it began to become much more broad to include small stocks, international stocks, emerging markets. and that and energy has been doing well and continued through the end of february. in addition to all that, we have also had a strong recovery and private credit which was up 2.38% for the month, particularly strong return for a single month for a credit book. the one part of the lag is in terms of recovery of real assets. we expected that. i expect there will be better news ahead. and as travel returning more to normal. hotel bookings and airfare and things like that. and energy prices stabilize as demand stabilizes. i will give an update on fiscal

year up to date. we were up 19.5%. and we see here that through january the absolute return portfolio was up 9.6% fiscal year to date now through the end of february.

>> moving on to closings that the board approved in closed session that have since closed, battery venture select fund. they have a long standing relationship in the venture capital portfolio. the board approved an investment of $15 million and closed on $25 million. and also in january the board approved the second investment with abbott properties a real estate investment. the board approved that allegation for $25 million and

easily did the second investment with the provision ridge as part of the natural resources book and the real assets portfolio. the board approved the initial investment in logos capital growth management. $100 million investment and this is a bio tech specialist and

opportunistic with the second meeting and what may prove more likely is to add on a portion to that meeting to review the canadian model so that is scheduled for april 21 from 1:00 to 4:00. in the next day or two, i expect the agenda for that to be finalized as the class updates and also include a review of the canadian model. do want to take note here that nepc as they do every calendar year end as part of the update to all the clients in one of the annual meeting is nepc updates their capital market assumptions periodically.

and so they did so a week ago. you see ore an page four what led to a pretty material decrease in the expected returns from 7.6% for the next 10 years and 6.9 and 8.1 down to 7.8 and volatility edge stuff. this is because the extraordinary returns. and anything along these lines with the forecasted returns are always very beginning point dependent and end point dependent. the results look completely

different six or 12 months from now. and this is just as they look different compared now to six months ago. we don't think this is any major change. and we have a personnel update and giatta rejoined spurs last year or maybe it's a little longer as an intern and she was very instrumental in helping us complete all of the detailed and blocking and tackling work and brings a wealth of experience to us already. and six years in experience in investment banking and working with others as well as background investing in the u.s. and asia. and you can see she has a

sterling academic career and also a very talented person in other areas as well. giatta joins the team that is just a rock star group of analysts. i would love to find the way for the board to have more time with our analyst. i am hoping we will be able to do that with the asset class update. we are talented at the analyst level. >> they had to drop off for an annual meeting. >> all right. well, board member, we can turn

it over to you for questions or comments. thanks, tanya. >> bill? >> you could have put your index funding into the barcap bag and if you had done that, if fiscal year to date return would be minus 88 basis points. as bill points out here, you took the labor intensive, somewhat less traveled path of pursuing private credit which takes a lot more labor and ironically has a lot less duration risk. senior floating rate secure and you earned 11.5%. that is a swing of 12% on 5% of your assets. again, i think bill made his

points well. and your board is very attuned to the issue that you don't get the results by throwing in an index fund but by working with good advisors and having the staff take the pad less trod by others. it's worked well this fiscal year to date. >> thank you, alan. the private credit underwriting is immensely complicated. and it's a constant treadmill that requires reunderwriting every 18 to 24 months. thank you for that, director. >> president: thank you. mr. smith, did you have questions? >> yes, always good numbers. a rise in tide raises all boats is the phrase.

and the absolute returns and with the different numbers is the return lies between the equity return and the six-month and going back to the longer report that alan completed and looking athlete-year number, let's remember some of those negative numbers cannot be explained away by, as you did in the private equity where that benchmark is sort of not specifically related to private equity and just something that spread of the 300 points over the public markets. so i am trying to come back to with the negative number, let's not forget about the negative numbers in the quarterly report. particularly the long-term numbers. the three-year numbers, not the

three-month numbers. thank you. >> we remember our pain points very well. >> president: thank you, commissioners. any other comments on this report? thank you for your great report. and congratulations on your recruiting as well. that is great. i notice in the write-up that she was a former intern as well. it is good to have interns that we can bring back in those roles. it is great. it says a whole lot in terms of what we do in terms of our commitment to the people who come in to work on a temporary basis and return back. thank you for that. if there are no other comments, at this time we will open up the phone lines for public comment. >> thank you. a reminder to callers if they have not already done so to

press star 3 to be added to the queue. moderator, are there any callers on the line? >> madam secretary, there are no callers on the line. >> thank you. public comment is now closed. president bridges? >> thank you, madam secretary. next item please. >> item 10, discussion item, deferred compensation manager report. >> thank you so much. >> thank you. good afternoon, commissioners. can you hear me okay? >> yes, no problem. >> excellent. thank you. good afternoon, commissioners. before you is the monthly activity report. planned assets remain healthy around $4.5 billion at the end of january 2021. at this time i wanted to provide you with some high level plan and d.c. industry updates if there are no questions on the report. more details will be provided

during the upcoming calendar report on the last half of 2020. so if there are no questions, a first at a plan level, our stable values fund which is over $1 billion in asset and approximately 23% of the sfdc portfolio is currently managed by galliart who is a wholly owned subsidiary of wells fargo and operated pretty much independently of the bank under their asset management arm. however, recently private equity ferms gtcr and reverence capital entered and agreement to require wells fargo asset management for about $2.1 billion. the transaction is expected to close in the second half of the year and wells fargo will maintain a 9.9% stake in the yet to be determined rebranded firm. details of the expected ownership and with the characterized and majority holder and referenced as a minority holder.

with the deferred compensation committee at the end of the month. in addition, the investment consultant rfp is in progress and finalists will be selected to present to the dcc at that meeting as well. if there there are no questions on plan update, on an industry level, record keeper consolidation will continue and announced a partnership with infosys in july and empower the acquisition of mass mutual and the recordkeeping business. for context, empower was also formerly great west who was a prior record keeper. and it became empower after acquiring j.p. morgan and putnam's recordkeeping lines. this type of consolidation is not that surprising considering margins in this business are not large and they are actually getting smaller due to automation and more and more

virtual services. >> the secure act 2.0 is building off the secure act. and include increasing the catch up amount to $10,000 for those age 60 or over. and also possible changes to rmds which are required minimum distributions currently for those who are age 70 1/2. and to change the rmda age and with 75 and exempt those with balances under the rules as well as possibly reducing the penalty

for failing to taking an rmd as subject to a 50% tax. at that point that sums up my manager report. i am happy to take any questions from this board. >> i want to make one comment. >> go on, commissioner. >> commissioner: i want to make one comment we will have the deferred comp committee at the end of the month on the the 31st. i just i added -- i wanted to add to that calendar a discussion on voya. i sent you an email regarding the performance and we plan on

talking through the watch list and what they are proposing as which firm should be on the list. we want to discuss it further with the committee. >> right. so we want to make sure. let's start with that item on the 31st. >> certainly. >> thank you. >> are there any other questions or comments? commissioner driscoll? >> it is not critical, but my impression is that the law had been changed to age 72 or the rmd to age 72 from 70 1/2. >> yes, that is true. that is correct. i'm sorry.

there's been an additional change. so excuse me for -- >> an i know. 75 is good. and i think also legislation being introduced and i don't know if it will fly to remove the that entirely. thank you for that point. i look forward to the committee meeting. >> good point, thank you. >> this is a discussion item. if there are no other questions -- are there any other questions? if not, madam secretary, open for public comment please. >> thank you. if there are any callers on the line, please press star 3 to be added to the queue. moderator, are there any callers on the line? >> madam secretary, there are no callers on the line. >> thank you. hearing no call, public comment is now closed. >> thank you for the deferred compensation manager report. madam secretary, next item please. >> next item, item 11, discussion item.

review sfdcp investment performance for the second half of 2020. >> thank you very much. so for this item, we would like to ask callan to present on the prior year and the last half of 2020. i know that alan martin from nepc covered the capital markets. in the interest of time, i believe we will focus on the sfdcp investment accordingly. darlene, i believe that mr. youngerman is trying to share his screen, so that we can walk the commissioners through the deck. but he doesn't seem to be able to do so. are you able to allow him to share his screen? >> grace, you are the host. >> you now have the ability to share, greg. >> wonderful. thank you very much. and good afternoon. i will jump right into my

presentation. share the screen. please confirm. please confirm if you can see it okay. >> we can see it. thank you. >> and thank you very much. and again, i will try to keep my comments to about 15 minutes if that is okay. and recognizing a lot has been covered on the capital markets. i really have a very strong report card for deferred comp plan that has performed quite well. a lot of it is captured here on page three with that gold line. you can see the quick draw down and the first quarter this year was a very challenging period, but since then it's been a very robust market. and very significant bounce back. roughly a 70% return since the bottom of the market through the end of the year 2020.

in the interest of time, i thought i would skip a few slides and just touch on a couple themes to augment some of the comments mr. martin had made earlier to not be redundant, but to be applicable to some of the funds we're going to talk about in a moment. and i thought this slide did a nice job in capturing 2020 because while the top end in an 18.5% return for the s&p is fantastic, but how did we get there? we look at the underlying sectors and industrying, it was a world of have's and have not's. you can see on the far left-hand side, online retail, technology, home improvement, really were the big winners in terms of returns and this is a one-year return period. to the far right, and industries

with real estate, airlines, energy, banks, financials were negative. and to bring this up and is one of the things that we are talking about as the extra plan as we think about the different types of investments. and the concept of growth and value, particularly in the large end of the market as well as the small. and are the returns and apple, microsoft, amazon, facebook and alphabet firmly fall into technology and online retail that have done exceptionally well and the value oriented sectors of financials and things that generate cash flow but has been a difficult time period. and we have seen a strong

reversal starting in october of last year and really carried forth through the first two months of 2021. i just want to highlight and one of the points on fixed income and we talked about private credit and how that did so well. and your fixed income manager and in the plan does as the core plus manager and and exposure to yield bonds. and up 6.5% and a big bounce back in the fourth quarter and for the trailing year to see in the blue horizontal bars high

yield was up 7.1%. with the high yield and being more conservative. you will see the performance and relative performance and outperforming the index in the fourth quarter. that is always going to touch on in the capital markets. and hitting on some of the plan statistics at the top level, page 12 shows the asset allocation by asset class. this is how participants have voted with their dollars at 4.4 billion and the two largest asset classes is large cap. and the large cap managers together and that is $1.4 billion. and stable value as diane mentioned earlier is over $1

billion. individual participant elections with the individual fund level found on 13 and here i think just an interesting point relative to after the first quarter and the plan fell by $484 million in that first quarter. to gain 551 and pretty big swing in terms of the total asset at the bottom of the page. and that first column and see that $4.4 billion on the far right-hand column. and the individual market values that is as of year end 2019. just to give you a frame of reference. in terms of returns, here is a snapshot of the target date funds.

and you will see a fantastic report card and double digit returns and many of these with the fourth quarter as well as the trailing one year. all the fund in the shorter time periods are doing quite well relative to their benchmark. and that is if you invested passively and these fee funds are managed by russell. longer term result with the column to work on the most conservative fund at the top of the page and down to the longer dated funds on that section. the individual core offerings in the plan and this is really where you get some more differentiation on page 15 as you will note to read this and call this a stoplight and is meant to be a quick snop

snapshot of where to spend your time. with the green symbolizes the top half and the return in the bold. and right below it is the appropriate index from the last quarter out to the last 10 years. as you go left to right on the page. the fixed income bond fund had 3-4% in high yield. they are a little more of a conservative fixed income manager relative to pierce. still handsomely outperforming the index especially left to right in longer term time periods. we don't believe that is a big

issue and we didn't want the fixed manager and this is a watch list qualification and is really just a way to capture what is going on with the benchmark and 5 to 10 and a lot of that has to do with the end period sensitivity that mr. markham mentioned that you are well aware of. and really bounced back as values come back with an outstanding return and ranked in the top third of the peer group. we have been expecting when value comes back in favor, we expect this fund to come back in favor and it certainly has. we believe so far in 2021 that it continues to be the case.

and it is matched very nicely or paired nicely with the large cap growth fund that was up 38%. and we talked about apple microsoft, facebook, and the large cap growth fund. certainly e plains that outstanding return and make up about 22% of the s&p. and within this fund they are over 30%. if there are areas for your participants to allocate the dollars according to the use on the market and is important that not all of the funds are doing the same job. and the last fund i would comment on the page is the active equity. so it's the second from the bottom on page 15. you will see some third quarter performances and not missing by

much and underperforming with the index as well. and to recall this fund is the fidelity low priced fund that tends to be an all cap. almost a global fund. it is hard to benchmark. and hard to put in a style box. it really doesn't fit. the portfolio manager has been allocating to small cap japanese companies in particular and finding great value there. it tends to zig when the peer group and benchmark zag at times. nonetheless, it is pretty strong longer term results in absolute terms. rounding out the core options is at the top of 16 and you can see fantastic results both absolute and relative.

hitting the ball out of the park, so to speak. the real estate fund in the fourth quarter last year and we made a fund change. the manageer is principal. and you can see their stand alone performance at the bottom of the 16 and they have done a really nice job taking over for morgan stanley. i will end my comments here on page 17 just to acknowledge that these are the target dates of our component fund. russell uses some of the core lineup that we just reviewed. they also use these participants don't have direct access to the funds. they tend to be very niche markets and a lot more volatility associated with them. russell uses them in very small doses. the two funds on the very bottom of the page also qualify for watch list.

this is a value theme and the manager and the emerging markets. you can see again they are outperforming as value came back in favor and exactly what we expected. when they are zigging, some of the growth oriented managers are zagging and vice versa. and that proves to be strong diversification for russell to utilize. i will stop there and see if there is any questions that i can help answer. >> commissioner: i have a question. turn to the chair? >> commissioner casciato, go on. >> commissioner: greg, my question is, when we had the dip last march, did you -- were you able to track how many people

left during that period of time the fund? >> i believe voya would have that information. i don't have it off the top of my head. that would be in my research question for them. >> commissioner: my concern is that we promote this plan to our members and they invest based on the education that we provide to them. and i know staff does a really good job about trying to educate, get the information out there, etc. but how much of it does it take? what i am concerned about is that when we do have a down

cycle, we have people who panic and leave. and when things come back up, they are basically left out there. i have two -- i have identified that that happened. i am probably -- probably several more. i struggle with how can we actively council -- to counsel people at the downside to not panic, to not leave. i know you don't have an answer for it, but that is a concern that i want to put out there because i know that it happens. and usually they are the people that can least afford it.

we just have that smuggle in my mind about it. when i look, are we doing -- is voya doing the best they can to educate so when a person is in a panic situation, they don't hurt themselves to a degree from which they cannot recover? anyway, those are the to why i stated about how i want voya to respond on the 31st. >> can i take that?

