this is a law. it clearly states, disaster plans should be rehearsed at least with twice a year. there should be a written report and evaluation of all drills. i've been in that institution for 12 years. i've participated in one disaster drill in the old hospital. i haven't put on the ppe that is supposed to protect me in a decon situation in three years. i haven't been trained on how to manage what the chain of command was. i was a night shift charge nurse for many years. i alerted my management multiple times that we were concerned about what would happen on a saturday night at 2:00 in the morning when the earthquake hits. because the staff are frightened. so that's where we are. and my colleague martha bear is going to let you know what this means for our patients.

>> thank you can, heather. i hope that was as powerful to the supervisors as it was me listening to it. the struggle so many nurses have been in so long to get an ear is very moving to me. it's also moving to me that our patients suffer from all the things that you're hearing. we're very dedicated people. nurses are good people, we're short on ego, we're long on competence, we do our jobs because we care about people and we don't like suffering. what we see because of these problems is more suffering that could be fixed. so patient experience, i'm not going to spend time on this. heather really gave you the story, but the patient experience due to these problems with staffing is obviously negative. i work in primary care. the worst -- the worst day of my

week is when i have a patient who is decompensating, running out of breath, turning blue, sweating and i have to say, we got to get you to the emergency room. and the patient says, no way. [please stand by] [please stand by]

>> to make my point, i would just suggest going on to yelp, and look at some of the reviews of the san francisco general emergency room. so that brings us to -- where does that leave our employees? you've heard a loft data about this already. 23 assaults in the emergency room in one month. okay. we know these are not all

being reported to the state. we have -- we have suddenly a new violence workforce, taskforce. there are 14 people on that taskforce to address violence problems. there is one nurse. i just want to mention -- this is another slide about mandated overtime. i just want to clarify. so what this means is, if i'm a nurse and i have planned out my eight-hour shift coming up, and i know i have my child care set up for 10 hours later, and i've organized with my family that we're going to do "x," "y," and "z," and i go to work in the psych emergency room, which is probably one of the more high-stress jobs in the city of san francisco, when i get to hour

searching they can say to me, you need to stay another seven hours. the employee has no choice. the city likes to go to very expensive consultant fees to get help when there are a lot of us here who would like to help. they consultant group do a survey of employee satisfaction at san francisco general. i'm not going to read through the whole slide. [buzzer] >> it took us a year to get the data from that. i would argue if you're struggling getting information from a group of people and they keep deliberately obfuscating with run around, there is something that is not

right. i don't know where the money is going to the m.t.s that are empty year after year. i hope they're not going to car repair. [laughter] >> and last, i just want to point out that as you've heard, a number of attempts are being made. i find that to be convincing that, there are attempts being made now to fix some of these problems. but what's wrong with that is that there are 10 years, at least, before any of those things starter. and these people are angry. nurses are very angry. and now i'm going to hand it over to jennifer. >> before jennifer -- jennifer, before you speak, supervisor stefani needs to make a comment. >> i want to thank you for your presentation. and let everyone know i do have to go. supervisor haney asked me to fil fill in for him, and i

could only do so until 3:30. i look forward to watching the hearing and hearing all of your comments. it is very important to me. i have called previously a hearing, in terms of the rate at which we're filling vacancies on for responders and nurses -- it is a hearing i will have again to discuss this issue. i wanted to let you know i'm only leaving because i have to, and i will be watching the rest of this hearing. there are a few of you that have come to public comment and i wanted to speak to you further. thank you very much for being here today. it'>> it's a tough crowd today. mrs. secretary, is it possible to

(indescernable)? so what we've talked about a bit has certain origins, and it may not be car repairs, but that are mayoral priorities. the mayor has stated very clearly in her budget plan she wants to reprioritize funding. she says she wants to be responsive to residents and support city workers who are out there trying to make a difference. and yet 3.5% budget cuts have been suggested. 3.5% budget cuts across the war board in every city department. even though right now we have this e-raf. for e-raf, in 2019, there was an additional $250 million.

the city is projecting a budget shortfall of $420 million, but if we use e-raf funds, that completely covers the shortfall. you guys have heard all about the dereliction of duty coming from the city of san francisco, the department of public health. can we switch to the slide. i'm sorry, guys. i don't have the ability to go back and forth. so we have a lack of accountability. we have a lack of transparency, and we have a lack of resources. all of this is unacceptable. the steps to a solution are that we request an immediate formal, independent budget audit and performance audit of the department of public health. we demand that the budget be immediately revised so that people can be hired, so that this budget cut that the mayor is proposing goes away. because the reason that we're focused on temporary

staff, registry nurses, is mainly because the mayor continues to say that e-raf funds have to be yufused for un-time one-time spending. can you switch back to this one for me? >> you kind of have to. >> the mayor says one-time spending. can we go back to the slide show? we want to fix the hiring process immediately and expedite frontline staff vacancies right now. we want to make employment rational so we can support executive leadership staff that have failed to address these issues by having a rational process. it is no longer dependent on leadership. we want to have comprehensive training for disaster preparedness,

pursuant to state law. we want protection for every employee in the hospitals, not just nurses, but everyone. we want to keep the department of public health management accountable believers and we want t.we want frontline care represented on the health commission and the joint commission, so that we can be hui sure that executive leadership is held accountable, and we can be sure that people who provide care on a daily basis to our community are the ones who give the feedback and the input to the mayor, not just special appointees. can we switch back to this one now? so...i just want to share with everyone the mission of the san francisco department of public health. i don't know if this is big enough for everyone to

read. basically to quote directly: "the mission of the san francisco department of public health is to protect and promote the health of all san franciscans. san franciscans." not san franciscans with money, no some, but all. the ultimate goal is to ensure that san franciscans have optimum health and wellness at every stage of life. that's hard to do with 3.5% budget quotes. one last quote comes from the health commissioner executive secretary. in 1983, and in 1984, general hospital's accreditation by the joint commission was in jeopardy. the hospital did not have an affective governing body and had antiquated management systems and staffing shortages. we heard from hillary ronen today, and she called it bizantine, antiquated, it sounds the

same. we've heard about staffing shortages. we've asked questions of our management that they are unable to answer. it seems similar. in addition to these accreditation issues, there were issues with ambulance response times. that's first responder issues. we're talking to e.r. staff who are on diversion 60% of the time. even then, many people in the community felt that the city mental health is not responsive to the needs. remember mental health s.f.? sounds similar. so the joint commission was created so that the city could make budget and policy decisions more transparent because the business would be conducted i in public meetings. when the joint commission was created, after this 1983 and '84 crisis, the aids epidemic was under way. and it was the frontline staff then that brought

ideas, that created 5b and 5a, which became our aids ward in san francisco general hospital. the nurses themselves physically erected the ward. it had previously been sleeping quarters, and instead became a life-saving unit. right now today we have nurses and frontline staff speaking out and bringing forward the problems in the department of public health. we're very appreciative of having this moment so we can bring these issues to the forefront again. we hope just like then, right now we can also help to lead the creation of something new and better. thank you very much. >> thank you. i think we're at the end of the presentations. right, jason? i think we're going to open it up for public comment. each person -- you can do it by the speaker cards?

would you like to do it that way? okay. so i'll call your name, and you can line up on the side there. if i haven't called your name and you would like to speak,please also line up. sonya reyes, derrick richardson, diane no yenez. debra -- i can't read it -- waniski. amelia aire. naomi shonfield. each people will have two minutes. if you would like to state your name, please do so. the first speaker, please. >> good afternoon, my name is wendy. i'm a member of the public. i came here because i saw you guys on tv talking about this, and i was going to be at city hall anyway. i have been a family care-giver. care-giver of three of my

family members. and i'm about to be a care-giver again, an unpaid care-giver, for someone who has throat cancer, and will be at san francisco general. i am appalled to here what has been transpiring. i know firsthand, as a family care-giver, that nurses do everything. and, um...and as a former retail worker, being the face of any organization, restaurant, or whatever, we had always been required to, you know, smile and be nice and so on and so forth, while taking care of people's needs. and i cannot imagine a bigger disconnect between nurses, who have always been great to me, my family, and my community,

while hiding behind the things that i have heard today. so, um...another part that i want to speak to -- [buzzer] >> -- is the fact that, um, the city of san francisco spends $7 million per police academy class, with graduates of about 35. and people come out and they make $100,000 with no student loan debt. i don't think it is the equivalent of nursing. >> thank you. next speaker. [buzzer] >> hello. i'm derrick richardson. i've been an emergency room doctor at the general since 20 is 13.

2013. and i'm here to support and advocate for my nursing colleagues. i would like to share a video from one of my nursing colleagues who couldn't be here today about her experience in e.r. >> make sure we keep it in the timeframe. can we just pause the time for a bit? >> okay. so -- >> hang on one moment while i get your audio. [applause] >> it should work for you now. >> i was violently... [no audio] >> by a patient on october 3, 2. we see these types of patients that are often

dangerous and agitated often. the patient punched me, pulled me down by my hair, slammed my head against the floor and clawed at my face. and there was difficulty getting the patient off of me. this assault was handled poorly by the hospital administration. some saw me shortly after the assault and asked what they could do. i knew this violence in the workplace was a very serious event, so i made a point to return to the e.r. four days later and talk to the e.r. staff and management about my safety concerns and the concern that this will happen again and someone might get killed one day. [buzzer] >> i even spoke to this at the management meeting in person at the e.r., and was heard by e.r. management, the e.r. director and physicians, and they assured me they would follow up. i have not heard anything back from anyone at the

hospital since then. i asked in writing to know if this had been reported to cal osha, and to clarify safety issues in the e.r., and no one has returned my e-mails or phone calls. i was not even paid for the shift after that. [buzzer] >> i think your time has concluded. >> thank you. >> next speaker, please. >> hello. i'm debra wineki, and i'm a registered nurse at san francisco general hospital. and i've been working there for almost 35 years. and i have heard the same responses from management for decades. and i feel like it is just paying lip service to the

labor force that works at the hospital. i work in the o.b. department, and you'll see one of my co-workers back there with a stack of requests for staffing over the last year. we had over 350 requests for extra staff in one year, and many of those requests were for two or three nurses. i feel that o.b., labor and delivery, gets staffed better than many other units because we're a very high liability -- we work in a high-lie detectorliability setting. so, you know, trying to find out how to fix this -- and i think that over the years the mantra has been: human resources,

human resources, human resources. [buzzer] >> so i think maybe there is something to that, and human resources needs to be, you know -- human resources needs to be focused on. we have a very high turnover rate. i don't think that the recruitment of nurses is nationwide. i think it is very small. the recruitment and retention -- [buzzer] >> thank you, ma'am. thank you. next speaker. >> hi, good afternoon. my name is diana anis, and i work at the birth center at san francisco general hospital. we often don't hear about the birth center because we're supposed to be the happy place. but we're not very nurse-friendly. these are the 359 e-mails

that debbie was talking about, asking for nurses, and they say things like, it is 2:00 in the morning, if you can't sleep, please come to work. if you don't come to work, your co-workers can't go home. if you don't come to work, no one is going to get a meal break. the nurses last year missed a thousand plus meal breaks. that's a thousand times a patient had to have a nurse that didn't rest, that didn't eat, and it is possibly even mandatory overtime. we know that maternal death is real. babies are born that need resuscitation. it used to be an exciting experience to be at a mom's birth, and now it is a scary experience because we decent know if we're don't io get that second nurse to help with that newborn resuscitation. i've been here for more than 30 years, and the story doesn't seem to

change. we're going to hire. don't worry. it's going to be better. it hasn't gotten better for 30 years. and working at the birth center, the baby-friendly hospital is not nurse-friendly, and it is getting tiresome, and the nurses are burned out. [buzzer] >> thank you. >> you still have 30 seconds, but thank you. next speaker. >> good afternoon. thank you for listening to all of us. my name is suzanna kylie, and i'm a registered nurse. i would first like to start by emphasizing that as a nurse, and all of us as nurses, we're accountable for our actions or non-actions. and i'm expected to show up every day at work prepared. i cannot ignore or otherwise not answer questions and get back to you later. i don't think it is an unreasonable expectation that others perform their jobs with that same level of accountability. i currently work in

behavioral health. and in three weeks i will begin working with the whole persons integrated health, also known as street medicine. i began my nursing career 36 years ago here at d.p.h. i worked on 5a in the '80s and continued working in h.i.v. care in the '90s. all of my career choices have been informed by my commitment for caring for underserved communities. i believe this kind of commitment is what drives all of the nurses in d.p.h. to continue working, short-staffed. s.f. d.p.h. has been propped up for too long by these hard-working, committed nurses. and the chronic understaffing has tested the resolve of great nurses and broken the resolve of many who have left. with currently chronically understaffed system, the ability to care for our clients has fallen short, which is unacceptable. [buzzer] >> it puts in the

question of this gasping system's ability to affectively respond to the coronavirus. the time for corrective action is long overdue, and this is certainly no time for budget cuts. i thank you for your time. [please stand by]

>> my name is herbert weiner. with patient safety this resembles the schoolyard and the bully victim and bystander.

