san francisco hospital, since 2008 as a faculty member. at the department of medicine. and over the past 12 years she's served as associate medical director and then the medical director of the people's clinic. and then since 2018, she's served as the then elected position of chief of staff for zzfg. and she's a dedicated educator and she focuses a lot on the health care system and change management. she has a tremendous amount of skills. i can say personally they worked with clare over a decade ago now, maybe -- at any rate when she was an intern and i i attended the people's clinic, she has political acumen that helps her to be a better administrator. and i always learned as much from her as she learned from me.

so i'm justice delighted to have her join -- just delighted to have her join the department. so it's a great announcement to make to you all today. and then i, again, i will go through the covid-19 update as the next. the agenda item and i am prepared to take any questions. >> clerk: thank you, dr. colfax. commissioners, before you might have any questions. number one, can i ask everyone except -- actually everyone to mute themselves except for dr. colfax right now. i see a lot of microphones on and we're hearing someone typing. so everyone would please mute yourselves. and then the public comment line, any public comment for the director's report? let's give it one second. i'm going to share the public comment line info real quickly.

okay. there are no questions from the public. i'm going to put this line up quickly for that in case number is watching. commissioners, if you have any questions for dr. colfax on the director's report, please raise your hand. >> commissioner chow: this is dr. chow. i can't raise your hand. i wanted to congratulate you on having dr. horton selected and in spite of everything that is going on that we haven't lost sight of keeping our eye on trying to get key administrative people to fit into our department. so thank you very much. and congratulations to dr. horton. >> i don't know if you can hear me but thank you so much and thank you for the nice introduction. >> clerk: thank you, dr. horton. >> hi, dr. horton. >> hi, dr. horton. thank you. >> clerk: great. shall we move to the next item,

commissioners? okay. so let me pull this up quickly. item 4 is a coronavirus preparedness update and, again, this is dr. colfax. >> hi. good afternoon, commissioners. i think that the slides are up. >> clerk: actually, no, give me one second dr. colfax. okay, now they're up. >> great. so good afternoon, commissioners. this is my -- this is the covid-19 update. i would say that it's a preparedness response and recovery update. i think that one thing that i would like to share with the commissioners is that not only have we been in this

unprecedented preparedness and response mode now since february, but now we are -- the department is also simultaneou simultaneously doing the recovery part as well as our ongoing response part. so you'll recall that in those situations that there's a more linear flow from the response and then one goes into recovery. we're both remaining vigilant in our response while we simultaneously enter at least a partial recovery phase. on top of that recovery phase as we just heard we're facing a very challenging budget situation as we also want to help to assist the city to recover in terms of providing the best public health guidance and assure acing that investmene made in public are health, and

providing guidance and advice. as we also look to have our own ber surprise for what the new normal looks like. so multiple challenges in the department right now. i am confident that we will be flexible, be resilient, and realize the care and services that we are committed to delivering, to reinforce the fact that the things that we're doing, the recovery, response, budget adjustments and then our fire service is adjusting to this as well. so lots of work ahead in the next -- in the next era of public health. next slide, please. so this is where we currently stand in san francisco. and some of these slides look familiar in terms of the format. and i have updated them

obviously from the last time that you saw these. but we currently have 2179 people diagnosed with covid-19. unfortunately, there have been 36 deaths. i will say that, you know, clearly one death is too many and it is terrible that we have lost these san franciscoians due to covid-19. it must be said though that our death rate is significantly lower than other jurisdictions. again, i think that is that we are remarkably 37 times lower than new york. we'ryork. and our rate is lower than many other local jurisdictions as well. so i point that out not to

minimize the suffering that the city and the community has in san francisco has had, but to also to reinforce the fact that the actions of san franciscoians and the community with the shelter-in-place has literally saved lives and i can't overemphasize that. next slide. these are the san francisco cases by zip code. and this really, again, rreinforces our commitment from the beginning. the reinforcement of the need to protect the most vulnerable and recognizing that the pandemic exploits the fault lines of other inequities and including social and economic inequities. and these maps as you know look very similar to maps that other

both chronic health conditions and infectious disease patterns in san francisco with the greater concentration of covid-19 in the tenderloin and the mission and the bayview neighborhood. and as we go forward you will see some of the work that we're doing in order to address these concerns. next slide. so these are our -- this is our covid-19 response so far to testing. and i'm sorry, i'm having a challenge with my microsoft teams -- (indiscernible) sorr sorry. oh, okay, one way. so this is now looking at our --

both our cases and our testing data since april 15th to may 18th. you can see a couple of things. i want to call your attention to the testing data, the covid-19 test reported to the health department and the proportion of positive results daily. you will see that we have escalated our testing since the end of april. our numbers in the last few days always look a little behind because not all test reports have been reported for that day. but you can see in general that we have been testing over 1,000 a day. and we are on track to reach our goal of testing between 1,600 and 2,000 within the next month or so. a couple of bar bars that do std out that i think is worth noting on may first that very large number of almost 4,000 tests.

we had the tests that we have done as part of the mission study. and the latino commission. the health department. and partnering with them on that. and then you also see on this graph the positivity rates of our tests. and you can see that for the most part there's been a drop in that positivity rate. and you can see in mid-april, it was up somewhere between 11% and 12%. it's now decreased dramatically to the range of 2% to 3%. and that really reflects the broadening of our eligibility criteria as our testing capacity has decreased. so remember that early on in the epidemic we were focused on testing folks who work in the hospital and those symptomatic. and the eligibility extended to people with close contacts and

new positives. we're now testing not only that -- continue to test that group, of course, but testing people -- i'm sorry -- testing essential workers, regardless of whether they have symptoms or not. and so as we assess eligibility, our positivity rate decreases because we're testing with the goal of finding as many covid-19 positive cases as possible. and in terms of our cases, we'll see on the yellow bars here on the top left of the slide, striking a number with regard to the disproportionate rate of diagnosis with the latin

populations, 43% and are among the latin ex population. and reinforcing our efforts in the mission neighborhood an ande population. and then you will see a large portion of cases are race ethnicity unknown, likely due to the refusal of the testee to reporter on a lack of caution of information by the testing agency. these are tests across the city and not just the health department, but by other health care providers, private entities and so forth. just to remind you that we support the health order that require all covid-19 tests to be done through the department. we have done almost 46,000 tests and a percent positive of 7%. again, that's the average at the time. next slide. so this is our hospital -- these

are our hospital numbers. and when we talk about flattening the curve, this is what i look like because these are the people who are sick in the hospital with no diagnosed covid-19 and since we're not able to test everyone, we count on this curve to help us to understand where we are in terms of the virus in the city. and you can see this is the top bars are the hospitalization numbers. again, from april 15th to may 17th. this curve is not really a curve, which is a good thing, it's a flat curve. this is what we had been aiming for since the beginning of our preparedness in february. and you can see, if anything, starting -- starting may 2, that we have seen a city decrease.

and the curve is not only flat but it appears to be decreasing. on the 16th we were down to 53 cases and we saw that decrease a bit. and on the 17th, that line over the past number days is statistically significant. so i'm really delighted that not only are we able to say that this curve is flat but that in the past few days we have been able to say that it is decreasing. so that's very good news. and then you'll see on the purple bars that those are, again, the number of people who are in the san francisco hospital system who are suspected to potentially to have covid-19 based on symptoms. but are awaiting a test result. and these numbers have remained fairly stable and just to remind you that when you see these blips like on may sixth, that is generally due to testing suspected cases at the laguna

honda hospital. so those cases get counted as (indiscernible) in our database. so overall, very positive picture right now. we know, of course, that this could change, especially as we gradually decrease shelter-in-place restrictions. i'll get to that in a minute. but the graph right now looks positive. it's something to be thankful for. while also, obviously, reflecting on the fact that we still have a number of people in the hospital receiving care. some of them in very serious condition. and as you can see in the light green bars, the number of people in the intensive care units. either the light green bars or in the light purple bars. next slide. so this is looking at a hospital

capacity with regard to hospital beds available for covid-19 patients and you can see there's a lot to take in on this slide. i'm not going to go into a tremendous amount of detail here. but to say that we have adequate hospital capacity in our system. we have 419 i.c.u. beds available and 866 acute care beds available at this time. and overall that covid-19 patients have represented in the last few days about 6% total of our hospital patients. so lots of capacity available. on the lefthand column under

hospital capacity as of 5-17-20, for instance, you could see that 9% of the i.c.u. capacity with covid-19 patients, 53% are taken up by other conditions and then 38% are capacity with the intensive care beds. and then our intensive care surge capacity is up at 100%. so basically this reflects (indiscernible). and i do think that it's important though as we go to the next phase -- and i'll show you some models on it -- that this could change very rapidly. and we expect this capacity to change independent of actual covid-19 cases. as hospitals go back to more routine surgeries. as people who have been staying out of the hospital do need to

get care. so those green bars in the non-surge areas will likely increase. as you know our own hospitals with san francisco general which, by the way, have had about half of the covid-19 cases recently, and i expect that the capacity of that hospital to increase rather dramatically over the next two to four weeks. next slide. so i mentioned our testing capacity has increased rather dramatically as well has our analytic capacity. these are maps that were just compiled a few days ago. and on the left of the slide are all tests done in san francisco across all providers in the last

seven days. so this is not where the test was done, and this is where the people reported their zip code of residence. and i have to just say this is a tremendous amount of work by the testing and the data analytics team to be able to literally take every test done in the last seven days and to geo-map it on to san francisco. and then you can see the positive test results in the past seven days. so i think that there's a couple key points on this slide. we are testing a broad segment of the population in san francisco based on where they are living. and also you can see that our testing density actually does correspond with the density of the virus. so we're basically testing where the virus is most concentrated. you can see the darker oranges

in the areas of the bayview and the mission and the tenderloin. and then, again, you can see that those positive tests do tratracksomewhat in the last se. this slide is not just a graphic to report to you, but it will also help us to iterate on our testing mobilization, especially as we increase our low barrier testing. as we execute on developing more mobile-based testing. and as we think about especially in this challenging environment where ongoing testing services are provided. next slide. so this is a complex slide and i'm going to take a minute to explain it. this is really focusing on the past two months with regard to

the propagation of covid-19 through the community graphed on the activity of san francisco overall. when i mean with activity, how much people are (indiscernible). so the y axis on this slide is the mobility index. that mobility index is a method that is used to determine mobility in populations based on cellphone movements on any given day. and the blue line, the blue jagged line going from march first to may first, shows that mobility in that through time. and you can see quite dramatic decreases in that mobility. and that is starting in that

first week of march and dropping dramatically with our shelter-in-place order which went into effect on march 16t 16th. you can see that mobility index was very low for the past month and a half as shelter-in-place orders have been in place. so this is not so much -- this is about the order, but it's also about the fact that people stopped moving around because of the order. we are on this chart with the reproductive rates of the virus. the estimated reproductive rate of the virus. and this is been calculated -- this is an estimate, there's no way to know the reproductive rate of a virus exactly in the population. but dr. peterson developed this slide and super imposed the rate estimate that she has developed based on looking at the data in san francisco.

