. >> mark, would you please take the roll? >> clerk: sure. [roll call] >> all right. >> next item is the approval of the minutes of the health commission meeting of march 2, 2021. mark, before we go forward, do we have any information to share? >> yes. commissioner christian has asked for several revisions. on page 10, underneath the

second commissioner's comments, underneath the commissioner comments session, and i will read the sentence that she's asked to add -- well, actually, i'll read all of her comments. commissioner christian noting she is a relatively new health commissioner, asking if cpuc is required to state to clients that they are going to close services in the community. several lines down, i had a typo where it is ordered in your minutes, it says what, but it should have said why, and she also asks why it was asked several years [inaudible] these are the revisions requested by commissioner christian. >> all right. thank you, mark and thank you, commissioner christian. upon reviewing the minutes, commissioners, do we have any

further amendments or is there a motion to approve? >> so moved. >> second. >> and before we move to do a vote by roll call, i'd like to check public comment. folks on the public comment line, i have a statement for you. for each agenda item. members of the public will have the opportunity to make public comment for up to two minutes. the public comment process is invited to promote ideas or information from the community. however, it's not meant for members of the public to engage in back and forth with the commissioners. please note that commissioners do consider comments from the public when discussing the item and making a request to d.p.h. if you'd like to make comments on the minutes of the march 2 meeting, please press star, three. star, three. all right. i do not see any hands, commissioners, so i will do a roll call vote. [roll call]

>> all right. the item passes. >> great. thank you, mark. we will move onto our next item, which is health commission officer elections. at this point, we will accept nominations for vice president of the san francisco health commission. do we have a nomination? >> commissioner guillermo has her hand up. >> commissioner guillermo? >> yes. i am excited and pleased to offer the nomination to commissioner laurie green as vice president of the commission. she's already served in this capacity and is currently serving in this capacity and has been an excellent leader to

date. i wanted to speak to a number of qualities that i think make her highly qualified for this position. the clinical expertise that dr. green brings is something that is really critical, i think, to us here on the commission. it's essential to our understanding both the clinical and the quality needs that need to be addressed as a matter of policy and program for the commission hand in hand with the department, particularly as it relates to the healthnet -- health network; that the issues and policies are things that she has a deep understanding had and lends not only knowledge but critical insight. she is a long-standing member

of the medical community in san francisco working on behalf of families and children in the city, and so i think that that, again, makes her highly qualified and valuable to the commission and to the residents of san francisco in terms of being able to provide input to the commission on program services and so on. also, being a member of the provider community for both parents and children is very critical. also, being a colleague and a positive force of energy to our problem solving and some

probing for the root causes of things to address them in programs and policies is something that i experienced, so i am more than happy to nominate dr. green or commissioner green to, again, be nominated or elected as vice president for the commission. >> thank you, commissioner guillermo. do we have a second? >> second. >> second. >> all right. lots of seconds. commissioner green, do you accept the nomination? >> well, it is such an honor and a privilege. this has been, commissioners, far and away, probably the most fulfilling, exciting, and meaningful thing in my career probably in the last three decades despite the number of events that i get to participate in when people have their children. so it's a real honor, and i

would very much enjoy continuing in this post. >> thank you very much. before we continue, mark, do we have public comment on this item? >> i do have a few hands raised. folks, if you'd like to comment on the nomination of vice president elections, please press star, three. star, three. i'm going to go to the one person who has their hand raised. caller, you're unmuted. you've got two minutes. caller, are you there? okay. commissioner, i'm not sure that person knows what's happening or maybe they're not around, but i think they can move ahead with the vote. >> okay. thank you, please, mark. [roll call]

>> all right. i do believe we have a vice president. >> thank you. >> thank you, mark, and congratulations, commissioner green. >> it's an honor to serve. i'm really pleased. thank you. >> all right. thank you. we'll move onto our next officer election, which is election for president of the san francisco health commission. do we have a nomination for president of the health commission? >> i believe commissioner christian has her hand up? >> yes, commissioner christian. >> so i enthusiastically nominate commission president dan bernal to serve as president of this very important commission. as you all know, i'm the newest

member here. if you remember when you were new how you recall in a way, daunting, it was to join with all the new information. some of you were in the medical profession, but even so, all the information that may have been new to you, all of the circumstances that you had to consider outside of your previous professional work to politics to the needs of many communities in our city, and so like commissioner guillermo, and like commissioner green, this is an incredibly -- i have a co-worker here who wants to participate, as well. i apologize for that. this commission does such incredible work, and it is an immense honor to be a part of it, and it has been for me,

since my short number of months since july, when i joined you, the most interesting and fascinating and consequential thing that i've done. so i'm thrilled to be a member, and i'm thrilled to join you here. and i want to thank commission president bernal for the way that he welcomed me on this commission, for the way that he spoke to me about the duties, for the way that he onboarded me, along with vice president green, incredibly generous with their time, and looking out for my interests here and ability to contribute. so i think for me personally, it's an easy choice. i also think that for all of us and for the community, san francisco's been through a lot, and the world has been through a lot in the last year. the leadership of this commission and with the department of public health, but i'm right now specifically talking about president bernal.

the leadership that president bernal has provided for the commission, from my perspective as a new person, diving into this time when so much has been requested and required and demanded of the department and the commission, and it has been very smooth, and the department of public health has done an extraordinary job, and i believe this commission has done an extraordinary job in rising to the occasion. and we're not through the pandemic, we're not through the challenge, but we're on our way, and it's critical, i think, for the leadership to continue that we've had. i'm glad that dr. green, commissioner green will stay on as vice president, and i'm looking forward to president bernal staying, as well. i've known commissioner bernal outside of this work for a

number of years, and his deep background in policy, in this state, and his knowledge of the workings of government and the needs of the people, and his dedication, his dedication to the needs of the people and in san francisco in particular qualify him beyond measure for this work, and so i ask commissioner bernal to preside as president for another term. >> and i enthusiastically second, and i could not be more agree with what commissioner christian just said. >> thank you, commissioners. i will check to see if there's public comment. folks on the line, if you'd

like to comment on the president of the commission election, please press star, three. i'm going to try this person who's got their hand up again. you're unmuted, caller. would you like to make comment? okay. so we can move forward. [roll call] >> congratulations, mr. president. >> thank you. thank you so much, and thank you to commissioner christian for your very thoughtful words. the depth of experience and knowledge you bring in terms of our criminal justice system, behavioral health, and equity in our city is such an enormous

contribution to our commission, so thank you, and thank you also to commissioner chung four seconding and to all of my fellow commissioners for the faith that you place in me for this position. today was one year that mayor london breed issued the stay-at-home orders in response to the pandemic. these are certainly extraordinary times, and i know that i, on that day, thanked mayor breed for her leadership and bold steps to keep us ahead of the curve to whatever extent possible and how proud we all are of the decisive actions taken here in san francisco. we all appreciate the great

commitment and leadership of the people of san francisco to protect their families and their citizens, as well. everyone's work has been critical to ensuring our work meets the needs of all people. in the next year, i can continue to work to ensure that we support the excellent response to the covid-19 pandemic here in san francisco to address and eliminate the health disparities and to advance our mission of equity for all san franciscans -- health equity for all san

franciscans, especially in our black-african american community. so i'm deeply honored for the opportunity to continue serving, and i thank everyone for the work that you've done to bring us through this pandemic and the work that we need to do even beyond this time, and also thank you to our commission secretary, mark moore, who is also excellent. >> how about a quick round of applause to our officers? [applause] >> thank you, everyone. we'll move onto our director's report. director grant colfax. >> good afternoon, commission, and congratulations on the election of the officers. certainly look forward to working with all of you during this next year. i don't know if this is a new year for many of us, but it certainly is for me.

in many ways, it feels like 20 years, and in some ways, it feels like a couple of days that the shelter in place went in order. such is covid times. my director's report has much detail in our covid work and our behavioral health detail, some of which we will go into detail later this afternoon, so perhaps, i would go right into the covid-19 update and double back on the director's report if the commissioners request more detail. does that make sense? >> dr. colfax, if we could ask for public comment on the director's report. >> yeah. >> it sounds like that would be a good time to do that since we're going to head into the -- >> i would defer to the commission. >> yes, let's go ahead and do public comment now and then

move into the covid-19 update. >> so folks on the line, if you want to make public comment on the director's report, press star, three to raise your hand, star, three. all right. i don't see any hands raised. >> all right. and director colfax's report is available on the department of public health website if anyone is interested. we will move onto item five, covid-19 update, director grant colfax again. >> so thank you, commissioners. this is our covid-19 update on the eve of the shelter in place order, and just expressing my thanks to the thousands of people that have been working on the frontlines over the last year, including our san francisco d.p.h. team. just an incredible unprecedented year with --

with, unfortunately, many people passing from covid-19, and now, as we continue with the vaccine rollouts, some hope at vaccines remain our ticket out of this pandemic. next slide. so with regard to our cases in san francisco, we've had over 34,500 covid-19 cases reported in the city. this is diagnosed, and you can see there that we had a sharp peak during the holiday surge, and now cases are thankfully leveling off, and unfortunately, we've had nearly 450 deaths in san francisco. any deaths from covid-19 is one death too many. i will say because of our actions early on in the pandemic, with mayor breed's leadership, independent analyses have shown that

hundreds of lives were saved due to that early action. just to put this into a clear perspective, an analysis at ucsf indicates that if the rest of the country had taken action similar to san francisco early on in the pandemic, nearly 350,000 lives across the country would have been saved. next slide. so this is in regard to our number of cases per 100,000. as you can see, we've had a very sharp decline over the last month or so with regard to cases diagnosed with covid-19. on that far right, you can see the purple curve is starting to level off just a little bit at four per 100,000, especially as we gradually reopen.