>> we're faced with the coro coronavirus and it's an a question of one disaster preparing for another. >> i have a master's degree in social work and ph.d. in clinic psychology. i applied for medical and psychiatric social workers countless of times and turned down based on the one of three rule. i hope this doesn't happen to other people. but basically the hiring had to be streamlined and we need it now more than of. this is a national emergency and even a question of homeland

security. >> thank you, next speaker. >> i'm a nurse at san francisco general. i have a lot to say but going to tell you what happened sunday morning when i was the team lead and we have six rooms and that day we were short one recessed nurse and got to the point where we had 12 critical patients in the resuscitation. i don't know how you can wrap that around your head but the reason why we couldn't move any of the patients is because we couldn't staff the rooms in pod a. there ways cpr in progress that came early in the morning. my co-worker was working on it.

the patient passed away and after she walked out i did not have time to let her decompress or think about it. i said i need you to hop in because there's another cpr in progress. cpr in progress means you need at least three nurses in the room depending on the cause. and we only had four trauma nurses assigned. this is not isolated either. i was put into a position where christen went into the room and had a patient with a bone stick out of his leg broken obviously. and she said chris tan can you come in and help me with medications. i said i can't because yefr -- every one of my trauma rooms is full and i needed help and she said i'm sorry i don't have anybody to send you. triage called me and said they needed to give me another

patient. this patient was ill as well and i said all right put a gurney next to the storage unit and we'll try to figure it out. >> thank you, next speaker. >> hi, i've been at the general 15 years in the emergency department for three. i've stoken at these things -- spoken at these things quite a bit and my generalized statement si don't want you to fix the problems alone i want to film them with you. after the incident with corina you saw in the video i joined the emergency room violence protecti protection task force and never missed a meeting and will be there march 30th to try to fix the problem in the emergency department. unfortunately many requests have been made for the workplace

violence prevention task force for me to attend and be a part of that and every time we heard no. so if you don't mind i'm going to take this opportunity to say dr. urlich do you mind if you join the hospital-wide prevention task force. i'd like to stand by you with you and help this problem. i really would like to help and put my name. put me in. >> please direct your comments to the panel here. the committee. >> thank you very much. >> thank you, next speaker. >> so folks understand there's rules of decorum in the chamber. you have to address public comment to the members of the board of supervisors. >> i'm rebecca grant a nurse practitioner in the emergency department. i've worked as an rn and nurse practitioner. most of my job is performing in

the triage area after the illegal care program was dismantled. what that means is i greet each and every patient who comes into the doors as much as i can. sometimes there's 25 an hour and i analyze them and screen them and see if i can refer them to their primary care to the urgent care clinic to p.e.s. and the urge urgent care is closed and the patients are telling me it takes months to get appointment to their clinics. if the refer them to a primary care provider it takes at least six months to get a call because the list is over 1300 patients long. that's terrible. basically we've all been working very hard to get our leadership in the department in the hospital level and now we're

here and we appreciate you guys listening to us to hopefully urge the department of public health and the h.r. department to hire more nurses and staff and the community clinic and micky callahan i was told is responsible for blanket firing and all dual rec questions for the -- requisitions for the temporary exempt positions and we're waiting on nurses and i was let know via e-mail anyway i think we'd like to know how many people are affected because the patient loads were immediately dismantled and it's a big deal. >> i'm bob ivory a retired nurse and i've been on the bargaining team for 25 years so i want to

give you historical background. everything these young nurses say has been going on for 25 years. it's not the hospital is under staffed but under budgeted. the union was in bargaining and we asked how many new positions are you going to put in. the answer is we don't know because we don't know the right size until a study and we don't know. it's not hard no figure out how many nurses it takes to run the department. i wish all the temporary nurses under the charter were doing relief work. however, in violation of the charter, they have opened whole new floors, departments with no budget for registered nurses.

they've had to rely on creative staffing through ftes for travellers and did i -- per diem. if you look at the budget you'll look at 500ftes a year. i'll address this to you maybe mr. brown when he comes back next continue how many nurses are participating on his task force. what their names are and have they actually been released to got to the meetings. thank you very much. >> thank you, next speaker. >> i work in the emergency department. thank you guys for having this hearing and many more that might follow. i'm reading comments from a

colleague of mine and the poor resources on the guaranteed coronavirus outbreak and we have a lack of preparation for managing the patients in other hospital the patients are going to other units and often bypassing the e.d. we're losing quickly without replacement and have no one in our disaster position. they have one person persist? i worked the past two shifts but there's no space. one without the other is useful in either direction. the lack of leadership and transparency by the nursing director is a big problem and the engage. the survey after a year or more. i find it insulting the only i time we see the ceo is when regulatory supervisor visits is

happening. and sarcastically i'm glad they're working on violence in the e.d. the whole hospital went to [bleep] when they went to the lean model even when they identified the needs they don't act on it. why even do it then? it's a waste of time, resources and money. we need a strong leader that can identify the problems and have the inside experience to make the changes needed to accomplish this not another work group. that's what i have for now. nothing was changed. >> thank you, next speaker. >> hello.

i'm also one emergency department nurses and also a steward. i have a portion of our petition that we submitted to the health commission back in october. the one thing i do want to talk about in administration is administration including chief officers ceos and chief nursing officer failed to provide consistent experience and ethical leadership for our department. as a level 1 trauma center it serves over 1 million people and consistent organization has been overlooked since e.d. has been functioning since a revolving panel in the last 10 years. the current nursing director was hired in february of 2018. since may of to 19, 50% of our managers or people in our leadership positions have resigned. they're reasons include but no not limited to the development

of new programs that affect be patient care, implementations of new programs against the objections of nursing staff and leadership and intimidation by management to remain silent on issues that affect safety and exclusion of the frontline nurses in programs and procedures and intimidation in regards to procedures of policies and the leadership style at san francisco general hospital has created a culture of intimidation and fear the employees fear advocating for their patients and avoid interactions with management whenever hospital. the hostile work environment is having detrimental effects on the mental health of staff and there's no chance for the members of the health care team to collaborate in a way that must be to provide comprehensive and compassionate care to our most vulnerable patient populations. i did submit something for the record for you guys to see.

>> thank you. next speaker. my name's and i've been an e.d. nurse three decade and i hung up my scrubs and retired but the subject's still dear to my heart and one thing i think of is the culture of austerity that seems to take root in public services in general and you get used to doing work arounds or figuring out how to glue things together. and i think the public's starting to wake up so this there's no excuse in a city as wealthy as this there should be no reason to not bring in enough people you can staff adequately. one thing i look at is the

culture of wishful filaments and wills never have babies or go on leave or get sick. that's never going to happen. i think 20% with us cited. that's always going to be there and if we had per diems co cover that you're covered but instead they're covering all the wrecks and all the positions that are unfilled so there's nobody around when you need a training program you're cutting down to muscle. nobody's left. we're not getting to a world where everything goes away. it's always there and you need toan toance -- to anticipate that. thank you for hearing this. >> thank you, next speaker. >> good afternoon. i'd like to thank the board and everyone here for their time and attention for listening to this important issue.

my name is cheryl randolph. i've been a registered nurse at san francisco general for the past 22 years. i take care of the overdose patients and make sure they continue to breathe. i take care of the trauma patient who thought this was just another day and now clinging to life. i take care of you, your friends and your family. i've always been proud of our dedicated and professional e.d. staff but i'm not proud now. now i'm afraid on a daily basis. i'm afraid this is going to be the shift when a patient's going to assault me more severely than every other time this has happened. i'm afraid this is the shift when i make a fatal mistake because i'm trying to do more work than a single nurse can safely accomplish. i'm afraid this is the shift my nursing license is in jeopardy and not conforming to the required standing of care and when my experience and training don't matter because people have

needlessly died. e.d. nurses have always been willing to suck it up and go without breaks because it's always short staffed and take care of more patients and we try to do right by fellow nurses. here in california nursing is protected by ratios. meaning a particular number of patients to nurse. while that protects us both it limits how many patients may be treated in a timely manner. on a daily basis my e.d. is impacted by patients taking 50% to 75% of the available beds and wait hours and sometimes days. that means the e.d. nurse takes care of floor patients in the waiting room swells with patients who wait for hours and hours. we need to refocus on patient safety by ensuring safe nursing staffing. i respectfully ask the board to approve funding or any other measures to help staff.

>> thank you, next speaker. >> i'm a registered nurse. for nearly 10 years i worked at san francisco hospital trauma department as an e.r. nurse while i left sfgh after my first child the mafg -- amazing nurses and doctors are still near to my heart i'd like to ride a statement for someone who wants to remain anonymous for fear of retaliation. the staff has been one of the more poorly run hospitals i've worked in but has gotten so much worse. this administration is known to offer false promises to anyone who comes to them for assistance only to appease them and then do nothing. i find it extremely upsetting now that our strong union folks have called the administrations out those same administrators come running to our department when board of supervisors visit

to buffer and present a misleading view to you of our department. in all my years at sfgh and when i've seen my chief nursing officer in our department. what are they trying to hide? when nurse were threatened they shut the door. the budget sin surplus yet administrations have not been paying staff nurses and clerks for overtime. i'm going skip the letter and when came from new york as a trauma nurse from the time i was interviewed and on to the floor it only took three weeks sow i know -- so i know the problem

can be fixed. >> thank you, next speaker. >> i work in emergency department as a nurse r.n. and been there 28 years. i've been there a while and it's been good to me and i've seen a lot of changes and different situations but i feel we're not properly equipped to manage and take care of the behavior and psychiatric patients which is ef departmentally increasing because of the homelessness and meth use and we're in the emergency department and we have four rooms for them which are monitored but the rooms are doubled. this is not right. it's very difficult to look the highly difficult stressful patients and unfair to the other patients and unsafe for the staff and i've seen many

situations, violence has escalated. i'm one of the nurses recently violated against and was there the day the other nurse who reported was assaulted. so i just feel it's difficult. i know they're having a hard time and on red alert. since we moved to the hospital i feel they've not been great because of the geographical distance. the psychiatrists rarely come to the emergency department and we become the p.d.s. thank you. >> i retired in 2018 from 12 years on the lift team or safe patient handling service and it's not just nurses in solidarity but cnas also have the same problems.

i was on the lift team and the team should have two. if either of anyone called in sick or was on vacation you worked by your several and that's the way they rolled. i submitted to my superiors some ideas for creating a safe patient handling department including an educational component for bedside safety for the nurses but basically ignored. i love the people and love the work but i couldn't stand it and bailed, i have to say. there is a moralee -- morale problem there and it would be a great morale shift if you staffed sufficiently and it's come to my attention it takes four supervisor to put a motion on the ballot asking the people if they would like to return the name of the hospital to san francisco general hospital. i think that would do wonders for morale.

>> next speaker. >> i'm mike hill a nurse in the e.r. since 20134. 2014. thank you for letting us speak. i was going to raise doubts in your mind in handling disasters and preparedness and i think it's abundantly clear and we have two confirmed cases. we can't even staff for a regular patient load. we joke how many people are in the waiting room, 40, 46. how many people are we holding that can't go upstairs? 20, 30? how many hours have they been here, 26 hours? 36 hours? this is day to day. how are we going to ever handle a crisis like we're going to be faced with pandemically?

s i haven't had disaster training since 2017 and we have a facilitator that retired six months ago. unfilled position. it's crazy, right? we're in the midst of crisis and we don't fill the positions. it's attrition. she's gone. i have nothing more to say but it's historic to feel this closeness with my co-workers and respect and admire all of you so much. >> thank you, next speaker. >> i'm megan green a nurse in the oncology and palliative care unit and also the same floor 58 is on. it's unbudgeted and has been the default overflow for the e.d. the e.d. has been bombarded with

patients as mike said. if there's admitted patients downstairs and no bed upstairs there's nowhere for them to. before the most recent contract negotiations we were frequently being asked to come in for overtime and still haven't been paid and later we were told we were never under staffed. after public pressure we were told we'd get a float pool and don't have one and there's 50 beds in 58 accounting for 38 bedside nurses not including a chart and break nurse and we're pulling nurses from other units. i worked last friday, saturday and sunday and for two of the 12-hour shifts i got one 30-minute break and one 15-minute break for a 12-hour shift. this happens quite a bit.

i'm not sure you want to be taken care of by a nurse with a 15-minute and 30-minute break. my co-worker was covered one nurse per break the other had a decompensating patient that needed to be brought down to cat scan when she left to go to cat scan she had seven patients. we wish we could say it's infrequent but it happens all the time. nurses who are burnt out call out sick. there's been multiple studies and we're told not to come in sick when we're sick and then blamed for short staffing when sick. >> next speaker. >> i'm a registered nurse in the

med surge unit and in supervisor heaney's district 6. mike dingal brought up about not just being a registered nurse understaffing but very much to do with our support staff not being at the bedside to help us. registered nurses have a defined scope of practice and have things we have to address and many things that fall outside of that. however, at san francisco general in the med surge floors if you're a danger to others or of falling you don't have the attention of a nurse's aid to make sure you're safe to address the issues a registered nurse doesn't have time to address because we're fulfilling our legal duties. it has led to patients who are already angry feeling as though they're being avoided.

they've become more agitated. this becomes a direct danger to the nurse. we know in hospitals all over the country assault is a big deal and many nurses every year are hurt and taken out of work for that reason. just a quick example i had a patient who was quickly running out of steam and unable to breathe on her own and addressing her and called for assist. my work phone kept blowing up.it was going and going and nobody could help address it until finally i was able to go to the other room and see what it was. a patient spilled their urine and the floor and needed help cleaning it up. it's not a reason to leave an unstable person's bedside. we need help and to be addressed. i appreciate your taking the time and i yield the small business of my time back. >> thank you, next speaker. >> good afternoon, supervisors.

i'm aaron kramer a registered nurse at san francisco general hospital 12 years and work in the cardiac lab. i would like again to thank you and all my colleagues that came with me today to speak and share a taste of the reality of what he public health care is today as we speak. it's short-staffed and stressful and dangerous. these are people's lives we deal with. we came here today because we need someone to listen to us. it's the feeling of the nurses at general hospital that we as the frontline staff we try and voice our concerns. we try and speak out and speak up and we're met with this wall and many nurses speak to me as their union delegate they don't want to get involved or want to do anything more at general

hospital because they feel a feeling of fear and intimidation and a culture of that and it's the scope of public health for san francisco general. i want to speak quickly on behalf of some of my colleagues. the meat and potatoes of the hospital as reported last week to the health commission 25 vacancies. again, my other colleagues spoke to a contractual obligation negotiated last year to help support med surge with a lift team. still unable to hire and staff that. i have petitions that are trauma med surge unit. the whole staff submitted asking for help. really quickly for the record, for labor monitoring who i serve as a delegate for we had to file

a grievance last year. >> next speaker. >> good afternoon supervisors safai and supervisor mar thank you for having this hearing. i'm with local 87. we represent the janitors and private sector and you may be asking what does the janitors' union have to do with this. we had 86 janitors here this afternoon. we had to pull them off their job today because of the fear of coronavirus. all those janitors were here because they wanted to be able to have somebody speak to them. these shortages in the department are affecting everybody and nurses are the first responders when they're in a situation and nurses hold us literally physically up when

we're at our most vulnerable. supervisor ronin and walter and supervisor heaney, they've all spoken but i wish they would have stayed for the remainder to hear the stories and witness tm of -- testimony. you can't give us the big words and then leave. i'm here because i understand the department has had its setbacks but this has been going on a while now and last year i happen to hear terry anne speak and how successful being able to fly in nurses and contract out nursing was working for the city. i find shame in that because these are workers being replaced and nurses deserve to have anything knit on the job. -- dignity on the job. janitors are here because we want to make sure we're heard and an understand dr. brown you started three months ago but you're inheriting a ses pool of

problems we hope you can guide and lead us to what needs to be fixed. i understand decorum but what you don't understand and everybody else in the back is my family and everybody's families -- [bell] >> thank you. next speaker. >> supervisors, it's incredible you did this. it's what should happen but it doesn't happen and it hasn't happened and so it's a profound thing that has happened. i say this as a nurse who's worked for the dph32 years and i can't imagine life without janitors. nurses and janitors are working most closely with body substances. let's put it that way. i want to tell you how i got

introduced to the culture of silence. there was a budget cut slated to cut our interpreters three years in a row until chris daily said if this happens one more time -- i knew the nurse manager of the interpreters office had important statistics and i was at a hearing the health commission or here and had the naiveté to slide over to the chief nursing over and say why are nay not up here -- they not up here giving the data and she looked at me like i had four heads. she said he can't talk. he's the boss of all of us. i learned we can go to our head nurses and manager and go to the cno and they'll put a whole different spin on it for the people above them. for a whole host of reasons.

