>> the meeting of the san francisco health commission. will you please call the roll. >> yes. [roll call]. >> i'll note for the record that she will join us she's having technical issues and i will note it on the minutes when she a

arrives. >> president bernal: thank you, mark. we'll move on to the next item. approval of the minutes of the january 19th health committee meeting. commissioners upon reviewing the minutes, do you have any amendments and if not do we have a motion to approve? >> so moved. >> second. >> president bernal: mark, do we have any public comment on this item? >> if you would like to make public comment on item 2 which is the minutes, press star 3 now. i'm not seeing any hands. no public comment request. >> let's go to a vote. >> yes. [roll call]

>> clerk: great. the item passes. >> president bernal: thank you, mark. we'll move on to the next item, the director's report. director colfax. >> good afternoon. i'm summarizing the director's report. i will also give a covid-19 update so we'll summarize some of the covid items here. we did have this state reopen and the state and removing this state home order across the state including our region so san francisco is now officially in the purple tier based on projected icu capacity in the region per the state exceeded 15% and weeks into the state

hospitalization numbers are coming down and case rates are also coming down and i'll show you some of that data in just a moment with the updates. basically with our moving into purple, it's a big item share including reopening outdoor dining, limiting it to two hours holds and allowing indoor personal services with the exception of where masks are removed and increasing capacity of certain retail and other businesses establishments so, those are the big-ticket items with regards to what it means to be in the purple tier. i will say that we also maintained the 10:00 p.m. to 5:00 a.m. curfew and the san francisco travel quarantine remains in effect per dr. seuss an phillip, our acting health officer. but things are moving in the right direction and we hope that they continue to do so. with regard on the vaccine front, some exciting news. mayor breed announced on januara

partnership with ucsf we opened our first mask site on the city college campus and it's very exciting there. we've been doing anywhere from 500 to 1,000 vaccines a day there since opening with the exception of when we were at inclement weather and the site had to close for a couple of days. we have 23 lines at the drive-in site to do 3,000 vaccines a day and that site continues to function and 80% of the people who have been vaccinated at that site live in san francisco. and people in that neighborhood have access to that site including people in the san francisco health network. yet, along with the mayor, senator scott wiener and partnership with the latino task force and ucsf, we announced the opening of the first neighborhood access site which

is at 24th and cap in the mission. it has asked -- it's doing 120 vaccines a day there now for people 65 above and healthcare workers. we do have capacity to go up to 250 and possibly 400 vaccines a day there. within our vaccine ecosystem, a good progress being made and i'll talk about that in the formal update and then, unrelated vaccine but i didn't want to announce some reinforcement exciting news is that we announced the hiring of our new behavioral health director and director of mental health sf and dr. hilary kunins who comes from new york where she's a deputy health commissioner. has long experience in working in behavioral work and she led many successful initiatives there so we're just delighted to have her start. she'll be starting here in march and really happy to have such an

outstanding person join our family after a long national search. so, some good news there as well. and i'm here to answer questions or comments about other items in the director's report or anything else i've already covered. thank you. >> president bernal: mark, do we have any public comments? >> folks in the public comment line, press star 3 to raise your hand. star 3. i don't see any hands so no public comment requests. >> president bernal: any questions or comments before we move on to the covid-19 update? seeing none. please proceed. >> all right. thank you. i think this slide will be coming up in a moment.

this is my covid update for the commissioners. as you know, we've been having an increasing cases coming out now of our winter surge. we have 31,377 cases of covid-19. you can see that steep increase starting in late november and unfortunately we've had an increase in deaths, we've at 324 deaths in san francisco. with regard to population charrer advertise ticks we see the inequity per sit evidence pa impact of covid-19 among the latino population. you can see here that with regard to h, the younger

population is -- not the youngest population but people between the ages of 18 and 50 accounts for the pullality and cases and gender and sex i'll sl orientation on the slide as well. in terms of deaths, most deaths are occurring in people 65 and older and this is 60 and older and you can see the distribution of the deaths by race and nice ethnicity. most people aside from covid-19 have associated co morbidity and we see a prepon derrance of male compared to female gender in the mortality. those are our local san francisco health indicators and our hospitalization rate of

covid-19 hospitalization is negative. we're at negative 9%. our i.c.u. and over all hospital capacity is robust and even three the worse of the winter surgery our icu beds were high compared to southern california and the bay area region and our case rate still extremely high and we are used to a high case rate and we're at about 20 per 100,000 and it's higher than the summer when it was 15 per 100,000 and it's down to less than half of what we were at the peak of our winter surge. that number continues to to decrease but certainly very high rates continue in the community and we're concerned about on going reports of higher prevalence of certain variants that we are concerned could

spread even more rapidly in our community. with regard to testing rates, we're doing 7,037 tests on average a day and you see our contact traceing and partnering notification and our p.p.e. remains robust. this is our hospitalization chart and the winter original and you can see those numbers have die creases to 172 hospitalizations and still higher though and just to say we are watching the numbers and carefully over the next week or so and you can see on the far-right of that slide about 165 and 170 and 150 under last few dares so weep hoping to see that number to decrease even

further and we'll see next slide. this is shown in the purple graph across this timeline and just to reinforce that the reproductive right now is .75 so below knife and also important to look at what we've been doing over this last year and we just passed a year recently in terms of our emergency and coming up to the february 5th anniversary and emergency and you can see rates fairly predictably influenced by our opening and closing activities and you can seen with regard to and this is takes so much amount of time into account

and you can't make the level of details and you just have to line on the far might and below 1.75 so that's good news and it dropped substantially from the speak of our winter arrange when the rate was above 1.4 so i report that number has dropped by over half. next slight. this is a brief update in addition to what i mentioned in the san francisco residents and nearly 69,000 people who live in san francisco have been vaccinated at least one dose. the vaccine that represents 9% of the population you can see cumulative doses of the bottom of that graph just to emphasize and population and phase one and the people 65 and over in the

city and that along accounts for over 210,000 individuals and live or work in san francisco that requires about 420,000 vaccines since each person vaccine second dose of the moderna and we are continuing our ecosystem and we have the city ledge opening another mass site with kaiser and we'll have to do at least 10,000 vaccines in san francisco is a day and it's vaccine apply and for instance this week we are getting 11,000 vaccines to the health department and the local and obviously not nearly enough and we are ready for more shots

and so, over 110 vaccines have been add minutes terred and 86,000 first deases and second doses and this is people who work in san francisco who may not live in san francisco and who may receive healthcare in san francisco and these vaccines are administered in san francisco so we're always looking at the number of san francisco residents as well the number of doses administered in san francisco and so we're making progress with vaccines coverage and it is slower than any of us would like and we've talked about those challenge and details the last health commission meeting and we are building a ecosystem of vaccine delivery focused in communities

we will give shots in the arms, particularly in the populations most effected and those dying which is people 55 over and death in san francisco so getting vaccines into arms and we asked them to stay together and it's a long tunnel but we hopefully will get there. thank you, commissioners. >> thank you. mark, shall we take public comment on this portion and commissioner comments or questions before moving forward? >> at your pleasure, if that is

what you would like. i saw one hand. if you would like to make comment on this portion of item 4, please press star 3. you will each have two minutes and commissioners, i'm going to mute you all and dr. colfax so these people can come across with no disruption. so, caller one, you are unmuted. can you speak. please let us know that you are there. >> can you hear me? >> yes. please, go on. >> caller: hi, i just have a question. knowing that covid-19 has had a large impact on mental health, especially for low-level populations how is san francisco adapting to overcome these challenges in terms of policy or

relief funds? >> this is a good time to note the commissioners and dph staff hear comment but there's not a back and fourth. i'm noting your question but it won't be responded to directly and even though it's frustrating, it's how we avoid having the public begin to take over the meetings with the discussion and questions. thank you for that comment. i'm note particular in a minute and hopefully we can get it answered. i'm going to move on to next person. give me one second to change the caller. next caller, please let us know that you are there. >> caller: yes, hello. >> i'm with the national union

of healthcare workers, good afternoon, president bernal and commissioners. i'm calling in about the city budget and department of public-health budget. we represent workers, the public-health workers and mental health workers in san francisco to telehealth and who are on the frontlines and have worked on the frontlines in hotels and reaching out to talk would you about the mental health sf program and is how we make sure in this time of pandemic and exacerbated the huge disparities and access to mental healthcare and substance abuse disorder and what we'll be formulated in the next few months expanding the ee who provide care and treatment for those seeking treatment and i will prevent and who have a

network of services contracted with the city and because of lack of funding and staffing it provides high-quality care in order for us to meet our goals during the pandemic and goals of mental health sf it's real reimportant that we put expanded resource noose our public-health system and behavior health system in san francisco and i hope that is going to be a major push for the commission this year. thank you so much. >> thank you. just a reminder. if the budget is on the agenda there's a item, make public comment at the appropriate time on that item. commissioners, it's up to you with questions. >> thank you, m.

>> caller: my question is access and i tried for a gentleman who is not that savvy so i did it for him and he it said your

position. and they said call the city and that was it. there was no communication or information (inaudible). i was able to find that site and it shut down at the time. and the sites that were opening, how are we communicating to the public and.

