yeararararararararararararararr approval of the minutes. is there any public comment on the minutes? on the public comment line if you would like to make a comment press * 3 now to raise your hand from the minutes. looks like there is no public comment commissioner. >> commissioner comments or corrections on minutes?

we have a motion to approve the minutes from the november 17t november 17th, 2020 meeting? >> i so move. >> second. >> all right i will call roll call and i also would like to welcome he just entered. [roll call] commissioner chow can you say yes? i will come back to you. [roll call] >> commissioner chow could you give a vote yay or nay on the minutes please. >> yay. >> okay great so the minutes have passed. commissioner i don't think that

commissioner bernal has has audio so please continue. i'm texting him as we talk. >> all right so the next item on the agenda would be the finance and planning committee update. >> if we could go back to the public comment line. press * 3 if you would like to make a comment. no comments so we can go on commissioner. >> now, the finance and planning committee update. >> good afternoon commissioners. the finance and planning committee met today at 2:00 p.m. right before the commission meetings and we have added a contract report and one new contract onto the commission consent calendar for your approval. one of the conversations that we had towards the end about

emerging issues is that we have asked you know like at some point, later on, to have a overview of some of these contractors that are really big organizations that are holding multimillion dollar contracts. so that we can get a better sense of who is providing what in the city in terms of these large providers. with other service organizations. >> all right mark how are we doing with commissioner bernal? >> he is, he showed up, but then wasn't able to access it so he's

closing his browser and trying over again. thank you i know this is awkward you are having to figure out what is going on, but thank you very much for stepping in. >> great is there further discussion or comments or questions on the finance and planning committee update? >> if i may check for public comment that would be great. anyone on the public comment line would you like to make a comment on item 4 the finance and planning committee report back. please press * 3. all right no public comment. commissioners i believe we can move onto the consent calendar item 5. >> okay. >> and that is just simply unless commissioners would like to extract and item for discussion, that is usually someone gives a motion to approve and then we move forward with the vote. >> so the two items on the consent calendar are item 5 on our agenda are there any comments, questions or motion to approve? >> i move to approve.

>> is there a second? >> i second. >> can you take the roll then? >> yes i will. [roll call] >> all right thank you. item passes the consent calendar passes. >> we're about to begin our strategic planning session with director colfax and we wanted to thank all of the dpa staff for their incredible work with this very complicated and very detailed meeting together. i know how much work it has been. we all are so appreciative given the backdrop of all of the incredible work you're doing with covid-19 and the

responsibilities that you've taken on what a superlative job you have done in all of that. we are looking forward to this presentation and understanding you know what your goals are for the coming year. what we think we can accomplish and hear a wonderful report on everything you have achieved in this very challenging and incredible year with this unbelievable pandemic. i guess mark is it time to turn this over to director colfax? >> yes. >> great. >> and i have given you permissioning tpermission to sh. >> thank you commissioner green. thank you commissioners and secretary morewitz and i want to acknowledge the leaders dpm leaders here for this meeting to tell you where we've been in the last nine months or so and where we're headed and really grateful for their leadership and their contribution during this

unprecedented time. i also think it's important to acknowledge today is world aid's day. it gives me pause and reflection about how san francisco was ground zero for hiv so much of our collectiv collective institl memory is grounded during that time. how hiv still remains an issue for many people in the city, the country and around the world. we have made tremendous strides and it gives me great hope as we confront this pandemic. of course there are differences. but i do think it is worth reminding ourselves where we've come from. where we are to we better understand where we're going. so i will just give a few introduction. i also wanted to update the commission briefly on this third surge we're currently experiencing. show you some data, but, hopefully we can also provide you the context for the broader picture beyond what is immediately in front of us. but what we anticipate come

willing over the next 12 months or so. nevertheless, acknowledging the fact that there is a great deal of uncertainty in what lies ahead. next slide please. so just an overview of the presentation, my introduction, we will then go into an overview of the covid command center. an update on the work very important work of the office of equity and update on operations including budget and human resources. population health, followed by the san francisco health network and there are some background slides that the commissioners can review at your leisure. of course between each of these sections we will take a pause for questions. and then continue to move through the presentation. there will be a variety of speakers. some of whom are familiar to the commissioners. some of whom are relatively new to the dph team.

>> director colfax if i may just for the public listening and watching you all will have an opportunity to ask questions or make comment at the end of this presentation. so the commissioners will have an opportunity after each section and the public will have an opportunity at the end. >> thank you. next slide please. so, commissioners you will see common themes through on this presentation. i think it's important to be explicit about some of these that covid-19 has and will nominate our dph activity for the foreseeable future. that rapid responses is required and made more difficult by uncertain and uncertain and rapidly changing environments. that our true north focus while not always explicit, as we may like to see it in certain times,

is still very much applying those principles are quality, safety, care experience, workforce, financial stewardship and equity. that across the departments, flexibility and resilience are key to success. there are rapidly shifting covid-19 priorities, we go from gradually and intentfuly reopening the city to closing things back down, focusing on testing, but also ensuring that we have a hospital surge capacity. just many priorities that covid forces us to focus on and respond to. and as a result, there are ongoing competing and delayed non-covid-19 priorities. as you will see today, these have had a significant effect on the ability of the department to

do things that we otherwise would do in a non-covid time. and then i just want to express my pride and the admiration i have with regard to the staff, staff commitment bandwidth and endurance and emphasize all of us also need to be here for the long haul. this is a marathon not a sprint and that staff especially nine months into this epidemic at all levels of the organization, are digging deeper and also we all need to support each other to ensure that we get through this together because it's only by doing this together and supporting each other, that we will have the outcomes for the department and the city and most importantly for the people we serve. next slide. so, just some data to share with the commission. i mentioned that we are in our

third surge. this is looking at covid cases per 100,000 in san francisco diagnosed cases. you will remember that in that mid, early spring period we had that first surge. we then had our summer surge peaking just before august and now we're in our winter surge. and unfortunately, this is not surprising. we were always concerned about the winter months for variety of reasons i won't go into now. but that increase is not only significant, but steep and we have exceeded the case per 100,000 rate that we had in the summer surge. that shows no signs of slowing down. so while we continue to expand testing and engage in community and provide those all important wrap around services from food security to behavioral health services and continue to work on our contact tracing, we are also

now again focusing on a medical surge and readying our hospital systems to meet the capacity. next slide please. and you will see here, that we're having an increase in hospitalizations at an alarming rate. right now we have a total of 87 san franciscans hospitalized with covid-19. we have four transfers from other communities. that's not quite as high as our peak summer surge, but we're at 1.4 now. we unfortunately expect to have a higher number of people in the hospital than either our first or second surge. we taken a number of aggressive steps. as you know we are assigned to the state purples here. we were assigned that last week and a number of steps have been taken decreasing indoor activities including activities where masking occurs at all times.

mayor breed instructed us to close indoor dining the week before even before we were in purple. today i announced we'll be taking additional steps to decrease high risk activities and we're exploring a number of options including decreasing further capacity of indoor activities, decreasing what number of people who are permitted to congregate together, and also exploring and looking at the santa clara county travel quarantine order and considering updating our travel advisory to a quarantine order. so number of steps that are being considered right now as we work to address this surge. we have turned back two surges. so i'm hopeful that we can do this again. i will add however, that both the rates per 100,000 in terms of diagnosis and these rates of hospitalizations do not

unfortunately take, the thanksgiving travel is not yet reflected in these numbers. so, given the fact that many of the airports were very crowded this holiday season, not as crowd as prior seasons, but certainly enough to make us very concerned about an additional cases of covid-19 being transmitted that badge has not yet been reflected in the numbers so we're watching that particularly over the next week or so. and readying our systems to be as responsive as possible. so, i'm sorry to start off this planning session with suc soberg news, but at the same time i think it exemplifies the changing environment that we're working in and the fact that so many of the dph leadership who will be presenting in this session, are being pulled in many different directions in

different times depending on what the data are telling us and for us to respond. next slide. so this does provide a transition to the covid command center. where troy williams who is our dph unified commander will provide an overview and provide condition text for what we're doing now and where we may be headed in the future, but i will see if the commissioners have any specific questions for me. >> commissioners if you would like to raise your hand to be recognized? i don't see any hands. >> all right then i guess we'll go onto troy. i wanted to just thank troy for

his incredible work at covid command center and also acknowledge his work in the early days of this pandemic. he was one of the key people who worked over there to help establish our safety protocols. many others were also very much involved in that. we come to covid command already steeped in some of the response for covid has been doing a great job. not sure how long it has been now troy, but a number of months and he will be hearing the presentation with a number of other key members of command. >> thank you dr. colfax really appreciate that. can everybody hear me okay? okay. great. so good afternoon commissioners. been a while since i've seen many of you. good to see you. on behalf of you know the committed staff here and dedicated staff, we're really

you know really happy to be able to present to you an overview of our work. on a personal note i'm very humbled to, working with such a committed dedicated group of people here at the ccc it's just been amazing all that has been accomplished and work to come. so just really proud of the group here. we're going to be presenting colleagues of mine, from operations, dr. andy tenor, from planning, dr. jim marx and for information and guidance dr. rita. so go ahead and go onto the next slide. so, what i have here is a high level chart that shows kind of the structure of the covid command center. i know that during the summer dr. bennett had presented a presentation to kind of show the when we went from eoc, doc model to a unified command.

and so just looking at the chart which i think is important, you can see at the top there which is the policy group, which is chaired by the mayor's chief of staff shawn and you can see the health officer to the side, who advises the policy group. that's also where a number of city department heads including dr. colfax sit and you know really make key decisions, policy decisions based on the activities of the covid command center. you'll see there the unified command. i share unified command with the human services agency, and linda from department of emergency management. and then below that you will see that there are sections. the operation section, and then the planning section logistics

and you have branches underneath that. what you are not seeing here is groups. this chart is much bigger, but definitely would not fit on one slide to give you the breadth of the operation that's happening here. so i want to give you just a little bit of background of how we got here and you know kind of why this structure is important. so, as you recall back in january 21st of 2020, the department of public health activated it's department operation center to prepare for and respond to covid-19. when that happened, a number of other city departments also activated their emergency operations center to coordinate our response efforts. so as that was going, this model of unified command was being planned, beginning in may. and this was based on best

practices of incident and emergency management called the incident command system. the unified command model was based upon a recommendation from fema which recommended a joint management covid-19 response done both by emergency managers and public health partners in order to ensure a coordinated response while keeping public health really at the forefront of everything that we do. there were a number of departments including dph human services, homelessness, technology and emergency management departments that were involved in the planning of this and on july 6th we transitioned to fully unified command structure. the structure the unified command is you know really led by four primary departments. and of course department of public health, department of emergency management, human services agency and the department of homelessness and supportive housing. this is really important for a number of reasons, but you know

when you think about how big this response is, and how big this pandemic is, it really was important to have this structure to breakdown silos, to really improve collaboration and partnerships, to make sure that any resources that were needed as a part of the response were available. it set forth you know a single set o objectives so everybody ws working from the same sheet of music to ensure we were all aligned in this covid-19 response and there was clear reporting structure and decision making authority embedded in this structure. so as i said, if you look at the chart we're going to focus on the biggest deph areas today which is operations, planning and information and guidance. and just to say this probably goes without saying, but dph expertise is in all levels of the response. so we're going to focus on a couple areas today, but really dph expertise is felt

throughout. next slide please. so the overall response the city wide response is governorred by a set of priorities and if you e all familiar with the north star. these are the objectives that we follow in terms of the response. these are developed and reviewed by the policy group if you will recall from the previous slide and the organization chart and any adjustments to operations based on these must go through the policy group prior to implementation. i will just review i think these are really important just to say because you know, this is, this is the work that we're doing everyday that's driving this response. planning and coordinating for covid-19 vaccine strategy, for city wide distribution, ensuring health and safety of covid vulnerable populations and essential workers. reduce covid transmission.

prepare for surge. which reare in th we are in thef now. maintain strategic public education campaigns, highlighting data, response operations, public expectations and requirements. coordinating with city wide reopening and recovery initiative its and planning for and coordinating. the overall, so these are the city wide objectives. and we operate as a ccc under the emergency response best practice of management by objectives. and so based on an operational period. each operational period lasts one week, saturday through friday. and then each thursday the section branches and groups develop objectives that are specific measurable action oriented realistic and time bound smart goals. and very much aligned with these objectives. so as you see these objectives here there is work occurring

underneaths these to help drive these specific priorities. i think the important thing also just to mention here and i would be remiss if i didn't highlight you know dr. lisa golden who is our director of the omg branch who is also the kpo for dph and all of you are so familiar with you know our improvement framework, lean, using a3 to really drive improvement has really been embedded into the ccc and you know samples and testing and omg where a3's have been created to really drive improvement work. this is a constant improvement. as we learn new things from the pandemic, we adjust. and using a3 thinking is the framework that we use just as we do back in our jobs and dph. the accomplishments from our

weekly objectives that come through are documented in a weekly situation report that's compiled. weekly and the objectives are published in our incident action plan which is created and distributed on fridays for the following operational period. so there is a way to really follow how we're monitoring our progress with the objectives and the goals we set for ourselves. next slide please. a little bit about the budget and staffing. i think important to note here that kurtly as of 11:13 there are 516dph staff that are officially deployed to the ccc. and you can see there are 331 is included in that number which is just the health services group. it just to say, this only tells half the story and i think you will hear more about this as we go forward. these are official deployments, but i think by the nature of our work and dph, you know i think

that everything we're doing in dph is touching covid and so all the work that is happening and all the different areas of dph and the network outside of the covid command center is also this is working on covid to some extent. this is the numbers that are officially deployed, but important to note how focused and everybody is on this pandemic. the just to say a little bit, this is health numbers. there is also again other city departments, many city departments that are also participating in this response as well. this is the focus on dph, but there is a lot of other data around other departments that are also participating in the response. next slide please.

finally, the budget, is and this is tortoise ca for fiscal year d budget put forth for us as you can see there are $204.8 million and this really you can kind of see the breakdown there, but this really is funding for new tte's, temporary hires and contracted staff, nursing registry, support is included in this budget allocation alongside funding for contracted expenses ranging from testing services, disinfection services, commodities such as ppe and covid-19 test kits. this as i said is the budget that goes through fiscal year 21st. and starting in january they will controllers will be working to look at the 22 fiscal year budget for the covid command center. this is funded the money comes from through combination of

fema. the cares act and general fund support. and the appropriation for the ccc operations by primarily with dph, hsa and dem. the departments specific departments are responsible for managing budgets within their scope of operations. dph holds the ccc appropriations authority for community and health services and is responsible for monitoring projecting commitments within these areas with regular reporting within the controllers and mayors budget office and ccc leadership. i get monthly updates on the dph budget and the ccc gets monthly updates from the controllers office for the entire ccc budget. so we're being supported you know by the city to make sure that we have you know what we need. and and we are cap kept apprised to make sure we're really trying

to stay within the budget that we've been provided. so with that i will go ahead and next slide turn it over to our fantastic operation section sheet dr. andy tenor who is doing an amazing job in our operation section turn it over to andy. dr. tenor. thank you so much troy. thanks for having me. good to see all of you commissioners. if you could go to the next slide please. so this is what troy showed you. this is just looking at the operations section. we undertake in the mitigation and response to the pandemic. within the operations we have a prevention and a response chief, and then we have four different

groups underneath the operations. so this first is the health services branch. and that is our branch that manages all of the health services response to covid so if we have our testing group underneath that. outbreak management group which is og that troy had referred to earlier. case investigation and contact tracing and our medical group. just to give you a sense of how big this work chart is the medical group alone has about 13 different units underneath that. that's why it would not fit on one slide from what troy had showed you earlier. we also have the human services branch. the human services branch is all of the housing support and food support. for the covid response. so we have food coordination group which provides food to our patients that are under isolation and quarantine. as well as our shelter in place hotels with our housing group supervisor, rehousing

coordination group and unsheltered services group. we also have a community branch. the community branch focuses on our outreach and our engagement. and within the community branch, we have populations group, unsheltered, persons experiencing homelessness. our community partner, our coordination groups and our congregate housed and we'll talk more about that about that later and our support services group. ensuring all of these operations can take place. next slide please. so first we're going to focus on the community branch and the health services branch because that's really what a lot of our resources are focused on. first we'll take the community branch the next slide. so our community branch their goal is to prevent a response to covid-19 and priority setting and engage with communities that are more vulnerable to infection or higher risk for outbreak.

