>> i would like to call the commission to order. i'll take the roll. [roll call] the second item on -- hello, everybody and welcome. the second item is the approval of the december 17, 2019 minutes. >> you have the minutes before you. i would like a motion to adopt these minutes. >> so moved >> is there a second? >> second. >> comments or questions from the commission? all those in favor say aye. >> aye >> thank you. there is no public comment for that item. item 3 is the director's report. >> good afternoon, commissioners. grant colfax, director of health.

happy new year. of a-of-i have a few things to highlight. very exciting news with regard to medy cal expanding coverage to undocumented immigrants up to age 26. this is an expansion that governor newsom authorized as part of the state's 2019 to 20 budget, including full scope medical to eligible adults ages 19 to 25 regardless of immigration status. statewide this is expected to have a wide impact, covering 90,000 people, and enrollment started the first of the year. we have to make that expansion will apply to about 1,000 to 2,000 individuals in san francisco. and we have been working with the human services agency to notify eligible san franciscans, including transitioning those who qualify from healthy san francisco to medical.

this is also an important opportunity to remind residents about the available of medi-cal, that immigrants are not pen liesed when they apply for a green card, and there are no changes to the public charge rule as the courts issued an injunction and the federal government cannot implement or force the rule indefinitely at this time. obviously, the health department just to remind the public, and the commission that we will continue to provide health care services through our clinics and hospitals in the san francisco network, regardless of immigration status or lack of insurance. everyone is welcome, and we encourage all san franciscos to get the care they need and deserve. last year, december, last month, mayor breed issued budget instructions to department heads to guide the budget process for fiscal years 2021 and 21/22.

the mayor directed the department heads to prioritize identifying funding to help people suffering on the city streets and to target deficiencies in their budgets. the city is projecting a budget shortfall of $420 million over the next upcoming budget years out of an annual budget of approximately $6 million. and i think that important for the commission is that the mayor has indicated that a priority for the coming year is providing shelter, housing and services for people struggling on san francisco streets, and this includes opening new shelter beds and expanding behavioral health coverage and services for people. so we will come back to the commission as we do every year, several, a couple times in february with budget proposals that of course you will review and help us modify and hopefully

approve. so looking forward to that process with our staff and with your guidance and leadership. i also wanted to to highlight the fact that given our vast network of services and all the work we do every day in delivering those services, that we are improving health services at three neighborhood clinics, serving more than 12,000 san franciscans. we are this year, we will be working on improving clinic facilities in three primary care clinics including the health center in the western addition, the castro mission health center and southeast health center in the bayview. and i'm a big believer in how care is delivered and the quality of care is also reflective of the environment in which it is delivered in. that care environment, that physical space reflects our value as providers and as communities and having worked in several of these clinics, a

number of decades ago, they certainly, and the staff and most importantly the patients and the community deserve the renovations that are going to go forward. and i'm hopeful it will also improve our ability to provide a top-quality care. so that's my summary today. i stand available for the commission to answer any questions or additional details of things i have covered or not covered. >> is there any public comment? >> not receiving public comment for this item -- have not received public comment for this item >> i have a question under the topic health department educating the public about mobile vendors and food safety and the need to have the current inspection. does that apply to the food trucks that are wandering the streets? >> in terms of current inspection, whether they require them? >> do the food trucks have inspections? >> yeah.

so i'm getting an affirmative from some of our team that led on this. is doctor -- here? do you want to fill in? i believe they do, right? require the defaults? >> so this has to do with food vendors that have trucks, carts. >> the hand trucks? >> correct. so they are permitted. but what happens is we have people that come from other areas that have not permitted, and there's always tension, there's always tension on how we deal with people who are not permitted, because it's really hard to deal with that situation when it happens. the carts should be permitted. what happens is some come that are not permitted, and how that gets mitigated has been one of our challenges. >> my question is not the pushcarts. it's the food trucks. >> those are also permitted. >> so all the food trucks that

are -- >> every single one. >> that everybody has to be inspected? >> absolutely. >> and have a decal? >> i'm not sure they have a decal but they have documentation inside the truck that they are permitted. those are absolutely permitted. we have times when they have violated a permit we have shut down some of those trucks as well. >> thank you, mr. coal max. >> item 4 is general public comment. we have one request. john edmond abraham. >> yes. i have a timer in my hand, and when the beep goes off, please know that is your time to stop talking. >> some people would say this is the time to stop talking.

good afternoon, commissioners. and my name is john edmond abraham. and it is easier to call me mr. abraham. i'm here to -- for a couple reasons. mainly to let you know of the deplorable condition of the way people in charge, small businesses, the aids foundation -- 50 plus at the aids foundation, others open house that are there to support old, gay men and women fall far short of the goal and also the what's now called the h.i.v.

care council, the h.i.v. community council. everybody is dropping the word -- the acronym aids out of the equation. the effect is out of sight, out of mind. they think this thing is over. and i just lost a friend two months ago to a.i.d.s that i've known and there's this huge hole. every other thought is about that person, and our lives, not together, but we were not lovers or anything like that. we were partners in a lot of ways. we came from new york. and i used to say, believe it or not, that the new york city opera and the metropolitan opera, and here, this man was a former eye surgeon, and when he got sick with aids, he couldn't do that anymore, and when i aim out here and i got sick sic with aids, i stopped singing.

is that -- i should shut up now. >> how about you finish -- >> okay. i just want to give you my telephone number because i know this is going to take some time. and this is not anecdotal. this is strait on from my experience. please take out your pencils, everyone behind me and everyone in front, 415-921-6211. we can do lunch or some other way, but i need to communicate the truth of my experience here. >> finish your statement, please. >> that is it. >> thank you. >> commissioners, item 5 is the finance and planning committee report today. >> good afternoon, commissioners. the finance and planning committee met earlier today to

consider a contract report and also a new contract. the contract report has one item on it and it is for the request to approve the total contract amount of $2,296,793. and this is like due to new grant funding in the amount of $120,511 annually from the california department of public health for overdose sponsoring nizers. this is funding going to the harm reduction coalition. the new contract is a contract in the amount of $107,250 with a

12% contingency. this is for realtime survey services to patients and physicians of the emergency department of zuckerberg general hospital as well as the primary and specialty care, and the term is from january 1, 2020 through december 31, 2020, and both items have been added to the consent calendar for your consideration. thank you. >> any questions, commissioners? questions? commissioners? item 6 is the consent calendar. it contains two items that commissioner chung just noted from the finance and planning committee meeting. oh, i'm sorry. is this better? the consent calendar contains

the two items commissioner chung just noted in her report back from the finance and planning committee. >> prepared to take a vote on consent calendar. >> so moved. >> signify by saying aye. >> aye. >> the motion carries >> if there is no public comment, item 7 is a resolution honoring winon a mindolovich. president loyce, commissioners, it is my honor to present a resolution to you this afternoon honoring winona's 21 years of exceptional leadership with the department of public health. it's a bittersweet moment for me

as she is retiring at the end of the week. as you have come to know her over the past years and most recently with her work on our transition formational electronic health program, i have come to see she leads with a great sense of compassion and puts her patients and clients at the center of her work which i think has defined so many of her successes here. she leaves us with a great legacy of diversity, inclusion, and diversity -- i'm sorry, equity, in the work that she does, by having supported and inspiring so many women to join the information technology field, both here and at other areas where she has been involved. i would just like to add that my initial work with her was not here. i have known her for several

years. the first time i remember meeting her is the feeling that i got and the sense that i received was warmth but also just a dogged tenacity to get the work done. and it is that that i'm going to remember most about you in that you just do not let it not get finished. and i'm just moved by that, and i hope that i can carry on as you have after you leave us at the end of the week. the resolution is before you. and if you have any questions, i'm happy to answer them. >> thank you, commissioner loyce. i want to express my gratitude personally and across the department for your leadership. we weren't able to work together that long, but the time that we

had was so incredibly valuable, both from what i learned from you and the integrity that you brought to the work. your perseverance was epic, and i think it's really key to remind ourselves that it got launched during a time when the department was undergoing a lot of transitions, including in leadership and the tremendous progress that was made and the effort that you invested and your attention to detail and the support of the team that actually executed on the august 1, right? august 3, sorry, how could i forget? but really the leadership that you showed, the tenacity and the fact that you have built a leadership team, i think one of the key marks of a great leader is the team that you build, the team that you mentor, the transition to ongoing leadership

is so important, and you have done that. i want to thank you for making a commitment, especially over the last couple years, to staying with the department, seeing this epic transformation be successful and go through, and we will continue the work, and your legacy will lead on. so thank you so much. >> thank you. commissioners. commissioner bernal. >> hi, winona. first of all, i share the observations of the director and him. i would add on top of tenacity, your enthusiasm was infectious this whole time. when you were making presentations, you couldn't help but be on board what you were talking about. my favorite moments were when something moved from red to yellow or yellow to green. at the top of the like a great victory. you always shared the credit

with your team as well, which is admirable because you had a great team. so thank you for seeing us through that whole period of time. we are deeply grateful, so thank you. >> commissioner chow >> i also want to add my thanks. having followed the episode of the birth of dhr from its conception, shall we call it, and the term during its gestation and the real question whether it could be carried off because of the challenges of transition, i couldn't imagine that came off not only on top but as well as it did. and it's got to be from your leadership. so i want to echo that not only i know for the many years that you have been working here but particularly for that project, which we've been watching so

carefully your shepherdship of it, your stupidship of it, and bringing it through -- your stewardship of it and bringing it through is by itself a credit to all you do here. thank you. >> commissioner >> i would like to echo everyone else. they call it epic for a reason. it was an epic task. i remember sitting here being through an implementation, and you would present these objectives and key results, i thought they were beyond stretch goals, i mean how many people you were going to train. i couldn't do the math. yet you did every one of them and got the team on board, and it's not easy working with epic, i mean people out of the corporate offices, and yet you obviously pulled the best from them and the best from our department. and your leadership was just incredible. i was so happy to see. i couldn't even believe those things were going green as quickly as they were and as on

time as you were able to accomplish them. that's fantastic leadership, and we are grateful, and i wish you would stay. [laughter] >> you are in good hands. >> i would like to add my compliments to you as well. i remember a couple of presentations you made for us. i think the compassion, the warmth and care about patients is very important, but i also think bringing a sense of humor and that smile when you were presenting, i always knew you were right on point and that if i listened, i might learn something. so thank you very much for your service. >> the resolution is in the hands of the commission. can i have a motion to adopt the resolution? >> so moved. >> second. >> all those in favor, signify by saying aye. >> aye >> i want to say a couple words to president loyce and commissioners and a few of you i have worked with in finance committee side of things and director colfax and secretary, it's been with our support that

we were able to accomplish this over the last few years and it indeed was an epic journey. there were many contracts and amazing number of contracts bringing to you so with your support and listening to me with my many yellows and greens and our status, and last time presented to you it was before we went live, so i knew we were going to make the date, but it isn't because of me. i had a fantastic team, many of which are in the audience and the leaders in dph, it has been an absolute pleasure to work with this group of people over the last 20 years and just to do the work that we do and serve the population that we serve has been an absolute pleasure for me so thank you very much. [applause] >> thank you.

>> commissioners, after you shake her hand, you can join her for a picture over by dr. colfax and i. [indiscernible]

[applause] thank you, everyone. i'll note there was no public comment for that item. item 8 is the office of compliance and privacy affairs annual report. i would like to note that mr. chatfield has been here three times. this is his third time. twice he had to be canceled due to a meeting having to end so can we thank him by a rand of applause -- a round of applause? [applause] >> thank you. can someone help me with that?