>> i think i got between 60% of that and what i was hearing was concern about the communication particularly to the public? around access to vaccine. is that the -- >> how do they access it? i mean, the physician said call san francisco health department to this 85-year-old man, his primary care physician. so i'm just concerned if i couldn't figure it out, i mean, i'm just concerned out do they

access an appointment. how are we putting out a website other than, yes, city college and how do they access it? >> so, this is been a big issue from the state to the regional to the local level. as you know, we have the site you mentioned where people can register to get more information about the vaccine when they're eligible and they're also working to create a common, a common portal people can go in and register for an appointment and that would be different healthcare systems. that's being somewhat complicated because the state called my turn and that my turn

portal, as we understand it t. will serve an ability for people to sign up and be notified when they're eligible for vaccine and where to go for vaccines. o they're going to be getting my across our system and the healte without insurance, the people in healthy san francisco and so within our san francisco health network, which as you know cares for the majority of those patients in our system, we are scheduling people 65 and older for appointments at our clinics. the federation of other systems that are getting vaccine, there's limited supply. at the city college site, for instance, that those limited

appointments are being managed by ucsf by patients and kaiser is providing limited numbers of vaccines to their patients as well. we hope with sighser's in partnership with kaiser we'll get more people through and the big issue is that the vaccine. either through the state or one beer working on to develop with our legal health partners, we can have a one-stop-shop where people can stop for notifications and it's their turn to sign up to make an appointment with their provider. there are many multi-county entities who provide local care in san francisco and.

>> do we have a timeline for an appointment for anybody who is over 75 right now? unless you are (inaudible). correct? >> i'm sorry, again, you are saying we don't have a timeline for someone who is 75 and older? >> i recommend you turn off your camera because we're having trouble with you being choppy. >> i'm looking to see if we are able to tell the general public of a timeline for an appointment system to that it's less

confusion, if we can even put that communication out, that we're working on it might be helpful. >> we can put that out. as soon as we get enough vaccine, we can get the vaccine to the arms to everybody that 65and up but there's not enough vaccine as i mentioned in my summary. we can give 3,000 doses a day and have those appoint thes ready to got eat city college. >> i understand that and i know the supply issue. i'm concerned about the public being so confused. with the information the site at city college open and now this new site at 14th and cap and it's like they have no -- there's no communication of how to do this. that's where i'm concerned that with our communication. that's all.

>> thank you. >> commissioner chow. >> thank you, director. i do want to emphasis with commissioner giraudo but i thought that the department has been working very hard to try to overcome the problems, which are of course, initially related to the limited amount of vaccines. because, clearly if we had more vaccines we can do much better as understand now, we can do a lot better in appointments. we can't make appointments if we don't have vaccines. i do want to first compliment the city college operation and personally, was able to make a reservation only by chance that we got a announcement about it

so i understand that frustration from commissioner gerardo because now i've gotten two or three different invitations but it was related to your healthcare systems. i do think that information that we are working on having a pointments and we're looking at and i know it's in the press a little bit but, something on our website that those there's no way of getting an appointment even though you are eligible and we are really working on this and in the next year, whether it's summer weeks, whether it's a state system or not, we're looking for a uniform situation. i think we've got to stop telling people to call their doctors. because, their doctor -- i mean, in the sense that the doctors don't have further information

and that you have to get it by way of one of our public entities perhaps the website that will give you more information when we do get times for the appointments and you make the appointments. perhaps it is that the organizations running the sites in the case of city comment was it was you see and -- well, yeah, i think it was u.c. but they were using event bright. if it is helpful, perhaps these individuals sites could place within our web sites at the city and a way of accessing those and so whether it be the kaiser site for mosconie because i understand you use right now the

sort of the host hospital system, right. that is up and around this and if we could put those on there saying these are sites to try because, i think that's what they tell you. you can go into providing that you first access sutter and sutter says, right, you are concerning into my health and from my health, you don't have to be a member but then you can go and look for it because if you are eligible, going through this list of questions, then we'll set up where you can get appointments and so if we have a centralized place right now, being able to direct people saying, look, here is my sights and the city and here is ways of making those appointments and ultimately we're going to have a central site and right now, this is the way to do it and taking what each of those organization have put together and it would be nice to have to centralize information and which i think could be helpful.

you have the covid site as just amazing in terms of all the data it has and we are still wondering how they'll get the vaccines because it sounds like they'll have it. if we clarify it on our site, there can be a way which our public would find this access to all of these sites that we're now opening. again, i understand, i think our department is working very hard to try to do this and i think it's admirable that we've already been able to achieve a vaccination for 9% of the population and the first and the

rest of the public is getting very frustrated. >> president bernal: thank you, commissioner. commissioner green. >> yes. congratulations for what you have been able to do and i guess there are two or three questions i had. one of my concerns is that i know many people were internet. internetsavvy have signed up with a multiple systems. if we have vaccine that comes to the various multi community entities as well as our d.p.h. people will get three calls within two days to go and they'll go to the first place and there may be a significant no show rates in other areas so i wonder if it speaks to central sites but i know many of my patients have signed up on

multiple sites and the thing is it the definition of provider they maybe don't say sutter dignity but dr. so and so and so i think there's a lot of frustration from that perspective so as far as we can define the provider and have everyone working together on the same page and the last really great concern is that the people who qualify for this vaccine, who are not either technically savvy origin the language issue, i think you said that the state is only going to be in spanish and english and i'm also wondering how we'll i objector k it's a multiple sign up thing that could really backfire in

people end up not showing and especially if we're lucky enough to get the vaccine, how wore we'regoing to manage these individuals and to reach out to the people that just don't have these resources by way of language or technical skills. >> i shared a deep concern about my language capacity so we're wait to go see if the state can inkeys that we node to make sure it's accessible for those without technology. you will hear some of that work beak done on the next presentation with regard to the work we're doing in communities. we're working closely to ensure

that peep who may not sign up on even a common platform and we'll have access to the vaccine and i think with the mass sites one of the key things with our partners is that people will have access whether or not they're a client of that host institution and if when we get those fees and there are ways we will hopefully be able to manage shows overflow and when we get into a state of more regular vaccines supplies and dr. horton is on this phone and asked or on the line and was going to add a little more detail to this site. is that correct? >> yes, i am here. i know commissioner chung also has her hand up so i didn't want to jump the line but i'm happy to add in a little bit if now would be pro pre a i guess i will if that's all right.

>> go ahead. >> ok. i just wanted to add, i'm happy to talk about equity strategy and how we're trying to prioritize that and any point and also i just wanted to add that i completely agree and sympathize with commissioner gerardo owes points. it's so hard, even in the network and not able to get information to our patients at the next tier level and i know that's been super challenging at the city level as well and i think we're really trying to figure out how to give that and i just want to see the limited supply of vaccine is not only appropriate and it's really hard to know what it tell people when we don't, we can't predict it and i would also hate for us to get into a said hey for sure, by february 15th, we'll have enough vaccines and it's not the way the supply has been working

so i think it's really important we all keep this in mind and give as much information with as much transparency and we'll note that people want more information and they want more clarity as much as we can give them and that's all i'm going to jump in and say. >> thank you, dr. horton. commissioner chung. >> thank you. first, i want to comment on all the staff who have been working on things and you know, really implementing the plans on the fly and more information is coming out everyday. i think that maybe i'm trying to speak from the more hopeful side for now. maybe in the month or so you know, the single dose would be approved already and so that site would reduce the traffic of people coming back and fourth for the second dose and

hopefully, that would help to move things forward and although this is the not so hopeful part is there is so much information right now you know, like about different strains of the covid-19 virus and the effect of the vaccine on them so i think that i am more interested in us being updated on this information. as quick as possible so everyone can make more informed choices in terms of where they stand instead of everybody rushing to the doctor and asking for the vaccine. >> thank you, commissioner

chung. >> thank you. again, i want to add my thanks and acknowledgment to the difficulty that we're all facing. for the vaccine as well as information for the supply. what i think is happening also is everybody is so desperate for information, that they're turning to more sources, right, and all of those multiple sources have different information sources themselves and so i think what is happening is even though we want to try to give people as much information as possible. that works at cost purposes and for folks who are trying to consume media from all the different places where they consume it whether it's social media or web sites it's

difficult to make sure that all of those sources get all the same information at the same time and for the right audience and so were in this place and try to be as consistent as possible and my sense is the biggest confusion sort of cross point and the difference that aren't hearing that the point that dr. grown raised that your provider is a source of who is your provider and the city and county is a source and where within the city and county and if we can just get it clear, with regards to that communication point that might call some of the basic concerns

and frustrations is that folks have and if we can really hold down closely with the media, in terms of making sure that they are providing, you know, appropriate information and you hear everything from we're worried that people weren't accessing the vaccine if they're eligible because they're fearful of it at the same time we're hearing vaccines are available to all these different groups. --i'm trying to say it without confusing myself, even. it's not always the county or the health department that is going to be the place for folks

to get the misinformation or get old information. it is really all these multiple sources so i totally understand it and my hope, along with minister chung is in a couple weeks, things get sorted out, this will have been a blip that we can all learn from and understand the difficulty that we went through. san francisco is a complicated city with multiple characteristics and multiple populations that need information provided to them in different ways. so, i think that's something we have to take into account. and do as much as we can. >> thank you, commissioner. commissioner christian. >> thank you. i just wanted to say that we are

feeling incredibly frustrated by this. our discussion has shown and we have colleagues and people that we see in a community who are concerned and uncertain and don't understand what is happening and it will continue to be very important for the messaging from the city and the department to be continue to be very clear that this is a long hall situation and the basic things that the health officers have been telling us to do are the things that we need to continue to do and the variants and all these different variants that are coming up and developing and more transmissible and more deadly and lethal and the only than thg that will get us through this time are the basics and the city

have been hammering on and the distancing, if you can stay out of big settings, do all of the basic things and letting people, reminding people these are the things that enable us to slow the transmission as much as possible. these are the things to keep ourselves and our families no one is coordinating with the other level, and first i stand up on several clearly they're not speaking to one of another and although we live in the hart of tech long cal advance weren't going to get to a point where someone can make those there is

someway for that to be acknowledged to that we don't have someone like me showing up for the first one and just for getting about another two sites that i signed up for and they're expecting me to show up so that's probably, you know, a fool's errand as a hope but perhaps there's someway to get rid of redundancy while we're moving forward and i just want to, i want to say what i have found most useful is that going back to the basics you've hammered before that we need to continue to share so that people just calm down a little bit and try to hang in there with the things that have been keeping us safe so far and to the extent

that the comments about adding more information to our website and it's all great and we also need to remember there are a lot of people who can't access this site and we're not technologically savvy who don't have the technology available to them and so i do imagine the department remains in close contact with the community partners and the people who are reaching out to the community for testing and the vaccination and there would be daily messages to them so people come and call and say i don't understand and they can say we spoken to the city this morning and this is what we know so that they don't feel like they're going to the only place they can and they get the message they don't me what to tell you so i think calm and steady and trying to keep people together with

this effort to slow the transmission of the viruses and keeping that out front it might help a little bit. >> thank you commissioner. i want to agree with commissioner christian and my fellow commissioners. we will hear from some of the community partners later in the agenda so i look forward to that as well and also i want to acknowledge all the hard work of our family at dph in building the capacity we've been able to build for vaccinations and also the work that needs to be done as the supply catches up with our capacity, which is going to be critically important and i want to back up in the we've seen significant reduction this is our hospitalizations and in our case rates and in our reproduction rates and this is all happening within an

environment of changing state guidelines and new health orders of the state and local level and extraordinary work of everyone to really comply with the healthors and social distancing and high gone and wearing masks because none of this would be possible and we would be in a much worse situation as you see in other parts of the date and the country. really, our constant has been.