>> just so i am understanding correctly and left the plan as a result of poor performance during the market last march? >> they withdrew their funds in response to the market going down. panic situation. >> i appreciate you bringing this up. as soon as i returned, i have been wanting to track sort of productivity and outreach on the record keeper's end via the counselors we employ specifically for the plan over the last part of 2020. as you know, that was a really difficult year. i think a lot of firms and counties were trying to get their sea legs in this environment. i commented on what i feel is a

decrease in productivity with the understanding that we are in the pandemic and try and work towards that. i don't believe that our participants may have been able to maximize the resources that are available in them to 2020. we have a lot of information out there and available online for them to see. there was a lot of uncertainty in the air. i apologize if those folks who felt they didn't have anywhere to go or they did not have a counselor to actually talk to, which is really what they are supposed to do. they are supposed to help talk through investor or participant concerns to stay the course. retirement is long term investing. we have a lot of information out

there about how important it is and when you leave and come back, when you leave and come back, this would be detrimental to your account over a long period. and unfortunately, sometimes having the information out there isn't enough to seek and find it. what i would like to do and i have been working with the record keeper is to figure out how to better make ourselves available. whether it's to let our participants know, hey, we have these dedicated counselors for it and whether it is to track the productivity more and innovate ideas to get in front of people because they cannot be boots on the ground, but ipped to confirm that i understand these concerns. we are trying to address them. i think march 31 is a really good opportunity to share with the committee sort of what ideas they have for 2021 and that we

can implement and we have learned from 2020. so i think what i am trying to say is we do have resources. i don't think those resources were as readily available in 2020 as a result of the pandemic. but i am certain we will try and make sure that they are apparent and available in 2021. >> greg, do you have any follow-up to that? >> the cares act was very generous an n allowing participants to leave the plan and certainly there were circumstances that necessitate that. it is a fine balance of the participant directed plan but yet having speed bumps in controls and place in that educational component as mentioned.

>> and i suggest you ask voya to give you this following information. this action that commissioner casciato is describing is the people deciding to stop saving versus withdrawing versus they simply didn't want to roll the money from small cap to large cap or stable value. voyo knows how the head count varies in all those accounts. let's look what happened in, let's say, march 31 and june 30t end of the period because of what happened in march that did scare a lot of people. let's see if we can find out if there is anything extraordinary, particularly the people who rolled out, meaning left the fund. that would be the distinction between the retired people and the people who are active and

have a choice to continue saving or not, let alone moving the money from and safer account to a less safer account. that is my suggestion so we can analyze how big a problem it is. as for the videos, training films that voya has on the website with us, we cannot make people watch it, but let's make sure there are websites there that actually help people understand that, hey, when you invest, you have to stay the course. that is an educational issue that maybe commissioner casciato is driving at. i have one question to ask, but i don't want to change the subject yet until everybody else is real ready. if there is no further comments on that subject, i will ask this question, greg. i forget exactly which page it is, buts the the red squares particularly in the three and five year columns. i know we're changing real estate. you focused on the large cap

value group. let's say we know quite a bit about that particular manager for a related reason. the debate about growth versus value has been a lot the last year. but their numbers are more than just that value discussion. i am not sure if this is one of the topics that commissioner casciato plans on bringing up in the next deferred comp meeting, but there is something more significant about that manager's performance than value has just started. what they did in the last quarter dunce explain the last 10 years. or justify the last 10 years. >> yes, and a lot of it just in response to lsb is the large cap value manager you are referring to, and they underperformed by almost close to 6% in the first quarter of 2020 which really brought down their longer term results. it is not that they underperformed every year of the last 10 years but tends to be end point specific.

certainly something that we can dive into much further, but certainly it is nice to see them bounce back given the values in favor. they tend to be more of a deeper value, so again, a further barbell given how growth oriented the large cap growth is. lsb tends to probably be one of the deepest value of the managers out there. >> commissioner: i think our investment team discovered other issues which we should discuss. that concludes my questioning. thank you, greg. >> president: commissioner, are there any other questions? if not, i would like to thank mr. youngerman for the report. and comprehensive follow-up in the deferred comp meeting. thank you very much. at this time we will open up the phone lines for public comment.

>> thank you. reminder to callers if they have not already done so, press star 3 to be added to the queue. those already on hold, please continue to wait until the system indicating you have been unmuted. moderator, are there any callers on the line? >> madam secretary, there are no callers on the line. >> thank you. public comment is now closed. president bridges. >> thank you, madam secretary. again, thank you for the deferred compensation investment performance report. madam secretary, next item please. >> next item is item number 12, discussion item, review of audited financial statements and supplemental schedules for years ended june 30, 2020 and 2019 and communications to the retirement board for the year ended june 30, 2020.

>> thank you, madam secretary. i believe our finance manageer is also on the call in the meeting. if not, i will go ahead and introduce this item. as you know, the city engages an outside accounting firm to audit the financial statements. can you hear me? and for the last few years it's been the performance of the

audit. we will make a brief report on the audit and the communication to provide to the retirement board. at this point, welcome, craig. >> great. thank you for the opportunity to present the reports of the audit. i will go over the level and in my world and the audit world. a no news is god news thing and i don't have a whole lot to go over. with that i will -- share my screen real quick here. as mentioned, we were engaged to perform a financial audit of the financial statements of san francisco employee retirement system for june 30, 2020 and

june 30, 2019. the conclusion to the audit is we issued three reports. one of the independent auditor's report and one is another kind of self-model report that we issue when we perform audits in the course of government audits and standards is an additional report that goes over any items and division and control and noncompliance with laws and regulations as we come across as a result of the performing the audit procedures. and the last report is the required communications or the report to the retirement board. what this is our audit standards require at the end of every audit we communicate certain averages and that is what we will be going over today. i will start with the financial statements and on page four of your agenda item or the agenda

package, the first item is internal auditor's report. and what this will contain is it will contain our opinion of -- before we two over the opinion, we will start with the couple of responsibilities that distinguishes between manager responsibilities for the fair presentation of the financial statements and also for internal controls related to the preparation and fair presentation and our responsibility as the independent auditor for auditing the financial statements and planning and performing our audit to obtain what we call reasonable assurance. to make sure that the financial statements are free of what we call material misstatement and with the to go into preparing these and a high level of

assurance that we provide. towards the bottom of this page and starts our opinion and we are happy to report we issued what we call an unmodified opinion on the financial statements as the highest level of assurance that the independent auditor can give and regarding that financial statement known as a clean opinion. so another year, another clean opinion for that. we issued the report on december. and the next part starts and independent auditor's report on internal controls and compliance. and what this report is as i mentioned is every time we perform an audit and with the government audit standards it

adds a little bit more on to us of what we have to do. part of that is we have to obtain and if we become aware of deficiencies that we believe rise to a level of what we call material weakness or significant deficiency, we are required to report these to the board in this letter. we are happy to say for the year ended june 3, 2020 we didn't have any items there or deficiencies in the controls. and the last part of this report is compliance. and what this results to is being compliant with laws or regulations that could have a direct or material effect on the financial statements. and then we are happy to report that we didn't have any noncompliance with such laws and

regulations. the last report starts on page 74 and this is our and the communications and to the retirement board is summarizing at a high level and the result of the audit. this is kind of a misnomer here with the findings, but it's a summary of the communications. and corrected and uncorrected and financial statement in the statement as a result of the audit. and and the financial statement and the presentation in the closure as it reports no and at

the time and policies over the year and we had no difficulty and for the last year and we were in the market. and so it is kind of a testament to the management staff to be able to come together quickly and still provide with all the documentation that we request and answer all our questions and pretty timely manner and so we didn't really miss a step there. >> and the knowledge to get the complications and regard with regard to the treatment and the t canning setbacks and no questionable.

in the report, there was a subsequent event that happens between the end of the fiscal year and something that happens in that period and from that in the late november 2020 and asset allocation and change tow the investments are managed on a go forward basis. and the last thing that i would kind of go over is it is in the middle of my chart here is the significant financial statement estimates. and what i bring this up is there is preparing financial statements, management is required to use estimates about

certain issues and required to report on the more significant ones where there is a lot more judgment involved and there are subjective. the two main estimates are the fair value of the investments particularly the private equity and private credit and the real asset. and then also in the note disclosures and more significant estimate to relate to the net liability which is an accounting term for the unfunded liability. and why that is important is because now the city and the remaining and the rest of the employer wills take that number and will come up with their proportionate share of that number to record that liability into their own financial statement.

and the estimate fair values and with the partners and to that actuarial to using the accounting standards and standards of practice and the board approved assumptions and methods to come up with what that accounting or actuary data is. we will look at the census data and make it complete and accurate. and to engage and come in and review the calculations and methods and assumptions being used to make sure they are reasonable. and so with both of those significant estimates, we were able to conclude they were reasonable as they relate to the financial statements.

we just wanted to communicate that. with that being said, that kind of concludes what i have to go over and i will be happy to answer any questions. >> thank you. are there any questions on the audit results? >> if there are no questions, i would like to echo what mr. harmer said. 2020 was a very difficult period of time for a lot of us, but in this case generally a normal year is the audit team comes on site, spends weeks talking to the investment team, to the actuarial team and operations team to do their field work in preparation for the audit. so the fact that we were able to actually in the same timeline we do in normal years be able to complete the audit is a credit

to our staff across the organization as well as the n.g.o. staff in being flexible. so i just wanted to acknowledge that. hopefully we won't have the same experience for this year, but certainly this was an more than normal extraordinary effort to make sure that this audit got done. i wanted to acknowledge staff. thank you. >> thank you. thank you for leading the team through the audit and the commitment and thank you to get us through the difficult year. thank you very much. thank you for the presentation. >> thank you. at this time we will open the phone lines for public comment. this is a discussion item. >> thank you. if you are not done so, press star 3 to be added to the queue. are there any callers on the

line? >> madam secretary, there are no callers on the line. >> thank you. public comment is closed. president bridges? >> thank you, madam secretary. again, thank you to all who worked on the audit in this challenging time. madam secretary, next item please. item 13, action item, review and approval of 2020sfers annual report. >> thank you so much. >> board member, allison johnson our communication manager has been working hard across the organization and the investment staff and the operations staff and the accounting staff to coordinate the drafting of an annual report which is a charter requirement that the department needs to create an annual report on an annual basis. we used a hard copy to print a lot of these in hard copy for distribution. we now do a very limited number of hard copies but we are asking

the board to approve this annual report for the fiscal year ended june 30, 2020 so that we can post it electronically on the board and make it available. a few years ago we conformed it to easily recognizable from over state plans and consolidated financial report format. and so for those who haven't been watching it year to year, it might appear different than it looked five years ago. and in many ways it made it easier for us to update it each year. and again, we would ask that the board accept this annual report approved for us to publish it. and make it available to the public. with that, i will be happy to answer any questions.

>> thank you. board members, are there any questions on the annual report? if not, i will entertain a motion to approve. this is an action item. >> correct. >> this is commissioner driscoll. two points. one, jay, thanks for including me in the statement piej four. two, i was hoping to get it done -- it's on me. it wasn't done, but to add a vision state statement to this which is slightly different than a mission statement. perhaps with the next one the new president will consider that when it is ready and adopted by the whole board. thank you. >> thank you.

u >> i approve this report. >> is there a second? commissioner, is there a second? >> president: sorry. >> i will second that. okay. >> moved and seconded that we adopt the 2020sfers report. please open for public comment. >> are there any callers on this

report? >> madam secretary, there are no callers on the line. >> public comment is closed. president bridges? >> roll call vote please. [roll call vote taken] commissioner casciato? no response. commissioner driscoll? >> aye. >> thank you. commissioner helfund? >> aye. >> u a commissioner safai? >> no response. commissioner stansbury? >> aye. >> thank you. we have four aye's. motion passes.

>> i am an aye. >> thank you. we have five aye's. motion passes. president bridges? >> thank you, madam secretary. and thank you for the report in challenging, difficult times. i appreciate it. next item please. >> item 14, discussion item, executive director's report. >> thank you. board members, again, i need to remind you that as board members, you are all e-filers or form 700s and so we have provided you the information that you will need to log in to electronically file your form 700. i was reassured again this morning that the state is not going to extend the deadline for

filing beyond april 1. last year they extended it to june 1 because of the pandemic, but they are stressing firmly they will be keeping to april 1 and sunshine and ethics training that will be required this year and you will need to hopefully not wait until closer to april 1. if you need help getting to the ethics commission website to complete this electronic filing, contact and i mentioned we had established an sfers presence on social media. and so we have opened up an sfers page on linkedin. and i just wanted to share with the retirement board the nature of the content that we are posted on linkedin.

i think we have 124 folks following us. and i am not on linkedin myself. i don't know if that good or bad, but i think it's rather low. we want the board to understand that we have posted our information that relates to the efforts on esg and might be easier if the board members are talking with people who want to know what we've done and if they are connected and direct them to the linked in page. i just wanted to show you that we are -- we do have an active presence out on social media. and with that, i will be happy to answer any questions you may have. >> i would encourage you to maybe have our communications person or teams do a social

media blast to join that linkedin or follow that page. i will go to it right now. we also have to know how to find it. what is it listed under? >> i think it's sfers. it's actually spelled out and parentheses sfers. >> okay. >> we use it to provide information as well as when staff are recognized by industry of publications. and we also post those types of articles. and recognize staff to promote

staff and so, like i said, i just wanted to give you an idea of what types of information posting out there. and sure enough to refer to the quotes and specific interest and interest in what they had been doing. >> are there any other questions on the executive director's report? if not, this is a discussion item and we will open the phone lines for public comment. >> thank you. callers, if you have not already done so, press star 3 to be added to the queue. moderator r there any callers? >> madam secretary, there are no callers on the line. >> thank you. public comment is closed.

president bridges? >> thank you, madam secretary. next item please. item 15, discussion item. retirement board members good of the order. >> board member, do you have anything for the good of the orred sner >> i do. really quickly. can staff and craig sort of really look at how we get rid of this background noise? from basically the office. for instance, a couple of times today i couldn't even hear what you guys were asking for. for a motion or whatever. so i think there's got to be a way to fine tune it because for some reason it just happens for this sfers meeting the most. just a suggestion. okay. thank you. >> thank you, commissioner

heldfond. today was very challenging with the background. i don't know what is going on. it kept saying low bandwidth, so we'll look into it. >> i have a suggestion assuming the board would support it. i want to bring in diane and justin and our deferred comp manager's attention. the semiannual performance report that was prepared is excellent. there was four pages on each one of the mutual fund. my point being is it is now a public document. anyone can go to our system website for the meetings that the executive secretary administers and it is on there. all the items on the agenda. and i was going to suggest if the board would agree to ask diane to load it up through the deferred comps separate website so when any member wants to dig into this, it is there with the staff on deferred comp as well as the representatives from voya

could direct people to go read more about the mutual funds they have selected. there are a few out of the 30,000 members -- not that many who will do it, but it is useful information and is there, available, public. it is online. with the information to share for people and saving and preparing. that is something the board should continue endorsing. >> thank you. any other comments? the other thing i would actually recommend and ask board members and committee chairs to schedule your committee meetings, contact darlene to schedule your board meetings or committee meetings, i'm sorry. if there are no other comments, madam secretary, we can open up the phone lines for public comment. >> thank you. moderator, do we have any callers on the line?

