and then in the second year, i'm proposing a $7 million cut, but in reserve, so that we can be working all year to figure out how we're going to change the system. and so what i believe and tell me if i'm right, chief, is that in terms of lay dozeoffs, the fe we're looking at is 3.5 million. am i understanding this correctly, everyone. >> chair: right. >> probably about a dozen layoffs. >> chair: so i'm just going to say, i am not comfortable with layoffs. supervisor ronen, i so appreciate the conversation that we're having. i just am not comfortable with layoffs because i know -- >> i feel very mixed about it myself. >> chair: i'm sorry. i'm not. pair ai(please stand by).

>> maybe some of these positions won't be necessary. i do not support layoffs this year.

>> supervisor walton, how do you feel about supervisor ronen's proposal. >> we are hearing from supervisor yee and mandelman that they are opposed to layoffs but open to putting money in the second year on reserve. excuse me, you are on mute. >> i am definitely open to putting $7 million on reserve for the second year. again, it is hard for me at this point. not an impossibility without knowing the officers it is an issue now. >> what you are hearing there is an appetite to put money the second year on reserve, not for layoffs. chief, what you have heard now is that what we are saying is that we are thinking a

substantial amount of money on reserve the second year. this committee is opposed to the layoffs. if we put reserves amount of money on the second year, colleagues, we would put it in budget and finance reserve, is that correct. >> yes, that is. >> i think we have a proposal on the table. we are looking at supervisor ronen has a proposal. we rejected the first proposal. is it to put $7 million on reserve the second year, supervisor ronen? >> yes. >> are you comfortable with that amount, supervisor yee? >> yes, i will support it. >> supervisor mandelman, are you comfortable with the $7 million

amount on the second year in reserve? >> yes. >> supervisor walton, amenable? >> yes. >> me, too. consensus. thank you for bringing that up for $7 million second year in reserve. we have before us did we decide on a compromise? do we have a compromise on

>> what i am hearing is -- i think what we have an agreement among us is 50% cut in over time, additional 25% on reserve. is that what i am hearing? >> i think we need to cut it in half.

>> 50% cut over time pan additional 25%. >> that is not what i said. >> i know that is not what you said. i am asking. you said you would be flexible. could we go there? that is my question to you. what president yee said was 50% cut in over time, 25% of that 50% would go to reserves. what i am saying is because supervisor walton wanted 75% cut in over time if we could get to 50% cut in over time and additional 25% in reserve. i think that is the question, president yee, you mentioned you could be flexible. that is what i am asking. >> i guess i will counter that to say can you be flexible with 50% cut? >> okay. i see the chief has his hand up. chief scott. >> i want to remind the

committee. we are 25% into the fiscal year. we have had some ongoing costs, including response to the wildfires and covid that have impacted us greatly, and the civil unrest in july. that is to keep in mind. we are 25%. we would be left with very small budget for the rest of the year, almost nonexisting over time budget. >> how much over time budget have you spent already? >> can i ask a question while we wait, supervisor fewer?

>> yes supervisor walton. >> what is your wildfire response? what does sfpd have to do in response to the wildfires. >> request from alameda county. coordinator. our duties help with evacuation when communities get evacuated often times they have security or police officers to make sure that people's residences and businesses don't get looted, which is common in this scenario. those are the two main duties. this original mutual aid call we responded as we did with the wildfire in the past couple years. >> supervisor walton. >> our spending is $2 million

already this fiscal year since july 1st. >> if nine months out of the year and you have a $17 million over time budget. for nine months you have a $12.7 million over time budget. i think that what we are -- we are dealing with a two year budget here. colleagues, we could have a compromise with supervisor yee in the first year perhaps doing cut and putting 25% cut and 25% on reserve. second year of the overtime budget a 50% cut. if people are am meanable to that. chief it looks like you are about to respond. >> we wanted to verify the

numbers. it is 2.4 has been spent since july 1st. >> chair fewer. >> who is that? >> this is supervisor walton. i can't take less than -- i would not agree to anything less than 50% cut for police department over time. they will have to figure out from a management perspective to work that. >> i will say, supervisor walton after being on the committee three years. when people exceed the overtime budget they come back for supplemental. much of the overtime as the police said we have been trying to cut is that it is mandatory, also. when ever it is off the council that is over time and court time

is over time. i understand that there needs to be an overtime budget. i actually think that we might want -- because this is an odd budget year and we are nine months into this already. i am wondering if you would be willing to look at this year with smaller budget cut and following year 50% over time budget cut? >> i can live with that. >> how abou about supervisor yed ronen. how do you feel about that. >> can you say it one more time? >> we are nine months into the year. that is why i am saying a smaller cut this year and then more cut next year. >> this year 25% cut and next year 50% cut in the overtime. >> 25 and then 25 in reserve.

>> no, it is 25% cut this year, this fiscal year. next fiscal year is 50% cut. >> i am okay with that. >> i am, too. >> supervisor mandelman. i am sorry we can't bring you along. we have agreement. before everyone changes their mind this is what we agreed on. first fiscal year because we are nine months into the year 25% cut from the police over time budget. following full fiscal year we are saying 50% cut in over time, nothing in reserve. is that correct? okay. then the academy, we said we would cut -- we will keep one of

the academies and cut three. when one do you want to keep 1234. >> the fall. we will push it. to save money we will push fall academy to january. >> that is the academy you want to keep? >> i am sorry. >> you are not doing the fall 2020. you want to do the beginning of 2021, is that correct? >> we want to do it in january. >> chief we will come back to you. it looks like you want to tell us something. >> only when the committee is done i would like to reiterate so we know we are implementing correctly on your behalf. the question i don't be understand would be the chief's

preference regarding which class. >> chief, back to you. the chief suggested class in 2021, am i correct, chief. >> that is the fall class, right. >> he would like to keep the fall class. okay. colleagues. i neglected to get consensus. >> wait. not finished. >> where shall we take -- where do you propose to take that money from? cut in the over time? >> it is the same money. whatever you decide. >> 50% cut in over time. president yee is looking to find some money to civilianize out of the 50% cut. >> we don't know how much money that is.

>> the civil linnieszation. >> it was in a budget at some point. >> no this is why these positions. >> chief, how much would it cost to civilianize those positions ready. >> a little work for that one, chair fewer, to give you a number. we will work on it right now. >> we will come back to you because we have another decision before us, committee. we are doing well, we are on a roll. body-worn cameras. we heard from the police department they are calculating it wrong. we heard about batteries being expired. the bla is recommending a cut of

77,000 -- [ inaudible ] >> is that correct. that is correct, chair fewer. we did speak with the police department earlier today. they indicated they could in fact take a $600,000 cut to the body-worn camera budget for 21. that was year one. that was what they thought was reasonable. 300 in year two. >> okay. i looks like the consensus 600 year one, 300 year two. consensus? thank you very much. please, controller, can you note that before we forget. there was another about supplies and uniforms. were you able to come to an agreement with the agreement with the police on that one?

>> i think we still disagree. what we agreed to do was to put $400,000 in year one on budget and finance committee reserve so that the department will come back and justify that spending. >> okay. you were suggesting $400,000 in year one and $400,000 in year two. >> that is 400,000 on reserve in year one. 200,000 cut in year two. >> it looks like the bla and police department have consensus on that. police department is agreeing. we agree with that? okay. thank you very much. mr. controller can you please note that also. the last thing pending here is on the chief and the cost to civilianize.

>> in approximately $7.5 million. >> $7.5 million. >> we can't do that. >> supervisor ronen. >> i am sorry. i thought all of this compromise including the civilianize issues. if it doesn't it changes my opinion on this. the think about the civilianize which i want to happen. if we add an additional $7.5 million to the police budget, we have undone half of what we have taken away. because those officers then go out to the street. it is all one budget. we have done it in pieces. we don't have control over any of this because it will all be the chief's decision. >> i want to say we don't have to fund the whole $7 million.

president yee, do you have a proposal? >> i would suggest 15 which would behalf. by the way the first year, i mean what they gave was full year budget for this year. it is going to be probably half of what is needed by the time they are up in these positions. i will go like 15 instead of the 30. >> you are asking $3.5 million from our over time savings that we are cutting the police budget? >> for this year. if it is a full year, you know, one year of salary. they are not going to have to pay one year salary. they haven't hired them yet. it would be a lot less than that, depending when they hire them.

>> where do you want to take this money from? >> wherever the pot is that came out of the savings we made suggestions in cutting. >> supervisor ronen. >> i can't support this at all. we have a list a mile long of over $300 million requests that range from subsidies for seniors, low income housing to violence prevention organizations that get in between the games to stop them from having a warfare. we will not get close to one tenth of that list right now. this goes directly to that. i cannot support this in any way and it will change how i have gone about this. >> mr. rosenfield, how much are we cutting the police budget by? can you give us a total. >> i have to take a minute to do that, madam chair.

i can give you an estimate. >> mr. bernard, do you have it? >> i just want to offer that when we -- the committee last year the plan that was approved which created positions throughout the fiscal year $2.7 million at that time because as president yee was saying. the positions aren't funded for the whole year. they start at various times throughout the year. it is low on the number. >> how much was used? well this is for fiscal year 21. those have all been deleted now or put on hold. >> mr. rosenfeld is getting us a

number of the total money in police cuts. >> there is a minor cut i want to make sure the committee did not overlook. you may remember on the library budget that came up there was a policy recommendation to delete the work order with the police department. this recommendation is both in the library budget and the police budget because it is a work order. i think there was consensus to agree to our recommendation for the second year 100% cut and 75% cut in the first year. there were questions if that could be increased in the first

year. there has been some discussion between our office and the library and the police based on what has already been billed in the current year. it is my understanding the library and police department both agree that the first year work order could be cut down to $15,000. i wanted to bring that to your attention for your consideration. >> the proposal with bla75% cut. supervisor ronen 100% cut in 2021 considering we are into the year. that is why 75%. are you in agreement, supervisor ronen? >> yes. >> controller, that is the recommendation number four that we are in agreement with. the controller is getting us the total money amount. >> chair fewer, it is

$3.5 million. >> it is not 2.7, it is $3.5 million. >> might i ask a question? >> yes. there was money for civilia civilianization in the 19-20 budget. >> yes. >> did that get fully spent? >> chief, did that get fully spent? >> i will turn it over to director mcguire for details and questions. >> supervisors, catherine mcguire strategic management. in 1920 we were funded for 25 positions. we had 20 still vacant. in fy21-22, i am sorry 20-21, we had 25 positions planned and cut

from our budget. 45 positions cut that were related to civilianization. >> is so i understand, the budget allocation we did last year was for 25 civilianized positions in that year and five got civiliannized? >> five were filled, yes. >> where did the rest of the money go? >> it went into the midyear cuts that we needed to do. >> do you have a sense if you had the full year runway how many do you think you would have been able to fill? >> at least three-quarters of them, but again, it is probably because we had 25 positions prior to that year that were filled. >> you did fill 25?

>> right. 75 positions over three years. 30 of which have been filled, then another 45 we had to cut from the budget. >> the i am trying to get caught up. >> $3.5 million that was taken out of the budget to rebalance at midyear. that was the civilianization budget? >> i would defer on the actual amount. i don't remember exactly what we gave back. >> what? >> i don't remember what we returned in the budget in 19-20. >> but of your civilianization budget you said you were going to hire so many but it was swept up in the midyear. i am going to be honest. i don't think you can hire that fast. i don't think you can do it. i think there will be cuts. i don't think we need

$3.5 million. i think it is going to take time to ramp-up and do this. considering that we have been talking about this for two years now and you have how many positions? president yee, i don't think it is about the money. they had the money in the budget and they didn't hire. it is going to take a while to hire up. it is takes nine months to hire in the position in the city and county of san francisco. they might not need the $3.5 million from the savings from police because i don't think they will hire that much. we allocated the money before and they haven't hired. >> that is what i said. i don't think it is possible in terms of ramping up and everything else. it is not going to cost this much. >> what do you think. if they said $3.5 million, what amount? i am trying to get to an amount

we might think is realistic instead of the 3.5, it might be less. >> same cut. 30 that they were targeting, then 15 is realistic. >> 3.5. the original figure was 7. >> that was for the the full year. this is not a full year. >> so i think what i am asking is what is the dollar amount for three-quarters of the year and the following year. the number i am looking for. supervisor walton, did you have your hand up? >> yes. thank you, chair fewer. i really agree with supervisor ronen. we shouldn't be giving this money back to the police

department to invest. [indiscernable] why would we take the money? [indiscernable] >> thank you. mr. rosenfield an amount? >> madam chair these are approximations. we will roll through the system. it is on the fly. approximately $29 million in reductions over the two years between the academy reduction that the committee discussed. over time reductions and b.l.a. recommendations. >> that doesn't include money on reserve? >> that does not include reserves. those worry deductions to the police budget. >> $29 million cut from the police department. what we had before to spend

$3.5 million of the $29 million into civilianizing positions in the lease department. supervisor yee. >> i am suggesting we further reduce that number. to less than that. maybe $3 million. again. this is about ramping up. >> $3 million out from the $29 million that we have. we have reduced the police department budget by. supervisor walton, would you consider that? >> i think this is one we have to go forward without my agreement. i can't see reducing the money and giving it back to them. >> supervisor ronen, we collected $29 million in reductions from the police department. supervisor yee proposed $3 million to restore it to

civilianize. >> i can't. the four things off the list, that $3.5 million or how much are we talking about? renatle child care for black teen moms. child care vouchers for teachers. >> i think that the great need, we have a list of over $350 million of ask, you know. where are you, supervisor mandelman? >> i am with president ye yee ai would like pressure to civilia civilianize and that won't happen if we don't give them money for the upcoming year. >> i would give $3 million back to civilianize because i have

been on them to do that. i understand supervisor ronen and walton. i am sorry we can't have full consensus on this. we are running now and i know supervisor ronen has to leave. i want to put this to bed before she has to leave. i want to say that i am proud of this work. i have been trying to cut the budget for many, many years. every year we have had tens of millions of dollars in increases. this is remarkable. the fact that we are all sort of still not fighting each other that we are good. i want to say and thank the chief, also, with a lot of this was compromise so i thank the committee and the hard work. i want to propose we take baby steps now. i want to say, mr. controller, take note of the intention to

accept recommendations agreed upon by this committee today. >> i will do so, madam chair. i will assume for the $3 million restoration that $1 million in the first year of the two year budget and $2 million in the second year given president yee's discussions. i think i understand the committee's intent. >> president yee, is that okay with you? >> that was not my intention. at this point i understand that we are not going to be happy with this. i will accept it. >> thank you colleagues. supervisor ronen. >> i am sorry, colleagues. i have a family emergency. i have to take a flight out. i am not going to be here. i wanted to say in terms i know i am not going to have a vote

because i won't be here. in terms of the firefighter budget, i am in agreement with the fire chief. i think we should give them the vehicles that they are requesting so you know my position. >> i want to say i had a discussion with fire chief and i think that will be next wednesday. >> thank you so much. >> i would ask then that i make a motion that supervisor ronen be excused from the rest of the motion. i see president yee second. roll call vote, please on the excuse for ronen from the committee meeting. >> to excuse supervisor ronen. supervisor walton. >> aye. >> supervisor mandelman. >> aye. >> supervisor yee. >> aye. >> chair fewer.