>> let's move onto the next section. >> good afternoon, commissioners. it's really my pleasure to (inaudible) topic. my dph colleagues will talk about our strategy in the community and as the commissioners snow, covid has had unfortunately, (inaudible) these impacts on specific populations and because of that, early on, they had to organize and think through how are we going to approach the equity issues that were occurring

because of case rates and death rates in our communities so they were talked about all of the things that have been happening on the places that we have worked on to improve and the places where we need to goin' concluding vaccines and that discussion. we have per these communities, based on those that have been most impacted by high disease burden and that includes community outreach and isolation and quarantine and access to medical and behavior health services and as we've gotten input and feedback from the community, filling out ways and any of the services and this is a true collaboration with our community partners to instruct that and inform us on where things are working and where they are not so this moves so we

can improve in our response so it's my pleasure to be able to introduce this work and emily the team and all of the individuals that have been working since march, april on this so i'll turn it over. >> thank you. i'm going to share my screen. >> see the button at the bottom. >> good afternoon, my name isn'a

ford. i've worked in the public-health for 20 years. it is my honor and pleasure to contribute to the covid-19 emergency response. in my current disaster worker activation, i am the district 9 lead for the equity and neighborhoods and latinx lead. today i am co presenting with my esteemed colleagues and i can introduce themselves. >> my name is naisha underwood. i work for d.p.h. i am currently activated in the covid command center working in the community branch as a population equity liaison and i am also overseeing the covid prevention funds that we put out to the community. i will turn it over to melinda martin. >> good afternoon. my name is melinda martin. i am currently with the

community branch of d.p.h. and also the branch of that you specific islanders population. >> thank you. >> thank you. >> before we start our presentation, we did want to read the land acknowledgment. >> actually, ms. ford, can you give, because the commissioners, as i think i mention, you have not yet done the work on this for their resolution, could you give a very brief summary to there's context for the commissioners and the public before you read that? >> yes. just wanted to acknowledge that a lot of our community partners are currently supporting acknowledgment particularly when we're convening meetings that are open to the public. in support of our native american community members.

>> we acknowledge we're on the unseated ancestorial homeland who are the original inhabitants of san francisco peninsula. and the indigenous stew arts of the land and in accordance with their traditions, they have never seated, lost or forgotten their responsibilities as a care takers of this place as well as their traditional territory. we benefit from living and working in their traditional home lapped. homeland. we wish to pay respects of the community and biff affirming their sovereign rights of first peoples. we're going to start our presentation and ask you hold questions until we completed our

presentation. >> go ahead. >> thank you. >> today's presentation will focus on our work specifically with the latinx black african american and a.p.i. communities from an equity framework and we will touch on on the data that we have used to prepare in this work and we're also going to review the equity framework that we're using within covid command center in our response and we will share some fee tales of our work in the acquisition specific islanders community black african american and community and latinx planned community as well as sharing our latest work with covid-19 vaccine and reaching these communities and that are most impacted by covid-19. with the leadership of dr. grant colfax going o san francisco has been responsible and we're

responding to the covid-19 pandemic. we know this because our ability a to capture and analyze various data points and use those to response efforts. to date, we have one of the lowest death rates in the united states and one of the highest testing rates in the bay area as compared to other major cities. this particular data snapshot is available on the covid cities covid data tracker and provides a breakdown of cases by race ethnicity. we used this data to plan and i will notment our work. with our focus mitigation efforts, in these communities, o'er goal is to decrease the number of infections among these people na people that are most impacted by covid-19. and this data said, it was pulled from january 22nd.

sips the activation of city's emergency response we have benefited from the input and guidance by the chief equity adviser. as we transitioned last year from e.o.c. to the covid-19 command center, mid-year the communities need an access to resource and were not adequately aligned to covid command center. the equity and neighborhoods group was established to support the work of the chief equity officer by leveraging neighborhood action plan city leadership and existing community partnerships. the focus on equity and neighborhoods provides a unique opportunity to continue to develop and continue to build authentic partnerships with community groups. and as you can see, this map highlights the communities that are currently most impacted by

covid-19. as a city, we have learned that our conflicts processes do not efficiently address the needs of support better health outcomes the populations residing in the neighborhoods' most impacted and i also like to we are all gate skiers and she asked we reflect on our role and ask ourselves if we are opening this gate when we partnering and in the community. the impact of health and equity and com bounded and ethnic populations and continues to persist. we know that living situations and low wage essential workers

are dis purport atly impacted and we know that the nine priority neighborhoods of san francisco continue to have high covid-19 positivity rates and these neighborhoods also have residents who experience and are impacted by structural and institutional barriers such as issues with transportation, food insecurity, poverty and growing unemployment. and the community is san francisco and across the united states. and in san francisco, and african american and as well as a.p.i. and our efforts, our response efforts have to be timely and efficient and culturally and focused to ensure and set fourth in our accreditation awarded and 2016.

we are implementing the program continuum and as you can see, our community partners, have supported education efforts that are the primary focus early on in our pandemic and most recently, we have also implemented community wellness teams that are community based and to support those who are testing positivity covid. since july 2020 we have supported community based covid-19 testing creating opportunities to build test and offer low barrier community testing in neighborhoods with highest positivity rates. this slide shares weekly and

anthony jones our equity officer with our community partners reporting back on our efforts to support testing. as can you see, with their pip, marketing opinions and they are more user friendly and also supported by our community partners. i'm going to turn it over to melinda who will share her work with api in the community. >> they needed the asian and

pacific population it's a strategic plan focused on structured problem solveing and utilizing a continuous approach. the asian pacific islander was created through engagement and feedback from members of the asian and pacific islander health parity coalition. as noted in the slides. some of the a3 encompasses goals of insuring that covid-19 materials are culturally lynn giss tickly appropriate and materials used for outreach and covid-19 testing sites are led and coordinated by community partners and showing there's adequate staffing with those who speak the language available for community members, there are resources available and for community members to feel comfortable. the need for collection of dis aggregated data to form appropriate and effective response to mitigate the spread of covid-19. lastly with plans for the roll

out and outreach. next slide. in respect to the community focus, there has been pop up testing at various locations and weekly, in chinatown and chinese hospital and all the main testing sites, pop up testing at the portola districts, the southeast asian community development center, japan town, visitation valley and collaboration with the community development center and the northeast medical services and two testing efforts at the first con agree inaugurational christian church and the south of market area. educational materials is translated in various languages and to ensure that testing sites have been the staff available to speak the communities native language. d.p.h. leaves monthly meetings

with the asian and pacific islander coalition to engage members and gather feedback on dph and the covid commands centers related to covid-19 and the a.p.i. communities n addition, they partner with the regional pacific islander task force and presented at the task force covid-19 briefing for faith leaders and is the a.p.i. community and the parity coalition and encourages to engage trusted community physicians as mass englisher. >> here is an overview of community outreach that is conducted in chinatown. they have been in partnership with chinese hospital and it has been mobile testing starting in

january in fall of 2020. since the summer of 2020, dpa the covid command center and chinese hospital have partnered with chinatown based and organizations northeast medical center services and those who have worked together with a sro rapid response team. since december 2020, dph and the covid command center has hosted weekly pop up testing in chinatown, at fourth and square or chinese hospital at each of these testing events, 400 people get tested where the majority of people being served are of asian and pacific islander, have limited english deficiency and chinese speaking. half of those being served live or work in chinatown which either are front line or essential workers. our community partners have raised additional testing and

chinatown and there's been a strong push from the joint information center's outreach team with in-person posting of efforts flyers outreach to ethnic language media and the use of inlanguage social media platforms such as facebook, we chat and what's app. due to the partnership between dph and the joint information center the covid commanding and the supervisor office and community partners, we have been able to establish a successful community operation model. chinese hospitals dedicate their boy lingual staff to provide pre and on sight registration and interpret tair rada services and in addition. chinatown community based organizations and dedicate bilingual speaking staff to support on site crowd control and operational support. there has been con sen us and feedback that chinese hospital are the preferred locations for pop up testing in chinatown.

