settlement a seat at the table. thank you for your time please vote no on the hastings settlement. thank you so much. >> thank you very much. could you please connect us to the next speaker. >> i am a resident of tenderloin district 6. i am calling to urge you to vote no on the hastings settlement item 12. my reason is contrary to what my colleague before me stated.

it is unfair for the settlement to occur on the tenderloin and leave others. this is not a question of poverty. there are 1600 unhoused. i think there needs to be a grand solution for such people. they need our assistance but these residents here on willow street have been suffering with not just them dwelling on the streets but there is a lot of disturbances, noise, crack addiction and all sorts of looting and garbage eve everywh. it is unhealthy to be here. that settlement should extend to all tenderloin not just the 300 tents committed to. thank you. >> please connect us to the next speaker. >> that completes the queue.

>> thank you. operations. hearing no further callers, public comment is closed. we can move to closed session. we will now convene in closed session. >> could we take a roll call on motion to convene in closed session. >> yes, please. >> on the motion to convene in closed session noting vice chair peskin is absent. haney. >> aye. >> chair mar. >> aye. >> mr. chair will are two ayes and one absence. >> thank you, mr. clerk. we will convene in closed session. >> thank you very much. a note. the members of the committee will be leaving this live meeting and connecting to did

closed session hall. they will reconnect to this live meeting when it is concluded. i will present a summary of the actions taken during the closed session. any members of the public invited to remain in this live session so you can hear summary of the actions taken. at this time the members o>> weo

order. will you please call the roll. >> (roll call). >> all right. moving onto the next item. the approval of the minutes of the health commission meeting of july 21, 2020. before we begin with this item

on maf o behalf of my fellow commissioners we approved to help equity resolution declari declaring-it was based by the human rights commission during their june 25th meeting. ours had the addition of some resolved statements that were tailored to health and programs. on behalf of my fellow commissioners i want to acknowledge the critical work of the commission and their staff along with members of the community group mega black sf. and develop the resolution of the same name that was approved of the commission and all the hard work and energy they put in to creating that resolution. the commission is very proud of the resolution that contains

some measurable outcomes to achieve equity and combatant eye black racism. it was apparent that there were some issues with respect to the development of the resolution and the process by which the commission approached the discussion of this item. last week the secretary and staff department of public health and human rights commission meant to resolve were committed to developing a process and protocols for our continued work together to address anti black racism and other crisis effecting san francisco and discussion of these critical issues. i speak on behalf of any fellow commissioners saying we'll continue to address anti black racism and advance other health related issues at our meetings

and in consideration of future resolutions. during the covid 19 pandemic and we're grateful for all the hard work being done to combat the pandemic. everyone is doing their best to conduct all of the necessary work. we can do better and will work collaboratively on developing a strong process moving forward. thank you for your attention and commissioners do we have a motion to approve the minutes of july 21? >> so moved. >> is there a second? >> let me check to see if there's public comment. give me one second. if you wanted to make public comment on this item, press star

three right now. i doapt se don't see any publict on this item. >> okay. we do have a motion, is there a second? >> second. >> please call the roll. >> (roll call). >> just a reminder to all the folks who aren't speaking, please mute yourself if you're not speaking so there's no background noise. it's a little hard to focus. >> good afternoon, commissioners. director of health.

the details where we stand with regard to our covid 19 response and budget. those follow on agenda items. i'm happy to take questions on any additional questions that you see on the director's report. i recommend we go to the covid 19 update in the budget that will answer many of those questions. >> it's fine to proceed. >> folks if you would like to make public comment on the director's report, please press star three. >> i actually had a question on the behavioral health dhr. >> yes. please go ahead, commissioner. >> it was only a question of clarification. the dhr being developed for

behavioral health would it be compatible or is this also developing a mental health ehr. this has been a long standing controversy about whether or not we'll have merging ehr. >> i turned this over to dr. hammer who oversees behavioral health. could you provide answers to the questions. >> could you clarify what you're referring to. i don't know what is in the director's report that you are referring to. i'll try to clarify. >> it's the new dhr that's being developed. the question is whether or not this is consistent, compatible with ethic or would one still

need to use two different ehr's to be able to get a complete record? >> the plan is that we will bring behavioral health services onto epic-i'm not sure if it's not. we're currently in early wave two. we had our anniversary-i'm not sure exactly what you are referring to. we will not have any interim new electronic health record for behavioral health. we'll continue to use avatar.

>> i guess perhaps i'm miss reading the item. it seems behavioral health services electronic health record is here. perhaps we can d do this of line in terms of trying to clarify that. >> sure. that sounds great. i'll look to see what you are referring to and get back to you on a more comprehensive answer. >> and congratulations on one year. we're looking forward to many more things with our present pandemic. >> and i have to say, it has been, i think a lot of us have been feeling so grateful that we have epic and that we passed the immediate post school live

period before the pandemic hit and had to put it to the test. we have really benefited from being able to use epic to coordinate care and access testing results. it's been such an important tool in our covid response. >> great. thank you. >> we'll move onto item four which is the covid 19 update. >> thank you commissioners. here to provide you with a covid 19 update. have some data to present updated information and i believe some time for discussion.

you see the deeper curve on that right side of the graph. next slide. in terms of our testing. we have far exceeding our testing goals. our average is thirty one hundred eighteen tests. i will note that demand for testing has out stripped supply not within city and health department sites but we are far exceeding our testing goal. our positivity rate, our rolling seven day average you can see here running from april to early

august is currently nearly four percent and consistent with a high number of cases we're currently diagnosing. as the commission is aware, we have inequities within the pandemic particularly in the latin x community. we've been working with key stake holders to address the pan emipandemic in that community. we continue to do well on many aspects of our response compared to other jurisdictions. our case counts per one thousand is relatively low compared to other jurisdictions with respect to king county. a death rate low, a total of

sixty one deaths. rate of one every ten thousand. our testing is not meeting the full demand but is certainly a success compared with other jurisdictions. baltimore is the one jurisdiction that's close to our total. d c is somewhat higher at a rate of four point one three per one thousand. next slide. this is our rate of hospitalizations and the commission recall that we are in a surge scenario. you can see that in april we peaked at a tole of ninet totale hospitalizations. it declined in mid june to

twenty six hospitalizations sm that number saidly cloimed in s. you can see the light blue lines represent the medical surgical beds. a slight decline over the last few days. we are watching these numbers very very carefully. because it takes about two weeks from someone's dates of infection to being hospitalizations, the hospitalization was about two weeks ago. a little bit of hopeful data

with regard to the declines you see there. watching it very carefully. next slide. our key health indicators, these were updated as of this morning. our hospitalization rate which exceeded the 20% was level four in red. just a week or so ago because of that decline and a negative three point six percent rate. we remained at good capacity. it's twenty three percent and twenty seven percent for medical and icu beds. the testing numbers that i described earlier, their one hundred and eighteen. our contract tracing had fallen behind.

this is due to a number of fact yores including the increase in keasecases and delay in test re. locally and nationally the labs have not been able to keep up with the testing numbers. we've currently experienced delays of seven to ten days as lab corp. and other commercial labs are waiting as long as two weekweeks. city test sf to get results turned around more quickly. our public health lab is catching back up. we expect returned results

within 72 hours. with regard to our personal protective equipment we're at 8l protective equipment has a thirty day supply in the city. this is our r reproductive rate. these are estimates through about august 1. you remember reproductive rate over the line is more than one person i is infected.