>> madam secretary, there are no callers on the line. >> thank you. hearing no calls, public comment is now closed. president bridges? >> madam secretary, thank you very much. if there is nothing else and no other business to support, this meeting is now adjourned. thank you very much. and thank you to everyone for your participation and thank you for your patience in dealing with the audio and sound issues. have a safe and be safe and be well. thank you very much.

>> this job, it's really not an i job. i wouldn't be able to do this job without other people. i make sure that all the regulatory and nonregulatory samples get to access in a timely manner. we have groundwater samples, you name it, we have to sample it every day. i have ten technicians, very good team. we work together to attain this sampling. >> a sample is only as good as

when you collect properly. if sample is not collect properly according to not the proper protocol, the sample could be biased, could be false positive or could be false negative. so all this to have good so you can manage the sample collectors, as well as the schedule, and she is pretty good, and she is very thorough. and so far, i think that she is performing a very good job. >> this job is really not an i job. i wouldn't be able to do this job without my team. you can assign them any job, they can handle it, and again, without them, i wouldn't be here. i take pride, you know, for what i do. we are providing a very good water department. my name is roselle, and i have been working with the water

department >> chairman: this meeting will come to order. this is the march 10th, 2021 budget and finance appropriations commission. i am joined by committee members supervisors safai and i would like to thank kaleena from sfgov for broadcasting this meeting. >> clerk: due to covid-19 emergency, city employees and the public, the committee room is closed. hover, members will be participating in the meeting remotely. this precaution is taken pursuant to the various state and local orders. the committee members will attend the meeting through

the video conference. public comment will be available on each item on this agenda, both channel 26 and sfgovtv.org across the screen. the public comment are available by phone call by calling 415-655-0001 and meeting i.d. 1877753464 and press ##. when connected, you will be muted and in listening mode only. when your item of interest comes up, dial *3. call from a quiet location, speak clearly and slowly, and turn down your television or radio. or you may submit public commit in a e-mail to the budget and finance committee clerk. it will be forwarded to

the supervisors and will be included as part of the official file. finally, items acted upon today or expected to appear on the board of supervisors' agenda on march 13th unless otherwise state. >> chairman: thank you, madam clerk. we have, as always, a full committee meeting, and so thank you, everyone, for being brief with your presentations and for your patience. madam clerk, can you please call item one. >> clerk: item one, resolution approving the rent agreement between the city and san francisco marine group for the illustrations of the covid food assistance program to extend the term by nine months for a total of july 1st,h december 31, 221. for a total not to exceed

17.3 million. members of the public who wish to provide public comment on this item to call 415-655-0001, meeting i.d. 1877753464, and dial *3 to line up to speak. please wait until the system indicates you have been unmuted and you may begin your comments. >> chairman: great. thank you so much. madam clerk, we have fanny lapaton from the human services agency here to present on this item. >> good morning chair hayden and supervisions mar and safai. please let me know if you hear me okay. >> chairman: yes. >> okay. thank you. thank you for your time today. my name is fanny lapatan with the human services agency and deployed to the covid command center food coordination group. i am joined by some of our

key staff and also our partners from san francisco marine food bank. we're here to request authorization to extend our grant agreement with the san francisco marine food bank to continue the covid-19 food assistance program through the end of this calendar year. this extension will be paying for $485,000 additional grocery bags to be distributed through december 31st. the grant agreement was first established in july of 2020in response to the emergency declaration for covid-19 back in march of last year. we recognized that food security was necessary to protect and save lives through this public health emergency. the food bank provides supplemental groceries to san francisco residents affected by the pandemic through two programs that are available wide. citywide.

one program is called "pantry at home," and the other is "pop-up pantry." the first program is used to aim the spread of covid by delivering groceries to covid-vulnerable individuals in need of additional food resources so they can remain sheltering in place. top eligible, the individual must be a san francisco resident and either 65 years of age or older or has an underlying health condition that puts them at greater risk for complications for the covid, or has difficulty attending a food pantry due to a physical or cognitive disability. pantry at home deliveries are done monday through friday, and individuals are able to sign up over the phone by calling the franchise marine food bank or the department of disability and aging services. on average, that program delivers about 23,000 bags per month to about 4500 consumers.

the second program, called "pop up pantry," is designed to supplement the food pantries of individuals equally affected by covid, by providing pop-up pantries and providing healthy supplemental food sources. to qualify, the person must be a resident of san francisco who is not already enrolled in another program. public pantries are available six days a week, monday through saturday. individuals are allowed to attend one pantry per week. on average, that program provides about 56,000 bags per month to close to 18,000 consumers. the grocery bags provided through the food bank will, at minimum, include sufficient seven meals for a single person household. the distributions usually

include an abundance of fresh fruits and vegetables, a protein item like eggs, poultry, and tuna, and a grain item, by pasta or oatmeal. other canned items or dairy are provided when allowable. the food bank has a quality control policy and procedures in place to ensure that groceries are wholesome and fit for human consumption. the food bank follows best practices as far as packing and meets state and local food safety requirements and standards based on the california retail food code. i also want to add that about 53% of the food bank's personnel or staff are san francisco residents. let's see. we agree with the b.l.a.'s report and recommendations, and at this time we would be happen to answer any questions that the supervisors may have on

this request. thank you. >> chairman: thank you so much. i appreciate that. can we hear from the b.l.a., please? >> yes, chair hayden, members of the committee, ms. lapatan has actually described the program, but the proposed resolution has an existing grant agreement between the h.s.h. and the san francisco food bank for the covid-19 assistance program. this amendment would extend the grant term by nine months until december of 2021, and increase the grant amount to $17.3 million. we do based it on the program -- well, we show the spending on page four of our report. but based on actually spending to date, we recommend amendinging to increase to the not to exceed amount. and i want to make a

correction. the amount would be from $17,325,000 to a proposed amount of $15,586,825, to reflect the actually spending needs. and i'm available for any questions you may have. >> chairman: thank you very much. it sounds like they're am amenable to that. supervisor mar? >> thank you, chair. i just want to express my support for this incredible nutritional program that has stood up during covid. i'm familiar with the pop-up pantries because there are two at my district, one at lincoln high school. and i've been out there volunteering. they rely on volunteers for the pop-up pantries.

i just had a question for the distribution program. is that volunteer-based as well, or are there paid staff delivering the groceries through the distribution program? >> yes. thank you for that question. and thank you for your support, supervisor mar. i do believe there are some volunteers, but there are also paid. so it is a mix. >> got it. and i just had another question around the scope of groceries being distributed to these two programs. is that -- how is lion the, lik, the number -- how is the scope of the program determined -- i'm curious if there is more need than

what this program is meeting, these two programs? >> yeah, so we have capacity to assist and support, i think, additional to what we are already supporting. so there isn't, like, a wait list. there is certainly demand, and we are meeting that demand as best as we can. >> supervisor: got it. okay. well, thanks again, yeah, for presenting this. i don't have any other questions, chair haney. >> chairman: thank you so much, supervisor mar. i agree with the supervisor that this is a very critical program and we're really grateful for your work and the work of the food bank. it is absolutely essential right now. madam clerk, can we please open it up for public

comment. >> clerk: supervisor safai is in the cue? >> chairman: i'm sorry. supervisor safai. >> supervisor: thank you, chair haney. i want to say i appreciate the food bank responding early on in the pandemic to our request to expand sites and open up sites in our districts. they are extremely utilized, and people are very appreciative of the additional support. i just have two questions. one is: one of the things we heard, particularly in our district, that has, you know, the diverse population of san franciscans from all different parts of the world, all different ethnicities and backgrounds, some of the things we've heard some of the cultural competency in the food, and how the food bank thinks about serving different cultures. so i wanted to get your thoughts on that because we certainly want to make

sure that people are able to access food that is culturally competent for them. and the second question is: we definitely would like to meet with executives of your organization because some people have come and said -- and i don't know if this is what happens all over the city, but they're kind of waiting in line for food. at times, some people can feel a little demeaned by that. and if there is another way to kind of coordinate food pickup or working with people that are experiencing food insecurity. so those are the two questions that i wanted to pose to you today. >> thank you, supervisor. i believe we do have our partners from the san francisco marine food bank. i have insight has to, you know, your question about the cultural appropriateness of the food, but i want to give

them a chance to answer. is sean brooks -- sean, are you here? >> yes, i am. >> okay. great. >> thank you, supervisor safai, for those questions. regarding the cultural competency of the food, we are distributing about 57,000 bags of food weekly to many, many different cultures. and as you can, i'm sure, understand the logistics of providing that level of distribution, you know, using primarily volunteers is quite challenging. and this county has so many different cultures that we are serving, so our goal has typically been to feature fresh, unprepared produce so that cultures can prepare it in the way that meets their needs.

we try to feature a protein, like eggs or poultry, as fanny mentioned, so they can cook it in the fashion that makes sense for them. when we do get products donated that are more culturally appropriate -- and we don't control the flow of donated items. you know, we're very aggressive at trying to get whatever we can. when we find items appropriate for a particular culture, we will try to ear mark it to sites that have a higher participation of those particular residents. so that is how we approach the food. and understanding that a lot of it really is based on what donations we can get. but it is primarily raw product that people can cook in their own fashion. does that answer your question enough? >> supervisor: yeah. i understand a lot of the foods donated -- maybe the

idea of kind of expanding or thinking about ways in which we can get things donated that is a little more culturally dominant. we can talk about that a little more later. do you guys think about it in terms of -- we have an office of equity. do you guys look at things through an equity lens, in terms of how you're distributing or approaching the different communities that you're working with? >> absolutely. that is a critical aspect of how we think about our work. and it really drives kind of future programming, as i think you're talking about in your second question as well. but i think it is important for us to fill gaps in service where we can see them. part of this program, you know, initially we just wanted to get as much food out there as possible. but part of our first effort was really to enroll folks to get information about who we

are serving. i had a meeting yesterday digging into information that we have both from the county and other private sources that really talks about the needs in this community and really looking at where are those gaps and how can we meet those? we understand in some cases we may need to target food that is specifically appropriate for a particular culture that may not be coming. and we will always try to get donated food when possible, but we may have to leverage some of the purchased food dollars that we have to try to augment the menu, like you are referring to, to attract folks that may not be coming to access our program. we're digging into this as best we can in this challenging environment. but it is really important to us. >> supervisor: and then we'll follow up with your executive team to talk about the -- you know, the food pantry line model, the culturally competent,

you know, food that is being distributed. so we'll talk about all of those things. i just wanted to that on the record to let you know what we were thinking. but my office will follow up with you. >> thank you. we are trying to manage lines as efficiently as possible so people don't have to wait around. so that has been part of our model. >> supervisor: right. it would be good to discuss alternatives. thank you, chair. >> chairman: thank you, supervisor safai. can we go to public comment now, please. >> clerk: yes, mr. chair. sofia from the department of technology is checking to see if there are any callers in the cue. callers who wish to provide public comment on item one, please press *3 to be added to the cue. please wait until the system indicates you have been unmuted.

mr. chair, there are no speakers wishing to speak on item number one. >> chairman: great. thank you. public comment is now closed. i want to move the amendments. can we have a roll call vote on the amendments. >> clerk: , item number one, vice chair safai? >> can you repeat that? >> >> clerk: on the motion to accept the budget analyst's recommendation to amendment item one? >> aye. >> clerk: member mar? >> aye. >> clerk: chair haney? >> aye. >> clerk: there are three ayes. >> and now i want to make a motion to move the item as amended to the full board with a positive recommendation. >> clerk: on that motion, vice chair safai?

>> aye. >> clerk: member mar? >> aye. >> clerk: chair haney? >> aye. >> clerk: there are three yaisms. ayes. >> chairman: that will go to the full board upon recommendations. madam clerk, can you please call item number two. >> clerk: item two, resolution approving amendment number one to the board area coffee shop lease between green beans coffee and the city for the reelection of tenants' operations, affording area seats in harvey milk terminal one (indiscernable) related to the original premises in the amount of $357,000 and a lease extension of 10 years. members of the public who wish to provide public comment on this item

should call 415-655-0001, i.d. 1877753464. and dial *3 to speak. please wait until the system indicates you have been unmuted and you may begin your comments. >> chairman: great, thank you so much. and we have, i believe, representatives from the airport with us today on this item. >> good morning, chair haney. deanna kuhan with the airport. we are seeking your approval for the first amendment for the lease between the airport and green beans coffee, providing for green beans to relocate to a new location in harvey milk terminal one. the lease commenced in march 2015, and was about to expire in march of 2025, which was a 10-year

term. it was located pre-security near the boarding area "c" check point. due to the renovation with the harvey milk terminal one, they permanently closed and decommissioned its location in july 2020. a replacement premises has been identified and green beans agrees to cover all construction costs. the airport will reimburse the original amortized construction investment. $357,200 and start the 10-year term. expected in a minimum rent is $416,445 over the 10-year term the board has recommended approval, and i'm happy to answer any questions. >> chairman: great. thank you. ms. campbell, is there anything to add on this? >> yes. very specifically, you're being asked to approve an amendment to an existing lease agreement between the airport and green beans for relocation to a

new location in the harvey milk terminal. we summarize the new lease terms on page eight of our report. the minimum rent that would be paid to the airport over the amended lease would be $416,000. however, based on revenues earned during the pre-pandemic period, the airport expects to receive a percentage rent and we recommend approval. >> chairman: great. thank you so much. colleagues, any questions for ms. kuhan or for ms. campbell? seeing none, can we open this to public comment, please. >> clerk: yes, mr. chair. d.t. is checking to see if there are any callers in the cue. members of the public who wish to provide public comment on item two,

please press *3. please wait until the system indicates you have been unmuted. mr. chair, there are no speakers in the cue for item number two. >> chairman: great. public comment is now closed. i want to make a motion to move item two to the full board with a positive recommendation. roll call vote, please. >> clerk: on that motion, vice chair safai? vice chair safai? >> yes. repeat the question, please. >> clerk: yes. >> i'm sorry. i apologize. go right ahead. >> clerk: on the motion by supervisor haney to recommend item two to the full board with a positive recommendation? >> yes. green beans, yes. >> clerk: member mar? >> aye.

