>> i'm trying to understand the disciplinary data chart, and that's probably because i don't understand which way the discipline is going. so we just take -- i guess d.p.a.s you have a big arrow, and we come all the way across to female and male. it tells me we have 69% are female employees and 33% are male. what does the next line tell me, that 63% got disciplined? i don't think i'm reading the chart correctly. >> i think -- i don't -- no. again, this is a city slide, but that is the total population of d.p.h., i believe. like, our gender breakdown.

>> right. >> so it doesn't have anything to do -- there's no correlation between that and the discipline. >> what is c.a.d.? >> if you look at those numbers, that is the percentage of discipline. so let's see how they explain that. okay -- >> it does look like, if i may jump in, it does look like underneath if we do female, it looks like 65.64% of women were disciplined, where only 36% of men were disciplined. i think that's how i -- >> i think it's right. >> that's odd. >> it might be better to use the actual numbers next time rather than percentages. for example, i don't have the gender breakdown, but like i said for white there are 1,866 white employees and 16 received

discipline, which is 0.85% of the total population. i think that would be more useful than these percentages, to have the actual numbers. >> yeah -- it sounds high the way it is there. >> it is confusing. in the next iteration we'll do the numbers. i think it tells a much clearer story. >> okay. because otherwise we seem quite high in our discipline from everybody else in almost all of the categories. >> actually just looking at the data, i believe if you add all the way across, it's the proportion of all of the corrective actions or disciplinary actions added together to show that some groups are overrepresented and other groups are under-represented in terms of the corrective or disciplinary action. is that correct? >> that's the intent of the slide. >> you're saying we should read

horizontally rather than vertical vertically. so the chart reads horizontally, but if you're trying to read between the two categories of 28% and 21%, i'm not sure what that means. >> so going forward, we'll do the numbers maybe as well as the percentages to make it clearer. other questions? yes. >> commissioner. >> do you offer mentorship services to other employees other than just those of color? >> we actually started -- we have a small training group. we started a mentorship program in nursing out at zuckerberg. we couldn't sustain it. i'll try to offer a broad

mentorship program, but we want to assist those in the [ indiscernible ] classification based on the data. it's just what we can do with staffing. >> commissioner green. >> yes, thank you. it's wonderful that you have the addressing disparities plan. this is all really excellent. i wonder, given the confusion with the data, can you just give us your qualitative assessment of where our greatest challenges lie, what our greatest vulnerabilities are. an unrelated question, given the number of days it takes to hire, can you elucidate, given all the new programs that are about to come on board since you've been funded, what is our assessment of hiring needs and if indeed to be successful we need to have staffing for our various programs as well as hospitals, how we can address this time frame and speed it up? because it seems like a lot of

the things we intend to do can't be successful because we don't have the manpower to address what we need. >> let me address the first question on speed of hiring. i had been asked a couple of weeks ago about doing a continuous posting for social workers or case managers, which i think is a good idea. we have done that with nursing. typically with a posting, you post it for a period of time, then people apply, then you close it and go through this big process, and then three years again you open it again. the idea is to have a continuous posting so people can apply and refresh the list in bring in new people. that is one way, a continuous posting. if we're going to hire the number of people i saw discussed during the earlier presentation, i would say one of two things. one, you want to look at hiring category 18, which are three-year project staff. you don't have the same burden

of the civil service roles as you do with the normal -- the ones that take 253 days. when you do that, that one you've got to get the approvals, post it, then there's an appeal period, then you have an exam, then there's an appeal period and all of that with the exam. you can speed all of that up. to do that we would have to get approval of the d.h.r. and the union. i think they would understand. i would say the other possibility is what is called a civil service exemption 12, which is an expert. so we did that with i.t. we now hire some of our i.t. staff under the civil service exemption which is a 12. we hired -- the project manager in h.r. hired on average everybody in six weeks using the epic hire using category 12s and category 18s. i would say if you want the speed of hiring for something like this, i would go with civil