we really need that reproductive rate less than one. the veer us had a reproductive rate of eight point five. you see that increase in estimates starting around june 15th. we went above one and went to about as high as one point three. this created a situation where we paused our reopening and took aggressive actions with regard to education around prevention activities that were needed to tract the reproductive rate down. we see some hopeful signs that

reproductive rate is tbing down again. it's wu one point five. this is still a high number. we're concerned that we're still above one with the reproductive rate. if there's no change in the reproductive rate even at one point one five we would estimate that peak hospitalizations would be three hundred seventy with three hundred ninety deaths in 2020. that is marked by the follow-up blue line going from the august fall through the end of year.

more vair eations in the reproduckive number can cause a difference in estimates in the fought you're. the plausible number that can be in the hospital which is neen tean hundred on ct 30th, 440 deaths. these are models and estimates. this is all about probablity. the shading of leans represents the probability of zero to 95%.

certainly we have a window of opportunity as we hope fle can ten to drive this reproductive rate down dramatically. if we're able to reduce by 30%, you can see a dramatic shif in our future. an update on our testing approaches going forward. we have set up across the city and this is not just e ph but across the city there's a total

of 29 testing sites throughout the city that has performed nearly a quarter of a million tests. we have achieved more testing access than any other surrounding county. we early on tested surrounding city sites and exceeded our testing goals. we expanded our access to anybody who requests to test. we have had to set priorities to challenges we have had locally and state wide and nationwide in regard to steadily supply of testing and unified testing strategy for the nation. we have prioritized san franciscans testing with

symptoms of covi covid 19, foret line disaster service workers. this is a slide that marks our relative success in addressing concerns about spread of covid 19 in our skill nursing facilities sm these arfacilitie? these are data-it's a little hard to read. the numbers of infected health care workers are shown in the blue line. infected residents with the orange line. hospitalled patients shown in the gray line. deaths in skilled nursing

facilities across the city has been relatively low compared to other testing facilities across the state and nation. this is due to the fact that we have a scaled up testing in these facilities. we are testing all patients and all staff every two weeks. this takes about three hundred tests a day. we have issued orders requiring other nursing facilities to do the same. obviously it's not just about testing. i've said repeatedly we're not going to test our way out of this pandemic. other resolutions have to do with good infection control, mask wearing and good hygiene. you'll see he on the far right an uptick in positivity rates

among the health care workers and that is certainly consistent with more community spread both in san francisco in the region. we inspect to see this as there's more community spread and that would obviously effect the people working at these facilities sm we also continue to focus on testing with regard to out breaks and residential care facilities, shelters, and sros. and being aggressive with our testing in the jail. in collaboration with our dph data teams is with u c sf. we continue to file the data with regard to our testing priorities. these maps of importance.

the green and orange map is prevalence of diagnosed covid 19 cases. you can see the darker orange census tracks represent where there's a higher prifl ens of covid 1prevalence ofcovid 19 in. the lighter green or some color between orange awnd green tha ai don't know the name of, those are the wider census tracks. the second map shows where testing is available in the city. there's a mismatch where testing is available and where covid 19 is being diagnosed. this is not just dph or city test sites this is health care

providers across the city providing covid 19 testing. you can see the testing rate per capita is hardly surprising that people are getting tested in the neighborhoods where there is testing availability. there's a pretty clear match there. our testing strategy going forward will be an adaptive testing strategy that will focus on where cases are being diagnosed and scaling up where those are census tracks. our new testing goal is five thousand tests a day by early september of twep 2020. pushing ourselves beyond that thirty five hundred to five thousand. really focusing on our

neighborhood strategy and concentrating neighborhoods most impacted. i would remind the commission that because of our health clinics across the city we impleimplemented multiple test s early on in the pandemic including south east health center and also in the parking lot of zuckerberg general hospital where the research building is supposed to go in the future. we did extend testing availability in those neighborhoods. we are also looking to expand capacity and speed of lab process to shorten turn around times. we're looking to ensure that private providers do their part. i'll show you data in response

stto that. we have more cases so they can manage up to two hundred cases a day. we're incorporating emergency technology into our time line for expanding testing. >> i don't have the private providers data. >> i'll provide the commission-with regard to the private providers and working with them to do their part. many of our larger health care systems. actually, if you could pre vied thaprovidethat slide so the comn see the relative number of tests that other health care sif ems s

have done. while waiting to bring the data up, i'll remind the commission that our health officer issued a health order two weeks ago that requires health care providers to test certain people who are at high risk for covid 19 within the 48 hour period of presenting to the system. this is data with regard to other health care providers and their contribution to covid 19 testing. just to say that our city supported systems and health department system has done a total of-relatively smaller contributions of certain key private providers in the city, seven point six percent, four point six percent, some of our

larger health care systems. i would iterate that these systems have been incredible partners during the pandemic. they are very committed to working with us and other key stake holders to ensure more testing is available for their patients and staff. with regard to our neighborhood strategy, the mayor announced also just last week, i believe, that we'll be expanding our testing options for people. we'll be working to scale up two new mobile test sites that will be able to go to various parts of the city. especially where covid 19 is highly preflen. highly prevalent. those are on the dprownd now as

wground now aswe speak. there will be a permanent site, we're working to select a permanent site in the southeastern part of the city which will have an additional ability to test five hundred people a day and be in addition to the city test sf sites which now have the ability to test approximately two thousand people a day, fifteen hundred at the site. i would also emphasize that in addition to the testing that we are ensure thag right now we all need to behave as though we're carrying covid 19. which is why we advise not to use a test as a way to indicate.

you need to use a facial mask and good hygiene. that's key to flatten the curve and key to getting that reproductive rate closer and hopefully below one. that's all i have for the commissioners and i will stand by to answer any questions. >> i'm not seeing any public comment. if you wish to make public comment press star three. seeing no public comment, commissioners. you can continue with your comments. >> i do have a comment and a question. going back to the long term hospitalization projection slide with regard to the reproduction number, i want to under score that if you're looking at the

four months since the beginning of the pandemic. we've suffered the loss of 61 lives. looking forward to november first, that number if we follow the median at the same reproduction number could be six and a half behind that. i know the mayor has spoken out about that and frustration with not wearing masks. this should say more than anything about lowering those numbers. we have six and a half times as many deaths in the next four months as we have had in the last four months. i hope everybody is taking that to heart. in regard to the testing priorities, i know we're looking at the prevalence in the latin x

community a lot of that has to do with members being essential workers working at grocery stores or other areas where people need to access services or the functions of daily life and also often times the latin x community has much higher rates than people who do private work. >> if people are essential workers, they can't get tests at city test sf. we've been working very hard with the latino task force on covid 19. establishing pop up testing availability for people, for

instance at the hub in the mission. we take-we don't turn anybody away for testing. that low barrier access to testing is really pivotal to our work. as people do test positive, we ensure there are ku culturally appropriate case investigations. half have been in spanish ensuring social services are made available including food and other wrap around services. if people are not able to isolate in quarantine, we offer free of charge hotel rooms where people can isolate in quarantine. there's a very robust package offered to people who do test positive. our goal is to continue and

expand testing and no one is turned away in communities that show high prevalence. we'll provide testing to anybody who requests it on that day if there is capacity available for testing. >> thank you. next queue, commissioner green. i ask that other commissioners and participants on the phone, please mute your microphone. >> thank you for this. it's very rich information and very much appreciated. along the line of testing health care workers. man dating the other health care

systems and expand testing. i was wondering if you could ewill be rate a little more on not only the mandated across the board. (please stand by)

you and hdiscussed. they provide people to test people with symptoms and close contacts to find if someone who is in contact with someone who is in dying know of for 15 minutes and more and those would be tested within the 48 hour window period. 48 hour period of asking for a test as well as anybody else and

