>> chairwoman: good morning, everyone, the meeting will come to order. welcome to the march 2, 2020, meeting of the rules committee.

i'm supervisor hillary ronen, chair of the committee. seated to my right is captain stefanie, and we'll soon be joined by supervisor gordon marr. mar. mr. clerk, do you have any announcements? >> yes. please silence your cell phones and all electronic equipment. completed speaker cards and copies of any documents should be submitted to the clerk. items acted upon today will appear on the march 10 board of supervisors agenda unless otherwise stated. >> chairwoman: can you read item number one. >> item one is appointing two members to the commission on aging and advisory council. >> chairwoman: than thank you so much. i believe we're joined by juliette rothman.

if juliette would like to come up and address the committee, thank you so much. if you just want to share with us your interest in the appointment. how are you? >> good. i'm here to seek reappointment to the advisory council, and just to tell you a little bit about myself. i worked in the direct practice of aging and disability for 25 years and have chaired ethics committees and hospice committees and all that kind of stuff. i got really concerned about some of the ethical issues in health care, and went back and got a ph.d. in health care ethics. and taught at catholic move to franchise, taught at cal for 15 years in special welfare and public health, and in the si

six-year joint medical program. and now i'm retired, and i'm really enjoying the shift from micro-practice, direct practice, to looking at things on a more macro level, after i taught macro, and now i'm getting to experience it. i'm serving on the aquatic park senior center's team lead, the neighborhood circle, and etc., etc. i really have been enjoying what i'm doing with the council. and i would like to continue. >> chairwoman: thank you so much for your service. do you have any questions? >> no. i just want to thank you for your service, especially with regard to aquatic park senior center since that is in district 2. thank you so much. >> chairwoman: if we could hear from ms. graff.

is that all we need from you? >> that's all. >> chairwoman: you're so impressive, we need no more information. >> good morning. thank you for listening to my petition here. i'm margaret graff and i'm a senior. this is specifically for reappointment to the advisory council to the commission for das. i am nominated by supervisor gordon mar. and i have the honor to be nominated by two different supervisors since i was originally, first time around, a nominee of katie king. i've been -- my term expires on march 31. and i am seeking renomination because i think my work isn't done, or what i can contribute

to the advisory council. presently on the advisory council, i serve on the executive committee because i am also the elected second vice president. i also serve on the legislative committee. what that specifically does is we review pending bills that are in the state legislature and follow them as they work their way through, or not, as the case may be. and as they work their way through, if we feel a response is a good idea, we bring to the advisory council a suggestion of writing a letter of support. as far as my background is concerned, i'm a retired registered nurse, and i'm a retired attorney. so i have a medical and a legal background. >> chairwoman: can came first? >> the registered nurse.

i was a registered nurse, and then i was a stay-at-home mom for 13 years, raising my three children. i've been a 56-year resident of district 4, so basically i was born in the midwest, and midwesterners tend to put down roots deep, so i did. >> chairwoman: can i ask you what inspired you to go to law school and get a law degree? i'm just curious. >> well, you're talking to an older woman here. i always wanted to be a lawyer. but i grew up in a very small town in the midwest, and at that particular time, women didn't go off to become attorneys. we, at best, got to be teachers or nurses. and so that had to be put aside, which i did. and empty nest syndrome,

where the children are beginning to get their wings a little and spread them, i thought, now or never. so i went to law school. >> chairwoman: well, speaking to two women attorneys, thank you for forging the bath for us. >> in my case, what glass ceiling? one of the things that inspired me to get so involved in the community, approximately seven years ago, my husband started to develop the symptoms of dementia and alzheimer's disease. and i was scared to death. and i didn't know where to go or what to look for or where to get help. and in the process of finding my way through that maze, and finding that i didn't feel that -- there were so many agencies in san francisco, and it is so hard to evaluate what will help,

but i felt i needed something locally, in my so about a year and a half ago, i went to katie king, and i said, i have an idea. i can't find what i want to meet the needs of a care-giver for a dementia patient, so i want to start something. and i started a group called "senior power." and if supervisor mar were here, he would readily tell you that i talk about it all of the time. no one is safe from my talking about senior power. but basically it is a non-profit organization. it is community-driven, and the focus is on seniors, their families, and the care-givers. because of the nature of the district i come from, which is predominantly asian and pacific islander, i'm very proud to say that within this past year we now have

offer translation services at our meetings. we meet monthly. we have guest speakers. we practice chi gong, and we have raffle prizes and light refreshments. it is a socialization, getting them out of the household. and that has led me to serve presently on three committees for supervisor mar. one for the elders. one for the safety -- street safety. and the other one for the city college satellite that we were able to bring to district 4. and within that city college satellite program, what we now have is a class for older adults, which basically is t tai-chi. so round-about circle, one

of the things we tried to do -- i'm probably going way over my minutes. one of the things that we need to do is all of these good services, to bring them to the outer districts, the to community, and serving on the advisory council, i have a firsthand seat at learning these. and i take it back. that's the whole point, frankly. >> chairwoman: thank you so much. >> thank you very much for listening. >> chairwoman: thank you. i will now open this item up for public comment. if any member of the public wishes to speak of these two appointments, seeing none, public comment is closed. i just wanted to thank supervisors peskin and mar for appointing these extraordinary candidates for this advisory board. thank you so much for your willingness to do this work. it is crucially important.

and captain stefanie has a few words. >> i want to echo your thanks to both supervisors for coming forth, both of you. i think this is such an important topic. i talk about seniors all of the time. i just actually returned home from mersed, where my dad was diagnosed with lewy body dementia two years ago, and he is declining rapidly. this weekend was the first weekend where he didn't recognize me. and it is very difficult for care-givers, and watching a man who his library is full of the most difficult books one could ever wrapped their minds around, and now he is holding children's books, and watching this, someone just disappear, is extremely difficult. i want so badly to be able

to figure out how we can help those suffering from dementia, and also how we can help the care-givers. so i really want to follow up with both of you, and to see if we can bring any of the programs you talked about to district 2, and how we can just support those that are care-giving, and those that are suffering. and if there is anything that we can do, i can't even begin to tell you what my family has been through with this diagnosis and just watching my dad disappear. thank you again for this extremely important work. i'm thrilled to be able to support both nominations today. so with that, i need to put my glasses on. i would like to move forward with positive recommendation. the appointment of juliette rothman to seat 4 on the aging council, and margaret graff, to the

full board without objection. >> chairwoman: without objection, that motion passes unanimously. thank you so much. [applause] >> chairwoman: mr. clerk, can you please read item number two. >> a hearing to consider appointing one member to the parks and recreation open space advisory commissioners. >> chairwoman: good morning. >> thank you for the opportunity to come in and speak about this. my candidacy for the prozac committee. i have been a district 4 resident since 1986, so that is 34 years, and i married a district 4 native, with hi our two sons in district 4, who have now grown.

and we have really relied on the open space and parks we have out there and throughout the city. the recreation centers, the west sunset, south sunset, we're very lucky to have these resources in our community, as well as the summer lakes, the kisar sports camp. that is to say i realize how important it is to have access to open space and parks for everybody, all ages and especially kids growing up in an urban environment. since 2016, i've been managing playland at 43rd avenue. it is a community resource that turned a vacant lot around the old francis scott key school into a community recreation area, that has skateboarding, gardens, art programs, yoga for all ages -- which i want to tell margaret about later. so that has been a really rewarding opportunity to see all of the different

people in our neighborhood coming together in different ways and using this really active space that houses all these different things. however, playland will be closing at the end of this year because of the teacher housing that is coming in, which is a great thing. and we knew that from the start of playland, even as the community was building and managing the space. supportive of the teacher housing, it is something we really need in san francisco. but it points to the other need of recreation and open space that we will now be losing. what is going to happen to those activities and where will the people go? i know i've been talking with supervisor mar, and i know he is looking at alternatives and what can we do? where can we find other spaces, other types of spots for these kinds of activities? and that's something i'm really looking forward to having the opportunity to support him on, as a member of this committee.

there are other things going on in district 4, like the sunset boulevard master plan where we might be able to combine some play or some gardening or maybe a little skate park. there is possibly vacant storefronts, church properties that gordon has been working on transitioning. i think it is opportunities and being creative and thinking of recreation and open spaces and environment in maybe different ways, and maybe alternative types of spaces than we're used to seeing in terms of rec and park. so if i have the opportunity to serve on this committee, i hope to make sure there are these kinds of spaces for our district 4 residents, but also throughout all of the districts. districts in san francisco. and at the same time, supporting our city's sustainable green infrastructure.

thank you. >> chairwoman: thank you for all of your service. i appreciate it. >> no questions for me? [laughter] >> chairwoman: i'm opening this item up for public comment. is there any member of the public comment that wishes to speak. seeing none, public comment is closed. again, supervisor mar made an excellent appointment. thank you so much fo for your extraordinary work. thank goodness we have such amazing people in san francisco willing to invest in their community. and all women. >> women's history month. >> chairwoman: do you want to do the honors again? >> i would like to move forward the appointment of susan ryan to seat 3 on the park and recreations open spaces. >> chairwoman: that without objection, that passes. >> i would like to note that supervisor mar was

absent for that vote. >> chairwoman: can you please read item number three. >> item number three is a hearing to appointing one member, ending march 31, 2022, to the pedestrian safety advisory committee. >> chairwoman: thank you so much. is ms. marta here? thank you so much. good morning. >> my name is marta lyndsay, and an education instructor at walk san francisco, and i've been there about two years. and i have enthusiastic support from the organization to be the person to represent the pedestrian safety advisory committee. and i am a long-time san francisco resident. i have two young children. and i walk for almost all of my trips everywhere, and i feel these issues very personally, and i'm extremely committed and excited to get on the committee at this time. i've attended several

meetings. we need to kind of get the committee sorted out on some fronts. and really harness the energy of the group for being another voice for pedestrians. so i think that's all i have to say. >> chairwoman: i'm just wondering, given what a horrible start to the year we've had with pedestrian fatalities and injuries, just your thoughts on how the group is doing and what additional resources, if any, you need. >> yeah. thank you. i would like to report back on that after getting to participate in the meetings actively. but i think there is one thing,, onthing -- one thing wed is more members. there are several vacancies, and it is

making it hard to have a quorum for voting. we're reaching out to senior and disability groups to fill the two empty seats right now that need to have folks representing senior disability groups. and there are a couple of other districts, i think, that i can't name right now. so that's going to be important. i think we have some great folks on there that are ready to get organized as a group and be a stronger voice, which we need right now. we need every voice possible. so, yeah. thanks. >> chairwoman: opening up this item for public comment. any member of the public wish to speak, or from city departments? >> good morning, madam chair. elo ramos speaking on my own personal time. i want to take the opportunity this morning to support ms. lindsey's appointment. i've had the privilege of knowing marta forgoing on 14 years now. i've had the privilege of working with her in the

past, when she was an advocate with myself, working for a safer, more inclusive and more functional, sustainable streets. she is a fierce advocate. she will hold us accountable. i knew her the whole time i was on the board of directors for the m.t.a., and just being her co-worker did not mean anything to her when it came to pulling me into conversations around doing better to get to our vision zero target more quickly. she has an extraordinary love for this city. she is deeply committed to the safety, and not just for her children, but for everyone. and she brings this incredible, talented lens that speaks to communications and inclusiveness, and just a wonderful vision for vision zero. so i'm confident knowing the two of you, and your values, from a safety and security perspective, you'll very proud to make her appointment. >> chairwoman: any other public comment? seeing none, public comment is closed.

[gavel] >> chairwoman: go ahead. >> okay. great. well, i'm thrilled to be able to put forward with positive recommendation to the full board marta lindsey for seat 1 on the pedestrian safety advisory committee. >> chairwoman: without objection, that motion passes unanimously. >> and i would like to note that supervisor mar was ab sen absent for the vote. >> chairwoman: can you please read item number four. >> item four is a motion for the board of supervisors' rules of order to set the process for the administration of oath for individuals testifying before the board, and to authorize the government audit and oversight committee to issue orders and issue subpoenas. >> chairwoman: thank you. and we're joined by supervisor peskin. do you have any remarks, supervisor peskin?