>> clerk: chair haney? >> aye. >> clerk: there are three ayes. >> chairman: this will go to the full board with a positive recommendation. thank you so much for your work and for bringing forward this lease. thank you. madam clerk, can you please call item three? >> clerk: item three, resolution approving and authorizing a long-term amended and restated ground lease with m.h.d. c.gardens on city-owned land for a term of 38 years to commence following board approval with one 44 year option (indiscernable) plus one staff unit for low income individuals. members of the public who wish to provide public comment should call 415-655-0001, meeting i.d.

1877753464. a system prompt will indicate you have raised your hand. please wait until the system indicates you have been unmuted and you may begin your comments. >> chairman: great. thank you so much. we have omar cortez who is here to present on this item. you're on mute. >> i'm sorry about that. yes. good morning, chair haney and supervisors. i'm with mo c.d. i'm here to present a ground use amendment (indiscernable) on existing 63-unit affordable housing complex located at 2445 mariposa street in the mission neighborhood.

we're requesting a ground lease amendment to incorporate additional amendments required by freddie mac, the new proposed mortgage lender. this amendment will fas facilitate refinancing of the project. it will may for the project's much-needed rehabilitation. the term of the amended ground lease is for 38 years, a compilation of the mutual term, with an option to extend for 44 years. the annual base rent is $20,000. and this, and all other terms of the ground lease, are consistent with the policies, and other ground leases for affordable housing approved by the board of supervisors. we ask the committee to recommend the resolution and forward it to the full board. the development team is on track to close this construction by the end of next month, and

rehabilitation is expected to be completed well within a year. on behalf of the project's sponsor, mission housing neighborhood corporation and mo c.d., i would like to thank you for your consideration here today and look forward to your continued support to this project and all affordable housing. i'm joined by my colleagues amy chang, and sam moss, mission house's executive director, and peter real, the lead consultant for mission housing for this project, in case you have any questions. with that, i would like to conclude this report and answer any questions you may have. >> chairman: thank you so much. much appreciated. is there a b.l.a. report on this item? >> yes, chair haney and members of the committee. the proposed resolution approves an amended and

restated ground lease between the mayor's office of housing and community development and the gardens. the ground lease continues the existing 55-year term and adds a 44 year option to extend the lease, totaling 99 years. the annual rent to the city -- to the mayor's office would be $20,000 per year. there is also residual rent, although that would only be paid to the city and to the mayor's office of housing in the event of surplus revenues. this is consistent with city policy, and we recommend approval. >> chairman: fantastic. thank you for that. colleagues, any questions or comments? seeing none, can we please go to public comment. >> clerk: yes, t.d. is

checking to see if there are any callers in the cue. members of the public who wish to pro to provide public comment, please press *3 now. yes, mr. chair, t.d. has confirmed there are no members in the cue. >> chairman: thank you. the public comment is now closed. any questions, comments, colleagues? seeing none, i want to make a motion to move this item three to the full board with a positive recommendation. madam clerk, roll call vote, please. >> clerk: on that motion, vice chair safai? >> aye. >> clerk: member mar? >> aye. >> clerk: chair haney? >> chairman: aye. >> clerk: there are three ayes. >> chairman: thank you so much. this will go to the full board with a positive recommendation. thank you for being here

and for your work. madam clerk, can you please call item four. >> clerk: item four, ordinance amending the business and tax regulations code to extend through fiscal year 2021 to 2022, the temporary suspension of the application (indiscernable) for company drivers and taxi drivers. members of the public who wish to provide public comment on this item should call 415-655-0001, meeting i.d. 1877753464, and dial *3 to line up to speak. please wait until the system indicates you have been unmuted and you may begin your comments. >> chairman: thank you so much. and i believe we have sonny angulo from supervisor peskin's office here to present on this item. >> hi. and i see amanda freida is here as well if folks have

additional questions from the treasurer's office. hi. thank you all for hearing this item this morning. as the findings in this legislation lay out a little bit of this back story, the state passed senate bill 182 a few years back which prohibits the treasurer from requiring t.n. c. drivers to register as a business if they live outside of san francisco. this is in stark contrast to all of our other independent contractors who do business in san francisco regardless of where they live. so the passage of b-182, cut off $1.2 million in essential revenue and undermined our business licensing authority. around that time, i believe supervisor peskin actually introduced a resolution putting us on the record as a city in terms of a formal policy

position opposing sb-182, and our city attorney's office has challenged the validity of this in court. in the interest of fairness, if the lawsuit proceeds, we wanted to avoid a situation where a small group of businesses and t.n.c. drivers who live in san francisco and who are taxi drivers continue to register and pay, even that we assert in court that this law is unenforceable and violates our charter city authority. it is intended to align with the timeframe of the litigation that has actually been extended twice during this litigation period, and, of course, during covid it is even more important that we get some relief and fairness and equity to folks that are on the ground suffering and dealing with having to pay bills, mounting bills. the litigation itself was

actually paused during the ab5campaign but has sincebeen presumed. in the meantime, hopefully we can give some relieve to our t.n.c. drivers and our taxi drivers, particularly the ones that lived here in san francisco. >> chairman: great. thank you so much. i absolutely agree, and thank you for your work on this, and supervisor peskin for his work. colleagues, do you have any questions or comments? supervisor mar? >> supervisor: thank you, chair haney. thank you so much for the overview and for all of your work. and, supervisor peskin, on these issues. yeah, this makes a lot of sense. this, to me, as well. i agree. i just had a few questions. how much, on average, are

the annual -- would the business registration fees be for these drivers? maybe that is a question more for -- >> i was going to say, it would be a question for (indiscernable). >> thank you, supervisor. up until this year, it was approximately $90. however, prop "s," as you all know, reduced the business registration fees for the smallest businesses. i don't have the exact amount on the tip of my tongue. i want to say it is something around $50 going forward, and we about halfed it for this small group of businesses, assuming they're not making more than $100,000. >> it is a fairly small fee, but it is an issue of fairness for the san francisco-based drivers. and how many drivers are

covered, would you estimate, by this? >> so prior to january 1st of 2018, we had about 21,000 drivers registered, which was about 1.9 million dollars in fees, and about a third of those, we believe, lived in san francisco at that time. however, i think as everyone knows, this population is one that changes very frequently. so that is just sort of a apoint in time before we started this process. also, we had about 2,000 taxi drivers that were registered as well. >> uh-huh. and the fee is the same for taxi and t.n.c. drivers? >> correct. >> thank you. no other questions, chair haney. >> chairman: thank you. madam clerk, is there any

public comment on this item? >> clerk: yes, mr. chair, d.t.is checking to see if there are any callers in the cue. for those already on hold, please continue to wait until the system indicates you have been unmuted. mr. chair, there are two callers listening and two in the cue. can we have the first caller, please. >> caller: hi. this is barry toronto. on behalf of the taxi alliance, i want to thank supervisor peskin, and specifically sonny, who i know personally is a supporter of taxicabs and taxicab drivers for continuing the suspension of this fee. we were billed $90 a year for this business license fee, and to not to have to

pay it if our counterparts on the t.n.c. side are not having to pay it. it is not fair that they don't have to contribute to the financial well-being of the city, considering be cab drivers also were paying a driver for hire fee through the sfmta. considering there aren't that many cab drivers out there right now, and to make it worthwhile to collect the fee, and there also aren't enough money to pay the fee and to meet expenses as well. thank you very much, committee. and in closing, i want to say thank you for supporting the green beans contract. the coffee is very good. >> clerk: thank you for your comments. next caller, please. >> caller: hi, chair

haney. this is chris weiss, and i'm the c.e.o. of yellow cab of san francisco. i want to echo the comments that we support the continuation suspension. it is a huge help to us. and it is something we feel keeps our drivers -- one is a minor thing that helps our drivers feel like there is a little bit of a level playing field. i want to thank sonny as well for all of her hard work. >> clerk: thank you for your comments. mr. chair, this completes the cue. >> chairman: all right. public comment is now closed. was there a b.l.a. report on this item? >> no, chair haney, we had no report on this item. >> chairman: great. colleagues, any other questions or comments. this makes sense to me. all right. i want to motion to move item four to the full board with a positive

recommendation. madam clerk, roll call vote. >> clerk: on that motion, vice chair safai? >> aye. >> clerk: member mar? >> aye. >> clerk: chair haney? >> aye. >> clerk: there are three ayes. >> chairman: this will go to the full board with a positive recommendation. thank you so much for your work. and we appreciate it. madam clerk, are there any other items before us today? >> clerk: there are no other items on this agenda. >> chairman: there is no further business. the meeting is now adjourned. thank you.

>>chair haney:this is the march 10, 2021 budget and appropriations committee meeting, and met haney , joined by committee members present

president welton, supervisors ronen, safai andmar and our clerk is linda long . i'd like to thank sfgov tv for broadcasting our meeting do you have any meeting announcements ? >>linda wong: house emergency, employees and the public and board of supervisors in the chamber andcommittee , members will be participating in the meeting remotely. miss mccutchen local and state federal orders. committee members will state a preference and participate and express if theyare physically present . [inaudible] sfgov.org osprey streaming the number across the street. callers are opted to speak when public comment is available by phone call by calling 415655 0001.

then press #, # twice. you will be muted and listening only.when the item of interest comes up you will be addedto the speaker line , call from a quietlocation, speak clearly and slowly turn you down your television . email myself or budget appropriations committee clerk at linda.wong@sfgov.or. it will be included as part of the official file .>> thank you mount clerk. can you please call first item. >>linda wong: fiscal year 2021 2010 in two. members of the public who wish to submit public comment call

415-655-0001, meeting id 20 187 775 3464 and press #, # if you have not done so, press á3. this will indicate you have been heard and indicates you have been on muted and begin your comments . >>chair haney: thank you so much madame clerk and we are joined by the dph team and i believe i will turn it over i think to director koufax. >> thank you chair and thank you other members of the board. i appreciate the opportunity to present our budget to the budget and appropriations committee and thank you for your support during this unprecedented year. it's been a full year since we been in this pandemic. and to acknowledge the many hundreds of people at dph on the front lines addressing this and other competing health

needs. i will dive right into this and then be available for questions as well as other members of the dph team. i will also, we have several other speakers during the slide presentation who will vote in our mission at the department of public health is to protect and promote the health and well-being of all applicants and our vision is an ambitious one, to make sanfrancisco the healthiest place on earth . you can see what we do in terms of the otherbullets on thisline . we do a lot . we as assess andresearch the health of the community , develop and work to prevent disease and injury, educate the public and trained healthcare providers to provide on complex healthcare andensure access fo all to healthcare in san francisco . next slide please .these

activities are reflected in the budget. we are, our base budget is $2.6 billion, healthcare unfortunately is quite expensive and you can see here our big bucket items include the running and management of the san francisco general hospital with over $1 billion budgeted . our 24 hour hospital trauma level one hospitalin the city . another big area of it is in behavioral health, obviously a key focus is in the many competing behavioral health needs in our city which i think is only and further besides in exposed during the pandemic. and then we also have in addition to the other components of the slide, one is the largest if not the largest skilled nursing facility in the country. and you see that is our largest expenditure. next slide please.

one of the key things about the health department that i think isreally , has been instrumental in our work to address the covid-19 pandemic is we are an integrated department. we have 2 major system delivery divisions that san francisco health network which includes the two hospitals i just mentioned as well as the hero health services and primary care these are service divisions where we're delivering care to people and then we have to our population health division which is really when we think about public health and disease control and prevention we are, the environmental health protection, our community health work and so forth so we really have an integrated department which means we're looking at issues with regard to health.

