>> would you please call the roll call. [ roll call ]

>> clerk: everyone is here. >> chair: all right. this meeting is called to order. we'll move to the next item for action. approval of the minutes of the health commission meeting on february 16. commissioners, after reviewing the minutes, does anyone have any amendments or if not is there a motion to approve? >> i make a motion to approve. >> second. >> we need to move to public comment before we move on to a vote. for each item on the agenda, members of the public can make

comments. the process does not allow questions to be answered or to engage in back and forth conversation with the commissioners. if you would like to make public comment, please press star 3. no public comment. i will do a roll call vote. [ roll call ]]. >> chair: moving on to our next item for discussion, the director's report. director colfax. >> grant colfax, director of health. much of the director's report involves covid-19 updates which i will provide for the next agenda item. but i did want to bring your attention to the last written item of the report which is

welcome news for d.p.a. we hired loretta kim as director of human resources. she is an outstanding candidate from a pool of outstanding candidates and has a wealth of experience in human resources, having been a d.p.h. and then the human resources director and most recently or currently at the human service agency and just really excited about having her join the d.p.h. team and thanking michael brown for his work. he will continue in an advisory roll with ms. kim as needed. just excited to announce this very important hire. her priorities will include partnering with the office of health equity to implement d.p.h.'s racial connect plan, supporting staff engagement and

improving the experience for the human resource customers. i just wanted to bring your attention to that. again much of the remainder of the report focuses on covid-19 and i will fill in much of that in my presentation. happy to take any questions. >> clerk: commissioners, are there any questions for director colfax? seeing none, director colfax, extend our congratulations and welcome to director tim. >> chair: and i want to check the public comment line to make sure we don't miss anyone. press star 3 if you would like to make a comment on the director's report. no hands, commissioners. >> we can move on to the covid-19 update. back you, director colfax. >> thank you. grant colfax, director of public health here with the covid update.

just to let the commission know as of tomorrow we will be in the red tier which has the mayor announced today at a press conference at pier 39 which i was also able to attend includes opening more of the city up for more activity, including allowing limited indoor dining, limited to one household inside, and also extending the dining capacity. starting to open gyms at 10% capacity in indoor museums, aquariums, and zoos will also be opening up to 25% capacity. ensuring that we have made great progress with regard to coming through the winter surge, our case rate is down to 7.5 per 100,000, so positive news there. obviously we need to continue the precautions of social

distancing and masking and the other -- avoiding gatherings and concern about the variants and getting vaccines into arms. next slide. we now have over 34,000 cases of covid-19. unfortunately 422 san franciscans have died of covid-19. you can see from the graph here that much of those deaths have come during the winter surge. next slide. with regard to cases, the racial disparities that you're well aware of at this point continue. i will note with the latino population, you will recall that earlier or last year the disparity was even more profound at over 50% of cases were among people who identified as latino. that number is now down to just

over 41%. still a key area that we need to continue to focus on, including with our vaccine roll out. you can see the other characteristics of the people diagnosed with covid-19 on this slide. next slide. in terms of the death, the proportions here have not changed dramatically since i last showed you the slide two weeks ago. just to emphasize that so many of the deaths, the majority of the deaths have occurred in people 65 and over which is the blue chart. that's why we're continuing to focus on vaccines being prioritized for those populations. you will also see at the bottom left of this slide with the comorbidity, two-thirds of the people who died have a known

comorbidity which is why we move into the next stage so people with comorbidities will be prioritized. our key health indicators, hospital capacity remains good right now. the high-level alert in terms of our covid-19 case rate as i mentioned, 7.7 per 100,000. you will see the testing and contact tracing and the p.p.e. numbers which have all been stable for the last couple of weeks. our testing numbers have gone down. our capacity is robust, but as we have seen across the state and the country, compared to the surge in demand for testing or in the winter months, we have experienced a decrease. next slide. we beat back three surges now. this is the hospital capacity.

the dark blue lines are the i.c.u. numbers and the light blue the hospital bed numbers. we are back from our peak of 256 people in the hospital now down to 74. we hope that those numbers continue to go down. the reproductive rate has remained steady at 0.75, below 1, but we will continue to watch that very carefully. as you may have noted, nationally numbers have started to level off and even gone up in terms of cases so we're watching that trend carefully.

as you just saw on the last slide, we're now down to just between 7 and 8 per 100,000 for the last couple of days. in terms of vaccinations, we have over 150,000 -- over 166,000 san francisco residents have been vaccinated with at least one dose. that's 22% of the san francisco population. we have experienced severe significant shortages of vaccine, as have the rest of the country. our systems have provided at least 10,000 vaccines a day into arms now. we don't have nearly that number of vaccine supply, but we're still making progress as you can see on the graphs on the bottom right side of this slide in the blue and purple shades. next slide. these are the doses administered

in san francisco. remember that there is a difference between the doses administered in people who live in san francisco and received a shot. people who live in san francisco can get the dose in san francisco or another site. and there is a corollary of that. we are vaccinating many thousands of san franciscans, but if people work in san francisco, they also can come to san francisco for the vaccine. we administered a quarter of a million vaccines. we can do more, but we need more vaccines to get the job done. this is again from our data tracker with regard to vaccinations of san franciscans by race and ethnicity. the vast majority of vaccine that's been administered in san

francisco, initially focused on health care workers and then on populations 65 and older. this is not necessarily representative of the population overall. this slide will reflect that. you can see in terms of the population where vaccines have been distributed. looking at these blue bars, it's the proportion of vaccine that's gone to populations that identify in the following race ethnicities versus the estimates of the representation of the san francisco population overall. next slide. then when you look at these numbers by age 65 and plus, this would not include many of the health care workers. you see the numbers as follows.

i would just say as we move into tier one essential workers, this is as of wednesday last week, this became available to emergency service workers and teachers. so we will expect to see on the prior side these percentages to start potentially changing as more people gain access to the vaccine. this is important to recall that d.p.h. only had some control of about a quarter of the vaccine that comes into the city. much of this is being focused through our health network and reaching populations most in need of healthcare, particularly in the medicaid population, people without medical coverage, people with healthy san francisco. these are the vaccines that are

administered by d.p.h. in the populations 65 and older. you can see here compared to the overall city distribution of how vaccines have been given to people 65 and older, we have more -- a greater representation of people of color receiving the vaccine compared to the overall city average. just in terms of vaccine, we are administering 4,500 doses of vaccine a day overall. we had a peak of over 7,000 vaccines going into arms. again, that has slowed down as vaccine supplies become -- you can see a big dip in the curve from last week. we are administering the second doses in the d.p.h.s, administering approximately 1,700 a day. i don't know if the commissioners saw the

president's announcement a few hours ago that they now expect to have enough vaccine for everyone who wants one by may, although it will take much time to get the vaccine into actual arms. that certainly moved up considerably from the prior timeline. we're very excited and that's hopeful news. especially with the johnson & johnson approval, that's an excellent vaccine in terms of its efficacy. we will be in a situation where supply is limited for at least the next couple of weeks. we have a slide representing the vaccines administered by d.p.h. by neighborhood. you will recall that much of the southeastern part of the city

carries the heaviest burden. this is the vaccine distribution by d.p.h. and you can see that the representation there is largely consistent with the burden of the pandemic. again, these are vaccines administered by d.p.h. we can fix the bottom of this slide which shows i think another part of the top neighborhoods which will be corrected. just to note that the darker blue colors on this map represent a higher concentration of vaccine in the neighborhoods where d.p.h. has delivered vaccines. and again, your website

continues to change and expand with more information and providing the most up-to-date information with regard to vaccine. those are the two resources where we send people and from there, there are lots more opportunities to learn about vaccines and we are encouraging people when they are eligible to get the vaccine. that wraps up my presentation and i'm happy to take additional questions. >> chair: any questions or comments. mark, do we have public comment? >> clerk: if you would like to make a comment on this update, please press star 3 to raise your hand. i see several hands. for each agenda item, members of the public will have an opportunity to make comment for up to two minutes. the process does not allow questions to be answered in the meeting or for members of the public to engage in back and

forth discussion with the commissioners. please know that the commissioners do consider comments from the public. one more time, press star 3 in order to be recognized. i see two hands. i will unmute you. once i unmute you, you will have two minutes to speak. please let us know that you are there, caller. caller? >> am i on now? >> clerk: you are on and you have two minutes. >> perfect. i'm a community activist and a community organizer with the neighborhood council. i am calling to draw your attention, commissioners, to the dire situation where our seniors and our loved ones live in nursing facilities and the elderly homes.

that is because they've been locked down for the entire year, the past year. they haven't had any systematic contact with their loved ones. i understand that things have changed, as evidenced by the testimony that we just heard, and i'm glad that city hall is reacting to good numbers, to good outcomes. but i am still disappointed that nothing is being done for our seniors who are still locked down in the facilities even though we are at a 98% vaccination rate. so if we're following the science, we should do something about this and we should at least have one designated family member with the ability to designate our loved ones. i will come up with several ideas.

surely the city of san francisco and the department of health can come up with a protocol that will maintain the health and safety of our loved ones in skilled nursing facilities, the s.n.f., as well as providing the mental health care and mental care that these seniors desperately need. i just want to draw your attention to this point that was unfortunately left out from the presentation that we just witnessed. i really would encourage you to do something about it. i appreciate you paying more attention to the senior facilities and providing more care in terms of relatives to visitation. thank you. >> clerk: thank you for your comment. caller, you're unmuted. you've got two minutes.