the reproductive rate of the virus, remember, is the rate at which the virus propagates through a population. and r1 means that for every case, every person living with covid-19, that person passes the infection on to one person. and at r2, every person infected with covid-19, that person passes the virus on to two people. and a reproductive rate of .5 means that for every two people infected with the virus that they pass that infection on to an average of only one person. so you can see that the estimate by dr. peterson is with the reproductive rate of the virus was a very, very high reproductive rate number of 3.5 in early march because of the

really aggressive actions and supported and directed by mayor london breed, and our medical health officer and other health officers, that reproductive rate dropped to 2.6 by mid-march. and then the reproductive rate, they estimate that it dropped to about 0.94 with the shelter-in-place order. this is incredibly important because it shows that the more that we move, the more that people move around, that the more that the virus moves around. you can see that when we stop moving, the virus stops. and the other key concept here is that we need to -- in order to prevent a surge of hospital numbers and in order to keep that curve flat and going down that the reproductive rate needs to stay below one. we have a narrow window here based on these estimates. that reproductive rate is .9. i'm going to stop here because

that was a lot of information and i just wondered if there were any specific questions about this slide and there's more to come. >> clerk: commissioners, raise your hand if you have any questions at this point. commissioner bernal? >> president bernal: george colfax, first of all, thank you and your team for the stats. it's very informative. is there anything that we have seen from the jurisdictions that may have loosened some of their shelter-in-place orders that suggest that their replication rate is increasing with more mobility? >> well, thank you, commissioner. yes, we are seeing some of that. as we have seen recently -- we have sent out outbreaks internationally in some countries that have reduced their restrictions and tracked and seen outbreaks. in the united states there's

foreseen increased cases in texas, maybe due to the relaxation of shelter-in-place or other restrictions. we have not seen a dramatic increase in cases or deaths in georgia which was one of the earlier states to relax shelter-in-place. but i would say that there's more data coming in now but certainly we'll be obviously be watching this. >> president bernal: thank you. >> so i'll go to the next slide. unless there are other questions. >> clerk: other commissioners have questions, dr. chow, anyone? okay. >> so this is, again, a model that was developed by dr. peterson. this is, you know, data that is

projecting into the future. obviously, we don't have data into the future. so i just want to make sure that everybody understands that this is a model. but it really shows what could happen if the reproductive rate goes to 1.1%. you will notice on the y axis here that these are the number of covid-19 patients in the hospital over time. so this is based on being at .94 right now. and then shelter-in-place being lifted on may 15th. now it wasn't lifted, just to be clear. it's been -- there's been more activity allowed so it's not as though shelter-in-place was lifted. but the key point here is that the reproductive rate just increases by 20%, which is not a lot. from .94 to 1.1. and the reproductive rate of

this virus is very high. so it's somewhere in the range of 3%. so if nothing happened and every person infected would pass the virus on to three people. so a reproductive rate of 1.1% is pushing the virus down to, you know, three times lower than it would otherwise propagate. so that still takes a lot of control. what you can see here is that the number of covid-19 patients in the hospital by august 1, is 250. which is right now over six times the number that we have right now in the hospital. so this just emphasizes the need for us to continue to be vigilant, to be gradual in our reopening, and to look at two and four-week windows, and one or two incubation periods with

the virus as we relax our restrictions on activities. and i also think that we continue to emphasize the need to mask, to socially distance, to implement a strong hygienic measures as we move forward. next slide. this is what happens if the reproductive rate increases by 50% to 1.4%. which doesn't sound like a reproductive rate of 1.4%, it makes all the difference between .9% and 1.1%. and then 1.4% we get into very serious -- very serious challenges. you can see here that on the patients on the hospital, note the change in the y axis where we have a thousand patients in the hospital. off a hous thousand patients ine hospital by august 1. so we have narrow windows and we need to stay vigilant and the

key concept is that we want to keep our numbers low as much as possible. these are general population estimates. these do not account for outbreaks which are almost surely going to keep occurring in certain settings. we will be vigilant in trying to manage and control those outbreaks. this is a reproductive rate that would be generalized across the city, just to clarify. next slide. so the other component to this is that we are in this for a substantial amount of time. most scientific experts believe that we are in this for an 18 to 24-month period at least based on prior flu outbreaks. i think that it's unrealistic to expect a vaccine anytime soon. and these are plausible future

scenarios based on a public health policy think group, cidr18 which happens to be directed by a world famous epidemiologist who directed many public health programs in minnesota for many years. and you can see that these are plausible scenarios based on other flu pandemics that we may see unfold with covid-19. a peak and valley response, a fall peak response where we have -- there is a seasonal variation and we see a fall peak much reflective of our flu challenges. and then a slow burn where we may have an initial peak and then -- (indiscernible) we don't know which of these will happen. but this does help us to conceptually as we can report about our preparedness and the

capacity to respond. i think that our need to be flexible and resilient in our response. next slide. so these are the key indicators that we will be watching in our covid-19 response. we will be looking at our covid -- in terms of cases and the number of cases and our covid positive test results rate. you saw that has been going down, which is good. and the daily count of confirmed positive patients admitted to all hospitals. that in many ways is our best indicator of the status of covid-19 in the city because that's where people will come and we have as you know a robust hospital system so it's unlikely that people who are very sick would not come to the hospitals for care. that also gives -- there's a

delay in that in terms of where covid-19 is in terms of the surge because it takes anywhere typically to take a week, even who weeks, for people who have covid-19 to get sick enough to maybe come into the hospital. we're continuing to manage to watch our hospital capacity. the goal is that fewer than 20% of our non-surge capacity with covid-19 and you can see that we're at 6 pr 6% now. and our goal is to get as high as 2,000 tests per day. and we're approaching that goal rapidly. you can see our contact tracing and these numbers have dramatically even in the last week and we're now reaching 80% of covid positive cases and 68% of contacts. and then our supply of personal protective equipment or p.p.e. and we need to make sure that we than we have a 30-day supply

going forward in order to protect our health care workers and first responders. next slide. so as we move towards this next phase of reopening, i think that, again, it's important to remember that the virus doesn't have a timetable. i think there's been a little bit of -- i don't know if it's a misunderstanding -- but perhaps the cadence of the health orders which was on a 30-day period sort of psychologically adjusted us to thinking in 30 days, in a period of epidemic, that the virus doesn't have that timetable. and we are in i think the second inning of a long game. i'm not usually one for many sports analogy, but i think that a second inning of at least a nine inning game is appropriate to think of here. and we have -- we are in phase 2a now of opening up lower risk

workplaces. we announced yesterday with the health order, issued a curbside pickup would now be permitted and that the manufacturing and logistics change that allow that to happen will also be opened. i would just remind the commission that on may third that the health order allowed construction to -- to restart as well as outdoor businesses. and in addition to the lower risk workplaces on phase 2a here, we have also issued orders allowing non-essential surgeries and other health care to resume. and then you can see over this next period that we will be looking to move into phase 2b. allowing retail to potentially

to adapt and allowing the reopening of schools, offices and child care. and i would just say that as part of that work that we are working closely with the city stakeholders to determine the safest way to potentially to reopen summer camps for children. we then move on to phase three and phase four. so this is the state, the california stages of reopening and we'll obviously adapt this for local use. and dr. eregon, and the office of workforce development, and the city controller, and the city assessor, and other key business stakeholders to -- to ensure that not only are we looking at this through a public health lens but there's a true partnership developed with the business partners so that we can provide insight, guidance, data, to help them open as safely as

possible. and then we will also, obviously, look at those key metrics going forward to ensure that this -- these relaxations are not associated with dramatic increases in covid-19. again, i think it needs to be said while we're hopeful that the masking and social distancing and hygiene will be effective in preventing that, if in the event that we see concerning data that suggests that a surge is imminent, we potentially would need to go back to restrictions on activity and possibly businesses as well. i think that is the last slide of the presentation. and i'm obviously happy to entertain any questions that the commission may have. >> clerk: commissioners, before we move forward with any questions from you, we should go to the public comment, all

right? public comment line, can you let me know if there are any callers on the line? no callers. okay, great. so, commissioners, any questions, raise your hand. commissioner guillermo. >> commissioner guillermo: thank you. and thank you dr. colfax, for the very comprehensive report. very informative. i had a question that goes back to that mobility projection set of slides. and i'm wondering -- there's two parts to it. one is how does that model incorporate or could that model incorporate and modify to incorporate the types of activity? because as informative as it is, given the mobility information from the cellphones, does the type of activity that people are

doing change the model projections in any way? and if so, even if not, how do those projections fit into how we are going to in san francisco to make the decisions about moving from any one of these phases to the next. and is the data that we're going to try to gather related to th that? >> yes, thank you, commissioner. that's a great question. and i'll talk to dr. peterson about whether she can provide more specific -- whether there are databases that allow for more specificity in terms of that activity. i do think that the question is also -- i mean, i think that one of the key issues is whether -- as the activity increases and whether people will still move around by themselves with their

cellphones and that curve will go back up. but because they're wearing masks and because they're soarg distancing and because -- social distancing and because they're washing their hands and cleaning surfaces appropriately, that we would hope to see that activity level will go up, right? so that's one of the key questions going forward. i think that the indicators will be what we will really need to use. the models are really helpful for us to think through what the implications are of our increasing. and the r is very -- it's only an estimate. and it's not something that we can rely on on a daily basis or even a weekly basis. it takes a very large data set to make r. and so we'd look at the numbers in terms of our testing and our

hospitalizations to determine whether -- in our surge capacity to determine whether these are moving to further restrictions going forward. and just determining, you know, whether people are able to adhere to some of the social distancing. that's going to be a huge determiner of whether we can keep the r below one, the masking and the social distancing piece. does that answer your question, commissioner? >> commissioner guillermo: yes, it helps and i wanted to just say first to thank you and the department and the cooperation that you have been having and leading with all of the other departments in the city. because i think that that leadership and that model of cooperation has really helped the residents of san francisco

to more easily to take on the types of behavior that we need in order to keep the numbers as low. and the infection rates and all of that as positive, relatively positive as they have been. and so just looking for more of that exemplary leadership and information that the department and all of the sort of visible evidence of that throughout the city, i think is very, very comforting. and it is helpful. i think that it is an important piece of, again, why san francisco county has been able to weather at least to date this pandemic to the extent that we

have. >> thank you. >> clerk: commissioner giraudo you had a question? >> so looking at the projections for what might happen with the replication rates, two questions about as we enter into phase two. i do understand that when you're looking at curbside retail we're not requiring applications or filing of plans or anything for the smaller employers. but do we have an indication of the extent to which retailers are opening up or intend to at this point? and then the second question, perhaps you can answer these at the same time -- there's been press coverage about predictions that we may move to phase b2 in two to four weeks' time and is that something that should be father qualified than what has been in the press? >> thank you, commissioner. so with regard to the indicator, i don't have a metric that i can

share with you about how many retailers have started curbside pick-up. i do think that there's been, you know, a qualitative feel that has had activity in the last couple weeks. and dr. peterson emphasized is getting that mobility table to track going forward as well. so it will be key for us to look at that. with regard to entering into phase 2b, these are the state phases for reopening and our phases, again, will be tailored to the local conditions around this. and we will need, again, to look at the data over particularly the next two to four weeks to determine whether we are ready to move into the next phase of db. so i -- 2b. so the balance here is for us to be resilient and to be

reasonably hopeful, but also not to be rash. and, again, to realize that the virus does not have a timeline, right? so i think that there's a question if we can stage this, is this going to be appropriately gated so that people can feel comfortable and safe going about their activities in a way that is not going to create an unmanageable surge in the virus. so i think that two to four-week cycle, because two weeks is one incubation cycle and it's going to be vital to determining whether we can go on to phase 2b. if a week from now that hospital surge is ramping up instead of down, we're going to have to take a hard look and to better understand that and to take aggressive action, depending if, you know, why we think that is

happening before we would be comfortable in moving to phase 2b. >> and just to be clear, any discussion of a two-week to four-week period of time has more to do with incubation intervals, the point where we'd have more data to make the determination? >> that's right. that's right. i said that the virus doesn't have a timeline, it does have a calendar in fact that it has a two-week incubation period. but remember that the other thing that we have to think about is that these are added steps, right. so can we keep the reproductive rate below 1, with curbside pickup. can we continue to keep it below when we enter phase 2b. and i think that it's also important to emphasize that i and the department have recognized the negative health consequences of, you know, a prolonged shelter-in-place and the economic crisis that we're entering.

