>> good afternoon welcome to the land use transportation committee for january 27, 2020. i am the chair of the committee,

aaron peskin. i am joined by vice chair safai see and dean preston. our clerk is erica major. do you have any announcements? >> please make sure to silence cell phones and electronic devices. speaker cards should be submitted to the clerk. items today will be on the february 4 agenda unless otherwise stated. >> could you please call the first item. >> item 1. ordinance amending the planning code to allow authorization of a limited restaurant use in the jackson square special use district that does not comply with the current requirements of a limited restaurant use if a building permit application

furthering the establishment of such use was filed by january 19, 2018. >> this is a piece of legislation trailing that adopted a year ago that we introduced at the request of the jackson square association. for those who do not know it, jackson square historic district is the city's first historic district, geographically small but rich in history, and over the years through fine tuning of the ground floor retail controls for this area including the jackson square special use district, it has been able to maintain a vibrant mix of art galleries, antique stores, design studios, unique restaurants and bars and retail

establishments along the alley network. the legislation before us today would allow for a blue bottle coffee store to open at 909 montgomery street on the northwest corner of montgomery and pacific. they submitted applications in july 2018 before the board approved the modifications to the special use district. the cafe has been sitting there ready to open. i want to thank the planning staff and planning commission for their graciously waiving authority to hear this item, which reduced the period of time that we otherwise would have experienced and will minimize any additional delays and we have since met with blue bottle. we are pleased to hear they are using this to pilot a zero waste

business model. representatives are here to speak to that in a little bit. i want be to also acknowledge the reuse coalition. i think miriam might be here and planning staff, ms. maloney, if you have any questions. with that i open it up to public comment. any members of the public or from blue bottle who would like to comment on item 1? if you do this is your moment. if you don't, all right. going once, come on up, sir. >> i am the c.e.o. of blue bottle. we are going to use this location as ground to test conversing use of the disposable cup with a reusable cup. first time done in san francisco by blue bottle, and we announced this at the end of 2019.

it has already had global amount of bless. it is inspiring people not only in the coffee industry but google and sweet green and whole food service and starbucks changes. a lot of eyes will be on this test. we are thrilled how supportive you are behind the initiative in san francisco. we want to do it at this location. >> thank you very much. any other members of the public to testify on item one? seeing none, we will close public comment. if there are no questions, can we send this to the full board with recommendation as a committee report? seeing my colleagues heads nodding up and down, that will be the order. please read the next item. >> 2. ordinance amending the health code to authorize the director to allow existing medical

cannabis dispensary to operate provided he has been verified as an equity applicant. they have complied with all requirements of article 33 of the health code. >> we had a long hearing on in two weeks ago. the city attorney advised because some of the changes were substantive that we needed to continue it to today before we could send it to the full board. i know that honey is here from supervisor haney's office if you have any questions. if not any members of the public who would like to testify on this item number 2? >> good afternoon, supervisors. i am terry finch.

i represent a medical cannabis dispensary 1944 ocean cooperative. we are opposed to the ordinance in the current form would suggest an amendment. my client empathizes with the dispensaries that suffered landlord abuse. when his landlord decided to break into the dispensary and put him on the street, when he had an existing lease and would not pay the same represent as other dispensaries that were willing to pay more. there was a lease in place the perspective tenant was willing to pay more money than he was. the ordinance as currently written fails to protect against those landlords who participate in this behavior. it only focuses on the location from which the permittee is moving because of the landlord's behavior. we propose an amendment to the

proposed ordinance to disallow portability to the mcd use location where the location is the subject of a wrongfully vacation or forcible detainer judgment. my client has personally beenen broiled in litigation over his location for two years. he has spent nearly $100,000 in attorney's fees currently in his location. we believe that this -- he is currently tried that case before judge and the ruling should occur within the next six weeks. we believe the ordinance as proposed will allow the current landlord to circumvent the relief requested in that particular litigation currently and allow that landlord to sell the particular property. because of that we would

request. >> than thank you. have you discussed this with the office of the sponsor or is this new information to everybody? >> we have discussed it with -- we tried to discuss with the aides of your offers. we reached out to honey mahoney but have been unable to talk to her about it. i left a message last week and several weeks ago. we have not connected. we intend to talk to herb about this -- her about this after the hearing, if possible. >> next speaker, please. >> i am sue. i was wrongfully evicted by the landlord. i am the mcd holder at 1944 ocean.

i operate a small businesses. the goal is to provide the protection of small business for the legislation. it should be considered potential abuse. equity mcd has been abused by landlords. i would like to voice to the supervisors how we could prevent the abuse. thank you. >> thank you for your testimony. next speaker, please. >> good afternoon. i am aaron. we own 1940 ocean avenue. according to the department of health there are two available

mcd locations at 1545 and 1944 ocean. i am also an equity applicant in the process of applying for the retail cannabis space at 1940. my retail application will be blocked by whoever decides to move into the vacant mcd at 1944. my family's location is 1940 it is within the 600 feet. my location will be blocked. i believe this comes down to equity applicant versus applicant. the town of the little guys fighting for the same right to operate in san francisco. i request the legislation is amended so an equity grandfathered mcd cannot move into an equity applicant in the process of applying within

600 feet of that available location. if this passes it would disenfranchise me from operating a business in a building owned by my family my father left it to his children and grandchildren. my family has been small business owners since 1937. my father saved to buy this building at 1940 ocean. this gives my family one shot to continue the legacy of mall business owners. my father passed in october 2019. his wife suffering from alzheimer's has 24 hour care. i can empathies with heidi. my family was forced to move from two separate locations. i would like to reinstate i am an equity applicant. >> next speaker.

>> good afternoon. you guys have heard numerous testimony over the last time we were here, and there is a clear issue what this is about. it is about keeping an equity business that has been in business over 15 years to continue their business. this is not about some lawsuit from previous owners, not about future equity applicants. this is about an owner and 20 employees already displaced. they have already suffered. i ask you guys to spend month more time hearing any more amendments or anything about this matter and move this to the full board. people are waiting to get jobs back the owner of the establishment is still suffering. please move this forward. thank you. >> next speaker, please. >> good afternoon.

thank you again. this is me just asking you as a operator, owner-operator for the past 15 years, we were made to close doors on december 15th. i don't think you realize the first person that spoke, the attorney, his client has an operation. his situation with that location was awful, it sounds like. they are now up and running. unfortunately, we had nothing to do with that. we have been working on this legislation now for almost 11 months. hoping that we would be able to be allowed to get our people back up and running. me as an equity applicant back up and running. yes, this is a town about equity. this is a town about opportunity, and as a native of san francisco i ask you to

please allow this to happen so my people can get back on their jobs. thank you. >> thank you. any other members of the public who would like to testify? seeing none. we close public comment. maybe we can hear from honey mahogany. there may be a misconception that this legislation which is pretty narrowly tailored would have any impact whatsoever on the -- what i don't fully understand the ins and outs of legislation -- i don't think that if it were amended per the attorney's request would apply. >> i am not clear that it would apply. we made arrangements to set up a meeting to talk about this. they have evidence they would like to show us. the intention was to allow a

limited portability to make sure someone on the original application was able to move if they were displaced from the current location to another previously designated as a cannabis ready location. to the best of my knowledge, the amendment they are asking for would not impact this case because again the landlord is potentially selling thing. the building. i don't know that this would have an impact on this. >> legislation as you saw we tacked on something to a piece of legislation we did a year ago. we did it in record short time. because this is an evolving area of law, why don't the folks from ocean meet with the sponsor's office. it is an intriguing idea. we have a long proud history of

not rewarding bad actors in residential evictions. there may be some crossover there to that kind of behavior in commercial situations. it is worth exploring. i urge you all to meet with supervisor haney and his staff and if it makes sense we can entertain amendments. i don't want to get in the way of the current case we are trying to solve but let's have that conversation. i am happy to participate as chair of the land use community. >> this is a stopgap measure for type 30 permits. they there transition to 16 so soon. it may be better served to apply an amendment there. >> good point. that is why we should have these conversations. if there is no objection we will take the legislation as is, send

it to the full board with recommendation, and we will do that without objection. honey, if you want to involve me now that supervisor haney is not a quorum of the committee i can talk to you. >> item 3 an ordinance to abolish the north of market affordable housing fund and have certain fees collected in conjunction with north market affordable housing deposited in the city-wide affordable housing fund. >> ms. chan. the mayor's office of housing. the one question i have because this is before us three times. you guys request a ti a continu. we are going to get this done. i understand the amendment you

are seeking changed -- i thought the fee was indexed way up. now you are asking for it to stay where it was. that is the one big question i have. with that i will turn ittofer to you. >> thank you. mayor's office of housing and community development. we originally brought this to the committee to allow mayor's office of housing to deposit fees from the north of market fees into the city affordable housing fund ana and the plannig commission recommended the fee get in decked since it -- indexed since it has not been done since created. there is one fee forthcoming. because we did not actually make the amendment in committee last time we were here, the legislation was sent back.

since then the planning department has gotten clarification that they are able to index. they have existing authorization to index the fee starting in 2011. the planning department can speak to that directly. we have spoken to supervisor haney's office and understand this approach of indexing the fee from 2011 is a reasonable approach, and that is why we are seeking to change the legislation back to the initial $5 per square feet fee amount. planning will automatically apply to indexing from 2011 forward. my colleague is here from planning if you have questions how they have that existing authority and are able to do that. >> is it meroln.

>> ne? >> are there any members of the public who would like to speak on this item. >> thank you. i brought this matter -- it came to my attention after it went to the planning commission. the agenda did not discuss increasing the fee 250% which is what the recommendation was. i represent two project sponsors. now, i represent one in the special use district. we have been in discussions with supervisor haney. this would increase the fee. this fee was originated in 1985 before there was an incollisionnary housing or program with market rate housing. as you know, since then we have

inclusionary ordinance that has increased the burgeon and obligation and the housing fund. in the special use district the inclusionnary is 25%, highest in the city. the project at 550 farrell street will have 25% inclusion air rehousing. it was not practical to pay a fiof $25 per square foot on the building. it doesn't work with the numbers. just a little background on the project. 111 units replacing a private parking garage with a 13 story residential tower. it will pay the child care fee, transportation sustainability fee, north of market fee, school fee, altogether with what ms. chanproposed the fee is

$1.8 million. that is a lot. the project sponsor thinks they can handle that with the increase. taking that fee several hundred thousands would endanger the feasibility of the project that is the reason we brought this matter to supervisor haney. >> thank you. any other members of the public to testify on this item? seeing none, public comment is closed. i believe what was actually amended in the board back in july is precisely what is in the packet so we don't need to take any additional amendments. that has the $5 and change in the long title. as staff discussed, that would be indexed by planning to 792.

anything to add? >> we talked to the deputy city attorney and we believe we had to make amendments today to go back to the $5 per square feet and provided the actual red line to chair peskin for the amendments. >> i think the red line is what is in the packet and has been publicly noticed. am i correct? >> that's right. the packet reflects the reduction from a 25 fee to $5 fee. >> that will be indexed by staff to 792. >> any questions or comments from colleagues? seeing none, can we send this to the full board with recommendation without objection? that will be the order. madam clerk please read the next item. item 4. ordinance amending the plumbing code to delete the local amendment to the california

plumbing code referring to the san francisco public utility commission's rules and regulations in the section on cross connection control and to add local cross connection controls for beverage dispenserses and a testing requirement for back flow prevention and assemblies or devices and affirming the findings. >> we had to continue this because the amendments were substantive. they have been discussed. any members of the public to testify on this item? seeing none, we will close public comment. without objection finally get this off our plate as they are finally getting -- finally getting along. this will be sent without objection. you do need a red line of the

previous item and you would like us to resined the vote. can we go back to item three? i will make a motion to c resined the vote and make the amended in the red line i have given to the two of you and send that item as amended to the full board with recommends without objection. now, madam clerk could you read the fifth and final item? >> eye team 5 ordinance amending the planning code to enable the use of development project sites during the project approval and entitlement process by authorizing the planning department to authorize certain interim activities at development project sites as temporary uses for up to 36

months, subject to extension at the discretion of the planning director. >> we are finally all on the same page as to this interim activity legislation which has been thoroughly discussed by this body. we dealt with 36 months to the 24 months and definitions what is eligible and interim activity. it is all discussed and all before us with a handful of amendments which we will speak to and hopefully we can get this to the full board today. ms. malone, the floor is yours. >> this was last heard on december 16th. before that the planning commission heard the item on april 25th. this has been amended quite a bit since the commission saw it one amendment was the intention

to make today is to take a requested modification from the commission which is to amend the requirement to increase residential density to instead only require an increase in residential density if there was existing residential on the site. i am happy to answer any questions. i will keep that presentation short. >> that is correct. that is oat out on page 6 -- set out on page 6 at line 11 to line 14. are there any questions? supervisor preston, the floor is yours. >> thank you. apologies. i have not been along for the whole ride of this item. i had a couple of clarifying questions. does this apply just for private development sites or public sites as well? >> this applies to all sites

across the city. >> in the same breath there are different things that apply to different sites in different parts of the city permitted use or in certain cases in an area bounded by division and market and whatever applies to other things. it depends on where you are. >> it depends also on the project application. that is the largest. there must be an application to what we call tantamount to demolition or demolish the existing structure. there has to be a structure. it has to be enclosed. that structure needs to be proposed to become a development of something else, the full demolition tantamount the

temporary use would go inside of the original structure proposed for demolition. >> does this -- i am wondering if this shifts decision making. thinking my district at 7:30 stanon there was an r.f.p. around the use. they were responsible for vetting those. some of those i could see applying here involved uses that may be at issue here. does this move decision making around those uses from the department over to the planning? >> i would say no. i think the big clarification is that this is a planning department permit that needs to have authorization of the property owner in order to be applied for so in the case where you have the property that is

owned they are applying in the first place. the decision to apply rests with whoever the owner is. >> last question. so i notice in the earlier iterations the homeless shelters were amended out. i am trying to understand if this advantages things other than home less shelter or if there are parallel provisions elsewhere putting homeless shelters on equal footing as interim use. >> i am not aware of the legislation that balances that to take the homeless shelter out. i believe they were taken out after the commission. we recommended that a much larger amount of land uses be allowed in these sites. i may be wrong. i believe homeless shelter was one of those. i would pose that question to

the land use committee. >> you want to add to something? >> i believe that the ordinance allows temporary use if it is principally permitted. homeless shelters are permitted where group housing is permitted. pretty much the whole city except rh-1 and 2. i don't think this applies to those. >> on 18 and 19 it does, any use principally permitted. >> thank you. >> you are welcome. >> i have been advised by council this happens from time to time that in so far as the legislation that is in our packet and before the public does not have the amendment that we just discussed which really takes us from a residential only

to much broader universe that when we actually accept those amendments which i think we will do it is going to require a one week continuance because that amendment will broaden the legislation. that is what ms. pearson advised me. i want to put that on the record. are there members of the public who would like to testify on this item? seeing none, public comment is closed. >> i make a motion to accept the amendments as proposed. >> we will accept and continue as amended for one week. you don't need to come next week. with that, the item will be continued and we are adjourned.