service exempt positions, work it out with d.h.r. and the union. the lean process improvement, that's going to take a while. we don't control a lot of what's going to be changed. it's d.h.r. is the civil service roles. but the existing category 12s and 18s, we could do as fast as six weeks. that's what i would recommend for that. what was your other question? >> i was wondering if you could give us your assessment. >> oh, the assessment. i think that we still have -- you know, this is really a sensitive area because to say we appear to be overrepresented with certain populations of staff does not make those staff feel very good or are very happy about it. so -- but i think the numbers sort of speak for themselves. we still have areas. we need to recruit more african-americans, for example, and we need to recruit them into

higher-level positions. the disparity is we hire them into the lower classifications and they never work up to the higher classifications. i want to work on pay equity. again i was saying if we want to break up these pathways causing us to be lopsided in our diversity, we take away the manager's right to determine where the person comes in at their pay level. i think the only way to break up that is h.r. has to decide and we have to decide that based on pay equity. i'm going to have to staff up to do that. what i would like to do is -- that payroll would do an analysis before we make the offer what we're going to hire you at, i want to make sure we see what we hired everyone else at and bring you in at the appropriate level. right now it's done by the manager and they say step one.

unless someone knows better, he says i want to bring him in at step four and they'll justify it. lots of people don't know to do that. that's how we end up with the pay disparities. >> can you give us more details about the types of positions that we have the greatest challenges. it's one thing to see the diversity charts and another thing to better understand. we have certain issues hiring nurses versus other employees in the d.p.h. if you break nursing out, which has a whole set of different concerns and brought to us information about the other subcategories of employees and how you're going to approach hiring and diversity in those jobs. >> we can do that. i know we've looked at it in the past and going to look specifically at each classification. yeah, we can do that. >> thank you.

>> looking at the new hires chart, page number 11, you mentioned there was a dip in new highers in august and september of this year because trainers were needed to really engage in the epic go live and training there. i know we had reviewed a number of contracts for surge staffing and other things related to epic and when to -- when these needs came up. was this not anticipated or contemplated in the staffing when you were looking at when you might need folks to come in with surge staffing? >> so i think it was -- i didn't of course do those contracts, but i think they did look into what they tried to do is make sure we used our money wisely. what they had done is brought in a surge of trainers and said, look, by mid-july, we're going to be at the point where everybody is pretty well trained except for new people. we're going to cut loose 100 trainers. we're going to keep the core

trainers, but we're going to need them to get this launched on august 3. once that's done they can return to training the new staff. we asked them to get people into the orientations in august and july because there wouldn't be one in september. whether they anticipated this way back i'm not sure. it wouldn't have made sense to bring on those extra trainers. it was a dip in our hiring, but we will make that up. >> thank you. >> looking at that disciplinary table again, it makes me wonder what is the gender parity of our workfor workforce, especially when there is no real way to know from these tables the size of our

transgender workforce, you know, in d.p.h., transgender men and women. it's kind of like a -- yeah, i'm just like -- my head is filled with questions, like where -- how they placed in those city tables. >> so we just started tracking based on -- there was a directive six months ago or so or maybe earlier, they want to give us the option of tracking gender and transgender in all forms. we're starting to track that. we may be able to have that going forward. we're about 75% female and 25% male. something like that. it's been a while since i looked at those numbers. that's not unusual for a health department. we can refine that. that's a good point. i will talk to d.h.r. this is their information, but i

think it would be a good point to track that. >> i was disappointed to see that we don't have those data, especially given the department's work on sogi. we're asking it of the people that we serve, but we're not doing the work we need to inwardly as a reflection. certainly it's a priority to work to get this data that you're asking for. >> commissioners, other questions? thank you very much. >> all right. thank you. >> all right, everyone, we move on to item 9, which is the epic post go live update.