the whole culture of silence. culture of safety. we go in the loop we've been going to the health commission for months and months. finally, we speak nothing back. we have to listen to the presentations that really if they're not live they put a nice bow on things and so we chanted a meeting down. what happened? they called the sheriff. they come marching in and came from the e.r. walked away from the e.r. >> thank you. next speaker. >> supervisors, my name is josie mooney i'm a proud member for many many years here on behalf of joseph bryant who couldn't be here today because he's on strike with health care workers in san joaquin county. this is an emergency. it is not a time for focus groups or more studies or

reviewing what's already been done or taking a look at the civil service rules. it's an emergency. what that requires is people act together. so i want to say on behalf of our union that we are prepared to sit down and confront this emergency with all of our beautiful amazing fierce warriors and their colleagues who are back at the hospital now. we have to treat this like it's an emergency and that means emergency measures which you on your own can't do and they on their own better not do. so it's up to all of us. so i pledge we will be at a meeting tomorrow, tonight, the day after tomorrow, on the weekend, this cannot stand as

is. we so appreciate so very much appreciate the hearing and the opportunity for you to hear from the frontline workers what they face every day and we're looking forward to being at a meeting this week to resolve the crisis. thank you. >> thank you, next speaker. >> thank you. i want to follow-up with what she stated. i want to add first we want to thank you for holding the hearing. we would not be here today if it was working. we would not be here today if the labor management committee meetings were working or if the health commission was listening to the r.n.s wen they go and speak and other health care workers and told the same stories you heard today. these stories represent a small fraction of all the stories across d.p.h. whether they're

workers at s.f. general in the community clinics or laguna honda. the staffing needs to be fixed and fixed now and we do need oversight and we do need accountability and that's why we are hear in front of the board of supervisors and asking, yes, more hearings, more oversight, more accountability. please stay on this process and please stay on d.p.h. until we get this solved and we thank you for raising these issues and having us all here today. thank you. >> thank you, any other members of the public wish to comment on this item? seeing none, public comment is closed. dr. urlich can you have -- can i have you back up and it may be for your team but i want to direct them to you. one thing i heard about and i know you rushed through your presentation and others did swell -- as well but the thing

not budgeting to your census. >> when we moved in the new hospital there was uncertainty to what the level of volume would be and quickly starting seeing the number of beds, medical, surgical beds was too low. we have a budget for 164 med surge beds and i think i mentioned to you in my presentation it's typically running well beyond that. so for the past two years we've had what has been called a project budget that has given us budget authority but not physician to staff that unit and that's what some nurses were talking about. we filled the beds with temporary staff. the good news is as i also mentioned this year the budget proposal to the mayor includes per -- permanent staffing about 30r.n.s sto -- to staff over the

course of the year as well as a 24/7 practice nurse to give us provider capacity as well. we feel very fortunate to have that in our budget proposal and hope it addresses some of the issues we've talked about today. >> so my next question would be in terms of the list and there's a list and people that have gone through and interviewed and once they're on the list, are there 1,000 people? are there hundreds if not 1,000 people on the list ready to be hired and we're not hiring them and i'm sure she list is not up to date but is there an active list you're working from in terms of hiring nurse. >> we have an active list and there's a list based on nursing specialty. i don't know the number right offhand. we'd be happy to get that for

you. as i said before, we're devoted to hiring nurses and other team members as quickly as we can so we can best take care of our patients. >> the other thing that disturbed me that i heard in the presentation is this idea of straight overtime and time and a half and can you talk about that, please? >> i would have to defer to my h.r. colleagues about that. >> okay. mr. brown. you have a ph.d. by one of the presenters. >> i have an advanced degree today. so it depends on the contract and looking at the hours the person is working. if they're working because nurses are exempt employees if they're working less than 40 or 80 hours or working overhours it's overtime straight until the meet the threshold. >> you're talking too fast.

explain slowly. you spoke about overtime and i understand the concept much time and a half. >> they have the ability to earn time and a half under certain conditions. if there's a part-time nurse not working full times the extra hours would be overtime straight and there's forced overtime under the contract. there's different provisions under the contract where payroll is looking to see when the time and a half kicks in. >> one of the things i heard in the e.r. listening directly to the nurses and i could be conveying this incorrectly, one thing they tried to do and ends up happening from management is the nurses are asked to stay. will you stay late, we're understaffed. it's a way to get them to say yes voluntarily without having to pay them the extra time. can you talk about that?

>> in light of the conversation? >> no, it seems to be a practice outside of the contract and seems to be one that should not be encouraged and in fact discouraged because if you're putting someone on the spot in that moment when they're short staffed from things we heard you're asking them to voluntarily stay extra and then you don't compensate them additional time and a half that seems to be a couple of different bad management practices. >> there may be and i can't speak to what actually has been said in those cases. i do believe in the nursing contract there if there was forced mandatory overtime they'd be paid time and a half versus volunteer. i don't know what the conversation is going on at this point and i don't know if there's anything they can add because use have to be in the trenches to know. >> i get it. i want to put it out there. i don't think we'll revolve it today. i want it on the record as an area of concern.

i think there's areas that are longer term that need to best adjusted and the immediate need with the crisis at hand in terms of hiring in an expedited man perp and the last thing as the head of h.r. because it sounds like a lot of people we heard and it's one i asked for in the resolution was the disaster training. are people getting the appropriate training, if not, what's the plan to ensure they're getting that training. >> for me it's the first time i've heard about the disaster training and i'm sure it's been brought up at the hospital where the training is provided. i'm not sure if susan has information on when or how that's being administered and i can come back and report if we're not able to today. >> the last thing i'd like to say to close out one of the things i want to highlight si appreciate all the time and

effort and energy the nurses put into this today. i know this took away from a lot of the different things. this is their time off and their free time. sounds like they're already over worked and stressed as it is so i appreciate that and appreciate the union coming out and giving their input and thank management and h.r. i know you're new on the job whether you lift or -- left or came back at least you came back with the perspective you understand where the problems are in the process. i'm glad the deputy director of human resources is here as well. i think that this situation n s necessitates a working group and need dph in the room and maybe the mayor's budget office. i'm going reach out personally to the mayor and her staff on this because we have to make this a number one priority.

we just grot -- got an announcement today that a high school was shut down and they clerd the school. these things may be happening more. people were asked to leave to deal with people that have been exposed. these are our first line responders and we can get ourselves in a serious crisis more than it is now. i think we need to commit to putting together an aggressive plan to hire people in an expedited manner. i know we can do it. if we create the bureaucracy and i understand and respect the civil service process and i know the unions have been involved in that as well in ensuring it's fair and equitable but at the same time we have to put our

heads together and figure out how to get people hired in 30 days or less into these positions. and this is years in the making. this is years in the making and sometimes it takes a crisis and a more exacerbated crisis like the one we're facing now to force us to put our heads together and get a solution. i'd like the commitment from dr. urlich and i'll talk to dr. koufax and follow-up with the mayor and her team and put together a plan to work together to come up with an immediate action plan to staff up in an appropriate way. i see her nodding her head. i'll note that for the record. also, i left out the union and the union should act the table as well.

>> so much, supervisor issafai r calling the hearing and thank you to the nurses and frontline workers who shared their stories, organized and demanded action by the city to really address the chronic understaffing and related workplace issues at the e.r. or emergency department at sf general and throughout our city and public health care system. clearly this is a crisis that is undermining the welfare of our frontline health care workers as well as the welfare of our patients. and as many have spoken to today, these are issues that have existed for years or even decades. you've certainly got the attention and support as supervisor safai and myself and our colleagues on the board and i think we appreciate the

leadership from d.p.h. and s.f. general and h.r. updating us to fix the hiring process as soon as possible. we'll continue to work with you and to push you on that to make sure that gets addressed as soon as possible. i also wanted to thank the leadership for sharing the broader solutions with us and address the broader budgetary and transparency and accountability issues that plague our s.f. general hospital and public health care system. have you our commitment to follow through on the proposals and to address these underlying issues that have led to this crisis in the hiring and for the

frontline staff at general hospital. thanks again, everyone. thank you, supervisor is a fa-- supervisor safai. >> can we send the motion. >> clerk: both items are called right now. >> i wanted to make a motion to excuse supervisor hany without objection. >> can we have a roll call on that? just kidding. that was a joke. no objection. so can we make i'd like to make a motion to send item 3 to the full board for positive recommendation and added as a co-sponsor as well, correct? >> and take that without objection. >> yeah. and then for item 2 i'd like to continue this hearing to the call of the chair. i'm going to confirm when the appropriate time frame is. i'm thinking 90 days to come

back and check and the leadership of the hospital and h.r. and others were beginning to work on because i had reached out to them and asked them and highlighted to them the things i needed them to work on. given the crisis at hand, i am going to ask to put together this working group in the interim and we'll work to get that to that aggressively. so maybe what we'll do though we'll continue this item to the call of the chair we might come back sooner than 90 days but we'll let everyone know in plenty of time to get back in touch. the leadership of the union has been in constant communication with me and working with shop stewards and the frontline nurse. they've been in touch with me. we'll be in constant communication with the findings of the working group and how to aggressively begin to staff up the hospital and i'll make a

motion to continue item 2 to the call of the care. >> without objection. >> thanks again, everyone. mr. clerk, is there any further business? >> there is no further business. >> we are adjourned. >> welcome to another episode of safety on today is episode we'll show you how 0 retroactive you're home let's go inside and take a look.

>> hi and patrick chief officer and director of earthquake for the city and county of san francisco welcome to another episode of stay safe in our model home with matt we'll talk about plywood. >> great thanks. >> where are we we if you notice bare studs those are prone to failure in an earthquake we need to stabilize those they don't lean over and plywood is effective as long as you nail along every edge of the plywood for the framing we'll nail along the sides and top and on the bottom 0 immediately you'll see a problem in a typical san francisco construction because nothing to

nail the bottom of the plywood we've got to wind block between the studs and we'll secure this to the mud sill with nails or surface screws something to nail the bottom of the plywood. >> i notice we have not bolted the foundation in the previous episode thorough goes through options with different products so, now we have the blocking we'll a xoich attach the plywood. >> the third thing we'll attach the floor framing of the house above so the top of the braced walls one to have a steel angle on top of this wall and types of to the top of the wall with nails into the top plate and the nails in this direction driving a nail it difficult

unless you have a specialized tool so this makes that easy this is good, good for about 5 hundred pounds of earthquake swinging before and after that mount to the face of wall it secures the top of wall and nailed into the top plate of the with triple wall and this gives us a secure to resist the forces. >> so you now see the space is totally available to dots blocking that he bottom and bolted the foundation in corneas

what the code in the next episode you'll see you apply. >> president bernal is away this afternoon on some business, so he's asked that i chair the meeting for this evening. the health commission will please come to order and the secretary will call the roll. [ roll call ]. >> our next item, please clanchts item is the approval of the february 18, 2020, minutes.

>> the minutes are before you for your approval. a motion is in order. >> i move to approve the minutes. >> is there a second? are there corrections to the minutes? all in favour say aye. all those opposed? the minutes are approved. >> clerk: there is no public comment for item 2. item 3 is the director's report. >> good afternoon, commissioners, grant colfax, director of health. you have the director's report in front of you. i am going to highlight our covid-19 coronavirus response. dr. aragon will have more details. i wanted to acknowledge the department staff who have been working for over eight weeks in terms of our preparedness and our response in terms of dealing with the coronavirus. last tuesday i am pleased to

announce that mayor breed declared a state of emergency in the city, which was transformative in our ability to better prepare for the response. it allowed us to activate the department to be more focused on the response, coordinate better with other city departments. this is a shared responsibility in terms of our response doing that. we were able to also be eligible for potential federal responses within an emergency response. we were also able to position ourselves to better educate the community and the public about how best to prepare for coronavirus and when coronavirus does arrive in san francisco. a key part of our message is that everyone can be a good public health hero in this response. that includes not going to work or school if you are sick. stay at home or seek medical attention.

avoid coughing into your hand. cough into your elbow or sneeze into our elbow. we recommend to not shake hands, but do an elbow bump instead. a key piece moving forward. and also a reminder to get a flu shot, and a flu shot does not prevent coronavirus infection, but it prevents symptoms similar to a coronavirus infection. get a flu shot to prevent getting symptoms. and, very importantly, wash your hands or use hand sanitizer frequently, especially after being in contact, close contact, with others, touching your face and so forth. regular hand soap for 20 seconds is one of the most effective public health strategies that we have as well as hand sanitizer. hand sanitizer is available outside with the commission materials.

we also need to focus on the outcomes. our department is working with other healthcare systems and other departments to focus on the most vulnerable. according to the w.h.o. those include people over 60 and additional data shows people with chronic medical conditions, especially diabetes, kidney or renal disease, people who have autoimmune disorders and are on medications. we're focusing on those populations. i'm pleased to say as of yesterday san francisco has started testing for coronavirus covid-19. this is a big step forward for us because until now we've had to send tests to the c.d.c. that turnaround time can be as much as seven days. we are now, because of our

laboratory leadership who worked very hard to scale up and to be ready for testing, we started yesterday and that turnaround time is now between one and two days. we do not have a newly diagnosed case of covid-19 in san francisco diagnosed at this time, but i just want to emphasize that given the situation that we're seeing in terms of community transmission in our surrounding areas, i think it's a matter of not if but when. when there is a case, the departments will report it as quickly as possible to both you and of course the public at large. i will also emphasize that as we continue our collective response in this epidemic, we need to ensure that we're following the science. part of that scientific literature is that stigma discrimination and xenophobia is very much bad for individuals, it's bad for community, and it's bad for public health. we are working with communities

across the message to ensure that stigma, discrimination, and xenophobia will not be tolerated and we must address this disease together using the best scientific evidence as possible. as part of that effort, we are having numerous communications, meetings, and engagements. those efforts are being coordinated with the department of emergency management, which is leading all the areas of the response that are not directly public health or clinically related. that's my focus on the director's report today. i am happy to answer any questions on the report. with regard to covid-19 response, i would ask dr. aragon to address more details in his report, which is the next agenda item. thank you. >> commissioners, before we go on to dr. aragon, you had received the report previous. are there questions on the other areas of the report that he has

given us today? most of these are areas to which are matters of interest. the joint commission is at zuckerberg general. we're actually going through the full survey at this point. let the commission know if you had not seen that point sent to you earlier. likewise, on workforce violence at zuckerberg we did address that during our joint conference committee. the information here in the director's report is very substanti

substantial. we are continuing to address this message in a very serious matter, also at the joint conference. >> commissioners, if i may add, i meant to say we have public health leadership here for the specific agenda items today. i have excused many as the executive staff who would typical be here because they are working on the coronavirus covid-19 response. i want to acknowledge that fact going forward, but per these agenda items, we have the leadership that needs to be here today. >> thank you, director, for the update in where we are. i think we will now hear dr. aragon, who will give us further information as to the status in the city regarding our response and what the science is today. this is item 4.