they're really focused on the groups that are at the highest risk. they are divided into a series of hubs. so the hubs are shown here. we have everything from childcare and schools to residential hubs to seniors hubs, persons experiencing homelessness and our community branch focuses on outreach to these groups and providing information and guidance as well as sometimes things like masks, hand sanitizer et cetera to groups to try to help prevent covid and those vulnerable groups. they are really the lynchpins are response and prevention strategies to try to flatten the curve with covid. they also are key for us in helping with our community engagement so they reach out to our community based organizations, they both provide

information, but also receive information on what the communities perceptions are. if there are gaps, things that need to be filled, groups that are overlooked. so they really are our cornerstone for our prevention strategies within covid response. next slide please. just some highlights of some of the work they have been doing. if you look at the childcare and schools hub they have been working to lead base school reopening and making sure schools are meeting require appellants forequirementsfor sao support for childcare. early year to five year childcare programs, k-12 higher education, camps right now are not a big issue, but those youth programs and summer camps early on and as we anticipate reopening. their population focus really works with equity and neighborhoods which is a group that reports directly to

incident command and really focused on those nine priority neighborhoods. they are utilizing that lean a3 thinking for problem solving and community engagement in particular for communities that are hardest hit by covid. they also were supporting community mobile testing with pretests and post test counseling and those highest covid neighborhoods with highest covid positivity. workplace and business hub, have responded to almost 2,000 workplace and business exposure since the beginning of the outbreak. we had our last peak in july although we're starting to see the numbers go up again. some of the key areas are restaurants and food service, construction and convenience stores. this is just a few of the things that community branches have been working on. the outreach has been significant. and they have really had their hands full trying to help us

mitigate these surges as they come. next slide please. next one we want to do the health services branch. next slide. so, health services branch, is encompasses all of our health activities as they relate to covid and we've adopted a response strategy that we call test trace and isolate. so testing to identify cases, as they come up so we have a sense for what the level of the prevelance of the community is. of covid-19. tracing so looking at the contact with both the patients that comous as covid positive and who are their contacts and how do we follow those contacts as to try to make sure that we can identify as many cases as possible. and then isolating so as we find cases really trying to keep them from spreading covid to others. that's again that's the

cornerstone of a health response strategy to try to mitigate covid. within that, in addition to that, we have our surge response. so our surge response is really the sandbags at the end of this. so if those, the intense work of those test tracing, are not enough, to stem the tide of a covid surge, as well as all of the work that the community has done, then trying to make sure that we preserve that emergency department hospital ward and icu capacity for the sickest patients within the city. we're trying to prevent unnecessary deaths. we don't want to see something like the new york saw the surge. how do we preserve the capacity of our hospitals and we work very hard to try to make sure that we have sufficient capacity. and that we have a game plan in case those efforts fail. and then finally, vaccinating.

this really is our this is our ticket out of the pandemic. as we are starting these vaccines are starting to become a reality and we're learning more about them how do we get them out to people. how do we make sure they are distributed in a equitable way and efficiently as possible so that we can try to extracts ourself from this pandemic as soon as possible. next slide. thank you. so our testing group uses a data driven strategy to target testing to the most, to the areas of highest positivity rate and the vulnerable populations. these are a handful of our testing, handful of our dph testing sites. there was a comment brought up earlier there does not include non-dhp testing sites. that data is a bit hard to pull together and aggregated in one map. this one really we're just showing what we need as dph

control. and we have targeted that strategy to look at where are we seeing positive cases, what zip codes are they in? how do we make sure that in areas with high positivity that we're getting sufficient testing to those areas. this has been a key strategy in understanding where we are in the pandemic and what the needs are. this also is kind of the link into our contact tracing case investigation if it comes back positive we can then follow-up with those cases make sure that we look at their contacts and try to get on top of this surge as they happen. next slide please. cation investigation and contact tracing follows testing. so to identify and test people with covid-19. we really are trying to make sure that as people are uncovering positive cases, that

we're making sure that we are able to isolate and quarantine contacts and persons under investigation to try to limit the spread of covid-19. so we are a provider that tests and screen individuals. they send a test to the lab. we have, we get all reports of positive and negative results in dph. people who test positive become cases and then we have staff that call those cases and ask an in depth series of questions to try to understand who might have been exposed and then they follow-up with those contacts. that's the contact tracing part. so and those further cases and the contacts we recommend isolation and quarantine depending on the quarantine for the cases and isolation for the contact. also ensuring that if someone is say quarantining at home they

have sufficient food to be able to stay inside. if they don't have the ability to quarantine at home so several people we've had a lot of patients who live in multifamily houses or they don't have the ability to be able to fully quarantine so they are to isolate at home and so they are referred to our isolation quarantine hotel. and for contact tracing, if patients if we identify close contact with those patients we work to try to get those contacts tested and isolate and quarantine as needed. and then again, the contacts then the cycle starts again. this is how we're trying to focus and identify cases. obviously this strategy is much more efficient when there are lower number of cases and we can really focus on those dayses and try to get to stop the spread. as we start to surge, the number of contacts and case investigations is increasing and

ur case investigation group is working hard to try to track as many of these as possible. next slide. our management group oversees the living sites in san francisco as well as facilities where outbreaks can occur. their mission is to reduce transmission and mortality in vulnerable populations. they led the response to this and it really is an interdisciplinary process. we have several interdisciplinary teams. for the elderly, sro's, clinical services, school, shelter, every campments. all of these areas are highly vulnerable to outbreak. when a outbreak notification occurs we do case investigation and contact tracing.

omg does site visits. and assesses the site and then we institute testing when testing is required. so which is facilitated by the testing group. our group then works on isolation and quarantine if needed. for the patients and surveillance is deny by omg and our community group. our community group also works with the facility to try to prevent further outbreak. next slide please. finally medical operations group. there are thirteen different medical operations, but the key ones to point out are isolation and quarantine hotels which are confirmed or suspected covid positive patients. they've had 600 guests since march. we also have alternate care

sites. i mentioned trying to preserve hospital capacity. and is essentially a little bit more than an urgent care little less than a emergency care department. it can accept ambulance transfer. we also have a field hospital. and has 93 beds that we can activate to try to help to support hospitals if oursome oum were to get overwhelmed. mohawk is our link to space. we request additional support and we have our shelter in place to help with locations for covid. our prehospital and health systems are also working to try to mitigate and treat patients and transferred over 7,000 covid positive patients and supported

over 1,000 covid field tests. we're working coordinating with the health system and developing city leadership. next slide please. thank you. >> good afternoon commissioner. i'm jim marx. great to see all of you. i'm going to take you through the planning session. next slide please. this is our organization chart. think ever the section as the nervous system of the covid command center with a purpose of providing the response with accurate and comprehensive

information that enables optimal decision making. so i will take you through this briefly. so on the far left there is your traditional planning section. if this were a traditional incident like a hurricane where there is an event that happens relatively short response and then there is recovery, what you see on the chart for the planning section would really just look like that planning section and the piece in the middle advanced planning would be small boxes under planning. so in the planning section provide situational awareness [indiscernible] to produce an overall assessment of [indiscernible] situational awareness. facilitate incident, briefing meetings and finding meetings works with the other sections

and branches to draft the action plan and [indiscernible] for each operational period. retain communication of the response and original response then coordinate the demobilization. a big chunk in the middle is advanced timing. again, in a traditional response, advanced means typical looking out a few days to as long as time period as a week in our response. but as you know, this response has been going on for over nine months, so when we talked advanced planning we're talking about not just days or weeks, but many months. so, that large chunk in the middle advanced planning looks

very [indiscernible] then sits analysts and leaders that manage the outbreak management data selection. what that key in the middle is manages all aspects of data, quality control, reporting and distribution of data provides in depth understanding and future state of covid in san francisco and enables data preventive action.

one of the boxes you will see right there, to the left there, modeling and test willing analysis, so we work with berkeley school of public health who is an international leader and model. able to project out into the future what the current trends are showing up what is going to happen with hospitals over time. finally, on the right we have the stablization unit with metrics and that represents manages the public [indiscernible] they also automate the retrieva retrieval. and provide [indiscernible] so

within advanced planning is all data requests. comes into advance planning where they receive triage assigned to handle it and executed on. so we have a centralized data request process, actually to date received over 220 data requests which is nuclease now t so about 185%. we developed, then report on the san francisco health indicators both the daily internal dashboard distribution and also on the [indiscernible] with respect to hospital coordination, so take in data from each of the san francisco hospitals on their daily census of covid positive patients, other patients remaining hospital capacity that provide

realtime understanding of hospital census by hospital and remaining capacity additional patients and as i mentioned, a number of testing and analysis projects where we look forward into the future to understand the trajectory of cases and hospital census groups to ensure that we're able to take action in order to prevent runsing out of hospital capacity. and i will stop there and turn it over for the section on information. >> thanks jim. hi good afternoon commissioners. supports chronic disease mention mark and in this pandemic war time.

next slide. our goal is to provide and ensure accurate science based stakeholder informed guidance to prevent, contain and mitigate covid-19. next slide. produces all of the official guidance from fftch and the activation as released to covid-19. so that means all sectors, childcare, schools, healthcare and human services providers and employers of all types an the general public. we work closely with the attorneys and have health directives. take our guidance to disseminate and produce visual graphics for the public. comes from all sources as you might imagine from the community and businesses through other

city departments entirely within the accusation of branches and so forth. on any given day we have 40 to 60 active requests and inquiries underway. we've developed a standard work to ensure high quality thoughtful products that are based in science and input. as part of that standard work we review guidance from all major jurisdictions from the u.s. and other countries that have done well and review the latest research when applicable. really proud to say it is because of that process and the shared talent and caliber of dph staff in particular that our guidance staff has often influenced guidance. similarly we were the only jurisdiction we know of to have written detailed guidance how to improve ventilation for general businesses in the public which

are we know is so critical as we get colder and people spend more times indoors which is a high risk for covid-19 transmission. the state asked if they could take our guidance and adopt it to issue statewide. early on we have guidance on ppe for shelter staff which was more protective of workers than anywhereless ianywhere else in . as of a month ago we had already put out nearly 300 guidance products and i look forward to returning in january to provide further details about the tremendous work too influence local policy and develop guidance that is health protective and responsive to public input. back to troy. thank you team so much. for all of your work really appreciate your presentations and just to highlight a couple of themes around you know standard work, a3's, continuous

improvement, you can see that really coming through in these presentations and terms of how we're thinking about the response. so i just want to quickly review with you our future work and priorities which you have heard a lot of from these previous presentations. but next slide. so, one of the big things that we are focused on right now is covid vaccine around distribution, strategy, staffing, logistics this is it a huge heavy lift. and a very very important milestone in the covid response. and so, there's a number of people leaders here in the ccc that are leading that work in collaborating with our community partners, our san francisco health network. other health systems in san francisco. to really make sure we have a really good plan for covid vaccine when it arrives.

flu vaccine is something we really early on wanted to make sure that we were preventing the twin democrati demic so we wante sure the flu vaccine was available and a group here in the ccc put together just a fantastic plan to make sure that flu vaccine was available. and for the residents of san francisco. testing is always a big part of what we're doing and how we're thinking strategically. and part of that the big thing around testing is our adaptive tests and response strategy where you know really letting the data drive where we're placing our testing assets. great example of that is couple weeks ago we were able to successfully open up the alamani test site because we were seeing

higher positivity in that area. we wanted to put a test site there to capture that that's been a successful move. working closely with equity in neighborhoods around our testing strategy and critical in assisting us in helping to select test sites and working with community partners. to make sure that we're you know effectively communicating test sites and you know where we you know really can get a lot of success with where we place our testing sites. strengthening our community partnerships and collaboration i think this is key with the vaccine coming this is going to be very important focusing on and supporting populations that are disproportionately affected by covid, but you know really working as dr. tenor talked about with our community

partners around you know different aspects of our strategy and response and they've been great partners to thus far in this response and continuing network moving forward. next slide. surge planning. we are in a surge. and you know we, we've been through two other surges and have learned from those experiences and have revised our surge playbook to ensure that we're ready for the next surge which we are currently in the midst of. we just did a table top where we learned quite a bit more and making adjustment its based on that reopen willing. really the guidance documents around that adjusting reopening coordinates with health indicators and reopening tiers that will be something as we come out of this surge and as things reopen from this will be

a big focus for us and finally the sustainability, demobilization planning. really determining covid command centers feature state over the next 12 to 18 months and filling critical staffing gaps. i think that there is a group here now that's looking at sustainability really doing a deep dive into the, the workforce here and seeing what we really need over the next 12 to 18 months. to really keep this structure in place which is so important as i described before. i will add one other bullet which is not on here and one of our big priorities as dr. tenor talked about under the community section was state school reopening. that's been a big big focus for us. and have a great team that's working on that and working very closely with schools around

reopening plans. so with that, i will stop there i know this is quite a pretty long presentation, but there is a lot to say and this is a huge response that you know that you know that takes a lot of time, a lot of resources, a lot of thinking, a lot of improvement and we're happy to answer any questions that you might have. thank you so much. >> commissioners, commissioner bernal is on the phone i will let him speak, but would you please press * 3 to raise your hand if you would like to make comments or questions so i can let him know you have your hand up. >> thank you so much mark. i apologize to everybody for the technical difficulties we're having wi-fi issues here i will be trying to get onto the video as soon as possible. so i apologize for this.

and we can go to any commissioner questions. mark can you please recognize who has their hands raised. >> sure right now no one has their hand raised so i want to make sure here we go. commissioner injur has her hand. >> i really appreciate it. this is a fabulous presentation. my comment would be in the future, you have presented data in various parts of this excellent presentation. if going forward for example the omg you had definitive data that was presented and numbers served et cetera. but if you know, my question was not that you need to answer, but in going forward, for example, in the community branch

highlights, are there numbers that would help us as commissioners understand the extent of the work you're doing so for example, there the childcare hub, in the population focus, the information if we had data numbers, throughout, rather than scattered in different presentations would really help since i know from your presentation the extent of the work you're doing. but i often feel that seeing the numbers make a huge difference. so as we're updating it going forward, any numbers of your extensive work would be very helpful and again, i really appreciate the presentation and your challenging very

challenging work. thank you. >> thank you commissioner. i note that commissioner has her hand up. >> thank you to all of the team members that have presented so far. i know this is putting this on paper is just a miniscule description of all of the work a toil of labor that goes into what you are doing 24/7 so i want to extend my appreciation. for all that you do and will continue to do because we know this is we're still in the throws of # this and the other phases that are coming.

this may be for the informationup, but i'm not sure, given that it appears the messaging around travel and just general gathering and all of that, does did not seem to take hold for the thanksgiving period. and that's not just in san francisco. but it's throughout the u.s. i think we actually did quite well in san francisco and that's an indication of the effectiveness of the communication and messaging we're doing in san francisco. but where do we formulate the messaging that goes to out to the public around behaviors, around safety, around precautions and such and is there any study or any opportunity to find out whether the messaging that we've been doing in san francisco that

seems to be a successful along with everything else that we've been doing to mitigate, is there any opportunity for that messaging to be also shared at the state level or across other jurisdictions that public health has in its responsibility its. >> that's a really great question. our chart you may have noticed has a sister branch called the joint information center. so where as information guidance writes the official based guidance based on policy decisions that one gets disseminated to a -- arm and turns itself into posters and flyers and so forth and like social media and so it is in charge of that public messaging and it is due to advocacy interim guidance when we were

part of the accusation for us to be colocated. the public messages and priority messages to be driven by public health as we were seeing who was getting sick and where the sectors and communities that most needed to hear messaging were becoming clear so that's how in the unified command we're actually colocated with chick who does public messaging and converts guidance into messaging and to your question about how have we coordinated regionally i think a good example around that is our latin ex, campaign. was interested in investing in a regional campaign for our latin ex, communities. and so they worked with the chick branch who also had a latino community engagement process to share some of those messages and the feedback they get is that they have a task force that works closely with them to develop the messages so

that sort of community informed and community developed messaging. and at the same time dph has been talking to them more and more about how do we measure the effects of messaging campaign. can we see effects and lasting compliance change as we roll out different messages. >> thank you and you answered m second question about do we have resources or are we evaluating the effectiveness of the messages on various messages on the different populations and you did answer that. i'm anxious when that information is available for us to be able to share that information so thank you very much. again applauding your work in that of your colleagues on the effectiveness that appears to have shown through the numbers in san francisco.