>> aye. >> supervisor ronen, take care. >> thank you so much. i want to say before i go. you are a remarkable budget chair, supervisor fewer. where you got us to on this point was nothing short of extraordinary. i appreciate you. >> you take care. >> colleagues i am going to propose we take a 10 minute break. it is now 304. come back amount 315. when we come back i don't remember which department we are going to hear. i will announce when we come back at 3:15 p.m. thank you very much. >> the budget and appropriations committee. after our discussion we are now going to hear from general city responsibilities.

is michelle here? >> hi, chair fewer. >> hi, lisa. are you joining us instead of michelle. >> i am representing for us right now. committee, we are here to discuss and finalize the committee positions on the recommendation regarding the reserves. as you might recall that the bla said that we could actually take $500,000 from each reserve and still leave it intact with 99% of the reserves intact. that is up to us if we would like to take that money. that is the bla recommendation. could i have a little.

mr. goncher would you refresh our memory. we have been through a lot this afternoon. about your recommendation. thank you. >> yes, i will bring this back to wednesday. we went over the general city responsibility. this is page 14 of the report from wednesday. this recommendation was for $1.5 million per basically reducing existing unappropriate reserved $1,500,000. recommended reductions include use of $500,000 or 10% from the housing authority reserve of $5 million which would leave $4.5 million or 90% in that reserve. the mayor's budget office did inform us on wednesday that i

believe that the mayor's office converted or shifted those funds to covid relief. i don't want to put words in her mouth. 1% from the affordable care act $49,500,000 or 99% for this purpose. $500,000 or 1 and a quarter percent from the reserve. 39,500,000 for that purpose. the action is considered policy matter for the board of supervisors. inappropriated reserves which require agreement with the mayor to increase the 20-21 budget. further use every serves would reduce amount available to reduce your budget $270 million dependent on renegotiation of

labor contracts. $300 million a business tax ballot measure in november. state reimbursement of covid-19 expenditure and impacts of the covid-19 emergency. >> okay. it looks like the recommendation has been modified a little bit. we are no longer considering taking money from the housing authorities budget. that has been taken. before us we have a -- >> 1 million without the housing authority. >> $1 million without the housing authority. one-time. how do you people feel about that? >> we will take it. >> supervisor mandelman.

>> sorry. i just popped out what is it? >> supervisor yee said yes he would take a little bit of the reserve, leaving 99% intact. >> i think that we will direct our questions to michelle. would this give you heart burn? >> no, not at all. thank you, chair fewer. as i said before, this is up to the mayor to grow the size of the budget for you. i do have heart burn given the revenue revisions i am seeing from departments for the current year and where we are ending the

last year and the amount of uncertainty out there and the fact that we are doing better, but the opening we had relied on earlier in the summer when we prepared the budget has not materialized. from the controller's perspective maintain reserves adequate to the challenge you face. >> ms. rothbergger. >> i concur with michelle that this is a major risk. we have many, many risks we are tracking and others we probably aren't tracking on the horizon. i cannot commit to growing the budget. of course, we are happy to talk to the mayor as we work through the next few days. at this time, i am not recommending to the mayor we grow the budget.

>> supervisor mandelman how do you feel? >> i will follow the chair. i understand the desire to free up money for our period priorities. this is not a huge amount but not terrific fiscal policy or financial policy. i will be a good soldier on th this. >> supervisor walton. >> i am definitely supportive as we also have an opportunity to address all of the cries cease anotheof the crisis thatexist i. do we have a tally where we stand and what is available to us at this moment? we all have different numbers. >> we don't. mr. rosenberg, do you? >> we have been implementing reductions and we should have

one later this evening or tomorrow at the latest which we would be happy to provide. >> i will go with my president on this one. >> i also would think that i am comfortable taking this money. if it requires the mayor to grow the budget, i think we can make the decision but it is up to the mayor. president yee, i agree with, supervisor mandelman, does this persuade you at all? >> sure. >> mr. controller, can you please take note the committee's intention to accept the bla recommendation number -- i forgot the number. >> i understand, madam chair. the item is not in front of the board unless the mayor grows the budget. it is contingent. that act by the board would be

contingent on acts by the mayor. >> we are requesting the mayor to consider the appropriation. thank you very much. thank you. juvenile probation. chief miller. >> good afternoon, everybody. >> chief, i understand under consideration today is your asking at the last committee meeting we decided 50% of the second year of your budget for juvenile hall on reserve. you are requesting 25% instead of 50% the second year on reserve. supervisor ronen has agreed. what say you? >> are we agreeable, supervisor

yee. >> i can give it to her. >> i think supervisor mandelman is in agreement. anything else, chief, you would like to talk to us about? >> the only other thing is i don't know when they need to provide information about the position that you are taking back from her. we are in agreement with that. >> she has generously provided us with additional positions, three positions. do you have an estimate how much those position savings are. >> yes, in the first budget yearsty mated 5 82,000 $666. second budget year $423,322. this includes a slight decrease to the savings because they are giving up basic positions. they need back in the savings as well as the addition in the

second year of what was taken out of the budget. >> i see consensus with my colleagues. controller's office please take note. their recommendation from the chief juvenile probation. thank you very much. okay. on to i don't think fire -- they are coming back to us on wednesday. we will see them for a very, very short meeting. now we have the sheriff's department. i believe that we are continuing what was proposed by supervisor walton for putting money for cbo on two year reserve and talking about over time, is that correct, supervisor walton?

>> that is correct. >> i will prefer for you to lead the conversation. >> continuing with the condition very session from the other day, i still ask that we put the community funds in the reserve until we find out where they are going to go afternoon th and thr them as well as $7 million in overtime. >> the overtime budget, sheriff? >> if we are talking over time the budget is in the neighborhood of $8 million. we can verify numbers. >> the proposal sounds like 100% over time budget. >> that is what i was trying to get to, i apologize. >> $8 million. >> that is the entire budget.

>> $8 million entire budget for over time. you would like to put 100% of over time budget on reserve, is that correct? >> correct. >> so let's take the community organizations under now the budget of the sheriff. what we heard is that there is $8 million in community based organizations pre-trial that are under the sheriff's department. supervisor walton proposed to take it out of the sheriff's department until we can decide where the home should be for those cbos. >> yes. go ahead. >> what did you say? >> i am sorry. >> supervisor yee and supervisor

mandelman, what do you think about this proposal? >> i guess i am not understanding exactly what it would mean. there are current programming going on getting administered under the sheriff's department. those dollars need to go out the door, i think. my concern about doing this. i can see doing this for the second year if there is a proposal or some other agency to run these programs and it is the sheriff. my concern in the first year i think we need these programs to grind to a halt right now. there wouldn't be the money for them. i have concerns about that. maybe i am not understanding. >> talk to the sheriff. what do you have to say about this proposal? >> to the timeframe i do not

have a lot to say. this is near and dear to my heart, not just to me but the sheriff's office. we are a national leader and innovatester in programming. in terms of what we are doing here and the construct of the taking the money away from us and going somewhere else i am confused. this is an area for the sheriff's office historically a leader in reform, the attitudes about public safety and law enforcement as relates to justice. this is an area of our attempt where we have been leaders and innovators. we have part of the forefront. we understand that there is a nationwide move for police reform, defunding. i just don't quite understand why we are defunding the things that are successful and work and hope a pathway to success and

including a sheriff's office in the process to do positive outcomes as opposed to stigmatizing and leading to devissiveness. i have been here 24 years. this is around for 30 years. progressively under every administration. we have done nothing but support and expand programs and implemented and moved for wart to support through the years. there is never a time when we have not moved forward on these things that make us an agent of change. we are setting an example. you want to talk about the types of things we do. i will say at the time we had slides to present in the short timeframe we had turnaround on the information. supervisor walton, you asked about which cbos were affected. we shared the information on the screen.

$10.3 million. we have worked towards increasing funding for pre-trial or increasing funding for the partnership that we have. this really leads to us talking about and i can go into the history. due to the partnership and collaboration towards public safety. nothing to do with law enforcement. it is putting people out on jail operations wide or court operations wide. this is about providing services to people and managing those services based on the needs. we are talking about multiple government innorvation. we are talking about kamala harris gave us an award in 2017 for our work. there is a list here that you will have. there is a listing of some of

the things. that is a partial list of the things we have championed and moved forward with. it is the fact we instituted these things because we felt the need as sheriff's office involved in the process to take it out of the equation in regards to the management of the programs. i am at a loss to understand why. when we talk about the safe guards already in place to ensure the fidelity of programs, we are talking about measurables and compliance through staff dedicated that are program service coordinators that are boots on the ground the outcomes to make sure these are successful. we have connection between in custody and out of custody alternatives for individuals.

more importantly we have the pre-trial which i mentioned earlier, a huge chung what we are talking about here. that partnership was established before the 30, 40 year margin. we started that in 1976. it is an incredible amount of time and energy we use to make sure we have success and dedicated to supporting it and mandates. we are really mandated to be part of that process with the reform. we are complying with that injunction through the work on public safety assessments with pre-trial and ability to provide them with a path to getting the information to make the right assessments. i am trying hard to keep this as short as possible. there is a large amount of information here to talk about in terms of success and the need for us to be part of the process and not separated out. it would challenge me to decide who else could possibly be in a

position to make sure there are successes. the most important thing is the management of these programs, beyond management of money. we engage with those cbos. they are part of the committee we are talking about. the most important thing that happens with our partnerships is that we get buy in from the staff. we decreased the potential for decision for us versus them mentality. we decreased stigmas attached to us but to people involved that sometimes people don't really understand are nothing but stereotypes and labels. when you get to know people through the use of programs and participation and management of the programs and services we provide, it is humanizing the situations to bring us together to set reset button for people

in our custody and care is a huge, huge piece of what we do. i think i have conveyed to you all the mandate as public safety office served by us being able to provide programs through our methodology. i really am scared. if we don't provide this support and are not part of that process we will be enforcements without opportunity for change. what we don't want to see the narrative about reforming police agencies and law enforcement agencies. we will start from the beginning, you know. the philosophy, the reason i ran for office as elected sheriff was to continue the philosophy and maintain all of these partnerships. i am getting emotional i apologize for coughing. we want to move forward with this and not take this

backwards. i am open to answering any questions you have about our participation in the programs. if there is any question about our ability to do so, please feel free to ask now. >> supervisor walton, maybe you can give clarity. >> thank you so much, sheriff, we appreciate you coming on. i definitely agree the sheriff's department has been innovative leaders and these recommendations have come up before. this is not the first time we had this conversation as a city. i am 100% not proposing these programs be eliminated at all. we are saying we want to hear more from the community. some organizations truly feel threatened and bullied by the sheriff's office at times. they have been told if they advocate too loudly, say things that are deemed out of pocket by the sheriff's department then

are threatened to be defunded. only a couple of weeks ago we saw employees by the department they have been on the news. they claimed intimidation even during this time of law enforcement reform. my question is really have things changed? intimidation is alive and well. we should hear from community about resources and have this conversation. what if you believed me by your statement, they have been, if we do this your department is going backwards and that you will become the department we don't want to see. i don't know how to take that. >> supervisor walton. i don't mean we want to go backwards. we will be moving backwards on what we moved forwards on. i don't want us to be in the

position where it doesn't feel a sense of collaboration. you mentioned about the fact that there is litigation which i can't comment on. it is litigation regarding people who have alleged that they have been bullied at work. that is why it is important. i have a slide to talk about the move forward we are doing right now as we speak. some of this is our efforts to make sure people have voices beyond just workplace environment. a seat at the table for formulating policy and moving forward. that is why we have the sheriff's lines for equity moving forward. the guidance given by the office of racial equity that is the kind of guidance this department needed to set foundation for it. we have started moving forward with these things. it is based on people's interactions with one another. that is created of the things we want to reform.