there are profound health effects to that as well. obviously, widespread covid-19 pandemic on top of that makes things that much worse. but i also want to emphasize that we understand and have a delivery system or seeing behavioral health issues and chronic health issues and other things that are happening that are associated i think with this -- these prevention and aggressive efforts that we have taken to prevent covid-19's spread. so we're trying to, again, to balance the increase in activity with the fact that we want to make sure that as we increase our current activity that the virus doesn't as much as possible. >> thank you. >> clerk: any other questions commissioners? >> mark, yeah, i have several if i can. >> clerk: yes, please. >> and to thank dr. colfax for really an excellent summary of

all of the things happening in the last several weeks. there's several questions that i had and one was simply technically in terms when you share a 30-day p.p.e. for this, and i wonder if you're considering that as a need for the other elements of our coalition, including the hospitals and practitioners? or -- and, if so, how you measure that. and the second question had to do with the long-term care facilities. i throa note to say that they sd be testing but your reports seem to indicate that we were doing this seqently first at laguna and then reading on. and maybe it's a misreading of that because it seemed to me that once we put in the orders,

that ought to be done at the other facilities on whatever resources that they have. and not wait sequentially. and i think that, thirdly, more of an overall philosophic issue -- i should say third is that you did mention restaurants and the state guideline. and in san francisco this is a very real issue. and, you know, we don't have a lot of outdoor space at a number of places that can be used for being able to spread out more. and i'm just wondering how we are working with the restaurant people in trying to see what was viable for them. and i guess that, fourthly, is more as the different counties are in different phases, how do we think that that will affect this county which is sort of the center of where the office is and the commerce are being done, right? it's one of the places.

so if one county said that you can do offices, do we do that? but then people often travel to those areas which also might be potentially more, you know, prone to covid, right? so i'm sorry to give you those questions but i thought that if you could answer those, i'd appreciate it. >> yes, thank you, dr. chow, commissioner chow. i appreciate those questions. with regard to the p.p.e. issue, as you know that we have worked very closely with the hospital council throughout this -- throughout this pandemic and coordinated the efforts very well. and has been a remarkable leader in that work. and our p.p.e. issues in some ways were the most challenging across the network of providers and they assured us that their p.p.e. concerns have diminished

quite a bit. and we think that as long as our supply chain is strong, theirs is probably even stronger. so we basically have developed a system where we don't require them to certify they have 30-day supply, but we have regular check-ins with them to make sure that they are able to have that 30 days. that hasn't been a major concern recently. with regard to the long-term care facility, i appreciate you pointing that out. and just to be clear, we issued -- not to be clear, but to remind the commission that we issued and they issued a health care order requiring long-term care facilities to test patients and staff for covid-19.

basically screening every two weeks. those numbers i do not believe that are reflected this those purple lines. and that would be if there's a patient at, laguna honda, for example, who might have covid or something who is symptomatic. and our testing has increased dramatically in regard to testing. and i'm trying to bring up those numbers. let me just tell you this is routine testing at laguna honda as part of that effort. in the last few weeks we have tested 2,087 residents and staff at laguna honda hospital. this is the routine screening so not symptomatic. and 718 residents, 1369 staff. and as a result of universal testing we did detect four new

positives who are asymptomatic. so that type of routine screening is yielding the desired -- well, it's yielding results. obviously, we prefer to not find any cases but the fact that we found a number of cases that were asymptomatic ensures that we are able to then do contact investigation and tests, close contacts, and hopefully contain the virus. we are assisting other nursing home facilities across the city in implementing this routine testing. we've already worked with numerous entities over the past few weeks and we're continuing to scale that up. so i hope that answers your question about the long-term care facilities. it's a change for them in this new era. and our expectation is that they will make investments in getting their staff and their residents routinely tested with a two-week

cadence in that regard. and another question that you had was about restaurants i believe. and, again, that is obviously a key industry in san francisco. and i have to say from a personal note i really miss our restaurants. and, certainly, we are working -- the health officer and his team is working with businesses to look at the guidelines from the state and other jurisdictions with regard to safer dining practices. but there is a lot of work that still needs to be done there to determine what would be a safer environment for people to dine beyond the pick-up and takeout that we currently have. and then the last issue that we have in place -- excuse me -- i could take out and pick-up, yes.

and so the last question was with regard to the regional approach. i think that one of the things that is really remarkable and should be celebrated is the way that the health officers across the region have come together and aligned our pandemic response. and we know that there's a lot of flow back and forth across the region. i think that there's been a lot of -- there's been a perception that that coalition may be less cohesive than it was previously. and i don't know that is the case. i think that for the most part that we are continuing to focus on the data, science and facts and overall the cautious optimism is aligned. again, we're going to be looking at very similar indicators going forward. and i think that we'll continue

to learn and to work with each other to ensure that not only the jurisdictions are directly accountable as much as possible but that we're working lock-step in regions because our focus continues to be on fighting the curve and to especially protect the most vulnerable who are most likely to die from the virus. >> thank you very much, i appreciate your responses. >> clerk: commissioners, any other questions, raise your hand. commissioner green. >> vice-president green: oops i muted again. >> clerk: you're on, you're good. now you're off. now you're muted. >> vice-president green: there i am. thank you so much. and commissioner guillermo said it so eloquently and the other commissioners with our gratitude for you and the teamwork that

you have demonstrated across all sectors has been remarkable. and nationally, now nationally acknowledge and publicize which i think is a great celebration of your work. i had two questions. one is there any worry that testing capacity -- we talk a lot about having enough p.p.e. is there enough worry about having enough test kits as we try to expand the questioning? and the other question that i had is -- there's a lot talk about things coming back and that second graph that you showed and a lot of indicat inds what would be -- what you're following to indicate that we might have to roll back some of our phases. so i'm wondering what your vision of that -- in other words, not only are there certain parameters that you would weigh more than others, but do you think that there's regional consensus if that came to be, especially in the winter. what would be the lagtime if it

were necessary between the gathering of data and the institution of a potential rollback of some of these -- or a reinstitution of restrictions? >> thank you, commissioner, for those insightful questions. with regard to the testing challenges that we continue to face, our supply chains for testing have strengthened considerably. i think that where we are facing challenges is in a couple of ways, in a couple ways. we have a vision of universal access to covid-19 testing for the city. and that has sometimes been translated into the health department is going to test everybody in the city on a regular basis. that is not feasible.

so i think that from our population health approach, we will be supporting various entities to supply technical assistance and to help them to invest in testing and think about if you're a business, for instance, what is your health plan under the covid-19 response. and how do you encourage and help your employees to get tested by their health care provider. so i think that there's that broader component where we set our goal and focus and in some cases the requirements for testing but don't necessarily conduct the test. and the other key component of this is as we look at data coming in from the communities that we have historically served, the vulnerable

communities, underserved communities and so forth, how do we not only provide testing sites, but we're ensuring that we're providing low barrier culturally relevant, appropriate testing and services, right? and this clearly has a history of both challenges and successes in the h.i.v. world and i think that we really need to draw and accelerate on that work and not --ry learned the lessons of hard way on that. but take the lessons from the epidemic and apply them as quickly and effectively as possible. there is a lot of demand for testing in some communities and among some stakeholders. and then i think that there's real barriers that people have about being concerned about testing. for instance, now that we know that there are a significant to portion of cases that are asymptomatic, how do we ensure

that workers, particularly workers who may not have paid sick leave, or who are on, you know, episodic employment and are already struggling to make ends meet before the epidemic, and how do we determine what policies need to be implemented to protect them, to encourage them to get tested and ensure that the consequences of the public test results are not the loss of a job or economic downturn. so we are going to be working with communities and listening and partnering to develop, again, robust low-barrier testing that really meets the need of the population that is most in need. and also applying this broader population health perspective that are with testing and asking

other health care providers in the city to do their part and to support testing for not only their patients but also with their workforce and then, again, extending that effort to the business community and other stakeholders as well. and then i think that you were asking about the indicators and how we would -- how we would respond in a way regionally if the indicators started to go up. i think that would just probably be a process where the communication across the different regions would continue and there were signals in adjacent regions that suggested that there was a surge either there or that there was a surge coming, that we would have to look at the data and to make a

decision about whether that would require the immediate or the medium term response. and some of those similar conversations that happened in february when as you know that the first outbreaks were really being focused -- concentrated in santa clara. and so we would just need to continue to look at that information and to determine whether a targeted shift would be needed or a more regional shift would be appropriate. i hope that answers your questions. that was a long answer. >> vice-president green: very much appreciated. thank you so much. >> clerk: any other questions, commissioners? okay. so before we move on to the next item, which is going to be item 7, the d.p.h. human resources update. i'm posting the comment information online and i'll keep up it for 30 seconds and

mr. brown and karen hill, would you turn on your microphones and cameras. >> before i go i wanted to acknowledge the incredible effort ever the d.p.h. team. we literally continued to have hundreds of people at the operation center and people have been working 18-hour longer days on the ground and anywhere from working in the hotels where we're placing people who have covid-19, to dealing with treating people for substance use disorders and behavioral health issues. and setting up testing policies and studies and testing programs like overnight. and working on these data analyses like that geo-map that i showed. it's just been an incredible effort the part of the team and it's very inspiring for me to be able to support so many people in the department. and also across the city.