not just from a service guide or a public health side that people are at the table representing expertise in both areas. this is one of the reasons why just like we wererelatively successful with our hiv work , we were able to apply this to covid-19 and we're continuing the work in behavioral health and making the population health side and healthcare delivery side in our approach cover. next slide. so i think like most departments, salaries and benefits are our greatest expenditure. accounting for justover half of our budget . we have a large number of people working in the department, over 7000 ftes again consistent with that integrated department and the fact that we have 24 hour hospitals running in a wide array of service delivery systems that are operating across the city. next slide. so we leverage a large amount

of revenue. our general fund numbers, this is drawdowns from the federal and some degrees of state including and especially medicaid dollars. you can see here the blue bars are total revenues not including general funds and orange bars are the city general fund subsidy and you see variations on this with hospitals zoning down. none general fund dollars to a large extent aswell as behavioral health . next slide. so our key strategic areas or 2123 included in this budget submission are continuing to focus on equity for our patients and staff. and also developing our new medical programs under county which is the states program that will be basically a modernized revised medicaid

program and i'll talk more about that briefly.then under another, underdevelopment with our stakeholder processes are underdevelopment with regard to our covid response and expanding behavioral health programs including mental health sf which we've worked with several of youon very intenselyover this year . and then our overdose response .next slide. >> i wonder if i could ask a clarifying question on that. is that possible? chair amy? >> yes, go ahead. >> doctor koufax, when you say underdevelopment in the stakeholder process that means those two things are not included in the budget submission ? >> that's right. and we will get into more detail about this duringthe

rest of the presentation . but we are working with the stakeholders to further flesh out these components of our budget. >> okay. i justwanted to clarify, thank you . and doctor koufax, if i could just add through the chair, acting cfo, we are underdevelopment our new initiatives related to covid response in behavioral health as opposed to anything already developed and included as part of the base budget for 2123. >> sorry if i didn't make that clear. >>. >>dr. colfax: included is continuing to focus on our task including our focus on

investment to implement the racial equity action plan and we will talk about this in more detail in a few minutes and then implementing new programs under county, it's still very much in development, it's postponed a lot of the state action on this. this is going to take several years and this is really we expect this to shift a lot of the medicaid focus to things such as pay for outcomes and performance . it's something that's been under discussion a number of years now but we are waiting for the state to really put some more specifics to this. and no changes including one year extension of fulkerson care. part of our proposal to meet our target.so calaim is very much a moving target but it's something that we are definitely working with the

state on very carefully to optimize the benefits of calaim and make sure we are prepared and ready as possible and then with regards to creating a sustainable covid-19 response, much work going on here. again, i think the board members, all the board members arefamiliar with this presentation to . to review particularly specific to dph, includes committee outreach and prevention. the all important contact tracing, the continuation of testing, isolation and quarantine . clinical support for the shelter and hotels, information guidance, outbreak management and our clinical capacity and of course the vaccination rollout. so we are continuing to work in creating this in terms of a

sustainable infrastructure support to meet the near and long-term needs. this is obviously a work in progress as things evolve and we're continuing to develop programs with an equity lens. right now this is being developed in conjunction with covid command leadership and other departments that are integral covid-19 response and with themayor's office as well . next slide.and just to build on supervisor ronen's question with regard to behavioral health programs, we're continuing to roll out mental health programs for facilities acquisition and things that we've spent a lot of time talking to many of you about. key areas that expansion for 2023 included expanding services of supportive housing for people who have high behavioral health, expanding

capacity and then these multiple stakeholder processes that will be continuing this spring. with the oversight committee . the mental healthimplementation group , the mayor's office and florida supervisors and ceos and other contracted behavioral health providers will be engaging in these expansion of this work going forward and i just want to be very clear that while some of this work was necessarily delayed because of the pandemic, i see department sees the behavioral health issues that have been brought in to even sharper relief because of covid-19 as a key area of focus as we work to transform our behavioral health system and a firm commitment to ensuring that we both address covid-19 and strengthen our

response in behavioral health programming on the mental health side and the treatment side. and now i'm going to turn the presentation over to jenny louis, are acting financial officer will get into detail with regards to some of our additional budget information. thank you. >>jenny louie: the next two slides will talk about our february budget submission and first i wanted to go over what our strategy approach was as we were developing our goals. first and foremost wasthe revenue opportunities to meet our general fund target . our goal is a safety as well as critical day service is always to maintain services and i think our proposal does not include anyservice reductions . just given the constraints we have in terms of operationally

as well as financially, we are goal is also to minimize new initiatives affecting our key areas of focus. then as doctor colfax mentioned, there are two stakeholder processes that are taking place this spring for the development of a covid-19 response in behavioral health services that are occurring so we wanted those processes to be complete and did not want to create initiatives into silos so those have not been included in our submission but will be developed in conjunction with the key stakeholders. i balance a proposal that outlines to the current year's fund balanceis reported in this expense report and i can go into more detail on the next slide . you have not permitted to an a half percent contingency

proposals but if required to do so we may be required to implement expenditure reductions to meet that target. so specifically, in terms of what wepropose , our evident half percent reduction target was about 50 million over two years. in addition, a portion of our revenue process is already assumed as part of the deficit. and so we sort of need to make good on thatpromise . that was protected as part of the mayor's office and controllers office projections and in addition we have a 2 and a halfpercent contingency . that we have notproposed yet but we are working on . in terms of revenue initiatives our first alignment was really around the initiative that doctor colfax mentioned and we did include the known changes and transitions that we are aware of.

i believe this is 24 million the first year and reducing to 15 million the second year. this is because of the whole person care which was extended only for one year. we are expecting a successor program to be developedover the course of this calendar year but we do not have any details and funding allocations . secondly, wehave two baseline initiatives , first related to general which is annual updates toour future service and our transportation rates . and then on the same baseline increase in year two. we already have a baseline increase in year one and at this point we are not testing additional revenue . in the first year of the budget.the next initiative we have is related to the federal

reduction to the disproportionate share of hospitals area recognizes a release that 51.6 million of deferred revenues that we have held to offset a federal reduction that was scheduled to go into effect december 2020 the late december, is passed legislation delaying effective date till the year 2324 so we've released those dollars in the current year and the mayor's office has approved to put these doors are balancing target . so this 51 million is part of believe hundred 25 million the controller is already projected for support. in addition we also have a one time reserve related to behavioral health and completed a final reconciliation of prior-year mental health cost supports and i do believe this is 8.4. with these initiatives we believe that we met the first reduction target that we have

and we put $1 million down payment on our contingency. and also i apologize, on the expenditure side the only addition is that we are putting forward is implementation dollars related toour racial equity action plan . this is primarily around reporting the training around our workforce and doctor bennett will be talking more about the action plan as well as equity in the department in the next slide. i'll turn it over to her. >>. >>chairhaney: can i ask a clarifying question about this slide ? your production target was 59 million but because you brought in 101 in revenue, you are well

above that so you're not going to make any reductions to your own budget. can you clarify a little bit what approach you're taking here and then what is happening to thenet balancing you have their above target ? is that included in the budget? i'm a little trying to see the approach you'retaking, can you clarify that a little bit ? >> the reduction targets are about reducing a general fund report so it can be achieved in one of two ways.either we reduce expenditures on the general fund or we reduce our reliance on the general fund through the leveraging of additional revenues . so you're correct, we're proposing approximately 101 revenue in year one and about 35 million in year 2. it's a

little bit lopsided how we actually met targets. so in the first year we sort of exceededour target of 59 million in year one . and we are short a little bit of our general fund reduction target inyear 2 overall , between the two years they balance and so it's sort of in the 2 year budget period we have met our target . doesthat answer your question supervisor . >> so to reduce your reliance on the general fund by not much because you're bringing in revenues separately. >>jenny louie: correct. >>chair haney: donna, thank you. >>chair haney: arianna. >> i want to go over briefly the complicated equity that we're doing and try to open it

to questions area and this is just the framework of the equity work that we're doing i the department . it's been out several years at this point so much of this is in place and we're talking now about which parts we're expanding. we are working on 4 different fronts, capacity building including roles for people, new positions, skills training, partnerships, health disparities, direct health disparity goals in our service quality improvement programs and community engagement to set priorities forthose things equity culture and a lot of that is workforce policy, how we're treating each other , how to the workforce works in terms of peigoals and equity training and accountability , how are we recording statistics to communities and our work, what's the planning and oversight so that the work that were doing. in this particular budget there

are resources focused a lot on what the racial equity action plan is calling for and those things arefocused on training, equity training, workforce and data tracking .so training, workforce policy, all those things you will see in our budget. it's less focused on community engagement or health disparities but we will be continuing that work in those areas it's advancing. thank you. so workforce and health equity. we have work currently in both areas and as we know we have room to grow in both areas. in this particular budget we will be asking for funding for new training. policies anddata tracking resources, those are all required by the racial equity action plan . some of that we have in place . we certainly have basic trainings in place but we don't

have the extent that is being asked at all levels of staff. and in some of the areas that are being asked so we need to expand their. policy changes and data monitoring will require something to be put in place doesn't currently exist , in particular data systems around professional development , around the hiring process and promotion, those things are reviewed but not tracked in any kind of consistent way and that will require some things to be dealt . establishing more consistent community engagement standards . it is asked for in the racial equity action plan, it is not as detailed as some of our own internal goals but we need to put resources to it if we want to do the priority setting with community and some of the communication package that's being requested.

and that we agree needs to happen. continue development of workflows and resources to improve quality of care. no health disparities are both about social determinants and things that are outside of our purview that are apart of our local government or part of our social makeup but much of it is also quality of care and assistance care and those things we are continuing to work on . we're going to be working to administer 50 million of the reallocation that's going to for the most part mentalhealth and other resources . to reinvest in the community from those public safety dollars . go forward. thank you. here's some examples of our health disparity programming. there are other things but these are good ones. in maternal child health area we are continuing the work on the dual program that was established with the cbo a few years ago area we're continuing to grow, we're getting additional funding this year and nextyear , food security

has been a major part of our work and its expanded and growing a lot because of covid because the demand of covid required an integration that we had been working for but had not yet achieved and that's in fact trapped. perinatal health disparities, we have persistent ones that we arewith the rest of the country but they have not yet been fully resolved by any means . primary care has several around heart health and food security and other issues. covid in particular is something theyare working on , making sure we have an equitable approach and they succeeded in many ways of doing and making sure the resources they are marshaling go to the communities where it is most impactful for covid. we have some reinvestment of public safety money, things happening with behavioral health leadership i will then decide that board. that's lots of changes around culturally congruent care and

telehealth and other expanded methodologies that might be more desirable to a broader array of communities. basically those that are served and are population health, public health programs, things we have disparities in health education, those sugary drinks distribution and taxes are heavily focused on correcting and equity and all these things are focused on health disparities and everything the apartment is expected to have those healthdisparity goals be expected to achieve. next slide . the racial equity action plan, all the departments are doing across the city we like everyone had multiple areas and i've highlighted one we want to be sure it was focus on that is

particular to us as a health department and in hiring we know we have a long persistent disparity in who are clinicians are so you come from our population itself is mostly black and brown and we look at our providers they are certainly not fast so our managers, providers need to reflect the community that were serving so you have initiatives to correct those recruitment strategies and in our standardization of higher increasing promotion of some staff that we do have in management, because he absolutely had disproportionate numbers of black and brown staff in our levels and not as much of the management management levels collecting thatinternally would be helpful . disparities in discipline have been documented that were working on that call for accountability and standardization of management practices . opportunities for staff for professional whether that's

promotional duties or simply development on track perhaps is different than theone on. respectful workplace standards . you have problems in discipline but there are things beyond discipline that are just in the level of disrespect for the treating each other. some of that is racially mediated and we know that's something we need to work on the record and equitystandards , being integrated into our budget and policy decisions. we're working without permission right now on establishing an equity tool thatthey are going to use that we expect to have in place soon . so i'll just talk briefly about how equity is impacting covid. it's been an issue from the beginning and it was clear therewere disparities early i would say late march or early april . so we've been working to be sure that our services were ableto reach communities that were being heavily impacted . that means letting amenities,

african-american, there are disparities really across the board and parts of the city that we traditionally have equity in other areas. so we will be working with the neighborhood and equity the command center and community branch which is to some degree integrated in the community programs of the health department transparency and accountability and making sure that programs continue to be weighted to help those communities that are most heavily in the end we have seen some success in that in both testing and vaccine distribution . and we're going to talk a little more about covid in particular. jenny, i'm sorry . idon't know who is muted on . class go back and i'll do.

>> you want me to go get it? >> sure. >> can go back to his life for me?>> a little bit of a delay . >> that's okay so the continuum of care , there have over the last year to a really clear and i think will of understanding what the needs are from all areas of the community along the continuum of covid both from prevention to recover and we have built i think fairly robust programs at each of those areas, prevention and education is done by our community branch within covid command but it's increasingly community education at this departmentstandard does . somethingdevelopment, exposure screening , is part of our health education programming and reusing community members and spreading the word about

trying to understand those things what to do to isolate and all of those things. actual clinicalcare testing , results disclosure, hospitalization and care primary bear as well or all things is focused on. case investigation and facing possible department primarily, isolation and quarantine services both supporting that through feeding and all those other things that people require to be able to stay in their house as well as the understanding of how long people need to quarantine and giving them places the poor and see if they are not someone who is currently has been in recovery services that people need to get the medical care for the sometimes long-standing impacts under covidand the other services to get people back to their functional life . next slide.>> jenny, are you

trying to. >>jenny louie: i think there is a delay. sleep well i'm going to talk about. the phones for covid are mainl going into . so we do have many outreach programs, much of that work is contracted out to various community groups. the intention with the community members who had trusted relationships and community had already reached groups that we may , they support testing sites that community member who might not otherwise beable to go to large capacity sites tested in their area in a trusted way . investigationcontact tracing is

also something we want to use . committee members and trusted ceos as much as possible because it is a lot of information and somewhat interested in all this information about yourself and we need people to be honest and open to their contracting with and community care, was going tothe who and who do people trust tell with any plumbing and other things . and then contact tracing, trainingcenters training community member continue that work . go forward. >> good afternoon supervisors, carefully and members of the committee, require the operating officer for dph. i wanted to respond to your message care katie but i have specific questions about contracts and our oversight of contracts process and how it

accompanies. we've been working actively since the controller and city attorney review produced our recommendations over the past year and their integrity and contractingassessment . we have a process going around we're working very closely with the city attorney's office to go through each of those recommendationsthat were produced , evaluate what's required from dph to meet those recommendations also to look at other opportunities. for where we can do better and where wecan make changes to our process . we also have in addition to what we're doing locally within dph a number of layers of oversight due to the fact that our funding as we described it from the previous slides is significantly comes to us through the state and federal

governments and that each of those programs comes from compliance disclosure and activities actually but add a layer to our programs for oversight of our contracts. next slide. >> one of the areas that we are workingon is with our foundations . we have three foundations that raise funds to supplement the mission of the department of public health and we're very grateful for that work that they're doing to supplement our mission. but given the recommendation and the controller and city attorney's integrity, we are really doing a rigorous review all of our processes working with the city attorney to make sure that we are in compliance

that we have the right safeguards and controls processes in place so those are our public health foundations for san francisco general hospital foundation and the new name for the organization. all those organizations are working with us and wish to be in compliance. we with the city attorney's office are updating our mo use, updating our internal processes around how we interact with foundations and the rules and processes around accepting gifts and how we manage that. and we will be formalizing back and bringing that to the health commission as we develop those recommendations so a lot of work there normalizing mou's and our processes. next slide.

