets, our goal in san francisco is to be compassionate and get people off the streets, on to their own two feet and on to better lives. thank you for being here today and with that i love to turn it over to director garcia for remarks. [applause] >> good morning. thank you mayor for your commitment to the effort of treatment access for those suffering from opioid addiction. i'm barbra garcia. i want to acknowledge all of the

d.p.h. staff here that work every day to heal and support san franciscans who are in need of healthcare. i'd like to give them another round of applause. [applause] we know science has proven, for a long time, with many personal stories and the medication assisted treatment works. addiction is a challenge of a lifetime treatment and recovery happen and people do get better. mayor lee, a year and a half ago, asked me is there something else that we can do? we need to reach people on the streets who are clearly suffering and in the grips of addiction. what else can we do? we know that some of our traditional approaches of addiction treatment, that is, waiting for people to be ready to come to us to seek help. it doesn't always work for those suffering from addiction and especially if they are homeless. all of our services are

voluntary and we have to develop care relations to engage people into care and it does take time. but i really want to thank dr. barrie sven who took this challenge for mayor lee and myself and add this service to his existing street medicine team. medication assisted treatment. to the streets where he goes daily providing care to the homeless people in need. that is how this program was born. in the fall of 2016. we have served over 95 people since then bringing medications to fight opioid addictions directly to them on the streets. by expanding the program today, we are first taking a big step towards our ability to combat the opioid addiction in this city. the new funding will allow us to directly serve 250 new individuals but we also know that we can serve more once we get those engagements and those

relationships because in all of our clinics, we can access the service and medication. so this program is a big step forward to saving lives, lost to heroine, fentanyl and methamphetamine addictions and overdoses. homeless people who use drugs are especially vulnerable and our health system is adapting going directly to them with compassionate outreach and expertise. we're able to help a group that gets missed in the traditional structure of visits and appointments. our low barrier medication program is just one piece of a city-wide effort to increase treatment. we are also providing emergency rooms at sucker burg general hospital and implementing a new addiction consultant service within our hospital to ensure all physicians at the hospital have access to treatment experts for their patients. the doctors from this service are also here today. so again, i want to thank mayor farrell for supporting all of

our efforts to address those with substance abuse disorders and continuing our efforts to save lives. with that i'd like to introduce dr. barrie sven. [applause] >> well, thank you very much, mayor farrell and director garcia and the city of san francisco for the opportunity to do this. i have been working with people experiencing homelessness in san francisco since 1991. my philosophy in this work is do what works, do what is needed. i didn't come into this work with a preconceived notion of what it is that is going to work. when we see what the problems are, then we develop what are the possible solutions? it doesn't feel like it's a great innovation to say if

people are not able to come into a clinic let's go out and see them where they are. i think what feels like an ininnovation about that is many people have the pre conception or the stereo type that a person experiencing homelessness doesn't care about their health. a person with a substance use disorder isn't very concerned about their health. what we see, day after day, one person after another, is that people are deeply concerned about their health. they may have more compelling concerns. where are they going to eat? where are they going to lay their head down and if they pend on drugs, where will they get drugs to prevent themselves from having severe and awful withdrawals. if we're out there with our team and this is absolutely about a team, not about me as a single physician, doing something, if we're out there as a team we're able to meet people where they are. we see and talk to people about

the harms related to their substance use. we also see what the damage to the community related to that substance use is. and we're talking to people about treatment. you've heard the term bupinorfine. that is our medication that we are primarily using. we're also often recommending and referring and assisting people when it's appropriate, to get to methadone treatments and we're using another medication to treat opioid use disorder. having these medications have changed my attitude towards seeing heroine users. earlier in my career, not that i didn't like heroine users, but i never felt like i had something

to offer. now they're my favorite patient. i have something that can immediately change your recollection with the drugs you use and change what your circumstances are. many people who we see have heard about it and they haven't had the opportunity to talk to medical providers who have expertise and get prescriptions. the basic idea is bring it to people where they are, get people stabilized, and then they're able to move into those next steps because when you are strung out on heroine, when you need to use or else have awful withdrawals, every four to six hours, it's really hard to do anything. what we need to do is provide something that is at least as compelling to people as what is

happening to them on the streets. medication is absolutely necessary. human contact, treatment and caring for people is the other thing necessary. with those things in place, and this program expansion, is allowing us to do that, we have the opportunity not only to reach the 250 additional new patients but that really has an amplifying effect. when one person is on the street felfeeling hopeless and sees thr buddy getting help, that is a tremendous boost to that person being able to take maybe that one more step to say, maybe things aren't absolutely hopeless, maybe there's something i can do. maybe that other person doesn't even have an opioid use disorder. maybe they don't use heroine. maybe they have a problem with alcohol? maybe they have a problem with

mental health disorder. seeing that hope where someone is hopeful. the most positive, most effective thing i've seen in this program is one person telling another, hey, i got this medicine from the street medicine team. i saw dr. evan, i saw one of their nurses. that person saying well, i can't believe it. you were the least likely to succeed guy. you were the worst-off person. you are the person with the worst addiction i know and now you are telling me you are not using? that's tremendous in building hope and that's what we need to do as we address the problems that we see. so i'm going to introduce chris, one of our initial low barrier buprenorp hine patients. someone who will tell you about his experience. so thank you. [applause]

>> good morning. my name is christopher rafino and to piggy back on what dr. svens said, one rainy morning, as i got out of jail, and i contacted dr. sven, via the mail and telephone and to other people, i did not want to use anymore. i had tried many, many attempts unsuccessfully of shaking my addiction to heroine of 28 years. nothing worked. i tried everything. residential programs, everything. well, dr. sven met me out in the rain with my bicycle in hand and the clothes on my back and spoke to me for 25, maybe 30 minutes. he said look, i'm going to do this for you. dodo not let me down. i don't believe i have. three and a half years ago, that

occurred right over here. three blocks away from here. my life has changed dramatically. i am a substance abuse councilor myself. i work in a facility across the bay. my life has changed. i have everything back i lost. i owe my love to dr. sven and buprenorphine. out that i was loosing hope you but i got it. i'd like to introduce someone from the homeless outreach program or the homeless program, jeff >> thank you, chris. [applause] >> my name is jeff with the department of homelessness and supportive housing. i want to thank you all for being here today. i want to thank the department of public-health. homelessness is a complex problem and it requires the partnership amongst many city departments and individuals and

people experiencing homelessness to resolve this issue and this is just one of many steps that we need to take. we're very excited about expanding this pilot that we started with d.p.h. many, many months ago. i believe it was in late 2016. i want to thank mayor farrell for his leadership in expanding this important program. so thank you again for being here today and we'll take questions over at the side. thank you. [applause]. >> working for the city and county of san francisco will immerse you in a vibrate and dynamic city on sfroert of the art and social change we've been

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considering a career with the city and county of san francisco >> welcome to our land use committee meeting of may 21, 2018. i'm katy tang, to my right, jane kim, to my