>> my name is theresa palmer, i'm a geriatrician and the daughter of a nursing home patient. the nursing home infection rate is now 0 in san francisco. a very good vaccination rate. families are willing to use p.p.e. and get tested or vaccinated the same as health care workers in order to visit and care for our loved ones. we're now in a year of lockdown. it needs to end now, not two weeks from now and not a month from now. we are turning red and no one has even mentioned nursing home. it's like nursing homes do not matter. death and isolations from failure to thrive are mounting and now isolation is more of a risk in our two main staff care homes in covid. what is the department going to do? how long will you delay? you've delayed before. this is unrelieved. this is unacceptable, okay.

the quality of life and life itself of our loved ones in care facilities is such a priority. why is it the san francisco department of public health is not asserting the care home administrators must rule in favor of visitation when residents are failing or in distress? state and federal rules allow this. you have not listened to families. you have been unresponsive and not transparent. we're turning red and you're delaying again. this is a pattern and unacceptable. the nursing homes need to do it and you need to. this is a human right. this is the nursing homes' job to care for the lives of those there. the state also allows it, you must do it. thank you. >> clerk: thank you, dr. palmer. there is one more caller.

>> in accordance with the sunshine ordinance, we are e-mailing testimony right now for inclusion in the meeting minutes. there has been reckless disregard for the right of s.n.f. residents to be in person in visitation. there was guidance issued on september 17 allowing in-person visitation in s.n.f. provided that some conditions were met. california department of public health also issued guidance on october 23, authorizing in-facility visitation of s.n.f. residents in jurisdictions in red tiers. the city entered the red tier

today. d.p.h. and mayor breed's health officer have reportedly been setting how to expand visitation going on nearly six months between september 4 and march 2, today, with no solution in sight. shame on that delay. if breed is so anxious to open restaurants and other venues, she damn well be opening up skilled nursing facilities for visitation. given the rate of resident and staff vaccinations in the city, now is clearly the appropriate time for the health commission to revise laguna honda visitation policies to allow indoor visitation immediately. you might act decisively today and order dr. rita, director of

the covid-19 command center information and guidance branch, to get off the path and issue guidance tomorrow allowing visitation in our facilities. elderly people -- >> clerk: thank you for your comments. that is the end of public comment, commissioners. i believe that dr. colfax wants to show a slide again. >> thank you. this is an updated slide. you can go to the data tracker and slide up and down on the bottom to see the percentage of vaccinations in the

neighborhood. this is now the neighborhoods with the highest incidence of vaccines that have been administered by d.p.h. the visual pretty much says it all, but you can look and quantify and see the numbering in descending order. i just wanted to highlight that and make the correction for the commission. that's all we have here, but i wanted to update the site. >> director colfax, that's much better. i did not see the order in which hands went up, so i will go with the order on the list. commissioner gerado. >> thank you, commissioner. my question is hopefully the johnson & johnson -- when the johnson & johnson vaccine comes, are we considering or i thought having a mobile team to be able to serve those that are hard to reach, particularly our homeless

population is what my question is. >> appreciate that, commissioner. we have already prioritized people who are experiencing homeless who are 65 and older would be eligible for the vaccine now and we have a number of mobile teams ready to go. in fact, we estimate given our mobile team capacity right now we could do a thousand vaccines a day using that. we are evaluating both the supply of the vaccine and the state eligibility criteria to determine how quickly we can start vaccinating the broader homeless population, the broader population experiencing homeless by including populations under 65 or have other chronic health conditions or factors that put them at risk. plus, many people are living in congregate settings. so we're evaluating that in the

policy team and also asking the state for specific guidance on this population. and also i would add the incarcerated population which is another population that we feel is that is obviously at risk for covid-19 spread. we are asking the state for those key populations and we will have mobile teams ready to go as soon as we get enough vaccines to potentially vaccinate those populations. >> in companion with that, will there be certain neighborhoods targeted where there are folks that really cannot take a bus or drive, is that being planned now? the witness: we've already done some pilot programs with the ones that we have where we have gone to incidents at living

facilities with high numbers of residents and aren't mobile to put vaccines in their arms. we've actually started doing that already. again, we will have those teams ready to go and concluding in the neighborhoods with the highest covid-19 prevalence to make sure we get people vaccinated in the areas with the highest prevalence of covid-19. >> how will that be publicized especially for some of those residents that don't have access to the internet, is the communication team doing posters? >> the covid command has a lot of engagement with community-based organizations and other groups. it's going to organizations that can guide us to here is a community -- or here is a location where there's a high concentration of people at risk

and they can't get to the vaccine any other way. that's why it would make sense and give people the injections. we want to reach people who may not be able to ask someone to assist them in having the vaccine. we want to make sure there is a large enough number of people in the facility to make the trip and the vaccine coverage a good investment, given our so very limited vaccines. >> thank you. >> thank you for your report, dr. colfax. i'm not sure if this is the jurisdiction of the department or the commission, but i had a question about i guess how the

inspections for outdoor dining now that it started to happen in terms of restaurants and those regulations being followed. one of the things i observed in the past when there was outdoor dining was there was a lot of i guess -- it would appear to be violations of the regulatory requirements of how many people could be seated at a table, whether they were from similar households, whether you needed to have certain clearance on the street and so on. i was just wondering if there was enforcement of the requirements there or whether the health department would or could use the health regulators to regulate that so we don't

have to worry about the spread of the virus is something that might occur in the outdoor park situation or now that indoor dining might be back on. >> thank you, commissioners. i don't know, acting director, if d.p.h. could assist -- i don't see my colleague on the call. she would have more information. so there is -- we are planning to have environmental inspectors go out including on weekends and after hours to expect restaurants to ensure they are complying. we will of course try to do everything we can to ensure voluntary compliance, given this is the third reopening, we will be more aggressive in our enforcement actions going forward. we will work with many partners, including the golden gate restaurant association for that

voluntary compliance. again, we are going to be taking an approach where environmental inspectors will take more enforcement actions if, again, there are examples of not following the health orders and not a willingness to comply with them. having said that, there are lots of, as you know -- many entities in san francisco that could be reopening. so we will do everything we can to work with them to make sure that everyone has the information. and then in certain cases where there is compliance in force. we're also working with covid command to ensure that other enforcement entities in the city have what they need to potentially enforce the health

guidelines. >> that's good to hear. in driving around the city it seems as if there are certain neighborhoods where it's more likely that inspections would need to be more aggressive than in others. and then also maybe more communication education information to residents or folks who may be visiting from out of town and dining in san francisco because it does seem to be something that if unregulated or not regulated aggressively could easily get out of hand again. >> absolutely. thank you, commissioner. >> chair: thank you, commissioner. >> thank you and thank you, director colfax, for the report. i was looking at the extensive list of things happening.

it's going to be a challenge. i was wondering several things, but first in regards to the order. it seemed to say that in the outdoor dining, if there were partitions, even if there wasn't a separation of six feet, that would be okay and you could leave it up, but there wouldn't be any new ones. i wasn't sure if that was expediency or that it would actually relate a public danger if those partitions weren't really effective anyway. i wasn't quite sure if i'm reading the order correctly. >> i'm going to let the acting health officer, dr. susan philips, who is on the line to provide some context in answering your question and for any additional information to

share. >> thank you, director colfax and commissioner chow. we are allowing the existing barriers outdoors to continue because many of the restaurants had established that earlier during the pandemic. at that time, it had been expressly allowed by the state. at some point after that, the city removed its language allowing the barriers to continue. they were saying that they didn't think they would reinstate that language. however, given that we were trying to encourage outdoor versus indoor. the larger table sizes and longer operating hours encourages the outdoor. i talked to the restaurant association and certioraris about is we're not sure if the state will come back and say

they're clear that they don't want the outdoor barriers. i think the chance is no, but we made a decision with industry to say not a good idea to invest in more until we have more clarity from the state. >> i wonder if i might ask several more questions. one is whether or not we have any information how the blue shield system will work and whether especially with the johnson & johnson we can start getting vaccines to our smaller offices or those areas in which they may not have had the deep freeze, so to speak. so i don't know if the department was getting ready for that, but are there a number of independent providers who have been asking again how to help with their patients.

with the new blue shield program i haven't seen whether there was an outreach or whether they would use still the existing system. >> thank you, doctor. we're still having conversations with blue shield and the conversations haven't gotten to levels that you're asking. we're hopeful that that vision will be realized. just to the context here is that blue shield has a third party entity which is starting its work in the southern part of the states first. the bay area county will adopt this in we think two or three weeks from now. we're having very general discussions. the first call this morning was the health network director and our vaccine team. again, the level of specificity that you're asking i think will become -- the answers to that

will become much clearer as we see the roll out happening in southern california. with regard to the johnson & johnson product which is an excellent vaccine in terms of its efficacy, the policy team at covid command is determining where and how those first doses of johnson & johnson -- where they should go and to whom. we don't have a specific timeline. we do know the state will be getting 300,000 doses as early as next week and we expect some of those to come to san francisco. this is a great opportunity for us to extend our vaccine capacity and cover more people as soon as we get robust numbers of johnson & johnson as well as the other vaccines. >> thank you for that. i mean, it's clear that we are certainly reaching large numbers of people.

as you say, to the most vulnerable, greater than 65 are already at nearly 65% of first doses. i think the department has really continued to do a marvelous job at getting those vaccines out there. i do know that -- of course i don't walk on the streets, but i do get phone calls what we will do. >> just, commissioners, the other pieces -- the website allows people to sign up and get more information about vaccines, including when they're eligible. willed encourage people to do that. i know it doesn't mean you'll get a vaccine in the arm right away, but this is a tool you can get as much information as potentially possible. >> i'm glad you brought that up

because if the state is using my turn and we have different sites, does it matter which site people are going to or my site would go to my turn? >> we hope the latter. these are the conversations we started to have with the third party administrator just a few hours ago. that would be our goal and we're hoping for the end user this will be a more efficient system rather than a more cumbersome one. i'm sure the administrator shares that goal. >> thank you. i look forward to that in the next several weeks. i'll stop sending phone calls. we are showing a

disproportionate death rate compared to the death rate. i'm wondering if the department has had time to really delve into that to give a better context. people are saying this is a disparity that needs to be responded, but i'm not sure how you respond to it because the last time you noted that these were more elderly people and also people that were in nursing homes. i continue to quote that, but that doesn't seem to go anywhere. this seems to be what we thought when it was at 50%. granted, the proportion has dropped and there continues to be discussions in the rest of the nation about certain of the asian death rates. i was hoping the department might have some better understanding of that for us.