>> sure. no worries. >> okay. good evening, commissioners. thank you for having me tonight. my name is chatfield, i'm the acting director for the office of compliance and privacy affairs. i'm here to give you an update and annual report for the fiscal year 2018/2019. just an overview, it was established to help mitigate the rest of the department, both financial and reputational in four general areas, one being compliance. this context, we are talking about fraud and abuse, financial compliance with the services that we get paid for by medicare and medical. privacy, of course, to protect patient privacy and data security, making sure when we share our information with our partners and members that it's done legally and appropriately,

and then of course to investigate complaints that come to the office either to the program or directly to us. and not just with compliance and privacy, but conflict of interest rules, misuse of city resources and things like that. so we try, as a general overview, we try to educate staff on responsibilities by doing annual training, providing newsletters and advice to departments. making sure our policies -- they understand what is appropriate and required of them, assess risks throughout the department to make sure we are doing the things we are meant to do, and then of course look into wrong doing and come up with corrective actions to correct that if we find something that needs to be corrected. so quickly just organizationally, how we are set up, the director reports to the director of health. the director currently has been

reassigned to home and hospital at the moment. there's currently two compliance officers that are in each hospital as privacy officers and two vacant positions as well for compliance officers. we have an auditor and an investigations officers for whistle blower and then there's three privacy investigation positions, two of them currently are vacant, which we are recruiting for. that's sort of the non-behavioral health side. the behavioral health side, we have more of a beefed-up team. we have an obligation to the mental health side to ensure the providers are doing the right thing. so we have many more auditors in there where we look at what they are doing and making sure they are complying with the rules, providing them guidance and assess their work.

so these laws, i'm not going to go into detail. i just wanted to make sure you are aware of the general universe we operate in, the first being the false claims act. there's a federal verse and state. that does deal with fraud, waste and abuse. our claims, our services, making sure they are appropriate when we go to get reimbursed for them. there are antikickback statutes, not prefers or profiting off that, the reduction act for medical and that with the affordable care act had a lot of compliance requirements in there to make sure that as an organization we have mechanisms in place to mitigate the risk that's inherent in such a large organization like us. and then of course dealing with patient privacy, and then there's a california equivalent called california medical information act, which is a

little stricter than hip pa in - hippa in some regards. a quick overview of some of the things we did accomplish in the last year. we developed a new compliance training module that is on onlie and interactive, a vast improve the over the last powerpoint slide presentation we had. this requires the users to interact with the program, answer questions along the way, click in the modules that they are actively engaged in it. that was the help of our compliance training requirements to show we are providing meaningful training and not just go ahead and read this. we also improved our monitoring efforts at the two hospitals. it went up from 14 projects at the end of the fiscal year prior to about 25.

[please stand by] -

>> are they flowing through properly on the clinical side. quality of care, audio compliance, they go hand-in-hand we want to make sure we are not delivering substandard care and if something is falling below

what is required, that we then look at that because it affects our claims as well. we want to make sure we are sending claims out for quality service we are doing. making sure our documentation is okay, complete and accurate in supporting the services we are sending out. and then most importantly, expanding our exclusion screening. the federal government has stuff to make sure that everyone we do business with, including employees, are not excluded, meaning they can't receive federal money. because we do receive federal money, we have an obligation to check that. we do check some employees, not all. we are working to get that process more streamlined. on the privacy side, for the privacy program, it was set up primarily to make sure our clients, our patients, our residents that are with d.p.h., their information is protected and we are doing everything we can to prevent any unauthorized

exposure or use of that information. we investigate potential breaches, we look and see what happened, to determine whether or not it is a reportable breach it's something that meets the definition of a breach and we need to notify the state and federal government that it has occurred. we provide advice to all of the divisions on their best practices, we encourage people to come talk to us before they do something so we can advise them and guide them the best way that we can. and we also issue a newsletter every other month about the privacy policies. we do focus on information. we have noticed in the last fiscal years an increase in the number of incidents that get reported to us. i -- it hasn't necessarily correlated with the breaches that we saw before, however, we think we become more culpable

and we make ourselves -- the awareness of staff -- they are more likely to tell us it is going on. although we are happy to see these go up a little bit, we would rather look at a lot of issues and determine where there is problems that we can help mitigate any potential breach. the more we looked into things that might be near mrs., we put systems in place to stop this from occurring. we have seen that go up. i don't have the numbers for this specifically. with that, it is one of our areas to watch. with the vast information this has, it has allowed people to have vast information. so there are chances for people to be looking where they shouldn't. we are setting up programs to make sure they reject that -- they check that.

handling people are records, we want to be careful as we transition away from paper that people don't become cavalier or careless. and they continue to treat it with the same level of care that they always have. we don't want people getting the wrong slips or things like that. and then, of course, making sure the people who are looking at records have a reason to look at that record, not just because they are curious. what we do here is make sure that when we are sharing our information, our health information with vendors and partners that we have a legal way to do so and that is secure. the data sharing side, we have a data sharing officer. they look at these agreements to make sure everything is in place and they have their own security protections in place. it is important that we do share this information with our

partners because we want to make sure care is carried out. we want to make sure -- we had a bit of an uptick in the last meeting. in the last fiscal year, a lot of those specifically were focused for care link, which is one of the ways our partners go into it. they all got approved in this fiscal year so they don't show up here, but we do get routine requests for this all the time and review this information. the program is something we do and work in conjunction with the controller's office. there are two ways we can get complaints. one is through the controller's office program or directly to us there is a hotline which is 24 hours a day or in person. we will investigate the compliance and privacy, but a lot about the whistleblower

investigations involve our misuse of resources, nepotism, and improper conduct. we are always looking at these things from an ethics side to make sure that our staff understands they have obligations under that as well. the results of these all go back to the controller's office if they were referred to us from them as well. looking forward to this fiscal year, as we continue to strengthen our programs, one of the things we are doing is developing a d.p.h. level compliance committee. currently there are separate compliance committees that live in the hospitals and the reporting doesn't -- hasn't gotten filtered out to the executive staff. they can understand what the risks are within the department. they can help allocate resources and also identify risks that

they may see. it is important we get that structure. we already did have our first meeting and we will have our next meeting in february. that is already happening. we do plan on hiring our compliance officer for laguna honda. currently that position is vacant. the compliance officer is covering that for the minutes. we're close to getting that filled within the next month or so. we are happy about that because then we can go ahead and get primary care the compliance program that we want to get established there. i mentioned about epic. one of the things that we have started doing is dedicating our staff to monitor for inappropriate use. we have tools now that allow us to do this much easier than in the past. we are looking at the reports to see who is accessing it. is it appropriate what they are

doing in there? we also want to develop a protocol for putting an auditory service on records that might get flagged as confidential high-profile, something like that, so we do this, but would like to have a routine way of deciding when these get flagged so we can look at who is looking at these records. and then to increase our live training, although we do to the annual computer training, what we are looking to do is targeted topics so that there is an area or division that wants us to come talk about something that is specific to them, or there is something we feel people should know about, then we would add that to that. we are continuing our education efforts. that does conclude my presentation to you. i'm happy to answer any questions you may have about what i discussed.

>> there is one public comment. >> it is public comment. >> good afternoon, commissioners i am a whistleblower. the d.p.h. is coping with the biggest compliance and privacy failure in laguna honda's history, yet today's compliance report seems oblivious to that scandal. no explanation for why the compliance program and its whistleblower hotline missed dozens of patient abuses over three years. no suggestion for how the program could improve to detect future privacy and safety violations. how could it better deal with a culture of silence? we are not told.

there are two reasons why decent employees do not report wrongdoing. the first is that they believe that nothing will be done, and the second is that they fear retaliation. neither of these barriers was addressed today. note how today's presentation only shows the number of investigations without disclosing the outcomes. the message is that nothing was done or that nothing was substantiated. that discourages employees from reporting misconduct and it promotes silence. therefore, investigation outcomes and substantiation rates should be reported. similarly, complaints of retaliation aren't mentioned.

the message is that retaliation is being ignored even though employees know that it happens and fear it. a compliance program that ignores whistleblower retaliation, promotes a culture of silence. the program should report retaliation complaints and what it did to address them. >> time. >> unless the compliance and proxy program explains what it could do differently to prevent future abuses, it should not be expanded. lastly, please consider more frequent compliance reports. once a year leaves you in the dark. thank you. >> thank you. >> dr. colfax, did you want to make a comment? >> i wanted to acknowledge the progress that has been made. this year has been a challenging

year. one thing i want to emphasize is that garrett really stepped up in this role. he is acting director and maggie who is our compliance director was recently at laguna honda and has built a lot of the foundation you built today. i want to acknowledge garrett's leadership. you are on the job a very short time in this role. we were very excited to be able to have him not only join the team, but bring in the leadership here. and the fact that we are really focusing on developing a d.p.h. wide compliance program. i thank you saw the evolution in the summary, but i want to emphasize that. having executive level compliance committee really signals in a very meaningful way that the d.p.h. values compliance and we need to expand that work across the entire department with executive level

oversight going forward. i really want to thank garrett and his team and acknowledge maggie's leadership in developing it up to this point. we look forward to 2010 tito 2020 which will be a year of expanding our compliance and oversight of the department. inc. you. >> commissioners? >> i have a question on one of your risk areas to watch, which was quality of care that you have brought up. how do you monitor, measure the quality of care? do you have specs -- specific variables? how is it measured? >> our compliance primarily focuses on the -- the quality side of things. we work with quality to

understand what they are looking at. we attended their meetings to understand what they are doing. what we look at to see is if quality issues are to the point where we shouldn't be claiming for the services that we are providing. i can't give you a measure at this point because quality, we don't do a quality assessment in compliance. we work with them to try to understand what they are doing and what we are trying to do is focus ourselves to pay attention to that so that we are aware of what is happening on the quality side. >> i guess my question and concern is, if, in fact, they have a metric that they are presenting to you for compliance is there such a thing? >> i don't have that for you. i'm sorry. >> commissioner ciao? >> yes, thank you for the presentation.

this is one of the times were normally where we begin with a slide that shows where your office is. it would have been helpful because i am trying to understand where compliance reports to, which i think is very high up, and number two, if i remember the old chart, and when the office organized itself into this manner? is it a recent organization or is -- has it been there for 10 years in the structure you are showing? >> i apologize for that. is my first time with you. next time i will make sure i will have it for you. >> that is why i was wondering. we have not actually -- i don't think recently we have seen this type of overview. so that is why i am wondering, is this also part of the build out of compliance to make it -- and privacy, trying to make it more robust.

>> sure. i will answer in order. the director for the compliance reports directly to the director of health. that is where it sits in the organization as the division under the director. part of the reason for this overview and the executive level was to make it more robust, provide reports to on a more regular basis. we do intend to report to you more then annually so that you are aware of what is going on, along with d.p.h. leadership and make sure that that is happening >> thank you. if i can, i wanted to hear the follow-up question. i did look at your interactive compliance module, which i thought was extremely comprehensive and wanted to graduate the department on it.

i was stressed by the fact that there was so much information, that i was wondering, was there a means for that to actually be more easily obtained by users? that its employees might think, i remember there was something about privacy but i can't remember what it was and what i can do. while i know we don't really know the number -- that is very nice. i guess i am asking, if resources are available beyond that module, that makes it easy because you have done a lot of work and have a lot of resources and secondly, more specifically, i found the code of conduct extremely detailed and it would seem to me that it really should be a valuable thing on our website. is it on our website? like here are our objectives and here is our code of conduct and the way that we do our business.

>> the code of conduct is on the website. we do try to reiterate what we talked about in the training through the privacy policies in the compliance matters that we issue to try to bring more detail to them. part of what we discuss is expanding the education so that we can either buy invite or by concern of an area, we can present topics in a little more detail. we do really want to encourage people to understand that all of these things are to be part of their daily work. it didn't just happen on the idea about patient privacy and making sure we are acting with integrity and reporting issues. we do encourage that. those are some efforts we are currently doing.

>> if i were an employee step -- working in the living room and i wanted to review, because now i remember -- [indiscernible] is there a way they can do that without going through the whole thing? >> sure. as far as the training, that is a good point. i think there isn't a way at this point, once a training is off the platform, it is off the platform, but that is a good point. i think it's something we can look at and see if that is something we can leave off. our policies are available in the website so we can look at the policies that are behind all the trainings. that is a pretty good point. >> right. i was fascinated by the fact you

do have risk areas you are watching, which means this is sort of your work plan for 20 years. you have given us a preliminary data. it does go back to the question of, from the data, then what did we learn and where do we go from it? which i would anticipate in your next reports we would start seeing. >> you will. >> i think particularly in areas -- we obviously have heard of data breaches and we get -- we get those reported as they happen, but it would be nice to see these in a report coming in and looking at the history and then understanding what we are doing in order to -- and here are the things. just like you did very impressively on the issue of decreasing disallowance is on incomplete clients. we knew that was a huge problem in terms of not properly documenting or inappropriately diagnosing for a large number of reasons, sometimes under

diagnosing and so forth. and to move that out in this type of way is a wonderful outcome of this. i think we would like to see some of the others where you are showing that we either have decreases or increases of reporting. and i know that for specific units, sometimes we get to look at that. i think it is at the -- at the department, this would be helpful. and then the lessons learned. we have this program in place. we think it is really meaningful that we then become much more aware of what is happening and we can articulate to our public that is often asking us because it shows up in the papers, what are we doing about this. >> certainly we can provide you with that data as we move forward when we report to you. >> thank you very much.