we want to be part of that. when you reference what you said about the people who are putting out the allegations of bullying, we are addressing that right now, not just through that civil process but looking into that internally. it reflects what we want to do moving forward to have dialogues and have the ability to have people bring things up outside of the workplace but at a larger table. that is what w we are working towards. we are looking to move forward. we believe, if i may reemphasize the point. by taking away the programs management from us, that we are going to lose part eve part of t partnership and that is what we don't want to see move backwards. i hope that helps. >> i appreciate your comments around working together and partnering. putting these resources in

reserve while we have those collaberative conversations. we need to bring the community to the table, bring your department to the table for these conversations. if everything you say is right and correct and community is excited as you are about the work that is happening and happening with your department, then i don't think we have anything to be concerned about. >> colleagues, anyone else. do we have any supervisors, any questions supervisor mandelman, president yee, anything to ask about this proposal? >> i just think i am k-9 of clear. i -- i am kind of clear. right now there these budget amounts are pretty much what the programs that were listed that

the sheriff put up there and you want to put that in reserves. is it the total amount for the year? you want to put it on reserves or is it just part of the amount? these organizations are paid for some of the work right now? that is one thing i want to make sure that the contracts or the organizations will not get paid for what they are doing? the reserves gives us an opportunity for a discussion to see if we want to continue supporting these under the

sheriff's department or another mechanism is that what you are saying? >> yes, definitely, president yee, you are in the right direction. one thing i would say as we talk about justice reform. we obviously need to move community programs to the appropriate department. i do understand your point about where we are and the nature of the typical fiscal year and the programs up and running. i would be okay with putting the portion of the dollar amount in year two in reserve while we have these conversations with community. whatever the amount would be to finish off the year make sure organizations stay whole while we have community conversations, put the next year's amount in reserve, whatever that amount would be for 21-22. >> thank you.

sheriff, i see your hand up. >> thank you, chair. yes, i am very concerned about what was raised by president yee there about we are under contract with these organizations. they are providing the services as we speak. one of the bigger concerns was making sure people who partner with us are getting paid through this process. i am not as well versed on this process. if that is under reserve for the second components of the fiscal cycle and we have the ability to pay people for the good work right now. i understand that, but what does that mean? i understand that we have the ability to talk more about this. i think that given the most freshness of this issue to our agency and organization i would like to make sure we are clear on what things are. again, as we have done since th

inception of everything we do. make sure we work together. you did mention one thing i was curious about. community programs. is it specific to all outside things we do when people has justice involved out of constructive custody and back in the community is that what we are talking about? >> culmination of all of the above, but basically the work you are doing with the community-based organizations and folks contracted to provide services with the sheriff's department or through the sheriff's department. >> i would love to partner with you to make sure we open up books to let you see what is going on. that is what we have to do when we manage these programs. there is absolutely transparent processes we can provide for you.

glow thank you. -- thank you. take the amount 21-22 fiscal year and put on reserve. make sure the organizations can finish this year and work on a plan for how things may work for next year. >> thank you for that suggestion, supervisor roman. it is a limited timeframe at the conclusion of that discussion. if the conclusion is to sever the nonprofit or whatever, it has to be done several months before the beginning of the next year or otherwise you will be stuck. i want to point that out.

>> sy love that program. i visited it twice, the charter. how inmates we act to that. i just want to put a plug in for that in the jail itself. >> i just want to say that i am reluctant to make the change this year without hearing from all of these organizations where they think that their home should be. i think this year and i really appreciate supervisor walton for making the suggestion because i think to give you a year to plan. what i would suggest is that perhaps this is a working group that these organizations actually we can hear from them

or the board. i don't know if i will be here when it happens. a practice where they can come together to see where they would want their home to be and if they need to go to the same home or some would like to be placed in another organization and so what i would suggest is that we could also, speakerrua speaker , legislatively we could have a working group and get together. i would say then we have a proposal on the table to keep the budget for this fiscal year, the nine months, for the second fiscal year 21-22 to put that remaining money in reserve, is that correct, supervisor walton? >> that's correct, chair fewer. >> we have that on the table. let's get rid of that item

first. supervisor mandelman, jose you on this proposal? >> i am okay with that. >> president yee. good. we have consensus. the controller please take note of the exit committees intention to keep the money in the original budget for this fiscal year to the end of this fiscal year. to for the money for fiscal year 21-22 will be in reserve. a practice to determine where the organizations home will be will be conducted during this fiscal year in time for next fiscal year. thank you very much. next to the point of over time. i see that the sheriff's over time budget is $8 million. we have a proposal to put 100% of those funds into the reserve account.

i probably suspect the sheriff or mr. holland has a comment to accompany this proposal. i would like to give them an opportunity to speak on it if they should so choose. >> thank you. i was not aware we were going to be talking until recently about this. the proposal to cut the overtime by 100% or put in reserve for 100% will be very challenging for us. regardless of the fact we are a public safety agency, we are also unique, not just in the fact i am elected but the fact we have mandated things through state agencies in our mission and what we do. not just through collective bargaining staffing level but through the needs of minimum standard in correctional

facilities. we have a staffing level that needs to be maintained. we have a court staffing level that needs maintained to complete our mission there. our level of mandated b by charr and entities. that leads to overtime challenges. there is a slide here regarding the overtime expenditures. i would like to highlight the fact that and put the elephant out there. elephant in the room in terms of the recent article that highlights the fact that a number of our employees were on the list for most highest paid civil servants. that is a reflection of systems where we have not been staffed to full needs in light of these mandated positions and staffing level. we had a csa audit last year

which highlighted the need of 238 f.t.e. short of the actual workload. we met some challenges with making sure we have adjustment for over time and number of people who made an increase in overtime for their salaries because they were filling positions that are needed and mandated. two, because we have so much over time throughout the system we have people involuntarily drafted, people that are held over from work hours and made to work additional hours because of that need to maintain minimum staffing level. some of those people voluntarily take the place of those individuals involuntarily drafted to make sure this happens. that reflects that article. the last thing i want to say about this without too much de

detail is the fact that we have the closure coming up which we look to as the ability to move some of the staffing into areas to backfill the areas of need where we have unfilled f.t.e. this will reduce over time expenditures significantly in terms of operational ability to do so. you will not see as much over time. that is part of our reduction process to advocate for the further reduction of over time to 100%. i don't quite understand and welcome to understand through your explanations why we are looking at that type every deduction. >> colleagues, any comments or questions? >> i will say personally that i think 100%. having been on this for three years i know the problems with over time. a lot of the overtime is

involuntary. they must because they must keep the staffing. they require the deputies to work overtime even if they do not want to work. we have been working hard to have adequate coverage. the sheriffs are at city hall, at public buildings. to get their level up so that the sheriffs don't have to involuntarily work overtime shifts. the problem is that it is not like a regular job. they are also within the building, too. when you are working double shifts we heard many complaints from deputy sheriffs that it would mean that they are doing long shifts inside the jails. having said that, supervisor walton there may be a compromise for the first year and second

year similar to the police department. if it is the intention to cut 100% i am going to propose to you that you be amenable to something we did with the police department is cut the overtime 50% or put it in reserve. supervisor walton, what do you think? >> thank you, chair fewer. my goal is to avoid a mess like we saw this past year. also to think about any of our workers and the danger of being over worked, particularly to your point during the pandemic. our county jail system i would rather did not read an article that shows and demonstrates a plan about over time but get something in place in the sheriff's department aboutover time plan to make conditions better for workers especially

during this crisis. i am definitely okay with reducing a certain percentage and hearing the plan and putting some in reserve because i think that it is something that we need to do. >> is there a proposal perhaps my colleagues might want to proposal to supervisor walton or do you have a proposal yourself? supervisor mandelman or supervisor yee? >> i don't know that it is reasonable to expect the sheriff's office not to run over time in this fiscal year. i don't think they are able to do it and do the things they have to do. i think it i it is reasonable wh the closing of cj4 and reducing over time to have a second year's worth of over time held in reserve and provide that to continue the conversation. i support that. i wouldn't support a consult or

putting this coming year's over time on reserve. >> are you proposing year two 100% in reserve? >> yes. >> supervisor yes, what do you say -- supervisor yee, what do you say? >> you are on mute. >> i would be fine with that proposal. >> supervisor walton, what do you think. >> that works for me. >> great. it looks like we have consensus. we put year two 100% on reserve. please take note of this committee's intention to put the second year of over time for the sheriff's department on reserve. thank you very much.

mr. clerk. any other committees before us today? >> there are lay items here. >> i believe we did. the fire department is coming back. hold on one second. you are right. there is one more thing with the sheriff's department. the bla recommendation on the general management system and

whether or not. i believe the bla recommended. can you please refresh our memory? we have had such a crazy day. >> my pleasure, chair fewer. yesterday we discussed the policy recommendation on the sheriff's jail management system replacement. what our recommendation was that the board should consider whether to fund the initial deployment of the jail management system replacement p.$1.8 million for the five year i pp plan starting in fiscal year 19-20. initial testing completed by the sheriff apartment 250 -- at $250,000. the total remaining project cost increased to $2,319,422.

the elimination of the funding for the two budget years, the sheriff is to cover the first budget year cost $687,720 in reduction in other general fund operating expenses. no funding is identified or secured for the second budget year. given the anticipated savings or replacement and the sheriff has not identified funding for 50% of the total development and implementation costs, without additional funding the project is at risk of delayed the simultaneous licenses in the new jail management system 550,000 in total. we did also note the replacement has been recommended by the jail work group.

would support the sharing strategy in 80-20 regarding closure of county jail 4. the department of public health indicated it would allow integration with their system. we also note the replacement is necessary savings of 140,000 per year once fully operational. chair fewer, and supervisors, the bottom line with our recommendation is that if you allow this to go through it would allow the upgrade to continue. we are not saying that we disagree that upgrade is needed but then you and the mayor basically the city is going to be on the hook for $1.4 million. we would have to come up with $1.4 million in the second budget year to keep this going.

that is why we wanted to bring it to your attention. >> thank you. i think we all appreciate this is a good thing in that advocates photo have the data aligned. the sheriff is in agreement. what i am hearing from you is that it is a concern about the fully funding of the program at $1.4 million in the second year where there is no current funding strategy for that. i will say myself and if my colleagues speak, this is something after the jail advocates have come to me and said this is extremely importa important. the bla, too, i understand the concerns. this is a really important project.

we have made $1.4 million short on this. i am going to depend on colleagues who will be here in the next fil fiscal year to find funding. i am open to comments. supervisor mandelman, do you have a comment? >> i am nodding with everything you say. i agree. >> how about supervisor yee. >> that is logical. i support what you just said. >> thank you very much. supervisor walton. >> we have a consensus, madam chair. >> thank you very much. i want to thank the bla for the work on this and thank you, sheriff and the advocates who pushed for this. our consensus can the controller please note that it is the committee's intention to not accept the recommendation on the

policy matter recommendation. mr. clerk, any other committees before us today? >> we do not, madam chair. >> that is very good news. colleagues, we recess this meeting. we will be back on wednesday. we will have a discussion with the chief. i would like to recess the meeting now. thank you, sheriff for joining us. i would like to recess until monday amount 10:00 a.m. where we will have a full day and possibly full night of public comment. colleagues get a lot of sleep. there are a lot of people to tell us what they are thinking and feeling. thank you, mr. clerk, we will see everybody at the meeting. >> a motion to recess. >> yes. >> second. >> thank you very much.

roll call vote, please. >> to recess the meeting until the august 24th meeting of the budget and appropriations meeting. supervisor walton. >> aye. >> supervisor mandelman. >> aye. >> supervisor yee. >> aye. >> chair fewer. >> aye. >> we have four ayes. >> thank you, colleagues.

>> staff and members of the public who are joining us for the san francisco health commission meeting for tuesday august 18th. we will call this meeting to order. will you please call the roll. >> yes, commissioner bernal. [roll call]

commissioner chow is supposed to be here. i thought he was on but he is not. mikaela, can you share that slide right now? i'm going to pop up the public comments slide so that everyone on can see how to make public comment. there's a few people on and i want to make sure everyone knows. give me one second and i'll pass you to ball. so, the phone number for public comment is (415)655-0003. the access code is (133)190-2636

and press pound twice to get on the line. when you are on, if you would like to raise your hand for a specific item, please press star 3. when you get on the line, you press pound twice and then star 3 if you would like to raise your hand for an item and we'll talk about the comments for each item. commissioner bernal, would you like to move forward with the approval of the minutes or wait for commissioner chow? >> commissioner ball: do we have a quorum? >> we do. is he dialing in now? >> i will call. and i apologize. >> no problem. >> we'll give him 30 more seconds. thank you to dph staff and everyone making this meeting possible by webex.