i don't know if we have the time to do it with other partners. >> i hear that concern and certainly will take that back to the at that time team to see if there are additional analysis they think would help us update the analysis already done. we also need to look at the literature you're alluding to and robert back to the commission. >> there is the effectiveness of vaccines that we would like an update on the reports requested regarding the whole issue of long-term care visitation.

we realize that that has been extremely helpful and was really needed especially at laguna. that has been largely a success although a few people did pass away. we are hoping to get back to zero, but i was hoping we could get an update with the opening of long-term care in san francisco, realizing they are the most vulnerable. now with the great work the department has done that we vaccinate all of our long-term care patients. >> yes, commissioner, we can bring you an update at the next meeting and i'll be sure to include that. >> thank you very much. again, kudos to everybody that's working so hard. >> thank you, commissioner chow

and director colfax. commissioners, any other questions or comments for director colfax? >> if i can just add at laguna honda the visits will resume tomorrow and we are prioritizing potential modifications to become more consistent with the state. i've asked dr. philips and the city attorney to prioritize that. >> thank you, director colfax and thank you for the report. it is very encouraging to see our metrics and our case rates and everything continuing to move in the right direction. as a commission, we need to acknowledge of course the leadership of the mayor, but also the extraordinary work of the d.p.h. staff and leadership and helping to get us to where we are today, the people of san francisco for complying with and with the health orders and caring for themselves, their

families, and their communities. i think especially our community partners in communities affected, such as the latin x and latin american communities, we've seen d.p.h. getting into these communities and neighborhoods and ensuring these resources are placed appropriately. thank you so much to all of d.p.h. staff and you and your leadership team. i did have a quick question with regard to the tier system. i know we moved to the red tier today and based on our case rate we're well on our way to progressing further through the state's roadmap in the tiered system. do we anticipate there will be any change to the state tiered system in order to factor in things like vaccination rates within different counties or do we expect we'll stay under the same system and measures for a while? >> i'm going to ask dr. philips

to speculate on that. >> there's no need. i know that's difficult. i'm just curious as to whether we should envision staying on this path. >> well, there is no definitive answer right now. i can tell you that the state has been receiving input from police officers across the state and having discussions. i do believe it is highly likely and almost certain that they will take into account the number of vaccinations given. i don't know if that will be collectively across the state or county by county. we'll have to see how that plays into it. we understand that vaccination is becoming a bigger part of how we open up. we will be hearing more shortly on that. >> chair: thank you, dr. philips. commissioners, any other questions or comments? if not, we can move on to our

next item for discussion which is the finance -- oh, sorry. we're going to general public comment. >> clerk: folks on the line, please press star 3 if you would like to make a general comment. these comments can be about anything that is not on the agenda. before we begin, i see one hand. at this time, members of the public may address the commission on items of interest. each member of the public may address the commission for two minutes. i see one hand. we'll go from there. please let us know that you're unmuted. >> this is patrick shaw, can you hear me? >> clerk: we can. >> i want to thank the

commissioner that raised the question of enforcement in outdoor dining venues. i want to report that a bar in my neighborhood is not in compliance. they are supposed to be supplying bona fide food with the drinks. they're not doing that and have not since opening their platform. and they have on at least three separate occasions put up folding tables outside of the platform exposing people sitting at those tables to street traffic. you need to get the enforcement folks over to ace's bar and make them come into compliance with the regulation. i am extremely disappointed that

not one commissioner other than commissioner chow raised the issue of opening up laguna honda hospital immediately to allow visitation indoors. it's an equity issue. it's complete bullshit that you're going to have equity in restaurants, but you're not going to have equity in nursing homes. you have got to solve that problem immediately. it's kind of ironic that commissioner chow says you're doing a marvelous job with vaccines, but i'm here to tell you, you're doing an absolute shit job, not a marvelous job, on the rights of residents to have indoor visitation. get off your butts and get it

done. you don't need to study and develop guidelines for another damn day. get it done. >> clerk: okay. thank you, caller. i will move on to another caller because i see another hand. caller, let us know that you're there, please. >> hi, can you hear me? >> clerk: yes, you have two minutes. >> so i'm here to advocate for visitation rights for those in assisted living. it's been over a year since lockdown. there are some very dependant residents that need oversight from their families. it is a real crime that you locked the families out. they are the ones that provide oversight for industries that have systemic issues and systemic chronic staff

shortages, untrained staff causing injuries. families are starting to smell mildew in the rooms that are having a little bit of visitation allowed. you need the eyes and ears of family back in these facilities. it is a real crime that you've locked the families out. they need to provide oversight for these facilities. all of them have chronic problems. it is an industry-wide problem. i'm here to advocate for opening up the facilities. making sure every resident has a family member coming in and checking on the resident every single week. people are dying. people are dying in isolation and it is a shame on you for allowing this to happen. i'm done. >> clerk: thank you very much, caller. we have one more.

caller, please let us know you're there. >> yes, i am. since i wanted to talk about similar to the previous caller was not agenda, unfortunately. very disappointing. the place where the great majority of deaths initially were occurring and of course much later into the pandemic, it was in nursing facilities and elderly care facilities. so why is it that this was not even on the agenda? why is it that there is no attention being paid to that the residents that have already been vaccinated, the facility that is 100% vaccination rate and there is no plan for the loved ones to start visiting these people who are basically prisoners in these facilities? this is another public health issue. this has got to do with the

mental health of these folks. i'm just at a loss that you guys aren't covering every possible angle of the pandemic, as you should. however, this is something that basically this segment of the population was the hardest hit. you're not even going there. you're not even announcing what the plans are for relaxing the rules of visitation. so, you know, i'm just hoping that myself and the few people that call actually are going to shed light on this omission. i hope it's not omission by design. i hope that you're paying attention to this. thank you. >> clerk: thank you, callers. those are all the hands that i see, commissioners. [please stand by]

extension of a year of their contract and some changes in services. and lastly, for our covid -- there is an extended contract now for an emergency contract that is able to find us skilled people that will help supplement our staffing from the city in those areas needed and it will be as-needed contract. they have been doing that previously under an emergency with covid, but this will be a regular contract that allows them to be as needed. we have several other new contracts that are before us.

and i'll name at least three of them. a contract that is for the internet -- being held in equipment at our facilities at laguna honda and san francisco general to use internet connectivity. there's a contractor to continue monitoring that -- these are not the hand held. they're the regular software and equipment being used for it programs. and it's a previous contractor under a different relationship and that's why it's listed under dph as a contract here.

item number 5, i will need to recuse myself and i will have commissioner bernal report on that later. and item 6 is the contract with cornerstone technology. i found this interesting because this is one that actually is the one that takes these different devices and make sure that we are properly using and monitoring inventorying these. we have a lot of these devices now throughout our system and so this contract will allow us to be able to be sure that these are being properly used and safeguarded. so that is the other contract. so, president bernal, that ends my report at this time and i would suggest that we could act on those and because of my nature, recuse myself on item

number 5, i would leave that to you to report after i leave the meeting in regards to the actions that need to be taken. >> president bernal: thank you commissioner chung. we can take those for the consent calendar. do we need a motion mark to remove the chinese hospital contract from the consent calendar before considering it without it? >> clerk: yes. >> president bernal: do we have a motion to remove chinese hospital from the consent calendar? >> so moved to take it off of the consent calendar. >> second. >> clerk: i have to do a vote. (roll call)

great. commissioner chung you can vote on everything else and then do the other item or vice versa. it's up to you. >> commissioner chung: whatever you recommend. >> clerk: let's do the others first. >> president bernal: do we have a motion to approve the consent calendar without the chinese hospital. >> so moved. >> second. >> clerk: (roll call).

that passes. we'll say goodbye to commissioner chung for a moment. >> commissioner chung: i shall now leave the meeting. >> clerk: i will text you to come back when we're done commissioner. >> president bernal: thank you. we acknowledge commissioner chow's removal and look forward to his coming back. the next item that commissioner chow did not summarize in his report is an emergency contract, a short term contract for seven months with the chinese hospital association to provide emergency surge beds in response to the pandemic. the total proposed amount is $9.5 million, including the usual 12% contingency.

again, it's a short term contract for beds if needed to create acute care and icu capacity at san francisco general hospital for potential covid surge. do we have a motion to approve that contract? >> so move. >> i second. >> clerk: thank you. (roll call).

>> president bernal: the next is the hearing on the sutter mission bernal clinic. we have brenda storey and tami chin and claire lindsay here for the presentation. >> good afternoon commissioners. >> president bernal: pardon me. commissioner giraudo. >> commissioner giraudo: yes, i have been advised to recuse myself from this item since i am employed by sutter health and the city attorney has recommended that i not participate in the discussion. i ask for myself to be recused.