>> commissioners and directors. i am the chief information officer for d.p.h. i'd like to start by sharing a number with you. 8,800. more than 8,800 people have gained credentials and used epic since our go live on august 23, 2019. that includes over 1,500 of our clients. my take-home message for you this evening is we had a great go-live experience, everything from the support of your commission all the way down to all # 7,500 people who participated in classroom training and took proficiency exam to be able to effectively use the new tools. it was across the board an outstanding effort. we had support from across the

city. we had support from a number of vendors in addition to epic. and of course we had the support of all of our organization, as we know that it takes attacks on any company, any agency, to make a transformative change such as we have. all of our consumers as users of epic are getting accustomed to the system and day by day are getting proficient with its use. it takes a little bit of time and we're not even three months in yet. i do want to assure you that we have a systematic process in place, a good-governance program, so we can monitor and improve based on the information we glean from epic. what i mean by that is epic is not just a system we put things in, we're seeing a return on information and not just in the form of reports, but information about how we're using epic, some of this in near-real time, so we

can understand how we're making best use of this very large investment. so a handful of cocktail party starters. i maybe lead you to the fourth ring, next to the last on the right, and that 21 systems were consolidated that bring wave one of epic to life. that's important because that's a really large number of systems. it's also important because it speaks to our readiness in the coming year to decommission those systems, which has been part of our financing plan. so what did we implement? i think you have all sat through several briefings. across the top row of items is our traditional electronic charting infrastructure, the support systems like lab, pharmacy, radiology, how we handle the revenue cycle, as

well as scheduling. the first one on the bottom is health information exchange which may not have come to mind. that's the bi-directional sharing from and to our organizations and others. as a result of epic, we are now part of an industry consortium of two or three dozen other organizations that make electronic health records. we all agree we are able to share information with one another. i will show you some statistics for that in a few minutes. i also mentioned briefly that there's a lot of information we're getting out of epic, and it's beyond the standard analytical tools. it is striking the progress that electronic health record systems have made in my 20-plus years of working with them. where we are today is that we are really starting to learn not just about how we can improve in

real time by giving managers dashboards to use, but as i mentioned in my opening remarks, how we're actually using the software. it tells us how well we're doing and it provides areas where we can say focus enhanced training and other learning experiences to help our teams become as expert with epic as they can. i'll keep saying it, we've given access to our clients and patien patients access to their own health records. i'm glad to say we're off to a good start. where did we implement? no real surprises. i draw your attention to the lasting point and that we have gone mobile. we have gone into is is a new place with being able to access the capabilities that epic provides for us. i mentioned that over 1,500 of our clients are now using the mychart application. if any of you are getting your

health care in the bay area, you are likely using epic mychart. that is the same tools our clients are using. for the providers, they can chart on a mobile device using hayku. for business partners and many others, you can log into epic and share in the care experience that we're providing. we're letting a lot of business partners in to have and to share in the experience that we have launched. we have, for a number of years, have been able to do the same thing the other way. so i mentioned how we know how we're doing. i wanted to just take one moment to share a slide with you. the numbers in the slide aren't terribly important at this time. this was a first cut at an epic

leader dashboard. this one is for primary care, but i wanted to share with you that we don't have to do anything special to create a dashboard like this. it's something that we get more or less out of the box, and all we have to do is tune it to our needs. in the past we've had to make a significant investment to deploy a dashboard like this. the nice thing about epic is that there are about five or six dozens of these dashboards that are available for us to use. they are very straightforward, and we are able to customize them to an extent to reflect the kinds of outcome measures and key performance indicators that are relevant to us to represent our true north strategic goals. nothing is perfect. going live with an electronic health record that is now in use by more than -- well, nearly 9,000 people, there are going be

issues. we have closed thousands of them since august 3. where we are now is dealing with some of our more complex concerns. they deal a little bit more with software, but we really deal more with workflow, people, process, technology, that intersection. as an example, we've always been spending a lot of time at sgfg tackling the topic of patient movement. how do they move from the emergency department to the intensive care department. in the past we had people and process and the technology didn't tell us much. today the technology can tell us a lot. epic can share a lot of information about what's going on and how to effectively manage that transition from one venue to another. when we first saw it, and i'm in this camp too, i didn't really believe what i was looking at. for the last month or so, there's been a really intense

effort to understand how we can get utilize the information that the information system gives back to us to inform our process and a lot of strides have been made there. there's a handful of other workflow examples where we're diving in deep. it's not about epic, but epic is forcing us to have the conversations and focus on problem solving. the second issue that we're having, and this was more or less expected, is our ability to deliver against many types of reports and outcomes measures that we have for regulatory purposes that are in support of value-based care. when you move from one information system to another, you are reporting all the way up to the last day that you had that tool. when you start in a new information system such as we did on august 3, we didn't go into it with a fully populated database. we did it with a mostly new