and i just want to thank the commission for their support. i know that you supported and delivered some support to us directly and they're not in the room but the team that's on the line and far beyond that team, the literally hundreds -- i think that thousands of people in the department, who are doing this work every day across the city to support our pandemic response. and it's just been a remarkable effort, unprecedented. i think we always -- you know, it reflects our core values and principles, but, certainly, it's been realized more than ever before. so, thank you. i want to express my gratitude for that and the commission. >> president bernal: thank you. and no expression of gratitude is enough for the extraordinary work of you and your team and every single person in the department of public health and our other city agencies to help

to address this pandemic. so thank you, again, and we'll continue to seek opportunities to say thank you and express our gratitude whenever possible. >> clerk: thank you. so now we move on to item 7 which is the d.p.h. human resources update. and i'm going to host mr. michael brown, the director of h.r. on the screen. mr. brown, welcome. >> thank you. commissioners, thank you for allowing me to speak with you today. and, you know, since i have been here since november 4th, i remember the exact date in 2019, and this has been a whirlwind of events that has been going on. i am pleased to present to you some data in terms of what we have been doing in terms of hiring. and with me on the call is karen hill who is my director of merit and staffing. and can explain some of data that we have already provided you. i think that there were some questions and we're here to

answer those questions if you have any. karen, are you on? >> yes, i'm here, can you hear me? >> yes. >> yes, i'm here. >> so we'd like to start with the questions that you may have unless you want to go through the data on the forms and explaining it to you. >> clerk: commissioners, you received a report in your packet and i emailed you some responses to questions that commissioner green had sent in a few hours ago. so does anyone have any questions or would you prefer that miss hill and mr. brown go through the data they have given you already or do you want to start with questions? commissioner giraudo looks like she has a question. >> commissioner giraudo: hello. i have one economy following commissioner green's request

about the lease (indiscernible) across d.p.h. and those were answered as far as percentages. do you have information on the type of leave that has been requested by the employees? is it family, rather it's medical, on what the kind of -- i know that you don't have that percentage data, but what is the breakdown or what you see as the possible breakdown of the -- within the leave request? >> hi, commissioners. this is karen hill. so the majority of the leaves are fmla. so regardless if they're covid related, covid leaves run concurrently with fmla. and so the breakdown of the type of leave that an individual

would request, whether it's covid related, child care related, if it's their dependent or their spouse or their parent that they're requesting a leave for, it will run -- it would be identified as an fmla leave. but their benefits would be tied to covid. >> clerk: can you turn on your camera, please? >> it should be on. can you not see me? >> no. >> oh, you know what, there we go. sorry. >> clerk: thank you. miss giraudo, any follow-ups to that or did that suffice to answer your questions? >> commissioner giraudo: no, that answers my question. i assume that is what it was. i didn't know if you had a further breakdown out of the fmla leave, whether or not it was more child care -- i mean, if you had any sub-groupings of

family leave? >> we can break that down if you want us to do a further breakdown, you know it would take some time based on the amount of leaves that we have. but we're working on a system where we'd be able to break down a type of leave because there's different categories now associated with covid and we never had to go into that granular level. and now that we are we are working on a process. >> commissioner giraudo: okay, don't do it just for my question -- the answer to my question. but as you're going forward with your own data, i would be interested just because i have the same issues with my staff in looking at the number -- the different categories of family leave. so it would be of interest as you are crunching your data to please share it. thank you. >> sure, sure. >> clerk: any other questions, commissioners? i'm not seeing commissioner

green, could you let me know that you're on here? i think that we might have lost her. >> vice-president green: i'm here, sorry. >> commissioner chow here. i'm impressed with how well we're able to move our hiring process and we have been struggling with this for a number of years literally. so, mr. brown, what do you see in the future -- if we can do this in an emergent situation which almost sounds like a normal way of doing hiring, how are we going to ensure that in the future -- and i'm taking you at your word that by may 31st that you actually have filled your vacancies. how do we keep them filled? because if we go back to our way

of taking up to a year, if not more, to try to hire people we'll be back in the same situation. so how do we take advantage of knowing new processes and work to see if these new processes -- or whatever the processes would be, for a more permanent way of making sure that hiring is really more effective as you have shown? >> thank you, commissioner, for that question. just so you know that part of what we did is that we dismantled some of the norm processees that we used in hiring. but even with that, if you looked at just the nursing, for instance, that there's some things that we did which we can keep as we go forward. and i'm hoping that it will also blend and lend into the rest of the type of hiring that we do. with the directive from the mayor we were able to by-pass some of the civil service rule processes in terms of hiring. but what we did specifically is

to start looking at with the nurses and hiring without having to wait for the supervisor who is doing the clinical work to do the interviews and the processing. and h.r. took control of that. and those are some of the things that we can do and to look at in the future as we start in our hiring process. one of the key things to make that work is to have a strong background in terms of the qualifications when you are putting someone on an eligible list so that we can just go down the list. and we don't have to really start looking at interviewing. if they're qualified by the minimum qualifications, those are the things that will be when you create that eligible list, anybody on there is ready to come on board and we can just go down the list. those are things that we can work in on the process. but we have to rely on the nurse managers to give us the right information on what we're creating to create that list. we have not done that. i think we're about 10 years or so before looking at the m.q.s so there's a bit of intertwining

and working that we need to do and working with d.h.r. and that's still in the process for the long run. some of the lessons learned, we can also look at trying to expand it to other classifications other than nurses. what we were able to do this particular time is because of the directive from the mayor and we can look at old eligible lists and hire people. we're not able to do that in the normal process. but we can use other things in terms of expediting the process and making sure that we have eligible lists that are going to be available or doing examination processes that will be more expeditious in terms of creating an eligible list. those are things that we'll look at in the future and whatever we can come out from this process and try to extend it so that we don't have long periods of 260 days for hires, yes, to me that is unacceptable. and hopefully we're not going back to that.

>> commissioner chow: i think that as we progress we should know that we're going to be putting those in, you know, some of the things that will then help to reduce to a reasonable hiring plan and we'll just continue to monitor the work that you're doing. thank you very much for getting the staff on board. >> first of all, thank you for this presentation and thank you to our colleague, commissioner green for the thoughtful questions which she had asked and your responses. i'm just looking at the data that you have here specifically as this and looking at the division (indiscernible) and the patient eligibility. and just wondering what the impact is of that on the ground in terms of providing services? it seems that these might be positions related -- for example, keeping capacity for a

potential surge. so i guess that is all to say are the divisions on which there's more people on leave -- are they necessarily people who, you know, wouldn't have as heavy a workload now because of the capacity of keeping open or is it creating an issue on the ground and in being able to perform the work? >> so in some of these areas like e.v.s. and food, nutrition services particularly, we know that there's been impact because based on now what the requirements are for the porters to have to clean, i think that it takes double the time. so since -- based on the leaves and the expectations and the surge from this, we have hired temporary covid related porters. i believe that we hired close to 80 porters across d.p.h. i think that our goal is 10 more, which is 90.

and those should be completed processing by the end of this month. so across d.p.h. we have an additional 90 that is covid related. and the same for food nutrition services. we don't have 90 but we're working on about 20 positions to support the leave issue for zuk areberg. and those -- zuckerberg. and those should be filled by the end of this month. >> president bernal: thank you for that clarification. >> clerk: any other questions, commissioners? all right, thank you very much to mr. brown and miss hill. we appreciate your information. >> thank you. >> clerk: so i -- let's see, the next item is item 8, the resolution authorizing the department of public health to recommend to the board of supervisors the assessments of $125,652 to the l.h.h. gift fund

from the friends of laguna honda. and mr. william fraser should be on. william -- i see and hear, can you unmute and get on camera? so what i'm going to do is to pause for a second and put on the public comment line -- >> i was testing as well to say, you know, to add that we needed resources in order to sustain this. >> clerk: so you're on the microphone so make sure that you mute yourself. is anyone on the line with laguna honda who can try to get william fraser on?

all right, so since i'm not hearing anything, with your permission can we move to the next item and try to come back to this? is that okay, commissioner bernal? >> president bernal: yes. >> clerk: okay. i see you. so, everyone, we'll move to item 9 which is the laguna honda c.e.o. report and hopefully mr. phillips is on. yes, i see you. that's great. >> and, mark, before i begin i'd like to take the opportunity on behalf of the comeation to welcome michael phillips as you're presenting as the laguna honda hospital c.e.o. for the first time. welcome. we're looking forward to your presentation. in addition we would like to acknowledge and maggie racowski as the acting c.e.o. at laguna honda and during an important time and as well as the work that you have done together, both of you, to sunday t respons

pandemic. and really putting laguna honda on solid footing, compared to where we see other long-term care facilities. so thank you to both of you for your fantastic work and welcome michael phillips. >> thank you very much, commissioner, and thank you to the entire commission for allowing us to present to you this afternoon. i am pleased to be here. and i'm going to try to do an abbreviated report to just allow sufficient time for questions and to speed along the agenda. our fixed team has been actively engaged in the effort to ensure that the health and safety of our residents and to minimize the spread of covid-19 among our staff and residents and to support the staff and to provide

the necessary equipment and resources. and also in supporting the staff's mental health and well-being. and we've really been focused and engaged in those efforts. we meet twice a day as a leadership group. there are some 20 or 30 of us and all are actually focused on achieving those goals in addition to the daily meetings, we also have two calls on saturday and sunday. and to continue that effort. in terms of the new admissions, so we as you probably know, have not been accepting new admissions since march. that was after the facility went on quarantine. the -- we received guidance from the c.d.c. that indicated that we should refrain from taking new admissions until the quarantine is lifted.

but despite the fact that we've not been taking new admissions, we've maintained an occupancy rate of 98%. in addition, regarding our census, earlier in the year laguna honda hospital implemented a goal of increasing our average census in both acute rehab and acute medical. and that effort was going really well until we went into quarantine. so we will continue that effort after quarantine is lifted. laguna honda hospital also implemented or requested a program flex to flex our acute beds to smith beds. this is an effort to assist san francisco general hospital in surge capacity and limiting the surge capacity. in terms of our human resources and staffing, staffing and

efficient on boarding continue to be a priority while the quarantine remains in effect. our vacancy rate was 6.5%. and we expedited the filling of nurse positions and that's one of our main focuses. dr. colfax talked a little bit about our covid-19 cases earlier. as of today, we have had a total of 28 -- i'm sorry -- 29 positive covid tests. of those 29 positives, 18 are staff related. and 11 are among residents. 13 of the 18 cases on the staff side have recovered while five of the 11 resident cases have recovered.

we began universal testing during the week of may fourth. thus far we have tested 1,369 staff. and with 1,207 tests, testing negative, and so we are pending 160 tests to see what the results will be with those particular tests. only two staff have tested positive as a result of the universal testing. and we continue -- we completed testing on 13 residents and on all 13 of our resident units. and thus far only five new residents have tested positive. we anticipate the completion of universal testing towards the end of this week. and we will wait for further

guidance on the frequency of universal testing going forward. we believe that it will be probably be a month, testing frequency on a monthly basis but that hasn't been determined as of yet so we wait for guidance on that. so i'll pause here and see if there are any questions. >> clerk: commissioners, before we actually ask you for questions, may i go to public comment? okay. public comment line, can you let us know? no calls from the public. commissioners, any questions, please raise your hands. or dr. chow you could speak up if you're on. >> yes, i wanted to also commend our team for coming together and getting back our medicare status.

and also to report that the reporting on the months for the aowl over the past year. and that's been something that we normally have asked for and thank you very much for providing that in this report. and i know that you're going to have other segments that i'll comment on later. >> clerk: thank you, commissioner. mr. phillips, you can continue. >> so that's the end of my report. unless there are more specific questions regarding it. >> clerk: great, thank you. any other comments or questions, commissioners? okay. thank you very much, mr. phillips. and, again, thank you for your help and assistance during the past month. we can move back and hopefully go back to item 8, is mr. fraser able to unmute himself? >> testing, do you hear me?