>> thank you commissioner. and i think i'm in for good now. so apologies again even though i wasn't part of the video presentation i was able to follow along with the slide deck so thank you for that excellent presentation. commissioner chow. >> thank you. i also share my admiration for the amount of work that has been put into help explain extremely complex operation and more to actually put it on different parts and bring it altogether in your presentation. i especially appreciate that the complexities that of course have demonstrated by all of these charts and understand why they are all needed now. so i'm just going to focus right now on one question that has been our curious in my mind, is

as we have added into the department a number of budgetary fte's, how will this then come to help replace or and well i guess one of the questions is, most people are those people supposed to then come and replace part of our regular dph staff, who are obviously very critical in the ccc, or are they going to take those places in the department, taking care of those functions while our highly skilled and now seasoned ccc, if we can call it that in nine months, continues their work. what is the objective of bringing in these people? what were they going to go or is it sort of a mix? and then, how will that answer some of the shortages of our

staffing, that have been hindered the other parts of the departments work? >> thank you commissioner chow. i will take that one. so, appreciate the question it's a great one. i think so there is we are in the process of so, what i talked about was dsw's. we're also hiring new people that are coming on. there's a large number over the next couple months some have already started that are coming in and we're looking at where some of our gaps are within the ccc to fill some of those gaps, but also, they will be used potentially to replace current dsw's and can then go back to their normal duties. there's a process that we have in place and dr. tenor is a big part of that.

where we review with our network partners on a weekly basis deactivations that are coming and whether or not covid command continues to need that person or 23 they can go back to their role in the health network and these new hires have been really helpful in that. there is also just you know, besides new hires there is also hiring through haluna health we have hired a number of people to help with our contact case investigation contact tracing and so the bigger picture of this, is the sustainability question that we're currently working on around what this is going to look like for the most 12 to 18 months while we're so focused on covid as our number one priority, you know really also trying to make sure that we have what we need to continue this in a really important work that we're doing here.

so, right now as they are going through the sustainability plan they are really going line byline to see you know what roles you know we continue to need that we would potentially back fill from a new hire or bringing another dsw in to replace someone that has a critical role in nor part of the department. so does that answer your question? >> yes and well, to some extent that's helpful understanding that you know there's no simple answer. how much time are you thinking that you would then get your sort of ideal well won't be ideal, but, be able to have a team in place that you would then know that some of the critical areas that the department itself is having, would then have been filled are we looking at trying to do that within two months or four months?

i don't think that would extend out to 18 months because by that point you should have stablized your workforce. >> yeah, thank you. we've made a lot of progress here over the last couple months to fill gaps that we've had here in the ccc. there's still work to do and the 18 months time line is really about you know how long at least right now we're thinking that the ccc will be in place. but in the meantime this constant collaboration and partnership with dph and the health network around looking at those positions that are really critical there the network and that's happening on a weekly basis where we're having these discussions. >> if i could just add to that. don't mean to jump in, but, i just to add thought to troy's answer which really captured it, if you step back and look at it we added about 110 new positions

in the budget for covid. and then there are other positions that other departments. we also as troy said, have haluna staffing which is several dozen additional staffing so that is coming on board and creating quite a lot of relief, but as you saw this the slide at the beginning of the presentation, we have up around 500fte's deployed. so the hiring that's coming on board, we are doing a lot of work to strategically target that to provide the greatest relief both on the c3 and the operating and the kind of baseline operations and the department. but it won't fully offset it and that is part of the trade off that we're kind of constantly making and thinking about and you're going to hear more about it later throughout the day or throughout the evening of things that are getting deferred or

trade off choices we're having to make. that will also spill into the budget process that we're starting for the upcoming year is those trade off decisions. so we won't get to the point where we're fully one for one replacing the staff that are being deployed to covid. >> thank you. that's very helpful i'm glad mrn because if i can have one more followup question, i was going to ask then as i understand from troy that you know there are finances that are being looked at almost constantly and under of course the city's per view, but how are we slotting in the covid expenses, and our budgets and how is that going to show up, is that you know, and maybe you want to speak under your operations instead. i defer to you, when you want to speak to that issue now. but this would be sort of how we would be able to follow also. how the budgets were working for

the department and looks like the covid is under the three c's are under the office, but how is that going to show up in our own budgets and how do we monitor? >> sure and we're going to have at the next commission meeting,some presentations on our financials that will go into some of that. but big picture so the covid budget for the city, is segregated into a project in the system. so the budget for covid is separated out from our regular operating budget. we categorize it differently. and then within that covid budget different departments have their share. so dph has the largest share, troy mentioned hsh, dem they have their share. so we are tracking it separately and we watch it through our regular finance process just as we watch

anything else. but in addition to our regular financial monitoring, we have a system that troy described a little bit that's led by the controllers office, and is looking at that covid project as a whole across the department. that involves us, that involves dem, it involves homeless and supportive housing. all of the departments that are involved in the response team and services agency. what we're doing monthly updates and projections. and then to the kind of collective governance structure. there are multiple layers of added financial oversight that get a little bit complicated and we're feeling them out as they go, but we will have some more of that for you at the next hearing. >> very good. once again i want to extend my appreciation for this overview.

i think it's one of the most important strategic planning sessions i will have attended within the department here and and the review of course as we're doing and i am so grateful that the department was able to be together so we can be continuing to look at your response for this very important pandemic. so i will reserve other questions for the sections later, but thank you very much. >> that's quite a statement from commissioner chow given his long standing leadership on the commission about the quality of this presentation and i would have to agree thank you. mr. wagner perhaps this is best directed to you and i will go to commissioner kristen in a moment, but you know it appears as though 516 staff that have been deployed over that represent maybe 6% of our entire workforce within the department,

and while we do need to discuss the budgetary issues surrounding hiring and other things there are also process issues that we have faced before the pandemic hit in terms of the amount of time it took to fill positions and hire people. are there any strategies that have been put in place during the pandemic or ways in streamlining that process that we've employed that could carry forward once we're through this so that we can permanently address some of the process issues that lead to vacancies being opened for you know hundreds of days before they are able to be filled. >> absolutely commissioner. we're going to in a few slides go once we get to that other section go into some of that, but we have the hr team has put into place some we're calling them expedited or batch hiring processes and those have been targeted at some of the areas

that we knew were preexisting, needs for hiring like nursing and some of our core client support positions and it became much more urgent once covid went into place. we have put new processes in place to really compress and hire at greater volumes and more quickly and we have had some good results in that. and then we will talk and we will we have learned a lot from that that we're going to continue to apply post covid and we are continuing to apply. so that will be going on that certainly hasn't solved everything we'll again talk about it a little more later because some of focus on covid has meant that where we were planning to do much more kind of laser focused hiring efforts and other areas of the department, that energy has really had to be applied to covid over the last

sex six months and that's taken a lot omonths -- six months ands commissioner kristen. >> thank you president bernal. i want toi to join my colleaguen thanking you all for this incredible work you are doing that is so fundamentally important to our well being. and this presentation is extremely helpful and i'm sure we'll all be referring to it later as the coming year goes on. i have a question about equity. and there the priority list i think on slide 7 of the handout that you went through with us says continue to prioritize equity and represent community needs through response planning and implementation.

then other slides show us that the equity and neighborhood advisory group is working with the command the unified command off to the right the equity and neighborhood advisory group. so can you help me understand how you think about equity in addition there this context? i mean it's a priority along with seven other things that are always there the forefront as priorities. [ pause for change of caption bees ] captioners

>> and at the forefront of why we're doing the work. so i've seen that be apparent in i.n.g. and in the documents that we work on, and we can always be better? the one investment that i posted on our slide was about safer social interactions, and i remember working on that one around how do we work on that, and we really discouraged it, and we went as far as speaking with a bishop in the bayview on how he thought it would be best messaged in a way that would resonate with folks who are worshipping. but i just wanted to agree and say that we also developed our own process in i.n.g. to make sure that our processes were

implementing the community's feedback. >> thank you for that explanation, and dr. lin, i appreciate what you just said. in addition, i'm so happy to have equity as part of the structure, the structures that you've created at different levels in the structure. but i think what we all need to have is this internalization of that. we have an officer who has their responsibility being that primary way to look at things, but i think it's also, we'll never make a dent in these

disparities unless each decision maker or each person who acts, each actor in our system internalizes equity as a way, as something that's in our mind when we look at what we do so that it's not given as a problem to somebody to come and say, well, we're thinking about equity for you, and this is what we have come up with. and i don't know whether -- it sounds like there are initiatives, and there have been initiatives in the department to work on racial equity and systemic issues, but i do hope that those are strengthened, and that there is an expectation in the department that each individual brings that to the work that they do no matter what and doesn't wait for a sponsor an analysis from a advisory committee or an -- from an

advisory committee or an officer. >> thank you. >> thank you so much for the work that you do. >> wiif i can just add, you wi see more of that in the presentation. that is my expectation in the department, that people have that, that perspective, that skill set, and that it's at -- it's not just a thought or a concept. it actually results in meaningful action in all the work that we do across the department sfl thank you, dr. colfax. >> thank you, dr. colfax. thank you, commissioner christian. commissioner green? >> thank you for all the work that you've done on the presentation, and seeing it here makes it incredible in as much a short time span under such stress that you not only developed such an intricate system. we can't thank you enough for the work that you've done.

i'm also very heartened to hear what you said about community input, as well, because i think that especially, as it relates to vaccine distribution and having the resources for our underserved communities, i think it's extremely important that we do keep this front and center, which sort of gets to a question that may be answered by mr. wagner or others later in the presentation. but, you know, given the really severe economic impact that this pandemic has had on the city and the city budget, i know we have a lot of external partners and external sources. one of the entities that's doing our testing for city test s.f., i wonder, in that context, what are we doing to assure that we are ultimately partnering with them. i think of this in terms of coverage for vaccines as well

as testing services so we can address more our underserved populations, because i think with these budgetary constraints, it may be extremely important that we are not only keeping watching on these partnerships, but also, that we're demanding increasing accountability, especially as it relates to collections. >> so that's a great question, and maybe dr. tanner would speak to that a little bit around that, as she's one of the leaders for the covid vaccine, so i think that's a good example of how we're engaging the community in the discuss around the covid vaccine. dr. tanner, are you there? >> yes, thank you. so i think there's a -- two different elements. if i understand correctly, you're thinking about

collections as far as insurance billing, is that -- is that what you were thinking about? >> insurance billing for both testing and vaccines and how that brings resources to us that we can direct to the equity efforts, and the more we can collect, the more we have in a constrained economic environment to utilize this as needed. >> okay. thank you. so with the covid vaccine, the initial supply is going to be paid for but the federal government, and so we are

working closely with our partners because this really is an all-hands-on-deck effort to get everybody in san francisco vaccinated. we're working closely with our -- >> dr. tanner looks like she's hopped out. it looks like we're having a little trouble with the platform. can someone pick up? >> i can -- i can jump in, and i'm having a little bit of -- it must be a webex thing. i'm having a little bandwidth, too. so a couple of things on that that is concern. so dr. tanner started to describe that we will have the vaccine paid for and distributed, but there is also the cost of administering and the logistics and the operations, and so that's a discussion that we're having

right now, is our ability to build for that piece. so it won't be for the vaccine itf itf itself, but there is some ability to build. on testing, we are working quite hard on trying to increase our revenue through testing. we have started working through by working through the health service system, so we're working through city test for city employees. we're working through the health system to bill those cost out to the providers that provide insurance for city employees. we have been working with kaiser on reimbursement in a number of firms, and then most recently, we rebid -- we did an r.f.p. for our testing vendor, and that is in -- just gone through the process and is now in the -- on contract award and

negotiation phase, and as part of that r.f.p., we included a requirement about testing -- or about billing for testing. so that will be part, and there has been a lot of challenges in terms of logistics, the technology, the relationship with insurance plans that are routine in a lot of areas. when it's new, it's taken a while to build that, but that is one of our relationships that we are actively working to build on, and that's one of our budgets for increased revenue that will, as you say, exactly will offset the cost and allow us to have fewer restraints on

all these important activities. >> thank you. do you have any idea on when the new contract will be settled and just when you anticipate some increased revenues, especially from the vendor? >> yeah. right now, i'm anticipating to have a contract in place in january, and then, there will probably be some potential transition and build-up time to the new vendor getting on, so that'll be in the springtime around march, if i'm remembering correctly. but in the meantime, we already are starting that work, reaching out to insurance companies, thinking through the -- the mechanics and the technology around billing, so that work is going to continue. but we can certainly update you, and we should have some information in the coming fairly near future about the

selected vendor and the contract negotiations for the testing and our progress on negotiating for billing. >> thank you. thank you, really, very much. >> great. thank you, commissioner green, and mr. wagner. commissioner chung? >> yes. thank you, everyone, for this, like, really informative presentation, and i'm have say, that you all have picked the right person, i think, for the unified commander positions. you know, knowing mr. troy, you know, and, like, his background in p.e.s. it seems like, you know, you are the right person, you know, for these kind of, you know, like, really intense, you know, and energy, you know -- the

intense kind of responsibilities. one of the things that i am curious is, you know, we talk about equity a lot, and in terms of equity, one of the first things that comes to my mind is through the economic burden. you know, it's great that we have all these, like, policies and assistance in place for testing, but i think that one of the economic burdens that we don't talk enough about is the cost of all these, like, protective gear. if you have a family of four, you know, that the cost of, like, purchasing face masks can be quite significant. and are there any, like, plans for us to be able to help supplement some of these costs, you know, for some of the most impacted in the city? >> first, thank you,

commissioner chen, for your kind words. greg, are you familiar with programs around this? >> yeah, i can touch on -- i can touch on this. there are -- so as we described earlier, there are multiple departments that have a piece of the covid response. your question is the need is vast, and the city has been working on various pieces, and i think this is going to be a continued discussion. but some of the items that we and our partner agencies have been working on, so within h.s.a., the human services agency, as a number of programs that are related to food support, other enrollment and benefits programs, where we -- the city is trying to get

people additional financial and other types of support who are struggling, have lost jobs, are required to quarantine, etc., i know that our partners at the office of -- the mayor's office of housing and community development have been doing rental support programs targeted at keeping people in their housing and all of those types of programs. obviously, the department of homelessness and supportive housing has a lot of the housing policies for people who are homeless or marginally homeless, so there is quite a range of those activities that are going on through the various partners in the city, but there is a huge gap. i mean, it's a huge impact, and the city's effort is one piece of it, but the need is great.

another focus that i know that the city has been working on is philanthropy and doing fundraising, targeted fundraising that is focused on a lot of these costs. we've done some things within our department to try to free up dollars, for example, for people who have health savings accounts through the city option program, to allow distributions of those funds for nonhealth care purposes, so there are a lot of efforts, but it's a huge issue, and i would not say that the city has solved it but any means, but there's a lot of work in those. >> yeah, and this is andy, so just -- and apologies for the technical difficulties earlier. thank you, guys, for stepping in for me. >> no problem. >> but just to -- to talk about the p.p.e. directly.