>> president bernal: thank you. >> clerk: we will say goodbye to commissioner giraudo through this item and let her know when to rejoin. and if i could clarify, commissioner, and add in, it's not that you're just employed, it's because you're involved in the logistics for this particular issue -- >> commissioner giraudo: yes, the nuances to be accurate is i am a clinical supervisor and i have been in ongoing discussions with mission neighborhood health center and their excellent staff on a seamless transition for

patients. >> sutter bay hospital notified the health commission of their intent to close two clinics on april 1st, 2021, the mission bernal clinic and the pediatric clinic that includes after care. they want to donate the assets of the clinic along side support to mission neighborhood health center for five years. you all received a memo in advance of the hearing that provides more details. for today's presentation, i'm going to be briefly going through and providing a summary of the information provided by sutter and mission neighborhood health center. i want to note that tami chin, the site administrator and senior director for sutter is here and she will be providing brief remarks after the

presentation and after that, you will be hearing brief remarks from brenda storey, executive director and ceo of mission neighborhood's health center. a brief overview of prop q, the voters of san francisco passed proposition q requiring private hospitals in san francisco to provide public notice to the health commission prior to closing a hospital inpatient or outpatient facility or reducing or limiting services they provide or prior to the leasing, selling or transfer of management of a facility. and so, proposition q allows the health commission to make a determination of whether or not the recorded change will or will not have a detrimental impact on healthcare services in the san

francisco community. in recent years as listed on the slide, the health commission has reviewed six proposition q notices. for the focus today, like i said earlier, sutter notified the health commission on december 9th and updated december 10th about closing the clinic, including the after hours care at the pediatric clinic. i want to define the after hours care, it is an appointment only service for children of all ages and operates week night evenings and weekends, so conditions that require immediate medical attention for things that don't require emergency care and i want to note there's an edit that i need to make in the memo, so you all will receive a revised memo. it said the hours were before the pandemic monday through

friday from 5:00 to 10:00 p.m. and saturday and sunday from 8:30 a.m. to 10:00 p.m. but during the pandemic, the hours have changed. now the after hours care are provided monday friday 5:00 to 8:00 p.m. and saturday and sunday 9:00 to 6:00 p.m. sutter is offering to donate the assets and support for five years to mission neighborhood health center. the purpose of the five year operating grant is to cover any of the losses that mission neighborhood may expect to incur as they ramp up the clinics. so sutter is planning to close both clinics on thursday april 1st and mission neighborhood will be reopening them the following monday april 5th. i should note that sutter has recently confirmed they're going to continue to operate the after hours pediatric services from

april 1st through april 5th. the after hour services will not close through the transition. today is the first hearing of this proposition q. the second hearing is scheduled for march 16th. so i'm going to briefly provide information about both of the sutter mission bernal adult clinic and pediatric clinic. first i'm going to look at the adult clinic. formerly known as the saint luke health center is located on mission bernal campus. the clinic offers adult primary care and preventive services for teens and adults and there are eight employees at the adult clinic. i wanted to show the patient mix. the largest proportion have private insurance followed by

medical care, california's public insurance for low income californians. moving on to the pediatric clinic, the mission bernal pediatric clinic also known as the saint luke pediatric clinic is also located on the campus just up stairs from the adult clinic. the clinic serves infants and children of all ages and provides regular check-ups, health assessments and management of eye infection, pulmonary infections or gi conditions and as mentioned earlier, the pediatric clinic has the after hours care, located in the same place and it operates weekday evenings and

weekends and by appointment only. i want to mention that the patients listed on the slide under the pediatric clinic, a significant number of those patients, almost half are patients seen during after hours and weekend care. many of the patients are only seen once, they are referrals from independent physicians across san francisco. so those patients may not go to the pediatric clinic for regular care. a question that was asked earlier before the hearing about weekend utilization of the weekend pediatric clinic, it has varied over time. recent data from sutter shows november and december of 2020, the weekend hours saw approximately 12 patients per weekend. and then finally, the mission bernal clinic has 17 total staff

for the clinic and five are per diem staff and only support after hours services. and this is a chart that shows the pair mix for the pediatric clinic. more than half are medical patients. next i want to briefly mention about mission neighborhood health center. they were established in 1967 to care for families and individuals and focus on immigrant and spanish speaking populations of the mission district and surrounding areas and they currently provide full spectrum primary care and preventive services to approximately 13,000 patients a year. the mission clinic is a partnership of 11 nonprofit health centers throughout san

francisco. and across the three sites, mission neighborhood is currently a medical home for about 5500 patients with medical managed care and these patients access dph specialists. and as such, as other clinics, mission neighborhood is an affiliated partner of the san francisco health network. with the addition of the mission bernal adult and mission bernal pediatric, mission neighborhood expects the add approximately 2600 medical managed clients and for the existing patients of the two clinics who access cpmc for their special or urgent care, they can continue to access the

same services as they do at cpmc if they choose to. it's really about patient choice. as a part of the effort, sutter has connected mission neighborhood with their health plan liaison to make sure they're set up with contracts if they weren't in existence so the patients may continue to seek services as they used to do. similarly another question was raised before the hearing regarding access to pediatric inpatient care and specialty care. for the medical managed patients who choose to be part of mission neighborhood specialists according to our dph leadership we could take on the patients without a concern.

the two have worked very closely to keep it seamless for patients. patients can keep appointments if they choose to. the pediatric clinic is going to remain open throughout the time, sutter will continue to operate it. the short timeline has minimized patient impacts keeping primary care to the patients and the mission neighborhood will continue to offer primary care at both clinics. both parties don't anticipate a gap in services.

they are working on establishing contracts so that mission neighborhood can retain patients that are currently at the clinics. when considering patient impact, i considered the fact that mission neighborhood has decades of experience serving the communitities they serve by the clinics and based on all of the information provided by sutter and mission neighborhood, we do not anticipate there will be a reduction or gap in primary care services due to the transition to mission neighborhood. next i'm going to look at the staff impact or potential staff impact due to the closure. upon sutter's notice of intent to transfer the clinics to mission neighborhood, all

employees were able to apply to remain at the clinics. otherwise sutter stated they would find similar positions for those employees who choose not to stay with mission neighborhood. and they will get positions within the sutter bernal hospital. at the time of preparing the presentation, mission neighborhood is still in the process of finalizing the hiring of the clinics but will be able to provide an update at today's hearing but have confirmed they will be ready and have the support they need for the two clinics to open, including the after hours date on april 5th. just to summarize the prop q presentation, they plan to close on april 1st and donate the assets in connection with an operating grant of support to mission neighborhood health

center that will reopen the same clinics in the same location the following monday april 5th and sutter will keep the after hours pediatric care open throughout that time. mission neighborhood is a close partner of the san francisco health network and key part of our san francisco healthcare community. after consulting with our ambulatory care leadership within dph and based on all of the information in the plan, we don't anticipate a detrimental impact on the community due to the closure and we are supportive of mission neighborhood's growth in san francisco. so today we are recommending that the health commission find that the closures of the mission bernal adult clinic and mission bernal pediatric clinic will not have a detrimental impact on the community and you have been provided with draft resolutions providing that conclusion as well. that concludes my portion of the

presentation. now i'm going to pass it over to tami chin, site administrator for cpmc and senior director of ancillary services for sutter and she will be providing remarks. >> president bernal: thank you. just a reminder to commissioners, this is the first of two hearings on this matter. today is a hearing for discussion and we will be having a vote during our next meeting on march 16th. >> is it okay if i start? >> president bernal: go ahead. >> as claire mentioned, i'm tami chin. and claire thank you for putting together a thorough presentation. i know you and kate worked a while putting that together. we are excited about the transition of our two clinics,

adult and pediatric clinics at mission bernal into mission neighborhood health center. i know you used the word closure and i look at it more as a transition because we've been working really hard to make this transition as seamless as possible for the patients, most importantly but also for our staff. i think the reason for the transition is we really are committed to providing quality affordable healthcare, especially to the communities that we serve and partnering and collaborating aligns well with our goals toward that effort. especially with it having a comprehensive medical center at the existing clinics already. we at cpmc and mission bernal campus will continue to play a

large role in the community in the mission bernal neighborhood area and we'll still be working in providing some supportive services the the patients in the clinics as mentioned. she is part of a program that supports pediatric clinics and those services will continue. as claire mentioned, we have been working closely with mission neighborhood health center for probably a little over a year to ensure really that this transition is as seamless as possible to primarily the patients. all of the providers for both clinics have taken positions with mission neighborhood health centers and that is a strong positive to this transition so that patient care really will

continue as it has been. the clinic will obviously remain in the same location. future appointments. we have scheduled patients with appointments past april 5th of course and we're working to provide information in a data conversion process so it can be uploaded to their electronic health record. our current clinic supervisor for both clinics will be transitioning with the clinic as well and i think a couple of her staff, so they will help with that transition. there are some staff as claire mentioned, that have opted to stay with sutter and we are working with them on the transition gradually now or upon the transition time to other

positions. >> president bernal: thank you dr. chin. >> i think now brenda storey was going to say a few words. >> president bernal: thank you. >> good afternoon health commissioners. i think claire gave you a good overview of mission neighborhood health center. we have been here in the mission district for over 50 years and in the -- the clinics are conveniently located between the two health centers. so we are very excited to increase our footprint and bring the mission bernal pediatric and adult clinics into our family. these clinics are located in

communities we serve and the patients seen at the clinics are part of our community. we plan to offer them our clinically excellent care and competent services and ensuring a seamless transition that will not impact patient care. the six providers that currently provide medical care at the clinics already signed up with us. i think from the patient perspective, they will continue to see their medical provider, they will continue to visit the site they're accustomed to. as a health center, we recognize that the patients on quality assurance and health center quality leader by the health services administration. we welcome the addition of the clinics and i think historically, mission

neighborhood health clinic has been attentive to the needs of the community we serve, whether it was h.i.v. care 30 years ago or needs of the homeless or resource center or the pandemic currently we're experiencing and our efforts of providing covid testing and vaccination efforts. the same passion and service we have provided for all these years is what we will bring to the mission bernal clinics. we're looking forward to expanding and continuing our collaboration with cpmc to the benefits of our patients and community. today i have our chief medical officer with me. our chief operating officer and our deputy director who can support any questions that you may have about the transition. thank you.