database. so we prepared how we would begin to use the new data as folks come in our doors after august 3. but we have to go through a validation process in order to ensure what we're looking at and that all of the pre-work we did to produce all of these measures is going to be valid and stand up to our data integrity checklist. we are close. hoping in the next 30 to 60 days to be completely back on course. it was expected that we would have a delay, and we had a bit of a delay. i want to be up front about that. the nice thing is epic is friendly about us taking the data out. that has been a real struggle with our electronic platforms, and that's not the case with what we have today. we've talked about benefits realizations before. i mentioned decommissions systems.

that work is beginning in earnest at the beginning of the calendar year and will take us to july, where we expect to spin down, which is something i.t. people don't like to do. we like to keep old systems on as heaters. but we plan to demission our legacy health record system by the end of the fiscal year. the great news about that is we don't need them anymore. the second piece of good news is we won't be paying for them anymore. that's been part of the budget and financial plan for epic since the beginning. i'd like to take a few moments, and i know we're getting towards the end of our time today, to talk about the our in our records, patient record exchange, something i mentioned at the beginning. since august 3 up through october 1, we have exchanged health information with 215 other healthcare organizations across the united states.

it's possible there are some international ones in there. i didn't dive deep enough to double-check. if you look on the bottom left, you will see who our highest-volume information exchange partners are. i don't think there are any surprises there. what's really powerful is in basically just shy of two months of being live with epic, 43,000 of our clients have had their records appended by healthcare information from other healthcare organizations. this is pretty powerful stuff. in addition to that, nearly 14,000 of our patients, their information has been requested and sent across this trust framework that i mentioned before with this industry consortium that epic is a member of to augment the records of our clients in other places. so really very powerful. we don't have to do anything special for this to happen, it just happens. so our epic journey, we spent a number of years in what i would

call a get-ready phase. we're definitely past that. we're coming up to the tail end of our get-going phase, where there's been a strong focus on having a really good governance program for epic, for having a great go live, which we did. now we're in this period of time which we call stabilization and we'll be there for the next few months. during this time of stabilization is where we process people, process, and technology, the couple of examples i shared with you before. what's really exciting is as we march into the new calendar year, we're getting ready to get better. getting better means tuning our governance process even more so we can do two activities in parallel. one of them is beginning the optimization of the epic environment so it can do things it's not doing today. we have a straightforward implementation and without violating our principles of sticking to that, we can still make it better.

so we're going to begin that process. in parallel, we will be locking in the scope and schedule for wave two and three of epic. when we're done with that in a few years, we'll be in a continuous improvement environment, where we will bank on everything that we learned and all of the good governance that's in place so we can keep getting better. so epic is both hard and it has been very rewarding. i just want to share with you the message that we're sharing with all of our staff because not every day is a great day with epic. it's okay to feel frustrated. this is the first message that we're sharing with our staff because we have really changed a lot. more than a thousand changes were made in order to get ready and learn epic. sometimes you look at the screen and you're like i'm not sure i remember how to do this, which is a reminder that we're all in this together. when i go in front of epic, i

look at the screen and i'm befuddl befuddl befuddled. the good information is we continue to help and train and build tip sheets which are in the epic user's first pane when you log in. you go to a place called "my learning home." that's where you go when you log into epic. we are an organization of helpers. i think during go live this was really evident and a lot of people could see how well everyone reached out and was supporting everyone, and that's the environment that we need to continue to maintain as we move forward with more change in epic. so we've asked staff to be there for one another because some day you're going to need some support as well. with that, i'm happy to take your questions. >> i have not received public comment request for this item.