i think this is good. also on the acceptance, we are changing our processes. we do post our donors on sfdph.org and refer to the health commissioner on gets regularly and the health commission as oversight over therelationships between dph and our foundations . we've also done a number of things, i think there are a few approaches here but they are process approaches and their changes but there's also the approach of making it part of our daily structure within dph to be cognizant of our ethics and the requirements of all city employees and we really are working to try to get our staff the tools they need to know what the rules are, no one

to ask and maybe to have conversations on these topics so we updated our safe compatible income activities and have training on online review and signatures by each employee. we develop and then further updated our annual compliance privacy and ethics training that goes through all of the local and state ethics rules and each employee takes training really from the health commission throughout our organization. and then we have established a number of communications tools including our regular quarterly compliance newsletter that highlights issues around these types of rules. for example in december we did gets between employees of the holiday season but also gifts

generally as part of the city just so ouremployees have access to regularreminders about information on this topic . next slide . i won't go into the details on this this is to give you a little bit of a sense of we have a real ecosystem of oversight monitoring that is built within our department and that we're kind of continuously looking to developand improve . this goes all the way from the have multiple offices that work at various points inthe contracting process . contract development, our office contract compliancewith reviews compliance with contract requirements . we had our financial goals, we had our office of compliance and privacy affairs evaluates complaints for the whistleblower program and all that is to work together and our approach is to try to make sure we have multiple eyes on

multiple parts of the process and that we don't have anyone single part of the organizatio , almost like an accounting control approach. where you have multiple parts of the department involved in transactions and not too much discretion and authority in any one place. next slide please. we also course at our internal processes you're aware of. city attorney, oca, general service division, controller's office involved in our contracted approvals and our contracts to go to the health commission , to the committee of the health commission for review. the majority of the contracts that dph enters into. next slide. so again, you also have charity

about quality and how we monitor performance in our contracts. we also have a pretty developed system and are always looking for ways to expand and enhance and improvethis . but we have multiple points in our system. we have you and the development of contracts so that each contract and each rfp we are working on thinking through outcomes that we wish to go off including those in contracts that a system of monitoring and auditing to determine whether we've met those objectives. this is always a challenge because there's so many pieces of work that we do that are about healthcare quality and outcomes that are challenging to measure this is a big focus for the department.we also

have our external stakeholders in our programs and we do client satisfaction surveys. we have structured processes for clients or members of the public to raise issues about quality of service provision in the department. these are normal agreements and there's always some of those there and next slide please. on it, we had a close working relationship with the controller's office . this is a little sample of audits that the controller's office has done with us. we always welcome audits and we often ask for audits in areas where we want to make sure that wehave third set of eyes . and then we course on its with the controller's office and we work on those and take the recommendationsseriously area

next slide please . so i think that is the end for that point. i know that's a lot of information i want to respond to the questions that were directly raised charity on contracting and we're happy to provide more information for discussion on those. and i think that concludes our slides so we will be happy to take questions on discussion. >> thank you so much, i appreciate it. there are anumber of questions. i've got someone i will let my colleagues go first . >>supervisor ronen: it was nice to see the department answer the questions enthusiastically

and that was great.i had a horse a lot of questions about the behavioral health funding and implementation of the mental healthassessment and starting with the budget , you had sent me last year when we were going through the budget processa spreadsheet on mental health ss . that basically, i just pulled up the version i had in my home computer so i don't know if that's the latest vision but we appropriated $34.4 million in implementation of mental health in fiscal year 2021 and 34.7 for fiscal year 2122 approximately and i'm just wondering what we're projecting we will actually spend that 34.4 million fiscal year 20-21 and any money that has been spentwith that , then just

lumped into the budget for the next year? i'm sorry, i'm not feeling articulate. does that make sense? >>dr. colfax: it makes perfect sense. i don't have the figure on the projections for actual this yearand we can certainly : tha for you and as you know , from discussions in this committee there are some of those funds that are fully released to stand and other portions that are not fully. on your question on whathappens to the unspent funds , proxy dollars which are the source of funds for those programs are in a special fund so they are self-contained . any unspent dollars will carry forward.

so they won't fall to the fund balance. they won't stay there and be available for future use. >>supervisor ronen: that's helpful, that's good to note. i always love to see that sort of line item budget like you gave us before for the implementation for mental health sf and thus far what you're expecting to spend , the rest of the fiscal year and sort of look at the implementation of mental health sf through the budget because we know that the crisis response team has been, that sort of component the first fiscal year has been implemented but the implementation has gone much slower for the rest of the legislation in the program.

>>dr. colfax: sorry, i was jus going to say , ididn't mean to cut you off . you're correct. i think there will be savings and my mind is going back to last year, i remember we had a discussion the budget process, where going to put it in such a way that the budget would be the source of any delay in implementing those programs. that has been the case. there has not been a restriction. i know that there are some that are going slower and there will be available balance for use for other purposes. other piece is that of course as you know there are crops see funds that when we passed the budget last year were not available because they were still the subject of lawsuits and what the outcome of that

lawsuit, those funds are available so that will be an additional pot of dollars in the proxy fund that was not appropriate and available and we talked about options for those including use to acquire sites but other options are available. >>supervisor ronen: i noticed on page 10 and this is something that we can perhaps talk about in a deeper way outside of the budget sf but the mental health service center is not included in the list of mental health sf. you're calling them an extension of the behavioral behavioral health center and that has been sort of a meeting

of the minds, a meeting of the minds has never occur on that aspect of mental health sf and iteven shows up in the language during a budget presentation . i just want to point out that we had specifically funded many aspects of the creation of a mental health sf service center that have nothappened. it has not occurred so much so you're not even expecting that in the future lookslike according to your budget presentation and that's something that's deeply concerning to me . before i read too much into that , i want to make sure i'm reading it correctly. >>greg wagner: please don't read too much into it. you're correct and you know from our discussions that there is still a lot moving around

the mental health service center and i don't think there's an intentional shiftin any kind of policy here . one of our donations, those are the poor working groups that form mental health sf is around the service center there is a lot ofwork going on . we talked about to some extent so that work and that finishing of the program iscontinuing . i know one of the things and i'm happy to have kelly weigh in but just on the budget, one of the things that we can focus on our first step is expansion which is clearly not meeting the whole vision but that's one step and i think that maybe what's reflected in the language here but point taken. i don't know if marlo or kelly wants to join in .

class i can speak more to it on follow-up questions but that was a good summary of where you stand. >>supervisor ronen: when does the new director start? >>greg wagner: march 29. >>supervisor ronen: and given that you did not include in this budget submission to the mayor anything new for mental health sf, does that mean more of this 21, 22 fiscal year the baseline that we had budgeted last year?>>greg wagner: a 43 million we had budgeted last yearwhere assuming will all continue . and we're not contemplating going backwards. it's really as miss louis had said earlier, it's really what is going to be added to that

program with the additional funds or other funds that were made available back from the lawsuit and forthat , we are working with committees. appointing committees that are invested in that and we are pretty actively having conversations about that and the next month that detail will, but we just didn't want to get ahead of that process when there are people who have been appointed to do that partnership and that's why we delay the process but it will be to come over the experience. >>supervisor ronen: thank you somuch and i wanted to shift gears away from mental health for a minute . just to talk more about the

covid response in the latin community. specifically we've noticed that vaccinations for example unfortunately we are not meeting so that the population of latin text fulton the city withvaccinations yet . in proportion to their population in san francisco. the community was hardest hit in san francisco so i'm wondering if there is a plan to specifically in the budget focus in on the latin executed interms of continued response ? >> perhaps i can provide some context.

absolutely as part of our community response we, it is and will remain the focus going forward. as we continue to expand aspectsof that , dph we focused on neighborhoods with greatest need in covid-19 and if you look at the data with regards to whohas been eligible for vaccine by criteria , wheredph vaccine is going , we have a higher proportion to the southeastern part of the city and compared to vaccine administration overall, within dph has administered vaccines we are the higher proportion of vaccine administration to populations 65 and older and the black african-american community compared to the population overall this is obviously driven by the fact that vaccines workers

implemented for healthcare workers 65 and older so that proportionality is very much dependent on some of those numbers . and as we go forward we will continue to strengthen our relationships and communication and are access points, really every door is the door for vaccines area our sites will continue to be key areas where he will provide access for people to go. our clinical sites? for instance san francisco hospital people are eligible for the vaccine and drop inwith the highest rate , they can receive vaccine and we will also be extending our neighborhood access sites so that in areas with the highest prevalence will have access as well to multiple sites for people who arehomebound this ecosystem of care , of vaccine administration is going to be really key and we're working with command to make sure the community and equity branch,

that the latino communities most affected have ready access to the vaccines. our main issue right now as we don't have enough vaccine right now in san francisco we are poised to do well over 10,000 vaccines a day and again, we just need more vaccine to get into arms. within the dph side we obviously received between a quarter and a third of vaccines coming into the city. we can certainly show this data on follow-up within our testing supply we are appropriately reaching the communities most at risk. obviously we need to continue to improve on that right now our numbers are better than the vaccine administration overall seen by our other health providers. >>supervisor ronen: on monday i was at the 24th and which is

amazing and a really great partnership between dph. and what's striking in talking to the latino task force on covid-19 and you can see it everyone in line for the most part was latino is they literally went to every business, every food establishment on mission street, on 24th street, on 16t , on valencia and said you are eligible for the vaccine . right down the door, and out the street and we will vaccinate you so especially for service workers that works really well. just putting a vaccination site in the middle of a hard-hit neighborhood where there are

tons of service workers and dragged into the vaccination site and i'm just hoping that more efforts like that can be placed in communities particularly since since the 24th i know my office is working very closely with the latino task was to put others at 15th street. and create partnerships there at different parts of the mission given issues that exist in the neighborhood. really hoping that we can work together to not remove that but add additional sites. is that something that'sgoing to be possible and is not requested in this budget ? >> it's something we've been partnering with on the task force from very early on, from testing canal vaccines and something we're engaging actively with them with regard to where other potential sites

both in the mission and other parts of the city where we can expand your talking to other community partners and other parts of the city where there's also agreat need . that part, are vaccine expansion , that conversation and the budget pieces on that underdevelopment in collaboration with command and the mayor's office and we continue to work to expand our vaccine access so not directly reflected in these numbers yet but while we specifically caught up to the response and expansion of mental health, there's work on the progress but it's certainly shares the, we share your concern on these priorities anywhere working with key partners to make sure as much as we can can recognize the mission we all hold which is access for everyone who needs a vaccine as much as possible.

>>supervisor ronen: thank you, those are my only questions. >>chair haney: supervisor safa . >>supervisor safai: i want to start backwards in a series of questions i have to build back to the last point supervisor ronen brought up with regard to the what tino task force . i know they have been also done amazing work in my district as well and i know they've done tremendous work for dph but it brings the question about one of the shortcomings of dph as doctor colfax in terms of not having a robust spanish-speaking latinx staff to deal with this and if not for the task force stepping up we would have been in bad shape so question becomes in terms of the equity lens that you're looking through and some succession planning as we move

back to normal, what is the aggressive plan to ensure that we have appropriate staff at the mid-level and managerial level and engagement with black and brown communities, appropriate staffing is extremely important and having that is extremely important to build up many of the successes that community driven. >>ayanna bennett: the lack of representation for black and brown staff at the managerial and in our clinical services or clinicians, that means that people who may be doing these kind oftreatments on activities that we want to see . it is not proportional where we wanted to be and we know that. what we tried to do over the last several years is look at why that is and we have done some work to understand that

better. but that is in recruitment and some of it is in the lack of folks in the pool that is reflected both in who is in the pipeline programs that we do know. that would be some of the city college tech programs that we could be getting people from. some of the nursing programs that we could be getting people from . they all have lack of diversity in them but we have more than we do so partnering with those groups and taking our hiring and recruitment process as part of our goal, it's part of the equity action plan and its where were going now. right now we're working with clinicians and with the primary care department on whatever hires they have which are a reasonable amountto make sure that we have the kind of

candidates that were looking for to fill those positions . we got a workforce equity director last year and is going to be a big project to do this. it's quite a lot of change or the apartment in terms of positions and policy so that is where we are right now and it will take some time to fix but we do not it's a problem and where building the infrastructure to fix that ren right now we were dealing with that is contracting with our community-based organizations . and trying to convert what we can of those positions to slightly more long-term, not all civil service and as it comes upwe try to get people in them . that is a band-aid right now in terms ofhaving people represented . >>supervisor safai: you do have in your equity plan that part of your strategy but maybe some of it also and again, i'm not going to tokyo at divisor equity plan, you have some one that's designed to do that and you have a staffer in an equity office, is that correct doctor

colfax? >>ayanna bennett: >> in my team is adirector of workforce equity . >>supervisor safai: so then you been producing the equity plan, i knew you were health equity, i just wasn't sure if there was physically an equity officer overall for engagement of staff and so on but that's great, i appreciate that. so then my next question would be there's also opportunities to do more contracted work with community-based organizations. that already have the infrastructure so could you speakabout that for a moment that could then also help fill in some of the gaps . besides waiting for the train of people there's already a whole infrastructure and if you want to speak about that for a minute. >> that is the interim plan and that certainly has been the approach that we've taken with

covid, that was not going to happen if the patient was needed so it was clearly eliminated and right now some of that funding is already flowing. there are plans or how to convert more of what is being carried by others and perhaps not conforming staff to those contracts and that is in the planningthat we have going forward . i don't have the details of where the sellers are. the one. >>supervisor safai: clinic question would be ins instead i'm going to shift focus. you might be aware we had a hearing in february regarding services and safety and the intersection now any of our criminal justice system, repeat offenders and those with significant substance abuse

issues. one of the things we've heard a lot of as we've been doing research leading up to the interim and after that particularly from the black community was that abstinence-based care in the substance of your small that you all have. our system is more based towards harm reduction, not necessarily about abstinence which is what from hearing from the community can be more effective than in black and brown communities and i wanted to hear if you're aware of this and was there a plan to engage and how more engagement about this type of service delivery. >> i think i can recommend that doctor bennett. >>ayanna bennett: i am aware of trying to make more culturally appropriate and that's based on

actual asking of the communities in san francisco what they want. we are making efforts todo that . that's part of the behavioral health equity plan expanding racial equity action plan within those communities and health objectives. i would not be the best person to give you the details of it, they have an equity chief of their own works with me and also bar lot maybe is the better one with the details but yes, there is a plan on how to redesign substance use services, i don't know. >>supervisor safai: who is the person that part of the mental health equity plan? that would bethe right person to have that conversation ? >>ayanna bennett: doctor hammer could be the person, sorry about that director. >> good afternoon. this is allie hammond, director of care for the san francisco health network and i'll answer

your question supervisor safai. after the hearing that you referred to, we had reached out to leaders from the recovery summit and the committee-based organizations thatthey represent . to begin the conversation about how we can explore options, abstinence-based substance use treatment programs and we can explore those two basically as doctor bennett referred to close the identified gaps that we have in our services, not just in terms of treatment modalities but also treatment programs, diverse treatment programs to serve the black and african-american communities

and that are in bayview. we approached them and in other neighborhoods. we approached them, i think we had a good meeting. i think we have a lot of work to do but we are very committed tobridging the gap . and then you asked about who doctor bennett was referring to, she wasn't occurring to me, she was referring to i believe jessica brown was the lead on the office of workforce development and equity in the behavioral healthservices . >>supervisor safai: obviously we would be concerned based on my previous statement about also about the latin american and latinx communities and how this plays itself out in terms of abstinence care but also potentially the way you all do your rfp process and substance

abuse care how can be done in such a way to make some space for that, how it couldbe more inclusive for these communities . doctor colfax, did youwant to say something ? >>dr. colfax: just following up with doctor hammer. we hear the concern that we will take this to task. to add that abstinence is part of our continuum ofrecovery program . there's a potential need to expand some of that but we do have that component in our recovery programs in our system of care but certainly we will take this back under consideration so thank you for the feedback. >>supervisorsafai: i don't think it's reflected in your rfp process when you are doing your work for substance abuse .