>> we can sweep by in front of a house in a matter of seconds. the only people who don't like it are the people who get the tickets. >> this is a street sweeping sign. don't let it get you. pay attention. [♪] >> in the morning, when we first go out, we start at six in the morning or seven in the morning. we call that our business run. we sweep all the main arteries of the city. after 8:00, we go into the residential areas and take care

of all the other customers. >> the idea with the street sweeping program is to get the leaves and the debris off the ground. >> we -- for not only appearance and cleanliness but safety as well. >> we will get anywhere from 2- 7,000 pounds per truck depending on the season and the route. the street sweeper and the choice of the use right now is an error sweeper. they have a motor in the back and it blows winds down one side and carried by air into the hopper. what will mess this up is new -- large pieces of cardboard or sticks or coat hangers. anything that is more than 12 inches. the tube on the tracks is only 12-inch diameter. >> people asked what they can do to help to keep the city clean.

there are people that letter. leaves are one thing. any of the garbage you see is from people being careless. [♪] >> one cars parked in the way, we can't sweep under the congress. to deal with this, we have parking control officers that are provided by m.t.a. and they go in front of our sweepers and pass out citations to people that are parking the wrong way. once the sweepers sweep past in san francisco, you may park behind the street sweeper. we all know parking is a big issue. north beach hasn't been swept since the eighties because of opposition. but we are getting a lot of requests to sweep. basically our trucks are 10 feet wide. we stick the brooms out and they are may be 12 feet wide. >> there are a lot of blind

spots when driving a large truck pedestrians and bicyclists and cars. and navigates this 22,000-pound truck through the city. >> we involve the public here -- to adhere to traffic laws. these routes were developed back in the eighties around the capability of the sweeper. things have changed since then so we have to adapt. luckily, public works is embracing technology and working on a system to alter our maps. this is literally cut and paste -- cut and paste. we will have a computer program soon that will be able to alter the maps and be updated instantly. we will have tablets in the checks for all of the maps. we will send a broom wherever it needs to go and he has the information he needs to complete the safety. what is needed about these tablets as they will have a g.p.s. on it so we know where they're at. you do get confused driving along, especially the inner

sunset. recall that to the be made a triangle. >> thanks for writing along with us today. i enjoyed showing you what we do and i urge you to pay attention to the signs and move your car and don't litter. with all i'm nicole and lindsey, i like the fresh air. when we sign up, it's always so gratifying. we want to be here. so i'm very excite ied to be here today. >> your volunteerism is appreciated most definitely.

>> last year we were able to do 6,000 hours volunteering. without that we can't survive. volunteering is really important because we can't do this. it's important to understand and a concept of learning how to take care of this park. we have almost a 160 acres in the district 10 area. >> it's fun to come out here. >> we have a park. it's better to take some of the stuff off the fences so people can look at the park.

>> the street, every time, our friends. >> i think everybody should give back. we are very fortunate. we are successful with the company and it's time to give back. it's a great place for us. the weather is nice. no rain. beautiful san francisco. >> it's a great way to be able to have fun and give back and walk away with a great feeling. for more opportunities we have volunteering every single day of the week. get in touch with the parks and recreation center so come

>> when i open up the paper every day, i'm just amazed at how many different environmental issues keep popping up. when i think about what planet i want to leave for my children and other generations, i think about what kind of contribution i can make on a personal level to the environment. >> it was really easy to sign up for the program. i just went online to cleanpowersf.org, i signed up and then started getting pieces in the mail letting me know i was going switch over and poof it happened. now when i want to pay my bill, i go to pg&e and i don't see any difference in paying now. if you're a family on the budget, if you sign up for the regular green program, it's not going to change your bill at all. you can sign up online or call.

you'll have the peace of mind knowing you're doing your part in your household to help the environment. >> good morning. the meeting will come to order. welcome to the january 23, 2020 regular meeting of the public safety and neighborhood service's committee. i'm supervisor mand elman. i want to thank st sfgtv for staffing this meeting. >> mr. clerk. >> please make sure you've silenced your cell phones and iteming acted upon today will appear on february 4, 2020 board of agenda unless otherwise

stated. >> please call our first item. >> number one is a hearing to consider that the transfer of general public premises' liquor license to the lion's den ventures doing business as lion's den at 51 wentworth place will serve the public of the county. >> we'll hear from the alu first. >> yep. >> good morning pup have a port for lion's den ventures applying for anti-58 license and if approved this would allow to have cater privileges. no letters of protest. there are 11 letters of support and located in plot 140, which is a high crime area and high saturation and central station has no opposition. unit recommends approval with the following conditions.

number one, the petitioner shall be responsible for maintaining free litter adjacent to the area they have control and number two, a petitioner shall actively monitor the area under their control never to present loitering and no noise audible at any nearby residence or consideration point. it should be noted on january 16th, the applicant had agreed to the above listed conditions. >> thank you. now we can hear from the applicants. >> good morning. i'm rick warren, counsel for lion's den ventures. i have manager members of llc. what you see before you is the product of a lot of pre preparan work, meeting with residents in

the neighborhood to solicit their support and mainly to solicit their ideas of what we can do to make this is thriving enterprise which will be a benefit to them. there's been no opposition throughout the process and so with that, i'll let my comments cease and say that the members are here to answer my questions you may have. >> i don't see any comments or questions from colleagues, so unless you would like to say anything else, we'll go to public comment. are there any members of the public who would like to speak on this item? seeing none, public comment is closed. colleagues, this has been a committee report to the meeting on the 28th and so i will move that we forward this with positive recommendation as a committee report to the full

board. >> and this would be a resolution that determines -- >> yes. before we do that, we will ask the clerk to prepare a resolution finding that this granting of the license will meet public convenience and necessity and then we will forward that resolution as a committee -- i will move we forward that resolution as a committee report to the full board for january 28th. can we take that without objection? great. thank you, mr. clerk. just keeping the chair on track. please call the next item. >> agenda item number 2 is a hearing to consider that the premise to premise transfer of type 48 on-sale general premiseses liquor license to destination bars and doing business at the lark bar at 65 market suite a serving the public for the city and county. >> we can call this with item 3, as well, right. so let's go both.

>> item two and three is also a hearing for a type 21 off-sale, general wine and beer sale and the issuance of type 86 instructional tasting license to future beverage corporations located at 685 market street, suite b, serving for the necessity of city and county. >> good morning, supervisors. officer mackey here. before you have a peace-enreport for the lark, i'll go over that. they have a type 48 license and if approved this would allow on sale beer, wine and spirits. there are zero letterings of lef protest and 22 letters of support. they are in high crime and census track 15 which is a high saturation area and the southern station has no opposition to the license and aou approves with the following recommended conditions. petitioners shall actively monitor the area under their

control in an effort to prevent loitering adjacent to the licensed on 253 and no noise shall be audible at any nearby residences and should be noted they agreed and signed the above listed conditions on january 14, 2019. and now i will move on to the 21 and the 86. the other report in front of you is for cask, applying for 21 license and type 86 license. if approved this would allow them to sell off-sale wine and beer and tastings. there are zero letters of protest, five letters of support and located in plot 212, which is high crime, census track 515, high saturation and southern station has no opposition and alu approves with the following recommended conditions. sales and services of alcoholic beverages shall be permitted

between 8:00 a.m. and 11:00 p.m. each day of the week didn't a petitioner shall monitor the area for loitering and should be noted that the applicant has agreed to sign the above-listed conditions on january 13th, 2019. i'm sorry, 2020. >> great. i see no questions from my colleagues and so we will hear from the applicants. >> good morning, supervisors. i'm with destination bars and future beverage operating under the group called future bars. thank you for your service and your consistent support of small businesses like ours and there's a lot of development happening in this part of town and the reason for our move is due to the pending conversion of the historic hurst building to a

boutique hotel. we've worked out arrangements with the hurst location and we're proposing to move caskin from third and market to the corner of market at 685. we did extensive community outreach. we met with district 6 and we presented to the community benefit district and most importantly, we made contact with our neighbors directly across the street from market. the ritz carlton residences, and the general manager of that property. there have been no protests to the license transfer application and we would appreciate to have your support in relocating cask and lark to market street. thank you, supervisors. >> great, thank you. i don't see any comments or questions. are there any members the public who would like to speak on either items? seeing none, i will close public

comment. noit's my understanding supervir hainey is supportive of liquor license transfers and unless anyone has anything to say, i will request our clerk has a finding that these liquor transfers will meet the necessity and i will make a motion that we forward those resolutions to the full board with positive recommendation and we can take that without objection. mr. clerk, can you call our next item. >> item number 4 is a hearing to consider that the issuance of a type 57 special on-sale general beer, wine and liquor license to mgscllc doing business as shack15 will serve public convenience or necessity of the city and county. >> let's get our alu back up. >> so before you have a pcn

report and they have applied for a type 57 license and if approved, this will allow on-sale beer, wine and distilled spirits to members and guests. they have zero letters of protest, zero letters of support and they are located in plot 216, which is considered a high crime area. they are in track 105 considered a high saturation area. the central station with no opposition to the license and alu approves with the following recommended conditions. sale service and consumption of alcoholic beverages shall be permitted between the hours of 7:00 a.m. and 12:00 a.m. midnight each day of the week and petitioners shall actively monitor the area under control in an effort to prevent loitering of persons on any property adjacent to the license, premises on the most recently certified abc 253 and noted that the applicant has agreed to and signed above listed conditions on december 13th, 2019. >> thank you.

is a representative of the applicant here? >> good morning. i'm counsel for the applicant. as described in the pcn letter, this is a request for a finding of public convenience for a type 57 on-sale general license for a new social workspace, meeting space on the second floor of the ferry building. and it is going to be a space and a platform for entrepreneurs and community leaders, start-ups to meet, interact, exchange ideas and learn from each other and with that will be food and beverage component headed up by

the mena group that will involve service of food and alcoholic beverages and so, we are requesting the pcn finding for that alcohol beverage license. there is a representative of the mena group here and if the supervisors have any further questions about the operations beyond what's described in the letter, we would be happy to elaborate. >> i do not see any comments or questions. so we'll take public comment on this. >> thank you. >> any public comment on this item? seeing none, we will close public comment. this ferry building is in district 3, supervisor peskin

requested a continuance to give him and his office some time to meet with the applicant and to talk with the port and sounds like they may not have been fully up to speed on this project. and so i'm inclined to grant that request and we do have time within our 90 days to get this to the full board. so i'm going to move that we continue this to the february 13th meeting of the public safety and neighborhood service's committee and we will take that without objection. mr. clerk, we have been joined by supervisors safye and can you please call our next item? >> 5 on subacute care in san francisco and plans to care for this vulnerable population to prevent unnecessary deaths. >> thank you. supervisor safye, the floor is yours. >> thank you, chair.

i appreciate this. it seems like we've been talking about this since i've been on this board of supervisors. this is, to us, an extremely important topic. we recently, i think about two and a half months ago, asked and tasked to the public of public health to come and present on subacute beds and we're talking about subacute care in san francisco. when w this was first brought to our attention, the remaining subacute beds in san francisco were slated to be shut down. and when i say shut down, i mean, we would have had subacute care in the city and county of san francisco. many of the activists and patients and family advocates came together along with some of the labouthe labor unions and te

folks, some of which are here today, worked with us and board of supervisors and we were able to compel cpmc to keep the remaining subacute care beds. they shut down the existing facility that was offering this care at st. luke's hospital and shifted it over to davies. in this process we've learned -- and i'll reiterate -- many of the families are indigent, have had to travel significant time to see their loved ones even within in the city and county of san francisco and sending them out of county seemed inhu inhume and un-indigenous. we asked tunjust.we asked to cre process. in the process, we have identified some partners that are willing to work with us, chinese hospital. we've been having that

conversation for some time and we feel as though we could potentially have a really strong fit there and we were asked recently by some of the patients and patient advocates to come down and visit the remaining patients at davies campus and i think everyone of us here visited those families and saw firsthand the care that they were getting and the need to ensure the care was consistent and we would keep this in the county and city of san francisco. unless any of my colleagues want to say anything else on this matter, i would like to bring forward the department of public health to give us a presentation on the plan they've put together and see how much progress we've made to ensure that we have the requisite number of subacute care beds in the city. i will say we've started at 60 and looked at other counties in the bay area and every county in the bay area has subacute care,

whether in hospital or in residence, in the community, they do have that care and i believe all of my colleagues agree it would be a major oversight to not have this care in the city and county of san francisco. so i'm hoping that we can hear some strong progress today and we can move forward with having a minimum. i think the target minimum would be somewhere around 80 to 90 beds in the county of san francisco at a minimum. thank you, chair. >> thank you, supervisor. supervisor walton. >> thank you so much, chair, and thank you, supervisor safye, for bringing this before us. i did say as someone who had an opportunity to visit the davies' campus i was definitely appalled at the conversation i had with the leadership of cpmc and feel

it is my opinion that their focus is to do everything they kcan to shut down this facility and stop providin start providie care. i want to talk about what we can do to work with other providers to keep this facility open to have a facility for subacute care base in san francisco. and i could tell from my conversation with the leadership that they were really focused on doing everything they could in their power to shut this facility down and stop providing subacute care, which is disheartening. we have families who have to go as far as fresno, southern california, to see loved ones. i know that some of the level of service that they had and even when the promise was made for the new hospital and they would keep the facility open, some of the same services they provided have now been reduced and in

some cases have been cut and so, i appreciate supervisor safye bringing this hearing and i appreciate your candor, but the reality of it is, i think that we need to the push to keep these beds open for the long-term and come up with a plan and a strategy to do that, working with all of our providers. it was also apparent to me that a lot of blame was coming from the cpmc in terms of the city could do this or keiser could do this and while i appreciate you have a subacute facility, this is something i would rather the narrative would be we work together to continue to provide the care. so i'm looking forward to hearing what conversations have taken place, what has happened because this is the important care for our patients and we should be doing everything we can to keep these remaining beds rather than trying to point

blame or denying service and trying to push it on other parties. so thanks again and i'm looking forward to hearing where we are so far. >> thank you, supervisor walton, through the chair. so not to relive some of this, but i think it's important to say it for the record, we would not have any subacute care in the city right now if we had not forced the conversation. and in the beginning, cpmc was not willing to keep the subacute care and through, essentially, public shaming -- because these are live bodies and these are real patients that are in these beds. and the idea that you would ask someone to move out of the city is just inhumane. it's just absolutely inhumane. so they stepped up and moved the patients to davies, but as supervisor walton has said, there has not been any commitment made to keep and retain those beds.

so we asked, and that was part of the task for dph and kelly heramoto, to come up with a plan because we asked hospital counsel to step forward. we want all of the partners. this is not just the cpmc problem. it's a city and county of san francisco problem. so all of the problems that are a part of the hospital have been asked to step forward. i know that we have some other types of acute care being offered at st. mary's hospital. it's a different type working to open up those beds and so we are making progress with partners, but i think to supervisor walton's point, this is a solution that needs to have many different actors participating in it. so without further conversation, i'm going to ask miss heramoto

to come up, once she gets her bearings. i know she was working hard to find parking, so we'll get you a minute to get yourself a story. >> together. >> sanfrancisco story. >> but we will ask her to present and some of the conversation is resolved around what partners can step up but i want to state for the record the idea that this is a crisis and that we need a full scale solution because the idea of asking people to leave the city and county to receive this care, i think in our city, is not acceptable. >> thank you, supervisor, and thank you for your leadership on this issue. we're going to give miss heramoto a minute to get her presentation set up.