>> thank you for your presentation. very impressive. you really can't under -- overstate the importance of your office's work to protect our patients and our resources. and as you said to try to prevent issues, that are particularly challenging an environment that is changing and often uncertain. looking at your organizational chart, there are 14 positions and four of them are vacant. one of them is being reassigned and another has been reassigned internally. that is a lot of vacancies or people doing work that is not there core work. how much of a barrier is that to the work you are doing and how is your progress in filling those positions? >> it is a barrier because people are doing work that is not their primary responsibility they have all done it willingly and i commend them all for doing it. the positions are moving through at the pace that they do. we do almost have the laguna

honda position filled. the other positions are moving along slowly behind there, but i am trusting that the h.r. process is doing what it needs to do to have that happen. to be perfectly frank, it's a challenge because there are people doing a lot of work and doing the best they can in a very, like you said, challenging and changing environment. >> kudos to them for their great work. we hope you will get the staffing you need soon. also, just two other quick observations. as commissioner chow had said, i'm wondering what would you attribute in the disallowance is for incorrect claims? it's an 80% reduction over two years. what would you attribute that to >> there was a big payback with the mental health services earlier and that -- the former compliance officer overall --

over there did develop a very robust program and that really did help. that was a lot of it. we do hope that this continues, although i would never make a guarantee on that because you never know what can happen. we do like to see that happening >> and assume a question when you're looking at the whistleblower program. it looks like there has been a 50 to 60% reduction year-over-year in investigations for improper conduct in fate -- and favouritism. what would you attribute those decreases to? >> it is not really meant to show a reduction, it is really just the number we looked at. during those two years, it was about 83 in the first fiscal year and 63 total and the other one. this really was to show the areas that we look at the most. that's all that was. it wasn't a comprehensive chart of reduction necessarily. there were 20 less cases.

>> the improper conduct one from 36 to about 17 or 18 the next year and also under favouritism, it went from 16 to about six. >> i couldn't tell you what caused that or because that reduction. it could be we just got less complaints around that. >> at some of that be due to not having a full complement of staff as well? >> yeah,. certainly we only have one person doing this so we handle them as quickly and as best as we can. >> thank you. >> commissioner green? >> thank you for this. it's very exciting all of your plans for the coming year. given that they are so extensive , you shared with us four of the goals or metrics that you have been following today. if you're going to expand the program, do you have any sense of what other objectives or metrics you might incorporate, and also what the actual numerical changes you might be targeting? we have seen that in other areas

, for example, at hospitals i'm wondering if you're doing any analogous work in these areas and when we might have access. i think the corlett his gigantic have you gotten a sense of how you might best utilize it and where you might focus? we have this resource, but without knowing exactly what you want to extract from it and what our goals to that information is , it is hard to assess where we are making progress. will you expand some of these and how will epic be a part of it? when will we be able to get report? >> definitely before the year goes by. i don't know when. that is part of having the executive level committees so we have more regular reporting and we can bring that reporting to you. we do plan to look at disallowance rates in the various areas and using that as a tool for that. you are right. epic is new and we are still

learning how to use its reporting functions and that is our learning curve to be able to look at what is going on there and figure out, okay, what is trending as a problem within their? which is why we are going to do that risk assessment early this year to see what might have a chain -- change in that environment. we can provide you with information on what types of breaches are happening, as well as if they are increasing or decreasing. that sort of thing. >> is that it? >> i just wanted mr. pickens to loop back on the question i was asked about the intersection of quality and compliance because i felt like there might be some more information that could be provided in response to the commissioners' questions. >> good afternoon. i'm director of the health

network. i want to add to garrett's presentation, particularly your question about quality. in terms of quality of care. quality of care sits directly within the delivery system. most of our delivery system is within the health network with a small component also within ph.d., mainly our city clinic and tuberculosis clinic. within the network, each of our units, laguna honda, zuckerberg, the various units of ambulatory care all have quality departments and staff that actually report on the quality of patient care. if you sit on those zuckerberg j.c.c., that is where quality is presented. similarly for laguna honda. recognizing that we are this vast network, we are in the

process of actually elevating quality to the network level so rather than looking at it at each individual section, you will see it up a larger network department level. we will be coming to you, the commission, at the department level to really present what we are doing in terms of clinical quality, what are the measures, the metrics, and so you will see them. it will not only be those who sit on those panels, but the entire commission will be able to see the full picture of clinical quality. those will be coming from the network side and we will also incorporate those components of quality that exist. >> when will those be appealed? >> in january we hopefully -- hopefully we will be coming to you within the next six months with a quality report from a

network department level perspective. >> thank you very much for your report. >> thank you very much. have a good evening. >> commissioners, the next item is a resolution approving the san francisco department of public health 2020 state and federal legislative plans i have both the resolution on the presentation just for you to know to stay on. >> thank you. >> good afternoon, commissioners i am the director of the office of policy and planning. today we will be providing you

with an overview of the department's 2020 state and federal legislative platform, as well as a summary of some of the actions that we are taking in 2019 -- that were taking -- taken in 2019. i'm here with max was a health planner in the office who i will be sharing this presentation with. as was mentioned, you have a copy of the resolution before you that approves our platform your consideration today. as i mentioned, we'll be providing you with some backgrounds on the purpose and the development of the plan, a summary of the actions that happened in 2019, as well as a high-level overview of the state and federal plans.

we prepared two plans. one federal and one state. these platforms are aligned with d.p.h.'s priorities and missions and serve as guides for monitoring bills of budget proposals and identifying any issues that might come up during the course of the year that may need some city action. the plans are informed using input from department leadership , subject matter experts throughout the organization, as well as many professional associations that several d.p.h. staff are members of. the plans are intended to cover a broad range of issues that are important to the department. additionally, they might serve as helpful tools for staff who are representing the department on other associations when it comes to representing what our position is. every year we present the plan to the health commission annually for your approval. after which the plans are sent to the mayor's office for review

and then they incorporate the plans into a larger city wide legislative plan. i also wanted you to know that if the commission has any additional feedback or input, we are happy to incorporate those thoughts in today. this is a little hard to read up here, but how do we advance positions as we already city department? there is a process that we have to go through. this starts with the plans which are the ones i just talked about as issues come up and are introduced at the state level or the federal level, typically d.p.h. staff work with leadership within their division to analyse and review what potential impacts are. then that policy or proposal will come to the office of policy and planning for review. we may also reach out to other organizations, other city

departments if necessary before developing a specific proposal. and then afterwards, this advances onto the mayor's office of legislative affairs. when it comes to state legislation, they can meet a monthly meeting that has seven members, seven voting members that are representatives of the board, the mayor's office, city attorney, and the controller's office who approves official positions by any city department after we receive approval from the office of legislative affairs and that committee, we may engage in advocacy. typically this is in the form of a comment letter that we can share with the legislature. i also wanted to note that the city contracts with state and from dural lobbyists who will work on behalf of the department -- and federal lobbyists.

we could also provide expert testimony if needed in sacramento. or provide technical support under the high priority issues for the department. on the right side, i wanted to note the nature of state and federal process that requires us to be responsive. we are often, you know, coordinating with partners outside of departments such as our associations, the mayor's office and other city departments and the city attorney's office. looking back on 2019, we monitored around 100 bills that were relevant to the health department's mission or function we officially took positions on 22 bills. six of which were signed into law by governor newsom, two which were vetoed and 14 which are currently held. they come back as two year bills this year.

some of the key issues included behavioral health. substance use disorder treatment this year we sponsored a bill that would have expanded medication assisted treatment options were individuals in the jail. unfortunately this was held this year and it may come back in 2020. we continue to support a bill on overdose prevention programs, conservatorship conservatorship was another key issue. we support it along with the mayor's office which was a follow-up bill to 1045, which is the new housing conservatorship law, which grates a pathway for conservatorship for individuals who are high users of systems as well and also have mental health and substance use needs. another bill that we supported this year was a.b. 1544 which would have permanently authorized our local e.m.s. agency to transport patients to

alternative setting such as a recovery centre. we expect this issue to come back again in 2020. and finally we supported a few proposals that are related to the integration of mental health and substance use funding for same-day billing when individuals are seen at a primary care setting and workforce development really had to introduce loan forgiveness for individuals are practising with the county mental health plan. other key issues this year were related to h.i.v. prevention. we supported s.b. 159 which is a bill that passed and allows for emphasis to dispense drugs. it also prevents insurance companies from requiring prior authorization.

maternal childhood and analysing health. we supported the pregnancy in childhood -- and childbirth act which recognizes maternal morbidity and births are highest among african-american mothers across the state. this requires hospitals, primary care clinics and other centres to implement implicit bias trainings. i will talk about the medi-cal eligibility and expansion proposal on the next slide and long-term care. there are efforts of the state to expand these systems, which would allow medi-cal beneficiaries to be placed in care homes in lieu of more costly nursing facilities. this year the governor was able to advance several healthcare proposals. the first was already mentioned in the opening remarks around expansion of medi-cal to undocumented adults aged 19 to

25. there was additional expansions for coverage california premium support for individuals between 40600% of federal -- between 400 and 600% federal policy -- poverty level. this is going to require all californians to have insurance or they can potentially face a penalty of up to a minimum of $695 per addled. this year, the government also issued an executive order with the goal of controlling prescription drug costs. there are two key proposals in this executive order. one is the transition of pharmacy services for medi-cal managed-care to free service. would you expect this proposal to reduce savings for public healthcare systems.

the executive order also included a goal to expand the state's bulk purchasing program, which would essentially allow us to collectively purchase drugs for the state to lower drug prices. the other key issues that i know you heard a little bit about from our behavioral health division earlier or in the fall of 2019 is california advancing medi-cal which is the state's process to renew its current waivers with the federal government. there will be a lot of attention and focus on that this year. and finally the governor is planning to release his budget this friday, so we will be monitoring that and we will provide the commission with an update regarding this proposal. i will hand it to max to talk

about some of the federal issues on the platform. >> my name is max and i am a healthcare program planner with the policy planning office. for this section of the presentation i will provide a brief overview of the federal issues that we monitored during -- and were engaged in and provide an overview of the department's proposed 2020 state and federal platforms. this past year, the federal administration engaged in various actions to undermine before able care act, immigration protections, women's rights and lgbtq rights. many of these issues have been ongoing from the previous several years and we will continue to monitor these into 2020 as they progress through the court system or through the rulemaking process and a more

complete overview of these issues are available in the table that was provided to you. at the start of 2019, your appeal of the individual mandate became effective. the california new state-level individual mandate and also the affordability initiatives are projected to help protect the state from impacts from this repeal. in addition to the mandates, other efforts were made to weaken aca related a form -- reforms including an ongoing challenge to the constitutional legitimacy of the aca. the federal administration also continue to undermine the health and safety of our san francisco immigrant communities with attempts to change charge rules which govern how the use of public benefits could impact immigrants or individuals with immigration status. in august of 2019, the state attorney, in coordination with human services agency of the department of public -- public health office in the mayor's

office, filed a legal challenge to the newly finalized public charge rule. fortunately in october of 2019 following that challenge, the board indefinitely delayed his limitation of that rule and is continuing to make its way through the courts now. if the rule does go into effect, it could significantly impact immigrants' use of publicly assisted programs like medi-cal. at the department has developed public awareness materials informing residents that they are welcome at all city clinics and hospitals regardless of their immigration or insurance status. this past year the administration also implemented new restrictions on title x family planning grant plan. these restrictions would restrict clinicians and other clinical staff from being able to provide a complete and unbiased reproductive health information and a full range of

services to their patients. last year, the department's funding planning coordinator provided an update on the health commission on these changes in the following august. these changes officially went into effect, at which time the department withdrew from the grant program. the department's maternal child and adolescent health section is committed to could tuning to provide financial support to the family planning program, which had administered the grand. before withdrawing from the grant program, the program had worked with the city attorney's office to provide official comment on the rule and provide testimony in a lawsuit filed by the california state attorney general. the board of supervisors also provided a resolution by opposing these regulations. finally, the federal administration implement the changes that would allow providers to refused to provide services, but they have a religious or moral or religious objection to like abortion or