>> good afternoon. my name is dr. tomas aragon. things are moving at a fast pace. i'm going to try to complement the things to dr. colfax summarized. as he mentioned february 25 mayor breed declared a local emergency. i want to clarify that it's called a local emergency versus a local health emergency. so local emergency is more encompasses and gives us broader powers and more authority to mobilize resources for the city. so that's really important to say. the other counties are asking us why we didn't declare a health emergency, and we said no, we're declaring a local emergency which gives us more power and authority. on february 26 solano county announced the first case of

community-acquired coronavirus. as of today the chronicles are reporting we now have 12 community-acquired cases. each day the number is picking up. if you imagine, if you have 12 cases, there's really an iceberg of people who are infected. we know that most people have mild illness. so that means that infection is circulating in the community. he also mentioned that on february 29 the first death was reported in washington state. the number of deaths now in washington state is up to nine, and six of those are connected to a long-term healthcare facility. so there's been a big pivot in the way that we're now focusing on the epidemic. this week has really been a big transition week for us. so we have three high-priority areas that we're really focused

on. dr. grant had mentioned number one is focusing on the most vulnerable, medically fragile persons. we know with what we're seeing is especially with people who are older and chronic medical conditions that we saw in those long-term care facilities, that the mortality rate is high. the second one is protecting our healthcare workers. healthcare workers have a unique situation that their cumulative risk of infection is higher than the general public because they're seeing lots of patients that could be infected and those are the ones we need to protect from becoming ill. the third is focusing on mitigating community spread. there the focus is on how do we interrupt transmission so we can reduce illness and severe disease, thereby reducing demands on our healthcare system and also reducing the social and

economic impacts of our community. as of this afternoon, the c.d.c. is reporting a total of 60 cases across the country. the chronicle is reporting a total when you look at the whole area including travellers. and as well the community acquired, there is 12. the total number in the bay area is 29. san francisco continues to have zero cases at the moment. santa clara county is up to 11 cases and berkeley just reported a case this afternoon. by focusing on the most vulnerable populations, we're asking people who plan large events or mass gatherings to really think through about the most vulnerable populations, to really take that into planning and to consider how they can adjust. just to let you know the health

department did adjust project homeless connect. we're going to make sure when we bring it back that we address the issues so that people are safe. the c.d.c. as well as d.p.h. just released our long-term facility guidelines so we have a real rigorous focus on protecting persons in long-term care facilities. within that, we have the focus on condegree gat settings. today dr. baba met with the s.r.o. committee to focus on what we can do around s.r.o.s where we have a high concentration of persons who are not just older but share facilities. another major area we're making progress reason is dr. colfax and dr. baba are working through the hospital council to identify and mobilize resources and figure out how the city will

handle medical surge, but not just in the system, but if the systems get overwhelmed, do we end up designating specific hospitals to take over where care can be provided. as already mentioned, we have started our testing in san francisco. i understand that the testing is going to be increasing dramatically at the national level. unfortunately the c.d.c. was very slow initially, but that's changing. two more things i want to mention. just this afternoon, the california department of public health just got permission to release from the stockpile that they have, it's in the millions, it's a large number of n95 for healthcare workers. so that's really good news. so we're going to have n95 res pirators for our healthcare workers in california. that's important for us to recognize. the last thing i want to mention

is for community mitigation which is interrupting transmission in the community, we think of personal measures. dr. colfax mentioned the personal measures because they are critical, it's the foundation. the community measures, i mentioned the issue of how to think about mass gatherings and large events. the third area is environmental measures. that's really cleaning and disinfecting our environment. and dr. colfax referred me to olga miranda who is a union lead for the porters in san francisco. and i believe it's 5,000, a large number of porters that we have that clean all the buildings in san francisco. so i mention this because they are really the -- they are part of the frontlines of fighting this epidemic and they need our support because there's a lot of issues around their working conditions that we can work on together to make it better for them. so i do want to mention that.

i do want to thank dr. colfax for referring me to her. it's an area where we would not notice it if it weren't for the epidemic. they came to us. i think it's a great opportunity for us to have a strong partnership. we don't see them. they're cleaning at night. they make a big difference in keeping us safe. i do want to acknowledge them and to thank dr. colfax. that's the end of my report. >> thank you, dr. aragon. commissioners, questions of dr. aragon. i think it's important to acknowledge how hard the department has been working and the fact that much of our usual staff who was at the meetings to help answer some of our questions are not here because they are busy, as dr. aragon described, doing all the different work that will be necessary in order to respond to

whatever happens with this as we move through this community phase of the problem of the infecti infection. so i do want to express on behalf of the commission the gratitude for the very fine work that we're doing, which is not only protecting our city, but also being able to address the anxieties of our city residents as to what it is that this virus is all about and what needs to be done. i think the success so far of the information that you have put out is indicated by the fact that people are appropriately using the techniques. i notice that hand wash materials are actually very squares to find in scores. and even though it appears you

can't really buy a mask out in the public areas for the fact that the city does not have everybody wearing a mask i think indicates that i think we've heard the message. it's important to have that if we believe that we have some sort of infection, but that very importantly that health workers need it because of the exposure that they're going to get. i think your last information that health workers are going to be able to access this is very importa importa important. i believe that we want to once again express our thanks to the department and the mayor for actually getting ahead of this. although, i guess it was in the hour that the government also declared with the c.d.c. that there was a real need on a nation-to-nation basis to be

mobilized. we were there also to mobilize the city. >> our timing was very good. i described it to a co-worker. we're like riding a wave and we're on the right part of the wave, not wiping out but just ahead of the curve. i feel confident in what we're doing. >> commissioners, some specific questions that you may have. >> thank you, dr. aragon, for your report. i want to add my thanks to commissioner chow for the swift action and the comprehensiveness of the work that's being done in riding the wave quite well. i had a question about the testing. the test kits, the c.d.c. tests, are they state tests or what -- >> the current tests that were sent out came from -- right as of today, all the testing are c.d.c. kits.

so the state health department has them and then selected local health departments got some of them. we got just over the ability to test 100 people. that still is limited to people who meet the requirements for testing. the f.d.a. just approved the ability for hospitals and private labs, as far as they can meet the full laboratory requirements, they can go ahead and start testing. i think over the next week or two you'll see a lot more positive tests. >> can i also state and reinforce the fact that current testing recommendations are to test people who are at highest risk for coronavirus infection. there's no on-demand testing in san francisco. i'm not aware that there's anywhere at this time, but just to emphasize that. the test has to be -- if people are correspond, they need to discuss this with their healthcare provider, who will contact the healthcare

department, and they will make an assessment with the c.d.c. guidelines whether a test will be done. >> that's correct. thank you as well. my question is of all the cases reported in the united states, are any of them children and adolescents? >> none are children that i'm aware of in the united states right now. i know from china the number of children involved is really, really small, very small. >> thank you. >> commissioner green. >> thank you so much. i was wondering if you could elaborate on how you're interacting with hospital councils. i work in the sudder system and most of what we're getting is from sudder corporate. so many of our hospitals are getting things system-wide.

>> i'm going to refer to dr. colfax because that's an area he's spending time with. if you could elaborate with, that would be great. >> using the hospital council, we have brought together the healthcare systems to have shared conversations to make sure we have the best understanding of how we are preparing together, focusing on the same priorities and the same populations and also ensuring that we are potentially being able to share resources, particularly with regard to the medical staffing and staffing up in the event we need more capacity to respond to an epidemic. so lots of planning going on on an ongoing basis with regular and structured calls, on a regular basis to ensure that point people are identified, leadership is activated, and that we're moving forward as consistently and as rapidly as

possible. >> thank you. >> i did want to thank dr. aragon also for responding to my question last time in regards to the s.r.o.s and that the d.e.m. is working with them in order to be able to help respond to another vulnerable area which i think especially in this city is very pertinent. >> commissioner, if i may add something else. the most up-to-date information on coronavirus and local guidance, sfdph.org and then the c.d.c. website also has up-to-date information. given there are multiple sources of information, some are more reliable than others. i want to encourage the public to go to sfdph.org for the most

up-to-date information. >> thank you very much. that's information, then, dr. colfax, that will be for laypeople also or for -- >> yes. >> okay. >> in multiple languages for san francisco. >> okay. and that would be through the department's website? >> yes. >> okay. very good. okay. any further questions? if not, once again the commission is very appreciative of all the hard work that you're all doing and we look forward to the report coming up -- well, we don't look forward to it, but we will then be receiving your report at our next meeting again. thank you. >> clerk: commissioners, item 5 is general public comment and i have not received any requests for that. general public comment would be on a topic that is not listed on the agenda as an item.

still none. we can move down to item 6 which is report back for the finance and planning committee. >> the finance and planning committee met earlier today. we had a couple of items that have added to the consent calendars for our approval. the first is the contract report and there are three contracts in that report. one is san francisco public health foundation and that is for -- in a contract came back to us for amendment because there were more sundays added through the text. so they have to adjust the contract figures. the second one is the san francisco aids foundation. due to the supervisors at that, they also have some additional fundings that they need to amend

into the existing contract. the third one is the mission neighborhood health center. this is actually a renewal contract. so the last contract ended in december 31, 2019, and this one -- this contract is for the period between january 1, 2020, to june 30, 2023. we also have a new contract with talemed and it is to provide nurse registry personnel to san francisco health network, zuckerberg hospital, and laguna

honda. this is the contract that we are approving for, just to make sure we do not get short staffed at any point in time. in addition to that, we have two discussion items. these items actually also would come to the commission later on today and the programs themselves would -- the contract would be coming back to the finance and planning committee meetings. these two contracts are -- first there's the hummingbird respite in 1156 valencia. the other one is the project 180 which is the methamphetamine sobering center on 180 jones street. we have received a lot of public comments for both items. for the hummingbird respite, we

get fairly positive support in the feedback that they really support the program. hopefully, this will help to alleviate some of the high-cost services that folks needed, such as going to the p.s. or other emergency services. instead, they would have this detox respite that they could go to. the other is the project 180, which is a methamphetamine sobering center. it has 15 beds. it is going to utilize one of the city's property which is currently a parking lot to set up a tent for these 15 beds. it is scheduled to go for a year. after that, that space would be used for affordable housing development. we have a lot of public comment

from both sides. some supports and some concerns about the process, but in general from what we gathered earlier is that nobody is opposing this kind of program from being implemented. you know, the concern is more about the timing and the process of it. i'm pretty sure that some of these members of the public would come back and speak on that later on our agenda as well. >> thank you. are there any questions? i think we'll take questions on the contracts, questions on the other two parts of the committee hearing. we'll actually defer to our own hearing because we will be hearing those two subjects here at the health commission very shortly. >> my apologies, i should add a

little bit is that we didn't have to approve any of those contracts because we have rescheduled them to come back to the finance and planning committee on march 17. that way, we could also meet the actual requirement for posting it and for the public notice and which needs to be 30 days. >> right. so to get into those items, we'll discuss what the process in and what we'll be doing in terms of taking up the two subjects and action on them. so i would accept questions on this point to commissioner chung regarding the consent calendar if there are any questions -- i should say in regards to the report and then we'll move on to the consent calendar. if there's no questions on the report, we'll move on to item 7.

>> clerk: item 7 is the consent calendar. >> the consent calendar is before you. are there any extractions? seeing none, we'll adopt that and move on to the next item. >> clerk: item 8 is the proposed program review of 1156 valencia hummingbird respite, a respite program to be located at 1156 valencia street. this is a discussion item. >> yes, once again, as we take up these two items, both items will be for discussion for the public to put their input in. the commission then will request the department in certain follow up if any occurs from the testimony. and then the final action on these two items will be taken at our next health commission meeting. so we'll proceed with the presentation on item number 8 now, please.

>> arrow up because i think it's at the end. >> good afternoon, commissioners. my name is kelly hiramoto and i'm the special projects director for the department of public health here to talk to you and give you a brief overview of the proposed hummingbird respite at 1156 valencia street. so identifying the need for a hummingbird that is in the neighborhood, we know that many

people in the neighborhood know the people we aim to serve and the need to support them locally. we know many of them as well. we want to create a safe place for them to rest and consider their options. it's also important to note that the neighboring district 9 has 661 people at the january 2019 point in time count. there are 317 people experiencing homelessness in district 8 according to the same point in time count. a known group of at-risk individuals are in the mission upper market and delores park corridor and they could be served by having a place closer. we know clients are more likely to seek out shelter from a nearby location with welcoming staff and activities that will keep them positively engaged. we're aiming to serve praerls homeless individuals who are not engaging care. our goal is to have recovery

programs to maximize each individual's capacity and quality of life. why 1156 valencia? as you know, san francisco real estate can be challenging, so we were fortunate to find this building in an area where the need for services is great. just as we were looking for a new location to expand the successful hummingbird place mod model, we were looking for an innovative way to serve people experiencing homelessness in san francisco. it's also important to note that salvation army is making this an affordable site for the city. it is the right size to serve a population in the hummingbird model. it has the right features, existing bathrooms, large community spaces, ability to support laundry and meals. it is close to delores park and corridors where the need is

great. the project itself is going to operate 24/7, 365 days a year. it will have 30 beds for overnight stays and up to 25 drop-in daily participants. we don't just mean people who will just drop in. at our current site about 70% of the population are people who have stayed at the program before and are coming back but just to stay for the day. a lot of folks come and stay during the daytime and rest during the day so they can stay up at night because they feel at risk in the community. low barrier means we're always open, you don't need an appointment, you can bring your partner, your pet, your belongings. inside, you will find trained, compassionate staff, access to activities and also substance

use treatment. if people are not able to get to our center, people will come to the site to do the paperwork and intake. we will offer individual and group counseling, laundry facilities, meals, connect to healthcare, link to social services, help sign people up for services like s.f.i., and help escorting people to their families when needed. we've talked about the kinds of people we hope to serve at 1156 valencia and now we are going to talk about what it would be for the neighbors. first, we encourage people to engage so the people in need are not vulnerable. neighbors would notice 24/7 security on site with staff escorting clients when they come and go. the captain from the san

francisco police department mission station is committed to partnering with p.r.c. baker with the on-site security. anyone experiencing homelessness in the vicinity is not in need of this type of support but needs housing. d.p.h. is exploring a partnership with the department of homelessness and supportive housing to help the community. d.p.h. convened two community meetings about this proposal about you today. we held a community meeting on february 10 and we had a follow-up one on the 17th. neighbors will be provided a phone number to report any issues 24/7. a community meeting will be

convened six months after opening. we are having conversations with the neighbors and the community. it may be that we'll hold further community members if that's necessary as we launch. we targeted for six months because we want to give the program time to get off the ground and have some structure to it before we have conversations with the community. the program will work with the community to provide referral to services. these referrals will come from many services in the area. the goal is for the majority of referrals to come into the

program to be from a known source so we're able to have escorts in and out. the good news is that we do have treatment to offer clients who are ready for it. clients who participate in this program get expedited access to these providers. because mental health treatment programs are also offered, it is a straightforward way of fast true and accurating folks into those programs. we also partner with the crisis service. salvation army also as a substance use social detox program and residential treatment program. we'll be having tight relationships with them. we also have relationships with additional community treatment providers such as friendship house or mission council. we'll continue to make sure we have warm handoffs.