next slide. i'd like to leave you with examples of translated filipino and chinese and they were translated with the joint information center and now i'd like to turn it over to presentation to for the outreach efforts within the black african american community. >> thank you, very much. >> thank you. >> so i'm going to start by by talking a little bit about the collaborative partnership that we built with some of the organizations that are pillars in the black african american community. as well as some of our city departments that work closely with the black african american communities. and so, we are partnering with

mega black sf and the black covid task force founded by the human rights commission by cheryl davis. we also sit on the african american faith leaders meeting to deliver firsthand information around what is going on with regards to covid in the city and county of san francisco. beer also partnering with hope sf which is a large scale community development initiative through the mayor's office and it's rebuilding public housing developments and san francisco southeastern region and so one of the regions that have been greatly impacted by covid-19. we're also partnering with many cbos in san francisco such as bayview and care and southwest community corporation in the omi

lake view area just to name a few. we started testing collaborating with the uc sfd-10 initiative where they tested in the bayview and bayview and sunny dale area where dph provided the case investigation in contact tracing for that event and our first testing event was in the sunny dale with sunny dale family day as a result of on outbreak that happened in one of the housing developments. we're also testing in the bayview and the omi lake view area and sunny dale visitation valley and western addition and some of the education vaccine education that is happening with the organizations and communities are that we are providing vaccine information and to some of the organizations

that we sit on as community members so i mega black sf and the black covid task force and will are dph staff that are part of these organizations as liaisons that deliver firsthand information. we are currently collecting numbers of community facing staff from organizations that we fund and the state defines community health workers as eligible for vaccination under phase 1 and we also on the 29th of january, we're able to do a pilot pop up vaccination site at the bayview opera house where some of the community organizations were able to get vaccinated. to take a deeper dive in the testing efforts of the black african american community started in june of 2020 in the sunny dale area as a result to

an outbreak in one of the housing developments. since then, we are providing testing four times a week in predominantly black african american neighborhoods with a huge focus on the bayview neighborhood because covid positivity. and our testing events in the bayview, are averaging about -- there's three much we test in the bayview three times a week and it's averaging about 500 tests a week and in the bayview area, next slide, please. just a minute. and what this graphic shows is a calender that mega black task force put together to distribute organizations in the black african american community. so they get the information on the testing event from us and they create their own flyers and calendars to distribute to

organizations throughout the black african american communities in san francisco. next slide, please. now i'll talk about the funding we put out in the community in november of 2020. so we released covid prevention mitigation and care fund in the amount of $5.2 million to the community in november and the funding announcement included two catagories. the first category is community outreach and care which we kind of look at as covid, a covid continuum of care model essentially and so that includes outreach and education and it includes prevention messaging and p.p.e. test sites support and we're asking our community partners to

support the test sites by registering and delivering tree and posed test message to the people that are there to city that messaging includes what happens, what you do if your test results will come back positive and providing the resources so that community members know that someone from the covid command center will reach out to them and offering them isolation and quarantine support. the nexcom phone ant is case investigation and contact tracing so we are training about our community organizations to provide case investigation in contact tracing to those community members that test positive for covid and we're asking our organizations that we fund to provide community care so basically that's the isolation and quarantine support for people that test positive in their community because we're

asking them to call them daily to check on them to provide p.p.e. and cleaning supplies and food. anything that they need so that they can safely isolate and quarantine for the period of time that they need to safely at home with the support they need without leaving their house. the second category of the funding announcement is it a cict training center. so we are partnering, we're funding a community based organization to help us on board and train our community organizations to do the case investigation and contact tracing work. so, how the $5.2 million is divided between those two categories, category one is where the bulk of the money is, it's $4.8 million. and the category 2 the training

center is funded at 450,000. if you look over to the right side of the slide, my right, sorry about that, how the funding was divided, it was based on a neighborhood positivity so, tier 1, bayview, bayview neighborhood, sunny dale, excel see year, those neighborhoods were funded at 950,000 and tier 2 was on my lake view neighborhood, mission bernal heights and tenderloin and that tier was funded at $450,000 and then tier 3, chinatown, western edition and it was funded at $200,000. right now we are currently, i want to take a step back just to acknowledge the fact that some of our organizations that we're funding now they were already

doing this work and they were doing prevention in this neighborhood and providing some of the test sites support for us and the funding is allowing us to do a lot more as well as evaluate how this community care response model will work in the end. he is tell a and now i'm going to turn it over to isela. thank you. >> thank you. >> president bernal: thank you. our focus on the latinx community and before i jump into the slides, i do want to take a moment to acknowledge my co-lead in these efforts. it has been a pleasure to work with him and i just want to

acknowledge that he is -- i wanted to call him the -- he embodies the definition of of a self-less public-health servant. thank you. so, i just want to highlight the efforts we've done over the past year as my co presenter shared the work that we have been doing starting in june of last year with our community partners and this particular effort focuses on the work that we've been doing with the latino task force and we started testing there, partnership with testing there on july 2020 in the mission district at the mission hub at 701 alabama and the following month in august, started testing at the ex site at crocker park. both sites have tested roughly

16,000 latinx with a high focus on latinx, there are other folks that get tested but the majority of the people testing there are latinx. to highlight they were one of the first sites to pilot with us, the flu vaccine clinic is the co site so we can do testing and flu vaccination. they have also supported our work with ensure particular and we are providing a appropriate services and similar to the other site with partnering with us and developing our educational materials and supporting the test sites, managing lines, supporting people in registering and providing education and information while people there are to get tested and then rolling out this community wellness team approach to those who are testing positive. they have also supported the

health department and covid commands contact tracing work and the over 50% of the cases at the beginning epidemic have been in the latinx community so those efforts to provide the case and contact tracing support for isolation and quarantine and provided in spanish and a lot of the majority of the folks testing positive are monolingual spanish speaking. the other area of our work that we've identified in our time to address as well is the population of mayan and indigenous-speaking members of our community here in san francisco and really beginning to establish a partnership with those community members so we can reach ut to those members who not only don't seek these types of services in community settings, so we're also making a strong effort to provide

services to those folks in their indigenous languages. last, we want to highlight that we have been partnering with over 307 community based organizations that serve the latinx community by meeting with them weekly and it's the beginning of september to develop the latino response and recover row plan and this is really -- this is been a really thorough process where we've engage our latinx leaders in the community to inform and guide our efforts moving forward with a focus on the recovery phase and now really partnering with them in the implementation of the vaccine distribution. i wanted to also take a little bit of time to highlight our work with our community partners. these are pictures from latino

task force sites, test sites again in the mission hub at 701 alabama and the crocker amazon park parking lot, actually. i wanted to show these photos. to just show that in their approach to the work, they're always paying attention to details supporting with families that have been impacted by covid-19 in their communities and the people that are serving and making it friendly for families, a lot of folks that come to get tested often times bring their children so making it a very welcoming space, a supportive space for families who are being impacted. also, i want to highlight that a lot of the work has been done on a voluntary basis from the begining and now that beer transitioning to this funding opportunities, they continue to support volunteers at some of

these sites and through our own tier program in covid command and the department of public-health. so really great opportunities for supporting our community partners interested in doing this work and learning and supporting our efforts out in the community. going to transition over to the work we're doing with the covid-19 strategy. part of my work is to trance nation this phase of our work and i'm very excited to be working on this and in really want to highlight the fact that we're adding to our prevention toolbox and we have this opportunity to offer these two fda approved vaccines and making sure that we're still building on our partnerships with community to ensure that have

access. this slide is from a presentation we're sharing with community partners and covid command center and that highlight, that we do want to partner with communities so, we have the three-prong vaccination strategy. the high-volume vaccination sites that was reported on earlier, city college, currently city college and then the two additional sites that are slated to roll out at mosconi center and the food market in bayview and we wanted to highlight we're partnering with community based organizations and it was organization that have received funding toll help us plan to roll out for community-based, we're now calling neighborhood based vaccination sites and one

example is that we piloted through the bayview last week and yesterday we also piloted, we also did a soft launch of our neighborhood vaccination site in the mills at 24th and cap in partnership with csf and latino task force. our specific focus on neighborhoods includes partnering with communities, they were most impacted by covid and i want to highlight that we are engaging with them and planning and implementation with these sites to ensure that they're successful. this includes site collection, identifying and addressing any barriers identified by community partners and providing opportunities to allow for on site support for community partners. and when you are having your presentation earlier and comments, taking votes, we are addressing hopefully going to be

addressing the concerns around registration and the digital divide which is already coming up for some of our community partners in these community neighborhood-based sites. and i want to share how we're ensuring information -- [please stand by]

can you hear me? no. you can? oh, great. is it time for public comment? all right. i can't hear you all. it is time for public comment? okay, i'm sorry everybody. i'll do this the best i can. okay. so i will go to public comment. give me one second. sorry folks. i'm having extreme technical difficulties. here we go. all right. i'm going to unmute you and give you two minutes. >> thank you.

hello. this is dina lawn from the san francisco community -- we serve 112,000 mostly very low income, mostly people of color patients. we indicated we are ready, willing and able to vaccinate our staff and patients according to the correct tiers. to clarify who we are, we're the non dph community health centers. two of our clinics were told this week there was no vaccine. we understand there's a severe national vaccine shortage and it's not in the city's control, however at the same time, mass vaccination sites are being opened this week. we were told send our patients to the mass vaccination place. i'm not sure what send means for

an asian elder who lives in chinatown and doesn't have a car. we don't understand why we're not getting vaccines to serve our own patients who are exactly the californians discussed when we talk about equity. thank you. >> clerk: thank you for your comments. let's see, any other public comments? commissioners, i know that you all are able to unmute yourselves right now. i think you know i'm having extreme technical difficulties. i will do my best when you raise your hand. are there other members of the public who want to make public. you can press star 3 to raise your hand. let's see -- okay.

i think that's all commissioners. if you can raise your hands -- i'm sorry, there are several callers. i will unmute you. you have two minutes. can you let us know that you're there? >> hi. >> clerk: you have two minutes. >> good evening commission. i am a second year pharmacy student at ucsf. the city of san francisco is experiencing two pandemics not only do -- (feedback) >> clerk: sorry. please turnoff your computer sound so we're not getting double sound from you. >> is this better now?