we are working with kaiser and starting conversations with other healthcare systems to better assist them where they can get expanding testing. they are under limitations as they are across the state and nation with regard to supplies and and additional technology that we could potentially use partner to use i don't know together is the right word and in terms of expanding rapid testing and using homes and so those home test kits there's not an actual test you can do at home but you can do a simple collection and accepted it in. those have relatively a short turn on times and we are whether

you can pool samples and test it's a more owe efficient way if you have prevalences of covid-19 in the institution or circumstances in what you are testing. so we're looking at working with all of them with regard to those techniques. in terms of testing healthcare workers. and really towards a consistent approach to this but we haven't reached that yet. that is certainly something that we would like them to do. we have limited capacity to enforce that. is my understanding. >> thank you. and in extension of what you were paying about home testing,

can you elaborate that what the potential is and when, as you look or not and the potential anticipated numbers that the commissioner was talking about and if that and it's an option. >> i appreciate the question commissioner. rather than my speculated on that it would probably be ok if we have some of the technology experts on test coming to the commission and consent what the horizon looks like. we have people working at covid commands including a testing so we can bring them to

commissioner to answer more specifics of the question that you are asking. >> thank you, development. very. >> yes, thank you. i was curious about who things and i appreciate the data on the swift institutions and it appears that i guess all smiths are following the same guidelines that laguna is. if i recall we were going to suggest and i have not seen the guidelines themselves but if they're following that it looks like one of the reasons i think that smith beds that we have in san francisco. so i appreciate that and i also

appreciate there are people who are really anxious to really do see their loved ones but i think with the surge going on right now it's really difficult to try to bring more people into an institution which seems to have been because of the community spared right now and we're really in danger of very vulnerable populations, i understand that. i want to go to test forgeron aa moment. your data shows that we are trying hard after that one incident that edmonton early in terms of strat guards which is frightening by itself. in testing, i thought it could be helpful to us in terms of looking at how you are doing in the testing of certain areas

because while you have tests sites it doesn't mean all the test sites are doing all the cases and also, i do note that apparently in the 29 sites, i'm not sure if those also include some of your other temporary sites because, i thought we were doing a lot more testing already in the mission and the bayview but it doesn't look like that from your test reports and i would think that it's to understand how many tests are being done continue a particular sensuous track or it would may be the better way to do it because there maybe several test sites within those census tracks so we can understand the numbers that are being done in the vulnerable areas. >> i appreciate that, commissioner. the purple map showed the

prevalence of testing per-capita by census track and you always said you are right the dots on the map, which showed the testing sites do not reflect the mobile sites so the pop up so if there's an outbreak where owe do a day of testing in a certain local cal that wouldn't be reflected in these testing maps. it's particularly with those resources we need to concentrate on the southeastern part of the city and go where the virus is and test as many people as possible particularly in those high prevalence census tracks and that what we will kobe with these new testing resources that the mayor announced just a couple of weeks ago. and then, i'm sorry, the other, with regard to the visiting at

the nursing homes, we are taking a look at our health order and our policy because five months into the pandemic, the social isolation that unfortunately has developed while we have been working to get people ways to connect we know it's not the same so we are looking at that and there's a teamworking on plows able, safer alternatives that could allow for more proximal interactions with skilled nursing home residents and their families. looking at things like outdoor visits and so fourth. i can't speculate beyond that right now but we're taking a hard look at that because the health consequences of we need to balance it by the risk of

what covid can do if and when it gets out of control in one of these facilities. >> thank you. i didn't appreciate your right-hand-purple map as much. i think we were to look at how well you were doing and increasing the testing we might see a progression of the number of test. this is darker because wore doing a great job and maybe that can match the prevalence. it could be helpful to understand how we are doing in terms of identifying and also i don't know this may be difficult, trying to understand how we have been. i had one more question was really related to contacts. is there any evidence by

delaying our information that is valuable after you've done a test, if it takes seven to 10 days, how many more people we have been impacted which could then drive even more -- well not more demand because that's the problem. a more urgent need to really get the supplies correct because while we've all talked about these delays, what has it meant which could then help us really push for own a better supply line? >> the delays are concerning. if you have a seven or even 10 or 14-day lag in getting your test results and the relative value for that person of getting a test result is diminishing as well as the close contacts of that person in terms of the

isolation there it snow because because of the contact trace asking challenging and the return diminish further because of that. so that's why we're focusing improving these turn around times at our dph site at city sf and working with providers across the city. these are issues of sings like free agents, right, and primers that are not available and sufficient supplies and this was the case in march, april, may, june, july, now august and it's -- we're doing everything we can do this work and i've explored homegrown copses around trying to come up with these supplies. how to process the specimens and it's really not efficient or feasible for us to do it because of the way the west works and

the cartridges and the materials need today perform those testings. we need a steady supply chain to get at the root cause of these terne around times from the larger labs. that's unfortunately not something that we have jurisdiction over and we have an ability to be flexible and move is to work with systems that are able to turn the test around and we're encouraging private providers to look to those systems. if you get a positive test result, it comes to the health department and we are the ones that are needing to reach out to do the case investigation and the longer it takes for the test

to come back it diminishes our ability to be reflective and the more risk there is to public-health. >> raise your hand if you have a question or comment for the director. if you do not see any currently unless someone would like to speak up. without any questions or comments, we can move on to the next item, general public comment. >> on the phone, dial star there. is it. >> i don't see any hands raised item 6 the dph proposed budget

and we have mr. wagner. give me 30 second to move you to presenter so you can share your screen, please. and we've got jenn on the phone. you are good to go with your screen.

>> mikaela, are you still on? >> yeah. at the top of your screen where it says display settings, do you see that? in webex. >> in powerpoint. do you have two screens sometimes?

>> let me text you a picture. everyone is going to be patient and we appreciate you working through this. >> i'd like to take the opportunity to think again for leading us through this new process. >> at the top of the screen when two monitors are active together it will show the full and

different features. so, i'm going to text it to you. >> i'm going to try this. i just unplugged my monitor so i'm working off the laptop. >> that's a good idea. >> nothing shows right now. >> of course. >> you can also send it to me and i can share it for you. >> and -- so, um, in the mayor's proposed budget, there is significant funding for three of our key priorities and to which

no surprise the response to covid-19 19 pandemic prior tieing racial equity and the allocation or resource and that is riel occasion of dollar from the city's and to initiatives and that are aimed at racial equity programs and mental health sf and the initiatives that the and it is meetings in june and i believe it's a last time we did this and it's an increase to our budget. is there quite a bit of uncertainty aren't budget and i will talk a little bit about that but, all of this good news is depending on assumptions and those include the assumption

that we have some sense of what is going to occur with covid-19 which is questionable. there are a lot of things that can change there. and it is assuming that there's going to be a voter-approval of a business tax reform measures on the november ballet that would free up dollars for mental health underlining the mental health sf initiatives. and, it's also assuming other federal revenues and labor contracts that have not been achieved so there's a lot of good news in this budget for us and i think over all, we're in a better place than i certainly expected that we would be but there's a lot of uncertainty and i think that this is going to be a situation where we'll real

evaluating the budget over the course of the year given the fluidity of the situation. so, this slide is a snapshot of the highest level change in the budget you can see in fiscal year 19 and 20, our total budget the year that we just passed was $2.4 billion. in the mayor's proposed budget that goes to 2.77, and 2.58 so it's an increase of $344 million in the first year of the two-year budget and 149 in the second year. down below you can see some of the big items are that make up that change. and i'll go through each of these in a little bit more detail.

obviously the covid-19 response is the largest-moving piece in our budget and a number of other city department's budgets the racial equity initiatives is $36 million and funding in our budget and the behavior health is 113 million in the first year and 108 in the second year of new pro appreciations and it's not available to us and i'll talk a little bit about more about the nuances to that and those are the big moving categories in our budget. first a little bit more detail on the covid-19 the entire city wide budget is $446 million for the covid response.

