doctor hunter, the prior chief medical examiner. the death certificate itself, the cause and manner of death is issued very quickly, typically within the first ten days. and then the actual final report which often times may be pending further toxicology testing, or may additional investigation. that has taken a longer period of time. the name standard is to issued the final determination and report, 90% within 90 days. our goal continues to reach that. we have particularly difficult time doing that in 2018, after the department move to the new location. all of our forensic laboratory equipment was being recertified. we fell very behind in that part of it. during the last two quarters of the last fiscal year we are now regularly the average of completing a toxicology testing is down to 71 days.

that has enabled us to be much closer to issuing that report within the 90 day window. we haven't finalized all of that to give you a concrete exact where we are as a last quarter. that is part of what we're doing now. all of which is to say, we are much closer during the past 12 months to being at the 90%. i would anticipate when we look at the data we would be somewhere in the 80% hike 90% range within the 90 day period. >> well we've got you up, there was an issue for a while that i heard about, this is the annual reports were not available on the internet, and now they are? can you speak to that a little bit? >> yes. the department did have prior annual reports available online, but we did not have annual reports for the prior two-year timeframe. that was rectified i believe in may, or june, of this year.

currently the department has annual reports up through 17-18 available online with various statistics of department review. >> somebody mentioned that some of them were longer when they were first posted and they became more truncated later, can you speak to that? >> the department did previously with the review back in 11-12, the way the department previously did their annual reports where they were much more extensive, but they also took approximately 18-24 months to complete. if you look back in history at the departments annual report, technically included data for 11-12. it was much longer. so we are looking out for version we are doing now is to find more of a sweet spot in between that has a series of grass and basic data and information and additional narrative and something that is complete within six months of

the fiscal year. but doesn't take a major thesis to do. >> what is the diffidence between -- what is the difference between a corner and a medical examiner? >> i am probably not the best one to answer that question. a coroner is under a sheriff, and other jurisdictions in the country. it could be anybody who runs for office and has absolutely no training. the medical examiner system is set up to bring a level of professionalism to death investigations and how death investigation should be properly handled. our office and many other major jurisdictions in california are set up in the medical examiner system. >> thank you. supervisor brown? >> thank you. i wanted to talk up a little bit about the timing of these

reports, because, i know i have talked to mayor mccallie, administrator. this is really tough for families when they are waiting for this report. i went through an experience with the jessica alba family. they were waiting for the death certificate to be um released because they felt it was a homicide and not suicide. um and, you know, the entire native american community came out and said this was a cover-up. i just filled that, and we have talked about this that the communications has to be a lot better with families um because as we know families are in um there worst times of their lives when they are dealing with this, the death of a loved one.

we need to be able to communicate with them what is happening, what the process is, why it is taking as long as it does. um because, what i have found, the board of supervisors to get that information. we are the in between um. so, i really appreciate that you're looking at this, and even having really skilled, qualified people to help with the families. i think that is so important because um, you know, it is a real issue when we are dealing with those families that are waiting for them. >> supervisor, i could not agree you more. being able to communicate with families at the time of a tragic loss is very key. this is information we are using to help with our recruitment efforts and some of the vacant positions we have. with the jessica alba situation, you know, after talking to you i

went back and looked at the timing, and the report came out 52 days -- after the ten day determination out and then the final report came 52 days later. had there been better trust and better communications the family would not feel this way right now. >> especially with a community that does not have trust of this government. >> exactly. >> when you say pending, does that mean there is a draft report that is available for people to review and then later on a final that may or may not be the same? >> yes. what doctor hunter did, instead of waiting for everyone, and i think this was right for determination to happen once you have the final report which could be 52 days, 90 days, that is a long time not to know. he waited call quickly and just say pending, pending toxicology reports. >> those were available?

>> the toxicology reports were not done yet when we did the pending. >> right, but the pending determination was available to the families? >> yes. that is why if we build trust a better communications we would be in a much better situation. >> thank you so much. thank you supervisor peskin for calling for this hearing. >> thank you. >> um are there any members of the public that was to comment on this item? seeing none. public comment is closed. can we file this hearing without objection? great. >> mr. clerk is there any further business? >> there is no further business. >> we are adjourned. thank you.