>> commissioner bernal: thank you. before we move onto the approval of of the minutes, i want to share with the commission, with dph staff and all those watching as members of the public, that as you know, we are under an excess i have heat advisory and there may be rolling blackouts in san francisco, the beginning as early as now 4:00 p.m. in san francisco with an anticipated restoration of power around 7:00 p.m. we don't know exactly when this will happen or if it will happen or what areas of san francisco will be affected, we do know about 103,000 customers accounts will be impacted by this. i know director colfax will talk about dph's response to the heat advisory during his remarks and i want to assure the commission and members of the public the health department will be monitoring the heat situation and take all appropriate actions

to prevent and protect vulnerable populations. so, hopefully we'll make it through the whole meeting but if we do suddenly go dark, we know why. apologies in advance if that happens. let's move on to the next item. approval of the minutes. the commissioners, you have the minutes before you if you have had a chance to review them. >> if would you like to make public comment on this item press star 3. this is for the minutes, item 2. and commissioner, i think we can move forward. >> o. do we have a motion to approve the minutes? >> so moved. >> is there a second. >> all those -- mark, call the roll. [roll call]

>> yes. >> thank you. >> all right, we'll move it to the covid-19 update. from director colfax. >> and actually sir, i'm sorry, it's the director's report first. item 3. >> i jumped ahead. director's report first. so, we will go into the director's report, thank you, mark. hello dr. colfax. thank you secretary morewitz. just a few things to highlight in the director's report, what you have before you. mayor breed presented her covid-19 budget for the next fiscal year, which is over $400 million, $446.1 million to be exact with significant portions allocated to help operations, including of course most of that to the department of public-health and focusing also on housing and shelter

programs and food security and human services in emergency communications and operations. this budget is being presented in various components by different departments to the board of supervisors. we presented the covid-19 dph portion of the budget to the board last week and there were a few questions and we'll go before the board for our fourth hearing on the budget on friday. i will give an update on covid-19 in more detail in the next agenda item. just to say that as some of you may have been reading in the paper, there were reporting delays and charges with regards to the state cal ready system that impacted our ability to better to optimize our understanding of the status of the deposi epidemic in san frano

and partner notification. the state is telling us that those data are fixed and we are improving our ability to monitor the epidemic as a result and as we look at the data coming in, there may be some adjustments with regard to the data that has been posted on our website. we've received a large bonus of thousands of tests, reports that were previously not calculated into our positivity rates. the good news is those were for the most part negative results so we were counting for the positive and of course, even with, not of course but just to highlight that with the cal ready system challenges people were still getting their positive test results from their provider. in terms of the few pieces on the behavioral health side, the mayor announced last week that a collaboration between the health department and the fire department ems6 in terms of

creating a street crisis response team that will pair first responders with behavioral health workers on the streets and ensuring that people get the behavioral health services that they need in real time when they are engaging with first responders and this is a pilot program and we expect to have it up and running in the fall and lastly per president bern allies discussion around the heat, we have been working with our community-based organizations and with our team to make sure that people understand the precautions necessary if given the heat advisory, and combining that messaging with covid-19 prevention messages, so drink water and stay cool, wear face recovering, avoid strenuous activity and wear light clothing and we've been coordinating with

office of emergency management to consideration of opening cooling centers if and when we meet the criteria to open them in this age of covid-19. that completes my directors report and i'm happy to take questions. and so, if the commissioners have any questions about those articles or what i went through i'm happy to answer them. thank you. >> i'm sorry you are muted. >> commissioner bernal: sorry about that. before we hear from commissioners, mark, do we have any public comment. >> anyone would like to make public comment press star 3 and i'm not seeing hands right now. let's check. star 3. looks like we can move forward. >> commissioner grown.

>> commissioner green. >> unmute yourself. >> sorry, i didn't have the question. i'm sorry. if i raised my hand it was in error. >> you are just waving at me. >> we don't see questions from commissioners. if we don't have any questions or comments, from commissioners or someone is having difficulty raising their hands in the system if you would like to just speak up. commissioner giraudo. >> my question is when do you think the state crisis team, which is wonderful, will be able to launch?

>> some time in the fall and i'm happy to provide updates as we get a sense of the capacity to resource the project and also to hire people. >> this is claire. i just wanted to say that we were working pulling together and a team to just really delve down as the next step for everything we need to do for that project to make sure that we're in close communication with hr and the existing stakeholders to move forward with that. >> >> i'm looking forward to it and i think it's going to be great. i'm hoping so as well. >> it's a department of the department and commissioner. >> any other questions or comments, commissioners. if not, we'll move on to the covid-19 update.

>> i was just going to ask -- i was going to ask when it does start, if we can be notified and then get an update because this is an exciting program and one that we would like to track and i'm sure the public will too. >> we would be happy to coordinate with the commission and provide an update on that. absolutely. >> >> if there are no further questions we'll move onto the covid-19 update. director colfax. >> >> can you hear me? >> we cannot hear you. >> now we can.

you are good. >> you can hear me? >> now we can. >> sorry about that. well, again, commissioners, director of health providing you with an update on covid-19. i have a series of data points to review with you and then of course happy to answer any additional questions. as you can see, we're at 842,700 cases of covid-19 diagnosed in san francisco. approximately in the last two weeks and under cal ready system has created challenges and we have estimated about 1,400 people who have been diagnosed in the last two weeks of this would be considered active infection and we have a total unfortunately of 70 total deaths among san francisco residents. next slide. this is our test team numbers and we far exceeded our goal of

1,800 tests today and we're now almost at 3,900 tests on a seven day rolling average and you recall that we set a new goal for september of doing 5,000 tests a day across the city and we're making good progress towards that goal and demonstrated by the seven day rolling average on the curve. our over all seven day positivity rate is 2.97% and we have started our adaptive testing strategy that i talked to you two weeks ago with mobile teams providing testing particularly in the southeastern part of the city and where we have high positivity rates and we currently have two test sf mobile sites going into neighborhoods with highest prevalence rate with a capacity to do a total of 500 additional

test as i day compared to where we were just a couple of weeks ago. with regard to cases of race ethnicity and continuing to see high preportion in the latin x community and we are working with key stakeholders, community leaders and providing the supports services and the cultural economy services and with regards to addressing the covid epidemic in the last inex population. with sexual identity data i did want to share this data with the commission looking at cases, cases diagnosed and you can see here that we have under sexual orientation, and this is again, a data that doesn't include all our cases.

you can see this was for cases interviewed and after april 27th of 2020 you can see the distribution by sexual orientation and by gender and next slide. i also wanted provide covid-19 case and deaths by age group just to emphasize to the commission that we have, in terms of distribution of cases, this is a pandemic people who are under 50 over all and we have seen a shift as we seen across the nation to a younger population that we've had an increase in cases among people younger than 18 and particularly

in the last few months and you can see our distribution here as currently stands and then that is by age group. you can see that we continue to reflect with over half of our case, our debt screen among people over the age of 81 and you can see 3% of our cases where people over 81 or over with regard to the deaths 90% of deaths that we've had in san francisco of the 70 deaths, 90% have a known whoa more bid condition about the disease and being particularly deadly among older adults and the people with

co-morbid conditions. so a quick county cove covid comparison. our case rate is low compared to similar jurisdictions across the country. death rate significantly lower than other communities and our testing rate is higher with the exception of the testing rate in baltimore and you can see where data are available and we are in excessive including new york city which has done a lot of work to stale of testing we're at 3.61 and they're at 2.59 per 1,000 residents. so this is our current hospitalization rate it's the far-right is our current hospitalization rate and this is our hospitalization rate through the pandemic that peak that we

saw in april and may going down to a low of 26 hoppizations in late june and we see the city climb to 111. you can see that we've had some variation in august where we're currently most recent data shows a total of 84 hospitalizations and the dark blue lines are the number of people in the icu and the light blue lines are people in our medicine surge that is so we're watching it carefully and it is to note the peak and the decline is quite similar and so far to what we saw in april and may with a 94 hoppization and another increase and in late april and early may so we're wait to go see if we see a similar pattern here so far it looks like it may be marrying

that. we don't have conclusive evidence why there's this by model distribution but it's something that we're observing and determining why we get this distribution again. next slide, please. these are data on our key health caters and we have the slope of covid-19 hospitalization that's rate of increase shown here at the 1% level is now green and that is alert just a few weeks ago commence rat with that indication we are in a surge. our hospitalization capacity remains in the green with 25% and of our acute care bed facilities and our icu bed capacity is in green and we are

high levels of case positivity and this is going on for a number of weeks now and we're at 11 and for 11 cases, per 1,000 over seven day rolling average and we, again, to stay at that high level. the testing numbers are ability to succeed our goals and now going to that goal 5,000 in september and our contact tracing and partner notifications those numbers are in the orange and lower than we would our goals and again, part of this we attribute to that backlog of testing that happened a couple of weeks ago that was very challenging for our team and we hope coming in, we will correct that and we caught up with our test teams window in terms of turn around times we hope the contract tracing numbers will improve.

we've made expansions in our contact tracing capacity and are staffing and anticipating the potential for 200 new cases a day. expect those numbers to improve. over the next few weeks and then our ppe within n.d.p. h are good and we're in a 30 day ply of dpe. this is update on our reproductive rate of the virus again is how quickly or slowly the virus is reading through the population and it's less than one and the virus is slowing down because fewer than one person is getting infected and it's basically neutral and one person infected infects one new person and a reproductive rate means for each person infected more than one person gets

infected and you will see the solid blue-line demonstrates the estimate the row productive rate based on models and this is not a number that we can precisely measure and this model at uc and uc berkeley is something we've been using on from early on in the epidemic. we were at a rate as low as .8 in may and june and it was 1.34 a number of weeks ago and we're down to .93 on the far-right of the curve. confidence are still wide so we could still be above one but over all the trend is the favorable direction but i would just add we want to continue to see that number go down so that

completes my covid update for the commissioners. it doesn't complete it because i did want to add one other component to this which is we were added to the state watch list because of our covid-19 hospitalizations. we remain on the state watch list due to our high case rate which means for now we are on pause on our reopening and we are working with the state to determine what the next steps would be when we are off the watch list and the state is -- we are hoping the state will issue more detailed guidelines about what accounting the may be able to reopen after coming off a watch list and i asked our health officer to create a detailed plan in terms of when our reopening face may look like

going forward given we've been on pause for most of the summer and we are in this pandemic and he will be in a serious situation for a number of months so he is now working on that in terms of what gates we may use to consider reopening and business and other entities going forward as we enter the fall into flu season and other challenge that's may lie ahead so that's my update for the commission. >> do we have my public comment. >> i don't see hands. if you would like to make public comment on this item, press star 3. let's give it a moment to make sure we don't miss anyone. star three -- we have one caller. give me one second. just for you to know, i have a timer and everyone can speak for two minutes per item and i will start in the order i see raised hands. we have several.

all right, caller, you are on. >> caller: hello. hi. my name is know he will and i'm a hairstylist in san francisco. the salon i work at has been closed for five months and that is seeing salons reopen safely. it's baffling we are unable to work in san francisco. we have been waiting watching neighbors and close there's door permanently and we're still unable to pay our rent as you know employment insurance have run out and the situation is dire. hair salons are controlled environment we we practice safely since we are licensed and regulated by the state and we focus on disinfection and client protection. i firmly believe and as evidence shows that by allowing salons to

reopen will not spread the covid. please let us reopen. >> hi my name is sha ray a and i'm the ex tough cultural district and one of the questions that i have was about the rates and ethnicity and how it's tracked on the presentation that you presented. specifically does that .4% include those who indicated both native american and other ethnicity? and also, on those health funding related to the mayor's most recent budget announcement, i'm curious if there's still proposed cuts to major native american health programs. thank you.

>> just a reminder and that the commission will not answer questions thaw may ask but they are hearing you and noting them and passing them on so you are being heard. let's see, next caller. you are on, caller. hello, caller. all right, there's no one there. >> there we go, i'm sorry. >> caller: you have me now. >> go ahead. >> i apologize, i have so many mute buttons i had to find the right one. i want to thank the commission for its time first of all, my name is craig and my wife owns a hair salon in san francisco and i want to join with the women's voice who said you know, they've been closed for so long now and

it's absolutely brutal and i would urge that these hair salons should be open and to ask the commission to do whatever it can to row think the policy of the city and county and urge the state to move that way and the main point i'd like to make quickly is that i think the instinct sof these salons and maybe come from a sense that this is close contact business they must be vectors of spread and that is based on proving to be an empirical mistake nation wide. you have the small study out of this cdc which was reported in the times of colorado governor tuesday talking about where you have two symptomatic hairstylist. they treated about 140 people not a case was report and they trusted 67 of the clients and none came back positive. on august 6th ut doctor and

saying he wasn't on board with even the states cutting people outdoor policy because he had seen quote no evidence end quote, that salons were spreading this as fast as other businesses were in allowed to remain or reopen and to have them lumped in with bars and restaurants is always seemed just misguided. one salon and perhaps this person will be on the phone but one salon in san francisco, who also owns a shop in austin, texas that has been open, reports over, this is maybe two weeks ago, a week ago, about 3100 clients in zero reported cases. >> i know my time suppose. fair enough. thank you. >> great. commissioners, i believe that is all. let me go. there's another hand but i believe -- give me one second to

try. >> i believe that's all. press the button to raise your hand. i do not see any. i will raise two questions. on your last slide it's encouraging news we see our reproduction number below one at 9.3. recognizing that our early success in containing the pandemic involved close coordination with the other bay area counties and with work that you and our health officer had done with them. do we know or do we believe the reproduction number is also

following the trend in surrounding counties and it may be below zero in those countries? >> thank you, commissioners. so, when is interesting in looking at the rate around the surrounding counties is they're leg than san francisco right now and we don't know exactly y one thing that happened is their rate increase before our reproductive rate did and so we may be behind. in other words, they went up faster and we were behind them in the increase so hopefully our decrease is lagging so we're watching that. the other cause for concern is that we are a much denser injuries diction than most of the other surrounding counties so, it is plows able because of our sense tee and because of the high level of virus that without greater adherence to the social distancing, the masking and good

high queen we will continue to see a relatively higher rate than the other surrounding counties and that's my response, thank you. >> san francisco is the second densest jurisdiction in the country. i believe. my second question goes back to case demographics you mentioned we were putting into place our adaptive testing strategy with mobile teams that are sent into neighborhoods in the city with higher prevalence and do we expect that result in a higher percentage positive number in our testing because we're being more work would community and

let people foe there is testing available so we're in the process of on what day and we'll look at the data evaluating whether we are in deed going where the virus is and based on those positivity rates and before we can draw conclusions about what the data are showing us in terms of how we may need to adjust. >> it may be the report and to understand and if we do see an increased positivity rate and it could be a better targeting our testing events that are most infacted. >> there are reason and if we're

being more more precise about where we need to test, that would mean we could have at least initially a higher testing rate. if our prevention interventions and our testing sat rates, we would expect to see that positivity rate to go down unless the numbers continue to go up and we continue to focus on basically the increasing cases going up as a result and reproductive rate so there's a combination of factors that could influence the positivity rate going forward and our goal is to basically look at our positivity rate our testing programs and the positivity rate at the mobile sights in conjunction with the reproductive rate as well as our contact tracing positivity rate and that positivity rate has been from two to three times above average of our over all positivity rate so that starts

to go down it's a good sign that we're basically saturating the groups with the highest risk for covid-19. >> one more question. you mentioned that we are doing a much better job in our resulting time for testing. what are we looking at for our resulting testing and is there a difference between the time for getting results between our public-health labs and private labs or private providers? >> the most recent data i have is that our large scale testing labs and lab course so i have lab core turn around time is 2.2 days now dramatically better than it was. and it's a huge advances there and with our city test sf site and oir public-health lab results are available within 24

to 48 hours with a possible outside window of 72 hours. >> thank you director colfax. commissioner giraudo. >> >> my question is about the increase in the rate of children that was up rather significantly it seemed and if you have any information on the root of the increase in this population of camps? >> so there are a number of consideration that's have been taken into with regard to that rate of increase. the most basic one is the outbreaks are more widespread and occurring in multi generational households and adults who are essential workers and working are essentially

infected bringing it home to the households and kids are becoming infected as a result. the other plausible explanation is we're six months into shelter in place and the kids are just getting out more and interacting more with other kids and perhaps other families and there may be increased transmission there as well. >> thank you. you don't see an increase in the daycare centers? >> specifically. >> i will check. we're not seeing a sustained increase in the centers that i'm aware of but i can report back to you on that. >> thank you. >> >> oh, yes. >> thank you. i had about throw questions.