>> president bernal: all right. thank you. are we ready for questions from the commissioners? i believe so. >> clerk: public comment first, please. >> president bernal: thank you mark. >> clerk: if you want to make a comment, press star 3 to raise your hand for item 8. all right. we'll unmute you caller. let us know you are there and i'll give you two minutes. >> hello. >> clerk: yes. you have two minutes. >> can you hear me? i'm a professor at hastings college of law and worked with the san francisco for healthcare, housing, jobs and justice for over 10 years. we were a factor in the

agreement reached with cpmc regarding the building of the mission bernal campus and the van ness campus. i just got today actually notice of today's meeting and i do think it has to be looked at in terms of both the background of cpmc and provision of services in san francisco and in terms of the impact on san francisco healthcare services beyond the five year period. our experience with cpmc is that in making its decisions, the revenue consequences are what's most important. and it tends to discard services it regards as revenue burden and not a profitble end of the

service. it is good they are providing the operating subsidy for five years but what happens after that point of time. it is likely that mission neighbor health center, an outstanding operation but not likely to have the kind of resources that cpmc, a much bigger entity has. part of the analysis should consider beyond the five year period. i think much more of analysis has to be done. what i found online was scant and largely conclusionary and for the commission to make a reasonable decision, i think it needs more information. thank you. >> clerk: thank you. caller, please let us know you

are there. >> am i unmuted? >> clerk: you are and you have two minutes. >> i'm dr. theresa palmer. this is an ongoing pattern with cpmc basically bailing out of serving poor people in order to act like a profit-making organization and not meeting the needs of people in their area of town that really need help. while calling themselves the center of excellence. i think this is really bad and they should -- if they're going to switch the pediatrics care to mission neighborhood health clinic, they should fund it in perpetuity. thank you. >> clerk: thank you dr. palmer. those are all the hands i see commissioners.

>> president bernal: thank you. we'll move on to commissioner comments or questions. commissioner christian. >> commissioner christian: thank you president bernal and thank you for the presentation. i'm new to the commission so probably a lot of this is helpful to me as initial information. i'm wondering -- it didn't seem under prop q, an organization like cpmc is required to discuss why they are seeking to close services or reduce their footprint in the community to serve people who can't really necessarily afford the private insurance. if that's the way to describe it. so, i wondered about that. if there's any information about

why cpmc is -- sutter is making the move right now. and i did wonder about the five years of support and what impact that's going to have after the five years is over, what impact it's going to have on potentially the city picking up the cost of it and the level of -- whether the level of care will change and whether why five years was chosen as the amount of time for resources to continue. if you could just educate me about the points i would appreciate it. >> this is claire lindsay from dph. i think i would like to ask tami from sutter to respond to the question or i would defer to sutter to respond to the

question about this. and then i did have discussion with brenda about the five year operating grant and how mission neighborhood health center plans to continue to efficiently operate the clinics post five years so brenda can respond further to that or i would defer to brenda to respond to the post five year plan. i'm emily webb and vice president of external for sutter in the area. i appreciate the opportunity to answer it today. on the first question of why we have decided to do this now, you know, sutter has had these clinics for a number of years and they're sort of anomaly for

a hospital to be running a primary care clinic. running primary care clinics is not what cpmc does. there's a good reason for the clinics to exist in this community, it was a much different time in san francisco. and so really what we wanted to do here is determine the best partner to provide the best care to the patients that we had currently been serving and that is certainly mission neighborhood. you have heard that throughout this presentation. so really what we're looking to do here is align healthcare providers that excel in each subset in the continuity of care continuum. so we have been in discussion with mission neighborhood and they are -- they have a long standing track record of providing excellent care in the community. so they will be on site at our

mission bernal campus continuing to provide that care to these patients and they have a lot of enhanced services actually that we have not been providing through the clinics today that our patients -- our shared patients will then have access to. and we will continue to provide the specialty in hospital services that we excel at. it's really a bringing together excellent partners on one campus, so they will be the same clinic and same providers. on the operational support, i'll allow brenda to speak to that, but we worked with mission neighborhood on financial model based on the revenue they get as a federally qualified health center and we feel confident after five years the clinic will be in a sustainable.

it wasn't to leave mission neighborhood or the clinics in a gap situation, that was actually the time frame that we determined was needed to get the clinics to a sustainable place under the model. >> thank you emily. this is brenda commissioners. you know, one of the things when we began to consider taking the mission bernal clinics, i think it was key to do due diligence to ensure financially it wouldn't impact our current services. we spent a lot of time doing that. we work with a consultant who did a financial performance for us to ensure that if we took this responsibility, we were going to be able to sustain the

clinics over the decades and, you know, as some of you know, as a federally qualified health center, we get a specific payment that is more favorable than for other providers. an additional thing we get as a federally qualified health center is malpractice insurance through the federal government, so that is a big cost that many clinics incur and it is a savings for us. we were very careful in terms of really looking at what was the kind of support we needed from cpmc and for what period of time to ensure that we were financially on a good foot moving forward with these clinics. i think the evidence of our success is really in our history of being able to maintain this clinic and the mission for 50

years and actually the other clinic, we acquired the clinic 20 years ago from ucsf. so, you know, we welcome more specific questions you may have regarding the financial performance as needed. >> commissioner christian: thank you for the answers and it is clear that mission neighborhood health centers provide excellent care and are in a good position to take it on. i do though wonder about private entities almost separating themselves from services made available to people in the community as a whole. again, i'm new to the commission, so perhaps this is part of my learning curve, but

it does seem over the recent years, we've lost psychiatric beds for instance, new hospitals and campuses open up and not provide -- not contribute to the beds that are necessary for the community that they had in the past or perhaps the way many people believe they should. so that is an overall question and concern that may or may not have direct bearings here given that the mission neighborhood health centers are available to take this on. but i think it would be useful to learn more about the financial model before we have to vote at the next meeting. thank you all. >> president bernal: thank you commissioner christian. commission guillermo. >> commissioner guillermo: yes, thank you and thank you all for your presentation. as somebody who worked at a community health center for

eight years in the east bay at the beginning of my public health community health career, i am a proponent of the community health center model and its ability to provide. in my opinion, some of the best care to the most vulnerable populations and stick with it against many odds and against many of the changing financial models and otherwise that have made it difficult to improve the healthcare to focus on improving the health status of the most vulnerable populations. i'm sorry, there's somebody on the phone -- should i keep

talking? >> clerk: i'm trying to find and mute them commissioner. sorry, i apologize. >> commissioner guillermo: particularly when it comes to primary care. i think the provision of primary care at the community level is something that has proven over the decades to be something that community health centers excel at over and above acute care systems in many instances. one of the questions i did have though with regard to this particular transition between sutter health and mission neighborhood has to do with the high proportion of private pay or privately insured patients that will potentially be

transferring over to mission neighborhood health center. given that community health centers primarily provide care to the uninsured or those with government insurance, the contracts that then will have to be negotiated between the payers for those patients is something i would have a question about in terms of mission neighborhood's ability to get the best rates for those particular contracts and i'm wondering whether sutter is going to facilitate that to the advantage of mission neighborhood health center if those patients decide that's where they want to transition their care over rather than find another setting in which they're

going to achieve their health services. and then one other question i had was given there was an inability to gather race ethnicity data by sutter, at least as shown by the data in the presentation, will mission neighborhood health center be able to then determine and collect that data so that as part of the san francisco health network, we'll really be able to define or determine the best background of the patients to have the data. and then one other request, if possible, for information, i know there are other models of this type of transition from a health system to community health centers with regard to

primary care, public health and return to care and in particularly pediatric behavioral health issues. i'm wondering if we can get information about the things that have made those transition models either successful or unsuccessful to provide us with context prior to the vote we need to take in a couple of weeks. >> claire lindsay, department of public health. for those questions and i hope it's appropriate for me to do this. i'm going to defer to sutter and mission neighborhood to discuss the coordination they've had together. i spoke briefly about it in the presentation, but the coordination they've had in setting up mission neighborhood with the contracts to retain the

privately insured patients in the clinic should they choose to continue. i will defer to sutter and mission neighborhood i gathered that information from the california from the state's data system and confirmed it through sutter and the only reason i didn't bring it up is because approximately 40% of patients that were seen at the mission bernal adult and pediatric clinics had missing or unknown race and ethnicity data through the state's data systems. i can go back before the next hearing and work with sutter to see if there's more complete

information we can provide for that. similar to your other models regarding transition, we can look into that and provide that for the next hearing. >> commissioner guillermo: and is that data particularly ethnicity data, i think because it was a significant proportion of data missing, i think it would be important to know demographically what the population is that is transitioning over from sutter to mission neighborhood. >> this is tami. i will begin to answer the question about the care.

i think basically everything that was a non government. if you look at it -- i just wanted to make that -- one of the things we did up front and this is part of our planning conversations with mission neighborhood is we did connect to begin working with and providing that we were working with and have them connect with the health plans. it's an ongoing process as you can imagine. i know they're continue together work with them to reach out and try to look at setting up the health plan that they may not already contract with.