>> the bond and item not marked -- mark primo is not here tonight. he offers apologies, he's suffering adverse reaction to a flu shot that he had yesterday. so he begged off. and so i'm going to try to do justice on his slides. we've moved right into it and you're familiar with this slide, this is the scope and the budget of the d.p.h. portion of the public health and safety bond. this one is the first bond sale of the $149 million and we're working all the way through. as you can tell i'm moving at a quick pace through this presentation. and by the way, back to introductions and i skipped over that, i'm from zuckerberg capital programs and i'm joined with joe chin from the department of public works. our city project manager on the

bond program. and michael bidai the associate chancellor capital program. and so this is the previous bond breakout was on the first bond sale. we were planning -- we are planning on a second bond sale. we were shooting for early 2020, but right now because of the current burn rate we may push that out into the late second quarter. this is a breakout for zuckerberg, the spend. we are about 23% through the original first bond sale. a lot of our projects have not hit the construction mark yet. once we do we expect to have that spending to increase. this is the community health center bond, they're a little bit ahead of us on the spend,

they're at 42%. and, again, as they progress in the southeast they will get a new contractor on board they'll be proceeding and the next one we presented at last presentation and this is the breakout of each individual project and grouping them together in how we're working with the budget. right now we are overall in the black. and even though the political improvements are showing in the red. overall we're juggling the dollars around to make sure that all aspects of funded. and we have some savings in the lower end that are helping with the overages in the top end. and with the community health centers, again, there's some projects. this one has the benefit of funding from different sources other than the bond and they're identified in the legend at the bottom. you can see how they're applied by fund type in the chart above.

so, again, this one is also in the black. since we last met a lot of work has been done and ones that i'll point out to you quickly for the billion five on zuckerberg, we moved with the i.t. design, and with that, we have a study for 8090 and one that i'm excited about is the psych emergency study for the new location for psych emergency. as far as seismic, we have moved through phase one, we're into the second half -- we're finishing up the first half of phase bo one which is the removl of the sunshade horizontal elements and then the fiber wrapping. and below you can see the bottom you can see the phases of a fiber wrap. so on section one is the column and you go to number five and that's actually number four is the complete column that is

fiber wrapped and strengthened. and number five is what it looks like from the outside. and the majority of care accomplishments, so we have them being seen over at the old urgent care since we vacated urgent care. and we have submitted 95% design drawings in august. and working to create a temp location. with that we'll pass the baton to joe chin to talk about the upcoming milestones. >> thank you. good evening, commissioners, joe chin, program manager for the public health and safety bond program. so moving to the first line, we'll focus this evening on the

upcoming milestones and accomplishments for three components under the health and safety. it's a southeast health center component and on building five for the team advancing 15 of our core projects under this component. not much has changed and we still have four projects in construction. one project is completed. and the remainder are in different phases of the planning, design, or plan review project life cycle. and so here on this slide 12, these are the two projects that are in construction, and we have the locations, and the rehab, and we're anticipating finishing by the end of the year and then rehab we're currently at 45% complete. and then looking at completion early part of 2020.

and then just quickly on another project construction site -- sorry. on seismic retrofit, as terry mentioned we're wrapping up the first part of phase one and moving to kind of the interior column strengthening scope and that's the new work that we're doing and learning the process and how to best do the work with the occupy facility. and we have a project from planning to design and it's the specialty services. so we've moved from plan to design right now and that's a new project that we're tracking. and then on southeast health center, really there's two key areas that we focus on. we have completed design. we have the drawings submitted to d.p.i. for plan review for permitting. and the next milestone is to get this to bid document and get it bid and construction early part

of 2020. we're looking to start bidding probably this month as our target to get this out on the street and start soliciting contractors. and then on community health centers, this is -- it's a comprehensive scope and we're doing work at two health centers, the maxine hall health center and maxine hall, i think that we talked about this earlier. and we're having our groundbreaking ceremony tomorrow. happy to report that this is the project where we're able to kind of show that we've awarded a contract to a contractor and there's also photos on the slide that show the prefabricated trailers that are now have been assembled. they're being worked on in preparation for the staff to move from maxine mau hall into e temporary clinics during the

entire construction duration. so a lot of things are happening at maxine and it's good to see this project moving. and the health center, we've received additional funding for this project from the mayor's office and kind of focused on the city initiative on global warming, climate change, and so the additional funding was to add air conditioning to this project. so because of that added scope we now had to push out the design and construction but it's -- this is the best time to do it. the building is already vacated and it's a good time to do a comprehensive improvement to the building. and then the last three slides is our typical -- i think that you have seen this before -- our high level schedule update on active projects that doesn't include all 19 projects but shows the more active projects. so i won't go through it, and i think that it's pretty

self-explanatory. one thing that i do want to mention is on the schedule update for the health centers and based on what i mentioned earlier, maxine hall have been the updated schedule duration that shows it being issued for maxine and kind of the construction duration for that project as well as castro missions design and construction schedule being pushed out because of the added scope. so at this point i'm going to turn back to terry, and we'll talk about the research project. >> just real quickly, this slide is a list of what has been going on to get to the points where we're completing the documents to and targeting to have that closed and it will allow them to

move forward with their plans. with that -- and we're also working diligently with other city agencies to help the process along with approvals for drawings and as well as providing all of the documentation with the bureau of real estate. and an inventory of all of the space is one of the items that is on our part. and we will move on -- i'm moving on to item 9 which is the presentation. >> as of practice at the health commission these items are presented together and then you all ask questions and the public can make public comment during either of those at the end of the presentation. so we're moving to item 9 which is the academic building update. >> thank you, good evening, commissioners. my name is michael bidet, at

uscf. we are nearing the end of the design phase for the research building and i will show you where the design is at later in the presentation to remind you of where it is on the b.c. lot. we are, as i said, towards the end of design and we anticipate construction to start in early 2020, once the final approvals are completed. and we are here at the health commission today and then in november on the 13th and we will go to the board of regents for the design and final budget approval. which constitutes the approvals needed to build.