>> thank you for giving me minute to get organized. i'm the project's director at the department of public health. i'm here to give an update on the project we've been working on. so today we're here to talk about this presentation and just to give you a current state of

affairs and we've been doing work in between the last time we saw you. our project objective is to ensure that we have adequate and subacute beds in sanfrancisco. just a reminder, these are the partner agencies we've been working with. the hospital and the health systems, all of the hospitals in san francisco, kaiser, st. mary's and vibra-health, a long-term acute care facility and california pacific medical center and ucsf and zuckerburg sfgh. we've been talking this round to freestanding skilled nursing facility operators. right now the operators in the city are san francisco healthcare, aspen skilled healthcare, which operates a few

facilities here in the city. province group also operates a a few free-standing in the city and generation's healthcare. we have been working with the milemen group to be discussing opportunities. we have been engaging with various potential hospital partners, chinese hospital is the one hospital that currently has vacancy and space that could accommodate to subacute. they have a 23-bed unit that is currently available and could be converted to this use. and right now, we worked with vibra to do a proforma for a cost of operating a unit if those 23 beds were to be converted to subacute. there would be a bit of a shortfall in terms of revenue generation because of the cost

reimbursement structure because medicare and medicale, between 350 and 370 a day depending on modeling. chinese hospital is willing to bring a proposal to the board to activate the 23 beds in the subacute, so these good news and it would still need to be reviewed by california department of public health to resolve the kitchen support issues. right now the kitchen that is at the hospital is not large enough to serve the 23 beds there are ways that can be addressed and if the board approves the plan to continue this discussion, we'll be working with chinese and other partners to meet that need so that we can take that forward. >> so when is that board hearing going to be? because we've been talking about the kitchen at chinese hospital for some time. so i'm glad to hear that it's going to be presented to their

board. >> yes. >> so when is that happen. >> there's a meeting next week. >> so once that happens, if they say yes, you just reiterate? >> the two things that need to happen is chinese hospital is trying to determine if they want to operate that unit themselves or contract that service out to a provider. >> one of the providers you listed? >> exactly, one of the community providers and that would be -- >> any of the four on the previous slide. >> except for province group. aspen, generation's healthcare. >> correct. >> we approached vibra healthcare and their preference was not to but there was one at st. mary's. >> they're not on the list. >> not on the list of freestanding but on the list of providers we spoke to. they're the top half.

>> got it. >> so they operate the long-term acute care. but we're confident we'll find a partner if chinese hospital would like to work with a provider to come in. >> they do want to do that or you don't know yet? >> we don't know if vibra will but we know generations and aspe in san francisco healthcare indicated a willingness to rent a unit if that became a possibility. >> my question is -- >> we don't know. that's the piece we don't know. the board meeting is next week and we've invited chinese hospital to answer any questions that you might have about the process for them going forward. >> we'll bring them up in a moment. >> and the gap there is about three and a half to $4 million a year, it sounds like? >> yes. so i did conduct interviews with the freestanding facilities

which we referenced and they are interested in partnering right now. san francisco healthcare and rehab is actually in the process of converting some of their skilled nursing beds to subacutes and so they're already in the process of creating subacute beds. the other freestanding ones are interested in partnering with the city and as i mentioned three of the four are interested in serving as an operator at a distinct part subacute in the hospital, chinese, the set for province. and san francisco healthcare and rehab has 38 beds they're planning on converting and they're phasing in the conversions. right now they have five to eight in the process of being converted. >> can you slow down a little bit? i'm sorry. say that last part again.

>> san francisco healthcare and rehabilitation. >> got it. >> is in the process of converting some of their skilled nursing facility beds to the smith subacute. >> and those are in community? >> in community, yes. they're building is on grove street. and so, right now, they have about the first set of beds is five to eight beds that are already in the process of being converted. >> oh, ok. >> with the ability to make as many as 38, so their plan is to make that unit, that wing to be smith subacute. >> and where is that? >> on drove. grove.i want to say 1177 grove. >> have they made a firm commitment, then, to get up to 38 subacute? >> i think they're waiting to hear on need, but the plan is that they would convert to 38. and so we've communicated to

them that we support the plan. >> how many beds do they have? more than 38? >> it's a big facility. >> please go on. that's a whole other conversation. >> yes. >> so really, just our next step is that we'll be working with developing the acute unit at chinese hospital. the next steps to determine the staffing model and cost estimate based on whether they'll do it as a self-operating unit or whether they'll contract that service out. we're discussing potential partnerships to discuss the operating costs and right now, dph communicated with all of the community hospital partners and all of them, except for dignity, have responded they're interested in participating in

some manner to support operation of the acute unit at chinese hospital. there are too many inknownunknot the dph fields to make a commitment. >> can we talk about that for a minute through the chair? that's potential partnerships with other hospitals, subacute demand and unit operating costs. >> yes. >> other than dignity, who has committed to doing that and what does that commitment mean? >> so kaiser, ucsf, sutte and zuckerburg sfgh, have all committed that they will support the unit's operation's officially either by doing a bed purchase. >> i don't know what ha means t.

>> the shortfall to run the cost of reimbursement is less than you would get back. >> the 310 a day. >> exactly. >> that adds up to a shortfall of 3 to 4 million annually? >> correct. >> these four hospitals, including our own public hospital? >> correct. >> is willing to contribute monetary to help cover the shortfall. >> correct. >> and do we know what level of commitment or we're still in conversations. >> we're still in conversation because we haven't been able to determine whether it's going to be a self-administered unit or a contracted unit that impacts the daily cost. >> first they have to agree. >> right. so once we know what model will go forward at chinese hospital and presuming there's a model to go forward at chinese hospital, it will allow us to cost

estimate to go back to the partnered hospitals to offer them opportunity to either do sort of a lump sum support, so to help with subsidizing the cost of the unit operations versus buying per bed. >> so are they going to equally contribute? >> that's something that needs to be worked out in the next phase. >> well, i would hope, since you've included public hospital, that our contribution would be less than the private hospitals so that we're reducing the costs on the public dime. given the fact that this was service that was provided on the private hospital delivery system, so we don't want to shift that burden completely over to public. >> understood. >> and then, the second question is, of the 38 subacute at san francisco healthcare

rehabilitation on grove, is there monetary shortfall that these same groups of commitment would need to help to cover the shortfall, as well? >> there's not at this time. san francisco healthcare had a mission to provide this service and so, began this journey separate from conversations. so actually the plan to do this was before we reached out to them. so they had already intended to create those beds, knowing the financial structure. >> because that's not in hospital, right, so there's a conversation and i'm sure we'll have from the patient advocates today, what, other than financial support do the hospitals provide? i mean, i'm assuming they have the same level of nursing care, but what's the difference in care delivery in community versus in-hospital?

>> the major difference is just if there's a crisis, care crisis, a free-standing facility has to have the means to do a medical transport from their location to the hospital in a distinct part because you're in the body of the hospital moving somebody to crisis care is more straightforward. >> do they have that capacity? i'll look it up on the map? i don't know where that is. >> we've talked about what service supports to help provide them it's possible and the conversation is preliminary. at this time, they feel like they have met the obligations to care for the clients adequately.

>> because we keep talking about the kitchen, are they self funding the upgrades, their grants or state's support. what has to happen to make that functional? >> so to make the food service work for california department of public health expectation, there has to be a means to show that there is a way to provide food service to that unit, plus

emergency food service if the systems were to go down that you can ensure the food would still be provided. having an outside entity and it means there are other means of showing that the food service needs are being met through delivery or through other off-site preparation and then bringing the food on site. >> so all that being said, what's the cost barrier to get this? >> so it will depend on whether chinese is planning to do it themselves and can broker deals to arrange for the food delivery service in a more economic cal manner versus a contractor making that same arraignmen arr. it's one of the unknowns factoring into the cost of care that will ultimately impact the potential shortfall. >> through the chair, can we call up the ceo from chinese hospital? and miss heramoto --

>> do you want to do that before? >> if you have additional questions, that's fine. >> thank you, chair and through the chair, i just wanted to get clear because we're talking about subacute care bed capacity and i'm wondering if we are actually looking at what the demand is. we're a city of under 9,000 people and we know that zero is not acceptable. i want to davies to see the patients and the families and we know that this is care we must provide in the city. so before we're looking at capacity and where we can get beds, are we determining what the demand is and how many beds we actually need? and then, are we tracking when san francisco residents have to be transferred out of county to actually receive this care, which, of course, will then help us understand the demand so that we can serve san francisco with subacute beds here in our city? >> yes. the report that we gave last time was our report out of what

our initial interviews with the hospitals around their current discharge patterns for the subacute patients and that number landed from a range of about 49 to potentially 90. at that time, we indicate ed this was a bit of an undercount because many people went to destinations other than the subacute because for various reasons one of them being there are no subacute destinations in the city and it's potential that some of the patients may have gone to the subacute had it existed. we know that our starting number that we're aiming for is a minimum of 49. in 2018, the discharge count was closer to 70 and that's where our range we're aiming for is filling beds somewhere in that range and we'll continue to monitor to see if more beds are available in the city, do we see there's trending there would be more candidates and then the city would be prepared to help

make sure we have more beds available. >> through the chair, i mean 49 does seem a bit low, and are we looking at possibly bringing those people back that we had to send out of county so that their families are closer to them and they're receiving care in the city? >> right. i think we'll have more accurate counts once we have bed destinations here in the city so that we can monitor. right now, the way that the hospitals collect the data, it's very hard to tease out sort of who was subacute specifically by these criteria, because that's not how hospitals are in the habit of tracking the data set. it was one of the things we learned trying to do the inquiry about exactly what number is it. so one of the things back to hospitals is that we're going to ask them to count this distinct population. >> thank you. >> mr. safaye. >> yes, thank you.

>> good morning. >> you want to say your name for the railroad. >> jen xang, ceo of chinese hospital. >> thank you, miss xanz. ng. to reiterate, you'll have the meeting with the board in the coming week. >> yes, tuesday. >> do you feel confident they'll approve that in. >> yes. assuming they were to approve that, do you have an idea which direction you all might be leaning in terms of doing it in hospital or contracting for service for the subacute? >> because of the kitchen issue, i know we've been talking about this for a long time. so we have several ways of thought on the kitchen issues. like kelly said what we would do, most likely, would be catering, would be the easier way to do. so, also, too, because we're working with cal mortgage under

our plan and there are a lot of initiatives we're doing. so it depends on how fast my team and kelly's team, really depends how fast we want these units to work. so we still working together to -- >> yeah. >> so we need to figure out which way would be the contracting part, like bringing in a third party to run the unit would be faster. >> ok, but in terms of the cost, you all will be able to assume that other than the daily operation? in terms of the costs of the kitchen. >> right. >> you'll be able to -- >> it will be in discuss. >> we won't be paying for the kitchen, for this matter. like it's a party, then most likely they'll be bringing it in. but our census is so low. we're licensed for 64 beds. >> in the whole hospital? >> right. >> we have the capacity to call

for the extra 23 be beds and we will work with the cdph licenses to see how they will let us do that. >> first you need the approval on tuesday and then you can start that secondary. >> yes. >> let me say why to underscore. i think there's around nine or ten patients that are still at davies and we started out with 60 beds at st. lukes and it's been atransition an attrition ay someone passes away, they reduce those beds. so we move e fast. i think the priority, at least for myself, would be that we have a significant number of in-hospital beds, as well.

we want that as an option. so my goal -- and we'll continue this conversation -- is to get a minimum of 90 beds city wide and we want a good portion of those to be in hospital. so the quicker we can move and work with you -- and we appreciate chinese hospital stepping forward and offering space. i think the history -- i think we have one individual in the room that was born in that hospital, president xi. it's such an important institution to our city and wonderful chinese hospital is stepping up and we appreciate that. president xi? >> good morning. so, yeah, thank you for stepping up and me realizing that this hospital is different from most of the hospitals in sanfrancisco

in the sense that i think the only one left that is a community-based hospital, nonprofit and actually much of the funds that is raised to support it is from the community donations. so the capacity to just quickly fix something is not really a big capacity. so my question is, the issue of a patient were there in subacute and needed more medical attention, chinese hospital, from my understanding, has limitations to that. it's certainly not as fully capable as general hospital, for instance. so how would you deal with that? >> so we have transfer agreements -- i mean, in we need to look into what medical needs they are, right?

and so we have existing agreements with all other hospitals like cpmc, trinity and ucsf. and so it depends on what the medical needs are and then we can transfer. >> thank you. >> thank you. i have no further questions. just we look forward to hearing the outcome of the vote on tuesday. i know you're working closely with miss heramoto and if you can just underscore, move as quickly as we can. >> absolutely. >> we would appreciate that. >> thank you. >> thank you. >> i think through the chair, i think we'll go to public comment. >> we will and i have some speaker cards so i'll call some names and if folks can line up on your right, our left. benson nadel, gloria simpson and teteresa palmer, ben kung, l

leah montono, kim tavvali and katie rose. we give you two minutes. we asked you state your first and last name clearly and speak into the microphone. if you have a written statement, you're encouraged to leave a copy with the clerk for file. no applause or booing is permitted and in the interest of time, speakers are encouraged to avoid repetition of previous statements. come on up. >> good morning, supervisors. excuse my cold. my name is benson nadell and i'm the director of the ombudsman office and we're tracking the

bordentaro issue. i just heard there's a scenario of subcontracting with community-based skilled nursing communities and that's not a good idea. if this will pass, we have to review all of public records of those nursing facilities.

facilities, we can look at hospitals over a long period of time in san francisco. we can look at how they discharge people back home to different levels. >> thank you. >> here is my handout. >> great, thanks. >> good luck to all of us. >> next speaker.