>> thank you, chair ronen, supervisor stefanie. before you are the amendments that were proposed in committee last week, that you verbally suggested the city attorney, in consultation with the clerk of the board, insert into the language that is before you today. i know that the clerk of the board, ms. calvio, is here if you have any questions for her. i'd like to thank her and deputy city attorney pearson for their work on this. i would like to, subject to public comment, duplicate the file and remove, in section 6.7.1, in a file to be forwarded to the full board, the

language with regard to the administration of oath to a department head, and leave that in committee so that if there is any desire by the m.e.a. to meet and confer on that, we can do so. and send this item, with the amendment removing that, to the full board with recommendation, if this committee sees fit. >> chairwoman: and to the city attorney, have we reached out to the m.e.a.? >> yes. this draft has been sent to the m.e.a. >> chairwoman: and when was that done? >> that was done at the end of last week. i believe it was on thursday. >> chairwoman: and have we heard back? >> i have not. >> chairwoman: and have we been in touch with d.h. r.? >> it was sent to d.h. r-- to m.e e.a.through d.h.r..

i don't know if they've determined there is a need for it, so we sent it to them. and it is up to them to decide if there is a need for meet and confer. >> chairwoman: why hasn't that happened before today? >> i don't know. it is a decision to be made by d.h.r. i don't know. >> so the legislation, without that language, was introduced and approved, and d.h.r. had no comment two years ago. so the only thing that changed is this language, which i think spurred the city attorney to send it to d.h.r. i think we have some options, one is we can send it to the full board with this language, and if there is a desire for meet and confer, we could remove that language at the

full board. that would be another option. >> chairwoman: yeah. i mean, this other language is important to me, given what we're facing. and it doesn't seem like there was the urgency to reach out to d.h.r., to ex them for their conclusion. it doesn't take two weeks to determine if the legislation is subject to meet and confer. >> i think a week has gone by. i like the language. i would like to keep the language. but i think perhaps, rather than duplicating file -- or we could duplicate the file, and keep one here, and send the exact same file to the full board. and if the full board needs to remove that clause in section 6.7.1, we could to so next week. >> chairwoman: okay. i'm just expressing my disappointment to

d.h.r., i don't know why it would take an entire week to decide if this is subject to meet and confer. it is a simple analysis and decision. so i don't know why that didn't happen, and i'm frustrated, so i just want to communicate that. having said that, are there any other questions or comments before opening this item up to public comment? no? >> i do want to thank you for approving item number one. >> chairwoman: yes. what an excellent candidate. is there any member of the public who wishes to speak. seeing none, public comment is closed. so i will make the motion -- i guess any supervisor -- it doesn't have to be a committee member -- can duplicate the file? or does it have to be a committee member that duplicates the file? >> i believe a member of the committee to request a duplicate. >> chairwoman: motion to duplicate the file and to send -- and we

already accepted the amendments last week, so we don't need to do that again -- to send the item as amended with recommendation. >> yes. just to clarify, you have duplicated the file. the version of the file that will be referred to the board of supervisor with recommendation will not have the information regarding -- >> chairwoman: no. no. no. we're duplicating the file so that they're identical. >> yes. >> chairwoman: we're sending one version to the board of supervisors, and we're keeping one version in committee, but they're identical. >> oh, yes. just to note that if they are identical, one of them -- there are some rules regarding identical files. but we can discuss that at a later time. >> chairwoman: okay. we have both the clerk of the board and the city attorney here, so i'm wondering if we want to talk about those rules? no? >> if they -- >> chairwoman: okay. great. one more time, i'll just

repeat: we're going to duplicate the files so we have two identical versions. one is going to stay in committee, and one is moving to a full board. my motion is to send the duplicated file to the full board with positive recommendation. >> yes. >> chairwoman: can we take that without objection? without objection, that motion passes unanimously. payers than >> thank you, madam chair and colleagues. >> chairwoman: mr. clerk, can you please read item number five. > [item five read] >> chairwoman: good morning, mr. agustine, how are you? >> david augustin augustine her. we're here to talk about

the exciting world of unsecured personal property taxes. things like business fixtures and things of that note, and equipment. we have an ordinance for the first time that we're approaching the board to consider. i would like to spend a couple of minutes to talk about why we're coming to the board because this is something we have not done, at least in my 15year years in office. it will allow the patroller to collect personal property debt on an ongoing basis. i want to make sure this legislation does not allow for cancellation of any secured security taxes, i.e., secured by land or ones difficult to collect. this ordinance would allow only for cancellation of unsecured personal property debt. all bills that could be canceled, we would only cancel them if they're literally uncolleccollectible.

there are three categories only. first, any amounts over 30 years old. second, any amounts that have been discharged after bankruptcy, again, we would be legally barred from collecting these accounts. and, third, any lean that has failed to have been filed or renewed. as a side note, before 2015, we had a manual lien removal process, essentially within three years of the debt being valid, to go and record with the recorder's office, and we could renew it up to two different times. we now have an automated process where liens are automatically renewed, and we don't have to have people walking across city hall to record a document. so that would be the third category. it is a relatively small

category. so why now? why are we asking now for this power? the office of the treasurer and controller are migrating to a new tax operation. and wcancellation of these accounts will allow us to transport tens of thousands of accounts. again, some of these obligations go back 50 years. we're proud, we have a high collection rate for unsecured personal property tax collection, about 95%. every year we collect about $170 million annually in unsecured personal property taxes from about 80,000 different taxpayers. our systems have all been overhauled and allowed for automated contact and imposition of liens. canceling uncollectible debt is a practice other

counties engage in. in addition, i did a quick survey of our colleagues in our california tax collector group and found out that hum belt, spanish law, and del nor have all canceled debt recently. what we're talking about is the accounts that have about $20 million, and with interest, it is about $100 million. and the reason the interest is so high because sometimes the accounts go back to about 50 years, and numbers about 35,000 accounts. by far, the greatest challenge to those accounts represent bills that are over 30 years old, and the other challenge is bankruptcy or failure to renew a lien. with that, i would be happy to take any questions or discuss this in more detail. >> chairwoman: sure, does this authority currently rest with the board of supervisors? >> that's right, it does. >> chairwoman: out of

curiosity, what ask to delegate this authority? >> great question. we proposed taking it out of the board's hands because we wouldn't be exercising, en m, in my view, any judgment. if we were choosing judgments that were difficult to collect, maybe there was a debtor that moved out of the country, i feel like that is of province of the board to cancel. these accounts we are legally unable to collect, so i thought we would take time off if we took ought off the board. we could come back to the board if it was not falling into any of the three buckets i articulated earlier. we want to make sure we use the power judicially and appropriately.

it is not our business to cancel accounts to begin with. it is my job to collect these taxes, and so that's certainly what we look forward to doing. >> chairwoman: why the controller and not the treasurer directly? is that because you want an outside party making the judgment call -- >> that is the state revenue and taxation code requirement that allows this to happen upon the state controller, usually the responsible power. it is a separation of powers issue, which we think is extremely appropriate. we would make a recommendation, and the controller would accept it or not accept it and we would go forward from there. >> chairwoman: thank you. is there any public comment on this item? see none, public comment is closed. it makes a whole lot of sense to me. it looks like my colleagues agree. so we would like to move this forward with a positive recommendation,

and without objection that motion passes unanimously. mr. clerk, is there any other items? >> that completes the agenda for today. >> chairwoman: and the meeting is adjourned thank you. >> shop and dine in the 49 promotes local businesses, and challenges residents to do their

shopping within the 49 square miles of san francisco. by supporting local services in our neighborhood, we help san francisco remain unique, successful, and vibrant. so where will you shop and dine in the 49? >> i am the owner of this restaurant. we have been here in north beach over 100 years. [speaking foreign language] [♪] [speaking foreign language]

[♪] [speaking foreign language] [speaking foreign language] [♪]

>> this is a huge catalyst for change. >> it will be over 530,000 gross square feet plus two levels of basement. >> now the departments are across so many locations it is hard for them to work together and collaborate and hard for the customers to figure out the

different locations and hours of operation. >> one of the main drivers is a one stopper mitt center for -- permit center. >> special events. we are a one stop shop for those three things. >> this has many different uses throughout if years. >> in 1940s it was coca-cola and the flagship as part of the construction project we are retaining the clock tower. the permit center is little working closely with the digital services team on how can we modernize and move away from the paper we use right now to move to a more digital world. >> the digital services team was created in 2017. it is 2.5 years. our job is to make it possible to get things done with the city online. >> one of the reasons permitting is so difficult in this city and

county is really about the scale. we have 58 different department in the city and 18 of them involve permitting. >> we are expecting the residents to understand how the departments are structured to navigate through the permitting processes. it is difficult and we have heard that from many people we interviewed. our goal is you don't have to know the department. you are dealing with the city. >> now if you are trying to get construction or special events permit you might go to 13 locations to get the permit. here we are taking 13 locations into one floor of one location which is a huge improvement for the customer and staff trying to work together to make it easy to comply with the rules. >> there are more than 300 permitting processes in the city. there is a huge to do list that we are possessing digital.

the first project is allowing people to apply online for the a.d.u. it is an accessory dwelling unit, away for people to add extra living space to their home, to convert a garage or add something to the back of the house. it is a very complicated permit. you have to speak to different departments to get it approved. we are trying to consolidate to one easy to due process. some of the next ones are windows and roofing. those are high volume permits. they are simple to issue. another one is restaurant permitting. while the overall volume is lower it is long and complicated business process. people struggle to open restaurants because the permitting process is hard to navigate. >> the city is going to roll out a digital curing system one that is being tested. >> when people arrive they

canshay what they are here to. it helps them workout which cue they neat to be in. if they rant to run anker rapid she can do that. we say you are next in line make sure you are back ready for your appointment. >> we want it all-in-one location across the many departments involved. it is clear where customers go to play. >> on june 5, 2019 the ceremony was held to celebrate the placement of the last beam on top of the structures. six months later construction is complete. >> we will be moving next summer. >> the flu building -- the new building will be building. it was designed with light in mind. employees will appreciate these amenities. >> solar panels on the roof, electric vehicle chargers in the basement levels, benefiting from

gray watery use and secured bicycle parking for 300 bicycles. when you are on the higher floors of thing yo of the buildt catch the tip of the golden gate bridge on a clear day and good view of soma. >> it is so exciting for the team. it is a fiscal manifestation what we are trying to do. it is allowing the different departments to come together to issue permits to the residents. we hope people can digitally come to one website for permits. we are trying to make it digital so when they come into the center they have a high-quality interaction with experts to guide then rather than filling

iin forms. they will have good conversations with our staff. >> what we're trying to aff. approach is bringing more diversity to our food. it's not just the old european style food. we are seeing a lot of influences, and all of this is because of our students. all we ask is make it flavorful. [♪] >> we are the first two-year culinary hospitality school in the united states. the first year was 1936, and it

was started by two graduates from cornell. i'm a graduate of this program, and very proud of that. so students can expect to learn under the three degrees. culinary arts management degree, food service management degree, and hotel management degree. we're not a cooking school. even though we're not teaching you how to cook, we're teaching you how to manage, how to supervise employees, how to manage a hotel, and plus you're getting an associate of science degree. >> my name is vince, and i'm a faculty member of the hospitality arts and culinary school here in san francisco. this is my 11th year. the policemrogram is very, ver

in what this industry demands. cooking, health, safety, and sanitation issues are included in it. it's quite a complete program to prepare them for what's happening out in the real world. >> the first time i heard about this program, i was working in a restaurant, and the sous chef had graduated from this program. he was very young to be a sous chef, and i want to be like him, basically, in the future. this program, it's awesome. >> it's another world when you're here. it's another world. you get to be who you are, a person get to be who they are. you get to explore different things, and then, you get to explore and they encourage you to bring your background to the kitchen, too. >> i've been in the program for

about a year. two-year program, and i'm about halfway through. before, i was studying behavioral genetics and dance. i had few injuries, and i couldn't pursue the things that i needed to to dance, so i pursued my other passion, cooking. when i stopped dance, i was deprived of my creative outlet, and cooking has been that for me, specifically pastry. >> the good thing is we have students everywhere from places like the ritz to -- >> we have kids from every area. >> facebook and google. >> kids from everywhere. >> they are all over the bay area, and they're thriving. >> my name is jeff, and i'm a coowner of nopa restaurant,

nopalito restaurant in san francisco. i attended city college of san francisco, the culinary arts program, where it was called hotel and restaurant back then in the early 90's. nopalito on broderick street, it's based on no specific region in mexico. all our masa is hand made. we cook our own corn in house. everything is pretty much hand made on a daily basis, so day and night, we're making hand made tortillas, carnitas, salsas. a lot of love put into this. [♪] >> used to be very easy to

define casual dining, fine dining, quick service. now, it's shades of gray, and we're trying to define that experience through that spectrum of service. fine dining calls into white table cloths. the cafeteria is large production kitchen, understanding vast production kitchens, the googles and the facebooks of the world that have those kitypes of kitchens. and the ideas that change every year, again, it's the notion and the venue. >> one of the things i love about vince is one of our outlets is a concept restaurant, and he changes the concept every year to show students how to do a startup restaurant. it's been a pizzeria, a taco bar. it's been a mediterranean bar, it's been a noodle bar.

people choose ccsf over other hospitality programs because the industry recognizes that we instill the work ethic. we, again, serve breakfast, lunch, and dinner. other culinary hospitality programs may open two days a week for breakfast service. we're open for breakfast, lunch, and dinner five days a week. >> the menu's always interesting. they change it every semester, maybe more. there's always a good variety of foods. the preparation is always beautiful. the students are really sincere, and they work so hard here, and they're so proud of their work. >> i've had people coming in to town, and i, like, bring them here for a special treat, so it's more, like, not so much every day, but as often as i can for a special treat.