as you know, in the region, variants are more spreadable, and we have two of the b-117 variants typed in san francisco. again, this is not unexpected, we knew that the variants were going to get here, and it's just a balance of optimism between what the vaccines have and the urgent need of the on going mask and not gather with people outside one's household outside of the current health orders. next slide. so with regards to cases diagnosed, you see the inequities in the pandemic that have been with us. 41% of cases are among latinos, and with regard to the age group, nearly -- over half of diagnosed cases are among people under the age of 40, and yet we are obviously focusing

on vaccinating people who are most at risk for the disease, including people 65 and over. you'll see that in the next slide. so this is with regard to characteristics of death. people have died in the city, 85% have been 65 and over. i would just call your attention to the bottom left of this slide with comorbidities. over two thirds of people that have died from covid-19 have had comorbidities. the other people, we don't know their difficulties. and then, with regard to race and ethnicity, you'll see that people who identify as asian account for 37% of deaths, and dr. jim marks, our advanced

planning commander at covid command, will be presenting a more in-depth analysis of this after my presentation. next slide. our key health indicators are hospital capacity remains good, and as you can see in these green -- first three green boxes, our rate per 100,000, again, is 4.0. just to emphasize, in december, we hit 43.5 per 100,000, so we're now at a decrease by ten fold of our cases per 100,000. our testing, over 5,000 tests a day being done. it is worth noting that you are on testing numbers -- our testing capacity is robust, and our testing numbers have dropped substantially since the november-december period as testing numbers have consistently dropped across the country. our contact tracing numbers remain good, over 80%. and then, our p.p.e. is at

100%. next slide. you saw in the first slide, the cases and deaths peaking there, as well. you saw a dramatic drop and an indication of cases leveling off as far as hospitalizations a day. we are obviously following that number very carefully. next slide. so just wanted to also provide the commission with an update. our long-term skilled facilities residents have been vaccinated in those facilities, and per your request from two weeks ago, we have modified our facility visitation orders to reflect both the orders of the

california department of public health and the california department of social services. this is good news for the residents of these facilities and their families, and you can follow the details there, and these are posted on our website, and we've worked with the facilities to make sure that the information is getting out both from the residence to the families, and at laguna honda, we have no active cases of covid-19 among residents, so indicative of how far we've come in this challenging year, particularly in these facilities. we're at very high risk for covid-19 outbreaks, and the residents were at a high risk for death. next slide. and i do just want to also just emphasize another population that is particularly vulnerable to covid-19.

which is the homeless population, and very early on in the pandemic, as you know, we aggressively moved to slow the spread of covid-19 in the homeless population, including putting hundreds of very vulnerable homeless individuals into shelter in place hotels, making sure there were isolation and kwaurnt teen hotels available, making sure that testing was -- was scaled up quickly in shelters and managed outbreaks appropriately, and i think that this work which was done in partnership with homelessness and supportive housing done in partnership with abigail stewart kahn and under the directorship of mary ellen carroll, we've had 678 cases in people experiencing

homelessness and four deaths. one death is too many, but this is much lower than other jurisdictions have experienced across the country, and i think certainly we've focused on this population very early on. and as of yesterday, people experienced homelessness in congregate settings or who are likely to go into cop greggate settings -- congregate settings are eligible for a vaccine as well as those 60 or over. just want to 'em if a sees the conditions that we have not talked about too much in the commission. next slide. in terms of vaccinations, we continue to vaccinate san franciscans as quickly as vaccine comes in. we have the capacity to do well over 10,000 vaccines in arms a day. we now have three vaccine products, excellent products,

safe products, effective products. i had the pleasure of joining mayor breed today at masking hall health center, where she received a vaccine, johnson & johnson vaccine. our vaccine is such that every door is the right door. low barrier vaccine access is the go for all san franciscans. we have made good progress with 31% of the population of san francisco receiving at least one dose of -- of vaccine, which is higher than the national average by quite a bit. right now, the national average is about 21%. next slide. and this is looking at

vaccinations by race and ethnicity and looking at the different populations in san francisco by race ethnic and the facts that you saw on the last slide, and the fact that these numbers really reflect that the eligibility for vaccines started with health care workers and now people 65 and over are eligible. just to point out on the left panel, this is san franciscans over 16 vaccinated overall in the blue bars. they had received one vaccine, compared to the gray bar, which is the population overall. you can see across our system of vaccine administration, there have been fewer vaccines administered to black african american or latino, a population compared to the burden of covid-19, and then,

on the left side, you can see the vaccine distribution that d.p.h. has administers, and you can see the much better numbers with regard to the distribution of the vacuumine there. so just to emphasize within the d.p.h. vaccines that we have, we have the ability to ensure the best that we can that vaccines are going to the arms of people who are most at risk for covid-19. next slide. and this is a another -- this -- this slide reflects the geographic distribution of vaccines in the city, and it tells a similar story. you can see on the last panel here, vaccine has been, for the most part, fairly evenly distributed overall in the city. you can -- as evidenced by this map, which shows the distribution of vaccine, again, across all providers, and then, on the right side, you see the

vaccine distribution by neighborhood of d.p.h. allocated vaccine, and you see a concentration in the southeastern part of the city which very much reflects the map of covid-19 prevalence in san francisco. and at the bottom, you can see the various neighborhoods that -- where -- where the -- and then, the percent of vaccinated in those neighborhoods. and i would just say also, just to emphasize the focus on people 65 and over, we have vaccinated 72% of the population 65 and over at this time, so good progress there. we do have -- we're continuing to look at our data across the city, neighborhood by neighborhood. it provides a census track to

discover where the high prevalence of nonvaccinated adults live and ensuring that our outreach teams, our community education teams, and our community partners are educating and encouraging people who are eligible for the vaccine to get the vaccine, again, at one of the many options that people have now to get the vaccine. again, the delay is the adequate supply of vaccine to make this go even farther than it is right now. next slide.

>> the confusion that has been created by san francisco having different guidelines for the state has not been mitigated by san francisco now saying they're going to have the same guidelines as the state, and the nursing homes are not being transparent. please keep in mind this is not granting a privilege to families and long-term care patients, it is a right of free association that is being resumed, and a lot of families and residents are hurting, isolated, failure to thrive, and i ask you to publicize what the rights are in a press release. the departments are going to place ash arbitrary limits thae

not necessary or legal. i am seeing this in my mother's own nursing home, which is one of the best nursing homes in the city. we know that the not-for-profit nursing homes are always a little bit better, and so i ask you to not dump this all on the frantically overworked long-term care ombudsman but to create a situation where families can call to have their visitation and care giving clarified to create a hotline for that and to also publicize what the rights are now, and once they are liberalized more, to notify us in a press

release. thank you very much. >> thank you, dr. palmer. >> hi. this is jessica lehman with senior disability action. i want to thank the department of public health for making vaccines available to seniors with disabilities and other health conditions. [inaudible] -- for all unhoused and [inaudible] people. one is i know we've been talking a while about -- [inaudible] >> you're breaking up, caller.