>> clerk: no, i'm sorry -- go ahead. i'll add some time on to your comments. go ahead. >> so -- sorry. >> clerk: are you there? >> hello? >> clerk: yes. i'm going to mute you and come back to you after the next person. i'm hoping that will fix it.

is it reverberating? sorry everybody. give me a second. actually, i'm going to get my laptop off and desktop on. if you can give me a minute? >> president bernal: actually mark it just stopped. >> clerk: i'm going to go back to the caller. again, i apologize. caller, can you start again? i apologize for technical issues. >> that's okay. is there background noise now? >> clerk: it was on my end. we're good now. i apologize. >> i'll continue where i left off. so, i'm a second year pharmacy student at ucsf. our overdose numbers have been increasing since fentanyl became

a staple in the street drug supply. the medical examiner's office found over 700 died of fentanyl in their system since last year and about 30% were experiencing homelessness and over 20% of the bodies were found in the tenderloin, more than any other area of san francisco. in line of harm reduction and overdoes prevention, increasing distribution of naloxone, i would like to advocate fentanyl test strips, they're a low cost overdose -- the user can implement methods. these strips can also detect several fentanyl analogs up to

100 times more potent than fentanyl. i recognize that dph is well aware of the problem and would like to advocate for increased test streets in conjunction with the safe injection program. thank you. >> clerk: thank you very much. all right. caller, i'm unmuting you. you are unmuted. please let us know that you're there. caller? (feedback) >> hi commissioners. i'm a second year pharmacy student as well and i'm in support of increasing public

access to fentanyl test strips. as i'm sure we're all aware, drugs and pills and marijuana laced with fentanyl with or without knowledge. i want to address misconceptions about people i have heard who use drugs that can be a barrier to the test strips. i think we're all aware that opioid addiction is powerful and the -- there was a canadian article published in 2018 in the harm reduction journal that looked at the use of fentanyl test strips and over 100 drugs. it found the majority of drugs could only were only in heroin.

40% reported planning to reduce their drug dose. not all people expect or want the drugs they use. and many of them seek out other drug but much less potent drugs and unknowingly ingest fentanyl. thank you. >> clerk: thank you very much. commissioners, we have a few more. caller, i'm unmuting you.

all right caller, i have unmuted you. please let us know you are there. >> can you hear me? >> clerk: yes, you have two minutes. >> i'm also a second year pharmacy student and want to support increased access to fentanyl strips and help prevent drug overdoses. fentanyl has been a leading cause and with the increasing trends expected to continue, fentanyl test strips can prevent many users from accidental overdose. the community has expanded through -- it's more than 47,000 doses of injectable naloxone -- in 2019 -- in

similar efforts, i want to advocate for expanding distribution and access of fentanyl test strips to help prevent overdose. the pilot in 2017 and 2018 found out about 54% of drugs tested were from tenderloin and given this high prevalence of fentanyl and drugs, it could hopefully decrease overdoses in the tenderloin. i think the city can implement this by providing test strips at dph pharmacies, injection sites and clinics and ensuring those that test strips are covered under a self health plan and patients are aware they could

have access to them. i believe we could prevent future overdoses and raise awareness and educate a large community on drug use. thank you. >> clerk: that is all the public comment for now. i want to make a quick announcement. folks -- sorry. please try to keep public comment to the item that we're on. the comments just made were important but didn't relate to the presentation or item we're on. in the future, please try to keep the comments to the item we're on. >> president bernal: thank you mark and thank you callers. we'll move on to commissioner comments and questions. commissioner christian.

>> commissioner christian: this was such a deep and strong presentation. i want to thank the three of you for this. this framework that you are building or deepening and expanding, it is so critical to taking care of the health of the people in our community, the most vulnerable people in the community. i thank you for being the face of dph and the arms and strength of dph in the community and working with community partners in helping us to do what we're all here to do. i was particularly interested in the fact that you are -- you touched on building the relationships with the native american community here. if there's anything you could say more about that, how that is working for you or anything else you want us to know. i wanted you to know i

appreciated that work as well. i can't tell you how impressive this presentation is and how much your work means to all of us. thank you for continuing to do it. >> president bernal: thank you commissioner christian. commissioner chow. >> commissioner chow: yes, i wanted to add my thanks for the presentation. i thought it was extraordinary work in a very short period of time that you have been working in all these different communities. and of course i'm pleased that you are also working with our asian pacific island community in the manner you are and the work you are doing. i'm sorry the funding wasn't a little more balanced or a little more money. i think the community really

needs some additional effort to be sure that the epidemic -- the pandemic stays under control in these areas. i do know the testing has been well received in the communities and especially the work within the sro's and engaging all of the different community partners, particularly our asian pacific islander community. thank you. >> president bernal: thank you commissioner chow. commissioners, any other questions or comments? >> president bernal: i would like to thank isela ford, nyisha underwood and melinda martin. thank you for all the work you

are doing to keep the gates open. particularly noticed the education messaging you are and will be doing around vaccinations and how critical it will be in the communities you're working in. and if you look at the front page of your presentation, you'll see these are the roles you have taken on and been assigned with covid activation. we're already aware of your fantastic long standing work within the department and so grateful for you taking on the additional roles and doing such great work in bringing the presentation to us and i need to acknowledge dr. albaba. we as commissioners see a lot of work behind the scenes but in this public forum would like to acknowledge for all of her great work, same as others, not only in your regular roles within the

department but taking on your additional roles in covid activation. anything else before we move forward? >> commissioner christian: i just wanted to say again how much i appreciate this work and if there's any way you can think of to assist you or amplify your work to help you do this incredibly important work, don't hesitate to let us know. >> president bernal: i see commissioner green and commissioner chung as well. commissioner green. commissioner green? okay. i don't see -- let's go to commissioner chung then.

can folks hear me? >> i think commissioner green was trying to say something. i think she may have been muted. >> clerk: i will try to unmute -- >> president bernal: commissioner green, you should be unmuted now. >> vice president green: everyone has said this so eloquently, i wanted to lend my voice of thanks. i know dr. baba was at the site and it wasn't lost to many that you were present interacting with the community as have other members of your team and we appreciate that you're doing that. i also was struck in this presentation, besides the incredible quality and care, it

represents such notable collaboration because your community groups and you represent our key populations that are underserved and left out so often. before the meeting i kind of looked at some of the demographics and notably, it's quite a mixture of individuals. black african americans, 28%, asian, latinx at 15%. it struck me in the way you are collaborating, you're sending a great example. the community health centers and partners have a whole mixture of individuals of different needs and different language skills. different degrees of understanding about medical care and i think you are really leading by example in the same way you are collaborating so well the community organizations

as well as other clinics are able to do that and use your work as an example, especially as it relates to the future of vaccine distribution which i know will create challenges that we spoke about earlier in the meeting. thank you so much for this incredible work and for the example you're setting for best practices and for really the critical aspect to addressing this pandemic for the people who really need help the most. i wanted to say that. thank you so much. >> president bernal: thank you commissioner green. commissioner chung? >> commissioner chung: i wanted to join all the commissioners to share my appreciation for all the efforts that have been involved with the project, both virtually that we're speaking with right now and those who might not be on this call.

i believe as mentioned, i want to make sure that we extend our appreciation and thank everyone for your leadership and like commissioner green said, a lot of times communities of color do not get the kind of access that others get. it's mainly because of poor planning. to see how well you are actually creating a strategy to connect with different part of the communities here in the city, means a lot i think. especially for someone like me who is an immigrant and also asian pacific islander.

it seems we often get forgotten like our brown and black brothers and sisters and thank you for upholding our values which is equity. >> president bernal: thank you commissioner chung. i do not see any other commissioner comments. >> can i say one final thing. building on what commissioner chung was saying, it's not lost on me that i think the work you're doing also is creating a network that we can use in the future to deepen wellbeing and to care for the health of people who have been systemically kept from healthcare and access to wellness. so, that is very exciting to me

about this, that you are leading the way for us to find the means to do -- to further the work we have not yet done and break the system of inadequate care. really looking forward to seeing how it plays out in the future, too. >> president bernal: thank you commissioner christian. all right. i think that's it for this item. thank you again so much for the excellent presentation. and we will move on to the next item. mark, is this additional public comment? >> clerk: folks on the line, press star 3 to be recognized for general public comment for items not on the agenda. if you have want to talk about other issues, the budget or resolutions, you will have an opportunity to do that in those items. anyone? no hands up commissioners.

>> president bernal: sorry. okay. then we'll move on to the finance and planning committee update. turn it over to the chair commissioner chung. >> commissioner chung: i'll keep this short, the finance committee met right before the commission committee and we added the contract report which includes like three h.i.v. organizations, the shanty project, project open hand and positive resource centers to the consent calendar and four stand alone contract, two of which are to expand out covid testing across the city.

and then we have lacuna health llc which is a contract to provide after hours telephone services to san francisco health network patients. and the last one is radixos llc and it is part of the services that we are using in terms of providing professionals furnishing and management services. and we ask that you approve the consent calendar with all of the contracts. >> president bernal: thank you commissioner chung. before we go into the acts on

consent calendar, is there public comment on this item? >> clerk: press star 3 to make public comment on this item. no comments commissioners. >> president bernal: the next item is an action item to approve the consent calendar. commissioner chung, shall we move forward to entertain a motion to approve? i think that's a move forward. do we have a motion to approve the consent calendar. >> i make a motion to approve the consent calendar. >> i second it. >> president bernal: mark, do we have public comment? >> clerk: item 7, the consent calendar, press star 3 to make comments. no comments commissioners. i will do roll call vote. >> president bernal: thank you.