one was first in terms of the data coming in i thought i had understood previously that because the reports also came directly to the department along to the state that we weren't going to be impacted to a great extent so is that still true or do we feel that actually a number of things slipped through and they never got to us and they got to the state and when do you then expect that the data would be aligned correctly within the week or give us an estimate if you can. >> yes, commissioner, thank you. so we do get some data directly locally but a significant preportion was set up through the system and sent back locally so we do expect some disruptions

as a result. for instance, this weekend we got 45,000 test results that were backlogged and not reported into our system. so we're now repopulating those test results based on when they were drawn and resulted so that will probably influence our positivity rate on some dates. almost all those test results were negative. so if anything our positivity rates should go down. rather than go up. and i'm being told by our data team we expect provided the state is accurate saying they fixed everything that they -- that was malfunctioning at the state level, we should have a pretty -- we expect to have this resolved over the next few days and certainly by next week. >> we would be able to see what

was there before versus once the state has repopulated -- the state data has gone out so that we can see the difference the two. >> i've asked the team to track that. >> yeah. that would be helpful in terms of understanding the impact and as you said, if these were negative it would lower our rate. >> if i could just clarify. our reproductive rate won't change because it's based on hospitalizations and those hospitalizations are local data so the fall function did not effect our hospitalization numbers and the reproductive model would still hold. >> i see, thank you. that is a very good clarification. second good evening i have and there's a publicity at this point in regards to flu vaccine

and does the department have been put out advisory about when people should be getting. there's some data that says thas people should get it earlier and versus the usual period of time where additional device is said because here in california we normally see it in december and january you should be closer to october or november but others are now saying it would be useful to get it earlier so it doesn't confound the symptom apology that may occur with a potential covid surge. i don't know if the department is looking that in terms of it offering officers our residents. thank you for the question. dr. horton, we have been working on killing our flu and ensuring

that gets out and people are aware of the importance and i don't know if you can share with the commissioner some additional details or certainly we can provide those at the next meeting if necessary. >> i can speak to that. this is how -- good afternoon commissioners. we have had our commercial meeting -- can you hear me ok? >> yes. >> we've had our initial meetings with ucsf and commune i canal disease putting together a strategy for the flu season for immunizing as many people as possible. dr. chow, i can't speak exactly to how it will workout the timing. it's still part of the discussions but i will say that our approach is going to be a -- one of removing as many barriers

as possible to immunizing the public. we expect we'll have a good supply of flu vaccine this year and we're interested in speaking outside the box and really getting as many people as possible in vulnerable populations and immunized as possible so we can prevent what everybody is concerned about which is the double pandemic. we have a team now from the dph that is working with folks in the public command center, across the network and with other systems including ucsf on our approaches here and taking it very, very seriously and if you would like, we can have that team come report or send you a

written report after this meeting. >> this is claire and i'm sorry i had trouble unmuting but just wanted to echo this is a top priority and it's a top data-driven and we'll track throughout our system as well to make sure that our stable patient population as well as the other patients and people we are treating throughout our system get the flu shot this year. >> i'm thankful for the response and i think because it's urgent, when you do come to a conclusion about how to roll out the campaign, some of us are being asked about this even though personally and professionally and it would be helpful for all of us if that information is available it's also passed on and it would be helpful. >> i have one more question, which was more trying to understand because as i

understand that you know we're in a city in which schools are not going to be in-person was we're on the watch list i think. can we get an understanding as to what is our position on schools? i know that there have been some orders and issued but they're not really quite clear and that would be in regards to the primary and secondary and then what are we doing about universities? i mean, are they just on their own and it's up to city college and sf state or usf or are we also giving advice at this point? >> there are two types of questions, the schools and advice and what happens with the upper higher education?

>> so we're in a situation where the state will not permit in-person learning until we're off the watch list for two days and the exception of that would be any waivers with the health officer so our health officer is in the process of drafting a letter to school administrators detailing the process that would be required and the criteria required to be even considered for a potential waiver. so, the plan is for us to ensure that the environment in which schools are open is safe and we adhere at a minimum to state guidelines with regard to social distancing and good hygiene and to keep children and staff as safe as possible and as you know, i think commissioners san francisco unified school

district has dedded not to open in-person a learning until next spring at the earliest and so right now, our focus is on schools that many wish to be grant aid waiver to reopen and welcome to the state for further guidance when we're off the wait list in terms of what the criteria would be from the state level and this is something that dr. aragone, along with our pediatricians and other experts including collaboration with ucsf are looking at the national situation and looking at cases where school offerings have been detected and what are our criteria going to need to be going forward so that schools can open as safely as possible and we have the authority with regard to hire education and learning and dr. aragone is working with institutions of ire

learning as well to ensure that if they do meet criteria and the guidelines are as concerned by the health officer. >> thank you. >> thank you. >> i'm doing my best to take commissioner comments and questions in the order that hands were raised. i see commissioner green and after that commissioner christian. thank you for all this excellent information. i was wondering if you had anymore detail on some of our hoppization lengths of stay and whether that is trending in anyway and also, the demographic of the patients who happen to be hospitalized as we see the case percentages in younger populations increasing. are we also seeing changes in the demographic of hospitalizations and how we have data that are the ethnic

backgrounds of our tested patients along with began you lar that patients that passed away but do we have the subset of people who are hospitalized and another thing that have we got any plans to offer flu shots at our testing sites, especially our mobile testing sites? >> >> so thank you for the question. our length of stay of hospitalization appeared to be going down in may and june which may have been evidence of less disease severity and the latest information that length of stay has gone back up again so i can provide more details about that length of stay in a update to the commissioner earlier and drr advance planning officer, has a lot of details on the

hospitalization data and we can certainly share that before at the next update as you request. we've also been able to work with hospital zoos that the detailed data on patient demographics is going to be made available across the system before now we've only had in sight into the hospitalizations at sucker burg san francisco general so that data system is on its way to being developed and we can report that to you on a timeline in terms of when we can report the demographics of the hospitalizations over all. it's been a lot of high work on part of the hospitals across the city and i want to thank them for their collaboration and cooperation and this is ensuring data across our systems and including systems that don't have our systems so there's a lot of work and a lot of good collaboration and it will help us better plan going forward in terms of our hospital capacity

and the needs of the communities of people who are being hospitalized. >> >> i just wanted to answer part 2 which is the "here & now" group is that has come up an as idea is going ahead and vaccinating as we swab them. many of many ideas that is no yonge door to the flu vaccine. >> great. thank you. commissioner christian. >> >> just adding onto the questions we've had about the flu. i was wondering whether one of the things that will be considered in expanding access will be pushing out the termination date for the flu vaccine. dr. chow mentioned there's been information that, here in the bay area it doesn't peak until

december. and so, i also know that in the past, it is difficult toward the winter to get a vaccine so i wonder if that also might be a part of what changes to make it more fatigued against us. and so, no need to answer that now obviously. my other question touched on one of my other questions touched on what commissioner giraudo asked about the demographics in kids and dr. colfax you said one of the hypothesis was related to essential workers and people living in larger households and bringing the virus home so are we seeing the same disproportionate rate of infection rising among children in people of color and the black

population and lean tino. i don't know whether it's accurate or whether or not you can see that yet but do you have any information about that. >> we have the information i can share with the commissioner. that is my understanding. >> yes. >> ok. >> and, obviously whatever strategies we're looking at will address that attempt to at lea least? >> what information can you give bus what we're seeing happening in the residential care facilities for the elderly, the rcfb versus places like laguna honda, the nursing homes? is there anything that the city has control over given it may be, i don't know a lot about these facilities but i imagine some of them are private and not

city run. >> so we do have a team that's been working with the rcfce since early on in the ep dem spick we support them with resources, guidelines, inform and guidance and information about where people can get tested and certainly if people are symptomatic and they need tested we support it and so we n report back in detail but it's a focus of ours since the beginning of the pandemic. >> is it voluntary to adhere to the guidelines you suggest? >> we provide the guidelines. we've not required it's much

les.the over all risk to the population is lower. certainly, we have the inform and guidance that can provide more details to the commission and to you by the follow-up. >> thank you. that would be appreciated. thank you so much. >> >> thank you, commissioners, before we move on, i know i did that commissioner chung did have a question and she's not able to be with us today but related to soji data and the end of july i believe. but looking at data -- [please

stand by] [please stand by]

>> we can move on to general public comment. please press star three and i'll give it about ten seconds and everyone please know that we're someone knew at webex.

>> speaker: i feel like we're kind of abandoned here and my main concern is there's a big inconsistency between the rule for opening churches and restaurants. i don't know why because we're under a much more serious height restrictions and i haven't gotten a clear answer from

anybody about that. and it's quite frustrating, especially we got rained on yesterday and as the winter comes in we're very worried you'll shut us down again and we can't go indoors to have our worship services. we've been waiting months and months and months and we can safely go inside and we wear masks and wipe everything down.

>> speaker: i just want to echo some of the things a couple other people said and one of the things i would like to request, i guess, is that you consider taking us off the high-risk list because it's keeping us from opening any time soon. we're trained anyone infectious diseases and we take courses in blood-borne pathogens and our clients are wearing mansions andmasks and alot of the peoplen francisco are small and sometimes it's one client, which seems very minimal risk and as the earlier caller said, there's data showing that we are not the

place that is the vector of spread with unemployment highly inaccessible, there's an entire industry that could go back to work that could help with that and san francisco and california is having less benefits to take care of and i think that the risk is very low as a cosmetologist, i wanted to throw that out there and be another caller to say, please, consider childrewhen you're looking at te businesses that are risky and cosmetologists, we don't gather in huge numbers. so, anyway, that's just what i wanted to say and hopefully you will consider that. grocery stores are far more dangerous to go in and thank you for your consideration.

>> so to discuss the proposed updates to the patient rates for the department of public health, for background, especially for those who are not on the commission over the past couple of years, we charge, we have a

charge master that is our patient rates for services that we provide in our hospitals and clinics and we periodically propose updates to those rates an.in ago decision to not coverg the cost, the remainder of the cost to the patient, to the

insured individual. we have about six% of our patients who are commercially insured and within that six%, about one-third of the six% was covered by health plans that were potentially in this category of legally being allowed to do this balance

billing where they'll cover a portion of the charge and the balance will go in a bill to the patient. and this is a practise that is wide-spread and kind of known through press coverage and that sort of thing, but it became increasingly clear that a lot of our patients were negatively effected by that practise. that was out of character with our mission and how we want to approach our relationship with our patients and it was in 2019, april of 2019, we brought a

package of proposed changes to the health commission which the health commission approved and designed to limit that practise. we're creating a new policy if you're commercially insured you will only pay what you would at an in-network hospital. we will simply say, tell us what your insurance plan is and charge the coinsurance or whatever it is under your insurance but not that additional cost for being out of network. secondly, we established out of pocket maximum payment at all income levels and it does vary by income level and that ranges from zero for those who are

below 138% of the federal poverty level up to a maximum of 4,800 who are at a thousand percent or more of the federal poverty level and those out of pocket caps are available to all patients and in addition to that, we put into place a lot of changes in our administrative policies about how we communicate about financial issues and how w and significans to the patients at our department work. and i'm describing all of this history, particularly because at that time, another one of the pieces that we exite committed o doing was to benchmark or charges and our patient rates

against peer hospitals. we wanted do that just to assure ourselves and assure the commission and other interested parties that our charges were within the realm of what other hospitals and consistent with the industry. and so we've done that and, i'll talk a little bit about what we found. i do want to emphasize, though, because of these protects that e put in place, the out of pocket maximum is the case that there's very little remaining relationship from the perspective of the patient between our rates and what they'll pay for care. it's primarily becomes an issue between the department and commercial insurance which is one of our cares, particularly at the zuckerburg general hospital. so we did go through this process to analyze our rates

much more rigorously than we have in the past several years before bringing them to the commission and we hired delight consulting to do a peer benchmarking study. they did that, selected a number of hospitals, compared our rates to those. and made recommendations on how we ought to adjust our rates to be more aligned with the industry standards in california, northern california in particular. and so, they evaluated 15 peer hospitals, made recommendations for areas where we are above the norm and below the norm and we applied a threshold where we are adjusting our rate so that we'll be within the 75% percentile of that peer group. that's higher than the median but that reflects the fact that san francisco is a higher cost in our study group and it keeps

us -- it takes that into account while keeping us in mind with the industry. and so we've proposed some adjustments in the rates here and there are some areas where the rates are proposed to go up and some proposed to go down accordingly and you can see that in the memo attached to your commission packet in a table at the end of the memo. and there are two areas where we've proposed to phase in those rate changes over time and those would be in the emergency department charges and trauma activation charges. ed charges would have gone down according to the trauma down. what we're proposing to do

because of the financial situation around covid is to hold those rates flat and allow them to catch up as industry-cost inflation occurs and that we would then be within that benchmark period over a period of three to five years as a opposed to making that change immediately in a single year. and so those are the modifications. taken together, these proposed rates would increase our revenue by about 2.63 million versus the last approved rates' ordinance and that's an increase but a lower rate of increase that we had -- then we have proposed over the last handful of patient rates' ordinances. and as i discussed, it would be variation and what's going up and what's going down in those categories. and so that was a lot of talking, but i wanted to make

sure to remind and connect this patient rate's ordinance with the previous discussion that we had at the commission and how we followed through on our promise to do this analysis and this study prior to bringing you a new set of rates to approve. i'm happy to take questions and we have the team from our outpatient financial services and reimbursement groups here, as well. >> folks, if you would like to make a public comment, please press star three. i don't see any hands raised commissioners, i don't see any hands, so you can move on with any questions or comments you have. >> commissioner chow.