>> my question is -- i'm an epic user and a frustrated epic user at times -- >> we're all in this together. >> yes. what is your i.t. or your help line for an epic provider? what is the response time for someone to be on the line to be able to help one walk through whatever the issue is? i mean, is it five minutes? is it ten minutes? i mean -- and what is -- do you have the adequate staff to be able to help those that are a bit befuddled, especially with epic going live? >> so we have a lot of support across the board. a program that we set up for the go live was to establish a super user program, where we could

have people much closer to where the value is being generated and the work is being done who are actually super users. we have team of infomaticists who can dive in. with regard to actually calling on the phone, when you call on the phone to our service desk, you're calling the general i.t. service desk, and the pickup times are less than two minutes now to get you in there and get your issue noted. many of the items that are coming in are being redirected to analysts on my team who are resolving these items in just a day or two. that's not all of the items, but we've reached that point where the number of items coming into our service during the day and the number of items we're resolving, we've worked down a significant amount of the go live backlog.

>> okay. thank you. >> thank you. >> thank you so much. i don't think we can overstate the significance of this accomplishment, having been through the same epic process, and the potential to improve patient compliance and care coordination. i've had about six patients almost that i've shared with doctors of the county and at u.c. and being able to reach into these records and really do a much better job for the patient, it's astonishing, how having these systems that used to be siloed and vulcanized be all one. it makes such a difference in a great outcome. i want to congratulate everyone involved and say as the few epic go lives that i've seen have been -- your team is spectacular and awesome. i think there's a show where

there's a gold buzzer or something -- i think you deserve a gold buzzer. >> thank you. i'll happily try and accept that comment, having only been here myself only 90 or 100 days. but it's obvious what a full court press there was by every part of this organization to be ready for epic and it totally paid off. >> if i may add to that, i do think it's important that we recognize the people who aren't in the room and worked on this for many years and no longer with d.p.h. i want to acknowledge director garcia's leadership. alice chen who was committed to this and made a lot of this happen. and also wynona medolovich who was acting c.e.o. for many months. i think it's important that as we move forward and go into the

next stage that was spoken about, that we recognize the reason we're at this point today is the incredibly hard work of literally hundreds, i think in some cases thousands of people to make this work. it was really that leadership, including the leaders i just mentioned, that helped us get to where we are today. >> thank you [ indiscernible ] -- >> my question was from the patient perspective, when patients come in and they're told they are able to access their records on their mobile device, for example, is there any kind of orientation offered to them or a guide they might receive, or are they more figuring it out on their own? >> i can't totally answer your question. i'm not sure if anyone is out in the audience who may be able to assist. doctor, i think you can address

this better than i can. >> in terms of signing up for the patient portal, we have information support for the patients to get into the portal. once they get onto the portal and they have access navigating through the site or submitting a quarterback with he have a contract with an outside vendor that specializing in providing the first-tier support. obviously if they need to ask about lab results, that would be routed back to our desk. >> is it an in-app chat function or a phone call? >> it is a phone call to the service, person to person. they would help the patient navigate real time because they know how to access the portal. >> thank you. >> thank you. i'm just going to ask if

presumably the app is better than the ucsf? [ laughter ]. >> that app is really a problem. [ overlapping speakers ] -- >> is there a language capability? >> yeah, that's a great question. right now it is limited in terms of other languages. so no to answer your question. >> that could be one of the -- whether they -- in wave two, three, four, or five, in this community it would be useful with the diverse languages we have. >> no doubt, as well as other epic communities where they serve large communities of multiple languages. that certainly is a push that all of these epic users is going to be pushing. especially with my chart and the patient portal piece of the

technology is being so readily available and enabling to the patient and client, we have to push that. there's no ifs, ands, or buts about that. >> no, you're correct. it's a nation-wide issue that really would make sense for epic. more towards our own problems and within the time frame and i forget on schedules -- could you remind us because you've done a great job getting this all together and having the basic epic work. now in terms of the optimization so to speak, we know that laguna is a challenge. do you have some time frame upon which you would be able to i guess enhance it and optimize laguna's use on a long-term basis, trying to close the chart

out -- when they talk about in terms of years versus days, right. secondly, our mental health programs and avatar and the timing in terms of trying to unify those records. >> maybe i'll go backwards. we'll start with the behavioural health. so behavioural health is slated for wave three which is -- i don't want to commit to a firm schedule. it's after wave two which will likely go live in 2021. so it's in late 2022 or 2023 before we're fully in place with the replacement to the community behavioural health function -- i mean the electronic health record. to your first question about optimizations for laguna honda,