those referrals can go in both directions. it may be somebody is having a tough time in the treatment program. rather than having those individuals discharged into the community, they can come to the hummingbird site to have a moment to think about it. we have included some data from our current existing hummingbird place. our average length of stay for the fiscal year of 2018-19, our shortest stay was less than a day. our longest stay was an individual with us for 220 days p. right now our average length of stay is around 17 days. thank you new site, tipping point community is funding because they've studied the

model and recognized the need for more services like it. we also collect data about the d.p.h. programs. here is additional data about the program that launched in august of 2017. our efficacy is measured in a few ways. for clients not really for treatment, willingness to keep returning. for those who come in, success is going to the program. and for those who leave, having 30 days or longer without a return to p.d.h. at our first hummingbird site, many of the clients did not return after a departure from the site. in our last fiscal year we increased the number that exited residential treatment to 34. we're getting better able to understand the population that we're serving. to give you an example of some

of the clients we've served, t.m. had a long history of homelessness, alcoholism, and other issues. he was using a wheelchair. he used the emergency department so frequently that the emergency department case management team stepped in to help. at hummingbird, he was able to maintain sobriety and get regular follow up and emotional support. he continued with his medical care and with time no longer needed the wheelchair and was able to graduate to use a cane. he continues to remain sober. here is another example. he completed a 90-day program, and moved to his own place where he continues to do well. these are good examples that we do have success and how we're engaging clients and moving them into a higher quality of care. i wanted to take a minute to

allow p.r.c. to talk about their program, what their history is, why we're partnering with them to do this program. here is the c.e.o. >> thank you, kelly. commissioners, good afternoon, director. i quickly ran home to walk my dog max and found out that joe biden won virginia. i have no dog in this race, but thought i would report that. it's a busy day in the united states. i am brett andrews and i am the c.o. of p.r.c. this was formerly positive resource center. in 2017 we merged positive resource center and baker places, a center that you all have been supporting since 1964. i think this is all teed up. i just put on the screen our

executive leadership to include myself and a chief operating officer, finance, clinical, programs, strategy, and our information officer. i have joe here who is our c.o.o. in the back and our director of property management jeremiah gregory who is here as well. p.r.c. has been around since 1964 as a combined entity with baker places since 1964. our mission is to help people affected by h.i.v. and aids, substance use and mental health issues to better realize opportunities by providing better integrated legal, social services that address the broad range of social factors that limit wellness and affect potential. we stand on our values of diversity, inclusion, and respect, to name a few.

i think i've skipped ahead a little bit. our headquarters are on 179 street. we just had the opportunity to merge the three organizations and of the 270 staff that we have, almost 100 of them are at 179 street between mission and howard. that was formerly the opera's costume house that we were able to take advantage of. we're glad to provide legal services there, workforce development, housing case management, emergency financial assistance, and peer-to-peer counseling. our staff is a total of 270 and we have a budget of about $31 million. in addition to our hummingbird facility that we have on

pretrero, we have another facility across the city of 100 beds of residential treatment programs and 114 beds of transitional and permanent supportive housing. this all speaks to a continuum of care and i know you're going to be later talking about 180 jones street. as we think about low-barrier services, allowing people to step into services where they are in a harm reduction model with a level of dignity and often in a home-like environment, this is san francisco's innovative way of introducing hummingbird as a behavioral health respite and allows people for many times, for the first time, to think about what is the next best right step for them. in a lot of cases people are going to go from the sobering center to hummingbird and stabilize them and into

treatment and care and living a life of wellness and recovery, something that san francisco as a value has been standing on for years. kelly talked a lot about 1156 valencia. i heard a lot about the process. i understand it's important to get feedback in the community process. we want to hear from the community while we are moving forward with this hummingbird and potentially if there are other hummingbirds. i will say as person who had a has been in the work for 17 years, i have seen those in the streets and watched our clientele become sicker, older, and darker. there will be a spot of individuals who we will never be able to save if we don't do anything. i would like to thank the commission for taking big and bold steps in this. with that, i'm happy to answer

any questions you have. >> [ indiscernible ] -- public speakers, which we will call before we go on to questions. actually, commissioner, if i may. for those of you new to the commission, my name is mark, the health commissioner secretary. i have a timer and everyone will get two minutes to speak. when the buzzer goes off, please stop and let the next person speak. many of you are passionate about the topic. if you would like to say the same thing, use your hands like this so we can keep the flow going. >> there are six people who have asked to speak on this item, so i will call each of the names. you don't have to be in this order, but be prepared to come forward. come forward into the aisle and

take the next spot after the previous speaker. each speaker has two minutes. >> hi, commissioners, director. i am the policy director at compass family services and we're a member of the treatment on demand coalition. i just want to speak in favor of this proposal. i think we need projects like this and so many more like them in order to offer people, as brett was saying, the low-barrier dignified care they need to access recovery and

maintain their own wellness over time. it's tough to go first because i'm not really responding to other perspectives, but as a family provider i want to say we shouldn't underestimate what it means for families to provide these spaces for people to be. it's extremely important for our families and our children that we move people inside in a dignified way that gives them safe spaces to be. and i think this project, like other projects, there's certain other refrains that we hear in the community in opposition to the project. while i acknowledge that those arguments are out there, i think the argument is always that we want this but not here, if that is the argument, we're never going to bring the projects online with the frequency to mitigate the cases of homelessness and substance abuse that we're seeing in san francisco. we need to also assess the goals that are laid out.

with that said, we support the project and thank you for your time. >> thank you next speaker, plea please. >> my name is anthony crosco and i work with mary-kate over at compass services. i'm not sure if you all have siblings, but i think it's similar how siblings can look similar or different. i have a very big family, about seven folks in my family. one of my older brothers named donnie, he's about 6 foot-5 and he has curly hair and he looks just like johnny depp and you couldn't tell them apart -- or he looked like him. i haven't seen him in 12 years. during the time in which my family navigated the obstacles

of homelessness, my brother developed a drug addiction and was incarcerated and he's been incarcerated ever since. i would not wish on any of you or anyone you care about the pain of losing a sibling. i can't tell you with scientific certainty that a program like hummingbird would have made it so that my brother wasn't taken away from me, but i can tell you with scientific certainty that with programs like hummingbird families can stay together and siblings won't have to grow up without their parents and without each other. that is something that is true. so i appreciate and i'm very, very grateful for all of your commitment to programs like hummingbird. i'm grateful to the mayor for her support of programs like hummingbird. i can just tell you that i hope

that this project finds great success. thank you. >> next speaker, please. >> good afternoon, commissioners. i'm sara short. i live at 1042 valencia. so it's just the adjacent block to the proposed site at 1156. as a neighbor, i just wanted to express my genuine support for the project. i see these folks in my neighborhood. i know some of them. i've become familiar with their stories. i also to some extent see them day after day for month after month. so i'm really familiar with how important this resource is so that rather than -- many

childrens and families in my neighborhood like any other, rather than have those children see suffering on the streets and see a city that doesn't care about people in crisis, i would like the children of my community to experience the knowledge that there's a facility where there's care and healing and treatment being provided to those folks. so i'm really excited about this facility and i know that this won't be the only one. that's the other thing that i'm happy about is our neighborhood being a leader, that if it's successful, hopefully we can replicate it. we already know it's been successful because we've had a model over at general. to do it in the community now is the logical next step. i just want to say that as a

resident, i've heard a lot of my neighbors express fear and concerns and such and say we really, really support this project, but not right here and now. i'm saying, yes here and now. please, thank you. >> thank you. >> welcome former commissioner guy. >> thank you, current, daily, president chow facilitating the meeting today. commissioners and staff, including our director. today i just want to -- i'm smiling because i didn't come to complain, which is what you usually anticipate, so relax. even though we have this virus that we know is coming. so i want to really support the

lessons that we've learned as a community from the first navigation center that was opened in the mission at 16th street. i just want to give credit to the staff leadership over the years. thank you. and also, the second point is part of the success of this is that the silos began collaborating. so you have housing, the department of public health, you have the community, even when we brought our criticisms. so this community collaboration is part of the achievement, including the financing and people who run for office now. that was not true four years ago. also, thank you especially for linking homelessness and incarceration because this is the first time that we've begun to do this. i just really want to thank you that all the navigation centers

are open to people where they're at, having them come back to the navigation center rather than being recycled at p.b.s. and the jail. thank you for this success and also thank you for showing that the navigation centers and others will not be afraid of the public, that we come to you and organize regular community meetings for feedback and learning more lessons. thank you. >> thank you. >> hello, i'm lidia branston and i'm coming to talk to you of a child that goes to school two blocks of the proposed hummingbird site. i'm wearing a hummingbird in support of the site. i'm here also with the support of my child. she has grown up understanding

that people all deserve respect, that they're inherently dignified, and sometimes as a society we need to give them that respect to remind them of their inherent dignity and their right to have a dignified life. one of my kid's friend's parents said, watch out, here comes a tomato and they were having an episode that was involved with drugs. my daughter was horrified and she said, you should talk to their mom. when does a person become a tomato? the dehumanizing aspect of stigma of people who are struggling with mental health and programs like hummingbird, like the 180 project, show our children that we have a society that actually cares for all people and that all people

deserve respect and treatment. thank you. >> thank you. i think i had one more also, lauren khan. >> hi. thank you so much for the opportunity to be here. lauren khan representing health 360 and also myself as a citizen of san francisco. i just want to say the need for expansion of the hummingbird program and more programming like this could not be more acute in san francisco right now. so really appreciate the work that many have done to advance this and to want to encourage the commission to do everyone in its power to move this forward. thank you. >> i think that ends public testimony unless somebody has not turned in a slip. yes, please. >> thank you for doing updates. bernie sanders won vermont. i'm amy wise, the founder and director of the san francisco homelessness challenge. our focus 2015 is to end the

crisis conditions of street homelessness through essential needs activism and also creating safe, organized spaces of stewardship, belonging, shared agreements, cultural enrichment, and participatory management. ah, that sounds good, right? one thing i want to mention to you, i support this project. i live -- i'm currently housing unstable, but one of the places that i stay at sometimes is just two blocks away. as a neighbor, i say, yes to in my backyard. one thing that our organization has been pointing out for a long time is that we need safe exits from the navigation center. originally what was the beauty of the navigation center, one part of it in addition to partners, pets, and possessions was that people got to stay

there until they got housing. and i understand there's been different policy changes, but i've seen the impacts of people's lives and having to get evicted for 30, 60, or 90 days. when you're talking about this, please think about a safe exits program. guess what, i have a solution. we don't have enough beds inside buildings. we don't have enough beds and shelters, but we can create safe, organized spaces on land that is underutilized right now. think about that, safe exits, so we're making sure that people aren't returning to the streets. s.f. public press just did a report on the amount of people that go through the healthy streets operation and go through a na.v. center and go back to the streets. >> thank you very much is there any other public comment? seeing none, though, before we

go to the commissioners, i would ask director colfax to make some comments. >> again, i would add to your comment, director chow, that this is an ongoing expansion of our behavioral work. this is another step in low-barrier opportunities for people and this is really in the larger picture the efforts of what mayor breed has said with mental health reform and mental health s.f. this is another key step going forward. as we continue to invest in mental health s.f. efforts, what i would like to communicate to the commission and the members of the public is that this would be one step forward, but over time this would be one of many of those types of opportunities for people who have mental health disorders to get the care and support. and then the exit strategies

that support them and the community to do better. thank you. >> commissioners, questions to any of our presenters or to dr. colfax? the presentations have been so outstanding that i have not actually remembered when the commission didn't think that they actually wanted to question it. i will take that then as an intent for us to then close discussion on this particular item, reminding the public that we will be taking this item up again for final discussion and action on march -- what is it? >> the commission will vote on the contract for this program on march 17. >> on march 17, okay. >> commissioner chow, if i may.

kelly, one of our key staff who has led the hummingbird concept, i want to acknowledge her leadership in this work. this is hard work to do and she mobilizes us enables us to get her. i want to acknowledge her here today. >> she has been doing a lot of work for a lot of years. this must be one she's feeling satisfied about in terms of being part of the exit. >> shall we move on, commissioners? >> yes, please, shall we go on to the next item. >> item 9 is the proposed program review project 180, a new drug sobering center to be located at 180 jones street, san francisco. this is a discussion item. the contract will be forked at the march 17 meeting. dr. martin.