gender reassignment surgery. these changes are referred to as conscience rights in healthcare, and under these changes, federal funding would be taken away from the state -- from state to do not comply. d.p.h. formally submitted written comments to the rules citing concerns with the rule's discriminatory effects in the california attorney general and san francisco city attorney's office filed lawsuits against this rule. in november of last year, a judge blocked these changes from taking effect. so next i will provide an overview of the department's state and legislative platforms for 2020. for the developed of this year's plans, we worked with leadership and experts from across the department to review the platforms to identify emerging policy issues and areas covered in the platforms are not too different from last year. modifications have been made based on the issues that the department is likely to engage in. this includes a new section on expanding policy goals for

long-term care, as well as furthering behavioral health integration. for the 2020 platform, we organized legislative issues based on their intersections to the two additions to the san francisco health network and the population addition. issues are categorized under one division based on who is likely the lead on the issue and to we would first reach out to better understand impacts of the policy those issues both impact both divisions and we will work with experts from across the department to understand the implications of the policy and weigh in on those issues. rather than reviewing the entire platform, we will highlight several state policies that the department expects to focus on in the upcoming year. medi-cal and healthcare reform will be significant issues as the state engages in the cal aim initiative. this will impact many different parts of the department's healthcare delivery system. we will want to monitor proposals to ensure that

adequate funding continues to be provided for public hospitals in the health system and that there is continuity in the whole person care system under the condition of long-term care that continues to be a pressing issue in san francisco and across the stage. we continue to experience issues of residential care facility closures and these facilities offer supportive residential living for individuals who no longer live independently. in order to stabilize and prevent the further loss of these facilities, we will support proposals to increase funding to prevent the further loss of these facilities. i like to discuss the department 's 2020 legislative platform. commissioner ciao, thank you for your feedback. i want to note it has been incorporated into this year's plans. we added language to support proposals to comprehensively fund hepatitis b services such as education, treatment,

screening, and vaccination. if also added a new subsection within the public health care section stating that the department will support proposals to ensure that emergency programs and planning are inclusive of the needs of vulnerable populations including those with access to functional needs, those with disabilities, those unable to be self-sufficient for 72 hours following an emergency, as well as other groups that may be disproportionately impacted during an emergency. given the broader categorization of federal issues, they are not organized by department division on this platform. as i mentioned earlier, the department is expected to monitor many of the same issues from the previous years. these include ongoing issues around a.c.a. health-related reforms, immigration issues like public charge, and proposed changes propose changes to patient privacy. because of our distance from the

federal level, will continue to work closely with professional organizations like california association of public hospitals and coordinate our efforts with the mayor's office and city attorney's office for engaging on any pressing federal issues that arise. this concludes our overview of this year's plans. before you for your consideration again is a resolution approving of the 2020 state and federal legislative platforms. we welcome your input on the platforms. >> is there public comment? >> there is no public comment. >> any comments you would like to make? >> just to reinforce the breadth and depth of the issues that we were looking at here. it is broad and has brought in several mandates. there are things that are very specific. really want to acknowledge the policy team in the work they do

across the department as well as the mayor's office and other departments were a lot of these policies intersect. we know they have a further impact on the people in the communities we serve. i just want to appreciate the work. it will be a challenging year. certainly the department is up to the task with your support. thank you. >> we will have a motion for the resolution. before we do that, i would like to hear from any -- from you any questions or comments you would like to make. >> i just want to thank the department for the work that they have been doing. each it gets even more robust and our issues become even more and the fact that you also have accepted -- and to explain to my

fellow commissioners, that while we were talking about hepatitis c company and civilly, we have omitted, especially in our town, the fact that hepatitis b also had treatment that was available i thank you have -- it's certainly beyond what i would even think about. and likewise, the whole issue of working with the whole vulnerable population. i think it comes up, as even as the director pointed out, in terms of not just the federal level, but within our own programs. i have been waiting for you to tie it all together at the federal and the state level and in our local areas. we do seem to forget that the vulnerable populations are not being treated and cared for or networked into the care because

we have this policy of you were on your own for 72 hours in many of these incidents. i know that reports given back to us recently have shown that, especially with our heat days and all, that we have begun to do more in terms of working with the different organizations or areas to try to reach these people. i think too often our local organizations and especially in the emergency preparedness, looking at the very large pictures and the need to mobilize for large populations forget the individuals. i think therefore, our role is to remind ourselves that they are out there and they are vulnerable, whether it be heat, earthquake, whether it be fire, and that we should be preparing for that. these are people who cannot survive 72 hours on their own.

i really appreciate that you will put that in at the federal level. i'm hoping that at the state and local level we would begin to really emphasize those areas of preparedness. >> thank you. i should also note we included similar language into the state platform as well in our public health emergency preparedness section. >> thank you very much. >> commissioner green? >> thank you for the work. it is remarkable to be able to read this and see it in the -- very easy to understand pages. it seems like the state's priorities and our own priorities have conflict. are there any areas that you feel or high priority for us that might not have been adequately emphasized at the state level and are there any areas of unique vulnerability or concerns that perhaps haven't been prioritized in the same manner as you might?

>> nothing that is jumping to my mind right now. i would say a lot of what you saw on the stateside, a lot of our focus was on behavioral health. i think that is also because of the synergy with a lot of the efforts that are happening here locally. i think we expect that to continue into 2020. right of the top of my head i can't think of anything that is potentially missing from the work that we are doing. >> that is great news. thinks. >> let me just ask the question to follow-up commissioner green 's question. it was just recently put forward on isis and the adverse child experience and i assume you supported it and then it was also just past that medi-cal -- the medi-cal reimbursement as well.

so i know you did mention it, but was that part of it? >> that was part of the governor 's budget proposal in 2019 which we did not take a formal supportive position, but we are supportive of. i checked when with our ambulatory care director about that. it sounds like we are still figuring out implementation of that and we are piloting it within a few places in the network. such as the children's health centre. it will be a process to get that up and running. unfortunately i think the screening was not part of our wave one tool, so i think it is an ongoing target and goal that we have to meet. >> thank you. >> i would just like to say that i really appreciate two things here. one, the language that is in the narrative that describes exactly

what our department's position is on this piece of the legislation both federally and statewide, and the narrative is very explicit and helpful to understand what these pieces of legislation will do and why the department is taking opposition on them or not taking opposition thank you very much for that work. it must be intends to accomplish this in the time frames that you have. thank you for your service today >> thank you, commissioner. >> thank you. >> the resolution vote. >> that is right. >> will someone make a motion to adopt this resolution? >> so moved. >> second. >> all those in favor say aye. >> aye. >> thank you. >> thank you. >> item 10 is the d.p.h. strategic priorities.

>> commissioners, if i make break in here before this could presentation is started, i want to provide some background on this document. something that stood out for me when i started here 10 months ago was all the great work going on in the department and the size and the scope of the department and the multiple levels of expertise, and for -- quite frankly, the challenges and barriers that we run into we challenge ourselves to do better there was no one overarching the document that summarized our priorities. i think that this is really an effort. i asked dr. golden, along with her team, to collate the key priorities that were brought forward to the commission in the last year or so to really develop through the lean process and to remind the commissioners, there are extensive details in those documents with regard to

these priorities, including very specific outcomes and timelines for achieving those outcomes. i would also say that for people just starting in the department, and somebody who has been interested in what we are focusing on, perhaps new commissioners and others, those main documents are somewhat challenging to move through, and certainly dr. golden and her team did a great job of hoping orient us. this is really a document that i expect over time in over the years will evolve, but it is our efforts, for the first time in many years, to summarize our broad brush strategic priorities going forward. i will let dr. golden take it from here, but also note that the subject matter experts in these areas are available to answer more detailed questions, or certain as we go forward we can go into the outcomes and the

timelines for achieving the specific granular objectives that you listed in the 83. i will turn it over to dr. golden to provide this. i want to think her for compiling this document with a relatively short notice and the work that her team did. thank you. >> good evening. i'm very pleased to be here and honoured to present the departmental strategies, particularly at the beginning of this new year and this new decade, as we embark on this. dr. colfax said this is the first time that we have actually put together something, a draft like this. it's actually very exciting. it represents the work and thinking of many people across the department and division. many of whom are actually in the room today. i want to acknowledge that as well.

the process for articulating our priorities really began with the affirming and reaffirming of our mission and vision. you maybe familiar with this, our mission, and it was an opportunity to expand on that statement so that it included all in san francisco, which reflects our deep-seated belief in the importance of actually serving all those who walk through our doors and also in serving the community itself. our mission is new. are you familiar with our mission? making san francisco the healthiest place on earth. does that sound familiar in any way? okay. it might sound familiar because it is very similar to something that disneyland does. [laughter] anyway, it is an aspirational

goal, obviously worthy of the challenge. true north triangle is really a visual representation of our mission, our vision, and true north. and it really builds on the work of many of the sections and divisions before ass. so at the bottom you have protecting our mission, protecting and promoting health and well-being for all of san francisco. what we do, who we serve, and at the top, we have our vision, which is what we hope to achieve and what we are striving for. in the middle is our true north, which is a set of universal ideals which, taken together, are a compass for us that describes our ideal state that we are continually striving towards. we may never get there, but we are obviously, hopefully always moving in that direction. so our true north never changes,

but our tactics and strategies may change. we have six dimensions can you rattled him -- can you rattle them off? i'm not sure if everybody in the department can rattle them off yet, with that could be a goal that we would strive for. so equity, which is looking at eliminating health disparities, safety and security, which is about how do we provide the safest environments for our clients and staff, health and impacts, which is really about improving the health of the people we serve, by providing the highest quality care. through service experience, which is about the best experience that we can provide for patients and clients, and then workforce, which is a very, very important piece of this, which is really about how do we value, invest, and respect in our staff, and lastly, financial

stewardship, which is about transparent accountability for the resources that we have. all right. so we went through a process. it is a japanese term meaning needle or compass and method or management and we put it together and we have strategic direction setting. it is a process of identifying and deploying strategic priorities. it is not just a single event, but it is a year-long process for deploying improvement work. there is a series of steps involved in this that includes not just setting the objectives and measuring them so we can focus ourselves, but also to look at how do we measure on a systems level to see how we are performing as an organization, and then having visual management to allow greater

transparency around the operational environment so that in the end, we can improve the work and develop our future thinking. once we set our strategies, we then catch ball them. we share them out with other leaders and managers in the division and other levels of the organization through a technique called catch ball. that is where we get feedback to refine our thinking and to refine our plan so that ultimately this becomes a two way communication and there is feedback between not just the owner of the issue he was responsible for delivering on it , but from subject matter experts at the same time. that strategic plan, which is very broad at the department level, then gets taken by successive divisions and factions and as they do their

own strategic planning, they think about, what is my role, what is my way of supporting the overall departmental goals? and they incorporate that such that the strategic plan is no longer just at the top, as a horizontal thing, but is vertically aligned up and down. this allows people not only to understand what the plan is, but also see what is my role in being a part of the most important objective for the organization? as we cascade down our strategic plan, it may become increasingly narrow, more concrete, more specific, and this allows everyone to participate in what is hopefully a dynamic and creative environment.