>> my name is teresa palmer and i'm a geriatrician and i wanted to reinforced about what was said about the quality of care in free-standing nursing home and the grove nursing home is especially problematic. when i was working or on-lock, we made an agreement to stop admitting patients there. there's sit understaffing and this is not far from my house. i went there everyday to make sure the patient was ok. and so i think you really need to look at the record of the nursing home. all free-standing nursing homes

have incredible incentive to understaff. my mother is what's considered one of the best nursing homes in the city and i just reported it to the state. i mean, it's just not a good situation. we need hospital-based for subacute care, which is really, really different from post acute rehab. the intensity of care is such that if you have to be hospitalized, you have to go straight to the icu and get there fast. and so i would encourage to look at beds of dignity, to look at other beds that are hospital-based. there may be some people who can do ok in a free-standing. we can't say no to someone who wants to open beds, but the quality of care has to be closely monitor. so basically, good studies show that elderly folks with multisystem illness, nou nour c

illness do better in based care. >> thank you. two minutes goes fast. >> miss palmer, one question. you underscored a point, but the idea of having in-hospital versus in-community. we should try to strike a stronger balance towards hospital care, in your opinion? >> yeah, because you have to go straight to icu. these people who have chosen to live, who are very fragile and if they need to go straight to icu. the skill level of nurses is greater than exists at free-standing sniffs which is already problematic. >> thank you. next speaker.

>> good morning. this is collin fang. i want to bring back that so many of us community allies, labor, people on the board were part of a fight to save st. lukes hospital and i'm bringing that up because we've within here repeatedly trying to hold cpmc accountable and supervisor safaye stood with us to save the subacute beds at st. lukes and here we are to serve the families in san francisco and i know you all visited the subacute unit and saw that countdown on the law where they were crossing people's names off, like they were a line item on the budget. just, you know, instead of people's lives here, it was just a cost that they were trying to whittle down. for us, it's great that chinese

hospital -- i really appreciate the work the dph and everybody is doing to get beds at chinese hospital, but honestly, we need to come back and we need permanent beds at cpmc where they have been served and where they can't buy out very cheaply their obligation to serve the people in this city. here we are battling bed by bed with them, patient by patient and we'll have that fight because these are people's lives. not that line item on a budget, right? and so we'll have that. but we need that permanent fix and it cpmc spent $2 billion building a campus could have that money to help serve the people of san francisco. thank you. >> thank you. next speaker. >> i want to say good morning but i don't know if this really what i should say. you know, i've been thinking, i

don't understand, really, how everything works in this city. we hav have these corporations h so much money and they still can't get out of the can get out of responsibility so so easy. i've been really angry. 2020 is making me angry because we're asking for the same things over and over and we still fighting awful people that don't want to do fair share to deal with these problems. i'm with senior disability action and we have a lot of seniors and a lot of people with disabilities in the city that might end up needing the cities.

cpmc, being as rich as they are, they always get away with not doing enough. and they're not doing enough and the city is allowing it somehow. i don't know what the power of the city is. i really wanted to see it. i wanted to see that things change before these people end up on the street or dying. i know that you here are trying to do the right thing and you understand the problems. please, hold them accountable. they need to do what they're supposed to be doing. why they even go into healthcare when they don't want to do it? thank you. >> thank you. next speaker.

>> i'm with the san francisco labor counsel. i think chinese will do this chinese hospital and chinese hospital is a true community hospital, unlike the rest of the hospitals. i still believe to this day that the hospitals are dis-crim thoughdiscriminatingagainst this and i really urge you guys to put pressure on the city attorney's office to maybe draw a lawsuit on behalf of all of these patientses that are getting shipped out of county. because basically, if you need a trach tube, you're shipped out of county because there are no beds and that's an entire class of people. they need to do better by these folks. these folks are disabled. we won't mince words and this entire class is shipped out of the city against their will away

from their families. i think these people have a right to stay in the city if they so need to. the companies are putting profits above all else. we need to think how to force cpmc kaiser sf. they're in the process of rebuilding the pronasis campus and i'm sure they'll come up before city planning at some point and we should look about opening up beds. thithe city is about people ande need to force the hospitals to do the right thing. thank you. next speaker. >> katie rose, california's nurse's association, a member of the coalition you've heard from today. once again, i want to reiterate

it's our position that cpmc needs to step up, along with the other private hospitals to step up and do their part. it's ashame to think about what we've seen over the last few years and this is consistent with their behaviour, generally, to shed, to consolidate, shed services that don't bring in the fastest, possible bottom line for them. and in the process, really, shunt patients aside. so, again, i wanted to reiterate for you today, it's our position that cpmc should absolutely be maintaining beds for admission, for subacute patients. no fewer than 15 beds and it's ridiculous that they're converting these beds as they empty out into, you know, other types of beds rather than add hitting new patients. their own case managers who work on discharge planning in their

own hospitals spends time looking for beds outside of the county for patients who need them. this is really ridiculous and it's ashame and we would like to see cpmc held accountable for this. thank you. >> thank you, next speaker. >> good morning, supervisors. i'm a professor meritus. we've been representing san francisco for healthcare, housing, jobs and justice near a decade. we've spun off a concern around subacute care and the other healthcare issues along the

whole continuum and another pending crisis is rising now around board and care homes closing and that's going to create a series problem because we have a continuum of care. and we have a lack of facilities at any one juncture in that care frustrating appropriate patients of placements at all levels of care. what i want to do today is to reintroduce a statement we did more than seven months ago on the crisis in subacute care. among the things we highlight in that statement is cpmc and what to me is a disturbing decline in the dollar amount of services it's providing to san francisco's low income residents. the san francisco chair can report from data on 2017, indicating that unlike all other

hospitals, cpmc has both had a decline in the amount of charity care, which explainable by the increase in coverage under the aca and a decline in the shortfall for medical which has gone up at every other hospital. cpmc should not be left off the hook. it should be very much supporting joint efforts, but it should be providing subacute care facilities in its own facilities, as well. >> thank you. are there any other members of the public who would like to speak on this item before i close public comment? seeing none, public comment is now closed. supervisor safaye. >> one of the people in the presentation, one of the family members. so i'll ask that either racquel rivera to speak on one of the families in the subacute care and if you would like to add on

something, that's fine. >> good morning, supervisors. just a reminder of who i am. my name is racquel rivera and my sister sandy is a subacute patient at bay leaf. she was at st. lukes before she was transferred to the davies campus. she's 55 years old and she's developmentally old. she's suffered irrepairable harm from trauma due to a loss of meaningful relationships, a painfupainful foot injury from l or consistent familiar faces and a severe lung infection since the transfer from st. lukes. it has profoundly affected her quality of life. due to her refusal to leave her room, she has become grocery overweight. just in the last several

months -- i'm sorry. this has impaired her already poor ability to clear her lungs via her tracheostomy. no other family should have to go through this. cpmc has to keep its promise to never transfer her again and care for her through the end of her life. although it appears there were some improvements due to scrutiny after the last hearing, they may be more cosmetic than real. there continues to be staff turn-over and lack of continuity. due to the fact cpmc needs to keep skilled staffing only until they die and cannot offer permanent assignments to skilled staff. there are only eight remaining subacute. patients at davies and 17

patients were transferred from st. luke and half died in less than a year and one patient that could not tolerate after being at home after transfers out of davies was not allowed to return and is now in a facility in sacramento county.. chinese hospital has offered 23 beds which still falls short. cpmc davies already has 17 beds and rooms that were retrofitted for this specialized type of care. they can easily resume the licenses for the 17 beds and contribute to the city's needs. as you may recall, st. lukes had 40 subacute beds before they closed the unit. the clock is ticking down. who else of the remaining eight will die before a resolution takes place? we need to establish permanent subacute care in san francisco immediately and cpmc needs to be a part of that solution. they already have the resources

in place and can start taking patients now. they can offer nine additional beds at the least and this will help to keep continuity of staffing for the patients that are there now. my sister needs to build a relationship again. and she can only do that with a consistent, permanent staff, thank you. >> thank you. i want to thank the rivera family. we were able to go around and spend time and learn and i don't believe other than a few of us have in-depth experience with this. so it was really important for us to have that personal visit and for you all to open up your family and for us to be able to see your sister and see that

environment and i'll have some closing remarks about the struggle that we've had with cpmc but i want to give you the opportunity to speak and i know some of my colleagues will, as well. >> i'm gloria rivera-simpson and i'm sandy's sister. what i have to say right now is very important and i just want everyone to please just listen. i'm going to compare this situation with the titanic. everyone on the ti titanic thout they were safe because it was the unthinkable ship so they did not put enough lifeboats on the ship because they didn't think they needed it. after the disaster, the titanic started sinking. it hit an iceberg so thousands of people died because the titanic was not prepared for the unthinkable. so imagine san francisco gets hit with the respiratory epidemic that i is happening around the world. san francisco does not have any

lifeboats. subacute care is the lifeboat for san francisco. san francisco will sink like the titanic because they are not prepared to save lives. 17 people got the remaining lifeboats in the city and only eight people are left. and once those eight are gone, there are no more lifeboats. basically, there are people in hospitals now in san francisco that are waiting for subacute beds. so let's say five on this panel who need subacute hospital beds, but there are only two available available, who will be saved? who will be able to stay close to their families? excuse me, can you please pass these to any two supervisors. pick any two supervisors that

you want. can you please hold up your lifejacket and tell me what it says? >> temporary subacute bed. >> is this really what you want for your city? at this moment, you have the foresight to make this right. you are the captain to steer us away from the iceberg. do you want to go down as the only city unprepared? >> thank you, miss rivera. so since there's no other public comment, i close public comment. i just want to say that, again, this struck me as one of the most obscene things that i have had to deal with since i've been on the board of supervisors. we came in after a saturday story in the examiner that said

that cpmc was going to shut down their subacute unit and i literally had to read that story twice, because i was confused. it didn't make any sense. were we talking about a unit that was not filled with patients? but, in fact, these were real human beings in these. so i came in on that monday and didn't have the experience with the development agreement because none of the members on this body were on the board when that happened and we heard things, like, the development agreement is silent on subacute care. it made no sense to me. so we called for an emergency hearing. we went straight to the heart. we called the ceo. and the first hearing we had in this room and many of you were there, we heard things like they were literally putting papers, moving papers, agreement papers to leave the hospital on subacute patient's chests, on their bed and asking them to

sign those. some of them are not conscious. it was some of the most obscene things i had ever heard. we then called for a committee of the whole. not surprisingly, the day before that hearing, cpmc, all of a sudden made the announcement that they were going to move these patientses from st. lukes over to davies' campus. the leverage that we have in the city, miss taverleone spoke about it and some of the patient's families spoke about it. right now cpmc believes they don't have any obligation to negotiate with the city because they built their hospitals. but there will be sna somethingt comes in front of this board, their city, that they will need our support again. there are other representatives from other hospitals in this room. there are expansion proposals. there are proposals to do this work. this is not a priority for a lot

of people and i understand this is one of the smallest subsets of one of the smallest subsets in the city. but like in-home nursing care -- and i know super mandelman and others are leading on -- this is an important part of our leading system. our own mayor's brother had to receive subacute care. we were getting daily updates about that. it so happened she had to leave the city everyday, not because of not being able to get the care but where the health deteriorated for her brother. he is thankfulfull thankfully td but he had to have trach support and i'm not saying anything that wasn't publically put out there in social media. my point is is that this is a vital service that we need. so thank you, miss heramoto, thank you, chinese hospital, but we need the other hospitals to step up and do more than just contribute to pay for the beds

in someone else's hospital. we have to have this care provided and it has to be equal. and we will continue to hold every single hospital in this city responsible. i do appreciate the another community service providers but i want to lean heavily toward in-hospital care and so i will ask the chair once folks are done speaking if they want to speak, that we continue this to the call of the chair and we'll set another update, probably in the next 90 days. but we need to have a full update on how this is moving forward. thank you, mr. chair. >> thank you, supervisor. supervisor walton. >> thank you, chair to every we out to speak. what we can do to support the right system of care, to make sure that we have more beds in our city of san francisco is

possible. i want to thank the public health, which is sometimes hard to do and the rivera family and the chinese hospital for stepping up. but as we -- i'm not a medical professional. and so i don't pretend to be an expert on the medical field, but i do have a heart. and the one thing that i have to say is that, i think that with t cpmc is doing is inhumane. it's the equivalent of a bait and switch and they got their brand new shiny hospital and decreasing the level of care for subacute patients and doing so in a manner that is very concerning for a hospital. it's a place that is supposed to be about saving lives and putting patients first. to close beds, send people away when you have a facility and you have a capacity to be a part of

a solution, it really is a travesty. when i spoke with leadership about this, the first thing they did was say, well, what did dph and what about every other hospital? rather than try to have a conversation like adults. i get that from the young people i work with, trying to put blame on something or someone else when they make a mistake. how about we talk about what we can do to solve the problem and make sure that we provide a space for subacute care? particularly when you already have a facility that is providing this care, particularly when you already have nurses who are skilled, staff that are skilled in this work and so, this conversation is definitely not over. i do appreciate the fact that we have chinese hospitals stepping up and working to make sure that we do have subacute beds available here in the city. but i just cannot understand how

you can already be in a position to save lives -- and these are human beings -- how you can be in a position to save lives and your response and your answer is that we made a deal and we got our hospital and every time someone passes away or moves on, we're going to shut down a bed, shut down a level of service and that's what we're going to do because we made a deal versus saying, we have an opportunity. we have facilities. we have capacities. we have skilled staff and we're going to figure out a way to work with human beings and figure out a way to make sure they are able to stay alive and we can provide a level of patient care. so we're going to continue this conversation, but there are things that are more important than the bottom line and the

life of our residents is definitely one of them. >> president xi? >> i just want to ditto supervisor sayaye and supervisor walton's remarks. >> thank you, supervisor safaye on your work and for bringing us this hearing today. and i want to thank public health for focusing on this issue and working with chinese hospital to find some potential solutions. and then i also -- i think this is critically important issue, that it's in the context of a set of profound health needs that the city has for beds of many different kinds, including skilled nursing beds. and when we have a conversation about, you know, one facility converting skilled nursing beds

to subacute beds, it makes me think about the hundreds -- our hundreds of bed deficit, of regular skilled nursing and our lack of subacute psych beds, of our lack of locked and unlocked beds. there is a bed crisis throughout san francisco. i took teresa palmer's point about needing to maintain quality in all of these institutions and that is a critically important conversation. but we also don't even have the facilities we need, public, private. we just are so lacking in beds. and so, i think i also appreciated supervisor safaye saying we don't want have the city, general fund on the hook for this 3.5, $4 million. the costs of getting san

francisco anywhere near where we need to be in terms of overall bed capacity is much, much more than $4 million. and it will be a burden that has to be shared by the public and private sector and so i know kelly heramoto does this work and worries how to stretch dollars that there aren't. and so the conversation will continue and we need a lot more beds of many, many kinds. supervisor safaye. >> so can we circle back on this hearing in 90 days? >> yeah, i'll move that we continue this to the call of the chair and we can take that without objection. and mr. clerk, please call our next item. >> item number 6 is a hearing on the impact of second-hand smoak on people, especially seniors and children. >> president xi. >> thank you. i'll try to make my remarks quick because one of my guest speakers has a time limit here,

where she has to get back and teach. a little over a month ago, the first study of the ecigarette was over and extended period of time was published. over 32,000 american adults were a part of the study that took place over three years from 2013 to 2016. the city found that there is a real casual link between the use of ecigarettes and a person's risk of developing chronic lung disease, like asthma, bronchitis, e emphazema and mor. i want to give thanks for the people work fighting tobacco and

cigarettes and ecigarettes. my interesting now with the legal of marijuana, the use of cigarettes, ecigarettes and the increasing nationally on top. continued use of tobacco use of cigarettes is the second-hand smoke. second-hand exposure has skyrocketed over the last two years according to the california department of public health. there's an 86% increase in second-hand marijuana exposure and 67% increase in vaping exposure in 67% of california is still exposed to second-hand tobacco smoke. why should we care about the impact of second-hand smoke?

cancer, lung disease, harm to the brain and heart functions and these impacts are even more troubling when the victims are children who cannot protect themselves from this kind of exposure. i recently heard from residents in my own district, long-term tenants asking me to investigate further what the city is doing and how we can do better to provide relief for them when it comes to being exposed to re second-hand smoke. i've heard from doctors because their patients are exposed involuntarily from second-hand smoke exposure in their own homes. these are tenants who lack the resources to be able to easily find and move into alternative housing, such as the seniors on fixed incomes and families trying to survive with limited income.

are we doing enough? are residents who have few housing choices able to bear the risks that come from the exposure of second-hand smoke? i want to thank the presenters who are here today from ucsf and department of public health for being here to provide the comprehensive and fact-based look at the impacts and how the city regulates exposures today. so right now, i would like to call up dr. myah vijyara, who is from ucsf, who is not only an expert on second-hand smoke, impacts on health but has studied the impacts of voluntary second smoke-free policies for

housing insecure playing populas such as residents of housing units. thank you for being here. i know you have to teach in about a half an hour.