>> when i have my interns in their final semester of the program go out in the industry, 80 to 90% of the students get hired in the industry, well above the industry average in the culinary program. >> we do have internals continually coming into our restaurants from city college of san francisco, and most of the time that people doing internships with us realize this is what they want to do for a living. we hired many interns into employees from our restaurants. my partner is also a graduate of city college. >> so my goal is actually to travel and try to do some pastry in maybe italy or france, along those lines. i actually have developed a few connections through this

program in italy, which i am excited to support. >> i'm thinking about going to go work on a cruise ship for about two, three year so i can save some money and then hopefully venture out on my own. >> yeah, i want to go back to china. i want to bring something that i learned here, the french cooking, the western system, back to china. >> so we want them to have a full toolkit. we're trying to make them ready for the world out there. is -- >> our united states constitution requires every ten years that america counts every human being in the united

states, which is incredibly important for many reasons. it's important for preliminary representation because if -- political representation because if we under count california, we get less representatives in congress. it's important for san francisco because if we don't have all of the people in our city, if we don't have all of the folks in california, california and san francisco stand to lose billions of dollars in funding. >> it's really important to the city of san francisco that the federal government gets the count right, so we've created count sf to motivate all -- sf count to motivate all citizens to participate in the census.

>> for the immigrant community, a lot of people aren't sure whether they should take part, whether this is something for u.s. citizens or whether it's something for anybody who's in the yunited states, and it is something for everybody. census counts the entire population. >> we've given out $2 million to over 30 community-based organizations to help people do the census in the communities where they live and work. we've also partnered with the public libraries here in the city and also the public schools to make sure there are informational materials to make sure the folks do the census at those sites, as well, and we've initiated a campaign to motivate the citizens and make

sure they participate in census 2020. because of the language issues that many chinese community and families experience, there is a lot of mistrust in the federal government and whether their private information will be kept private and confidential. >> so it's really important that communities like bayview-hunters point participate because in the past, they've been under counted, so what that means is that funding that should have gone to these communities, it wasn't enough. >> we're going to help educate people in the tenderloin, the multicultural residents of the tenderloin. you know, any one of our given blocks, there's 35 different

languages spoken, so we are the original u.n. of san francisco. so it's -- our job is to educate people and be able to familiarize themselves on doing this census. >> you go on-line and do the census. it's available in 13 languages, and you don't need anything. it's based on household. you put in your address and answer nine simple questions. how many people are in your household, do you rent, and your information. your name, your age, your race, your gender. >> everybody is $2,000 in funding for our child care, housing, food stamps, and medical care. >> all of the residents in the city and county of san francisco need to be counted in census 2020. if you're not counted, then your community is underrepresented and will be underserved.

sfgovtv sfg . >> the san francisco health commission is called to order. i will call roll. [roll call] >> clerk: the second item on the agenda is the approval of the february 4, 2020 minutes. >> commissioners, after review, does anyone have a motion to approve? >> motion to approve. >> second. >> all those in favor? okay. >> clerk: thank you. there are no public comment requests for that item. item 3 is the director's

report. >> good afternoon, commissioners. gra grant colfax, director of health. you have the report in front of you. just a couple of things. one is we are continuing our covid-19 preparations and actions. i've asked dr. aragon to provide more details after my report, so he will be doing that in just a minute. we are continuing with our ongoing daily work, and that includes behavioral health options for people in the city as part of our behavioral health reform as part of health s.f. we are currently establishing a health center, to be established at 180 jones, with a particular focus on methamphetamine users. this will have a 15-bed

capacity, take care of many more than that over a 24-hour period. this is really the beginning of a larger expansion if this initial phase is successful at providing more low-barrier opportunities for people to have a place that is safe, that provides harm reduction approaches and also not only helps them but also mitigates the effects of behavioral health issues in the surrounding community. i'm proud to announce an expansion of our hummingbird work. this is a pilot model that we've launched in the recent past, and we're now looking at 36 valencia with 25 beds. a key issue in the city has been the issue around boarding

care, and supporting boarding care. we've had a number of boarding cares close in the city in the last few years, and we have a number of boarding cares going forward. so just a lot going on in terms of that, creating more beds, and more infrastructure. i also want to say that tonight is black history month, and a key focus across the department has been black african american patients in the community. we have a number of articles that you can read at your leisure. the lunar new year parade was particularly relevant this year because of concerns of covid-19, and we know that with

misunderstandings with regard to how covid-19 is transmitted and the people that are at risk, there's an element of stigma and discrimination with this epidemic, and we're concerned that we're doing everything we can to mitigation that -- mitigate that, including having a very robust presence at this event. another event was the hearts in san francisco event, which is really celebrating the work that's being done at zuckerberg san francisco general hospital. there was a discussion around behavioral health work and strengthening our behavioral work. a number of key faculty were highlighted and honored, including, i'm proud to say, the social medicine team, and the staff there. as you know, dr. deb bourne and some of her team launching that

across the department. so there are lots of news reports. the d.p.h. was in the news quite a bit, particularly with regard to covid-19 and the expansion of our health work. and i will just ask dr. aragon to give a brief update on the ever-changing dynamic situation with regard to covid-19. >> good afternoon. thank you. the first thing i want to point out is the number of confirmed cases globally is over 75,000. currently, there have been over 2,000 deaths. in the united states, we have a total of 29 cases. i want to explain what i mean by 29 cases. 15 cases -- the 15 cases i

reported last week were people that were infected in wuhan, china. 13 of those, two were spouses. and then, 14 were infected near china. these were the cruise ship passengers that just returned, so the total is 29, but there has not been any documented community transmission in the united states at this time. california continues to have six cases plus two of -- what are on military bases. san francisco continues to have zero cases. i want to point out that the virus has been named sars

ii but it's been officially named covid-19. the virus that causes covid-19 is sars cov ii. i also mentioned the repatriation of 14 passengers from the cruise ship in japan. we realize we're not able to contact everybody, but we're

doing the best we can. and the other thing i want to mention is we've been doing site visits to hospitals, making sure they're prepared there there be any transmission. in san francisco, we're preparing for the time when we would have community transmission in place. we're focusing on transmission, containment, and then, community education. if there's ongoing transmission, what would we do in that scenario? that's what we're doing. the last thing i want to mention is because there are no cases in san francisco and because there has not been documented community transmission in the united states, we continue to have the

same advice that we had before, so it's business at usual. so that's the last thing -- that's it, unless there's any questions. >> before we move on, i just want to take the opportunity to acknowledge you three. because of your expertise and your preparedness. a lot has been asked of san francisco by the c.d.c. and others. i know folks have been putting in very long hours, whether it's doing outreach or addressing xenophobia in the community. you all deserve acknowledgement for this additional task that you've been doing in addition to everything else. so thank you to everyone in the

department and for really helping to keep the public and the community informed and feeling safe, so thank you for that. commissioner girado? >> i want to echo that. i have one question, and i need some words for you, okay? >> sure. >> if i may. at our child development center where we do treat medically fragile kids who are on m.g.s or g.-2s, etc., we've had a number of families cancel because they do not want to come in to a place where there are a lot of people in that

area. and they specifically state flu or coronavirus. do you have something we can state to families on the phone, in your best way versus mine, to be able to give one versus the other? >> yeah. we don't have any confirmed cases, and that's really important. we're about one week away from being able to do diagnostic testing. it'll be another week before the state starts testing, and then, our own lab is going to be doing testing. testing is really critical because we'll be able to test folks and to provide

reassurance and then also to monitor the situation. so i think having a lot of negative tests as we start testing people is going to provide that reassurance that things are okay, so that'll be a real game changer when we have a diagnostic test. >> so at this point, i should state these two facts that you gave me. >> yeah, state the fact. it's important -- it is important to do that because i know that people do worry, and it's natural to worry, so we just keep emphasizing the facts, and tell them to work on sthings th sthi things that they can do, like the vaccine and education. >> okay. thank you. >> commissioner chavez? >> yes, thank you. i also wanted to add and thank president bernal for his

comments, and commissioner b gerardo. -- as an emergency, and i would say that the press here seems to have been more responsible, also, probably at the fact that you were able to communicate with the press adequately and be able to have a level of credence with them that they were able to give that message out that in our community in chinatown to have the department of public health to have dr. colfax, to have dr. aragon, to have dr. faba, be

spokespersons. and it looks not only at the medical issues that might arise from this, but also the social issues that were involved, and that the city took a very positive position that was important to have all of us continue. but the other thing was to continue good sanitation at this point in time, and if anything was needed later, i think the credibility of this department is such that they're going to follow this and listen. but i did want to thank the department also for the very swift outreach and meeting the community. i think it's very different from where 13, 14 years ago, when we had the sars.

we weren't as well prepared, and there was a lot more concern and hysteria partly from ignorance. that still extends through much of the world, and particularly, of course, in the areas that are greatly affected, by i noted, but i was very pleased to see how san francisco is handling the issue. >> i want to acknowledge victor lim at the department of emergency management. he's been partnering with rachel kagan and her assistant, veroni veronica vane, and they have been instrumental in bringing us to gordon lau to speak to the students and bringing us to the parents. >> can i just -- i just also

want to acknowledge the department of emergency management, interagency, interdepartment response, so i want to acknowledge that. and i also think with regard to many people in the department who have been mobilized for this effort, you know, there's many people who are working literally 24 hours a day, in some cases, on this. and i think acknowledging susan phillips who were here just a couple of weeks ago, presenting on communicable diseases, as is dr. julie schulte, who are a communicable disease specialist. they've been doing outreach at the federal level and also community level, as well. and finally, dr. pak, who is

our director of the chinatown health clinic has just been a really key part of our community response as well as our medical response. >> thank you, director colfax. commissioners, other questions? >> thank you. >> i will note for the record that there were no public comments. item 4 is general public comment. just for you all to know in case you don't know how we work here, i toldhold a timer. when the timer buzzes, your time is up. >> great. fix request is from -- first request is from ron weidel. >> good afternoon, commissioners and president. my name is ron weidel.