all right. the department identified five strategic priorities and this represents a double pronged approach which looks at, first and foremost, the development of the infrastructure for doing this work, whether it's with this topic or any topic in the future, and focusing in on three key areas. we are looking at process improvements, daily management system deployments, as well as looking at how do we continuously improve. we're also looking at how do we engage our staff and our people in doing the improvement work. and lastly, how do we provide them with the tools to doing this improvement work, the data tools, and epic is a comprehensive electronic health record system that will enable us to provide care across the continuum. the application of those areas

focuses on advancing equity, behavioral health and homework -- homelessness health. they're five strategic priorities. the first priority is looking at advancing equity which is really about how do we achieve our vision of being the healthiest place on earth through an elimination of health disparities. there is work already underway through hypertension control and in a black african americans through chlamydia screening in youth, through sexual discriminatory health, and on the flip side, we need to look at how do we create an equitable and respectful workplace for everyone such that they feel like they have the opportunities to succeed. at the same time, we look at how do we train staff to recognize racism and inequity through the development of equity skills

curriculum training, as well as the equity champions, and then establish the department's infrastructure for doing this work overall through the development of an equity council , and the office of health equity. probably we would like to actually align this work with work that is being done throughout the city with other agencies as well, and with, in particular, the office of racial equity at the human rights commission. our second strategy is about workforce development and we acknowledge that an engaged workforce is best able to provide the highest quality care for our staff. based on a recent staff engagement survey, both communication and advancing equity were identified as top priorities. so we are looking at how do we provide a culture of open and

respectful communication by training our leaders and our managers tween communication, crucial conversation, critical problem solving, to look at how they can better manage with greater understanding and clarity. we are also aligning this work with the advancing racial equity work by developing curriculum that is aligned. for our third strategy, we are looking at the power lying -- deploying a performance improvement system and a management system, really as a philosophy around how we do the work. we will try to create greater focus that are really important to the organizational -- organization. we're looking at how do we communicate that out so it is a vertically and horizontally understood and that everybody

has a chance to provide input, particularly our subject matter experts in these areas. one of the main pillars of this is also looking at developing our people, which is about how do we develop 8,000 daily problem solvers, a fundamental building block of doing this improvement work? and then how do we sustain that improvement by employing a daily management system that involves everybody every day and doing improvement work? our fourth strategy looks at how do we use data effectively on the service of our mission to care for all in san francisco? that really is our goal in terms of deploying an electronic health record system. we started that process, we talked about it earlier. we're happy with how things have gone. we know we have to continue to deploy to other sites and other

areas, and also recognized that there are other groups, community-based partners who we need to connect with in order to create those systems to build better care for our patients. we need to look at how we increase success ability -- accessibility, align organizational priorities such that we can actually meet the operational demands for data and data sets. and lastly, how do we train our staff to use data more effectively in supporting problem-solving, analysis, decision-making, and continuous improvement? our last strategy, certainly not our least is homelessness and behavioral health, which is looking at how do we create a unifying vision for the delivery of behavioral health services to adults experiencing homelessness and while we know that care is provided individually one-on-one

, we also need to step back and look at a systems approach to doing this work. so a population-based approach to behavioral healthcare. looking at streamlining housing and looking at increased access to healthcare. focusing on the 237 highest risk station and building that model and applying it of the population. we are also in silicon valley looking at innovative opportunities for doing this work and aligning it with the advancing equity strategy to eliminate health disparities and using data and evidence-based practices to inform and guide the decision. so we have learned a lot about doing this and we're continuing we are continuing to learn. we know that strategic planning is not just planning, it is about deployments. it is a year-long process.

it is not about a one-day event. it is also about horizontal or vertical alignment in the work that we do. so everyone sees their role in the importance of how they can move things forward. we talked about yellows and greens and reds are things that people are usually really afraid of. we need to teach people that read is an opportunity and that the work is not about individuals, but it is about the system and how do we actually worked through that system. and we need to focus. we need to prioritize and think about where we can do you prioritize in order to have the bandwidth to do all this work. so this has been a high-level

summary of our strategic plan. i want to thank everyone back here for all of their work in putting this together. thank you. >> thank you. i would like to move to public comment. i like to remind you that will be voting on the strategies and priorities. >> commissioners? >> i do have a question. >> thank you. it's not really a question. i was looking at the switch -- the switch. it is a marvellous attempt to pull together everything. we are trying to understand which year we are talking about

as this represents because in that case, because you have some bars and also this is trying to get some context on it. you have some examples, but as the director has said, there's a lot of things backing this. what do we then take this as? is this a 2020 version and that is what we are working on? or is it the fiscal year that goes from 2019 to 2020? and where then -- if we are going to use this as the framework, where do we see the arrows which we want to now soon to be -- seem to be hitting the bull's-eye by going to get there , or as you say, if not, what are the opportunities to move forward. it's like the scorecard that we get in the other measures.

will we be seeing there are measures under here that then we could measure your progress and where we are going to go, and that does -- does that then inform a new program? i'm really fascinated by your idea of if we are going to prioritize, we have to do you prioritize. and what does that really mean to a lot of people, and then how does this really affect the poor clinician sitting in the emergency room trying to handle that emergency that just came in and meanwhile, we have these wonderful ideas of what you should be doing? sorry. >> i will try to answer all five of those. these are obviously very broad strategies that are not going to be accomplished in one year. it is a multiyear process. behind each of the strategies there are measures outcome

measures that are going to be looked at, as well as process measures that are also going to be developed based on what we see are the key drivers for this work. and over the course of the year, we want to present each of these strategies so you can see this in more depth. this is really just an initial overview. >> okay. so if i could follow that up, i understand that by doing that, you are seeming to say that this is more than a one year program. so therefore, there was a timeline that stretches this. how do these strategies fit in with all the other ones that we have? i know you have tried, but we have different objectives

through quality measures or, you know, targets and waiting times and the work that the network is doing to give us a comprehensive report. and it's kind of like one day we are going to hitch that report card. that is where all these are. where would we want to go after that? i am just trying to get -- >> i hear what you are saying. i think that is the challenge of the department because we have a set of regulatory measures and compliance measures that we have to work on, and at the same time we need to focus in on our true north and where we hope to get over time. there is always this tension and balance between that. so we don't stop everything. we still have to do the

regulatory and compliance and filled those measures to the extent as we do strategic planning that we can align that. i think that that is obviously the perfect goal. it's not always the case. >> and perhaps because they know the president has asked us to try to weigh in on what we will do with the planning session -- i know this might now become something that could be useful. at one point we were talking about maybe getting educated. but by now we are probably well along our way to understanding the product. now you have just explained more japanese terms. that is great. thank you. perhaps this would be something we could take as -- within the planning retreat and try to understand how this fits in with our partner as a compilation of

where they are going and what we might then be expecting, and what the public might expect out of this strategic plan and how we then continue it as a living document. it is beyond our knowledge today it is a nice exposition of where we are and obviously a great deal of work in order to do it. it might be something where they need a planning session. they've not actually done something like this. it might be a way to learn how much more they are expecting. >> if i could just add to that. one of the challenges is we

could also link it to the specific parts of the people -- how does this apply to getting 20 with h.i.v. infections? these are overarching things. before the broader detailed pieces, we can attach and link the specificity from this document. i think the goal is to summarize something that people would actually look at when they start having an interest in the department that is readable in 20 pages. then we have the much more detailed pages and hold ourselves accountable to these. i think the question of the years is really an important one because these are long-term issues that we need to address to hit the bull's-eye for most of these. it will take a long time. we thought it would be good to

entitled this so as to go through the cycle of the year, we can have that conversation about how from hitting that bull's-eye and are there other things that come in over these five that will display some of these because of an emerging issue or a shifting priority. for right now we were thinking that this would be our anchor and our true north. i'm not trying to contradict that. we are anchoring around what true north is going forward. >> thank you. >> i do have a question. i was in a comment -- i was at a meeting yesterday. one of the issues that is coming up over and over again is not only are we talking about single men out there and large -- a large population of black african-american single men out there, but we also have to think about families and transitional

age youth and transgender communities. this came up yesterday where the folks at the local homes and the advocates the community were saying loudly and clearly, you can't always mend, but you don't count our families are out there and you do not count our youth. i recognize this is supposed to be a global and high-level look, but i think they will have some mention of families and transitional age youth and transgender folks in this discussion. it may be in the details somewhere, but it isn't in this. >> thank you. i appreciate the feedback on that. we can look at how we incorporate that. >> thank you. >> dr. green? >> thank you so much. would it be possible to get this before we have to help with the next meeting? it would create such clarity. i keep thinking about the instruction book and i don't understand those documents. you can actually tell where they

keep their market is. that is easier when you are building systems and all the other roles we have here. >> we can do that. >> that would be very, very helpful. and then we can celebrate and we know we have to rethink. it's really helpful. it would be something we could aspire to. >> yes, absolutely. >> i hope we don't get into some of these problems, a few years ago, we did a structure of the department goals, and then for a while, we were asking that any initiatives or any surfaces coming up get tagged to it. we are almost doing that with some of these icons. i think we have to be careful

having experienced that, that that actually doesn't quite work it gets very rigid and then people get very mechanical to it i don't know if the commissioner remembers around that time, but we were trying to do it, but there was that idea that anything we were doing needed to fit. that is what was created. and so people were writing down and saying this was one a, and this is it. i think that while we were working through it, it looks like a good idea to be sure that everything was matching what we were saying, but i think it did not achieve the purpose that i would think we are hoping for and i know it was a lot of work. there then quoting it and i don't think we did the department a service in trying to do it that way.

i just now suddenly realized that i don't want us to get back into that mechanical area. the idea that they had with trying to link these, but i don't know how accurate it is, but you can come down and see where we are standing with some of the prospects an understanding, how as they rise, they become part of this. it's probably the right way of trying to do it without it becoming over burdened. >> okay. that is good feedback. >> thank you for indulging me. >> thank you so much for your report. i would also like to say that it looks like there is some outcomes expected of the strategies that you are going to employ and i will look for to have a deeper discussion about what the outcomes of these strategies the strategies actually are. [please stand by] in favor.

aye. thank you everyone have a good night. >> is there a motion to disclose or not disclose what was

discussed in the session? >> motion to not disclose. >> second. >> second. >> those if favor signify by aye. >> move to adjourn. >> those in favor signify by saying aye. >> thank you. george washington high school marching band. [applause]

>> please welcome kayla smith. [applause] >> good morning, everyone. how's everybody doing today? thank you. thank you for joining us today for this historical occasion. my name is kayla smith, and i will be your mistress of ceremonies for the evening. growing up in san francisco d-5, hayes valley, to be exact, since the age of four, i have been privileged to receive mentorship from my community. i went from running departments at project level to now earning my internship at nbc this upcoming summer. [applause] >> i've always been ambitious,

but i was lucky to have women in my life that looked like me and achieved great things, and one of those great women that i looked up to the most, our current mayor, my godmother, london breed. she wasn't changed much, by the way. to this day, she is still the same wise, inspiring, and supportive person that she was when i was a child. i know all too well the impact that mayor breed has had on myself, and i am extremely excited to see all the wonderful things that she will do for the city, and for that, i say thank you. [applause] >> and now, please join me in welcoming father paul fitzgerald, president of the university of san francisco, to deliver today's invocation. [applause] >> thank you, kayla, and thank you all for being here today as

we honor and congratulate and thank our mayor, london breed. mayor breed completed a masters in public education -- public administration at the university of san francisco back in 2012, and i offer the following blessing on her behalf and on behalf of her fellow professors who loved her, her fellow students at san francisco who loved her, and for all of us who love her and are praying for her continued success. but even more so, we are continuing to pray that mayor breed will continue the goals of the degree program that she so ably completed. in it our masters in public education program, we prepare our graduates, people like london breed, for public leadership by advancing a challenging curriculum while pursuing complimentary research, transforming learning into actions that serve our

communities, especially the most vulnerable among us. our diverse graduates become outstanding leaders who provide ethical, workable solutions, societial needs, and who advance justice. so in london, we see all of the learning outcomes of this degree program. social justice for all people of the city and county of san francisco and beyond. diversity in all its forms. integrity in all that we do. accountability to all whom we serve. excellence. educating students like london breed to become compassionate and effective leaders who humanely manage organizations. providing and facilitating interactions between government, for-profit and

nonprofit sectors to provide ethical and workable solutions to societial needs. i join with her many fellow usf alumni of the city and county of san francisco on asking blessing for mayor london breed this day and every day as she brilliantly fulfills her leadership of justice and hope into a future of inclusiveness, peace, and prosperity for all. so i ask you to join me in raising a hand of blessing. we ask god to bless london breed with the seven gifts of the holy spirit. wisdom, understanding, council, piety, and fear of the loving god. and please bring her great

satisfaction as she joins to lead all of us, and i ask all of you to join me in saying amen. [applause] >> thank you, father paul fitzgerald, for that beautiful invocation. and now for the posting of the colors of today's inauguration is the color guard from george washington high, where london breed attended. please rise and join me for the posting of the colors and singing of our national anthem.