>> i'm an assistant professor at ucfs. i'm a physician and researcher with the focus on tobacco use in vulnerable populations including people that are homeless. the primary objective of this talk is to describe some of the historical evidence of the harms of second-hand smoke, describe exposure to second half hand smoke in multiunit housing, describe our study results and attitudes towards smoke-free residents and staff working in multiunit housing working and living in san francisco. so as you may be aware, second-hand smoke is the combination of sidestream and mainstream smoke. it's carcinogenic and since the

1960s, 2.5 million nonsmokers have died from exposure. there are stark despairties by ethnicity and children in are particularly vulnerable. as you can see on this graph on right, african-american children between 3 and 11 years have a higher burden compared to other racial groups. so the earliest evidence about the harms of second-hand smoke was in the 1960s and in 1970, the u.s. surgeon general was the first to declare a right to breathe clean air. in 1972, we have the first surgeon general report to mention second-hand smoke was harmful and in the 1980s is when we had two landmark studies that showed that second-hand smoke harms pulmonary function. in 1986, the surgeon general declared that second-hand smoke

caused lung cancer and as you can see from a letter that he wrote to george bush in 1986, based on current reports, the judgment can now be made that exposure to environmental tobacco smoke can cause disease. in 1992, the epa declared that second-hand smoke was a public health problem and the surgeon report declared the debate was over, that second-hand smoke caused lung cancer and heart disease. so what have we done to address this risk? as you know, that the smoke-free policy movement has been robust and california is one of the states leading in this movement. in 1995. california was the first state to restrict smokes in restaurants and later expanded to bars. from the graph on the right, you can see that in the '90's be 78% california supported this in

comparison to 57% nation-wide. the most recent data from the american for nonsmoker's rights, in 2019, 81% of our u.s. population is covered by either state or local 100% smoke-free laws that include non-hospitality workplaces, restaurants and bars. but despite the benefits of the state laws, this policy does not cover the homes. home is one of the most common exposures to second-hand smoke. 80 million americans living in -- there are 80 million americans living in multiunit housing and 7 million in subsidized housing. while the voluntary adoption of smoke-free homes, that is thist adequately protect nonsmokers from second-hand smoke exposure. there are many benefits to

having a smoke free home. not only does it reduce exposure among nonsmokers to second half hand smoke. among smokers, there is ample data to suggest it helps to reduce smoking behaviours. so we were interested to see what was happening in subsidized housing in san francisco and we decided to focus among our populations that would be most impacted by second-hand smoke, those who experienced homelessness in our low-income population. so we looked at permanent support of housing and section 8 housing. we interviewed residents and staff to a smoke-free policy in living units as well as common shared areas and perspective pol benefits a policy and looked at adopting a smoke-free home and considered enforcement challenges, as well.

i think before we talk about the results from the study, it's important to come back to who our residents are and these were people in permanent supportive housing experiencing chronic homelessness, who have mental health and substance use disorders, cognitive impairment and for these individuals, housing is focused on the harm reduction approach where maintenance of housing a prioritized over any preconditions of abstinence or need to engage in behaviour. and really the goal is to provide a permanent exit out of homelessness. so hir here is a brief summary f our findings. we did find there was general support for a policy among both residents and staff. there were definitely concerns about smokers' rights, arguments, about the policy encroaching people's rights to smoke, but we found people are generally supportive. people also acknowledged overall

benefits of the policy from reducing smoking behaviour. however, there were several barriers that were raised. one of the biggest barriers that was raised among staff were concerns about enforcement. in particular, concerns that eviction might increase among people who are unable to adhere to the policy. in particular, one interview comes to mind about staff member working with a resident who was severely depressed, who spent most of his time indoors and smoked over 20 cigarettes a day and couldn't envision having that person come downstairs to smoke 20 times a day and envisioned that a policy violation would take place leading them to consider serious actions like eviction, which would not be ethical for someone who experienced homelessness. the other barrier was lack of cessation services. these are individuals who have a

high level of nicotine dependence and find it difficult to abstain from smoking for short periods of time. so it would be beneficial to have these services to augment a policy to help people adhere to the policy better. residents also were concerned about the fact that if tobacco was regulated, what would happen to other substances that were also being used indoors, such as ecigarettes or cannabis or even illicit substances and if there were policies around smokes, there would be policies around other substances, as well. we concluded to minimum highs in barriers to implementation and enforcement of smoke-free policies in multiunit housing, it was critical to obtain by and among residents didn't staff for the policresidents and staff.wen to increase the voluntary

adoption of smoke-free homeses in the san francisco bay area. we focused on 15 sites that provided housing to formally homeless individuals. we worked with hundred residents and 62 staff in the 15 sites and we delivered an intervention where our team trained residents on how to adopt a smoke-free home voluntarily and we trained staff on how to refer residents to smoking cessation services. and here are some of our materials. these are all freely available online, which we adopted for our study. we talked about the impact of second-hand smoke and third-hand smoke, the impact on children and pets. we offered them pledges to designate their units a smoke smoke-free if they chose to voluntarily chose to do so. our results in promising in this pilot. we found that at six months, 31%

had adopted a smoke-free home voluntarily, compared to 12% at baseline. 17% reported stopping smoking didn't we found that having a smoke-free home increased cessation behaviours. so in summary, we found a ground-up approach that empowers residents who would ordinarily have been resistant to such a policy, we found a ground-up approach of voluntarily becoming smoke-free do provide a pathway to policy implementation. and the benefits of this voluntary approach is that it's self-enforced. the resident is invested in keeping their home smoke free and can eventually make policy enforcement easier. it can lead to a spill-over effect of other residents becoming smoke free, in particular, around social networks. it can implement or augment a top-down building wide approach and if the policy is accompanied

with cessation services, it could increase quid attempts and so in conclusion, as the city is considering this important policy to regulate smoking in multiunit housing, we believe that these voluntary approaches to increase by and among residents and staff and to support cessation could tale acy make policy implementation more important. >> i know you have to leave. >> i can stay a little longer. >> i'll ask questions later. thank you. >> no problem. >> next, i would like to call alice nuen who is our san francisco tobacco-free project, community health and equity

branch to give her presentation. >> good morning and thank you for inviting me to speak about the impact of second-hand smoke exposure in san francisco. i'm alice and i'm the director of the tobacco-free project. we want to thank the supervisors

for this, for prohibiting the use of ecigarettes in our brick and mortar stores and online. your support ensures san francisco continues to be a leader in protecting communities, especially people of colour, youth and low-income communities from the harm of tobacco. and so, we are here to share the most current data that the department of public health has on this issue. first, we'll talk about the rates and the harms of second-hand smoke on people in san francisco, especially their homes, the existing policies that regulate smoking in san francisco and how the department of public health experiences these policies. i want to let you know that smoke is smoke so when we're talking about second-hand smoke exposure, we'll be talking about

smoke from cigarettes and cigars and also second-hand ecigarette air exposure and cannabis smoke. so i think first it's important to know how many people in san francisco are smoking and vaping and using cannabis. our most recent data is from 2018. data shows that the smoking rates among adults and young people have not changed much over the years. approximately 12% of adults currently smoke and 6.5% of our san francisco unified school district students smoke. on the other hand, more students than adults have ever tried an ecigarette, a rate that increased over the years. the portion of students who currently use ecigarettes have doubled. we believe that supervisor walton's ordinance that will

take effect at the end of the month will help to curb youth rates. lastly, you'll see that about 6-10 adults use cannabis and 3-10 high school students have ever used cannabis. didn't the good news is that the majority of people in san francisco, adults and youth do not smoke or vape ecigarettes. so let's talk about second-hand smoke exposure. we do not have recent population level second-hand smoke exposure in san francisco, unfortunately. we have state-wide california data for adults and high school students for 2016 and '18. you'll see more than half of the adults report being exposed to second half hand tobacco smoke in the last two weeks. it hasn't changed much over the years. but notably, as president xi mentioned, there's been an increase in reported exposure to ecigarettes and aerosol cannabis smoke among adults.

more california high school students, about 1-3 have been exposed to each type of smoke. in the last 30 days in a room or car. it's likely the trends are the same in san francisco. we do have some data from 2019 at zuckerburg general hospital in patient pediatric ward. caregivers are asked their children's second-hand smoke and cannabis smoke exposure during a screening, and you see the 22% of inpatients were exposed to second-hand smoke and 9% to cannabis smoke. so as dr. mia mentioned in her presentation, there's no risk-free level of second-han smoke. second-hand smoke. all three types are harmful to users and others, especially for children and elderly and those with health issues. so i'm going to talk through the

three different types of smoke. for cigarette smoke, every year about 40,000 people in the u.s. die from second-hand cigarette smoke exposure. cigarette smoke includes about 7,000 chemicals, 70 carcinogens, like nicotine and children and babies have an increase in sudden death syndrome and asthma attacks. ecigarette nano particles are more easily breathed in and have ten more toxins like benzene and lead from the list of carcinogens. and exposure to second half hand

aerosol can result in asthma and damages to lung and blood vessels. in terms of second-hand cannabis smoke, this includes about 33 plus toxins from the top 65 use. children who have been exposed to second-hand cannabis smoke have detectable levels of thc which can impair the developmentment of their brain and service system. so in san francisco, there are local and state policies that have created smoke-free and vape-free places for san francisco. in san francisco, vaping is prohibited in enclosed common areas like business areas and schools, like parks, farmer markets and public transportation. one place people in san francisco may be exposed to second-hand smoke is in their own own.

home. we spend a majority of o time in her homeses. half of san francisco lives in a multiunit housing and that's a building with two more units. so a duplex, a condo building, public housing and apartment buildings. people of colour, young adults, low-income and smokers are more likely to live in these multiunit housing. second-hand smoke, it can easily seep through, like, a window or crack and vents. third-hand smoke is a concern because smoke and vape can stick to the furniture and the carpet and continually expose the smoker or nonsmoker alike. opening windows, air purifiers and fans, that doesn't completely eliminate second-hand smoke harm. a study by ucsf researchers found san francisco residents who live in high density multiunit housing, those are

building of five plus units are about three and a half more times likely to report drifting smoke exposure than those who do not. so next, i want to talk about what are the existing policies that we have here in san francisco that regulate second second-hand smoke exposure for those living in multiunit housing. i'll walk from the timelinech leftimeline ofleft to right. starting in 2010, this ensured common areas in multiunit housing are smoke free, like the entryways, mill rooms and even shared open spaces that are ten feet from a window or a door. the policy also states smoking should happen at curb or 15 feet away from an entryway or an exit or window. this policy applies to apartment buildings, sros, hud housing,

and senior housing, among others. in 2010, the sanfrancisco housing authority add ad added a smoke-free policy and this applies to common spaces and this means that a portion of our low-income families and individuals are protected in sanfrancisco. next in 2012, the california state senate bill, 322, allows property owners to prohibit smoking in their units through lease or rental agreements. and it's important to note that the san francisco rent board rules and regulations does not allow property owners to evict the tenants based on a unilateral decision. so just forcing them to be a smoke free. if a lease on a property doesn't specify it's a smoke-free unit, then smoking is permitted. this also means that many

tenants, especially in rent-controlled units are still allowed to smoke in their units, potentially exposing their neighbors. and let's look at the federal level -- sorry, let's go back to our local policy. so in 2013, our health code 19m, smoking disclosure increas incrd transparency between renters and owners about the smoking status of each unit. so manager are required to designate whether a unit is smoking or smoking optional. when a unit is up for rent, they would need to disclose to a renter whether it's smoking or not, as well as keep a master list of a smoking designation. 19m is just solely an educational tool for landlords and tenants. there's no enforcement language in this policy. so now on to a national level, 2017 hud, they passed a smoke-free policy for public

housing through the public housing agencies and multifamily federal assisted properties. the policy covers smoke-free indoor common areas and residential units and 25-feet perimeter around their building. all public health authorities were asked to comply by july of 2018 and this means less amendments to new and existing residents would include a smoke-free policy. since this is a federal policy, we do not have any enforcement over this, as billion. as well. given existing policies as mentioned within sa, san francig managers adopted policies. they view this as an economic benefit because it takes about $15,000 to turn over a smoking unit. in the past, the tobacco-free project supported the resources

to help low income and transitional housing managers to implement voluntary policies with the engagement and input of their residents. so next i'll have my jennifer speak on enforcement framework. >> where smoke is permitted is dwelling units and private balconies and private shared outdoor spaces ten feet away from doors and windows. what property owners are required to do based on the

policies in the city is to post no-smoking signs at the building front, to direct smokers to the curb, as well as posting no-smoking signs inside the multidwelling unit common spaces. if a smoker is seen by a p property manager or owner, they are to direct the smoker to smoke either inside their units or at the curb. and they will also do this for guests of tenants but not required to enforce any smokers that are not associated with the property. so, for instance, people on the sidewalk in front of their business that aren't customers or live there. in general, environmental health enforces the health code in relation to businesses and property owners and does not

enforce individuals or residents at this time. and then the health code does not allow, as mentioned, eviction or smokes in prohibited areas. so we received second-hand smoke complaints and they are directed in three different channels. the main channel for multi-used housing is in terms of complaints about work spaces, common areas and outdoor dining areas, which environmental health is able to do enforcement to ensure the signs are posted and any tenant notifications are posted if the smoker is seen. and then also providing the tenant who is smoking that is issued a notification, as well. so that's the level of

enforcement for environmental health. for complaints that come through around smoking inside and drifting into from one unit to the other, the tobacco free project also issues a lefte leto give potential resources and voluntary programs and information about quitting and what the tenant can do next, who's concerned about multiuse drifting smoke. this is a slide around 3-1-1 complaints over the past ten years. we have on average about 155 calls from 3-1-1 around smoking and this is including any kind of smoking complaints. i want to be clear it's not

housing. it might have to do with smoking in front of businesses, drifting smoke from barbecues, but it most certainly covers a large number of complaints around smoking in dwelling units and in common areas of residential units -- housing in san francisco. and then tobacco-free project also receives calls. they have reported about drifting smoke in multiunit housing. about a quarter from drifting smoke from other buildings into their units and about 8% dealing with cannabis smoke drifting. and roughly 7% of those calls are actually enforceable through the mechanisms that i have mentioned for environmental health branch.

exposure to second half hand smoke within san francisco housing unit, yo as you can seee name of it, san francisco is concerned based on the complaints we're getting. the gaps in the existing policy means tha that those in san francisco may be exposed to second half hand smoke, especially living in multiunit housing and this impacts the health of all smokers, whether they rent or own. just to reiterate, no level of exposure from secon second-hand, whether it's vape or cannabis.