>> i can add that we have a tremendous amount of work going on right now to establish contracts with the commercial payers. and we have a couple of very experienced negotiators when it comes to fee schedules in our discussions with the various health plans. so i feel very confident that we're going to be in a good position and our financial projections do account for what we believe will be the average rates of reimbursement from the private health plans. >> thank you. and it would be good to have an update on those negotiations then at the next meeting.

thank you. >> president bernal: thank you commissioner guillermo. commissioner chow. >> commissioner chow: yes, i wanted to thank staff for the presentation. their conclusions and many of the questions have actually been asked by my fellow commissioners. i think that it would be important also to see if there was any -- because of the large number of private insurance that really is here, that we understand that block a little more. from what i understand from dr. chin, this is just sort of putting everybody else who was in insurance. it could be that we need to better understand that and better understand the ethnicity of the private insurance to be sure that the goal of the bernal

hospital -- i'm used to calling it saint luke's -- is actually a community-based focus. when -- do we call it, i guess the agreement. that's it. the agreement was made in terms of building the van ness avenue, it was that the bernal -- the saint luke's campus would be maintained because it was a community asset. the part of cpmc not doing

community service because they are a hospital system, is not the understanding we had when we did the development agreement. however, the working relationship that you have established with mission neighborhood i think is very commendable. but i would like to also along with commissioner christian, agree i think we need to understand the finances better and that if in fact, for example, the five year projection wasn't working, is there something that could be put into the agreement that would say that sutter would continue to work with mission neighborhood to be able to sustain the service until it became self sufficient. that i think would go a long way to help us understand that while you are transitioning from doing clinics in the neighborhood, that you really sincerely meant

to help and make sure it was a service still available to the neighborhood. i think i would like to have us understand how sutter would go beyond maybe the five years, would like to have an understanding also that is a contract that sutter says you can stay in this site for an indefinite period of time because it sounds like maybe it's a five year lease, i don't know. i think we would like to see that even if it transitions to a well respected organization, that it retains the ability to serve this community and serve it in the sense that it would have been if it was under the saint luke's program and as a community service in that sutter

has found a partner in which it is connecting with. are those relationships with sutter and the use of cpmc also in the contracts that say that will continue for the patients and i think those questions we need to get answered by our next meeting so we can take comfort even though you are transitioning to a different provider, you are still committed as sutter to develop and support community programs for the community. that is something i would look forward to in the next hearing. >> thank you commissioner chow.

>> president bernal: thank you commissioner chow. commissioner green. >> commissioner green: first, thank you for the detailed work you have done here and i'm pleased to see what i believe to be improved collaboration in the area between the community and sutter. i have three questions i hope will help clarify some of the other things commissioners have asked. the first is, from my knowledge, a lot of people who simply live in the bernal heights area used the after hours clinic. and this may constitute a large proportion of the individuals who are privately insured or in your other insurance bucket and i wonder if you could look at it as that a large proportion of the individuals will go to the van ness campus because they're using the mission bernal campus.

as the covid testing winds down, do you have any way of parsing out those unlikely to go to mission neighborhood health center and just using the mission bernal out of convenience especially if it's going to be looking at third party payers and the contracts are. the second thing is, i wonder if you can in fact project and this may have been part of your analysis already, you have a pretty decent population of individuals who are managed medicaid now and they do have a different compensation plans for medicaid than would a private office. i'm wondering if you can give us comfort and reassurance based on the profile you may already have with the individuals you expect to accept as of now is breaking even and sustainable and barring

any change with the way medicaid is compensated, you can give us reassurance that five years from now it will be sustainable and maybe the funding won't be necessary. if there's any information you can give us and my third question involves hospitalization. for the population likely to go to mission neighborhood health center, van ness is not convenient for families if they have children in the hospital. so i'm wondering if you have thoughts about how likely it is that the focus for hospitalization for care will be the general hospital rather than the sutter hospital and then i believe you have excellent relations with the general. and wondered just if you had any insight into that. obviously i don't need an answer now, i was just wondering those things to help round out this

picture. >> president bernal: would any of the presenters like to respond? >> i can take that. thank you commissioner green. we'll definitely work with dph staff on some of the pieces you brought up. we did look at some of the questions you contemplated and that's why we ended up with what we ended up with. we -- neither party is interested in having the clinics close after five years. of course cpmc is supporting this to be a sustainable transition. i would say that is the expressed goal. and it does take into account some of the sensitivity analysis as you mentioned around the

medicaid pieces. to your question about hospitalizations, the way i would answer that, there's really no change for the patients in where they're getting specialty in hospital care today, if they need to go to van ness today, they're going to van ness today. what our goal was to make sure that we provided continuity on the specialty and hospital side. while we're making the shift on the primary care side with mission neighborhood, the issues that you brought up will not be different for these patients post transition. >> i'm from the neighborhood health center, in regards to dr. green's questions regarding pediatric services and care, yes, you're right, a lot of them come for the evening and after hours and on the weekends. it's going to be the same staff and same insurances. to the people who visit the

clinic, we anticipate they would continue the services there. in the after hours clinic and on the weekends. in terms of hospital care, usually we ask the patient and their insurance if it's a hospitalization inpatient or outpatient in a clinic. when a patient is sick and they choose to go anywhere, they can go to any emergency room they want basically and get served by that. but we still have a relationship with cpmc and they could be admitted there. >> commissioner green: thank you. >> president bernal: all right. any other questions or comments? if not, i would just like to add to others who raised the question about both the five

year financial agreement and understanding the donation of all of the equipment and other things, but what does happen to the physical clinical space after the five years and what would be the arrangements for the clinic to remain in the same space. something addressed today or at the next hearing. >> this is tami. we have -- working with mission neighborhood coming up with the proposed lease agreement. initially it is five years, after which of course it would be available and open to renew if sutter would want to. >> president bernal: thank you to our presenters and we'll see you again at the next meeting for the second hearing.

next item for discussion. dr. ayanna bennett director of the office of health deputy with the racial equity plan update. dr. bennett. >> clerk: i have given you permission to share dr. bennett. i know it's a little late. i apologize. >> that's okay. i'm getting to it. okay. hello. i'm -- there we go. good evening everybody. thank you commissioners for bringing this issue back to be discussed again. we're going to develop a regular sense of how we're going along and what we should do in the updates but for now, i'm going to do my best to give you a sense of what we're doing right now and you can let me know in

the questions or afterwards how you might want the regular updates to look. so this is an update specifically about our racial equity action plan. i am going to include a little bit of the broader sense of the office of health equity because the racial equity action plan has a definitive focus on work force. you had seen a draft version and then we were given 30 days extension and so a much more graphically attractive version was created that you now have and some of the timeline was tweaked in the version. this is where the office of health equity sits within the executive staff. i'm trying to give a little bit better sense of the entirety of what the office does and i think

it sometimes gets lost when we're talking about one particular item. i just want to quickly go over it. a lot of work has happened in the past two years that you heard about was strictly capacity building. a lot of training and definitive role, work groups, teams or councils and then collective impact. so inclusion in groups that we're doing things in the community or partnerships with other department areas. we're always going to be working on service quality. health disparities, community engagement, anything that touches the public, how are we doing that equitably. and equity culture here in the way people treat each other and the way we think about service and data and all of our other normal activities. that's where i put work force policy, it is meant to make it a

place that equity feels it is happening, including for staff and the last is accountability, tracking what is happening, planning, data reporting. the ones i have put in blue and highlighted are things we're concentrating on more this year and some of them are in the racial equity plan but not all. so this is a very quick look back at something i showed you before, which is that the last year's goals, actually the 2019-20 goals we had, some were deferred or changed because of resources related to covid. much of the staff was deployed. but we did in the end get a lot of it done. and some of those things will show up again this year.

many things in terms of our things have been done and things put in place. i put deferred on leadership training because we have a curriculum, we had a contractor, we had the first meeting of our leadership training series and then covid hit and it has been deferred. we will be bringing that back as soon as we can this year.

everybody has designated who is going and participated in development. it is ready just not ready to launch right this moment. the same with the equity leads. lots of them were in place, many got created in the interim over the last few months of covid. there is a lead at primary care. i'm saying it early because they just designated the person and i'm not sure it's going to stay that person as stably as other areas but they are making progress. the same for all of the other areas. the equity champions program continued throughout the year. the champions got orientation and training and were on their own to keep projects going and they have done that. not as robustly as people were deployed but they have done it. we have patient clinic service goals in place in the a-3 and

most of them got some if not all of the work done. we have work force goals, a little less active but partly because so much went into the racial equity action plan work force. a reminder these are the categories. hiring recruitment, retention and promotion. discipline, leadership, professional development, culture and then you all have a set of activities also. these are the things pulled from the racial equity action plan that we designated to happen this year. there are many, many more activities that happen over the three year period and there are some that happen in year one that have either collapsed into one activity or things we have already done or think are simple to check off. so i haven't included those. in hiring and recruitment, we are right now a lot of it is

baseline stuff that will be helpful next year, like assessing where the problems are, tracking systems to tell where applicants are and have data about that. but for the most part, right now the effort is going into making equitable hiring policy to standardize across the department. that is in late draft form and we expect we will start to implement that. it is being piloted in primary care right now. they nicely reached out saying they felt like all of the -- they had a strangely largely number of medical director positions open at once and felt it was an opportunity to make progress on equity in that level of leadership they haven't been able to do before. they should start hiring around the positions soon using it.

needing to do more analysis for where we have poor diversity. we know based on the numbers but where do we have the opportunities to impact it. there are not positions opening every where. we know we have some areas we can actually make progress in immediately because we have been working on that for the last couple of years in one way or another. discipline and separation. we of course have had over the past year or two a great increase in data around how discipline and separation are racially mediated for the most part in our departments. they do have some activities happening at dhr around the issues but we are starting at

the level of the managers and it's going to be a significant amount of manager training going into this. and that's combined with standardizing some of the activities around discipline. the manager s are going to be trained to use the system being developed for how they discipline and how they feel about the probation period. the leadership training is the racial equity health equity fellowship we had in place early last year. we still have the curriculum and we're going to make a companion series that is really about managing for equity. that's more about referralble skills that could work in any place and the health equity training is going to be specifically the ways we look at health data and ways we talk about clients or patients, specific to healthcare.