>> good afternoon, commissioners. some of you are going to feel like it's groundhog day. so my name is judy martin and i'm the medical director for seven seas services for the city and county. i'm going to be presenting some slides for project 180 along with my colleague from health 360. first i would like to call another colleague dr. anton nigusse bland who has had a lot to do with this project. >> thank you, dr. martin, and thank you, commissioners, for the opportunity to present this

information and our proposal for a drug sobering center in the tenderloin. the drug sobering center was the foremost recommendation and it was co-chaired by leaders from the department of public health. over six months this group of individuals, including healthcare providers, policymakers, safety officials, members of the judiciary, as well as most importantly members of our community who have lived with the experience of methamphetamine use, committed to inquiry and develop recommendations for how our city can best move forward in response to the growing methamphetamine epidemic. today i'm pleased to join with our team members in presenting this proposal. over the past several weeks, i've had the opportunity to listen attentively to concerned community members and directly driveways their concerns about the drug sobering center.

what i hear mostly in these conversations is trauma. i want to acknowledge and spaes for the experiences of inequity and i also want to acknowledge as your health systems attempt to improve, we must allow for our experiences of inequity. what we cannot do in the face of inequity and in the face of rising deaths and other harms linked to methamphetamine use, which disproportionately affects people experiencing homelessness, what we cannot do is wait. the mayor made it an urgent priority for city agencies to work collaboratively and partner to create the first drug sobering center. our aim for this program is to increase safety for the tenderloin community and the many children who live there. as the department of public health previously did when

placi placi placing syringe boxes, we will continue to request the advice and insight from concerned community members and incorporate their feedback into our programming. our hope is that as we continue to build relationships in the tenderloin community, the community will feel a difference, continue to thrive, and people will receive the care that they need with dignity and respect. with that, i'll turn it over to dr. judy martin and kathleen stokes. >> i wanted to start by saying this is noticed under chapter 79(a) of the code.

if commissioners have questions, my colleague is here to help answer questions. the drug sobering center is a recommendation of the methamphetamine task force and the other 16 recommendations are in your packets. this one was the number one recommendation. in october when these recommendations were presented, mayor breed said the city would implement the top recommendation and then in february announced that a proposed opening of a drug sobering center at 180 jones street. the methamphetamine task force was informed by focus groups that included people with lived experience using methamphetamine and experiencing homelessness. it included residents and

merchants from various neighborhoods and included healthcare providers. between april and september 2017, the task force convened four public meetings, studied best practices, compared our situation to other countries and state states, and weighed public comment at those meetings. the two words that they used in this initial recommendation that we used is trauma informed and harm reduction. i just wanted to point out that trauma informed means that our care for people takes into account all kinds of previous trauma, current trauma, et cetera. the approach which is to care for physical, psychological, and emotional safety for clients also includes the same for providers and neighbors.

harm reduction is something that san francisco has led and has been a shining example for many years. it's been our policy, we've had a harm reduction policy for 15 years or so. the harm reduction services help to mitigate the dangerous effects of drugs and alcohol use and is not predicated on coming into treatment. so syringe access is a good example of this. we're good at opiates doing harm reduction. i wanted to point out in 2018 there were over 1,800 bystander reversals. so the community is very well aware of these efforts and sophisticated about protecting each other.

so this geo map, sometimes called a heat map, represents some of the challenges of the tenderloin neighborhood. the darker the blue, the higher the over dodose rate. you can see that the darkest of all is in the area where this sobering center is being placed. we also wanted to mention that the homeless count in 2019, the single day count would look fairly similar with 3,659 people experiencing homelessness counted in district 6, which is 10 times more than the neighboring counties. i mean that in district 6.

so the effects of methamphetamine are a challenge for the neighborhood and for the people who use methamphetamine and for this system. the hospitalizations have increased dramatically since 20 2013. psych emergency visits have -- many of them are related to methamphetamine use, including people walking in for help to psych emergency. we're hoping to help some of those people at the sobering center. also -- there are also a lot of arrests related to methamphetamine, and 55% of those occurred in tenderloin and south of market. so this project is meant to provide an alternative to being arrested or going to the emergency services.

and a more appropriate response. so a drug sobering center, the word sobering center comes from the alcohol ones, like the ones we have in the city that's been successful for many years. some of the learnings we got from that program we used in designing this one. drug sobering center is focusing on other drugs, most importantly methamphetamine. it's a place where people experiencing homelessness and who use drugs in the street in the open can come in and their needs be addressed by professional staff who also are caring and trained in trauma-informed systems. the monitoring for health and safety is especially important to notice.

so part of the triage and evaluation is the risk for overdose. so people at higher risk would be monitored more frequently than those who may be at lower risk. the sobering center includes needs for people who are stimulated and want to walk around and do things and also for people who are crashing and need to rest and sometimes stay overnight. so the site selection, one of the things i mentioned earlier is the tenderloin in general, but this particular site, part of the reason for selecting a site that was immediately available to the city and owned by the city is the urgency of this issue. the location at jones and turk was also good.

it was sited for affordable housing starting in the fall of 2021. that makes this a temporary project. we're looking at it as a pilot that will further inform the development of other sobering centers in the city. one of the commissioners was asking what we will be looking at and how that will inform. we're immediately looking at how does it flow. where do people come from, how many people come back twice. how are the warm handoffs in the community, which is one of the most interesting parts of this project that i think is brilliant and is going to work well is to meet people in the community and walk them back, how much that works. whether the screening or triage process works. can people stay, are we picking

the right people to be there or should some people be in the hospital. we're looking at that. depending on the results of the pilot program, we might tweak some of the other proposals and even this one. we're hoping that this one will continue in a more permanent site in the tenderloin neighborhood. it's meant to be embedded in the tenderloin and working in other tenderloin agencies that serve peop people. so people will not be bused in from other parts of the city. they're already in the tenderloin. many of them we expect to come from referral partners that serve the neighborhood programs in the area. one of the commissioners asked

too what other programs are in the area. so we attempted to make a list, an initial list. st. anthoniny's hospitality house, boys and girls club, glubio project, drug users union, larkin street, antonio manner, compass, guide. lots of programs can use this. curry seniors center is another place and might be using this if someone is compensating. the calls will come from the tenderloin area. we're not screening people at intake like saying, where did you come from, what's your address? we're more trying to get referrals that only come from the area.

health 360 is probably going to speak about that more. where do people go? well, we have other programs that address clients experiencing homelessness. 90% of the residential treatment clients are experiencing homelessness. many of those use methamphetamine. one obvious potential warm handoff on referral would be a residential treatment program. we now have finetreatmentsf.org that let's people know day-to-day the open bed count of these programs. so we'll probably use that as well in referral. we wanted to say, though, that we're supporting people, regardless of whether they choose a treatment program or not or just harm reduction

services. we want to recognize that even coming to that site is already a commitment to health and the beginning of a relationship. so we are committed to community engagement and we'll be active with community partners in the tenderloin. we recognize that the community wanted to be involved before the announcement of this proposal in february, and we apologize for not gathering their input sooner. we're committed to repairing those communities and rebuilding them in the future. what we found is most people approve of the service and see the need for it. so we're hoping to work with other issues that people are raising about the location.

so i'm going to turn this over to my colleague kathleen silk to talk about health 360 and how they see the program. >> good afternoon, commissioners. thank you for having me again this afternoon. my name is kathleen silk. i'm a licensed marriage and family therapist. i specialize in substance use disorder and trauma treatment. i'm also currently the managing director of behavioral health services at health right 360 in san francisco, overseeing 200 staff over a dozen behavioral health programs in san francisco, which include outpatient recovery services, detoxification, as well as transitional housing and criminal justice programs. i'm also a native of san francisco and live in the civic

center area. health right 360 is one of the substance use disorder treatment centers. the agency is the result of a merger of two san francisco non-profits organizations waldon house and ashbury program. we currently provide an array of services here in san francisco aimed at integrated whole-person care. those include street outreach, primary health and dental care, and social supports. underlying all of our work is the belief that everyone has a right to access healthcare. the way we practice that value is by offering services that are non-judgmental and affordable. we serve people who are uninsured, experience homelessness, and are socio-economically disenfranchised. we love the people that we serve

and we love the work that we do. we're deeply concerned about the increasing dangers and harms for those experiencing homelessness in san francisco, particularly the growing risk of overdose and death. i will describe some of the major features of the proposed program we hope to open. as was mentioned, the top recommendation from the methamphetamine task force was to open a trauma-informed drug sobering center. this is a neighborhood pilot program focused on serving people in the tenderloin who are intoxicated by methamphetamines and other drugs. all stays are voluntary. the program would be built on the principles of harm reduction and care. as a result of the harm reduction approach, we acknowledge that harms caused by substance use can be numerous

and impact communities in vastly different ways. in this proposed program, we would meet participants where they are motivated to engage. some people may stay for only a couple of hours, while others will be invited to stay overnight. some may only accept a few resources on their first visit, but we want to create a space where they will feel comfortable returning. we would have staff at this program 24/7, included registered nurses, health workers, supervisors, van drivers, and safety monitors. we understand that the harms of substance use are not just ones that impact individuals, but whole communities. our goal is to be a positive

influence on that corner. one way we will do that is with staff encouraging a sebs of stewardship for the area as an extension of our program. the program is based on a few key elements listed here. as i mentioned, we believe in treating people without judgment and with compassion. we care deeply about people who use drugs seeking our services and we want to minimize barriers to engaging in our program. the services would include self referrals, community organizations, the department of public health, the street outreach team and street medicine. our warm handoff process was referenced that we're working with the tenderloin substation to facilitate, which would include our van or outreach workers walking or picking people up in the community. this will be particularly important, as there is no 24-hour service in the neighborhood and this is something that we know that an

overnight shift of police officers would be able to utilize. we will have registered nurses on staff around-the-clock to provide medical assessments and refer out as necessary. they can provide first aid, educate people on their medications, and assist in linkages to healthcare providers. the layout of the program would be at the lot of 180 jones. it's enclosed by a perimeter fence and would be with a large te tent. we want to be able to use this temporary space while looking for an alternative space in the neighborhood for this project. while we have this chance, we are working with the department of public works to have a weather-proof, as durable as possible on this timeline tent and make the most of the space. so that includes outdoor spaces for walking and pacing, a pet area, as well as baths and a

shower. people can present with various features. we're hoping to create a space that can provide flexible accommodations for people in those states and help people feel better. we wil provide an offer to rest, be active, as well as places for medical assessments. underlying all of our services is the prioritization of safety of our participants, our staff, and the surrounding area. health right 360 has 50 years of experience running 24-hour facilities. we have learned a lot of lessons on running facilities where participants have traumatic histories. we account for traumatic experiences in people's backgrounds. we make an assumption that people react from a place of

vulnerability and fear and need a safe space. we hope there will be a sense of calm and familiarity. these principles are also underlying our staff training which include non-violent communication, restorative justice. we also want to be responsive to the community that we serve, given that we are aiming to serve those in our community who need help. our safety monitors may become the most visible in our neighborhood, as we hope to have them work in the areas surrounding the program.

partnerships are very key in the development of this program and its success. we recognize that building a strong evidence-based community engagement component is also essential. health right 360 is going to partner with the ucsf center on a formal evaluation of the impact of this project and the engagement of the community in the tenderloin. the goal is to learn lessons and what we need to improve upon. we have begun the process preliminarily in engaging some community stakeholders, including people who work in the t.o., use drugs, and other participants. we would also like to create ways for immediate and community feedback partners. many of the partnerships will be major players into the referrals for the program. the program will be for

providing transportation on leaving 180. we also plan to partner with many amazing organizations to create more linkages to refer back and forth and to coordinate with the services we offer. we have also received honest and generous feedback from many partners about specific considerations for that corner. this includes concerns that this program would be a negative presence in the area. our hope is to be a positive presence with 24-hour staff on hand. one consideration we would want to follow up on would be the ins and outs of safe passage and school sometimes. another partnership we hope to build on is with the community

of people who use drugs in the tenderloin. this program should have the voices and expertise of people who would use the services built in the structures and practices. we plan to formally engage in that process if this program moves forward by creating community feedback forums and other mechanisms. ultimately this program is for them and we hope they would be able to guide its success. thank you for nowing me to describe this program and please let me know if you have any questions. >> we have a number of speakers. i will call out five at a time.

>> hello, i live around the corner from the site. i am here on behalf of myself and many of my neighbors. we oppose the application. the families and children living and going to school nearby are already facing persistent traumatic stress and by diminishing their voices and concerns, you are continuing to oppress an already-oppressed population. the city has done a horrific job of disseminating information. when i spoke to an administrator at city academy, it was the first the administrator had heard of the site. the disregard and disrespect shown for residents in the tenderloin is infuriating. we have been given no concrete answer where this will go. only the potential options.

$6.8 million is an outrageous amount of money for a 15-month tent and that doesn't even meet the recommendations of the methamphetamine task force. two of the recommendations were that it should be a calm environment. this is a 15-bed tent on a loud corner surrounded by open-air drug dealing. there has been little-to-no transparency regarding the budget or the position selection. i would like to request we are given a second public meeting in a room large enough to fit everyone with translation. the first meeting wasn't large enough to fit everyone and didn't have a spanish translator. thank you for your time. >> good afternoon, commissioners. my name is joseph inervera. i am representing local 2.

our home for 13,000 members has been at the corner of golden gate avenue and living worth for 42 years. my family and i also live in the tenderloin since 1990. a block away from the proposed site of the methamphetamine sobering center. local 2 strongly urges you to postpone any vote on the 180 jones facility until concerns regarding the proposed sites are addressed. more details regarding our concerns are contained in the letters you received from us. we are not opposed to this type of facility in our neighborhood, but you must work in partnership with the community to make it happen in the right way. thank you. >> thank you. next speaker, please.

>> thank you, commissioner. rose mcguy. we're a member of treatment on demand also, part of this whole process. i just really want to add the major criticisms. you know, we can work with health right 360 to better the program, to make it unique to the program, et cetera. that's not the problem here. the problem is that, again, the department did not bring the community in to design and have a discussion about what would be appropriate in this already-traumatized community. in the previous discussion about the navigation center at valencia, we've learned that you've got to take people where they're at and build on it and problem solve. that didn't happen. it just didn't happen and now we

have spilled milk that we have to try to put back in a bucket and it ain't working. whether it's a delay which we would support, we have to problem solve at another level. you want to do equity work in a community that's been traumatized over the years of sending people from the avenues or whatever, trauma, trauma, trauma for the community. this has not been considered and it's really bad organizing. i just really think that the department of public health has to learn its lesson. as dr. bland said, this is an equity issue now that doesn't look good. really, could you please pay attention to this and problem solve at this level. thank you. >> next speaker, please.

>> good afternoon, commissioners. just quickly, i actually live over in the mission district and just wanted to say that my wife and i 100% support the proposal for the hummingbird space there. i work for st. anthoniny foundation. we've been on the corner of golden gate and jones for 70 years. we really wanted to emphasize that we've had many conversations with folks from the community. we understand there's some anger around how this process went through, but that said to us this is an issue of urgency. people are dying in the street every single day. many of our staff respond to overdoses, medical emergencies, see people die on that corner, in that corridor. we would welcome help from the city, department of public health, health right 360, glide. we believe the right people would be in place for that

corner for people to get the help it needs. i know there's a lot of talk about postponing and i want to reiterate there is so much urgency around this issue. people are overdosing and dying every single day. thanksgiving day i got off work and walked down the street and saw another person dead on that corner. i don't know how many more people have to die in the city before we take this absolutely seriously. as has been said before by paul, the reality is there is not a place for folks that are going through issues like this around methamphetamine use as a provider. we have nowhere to take folks right now and we would welcome any help to be able to bring our guests and our neighbors to a place that could help them on any level. thank you so much. >> thank you.

as we have one more speaker called, i will call more. >> i'm robert hoffman. i was called in the first round. i work as a director of the syringe access and disposal program. i have also lived in the neighborhood of the tenderloin for over 12 years. i see the people that could benefit from this program are part of this community already. they are already here. we would need multiple low-threshold services like this

pilot to serve the need that already exists in the neighborhood. i understand that there is a lot of fear to move forward with the project. i know people get concerned about the idea of moving people in from other neighborhoods, but we already have an urgent need to help people who are dying and who are suffering and are marginized in our neighborhood right now. so i fully support this project. in my position at the san francisco aids foundation, we would partner to try to make this the most success we can with all the support that we can provide. so i guess that's what i'll leave it at, but i think we need to move this forward, not postpone it. thank you. >> thank you.