205 of that is within d.p.h. and we're the single largest department in the covid-19 response but they're big programs that are outside of d.p.h. and the two biggest of those are the hotel leasing and operational costs born by the human services agency and the leases for the shelter in place hotels and the this gives you in the dpr portion of the this program so you can see on the left row labels are categorizing where the expenses are in the budget. the first numerical column is

the total effort so you can see we've got a budget of about $299 million worth of total effort so a very major effort is expected to continue and expand over the coming year. the second new measure i canal e intend to satisfy by repurchasing existing resources so the majority of that is disaster service work source it's taking an existing department worker and repurchasing their job for a new lead under covid-19. they're also some contracts in that category and that leafs us with a gap about $205 million that is required to english pendture and it will be a new experience. back for the department of

public-health and the city wide covid budget we're making some assumptions and these are out of the controllers office and some assumptions about what we will be able toll draw for reimbursement for this program through fema and through the federal legislation that has been passed so far to help with reimbursement for expenses related to covid. you can see on the cot um of the right, how much is leftover after we assumed the seem a reimbursement and i'll show you the cares act on the next page but it's a large program. couple of the biggest categories, as you can see, looking at that first new mer i canainumerous numericalcontract.

our contact traceing and case investigation programs and testing as you have just been discussioning will be a and we also have hospital surgery, support for the hotels and support for our outbreak programs and all of those and grouping categories. so, that is a very high level description of what is in our budget and we're happy to talk in more detail about that or take questions on it. i will say that we have been very intentional both dph and city wide as we developed this

budget in acknowledge interesting are unknowns and we have to be adaptable to to what the world brings us over the course of the year. so this will have controls around it and we're continue to go put those in place but we will, within those parameters have a lot of flexible to move dollars around to respond to changing circumstances in a way that we don't in our normal city budget with our normal city financial rules and constraints. next slide, so this is going up to the city wide level. this is the city wide covid-19 budget. you can see at the bottom of the page the grand total is

$446 million. again, the reason for that sue can see that so many of the dph costs are in the big-line items in this sheet as well testing ppe and operating supports and we have large dollar and the good thanks and programs and pit stops and they are the hand washing and hygiene stations throughout the city and all of that together adds up to $446 million and when you subtract the fema and cares act funding you can see the net general fund bottom line for the city is about $93 million. i'll just lately say on this, we have flexibility and there's an

understanding that we're making some assumptions about developing this budget. we've come at this from a perspective of you've seen a lot of the modeling that's been done and command center where we're taking up a more pessimistic than median approach but acknowledging that we're not going to be able toll plan in the budget for every scenario so we made some assumptions here and i think there's a collective understanding that we got this wrong and the coroner's office is hold something reserves against the need for a surge and we're already obviously starting to see some of that surge happening even sooner so i think this will be changing and

evolving for the course of the year. so next big category, on racial equity and resources. city wide, the mayor's budget redistricts $120 million over two years and from the public safety department. so primarily the police department and sheriff's department and that funding has been allocated into multiple departments with the idea that that those dollars will be repurposed to programs that are being district today repair the legacy of racially disproportionate policies on health, housing and economic outcomes for african americans. leading up to the budget, the human rights direction at the direction of the mayor has been taking a leadership role in this process and has been doing a lot

of community process gathering input and talking to various folks within the community and to get input on what are the best uses of these funds, what are people seeing as a need that can be met with these funds. one the big categories that came up was health and behavioral health in particular. because of that, the mayor's budget of that $120 million, 72 million of it is allocated to dph so $36 million a year. right now it's still at that relatively high level, there's not a granular program for how this $36 million is to be spent and that is intentional. the next steps are the human rights commission and it's going to continue to lead a process after that commercial round of

input and to make decisions and we will be closely involved in that and it's a community-driven process to make decisions about specific allocations and so there's more to come but this is really aligned with a lot of what the health commission and the department had been focused on in terms of racial equity and its a big step for the city, really trying to make tangible changes in a short timeline where we can have some effect on our racial equity. next up is mental health sf. so, could the commissioners know that this was legislation that

we worked on and the mayor breed led on and ultimately came to ar ordinance board by the board of supervisors last year and it's a big visionary program and total estimated cost is $100 million or more per year to implement and we're not going to have $100 million or more but in this budget is funding for us to take big steps into the first phases of implementing that visionary program. the budget does make the assumption that they will approve a business tax reform ballot measure and it's on the ballot in november and what that measure will do, if approved by voters, is you will recall in june of 2018, voters passed proposition c a business tax measure for homelessness and behavioral healing health and ts

held up due to a lawsuit in the courts and is being litigated in the courts. it will free up a significant portion of those dollars regardless of the outcome of the legal back and fourth. and make it available to dph and the department of homelessness and support of housing to begin spending those dollars. so there are two categories. the first is, the on going revenue from that business tax measure. that would be $28.1 million in fiscal year 2021. $38.4 million on going and that is kind of the core basis where we have used to design the programs that is in the budget. in addition that, there are one-time funds and those total

about $115 million and it's been collect today date that's been held under litigation that would be released and because that is kind of retroactive one-time funding and because there's still quite a bit of legal processed to play out, those funds are going to be held really strictly and they may be used in some circumstances for one-time uses and there are a lot of restrictions around those so those are appropriated in dph's budget but we will to go through the process with the controller's office before we program them for specific use and they may be available to be available for capital spacek what decision and other costs

associated with the program. in the mental health sf program, there are four core pieces to the program that assumed in the budget. the first is establishing the office of coordinated care and this is a piece of the mental health sf budget and the past and this is in some ways it's really the core of the vision for the mental health sf program and this would be the new function where we've heard, in many cases, we have a lot, we have a strong system but it's not use working together in a way that is client-centered it can be hard to navigate and the pieces 2003 have the infrastructure to make sure the pieces of the system are alike. so the office of coordinated care will create that infrastructure to do coordination data analysis,

planning for our case management and care coordination functions and really the glue that holds the system together. the behavioral investments. you know from previous hearings we have, under the work of dr. bland, and his team, been doing analysis of our behavioral health med supply and demand and trying to make determinations about the gaps in the system that are really creating a do theel neck odobottleneck. that work has been completed and identified a number of needs and they include lock beds, residential mental health beds,

site beds and the last category and we're going to assume that we will meet those recommendations and it will be a process as we go in through future budgets. this is a new street-based team that would be in partnership with the fire department's ems6 group and dph where we would have clinical staff that would be out on the streets responding to calls for 311, 9-1-1, other courses and this would be a way to have more appropriate response where we can send out people with medical and clinical experience and knowledge to respond to these calls today which are by police due to availability of resources so this is a big improvement in our

ability to be responsive in a appropriate way and get people linked into the system of care. and then lastly, as i mental health service center, another piece of the legislative vision would be a physician site and have access for people to come in and engage with services. there would be a pharmacy on site so out of these opportunities to connect people who need services to the system of care could occur at that site. they would be expanded hours and services on site. in addition to the legislation tied to the business reform tax there's quite a bit of general fund included for behavioral health and a lot of this is tied

to programs that are already on the way but need to be funded to continue and for our emerging increases that we're adding up and i woke up to all of these in details but you can see a lot of things we've done over the past couple of years, which we're adding treatment beds and doing expansions with grant money. the mayor's budget is providing general fund to continue the funding for those services so we'll be able to maintain and pod fie that capacity as we think of a best concern of the clients. also, we have $5 million for a creation of a psychiatrist class. this is one of the things the city has done to address the

issue of difficulty and recrewment and retention of psychiatrists in our system of care this was done with the department of human services and our labor partners to really take a deep look at our competitiveness in terms of our compensation and make us more competitive. this is to emphasize a lot of good news in this budget and a lot of opportunity and a lot of uncertainty and they are what is going to happen with the covid-19 pandemic, i don't need to spell that out for the commissioners. a lot of things could change including federal response. we have the budget continuing on

border approval of the business tax in november and the other city wide assumptions including wage increases. i will lastly note we talked last week about the fact the mayor's office and the asking us to be prepared with a potential adjustment should they be needed if the city cannot come to agreement on its labor union partners on modifications of the of of the contract. there are wage increases scheduled to be in effect over the next two years of the budget and to have asked the labor partners to host home and delay the wage increases but it has not crept yet.