mobility and professional development is in its early stage. we're developing some performance evaluations. i don't put those as active right now. the organizational culture, the -- the respect for work place policy you saw about a year ago was meant to start implementation in the spring or early summer. that was of course deferred. we backed off on the way we were going to implement it. now that we have the director of work force equity programs, we have a more robust system of looking at talking about complaints and how we may look at individual complaints and do

screening or auditing that i think will be more effective changing with culture and not just dealing with a few items. the last bit is very long. that's because the other areas are dependent on staff and services that are quite stretched at this moment. and also because what happens through them is supposed to be monitored and overseen and understood by you. so i want to be sure that we have gotten some of the things that you need done even before those other things come into play so they can be coming to you prepared to deal with the issues. like looking at the bilaws and hearing from the community. some of that is already very clear how we will go about it and it will happen at some point during the year. the ones i'm concentrating on

right now and you'll hear about today, the demographic report has been done. the resolution on racial equity. you already did that in advance of this requirement even coming up. the plan put in place for how to follow it, we need to remarshal around because we were not in a place to really do that planning when it was done because i was gone and many people were gone. now that we have reconstituted a bit, i will be talking about how to monitor the plan with the racial equity action plan. the resolution honoring the land acknowledgement that we're going to extend to be a declaration of intent for inclusion and health equity for that group. that has already been started and written. your very efficient secretary has written a draft and that is something you'll look at going

forward. adopting a racial equity assessment tool. we did an initial talk in committee but i'm going to come back with an example. i was going to make a mock example but then in talking with staff, they do have some things they really want to try this out on. we're going to use a real example for food scaresty work we're doing. monitoring of the implementation of the equity action plan we are doing right now. and we're going to be doing over the next year. the land acknowledgement, the way it is phrased in the racial equity action plan is that commission will pass a resolution, the land acknowledgement and we have added the indigenous inclusion statement. so that is a statement of

commitment and a statement of acknowledgement that will be read before your meetings and read at dph public events and meetings. we have thousands of internal staff meetings we won't necessarily do with that, but we are interacting with the public in many, many ways and when we do that, we want to be sure we take this step along with you. the racial equity assessment tools, there's a brief that i'll send around when we're ready to talk about this more. it is essentially a set of questions that can be quite detailed. we have made a form out of them and it is multi pages long but it should identify clear goals and planning for the implementation of something that is meant to increase equity. those are all things our staff know how to do. looking at making something more concrete and getting measurable outcomes, that's essentially the

skills that we have been developing for years. what i think is added and we need training around is that it is meant to be done very early in the process, so that you shape programming to proactively eliminate racial inequities. some of the time you're going to try to just not worsen them but it is not always a thought in the program of what the longer term broader impact is. that's something people have to learn how to do. the engagement in the community in the decision making process and not just telling them what we decided to do, that's a different approach than sometimes we have taken in the past and identifying who is going to benefit, predicting what is going to happen. who do we think is going to benefit, who will be burdened. who is going to use the service. thinking into the future and not just about the service we want to give but the impact the service is going to have on

people more broadly. we're going to develop the trainings and i'm going to use the example we're using to help you understand the tool in the next maybe two months. i'm hoping you start to see this slowly be entered into the presentations you see toward the end of this fiscal year every summer. we won't get every presentation every meeting but my hope is by the end of the year it will be somewhat routine and you can expect it with everything you see. the timeline for the adoption that i just told you about, we're going to deliver the trainings between may and june. we will start so people use it in july. i want to make the point in order to be talking about it in july, people are going to have to do community engagement and analysis as early as may and june. it is not something people can

figure out how to do at the last minute. it's change that will have to have quite a bit of intention around it and slow to come on. i'm hoping by october we will have done enough of them that we can talk in the november meeting about the data we have seen and how that support continues, what impact you feel it has had. monitor the implementation of the racial action equity plan. we'll meet again in may and i hope i can fold into that some updates on what is happening with the racial equity resolution you had already done and then some of the other projects that really have inequity focus, like incarceration or any of the

other things that all really are moving in the same direction. i'll see how much we're able to do that in the time frames we're given. and the last thing, by december, we should be getting ready to publish our racial equity action plan report -- not publish it. that doesn't happen until maybe march of the next year but you should hear end of the year report, that's the end of the plan you heard about in february and hear where we were on all of those. so i'm expecting that will be more like a report card by that time and we'll preview that november 12th but by the end of the year you have a sense of what got done and what will be continued into the next year. that is all i have for today. i'm ready for any questions you may have. >> president bernal: thank you dr. bennett for your presentation.

commissioners do we have any questions or comments for dr. bennett? commissioner chow. >> commissioner chow: i'm wondering if you wanted to take public testimony first? >> president bernal: yes, thank you. >> clerk: there's no one on the line but thank you commissioner chow. >> commissioner chow: thank you. and thank you for this extensive overview of the office and i particularly am focused on at the moment, the discussion about your third slide and i understand that as you presented a great piece of information here about the work force policy and how to work on that, i'm actually quite curious about how we will be looking at health disparities under your service quality. and as i heard you talk about the racial equity assessment

tool, it sounded like that was going to evaluate which programs we currently have rather than i'm not hearing that we would be actually doing something to find out what programs we need. obviously today's presentation was an internal work force one, so i'm looking forward to understanding the health disparities. i have spoken before and wanted to remind us there is no such thing as asian disparity, but especially within the asian american population as it is called, each of the different major groups even have had different disparities that really would need to be

addressed. so i wasn't quite sure -- is that kind of a second year program or is it being done concurrently now or how will we look -- for example, i mentioned this for many years, we have the highest tuberculosis rate in the nation. we get very little support to trying to reduce it beyond what we currently have. it doesn't mean we're not doing the right level but it would seem to me it would be an example, another one might be diabetes or -- be it as it may, i was impressed over the past several years how well the african american health initiative has worked and i'm wondering if it is a model to be applied to different

populations, native american, pacific islanders have a great deal, large latino population. what was your intent on and when would we hear about service quality health disparities. >> so i will frame that the monitoring in the racial equity action plan you were meant to do doesn't mean every time i come, is the racial equity plan. i'm happy to adjust over time but i wanted to be sure we understood the structure. we have been working on service quality the entire time. it will be concurrent and not really referred to in the racial equity action plan per se. they are thinking that as phase 2 and starting to discuss metrics. we'll hear about that this year. service quality embedded in our

quality improvement work, what we're trying to do is generate a real cultural understanding that when we're talking about quality, we have not achieved quality unless we have achieved equity. so this aggregating data routinely looking at using the racial equity assessment tool really is going to impact service quality much more than it is simple of the work force things that we are talking about. those are the things we do more. the example is going to be a proposed change in our food insecurity work. so it's niche programming working with a partner in the community, that's the kind of thing that could have before it is formulated, a community engagement component and that should be telling us what the community needs and then the program should respond to that.

rather than making completely different programs but try to make our program development involving asking what the community what they need and looking at the data for disparities. when we go over the assessment, it will be clearer that it should include those things. but what is the disparity you are finding, how did you engage with community that will be impacted. what kinds of needs did they express. it is more comprehensive than that. on your other -- every area in the a-3 is meant to have at least one health disparity measure and most of them have more than that.

we need better focus on some of the groups. the way i did the black health report, in particular the smaller communities who almost never get their health data. they're unstable in the gaps we use. we use three years and the community is too small for three years to work but they can get

stable data, five or seven years. look at getting some of the community data who haven't had any is really important. native american and pacific islanders, i'm hoping to get at least one done this year. latinx and asian populations both need to be looked at in the same way. but it's really about breaking the sections down into immigrant, not immigrant. all the ways you actually have disparities attached to groups. that is much easier once we have the more detailed race ethnicity data which we didn't really have before. our data in the clinics and hospitals, we're now mostly done in getting that data inputted

for patients but that has taken a couple of years where we had to train to get staff to not guess, did not just put what they think. to actually put country of origin and ethnicity. that granular data to allow us to get information based on the small groups, it has been there until recently. now is the time when we can start to give better community data, once we have the data, that is the disparity problem statement. that tells us which things we can go after and hopefully we will have developed better community processes to include those requirements, requests, needs, recommendations in that

process. >> commissioner chow: i appreciate it. i think you have a good understanding of the problem, when you have to go by ethnicity and immigrant status and sometimes disparities are not seen because it's merged together. >> and some gender and sexual orientation disparities need to be worked on. we started the data initiative after the state's request around reporting that data. didn't start all that long ago. so getting everybody's data

inputted so we can have something to aggregate. we're only sort of reaching that point and i think it got significantly disrupted by covid because it wasn't as engrained as getting the racial equity -- i mean the racial ethnicity and language data was for staff. they had done it about a year, not that long into epic. i think we need to reengage on that. >> president bernal: thank you. commissioner green. >> commissioner green: i wanted to commend you.

that long form racial equity action plan is exceptional and even more remarkable having been developed in the time of covid-19. i don't know how you did it. and as i look at this, i see so many best practices that can be used nationally. the comprehensive analysis, the timelines, i feel so confident the data you'll generate will really yield actionable items and cultural change. i certainly look forward to learning and to understanding and i think the way it is structured couldn't be improved. i just wanted to express immense gratitude and compliment you for that report. i don't know how you found the time and your team found the time to do that. i think it's 113 pages well documented. it's remarkable. >> a lot of people have been

doing it. we got it done. >> commissioner green: it's just incredible. i'm looking forward to see how it evolves over time. thank you so much. >> i just want to respond to that, thank you very much and also we can put it down on paper but there's a lot there to track. the struggle is going to be pacing things out so we can actually pay enough attention to make things happen in some kind of quality way. and then there's a lot of interest from staff long overdue interest in having many of the things corrected. but at the same time, all of the theories about what needs to happen, there are a lot of competing guesses and in order to be able to tell that we're doing the right thing, we're going to have to do those things with some rigor of having data to track, but developing the systems takes time. it doesn't -- we're not

immediately fixing bad management practices tomorrow because i want to know what are they now, how will i know they're different, what kinds of things do i need to put in place in order to tell. >> commissioner green: you have a great start and the document is incredible.