>> i'm sorry. can you hear me? >> okay. so i want talking about the need or mobile -- i was talking about the need for mobile or house care vaccinations for the very old or very disabled or those who can't get to a vaccination site. we need to make that happen right away, and to make appointments available for people who need them. i was hearing today about home care workers who have been eligible since january, and they still have not received a vaccination, so to find a way to make that work. also, to support the last caller, dr. palmer, that you're working with nursing homes to ensure that people are able to visit and patients are able to receive the emotional and health support from friends and family. >> thank you so much.

all right. caller, i've unmuted you to let you know that you're there. >> hello. >> yes. it's your turn to talk. >> yes. my name is betty trainer, and i'm also with senior and disability action. first, i would like to thank the department for allowing people are disabilities to get vaccinated. also, people that are not able to make it out to a vaccination site -- we know people in our neighborhoods who just can't get there, so we really need an emphasis on the mobile vans or other ways to reach these

people. i know it was kind of mentioned in dr. colfax' report but if our organization or other organizations can be of help in reaching people who just can't make it to vaccination sites. thank you very much. >> thank you for your comment. that is the last caller, commissioners. >> mr. moore, could i ask to get that last person's contact information and outreach. it would be wonderful to work with that organization, so if we're not already, it would be great to do that. >> i've got her name and organization. i've provide that. >> thank you, mark, and thank you, dr. colfax and those who

called in to share their opinion and perspective. we can now move onto the next portion of the update. >> good afternoon. good afternoon, commissioners. this is jim marks. i am currently the planning section chief at the covid command center. >> hello. welcome. >> thank you. in early january, we had come and presented to you data on asian deaths in san francisco from covid, and you had asked for an update, so i'm going to present that update today in six slides, and then happy to take any questions. just to present a perspective, as dr. colfax had alluded to, if you look at the 26 biggest

jurisdictions in the united states, san francisco has the lowest death rate per 100,000 population at a little above 50. once you get to the fourth jurisdiction, santa clara, the death rate is actually twice as much or higher than the death rate in san francisco. we can look at the two biggest contributors to the death per 100,000. how many cases per unit population are there, and you can see san francisco has 39.7. that's the second lowest population-based case rate, and then, the second contributor would be the case-based death rate, so what percent of those cases die? and san francisco has the second lowest case based death

rate. and those two things together, having a low case rate, which reflects the rate of transmission going on in the community, and then, your case-based death rate determines your deaths per 100,000 population, and we can keep that in mind when we look at contributors to deaths person 100,000 by race and ethnicity. here's a graph of that for the 446 deaths that have occurred to date in san francisco. you can see right above the highlighted green boxes which highlights the asian data is data for all of san francisco, so those 446 deaths population-based case rates. you can see the asian-based deaths per 100,000 population is pretty comparable to the overall san francisco rate, so

56.6 versus 51.3. and then, we can shift a column over, and what we see is actually the asian case rate is quite low, at 21.1. about half of the rate in san francisco and comparable to the -- the rate in whites, and actually five times less than the rate in the latinx population. so the asian population has a lower population-based case rate. however, if we go all the way to the right and look at the deaths per 100 cases, the asian case based death rate is actually the highest in san francisco at 2.7%. it's double the san francisco rate and 50% -- a little over 50% higher than the white race, so that's -- while the overall death rate per unit population

per asians is comparable to all san franciscans, the case based death rate is significantly higher. it's more than doubled. so we can start asking ourselves why, why that would be. next slide. so we know probably the single most important contributor to case-based death rates is the age of -- age of the cases, so in san francisco, 83% of deaths occur in those 65 and older. and 65% of the deaths occur in that small population that's over 80. so here, you can see by race, ethnicity, the percent of cases over age 65 and the diagnosis. and what you see, the asian population has the highest percent of cases over age 65 and the highest average age at

diagnosis. next slide. we can dig a little deeper in that by actually looking at the histogram, so distribution on the cases, the case count on the y-axis is a function of the age bracket on the x-axis, and the age brackets are every five years, starting with 0-5 on the right and ending 95-100 on the left. i appreciate that the x axis is a little small and hard to read, so i've highlighted the bar with the 65 and over case counts. to the right of that would be 65 and over five-year age increments. what you can see, for the asian population, there's a high fraction that's over 65, and a significant fraction of the population actually of cases

that are over -- that are between 80-85, 85-90, and 90-95. so to summarize this part, asians have a higher case-based death rate and are significantly older than the other race ethnicities, a significant fraction of that age. not just above 65, but above 80. and then, the last slide -- the other thing we looked at besides age was cases in skilled nursing facilities, because we know, for example, is that while there are residents [inaudible] these are

cases, the numbers overall in asians and non-asians. if you look at the number, 422 total, asians are a little over 40% of cases in skilled nursing facilities. that's pretty similar to the 41% overall of the population. don't have a race ethnicity denominator for the skilled nursing population. however, because the overall asian case rate is quite low, at 3688, compared to whites at 18,403, the actual number of the total number of cases of asians that are in skilled nursing facilities at 4.3% are

about threefold higher than non-asians, so proportionately a higher fraction of asians are in skilled nursing facilities, which are congregate facilities, which is easier for spread to occur. and then, if we look at the right, what we can see is that the asian case-based death rate in the skilled nursing facilities, which turns out, it's 21.6%, which would be 36 deaths out of 167 cases on the left. this 21.6%, in the non-asian case-based death rate is a little higher. we would hypothesize that that could be because that asian population in the skilled nursing facilities is older? we don't know that yet. we're digging into that, so to summarize what we know of the -- of the total deaths to

date, that the overall death rate in the asian population is comparable to that of all san franciscans, but the overall death rate is lower, but the overall case rate is higher, and we believe that's wholly attributable to the fact that the asian cases are older and disproportionately older at 65 and older. remaining work that we have to do, we're going to dig into the ages of the asian and non-asian deaths in skilled nursing facilities to confirm that the average age of asian deaths is older, and we'll also do a regression analysis of deaths by age, ethnicity to confirm whether there are other nonage

based factors that are contributing to that higher death rate. we looked into doing that earlier with the data before the last surge around february, and there just -- there weren't enough deaths for us to be really be able to draw a conclusion, but we'll repeat that. unfortunately, there have been a significant number of deaths during the third surge, so we'll -- our best thinking right now is that this higher case-based death rate is due to the fact that the asian population of cases is older, but we will do some additional data analysis to confirm that, and i'm happy to take questions. i think i'm on mute or you're on mute. >> thank you so much. thank you. thank you, mr. marks. before we go to commissioners'

questions or comments, mark, do we have any public comment? >> folks on the comment line, could you please press star, three if you have any comments? all right. we've got one caller. i will unmute you, and you'll have two minutes. okay. caller, you're unmuted. please let us know that you're there. >> yes, this is dr. palmer again. i just wanted to point out with the vaccinations in the nursing homes, the nursing home rate of staff infection and resident infection and similar long-term care facilities is really down to nothing or almost nothing, and this should not be an excuse to prevent visitation and family caregivers coming in if they use the same precautions as staff. i just wanted to put that in

here. thank you. >> any other callers would like to make public comment on this item? >> thank you, mark, and thank you for our comments. before we go into commissioner questions, given that both mr. marks' presentation and director colfax' presentations touched on skill nursing facilities, dr. colfax, could you just clarify, what are skilled nursing facilities? >> yes. so the skilled nursing facilities in san francisco are licensed and overseen by the state overall. obviously, we have jurisdiction over the skilled nursing facility laguna honda hospital, and the state monitors and licensed d.p.h. and laguna honda, but the other licensed facilities are licensed and overseen by the state. the local facilities are

required to comply with our local health orders, which is why we wanted to make sure that the commission has orders that align with the state, and we've been working with over 99 facilities in the city that were affected by the order so that they and their staff understand the implications and that people and their families can reunite with their families in a way that is safe and welcoming. >> thank you, dr. colfax. commissioner guillermo? >> thank you, dr. colfax, for coming back to the commission with that data and that analysis, and looking forward to the additional data that you're going to bring. i had one question. i don't know if this data is possible, if you're looking at the nursing homes and long-term

care facilities. going beyond age as a factor, would we be able to determine if there are comorbidities present for that population that we're focusing on? because the general data that dr. colfax presented show that it's also due to the existence of comorbidities, so i wonder if that's a factor that goes along with age in the asian community? >> i haven't looked at that. i would say that the comorbidity rate is very high? but we can look at one of those things and get it to you when we come back.

>> if you, commissioner guillermo, and thank you, dr. marks. our next commissioner is commissioner chow. >> dr. marks, i want to thank you for providing this data because i think it will helpful and will be helpful as the national asian community continues to analyze the raw data that shows that there seems to be greater numbers of deaths in asians in different jurisdictions in the united states but they don't present really the data behind you. i know leaders have been telling communities that this was initially due to the s.n.f. concentration of asians and that the probability was older.

i think that commissioner guillermo's requested that we also look at the comorbidities, that that is helpful, but i think more to the point that you were saying is you're really going to go back into depth yet about the s.n.f., because i think that's really part of the key in terms of that, so i really do want to thank you for taking this effort. it looks like a small segment of people in the city, but it has become a great concern as this has become a finding in many of the other jurisdictions but without the data that you have provided us, so i want to thank you for that. i do want to again, also, ask, in the congregate setting, because we do have a lot of the

single occupancy hotels, is that also part of the numbers of deaths that were not within a certain number? >> thank you for your comments, commissioner. they're always insightful, so i don't know in we [inaudible] see if there's something there other than just age differences. and then, to your point about other congregate settings, i

want to say that if we combine s.n.f.s, s.r.o.s, and other long-term care facilities, they're about 42% of deaths. so s.n.f.s in and of themselves are the largest contributors, but they definitely contribute. those are generally associated with outbreaks, and so we can go back and look at that also by race, by race and ethnicity. there may be that we get so stratified there that we can't look at such small numbers, but we're willing to look at that.

the facilities are more kong greggate, and the residents tend to be old -- congregate out. >> thank you. the s.r.o. reports were brought to be a few years ago, such a high percent of the reports of the s.r.o.s were from the asian community [inaudible]. >> oh, thank you very much.