it's a very high level look at if we were asked to meet those additional targets what would that mean in terms of kind of the the scope of solutions we see would look at that and it would change the equation for our budget and we would go back to do some additional thinking at that the is case. so, very last august 14th, next week we start our hearings at the board's budget committee and then we expect budget will pass out of the board in august and full board approval in september in the mayor's signature in late september and early october. so, it's a lot of talking. i'm happy to take questions.

>> i see that one person has raised their hand if you would like to make public comment. please, press star 3 and i will recognize you by unmuting you. we have one person so give me one second to get this going many of. >> my name is francisco decosta and i've been paying attention to this subject not only today but it has come up before the different committees of the board. what i see missing is that we haven't filled some positions. leadership positions. and yet we talk in general tees so if you haven't filled the

leadership in behavioral management we cannot talk in generalities, the other thing is that, somehow we are not really having dialogue with the community at large. the well-educated, stellar, citizens of san francisco. we have a budget of over $2 billion and fundamentally, whatever programs we have we have to have rep around services. so, when we lack empathy and compassion, and we are not going

to have results so right now all over san francisco, we have thousands of people slowly dying. but the most important thing i want to say today is, we cannot allow our infants, our children, and our youth, our elders, those are compromised health, more mentally and physically challenges to slowly die. >> your time is up, sir. i'm going to move onto the next call. thank you. >> i'm trying to make sure everyone as a chance. star 3 if you would like to make a comment. you can condition your discussion. >> do you have any questions or comments for mr. wagner? >> if you do so, please raise

your hand. >> press the hand button. or just speak up as well. >> mine is only a comment to say that i am actually very appreciative of mr. wagner's presentation is -- as he began it is a farber picture in terms of trying to obtain resources to do the work if the department has to and the recognition on the part of the mayor and hopefully we'll be the board's recognition and it's important to be able to continue the work and we're not pitting covid against that and not for getting

the initiatives that the city has prioritized including mental health programs and programs for racial equity so i just wanted to compliment mr. wagner for actually taking that almost-sounding -- impossible sounding task and really being able to show thousand could be done obviously contingent upon many things including the voters in november and i think we recognize that. i just wonder, i guess it would be at the time there are significant changes during the i do a log you might want to bring that back just to keep us updated on what is happening with the bored. >> absolutely. we'll stay in close touch with

mark and at this time of the year, we often have at least a brief check in on each health commission agenda. until the budget is complete. so we'll certainly keep in touch as things move and change its course. >> thank you. >> we have a commissioner. >> thank you, excellent presentation. i submitted a question earlier through a comment. in my concern to the public safety funds that will be coming to us and in focusing on behavior health with a racial equity lens that we are cognizant of the fact that with the community input, et cetera,

that we really look at youth and elementary and middle and high school since my concern is this group is often not totally focused on it until the kids are in trouble. so, i'm hoping we can look at formulating some prevention strategies within these dollars and within the areas that i think could be very, very helpful. >> thank you, commissioner. i received your questions and i meant to touch on it and i also do know if dr. hammer or anyone from behavioral health wants to chime in on that comment and that element of the work.

>> i think it's a great question and it's a lot of receptive teeo that idea to go in that direction. we have, as probably know, a number of early intervention programs for school based and some community-based organizations and there's a lot of interest in using some of this redistricted money focused on health equity and reducing health disparities and to this early intervention work and they are acting direct to be of behavioral health services wasn't able to be on the call but she has expressed to me lots of interest in this sort of work

and in really with community input figuring out which of our intervention programs are really having an impact and we have a good program at the bayview and working with dcyf and identifying where we can really focus on this work o so it has the biggest and we'll definitely be working on this. >> next also, well, we'll make sure that we do some thinking as we understand what this process is to make sure that we're communicating what all the commissioners and bringing you in on that process as it happens. >> commissioner. >> thank you, very much, i

appreciate it. >> any other questions or comments? >> >> i want that thank greg and his team for the work. this is the been an unprecedented year in many ways including on the budget. you saw the multiple opportunities and also challenges the budget presented on any sort of normal year any one of those would have been a challenge and talk about having many balls in the air and a tight deadline and i want to thank craig and their team for doing such a remarkable job and coordinating with the mayor's office, the controller on all of this, it was a effort but this one was for the record books so thank you the team for the work. >> thank you.

>> you beat me to it. in addition to the work that goes into putting together the budget every year to have to scrap the whole process and start over again in the midst of a pandemic, greg, for you and your team, for jenny louie, thank you dr. hammer, i know that dr. bland had a lot to do with the mental health aspects of this as well. so to your entire team thank you for your hard work and we look forward of track particular to the process. >> thank you and i will pass it onto the team that has really worked hard on this. so thank you. >> thank you. >> item 7 is the monthly contracts report. and we have folks inform present furniture across the city. >> next commissioner. >> good afternoon. this is michelle rugel.

sorry i don't have all of a camera. and so i'm going to go through the report and we have other staff, i believe, on to line your questions and do my best ok. the first contract my hospice. this is an ongoing contract and we are here today to ask for approval of an amendment and which will be to extend the contract terms by throw years for a total of $6.6 million. i mean 6.6 year term and then we have increased the contract amount with con ten again see so it's the full amount of the contract to and there's a

$71,200 increase which is the inclusion of one-time funding and this is a program that the san francisco residents living with hiv aids and the end of life hospice or 24 hours killed nursing care and the program has they have met their declarement. do you have any questions of this contract? >> it looks like not. please continue. >> ok. the second contract is asian and pacific islander wellness center doing business of san francisco

community health center and it's improvement of amendment that would extend the contract by 14 months picking it up to 10 years and that also has rised under the existing contract terms and this is on going and the target population is trans women and trans men, including transgender persons of color and joseph is on the phone and he worked hiv health services as the manager to talk about this contract and also to point out, as we bring these contracts back to you, and this one has been at the opened of a long-term, the terminology has been evolving with the contracts and so you received

one v. and we have the newer terminology and is joseph on the line? >> not joseph but john is. >> john, i'm sorry. yes. [laughter] >> hiv prevention. >> just contract is really an extension of a contract that has begun in 2010 and we had rfp on these services out last year and they were to begin or they should have already started by now but we had to put a hold on everything due to about what we're dealing with in terms of covid-19 so the original language at that time we were talking about men and women as female to male and male to

female and now that we realize it's no longer appropriate that really focuses on a procedure rather than the person and so similar to other types of language with people first-type language where we talk about people experiencing homelessness and rather than the homeless so it's really more oust respect to the individual that we've changed that language. we'll continue to do so. >> any questions on this contract? >> thank you. >> hi, thank you, john. the last contract on here is called the shanty project. this is on going services but we had to move it into a new