>> yes, thank you, mr. wagner. it was a very good explain expln as to the events over the last 18 or so months. i am only looking at -- i think technically, on your page two of the ordinance, i think it's a typo that since we'll be passing this, i just thought that we should at least take note that in your column or medical, surgical 2021, you actually have it has 9796 and i think you meant 9769 because the next year, it is 9769 and that would go along with your thought that you weren't raising rates. you put an extra $30 there and you can let me know why. >> i believe that you are correct, dr. chow and thank you

for catching that. i think that has two reverse numbers and intended to be 9769 and we will clean that up. and right, that was all that i wanted to comment on so that we can have an odd rate going through. >> thank you, thank you for that catch. >> thank you. otherwise, i saw your explanations to commission grange and she may have some questions but i'm fine, thank you. now. >> thank you. >> i just wanted to thank you for the extensive answers to the questions, they were clarifying and i congratulate you with the

things that were troublesome to the public and very much appreciated the work, yes. thank you, commissioner and i'm sorry that i got the ann answero you last minute. >> perfect, thank you. i would like to move to approve if we're at that point. >> one second. do i have a second? >> second. >> i will do a role call? actually, i'm noting to amendment needs to be made for the correction commissioner chow has made and we'll make sure that is taken care of. role call, commissioner chow while you're on the screen. >> yes. chair car(role call). >> the item passes, thank you. >> thank you, mr. wagner, and your team. >> we'll move on to the next

item, the laguna honda hospital and the gift fund budget for fiscal year 2020-2021. >> hello, commissioners and good afternoon, commissioners and dr. i'm william frasier. currently i'm a dsw worker in outbreak management, and so thank you for having me on your meeting agenda today and thank you, mark, for your excellent work in facilitating this meeting. laguna honda hospital seeks your approval of the 2021 fund budget. we are putting our budget together in the spring before the fiscal year and this year we faced a bill challenge

determining what life was going to look like at the laguna honda and how best to meet the needs of the residents through our gift fund budget. our approach was to go at it with the hope that things would return to normal sooner than later. of course, that doesn't seem to be the case, but we're hoping that we'll be able to pivot and adjust. and an example of this is early on in the public health emergency, we use gift fund monies to purchase 20 ipads -- i'm sorry, 50 ipads, to facilitate video messages between the residents and the families and friends. the gift fund remains a a wonderful resource to help us meet the needs of the residents.

and so, i'm going to take you through the budget and just point out any variables that you may be interested in and i will let you know that there's been some reorganization and you will see for the first time we have an item called discharge support previously undermiscellaneous and we're ramping up to prove the success of the discharges to the community and we're using the gift fund to provide residents with items like toiletries, clothing, luggage, and things like that that would help them be successful in their discharge. and some other variables that you should be aware of that there are some expend tour expee

related to purchase orders in the previous fiscal year and there will be -- well, actually on the 14th, those charges reverted back, but i had to have this information in on the 13th and so, i would say that the total expenditures for the gift fund budget, you can see at the very bottom as of the 30th i would probably would estimate there's another 15 to $20,000 that will be reverted back to the previous fiscal year. but just going through the different line items and the variables you may be interested in on. first on behavioral health, i want to explain the increase. increase. our behavioral health program,

specifically what we call our laguna premiere club acquired a special computer system, especially designed to meet the needs of the ederly and disabled residents. we got that through the wish list and that comes with a $3,000-a-year subscription for the content and it's a great, great resource for that particular items going up. and you can see that we've also added covid-related support. of course, we'll need to address those needs, but we received $13,000 of donations, specifically to benefit the residents. and that is our practise, is to acknowledge and to try to meet the intent of the donors.

then there's discharge support and i do want to explain the friends of laguna honda wish list. we've been working with the friends to kind of line up our fiscal -- our years. they work in a calendar year and we work in the fiscal year and we've been working to kind of align those so that they'll work together, but you may remember i came to see you maybe -- well, i came to see you in 2019, asking you for an increase in that particular budget and we have to go through a process of having their donation accepted through you and the board of supervisors and a number of issues, including covid-19, prevented us getting that through the board of supervisors before the end of the fiscal year so we were unable to spend that. so we were carrying that over

and the $90,000 reflects what laguna honda committed to donating this year. the only other item that looks variable is the memory care program. there's about $5,000 worth of expenditures that will be reverted back to the previous budget and will be eventually reflected there, but that also represents plans on the part of our memory care programs to up the acquisition of century stimulation equipment. and if there are any other items there that you would like an explanation for, i would be glad to give them to you and i would glad to answer any questions that you may have. >> before we move on to commissioner comments and questions, secretary, do we have any public comment on this item? >> we do have at least one. i will remind the public if you

would like to make a comment, press star three now and i'll un-mute the one call they're i see. and i will put two minutes on the timer. are you there? >> i see commissioner green. is that a leftover han raise from the previous item? >> i think that's a left-on the other hand hand. >> thank you, commissioner green and do we have any other comments or questions from commissioners? >> can i just express my

appreciation to mr. frasier for the completion in the work that laguna honda are down as representing by mr. frasier and in the overall covid response? this is an intersection and i just wanted to add that laguna honda, we've had a total of 82 total covid cases, 60 among staff and 20 among residents and so far, right now, we've had no dennings among the residents due to covid-19. and we have no active cases among residents. we have ten active cases among staff, which we attribute to the increasing community spread. but just to reinforce that this is supported by the gift fund are more important than ever given the covid-19 pandemic. as the commission knows, laguna honda has been severely restricted because of the covid-19 pandemic and just i want to reinforce how important

it is that the residents get the support that they need, especially during this extremely difficult time. thank you. >> thank you, director. and i also want to add to director's word, thank you, mr. frasier for your work and the work from all of your colleagues and laguna honda and your adaptability in your personal work and everybody there. laguna honda is a model for the nation in responding to potential covid outbreaks and it's work on the ground, as well as cooperation with it federal government, the cdc and i know there are many lessons learned that dph has applied with other long-term care facilities in san francisco. and so that is directly attributable to the excellent work that's being done at laguna honda and thank you for that. if we do not have any other questions or comments from commissioners, we can entertain a mission to approve. (please stand by).

i'm not hearing him. >> ok. well, i guess what we can do is he is in the next office over. we can mask up and carry an with our presentation. thank you very much, this is just a special report from our covid response dr. brown is on our office right now. >> good afternoon, commissioners. >> this is a special report of our projects that we have been doing with the covid-19 response. we've been activated since day one towards the end of january and been very busy both with covid response and also running the 9-1-1 system. we've been wearing multiple hats and i just have to do a big shout out to our staff they've

been working tremendously hard on creating innovative projects and not complaining and just doing a fantastic job. is without them we wouldn't be in the place we are right now as far as our projects that we're doing and also the 9-1-1 system. so, just to give you an update of our presentation summary we're going over some of the projects that we've been working on. and i think the commissioners did receive a dictionary of we're start with the mow chalk dr. brown will go ahead and give

his presentation on this. can you hear me ok, commissioners? >> >> yes, we can. one of the major functioning is acting as this medical operation coordinator or mohawk and we are a link between the san francisco as a city and county which is called operational area so we're looked for coun tease in our region which is region two of the state the bay area going up to the oregon border and and through that region to the state, so when there's a need that we can't fulfill within san francisco, either by the normal functions such as a hospital

purchasing to their supply chain or obtaining through their hr process personnel, then we go to the region with the request and if it can be filled by our coun tease in the bay area, that will be done and if not it will be brought up to the state level. so, some examples of the functions that we're doing coordinating disaster medical health resource and patients distribution and medical evaluation and inpatients emergency care provider around clarifying regulations, getting a scope to practice established that type of thing and then, assist ing the establishment of field treatment facilities and these are examples what we've been involved with so far. we're now up to 64 resour request examples of these range

for large items like a federal medical station which is the basis for the sites up in the practice seed yo to cleaning supplies such as wipes disinfect apartment rapes and it depends what we are unable to we have helped out other communities in the drug during a phase of their illness. it's closely allocated by the state to the difference county and the different cities and counties by their hospitals covid patients burdens. we saw dr. colfax's presentation it's dynamic. by the time the allocation is received by the hospital, they no longer need it or they need

more. when we tried to exchange within the city we do it through our hospital unit here at the covid-19 command center however when we don't have that ability we need some and we'll go outside the county and so we have helped out slano county that needed an emergency transfer. that's an example that came through the mohawk. coming in and out of the county most recently you are aware from imperial county and the surge they had down there and from the difficult outbreak at san quinton, san francisco is still receiving some patienc patientsk when this started in february or so we had the grand princess cruise liner that came in with several patients that had to be distribute today the bay area counties and participated in the distribution of those patients' determination of where they went

to. we've been helping with plans on the dph side and board and care facilities utilizing a blended ems providers and emergency providers from hospitals and from the field care clinic. we have responded to request mainly for information from the state office of emergency services and then we've been working with dr. luke john day and the group of chief medical officers from all of our hospitals on the distribution of the medication. we're now getting weekly allocations and they've been increasing in size. when this first started, we were getting them every two weeks and it was a much smaller number. we're trying to respond quickly and pivot quickly as our needs change when we don't need the medication we try to make sure it goes to other counties that need it and when we need it we get exactly what we do need. next slide. >> thank you, dr. brown. the mohawk program is something

that is on going. it's not necessarily due to disasters but it's a program that is constantly in the background and so early on, we're test come up with a based on very little information knowing that there was a pandemic pending and it looks like historically there was a big push on the 9-1-1 system and those patients would end up in the hospital and we looked at it and we came up with our ems search plan for the system and we followed the same color coating and it means the

different levels of search we've had. our expectation is we would surge just like the hospitals were but what we found out, up until a week ago is the 9-1-1 system actually dropped about 25% in call volume so for the last five months, the call volume, the 9-1-1 call volume has been down about 25% and up until about two weeks ago, we're back to normal levels. our ems surge plan is based on a lot of different factors or triggers and each one of those triggers represents a response that this system will automatically kick in from green to austere care out in the community when things the system overwhelmed and we had this in

place and it's our working document for when or if a surge happens in the 9-1-1 system that it's pushed over to the hospital system. along with that, we developed a transportation and communication hub. we started out with one dispatcher and in our conference room at 90 van ness into a fully functioning interactive dispatch center at bill graham. we have multiple people 24 hours a day running a, basically a transportation service and part of that service is we do the inter facility transports from the shelters to the hospitals. we do street to shelters, greet

to hospitals and we also support the 9-1-1 system. we provide support to the public-health services field testing unit on top of that and we have partnered with a lot of different people the public-health nurse and nor cal ambulance and amr ambulance and they've been very, very beneficial and the success of this program as you can see our volume is has up and down and they've been steady and increasing and the need and transportations and we have about 15 paratransit bands on a daily basis and five ambulances for supporting ambulances and they're there basically from 7:00 in the morning until running those calls and we have

another based out of there which is the program which dr. brown will talk about in a few minutes and it's a very robust program and it's been very successful and we've also just started a new program from a health officer order to test in the communities and we have a unit that will either go out on site and test someone that has passed away or we will go to the funeral establishments and test and take this gust and to the public-health and finding out about that did have a cove and and up to date, along with that, we felt with all the shelter sites and place and we decided

that one of the things is a safety of the individuals that are at the shelters, we developed a aed and external and and training program so we purchased the defibrillators and we're currently scheduling training to train the staff at all the sites and the use of the it's been a year and a half in the development process originally envisioned starting last doing a better level loading or matching of capacity

for the system with their new hospitals coming online and for san francisco central begun for helping with the diversion. we realize quickly in the development of this program we have a lot of input and thanks to our partners commercially and who went through three test of concepts and assimilation, pretty large scale and helped us to define the program parameters so we're getting some data and looking at some specific outcomes that i'm about to discuss and should we experience levels of surge in the system and we have not, we're very fortunate and being done on the preventative side and should we have that we will be able to absolutely maximize the ability of the ambulance fleet to find every single area of capacity in

this system and have utilized every capacity with available rather than overload some areas and under utilize others. so this program is operating 24/7. it operates out of the health that you have just seen. it's staffing models it's either a paramedic supervisor plus a emergency physician with base hospital training and base hospital means that physicians, emergency physicians that workout of san francisco general hospital who are trained in contacting and working with ambulance crews on a regular basis so every day there are calls to the base hospital from the ambulance crews or advice and for certain protocol items so they're working with the county supervisors and when not available we have two paramedic supervisors that are again looking at the over all system and the hospital and and they're

able to factor in such items as icu capacity if that is limited and it's been the biggest change that we've seen in issue we've seen around covid patients. look at number that is 11,600 calls in three months and in our system to give you a sense of perspective, we have 50 to 60,000 destination calls in a year's time and these calls they are the code two calls and redirect patients that are critical because it's important they go to the nearest facility regardless of the capacity issues and then we're also not trying to direct specialty center patients that they're not directed by the caddy pilots and individuals who are on duty at the caddy system. briefly listed are the goals of the system and in the first

slide in the center daily transport -- average daily transport to static emergency department capacity. what this means is, if hospital has a 20 emergency department bids, then they are getting 20 ambulances over the course of the day. if they have more than that number of ambulances the ratio is getting to be greater than one and if they're getting less than that, they are getting a ratio and the same 20 beds they were getting and 30 ambulances a day a 1.5 ratio and five ambulances a day, so we're trying to get this ratio this is all data post cove because it's

important to remember emergency department volumes have dropped by 35% city wide since the shelter in place order and ems has dropped 25%. we're not taking data before the pandemic, that would not be a good comparison. we're taking pandemic data before the program start and after. we're seeing improvement are goal being to get one the large number you see in the lower is the compliance rate of the crews with the programs are targeted here with 80% comply bans because from are exceptions and the crews can't communicate very well with caddy due to technical issues or other extenuating circumstances you might not call in and it's present in hospital.