>> commissioners, any other questions or comments? >> well, yeah. i'd like to make one more, which is that i know there's been a lot of discussion in the skilled nursing and the need that have been expressed by the public in terms of trying to outreach their loved ones. i think the overall approach from the city has been just like it's been for the rest of our population, showing, therefore, our lowest death rates, and i would imagine that remains true for our big laguna honda. i think over the past years there's been six or seven deaths in a congregate setting of over 800 patients. so i do think that the department should get credit for the fact that it has looked at how, then, to respond to the social needs of that

population, and that these rules apply also to laguna honda. so first grateful to the department for having actually, you know, worked hard on a very vulnerable population, and as we know, the s.n.f. portion has been a high proportion of total deaths. i also do think that it's important for us to all under, as president bernal pointed out, and dr. colfax, overall, the skilled nursing facilities are not in our jurisdiction, and i think they will put out

advice from the department already on what's to be done. and i suppose if there are any ways in which the department can be helpful, it might target those. but even if it's the jurisdiction of the state, then it makes it hard for the city to just intervene. it's almost as frustrating as watching the board of education here try to work while the city is trying to tell them it's safe to work and standard schools again, so i know this is a major problem, but i do [inaudible] think that it's to say okay, just like we are doing with schools. it's okay to really try to bring these back, and we will

continue to try to monitor for any changes. >> thank you, commissioner chow. any other commissioner comments or questions? thank you, dr. marks, for your presentation to illuminate the data. i know what we've seen in the cases and death rates among our asian community members, particularly as they're much more often targets of violence in our communities based on some of the really hateful rhetoric that we've seen over the course of this pandemic, so thank you so much for that. i also would like to say with regard to this overall agenda item and the presentation of the city's response to the pandemic, it's important to

recognize our work of the facilities of the city's public health department, and note that there are no active cases now at laguna honda and everyone, so thank you, again, as having a robust vaccination effort there. so thank you to everybody within san francisco d.p.h. and the general and laguna honda for your really extraordinary work that saved lives. with that, we will move onto our next item, which is general

public comment. mark, do we have any general public comment? >> sure. i'm going to read a statement first, commissioner. at this time, members of the public may address the commission on items of interest of the public that are within the subject matter jurisdiction of the commission but not on the agenda. for each matter, members of the public may address the commission up to two minutes. all right. so folks, this item is for items that are not on the agenda. if you'd like to raise your hand to speak, please press star, three. caller, i have unmuted you. please let us know that you're there. >> hi. can you hear me? >> yes, please go. you've got two minutes. >> excellent. thank you. my name's ryan murphy. i work the eviction defense collaborative. i am the deputy director of litigation there, and i am here today to request that d.p.h.

amend its public health guidance with respect to s.r.o. residents, specifically a good that d.p.h. guidance be amended to recognize that s.r.o. residents in supportive housing are allowed present visitors, and also that d.p.h. put some language in its guidance and recommendations that nonof its rules should be used to support eviction of low-income tenants. so why am i requesting this? is my office, the defense collaborative, we've still got

many [inaudible] i personally represent many tenants who are being evicted basically for violating the strict visitor policy, and landlords are relying on this d.p.h. basis to evict. this is incredibly harmful to our older tenants, but it also undermined the d.p.h. purpose of the rules and really what they're geared to do, which is to reduce transmission. i think it's not controversial to say any --

>> sir, your time is up, can you wrap up and finish your sentence? >> sure. i think it would go a long way to allow visitors back in hotels -- >> sir, your name is way up, so i'm going to have to mute you, but thank you so much. >> thank you. >> all right. commissioners, that is the only comment on public comment -- on general public comment. >> thank you, mark. we'll move to our next item, which is the community and public health committee update. commissioner giraudo. >> thank you. hi, president bernal. we had excellent discuss with

director almeida. our first discussion was on the housing health service programs. the board of supervisors implemented it in june 2019. this is a pilot program for individuals incapable of caring for their own health and well-being and have refused voluntary services. the [inaudible] is in the pathway for conservatorship is if one has eight or more 5150s in a year, and if one has five or more, they are on the pathway to conservatorship. in a random sample that was presented, 84% of the 5150s called were by either a

stranger or a friend. the average age was 50, and the gender was male, and the race was caucasian and african american, but the african american population was disproportionately higher with our population. so the average of one had 10.4 visits with emergency psych services in one year. so it is a pilot program, and it is also integrated with

our second agenda item, which is the assisted outpatient treatment program, which moves severely mentally ill individuals into court ordered treatment. it is community based, it's mobile, it's multidisciplinary. and the approach, which i thought was excellent, was whatever it takes to help, we are going to work with that individual to try to make it work. we had 98 referrals.

78 had on going commitments or hospitalizations or been incarcerated. so of the 95, 78 were served, and the -- again, the breakdown of age group was between 26 and 45, more male, african american male and white. 52% of people in the program came from p.e.s. 51% have been in intensive case management, and the redirection in negative case contacts, it's a good reduction for both recycling into p.e.s. or into the jails. what was significantly noted

for this program is covid has had a real impact over the years because it has been difficult to connect and contact individuals, so it is, as things loosen up, it is hopeful that more individuals will be served. and the last presentation that will be given on this street crisis response team also impacts the information that i was giving to committee today. and that's the update. >> thank you, commissioner giraudo. before we have any commissioner comments or questions, mark, do we have any public comment on this item? >> folks wishing to make public

comment on this item, please press star, three. this is item 7. no hands, commissioners. >> commissioners, any questions or comments? >> well, actually, i did have one, i'm sorry. if i may, president bernal, because laura's law was presented to the commission several years and was controversial by some people, and the city thought this would be an added tool, i wonder if, during the presentation, because it was made at committee level now, and it does look like they're using it, does the department feel like this is a useful rule? it isn't that we need to put people under conservatorship.

i think it was one of the sticks over the carrots of the character work with treatment, so i just sense that people were really happy to have this as a tool. >> my understanding, and i think director almeida is on her, too, but laura's law is really the assisted outpatient treatment program, so that is really the mandated court ordered outpatient treatment per the severely mentally ill, so that is, from my understanding, what is preferenced to go forward before conservatorship. and doctor, you might have a

little more specific information to answer the question rather than me, please. >> of course. i'm happy to jump in, and thank you for the opportunity. commissioner, i would just is a that, you know, i've mentioned this earlier in the presentation that conservatorship is in the continuum. [please stand by]

>> -- patients of the pediatric clinic. let us know that 16% of the pediatric after hours patients are referred by the mission bernal pediatric clinic. also, i provided information from suter like race and ethnicity for the mission bernal and pediatric clinics and after hours services and there was also separate analysis about privately insured patients of all clinics. and, the last thing i want to note just on the data portion from the last hearing is that mission neighborhood, the information they collect from

the patients includes age, date of birth, ethnicity, sexual orientation, gender identity. and so that information will be collected at these clinics as well. so under prop q, the health commission holds these public hearings prior to a closure, prior to the level of services in the community. and the health commission makes a determination of whether the reported change will or will not have a detrimental impact on the community. and, as a reminder in the first hearing, a recent health review has reported six closures throughout san francisco. so for this prop q, we are discussing a conclusion that's coupled with a community support. so they obtain the level of services and the community in

the same location. and, i want to end just by stating that mission neighborhood is a close partner of the san francisco health network and they are a key part of san francisco's health care community and that based on all of the information and the plans that were provided by both suter and mission neighborhoods, we don't anticipate any major detrimental impacts on the community due to this closure and we are in support of mission neighborhood's growth in san francisco. and, so, if appropriate at this time, i would like to invite patty caplan our chief operating officer of the mission neighborhood to provide a quick update about their ongoing negotiations. >> yes, my name is patty caplin and i'm the chief operating officer. just to update you on our

progress with the various health plans through our pre-existing and executed contracts, mission neighborhood can reach 65% of the patient population at the mission bernal clinics. the largest patient group is through the san francisco health plan northeast medical services for medical. we have long-standing collaborative relationships with both the san francisco health plan and northeast medical services which is a fellow federally qualified health center. we also have contract with san mateo and from blue cross and blue shield and we are a medicare provider as well. we are in the process if adding additional commercial agreements and hill physicians medical group that will get us to reaching another 30% of the

patients. and brown and tollen has about 14 relevant pairs and products and hill physicians as 16 and we already have agreements with those two medical groups and medical and that is my update. >> thank you. so then to move forward, i just want to mention commissioners you were presented with a proposed resolution today and the resolution that i believe also proposed the revisions from commissioner chow . so if you'd like to go through those revisions, i can read

them. >> actually. >> is that the conclusion of the presentation? >> yes. sorry about that. >> thank you very much. so, before we move into any discussion of possible amendment, do we have a motion that the closure of the mission bernal will or will not have a detrimental impact on the health care services in the community? do we have a motion? >> clerk: commissioners. >> i'll move the motion that the transfers of the clinics will not have a detrimental

impact. >> clerk: thank you commissioner guillermo. do we have a second? >> commissioner: i second that. >> clerk: commissioner chow. chow actually i have some amendments and we should consider them as coauthors but i'm certainly happy to present that we wanted to put into the whereas is the agreement with the five year grant and wanted to also note that the louise arrangements of both sutter and the mission neighborhood have were consented to be another five-year term if so desired and maybe commissioner christian can also then add as