>> thank you. maybe this is a question for you and miss nuen. i wanted to be sure i understand the current protections for tenants in multi unit housing. right now if i live in a unit and my mother is suffering from lung disease or my child has asthma and my neighbor, in their own unit is smoking everyday, there's really nothing the city can do about it to help? can you explain the situation? >> thank you for the question, president xi. right now given the city policies, there's nothing the city on a policy or an enforcement level can do about a complaint of drifting smoke going into someone's home.

>> i think my recent contact from some of my residents in 7 explained this situation and i wasn't too sure, really, we can't do anything? i guess you just answered it. thank you. anybody have any questions for those two? then can i have dr. -- there you are. i just wanted to say dr. mia. i'm sorry i can't pronounce your name correctly. >> the way to se so i'm just wondering, i wanted to confirm that even in support of housing, where many of the residents may be smokers, that having a

smoke-free home increased -- you said in a smoke-free home, it actually increases the likelihood people will stop smoking? >> yes. so there has been data on a population level looking at the impact of smoke. -free homes on cessation behaviours. at the population level, we found smokers who have a smoke-free home are more likely to quit and then relapse. we wanted to incorporate that into an intervention in a fight where the vast majority of people who are living in that site are smokers. in getting people to think about a policy to see whether they would voluntarily consider going smoke-free in their homes. so the primary goal was to have them not smoke in their units, but secondarily and sort of a downstream effect of not smoking in their unit was the effect of

increasing cessation. so people by not smoking in their units, either cut down to stop or reduced their smoking enough that they were able to attempt to quit and because of the limited reinforcements of smoking, because they're no longer smoking in their units, they were able to sustain their quit attempt. >> what happens to residents of supportive housing right now if they don't want to smoke or be around second half hand smoke? >> so we did actually come up with those issues. i think they're in the minority because most of the people who are living there are smokers. i think participant management stafproperty managementstaff tho

minimize the second-hand smoke drift. but i think you have to also look at it from the perspective of someone who hasn't had a home in a long time. and for them, the issue, whether you're a smoker and you have a policy or you're a nonsmoker and you have a policy is that you have a home and that is their priority to maintain it. pai(please stand by).

this is especially benefiting children, senior as and people with health issues like asthma. as we heard from the u.s. surgeon general's report, no safe level of exposure to drifting secondhand smoke and also sadly that the home where our children remain most exposed. residents tell us that smoke easily drifts between the units. over the years, ive received many calls and emails from san francisco residents who are

telling me how much they're suffering from breathing in their neighbor's drifting tobacco and marijuana smoke. and how little recourse they have in real life to improve the situation. the most difficult calls i get from parents whose young children are getting sick firsthand seniors whose health is seriously compromised from the drifting smoke. it's only one resident who is smoking in the building and their smoke is creating a constant health threat for many of the other neighbors. most callers have tried talking with their neighbors or landlord or h.o.a. and they're trying their best to have a healthier living situation, but they can't find relief or recourse on their own. they simply want to breathe clean air at home and it's time that the board of supervisors consider taking action to help residents have this basic health. as we all know, the housing situation in san francisco is very challenging. and it means that most people don't have the means to up and move to escape the smoke. even if they did, there's no guarantee the next place they

move to would be even better. we want all san franciscans to have a healthy living environment. san francisco would be in good company. i brought a list of the 56 other communities in california that have 100% smoke-free multi-unit housing. [bell dings] >> thank you. next speaker. >> good morning, board of supervisors. my name is marykemp. wewe are especially concerned about secondhand smoke in multi-unit housing and we encourage you to consider policies that will protect residents from the dangers of secondhand smoke. exposure to secondhand smoke has killed more than 2.5 million non-smokers since 1964, according to the 2014 report from the u.s. surgeon general,

who has also declared there's no safe level of exposure to secondhand smoke. secondhand smoke in multi-unit housing is especially troubling. smoke can and does transfer between units, seeping under doorways and through cracks. everyone deserves to breathe clean air, whether they can afford to rent or buy. best practices support that any policy be made effective for new, as well as existing multi-housing residences, both rented and owner-occupied. adoption of such a policy protects our children, since more than a quarter of people living in multi-unit housing are under the age of 18. and the home is a primary source of secondhand smoke for children. in addition to significant health benefits for residents, smoke-free policies would save california multi-unit housing property owners 18-point $1 million in renovation expenses each year. thank you for continuing to

consider a strong smoke-free policies that work toward a healthier community. smoke-free spaces help former smoker quit and from ever starting. we encourage you to make the health of san francisco residents a priority and join the numerous communities throughout california who adopt ed comprehensive social media policy -- smoke-free policies. >> good afternoon, supervisors. my name is kalen kelly. i'm a program director with bay area community resources. i would like to shed some light on how the residual impacts of secondhand smoke, specifically in concentrated residents of people of color, not only compounded issues of environmental justice, but have also caused generational health concerns regarding the most vulnerable community members in areas like valley and the hill. and especially baby hunters point. it's no secret that areas such as hunters point and visitation valley have had disproportionate

environmental concerns, leading to high rates of asthma and many other health hazards. what some people don't consider, these health issues are impacting generations of residents and people of color residing in these areas. consider this. according to the san francisco department of health's 2018 report on african-american health, it was found that due to social, economic, and environmental burdens, the life expectancy for african-americans is the lowest of all ethnicities in san francisco. and when it comes to asthma in african-americans in san francisco, the report found that the condition asthma, amongst african-americans, is exacerbated by mold, pollution and tobacco smoke. generationally speak, according to the centers for disease control and preventions website, in general during 2013 and 2014, secondhand smoke exposure was found in 61% of african-american

children age 3 to 11. it was found in 53% of african-american adolescence from age 12 to 19 and 45% of african-american adults among the age of 20. secondhand smoke presents a particular health risk to communities of color and so we do ask you to advocate and consider multi-unit housing to prevent -- [bell dings] >> thank you. next speaker. >> good morning, supervisors. my name is bob gordon. please consider the story of a fellow san franciscan. he now lives in district 8, supervisor mandelman's district, as do i. he live an unit rented out on airbnb for 30 days at a time. every month brings a new set of

temporary tenants downstairs. many of these airbnb guests would smoke. and their smoke would enter upstairs through his kitchen windows, which was his only source of fresh air. even if he closed the windows completely, the smoke would still enter the unit. not only was the smoke a nuisance, it was leading to physical symptoms. he had no real control over this harmful smoke coming inside his unit, other than to plead with the airbnb guests to stop harming him. some of the downstairs guests listened to his pleas for fresh air. others did not. the smoke problem persisted, until this fellow san franciscan was able to move, not an easy feat in this town that's so expensive for housing. health comes first. and all of our housing must be safe from the dangers of drifting smoke. for seniors, for youth, for people with h.i.v., for people

with asthma and heart conditions, for everybody. berkeley, another city with rent control, has an ordinance protecting people from such harmful drifting smoke. san francisco would do well to follow berkeley's lead. thank you. >> thank you. next speaker. >> hi. i'm here with my organization. a personal thing that really matters to me. we are kids from the '60s, all of my family is. and out of all of my siblings, four of us have asthma. and my parents didn't know better, so they were heavy smokers. and i know what secondhand smoke does to you, you know, because it happened to me.

and i just wanted to say that if you can really help the newer generations to be, you know, free from those problems. respiratory issues are so scary, you know. i cannot even tell you how many times i went to the emergency thinking that i was going to die. and so if you can help and change this and maybe even apply it farther, because i live on san bruno avenue. it's one of those very heavy traffic places. and a lot of smokers. and they are outside the street smoking all the time. you know, outside of the street, even i can feel it on the second floor. [bell dings] please, if you can do it for the units, you know, where people

live, it can even get bigger than that. thank you. >> thank you. are there any other members of the public who would like to speak on this item before i close public comment? seeing none, public comment is now closed. [gavel] supervisor walton? >> thank you, president yee, for calling this hearing today. i want to ucsf and the department of public health for presenting today. just one thing i just want to say is that nobody should ever be forced to inhale secondhand smoke. you should never be in a position where you have to be around secondhand smoke. and you don't have an opportunity to get away, and particularly if you're in your own household. so i do appreciate this hearing and i do appreciate president yee bringing this forward, because that's important. as you know, we have a lot of fights against big tobacco and keeping people safe and out of harm's way from secondhand

smoke. and i just do want to reiterate the fact that it is our job to put policies in place to make sure that people don't have to be forced to be around any kind of secondhand smoke. thank you. >> thank you, supervisor walton. president yee. >> supervisor yee: yeah. i want to thank the speakers that came today and really at least educated myself. and also the people that made public comments. i appreciate your comments and wanting to address this issue. and, you know, it's really troubling what i heard also today. because i grew up in a triplex. we call them flats in san francisco. and everybody smoked. and even when the people were smoking downstairs, even when the windows were open, the smoke

would go through the floor. never thought about it when i was younger. and maybe because i was -- i had the opportunity to buy my own home, single family home. and my kids were growing up. and, of course, there was no smokers around my household. so i didn't think about it i thought all of these laws that we passed in the last few decades, that everybody would have an environment where they wouldn't have to worry about secondhand smoke in their own homes. and then when these issues were brought up to me more recently, are you kidding me. even when my father -- when he was 89, i had to -- well, i moved him into my home. and he was a smoker. i said, you know, i really want to move you into my home. you need help. but you can't smoke in my house. you know, he's -- he probably had been smoking for like almost 80 years.

and lo and behold he not -- he didn't say anything. he just stopped. and, you know, once he moved in. people can stop. and so part of me is -- like i think supervisor walton, i believe we can do better than this in the city. i mean, why in the world would -- any of you have kids or older adults that you take care of, why would you expose them to secondhand smoke? and yeah you have almost no right in a multi-unit household. and, as you know, we're creating more and more of these multi-unit households, because we're making it easier to add those a.d.u.s. so i'm looking forward to -- i have already made a statement earlier in one of our board meetings that i will look at legislation to see what we can

do about this. and i'm hoping that some of my colleagues will join me in supporting this legislation that will, you know, basically keep our -- not only our children and these seniors, but also the regular adults healthy in the city. so thank you very much. >> thank you, president yee. supervisor walton. >> supervisor walton: just for the record, i do want to say that one thing that does concern me, as we get ready to shape policy, is that we are very careful of how we deal with enforcement, with policies around ensuring that people don't have to inhale secondhand smoke. because i can see a speculator, i can see our predatory property owners doing everything they can to use laws to promote evictions. and so i definitely want to make sure that we're careful about how we address that and deal with that. because i do not want to

encourage negative interaction between property owners and tenants. and so when we do shape policy, we must take that into account, because there are landlords and property owners out there that would love to create something that would help them push towards more evictions. >> thank you, supervisor walton. president yee, are you all right with us filing this hearing? >> supervisor yee:. >> i'll move that we have the hearing heard and filed. and we can take that without objection. thank you, president yee. >> thank you. >> mr. clerk, please call our next item. >> clerk: agenda item number,. including positions created as part of the police department's civil zannation plan, in order to understand how long it takes to fill vacancies and ascertain ways to improve or prioritize hiring these urgent positions.