contract document to update because it was easier to move it into a new contract because the boiler plate has changed so significantly than to document all the changes so that is why it shows us the new contract. it's really the continuation of on going services. this is going to be, we're asking for approval for this contract and when this contract is over december 31st, 2021, then we would have -- this would have gone out to bid in a new contract will replace it. this is bridging the gap for that period. this contract provides services for and the and i lost my place. it provides services and support of the margi breast cancer program and then services and

and san francisco and the, i think the still on the phone. and she has patients and then i think and i'm just going to carry on if there are too many questions i can't answer, then t. we can either foal up or bring it back but it's an ongoing contract you've seen before and dr. chow raised a question or brought up a question and he was interested to know how much this is being used and what the volume of usage is so one question was specific to the mammogram. the manovan volume. i'll use 2018. they did 5,305 screens of --

barbra just e-mailed and 5,305 screens. 1,637 diagnostic -- i don't know what the rest of that word is. that is the whole thing. and then -- i'm sorry. i don't know what these -- if the table, let's see. the table says screens, 5,305, dog months tick 1,637 and the mamovan1190 so -- >> those are the numbers for that program and follow-up and then the director of the program

provided with the support services, which is a different grand, they had 384 clients had received care navigation, 78 had received survive oership navigan and support service ideas servie provided to clients as of july 1st, 2019. that's the update on the numbers. i don't know if that answers all your questions or if you have other questions that i can stumble through. >> commissioners, any questions or comments? >> there's public comment on this? >> my name is francisco decosta

and i've been involved with health issues for the last 40 years and i've especially been involved with the shanty program and and while i want to advise the commissioners is that over the last 25 years, it's been difficult to support our most vulnerable population in san francisco even though our budget is over $2 billion. so we need those in charge to think outside the box. and now this pandemic is going to challenge us. and san francisco and this is a where to think outside the box and do something.

so that the positivity we had to bring to the fold. we cannot allow people to die in the tents. we cannot allow the most vulnerable to die. if you do you can really read the laws that have been brought fourth by the united nations. thank you, very much. >> thank you for your comment. there's one more caller, commissioners. caller, welcome. you have two minutes. >> caller: hello. >> the caller disappeared. that's the last public comment for this item. this is an act item. >> it's a rewinder to my fellow

commissioners and the public given our abbreviated meeting schedule during the full commission is acting as opposed to the finance and planning committee and the public-health committee to we will be considering for action for a vote which normally would have gone through the finance for planning committee before coming to the full commission, however, both those committees that the mentioned, the public-health committee will resume meeting starting in september and we'll have that schedule available online for people so they chose to view. so, commissioners, do you have any questions or comments? >> see before we go to a vote. >> thank you, commissioner.

in the spirit recently passed resolutions, i also want to mention that you know, from what we know, in general, is that african american women tend to have their diagnosis more advanced stage you know like of breast cancer so i am very curious, you know, to know more about how a program like the

role is shanty's providing helps to fill some of those disparities so hopefully in the future, that we won able to invite them to come into the presentation. that's it. >> thank you, commissioner chung. any other comments or questions before we move to a vote? seeing none. mark, would you read the roll, please. >> we need a motion to approve. >> motion and a second. >> i'll move. >> i'll second. [ roll call vote ] >> thank you. next is a request for approval of a new two year contract with

brightbart health. >> also, marcus judy martin on the line. i'll just introduce it and turn it right over to judith martin who is the director of -- there she is. substance abuse services. so, just to introduce it this is brightheart health and it's upon your approval would be a new contract for dph under behave yearal health services in the amount of 232,960 which includes the contingency and that is a two 46 year contract and it's a sole source contract. this one is a sole source 21.5 which skates there isn't another provider similar to this and as dr. martin explains this you will see why this one is a little bit different than a few dialed up and looked in google

tele health, opportunities the same. i'm going to turn it over. >> thank you, michelle. i think this is an unusual contract because it's a vendor. it's a telehealth vendor and we started talking about it last august when director coal fax invited us to meet with dr. di vito from marin who had experience with this agency, with this vendor, telehealth vendor, brighthart health in helping with behavioral health services to extend the reach in marin county. we've been working on san francisco is a very compact county. we have seven methadone clinics and we have had since 2003

funded and now drug medi-cal covers it and medi-cal pays for it and it's a pharmacy benefit. many of our primary care programs and many of our regular out patients substance use programs and some of our residential programs all offer these services and yet, we have an overdose increase every year and so and so, where they provided medication at harm

reduction sites in other words, they're approaching people who do not perceived the need for treatment or do not feel they can access our treatment for whatever reason. if they have same day access at methadone clinics it's still there's some people who don't reach and of course, those are the people who are highest risk for overdose and so, if someone comes to the access center and picking up needles because they're planning to use heroine and how about morphine instead of heroine and evaluates them and sends them with a prescription to the pharmacy three blocks away. it's equipped to provide and observe dosing and do tox screens and has done this since

2003. they're very experienced clinicians in terms of providing medications as their treatment. we designed this use because they have started providing people morphine in response to the opioid epidemic and they're unusual because they have worked with this state to under the spokesmodel that the state used their state of i remember response funds and when they first got them and they have been a hub and spoke to one of our san francisco clinics and they also provide the health services to ucsf and since august, we've met with several and did surveys and met with several of our providers in the city of harm reduction and in particular glide and harm reduction therapy coalition and

syringe access san francisco aids foundation. we're interested in working with us and a lot of their services are located in the tenderloin which is one of the most highly impacted areas for overdose deaths and so, we asked them to ask brightheart health to do demos and talk to the harm reduction providers just to be sure it was a cultural match that brightheart health clinicians who we'll play a talk with someone who was anxious to get out of there and couldn't stand in line and couldn't fill out forms and maybe didn't have current medical and really didn't, wasn't there for the highest purpose of treatment was there because they were using drugs. and yet it was something they were willing to talk about. so this kind of very low

threshold is what street medicine has been doing now for several years and it has been judged to be successful and so this is our way of expanding it. so, we didn't expect to start this in february and then in april and you know what happened. >> we brought it up because we thought it would help in the sick centers and the doctor wants to use it at the alternative care sites and expand hospital locations and step down from acute care for covid-19. so that's what this is about.

the structure of it is that bright heart health would provide tablets that are key to them and in other words, they wouldn't be used for playing games or being on the internet, it would click open to their clinic there would put them in a waiting room until the doctor is ready and in the case, they would be interviewed immediately by a nurse and they would take down a lot of the information that is needed to make a decision about treatment. even if the physician wasn't ready right away the person wouldn't have to wait and this is a response to testing they've done in other sites and in

california. they designed a whole model and had a whole program for low threshold. that is what we're proposeing and we're looking forward to having it. >> i apologize for jumping in. no, you are not. >> my questions or comments? >> again, just stating one more time that it's the financial and planning committee and will be taking action on this item today. commissioner chow. >> yes, there was only thank you dr. martin for explaining how this works but then how does the recipient not and the tele health get the medicine? >> so there's several ways that that can happen. this is partly because this

organization has response that can cover the medication. so, if the behavioral health pharmacy is open and has hours and near walking distance, which typically would be true for those organizations, then the person would be advised to go to the behavior health pharmacy and to get their medications and including motivational interviewing techniques and so on and so we would be able to decide and talk to a person about how long and help the clinician decide if they need it was a street medicine program the pharmacy had found is many

people didn't come in for a month after the prescription had been given and so it was stale and needed to be reassumed or refilled or reinitiated and the person sometimes came in in a different state of health and looked like they needed to be evaluated so the pharmacy in this case will have a tablet to talk to the heart great people and they can evaluate people on site at 1380 howard. >> they could call in a prescription and raise funds for it to be billion dollar to the grand they have at bright heart