>> next speaker, please. >> we support the project. again, the argument is always that we support the project or that it shouldn't be here. clearly there's repairing of trust that needs to be done between the department and the community. i'm optimistic that can be accomplished with some community education and outreach, having the right conversations and the right meetings with the right folks at the table. i think the providers in this case are extremely experienced. the agencies that provide services in the area, compass being one of them, we see these problems every day. we see that people are suffering and dying in the street. delaying is not going to solve the problem. we need solutions right now. we have to focus on bigger-picture issues, how we're going to coordinate to solve the issues of homelessness and substance use. we need more interdepartmental

coordination and roll out the vision that's been part of the mental health s.f. planning. so from that perspective we have so many things to talk about and solve and delays and opposition are really getting in the way of providing people the care that we need today and also building the system to serve all of the people that need help. thank you. >> thank you. next speaker, please. >> my name is anthony. i work with mary kate over at compass. time and place, it's the right place and it's not the right time only because it should have been a while ago. earlier it was brought up before this meeting started, some folks have communicated again like mary kate alluded to, why the tenderloin, we have so much drugs in the tenderloin, we have all these drug dealers in the tenderline.

why don't we open this thing up on alcatraz island or in golden gate park and have people basically have to make a trek in order to have a place to sleep at night. the best location is the tenderloin. that's where the need is. you all know that. that's where the service needs to be. the time, again, it's already too late for so many who have died and a delay is unconscionable. it's an emergency. we already know it's an emergency. when it's an emergency, you don't delay things like this. of course from now until the 17th, there will be dialog from now until the 17th. there can be conversation between now and the 17th. there can be collaboration, but not a delay. if there's any entertainment of a delay, that's a clear statement that this is not an emergency. when it comes to it, if there's

a fire in this place, can we have as much consultation as we want? no. but we have to get out if we want to survive. there are folks who are in a place where they need to get the support now. so again, you can't deny that this is an emergency. a delay is unconscionable. thank you for your work and please keep working on this project. thank you. >> thank you. next speaker, please. [speaking spanish]

[speaking spanish] [speaking spanish]

[speaking spanish]. >> good afternoon. what i would like is another community meeting where the community can actually vote as a gro gro group, one that involves interpreting for all languages, one that actually reaches out to schools and organizations and families because we're all part of a community, a community that has been traumatized. what we would like is for our voices to be heard. we are families of young people,

of children, of elderly, of adolescent adolescents. since we're talking about it, where is the budget for families that have been through such horrible things that we can't even explain to our own kids how someone can end up like the people we're seeing. so we're in favor of this, but we want to do it as a family and we want to have compassion, but we want to be able to explain this to our children and as a community. i feel my heart broken, but i need to ask for compassion and justice to be done. i would like us to be one community at some point, the people that are homeless, the families, the doctors, the commissioners. so i'm asking for another meeting with us.

>> thank you very much. next, please. >> thank you. my name is randy orovelo. i think i have a keen perspective on this. not only am i a former methamphetamine user, i'm a pure navigator at glide. i go into the community where people are actively uses and try to get them to help get services. i sleep at that corner. every night i set up my tent and every morning at 6:00 i take it down. every night on jones, there is a whole row of tents. people are dying. other drugs are being used. this can't be delayed. it needs to be done now. i help people in the community, but i also am part of that community. i am on the street literally.

we really need to get this thing off the ground and going. >> as we're waiting for the next speaker, i'll call the next five. >> my name is lidia brampton. thank you for allowing me to speak again. i would like to address the gentleman who just spoke. he said something which i think is really valid to this conversation, and that was that he sets up his tent every evening. he sleeps outside st. anthoniny's, and in the morning at 6:00 he takes it down. why 6:00? because we have a community agreement. we have a community agreement with the community that lives both in houses on the 100 block of golden gate and on the street of golden gate. we came up with an arrangement with gubio project where they

open up earlier, where if people want to continue resting, they can go into the church. we wash the streets at the end of the day and in the morning. we keep the environment clean not just for the pedestrians walking by, but also for the people who are sleeping on those streets. we can do the same thing outside of this program. that street right now is unsafe for the people having to live on it during the evenings, in their tents, on a cardboard box, barriers that keep getting put up. d.p.w. comes and takes their stuff. people dump their trash on the street which ends up back into the community. we come up with community agreements to make this street better, not just for the people who need the service, but the people who live around the service. thank you.

>> my name is rose juliano. i wanted to voice support for the 180 project today, but also to say from my own personal experience at the reduction center that we low that low-threshold harm reduction services like this work. there are no 24-hour services for folks living on the street in the tenderloin. there are many services for folks using opiates, but really nothing for folks using methamphetamine. this is a great step in the right direction for folks who are out there. i want to say thank you and we support the project. >> thank you very much. next speaker, please. >> good afternoon, supervisors. my name is joe. i live at geary and jones and i'm fortunate enough to work at st. anthony's foundation at golden gate and jones. i see this problem all the time.

i was struck listening to the opening conversation on what the city is doing to prepare for the coronavirus. it's fascinating to me that all of this money has been freed up and resources have been rearranged to deal with something that may be coming in some form we don't understand. right now we are in the midst of an epidemic. i live right in the middle of it. why do you put a temporary tent up in the tenderloin? because you meet the crisis where it is. you don't build a permanent building where a tornado is hit. you put a tent up and get the crisis workers in there to deal with the issue. i see children all the time stepping over needles. i see them pointing and crying at people that are frankly in the midst of methamphetamine addiction. they're taking their clothes off, they're screaming. it is traumatizing.

if we're worried about those things in the tenderloin, let's remember right now the city is currently rebuilding a playground across the street from a strip club. so i'm sure that there are more than enough awkward conversations going on in the tenderloin. there is a sex club on jones street that shares space with after-school programs. children are exposed to a lot whether we want to be comfortable with that or not. i think getting people into a sobering center so they can come down off the high and be exposed to other options in their life is a god send for a community right now that is constantly traumatized. i just want to add that i lost a friend who died of an overdose right there on jones and geary. that would have been a few blocks away from this center. so i am very much in favor of

it. thank you. >> thank you very much. next speaker, please. >> amy fairwise with the st. francis homelessness challenge. 180 jones, just the name of it, elicits such love in my heart and mind and you might wonder why. that's because we've spent hundreds of hours there with our organization when supervisor haney and someone from st. anthony's told us maybe we could use that site as an interim use. we started to do the work at the site and engaged with the sheltered, unsheltered, and housed neighbors around that area doing that work, hundreds of hours. i don't know if you know we did an r.f.p. process, did everything we were asked to do. the mayor's office made the decision to stop that process at the very last minute and put in this project. now, that's egregious, that's terrible planning. everyone here agrees.

that was the mayor's office. that wasn't department of public health, health right, glide, it was the mayor's office. now, you would think, oh, they took the place where you were trying to do your work, a safe, organized space at no cost to the city, by the way. ours was fully funded and we wanted to activate it months ago, talk about crisis. the mayor's office decided to do this. we're not opposing this, we're supporting it. i think with paul and glide and health right 360 doing this, it's going to be a great program and it's actually going to alleviate a lot of the concerns here, so i want to reiterate that. it's a big price tag, $6.8 million. one thing that we're asking is we have done interviews and have organized lots of the unsheltered people that live in that area. we would like a small part of that budget, $50,000, to go to peer organizers so we can do the

work in the neighborhood, to partner with dr. anton nigusse bland and others to do that. there should be $10,000 for a community council. and i want to say people living there on the street have all been offered navigation center. that's a really good thing. it took this project happening before the people i have been working with for a year got offered services. the city should do everything all over because people will be offered services. >> thank you. next speaker, please. as we get to the remaining speakers i will call john shoulder and jason alverson. >> i want to acknowledge amy's activism and commitment to the community. >> i want to say i believe in this project --

>> this project gets my endorsement. >> i've got 20 years in the tenderloin so i feel like i know what i'm talking about. at glide i've done 10 years of community building. i walk the streets. i do syringe sweeps and i see what's happening on the ground and i work with the partners. even the folks who disagree, i want to commend the tenderloin for not having a knee-jerk reaction here. they're saying you didn't include us enough. as we move forward as this project happens, they will be included for sure. we build with community, not just for them, but with them. this is an asset for the community. this will be a 24-hour center where people will be taken care of, that's what we're talking about here. i don't even know if this exists

in the country yet. the location is always going to be complained about, but when you talk about wanting trau trauma-informed responses, that's what this is because of the situation. i don't want to play one house versus another game, but people are dying needlessly because we don't have centers where they can come and be safe. this is a center that will immediately reduce the impact on people. it's not just people coming in and having a bed and a tent, this is a bridge to multiple services and an connection of lots of collaborations that will have the regard for people who use drugs and their health and well-being. you'll see a healthier tenderloin having this asset. do not wait this much-needed asset. >> thank you very much. next speaker, please.

>> good afternoon. my name is john shoulder. i'm the night manager for 249 eddie tndc and we have a sister building right next store. i also volunteer in the community with street soccer u.s.a. and work with youth in the community. someone was quoted earlier as saying after the last presentation that they were really excited about the last presentation because the silos began collaborating. there's been no collaboration, especially with the community. i'm embarrassed if this is the best our city can do. during the one and only community meeting i was called as a spanish translator after the meeting already had begun. not only was there no translators, there wasn't sufficient space for those who wanted to attend. and the leaders abruptly ended the meeting without hearing the voices of those in the room.

if they can't run a community meeting, how can we trust them to run a program of this magnitude. if it's an emergency and another emergency is created, it's all-for-naug all-for-naught. there was no voices from the neighborhood. the location selection which one of the leaders said the reasons being selected, number one, is the urgency. given this presentation we just saw, that shows the proposal and process is embarrassingly unprofessional. one of the leaders from this project is hoping to work with the community and i plead that you delay this vote to my neighbors have a chance to be heard. [ please stand by ]

>> this is an illness, methamphetamine use, that is

profoundly isolating and profound profoundly destructive. it potentially destroys or it can destroy people. in the 1970s, we said that speed kills, and this does more than kill. it kills the self, and it kills the ability to be a part of the community. to engage with these folks who are strung out, who have no other options, who are meth dependent is completely necessary if we're going to consign a segment of our community to disability, to mortality, and to psychosis. there is no choice. this is engagement, this is where it starts. this is the beginning, this is where, deep down, the spirit meets the bone.

i urge you to vote yes on this proposal. thank you so much for hearing me today. >> thank you. are there any other speakers that i didn't call or perhaps they -- i didn't pronounce correctly? >> hi. i'm colleen rebecca. i'm the director of community policy, organizing, and developing for tenderloin development corporation. i just wanted to come up and make sure that it's clear that everyone knows that t.d.c. is a company that doesn't have a position opposing or supporting the center right now. part of that is because the community process, if we can call it that, that has happened so far regarding the center has been so poor that it has actually taken a lot of our residents and community members who were supporting things like the -- like safe injection

sites and other things and has turned them into opposing just because of how disrespectful how the city was in presenting this to the community a few weeks ago. and we have a lot of constituents and stakeholders that are really concerned, and we also have a lot of people who see the need for this type of -- this type of program in the neighborhood. speaking only -- so because we haven't been only to reach concenab concensus within our community and the different stakeholders in the organization, we're stepping back now and trying to listen. and hopefully this -- this delay will allow us to have another community conclusion that can include more people and can also address some of the unanswered questions about how this program will run, ensuring that we're not dumping

people back onto the street after they've been in this program, because that is not a good model, and some of other issues that we're concerned about. seeing that this is really a program that -- that works on a harm reduction model, and that's respectful to people that use drugs. thank you. >> thank you very much. i have no other public speakers at this time. before i go to colleague questions, i'll ask dr. colfax for any statements or comments. >> thank you. i just want to say with regard to the recommendation of the meth task force, at mayor breed's request, i chaired this task force along with supervisor raphael mandelman, and it's certainly in keeping with the recommendations with mental health reform and in the

broader context of mental health s.f. i do want to express regret for the community process. we are certainly committed at the health department to improving that work. one of the -- as i've listened, i think there's a lot of things that we can do together here. there are actually a number of -- of ideas proposed that i think we need to have further discussion on. perhaps here, but in another community meeting. we will be scheduling that community meeting. we will be doing our best to find adequate space and interpretation. i think that that's very key. i heard that, and really committed to not only listening more but being responsive to -- to as many of your concerns as possible and also recognizing that we're committed to the integrity of the program and working to do that in partnership with the community. so we will schedule that meeting prior to march 17 to

get more -- to have additional conversations and input from people here and other stakeholders who may not have been able to be here tonight. >> thank you, dr. colfax, and thank you for, you know, speaking about the need for the meeting, which i believe it's quite clear that such would be very important before we actually go onto a vote on the contract on march 17. commissioners, questions at this point? let me go to commissioner chung, because she had some questions from our previous committee, and it was deferred to now. >> well, thank you, commissioner chow. so the first questions i have is because of the uniqueness of that neighborhood, because there's a whole corridor of other, like, social services, you know, like health clinic and tndc.

how are you working with these organizations moving forward? >> so i'd actually like to call up paul harkin, the director of 360. he's worked in the tenderloin for decades and has some really nice ideas about how to do that. >> so yeah, the tenderloin's at good with partnerships. and in my work at glide, i was involved in partnerships with st. antony's, the sheriff's department, naloxone reversal. i partnered with the agencies like homeless coalition, people that have been involved in many different initiatives that are improving the well-being of marginalized folks, particularly with people with

mental health issues and experiencing homelessness. so i do not see any reason that this, if it gets selected to go on forward, won't utilize the is partnerships that are -- won't utilize the partnerships that are available because it is beneficial to have this up and running. and once people get the trust back with the way the process worked, i certainly believe that it will be seen as a model and an arrangement that can be replicated in other districts, in fact, other jurisdictions because there's nothing like this right now. everything has been opioid focused, and opioid treatments are incredible. but meth treatment is very little because more people are dying of meth overdoses than

opioid doses in this city. >> and what really caught my attention was the police department can be a referral point, as well, like, that's kind of, like, unusual because, like, for the police officers, they have two different ways of handling these situations, right? one of them is bring them to 850 bryant, and one of them is bring them to emergency services. so this seemed to, like, open up, like, tools for the law enforcement to use. so are you planning to train the officers around that? >> i think, you know, if you look at the l.e.a.d. model, where we have law enforcement-assisted diversion, where we don't want law enforcement bringing people to our building because we've got a trauma-informed care building. we're seen and coming and liberating that person, so

it's, like, do not go to jail, come with us. similarly, we don't want police to rile up and drop them at the door. we'll probably be sharing with them some of the criteria. we would say this comes here, versus someone is an extreme health dangerous, this is where they're not going to be coming because we're going to have a sweet spot of folks that we're going to meet with. >> i have meet with the tenderloin substation, and we've talked about training the midnight shift, when this is going to be the only service open and interesting a team ready at all times, like first responders for the teams to be able to call for the warm handoff that paul just described. future models may include also training hsoc officers, but right now, we're just focused on the tenderloin substation.