part of the process is to be inclusive. we had a domain structure presented several months ago. the idea with that domain structure is it's a place that has almost no i.t. people engaged, which is probably a great thing, and it's all about the line of business being able to bring items together that can be prioritized that are based on how do we not just get better against our performance outcomes, how are we getting better for how folks are engaging in the system. that is the process that we've been using so far. i'd be happy to take more information about the laguna honda concerns and make sure that we get that roped into our governance process, so that as we approach making epic better for all of us, that we can address those. >> yeah, the thing i raise there is mostly because it is sort of different from most epic acute

care, that there seems to be an issue of having it flow in as seamlessly as it does at the hospital. i don't know where all the priorities are. i do think laguna or its joint conference should understand what is happening there so we can understand the challenges staff had in terms of trying to optimize the use of an electronic record over there. >> sure. laguna honda is the largest long-term care facility in epic's customer base. sonch >> so i think a report back to there would be quite useful. >> commissioners, other questions? thank you very much. congratulations again. >> thank you. >> commissioners, item 10 is other business and we have several public comment requests for this item.

just so you know making comments, i have a timer. when the buzz -- buzz ergos off that's time for you to end your sentence. >> good evening, commissioners. my name is nathan dang, this is holly and kyle. we have pharmacy students from san francisco joined by some of our classmates in the back. we are here to bring attention to a current pharmacy related issue, pertaining to

reimbursement rates authorized by the 2013 california senate bill 493. so the services affect patients all over california, but especially in san francisco. so sb-419 had expanded the practice for pharmacists that authorized them to perform additional services such as nicotine replacement therapy, as well as participating with other providers in the evaluation and management of various disease states. this bill, however, didn't address payment or reimbursement for these services. >> my name is kyle merchant. really what we're just advocating for is support in implementing additional codes so that pharmacists can be reimbursed appropriately for services, because not every patient is as straightforward as come in, let's have a discussion, and here is what you're looking for. sometimes we have more complex

situations and medical histories that need to be taken, discussions that need to be had with patients. i think this will be especially important as we move towards the implementation of prep being made available in pharmacies. >> so as you know, people [ indiscernible ] -- this is to expand the ability for pharmacists to furnish prep which is proflax sis for h.i.v. we can give a 60-day supply in our practice. in the spirit of getting zero, i believe -- i also have -- >> we'll give you a 30-second extension. >> thank you so much. i think it's paramount that we include reimbursement for the pharmacist counselling because the adherence to these

medications is critical and the only way this will be happening is counselling in the scope of the community. >> thank you. hello, my name is manuel and i'm a pharmacist student as well. this is my first time at this hearing. thank you for this opportunity. i just want to start by addressing that i know we're trying to understand and address mental health issues, specifically those that may be untreated, it's dr. hammer and ms. martinez mentioned in the presentation a while back. i want to bring to light the implicit biases in the government and also officials, the sfpd as well as local security guards, their attitudes they may have towards a subset of our population and those afflicted with mental health conditions. i'm wondering what kind of steps the condition plans to take in

order to mold the attitudes of our city to humanize attitudes to be more empathetic when interacting with the subset of homeless individuals, perhaps less likely to incarcerate them and more so aiding them and escorting them to hospitals, social support systems, as well as shelters. if we start with the city employees, we can expand on that towards the population of our residents. so they will no longer see someone on the streets and think they are crazy, because that's really not the case. but it's just that they're not intentionally being disruptive. it's just some underlying mental illness that's not been resolved. >> thank you. >> hello. my name is jane. i'm also a pharmacy student from

ucsf. currently i also intern at the santa clara hospital down in south bay. i have a lot of counselling sessions with the patients there. a lot of them are homeless and they end up being discharged back to the streets. beyond the counselling sessions, we also talk about -- go on tangents and about their personal lives. what i hear from patients they're struggling to access public washroom facilities, they're not clean or not accessible. a lot of them travel around the city as well. this is something i wanted to bring up because i wanted to bring attention to how feasible it is to increase access public washrooms in the city, that