i complained to you on february 4. i stated that that article would render my ability to be ever employed, and if employed, it would reduce my ability to earn what i earned here. while my resume has impressed recruiters and employers, i still have no job offers. as one recruiter explained it to me last week, he was able to show the recruiter and the employer my impressive background and how i'm an impressive fit for the position. however, the employer had read the article prior to the interview and said it came across me looking at sketchy. i have a career that includes 12 years of military service, 18 years of service with city and county government. every employer who has hired me has found me to be a valuable

and valued memory mer of management. i have no reviews less than exceeds or meets expectations. i have no discipline actions. i also have no negative perceptions with the exception of that examiner article of october 7, 2019. while i have some ideas why the department would orchestrate such an article, i have no proof. but it is keeping me from being employed and putting the welfare of me and my family in jeopardy. when they asked senior management why the article was created, they were told it was a mistake. in closing, i'm asking that you pass a resolution requesting that the examiner have the article unpublished, which

would have the effect of getting it offline. i'm going to leave a copy of my remarks with mr. moore, should you desire. thank you. >> thank you, mr. weidel. >> and i think someone from the audience looked like he was going to -- >> good afternoon, commissioners. my name is barry pearl. i'm a san francisco homeowner, a resident of the ingleside and district 11. i'm not sure if this issue has been raised with you, but we received a letter from recology dated january 17 of this year. the subject is adequate service requirements. i called recology in response to this letter which indicates that basically the property was not maintaining the garbage

service properly, that the cans were overflowing. and when i contacted one of the customer service people at recology, i was told that they were completely unaware that this letter was going out, that it was sent to all residents of district 11. it's very accuseatory, without any basis in fact. it should never have gone out to district 11, and i'd like to know why this district was chosen essentially as this pilot project. so i think your relationship with recology needs to be reevaluated, and you need to look into this particular issue. >> thank you. >> okay. those are the two public

comment requests for item 4. item 5 is a report back from the community and public health committee today. >> the community and public health committee met today, just before this meeting. we discussed sb 5 and sb 40, and the local efforts to implement the conservatorship program. we discussed the eligibility criteria and also what we might expect based on data from previous years. the goal is to provide conservatorship for somewhere between 50 and 100 individuals in san francisco based on the criteria with an effort to directing them towards permanent and stable housing as well as addressing some of their behavioral health and substance abuse issues. after that, we received an update on the methamphetamine task force. the recommendations of the task force included the meth

sobering center, which was addressed by director colfax in his report. the recommendations were grouped into four themes. i believe there were 17 recommendations and those included investing in models to improve health and wellness, to build capacity and training for staff and service providers, and to strengthen coordination among city services and systems. >> all right. we can move onto item 6, which is an action item, commissioners. this is a d.p.h. report, the budget for fiscal year 20-21 and 21-22.

>> as usual, we're having two budget hearings in the month of february. this is the second, however, our format is different than in

previous years thanks to a ordinance passed by board of supervisors across all departments on how hearings on the budget should occur. so last year, we did an overview on the instructions and our target, the mayor's five-year budget forecast, and some goals and themes for the budget submission, and today, we're bringing you a package of budget initiatives that show specifically how we intend to propose to the commission that we meet those goals and targets. so you have a set of initiatives in front of you that we're seeking your approval for today to submit to the controller's office at the end of this week and then to the mayor's office following technical amendments or technical analysis. so this week, we are seeking that approval. the budget process, of course, doesn't end today. once we submit our proposed

budget from the departments to the controller's office and mayor's office, the mayor's office has really a space of about three months to deliberate what we've submitted, to have discussions with us and other policy makers in the city about what the mayor and the mayor's office would like their budget submission to look like, and then, the mayor submits a budget to the board in june, and then the departments submit their budgets. we've got a lot to do until june, and in previous years, we were going to use that time in collaboration with the mayor's office and other interested stakeholders. the biggest piece, as we discussed last week, was the mental health s.f. program, which, as you know, was legislated in 2019 with the active involvement of the defendan department. it was an ordinance passed by

mayor breed and the board of supervisors, and it was a robust ambition that we could tackle budgets in san francisco. we're not proposing exactly what that would look like. what we're proposing to do is use that remaining three to four months to work with the mayor's office and other stakeholders to come back then with a proposal for what that first two-year budget cycle of mental health s.f. would look like. the scope of the -- the real vision for that program is going to take time to really roll out, and it's going to take money to roll out, and those are both things that are still under discussion is what's the sequencing of how we

approach this, and what are the funding sources there? the funding measures could include budget measures or other sources of revenue. we want to build the infrastructure and start to launch on this as soon as possible. so in the budget proposal before you, we are meeting the instructions from the mayor's office, so that means we're covering the revenue projected in the five-year plan, we are meeting our target for reducing the rate of our general fund growth that was given to us in the mayor's budget instructions. and in addition to that, we're attempting to leave some balance over and above our target that would be a starting point for kind of a down payment to begin building out some details of how that mental health s.f. program will look like over the next several months. so that theme, a little bit of

a different approach, we have used in some past budget -- budget cycles before the commission, but i think it's an acknowledgement of there's still work to do and thinking and decision make to do about mental health s.f. as we go through the rest of the budget cycle. so i'll turn it over to jennie, and we're happy to take questions. >> 'afternoon, directors. i'm jennie tam. the first two items were around revenues at zuckerberg san francisco general. the first item is our baseline revenues, which you've seen in years past, and so i'm pleased to say that we project to continue -- continue to project revenue growth at the hospital, and one thing you'll note is that in the second year, our projection does drop by $15 million. this is due to the current --

the expiration of the current medi-cal waiver that's due to expire at the end of this calendar year, december 2020, and the state and federal government are in the process of negotiating a new waiver. however, the devil's in the details on that, but our team is definitely monitoring all the changes that are happening at the state given the close contact. but given the fact that they don't expect the actual specific details until the end of this year, it makes it hard for us to predict which programs will continue, in what format they'll continue, in what forms they'll be implemented, how do the other counties actually factor in, because it's not just san francisco that are interested in these waivers. so with that uncertainty, we're projecting a lower amount of revenue, but this is something we'll definitely revisit in the following year. the second is around s.f.g.

revenues. basically, we're projecting $69.5 million of one-time settlements, and this is related to the waiver, as well. as part of the negotiation, the federal government says if california is interested in any kind of new waiver, it must close out all the old reports from prior waivers before the end of this year. currently, for san francisco, we have eight years open, starting from '07-'08 to '14-'15. assuming there are no significant changes in our cost reporting, we do expect we will be able to release the reserve against those reports, recognizing that revenue to help us balance. the third item is laguna honda baseline revenues, and this is our annual baseline projections for laguna honda, and this does report a release date.

item 4, i'm excited about this. commissioners who have been here for several years, you'll note that for several years, '16-'17, we've been loggislogg away for electronic health records. it's an integrated system that's both clinical and billing. there were multiple systems, multiple incident faces that will all be replaced, and i'm pleased to say that for wave one, we're expecting $11 million worth of savings for that. this is partially catching up on the cost of doing business, so we're requesting a 5% adjustment on our base contracts just for i.t., but that still leaves $9 million

and $8.6 million ongoing to reach our general fund reduction target for the department. 8-5, the next item, is related to back funding, population for federal funding health grants. population health is pretty specific about receiving grants from the federal and state governments, but there were some grants that expired, and pilots that were expected, and then, there were some grants that supported our core functions. so they've requested to backfill $1.5 million related to grants that are expiring and not expected to be renewed. the last revenue initiative is actually one that's revenue neutral, and it's around the san francisco health net work creating its own specialty pharmacy. this is a new program that would actually allow for the

network to create a specialty pharmacy for patients with complex needs. this isn't just penicillin, but h.i.v., oncology, antipsychotic drugs. it's a real high-touch population, and it's a need that we see in the community. based on our projections, we believe that we could cover recover and still provide the services for the community. it will take about two years to fully implement. the next cost is $3 million, analyzing the $8 million, but recognize many of these costs are having to do with contracts with smaller pharmacies to fill

these requirements. we are centralizing our quality management program at the two hospitals, at laguna honda hospital and san francisco general. this is being driven by three reasons. the first, as you know, drrp deficiencies found at laguna honda hospital with the discovery of patient abuse and diversion of nonpharmaceutical drugs. secondly, with the implementation of epic, we found that the work flow has changed significantly, and to ensure that we are sort of maintaining best practices, we need to augment staff. and then third, in the last several years, the center for medicare and medicaid studies have been increasing its regulatory reporting requirements. these three events have caused us to think and rethink our quality management, and so we

are centralizing, and so it is all under the health net work as opposed to having the central -- the hospitals having their own individual programs, and both the programs would report to a single q.m. director, and this allows for a standard report and also allows for assigned separation of the g.m. versus -- q.m. versus the operations at the hospitals. in addition, to support our own requirements on compliance and privacy affairs, we're going to be adding two positions to that program, just to make sure that we are maintaining and keeping up with all the regulatory requirements there. next, we have three new maternal child health equity initiatives. these initiatives are really focused around -- around birth and young families and pregnant young women, particularly from communities of color.

what's interesting about these programs is they really touch on three narratives. the first one is perinatal, and it provides basically community support and engagement for -- for expecting and new mothers. the second is a doula program that, again, supports women that have been identified by a maternal child health program that would be interested in additional care and support during their pregnancy and shortly thereafter. and last is the abundant birth program. it's a financial payment program for women who are expecting. and so -- and women of low-income that are expecting, and it actually is an income supplement program. and so when you're looking for

these three initiatives, we're looking at creating a community with the financial support and with the care, and that is sort of this multi-pronged approach that we're looking at in terms of health equity. because if we can intervene early on, that's where we're going to get the most bang for our buck. these are interesting pilots and we'll be interested to see the impacts of them in the future. next, we have operation and the census at san francisco general. as you know, since we've opened up the new san francisco several years ago, our census has been about budget, and so we've been running at a high census. and we recognized this in '17-'18. we created what was called the census project, which was sort of a pot of funds which would allow for the s.f.g. to tap into should it be going over census. but what it didn't provide was

actually permanent positions, and so we now fast forward three years into the new zuckerberg san francisco general, what we're seeing is that our census projection isn't really dropping. what we hear is we want to operationalize the census that we have, add permanent positions, and we're supporting the operations in three ways. the first is we're going to be opening up a new med surge unit. they'll be funding to flex up to 15 beds annually on average for -- i'm sorry, up to 15 beds per hospital policy, but it has permanent nursing positions to staff that adequately. we need to support our ancillary services, so we need to support food services and

environmental services, including porters just to sort of maintain the hospital operations. and lastly, we'll be budgeting permanent licensed psychiatric technicians to support the e.d. to make sure that we're meeting the hospital requirements around observation of clients with some acute behavioral health issues and be able to intervene as needed. lastly, we're -- our goal is really around workforce and supporting the work that we do, we have a lot of existing operations, and our goal with these -- with proposing 20 positions, supporting all aspects of h.r. is really to better support our h.r. operations. this is really just about

getting -- supporting the operations, but what it does is it enables us to take on new initiatives, including mental health s.f. as well as meet the regulatory requirements at zuckerberg general and laguna honda. so when we take everything into consideration, and when we look at some of the revenue growth that was already assumed as part of the deficit, we see what is proposed as a surplus of $7 million. what we would like to do with this surplus is to put it as a down payment for mental health san francisco.

again, we don't have the specific details of how we would implement that. we're working on an implementation plan, working with the mayor's office for her budget submission. but with your approval, this is what we would like to do. all right. so as mentioned before, we'll be requesting your approval, and we'll be requesting programming, which can include all of these items, mental health services, drug sobering, street outreach and infrastructure included in the legislation. a few commissioners have asked me about wage equity in our department, and it's a reporting requirement as part of the minimum compensation ordinance, and i'm pleased to say that the department has been involved with the planning efforts around the minimum

compensation ordinance. for the commissioners that aren't aware, it's an ordinance that increases the minimum wage for employees on city contracts. so what this does for the current year, it increases the minimum wage from $15.50 to $16.50. the city participated in a process with the controller and nonprofits to sort of plan for the impacts of the minimum compensation ordinance. that is a citywide process that was represented also by the human services agency and the controller's office. as a result of that, that committee made recommendations on how to address both of direct and the indirect impacts. so when we say direct impacts, it's literally that change in the base wage, from $15.50 to

$16.50 an hour, if you're making $15.50, and reporting to somebody who made $17, there's sort of a compression issue. the controllers went through a rigorous application process where we notified the pool all of the funds were available. nonprofits actually submitted applications to the controller's office, and through their evaluation, they allocated the department $1.2 million that will be ongoing in our budgets to address the facts of n.c.o. we are expecting a 2.5% increase for the cost of doing business also for our city contracts. we've been receiving 2.5% to 3% for the last several years. c.p.o.s are free to allocate this as they feel is appropriate, so they could use

it towards wages or rent or whatever they believe is most appropriate for the organizations. all right. so the next step is we submit on friday, but we are not done. we'll work with the mayor's office over the next several months. on june 1, the mayor will submit her balanced budget, and we will go through the board approvals in june and july. that's all i have for you at this time, but i'm happy to answer any questions you may have. >> all right. before we go into questions have commissioners, we do have four requests for public comment. the first, taken in order, is mary kate buckelew, and after that is anthony carrasco, wesley reagan, a.