we are finding that some things have been improving and other things staying the same and other things have not been improving. there's been a total decrease in diversion which is part of our goals but we're trying to analyze is that do you to the decrease volume in emergency departments and due to both. we're also seeing a little bit of a trend in off load time which is the delay that patients might have when they're in emergency department getting

we're following up with hospitals with higher levels of diversion and longer turnover times and seeing where those might be cause be and whether or not they're causing problems for the system. >> thank you, doctor. one of the things that we have really looked at is the pre load of the hospitals or the front end of the hospitals. we're also with the communication hub. west ambulances there to help on the off load of the hospitals so for patients that are needing to be discharged to free up room for patients that are sitting in emergency departments waiting from a bed to free up. these ambulances and units can be used to move those patients out to sit by the sites or where they can do for a step down error. the other program that i talked about earlier is the testing unit. just to give you an idea of where we are. we started out in june, late

june, when we looked at our data in july, we only were at the 55 test and as of today, we're at 230 tests. so fairly busy operations in coordination with the communication hub. one of the other things that we looked at in our surge plan is cardiac arrest. the potential of the exposure to the providers and doing cpr because we're doing cpr you are pushing down on someone's chest to compress the heart but you are also pushing the lungs which then air comes out which could be droplets so what we tried to do is create some programs it's

an assist program and if it's a mechanical compressor so it simulates or does mechanical chest compressions we have less chances for exposure. we have 12 devices and four on the rescue with the fire department on 24/7 and one each on the amc supervisor and one on the marine union exit we have a few back ups. we did a lot of training and we did train the trainer and along

with all of the covid responses, we had to stay on top of our policies and procedures and being -- thinking more towards what is coming next and preparing for it. we have the new protocols on mechanical cpr devices, the lucas device. we had to redefine our protocol on respiratory pandemic so we don't use certain drugs for ar solation of medicine and increase providers in an enclosed space in the back of an ambulance taking care of a patient. we looked at assess and refer things where we respond and 9-1-1 searches where someone might not need to go to the hospital so a 9-1-1 unit will go out there and assess the

patients and refer that to another source of care. and we also looked at airway management policies and other than a designated and emergency room and i work with the state to allow us to take those patients as needed through other sites through the field care sites at southeast and we can take them to a couple of other sites and pick them up and and

we used the basic life-support ambulances in the 9-1-1 system through the communication hub or or we'll do a memo that allows other providers to provide els ambulances in the system when it becomes very busy. we have changed our local optional scope of practice that allows ems providers to do testing and also we've allowed our ems providers to work in static healthily facilities like the field care treatment centers or skilled nursing facilities in they run into staffing issues. we have looked at ems providers to assist in giving injections

and and to make sure the crews have that information and they can proceed with monitoring their own health and falling over there occupation we have cooperation from systems and we have some holes in the system and we're working and we've had about 316 positive notifications for ems contact patients than we've contacted up to 10 or 12 individuals because it depends if it's a ill patient and there was multiple ems providers on site doing resuscitation and we

want to be sure they have that information followed up with their providers. one of the last slides that we have is not only are we really deeply involved in the covid at multiple levels, so the covid response, we have our regular ems business that we have to attend to and running the 9-1-1 and they went out on july 1st. we have all the providers signed and we're still waiting on one. hopefully it's coming soon. we've instituted a new ambulance audit tool which helps us evaluate new ambulance service that's would like to come in and work in the city so that is up and running and we have one in the process currently and we have to do emt certification and accreditations and both emt and

paramedic and we also had to move like i said earlier and the program, we've moved from 90 van ness to 25 van yes and this is a temporary location and we'll be moving again and probable february of 2021. i just want to give another shout out to the staff, they have been in absolutely an incredible humbling experience working with some fine, dedicated individuals and we would not be as successful as we are currently without their dedication and involvement and i just want to say thank you again and that is the end of our presentation and we will answer any questions that you might have. >> do we have any public comment on this item? >> do i not see any but if you

would like to make comment on this, press star 3. we'll give it a few seconds to make sure we catch anyone who raises their hand. >> thank you dr. brown for your detailed presentation even outside of a pandemic and services requires a great deal of precision and planning so thank you for bringing this presentation to us and for all the fantastic work you and your colleagues have done. we have a comment from commissioner chow. >> thank you. i certainly echo president's comments and concerning this division and agency and i'm a very impressed with the caddy

project. after so many years of looking at ways of trying to help the different adjust and and, i think that as we look at the future, and it's not and under which if it's someone else's work we would look at some of the previous benchmarks that had been established in terms of response and where we are now in regards to that and either in a local and comparison to either region or a national levels.

>> in a couple of areas, we are continuing to monitor the situation and i think we have not seen any deterioration and improvements so two examples are, we've participated in the cares response and survival data base and national project and 20% to 30% of the ems systems in the country, including all of california, and they provide over a two hospital discharge with good neurological outcome are in the high 30s range and that is good in the sense got continuing however, it's not our goal. our goal is to get into the 50% range it's been a long-term coal so we're not satisfied that we're not sliding backwards.

we need to continue to improve there and so aed project you heard about is one small component and we hope when we get into phase 3 of this pandemic we'll redeploy those devices to areas of the community that are under populated since the whole southeast corner of the city has very few aeds per person as opposed to the financial systems in north beach. we want to try and apply that and to get more survival because it's clear rapid cpr and defibrillation are very important part of life saving even more so than the response times and it's what we measure. our response intervals are still not where we need them to be. we're trying to reconfigure how we evaluate them and to be careful we're applying a national standard that we're taking the same times everyone

else in the country and another area which is our life-support therapies that the paramedics are refield we are trying to adjust our protocols that follow what is the best practice that the paramedics are providing so for instance, we made a change where we're favoring the over and the because it's more successful in the field and we want the most successful therapy to be applied that we're using in the community and we want our rate improve and we want to get them off the national standard they're in the 60% frame so the fire department has a program and to implement video learn which is the type of technique to improve that and therapy and working with dr. crayon that we'll be leave evolved in the

training and the roll out so that we get up to the national standard in that area. while we are not backsliding we moved from one emphasis of one therapy to another and we want to get up to exceed and on our website and the commission devise and i think in the past sense either quarterly and metrics and i think we would be happy to continue to do so. thank you. >> we'll be introducing new dashboards january 1 to reflect the standard. the other thing that we're doing as far as cardiac arrest, we have developed a very innovative

program that looks at com operation rate and a quality of chest com persions and it's nowhere else in the world that they're actually looking at it and at the level we are according to a lot of industry experts and they have a keen eye on the work that our staff is doing and creating that program where we can actually analyze the quality of a single com operation. with rate and release with the hopes of increasing cardiac arrest outcomes with quality chest compressions. >> i thank you very much for actually getting offer to bring black information and i know how busy it's been during the transition with the department and all the challenges at covid

we don't want to interfere with the great work you are doing and you were able to create the caddy project which had been something that was dadly needed as we looked at our different institutions and the issues of diversion or rightly getting patients to where they building. so i suggest working with the commission secretary and president to find the right time to begin again a reporting back our success as we tried to move our own numbers back in terms of response and the goals that you are saying so we can appreciate the work that you are going to be continuing along that line and i would leave that with our officers to find the right time to do that.

thank you. >> do we have any questions or comments? >> if not we can move on to our next item. >> can i just want to acknowledge and thank patrick brown and the incredible work during covid and the epidemic they were engage and involved and i think that the work they've presented speaks for itself and just to say that the pandemic has brought the best forward in our ems system and the work that they've, the foundation that they've laid for the last few years in terms of the ems roles and responsibilities really shined brightly during the pandemic response so just acknowledgment

of their leadership across the department and the city as a whole. thank you dr. brown and jim. >> thank you director colfax and we associate ourselves with your remarks. moving onto the next item for action. resolution honoring maria x martinez. she passed on july 15th. she was highly respected both within the department and large and we all mourn her passing and we're grateful to have dr. hale hammer before the commission acts on it and i would like to hand it over to secretary mor morewitz and dr. hammer. >> thank you very much commissioners, dr. colfax and

secretary morewitz. it's a honor to introduce this resolution recognizing maria x. maria x, as many of us knew her was a trusted colleague, mentor and friends she served as our director of whole person care so this resolution before you is well primed with our hope and care act which will follow. when i think of my dear friend and colleague, maria, the four words i think of are commission, wisdom, vibrant, and ex h again.

she left a mark on the department of public-health in san francisco in the programs that she helped develop which served people experiencing homelessness and think the latest of these programs but it's really a tremendous honor again to radio introduce this spirit and the work she did for us over her 23 years. i'm going to turn it over to mark. so you all can hear and the public can hear, honoring maria x martinez. whereas, she served the city and county of san francisco as a devoted san francisco department

of public-health and staff member and leader for 23 years and whereas, during mrs. teen he is tenure, she served in the following leadership roles. deputy director of community programs, senior staff, director of health, chief integrity officer and and whereas the highlight of her career at the dph was her role and extra care and aims to improve outcomes for adults and experiencing homelessness and san francisco and to enhance care coordination and they solidified among dph the department of homelessness and supportive housing and bringing them together to wrack in ways they had been under her leadership envision san francisco adopted a population based approach providing housing and human services to adults experiencing homeless.

it highlighted care coordination and inner agency data share to identify and problem soft and street to home plan with whatever it takes approach. she helped build initiatives and public policy and for the past 15 years she was an active board member of the chicana latina foundation where she developed the leadership institute for relationship recipients and she died on july 15th, 2020 surrounded by a loving circle of close family and friends now be it resolved that that san francisco health commission honours maria x martine he is for her lifelong commitment and dedication to improving the lives of others through her service and thoughtful leadership. the san francisco health commission conveys its heartfelt condolences to ms. martinez's

daughter and other family and colleagues and friends. >> thank you dr. harmer and thank you for mark i would like to say and in addition to the remarks offered by dr. hammer in reading true this resolution there are so many words that just pop out that remind us of her fantastic work, partnership, vision, problem solving and it's all things we knew to be closely sewated with maria x and her work. we would approve this resolution and it's though we can take this on whole person care both as a tribute to maria x and her leadership and our contributions because this is such a deep and strong legacy that she's left not only within the department but serving the entire community

in san francisco. >> i don't see any public comment before you all move forward. >> thank you, mark. commissioners, do we have a motion. comments or motion to approve. >> so moved and i would echo your comments, so. >> thank you. >> we all -- (inaudible) and she was always wonderful. >> everyone she touched was someone that seems so personal to her. it was just amazing. >> thank you. >> thank you. >> second. great. >> yes.