we're helping the homeless population to improve their health hygiene, but also to increase the cleanliness. i wanted to bring it up and see if it is feasible in the city budget. >> good evening, commissioners. my name is franceska okala and i am also a second-year pharmacy student at ucsf but also expressing some of my concerns. there was a bill signed into law that allows h.i.v. post-exposure proflax sis and pre-exposure proflax sis to be in pharmacies. my comment today is this access

to medication is extremely important to several of the vulnerable populations we've been discussing all throughout the session today, including homeless patients who might be using injectable drugs of abuse. my concern i wanted to bring up to the commission is how exactly the department of public health wants to implement these services in the coming year and how it's going to be advertised to these vulnerable populations to make sure they get access to these resources. >> good evening, commissioners. i am also a second-year pharmacy student at ucsf and a pharmacy intern. i am also here representing just my own self and concerns and beliefs. as was just mentioned the bill was recently passed, but beyond promoting this new accessibility of two of the most vulnerable

populations, i also wanted to ask the commissioners to explore potential ways to help promote training for our pharmacists as well. under sb-159 in order to make pre-exposure and post-exposure proflax sis available, pharmacists are meant to attend training. i would ask that we provide this training in san francisco department of health as well as make resources available to ensure that we have enough resources for that. thank you. >> seeing no other new business, do we have a motion to adjourn? >> i had one quick comment. >> are you sure? do we have a motion to adjourn? >> so moved. >> do we have a second.

>> second. >> all in favour. >> aye. >> we're adjourned. [♪] >> the bicycle coalition was giving away 33 bicycles so i applied. i was happy to receive one of them.

>> the community bike build program is the san francisco coalition's way of spreading the joy of biking and freedom of biking to residents who may not have access to affordable transportation. the city has an ordinance that we worked with them on back in 2014 that requires city agency goes to give organizations like the san francisco bicycle organization a chance to take bicycles abandoned and put them to good use or find new homes for them. the partnerships with organizations generally with organizations that are working with low income individuals or families or people who are transportation dependent. we ask them to identify individuals who would greatly benefit from a bicycle. we make a list of people and their heights to match them to a bicycle that would suit their

lifestyle and age and height. >> bicycle i received has impacted my life so greatly. it is not only a form of recreation. it is also a means of getting connected with the community through bike rides and it is also just a feeling of freedom. i really appreciate it. i am very thankful. >> we teach a class. they have to attend a one hour class. things like how to change lanes, how to make a left turn, right turn, how to ride around cars. after that class, then we would give everyone a test chance -- chance to test ride. >> we are giving them as a way to get around the city.

>> just the joy of like seeing people test drive the bicycles in the small area, there is no real word. i guess enjoyable is a word i could use. that doesn't describe the kind of warm feelings you feel in your heart giving someone that sense of freedom and maybe they haven't ridden a bike in years. these folks are older than the normal crowd of people we give bicycles away to. take my picture on my bike. that was a great experience. there were smiles all around. the recipients, myself, supervisor, everyone was happy to be a part of this joyous occasion. at the end we normally do a group ride to see people ride off with these huge smiles on their faces is a great experience. >> if someone is interested in volunteering, we have a special

section on the website sf bike.org/volunteer you can sign up for both events. we have given away 855 bicycles, 376 last year. we are growing each and every year. i hope to top that 376 this year. we frequently do events in bayview. the spaces are for people to come and work on their own bikes or learn skills and give them access to something that they may not have had access to. >> for me this is a fun way to get outside and be active. most of the time the kids will be in the house. this is a fun way to do something. >> you get fresh air and you don't just stay in the house all day. iit is a good way to exercise.

>> the bicycle coalition has a bicycle program for every community in san francisco. it is connecting the young, older community. it is a wonderful outlet for the community to come together to have some good clean fun. it has opened to many doors to the young people that will usually might not have a bicycle. i have seen them and they are thankful and i am thankful for this program.>> it is 5:38 p.m.n

meeting of the san francisco enn bleiman, i'm the member presideo speak, there are speaker forms n hand them to staff or you can je when i call public comment. that everyone turns off their cell pd commissioners. i want to thank s for sharing this meeting with th a roll call. >> commissioner perez is en rou. [roll call] commissioner thomas is an