>> hi. my name is mary kate buckelew. i'm here to support hespas budget asks and our behavioral health bucket. there are three asks that we're making this year. one is for an overdose prevention site. they basically let people use under clinical supervision and access counseling and referrals and cares. the second is transition youth services for transition-aged youth or t.a.y. the request is for a t.a.y. residential center. we don't have ongoing funding. so the overdose prevention site would be about $2 million, and

the special treatment ongoing operational funding would be about $1.4 million. and i also just want to put in -- i'm very grateful to the department for the budgeting around the m.c.o. and codb, as a member of the human services network, we're always pushing to see the deficits that we're seeing across the nonprofit organizations are properly funded. it would be great to see the investments in the codb as well as the increase of 4.3%. thank you very much. >> thank you. >> hi there. my name is anthony carrasco. i work with mary kate over at p compass, and for the city of berkeley, i serve on the city homeless panel of experts. maybe something that you might not be aware of, if you engage

in conversation with someone about the topic of family, studies have shown that they're dramatically more likely to have a strong sense of connection with you, and it's a very, very interesting phenomenon. i have a hard time talking about family. i don't come from a very good family. my family experienced homelessness for about ten years, and substance abuse took one of my brothers away from me. but got to go to u.c. berkeley, and i get to have a nice job now, but i do want to advocate again for some of these substance abuse issues. you're all here because you care. you're all here because some of this impacted you, and i just hope that other folks can be able to engage in conversation about family like anybody else. so the last thing i'm going to say is the ask that hespa are putting forward are completely in line with the mental health s.f. initiative, and i hope that you'll consider supporting

it. thank you. >> thank you. >> thank you, commissioners. my name is wesley saber, and i am the project manager with glide, and i'm speaking in support, to, of the hespa budget requests. significant gaps persist. these result in long waits for shelter and housing, unmet mental health needs among homeless people, and a lack of exit from the emergency shelter system. young people, too, need safe places to sleep and places to meet their needs. we desperate we -- i want to focus in on the homeless youth population. current estimates suggest there are 1,145 transition age youths

on the streets and in transition shelters. among the homeless youth population in san francisco, 76% of unaccompanied youth under 18 and 8 # 3% of transition-aged youth need shelter. homeless youth experience major psychiatric disorders at rates up to 4 times higher than their peers, and 31% identified areas of substance abuse as a homeless need. addressing homelessness is widely viewed as a preventive strategy -- up to 50% of chronically homeless adults are estimate today have been homeless as youth. homelessness now translated to

homelessness later. we have fantastic youth providers in san francisco such as the homeless youth alliance, and larkin youth street services. thank you. >> good afternoon. my name is marny reagan. i'm the director of larkin youth street services. i'm here to support the hespa budget ask. it would use a model that sbienz substan sbienz -- combines substance use treatment and counseling,

capturing youth through early intervention, screening and referral and decrease or eliminating substance misuse while increasing wellness through clinical intervention. currently there are no programs to serve the needs of transitional age youth. there is tremendous need for both residential need for transitional age homeless individuals suffering from severe behavioral health needs. the two are linked as one is not successful without the other. as individuals churn through the systems, through the hospital and back on the streets, this is a key intervention to halt that cycle. thank you. >> thank you. commissioners, questions? commissioner chaplin? >> yes, thank you. thank you for the very

comprehensive explanation of the budget initiatives. i'm struck by the fact that we are looking at a total budget of almost $2.5 billion, and therefore, our target, there, as you have pointed out is somewhat less, of course. it's a 3.5%, right, per year. >> correct. >> which is therefore -- and that will equal $141 million over the years. and so i think what we would -- what i would like to look at is the thought that has gone into the initiatives. i'm assuming that we have carefully been evaluating the different programs that we already have, and i guess the first thing, though, if you'd answer, when you brought up the wage equity initiatives, this

is in addition to this or it's already been incorporated into the total cost, and likewise, the cost of doing business. are those additional amounts that we don't have to count for or that have come from the controller or is it in our budget? >> that's correct. the 1.2 million and the 6.6 million we're expecting for the cost of doing business are in addition to the proposal you see before you. as you know, there's a number of costs that the city looks at overall in addition to the cost of doing business, m.c.o. it is our staff wages, health benefits, fringe benefits, and what you haven't seen it the impact -- is the impact to that because that's sort of centrally managed by the mayor's office and controller's office

>> i do think that's an advancement in our budget here because perhaps in the distant past, those had to be absorbed by our budget. so i thank the mayor's office for such instructions, really. okay. so if we can go -- and i'm sorry i wasn't here at your first presentation. i'm sure it was excellent, so i'll only look at the budget initiatives and ask several questions -- maybe you had already answered them in the previous meeting. and in particular, the first one is i -- the estimate of about $38.5 million additional in general revenue seems very large; so could you put that into a perspective? what percentage is that increase? i know it's in here, i've read

it before, but i can't quite remember. i mean, that's a big piece here of our budget balance. >> well, i don't have the exact figures with me, which i should have. but so of our 2.4 -- 2.3 to 2.4 billion budget, about three-quarters of that is revenue based. so actually, in the grand scheme of things, if you take our revenues together, and we're at 1.6 billion or so, this $38 million is significant. it's big. it's a lot of money, but it's not often that we see in terms of how it's increasing or how it comes through the various state and federal programs. so a couple of things that you

are seeing in these rates is that we have or in the revenues that are in front of you are we have continued for the last several years, and you see it in our financial statements, to outperformed our service budgets in our fifa revenues and our budget revenues. those are kind of the core waiver programs. we're conservative in those estimates. a portion of this revenue increase is us shoring up our revenues to what we're seeing in terms of our actuals in the prior year's financial statements, in the second quarter, the previous year's

financial statements. we'll have those to the commission shortly. as generally described -- jennie described, we are budgeting a back down, so it's not a year-over-year, but it's less aggressive, and that is us trying to be conservative for the reason that jennie described. we have a lot of moving pieces in terms of the current medicaid waiver, which is about $150 million in revenue for us. we don't know exactly what that's going to look like. in prior waivers, we've done better or worse, depending on the waiver and depending on the subbucket of money within the waiver, so we are anticipating that we'll have pieces of our waiver funding continue, albeit in a different form, but we're trying to leave ourselves both a little bit of room, both to be conservative if something goes wrong, and frankly, so that next year, when we're back

here, if things go right, we'll have a little bit of room to work with. >> okay. so if i may ask several more of them -- and i agree. i did find also that you're putting in 13 million of new revenue from the graduate program, is that right? >> yes. >> well, your first year. >> that's correct. >> and then, the second year, you've dropped back. >> yeah. that's a new funding source. >> compared to the 1.6 billion -- thank you -- this is a smaller amount of money. it looks big -- it is big. >> it is. >> but i think at one time, when we started on this commission, we were under 1 billion as a total, and these numbers are just sort of shocking to me sometimes. and so when you're speaking -- oh, let me go onto actually the

expenditures. on the expenditures, we show a considerable number of f.t.e.s that are being added to the budget, and i know that each one seems to have a logic. i'm wondering, we currently have two quality management programs already, one in each of the hospitals. by combining them, what is the logic for them adding ten more f.t.e.s? >> the basic logic is the event the at laguna honda exposed some deficiencies in our q.m. systems, and so as we've reacted to that, and the team is still learning and going to learn as we implement this about what our program is going to look like. there's several things that have come up. first, it's the fact that there were issues that we didn't identify and remediate.

we've got work plans that have come out of the regulatory reviews in addition to that. and in particular, we've identified some issues -- when issues are identified, they are delivered to the management in nursing to investigate, and that's not a best practice. the best practice would be that you have a team that is outside and doing that investigation both so that you're not pulling away from patient care time, but also so that you're having clear delineation between those that are investigating and those who are responsible for providing the care. and so that's a piece of it. i think that the q.m. team is being pretty direct, that there is going to be learning to do as we get this up and running. we'll have parallel structures

at each of the opportunities, and i think this is one of the things that came from the laguna honda patient care issues. when that happened, the zuckerberg general q.m. team flexed over. it's more productive to look at ourselves as a system, where we can support each hospital. if there's a problem at one hospital, the team can flex to support that hospital and vice versa. i think there'll be some learning, and over time, as we ve develop this model, there'll be opportunities where we can share learning, but this'll be a learning program building out programs at the two hospitals. also included in the network are some pharmacy positions

that are driven by the work flows in epic where the medication -- the pharmacy protocols associated with epic are more rigorous and labor intensive than they were under our previous system, and so we're correcting for that belatedly. >> so if i may go on with the issue of the f.t.e.s and understanding, under b-3, there's f.t.e.s -- and i assume you really are meaning medical surge as versus medical surgical. >> there's two words. there's a medsurg unit, and we have a medical surgical policy, which is related to census. so when we open that unit based on criteria of census. >> right, and that's what you're referring to,

med/surgery wimed/surge, with an e, as opposed to a medical surgical unit. >> okay. >> she's giving me a thumbs up. >> with regards to this, we've heard of staffing in the emergency room and all. i notice that you're talking about bringing in also technicians to work in the psych units, right? >> yes. >> at psych emergency. are both going to help resolve part of the problems that we have heard in public testimony with regards to the issue at general? sk >> yeah. and maybe i'll ask if susan would be willing to come up and give a little color commentary. [inaudible] >> so i'll comment about both

initiatives. the first one, the staffing medical surgical beds for when we have surge at the hospital, like now, h 58 is one of our medical surgical units. we have been using it almost continuously for the last several years, and as greg mentioned, we've been doing that using temporary or p-103 staff. there have been several times over the last few years that we've been able to close it, during the summertime, but most of the time, it needs to be open to accommodate four to 15 patients. today, for example, it's open with 12, and it's only open to 12 because we don't have the staff to initiate it to 15. what this would allow us is to have that staff of 15 so we can

staff it more reliablely, particularly in the winter, when we need it. so that's h-58. the l.p.t.s, when our joint commission survey -- which was exactly almost eight years ago, we have four emergency rooms in pod a. those require constant monitoring, and we do that with two assistants who can do that with cameras and staffing in the rooms. recently, we've been using l.p.t.s -- one l.p.t., precisely, that we've been able to find through the registry to

ha staff that function in part. and it's been extremely valuable because they come with training that even nurses in the medical department don't have. so we've been trying to use them to help us manage those patients who come in with behavioral health issues, some of which we treat and release, and some of whom who get medically cleared and go to psych emergency. >> so is the answer partially yes towards what we have been hearing in terms of the stress in the units, especially in the emergency room? there are stresses in the emergency department, for sure, and we've acknowledged that, and we have multiple plans in place to address both the staffing issues, the just basic keeping the -- keeping our units staffed, but also the issues that come with the behavioral health issues we have. these l.p.t.s are just one of

the many things that we're doing in the emergency department to address some of the things that you heard about. >> i have questions, but not on that. >> thank you. >> i'm great satisfied with the explanation on b-3, and i'm hopeful that it will improve our overall quality of care. strengthening the h.r. says you're adding more personnel again, and i know that several years ago, we had very few personnel, and that created a number of issues. how do we know that this is the right number, because you've been adding all this time? number two is that part of the problem is not our own department, but the city's own system in the delays in hiring. so how does -- and what creates an anticipation that this will actually then help answer our

problem of more swift -- swiftly being able to add personnel to our staff? >> yeah. good question that we've been talking about ourselves, and it is part science. it's try as we might, the staffing in the division doesn't lend itself to a clean model like you might see in other areas where you have similar class or type of worker that's performing a similar type of service repetitive.