health. we'll see how many people go to wall greens and how many people go to behavioral health pharmacy. >> i asked, you led up with a various program that you had pointed out they would have to go to the pharmacy so i was thinking maybe you actually had a way on site and that avoids them going two or throw blocks or over to wall greens but it's not true. you still have to go off site in order to get the medicine. >> yeah, there's no way that we can figure out the dea would allow us to have a scheduled narcotic and there's no safe storage for medications. >> ok. because in they were trying to

get a clinician to match without giving the drug, right, at the same time. and i guess that just isn't possible from what you are saying. >> so, the program say methadone clinic. they can dispense at the window so they're a mini pharmacy for specific medications for methadone clinics. is that what you were referring to? >> that's what i was thinking if you were doing this, one of the barriers after the consultation district said whether it's live or way way of the tablet is getting them to the next step and by these are difficult and

it's just another one of those, right, when you get and you convinced them and it's just better or perhaps even more effective to be able to say and here it is. >> the only time it would happen for this effort is and that is why we have office space and they have been there and we snuck out so these are even lower threshold in the office space induction clinic and at hu

looked at the experience and you were placed at an uptick that was worth doing this and in order, half the patients moved on and did get the medication or acceptance or higher and in carrying telemedicine for this type of a visits. >> these are some of the things we're going to follow. the street medicine effort was studied and they found that they had treated about 400 people when it was studied and 140 of them were remaining in care in some forms. that's pretty high. >> yes. very good. i hope our results will be just

add good. it sounds like a good program to try. thank you. >> commissioner green. >> yes, well, thank you for your presentation and it's row marketable to recognize the potential of tele health in this area and i wonder if you would comment on a few things, there's a amazing article foray dex treatment and i don't know if you saw it but one of the pointed it made was entry into a program does not require an inperson visit as the first encounter and you can also give pain for a month rather than a week. so there are things i would really love to know your vision. one is, do you that i that we have better entry points, this is one of the points in the entry barriers we talk about in what we're doing and do you

think that would lower a significant number beyond what we've just said about not having to be this person and this first go around and whether the ability to read the pharmacy is a big barrier when someone is in the program and also, they talk about the program where they use their mobile them for purpose and wondering how you rethink that whole program and in relationship to what's really becoming i think a much more accessible type of treatment and how we plan on capitalizing on the changes that legislation promoting telehealth have come along as a result of covid-19. snail of all of a sudden our heavy regulations went rational

and so, counseling was banned and it was considered the height act with around inperson visit starting medication assisted treatment has a statement related to emergencies and so covid-19 was an emergency and allowed initial contact to be by telephone so a lot of the providers from primary care taking advantage of that and using telephone visits to provide medication and this is what happened at the containment center as well and people were

using opioids and prescribing it and then the containment nurses would pick it up and so, there have been a lot of creative things that happened with addressing that the opioid epidemic because the pandemic allowed people to declare it an emergency. that's one of the things we need to look at and maybe collect actual data about to see how much advocacy we should do to keep that going after the emergency isn't an emergency anymore. is that what you were asking? >> there was great potential here that you never had before. and you are way ahead to reach

people and to treat them. >> yes, thank you. i'm also very impressed with what otap493 has done in the parking lot. i don't know if you heard about that. they have decided to use fresh air as much as they can because to reduce the traffic through their clinic as a way of keeping people safe and methadone maintenance was a initial visit that was not required and so, they came up with very creative things that they already had methadone vance in the bayview and they moved a van into the parking lot outside of clinic and the csfg and moved a lot of their stable patients to go to the van. they didn't even have come in the clinic and there was a tents

which now i think they're using a container and one of those modified containers to be the councilor. they have ordered telephone booths with glass doors where they're installing tablets for video conferencing with their councillors so people who walk in can now have tele health which was not so possible. >> thank you dr. martin and commissioner green. commissioner chung. >> i'm sorry, you are muted, commissioner. i echo the innovation of this program. there are a few things i'm curious about also. one is you know, i'm assuming that these tele health

consultations done in soundproof rooms? >> the booths are described are soundproof. but the harm reduction though therapy is not soundproof but the clinics have chosen spaces where there's a small room where the person can go. they're trying to -- i mean, we're allowed, because of the emergency, we're allowed to use telephone and tele health and get verbal consent on the phone to explain that this might not be completely meet the standards of complete privacy because we're here on the street or in a

van but as much as possible, people will be they have a place for the nurse practitioner which is pretty private. >> thank you, i think they're clearly important because a couple of things that i could think about immediately is the privacy and also the stigma around being engage in this kind of behavioral health services and though like ownership treatment. so i think that you know, san francisco has always been very owe have a tive and as a and my

follow-up question, does bright heart also prescribe naloxone to these patients if they are -- do they need to ask for it? >> they have to the rules like the rest of us to do when you prescribe a ownership and i think it's unlikely they would have to do it because harm reduction sites are offering naloxone and in fact, that might be why the person was contacted and you need naloxone by the way would you like some. naloxone provision also happens at the pharmacies. the pharmacies so they'll be multiple chances for the person to get naloxone. >> and i'm really impressed and all this innovative searches that we're doing to lower the

barriers for access, you know, to this much needed services so, thank you so much. and i look forward to hearing what the outcomes are like. >> good, thank you. >> thank you, commissioner chung. commissioners, any other questions? >> thank you, dr. martin. thank you ms. ruggles. commissioner green used the word present. i would have to go with her the timing is fortuitous and this is, as you mentioned in your summary, preserved staff resources and limits the opportunity for exposure to covid and i'm hope be suggest cease for this program and it made be a model for the nation and providing these critical services in the future. and i support it. >> thank you, commissioner. >> thank you. >> since we have no other questions or comments from commissioners, do we have a motion to approve?

>> so moved. >> second. >> i will do roll call. [ roll call vote ] >> all right. move to the next item, commissioners. >> item 9 is the sfz medical staff by-laws and medical staff rules and regulations and just to note the zsfg joins the recommended approval of this document at its meeting last week after a thorough discussion and review. >> thank you, mark. lisa is here to present. >> you are muted.

>> thank you. thank you for the opportunity to present the bylaws and rules and regulations today. i believe a written copy was submitted that includes the major changes and as was mentioned, we did have a in-depth and at the jcc on jul july 28th, and people might have questions about any of the changes or updates. >> public comment on this item, commissioners. >> commissioners, do we have any questions? >> i would really like to know

the chair of the zsfg on i don't know conference that within that discussion we did say that there were still considerations they're not going to await just another one or two year they hae discussion and recommended that the commission accepted it at this point and met be back and i'm absolutely correct. >> thank you, commissioner chow. >> public comment. >> thank you. any other questions from commissioners or comments?