♪ o say, can you see by the dawn's early light ♪ ♪ what so proudly we hailed at the twilight's last gleaming? ♪ ♪ whose broad stripes and bright stars through the perilous fight ♪ ♪ o'er the ramparts

we watched were so gallantly streaming? ♪ ♪ and the rockets' red glare the bombs bursting in air ♪ ♪ gave proof through the night that our flag was still there ♪ ♪ oh, say, does that star-spangled banner yet wave ♪ ♪ o'er the land of the free ♪ ♪ and the home of the brave? ♪

[applause] >> thank you, katie. it is truly an honor to introduce our next speaker who will administer the oath of office. as our first female african american to be appointed at the san francisco superior court,

she has paved the way for women and people of color to succeed in law and has been a role model and mentor to lawyers who are people of color. please join me in honoring judge teri l. jackson. [applause] >> i have to guess dresset dre in front of you. welcome. just as a little aside, when i see this many people in a room, i'm ready to swear you in as jurors and you just report in across the street, so watch with a me. but on behalf of the superior court for the state of california, all 1600 strong trial judges throughout this state, it is such an honor and such as pleasure to be here.

as my last official duty as a superior court judge, it is such an honor to be able to administer of oath of office to our mayor, london breed. [applause] >> i've also been told to explain why this is my last duty as a superior court judge. as of january 21, 2020, at 11:00, i will be elevated to the california supreme court, as the first african american woman. so with that being said, madam mayor, could you please come forward.

[applause] >> are you ready? >> the hon. london breed: yes. >> okay. raise your right hand and repeat after me. >> i, london n. breed, do solemnly swear that i will support and defend the constitution of the united states and the constitution of the state of california against all enemies, foreign and domestic. that i will bear true faith and allegiance to the constitution of the united states and the constitution of the state of california. i take this obligation freely without any mental reservation

or purpose of evasion. that i will well and faithfully discharge the duties upon which i'm about to enter, and during such time as i hold the office of mayor of the city and county of san francisco. congratulations. [cheers and applause] >> the hon. london breed: thank you. thank you. thank you all so much forum

here today, and thank you to the people of san francisco for trusting me to continue to serve as mayor of such an incredible city. as we welcome a new decade, it's really worth taking a moment to reflect on how far we've come in this decade. in 2010, san francisco was deep in the great recession, and our workforce was in trouble. our unemployment rate had more quadrupled since 2000 and was at a 20-year high. ten years later, we are riding the longest period of economic growth in our history with one of the most -- the lowest unemployment rates in our city's history. [applause] >> the hon. london breed: the homicide rate has dropped to its lowest in more than 55

years. [applause] >> the hon. london breed: in the last decade, san francisco's stance on marriage equality and medical cannabis became the laws of the land. we made a record investment in our parks and our libraries. we modernized our muni fleet and made it free for those in need. we launched our clean energy program, dramatically reducing greenhouse gas emissions. we even got our hands dirty, replacing our sewer system. we passed paid family leave, a $15 minimum wage and made city colle college free for all. we paved our streets and

remodell remodelled the moscone center. we welcomed the warriors home. we watched the giants win it, and win it again, and our congress woman gave up the gavel and won it back. [applause] >> the hon. london breed: and we became the capital of the resistance. [applause] >> the hon. london breed: over the past decade, we've made great progress, but through it all, we've grappled with the twin troubles of homelessness and housing availability. i was an intern in the mayor's office right here a quarter of a century ago. i had the privilege to walk up these stairs every day as a

member of the board of supervisors. this building's beauty is timeless, its spirit and inspiration. earthquake and fire destroyed san francisco's first city hall, but we built another even more magnificent than the first. why? why do we build these monuments? what do these marble stairs and golden dome -- what does it mean to us? it isn't excess or vanity, it's a reminder. we swing the doors open for everyone because it reminds us that our government welcomes everyone. our successes are shared, our potential unbound, and that none of us would be left out in the cold. i take the oath of office today remembering that not too long

ago, my ancestors were in chains. i've never found out exactly where they lived, but i know a bit about how they lived. i know their masters sat at tables eating generous meals that they didn't prepared. i know they hudled outside. they ate mush not with wooden spoons but with hands in a trough. the civil war ended the bondage, but the inequity had only begun. the slave owners kept their lands, and the former slaves kept the nothing they already had. so with that nothing, most went back to work at the farm. they rented their labor as share croppers, or if they were

lucky, tenant farmers. generations of poor african americans scraped by, living in fear that if they protested too loudly, men in hoods would come. when the depression hit, two of those share croppers, a young couple with 11 children moved from louisiana to texas. sometime later, their daughter, miss camellia brown came to san francisco. she came in search of work. she came in search of something better. she came to raise her children in a place where they might be equal. my grandmother came here to believe in a city of hope, a city where a young black girl can go from public housing to the mayor's office. [applause]

>> the hon. london breed: and she was right. san francisco is so much more than our home. it's a refuge for the gay, lesbian, and transgender brothers and sisters from all over the country. it's a new start for immigrants from guatemala and guangzhou and everywhere in between. it is my promise that everyone has a place in this city, that no one should be left out in the cold. so when we come to this hall or walk down market street and see the suffering of thousands of people outside our doors, it hurts. it hurts not because we are callous but because we care. the suffering on our streets, it offends our civic souls, and it should. but if we're going to do something about the conditions

on the streets, we need to level with each other. homelessness isn't new, it isn't easy. we are not the only city struggling with it, and quite frankly, we are not going to solve it in 100 days, a year, or even entirely in this term. and i'm not sure solve is the right word any way. while the city has helped thousands of people out of homelessness, thousands more took their place. and sadly, sadly, there will always be people whose addiction or mental illness or poverty leads them down a dark path or puts them in need of help. los angeles has more than 36,000 homeless residents and a skid row that is its own tragic city within a city. three years ago, san diego had a hepatitis outbreak among its homeless population that killed 20 people. they had to spray their sidewalks with bleach to fight

the infection. i point this out not to criticize those cities. i know how hard they are fighting to address these problems. cities up and down the west coast, seattle, santa rosa, portland, los angeles, san diego are launching this fight. too many people are grappling with drug addictions and insufficient resources and insufficient housing. [applause] >> the hon. london breed: now we haven't stopped sending our taxes to washington, d.c., but they stopped sending back anywhere near enough for homelessness and affordable housing. so each year, san franciscans write bigger and bigger checks, and we ask ourselves, why doesn't it keep getting better? why do we keep sending money,

yet the homeless count keeps going up? first, let's dispel some of the inaccurate conversations that we hear. it's not because we aren't funding solutions. it's not because we are indifferent. no one in my office, no one at the board of supervisors, no one in any city department, no one who works here is kicking back and throwing their hands up and pretending like we've been able to do something great. we are all working on it every day, frustrated by it every single day. homelessness is so severe, so acute up and down the west coast for a few simple reasons. housing is too expensive. working class jobs are too uncertain, and their wages too outpaced by the cost of living. drugs, opioids and meth in

particular are too common. and two decades after the state closed its mental hospitals, california still hasn't come to grips for how we're going to care for people who are severely mentally ill. [applause] >> the hon. london breed: homelessness isn't just a problem, it's a symptom. the symptom of unaffordable housing, of income inequality, of institutional racism, of addiction, of untreated illnesses, of decades of disinvestment. these are the problems, and if we want to fight homelessness, we've got to fight them all. [applause] >> the hon. london breed: and in san francisco, we are. we will meet our goal of opening 1,000 new shelter beds by the end of this year. we just opened a new navigation

center along the embarcadero center, and our bayview shelters break ground shortly. [applause] >> the hon. london breed: we just opened our first state parking facility to help people who live in their vehicles. we're adding more than 200 new mental health beds, expanding outreach, and we are transforming how we deliver mental health and substance use treatment in our city. we have more permanent supportive housing units per ca capi capita than any major city in the country. we've expanded rental assistance and emergency problem solving funds to help people avoid homelessness in the first place. we are expanding our

conservetorship program to help people on the streets and get them the support that they need. [applause] >> the hon. london breed: we are working to open meth sobering centers, safe injection sites, and managed alcohol facilities so we can stop walking by addictions spilling out on our streets and start treating it like the health care issue that we know it is. [applause] >> the hon. london breed: i've directed our city departments to reprioritize spending towards making our streets safer and cleaner for all of us. we are riding ballot measures to housing shortage.

[applause] and if we want to relieve the pa pain on the streets and stop seeing our family members and friends moving away in moving vans, we need to build more housing, build more homes a lot more and set policies that make this possible. [applause] >> the hon. london breed: over the next decade, in addition to our work on preserving thousands of permanently affordable homes, we need to build at least 50,000 new homes, at least 50,000 new homes. [applause] >> the hon. london breed: and

at least 17,000 need to be affordable. and to get to 50,000, we can't let disingenuous warnings of shadows and heights get in the way of badly needed housing. [applause] >> the hon. london breed: to get to 50,000, we need to recognize that density is not a dirty word. to get to 50,000, we have to push for solutions to build homes faster and support policies like sb-50 that will allow more housing all over the bay area. [applause] >> the hon. london breed: i'll be going to sacramento to fight

for new housing because we need more housing for our workers, for our families, for our seniors. because our retail shops can't afford to hire people who live here, because housing should be affordable and viable to san franciscans of all levels. >> the hon. london breed: we can't say we need more housing and then reject the policies that actually allow us to build that housing. [applause] >> the hon. london breed: i wasn't here decades ago when we imposed restrictive laws to prevent more housing, but i will be here when we start build housing in san francisco and the bay area again.

it is time. so here's what i want the next decade to look like. i want this to be the decade where we no longer walk by a person shooting up or a person who's shouting out of control or suffering on our streets and shrug our shoulders or turn away and wonder, what should we do? i am determined over the next four years to take in people with addiction and mental health problems so that when you encounter someone in need, you can make a call and know that person will get the help they need. [applause] >> the hon. london breed: as i said before, compassion can no longer mean anything goes. i want this to be the decade when residents and visitors to our city can enjoy every

neighborhood every single day without fear of crime or unacceptable behavior. we have what we know is one of the most beautiful cities in the world. this is an incredible city. i want it to be lively, i want it to be diverse, i want it to be safe, and i know you all want that, too. [applause] >> the hon. london breed: and i want this to be the decade when san franciscans from the multigenerational native to the newly arrived immigrant that he, she, or they can arrive with their children and call this city home for generations to come. [applause] >> the hon. london breed: we can be a vibrant and welcoming

city, a city of affordable and diverse homes, a city where we come together and put aside our differences to meet the challenges that we know we all face with clarity and conviction. a city where we can care for one another, where our streets are safe, and no one is left out in the cold. san francisco can be the city that a share cropper's daughter dreamed it to be. san francisco can and will be a city for all of us. thank you.

[applause] >> the hon. london breed: ladies and gentlemen, this person said to me, it is a blessing to be a blessing. and today, the person that's providing a blessing to all of us so that we can start 2020 off right and what we need to do to move our city forward is no other than san francisco's santana! [cheers and applause] >> the hon. london breed: and with his amazing special guest, yolanda adams. [cheers and applause]

[♪]

[applause] [♪] >> put your hands together! [♪]

>> carlos santana. [applause] >> sister of life yolanda. [applause] >> we want to say we're so

grateful and it's such a deep honor to be here in this most memorable location because our sister of light is in charge of changing -- changing the narrative. her light will efficient, sufficient to change the whole -- not just the bay area, this nation and the whole world because she's anointed. she is designed by grace, and we salute you and say it's about time. [applause]

[inaudible]

>> my background is in engineering. i am a civil engineer by training. my career has really been around government service. when the opportunity came up to serve the city of san francisco, that was just an opportunity i really needed to explore. [♪]

[♪] i think it was in junior high and really started to do well in math but i faced some really interesting challenges. many young ladies were not in math and i was the only one in some of these classes. it was tough, it was difficult to succeed when a teacher didn't have confidence in you, but i was determined and i realized that engineering really is what i was interested in. as i moved into college and took engineering, preengineering classes, once again i hit some of those same stereotypes that women are not in this field. that just challenged me more. because i was enjoying it, i was determined to be successful.