so we've had some small outreach programs, so persons in the community happened out masks and hand sanitizer to some of our homeless population. they go out daily to try to help that population protect themselves. we've been doing some limited distribution at our community testing sites to try to help -- and again, they're small efforts, but trying to chip away at this problem. but i think that this is something that we are thinking about and trying to help in whatever ways we can. thank you. >> well, thank you. interestingly, i think that i have full confidence in staff in terms of supporting our homeless populations at this current time. i think that, like, for me, you know, what comes to my mind more right now is the working

families, you know, like, who might have, like, been impacted economically by the covid, and they might have, like, a family of four or five, you know, that they all need masks. they all need, like, sanitizing supplies, and those not costs that we normally budget, like, in our groceries list, for instance, let alone trying to plan that for the next 12 months. and i think those are the things that -- i just, like, keep coming back to that, and i think that is part of the social determinants that we need to be able to address as a department. but thank you so much for, like, all the work that you all have been doing. and another point that you mentioned is, you know, like, some of the challenges and barriers that you see is, like, delaying r.f.p.s as well as contract approvals, so switching my head to the chair of the finance and planning

committee, are there any things that you think we can do to help make that process a little bit less difficult, especially, you know, this is an extraordinary time, and we need some extraordinary measures in place? you know, should we actually have some discussions around, you know, like, suspending the current procedures and have some emergency procedures in place so, like, that, that you can operate in your fuller capacity, you know, in a more, like, expeditious way? >> commissioner, i am so appreciative of that offer and that thought. i would like to talk with the team. i mean, i know right off the -- and take you up on kind of thinking through how we can do that. i know from the contracts team, for example, they have -- the

volume of covid work that has brn added to their plate is immense. so we have contracts received on what type of review on which time frame, and so we can talk about that. i think another piece of it is we have, frankly, in a number of areas, not been able to hold ourselves to the same standard that we would have liked to in terms of analysis, in terms of reporting, in terms of doing the kind of data analysis work that you have come to expect from us, so i think there are going to be some times where we'd love to have the data and have the full context, and we

may need to kind of shorten that and stick to the -- moving the contracts through the process until we can get a little bit more -- catch our breath and get our bandwidth back. but i will go back and talk to the team and take you up on that, and appreciate that, given they are, like the rest of the d.p.h., working around the clock, and it's been going that way for a long time. thank you. >> yeah, and this is not just about appreciating your work, it's also, like, you know, like, providing oversight, you know, like, as tasked by the city. we are, like, here to support you all, you know, like, to make sure that you all can do the work that you've set out to do because this is not an easy time, and we get it, and we want to make sure that we can do whatever we can, also, to support that.

so thank you. >> thank you, commissioner chung. i just wanted to remind folks, we are about a third of the way through this presentation, and while i know all commissioners have thoughtfully reviewed the entire presentation, in our enthusiasm, we may be raising topics that will be addressed later on. i know that's something that i have done, so i would ask that our d.p.h. staff and leadership feel free to tell us if something is going to be addressed later in the presentation rather than having to address it twice, and i think we are ready to move forward. >> hi, everyone. barbara bennett. >> hello. >> so i'm going to take you through an overview of what the

office of health equity is doing and will be doing. there's a much more comprehensive discussion about the racial equity action plan, and you'll also have your own time to review it. it's quite long, so this isn't really a form where i can give you all that much detail, but we will cover the waterfront on what we're trying to do and then see what we can do in the next week to two weeks to get you more information. so the office of health equity staff is small. it's gotten a little bit bigger since last we spoke, but we still have three staff deployed now. at one point, it was four or five. we left one person to hold up the entire portfolio, and we've been -- had staff deployed everywhere, which i think is a good thing, because i think it's brought some principles, people have been able to speak

up for things. i agree with you, commissioner christian, that we need this to be a lens. at the same time, i want -- we have come to find that it is a lens that people need to develop, and that is a skill that they can be taught. until they are taught, we often need someone to speak to that lens in the moment when decisions are being made, so the fact that we've had staff in all of these different areas, i think, has been a helpful addition to the response, and that means standing up for access, data disagregation, looking at community collaboration, all of those kinds of things. next slide. so this is just an overview of what we thought we were going to finish 2019-20 fiscal year doing. we had a lot of goals that are in our a-3 that you received

last year that should have been finished out by the spring, and in the springtime, we would have had our developmental analysis for the next a-3, but that is not what happened because of the deployment. it does not mean that services -- that the equity work in the department stops. it does mean that it did not change necessarily in a way that we might not have otherwise done, so equity being an orientation that was already accomplished in 2019, so that did continue at a minimal level, but not as much as before partly because our orientation had changed. equity process, we had a lot of people deployed, and we weren't able to get all of the

resources deployed. we have been doing some work on other kinds of trains that the department wants to have an equity. in fact, we just released an electronic -- an on-line training for staff, kind of a racial equity 101. next slide. so you are aware now of the racial equity action plan that the office of racial equity ordinance put in place last year, so every department has to create one that's due by december 31 of this year, and then, you update it every three years, report it once a year to the board and the mayor. so it's a little different than our usually a-3 process. this face of it is -- this

phase of it is devoteden inventorily devoted entirely to racial equity. it's just a lot of it, so we are looking now at how to right this in a way that is feasible with our current capacity and what our expected capacity will be in the next six to nine to 12 months. the areas of interest for the racial equity action plan are on the side here, and they run the gamut from hiring to just motivational culture and even the commission's own training and approach. next slide. [please stand by]

and every division -- those things are still ongoing. they have been delayed because there hasn't been a department that has a large number of staff and particularly leadership. a lot of the staff who are deployed are people who are those we don't need on ground to do things, so those are our managers and senior leadership and people who otherwise might do this kind of planning. so the 2019, the 19-20 goals that we had are really just starting to be relaunched, and

we will likely do most of our work on those. for sometime, the racial equity action plan follows a calendar year rather than a fiscal year, so it makes sense to consider just re-timing all of our racial planning, racial equity planning around that calendar year, which would mean that we would be due for a 2020 plan -- i mean a 2021 plan in january or so rather than saying that we have not been working on the 2021 plan. community engagement, workplace culture and clinical quality improvement are all areas that we want to do further. the workplace culture is the only -- and accountability is the only one that's included in the racial equity action plan. the other two are things we have ongoing and want to develop still further. next slide. >> thank you, dr. bennett.

it appears from the slide with the impact of covid that you are on track in a number of measures, that the majority of them, i know that given your work also at the command center, that was a lot on your shoulders and are certainly grateful for your hard work and attention to not only your normal but the command center as well. i see -- do we have any questions from commissioners? i do not see any questions right now. so i think we are able to move on. thank you, dr. bennett. >> you're welcome. you will get the racial equity action plan in its form for you to review in about a week to ten days or so, and then we'll have the longer discussion at the next commission meeting. thank you for your attention. >> great. thank you. we look forward to it.

the next topic. >> michaela, do you -- oh, there we go. great. hi again, commissioners. greg wagner, chief operationing officer. i'm going to go through -- i think we -- as you mentioned, president burnel, we have touch on a number of these areas in previous conversations, so i'll go through this in most cases relatively quickly, but talking about hr, it, finance, business office, compliancy and privacy and security. next slide, please. so we'll start with human resources, which we did already touch on earlier, but as we talked about, we have had an expedited hiring process that

was in planning leading up to covid, but really kicked into gear as we got into covid and recognized the needs across the system for a response, and you can see some of the numbers here in the core areas where we really made a push and really modified our -- and shortened our processes and tried to compress steps and that the hr teams, michael brown, karen hill, are both on the call, and their teams have been amazing. this is progress that we have been looking for for quite some time, and those numbers really speak. can you see in particular 315 rns retired and 70 porters since march when this -- the pandemic really began kicking into gear and [indiscernible] really game into existence. we are also hiring 109, which we had also talked about, 109 new positions that were in the budget for covid to offset some

of the impact, partially offset the impact of deployments across the department, and so that work is happening. there are other impacts on our hr processes. we have had dramatically increased volume of leaves as people are out sick or taking care of family or loved ones, and it really has been even for those staff that are not directly deployed, it's really changed a lot of the need and a lot of the things that we need to focus on in terms of work. next slide, please. a couple of the hours again where we have talked about, so filling key vacancies, aside from covid, we have a huge amount of work to do that pre-existed covid to do hiring for our basic operations, and that includes primary care. it includes behavioural health, population health and mc age.

behavioural health in particular has escalated higher with the inclusion in the budget of funding for the mental health sf initiative and staffing up to meet those needs is going to be critical. we have across these divisions 250 prioritized positions, and our priority hiring plans. we have been working on these. they are probably not going as fast as they otherwise would have because of the focus on covid, but this will be a big focus for us going forward. we are expanding our h.r. staff, as you may recall from the budget process, we added 20 new h.r. positions in the fiscal 21 budget that were approved by the board. those positions are being brought on forward right now, and we're -- board right now, and we're adding another seven physicians related to mental health sf and behavioural health hiring. so that should add some capacity

and allow us to make some progress. but there are impacts in terms of where we focused our priorities and where we have been able to hire. next slide, please. back one, i'll just touch on information technology next. i know that we had an i.t. and f.x. presentation not too long ago, a few meetings ago, but we obviously have a lot going on that has impacted the i.t. team, the i.t. leadership has been at the covid command center providing support for a lot of the laid off work and the logistics of some of these operations. it has been a big effort for our

i.t. division that came right, you know, as we were going through our optimization phase for the first wave of epic, which occurred about eight months -- i guess it was about -- even less than that, about five months prior to the emergence of covid, and that has somewhat changed our plans. efforts are going to continue as we go through a couple of things with covid, the rollout of the vaccine continuing to refine our operations, and then also the fact that we do, again, have mental health sf coming, and we expect that there's going to be data and i.t. work to support those programs. we have had i.t. staff deployed is the word i'm looking for to covid, but we've also had an impact of a lot of the i.t. work

where we rely on the subject matter experts from the network and elsewhere focused on covid has affected the bandwidth to implement some of our programs. so one of the things that we have done is we have made some shifts to the anticipated schedule for our future epic waves, and if you go just briefly to the next slide, michaela, i'm not going to go into all of this. i'm just kind of flashing it up to show you, because we will add more detail on as we talk through at our regular epic and i.t. updates at the commission, just show you at a very kind of high level what the program looked like before, which is this slide, and then the next slide, which is the after being flashed on the slide. and michaela could you switch to the next slide? and what you can see here, again i'm not going to get into all this detail, but there's this

big block in the middle that says mental health initiative support and covid-19 mass vaccinations. we anticipate that that work is going to kind of come break up some of the anticipated schedule for the wave two of the epic. you can see some of the items on the right, mc hmcs fredericton, nephrology, phd clinics. those were previously anticipated to happen sooner. they are getting pushed back in time due to our bandwidth to roll those out. there are some epic waves, 1bs and 2s that are moving forward on schedule, but we're kind of strategically planning those based on bandwidth in the i.t. division and within the network. last thing i'll mention on i.t. is we have just launched a new

process portfolio governance process which is a much rational way of measuring our i.t. bandwidth and making criteria-driven decisions about which projects we are going to take on this year or which ones have to wait, and that i think will help us really do a better job of managing demand and also thinking about how we can right-size our work program to the staff that we have instead of trying to do everything at once and doing as efficiently as we otherwise would. next slide, please. so other divisions, i think we also touched on some of these, but contracts, commissioner chung brought up, that has been a huge amount of workload on emergency contracts, addendums, amendments that we have been

processing frantically to keep up with covid. office of compliance and privacy affairs, that program is continuing to meet our obligations, but there have been staff deployed which has slowed down our ability to do some of the improvement work that we had planned and some of the additional programming that was scoped out, and i know you also heard from ocpa recently. next slide, please. on finance, we are also strained, but we are working through it. i know you've seen some -- we've got the covid-19 budget. we've got the economic downturn that we're trying to plan for and the revenue cycle issues, some of which we touched on, but epic revenue cycle optimization and things like billing for testing, et cetera, that we talked about earlier. we are keeping up with our

obligations. we have had some reductions, again, in our ability to present you the level of supporting analysis and information that we normally wish to and hold ourselves to. we have kind of scaled back the financial reporting to meet the controller requirements, but not -- we haven't given you as much as we usually do. so there has been some impact on that front. on security, we are continuing to maintain our security program. i'll just mention here that we are in the process, and you'll be hearing more about it soon, of evaluating and planning changes to our security services and health care environments or hospitals and clinics, and this is in response to some of the events that have occurred throughout the network, where there was use of force or interactions between security and patients that don't fit the standard that we aspire to for

how we interact with our patients and health care environments, and so that work is going on right now. we're evaluating our security model and hope to have recommendations to talk about what the commission soon on what changes we can make there. i will leave it there. i think that's my last slide. happy to talk through any questions that you have. >> commissioners, i know you've had an opportunity to review this presentation and present some questions beforehand that i believe were already addressed. if you have any questions beyond that, please raise your hand. mr. wagner, i know you set a very high standard for the work in terms of finance and everything else, and certainly understand what limitations might exist now during the pandemic. so thank you for that. >> thank you. >> we do have a question from

commissioner chow. >> thank you. i actually was going to concur with commissioner chung that if there are ways in which we could look at helping to streamline the process in emergent way, and perhaps being able to break up some of the contracts in a different way in which you could then be able to present them and we would understand what was being presented as the emergency type of presentation, i would support that also. and i think it would be something that could be helpful, because we know there's contract staff, especially as you're getting all these new contracts and new services to render, need to have those go through too. so you know, what really can be

blocked together or however it is in terms of overall presentation that have individual ones, it might be that the epic process that we use for all the different contracts might be something that could also be looked at, and i think we were starting to look at that with your mental health program. so if there's some way to be able to assist you in lowering work that we know you don't have -- well, you have additional work now because we're having additional services and all, you have less of a staff than i think we would all be very supportive of trying to work this through and yet be able to do our due diligence. >> thanks very much, dr. chow. i appreciate that, and we will take you up on it. >> thank you for all of the very hard work that you've all been doing, and i think we -- we just need to see how best we can also

do our part with you. >> thank you, commissioner chow. seeing no other questions from commissioners, we can move on to next section, population health division. >> dr. aragon, are you all going to -- who's going to present on this? >> yes, tomas, are you going to present first?