>> clerk: yes, yes. hello, nice to hear you. >> okay, thank you very much. >> clerk: actually i was going to say to call the item again to make sure that the public understands what we're doing. so moving to item 8, a resolution authorizing the department of public health to recommend to the board of supervisors to accept and expend a gift of $125,652 to the laguna honda gift fund from the friends of laguna honda. thank you. >> all right. good afternoon, commissioners. thank you for having me at your meeting, especially in such a busy time. my name is william fraser. i am the gift fund program manager at laguna honda hospital. laguna honda report requests that the health commission passes a resolution recommending to the board of supervisors that they authorize the acceptance and the expenditure of a donation from the friends of laguna honda totaling $125,652 to the laguna honda gift fund.

the friends of laguna honda is a private non-profit organization whose mission is to benefit the general well-being and the quality of life of laguna honda residents. and they've been supporters of our communities for over 60 years. give me a breakdown of their donation, again, $125,652. $50,000 of which goes to the wish list. let me tell you a little bit about the wish list. it's a long-standing tradition of funding by the friends of laguna honda that allows the departments and the nursing units to request materials, equipment and supply that would be used directly to benefit the residents and to be used directly by our residents. some examples of that are ipads and computers, large flatscreen tvs and electric

pianos and home-like furnishings and those types of things. and then our next category is $5,000 for farm program, our farm is what we affectionately call our animal assisted therapy program. and the $5,000 would be used mostly to pay for veterinarian service. however, our farm program is much bigger than that. but the $5,000, again, would go to just veterinary services. and next category is $20,000, that's been enthusiastically embraced by the friends of laguna honda. we asked for much less than that and they said that we're giving you more. so they wish to donate $20,000 for that for discharge packs. and discharge packs would allow us to buy supplies for residents as they're discharging with the

success of that discharge and to maintain that discharge. some of the items that we would purchase with them would be toiletries and clothing and we're hoping that we also can add to that grocery store gift certificates and to help them to tide over from the hospital to the community setting as the services are getting ramped up, it would help to tide that over. wellness programs, $15,340. we have our wellness center at the hospital, it's quite nice. and in the wellness center we have classes for our residents, including tai chi and yoga. and $17,000 of the donation would be for music programs. and that allows us to bring in professional or semi-professional musicians to perform live music for our

residents. and then the last one is for our voices choir, $18,312. and the choir is a collaboration with the community music center. we have a contract with them. this would pay for the next contract year. and i know that a question was submitted by the commissioners about that program continuing. generally the latin voices choir runs from september to about may of the following year. so we will have to see what the outcome of the current situation will be to see if that would continue on. i know that the controllers office instructed us to continue to pay our non-profit providers,

but i think that that's a limited time period. so i have contacted the controller's office and our contract staff at d.p.h. to get clarification on that. however, again, the normal contract year runs from september to approximately may, 36 weeks, which includes weekly rehearsals and at least two performances by our residents. and as you may understand that its primarily focused on our spanish-speaking residents. and i'd like to take any questions that you may have at this time. >> clerk: before we do that i want to check to see if we have any public comment. public comment line, could you let me know if there's anyone on the line for this item. okay, no public comment. commissioners, do you have any

questions or comments? commissioner bernal? >> president bernal: yes, first of all, thank you soap for this presentation -- so much for this presentation and thank you to the friends of laguna honda, mr. fraser, for these generous contributions. the programs that are being funded through this contribution i think are really critical to you know, maintaining and enhancing morale and also creating community and connectedness among the residents there. given the current situation in particular, are these programs able to function currently with this lockdown and with the response to the pandemic? >> well, i'm going to try to give you my best answer on that. the wish list again is the procurement of equipment, supplies, and so those things can easily be brought to the resident units. many of the residents are having to remain on their units so that

is a big challenge for us. but, again, this funding would be focused on the next fiscal year. so we can hope for the best for that. and i can't tell you whether or not the farm programs are continuing. i know that it is normal for them -- the therapy department to bring in animals into the hospital. but i don't know if that's continuing at this time. discharge packs would certainly continue because it is always to be our goal to get residents in the least -- lowest level of care and that continues where possible and it's just a beautiful program, the discharge packs. and the wellness programs, yes, are not currently happening because they're communal and they have been in our wellness center. and the music programs are not continuing to happen as we're

restricting non-essential personnel, but, again, i say that the hope is that we be able to use that money with less restrictions on our population next year. >> president bernal: great. thank you. we all look forward to the day when these programs can continue to the benefit of everyone at laguna honda and the community. so thank you for that and thank you again for the generosity of the friends of laguna honda. >> clerk: commissioners, it turned out that there was someone on public comment so with your permission let's take that now. caller, are you on? caller, are you there? my understanding is that there's one person on the line.

caller, you can hear us or hear me? i'll announce one more time, anyone there for public comment? okay. so commissioners, it's time to move on to a vote. i will note that commissioner guillermo had to leave the meeting temporarily so there's four of you. commissioner bernal. commissioner bernal? undo your microphone to vote so that we can hear you. >> president bernal: yes. >> clerk: commissioner green, yes. commissioner giraudo, yes. and commissioner chow. yes. great, thank you very much. we can move on to -- let me see -- we move on to item 10 which is the laguna honda regulatory affairs report.

mr. smith. >> hi there. it's troy williams first before we have adrian come on. and i just wanted to report that and to acknowledge the work that adrian has been doing here as the acting chief quality officer for laguna honda. he'll be transitioned back to zuckerberg san francisco general on june 1. and since this will be his last laguna honda regulatory report, i just wanted to take the opportunity to thank him for all of his work over the last year and really helping to stabilize the quality program here at laguna honda. we were working on transitioning him back in february, and then our covid response began and as usual adrian stepped up to the plate when we were asked to stay and to be the incident commander and the deputy incident commander for our structure.

so i just really want to personally thank adrian for all of his work. i know that here at laguna honda that there is soa so much gratie for everything that he's brought to this team and, you know, he'll still be available to, you know, to consult on regulatory issues as they come up, but i really just wanted to take this opportunity before he reported out to you to acknowledge all of his work here at laguna honda. so with that i turn it over to adrian. >> thank you, commissioners. >> clerk: thank you, troy. >> i'm embarrassed so i'll try to not trip over my words. thank you, commissioners, for giving me time on the agenda to bring you up to speed with the regulatory report. and i will give you a summary and have time for questions. if we look at the first page i wanted to point out that we had a slight reduction in the amount

of cases that are reported. and a significant reduction in the resident-to-resident allegations and that really speaks to me about the family that we have here at laguna honda. our residents have been as much a part of the wave that we have responded to shelter-in-place as the staff and providers have been. and they've really coped with this containment in their neighborhoods incredibly well and that's reflected in the reduction of the resident-to-resident cases. and we also had some great news. as part of the waivers submitted to the california department of public health and to the center for medicaid and medicare services, we asked if our first survey could be reviewed as a desk review instead of requiring a reset and revisit survey. and that waiver was accepted. and the district office of the

california department of public health really asked for a lot of information and a lot of data that have been collected regarding the plan of correction. so it was a fairly stringent desk review and they found us to be in substantial compliance with all of the conditions of participation on april 24th. and the denial of payment from new admissions and the daily civil penalties seized a ceasede 23rd of march. which was a huge achievement for the operational side of laguna honda because these changes really showed a significant amount of work and improvement and focus on the patient and resident safety. so i wanted to celebrate that. and i also wanted to acknowledge that we -- as we move forward in this process that the continual survey and readiness and educational update, that we would normally do on an ongoing

basis have been entirely focused on covid and our response to covid. but the state an have asked thae adjust our plan or quality assurance and performance improvement plans to focus on covid. these two things really have put us in a good place to move forward with our plan because we have a phenomenal amount of data and we have a phenomenal amount of evidence to demonstrate how we have been nimble in the way that we have delivered care to our residents and how we have maintained our infection prevention practices here at laguna honda. that's the high level summary. but i want to give time for any questions that there might be about the material. >> clerk: commissioners, let's check to see if there's any public comments before we are

taking questions that you might have or comments. any public comments on the line? i'm still waiting. anything there? let's go ahead and take your commissioners. i haven't heard back and i think we're having trouble with the line. any comments or questions, raise your hand. dr. chow. >> commissioner chow: i want to congratulate dr. smith and his work and look forward to seeing you again at general. but i particularly wanted to comment on the manner in which the regulatory affairs report has been given in terms of the status bars and it helps to summarize what's been going on. when he said that the numbers have gone down, this is really very helpful to allow us to see how each of these are being

answered -- >> all participants are now -- >> commissioner chow: to compliment this is something that we have been looking for for quite a while and i appreciate it. >> clerk: thank you, dr. chow. looks like commissioner green, yes. >> vice-president green: yes. i just wanted to echo commissioner chow and mr. williams' comments, adrian, about the work that both you and maggie have done. you came in with insurmountable challenges and a huge agenda and an environment where you really hadn't worked before, just like maggie. i think that the way that you not only led the two of you working together but the way that you engendered the confidence of the team on the ground. and it was remar remarkable to u come together to address these challenges and to do so in such a positive manner. and i think that you have created a culture that there that since i joined the j.c.c. i

have seen evolve in a positive way and the data that we're getting are much easier to understand. but i think that the idea that you and maggie came in and you were able to accomplish so much both culturally and statistically and the effect that you had on the whole profile of the l.h.h. community with the cdph, is really quite remarkable. and so i just can't quantify how grateful i think we all are to the way that you have all worked together and to your contributions in particular. >> thank you, commissioner. >> clerk: any other comments or questions? so commissioners, we had an issue with the comment line so i want to make -- go ahead and activate it and let everyone know who might be listening to call in again if somehow they were dropped.