>> thank you. >> president bernal: thank you commissioner green. i want to echo the sentiment for the excellent work you and your team have done. particularly appreciate the comprehensive set of focus areas and objective for commission development and leadership as well. we're working hard to put in place the tools and great work of our commission secretary as well passing resolutions but as a commission we are looking forward to being in a time where we can engage with the community in a meaningful way, to be able to go out and have our meetings in the community as we have certainly committed to doing. it has been difficult to feel this distance from the communities that are so impacted by the work of the department. we look forward to your continued guidance and leadership as we move forward with that and merge into a time we can engage more meaningfully and fully. >> i look forward to that too. i hope when you listen to community, what they're saying is somebody listened to us

already. sometimes we get this pint up explosion that no one talked to me and i'm hoping we develop better practices across the board so you're hearing about how the department is doing and not just being an ear because people feel they're not being listened to. the community engagement arm is one we haven't spent as much time on. wanting to get care better and deal with work force issues. this is the year and that's a good marriage of your goal and the goal we need for the whole department. >> president bernal: it's our responsibility to listen. thank you. commissioner guillermo. >> commissioner guillermo: i wanted to add my thanks and congratulations to you dr. bennett and to the staff for what you have delivered to us today. and for listening to us over the

course of the last couple of years now i think in putting the plan together. it's an example to me of the thoughtfulness i think as you said, the rigor and really the seriousness you have taken this on. i also want to commend you on making sure that we are going to evaluate this or provide insight on this with realistic expectations on a timeline and on a process because as you said, people are anxious for some action and they want to see things done and often times when that happens, you don't get something that can stick or that actually is going to be adopted across the board.

in order to do this right, we want to be able to do this and not have to do it on zoom, not have to do it at a distance so if we are able to do this, the timeline may end up being extended depending on what happens over the course of the year. and not just for the department being able to do this, but for communities to able to gather themselves, respond to the outreach, really gather within community the kind of information or consensus that

they might -- agreement they might be able to reach in terms of responding to the kind of engagement that the department and your office is going to put out there in terms of getting at some of the real questions, strategic things and then explaining the importance of the data that folks are going to need to work with to understand to do their own assessment around in order to be able to engage appropriately. and then to speak to that data when you spoke about the small population size, i know that is really difficult in terms of being able to have confidence that a small sample size is going to provide you with the confidence around the kinds of research that you're going to

have and i know there are researchers, community based researchers that do excel in developing small sample size particularly for communities of color and people with language issues. i think that would be helpful to the department and to the office and to the process if we could engage them or follow along with the kinds of survey research tools or data gathering tools they use. i think dr. chow and i in particular because of the asian american populations is a population we have worked with overtime have some experience with some of the expertise involved in doing that. and lastly, in doing that, being able to put it in context of,

and i think i have spoken of this before, putting it in the context of the larger public health environment that we're in with regard to the state of california or the counties we engage with because we are in a geographic area with a lot of mobility and movement. we are a center within a larger -- very dynamic environment health wise. >> we have been doing our equity work as a region for -- since the beginning when the health

department combined with almeda and a few others to create the bay area health inequities initiative, that organization has served as a convener. right now they do a weekly call on vaccine statements and who is doing what and share ideas over what we're doing now but that collaboration has been useful. for example, the pacific islander task force was in agreement between three health departments and accepting the reality of people's communities across the bay. we are continuing with that work and going to continue and try to figure out how to do that around other communities. i don't have a great intro in what we need in the native american community but we have done that to some degree with

african american folks and on regional calls. we're moving that forward because we do need to be a region. and partly because it is new. we're all trying to figure out what to do, so you have to have thought partners. we're trying to use each other for that. in terms of what we can do with community this year, we are engaging quite a lot because of covid. when you hear about the food security issue, in order for people to shelter in place and survive job loss and all the things that have happened, food security has become very important and we have been able to get information about something, it's not about all of their needs but we have a way to start moving forward on the issue. the other thing i'll say, we really need to get more broad about our tools. i think you're right, we did an

ethnic program in the african american community in bayview talking about we want to change heart health but they have to come and actually engage with us. why are they not? so people were followed from the visits and did other ways of getting maybe feedback from community. but we need more shallow feedback. we have feedback from a focus group but who can come to that. a certain number of people can come to a meeting no matter when we have it. i just had my first meeting today with around trying to jointly get behind a project we have been trying to do for a few years and started it around a text base kind of continual survey instrument where people can sign up and be ambassadors and spokespeople for the community and ask them what we should be doing and we don't

reach everybody. there are whole groups of people in whole areas where we don't have as much in and we don't have as much ability to tell us what they want. i want to have different techniques to get to community and have the ones that work for that community be available. it will be different across the board. i think i got them all. >> commissioner guillermo: thank you. again, just to speak to your thoughtfulness of the area. thank you so much. >> president bernal: thank you commissioner guillermo. commissioner christian. >> commissioner christian: thank you president bernal. dr. bennett, this is astounding. i just want to thank you and same thing that my colleagues have said already for this deeply serious and impressive structural guide that i think it's going to really make it

possible for us to start making some structural change at the community level which has been the elusive thing, how do you do it, how do you attack these structures. really looking forward to it. and especially this great guide for the boards and commissions. as a new commissioner, i look forward to continuing my orientations perhaps in this construct as well. and with regard to the kind of disaggregating asian american population and being able to start talking about the individual communities and people, i know it's going to be -- i understand what you're saying about the data and lack of data. it's going to be maybe a year or two. but i think it will be helpful and important along the way beginning now for all of the

presentations we have to acknowledge that absence and to talk about it. i remember when i asked about native american members with regard to covid and what was going on and the answer was, the size is so small, we haven't been able to figure out how to touch it. but they started to show up in the reports. even if it was like, we don't have any information. and so i think it's really important for that building of the structure to be visible as we go along so we don't continue to get reports that say asian and we all know or if we recall what you have said, why that is. but perhaps somebody who is come together the committee for the first time won't and then we have this document that is our meetings that doesn't speak about the complexity of our

community, so i think that would be helpful. but i do want to thank you so much for this. we don't want to do the three year and have the one year next to each other. we have to get in the habit of seeing them in two different places. they have two time scales, this one is regional and this is just san francisco instead of not doing the data if it doesn't fall an the page we want. doing the data however we need

to do it to let people interpret the difference. we're not there yet. but we do need an argument for setting best practices. i will say a lot of what is in the racial equity action plan was put in place by the office of racial equity and human rights commission, so a lot of the format of that had to go through how are we going to do these things and added some things. the framework and all the different departments doing it at the same time, i think really just fundamentally changes the work and allows us to do things that we couldn't do before and maybe have a bigger impact. so we have been talking about data standards for years. it's a much different thing to talk about that for the city than to talk about it just for the health data. we're going to pull out pacific islanders. well, it would be better if nobody did it that way.

so i think we have a chance. it may slow things down in some places but i think it's going to have the structural impact that you were talking about, which is really harder to get. >> commissioner christian: that makes a lot of sense, even just a foot note or text at the bottom, explaining where we are and why we are here and where we're going would be helpful. thank you. >> president bernal: thank you commissioner christian. commissioners, any other questions or comments for dr. bennett? all right. i'm not seeing any. thank you dr. bennett for your time tonight and for your excellent presentation. we look forward to seeing you back soon. >> my son didn't interrupt for three solid hours. this is a day in america you should buy a lottery ticket.

we're going to go have some special tonight because it is a miracle. thank you for having me. >> president bernal: all right. moving on to the next item. which is other business. is there any other business? >> i'm going to make this brief. the hour is late. i wanted to with commissioner chow requested information and a little update on the san francisco general hospital fund-raiser for february 11th. i did attend, it was free. it was virtual. it was attended by over 1200 households. it was all done in an hour with wonderful music for those who

wanted to stay afterwards. and the event raised more than $1.6 million. and its focus was honoring three health equity programs at the medical center. it was an excellent program. it was the different board members worked very hard to put this together since it was a brand new concept where it was wonderful they raised so much money. so that's what i wanted to

report. >> clerk: press star 3 for item 10. no hands commissioner. >> president bernal: thank you mark. any comments or questions from the commission? seeing none -- commissioner giraudo, i also attended virtually and was happy to see and impressed to see the excellent work of the sfgh in the community and our excellent people showcased. it was a great event. thank you for sharing that with us. next item. joint conference committee and other committee reports. we'll have a brief summary of the february 26th jcc meeting. >> commissioner chow: i thank

commissioner giraudo. the hearts program was presented and i felt that it was so impressive and that it would be good for the commission to have heard how successful it really was. i think it shows the dedication of san francisco towards our hospital. at the february 23rd meeting we did review the standard reports which always include regulatory report and by the way, we were expecting a joint commission survey almost any day now. they have notified us we're on their list now for a visit. so, i know that our joint conference members are prepared to participate if we're needed in order to assist with the survey. we also did discuss psychiatric referrals and the fact that there's a limited capacity in

that currently almost all entree into our psych unit is by way of emergency room. and they're working to see how we're going to then in the future handle community referrals that are really needed. at the same time, we then also discussed the employees engagement survey. and learned that the satisfaction levels and the work that the department is doing at the hospital try to improve morale and of great note was communications has been much improved between the staff and outreach is continuing to be underway in that regard. during the medical staff report, we did approve the nurse

practitioner position assistance at mercy department and clinical decision unit standardized procedures in addition to reviewing a revised medical malpractice review form we'll bring more uniformed information. in the closed section we approved the report and minutes report. that ends my report. if any fellow commissioners wanted to add to it, that would be most appropriate. >> president bernal: thank you commissioner chow. mark, do we have public comment? >> clerk: no one left on the line, sir. >> president bernal: thank you mark. commissioners, any comments or questions on the jcc report from commissioner chow? all right. seeing no comments or questions. the next item is a closed session regard to litigation.

we'll need a motion to enter closed session. >> so moved. >> second. >> clerk: (roll call). >> president bernal: assuming there's nobody on the line for public comment. >> clerk: there's not but this is a great time to say thank you to anyone who doesn't belong in the closed session. looks like everyone does belong. sfgov folks we're going to move you over to attendee and we'll be