okay, he may have -- but i will go ahead, and thank you, commissioners. good afternoon. it's a pleasure to be with you this afternoon. today i wanted to focus on population health division and our covid-19 efforts as well as some of the priorities, non-covid priorities and operational challenges that exist. so since the beginning of the pandemic, and since january 2020, phd played a leadership role. initially we activated our departmental observations center and led the covid response until it got to be much bigger than we could handle, and that opened up, then the mayor declared a public health emergency and we were able to have the covid command center. initially the elc and then the covid command center. public health efforts have saved lives, and resourced prevention, and i can tell you that almost

all of our staff at one time or another have been asked to [indiscernible] as part of the covid-19 efforts. currently we have 310 staff activated, and or are participating as part of their normal roles. we've estimated that over 38,000 hospitalizations were prevented due to public health efforts, and we have been able to secure over 6.7 million in funding to support epidemiology and lab capacity for covid-19. as you all know our health officer has been very, very [indiscernible] and has been really responsible taking the responsibility for developing the health orders to protect public health and prevent the spread of covid-19. our public health emergency preparedness -- branch has held leadership roles since the very beginning of the activation and continues to play a key role for the activation. our community health equity and

promotion branch is leading the community branch as part of the covid command center, and all [indiscernible] have been activated as part of the community branch. next slide, please. our applied research community health epidemiology and surveillance, this is our surveillance branch, is playing key roles in covid command regarding surveillance, epidemiology, informatics, data analytics and reporting. our center for learning and innovation director is leading the developmental and adaptive test and response strategies, developing testing strategies for safe and successful school reopenings and the dissemination plans for the next [indiscernible] care rapid tests for the states, and disease prevention control branch under the leadership of [indiscernible] played a key role in specialized [indiscernible] disease, lab diagnosis and investigation. and b.p.c. is leading case

investigation and contact tracing and information and guidance. our d.p.c. can playing key rolls in management. there you are, tomas. did you want to pick up? >> sorry, i had to change microphones. i'm not sure what happened. >> okay, i'll let you pick up from there. >> okay. i'm sorry. thank you. first of all i want to thank everybody for all your support during this pandemic response, and let me just make sure -- i'm just going to just mention a couple of things before i cover this slide. i just want to mention really briefly is that the population health division does cover i think mentioned the core public health services for the city, which include core public health, environmental health services and the emergency medical services authority, and the reason why i mention this is if we can go back one slide, and

just go back one more slide, sorry. i'm going to mention just one important point of this, is that in public health we are really, really focused on prevention, prevention, prevention. and that's so critical, and so the university study that evaluated our shelter-in-place order in march estimated that we prevented over 38,000 hospitalizations and close to 4,000 deaths. i think that's really, really critical, because the most important thing to remember is that by prevention we prevent -- we are able to prevent the surge, the cases, the hospitalizations and ultimately the deaths, and we saved tons of money. i think that's very important for public health because oftentimes people really miss the most important thing about public health. next slide. and christine already mentioned the role that i have in doing health orders, and then i've also been focusing on clinical

policy really working with the schools team and also working with -- interacting a lot with community members, businesses around health orders. in terms of public health emergency preparedness service response, we've had a chance to hear dr. andy tenor, now the new director of -- and that was one of the first sections that i created when i became the health officer in 2011. since 2011, public health preparedness has become a really core aspect of just public health in general, and we had h1n1, sars, mers, ebola, zika, and so public health awareness has been really critical, and so we emerged into an all-hazards approach, and so in a sense we have been preparing for this pandemic for a long time. part of preparation requires us

to work not just at the regional level with -- that you may have heard of earlier, but also at the state level with the officers. and the other -- with public health is working with the community. you can see the community health equity and promotion, chep. next slide. a core component of public health is epidemiology, surveillance and research, and that's an area where historically we have been pretty strong, especially in hiv, and that's really gone on to play a real critical role with the covid response. right now that's -- those functions are operating under advanced planning that's been an amazing collaboration, not just with clinical side, because we have those experts both in computer programming, infomatics and working on our side where we focus on surveillance, public health and epidemiology. the other area that's been important for us is our center

for learning and innovation, and they have been playing an important role in our high-impact adaptive testing and response strategy, and so a lot of our testing strategy is being led by dr. jonathan fuch, and he's the director of cli, and of course disease prevention and control is where the labs, tuberculosis, std, hiv, this is where all our clinical and laboratory expertise is around communicable disease control, and so they are playing an important role in the areas of case investigation, contact tracing, information and guidance and outbreak management and now vaccine planning, so it really is core pillars for public health. and the covid response. next slide. the e.m.s. agency, all counties have to have an e.m.s.

authority. oftentimes this is separate from public health. we're fortunate that e.m.s.a. is part of public health, and you can see there that they actually did a lot of the field testing early on where they tested teams as nurses that would go out and do covid testing. you can see they've completed close to 13,000 tests in the field, inspection, coordinating how patients are distributed across hospitals as well as first responder contact tracing. so we're incredibly fortunate to have emsa as part of us. the other important function that comes out of emsa is going to be mutual aid with other counties. so when we have patients that are being transported to san francisco, it works through this mutual aid system that's really directed out of the e.m.s. agency. of course environmental health is an incredible component of

phd. they have over 25 programs, and they are the ones who are really out all over the city inspecting restaurants, hotels, s.r.o.s, et cetera. so they have played an incredible important role in terms of two major areas that are going to be primarily in terms of environmental disinfection, the area of food safety and networking closely with issues around covid and essential workers. it also helped to deploy the issue around ventilation. so all the occupational health and safety is separate from environmental health. the expertise for understanding ventilation systems exists in environmental health that we are taking advantage of. phd has been very fortunate that we have a history of conducting primary research and have -- and are recognized for the research of a doctor who runs bridge hiv

and is now leading the vaccine trials in san francisco, and then we have a center for public health research where historically we've been doing research on substance use and hiv and hard-to-reach populations, and now they've become subject-matter experts which is really helping us -- really helping us design our testing strategy, but doing it in a much eviden more evidence-based approach. the other thing i want to mention is the other area of population health division is we do have a new office of anti-racism and equity that's part of the departmental emphasis on racial equity. so it's an important area of us. i'm going to go ahead and turn it over to christine. she's going to cover the operational aspects of phd and moving forward. thank you. >> great, thanks, tomas. so i want to focus on some of our non-covid priorities moving

forward, as well as our operational challenges. so public health accreditation, as many of you know, we are up for re-accreditation in march of 2022, and this is a key priority for the department, and we have a lot of work to do to prepare for re-accreditation and really need to focus in on this area. just so you know, we have reached out to the accreditation board to inquire about a possible extension given covid. however, we were told that we could not request an extension until we received our final accreditation instructions, which we expect to receive in march of 2021. so given that we are -- be able to obtain an extension, we really need to dedicate resources to focus on our performance improvement initiatives. another priority is the climate change adaptation and our ability to prepare and respond to extreme weather events.

again, thomas mentioned our substance use prevention, environmental justice, racial equity and our new office. we have hired a new director for that office, and focus on investment in phd for the long term. i think the pandemic confirms what we already knew was that we do not currently have adequate number of clinicians in our communicable disease control and prevention unit. currently we only have 1.5 ftes of public health nurses which was highly inadequate to respond to covid-19 or any major -- primarily from maternal and child health, which left a gap in their ability to serve pregnant mothers and children. this is an area we need to work on. and then also to focus our transition and reintegration of the covid activities into our regular phd operations.

as tomas mentioned, the entire chep branch is activated as part of the community branch in covid command. so that means that a lot of our chep work isn't happening, isn't getting done. we've got to figure out how we can reintegrate the work into our normal chep operations. some of our major operational challenges that include, like you already know, filling our vacant positions that can be activated to support covid and allow some of our staff to resume some of the activities that have been paused. we currently have over 80 vacant positions in phd, and with a small staff, you know, that's critical to fill some of these positions. and then they get another operational challenge across the board, a positive strategic priorities and activation. next slide, please. in our disease prevention and control branch, which includes

three public health clinics, our communicable disease prevention and control unit, as well as the public health lab, the priorities includes [indiscernible] and treatment, congenital syphilis prevention work is key. we are seeing a rise in cases in the past two months we've seen four cases including a stillbirth. this work has been hampered by, you know, the activations, both from our staff as well as the network, but we really do knead to refocus in this area. hiv prevention continues to be a priority. implementation in tb clinic is happening as part of wave two. the other clinics have been pushed back, but we are currently in the process of epic implementation in the tb clinic. and then maintaining and expanding our lab capacity. i think that for covid as well as for other diseases, and the

public health lab was the first lab in san francisco to offer testing. it has diagnosed 24% of all of the cases in san francisco residents. some of our major challenges are we're seeing fewer patients at city clinics. we're seeing about half of the amount of patients that we see during the normal weeks. we're seeing about 150 visits versus 300 a week, and tb clinic is also seeing fewer patients into limited clinical services given that many of the smes are completely or partially activated to covid. all of our routine non-flu immunization work has been slowed. chronic disease work has drastically been reduced, and our annual provider communicable disease updates have [indiscernible] and we're seeing youth sexual health services decrease given that the clinics are not currently open.

next slide, please. in our arches branch, this is our epiand surveillance branch, our key priorities are standing up the center for data science. this is a new phd branch and arches is helping to support the hirings of the new director for this new branch. supporting mental health sf is a key priority, as well as vision zero and our partnership with m.t.a. outside of that are all of our focuses -- has been and continue -- will continue to be covid-19. the operational challenges of all our surveillance and activities have been decreased, non-covid conditions, that includes hiv, std, communicable disease of the viral hepatitis, informatics work to support [indiscernible] has been slowed. maven, which is our communicable disease surveillance system, the development has also been hampered and slowed down, and we're unable to complete the

community health needs assessment given that the majority of our staff are activated. next slide, please. and moving -- this is chep branch, the community health equity and promotion branch, and as i mentioned already, they have been fully activated and are serving as the community branch for covid command. we're exploring how we can transition this work back into h phd, because we do have some other key priorities, and hepatitis c, we have an rfp to fund new programs to address disparities, our health access points. that needs to move forward. just our work in prevention of hiv, std and hepatitis c, our grant programs, we have many grants. chep has many federal and state grants that need to get back on track. we have priority to continue to manage and monitor the cbos that

the chep branch currently funds, and our harm reduction efforts are another key priority. operational challenges for chep, many of our programs, prevention programs have significantly been produced or put on hold, you know, such as cannabis social media, some of our tobacco cessation programs, newcomers health programs, shape up san francisco, safe -- our connect prevention of the human trafficking, and some of -- that's just a few of our programs, but the majority of our prevention programs have been put on hold, have been paused due to covid-19. next slide, please. tomas mentioned our work in research. although the majority of our principal investigators are

serving as subject-matter experts for information and guidance, they are also keenly trying to get our programs and our research studies back on track, and the priority is our national hiv behavioural surveillance study and the nih-funded study of sexual partners. shifts of trans women, our key priority across the board is resuming study participants and increasing enrolment in our research including our substance use studies. the challenges that our research branches are experiencing, that we're behind in our trials, limited ability for in-person sessions due to covid-19 risks for participants and staff. that's resulted in new studies, start-ups for new studies have slowed down. efforts to -- drop-in centers

and start safe consumption sites, that's kind of been paused. initiation of drug sober center has been paused. and our struggle just to maintain p.p.e. supplies research given the shortage in the supply chain. that's been a challenge. next slide, please. so emergency medical services agency, thomas talked a little bit about that. outside of covid, we do have some other priorities that we need to focus on. the evaluation of our 911 system, that's been ongoing. the development and implementation of our regional stroke plan, the completion and submission of required plans to the state, they have been a little understanding, but definitely have to focus on those. our hospital m.o.u.s and getting those renewed. regional ems online training platform, that's been one of our priorities.

what's been put on hold at the moment is our grand funded program to distribute cpr man quinns, aed and cpr training to vulnerable populations, definitely would like to get that back on track as well next slide, please. and environmental health. environmental health is playing a key role for us right now in supporting the response to covid-19 by enforcing the health orders of directives, by sflooding smes, and they have also been flooding smes of informational guidance. [indiscernible] key programs, such as food, hazardous materials, agriculture and housing, but on the other side there have been reductions in some of their inspection work and enforcement, delays in areas such as noise, cross connections, programs, measures and hazardous material programs.

so again, also as well we've not been able to do the massage and body arts since they are not open, so that's -- we've had some inspectors being able to focus on covid. we're not doing tobacco enforcement at this time. so as you can see, we are fully committed and we've been committed to covid response since the very beginning. we've led that effort at the very beginning, since january, but we also -- it's come at a cost. there's a lot of things that have had to be put on hold, and hopefully as we can get new staff in, get new staff hired, we can deploy the new staff and bring back some of the staff to get our -- some of our programs back on track. so that's it. next slide i think is just questions.

>> commissioners, do we have any questions? all right, it looks like we do not have any. >> [indiscernible]. >> i'm sorry? >> commissioner raised his hand as you were speaking. >> okay, great, commissioner chow. >> okay, thank you. understanding the great words that obviously your staff has done, dr. aragon, and yourself, in all the covid, what are you seeing as the time frame that some of this could actually be coming back? we're talking about the hiring and all, and thank you for updating us on the public health accreditation issues, but how are you envisioning that in the coming year some of these that

are really important areas that you put into priority, once you have staff back you're not going to be able to do a lot of that. is there kind of a time frame for yourself, or are there some things that we could help do or that could be done that would help assist putting some of the key area of public health back on track? [please stand by]

department section how do you see that we would be able to -- because of response times and working on the hospital sections, because that's responses and -- and the diversion questions, is that being postponed or is dr. brown and you all continuing to really work on this? it is a priority on your documents here, and it's been a priority for some years, but now that it's back in the department, i have hope that it

could really get resolved. >> well, yeah, i am hoping that because the city agencies have been work a lot more closely with the hospital and fire, e.m.s., but also with the transfers in and redistributing patients in a lot more equitable in hospitals, i'm hoping that all of that distribution is going to payoff. when the pandemic dies down, we should acknowledge that they're going to address issues like diversion, so hopefully, that will improve into the future. actually, the other thing i want to point out, being able to work with the network side, implementing the ethnic and just all the i.t. issues and data issues where we've been able to work closely together, i think that's really going to help us problem solve. >> i just want to finally thank you for the very exhaustive

health orders that you do put out. it's certainly a volume of material that i wonder if we could copyright that, and we could send it to all the other departments in the nation? but it's clear that you have really thought out what our [inaudible] is. thank you. >> yeah. i just want to acknowledge the city attorney. they have a small army of people who love to write, with a lot of attention to detail, so we owe a lot to the attorneys that are really helping us. they take our intentions and our vision, and they put it in legal language, and then, we have i.n.t.s that then translate it into guidance, and that translates to the community, so we have an army

of people that make it all happen. >> i actually pulled your advice on ventilation, did realize what it was all about. >> one of the ways that we're going to tackle covid is remember it's an airborne disease, so a lot of it is ventilation tracking, and behavior. >> thank you, commissioner chow, and thank you, dr. aragon. you said you had hoped there would be a new appreciation for public health and population health. there's certainly a great deal of appreciation from the other commissioners and myself as well as, i think, the people of san francisco who have been so instrumental in ensuring that we are able to control the pandemic to the extent we have

been able to do so, so, you know, just thank you so much for the example that you set for the people of san francisco and for the state, and we are very grateful for your efforts. and i wanted to especially being acknowledge christine -- to especially acknowledge christine, who has taken on so much during the pandemic, who has had to take on so many responsibilities and so much hard work, as well as the entire population of the health division. the entire division has been so key to our efforts, so i really wanted to, on behalf of the commission, extend our heartfelt gratitude for all of your excellent work, dr. aragon. i do see that commissioner

guillermo has her hand raised. >> yeah. i just wanted to lend my voice, again, to the gratitude and to the -- and just a sense of -- aside from covid, from the litany of things that are still on the agenda that the department is still -- in this division is still on top of, and, you know, not waiting to see whether you're going to get a pass or waiver on the accreditation, you know, going full bore into it as though that was the only priority you had to focus on. it's just an indication, i think, of the -- just the excellence and the sort of training that occurs in the department and how lucky we are to be able to recruit the public health professionals that we have.

and hopefully, you know, you all stay, last through the next many months, and we will all be able to celebrate the successes that i think san francisco represents, notwithstanding all the challenges that we're going through, but really to celebrate what we have witnessed thus far. and so i want to thank you -- and i wanted to mention christine, as well, because christine worked for me many, many years ago before i [inaudible] and hopefully that's an indication of some of growing up from the community and sort of lending her expertise. >> thank you, commissioner guillermo. and just so you know, i always appreciate you as a mentor, so

thank you very much. >> thank you. >> sounds great, commissioner guillermo, and thank you to the entire public health commission. and i think we can move onto our next presentation, which is s.f. health network. >> all right. good afternoon, commissioners. >> good afternoon. >> hi. so i'm roland pickens, director of san francisco health network, and given the lateness of the hour, i will make my remarks brief and concise. thank you for this opportunity, and i need to let you know, i'm joined by other senior executive leaders of the network, our chief medical officer, clare horton, or director of ambulatory care, hali hammer. also our c.e.o. of laguna honda, our c.e.o. of

zuckerberg, and you've already heard from troy williams, who who's currently incident commander. next slide. so briefly, very much like ph. p.h.d., we've had many of our key leaders deployed and activated for covid. christine and troy were the first ones at the table, given their public health responsibilities, and then quickly, once we saw the magnitude of the pandemic, joined them in the initial department of operations center and now the covid command structure. what you see are just a few of the individuals from the network leadership who -- who have and are continuing to play major roles within covid command center, and one you don't see here is dave woods,

our chief pharmacy officer, who is the deputy incident commander and will be taking that rein once troy williams rotates out of that future. next slide. and this is similar to the slide you saw from p.h.d. they kicked it off in january. we've collaborated in terms of putting our best and brightest staff toward the covid response, and as p.h.d. said, our efforts have contributed to i have been is aing live -- have contributed to saving lives. in the upper right hand corner, in emergency room iterms of ac response, at zuckerberg, we've

put in medical surge and extra bed and s.n.f. beds, and we are also instrumental in setting up the low acuity site. many of us in executive leadership have been activated and deployed. i have the privilege of being activated and deployed to covid command, and i serve as the [inaudible] for the lower acuity site. i'm proud that it's open at presidio and ready to operate when our surge in san francisco dictates. and then finally, on this slide, we've secured about $82.3 million in c.a.r.e.s. act funding. i think it's important to note that this c.a.r.e.s. act funding really is not added new budget revenue.