>> your conference is now in question-and-answer mode. to summon each question press 1, and then 0. >> clerk: great. do we have any callers? >> michael, this is grant, can i make -- >> clerk: sure. >> can i make a comment? >> clerk: sure. >> i just wanted to thank the laguna honda team and, again, to add my appreciation for adrian. and also to troy's remarkable work and maggie's work with the support of roland. and to the endeavor, i think that it's really -- we have made great progress at laguna honda. and the strength of laguna honda have been reinforced where there were challenges and quite frankly some problems. i think that work has made

significant progress and i think that while the pandemic is challenging the institution even further that we were fortunate to be able to have the team do the work that they've done and the staff at laguna honda to do the work that they've done across the neighborhoods to improve. and as a result we're in a much better place for the pandemic and i just wanted to express gratitude to the teams for the incredible improvements they have made and the hard work that that has taken them to do. >> clerk: thank you, dr. colfax. commissioners, we may move on to item 11 which is the action item and another item action, laguna honda hospital-wide policies and procedures.

all so, distancing appropriate. >> good evening, commissioners. laguna honda hospital is the hospital-wide policies and procedures for approval. and included in the list are one new hospital-wide policy. one revised hospital-wide. two revised e.v.s. or environmental services. and one revised medical staff policy. and two revised nursing. one revised pharmacy. approval is requested unless there are any questions. >> clerk: so, lena, i forwarded some questions from commissioner green. i'm wondering if they got to you? i think that one was specifically around the environmental health -- the e.v.s. policy, a concern about bleach. i'm not sure that, commissioners, if you want to

articulate anything else. >> and if i checked in and out of hospitals with temp checks and so forth, depending what you're cleaning the surfaces with, there's a duration that the material has to be in contact, especially with viruses and bleaches is about a five-minute window. so i didn't know if in light of covid-19 whether there should be detail there depending on the product about how long it must be in contact with the surfaces to be effective? >> we have notes from the reviser of this policy in response to your question. and it says that there are many different clorox products. clorox pro is a five-minute contact time. but we have clorox health care and for the cleaners they are both one-minute contact time or kill time. for covid and three minutes for

c-diff. >> vice-president green: that's great. >> clerk: i'm sorry, any other questions? >> we're talking about cleaning and chemical products. it seems to me that are these the only ones being used? and -- or are we then having to add each time another product? and i think that you mentioned several other products that don't seem to be listed here. >> actually, the reviser of the policy did reach out to me just yesterday and they mentioned that they forgot to make a little note. and if it's fine, we will be adding a little note in the policy to state that, you know, when we run out of a product that it will be replaced. and so this was caught but not in time to make it into the version that you're looking at. so if that's okay, we will add

that little note so that we don't have to keep revising the policy. >> yes, because it seems that with it would be better in general to be -- well, to be more general by saying that, you know, you need to follow the product time and in this certificate of limiting you, right. so are you suggesting that as we pass this that note to be added to the approval of the changes here? >> yes, we would like to do that. >> okay, so you're recommending that a note that will indicate that these are sort of examples and not limited to only these, right? >> yes, that's correct. >> clerk: and if you would send the final policy with that note to me i can forward it to the commissioners. >> sure, no problem. >> okay, that would be helpful.

so does this help -- i don't know if there any other comments but i can make a motion to accept these otherwise. >> clerk: please do, commissioner. >> so moved. >> second. >> second. >> clerk: great. i will do a roll call. commissioner bernal. yes. commissioner green. yes. commissioner giraudo yes. and commissioner chow. yes. and thank you all very much and thank you for presenting and we'll say goodbye to the laguna honda folks. thank you very much. and the next item -- >> can we also again commend maggie for the amount of work that she's done and keeping her eye on the ball along with responding to covid in such a very positive manner really. so i'd like to see if the commission can commend her for that. >> clerk: absolutely. thank you very much, miss

racowski. item 12 is the zsfg c.e.o. report. and i wonder if dr. ehrlich can pop on. >> i am here. >> clerk: great. now you're on. >> great. so commissioners, thank you so much for having me here to do this report. i thought a lot about this report because there is so much to say and i'll try to be as succinct as possible and to invite your questions. i wanted to start by talking about our staff because i just can't say enough about how incredible our team here has been. and the thing that came to mind for me was in this definition of "heroes." a person who in the face of danger combats adversity through ingenuity and courage and strength. i think that says it all about our team here because they have

really done it all. and as i go through this description of what we have been doing with covid, it's really hard to overstate how much things have changed here. the buildings look the same, but everything inside them and all around them has really changed so much with covid. and that's been just a huge lift for our team. and they've done remarkably well. to start we're part of the overall department operations center and we have our hospital incident command systems that meets here now once a day, every day at 10:00. and it's basically an expanded executive team meeting that we have that explores every aspect of our operations in detail. and we went from meeting twice a day now to once a day because of the situation that we have. and that's led by our chief of clinical operations jeff schmidt who has been an amazing leader through all of this.

and our work is led by a surge plan that we created as well as a de-surge plan which we're in the process of being operational under now and that work has been led by our chief medical officer, and not only has that plan been really been instructive for us and guided us through our operations here, but it's also been a model for other hospitals in the city. we've shared it with them and they've adopted similar plans and we have, in fact, have a city-wide plan that guides our work and has been very helpful in the paradigm that dr. colfax described. and three people that i want to call out for their contribution and that is our infection control nurse elaine decker and our feinfectious disease specia.

they have been our guides and leaders on all things clinical and every question that you can possibly imagine having to do with pretty much everything that we're dealing with right now. so they've been front and center in everything that we do. and they have daily clinical rounds and consulting with teams on the patients who are in the hospital and then to the rest of us on various topics and issues. and the other thing that has changed quite dramatically with the entry of patients into our facility. i would say that is a combined effort of the emergency department, of course, and psych emergency service and our urgent care clinic and the richard fine peoples clinic. and i'm going to show you -- walk you through data but the data really tell a picture about who how that has changed by

necessity as the types of patients have changed quite a bit and as well as the way that we see them and we need to cohort them both in terms of patients presenting with respiratory symptoms and non-respiratory symptoms and then for what they're presenti presenting. and the other issue has to do with staff and patient and visitor screening. so as dr. green mentioned, anybody who comes into the building is screened. we screen staff every day and using temperatures. and we have an online tool and also asked questions when they present. and we are screening patients and visitors and it's a very complex way that we have screened them. we have the urgent care clinic set up in the lobby of building

five to address patients who have respiratory complaints. and then we have tents set up where people get tested. those patients as well as staff who present with symptoms. and we have various types and brent and andrew, our chief communications officer is the leader on that but we had couldn't biewgzs from other members of our team, including iona johnson who led the screening work. and to address the spiritual issues and the wellness issues that we will try to work with the staff on. and then last but not least we had a huge outpouring of gratitude from the community

through the san francisco general hospital foundation and the philanthropy they have bought in, totaling $4.5 million and that's gone for all things directed at patients and staff. and so i will pause there. and there's an update and i won't go through in detail and it was prepared by our amazing chief medical information officer dr. nita. and you can review that and i'm happy to answer questions on that. and i'll pause for a minute before i go through the data which i wanted to go through in a little bit of detail as well. >> clerk: any questions, commissioners? >> this is dr. chow again. and on the update could you see us running down and how they are used in this setting and whether

it extends into your exterior efforts. >> you can see in the report that is written both in terms of optimizing surge, so the epic team has been front and center with planning for the alternative care sites and we -- they have been very involved with testing or preparing reports so this is not just a cfgsc, but throughout the health network and the department. and also with the command center. so there isn't -- as this report goes through, there really isn't anything that the team and i.t. hasn't been involved with from terms of helping us to understand the patient population and to delivering the data reports which are really

been phenomenal and what is going on internally and helping to explain what is happening with the public. >> so it's what we would have hoped, the e.h.r. system could do for us then, is that right? and it's really fulfilling the promises that we are hoping for from this type of electronic records? >> yes, absolutely. and the other thing that i just want to comment on because you might not notice it but recall that almost exactly four years ago we moved into our new acute care tower. and almost every day i think about how critically important that building has been to us being able to meet the demand of this pandemic. and that starts with the emergency department that was quite a bit larger than previously and had individual patient rooms. our whole in-patient area that

has single occupancy rooms. we have an additional i.c.u. unit that has enabled us to meet the surge in that demand. and so i just am grateful every day that this community and our foundation built that building, because i don't know where we would be without it. >> thanks. >> clerk: any other questions, commissioners, before we move to data. go ahead, dr. ehrlich. >> okay, great. so, you know, we have reviewed these charts every month at the j.c.c. and they are really different now than they've ever been and so i think that they're a great representation of how much things have changed here. so i wanted to just walk you through some of the changes and to give you a chance to reflect on that and to ask questions.

and so first of all, you can see right away with the emergency department that our average daily volume has dropped by about 30%. and we don't know exactly why. and it's probably due to a few things, one, that there's fewer city in the people now. and as dr. colfax showed you, people are moving around a lot less and they're clearly moving less into the emergency department. also dr. green, i wanted to respond to your questions about how -- what are the people presenting for. and as we look at in epic and we see both the chief complaints and the diagnoses that people are presenting with they have shifted and so the top diagnoses pre-covid were falls and headaches and chest pains. and now the three most common diagnoses are shortness of breath, cough and suicidal iraq

ideation, interesting enough. and we have still coughs and headaches and chest pains but lower on the list. and so -- and along with your emergency department being down, the volume being down, so have our average daily admissions gone down which is not surprising because most of our admission comes from the emergency department. you will notice though that they are down by as much and that's because the percentage of admissions from the emergency department have gone way up. for as long as anybody can remember that percentage has been about 15%. and now it's somewhere between 20% and 25%. reflecting that the people who do show up in the e.v. are sicker than they were before. on the next graph we can see some really dramatic and

positive changes that have come as a result of covid. and one is that our leave without being triaged numbers are almost non-existent. and ambulance diversion which was commonly thought to be an intractable problem is suddenly solved by covid, which is fascinating. this is not just because the volumes are lower. we also simultaneously have an experiment, if you will, going on in the city called cave. which is run out of our emergency medical services agency. and it's basically a project that was envisioned for long before it happened this month. and very fortunately coincided with this pandemic. and the idea is to ambulance load traffic throughout this. and it's with the ambulances calling in to the physician to

get destination advice. and what has this has resulted in is that it's a level loading. so we're not experiencing the same ambulances that we did prior to the experiment. and, fortunately, everyone sees how valuable this has been and so now the experiment is going to continue i believe through july at least, which is great. urgent care has also gone down and now part of this is because the urgent care volume is split between urgent care which is seeing all of the respiratory urgent patients and the people's clinic that is now seeing the non-urgent patients. and we're reducing the care in r.c.c. that is combined back with the urgent care clinic and

that's a workload that we're working on. and the other thing that i will say is that you will notice that the psychiatry volume has not changed much at all. and there are some slight changes that belie some of the big changes that we have made in that volume. so a while back now we decided that every single person going into p.e.s. needed a test for covid. i can explain more about why we made that decision a while back. but if you see the p.e.s. encounters going down, part of that is because all of these patients are going first to the emergency department where they get tested. and they're also being evaluated there in some cases by a psychiatrist and so more people i believe are being discharged from the emergency department before they even make it to the p.e.s.

and the admissions to 7b and 7c don't include the fact that we now have covid positive patients who are admitted just for psychiatric admissions on h52. which you will recall is the forensic unit that we never used but now thanks to the sheriff's department being flexible with us that we can use that unit for these patients who would otherwise really not have a safe place to be at. and i think that i will stop there and -- because i have been talking a long time and see what other questions that you have about the data or any other aspect of our operations which as i think that you can see have changed pretty dramatically in the last few months. >> clerk: and dr. hammer is here after -- to answer questions that dr. green had. i don't want to leave her out.