and and we're on schedule. this is a section through the building. showing the way that the program components are distributed on the dry research floor, so that would be four or five. and this is the design that has been by the arts commission and this is what we are presenting to the board of regents. this is a view from the 23rd street entrance, looking up from the west to the east. and the glass corner is the sort of internal kitchen and the

breakroom and conference area. with vertical transportation, and the glass lobby at the ground floor is the main entrance to the building. and you can see building five behind it. and the building is clad in terra cotta which is very much like brick in its texture and color. and this is a view of the -- looking due east, showing the main entrance and one of the connecting stairs going up. and the relationship to building five. i think that is the last picture

in the presentation. can i answer any questions? >> clerk: i have not received any public comment or requests for this item. >> commissioner? >> i have a fairly naive question. so it looks like there's more green lines ahead of red and a few times ago when you presented it seems that you're doing well with keeping to time lines and what i'm confused about is how do you link, you know, kind of your expected expenditures to timelines? like if you're ahead or behind, how do you analyze the expenditures compared to where you are and how often do you do it? and how important is it to look at when you're going through the bonding and how you make those decisions. and then my second question -- is there room for us in this

building? just a little office? just a little one? please? >> as far as the budget analysis, we are constantly, joe, myself and mark -- constantly -- greg -- we're constantly going over the budget on this. the key milestones that are keying us to where we're at are estimates. so we do estimates at the design completion and the project 50% design and 100% design and we estimate on the executive management team. and so we will constantly estimate the jobs. but it didn't get real until we have a contract and we have a bidder and a signed contract. and that's where we get to true up the budget and true up the timeline and match it to our projections. that's really where it happens. and once we're in construction phase it becomes just a regular

part of the construction process and tracking the budget and the spend and making sure that we don't have cost overruns. anyone else? >> any other questions, commissioners? >> so it looks like we're kind of slipping in time on the p.e.s. and all. is that -- is that, you know, good? >> it's not good but to be expected. so if you recall the p. s. program has changed and before we were going to try to do a 10-phase project in the same location that was going to be -- it turned out to be a budget buster and we couldn't do it. so we identified a place adjacent to that that was vacant and we took it over. and so we started the clock on that but we're still keeping the same baseline. so once we get to that process where we go through the design process and then we try to get a contract, then we'll reset all of those milestones. >> okay.

so you're rethinking the original? >> yeah, and it's a good move. >> all right. >> absolutely. >> that's the only question. >> other questions, commissioners? hearing none. >> thank you. >> thank you for staying and we appreciate it. i know that it's late. so commissioners, item 10 is the person is no longer here, item 11 is other business and i will note that some of you are going to be at the joint hearing with the planning commission on the cpm agreement on thursday at 10:00 a.m.. and then shall we do the item 12? the update ithere's people here. the report back from the september 24, 2019, zsfg jcc

meeting. >> they discussed reports, including the regulatory fares and the c.e.o. report and human resources report. and also discussed the epic related salary variance issues. and it will be continuing to track the epic program as it moves into its new phases. and at the medical staff report we reviewed the process for the affiliated staff form and approved that. and the registered nurse standard practice was a standard practice was created for administration of flu vaccines by registered nurses in the hospital. in closed session the committee then approved the credentials report and the minutes. and that ends my report. >> thank you. questions? commissioners? >> clerk: there's no public request for that comment so

we're at the consideration of adjournment, commissioners. >> so moved. >> all those in favor? >> aye. >> aye. >> thank you, everyone. >> this noting will come to order. i will call the roll. (roll call). >> president james loyce: before we get started i would like to read a statement from the commission. thank you for attending today's

meeting. there have been several articles about the property of public health adult residence facility. there is frustration and confusion about the past year. in response to the changes made in areas of homelessness and behavioral health issues in san francisco we request the next three meeting including the following relevant items. today we will discuss the presentation. next meeting whole person care initiative to address the needs of the highest utilizers of public health services. on the fifth of november a broad update. we are concerned about the health and well-being of those in san francisco. we take our role seriously and we will continue to use our meetings as a public forum to discuss important public health issues. members of the public are always

invited to attend and provide input. >> i am mark. health commission secretary. if you have public comment, please hand a slip to me. if you would consider today, there are a lot of people who feel passionately about what you are here for. as others speak, they may have different opinions than you, try to be respectful. be silent in your show of your opinion by either doing something like this or this. if you like what is being said. if you don't like being said do this. vocalizes is not respectful to the person at the podium. please consider that. item 2. approval of august 20 and september 17 meetings. in front of you is slightly revised meeting minutes for the 17th. i was to add it was adjourned