it was really meant to replace the huge revenue losses that health care systems around the true and other employers is u sustained because of the loss of business and revenue from covid. next slide. so now, i'm going to turn it over to our chief medical officer, dr. clare horton. you just heard from me about 30 days ago when i gave my presentation about the network. we really lived the last nine months really in what i call a tale of two cities. maintaining our excellent services while also having f fidelity and being part of our covid-19 response. so i'm going to turn it over to clare now. >> thank you. good evening, commissioners,

and thank you, roland, and i'm sure there will be some questions at the end, and we appreciate you being here for them. we are going to focus on the next couple of slides on just the sheer number of people that we have deployed from the network to covid command and to the covid efforts from the city. we've been very proud to be a part of this effort, and i do think it has been helpful, i think, the partnership between us and covid command, and also in emergency roterms clinical , to have a staff of people ready i think has been a really helpful partnership.

we've currently got over 300, probably in the high 300s deployed. there have also been quite a lot of internal deployments, and we estimate that as being probably over 300 people, and by internal deployments, for instance, at san francisco general, they've had to deploy a lot of folks to do screening in the lobby. we've deployed a lot of folks to some of our increased testing areas at all of our health care centers, so -- and beyond that, i think many, many of our staff have taken on additional responsibilities to respond to covid needs in our areas, even if we -- even if those staff have remained in place. but turning now to the number that's have been deployed to c3. in this slide, you can see the areas where the deployments

have come. these are accumulative deployments throughout the duration of the pandemic, and one thing that's a huge contribution is the ambulatory care division. it's separated out into its different divisions. behavioral health has deployed a total of 270 individuals throughout the pandemic. primary care, 152, and maternal and child health, which is a smaller department, 60. you'll also see that despite a lot of internal deployments, zuckerberg san francisco general has also deployed quite a few numbers of people to c3, and then, laguna honda and the jail has deployed fewer.

there's quite a few people that have been serving as project analysts or operations leads in all of these places, but you can also see the heavy clinical impact that we've had, and so it's probably worth point is out that although the number that we've deployed from our total sfhn staff is about 12% of our total staff. when you look at the percent that have been deployed from our clinical staff, it is -- it is a much higher percentage than that, and that has definitely had an impact on our clinical operations, as well. next slide, please. in addition to sending a lot of

folks to the c3, this is a little bit of our experience with the internal challenges that we've grappled with over the last few quarters, so just a little history in one slide of the other things that we've been working on during quart. during quarter one in 2020, we had to figure out what our c.o.o.p. planning, so continued organized operation planning, so how can we take a little bit extra and deploy it to the c3 effort. we set up a committee, now it's called the network resources team to request to the c3 for deployment, and that's been a fruitful exercise with lots of appreciation to the leadership of that group. we've dealt with a lot of cross coverage planning to get med surge and i.c.u. adequately

staffed. we freaked out about p.p.e. and got that figured out. in quarter two, we dealt with some outbreaks at laguna honda, very successfully contained, unlike other areas of the country. very proud of that. set up testing sites that are staffed by our ambulatory care staff. worked on a covid database and dashboard. obviously, we've had a wave two, and quarter four, wave three surge response, which has required more people and more staffing. there's been a lot of work between our behavioral health folks and the community communications around this, and then, in quarter four, of course, we've really dealt with and successfully pulled off a

mass flu vaccination for our staff and patients, and the other thing in quarter four has just been staffing, staffing, staffing. about 90% of our sfhn deployed staff were due to have that deployment end on 12-31, so we've spent a ton of effort working closely with c3 to see who is needed, see what we need today do so we can keep supporting the covid efforts. next slide, please. so this just shows where our people have been going, and again, it just extort of illustrates that we've been heavily supporting more of the clinical areas of c3. in the interests of time, i'll go to the next slide. so i wanted to dive in a little bit to the different areas, both the priors and operational challenges that we've been working on during covid. as a reminder, ambulatory care

is comprised of five divisions. the jail health again has worked very, very hard and has had fewer deployments because we've really been very focused on preventing outbreaks. we're proud to say that despite 76 jail positive residents, we've had no outbreaks at this point, so we're proud of that. however, i would say with the heavy toll of deployments in ambulatory care, there has been a lot of slowing down and reductions in really services across the board, and so we're working very, very hard to try and prioritize the areas that we've build. you can see some of these examples here. intensive case management, wait times have increased.

wait times for many other services have increased, especially for public health nursing home care. some activities have -- it's really been hard to maintain our previous rates of those things, and some, you'll hear more about mental health san francisco in a bit, but there's been some delays and prioritization that we are working to get back on track for, but ambulatory areas is where there's been quite a bit a lot of reductions and we're hard to share some examples later in the presentation if you'd like.

they've deployed over 200 staff at various times to the covid effort, including many senior leadership positions, and then, the internal deployments have been significant at s.f.g., so they've had to completely redesign how they screen and allow people into the building, lots of internal deployments to do, screening in the lobbies, etc. they've had to -- partly because of deployments and partly because of covid it ese, they've had decreased clinical room capacity, and they have had some delays in improvement performance activities, but they're really kind of back on the band wagon for that. next slide, please. for laguna honda, again, very happy that they have really managed to prevent a major outbreak, as many other long-term care facilities

experienced throughout the country, but it's come with a lot of work. there have been times when they've had to decrease and delay admissions, restrict -- they've had to really redesign how they do visitation, how they work with covid-19 quarantine, and they also had a hard time kind of, i think as we all had, kind of staying on top of our strategic planning, especially with our project management support and k.p.o. support management deployed. nonetheless, they've done a great job, and really all of our networks across the left-hand side have been the same, but i think in all of our areas, really, continuing to deliver the core set of clinical services that we ne--

of services that we need to for our clinical population, while also contributing to the covid effort have been our key priorities throughout this time. next slide. so this slide is really busy, and you might have gotten a chance to look at it in your packet, and i know it's quite hard to read. but what we tried to do is true north something that's very important to us, and all of our areas have true north goals that have been outlined, so we went through this and tried to take an honest accounting to see what areas are we meeting at our baseline levels, and what areas in purple do we not know that we're meeting our goals, but we've had to significantly slow down or accept away from the project planning there -- step away from the project planning there. so you can see there are a few areas that we're keeping a close eye on, but of course, like in many other parts of the country, we have concerns about getting back on track once

covid gets under better control. i think we've all realized that covid is a top priority, and that if we have a masstive outbreak, you know, we -- they'll be -- you know, we won't be able to get our folks past it in order to go back to regular routine health care, but at the same time, we do worry about having to decrease our efforts for some of our chronic disease management and cancer screening in particular. next slide. all right. so this is the last slide before i hand it over to hali hammer who's going to talk about mental health sf. i think our challenges overall have been reduction in clinical services. we're worried about some of the potential impacts.

we're working hard to make sure we don't get a major reduction, and we're really focused on staff experience with deployments and on staff stress, and how we can mitigate some of the effects of that, and some of worst parts of the potential burnout. that said, i would say this has been tremendously hard work, but it's been really amazing to see the team come together. i think it's been particularly amazing to see the work between the c3 and all the parts of the network. it is really great that we all like each other so much and respect each other and have these preexisting collegial relationships because this is really hard to figure out where we're going to shift staff from to staff something else.

i would say there's also been a lot of creative mitigation for the short staffing. we've got podiatrists and nurses swabbing noses and receptionists checking temperatures, and then, we're really trying to prioritize our goals and try to centralize services as we're able. i thank you for your attention tonight, and i'm going to turn it over to hali hammer, who's going to tell you a little bit about what's happening with mental health sf during the pandemic. >> thank you, clare, and good evening, commissioners. i'm hali hammer, director of sf mental health network. it's a tremendous honor to talk to you about mental health san francisco. i want to say the planning team of the last almost 1.5 years,

starting with very contentious meetings with the board of supervisors, and culminating with the launch of our mental health sf program has really been one of the highlights of my 26-year career in mental health. this has been incredible in terms of the vision and commitment to cutting edge health care reforms that i had only experienced before when we were working on healthy san francisco. but in terms of true impact on the health of the population of san francisco and especially the most complicated and high risk of the people we serve, i believe that what we're building with mental health san francisco will surpass even -- even healthy san francisco. we have a ton of support from the city, including the mayor and the board of supervisors, and i feel very proud and

privileged to be part of the team who's working tirelessly on this huge mental health reform effort. it's truly awe inspiring and incredibly satisfying to see mental health san francisco programs launching even as we're complete immersed in our >> there slide shows you the mental health san francisco government structure. i will give you an update on our planning process to date. dph san francisco committee evolved during the initial phase of san francisco planning for the working group focused on behavioral health reform at-large. we had been meeting about a year before the mental health ordinance was passed unanimously by the board of supervisors last fall. the mayor's appointed director

of mental health reform was active member of the steering committee and continues to be so. we continued to meet weekly. the planning was disrupted in february when covid hit. then we took a number of months off. then reconvened this summer. when we reconvened, it was under the leadership of executive sponsors horton and wagner, both of whom you have heard from today. i want to remind you about key aspects of mental health san francisco. we expect the mental health reforms we are embarking on will impact a latter part of san francisco and most people with behavioral health issues. we specifically target the approximately 4,000 people who are experiencing homelessness

with co-existing behavioral health and substance abuse issues. there are other specific populations with barriers to accessing high-quality behavioral health including and importantly justice involved people and those released from county jails who are included in the mental health san francisco legislation. including the justice system involved people it acknowledges incarceration is a public health issue. it is imperative reforming mental healthcare and substance abuse services must be done with this population in mind. some key parts of the vision he involve to the planning to bring you up to speed and refer to this graphic. we have reconfigured the key projects which we will focus on first based on budget, covid and

all of the change and making sure that the work aligns with other city priorities. the general budget framework was to budget for four projects which you see here. number one, two, three, four which direct three of the five key components called out in the mental health sf legislation. we have since added a fifth project overdose response work. not specifically called out in the legislation overdose response. responding to the skyrocketing rates of drug overdose deaths in the city and widening disparities impacting the black and african-american community. our overdose response work is in the overall trajectory of the project. we included that in the project.

we have recently been joined in our work by moss evans consulting. we have a long history providing project and coaching for the mental health sf domain and working with heartter and company who we are working with the controller's office and harter will help support our work to convene the sf implementation working group which is to launch. so this gives you a little more detail on the status of each of the five domain working groups. briefly, the office of care coordination we have a work group planned. we are hiring, hiring because it is largely staffed by care

managers and that is an area behavioral health clinicians where we have shortage. we are also, as greg mentioned, hoping to have a new team focused on behavioral health hiring in hr to help us get up to speed and get that project launched. the seconded project domain is the response team. i am excited to announce the launch yesterday. i hope you saw the announcement by the mayor and news reports. it was exciting. this team, this model and development model was led by behavioral health director of

forensic and justice, our director of mental health reform, cathy simon, the fire department pms6 team. in collaboration with emergency management, police department and others across the city who were really committed to a successful development of this innovative model of trauma-informed person centered humanistic response to people who are experiencing behavioral health crisis on the street. i just want to congratulate the team for successful launch yesterday. they are currently we have one team working eight hours each day five days each week. by the end of this week we hope to learn from that team's

experience and progressively spread until we have six teams and eventually we hope to have the teams active 24/7. the mental health service center is the third of the domain groups. the work group was formed. we are working to expand services that are now based in our behavioral health access center redesign the center and behavioral health pharmacy and also really develop a welcoming, inviting space where people can come to either in crisis or not to access behavioral health services across the city this. is the site where we will develop our telehealth program in psychiatry and we are excited

about the ideas floating around that we hope to crystallize with this design workshop coming up later this month. then there is the facilities. this project domain is direct outgrowth of mental health reforming group done by dr. bland to use an analysis of demand and identify gaps in our residential treatment beds. we are hard at work identifying new sites, new existing programs that we can contact with so we can fill those gaps. last, as i mentioned before, the prevention work. this domain is looking at investment in the evidence-based substantive treatment programs like the treatment, harm reduction and other new programs

to help usury vers help us -- ue overdose deaths in san francisco. this is my last slide. i want to flash on and i am happy to answer any questions. as part of the work to reform behavioral health services we are redesigning the original framework. we are changing the place in the department as klare mentioned. it will be a stand alone division of the health network with a new director reporting directly to health network director pickens and to director colfax providing mental health sf patient work. this chart shows the new structure. the most important to note is we are moving from a very flat

organizational structure with the entire executive team reporting to the director to one which is more in line with one of the other drivers of transformation work which is adherence to the medicare final rules. as you can see on this chart we have the managed care director. our health plan on one side and then supportive care with work force development on the other side with two distinct directors of those areas. managed care on one side and systems care on the other. you can see the light blue boxes are the new mental health sf programs and positions. most of those if you can see fit under the health plan. most are managed care functions. we are excited to build mental health san francisco as we move towards compliance with the

medicare final rule and develop the mental health plan which is separate from the systems of care. i am going to stop there and open it up to questions to any of the three of us about what we have presented regarding the health network. i want to close by saying that we are moving forward even though we are still so immersed in our could individual response work. one of the really satisfying things is to see how we can learn from our mobilization to meet the needs of people in isolation, quarantine hotels with some of the programs that we had hoped to implement with mental health sf and we are getting a jump start in covid response work.

exciting. thank you very much. >> thank you. just a couple quick questions for you. starting with dr. hammer and this is nothing that needs a response now. once the teams rollout in the next few months and we have all five teams up and running, the commission would love to get the status of that program. we look forward to hearing perhaps at the end of first quarter next year. nothing that needs done any time soon. the other is a comment and i want to go back to what dr. horton was saying about staff fatigue and burnout. when i was reviewing the presentations before the meeting, i was putting big

exclamation points about deployments across the department. it shows the extraordinary work being done from every part of the health network when it comes to responding to covid. i wanted to read what those different jobs and roles were. clinical support, nurses, behavioral health workers, information technology, certainly doctors, inspectors, health program coordinators. all kinds of analysts and managers and clerks, finance and hr and every other function of the department. that is to say that we as a commission are grateful for the work that everyone in the entire division is doing. we recognize those contributions and how thin that can stretch people and the stress they are under. we are here to support your work in any way we can. that is just a comment and statement of appreciation.

thank you very much. >> commissioner, i want to mention that one of the highlights of my last few months with joining the debrief session with the crisis response team yesterday at the end of the first day, and we certainly will bring back data. i hope some testimony. it is inspiring work and what we need to do right now to better serve people in crisis in our city. >> i wanted to thank you. >> any other questions or comments? >> i just want to thank you for your double exclamation points. it is a huge effort. one of the reasons it is very helpful to feel all of the support from the commission is that i know in a few months we will look at some of those metrics and we have worked so hard to get where we have gotten

and we are not going to hit the marks we did. we really appreciate the understanding for how we are trying to balance and prioritize right now. >> thank you. i think that we do not have commissioner comments or questions on this topic. we can move along. we are through the presentation. >> actually, commissioner chow just raised his hand. we promised the public they would have an opportunity to make comments at the end of the presentation. >> of course, and i know we have been taking commissioner comments and we are happy to have public comment after this. >> commissioner chow. >> extraordinary presentation and to hear the beginning of the

mental health san francisco and it continuing to move on and working hard to make it successful. i am somewhat concerned and wondering what we can de able to do in responding to that overall challenge of staff fatigue and manager burnout. or how the department is looking at it. the department talked about in mental health san francisco how to deal with our residents and i am wondering whether there are programs to assist staff are robust enough. >> i can start and if others have information. you know, once we got into this whole covid response it became clear we needed to up the ante in terms of the mental health support services that we provide to our staff. not only within dph but across

the city. a few different things were done. first, the city's employee assistance program through the department of human resources was expanded significantly. they actually contracted with an outside organization to be able to provide more services to enable more staff to have access to individual counseling for their needs. they have also been able to come out and do on site counseling for individuals and groups across the network. in addition, as you know from many years on the commission, we already had somewhat robust services,ticl, particularly at zuckerberg tan climb counseling services. those are tapped into and

maximized to respond to staff's needs. >> i wanted to at one thing. i think what is interesting to me is witnessing all of this -- it has been hard to be deployed for long periods of time. i think some people have thrived on that and it is a wonderful opportunity for them. i think we try to have a standard approach to who we maintain deployed and bring back, we try to have flexibility. we are working on internal promotions so people enjoying the work and growing into leadership get to do so. keeping our eyes open for opportunities like that is important. it is not just counseling when people are burned out but mitigating the original cause of burnout. >> thank you for the perspective. it is helpful. >> one more thing to add. this is troy.