>> clerk: (roll call) all the items passed. thank you commissioners. >> president bernal: the next item, resolution to recommend to the san francisco board of supervisors authorize the dph to accept and authorize a grant

from the center of disease control. and mr. wong. >> department of public health grant award for new h.i.v. infections. in order for the department of public health to use the funds, the board of supervisor must accept the extended grant. we provided the resolution, expanding the public health plans for this one and ask for your approval. please let me know if you have questions for the resolution. >> president bernal: mark, do we have public comment on this matter? >> clerk: press star 3 to make public comment on item 8. no public comment commissioners.

>> president bernal: all right. commissioners do we have questions or comments on the item? seeing none, commissioners had a chance to review it. do we need it to read it in its entirety? >> clerk: you do not. >> approve to accept the grant. >> i second. >> clerk: (roll call) the item passes. thank you mr. wong.

>> president bernal: our next item, another action item, the proposed budget for fiscal year 2021-2022 and 2022-2023. mr. wagner and jen louie. >> good evening commissioners. briefly to remind us after hearing at the last commission, this is the second of our hearings and there will be more to come. our second hearing on the dph budget. as we have discussed and i think as jen louie will touch upon, things we'll need in a different fashion this year than in some years passed particularly because we have two large city wide initiatives, the covid and mental health sf budget. those are being developed

through processes led by the mayor's and controller's office. you won't hear about those today. you will hear about the plan for meeting general fund instructions from the mayor's office and we will return to you with the other initiatives later in the spring for your discussion and input and approvals. today we'll talk about our baseline operating budget and our compliance with the mayor's budget instructions. with that, i'll turn it over to jen louie.

>> we gave you the context of the budget the last time we were here. at this hearing, we have detailed proposals for your review and requesting approval of these proposals as part of our approved budget. mr. wagner said before, we are

of the four major initiatives we have two of them, the covid-19 response as well as the hippa health will be in the spring, we'll engage in fully developing this budget. for now, we have the remaining two strategic initiatives looking at revenues and focusing on changes related to the medical under the non cal program, california advancing medical. in addition, we are moving forward with a proposal to supporting the equity action plan. jumping right into it. a revised proposal was released in january that provides framework for new programs that

builds on existing programs, many of which were set to expire at the end of last year or the end of this calendar year. and provides some detail on what will move forward. significant work remains for the state as well as managed care plans. the programs are being developed by the state and we expect them to be phased in over the next several years and many are still in the beginning stages of planning. we have minimal detail on the funding amounts and how they'll be allocated to the county and the mechanisms that might be used for it. the guiding principles, i won't read this to you, this list of the principles that they list in their proposal, just the

ambition and goals behind it. in terms of improving member experience, person centered care, data reporting, population health, transformation, community activation. really interesting and exciting things and very complex programs and we will require a lot of thought as we implement the programs. so what we know right now. i was struggling with the alphabet soup that is the medical waiver. i created this graphic just to show how all of these programs are shifting and i'll go into a little more detail in the next slide. the global payment program, which expired at the end of last -- it is set to expire, will continue the program is worth 83 million to us annually in net

revenues. we had two paper performance programs, prime and equal incentive program. prime has sunset and it is being merged into the quality incentive program for net revenue of 47 million. and a pilot program we worked on at the department of homelessness in support of housing, the annual net revenue was worth about 9.3 million. this program was set to expire in december of 2020. and we have been notified it will be continued for an additional year. after that year, they'll implement two programs called enhanced care program and in lieu of services and we are not sure what the annual impact of those programs will be.

more specifically about the programs. the global payment program is a reminder, i know you are familiar with this, for services to the uninsured and every type of service we have allows some sort of add points for the total target and then funding is allocated proportionately. and we will add in 1.6 million annually to the program. second, with the changes to prime and the quality incentive program, we are expecting for this to result in the net increase of 13.6 million. this is more related to the changes in required match of the non federal share or intergovernmental payment that is supposed to increase the

funding. and whole person care, 9.3 million in the first year but in the second year, we have not made an assumption because of the lack of details behind the programming. in addition to those programs i just mentioned, the proposal discusses future programs regarding incentive payments for infrastructure, population health management, demonstration pilot, seriously mentally ill or seriously emotionally disturbed. behavioral health payment reform, the extension of our current organized delivery system as well as dental benefits. these programs are expected to be phased in over the course of 2020 through 2027.

while there are some initial time frames for either proposed additional details for implementation, at this point there's not significant enough detail to talk about what those programs may look lik for dph. in terms of next steps, we'll continue to monitor and get additional information from the state. in the meantime, we're assessing our current programming and trying to figure out how they might change under the new framework. we have started planning and collaborating with key stakeholders, including the department of homeless and supportive housing. with the goal of creating strategies for successful implementation of the program.

so overall, the changes we believe will result in about 24.5 million of additional revenue in the first year dropping to 15.2 in the second year as a result of no projection as far as enhanced care management and in lieu of services but that is something we can revisit at a later date when we have more information. we have regular revenues, patient revenues as well as payments for graduate and medical education program. we believe worth around 18 million annually for the next two years. laguna honda hospital, projecting additional revenue in the second year. this is a slightly odd year,

ordinarily we would have received a notification of updated rate for laguna honda hospital. we usually get it in the fall but due to delays in the state, they have not provided an updated number. this 4.3 number is a projection based on prior years and we'll update the number when we actually receive the rate. the last two initiatives are around deferred revenues. the controller's office has the ability under the annual appropriation ordinance to defer revenues to be able to move the volatile state and federal issues that can lead to significant variances in dph's budget year over year. these are revenues -- deferred revenues that we report on to the commission every quarter.

under our current reserved revenue, we have 51.6 million we had held in anticipation of a federal reduction to the disproportionate share hospital. this was continually delayed by congress and was scheduled to go into effect as of december 2020. in the last minute, the congress did actually take action and delayed any reduction until fiscal year 23-24. with that move, we can release the reserves of 51 million and recognize that towards balancing. somewhat similarly under behavioral health as a matter of practice, the state provides --

we submit cost reports to the state and they have an interim rate that we're paid. based on the expected potential we may need to pay back once they do the final audit of cost reports. ordinarily it happens several years in the rears but based on notifications in the state, we expect they'll be accelerating the rate of the cost reports. we expect that the review would be favorable and result in 8.4 million in savings related to the 16-17 and 17-18 fiscal years. this is an additional 8.4 million of revenues we'll be able to recognize and put towards our target. on the expenditure side, the commission may recall dr.

bennett presented in december a racial equity action plan, an ambitious three year plan to support efforts to advance equity within our work force and services for patients. it's a three year plan and we propose to add nine positions to support the training and coordination efforts involved with the plan. we are phasing them over two years recognizing with all of the efforts going on with covid, we won't be able to do it all in the first year but we want to have the resources in the first year to begin it and then we'll have additional programs according to the three year plan. many commissioners remember we have inflation initiatives that do not affect the target. they were assumed under the deficit and allows us to

continue our operation at the hospitals the first is related to pharmacy and food inflation where we have projected 8.9 million increase. this is really around maintaining -- keeping up to pace with our expected cost of pharmaceuticals which as you know, the inflation rate far exceeds regular cpi. and secondly, we have cost related to the uc affiliation agreement. this is 18.5 million to cover the gap of the cost of care they provide, the services they provide that are not covered by their own revenues and similar to the city. they have their own inflation around their civil service

staff. our general target is around 16 million. as you know, there was some revenue in the deficit in the second year. with the proposals we put forward of 140 million off set by some of the costs related to the racial action plan initiatives, we met the first 7.5% target and put a $1 million in down payment toward the remaining contingency. as we mentioned in the memo, due to the extraordinary efforts underway by dph to support covid response and vaccine program, the mayor's budget office has authorized us to delay development of specific plans for the contingency until later in the budget process.

if conditions are needed, we will return to the commission with a proposal for their consideration prior to submission to the mayor's office. at this time, with your approval, our next step would be to submit these proposals for consideration to meet our general fund reduction target on february 22nd and then over the course of march and may, we will continue our work on developing covid and behavioral health and homelessness projects and continue to understand and plan programs and update the commission on the mayor's june 1st budget proposed budget and work with the board in june and july as part of the review. that completes my presentation and i'm happy to answer questions.

>> clerk: if you have comments press star 3. you have two minutes. please let us know you are there. >> good evening. >> you have two minutes. >> good evening commissioners. i'm dr. brown, i have been a healthcare worker in san francisco for 30 plus years. i currently work for richmond area multi services and here for the national union of healthcare workers to promote you approving this budget. i work for dph contracted

program that provides counseling to dual diagnosed children in the juvenile justice system. i'm happy to see that san francisco is committed to passionate equitable responses, we're charged with developing even more creative robust mental health system of care. as the result of covid, i have seen an increase in despair driven by more danger and anxiety in the community. our economy will eventually reopen but the heightened emotional issues will remain and a greater challenge for all community stakeholders. we often deal with a marginalized population that deserves the most experience quality clinicians. far too often we lose clinicians. we need to pay them enough to live in the communities they

serve and stay abreast of the rapidly changing landscape of mental health issues of our residents. thank you. >> president bernal: thank you. >> clerk: that was the only comment. >> president bernal: commissioner giraudo. >> commissioner giraudo: i just wanted to comment and thank you for the presentation. the memo that was put together was exceptionally helpful to really understand the slide presentation, so i just want to thank you for the memo and making it very understandable.

>> president bernal: commissioner chow. >> commissioner chow: i would join saying the budget presentations are as clear in a very complicated process and one day i think it would be good not necessarily within the budget but for the commission to see again the structure of how this fits into the entire budget of the department and i know that it has been some time that we have looked at the grants and department that has grown over the year and continued to do good work. i have no objection to the manner in which you have been

able to actually piece together a response to the mayor's request for 7.5% reduction of the general fund support. i won't ask the questions that you don't have the answers to. i do wonder the increase in the uc contract and we should be reviewing in some setting is the program that at one time i believe we had to look at performance criteria and evaluation of that. we know the value -- the

enormous value that the uc staffing has but the complexity of the entire enterprise i think does deserve at some point an additional review. not just in terms of what would be expected as a personnel increase and i'm not sure what setting that the chair might wish to have that done, whether it is at a finance and planning meeting or how that should be looked at.