now i took that drive that i have and a couple it with public service. often we are the unsung heroes of technology in the city whether it is delivering network services internally, or for our broadband services to low income housing. >> free wi-fi for all of the residents here so that folks have access to do job searches, housing searches, or anything else that anyone else could do in our great city. >> we are putting the plant in the ground to make all of the city services available to our residents. it is difficult work, but it is also very exciting and rewarding our team is exceptional. they are very talented engineers and analysts who work to deliver the data and the services and the technology every day. >> i love working with linda because she is fun. you can tell her anything under

the sun and she will listen and give you solutions or advice. she is very generous and thoughtful and remembers all the special days that you are celebrating. >> i have seen recent employee safety and cyber security. it is always a top priority. i am always feeling proud working with her. >> what is interesting about my work and my family is my experience is not unique, but it is different. i am a single parent. so having a career that is demanding and also having a child to raise has been a challenge. i think for parents that are working and trying to balance a career that takes a lot of time, we may have some interruptions. if there is an emergency or that sort of thing then you have to be able to still take care of your family and then also do

your service to your job. that is probably my take away and a lot of lessons learned. a lot of parents have the concern of how to do the balance i like to think i did a good job for me, watching my son go through school and now enter the job market, and he is in the medical field and starting his career, he was always an intern. one of the things that we try to do here and one of my takeaways from raising him is how important internships are. and here in the department of technology, we pride ourselves on our interns. we have 20 to 25 each year. they do a terrific job contributing to our outside plant five or work or our network engineering or our finance team. this last time they took to programming our reception robot, pepper, and they added videos to it and all of these sort of

things. it was fun to see their creativity and their innovation come out. >> amazing. >> intriguing. >> the way i unwind is with my photography and taking pictures around the city. when i drive around california, i enjoy taking a lot of landscapes. the weather here changes very often, so you get a beautiful sunset or you get a big bunch of clouds. especially along the waterfront. it is spectacular. i just took some photos of big server and had a wonderful time, not only with the water photos, but also the rocks and the bushes and the landscapes. they are phenomenal. [♪] my advice to young ladies and women who would like to move into stem fields is to really look at why you are there.

if you are -- if you are a problem solver, if you like to analyse information, if you like to discover new things, if you like to come up with alternatives and invent new practice, it is such a fabulous opportunity. whether it is computer science or engineering or biology or medicine, oh, my goodness, there are so many opportunities. if you have that kind of mindset i have enjoyed working in san francisco so much because of the diversity. the diversity of the people, of this city, of the values, of the talent that is here in the city. it is stimulating and motivating and inspiring and i cannot imagine working anywhere else but in san >> my name is kamal lane, and

i've lived in san francisco for 30 -- let's say 31 years. i lived there a year february 29, 2017, my grandma's birthday. the thing that's cured my home is the mayor's office. when my number was called, i was excited because my number was number three. to rent a home in san francisco means that i'm able to be with my family to support me, me to support them. then, the opportunity for my daughter to get a good paying job. my favorite thing of my new home in hunters view is the view of the bay bridge, oakland, and a piece of the

golden gate. it's peaceful and quiet, and they have a lot of activities for families. they have art class, where you can paint, they have trips, where they take the children. we went to a black art museum, we went to a jazz festival, we went ice skating. there's a lot -- they have a lot of activities up here, and that's one thing that i really love about it, i love my bedroom. it's peaceful, it's quiet, where i can think, play, and just have my quiet time. i love my bedroom. this is my home because this is where i live. me and my children, we love in here, we -- just being with my grand kids and loving somewhere and having somewhere is home. we love being together, and your heart -- wherever your

heart is, that makes it home for you.

[drumming]

[cymbals] [cymbal]

>> ladies and gentlemen, please welcome sheriff matt freeman. >> that's a great way to kick off a party and celebration. ladies and gentlemen, let's hear it for the san francisco police department lion dance team. [applause] my name is matthew freeman and i'm the undersheriff for the city and county of san francisco sheriff's office. and it is my honor and my pleasure to serve as your master of ceremonies for today's event

for this auspicious occasion, and i cannot tell you enough how happy the men and women that wear this uniform are of the person we are going to swear in as sheriff today. [applause] and welcome to san francisco's crown jewel, this beautiful san francisco city hall. ladies and gentlemen, at this time, if i can please ask you to stand for the presentation of the colors and pledge of allegiance. [pledge of allegiance]

please join me in reciting the pledge of allegiance. i pledge allegiance to the flag of the united states of america, and to the republic for which it stands, one nation, under god,

indivisible, with liberty and justice for all. please remain standing as we invite you to the podium to sing our nation's national anthem. >> oh, say, can you see, by the dawn's early light what so proudly we hailed at the twilight's last gleaming? whose broad stripes and bright stars through the perilous fight, oer the ramparts we

watched were so gallantly streaming, and the rocket's red glare, the bombs bursting in air, gave proof through the night that our flag was still there. oh, say, does that star. spanninglyspangled banner yet wr the land of the free and the home of the brave. [applause]

[military salute]

>> ladies and gentlemen, how about a round of applause for the singer and the san francisco police department color guard. (applause.) [applause] thank you. please be seated. i would like to take this opportunity to recognize some of our dear guests, some of our elected and important people here in the city and county of san francisco. and if you could hold your applause until i complete each group, i would appreciate it. our city and county of san francisco elected board of supervisor members, president of the board norman yee, district 7, dean preston, raphael

mandelman, district 8, ashad, district 11. ladies and gentlemen, our county board of supervisors. [applause] our district attorney, chesa boudin, public defender, our recorder, carmen chew and her treasurer jose cisneros. [applause] we are honored and pleased to have members from our state government present today, attorney general of the state of california, javier, state board of equalization, state of california, cohen, treasurer, state of california, assemblymember, state of california, our state of

california, ladies and gentlemen. [applause] we work with some of the public, finest public safety partners in any jurisdiction in the entire country. our public safety partners, chief of police, san francisco police department william scott. san francisco fire department, fire chief, jeanine nicholson. chief of the probation department, city and county of san francisco, karen fletcher. we are truly honored here today to have someone that we work very closely with and are fortunate to have that opportunity, sheriff of the san mateo county. [applause] and his undersheriff.

[applause] city and county of san francisco has some of the finest public servants in any jurisdiction in california if not the entire country. our city administrator, naomi kelly. san francisco public utilities commission general manager, harlan kelly. and i really enjoy working with our department of public works director, mohammed nuru. events such as these can't go off as well as they do without the hard work of our city and county of san francisco chief of protocol, charlotte schultz. and no one has been around city hall for any length of time knows that we cannot go without thanking director of mayor's special events, martha cohen.

[applause] we would like to thank all the city and county of san francisco commissioners for all the work that you do. we would like to thank all the city and county of san francisco department heads, certainly want to thank all of the current members of the san francisco sheriff's department and the many retired members that i see here in attendance today. it's wonderful to see your faces. you all look younger. i look older. you do something about that? the sworn command staff of the san francisco county sheriff's department and our entire management team, thank you all for being here. [applause] i would also like to do a special shoutout and maybe if we applaud loud enough, i'm sure they can hear it upstairs, in case you didn't know, there was

another inauguration here this morning, how about a round of applause for our mayor london breed? [applause] at this time, i would like to invite to the podium father tom hamilton of saint gabriel church for our invocation. >> public service is an invitation to a life of personal devotion and sacrifice. today we entrust the important work of leadership in our

sheriff's department to paul miyamoto. we offer him our good wishes and our sincere support today and of the days ahead. please join me, then, in the spirit of prayer and of hope. oh, god of many names, known by many signs throughout this beautiful world, we pause during this celebration to invoke your blessing upon paul, chosen for service as sheriff. please support him with the ability to confront the challenges that will inevitably come, making judgments that are in the best interest of this exceptional community of san francisco.

may his service be typified by patience, courage, stability, honesty and loyalty. in the name of all that is good and holy, we offer this prayer in humility and praise. and we all say together amen. >> thank you, father. for the last 4 years, this agency has had the pleasure to serve under outgoing sheriff

vicki hennessy. sheriff hennessy would have loved to have been here today, but just last week she underwent hip surgery and unfortunately could not be in attendance today. i'm sure that she would have liked nothing more than to be here to wish paul all the best and encouragement as he assumes office of the sheriff. she did, however, leave for paul and for all of us, a video message. >> hi, sheriff paul. vicki hennessy here, room 456, city hall, sheriff's office. coming to you through the magic of video. i regret i cannot come to the ceremony. however, i am sending you and your family my congratulations, best wishes and deep

appreciation for the service you have given to the san francisco sheriff's department and the city and county. there's nothing quite like your first day on the job as sheriff. the pomp, the ceremony, the love you feel from your supporters and the expectation. enjoy it every moment. as soon as you have taken your oath, you will hit the ground running. just remember, the sheriff's job is a marathon, not a sprint. this is a demanding job where you will feel the glare of the spotlight, whether you want to or not. as you know, the one constant will be your family. i know you will make time for them and you will be successful no matter what you do. you have the respect of the rank-and-file. you are already building relationships with the criminal justice stakeholders. you are already a community leader. and you have the benefit of more than 23 years of experience

serving in this department. i know that you will bring multiple perspectives to your new position. you are the right person for the right time to take up the sheriff's man tell. about those expectations, i expect great things from you. so, paul, congratulations. you've earned it. now, get to work. [applause] >> a little bit nervous. i might be more nervous than you. well, the big moment, the swearing-in of the 37th sheriff of the city and county of san

francisco is but minutes away. i would like to take a brief moment and share with you some information about the office of the sheriff and the awesome responsibility one assumes when holding the esteemed title of sheriff. there are 58 counties in the state of california. as required by the state constitution, each county must have a sheriff, and the sheriff shall be elected. the office of the sheriff is not simply another department of the county government. the office of the sheriff is a statutory, constitutional office, having exclusive powers and authority under state law and/or the state constitution. the county sheriff serves multiple constituencies, the county board of supervisors, when executing county laws and ordinances, the state attorney general when enforcing state

laws as a peace officer and as an officer of the superior court in and for the city of san francisco and of course, the sheriff ultimately serves all the people and communities of their county and in our case, city and county. the management and leadership of the san francisco county sheriff's office is no small task and will test the skills and abilities of the brightest and strongest of leaders. our department is authorized for 946 sworn peace officers, 130 professional support staff, and 98 sheriff cadets. the sheriff is responsible for leading and managing the workforce approaching 1200 employees, spanning four divisions, with the annual operating budget north of $150 million. this includes, in part, the operation of four distinct jail

facility, judicial protection and court security at four courthouses, execution of all civil processes in the city and county, operation of three community-based sites offering a myriad of services to those criminal justice involved, robust, criminal internal affairs and background investigation units and emergency services unit to include a type 2 law enforcement mobile field force and special response team to deal with critical incidents that occur in the jurisdiction of the sheriff. general law enforcement and public safety services for the department of public health at san francisco general hospital, ten department of public health neighborhood clinics, the department of emergency management, the san francisco main public library, and, yes, here in the crown jewel of san francisco, our beautiful city hall and much, much more all

supported by training and personnel units. the daily operation of a law enforcement agency this size in a city and county as eclectic, diverse, dynamic and, yes, challenging as ours, requires the right person for the right time. and san franciscan, a graduate of lowell high school, a husband, a father who lives in and is raising his family in our city, a 23-plus year record of service to this agency and the people of san francisco, a leader that holds himself accountable first and by example will expect the best from all who work for this agency. a person of the highest integrity, character and moral compass, paul miyamoto embodies if not exceeds all the core elements required to be the

sheriff of san francisco. the deputies have assumed that i shall posts. they are eager, and they are ready to receive your direction. paul miyamoto. [applause] >> ladies and gentlemen, it is a real pleasure at this time to invite to the stage for the oath of office, state of california attorney general xavier becerra. [applause] i would also like to invite to the stage sheriff elect, paul miyamoto. [applause]

i think you can hear me. also coming to the stage is paul's other, his wife, and his children. melanie, jordan, joseph, marissa and mia -- maya. [applause] >> please raise your right hand and place your left hand on the bible. i will ask you to repeat after

me. i, state your name. >> i, paul miyamoto. >> do solemnly swear. >> do solemnly swear. >> i will support and defend the constitution of the united states. >> that i will support and defend the constitution of the united states. >> and the constitution of the state of california. >> and the constitution of the state of california. >> against all enemies, foreign and domestic. >> against all enemies, foreign and domestic. >> that i will bear true faith and allegiance to the constitution of the united states and the constitution of the state of california. i take this obligation freely, without mental reservation or purpose of evasion. and i will well and faithfully

discharge the duties upon which i am about to enter and during such time as i hold the office of the sheriff of the city and county of san francisco of the sheriff of the city and county of san francisco. >> i present to you, sheriff miyamoto. [applause] [cheering and applause] >> i guess i'm supposed to say something right now. [laughter] hang on one second while i get my notes.