commissioners, any questions? yes, commissioner green. >> vice-president green: well, first of all, you and your team are to be commended for your work. it's remarkable. and i know that you had a lot to do with bringing the hospital council together. when you stepped up to lead i saw big changes in the leadership of my own institution every day. i'm so grateful to you because i can see your invisible hand guiding them. >> thank you. thank you. >> vice-president green: and know that you will see us through regardless of the future in this epidemic hold. one of the things that was brought up at the last meeting and maybe dr. hammer can talk about this, and the primary care clinics that we have recruited some staff from those clinics and i'm wondering where you stand on the analysis -- this sort of post-surge aftermath where we have untreated conditions. (please stand by)

>> oh, dr. ehrlich? i think she may have had some connectivity issues. >> can you hear me? >> yes. could you speak up? you sound very faint. >> thank you. is that better? >> yes, thank you. >> good afternoon, commissioners, and i just want to -- this is hallie hameran, director of ambulatory care for

the san francisco health care network, d.p.h., and also the outpatient -- well, the outgoing outpatient lead in the medical branch of the d.f.d., and i'd be happy to answer commissioner green's question about ambulatory care and particular the primary care in our plans for reopening. i just want to add my recommendation to the leadership that you all have -- commendation to the leadership that you all have recognized at the start of this meeting. it's been great to be a part of this department, citywide activation, and starting with mayor breed and certainly our leaders, dr. colfax and dr. aragon, and then, just really want to call out susan ehrlich

and her team and s.f.g. and the service that i get to witness each day when i call in to the meeting. it's been an incredible operation, and i think we have a lot to be proud of in san francisco, and a lot to be grateful know, and our staff know or at least i hope they know that they've been part of saving lives every day. as far as ambulatory care, and just to remind you, ambulatory care includes jail care, maternal care, integrated health, and the whole person care, which brings together a number of nontraditional services which serve people experiencing homelessness across the city. so across ambulatory care, we basically deployed a huge number of staff from three of

those five sections. those three sections being primary care, behavioral health, and m.c.h. which in response to the health order to limit our ambulatory care services, those three sections really stripped down their staff and their services to just the most urgent services being provided in staff, and in so doing, we were able to deploy 200 ambulatory care staff to the d.o.c., and then even more to our clinical services that grew in response to the covid pandemic. and so -- so -- so three

services really stayed the same because we had to prevent outbreaks in the jail, so jail health, we really maintained our staff there. and then, particularly integrated care, as attention shifted to the impact of the covid-19 on the people experiencing homelessness and living in supportive housing, we shifted a lot of ambulatory care staff to whole person integrated care. as -- as we've been -- realize that we're in this fortunate place to start looking to phase 2 and phase 2 planning, we've been planning on resumption of some ambulatory care in those areas where we really had to

reduce our services. many of them will have to stay in the d.o.c. where they're continuing to provide care. the areas of the d.o.c. that we will really continue to support with ambulatory care staff and ambulatory care leaders are the hotels where over 1,000, now about 1400 people experiencing homelessness who could not -- who could not do so safely on the street have been housed. we've also been supporting the isolation and quarantine hotels, both in terms of leadership, administrative support, and frontline clinical sites. so we have some testing attached to care clinics in areas of the city where we really wanted to focus on low

barrier testing for our san francisco health network and other safety net patients. so those are the areas of the d.o.c. that we'll continue to support as we move to resumption of ambulatory care services. commissioner green, we've been working with -- with ambulatory care providers throughout the city, especially in the safety net, to help give guidance to provide resumption of ambulatory care services, particularly in ambulatory care. a lot of this is dependent on facilities, so there's a lot of variability in our facilities, which -- which will dictate how we treat this and the number of patients we'll be able to call back for in-person visits. our expectation is across ambulatory care, along, with a lot of variability, and

including, i should also mention, specialty care, that we will shoot for going back to about 30% of our visits being in person and continue to provide the majority of our care with telehealth visits, so telephone visits and some video visits. our behavioral health services has done a phenomenal job in converting a lot of their routine outpatient services to telehealth. i'd like to call outline dr. hamilton holtz who is the medical director for primary care behavioral health and has been the lead for mental health behavioral services in implementing telehealth, and telehealth has been able to engage approximately 85% of their patients through limited -- very limited in person visits and then a lot of telehealth. so as we -- as we move to phase

2, to some limiting of restrictions and sheltering in place, we will be moving to some things that we can't do with telehealth. childhood immunization, the kind of things that we need to be face-to-face, clinical exams, and also visits for those people who are hard to engage over the phone, so people with serious behavioral health issues, those with limited english proficiency, and those with severe health concerns. we're working with occupational safety and health to assess the physical spaces and work with teams on their workloads to

make sure that they can do that safely. i think i'll stop there. i've been talking a lot, and then, i'm happy to answer questions if there are more questions about ambulatory care. >> i'm not sure if there's any follow up questions. commissioner green? >> yeah. i was wondering if you had an assessment of the financial health of some of the clinics because we know that telehealth appointments aren't compensated very well, and i wonder if you've talked to clinics about their ability to stay open and their ability to maintain staff? >> yeah, and that's a big concern and has been a concern right from the beginning. we've been fortunate among the safety net clinics, that most of our telemedicine, it's been

reimbursable. behavioral health, we're also fortunate that we can bill for much of the telehealth. our biggest concern is the safety net clinics that rely a lot procedural -- procedure -- procedural care, so, for instance, those san francisco community clinic consortiums, clinics which have a large dental -- have large dental services and rely, in large part, on their dental revenues. i think those clinics have taken a large hit. yeah, i mean, this has been really, really devastating for, i think especially some of the small providers of -- throughout the city, small primary care providers throughout the city. i think fortunately, for a lot of the behavior health

providers, they've been able to pivot very well to telehealth, which is great, but i think the -- what we're going to see as we move into phase 2 is not just as -- as mr. wagner mentioned earlier, that we'll be having a lot of people who have lost their employer-based health insurance and will be enrolling in medi-cal, but i think we'll see some real impacts in terms of access because of some -- some of the -- some of the providers of care not being able to stay afloat. >> thank you. it would be great to follow up on that. i think there's national concern about it. >> commissioners, i believe that there's a long-term plan maybe in september to have a primary care update, and i will

talk to dr. hammer and talk to shan and dr. pickens. are there any questions for dr. ehrlich. >> well, i just wanted to ask dr. hammer one question, which is as you're trying to move towards having additional in-person visits, what is your time frame for that, and how does that affect our phase 2, you know, program? >> our san francisco health network clinics -- primary care clinics have been planning -- they were instructed at the beginning -- or at the end of april to look at may as their planning month, so they're really planning now for early june to be resuming some in-person and in-home care.

we'll be looking to make sure we can do that safely, so screening everybody that enters the clinic, making sure that everybody's masked, making sure that we really limit the number of people in waiting rooms and nursing stations, etc., so there's a lot of work that needs to be done to be able to do that safely. but i think what we'll begin to see in most of our clinics some -- some return to in-person care at the beginning of june. and before we shift the questions to dr. ehrlich, i wanted to make sure that the question that i was asked was primary care, and i'm the director of ambulatory care. primary care is part of ambulatory care, but the director of ambulatory care will come back to report to you, and that's ana behr.

she's been working 80-hour weeks since the beginning of the activation in the d.o.c. while also running ambulatory care, so just want to commend her for her incredible leadership. >> so dr. hamer, thank you also for your services these years. and since, as you reminded us at uhir about ambulatory care, jail is actually part of that. can you tell us if jail is actually able to cope with the issues of social distancing and so forth that's necessary within the jail? >> and actually, dr. hamer, before we answer, commissioner chow, just so you know, there'll be a jail update at your june 2 meeting, so the

next hearing, you'll get an update on jail health. >> well, i'll wait to hear the report, and that's perfectly fine with me. >> i'll just say briefly, like the rest of us, that we have the gift of time that a lot of municipalities did not have at the beginning of the covid outbreak across -- across the nation. we were -- i think it was mid-march before we had our first positive case of covid of a person in custody, and -- and before that time, dr. pratt was observing, really learning from the experience of other county jails across california and the country and in touch with jail

health directors all over the place and used that experience to develop a really, really comprehensive prevention and mitigation plan. it was right after we started testing all people in custody at the time of intake? right after that, i think it was within a few days that we had our first person test positive, and -- and they already had in place a protocol for keeping people as distant as possible from the rest of the population until their test came back? unfortunately, that's -- it's not really possible to completely isolate everybody coming into the jail, nor would we want to, so it 's been very very challenging. dr. pratt did work with the investigation team. when that person tested positive within about a day of

admission into the jail, and unfortunately, we've had no -- within the jail transmissions, as far as i know, and i'm really, really pleased to say that, and it's a testament to the planning that dr. pratt and her team did. we've had, i think, about five positive cases of people in custody in the jail, not staff. there have been some positive cases among the sheriff's department staff, and those cases of people testing positive in the jail have been up -- up -- you know, managed appropriately. dr. pratt can share with you more details. some have come as transfers from other county jails. like, last week, we had one from santa rita. it's been really challenging to make sure we stay on top of everybody coming in, but i think so far we're doing an excellent job in the jails.

>> all right. thank you very much. >> all right. commissioners, any final questions for dr. ehrlich before we move on? >> you know, the treatment in the jails, is that something that can be continued on an emergent situation? would we be able to continue to find ways in which we would continue these lower levels of lower levels? >> hi, dr. chow. so one of the things that really helped us a lot was the contract that we had with chinese hospital. right after laguna honda closed to admissions, we had a big spike in cases waiting for skilled nursing care. and now, chinese hospital has 23 of our patients, and there's been a little bit of turnover

with that group, but -- but mostly, it's the same patients kbho who were there from the beginning. we have patients who require skilled nursing care, especially custodial care, and so that is an asset that concerns us, the lack of that asset, especially because laguna honda, for very good reasons, is going to be closed to admissions to us probably at least until june. so even though the numbers look really good right now, we -- we are concerned about them staying as low as they are, and we have an amazing skilled and resourceful team who manages placement of people and patients in all kinds of settings, so it's something we're keeping a very close eye on right now. >> thank you.

>> thank you, dr. ehrlich. we're going to move onto the next item. >> mark, before we move onto the next item, i want to reinforce my gratitude for dr. ehrlich and dr. hamer for their incredible leadership. their teams have been engaged in not only doing the work that they've been responsible for for several years now, but especially at the department operations center, their teams, their leadership, their detailing of the membership of the d.o.c. has been fantastic, so i just want to collectively thank them. they themselves have been working seven-hour and many hours every day, and i just want to express my gratitude to them, and to their families for supporting them during this

time. >> thank you, dr. colfax. so everyone, the next item will be item 13, zuckerberg general's family hospital. [inaudible] >> good evening, everyone. thank you for giving us time to present the regulatory status report from san francisco general. the status of this report, we had three high stakes surveys still scheduled for this year. the joint commission surveys remains suspended, but my understanding from speaking to the administrator of the joint commission, for the rest of 2020, the focus will be on the

infection prevention and control. i think that will put us in a great place to address when that happens later in the year. the commission on cancer, granted, all of their accredited facilities are one-year extensions, so we now have that survey scheduled for 2021. also, the biggest piece of new in there is the cal-osha workplace violence emergency department complaint, and we submitted an appeal today around some of those citations because we really have requested some more information so that we can address the complaints more fully. in the background, the workplace compliance committee led by frontline staff have been doing a lot of work to -- to abade many of the things that were discovered, and we're

definitely moving in the right direction with that piece. of the open site visits, the three -- or 8, 9, and 10, we have ongoing investigations into those three events, and we've seen a different methodology from the california department of public health, with a lot of the investigation being done remotely by -- via document requests and interviews done over the phone. so that has enabled us to continue with those investigations. and we only have one new facility reported incidents to bring to the committee today. and we have submitted the preliminary investigation into the last one. the last allegation, we were unable to substantiate that. those cases, when investigated,

we have a lot of data to present to the investigators when they come from california department of public health. i'm looking forward to being full-time again at s.f.g. so i can work in collaboration with the executive team there and the rest of quality management so we can really shape the way that we focus on the infection contro control kra control's more regulatory response to covid. is there any questions or comments? >> commissioners, there are no public comment items. commissioners, questions from you? i don't know if you are itching, but i don't think any of you have your hands up. thank you very much, mr. smith. >> thank you, commissioners.