>> commissioner ger add owe. >> yes. >> commissioner christian. >> yes, commission gren. >> thank you, the item has passed. >> thank you and i know i wish we would be seeing maria x for this next item which we will now bring up the whole person care update. >> i've given you permission to present and i'm not sure if you are the person that will share your screen i need to do a special -- it looks like you are, great, thanks. >> can you see my screen? >> yes. >> great. >> thank you very much and i did want to add that we'll have another chance to celebrate her

life on september 3rd. we'll send out an announcement about the event we are planning. the whole person care team is working with the family and looking forward to a beautiful event to celebrate maria. ok, so, i have the pleasure today of producing amber reed who is the acting director of whole person care and our medical director for whole person integrated share and edge under care and amber will present the update on whole person care and the last time we presented this update was maria and me presenting to the health commission and there were some follow-up items we were asked to come back and share and that's

what we're doing today and i just want to let commissioner green know that we received your questions and they should be addressed in the talking points and if not we'll be happy to address them after the presentation. so, with that, i will hand it over to amber. >> >> hello, everyone. can you hear me? good afternoon commissioners, i'm pleased to be here giving you an up update this afternoon and thank you for your kind remarks about maria. today, we are going to be level setting on our program goals, providing an update for our data sharing solution and care coordination services and discussing sustainability for whole person care beyond the 2020 waiver. so as a reminder, san francisco

whole person care is focused on people experiencing homelessness and we have a two-pronged approach. first is innovation and technology and second innovations in service and we talk about a data-sharing platform that will allow us to share comprehensive, integrated health hazard and benefits data for shared clients. the innovations and service, care coordination and structure to care for the highest risk and utilizing clients across the city's echo system and services and it's unique it's an inner agency partnership also. we've taken a human-centered design approach to identifying and understanding opportunities for improving the homeless system of care. this is a map of our discovery work and there's a lot of detail

here and we don't expect you to read through it. it's an example of a whole person care client and they're run by different departments and different locations. what this highlights is the opportunities we have for improving coordination and communication between these programs. it's during these times of transition between and wore optimistic our inner agency data sharing will facilitate better communications between providers and staff. next slide, please. are you able to go to the next

slide. through whole person care we're implementing the inner agency data sharing solution and i'll walk you introduce the component. we're care coordination functionality to the current installed and this means and shared cool set and care coordination and working together and we will make the data in information more accessible to providers. this will also help us to identify people experiencing homelessness who enter the

system of care through any door and so if they come in through hsh, the shelter system or dph or through hsa we'll be able to identify them and locate them more easily. we're expanding access to non dph teams to epic and we're excited about this because this means that teams like ems6 who provide critical services to people experiencing homelessness who will also have access to that shared care coordination tool set, and this will facilitate better coordination and this is possible because of the groundwork that we've been putting in place for the last several years is data sharing agreements and implementing protocols to allow this information to be shared. next slide, please.

our work is positioned us to be a key source of data and specifically attempt to mitigate the impact of the pandemic on people experiencing homelessness and our data infrastructure is built on longstanding relationships and partners between agencies and because we have this data and understand how we're able to use it, we were able to quickly develop a risk assessment methodology based on cdc guidelines enabling us to locate and identify individuals rapidly and individuals who are at high-risk for complications analysis of this has helped inform policy and planning decisions as well as we're able to provide a daily census report for people in the shelter in place hotels and isolation and quarantine sites and provide that to providers which facilitates targeted

outreach and linkages to necessary services and then finally, because we have this data infrastructure in place we'll be able to more effectively evaluate our interventions in the future. next, please. so, i want to give you an update on the shared priority project which you all heard about in october. just to remind you, last summer an inner agency group of stakeholders came together and through this project dph, hsa and hsh came together to take a population-based approach to provide in the health, housing and benefits. the goal of the project was to create street to home plans and then to identify and problem solve system barriers that arose

throughout the process and those system barriers that we were able to identify and problem solve for and not just the 237. so an interim evaluation of the or progress update for the project was conducted with take stakeholders in february and the evaluation of the process is on going. some of the things that we heard from providers during that initial check in was the shared priority label is effective and opening doors that won't be open. that shared party project is helping teams to be creative and flexible and carrying for vulnerable clients and individuals are getting help that wouldn't be if it weren't for this project. so the shared priority project team continues to meet weekly and we report on on going progress through by by weekly dashboard. can you go to the next slide.

so this is an example of our by weekly dashboard from august 11th and the dashboard exclusively follows the original 237 and it highlights our progress and the difficulty of the work. since we kicked off in october of 2019, from the 237 clients, 126 are currently housed and 35 are ready and awaiting and ununits and they have all the document this is place just waiting for the unit to open up and 117 are connected to dph case management and 184 is received housing navigation or case management services through hsh. sadly, 13 are deceased, which confirms that this is a very vulnerable group of people.

this is a living situation overtime since october. you can see along the bottom is the green is the placement into a permanent supportive housing. our goal is to provide services to all 237 of these individuals in the cohort and support their journey towards recovery wellness and housing and we are continuing to work on that project. i want to turn it over to the doctor for the next couple of slides. thank you. >> thank you, everyone. thank you commission for the honoring maria x. it is very strange to be giving this presentation and very hard to be giving this presentation without maria here and her work

is absolutely inter woven into all the work we've done. i want to talk about a few things. this is the clinical arm of whole person care. at the onset of the covid pandemic, we had quite a lot of knowledge and monday evidently quite a lot of anxiety about what the effect on people experiencing homelessness would be knowing that much of the homeless population was in categories that were high-risk for acquisition and categories that high-risk for complications and death from covid-19. we also understand that outside of the effects of the virus the

homeless population historically is our high users of emergency departments and high users of acute hospitalizations and we wanted to do everything we could could be ready for the surge and cope these people kept out of the hospital out of the hospital. and we were aware that the interventions meant to prevent spread of covid would have great disruptions on resources for people experiencing homelessness and related to sheltering and drop-in centers and all the other services. the goal was to design a response to mitigate these risks and the work that was done through whole person care through our experienced with the

shared priority project and made this -- i think i can say, made what would have seemed to be impossible a couple years ago feel like it was in the realm of possibility. because we have data that we had never had before and we had relationships between departments and among divisions that we never had before. and that was an incredible gift, really, to be prepared that way and prior to cove. when cove started and the smelter in place were ramped up we were able to quickly work with human services agency department of homelessness and supportive housing and on having a mold of care that would work

and didn't require hours and hours of plan tag it would have required had we not done this work together previously, i'm very aware that looking at dashboards is, they look very good and in the real world and this has really made it a big difference for us in being able to develop these systems quickly and provide care. next slide, please. i also want to talk about our response to unsheltered people experiencing homelessness and during the covid period of time. we started this spring and late last winter planning for an

expansion of a high intensity care team related to shared priority. we took the existing ems6 model and said what do we need to add to it to be able to be the outreach arm 20 hours a day for the shared priority project. and we were well way with planning that although not particularly implementing it when covid hit. we were able to say, we need this team to be up and running. we need to be working closely with ems6 and with sf hot and we were able to reach out both to the shared priority population,

to the ambulance and 9-1-1 system high user population which were the original populations but we were able to expand to unshelter people at high-risk of high-risk of harm and develop a daily model in which we have street medicine staff working with ems6 and nsf hut on a seven day a week basis. planning that would have taken many months that was compressed into a period of time of days and it was greatly helped by the work we had done before. among people experiencing homelessness we've had a few cases of cove diagnosed and very

few deaths. one death recorded of a person experiencing and although we believe that person's death was related to an oohed medical condition that were identified as also covid positive. we've seen a big increase in homeless deaths during this period of shelter in place and we have no way of knowing, it's certainly seems to me that increasingly in homeless deaths would be much greater had we not implemented these interventions and work with what we had built on with home person care. i wish that we had the epic care

coordination module implemented already and it's very easy to see how that module is going to be very helpful to the on the groundwork that we're doing when it is developed and goes live. back to amber on the next slide. >> thank you. i want to wrap-up with talking about the sustainability and the whole person care work. over the next year we'll focus on sustaining that work. the whole person care team will be integrated into the clinical arm of whole person incompetent greated care which we'll talk about on the next slide. we'll continue with the optimization of the care coordination tool set through our work with inner agency partners and we'll foam us on

new homeless health resource center on track to open in november 2021. next slide, please. in the future the whole person care team will sit back in the whole person integrated care organization and this is a simplified chart of that. as a reminder, whole person integrated care is and we've identified behavioral health service leaders that will bridge between and and inner agency and

collaboration. and i am very please today introduce our new director of whole person integrate care dara and it's coming to up from the supportive housing and she's here with us today. she will start in august and august 22nd in her new role but she's been a member of our team for the past three years so we're very excited that shell be taking on this new and important role. thank you, dara. i want to wrap-up with an image

from the project design workshop late last spring and you can see maria x martinez and to her right, and maria x martinez's vision and commitment to the vulnerable population and on our project the department approach to serving vulnerable populations and our team is so proud to be here today and thankful for everyone's support bringing this important work to fruition. thank you. next slide, please. >> before we move forward, do we have any public comments. >> i don't see any hands raised.

i'll give it a second. do you want to make public comment on this item, press star 3. all right, no comments, commissioners. >> welcome to your new and very important role. thank you dr. hammer and dr. zevin and ms. reed for this presentation. before we go to commissioner comments or questions, i'd like to recognize director colfax. >> thank you, commissioner bernal and i just wanted to thank dr. hammer and the commission for dr. hammer for her introduction of the resolution honoring maria x martinez and just to reinforce that maria was a beloved colleague in the department and a mentor to so many of us. i was able to work with her very closely during my prior tenure at department and was just

incredibly -- i am so grateful for being able to have done that and be training as a department and seeing what she was building and what she developed and with all the kindness and guidance and commitments that is shown through in everything she did so just acknowledging that and supporting the words that have already been spoken and her spirit and we all feel her spirit with us here today. thank you. >> thank you, dr. colfax. commissioners, any questions or comments? not seeing any questions or comments, thank you again for your presentation and for giving us an update on this critical work. i just personally i particularly appreciate the slides showing the journey of someone who is

receiving care and their experience and how we can provide services to them. it helps visualize and understand what the experiences from sort of a client perspective so thank you for that as well. >> commissioner christian raised her hand after you began speaking. >> thank you president bernal and thank you mark. i just want to say thank you and how grateful i am as a person who lives in san francisco and someone who works in the criminal-justice system and has spent a number of years working with the population that people who need and and seeing up close and firsthand what a difference

it makes to have these great emphasis on providing the care that the person needs and a coordinated way in a way that is collaborative with who do work closely with some people in the population and i wanted to know, i know there would be written 237 in the -- i don't know if you call it a pilot originning thor theinitiative what about bg in more people and how do you know what the capacity is that you are going to aim for? i'm just curious to see what

work goes through there. amber, do you want to take that? sure, i guess i consider this was a pilot program to better understand what it will take toktoeffectively serve this population and we heard to be successful, we need to ensure we have adequate staffing to support inner agency care coordination it's a high touch work and we also need a shared tool set and so we're really excited about the implication of the ethic care cor din module because it's all od and better identify and cohort and groups in the future should the department chose to carry on this work in this way.

>> thank you, i can't imagine the circumstances we would not want to expand this work. for only people outside of the public-health system and you know, ela person to the system and you talked about it being high touch work and seeing how high touch it is and seeing it does give result and it can work and it's not a trajectory or always up and always down it's up and down and it's the way of life for human beings and please note your work is experienced by those of us who see it in another realm as experiencing working thank you. >> thank you very much for your important words. we really appreciate it. it's great to hear that.

>> she will keep in that mind as a model for this work. >> thank you. >> thank you, commissioner christian. >> thank you. commissioner chow. >> yes, thank you. and i want to thank everybody for their wonderful presentations. i'm looking at the future chart and i'm trying to understand because you've already developed an entire system that seems to be working so well and does it mean that whole person incompetent greateintegrated cae people. how much better can you get and what does the full person emigrated care have to what you are already doing with the 200 -- 238 or some odd people.

are we meaning to add more people or additional services or just trying to understand our next steps that you are talking about. >> so i'll address that. so, whole person integrated care is a constellation of clinical programs and you'll of which serve primarily serve people experiencing homelessness so these are programs interested in the health department and in different areas and until we hold them together, and started to integrate the program they did not all work in a coordinated way with each other. by having one organizational

structure a director to a medical director and really coordination through the ccm module and ep dick and case conferencing and cross training staff and we hope that we can do a much better job of taking care of this essentially a larger than the 237 who are in the shared priority group and it's really all people experiencing homelessness who touch our systems and provide these services and the health department. so, none of these is a new program and the newest program is actually in care so that's the data design and quality increasement program that came about because of the current

medical waiver and now it's a waiver that is ending and wore bringing it into whole person integrated care as the data and design team for these clinical programs. so, i hope that answers your question. i'm really excited to have them all come together and i think we addressed, it was really signed of fast tracked this work of coordination and synchronizing our work with covid because we had to come together and say how does cheap medicine and how do we work with the care coordination team for transition and our respite group in terms of comment -- how can we elaborate our work is much more integrated and coordinated and

the epic work wore doing right now is the culmination of that. >> if i may just try to understand the follow-up, our current whole person care is a wonderful example to try to draw these agencies together as you depicted here to try to work on everybody that needs this beyond the 237 and will the 237 stay in this pilot then and a group or is that going to really transition so that the 237 might be 500 or 600 within the whole person integrated system? >> amber was correct in how she addressed that the commissioner and it's a pilot and we really learned a lot from it how much

you can came by coming to the table together and across agencies with human services agencies and the department of homelessness and supportive housing with services and focus on the population that we can find as being highest needs and where we can really make some progress focus on a defined group of people. the boundaries around that group will fade away as we implement this module and epic as we figure out how we continue those cross agency work after the end of the waiver which was ending at the end of next year as we continue to see the benefits of

cross agency collaboration, in our care of these complicated population. not just 237 but but really the whole the with complex behavioral health medical, and psycho social needs. in terms of sustainability, our new homeless health resource centers that you heard of referred to that would be opening in november of 2021, that will be a sustainability plan for this because we'll be co located and staff will be co located with hsa and hsa team and we'll have a place for people to come to access housing

benefits and healthcare as we've envisioned in our homeless and care work. thank you for helping to amplify further and we can all look forward to the build out of this future. a great legacy for maria x. >> this is definitely her vision and this agency collaboration and data sharing was her vision. >> >> thank you. >> any other questions or comments? >> thank you for the great presentation and we look forward to hearing back the next time. thank you. >> we'll move on to the next item which is other business. commissioners have any other business? >> i believe we can move on to the next item.

which is closed session. did we have a motion to enter into a closed session? >> moved to enter. >> so moved. >> i'll do a roll call vote. [ roll call vote ] all right. so thank you to everyone who is not going in the closed session. i'll turn a function to cut you off and thank you to the public who joined us. you also will be cut off from this portion but you can stay on if you like and join later. to see what happens. commissioners, give me 30 seconds please to turn on the extra.

>> commissioner chow [roll call] thank you for a great meeting. >> thank you all, great to see you. >> thank you. >> great to see everybody. >> good night.

>> the meeting will come to order. we welcome to the thursday, august 20 meeting of the government audit and oversight committee. i'm gordon mar, the chairman of this committee. joining me is supervisor aaron peskin and matt haney. mr. clerk, do you have any announcements? >> clerk: yes. thank you, mr. chair. in order to protect city employees, the board, and the public during the covid-19 emergency, city hall and the board room is closed. committee members will participate remotely in the conference to the extent as