t the -- so far starters, the department has added a lot of f.t.e.s over the last few years or so, but so those have been f.t.e.s associated with the opening of the new zuckerberg hospital, expansion with our new initiatives, etc. second issue, within these f.t.e.s, there are a number of these that we have added as temp staffing to try to close the gap and keep up, but we've never budgeted them permanently. if we don't budget them permanently, we'll actually go

backwards on those positions, and that's a quarter -- how many of those positions are cad-18s? that's a piece of this that we're trying to lose ground. the other piece of data that we have that is imperfect is a couple of years back, the budget and legislative analysts did a comparison of city departments to try to look at kind of very high level squint and take a look at your ratio of h.r. staffing to f.t.e.s, and it wasn't perfect, and they acknowledged that it wasn't perfect, but we had fewer h.r. to f.t.e. compared to some bigger departments, including the p.u.c., airport, h.s.a. so this is moving us toward that direction and catching up.

what this would get us to is if you would add all our positions, including the ones that aren't filled, we'd be a little over a 50:1 ratio, so that is one person doing all of those functions that i managed per 50 staff, which it's a big number of h.r., but it's relatively lean in terms of what you see regarding benchmarks. so i won't make the i.d. that we have identified the perfect number, but we have a new human resource director who -- you know this -- has been with the department in the past, has had a citywide civil perch, and this is his recommendation kind of coming in and doing a review of some blatant gaps that need to be closed, 1and we'll continue to evaluate that as he

gets a little bit more time and his team gets a little more time to get a confident level. but i think we all agree if we don't make a change, we're going to continue to lose ground. >> well, i think my next question -- well -- well, it is a question. i'm glad we're taking the position, and we should take the position that we cannot do this without resources. you have indicated that the two-year total shows $7 million. however, only the first year shows a positive, and by the second year, we show a negative. i'm not sure if we use this balance -- well, first of all, it's a very small amount compared to what must be a big

program. i'm in favor of being able to maintain the balance or even a positive that allows us to have health programs. but seriously, how much do you really consider that mental health is going to cost all of us? >> well, so your first point about it being lop sided between the two years, that's a concerning one. it's a little beyond our view how all the city pieces will fit together, but we've already kind of contemplated for the vision for mental health s.f., but there are pieces that are going to need to be definitive ongoing programs, and there are

other pieces that are building infrastructure. so for example, if we're going to launch a new program, one of the first things that we might need to do, and in some cases, we've already identified, is renovate a space to increase capacity, and that's the perfect use for a one-time or year one pool of dollars. on your second question, in terms of the total scale, there's still a lot of decisions to be made, but as we ballparked what this looks like, i think there's consensus that full implementation of this vision would be $100 million or more, and that would of course happen over time, and that is dependent on a lot of decisions, including how you scale up each time of programs. that's why we're going to look at the building blocks, but to get that full vision is going to require a revenue source

that's either -- comes from their discussion about potentially a ballot measure, about whether there'll be state or federal funds that we could draw that would support this. it is building the infrastructure so that we're prepared to scale up when the city identifies the funds to do so. >> thank you very much. >> commissioner guillermo. >> thank you, and thank you for addressing the questions last time that i had about the waiver -- my cowaiver impact, but i had another medi-cal question. as c.m.s. has had a couple of new proposals about how the states are going to fund their portion of medi-cal, and the oversight that they're going to impose, has that been built into projections? >> are you referring to the

mfar proposal? >> yeah. >> so we are not proposing a budget that assumes that that regulation goes forward. it's such a big change that it's hard to comprehend. i am confident to say that that would really very significantly disrupt the medi-cal and safety net delivery system, and the biggest piece of that would be, as you point out, restrictions on the way that states or local governments can fund that nonfederal share. in san francisco, we are predominantly funding our nonfederal share with city and county general fund revenues, and so that, at least on the very surface of it, is an issue for san francisco counties. there are other counties in that systems that are funding that with kind of patch work revenues that they're able to put together.

but regardless of which county, we know that our entire statewide financing system is built collectively around those tools for financing the nonfederal share. and the counties are tied together. we're in it together, because we have the statewide allocations of resources that are distributed across the counties. we have a collective effort for -- that's being built over many years for the counties and other entities fund that federal share, so if that goes through, it's going to cause a significant rethinking of the safety net that goes on in california. i think we're very actively worrying and watching that and working through our organizations to advocate on that, and i know we have support from our policy and

elected officials in california. but we haven't budgeted around that because it doesn't exist -- it's not finalized, and if it does become finalized, there's going to be a lot of steps for the state to determine how we react to that. so that is a big risk and fear that's out there. >> yeah, and it'll affect across the board pretty much everything that we provide through medi-cal, and so i'm just -- i'm glad that you're watching it and worrying about it and working with other constituents, medi-cal constituency provides around that. but i think -- providers around that. but i think if that's not the proposal that goes through, there's going to be something like that just because that's the way it's going with this particular administration at c.m.s. and so i think the

beneficiaries of our medicaid services are going to have to be informed because it affected -- it's going to affect -- it affects us on a budget basis, but affects them in terms of their lives and their well-being. >> absolutely. >> so i think that's something we should get involved with. the other question i had was around laguna honda. there is almost a double -- or a 100% increase in projected revenues that is shown. i think jennie, you mentioned it was rate increases. i was wondering if those rate increases are related to the new regulations that c.m.s. has put into place with regard to the -- i don't know what to call, the -- not paying for therapists or therapy and other kind of things. are those two things related at all? >> no. so the revenues that you see,

you look at the numbers on a-4 i totally see why it looks like 100%. that first $6 million incremental, that's over and above what we budgeted today. i think jennie knows what that percentage is -- it looks like she's looking. >> off of a 200 and 300 million base, so it's a few percent. and then, in the second year, that incremental portion doubles, but it's -- all told, it's a single digit increase to the rates. and what's represented here is simply taking our updated estimated medi-cal per diem, multiplying it by our bed days, and then calculating our medi-cal revenue. so it's a -- this is a fairly

straightforward, and there are -- there are a number of potential changes that could significantly affect revenue at laguna -- laguna revenue, including how nursing funding is financed entirely. but what we're proposing here is just that very simple baseline revenue based on the medi-cal daily rate. >> so again, just something that would, i guess, bear watching and informing both us at full commission and the j.c.c. in terms of those impacts. >> absolutely. thank you for that suggestion. >> thank you. >> is there other questions? all right, we can move onto a motion to approve the sfdph budget 20-21 and 21-22 budget. >> so moved. >> second.

>> all right. all those in favor? >> commissioners, if i could, i just want to say a special thanks to jennie lui. i could standup here, but she really is here until 9:00 at night, pulling this stuff together, as well as the budget team for the department. we have a really incredible team who does a huge amount of work of pulling it together and then keeping it together for the rest of the year, so i just want to acknowledge all of that work by jennie and all the budget team. >> thank you. thank you, jennie and all of you, as well. >> all right, commissioners. let's move onto item 7, which is drug overdoses and drug use, a presentation. and let me know if y'all need me to help you. [inaudible]

>> good afternoon, everyone. good afternoon, commissioners. thank you so much for providing us the opportunity to come speak this afternoon. dr. kaufman and i are going to

speak to drug overdoses in the community and some of the ways to address those. so today's presentation -- today's presentation, we're going to go through some data that's going to show overdose reversals and some of the work that's happening in the community. we're also going to discuss treatment options and some of the services that we have to address drug use in the community and overdoses, and then finally, we'll end with some of our immediate and longer term strategies to address the situation. >> okay. so i want to start with the

data, how we get the data initially. so when a drug overdose happens, the death is reported to the medical examiner's office, and then, the toxicolo toxicologist collects all the data, and that data is important because a drug overdose is different from other deaths in that it's a rule out death in most circumstances. for example, somebody passed away, and you have no idea why. you have to collect all this data. maybe they have a high level of methadone in their system, but they're a patient in a methadone clinic. it takes a while to collect all of that and come to a cause of death. the cause of death determination is what takes the most time and limits our

ability to get real-time data. that data then goes to department of vital records, and they confirm, fact checking and make sure that everything is collect. california has the reporting system, which is a fantastic system, that reports on all deaths that occur, and that is the data that we get back that we use for our analyses. overall, because of the time it takes to close a case, it's about five to six months before we have complete data. for example, if i were today to pull the data for january, i would capture about 3% to 4% of the overdose deaths that happened, which means that i can't pull data until about six months have passed in terms of getting complete data for any period of time. we are not alone in that. most -- all the cities that i know of that report mortality

dat data, they generally have a six-month lag between the time it takes to report cases. the other question i have is the frequency of reporting. the data i'll present today is we're going the presenting every six months. we have anywhere from 7 to 31 deaths in a month, so if you look at it by monthly reporting, one month, it looks like we're doing great, and the other month, it looks like we're doing terrible. the numbers are small, and they're unstable until we get to at least six-month time periods. in terms of the number of overdose deaths, this chart gives you the numbers per six-month period because we only have the first six months of 2019 as complete data. as you can see in the first -- as you can see, we really

maintained a flat number of overdose deaths relatively -- until through the first half of 2018, which is pretty impressive. we had the prescription opioid crisis, we had the heroin crisis, we had an estimated tripling of the number of people who inject drugs in san francisco, and the mortality level remained flat during that time. with the second half of 2018 and progressing into at least the first half of 2019, we are seeing escalating deaths, and we'll run through those numbers more, but they're generally driven by fentanyl. i haven't seen a community that didn't suffer an increase in the vast number of overdose deaths, including places like

vancouver, british columbia that doesn't have the restrictions on federal programming that we face. a little more detail on this data in terms of opioids. what you can see here in gray is the number of fentanyl deaths. below that is heroin deaths, and below that is prescription deaths. back in 2010, we were pretty much all prescription deaths. as prescribing reduced, the deaths kind of transitioned to heroin, and then fentanyl started to emerge. we saw the first whiffs in 2015, and then, in 2019, fentanyl deaths increased substantially, and all of our

data from 2019 are partial. they may represent anywhere from 30% to 70% of what the total will be. >> so harm reduction is the philosophy of the health department, and that's recognizing that people make change in different ways. so while we have the syringe access and disposable program, we also have absent space programs, and there's all these entry points in between, and that's acknowledgitaking the s acknowledge that everyone is different, and everyone's behavior to change is different. harm reduction treats people with respect and dignity so that when they're ready to make that change, we're there as the health department to offer that

array of services. harm reduction principles often come directly from the community, and i say this because philip mentioned the increase in fentanyl use in the city, and we're definitely seeing that. and amongst the community of people who use drugs, many people are seeking out fentanyl, and many of them have developed a mechanism to reduce their harm, and we sue thee th a harm reduction strategy, for example, smoking fentanyl opposed to injecting it. many safe consumption sites are offering tinfoil now. other reduction strategies

include methadone, and buprenorphine, which also allows that flexibility and that low barrier to engage people into services. so this slide demonstrates the work of our funded provide, the dope project, drug overdose prevention education project. the blue bars show the number of refills, people are returning to, whether it's our syringe sites or any of the distribution sites to get a refill on their naloxone, and that may mean that they've reduced an overdose, or it may mean that their naloxone was taken, but you can see that number has significantly increased overtime, and that just demonstrates the great work in the community and the importance of the messaging of

having narcan available, and being trained to be able to administer it. other efforts that are happening in the community to address the overdose are in the jail, where if someone has a history of opiate use or mentions that they are an opiate user, then narcan or naloxone will be put in their property upon release, and that's key because we know that a lot of people leave the system or leave jail and go immediately to use, and so it's another strategy. and then, the newest is project friend, and that's working with first responders and their families to distribute naloxone. and i believe it's federally funded, but it's available through san francisco general and also u.c., and these are just strategies to address the current trends.