she did on the further resolve on the further in financing that we've received. >> commissioner christian: thank you, commissioner chow, for drafting those to the proposed resolution. mark, could you do me the favor of reading them as they stand right now. >> sure. so on commissioner chow requested or suggested that there be two new whereases and i will read the combined language of commissioner chow and commissioner christian together. i'll do the first one first. whereas sutter bay hospitals and mission bay health will ensure adequate bridge funding for successful transition and second whereas, sutter bay has affirmed it is really to continue the lease in its

current location in mission neighborhood health center after five years. and then, for the now therefore it be it resolved clause, i'll read what exists and i'll note what's been added. that with the closure of the mission bernal adult clinic and the admission bernal pediatric clinic, the availability of is the new part of quality primary care and after hours pediatric care, san francisco will not be reduced. and, then the final further resolves has been commissioner christian suggested this amendment: the closure of the bernal adult pediatric clinic will not have a detrimental impact on the health care services in the community, here's the new part, under the term set forth in the new financial plan in the sutter

and mission neighborhood health center. >> commissioner: the primary concern i have is whether the sutter and mission neighborhood feels that language is correct. i had questions about how strong the -- and how [inaudible] the commitment to successful transition past five years is, what commitments are being made, if any, to ensure that should the projection be incorrect or inaccurate in any way, that the necessary support would continue and i think this was a question that was raised by several commissioners at the last meeting and i'm not certain that the information

that we've been given [inaudible] in the proposed amendment. so procedurally, i'm not really sure where we go at this moment given what i -- i just need some confirmation whether or not the proposed language is acceptable to sutter and to mission neighborhood tip. >> clerk: at this point, we would ask the commissioners who moved and seconded the resident halucination whether or not this amendment is acceptable to them. commissioners. >> commissioner: i accept the changes to the revisions to the resolution. >> clerk: thank you. before we move in to

commissioner discussion and/or a vote, mark, do we have public comment on this item? >> while we're checking on public comment i would just like to ask commissioner christian to help facilitate that the new language is accurate and i'm also going to jump in and say that this resolution is not binding, this resolution is a record of what you all at the commission are approving today based on your understanding of the situation. just to clarify, it's not binding to action in the future, it's more like a road map for the commission and the dpa in the future to see what happened today. there are several folks here. >> clerk: and, mark, thank you for bringing that back up. is this an appropriate time to ask claire lindsey and her colleagues to respond to

commissioners questions. >> hi commissioners. we are accepting of the amendments and i would like to invite my colleagues from sutter to respond. >> clerk: thank you. >> if i'm understanding and following the verbage or recommendation of the amendment was after we were going in to the additional 5-year lease, then the question is would we be looking to renew that should mission neighborhood want to continue and the answer is "yes". >> commissioner christian, does that respond to your question? >> commissioner christian: it

responds to one portion of the amendments that were made. there's also the question of -- at the last meeting, several commissioners brought up the question whether there was any room for as commissioner chow noted whether there is any room for a safety net to ensure the clinic to continue if the projections are not accurate. so, in addition to the lease, there was a question of whether there was any commitment to ensure that financially things would be fine if the projections for some reason were not accurate. and i think that the spirit and the intent of this resolution is to understand that there is a commitment from sutter, whether there is a commitment from sutter but hopefully there

is a commitment from sutter but the financial should be after the 5-year period based on the projections for after whatever reason. another pandemic, let's say, might come and there could be costs that no one could foresee. in such a situation, whatever it might be, would sutter be there to continue support for the clinic? i think we need to understand that in determining whether we can say that it will or will not be a detriment for this transfer to take place. >> so i'd love to share with the group today. this has been a very collaborative journey for the past year plus. i mean, really how we came to this grant agreement and the amount really was a collaborative effort and it was based on looking at our historical data.

we purposefully did not look at data this past year with the pandemic because it's not an accurate reflection on what's happened in the past. so i mean, if needed, we can talk, but it seems like, i mean, we feel pretty strongly that the grant is pretty accurate and the amount. i mean, i'll ask brenda or patty if they want to add comments from their perspective. >> thank you. do we have additional comments from bernal health center?

[inaudible] if not, did that respond to your question, commissioner christian? >> president bernal: hi, brenda. >> sorry. i was having some trouble with the mute. the only comment that i would make is that, you know,, again, we are confident on the performer we developed. i think as a health center, we're also confident on our relationship with cpnc and our ability to reach out to garner more support or to leverage services in a way that would ensure that we continue to meet the needs of the patients that are being served at mission bernal. and, i mean, all we can give as

proof is really our history, right, of being able to serve this community and finding resources and ways to do that. clearly, we have other health centers and should we have to also support with some of the revenue from our other health centers, we would do that, you know. that wouldn't be ideal, but we can do that and ensure that the clinics are successful over the long term. >> president bernal: thank you, brenda story. >> clerk: vice president green has her hand up. >> president bernal: i'm sorry. i was not looking at that part of the screen. thank you, mark. vice president green. >> vice president green: i'm sorry i wanted to amplify with what commissioner christian

said. if the volume of the individuals come to the after hours clinic which i think is particularly critical for working families, would there be a point at which you would feel the need to close services? certainly many of them closed in the face of covid around the city. and i think it would be very helpful to have the reassurance that those hours will be maintained even if a hyperportion of the commercial patients actually don't utilize the clinics because it's great to have contracts, but the patients still have to decide where they wish to access care. if you could give us that reassurance, that would be really helpful. >> i would say vice president green that we have an amendment for after hour services, but we would have to from a business perspective match the need to the resource. so we do have two other clinics

that serve children, so it could be that we might consolidate after hour services. so our goal would be to meet the need of community, but we also have to do it from a business smart perspective. if we see that there's very little demand, then maybe we want to consolidate our after hours services across our sites. >> vice president green: i would just encourage those because, again, it's the population we're trying to serve that have long work days that really utilize those after hours. thank you. >> president bernal: thank you . commissioner guillermo, you have your hand up. >> commissioner guillermo: yes. thank you. this is a comment that encompasses the ability of mission neighborhood health center to respond to the needs

of the community that they serve, but it's a general statement also about the fact that community health centers throughout the united states and history, their history have dedicated themselves in fact even more diligently than many health systems that serve the same population to those most vulnerable and most underserved populations in their [inaudible] areas and they are monitored in order to be able to do that by the federal funding sources in order to maintain their status. they have also received and are about to receive hopefully advantageous c-structures, the

rate structures that are not going to protect their ability to not only maintain their services but to expand their ability to do more and to network much more comprehensively to reduce the fragmentation in reduction of care. much like the department did when incorporating the department clinics into the overall model health network. and i know with the covid legislation that was just recently passed, there is a significant implication of community health support networks and i just think there's a recognition that particularly for older populations that the place for particularly primary care, family care consistently and across all barriers and

challenges that community health centers really provide the most valuable service in this regard and partnership with health systems and their health departments. so i would say that, and particularly, given that mission bernal has been in san francisco for decades and has that commitment. so i understand the concern about sutter, but i also would like to promote that community health centers have the ability to rise above the challenges and that commitment to the needs of the communities that they serve and i think that that's something that we should consider. >> president bernal: thank you, commissioner guillermo. mark, at this time, i'll move in to public comment. >> thank you.

so, again, if you'd like to make comment on this item, please press starthree and you'll have two minutes to speak . i will unmute each of you as i see and then we'll go from there. okay. caller, you're unmuted. please let us know that you're there. >> yes. thank you, so much for clarifying that the decision you're going to be making now is not binding and instead it's a guidance for future actions. this is going to be a guidance for future action and we should definitely not pass it because cpmc has old history with st. luke's and southeast san francisco. as one of the services which are not profitable to them.

if you ask this about this today, you will continue that service. you, the health commission has been through this again and again on particularly on sutter and st. louis hospital and when are you ever going to learn? thank you. >> thank you, caller. please let us know that you're there. >> hello, my name is kong phan. part of san franciscans for health care during this pandemic, we've seen how these people pull together and the ideals of what a health care system is about to take care of everyone regardless of how much people make or who they are. sutter has a track record of

doing the exact opposite. closing the nursing facilities and not adequately meeting its obligations here in the tenderloin medical recipient. we support the sutter community health care. but really sutter just can't simply pay someone else to take the responsibilities for five years and it's not up to mission neighborhood health to be able to prove that it's financially sustainable after five years. i feel like there's a lot of questions and the assurances that we're getting here about whether mission neighborhood can live up to it but really the question should be on sutter. sutter has a burden to show that the closure of these clinics is not going to be detrimental as we look past five years. i don't think sutter has the

answer. so i think i urge the commission, i feel like there's great questions being asked here and i really would like to make sure that sutter is the one answering to us as a community. we still consider the mission bernal campus not just tertiary or coronary specialized hospital. people we know are born there, walk past there. we see that campus as still a community hospital and we think that sutter still has the obligation to continue that. thank you. >> thank you. all right. caller, please let us know that you're there. >> hello? >> yes. you've got two minutes. >> am i unmuted? >> you're unmuted. >> hi, this is dr. teresa palmer again. i was attending st. luke's. my kids were born at st.

luke's. i worked in the safety net clinic years ago. st. luke's was a community hospital that had a lot of safety net services including the st. luke's clinic and cpmc upon purchasing st. luke's has progressively dismantled services to the surrounding community and underserved people and this is part of the pattern. i have no question that mission neighborhood health clinic is a good organization that i urge you should rule that this is detrimental because this is part of the pattern in prokts of cpmc doing what brings the most revenue to its already very rich corporation and not doing what the people need who live around st. luke's. this clinic serves undocumented immigrants and people who are uninsured and cpmc is trying to

buy its way out by paying for five years of some of the expenses. so it can generate more revenue doing stuff like super specialty services, micro-surgery, blah blah blah. so well off ensured rich people will come to st. luke's and make revenue for the corporation. this is not -- this should be judged as detrimental because this is not -- cpmc sutter is not going what the community needs, it's doing what it needs to benefit its revenue and this pattern should not be supported. this should be judged as detrimental. already, we have lost many snff beds. >> your time is up, dr. palmer.