in the ccc background slides we have a wellness center in the ccc at moscone with a wellness officer and we have been collaborating. the update is good making it available and having folks feel supported. there is a slide on that in the presentation, but it is an important piece of the work we are doing at ccc. >> i did see the slide. thank you for tieing it into the network and discussion. thanks. >> it is important to acknowledge those supporting the team and the important work. >> commissioner kristin. >> thank you. i just want to reiter rate my admiration for this 1,000% everything said.

dr. hammer, i can't say how excited i am about the update you just gave. i i did see the crisis response team was activated yesterday. i think many people don't understand simply because they haven't had to touch it directly how significant this is and the work that these teams are going to be doing is going to save so many lives and help people stay out of the system and get out of the criminal justice system. i just want to say that i see what you are excitedded about and share it. thank you so much for advancing this work in the midst of this pandemic. i really appreciate it. >> thank you, commissioner. >> commissioner green. >> i want to echo what

commissioner just said. as a clinician, it is so regardable the way you pulled together accomplishments you have been able to do in the midst of other responsibilities. dr. hammer, the joy you are expressing. it is unusual in medicine. i have been around a long time to have people work together and like each other and bring it altogether to move forward to the initiative to help the community in such a profound way. i am impressed by all of this. one question i had. i think jailhouse has done an incredible job. i know it was briefly mentioned here and i know, dr. hammer, you have been involved in that. could you just say a few words. the same we are successful at laguna. this is another area that is

really remarkable for all they have been able to do. >> thank you, commissioner green. i just can't say enough about what dr. lisa her teams and, obviously, the other city partners whose responsibility it is to keep people safe and when they are in our custody. we have had 76 people test positive on intake to the jail. we were successful in working with c-3 and the labs to get rapid testing for fast turnaround for people, everybody at the jails. it has allowed us to prevent transmission within the jails, which are, as you know, places

which otherwise are so high risk in terms of transmission. the fact we have no known transmissions within the jails this far into the pandemic and even during the surges, knock on wood. i just really attribute it to the incredible advocacy of dr. pratt and others who hav --d our good fortune the census decreased. we reached a low point b in terms of number of people in the jails when the first surge hit. that contributed. we are still able to use the more limited space creatively and keep people who either had tested positive or had symptoms

or whose test results we didn't have to keep them as far from the other people as possible. this is a huge accomplishment for san francisco, i really think, and it just is the success. i am worried we are going to hear about transmission in the jails and it could spread like wildfire. it is our responsibility to keep people safe in the jails. >> thank you to the entire team. >> before public comment, dr. colfax would like to say something. >> thank you, commissioners, i want to acknowledge my gratitude to the hardworking team that presented today.

i hope despite the uncertain times that we pays this presented a path forward with regard for the covid-19 response and our other many priorities across the department. flexibility and accountability came through. i just want to say thank you and i am proud of the department. we will do everything we can to continue to serve the public, and thank you for your leadership, commissioners. >> do we have public comment? >> thank you for staying late and for your interest in the presentation. if you would like to comment press star three and i can

acknowledge you. >> no further comment, commissioners. >> thank you. i want to thank everyone who stayed for that informative and excellent presentation. with that we will move on to other business. no other business. we have the joint conference committee report. >> no report. it is on this. there is no meeting. they have not medicines the last commission meeting. nothing to report. >> thank you. with that. thank you again to everybody on the staff of the department for all of your extraordinary work under extraordinary circumstances. it is never anything that we

anticipated when we signed up for this work. it is work that we love and are very committed to. we know that we have no choice but to act and that is clear from the work and the leadership of everyone in the department. thank you director colfax for your leadership to everyone on staff. with that we can have a motion to adjourn. >> i so move to adjourn. >> second. >> i will call roll call vote. [roll call]

>> the meeting is therefore adjourned. >> thank you everyone. be safe. be well.

>> good morning. the meeting will come to order. the december 3rd meeting. i am joined by committee member peskin. committee member haney will be joining us. i would like to thank sfgovtv for staffing this. do you have announcements. >> in order to protect the public and city employees during

the health emergency the board of supervisors legislative chamber and committee room are closed. this is taken pursuant to local state and federal orders and directives. committee members will attend through video and participate to the same extent as if physically present. public comment is available for each item on the agenda. both cable channel 26 and sfgovtv are streaming the call in number on your screen. your opportunity to speak and provide comments will be available by phone by dialing 415-655-0001. once connected and prompted id for today is (146)215-7375. following entering the id you will press topped twice to be connected to the meeting.

you will hear the discussions you will be in his senning mode only. when your item comes up dial star three to be added to the speaker line. it will indicate you raised your hands. best practices call from a quiet location to speak clearly and slowly and turndown your television, radio or streaming device. everyone must account for time delays that we may even counter between live coverage and streaming. if you have public comment you can e-mail to me, john carroll, clerk of the oversight committee john.carroll at sfgov.org. if you submit as e-mail i will

include ate as the legislative file. the clerk's office is room 2441, doctor carlton b. goodlett place 94102. mr. chair, items today will appear on the board of supervisors agenda of december 15, 2020 unless otherwise stated. >> thank you, mr. clerk. i would like to start by congratulating the civil grand jury for the issuance of the three reports we will respond to today. i would like to thank everyone who served this year for the careful and thoughtful and valuable time, work and insight you provided. this process and these reports are a testament to the oversight. i am grateful for your willingness to serve the city and hold the government accountable.

for each report we will call the resolution and hearings together while taking discussion, comment and motions on the reports one at a time. we will welcome the representative to speak on the reports and hear from representatives from city departments to summarize responses before turning to commission discussion and public comment and our responses on behalf of the board of supervisors. mr. clerk, please call items 1 and 2 together. >> clerk: agenda item 1 hearing on the 2019-2020 civil grand jury report strengthen our behavioral health services. number 2. findings and recommendations contained in the report. the report entitle strengthening behavioral health services. members of the public who wish to comment on these matters call the public comment number.

415-655-0001. enter today's id1462157375. press pound twice and press star followed by 3 to enter the queue to speak. wait until you are unmuted and that is your opportunity to begin your comments. >> thank you, mr. clerk. i would like to welcome our speakers from the civil grand jury. thank you for all of your work on this report. the floor is yours. >> thank you, chair and members of the committee. i want to make introductory comments. i am the foreperson of the 201 2019-2020 san francisco grand

jury. on behalf of the grand jury i extend gratitude and thanks forgiving us the opportunity to present our report in a public forum. the grand jury embraced our mandates seriously to investigate and report upon the affairs of local col local gove. we worked hard and have reports that are a consequence to the residents of the city. we had the assistance of many public servants and ordinary citizens of san francisco. we have great faith that our reports are worthy of their time and dedication. the chairperson of the committee will shortly present our report, outline our findings and recommendations and carefully listen to all of the respondents. we are excited to move forward. finally, i would like to recognize each and everyone of

our grand jurors. they confronted the task with perseverance and resilience. we trust we have made san franciscans proud. we look forward to addressing all of your questions. thank you very much. >> thank you. >> good morning, supervisor mar and members of the san francisco board of supervisors and esteemed colleagues. i am patricia levenburg and i represent the five members of the civil grand jury who wrote the investigation entitle strengthening our behavioral health services. we will review the findings and recommendations. i will take this opportunity to

thank all of the employees of the city and county of san francisco for their experience, effort, knowledge antennasty to reduce the impact of covid-19 on the residents of the city. this is atum you will di a diffr country. this is an endeavor where citizens like those who serve on the civil grand jury and legislators like you are working together to improve. [ inaudible ] >> doing what we believe will be right for the residents. let me put my headphones on. hold on. >> i don't think that wases coming from you. it may have been technical

issues in the background. hang on, please. >> while our investigation began in the late fall of 2019, we realized early in the spring of 2020 at the onset of covid-19 pandemic that our investigation would necessitate modifications to realize our goals and

outcomes. we feared there would be insufficient funding to do everything we were considering. at the same time earlier in the year, legislation for mental health sf was passed. the comprehensive plan by the mayor london breeds, supervisor ronen and matt haney to address the mental health and substance challenges in san francisco which was music to our ears. they committed to working together to secure the approximately $100 million needed for mental health sf implementation. at the outset, we, too, were eager for reforming mental health services provided by the city. we wanted a mental health services center open 24/7. we wanted expansion of behavioral health and access. a response team as in eugene,

oregon. a 311 number to call and focus to improve delivery of mental health and substance abuse services to those in meed of services. , we, too, were interested in the center. we were investigating the conservatorship law passed in 2019. to date we don't have information on the city's efforts to implement mental health sf. our hopes are high for this initiative to be actualized. all of that said our investigation instead examined three areas with behavioral health services, which we believe deservetic attention. number one, a hiring bottleneck and the hiring problem. two, executive turnover. three, public information challenges. now for findings and responses. we issued three findings and two

recommendations directed at reducing staffing shortfalls. the department of public health agreed with all three findings and would implement one of the two recommendations we made. ththe author's of the study secd recommendation states by jun june 2001 they should fill 50% of the vacancies in 21 days or less intensive case managers. they admit that 21 days might be used as a stretch goal. department of public health responds however highlights an ongoing hiring process which we believe unnecessarily hampers service delivery to behavioral health service clients needs. the department of public health response states fastest hiring time projections from the department of human services at the department of public health

is 120 days. it goes on to respond that the current average for behavioral health services hire is about one year from when the position is identified as needed, then entered into the system to the start date of that position. in the private sector, filling a vacancy in 21 days might be a stretch, but it is accomplished. every day while dph indicated that it is working to improve this timeline, we remain extremely concerned that this practice has gone on for too long. know that it can be solved in other places such as the private sector. we wonder why does it continue to be a seemingly stubborn circumstance at the department of public health human services office. we wonder when you find a suitable candidate will they

wait one year to be hired? moving to the second area of concern. we commend the department of public health for the planned hiring of 40 new intensive case managers by january 2021. we continue to be concerned about the long standing attempt to streamline the process. also, what can the department of public health do to subsidize salaries for the intensive care managers working for the community-based organization? reportedly there were 100 slots open for intensive case managers. we may fill only half of those vacancies. how does this change the ratio of providers to clients? the gold stale standard is 1-10. san francisco has a ratio of

1-17. there was one other respondent to be made this the recommendation, that is the department of human resources for the city. the san francisco civil grand jury did not receive the response in sufficient time to address it for this presentation. i am sorry to say. we will talk about executive turnover. we issued two findings and two o recommendations at behavioral health services director level. the department of public health disagreed in part with one of the findings and would seek to implement one recommendation and stated they had already recommended the other. the authors of the study sought to clarify what led to this disparity. as of drafting, no change was announced that the jury could

report. beginning with june 2020 and plans filed in public view in october 2020 that the department of public health has reorganized and the position of director of behavioral health services will report directly to the director of the health department and the director of the san francisco health network. enhanced remuneration to the expanded responsibilities is also taking place. it has substantially -- all of these actions accomplished what we addressed. we are pleased with this outcome. however, we would like to know if there is a timeframe for hiring or a deadline fo for hirg the individual. in our last area, the concern for the area of public health information or challenges.

we issued three findings and three recommendations in the area of report publications on the web and public directories and disability. while the department of public health partially agreed with one of the findings, it went on to state it would implement all three recommendations. however, we did not receive a plan to improve the signage, guidance and directory at public health department site and on the web, nor was there mention of phone assistance with the main phone number to the department of public health. we acknowledge the involvement of the san francisco health commission to monitor implementation of these recommendations by asking for quarterly reports from the department of public health. finally, we are honored to have been part of the tradition of the san francisco civil grand jury. we are pleased to have been part of an ongoing pattern of civic

involvement and hopefully improvement in our county and city services. thank you very much. >> thank you, doctor. is there an additional presentation from richard bogan? >> no, there is no additional report from richard bogan. >> thank you for all of your work on this very important report. i want to invite up marla simons from the department of public health to present responses from the city department. i want to note we have representatives from human resources department here as well for questions. ms. simons the floor is yours. >> good morning. thank you. that wases a terrific synopsis

of the report. can i share my screen? >> you should be good now. >> we appreciate the work of the civil grand jury and definitely saw a lot of alignment. i agree with the recommendations. i did want to clarify. there was one comment that doctor made about dhr not responding. the responses that were provided

were done in collaboration with dhr and dphhr. i wanted to be sure that what we submitted was a joint response. i won't go into it. the key points here to the report. what we saw in the report was the recognition of the growing concerns around people experiencing homelessness not having mental health and substance abuse needs addressed as quickly as they should be, and a lot of work has gone into mental health reform and now we have prop c funding to help expand services. a lot of great opportunities, and the same exact three points were raised about the hiring behavioral health leadership and public information and the summary of the responses.

i am repeating the things doctor levenburg said. it is the acknowledgment that hiring is a top priority and very, very clearly understood as a challenge. we did reclassify the position of the dhs director. i am -- bhs director. i am acting director now. there are a few people committed to the new director. we hope to announce this month and eta in the name of a new director. we are getting close to final selection. that is very exciting. there is a lot of opportunities that we have to improve access to information for dph as a whole and for behavioral health. we will be working on more

concrete plans. there is a lot of information that we provide online. we acknowledge it is not easy to navigate and could be better maintained. the few points of clarification we want to provide and where there was technically disagreement is that the intensive case management position are one type of case manager. we have concerns about vacancies across the board for clinicians and case managers and intensive case management is a narrow group within that. many of our intensive case management programs are managed by community-based organizations for whom we don't have oversight over the hiring but definitely do acknowledge the salary

disparities. it is something the city has acknowledged and hopes to address. again, just acknowledging that 21 days to hire a position given the current hiring challenges and overall process is just not -- never would be feasible in our current civil service system. we wanted to provide a couple of updates. currently the behavioral health services has 113 vacancies. we prioritized 90 of them. these are not just clinical. we have leadership, analyst, care coordinators and clinicians that are involved and are part of the list. 90 positions are moving through the hiring process. as highlighted here, some of the

clinical positions that are vacant, some of the work that we are doing to improve the process. we have improved communication between the behavioral health services and hr at the dph level. we are hiring a batch of the behavioral health clinicians that include some of those are icms that we expect to on board in january. this will help with a lot of our vacancies. some of these are covid intended to be for the covid response and a couple other positions in dph. behavioral health services we are working with hr to develop reporting tools. the hr team is expanding. currently they are working on hiring december or january for

new analysts to focus on mental health sf hiring. one of the other things that is important. vacancies in hiring is one piece of a more complicated puzzle where we need to focus on retaining the staff we have. we have the work force development plan focused on retention and staff wellness. we are working hard to be sure the polks we are hiring are as reflective of the communities as possible. karen hill is also with me. we can both answer questions or provide more information, if needed. >> thank you for that response. i am wondering about the one

year that we keep seeing. although it was not in the report, along the way we learned there could be up to 65 touch points for an application before it gets -- before the person is hired. people are lost because they can't wait for a year to be employed. maybe you can respond to that. >> thank you. thanks very much. i would definitely invite karen if karen is on to talk a little bit about that. there are many opportunities in our system to streamline the hiring process. unfortunately a lot of those conversations happen outside of behavioral health. they are things required in the dhr policy and civil service

rules that have been in place for 100 years. there is opportunity to improve. i definitely agree that is not acceptable. we need to hire faster, but that conversation how we improve the hiring process really belongs at the city level. karen, i don't know what else you want to add. >> hi, yes, i am karen hill, director of staffing for department of public health. based on what marla actually put the nail into the explanation. great job, marlow. we have processes in place to create a barrier. i hate to say barrier. we are civil service employees

but there are processes in place to improve and remove those barriers. we have improved our internal processes with the department of public health to increase -- well decrease the time it takes to hire and remove some of those delays to speed up some of our hiring. specifically, a pandemic had yous look at our process and to allow us to move quickly to on board and hire front line staff to address the pandemic. [please stand by]