>> thank you. i have some other comments, but i'll let the other commissioners -- for now. >> thank you. [inaudible] >> i just want to say that as a native san franciscan, i spent my late 60s and early 70s in grade school and high school every day in the tenderloin at my father's barber shop on hyde and turk. i have a very personal interest in seeing that the neighborhood returns back to the kind of neighborhood where a ten-year-old can take the bus in the tenderloin, play in the streets, and feel safe, so this is not just questions from a commissioner on the commission.

and so i -- at the same time, however, as i have a personal interest in not delaying a response to this crisis, which has actually been a crisis for a long time. i also spent my adult years as an advocate for community input and process, and i feel that we can't ignore the voices. that even though expediency is important in this, wanting to respond quickly to the need, i also feel that oftentimes, the voices that are most impacted in the community who can't come to meetings like this because they're either working, or they're at home, back at home, taking care of their kids, or they're trying to find some transportation to meetings, we don't get to hear from them, or

we hear from them by proxy. so i feel very committed to making sure that there is additional opportunity for community voice, and i'm very glad to hear from director colfax that there will be. this isn't going to be something that's going to be solved as easily. as much as we want smiwift action, we have to make sure that the program is successful is a surety. i just want to let you know, as a member of the commission, this is something we have to consider carefully and consider the right solutions [inaudible] >> thank you. dr. colfax, thank you for requesting another community meeting. my only concern is our next commission meeting is in two weeks, and i'm not complete sure that we're going to have

enough time within this period to notify the community of the next meeting so we can plan and have the input. so i'd just like to raise that as a concern because i do believe that the community input is extremely important. i do know that the school had not been notified until a couple of days ago. and from the feedback, i have heard from a number of organizations that work with the kids that neighborhood -- which, of course, there are ten of them -- there is a big safety concern. and i know you're addressing with the time of discharge, and i am hoping that you have done enough homework to know that the discharge of the kids from

the schools is at various times, anywhere from 2:00 to 5:30. i know the underlying issue is not to support the center, but it's safety. i'm hoping that you would be able to bring back to us a much more significant and detailed safety plan for the center before we go forward. thank you. >> commissioner green? >> yes. well, i wanted to thank everyone for their presentations, and the elegance and compassion everyone is here with. everyone is here to solve a problem, and with these issues, i think there's universal

pledges, and i'm truly moved by many of the comments that people have made here. i'm wondering by the next meeting you could give us more information about community safety, and what you plan, vis-a-vis, community input. and, also, when we might receive reports. i'm hearing it should be far greater frequent and with far greater detail that already go in there. what i'm hearing is that children in this community and adults in this community have experienced trauma of their own, seeing what's going on in the streets. and i'm wondering if that's part of your program and how you plan to address that. >> i can speak a little bit to that now. health right has already spoken with the tenderloin to do an

impact program that dates back to the start of this, which we've heard has been really messy, to include that, to take seriously the concerns that have already occurred, and also, see going forward, if some of our attempts can do that. also, we'll be conducting evaluations of thissum practice. i think to begin with, we're going to be doing weekly report-outs, so that would be in conjunction with the department of public health, and you are right. it would be much more frequent and more detailed than the hummingbird program. we can go into more detail about this at the next meeting, accountability going forward.

we at health right are committed to that, and we do take our integrity seriously, and we've been a provider in a lot of different neighborhoods and have had similar experiences on both sides, and so we really understand and appreciate that you all are advocating for that, and i appreciate the personal story behind that. i feel that, too, and we're very committed to that, so we can absolutely provide more detail on that at the next meeting. >> thank you. commissioner chung? >> so thank you for the presentations again, and thank you for all the input. like i mentioned earlier, you know, in the committee meeting, you know, this is really actually personal for me not just because i believe these programs work. it's because i've worked in the neighborhood on eddy street. one of my clients died in his room without the ability to get services, and i've also worked along the corridor, you know, doing outreach services. knowing where that corner is

and what's going on right now, i think that's actually pretty much a really good place. you're almost putting, like, a crisis center at, like, the epicenter where the activities are happening. and i've also been working in the substance abuse services before. i still remember, like, referring folks with, like, alcohol withdrawals to alcohol centers. that's a while ago, and they're willing to just stay on the floor, waiting for the bed to open. that's how scared some of these programs are. and that's the first time that i've heard we're going to do anything for methamphetamine users. i don't believe there's anything like this anywhere in the country, am i correct? >> that's my understanding, as well. >> so it means the whole world is looking at us, how we respond to that and how we're going to continue to develop

this program. and i appreciate you saying, you know, that there's going to be regular report back. and part of it, i'm sewereous because the neighborhood seems to think they're not being informed enough. how would you engage them and allow a space -- i'm serious because the neighborhood seems to think they're not being informed enough. how would you engage them and allow a space for them to find out? >> i know the commission has ways for people who can't be here for meetings to submit comments, so figuring outweighs to do that. also, making sure that staff and leaders are known in the neighborhoods, that they know they have a contact that they can reach. those are just a few things. and again, part of the model is outreach into the community to

gather participants, and so really being a participant in that way. >> yeah. so what i've heard from the public comment, it's not that anybody's opposed to anything like that being implemented, but it's more like how to engage them in this process and find a way to build that relationship. i think it's pretty clear that the -- you know, the main thing that, you know, people want to know. so i appreciate you saying that and appreciate all you adding all that transparency to that. but it also looks in the timeline that you haven't set a date for that to open yet, so that's kind of, like, flexible. so it doesn't affect how we plan to move this forward. so we can approve the contract for the services. the rest is going back to director, your court, and to healthright 360 in terms of, you know, how to plan, you know, the program itself and

how to continue to engage the nake neighborhood. so, yeah, i think that's what i heard, and i feel pretty comfortable. >> thank you. >> thank you. any further comments? if not, i think i'll try to sum up where we are. we're very grateful that -- the input that the community has given and the time that we were spent. many of you were here at 2:00, and it shows a dedication and importance of this topic, one in which everyone here has said they want to help resolve, and i think, then, the department's offer to at least begin with that second meeting -- well, the next meeting of the community, and this time, with the appropriate people there -- and clearly, schools need to be there, the people who are actually right on the scene,

some of the partners that health right is talking about, all of that so we could receive answers back to what we have all heard and feel comfortable about it. this does not preclude that future meetings, obviously, would not be needed, and a solution doesn't have to really come out of just one single meeting, but the beginning of looking towards a way will take the immediate problem, which everybody has greagreed is an emergency, and working with the neighborhood. i think someone told us that everybody in the tenderloin had worked off times when the kids would be off the streets and went back -- i mean, those types of arrangements are important to be able to work together and yet answer the

very important need. for the commission, we will take this up as a potential item on march 17 as calendared. >> on the contract? >> yes. >> we'll consider a vote on that? >> yes, as a topic in regards to the contract. obviously, it does reflect all of the discussions of today because the performance of the contract is very dependent upon us understanding how that is going to be. commissioners at that time, then, can decide on what it would like to also understand in terms of are there further actions after that, and it will be an action item for the commission, so i would ask that the commission think now at this time during the next several weeks, also, our homework is to how we can figure out how to make this an effective program to answer the

great need that we have all been expressing today. so with that, i believe that, again, we really thank all of you who have taken the time to help all of us and help our city to find a solution, one solution that we are facing with our homeless, with those that are actually needing help, and with our communities, also. >> i believe that commissioner chung has something to say? >> yes, commissioner chung. >> i have two things. one is for clarification. this seems like two different things, right? one is to approve the contract because, you know, that is what the mayor's office had set aside for this initiative. the other is helping facilitate conversations between the community and, you know, the

department and, like, healthright 360, so it's not the same. >> no. obviously, approving the contract is quite different and has to do with the services that the contractor had. how the contractor does that, however, is pertinent, and how -- what you said, how it would work with the community and with those in need, all of that is pertinent and makes sense. >> and i think these questions can wait until next time for answers because, like, we as commissioners are, like, very mindful of general funds. like, we're trying to make sure that outside of general funds, there are other resources that will fund this as things move forward. so the next time when you come to do the presentations, it would be good, you know, to know what -- what that part is, you know? is this, like, a one-year deal or is this something that has already been planned, you know,

with kind of a vision moving forward? >> thank you. >> right. and i appreciate that, commissioner chung. that goes, also, to that question that was out there. if this is the temporary site, what is it that we're looking for, and what type of approach? and either that comes from our department or others that tracks how this program ultimately will be successful. any other comments or questions from our commission? okay. then again, we thank the public for the time that you have spent. we hope that you would also engage within the community meetings to actually have additional dialogue, and at our next meeting, we will hear some of the results of that. and with that, we'll go onto the next item, please. >> i'd like to also thank our

d.p.h. translator who assisted during the meeting today, which shows just how important translation can be. >> clerk: so item 10 is other business, and commissioners, i'll note to you that your march 12 meeting is at 10:30, not 10:00, as we had originally thought, so make sure you have that in your calendars. item 11 is a report back from the csfjcc meeting. >> i think the majority of those i did report back on the director's report. we otherwise did the regulatory report at j.c.c., the c.e.o.s report, the h.r. report, and also took on the medical staff report. and the presentations included the quality measure update on the true north scorecard. these are all on track or else somewhat behind partly because of epic in terms of trying to

get the right measures with the right types of data in order to actually use that. so we understood that has a problem. in open session, we approved ophthalmology and cardiology changes, and we had closed session. so dr. green was part of that meeting. i don't know if she wants to add anything? >> i think well summarized. >> thank you. >> clerk: and commissioners, now you're at motion for adjournment. >> so motion for adjournment is in order. >> so moved. >> and a second? >> second. >> all those in favor, say aye, and none opposed, and we are now adjourned. thank you. [gavel]

>> after my fire in my apartment and losing everything, the red cross gave us a list of agencies in the city to reach out to and i signed up for the below-market rate program. i got my certificate and started applying and won the housing lottery.

[♪] >> the current lottery program began in 2016. but there have been lot rows that have happened for affordable housing in the city for much longer than that. it was -- there was no standard practice. for non-profit organizations that were providing affordable housing with low in the city, they all did their lotteries on their own. private developers that include in their buildings affordable units, those are the city we've been monitoring for some time since 1992. we did it with something like this. where people were given circus tickets. we game into 291st century in 2016 and started doing electronic lotteries.

at the same time, we started electronic applications systems. called dalia. the lottery is completely free. you can apply two ways. you can submit a paper application, which you can download from the listing itself. if you a plo apply online, it wl take five minutes. you can make it easier creating an account. to get to dalia, you log on to housing.sfgov.org. >> i have lived in san francisco for almost 42 years. i was born here in the hayes valley. >> i applied for the san francisco affordable housing lottery three times. >> since 2016, we've had about 265 electronic lotteries and almost 2,000 people have got

their home through the lottery system. if you go into the listing, you can actually just press lottery results and you put in your lottery number and it will tell you exactly how you ranked. >> for some people, signing up for it was going to be a challenge. there is a digital divide here and especially when you are trying to help low and very low income people. so we began providing digital assistance for folks to go in and get help. >> along with the income and the residency requirements, we also required someone who is trying to buy the home to be a first time home buyer and there's also an educational component that consists of an orientation that they need to attend, a first-time home buyer workshop and a one-on-one counseling session with the housing councilor. >> sometimes we have to go through 10 applicants before

they shouldn't be discouraged if they have a low lottery number. they still might get a value for an available, affordable housing unit. >> we have a variety of lottery programs. the four that you will most often see are what we call c.o.p., the certificate of preference program, the dthp which is the displaced penance housing preference program. the neighborhood resident housing program and the live worth preference. >> i moved in my new home february 25th and 2019. the neighborhood preference program really helped me achieve that goal and that dream was with eventually wind up staying in san francisco. >> the next steps, after finding out how well you did in the lottery and especially if you

ranked really well you will be contacted by the leasing agent. you have to submit those document and income and asset qualify and you have to pass the credit and rental screening and the background and when you qualify for the unit, you can chose the unit and hopefully sign that lease. all city sponsored affordable housing comes through the system and has an electronic lottery. every week there's a listing on dalia. something that people can apply for. >> it's a bit hard to predict how long it will take for someone to be able to move into a unit. let's say the lottery has happened. several factors go into that and mainly how many units are in the project, right. and how well you ranked and what preference bucket you were in. >> this particular building was brand new and really this is the

one that i wanted out of everything i applied for. in my mind, i was like how am i going to win this? i did and when you get that notice that you won, it's like at first, it's surreal and you don't believe it and it sinks in, yeah, it happened. >> some of our buildings are pretty spectacular. they have key less entry now. they have a court yard where they play movies during the weekends, they have another master kitchen and space where people can throw parties. >> mayor breed has a plan for over 10,000 new units between now and 2025. we will start construction on about 2,000 new units just in 2020. >> we also have a very big portfolio like over 25,000 units across the city. and life happens to people. people move. so we have a very large number

of rerentals and resales of units every year. >> best thing about working for the affordable housing program is that we know that we're making a difference and we actually see that difference on a day-to-day basis. >> being back in the neighborhood i grew up in, it's a wonderful experience. >> it's a long process to get through. well worth it when you get to the other side. i could not be happier. i could not be happier.

>> this is a special meeting on wednesday, february 26, 2020 and et cetera called to order at 1:06 p.m. we thank sf gov tv. members, please take this opportunity to silence your phones. public comment during the meeting is generally limited