>> thank you. >> okay. dr. borden -- horton, the video is not on, so she's just on by phone. dr. horton? let's see...let's give them one second. i'm going to text her.

dr. horton? all right. so she's having trouble being heard. give me one second. i'm going to ask her to hang up and call back. dr. horton is going to have to hang up and call back, so give us another 30 seconds. >> hello? can you hear me now? >> yes. >> can you hear me now? >> yes. >> okay. great. wonderful. so i will go ahead and launch into my achievement staff report. thank you very much for the welcome for my new role earlier. the one thing that's not listed on the chief of staff report that i wanted to comment on is we are doing a virtual med

staff dinner, which is not surprising that we'd have to go virtual on. it is on june 8. most of the business we covered at m.e.c. were similar to all the reports you've heard. tonight, we've been discussing p.p.e., we've been trying to keep leadership up to date on all of those issues as well as working on staffing the surge areas and the potential surge areas. there was no p.i.p.s. meeting, but there will be in june. we did send out documents to commissioners that presented the results of the committee that was led by dr. jack chase, chair of our ethics committee that really took a deep dive and laid out some key

priorities and worked towards how we will proceed if we hit a time of critical resource scarcity during the time of covid. so i believe those were in the documents that we sent around, but i did want to commend the codirectors of the unit that worked on this, as well as dr. chase and his whole committee for bringing such thoughtfulness and getting such work into these documents because we have so successfully flattened the curve and have not overwhelmed our medical system. i'm very grateful to have them in place so that if anything should happen quickly, we have -- we can have a really thoughtful approach to it. so i'm going to pause for a second and find out if anyone has any questions for dr. chase from those documents that we sent around? >> commissioners, any questions? these are about the resource

allocation during crises? >> this is dr. chow. on the color coding, is that the color coding that's traditionally used in triage? >> thanks, dr. chow, for the question. this is jack chase. that color coding that we use is consistent with the main published guidelines on the topic most specifically from the university of pittsburgh allocation criteria, which was set up by doug white and bernie lowe, who are two experts in the field. >> no, thank you, because i know in the military, of course, we had different colors, and i couldn't remember what the colors were. so just when i think -- okay. so red is the highest priority, and this comes from the standards that we're using. that's great. thank you. >> i also see that commissioner

green has a question. >> oh, i just wanted to thank you and commend you for these documents. they're so thoughtful, so well written, so compassionate. the letter is so well written, and i just want to thank the team for coming together and coming up with such an excellent template and guidelines. >> thank you, commissioner. >> we'll definitely convey that to the committee, as well. [inaudible] >> procedures were actually

called out as special privileges that required individual doctoring, and so we have simplified that. the division of cardiology has simplified that and lumped those that are more considered to be core cardiology privileges into the core section and only are falling out four special privileges which require individual proctoring as opposed to proctoring for a general type

of procedure. are there any questions about the cardiology privileges? >> dr. horton, i think my only question, and it's actually my ignorance is the prerequisites, is that -- these are the specialty boards from abim and not -- not the primary board, then, is that right, that we're asking for? >> it's the specialty boards for interventional cardiology. is that your question? >> yes. as the thing for specialty board for cardiovascular disease, which is different from just getting a regular abim, right? >> right. that's my understanding is specifically, it's the interventional cardiology board. >> right, right. no, that's what i was trying to clarify. >> right. >> because if i remember now, they have a number of different

specialties which are added boards, right, on top of the regular boards. >> yes. >> yes, thank you. i have no problem. move for acceptance. >> there's no one on the public comment line for this item. any other questions on this, commissioners? okay. so there's a motion. is there a second? >> second. >> second. >> thank you. any other discussion? all right. so i will do a roll call vote. [roll call] >> all right. thank you very much, dr. horton. >> you're welcome. >> commissioners, item 15 is other business. yeah. any other -- okay. there's no public comment on this item, so we can move onto item 16. sorry that agenda item is incorrectly done on that slide.

16 is a consideration for a closed session. >> is there a motion to move into closed session? >> so moved. >> second. >> mark, we need public comment? >> yeah. there's no public comment on this item. i'll do a roll call vote. [roll call] >> okay. so just a reminder to everybody, laguna honda folks, you're going to be first, so dr. hu, please sign out of this. everyone has to go to the closed session. s.f.g. folks, please stay out -- i'm going to notify kim and dr. ehrlich that we're

we spoke with people regardless of what they are. that is when you see change. that is a lead vannin advantage. so law enforcement assistance diversion to work with individuals with nonviolent related of offenses to offer an

alternative to an arrest and the county jail. >> we are seeing reduction in drug-related crimes in the pilot area. >> they have done the program for quite a while. they are successful in reducing the going to the county jail. >> this was a state grant that we applied for. the department is the main administrator. it requires we work with multiple agencies. we have a community that includes the da, rapid transit police and san francisco sheriff's department and law enforcement agencies, public defender's office and adult probation to work together to look at the population that ends up in criminal justice and how they will not end up in jail.

>> having partners in the nonprofit world and the public defender are critical to the success. we are beginning to succeed because we have that cooperation. >> agencies with very little connection are brought together at the same table. >> collaboration is good for the department. it gets us all working in the same direction. these are complex issues we are dealing with. >> when you have systems as complicated as police and health and proation and jails and nonprofits it requires people to come to work together so everybody has to put their egos at the door. we have done it very, very well. >> the model of care where police, district attorney, public defenders are community-based organizations are all involved to worked

towards the common goal. nobody wants to see drug users in jail. they want them to get the correct treatment they need. >> we are piloting lead in san francisco. close to civic center along market street, union plaza, powell street and in the mission, 16th and mission. >> our goal in san francisco and in seattle is to work with individuals who are cycling in and out of criminal justice and are falling through the cracks and using this as intervention to address that population and the racial disparity we see. we want to focus on the mission in tender loan district. >> it goes to the partners that

hired case managers to deal directly with the clients. case managers with referrals from the police or city agencies connect with the person to determine what their needs are and how we can best meet those needs. >> i have nobody, no friends, no resources, i am flat-out on my own. i witnessed women getting beat, men getting beat. transgenders getting beat up. i saw people shot, stabbed. >> these are people that have had many visits to the county jail in san francisco or other institutions. we are trying to connect them with the resources they need in the community to break out of that cycle. >> all of the referrals are coming from the law enforcement agency. >> officers observe an offense.

say you are using. it is found out you are in possession of drugs, that constituted a lead eligible defense. >> the officer would talk to the individual about participating in the program instead of being booked into the county jail. >> are you ever heard of the leads program. >> yes. >> are you part of the leads program? do you have a case worker? >> yes, i have a case manager. >> when they have a contact with a possible lead referral, they give us a call. ideally we can meet them at the scene where the ticket is being issued. >> primarily what you are talking to are people under the influence of drugs but they will all be nonviolent. if they were violent they wouldn't qualify for lead. >> you think i am going to get arrested or maybe i will go to jail for something i just did because of the substance abuse issues i am dealing with.

>> they would contact with the outreach worker. >> then glide shows up, you are not going to jail. we can take you. let's meet you where you are without telling you exactly what that is going to look like, let us help you and help you help yourself. >> bring them to the community assessment and services center run by adult probation to have assessment with the department of public health staff to assess the treatment needs. it provides meals, groups, there are things happening that make it an open space they can access. they go through detailed assessment about their needs and how we can meet those needs. >> someone who would have entered the jail system or would have been arrested and book order the charge is diverted to

social services. then from there instead of them going through that system, which hasn't shown itself to be an effective way to deal with people suffering from suable stance abuse issues they can be connected with case management. they can offer services based on their needs as individuals. >> one of the key things is our approach is client centered. hall reduction is based around helping the client and meeting them where they are at in terms of what steps are you ready to take? >> we are not asking individuals to do anything specific at any point in time. it is a program based on whatever it takes and wherever it takes. we are going to them and working with them where they feel most comfortable in the community. >> it opens doors and they get access they wouldn't have had otherwise. >> supports them on their goals. we are not assigning goals

working to come up with a plan what success looks like to them. >> because i have been in the field a lot i can offer different choices and let them decide which one they want to go down and help them on that path. >> it is all on you. we are here to guide you. we are not trying to force you to do what you want to do or change your mind. it is you telling us how you want us to help you. >> it means a lot to the clients to know there is someone creative in the way we can assist them. >> they pick up the phone. it was a blessing to have them when i was on the streets. no matter what situation, what pay phone, cell phone, somebody else's phone by calling them they always answered. >> in office-based setting somebody at the reception desk

and the clinician will not work for this population of drug users on the street. this has been helpful to see the outcome. >> we will pick you up, take you to the appointment, get you food on the way and make sure your needs are taken care of so you are not out in the cold. >> first to push me so i will not be afraid to ask for help with the lead team. >> can we get you to use less and less so you can function and have a normal life, job, place to stay, be a functioning part of the community. it is all part of the home reduction model. you are using less and you are allowed to be a viable member of the society. this is an important question where lead will go from here. looking at the data so far and seeing the successes and we can

build on that and as the department based on that where the investments need to go. >> if it is for five months. >> hopefully as final we will come up with a model that may help with all of the communities in the california. >> i want to go back to school to start my ged and go to community clean. >> it can be somebody scaled out. that is the hope anyway. >> is a huge need in the city. depending on the need and the data we are getting we can definitely see an expansion. >> we all hope, obviously, the program is successful and we can implement it city wide. i think it will save the county millions of dollars in emergency services, police services, prosecuting services. more importantly, it will save lives.

>> please prepare to take us back -- to take us into the budget and appropriatations meeting. >> good afternoon, everyone. the meet willing come to order. this is the may 20, 2020 regular budget and appropriatations committee meeting. i am sandra fewer and hillary

roanen and rafael mandelman, norman yee and shamanne wallon. madame clerk, do you have any announcements? >> yes, madame chair. due to covid-19, city employees and the public, the board of supervisors, legislative chamber and committee room are closed. however, members will be participating in the meeting remotely at the same extent as if they were physically present. public comment will be available for each item on the agenda. the number is streaming across the screen. comments are opportunity to speak during the public comment period are available via phone by calling