4:29 p.m. due to disruption of the meeting. please consider that version for your approval. >> the minutes are in the hands of the commission. if you have comments about the first set of minutes on september 17, please do so now. we will follow with the minutes from august 20th. >> i move approval of the minutes. >> second. >> those in favor signify by saying aye. is that both sets? >> i move september 17th. >> second. a. >> item three director's report.

>> good afternoon, commissioners, grant colfax director of health. we have a full agenda this afternoon. i will highlight the key items in the director's report in front of you. one thing that is exciting, the first item. yesterday mayor breed and the department of health announced a new overdose prevention program for the hotels to be carried out. this program is in response to the rising number of overdose deaths in san francisco, approximately which 30% occur in single room occupancy hotels. this program is based on the successful tenant overdose response program from vancouver. we will work with the sr operators to develop the prevention programs. it will expand the overdose prevention further and support installation of naloxone boxes.

that will begin later this year. the health department supports harm reduction coalition drug overdose prevention project which provides 15,000 doses of naloxone to thousands of those witnessing overdose in 2018 alone. the drug overdose prevention product reported 1658 overdose reversals that year and is on track to double that in 2019. we are concerned about overdose death in san francisco. we are doing everything we can to minimize that terrible situation, and this project is a major step forward to help people most at risk for overdose. i want to emphasize that on september 24th, the mayor and the director of mental health

reform announced plans to launch an online inventory of dph substance abuse and mental health treatment beds, we want to be sure there is increased transparency in terms of bed availability in the city within the system. we expect this public web page will improve the timely access to treatment and health providers make the best use of beds in the programs. the first space in november will have withdrawal management and 90 day programs. in the second phase the short term beds will be added. in addition to transparency this will help data driven decisions where we need to target new investments and bottle mecks in the -- bottlenecks in the healthcare. we are going to spend time on

the behavioral health system today. the department has chosen to pause changes while the mayor and board of supervisorses have a conversation how to have expanded access to services. you will be hearing about that today directly from the dph in terms of history and public comment. i look forward to that part of the agenda. just to emphasize with regard to vaping, the california department of public health urges everyone to refrain from vaping given the current status of vaping risk. since june of 2019 the california department has received reports of 90 people in california who were hospitalized for severe breathing problems and lung damage. san francisco does not have any suspect cases we will be diligent in that regard.

nationally the epidemic associated with pulmonary injury grew 52% compared to the prior week. there are 805 from 46 states with 12 deaths reported. we continue to be vigilant on both the regulatory and the policy fronts. with regard to the recent heat wave on september 24 and 25, the national weather service issued a heat advisory in san francisco with temperatures in the 80s and 90s. they worked together with the department of emergency management and joint information center for city agencies to coordinate efforts and share messages to stay cool, hydrated and connected. city officials remind the people about the importance of window, water and pet safety. i think as we see the effects of

climate change continuing, dph will ensure that we are resilient in the city with regard to our adaptation to climate change, including potential health risk for residents. that is a final note. i am excited to announce tomorrow the mayor celebrates the groundbreaking for the maxine hall remodel. she will celebrate the remodel, to improve safety during an earthquake. locate primary care services and for the construction maxine hall will move to a temporary clinic on golden gate avenue. we want the community to be informed of that. as a provider i recently visited. the staff is committed and clients are receiving great care.

it is time for refresh. i am excited that is happening tomorrow. thank you very much. i will take any further questions on the director's report. >> commissioners. >> i thank you for the report in regards to especially the coordination during the heat advisory, and because we were in chinatown just several months ago. i am wondering what type of coordination actually occurred in chinatown for that because it would be a very good example of what we are trying to do down there. >> i believe that doctor aragon has an update with regard to the specifics there. thank you. >> good afternoon. i am sorry i don't have an update. >> doctor baba does.

>> thank you, doctor chou. there are a couple places impacted with heat. we checked in with the chinatown community. chinatown has a library with air-conditioning, which is great. the messages really went to the community. as with all of these incidents we debrief to see what we can improve in our communication. >> we will keep our eye on how we are able to respond to that community during these heat advisories. >> we did the same thing with bayview because that has a lot of heat as well. >> thank you. other questions? thank you, doctor. >> no public comment for that request.