so i mentioned the needs to be flexibility with people who use drugs, and with that comes the need of many different strategies. often low barrier strategies to engage people into services, and these include going out with health fairs, going out to homeless homeless encampments, and really engaging people. also, the harm reduction therapy van has been able to set up in communities where people are -- hangout and just engage people into services. in the earlier presentation, it was mentioned about the crisis outreach teams that will be

part of mental health s.f. again, that's another example of really just responding to the needs in the community and recognizing that one strategy does not work for everyone and the need to constantly be flexible and reinvent the services that we have so that we can engage people. and the low barrier medical services at the syringe sites is such a good example of that. i had the opportunity to be at one of those sites one night, and it was amazing to see five people waiting in a queue to talk to a medical provider because they heard that they could get started on buprenorphine to curb their opiate cravings. and i think that that's very telling because it's a safe place where people are already

accepted. there are multiple different strategies that we use at the health department when there is a spike in overdoses. we're really fortunate that we work so closely with our funded provider, the drug overdose prevention education program, or d.o.p.e. so when there is an indication of overdose is, they work very closely with their providers to get the message out to the community to people who use drugs. additionally, the health department sends out a medical advisory, and we send out messaging to the navigation centers, to homeless shelters, to schools. we have a very exhaustive list to share that sort of messaging. additionally, with the syringe access and disposal program, we have a monthly meeting that's called the syringe access collaborative, and that's an opportunity for us to discuss the trends that we're seeing in the community and have an

opportunity to say, well, how should we address that? additionally, there is a project that's called acdc, and that's a project of the d.o.p.e. project, and that's where they're actually able to get a sample of a drug supply that may have been associated with an overdose and test it, and then get that messaging back to communities. i should also add that our syringe access and disposal programs all carry fentanyl test strips, and that's an opportunity to test your drugs to see if it is tainted with fentanyl, and if it is, to use a harm reduction mechanism to engage in your activity. so basically what this slide shows is what i've been saying,

there's just -- there needs to be a comprehensive plan when addressing substance use disorder. and so we have multiple -- or the behavioral health system has multiple entry points to address substance use, and that ranging from low barrier, that may be at a syringe access site or maybe as telebupe being offered as an option all along that continuum. and i think that's really important to note, and i often sound like a broken report saying that because no one's path getting into the system is different or some people may want to manage their use, and low barrier is what works for them. other people may need more comprehensive services, and we have that capability with our

system of behavioral health care. >> so just a little more on the behavioral health side. generally, they're providing buprenorphine and methadone, and this is in the context of substance use disorder treatment programs, which don't account for all the substance use disorder that goes on, has that treatment has definitely expanded within primary care settings, and jail health, as well, provides this therapy. there are 491 residential beds that are going to do residential management and treatment that goes up to 90 days as well as the residential step down programs. the residential program which eileen has referred to include the medical street program that

dr. zephen runs, and that's been impressive. i think one of the most innovative things that san francisco has done is by going out to where people who are experiencing homeless live and providing buprenorphine in those settings, i think that's some of the really impressive work. the behavioral health pharmacy has expanded services. they're able to provide buprenorphine and continue patients on buprenorphine in that setting. and the buprenorphine prescriptions having increased in san francisco. we also have two programs that provide contingency management for methamphetamine use disorder, and that's really the most evidence-based intervention that we have at the time. and then, we have pharmacotherapy research, which

is the work that i run, and that dr. colfax initiated in his prior incarnation at this department. and we've had some success in particular with medication mirtazapine, a research pathway that we continue to explore. in terms of use disorder treatment, these are the numbers for 2014 through 2018. there has been some reduction in treatment numbers, particularly, you can note in hal and a little bit of a reduction, about 150 fewer people treated for heroin use disorder in 2018 compared to 2014. i actually think a major driver of the decline in some of these numbers is the transition to primary care for treatment of many of these use disorders. for example, expanded use of medications for alcohol use disorder and have really seen

an up tick in recent years. as you can see in the graph on the right, buprenorphine treatments have increased substantially. so we've actually probably seen an increase in the number of people receiving treatment for use disorders, although a slight decrease in those accessing traditional treatment programs. >> so we gave some background on some of the stuff that we're working on, and i just want today highlight some of the immediate actions. one of the biggest things is findtreatment.org, and that was

the site that was mentioned earlier at the committee meeting where it shows the availability of treat beds, and that's huge because it's updated every day, and it will allow us at d.p.h. the opportunity to also have real-time feedback of, well, why are x beds at x agency always empty as compared to other beds that are full? so it'll give us real-time feedback and data, and it'll also provide the opportunity for different levels of staff to be able to just check in real-time what are the treatment options available as i work with my client. also, the expansion of the hummingbird community model, which we know that the model at san francisco general has been very successful, and now, the health department is looking at expanding that to a community location where programs such as

the syringe programs will be able to refer people directly to anybody needing that sort of respite. additionally, we are working on expanding the -- or opening the first meth sobering center, which is also something that we heard directly from the meth task force. it was a recommendation by the group, and we're able to move forward on that. so there's a lot of different things that are very exciting, and to address the issues on the streets. >> and a little further on that note is the efforts on overdose prevention. so about a third of the overdose deaths in san francisco occur in single-room occupancy hotel units, and that's always been a particular challenge because people are oftentimes isolated, and so simply providing naloxone in the community may not be able

to prevent some of these deaths. so we have some support from california partner of public health to initiate this as a pilot project working with some of these facilities to try to develop really tenant run overdose prevention projects. project friend was already mentioned by eileen, and that is a situation where paramedics are able to give innaloxone take-home kits to community members. >> and then finally, just lowering barriers to treatment,

and that includes expanding the hours at our cbhs clinic, and also expanding the opportunities for telebupe, and thinking how can that expand, how can we expand other areas for people to access treatment? so for future initiatives, back in december, the mayor and the board of supervisors unanimously passed mental health s.f., and we're really excited about that because in that, we will be able to think through other initiatives that we'll be able to address issues on the streets, and that includes the expansion of crisis outreach teams that will be out in the streets that will be able to work and address concerns and be able to engage people directly into services.

that also means expansion 24-7 of the behavioral health pharmacy, mental health reform, and also thinking through, well, how does substance use and alcohol use fall into that, and just thinking of the opportunities for expansion within that? and just thinking of the overdose prevention sites and other drop-in sites that are an opportunity to engage with people who are on the streets and need a safe place to be inside. and then finally, we are available for questions, but we also have our colleagues here from behavioral health who would be able to answer any of the questions on behavioral health services and substance use treatment. thank you. >> thank you for your presentation. commissioners, questions? commissioner chung? >> hi.

thank you for the presentation. so this is the questions that i asked in our previous meeting, and hopefully, you'll be able to help me out here. i see that there's actually an increase in meth overdose related deaths, and how do we -- well, since there's no real treatment, how do you prevent death? like, what strategies are we using to prevent meth-related overdose deaths? >> that's a great question, and a very difficult one to answer. the cause of death from acute methamphetamine poisoning is a difficult one. it's not like an opioid death that can be reversed with naloxone. it's generally thought to be a cardiac event or sesh certi--

cerebrovascular event, or a brain bleed. this is to encourage people to get into a treatment program or to modulate use, things like that, and those are -- those are also sometimes full of challenges, so i don't have a great answer for you. i wish i did because i'd love to see -- love to be able to directly address that the way we can directly address opioid overdose. >> thank you. i don't have any other questions, and i appreciate that in addition to that because personally, i think

that sometimes there might be a different cause of death and -- and sometimes -- like, you know, exceptional death, like falling out of buildings or something, but it might be caused by psychosis of stimulant use. how do we actually tell that story, you know, in these, like, death reports? >> so in those death reports, the data that i provide are deaths that were determined to be due to acute prisoning from the given drugs, when you look more broadly, you could, for example, look at all deaths that involved a positive toxicology report, and that's going to include a motor vehicle accident, a motor vehicle collision, or, you know, any cause of death. and so in order to look at more -- something more directly that we know can reasonably be

attributed to the drug, we restrict it to acute prisoning. the other one -- acute poisoning. the other ones are going to be tricky. if somebody falls out of a window due to a drug, that may be, but it's a tougher question to answer. >> thank you. >> director colfax, you had a comment? >> i just wanted to thank the team for their presentation, and i think the other key point, as dr. kaufman has made, just the important of good data here, and ensuring that we're using data to drive our decisions. i think one thing that bears mentioning is the s.t.d. reports that you see that dr.

ph phil -- dr. philip presented. and then, the work that eileen did with, the work for community partners, they're not here as much today, but that we're always reaching out and engaging in. to the commissioner's discussion about methamphetamine use, and i think we have to be -- and the meth task reports emphasizes and says that an array of options need to be available. we don't have the buprenorphine that we need to see. we have a national institute of

health research program that is specifically looking at these pieces so you have a full spectrum of work being done across the departments, including the harm reduction approaches that we're taking today. and then dr. kaufman's team has done a number of randomized controlled studies. but i think there are tihings that we can do for methamphetamine users going forward. i also think from the harm reduction perspective, the morbidity piece, while the overdose death is the final common pathway, and the most tangible one, we know that drug use is affecting people. we need to know that the department is commit today that, and we don't lose sight of the use or primary use. really make sure we take that harm reduction approach, not

just focused on that drug at the moment but across the continuum of care. thanks. >> i just had a quick question. with regard to -- first of all, the data is excellent. thank you very much. looking at the dramatic increase in deaths by fentanyl overdose, does your data differentiate whether the fentanyl is in a different substance or fentanyl on its own? >> no, in general, it doesn't do that. in general, we know the narratives from case reports of people who had died as well as the access of the d.o.p.e. project and the syringe project and research of people who use drugs in san francisco, most people who are using fentanyl choose to use fentanyl. it's a drug that can produce a

more reliable effect than, for example, black tar heroin. it is less expensive, it's easier to transport, so it has largely replaced the other opioids on the street because it is favorable -- it has those favorable elements to it. unfortunately, it's also much more likely to result in death. there are cases where there may have been contamination, and there are definitely cases where people who were using -- intended to use cocaine or methamphetamine but it happened to be fentanyl. i think in general, opioids in san francisco historically were black tar heroin, easily distinguished from a white powder stimulant, and now we're seeing white powder opioids that aren't so easily distinguished, and there's been some tragic errors in

consumption, as well. >> commissioner green? >> yes, thank you for this wonderful work. i had some questions about your point of entry because it seems, you know, that a lot of these require clients to come to a place or show up to a place, and i'm wondering if you're gathering data about a few things. one would be what time of day to people come? what point of entries are prominent? are you giving out, you know, both fentanyl test strips and naloxone? and then, how are you going to kind of quantify that so we can understand where to focus the resources? we have a system and you're going to obviously expand it, and all the ideas that i think are forth coming are really excellent. i guess the other one is how much is this happening at night because that's one of the worries in terms of points of entry. so what date are you planning

to gaer to gather on that component. >> i think i would call one of my colleagues from behavioral health as far as points of entry on the systems of care. i can say for the syringe access and disposal programs, we have services available seven days a week at different sites and hours vary to meet the need. two of the sites specifically that offer low barrier medical care are in the evenings, and we've had to think creatively on how to, if someone needs a prescription for buprenorphine, how can that get filled in the evening hours so that we can stay engaged with people. but i think that people are staying engaged, people are coming back to the syringe site do -- sites, and for whatever

reason, they weren't seeing that same type of respect at a four-wall clinic. we're, again, recognizing that need because we had a meeting about a year ago with front line workers, with behavioral health, and we talked about a lot of the barriers that we're seeing directly in the field, and that was one of them. like, if someone's ready at 9:00 at night, saying we'll come back at 8:00 a.m. doesn't exactly work. >> good evening, commissioners.

i'm the project manager. so we have about 65 programs that we are funding from outpatient methamphetamine services, residential. and what eileen was mentioning, we were expanding the service hours. we are working with healthright 360 to have an intake person that can go into homes in the evenings and provide the medication. because in healthright 360, we have two intake sites that will be open from 5:00 p.m. to 9:00 p.m., and also we are working to expand the pharmacy 24-7. those are the improvements that we are making into the point of entry that you're requesting. >> so do you think you'd be able at some point to give us

some data about points of entry, which are more successful, whether expanding hours makes a difference, you know, in terms of zip codes and things like that? also, the other thing i think we'd be interested in is working compliance, what's working and has the least chance of recidivism. i think 95% of our high risk homeless and mental patients are alcohol, not necessarily drugs or maybe a combination, and also i'm wondering how that works in the system. >> yeah, we can provide that because we work very close with healthright 360, and they have the drug management services. with their drug management is mostly alcohol, but then, we are expanding services in the pharmacy to provide medication,

and also, the telebupe that we are providing. and also, healthright 360 is a close partner that we can collect some data. also, this is a pilot that we are studying? maybe in six months we can come back and give you some preliminary data that we have. >> i think also -- i know philip mentioned earlier dr. barry zephen who manages the street response teams and prescribing the buprenorphine, and i think they would be able to share that story, really, about how people are showing up and how people are being really successful, and situations where people have graduated from having a regular prescription to some people transitioning to getting a month-long injection because they have been consistent, so i think that would be an

opportunity to share. additionally, we have our sobering center, and what sort of -- what the different hours are and people that are there. that's something we could go back to our colleagues and our partners to find out that information. >> yes, that's true. we are opening that sobering center at 180 jones in the tenderloin. we are partnering with healthright 360 and their staff. they can come in and mostly rest, and it's going to be mostly alcohol. i think dr. colfax mentioned at the beginning, it's going to be 15 beds, and it's like, you know, every eight hours, we can

turnaround, so we can provide some preliminary date -- data probably in the next six months. so we open april 20. we have varying staff working with d.p.w. and the various departments in all these settings to be ready to start april 20. >> so just -- thank you for that. i just want to clarify. we are looking to open the sobering center as quickly as possible. hopefully in the spring. we don't have a specific date yet. >> if i may, just for your edification, commissioners, you will have two items at your next full commission meeting on a pop up to approve the hummingbird as well as the drug sobering center, so you'll hear more at your next meeting on both of those.