oh. that's not a great start, but -- [laughter] good afternoon, everyone. thank you, attorney general xavier becerra and to all of you who are here today in celebration of the office of sheriff. i have many people to thank for this moment. all of you here today played roles and given support for my rose through the ranks and my occasionally descent. [laughter] i begin by thanking my mom and my dodd, phil and ella. my dad is in the hospital today and couldn't make it, but my mom is here for both of them, and i just wanted to recognize her for the person that she is. [applause] growing up, my mother was a very strong advocate for

both me and my brother when we were very young as we went through the school system here in the public schools of san francisco. she was actively involved in our education to the point where even after we graduated she continued to volunteer her time and service, both with home and advocate for children and youth all the way up to the state ptsa level where she volunteered for many years and was so effective as a leader in the ptsa who worked to improve the lives of the children and the educational system that we have here in california. my father's family immigrated to san francisco around the time of the earthquake of 1906. and during that time, built a successful dry cleaning business and some of my family is here today, and i want to thank them for being here as well. world war ii happened and the federal government ordered the internment of americans of japanese ancestry, which included the miyamotos. our family lost everything here

in san francisco and were forcibly relocated to heart mountain in wyoming for the first part of the war. did they give up? of course not. in fact, my grandfather's three brothers proudly fought for the united states as part of the most decorated unit in military history, the 442nd regimental combat team. lucky for me, after the war, the miyamotos returned to san francisco and began a new. my father grew up and became an attorney, he practiced law for the state of california and actually became appellate-level judge for the workers compensation review board. i share this with you because this is my family. they are the role models who influenced me. they faced adversity and racial discrimination and yet they

responded with grace, strength and grit and actually became civil servants. the miyamotos became the change they wanted to see. they embody resilience. inspired by my family tradition of service, i chose to join the san francisco sheriff's department over 23 years ago to try to make a difference in people's lives. every day, i don this uniform and serve our city with some of the finest people i know. people like our outgoing sheriff who has been a role model and mentor to me, she is the first to actually rise through our ranks and become sheriff, and she's also the first female to serve as the sheriff of san francisco. i'm honored to have worked for and with vicki hennessy and even though she is not here, i would like to ask for a round of applause for her and her contributions. [applause]

it's really wonderful, because i serve with people who put other people first, who ensure public and individual safety, both inside the criminal justice system, in the jails, in the courts, and outside in the community. we take pride in all of our work serving san francisco. i'm honored to call all of you my colleagues and serve as the sheriff for the next four years. you all embody resilience to me. we as department members have been at the forefront of some of the toughest challenges facing the city, including an increase of the numbers who are incarcerated who suffer from behavioral health issues. not surprisingly, this has challenged our infrastructure and our staff. we share these challenges across all our city agencies and with our justice and public safety

partners. we collaborate to build and nurture relationships and trust and to provide services to everyone. in response to our changing populations, we've created psychiatric sheltered living unions which provide consistent care and structure. our behavioral health assistance team, comprised of both trained deputies and department of public health specialists, are sporting people incarcerated, collaborating for individual treatment for people housed in all of these different units. and it's making a positive difference in their lives, creating new hope for their successful reentry into our community. as the department moves forward, you can expect more of this from my staff and myself, care, compassion and collaboration. i started my career with the department back in 1996.

it has shaped me in more ways that i can count. on my very first day, my training deputy sent me on a errand which made me late for the shift, i was scheduled to relieve. the deputy on duty at the time was not very happy with me for being late, but we actually, the both of us overcame that initial stumble. we fell in love and we were marid five years later, and that's my wife leeann. [applause] i wanted to recognize her for who she is and also my children who were introduced earlier. melanie, jordan and the triplets, joseph, merissa and maya, if you guys could stand. [applause] come on, stand up. they have been my source of personal strength and love, and i wanted to thank them with all

of my heart. leanne and the children have supported and inspired me every step of this journey. they bring me joy and happiness. at the department, we have a faith in others to change for the better. as a young deputy working on the sixth floor of the hall of justice, i connected with a man who suffered from addiction. he was sober in jail, overcome his challenges, got released and then relapsed out in the community over and over, time and time again. inevitably he would end up back as an incarcerated person. most of you know that story, and hear it. we in the department actually live it and see it every day. but you know what? that individual never gave up. and i didn't give up on him either. i saw something of myself in him.

someone from the same ethnic and cultural background, on a different path but for one or two choices. eventually, his commitment to stay sober stuck. he made changes and then went back into the community and served the community. he's a mentor to many others in the community. i see him out there every day with rehabilitation services. i'm proud to say he is one of my friends in the community and to see him there every day gives me strength. he embodies my father's favorite quote which is to never give up. his mantra of resilience follows me along with my family's story of optimism and persistence in the face of internment, not just to survive but to give back to the nation that placed hardships on our family. my family has guided me. their positive attitude will

make a mark on the sheriff's department over the next four years. i actually lost my first election back in 2011. eight years later, i am the first asian-american in history to be elected to be sheriff in the state of california. [applause] so please -- [applause] i just want to end with my father's quote. i want to say to him as elis in the hospital bed -- as paul, bee

will be addressed as sheriff. ladies and gentlemen, a round of applause for our sheriff, paul miyamoto. [applause] [applause] >> this is kind of mean now that you have sat down. ladies and gentlemen, if i could please ask you to stand for the

retrieval of the colors.

[military salute] how about a round of applause for the color guard? [applause] thank you very much. you may be seated.

ladies and gentlemen, this brings to a close our celebration today, our swearing-in of the 37th sheriff. i hope've each and every one of you enjoyed your time with us today. if you are so inclined and interested, the sheriff will be receiving guests and visitors in the sheriff's office on the fourth floor, 456, the corner of the building over there. we would ask at this time that members of the public remain seated until such time that the sheriff, the elected and the city department heads have had an opportunity to exit the rotunda. thank you very much for being here today. [applause] [applause].

>> my name is naomi kelly the single-story for the 775 i started with the city and county in 1996 working for the newly elected mayor willie brown, jr. not only the chief of staff a woman but many policy advisors that were advising him everyday their supportive and nourished and sponsored united states and excited about the future. >> my name is is jack listen and the executive director of a phil randolph institution our goal to have two pathways to sustaining a family here in san francisco and your union jobs are stroen to do that i have this huge way to work with the

community members and i think i found my calling i started in 1996 working for willie brown, jr. i worked in he's mayor's office of housing in the western edition and left 3 years went to law school of san francisco state university and mayor brown asked me to be the director of the taxicab commission and through the process i very much card by the contracting process and asked me townhouse the city purchaser and worked with me and i became the deputy administrator and . >> having trouble struggling to make ends meet folks will not understand what importance of voting is so we decided to develop our workforce

development services after a couple of years offering pathways to sustainable jobs. >> (clapping.) >> we've gotten to a place to have the folks come back and have the discussion even if participation and makes sense we do public services but we also really build strong communities when i started this job my sons were 2 and 5 now 9 and 6 i think so the need to be able to take a call from the principal of school i think that brings a whole new appreciation to being understanding of the work life balance. >> (clapping.) >> i have a very good team around me we're leader in the country when it comes to paid and retail and furiously the affordable-care act passed by 3079 we were did leaders for the healthcare and we're in support of of the women

and support. >> in my industry i feel that is male dominated a huge struggle to get my foot in the door and i feel as though that definitely needs to change this year needs to be more opportunities for i don't know women to do what tell me dream i feel that is important for us to create a in fact, network of support to young people young women can further their dreams and most interested in making sure they have the full and whatever they need to make that achieveable. >> education is important i releases it at my time of san mateo high ii come back to the university of san francisco law school and the fact i passed the bar will open up many more doors

because i feel a curve ball or an where you can in the way can't get down why is this in my way we have to figure out a solution how to move forward we can't let adversity throw in th. >> (speaking foreign language.) >> i wanted to wish you a best wishes and congratulations the community has shifted a lot of when i was growing up in the 60s

and 50's a good portion of chicano-american chinese-american lived in north beach a nob hill community. >> as part the immigrant family is some of the recreation centers are making people have the ability to get together and meet 0 other people if communities in the 60s a 70s and 80s and 90s saw a move to the richmond the sunset district and more recently out to the excelsior the avenue community as well as the ensuring u bayview so chinese family living all over the city and when he grape it was in this area. >> we're united. >> and growing up in the area that was a big part of the my leave you know playing basketball and mycy took band

lessons and grew up. >> (speaking foreign language.) >> allergies welcome to the community fair it kicks off three weeks of celebrations for the year and let's keep everybody safe and celebrate the biggest parade outside of china on february 11th go best wishes and congratulations and 3, 2, 1

happy enough is enough. >> i grew up volley ball education and in media professional contrary as an educator he work with all skids whether or not caucasian hispanic and i african-american cumber a lot of arrest binge kids my philosophy to work with all kids but being here and griping in the chinese community being a chinese-american is important going to american school during the day but went to chinese school that is community is important working with all the kids and having them exposed to all culture it is important to me. >> it is a mask evening. >> i'd like to thank you a you all to celebrate an installation of the days here in the asian art museum. >> one time has become so many

things in the past two centuries because of the different did i licks the immigration officer didn't understand it became no standard chinese marine or cantonese sproupgs it became so many different sounds this is convenient for the immigration officer this okay your family name so this tells the generations of immigrants where they come from and also many stories behind it too. >> and what a better way to celebrate the enough is enough nuru with the light nothing is more important at an the hope the energy we.

>> (speaking foreign language.) >> relative to the current administration it is, it is touching very worrisome for our immigrant frames you know and some of the stability in the country and i know how this new president is doing you know immigration as well as immigrants (fireworks) later than you think new year the largest holiday no asia and china those of us when my grandparents came over in the

19 hundreds and celebrated in the united states chinese nuru is traditional with a lot of meani meaning. >> good afternoon my name is carmen chu assessor-recorder i want to wish everything a happy new year thank you for joining us i want to say. >> (speaking foreign language.) >> (speaking foreign language.) >> i'm proud to be a native san franciscan i grew up in the chinatown, north beach community port commission important to

come back and work with those that live in the community that i grew up in and that that very, very important to give back to continue to work with the community and hope e help those who may not be as capable in under serving come back and give shop and dine on the 49 promotes local businesses and challenges residents to do shopping and dining within the 49 square miles of san francisco by supporting local services within neighborhood. we help san francisco remain unique, successful and vibrant. where will you shop and dine in the 49? san francisco owes the charm to the unique character of the neighborhood comer hall district. each corridor has its own personality. our neighborhoods are the engine

of the city. >> you are putting money and support back to the community you live in and you are helping small businesses grow. >> it is more environmentally friendly. >> shopping local is very important. i have had relationships with my local growers for 30 years. by shopping here and supporting us locally, you are also supporting the growers of the flowers, they are fresh and they have a price point that is not imported. it is really good for everybody. >> shopping locally is crucial. without that support, small business can't survive, and if we lose small business, that

diversity goes away, and, you know, it would be a shame to see that become a thing of the past. >> it is important to dine and shop locally. it allows us to maintain traditions. it makes the neighborhood. >> i think san francisco should shop local as much as they can. the retail marketplace is changes. we are trying to have people on the floor who can talk to you and help you with products you are interested in buying, and help you with exploration to try things you have never had before. >> the fish business, you think it is a piece of fish and fisherman. there are a lot of people working in the fish business, between wholesalers and

fishermen and bait and tackle. at the retail end, we about a lot of people and it is good for everybody. >> shopping and dining locally is so important to the community because it brings a tighter fabric to the community and allows the business owners to thrive in the community. we see more small businesses going away. we need to shop locally to keep the small business alive in san francisco. >> shop and dine in the 49 is a cool initiative. you can see the banners in the streets around town. it is great. anything that can showcase and legitimize small businesses is a wonderful thing.

>> the commission meeting of the san francisco entertainment commission. my name is ben bleiman and i'm the president. there are speaker forms to fill out on the tables and you can hand them to staff or you can come up to the microphone when i call for public comment. we ask that everybody turns off their cell phones including commissioners and staff. i want to thank sf gov tv for sharing this meeting with the public. we can start with a roll call. [roll call] >> the first orer of business is general public comment for any item not listed on the agenda today.