>> vice chair stefani, this is your hearing. >> i called this after an issue about new civilian classifications within the police department. as you look more deeply into the issue, we discovered greater structural and environmental challenges, that impact how the san francisco police department, fire department and the department of public health are able to fill the ranks. the reason they deserve special ascension is because these are dedicated public servants who intervene when the rest of us are often in crisis. they are our first responders, emergency medical professionals, police officers, firefighters, nurses and clinicians. when our residents are injured or in danger, these are the people who come to our rescue. as a government, one of our core functions is to keep our fellow citizens safe. that should be obvious. filling these positions ensures that we meet that. so. these positions are absolutely critical to make sure that we are fulfilling that

responsibility. and we can't do that with ongoing or chronic vacancies among our police, e.m.t. or nursing staff. we can't function as a city if we can't respond to emergencies with the speed and urgency required. the low unemployment rate and high cost of living make recruitment and retention very difficult. for all of these positions, but especially for our police department. rent is higher, commutes are longer and working in a large complicated city is much harder than in some of our quieter suburbs. but it's our job, as policymakers to respond to these environmental factors and find solutions. this committee is tasked with understanding the public safety landscape in this city. and we need a mechanism to receive reporting on what the demand for public health and safety services is in this city. and how well we are meeting that demand. i intend to ask our department of human resources to work with other departments here to find a way to give us consistent,

clear, ongoing reporting for how we're meeting our public health and safety hiring goals. we need to adjust to the new hiring environment and reform our own processes, so these vacancies can be filled as quickly as possible. and with that i'd like to invite our guest from d.h.r. to start us off and then we'll hear from the fire department, our chief janeen nicholson. hi, sister. and deputy police chief greg yee and michael brown from the department of human resources. oh, kate howard. hello there. >> good afternoon, supervisors. hate howard from the department of human resources. chair mandelman, members of the committee, it's my pleasure to be here with my colleague, as well as the director of employment servicesser steve

ponder, the director of classification and compensation for the city. and dave johnson, who is the manager of our public safety recruitment team at d.h.r. i'm here to present briefly on the city's hiring process for critical public safety positions. and my understanding is that our colleagues from the police department, fire department, and public health department will present, in more detail, about the specific opportunities and challenges associated with rerouteing and retaining those positions. we use fair and equitable to practices to support and retain highly qualified organize -- workforce. we're unique in needing to hire and retain public safety and first responder, as part of our -- as part of that workforce. briefly before i go into detail on the public safety positions,

i'd like to answer a question that i know has come up regarding the creation of new classifications. so this slide is really intended to describe very briefly how we establish new classifications at d.h.r. a job classification essentially describes the duty and the scope of work for each job in the city. and currently there are about 1,100 job classifications that d.h.r. is responsible for maintaining. as you can tell, that really reflects the diversity and the complexity of the kinds of work that we have. so in order to create a new job class 1:00 finish, it's a collaborative process, the set of classifications and departments. departments typically will identify a need and work with d.h.r. to refine the specific job duties and scope of work. we would consider factors like minimum qualifications,

desirable qualifications, special conditions, things like the ability to speak spanish or another language. and then we would work with labor to finalize that new job specification. our goal is really to write those specifications in a way that they are clear, that they don't overlap, but that they're not too rigid and allow departments to have the ability to complete their work, as they need to. i think this came up in the context of some work we did with the police department, to create a new background, personnel technician. so that's just an overview of how we approach the creation of classifications. the rest of my presentation will briefly highlight the processes that d.h.r. owns, associated with hiring of police officers and firefighters.

so these are the positions that we'll cover today. police officers and then for the fire department the process that i describe is similar for firefighters, emts and e.m.t. paramedics. the health department will cover the work around registered nurses and other critical positions that they're intending to fill. i wanted to -- to start off with on police officers, i wanted to just highlight for you some of the work we have done over the last several years to really bring down the time to hire and to move people through the process more quickly. i think the takeaway from this slide is essentially that before 2013, it took between five and six months to go through the initial screening process, in order to get on a list to be able to be considered to go through the rest of the police background and then to move forward to the academy. so five to six months in just

d.h.r.s part. over the last several years, due to some changes that we've made, that i'll highlight on the next slide, we've essentially been able to move what were sequential processes into parallel, so that you can complete the physical ability test and the oral exam on the same timeline. you don't have to do one before the other. so that's cut the time to -- that folks are in our process in half. in addition, before 2014 we would create an eligible list. so we would run people through a series of exams. we would create a list and that list would be valid for two years. and people wouldn't have an opportunity to get on to a list, other than every two years. what we're doing now is essentially continuous testing, so any time someone is interested in taking a position with the police department as a police officer, they're able to take the exam and move quickly into that next step. get on the list within

approximately three months. so the next slide shows you the way the process works now. and this is a partnership between d.h.r. and the police department. as you can see, the first step is that an interested police officer candidate would submit their application and register with the national testing network. this is a vendor that we use, that has contracts with public safety departments across the country. and they conduct the initial judgment-based test. it's the first screening for folks who are interested in becoming a police officer. that exam is given one time a month in san francisco. and they can take the test at any local testing center. they can take it at our test center, which is 1740 caesar chavez in the dog patch. within 30 days of taking that exam, the candidate needs to schedule their physical ability

test and their oral interview with the san francisco police department. and while that scoring is taking place, candidates are placed on a tentative eligible list. that list is published within two weeks and provided to the police department. once all of the scores are in, those individuals names are confirmed and sent to the police department. and they own the process from there. essentially this process takes approximately two to three months. and one of the other i think innovations here is that folks have the ability, if they're not successful in one of the elements of the exam, they're able to retest and continue to try to be successful to get on to the list. i would note that the police department has done some significant work trying to improve their process through some lean process improvements, in partnership with other

departments. and that d.h.r. has a regular, collaborative recruitment meeting with our staff and with the police department staff, to ensure that the process is working smoothly and to try to identify other improvements that we can make. on the firefighters' side, the process is similar. candidates submit their application to n.t.n. again not to the fire department. they take their test. and then are required to submit their valid california e.m.t. certification and any other testing that's required by the state. once the scoring has been completed, we've got the certifications from the state e.m.t. certifications, as well as their test scores. the fire department requests their eligible list to be refreshed, in advance of any

upcoming academies that are scheduled. folks are listed on the tentative eligible list and after three days, it's adopted. and that information is sent to fire department human resources for their next steps. i think the main difference between police and firefighter hiring process is that the physical ability test happens at a later stage in the firefighter process. it happens earlier for police officer candidates. both exams are given on a continuous basis and both lists are adopted on a continuous basis. and that means that new individuals can be added any time to that list. and so there's always a refreshed pool of candidates, who are interested in becoming firefighters or police officers. a couple of highlights of things that we have done in partnership

with our public safety departments, to try to expedite the hiring processes. we started off the conversation with our discussion about new job classifications. and so we did create a position 1251 background investigator. so that's a new civilianized position, whereby the police department no longer needs to use foreign officers to do background investigations of potential police recruits. we've also made several improvements to the hiring process, which i have highlighted, including our partnership with n.t.n., so that the exam can be given more frequently, a continuous list, so the pool of candidates who are interested is always available. and then creating a parallel track for the process, rather than a sequential track. we also have in our departments, in particular and police can talk more about this, several

folks who are doing recruitment work, that do targeted recruiting in other cities and communities to try to bring qualified candidates into the mix. we also provide fee waivers for individuals for whom the cost of taking the exam is prohibitive. we are able to provide them with a fee waiver, so they don't have to pay to take the exam, to try to qualify to become a police officer or firefighter. and then finally we've done some work with the health department in the past around nurse hiring and doing some job fairs there. as i mentioned, these are ongoing partnerships with fire department, police department and the health department. and we look forward to continuing to improve our processes with them. finally, i'll just mention, as you know and as supervisor stefani highlighted, we are in a

very competitive job market at the moment, given the low unemployment, given the challenges that public safety employees face in doing their jobs. they're very challenging roles for folks. and so we're in a competitive market. however, we do continue to provide very competitive salaries for all of our employees. as well as competitive benefit packages. i think one of the places where we're continuing -- where we're going to continue to do more work is in terms of targeted recruitment. given the labor market we have to work even harder to encourage people to take on these challenging roles and for them to understand what kinds of salary and benefits come along with that. as well as to understand what the process is to qualify to become a police officer, firefighter or nurse with the city.

that's important not just to have filled positions, but also to maintain and enhance the diversity of our workforce, so we're able to meet the needs of our diversity community. with that i'm happy to answer any questions. as i mentioned, this is really a brief overview of the portion of the process that d.h.r. controls. i know that the other departments will talk a little bit about what they do, once they get eligible lists from us. >> supervisor walton. walton railroad thank you -- >> supervisor walton: thank you so much. do we know the breakdown of how many individuals in the fire department and the police department are san francisco residents? >> are you asking how many of our current employees -- we do have that information. i don't have it with me. i'm happy to provide it. >> supervisor walton: and maybe this -- i'll wait until i hear from the police department.

thank you. >> happy to provide that information to you, to your office. >> thank you, miss howard. i don't have any questions. you answered the questions that i did have. i'm really happy to hear that you're focusing on recruitment. and i think that there also has to be a focus on retention as well. so with that i think we'll call up chief nicholson. >> not to rush anyone at all, some of us are turning into pumpkins at 1:00.

there's some desire -- >> i can speak quickly. >> okay. >> don't you worry. >> thank you, chief. >> i am an emergency responder after all. [laughter] thank you for this opportunity today. chair and supervisors, it's a pleasure to be here. janeen nicholson, chief of the san francisco fire department. with me i have my director of finance mark corso. so, as you know, with prior support from the board of supervisors and the mayor's office, we have seen a successful implementation of hiring firefighters, entry-level firefighters. we are also working on improving our e.m.s. -- hiring of emts and paramedics. i'm happy to talk to you about that a little bit in more detail offline. obviously given the budget and hiring environment challenges, we have had various issues with filling and retaining other job

classifications, both uniform and civilian. but let's talk about e.m.s. because that's really where things are really -- have really changed over the past several years. we know that our city is growing. we've had an increase in call volume. since 2015, the fire department has sign -- has seen a 14% increase in call volume, with no new additional resources on our ambulances. and that has had a huge impact. so it's had an impact on our members, in terms of burnout, post-traumatic stress and the like and also the conditions we see on the street with a lot of people suffering behavioral health issues and other issues. we're having more challenging patients. our members are being assaulted more often, more frequently. and, you know, it's -- the entire system is also really, really backed up from call

taking to the hospital. so it's a systemic problem as well. so in e.m.s. or station 49 as we call it, we have been forced to rely on more overtime and per diem resources. and even those are not always available. on average, on a daily basis, we are unable to staff five ambulances. so that's -- that's pretty significant. and we've seen what's, you know, what's happened with that. it leads to burnout. it leads to longer response times and the like. now there is a shortage of e.m.s. personnel, e.m.t.s and paramedics, including in the bay area, but nationwide. but i think with the right recruiting strategy and some other programs, that we're going to put into place, including an e.m.s. core that i have spoken

with supervisor walton about, i think that we can definitely attract people. but as you know the nature of the job has changed, with our opioid crisis, we've all seen the articles in the last couple of days that our overdoses went from 90 last year to 234 this year. and then additional threats, active shooter, we didn't have that a few years back. we have to do that for training. and then the repeat callers. repeat callers -- and again the behavioral health callers. and what i can say is 80% of our medical calls -- 80% of our overall calls are medical. and of that 35% of those are from people with an unknown address. so it's really -- it's been a very challenging environment for our people. and especially with a lack of additional resources. now let's move on to fire

prevention. we also have difficulty in attracting fire protection engineers. it's a very specialized job. and there's a very limited pool of qualified individuals region wide. it's smaller than like an electrical engineer or mechanical engineer pool. and and we also have competition with our opportunities, due to our cost of living. that's our disadvantage. and then they're also unable to earn overtime, due to the classification that they're in. because we're unable to get enough of them, they have to work more than their regular hours. so there's that. and these positions are really critical in terms of our housing crisis, right. and i know the fire marshal has been doing his best. and they've really made some wonderful strides.

but that is definitely an issue for us. and then in our civilian workforce i.t. positions. we know all of the competition we have with corporations and private businesses, in terms of being able to fill our i.t.-related positions. i think that's facing other city departments as well. and then a lack of resources has led to delays in filling numerous civilian positions. and what i would say to that is we used to have our own exam unit. it was absorbed into d.h.r. and they do a great job for us. but there's a lot of work. and we are unable to really hold our own civilian testing processes. and so then typically we will have to wait on another department's list. so that has led to some delays for us as well. so those are our challenges right now. and i'm happy to answer any

questions, as is director corso. i don't want you to turn into pumpkins. >> thank you. supervisor walton. >> supervisor walton: just two questions. chief, thank you so much. one, what's the history around why your civilian hiring was absorbed under d.h.r.? >> i don't know. does anybody else know? do you guys know? >> supervisor walton: well, what i was going to say, because i know we talk a lot about pathways, both with the fire department and the police department. so i have questions. i'll talk to both departments separately for the sake of time. we can talk about getting that information. but then the second question, i had a great learning experience participating in fire ops and really got a chance to see, of course, not to the level of what firefighters actually see every day. but some of the amazing work that you do as firefighters and really appreciate you. but i am a little bit disheartened that i did not get any active shooter training. >> we can hook you up.

no problem. we've got you. >> supervisor walton: thank you, chief. thank you. >> supervisor mandelman: supervisor stefani. >> supervisor stefani: i'm hoping that changes at some point. real quick. you mentioned that on a given day, you're unable to staff five ambulances, is that correct? >> that's the average. >> supervisor stefani: i remember one day, when we had the heat wave, you and i were discussing this. can you talk about the consequences of having unfilled ambulances and what can happen and how quickly we need to react to this and solve this problem. >> sure. so in say a heat wave or something else, we tend to run a lot more calls, because our at-risk population, whether on the street or in their homes, elderly, really feel the impact from heat. and so our ambulances are very busy. the hospitals are very busy.

we will have delayed response times for our ambulances. and we've also had to -- we've also had the local emsa has brought in strike teams from outside of our county to cover our city for us. and that also -- that's happened three times in the last year. so we really -- we really are in need of some resources. we take great pride in our city and i don't want to have anybody else have to take care of us. >> supervisor stefani: now best to address the issue of the overdose deaths doubling in the city? i mean, it's -- it's almost an impossible thing to do, given the staffing you have right now. i don't understand what the capacity -- how we address that issue, just with e.m.s. i mean, there's other ways to deal with that issue. but through your department. >> yeah. so great question. i just came from the healthy streets operation center meeting. and they're changing the structure of it a little bit.

but we need to expand our community paramedicine. that what has worked. they've been extremely successful in not just our opioid epidemic, but getting people off the streets, getting them into services. they tend to trust us more than some others. and they trust -- they also trust the hot team, so we work with the hot team. but we've only been able to reach 13% of our frequent callers. so we have a list of people that use 911 on a greater basis than most anybody else. and we've only been able to reach 13% of them. we really need to expand community paramedicine. it's been proven to work. >> supervisor stefani: thank you. i don't have any further questions, unless my colleagues do. great. thank you. >> thank you so much for your time. appreciate it. >> supervisor stefani: can we hear from the police department.