i think that health 360 gets a significantportion and a lot of that model is harm reduction , a lot of the, you've all invested time and energy and yes there is a continuum of care for accidents is arrogant talking about the pure abstinence-based peer-to-peer alcoholics anonymous, narcotics anonymous that are in a residential setting so we have proposals that we're working on budget wise that we're doing are going to bring forward and important conversations, we just wanted to put that out there andwe think it's an important part of this conversation here . i appreciate that. my next question and this will be, i only have one or two more is with regard to mental health as staff, i know you all have community working group one of the things again just going back to intersection allergy

between incarceration and substance abuse and incarceration and mental health issues, there did seem to be a feed on the design for someone thatwas incarcerated . can you talk a little bit about that and how the final working group groups were created. i know that you and others spent a lot of time working with their departments andit's just something that jumped out to my team and i wanted to see what your response was .>>. >> dbh didn't like the law supervisor . >>chair haney: i just wanted to see, it just seemed as though three out of four people were on probation in some form or another and with mental health and other issues it seemed like

it would be something that could be helpful. normally incarcerated, you probably need some representation. >>ayanna bennett: there's a coalition of service providers to create mental health sf and the working group was kept active withany interest in mind and there is some representation on that group . from organizations and people that work a lot with incarcerated populations so it didn't get, you know how these working groups work out that everyone and their mother wants to see and if you put too many seats on them, no work gets done. so that's how it happened but dph did not have a role to play in creating this escape for mental health sf. >> i wanted more of their, i knew you guys had created this is not in any way a slight.

i just wanted to see whatthey thought because three out of four , there seems to be a lot of intersection allergy between our incarcerated community, i want to see what they thought in terms of obviously you guys went to a large stakeholder process and there's a lot of people weighing in but i wanted to see what dph thoughts were on that in terms of having some type of overlap with maybe a seat that hassomeone normally incarcerated . it seems to be some, it's coming up over and over. >>dr. colfax: i'm going to have doctor hammer providers perspectives thatanswer your questions . >>supervisor safai: maybe it's a separate group of formerly incarcerated to deal with some of these issues.

>>ayanna bennett: i'm going to divert acting director simmons to answer that and after that i have some thoughts but i am a member of the implementation working group so i think it's more important that marlo simmons been working closely with the group that she answer the question. >>marlo simmons: as you know behavioral health services as a very robust network services were people who were involved and have grown a lot over the last 3 to 4 years and mental health sf is explicit in calling out the population coming out of jail as a priority so we work closely with the staff at our mental health and also all of the probation and parole folks and in particular straight crisis response. i'm sorry, not crisis response, care coordination happening

with the office of coordinated care. helping people that are transitioning from jail is one of the first groups that were prioritizing. so idon't know that , >>supervisor safai: i think kind of a larger macro from this and yourself and mister colfax that there seems to be attention paid by only point wasóin some ways there needs to be some proof that you all have a working group working with the formerly incarcerated or some of these larger models to try to create people to work with the working groups to create a seat where there might be a dual partner and some of this isformerly incarcerated . substance abuse because this is something that it's a reoccurring theme and i think that voice is missing. that was my only point. i do have one question, one last question for you doctor

colfax this goes back to the conversations we are having about the emt program, citywide emt program, what division does that fall under on the slide that you had in terms of where it falls on your budget and what section of your agency. >>dr. colfax: are you talking about the ones that program? that isunder population health division . so. >>supervisor safai: can you pullthat slide back up so we can see what section of your budget that's in ? i can understand a little bit better. >>ayanna bennett: i'm working on it right now. >>supervisor safai:you said population health . >>dr. colfax: if you look under the population health division

you see the emergency medical services. that is one of the ones in their. >>supervisor safai: it's hard for me to see it. >>dr. colfax: it's under population health, it's on the far right in the box on the far right. >>supervisor safai: got it. andwhat percentage , how much of your budget is allocated to that emergency medical service. >>dr. colfax: i don't have that in front of me but i will defer to your chair minor and if we don't have it wecan get it to you before the end of this process . >> one of the, maybe the, one of the things is that that hasn't always been part of your department, is that correct? it used to be part of the department of emergency

management . >>dr. colfax: that's correct, it was part of the public health department andemergency management and it was put back in the health department >> . >>supervisor safai: so it hasn't always been part of your division and is that something you feel is fully integrated in the sense that you allocated the money and there's been quite a bit of back-and-forth in the fire department and you and i have talked about that and we're going to continue to talkabout that moving forward but i guess what i'm trying to get is does it seem to fit 100 percent in your department, it seems as though it's really a 911 function and i'm trying to figure out , i guess my overall statement is you guys have a very large bureaucracy. you have a very large system of management and a lot of that has to do with public health and i'm trying to wonder if

that is the right fit for your department . if not department of emergency management, i want you to contact comment on that for a moment . >> i'd say thank you, i would say that the, it is an emergency responsedepartment . it's not, it has not melded as well as i think we have anticipated with regards to the population health function. and it's clear that within the department of emergency management with the responses that the 911 calls that there hasn't been a disconnect. as a result of the transfer between the emergency medical services as currently constructed under the department. and with fire.

>> it seems to me it's a little incongruent based on your stated mission with all the areas of focus you have and your expanded responsibilities, it seems to fit more neatly under department ofemergency management so i just wanted to get your thoughts on that . we can have more follow-up conversations but for the integrated approach for fire, 911 and emergencymanagement , it might be something that fits morbidly back over emergency management and again, part of my conversation that in this instance is trying to not trying to reduce the responsibility that you have what you have so much responsibility and some of it is not necessarily part of your primary core function. so anyways, that's mylast statement and i appreciate it and we can follow up . you are on mute, mister chair.

>>chair haney: president walton and. >>supervisor walton: the entir team, thank you for this presentation and i have a few questions . how much staff does the department have? >>dr. colfax: as we presented on slide five we currently have 7163 ftes across our care and delivery. >>supervisor walton: just so i'm clear, you have 726 thousand $300 of your 2.6 and other budgets going towards racial equity for 21 and 22. >>dr. colfax: i believe that's

correct. i can have jenny or greg. >>jenny louie: in addition to the current funding. the staff is already there and dollars thatalready existed . >>supervisor walton: what that amount, do we know ? >>jenny louie: i know the staff but i don't know alltheir salaries but we can get it for you . >>supervisor walton: from my calculations and math has never been my best subject we're talking about .002 percent of your budget for 2122 on towards racial equity. so i'm wondering how we implement a plan that affects 7126 employees and probably more with .002 percent in the budget. >>ayanna bennett: it's a big

list . i will say what you're looking at right there does not reflect the entirety of what's available because we have not started it this year so there are designated equity staff at both hospitals and primary care in every area there's at least one part-time and the larger area there's some full-time. some of them have additional staff. there certainly can be councils of champions and other staff that we designated to work on these issues. the training needs of that racial equity act with action plan accelerate what we're doing with our current resources quite abit so it is a large left . we think we can do it with the additionalstaff that we are in place . there's going to be a lot of data development which for the most part we're going to try to do with internal resources and it's a lot. it's a lot in fact we do already have some resources in place.

it's ambitious you are correct in that . >>supervisor walton: we know it'sambitious and heavy lift, what we just put more resources into the work ? >>ayanna bennett: to we thought we needed. i did not pad it, make it extravagant but i can use whatever i can get so we certainly can rethink it in terms of how much we have in totality and letyou know what the entire picture is and we will have a better sense that i think . >>supervisor walton: i know we talked about a lot of our black and brown employees getting entry-level and lower-level positions. how are you going toprovide a pathway or employees of color example ? what's the actualplan ? >>ayanna bennett: there's several strategies . the first is that we believe there is some element of bias

that happens in all of hiring. i think that's not for us but everybody. so standardizing that process to manage that as well as we can. we already do as we started this years ago at this point asking people to get trained in antivirus hiring and being aware of who's at the hiring panel so it's been in place for several years. what is it necessarily in place is the screening of candidates. it's not necessarily a standardized recruitment, it's not a standardized so getting those things to be more enriched with people from different backgrounds and to make them more fully directed our internal staff, we have black and brown staff who could fill these positions. we justdon't have clear pathways . we're starting with the places we know that have gotten trapped at one level.

we have some known classes where there is a ceiling where the lower levels of that class we don't see promotions path that for some kinds of staff. particularly black staff but all staff so we're working on those in particular those will start relatively soonlooking at standardizing those . the plan is still being developed with our workforce equity director. that is what's going to start andthat should expand to everyone . in terms of getting professional development and performance reviews and other things inplace , that would help those staff know the skills that they need to get to the next level, develop those skills to manage antivirus managers and preventing them from documenting those skills. those are going to be worked on

so there's manager training, manager for equity series coming up andputting some conflict processes and other things in place to do possibility for managers . so in the racial equity action plan i can give you more details to move forward hiring and promotion. >>supervisor walton: into 2018 and early on in conversation, we talked about the department has a recruitment plan in place as to how they were going to hire, who they were going to hire and all these components and has ever been developed? we've been talking about that for 10 years. >>ayanna bennett: i think it has been in some areas. so we have some plans of going forward aroundclinicians .

some have gone forward on the population healthside around some of our community physicians . i don't think, what has not happened is the standard across the department. those are always challenging because we have very different areas of the department operating at the hospital and environmental health are two entirely different animals so getting that standardization has depended on having a network infrastructure for people to be accountable for i those areas and we had just developed in the last few years so that is where we are going . >>supervisorwalton: what do you think the timeline is to have these policies developed ? is it important to have something in place that illustrates also for us as other party leadership and support what the plans look like.

>>ayanna bennett: i think in terms of where we are trying to recruit from which classifications we are focusing on, i think that's a matter of months. right now are focusing on the hiring policy and the training so we are trying to get those people in. are not expending energy to pull people into a broken system will have a which has happened in the past. we're telling people we haven't really developed antivirus hiring and support that we that's why we see people leave on probation and the separations that are out of proportion so we're doing a little bit ofinternal work around making sure we have accountability systems for managers in place .that policy about respectful workplace andcomplaints is in the works right now and we have to ask them to put in place in the next few months . i would say in all of that

background support this fiscal year i can imagine and we can talk about who it is we're looking tohire and where were trying to get them from . i think we already know to some degree but i don't think it's been as articulated as it could be. >>supervisor walton: last year i know you have several resources for covid response, are you going to continue to support this program with funding for vaccine clinics? you gave resources to ceo tobe able to provide those services in communities . that included in those resources for these organizations still included in the budget moving forward ? >>dr. colfax: i will let greg wagner had had more to this . basically this is exactly the covid-19 budget that we're developing to ensure that there are various supports for the community response and vaccine

rollout as we discussed earlier i will let greg wagner or jenny louis talk aboutthat process . >>greg wagner: yessupervisor, thank you for the question . i'll let ginny waitin we are in the process right now .the process is being led through d3 citywide from themayors and comptroller's office . withineach branch , evaluating the needs and for the coming fiscal year and as you will recall where you mentioned last year's budget we had a one year budget and now we're refreshing and doing some projections for what they need for the coming year so that process lacks, the budgetselection we made in february . we will come together in the

probably the late spring. with the citywide budget for all those topics that you raise and the funding that you raise is part ofthat planning process . >> back to you this is my last question for now what do you have in place for employees other disparities gaps in pay and investment. >> right now i don't think there are adequate internal supportfor , where thisemployee resource groups . those are at least one or two areas of the that are starting to develop those and if we get that model going we will spread to the rest of the department so that will be peer-to-peer support . in terms of supporting people in pay other things that they feel are not being equitable in

the area, one of the things we're trying to do is develop what the complaint system is outsideof eeo and labor . we don't really have ways for people other than big formal things that have real high bars or what the real problem is to really look at those things so that is one of the policies and developed right now. it's being wrapped around a respectful workplace policy which is hopefully going to fill the void of all of the lack of respectful behavior that might reach the bar of eeo, doesn't quite violate labor and that could be expanded to include other ways in which peoplefeel like things are not fair . they don't really have a pathway to make those complaints at this point. so that's what we're developing right now 's i think as one of our larger departments and one of our most resource rich departments, you should be

setting an example of racial equity, how to address the disparities onissues that exist .because of the size and resources. so hopefully you all can come up with a lot of strategies and really start implementing how we're going to achieve racial equity. within dph because i think that will be important for some of our smaller departments. >> president walton, supervisor mar couple of questions, actually one is pretty broad and one is specific. on the wrong question, doctor colfax in the beginning, you highlighted that one of the strategic priorities on the

junior budget is going new medical health programs under calaim was in one of the slide jenny shared, if i understood it correctly the projected revenue increase of $39 million over two years. i just throw that number down as a result of these changes. i don't know if i understood correctly but i realized that it's obligated but i was wondering if you could just provide a little more description about what calaim is and how it would impact services to patients in san francisco and how that impacts the budget again if iunderstood it right, i think it's going to be an increase in revenue . >> acting supervisor and i'll let ginny talk about the numbers simply but just with regard to calaim, we would have a lot more specific about