>> commissioner giraudo: thank you very much. i was able to understand it so thank you. >> president bernal: commissioner guillermo. >> commissioner guillermo: thank you. i just wanted to lend my comments to commissioner chow in thanking you for -- all the commissioners who have spoken about making it a clear presentation. i think the complexity with which you have to deal with in pulling this all together for a very unique health department that we have that encompasses both public health and operational arm that includes the hospital and the clinic shouldn't be understated by any means because it's not a common

thing. with all of this difficulty and complexity, for you to be able to make a down payment on the -- it might sound small but i think that's tremendous. it speaks to -- the ability to put the down payment or project the down payment in some ways speaks more to what the expertise and excellence of the staff is and how dedicated you are to make sure we can continue even in the face of the pandemic and the uncertainty of what it is going to do to us and knowing covid and behavioral health are going to come down with a budget and budget constraints that in some ways you don't have control

over. all of those pieces put together really sort of could make it impossible. so i want to really punch in on how appreciative we should be and i am for what you have been able to achieve with this budget. >> president bernal: thank you commissioner guillermo. commissioners, do we have any other comments or questions before we take a motion to approve? all right. seeing none, is there a motion to approve? >> i move. >> second. >> clerk: i'll do a roll call vote. (roll call)

the item passes. >> president bernal: all right. thank you. >> thank you commissioners. >> president bernal: moving on to the next item. other business. do we have any other business? >> clerk: in the calendar i sent you the joint meeting for the planning commission is scheduled from 10:00 to noon because that was the date most of you could go, some of you couldn't. i apologize we couldn't find a date for everybody. but that is the date on the calendar. >> president bernal: thank you mark. public comment on our other business items?

>> clerk: press star 3 to make a comment on other business. no hands up commissioners. >> president bernal: next is the joint conference committee report from the sfg committee. commissioner chow. >> commissioner chow: at the january 26th meeting we held, we discussed the standard reports including the joint commission survey that we were expecting still was on hold because of our status with the pandemic. we received also the medical staff report. and discussed covid-19 vaccine update and how the hospitals had organized vaccine distribution sites on campus for the front

line workers and how well it was being accepted by the front line workers. during the committee meeting, we also approved the radiology rules and regulations, dermatology rules regulations and ems medication privileges list. and in close session, the committee approved the report and reviewed -- happy to answer any other questions. >> president bernal: commissioners, any questions for commissioner chow? and mark, do we have public comment on the item? >> clerk: press star 3 to make public comment on this item. there's no hands up. and i want to apologize, i didn't have anything to do with

it but my technical difficulty, i hope it didn't get in your way of the experience of your presentation. i will check with my it folks to prevent it from happening again. >> president bernal: thank you mark. we know it can be challenging with the technology. okay. then we'll move on to the next item. do we have a motion to adjourn? >> so moved. >> second. >> clerk: (roll call) the meeting is adjourned. >> president bernal: thank you everyone.

thank you. this morning, our office filed a lawsuit with the superior court against the san francisco board of education and the san francisco unified school district for its failure to formulate a plan designed to get the 54,000 students in the san francisco unified school district back to in-class learning as quickly as possible. more specifically, the

california education code requires school districts across the state to adopt a learning continuity and attendance plan, lcap, describing the actions school districts will offer to take classroom-based instructions whenever possible. particularly for pupils who experienced significant learning loss due to school closures in the 2019-2020 school year. or are at greater risk of experiencing learning loss due to future school closures. the requirements under state law are detailed and specific. unfortunately, the plan prepared by the san francisco unified school district and adopted by the board of education is ambiguous empty rhetoric. it's a plan to make a plan. it's legally insufficient. the city is suing for a single cause of action at this point,

violation of duty, when government officials fail to perform their official duties. the city is seeking a court among that among other things, requires san francisco school district to fulfill under state law to "prepare to offer in-person instruction" now that it's possible to do so safely. we're asking the court to order the school board and school district to put in place a plan -- a viable plan to reopen safely. if that plan is followed, schools will reopen. san francisco schools have generally been allowed to reopen since september 2020. the san francisco department of public health, the california department of public health and u.s. center for disease and prevention all say schools can reopen safely. in san francisco, the overwhelming majority of private and parochial schools have done so. over the past several months,

113 private and parochial schools in san francisco have reopened and remain open. almost 16,000 students have returned to in-person schools. and less than five cases of in-class transmission have been reported. in [indiscernible] county 90% of schools resumed in-person instruction, including public schools which began opening classrooms last fall. there have been only nine cases of suspected in-class transmission there. various public schools opened in san mateo, santa clara and napa counties and the results were similar. undisputed scientific consensus is schools can reopen safely for teachers, staff and students with proper precaution. and that in-person instruction is not causing spikes in covid infections. but as of the date of this complaint, not a single san

francisco public school student has set foot in their classroom in 327 days. disturbingly, the school district and the board of education seem to have no plan for how or when in-person instruction will begin for any of its students. other than falsely proclaiming schools cannot be reopened safely and telling families that it is unlikely we'll be able to offer most middle and high school students the opportunity for in-person learning this school year, the district and the board have provided virtually no current information to the city or to the public. the leadership for both the school district and the educators union can't seem to get their act together. the board of education and the school district have had more than 10 months to roll out a concrete plan to get kids back in school. unfortunately, so farther's earning an "f". having a plan to make a plan, doesn't cut it, and is no plan

at all. the district's own data show the achievement gap is widening under san francisco school district's distant learning approach. black, latino and other students of color in san francisco, as well as those from low-income families, have lost significant academic ground compared with wealthier and white students during the pandemic. while research is increasingly showing that the mental and emotional health of many students is at greater risk during the pandemic as they struggle with distance learning, san francisco officials, children, and families do not know what steps have been taken, what remains to be done, or how they can help. this is not just shameful; it's also unlawful. it's regrettable we've had to take this decision that we filed today. suing the school district is not something we ever wanted to do. but something needs to change. the status quo is failing our children.

and we hope that this will move the district to do the right thing. i know that there are countless teachers doing heroic work to educate their students in these unprecedented times. ; to them, we say thank you. day after day, they're fighting the impossible battle against the tide of isolation and distance learning. we couldn't be more grate he have for their service and sacrifices they've made to educate our kids during this very difficult time. we want them to be able to return safely to the classroom. it is up to the district, the board of education, and their leadership to agree on a plan to do so. more than 54,000 san francisco school chirp are suffering. they are being turned into zombies by online schooling. enough is enough. getting kids back in school needs to be the only priority of school district leadership. and with that, i'd like to

introduce marilyn -- mayor breed who is supportive of the lawsuit. >> thank you to our city attorney herrera working with us to find a solution we know is not easy. i know, but i appreciate you are really stepping up to help meet what we know is an incredible, incredibly challenging time facing our city. nothing matters more than getting our kids back in school. as a city, we don't have control over this decision, which is really frustrating. but we've offered support and help for months. we've helped inspect schools and classrooms to get them ready. we work with the district to set up the testing necessary to monitor the virus when our educators he and students return. we've given $15 million to support our schools.

above what we already do through our normal budget process. and look, i know some of our educators have concerns. i understand those concerns. and i believe we should listen to them and work to address them. and i do support our teachers. in fact, i led a ballot measure last fall to support pay increases for teachers with the -- which the voters of this city supported overwhelmingly. the legitimate concern of our teachers cannot stand in the way of getting kids back in the classroom. when i was in the community the other day, i had a teacher approach me who said i want to go back into the classroom. what are we going to do? i believe we can do this safely. as we've seen in private schools and community hubs that we've been -- they've been open for months. as we've seen in other districts across the bay area and the state, that our city attorney

just talked about, our kids are suffering. the inequalities that existed before the pandemic have become more clear. the data is clear. students have lost ground in academic achievement. and that is a problem. health experts say that issues relating to mental health such as depression and eating disorders are on the rise. almost 1,000 of the school district's 53,000 students have missed over 60% of their classes. 70% of those students are from low-income families. and 3/4 of them are from black and latino families. the school district is failing to meet this most basic responsibility. and for all of the talk i hear from the board of education about equity, the data speaks for itself.