>> good morning, supervisors. how are you today? greg yee deputy chief of the police department. pleasure for me to be here today to express our challenges that we face in the law enforcement community. first challenge was the computer. anyways. you know, the san francisco police department is actively recruiting members to become one of san francisco's finest. and as we look at traditional recruitment efforts, we're all

still looking at nontraditional. and looking at this list that's up on the board there, you know, our boot camps -- boot camps are really designed to help members or applicants be prepared physically and mentally for the physical agility test that they will face. so we in the police department bring the boot camps into the neighborhoods of san francisco. so we're bringing training, we're bringing workshops to the communities. so it makes it more accessible for them. our hiring workshops, our recruitment unit does a fantastic job in preparing applicants on a monthly basis to sign up, get to go through the physical agility tests. get the exposure to the wall, how many push-ups they need to do, how many sit-ups they need to do. so they're prepared to take the test and be successful. our recruitment unit also

conducts oral board mocks, mock oral boards, where we bring in the applicants who sign up. say, haney, this is what an oral board looks like. these are questions thattual be faced. this is how you should dress. just really the social skills and the interview skills they need to be successful. we help prepare applicants for these stages of the hiring process. our nontraditional are becoming traditional recruitment efforts. but we're reaching to the peace core, we're looking for people who have the sense of service. and we just published a full-page ad and an article in the peace corps magazine, looking for individuals we traditionally didn't seek in the applicant pool. we're looking at university sports programs, who people who are fit, have an education, who are used to working in teams. because coming into the police

department you are working in teams, you're not working alone. we're looking at sociology majors, we're looking at business major. we have veered from a focus of criminal justice majors. we're looking at people -- police officers coming into san francisco or in general are dealing with the sea of humanity, it's not just law enforcement. it's meeting people where they are in the streets to address whatever concerns, whatever services they need. and it's not always law enforcement. we're also looking at different organizations to market the police department. what's our brand, how are we marketing our selves and looking at recruitment specialists to help promote what we have in san francisco. what we can offer police officers in san francisco. that other agencies can't. and it goes into our recruitment challenges. it's just the cost of living. many police officers don't live in san francisco any more because of cost of living.

competitive salaries between the whole region, with smaller agencies in the east bay, north bay, with one-fourth the call volume they have on a daily basis, it makes it more attractive for some members to want to be police officers in smaller communities. but not only are we competing against law enforcement, we're also competing with the global job market, where people have choices now. where people can make the decision, haney, i want to be -- i don't need to be a police officer to make x dollars, i can work for google or some other private company. the dot com of 2008, we became a default for people, haney, you know, i'm out of a job. let's become -- let me become a police officer. we don't have that luxury right now. and then we also have a shift in -- a generational shift in careers. people, you know, are deciding they don't want to go into public service. and, you know, the applicant pool there is smaller than it

used to be. and throughout the years it's just slowly declining. as the population declines, the police department still has its requirements to test higher and conduct background investigations on applicants. so those are some of the recruitment efforts and some of our challenges. as i move to the next slide. like i mentioned, you know, kate howard and the fire chief, you know, working with d.h.r., you know, that's -- that's one of the best things we can do is just streamline our processes. but in addition to streamlining our processes with d.h.r., we are taking upon ourselves to focus on women and underrepresented groups within san francisco and communities throughout the state, and even the nation, to draw and recruit people to become police officers in san francisco. the streamlining of the process,

like the continuous hiring, the -- excuse me, the continual testing and having the oral and the physical agility testing run parallel. i mean, those are time savers that really help us hire police officers. but the process. how do we always improve. that's something that we need to do all the time. is how can we be doing better in recruitment, hiring, our backgrounding process. and particularly our retention. we cannot recruit our selves out of our shortage of police officers. we need to retain the members that we have now. and like i mentioned before, we do have, you know, competitive -- we do have competitive salaries and benefits. but benefits and salaries are not everything that keeps people here. their quality of life, the commute, driving over two bridges every day to come to work, facing that traffic. it's a challenge for members in

our public safety community to come here. but we also try to focus on what we can offer them. and what do we do as an organization, as a city, to ensure that our members have complete job satisfaction. they feel valued in the organization and that they're making a contribution. but also how are we caring for our members through health and wellness. because as chief nicholson mentioned, you know, there is a lot of things that our officers see and our firefighters see every day. but who are you we caring for them to ensure that they are mentally, physically able to take care of themselves, to provide that service that the community expects. so really focus for us in the police department is how are we going to take care of our members, show that they care. and as a city family, showing that all of our public safety -- our first responders are cared

for and appreciated for what they do every day. for them to put on this uniform every day, to give 1000% to a total stranger, for them to do that, we want them to want to do it, not that they need to do it. and how do we inspire and maintain their passion of what drew them to this noble profession of serving others. as kate mentioned, there is a process. there is -- our recruitment efforts that we have and then we'll go through the d.h.r. streamline process. that's two to three months, as kate mentioned. but for us the background investigations is probably the biggest block of time. one of the biggest blocks, three to nine months. and because the state of california has requirements for

the extensive background investigation for police officers or law enforcement officers in the state of california, we need to comply with that. and it's an extensive background, that includes a medical evaluation, a psychological, a polygraph. and it also goes into financials. so we really go into a lot of aspects of a person's life to become a police officer within the state of california. and a lot of times many people aren't able to pass the backgrounds because of their lifestyle, their choices. so after the background process, we are able to put people into the police academy. we have one of the -- we have the longest police academy in the state of california, with over 1220 hours of instruction. we have the longest at 34 weeks. and through a 34-week program, there's another 17 to 23 weeks of field training, where they apply what they've learned into the street. and then after that there's a

12-month probationary period for police officers. so there is significant time that it takes. and our academy is longer because we train to state's expectations. we train to the city's expectations and we train to the diversity of the city, where we have more training courses on de-escalation, procedural justice than some other academies do within the state. and with that training we also, if you will shoot ourselves in the foot, we train our members and they get the experience within the city and county of san francisco. and other smaller agencies, c.r. officers as seasoned veterans, that they can lateral into their organizations and take the training that we provide our officers to their benefit within their organization, without having to expense those costs of that initial training. so we train our officers very well, which is appealing to

other offices within the state. for that 64% of our police recruits pass the academy. once they get into the field training program, 82% of them complete the field training program. and then officers who have -- up to five years of service, 97% of them stay. and based on their staffing and employment, we're look at why. what is the why? why are people staying. with zero to five years in, you're talking about a young adult who doesn't have a family, who is single and they can work shift work, they can work off hours, they can do a lot of things. but as people grow, they settle, start a family, other things come into play. now that long commute at 21 years old with no family becomes different and difficult for them as they are trying to raise their families three, four counties away. so those are some of the challenges that we face. and, you know, as we continue to fill our vacancies, which is a fluid number, we want to make sure we fill those vacancies

with the right individual, who understands the diversity of this city, understands the values that this city and this department have. so we are selective of who we choose to be one of san francisco's finest. you know, our crime rate is down for violent crime. but as any organization, we can always use more police officers. because as we focus on one area of crime fighting, other areas may not get that same level of attention, such as our property crimes, where we see auto burglaries and property crimes rising in san francisco. the environmentals -- like we said it's difficult to compete with the global economy right now. and where people have choices. and it really takes a one-on-one effort to really recruit and touch a person's emotions to say, do you want to be a public servant. and with that i will take any questions. >> supervisor stefani: thank

you so much. i do have a few questions. i want to be quick. do you know how many officer vacancies we have currently? >> that's a fluid number. i don't have that exact number. >> supervisor stefani: okay. i know we've had trouble in the past actually filling our academy classes. can you tell us how many spaces are left unfilled in the last one? >> ideally the state of california allows us to fill 55 members. that's the maximum number of members we can fill. you know, back in 2014 to 2017, when we had an aggressive hiring plan, we were filling the classes with 55. but at this time we may be filling half those classes. and a lot of that is based on the applicant pool. people have choices of whether they want to be a police officer in san francisco, san bruno, red redwood city, in the state. we're competing. and as we have continual hiring process -- we announce when we're going to hire police officers, other agencies looking at our schedule and selecting individuals prior to our start. so they're getting us.

they're pulling candidates from us, knowing that if our academy starts in june, they're going to make a job offer in april. so it's difficult. >> supervisor stefani: have we we looked at ways to prevent that, in term of signing commitments. i don't know the legality of that. i know there's incentives, sticks might not be the way to do it. i know there are incentives for people to stay, so that they aren't poached by others. >> those are things we look at. we look at lateral signing bonuses to bring people over. but i think really we as a city just really need to highlight what we offer. we offer many other assignments that some agencies don't have, such as the mounded unit, motorcycles, a marine unit, which has drawn members from other agencies to san francisco, because they want to serve on a maritime assignment, which there aren't too many. full-time tactical unit. if you want to be on a full-time tactical unit, you come to san

francisco. in other agencies, it's a part-time ancillary duty you don't do full time. how do we promote not only the benefits and the specialties can offer, but also how do we care for our members. >> supervisor stefani: i know we're discussing police staffing at the full board on february 25th. i have a lot of other questions. i know my colleagues want to ask them. and we're on time limit. so i will allow you, supervisor walton. >> supervisor walton: thank you. just one question for now. what is the cadet program standing in terms of recruitment? >> the cadet program, you have college students. so we have the san francisco law enforcement cadets through high school. and then there's the san francisco police cadet program. so while in college, you can work within the police department. and this is like the feeder to the police department. so it's a matter of engaging,

continuing to engage with the cadets as they work through various assignments from the police department and prepare them for a career in law enforcement. so we still do have that. it is a feeder to full-time police officers. >> supervisor walton: when you get a chance, can you give us the data in terms of our participants who participate as cadets, that actually become police officers. or actually even work for the police department. >> yes. i will get that. >> supervisor stefani: i think that's it for now. thank you. >> all right. thank you. >> supervisor stefani: mr. brown. and i know this is only your second or third month on the job. i'm already hearing wonderful things. no pressure. >> you know, i can always come back. i think you are hard pressed for time right now. i can go ahead through my presentation. hopefully it will be quick.

so i just wanted to let you know that you may have seep my face before. but i used to be the director for the civil service commission. and i recently went back to the department of public health. and i had been working there from '92 to 2015. so i have some familiarity with some of the things that are going on. but as you began your presentation for this item, i noticed that you are focusing on the nursing positions. and so i will fill you in with some information that may not be in this presentation. that may be helpful. but i also wanted to include in my presentation, as you will

see, the behavior health clinicians. because i think that's also important public safety issue for the city as well. so there's some changes that have occurred in 2019, which i think is going to affect us going forward. and hopefully in a positive way. and our top priorities are going to be hiring registered nurses and behavioral health clinicians. we have a new director of public health grant colfax. a new director of human resources, myself, michael brown and new chief executive at the hospital. i have from my first two months being there, i have identified some problems, which we're working on, that were a result from the previous administration the hiring processes are not working. hiring time might still remain to be excessive and complain of inadequate h.r. staffing to support. so those are the things i'm work well. we have a budget and

trying to do something about that as well. when we talk about -- i skipped something here. what is our next slide? it's not showing up. it is, okay. let me just talk about briefly the behavior health clinician positions and i'll get back to the nursing a little bit later. there has been identified 51 or 52 positions that we're looking at to fill for mental health clinicians. i don't know where we are in the process. i think they're just now identified. but those are just the kind of clinician positions. also the ancillary positions that are going along with that as well, which will be a different number. as you see in the slide, there are a number of classifications. i don't have how many would be in each one of those classifications. but we also want to talk about this last one, which is currently recurrenting for behavioral health center director and also for mental health san francisco director.

they may be one in the same possibly. they may also be two different positions. those are going to be important positions we're looking for for that. for the nursing positions -- >> what's the denominator? 52 vacant out out of how many? >> total number i do dirk nowit. that's what's identified as prioritized for filling right now. there may be other monies coming into the city, even hiring more staff. i don't know what legislation would be coming forward from the state, for instance, for funding for mental health programs. >> it's just hard to know in a vacuum whether 52 is okay number, a terrible number or, you know, how it fits into however big -- however many behavioral health clinical positions are vacant out of some -- my suspicion is we probably have -- i think we've heard high vacancies.

but i'm not sure. but i don't know. >> i think you are going to have further meetings to talk more about the programs as well. and there will be somebody coming from the department that can probably give you more information on that. in the nursing -- from the nursing contracts, we had mandates that came out of the last negotiated session that ended if 2019. and we had come up with, i'm skipping down to additional hires, where converted three p103s to 2320s in the e.d., emergency department. we've also added two 2320s in the e.d., in addition to our budget for that. street medicine is something that i think the umbrella of ambulatory care, which is more like a central office, not necessarily at zuckerberg. we have converted two p103s to create two r.n.s for that. float pool. we created a float pool at zuckerberg. and we're also creating a float

pool of r.n.s at laguna honda hospital. we've added another 2420 positions at zuckerberg. my understanding there is currently identified 75 positions, r.n. positions for zuckerberg that are not filled. and i want to caution, understanding about the number. because there's 18 specialties. it doesn't mean that an r.n. is an r.n. there may be recruitment problems in terms of hiring people the specialty areas. we're going to be working on filling those vacancies as soon as possible. i am also in contact with the department of human resources on streamlining the process. so as i talked about inefficiencies and some of the things that were in the way, one of the things i did in 2015, i worked with the department of public health to give them the

ability to refresh the list on a continual list and hire in a timely manner. as i am back now in the department, it didn't -- for some reason the information of how to do it didn't get transferred correctly. it's now like a backlog of how to do this. we're working to streamline the process and working with d.h.r. and getting a commitment from the nursing department to also fund a recruiter, a full-time recruiter for nursing positions as well. and i think that's my quick five-minute presentation. if you have any questions, i can try to answer. >> supervisor mandelman: supervisor walton. >> supervisor walton: one quick question. i see the slide for identified problems. i don't see one for identified solutions. >> because we are still working on it. i'm still meeting with d.h.r. first, i've only been there for two months. so i'm identifying what the problems are, before i can talk about what the solutions are.

and it won't be a magic wand where i just come in and say stop and do this. i want to understand why we did something before i make a change. because there may be a reason why we're doing something. if we're going to fix it, how do we fix it so it works. >> supervisor walton: this is definitely not just on you. this is a concern that's been ongoing for a while. and so hopefully from a timeline perspective, we get some responses pretty quickly. but thank you so much for your work. >> supervisor mandelman: supervisor stefani. >> supervisor stefani: i'm going to hold my questions. mr. brown, thank you for the presentation. i know you've been on the job two months. i know what's that like when i became the county clerk. i did not know really what i was doing. but i had to turn the department around. and a lot of things needed to change and that tikes -- takes time. i want to thank again human resources, fire and public health for coming and presenting

today. this is such an important subject. as we head into the next budget season, we need to be aware of the tremendous need for these public health and safety positions. and we can't just make cuts because these departments have ongoing vacancies, as we've heard from the departments. they're often indicative of larger environmental challenges. and that's the reason why we have the vacancies, not because we don't need the positions. and i think, too, going forward i will be working with d.h.r. and the departments on is an alert mechanism for policymakers. so when we know like when supervisor walton just mentioned about what was going on at d.p.h. before you came along to fix it. you know, how can we be alerted to that going forward, if that should happen again. i know it won't happen under your watch. but not just in d.h.r., but in other departments, too. so let's see. what else? i think what i want to do, chair

mandelman, is continue this to the call of the chair. and come back at another time and see where we're at. i know the departments are all working on recruitment and retention and streamlining the hiring processes for, like we said nurses and a lot of positions under d.p.h. so if we can do that, i would greatly appreciate it. and thank you everyone for coming today. >> supervisor mandelman: are there any members of the public who would like to speak on this item? seeing none, public comment is now closed. [gavel] mr. bano, were you presenting? no. then i will -- then i will make a motion that we continue this to the call of the chair. we can take that without objection. [gavel] and, mr. clerk, any other items before us today. >> clerk: there is no further business. >> supervisor mandelman: then we are adjournedded. thank you.

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