>> there no beds in the city because of this. this is enough. it should be detrimental. >> thank you, dr. palmer. thanks. caller, you're unmuted. you've got two minutes. >> hi, can you hear me? >> yes. >> hi, my name's jane sandoval. i'm a registered nurse. i currently work at st. luke's and i've been working there for 36 years. st. luke's now the new mission bernal campus. i'm also on the association board. i've been attending these hearings regarding the livelihood of st. luke's for more than a decade. by the way, i'm also a hands-on bedside emergency room nurse. i'm not a manager or someone from the outside looking in. i live this every day. so the theme has been repeating itself. all these hearings through all these years and the repeating theme is the erosion of services and preserving the mission of health care for the marginalized and the

underserved. we as a union and myself as an rn and a patient advocate, we raise our eyebrows because of the track record of cpmc which speaks for itself. i'm concerned not perplexed about it. historically, we've had the attempted closure of st. luke's and those of us who member it. it was a death by a thousand cuts, and, moving forward, it was not easy and fast forward, most recent closures were the sub acute units, it was a fight. and, now we have this closure. so speaking on behalf of the community served and the pooed trick and adult clinics, i know their care matters. mission clinic is a wonderful clinic i don't do you think that but track record speaks

volumes. so further oversight, a look at transparency and the process and regard to this change is highly recommended. thank you. >> thank you. all right. caller, please let us know that you're there. caller? can you hear me, caller? all right. i'll try the next one. caller, please let us know that you're there. >> hello. >> yes . you've got two minutes. >> can you hear me? >> yes. yes. >> okay. my name is ken barnes and i'm a physician and i practice primary care at mission bernal campus for over 30 years. my comments are made as words with caution. i was involved with the struggle to save st. luke's in

2007 cpmc announced it was going to close st. luke's campus and make it an ambulatory hub. st. luke's was not closed and sitting there now is the new mission bernal campus. the announcement of cpmc wanting to transfer ownership of administration of the adult and pediatric ambulatory clinic to a mission neighborhood health center brought me back to those days of it wanting to close st. luke's hospital. the commitment of cpmc underserving poplations has always been in question. examples others have shown as stated of the closing of the sub acute, the closing of the alzheimer's residential care, the failure to recruit the promised 1,500 medical patients as part of the 2013 development

agreement. the failure to develop centers of excellence and community health at mission bernal also parted with the development agreement and the reducing scrapping of the diabetes center at st. luke's cutting back in bilingual care. rooted in the community. staff is not the issue. the issue is a lack of commitment on the part of cpmc to serving the underserved. when serving in this way, the bottom line is impacted which is what i believe is the driving force of this change. in return for nonprofit status, cpmc much demonstrates its service to the underserved. >> dr. barnes, please finish your sentence, your time's up. >> i'm finished.

>> thank you. caller, i'm going to try you again. are you there? >> yes. this is mark aaronson and i'm an ameritas -- >> i'm sorry. go ahead. >> this is mark aaronson. i'm a professor at hastings law school and i worked for the last more than 10 years with the san franciscans for health care housing, jobs, and justice on matters pertaining to cpmc sutter. we submitted a paper to you as a statement and some of the previous speakers all are associated with san franciscans for health care. i just want to emphasize with sutter cpmc it's absolutely important to have in writing an

enforceable way exactly what they're going to do. a good example is development in 2013. the dollars, the millions of dollars that cpmc pledged were written in hard written terms and there was no problem of enforcement. the promises in that development agreement that involved the provision of services have not been fulfilled. and, cpmc also goes out of its way to avoid responsibilities that might logically follow. you must nail down everything. this agreement from what i understand from today's hearing and the paper submitted, nothing submits cpmc in an enforceable way could do anything after five years. there are also questions about whether it is there are sufficient provisions for the uncertainties that might happen during those five years.

there is no question that there will be a detrimental impact upon services in san francisco particularly for low income individuals as a result of these closures. not withstanding the high quality of services provided by mission neighborhood health center. the image i would like you to keep in mind is from peanuts. you all remember the image of lucy holding the football for charlie brown. and in each instance, she takes that football away from where charlie can kick it. that's exactly what's going to happen here as well. >> thank you. your time's up. all right. i don't mean to be rude to everyone, but i do need to keep the two minutes. caller, you're unmuted. are you there? caller, are you there?

try one more time. caller, are you there? okay. commissioners, that is all the public comment that i could help facilitate. >> president bernal: thank you, mark. commissioner christian. >> commissioner christian: i wanted just to start again by making it clear that i have the utmost confidence that the mission neighborhood health center will continue for the next 50 years to do the amazing and excellent job it's done for the community in the last 50 years. this is in that they will do everything within their power to provide the best service to continue to provide the best service to the residents that need them. so i just want to make that clear that my comments were not about the and are not about the ability or any concern about

the ability of the commission neighborhood health center. and i want to say how much i appreciate commissioner guillermo's restatement today and her statement at our last meeting about how significant community health centers are and in providing the best care for the community because they are so close to the community. the concerns that i raised today are about the commitment of sutter to enable mission neighborhood health center to continue to do this work should the five year projection prove to be problematic in some unforeseen way. and, i don't even question particularly because of the information that i've received through commissioner guillermo

about the role of neighborhood health centers and they're in many ways being the best way for primary care to be given within a community. i don't -- what i wonder is whether sutter is able to commit to make exceptions that they have done with mission neighborhood health center. i understand a third party assistant and figuring out how much financial support will be necessary. if sutter has the commitment they say they have to commit to the community having this resource, why can they not say that should their projections be wrong, the projections they've made in

sutter be there to see these

commitments through. >> so, yes, we will be there to partner with them, to talk with them if their projections are not coming through to reality. we will be there with them and we will definitely talk with them. >> commissioner christian: so, president bernal, please forgive me for just jumping in. i appreciate you saying you're going to talk to them. it's going to need to be something more than talk. will sutter be there should it become financially necessary? >> i mean, we have committed, you know, for the initial five years for the grant, we will be there to talk with them and to work with them to help. i can't commit to anything financially past what we've committed to right now. but, i mean, we are there,

we're here to support. they're going to be working on our campus, seeing our patients, we will be helping to provide the in-patient care if needed. we have to see kind of -- it's hard to project what the future's going to hold and turn out to be in showing. so, i mean, we did partnering with them and working to come up with our best projections of what things can look like over the next five years. i don't know what it's going to look like after. i don't know that brenda knows either or patty, but i think we have a very solid relationship with mission and if there's a need to talk about other opportunities we will definitely be there to partner with them and work collaboratively to explore what that will look like. i cannot tell you that i'm going to commit additional

funding at this time because i don't know what that would be. >> commissioner christian: thank you, for that answer. this will be the last thing i will say at the moment is that i don't understand -- first of all, none of us know what's coming. we don't know what's coming at 6:25. none of us know what's going to be coming in five years. sutter is a very financially secure institution. i don't understand what the difficulty is for sutter to say that should our projections prove to be inaccurate. we will revisit the contractual agreement and do what is necessary for this clinic to

continue to do its work should our projections prove to be inaccurate. and it doesn't -- based on what you've said right now, your answer to my question is "no," but i won't speak for you and i'll let president bernal take the meeting to wherever it needs to go after this. >> president bernal: thank you. is there any further responses to this question either from dph staff or mission neighborhood health center? all right. our next -- >> it looks like ms. web has something to say. >> yes. good evening, commissioners. i just wanted to jump in here and make sure that you heard what tami said which is that

we're long standing partners of mission neighborhood health center. we've come up with this agreement based on the best experience of what we know today and with some sensitivity analysis that we've shared with you and the staff. we continue to be partners with mission neighborhood and should something happen, if it means our projections are not correct, not only will we be in dialog with them at that time of five years, but we actually be will be working with them over these next five years to help make sure there's sustainability along the way. so it's not for the commitment to continue to support them to make sure that these clinics are seasonable past these five years. we'll also be working with them throughout this period of time. i don't think that asking us to commit to financial support past five years specifically is something that we can agree to today, but there's also a lot of other types of support that