i'm hearing every day from parents, who are concerned that their kids are falling behind. mostly single parents. i'm hearing from parents who have had to leave their jobs to stay home and facilitate distance learning. and we know when this happens, it's almost always women, who bear the brunt of this responsibility. families right now aren't able to plan for their future. they can't decide whether to accept a job offer, because they don't know when they're going to be able to once again have their kids return to the classroom. i know that this is a drastic step. but i feel we're out of options at this point. the department of public health. the leading force around this pandemic, the department of public health that has been the most conservative putting out health orders, they issued guidance to this school district

will safety precautions needed to open schools last september. it's been five months since then. and there's not even an agreement or a plan in place to start reopening. in fact, there were a number of agreements put into place, and then, they changed. during that time, the school board has alienated parents and made national news for renaming 44 of our schools, all while there wasn't a plan to reopen those very same schools? all while even the children who are a part of these schools have not necessarily been able to participate in the discussion, which could be an incredible learning opportunity. look, i'm committed to working with the school district and the school board. we've been providing support for months. we've been prioritizing the schools and rolling up our sleeves in the city and doing everything we can. we're still here, ready to help. and while i don't control the schools, i am the elected leader

of this city, and i'm not going to stand by while our students and families continue to suffer with no end in sight. it's not acceptable to tell parents, who are already under unbelievable stress, and are seeing with their own eyes how their children are falling behind. that distance learn something not good enough. this is offensive. and completely unacceptable. this is san francisco. we have been a national leader in our response to covid. let's be a national leader in getting our kids back to school. i'm a proud graduate of san francisco's public schools. the only reason why i was able to grow up in public housing in a very challenging environment, in poverty, in this city, and go onto become mayor, was because of our public schools. but if i were in school today, i

would likely have been one of those very same students who today are falling behind because of distance learning. in fact, my niece and nephew are two of those san francisco students. so yes, i'm here as a mayor, but i'm also here as an aunt who is concerned about her family. every day we wait is another day we let our students fall behind. this is not the route i would have chosen five months ago. i'm not sure that -- this is not the route i would have chosen five months ago, but i don't see any other option. we're ready to help. but the school district needs a plan to reopen, and they need it now. our students and our families deserve nothing less. so once again, i want to thank our city attorney herrera and his team at the city attorney's office. i know in their hearts, all they want to do is see our schools reopen. people of san francisco want to

see our schools reopen. and i'm hopeful that we are one step closer to getting there today. let's not continue to let our children suffer in this city. thank you. >> thank you mayor breed, and thank you city attorney herrera. we will be taking a select number of comments from reporters. so if you do have any questions, please send them to myself, the host. and we will try and get in as many as we can. for mayor breed, we have a question from jim carlson. can the mayor speak more on the remaining controversy and why this is quote-unquote "the wrong time"?

>> mayor breed: i am sorry. i don't understand the question. >> jim, can you narrow that down a little bit. >> mayor breed: what media outlet? >> sorry. jim, can you cite your media outlet as well, thank you. for city attorney herrera from "the examiner", there are a few questions. i'll start with one. did the city offer to meet before filing suit? and if so, did they refuse so? >> let me put it this way: if the question did i, the city's attorney office, meet with the school district, the answer is no. but in terms of the city itself as an entity, going back for the

entirety of the time the school has been closed, there were numerous conversations between the city as an entity and the school district about how we could be of assistance in terms of giving them the resources they need to ensure that schools could reopen as safely as possible from discussions of testing, money, of other availability of resources. that's something that the city as an entity and my client's departments and the mayor's office has had numerous conversations, continual conversations. members of the board of supervisors with the district over the past several months. with respect with me filing this lawsuit, did i have a meeting and discussion with them? no. quite frankly, i didn't think it was worthwhile considering the lack of progress that has been made over the last several months, despite all of the

continual discussions that were happening with the city and the school district. >> thank you, city attorney herrera. the second part of the question is why isn't testing help offered, considering it's a major barrier, as school officials have said. maybe mayor breed can answer. >> i don't agree with the supposition of the question. i think there have been numerous conversations from the department of public health and other places in the city to say that they would be at assistance and try to be at assistance to try to deal with testing issues. i think that's been something that's been discussed quite often over the course of the last several months. >> mayor breed: in fact, we worked with the school district and had a plan to implement testing capacity to support the

request of the teachers' union, and unfortunately things changed after that. >> thank you, both. this comes from kathie novak. for city attorney herrera, what could happen in practical terms if the court rules the schools should reopen but the teachers refuse to return or strike? >> >> attorney herrera: i'm hopeful with the policy issues you've seen across the state. this is legal, and based on a failure of the school district to do what is required under the law. so we are not seeking a court order requiring schools to reopen exactly. we're asking the court to order the unified school district to prepare to offer in-person

instruction, file the appropriate plan to show they're ready to do so. and that is going to require that -- and hopefully provide a platform for the district and the board and the union to hammer out an agreement to get this done. so schools can reopen as quickly as possible according to the plans that the court will likely require -- the detail and specific plan the court will likely require the school district to file. so i think this is providing a platform and vehicle for everybody to come to the table and hammer out an agreement that will result in kids getting back to school as quickly as possible. >> thank you, can city attorney herrera. we've got another question from ktvu. if the district board and teachers' union comes up with a plan, would the city drop the

lawsuit? >> attorney herrera: i'm not going to speculate on what i would do or not do based on an agreement that hasn't occurred. we're going into court. i'm seeking a preliminary injunction next week. if that forces folks at the district and at the teachers' union to come to some kind of agreement, great. if that's embodied in the documents that we're asking the court to require the district to come up with, fabulous. but i want to see the details, concrete results, and then, i'll make my decision about where this lawsuit goes or doesn't go based on the circumstances at the time. >> thanks very much. we're waiting for just a few more questions to come in. for mayor breed, this comes from

kpix. for the schools closed in march 2020, how many times did you meet with superintendent matthews to discuss reopening and what city officials could do? how many times have you met with uess since schools closed? >> mayor breed: i meet with superintendent matthew quite frequently. we have a regular meeting on a monthly basis. we've had to increase the number of conversations we've had to focus on our reopening efforts. and -- what was the second part of the question? >> sure. the second part of the question is: how many times have you met with uess since schools closed? >> mayor breed: so i've talked individually to members of uesf on numerous occasions. i don't know the exact number of times i've met with either. but they've been over the course of the past year, there have been a few times.

thanks very much. sorry. just to clarify, you know, how many times have you met with superintendent matthews? and have you discussed reopening with him and what city officials could do to help? >> who is that question for? >> for mayor breed from kpix. >> okay. >> mayor breed: look, i can get back to you on the exact number of times. but i have a standing monthly meeting with the superintendent. and there have been increased in the number of meetings that i've had with him around the reopening efforts. so i don't know the specifics of how many times. but we definitely have a open

relationship. we constantly communicate with one another. we're definitely trying to work together. i know he's working very hard to get the elected board of directors for the school district on board with number of plans and initiatives. and this is what we discuss on a regular basis. so the specifics of the number of times, i do not know off the top of my head. >> thank you. and just a follow-up. we're going to take two more questions. this is from ken troth. what else will be done in the next couple of weeks by city officials such as yourself? you mentioned testing and money for schools. can we elaborate on that. >> that was for mayor breed,

correct? >> mayor breed: what else? >> what else could be done in the next couple of weeks by city officials? you mentioned testing, offering money to inspect schools. >> mayor breed: that as far as i'm concerned, we don't know what else we could do. president that's what the problem is. we've tried to meet every request that has been made. and there was actually just to clarify, an agreement for testing. and so we have provided the resources, the systems, the support. and we just need the school board and the superintendent to move in this direction. and so we're here. we're here to work with them. we're here to continue to provide whatever resources that are available to support them. but it doesn't -- we're not sure what else we could do to move this forward. and i think that's really why we're here today, because now

it's time for us to start using whatever tools we have, whether it's a lawsuit or legislation or what have you to address this issue. and sadly, you know, take matters into our own hands. >> thank you, mayor breed. one more. we're just sorting through. we've gotten quite a few. that's all we have time for today. i really appreciate everyone coming. and their interest in this issue. thank you to mayor breed for her time. and thank you of course to the city attorney herrera for speaking today. if you would like more additional information on the lawsuit filed today or anymore of city attorney herrera's comments visit www.sfcityattorney.org for our full press release.

san francisco is surrounded on three sides by water, the fire boat station is intergal to maritime rescue and preparedness, not only for san francisco, but for all of the bay area. [sirens] >> fire station 35 was built in 1915. so it is over 100 years old. and helped it, we're going to build fire boat station 35. >> so the finished capital planning committee, i think about three years ago, issued a guidance that all city facilities must exist on sea level

rise. >> the station 35, construction cost is approximately $30 million. and the schedule was complicated because of what you call a float. it is being fabricated in china, and will be brought to treasure island, where the building site efficient will be constructed on top of it, and then brought to pier 22 and a half for installation. >> we're looking at late 2020 for final completion of the fire boat float. the historic firehouse will remain on the embarcadero, and we will still respond out of the historic firehouse with our fire engine, and respond to medical calls and other incidences in the district. >> this totally has to incorporate between three to six feet of sea level rise over the next 100 years.

that's what the city's guidance is requiring. it is built on the float, that can move up and down as the water level rises, and sits on four fixed guide piles. so if the seas go up, it can move up and down with that. >> it does have a full range of travel, from low tide to high tide of about 16 feet. so that allows for current tidal movements and sea lisle rises in the coming decades. >> the fire boat station float will also incorporate a ramp for ambulance deployment and access. >> the access ramp is rigidly connected to the land side, with more of a pivot or hinge connection, and then it is sliding over the top of the float. in that way the ramp can flex up and down like a hinge, and also allow for a slight few inches of

lateral motion of the float. both the access ramps, which there is two, and the utility's only flexible connection connecting from the float to the back of the building. so electrical power, water, sewage, it all has flexible connection to the boat. >> high boat station number 35 will provide mooring for three fire boats and one rescue boat. >> currently we're staffed with seven members per day, but the fire department would like to establish a new dedicated marine unit that would be able to respond to multiple incidences. looking into the future, we have not only at&t park, where we have a lot of kayakers, but we have a lot of developments in the southeast side, including the stadium, and we want to have the ability to respond to any marine or maritime incident along these new developments.

>> there are very few designs for people sleeping on the water. we're looking at cruiseships, which are larger structures, several times the size of harbor station 35, but they're the only good reference point. we look to the cruiseship industry who has kind of an index for how much acceleration they were accommodate. >> it is very unique. i don't know that any other fire station built on the water is in the united states. >> the fire boat is a regional asset that can be used for water rescue, but we also do environmental cleanup. we have special rigging that we carry that will contain oil spills until an environmental unit can come out. this is a job for us, but it is also a way of life and a lifestyle. we're proud to serve our community. and we're willing to help

people in any way we can. commission. i do that because it's a two-day meeting. can you call the roll? >> secretary: yes, director borden? >> chair borden: here. >> director brinkman: present.