-- to all of our hiring across the department. but, again, with partnership with the department of human resources. civil service rules were lifted from the ma mayor's dlerkation'd we than is removed we'll fall back into the civil services processes. but we're looking to see how we can maintain those processes ongoing so we can keep the momentum and implement those processes in standard work. while we're in this state of

emergency, you know, we're going to take those processes and be able to utilize those in filling those vacancies that we have right now with behavior health. >> thank you so much, miss hill and also miss simmons for the presentation and the further response to dr. levinberg's question about the long hiring process. i did want to ask acting human resources director issan, if you could also respond to the question that -- or the point that dr. levingberg raised about d.h.r.'s lack of response to the civil grand jury report, findings and recommendations? >> supervisor, members of the committee, thank you for giving me an opportunity to address you.

i think that we just had a simple misunderstanding which we clarified late yesterday. as miss simmons stated, the department of human resources and the department of public health collaborated on the responses on the hiring issues. and the department of public health provided a mai matrix tht indicates that human resources response that we develop jointly. so we -- we wrote to the -- to judge wong yesterday afternoon when we realized the discrepancy to explain that and to let him know that these were giant responses. i'm happy to comment on the concerns of the grand jury and let you know some of the efforts that we could undertake with the d.p.h. as they move towards creating more robust behavioral health response. >> thank you, director eisen.

actually, i would like to hear your response to the -- particularly the issue -- at the long timeline for the hiring process for intensive case managers and other key staff in behavioral health systems. >> the -- the human resources director broadly has responsibility for hiring city employees. we do conduct this hiring with some of our large agencies through delegated human resources departments. the department of public health is one of those agencies that has delegated authority to conduct its own hiring processes. but they still are constrained by the same rules that miss hill referred to. our hiring is governed and overseen by a very robust system of rules that are maintained by

the civil service commission. these rules are not all, but many are subject to needing confirmed if the rules are going to change. the hiring process -- and i would say generally speaking, the hiring process places great weight on making sure that -- protecting the rights of the candidates. we have multiple points along the way where protests can slow us down and we also have robust processes to guarantee fairness in the process itself. both starting at the beginning that we actually have the authority and the funds to fill the position and then all the way through the process of advertisement, recruitment, examination, interviews, then we go through a vetting process once we established all of that,

and then we have medicals and, finally, appointments there's been a number of looks at the process. we've done work flow on it and we can do more. we certainly did have a heroic effort when it came to hiring nurses during the pandemic, but as miss hill explained we were able to accomplish that in part with relaxation of the rules under the local emergency. we could certainly engage in a similar effort around behavioral health as the policymakers make their decisions about the direction that you wish to go in terms of resourcing. and we stand at the ready to assist in any way that we can. and we absolutely appreciate the frustration expressed by the grand jury and the department of public health. in many instances our own staff shares it. we too feel that these -- it could be a great impediment to

highly qualified candidates to enter into a process that takes as long as it does. >> thank you, thank you so much, director eisen. you know, i don't have any other questions. colleagues -- dr. lea arevingberg, you have a question? >> i have one additional question. i'm not sure who should respond to improving the signage at department of public health -- the phones. i think that it weighs heavily on us as facilitating communication with the health department. and if any of you have tried that, i would advise you to call that number of the health department and think that you're going to really speak to someone. or walk into the building on 101 grove and think that you're going to find anyone, because there isn't a direct person

there. so i'm hopeful that there can be more -- the access to the department can become easier for the public. and, thank you. as you talked about the emergency efforts, i would say go for it, if you can do it. thank you, thank you for your comments. >> thanks again. miss simmons, if you have any response to the questions about clearer public navigation. >> yeah, i would say that i will need to say for d.p.h. that we would want to get back. there are lots of people that would need to be involved in that conversation. for behavioral health services which is one director and i'm the acting director, i can say that we are absolutely focused on improving communication. both internally amongst our

staff and externally with stakeholders, with clients, and we have plans in place to upgrade our website and the idea of better signage and kind of support navigating our system is something that we definitely will -- will have on the to-do list. there are a lot of competing priorities. mental health s.f. has very specific language calling on us to really improve how our communication is managed and so i'm pleased, really pleased, it's been a long time coming that you will see improvements from behavioral health. and i know that d.p.h. is committed to that as well, but specific plans we would need to get back to you for 101 grove in particular. and, yep, so thank you very much. >> thank you, miss simmons. colleagues, do you have any questions or remarks before we go to public comment?

>> i do not. >> great. all right, well, why don't we go to public comment. mr. clerk, there are any callers on the line? >> clerk: thank you, mr. chair. operations is checking now to see if we have any callers in the queue. if you could, please let us know if we have any callers that are ready. for those already connected via phone, press star, followed by 3, to be added to the queue if you wish to speak for this item. this being the civil grand jury report on the behavioral health services. for those already on hold in the queue, please continue to wait until you are prompted to begin. you will hear a prompt that informs you that your line has been unmuted. for those watching our meeting on cable channel 26 or via streaming link or through fof sfgov-tv.org, follow the instructions on your screen at this time. by dialing 1-(415)-655-0001. when prompted enter the meeting

i.d. of 146 215 7375. followed by pressing the pound symbol twice and then by pressing star, followed by 3, and you will be added to the queue to speak. mr. coe, can you connect us to our first caller. >> mr. chair, we have no callers in the queue. >> thank you, operations. public comment is now closed. i do want to again to express my deep appreciation to dr. levinberg and the members of the civil grand jury who worked on this particular report and, supervisor haney, i don't know -- would you like to make the motion on the board's responses? >> supervisor haney: sure. well, first of all, thank you so much to the members of the civil grand jury for your work on these reports and especially on this particular report related

to strengthening the behavioral health services in our city. through our work on mental health s.f. in partnership with the entire board and d.p.h. and frontline staff and supervisor ronen, we came across many of these same issues in the report and the goal of mental health s.f. is in many ways to address these same concerns. in particular, the lengthy and inefficient hiring protocols have been a long-time concern. the turnover, the lack of clarity around streamlining services and processes, and we hope that mental health s.f., along with the recommendations brought forward by the civil grand jury can help us to address and fix many of these issues. i also want to recognize that this report was drafted in the last year and that there have been some changes in recent months related to mental health s.f., including partial funding that has been identified from various sources, including the

revenue and general fund appropriations and erap appropriations and implementation is underway as of november 2020, including the launch of street crisis teams and the hiring of a new director. and, number three, all of the members of the mental health s.f. implementation working group were appointed in the fall of 2020, and the group is scheduled to begin meeting this month. so consistent with the responses from d.p.h. and the health commission and the civil grand jury as recognized in their comments i move to amend the board response resolution, a copy of which you should have in your email, so that the first two resolve clauses should read, resolve that the board of supervisors report that recommendation number r3 will not be implemented because of the permanent public health is already reclazzified, the department of behavioral hel position to reflect a new structure and salary. that's the recommendation does not need to be implemented and

be it further resolved that the board of supervisor reports that recommendation number r4 has been implemented as follows -- the department of public health has changed the reporting structure of the department of behavioral health to report directly to the department of the san francisco health network, and, thus, the recommendation does not need to be implemented. i thank the members of the civil grand jury and we will be committed to these recommendations that still need to be implemented as part of a broader outreach structure and connected to mental health s.f. >> supervisor mar: thank you so much, supervisor haney. so, yeah, you have made the motion to amend the board resolution, and so i would also move that we recommend item 2 as amended to the full board and then also move that we file item

1 for the hearing on this. >> clerk: should we do a roll call vote on each of those motions? so for the motion offered by member hane tow amen haney to al call] mr. chair, there are three ayes on the amendment. and then on the motion offered by chair mar that the resolution to be recommended as amended [roll call] mr. chair, there are three ayes on that motion. and then on the motion offered by chair mar that the hearing be now heard and filed [roll call]

mr. chair, there are three ayes. >> supervisor mar: great, thank you, mr. clerk. can you call items 3 and 4 together. >> clerk: yes. agenda item number 3 is a hearing on the 201-2020 civil grand jury report entitled "sustain our city's high performing moscone convention center," agenda item 4 is a resolution responding to the presiding judge of the -- i'm going too fast -- resolution responding to the presides judge of the superior court on the findings and recommendations condaned in the 2019-2020 civil grand jury report entitled "sustain our city's high performance moscone convention center", and urge other the mayor to cause the implementation of the accepted findings and the recommendations through her department heads and through the development of the annual budget. to provide public comment call

1-(415)-655-0001. and enter the i.d. of 146 215 7375. press the pound symbol twice to connect to the meeting and then press the star key, followed by the number 3, to enter the queue to speak. a system prompt will indicate that you have raised your hand. wait until the system indicates that you have been unmuted and you may then begin your comments. mr. chair? >> supervisor mar: thank you, mr. clerk. i welcome back the guests from the civil grand jury and mr. peter mills who led the effort on this report. >> chair mar, mr. peter mills is the chair of that investigation and report. and he will proceed with our presentation. thank you. >> supervisor mar: thank you. >> okay, hello. we will recover and the muscone

convention center business will recover from the big hit that has been covid-19 over approximately the next two to five years. as that convention business does recover, it's important for us to continue to support, to invest in the muscone convention center to that end. chairman mar, supervisor haney, supervisor peskin, good morning, and it's wonderful to share this time with you. thank you for your attention to this report. and i will work to be brief and i want to go over some important points. i also want to take a moment to recognize the mucone convention staff and all of the people in the city involved in repurposing the convention center for this time of covid-19. what a dynamic and versatile operation it has been. but hopefully we'll get back to business as normal with the thriving convention business

going forward. pre-pandemic, muscone's business was indeed robust. and we recently finished building out the muscone building expansion on the tail of a half a billion dollar investment. with our recent past with these investments, we fully expect that the future of the convention business in san francisco can be, should be, bright, it should be vital. so we've made significant investments and we want to derive good returns on those investments. as we all know, past returns do not guarantee future success, future returns. and there are legitimate concerns with respect to that future. the post-pandemic success of our convention business is not guaranteed. coming out of the crash going forward in this next two to

five-year period and beyond the convention business is indeed a long-term business for the city. there will be enhanced increased competition from other venues around the nation and international as well. there's going to be slowly increasing demand for convention centers, for venues, corporate budgets are shrinking. conventions may be reinvented into some hybrid forms with more remote activity, less on-site activity. and there's going to be increased competition from other venues who see the same benefits as we do from our convention business. they see those benefits from theirs and they have also been investing. so the competition is going to continue to be strong. i want to make some find -- sorry, i want to make some comments on specific findings and recommendations, not all of

the findings, just some of them, in each of the four recommendations. but as a prelude to that, let me raise some of the key aspects alluded to in our discussion and analysis in the report. it's clear that covid and pre-covid, the munc, muscone cen play a significant role in creating in our economy jobs, local jobs from diverse communities. if we stand for -- if we stand up for the muscone convention center, we're standing up for revenue for our city, sorely needed revenue, and we're standing up for jobs for our citizens. that is san francisco's convention business does indeed have a significant impact, positive impact, on our economy. that said, our visitors,

convention planners and convention attendees, they have been articulate and vociferous in expressing concerns about the costs of hosting conventions in san francisco and the situation in our streets whereby planners and attendees feel uncomfortable, frankly, uncomfortable -- and sometimes insecure. yes, we have a strong brand. our city has a strong brand. our convention center is a high-quality institution and has strong brand. it's recognized as a top tier convention center. that's great. we have competitive advantages. we also have competitive disadvantages that our post post-attendeeees have capitalizd

on. we need to promote the favorable aspects of our valued proposition as a venue. we also need to pay attention to protect our investment over the long term of our convention events. sales of new events with the retention of existing events as we go forward. i'm not talking about today. i'm talking about the long term. two to five years out and beyond. so with that, we will now take our attention to findings, six, seven, eight, nine. for findings one through five, i think that there's general agreement from all respondents as to those first five findings. the final four findings in the report, i think that we can see that all respondents have said they agree but -- right, it's a qualified agreement. so it generates the value of

making some commentary. number six -- compared to many cities' competing venues, high costs make contracting future conventions a significant challenge. and one of the comments on that finding from respondents has been that while, yeah -- but -- talk to your convention cities, all have high costs. in the grand jury's view, not so, or maybe that's not so accurately stated. the fact of the matter is that in the range of costs for convention centers around the nation, our costs are at the top of the range. we can look at different examples. we can look at the rental cost for the facility itself. we can look at wholesale room rates beyond the control of the city, to be sure. trends -- excuse me -- hotel

taxes, and occupancy taxes. we are way at the top of the range. if i remember correctly, the report signaled that in san diego the hotel taxes 4.25% lower than ours. so, yeah, other cities have high costs in hosting conventions, but it's difficult to match our high costs. so that continues to be a concern. finding number seven -- compared to some cities competing venues, convention planners and conventioneers, they have concerns about insecurity. sometimes, unfortunately, there are incidents of real security issues. sometimes it's just a perception. but in terms of selling convention events and retaining convention events, perception matters. respondents have said that, yeah, but the stakeholders in

the convention business in san francisco already closely collaborate to address security concerns. in our view, yeah, it's true -- we were impressed by the quality of different stakeholders involved in building our convention business. and we are impressed by their close collaboration, but we need to achieve more because, frankly, the problem of perceived insecurity persists. finding number eight, unwelcome street behaviors and street uncleanliness bother the convention attendees. and have been behind the reasons some medium and large events have chosen to abandon san francisco as its venue and move to other cities. respondents have said that all top tier cities for convention venues have the same problems.

so one degree or another, yes, in our view san francisco -- while we have been successful because of the strength of the positive attributes of our valued proposition, we have worse problems around street cleanliness and street behavior than some other cities, and, certainly, some other cities use our reputation to sell against us in selling conventions. so it's a significant concern from that competitive aspect of long term realizing muscone convention center's potential despite the odds of addressing these particular areas. finding number nine -- in the face of san francisco's challenges in the area of event hosting costs, streets and behavior, we could partially offset those negatives by reducing our costs with some

additional subsidies from san francisco. one -- some of the responses have been that, well, we already constantly continually review the convention center rent rates. okay, but they continue to be significantly above the competition. and we need some additional support to sell and to retain conventions by addressing that excess cost. let's go to the recommendations. and i apologize, i think that i have been a bit wordier than intended so i'll try to become a little bit more brief to ensure adequate time for others. recommendation number one -- frankly, i think that this recommendation perhaps was misunderstood by some respondents in that the word "renew" did not imply that san

francisco can unilaterally renew the t.i.d. yes, there's a number of parties that need to come to the table and agree on the agreement. what this recommendation was targeted to was to have the city promote and to advocate for renewal of a strong t.i.d. the t.i.d. agreement is fundamental to the success of the muscone convention center and our convention business. let's keep that good thing going. recommendation number two. so recommendation number two is where we recommend adding additional subsidy to sell and to retain convention events. there's respondents saying that, well, in current finances with the precarious financial condition that we're in with an uncertain future, there's just not the money to do this. i'm paraphrasing here, of

course. but, number one, we're looking long term. and, number two, the $2.5 million outlined in our recommendation is not a giveaway. the money is not necessarily handed out as direct subsidies to any event, no. the idea is to be strategic about it and make a decision on a case-by-case basis to subsidize or not with the additional $2.5 million. so, for example, an attractive piece of business for the city could be an association convention event with a multiyear contract.

>> the recommendation is not to hire additional policemen. the recommendation is to focus priority on themus coney convention center and its events. the san frano