we work with community clinics on whether it be helping with staffing, recruiting, with outreach, with service partnerships and there's a lot of other things that i think are just as vital and important to the community that we do every day across northern california. so i wanted to just jump in that what you are asking is a commitment to continue to dialog and work with mission neighborhood to make this transition successful. we've reiterated that today and so i hope that that helps clarify what our position is and how we'll work with mission neighborhood. >> president bernal: thank you, ms. witness box. i will take the next commissioner comments in order. commissioner chow. >> commissioner chow: thank you. and, like many people who are

in this hearing, some of us have participated all the way back to the development agreement. and, one could say that this isn't necessarily within the spirit of the understanding that we have when we did go into the development agreement and we're talking about the maintenance of community services and a whole range of things that were sort of projected for the neighborhood. but the prop q hearing i see is really quite different. the prop q -- in my mind. the prop q hearing is related to whether or not the changes will be detrimental in the health care services for this community. i think we've all said that it would appear that using mission health center as a deliverer of those services are probably not

detrimental. i mean, in fact, it would be quite complementary. the only question is whether or not the private sector patients in the clinic feel that they did or not have the type of attention that they felt they should have and mission has already indicated that they've taken that into consideration. i think commissioner christian has added also for this limited prop q hearing, in my mind, the appropriate phrasing that it's not detrimental providing really that the plan works. that's really what she's saying. and, i don't find that if -- so if the plan works and mission bay is delivering services with cpmc's lease and the lease could be extended and mission itself is saying that they are

confident that they're going to be able to do it, i know ms. web doesn't have the financial authority to say we're going to come through, but that's aside from what, to me is the limited question that the change would create a detrimental health care deficiency in this community from everything i've heard about mission and know about them and the fact that they have worked out with sutt er a five year agreement that they feel confident is also one that they believe is financially sound or prop q

finding is proposed that that itself is not detrimental. i think the issue of whether or not sutter is upholding to the spirit of the development agreement is the topic that really belongs at the hearing on that agreement which is at the planning commission and that is some things that can be brought to the attention of the city if that was a desire on the part of many of the people who would like to say that this was again further you know a loss of support of services changes from a community center. really, the services are being presented at the community center, at the center at st. luke's, we really haven't changed those services.

so from, again, just limited prop here, it seems to me that the transfer not withstanding it be sutter but most particularly because it is mission nand that it creates and it's able to support good services and they themselves said they have confidence in the financial plan that the proposition, that it is not detrimental would seem reasonable. thank you. >> president bernal: thank you, commissioner chow. vice president green. >> vice president green: thank you, commissioner chow, for pointing out we have to not point out this particular develop. and i would also echo what commissioner guillermo said which is i think the expanded support to the community health centers, i think we feel very confident that financially

mission neighborhood health center will be in an excellent position to give high quality care and to have all the resources needed to do so. the only thing i would say is this is probably one of the most perfect situations for the sutter system to be able to show a commitment to the community and to help reverse and perhaps improve the perception of the system's support for the needs of the community, especially the underserved individuals in the community. so i would hope that the templates when they also work for the community clinic and transferred patients there, they would look very carefully at that and keep us updated should any problems arrive. especially in the coming five years and beyond.

>> commissioner bernal would this be a perfect time to share the proposed changes? >> president bernal: yes. thank you. >> and, folks i read the proposed amendments and this gets back to what commissioner chow was saying that your purpose today is multi-facetted, but your action is based on the resolution, is a resolution. so i will share the resolution with you now. give me one second. give me one second.

there we go. okay. can everybody else see this? >> it's in very small print. >> okay. sorry. i can't see what you're seeing. how is that? is that better? that's perfect. >> okay. so i'm not going to go through the whole resolution, but it's in color. you'll see the proposed amendments. >> president bernal: you can stop now. there they are. >> okay. >> president bernal: would you like me to -- >> [inaudible] >> president bernal: do you need one of us to read them? >> no. i'll read them. the five year grant will ensure adequate funding and whereas sutter bay hospitals is

affirmed is willing to continue the lease in its current location mission neighborhood after five years and there's one more proposed amendment. >> president bernal: there is? >> further resolve the closure of the mission bernal clinic and mission bernal pediatric clinic will or will not have a detritivore theal effect on the community between sutter and mission health neighborhood center. >> mark, can you scroll up for a second. sorry. keep going. stop. there was an addition there as well. >> yes. thank you. now therefore be resolved the availability and quality of primary care services and after hours pediatric services will

not be reduced. thank you. >> president bernal: thank you, mark. and i see commissioner green has her hand raised. is that a holder. >> vice president green: holder. thanks. >> president bernal: thank you, commissioners for all your thoughtful comments and questions and concerns with this. seeing no further commissioner comments, we will move to a vote on this item. mark, would you call the roll please. >> clerk: yes. i was trying to think there was a motion.

[roll call] >> clerk: thank you. the resolution passes with a statement of not detrimental. >> president bernal: thank you, mark. okay. we'll move on to our next item and, thank you, again to commissioners for that robust and thorough examination of the last resolution in the provisions. our next item for discussion is

behavioral health services and mental health sf update. we have dr. marlo simmons acting bhs director and claire orton. >> could you all let me know who show sharing your screen. >> yes, i'm sharing my screen and it is dr. halle hammer and i who will be presenting. >> president bernal: we're happy to have both of you. >> okay. wonderful. so, one moment and i will share my screen. >> so, commissioners, president bernal, i just want to get clarification before we start. should we expect that all our presentation that are on the agenda for tonight.

i just have team members who are waiting to present. i want to get a sense of what the plan is. >> and, to clarify, we're happy to present and we know it's a long meeting and we're happy to delay parts of our presentation. >> president bernal: thank you doctors hammer and orton. with great respect for our staff's time and the investment in their presentations as well as the investment they've made of their time in this evening's meeting, we believe it would be appropriate to postpone the street crisis team presentation until a future meeting, but, again, please know that that is with deep gratitude for their excellent work and i know it's a presentation that we've been looking forward to hearing and will look forward to hearing it in our next meeting. >> thank you, very much. so i'm going to start out and i will say that that is a presentation to look forward to at the next meeting. it's a really really

what mental health san francisco aims to do is to remove barriers at all points of entry and for all points

along that continuum of care so that we can get people right in to services when they present to us wherever that might be. next slide, please. so just some quick highlights and i will go through this briefly. our director of quality management deborah sherwood retired from the department of public health after 20 years of service and we now have an acting director as we search for a new director. just a few other highlights. we are really excited about the ag transitional care. our team has really done incredible work on engagement and then linkage to care for transitional hu. we also have i think really

come a long way during the covid-19 pandemic in our public health activation. it's an amazing work around communication. so regular e-mails that go out to all of our behavioral health staff and contacted providers with updates, connecting them to trainings and support services for people throughout our behavioral health services. so i just want to really commend our communications team and how far we've come during the pandemic. also, yeah. next slide. that's fine. we're really excited and i know you know this to announce that our new director of behavioral health services and mental health san francisco dr. hillary cunnen will be here

and start her new role on march 29th. we're thrilled to welcome hillary, she's fantastic. actor director simmons and orton and i have been working closely with her and preparing her any way we can before she's here. she's coming to us from new york city where she is the executive deputy commissioner at mental hygiene. she has led the implementation of new york city's $60 million strategy to address the opioid crisis which was called "healing nyc." it's been a successful program and we look forward to learning from her and having to learn about our

system as well as address the other behavioral health crisis that we're facing most notably the crisis in skyrocketing overdose deaths. next slide. i also want to announce to you again a really exciting new leadership appointment. dr. flinders aluminumna farmange has more than 15 years of experience working with children, youth, and families and she's just been an incredible, respective, compassionate, team building acting director for the past two years and we are excited to welcome her as the newest member of our executive team. next slide, please. and, now it's a pleasure to

hand it over again to our acting director of work force development and equity, jessica brown. so i'm hoping jessica's on. >> hi, this is jessica. thank you for joining. >> thank you holly. thank you, everybody. happy to be here and support hbs. so just for starters, just to give a little bit of background, bhs has established the office of equity and work force ability known as the office of equity and social justice multieducation back in 2018. and the goal of the oewd is to focus on developing

implementing to serve the community as far as mental health. throughout 2019 to 2018, our team has been very successful in collaborating with bhs leadership and dph leadership in developing a structure and activity for racial equity work plan in fiscal year 2019, 2020. and this plan really looked at and guided our work with our culturally linguistic services and culturally competent in language and management as well. we also use this equity work plan to develop positive initiatives and a strategic plan on really evaluating and improving our efforts. one of those improvements included looking in to our dhs department health equity center which is really looking at a