>> seeing none. we can entertain a motion to approve. >> move to approve. >> second. >> all right, roll call vote. [ roll call vote vote ] >> thank you dr. winston. >> thank you dr. winston. item 10 is the 2006 public-health and safety bond update and we've got mark mark o and harry salas. >> can you see us? >> yes, we k. >> ok. >> good afternoon,

commissioners, dr. cofax and my name is mark and advise tore the director's office. we'll not go through every slide in the interest of time but i don't want to say as of a couple of hours ago, the city and the negotiation team just agreed to all the terms and conditions and closed escrow which means we can sign on wednesday or thursday for 99 years and ensure that the research building gets built. i want to thank the city team and the real estate department and city attorney's office and the ucsf side and their legal council office of the president and then the real estate chain as well. this is .2012 and the second

flor in city hall as a discussion and exploration of whether it can be done and it took a while to get this point. the exciting thing the is the building can serve when i'm in august and then moving in the first or second quarter of 2023. um, in this program of the 2006, we are gearing up to be the last sale of 174 million sometime this november and that will complete the entire funding that is in the 2016 bond. i will just go to slide six which is a little bit more detailed view of the zuckerberg piece which is 222 million. if you noticed, we've added a

second column across to the right from the budgeted and it's called other funds sources and although, we have not identified any particular sums right now because we're working closely with the general foundation and capital campaign is underway and we'll start it as soon as we start seeing commitments come in and supplement with the bond funding and then the other column is pretty much what you are seeing before except now we track the actual money that is spent and in one column and we look at what is inkum berdych for various reasons. we want to make sure we're spending actual spending money at a pace that the controllers office and we want to see and in

slide seven, it's identical slide that you saw previously and the other funding sources here we start to see supplemental funding sources that will come and sustain and the mayor's office and at the state level and now we start incorporating that into various categories whether construction or project control and we're taking advantage of other funding sources and not just the sorry obligation model and then the next slide, we'll jump to slide 18 because i want to show you what we've identified as optical funding services and so it's from a to i and these are things that we know now and it doesn't mean that this will be the complete list and these are some of the targets that i'll go

to slide 15 and i'll turn it over the director for zuckerberg office. this is what we've been doing accepting document and get the design and team and ready to go on the roadway and as i said, we'll close on wednesday or thursday and they'll start construction and that roadway south and of the hospital in august and a couple of years later they get them into first and second quarter of 2023. at this time, i'm going to turn it over to jerry and.

>> our contractor has been awarded with eight projects under the belt and so we passed this this proposal and issued it to builders and right now they're in a phase when they're reviewing the packages for awards to the trade and hopefully it will be starting construction in early 20-21 on those projects. for projects we have going on, we have our seismic retro fit phase 1 which is completed.

that did a lot of work to strengthen the building as far as the stoke which was the south side of the building we the fiber wrap and we had concrete columns to strengthen them and also did some strategic to reach the structure and the next activity that the panel will be doing will be validating the sequencing and instruct ability of the proposed work completes too. our 6h office search space is 90% complete and they should be completed by the end of the year in 2020. first, open office work plan that is kind of a wrong time to come out with an open office

work plan because it will open area and so we're addressing the social distancing issues in this plan by changing some of the higher transitions and afford more social distancing so it's interesting to see how it will come out. we have a project coming along and construction continues and walls are in place and we have multiple issues on the project and covid-19 is one of the impacts with resources and actually permanent delays and we're looking forward to the construction to continue and with a completion in 2020. a family health center has been designed and and we're looking

forward 100% normal reestimate the project and do some reconciliation and our specialty project out of the relocated building 5 is in a design phase and it's completed 100% we've done the programming and we've got issued 100% snag design and it's reestimated and we'll be doing some budget wreck salati n and to the inventory chair bold

for health centers and the health center and and the improvements happening there and the structural permits are actually this month and the mission health center receives plan approval back in 2019 and the instructions are supposed to start by the end of the year. we were able to secure a has ar mitigation grant to support this project as well. and then the south east health center project approval and plan

approval and construction contract was awarded and it started and right now they're doing site work and site gradi grading. that completes the 8-12 as far as had are impacts with all the projects and those surrounded are they involve the supply chain and contractors interpretation of the health orders and clarifications basically communication and we seen the impacts to labor and we're contractors will not come to this price. project approvals are hard to get when some of the offers have shut down.

the amount of work happening from the homes so that proper design process is impacted because of the work from home. and then we also have campus restrictions which it hard to get around campus and then, it requires social distancing and there's an impact. we're basically evaluating these items and we'll be available for that at a later date and total impact on these covid related issues. that completes the accomplishments and the (inaudible). >> are there any questions that we can address? >> mark, do we have any public comment? >> we have public comment. >> commissioners, any questions? >> i would -- if it would be --

>> can i interrupt you. for anyone else who is not speaking please put it on mute. >> mark, you -- >> let's go. >> my question is really mostly on your timing. understanding all the issues that we're facing whether at the next quarterly report is what you are intent is in terms of telling us what your making these and what is a dollar consequence of the delays. terry has been modest. i have been dispatched over here

for to help out with various things of from the testing sites to the food activation and to the general foundation to help the doctors and the nurses who are working so hard with this chair and i have been able to

and we're finding out we need to do those and they're cost savings but some things are costing more and we should have all that analysis done for the next condition meeting and be for that. >> commissioner, any other questions? >> seeing none. that's the presentation. this is not an action item. >> thank you. >> commissioner, item 11 and other business. >> any other business from commissioners? >> seeing none. all right. item 12 is closed session.

>> do we have a motion to move into closed session? >> so moved. >> second. >> all right. i will take roll call vote. [ roll call vote ] can everyone who is not in the closed session leave the room. we thank you so much for your.

>> i just feel like this is what i was born to do when i was a little kid i would make up performances and daydream it was always performing and doing something i feel if i can't do that than i can't be e me. >> i just get excited and my nickname is x usher my mom calls me i stuck out like a sore thumb for sure hey everybody i'm susan kitten on the keys

from there, i working in vintage clothing and chris in the 30's and fosz and aesthetic. >> i think part of the what i did i could have put on my poa he focus on a lot of different musical eras. >> shirley temple is created as ahsha safai the nation with happens and light heartenness shirley temple my biggest influence i love david boo and el john and may i west coast their flamboyant and show people (singing) can't be unhappy as a dr. murase and it is so fun it is a joyful instrument i learned more about

music by playing the piano it was interesting the way i was brought up the youth taught me about music he picked up the a correspond that was so hard my first performing experience happened as 3-year-old an age i did executive services and also thanks to the lord and sank in youth groups people will be powering grave over their turk i'll be playing better and better back la i worked as places where men make more money than me i was in bands i was treated as other the next thing i know i'm in grants performing for a huge protection with a few of my friends berry elect and new berry elect and can be ray

was then and we kept getting invited back you are shows got better we made it to paris in 2005 a famous arc we ended up getting a months residencey other than an island and he came to our show and started writing a script based on our troop of 6 american burr elect performs in france we were woman of all this angels and shapes and sizes and it was very exciting to be part of the a few lettering elect scene at the time he here he was bay area born and breed braces and with glossaries all of a sudden walking 9 red carpet in i

walgreens pedestrian care. >> land for best director that was backpack in 2010 the french love this music i come back here and because of film was not released in the united states nobody gave a rats ass let's say the music and berry elect and performing doesn't pay very much i definitely feel into a huge depression especially, when it ended i didn't feel kemgd to france anymore he definitely didn't feel connected to the scene i almost feel like i have to beg for tips i hey i'm from the bay area and an artist you don't make a living it changed my represent tar to appeal and the folks that are

coming into the wars these days people are not listening they love the idea of having a live musician but don't really nurture it like having a potted plant if you don't warrant it it dizzy sort of feel like a potted plant (laughter) i'm going to give san francisco one more year i've been here since 1981 born and raised in the bay area i know that is not for me i'll keep on trying and if the struggle becomes too hard i'll have to move on i don't know where that will be but i love here so so much i used to dab he will in substances i don't do that i'm sober and part of the being is an and sober and happy to be able to play music

and perform and express myself if i make. >> few people happy of all ages i've gone my job so i have so stay is an i feel like the piano and music in general with my voice together i

>> if the moderator can open the phone line to public comment on the minutes of the june 30t june 30th special meeting. ok, we're opening phone line, madam chair. >> ok. it is sl