>> dr. tare? >> yes. that was a great presentation. other places have used this data to indicate that san francisco and its programs are failures. as always, you can take those numbers and make them say whatever you want to say. with that, you can say the increasing overdose deaths, obviously, our program has failed. i think we also need to hear, as we've been talking about here, what are our points that we consider a success, how do we measure how well the population that we're working with is doing?

who have been able -- and some of that is anecdotal, and some of it will be referred to -- but i do think it's important to demonstrate as we continue to go along, why the harm reduction model, and why these programs are really effective because some of these are under attack, and i do think we need to show that people are being helped with this with transition people into various things, we've been able to -- you know, whatever data we can say. it's always hard to show how well preventative measures have worked because it's a preventative measure. but there must be some sort of measure that we can point to as advocates of this to show that this is the right way to go, so that's -- i think moving along that same line of requests, whether it be at the next

presentations. but i think when we do get these presentations, it would be also good to look at what we have been doing on the positive side. thank you. >> thank you so much for that. i just wanted to make one comment on that. what's happening with the overdoses is happening nationally, and we're really fortunate in san francisco in that we have always had such a proactive approach, and that our syringe programs and the d.o.p.e. project are working directly with people who use drugs and getting narcan into the hands of people who are using together. and so fortunately, we're not at that place where our deaths are at that number. but i feel like because we already have a lot of mechanisms in place, it's why we're allowed to be ahead. just recently, the community health equity and promotion branch was funded to be mentors

for other jurisdictions in the u.s. to develop an overdose response. and san francisco has been assigned jefferson county, which is in colorado, king county, which is in illinois, and perry county, which is in rural missouri. and just having phone conversations with these three jurisdictions, and just really reflecting on, like, how can we -- how can we share knowledge with them so they can, like, at least get ahead to the point where they have narcan available in the community when they're not even talking to? so there's always work to be done, but also, i feel like we're doing a lot of work, and i feel like we could do a better job of highlighting the efforts that we do, so thank you for that. >> thank you. >> other questions, commissioners? commissioner chen? >> i have one more because

we -- and thank you, director colfax, for reminding me of this question. we talked about death and also prevention and also, you know, presenting a psychiatric emergency. but how -- how about, you know, medical hospitalizations? like, home -- you know, do you have any data at all? >> sure. so we -- we published a report in december that included multiple data points for each drug, emergency room visits, hospitalizations, substance use disorder treatment admissions and death. those are the four main data points that i've tracked over the years, and those numbers tend to go up. they're not -- we can't narrow down to the type of opioid, for example, so it's opioids in general, but methamphetamine numbers have definitely gone up in terms of emergency department visits and

hospitalizations. the -- i apologize. i'm doing this from memory, but i think opioids went up a little bit. you know, i also wanted to go back to your methamphetamine question. and you know, a lot of those deaths -- increasing methamphetamine deaths in the last couple of years have been attributed to fentanyl. reviewing it, if i had to blame it on one, i'd blame it on fentanyl because those deaths tend to look a lot more like fentanyl deaths that the person has in terms of morbidities. you know, methamphetamine is a major issue to address in san francisco francisco. in terms of addressing the mortality, i think our focus is more on fentanyl, and our

resources, including things, like, buprenorphine which functions not just as a medication to treat as opioid use disorder, but also, it blocks the reseceptors, so if u have buprenorphine in your system, it's hard to overdose on fentanyl. there are things that -- that we're not able to do here, but -- that might help us push through a crisis like this one. >> no other questions?

thank you very much for your presentation. thank you. thank you. >> all right. commissioners, we can move onto item 8, and let's thank mr. garra, the presenter, for his late presentation. it's the 2008-2009 d.p.h. annual report. >> good evening, commissioners. my name is max garra, and i work in the office of policy and planning. i'm here to present to you the final draft of the report for the fiscal year 2018-2019. i want to appreciate you for the feedback that i presented to the committee, and for the

feedback afterwards. your recommendations have been incorporated into this draft, and i would like to request your approval for this report. as you're aware, the report is required by the city administrative code. it provides a summary of the departments highlights and accomplishments over the past fiscal year. this year's annual report maintains the overall format and design elements from the previous years. so the onannual report opens wh a message from our director, grant colfax. it features three stories. the 2019 community needs assessment, mean tall healntal reform, and mental health is a right issue. it touches on leadership issues the department has experienced over the past fiscal year. it acknowledges the successes

of former director barbara garcia, and welcomes dr. colfax as our new director of health. it notes our preparation for epic and efforts on behavioral health. lastly, it acknowledges the services of former commissioner david sanchez. both messages provide our leadership's organizations to the department. so the next set of sections provide an overview of the functions and services across the department. the sections start by introducing the department's two divisions and their roles in protecting and promoting the health and well-being of all san franciscans. the next section reviews the departme department's true north and its six true pillars, which is then followed by the department's organizational chart.

the last introductory section provides an overview of the commission. so at the commission kaerz -- commission's request, it includes commissioner guillermo, and notes that she joined in the previous year. it includes the numerous accomplishments of the department over the last fiscal year. the first describes the community needs health assessment and the adoption by the commission. the summary describes the stakeholders that supports this process, the findings that were identified by the assessment, and how the cfha improves the department and processes. the feature discusses the appointment of the director of mental health reform, and it introduces the reform framework

that's being used to drive this work. the feature also touches on some early milestones and provides a preview of what this work will look like moving forward. the last feetu [inaudible] >> -- and the department's efforts to address this issue. so the following section provides the different features and the 22 -- or i should say the 22 different highlights that span the different d.p.h. services and programs. the highlights are sorted into three main categories. building infrastructure, protecting and promoting health and administration, and i want to thank all the d.p.h. staff that provided their support in drafting and collecting these highlights. and commissioner chung, i want to note that your comments have been incorporated into the soji update. so the next major section

focuses on data, starting with the d.p.h.s budget. it provides information on expenditures, revenue, and major investments. the next section highlights the san francisco health net work data on visits, patient demographics, and care type across the major systems of care. this is followed by the population health data section, which focuses on the various program impact metrics, and as recommended by the commissioners last year, additional data has been included to demonstrate the impact on the division. so for example, new data points are included on food safety program inspections, healthy housing program inspections, and the number of major events or major emergencies and events responded to by the department. and lastly, each of the 15 health commission resolutions are also included in the report. so the report ends with an overview of the department's service sites and contractors.

the maps for service sites this year have been updated with a more stream lined look, and lastly, the report includes additional d.p.h. resources, such as where an individual might obtain health coverage and several key foundations and organizations that support the work of the department. so at this time, i want to thank you for your time, and i'm here to take any questions or comments. >> thank you, max. any questions or comments from the commission? commissioner chung. >> just a comment, and thank you for incorporating the suggestions into the soji data highlight. and i also want to thank for putting into the footnotes for patients by gender to really help understand where the gap is and provide insight of, like, what had it just

sort of sitting there -- or you had it just sort of sitting there rather autonomousily. >> thank you for the feedback. >> and thank you for the

report. i just happened to see that the other night. >> commissioner guillermo. >> thank you for your presentation and for an impressive report. i just had a question about the distribution of the report because it really is an opportunity to see -- you know, let the public know and other constituencies how important this department is, and who is responsible to who, so what's the mechanism, and how far and wide does it go? >> so once the report is approved, we'll incorporate the final edits and post-it on the department of public health website and distribute it to other departments with a message. we're also going to do a printing of about 15 to 25 copies, as well, for distribution to you, as well, but we're open to feedback and other suggestions. >> does it go to the board of supervisors.

>> yes, and the mayor's office. >> and the mayor's office. >> and the library, as a record. >> i would suggest if it goes -- i don't know if hard copy or on-line, but to the other hospitals that do and do not partner with the department. i think it's really important that private sector providers also understand the scope of the department's reach that oftentimes intersects with what they do and should intersect more. >> great. thank you for that feedback. >> commissioners, other questions or comments? >> all right. so this is actually a discussion item. traditionally, you all say thank you, and thank you, and is. >> thank you. >> thank you. >> thank you. >> great. commissioners -- there was no public comments on that item.

item 9 is other business. you've got the calendar before you. you can always e-mail me with questions. item 10 is the joint committee reports. >> february 11, 2020, j.c.c. meeting was mostly closed session regarding quality affairs and that's it. >> okay. item 11, motion for adjournment. do i have a motion? >> so moved. >> second. >> we're adjourned. thank you, everyone.

>> hello everyone. welcome to the bayview bistro. >> it is just time to bring the community together by deliciou deliciousness. i am excited to be here today because nothing brings the community together like food. having amazing food options for and by the people of this community is critical to the

success, the long-term success and stability of the bayview-hunters point community. >> i am nima romney. this is a mobile cafe. we do soul food with a latin twist. i wanted to open a truck to son nor the soul food, my african heritage as well as mylas continuas my latindescent. >> i have been at this for 15 years. i have been cooking all my life pretty much, you know. i like cooking ribs, chicken,

links. my favorite is oysters on the grill. >> i am the owner. it all started with banana pudding, the mother of them all. now what i do is take on traditional desserts and pair them with pudding so that is my ultimate goal of the business. >> our goal with the bayview bristow is to bring in businesses so they can really use this as a launching off point to grow as a single business. we want to use this as the opportunity to support business owners of color and those who have contributed a lot to the community and are looking for opportunities to grow their business. >> these are the things that the san francisco public utilities commission is doing.

they are doing it because they feel they have a responsibility to san franciscans and to people in this community. >> i had a grandmother who lived in bayview. she never moved, never wavered. it was a house of security answer entity where we went for holidays. i was a part of bayview most of my life. i can't remember not being a part of bayview. >> i have been here for several years. this space used to be unoccupied. it was used as a dump. to repurpose it for something like this with the bistro to give an opportunity for the local vendors and food people to come out and showcase their work. that is a great way to give back to the community. >> this is a great example of a

public-private community partnership. they have been supporting this including the san francisco public utilities commission and mayor's office of workforce department. >> working with the joint venture partners we got resources for the space, that the businesses were able to thrive because of all of the opportunities on the way to this community. >> bayview has changed. it is growing. a lot of things is different from when i was a kid. you have the t train. you have a lot of new business. i am looking forward to being a business owner in my neighborhood. >> i love my city. you know, i went to city college and fourth and mission in san francisco under the chefs ria, marlene and betsy. they are proud of me. i don't want to leave them out of the journey.

everyone works hard. they are very supportive and passionate about what they do, and they all have one goal in mind for the bayview to survive. >> all right. >> all right.

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