calaim the state was working on it's very intensely and now it's been significant delays. there are two key components to calaim that we are hopeful on and again this can be worked out. one is to think on a positive scenario would be there would be more flexibility in how cows dollars can be spent so that services that may not have been historically reimbursed, supportive services that we know are so important to help whether it's mentalhealth or behavioral health .that would be supported in a way that for instance case management services potentially even more flexibility around food insecurity issues and so forth. transportation would be supported with calaim dollars,

with medi-cal dollars and there's a stateconversation in the federal administration , there's i think more flexibility could be potentially realize you the second phone it is bringing what we call a value-based approach to care and i think we have to be awful about. overall we are supported and particularly with local populations with these chronic conditions and multiple socioeconomic challenges, we want to make sure it's in a place that is basically value-based performance or pay for performance set the outcomes are tangible and reachable and things that allow us to draw down a positive outcome.rather than a more of a pay for services, there's going to be more of a focus on outcomes and paying for

outcomes and we expect that will be a transitiontraining . it's challenging in terms of determining what those outcomes would look like and what the payment would be but that's the vision of calaim going forward so the increasedflexibility and in a more specific outcome focused , the medicaid program with those value-based and a4 performance programs. that's the what we've got so far and details are going to really matter here and that's why we're engaging with the state on this and then i'll let denny or greg talk about the $39 million figure that you brought up. >>. >> and happy to take the question so as doctor colfax mentioned there's asignificant change will be happening .we don't have sufficient details to understand what impact will be our budget commissions include three known changes

that we're essentially either extensions of programs that we are expecting to hire an adjustment to a matching requirement that's created a benefit for counties and then the one-year extension of the whole person care, need hs mentioned in the last presentation which is the shared benefit we have between other city partners. so the first year we had about 25 million in the second year we have about 15 million so 39, i think you're looking at. we will continue to looking at what the state will provide. for the next months, probably the most, the program that we will likely see those details come out, sooner rather than later would be exploited to the successor to the whole person share program. we've reached initial details but we won't get specific funding mechanisms for rate

settings which is basically county allocations until may or june. so it's something we're going to be watching carefully and in the meantime we are assessing our current programs and we have a broad framework and we're trying to understand what our current programs look like and then repairing for a fundamental shift for two value-based payments. it's one thing if we're trying to focus on service outputs and volume-based payments purses looking at outcomes and making sure we have the infrastructure to be able to track the report and again, where not quite sure what the mechanisms we will need in place to ensure that we can draw down this but the good news is that the current waiver that we have did have significant focus on value-based payments and we

have some of the infrastructure in place that will be required additional shifts andoperations but again at this point , until the state releases additional recommendations on multiple health plans we don't have much detail at this time. >> thank you for that and yes, it sounds like there are pretty significant sort of shifts in how calaim patients or folks on that will be served in our city and they have such institutions to be really interested in continuing to monitor those and engage. and can you just mention how many folks in the city are talking about that. and would be impacted by these changes can mark . >>.

>> it depends on how the programs are developed. i don't have the managed-care numbers area i don't know if you have it at the top of your head. it may be defending, if not some programs may not be for all calaim beneficiaries. that focuses on again how they actually roll out. >> we will get you that data in the thousands. i have in my head the numbers in our network but they are beyond that there served in other systems but i don't have, we can easily get that. it is a large portion of the population that's served. >> thank you and just my more specific question is about the crisis stabilization unit for children and youth. dph started off as. in 2014 i think it was at edgewood center for children .

you know it's extremely important and unique services for children and youth experiencing severe psychiatric and behavioral health crisis. so i just wanted to see area i know there's been challenges in sustaining that program and democrats otherwise the last few years but iwondered if you knew the status of that or whether that's continuing in the budget . >>greg wagner: i will have jenny get an update on the budget piece on that and when jenny's programming alter to director martin. jenny, i'm not sure, maybe

marleau you could talk about the program and i don't know if you heard if you could update the supervisor on the budget line there . >>marlo simmons: i can add obviously had a very tough year couple of years ago and i can ask for and get you information on any recent updates. i haven't heard anything since they started opening and taking referrals. it's been quite a while that's been happening and there hasn't been anything new to add so they are still in the budget and still doing that service. >>jenny louie: i believe the funding is in place but mister wagner has more details onthe contract . >>greg wagner: echo what marlo said and the funding is in place but there were issues around the process that contract so we will as marleau

said get you more details on what's going on but i know a lot of those issues and corrective action plans of the department are required or delivered. the deliverables under the grant programin florida , supervisorsapproved as an interim measure . we were working with edgewood on the corrective action plan. it has been met with the potential of the final deliverable and we will get you an update on that one as well we will get a much more stable situation than last year when we were atthis point . >>supervisor mar: i don't have any other questions. >>chair haney: i have a few. the first thing i wanted to ask and i noted that i have discussed this i think with many of you before and i just

wanted to flag as something that i hope to see in more detail in your budget proposal that comes in front of us in a few weeks or months. and that's what we are going to do to stop the explosion of overdose deaths, particularly of antonello in our city. as you know very well we have three times as many people die of overdoses in 2020 and died of covid-19 and of course i understand and support the huge focus and effort we are giving to prevent the spread of covid-19 and save lives but th explosion of deaths has continued into 2021 . in fact we had a much higher number of deaths in january of this year and in january of last year.

fentanyl in particular is a huge concern of mine. i really would like to see a much more specific and built a plan to address the fenceno crisis in our city . we had 11 people die of fentanyl in 2015 and in 2020, it was over five. that level of growth in one cause of death i think has very few precedents in our city and is a public health emergency unlike many we've seen. so i know that your slide identified areas of focus on this including expanding services in permanent supportive housing and overdose prevention and response. i wonder if you could speak especially doctor colfax, what

your sort of general plan is around us and i know that hopefully we will see more details in the coming weeks and months but i really do think that we need a response that matches the crisis we are facing or we are going to just continue to see this growth that we've seen over the last few years and it's happening right in front of our eyes and i really look to you all as experts to bring us forward solutions and the resources that you need to be able to reverse this really just terrifying and deadly epidemic that we are facing in our city. >>greg wagner: just to reiterate that we share your concern and the public's concern with regard to this incredibly tragic and

concerning crisis. we will come back with more specific proposals and as you know we continue to expand our overdose prevention efforts. we have expanded our treatments with other substitution therapies but we certainly need to continue to do more and as part of mental health sf and other initiatives i think we will come back a set of initiatives that i think both evidence-based, innovative and also trackable in terms of outcomes with regard to that and i do think that in response or following on supervisor ronen's questions with our new behavioral health director doctor hillary coons will be starting this month and comes with a wealth of expertise and overdose prevention efforts.

i think we are moving inthe right direction . the covid-19 pandemic intersected with the overdose pandemic making things even more challenging but certainly that's a priority for the department and a priority for our team and i will turn to doctor hammer to provide any additional comments but we will return with more specific vocals to put these on the top of the list ofthe department's response . >>hali hammer: thanks doctor and supervisor amy, i want to start by saying that we share your sense of urgency this is terrible , terrible problem. it's really a crisis we all have to both joined together and i would say start taking outside the box, building on

the things we know work really thinking of approaches to this problem. it's just unacceptable and also i want to say i appreciate your partnership and your working with us to figure out how we use data, listen to the voices of the people in the communities most impacted and develop interventions that we can evaluate and makesure they work . one of the things i'll say and this is certainly not the only thing that we are hanging our hat on by any means but in 2020 we had approximately 4000 overdoses reversed by bystanders in san francisco and that an incredible number so while we have an acceptable anticrisis point number of people dying from overdoses and going to the hospital cause of

overdoses, we also are getting a lot thrown into the hands of peoplewho live with , you people you've seen using opiates and i think our teams on the ground, incredible community efforts to teach people how to prevent overdoses and then reverse it when it happens. as doctor colfax said, our work is really around both removing barriers to treatment and we don't make it easy enough to get into whatever kind of treatment is amenable to the person who gets to that place of readiness so we want to remove barriers. also want to expand treatment options as we spoke about earlier as supervisor safai and so we can share specifics but

we really have i think a team of experts in addiction medicine and public health experts who are developing this new really innovative approach. i think lots of innovation but also engaging voices and community we had heard before and have engaged before so we can bring back this work to you and show you what we're hoping to implement and that we will be including in the budget but again, i want to end by saying we are all just in place of horror what you see every day in your district and what we see all over san francisco and know that we have to try some of these things in order to let this particular curve in terms of reversing these trends,

reversing disparities and ending this health disparity. >>chair haney: thank you for that commitment from both of you and for your work and the work of both your teams and i look forward toseeing those plans . as early as i've said many many times in many hearings and many legislation and everything else that we've done that i really feel that we need solutions that are as big as the crisis that we'refacing . otherwise things will continue to get worse. i think we've learned a lot, i hope all of us and you all probablysurely more so than me , from the covid-19 pandemic in terms of how to respond to it as a pandemic and i hope that we can bring some of that same morning to how we approach fentanyl and deaths from overdoses and i really do

appreciate all of the work. 4000 reversals is extraordinary so many people whose lives were saved. it also suggests and reflects the fact that the problem is much larger than the 500 people who tragically and awfully die . this is impacting many many thousands of our residents and many thousandsevery single day at risk of dying . so just the is just you and i know a lot to put on your shoulders but in reality this is a public health academic and it's on your shoulders and our shoulders i just want to be clear that i'm not going to be able to support a budget moving forward that doesn't this year take the level of action and priority and strategy that is needed to confront this crisis.

>>. [please stand by]

>> supervisor haney: thank you

talk to this a little bit, dr. colfax? i've brought forward treasure island as a general thing with not only covid, but i hope you and your team can keep an eye on treasure island because this is a neighborhood that has a lot of public health needs on the island, and as we're seeing from the vaccination rate on the island, that does translate into less access to help treatment and the vaccine, but it goes broader than that. so can you with sort of the funds that you have, the $5 million, how that's being distributed equitably and if you can share anything how we're responding to the crisis in the tenderloin and the high case rates here? >> sure. so thank you, chair haney, and just a couple of things. the 5 million, those were

distributed through an r.f.a. process where organizations were working with the highest covid-19 burden were eligible, and just to emphasize, that was to supplement and augment -- that was to augment the other efforts that were going on through the many community based organizations that partnered with us in our covid-19 response during the pandemic, so just to emphasize that piece. right now, we don't have enough vaccine, and we're going from people most likely to die, teachers and health care service workers to food service

workers. so people who have received the greatest number of vaccine are those who went earlier. we are expanding vaccine access across the city, including in your district. with regard to specifically in the tenderloin, tom o'dell clinic is starting -- is vaccinating, st. anthony's is vaccinating. we're also allowing or providing access to people in certain zip codes in the tenderloin to allow them to drop into zuckerberg general and get vaccinated, and we're talking to the consortium, st. anthony's to figure out when we have vaccine available, we can expand there. and then, we have our mobile sites, our mobile teams that can be deployed.

at mobile command, roland pickens, who is our san francisco health director who has been designated as director of mobile command, he has been getting vaccines into arms as quickly as possible when we get enough vaccine. so you have our commitment to ensuring that, in your district as well as in other districts in san francisco, where there are populations that don't have access to vaccines through their health care provider and/or who will not go

[inaudible] including right now, as you've pointed out, in the tenderloin. d.p.h. has, again, control of a quarter to a third of the vaccines that are coming into the city, so our efforts, unfortunately, are not inclusive of all the other health care providers, but we are working with the health care providers to make sure that we have a coordinated response. and again, for more details, we can have mr. pickens or covid command to pick up details as part of follow up. >> chair haney: thank you for that. i appreciate it. and, you know, i do think that we are going to get to a point where we're really going to have to be meeting people where they are and particularly in the neighborhoods who might not

have enough access to technology or are disableds, and so making sure that we're deploying, you know, those resources and doing the outreach and those kind of things is important in the tenderloin and treasure island, or those two neighborhoods, and there's probably more, as well. the last thing that i wanted to ask about, and we've had hearings on this before, is around extort of staffing ratios at -- at general hospital, sort of general, sort of nursing staffing and other sorts of staffing in the more clinical settings. is this something that you all are looking at in this budget or helping to address in any sort of way or filling those positions? i know there was some conversation there about hiring, as well, but i'm wondering how you're looking at

kind of general staffing and ratios, particularly in sort of more health care settings and how that's reflected in the budget? >> so thank you, supervisor, and i would say -- i will say that, as we scaled up our covid-19 response, one of the things that we were able to do was lots of work from people on this call and others, particularly as san francisco zuckerberg hospital and our h.r. leadership, we were able to hire a number of nurses to address what had been chronic shortages there. i can also turn to jennie and greg with more information on this upcoming budget. >> i can respond to that. thank you, supervisor haney. a lot of moving pieces on that question. as dr. colfax says at the

beginning of the pandemic, and we have been leading up to it, we did put in an expedited hiring process in place. there are two factors that play into, i think the question that you're getting at. there's the budget and the funding available, and there's our ability to get permanent hires into our budgeted positions, and so both of those, we have been working on. we established the expedited hiring process, and we have -- we'll get the updated data, but a lot of registered nurses through that process, reduced our vacancy rate significantly. at the same time, one of the things that we're seeing is since a year ago, we have had an increase in the number of our staff on leave for understandable reasons, and so

those are offsetting factors as we continue to try to get the ratio of permanent staff up. we do have funding for clinical positions as part of the covid-19 funding at zuckerberg, so that's additional staffing for the covid unit, additional staffing for other units in the hospital where we need to enhance staff for infection control, isolation, etc., and we're reevaluating that with the hospital right now as we go through development of the covid-19 budget, so there's a lot of activity around nursing, but we are trying to hold the ground that we've made through hiring so we can be at the

optimal level of our staff shift and supplement with 30-ms as needed for surge and backfill, that we get that core level up to where we need it. so we will certainly send you the updated levels on what we have if that would be helpful. >> chair haney: thank you. i appreciate that. that would be helpful. when you come back, if you could let us know about the staff levels and employee hiring, i think those were some of the questions that i had asked, and we can hear those in preparation or receiving those for the next hearing. with that, colleagues, any other final questions or comments? and we will see each other again, and we do really ap