respectful culture, acts of engagement outcome and for our work force. we also developed an assessment in collaboration with the mental service staff to really look at our workforce and the reflectiveness of our work force and as it pertains to the communities we're serving and i'll go into that when we talk about our action plan that we developed. with that assessment, we not only look at where are some gaps with our work force, but also figure out on how to recruit, retain, and hire to fit the needs of our communities especially those that are mostly marginalized. and so looking at that workforce disparities was the part of the office of equity and work force development of what our system needs. in collaborations with us doing workforce assessment, we were able to impact a different

disparity that we're seeing across our system such as looking at african american and latinx employees reporting higher amounts of stress on the job and also having low levels of trust within units and feeling like they're low level of career development opportunities. and, we'll talk about some of our counter measures to address some of those disparity gaps. also working alongside the office of health equity to better understand these gaps and develop strategies to help with reducing some of these disparities that we're seeing in the workforce. the other component that we developed alongside with working with the mental health services act is developing a culturally congruent innovation practices for black african american communities. the mental health services act prides itself on doing a very robust community outreach

service. where we've heard from communities there are outpatient services for black african american communities. so out of those community engagement processes, they will developing a proposal. dr. colfax, please write a letter so they can approve it. for outpatient services that are afro sen trick. and, lastly, you know, part of our office of equity and work force development is working in partnership with cyf, the children, family, and youth to really understand our key process through black and african american communities through a model. it was intended to move the walls and community service

sites that are accessible for black african american children. so with lining out all of that, we developed our a3 which is back on the side. you really can't see it. i'll kind of briefly go over it. where we looked at the problems and as i mentioned before, looking at the reflectiveness of our community. we had a high rate of black african americans in our system, yet, we only had 13% of our workforce that identified black african americans of our behavioral health commission and that's lower. we have about 4%. and so really looking at why we have that gap has really developed our priorities for our a3 and also for our racial equity action plan in relation to our racial action equity

plan. so coming out of that again as i mentioned, we get our work force assessment and combining that data from 2019 and also the staff serving in 2020. again, to look at the disparity. we levels of trust. workforce and also our latinx. and then also too we received feedback that our black african american and latinx community did not feel that they were seeing an effort on racial equity action within dhs and so this is what actually inspired us to develop these priorities and i'll just go over a couple of them because they're a little bit long winded to address racial inequities. one of them is to look at our racial equity champions and

affinity groups. on developing to provide our staff support of color with having trainings on racial equity. also implementing staff wellness retreats being able clinics and staff, a program within dhs to provide informed racial equity to really help our clinicians and our front line staff to be able to have wellness within themselves. lastly, i will say looking into a anti-racist leadership review

to really impact any implicit also staff and appraisal reviews and also to ensuring that managers have coaching. and the last thing i will mention for sure this time is the community engagement piece. as i mentioned to you all, the mental service act has a community engagement process because it's been so effective in helping us even to engage the community and repair the broken relationships that have happened over the years. so this process is really developing, we're looking to develop this year a racial equity action plan. sorry. action council that would be in collaboration with our cultural competency task force in order for that task force to have more engagement and racial

equity initiatives. and so those are some of the things we are looking to do and also, too, we developed this plan actually in january very quickly after we turned in our racial equity action, our workforce plan and this is actually phase 1. so we have more things we want to initiate. but so far, we've been able to reengage our equity champ on and also to the culture and congruent behavior which i mentioned we will be presenting to the state if anybody wants to attend and support and hopefully with that money that we are approved for, we'll be able to implement this cultural congruent behavioral approach. i will say before the fiscal year ends. thank you. >> president bernal: thank you, ms. brown. >> thank you so much, jessica.

and now we'll hand it over to claire for the mental health san francisco updates. >> i believe i'm muted now. can you hear me? >> yes. >> great. i just wanted to thank jessica brown for reviewing the racial equity action plan, but most importantly, not only for her leadership in behavioral health services which is -- which the leadership group is really kind of managed to pull together and provide extraordinary leadership during a time when we were between directors and also for her leadership over the as the equity champion and director for bhs. no now, i'll be moving in to mental health sf presentation. i know that mental health sf is something that has been presented here several times. i know we wanted to regroup and

provide you with some updates at this point. this is based off of some legislation after much negotiation calling for increased access to treatment for behavioral health service and with a real focus on people experiencing homelessness who have behavioral health needs. when i looked back kind of historically, i know it had been presented several times about a year ago, there was a very robust presentation with how we were organizing mhsf's efforts and what we really had to do was regroup. despite a lot of the focus shifting to covid during this time, we're very delighted to have the structure, the steering committee and the work groups up and running with very strong leadership. it's also kind of remarkable that a lot of these staff and

leadership of behavioral health services has been deployed to the covid effort and there are a number of positions that are open which we're working on but i think it's even more remarkable that we're sort of where we are with mhs for that reason. the reason that greg wagner and i have been the executive sponsors of the mhsf commit. and hali hammer and lucy bland and others including from communications data and analytics, finance, and other bhs leaders are really providing a lot of the content knowledge and leadership of these groups. i just had a couple of things say about the way the domains are organized. you can see here these are the main work groups. the off coordinated care. the mental health services center. the new beds and facilities group and analytics and

evaluation. i should also say an important element of mhsf is the working group which as group that does internal and external partner key stakeholders that's overseeing all of the work at mhsf. you can see here is underlying all of the work groups is support of our data and ichlt t. systems. a strong equity lens as well and then we actually have recently made analytics and evaluation its own work group to make sure we get all of the structural things we're trying to put in place. before i go to the next slide, i did just want to comment, my presentation now covers all the work groups except for street crisis team. the reason for that is because

we were going to have angelica almeida share the street crisis response team's update. they really had a phenomenal kick off and start and is having a lot of success already and so we're very excited to hear that next full presentation at the next health commission meeting. so the first domain i'll talk about is the office of coordinate care and this is specifically focused on launching the office of coordinated care within the bhs structure but also as a major arm of mhsf. and also just as a side note we're trying to with mhsf not create a totally separate bhs but create a system that's fully integrated with bhs's goals that works seamlessly to both strengthen all of dhs

services and build additional services clearly informed by all of the leaders of dhs. so the office of coordinated care will exist within the bhs structure. there's a couple of things that are going on here but this is by way of explanation. we are required to put in place a manage of care structure within behavioral health services. and so, what you will see here there's really kind of two branches of the office of coordinated care. the top elements include things like marketing which is sort of a foreign word to us in public health but we will be getting our heads more around. network add question sea, timely access and there's also a piece of utilizization

management. to chart client complaints and feedback etc. and so we will be looking forward to implementing a more robust system within the office of coordinated care. the other piece in the office of coordinated care is the case management piece. this is a critical part of what we do in behavioral health services in general,, but it's really going to be more robust under mhsf. and it includes the intensive case management which is really the which is really again for clients who require very intensive services and then who have a lot of comorbidities and struggles and also case community management which is that next layer of the iceberg. so i'm really looking forward to the office of coordinated care to oversee and bring all of these pieces together. i'll do some hiring updates at the end including for this.

i will say that some of the challenges for office of coordinated care are going to include identifying new office space. we are working on that. that's always a challenge for us and some of the successes recently is that the occ leadership have had a number of stakeholder and community engagement sessions. so we're really building in that piece in. the next update is the mental health services center. as you can see, it's a centralized access point for patients or clients who are seeking access to mental health and substance abuse treatment and also for longer term care and so what we are really looking to do is expanding the services that we currently have in our behavioral health access center to expand the hours and to also just expand more access in terms of where referrals can be made, how many hours per day

people can receive direct access to urgently to services when they want them. we are looking at currently expanding in the fight it's currently in but we are also looking at additional space and making sure how we can be very available to the san francisco residents who really need these services. so we would like it to be near other city funded mental health services, but also near where a lot of people have behavioral health challenges and are spending their time. so 1308 howard is the current space, but we're also looking at some additional spaces. and, the other thing that we're currently working on is just really working on the phone access there because some people will continue to want to access by phone and we want to have a seamless entry system through the mental health

services center. the new beds and facilities. this can get a little confusing. the office of coordinated care is really going to be coordinating access to long term treatment, to psychiatric beds to substance abuse treatment facilities. but we know that a key part of that is the supply. and so the new beds and facilities group is specifically trying to expand our supply of these types of resources and some of -- and that's actually as you, of course, know in san francisco is a tal order, but what we really realize is at some point, we just have a supply demand mismatch and we don't have enough places for people who need these services to go and in the interest of trying to get to treatment on demand, we do need to invest in more

partnerships or ownerships ourselves of some of these facilities. so some of the things we are working towards is the drug sobering center. so i believe that there was a question from one of the commissioners about this. we are working very hard on this. my apologies, greg wagner who is my cosponsor could not be hear for this part of the call tonight. he has more details on this, but we are looking at a realistic timeline of maybe more like fall 2021, but we're working hard to get this done. we are also looking at contracting or developing ourselves multiple of these other facilities in the interest of time, i'll take questions at the end about this. i will note that we have a page that's fine treatment sf which is a client page that does allow the patients to see where all the beds are available in town or to see their provider and enable their provider to see that when they're wanting

to seek services and so this is when